Kentucky scores first Medicaid work requirement approval

Kentucky scores first Medicaid work requirement approval

Governor Matt Bevin made a public announcement Friday afternoon about the waiver.

"Overall, CMS believes that Kentucky HEALTH has been created to empower individuals to improve their health and well-being", CMS Principal Deputy Administrator Demetrios L. Kouzoukas wrote in a letter announcing the change.

Bevin said the waiver will be "transformational".

Under Bevin's Democratic predecessor, Gov. Steve Beshear, Kentucky embraced Medicaid expansion and was viewed as a national model for its implementation of the ACA.

"I want to publicly thank Cabinet for Health and Family Services Secretary Vickie Yates Brown Glisson, Education and Workforce Development Cabinet Secretary Hal Heiner, and the countless dedicated state employees who worked tirelessly to develop and secure approval for a program that will positively change Kentucky's health narrative for generations to come".

While Bevin said that Kentucky's new program, called HEALTH (Helping to Engage and Achieve Long Term Health) would improve Kentuckians' health outcomes, critics, including U.S. Rep. John Yarmuth, D-Ky., said it would kick tens of thousands of people off health insurance. Or they're caring for a child or family member, or they're sick or disabled.

Bevin agreed the plan might face a legal challenge but seemed unconcerned. In the past, federal officials said work was not among those objectives.

However, Kristi Putnam, program manager for Kentucky's Medicaid overhaul request, has told Insider that people with chronic diseases - mental illness, chronic substance use disorder, blood clotting disorders - will remain eligible for Medicaid as they are exempt from the work requirements. Anyway, it's one of those "damn straight" type ideas that politicians often say they believe, but never actually do because it's not that simple, or because there's too much resistance, or. well, or because they never really meant to do it in the first place.

Advocates for the poor have said work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork. "It's not about employment encouragement".

And while the LePage administration tries to argue in its waiver application that imposing work requirements improves people's economic circumstances, its own analyses have shown this isn't the case.

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Certain Medicaid populations would be exempt from the rules, including those with disabilities, the elderly, children and pregnant women. The letter released Thursday by CMS contains similar language on the work requirements.

Many people insured through Medicaid are working low-income jobs with unpredictable and irregular hours.

The Bevin administration has estimated the work requirements likely will affect about 200,000 of the adults added through the expansion.

The Centers for Medicare and Medicaid Services issued guidance making it easier for states to design and propose test programs that implement such requirements. And when someone gets sick, the last thing she needs to worry about is whether she'll also lose her health coverage for not working.

In a 10-page letter to state Medicaid directors, CMS Director Brian Neale announced the new federal approach, "designed to assist states in their efforts to improve Medicaid enrollee health and well-being through incentivizing work and community engagement".

Why can't the USA provide both a cost-effective safety net for health care and opportunities for people to find meaningful work?

"They're going to try to force a square peg into a round hole", he said.

Liberal-leaning groups had already hinted at challenging Medicaid work requirements in court before the Kentucky waiver was approved, and some of those same groups harshly criticized at the policies in the state's demonstration project.

Kentuckians on Medicaid won't see any immediate changes.

"Kentucky is leading the nation in this reform in ways that are already replicated by well over a dozen states and growing", he said.

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