FRANKFORT (AP) — Health insurance for more than 400,000 Kentuckians is at stake as federal officials begin reviewing a plan submitted Wednesday by Gov. Matt Bevin to overhaul the state’s Medicaid program.
The proposal, dubbed Kentucky HEALTH, now heads to the federal Department of Health and Human Services, which jointly operates the program with the state and must approve any changes following a 30 day public comment period and negotiations with state officials. The stakes are high. If the federal government does not approve a proposal 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.
“If there are not structural changes made, there will not be the ability to have expanded Medicaid in Kentucky. That’s just the reality of it,” Bevin told reporters Wednesday. “So the ball is in HHS’ court.”
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 the plan in June, Bevin said he has receive nearly 1,350 written comments, prompting some changes. In one substantial change, the program would continue paying for allergy testing and private duty nursing, two benefits that Bevin initially proposed to eliminate.
The plan would still require people to pay monthly premiums of up to $15, penalizing people who don’t pay by locking them out of their insurance for up to six months. But the new plan eliminates premiums and copays for the “medically frail.” That category now includes people in hospice care, HIV and AIDS patients and people receiving federal disability benefits.
The plan would still force people to get a job or volunteer at least 20 hours per week to keep their health insurance benefits. But under the new plan, people who care for non-dependents, such as elderly parents, would still qualify for insurance benefits. And anyone who is the primary caregiver for a disabled adult would be exempt from the requirement.
The proposal would still eliminate automatic dental and vision benefits, instead requiring people to pay for those services by earning credits in a “My Rewards Account.” But Bevin said he will delay those changes by three months and give people more opportunities to stock those accounts by awarding credit for earning a GED.
Other tweaks include charging monthly premiums based on households, not individuals, so a married couple would pay one premium instead of two.
Bevin had originally said he wanted the federal government to give him an answer by Sept. 30. But he backed off from that on Wednesday, saying “we’re not going to hold it hostage to a set date, but time is of the essence.”
Health and Human Services spokeswoman Marjorie Connolly said the agency is prepared to negotiate “for as long as it takes to find a solution that maintains and builds on Kentucky’s historic progress, and avoids moving backwards.”
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.
Some health care advocates were generally supportive of Bevin’s changes, but still criticized the plan for charging premiums and imposing penalties for not paying them.
Save Kentucky Healthcare, the group former Gov. Steve Beshear founded to oppose Bevin’s health care policies, said in a news release that Bevin “is putting his own political ideology ahead of the health and well being of hundreds of thousands of Kentuckians.”
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.”