Members of the state Medicaid Oversight and Advisory Board questioned the administrators of Kentucky’s health insurance exchange, kynect, in a board meeting Wednesday. Some appeared skeptical of the benefits of providing a state-level versus federal health exchange.
Officials argued the exchange, which former Gov. Steve Beshear started under the federal Affordable Care Act, allows Kentuckians who need support to access a number of resources via a single platform and application.
“When we operated on the federally facilitated marketplace, those families had to fill out another application. They had to go somewhere else. They couldn't just move from one program to the other if their circumstances changed,” said Lisa Lee, the Commissioner for the Department of Medicaid Services.
But some appeared skeptical of the benefits, asking about the costs of keeping up a state-level program instead of relying on federal platforms. GOP co-chair Sen. Julie Raque Adams of Louisville asked officials twice if the program really doesn’t cost the state money after they testified that it did not.
“Is it your testimony that there is not even one dollar of General Funds that goes to execute this state-based exchange? You said it was all pass-through dollars,” Raque Adams said. “Is that accurate?”
David Verry, the assistant director of the Division of Health Plan Oversight, testified that the program costs the state General Fund nothing — upkeep of the state exchange is funded through a percentage of all insurance premiums and its original development was federally funded.
Former Republican Gov. Matt Bevin told the federal government he would dismantle kynect in 2016 in favor of the federal health insurance site, HealthCare.gov. Bevin also ended the marketing campaign promoting kynect and the services it could connect people with. Beshear brought back the exchange in his first term, calling kynect “the gold standard” at the time.
Through kynect, Kentuckians can access information about qualified health plans, advance premium tax credits, but also food assistance benefits, Medicaid and child care assistance.
Verry said some individuals who should have been directed to Medicaid services were instead paying premiums through a qualified health plan because they didn’t know they were eligible.
“When we came back from HealthCare.gov there were nearly 9,000 Kentuckians who were Medicaid eligible and didn't know it, and they're paying copays, and they're paying deductibles because HealthCare.gov doesn't care, doesn't know,” Verry said. “To me, that's a crime.”
GOP board co-chair Rep. Ken Fleming of Louisville said he believed there were flaws in the state-level portal that may not exist in the federal one. He said he’s seen examples where individuals plug in their income, which he doesn’t believe should qualify them for Medicaid, but the platform allows them to continue.
“I know part of the thought in terms of going from a fed to state is more control, more flexibility that y'all can dictate. I get that,” Fleming said. “On the other side of the coin, you also have the federal market that's more strict and has a whole lot more data, databases and data resources in order to look at eligibility to verify things.”
State officials with the Department for Medicaid Services assured the board that they use federal databases to check applications for fraud and discrepancies on an individual's application for benefits when they confirm eligibility.
Vickie Yates Glisson, a nonvoting citizen member of the board, questioned whether the state couldn’t take a hybrid approach, still providing some amount of local assistance while moving to the federal system to avoid costs. Glisson previously served as Bevin’s secretary of health and human services when he dismantled kynect.
“There are a number of states that have chosen to implement the federal platform, which means that you don't have to maintain staff. You don't have to maintain the IT system. You don't have to have that cost and staffing and so forth and maintenance that they use the federal platform,” Glisson said.
Verry pushed back against that option, saying it would still require people to jump through more hoops to access different pools of benefits.
“Unfortunately, it's not quite as simple as that,” Verry said. “If you are a state-based marketplace, using the federally facilitated marketplace as your platform, you have to use HealthCare.gov which is a separate, completely separate environment from any state Medicaid.”
State government and politics reporting is supported in part by the Corporation for Public Broadcasting.
