Kentucky is known nationally for reducing the percentage of people without health insurance — from 20.4 percent uninsured in December 2013 to 7.5 percent in December 2015. What is needed to sustain these gains? Making insurance — and health care — harder to access is not the answer. Making health care delivery more cost-effective is a better path.
Newly insured individuals and families living near or below the federal poverty level often have poorer health and years, perhaps a lifetime, of being uninsured. Even with insurance, low income Kentuckians are less likely to have paid sick leave, reliable transportation or a bank account. Overcoming these obstacles often means a more substantial time investment and wages lost, to get insurance coverage and timely care.
A sustainable Medicaid reform plan must be grounded in an understanding of who Kentucky’s low income families are — their resources and challenges — and designed to offer timely, accessible and cost-effective care. Healthy Kentuckians are better able to learn and be more productive on the job.
The current version of Kentucky HEALTH, the Medicaid reform plan being developed, has several pluses:
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▪ Expansion of substance use treatment services.
▪ Incentives to encourage healthy behaviors, such as quitting smoking.
▪ Changes to Medicaid managed care organization contracts and processes to control costs, streamline administration, move from volume- to value-based reimbursement.
Research shows that some features of Kentucky HEALTH, however, would create more barriers for low-income Kentuckians and likely make the state’s health and health disparities worse. Among them:
▪ Cutting dental and vision benefits in the core Medicaid package could increase emergency room use and leave preventable health problems unaddressed.
▪ Removing retroactive eligibility will leave Medicaid-eligible individuals (especially those with chronic conditions) without coverage and providers who serve them unpaid.
▪ Monthly premium requirements are especially problematic for those living below the poverty level without a permanent address or bank account.
▪ Penalties (lockouts and copayments) for failure to pay Medicaid premiums or enroll on time risk care delay and increased illness.
▪ Mandatory work and volunteer requirements — 52 percent of Kentucky Medicaid families have at least one full-time worker in the home, and an additional 14 percent have part-time workers. Instead, let’s offer expanded, accessible job training and referral services for those who need them.
▪ Loss of non-emergency transportation to and from medical services, especially important in rural communities.
Medicaid reform is an opportunity for Kentucky to try evidence-based approaches that meet the purposes of federal waivers: increasing coverage and access for low-income individuals, improving health outcomes and yielding sustainable cost savings.
Let’s build on solutions already being tried in Kentucky: better integration of primary, behavioral and oral health care; information technology for telehealth, coaching and tracking; increased price transparency for providers and consumers; and permitting care to be delivered more effectively and efficiently, while engaging community partners and members to support healthier communities and more equitable outcomes.
Done right, Kentucky can continue to be a national model for Medicaid reform.
Susan Zepeda is president and CEO of the Foundation for a Healthy Kentucky.
Give your comments
Comments on the Medicaid proposal can be sent this week to firstname.lastname@example.org or by mail to Commissioner Stephen Miller, Department for Medicaid Services, 275 E. Main St., Frankfort, Ky. 40621. There will also be a 30-day public comment period after the plan is sent to the federal government.