‘It’s not about losing coverage, it’s about having fewer members enrolled in Medicaid,’ state health secretary says of new plan

Health Secretary Adam Meier and Deputy Health Secretary Kristi Putnam speaking about the state’s new Medicaid plan, Kentucky HEALTH

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By Melissa Patrick
Kentucky Health News

The administration of Gov. Matt Bevin changed very little in the Medicaid plan that was recently re-approved by the Trump administration, which means “able-bodied” members of the program will soon have to work or participate in certain activities 80 hours a month to keep their health insurance.

The new plan, called Kentucky HEALTH for “Helping to Engage and Achieve Long Term Health,” also includes premiums, deductibles or co-payments, strict reporting requirements and lock-outs for non-compliance. It is tentatively set to start April 1, with the work rules and other community-engagement options to be phased in regionally.

Kentucky HEALTH will largely affect the nearly 500,000 Kentuckians who have gained health coverage through the 2014 expansion of the program to those who earn up to 138 percent of the federal poverty line ($16,653 for an individual). Kentucky has about 1.4 million people on Medicaid, but only 165,000 are expected to come under the community-engagement requirements.

Health Secretary Adam Meier told the legislature’s Joint Committee on Health and Welfare and Family Services Nov. 27 that the community-engagement rules will likely roll out in Northern Kentucky first, as was scheduled before a federal judge blocked the previous version of the plan.

On June 29, two days before the rollout was to start, District Judge James Boasberg of Washington, D.C., sent then plan back to the U.S. Department of Health and Human Services for review, ruling that, among other things, HHS Secretary Alex Azar had not fully considered the state’s projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

Asked if there was a chance it could be blocked again, Meier said, “There’s always a chance.”

After the committee meeting, Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the lawsuit on behalf of 16 Kentucky Medicaid recipients, said they were working on amending their complaint. “It’s hard to expect a different result with everything the same,” Stewart said.

During the meeting, several Democrats on the committee voiced concerns that thousands of Kentuckians could lose their health coverage because of the new Medicaid rules.

Rep. George Brown, D-Lexington, asked Meier exactly how many people were expected to lose coverage as a result of these new requirements.

Meier said he didn’t have a “crystal ball” to determine that number, but assured him that the state has worked “diligently” with the Centers for Medicare and Medicaid Services to provide appropriate exemptions and to protect Kentuckians from any unintended consequences that could occur under the new rules.

“The same people that have access today will have access post-implementation,” Meier said.

Brown noted the importance of keeping track of the numbers of Kentuckians who might fall through the cracks under the new plan. He said, “The 95,000 prospective citizens that are going to lose health care coverage is problematic. I think we have to be concerned with what happens with them.”

Meier took issue with the term “losing coverage,” saying, “It’s not about losing coverage, it’s about having fewer members enrolled in Medicaid. . . . If we can move more people to private-market insurance coverage, that’s a good thing. And that’s what this waiver is designed to do.”

Rep. Mary Lou Marzian, D-Louisville, noted that many Kentuckians who will be affected by Kentucky HEALTH are already working, but their employers don’t offer health insurance. She asked what jobs were available for them to move to that offered health insurance.

Meier said that while many are expected to move to higher paying jobs that offer health insurance, others will move to higher paying jobs that will price them out of Medicaid and into what is called a qualified health plan on the federal exchange, otherwise known as Obamacare.

A Kentucky Center for Economic Policy report shows that between 1980 and 2016 the percentage of Kentucky employees getting health insurance at work dropped from 80 percent to 54.5 percent respectively.

Meier said that in the last five to six months, Kentucky has seen an enrollment decline of “probably around 41,000” and attributed this to an improving economic climate. “The number one reason that people are not enrolling is because they are making too much income,” Meier said after the meeting.

Meier was referring to a decline from 1,434,024 members in May to 1,392,293 in September. Most of that drop, 21,508 occurred from May to June. From September 2017 to September 2018, overall enrollment dropped by 35,571, or 2.5 percent, from about 1.43 million to about 1.39 million. Expansion enrollment, which would be much more sensitive to improvements in the economy like those Meier mentioned, dropped 5.26 percent during the period.

After the meeting, Meier assured reporters that the health cabinet will be conducting a “robust evaluation” of what happens to Medicaid beneficiaries on the new plan, including tracking of labor and wage data, reasons for disenrollment, enrollment in federally subsidized insurance, and qualitative interviews.

Rep. Joni Jenkins, D-Shively, asked what Kentucky has learned from other states, like Arkansas, where more than 12,000 people have lost Medicaid coverage since the state implemented its work requirements in June.

“We’re in a little different situation than Arkansas,” Meier said. “They had utilized existing infrastructure and they operationalized very quickly. In Kentucky, we’ve been planning for several years now how to operationalize this.”

In addition, Meier said it’s not yet clear why Arkansas Medicaid recipients lost their coverage and that it’s important to “hold our collective analysis until we have a little bit more better data to analyze what’s happening and then use that data in a way that is constructive to inform policy and outreach.”

Deputy Health Secretary Kristi Putnam said Medicaid members will get information about the new plan 30 days before any changes in their benefits, and that information will be posted on social media and a Cabinet for Health and Family Services website. The cabinet is working with various community partners, including the Foundation for a Healthy Kentucky, to push the information.

In addition to Arkansas and Kentucky, HHS has approved Medicaid work requirements in Indiana, New Hampshire and Wisconsin, with approvals pending for Alabama, Arizona, Kansas, Maine, Michigan, Mississippi, Ohio, South Dakota and Utah.