Most of the 1.2 million Kentuckians who have health insurance through the state’s Medicaid program would have fewer benefits and pay monthly premiums to keep their coverage under a proposal Republican Gov. Matt Bevin released Wednesday.

The goal, Bevin said, is to move people off Medicaid and into the private insurance market.

Medicaid is paid for by state and federal funds, so the federal government must approve Bevin’s proposal. If they don’t, Bevin said he would eliminate Kentucky’s expanded Medicaid program, meaning some 400,000 people would lose their health insurance.

“I don’t want us simply to provide people with a Medicaid card and feel like we’ve done our part,” Bevin said. “If (the federal government) does not approve this, there will not be expanded Medicaid in the state of Kentucky.”

Medicaid patients do not pay monthly premiums, but are charged copays for each doctor visit. Bevin’s plan would eliminate the copays and replace them with monthly premiums ranging from $1 to $15.

Kentuckians on Medicaid could no longer go to the eye doctor or the dentist, but they could get those benefits back if they do things such as enroll in a smoking cessation program, take a community college class or get a job. The government would also stop giving patients rides to the doctor, leaving those who can’t drive to find their own transportation.

The changes would only apply to able-bodied adults.

Once Medicaid recipients have been in the program for one year, they will be required to move to their employer insurance plan, if they have one. The state would agree to cover any benefits lost in the transition.

Mark Birdwhistell, Bevin’s senior Medicaid adviser, called the proposal “commercial insurance on training wheels.” If people don’t pay their Medicaid premiums, they would lose their insurance. But they could get it back if they enroll in a financial literacy class and pay off their debts, something Birdwhistell described as a “teaching opportunity.”

Republican lawmakers praised Bevin’s plan, including U.S. Senate Majority Leader Mitch McConnell who called it “innovative” and said it would “reduce the burden on Kentucky taxpayers.”

State officials estimate that if the plan is enacted, at least 17,800 people would lose Medicaid coverage in the first year, either because they did not pay their premiums or voluntarily left for a private insurance plan. That number could grow to nearly 86,000 people by 2021.

“We are trying to create a program whereby we will have healthier people who have more responsibility,” Bevin said.

Former Democratic Gov. Steve Beshear joined 31 other states by choosing to expand Kentucky’s Medicaid program under President Barack Obama’s health care law. About 400,000 people got health insurance because of it, and Kentucky’s uninsured rate fell to 7.5 percent from 20 percent, among the largest drops in the country.

But the program’s success meant taxpayers were now paying for the health insurance of more than a quarter of the state’s population. Bevin, who took office in December, said the state can’t afford it and vowed to change the program.

Beshear called Bevin’s proposal “draconian” and said he “declared war on Kentucky’s working families.”

“It is up to Gov. Bevin himself to decide whether to terminate expansion, not the federal government – and the accountability for that decision will lie on his shoulders,” Beshear said. “Our families deserve better than these petty threats.”

Bevin said his plan would save taxpayers $2.2 billion over the next five years.

While Bevin’s plan reduces some benefits, it expands others, especially for drug treatment and mental health care. Kentucky has some of the highest drug overdose deaths in the country. The Centers for Disease Control and Prevention recently listed 220 counties across the country it said were at high risk for Hepatitis C outbreaks because of drug use. Of those counties, 54 are in Kentucky.

Bevin’s plan would pay for drug addicts to get inpatient treatment for up to 30 days at a mental health facility.

“That has never been done in the United States,” Bevin said. “We as a state owe it to our citizens, America owes it to our citizens, to get our arms around this drug epidemic.”

Sheila Schuster, executive director of the Kentucky Mental Health Coalition and chairwoman of Kentucky Voices for Health said Bevin’s drug treatment program “would be fantastic for Kentucky.” But she worried the overall plan would increase out-of-pocket expenses among the state’s poorest populations.

“Anytime you cut off coverage and access for people, I think it’s a problem,” she said.

Bevin’s plan is posted online at The public has 30 days to comment on the proposal, and state officials plan to hold three public hearings beginning next week. Bevin wants to submit the plan to the federal government by Aug. 1 and said he hopes to have a decision by Sept. 30.

Kentucky governor Matt Bevin outlines Medicaid overhaul
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