Tuesday, July 4, 2017

State asks feds to let it increase work required of some on Medicaid in first year, impose penalty for not reporting changes

July 12 - This story was updated to reflect that public comments can also be made to the Centers for Medicare and Medicaid Services through Aug. 2. 

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has proposed modifications to the state's Medicaid waiver request, with stronger work and volunteer requirements and a six-month disqualification for those who fail to report changes in their work and employment status.

Kentucky submitted its original proposal to the federal Centers for Medicare and Medicaid Services about ten months ago requesting changes to its Medicaid program under a waiver from the Medicaid rules. The proposal focuses on “able-bodied adults” who qualify for Medicaid under the 2014 expansion of the program to those who earn up to 138 percent of the federal poverty level ($16,400 for an individual) without dependents, under the 2010 Patient Protection and Affordable Care Act.

Kentucky has 1.4 million people on Medicaid, with around 470,000 of them covered by the expansion. Bevin has said the state can't afford to pay for this expansion of benefits to "able-bodied" Kentuckians (the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020). The waiver, which is expected to be approved, is meant to not only save the state money, but also encourage personal responsibility through premiums and work requirements.

The updated proposal estimates the changes would save taxpayers an additional $27 million over the next five years, bringing the state's total savings to $358 million by 2021. It also estimates that 9,000 fewer Kentuckians will be on Medicaid than if the changes weren't implemented, bringing this total to 95,000 fewer people on Medicaid than would otherwise be the case.

The proposed changes to the work and volunteer requirement would now require Kentuckians who qualify for expanded Medicaid to work or participate in community service activities 20 hours a week. Participants who have never been enrolled in the program are given a three-month grace period before these requirements kick in, but enrolled participants are immediately responsible for this requirement. The original proposal called for five hours a week in the second quarter, 10 in the third quarter, 15 in the fourth and 20 hours after one year.

The proposal still exempts children under 19, pregnant women, primary caregivers, people who are medically frail and full-time students.

The proposal says the changes are needed to alleviate “administrative complexities” and bring the requirements in line with the Supplemental Nutrition Assistance Program requirements (formerly food stamps), noting there is a “significant overlap” between Medicaid and SNAP eligibility.

Changes in the proposal also include a provision to disenroll for six months participants who fail to report a change in their circumstances – income, employment and community-service status, which are used to determine eligibility. Disenrolled members can re-enroll prior to their six-month lock-out if they complete a financial or health literacy course, unless they have engaged in Medicaid fraud. A news release says the change is intended “to dissuade members from failing to timely report changes in income and/or employment or falsely reporting community engagement or employment hours.”

The proposal also eliminates the expansion of “presumptive eligibility,” which allows certain health-care providers to bill Medicaid even if a person isn't in the program because they are presumed to be eligible for the program. The proposal says the expansion isn't necessary because of a new provision that allows for timely enrollment.

The state is not required to seek comment on the proposed changes, unlike the original plan, but will hold two public hearings and is offering a 30-day comment period that ends Aug. 2 at 11:59 p.m. Send written comments to Commissioner Stephen Miller, Department of Medicaid Services, 275 E. Main Street, Frankfort KY 40621; or send comments via e-mail to kyhealth@ky.gov. The hearings will be July 14 at the Center for Rural Development in Somerset from 10 a.m. to noon and July 17 in Room 154 of the Capitol Annex in Frankfort from 10 a.m. to noon, or upon adjournment of the Interim Joint Committee on Health and Welfare meeting. Public comments can also be submitted online to CMS through Aug. 2. Click here for the link.

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