In county with 75% on Medicaid and 12.4% unemployed, Salyersville mayor ponders Medicaid's new work rules

Kentucky's new Medicaid plan requires some of its recipients to work or volunteer will be phased in, with poor areas last, but some are worried that finding work there won't be easy, and that enforcing the new requirement will cause some to lose their coverage.

"I would not be truthful if I didn't say it's a big challenge," Kristi Putnam, the Medicaid waiver program manager for the state, told Miranda Combs of Lexington's WKYT-TV.  "It's a big project. There are a lot of moving parts and lots of partnerships."

Kentucky was the first state the federal government allowed to require some of its Medicaid recipients to work, volunteer or get job training 80 hours a month to keep their health insurance. This requirement will largely affect those who gained coverage through the expansion of the program, under federal health reform, to those with incomes up to 138 percent of the federal poverty level.

Combs compared unemployment and Medicaid numbers and found that "the latest unemployment rate numbers were above the state average in each of the 10 counties with the highest percentages of Medicaid recipients," making many wonder where these people are going to work.

Screenshot of WKYT interactive map with percentage of population on Medicaid 
The top 10 Medicaid counties have between 58 percent to 82 percent of their population on the program, and have unemployment ranging from 5.2 percent to 12.4 percent. The statewide unemployment rate is 4.4 percent.

Combs talked to Salyersville Mayor Pete Shepherd about how 75 percent of the people in Magoffin County ended up on Medicaid.

"We got here because the federal government decided in the 1960s to give food stamps and welfare to everybody that was under a certain threshold," Shepherd said, adding that the loss of coal jobs added others to the rolls.

"We had a lot of people that went off good-paying jobs to nothing," Shepherd said. "It's not their fault, and a lot of them would work if there were jobs available."

Shepherd, who said he needed more guidance from the state on the program, also voiced his concern about the new work rules, saying, " You can't make jobs if there's nothing there to have for jobs."

Putnam told Combs that the state will help people meet the  new requirements, which won't be rolled out in Magoffin County until November.

Putnam estimated that about 239,000 people in Kentucky will have the "community engagement requirement," and that half of them already meet it. "It's really intended to help connect people to resources so that they aren't in the multi-generational poverty situation where they depend on benefits," she said.

Opponents of the plan are concerned that the lock-out periods for failure to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner will result in Kentuckians losing their health coverage. The Bevin administration recognizes that many will lose their coverage, estimating that there will be 95,000 fewer Kentuckians on Medicaid in five years than without the program, partly because of "non-compliance."

Three nonprofit groups representing 16 Kentuckians have sued the federal government to block Kentucky's Medicaid waiver. The Trump administration and Gov. Matt Bevin want the case to be heard in federal court in Frankfort.

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