Bills aim to stop people from coming to Ky. to have Medicaid pay for addiction treatment; programs could have to get them home

By Melissa Patrick
Kentucky Health News

A bill aimed at preventing people from coming to Kentucky solely to establish residency so that they can sign up for drug treatment to be paid for by the federal-state Medicaid program passed unanimously out of the state House Health Services Committee Thursday, Feb. 22.

Rep. Shane Baker

Rep. Shane Baker, R-Somerset, said House Bill 408 was born out of a situation in Pulaski County that has been repeated in "many other communities" and added to homelessness in Kentucky.

It's "an issue of people recruiting individuals from out of state and bringing them to the commonwealth, putting them on Kentucky Medicaid in a drug- treatment facility and then when they're finished, they're homeless on our streets," he said.

The bill would prohibit someone from relocating to Kentucky solely for the purpose of receiving medical services using Medicaid. 

Pulaski County Government Public Information Officer John Alexander told the committee that local governments want to make sure that anyone who leaves the treatment programs are able to return home. 

"If they bring someone from out of the community, especially out of the state, the basic, humane thing to do is that if they don't make it in the program, for whatever reason, that they are able to find their way back home," Alexander said.

Actiong Somerset Police Chief John Wesley said law enforcement has had to deal with such people stealing vehicles or engaging in other crimes in efforts to return to their home community. 

The Kentucky Association of Independent Recovery Organizations told Kentucky Health News that they share many of the concerns that this bill addresses: "KAIROS is aware of the problems many of our communities face with substandard, and often times unethical, practices implemented by some less-than-reputable recovery providers across Kentucky, and we share many of these same concerns. 

"We appreciate the efforts of Rep. Baker with HB 408 and Sen. [Phillip] Wheeler with his companion bill, SB 71, to address this issue. These bills and others pending in the General Assembly will go a long way in closing the loopholes that unsavory actors have used to exploit people at their most vulnerable, when they could be getting lifesaving help from reputable, evidence-based providers."

SB 71 was approved by the Senate Health Services Committee on Feb. 21 and awaits a vote on the Senate floor. Its sponsor is a Republican from Pikeville.   

HB 408 would require the recovery facility to provide transportation for the individual to get them back home if they "voluntarily" leave the treatment program. The bill list several ways this could happen, including the engagement of a mobile response team.

The bill also has provisions to ensure that these recovery facilities don't recruit patients who are on Medicaid. Baker said changes made in committee moved the penalties from the individual to the provider. 

If passed, the bill would prohibit treatment centers or programs licensed as a chemical-dependency treatment service from recruiting out-of-state residents if they are enrolled in Medicaid, or with the purpose of enrolling them in Kentucky Medicaid.

It would require the facility to submit the recipient's proof of residency when submitting a request for Medicaid reimbursement, and says any out-of-state resident found to be ineligible for Kentucky Medicaid as a result of failure to establish Kentucky as their official residence must reimburse the state for any Medicaid fees that have been paid on their behalf. 

The recovery program would be fined not less than $500 for each day an out-of-state resident received Medicaid services in Kentucky, and face a general fine of $20,000 per offense. 

Rep. Lindsey Burke, D-Lexington, suggested that the bill exclude people who have significant ties to Kentucky or ones that previously lived here.

"Perhaps we wouldn't want to include them if this is the best community for them to return to, to gain sobriety," she said. "So I don't know if there's an opportunity to create an amendment that someone who has substantial connections here may not be subject to this provision or not." 

Baker said they would look into that. Rep. Kim Moser, R-Taylor Mill, chair of the committee and a co-sponsor on the bill, said she wasn't sure if this is something they could resolve in this bill.