Health

Gov. Matt Bevin said he will take away Medicaid expansion coverage from about half a million Kentuckians if a court blocks Medicaid changes that were approved last week.

The most controversial change to the governor’s planned overhaul is a requirement that many of the state’s Medicaid enrollees perform some kind of “community engagement” — work, volunteer service, job training or education.

The Courier Journal first reported Tuesday that Bevin issued an executive order directing the secretary of the Cabinet for Health and Family Services and the Medicaid commissioner to terminate Kentucky’s Medicaid expansion if any part of his plan is struck down in court and once all appeals are exhausted.

Woody Maglinger, Bevin’s press secretary, issued a statement saying that these terms were clear when the governor submitted the waiver.

“Gov. Bevin has consistently said since submitting the 1115 application that these are the terms under which Kentucky will maintain expanded Medicaid,” Maglinger wrote in the  statement. “Accordingly, he has signed an executive order to terminate Kentucky’s Medicaid expansion in the event that a court decision prohibits one or more of the components of the Section 1115 waiver from being implemented.”

No one has filed a lawsuit to stop Bevin’s Medicaid changes, which were approved last week. But advocacy groups and Democratic lawmakers who have long criticized the overhaul have questioned whether the work/volunteer mandate is legal.

Last week, the federal government approved the long-awaited Medicaid waiver that Bevin submitted in the summer of 2015. There are several changes to the program, the bulk of which are directed at people in the Medicaid expansion population and “able-bodied” adults who make under 100 percent of the poverty limit.

Kentucky is the first state to win approval to require some Medicaid enrollees to perform “community engagement” hours to keep their coverage. This requirement means an enrollee has to work, volunteer, take GED courses or do other activities for at least 80 hours a month, or lose coverage.

This change affects the Medicaid expansion population, or people who make between $12,061 and $16,642 for a one-person family; and people who qualify for Medicaid because they earn $12,060 or less (the poverty level).

Enrollees who will be exempt from this include full-time students, former foster care youth, pregnant women, people with an acute medical condition and primary caregivers. People working 120 hours a month are also exempt.

People who gained coverage through Medicaid expansion (who can make up to $16,670 for a one-person family) will have to pay a copay or premium. But they’ll only get access to vision and dental coverage if they pay a premium and then earn points.

People who have coverage because they make less than 100 percent of poverty will have to make a monthly payment or copay, but will maintain access to vision and dental. People who are deemed medically-frail and former foster care youth will only have access to vision and dental services by making monthly premiums and earning points.

Pregnant women, the traditional Medicaid group and kids will not have to pay copays or premiums.

People that qualify for Medicaid because they receive Supplemental Security Income (SSI) won’t see any changes to the coverage they already have. SSI is for people with low-incomes and have limited assets who are either aged 65 or older, blind or disabled.

People who have Medicaid as well as Medicare are excluded, as well as people living in a nursing home. Also excluded from the changes are people who are on numerous specialized programs in Medicaid. This includes people with a Home and Community-based waiver, the Michelle P. Waiver, Acquired Brain Injury waiver, and the Supports for Community Living waiver.

The state says it will begin implementing changes in July.

Lisa Gillespie is WFPL's Health and Innovation Reporter.