Feds reject Ohio’s Medicaid proposal, which was a lot like Ky.’s; federal comment period for Kentucky plan runs through Oct. 8

By Melissa Patrick
Kentucky Health News

The Centers for Medicare and Medicaid Services rejected Ohio’s new Medicaid plan Friday, saying it could lead to the state’s low-income people losing health coverage — a decision that should place Kentuckians on alert, since it has a lot of similarities to the one Gov. Matt Bevin has proposed.

Ohio’s new plan would have required all non-disabled Medicaid beneficiaries, except pregnant women, to pay up to $8.25 per month, depending on income, into a health savings account, with a $99 annual limit. Beneficiaries who failed to make their payments within 60 days of the due date would have lost coverage and would have had to pay back all missed payments to re-enroll.

“CMS is concerned that these premiums would undermine access to coverage and the affordability of care, and do not support the objectives of the Medicaid program,” acting CMS Administrator Andy Slavitt wrote in a letter to the state’s Medicaid director.

Bevin’s proposal would also require Medicaid members to pay premiums, between $1 and $15 per month, depending on income, except pregnant women, children and the medically frail. These amounts would be assessed on households, not individuals.

Kentucky’s plan would also dis-enroll members for non-payment, but has different penalties for those above or below the federal poverty level. Non-payers under that line would be required to make co-payments and lose $25 from their health savings account, which would be suspended. Like Ohio, Kentucky would stop coverage for those above the poverty line.

Kentucky’s plan, like Ohio’s, would allow suspended individuals to re-enroll by making back payments. Kentucky’s plan would also require them to participate in a financial or health literacy course.

Slavitt, of CMS, said Ohio’s application indicated that more than 125,000 Ohioans would lose coverage each year because of these changes, and “We do not believe that this practice would support the objectives of the Medicaid program, because it could lead to a substantial population without access to affordable coverage.”

Kentucky officials also forecast that their plan would decrease enrollment: by about 17,000 in the first years and by 85,000 in the fifth year.

Another challenge for approval that Kentucky’s plan faces is its “community engagement” requirements, which requires all able-bodied adults who aren’t primary caregivers to work or volunteer, eventually 20 hours a week. No plan has been approved so far with any work requirements.

Ohio had proposed to require that a workforce-development agency referral be offered to any of its members who worked fewer than 20 hours a week, while clearly stating that participation in any such program was not a condition of enrollment.

Why should Kentuckians care about what happens in Ohio?

While Bevin has said he would negotiate with federal officials, his plan says it constitutes the conditions under which Kentucky will continue the Medicaid expansion implemented by his Democratic predecessor, Steve Beshear. Thus, a failure of negotiations could take health insurance away from the more than 430,000 Kentuckians who qualified under the expansion of eligibility to households who earn up to 138 percent of the federal poverty level.

Ohio could not negotiate with CMS because its legislature wrote its plan into its two-year budget. Slavitt clearly stated in rejecting Ohio’s plan that waivers allowing changes in Medicaid rules cannot be approved unless they “strengthen coverage of health outcomes for low-income individuals in the state, increase access to providers, or otherwise increase the efficiency and quality of care provided to Medicaid beneficiaries and other low-income populations in the state.”

Kentucky’s waiver comment period runs through 11 p.m Oct. 8. Click here to comment. Click here to see the proposal.

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