Kentucky and the ACA’s Medicaid expansion

Enrollment up 87%; Expansion could be changed with a waiver

Where in your state to call or visit for Medicaid.How to apply

Enroll online at Kynect. Apply by telephone by calling 1-855-459-6328 or TTY 1-855-326-4654. Fill out a paper application. Apply in person at a local office of the Department for Community Based Services.

Who is eligible in your state to get Medicaid?Who is eligible

Children up to age 1 with family income up to 195% of FPL. Children ages 1-18 with family income up to 159% of FPL; children with family income up to 213% of FPL are eligible for the Kentucky Children’s Health Insurance Program. Pregnant women with family income up to 195% of FPL. Adults with income up to 133% of FPL. See the Programs and Services page for guidelines for elderly, disabled, and others who may qualify.

  • By
  • contributor
  • September 26, 2016

Kentucky has been one of the most successful states in reducing its uninsured rate through the Affordable Care Act (ACA) — both by expanding Medicaid and adopting a state-run health insurance marketplace. The Centers for Medicare and Medicaid report that Kentucky’s Medicaid enrollment increased by 84 percent from 2013 to July 2015. And according to US Census data, Kentucky’s uninsured rate dropped 5.8 percentage points – the most of any state – from 2013 to 2014, reaching a low of 8.5 percent.

Changes in store?

Kentucky residents elected Matt Bevin in November 2015 (incumbent Steve Beshear was term-limited and could not run). Bevin, a Tea Party Republican, has expressed his desire to pull back from the current Medicaid expansion in Kentucky. Early in 2015, Bevin said he would eliminate Medicaid expansion entirely, but his position softened towards the end of the campaign. He’s most recently said that he no longer plans to eliminate coverage for the 400,000 people who obtained Medicaid under Kentucky’s expansion. Instead, Bevin has proposed that the state seek a Section 1115 waiver from the federal government to allow Kentucky to design its own version of Medicaid expansion.

But Bevin’s underlying point throughout the campaign has been that the state can’t afford to have half a million new enrollees in its Medicaid program under the ACA. Although Medicaid expansion waivers are certainly better than rejecting expansion altogether, they tend to limit enrollment more than straight expansion. That’s because waivers typically include some way for enrollees to have “skin in the game,” including premiums for some enrollees. But numerous studies have shown that imposing premiums on very low-income people tends to result in fewer people obtaining coverage.

Bevin’s opponents – Democrat Jack Conway and Independent Drew Curtis – both supported keeping the current Medicaid expansion system intact in Kentucky. They and Beshear pointed out that Bevin’s plan – which seems to have evolved throughout the year – would result in a loss of coverage for at least some of the half million people in Kentucky who are newly-insured under Medicaid expansion.

Bevin has also said that he will eliminate Kynect – the state-run exchange – and transition Kentucky to by the end of 2016. Opponents note that such a move would result in higher fees for Kentucky residents, in addition to $23 million in IT costs for the transition.

See if you qualify for Medicaid

Use this chart to see if you may qualify for Medicaid. Kentucky’s eligibility levels are as follows:

  • Children up to age 1 with family income up to 195 percent of the federal poverty level (FPL)
  • Children ages 1 to 18 with family income up to 159 percent of FPL
  • Children with family income too high to qualify for Medicaid are eligible for the Kentucky Children’s Health Insurance Program (KCHIP); KCHIP is available to kids with family income up to 213 percent of FPL
  • Pregnant women with family income up to 195 percent of FPL
  • Parents and other adults are covered with incomes up to 133 percent of FPL

Kentucky Medicaid is available to a number of other populations, such as individuals who are elderly or disabled. See the Programs and Services page for more information.

Apply for Medicaid

You can do any of the following to apply for Medicaid.

  • Enroll online using Kynect.
  • Apply by telephone by calling 1-855-459-6328 or TTY 1-855-326-4654.
  • Download a paper application. Mail your application to the Office of the Kentucky Health Benefit Exchange; 12 Mill Creek Park; Frankfort, KY 40601. You may also fax your application to: 1-502- 573-2005.
  • Apply in person at a local office of the Department for Community Based Services (DCBS).

Big benefits through Medicaid expansion

Despite the political unpopularity of the Affordable Care Act, Gov. Steve Beshear strongly advocated for Medicaid expansion and a state-run marketplace (Kynect). Beshear’s administration touted both the public health and economic benefits of Medicaid expansion, including improved health outcomes through access to health insurance, the creation of nearly new 17,000 jobs, and a $15.6 billion impact on the state economy over seven years.

A study by Deloitte concluded that through 2020, Kentucky’s Medicaid expansion will be a net financial positive for the state, although supporters of Medicaid expansion note that the improvements in the economy under Medicaid expansion will likely result in the program remaining financially sustainable long-term.

Medicaid expansion was effective as of Jan. 1, 2014. In the fall of 2013 — before the first open enrollment period under the Affordable Care Act — 606,805 people were enrolled in Kentucky’s Medicaid program. As of August 2015, total enrollment had increased by 87 percent, to 1,136,937.

According to Families USA, 55 percent of the newly-eligible Medicaid population in Kentucky is working adults – people who work in industries that are vital to the economy of the state, but who survive on household incomes under 138 percent of the poverty level.

Data collected by the Kentucky Cabinet for Health and Family Services shows that the new Medicaid beneficiaries are taking advantage of preventive screenings, with the following increases from 2013 to 2014:

  • 30 percent increase in breast cancer screenings
  • 3 percent increase in cervical cancer screenings
  • 16 percent increase in colorectal cancer screening
  • 37 percent increase in adult dental visits

The lead up to Medicaid expansion

Despite Gov. Beshear’s conviction about the benefits of expanding Medicaid, Kentucky did not announce the decision until May of 2013. Beshear cited concerns about the cost in explaining why the state’s decision came slower than in other states that adopted expansion.

The Kentucky legislature did not authorize Medicaid expansion, which was a concern for Senate President Robert Stivers. However, Kentucky’s Medicaid eligibility rules are defined in state regulations, which can be changed by executive order. Accordingly, legislative approval was not needed.

While Medicaid expansion was secure during its first couple years, analysis by the Rockefeller Institute indicated that the lack of legislative approval could leave the program in jeopardy after Beshear leaves office. That is exactly the scenario facing the state in the fall of 2015, with the future of Medicaid expansion largely dependent on the path chosen by Governor-elect Bevin, who will be sworn into office in December 2015.

Bevin would be able to roll back Medicaid expansion, although he appears to have backed off from that tactic. He’d also be able to seek a Section 1115 waiver to change how Medicaid expansion is implemented in the state, although a waiver requires HHS approval and is typically a process that takes several months. Waivers have been approved by HHS for several other states, although none of them have been to replace an already functional Medicaid expansion; if Bevin switches to a Medicaid expansion waiver, Kentucky would be the first state to eliminate straight Medicaid expansion and replace it with a waiver.