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Bevin Isn’t Likely To Get Everything He Wants In Medicaid Changes

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For at least the next seven months, give or take, there’s no need to worry that the proposed changes to expanded Medicaid benefits will affect your coverage.

Seven months is the average time it takes for the federal government to negotiate with a state over changes to Medicaid. And even then, some of the changes likely won’t happen.

On Wednesday, Gov. Matt Bevin submitted those proposed changes via what’s called a “Medicaid demonstration waiver” to the U.S. Department of Health and Human Services.

The Affordable Care Act was originally designed to extend Medicaid to residents in all 50 states who earn below 138 percent of the federal poverty limit, or $16,394 in 2016. But the Supreme Court famously struck down that provision.

Most states expanded Medicaid as the ACA plan set out several years ago. But a handful of states, now including Kentucky, have applied for waivers to change what the federal government intended for expansion.

In Kentucky, some 428,000 people have received health coverage through expanded Medicaid.

Arkansas, Iowa, Michigan, New Hampshire and Montana have gotten waivers to tinker with the benefits of people making between 101 and 138 percent of the federal poverty limit ($11,880). That includes Indiana, which in 2015 expanded Medicaid to those people.

Gov. Mike Pence originally proposed a work requirement, but after negotiations with the federal government, that was removed.

The Kentucky waiver states, “The Kentucky HEALTH program represents the terms under which the Commonwealth will continue Medicaid expansion.” And Bevin has said publicly if the feds don’t approve his plan as it is, he’ll end the expansion altogether.

But he’s not likely to get everything he wants, according to Adam Searing, a senior research fellow with the Center for Children & Families at Georgetown University.

“That’s not how any waiver has worked,” Searing said. “The federal government has never gone and said, ‘We’ll just give you everything you wanted.’ Mike Pence in Indiana tried that, and it didn’t work. And he was just as adamant [as Bevin].”

Things that probably won’t fly? A six-month lockout if recipients don’t re-enroll every year. A three-month open enrollment period. And copays for people making below 100 percent of the poverty limit. HHS has nixed such elements from other states’ waivers.

“The idea is that it’s there when you need it,” Searing said. “Every one of these waivers is a negotiation with the federal government.”

U.S. Rep. John Yarmuth, a Democrat who represents Louisville, said Bevin is deliberately proposing changes he knows the federal government will reject.

“His administration has been told what would be acceptable and won’t be,” Yarmuth said. “And I believe he’s done that so he can then blame the administration when he rescinds Medicaid expansion and takes health coverage from 440,000 people.”

But state Sen. Ralph Alvarado, a Republican from Winchester who is advising Donald Trump’s presidential campaign, said this is an improvement from the platform that Bevin ran during the governor’s race last year, which was to dismantle benefits for the expanded population completely.

“This is getting it an opportunity for Medicaid expansion to survive in Kentucky,” Alvarado said. “You have to do it in a finally responsible way.”

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