U.S. Rep. John Yarmuth sends letter to health secretary asking for update on Ky.'s Medicaid waiver; also urges him to not approve it

U.S. Rep. John Yarmuth

By Melissa Patrick
Kentucky Health News

In a June 15 letter, Democratic U.S. Rep. John Yarmuth of Louisville asked U.S. Health Secretary Tom Price for an update on the status of Kentucky's proposal to reshape its Medicaid program, and urged him to not approve it. The proposal went to the Centers for Medicare and Medicaid Services almost 10 months ago. Approval is expected, but it may include provisions that were not requested of the Obama administration.

Doug Hogan, spokesman for the Kentucky Cabinet for Health and Family Services, said in an email that there isn't anything to update: "We remain in negotiations with CMS on our 1115 Medicaid waiver and feel optimistic about the ultimate outcome."

Kentucky's request for a waiver from the Medicaid rules targets "able-bodied adults" who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty level ($16,400 for an individual).

If approved, the waiver is expected to leave the state's Medicaid rolls with 85,000 fewer people in five years than without it. The waiver proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," but only $331 million of that would be state tax money because the federal government is paying 90 to 95 percent of the Medicaid expansion that included able-bodied adults. This amount could change under a new Republican health plan if passed by Congress.

The bill that House Republicans passed last month to replace Obamacare, called the American Health Care Act, would end the Medicaid expansion in 2020, but Senate Majority Leader Mitch McConnell has proposed that the Senate's version of this bill -- being drafted behind closed doors -- should end the expansion in 2023.

In addition to saving money, the waiver is also meant to increase participant engagement in their health care through things like monthly premiums, volunteer and work requirements for those who aren't primary care givers and lockouts of coverage for some who fail to pay.

In the letter, Yarmuth reminds Price that under the current law, these waivers should only be approved if they further the objectives of the Medicaid program, including “strengthening or increasing coverage for low-income individuals in the state; improving health outcomes for low-income individuals in the state; strengthening providers and provider networks available to serve Medicaid and low-income populations in the state; or otherwise increasing the efficiency and quality of care provided to Medicaid beneficiaries or other low-income populations in the state.”

Yarmuth argues that Kentucky's waiver does not further these objectives because it will result in fewer people being covered than without it. He adds that "charging premiums for individuals living below the poverty line, a work requirement – which CMS has never approved – and excluding individuals from coverage for six months for non-payment of monthly premiums, among other provisions" does not further the objectives.

The letter also notes that because Kentucky is heavily rural and one of the poorest states, the waiver "will bear disproportionate personal and economic pain on our residents." Yarmuth pointed out that the work requirements for Kentuckians who live in regions with "poor job prospects" could cause them to lose their coverage and that the provisions, if approved, would make it harder for many Kentuckians with substance-use and other behavioral-health disorders to keep their coverage.