Health Politics

State and city leaders gathered in Louisville Monday to voice opposition to Gov. Matt Bevin’s decision to take away dental and vision benefits from Medicaid recipients who gained coverage under the expansion.

The Bevin administration made the announcement this weekend following a Friday court ruling striking down the governor’s changes to the program.

State Senator Gerald Neal said he’ll introduce legislation mandating that Kentucky’s Medicaid insurance program covers dental and vision benefits.

“I’m going to file a bill to mandate dental and vision across the Commonwealth,” Neal said at a news conference Monday. “I’m very disappointed that the governor would take not only a rash step, but a harsh step as it relates to hundreds of thousands of individuals.

Lisa Gillespie | wfpl.org

Former State Auditor Adam Edelen addresses the media Monday as State Sen. Gerald Neal (right), Congressman John Yarmuth (center), and Jennifer Hasch with Shawnee Christian Healthcare Center look on.

States do not have to offer dental and vision benefits to Medicaid enrollees, and many states do not; some only offer emergency dental care.

Bevin took away vision and dental benefits from adults who became eligible for Medicaid when it was expanded, including adults without dependents who the state considers “able-bodied.” That also includes parents who make above 28 percent of the federal poverty limit. 

In a statement Monday, Cabinet for Health and Family Services Spokesman Doug Hogan said the elimination of dental and vision benefits is a direct result of Friday’s court ruling striking down the Medicaid changes.

“When Kentucky HEALTH was struck down by the court, the ‘My Rewards Account’ program was invalidated, meaning there is no longer a legal mechanism in place to pay for dental and vision coverage for about 460,000 beneficiaries who have been placed in the Alternative Benefit Plan,” Hogan wrote. “As such, they no longer have access to dental and vision coverage as a result of the court’s ruling.”

Hogan wrote in his email that vision and dental benefits will be made available again through My Rewards accounts once Kentucky HEALTH moves forward with implementation.

State Plan Amendment

At a news conference Monday, Kentucky State Representative McKenzie Cantrell questioned if the state’s action was legal.

“There was no public notice, no comment period,” Cantrell said. “I’d say that could be a cause of action right there. You don’t just trip the rug out from under people.”

But late Monday, the state posted a notice on the Cabinet for Health and Family Services website saying it had updated its “state plan amendment,” pulling back vision and dental coverage. According to the notice, officials filed a state plan amendment in April to change vision and dental coverage for Medicaid expansion adults. These adults would have only had access to vision and dental through earning “My Rewards” dollars through a number of health-related activities. Enrollees then would have used their virtual dollars to pay for dental services.

MaryBeth Musumeci, associate director of Medicaid and the Uninsured at the Kaiser Family Foundation Program, said it’s perfectly legal for the state to update the amendment and backdate the effective date to make the changes retroactive. The federal government would have to approve the state plan amendment. 

“So the state can change its benefit package by filing another state plan amendment, saying ‘we’re now going to take optional benefits out of the benefit package,’” Musumeci said. 

Musumeci also said the state could continue offering dental and vision coverage, basically maintaining coverage as-is.

“The court’s decision is not prohibiting Kentucky from continuing to offer vision and dental as they have prior to the waiver,” Musumeci said. “Those benefits continue to be optional and they could include them in the benefit package, or not.”

The elimination of vision and dental coverage doesn’t apply to pregnant women, children, individuals who are considered medically frail, former foster youth up to age 26, and groups covered by Medicaid before the expansion, including parents who make below 28 percent of the federal poverty limit. 

In it’s ruling on Friday the court said that the state and the federal government had not considered how all the Medicaid changes would impact low-income residents’ ability to get health insurance, as that was the goal of the program written by law.

That ruling struck down the most-controversial part, the “community engagement” requirement that would have meant many enrollees work, volunteer or job train for 80 hours a month in exchange for insurance.

On Friday, Cabinet for Health and Family Services Secretary Adam Meier wrote in a statement that the state will work with the federal agency, the Department for Health and Human Services, to address that single issue: how the waiver might affect health coverage.

“Without prompt implementation of Kentucky HEALTH, we will have no choice but to make significant benefit reductions,” Meier wrote of the new plan in a statement.

Bevin has said he will take away Medicaid expansion coverage if a court blocked any of his approved changes.

Correction: Medicaid expanded to include parents making above 28 percent of the federal poverty limit. A previous version of the story incorrectly stated the people who were affected by the change.

Lisa Gillespie is WFPL's Health and Innovation Reporter.