by , @d_yetter –

Gov. Matt Bevin’s plan to reshape the state’s Medicaid program was debated in Louisville on Wednesday, with top officials from his administration defending it and health advocates arguing against his proposal submitted last week to the federal government for approval.

Vickie Yates Brown Glisson, Bevin’s secretary of the Cabinet for Health and Family Services, said the changes are essential to control costs of the federal-state health plan that covers more than 1.3 million Kentuckians, citing the governor’s warning to her about Medicaid.

“This is one of those issues that could take our state down down,” Glisson said, speaking at the Louisville Forum, a non-partisan public issues group.

But Jason Bailey, executive director of the Kentucky Center for Economic Policy, argued that the program expanded under the federal Affordable Care Act to cover more low-income Kentuckians is just what the state needs to provide much-needed health coverage for many people in low-wage jobs that don’t include it.

“This is a good investment for Kentucky,” said Bailey, adding that the Medicaid program brings about $2.5 billion a year in federal money to Kentucky.

The federal government pays 70 percent of the costs of the about 875,000 Kentuckians who were on “traditional Medicaid” before the expansion of 2014 that added another 440,000 people to the program. The federal government paid 100 percent of the costs of the additional enrollees for the first two years but that drops to 95 percent in 2017 and eventually to 90 percent with the state picking up the difference.

In changes aimed largely at “able-bodied adults” among the new enrollees, Bevin is seeking a waiver from the federal government to change the program to charge premiums ranging from $1 to $37.50 per month, based on income and length of time on Medicaid. His proposal also includes “lock-outs” of coverage for some who fail to pay premiums and requirements that people work or volunteer up to 20 hours a week in order to keep Medicaid benefits.

And it eliminates dental and vision benefits from basic coverage, though, in response to critics of that provision, the benefits would continue for three months, giving an individual time to accrue credits in a separate “My Rewards” account that could be used to purchase dental or vision care.

Bailey objected that the changes are overly-complicated and will present barriers to health coverage for many low-income Kentuckians.

But Bevin’s budget director, John Chilton, who also spoke at the hearing, disagreed, saying requirements such as monthly premiums are reasonable.

“A dollar a month for someone that’s got money doesn’t sound like a lot,” Chilton said. “They ought to have some skin in the game, as the governor says.”

All changes must be approved by the U.S. Department for Health and Human Services, or HHS.

Glisson said she’s optimistic, saying that many of the features of Kentucky’s waiver application have been approved in other states.

“We are very hopeful the federal government will approve this waiver,” she said. “There is nothing new here.”

But Cara Stewart, a legal aid lawyer who works with poor clients, said some of the changes, such as the work requirement, have never been approved by federal officials. Just last week, she said HHS rejected changes sought by Ohio including premiums and “lock-out” provisions

In a letter to Ohio Medicaid officials, HHS said such proposals would “undermine access to coverage.”

Stewart said “there’s no doubt” federal officials will reject Bevin’s proposed changes for similar reasons.

HHS has accepted Kentucky’s proposal as complete and will take public comments through Oct. 8. People may comment online at Medicaid.gov.

Contact reporter Deborah Yetter at [email protected] or at (502) 582-4228.