By Melissa Patrick
Kentucky Health News
In a national television interview, Gov. Matt Bevin reiterated his assertion that the work requirements for some in Kentucky's newly approved Medicaid program will provide them with an opportunity to have more "dignity and self-respect" by allowing them to be more engaged in their health care.
"So what is it we’re looking to change is, we simply want, for those that are able to be engaged in their own health outcomes, we want them to be, because there’s dignity and self-respect that is offered to people through the ability for people to do for themselves," he told PBS NewsHour host Judy Woodruff Jan. 15.
The new program, called Kentucky HEALTH (Helping to Engage and Achieve Long-Term Health), requires "able-bodied" Kentuckians on Medicaid to work 80 hours a month and document their participation requirement on a monthly basis. The program will be phased in regionally starting July 1, and Medicaid members will get 90 days notice when it applies to them. Kentucky is the first state to establish such requirements, under a new policy of the Trump administration.
The "community engagement" requirements will be phased in with the first phase starting in July and the full program expected to be rolled out by the end of the year, Beth Kuhn, commissioner of the Department of Workforce Investment, told Kentucky Health News.
The work requirements will mostly affect the 480,000 or so Kentuckians who are on Medicaid through the 2014 expansion of the program under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level: $16,643 for a single person and about $34,000 for a family of four. Pregnant women, full-time students, and the medically frail will be exempted.
The requirements can be filled by doing a number of things besides working at a job, such as looking for work, volunteering, getting job training, going to school, or caring for an elderly or disabled family member.
Bevin didn't answer Woodruff's question about how the state will determine who is medically frail, or who will qualify as caregivers. Instead, he again explained who would be exempt and how the work requirement could be filled, stressing the value of community engagement on a person's well being.
"The key is to have them engaged in their communities, because it is through that engagement that people have healthier outcomes. They have an interaction with people. They become a part of the fabric of their community. It’s better for them, and their health, and for their children and their families as well," he said. He added that the program isn't designed to find "big savings," but to "create opportunity for people to pursue the American dream."
Woodruff noted that the Kaiser Family Foundation reported that in 2016, 60 percent of "able-bodied adults" on Medicaid were already working. She asked what percentage he thought should be working, and Bevin said 100 percent, adding that there are 200,000 available jobs right now in Kentucky "waiting for somebody to fill them." He added, "Why should somebody have to go to work every day and pay taxes to provide something to someone who could do the same thing, but chooses not to? That’s very un-American."
Woodruff told Bevin it sounded as if his "underlying assumption" is that "many, many" of the able-bodied people on Medicaid are really trying to avoid work, and asked him if that assumption was true. Bevin said, "No, I think, again, this will be a very small subset. . . . This is for those who are not working and maybe want the opportunity. . . . Human beings want to be treated with dignity and respect. They do. And we’re going to give them that opportunity."
Opponents of the program say it is so complicated that it will create "barriers to care" that will result in low-income Kentuckians losing coverage merely for failing to report or pay small, income-based premiums, the other major facet of the program.
The Bevin administration has estimated that the number of people on Medicaid will be 95,000 fewer in five years than without the program, partly because of "non-compliance."
Judith Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, writes that she expects the number will be much larger than 95,000 because the state doesn't account for those who will experience gaps in coverage "due to the lock-outs for failing to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner."
Solomon says there is a "robust body of research" that shows premium requirements will reduce enrollment. She notes that in Indiana, the model for Kentucky's program, 55 percent of the affected enrollees either never made a first payment or missed a payment while enrolled.
Under Kentucky's new plan, missing payments -- along with failing to meet work requirements, not reporting changes in work status or not renewing coverage appropriately -- would result in a six-month lock-out for those with incomes above the poverty level. Those below that level will be be placed in a different plan that requires co-payments. Those above the poverty level will be allowed to re-enroll if they pay their past-due premiums and take a financial- or health-literacy course.
Recognizing that there are exemptions to the work requirements for those who are medically frail, Solomon says this is not a fail-proof safeguard, because many with disabilities won't meet the strict medically frail definition, creating yet another opportunity for people to lose their coverage.
Kentucky Health News
In a national television interview, Gov. Matt Bevin reiterated his assertion that the work requirements for some in Kentucky's newly approved Medicaid program will provide them with an opportunity to have more "dignity and self-respect" by allowing them to be more engaged in their health care.
"So what is it we’re looking to change is, we simply want, for those that are able to be engaged in their own health outcomes, we want them to be, because there’s dignity and self-respect that is offered to people through the ability for people to do for themselves," he told PBS NewsHour host Judy Woodruff Jan. 15.
The new program, called Kentucky HEALTH (Helping to Engage and Achieve Long-Term Health), requires "able-bodied" Kentuckians on Medicaid to work 80 hours a month and document their participation requirement on a monthly basis. The program will be phased in regionally starting July 1, and Medicaid members will get 90 days notice when it applies to them. Kentucky is the first state to establish such requirements, under a new policy of the Trump administration.
The "community engagement" requirements will be phased in with the first phase starting in July and the full program expected to be rolled out by the end of the year, Beth Kuhn, commissioner of the Department of Workforce Investment, told Kentucky Health News.
The work requirements will mostly affect the 480,000 or so Kentuckians who are on Medicaid through the 2014 expansion of the program under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level: $16,643 for a single person and about $34,000 for a family of four. Pregnant women, full-time students, and the medically frail will be exempted.
The requirements can be filled by doing a number of things besides working at a job, such as looking for work, volunteering, getting job training, going to school, or caring for an elderly or disabled family member.
Bevin didn't answer Woodruff's question about how the state will determine who is medically frail, or who will qualify as caregivers. Instead, he again explained who would be exempt and how the work requirement could be filled, stressing the value of community engagement on a person's well being.
"The key is to have them engaged in their communities, because it is through that engagement that people have healthier outcomes. They have an interaction with people. They become a part of the fabric of their community. It’s better for them, and their health, and for their children and their families as well," he said. He added that the program isn't designed to find "big savings," but to "create opportunity for people to pursue the American dream."
Woodruff noted that the Kaiser Family Foundation reported that in 2016, 60 percent of "able-bodied adults" on Medicaid were already working. She asked what percentage he thought should be working, and Bevin said 100 percent, adding that there are 200,000 available jobs right now in Kentucky "waiting for somebody to fill them." He added, "Why should somebody have to go to work every day and pay taxes to provide something to someone who could do the same thing, but chooses not to? That’s very un-American."
Woodruff told Bevin it sounded as if his "underlying assumption" is that "many, many" of the able-bodied people on Medicaid are really trying to avoid work, and asked him if that assumption was true. Bevin said, "No, I think, again, this will be a very small subset. . . . This is for those who are not working and maybe want the opportunity. . . . Human beings want to be treated with dignity and respect. They do. And we’re going to give them that opportunity."
Opponents of the program say it is so complicated that it will create "barriers to care" that will result in low-income Kentuckians losing coverage merely for failing to report or pay small, income-based premiums, the other major facet of the program.
The Bevin administration has estimated that the number of people on Medicaid will be 95,000 fewer in five years than without the program, partly because of "non-compliance."
Judith Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, writes that she expects the number will be much larger than 95,000 because the state doesn't account for those who will experience gaps in coverage "due to the lock-outs for failing to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner."
Solomon says there is a "robust body of research" that shows premium requirements will reduce enrollment. She notes that in Indiana, the model for Kentucky's program, 55 percent of the affected enrollees either never made a first payment or missed a payment while enrolled.
Under Kentucky's new plan, missing payments -- along with failing to meet work requirements, not reporting changes in work status or not renewing coverage appropriately -- would result in a six-month lock-out for those with incomes above the poverty level. Those below that level will be be placed in a different plan that requires co-payments. Those above the poverty level will be allowed to re-enroll if they pay their past-due premiums and take a financial- or health-literacy course.
Recognizing that there are exemptions to the work requirements for those who are medically frail, Solomon says this is not a fail-proof safeguard, because many with disabilities won't meet the strict medically frail definition, creating yet another opportunity for people to lose their coverage.
No comments:
Post a Comment