Questions linger over Bevin’s Medicaid plans

Homeless and battling severe mental illness and alcoholism after years of brutal childhood abuse, Gene Miller said that gaining Medicaid coverage in 2014 was a lifeline.

Regular health coverage for the first time in his adult life provided him with a way to pay for mental health treatment and medication he needs, Miller, 44, of Louisville, said in a recent interview.

“We really need to keep this,” Miller said. “I don’t know what I’d do without it.”

Miller was among more than 400,000 people added to Kentucky’s Medicaid program under the Affordable Care Act that allowed the state to accept anyone earning below 138 percent of the federal poverty level – about $16,200 for an individual.

As the 2016 session of the Kentucky General Assembly opens, lawmakers say they plan to keep a close eye on changes to the state’s Medicaid system proposed by Gov. Matt Bevin, who has said he wants to reshape it along the lines of one operated by Indiana, which requires premiums, co-pays and provides different tiers of coverage.

“It’s going to be interesting to see how it shakes out,” said Rep. David Watkins, a Henderson Democrat and retired physician who serves as co-chairman of the legislature’s Medicaid Oversight and Advisory Committee. “We’re already at the bottom of the heap here in Kentucky. We don’t need to go down any further.”

Watkins said that while no major legislation is pending that would affect Kentucky’s expansion of Medicaid, he expects his committee and others will seek regular updates from the Bevin administration during the legislative session.

“I think it will be a pretty significant issue,” he said.

Senate President Robert Stivers, a Manchester Republican, told the Kentucky Health News last week that lawmakers could enact legislation, but Bevin has the authority to redesign Kentucky’s Medicaid program without legislative approval.

“The ultimate goal is to make sure there is health care … that is sustainable and covers the same population,” said Stivers, whose home Clay County is one of the state’s poorest and has about half its residents enrolled in Medicaid.

Ramona Johnson, president of Bridgehaven, a center in Louisville where Miller receives mental health services, is working to make sure lawmakers understand what’s at stake for people who’ve been added to the Medicaid rolls.

Not only has having health coverage dramatically expanded access to health care, it has expanded access to mental health and substance abuse treatment in a state with high rates of drug and alcohol abuse, she said. Many new enrollees have gained health coverage for the first time in their lives, she said.

“They’ve been struggling under the radar,” Johnson said. “These people have really benefited from this.”

Bridgehaven has added about 75 newly-insured members in the two years since Medicaid was expanded, Johnson said.

With regular treatment, such individuals have dramatically reduced time in jail, or psychiatric hospitals and avoided becoming homeless, she said in comments at the Dec. 16 joint House-Senate Health and Welfare Committee meeting. Some have been able to obtain and maintain jobs, others are attending school or volunteering.

Bevin, a Republican, campaigned on dismantling most of the federal health law benefits enacted in Kentucky by his predecessor, Gov. Steve Beshear, a Democrat. Since winning the November election, Bevin has toned down his claims to indicate he plans to restructure, not repeal the Medicaid expansion, one of the key features of the health law in Kentucky.

Bevin said at a Dec. 30 news conference that he plans to seek federal approval, known as a waiver, from the U.S. Centers for Medicare and Medicaid Services, that would allow Kentucky to revamp its Medicaid system with an eye toward making it more sustainable.

“Clearly, we cannot afford the traditional approach,” he said.

Bevin said he will work this year to develop a plan that meets CMS approval and would expect to introduce it in 2017.

Bevin has offered few details but has referred repeatedly to the federal waiver CMS approved for Indiana in early 2015. Indiana Gov. Mike Pence attended Bevin’s inauguration as a guest of honor.

Unlike Kentucky, Indiana was among 20 states that refused to accept the Medicaid expansion. But with 765,000 Hoosiers with no health coverage and growing pressure from groups including health advocates and hospitals, Pence sought permission from CMS to introduce a more limited version in Indiana.

Health advocates “were early and vocal advocates” for the expansion of traditional Medicaid services, said Caitlin Priest, director of Covering Kids & Families of Indiana, a coalition of health advocacy groups. But when it became clear Pence and Republicans who control Indiana’s legislature would not do so, advocates joined to try to help shape the best Medicaid plan possible, she said.

“We were at the point where three-quarters of a loaf was better than no loaf at all,” she said.

Since Indiana’s plan was launched in February 2015, advocates have discovered that new enrollees in the system, most who aren’t used to having health coverage, need extra help learning to use their benefits and keep up with premiums and co-pays, Priest said.

“This is a fairly complex program,” she said.

Johnson said she worries about how an Indiana-style system would work in Kentucky.

“I think that would be a very difficult system for someone with severe mental illness to navigate without a lot of assistance,” she said. “Why make the system more difficult?”

The prospect of potential changes in his health coverage already worries Miller, the Bridgehaven member.

After decades of untreated mental illness, Miller said his life has stabilized. He’s been sober since March 2014 and, with the aid of St. Vincent de Paul-Louisville, he recently moved from a shelter into his own apartment on the campus of the charitable organization.

“The fear of losing health coverage, that’s huge,” he said. “My mind is racing all over the place.”

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