With the state’s Medicaid demonstration project — Kentucky HEALTH — set to kick off July 1, people are being urged to get ready for the program and to stay alert for information coming through the mail and other channels.
The state is sending out notices to affected residents and people should be starting to receive invoices for premium payments coming due but may not understand what they’re getting or mistake it for junk mail.
“Do not get overwhelmed and throw it away,” said Liz Edghill, a nurse who teaches a Know Your Healthcare Class at the Portland location of Family Health Centers (FHC).
Although the Bevin administration’s plan to overhaul Medicaid has garnered national news coverage, some Family Health Centers staffers say they think a lot of people still are unaware of the changes that are coming.
“I don’t think we’ll start getting inundated (with questions) until Sept. 1 because at that point, people will have started losing coverage or being shifted to the copay plan for nonpayment,” said Ashley Shoemaker, an outreach and enrollment supervisor with FHC. “We have had some questions, but a lot of people still don’t know.”
Kentucky HEALTH, the state’s 1115 Medicaid waiver, will require people who do not qualify for an exemption, such as being “medically frail,” to meet new requirements, such as paying premiums in some instances and completing 80 hours a month of “community engagement,” such as working or volunteering.
To keep coverage, “planning ahead is key,” Edghill said, noting that people need to be proactive about trying to keep their coverage. “It’s going to be much easier to navigate than trying to get back in” because there are penalties and lockouts now, she said.
For example, you may have to make back payments and do a health or financial literacy course to get back in, she said.
The state issued a news release Monday urging recipients and others, such as business and community partners, to check out resources on its website at KentuckyHEALTH.ky.gov. Those resources include a new eligibility tool to help people figure out which components of the program apply to them.
“We also have pamphlets, guides and booklets available in state offices everywhere and available for download,” Adam Meier, secretary of the Cabinet for Health and Family Services, said in the release.
The community engagement — also known as the work requirement or PATH (Partnering to Advance Training and Health) will be phased in across the state, starting July 1 with Campbell County in northern Kentucky (unless a court challenge puts the brakes on Kentucky HEALTH). It’s expected to reach Louisville Oct. 1, with the rollout continuing through the end of the year in other parts of the state.
“People enrolled in Kentucky HEALTH who have a PATH requirement will get more information 90 days before they are required to start reporting their PATH hours at www.citizenconnect.ky.gov,” which is a new website where people will go to report their progress, according to material posted on the state’s website.
“Most people ages 19-64 who are able to work will need to complete 80 hours of PATH-approved activities each month to stay eligible for their Kentucky HEALTH benefits,” the state said. “People who are employed and work at least 20 hours per week are already meeting the PATH requirement.”
Kentucky Career Centers will be among the places to turn to for help meeting PATH requirements.
Other features of Kentucky HEALTH include a $1,000 deductible account — to track health care spending but not to require out-of-pocket payments — and monthly premium payments, typically $1 to $15.
“You will be charged monthly premiums based on your household income,” according to a fact sheet from Kentucky Voices for Health. “Over time, the state may increase premiums up to 4 percent of your total income. For example, if you are an individual making about $16,700/year (earning about $8 an hour at 40 hours per week) your premium payment will start at $15 per month but could increase to $55 per month over time.”
Penalties vary. “For (failing to pay) the monthly premium, if you’re at or below 100 percent of the federal poverty level, you will not get locked out, but you’ll get shifted to the copay plan,” Shoemaker said. “If you’re above 100 percent of the federal poverty level, there is a grace period, so you would need to catch up on your payments by the end of the second month, and then if you don’t do that, you would be locked out for up to six months.”
Copays vary but could end up being more expensive than monthly premiums, according to the Kentucky HEALTH website. For example, a Kentucky HEALTH recipient might have a $3 copay for an office visit or a $50 copay for a hospital visit.
Another new wrinkle is that some Medicaid recipients will have access to a My Rewards account to pay for things like vision and dental benefits instead of that coverage being automatic. People will accrue virtual dollars in that account by doing things like getting preventive services, such as health screenings, or taking classes, which some people have been doing since the spring.
Along with holding forums and summits around the state to inform people, the state is educating the public about the program through the mail, internet and social media channels.
“The state has been sending out letters and the MCOs (managed care organizations) are sending out letters with a lot of very important information about how benefits are changing or if they’re staying the same. Also, if someone has a premium or a PATH requirement,” Shoemaker said.
So, it’s important for people covered by the program to keep the state up-to-date on how to contact them. (The state notes you can log in to benefind.ky.gov or call (855) 306-8959 to update your mailing address.)
“If you haven’t been getting the mail, now’s the time to get with DCBS (Department for Community Based Services) and make sure that the system, the larger state system, has your information … and that will be important going forward,” Edghill said.
It’s also important to start trying to create a Citizen Connect account, which means you’ll want to get an email address if you don’t already have one.
“Anyone who is enrolled in Kentucky HEALTH and who has access to a My Rewards account and/or who has a PATH requirement needs to set up a Citizen Connect account,” Shoemaker said. “That’s how people go in and earn My Rewards dollars in addition to (doing) preventive screenings and wellness activities. That’s also where people go to report their PATH requirement (hours) once that rolls out.”
The Family Health Centers are among the organizations that have application assisters, such as Shoemaker, in place to help Medicaid recipients set up an account and to understand the material that they’re receiving. And people do not have to be FHC patients to meet with an assister (To make an appointment, call FHC at 502-772-8182).
“To set up an account, the easiest way is to go to mykentucky.gov, click the sign-up link and as you through the steps, it will direct you to Benefind,” Shoemaker said. “There, you’ll see a link to click to get more details and that directs you to Citizen Connect. It is a pretty complicated process to set up an account. If anyone has trouble with it, we are here to help people.”
Shoemaker said it’s taking about 30 minutes “for us to help people get set up. I think once we get into the swing of things, we’ll be able to do it a little bit quicker.”
Some other organizations with assisters include KIPDA, the Shawnee Christian Healthcare Center and the Park DuValle Community Health Center, Shoemaker said.
People with questions also can turn to their managed care organization, also known as an MCO. There are five and sometimes there is more than one per household: Anthem, Aetna Better Health of Kentucky, Humana CareSource, Passport Health Plan and WellCare of Kentucky.
MCOs such as Passport are sending out new benefit cards with the Kentucky HEALTH logo on them. People also may get other new materials.
Edghill recommends that people go ahead and pay their premiums as soon as they get the notices. “Nobody in Kentucky has had to pay premiums before so that’s new and they need to figure out how to do that.”
Shoemaker suggested looking for shortcuts being offered. “You can pay with a bank card or credit card and you can pay the entire year in advance. For people who just have a dollar a month premium, if they can pay $12, then they’re set for the year,” she said.
Each MCO also will have a cash payment option. Aetna Better Health of Kentucky will take cash payments at places like CVS, Family Dollar, Casey’s General store and at its office. Also, Passport, which has several types of payment options, is working with Walmart to try to make them a payment location, said Michael Rabkin, a Passport spokesman.
If you think that you have a physical or mental-health challenge, addiction or other limitation that will keep you from meeting Kentucky HEALTH requirements, check with your MCO, and consider visiting your medical provider to get them to fill out a medically frail attestation form (once those become available). In some cases, your MCO may already have notified you that it thinks you’re medically frail.
Edghill stressed the importance of establishing a relationship with a medical provider and your MCO. “The MCO won’t have claims data to look at if you haven’t been seeking care,” she said. Also, “a provider may also not want to fill out this paperwork for you if they don’t know you.”
Kentucky Voices for Health has information available at https://www.kyvoicesforhealth.org/ as well as its Facebook and Twitter sites.