Kentucky became the first state to receive a waiver to require able-bodied Medicaid beneficiaries to work to receive Medicaid coverage, on the heels of the Trump administration's new policy allowing states to test work requirements for program recipients.
Kentucky’s Medicaid program will require adults able to work to spend at least 80 hours in work, job training, education or other qualified 'community engagement' activity monthly. The waiver also allows Kentucky to cut dental and vision coverage for adults and remove recipients above the poverty level for six months if they don’t pay premiums within 60 days.
Kentucky estimates the plan will reduce its Medicaid population by 100,000 recipients after five years and will save $2.4 billion.
Cutting the Medicaid rolls is an ongoing goal for the Trump administration, which unlike previous administrations has used Section 1115 demonstrations to find ways to cut the program. Conservatives praise the new policy, calling it a welcome bid to give states more flexibility. Doctors and advocates for the poor are threatening to sue to stop the requirement.
In addition, Energy and Commerce Ranking Member Rep. Frank Pallone Jr. (D-New Jersey) and Senate Finance Ranking Member Ron Wyden (D-Oregon) sent a letter to the Government Accountability Office asking the GAO to review major changes that the CMS has allowed states. They requested the GAO look into CMS policies and procedures to make sure the changes are transparent and comply with federal law.
Nevertheless, Kentucky Gov. Matt Bevin, a Republican, said the approval of the waiver called Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) “will improve the health of its participants, strengthen Medicaid’s long-term fiscal sustainability and promote personal responsibility for health and well-being.”
Kentucky is leading the nation in this reform. It will soon become the standard and the norm in the United States of America, and America will be better for it. #KentuckyHEALTH https://t.co/sLrNrwA1IC— Governor Matt Bevin (@GovMattBevin) January 14, 2018
No worker should be earning so little that they need extra benefits on top of their paycheck to support themselves and their families. If Republicans are so concerned about Americans receiving Medicaid and SNAP, maybe they should support a living wage.— Ro Khanna (@RoKhanna) January 14, 2018
Most coverage of KY Medicaid waiver focuses on work req. but just as important are multiple "lockouts" if you don't pay your premium, report a change in income, or miss a paperwork deadline you are forced to be uninsured for 6 months. Too high a price to pay.— Joan Alker (@JoanAlker1) January 12, 2018
Kentucky is one of at least 10 states interested in the waiver with Arizona, Arkansas, Indiana, Kansas, Maine, Mississippi, New Hampshire, Utah, and Wisconsin all citing interest in the work requirement. Half of those states, including Kentucky, expanded Medicaid after the Affordable Care Act. Kentucky’s Medicaid population doubled to 1.2 million people after the expansion, which allowed states to cover people beyond the Medicaid income levels.
States interested in the work requirement will be able to decide how to define the requirement and who’s exempt. Kentucky is exempting children, pregnant women, seniors, primary caretakers of a child or disabled adult, full-time students and people who are unable to work, such as people who are frail or with a medical condition.
Though requiring Medicaid recipients to work is seen by some as a way to both nudge people into the workforce and decrease the number of Medicaid recipients, a Kaiser Family Foundation study found nearly eight in 10 non-disabled adults on Medicaid are already in working families and most are working themselves.
Many of those people with jobs don’t have health insurance benefit options at their job or can’t afford them. Of the nearly 5.2 million working Medicaid recipients in 2016, almost 1.5 million worked in restaurants and food services and another 974,000 worked in construction, according to the report.
A Health Affairs analysis found that 11 million Medicaid enrollees would be at risk of losing coverage if the work requirement spreads nationwide.