Medicaid Expansion
Rep. Marianne Proctor, District 60
Avoiding An Irresponsible and Unsustainable Expansion of Medicaid
Legislators legislate. We represent our constituents in the making of new laws and the repealing of those that no longer meet our state’s needs. However, the legislative branch of government also has a constitutional obligation to oversee the judicial and executive branches. To accomplish that task, our committee system reviews the policies put forward to ensure they are good for the commonwealth.
One of those legislative panels, the Administrative Regulation Review Subcommittee, met last month to discuss a set of policies, or regulations as they are formally called, that seek to expand the taxpayer-funded program that provides health coverage to low-income Kentuckians to include coverage for vision, dental, and hearing devices.
More than a third of the state’s population already receives Medicaid benefits, and the program already accounts for 82% of the Cabinet for Health and Family Services (CHFS) budget, which translates to $19 billion. The budget comprises state and federal funds, with 72% of the budget being federal dollars, but that does not matter because whether it is state or federal dollars, they are still funds from taxpayer dollars. That alone means we must be vigilant in determining if an expansion is needed. However, two other factors must be taken into consideration. The first, how such an expansion would impact the already overburdened system of health care providers. After all, the entire state is suffering from a shortage in health care providers of all types and Medicaid recipients have a harder time finding providers than those with private insurance. In addition, the legislature must look to the return on investment for every tax dollar we spend. What we are getting for the billions we spend to fund Medicaid? By most if not all metrics, our population is sicker than ever, struggling daily with the impact of hypertension, diabetes, and cancer. Medicaid has existed for decades and we still have not made a dent in our health problems.
These are the three major reasons the administration’s proposal met with concern. The Beshear administration could not have been surprised. After all, another expansion proposal was found deficient by the same subcommittee just a few months ago, and declared “null, void, and unenforceable” by the legislature with the passage of SB 65. By law, if the legislature finds an administrative regulation deficient, the agency can only bring it back if there is a substantial change to the regulation. Even after the legislature found the regulations deficient, the cabinet filed new emergency and ordinary administrative regulations expanding Medicaid coverage for dental, vision, and hearing services. According to CHFS, they will be able to pay for expanding Medicaid services through the savings from SB 50, which forced the Department for Medicaid Services to use a single pharmacy benefit manufacturer (PBM) instead of multiple. They also have stated that by using only one PBM, the cabinet will save $38 million a year, which they say will be enough to cover services in the expansion. This money may be convenient today, but may not be able to sustain the actual expansion
However, they provided no plans to increase access to providers, nor presented data showing how the expansion benefits recipients or the state. With such a large expansion and expenditure, it is crucial to have multiple studies done with Kentucky-based numbers.
We must be methodological about expanding Medicaid because the current services provided within the Medicaid Program are not adequately covered. For example, the cabinet cut Medicaid rates for Behavioral Health Services and sends children out of state for services instead of providing them here. Also, the cabinet is aware that reimbursement rates play a major factor in increasing access to providers. For example, last year the Emergency Medical Services Task Force found that surrounding states have 30-40% higher Medicaid reimbursement rates for emergency medical services. Even after these findings were presented to the cabinet, rates remain staggeringly low. And, funding for existing services like the Michelle P and the SCL waivers for individuals with intellectual or developmental disabilities remains untouched because there simply are not enough providers. There are 7,694 individuals waitlisted for the Michelle P and 2,987 individuals waitlisted for the SCL waiver.
Despite all these issues, the cabinet continues to push for expansion when they know they are not able to deliver the services Kentucky Medicaid already covers. Why build false hope? Why make promises they cannot keep? Why not focus on getting what you are already doing right?
The legislature is committed to creating a healthier Kentucky, and has proven that time and again over the last six years. We know how important these services are to people, but we are still a state of limited resources and many needs – we must be responsible with Medicaid spending. This issue will continue to receive lawmakers’ attention as we prepare for the 2024 Regular Session.