Sixteen of Kentucky’s Medicaid recipients are suing the federal government to stop Gov. Matt Bevin from adding work requirements, premiums, coverage lock-out periods and reporting duties for able-bodied adults in the state’s $9.7 billion-a-year Medicaid program.
A similar group of plaintiffs successfully blocked Bevin’s Kentucky HEALTH initiative last June. U.S. District Judge James Boasberg in Washington, D.C., halted the roll-out, ruling that the federal government “never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders (the government’s approval) arbitrary and capricious.”
In November, the U.S. Centers for Medicare and Medicaid Services re-approved Bevin’s Medicaid waiver proposal with minor changes, prompting the amended lawsuit that was filed Monday, again in Boasberg’s court in Washington. Bevin has tried unsuccessfully to get the legal battle moved to Kentucky.
The lead plaintiff in the action filed Monday is Ronnie Maurice Stewart, 63, a medically frail Lexington man who lives on $16,642 a year in Social Security benefits and part-time wages from Goodwill Industries.
The suit says Stewart has needed Medicaid to pay for treatment for diabetes, arthritis, high blood pressure and cataracts. He works 60 hours a month at Goodwill, which falls short of the 80-hour-a-month work requirement that Bevin seeks to impose. And he will face a monthly premium under Kentucky HEALTH that gradually will rise from $8 to $15.
“Premium payments are a significant concern for Mr. Stewart,” the suit says. “He thinks he can afford the premium so long as he is able to continue working part-time. But if he is unable to pay the premium, his My Rewards account (paying for vision and dental coverage) will be suspended.”
The plaintiffs are represented by the Kentucky Equal Justice Center, the Southern Poverty Law Center and the National Health Law Program. The defendants are CMS, the U.S. Department of Health and Human Services and their top administrators.
By the state of Kentucky’s own estimate, roughly 95,000 would lose Medicaid coverage within five years of Kentucky HEALTH taking effect, the plaintiffs argued in their amended complaint. In Arkansas, which imposed similar work requirements and co-pays last year, at least 17,000 people have lost their health coverage so far, the plaintiffs said.
“The Trump administration’s desire to explode Medicaid and transform it into a work program seems to have no limits. After being declared arbitrary and capricious last year, the administration has now issued a virtually identical re-approval letter; it should face a similar fate and be declared illegal,” said Samuel Brooke, deputy legal director of the Southern Poverty Law Center.
The reporting requirements alone — the monthly burden of checking in with state officials — can lead to problems for the working poor who rely on Medicaid, according to the Kaiser Family Foundation.
“Early experience in Arkansas, the first state to implement a work requirement in Medicaid, shows that the challenges of reaching and informing enrollees about new requirements and enrollee difficulties of navigating the online monthly reporting process and finding stable work can result in significant coverage losses,” Kaiser reported last week.
Bevin’s office did not immediately respond Tuesday to a request for comment.
In a prepared statement, the Kentucky Cabinet for Health and Family Services said: “The cabinet is not surprised by the refiling and will continue to work toward implementation of the Kentucky HEALTH waiver. Kentuckians, and specifically our Medicaid members, deserve a Medicaid program that will improve health outcomes and provide paths for employability, long-term stability, and future success while also ensuring the long-term sustainability of Medicaid for those who need it most.”
Bevin has promoted Kentucky HEALTH by saying able-bodied adults on Medicaid will be healthier if they are engaged in their communities as workers, volunteers or students, and if they contribute toward the cost of their care. Monthly premiums would begin at $1 to $15, eventually topping out at $37.50
“This idea that we are somehow punishing people — that somehow this will be a detriment to people — I think is a huge, huge misunderstanding of what people need, the dignity and the respect that comes from giving people an opportunity,” Bevin told reporters earlier this year.
Bevin repeatedly has threatened to terminate Kentucky’s expanded Medicaid program for more than 400,000 low-income adults if the courts prevent him from going forward with Kentucky HEALTH.
More than 1.3 million Kentuckians were enrolled in Medicaid last fall, about 30 percent of the state’s population. That includes the traditional Medicaid program covering the disabled, the elderly and families with dependent children, and the expanded Medicaid program, approved under the Affordable Care Act, covering able-bodied, low-income adults, many of them workers who are not provided with health insurance by their employers.
The percentage of private sector jobs in Kentucky that came with health insurance fell from 70 in 1980-82 to 54 in 2014-16, according to research by the Kentucky Center for Economic Policy in Berea.