Health

Gov. Matt Bevin is delaying submitting changes to the state’s Medicaid program, which his administration had intended to submit to the federal government by Monday.

Adam Meier, Bevin’s deputy chief of staff for policy, said the extension is due to the large number of comments the state received regarding the proposal.

Under Bevin’s proposed plan, some recipients would have co-pays for doctor visits, basic dental and vision benefits would be eliminated for able-bodied adults, and beneficiaries who earn above the federal poverty line would pay monthly premiums. Those who don’t pay premiums would have co-pays.

In addition, beneficiaries would be required to accrue funds to earn dental and vision benefits by participating in activities such as community service or job-training.

The penalty for unnecessary emergency room visits would increase — from $8 to as high as $75 — in an effort to keep people from using the ER for non-emergencies, like tooth pain or a common cold. Unnecessary emergency room visits cost as much as $30.8 billion a year nationally, according to a study in Health Affairs.

But advocates warn that eliminating benefits will drive up emergency room visits. In 2006, the state of California eliminated dental benefits from the Medicaid program. ER visits for dental issues increased 32 percent after the change was made.

“If we start to impose emergency room penalties at the same time we’re reducing benefits, we’re really going to have a situation where more people rely on the emergency room but people won’t be able to afford it,” said Emily Beauregard, executive director of patient advocacy group Kentucky Voices for Health.

Bevin’s Medicaid plan would also mandate that able-bodied recipients without primary care responsibility work or volunteer at least 20 hours per week after their first year of receiving Medicaid benefits.

Meier said there’s already a work and volunteer requirement for people receiving food stamps. But there are only eight of Kentucky’s 120 counties where the requirement is in place because there are not enough places to volunteer or work in many counties.

“We would phase it in by county, and we’d ensure there are adequate opportunities for people to meet the requirement,” Meier said.

Questions Remain

There are questions, however, about how the work requirement would be monitored. Jeff Myers, CEO of Medicaid Health Plans of American (MHPA) said health plan providers would want to make sure they’re not the ones on the hook for collecting volunteer and work information.

“MHPA would strongly encourage the state to work with its participating plans to reduce the overall administrative burden of this requirement on the plans,” he said. “Perhaps the state could collect all info on the volunteer effort to ensure that it is appropriate and then report it to the plans.”

Myers said Medicaid providers put a lot of effort into making sure sick patients get the care they need. Having such a requirement, he said, could interrupt those efforts to get people healthier.

Since Medicaid expanded in Kentucky two years ago, preventive screenings for diabetes and cancer doubled in the first year, trips to the emergency room decreased by 3 percent, and 15 percent more people with chronic conditions are receiving regular care.

Last week, the U.S. Department of Health and Human Services told the state of Indiana that it would not approve a portion of its proposed waiver to lock people out of Medicaid if they did not enroll annually. A similar provision is included in Bevin’s plan, although his includes a way for former beneficiaries to return to the program.

Dustin Pugel, research and policy associate with the Kentucky Center for Economic Policy, said overall, Bevin’s plan would require more time and money from the state government.

“There’s so much red tape in this plan that I’m skeptical about the claim that it will save a lot of money,” Pugel said.

After Kentucky submits the waiver to the federal government, there will be another open comment period. During that time, HHS and Kentucky would negotiate.

A final plan will likely be announced seven months to a year from now, according to Pugel. A Bevin spokeswoman said it could be as soon as a few months.

Correction: A previous version of this story implied the Bevin administration missed a federal deadline. It missed a self-imposed deadline to submit the waiver to the federal government.

In addition, a part of the story detailing Bevin’s proposal has been clarified to reflect that some beneficiaries would either pay premiums or co-pays for doctor’s visits, and be able to earn dental and vision benefits.

And a line in the story saying the U.S. Department of Health and Human Services would not allow for the removal of retroactive payments has been removed; it was included due to a reporting error.

Lisa Gillespie is WFPL's Health and Innovation Reporter.