While a court in Washington mulls its constitutionality, lawmakers in Frankfort should nail down the practical details of Gov. Matt Bevin’s Medicaid revamp recently approved by the Trump administration.
Aside from legal questions raised by a lawsuit filed against the Trump administration on Wednesday, there are a bunch of other questions that not only haven’t been answered, they haven’t been asked, starting with costs, timetable and lines of responsibility.
The legislature should bring Kentucky stakeholders to the table for this discussion. A stakeholder advisory board could help assure a smooth transition to Bevin’s Kentucky HEALTH demonstration waiver, assuming, that is, that the administration wants a smooth transition.
While the shorthand for Bevin’s plan is “work requirements,” the system, set to launch in July, is really a grossly complicated set of rules tailored to snare low-income people in record-keeping errors, missed deadlines and missed premium payments; such failures can cost them their health care, even if they are otherwise eligible for Medicaid and working.
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Kentucky faces a budget crisis that, among other things, threatens the ability of some schools to run buses. The legislature owes it to Kentuckians to account for the unspecified millions of dollars that will go into building the bureaucracy and technological capacity to run the Medicaid changes.
Lawmakers need to know how much of the cost will be borne by the federal government and how much by the state; how the new responsibilities will be divided among state agencies, managed care organizations and health care providers, and how much work remains to be done to get the system up and running.
The potential for glitches and confusion is huge, and the consequences dire for patients, health-care providers and taxpayers. Think back to the “unforseeen technical issues” that plagued rollout of the $101 million Benefind system and disrupted the security of thousands of vulnerable Kentuckians in 2016. Before that, the rollout of managed care Medicaid strained the finances of health-care providers, threatening the survival of some rural hospitals.
The Bevin administration estimates that in five years, the equivalent of 95,000 fewer low-income Kentuckians will be covered by Medicaid, although the actual number of people who will temporarily lose health coverage is likely to be much higher. Failing to report a change of income, for example, even if the person is still eligible for Medicaid, can result in being locked out for six months. Going for six months without blood pressure or diabetes medicine ensures that the person will be sicker — and more expensive to treat — upon being restored to Medicaid.
All Medicaid enrollees will have to repeatedly prove their eligibility, although even Bevin says only “a small subset” is shirking opportunities to work. The new system also will have to track a rewards program that lets people earn vision and dental care by participating in certain activities. The complexity all but guarantees that some people will lose health care because of breakdowns in the record-keeping system.
Bevin, who brags of ending government red tape, is building a red-tape-o-rama designed to deprive Kentuckians of health care. Lawmakers should ask questions.