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Tuesday, January 5, 2016

Legislators are keeping a close eye on Gov. Matt Bevin's plans for Medicaid, and his likely model in Indiana

"As the 2016 session of the Kentucky General Assembly opens, lawmakers say they plan to keep a close eye on changes to the state's Medicaid system proposed by Gov. Matt Bevin, who has said he wants to reshape it along the lines of one operated by Indiana, which requires premiums, co-pays and provides different tiers of coverage," Deborah Yetter reports for The Courier-Journal.

Rep. David Watkins of Henderson, a Democrat and retired physician who co-chairs the Medicaid Oversight and Advisory Committee, told Yetter that his panel and others will ask for regular updates from the new Republican administration. "I think it will be a pretty significant issue," he said. "We're already at the bottom of the heap here in Kentucky. We don't need to go down any further."

For the Republican side, Yetter quotes what Senate President Robert Stivers of Manchester told Kentucky Health News Dec. 30: "The ultimate goal is to make sure there is health care ... that is sustainable and covers the same population." Yetter notes that about half of Stivers's home Clay County is on Medicaid.

Bevin has given few details of what he wants to do with then-Gov. Steve Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level under federal health reform, other than require at least some participants to pay something for their benefits and reduce the state's costs.

The federal government is paying the full cost of the expansion through this year; in 2017, states will begin paying 5 percent, rising in annual steps to the law's limit of 10 percent in 2020. Bevin and Stivers have said the state can't afford its estimated costs, starting at $250 million for the two-year budget that begins July 1.

Stivers and Bevin have pointed to Indiana as an example of what Kentucky should do. That state, under Republican Gov. Mike Pence, requires Medicaid patients to pay co-payments and income-based premiums. Health-care advocates say Republican-controlled states have used Medicaid waivers from the federal government to make the program harder to use, thus reducing utilization and expenses.

Caitlin Priest, director of Covering Kids & Families of Indiana, a coalition of health advocacy groups, told Yetter that new enrollees in the system, most of whom aren't used to having health coverage, need help learning how to use their benefits and keep up with premiums and co-pays: "This is a fairly complex program."

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