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Kentucky to Advance Medicaid Changes Even if Obamacare is Repealed

Gov. Matt Bevin’s administration is moving forward with a plan that would alter the state’s expanded Medicaid system, even if the Affordable Care Act is repealed or replaced by Congress.

The proposal has been billed as a way to get Medicaid recipients more involved in their healthcare choices and also a way to reduce Medicaid costs for the state. Bevin’s administration expects about 86,000 fewer people would be enrolled in Medicaid if the waiver is approved.

Vickie Yates Brown Glisson, secretary of the Cabinet for Health and Family Services, said on Wednesday that the state would still move forward with the plan, even if Congress moves to fully repeal the Affordable Care Act.

“At this point, the governor has said to me ‘that is my number one priority, you’ve got to get this done in 2017 and have it ready to go on January 1st of 2018,’” Glisson said.

Last year, Bevin formally asked the federal government for permission to require able-bodied Medicaid enrollees to work or volunteer up to 20 hours a week and pay a monthly fee ranging from $1 to $15 to receive benefits.

The plan also removes vision and dental coverage from the built-in list of benefits. Medicaid recipients would be able to earn credits to purchase vision or dental benefits by participating in volunteer work or taking a health risk assessment.

Glisson said the state might be able to implement the waiver, or a policy similar to it, under an ACA replacement that allows states to apply for federal block grants to fund Medicaid programs

“If we get approved, I think it answers a lot of questions that I think other states have had, a lot of things that they put in their waivers and maybe were not entirely approved,” Glisson said. “If this gets approved yes, I think it’s really going to really set a tone, I think it’ll be a model for the rest of the country.”

Other states didn’t have success applying for Medicaid waivers — under President Barack Obama’s administration — that have work requirements or imposing premiums that prevent low-income people from accessing coverage.

But under incoming President Donald Trump’s administration, the state might have an easier time passing the requirements.

Stephen Miller, Kentucky’s Medicaid Commissioner, said that the state can’t afford to continue funding an expanded Medicaid system without changes.

“Medicaid consumed every new dollar plus a couple that comes into the state. It crowds out so many other expenditures and makes education and other expenditures so difficult as well,” Miller said.

Former Gov. Steve Beshear enacted Kentucky’s Medicaid expansion by executive order in 2013, making everyone who makes up to $16,243 per year eligible for coverage through the program.

Over 440,000 Kentuckians signed up for the program, helping lower the state’s uninsured rate among working age adults from 21 percent to 8 percent by 2015.

The federal government paid 100 percent of the cost of Kentucky’s Medicaid expansion until the end of last year.

Starting this year, the state has to chip in 5 percent of the cost ($74 million), increasing to 10 percent ($294 million) by 2020.

Rep. Robert Benvenuti, a Republican from Lexington, said that citizens and businesses will flee the state if something isn’t done to reduce Medicaid costs.

“The hardworking Kentuckians that are pulling this bloated cart are going to say enough is enough and they’ll take their businesses elsewhere,” he said. “We have made entitlements a way of life in this commonwealth and you’ve seen the poor outcomes that you get.”

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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