Indiana Gets Federal Approval to Add Work Requirements to Medicaid Program

Following in the footsteps of the Kentucky HEALTH waiver – which was approved in January by the U.S. Centers for Medicare and Medicaid Services (CMS) to offer Kentucky Medicaid members the ability to customize a path based on individual needs that will lead to better health, engagement in their communities, improved employability, and success through long-term independence – Indiana recently received federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act.

Indiana’s Medicaid expansion began in February 2015, providing coverage to 240,000 people who were previously uninsured. The federal approval extends the program, known as the Healthy Indiana Plan (HIP), through 2020, according to an article from Kaiser Health News.

Included in this new plan is a “lockout” provision that could lead to tens of thousands of enrollees losing coverage if they fail to submit in a timely manner their paperwork showing they still qualify for the program.

Like Kentucky, Indiana’s Medicaid waiver’s work requirements, which mandate adult enrollees to work an average of 20 hours a month, go into effect in 2019.


Rural areas saw greatest increase in access to healthcare under Medicaid Expansion, according to Indiana University study

Medicaid expansion under the Affordable Care Act greatly increased access to health care for Americans, especially in rural areas, says an Indiana University study published in The Journal of Rural Health.

Researchers, who used data from the Census Bureau’s American Community Survey from 2011-15, found that expansion “increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas, but some of these gains were offset by reductions in individual purchased insurance among rural populations,” according to a Kentucky Health News article.

Medicaid covered almost 636,000 adult Kentuckians in the second quarter of this year, with the great majority of enrollees covered under Medicaid expansion and almost half of them young adults, according to a report done for the Foundation for a Healthy Kentucky. The report found that 493,199, or 78 percent, of the 635,747 adults covered by Medicaid in Kentucky were covered by the Patient Protection and Affordable Care Act’s expansion of the program to those who earn up to 138 percent of the federal poverty level. The remaining 142,548 were covered by traditional Medicaid.

IU researchers found that Medicaid expansion increased the probability that low-income people would have health coverage, and it increased Medicaid coverage more in rural areas than in cities. There was some evidence that in rural areas, the expansion was accompanied by some shifting from individually purchased insurance to Medicaid.


Organization helps Americans understand what Medicaid is all about

commonwealth fund logoMedicaid now covers more than 73 million people, according to the U.S. Centers for Medicare & Medicaid Services (CMS), making it the nation’s largest insurer. Yet the program is not well understood by the public.

That’s why The Commonwealth Fund put together these five facts about Medicaid:

  1. Nearly 16 million people have gained Medicaid coverage under the Affordable Care Act’s expansions; most had previously been uninsured. A recent Commonwealth Fund survey found that about 60 percent of these newly insured adults were uninsured prior to gaining Medicaid coverage. Half were either uninsured for more than two years or never had coverage.
  2. Most people are satisfied with their Medicaid coverage. A recent Commonwealth Fund survey found that 88 percent of adults are satisfied with their new Medicaid coverage: 77 percent rate it as either good, very good, or excellent.
  3. Medicaid helps people get care and improve their health. About 70 percent of new Medicaid enrollees who’ve used health services said they would not have previously been able to access or afford their care. One study compared adults in two southern states that expanded Medicaid eligibility (Arkansas and Kentucky) to those in Texas, which did not. It found that people in Kentucky and Arkansas had greater access to primary care, were less likely to skip medications due to cost, were less likely to visit the emergency department, and were more likely to say they were in excellent health.
  4. Medicaid provides access to timely care. About two-thirds of adults with Medicaid coverage who tried to find a new primary care doctor found it very or somewhat easy to do so and 59 percent waited two weeks or less to see them.
  5. Medicaid provides comprehensive benefits and financial protection from large medical bills.

The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. For more information, please click here.


Nearly 636,000 Kentucky adults covered by Medicaid, new report shows

foundation for a healthy KYMedicaid covered almost 636,000 adult Kentuckians ages 19 to 64 in the second quarter of this year, according to a new report released by the Foundation for a Healthy Kentucky.

The findings are in the latest report from an ongoing study of the impact of the Affordable Care Act (ACA) in Kentucky, commissioned by the Foundation in 2015. Of the 635,747 adult Kentuckians covered by traditional and expanded Medicaid as of June 30, 2016, 493,199 comprised the expansion population and 142,548 were covered by traditional Medicaid, the report said.

A copy of the new report, the 6th quarterly snapshot of the Study of the Impact of the ACA Implementation in Kentucky, is available by clicking here.

Funded by an endowment, the mission of the Foundation for a Healthy Kentucky is to address the unmet health care needs of Kentuckians by informing and influencing health policy, improving access to care, reducing health risks and disparities, and promoting health equity. For more information, please click here.


Number of uninsured Kentucky residents continues to drop, report shows

foundation for a healthy KYThe number of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform’s impact in the state.

According to the latest quarterly report, the rate of uninsured Kentuckians was 7.5 percent in December 2015, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the Affordable Care Act (ACA), Kentucky’s uninsured rate was 20.4 percent.

“Lack of insurance is a significant barrier to getting necessary health care and preventive services timely,” Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. “Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions.”

The report also showed that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance abuse treatment services, and 5,589 colorectal cancer screenings to enrollees age 19-64 during the fourth quarter of 2015. Most of these services were provided to beneficiaries covered under Expanded Medicaid, rather than traditional Medicaid.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the ACA is affecting Kentuckians. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.


Federal government issues new managed-care standards for Medicaid, CHIP

CMS logoThe U.S. Centers for Medicaid and Medicare Services (CMS) has set new standards for Medicaid private insurance plans, which apply to insurers operating as so-called Medicaid middlemen in 39 states and Washington, D.C., and the Children’s Health Insurance Program (CHIP).

Each state, including Kentucky, runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years, according to an Associated Press article.

“A lot has happened to health insurance coverage through Medicaid over the past several years as millions more people have gained coverage because of the Affordable Care Act: The federal government and the states have sought to strengthen the program’s focus on the consumer, the delivery of high quality care, and providing greater access points, and on developing a modern set of rules,” wrote Andy Slavitt, acting administrator of CMS, with Vikki Wachino, director for the Center for Medicaid and CHIP Services at CMS, in a blog post  announcing the final rule.

“Today, we’re taking a next step in that work today by finalizing a long-anticipated rule that updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans. These improvements modernize the way these managed care health plans operate so that Medicaid and CHIP continue to provide cost-effective, high quality care to consumers,” they wrote.

The regulation is more than 1,400 pages long, and it will take time for states, consumer advocates, and insurers to assess all its implications.

According to an article in Morning Consult, “Wachino described it as having four parts: It will enhance delivery system reform, strengthen consumer experience and protections, strengthen the integrity of the program, and align the rules across different insurance programs.”

The changes start to take effect next Jan. 1, and will take years to fully put into place.


Kentucky leads nation in reducing number of uninsured residents

KentuckyKentucky continues to lead the way in the reduction of people without health insurance, according to new polling by Gallup Inc.

Both Kentucky and Arkansas registered a decline of 12.9 percentage points from the time that the Affordable Care Act took effect in 2014 through the end of 2015, but in percentage terms, Kentucky’s drop of 63.2 percent was larger than Arkansas’s drop of 57.3 percent. Oregon came in second place, with a drop of 62.3 percent.

Kentucky and Arkansas are the only Southern states to have expanded Medicaid and have a state health-insurance marketplace under the ACA. In both states, the uninsured rate was cut by well over half – Kentucky’s dropped from 20.4 percent to 7.5 percent, while Arkansas’s dropped from 22.5 percent to 9.6 percent.

However, with 7.5 percent still uninsured, Kentucky still trails several states in the percentage of population that does have health insurance.

For more information, please click here.


Governor Bevin tells federal government he wants to dismantle kynect

Kynect LogoAs you may have heard, Governor Matt Bevin has followed through on a campaign promise and has notified federal authorities that he plans to dismantle kynect, Kentucky’s health insurance exchange created under the Affordable Care Act.

According to an article in the Courier-Journal, Bevin wrote in a Dec. 30 letter to Sylvia Burwell, secretary of the U.S. Department of Health and Human Services, that he plans to wind down the state health exchange and transition Kentuckians to the federal site,, to shop for insurance under the law.

Meanwhile, kynect  remains open and the changes will not affect anyone shopping for insurance for the current enrollment period, which ends Jan. 31. Nor will the changes affect anyone who signed up for Medicaid, the government health plan for low-income citizens, through the kynect site.

The earliest changes to kynect would come in November 2016, if the governor can work out a plan with the federal government to wind down kynect, which includes the online site people use to obtain health coverage. If he succeeds, Kentuckians would use the federal site starting in November 2016. People would continue to enroll in Medicaid through the state.


Most Kentuckians want to keep Medicaid expansion in place, according to new poll

kaiser family foundation logoA new Kaiser Family Foundation poll of Kentucky residents finds that after much discussion of the issue, health care is the top issue residents want state lawmakers to address, and a strong majority opposes scaling back the state’s Medicaid expansion to cover fewer people as new Gov. Matt Bevin proposed during his campaign.

About seven in ten Kentuckians (72%) say they would prefer to keep the state’s Medicaid expansion as it is today rather than change it to cover fewer people. A much smaller share (20%) say they would prefer to scale back the expansion to cover fewer people.

Taken before Gov. Bevin’s inauguration last week, the poll finds that Kentucky Republicans are more divided about the Medicaid expansion, but a majority (54%) favors keeping it over changes that would reduce the number of people with coverage. Among those who say they voted for Gov. Bevin on Nov. 3, somewhat fewer (43%) support the Medicaid program as it exists, while half (50%) say they want it scaled back to cover fewer people.

“Kentuckians don’t particularly like the Affordable Care Act, but they do like their state’s Medicaid expansion and marketplace, and most want to keep them,” Foundation CEO and President Drew Altman said. “The findings in a red state may show other governors considering expansion that it could be equally popular with their state’s residents, and illustrate to Republicans in Washington how difficult it may be to take away health coverage from people who have it.”

The Kaiser Family Foundation is a non-profit organization focusing on national health issues, as well as the U.S. role in global health policy.  Unlike grant-making foundations, Kaiser develops and runs its own policy analysis, journalism and communications programs, sometimes in partnership with major news organizations. For more information, go online to

For more information about this poll, please click here. To read an article in the Lexington Herald Leader about the poll, please click here. To read an article in the Louisville Courier-Journal about it, please click here.


Kentucky Sees Great Improvements in National Health Rankings

commonwealth fund logoWhile it’s still at the bottom of the pack nationally, Kentucky was among the states that saw the greatest improvements over time in health rankings released this week by The Commonwealth Fund.

The Commonwealth Fund’s Scorecard on State Health System Performance  looks at 42 indicators grouped into five domains: access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and health equity.

Kentucky ranked just 40th overall, but improved on 13 indicators of health and worsened on only three. Louisiana, Oklahoma, and Rhode Island were the only other states to improve on more indicators.

Although states such as Kentucky have a long way to go, “they also have more to gain from improvement,” Douglas McCarthy, senior research director for The Commonwealth Fund, said in an article by The (Louisville) Courier-Journal.

According to the report, Kentucky saw substantial improvements in:

  • The numbers of insured adults ages 19-64 (Kentucky led the nation in declines among uninsured adults)
  • Adults who went without care because of cost in the previous year
  • Adults 50 and older who got recommended screenings and preventive care
  • High-risk nursing home residents with pressure sores
  • Readmissions to the hospital in 30 days among Medicare patients
  • Infant mortality rates

This 2015 edition of the Scorecard on State Health System Performance is the fourth in an ongoing series. This edition measures changes in performance during 2013 and 2014 to assess the effects of the Affordable Care Act’s 2014 health insurance expansions. Click here to see the full report.

The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults. For more information, go online to