- Kentucky Gov. Matt Bevin (R) has officially submitted a waiver to HHS for approval to make significant adjustments to the state's expanded Medicaid program.
- Bevin originally announced the plans in June but has since made some changes in response to feedback from public hearings and comments provided during the past two months.
- The state initially underwent Medicaid expansion under its previous governor, Steve Beshear (D), in a move the current administration says lacked a plan for how to begin to cover the state's share in 2017, which it says would come to $1.2 billion from fiscal years 2017 through 2021.
Bevin's overhaul could come with some controversy given that it imposes a weaning of benefits, and that data show positive impacts from the program's current form of implementation. A recent JAMA study focused on Medicaid expansion in Kentucky, Arkansas and Texas found it to be associated with improved access to care, quality of care and outcomes among low-income adults, as well as a 22.7% reduction in the uninsured rate. Kentucky's expansion was also associated with reduced ER visits, and increased outpatient visits, preventive care and adults in "excellent health."
However, the state's current administration doesn't see that picture as quite so rosy due to the impending price tag, suggesting its new plan will "help improve health outcomes while ensuring the long-term viability of the Medicaid program," as spokeswoman Amanda Stamper told Morning Consult.
The current proposal aims to transition people away from Medicaid if they become eligible for employer-based insurance, though the state would continue to cover any lost services. The plan would leave those within 138% of the federal poverty level fully eligible, and ask those between 34% and 138% to pay modest premiums to encourage their involvement in their care.
Enrollees would have the opportunity to earn additional benefits such as dental or vision coverage through actions including volunteering, making changes to improve their health, caretaking, passing the GED, and getting their children immunized.
Recent updates to the proposal include continued coverage of allergy testing and private duty nursing, and reduced costs for those deemed “medically frail.” The new version also clarifies that those who were eligible for Medicaid prior to expansion will continue to receive the same benefits, and full-time students and people working more than 20 hours per week fulfill the community engagement and employment requirements of the proposal.
The CMS should confirm the waiver's submission within 15 days and then open it to a 30-day federal comment period.