Saying cost is the "primary" concern, Gov. Matt Bevin says his administration will seek federal waivers to change how Medicaid is delivered in Kentucky.
The new governor has been critical of Medicaid expansion, which has provided coverage to more than 400,000 uninsured Kentuckians as part of health-care reform. Bevin claims the current system, in which nearly 30 percent of the state's population is now on Medicaid, is "imploding financially."
"That is literally not sustainable financially," he said. "The only way in which we are going to allow it to continue in any form, traditional, expanded or otherwise, is to transform the way in which it is delivered."
Economic policy analyst Jason Bailey disagreed. Medicaid expansion is "a great deal" for Kentucky, he said, because jobs are being created and health care is improving, while the federal government is paying most of the costs.
"We are saving, literally, hundreds of millions of dollars a year in monies we were spending previously on the uninsured, on public health, on mental health, and substance abuse," he said.
Bevin said Wednesday that he will have a plan in place by the middle of 2016 to customize Medicaid to Kentucky through waivers of federal rules on eligibility and coverage.
Bevin cited Indiana's model as an example of the direction he wants Kentucky to head. In Indiana, Medicaid recipients pay either premiums or co-pays, sometimes both.
Bailey, who heads the Kentucky Center for Economic Policy, said he fears that approach will make it much harder for Kentuckians to get, keep or afford their coverage.
"We will begin to move backwards on some of the progress that we've made in terms of getting people those cancer screenings that they need," he said, "and the cholesterol screenings and the other things that we know will pay off in a healthier population."
Currently, around 1.3 million Kentuckians receive Medicaid.
