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Bevin’s Medicaid Overhaul Might Not Require ‘Skin In The Game’

J. Tyler Franklin

Kentucky’s Medicaid commissioner says the state’s plan to scale back the expanded Medicaid system will not require beneficiaries to pay premiums, according to an Associated Press report.

In the report, Commissioner Stephen Miller goes on to say that Medicaid recipients could receive fewer benefits, including reduced vision and dental services.

Late last year, Gov. Matt Bevin announced that he would by 2017 “transform” the state’s expanded Medicaid system into one where recipients have “skin in the game” by paying for benefits.

Doug Hogan, communications director for Kentucky’s Cabinet for Health and Family Services, said that the state couldn’t comment on the proposed changes or negotiations with the Centers for Medicare and Medicaid Services (CMS).

“Everything is on the table and no decisions have been finalized. We are continuing to engage stakeholders and CMS in good faith,” Hogan said.

Over 400,000 people got health insurance through the Medicaid expansion, which made Kentuckians who earn up to 138 percent of the federal poverty line eligible for benefits.

Along with the 85,000 people who signed up for qualified health plans through the state health exchange Kynect, the Medicaid expansion helped reduce the state’s uninsured rate from over 20 percent to 7.5 percent in two years.

Jonathan Gold, press secretary for the U.S. Department of Health and Human Services said “any changes to the program should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security.”

According to an HHS official, requiring beneficiaries to be employed may not be a condition of eligibility for Medicaid.

Bevin has said that Medicaid recipients should have to pay something for state healthcare.

“I don’t care if it’s a dollar or two dollars, if I’m governor in this state, people should have skin in the game,” Bevin said during a gubernatorial debate on KET. “You rob people of dignity if you rob them of any expectation of doing for themselves.”

Starting next fiscal year, Kentucky has to start paying more for its Medicaid expansion, which is currently 100 percent subsidized by the federal government.

In 2016, the state will pay about $109 million or about 5 percent of the cost of the expansion. By 2020 the state has to pay 10 percent, or about $409 million.

The federal government will continue paying 90 percent of the expansion cost thereafter.

Ryland Barton is the Managing Editor for Collaboratives. He's covered politics and state government for NPR member stations KWBU in Waco and KUT in Austin. He has a bachelor's degree from the University of Chicago and a master's degree in journalism from the University of Texas. He grew up in Lexington.

Email Ryland at
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