Health

Kentucky Medicaid Commissioner Stephen Miller said the state is moving full-speed ahead with changes to the Medicaid program known as “Kentucky Health” and he fully expects the waiver to be approved.

Miller’s comments Thursday come as Republicans in Congress work to repeal and replace the Affordable Care Act, known as Obamacare. A vote was scheduled for Thursday but was delayed due to opposition to the measure both from the center and the right within the party.

Miller said either way, he expects to know about the Medicaid changes by the end of June.

A timeline of the rollout of the new Medicaid changes obtained by WFPL shows officials expected approval to come in March. Miller, however, said there was radio silence for a couple months after President Obama left office.

Some of Kentucky’s proposed changes to the Medicaid program include:

    • A 20 hour a week requirement for the unemployed to volunteer, take GED classes, etc. (The requirement would gradually increase to 20 hours by the year mark of enrollment.)
    • Monthly payments for everyone, including those with no income and single people earning up to $15,000 a year.
    • Co-pays for services like doctor visits, if the enrollee decides against a monthly payment.
    • A 6-month lock-out period if an enrollee lets their monthly payment lapse.

Pregnant women, children and the “medically-frail” would be exempt from the above. However, Medicaid officials are still figuring out how to determine if a person is “medically-frail.”

One of the key parts of the American Health Care Act, which some are calling “TrumpCare, is a change in how Medicaid is funded. Currently, the federal government reimburses states for every medical claim. But under the GOP plan, states would receive a lump sum for the year and no more. That could be a problem for states if there’s an economic downturn and more people become unemployed and need Medicaid, or in the case of a major health crisis like an Ebola outbreak.

Commissioner Miller said using the lump sum funding model — called a block grant — to operate Bevin’s proposed Medicaid changes wouldn’t necessarily be a problem, depending on the amount of the grant.

“Then the issue becomes what will be the level of the funding,” Miller said. “Until we know that, you just don’t know.”

Miller spoke Thursday at the Advisory Council for Medical Assistance in Frankfort, which acts as an oversight and complaint board for the Medicaid program. Medicaid insurance companies and the state Department for Medicaid Services have met twice a week since January to work out changes, and now the working group will work on technology needed to support the new Medicaid plan.

There are many pieces yet to be worked out in the Medicaid plan. Sheila Schuster, executive director at Advocacy Action Network, is concerned. She worries about the term “medically-frail,” for instance. It’s a federal definition that includes people receiving Social Security and disability benefits. However, the Medicaid waiver states that people with chronic substance abuse issues would also qualify.

“Do you have it for life,” she said. “One of the populations we’re concerned about because of the public health crisis is people with substance abuse disorders. And we know people go periodically in and out of recovery.”

Schuster said it is unclear whether people who are stabilized in recovery lose the “medically-frail” status.

Commissioner Miller said the goal date to put the new system in place is Jan. 1, 2018.

Lisa Gillespie is WFPL's Health and Innovation Reporter.