Bevin celebrated federal approval Friday, calling it "a significant milestone on our journey to lead the nation in transforming Medicaid in a fiscally responsible way". "We're ready to show America how this can and will be done".
According to the U.S. Department of Health and Human Services, about 78 percent of enrollees paid less than $100 per month for their plans in 2016.
"With the approval of the Medicaid waiver, the historic progress Kentucky has achieved in health care in recent years comes to a halt", said Dustin Pugel, a policy analyst with the Kentucky Center for Economic Policy.
"By approving Governor Bevin's risky and irresponsible Medicaid waiver, the Trump administration has agreed to end health coverage for 95,000 Kentuckians".
The announcement came in a 10-page memo with detailed directions about how states can reshape the federal-state health program for low-income people. Of the share of "able-bodied" adults (on Medicaid but not receiving Supplemental Security Income), six in ten are working themselves and eight in ten are in a family with one working member - meaning other members may need to stay home due to caregiving responsibilities.
Bevin agreed the plan might face a legal challenge but seemed unconcerned.
Milliman, an Indianapolis-based actuarial firm hired by the state to evaluate its program, predicts just under 133,000 Hoosiers on the state's Medicaid expansion HIP 2.0 would be subject to the work requirement.
"It will indeed become the model for the nation - mark my words", Bevin said Friday.
The program will be phased in starting in July, officials said Friday.
But it makes suggestions for states as to what counts as work, including state work programs, job training, volunteering, or caring for a relative. "This is about helping those individuals rise out of poverty".
Kentucky was one of the 32 states that expanded Medicaid, the health insurance program traditionally covering children, the elderly and disabled, under the Affordable Care Act. Beneficiaries will manage a My Rewards Account and have Deductible Account, which provide incentives for preventive health services and serve as "an educational tool to inform beneficiaries about the cost of healthcare". "It's not about employment encouragement". The current request would require able-bodied adults without dependents to work at least 20 hours a week. Those who don't will complain long and loud about the work requirements and offer all kinds of reasons they can't possibly be expected to meet them. The letter released Thursday by CMS contains similar language on the work requirements.
"The action appears created to achieve significant cuts in Medicaid enrollment rather than Medicaid's stated goal of furnishing medical assistance to low-income people", NHeLP Legal Director Jane Perkins said.
In a speech to state Medicaid officials in November, Verma indicated that the Trump administration would be receptive to adding work requirements and considering other conservative policy ideas to reshape Medicaid.
But Cuello noted that many more beneficiaries will be affected by the new, more complex requirements, such as people who are exempt from work because of a chronic illness but will have to prove they are exempt.
Before the payment increases, Medicaid fees for primary care services for all age groups were typically 59 percent of the amount paid by Medicare, the US health program for the elderly, researchers note in Pediatrics. And when someone gets sick, the last thing she needs to worry about is whether she'll also lose her health coverage for not working.
Pregnant women and children won't have premiums, won't have a change in benefits and won't have to complete the community engagement requirement.
Although the first waiver has been approved, the road to work requirements could be longer than their supporters hope: Health policy experts anticipate that lawsuits will be filed quickly.