New Medicaid requirements require community engagement to maintain coverage

By Ben Keeton

Editor’s Note: On June 29 Judge James E. Boasberg of Federal District Court for the District of Columbia, blocked Kentucky’s plan to require many Medicaid recipients to work or volunteer in order to continue receiving benefits.

Changes are coming to the Medicaid program in Kentucky as part of the recently approved 1115 waiver submitted by Governor Matt Bevin in 2016. These changes, known as Kentucky HEALTH, are intended to improve the health of its participants, strengthen Medicaid’s long-term fiscal sustainability and promote personal responsibility for health and well-being.

Kentucky HEALTH introduces innovative delivery system reforms for the treatment of substance abuse, and a first-ever community engagement initiative for Kentucky HEALTH members designed to improve their health and strengthen Kentucky’s workforce.

The roll out of the new initiatives will begin July 1 in Campbell County and will be followed immediately in Kenton and Boone County. The program will then expand statewide in various stages starting October 1, 2018.

Work Requirement

While there are many aspects of the Kentucky HEALTH program that may impact the Medicaid system, but the most potentially impactful is the Community Engagement or work requirement for able-bodied adults.

Some people receiving Kentucky HEALTH need to participate in 80 hours of community engagement activities each month to keep their medical benefits. PATH Community Engagement activities include looking for a job, working, volunteering, care giving, job training, participating in substance abuse treatment or enrolling in classes.

Kentucky HEALTH is working with Kentucky Career Centers and adult education agencies across the Commonwealth to connect people to resources that will help them find ways to pay for school, gain skills that employers are looking for and find good-paying jobs.

Most people ages 19-64 who can work will need to complete 80 hours of community engagement-approved activities each month to stay eligible for their Kentucky HEALTH benefits. People who are employed and work at least 20 hours per week are already meeting the community engagement requirement and will not be required to do additional activities.

Penalty Period

If a Medicaid member does not complete and report their community engagement hours on time, they will be in a penalty period and will have their medical benefits suspended for up to six months. They can end the penalty period early and get their benefits back by either completing and reporting a full month of the community engagement requirement or taking a re-entry course.

These courses will be available both online and in-person. Different topics and skills around managing health, money and career are covered. After they complete one of the options above, they will get their medical benefits back.

Maintaining Coverage

The Foundation for a Healthy Kentucky is partnering with the Bevin administration to help Kentuckians maintain coverage under the Kentucky HEALTH Medicaid waiver demonstration program. The Foundation has hired Veronica Judy Cecil to oversee the initiative.

Ensuring that those with substance use disorders can obtain treatment and work toward long-term recovery and employment will be an initial, primary focus of the initiative, the Foundation said. About 13 percent of Kentucky’s Medicaid population ages 18-64 suffers with drug and other substance use disorders. Under the waiver program, Medicaid covers the cost of treatment for those diagnosed with such a disorder.

“Our singular goal in this project is to help ensure that as many Kentuckians as possible who are currently eligible for Medicaid are able to retain their health coverage for necessary healthcare,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “If they need substance use treatment, we want to help them get it. If they need support getting and keeping a job or paying premiums, we want to help make that happen. Health coverage leads to better preventive care and better health. Neither the people nor the budget of Kentucky can afford the health costs of lapses in coverage.”

The Foundation will support Medicaid beneficiaries with meeting the waiver requirements and work with employers, providers, payers, assisters, advocates and the Kentucky Cabinet for Health and Family Services toward that effort. In addition, the Foundation will create an advisory council to gather and share input among all stakeholders and resolve issues as the waiver is implemented.

“As a nonprofit, nonpartisan organization committed to making people healthier, the Foundation can play a unique role in creating safe spaces to gather and share this information, and help ensure the quickest, most equitable resolution,” Chandler said.