Health Politics

Kentucky’s Medicaid commissioner says federal officials are “real close” to approving Gov. Matt Bevin’s proposed changes to the state’s Medicaid system.

Bevin has asked the federal government for permission to require Medicaid recipients to pay monthly premiums and work or volunteer to keep their coverage — a policy which the governor claims will lead to better health outcomes and save the state money.

Federal officials have been reviewing Bevin’s request for more than a year.

Stephen Miller, commissioner of Kentucky’s Medicaid system, said he expects to be able to roll out the changes by July 1 of 2018.

“In the conversations we’ve had with [Centers for Medicare and Medicaid Services] since then, they even say we are real close and it’s going through the final review,” Miller said in an update given to state lawmakers on Tuesday.

Kentucky is one of a handful of states that have applied to require Medicaid recipients to work or volunteer in order to keep coverage — a policy that was rejected under the Obama administration.

But last week, the head of the U.S. Centers for Medicare and Medicaid Services under President Trump’s administration said that the federal government would approve the policies.

Miller said that the announcement was good news for Bevin’s “community engagement” requirement — Medicaid recipients considered to be “able-bodied” would have to work or volunteer 20 hours per week to keep coverage under the plan.

“They will be approving any 1115 waivers that come forward with community engagement. It is very much in sync with where we are, with what we had presented to CMS,” Miller said.

More than 400,000 people have been added to the state’s Medicaid rolls since former Gov. Steve Beshear raised the bar for how much money you can make and be eligible for the program — now $16,642 per year for an individual.

Bevin’s proposal would keep that threshold in place, but add restrictions that would trim nearly 100,000 Kentuckians from the state’s Medicaid rolls over the next five years, according to the state’s application.

“Able-bodied” individuals would have to pay premiums ranging between $1 and $15 per month under Bevin’s plan.

Cara Stewart, a health fellow at the Kentucky Equal Justice Center, said that Bevin’s application will lead to fewer people getting health care.

“I think that it’s a harmful barrier that prevents people from getting coverage or being able to access their care,” Stewart said. “I think it’s designed to be a barrier.”

Seema Verma, the federal CMS administrator, helped craft Bevin’s application last year and is now a key player in reviewing the policy in the Trump administration.

Last week, Verma called opposition to the work requirements “soft bigotry.”

“Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma said in a speech given to the National Association of Medicaid Directors.

Bevin has said he would repeal Kentucky’s Medicaid expansion if the federal government doesn’t approve his proposed changes.

Ryland Barton is the Capitol bureau chief for Kentucky Public Radio.