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Concerns Raised Over Medicaid Work Requirements

Mary Meehan

Members of InsureKY, a coalition of health advocacy groups, is deeply concerned about the impact of the recently re-approved Kentucky Health Waiver.

During a press conference Wednesday the group bemoaned overly-complicated paperwork, vague-yet-crucial definitions and the potential for rising medical costs as Kentuckians who lose Medicaid coverage turn to expensive forms of treatment like visiting the emergency room.

“It’s a mess,” said Sheila Schuster, executive director of the Advocacy Action Network which is part of the coalition.

A controversial linchpin of the waiver is the requirement that able-bodied Medicaid recipients must work, volunteer or go to school 80 hours a month in order to maintain healthcare coverage.

Medically Frail

The state has allowed people who are determined to be medically frail to be exempt from the work requirement. But what, exactly, determines that designation  has proven elusive.

During the hour-long conversation, Schuster and other health advocates said they have not been able to determine how that criteria is applied. Ramona Johnson, president, and CEO Bridgehaven Mental Health Services said people who have been diagnosed with severe and persistent mental health problems are supposed to be automatically exempted from the work requirements. She said that has not been the case as some of her clients apply for the medically frail designation and are not approved.

Johnson also expressed concern at the 20-hour-a-week requirement.

“It is very arbitrary and unrealistic,” she said. “We have many people who are working and they are contributing to their recovery but they are simply not able to work 20 hours a week.”

Krista Seymour has been diagnosed with Stage 4 thyroid cancer. She said she depends on Medicaid to supply the medication which keeps her alive. She said she has been unable to be approved as medically fragile.

“Dead woman walking here,” said Seymour, who is a  college-educated broadcast production professional.  “I’m a Stage 4 cancer patient and the state says I am not medically frail enough to meet their requirements.”

“If I can’t jump these barriers then thousands of other Kentuckians won’t be able to,” she said. “I am quite frankly terrified.”


Executive Director of Kentucky Voices for Health Emily Beauregard said the state uses an algorithm to determine medically frail status. But, she said, the state also says that algorithm is proprietary….meaning the details can remain shielded from the public.

That, she said, makes figuring out who qualifies for that designation extremely difficult.

“The tool is making the decision,” she said. “You are entering information into a black box and hoping you get the right outcome.”

Jason Dunn is a policy analyst for Kentucky Voices For Health. He said work requirements applied last year to SNAP – or Supplemental Nutrition Assistance Program - offer a glimpse into the impact of work requirements on Medicaid patients.

He said 10,000 of the 50,000 people eligible for the SNAP program have lost their benefits because of the work requirement.

Dustin Pugel, Policy Analyst at the Kentucky Center for Economic Policy, said a work requirement in Arkansas also found that many people were unable to fulfill to work requirements and lost health coverage.

Pugel called the policies “disastrous.”

Many of the concerns raised Wednesday have been raised before but the state made few changes in the waiver application when it was re-submitted to federal health officials for approval. 

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