Although debates over health care legislation have stalled for now in Washington, officials in the Bevin Administration remain optimistic that their plan to overhaul the state’s Medicaid program will receive federal approval in the coming months.
Cabinet for Health and Family Services Secretary Vickie Yates Brown Glisson appeared on KET’s Connections to discuss Kentucky’s Medicaid waiver proposal and recent changes made to that plan. She also updated efforts to help children in state care and provide better working conditions for social workers employed by the commonwealth.
”Fairly Minor” Changes to Medicaid Overhaul
Last summer the Bevin Administration filed a waiver request with the federal Centers for Medicare and Medicaid Services (CMS) to overhaul the state’s Medicaid program. The plan, called Kentucky HEALTH, would levy monthly premiums ranging from $1 to $15 on most Medicaid members, and require all able-bodied working age adult enrollees with no dependents to participate or engage in 20 hours of employment-related or community service activities each week. The changes would apply to those enrolled in expanded Medicaid (for individuals making up to 138 percent of the federal poverty level) and non-disabled adults covered by traditional Medicaid.
The governor argues that without the changes Kentucky cannot afford to cover the 1.4 million people now enrolled in traditional and expanded Medicaid. If left unchanged, the commonwealth’s tab for Medicaid is estimated to be more than $1 billion over the next five years.
Secretary Glisson says state officials have been in negotiations with CMS about the state’s waiver request. As part of that, she says the Bevin Administration filed a revised overhaul proposal in early July.
“Those modifications are really more operational in nature,” says Glisson. “They’re fairly high-level… and fairly minor.”
Under the initial plan, Medicaid members facing the work requirement could gradually increase their work, community volunteerism, or job training activities to reach the mandated minimum of 20 hours per week. Glisson says that incremental ramp-up would have been too difficult to track for thousands of enrollees. Now with the revised proposal, some members will have to start their 20-hour minimum immediately, while others will have up to three months to meet the requirement.
The revision also sets a six-month disenrollment period for individuals who fail to update the state Medicaid office about changes to their income, employment status, or community engagement hours.
Helping People Transition Off Medicaid
State officials estimated that Medicaid rolls would shrink by about 86,000 people under the original waiver plan. That number grows to 95,000 enrollees with the updated waiver proposal. Glisson contends it’s not accurate to say those people would be forced out of the system.
“No one is going to be pushed off of Medicaid, no one is losing their benefits,” says the secretary.
Instead she says those people will transition out of the system as they get better-paying jobs that put them outside of Medicaid eligibility or as they get employer-provided health insurance. She says one of the goals of Kentucky HEALTH is to help people improve their jobs skills so they can get gainful employment.
“We need to connect you with the jobs, we need to get you the training for those jobs,” Glisson says, “and if you chose to, we’re hoping that you’re going to be able to transition to an employer-sponsored insurance product.”
CHFS held a new 30-day comment period for public input on the changes, and held two town hall-style meetings to get additional feedback the plan. She says the final revision will go to CMS later this month.
“We are hopefully getting to the end of this process,” Glisson says.
The secretary says her cabinet is preparing to implement the waiver even before receiving final approval. She says CHFS is prepping Department of Community Based Services personnel in all 120 counties as well as contract assistors from the former Kynect healthexchange to help guide Medicaid members through the new requirements. They’re also training staffs of local health departments, workforce development boards, and career centers on how to assist enrollees with the changes.
Glisson adds that the waiver will put Kentucky on track to deal with changes that Congress may make to Medicaid in any future health care legislation. Medicaid advocates sounded alarms over Republican proposals to convert Medicaid funds to a block grant in which the federal government would provide states a fixed amount of money for their Medicaid programs regardless of how many enrollees they have. Even if that happened, Glisson says she’s not worried.
“We’ve been very proactive, we’ve got a plan,” the secretary says. “We feel that that plan allows [Medicaid] to be more sustainable no matter what happens on the federal level.”
Child Welfare and Social Workers
The secretary says more than 8,500 Kentucky children are now in state care. She says upwards of 71 percent of those cases are directly or indirectly related to the drug scourge ravaging the commonwealth.
As the numbers of children needing foster or adoptive homes continues to increase, the Bevin Administration has made it a priority to improve how it handles children in state care. In the 2017 General Assembly session, lawmakers made it easier for non-blood relatives to take in foster children. These “fictive kin” could include a coach or teacher, a neighbor, or a church member who already has an existing relationship with the child.
Child welfare advocates want state support payments restored for so-called kinship caregivers. The state once paid a small monthly stipend to relatives who stepped up to foster a grandchild, niece, nephew, or cousin who is in state care. But the Steve Beshear Administration ended those payments during the state budget crisis. Kinship caregivers say it’s unfair for them to shoulder all the financial burden of raising a child even if they are related when traditional foster parents still receive monthly stipends.
Glisson says the governor and First Lady Glenna Bevin are concerned about the problem.
“They’ve asked us to go in and look at this issue to see if there’s a way, as we approach this budget session, to try to help out grandparents who are taking care of children and grandchildren,” the secretary says.
CHFS is preparing an omnibus foster care and adoption bill for the 2018 legislative session. Until then, Glisson says the DCBS can connect kinship caregivers with other financial supports such as Medicaid coverage for health care, Supplemental Nutrition Assistance Program (SNAP) benefits to help pay for food, and stipends for child care assistance.
The secretary says the cabinet is also exploring ways to address the enormous work demands placed on state social workers. To start Glisson says the cabinet is conducting a county-by-county survey of social workers and caseloads. She says Jefferson and Fayette counties and the counties in northern Kentucky are particular hotspots for overworked staff.
“How many social workers do we need to be able to take care of the issues there, and then look at the state as a whole,” Glisson says. “Then using those numbers to be able to figure out what are the numbers [of social workers] that we need,” says Glisson.
She says the cabinet will use this information to craft a request to lawmakers for more competitive salaries, stronger recruitment and retention efforts, and more downtime for social workers to recover from handling especially intense cases.
“Right now they’re on 24-7,” Glisson says. “It’s too much, so we’re trying to build a better work environment.”