It’s what the Trump administration wants — and more states will likely follow.
The Trump administration on Friday told Kentucky it can go ahead with its controversial Medicaid overhaul ― an initiative that would reduce benefits, require some beneficiaries to work, and generally make it more difficult for people to stay on the program.
Administration officials and their Kentucky counterparts have portrayed the plan as a way to improve the health of low-income residents and encourage self-sufficiency among poor but able-bodied adults. “The result will be a transformational improvement in the overall health of our people and will provide a model for other states to follow,” Matt Bevin, the state’s Republican governor, said at a press conference Friday.
But there’s scant evidence that Kentucky’s changes will have the effects that Bevin and his allies are promising. In fact, of the roughly 95,000 people expected to lose coverage, some will almost surely be people who are working ― or have reasons why they can’t work ― but who failed to satisfy the new system’s paperwork requirements.
Almost by definition, the people likely to lose coverage already have some combination of financial and medical problems, and without coverage, both are likely to get worse. It’s not clear how much this worries Bevin and his allies in Washington ― or whether it worries them at all.
In the new scheme, most working-age adults in Kentucky would have to demonstrate that they have spent at least 80 hours a month working or engaged in employment-related activities, like searching for a job or performing community service. Many would also have to pay premiums, of up to $15 a month.
Anyone who does not pay their premiums or submit paperwork to show their eligibility would lose their coverage and would not be able to reapply for six months, although people who don’t pay premiums could restore coverage by completing a financial literacy course (the details of which aren’t yet clear).
The Kentucky initiative also eliminates a transportation benefit, designed to get poor people to the doctor or hospital when they don’t have the means to do so. And it ends “presumptive” or “retroactive” eligibility, under which Medicaid covers bills from the past three months for people who sign up for Medicaid only after they’ve had a medical episode that landed them in the hospital.
Kentucky’s proposal is likely to prompt legal challenges. If it survives, then the result will almost certainly be a smaller Medicaid program. Both the state and the federal government would likely end up spending less money than they would otherwise. But fewer people would be on Medicaid: The number of beneficiaries would drop by roughly 95,000 within five years, according to official state estimates.