In a move the state says would save money but cut another 9,000 people from Medicaid, Gov. Matt Bevin's administration is seeking permission from the federal government for more changes to the state-federal health plan that serves 1.4 million Kentuckians.

The changes, filed this week, revise a sweeping plan to the state's Medicaid program Bevin proposed last year seeking federal permission, or a "waiver," to reshape the program in order to impose more costs and personal responsibility on consumers.

The Bevin administration said the changes, aimed largely at "able-bodied" adults, are part of an effort to "provide dignity to individuals" and help them toward "independence from public assistance."

The changes are not designed to cut anyone from Medicaid, according to Doug Hogan, a spokesman for the Cabinet for Health and Family Services. Rather, the administration expects Medicaid enrollment to drop as people transition to employer health plans or choose not to participate in requirements such as work or volunteering.

But health care advocates in Kentucky said the changes do nothing to improve the proposal Bevin introduced last year and worsen it in several ways, most significantly increasing from about 86,000 to 95,000 the number of people expected to lose health coverage over the five-year life of the plan.

They say many people will find the new requirements excessively complex and will lose coverage because they are unable to meet them.

"In my mind, this just takes a bad waiver and makes it worse," said Dustin Pugel, a research associate with the Kentucky Center on Economic Policy.

More:Gov. Matt Bevin's likely Medicaid shake-up scares Kentucky patients

More:Bevin Medicaid plan debated at forum

Ben Chandler, president of Foundation for a Healthy Kentucky, a non-partisan health policy organization, said he can't speak to details of the changes but would oppose any revisions that would reduce health coverage to Kentuckians.

"Our position couldn't be more clear," he said. "We want more people with coverage rather than fewer."

Changes proposed this week include:

► Stiffening the requirements that most able-bodied adults on Medicaid work or volunteer at least 20 hours a week. Originally the proposal called for individuals to work or volunteer at least five hours a week and gradually expand that to 20 hours a week; the changes require individuals to start at 20 hours.

►A sixth-month "lock-out" of health benefits to people who fail to promptly report changes in income or circumstances that might affect their Medicaid eligibility or premiums. The proposal says the sanction would serve as a "learning tool for enrollees regarding the importance of maintaining accurate information to maintain insurance coverage."

► New projections that show the changes would result in about 95,000 fewer people on Medicaid at the end of five years, an additional savings to the state of about $27 million. Bevin's original proposal projected a total savings to the state of about $331 million.

Bevin last year proposed reshaping Kentucky's Medicaid plan along the lines of commercial insurance with reduced benefits — for example, it eliminates dental and vision coverage as a basic benefit for adults. But it adds a "My Rewards" account where people can earn points toward purchasing benefits not covered by Medicaid, such as dental or vision services.

It also would impose cost-sharing through monthly premiums and adds requirements that able-bodied adults either work or volunteer, described as "community engagement."

More:What Bevin's Medicaid changes mean to consumers

More:Medicaid changes could affect diabetes care

The changes are aimed mostly at the approximately 440,000 people added to the program under the Medicaid expansion allowed under the Affordable Care Act, also known as Obamacare. That expansion, authorized by Bevin's predecessor, Democratic Gov. Steve Beshear, allowed states to add low-income people up to 138 percent of the federal poverty level, $16,643 a year for an individual, to Medicaid, a program previously for poor children, pregnant women, disabled individuals and the elderly in nursing homes.

As a candidate, Bevin, a Republican, vowed to scrap the expansion but later said he instead would seek to restructure it. He has said if the federal government does not grant the changes he seeks, he would end the expansion.

More:Talk of Obamacare repeal alarms Kentuckians

More:6 proposed changes in Bevin's Medicaid plan

The Bevin proposal filed Monday envisions using Medicaid as a tool to put more people back to work and reduce their dependence on government, saying, "This program offers opportunities for individuals to take control of their life."

But Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health groups, said the proposal fails to account for the fact that the majority of people who gained coverage through the Medicaid expansion already work, most at low-wage jobs such as construction, food service or housekeeping. Most such jobs don't come with benefits, including health insurance, she said.

They don't need government to provide them with dignity, she said.

"Medicaid should be viewed as a work support," she said. "It's a hand-up, not a handout."

The state Cabinet for Health and Family Services plans two public hearings on the proposed changes:

► July 14, 10 a.m. to 12 p.m., in Somerset at the Center for Rural Development, 2292 South Highway 27, Suite 300.

► July 17, from 10 a.m. to 12 p.m., in Frankfort, after the meeting of the joint House-Senate Health and Welfare Committee.

Contact reporter Deborah Yetter at 502-582-4228 or at dyetter@courier-journal.com.