Politics & Government

Many Kentuckians face ‘significant barriers’ under Bevin’s Medicaid plan, study says

Ronnie Maurice Stewart is one of 16 Kentucky Medicaid recipients suing in U.S. District Court in Washington, D.C., to block changes that Gov. Matt Bevin wants to make to the state’s Medicaid program. Stewart lives in Lexington.
Ronnie Maurice Stewart is one of 16 Kentucky Medicaid recipients suing in U.S. District Court in Washington, D.C., to block changes that Gov. Matt Bevin wants to make to the state’s Medicaid program. Stewart lives in Lexington. Charles Bertram

Of the more than 350,000 Kentuckians most likely to be affected by Gov. Matt Bevin’s new Medicaid rules taking effect in July, many already have jobs but fall short of the 80-hour-a-month work requirements, while others are unemployed and face age- and health-related challenges in getting hired, according to a new study released Friday.

“These are significant barriers,” said Anuj Gangopadhyaya, a research associate at the Urban Institute’s Health Policy Center in Washington, D.C., who worked on the study.

The federal government has approved Bevin’s plan to require able-bodied adult Medicaid recipients either to work or perform other kinds of “community engagement” and to pay monthly premiums or risk being locked out of their insurance coverage. Fifteen Kentuckians on Medicaid are suing in U.S. District Court to block Bevin’s plan.

To learn more about who might be affected by Bevin’s plan, the Urban Institute said it analyzed U.S. Census survey data provided by Kentucky residents to draw conclusions about the 653,000 adults age 19 to 64 enrolled in Medicaid.

The study concluded that of those 653,000 adults:

▪  310,000 might be exempt from the plan because they are considered disabled – nearly half of this group is enrolled in a federal disability benefits program – or because they are students or primary caregivers for children or for someone who is disabled.

▪  169,000 are employed. But only 64 percent reported working at least 20 hours a week for 50 weeks in the previous year, which is what would be required to keep their Medicaid coverage under Bevin’s plan. That means 36 percent of this group did not work enough to meet the minimum threshold.

Gangopadhyaya said seasonal jobs and minimum-wage jobs with high turnover can result in low cumulative hours. Workers sometimes must stitch together whatever labor is available. Workers also can have problems finding reliable child care: Nearly half of this group reported having children under age 18.

“It’s not that they won’t work. They’ll work when there’s a job on the table, but in some cases, there isn’t always a job on the table,” Gangopadhyaya said.

Also worth noting, he added: Despite being employed, 41 percent of this group have incomes under the federal poverty level.

“You can work and still be in poverty. The two are obviously not mutually exclusive,” he said.

▪  188,000 are unemployed, which is the key sector that Bevin says he hopes to reach with his Medicaid plan and steer into the workforce.

However, of this group, nearly half – 48 percent – are older than 50; 41 percent report mental acuity limitations, such as having trouble concentrating, remembering or making decisions; and 26 percent said they have physical difficulty walking or climbing stairs. Also, 25 percent do not have a high school diploma; 26 percent do not have Internet access; and 12 percent lack access to a vehicle.

Not having Internet access could be a problem, because the Bevin administration expects a new website that it has created to be the portal that many Medicaid recipients use to report their work hours and current incomes as required and, if necessary, look for jobs in their areas.

“Those who are most likely to be affected by these changes — it’s this group, the people who are relatively older, who are less healthy, less informed, more isolated, so they’re going to have a much harder time fulfilling the obligations expected of them,” Gangopadhyaya said.

The largest portion of unemployed, able-bodied Medicaid recipients – 58,000 adults, or roughly one-third of the total – lives in Eastern Kentucky, an area known for its “persistent poverty counties,” according to the study. So that is where they will be looking for work in the months ahead. By contrast, only 7,000 people from this group live in Lexington, according to the study.

John Cheves: 859-231-3266, @BGPolitics

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