Since the coverage expansions in the Affordable Care Act (ACA) began in 2013, Kentucky’s model for streamlined eligibility and enrollment has widely been considered one of the most successful in the country. Many factors contributed to its success, including: champions in state leadership; cross-agency and organization collaboration; an integrated eligibility system that made the application and enrollment process easier and more intuitive for consumers; and an overall commitment to continuous improvement. This model has led to remarkable Medicaid enrollment gains and a plummeting uninsured rate, from 19.2 percent in 2013 (higher than the national average at the time, 16.4 percent) to 9.8 percent in 2015 (below the national average of 10.7 percent in 2015).
We recently submitted comments to the Kentucky Medicaid Commissioner highlighting two main areas where the Kentucky HEALTH waiver proposal threatens to reverse the enrollment gains made in covering Kentuckians over the past three years. Here’s a quick overview:
Importance of financial help: Enroll America’s consumer research has found, year after year, that the availability of financial help is one of the biggest motivators for consumers to enroll in and retain coverage, especially plans with little to no premium. The Kentucky HEALTH proposal includes increases to premiums on an annual basis, charging enrollees more the longer they have been enrolled, making it even more likely that eligible consumers will fail to retain coverage over time. We are concerned that exposure to increased financial burden in the form of premiums, as included in the waiver proposal, could lead eligible enrollees to lose Medicaid coverage unnecessarily.
Making coverage easy to understand and use: The Kentucky HEALTH proposal would increase the complexity of the Medicaid program, jeopardizing retention and making new enrollment more challenging. Consumers would need to meet new community engagement requirements, manage an account for payment of deductibles, and navigate several complex coverage programs with different rules governing premium payments, disenrollment, and lock-out periods. This complicated web will put the hundreds of thousands of Kentuckians currently enrolled in Medicaid at an increased risk of losing coverage despite still being eligible.
At a time when policymakers should be making it easier for eligible consumers to enroll in and retain coverage, this proposal instead threatens to move Kentucky in the opposite direction.
You can read our full comments here.