“What I am concerned about is that we still seem to be turning a blind eye to managing and encouraging good behavior on the recipient side,” Rep. Robert Benvenuti, R-Lexingtion, said at the Sept. 16 meeting of the Medicaid Oversight and Advisory Committee.
“I am afraid with one-fourth of our population now in this program that the most vulnerable, the truly vulnerable, are going to fall through the cracks and are falling through the cracks and part of that is because a group of folks, especially through expanded Medicaid, who I don’t consider truly vulnerable, are paying nothing and I just don’t think that is at all sustainable or responsible.”
Benvenuti said that he thought a co-payment should be mandated in the contracts because, “We’ve got to have folks to have skin in the game.”
The five MCOs with contracts in Kentucky are Anthem, Humana, CoventryCares, WellCare and Passport.
Medicaid Commissioner Lisa Lee said that the main reason MCO’s don’t charge a co-payment is to assure that the providers get maximum payment for services under federal guidelines. For example, if the co-payment is built into the service billing, if the recipient doesn’t pay their co-payment, then the provider loses that amount.
Benvenuti also suggested MCOs are hesitant to include co-payments on their own because it would make their plans less attractive to Medicaid clients, who choose their MCO. Certain services are exempted by federal law from any cost-sharing provisions, such as emergency services, family planning, pregnancy-related services, preventive services for children and others.
Lee agreed with Benvenuti that it was important to continue to explore ways to pay for the expansion of Medicaid under federal health reform. The state will have to start paying 5 percent of the expansion cost in 2017, rising to the law’s limit of 10 percent in 2020.
“I think as a group we just need to come together and figure out what we can do to make this program sustainable going forward and look at every option on the table, put everything out there and try to see what we can do,” Lee said. “And of course we know that we have a new administration coming in next year, and we’ll have opportunities to kind of look at the program and how to best move forward to make sure that we are providing services and being fiscally responsible.”
The “skin in the game” concept is one that gubernatorial candidate Matt Bevin supports, having said that this is one of the reasons he likes the Indiana model of Medicaid expansion as it requires people to be vested in their healthcare through co-payments.
“Having skin in the game is a big, big differentiator when it comes to whether or not a person has the dignity that comes with making decisions for themselves…,” he said at a Kentucky Chamber of Commerce meeting in Louisville in July.
But Rep. Joni Jenkins, D-Shively, while saying all avenues should be explored, offered some caution on this idea, reminding the group that this was a complex issue.
“I think we need to remember what this population looks like and what the income requirements are to be eligible for that,” she said. ” I think we have to be very careful here that we are not dissuading people from seeking out health care.”
Gov. Steve Beshear expanded Medicaid to include those up to 138 percent of the poverty line. For a family of four, that is $33,465. About 400,000 Kentuckians now have free health coverage because of this expansion. The total number of Medicaid members in Kentucky is 1,264,275, according to Lee’s report.
Rep. David Watkins, D-Henderson, said that he was a “big proponent” of indirect charges to help promote healthier behavior, such as raising the prices of cigarettes and other tobacco products. He also stressed the importance of “educating our people when we provide these services to them.”