Beshear Plans To Bring Back State-Based Health Exchange In 2022 Wednesday, Jun 17 2020 

Democratic Gov. Andy Beshear announced on Wednesday that Kentucky will transition back to a state-based health insurance exchange, known as Kynect.

In 2017, Republican Gov. Matt Bevin dismantled Kynect, and Kentuckians had to start purchasing health coverage on the federal exchange instead. That federal program comes with about a 3% user fee, which Beshear said cost people in Kentucky $9.8 million in 2018.

“In the last four years we moved backwards on health care,” Beshear said. “We’ve been paying more, over the last four years, to get less.”

The move back to Kynect also has a price tag: a one-time cost of $5 million to get the system going again, and between one and two million dollars in annual operating costs. But Beshear said it will lower the premiums Kentucky patients pay, simplify coverage, and improve health outcomes statewide.

The governor pointed to Kentucky’s high rates of diabetes, lung cancer, and congestive heart failure as factors that made our population susceptible to complications from coronavirus.

“This pandemic shows us that lack of good health care options makes us more vulnerable and less resilient,” Beshear said.

Kynect was started in 2013 by Beshear’s father, former Democratic Gov. Steve Beshear. When the state-based exchanged was launched, about 500,000 people who previously didn’t qualify were able to enroll in Medicaid and other health plans, according to the state.

Gov. Beshear said he has sent a letter of intent to the Centers for Medicare and Medicaid Services informing them of Kentucky’s plans to move to a state-based exchange beginning January 2022.

Passport Considers Selling West Louisville Site To Revive Stalled Headquarters Project Saturday, Jan 4 2020 

Passport Health Plan is taking a new direction in its approach to the west Louisville site where construction on its planned headquarters has been stalled since last year. As the company aims to win a bid to renew its contract with the state, its CEO Scott Bowers announced Passport will issue a call to interested developers to restart the project.

Bowers said Passport will issue a request for proposals by the end of next week. In an interview Friday, he said the RFP would include an opportunity for a developer to buy some or all of the 20-acre property at 18th and Broadway.

“Instead of Passport developing it ourselves, financing it ourselves and managing the project ourselves, we want a partner developer to do that with and for us,” he said.

Though the company first said it would switch to outside development last summer, this is the first indication it is open to selling some of the land in west Louisville.

A West End Headquarters?

The west Louisville site was intended to host a $130 million, multi-building campus that would include a new corporate headquarters for Passport. The company put construction on hold in February, citing financial difficulties.

Passport is now ready to get it going again as it pursues a new state contract and finds itself on stronger financial footing, Bowers said.

“I don’t want to over-sell that … you’re [not] going to see the dirt turning tomorrow,” he said. “It’s going to take us a little bit of time to get the developers all pulled together, reset our financing, but we’re no longer in that sort of wait-and-see mode.”

The company has been working on ways to restart the project since last summer, around the time it named Bowers CEO. He came over from Evolent Health, the Virginia-based company that completed its purchase of a 70 percent stake in Passport this week.

Now, as Passport seeks to reverse its luck and win a contract renewal from Gov. Andy Beshear’s administration, it is attempting to “revitalize” the west Louisville project. Beshear announced last month that he would redo the bid process for state contracts amid concerns of bias around the awards given by his predecessor Matt Bevin, who elected not to renew Passport’s contract.

Bowers said the RFP could lead to a developer buying the site, as long as the developer lines up with Passport’s vision of helping the community, bringing jobs to the area and improving health and quality of life.

“Certainly the development takes on a very different look and feel if we don’t have a long-term contract, but what we’re doing is creating a flexible RFP that allows, you know, a developer to see the benefits of Passport as a long-term tenant,” he said.

Passport and Evolent have 600 employees in Louisville and are committed to leasing up to 140,000 square feet on the campus.

Bowers said the company is trying to be “flexible and helpful to a developer to encourage them to want to invest in that area.”

A Path Forward

The Passport project is one of a number of major planned investments in west Louisville, a group of neighborhoods that are economically depressed as a result of decades of racist government policies. A historical lack of development has made the area unattractive to companies. An attempt to build a Walmart there failed in 2016.

West Louisville is also home to many low-income and African American citizens, including many enrollees in Passport’s plan.

Bowers said Passport is pursuing a new financial setup to complete development of the land and campus. A spokesman for the company recently said it had already invested $40 million into the project. Passport also received federal New Markets Tax Credits and a local Tax Increment Financing district for the project.

David Zetter, a Pennsylvania-based healthcare management consultant, said it makes sense for a healthcare company to focus on its core business rather than property development.

“Why would they want to be involved in building, developing a piece of property? Let an expert do that,” he said. “They are a health insurance company, not a property developer or a building developer.”

A competing bidder, California-based Molina Healthcare, is also interested in the site. A source familiar with the situation said the company would be willing to commit to a medium-term lease for more than 1,100 employees. Bevin awarded a contract to Molina, which plans to reapply to the Beshear administration in hopes of gaining entry to the Kentucky Medicaid market.

Have Medicaid And Confused About The Recent Ky. Contracts? Here’s What to Know Friday, Dec 13 2019 

A little under a half a million Medicaid enrollees in Kentucky may be confused about what recent news about the state’s Medicaid contracts means for their health benefits. About 435,130 Kentuckians currently have Medicaid health insurance through Passport and Anthem, both of which recently lost out on contract renewals.

The companies are still offering coverage now, and people are able to sign up for a plan from either during open enrollment, which ends December 13. But as the situation stands, these two plans won’t offer Medicaid benefits starting July 1; Molina and United Healthcare will take their places. And all that could change depending on decisions by new Gov. Andy Beshear’s administration or the success of the companies’ appeals. 

That uncertainty is likely confusing for Medicaid enrollees, according to health care consultant Jerry Vitti.

“To the member, it’s confusing and it’s scary; when you hear ‘I’m losing my Passport coverage,’ most folks don’t understand whether they’re losing just their plan or their eligibility,” Vitti said. “So the fear is that they’re going to lose both. And that can be a very dramatic thing especially folks who have high healthcare needs.”

So here are some things to know.

Here’s the background.

About two weeks ago, previous Gov. Matt Bevin’s administration issued contracts to five insurance companies that will administer Medicaid benefits in the state starting in July; Anthem of Kentucky and Passport Health weren’t among them. Meanwhile, United Healthcare and Molina will offer the benefits starting in July. 

But the new administration under Gov. Andy Beshear could revoke those contracts, and legislators haven’t been pleased about what they say was a lack of transparency in awarding the contracts.

You can keep your Passport or Anthem plan until July of 2020.

Enrollment is currently open until Dec. 13, when enrollees can switch plans if they choose to. This coverage will start Jan. 1 and last until the end of June. At that point, that’s when Anthem and Passport will no longer offer plans, and United and Molina move in.

Christina Dettman, former spokeswoman for the Cabinet for Health and Family Services, said the state will send out information before the July enrollment period starts. Passport and Anthem will also send enrollees information telling them they will need to choose a new plan.  Enrollees should make sure the state has updated addresses and contact phone numbers to ensure they’re notified.

Frank Siano, a health care consultant at EMD Consulting, led Aetna when it entered Kentucky’s Medicaid market. He said both United Healthcare and Molina are likely building networks of providers right now to make sure new enrollees have a choice of doctors come July. That can be important if an enrollee has a chronic health condition and wants to keep their existing health providers.

“I would encourage anybody who has any concerns is to check with their providers to make sure that they are enrolled in the new health plans,” Siano said. 

And after an enrollee picks a new plan in July, they’ll have at least 30 days to make a change for any reason.

You may not be able to keep your doctors.

If you change from Passport or Anthem to a new plan, there’s a chance your current doctors won’t be signed up with your new plan, meaning you won’t be able to see them. This could be a big deal, especially for enrollees who have complex medical conditions.

Vitti said the state may have care navigators that help enrollees figure out if a new plan includes  their doctors. The health insurance plans should have that information as well when open enrollment starts next year.

“What I mean by help, is figuring out if you switch a plan, if you can see your doctors,” Vitti said. “Not all folks will be able to see the list of specialists that they see now, or even primary care doctors.”

UnitedHealth and Molina are hopefully staffing up on people that will take those calls, according to Frank Siano.

“They need to be making sure that they’ve got the people hired to take care of the enrollees, making sure they have all their care managers in place to deal with the medical needs of the members as well as answering questions for providers,” Siano said.

The transition may be messy.

 Almost half a million Medicaid enrollees will have to pick a new plan. That’s a lot of people who will be calling and logging in online to make their choice.

“You’ve got to remember that we’re talking about hundreds of thousands of enrollees who will be transitioning from one plan to another, so just the sheer error of numbers can happen,” Siano said.

Siano recommends that once enrollees make a plan choice, to trip check with both the plan and state to confirm that they will have coverage.

The state should also send out clear communications to enrollees about what’s happening to make sure everyone knows what they need to do.

“And how are they receiving that information is going to be important,” Vitti said. “The state needs to have culturally competent communication with folks that take into consideration their varied health needs, the geography, their languages, and their reading level in order to make a cogent decision about their coverage and their healthcare.”

That communication should ideally come in the form of radio and TV ads, outreach at public gatherings and putting care navigators in places where Medicaid enrollees can get help.

“You need a whole you need an entire continuum of communication, and outreach and assistance in order to make any transition with this population successful,” Vitti said.

Kentucky Republicans Tepid On Writing Medicaid Work Requirements Into Law Monday, Nov 18 2019 

For the past four years, Kentucky officials have been trying to institute a policy requiring some Medicaid recipients work or do community service to keep their health coverage. It’s been a pillar of Republican Gov. Matt Bevin’s policy priorities, but with Bevin soon leaving office and Democratic Governor-Elect Andy Beshear opposed to the requirement, it would be up to the legislature to continue that effort. 

However, it appears there’s little appetite among Republican legislators who would have to lead that legislative fight. 

On Monday a panel of lawmakers did not recommend that the Kentucky legislature codify work requirements in the Medicaid program. 

Over the past seven months, the task force heard from numerous experts on work requirements in various public assistance programs, including Medicaid. Republicans at that time were trying to push through a bill that would have written the Medicaid work requirements into state law. Bevin’s signature program has so far not been implemented because of court challenges. 

The group’s recommendation comes a week after Bevin conceded the gubernatorial election to Beshear. Beshear is currently working on rescinding the Medicaid changes in his first week in office, according an email from his transition team spokeswoman. That means Medicaid will remain as-is for the time-being.

Republican Rep. David Meade, co-chair of the Public Assistance Reform Task Force, said it’s possible that Republicans could bring up another bill to require work requirements through the legislative process, but it doesn’t seem top of mind. 

“I don’t know how much of an appetite we have for that right now,” Meade said. “What we’re concentrating on right now is the budget, and that’s taking the most of our time right now.”

GOP Senator Stephen Meredith, co-chair of the Medicaid Oversight and Advisory Committee, said he never really supported the Medicaid work requirement proposal, and that he doesn’t see Republicans wanting to legislate requirements. 

“I don’t see a strong sentiment within the legislature to embrace this program,” Meredith said. “It’s one of those things in theory that may sound good, but in terms of practical application, not so good.”

But the work requirements do still have support among some. 

“I think too often we tell [Medicaid recipients] ‘you don’t have anything to contribute’  and we give you handouts and I just think I think it’s something [that] needs to be explored and continue to be looked at,” said Rep. Melinda Gibbons Prunty, a Republican from Belton. “So honestly, I don’t know, it’s just going to depend on who gets put in the Cabinet [of Health and Family Services] and if they’re willing to work with it.” 

The Public Assistance Task Force made several recommendations on Monday not dealing with Medicaid. Those included instructing the Cabinet for Health and Family Services to look at creating one card for all public assistance benefits. It also recommended that a separate committee investigate the so-called “benefits cliff,” that forces people off Medicaid coverage when their income increases even slightly over a certain threshold. 

Homelessness And Health Costs: This Kentucky Mom Faced Cancer While Living In Her Car Monday, Nov 18 2019 

Photo 1 (4)

Cancer was what finally pushed Kristi Reyes into living in her car.

The mother of four had worked all her life, starting at age 7 when she helped out at her family’s furniture store. Most of her work was in retail. It was paycheck-to-paycheck but she kept her kids together and a roof over their heads.

But then in 2012 she was diagnosed with breast cancer. She started cycling through jobs because of the time she needed to take off for recovery from treatment. Soon, she was too sick to work at all and things continued to slide. She had Medicaid, what she calls a medical card, but it wasn’t enough.

“Even though I had a medical card, there were out of pocket things that medical didn’t cover,” Reyes said. “I don’t care how much money you make. Money is never enough when you’re sick like that.”

Mary Meehan | Ohio Valley ReSource

Kristi Reyes now spends time with her grandson in her new home.

She and three of her children, who were ages 11, 13, and 15, all stayed in the car for awhile. But soon she was forced to let her children live with other people.

She remembers recovering from surgery to remove cancerous lymph nodes, homeless and alone. Eventually, she was too sick for treatment to even continue.

“I couldn’t even walk up a flight of stairs without being out of breath, almost needing oxygen,” she said. Her diabetes was out of control. She was also having trouble with her kidneys.

But Reyes said she knew other people who had it worse.

“At the same time, I think that was kind of something that kept me going. Right? Like knowing that somebody had it worse than I did.”

At least, she said, she had a car.

Housing And Health

In fact, Reyes’ case is not unique. The National Alliance to End Homelessness estimates there are 15,000 people experiencing homelessness in Kentucky, West Virginia and Ohio. Many more are living on thin financial margins. The Robert Wood Johnson Foundation reported earlier this year that half of rural Americans say they could not afford to pay an unexpected bill of $1,000, and nearly a third say that they have had trouble paying medical bills.

Jessica N. Sucik directs homeless services for HealthFirst Bluegrass, a federally qualified health center in Fayette County, Kentucky. HealthFirst serves 25,000 patients, many of them poor. It also runs two health clinics for the homeless.

HealthFirst Bluegrass

Jessica Sucik of HealthFirst Bluegrass.

She said there is a saying in public health that “housing is healthcare.”

Just the nature of chronic illnesses such as diabetes or COPD can limit how much people can work. 

“So they know they can’t work permanently, 40 hours a week,” she said. “They’re working as they can, but they also can’t afford housing or whatever treatment they need to overcome their condition.” 

Circumstances can change quickly. 

“With chronic medical conditions, something temporary can very, very quickly turn into a permanent homelessness status,” she said.

That leads to challenges paying the bills. It can be an unrelenting cycle.

“Without that, it’s like, you know, building a house on sand,” Sucik said. ”You have to have that safety and that security blanket of safe, stable and affordable housing before you can take care of yourself and be able to meet your needs.”

In recent years, HealthFirst has adopted a team approach with all patients. There is a medical provider, a social worker, a case manager and psychiatrist to provide medical, psychological and social support instead of leaving patients to fend for themselves.

“The magic that happens when you address not just the physical health issues, but also the things that are preventing them from getting those physical health issues addressed, is really, that’s where it’s at,” she said.

Alexandra Kanik | Ohio Valley ReSource

Policy Solutions

But others say homelessness or personal bankruptcy due to medical costs point to a need for more systemic change.  

One policy solution gaining traction among Democratic presidential candidates is Medicare for All, a proposal that would eliminate private health insurance and replace it with a government-run system. Leading contenders Sen. Elizabeth Warren and Sen. Bernie Sanders support such a proposal. 

rural-homeless-rent-burden-map-v3Alexandra Kanik | Ohio Valley ReSource

Warren estimates her proposed plan would cost $20.5 trillion above expected health care costs over ten years. She says that could be paid for largely with an increase in taxes on the top income brackets and through savings in medical costs, but that claim has met some skepticism from policy experts. Sanders has been less specific about the costs and has said his proposal would find savings through cutting administrative costs. 

The Urban Institute has estimated that a switch to a single-payer system would require $59 trillion over 10 years, about $7 trillion more than the costs under the current system.

Dr. Steffie Woolhandler is co-founder of the advocacy group Physicians For A National Health Program, which argues for a single-payer system. Her group says research shows more than 60 percent of personal bankruptcies are tied to medical bills. She says a single-payer system can reduce costs and relieve families from going into debt, which is why many other countries have such a system.

“Virtually every other developed country guarantees health care to everyone living there,” she said. “This is true in Europe, it’s true in Canada, and it’s true in Australia. The United States is an outlier.”

She said the idea is gaining appeal in the U.S.

“What I’m seeing, really since 2016, is that the idea of Medicare for all has become an issue with non physicians and a lot of people who don’t work in health systems but are users of that healthcare system are actually talking about Medicare for All,” she said.

rural-homeless-care-categoryAlexandra Kanik | Ohio Valley ReSource

A Kitchen Table

Reyes doesn’t spend a lot of time considering such policy decisions. Taking care of herself and her family is about all she can handle. 

For about four years from the time she was first diagnosed with cancer, she was struggling to keep her employment, living mostly in her car, and separated from her children. 

She tried from time to time to get into a shelter but whenever she’d reach out, they were full.  One day, she said, she couldn’t take it anymore.

“I was at my wit’s end. Like I didn’t know what else to do. I was tired, worn out. My body felt like I couldn’t handle it anymore,” she said. “Honestly, I just started praying.”

Finally, she found help and a new home. 

She called the Salvation Army and was referred to the Housing and Homeless Coalition of Kentucky. Within two months, she was off the street.

Last year, she moved into a house in Frankfort, Kentucky, where she lives with her children, two grandchildren and her boyfriend. Because of her ongoing medical problems she has been approved for lifetime housing assistance and resumed her cancer treatment. 

“That made it even better. Because I know no matter the struggles of my health, or the battles that I got to fight with it. I’m always going to have that support.”

About a month ago, she was well enough to start working at a Subway sandwich shop.

A simple, second-hand dining room table is her favorite place to be.

“That’s the thing, that’s my thing,” she said with a laugh. “Because I can come in, I can cook for my children. And we can sit at the table and have a meal together.”

Looking back, Reyes said, she realizes now that she was in denial about just how bad her health was. And she hopes other people will take some comfort in knowing things can change for the better. 

“You just have to tell yourself, ‘OK, I’m not going to give in today,” she said. “You know, people just need to know that just because you’re going through things, it doesn’t necessarily mean that you’re going to be stuck there for a lifetime.”

Indiana Halts Medicaid Work Requirements In Light Of Pending Lawsuits Thursday, Oct 31 2019 

Indiana’s Medicaid program won’t cut off enrollees’ coverage for not meeting work requirements for the time being, state officials announced Thursday.

Indiana was set to suspend Medicaid benefits in January for some enrollees not working, volunteering or taking classes, sometimes known as work requirements. Seventeen other states have similar programs, but none are in effect, in large part because of court challenges. 

The state said it is temporarily suspending the requirements because of a lawsuit by Indiana Medicaid enrollees that is pending in federal court against the federal government for approving the requirements.

“We remain committed to operating the Gateway to Work program and to continuing to build on the early successes of the program, through which HIP (Healthy Indiana Plan) members are reporting successful engagements in their workplaces, schools, and communities,” Indiana Medicaid Director Allison Taylor said in a press release.

Earlier this year, the state of Arizona also delayed implementing its work requirements, which were set to go live in 2020. And a judge has twice blocked Kentucky’s attempts to implement work requirements. The lawsuit is currently under appeal in the U.S. Court of Appeals for the District of Columbia.

In New Hampshire, the state said it spent about $187,000 working this summer to help Medicaid enrollees gain employment or volunteer work and track that work in the lead-up to enforcement; then in July, a federal judge struck down the requirement. The same judge also struck down Arkansas’ requirements after they’d been in effect for eight months.

Dustin Pugel, a policy analyst with the Kentucky Center for Economic Policy, said it would be an administrative nightmare for a state to halt enforcement due to a court ruling, which might be why Indiana decided to do so on its own.

“They voluntarily suspended, I assume, thinking about what will be coming similarly for them that came to New Hampshire, Arkansas and Kentucky,” Pugel said. “I imagine they were doing it this way so that they could smooth out any administrative bumps that could come up from having to pull the plug quickly in response to a judge’s order.”

Work requirements in Medicaid are a largely untested idea some Republican-led states are attempting to employ. The theory is that getting enrollees into jobs will cause some people to gain employer-based coverage, and therefore no longer need Medicaid. Medicaid, the health insurance program for low-income people and those with disabilities, is often a huge part of states’ budgets. But research shows that a majority of Medicaid enrollees are working already, with some in jobs that don’t offer insurance.

Proponents of the requirements also say getting enrollees more engaged in their communities through volunteering and educational courses will result in better health outcomes.

Both ideas are experimental and don’t have much evidence behind them. Medicaid, which Congress created in the 1960s, has historically only offered health insurance without strings attached. A federal judge who heard arguments over the programs has struck down Kentucky’s work requirement program. He said that the original intent of the program was to offer health insurance and improve enrollees’ health; work requirements, he said, don’t advance that goal.

Adam Mueller, an attorney with Indiana Legal Services, said he expects Medicaid enrollees who could have been kicked off are likely relieved.

“For folks that may have been facing a potential suspension of their Medicaid because of this, this is a good thing for them,” Mueller said. “We’ve sort of seen that there’s been a lot of confusion around the program about how to comply and some of the other issues that folks have had. So this may be a good thing.”

Indiana notified Medicaid enrollees of the work requirements this summer. The Indiana Family and Social Services Administration said in a press release that it will continue to encourage enrollees to report their activities to the state or their health plan. Job training programs that were set up to help people find work will also continue to operate. The state said it would give enrollees “substantial” lead time if the program is restarted, pending a court decision.

The work requirements did not apply to all Indiana Medicaid enrollees. Out of about 400,000 enrollees, 80,000 would have had to track their hours and risk losing coverage if they didn’t.  

The first state to implement work requirements, Arkansas, kicked 18,000 enrollees off Medicaid for not complying.

Government Report Questions $270 Million Estimate For Kentucky’s Medicaid Changes Friday, Oct 11 2019 

Kentucky estimates that it will spend $271.6 million in 2019 and 2020 alone to overhaul the state’s Medicaid program, according to a federal audit. That’s almost four times as much as the next highest ranking state is spending.

The findings published Thursday come from the Government Accountability Office, a federal watchdog which compiled spending estimates from five states working to tighten accessibility to the health insurance program for low-income people.

The GAO asked Kentucky, Indiana, New Hampshire, Arkansas and Wisconsin for their calculations on how much it has and will cost to put work requirements in place.

Kentucky reported the greatest expenses, reporting that more than three-fourths of its calculated $271.6 million in 2019 and 2020 would come from technology costs. A smaller portion would go toward paying private Medicaid insurance companies to administer the program. Some of the costs, the state said, would go in part toward hiring staff to help figure out who gets an exemption from the work/volunteer requirements.

Indiana, in comparison to Kentucky, estimated it would spend $35.1 million on a similar program.

Cabinet for Health and Family Services Spokeswoman Christina Dettman wrote in a statement that the report only represents the maximum amount that Kentucky has been approved to spend, “rather than the amount spent, which is significantly lower.”

“Kentucky’s share of those costs is covered through savings from shutting down the duplicative and expensive KYnect system, and our investment in user-friendly, comprehensive and national award winning technology for Kentucky HEALTH is expected to save $2.4 billion over time, while also improving the health outcomes of Kentuckians,” Dettman said.

The federal government will pick up the tab for the majority of states’ costs for work requirement programs, but Kentucky estimates it will spend $70 million of in state money. Dustin Pugel, a policy analyst at the Kentucky Center for Economic Policy, said that’s a big chunk of change for Kentucky.

“$70 million in our state budget is a lot,” Pugel said. “Especially for plans that by their own estimates, will result in at least on itself, well, 95,000 people losing coverage.”

Kentucky officials have previously estimated that around 95,000 people will eventually no longer have Medicaid, either because they’re kicked off the program for not fulfilling requirements or they’ve found new insurance through an employer.

The GAO report questioned whether some of this federal spending is allowed under the law and in contracts with states.

Kentucky Governor Matt Bevin spearheaded the changes to the Medicaid program when he was first elected in 2015. The changes include making some adults work, volunteer or take educational courses to keep their health coverage. Additional requirements include paying co-pays or premiums to keep coverage and losing automatic dental and vision coverage. Some enrollees would be exempt because of a caregiver status or being too sick to work, among other reasons. According to the Kaiser Family Foundation, a majority of Medicaid enrollees already work, or are not because they’d qualify for one of those exemptions.

But the proposed changes have been tied up in courts and haven’t been implemented. On Friday, a federal court of appeals heard oral arguments in a lawsuit between the federal government and a group of Kentuckians that is keeping the program from moving forward.

According to the Associated Press, the three judge panel expressed skepticism about whether the Medicaid law actually allows states to make enrollees work to keep coverage. That case, experts say, will likely land in the U.S. Supreme Court.

The changes in Kentucky and in other states have been politically divisive. Senator Ron Wyden, D-Ore. and Representative Frank Pallone, Jr., D-N.J., requested that the GAO look into the estimated costs to implement the changes in the five states.

In its report, the nonpartisan GAO questioned whether the expenditures meet the federal requirements that the work requirement demonstration projects be budget neutral, meaning that a federal project doesn’t create a spending deficit.

The GAO recommended that the federal government require states to provide cost estimates before approving projects like Kentucky’s. It also said these estimates should be made available to the public in a transparent way.

In a letter in response to the GAO, the federal Department for Health and Human Services disagreed with all of the report’s recommendations, including that administrative costs should be made public.  HHS also said experience shows those costs are relatively small and that there was no value in making them available to the public.

Details

Through the end of 2018, Kentucky spent $99.5 million on the changes to the program. As of that date, Indiana, New Hampshire and Arkansas collectively had spent $29 million, though those states had later approval dates.

The GAO also said in the report that the federal government approved spending from Kentucky and Indiana that the feds had previously said they would not pay for. For example, Kentucky got approval  to pay $42 million to the state’s Workforce Development Cabinet to help Medicaid enrollees with job searching and job training.

“Twice [it’s] explicitly mentioned that you’re not allowed to do this, yet we spent $42 million on just that, which is more than three of the five states highlighted in the GAO report spending on their entire administration budget for their waivers,” Pugel said.

Federal officials told the GAO the Center for Medicaid Services didn’t review the contract and took Kentucky’s word that costs were going toward technology, which is allowed.

GAO also said payments to Medicaid insurance companies might also not be allowed, though they’ve already been made or will be made in the future. Indiana, Kentucky and New Hampshire are requiring these insurers to help enrollees meet work requirements and refer enrollees to job training. GAO said Medicaid usually only pays insurers for an enrollee’s actual health care bills.

This post has been updated.

Working Medicaid Enrollees Gain Access To New Kentucky Program, But With Caveats  Tuesday, Aug 6 2019 

Kentucky Medicaid enrollees who work now have the option to enroll in their employer’s health plan — with Medicaid picking up the tab for premiums. State officials say the voluntary program will save Kentucky money, but some health advocates say it has the potential to limit options and add a financial burden for Medicaid recipients.

“It allows them to get access into their employer-sponsored insurance,” said Carol Steckel, Commissioner of Kentucky’s Department for Medicaid Services. “And the biggest thing is, it helps the Medicaid budget so that we’re more financially stable.”

Steckel said the state estimates it will save about $40,000 a month by not having to cover the full cost of a Medicaid enrollee’s health care bills.

It works like this: a Medicaid enrollee will first find out if the state will pay for them to enroll in an employer’s health plan. Steckel said the state has a formula for figuring out which is cheaper – keeping them in Medicaid, or paying for the enrollee to go into an employer plan.

If it’ll save the state money, then an enrollee can sign up for employer-sponsored coverage. That employee will have to pay any premiums up front, or the upfront cost to get that coverage. Then, they’ll have to submit paperwork to get reimbursed.

Emily Beauregard, the executive director of advocacy group Kentucky Voices for Health, said this program won’t work for everyone.

“So that just adds a lot of burden to an individual’s life to keep track of that and do it,” Beauregard said. “Some people may be able to if you’re very organized and if you can float the money between the time that [the premium is] taken out of your paycheck and you get reimbursed.”

Medicaid enrollees will still pay the same amount for doctor’s visits, which could be up to a four dollar copay.

The state says this new program will give enrollees access to a broader range of doctors and health providers through private insurance than Medicaid does. But there’s a catch: if an enrollee goes to a doctor who doesn’t accept Medicaid, the state won’t pay those bills.

“You can only really see Medicaid providers unless you’re able to pay large out-of-pocket costs,” Beauregard said.

An analysis from the Kaiser Family Foundation of these premium-assistance programs noted that it’s likely enrollees will have to find a doctor that accepts both their private insurance and Medicaid, which “further restricts their provider options rather than expanding them.”

Beauregard also noted that enrolling in this program could end up putting a person in a bind financially if they get a raise or more hours at work and their income goes over the Medicaid income limit.

“Let’s say you get an extra five hours a week at work, and you’re no longer eligible for Medicaid: if you’re enrolled in this program, you may be stuck paying the premium yourself,” Beauregard said. “And you might not be able to afford it with just that extra few dollars that you get every week.”

But one potential benefit to an enrollee is that their family members could gain health insurance. For instance, there are many households in Kentucky where kids are covered by Medicaid, but parents aren’t. That’s because the income threshold for kids to qualify is higher than the threshold for adults. If the parent has access to employer coverage, but doesn’t buy it because of the cost, the state could determine that it’d be cheaper for the child to go onto their parent’s employer plan than stay on Medicaid. In that case, the state would pay for the premium for the parent, as well as the child.

“As long as that employer insurance is less than what we would spend under Medicaid, we’ll approve it, and that’s where the savings are,” Steckel said. “Everybody else in that family would have to pay for their own services — the copays, deductibles they’d have to pay for, but at least it buys them into an umbrella of coverage in that insurance policy.”

Gov. Matt Bevin’s proposed Medicaid changes that have been tied up in court includes a program similar to this new state initiative. But the difference is that this new state plan is voluntary, and under the Medicaid waiver, it would be mandatory for Medicaid enrollees who are in the program for at least a year to take employer coverage if they have access.

Alex Shekhdar, founder of Sycamore Creek Healthcare Advisors, said this optional program is a step toward that mandatory program.

 “They are seeking to keep Medicaid limited to traditional categories of eligibility, like [the] medically indigent, moms and kids,” he said.

Several other states have programs that give Medicaid enrollees the option to go into an employer plan. But according to the 2015 analysis from the Kaiser Family Foundation, only a small group of Medicaid enrollees actually have access to employer coverage — they may not work enough hours. According to a University of Pennsylvania review of Kentucky Medicaid data in 2018, about 57,981 enrollees worked 20 or more hours a week. That’s about 17 percent of the state’s Medicaid population.

Oral arguments set in Medicaid court battle over Kentucky HEALTH Friday, Aug 2 2019 

A date has been set for oral arguments in a legal battle over whether work requirements should be imposed on some Medicaid recipients in Kentucky and Arkansas. Oral arguments on the Kentucky HEALTH and Arkansas Works programs are set for Oct. 11 at the U.S. Court of Appeals for the District of Columbia Circuit. Both […]

New Anthem Program Offers In-Home Addiction Recovery Tuesday, Jul 30 2019 

Louisville residents who have employer-based insurance through Anthem will soon have access to a new addiction treatment program run through a local recovery center.

Amanda Newton, the CEO of Louisville-based Renew Recovery, said the program is a little different from what the center currently offers. Instead of having to go to a brick-and-mortar location, Anthem enrollees will stay at home to receive treatment. Newton said this will remove a barrier to treatment that exists for a lot of people.  

“Treatment historically is set up for folks that have lost everything,” Newton said. “So what do we do about the people that still have jobs and families that are struggling? I thought we should meet them where they are instead of meeting us where we are.”

At-home treatment is common in behavioral health, but pretty new to substance abuse treatment. That’s why Anthem is calling the benefit a pilot.

Mike Lorch, Anthem regional vice president for provider contracting, said there are more options for addiction treatment for people who might not have a job and have hit rock-bottom, and are able to spend time during the day at a treatment program.

“There’s more treatment for that Medicaid population, more options,” Lorch said. “This employed group is the untreated population right now that haven’t had a lot of options. You either go off to Florida or California for a 30- or 60-day treatment plan, or you just continue to spiral.”

How It Works

Jeff Reynolds

Enrollees can call Anthem or Renew Recovery to get an initial assessment. Qualifications include factors like having a safe home and family support.

The program will send a therapist and psychiatrist to an enrollees’ home for an initial visit to set up a treatment plan. That would likely include daily telehealth visits with a therapist, virtual group therapy and visits from a peer support specialist to check in on an enrollee’s progress. After two months of the intensive program, the enrollee can either continue with outpatient behavioral therapy for up to two years at Renew or with another therapist. The treatment plan might also include medication assisted treatment, like the drug naltrexone, administered by a pharmacist.

Jeff Reynolds, medical director of Anthem Blue Cross and Blue Shield in Kentucky, said the insurance company is hoping there will be a benefit to enrollees getting treatment at home. He said inpatient treatment that lasts for a finite amount of time doesn’t always equip people with the skills needed to handle their addictions back home.

“And then you walk back into reality, you have to deal with the real: and the real is that those triggers are there,” Reynolds said. “This way, we’re addressing the triggers where they happen.”

Reynolds said Anthem’s pilot project doesn’t have a ceiling on how many people can get treatment, or a deadline for when they’ll no longer offer the benefit. The goal is to track outcomes and potentially expand it nationally.

Lorch said Anthem also doesn’t have an estimate on how many enrollees might use the benefit, but that it will be open to almost one million current customers with Anthem’s employer-based insurance.

“It’s hard to estimate because this is an audience that hasn’t been served before,” Lorch said. “We don’t know how many people are out there that have an addiction that are still functioning, and if this treatment were available, would seek it out.”

And Lorch says there’s another potential benefit: the program may save both enrollees and the insurance company money. Research shows that when a person has a chronic disease in addition to a substance abuse disorder, their overall medical costs are higher. That’s because of factors like forgetting to take medicine or spending money on illegal drugs rather than treatment for chronic conditions.

“”We’ve seen that time and time again – they probably have close to twice the medical spend as somebody in their same demographic that doesn’t have that [substance abuse disorder] diagnosis,” Lorch said.

Newton with Renew Recovery said about 60 percent of the treatment center’s clients have Anthem insurance, so the partnership was a natural fit. The addiction recovery center is also in talks with other insurers.

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