Louisville clinic's patients illustrate worries over Medicaid changes

Under an online headline, "Rush to Impose Medicaid Curbs Creates Unease," health reporter Abby Goodnough of The New York Times takes a look at the changes coming in Kentucky's Medicaid program.

Mark Lee Coleman's blood is drawn at a Family Health Center.
(Photo by Aaron Borton for The New York Times)

Her main example was Mark Lee Coleman, 49, of Louisville, a diabetic who has neuropathy, numbness and tingling in his hands and feet, and sometimes trouble walking. When he went to get health care recently, he found that Medicaid had dropped him from the rolls because he failed to report a change in his employment.

Now he and other Medicaid beneficiaries will have to make monthly reports about their income and work, and if they're no working, do volunteer work or take job training. Coleman works 20 hours a week, but fears his health might force him to work fewer hours, which would take him below the minimum work requirement of 80 per month.

"He’d either have to try to get classified as 'medically frail,' which would exempt him from the work rule, or lose his coverage," Goodnough notes. "He hasn’t thought all that through yet. In concept, though, he supports work requirements — as do most voters, polls have found.

“That’s not bad, to tell you the truth,” he told Goodnough. “If you’re working, that’s good for your health.”

That's part of the argument for the work rules created by Gov. Matt Bevin with approval of the Trump administration. Their argument "is that Medicaid was created for the most vulnerable citizens — those who aren’t only poor, but pregnant, elderly, children or disabled — and that for everyone else, working or otherwise engaging in their community will provide dignity and better health," Goodnough writes. "About 500,000 Kentuckians have joined the Medicaid rolls under the Obamacare expansion, and the state estimates some 350,000 will be subject to the new work rules."

However, "Many who work with the poor are worried that the thicket of new documentation requirements in Medicaid will be daunting for low-income people, who may have little education and struggle with transportation, paying for cellphone minutes and getting access to the internet," Goodnough reports.

Melissa Mather, the communications director at Family Health Centers, where Coleman gets care, "said she worried that patients like him, who already stumble over Medicaid’s paperwork requirements, will be more lost under the new rules."

Mather's boss, Bill Wagner, listened as state health official Kristi Putnam explained how the changes will be implemented. One example: "The 'rewards dollars' that many will need to earn to get their teeth cleaned or their vision checked? They’ll be tracked through a new online platform, where Medicaid recipients will also be expected to upload their work, volunteer or training hours," Goodnough reports.

“I know it sounds a little bit complicated,” Putnam said. Wagner, "after four years of signing up thousands of people for coverage under the health law’s expansion of the Medicaid program," told the room, “We’re shifting our focus from helping people gain coverage to helping people keep it.”

"Wagner and others say they’re just as concerned about other new rules that will be confusing and hard to follow," Goodnough writes. "For example, many adults who don’t pay their small premiums can be locked out of Medicaid for six months, unless they complete a financial or health literacy course. . . . Critics of the plan point to Indiana, which dropped about 25,000 adults from its Medicaid program from 2015 through 2017 for failing to pay premiums there. About half found other coverage, according to state surveys, typically through a job."