Tuesday, July 18, 2017

Opponents dominate public hearing on Kentucky's revised proposal for changes in state Medicaid program

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Only three of the 17 Kentuckians who spoke at the final public hearing on changes to the state's Medicaid proposal supported it. The advocates said the work requirements "will make their lives better" and cited personal responsibility as reasons for their support.

Opponents, however, said the changes create a barrier to care for some of the state's most vulnerable citizens, and called the waiver "cruel, irresponsible and wasteful" "reprehensible and immoral" and likened the recent changes to "putting lipstick on a pig."

The changes have stronger work and volunteer requirements and a six-month "lock-out" for those who fail to report changes in their work and employment status.

The original proposal for a waiver to make changes to Medicaid was submitted to the Centers for Medicare and Medicaid Services about 10 months ago. The proposal targets "able-bodied adults" without dependents who qualify for Medicaid through the expansion of the program to those who earn up to 138 percent of the federal poverty level, under the Patient Protection and Affordable Care Act.

If federal officials approve the revised waiver, as expected, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted. Kentucky has 1.4 million Kentuckians on Medicaid, 470,000 of them through the expansion.

More than half of Kentuckians who have coverage because of the expansion work at low-income jobs that typically don't provide health insurance.

Andrea Welker, a lawyer with the Child Advocacy Today legal clinic in Lexington, said her mother falls into this category and that she was there to speak on her behalf about her concerns that she might lose her health insurance, which has been a "blessing," because her work hours vary so much from week to week.

“So when she goes to work, she gets there that day wondering if they are going to send her home four hours early and if she's going to be able to work her full shift. And at the end of the day, at the end of the week, is she going to be able to make her bills," said Welker.

Harriett Seiler of Louisville, a longtime advocate of single-payer health care, said the changes to the waiver were like "putting lipstick on a pig," saying they did nothing to improve it. She added that she "objects strongly" to the waiver's "patriarchal concept" of teaching people how to be "good employees, good purchasers of private insurance."

Rev. Rachel Small-Stokes, an associate pastor at Union Church in Berea, talked about the transportation challenges people in her community have to work, also noting that often they get to a workplace and are told they aren't needed. She added that "out of the goodness of their heart," the transportation burdens will likely fall to community members to get these people to and from their newly required work and volunteer requirements.

“And I actually wonder if maybe the underlying goal of this is for people not to get health care," she said. "And if that is the case, then it is absolutely immoral and so I urge you please re-look at this."

Beverly May, a family nurse practitioner from Floyd County, described the plan as "cruel, irresponsible and wasteful." She said the expansion has doubled the percentage of Kentuckians with a medical home and the uptake of preventive services, like breast and colorectal cancer screenings. She said the proposed changes in the waiver simply provide "unnecessary barriers" to care.

Some favor the changes

Amy Luttreel, chief executive officer of Goodwill Industries of Kentucky and also a spokeswoman for the Kentucky Workforce Innovation Board, said both organizations endorse the bill, primarily because of the work requirements, which “will make their lives better.”

“We also see this waiver as something that brings new tools to help people who are not in the workforce, but who could be in the workforce -- to help them to achieve more stability in their lives and to also gain the skills that would allow them to be competitive in today's labor market,” Luttreel said.

Johnny Pittman of Louisville spoke about personal responsibility, saying he had been on disability and Medicaid at times due to multiple sclerosis, he is now able to work and that it was his responsibility to do so. He works at Oxmoor Auto Group in Louisville.

“Disability and Medicaid worked great for me,” he said. “It was a program and a vehicle to get me to a point where I needed to be.”

One speaker who favored the waiver said administrative difficulties at the Department for Community Based Services need to be fixed before the work and volunteer requirements are put in place.

Dylan Gorski, a law clerk at the Child Advocacy Today legal clinic, said he was “totally in favor of the waiver,” but implored the Bevin administration to make sure DCBS was ready to handle the additional administrative responsibilities that would come with the waiver's proposed community engagement requirements.

He cited several examples where his clients had lost coverage because of administrative and system errors and said the waiver needs an “agency error exception” to keep Kentuckians from being locked out of their health insurance because of any agency error.

The modifications would require able-bodied adults who are not medically frail or a caretaker to work or volunteer 20 hours a week, or 80 hours a month, instead of the original proposals plan to gradually increase the number of hours required, until the participant reached the maximum of 20.

The updated proposal also includes a provision to "lock out" for six months any participant who fails to report a change in circumstances, such as income, employment and community status, which are used to determine eligibility.

Kent Gilbert, pastor and president of the executive board of the Kentucky Council of Churches, called the changes “reprehensible and immoral.”

Health Secretary Vickie Yates Brown Glisson, asked after the meeting to reply, said " I understand their position. . . . But I likewise feel very strongly that we are doing the right thing for Kentucky. So I'm very comfortable with that."

About 45 opponents showed up to speak, filling up an overflow room next to the legislature's Interim Joint Committee on Health and Welfare meeting that started at 10 a.m. and ended at 12:15 p.m.. The hearing was scheduled to follow the committee meeting, which ended up having 10 weighty items and several speakers. Many who came to speak at the hearing left before it even began.

“I think it was planned to put so many things on the agenda,” Rep. Mary Lou Marzian, D-Louisville, told Ronnie Ellis of CNHI News Service. “They don’t want people to know how callous they are.”

Committee Chairman Addia Wuchner, R-Burlington, told Marzian during the meeting that everyone would have the opportunity to speak after the meeting and noted that all of the agenda items were important issues that needed to be considered as they prepared for the 2018 legislative session.

Glisson said the remarks would be transcribed and attached to the waiver request sent to Washington. She also noted that the state was "still in a process of negotiation."

The state and CMS will continue to take written public comments through Aug. 2 at 11:59 p.m. 

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