Bevin issues ultimatum: If courts block Medicaid plan, half million Kentuckians will lose care

Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.

No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.

But several advocacy groups have said some of the changes — such as requiring some "able-bodied" adults to work or volunteer at least 20 hours a week — likely will be challenged in court because they violate federal law that establishes Medicaid purely as a health program and does not authorize work requirements.

More: How deep will Matt Bevin's budget cuts be? Here's what we know

Advocates who criticized the Republican governor's overhaul of Kentucky's Medicaid program were also critical of the executive order Bevin issued Friday, the same day the Centers for Medicare and Medicaid Services approved his plan to reshape Medicaid in Kentucky.

"Is the governor of Kentucky saying that if he is caught doing something illegal, he will take health care away from hundreds of thousands of Kentuckians who have done nothing wrong?" asked Leonardo Cuello, director of health policy for the National Health Law Program.

Cuello's Washington-based health advocacy group is considering a legal challenge to Bevin's plan.

Bevin, a Republican, said his changes would affect mostly adults added to Medicaid after his predecessor, Gov. Steve Beshear, a Democrat, expanded it under the Affordable Care Act that authorized states to add poor adults up to 138 percent of the federal poverty level. That represents an annual income of about $16,643 for an individual.

The expansion added about 480,000 people to Kentucky's Medicaid program, which covers about 1.4 million people. Bevin's changes are aimed largely at those added through the expansion though some, such as pregnant women or disabled and chronically ill people, would be exempt.

Bevin spokesman Woody Maglinger said Bevin's order is consistent with his view that if the federal government refused to approve changes to the program, known as a "1115 Waiver," he would terminate the expansion of Medicaid to that group.

"Gov. Bevin has consistently said ... that these are the terms under which Kentucky will maintain expanded Medicaid," Maglinger said. "Accordingly, he has signed an executive order to terminate Kentucky’s Medicaid expansion in the event that a court decision prohibits one or more of the components of the Section 1115 waiver from being implemented."

U.S. Rep. John Yarmuth, a Louisville Democrat who supports the Medicaid expansion, criticized Bevin.

“If the Bevin administration has made any errors or drafted this reckless Medicaid waiver in a way that doesn’t meet legal standards, they could redraft and resubmit the request," he said. "Instead, the governor will punish the more than a half million Kentuckians by entirely eliminating their health care coverage. It’s hard to imagine anything more spiteful and less rational than that.”

Background: Kentucky first to win federal approval to roll back Medicaid expansion

From last summer: Speakers call Bevin's proposed Medicaid overhaul 'cruel'

Kentucky's proposal is the first in the nation the Centers for Medicare and Medicaid Services approved to allow work requirements for people on Medicaid. About eight states have similar requests pending, including Indiana.

In announcing federal approval of his plan, Bevin said the changes would help more people obtain the "dignity" of work and move out of poverty.

Bevin initially ran for governor on a pledge of reversing the expansion. After he was elected, he instead said he would seek federal approval for changes to make people more accountable and take on more personal responsibility for their health and coverage.

But he has said if federal authorities declined to approve the changes he sought, he would terminate the expansion.

More background: Bevin's plan to make Medicaid recipients work will get federal approval

The order Bevin filed Friday directs the secretary of the Cabinet for Health and Family Services and the Medicaid commissioner to "take necessary steps to terminate Kentucky's Medicaid expansion" if any part of his plan is struck down in court and all appeals are exhausted.

Changes approved Friday by the Centers for Medicare and Medicaid Services will allow Kentucky to charge monthly premiums and co-payments as well as require many "able-bodied" adults to work or volunteer 20 hours a week. Those who failed to comply could be "locked out" of coverage for up to six months.

Health advocates have been particularly critical of the work requirements, arguing that research shows at least 60 percent of adults on Medicaid already work, generally at low-wage jobs that don't include health benefits.

The changes also eliminate dental and vision coverage for the "able-bodied" population but members would be allowed to earn points for such services through a "My Rewards" program by volunteer work, attending classes or other activities.

Deborah Yetter: 502-582-4228; dyetter@courier-journal.com. Support strong local journalism by subscribing today: www.courier-journal.com/deborahy.