Medicaid

Rob Canning

The federal government has given its most forceful statement yet in response to Gov. Matt Bevin’s proposal to apply for a waiver to change Kentucky’s Medicaid system.

Bevin’s plan, which requires federal approval, would make most Medicaid recipients pay monthly premiums, eliminate vision and dental coverage and institute a credit program whereby individuals could get better coverage by volunteering or applying for a job.

At a forum hosted by the Health Enterprises Network on Thursday, Bevin’s deputy chief of staff Adam Meier said that the administration had little doubt the federal government would accept the plan.

“We’re pretty confident they’ll approve our waiver or something pretty close to it,” Meier said, according to the Courier-Journal.

In response, Ben Wakana, press secretary for the U.S. Department for Health and Human Services, said in an email that during talks with Bevin’s administration, the department has “repeatedly been clear” about “principles of access to coverage and affordability of care.”

Rhonda J. Miller

Gov. Matt Bevin says he’ll do away with Kentucky’s expanded Medicaid system if the federal government doesn’t approve a waiver he’s seeking to augment the expansion.  No state has repealed a Medicaid expansion yet.

If the expansion is totally repealed, those who earn more than 100 percent of the federal poverty level—that’s a little under $12,000 a year—would still be eligible for subsidized insurance through healthcare.gov.

Marybeth Musumeci with the Kaiser Family Foundations says. “They would likely experience higher out-of-pocket costs compared to what they experience under Medicaid and there may be some differences in the benefit package”

Ryland Barton

A public hearing on Gov. Matt Bevin’s proposal to change the state’s Medicaid system drew mostly backlash from a packed crowd in Frankfort on Wednesday.

Bevin wants to require most Medicaid recipients to pay monthly premiums, eliminate vision and dental coverage from the program and create an incentive system that would allow people to volunteer or get job training in exchange for more benefits.

Harriette Seiler, a Louisville resident, said Bevin’s plan for Kentuckians to put “skin in the game” will “scrape a pound of flesh” from the most vulnerable people.

“The sick and the poor and the unemployed are not naughty children who need to be incentivized or scolded or humiliated by constantly having to prove how poor they are in order to sign up for care,” Seiler said.

Rhonda J. Miller

About 125 people attended a public hearing in Bowling Green on June 28 to get an overview and offer comments on Gov. Matt Bevin’s proposed changes to Kentucky’s Medicaid program.

Vickie Yates Glisson is secretary of the Kentucky Cabinet for Health and Family Services. At the public hearing, she said one of the major proposed changes is that instead of copays for medical services, those on Medicaid will pay a small monthly premium. Glisson said the proposal also seeks to include services that address Kentucky’s most critical health issues. 

Cardiovascular health, we have the fourth highest in the nation in heart disease. We have the highest rate of cancers, so we’re addressing lung cancer, smoking cessation, slash lung cancer. We have an out of control drug abuse problem.”

Some at the hearing expressed concern that even a small monthly premium would be barrier to health care for low-income residents. 

Another area of concern that some expressed is that dental and vision care are not included in the basic health care plan.

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If Gov. Matt Bevin’s proposal to change the state’s Medicaid system is approved, about 86,000 fewer people will be enrolled in the program by July 2021, according to his administration. That will save the state money, as he’s said, but it’s also raising concerns about lost coverage.

The plan would require most beneficiaries to pay premiums ranging between $1 and $15 per month and lock out those who don’t pay. Recipients would be able to get benefits again once they take a health literacy class and pay back the amount they owe.

During an interview on WLSK in Lebanon Tuesday morning, Bevin said the proposed program would give recipients “dignity.”

“There’s no dignity involved in being a ward of the state, in being completely dependent on the government and on your fellow neighbors, and have no expectation of you or any opportunity to give back,” Bevin said. “I think this is a win-win.”

Flickr/Creative Commons/Leicester Royal Infirmary

A public hearing on Governor Matt Bevin’s proposed changes to Kentucky’s Medicaid program will be held Tuesday, June 28 in Bowling Green.

The leader of an Owensboro-based community development group sees positives and negatives in  Bevin’s proposal. 

Jiten Shah is executive director of Green River Area Development District and is on the board of Kentucky Voices for Health.

He’s concerned about Bevin’s plan to have Medicaid recipients pay a monthly premium.

“I do have some concerns, you know especially, the recipients would have to have a monthly premium. Since the Medicaid expansion is serving the low income population for the insurance, and many of them may not be able to afford monthly payments of $1 all the way up to $15 a month.”

Shah said even relatively small payments could be difficult for many low-income people already struggling to make ends meet.

The proposed changes would add the premium, but do away with the co-pay that Medicaid recipients are charged when they go for a medical appointment. 

Ryland Barton, WKU Public Radio

At a news conference Wednesday morning in Frankfort, Gov. Matt Bevin announced his much-anticipated plan to remake the state’s expanded Medicaid system.

Under the plan, which would require federal approval, Kentuckians who earn between 34 percent and 138 percent of the federal poverty line would be required to pay fixed premiums for the insurance. The premiums will range from $1 to $15 for “able-bodied adults,” according to Mark Birdwhistell, University of Kentucky HealthCare’s vice president for administration and external affairs who is heading up the state’s waiver process

Bevin said requiring users to pay premiums would give them “dignity and respect.”

Bevin also said the changes would save the state $2.2 billion.

The program will be called Kentucky H.E.A.L.T.H., which stands for “Helping to Engage and Achieve Long-Term Health.”

While Gov. Matt Bevin’s administration is privately working on a plan to change Kentucky’s expanded Medicaid system, a coalition of advocacy group has created its own recommendations.

Bevin has said his administration would apply for a federal 1115 waiver — a course of action that allows states to test out new ways to operate Medicaid.

Although there hasn’t been any public input on the waiver process, a coalition called Kentucky Voices for Health has crafted its own suggestions designed to improve health and manage costs of the system.

Rich Seckel, executive director of Kentucky Equal Justice Center, said the group’s report could help improve the Medicaid system.

“What I found exciting about these recommendations was not the sort of predictable concern about cost barriers but the opportunity to do some innovation,” Seckel said.

Jacob Ryan, WFPL

Kentucky’s Medicaid commissioner says the state’s plan to scale back the expanded Medicaid system will not require beneficiaries to pay premiums, according to an Associated Press report.

In the report, Commissioner Stephen Miller goes on to say that Medicaid recipients could receive fewer benefits, including reduced vision and dental services.

Late last year, Gov. Matt Bevin announced that he would by 2017 “transform” the state’s expanded Medicaid system into one where recipients have “skin in the game” by paying for benefits.

Doug Hogan, communications director for Kentucky’s Cabinet for Health and Family Services, said that the state couldn’t comment on the proposed changes or negotiations with the Centers for Medicare and Medicaid Services (CMS).

“Everything is on the table and no decisions have been finalized. We are continuing to engage stakeholders and CMS in good faith,” Hogan said.

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A recent report by Kaiser Family Foundation says Kentucky has one of the most successful implementations of the Affordable Care Act in the U.S.

The report cites the “single, integrated eligibility system [Kentucky] built for Kynect and Medicaid” as one of the most pivotal components to its success.

The foundation also concludes that the state’s leadership and collaboration, outreach and marketing efforts, and diverse network of enrollment assistance were also contributing factors to its success.

In a statement from Saving KY Healthcare, former Gov. Steve Beshear — a principal with the nonprofit — said Kynect and Medicaid expansion had a big impact.

“The successful rollout was largely due to thorough coordination by officials throughout the state, and a comprehensive effort to ensure that all aspects of Kynect and the expansion were ready to launch on day one,” he said.

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A new report shows Medicaid expansion in Kentucky would continue to save the state money were it to remain in its current form.

The Robert Wood Johnson Foundation released the report Tuesday. It examines the financial effects of Medicaid expansion in 11 states and the District of Columbia.

Overall, the report found state spending in Medicaid expansion states grew by half as much as spending in non-expansion states between 2014 and 2015.

“There are a lot of examples of people whose care can be funded under Medicaid expansion,” said Kathy Hempstead, director of coverage for RWJF. “That’s sort of an easy way for states to save money on people they were providing services to anyway.”

In fiscal year 2014, Kentucky saved $2.4 million on coverage for medically needy enrollees, which accounts for six months of savings, according to the report. In the next fiscal year, the state is expected to save $14 million.

Creative Commons

The health care industry in Kentucky continued to add jobs in 2015, according to newly revised data from the federal Bureau of Labor Statistics.

The Kentucky Center for Economic Policy analyzed the data and found 10,500 more people work in the health care industry in January 2016 than in the same month two years prior. Jobs in health care were up nearly 5 percent over 2014, while the overall economy in Kentucky saw 3.1 percent job growth in that period.

Jason Bailey, executive director of KCEP, said employment in health care and social assistance sectors picked up after the implementation of the Medicaid expansion, which former Gov. Steve Beshear did under the Affordable Care Act.

“So many more people have health care coverage and are going to the doctor, and that’s very likely having a strong influence on the job growth that we’re seeing,” he said.

More than 500,000 Kentuckians have gotten health coverage via expanded Medicaid and the state’s insurance exchange, Kynect, since the program began. The rate of uninsured in Kentucky has dropped from 20.4 percent before Kynect to 7.5 percent today, according to the Gallup-Healthways Well-Being Index.

LRC Public Information

Kentucky’s new health secretary says her state agency will meet proposed budget reductions through a variety of cost-cutting measures, such as not filling vacant positions and cutting back on travel.

Under Gov. Matt Bevin’s proposed spending cuts, the cabinet’s budget will be reduced by $64 million over the next two years and $31 million this year.

Secretary Vickie Yates Brown Glisson, who heads up the Cabinet for Health and Family Services, said Wednesday that implementing the cuts allows her a “clean look” at the cabinet’s programs and services.

“It does give us an opportunity to evaluate areas that certainly haven’t been delivering a satisfactory return on investment,” Glisson said.

Creative Commons

The expansion of Medicaid has closed an economic gap for health insurance in Kentucky, according to the latest Kentucky Health Issues Poll.

The poll shows more lower-income adults have become eligible for insurance since the implementation of the Affordable Care Act and the expansion of Medicaid. In 2013, before the expansion took effect, more than three in 10 adults earning less than 200 percent of the federal poverty level were uninsured.

Now, only one in 10 adults earning that same amount are uninsured, according to the poll.

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said the ACA and Medicaid expansion are a step towards health equity in Kentucky.

“What this is doing is improving the equity to access in health care by reducing those gaps between lower income people who have insurance and the number of higher income people who have insurance,” said Zepeda.

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.

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