House Task Force on Vulnerable Kentuckians hears complaints about proposed changes to Medicaid program

By Melissa Patrick
Kentucky Health News

BEATTYVILLE, Ky. – Several speakers at the July 15 meeting of the House Task Force on Vulnerable Kentuckians said Gov. Matt Bevin’s proposed changes to the Medicaid program would be too complicated for the most vulnerable Kentuckians and will create barriers to care on several fronts.

Mary Mead-McKenzie, executive director of the Kentucky River Community Center, which offers behavioral and addiction services to eight of Kentucky’s poorest counties, said the work-or-volunteer requirements for able-bodied adults who aren’t primary caregivers of dependents are not feasible in areas where there are no jobs. “Are we going to say that we are going to punish you because of the economy?” she asked.

Mead-McKenzie also opposed the proposed monthly premiums for most Medicaid recipients that would initially range from $1 to $15 per person. She painted a picture of what coming up with an extra dollar means for many of the families she serves.

“A dollar is a lot to some people,” she said. “Look at people who have to dig in their cushions to get enough money to buy one gallon of gas to get to work and back . . . and then you add on a $5 premium. . . . Yes, it does impact people and these are the most vulnerable people in our state.”

The bipartisan task force, formed by House Speaker Greg Sumbo, D-Prestonsburg, will hold meetings in each of the state’s six congressional districts this year to study issues facing the state’s poorest citizens and make recommendations to the 2017 legislative session. The first meeting was held in Louisville and focused on the lack of affordable housing.

Mary Lee Underwood of the Commonwealth Council on Developmental Disabilities voiced concern about how the plan, for a waiver of normal Medicaid rules, would impact those with disabilities.

She said some individuals with disabilities and their families under the new plan will be considered able-bodied because they don’t receive any Social Security or disability benefits and have been able to get health insurance only through the expansion of Medicaid eligibility to those with incomes up to 138 percent of the federal poverty level. She said one-third of Kentucky adults with disabilities live in poverty.

“We can guarantee that there will be a disparate impact on people with disabilities and their family members because they are so highly represented in the population of people who are living at or near the poverty level,” Underwood said.

Underwood also noted that while those who are deemed “medically frail” are “somewhat protected” from the proposed changes, they will have to pay premiums and are subject to the penalties associated with the plan if they don’t. She said that the “scary part” is that managed-care organizations, which have a “history of inconsistent application of standards with other Medicaid waivers,” will decide who is medically frail.

She and other speakers stressed that the proposal is too complicated. “That complexity will create barriers, especially to those with disabilities who are already struggling to understand multiple systems and to comply with the demands that those systems place on them,” Underwood said.

Democratic Rep. Terry Mills of Lebanon said he spent 35 years processing Social Security and disability claims, and “We need to acknowledge that able-bodied is so subjective, it can be dangerous.” He also said,  “I sort of formed an opinion during that time that if you want to keep people from asking, make it so complex that barriers are created.”

Bill Dolan and Kevin Fleming, lawyers from Kentucky Protection and Advocacy, a government-sponsored group that serves people with disabilities, said they were aggressively seeking clarification from the Cabinet for Health and Family Services to determine which disabled populations would be covered and which would be exempt.

Dolan did offer one of the few positive comments at the meeting, saying that the increased funding for inpatient substance-abuse treatment was a “great thing.”

Emily Beauregard, executive director of Kentucky Voices for Health, disputed Health Secretary Vickie Yates Brown Glisson’s assertion that the expansion has done nothing to improve the health of Kentuckians.

“It is worth remembering that in 2014 alone, preventive screenings for diabetes and cholesterol doubled, trips to the emergency room decreased, tens of thousands more Kentuckians invested in early detection, treatment and disease management – and that’s good for all of us,” she said.

Rep. Cluster Howard, D-Jackson, acknowledged surveys that show most Kentuckians want to keep the expansion as it is, but noted that Bevin won by a “substantial margin” in the district he represents and  clearly campaigned on changing Medicaid. “Where did the disconnect occur?” he asked.

Cara Stewart of the Kentucky Equal Justice Center said people vote on more than one issue, and won a laugh when she said, “Also, a lot of people don’t pay attention to what people say when they are running.”

Beauregard said, “I remember clearly during the election that Governor Bevin said no one is going to lose their coverage. … When you hear that you feel comfortable, you feel secure with your coverage and you go on to worrying about other things in life.”

Rep. Darrell Owens, D-Louisville, passionately pointed out that 70 percent of registered voters did not vote in the governor’s race. “The reality is that citizens went to sleep,” he said. “So it’s an indication to me that we need to be a little more concerned about voting and understanding the issues.”

Owens said he thinks the federal government will reject this proposal as it stands now, and Bevin will do what he said he would do: end the expansion, leaving more than 400,000 Kentuckians without health insurance, which is “more folks than voted for him.”

Mahak Kalra and Stephen Lin of Kentucky Youth Advocates were glad to see that the plan would not directly affect children and pregnant women, but voiced concerns about parents and children having different benefit packages. “We believe that parents may become confused about the differences in requirements and also the coverage for themselves and their children,” Kalra said.

Nicole Huberfeld, a University of Kentucky associate law dean, discussed findings from her paper, “Health Care and the Myth of Self Reliance,” which explains why Americans believe what they do about health care access to the poor, and why a single government program for the poor would be more economically and administratively efficient. A report on her views will appear later.

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