But Gov. Matt Bevin’s office told Beam that Miller’s comments were preliminary: “Everything is on the table and no decisions have been finalized,” spokeswoman Jessica Ditto told him.
Bevin has said Medicaid recipients should have some “skin in the game” and has pointed to Indiana, which received a federal waiver allowing it to charge premiums based on income levels to people who want benefits beyond the basic Medicaid program.
The idea drew strong opposition from health-care providers, consumer advocates, public-health professionals and representatives of higher education in a May 12 meeting, according to the Foundation for a Healthy Kentucky, which convened the gathering.
“Miller said negotiations with officials at the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, indicate they will not approve a plan that requires Kentucky’s expanded Medicaid population to pay for a portion of their health insurance,” Beam reports.
Miller told him, “That, today, is not part of the plan. That is something that’s going to be a tough sell.”
Bevin is seeking changes that will save the state money. Starting Jan. 1, it will have to pay 5 percent of the costs of those who have joined Medicaid under the expanded eligibility created by the federal health-reform law. Its share will rise in annual steps to the law’s limit of 10 percent in 2020. The state’s expected bill for 2017 and the first half of 2018 is $257 million.
Now it seems that savings are likely to come by cutting benefits. “Miller said some Medicaid recipients could see fewer benefits under the new plan,” Beam reports. “He said the health insurance plan for the state’s Medicaid recipients is better than the basic plan offered to state employees. He said the new plan will likely bring the Medicaid plan more in line with the health plan offered to state workers.” Miller said, “That would be a reduction in some benefit levels, such as in vision, dental.”
Also, Miller said the program could encourage healthier behaviors by funding health savings accounts if they did such things as participating in smoking-cessation and weight-loss programs.
“It may sound like we are rewarding them for that, but the long-term effect is it makes their health care coverage less expensive,” Miller told Beam.
He said the state hopes to submit its waiver application in September. HHS spokesman Ben Wakana, told Beam that any changes “should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security.” Before the expansion; 20 percent of Kentuckians had no health coverage; now the figure is 7.5 percent.