Kentucky's Medicaid waiver application "real closer" to approval, state Medicaid commissioner says

11/15/2017 04:06 PM

The head of Kentucky’s Department for Medicaid Services told lawmakers Wednesday that the state is “real closer” to getting federal approval for its 1115 Medicaid waiver program dubbed Kentucky HEALTH.

It’s been more than a year since officials submitted the waiver application, but Steve Miller, commissioner of the Department for Medicaid Services, said he’s optimistic that the Centers for Medicare and Medicaid Services will give Kentucky the OK to proceed with their proposal ahead of the anticipated July 1 rollout.

“We’ve gone from basically saying when asked, ‘Close,’ and I know some people have even snickered when I’ve used a term, ‘Now we’ve gotten real close with it,’” Miller said during testimony before the Medicaid Oversight and Advisory Committee.

He based part of that optimism on recent comments from CMS Administrator Seema Verma, who told the National Association of Medicaid Directors last week that waiver applications with community engagement requirements, one piece of the Kentucky HEALTH proposal, would get approved by her agency.

“It is probably improper to say but I would say we’ve gotten real closer in the process,” he said, adding that Verma’s remarks at the NAMD conference are “very much in sync with where we are with what we had presented to CMS.”

The Kentucky HEALTH proposal makes a number of changes to the state’s traditional Medicaid offerings, not only requiring set hours of work or volunteering, but also charging monthly premiums for many in the program ranging from $1 to $15 based on recipients’ incomes.

Miller said the state still expects to save about $300 million from its share of Medicaid payments, although most would come after the proposed waiver program begins.

The Cabinet for Health and Family Services estimated the state would save $358.6 million in the first five years of Kentucky HEALTH, with 1.1 million fewer Medicaid recipients projected by 2021.

“The reality of it is second year, might start seeing some savings, but I think you’ll look at more of that in the third year,” Miller said, noting that he expects some startup costs associated with educating recipients on changes in the waiver.

As the state grapples with the financial strain of Medicaid costs on its budget, Sen. Stephen Meredith said Medicaid recipients must face other underlying issues, like poor health and bleak job prospects, that wouldn’t be resolved through a waiver.

“I don’t see the 1115 as being a panacea for the issues that face our Medicaid program,” Meredith, R-Leitchfield, said.

“The only way to truly impact the cost associated with that is improving the health of our population and moving people to meaningful employment in Kentucky, and I just haven’t seen anything to date that is substantive in nature that really identifies those as goals and how we’re going to get there and how we measure it, and I just hope that the 1115 doesn’t overshadow, again, what I think are the most pertinent means of addressing our Medicaid cost.”

Miller did not say exactly when he expected CMS to approve the state’s waiver application.

He noted that the agency has not asked the state for any additional information on its proposal.

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