Politics

A public hearing on Gov. Matt Bevin’s proposal to change the state’s Medicaid system drew mostly backlash from a packed crowd in Frankfort on Wednesday.

Bevin wants to require most Medicaid recipients to pay monthly premiums, eliminate vision and dental coverage from the program and create an incentive system that would allow people to volunteer or get job training in exchange for more benefits.

Harriette Seiler, a Louisville resident, said Bevin’s plan for Kentuckians to put “skin in the game” will “scrape a pound of flesh” from the most vulnerable people.

“The sick and the poor and the unemployed are not naughty children who need to be incentivized or scolded or humiliated by constantly having to prove how poor they are in order to sign up for care,” Seiler said.

Bevin and other state officials have been meeting with representatives from the U.S. Health and Human Services Department in anticipation of applying for an 1115 waiver, which allows states to change their Medicaid programs.

Kentucky is one of 26 states that has a fully-expanded Medicaid program, which makes people up to 138 percent of the federal poverty line eligible for Medicaid. There are six additional states that have expanded Medicaid but have received a waiver as an alternative to the traditional program.

Bevin’s proposal would require most beneficiaries to pay premiums ranging between $1 and $15 per month and lock out those who don’t pay. Recipients would be able to get benefits again once they take a health literacy class and pay back the amount they owe.

Adam Meier, Bevin’s deputy chief of staff, said the program is designed to help people transition to private insurance.

“This whole plan is really to help teach people how to be engaged in their health, in their insurance plan, to teach them how commercial coverage works and the basic elements of those programs,” Meier said.

If Bevin’s waiver goes into effect, state officials predict about 86,000 fewer people will be on Medicaid and the state will save about $331 million over the next five years.

Nancy Galvagni, senior vice president of the Kentucky Hospital Association, applauded the program, saying Kentucky’s current Medicaid system is not sustainable.

“Since most health costs are related to unhealthy lifestyle choices, we really think that in the long-term the only way to really lower the Medicaid program cost is to incentivize individuals to make different choices about their lifestyle and their use of healthcare services,” Galvagni said.

Medicaid covers about 1.3 million Kentuckians, about 30 percent of the state’s population. Since 2014 when the Medicaid expansion took effect, more than 440,000 people have enrolled in the expanded program.

Elizabeth Partin, a nurse practitioner representing the Kentucky Nurses Association, asked state officials to consider putting some form of vision and dental coverage into the waiver proposal.

“I don’t think that one annual eye exam or one annual dental exam is going to break the bank either way,” Partin said. “And it may help to improve people’s health.”

Bevin’s official plan is posted on the state’s Cabinet for Health and Family Services website. Officials said they intend to submit the waiver to the federal government on Aug. 1, with hopes of getting approval sometime in September and rolling out the program in the spring.

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