Politics & Government

Many might lose coverage if Ky. charges Medicaid premiums, study suggests

Gov. Matt Bevin, right, and health care adviser Mark Birdwhistell unveiled details of Kentucky’s plan to overhaul Medicaid at a news conference last year.
Gov. Matt Bevin, right, and health care adviser Mark Birdwhistell unveiled details of Kentucky’s plan to overhaul Medicaid at a news conference last year. Charles Bertram

A key change that Gov. Matt Bevin wants to make to Kentucky’s Medicaid program could cost a lot of people their benefits based on a study of a similar change made by Indiana, the Kentucky Center for Economic Policy said Tuesday.

The Lewin Group, a health care consulting firm, studied two years of data from Indiana’s federally approved Medicaid waiver, which allows the state to charge Medicaid recipients a monthly premium, just as a private insurer would. People above the poverty line are kicked out of Medicaid for six months if they miss a payment, while people in poverty are transferred to a more limited coverage plan that charges co-payments for services.

More than half of the Indiana beneficiaries required to pay premiums missed at least one payment during that time, the study concluded. The rate of non-payment was highest among people living at or below the poverty line.

“During the first 21 months of the waiver program, 324,840 (or 55 percent) of the 590,315 people eligible to pay didn’t make a required payment at some point. All of them were then kicked off of Medicaid or were left with inferior coverage,” KCEP said on its policy blog.

KCEP is a liberal-leaning think tank based in Berea.

“People didn’t make their (payment) for many reasons, but the most common were that people could not afford the contribution, were confused about the payment process or didn’t know they were required to make a payment,” KCEP said.

A spokeswoman for Bevin had no immediate comment on the study.

Like Indiana’s waiver, the Medicaid waiver that Bevin requested for Kentucky would punish people for missing a premium payment either by locking them out of Medicaid for six months or dropping them to a more limited coverage plan. Recipients initially would have to pay from $1 to $15 a month, based on household income. After one year, people above the federal poverty line would have to pay $37.50 a month.

“Given the findings of the (Indiana study), we can expect large numbers of Kentuckians to be left without coverage if the waiver is approved by the federal Department of Health and Human Services,” KCEP said. “The assessment of the Indiana waiver confirms that both the cost and process of paying premiums is a barrier to coverage for low-income people.”

Kentucky’s waiver application is being considered by the U.S. Department of Health and Human Services. Over the next five years, the changes it would make could shave $2.2 billion off the expected $37.2 billion cost of Kentucky’s Medicaid program, according to the waiver application.

The most controversial measures in Bevin’s plan include premiums and co-pays and a requirement that able-bodied adults be engaged in their communities for at least 20 hours every week, through a job, classes, volunteering or other specified activities.

Also, the final plan continues to classify dental and vision care and over-the-counter medicines as “enhanced benefits” that Medicaid recipients could earn only by performing various tasks. Medical transportation no longer would be covered except for emergencies.

John Cheves: 859-231-3266, @BGPolitics

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