Diverse Groups Find Considerable Agreement in Ideas to Change Kentucky Medicaid Program

Input released today from a broad cross-section of stakeholders interested in how the state will implement changes to Kentucky’s Medicaid program includes a wide array of suggestions, many of which are reflected in two overarching themes: support for integrating behavioral, physical and oral health services; and a desire to better address the wide set of social factors that shape Kentucky’s health. Stakeholders generally said they are open to including incentives for healthy behaviors in Kentucky Medicaid but opposed to penalties for cost-sharing provisions.

“The input reflects avid interest from every group that participated, and suggests more alignment than disagreement on how to improve Medicaid,” said Susan Zepeda, President and CEO of the Foundation for a Healthy Kentucky, which released a report summarizing these stakeholder ideas. “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.”

The report captures input generated by a May 12 meeting convened by the Foundation to gather ideas and feedback from a variety of stakeholders regarding Kentucky’s plan to apply for a waiver, under Section 1115 of the Social Security Act, that allows states to test and evaluate new ways to provide Medicaid. A Section 1115 waiver could permit Kentucky to try innovative, cost-effective approaches to providing services under Medicaid, the federal health care insurance program for low-income individuals that is administered by the states.

The Foundation’s Medicaid waiver stakeholder report summarizes participants’ suggestions and concerns, which were grouped into eight themes:

  1. Cost-sharing and penalties: Participants shared diverse perspectives, ranging from opposing cost-sharing to proposing specific premium and co-payment amounts; participants uniformly opposed penalties for failure to make cost-sharing payments, however.
  2. Incentives: Participants generally support implementing evidence-based healthy behavior incentives, such as smoking cessation.
  3. Benefits: Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits. All agreed that medically necessary services should be covered for all enrollees.
  4. Reimbursement: Participant suggestions included streamlining and accelerating the reimbursement process, increasing reimbursement rates to providers, and adding new categories of reimbursed services and providers.
  5. Systems Improvement: Participants suggested simplifying administrative processes for providers; expanding provider scope of practice; adding review panels; reducing the number of Medicaid Managed Care Organizations (MCOs) currently in Kentucky’s Medicaid system; creating a single formulary for all MCOs; and aligning all existing Medicaid waiver populations under the 1115 waiver program.
  6. Health Systems Transformation: Suggestions included creating price transparency, through an All Payer All Claims Database; improving consumer health literacy; moving from volume-based to value-based and outcomes-based care; and moving beyond coverage issues to addressing access and quality.
  7. Current Medicaid Expansion: Many participants expressed opposition to changing the existing Medicaid expansion program.
  8. Evaluation: Participants offered many ideas around the process and the metrics that should be used to evaluate the implementation of the 1115 waiver, and agreed that the process should include stakeholders and that findings should be made public periodically.

The May 12 meeting gathered a variety of stakeholders: physical, behavioral and oral health providers; consumers and consumer advocates; public health professionals; academic researchers; health systems; and payers. The Medicaid Waiver Stakeholder Convening report, as well as a brief examining 1115 waiver provisions employed by five other states and summarizing research about how those provisions are working (prepared by the State Health Access Data Assistance Center, or SHADAC, at the University of Minnesota), and a Kentucky Voices for Health presentation summarizing recent changes to Kentucky’s Medicaid program, are linked.

Bonnie J. Hackbarth is with the Foundation for a Healthy Kentucky.