Bevin should refocus Medicaid plan on improving health outcomes

Warnings from nonprofits about the burdens and costs that Gov. Matt Bevin’s Medicaid plan would impose on Kentucky’s charities come as a timely reminder: Bevin’s best proposals — reforms that would do the most to improve Kentucky’s health outcomes — can be accomplished without permission from the federal government or building costly new bureaucracies.

Nonprofits are worried about the governor’s proposal to promote “community engagement” by requiring able-bodied, working-age adults to work or volunteer in exchange for Medicaid coverage. The requirement would be 20 hours a week of work or volunteering after a year on Medicaid and would be phased in slowly, county by county. Also, under Bevin’s plan, volunteering is one way that Medicaid participants could earn dental and vision care.

A “back-of-the-envelope calculation” by Richard Seckel, Kentucky Equal Justice Center director, reveals the practical challenges. Medicaid covers 1.3 million Kentuckians. Of the roughly 400,000 adults who gained Medicaid through the 2014 expansion, more than half are working. Others are medically frail and would be exempt from the requirement. Say 100,000 would be subject to the requirement.

If just 10,000 were part of a pilot project, it would require that 10,000 nonprofits take one volunteer, 5,000 nonprofits take two or 1,000 nonprofits take 10.

An Aug. 14 letter from Danielle Clore, executive director/CEO of the Kentucky Nonprofit Network, to Bevin aide Adam Meier lays out costs and complications.

While volunteers are prized by many nonprofits, they must be trained and managed. Organizations employ volunteers a couple of hours a week, seldom more than 10 hours a week. Some organizations require and pay for background checks and medical and drug tests for volunteers. There’s no provision for reimbursing charities for any of these new costs under Bevin’s plan.

As one nonprofit official said, “Funding is down and demand for our services is up — some of our former donors and volunteers are now recipients of our programs. ... We are not eager for more unpaid assistance from folks volunteering only because they are trying to earn enough credits for a root canal.”

Volunteer opportunities and public transportation are severely limited in many counties.

And a system for recording hours worked or volunteered would have to be developed, diverting public funds better spent on health care.

The federal government has made clear that it will reject a work or volunteerism requirement as a condition for receiving health care through Medicaid which uses mostly federal dollars to cover low-income and disabled people. Also, the feds are likely to reject Bevin’s proposal to cut people off Medicaid for failure to pay new premiums on time.

The good news: Bevin can — and should — accomplish his smartest proposals — promoting prevention, curbing emergency room overuse, better managing chronic diseases that disable so many Kentuckians — without going through the lengthy process of gaining federal approval for a Medicaid demonstration project.

Everyone agrees that work and community engagement are life-enriching. Reasonable people will also agree that the costly unfunded mandate imposed on nonprofits by Bevin’s plan is impractical and unjustified by potential benefits. This poorly thought out provision could have been averted by consulting nonprofits on the front end.