Kentucky: Matt Bevin thinks Medicaid is a Frequent Flyer program

I used to write about Kentucky quite a bit shortly after incoming GOP Governor Matt Bevin made good on his promise to disassemble their beloved and award-winning "kynect" state ACA exchange. I haven't written much about the state since then, however, until now.

Bevin made two major campaign promises while running to replace former Democratic Governor Steve Beshear (who expanded Medicaid and established kynect via executive order): He said he'd kill kynect and get rid of ACA Medicaid expansion. He stuck to his guns on the former, and while it's a damned shame that he did so for a number of reasons (it was working perfectly well, had a high public image and awareness, etc), it didn't cause too much damage, since KY simply shifted to the federal exchange instead (HealthCare.Gov). Enrollment did drop off by over 13% year over year, but a few other states saw similar drops, so the move probably wasn't a major factor.

Repealing Medicaid expansion, on the other hand, turned out to be quite a bit tougher than he thought, due to both public backlash and simple economics. To be honest, I'm not even sure whether he actually has made any changes to it so far, though I know that he's been working on changing the current structure ("straight" Medicaid expansion) to some sort of customized waiver version. And what sort of changes does he have in mind?

Kentucky is moving closer to an overhaul of the state's Medicaid program Bevin has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most "able-bodied" adults who instead would have to earn them through a "rewards" program.

..."It is expensive to go to a dentist," he said. "These changes are just ludicrous."

...Proposed changes include monthly premiums, co-payments for services, mandatory work or volunteer activity to maintain Medicaid coverage and "lock-outs" of coverage for up to six months for some who fail to pay premiums. The state proposal also includes a "My Rewards" account where people can accumulate points for activities such as passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes, points that go toward the purchase of services such as dental or vision care.

But Medicaid members also would have points deducted from their rewards account for infractions such as failing to pay premiums or "inappropriate" use of emergency rooms up to a negative balance of $150.

(sigh) Once again: 87% of Medicaid expansion enrollees work already, and most of those who don't are caring for family members and so forth. This is an absurdly unnecessary requirement. In addition...

Collecting premiums and co-payments, tracking work or volunteer activity and managing the rewards accounts all will involve major technology systems changes and likely, hiring of outside vendors to manage such systems, advocates say. That adds to expense and potential complications, they said.

...Seckel said other states that have attempted to impose modest premiums allowed by Medicaid have found that the cost of collecting monthly payments greatly exceeds any revenue the state takes in.

...Much of the administrative work would be delegated to five private managed care companies that oversee care for the majority of the more than 1.3 million Kentuckians enrolled in Medicaid.

...Carter said the increased work will increase Passport's costs, which likely will mean more costs to the state Medicaid program. And he said it's inevitable some people won't understand the changes or be able to meet new demands and lose coverage.

Yeah, this obsession with "work requirement" for Medicaid strikes me as being very similar to the "drug testing welfare recipients" thing which has been an ajbect failure in every state where it's been tried.

Having said that, the work requirement provision, while unnecessary and wasteful, at least sounds kinda, sorta reasonable on the surface. The "reward program", on the other hand, seems to be nothing more than an attempt to shame people for its own sake. You're basically taunting someone with a toothache at that point.

...After that, the benefits are available only through the "My Rewards" system for the adults considered "able-bodied," not including those who are disabled or "medically fragile," according to the state proposal. The changes also do not apply to pregnant women or children.

A 2016 report by Pew Charitable Trusts found oral health to be dismal throughout Kentucky but problems were the most severe among poor residents, especially those in rural areas with less access to dental services.

Kentucky optometrists have argued routine eye exams often uncover other serious health problems including diabetes, high blood pressure and eye disease that can result in blindness.

Look, I get the whole "no free ride, you lazy bum!" mindset, and encouraging people to pass their GED is a good thing, but making someone get their GED before you're willing to pull out a rotten tooth is a few steps away from forcing them to wear clown shoes and ride around on a unicycle for your amusement.