Kentucky Gov. Matt Bevin on Wednesday 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. A state-funded analysis released in July found problems and successes with the program.
Bevin campaigned on his opposition to Medicaid expansion, which was implemented by his Democratic predecessor, Steve Beshear. The waiver states the program “represents the terms under which the Commonwealth will continue Medicaid expansion."
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 five-year 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.
Money for the rewards account is earned through community engagement, job training, wellness activities and proper emergency room usage. In public hearings on the proposal, optometrists and dentists in particular opposed the plan and argued it would limit access and increase costs.
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 will be required to 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.
Judith Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, argued in a blog post that evidence shows Indiana's plan, after which Kentucky's is modeled, has excluded some eligible beneficiaries and kept some who are enrolled from getting the services they need.
She also said Kentucky's health outcomes have been improving, although change will take time.
“Contrary to what Gov. Bevin says, increased coverage has already produced better health among Kentuckians, and CMS should not allow changes that would keep people from enrolling in coverage or getting the health care services they need,” she wrote.