A nonprofit publication of the Kentucky Center for Public Service Journalism

State has approval for new rules for Medicaid participants, including some ‘work’ requirements

By Tom Latek
Kentucky Today

FRANKFORT, Ky. (KT) – The federal government has again approved new rules for some of Kentucky’s Medicaid participants, including a community engagement component of either going to school, getting a job or volunteering in the community to keep their government health coverage.

The Medicaid waiver is known as Kentucky HEALTH, an acronym for Helping to Engage and Achieve Long-Term Health. The Centers for Medicare and Medicaid Services, or CMS, made the approval, according to a news release from the Kentucky Cabinet for Health and Family Services.

CMS provided guidance that the newly approved program can begin as soon April 1, 2019. Accordingly, the PATH, or Partnering to Advance Training and Health, community engagement component will be rolled out regionally over a several month period, beginning no sooner than April 1, 2019.

Gov. Bevin

A federal judge had halted implementation of the waiver program on June 29, 2018, just two days before it was to begin.

In July, Deputy CHFS Secretary Kristi Putnam told the General Assembly’s Medicaid Oversight and Advisory Committee that the order did not rule any component of Kentucky Health to be unlawful and did not stop the community engagement.  “The judge’s order did remove the waiver approval on a narrow basis and sent it back to the Secretary of Health and Human Services to reconsider,” Putnam said.

Since then, she said the Cabinet had been working with the Governor’s office, CMS, the federal Health and Human Services Department and the U.S. Department of Justice toward a re-approval of the waiver.

After the judge’s ruling, Putnam said there was some confusion by providers over who did and did not have vision and dental coverage following the court decision because the changes they had to quickly make to the website after the ruling were not as clear as they could have been.  That was later clarified and services resumed.

Gov. Matt Bevin’s plan institutes requirements including monthly “community engagement” for recipients to keep benefits. That could be accomplished through such things as employment or job training, school and community service. There were other changes to the federal system as well.

Kentucky HEALTH would put about 460,000 “able-bodied” adults in a plan with limited benefits that didn’t include dental and vision. However, individuals could earn points toward paying for dental and vision care through volunteer activities in the community or by taking online classes through a “My Rewards” system.

They will require adults ages 19 to 64, with some exceptions, to complete at least 80 hours per month of “community engagement” to keep their health benefits. That includes getting a job, looking for a job, going to school, volunteering for community service or taking a job training course.

“Kentucky HEALTH offers a customized path based on individual needs that will help beneficiaries gain better health, engagement in their communities, improved employability, and success through long-term independence,” said CHFS Secretary Adam Meier. “This individualized approach affords flexibility and procedural protections that will ensure Medicaid is able to provide beneficiaries access to services and opportunities, while utilizing a holistic approach to addressing barriers and challenges that affect overall health.”

CHFS describes Kentucky HEALTH as an innovative approach that will put Kentuckians on a path to better health and is key to ensuring the long-term viability of the Medicaid program.

Bevin, in a statement posted to his official Twitter account, said the approval means the state can “continue to provide services for traditional Medicaid beneficiaries, while also offering a path toward improved health outcomes for all recipients.”

They say it is not a one-size-fits-all program. It includes new opportunities for beneficiaries to earn rewards for healthy activities through the My Rewards Account, introduces premiums for some individuals to have a stake in their health care services, and requires some able-bodied adults to participate in community engagement activities that will lead to improved long-term health and increased career opportunities.

The program also includes expanded access to Substance Use Disorder treatment for Medicaid beneficiaries, a fully-funded $1,000 Deductible Account to help beneficiaries track their healthcare spending and show the cost of healthcare services, and the Kentucky Integrated Health Insurance Premium Payment program that lets Medicaid help beneficiaries pay for the cost of private health insurance.

According to CHFS, initial Kentucky HEALTH estimates project that the program will save the Medicaid program over $2 billion during the five-year demonstration period, with more than $300 million in savings to Kentucky’s General Fund and will help ensure availability of Medicaid resources to the Commonwealth’s most vulnerable citizens.

“When it comes to this – or any policy – our question is always the same – ‘Is it good for kids?’ And the key to this significant policy change’s success or failure lies in its implementation,” said Dr. Terry Brooks of Kentucky Youth Advocates. “Kentucky HEALTH’s initial rollout and ongoing management must be family-centric. That is especially true after the unintentional denial of routine dental care that several Medicaid-eligible children and pregnant women experienced in July due to the confusion after the hasty transition to the new eligibility platform.”

The Cabinet says additional details regarding the implementation of Kentucky HEALTH will be available in the coming weeks.

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