The Affordable Care Act expanded Medicaid eligibility in January to nearly all low-income adults in states that chose to participate, and several hundred thousand Kentuckians swiftly enrolled.
The United States government is picking up the bill for expanded Medicaid for now. But the federal share will drop to 95 percent in 2017 and to 90 percent in 2020. The state of Kentucky, which struggles to pay $1.3 billion a year for its 30 percent share of traditional Medicaid costs, will have to dig even deeper as Uncle Sam gets less generous.
How much will that cost Kentucky? Pressed for answers by state lawmakers, Democratic Gov. Steve Beshear's administration says it does not yet know.
"What is that going to translate to in terms of dollars, that 5 percent and 10 percent, respectively?" Sen. Chris McDaniel, R-Taylor Mill, asked in July at a legislative state budget hearing in Frankfort.
"Yeah, I don't — I don't have those numbers," state Medicaid Commissioner Lawrence Kissner replied.
"Do you have a rough guess of where we will be at?" McDaniel asked.
"I don't, no," Kissner said.
In a Sept. 8 letter to Senate budget Chairman Bob Leeper, a Paducah independent, Kissner said the state Department for Medicaid Services will have a cost estimate available for lawmakers "in the coming months, after the newly insured population has stabilized."
The Beshear administration offered an initial estimate for expanded Medicaid costs in a spring 2013 report from the state Cabinet for Health and Family Services. In that report, state officials predicted that Kentucky would have to pay $33 million in Fiscal Year 2017, as the federal match began its decline. In 2020, when federal payments dropped to 90 percent, or $1.36 billion, Kentucky would have to find $151 million for its share.
However, those sums were based on the theory that about 147,000 Kentuckians would enroll in expanded Medicaid this year, eventually climbing to about 187,000. By July, the actual enrollment was 316,692.
"Kynect was a tremendous success, and we experienced greater enrollment than we originally anticipated," cabinet spokeswoman Jill Midkiff said Friday.
"And unlike individuals in traditional Medicaid, about whom we have much data, individuals who qualified for the Medicaid expansion are a population about which we know very little. As a result, it will take more than a few months of claims data to identify reliable trends for those who are newly insured as a result of the expansion," Midkiff said.
Offsetting the added expense, the same 2013 report also predicted tens of millions of dollars in annual savings for the state budget as a result of expanded Medicaid. Many medical expenses for which the state previously was responsible — including care for prisoners, foster care children and poor adults at hospitals and other facilities — largely can be shifted to the federal government under the health care law, the cabinet said.