“These are really basic things, folks. If you can’t see, it’s really hard to work. If you can’t hear the instructions that you’re getting, it’s really hard to work. If you have massive dental problems that are creating major pain or other complications, it’s really hard to work.. . . Today, we’re announcing that for many Kentuckians, we’re removing the roadblocks that they face in accessing dental, vision and hearing care.”
Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, told the Louisville Courier Journal that federal funds would cover 90% of the estimated $36 million annual cost for the expansion, with the state covering the rest. She added that the state’s move to one pharmacy benefit manager last year “has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward.”
Medicaid is a state-federal program that provides health insurance for low-income adults and pregnant women, the disabled, and families with incomes at or below 138% of the federal poverty level, which amounts to about $18,700 per year for an individual or $38,200 for a family of four. Youth 21 and under who are enrolled in Medicaid already qualify for dental, vision and hearing services.
Kentucky adults on Medicaid already have access to some dental and vision benefits; the hearing benefits are very limited. Starting on Jan. 1, those benefits will be greatly expanded.
For example, the only dental services Medicaid now covers for adults are an annual cleaning a year and extractions based on certain medical conditions. Dunlap said fillings are not covered for adults, but the expansion will add coverage for fillings, dentures, implants, root canals, extractions, restorations, periodontics and an additional cleaning each year.
Dunlap said the new hearing benefits will cover screening tests and hearing aids for adults. Now an adult can be evaluated only if they had a referral from their primary doctor.
The vision changes will cover eyeglasses and contacts for adults. Now, vision exams are covered by Medicaid, but glasses and contact lenses are not.
Managed-care organizations, which provide care for Kentuckians on Medicaid, were already offering some of these services as extra benefits to incentivize beneficiaries to choose their company.
Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded Beshear’s decision to expand benefits, noting the value of employment as one of the most important “social drivers of health.”
“All of the data shows that when you work, you’ve got a much better chance of having good health,” he said. “So, it’s a circular thing. You have to have good health to be able to work and you have to be able to work to have good health.”
One of the challenges that people on Medicaid already have when it comes to getting dental care is that there aren’t enough dentists who will accept Medicaid insurance, mainly because the rates are so low.
Asked about this, Beshear said, “We are going to have to make sure that there is access all across Kentucky,” he said. “When you think of health care, it has to be affordable. . . . So it’s going to be hard work. We’re going to see what those barriers are, but it’s about commitment and being intentional to make sure we get health care to those folks. “
Dunlap said Kentucky is submitting the state Medicaid plan amendment to make these changes to the Centers for Medicare and Medicaid Services and that they do not anticipate any issues with approval.
Open enrollment for Medicaid members runs through Dec. 1 for coverage beginning Jan. 1. Medicaid open enrollment gives Medicaid members a chance to change the insurance company that manages their care. Medicaid members who chose to not participate in open enrolment will keep the same managed care organization, or MCO, that they are currently enrolled in.