Friday, July 1, 2016

Despite Bevin's take-it-or-leave it statements, officials say negotiations continue with feds on proposed Medicaid changes

Gov. Matt Bevin said when he announced his plan to change Medicaid that if the federal government didn't approve it, he would end the eligibility expansion that has added more than 440,000 people to the program. But his lieutenants say the proposed waiver of normal Medicaid rules is still being negotiated with federal officials.

"We're continuing to negotiate in good faith. We're pretty confident they'll approve our waiver or something pretty close to it," Adam Meier, Bevin's deputy chief of staff, said at a forum hosted by the Health Enterprises Network, a Louisville health-business group, Deborah Yetter reports for The Courier-Journal.

Mark D. Birdwhistell spoke as Gov. Matt Bevin listened June 22.
The architect of the plan, University of Kentucky health Vice President Mark D. Birdwhistell, said likewise. "It is not an all-or-nothing transaction,” Birdwhistell told Kentucky Health News Editor and Publisher Al Cross for his fortnightly C-J column.

"There’s negotiation on pieces and parts and components within the various waivers, and I expect that same negotiation to take place here as well."

Birdwhistell told Cross that the stickiest point is likely to be its requirement that able-bodied adults who aren’t the primary caregiver of a dependent have a job, look for one, take job training or do volunteer work. The Department for Health and Human Services has never approved a work requirement, and said in response to Bevin's June 22 announcement, “States may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities.”

Birdwhistell "wouldn’t speculate about how that might be negotiated, but the structure of the plan strongly suggests that one solution would be to make work-oriented activities part of the plan’s rewards system – in which Medicaid enrollees can earn better benefits (including vision and dental, which the plan would remove from the program’s basic benefits)," Cross writes. "Bevin could declare victory, and so could President Obama, who counts health reform as his main accomplishment."

Cross noted criticism from Democratic U.S. Rep. John Yarmuth of Louisville, in an interview with Nick Storm of cn|2’s “Pure Politics.”

“He just wants to blame the Obama administration for ‘forcing him’ to roll back the Medicaid expansion,” Yarmuth said of Bevin, a Republican. “This is a way to do it with less political pushback. I hope that people in Kentucky figure out what he’s doing and don’t let him get away with it ... a very cynical approach to doing business.”

Cross suggested that Bevin could avoid much of the pushback if he dragged out the negotiations "past the Nov. 8 election, in which Republicans have a good chance to gain control of the state House and thus full control of the General Assembly. That power struggle means a lot to Kentucky, but probably little to the White House. And it probably means little to the 400,000-plus Kentuckians whose health care is at risk. But they have the most at stake."

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