Gov. Matt Bevin’s week-old proposal to overhaul the state Medicaid program already is under fire from critics, who say it will cut benefits and reduce health care for some of Kentucky’s poorest citizens.
But a team of officials promoting Bevin’s plan on Thursday told a group of health executives that they are confident of winning the required federal approval for a “waiver” to enact changes that the governor pledges will transform the $10 billion-a-year federal-state health plan that serves nearly one-third of the state’s citizens.
“We’re continuing to negotiate in good faith,” Adam Meier, Bevin’s deputy chief of staff, said at a 90-minute forum hosted by the Health Enterprises Network. “We’re pretty confident they’ll approve our waiver or something pretty close to it.”
Mark Birdwhistell, a former Kentucky health secretary whom Bevin has called the architect of his Medicaid proposal, said “high-level” federal officials have been in direct contact with the Bevin administration and seem anxious to “solidify” a plan, given the national attention Kentucky has drawn for its successes under the federal health law known as Obamacare.
“Kentucky had been put out as the poster child of the Affordable Care Act,” said Birdwhistell, a vice president at University of Kentucky Healthcare.
Under the Medicaid expansion, Kentucky added 440,000 people to the program that now serves about 1.3 million people, helping Kentucky achieve the sharpest reduction in the nation in the rate of citizens with no health coverage.
Federal authorities have been noncommittal since Bevin released his plan last week, saying in a statement only that they will “evaluate the waiver based on our longstanding principles of access to coverage and affordability of care, principles that we have repeatedly shared with the state.”
The statement by U.S. Department of Health and Human Services spokesman Ben Wakana didn’t suggest any reason for haste in the plan Bevin has said he would like to have approved by September.
“We are prepared to continue our dialogue for as long as it takes to find a solution that continues progress for the people of Kentucky,” Wakana’s statement said.
Still, Vickie Yates Glisson, secretary of the Cabinet for Health and Family Services, said at Thursday’s forum that Bevin personally has met several times with Sylvia Burwell, secretary of HHS, to discuss Kentucky’s Medicaid waiver proposal and the meetings have gone well.
“They are two individuals who really like and respect each other,” Glisson said. “At the end of the day, I’m really hopeful they’ll come to some kind of consensus.”
Most of Thursday’s forum focused on details about Bevin’s proposal, similar to information officials provided at two public hearings this week, one in Bowling Green on Tuesday and the other in Frankfort on Wednesday.
Glisson and other top officials said the changes are needed to cut costs to make the program sustainable. Even though the federal government provides the majority of funding for Medicaid, Kentucky’s share of the cost continues to increase and would demand a growing share of state general fund dollars, Medicaid commissioner Steve Miller said.
The governor’s proposal would result in substantial savings, about $331 million in state money over five years, Miller said.
“We’re trying to avoid the train wreck of tomorrow,” he said. The plan is aimed largely at “able-bodied” adults added through the Medicaid expansion, which allowed anyone below 138 percent of the poverty level to enroll in the plan that, prior to the Affordable Care Act, had been available mostly to poor pregnant women, children, people with disabilities and low-income elderly in nursing homes. Bevin’s proposal would require monthly premiums of $1 to $15 per month for coverage, except for pregnant women and children, that is now largely free. It would impose a “lockout” of coverage for some of those who don’t pay. But only those above 100 percent of the poverty level would face a lockout of up to six months; those below that income level would still get health coverage but would have to make co-pays for services.
The proposal does not include basic dental and vision coverage for adults now covered by Medicaid.
It offers rewards for desirable behaviors, such as completing a health assessment or participating in stop-smoking classes by adding points to a “My Rewards” card people could use to purchase services such as eye or dental exams. But it would penalize consumers by deducting points for misuse of benefits, such as seeking care from a hospital emergency room for conditions not classified as emergencies.
It would require “ablebodied” adults with no dependents to work or perform some type of community service of up to 20 hours a week, a requirement federal officials have rejected in other states including Indiana, which the Bevin administration has cited as a model. And it would push people toward commercial insurance by requiring people on Medicaid who are working to transition to employer insurance, if available, after a year. Medicaid would subsidize employer premiums and other costs to the employee, such as deductibles and copays.
Birdwhistell said the goal of the new Medicaid proposal is to get people used to commercial insurance plans.
“This is commercial coverage on training wheels,” he said. The final public hearing on the proposal is 11 a.m. July 6 at Hazard Community and Technical College. More information about the Medicaid proposal and how to comment is on the cabinet’s website, chfs.ky.gov.