In June, Governor Matt Bevin proposed changes to Kentucky’s Medicaid system that would make it more difficult for Kentucky residents to maintain their Medicaid coverage. Bevin’s proposal for a Medicaid waiver affects Kentucky’s coverage expansion and removes vision and dental care from the state’s current Medicaid benefit package. Under Bevin’s proposal, beneficiaries that complete specified health-related or community engagement activities receive rewards to assist them in paying for vision and dental care. However, the history of similar programs in other states indicates that few Kentuckians would earn such rewards, thus essentially leaving them without coverage.
Iowa’s program requires beneficiaries with incomes at or above 50 percent of the poverty line to pay premiums after they’re enrolled in the program for a year, but premiums are waived if they get a wellness exam and complete a health risk assessment. Despite the incentives, well under 20 percent qualified for a premium waiver in 2015. Also, a considerable amount of healthcare managerial personnel indicated a very limited awareness and knowledge of the program. Most beneficiaries knew nothing about the completion of the health risk assessment and its related healthy behavior reward.
Michigan’s program hasn’t been any more successful. Its program allows beneficiaries to receive incentive payments that offset their liability for cost-sharing if they complete a health risk assessment. As of December 2015, only 14.9 percent of beneficiaries enrolled in a health plan for at least six months qualified.
Kentucky’s waiver proposal states that the rewards program “will encourage healthy behaviors and increase member access to enhanced health services.” The results so far of Iowa and Michigan’s programs (and common sense) indicate that Kentucky will achieve anything but healthy behavior and increased access to enhanced health services for low-income individuals.