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Now That The Comment Period Is Closed, What's Next For Kentucky Medicaid?

consult doctor on the Internet
consult doctor on the Internet

Kentuckians are one step closer to learning what changes will be made to their Medicaid benefits.

During the comment period for Gov. Matt Bevin's proposed Medicaid changes, a total of 1,643 individual comments were submitted from Kentuckians and people around the U.S. The feedback was released earlier this week, and the Kentucky Center for Economic Policy analyzedit.

According to KCEP, the majority of feedback received during the open comment period was personal stories from individuals or comments from national and regional groups, including the Kentucky Dental Association and the American Lung Association.

“There were a lot of stories about people who got treatment for conditions they hadn’t had looked at for a long time, people who were able to go to the dentist for the first time in 10 years,” said Dustin Pugel, research and policy associate at KCEP.

According to KCEP's analysis, 90 percent of the comments were in favor of keeping Medicaid benefits the same as they are now, 134 or 8.4 percent of the comments were in favor of the proposed changes, and 25 comments were mixed.

When asked for a response to KCEP's analysis, Bevin spokeswoman Amanda Stamper. said, "Gov. Bevin campaigned on reforming Medicaid expansion and was shown overwhelming support by Kentucky voters who elected him to do just that."

The Affordable Care Act was originally designed to extend Medicaid to residents in all 50 states who earn below 138 percent of the federal poverty limit, or $16,394 in 2016. But the Supreme Court famously struck down that provision.

Most states expanded Medicaid as the ACA plan set out several years ago. But a handful of states, now including Kentucky, have applied for waivers to change what the federal government intended for expansion.

Next year, Kentucky will begin paying a portion of the Medicaid costs that the federal government was previously covering. That's estimated to cost $1.2 billion over the next four years, according to the Bevin administration.

In Kentucky, some 428,000 people have received health coverage through expanded Medicaid.

If Bevin's changes are approved as-is, Kentucky would put into place monthly premiums for individuals earning more than $11,880 a year, copays for people earning less than the federal poverty limit, and eliminate default vision and dental coverage for able-bodied adults. Bevin is proposing a ‘rewards’ account that would allow people to earn points toward those benefits.

Dania Douglas, state advocacy manager at the National Alliance on Mental Illness, said one of their big concerns is the proposed elimination of non-emergency medical transportation. The service allows people without their own transportation to get to medical appointments including dialysis and mental health therapy.

Douglas said the service is critical for people -- especially those with mental illness.

“In a state like Kentucky where it’s so rural and so many people who are low-income without transportation, it can cause more missed appointments,” Douglas said. “And that would be a concern because ongoing consistent treatment is so important to people with a mental health condition.

The comments will now be analyzed by the Department of Health and Human Services in preparation for negotiations with Bevin. That process on average takes seven months, according to HHS.

Judith Solomon, vice president of health policy at the Center on Budget and Policy Priorities, said what happens next is anyone’s guess.

“The big question is if the governor is going to be willing to negotiate," she said. There are some things on the table that won’t clearly be approved."

Solomon said changes unlikely to be approved include adding an open enrollment period for signing up for Medicaid, which has never been allowed for Medicaid in any other state, and locking people out of coverage if they don’t renew.

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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