Centers for Medicare and Medicaid Services Acting Director Andrew Slavitt said in a letter dated Oct. 4 to Gov. Matt Bevin that Kentucky had met all of the necessary requirements to make the transition and granted its approval to make the change.
“This transition will allow Kentucky to achieve substantial cost savings while still allowing citizens to enroll in qualified health plans,” Amanda Stamper, press secretary for Gov. Matt Bevin’s administration, asserted in an e-mail.
Kynect was created with a federal grant and funded by a 1 percent tax on all insurance policies sold in the state, both on and off the exchange.This revenue had previously funded Kentucky Access, the high-risk insurance pool that federal health reform made unnecessary.
The 1 percent tax will continue, and be used to help pay for transition costs, fund the Kentucky Health Information Exchange and “legacy costs” of Kentucky Access, the Bevin administration told a legislative committee in March.
Bevin has said it is unfair for all insurance customers to pay for an exchange that fewer than 100,000 people use. He does not include the 425,000 Kentuckians who used Kynect to sign up for Medicaid year-round.
The fee for using the federal exchange will be 1.5 percent, plus a proposed 0.5 percent state fee to cover outreach and plan-management functions.
Despite CMS’s approval, the bulk of Slavitt’s letter expressed concerns about the change.
“We remain concerned that Kynect’s transition to the federal platform may disrupt the
seamless system of coverage that Kynect established. As a result, eligible people may face delays
in or lack access to the coverage for which they are eligible,” Slavitt wrote.
Slavitt called Kentucky’s transition timeline “aggressive” and said “key milestones” remain. He added that such a major transition creates “significant risks.”
The approval comes less than one month before open enrollment will begin on Nov. 1. (It ends Jan. 31, but to get coverage starting Jan. 1 enrollees must sign up by Dec. 15.) Stamper told Lisa Gillespie of WFPL that the state will be able to make the switch in time.
“We’ve also been working with [the Centers for Medicare and Medicaid Services] and stakeholders to develop a comprehensive outreach plan to ensure people have the information they need well before open enrollment to know when and how to enroll,” Stamper told Gillespie.
But Cara Stewart, a health-law fellow at the Kentucky Equal Justice Center, said there isn’t enough time to make the transition before Nov. 1. One reason, she said, is Kentucky hasn’t conducted the same level of outreach that it has in years past because Kynectors who help people navigate the system didn’t know what to tell people until today. She also noted that Kynectors must go through training to assist people on the federal exchange.
“And yet this is a change as big as the change the very first year of Medicaid expansion,” said Stewart, who is also a Kynector. “And so we are looking at a tremendous amount of information that is not being pushed out there. And on HealthCare.gov, every single person has to create a new account and start from complete scratch, and this system is more cumbersome and more difficult to use than Kynect.”
Stewart noted that assisters on the federal exchange are limited in how much they can help their clients because the system doesn’t offer a shared dashboard, and without that dashboard they can’t help help their clients fill out their applications or check on the application’s status.
“We are choosing to set ourselves up for failure,” she said. “I don’t see any way that we won’t have access issues.”
Slavitt also noted that on the federal exchange many Kentuckians will have to manipulate two systems instead of just one, as they do now on Kynect, to maintain their health insurance.
Slavitt emphasized the importance of making sure Kentuckians are informed about these changes.
“Changes in system functionality may result in confusion for Kentucky consumers,” he wrote. “It is therefore essential that the transition be clearly and effectively communicated to Kentucky consumers to ensure that they have the information they need to enroll in coverage on HealthCare.gov starting Nov. 1, 2016.”
Save Kentucky Healthcare, a non-profit founded by former Gov. Steve Beshear, who created Kynect, noted the warnings in Slavitt’s letter, including “the high risk of user delays, gaps in coverage, and anticipated confusion as Kentuckians attempt to adjust to a more complicated system.” It also asserted that “study after study has found the current system sustainable and affordable.”
“It is disappointing that Gov. Bevin is once again putting his rigid right wing ideology ahead of the health and well-being of Kentuckians,” Beshear’s group said in a press release.