Led by the state\u2019s Republican governor, the plan calls for many Medicaid recipients ages 19-64 to work at least 20 hours a week, beginning in July.<\/b>
\nWASHINGTON \u2014 Kentucky will be the first state to require many of its Medicaid recipients to work or face losing their benefits after the Trump administration approved its plan on Friday.
Advocates for the poor threatened lawsuits, while Gov. Matt Bevin, a Republican, celebrated the approval as \u201cthe most transformational entitlement reform that has been seen in a quarter of a century.\u201d
The plan calls for most Medicaid recipients who are not disabled and aged 19 to 64 to work at least 20 hours a week, beginning in July. In addition to paid jobs, they could meet the requirement through volunteer work, job training, searching for a job, taking classes or caring for someone elderly or disabled.
Pregnant women, full-time students, primary caretakers of dependents and the chronically homeless will be exempt from the work requirement, as will people deemed medically frail. But the Bevin administration still expects about 350,000 people to be subject to the requirement, which will be phased in around the state starting in July. About half of them already meet it, according to the administration.
\u201cWe are ready to show America how this can and will be done,\u201d Mr. Bevin said at a news conference in Frankfort. \u201cIt will soon become the standard and the norm in the United States of America, and America will be better for it.\u201d
Roughly 500,000 adults have joined Kentucky\u2019s Medicaid rolls since the state expanded the program under the Affordable Care Act in 2014.Mr. Bevin has consistently attacked the expansion as a waste of money, questioning why \u201cable-bodied\u201d adults should be given free government health care that used to be largely limited to children, the elderly and the disabled.
He filed for federal permission to impose work requirements in 2016 \u2014 notably, instead of seeking to end the state\u2019s Medicaid expansion altogether. And since then, more than a dozen other states have also sought work requirements or said they plan to. Several sought Medicaid work requirements during the Obama administration but were rebuffed.
The approval came just a day after the Trump administration gave states the O. K. to impose work or other \u201ccommunity engagement\u201d requirements as a condition of getting Medicaid. According to the nonpartisan Kaiser Family Foundation, 60 percent of working-age Medicaid recipients who aren\u2019t disabled already have full- or part-time jobs.
Under its plan, Kentucky will also require many adults who aren\u2019t elderly or disabled to pay premiums of $1 to $15 a month, depending on their income. And it will disenroll people from Medicaid for up to six months if they fail to report changes in income or work status. Those who qualified for Medicaid under the Obamacare expansion will also have to \u201cearn\u201d dental and vision benefits, which they have been able to access freely until now, through activities like taking a financial literacy course or getting a GED.
The Bevin administration has estimated that the plan will result in 100,000 fewer Medicaid recipients after five years and save $2.4 billion, mostly in federal Medicaid funds. But Mr. Bevin couched the policy change as a moral rather than a fiscal decision, saying he did not care about the savings and saw it as an opportunity for Kentucky\u2019s poor \u201cnot to be put into a dead-end entitlement trap but rather to be given a path forward and upward so they can do for themselves.\u201d
Advocates for Medicaid beneficiaries said they disagreed with the Trump administration\u2019s assertion, in approving Kentucky\u2019s plan, that work requirements were consistent with the goals of Medicaid because work could improve people\u2019s health.
\u201cConsidering that it will seriously harm over 100,000 Kentuckians, in violation of numerous provisions of Medicaid law, we are very seriously considering taking legal action \u2014 and as we analyze the meager legal rationale in the approval itself, it seems inevitable,\u201d said Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for the poor.
Emily Beauregard, the executive director of Kentucky Voices for Health, an advocacy group, said the state had provided little information about how it would make sure people were complying with work requirements, how exemptions would be determined and other details.
\u201cWe\u2019re anticipating Kentuckians by and large are going to be extremely confused and worried about what they\u2019re going to face and whether or not they\u2019ll continue to have coverage,\u201d Ms. Beauregard said. \u201cThey\u2019ll be looking to advocates and enrollment assisters and their providers for answers, and at this point we don\u2019t have any.\u201d
She added, \u201cThe idea that we are encouraging work and independence, then taking away the health care that makes people more employable and better able to function \u2014 none of this adds up to something that\u2019s going to be good for Kentuckians or our economy.\u201d
But Hal Heiner, Kentucky\u2019s Education and Workforce Development secretary, said during Mr. Bevin\u2019s news conference that there was \u201can abundance of jobs\u201d available to Medicaid recipients, as well as resources to prepare them.
\u201cWe have the jobs, we have the tuition resources, we have the job coaches in our career centers all across the state,\u201d he said, \u201cand now we\u2019ll be able to connect the dots.\u201d
Other state officials said the state was building an IT system to track people\u2019s compliance with the work and premium requirements and participation in activities, like taking the financial literacy course, that would earn them points toward dental and vision care. They did not, however, provide a cost estimate for building and maintaining the administrative infrastructure necessary to monitor compliance with the new requirements.
Kentucky\u2019s uninsured population has dropped more than almost any other state\u2019s under the Affordable Care Act, and several studies have found significantly increased access to primary care, preventive screenings and care for chronic conditions there since the Medicaid expansion. But the state\u2019s population remains unhealthy overall, which Mr. Bevin pointed to as proof that the Medicaid expansion was not working.
\u201cThe idea that we should keep doing what we\u2019re doing is an insult to the people of Kentucky,\u201d he said.
Sheila Schuster, a longtime health care advocate in the state, said she saw it differently.
\u201cThe administration has their chicken-and-egg story completely wrong \u2014 they say people need to work to get healthy,\u201d she said. \u201cWe all know that health is the foundation from which people go to school, go to work and keep their employment. So I\u2019m afraid the administration is not only going backward, but doing it for completely the wrong reasons.\u201d
Such opposing views were evident in comments people posted on Mr. Bevin\u2019s Facebook page during his news conference, which was livestreamed there. \u201cABOUT TIME to get others to pull their weight!\u201d one viewer in favor of the new requirements wrote.
\u201cI feel this is wrong,\u201d another said. \u201cWouldn\u2019t they not be in Medicaid if they could get a job?\u201d<\/p>\n

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