Transportation officials leery of potential Medicaid waiver effects

July 14--Critics of Gov. Matt Bevin's proposed Medicaid overhaul have blasted the Republican administration over the jobs-centered plan aimed largely at transitioning beneficiaries to the private health insurance marketplace.

The proposals to cut dental and vision benefits and add small monthly premiums to Kentucky's low-cost health coverage program have been labeled "dangerous" and far too conservative.

But one local official who heads up the area's Medicaid transit program said the effects of the transportation component of the governor's plan are still largely unknown.

Dan Lanham, director of transportation for Audubon Area Community Services, said he doesn't know what to expect from possible slashes to transport benefits.

"The truth of the matter is we just don't know," Lanham said earlier this week. "I don't know what to expect."

Bevin announced his intent to request a federal waiver for the national Medicaid expansion program late last month. President Barack Obama's Affordable Care Act required states to expand coverage to individuals living at or below 138 percent of the federal poverty line, but a later Supreme Court ruling gave states the option to request waivers for the plan.

Former Gov. Steve Beshear enacted the expansion through an executive order in 2014, bypassing the General Assembly altogether. It has resulted in some 400,000 new Medicaid recipients, driving down Kentucky's uninsured population by about 12 percent. Still, Bevin has argued that expanded coverage is too costly. His federal waiver reshapes parts of the commonwealth's Medicaid coverage but mostly targets the expanded population.

State transportation officials confirmed this week that if Bevin's waiver received federal approval, those who qualify for Medicaid above the federal poverty line would lose non-emergency medical transportation benefits.

As it is, the Kentucky Transportation Cabinet's Human Service Transportation Delivery Program (HSTD) provides non-ambulance transit for eligible Medicaid, vocational rehabilitation and Department of the Blind aid recipients through a public-private brokerage partnership. Community action agencies like Audubon or individual companies transport beneficiaries through the brokerage program and receive funding according to the size of the Medicaid population in their service area.

Audubon operates the Green River Intra-County Transit System for 15 counties in Kentucky. Lanham said the 2014 Medicaid expansion had a huge impact on those counties and significantly increased his annual operating budget. Medicaid transportation accounts for about 95 percent of the 1,800 trips GRITS vehicles make daily. The expansion was large enough in western Kentucky to reverse the role Medicaid served in the GRITS budget.

"In the past, Medicaid transportation has been dependent on the the equipment provided by public transportation grant funding," he said. "Over the last couple of years, that's changed. Now you can buy equipment with the dollars you were getting from Medicaid transportation alone."

If Bevin's waiver proposal, called Kentucky HEALTH, earns a federal stamp of approval, it would certainly cut transportation services to individuals within the Medicaid expansion population at least, but the state has been somewhat silent on how the HSTD program would allocate funding to transit brokers if there was a split in Medicaid recipients who qualified for its services. Several calls to the governor's office this week on the issue went unanswered.

Another facet to the complicated plan remains even if the federal government denies Kentucky's waiver request. Bevin has suggested he might sign his own executive order reversing the expansion in Kentucky altogether. If that happens, Lanham said he thinks the area would see some negative effects.

"I think it would have a negative impact on us, but to what extent, no one knows," he said. "There are a lot of people who came on to the Medicaid rolls after the expansion, who would have qualified anyway, but they just didn't know that they did. ... Until I see hard numbers, it's hard to guess what might happen to the dollars and cents.

"There are a whole lot of moving parts here, and nobody has a really good grasp on what the eventual outcome will be for everyone involved -- the patients and the people who serve them," he said.

The Cabinet for Health and Family Services has finished three formal public hearings across the state for the Medicaid plan, but there is still time for public comments. For more information on the proposal and how to comment, see the Cabinet for Health and Family Services website at chfs.ky.gov. All comments must be received by 5 p.m. July 22.

Austin Ramsey, 270-691-7302, [email protected], Twitter: @austinrramsey

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