Kentucky will be the first state to embrace new guidelines that allow states to require Medicaid recipients to either work or engage in community service in order to receive coverage.
The new rule requires able-bodied, working-age Medicaid recipients to complete 80 hours of “community engagement” per month to keep health coverage. This includes going to school, working a job, volunteering, or taking a job-training course.
Recipients will also be required to pay a small premium ($1-$15 per month), and they will only have access to vision and dental if they participate in certain “reward programs” – such as getting a physical once per year, participating in an anti-smoking program, or completing a weight management course. These “reward programs” reflect concerns about public health in Kentucky, which lags behind the rest of the country in 33 of 41 health indicators.
The new rule eliminates non-emergency transportation benefits designed to help poor people get to doctors and hospitals and ends “retroactive” eligibility, which pays for bills accrued just before a person signs up for Medicaid.
The Centers for Medicare and Medicaid Services approved the new changes Friday, just one day after the Trump Administration announced the new guidelines. The agency is currently reviewing similar proposals from at least 10 other states.
“There is dignity associated with earning the value of something that you receive,” says Kentucky Governor Matt Bevin (R), who argues that Medicaid fosters dependency. “The vast majority of men and women…want the dignity associated with being able to earn and have engagement.”
Bevin’s office estimates that taxpayers will save $300 million over the next five years, and that 95,000 Kentuckians will lose Medicaid benefits because they will either fail to meet the new requirements or get a job that pushes them out of the low-income bracket. Those who fail to meet payments or fail to prove eligibility will be allowed to reapply in six months.
“The result will be a transformational improvement in the overall health of our people and will provide a model for other states to follow,” said Bevin.
Those exempt from the new rule include: children, full-time students, former foster care kids, pregnant women, the elderly, the infirm, primary caregivers, and those struggling with drug or alcohol addiction.
There are currently about 1.25 million Medicaid recipients in the state of Kentucky (including children). This number doubled in 2014 when Bevin’s Democratic predecessor, Steve Beshear, used the Affordable Care Act to expand Medicaid coverage.
Democrats insist Kentucky’s new rules will take coverage away from the people who need it most.
“The policy could allow many people to fall through the cracks, including those with chronic health conditions and those with mental health or substance use disorders such as opioid addiction,” complains Hannah Katch of the Center on Budget and Policy Priorities. “And for those who are eligible for an exemption, the policy could still require someone who is medically frail, for example, to jump through administrative hoops to demonstrate that they are eligible for an exemption.”
Author’s Note: The Trump Administration’s new guidelines are a major shift from the Obama Administration, which added 12 million Americans to Medicaid but prevented states from imposing work requirements.
Over 70 million Americans are currently enrolled in Medicaid, but none are required to work. This is an unsustainable system that is driving up our national debt.
Requiring certain recipients to work just 80 hours a month isn’t asking much, especially considering the fact that most working age, able-bodied recipients already have jobs.