Once Again, Work Requirements Approved For Kentucky Medicaid

Nov 20, 2018

Credit Natalia Merzlyakova / 123RF Stock Photo

The Trump administration has again approved work requirements for Kentucky's Medicaid population after a judge blocked the state's first attempt earlier this year.

The Kentucky Cabinet for Health and Family Services said Tuesday the new requirements can begin as soon as April 1 and will be phased in regionally over several months.

Kentucky is one of 37 states that has expanded its government-funded health insurance program to include low-income adults with no children and no disabilities. More than 400,000 people signed up for the program, drastically dropping the state's uninsured rate and propping up some rural hospitals who depend on the new revenue.

But Republican Gov. Matt Bevin has criticized the program, saying it is too expensive and does not make the Kentucky's citizens healthier as the state is still behind most of the country in some key health indicators.

Bevin proposed requiring some Medicaid recipients to have to work to keep their benefits. In January, Kentucky became the first state ever to win federal approval for such a plan. But in June, a federal judge blocked it, ruling the government did not adequately consider how the plan would impact people who receive coverage.

The judge's ruling re-started the application process, which was completed Tuesday. It's possible the program could wind up in court again.

The work requirements will be in place for five years. The Bevin administration predicted the new rules would save taxpayers more than $2 billion during that time, including $300 million in state dollars. State officials estimated at least 95,000 people would lose coverage, either through not complying with the rules or by getting jobs and earning enough money that make them ineligible for the benefits.

Arkansas was the first state to implement work requirements for Medicaid. Last week, the state announced more than 12,000 people had lost coverage in the past three months for not complying with the new rules. The Arkansas Department of Human Services said another 6,000 people are at risk of losing coverage by December if they do not comply.

It's unclear what changes, if any, Kentucky made to the program. A cabinet spokesman referred questions to the Centers for Medicare and Medicaid Services. Cabinet for Health and Family Services Secretary Adam Meier said in a news release the "individualized approach" of the plan "affords flexibility and procedural protections that will ensure Medicaid is able to provide beneficiaries access to services and opportunities."

Kentucky's initial proposal would have required adults ages 19 to 64 to complete 80 hours per month of "community engagement" to keep their benefits. This includes working, volunteering, going to school or receiving job training. It would also require those adults to pay monthly premiums of varying levels.

The plan includes many exemptions. The rules would not apply to pregnant women, full-time students, former foster care youth, primary caregivers of children and the elderly. It would also exempt the "medically frail," a broad term that includes people suffering from alcohol and drug addiction.