Tag: Medicaid Reform

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[MM Curator Summary]: Montana was ok with expanding Medicaid for thousands of Chad the 27 year old otherwise healthy bartendesr in 2016. Not OK with clearing the waiting list for 160 members with intense healthcare needs on a waiting list for services.

 
 

 
 

Clipped from: https://www.news-medical.net/news/20230714/A-plan-to-cut-Montanae28099s-Medicaid-waiting-list-was-met-with-bipartisan-cheers-Then-a-veto.aspx

Montana state Sen. Becky Beard thought she’d found a fix for a shortage of assisted living care options for Montanans who can’t afford to pay for it themselves — a shortage she became aware of while searching for a suitable place for her mother to live.

Beard, a Republican from the rural town of Elliston, ushered a bill through the GOP-controlled legislature this spring. The proposal would have moved more than 200 people off waiting lists for government-supported care and saved the state money by accessing more federal Medicaid money to cover their costs and the cost of those already in assisted living.

The bill had broad support from assisted living facility owners whose facilities eventually would accept more of these patients covered by Medicaid, the state-federal program that pays medical and other health-related bills for low-income and disabled people. In Montana, the federal government pays about 65% of the cost of most Medicaid-covered services, and the state pays for the rest.

But Republican Gov. Greg Gianforte vetoed the measure May 18, two weeks after the legislature adjourned. A post-session vote in June by Montana’s 150 lawmakers to override the veto failed by 10 votes.

Gianforte’s veto disappointed and mystified the bill’s supporters.

“I don’t see where there is any negative impact, financially for the state, for the residents, or to us as providers,” said Mike White, who co-owns seven assisted living facilities across Montana. “I thought, of all the bills out there, this would be the last one to get vetoed.”

Gianforte said the bill, by creating another Medicaid entitlement program, could have ended up costing the state much more in the long run. He also said it would have restricted the state’s ability to serve Medicaid-funded residents “in a community setting.”

Supporters of the bill said that the governor is simply wrong — and that Montana missed an opportunity to tackle a long-standing problem: the lengthy waiting lists for people on Medicaid who need assisted living or in-home care, to keep them out of more expensive nursing homes.

An analysis by Gianforte’s own budget office said the bill would have saved the state $1 million during its first two years by using more federal money. Some supporters also pointed to the state’s $2.4 billion surplus, saying the state could certainly afford this small change to its Medicaid plan, if it ended up costing the state.

“This administration has shown that they don’t care about poor people, about people who are struggling,” said state Rep. Mary Caferro, a Democrat. “They simply don’t care, because we had the money to do it.”

The Gianforte administration insisted that there is no accurate way to estimate the long-term costs of placing assisted living under a Medicaid option called Community First Choice, and that doing so would complicate management of in-home and assisted living services.

Beard’s Senate Bill 296 would have required the state to place Medicaid funding for assisted living under Community First Choice starting in 2026, instead of a “waiver” program, where it’s been for many years.

States must ask the feds for Medicaid waivers to offer services or cover populations not covered under federal law. Like many other states, Montana asked for a waiver decades ago to cover nonmedical services that help keep older or disabled people out of nursing homes or other institutional settings. About 2,700 Montanans use these waiver-covered services each year, including about 900 in assisted living facilities.

But funding for Montana’s Big Sky Waiver program is capped by the legislature, so it has a waiting list for covered services. As of this spring, about 160 people who’d qualified for Medicaid coverage were on the waiting list for an assisted living spot.

An additional 150 people were waiting for other Medicaid services, such as in-home care that helps with daily chores like eating, dressing, and bathing. Those spots open only if lawmakers approve more funding or if a person getting the services dies or no longer qualifies for Medicaid.

Community First Choice, however, has no waiting list because it’s an entitlement, with no funding cap. A person who qualifies for Medicaid gets whatever services are covered under the program.

CFC was created as a state Medicaid option by the 2010 Affordable Care Act, in hopes of expanding coverage of services that help older and disabled people who have little income and few assets live independently, staying out of pricey facilities.

To encourage states to incorporate CFC into their Medicaid plans, the Affordable Care Act offered a higher federal match, of 6 additional percentage points.

Only nine states, however, have adopted CFC, and only three — Washington, Oregon, and California — have chosen to cover assisted living under the program.

Montana is one of the nine states that applied for the program, 11 years ago under Democratic Gov. Brian Schweitzer. But the state did not include assisted living as a covered service under CFC.

Rose Hughes, executive director of the Montana Health Care Association, which represents nursing homes and assisted living facilities, said states apparently worry that making these services an entitlement will increase their Medicaid budgets.

But she argued that expanding assisted living coverage under Medicaid saves states money because it can keep people out of more expensive nursing homes and, in some cases, costs less than in-home care.

Assisted living “is an extremely cost-effective service, and it’s one that seniors like,” Hughes said.

She also noted that anyone who qualifies for assisted living under CFC or the waiver is eligible for nursing home-level care.

“The day they get put on a waitlist, they could go to a nursing home, and the state would pay for that,” Hughes said.

And getting rid of the waiting list simply is the humane thing to do, bill supporters said.

The waiting list, managed by the state, rates people’s level of need and can seem incredibly arbitrary, bill supporters said. There are separate waiting lists for different locales; if you’re on the list in one town and move elsewhere, you must get on another waiting list.

“These systems are designed to protect people when they run out of resources. These people did their part, and we owe it to them,” said Michael Coe, director of operations for Caslen Living Centers, the company co-owned by White.

Beard eventually found her 82-year-old mother a spot at a Helena senior living facility that her mother pays for herself, without help from Medicaid.

Beard said the experience drove home the difficulty many Montanans face in finding such services if they can’t afford to pay.

She said she shares the concerns of her fellow conservatives about the state budget, but on this issue, she thinks paying for more assisted living slots is both fiscally sound and the right thing to do — and she’ll pursue it again in the 2025 legislature.

“This is a real need, and we’re not done with it,” Beard said. “I’m not giving up on this.”

 

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[MM Curator Summary]: All the reasons Medicaid members are frequent flyers at more than 2x even those with no insurance. And some thoughts on what to do about it.

 
 

 
 

Clipped from: https://www.cato.org/blog/medicaid-emergency-room-use

CDC data show that Medicaid beneficiaries visit emergency rooms more frequently than individuals with private coverage, Medicare beneficiaries, and even the uninsured. Because ER visits are so expensive, federal and state governments could realize large savings by reducing the gap in ER utilization between Medicaid beneficiaries and other individuals.

The accompanying figure shows ER utilization rates by coverage type in 2019, which are probably more indicative of post‐ pandemic usage than data from more recent years. Utilization rates across all four categories fell in 2020—the last year for which the CDC has published data—as fear of COVID-19 exposure kept prospective patients away from hospitals.

 
 

The gap between Medicaid and uninsured ER use seems counterintuitive. Uninsured individuals should have difficulty accessing many non‐ emergency medical services, but emergency rooms cannot turn anyone away (if the hospital participates in Medicare, as almost all do). On the other hand, hospitals can charge uninsured patients for services they receive in the ER, and the fear of a large bill is likely to deter many from visiting.

While Medicare and privately insured patients are insulated from such large hospital bills, they usually face a significant copayment. Government survey data show that ER co‐ pays of $100 to $250 are most common for privately insured patients, but some pay up to $1000.

By contrast, most Medicaid beneficiaries face little or no out‐ of‐ pocket costs for ER services. CMS gives states the option to charge Medicaid patients up to $8 if they visit an ER without having a true medical emergency. But, as of 2020, only fourteen states enforced this copayment provision, and some categories of beneficiaries (e.g., children and pregnant women) are exempt.

While Medicaid beneficiaries have little or no financial disincentive to visit the emergency room, they may not be able to access less costly alternatives. Survey data published before the pandemic showed that general practitioners were much less likely to accept new Medicaid patients than privately insured or Medicaid patients.

Although this acceptance gap is normally attributed to relatively low Medicaid reimbursement rates, many physicians cite bureaucratic hurdles to obtaining reimbursement as an additional deterrent. In any case, many Medicaid beneficiaries do not have a primary care doctor to call as an alternative to visiting the ER.

Another ER alternative is urgent care, which is a less costly alternative to the emergency room for a subset of acute medical issues. Urgent care facilities accept Medicaid patients in some but not all states. For example, Kaiser Permanente takes Medicaid patients at its urgent care centers in two of the states in which it operates, but does not accept them in six other states plus the District of Columbia.

One state that attempted to address the ER incentive problem is Kentucky. In 2018, the state obtained a waiver from CMS allowing it to implement a rewards program for certain Medicaid beneficiaries. Under this program, each qualifying Medicaid beneficiary receives an account that can be used for health‐ related benefits normally excluded from the state’s program including certain dental and vision services, other‐ the‐ counter medications, and gym memberships. The state deposits funds into a beneficiary’s account whenever the individual completes a recommended healthy activity such as getting a checkup, receiving a flu shot, or participating in a tobacco cessation program.

Originally, Kentucky planned to deduct funds from a beneficiary’s rewards account if he or she visited the ER without suffering a medical emergency. The deduction would range from $20 for the first unnecessary visit to $75 for the third such visit. However, this measure was dropped after Governor Matt Bevin failed to win re‐ election.

Since the deduction scheme was not fully implemented, its effects cannot be assessed.

Aside from asking Medicaid beneficiaries to share the cost of ER visits, providing options to the ER could also reduce utilization. If physicians are unwilling to accept more Medicaid patients, nurse practitioners and physician’s assistants to care for this population. But many states limit the scope of practice for these professionals, prohibiting them from working independently or prescribing drugs on their own. States should expand their scope of practice so that they can provide care to all patients.

Finally, it is worth noting that lack of a financial incentive to avoid the ER and lack of access to alternatives are not the only factors driving high ER utilization by Medicaid beneficiaries. Another factor driving ER use among the Medicaid population is its higher level of substance abuse. In 2020, Medicaid recipients accounted for 18% of the overall adult non‐ elderly population, but 21% of adult non‐ elderly individuals who have substance abuse disorders. Substance abuse can lead to more ER visits due to the threat of overdoses and of an increased risk of accidents while impaired.

There is unlikely to be a magic policy bullet that will reduce ER utilization by Medicaid beneficiaries to that of the privately insured. But states should experiment with financial incentives as a way to start addressing the problem.

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[MM Curator Summary]: Let’s wait until Lord Biden is out, then ask again.

 
 

 
 

Clipped from: https://www.cleveland.com/open/2023/07/ohio-to-seek-work-requirement-again-for-medicaid-enrollees.html

 
 

A demonstrator walks through a crowd with a sign on her back during a protest calling for an expansion to Medicaid outside the State Capitol in Atlanta. on the first day of the legislative session, Monday, Jan. 13, 2014, in Atlanta. (AP Photo/David Goldman) AP

By

• Jake Zuckerman, jzuckerman@cleveland.com
  

COLUMBUS, Ohio – Ohio will again ask the federal government in 2025 whether it can impose a work requirement on residents who get health insurance through Medicaid.

Language contained in the state budget, which Gov. Mike DeWine signed Tuesday, requires Ohio to apply to the federal government to impose the new rule. If granted, able-bodied Ohioans 55 and younger would need to either work or study for at least 20 hours per week (with exceptions for the mentally ill and some others) as a term of enrollment for Medicaid, a state and federally funded program that provides insurance for lower-income Americans.

This marks the state’s second attempt to impose Medicaid work requirements in the last decade. In 2017, state lawmakers included a Medicaid work requirement within the state budget. The federal Centers for Medicare and Medicaid Services under President Donald Trump approved Ohio’s request in 2019. However, the coronavirus pandemic blocked it from taking effect. President Joe Biden’s administration subsequently rejected the requirement.

An earlier version of the budget would have required Ohio to apply in November 2024. The final version, though, delayed it until February 2025 – after the conclusion of Biden’s first term and possibly under a different presidential administration.

The Biden Administration’s reversal letter in 2021 echoed reasoning shared by judges who blocked other states’ applications: the work requirements will lead to people losing health care coverage, when the point of Medicaid is to expand access to care to those who need it. The letter cited research estimating as many as 163,000 beneficiaries in Ohio would lose health insurance in the first year under the policy.

About 3.6 million Ohioans (30% of the state) receive health insurance through Medicaid, including about 1.3 million children. With some exceptions, Medicaid is available for those earning less than 138% of the federal poverty line. For a single person, that’s about $20,000 per year.

The status of work requirement policies has ping-ponged over the last decade. Alongside Ohio, the Trump administration approved 12 such waiver requests, according to KFF, a nonprofit that researches health policy. Those would have been the first work requirement policies in its nearly 60-year history.

Of the 13 states, Arkansas was the only one to implement its policy. In nine months of existence, the state with about one quarter the population of Ohio saw 18,000 residents knocked off their coverage. A study published in Health Affairs found the policy didn’t increase employment, forced recipients into medical debt, and caused enrollees to delay both care and medications due to cost.

The Washington D.C. Circuit Court of Appeals, the second-highest court in the U.S., later overturned CMS’ approval of Arkansas’ program, ruling that the decision to allow it deviated from the intent of the program when Congress enacted it – providing health care for the needy. The U.S. Supreme Court declined to take up the case, but other lower courts have issued similar rulings. Meanwhile, the state of Georgia just launched its own such policy, The Washington Post reports.

An Ohio Department of Medicaid spokeswoman said officials will begin to work with other employment-focused state agencies to “encourage self-sufficiency among enrollees.” She said she did not have any data immediately available regarding the employment rate of Medicaid enrollees.

“Governor DeWine and our administration are supportive of work efforts, believing an individual’s active engagement in their own economic wellbeing is consistent with the program and furthers its objectives,” said department spokeswoman Lisa Lawless. “Further, the U.S. Department of Health and Human Services “Healthy People 2030″ campaign also identifies job opportunities, education, and income as social determinants of health.”

A KFF survey of federal 2021 data found that about 60% of nonelderly Americans who don’t receive disability benefits were working. The top reasons for not working were caregiving responsibilities, illness, disability, or school. About 9% said they were retired, unable to find work, or gave another reason.

DeWine in 2021 directed Attorney General Dave Yost to appeal CMS’ rejection of Ohio’s Medicaid work requirements. When he announced the appeal in 2021, he said the policy was a reasonable approach that “provided individuals with options while supporting them on their way to self-sufficiency.”

At a press conference Wednesday, DeWine said little when asked about why he signed the provision.

“That’s not any change at all,” he said. “That’s consistent policy.”

Jake Zuckerman covers state politics and policy for Cleveland.com and The Plain Dealer.

 
 

From <https://www.cleveland.com/open/2023/07/ohio-to-seek-work-requirement-again-for-medicaid-enrollees.html>

 
 

 
 

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[MM Curator Summary]: Cue the 2 minutes of hate. It’s a 1984 reference. Look it up.

 
 

 
 

Clipped from: https://www.wsbtv.com/news/local/georgias-push-work-requirements-some-medicaid-coverage-set-start/3IPCN63FVFFOLI2YQ6OJI7DDGA/

 
 

Kemp announces plan reshape Medicaid and individual insurance in Georgia (WSBTV.com News Staff)

(WSBTV.com News Staff)

ATLANTA — Georgia’s limited expansion to Medicaid launches Saturday, making the Peach State the first in the country to tie work requirements to some Medicaid benefits.

The program, called Pathways to Coverage, was first passed by the Georgia General Assembly in 2019, but faced a battle in the courts to enact it after President Joe Biden took office.

The Pathways program was first greenlit by former President Donald Trump in October 2020.

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In December 2021, the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, sent a letter to Georgia officials citing concerns over how the policies would ” potentially create access barriers to health care coverage and cause harm to beneficiaries.”

Outside of this limited expansion, Georgia is one of just 10 states that has not expanded Medicaid eligibility since the passage and enactment of the Affordable Care Act.

As previously reported, the Georgia plan expands coverage to adults who earn up to 100% of the poverty line.

This means any single individual who earns $14,580 per year, or a family of four whose household income is $30,000.

Georgia Pathways is expected to cover about 64,000 Georgians, according to Georgetown University Health Policy Institute.

The coverage is only an option for those beneficiaries if the adults show they are working, volunteering, studying or in vocational rehabilitation for 80 hours each month.

TRENDING STORIES:

The program was approved to run through September 2025 by CMS.

In addition to concerns about patients losing their health coverage as a result of the policy, organizations focused on policy and economic issues in Georgia said the plan would also be more expensive than a normal Medicaid expansion.

The Georgia Budget and Policy Institute reported that the Pathways program would cost Georgia taxpayers roughly $249 million.

Gov. Brian Kemp said in January that up to 345,000 Georgians may be able to qualify over the program’s course, with the first year opening to between 31,000 and 100,000. He said unlike a Medicaid expansion, Georgia Pathways will not kick 200,000 Georgians off of private insurance.

Georgia Pathways is expected to help between 12% to 14% of the state population, according to Georgetown University.

The report also said the way Pathways is designed could leave workers out of eligibility due to the monthly reporting requirements, mostly in the food service and retail industries.

Speaking to the Associated Press, Caylee Noggle, commissioner of the Department of Community Health said Georgia has put a pause on removing people from their coverage during the unwinding process if the individuals are potentially eligible to transfer into the Pathways program.

“I think we are going to make it as easy as possible as we can for our members to verify their eligibility,” Noggle told the AP.

The program enrollment starts July 1, with the coverage set to begin in September.

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OTHER NEWS:

 
 

MM Curator summary

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[MM Curator Summary]: Far left extremists want to use NFIB vs Sebelius as precedent for not being able to do national Medicaid work requirements.

 
 

 
 

 
 

Clipped from: https://www.beckerspayer.com/payer/viewpoint-federal-medicaid-work-requirements-are-unconstitutional.html

Forcing states to implement Medicaid work requirements would fail basic constitutionality tests, a group of health policy experts wrote in Health Affairs. 

In the article published May 3, professors at the Milken School of Public Health at George Washington University in Washington, D.C., argued federal work requirements for the program would “utterly depart from Medicaid’s tradition of providing coverage to people at their most vulnerable.” 

House Republicans have proposed Medicaid work requirements as part of their proposal to raise the debt ceiling into next year. The bill passed in the House April 26, though the bill is unlikely to pass the Democratic-controlled Senate. 

The proposal would result in 600,000 people losing Medicaid coverage, according to estimates from the Congressional Budget Office. 

In 2011, the Supreme Court ruled the federal government could not require states to expand Medicaid under the ACA. The same standard should apply to requiring states to add work requirements, the authors wrote in Health Affairs. 

“In short, Medicaid is all about getting health care to eligible people when they need it; this is its core purpose,” the authors wrote. “By imposing a work requirement as a condition of state entitlement to payment, the bill would completely undo this foundational feature by withholding federal funding for reasons unrelated to basic eligibility factors and the need for care.” 

Some states have moved to implement work requirements in their Medicaid programs. Arkansas Gov. Sarah Sanders is asking the federal government for a waiver to implement work requirements for Medicaid recipients. 

Arkansas implemented work requirements for Medicaid recipients in 2018. A federal judge blocked the requirements in 2019. 

Georgia is set to implement work requirements for Medicaid recipients in July.  

Read more here. 

Subscribe to the following topics: medicaidmedicaid work requirementsdebt ceilingacasupreme court

 
 

MM Curator summary

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[MM Curator Summary]: CMS thinks it will open up the black boxes of provider pricing and the true depth of the network access problem with this new rule. Cute.

 
 

 
 

 
 

Clipped from: https://www.healthcarefinancenews.com/news/cms-proposes-national-standards-medicaid-and-chip

The proposed rules would establish wait times and require states to disclose provider payment rates in fee-for-service and managed care.

 
 

Photo: SDI Productions/Getty Images

The Centers for Medicare and Medicaid is proposing new standards and requirements for Medicaid or CHIP services, including ones for in-home and community-based services. 

Among other standards, the proposed rule would establish national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees and require disclosure of provider payment rates in both fee-for-service and managed care.

CMS on Thursday unveiled the two notices of proposed rulemaking: Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM).If adopted as proposed, the rules would establish historic national standards for access to care, regardless of whether that care is provided through managed care plans or directly by states through fee-for-service, CMS said. Over 70% of people with Medicaid or CHIP coverage are enrolled in managed care plans.

WHY THIS MATTERS

Together, the Access NPRM and Managed Care NPRM include new and updated proposed requirements for states and managed care plans that would establish tangible, consistent access standards, and a consistent way to transparently review and assess Medicaid payment rates across states, CMS said. 

The rules propose:

• Transparency for Medicaid payment rates to providers, including hourly rates and compensation for certain home care and other direct care workers. 
  
• Standards to allow enrollees to compare plans based on quality and access to providers through the state’s website. 
  
• To establish national maximum standards for certain appointment wait times for Medicaid or CHIP managed care enrollees; stronger state monitoring and reporting requirements related to access and network adequacy.
  
• To require states to conduct independent secret shopper surveys of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate.
  
• To create new payment transparency requirements for states by requiring disclosure of provider payment rates in both fee-for-service and managed care, with the goal of greater insight into how Medicaid payment levels affect access to care.
  
• To establish additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), as well as a requirement that at least 80% percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit).
  
• Create timeliness-of-access measures for HCBS and strengthen safeguards to ensure beneficiary health and welfare as well as promote health equity. 
  
• Strengthen how states use state Medical Care Advisory Committees, through which stakeholders provide guidance to state Medicaid agencies about health and medical care services, to ensure all states are using these committees optimally to realize a more effective and efficient Medicaid program that is informed by the experiences of Medicaid beneficiaries, their caretakers and other interested parties.
  
• Require states to conduct enrollee experience surveys in Medicaid managed care annually for each managed care plan to gather input directly from enrollees.
  
• Establish a framework for states to implement a Medicaid or CHIP quality rating system, a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost and other plan performance indicators. 
  

THE LARGER TREND

Medicaid is the single largest health coverage program in the United States, covering nearly one in four Americans and over half of all children in the country.

Medicaid and CHIP provide benefits with little to no out-of-pocket costs for over 92 million people. Many of those enrolled in Medicaid or CHIP come from underserved communities whose populations have disproportionately higher uninsured rates, and who often experience chronic health issues. 

ON THE RECORD

“The Biden-Harris Administration has made clear where we stand: we believe all Americans deserve the peace of mind that having health care coverage brings,” said HHS Secretary Xavier Becerra. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs. One in four Americans and over half of all children in the country are enrolled in Medicaid or CHIP – and the Biden-Harris Administration is committed to protecting and strengthening these programs for future generations.” 

“Having healthcare coverage is fundamental to reducing health disparities, but it must go hand-in-hand with timely access to services. Connecting those priorities lies at the heart of these proposed rules,” said CMS Administrator Chiquita Brooks-LaSure. “With the provisions we’ve outlined, we’re poised to bring Medicaid or CHIP coverage and access together in unprecedented ways – a key priority that’s long overdue for eligible program participants who still face barriers connecting to care.” 

 
 

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

 
 

MM Curator summary

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[MM Curator Summary]: So it re-starts where it began.

 
 

Clipped from: https://www.kansascity.com/news/politics-government/national-politics/article274946496.html

National Politics

By BRUCE SCHREINER and DYLAN LOVAN Associated Press

Updated May 02, 2023 8:51 PM

Several Republican gubernatorial candidates offered support for imposing work requirements for some able-bodied Kentucky adults receiving Medicaid health coverage as they met in a high-stakes debate on statewide television Monday night, about two weeks before the state’s primary election.

The 90-minute event on Kentucky Educational Television marked the long-awaited first faceoff between Attorney General Daniel Cameron and former ambassador Kelly Craft on a debate stage. The two rivals — at the center of an increasingly combative GOP contest — quarreled over campaign contributions and a U.S. Justice Department report that found Louisville police engaged in a pattern of violating constitutional rights and discrimination against the Black community.

The debate featured five candidates — Cameron, Craft, state Agriculture Commissioner Ryan Quarles, Somerset Mayor Alan Keck and retired attorney Eric Deters. They’re among a dozen candidates in all who are competing for the state’s GOP nomination for governor in the May 16 primary. Democratic Gov. Andy Beshear is seeking reelection to a second term, in a campaign drawing national attention to see if the popular incumbent can overcome his party’s struggles in the GOP-trending Bluegrass State.

The Republican rivals spent considerable time delving into the past, focusing their attacks on restrictions imposed by Beshear during the COVID-19 pandemic. They accused the governor of overstepping his authority, with Quarles pointedly saying that Beshear “ruled by a committee of one.” Beshear says his actions saved lives. The pandemic is blamed for more than 18,000 deaths in Kentucky.

The GOP candidates also delved into a range of issues including education, tax-and-spending priorities, gun rights and putting conditions on some adults to be eligible for Medicaid coverage. Medicaid is a joint federal and state health care program for the poor and disabled.

Cameron offered more details about his support for Medicaid-related work requirements for able-bodied Kentucky adults — an issue likely to reignite during the general election campaign. Cameron said that Medicaid should be “a transitory program unless medically necessary or means tested.”

 
 

Cameron offered a plan that sounded similar to what former Republican Gov. Matt Bevin unsuccessfully tried to implement in Kentucky. Cameron said the requirement could include such other conditions as volunteer work to qualify for Medicaid.

“If you are a mother who has a baby at home and aren’t able to get out into the workforce yet, that is OK,” Cameron said. “This is not targeted or applying to you.”

Quarles and Craft sounded supportive of the Medicaid proposal as well.

“Whenever people are healthy, able bodied Kentuckians, it actually takes away from those that truly do need benefits like the disabled and those that truly need help,” Quarles said.

Craft said Medicaid coverage should be “a pathway to take them from poverty to work.” Craft mentioned either work, study or community service standards for some recipients. Craft is a former U.S. ambassador to the United Nations.

Medicaid became a flash point during the state’s 2019 gubernatorial campaign, when Beshear narrowly defeated Bevin. After taking office, Beshear rescinded efforts by Bevin to set work requirements for some able-bodied adults to receive Medicaid coverage. At the time, Beshear referred to his action as the “moral, faith-driven thing to do.” Advocates have said work requirements would become one more hoop for low-income people to jump through, and many could be denied coverage because of technicalities and challenging new paperwork.

During a discussion about education, Quarles said it’s important that Kentucky get a good return on its investments in schools. Such reviews should include public universities and colleges, he said.

“We need to make sure that the cost of education is affordable, and that our educational programs are aligned with what employers are looking for,” Quarles said.

Meanwhile, the escalating back-and-forth attacks that have focused on Craft and Cameron — and their surrogates — spilled over into the debate.

Craft borrowed an attack from one of her TV ads, criticizing Cameron for not opposing the U.S. Justice Department’s investigation of Louisville Police practices.

“What does say about backing the blue?” Craft asked.

The federal investigation was launched after the fatal police shooting of Breonna Taylor, and found a years-long pattern of discriminatory practices by the department.

Cameron countered that he had the support of more than 100 law enforcement officials. Cameron called Craft “naive” for believing that he “could have stood at the Ohio River and told the Department of Justice they couldn’t come into the state.”

Deters was critical of Craft after she said she was not aware of her husband’s contributions to a political action committee that supported her.

“Her husband is financing her campaign and they’re trying to buy the governorship,” Deters said.

After one prolonged round of joisting that featured Cameron, Craft and Deters, Keck expressed disgust. The Somerset mayor said: “The last 10 minutes are why people are sick of politics in America.”

This story was originally published May 1, 2023, 9:17 PM.

 
 

MM Curator summary

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[MM Curator Summary]: In which an opiner suggests the unthinkable.

 
 

Clipped from: https://www.washingtonexaminer.com/restoring-america/fairness-justice/dont-expand-medicaid-twe will seeo-noncitizens

 
 

About one in five Americans are enrolled in Medicaid and the program now makes up about a quarter of all state spending. (AP Photo)

Last week, the Biden administration released a plan that would open up Medicaid and Obamacare to nearly 580,000 undocumented immigrants. Never mind that the federal deficit is projected to reach $1.4 trillion this year. What’s another few billion dollars?

The proposed rule centers around the Deferred Action for Childhood Arrivals program, which allows undocumented immigrants who came to the United States as children to live and work here without being deported. DACA recipients aren’t citizens. So they’re not eligible to enroll in most government health programs, like Medicaid and Obamacare. President Joe Biden wants to change that. And he wants to do so at a time when federal spending on health insurance is already spiraling out of control. Medicaid, for instance, cost $734 billion in 2021, the latest year for which data are available. That’s a nearly 10% increase from the year before and amounts to more than one of every six dollars the nation spent on healthcare in 2021.

Or consider Obamacare. The Inflation Reduction Act extended more generous subsidies for exchange coverage through 2025 at a cost of $64 billion . Extending them permanently, which is what Democrats are hoping to do, would increase the federal deficit by nearly $248 billion between 2023 and 2032. It’s not yet clear how much expanding federal healthcare to DACA recipients would cost. But one need only look to California to make an educated guess.

The state has committed to offering Medicaid, called Medi-Cal in California, to all low-income adults aged 26 to 49 regardless of immigration status starting in 2024 — about 700,000 people. (California already provides Medi-Cal to undocumented children and seniors.) The cost of the expansion is expected to be $844.5 million in 2023-24, $2.1 billion the following year, and $2.5 billion annually thereafter.

Extrapolate those costs to the entire country, and Biden’s proposed expansion of federal health coverage to DACA recipients stands out as yet another exorbitant expansion of government healthcare programs — one that taxpayers simply can’t afford.

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Sally C. Pipes is president, CEO, and Thomas W. Smith fellow in Health Care Policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.