Wanting Medicaid beneficiaries to have some “skin the in game” is a popular political position among many Republican governors. That “skin” often translates into wanting adult beneficiaries to work or volunteer, pay premiums, and copays.

In August 2016, Kentucky GOP Gov. Matt Bevin submitted a Section 1115 Medicaid waiver to the Centers for Medicare & Medicaid Services. Some of Bevin’s requirements include having childless adult Medicaid beneficiaries work, volunteer, or take worker training. Other requirements include monthly premiums, health accounts, and a plan for member noncompliance.

The program, called Kentucky HEALTH, reportedly would save $126,400,000 during the first year of the waiver, increasing to $803,300,000 during the fifth year. The program is projected to save taxpayers $2.2 billion over the five-year waiver period (Kentucky HEALTH: Helping to Engage and Achieve Long Term Health, accessed Oct. 20, 2016).

Many of Kentucky’s requests are somewhat similar to what Indiana received from CMS for its Medicaid expansion waiver, but Bevin’s work requirement will be dead on arrival.

A Medicaid work requirement will take congressional action, according to a panel of Medicaid directors at the Americas Health Insurance Plans National Conference on Medicaid held in Washington, D.C., Oct. 26-27. In fact, New Hampshire learned in early November that CMS had denied its Medicaid work requirement waiver request.

Bevin has said he would repeal the state’s Medicaid expansion under the Affordable Care Act if CMS does not approve the waiver as is. Former Democratic Gov. Steve Beshear expanded Medicaid through an executive order, and as such, Bevin can repeal the expansion by a similar order. Bevin, who took office in December 2015, campaigned on scaling back or undoing the expansion.

Thus, things have turned into a ‘who will cry uncle first’ situation between the state and CMS. But if Bevin follows through on his threat to repeal Kentucky’s Medicaid expansion under healthcare reform, which has helped decrease the state’s uninsured rate from 14.8 percent in July 2013 to 7.4 percent in January 2016 (Decision Resources Group data), these newly insured will be the real ones crying.

 

Follow Joyce Caruthers on Twitter @JCaruthersDRG.

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