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Bevin Announces First Steps Toward Medicaid Expansion Changes

Gov. Matt Bevin
J. Tyler Franklin
Gov. Matt Bevin

Gov. Matt Bevin on Wednesday said he intends to ask the federal Centers for Medicare and Medicaid Services to "transform the way in which Medicaid is delivered in Kentucky."

Reshaping the Medicaid expansion instituted by his predecessor, Steve Beshear, was a key promise of Bevin's earlier this year as he sought the governorship.

He said the state will apply for a waiver — either what's called a 1115 waiver or a forthcoming 1332 waiver — that would allow the state to formulate its own model for dispersing the health care services that covers people who live in poverty.

Bevin has appointed Mark Birdwhistell, who served as secretary of the Cabinet for Health and Family Services under Republican Gov. Ernie Fletcher, to work on developing a plan to present to CMS.

He said he hopes to have a plan by the middle of summer, with the goal of knowing whether it can be implemented toward the end of next year. He said he hopes to have a plan ready to launch in January 2017; if not, the state would continue for the time being under the current model.

The Medicaid expansion was implemented under the Affordable Care Act, along with the state's health care exchange Kynect.

Both were signature accomplishments of Beshear, a Democrat. But the state will be required in coming years to begin paying for a portion of the Medicaid expansion, which has since its launch in 2013 has been covered entirely by the federal government.

Bevin said the Medicaid expansion will lead to a $128 million budget shortfall in 2016. He added that the state cannot afford the cost, especially as the number of Kentuckians on Medicaid continues to increase.

"That is literally not sustainable," Bevin said, dismissing the previous administration's confidence in the affordability as a "lie" and "happy talk."

In a statement released after Bevin's announcement, Beshear said the governor "proposed a vague solution to an unclear problem with hopes that it may or may not be implemented at some undetermined point in the future – all for reasons of political ideology. Kentuckians deserve better."

The former governor reasserted that the Medicaid expansion was paying for itself, and he also accused his successor of participating in "strident partisan rhetoric and petty name-calling."

The Medicaid expansion led to about 400,000 Kentuckians getting health care coverage.

He also said Kentucky will look to other states, including Indiana, for for ideas for how to reform Medicaid.

He said he intends for the reformed Medicaid to require recipients to pay for some of the costs of their plans.

"We want to take people from full dependency to a point where they can support themselves," he said.

This story has been updated.