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Kentucky Governor Proposes Waiver for Medicaid Expansion

Kentucky Governor Matt Bevin (R) is seeking for HHS to approve a waiver that would impact Medicaid expansion and potentially cut coverage from low-income families.

By Vera Gruessner

The status of Medicaid expansion has floundered around the nation ever since the Supreme Court ruled that individual states will have the option to choose whether or not to expand their Medicaid programs as called for under the Patient Protection and Affordable Care Act.

Affordable Care Act

At this point in time, 19 states have still chosen to forgo Medicaid expansion, which essentially creates a coverage gap in these states and keeps people from achieving healthcare access. The state of Kentucky is currently undergoing some turmoil with regard to Medicaid expansion, according to the Center for American Progress.

Earlier this month, Kentucky Governor Matt Bevin (R) proposed a Medicaid waiver that would impact a number of citizens covered by the current Medicaid expansion program by cutting the number of people who would be eligible for coverage.

In fact, Bevin has stated that he would consider repealing Medicaid expansion completely if this waiver is not approved by the federal government. The issues at hand is that the policies with the waiver are not compatible with the typical requirements of Medicaid expansion under the Affordable Care Act.

Work requirements, for instance, are some of the policies required under the waiver for adult Medicaid beneficiaries. However, this is not compatible with the mandatory requirements under Department of Health and Human Services’ waiver authority.

“Instead of issuing reckless ultimatums that threaten the health and financial security of low-income Kentuckians, Gov. Bevin should take a more responsible approach and build on the historic successes of health reform in Kentucky,” Thomas Huelskoetter, Research Associate for Health Policy at the Center for American Progress, said in a public statement.

In a separate column by the Center for American Progress, it is acknowledged that Kentucky has been very successful in adopting the models set forth in the Affordable Care Act including covering 439,000 more people through Medicaid expansion. Data from the Centers for Medicare & Medicaid Services also shows that the rate of preventive screenings has also increased in Kentucky ever since the state expanded their Medicaid program.

However, Governor Bevin has been seeking ways to shut down a number of major healthcare reforms under the Affordable Care Act including closing the state’s health insurance exchange platform.

Additionally, Bevin’s plan for the Medicaid waiver would lead to fewer coverage options for low-income adults. While Bevin has argued that Medicaid expansion in Kentucky is not sustainable, reports have shown that it would actually add 40,000 more jobs to the economy in this state.

The other important point to remember is that residents of Kentucky actually approve of Medicaid expansion. A Kaiser Family Foundation survey from 2015 found that 72 percent of Kentucky residents said that they would prefer “to keep the state’s Medicaid program as it is today rather than change it to cover fewer people” while 63 percent stated being in favor of Medicaid expansion.

The waiver proposed by Bevin attempts to align the Medicaid program to that of private insurance by requiring deductibles and health savings accounts as well as premiums.

Regarding the changes he proposes through the Medicaid waiver, Bevin explained in an interview with WLSK, “There’s no dignity involved in being a ward of the state, in being completely dependent on the government and on your fellow neighbors, and have no expectation of you or any opportunity to give back. I think this is a win-win.”

“It encourages them to be a part of the fabric of their communities,” Bevin continued. “That’s healthy, frankly. That engagement is one of the things that leads to better and healthier outcomes.”

The future for Kentucky’s Medicaid program will depend upon the actions taken by Governor Bevin in the coming months. The Supreme Court ruling allowing states to have the option to expand their Medicaid programs has made a significant impact on coverage in many states since the passage of the Affordable Care Act.


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