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You are here: Home / Anderson On Health Insurance / Lots of lawyers heading to Kentucky

Lots of lawyers heading to Kentucky

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Kentucky recently received approval for a Medicaid Section 1115 waiver from the Center for Medicare and Medicaid Services (CMS). The Kentucky 1115 imposes work or volunteer requirements on Medicaid recipients. I am not a lawyer but I knew that there would be lawyers involved.

The 1115 waiver process allows states to experiment and modify the basic Medicaid program as long as the experiment furthers the objectives of the Medicaid program. Medicaid’s objective has always been perceived to be “Get people health care!” Some states will experiment with money follows the individual programs, other states may want to allow for more substance abuse providers to be eligible, most states use some managed care components.

Work requirements have never been part of the mission of “Get people health care”. The justification in the CMS guidance is either acontextual or flips correlation and causation on its head. So there will be lawyers running up billable hours for a very long time.

Now Governor Bevin (R-KY) has threaten that if any part of the waiver is ruled illegal by the federal courts, he will shut down the entire Kentucky Medicaid expansion project. Rachel Sachs notes that this is a threat with a long and variable lag.

And if that happens, I imagine that there will be lawyers as well.

Reader Interactions

13Comments

  4. 4.

    ArchTeryx

    Yeah. Work requirements have exactly one purpose and one only: To knock people off the rolls. They are especially pernicious when combined with Medicaid, because moire often than you think, Medicaid is what gives poor and sick adults the ability to get healthy enough to get employed in the first damn place.

    We (in New York State) had a layabout housemate, someone who was a real jerk. He originally came from Alabama. It turned out he had an undiagnosed and extremely severe case of psoriasis, a mouth full of bad teeth and other autoimmune problems. After 6 years we FINALLY convinced him to shuck the right wing programming and get on Medicaid. Suddenly he had a new set of dentures, a full medical team, and a bunch of new treatments including biologic therapy for his autoimmune conditions.

    He not only became a model housemate, about a year after the treatments began, he had himself his first full time job with benefits in nearly a decade, and will soon be off Medicaid on his own.

    None of that would have been possible with a work requirement. He eventually would have just died. Work requirements tied to a MEDICAL program are nothing more then a culling move, the same as if Medicaid was eliminated altogether. Something which is still Paul Ryan’s wet dream. I call him our very own Hermann Goering for a reason.

  5. 5.

    dr. bloor

    his current term in office (which ends in 2019).

    Her implicit assumption here seems to be that the fair citizens of Kentucky would throw him out in such a scenario, which, given we’re talking about the fair citizens of Kentucky, is entirely unwarranted.

  7. 7.

    ArchTeryx

    @Sab: Actually it was Michigan that ran me off. They gave me the choice when they became a refusenik state: Leave or die. They aren’t a refusenik state any more but too late for me. Now I’m a New York State taxpayer and likely will be the rest of my life. The good Calvinists of Western Michigan can all go fuck themselves.

  8. 8.

    Feathers

    After hearing all the horror stories coming out of England, I’m sure Kentucky will be able to handle this. The ones that stick in my mind were cancer patients being told they needed to find a job, with notices arriving at the hospice.

  9. 9.

    laura

    Maybe it’s just me, but I can’t help but believe that this Matt Bevin would prefer to go to the homes of medicaid recipients and beat the life out of them with a claw hammer than provide them with health care.

  11. 11.

    Mnemosyne

    There is this weird belief that a lot of conservatives seem to have that people just love going to the doctor for no reason and will fake illnesses and injuries so they can do it. I really don’t get where this belief comes from, but it seems to be all-pervasive.

  13. 13.

    kindness

    Re – Bevin’s whining. Isn’t it funny how Republicans can dish it out but can’t take it.

    Typical of the species I guess.

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