By Amy Goldstein,
A day after the Trump administration announced it would allow states to require poor people to work or get ready for jobs to receive Medicaid benefits, federal health officials on Friday granted Kentucky permission to impose such conditions.
Becoming the first-in-the-nation state to move forward with the profound change in the safety-net insurance program is a victory for Kentucky’s Republican governor, Matt Bevin, who during his 2015 campaign vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.
Bevin first pledged to undo his state’s expansion of Medicaid, which had helped the ranks of uninsured Kentuckians dwindle more than in almost any other state. But shortly after taking office, he pivoted to the idea of keep the additional people in the program with strings attached that the federal government has never permitted in Medicaid’s half-century history.
The federal Centers for Medicare and Medicaid Service announced early Friday afternoon that it had approved the state’s application to make changes. Bevin said at a news conference in the state capitol in Frankfort that state agencies will phase in the “community engagement and employment initiative” in different parts of the state from July to November.
The governor said the changes will be “transformational . . . in good ways and powerful ways.” Arguing that helping people find work will lead them out of poverty and government dependence, ultimately improving Kentucky’s health status, Bevin said: “Why should a working-age person not be expected to do something in exchange for what they are provided?”
Since Kentucky expanded Medicaid under the ACA four years ago, including residents with somewhat higher incomes, nearly a half-million people in that group have joined the program statewide.
Briefing reporters, aides to the governor estimated that about half of 350,000 able-bodied, working-age Medicaid recipients subject to the requirement will already meet its terms to work at least 80 hours per month, volunteer or be in job training. Those individuals will need to send documentation to prove their compliance. If they do not, they will receive a notice after a month, then be given one more month to “cure” their violation. After that, their benefits will cease until they prove they have begun following the rules.
The country’s first work requirement, for state residents who have joined Medicaid under the ACA or traditional Medicaid beneficiaries who are not pregnant or primary caretakers, is part of a multitude of changes that CMS is allowing Kentucky to adopt. They include a new system that will require some people in the program to make small monthly premium payments, incentives to adopt healthy behaviors and different benefits provided to certain groups.
Once the changes take effect, benefits also will be stopped for people who do not reapply in time to determine whether they remain eligible or who do not promptly report any changes in their income.
One aide to Bevin said the state’s Medicaid rolls are forecast to be reduced by about 95,000 people by the end of the five years CMS granted for this experiment. He did not say how many of those individuals would lose eligibility versus no longer needing the program.
Critics of the Trump administration’s move have vowed to sue as soon as the first state won approval for a so-called 1115 waiver permitting such changes, contending that they will violate the objectives of the vast insurance program created a half-century ago as a major advance in access to care for the nation’s poor.
Brad Woodhouse, director of Protect our Care Campaign, a pro-ACA group led by many alumni of the Obama administration, said that CMS’s approval of Kentucky’s plan “marks not just a shift in policy, but a shift in the fundamental decency of the United States . . . Changing Medicaid will do nothing to help Americans find jobs. It will merely take away their health care.”