Waiver Tweaks Likely To Further Shrink Medicaid Rolls

Jul 18, 2017

Kentucky’s latest revised Medicaid waiver is expected to trim more Kentuckians from the Medicaid rolls than the original draft. Whether that’s a good or bad thing depends on whom you ask.

Estimates suggest the Bevin administration’s latest proposed changes to the commonwealth’s Medicaid expansion would subtract another 9,000 people from the program – combine that estimate with those projected to exit under the initial version and the numbers near 100,000.

Reactions highlight philosophical differences between the parties. Monday, Leitchfield Republican Sen. Stephen Meredith called the waiver a “bandaid.”

"We added 400,000 people to the Medicaid rolls as a result of the expansion of the Affordable Care Act," he told colleagues. "Not quite sure if that's anything to be proud of. If anything, it should be a wake-up call for Kentucky. We have a third of population that's eligible for Medicaid now. I don't think we're getting to the core root of this problem."

The waiver looks to scale back the expansion ushered in under former Gov. Steve Beshear by adding premiums along with work or volunteer requirements for some recipients.

This week, state policymakers heard about new operational changes that scrap a gradual phase-in for 20-hour weekly work requirements in favor of a 3-month grace period before the full hours become mandatory. The tweaks also lengthened the list of reporting failures that could result in a 6-month lockout for beneficiaries. For example, a worker who fails to report changes in his or her income or hours within 10 days would risk being temporarily shut out of the program. 

Shively Democrat Joni Jenkins wondered whether Medicaid recipients could juggle the additional paperwork.

"Not being able to comply with these reporting (requirements) would make somebody be kicked off. Now there's a way that they can come back in, but that just seems so administratively complex. And, as I told someone earlier, I can't figure out my Kroger Plus points. I'm not sure how folks are going to figure out all their rewards points," she said.

Dustin Pugel with the left-leaning Kentucky Center for Economic Policy cautions – though the latest changes won’t affect children, seniors living in nursing homes, and other exempted groups – they present new barriers for many beneficiaries, even some enrolled in traditional, pre-expansion Medicaid.

"And they will still have to adhere to a lot of the requirements in it, and a lot of them will lose coverage because they're not able to meet all the requirements set out," he adds.

Pugel says ongoing uncertainty on the national level regarding the fate of Obama-era health reforms won't likely derail the 1115 waiver, which state officials hope to implement by mid-2018.

The Bevin administration argues the waiver will save the state $338 million over the next five years, while rescuing an unsustainable expansion that threatens to engulf the state's already squeezed budgets. In addition, the governor promises the new policies will get able-bodied Medicaid recipients more engaged in their own healthcare.

“We can provide all the lip gloss we want and all of the encouragement to do something without actually doing anything and make ourselves falsely feel good. I wasn’t looking for that in any way shape or form… I don’t want to simply provide people with a Medicaid card and feel like we’ve done our part. We owe them better health outcomes," the Republican governor said in 2016.