Kentucky: As expected, Bevin to shift from standard Medicaid expansion to some form of waiver 2017 (UPDATE: Except he might not be able to?)

When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

While all waivers involve some amount of administrative complexity, Indiana’s demonstration is more complex than others approved to date. The program has multiple parts, including four different Medicaid benefit packages for the populations covered by the waiver (aside from premium assistance for employer-sponsored insurance). It also requires administering and tracking a number of elements, such as premium payments or co-payments, compliance with healthy behaviors, health savings account balances and rollover funds, presumptive eligibility determinations, and services that would have been covered retroactively for certain groups. Beneficiaries are treated differently based on their coverage group, and beneficiaries within the same coverage group are treated differently depending upon their income level, medical frailty status, and whether they have paid premiums.

He's continued to kinda, sorta walk it back since winning the election and taking part because the legal hoops he'd have to jump through to do so turned out to be more complicated than he thought.

Anyway, today he made an official statement on the issue...which didn't really give any new info aside from two key points:

FRANKFORT – A plan to overhaul the state’s expanded Medicaid program will be drafted by the middle of next year, so it can be in operation by the start of 2017, Kentucky Gov. Matt Bevin announced Wednesday.

Bevin, elected in November, campaigned on a promise to dismantle the state’s Medicaid expansion under the Affordable Care Act. He said Wednesday that the plan will include waivers from the federal government that would allow the state to create its own system for providing health insurance to the poor.

He announced that Mark Birdwhistell, former secretary of the Cabinet for Health and Family Services, will lead the team creating the “transformational program.”

In the meantime, the 400,000 Kentuckians who received coverage under the expansion will keep it until a new plan is approved by the federal government.

  • ONE: He's finally confirmed that he will not be fully repealing ACA Medicaid expansion after all, and will instead push for some sort of alternative waiver plan.
  • TWO: The 400,000 Kentucky residents currently covered by "standard" Medicaid expansion will not lose it until at least January 2017.

So, you know...hooray for that, anyway.

UPDATE: Hmmm...according to ACA opponents Josh Archambault and Jonathan Ingram at Forbes, Bevin can't carry out the Medicaid waiver in the manner he supposedly has in mind...because as far as I can tell, he's basically mixing up the Medicaid expansion waiver (Section 1115) with the ACA coverage waiver (Section 1332):

On Wednesday, Kentucky Governor Matt Bevin announced that he was planning to keep Obamacare’s Medicaid expansion, but would seek federal waivers to “transform” the program. But Bevin’s plan is already hitting an a snag: he wants to use a Section 1332 waiver to “transform Medicaid.” The snag: Section 1332 doesn’t provide any authority for Medicaid reform.

These waivers were created under Section 1332 of the Patient Protection and Affordable Care Act, otherwise known as Obamacare. Starting in 2017, they allow states to tinker with a few Obamacare rules, but only if they meet certain statutory conditions.

...Supporters of a ballot question for single-payer in Colorado have cited Section 1332 waivers as the vehicle for such a plan if voters pass it.

But even if the waivers were worth pursuing, this new waiver authority does not extend to the Medicaid program. The statutory language of Section 1332 does not grant any new authority for states seeking waivers of federal Medicaid rules. Instead, states are only allowed to make modest changes – subject to statutory restrictions – to specific provisions of the law, mostly affecting Exchange enrollees.

Recent guidance from the U.S. Department of Health and Human Services confirms that Medicaid reform is impossible through Section 1332 waivers. That guidance explains that Section 1332 waivers “may not change the terms of a state’s Medicaid coverage.” States wishing to make changes to their Medicaid programs must continue to rely on Section 1115 of the Social Security Act, among other provisions, to do so. And the federal government has made clear that Section 1332 doesn’t change the review or approval process for those other types of waivers.

Of course, as opponents of the law, Archambault and Ingram conclude by recommending that Bevin stick with his original promise (killing Medicaid expansion outright), but the point is that whether you support or oppose Medicaid expansion or the ACA in general, it certainly looks like Bevin doesn't have the slightest clue what he's doing here...which isn't exactly a shocker.

UPDATE 2: Good heavens, it sounds like I should've tuned in to today's press coference; apparently it was chock full of #Derp on Bevin's part:

@charles_gaba He also said during press conference that if feds reject waiver request, program continues as-is. Not much leverage there.

— Jonathan Ingram (@ingramlaw) December 31, 2015 basically, "If you guys don't let me screw around with your program, I vow to....keep your program exactly the way you want it kept!! So there!!"

What kind of a threat is that?