The implementation of the Affordable Care Act (ACA, also known as ObamaCare) has resulted in a great deal of change to Medicaid in the past several years. As Medicaid is a federal program that each state adopts differently, every state has handled it in their own ways. Some states are staunchly opposed to expansion through the ACA, while others welcome it. One of the states that has welcomed it is Kentucky.
Current State of Medicaid in Kentucky
Kentucky has expanded its Medicaid services through the provisions of the Affordable Care Act. This means that any parents and single adults with an income up to 138 percent of the federal poverty line (FPL) can be eligible for Medicaid healthcare. Pregnant women are eligible at 200 percent of the FPL, while children are eligible if their family income is up to 218 percent of the FPL. Seniors and individuals with disabilities are eligible at up to 74 percent of the FPL. As of October 2019, 479,600 adults are in the expansion group.
As a result of Medicaid expansion, along with the implementation of a healthcare marketplace, Kentucky has seen great success with reducing its uninsured rate. In fact, enrollment through Medicaid/CHIP rose 99 percent between 2013 and 2019 because of expansion. This is a far higher percentage than any other state and is over three times higher than the national average enrollment increase of 28 percent. Over 1.3 million people in Kentucky are now covered by Medicaid, which is more than a quarter of the state’s population. Also, rural hospitals have gained much more of the financial support that they need to care for their patients due to expansion.
Often one of the most divisive topics that a state must decide on when implementing Medicaid expansion is whether or not to require nonexempt Medicaid recipients to clock in a certain amount of time at work or in a “community engagement” activity. Some see this potential requirement as a way to encourage residents to build a more self-sustaining lifestyle, while others reject it as an obstacle to receiving quality insurance.
In 2016, Kentucky lawmakers submitted a waiver to the Center for Medicare and Medicaid Services (CMS), which sought to implement such a work requirement (80 hours per month of work or community engagement), which was known as the HEALTH waiver. This waiver also included certain stipulations for premiums and deductibles and a regulation to end retroactive eligibility for most individuals. It was approved by the federal government with some modifications in early 2018, but through a series of court-ordered blocks and pushbacks, it was never officially implemented. In December 2019, an executive order rescinded it before it could go into effect. This means that for the foreseeable future, community engagement is not required in order to maintain Medicaid coverage in Kentucky. Eligibility requirements will remain the same as they have been since Kentucky expanded Medicaid through the ACA.
How DECO Can Help
The world of healthcare can often be confusing, but we’re here to simplify it. We know the ins and outs of the eligibility and application processes for Medicaid and other services. Our goal is to help healthcare organizations understand it, too, and get reimbursed for the care they provide. We take a compassionate and collaborative approach, meeting with patients to walk through the process of determining eligibility and working with clinical staff to improve their revenue cycle management process. If you’d like to learn more about how we can assist your healthcare organization, contact us today!