Sunday, July 1, 2018

460,000 Kentuckians on expanded Medicaid have lost their dental and vision benefits; officials blame judge's ruling against new plan

By Melissa Patrick and Al Cross
Kentucky Health News

One of the major objections to Gov. Matt Bevin's changes in Medicaid was that people who are covered by the program's 2014 expansion would have to participate in certain self-improvement activities to get dental and vision benefits that they had enjoyed for free, starting this week.

A federal judge vacated the plan Friday, but on Sunday those 460,000 Kentuckians lost their dental and vision benefits, because the self-improvement "rewards" program was part of the plan -- and state officials had acted separately to end the dental and vision benefits for those in the expansion.

Family Health Centers in Louisville built a dental clinic after
Medicaid expanded. (Angela Shoemaker, Courier-Journal)
When the plan "was struck down by the court, the My Rewards Account program was invalidated, meaning there is no longer a legal mechanism in place to pay for dental and vision coverage for about 460,000 beneficiaries who have been placed in the Alternative Benefit Plan," said Doug Hogan, a spokesman for the state Cabinet for Health and Family Services.

Hogan said the cabinet "made it clear" that dental and vision benefits were dependent on the plan taking effect, and that without it, "immediate benefit reductions would be required to compensate for the increasing costs of expanded Medicaid. This is an unfortunate consequence of the judge's ruling. Once we ultimately prevail in this legal challenge . . . beneficiaries will have access to these optional services."

The state is expected to appeal the decision of U.S. District Judge James Boasberg of Washington, D.C. Bevin has said the issue will ultimately be decided by the Supreme Court.

Kentucky Voices for Health said the state can't eliminate dental and vision benefits without having the change approved by the federal Centers for Medicare and Medicaid Services, "followed by filing a revised state regulation, holding a public comment period, and providing notice to affected Medicaid members."

Hogan disputed KVH's assertion that the changes are illegal. He said the state posted the changes in April and notified the affected members. The state has long had the authority to make dental and vision coverage optional in Medicaid.

KVH, an organization of lobbying groups, said people affected by the changes have the right to appeal, and suggested that they call their local legal-aid office for assistance and tell KVH about it.

Health Secretary Adam Meier told legislators June 20 that dental and vision benefits would be cut for some people if the court blocked the overall plan. He also said the state would consider cuts to the prescription-drug program, and consider rolling back the expansion, implemented by Bevin's Democratic predecessor, Steve Beshear, which covers people with incomes up to 138 percent of the federal poverty level.

Bevin, a Republican, has said Kentucky will end the expansion if courts block his plan, and has issued an executive order putting the termination into effect six months after the final judgment.

Under the vacated plan, people covered by the expansion were to earn credits for dental and vision care by participating in certain activities, such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion work.

Critics of making vision benefits optional have said it is unwise because Kentucky has one of the highest diabetes rates in the nation, and the disease is often discovered through eye examinations.

Pregnant women, children, those who have been deemed medically frail, former foster youth up to age 26, and people covered by Medicaid before the expansion will get to keep their dental and vision benefits.

Bevin's plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," included, requirements for work, volunteering, job training or drug treatment; monthly reporting; lock-out periods for failure to comply; and premiums and co-payments based on income.

Hogan noted that Medicaid still "offers support and resources for those interested in improving their incomes and health. This ruling does not threaten the opportunities Kentucky HEALTH has already created. We look forward to offering these new resources to Kentuckians on a voluntary basis. You can log on to to take free online courses about health skills, life skills, and work skills. You can also visit to find a career center near you, where a coach can help you find training, education, and job opportunities in your area."

For most of the 1.4 million Kentuckians on Medicaid, the program remains the same for now -- no premiums or co-payments, no deductibles, no reporting requirements and no requirements for work or other "community engagement." Managed care organizations will be charging co-payments for services, according to a state document issued to call-centers and front-line staff. 

If you are one of the 300 or so Kentuckians on Medicaid who had already paid their premiums, the Kentucky HEALTH website says your managed-care organization will provide you further information about what to do.

County totals of people on Medicaid, the expansion and other categories is at

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