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Proposed Kentucky Medicaid Changes Likely to Harm Enrollees

By Melissa Burroughs,


Since he was elected in November, Kentucky Governor Matt Bevin has been threatening to recast a successful health care program to fit his political ideology. This week his administration released their proposal for a section 1115 waiver to make changes to its Medicaid expansion program.

Many of the proposed changes are likely to harm the hundreds of thousands of Kentuckians who have coverage under the program. July 25 update: Families USA submitted comments detailing our concerns.

Waiver proposal adds significant barriers to care

The proposal, called Kentucky HEALTH, would put in place harsh new barriers to both coverage and care. Key pieces of the plan include work requirements, premiums, health savings accounts, benefit reductions, and the elimination of retroactive coverage. Bevin’s administration claims that these changes would improve health, build personal responsibility, and promote financial sustainability.

However, evidence from other states suggests that all of these elements could make it harder for beneficiaries to afford their coverage and access the care they need. Many of these changes are also difficult and expensive for states to administer. Our interactive map of state Section 1115 waivers has more information about common waiver elements.  

Proposal elements could destroy gains in coverage, limit access to health care

The Kentucky HEALTH plan could undo the tremendous progress the state has made over the past two years. Since 2014, the state has experienced the second largest decrease in its uninsured rate in the entire country. As a result, enrollees’ have been able to get the health care they need.

Data show that this improved insurance rate is associated with people in the Medicaid program getting more preventive health care. Despite this success, Bevin’s administration claims that the state will only continue Medicaid expansion coverage if it is allowed to implement this new waiver program.

It will be nearly impossible for the state to maintain these gains if it makes coverage and health care services more expensive and difficult to obtain.

Kentucky advocates, federal officials concerned waiver would reverse health coverage gains

As Kentucky enters into a period of public comment and negotiation with the federal government, stakeholders are beginning to express their concerns. Advocates in the state, led by Kentucky Voices for Health, have already indicated that this waiver would “put more burden on low-income, working Kentuckians and our most vulnerable citizens.” Similarly, the federal Department of Health and Human Services has expressed its hope that “ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards.”

Going forward, stakeholders have an opportunity to express their concerns to both state officials in Kentucky and the federal government and it is important to do so. The proposal is currently undergoing a 30 day state public comment period that will end on July 22, 2016. July 25 update: Families USA submitted comments.

Kentucky Voices for Health will be coordinating the effort to craft consumer-friendly comments through their Waiver Taskforce. After the state comment period is over and the state has made any changes it intends to make based on the comments received, Kentucky will submit the waiver for approval by the Centers for Medicare and Medicaid Services (CMS) and there will be a 30-day federal comment period.

Families USA believes that the Kentucky system is one of the most successful in the nation. The Medicaid expansion program doesn’t need to be hampered by bureaucratic barriers and red tape that will prevent hardworking low-income adults from getting access to health care coverage.