Ky. is first state al­lowed to im­pose Med­i­caid work rules


A day af­ter the Trump ad­min­is­tra­tion an­nounced that it would al­low states to com­pel poor peo­ple on Med­i­caid to work or get ready for jobs, fed­eral health of­fi­cials on Fri­day granted Ken­tucky per­mis­sion to im­pose those re­quire­ments.

Be­com­ing the first state to move for­ward with the pro­found change to the safety-net health in­sur­ance pro­gram is a vic­tory for Ken­tucky’s Repub­li­can gover­nor, Matt Bevin, who dur­ing his 2015 cam­paign for of­fice vowed to re­verse the strong em­brace of the Af­ford­able Care Act by his Demo­cratic pre­de­ces­sor.

Bevin first pledged to undo the state’s ex­pan­sion of Med­i­caid, which had helped to shrink the ranks of unin­sured Ken­tuck­ians more than in al­most any other state. Bevin then piv­oted to the idea of keep­ing the ad­di­tional peo­ple in the pro­gram — with strings at­tached that the fed­eral govern­ment had never per­mit­ted in Med­i­caid’s half-cen­tury his­tory.

The fed­eral Cen­ters for Medi­care and Med­i­caid Ser­vices an­nounced early Fri­day af­ter­noon that it had ap­proved a “waiver” — that is, the state’s ap­pli­ca­tion to ex­per­i­ment with changes to Med­pol­i­tics icaid’s usual rules. At a news con­fer­ence at the capi­tol in Frankfort, Bevin said that state agen­cies will phase in the “com­mu­nity en­gage­ment and em­ploy­ment ini­tia­tive” in dif­fer­ent parts of the state from July to Novem­ber.

The gover­nor said the changes will be “trans­for­ma­tional . . . in good ways and pow­er­ful ways.” He ar­gued that help­ing peo­ple find work will lead them out of poverty and govern­ment de­pen­dence, ul­ti­mately im­prov­ing Ken­tuck­ians’ sub­par health sta­tus.

“Why should a work­ing-age per­son not be ex­pected to do some­thing in ex­change for what they are pro­vided?” Bevin said.

He fo­cused in par­tic­u­lar on the ACA’s ex­pan­sion pop­u­la­tion, re­peat­edly call­ing them peo­ple “for whom Med­i­caid was not orig­i­nally de­signed.” Bevin has been one of many Repub­li­can gov­er­nors con­tend­ing that their state bud­gets can­not af­ford the ex­tra ben­e­fi­cia­ries, even though fed­eral money cov­ers the vast ma­jor­ity of the ex­pense. While Ken­tucky of­fi­cials pre­vi­ously said the changes would rein in Med­i­caid costs, Bevin on Fri­day sug­gested that in­creases in job-train­ing ef­forts might off­set any sav­ings from fewer Med­i­caid ben­e­fi­cia­ries.

Since Ken­tucky ex­panded Med­i­caid un­der the ACA four years ago, to in­clude peo­ple with in­comes of up to 138 per­cent of the fed­eral poverty level, nearly half a mil­lion newly el­i­gi­ble res­i­dents have joined the pro­gram.

Brief­ing re­porters, aides to the gover­nor es­ti­mated that about half of 350,000 able-bod­ied, work­ing-age Med­i­caid re­cip­i­ents sub­ject to the “com­mu­nity en­gage­ment” re­quire­ment al­ready meet its terms to work at least 80 hours per month, vol­un­teer or be in job train­ing. In­di­vid­u­als will need to send doc­u­men­ta­tion to prove their com­pli­ance.

Those who do not will re­ceive a 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.

When the state first ap­plied for fed­eral per­mis­sion in 2016, it pro­posed that “com­mu­nity en­gage­ment” grad­u­ally in­crease to 80 hours a month over the first year. Of­fi­cials later al­tered their ap­pli­ca­tion to re­quire 80 hours from the be­gin­ning, say­ing that the re­quire­ment aligned with rules for peo­ple on wel­fare or the Sup­ple­men­tal Nu­tri­tion As­sis­tance Pro­gram, as food stamps are now called.

The coun­try’s first work re­quire­ment ap­plies to Ken­tucky res­i­dents who joined Med­i­caid un­der the ACA, as well as tra­di­tional Med­i­caid ben­e­fi­cia­ries who are not pregnant and not pri­mary care­tak­ers.

The re­quire­ment is among sev­eral changes that the CMS is al­low­ing Ken­tucky to adopt. They in­clude a sys­tem that will re­quire some peo­ple in the pro­gram to make small monthly pre­mium pay­ments, in­cen­tives to adopt healthy be­hav­iors and dif­fer­ent ben­e­fits pro­vided to cer­tain groups.

Once the changes take ef­fect, the pro­gram can lock out for six months peo­ple above the fed­eral poverty line who fail to pay re­quired pre­mi­ums or who do not reap­ply in time to de­ter­mine whether they re­main el­i­gi­ble. Peo­ple also can be pe­nal­ized if they do not promptly re­port any changes in their in­come.

One aide to Bevin said the state’s Med­i­caid rolls are fore­cast to be re­duced by about 95,000 peo­ple by the end of the five years that the CMS granted for this ex­per­i­ment. He did not say how many of those in­di­vid­u­als would lose el­i­gi­bil­ity vs. no longer need­ing the pro­gram.

Crit­ics of the Trump ad­min­is­no­tice tra­tion’s move had vowed to sue once the first state waiver was granted, con­tend­ing that work re­quire­ments vi­o­late the ob­jec­tives of the vast in­sur­ance pro­gram cre­ated in 1965 as a ma­jor ad­vance in ac­cess to care for the na­tion’s poor.

Leonardo Cuello, health pol­icy di­rec­tor at the Na­tional Health Law Pro­gram, said that the plan ap­proved by the CMS “will harm thou­sands upon thou­sands Ken­tuck­ians and con­tains nu­mer­ous vi­o­la­tions of the Med­i­caid statute” and that the or­ga­ni­za­tion “is very, very care­fully con­sid­er­ing tak­ing le­gal ac­tion.”

Brad Wood­house, di­rec­tor of Pro­tect our Care Cam­paign, a pro-ACA group in which many alumni of the Obama ad­min­is­tra­tion are in­volved, said that the fed­eral agency’s de­ci­sion “marks not just a shift in pol­icy, but a shift in the fun­da­men­tal de­cency of the United States. . . . Chang­ing Med­i­caid will do noth­ing to help Amer­i­cans find jobs. It will merely take away their health care.”

Bevin re­jected such crit­i­cism, call­ing the CMS’s ap­proval “a sig­nif­i­cant mile­stone on our jour­ney to lead the na­tion in trans­form­ing Med­i­caid in a fis­cally re­spon­si­ble way.”


Ken­tucky Gov. Matt Bevin on Fri­day an­nounces fed­eral ap­proval for Ken­tucky to use a work re­quire­ment for Med­i­caid ben­e­fi­cia­ries.

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