Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

health insurance Kynect Medicaid obamacare state government

Gusty 16:00 Add Comment

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

Princess Health and Kentuckians agree regionally on tobacco controls; poll shows wide differences among regions in impact of drug abuse. Princessiccia

drug abuse health insurance health reform heroin obamacare poll polls prescription drug abuse smoking smoking ban smoking bans tobacco

Gusty 21:01 Add Comment

By Al Cross
Kentucky Health News

In a state that once had more tobacco farms than any other, Kentuckians in all regions of the state support policies that discourage use of the product, according to the Kentucky Health Issues Poll.

"Such policies could greatly improve Kentucky's overall health," says the Foundation for a Healthy Kentucky, which co-sponsors the poll each fall. It issued a package of reports that broke down a wife range of previously reported poll results on a regional basis.

Kentucky has fewer than 5,000 tobacco farms, down from a high of 60,000 in 1982, but still has one of the nation's highest smoking rates, 26 percent. That leads to an estimated $2 billion in annual health-care costs.

In every region of the state, a majority (ranging from 59 to 70 percent) of people polled said it would be "difficult" or "very difficult" to make the most important change in their personal health behavior, which for most smokers would be to stop smoking.

"Kentucky adults in every region recognize that improving diet, getting more exercise and quitting smoking could help improve personal health, but the changes are difficult," said Susan Zepeda, president and CEO of the foundation. "Policies around these areas could help all Kentuckians improve their personal health."

The policy getting the strongest support in the poll was tobacco-free school campuses, favored by 85 percent statewide. Fewer than a third of Kentucky's school districts have such policies, but enough do to cover almost half the population.

A statewide ban on smoking in workplaces got 66 percent support. Such a ban is unlikely during the administration of Gov. Matt Bevin, who says the issue should be decided locally. About a third of the state's population lives in jurisdictions with comprehensive smoke-free ordinances; another 10 percent or so live in places that have ordinances with varying exceptions.

There was little difference among the five regions in polling on the two issues.

The poll found regional differences in the percentage of Kentucky adults who said they had no insurance, from 18 percent in Western Kentucky to 8 percent in Eastern Kentucky. The statewide uninsured rate reported at the time of the poll was 13 percent. Other surveys have showed the number in the single digits statewide, after expansion of the Medicaid program under federal health reform.

Health reform also provided subsidies for buying insurance, but some consumers have complained about high deductibles and co-payments. In Northern Kentucky, 34 percent of poll respondents said they had difficulties paying their medical bills in the previous 12 months. The figure was 31 percent in Appalachian Kentucky, 30 percent in Greater Louisville, 25 percent in Western Kentucky, and 22 percent in Greater Lexington.

"An increasing number of Kentuckians have health insurance, but many are still delaying or simply can't afford necessary health care," Zepeda said.

Federal health reform was most popular in the Louisville area, at 44 percent support, and least popular in Northern Kentucky, with 33 percent. Generally, the more impact people said reform had on them, the more likely they were to support it. Three of five Northern Kentuckians said they had not been affected by the reforms but only 45 percent in the Louisville area said that.

There are bigger differences in the impact of drug abuse. One-third of Eastern Kentucky residents in the poll reported reported family members or friends struggling with prescription drug abuse, but only 16 percent in Western Kentucky said so.

Heroin use has caused problems for 35 percent of respondents' families and friends in Northern Kentucky, 17 percent in Greater Louisville, 14 percent in Greater Lexington, 10 percent in Eastern Kentucky, and 8 percent in Western Kentucky.

The regional reports for Eastern Kentucky, Greater Lexington, Greater Louisville, Northern Kentucky, and Western Kentucky, and associated news releases, are available at http://healthy-ky.org/news-events/press-releases.

The poll was conducted Sept. 17 through Oct. 7 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,608 adults from throughout Kentucky was interviewed by landlines and cell phones. The statewide poll has a margin of error of plus or minus 2.4 percentage points, but the smaller regional samples have higher error margins. The complete data file, codebook and survey instrument will be posted by June 30 at http://www.oasisdataarchive.org/ with other data files from previous polls.

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

governor health insurance health reform Medicaid obamacare politics state budget state government

Gusty 19:05 Add Comment

The state's revised Medicaid program won't require any beneficiaries to pay premiums, but it may offer fewer benefits, Medicaid Commissioner Stephen Miller told Adam Beam of The Associated Press.

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.

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

federal spending health care costs health insurance insurance coverage managed care Medicaid obamacare Patient Protection and Affordable Care Act state government

Gusty 13:11 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Groups of people concerned about changes in Kentucky's Medicaid program are open to the state offering incentives for healthy behaviors, but they don't want to penalize recipients who can't or won't pay premiums, deductibles or co-payments.

So reports the Foundation for a Healthy Kentucky, which convened a meeting May 12 to hear from people with stakes in the program: individual health-care providers, health systems, consumers, consumer advocates, payers, public-health professionals and representatives of higher education.

�Participants were unified in opposing penalties to enforce cost-sharing provisions� such as premiums, deductibles or co-payments, the foundation's consultant said in a report on the meeting.

However, they supported cost sharing for procedures not deemed medically necessary and �had diverse perspectives on this matter, ranging from opposing any cost-sharing in Medicaid to proposing specific premium and co-payment amounts,� such as $5 monthly premiums.

Also, �Participants were generally very supportive of implementing incentives for healthy behaviors such as smoking cessation and health risk assessments,� the report said. �Incentives might be reductions in the amount of cost-sharing or themselves supportive of healthy behavior,� such as gym membership.

Gov. Matt Bevin has said he wants Medicaid recipients to have "skin in the game" through cost-sharing, arguing that Kentucky can't afford to have more than a fourth of its population getting free medical care.

Under federal health reform, then-Gov, Steve Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level, adding more than 400,000 more people to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin's administration is working on getting a waiver from the federal Centers for Medicare and Medicaid Services to create new ways to cover those in the expansion. Six states have such waivers, including Indiana, which Bevin has cited as an example of how Kentucky might change its program.

In Indiana, recipients who pay premiums based on income levels, ranging from $1 a month to 2 percent of income ($27 a month for those at 138 percent of poverty) get expanded benefits and are charged co-payments only for non-emergency use of emergency rooms, according to the Kaiser Family Foundation. Those above the poverty level who fail to pay are disenrolled and barred from re-enrolling for six months, in what is known as a "lock-out" rule.

Bevin has indicated that he wants to announce his plan this summer. By law, states that seek a waiver must hold at least two public hearings: one at least 20 days before submitting the application to CMS, and the second after CMS accepts the application.

Stakeholders who attended the foundation's May 12 convening wanted to make sure their voices were heard early on in the process.

"Our goal is to help inform the process of changing the way Kentucky provides Medicaid services to ensure that we maintain the gains achieved under the Affordable Care Act, while also enabling the state to try new methods of ensuring access to affordable quality health care for Medicaid beneficiaries," Foundation President and CEO Susan Zepeda said in a news release.

"The biggest takeaway for me was the energy and commitment in the room," Zepeda said in a telephone interview. "A lot of thoughtfulness clearly went into sharing their experience and making suggestions on how to make the system more cost effective."

Before breaking into groups to offer their imput, stakeholders were given an overview of the state's Medicaid expansion and an overview of an issue brief created by the State Health Access Data Assistance Center at the University of Minnesota that looked at how waiver provisions are set up in five other states. Foundation staff wrote the 25-page "Stakeholder Input Report" that summarized suggestions and concerns and broke them into eight areas:

Cost-sharing and penalties: Health-care providers strongly opposed any cost-sharing, and uniformly opposed to any measure that involved "lock-out" penalties for failure to pay premiums, co-pays or deductibles.

"Our shared experience has been that we�ve been prohibited from denying care if a patient refuses or is unable to pay," the Physical and Oral Health Provider group said. "Therefore, the desired behavior isn�t actually enforced."

The Behavioral Health Provider group offered a compromise: �If the administration chooses to explore lock-outs we recommend that lock-outs be immediately lifted (upon payment) and payment be retroactive to the date the consumer re-enrolls.�

Participants in general were open to the idea of low co-payments, cost-sharing for non-medically necessary services, using Medicaid dollars to pay premiums for employer-sponsored insurance plans and charging co-payments for non-emergency use of the ER. They also agreed that certain groups, like those with chronic illnesses or disabilities, should be exempted.

Incentives: Most post-ACA waiver programs have implemented incentives for healthy behavior, and those at the meeting generally supported implementing evidence-based incentives, such as smoking cessation and health-risk assessments.

Zepeda said that most of the stakeholders wanted to see healthy behavior incentives used as credits against premiums, especially for recipients who can't afford them. "There is a recognition that people have a role to play in their own health care and the health decisions that they make," she said.

Benefits: Benefits include services covered under the health insurance plan. Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits like housing. All agreed that medically necessary services should be covered for all enrollees.

Reimbursement: Kentucky shifted Medicaid in 2011 to managed care, in which managed-care organizations (usually insurance-company subsidiaries) are paid a flat fee per person as an incentive to limit claims. Providers have complained about the slow and low reimbursement, and participant suggestions included streamlining and accelerating the reimbursement process, increasing provider reimbursement rates, and adding new categories of reimbursed services and providers, like telehealth.

Systems improvement: Participants suggested simplifying administrative processes for providers; expanding providers' scope of practice; adding review panels; reducing the number of managed-care organizations; and creating a single list of drugs for all MCOs.

Health system transformation: Waivers allow states to explore ways to provide care differently through various transformation approaches. Suggestions included creating price transparency, through an all-payer, all-claims database; improving consumer health literacy; and moving beyond coverage issues to addressing access and quality.

�There was also interest among our group in examining a PCMH (patient-centered medical home) or health homes model to promote care coordination, and we feel strongly that pharmacists are essential part of the team and should be used in novel and more expansive ways,� the Colleges and Universities group said.

Evaluation: Waivers require states to perform an evaluation and make it public. Participants agreed that the process should include stakeholders and that findings should be made public periodically.

The Physical and Oral Health Provider group suggested the evaluation should answer the questions, �Have we maintained coverage levels? Have we improved access to care?�

Overarching themes: Many of the stakeholders mentioned two issues that were not included in the issue brief or discussion: integrating behavioral, physical and oral health services, and addressing the wide set of social factors that shape Kentucky's relatively poor health.

�Waivers should include methods to address social determinants of health as these areas are proving most effective in improving outcomes and reducing cost,� the Physical and Oral Health Provider group said. �We encourage inclusion of community health workers, peer support, medical respite care and other innovations to support social needs of patients.�

Zepeda said the Medicaid waiver drafting team faces many challenges. "We consider the rich conversation that happened on May 12 to be the start of the conversation," she said. "We have to find the cost effective win/win strategies that can reduce the cost of Medicaid going forward and let us continue to serve this expanded number of Kentuckians who now have health insurance."

Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

Princess Health and Health-insurance companies ask state for rate increases averaging 17 percent; failure of non-profit insurer blamed. Princessiccia

health insurance health reform insurance coverage insurance exchange obamacare

Gusty 13:25 Add Comment

Department of Insurance website

Health insurers want rate increases averaging 22.3 percent in 2017 for individual policies in Kentucky. Counting small-group plans, the overall increase would be 17 percent, "continuing a national trend of hefty hikes as insurers adapt to a market reshaped by President Barack Obama's signature health care law," Adam Beam reports for The Associated Press.

"But the rate increases, if approved by state regulators, do not guarantee double-digit increases in the monthly premiums people have to pay," Beam notes. "The base rate is one of many factors companies use to determine how much someone pays in a monthly premium. Other factors include age, where a person lives and whether the person smokes."

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

Read more here: http://www.kentucky.com/news/politics-government/article79766917.html#storylink=cpy

The average requested increases for individual policies range from 7.6 percent for Aetna Health Inc. to 33.7 percent for Louisville-based Humana Inc., which said recently that it was losing money on Obamacare plans and is working on a merger with Aetna (to which Missouri objected this week). Baptist Health Plan wants 26.68 percent more, Anthem Health Plans 22.9 percent, and CareSource 20.55 percent, all on average.

�The Department of Insurance will fully investigate all proposed rate increase requests to make sure they are warranted,� Commissioner Brian Maynard said in a release. �Insurance rate increases are not specific to Kentucky; states across the nation are dealing with this issue.�

The department said some of the rate increases "appear to be attributed to the failure of the Kentucky Health Cooperative Inc.," a non-profit that was created under the reform law to provide more competition but then was not fully funded by Congress.

"The co-op went bankrupt and was placed into liquidation earlier this year, leaving other insurance companies to cover the more than 51,000 former co-op customers," the department noted. "Many of those customers were high-risk, and Kentucky�s remaining insurers appear to project that those high-risk customers will affect the risk pool." Anthem spokesman Mark Robinson told AP that the expectation of insuring co-op customers was responsible for its rate request.

UnitedHealth Group Inc. said recently that it would stop selling exchange policies in Kentucky, leaving many counties with only one insurer on the exchange. The only company that seeks to sell individual policies statewide is Anthem. It will be the only choice on the exchange in 54 counties.

However, Indianapolis-based Golden Rule Insurance Co., a United subsidiary, will sell "in all counties, off the exchange," the department said. Golden Rule, which still won't sell exchange policies, is seeking a rate increase of 65 percent.

Anthem, Aetna and Baptist will also offer non-exchange policies. Aetna plans to sell in only 10 counties: Jefferson, Fayette, Kenton, Campbell, Boone, Oldham, Trimble, Henry, Owen and Madison. Baptist will sell in 38 counties off the exchange and 20 on the exchange. Humana will sell on the exchange in nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton). CareSource will sell in 61 counties, all on the exchange.

Consumers in Fayette, Jefferson and Oldham counties will have five insurers to choose from on the exchange. Jessamine, Woodford, Bullitt, Henry, Madison and Trimble counties will have four. Thirteen counties will have three choices, and 44 will have two. An Excel spreadsheet listing the policies for each county is available at www.uky.edu/comminfostudies/irjci/Kyhealthinsbycounty2017.xlsx.

The filings are online at insurance.ky.gov/ratefil/default.aspx. Rates must be approved within 60 days of each filing, or no later than July 11.

The administration of Gov. Matt Bevin is dismantling the Kynect health-insurance exchange and will use the federal exchange, HealthCare.gov, as a portal for enrollment in exchange policies.

Princess Health and Feds strengthen anti-discrimination health rules. Princessiccia

Princess Health and Feds strengthen anti-discrimination health rules. Princessiccia

disabilities federal regulation gender disparities health health care health care access health care reform health communication obamacare Patient Protection and Affordable Health Care Act

Gusty 13:20 Add Comment

Photo from mdxipe.wordpress.com

By Danielle Ray
Kentucky Health News

The Department of Health and Human Services issued rules Friday in an effort to ensure equality in health care for women, the disabled and people who speak English as a second language.

The new provisions protect women from discrimination not only in the health coverage they obtain but in the health services they seek from providers. They also prohibit denial of health care or health coverage based on a person's sex, including discrimination based on pregnancy, gender identity and sex stereotyping.

The rule also requires providers to take reasonable steps to provide communication access to people with limited English proficiency. In addition, it requires that providers make electronic information and newly constructed or altered facilities accessible to individuals with disabilities, including providing auxiliary aids and services.

HHS Secretary Sylvia Burwell called the rule "a key step toward realizing equity within our health care system." She said in an agency news release that it reinforces the central goal of the Patient Protection and Affordable Health Care Act, to improve access to quality health care.

The rule covers any health program or activity that receives federal funding, such as providers who accept Medicare or Medicaid; any health program that HHS administers; and federal- and state-based health insurance marketplaces and insurers that participate in them.

The new rule implements Section 1557 of the 2010 health-reform law, which is the first federal civil-rights law to prohibit discrimination based on sex in federally-funded health programs. Previously, civil rights laws enforced by the agency's civil rights office barred discrimination based only on race, color, national origin, disability, and age.

The rule does not resolve whether discrimination on the basis of an individual�s sexual orientation status alone is a form of sex discrimination under the reform law. However, the provisions leave room for the agency's civil-rights office to evaluate complaints that allege sex discrimination related to a person�s sexual orientation to determine if they can be considered sex stereotyping, which the rule prohibits. In cases where religious freedom would be violated, health-care providers are not required to follow the regulation.

A summary of the new rule can be accessed here.

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

economy federal spending health reform jobs Medicaid obamacare Patient Protection and Affordable Health Care Act politics prevention state budget state government

Gusty 13:15 Add Comment

By Danielle Ray

Kentucky Health News

A research group with a liberal outlook warned Monday that Republican Gov. Matt Bevin should be careful in changing the state Medicaid program.

The Kentucky Center for Economic Policy said the state�s expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has increased health screenings and job growth in health care.

Tobacco counseling and interventions increased 169 percent from 2013 to 2014, the first year of the expansion, the report noted. Influenza vaccinations went up 143 percent and breast cancer screenings increased 111 percent, it noted.

In addition, Medicaid expansion brought Kentucky health-care providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job growth in the health-care sector from 2014 to 2016, according to the report.

�No matter how you look at Medicaid expansion in Kentucky, it�s clear it has had a positive effect on access to health care that will improve our state�s economy and quality of life,� Jason Bailey, executive director of KCEP, said in a news release.

However, Bevin says the state can�t afford to have more than a fourth of its population on Medicaid and is seeking a waiver from the federal government to make changes in the program, such as �skin in the game� for beneficiaries: co-payments, deductibles or health savings accounts, as used in a year-old experiment in Indiana, which he has cited as an example.

The KCEP reports says the Medicaid waiver Bevin is seeking could result in additional costs to recipients and benefit changes. Arkansas was the first state to design a Medicaid expansion using such a waiver. So far, five other states have implemented similar waiver-based programs.

Waiver programs differ from standard Medicaid expansion in that they utilize some or all of the following: health savings accounts, a cost-sharing account to be used for health care expenses; lockouts, periods in which recipients who have been dis-enrolled for failure to pay premiums are barred from re-enrolling; and premium assistance, the use of Medicaid funds to buy private insurance plans.

These waivers are designed to grant states the freedom to enact experimental programs within Medicaid, so long as the programs continue to reflect the overall goal of Medicaid, increasing coverage of low-income individuals and improving overall health care, as well as efficiency and stability of health care programs that serve that population.

The Foundation for a Healthy Kentucky, which convened a meeting of Medicaid stakeholders last week, is holding off on making judgments of the proposed waiver program. �We believe that diverse input is essential to sustaining these gains, and to continue improving our health care system and health outcomes in Kentucky,� said Susan Zepeda, president of the foundation.

Zepeda said research the foundation has funded has shown a greater decrease in the number of Kentuckians who lack health insurance than any other state, which she attributes largely to Medicaid expansion adding about 400,000 Kentuckians to the rolls.

More than 1.4 million Kentuckians are enrolled in Medicaid, 39 percent of whom are children. Nearly 32 percent are enrolled under the expansion: childless adults in households that earn less than 138 percent of the federal poverty line, currently $33,000 for a family of four.

The KCEP report also asserts that Kentucky�s Medicaid benefits are on par with those of other states, specifically that 12 out of 13 of Kentucky�s optional benefits are also covered in at least 40 other states and territories. Kentucky Medicaid only covers services that are deemed medically necessary.

KCEP noted that Medicaid is a partnership in which the federal government funds a minimum of half of traditional Medicaid spending in each state, with poorer states receiving a larger federal match. In Kentucky, the federal share is about 70 percent. For people covered by the expansion, the federal government is paying the full cost through this year, but the state will pay 5 percent in 2017, rising in annual steps to the law�s limit of 10 percent in 2020.

The full KCEP report is at http://kypolicy.org.