Kentucky Gov. Matt Bevin has unveiled his proposal to move the state into a more conservative expansion of Medicaid.
Seeking public comment, Bevin, a Republican, posted a waiver request (PDF) regarding the plan, known as Kentucky HEALTH, on the state's Medicaid website. Bevin's plan mimics Indiana's expansion effort. Bevin said he is pursuing the waiver now because the state will begin to pay for its expansion enrollees in January.
Bevin's predecessor, Democrat Steve Beshear, announced his intention to expand Medicaid in May 2013, and coverage kicked in for newly eligible individuals Jan. 1, 2014.
Under the Affordable Care Act, the federal government is paying 100% of the healthcare costs of newly eligible Medicare recipients through calendar year 2016. That support will then begin to decrease, eventually hitting 90% by 2020.
An estimated 1.2 million people would be moved into the Kentucky HEALTH program. Paying for expansion is expected to cost Kentucky taxpayers approximately $2.2 billion for fiscal years 2017 through 2021. Bevin estimated the state will save that same amount if his waiver is approved within five years of its implementation.
Under Kentucky HEALTH, enrollees will make a monthly payment ranging from $1 to $15 depending on income. Pregnant women and children will be exempt from cost-sharing.
To encourage healthy behaviors, the waiver calls for the creation of a rewards account that may be used to access such enhanced benefits as dental, vision and over-the-counter medications, as well as some limited reimbursement for the purchase of gym memberships.
Members can accrue funds in their account safter completing health-related activities such as taking a disease management class or community engagement activities like volunteering or job training.
Funds will be withdrawn from the account each time a member utilizes a hospital emergency department for a nonemergency condition.
If a person above the poverty level does not pay their premium in 60 days, they will be kicked out of coverage for six months . A beneficiary can return to the program earlier if they pay two months of missed premiums and make one new premium payment. The individual also must complete a financial or health literacy course.
If an enrollee falls below the poverty level, they must make co-payments and their rewards account may be suspended, cutting off access to dental and vision benefits.
Kentucky also seeks to eliminate retroactive coverage for Medicaid beneficiaries. Under current Medicaid rules, eligibility begins the day an application is submitted, assuming the applicant is ultimately deemed to qualify for benefits. Providers can also bill for services performed in the preceding three months, assuming the patient met eligibility rules during that time.
Under the waiver, eligibility would not begin until a Medicaid application is approved. The state also seeks to avoid providing nonemergency transportation to beneficiaries.
Kentucky has posted the waiver for a 30-day public comment period. The state hopes to secure approval by Sept. 30, allowing it to implement the program in spring 2017.
