Forging ahead on sweeping health care policy changes despite legal setbacks, Gov. Matt Bevin's administration took public comments Monday as it develops regulations to overhaul Kentucky's Medicaid program.
But opponents of the Medicaid changes questioned why the state was pushing ahead with the regulatory process when the Medicaid changes are in limbo.
"We think it's confusing to have regs filed on something that a federal judge has ... blocked," Emily Beauregard, executive director of Kentucky Voices for Health, said in an interview after the hearing.
Medicaid is the joint state and federal health insurance program for poor and disabled people. Kentucky was the first state to win government approval for a Medicaid-related work requirement, but a federal judge blocked the state from enforcing it in a late June ruling.
Kentucky officials are optimistic the federal government will reapprove Kentucky's Medicaid changes, Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, said later. Bevin's administration refers to the plan as Kentucky HEALTH.
"It's imperative that Kentucky HEALTH be reapproved in order to create better health, wellness, education and employment outcomes for our recipients and create sustainability for the Medicaid program," Hogan said in a statement.
However, Cara Stewart with the Kentucky Equal Justice Center said: "It is not reasonable for Kentucky to have filed regulations to enact something knowing that it is not permissible within federal law."
President Barack Obama's health care law gave states the option of expanding Medicaid coverage to able-bodied adults. Under former Democratic Gov. Steve Beshear, Kentucky was among states that did so. But Bevin, a Republican elected in 2015, said the program was too expensive to continue.
In January, the Centers for Medicare and Medicaid Services approved Kentucky's Medicaid changes. The new rules would charge monthly premiums and require adults between ages of 19 and 64 to complete 80 hours per month of "community engagement" to keep their coverage. That includes getting a job, going to school, taking a job training course or community service.
State officials have predicted the work requirements would result in Medicaid covering 95,000 fewer people in five years, leading critics to accuse the Republican governor of taking away people's health insurance.
U.S. District Judge James E. Boasberg blocked the rules, saying that President Donald Trump's administration never adequately considered whether the changes would comply with the central tenet of Medicaid: Providing health care for its citizens.
Boasberg ordered that Kentucky's approval of the project be vacated and sent it back to the U.S. Department of Health and Human Services so the process could be restarted.
The plan's critics reiterated their overall objections to the changes on Monday.
"The design of the program starts with an assumption that beneficiaries simply aren't trying hard enough to extricate themselves from the grips of poverty," said Jason Dunn, a policy analyst with Kentucky Voices for Health. "It then piles on layers and layers of red tape and penalties that are in no way designed to accomplish the primary goal of the program ... to provide health care coverage for individuals and families in poverty."
Dunn and other speakers raised narrower concerns about the proposed regulations.
In one instance, Dunn said the regulations should contain specific dollar amounts that the state intends to charge Medicaid recipients for premiums. Omitting the actual amounts would make it "too easy" for the state to change premium amounts "on a whim," he said.