Cause for Concern: Many fear they can’t meet Medicaid work requirement
Earlier this year,
The state's new regulations are set to begin
When Gov.
The
Until two years ago,
Working, school or volunteerism are not options right now.
Even if the state's new regulations allow her, as her parents' caregiver, to keep her Medicaid benefits, she disagrees with the waiver and its requirements.
"For me, (
Risks for working residents
State officials expect 95,000 Kentuckians to roll off Medicaid within the next five years.
That number includes people who may transition to commercial insurance as well as those who may fail to comply with new state requirements, said
Many who will lose benefits are already employed, according to the Center on Budget and Policy Priorities, a
Most Medicaid recipients work, but they often face frequent job losses and fluctuating hours. Because of the instability associated with many low-wage jobs, the center estimates one in four enrollees may be at risk of losing benefits or experiencing interruptions in medical coverage each year because they will fail to be compliant.
"Approved and pending state work requirement policies are based on the assumption that people who want to work can find steady employment at regular hours," the national center reported. "This assumption is out of step with the realities of the low-wage labor market."
That is especially true in rural
Putnam said state officials have the authority to roll out the community-engagement requirement on a county-by-county basis. If a county's unemployment rates are high, the new requirements may be stalled.
"We know there are areas in the state that have challenges when it comes to job opportunities," Putnam said.
And, during the interview, she took issue with those who use the term "work requirements."
"Work is only one way to meet the requirement," Putnam said. The term community-engagement more accurately reflects the intent because people also can attend school, take care of their disabled children or volunteer at a park, for example.
Local concerns
In general, though, all able-bodied Medicaid recipients will see some changes. For example, they will have to provide documentation of work or volunteer hours.
"Some may have co-pays or be required to pay premiums," Horton said. "Also, some of their benefits, like dental and vision coverage, will shift to an alternative benefit plan called My Rewards, where the participant must earn dollars through completing education or community engagement activities."
Prior to the Affordable Care Act, some regional counties had uninsured rates as high as 22 percent.
"Our community suffered much under that reality," said
Last year, Medicaid clients made up about 30 percent of the health department's revenue. The biggest portion of those clients were children, pregnant women, parents and the medically frail.
"These groups shouldn't see as many changes to their coverage and requirements," Horton said.
Right now, the health department doesn't know of any direct impact to its revenue, but there could be an indirect impact if some clients lose coverage.
More than 13 percent of
"We have patient financial advocates at the hospitals and clinics that assist our patients with applying for Medicaid coverage," Ranallo said. "We expect the reduction to be minimal."
The My Rewards program -- which Putnam said will roll out statewide on
In addition, recipients will be docked points if they go to an emergency room for anything not considered to be an emergency. Toothaches may fit in that category, Taylor said.
"So a possible scenario is that someone worked to accrue enough points through community engagement only to lose them when their face swells in the middle of the night due to an abscessed tooth. Now, they are unable to have the tooth extracted because they do not have enough points," he said.
Taylor wants emergency dental procedures excluded from the My Rewards program. "These procedures should be a guaranteed benefit to Medicaid recipients."
Lack of communication
Earlier this year,
WellCare representatives told her providing care at least 80 hours a month should protect her benefits. However, at the time, they offered no guarantee.
It's been hard to get answers,
She received a brief letter with no details months ago from state officials, which told Medicaid recipients to expect upcoming changes. But, since then, nothing.
"When something this major is going to change, it needs to be handled in a more organized way, and the communication should be handled better," she said.
Putnam said state officials wanted to get more information out before now.
However, in the state's defense, she said the federal government approved
In the meantime, the Medicaid waiver staff enlisted the help of a citizen-engagement team that interviewed residents to learn what parts of the waiver were confusing and how the state could communicate better.
Putnam said state officials will focus on getting the word out during the next two weeks. "Communications are coming."
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