Bevin: Medicaid changes to come in time

FRANKFORT, Ky. -- Gov. Matt Bevin's announcement Wednesday about his plans to change the state's Medicaid program quickly devolved into a harsh war of words between him and his predecessor, Steve Beshear, after the new governor accused Beshear's administration of lying about true costs of the government health plan.

Bevin derided "happy talk" from the Beshear administration about Medicaid expansion under the Affordable Care Act and ripped as a "smokescreen" previous findings of an outside consultant that found Kentucky stood to gain economically from the expansion that has added some 425,000 Kentuckians to Medicaid.

"That was a lie," said Bevin, a Republican who replaced Beshear, a Democrat,  on Dec. 8. "A straight up, straight out lie."

Beshear, in turn, responded with a Facebook post that chastised Bevin for his comments and defended the success of the health law that he launched by executive order.

"All of Kentucky looks forward to the day when our new governor transitions from strident partisan rhetoric and petty name-calling to the real and more difficult business of governing," Beshear said. "Medicaid expansion was and remains a smart policy move."

In fact, it appears the Medicaid changes of the Beshear administration will remain largely untouched as Bevin explores ways to restructure the program, according to Bevin's comments Wednesday. He said major changes would not take place until 2017, if the Bevin administration gets permission from the Centers for Medicare and Medicaid Services.

"We are going to transform the way Medicaid is delivered in Kentucky," Bevin said.

Bevin did not address his plans to dismantle kynect, the state health exchange and website where Kentuckians can shop for health coverage.

Meanwhile, even as Bevin castigated Beshear over what he claimed is a $128 million shortfall in this year's Medicaid budget, Bevin introduced as the architect of his Medicaid makeover a former state official who presided over a Medicaid program that ended with a shortfall of nearly $400 million.

Mark D. Birdwhistell, whom Bevin praised as "one of the most knowledgeable individuals in the country"  on Medicaid, served as secretary of the Cabinet for Health and Family Services under former Gov. Ernie Fletcher, the last Republican before Bevin to serve as governor.

Ten days after Fletcher left office in 2007, then-state Auditor Crit Luallen released an audit that found despite claims of massive Medicaid savings, the Fletcher administration left incoming Gov. Beshear facing a Medicaid shortfall of $389 million.

Earlier that year, Birdwhistell, as secretary of the cabinet, had assured lawmakers that the Medicaid budget was in the black.

"It is a different day in Medicaid than it was several years ago," Birdwhistell told the General Assembly's Medicaid oversight committee at a meeting in June 2007.

But six months later, Luallen said her audit had found no evidence of savings claimed by Birdwhistell or the Fletcher administration.

"They claimed they were saving $120 million a year," Luallen said at the time. "We see no documentation of that."

The Bevin administration had no immediate comment Wednesday.

But advocates praised Birdwhistell for understanding the complexities of Medicaid and his willingness to work with outside groups. He and the new CHFS Sec. Vickie Yates Glisson appeared with Bevin at Wednesday's news conference.

"I was really encouraged to see Mark Birdwhistell on the stage," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of advocacy groups. "I know he's been an advocate for our Medicaid safety net."

Birdwhistell, vice president for health services at the University of Kentucky, said he's ready for the challenge.

"The people of Kentucky need a Medicaid system that is affordable and sustainable," he said.

And most health care advocates appeared relieved Wednesday that despite some of his campaign rhetoric, Bevin announced no immediate changes for Medicaid.

"We have to do it the right way," Beauregard said. "We need to encourage access to care and improve quality of care."

Terry Brooks, executive director of Kentucky Youth Advocates, praised Bevin for being willing to take the time to develop a plan for Kentucky.

"We applaud Gov. Bevin for upholding the commitment to those currently on Medicaid by continuing their coverage until an alternative plan is developed and approved by the federal government," Brooks said.

During the campaign, Bevin initially said he would "repeal immediately" the expansion of Medicaid under the federal health law that covers anyone earning up to 138 percent of the federal poverty level, about $16,200 a year for an individual. Traditional Medicaid covers only very low-income women with children, children, the disabled and elderly in nursing homes.

Bevin also had said he would not continue to enroll people in Medicaid at up to 138 percent of the federal poverty level, believing that to be too high. Yesterday, he acknowledged he could not change that immediately.

"That's not actually possible," he said.

But Bevin said the current Medicaid program, which covers nearly 1.3 million Kentuckians, is not sustainable. The federal government pays 70 percent of costs of about 875,000 people in traditional services and 100 percent of costs for those added through the expansion, dropping to 90 percent by 2020.

Instead, Bevin said his administration in the coming months will focus on devising a plan to restructure Medicaid using a waiver, or federal approval, that would allow it to make some of the changes he has envisioned such as charging premiums or co-payments for services.

Most Medicaid services in Kentucky are free although the state has experimented in the past with small co-pays and premiums.

Bevin has cited as an example a waiver Indiana obtained last year but said he will not be limited by it and will look for options that improve the health of Kentuckians. Indiana's waiver, which includes two tiers of coverage, premiums, co-payments and a "lock out" provision for people who miss payments, has been criticized by some advocates as overly complex and burdensome.

Beauregard said she is concerned increasing costs to poor consumers could cut access to care.

"I don't think that imposing premiums or financial barriers to low-income citizens is the way to get better outcomes," she said.

Still, Bevin, who in the past has said too many Kentuckians are "on the draw," said he is committed to making sure most people on Medicaid accept some personal responsibility for the costs.

"Ultimately, we want to take people from full dependency to a point where they can sustain themselves," he said. "We owe people the dignity and self-respect of being able to make decisions for themselves."

Contact reporter Deborah Yetter at (502)582-4228 or at dyetter@courier-journal.com.