Kentucky was the first state approved by the federal government for a Medicaid waiver known as Kentucky HEALTH.
Becoming the first-in-the-nation state is a victory for Kentucky's Republican governor, Matt Bevin, who during his 2015 campaign vowed to reverse the strong embrace of the Affordable Care Act by his Democratic predecessor.
Critics, however, said the state plan would simply take healthcare away from poor Kentuckians.
"The idea that we should keep doing what we're doing is an insult to the people of Kentucky". As of October 2017, Kentucky has more than 1.2 million people in Medicaid and the Children's Health Insurance Program, a net increase of 108% since Medicaid expansion under the ACA, according to the CMS.
Bevin expects the changes to save the state more than $300 million over the next five years.
Bevin said that requiring able-bodied recipients to work, to give something in return for the insurance they're receiving, gives them dignity, respect and an opportunity to escape from a "dead-end entitlement trap".
Bevin cheduled a news conference Friday afternoon to discuss the approval.
"With federal approval of our Medicaid waiver, Kentucky will lead the nation in constructive changes to Medicaid", said Gov. Bevin. Consumer advocates and health policy experts fear that such a requirement could prove a big hurdle for many recipients, leaving them without the care they need.
Pregnant women and children won't have premiums, won't have a change in benefits and won't have to complete the community engagement requirement. But they'll only get access to vision and dental coverage if they pay a premium. The activities include jobs training, community service or education. They have to want to make them. Many of them have jobs that don't provide health insurance. In the remaining, only a small number of people will be subject to the requirements. It also encourages an exemption for people who are deemed "medically frail". Only once they are healthy will they be able to focus on employment. In recent years, many states have expanded Medicaid coverage to include more of the nonelderly population, including the working poor and adults with disabilities. A detailed evaluation of Medicaid expansion in OH by that state's Department of Medicaid explains how it pays off for workers and taxpayers. Medicaid expansion is exactly that type of policy.
CMS has asked that the state submit, within the next six months, a draft evaluation design and implementation timeline. Since applying for the waiver, Gov. Bevin said these are the terms under which Kentucky can maintain extended Medicaid.
But people rarely make them because someone else forced them to. Thousands of Kentucky families will face financial ruin. This last part is controversial, as Medicaid has historically enrolled beneficiaries when they needed care.
There is only one way to get out of poverty, and that's to change your behavior - which starts by changing the way you think about your life and how you'll get what you need to live. And Bevin has shown he doesn't care about the lives of these almost 100,000 Kentuckians. "It's the antithesis of how we're created".
"Kentucky HEALTH is specifically tailored with the unique needs of Kentuckians in mind". It's not about personal responsibility - most already work. "We're ready to show America how this can and will be done".
In addition to the large group of enrollees already working, the federal guidelines excluded children - who make up almost half of Medicaid enrollees.
Additionally, there's not consensus the programs are effective at getting people into jobs, said Joan Alker of Georgetown University during a conversation in Lexington, Kentucky in November.
The Trump administration, along with many Republican leaders in Congress, has long supported such a move.
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