To Get Medicaid in Kentucky, Many Will Have to Work. Advocates for the Poor Are Horrified.

Kentucky Gov. Matt Bevin, a Republican, on Friday, announcing new work requirements for many of the state’s Medicaid recipients.

WASHINGTON — Kentucky will be the first state to require many of its Medicaid recipients to work or face losing their benefits after the Trump administration approved its plan on Friday.

Advocates for the poor threatened lawsuits, while Gov. Matt Bevin, a Republican, celebrated the approval as “the most transformational entitlement reform that has been seen in a quarter of a century.”

The plan calls for most Medicaid recipients who are not disabled and aged 19 to 64 to work at least 20 hours a week, beginning in July. In addition to paid jobs, they could meet the requirement through volunteer work, job training, searching for a job, taking classes or caring for someone elderly or disabled.

Pregnant women, full-time students, primary caretakers of dependents and the chronically homeless will be exempt from the work requirement, as will people deemed medically frail. But the Bevin administration still expects about 350,000 people to be subject to the requirement, which will be phased in around the state starting in July. About half of them already meet it, according to the administration.

“We are ready to show America how this can and will be done,” Mr. Bevin said at a news conference in Frankfort. “It will soon become the standard and the norm in the United States of America, and America will be better for it.”

Roughly 500,000 adults have joined Kentucky’s Medicaid rolls since the state expanded the program under the Affordable Care Act in 2014. Mr. Bevin has consistently attacked the expansion as a waste of money, questioning why “able-bodied” adults should be given free government health care that used to be largely limited to children, the elderly and the disabled.

He filed for federal permission to impose work requirements in 2016 — notably, instead of seeking to end the state’s Medicaid expansion altogether. And since then, more than a dozen other states have also sought work requirements or said they plan to. Several sought Medicaid work requirements during the Obama administration but were rebuffed.

The approval came just a day after the Trump administration gave states the O.K. to impose work or other “community engagement” requirements as a condition of getting Medicaid. According to the nonpartisan Kaiser Family Foundation, 60 percent of working-age Medicaid recipients who aren’t disabled already have full- or part-time jobs.

Under its plan, Kentucky will also require many adults who aren’t elderly or disabled to pay premiums of $1 to $15 a month, depending on their income. And it will disenroll people from Medicaid for up to…

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