Medicaid

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For at least the next seven months, give or take, there’s no need to worry that the proposed changes to expanded Medicaid benefits will affect your coverage.

Seven months is the average time it takes for the federal government to negotiate with a state over changes to Medicaid. And even then, some of the changes likely won’t happen.

On Wednesday, Gov. Matt Bevin submitted those proposed changes via what’s called a “Medicaid demonstration waiver” to the U.S. Department of Health and Human Services.

The Affordable Care Act was originally designed to extend Medicaid to residents in all 50 states who earn below 138 percent of the federal poverty limit, or $16,394 in 2016. But the Supreme Court famously struck down that provision.

Most states expanded Medicaid as the ACA plan set out several years ago. But a handful of states, now including Kentucky, have applied for waivers to change what the federal government intended for expansion.

Bevin Submits Medicaid Plan Restoring Allergy Testing

Aug 24, 2016
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Kentucky Gov. Matt Bevin says he has changed his proposal to overhaul the state's Medicaid program and submitted it to the federal government for approval.

The new proposal will cover allergy testing and private duty nursing for about 400,000 Kentuckians who have health insurance through the state's expanded Medicaid program under the federal Affordable Care Act. People who are in hospice care, have HIV or AIDS and receive federal disability benefits will also not have to pay premiums or copays.

And the elimination of automatic dental and vision benefits will be delayed by three months. People can still get those benefits by earning credits in a "My Rewards Account" by doing things like earning a GED and having a health assessment.

Bevin said his administration received nearly 1,350 public comments on the proposal.

J. Tyler Franklin

The secretary of Kentucky's Cabinet for Health and Family Services says officials will be making some changes to Gov. Matt Bevin's Medicaid proposal.

Vickie Yates Brown Glisson told the state Medicaid Oversight and Advisory Committee on Wednesday that officials are still reviewing the public comments submitted on the proposal. She said the comments were "thoughtful and very helpful." She did not detail what the changes might be.

Kentucky was one of 32 states that expanded its Medicaid program under the federal Affordable Care Act. More than 400,000 were covered under the expanded program, which Bevin says is too large for the state to afford.

Bevin's proposal would charge small premiums to able-bodied adults, and it would require them to have a job or volunteer for a charity in order to keep their benefits.

Kentucky Reopens Medicaid Waiver Comment Period

Aug 9, 2016
LRC Public Information

Kentuckians who missed the chance to give input on proposed changes to state-run Medicaid now have until the end of the day on August 14 to comment.

Officials with the Kentucky Department for Medicaid Services say the comment period was reopened because of the high volume of remarks received after the original July 22 deadline.

“We got 30 percent of comments on the last day and even some after the deadline,” said Jean West, Cabinet for Health and Family Services communications director. “So we decided to extend it to accept the comments that came right after the deadline and allow any others.”

She said the state has not determined a date for submission of the revised waiver to the federal government. That will allow officials time to go through comments, she said.

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After the state expanded Medicaid under the Affordable Care Act in 2014, low-income Kentuckians made fewer trips to the emergency room, had less trouble paying medical bills, received a checkup and sought help for chronic conditions. That’s according to a new study released Monday from the Harvard Chan School of Public Health.

Researchers surveyed almost 3,000 low-income Kentuckians in 2013, 2014 and 2015. Participants were asked about their coverage and about their health habits, including if they skipped doses of medication, had a personal doctor or had any emergency room visits in the past year.

In 2013, prior to the Medicaid expansion, 46.3 percent of Kentuckians surveyed said they had a checkup in the past year. Of those surveyed in 2015, after the expansion, that number increased to almost 59.8 percent. There was also a big jump in the number of people who said they had a primary physician after the expansion – from 56.6 percent to 71.7 percent.

Bevin Delays Applying For Medicaid Waiver

Aug 2, 2016
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Gov. Matt Bevin is delaying submitting changes to the state’s Medicaid program, which his administration had intended to submit to the federal government by Monday.

Adam Meier, Bevin’s deputy chief of staff for policy, said the extension is due to the large number of comments the state received regarding the proposal.

Under Bevin’s proposed plan, some recipients would have co-pays for doctor visits, basic dental and vision benefits would be eliminated for able-bodied adults, and beneficiaries who earn above the federal poverty line would pay monthly premiums. Those who don’t pay premiums would have co-pays.

In addition, beneficiaries would be required to accrue funds to earn dental and vision benefits by participating in activities such as community service or job-training.

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.”

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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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