Proposed changes to Kentucky’s Medicaid program could cost another 9,000 vulnerable people their health coverage while possibly saving taxpayers an extra $27 million.
Those are both projections for Republican Gov. Matt Bevin’s updated plan to overhaul the state’s Medicaid program, the joint federal and state health coverage program for the poor and the disabled.
Bevin asked the federal government last year for permission to overhaul the program. Monday, Bevin updated that proposal. State officials estimate the changes would increase taxpayer savings to $358 million by 2021. But it means a total of 95,000 people —9,000 more than originally proposed_would likely lose their Medicaid coverage in a mostly poor, rural state where more than a quarter of the population relies on the taxpayer-funded program to pay for their health care.
Bevin says the state can’t afford to pay for all of the new people who were allowed to enroll in Medicaid because of the federal Affordable Care Act, especially with the state facing a multibillion-dollar public pension shortfall. But critics say Bevin’s plan would unnecessarily hinder access to one of the Appalachian region’s vital social safety nets.
Dustin Pugel, a research and policy associate for the Kentucky Center for Economic Policy, noted these plans to overhaul Medicaid are supposed to strengthen coverage for lower income people while increasing their access to medical providers and making people healthier overall as part of a more efficient system.
“I don’t see how this accomplishes any of those four things, unless your definition of efficiency is ‘covering fewer people,'” Pugel said.
Doug Hogan, spokesman for the Kentucky Cabinet for Health and Family Services, called the changes “minor revisions” that were a “logical outgrowth of the original waiver application.” The cabinet did not specify the updated savings and enrollment projections in its news release announcing the changes. But the estimates are part of the state’s official application to the federal government.
People could lose their Medicaid coverage for a number of reasons. Some would work more because of the new rules and would make too much money to qualify for the program, thus moving to the private insurance market. Bevin has said this is his primary goal. Others would lose their coverage because they did not pay their new monthly premiums or they did not meet “community engagement” requirements, which call for people to work or volunteer for up to 20 hours each week.
Kentucky was one of 31 states that expanded their Medicaid programs under the federal Affordable Care Act to cover childless adults with a certain income level. Former Gov. Steve Beshear made that decision, which added more than 400,000 people to the state’s Medicaid rolls and is credited with slashing the number of people without health insurance in Kentucky to historically low levels.
Bevin’s plan calls for those new Medicaid recipients to pay small premiums of as much as $15 per month. And beneficiaries would, for the first time, have to have a job or volunteer for at least 20 hours per week to keep their benefits. Those requirements would not apply to everyone. Children younger than 19, pregnant women, primary caregivers for children or disabled adults, the medically frail and full-time students would be exempt.
Monday, Bevin altered this proposal. Now, people could lose their Medicaid coverage for up to six months if they got a new job or salary and did not let state officials know about it so they could double-check their eligibility for the taxpayer-funded program.
In a document outlining the proposed changes, state officials called this new penalty a “learning tool” to help people on Medicaid understand “the importance of maintaining accurate information to maintain insurance coverage, helping further prepare enrollees for commercial market insurance policies.”
Other changes include eliminating a phase-in period for the work and volunteer requirements and canceling a plan to expand Medicaid enrollment centers.
Last week, Bevin said he expected the federal government to approve his proposal “in the next few days and weeks.” But any approval would likely come after a 30-day comment period. The comment period is not required, but state officials are doing it anyway, along with two public hearings : one July 14 in Somerset and the other July 17 in Frankfort.