FRANKFORT (AP) — Kentucky Gov. Matt Bevin formally submitted his plan to overhaul the state’s Medicaid program Wednesday, restoring coverage for allergy testing and private duty nursing while eliminating automatic dental and vision benefits.
The proposal, dubbed Kentucky HEALTH, now heads to the federal Department of Health and Human Services, which must approve any changes to the program following a 30 day public comment period and negotiations with state officials. The stakes are high. If the federal government doesn’t approve a waiver to Bevin’s liking, the Republican governor has said he would repeal the state’s expanded Medicaid program, causing more than 400,000 people to lose their health insurance.
“Kentucky HEALTH will allow us to continue to provide expanded Medicaid coverage, but unlike the current Medicaid expansion under Obamacare, it will do so in a fiscally responsible manner that ensures better health outcomes for recipients,” Bevin said in a news release announcing the changes.
Health and Human Services spokeswoman Marjorie Connolly said the agency will assess Bevin’s proposal based on “longstanding Medicaid principles of access to coverage and affordability” while noting that Kentucky’s Medicaid expansion “has been very successful.”
The new proposal only affects the more than 400,000 people who have health insurance through Kentucky’s expanded Medicaid program, mostly able-bodied adults.
Since announcing his plan in June, Bevin said he has received nearly 1,350 public comments, prompting some changes before the proposal was submitted to the federal government. In one substantial change, the program would continue paying for allergy testing and private duty nursing, two benefits that Bevin initially proposed to eliminate. Bevin said about 40 percent of the public comments were about allergy testing, the most of any topic.
While people still must pay monthly premiums of up to $15, the proposal eliminates premiums and copays for people who are “medically frail.” That category now includes people in hospice care, HIV and AIDS patients and people receiving federal disability benefits.
The proposal would still eliminate automatic dental and vision benefits while giving people the chance to pay for those services by earning credits in a “My Rewards Account.” But Bevin said he will delay those changes by three months to give people more time to accumulate the credits. And he said he would give people more opportunities to stock those accounts by awarding credit for earning a GED and covering the cost of taking the exam.
Other tweaks include charging monthly premiums based on households, not individuals. That way, a married couple earning 75 percent of the federal poverty level would pay $8 per month instead of $16 per month. And the primary caregivers for disabled adults would not be required to get a job or volunteer up to 20 hours a week to keep coverage. Others who care for non-dependents, such as elderly parents, will get credit for that care.
Under former Democratic Gov. Steve Beshear, Kentucky was one of 32 states that expanded its Medicaid program through the federal Affordable Care Act. More than 400,000 people got health insurance as a result, cutting the state’s uninsured rate to 7.5 percent from more than 20 percent — among the largest such drops in the country.
But the massive influx of beneficiaries was much more than state officials predicted. Bevin says the program will cost taxpayers $1.2 billion by 2021. He says Kentucky can’t afford it, given its estimated public pension debt of more than $30 billion. Advocates have warned Bevin’s changes would undo much of the state’s progress over the last few years by making it harder for poor people to get health insurance.
But Bevin defended those changes Wednesday, pointing to one comment he received from a Medicaid recipient who “indicated they would be willing to pay for more coverage.” He said of the nearly 1,350 public comments, 224, or 16 percent, were about charging monthly premiums, which Bevin called “relatively small.”
The Bevin administration will now begin negotiating with a federal agency he has sued. Tuesday, Bevin announced he had joined a lawsuit against Health and Human Services Secretary Sylvia Burwell for interpreting the definition of “sex” in the federal Affordable Care Act to mean “internal sense of gender.”