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Bevin's Proposed Medicaid Changes Would Create Hard Transition to Employer-Based Insurance

Natalia Merzlyakova
123rf Stock Photo

A recent news report said the federal government has OK'd most of the Medicaid changes Governor Matt Bevin proposed a year ago. All but the work requirement, which is still being negotiated.

The new Kentucky Medicaid program — if approved — would include a de facto work requirement for the first time in the program’s 50-year history.

Recipients would be required to spend 20 hours a week working, volunteering, searching for a job, participating in job training or attending school. Some people, like primary caregivers and those with disabilities, would be exempt.

Amanda Mills has insurance through Kentucky’s expanded Medicaid program. She also has a full-time job working with homeless people in Louisville.

In January, she’ll lose that Medicaid coverage because she recently started making $1,000 a year too much.

It’s the kind of situation Governor Bevin is looking for – going off the Medicaid rolls and becoming financially independent.

But Mills won’t be able to afford the insurance her employer offers.

According to research that appeared in the journal Health Affairs on Wednesday, one-third of people with Medicaid coverage are already working.

Mills’ employer’s plan costs $200 a month. She says she’ll go without insurance after she’s kicked off Medicaid in January.

“The option is there, but there’s no money," she said. "I could pay that and then we could be homeless. Or I could pay that and then my kids wouldn’t eat.”

Mills also looked at buying a plan on and getting cost-sharing help. But people with the option of employer-based insurance don’t qualify for subsidies and can’t sign up under the Affordable Care Act.

Jessica Greene, a professor of health policy at Baruch College in New York and author of the report, conducted focus groups with 79 low-income people.

She said many of them are in a similar position as Mills. But they’re stuck in a place Bevin might not have anticipated.

“So there are all these people doing the right thing, and trying to get their lives in order, yet they’re facing this gulf and it’s an area that the ACA has left this huge gap,” Greene said.

Some focus group members proposed policy ideas that could help people transition from Medicaid to employer-based coverage.

Lisa Gillespie is WFPL's Health and Innovation Reporter. Most recently, she was a reporter for Kaiser Health News. During her career, Gillespie has covered all things health — from Medicaid and Medicare payment policy and rural hospital closures to science funding and the dietary supplement market.
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