Kentucky Center for Economic Policy report warns about impact of Bevin’s proposed Medicaid changes

By Danielle Ray
Kentucky Health News
A research group with a liberal outlook warned Monday that
Republican Gov. Matt Bevin should be careful in changing the state Medicaid
The Kentucky Center for Economic Policy said the state’s
expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has
increased health screenings and job growth in health care.
Tobacco counseling and interventions increased 169 percent
from 2013 to 2014, the first year of the expansion, the report noted. Influenza
vaccinations went up 143 percent and breast cancer screenings increased 111
percent, it noted.
In addition, Medicaid expansion brought Kentucky health-care
providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job
growth in the health-care sector from 2014 to 2016, according to the report.
“No matter how you look at Medicaid expansion in Kentucky,
it’s clear it has had a positive effect on access to health care that will
improve our state’s economy and quality of life,” Jason Bailey, executive
director of KCEP, said in a news release.
However, Bevin says the state can’t afford to have more than
a fourth of its population on Medicaid and is seeking a waiver from the federal
government to make changes in the program, such as “skin in the game” for
beneficiaries: co-payments, deductibles or health savings accounts, as used in
a year-old experiment in Indiana, which he has cited as an example.
The KCEP reports says the Medicaid waiver Bevin is seeking
could result in additional costs to recipients and benefit changes. Arkansas
was the first state to design a Medicaid expansion using such a waiver. So far,
five other states have implemented similar waiver-based programs.
Waiver programs differ from standard Medicaid expansion in
that they utilize some or all of the following: health savings accounts, a
cost-sharing account to be used for health care expenses; lockouts, periods in
which recipients who have been dis-enrolled for failure to pay premiums are
barred from re-enrolling; and premium assistance, the use of Medicaid funds to
buy private insurance plans.
These waivers are designed to grant states the freedom to
enact experimental programs within Medicaid, so long as the programs continue
to reflect the overall goal of Medicaid, increasing coverage of low-income
individuals and improving overall health care, as well as efficiency and
stability of health care programs that serve that population.
The Foundation for a Healthy Kentucky, which convened a
meeting of Medicaid stakeholders last week, is holding off on making judgments
of the proposed waiver program. “We believe that diverse input is essential to
sustaining these gains, and to continue improving our health care system and
health outcomes in Kentucky,” said Susan Zepeda, president of the foundation.
Zepeda said research the foundation has funded has shown a greater decrease in the
number of Kentuckians who lack health insurance than any other state, which she
attributes largely to Medicaid expansion adding about 400,000 Kentuckians to
the rolls.
More than 1.4 million Kentuckians are enrolled in Medicaid,
39 percent of whom are children. Nearly 32 percent are enrolled under the
expansion: childless adults in households that earn less than 138 percent of
the federal poverty line, currently $33,000 for a family of four.
The KCEP report also asserts that Kentucky’s Medicaid benefits
are on par with those of other states, specifically that 12 out of 13 of
Kentucky’s optional benefits are also covered in at least 40 other states and
territories. Kentucky Medicaid only covers services that are deemed medically
KCEP noted that Medicaid is a partnership in which the
federal government funds a minimum of half of traditional Medicaid spending in
each state, with poorer states receiving a larger federal match. In Kentucky,
the federal share is about 70 percent. For people covered by the expansion, the
federal government is paying the full cost through this year, but the state
will pay 5 percent in 2017, rising in annual steps to the law’s limit of 10
percent in 2020.

The full KCEP report is at
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