CMS Reapproves Kentucky's Medicaid Work Requirements

Five months after a federal judge blocked Kentucky’s Medicaid work requirements, CMS has again approved the requirements, known as Kentucky HEALTH. The Kentucky Cabinet for Health and Family Services (CHFS) announced Tuesday that the newly approved program can begin as soon as April 1, 2019, and will be phased in regionally over several months.

Kentucky became the first state to get approval from CMS for Medicaid work requirements in January. The 5-year demonstration project will require able-bodied adults in the state to work or volunteer 80 hours a month.

“Kentucky HEALTH offers a customized path based on individual needs that will help beneficiaires gain better health, engagement in their communities, improved employability, and success through long-term independence,” said Adam Meier, CHFS secretary, in a statement. “This individualized approach affords flexibility and procedural protections that will ensure Medicaid is able to provide beneficiaries access to services and opportunities, while utilizing a holistic approach to addressing barriers and challenges that affect overall health.”

According to CHFS, the program is estimated to save the Medicaid program in excess of $2 billion during the 5-year demonstration period. However, estimates have also indicated that at least 95,000 people would lose coverage, either through not complying with the requirements or by getting jobs and earning enough money to make them ineligible for benefits.

Responding to the announcement, the Foundation for a Healthy Kentucky—who in May announced a partnership with Republican governor Matt Bevin's Administration to help Kentuckians maintain their coverage under the program—reaffirmed their commitment to assisting Medicaid beneficiaries in understanding and complying with the requirements.

“While there is much work to do, the Foundation’s initial efforts are focused on a premium payment assistance program; a stakeholder workgroup to evaluate program inefficiencies and successes, and recommend resolutions to policy, program, or system issues; and a collaboration among local and state officials, employers, and community organizations to identify community engagement activities,” said Veronica Cecil, vice president for policy at the foundation, in a statement.

The program was blocked in June by Judge James E. Boasberg of the Federal District Court for the District of Colombia, who concluded that the approved waiver was “arbitrary and capricious” because it had not adequately considered whether the plan would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.” Following the decision, Bevin cut Medicaid dental and vision benefits for nearly half a million enrollees.

CMS’ approval of Kentucky’s requirements comes just days after Arkansas—the first state to implement work requirements—said it dropped more than 12,000 from its Medicaid expansion programs over the past 3 months for not complying with work and community engagement requirements, and another 6000 are at risk of losing their coverage by December.