Bevin administration submits revised Medicaid waiver proposal to federal government

Gov. Matt Bevin submitted the Section 1115 demonstration waiver known as Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) to the Secretary of the Department of Health and Human Services, Secretary Sylvia Burwell Wednesday.

The waiver will put Kentuckians on a path to better health outcomes, ensure long-term sustainability of the Medicaid program and familiarize members with commercial insurance and prepare them for self-sufficiency, according to a news release from the Governor’s office.

“The submission of this waiver is the result of many months of extensive research, planning and time spent traveling the state listening to Kentuckians,” said Bevin. “Kentucky HEALTH will allow us to continue to provide expanded Medicaid coverage, but unlike the current Medicaid expansion under Obamacare, it will do so in a fiscally responsible manner that ensures better health outcomes for recipients.”

This submission comes after an extensive public comment period that included three formal public hearings (only two were required), several public legislative hearings and an extended comment period to ensure that every interested Kentuckian could have their voice heard.

During the public comment period, the Cabinet for Health and Family Services held public hearings in Bowling Green, Frankfort and Hazard.

In addition to the public testimony, the Cabinet also received nearly 1,350 written comments. In response to those comments, several changes were made to the waiver application.

Highlights of those changes include:

— In response to the topic that received the most comments by far: allergy testing and private duty nursing will continue to be covered services.

— The implementation of changes to the dental and vision benefit will be delayed by three months to allow members additional time to accrue funds in their My Rewards Account.

–Individuals determined “medically frail” will be exempt from required premiums and copayments.

— GED testing costs will be added as an additional covered benefit for Kentucky HEALTH members.

— The list of activities resulting in contributions to the My Rewards Account will be expanded to include caretaking responsibilities, passing the GED and ensuring children receive recommended preventative services, like immunizations.

— Sliding scale premiums will be collected on a household basis (not individual basis).

In addition, several existing policies were clarified to address misconceptions in the public comments:

— Benefits will not change for children, pregnant women, medically frail and adults eligible for Medicaid before expansion.

— Full-time students or individuals working more than 20 hours per week are already meeting the community engagement and employment requirements.

— Smoking cessation benefits are not reduced under the waiver.

— Disabled individuals receiving waivers or SSI will not be impacted by the waiver.

CMS has 15 days from the date of submission to acknowledge that the waiver has been submitted correctly. There will then be a 30-day federal comment period similar to the public comment period Kentucky recently conducted. After that time, the Medicaid statute provides authority for the Secretary of HHS to approve the waiver at any time.

Beginning next year, Kentucky taxpayers must begin paying a portion of Medicaid expansion costs for the first time. The prior administration unilaterally implemented Medicaid expansion without a plan to pay the additional $1.2 billion in new state spending for fiscal years 2017 through 2021 necessary for the program.

Kentucky HEALTH will help improve health outcomes while ensuring the long-term viability of the Medicaid program, the administration says.

Click here to read the full Medicaid waiver.

The Foundation for a Healthy Kentucky responded to the revised waiver proposal:

“On a first reading of the proposal, we find that some of the concerns expressed in our initial comments have been addressed, while others remain.  We are pleased that the term ‘medically frail’ is better defined and that this population is excluded from paying premiums and copayments.  We are also pleased to see that there is a cap for family premiums. 

“In regard to work requirements, we are glad to see that individuals who are already working more than 20 hours per week will not be required to perform community service or other job training activities as a condition of continued enrollment.  Additionally, we support the exclusion of primary caregivers of disabled adult dependents from the community engagement and employment requirement, and the inclusion of a provision that primary caregivers of elderly parents will count toward that requirement.  Further, we applaud the administration’s inclusion of GED testing costs. 

“We remain concerned, however, about a number of elements that are unchanged in the proposal, including the exclusion of dental and vision benefits in the standard benefits package, anticipated significant drops in Medicaid enrollment, elimination of retroactive eligibility, lock-out periods, loss of non-emergency transportation, and re-enrollment requirements and penalties for those who fail to pay mandated premiums.”