Wednesday, May 30, 2018

Foundation for a Healthy Ky. will help state keep people covered as Medicaid changes; summit discusses new work requirements

Ben Chandler, president and CEO of the foundation,
with Gov. Matt Bevin (Associated Press photo by Adam Beam)
By Melissa Patrick
Kentucky Health News

LOUISVILLE, Ky. -- The Foundation for a Healthy Kentucky is partnering with the administration of Gov. Matt Bevin to help low-income Kentuckians keep their health coverage under the new Medicaid plan that starts taking effect July 1.

"We have a singular objective in the endeavor announced today, and that is to keep Kentuckians covered," Ben Chandler, president and CEO of the foundation, said at a May 30 press conference to announce the partnership.

Chandler told the nearly 200 people in attendance that "an independent, non-profit, non-partisan foundation" is "uniquely situated" to help Kentuckians on Medicaid meet the new requirements.

"The foundation's passion for this is our passion for this," Bevin said. "It is not a partisan issue." He is a Republican; Chandler is a Democrat who was in Congress in 2004-12, state attorney general in 1996-2003 and a 2003 nominee for governor.

Bevin's new Medicaid plan, called Kentucky HEALTH (for Helping to Engage and Achieve Long Term Health) includes, among other things, requirements for work, education or training; monthly reporting; lock-out periods for failure to comply; and premiums and co-payments based on income.

The changes will largely impact "able-bodied" Kentuckians who have gained Medicaid coverage through the expansion of the program to people with incomes up to 138 percent of the federal poverty level, which is less than $16,394 for an individual.

Medicaid covers almost one in three Kentuckians, almost half a million of them on the expansion. A county-by-county spreadsheet of enrollment in Medicaid, as of January 2018, can be downloaded from http://www.uky.edu/comminfostudies/irjci/MedicaidbycountyJan2018.xlsx.

Chandler said that through this partnership, the foundation will help Kentuckians keep their health coverage by helping them to better understand the new requirements; helping communities offer ample community engagement requirements; helping people find ways to pay their premiums, promoting preventive health initiatives, focusing on helping those with substance use disorders, and providing health and financial literacy education, as required by the program.

In addition, he said they will facilitate a "statewide feedback program," as the implementation rolls out " to identify best practices and lessons learned, and to resolve program inefficiencies."

Bonnie Hackbarth, spokeswoman for the foundation, said in a telephone interview that while they haven't specifically talked to other health advocacy groups in the state to enlist their help in this endeavor, like the Friedell Committee or Kentucky Voices for Health, she said they would likely reach out to them as they look to engage.

Veronica Judy Cecil, who had served as a deputy commissioner in the state Department for Medicaid Services under Bevin and Democratic predecessor Steve Beshear, has been hired to oversee this partnership. Cecil ran Chandler's congressional office.

Critics of Kentucky HEALTH say it is too complicated and creates barriers to health care.

The Center for Budget and Policy Priorities recently released a report saying that the plan's new rules, which were approved by the federal government through what is called a demonstration waiver, will likely cause many people to lose coverage.

"Current waiver proposals and recently approved waivers will cause large numbers of eligible people to lose coverage and will increase administrative costs," the report concludes. "Those who lose coverage will have less access to care, less financial security and worse health outcomes."

The Bevin administration estimates that 95,000 fewer Kentuckians will be on the Medicaid rolls with the changes than without them, partly because of non-compliance. The state has budgeted $186 million for fiscal year 2018 and $187 million for 2019 to implement the waiver, and has requested that the federal government pay for 90 percent of these costs, according to the budget center's report.

Chandler said the foundation was well aware that many stakeholders had "deep concerns" about beneficiaries losing their coverage, and added, "So do we."

Bevin has said that the state can't afford to have nearly one-third of its population on Medicaid, but when asked if his goal to decrease the Medicaid rolls was in conflict with the foundation's goal of keeping people on them, he said that kicking people off the program was never his goal.

“My goal is to get a healthier outcome for the people of Kentucky. I’ve never made any mention with respect to the size and scope of Medicaid," he said. "What I do believe is if you have a healthier population, you won’t need as many people.”

Chandler later added, "Not at any time have any of these folks here suggested to us that they are trying to throw people off Medicaid."

Attendees at the Partnership Summit (Photo by Melissa Patrick)
The second part of the morning was devoted to the Kentucky HEALTH Partnership Summit, which brought together state, business, health and education leaders to discuss the details of the community engagement requirements -- which require "able-bodied" Kentuckians on Medicaid to work, volunteer or attend school or job training at least 80 hours a month, and document their hours monthly, to keep their Medicaid coverage.

Bevin talked about the benefits of the engagement requirement, likening it to the pride in ownership a child has when they buy their own bicycle instead of having it given to them: "If you don't have engagement in your own health outcomes, you're not as likely to get the health outcomes you desire."

Most of the new requirements will kick in July 1, but the new work or community-engagement rules requirements will be phased in slowly, starting in Northern Kentucky. Campbell County's requirements begin on July 1, followed by Boone County on Aug. 1 and Kenton County on Sept. 1.

After that, large groups of counties will be rolled into the program each month until the last scheduled counties are added Dec. 1. Eight counties in Eastern Kentucky are exempt until December 2019 because they are already part of a pilot project that helps find jobs for people in the Supplemental Nutrition Assistance Program, formerly called food stamps.

Hugh Haydon, chair of the Kentucky Workforce Innovation Board, told the summit that from an economic perspective, his group fully supports the community engagement requirements. And he implicitly disputed some critics by saying that there are plenty of jobs to be found.

Calling it a huge "disconnect," Haydon said 200,000 more Kentuckians need to go to work for Kentucky to meet the national average for workforce participation and that there are "hundreds of thousands of jobs available. "

"We also know that for this program to succeed, employers have to be fully engaged," he said. Later adding, "We are ready to do this."

Tim Robinson, founder and CEO of Addiction Recovery Care, who said he was also in long-term recovery, spoke passionately about the importance of the new work requirements for recovering addicts.

He said that while his 14 treatment centers have always maintained a holistic approach to recovery, including clinical, medical and spiritual care, they added vocational rehabilitation and job training to their continuum of care two years ago and "the results have been amazing."

He said 46 of his patients have graduated from his company's Peer Support Specialist Academy, which was launched in 2016, and that 40 of them are sober and working full time. "Which tells me that job training is just as important as drug addiction treatment," he said to applause.

"Incredible things happen when you give someone whose trashed their life a path from crisis to career," Robinson said. "You give them hope for the future, the power of purpose, the dignity that comes from work, raising their self-esteem and an opportunity to pay their recovery forward."

At the end of the meeting attendees broke into groups, based on their local workforce development area, and discussed their concerns about implementation of the new plan.

Some of the concerns included the need for more communication about the changes; the importance of individuals learning how to self-report their monthly engagement requirements, and to manage their Kentucky HEALTH accounts, because there are no added resources to help them do this; concerns about transportation barriers, prompting a suggestion for a Kentucky HEALTH Uber service; and the need to create a "ramp" instead of a "cliff" for the many who will only work up to a certain number of hours for fear they will earn too much money and then lose their health coverage.

Smaller Kentucky HEALTH summits modeled after this bigger one are expected to be held across the state. Click here for Kentucky HEALTH resources page.

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