Monday, April 16, 2018

New Medicaid rules would lead to many more people losing coverage than Bevin administration has estimated, critics say

Changes in the state Medicaid program, to be phased in starting July 1, would lead to many more people losing health coverage than the state has estimated, 43 academic experts say in a friend-of-the-court brief filed in a lawsuit challenging federal officials' approval of the changes.

The experts argue that the changes are "likely to remove at least twice as many beneficiaries in the first year while barring initial enrollment for countless others," then go on to forecast much higher numbers. The Bevin administration disputes the projection.

The state has estimated that the changes will cause about 20,000 fewer people to have Medicaid coverage in the first year than would have been the case without the changes, rising to a total of 97,000 in the fifth year.

Critics of the changes say the numbers are likely to be higher, based on recent experience with work requirements in the Supplemental Nutrition Assistance Program that are similar to the new rules requiring work, job training or community service by adults who are not disabled, medically frail, pregnant, or primary caregivers.

SNAP, formerly known as food stamps, requires able-bodied adults 18 to 49 without dependents to work at least 20 hours a week or lose benefits after three months in any three-year period. The requirement was waived in most of the country from 2009 to 2015, due to high unemployment; some states have re-instituted it in some counties.

In their court brief, the academic experts cite examples in Georgia, Maine and Alabama, where SNAP participation fell from 62 to 85 percent in counties where work requirements were reinstated, and assert: "Viewed from that lens, of the 350,000 people subject to the work requirements in Kentucky, Medicaid losses will be much higher and faster than the Commonwealth predicted, between 175,000 and 297,500 losing coverage in the first year."

On the blog of Health Affairs, a policy journal, Erin Brantley and Leighton Ku cite the same data but add cautionary notes: "There are certain differences in the work requirements in SNAP and Medicaid," and "Improving economies might explain a small portion of the declines" in SNAP participation. "Impacts in other states and areas may differ. In some cases, the reports are unclear about which SNAP beneficiaries are included in the estimates of those subject to work requirements."

Still, the writers conclude that the data "suggest that Medicaid enrollment could plummet rapidly" in Kentucky due to the program's new requirements.

Gov. Matt Bevin's deputy chief of staff for policy, Adam Meier, said in an e-mail that while he couldn't speak for the methodologies used, the differences could be because the Medicaid benefit is so much higher than the SNAP benefit.

"The differences could be attributable to the fact that the state spends approximately $6,700 on average per Medicaid eligible individual—thus it is [a] much richer benefit than SNAP, so there is more incentive to participate," he said.  "Further, it may also be due to the broad spectrum of qualifying activities that can be done to satisfy Kentucky’s community engagement requirement, making it easier to satisfy than the basic SNAP employment and training requirements."

Meier said the SNAP enrollment declines cited weren't simply due to non-compliance, but also because many had improved their personal situation and no longer needed, or qualified, for the program.

"For example, in Kansas, SNAP able-bodied adults without dependents (ABAWDs) subject to the requirements experienced a 127 percent increase in their income within one year of leaving, the average income among those working were now above the poverty line, and enrollees’ average income more than doubled. In addition, nearly one-half of Kansas ABAWDs were employed within one quarter of leaving SNAP, and the amount of time ABAWDs spent enrolled in SNAP was cut in half," he said.

Meier also pointed out that Kentucky's new Medicaid plan does not make any changes to initial eligibility or application requirements, so no one will be barred from enrollment, as the court brief suggests.

Bevin's administration estimates that about half the estimated 350,000 people who will be subject to the work rules are already meeting them. It says an unspecified part of the enrollment decline will come from people failing to meet reporting requirements.

The rules will be phased in, beginning in areas with low unemployment, administration officials have said.

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