Three justice organizations have sent a letter to the federal government challenging the state’s right to cut the dental and vision benefits of Medicaid expansion adults after the state’s 1115 Medicaid waiver, also known as Kentucky HEALTH, was halted.

The National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center have sent a letter to the U.S. Centers for Medicare & Medicaid Services questioning whether proper procedure was followed by the state of Kentucky to make the cutbacks.

It takes issue with the state’s requested amendment of the benefits package for Medicaid expansion adults.

“The submission process used by the state violated federal laws designed to ensure government transparency and public participation,” the letter states.

It asks CMS to reject the amendment, which Kentucky maintains was filed in April to request approval to terminate the adult dental and vision benefits and nonemergency medical transportation.

In addition to the letter, Kentucky Equal Justice has filed an open records request seeking more information on the State Plan Amendment (SPA), including proof of approval. The groups note in the CMS letter that the amendment couldn’t be found on the CMS website and “thus, we have concluded that CMS has not approved this SPA.”

Doug Hogan, a spokesman for the Kentucky Cabinet for Health and Family Services, said in an email, “We are still reviewing the letter, but we have been in contact with CMS throughout the State Plan Amendment process going all the way back to April and will continue to work with them through the approval process.”

Gov. Matt Bevin

The challenge by the justice groups follows several days of controversy over the state taking away the dental and vision benefits of nearly 500,000 people after a federal judge decided June 29 that the Bevin administration’s Kentucky HEALTH program needs further review by the U.S. Department of Health and Human Services.

U.S. District Judge James Boasberg’s ruling stopped Kentucky HEALTH from going into effect July 1. The program was to include a way for participants to earn virtual dollars for dental and vision benefits instead of automatically receiving coverage.

The decision by the judge, who took issue with the way the program had been approved by the Trump administration, came in a lawsuit that was brought by the same groups that are now asking CMS for help.

In the July 6 letter to CMS, the groups assert that the state didn’t give the public an adequate chance to comment on its plan to cut the benefits. They make note of a broken web link and contend that notices about the plan weren’t posted or available in each county’s Department for Community Based Services offices.

The groups also maintain that Boasberg intended to “maintain the status quo,” which was coverage of vision, dental and nonemergency medical transportation (NEMT), and that the state didn’t need to end those benefits to comply with the court’s order.

“We ask you to reject the SPA and return it to the state,” the group’s letter states. “We ask you to take this action quickly. The state’s actions regarding termination of the vision, dental, and NEMT benefits are causing great confusion and harm.”

As an example, the group mentions a person who couldn’t get medically necessary surgery because she needed some teeth pulled first but couldn’t get dental service because of the state’s cutback.

In recent days, health care providers have reported patients being confused about the benefit cuts. There also were reports of children and pregnant women being denied benefits, but the state said coverage for those two groups continues and that they’re taking steps to work with providers on how to better understand what’s on their computer screens.

Darla Carter
Darla Carter is a hometown girl who recently joined the staff of Insider Louisville to mostly cover health. She previously served as a longtime health and fitness writer for The Courier-Journal, where she also worked for the Metro, Neighborhoods and Features departments. Prior to that, the award-winning journalist wrote for newspapers elsewhere in Kentucky and Tennessee, covering a range of topics, from education to courts. She's a graduate of Western Kentucky University, where she studied journalism and philosophy, and is the proud mom of two young children.