Differences over Kentucky’s health insurance exchange kicked off the war of words between Republican Gov. Matt Bevin and former Democratic Gov. Steve Beshear, and now the feud is moving to a new front.
Bevin intends to seek federal waivers to tailor the state’s Medicaid expansion, implemented under the previous governor, and fix a system he has called “financially unsustainable.” Last week, Bevin told WLKY-TV talks are underway with the Centers for Medicaid and Medicare.
"We are working with the federal government, with CMS specifically, on customizing things in Kentucky that have never been done nationally," he said. "What we're doing is actually something I'm quite excited about. An amazing amount of work has gone into how we can care for people, provide healthcare for all Kentuckians to the highest degree possible."
One Kentuckian who’s none to pleased about the changes is former Gov. Beshear, who penned a letter to both Bevin and U.S. Health and Human Services Secretary Sylvia Burwell Monday saying a veil of secrecy has surrounded the proposal. The letter goes on to question whether Bevin’s stated goals run afoul of federal rules he argues prohibit waivers for the “sole purpose of saving money or shrinking the size of the program.”
Beshear then calls on officials to make the Medicaid waiver proposal public before a stakeholder meeting hosted by the Foundation for a Healthy Kentucky this Thursday.
WUKY reached out to the governor’s office, but did not receive a response in time for broadcast.
Update: State and federal officials directed WUKY to more background information.
- The state is required to host a 30-day public comment period on a Medicaid 1115 waiver. To initiate that process, the state must publish a public notice that outlines significant features and impacts of the proposal. And the state must hold at least two public hearings on the plan before sending it to CMS. After a review, lasting no more than 15 days, the law requires a 30-day federal comment period as well.
- Mark D. Birdwhistell, the former Secretary of the Cabinet for Health and Family Services overseeing a team of experts tasked with drafting the Medicaid waiver for the Commonwealth, is aware of the Foundation for a Healthy Kentucky meeting. The administration is not participating at the foundation's request. The purpose is to gather information they want to provide to the governor's office for consideration.
- The waiver plan is still in the development phase, but governor's team is in the process of organizing meetings with more stakeholders.
Update 2: U.S. Department of Health and Human Services National Press Secretary Ben Wakana issued this statement to WUKY: "Kentucky's Medicaid expansion has led to one of the biggest reductions of uninsured people in America, and any changes to the program should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security."
Read the full letter from Gov. Steve Beshear below.
Governor Bevin and Secretary Burwell,
According to a recent news report, the two of you recently met, and Gov. Bevin is “ready” to submit his new proposal to dramatically change Kentucky’s successful Medicaid expansion implementation. His proposal has been created in secret with no public meetings, no public review, and no public input of any kind, and its contents are unknown. However, based on public statements made by Gov. Bevin, it is likely to result in significantly decreased access to healthcare for Kentuckians. Gov. Bevin has said many times in public remarks that he looks to Indiana’s plan as a model for Kentucky, a model that evidence suggests would lead to increased costs for enrollees, and less access to healthcare for the most vulnerable Kentuckians.
Federal rules prohibit using waivers for the sole purpose of saving money or shrinking the size of the program, both of which Gov. Bevin has publicly stated are his goals. Many healthcare advocates agree that when a state proposes to alter the terms of its Medicaid program, it must put forth a sound rationale as to how the proposal would further the objectives of the Medicaid program. They are exactly right. CMS should not approve changes that would leave beneficiaries worse off than they are under a state’s existing Medicaid program. It is precisely these types of changes that we anticipate in the Bevin administration’s proposal, changes which are vitally important to public review and debate
So today, on behalf of all who care about the health of Kentuckians, we demand the Bevin and Obama administrations pull back the curtain, stop the back room deals, and allow for full disclosure and transparency throughout the development of this Medicaid waiver proposal that will impact the lives of hundreds of thousands of Kentuckians, and the future of the entire Commonwealth. Specifically, we are aware that there will be a large stakeholder gathering later this week, hosted by the Foundation for a Healthy Kentucky. The Bevin administration should lift the veil of secrecy and make this proposal public before the meeting, which will be held on Thursday, May 12. This meeting of stakeholders should mark the beginning of the the process to solicit input from as many Kentuckians as possible, and the Bevin administration must create future opportunities for other interested stakeholders to weigh in before taking any next steps in the process. Furthermore, we ask Secretary Burwell to demand that the Bevin administration provide a public copy of the waiver proposal and allow for public input before any formal or informal decisions are made on any or all parts of the proposed waiver.
Healthcare touches the lives of every single Kentuckian, and they deserve a meaningful place in the debate on its future in the Commonwealth. Transparency, openness and honest conversation with the people of Kentucky is not only the right thing to do on such a critical decision, the people demand it.
Former Gov. Steve Beshear