The Trump administration has reapproved Kentucky’s proposed Medicaid changes, following a June district court ruling striking them down.
The decision by federal health officials sets up another likely legal battle over the changes.
The 1115 waiver sought by Gov. Matt Bevin – which includes premiums and work, volunteer, or job training requirements for some recipients – was blocked by U.S. District Judge James Boasberg before its slated debut this summer. Since then, it’s undergone some tweaks and yet another round of public comment.
Dustin Pugel with the left-leaning Kentucky Center for Economic Policy says it doesn’t appear the Bevin administration made any major alterations to the more controversial elements of the plan when it resubmitted the waiver.
"They really didn't change anything substantively," he reports. "They had four buckets of changes, but most of them were technical and all of the main parts that we've been talking about are still there. So there are still premiums, lockouts, a community engagement requirement."
Pugel notes a roughly 20-1 negative reaction to the waiver during the latest public feedback window and says he expects the Medicaid overhaul will go back before the judge who originally voided the federal government’s first approval.
If unsuccessful, an executive order signed by Bevin would scrap the entire Medicaid expansion ushered in under his predecessor, Gov. Steve Beshear. Arguing the state has made serious investments in preparing for implementation, Bevin's order said "any delay in the implementation of the waiver due to judicial action will cause harm to the commonwealth and will prevent Medicaid beneficiaries from realizing the benefits under the waiver.”
Pugel believes that action played some role in the federal Centers for Medicare and Medicaid Services' decision to reboot the waiver.
"I think they basically feel like, from what I can tell, the governor's executive order... sort of gives them justification to approve it no matter what the coverage losses," he says.
While the state estimates up to 95,000 could lose Medicaid coverage under the waiver, Bevin has cited several reasons he believes it's necessary to maintain the viability of the expansion. He's argued the overhaul will retain and ensure benefits for those who need them, while helping transition able-bodied recipients to private insurance, cut back on costs in a time of lean state budgets, and encourage participants to embrace a greater role in their healthcare.
“The vast majority of men and women, able-bodied men and women … they want the dignity associated with being able to earn and have engagement,” the governor has said.
But Pugel and health advocates fear the state will erase coverage gains made under the Affordable Care Act.
"We've made historic gains in the number of folks who got coverage after the ACA, our uninsured rate is one of the best in the country, and I'm confident that if the state moves forward with this waiver, we'll see both of those things reversed," he predicts.
