Gov. Bevin picks former CHFS head to lead planning for new Medicaid delivery model

12/30/2015 03:37 PM

FRANKFORT — After campaigning aggressively this year on reshaping Kentucky’s Medicaid expansion, Gov. Matt Bevin laid out on Wednesday the initial stages of how he hopes to accomplish that feat by 2017.

Concrete details were few at a Capitol news conference, but Bevin tabbed Mark Birdwhistell, a former Cabinet for Health and Family Services Secretary under Gov. Ernie Fletcher and vice president of health affairs for University of Kentucky HealthCare, with the task of assembling health experts and stakeholders to draft and apply for a Medicaid waiver plan to the Centers for Medicare and Medicaid Services.

Bevin said Wednesday he hoped the proposed program for both traditional Medicaid and expanded coverage — approved via executive order by Bevin’s predecessor, Gov. Steve Beshear, in 2013 – will become “a model to the nation.”

“That is the intention,” said Bevin, flanked by Birdwhistell, Lt. Gov. Jenean Hampton and CHFS Secretary Vickie Glisson. “It is to find a solution for us, but one that, frankly, will serve as a beacon for others as well because ultimately it’s a function of making sure it’s sustainable. We are spending the taxpayers’ money.”

About 1.2 million Kentuckians are enrolled in Medicaid coverage, according to preliminary September figures from CMS.

He noted that he often pointed to Indiana’s waiver program under Section 1115 of the Affordable Care Act, which requires premiums for most adults covered under Medicaid expansion. But with new waivers under Section 1332 of the federal health law available starting Jan. 1, 2015, Bevin said he hopes to craft a unique Medicaid delivery system here.

Birdwhistell, who served in the state’s Department for Medicaid Services as a director and assistant director from 1986 through 1994, said he was eager to begin the work, but Kentucky is in “a very challenging time.”

“We’ve looked at other models in other states,” he said. “One of the things that we keep talking about, looking at the Indiana model. My personal preference is we need a Kentucky model.”

Bevin said he has spoken with U.S. Health and Human Services Secretary Sylvia Burwell since his inauguration “about what solutions look like for Kentucky.”

“Indiana’s is the model that, frankly, is the most likely that we will look to replicate the best examples of,” he said.

Bevin also criticized Beshear’s administration and called the study by Deloitte Consulting that found economic activity created by Medicaid expansion would cover increased costs “a straight up, straight out lie,” saying the state faces a $128 million deficit in its Medicaid budget for the current fiscal year.

“This was known by the outgoing administration, and yet we hung onto, misleading you all to believe that somehow this is sustainable,” Bevin said. “It is not. … Ultimately this isn’t just about where we can spend the least amount of money. It’s how can we ensure that Kentuckians are healthier, have access to, take advantage of and made better by their ability to be healthy citizens. That is the point of this, and to make people as undependent as is possible, ultimately.”

Beshear shot back in a statement posted on his Facebook page in which he defended expanding Medicaid, saying the state “looks forward to the day when our new governor transitions from strident partisan rhetoric and petty name-calling to the real and more difficult business of governing.”

“Medicaid expansion was and remains a smart policy move — it’s the most cost-effective way to get the poorest Kentuckians healthy, to shore up our local hospitals which were losing huge amounts of money providing indigent care, and to keep our workforce healthy so businesses can grow,” Beshear said on his Facebook page.

“And contrary to what Gov. Bevin alludes to, facts and figures show that the reform we implemented is both sustainable and effective. It’s paying for itself, and it’s paying off with better health. Today he proposed a vague solution to an unclear problem with hopes that it may or may not be implemented at some undetermined point in the future – all for reasons of political ideology. Kentuckians deserve better.”

Bevin said he expected a clearer image of his administration’s Medicaid proposal to develop by midyear in 2016.

It’s unclear at this point whether the state will continue enrolling Medicaid recipients at the expansion limit of 138 percent of the federal poverty level beyond 2016.

“It’s not possible over the course of the next 12 months because of decisions that were made in 2015,” Bevin said of altering Medicaid expansion enrollment requirements.

“And so to that end, what we will be doing in 2016 is determining exactly how things will be handled in 2017. So it is still my intent that going forward, what I’ve always said is under the existing construct that is not something we’re going to do, and I still believe that because we cannot afford to enroll people up to 138 percent under the existing reimbursement model.”

Health advocates sounded eager to offer their input as Kentucky develops its Medicaid waiver application.

Emily Beauregard, executive director of Kentucky Voices for Health, said she was encouraged to see Birdwhistell in such a key role in the process as well as plans to involve stakeholders in the process.

“To me, coverage is a foundational piece – everyone needs to be secure in knowing they have affordable access to care when they need it. It allows people to get preventive care, manage chronic conditions and seek care when they first get sick, rather than putting it off until it becomes a life threatening condition,” Beauregard said in an email to Pure Politics.

“So coverage is critical, but it’s certainly not a silver bullet for Kentucky’s health problems. If we really want to improve the health of Kentuckians – and in doing so, strengthen our economy – we have to transform the way health care is delivered. In the long-term, we won’t save money by cutting access to care for Kentucky’s low income families and most vulnerable citizens. But there’s a lot we can do to improve care delivery and I was really pleased to hear from Mark Birdwhistell that he intends to help the Cabinet develop an innovative model for Kentucky.”

Susan Zepeda, president of the Foundation for a Health Kentucky, said in a statement that her group “looks forward to contributing to a thoughtful and inclusive process that builds on what other states have learned and on the expertise of Kentucky providers, payers and consumer advocates to assure that Kentucky sustains access to needed care for its residents.”

House Speaker Greg Stumbo said he could not support a Medicaid waiver program “that is not well thought out or that would cause health insurance rates to go up.”

“Just because the governor doesn’t believe the economic studies, that doesn’t necessarily mean their overall findings are wrong,” Stumbo, D-Prestonsburg, said in a statement. “The governor, I believe, needs to be very cautious, because an erroneous decision could very well cause costs to rise for everyone.”

House Minority Floor Leader Jeff Hoover applauded Bevin’s efforts to rethink Kentucky’s Medicaid delivery model.

“I commend Governor Bevin’s approach to begin the process of stabilizing the financial security of Kentucky’s Medicaid program,” Hoover, R-Jamestown, said in a statement. “I look forward to working with Governor Bevin and others to address this issue in the coming months.”


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