Gov. Beshear rescinds Bevin’s Medicaid waiver plan but asks federal government to let Kentucky keep four parts of it

Beshear signs executive order on Medicaid. (Melissa Patrick photo)

By Melissa Patrick
Kentucky Health News

As he promised in his campaign, Democratic Gov. Andy Beshear rescinded defeated Republican predecessor Matt Bevin’s Medicaid plan, which included highly controversial work requirements. But Beshear said he also wants to keep using four parts of it.

“We were convinced that the only way to address this waiver initially was to fully rescind it and then move forward on addressing or creating those programs that might be beneficial inside of it,” he said at a Dec. 16 news conference, where he signed an order rescinding Bevin’s request for a waiver of federal rules to implement the plan.

The plan would have required “able-bodied” adults on Medicaid to work or participate in approved “community engagement” activities 80 hours a month and pay small, income-based premiums monthly to stay covered.

Bevin’s original proposal projected that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it, largely because of non-compliance with its requirements, including monthly reporting.

“My faith teaches me that rescinding this waiver is not only the right thing to do, it is the moral, faith-driven thing to do,” Beshear said. ” I believe health care is a basic human right.”

“That’s spot on,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “That’s what I was always taught Jesus Christ was about, is about including people and giving them a hand up when and where you could. And that’s what this is and I think it’s a great thing.”

Chandler noted that the foundation had committed to helping the state keep people from losing coverage under the waiver, and could now use those resources for other efforts.

“We had been concerned about the hundred thousand or so people who were predicted to ultimately lose their coverage had the waiver been implemented.” Chandler told Kentucky Health News.

Bevin’s proposal had already been struck down twice by a federal judge in Washington, D.C., and was awaiting the decision of an appeals court. Beshear told reporters that by ending the waiver, Kentucky would no longer be involved in that lawsuit. Arkansas, which implemented a similar plan before being sued, will remain in the suit.

Beshear’s office hinted in a news release that he might use his order as partial grounds for also rescinding “the $8 billion in Medicaid managed care contracts that the previous administration awarded with just 11 days left in the administration. Those contracts were awarded based on the waiver.” Legislators in both parties have objected to the awards.

Two days after signing the executive order, Beshear’s administration sent a “clarification” letter to the Centers for Medicaid & Medicare Services saying his request did not apply to four provisions in the waiver.

Two of those provisions involve substance use disorder. One allows non-emergency medical transportation for methadone treatment for most people on Medicaid; the other involves the substance-use disorder program that is available to all Kentucky Medicaid beneficiaries.

The third involves a provision that extends Medicaid coverage to former foster-care youth who were the responsibility of another state before moving into Kentucky; the fourth allows a family to coordinate its annual Medicaid re-determination with an open-enrollment period for an employer-sponsored insurance plan. It would include any children who are enrolled in Medicaid or in the Children’s Health Insurance Program and are covered by a parent or caretaker’s plan.

The judge’s rulings against the waiver had no effect on those four elements, as the letter to CMS notes. It also points out that the four have operated without interruption in Kentucky during the suit.

“I am glad Governor Beshear sees the importance of keeping these positive policy changes,” Marcie Timmerman, executive director for Mental Health America of Kentucky, told Kentucky Health News in an e-mail. “Mental health and substance use disorders affect people from every race, class, ethnicity, and orientation. The commitment of Kentucky to help our citizens have access to substance use disorder recovery is something we can all build on.”

Kristen Arant of Newport, who receives coverage through expanded Medicaid, told reporters at the news conference that it had saved her life, allowing her to receive treatment for her substance-abuse disorder. She’s now a college graduate and a social worker.

“Health care is not a luxury,” she said.  “It is not a commodity. It is a God-given right. People who do not feel well have the right to feel well. People who need medications have the right to have access to those medications.”

The expansion has increased by more than a 500% the number in Medicaid beneficiaries receiving treatment for a substance-use disorder, said Emily Beauregard, director of Kentucky Voices for Health. She called Beshear’s order a tremendous victory for the 16 plaintiffs who challenged Bevin’s plan in federal lawsuits.

The Kentucky Equal Justice Center, which was largely behind the lawsuits that kept the plan from taking effect, are “real heroes in this,” Chandler said.

Center Director Richard Seckel diverted his appreciation to the 16 plaintiffs, calling them courageous. “We do hope that as this suit goes on with Arkansas that there will be findings that this waiver never should have been approved in the first place,” he said.

Kentucky’s Medicaid program covers about 1.3 million people; about 600,000 of them are children, and nearly 450,000 of the total are covered the expansion. Each month, tens of thousands of Kentuckians go on and off the program as they gain or lose eligibility.

“On any given day, most Kentuckians are simply a lost job, reduced work hours, a new baby, an accident or an illness away from qualifying for programs like Medicaid,” Beauregard said. “That’s why we call it a safety net.”

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