Sudden Ky. Medicaid cutbacks done without adequate public, federal input

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Monday morning, Kentucky’s Medicaid beneficiaries and providers woke up to a surprising new reality: Dental, vision and medical transportation services were no longer to be covered. These services were covered on Friday, the last weekday before new rules were set to kick in and the day a federal court ordered those new rules to be invalid.

Baffling, yes.

But how did we get here?

On April 23, Kentucky submitted a state plan amendment to the Federal Centers for Medicare and Medicaid Services that outlined its plan to reduce benefits for the expansion population. It would only allow dental and vision services to be paid for through a new rewards scheme and do away with non-emergency medical transportation altogether.

The rewards scheme was part of the Kentucky HEALTH waiver, and not too surprising, except for two things:

First, no one was aware this amendment had been submitted. It was not mentioned by the state in the two stakeholder forums held after this date, nor could anyone find it on their website or other repositories of state actions.

Second, the amendment had not yet been approved by CMS, so whether it could go into effect or not was shaky. After all, there were no state regulations to support such an action, either.

Regardless of those issues, the district court’s decision handed down June 29, which invalidated the Kentucky HEALTH plan in its entirety, certainly made this plan amendment moot.

In effect, it truly did force the state to take a different course of action. If the state is so confident that the waiver will be implemented soon after making only a few tweaks to the wording (another shaky proposition), the prudent course of action would have been to simply withdraw the plan amendment and allow benefits to continue until such time. After all, there were still (at that time) no state regulations to support such an action.

Ah, but an emergency regulation did magically appear on July 2, stripping dental, vision and non-emergency medical transportation entirely from almost the entire expansion population.

Not publicized, mind you. You have to go dig for it in the basement of the Capitol Annex. It references the need to do so based on the approval of the state plan amendment that was also not publicized and no one can seem to find.

To reiterate and emphasize, the state had two options here. Withdraw the plan amendment and go back to the drawing board, or make a last-minute change that reduces the benefits and access of nearly 500,000 vulnerable Kentuckians.

A change with no warning to providers, no notice to beneficiaries, no approval from the federal government, no legislative input through the regulation promulgation process, and no chance for public input.

This is not how government is supposed to work. If it’s all on the up and up, just show your cards. Their reasons for doing so are for the administration to answer, but it’s callous and reactionary at best. Saving money can’t be one, since they like to tout the fact that too few beneficiaries were utilizing dental services.

Right after taking my current position at Kentucky Voices for Health in March, a former coworker who still worked with the administration on the Kentucky HEALTH project promised that this process would be completely transparent. We’re hoping one day to see that.

Jason Dunn is policy analyst for Kentucky Voices for Health, a nonprofit coalition focused on consumer advocacy.