Kentucky Health News
Legislation aimed at tightening Kentucky's rules for public-assistance programs passed out of committee and the full House just hours later on Thursday, with strong opposition from advocates and many Democrats and cries of "fear-mongering" from the sponsor.
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| House Speaker David Osborne and Speaker Pro Tem David Meade presented House Bill 7 in committee. (LRC photo) |
Meade and other supporters of House Bill 7 said it aims to ensure that Kentuckians who are receiving safety-net services such as food assistance qualify for them, and to move more able-bodied Kentuckians into jobs, especially as extensions provided because of the pandemic phase out.
A similar bill passed the House in 2020, but stalled in the Senate. Just like last time, this bill is sponsored by Meade, from Stanford, and House Speaker David Osborne of Prospect, both Republicans.
The 27-page bill moved to the Senate on a 71-26 vote. Norma Kirk-McCormick, R-Inez, was the only Republican voting against the measure.
The latest version of the bill would require the Cabinet for Health and Family Services to apply for an 1115 waiver to allow Kentucky to require able-bodied adults without dependents on Medicaid to participate in at least 80 hours of qualifying community engagement activities a month to get health insurance if they have been enrolled in the program for more than 12 months. Further, CHFS must reapply for such a waiver every 12 months.
"So at this point, there's not a chance really that the Biden ministration is going to approve them," he said. "There's Supreme Court precedent now against it. But that says nothing about what perhaps a future administration or future Supreme Court might decide."
In addition, the bill directs the Legislative Research Commission to establish a Benefits Cliff Task Force to find ways to bridge the benefits cliff as income increases. There is also language to work on childcare assistance programs for people as their incomes increase above the current threshold allowed.
Rep. Lisa Willner, R-Louisville, told the House members that her concern is that the consequences of the bill will be different than the stated intentions and will result in people getting kicked off their benefits.
At the earlier Health and Family Services committee meeting, Health Secretary Eric Friedlander said that based on the original bill, the health cabinet would need to probably double its current workforce to accommodate all that the bill asked them to do and would cost tens of millions of dollars to simply be able to answer the phones.
"I just think we have the potential for a real disaster situation," he said.
Meade pushed back on this estimate on the House floor, calling it "puzzling" because they removed the most costly part of the bill and because some of the work required of the Cabinet will also be required by the federal government. Further, he said that the rest of the bill is the same as the 2020 bill and that fiscal note was $20 million, with $15 million of that coming from the federal government and the rest from the state.
Asked at the committee meeting what this bill was trying to solve, Meade said his goal is to reduce the number of ineligible people who are on Medicaid; to put both Medicaid and SNAP benefits on the same EBT card to eliminate any possibility of selling them; and to create a task force to develop a "bridge program" for people who make too much money for Medicaid, but not enough to purchase insurance and to work on the childcare gap to help people work.
Asked on the House floor how many people are on the Medicaid rolls that should be ineligible, Meade said discussions with researchers at the University of Kentucky say it could be upwards of 200,000 people. At this time, there are 1.6 million Kentuckians on Medicaid.
"We're really trying to streamline and make sure that this is creating efficiencies and not creating barriers," Moser said
Rep. Tom Burch, D-Louisville, later refuted Moser's suggestion. "It is not a bill to streamline our system. It's an evil bill," he said. "It's a bill that's going to hurt people.
In support of the bill in committee, Rep. Ryan Dotson, R-Winchester said, " I think this Commonwealth is long overdue with welfare reform and purging those out of the system that really don't need to be there. . . . I do believe this is a good first step."
Speaking against the bill, a number of advocates painted a real-world picture of the challenges people face when seeking out public assistance at the committee meeting.
"I'm here to ask that we don't punish Kentucky's hardworking people who are in transition or trouble," said Mike Wynn, with Grace Health in Eastern Kentucky. "Don't punish them for the few bad actors that abuse the system." Wynn said he had been a Kynector for seven years.
"This bill would make a very complex process even harder and nearly impossible for some," said Celine Mutuyemariya, a community policy strategist with the Louisville Urban League. "I urge the members of this committee to think about the very real consequences of this bill." She added that she has worked as a community health worker and Kynector in the past.
Christina Libby, a certified community health worker and Kynector with the Homeless and Housing Coalition of Kentucky, said it's important to dispel the myth that everyone who is eligible for benefits are getting them or can get them easily. Further, she said it is an "unnecessarily complicated" process.
"Getting help is already hard, very hard," she said. "It's a demoralizing and discouraging process."
Kentucky Voices for Health provided lawmakers with a letter stating their concerns about the bill signed by 60 organizations and 64 constituents across the commonwwealth.
Here are some key provisions related to Medicaid in HB 7 related to Medicaid:
- CHFS has 12 months to do full audit the state's Medicaid rolls after the federal government removes its temporary Medicaid funding given to states under the Families First Coronavirus Response Act that limits state's ability to disenroll individuals from Medicaid while they get the funding, called "maintenance of effort" restrictions.
- Prohibits the CHFS and the state Department of Medicaid Services from making presumptive eligibility determinations, a process that allows a person to be approved for Medicaid before their qualifying paperwork is completed.
- Creates new rules for hospitals around how they make presumptive eligibility determinations.
- Requires Medicaid coverage for substance use disorder treatment for incarcerated individuals, thus codifying language that was in the 2020 budget bill.
- Directs the Education and Workforce Development Cabinet to establish a job placement assistance program for individuals enrolled in Medicaid, to be made available for those enrolled in the community engagement program once approved and any able-bodied adult on Medicaid if the community engagement program is not approved.
- Authorizes the Attorney General to bring action against CHFS if provisions of the Act are not appropriately implemented.
- Creates the Public Assistance Oversight and Advisory Committee to provide legislative oversight of these programs;
- Prohibits CHFS from accepting self-attestation of income, residency, age, household composition, caretaker or relative status or coverage for the purpose of determining Medicaid eligibility, without verifying that information prior to enrollment. Residents of assisted-living and long-term care facilities are exempt.
- Require the cabinet to use only the most recent income verification data available when determining public assistance eligibility
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