Kentucky first to win approval for Medicaid work requirement

FRANKFORT, Ky. — Kentucky has become the first state to require many of its Medicaid recipients to work to receive coverage, part of an unprecedented change to the nation’s largest health insurance program under the Trump administration.

The Centers for Medicare and Medicaid Services announced the approval on Friday. The change will require adults between the ages of 19 and 64 to complete 80 hours per month of “community engagement” to keep their coverage. That includes getting a job, going to school, taking a job training course or community service.

The decision marks a dramatic shift for Kentucky, which embraced former President Barack Obama’s Affordable Care Act under its last governor, a Democrat,

and won praise for posting some of the largest gains in getting its residents insured.

Republican Gov. Matt Bevin, who was elected in 2015 and vowed during his campaign to reverse the strong embrace of the Affordable Care Act, said Friday that the state consistently ranks near the bottom of the country in health outcomes.

“The idea we should keep doing what we are doing is an insult to the people of Kentucky,” Mr. Bevin said, adding that while more Kentuckians have insurance, it is not making them healthier.

In its application to Washington for a so-called 1115 waiver, Mr. Bevin’s office said the new rules will apply to about 350,000 Kentuckians, about half of whom already have jobs.

Mr. Bevin expects the changes to save the state more than $300 million over the next five years. But he also estimated as many as 95,000 people could lose their Medicaid benefits, either because they did not comply with the new rules or because they make to much money.

“It will be transformational,” Mr. Bevin said at a news conference. “Something we have not seen in America in a quarter century .”

Kentucky, along with the rest of Appalachia, still falls behind the rest of the country in 33 out of 41 population health indicators, according to a recent study. Mr. Bevin said he believes his program, with its emphasis on work and community service, will encourage people to be healthier.

“There is dignity associated with earning the value of something that you receive,” Mr. Bevin said. “The vast majority of men and women, able-bodied men and women ... they want the dignity associated with being able to earn and have engagement.”

Kentuckians subject to the work requirement will need to send documentation to prove their compliance. If they do not, they will receive a notice after a month, then be given one more month to “cure” their violation. After that, their benefits will cease until they prove they have begun following the rules.

Advocates for the poor have said work requirements will become one more hoop for low-income people to jump through, and many could be denied needed coverage because of technicalities and challenging new paperwork.

Lawsuits are expected as individual states roll out work requirements.

Mr. Bevin has dubbed the new program Kentucky Helping to Engage and Achieve Long Term Health, or Kentucky HEALTH. It is expected to begin in July.

“Overall, CMS believes that Kentucky HEALTH has been designed to empower individuals to improve their health and well-being,” CMS Principal Deputy Administrator Demetrios L. Kouzoukas wrote in a letter announcing the change.

Democratic U.S. Rep. John Yarmuth called the changes “dangerous and irresponsible.”

“The Trump administration has agreed to end health coverage for 95,000 Kentuckians,” Mr. Yarmuth said. “Make no mistake: People will die because of this.”

Created in 1965 for families on welfare and low-income seniors, Medicaid now covers more than 70 million people, or about 1 in 5 Americans.