Will thousands of Kentuckians lose health care coverage as a result of the state’s recently re-approved Medicaid waiver, or will many of the low-income participants “graduate” to greener pastures?
State health official Adam Meier promoted the latter possibility Tuesday as some legislators expressed concerns about the risk of many Medicaid recipients falling through the cracks because of the state’s Section 1115 waiver, Kentucky HEALTH.
During a legislative committee meeting, state Rep. George Brown, D-Lexington, called the state’s previous estimate of 95,000 people losing coverage over the course of five years “problematic,” noting, “We have to be concerned with what happens to them.”
Meier, who is secretary of the Kentucky Cabinet for Health and Family Services, quibbled with the term “losing,” saying that it was a misconception and that some people would instead be graduating from the program.
“If we can move more people to private market insurance coverage, that’s a good thing,” Meier told the Interim Joint Committee on Health and Welfare and Family Services. “And that’s what this waiver is designed to do.”
The U.S. Centers for Medicare & Medicaid Services approved Kentucky HEALTH right before Thanksgiving. The program initially had been approved by the Trump administration in January but was sidetracked by a court challenge from more than a dozen Medicaid recipients, who argued that the waiver would jeopardize the health coverage of tens of thousands of people.
Tuesday, legislators questioned Meier about various aspects of the program, including the number of people who would be affected. The program, which could face another court challenge, will require some Medicaid recipients to complete 80 hours a month of work or other acceptable “community engagement” to keep their benefits. Other features include premiums and a My Rewards account to earn virtual dollars for things like routine dental and vision coverage.
The program is expected to start April 1, with the work requirement being phased in regionally. That requirement is most likely to start in Northern Kentucky, Meier said, but the state is continuing to work with area officials to finalize the rollout across the state.
Although Kentucky has a total Medicaid enrollment of about 1.4 million, half a million are enveloped in the waiver and an estimated 165,000 will be impacted by community engagement, “after you take away the exemptions,” Meier testified.
When initially asked by Brown how many people might lose coverage, Meier said, “I don’t have a crystal ball as far as how many people will lose coverage.” He also noted that the state has worked with CMS to make sure there are exemptions and exceptions, covering certain people, such as domestic violence survivors.
“A large part of what we’ve done with CMS in our negotiations is really finding ways to mitigate any unnecessary interference with people’s ability to have access to care,” Meier said. “The same people that have access today will have access post-implementation.”
Meier said having Medicaid recipients move to private insurance would be “good for our ecosystem of providers.”
He also noted that having a paying customer is better for the bottom line of hospitals and physicians.
However, Brown said coverage should not be based on that. “I would hope that we would keep our eye on the ball as we move into the 2019 session and beyond that we’re concerned about providing service to the most vulnerable people in the commonwealth.”
State Rep. Joni Jenkins, D-Shively, asked whether any lessons had been learned from other states, such as Arkansas, where more than 12,000 people recently lost coverage after a work requirement was implemented.
Meier and Deputy Secretary Kristi Putnam said there were differences between Arkansas and Kentucky’s programs and that more data was needed to truly know what happens to people and whether their circumstances improve several months out.
“I think it’s important that we maybe hold our collective analysis until we have a little bit better data to analyze what’s happening and then use that data in a way that’s constructive to inform policy and outreach and those sorts of things,” he said.
During the meeting, a legislator questioned Meier about how the state would be avoiding confusion with dental and vision providers so that people wouldn’t be turned away. After partly blaming the media, Meier said he would encourage providers who have “an issue or confusion to contact the Cabinet.” He also said providers would continue to be offered training on how to read any new screens.