After years of expansion because of a poor economy and new eligibility rules, Kentucky's Medicaid population has been steadily declining since January as more people get jobs that pay them too much to be eligible for government-funded health care.
Kentucky's Medicaid enrollment is down "probably around 41,000" over the last five months, Cabinet for Health and Family Services Secretary Adam Meier told state lawmakers Tuesday. The Kentucky Center for Economic Policy says the decline is steeper than that, with enrollment falling by more than 96,000 since January. A decline is also happening in other assistance programs, including the Supplemental Nutritional Assistance Program, formerly known as food stamps.
"We're seeing the No. 1 reason people are not enrolling is they are making too much income," Meier said.
The decline comes as the Trump administration has approved new rules — tentatively set to begin April 1 — for some of Kentucky's Medicaid population that would require them to get a job, go to school or volunteer at least 80 hours per month to keep their coverage. Critics say the new rules will prevent people from getting health care, noting official estimates show it will decrease Kentucky's Medicaid enrollment by 95,000 people over the next five years. Similar rules have been applied to Kentucky food stamp recipients this year, with about 10,000 people losing benefits because they did not comply.
"The 95,000 prospective citizens that are going to lose health care coverage is problematic. I think we have to be concerned with what happens with them," Democratic state Rep. George Brown said.
But Meier said Tuesday it is a "misconception" that people will be losing coverage. He said many of those 95,000 people will likely lose eligibility because they make too much money or get a job with a company that provides health insurance. He noted the state has exemptions for people with drug and alcohol addictions, primary care responsibilities for children or the elderly and for victims of domestic violence.
"If we can move more people to private market insurance coverage, that's a good thing. And that's what this (program) is designed to do," Meier said.
Traditionally, Medicaid has covered poor adults with children or a disability. But Kentucky, under former Democratic Gov. Steve Beshear, was one of 37 states that expanded its eligibility requirements under former President Barack Obama's health care law to include childless adults who earn up to 138 percent of the federal poverty level, which is just over $12,000 a year for single people.
Kentucky's Medicaid population exploded, adding more than 400,000 people. Republican Gov. Matt Bevin said the expansion was too expensive and does not do enough to make Kentucky's citizens healthier. He sought permission to impose new eligibility rules on the state's expanded Medicaid population.
In January, Kentucky was the first state in the country to get approval for the new rules. But a federal judge in June blocked the rules from taking effect. The Trump administration re-approved those rules last week. But advocacy groups, including the Kentucky Equal Justice Center, say they will continue to challenge the rules in court.
Meanwhile, Arkansas was the first state to implement the new rules for Medicaid. In the first three months, Arkansas officials reported 12,000 people lost coverage.
Meier said he did not know how many people would initially lose access to Medicaid in Kentucky because of the new rules. But he said state officials have worked hard to "mitigate any unnecessary interference with people's ability to have access to care."
"The same people who have access today will have access post implementation," Meier said.