National Council Submits Comments on Kentucky Medicaid Work Requirement

Last week, the National Council submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding Kentucky’s Medicaid proposal to impose work requirements on Medicaid beneficiaries. In July, a district court judge blocked the state’s waiver request and required the agency to reevaluate the waiver application and analyze its impact on beneficiaries. This legal decision only applies to Kentucky and has no bearings on work requirements being imposed in other states.

Since the announcement of the waiver in January 2018, the National Council has voiced strong opposition to work requirements in Medicaid. Work requirements not only prevent individuals with mental health or substance use disorders from receiving the treatment they need, but are in opposition to the core mission of Medicaid.

In the latest comments, the National Council highlighted the following:

• Rising rates of uninsured Kentuckians: Kentucky’s proposal to take Medicaid coverage away from people who do not meet work requirements, pay premiums, renew their coverage on time, or report minor changes in income will cause a significant loss of coverage — resulting in a corresponding increase in the number of uninsured Kentuckians.
• Medicaid provides an important lifeline for people with mental illness and SUD as they face barriers to work and need additional supports. While most people with these conditions can and want to work, many face significant barriers to sustained employment. It is estimated that 87 percent of adults with serious mental illness are unable to work as a result of their illness.
• Under the guidance as written, many Kentuckians will not qualify for an exemption or will be unable to prove that they do. Guidance from the Centers for Medicare and Medicaid Services on imposing work requirements mandates states exempt people from the requirement if they are deemed “medically frail,” but the definition of that term is strict and will leave out many people with behavioral health conditions.
• The bureaucratic obstacles and paperwork requirements will reduce enrollment in Medicaid. To prove exempt status, individuals with a mental health condition or substance use disorder will need to obtain letters from their health care providers, medical records, or whatever documentation a state deems necessary. Some individuals with a mental health condition or SUD will have significant privacy concerns about disclosing their condition to Medicaid eligibility staff. 
• Premiums have been shown to confuse beneficiaries and have likely prompted fewer people to enroll in and maintain coverage. Kentucky’s waiver would require all Medicaid enrollees except pregnant women, children, and those found to be medically frail to pay monthly premiums as high as four percent of their monthly income. Extensive research shows that premiums significantly reduce low-income people’s participation in health coverage programs. People who lose coverage most often end up uninsured and are unable to obtain needed health care services.

Read the National Council’s comments in full here.