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Changing Kentucky’s Medicaid Expansion Would Set Back a Successful Program

By Dee Mahan,


In June, we wrote about Governor Matt Bevin’s proposal to change Kentucky’s hugely successful Medicaid program, which had just been released for state comments.  The proposal has made its way through the state comment process and was submitted to the Center for Medicare and Medicaid Services on August 24 for federal review and approval.

The federal submission didn’t change very much from what was released for comment at the state level. That’s a shame, because many of the proposed changes are likely to harm the hundreds of thousands of Kentuckians who currently have coverage under the program.

Governor Bevin’s proposal would be a step backward for a great Medicaid success story

Kentucky’s Medicaid expansion has been tremendously successful. Since it began in 2014, the state has experienced the second largest decrease in its uninsured rate in the entire country.

The Kentuckians gaining coverage have seen improved access to health care, including better access to preventive care. In the first two years of the Medicaid expansion, there was a 40 percent reduction in unmet medical needs among low-income Kentuckians.

With data showing that access to preventive health services can improve individuals’ health, the state’s Medicaid expansion has put Kentuckians on a path to better health.

Unfortunately, the changes sought in the waiver request put those gains at risk.

Kentucky Medicaid waiver request imposes new barriers to health coverage

The proposal would put in place harsh new barriers to people getting the health coverage and care they need. The plan includes:

  • A requirement that people enrolled in coverage through Medicaid expansion work or perform community service—which is something that CMS has said is not allowed in Medicaid programs
  • Premiums
  • Health savings accounts
  • Reductions in health benefits
  • The elimination of retroactive coverage

There’s ample evidence showing that the proposed changes could make it harder for people eligible for Medicaid to afford their coverage and get the health care they need.

Weakening the Medicaid expansion would have ramifications throughout Kentucky

In the waiver document, the state asserts, “This expansion will be maintained only under this demonstration waiver.

This is concerning, given the fact that the waiver includes elements, like a work requirement, that CMS has clearly stated cannot be part of Medicaid. We hope that assertion means “under the waiver that is approved after good faith negotiations between the federal government and the state.”

Increasingly, we are seeing data that illustrates the broad benefits of Medicaid expansion for states. These extend beyond the people gaining health insurance coverage and range from lower marketplace insurance premiums, to improving the fiscal health of hospitals’ and health systems, to creating jobs and generating economic growththroughout the state.

For Kentucky to give up those gains would be disastrous not just for the 400,000 Kentuckians who would lose Medicaid’s health insurance, but for the whole state.

Once CMS has certified Kentucky’s waiver submission complete, there will be a 30-day period where CMS will be accepting comments on the waiver.  Comments can be posted here. We urge all interested individuals and groups to submit comments.