Kentucky's new Republican Gov. Matt Bevin is under fire from healthcare providers and patients for proposing that Medicaid expansion beneficiaries be required to participate in job training, community service or wellness activities to continue receiving dental and vision care coverage.
Beyond that, specified employment and “community engagement” activities would be required as a condition of eligibility for all “able-bodied,” working-age adults in the Medicaid expansion program.
At a public hearing Wednesday in Frankfort, Bevin's deputy chief of staff, Adam Meier, said the governor's complex 69-page plan to modify the state's Medicaid expansion program would let beneficiaries earn the right to dental care, according to the Lexington Herald-Leader. Meier reportedly drew groans from the audience when he said that filling out a personal health questionnaire online “would be enough to pay for three fillings and a tooth extraction.”
Beneficiary A.J. Jones responded that he didn't think that was right. “I don't think it's dignified to have to pick up trash on the side of the road to have a tooth pulled,” he told Bevin's aides.
The politically influential Kentucky Optometric Association said it intends to file written objections to the governor's plan during the 30-day public comment period. Richmond optometrist Dr. Matt Burchett noted that 15% of diabetics are first diagnosed during optometry exams. “We are concerned that these changes will limit patient access and will actually increase cost when patients miss their preventative care,” he testified.
Dentists also testified against the plan, with one pointing out that Medicaid saves more than $700 by paying him to pull a tooth rather than having the patient go to a hospital emergency room. Some speakers argued that limiting dental coverage makes no sense in a state with some of the worst oral health in the country. “We're No. 1 in toothlessness so we're not going to provide dental care for those who need it the most?” asked Chris Keyser, executive director of the Fairview Community Health Center in Bowling Green, during a public hearing in that city.
But officials from the Kentucky Hospital Association and Baptist Health spoke in favor of Bevin's Medicaid waiver request to the Obama administration, which is partly modeled on Indiana's Medicaid waiver program. Hospitals are eager to see the expansion continue even with the proposed changes. That's because the state's Affordable Care Act Medicaid expansion, launched over Republican opposition by Bevin's Democratic predecessor Steve Beshear, has sharply reduced uncompensated care. It has enrolled nearly 440,000 low-income adults, helping slash the state's uninsured rate from about 20% to 7.5%.
Bevin, who before he was elected favored repealing the Medicaid expansion, has said the goal of his waiver proposal is to encourage people to make more responsible choices and transition people to commercial and employer-sponsored coverage. He has called for beneficiaries to have more "skin in the game," though one critic said his proposal would "scrape a pound of flesh from Kentuckians."
The plan includes premiums of $1 to $15 a month based on income, a six-month lock-out for people who don't pay, and a work requirement for some “able-bodied” adults.
Beneficiaries would use a rewards account to pay for dental and vision services by earning credits for participating in specified health-related or “community engagement” activities such as job training or community service. But they would lose credits from their account whenever they used a hospital emergency department for a non-emergency condition.
In addition, the plan would eliminate coverage of non-emergency medical transportation for the adult expansion population, which providers say would reduce many low-income patients' access to care.
No other state including Indiana has conditioned dental and vision care coverage on participation in job-related or other activities, though Indiana offers those benefits only to Medicaid expansion beneficiaries who pay their premiums.
The Obama administration so far has not approved any state requests to tie Medicaid expansion coverage to work-related activities. But administration officials may be concerned about Bevin's threat to eliminate the entire expansion program if his plan is not approved.
Republican leaders in the U.S. House proposed last week to allow states to establish work requirements for low-income, non-disabled adults a condition for receiving Medicaid expansion coverage, without the need for seeking federal waiver approval.
Bevin's proposal “is attempting to turn Medicaid into a jobs program without creating any jobs,” Emily Beauregard, executive director of Kentucky Voices for Health, told the Louisville Courier-Journal.