Concerns about premiums, loss of dental and vision coverage for expansion population aired at Medicaid waiver hearing

06/29/2016 09:07 PM

FRANKFORT — An overflow crowd gathered in the Capitol Annex Wednesday afternoon to voice either their support or concerns with Gov. Matt Bevin’s administration’s proposed Medicaid waiver program, Kentucky HEALTH, that will go before the Centers for Medicaid and Medicare Services on Aug. 1.

The meeting also included the Advisory Council for Medical Assistance, which asked Bevin officials questions before the public got its turn to speak.

A pair of general misgivings emerged from Wednesday’s public hearing: Many are worried at the loss of dental and vision coverage for the expansion population as well as the proposed monthly premiums for all recipients.

Dr. Elizabeth Partin, chair of the advisory council, asked officials to consider the preventative value of routine dental and vision checkups.

Bevin’s administration, which bills its proposal as a means to improve healthcare and sustainability while ushering recipients into the private market, has proposed rewards accounts for recipients to help cover dental and vision visits, which will remain in Medicaid plans for non-expansion recipients, children and the medically frail. Activities that can earn dollars include community service, job training and career coaching.

“Those providers are looking for other chronic conditions and get those patients referred back to their primary-care providers,” Partin said of optometrists and dentists, “and so I would just ask to consider putting those services back in.”

“One annual eye exam or one annual dental exam is not going to break the bank either way, I don’t think, and it may help to improve people’s health,” she added.

Dr. Matt Burchett, an optometrist from Richmond, echoed that sentiment and said eye doctors are key partners in helping diagnose severe problems in patients, listing conditions such as diabetes, hypertension and high cholesterol that can be spotted during eye exams.

“According to United Healthcare, 15 percent of their covered diabetics were first diagnosed in an optometrist chair,” Burchett said.

“Another example of either an acute or chronic disease which is often detected during a routine eye exam is glaucoma. If left untreated, but more importantly undetected, a patient may lose peripheral, central vision or at worst a total loss of vision.”

Dr. Susie Riley, a member of the Advisory Council for Medical Assistance, said dental issues could be caused by other complicating conditions like diabetes or poor cardiovascular health.

Adam Meier, Bevin’s deputy chief of staff, said those individuals would likely qualify as medically frail and have their dental visits covered under the proposed waiver.

“We would look at actuarial data, claims data, work with a formula, work with (Medicaid managed care organizations) to create a formula for people who require a lot of care,” Meier said.

Advisory council member Barry Whaley expressed his concerns with booting people off of Medicaid for missing premium payments. Premiums would range from $1 per month for those below 25 percent of the federal poverty level up to $15 per month for those between 101 percent and 138 percent, with the latter figure gradually rising the longer recipients stay on Medicaid.

“It seems rather harsh, the disenrollment piece,” Whaley said.

Meier said that was done to get recipients accustomed to the private-sector market, noting the proposed waiver includes a path to resume benefits.

Recipients above 100 percent of the federal poverty level would have their Medicaid coverage suspended after 60 days of nonpayment, and those benefits would resume after they pay back two months of missed premiums and another month’s premium as well as complete either a health or financial literacy program, according to a presentation Wednesday.

Those below 100 percent of the federal poverty level or medically frail would return to co-pays, which officials estimate cost more than monthly premiums, and have their rewards accounts suspended and $25 deducted from them.

“This whole plan is really to help teach people how to be engaged in their health and their insurance plan, to teach them how commercial coverage works,” Meier said.

Mark McKinley, of Louisville, raised a question about possible glitches in the payment system, noting that he was twice cut off from his insurance through kynect due to a glitch that showed he hadn’t paid his monthly premiums.

It took him more than a day to get his coverage back, and he worried how a similar technological breakdown would impact the most vulnerable.

“I’ve seen the governor speak before the (Shaping Our Appalachian Region) conference in Appalachia, making the commitment to help struggling regions in our state, but I feel like there’re many components of this plan that are going to pull the rug out from under struggling families,” said McKinley, who said he supported expanded Medicaid.

Bevin, who unveiled the proposed waiver on June 22, has said if CMS does not approve Kentucky’s request for a waiver, he will rescind the Medicaid expansion, enacted by former Gov. Steve Beshear via executive order in 2013.

The third and final hearing for the governor’s proposed Medicaid waiver will be July 6 in Hazard. The first hearing was held in Bowling Green on Tuesday.


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