Medicaid and kynect: Facts as Bevin eyes cuts

Here are some questions and answers about Medicaid and kynect as Gov.-elect Matt Bevin gets set to take office.

Could Gov.-elect Matt Bevin end the Medicaid expansion in Kentucky under the Affordable Care Act that has added about 400,000 people to the state's Medicaid plan?

Yes. Gov. Steve Beshear authorized the federal Medicaid expansion through an executive order and Bevin, as governor, could terminate it through his own executive order after he becomes governor Dec. 8. But Bevin has said he has no plans to do that and instead will ask the federal government for a waiver that would allow Kentucky to create its own Medicaid plan with more cost-sharing by consumers.

What is a Medicaid "waiver?"

A waiver is essentially a permit from the federal government that allows states to design programs that vary from standard benefits offered under Medicaid, a health plan for low-income or disabled persons. Since the federal government provides most of the money for Medicaid, it gets to sign off on such waivers. Several states, including Indiana, have obtained waivers to offer their own versions of the federal Medicaid expansion under the law also known as Obamacare.

What happens to Medicaid in Kentucky in the meantime?

Likely nothing. Bevin has said he has no immediate plans to make changes in the current system while he considers options for a new Medicaid program in Kentucky.

What is kynect and can Bevin shut it down, as he promised to do during his campaign for governor?

Kynect is Kentucky's version of a web-based health insurance exchange authorized under the 2010 Affordable Care Act. People may use it to go online and shop for health coverage or determine whether they are eligible for Medicaid.

And yes, Bevin could terminate it through an executive order. He has said he intends to do that and transition people to the federal exchange, healthcare.gov.  But it will take some time. The federal government, which financed kynect, requires 12 months notice of intent to shut it down. And it will involve major technical changes to a massive database that allows people to create accounts, shop for insurance and apply for Medicaid. Meanwhile, kynect is open to anyone seeking health insurance.

If I don't have health coverage, can I still sign up for it through kynect?

Yes. Enrollment for 2016 is now underway. Most Americans are required to have health insurance under the federal law, and the penalty in 2016 for not having such coverage is $695 per adult and $347.50 per child. Medicaid counts as health coverage. None of the changes proposed by Bevin change the fact that most people are required to have health coverage and will owe a tax penalty if they fail to obtain coverage.