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Kentucky Health - Proposed Modifications to Application

Jul 5th 2017 10:02 am Response: #228357 This looks like we are proposing cutting access to Medicaid to a significant portion of the population. This is exactly the wrong thing to do. Our country and it's economy can only benefit from a healthy population.
Jul 11th 2017 5:04 pm Response: #228465 Just read in the paper about the latest republican plan to save a nickel at the cost of a Dollar. It seems that they now want to save that nickel by taking away the ability of an individual to make a common sense decision to feed a hungry child, after all the child is only going to go hungry for another month or so while the process works its' way through some government bureaucracy. Am I not right Comrade?
Jul 12th 2017 4:06 pm Response: #228549 We work with the homeless and mentally ill in Lexington, KY. Most, if not all, are also dealing with substance abuse. One of our priorities is to get them into detox and rehab. Detox is already difficult enough to access due to lack of available beds, but without insurance, our population will be locked out of many - if not all - detox opportunities, some rehab, and most out-patient drug treatment programs if they do not have insurance.

Jani Lewis
Executive Director
Natalie's Sisters
Jul 13th 2017 11:10 am Response: #228689 1) Will individuals who work jobs with varying wages that fluctuate over/under 138% on a regular basis, but annually remain under 138%, report changes?
2) Does the Presumptive Eligibility fast tracking process apply to those seeking emergency coverage at hospitals? Will backdating coverage be allowed for emergency/same day medical service needs while the person is under PRESUMED coverage?
3) Will residents of counties where SNAP work requirements are waived due to a lack of opportunity for work/volunteer hours (waived in 100 of 120 Ky counties) also receive a waiver for the CE requirement, particularly since the modification states it is being modeled after the SNAP work requirement?
4) Can someone earn My Rewards Credits for health related activities beyond education such as medical appts, screenings and behavior modification (i.e., quits smoking, loses weight)?
5) Will experienced, subject matter experts, be able to attain accredidation to offer health or financial literacy courses (particularly those already accustomed to providing such)? How do community entities attain accreditation to offer volunteer hours? If so, how?
6) Can members attain a service credit instead of a specific amount for their My Rewards Credit due to fluctuation in charges for services or access to participating providers? For instance, attend 3 classes to earn a dental exam and xrays. Can members make monetary deposits, in addition to earning credits, to their My Rewards account for services such as dental?
7: Will at least a 1x grace be offered for anyone who doesn’t understand the new guidelines, particularly those who are illiterate (English or any language) or have learning or language/cultural barriers/comprehension difficulties? Most Medicaid notices are sent in English with terms or phrasing difficult to understand, even for English speaking, native residents. There are limited Spanish language and nearly no other language/cultural translated items currently. Will this change or will there any grace or exceptions for those with comprehension difficulties?
8. When will consumers, front line enrollment staff or Providers (these are not the same as MCO Insurance Carriers) be allowed to participate, provide input in development of the proposed changes? This is in addition to being a communication or educational component after assumed waiver approval.
Jul 13th 2017 1:18 pm Response: #228721 Please do not cut medicaid, these services are needed for so many Americans. I will be very disappointed in all of my elected representatives at the state and federal level if you let this happen. It will be shameful to let people suffer for want of medicaid and health services. Children and the elderly should be helped not harmed by their government.
Jul 13th 2017 11:00 pm Response: #228745 By K.A. Owens July 13, 2017

Kynect and expanded Medicaid have been one of the most extraordinary accomplishments Kentucky has made in the last 30 years. We are talking about 400 hundred and forty thousand people in Kentucky who now have a primary care provider, who can get an eye exam, who can see specialists, who can get a dental exam, an x-ray and their teeth cleaned once a year. It has been a tremendous step forward.

For some reason Gov. Bevin wants to reverse this progress.

The changes Gov. Bevin wants to make in expanded Medicaid to eliminate vision and dental, and create premiums with lockouts for people who can’t pay the premiums – these actions have nothing to do with health care.

As a matter of fact his changes are not even justified by economics, but seem to be motivated by the concept that poor people are defective morally, that poor people (poor people being defined as people whose wages are artificially low) are not trying hard enough and that poor people need to be guided by people like him.

In reality, poverty is structural; poverty is built in to the system by the people who have the power to do so. The people on Medicaid are in no more need of moral guidance than the governor and the people on the governor’s staff.

There is nothing more offensive than the wealthy (people whose earnings are artificially high and who have the best health care that money can buy) having the nerve to tell poor people they can’t have health care.

Gov. Bevin’s tactic is to submit a 1115 waiver to the federal government detailing his desired changes to expanded Medicaid and then announce that if his changes are not accepted he will abolish the program. He uses this tactic because he obviously feels that poor people in Kentucky just haven’t suffered enough.

As a citizen of the state of Kentucky I ask that Gov. Bevin withdraw his 1115 waiver and consult with people who have the best interests of all Kentuckians at heart before he makes his next move regarding health care.
Jul 14th 2017 1:09 pm Response: #228841 I have grave concerns about the 6 month lock out period if a premium is submitted late. I am the Administrator and a RN who cares for people with HIV/AIDS. Our patients who are on life saving medications and then get into a lock out period, they will not have access to their there medication. HIV will develop resistance and when they do have access to medication again the old ones will no longer be effective. This makes no sense to me. It is much less expensive to treat HIV than to treat AIDS! These folks who run out of treatment options will require more hospitalizations with days in the ICU with PCP pneumonia when the immune status is destroyed and they can no longer fight off infections. This takes us back to the 80s not forward! Insanity, if you always do what you have always done your going to get the same as you have always gotten!
Jul 14th 2017 3:31 pm Response: #228905 This waiver is harmful for Kentuckians
Jul 14th 2017 4:50 pm Response: #228925 Kentucky has not described the way these changes will be operationalized. For those of us that work in healthcare and recognize the current holes in the system, I find it hard to believe that adding layers of change on top of the current system will lead to improved healthcare outcomes for our patients. Additionally, I find it very concerning that those that have presented refuse to answer questions on these issues. So my questions/concerns are as follows.
1. What if I become ill and can not meet the volunteer hours for a week will I lose coverage?
2. Health care has been defined as a human right. Knowing that, the work requirement seems to mirror the United Nations definition of human trafficking. Specifically: Article 3, paragraph (a) of the Protocol to Prevent, Suppress and Punish Trafficking in Persons defines Trafficking in Persons as the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs as the the mandatory volunteer hours specifically lead to unpaid labor services with the plan endorsed by many businesses.
3. Who will track the hours? The businesses?
4. If a business can meet their needs with all volunteers, how does that impact the job market in Kentucky? Knowing that the volunteers are providing a service for free, they will not be contributing to the tax base of the Commonwealth were as a paid worker would. This seems to impact the economic state of Kentucky.
5. If the value of the volunteer hours is $7.50/hr then the mandatory volunteer requirement has a financial value of $600/month. This exceeds the cost of the service (Medicaid) that they are receiving. Thus, the exploitation as defined in #2 is reality.
6. The Secretary mentioned that points can be used to purchased dental, vision and screenings. She provided the specific examples of cancer screenings and cholesterol screenings. Does this waiver obliterate preventative care? Evidence to support?
Jul 14th 2017 6:09 pm Response: #228937 Please see attached comments from Anne Marie Regan, Kentucky Equal Justice Center.
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