Federal government paves the way for Kentucky to impose Medicaid work requirements; approval expected soon

By Melissa Patrick
Kentucky Health News

The Trump administration announced a new policy Jan. 11 that allows states to establish the first work requirements for Medicaid beneficiaries, paving the way for Gov. Matt Bevin's plan for the Kentucky program.

The Centers for Medicaid and Medicare Services policy guidance authorizes work and community engagement among able-bodied adults who are not pregnant, elderly, disabled or medically frail, and Bevin's request for a waiver from the usual rules requests exactly that.

The Bevin administration calls its plan Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) and says is designed to encourage participants to have what Bevin calls "skin in the game" through co-payments, premiums and a higher level of involvement in their care.

A key component of the plan is a requirement for able-bodied adults who are not primary caregivers to work or volunteer 20 hours a week to get the free health insurance -- a requirement that has never been part of any state's Medicaid program, but is now specifically authorized.

Medicaid boss Stephen Miller
“We are excited about the new guidance issued by CMS to allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries," state Medicaid Commissioner Stephen Miller said in a statement. "This guidance is a critical step to moving the Kentucky HEALTH program forward and we eagerly anticipate a quick approval."

The plan will largely affect the 478,000 Kentuckians who are covered by the expansion of Medicaid under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level.

Medicaid covers about 1.4 million Kentuckians. A list of enrollment by county in June 2017 is at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.

If implemented, the proposal estimates there will be 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise. The Bevin administration has said this will be a result of people moving to better-paying jobs that offer employer health insurance, but critics say the new requirements create barriers to access that will cause people to lose coverage

U.S. Rep. John Yarmuth, a Louisville Democrat and a vocal supporter of the Affordable Care Act, said in a press release, "Work requirements do not make it more likely low-income individuals will find employment, but they will result in struggling families becoming poorer and sicker. . . . My only hope is that the chaos caused by this policy and the desperation of the Kentucky families who will soon lose their only access to health coverage will force Gov. Bevin to demonstrate some level of compassion and reverse this disgraceful policy."

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