A federal judge on June 29 struck down Kentucky’s plan to implement Medicaid work requirements, answering the question of whether the state’s waiver — the first of its kind to be approved — would hold up under legal scrutiny.

The ruling has implications beyond Kentucky’s borders. Three states — Arkansas, Indiana and New Hampshire — have had waivers approved by CMS that include work requirements, and all are moving ahead with implementing them, Kaiser Health News reported. Another eight states have pending applications, according to AIS’s Medicare and Medicaid Market Data.

The ruling will likely “give states pause in pursuing policies that the court’s ruling calls into question,” said Cindy Mann, a partner at Manatt Health, noting that “implementing policies such as work requirements is a large, costly undertaking.”

In Kentucky, the state’s five Medicaid MCOs have “invested a lot” in helping the state prepare to roll out its waiver program, which was set to take effect July 1, says Jeff Myers, president and CEO of Medicaid Health Plans of America. “Now the question is, where do we go from here?” he adds.

In Wisconsin — among the seven states that submitted an 1115 waiver request that includes Medicaid work requirements — one insurer isn’t certain what effect the Kentucky ruling will have.

“On the work requirements, it’s interesting because DHS [the Department of Health Services] has been fairly limited in their discussions at this point — and I don’t know if that’s a political reason or they don’t know themselves [what will happen],” says Al Wearing, chief insurance services officer at Group Health Cooperative of South Central Wisconsin, which covers 5,400 beneficiaries in the state’s Medicaid program.

“And of course the thing that happened in Kentucky the other day — I’m not sure what that changes, if anything,” he adds.