Kentucky rushes to remake Medicaid
LOUISVILLE, Ky. — With approval from the Trump administration fresh in hand, Kentucky is rushing to roll out its first-inthe-nation plan to require many Medicaid recipients to work, volunteer or train for a job — even as critics mount a legal challenge to stop it on the grounds it violates the basic tenets of the program.
At least eight other Republican-led states are hoping to follow — a ninth, Indiana, already has won permission to do so — and some want to go even further by imposing time limits on coverage.
Such restrictions are central to Republican efforts to profoundly change Medicaid, the safety net program that has provided free health insurance to tens of millions of lowincome Americans for more than 50 years. The ballooning deficits created by the budget deal President Donald Trump signed into law Friday and the recent tax bill are likely to add urgency to the party’s attempts to wring savings from entitlement programs.
House Speaker Paul Ryan, R-Wis., said Thursday that addressing entitlement spending is “what you need to do to fully deal with this debt crisis,” though Sen. Mitch McConnell, R-Ky., the majority leader, said he has ruled out doing so this year.
As Kentucky pushes forward, many who work with the poor are worried the thicket of new documentation requirements in Medicaid will be daunting for low-income people, who may have little education and struggle with transportation, paying for cellphone minutes and getting access to the internet. The new rules also will add the type of administrative costs and governmental burdens Republicans tend to revile.
On a recent rainy Monday, Bill Wagner, who runs primary care clinics in poor neighborhoods here, listened tensely as a state health official explained how the state would enforce the complex and contentious new rules.
The 20 hours a week of work, job training or volunteering? Ten regional workforce boards will monitor who complies, said the official, Kristi Putnam.
The monthly premiums of $1 to $15 that many will now owe? The managed care companies that contract with the state will collect them.
The “rewards dollars” that many will need to earn to get their teeth cleaned or their vision checked? They’ll be tracked through a new online platform, where Medicaid recipients also will be expected to upload their work, volunteer or training hours.
“I know it sounds a little bit complicated,” Putnam conceded as the group meeting with her, which has overseen efforts to enroll Louisville residents in health insurance in the Obamacare era, jotted notes. Someone heaved a sigh.
After four years of signing up thousands of people for coverage under the health law’s expansion of the Medicaid program, Wagner told the room, “We’re shifting our focus from helping people gain coverage to helping people keep it.”
The rationale of Gov. Matt Bevin and other supporters is Medicaid was created for the most vulnerable citizens — those who aren’t only poor, but pregnant, elderly, children or disabled — and for everyone else, working or engaging in their community will provide dignity and better health. About 500,000 Kentuckians have joined the Medicaid rolls under the Obamacare expansion, and the state estimates some 350,000 will be subject to the new work rules.
While the work requirement is unprecedented in the history of Medicaid, Wagner and others said they’re just as concerned about other new, confusing rules. For example, many adults who don’t pay their small premiums can be locked out of Medicaid for six months, unless they complete a financial or health literacy course. Others will lose access to dental and vision care.