Kentucky seeks stricter work requirements for Medicaid enrollees
After nearly a year of negotiations, Kentucky Gov. Matt Bevin has submitted an amended Medicaid waiver request to the CMS that proposes a stricter work requirement than the state originally requested.
The waiver, first submitted in August 2016, has been largely criticized by advocates who say the proposed changes would harm access to care.
The 1115 waiver, named Kentucky Health, would require able-bodied adults without dependents to work or participate in job training or community engagement such as volunteering for at least five hours a week, gradually increasing to 20 hours a week after a year.
On Monday, Bevin submitted a series of alterations to the request. The waiver would eliminate the proposed ramp-up period for the work requirement, mandating that beneficiaries work at least 20 hours per week to qualify for coverage.
This change mirrors Kentucky's current policy for residents receiving food stamps.
Bevin also suggested locking beneficiaries out of coverage for up to six months if they obtain a new job or salary and don't alert the state so that it can confirm the person is still eligible for the Medicaid program.
Bevin said the policy would be a learning tool for Medicaid beneficiaries to maintain accurate information to qualify for insurance coverage, which will prepare enrollees for commercial market insurance policies.
But some experts disagree with Bevin's proposal. Dustin Pugel, a research and policy associate for the Kentucky Center for Economic Policy, told reporters Monday that the change will cause more people to lose their Medicaid coverage because many of the people on Medicaid have jobs with variable income, including retail, restaurant and construction jobs. If those people fail to notify the state of their frequent changes, they could lose coverage.
Bevin estimates that these and other administrative changes suggested Monday will result in Kentucky Health saving $2.4 billion in federal and state dollars over a five-year waiver period, more than the $2.2 billion in savings stemming from the original waiver.
Several other states, including Arizona, Arkansas, Indiana, Maine and Ohio are considering implementing work requirements.
The CMS and Kentucky will conduct their comment periods simultaneously for the waiver amendment, a controversial policy first implemented for Indiana's recent request to amend its pending 1115 waiver and add a work requirement.
Typically, states have had their own comment periods and made changes to their requests based on the feedback they receive before the CMS conducts its own comment period.
Legal experts have questioned the ability for either a state or the CMS to make this change as it seems to weaken the ability for the public to weigh in on proposed changes.
Kentucky and the CMS will collect public comments simultaneously through Aug. 2.
The CMS has already received nearly 1,800 comments on Kentucky's original waiver. Many were critical of the work requirement and its impact on access to care.
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