Kentucky seeks stricter Medicaid work requirements

Kentucky is asking the Trump administration for permission to impose stricter work requirements for Medicaid beneficiaries than originally requested, according to an updated plan to overhaul the state’s Medicaid program.

Gov. Matt Bevin (R) this week submitted an amended plan that would eliminate the phase-in period for a controversial work requirement. The waiver would require able-bodied adults without dependents to work at least 20 hours a week to qualify for coverage.  

The 20-hour requirement would start as soon as the waiver is approved. The initial proposal would have started the requirement at five hours a week, gradually increasing to 20 hours after a year.

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Requiring work for benefits is a GOP policy staple, and the party points to welfare and food stamps as a model. But policy experts and advocates say the idea that poor people are taking advantage of the Medicaid system is a false characterization of the state-federal health program for the needy.

The changes to the waiver proposal are aimed at decreasing the cost to the state of running the Medicaid program, which is jointly financed by the federal government. According to Bevin, the changes would save the state $2.4 billion over five years.

The original waiver to overhaul Kentucky’s Medicaid program was submitted last summer, in the waning days of the Obama administration. The waiver sought to implement conservative reforms to slow the state’s spending on the Medicaid expansion, and drew intense criticism from Medicaid advocates that it would harm access to care.

The Obama administration had expressed opposition to work requirements, but the Trump administration is poised to allow unprecedented flexibility for states to remake their Medicaid programs with a conservative bent.

Negotiations with the Trump administration are ongoing, but the administration is expected to eventually grant approval for the waiver.  

Arkansas, Arizona, Indiana, Maine and Ohio are also considering implementing work requirement provisions.

Bevin, a fierce opponent of the healthcare overhaul, was elected on a promise to change the state’s expansion of Medicaid that came as part of the federal health law. Bevin has said the program is not fiscally sustainable, but the state’s uninsured rate has fallen from about 20 percent in 2013 to less than 8 percent by 2016, among the largest coverage gains in the country.

Bevin also requested a six-month lockout if Medicaid beneficiaries get a new job or a new salary and don’t tell the state.  

One provision of the original waiver that remains unchanged is charging people monthly premiums, no matter how little they make. If a person misses a payment, he or she would either be locked out of Medicaid for six months or dropped to a more limited coverage plan.

As an alternative to that monthly premium, enrollees would be able to pay a fixed amount every time they see the doctor.