Recently, the Centers for Medicare &
Medicaid Services (CMS) approved Medicaid 1115 demonstration waivers in
Kentucky and Indiana. The waivers continue to signal a new direction by this
administration regarding the future of Medicaid. Below is a brief overview of
On Jan. 12, CMS approved
Kentucky’s Medicaid 1115 waiver, entitled “Kentucky Helping to Engage and
Achieve Long Term Health (KY HEALTH).
Kentucky’s approved waiver
charges premiums to most nondisabled adults on a sliding scale from $1 to $15
per month in lieu of copayments. For individuals above 100% of the federal
poverty line, failure to pay premiums within the 60-day grace period would
result in disenrollment and a six-month lockout unless they pay their back-due
premiums and participate in a financial or heath literacy course.
The waiver also imposes a six-month
lockout for a failure to report a change in circumstance, such as income or
hours worked, or failure to timely complete their redetermination paperwork.
The waiver conditions
enrollment for working-age, childless adults on employment or community
service. This includes both paid and unpaid work, education and job search
activities. A Medicaid member must be engaged in work-related activities for at
least 20 hours per week; failure to do so would result in suspension of
benefits until the member satisfies the requirement for at least one month,
resulting in what could be an indefinite lockout for unemployed Medicaid-eligible
On Jan. 12, Gov. Matthew Bevin (R-KY) issued
an executive order directing his
administration to end Medicaid expansion in Kentucky if any part of the 1115
waiver approved by the federal government is blocked by a legal challenge in
the court system. On Jan. 24, a complaint was filed against the
Trump Administration in the U.S. District Court for the District of Columbia by
15 Kentucky residents.
In the complaint, the Kentucky residents argued that CMS’s
actions regarding work requirements “sharply deviate” from the requirements of
the Medicaid program and “vastly exceed” any legal use of the HHS secretary’s
limited waiver authority. Their complaint goes on to say, “This change
will harm Kentuckians across the state—housekeepers and custodians, ministers
and morticians, car repairmen, retired workers, students, church
administrators, bank tellers, caregivers, and musicians—who need a range of
health services, including check-ups, diabetes treatment, mental health
services, blood pressure monitoring and treatment, and vision and dental care.
The [CMS] letter and approval of Kentucky’s application are unauthorized
attempts to re-write the Medicaid Act, and the use of the statute’s waiver
Feb. 1, CMS approved Indiana’s Medicaid 1115 demonstration waiver, entitled “Healthy
Indiana Plan” (HIP).
Under the approved waiver, Indiana
is changing how HIP Plus beneficiaries will be charged premiums.
The state will apply a premium surcharge for HIP Plus beneficiaries who use
tobacco and who do not participate in tobacco cessation activities. This
increased premium will be applied after the first-year of enrollment, during
which beneficiaries are encouraged to use the various state plan options
available to cease tobacco use. By charging beneficiaries a surcharge related
to a specific behavior (i.e., tobacco use), the state will test whether
incentivizing beneficiaries to change behavior and engage in their own health care
will achieve better health outcomes.
Under the approved waiver,
beginning in 2019, Indiana will implement a community engagement requirement as
a condition of continued coverage and eligibility for adult beneficiaries
enrolled in HIP who are not exempt. Certain groups, including pregnant women,
beneficiaries identified as medically frail, students, some caregivers of
dependents and beneficiaries in active substance use disorder treatment, will
be exempt from this requirement.
has comprehensive benefits including vision and dental. The member pays a
monthly POWER account contribution based on income. There is no copayment
required for receiving services with one exception: using the emergency room
where there is no true emergency.