State restores dental, vision and non-emergency transportation benefits for 460,000 people covered by 2014 Medicaid expansion

Susan Wells of Louisville, who lost her dental benefits during a
series of extractions of decayed teeth, got them out at Shawnee
Christian Healthcare. (Photo: Mike Clevenger, Courier Journal)

By Al Cross
Kentucky Health News

State officials reversed course Thursday and said they would resume paying dental, vision and non-emergency medical transportation costs for 460,000 Kentuckians on expanded Medicaid.

The benefits were supposed to become optional July 1, under a new Medicaid plan in which those members could regain the benefits by participating in certain self-improvement activities, such as 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, which began in 2014, work.

On June 29, two days before the overall plan was to take effect, a federal judge in Washington, D.C., blocked it, and state officials said that left no way for people to earn the benefits, or for the state to keep providing them.

The abrupt change created confusion, chaos and complaints. Democrats demanded that the administration of Republican Gov. Matt Bevin restore the benefits. At 5:40 p.m. ET Thursday, the Cabinet for Health and Family Services issued a press release saying that it would.

In a statement that quoted no one directly, the cabinet said "We had hoped for a quick federal re-approval" of the plan, which it calls Kentucky HEALTH for "Helping Engage and Achieve Long-Term Health." However, this week federal officials said they would not act for at least 30 days, as they sought more public comment on the plan. That move that could allow them to submit evidence aimed at overcoming the judge's concerns that they had not addressed the state's forecast that the plan would cause tens of thousands of people to lose their medical coverage.

Since "the program will not begin as soon as we hoped," the cabinet said, "In order to mitigate the consequences of the judge’s ruling, and avoid a prolonged coverage gap prior to the re-approval of Kentucky HEALTH, we have begun the process to reinstate vision and dental coverage, as well as non-emergency transportation services, for those whose benefits were affected by the June 29 court action."

The cabinet said it had "spent the last few weeks working on a temporary solution for restored benefits to be implemented by Aug. 1," and "is close to completing a manual system work-around that will allow payment of claims incurred by any eligible Medicaid beneficiary for dental, vision, and non-emergency transportation services incurred during the month of July."

The issue arose in the latest skirmish between Bevin, who has not said whether he will seek re-election in 2019; and Democratic Attorney General Andy Beshear, who announced his candidacy for governor this month, and Beshear's father, who expanded Medicaid under the Patient Protection and Affordable Care Act when he was governor in 2014.

When Bevin doubled a $500,000 contract with a Cincinnati law firm to investigate Steve Beshear's administration, the ex-governor said Bevin “has now decided to waste another half a million dollars and another two years to continue his fruitless search. Mind you, a million dollars wasted at a time when he is ripping vision and dental care away from hundreds of thousands of Kentuckians.”

State officials have said that about 10 percent of the eligible beneficiaries use those benefits.

"Advocates were delighted with the prospect that dental benefits would be restored," Deborah Yetter reports for the Louisville Courier Journal, quoting Jennifer Hasch, manager of dental services for the Shawnee Christian Healthcare Center in West Louisville: "That is such good news. I think people are going to be thrilled. I think it's weight lifted for our office, both for our patient population and our team."

Yetter writes, "While health advocates say all three services cut—dental, vision and transportation are important—the loss of dental services were most critical because of the very poor dental health of some Kentuckians and the fact that dental abscesses and infection can be life-threatening."

The legislature's top Democrat, House Minority Leader Rocky Adkins, told the Lexington Herald-Leader, “The governor and his administration were wrong to blame this cruel action on the federal court ruling . . . but I’m glad they appear to be back on the right track. I’m hopeful that our citizens will not be faced with the devastation of losing these benefits again.”