Gov. Matt Bevin said in a press conference he will seek permission from the federal government to reshape the federal-state health program that covers about 1.3 million Kentuckians.
Michael Clevenger, CJ
FRANKFORT, Ky. — Gov. Matt Bevin on Wednesday announced sweeping changes to the state’s $10 billion-a-year Medicaid program, saying he will seek permission from the federal government to reshape the federal-state health program that covers about 1.3 million Kentuckians.
Bevin, in a press conference at the Capitol Rotunda, hailed his proposal for a “waiver” from the federal government to revise Kentucky’s Medicaid plan as an opportunity “to come up with what is going to be truly a transformative and sustainable and fantastic program.”
The proposal called Kentucky HEALTH – for Helping to Engage and Achieve Long Term Health – would encourage Kentuckians to get healthier and transition to the commercial health insurance model to become independent of the government program, Bevin said.
“We are robbing people of the ability to do for themselves,” he said.
Bevin’s proposal would allow Medicaid to begin charging a small monthly premium for coverage that is now largely free. It also would allow the state to cut off Medicaid coverage for those who don’t pay, a “lockout” provision similar to Indiana’s Medicaid plan, which Bevin has cited as a possible model.
It limits coverage to that offered by the plan for state employees and does not include dental and vision coverage now included in Medicaid.
The U.S. Department for Health and Human Services must approve the changes, and a spokesman for the agency said Wednesday the review will begin once Kentucky submits its waiver application. But the spokesman said officials will proceed carefully when it comes to approving changes to what has been widely viewed as a highly successful program.
“As we have said many times, Kentucky’s Medicaid expansion has led to one of the biggest reductions of uninsured people in America,” said Ben Wakana, national press secretary for the department. “We are hopeful that Kentucky will ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards.”
Bevin’s proposal drew immediate fire from health advocates.
“I’m very disappointed,” said Bill Wagner, executive director of Family Health Centers, a Louisville network of community clinics that serves about 40,000 patients a year. “I’m most disappointed that they’ve introduced premiums and lockouts.”
“It creates a lot of barriers,” said Sheila Schuster, a longtime Kentucky health advocate and member of the group Kentucky Voices for Health. Her group, she said, “has always been very clear that we don’t want barriers to care.”
Schuster said she also is concerned Bevin’s plan would eliminate dental coverage in a state with high rates of toothless adults and untreated dental decay and disease.
“I think those are vital services,” Schuster said. Under the Medicaid expansion of 2014, “some people are getting dental care for the first time in their lives and now they’re going to lose it.”
Under the plan, Medicaid consumers would be able to obtain dental and vision coverage by accumulating points in a My Rewards account for activities such as volunteer work or taking a financial literacy class.
In announcing the proposed changes, Bevin, a Republican elected in November, fulfills a campaign pledge to scale back the Medicaid expansion and other initiatives of his predecessor, Democrat Steve Beshear, under the federal Affordable Care Act.
Beshear, who has criticized Bevin’s plans to dismantle his signature accomplishment, promptly blasted Bevin’s plan through an organization he founded called Save Kentucky Healthcare.
“Gov. Matt Bevin declared war on Kentucky’s working families today by announcing his intentions to take away health benefits, increase costs and institute unwieldy requirements for those families to keep health coverage,” he said a statement from the organization.
Mental health advocates praised provisions of Bevin’s plan to tackle addiction through a pilot project in a state with high rates of drug overdose deaths and to enhance Medicaid coverage for psychiatric hospitalization.
“That’s an opportunity,” said Steve Shannon, who represents the state’s 14 regional mental health agencies. “We all acknowledge that addiction is the number one problem for the Commonwealth.”
But the proposal also appears to reduce the overall number of Kentuckians on Medicaid – a change that could clash with a federal directive that requires such waiver plans to provide consistent or improved coverage. The 70-page waiver document shows a decline in Medicaid enrollment of nearly 86,000 people by 2021, a decline the administration attributes to moving more people to the commercial insurance market.
In introducing his proposal, Bevin said once again that growing up in rural New Hampshire, he had no health insurance – a point he made during his 2015 campaign for governor. For that reason, he said, he understands the importance of health care.
Bevin said he wants to create a plan that makes people healthier by getting better outcomes in a state with some of the nation’s highest rates of obesity, cancer, diabetes and cardiovascular disease.
Bevin’s plan includes premiums of $1 to $15 per month to those between 34 percent and 138 percent of the federal poverty level. Those who get locked out for nonpayment would be allowed to regain coverage by meeting certain conditions.
While the premiums seem modest, they could cause some of Kentucky’s poorest citizens to drop coverage, Schuster said.
“What seems like a little bit of money to us is a huge amount to someone at the poverty level,” she said.
Bevin’s proposal would not include any copays for services, as currently allowed by Medicaid.
It also requires working people whose employers offer health coverage to take it after a year on Medicaid.
That troubles Wagner, who said many low-income people can’t afford the plans offered by employers that come with high premiums, deductibles and copays.
“It’s very alarming,” Wagner said. “It’s going to lead to less coverage in the state.”
Bevin said he wants to ensure that people covered by Medicaid become more engaged in their own health care and become better consumers.
And he said he wants to make the program sustainable. The federal government currently pays 70 percent of the costs of those in “traditional” Medicaid and 100 percent for the more than 440,000 people who enrolled starting in 2014 when the program expanded to include anyone at 138 percent of the federal poverty.
In 2017, the federal government’s share drops to 95 percent for the expanded Medicaid population and eventually declines to 90 percent. Bevin has argued the state can’t afford the additional costs.
If his Medicaid proposal is approved, Bevin said it will result in $2.2 billion in taxpayer savings over five years. The proposal estimates the reduction in “member months” covered by Medicaid under the new rules, suggesting it would cover 17,800 fewer people in 2017, rising to nearly 86,000 fewer people in five years.
Bevin’s proposal was designed largely by Mark Birdwhistell, a University of Kentucky health official and former health secretary for Kentucky.
Bevin said he is confident the federal government will approve the plan and hopes to have it in place by fall – a view many advocates believe is unrealistic given the months or years it has taken other states to have such proposals approved.
Bevin said if the federal government does not grant the waiver, he would still move ahead with his plan to repeal Medicaid expansion in the state. But he said that would be the fault of the federal officials for failing to approve his proposal. “This is in the hands of the federal government,” he said.
Wagner said he views that as an implied threat to abolish Medicaid coverage in Kentucky.
“I’m very concerned the governor has proposed this as an either or – either approve this or we’re going to do away with Medicaid,” he said.
Contact reporter Deborah Yetter at 502-582-4228 or at dyetter@courier-journal.com.
What’s next
Matt Bevin’s Medicaid proposal, posted on the website of the Cabinet for Health and Family Services, must now undergo several rounds of public comment. The public may send comments to state Medicaid Commissioner Stephen Miller, Department for Medicaid Services, 275 E. Main Street, Frankfort, KY 40621, or by email to kyhealth@ky.gov.
All comments must be received by 5 p.m. (ET), Friday, July 22.
The state also plans three public hearings on the proposal:
» Western Kentucky University, Knicely Conference Center Auditorium, 2355 Nashville Road, Bowling Green, KY 42101, 10 a.m. – noon (CT), Tuesday, June 28.
» Advisory Council for Medical Assistance (MAC) Special Meeting, Kentucky Capitol Annex, 702 Capital Avenue, Frankfort, KY 40601, 1– 2 p.m. (ET), Wednesday, June 29.
» Hazard Community and Technical College Campus, Room 208, Jolly Classroom Center, 1 Community College Drive, Hazard, KY 41701, 11 a.m. – 1 p.m. (ET), Wednesday, July 6.