Kentucky Is First To Get Federal OK For Medicaid Work Requirement

The main effect of LePage's, Trump's Medicaid work rules? Fewer people with coverage.

"They'll be able to fill out a document to say, 'I encounter these things, whatever the diagnosis may be'".

HHS and the states proposing work requirements seem to assume that anyone who finds work will have access to employer-provided insurance and, thus, will no longer need Medicaid. "We're confident that there will be people who qualify for exemptions who don't get them, and the end result is that more people are going to lose health care". "Overall, CMS believes that Kentucky HEALTH [Helping to Engage and Achieve Long Term Health] has been created to empower individuals to improve their health and well-being".

CMS also advised states to make work requirements for Medicaid similar than those used with food stamps to "reduce the burden on both states and beneficiaries". He says it does not apply to anyone receiving Medicare or the traditional Medicaid recipient. The failed efforts in the House to replace Obamacare included a work requirement for Medicaid.

Kentucky's program would require non-disabled adults each month to participate in 80 hours of work, job training, education or other qualified "community engagement". Those insurers said they remain concerned that as the work mandate unfolds, their jobs might become harder because of increased churn in enrollment and administrative work. But many of those would drop out not because of finding work but because they can't overcome the new bureaucratic hurdles, say advocates for the poor.

More than 400,000 Kentucky residents gained health insurance through the program, the highest growth rate of Medicaid coverage of any state.

The revisions would cut dental and vision coverage for many adults, although they can regain it by completing health-related activities, such as taking a disease management class or volunteering.

Individuals with income above the poverty level ($12,060) who do not pay their premiums in 60 days will be kicked out of coverage for six months.

Medicaid is one of the largest expenses from the state's General Fund, with $8.4 billion of almost $32 billion in state spending paying for the program.

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A bipartisan commission appointed to study the issue over the summer, led by Majority Leader Jeb Bradley, R-Wolfeboro, recommended that the program be continued but left numerous details to lawmakers - including how the state will pay for its 10 percent share of the expansion in 2020 and beyond.

Under Kentucky HEALTH, enrollees will make a monthly payment ranging from $1 to $15 depending on income.

One-third of Kentuckians are on Medicaid.

CMS Administrator Seema Verma recused herself from the Kentucky decision because she had worked with state officials on the waiver request when she was a consultant before joining the Trump administration. The new policy allows states to make exceptions to the work rules for caregivers and students, but it doesn't require that they do so.

Greg Moore, state director with Americans for Prosperity, points out that the state budget requires the state to enact work requirements for the Medicaid expansion population by April 30, or notify expansion recipients that the program will terminate on December 31. "If you look at our Medicaid population, mostly children, mostly seniors, and single pregnant moms, I don't think that is necessarily something that we would do".

Former President Obama, under the Affordable Care Act, allowed states to expand the program to include low-income adults who have jobs that don't provide health insurance.

Update: This story was updated on January 12 to add information from the governor and more details on the Kentucky waiver once they were released.

This story was produced by Side Effects Public Media, a reporting collaborative focused on public health.

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