1115 Medicaid Waivers in Kentucky
On January 24, 2019, another lawsuit was filed in federal district court to challenge CMS’s reapproval of the waiver and on March 27, 2019, the federal district court ruled to block CMS’s reapproval of the waiver. On April 10, 2019, the Trump administration filed a notice of appeal to challenge the federal district court’s ruling. The waiver has not been implemented. The U.S. Court of Appeals for the District of Columbia Circuit heard oral arguments on October 11, 2019. The Court is expected to issue a decision in the near future.
The state submitted its 1115 waiver in August 2016. Subsequently, the state submitted an amendment to the waiver July 3rd, 2017. In January 2018, Kentucky received federal approval for its waiver request, with implementation scheduled for July 1.
On June 29, a ruling in federal district court vacated that approval, halting implementation. The court sent the waiver request back to CMS for review consistent with the court’s opinion that CMS did not “adequately consider whether Kentucky HEALTH [the waiver program] would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.” The court found that HHS/CMS was “arbitrary and capricious” in approving the waiver.
In response to this ruling, CMS held an additional 30-day federal comment period from July 19 through August 18 and reapproved the waiver request on November 20, 2018.
- Families USA’s Comments on Kentucky HEALTH Demonstration, reopened comment period (2018)
- Families USA Comments on Kentucky HEALTH 1115 Demonstration Modification Request(2017)
- Families USA Comments on Kentucky HEALTH 1115 Waiver Proposal (Federal) (2016)
- Families USA Comments on Kentucky HEALTH 1115 Waiver Proposal (State) (2016)
- View All Federal Comments for 1115 Medicaid Waivers
The Kentucky HEALTH waiver applies to the Medicaid expansion population, as well as most other adults covered by Medicaid. Other populations such as children and other non-disabled adults (like low-income parents, pregnant women and caretakers) are also subject to certain elements of the Kentucky HEALTH waiver.
- Cost-Sharing (ED Copays)
- Work Requirements
- Health Savings Accounts
- Impact on oral health
Kentucky proposes to charge premiums to most non-disabled adults on a sliding scale from $1 to $15 per month in lieu of copayments. For individuals above 100 percent of poverty, failure to pay premiums within the sixty day grace period would result in disenrollment and a six month lock out unless they pay their back due premiums and participate in a financial or heath literacy course. Those below poverty who fail to pay premiums in the first six months of coverage would be required to pay copayments instead. Learn more and get advocacy strategies to combat the premiums.
The state requested to deduct $20, $50 and $75 from enrollees’ Health Savings Account (see below) for non-emergency use of the ER, with the amount increasing with each subsequent use. The state did not submit a 1916 cost sharing waiver for this request. Learn more and get advocacy strategies to combat cost sharing.
Health Savings Accounts
The waiver proposal contains two separate individual accounts paired with a high deductible health plan. One account is used to cover a $1,000 deductible and is funded through state Medicaid dollars. Any claims above and beyond $1,000 dollars is paid in full by the Medicaid program. The second account, My Rewards Account, can be used to buy enhanced benefits like dental and vision services. Enrollees may earn funds in the My Rewards Account by completing healthy behavior and work activities. Learn more and get advocacy strategies to combat HSAs.
- Impact on oral health: Dental benefits to adults who are not medically frail, pregnant, or parents of pregnant women will only be provided through HSA My Rewards Accounts.
Work and Community Service Requirements
The waiver would condition enrollment for working age, childless adults on employment or community service. This includes both paid and unpaid work, education, as well as job search activities. A member must be engaged in work-related activities for at least 20 hours per week; failure to do so would result in suspension of benefits until the member satisfies the requirement for at least one month, resulting in what could be an indefinite “lock-out” for unemployed Medicaid eligible Kentuckians. Learn more and get advocacy strategies to combat work requirements.
The proposal would impose a six month lock out for a failure to report a change—like income or hours worked—in circumstance in circumstance or failed to timely complete their redetermination paperwork.
The waiver seeks to waive non-emergency Medicaid transportation for expansion adults. Learn more and get advocacy strategies to combat benefit reduction.