For a second time, the Kentucky HEALTH Medicaid waiver has been approved, this time backed by the Trump administration after review by the federal government. This Medicaid waiver is set to take effect April 1, 2019, and will require working-age, able-bodied adults from 19-64 to either work, volunteer, train for a job, or participate in other approved community activities for a minimum of 80 hours per month in order to maintain their insurance coverage. Initially proposed at the very beginning of the year, the mandate was blocked by a federal judge in June and drew a swift lawsuit by other opponents of the waiver, who contended that it had been proposed without significant thought into how the it might undermine the program’s central purpose: to provide medical assistance to citizens of the state. After a second review, the approval letter argues that the KY HEALTH plan upholds Medicaid’s ultimate goals and central objectives, with only minor changes made to the initial proposal. Kentucky, along with Arkansas, are among the first states to be implementing these historic changes to the 53-year-old Medicaid program, changes which could have national implications for the future of Medicaid.
Implications for Medicaid Recipients
Many of those opposed to work requirements argue that imposing them will eventually lead to an excessive number of individuals removed from the rolls, significantly reducing the number of people with access to healthcare. It has been estimated by state officials at least 95,000 people would lose coverage as a result of either not being able to find work that complies with the community effort requirements or by making too much money to be eligible for Medicaid benefits. In Arkansas alone, about 12,000 impoverished residents have lost their eligibility for Medicaid since the application of work requirements this past June. Many of these individuals have lost eligibility due to the poor implementation of the system, with many claiming they have lost access to their healthcare because of how complicated it is to prove that they are working the necessary amount of time. These complications can produce a domino effect with significant ramifications, as many people relying on Medicaid need insurance and medication to continue being healthy and productive workers. Not having access to healthcare can cause many people to fall below the 80-hour minimum by no fault of their own and creates a cycle of continued poverty and sickness without any foreseeable way out.
What Does This Mean for Medicaid and Addiction Treatment?
There are a couple of select groups of people exempted from these new work requirements, including pregnant women, full-time students, primary caregivers for children, former foster care youth, the elderly, and the “medically frail” amongst others. Those suffering from addiction disorders and alcoholism fall into the broad category of those considered “medically frail,” and are potentially eligible for exemptions and possible premiums under the KY HEALTH program, which includes a substance use disorder program available to all Kentucky Medicaid beneficiaries. Although the benefits for those struggling with addictions have immense potential there are considerable complications within this proposal, with critics stating that the requirements for exemption are onerous and will leave people uninsured. Only those identified, stratified, and diagnosed with disabling mental disorders and chronic substance abuse over the course of multiple medical appointments are capable of being admitted to the Medical Frailty program in Kentucky.
Those willing and capable of following through the process to become eligible for access to these specific healthcare premiums will receive more access to treatment and a deductible of up to $1,000 for out-of-pocket medical expenses. In short, although the substance abuse program is far more rigorous and in-depth as a result of the KY HEALTH plan, if you’re an addict and haven’t formally been diagnosed with a substance abuse disorder, you might not be able to gain access to the healthcare you need without jumping through hoops.
The Future of Public Health Insurance
Although in many ways the KY HEALTH plan intends to support the core goals and purposes of Medicaid, the truth is that there are many possible negative ramifications for impoverished individuals with health issues and substance abuse disorders. Kentucky has become a lightning rod and trailblazer for the future of Medicaid, for better or for worse, and the outcome of the KY HEALTH plan may dictate the future of the public health insurance system for poor Americans. Many on both sides of the political spectrum are wary of the changes and recognize that these changes may potentially allow red states to begin combating Obamacare by privatizing and expanding insurance on their own terms without consideration for the poor and addicted Americans. The Kentucky HEALTH Program is effective beginning this upcoming April and will remain so until September 30, 2023.