Bevin submits updated Medicaid plan to federal government

08/24/2016 02:14 PM

After some tweaking Gov. Matt Bevin, R-Kentucky, has submitted his Medicaid waiver plan to the federal government, but not everyone is on board with the proposal.

The waiver, known as Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) was sent to the Secretary of the Department of Health and Human Services, Sec. Sylvia Burwell on Wednesday — and reflects changes to the proposal after a public comment period.

Among the changes to the proposal include allergy testing and private duty nursing will continue to be covered services. The start of changes to the dental and vision benefit will be delayed by three months. The delay is intended to allow those on the program to “accrue funds in their My Rewards Account.”

People determined to be “medically frail” will be exempt from required premiums and co-payments. There will also be addition “activities” which will result in contributions to the rewards account. The rewards activities include: caretaking, passing a college equivalency exam and ensuring children receive recommended preventative services, like immunizations.

Another change included in the waiver is the sliding scale used to calculate premiums will be now based on household income and not individual income.

“The submission of this waiver is the result of many months of extensive research, planning and time spent traveling the state listening to Kentuckians,” said Gov. Bevin in a press release. “Kentucky HEALTH will allow us to continue to provide expanded Medicaid coverage, but unlike the current Medicaid expansion under Obamacare, it will do so in a fiscally responsible manner that ensures better health outcomes for recipients.”

Republican state Sen. Julie Raque Adams, the chair of the Senate Health and Welfare Committee, and Sen. Ralph Alvarado, the co-chair of the committee, issued a joint statement applauding Bevin’s plan.

“The current Medicaid model in Kentucky is broken,” the pair said. “If we continue down this unsustainable path, many Kentuckians will lose their healthcare coverage and we will have less state dollars to fund education and fix pension systems.

“The waiver proposed by Governor Bevin is a common-sense approach to keep Kentuckians covered and become personally engaged in their own health,” the statement continued. “This waiver promotes accountability and provides a pathway to private insurance.”

Not everyone agreed Bevin’s plan would hit the mark for vulnerable Kentuckians.

Dr. Terry Brooks, the executive director for Kentucky Youth Advocates, said he was pleased with some of the changes Bevin made, but indicated there’s more work to do to make the proposal acceptable.

“The final waiver also included several additional options for individuals to gain rewards in their My Rewards Account through activities we recommended, such as a parent taking a child to the doctor for a well-child exam,” Brooks said.

“However, we still have major concerns about how the final 1115 Medicaid Waiver will negatively impact many parents and, as a result, impact their children as well,” Brooks continued. “We are concerned that certain populations of families such as kinship families are not exempt from cost-sharing and other lockout periods. We are concerned that the lowest income individuals (those under 100% of the federal poverty level) are still subject to copayments or premiums they likely cannot afford to pay.

“We are concerned that individuals without job growth potential will not be able to pay increasing monthly premiums throughout the five-year period of the waiver. We are concerned that vision and dental services are considered an earned benefit rather than services covered in a standard benefit package.”

Brooks wasn’t the only one to raise concerns, Jason Bailey of the left leaning think tank Kentucky Center for Economic Policy, said the plan still contains poison pills which were pointed out months ago.

“The administration submitted a plan that is fundamentally the same as the problematic proposal they released a few months ago, with only minor changes. It contains work requirements, lockout periods, premiums and other barriers that will reduce the number of Kentuckians getting coverage and move us backward on our nation-leading health progress,” Bailey said. “It continues to include measures that HHS has rejected in multiple other states for that reason.”

The Center for Medicare and Medicaid Services now has 15 days to acknowledge that the waiver has been submitted correctly. There will then be a 30-day federal comment period similar to the public comment period Kentucky recently conducted, according to the Governor’s Office.

Brooks encouraged CMS to address his concerns with the new proposal during negotiations with the Bevin Administration.

“We encourage the public to submit comments to CMS during the open comment period and highlight these outstanding concerns,” he said. “And, we encourage the Bevin Administration to work with CMS to come to an agreement on an 1115 Medicaid Waiver that can move forward in a way that works for Kentuckians, helps improve health outcomes, and is sustainable.”


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