Health secretary says 'No one is going to be pushed off Medicaid,' but plan says fewer will have it, and has pitfalls to lose coverage

Health Secretary Vickie Yates Brown Glisson on KET

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposal to overhaul the state's Medicaid program, with its latest modifications, says it would leave 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise.

Exactly what that means depends on whom you ask.

"No one is going to be pushed off of Medicaid, no one is losing their benefits," Health Secretary Vickie Yates Brown Glisson told Renee Shaw on KET's "Connections with Renee Shaw."

Glisson's comment prompted a Twitter storm from Dustin Pugel, a research and policy associate for the liberal-leaning Kentucky Center for Economic Policy: "What happens when someone fails to report that they got a couple extra shifts, or their tips lowered their wages? . . . What happens if someone fails to make their $1-$37.50 monthly premium one month? . . . What happens if someone works 19 hours one week instead of 20 and can't find an extra hour of qualifying volunteer work? . . . What happens if someone loses track and doesn't re-enroll at the end of a year's coverage? Kicked off."

Asked to clarify Glisson's comment, Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail: "Kentucky HEALTH does not change income eligibility thresholds. People who participate in the program will have access to the same health coverage and benefits they have today." He added, "There will be no changes in benefits for certain low-income adults, caregivers, children, pregnant women, the elderly, and those with disabilities."

Pugel said in an interview, "If you add these new requirements that people can't meet, those requirements are responsible for people losing coverage." He added, "Indiana’s requested work requirement is very similar to ours, and it states that a quarter of the people who must comply with a work requirement will lose coverage because they are unable to meet it. Also in Indiana, the premiums they charge led to tens of thousands either losing coverage or never getting coverage to begin with because people didn’t pay them."

Glisson said on KET that with the help of a "continuum of services" to be offered in the new Medicaid plan, called Kentucky HEALTH, able-bodied adults without dependents who are on Medicaid will eventually transition to better paying jobs that offer employer health insurance.

"We need to connect you with the jobs, we need to get you the training for those jobs. And if you chose to, we're hoping that you're going to be able to transition to an employer-sponsored insurance product," Glisson said.

In the separate interview, Pugel argued that the high-paying jobs with health benefits that the Bevin administration expects these able-bodied adults to move to simply don't exist in Kentucky.

He said many Kentucky counties have fewer jobs than they did before the recession, and the handful of counties that have seen some job growth are seeing it in temporary-agency work, which he said "nearly never" offers benefits like health insurance.

"There are a lot of folks who live in areas where there just aren't jobs, let alone the kind of jobs that would offer the kind of benefits she is talking about, Pugel said.

He added that employers don't offer health insurance as a benefit nearly as much as they used to, especially in the kinds of jobs held by people who earn near the Medicaid income limit, $16,400 for an individual. He said the share of Kentucky workers who received insurance through their employer has fallen from 70 percent in 1980-82 to 53.7 percent in 2011-2013. The Kaiser Family Foundation reported that only 47.8 percent of private sector firms in Kentucky offer health insurance in 2015.

"These folks work in jobs like construction and child care and restaurants. These are not jobs where employers offer coverage, or coverage that these folks can afford," Pugel said. "Medicaid fills a role. It really does for working Kentuckians."

Kentucky submitted its proposal to overhaul the state's Medicaid program to the federal Centers for Medicare and Medicaid Services about 11 months ago. Glisson told Shaw that the state expects to submit its final version in mid- to late August.

The proposal, which is expected to be approved, focuses on "able-bodied" adults without dependents who qualify for Medicaid under the expansion of the program to those who earn 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act.

Kentucky has 1.4 million people on Medicaid, with around 470,000 of them covered under the expansion. Bevin has said the state can't afford to pay for this expanded population (the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020) .

The new plan is designed to not only save Kentucky money, but to also encourage participants to have some "skin in the game" through premiums and work or community engagement requirements that encourage people to have a higher level of involvement in their care.

The state proposed modifications to the original proposal in July. Glisson called the changes that strengthened the work and community engagement requirements and added a six-month lock-out period for those who fail to report changes in their work and employment status within 10 days of the change, "fairly minor."

To this, Pugel tweeted, "The 'minor changes' she's referring to kicks an extra 9,050 people off Medicaid and reduces spending by tens of million." Actually, the "kicked off" number is the difference between the number who are expected to be on the program in five years and the number expected to be on it if no changes are made.

More than 1,000 Kentuckians submitted comments about the added changes to the proposal, and almost all of them opposed it.