Kentucky Governor Revamping Medicaid and Taking a Cue from Indiana

Feb 25, 2016

Deaconess Hospital in Evansville, IN
Credit Lisa Autry

This is the second of a two-part series on proposed changes to Kentucky Medicaid and how Governor Matt Bevin wants to model the program after a similar one in Indiana.  You can see Part 1 here.

When the federal Affordable Care Act was rolled out, Indiana was faced with the same dilemma as other states: give health coverage to more of the uninsured by expanding Medicaid, while taking on hundreds of millions of dollars in costs. 

Indiana Governor Mike Pence persuaded the federal government to approve an alternative for his state. Just over a year ago, the state implemented the Healthy Indiana Plan 2.0.  Kentucky Governor Matt Bevin wants to launch a similar program as he looks to revamp his state's Medicaid system. 

In the year since Indiana implemented the Healthy Indiana Plan 2.0, or HIP, more than 370,000 Hoosiers have enrolled in the program.  Among them is Mary Buchanan, who is self-employed.  A shoulder injury no longer allows her to work full-time.  By working less, the 63-year-old from Rockport couldn’t afford the private insurance she used to carry.  She picked up the Healthy Indiana Plan 2.0, or HIP, about a year ago.

"One less thing for me to worry about 24\7, said Buchanon, who met WKU Public Radio at the Spencer County Library.  "What if something happens to me?  Am I going to have to file bankruptcy?  One trip to the hospital can wipe you out.”

Under HIP 2.0, Buchanan pays just under $14 a month in premiums and has no co-pays or deductibles for her medical care.

HIP 2.0 is an offshoot of the Healthy Indiana Plan, a pilot Medicaid program the state created in 2008 to provide coverage to Hoosiers who earned too much to qualify for the state’s traditional Medicaid system, but not enough to buy private insurance.  Rather than expanding Indiana’s traditional Medicaid program, Governor Pence petitioned the federal government for a waiver.

"We fought for the right to expand access to coverage the Indiana way, through consumer driven healthcare choices," said Pence in a speech.  "We were always willing to compromise on details, but we were never willing to compromise on the principles of personal responsibility that are at the heart of the Healthy Indiana Plan.”

The waiver program requires participants to make monthly contributions, based on their income, to health savings accounts. 

Forty-three-year-old Carol Roberts works as a gas station attendant in Rockport.  The single mom never had insurance before and went the emergency room for care.  She recently enrolled in HIP.

"Getting insurance is so expensive and my spend down under $30 a month," commented Roberts.  "I just found out I have a heart condition, so it makes it much easier and better that I can get my medication at a cheaper rate and no co-pays.”

Indiana, like its neighbor Kentucky, has high rates of obesity, diabetes, and heart disease.  Supporters say HIP encourages people to make more responsible choices about their health care. 

Steve Russell is Director of Patient Financial Services at Deaconess Hospital in Evansville.  He says HIP has resulted in fewer patients seeking treatment in the emergency room.

"With that $25 co-pay they’re given, the idea is to get them to try to get in to see their doctor, or maybe it’s something that could be taken care of over the phone or instead of showing up in the emergency room which is always the most expensive place to get healthcare," Russell explained.

The waiver comes with federal funding to pay for most of the cost.  The state pays its share with cigarette tax revenue and a tax on hospitals. 

Governor Matt Bevin has said he plans to restructure Kentucky’s Medicaid program similar to that of Indiana’s, but not everyone is on board.  Emily Beauregard heads Kentucky Voices for Health and suggests even small contributions to their health care may be too much for some.

"People who are on Medicaid are very low income.  You're not on Medicaid because you have a lot of expendable income," said Beauregard.  "These individuals have many other bills every month, and whenever you are making a decision between paying your electricity bill and going to the doctor, you're being put in a position where you're probably going to be delaying care."

Governor Bevin has said he would work this year to develop a plan to submit to the federal government with hopes of rolling it out in 2017.  If the governor succeeds, Kentucky would join six other states that won approval to expand their own brand of Medicaid.