Recipients Leery of Proposed Changes to Kentucky's Medicaid Program

Feb 24, 2016

Credit Flickr/Creative Commons/Brandy Shaul

This is the first in a two-part series on Medicaid, Kentucky's expansion of the government-subsidized program, and proposed changes to Medicaid.

As Governor Matt Bevin prepares to re-design Kentucky’s Medicaid program, a new national survey shows the commonwealth with the second-largest gains in insurance coverage. 

More than half-a-million Kentuckians obtained coverage under the federal Affordable Care Act.  Some 80 percent of the newly insured went onto the Medicaid rolls. 

But many Medicaid enrollees are worried about what lies ahead under the state’s new Republican governor.  Teresa Bowley was at a recent health insurance sign-up event in Bowling Green to ask a question about changing providers.  Six months ago, she qualified for coverage through Kentucky’s Medicaid expansion. 

Now when she gets sick, she goes to the doctor. But that hasn’t always been the case. 

”You just don’t. You just try to think this will go away on its own.  You have to miss work," Bowley explained.

For most of her adult life, the 50-year-old from Bowling Green has been without health insurance.  She was among more than 437,000 Kentuckians added to Medicaid, which former Governor Steve Beshear opted to expand under the federal Affordable Care Act.  The law accepted anyone earning below 138 percent of the federal poverty level.

Bowley is a single mom who makes $13 an hour at a local packaging company.  She says she can’t afford the nearly $400 a month in private insurance offered by her work.

"There’s no way.  It’s absolutely impossible," she said.  "I have two kids at home and I can’t afford that.  I’m better of paying the fine that they’re going to give you for not having insurance than I would trying to pay that.”

Bowley has a seven-year-old daughter at home.  She qualified for Medicaid when her teenage daughter moved back home.

"She was staying with her dad and she came back," explained Bowley.  "Other than that, they would have said at $13 an hour, that’s making too much.”

Now that she’s covered by Medicaid, Bowley is visiting the doctor more often and seeking preventive care.  At age 50, she recently had her first mammogram.

"All those tests they tell you to have done starting at 40, never had them. It’s been nice to be able to go in and do that.”

Kentucky has had the second-largest drop in the percentage of people without health insurance in the country, according to a new Gallup-Healthways survey.  In 2013, more than 20 percent of Kentuckians lacked insurance.  After Kentucky created an online health insurance exchange and expanded Medicaid, the number was down to 7.5 percent by the end of last year.

Campaign pledges by Kentucky’s new governor have Teresa Bowley and other Medicaid recipients uncertain about the future of their health care.  Governor Matt Bevin says he will seek a federal waiver to revamp the state’s Medicaid system similar to that of neighboring Indiana.

Governor Bevin referenced the waivers in his inaugural speech.

"This is a model that we are going to copy," Bevin said.  "I’m not above copying what other people are doing well.”

The waiver would offer different tiers of coverage and require Medicaid recipients to pay small premiums and co-pays.  Bevin says the goal is to cover the same population, but make the Medicaid program sustainable. 

"We have a need to be filled and we understand that.  The number that is often quoted is that we have 25 percent of Kentuckians on Medicaid.  Sadly, that number is just about 30 percent now, 1.3 million Kentuckians.  That is literally not sustainable financially," Bevin said.  "The only way we are going to allow it to continue in any form, traditional, expanded, or otherwise is to transform the way in which it is delivered.”

For now, the federal government is picking up the cost of the Medicaid expansion, but starting next year, Kentucky must begin bearing a share of the cost.  Teresa Bowley says she isn’t afraid to put some skin in the game.

"I’m not against that, but make it affordable," she said.  "I wouldn’t mind paying something.  It bothers me to even have to be on Medicaid, but sometimes you don’t have a choice.”

Melissa Grimes, with Community Action of Southern Kentucky, helps people navigate the state’s online health insurance exchange and sign up for plans.  She’s been fielding a lot of questions from enrollees about the future of Medicaid.

"It has impacted so many families," said Grimes.  "I get daily messages from concerned citizens asking if this will go away and what will they do.”

Part 2 of our series will look at how Indiana Republican Gov. Mike Pence revamped his state's Medicaid program. It's a system Kentucky Gov. Matt Bevin says he would like to emulate.