A number of Democratic elected officials from Louisville blasted the Bevin administration in a news conference Monday morning for ending dental and vision benefits for the expanded Medicaid population over the weekend, which several local dental providers fear will jeopardize such services and the health of the working poor.
This move by the Cabinet for Health and Family Services followed a Friday ruling by a federal judge vacating the Trump administration’s approval of the Kentucky HEALTH program waiver that was scheduled to begin Sunday, which seeks to add premium payments and “community engagement” requirements for “able-bodied” Medicaid recipients.
The Kentucky HEALTH program was also expected to strip the automatic dental and vision benefits of expanded Medicaid recipients on July 1, creating instead a “My Rewards” account in which those individuals could earn points that could be used to purchase dental and vision services.
Instead, the cabinet posted on the Kentucky HEALTH website Friday night that such individuals would no longer be able purchase dental and vision services through My Rewards, as the judge struck down the program.
Additionally, Sec. Adam Meier said recently that an adverse judicial ruling in the lawsuit challenging the waiver would cause it to evaluate ending Medicaid for the entire expanded population of nearly 500,000, just as Gov. Matt Bevin had instructed the cabinet to do in a January executive order in the case of the program being blocked in the courts — arguing that the state cannot afford to cover these individuals without the Kentucky HEALTH program.
Congressman John Yarmuth said Monday that the judge was correct to vacate the approval of the Medicaid waiver that he called illegal, accusing the governor of being “driven by ideological motivations” in the creation of Kentucky HEALTH, which was “trying to find a solution to a problem that doesn’t exist.”
“Medicaid is not a work program,” said Yarmuth. “It is not a program designed to familiarize people with commercial health insurance, as the governor has said. It is a program to provide medical coverage to the poor and working poor.”
As for the Bevin administration’s threat to end Medicaid expansion, Yarmuth said this would not only amount to a “human tragedy,” but would cost the state an estimated $30 billion in economic activity for hospitals and providers over the next 10 years. He added that the federal government would pay 94 percent of the costs for the expanded population this year, lowering to a floor of 90 percent in the near future.
State Rep. Joni Jenkins stated that dental services only make up 2 percent of the state’s Medicaid budget, but that “unresolved dental pain is a gateway to addiction,” which is “like throwing gasoline on our opioid epidemic here in Kentucky.”
Jennifer Hasch, a dental hygienist at the Shawnee Christian Healthcare Center — which serves people regardless of income in west Louisville — also said she was “deeply concerned for our patients and the sustainability of dental services at our health center,” noting that 17 of their 19 patients that morning had Medicaid.
“Eliminating an essential benefit like dental coverage for the Medicaid expansion adults impacts families, the workforce, and overall well-being in the commonwealth,” said Hasch. “70 percent of our patient population has Medicaid, and we estimate half of those are in the expansion population.”
Noting that over 100,000 more Kentuckians received dental services in the first year of Medicaid expansion, she added that dental related emergency room care is at least three times as expensive as a normal dental visit, where key medical issues can be discovered and initiate preventive care.
Hasch later told Insider Louisville that there is a lot of uncertainty about which of their patients no longer have dental coverage, “so our main goal is to try to stay connected to the community and educate them about how their benefits have changed and what their other options are.”
While the Shawnee clinic braces for a potentially dramatic decrease in Medicaid reimbursement for serving the low-income clients that no longer have coverage, so too do the Family Health Centers in Louisville, which are also federally qualified health centers treating patients regardless of income.
Family Health Centers CEO Bill Wagner told Metro Council last month that they feared 8,400 of its patients could lose Medicaid coverage over the next five years with the waiver program in place, but that would likely be a much higher figure with the end of the expansion altogether.
Wagner added that with the dramatic increase in patients covered by Medicaid expansion over the last five years, the city has lowered its annual amount payments to FHC for uncompensated care by roughly $1.1 million.
Monday’s news conference was held at the Phoenix Health Center in the FHC network, which provides medical and dental services for 4,000 of the city’s homeless population. Andy Patterson, the director of homeless services, told Insider that it would continue treating all of its patients, but “it’s just that we won’t get reimbursed” for those who have lost dental coverage.
Asked if the city would have to start increasing funding for uncompensated care, Patterson replied, “We would hope that they would, but we don’t know that they would.”
At Monday’s news conference, Sen. Gerald Neal noted that he and Sen. Morgan McGarvey plan to file a bill in next year’s session of the General Assembly that would mandate that all Medicaid recipients in the state have dental and vision benefits.
Mayor Greg Fischer and Metro Council President David James also spoke, urging the people of Louisville to call their legislators and the governor’s office and tell them to reverse the current course on Medicaid.
Monday afternoon, cabinet spokesman Doug Hogan issued a statement indicating that after Friday’s judicial ruling, the administration had “30 hours to undo 1 ½ years of meticulous planning across multiple partners and cabinets,” but adding that “it is great that people are talking about the importance of routine vision and dental coverage.”
Stating that Kentucky HEALTH’s My Rewards program was designed to increase people’s use of vision and dental coverage “by incentivizing them with earned credits,” Hogan suggested that they were forced to instead end this population’s benefits entirely by the ruling vacating the program’s federal approval.
“When Kentucky HEALTH was invalidated by the court, the My Rewards program was eliminated, and there is no longer a funding mechanism in place to pay for dental and vision services,” stated Hogan. “We hope that we can work together to quickly resolve the fallout from the court ruling, so that the My Rewards program can be reinstated.”
However, several Democrats questioned the legality of that move by the Bevin administration on Monday, and Kentucky Voices for Health — a nonprofit that had opposed Kentucky HEALTH — issued a statement that it “goes against federal Medicaid rules that a State Planned amendment first be approved by (the Centers for Medicare and Medicaid Services) to reduce benefits, followed by filing a revised state regulation, holding a public comment period, and providing notice to affected Medicaid members.”
Republican Party of Kentucky spokesman Tres Watson stated Friday after the ruling that Democrats “expanded Medicaid by Executive Order while ignoring our growing pension crisis; making politically motivated promises to Kentucky families, teachers and state employees that they knew they’d never be able to fulfill. Republicans are working to find a way to deliver on as many of those promises as possible but the money simply isn’t there to sustain the status quo.”