Ky. submits Medicaid waiver with controversial work requirements

Kentucky Gov. Matt Bevin submitted a waiver request to the CMS outlining a conservative vision of Medicaid expansion that includes requirements for most beneficiaries to participate in job training or community service.

The waiver is similar to one used by Indiana, which the CMS is analyzing to see if it has been harmful to beneficiaries.

Kentucky Health would require able-bodied adults without dependents to participate in job training and community engagement such as volunteer work to remain eligible. The hours required would increase with the months of eligibility, reaching 20 hours per week after one year.

The waiver request outlines a program that would require monthly premiums ranging from $1 to $15 and includes two health savings accounts. One is for the $1,000 deductible, and the other is a rewards account that could be used for dental and vision services as well as some over-the-counter medicines and gym memberships. Those who are above the poverty level and miss two months of payments would be disenrolled from the program and required to sit out for six months. Those below the poverty level would pay copays and will have their rewards accounts suspended after 60 days of nonpayment. There are options for early re-entry if the debt is paid and the beneficiary takes a financial or health literacy course.

The proposal claims the current Medicaid expansion is unsustainable and is not resulting in better health outcomes. It estimates a savings of $2.2 billion over the five-year waiver period.