The state held a forum in Louisville Thursday to explain coming changes to Medicaid. | Photo by Darla Carter

The team in charge of implementing the state’s Medicaid overhaul was met with a flurry of questions Thursday about the program, including how people with unreliable work hours will be able to meet a “community engagement” requirement.

The questions came during a forum that was held in Louisville to explain changes being brought about by the recent federal approval of Kentucky’s Section 1115 Medicaid waiver known as the Kentucky HEALTH program.

There is a component of that program called PATH — Partnering to Advance Training and Health — that will require certain Medicaid beneficiaries to complete 80 hours a month (roughly 20 hours a week) of so-called community engagement activities, such as working or volunteering. Kentucky is the first state in the country to make such a rule, which the state maintains is not a work requirement.

Kristi Putnam of the state Cabinet for Health and Family Services led the presentation. | Photo by Darla Carter

“It’s very different from just requiring someone to work,” Kristi Putnam, program manager for the Kentucky HEALTH Medicaid transformation, said during the forum. “It is intended to be an engagement that is meaningful, that provides a link and a network to that community because people who are actively engaged … tend to be healthier overall.”

Kentucky’s program also is intended to help address the state’s drug epidemic, she said. Substance abuse disorder treatment is one way people can meet the community engagement requirement and so is education and job training.

There’s a myth that “we want to kick people off benefits,” Beth Kuhn, commissioner of the Kentucky Department of Workforce Investment, said in an interview. But “if we work this right, people will have better jobs, better health.”

During a question-and-answer session at the forum, Putnam was asked about people who get jobs with fluctuating hours. For example, they might have an employer who schedules them for 20 hours one week and 10 hours the next.

“It’s the individual’s responsibility to find another opportunity,” she said. “That’s why we want there to be a number of different ways somebody can meet that” requirement. That might include online learning, baby-sitting, or a job-skills opportunity from the Kentucky Career Center, she said.  “We’re also seeking additional suggestions for how can we improve our opportunities for community engagement hours.”

It is unclear whether the state’s efforts will be derailed by a lawsuit challenging the federal government’s approval of the state’s plan. It was filed against the U.S. Department of Health and Human Services by a small group of Medicaid recipients, and Gov. Matt Bevin subsequently filed his own suit to uphold the plan.

But Cara Stewart, an attorney at the Kentucky Equal Justice Center, said, “I’m very hopeful that the courts will see that … the federal government stretched their authority in approving an experiment that takes benefits away from Kentuckians and does not improve efficiencies and does not promote the purposes of the Medicaid Act.”

The dashboard | Photo by Darla Carter

Meanwhile, the state is moving forward with the HEALTH (Helping to Engage and Achieve Long Term Health) program. It has many features, including an online dashboard to help participants track their progress, premium payments for some, and a rewards account.

Putnam encourages the public to go to citizenconnect.ky.gov by July 1. “That’s the big date when the benefits change.”

“Not everybody is going to see the full spectrum of changes,” Putnam said.

For example, there are some groups that will be excluded from having to do community engagement activities. Among them: pregnant women, people determined to be “medically frail,” former foster youth up to age 26, and most caregivers.

The Kentucky HEALTH Medicaid Transformation Leadership Team is holding a series of forums around the state to inform people about the Medicaid changes and to get feedback on “what are some things that we might need to go back and look at,” Putnam said.

“Each time we meet with a different interest group, we get some different ideas on maybe how we can better implement the policy, communicate things. There’s a lot of moving parts to Kentucky HEALTH, as you all know, and so we are doing our best to get information out, but we always can improve.”

Before the new community engagement requirement or PATH comes to Louisville, it may be tested in Northern Kentucky as part of a gradual roll out across the state, Putnam said.

Northern Kentucky would be an ideal area for PATH to start because there’s an abundance of job opportunities, good community partners and has been the site of a small initiative similar to PATH, state officials said.

Tentative plans call for PATH to start there in July as a test pilot to work out any kinks. It would then gradually roll out to other parts of the state, with Louisville expected to come on board in October, Putnam said.

Another features of HEALTH is a My Rewards account to pay for certain health expenses, such as routine vision and dental services. People can earn My Rewards dollars by taking online courses, some of which are ready for people to start taking now. They also can earn credit by getting preventive services, such as mammograms, done.

The state wants to “really encourage beneficiaries to improve health care by incentivizing preventive care,” Putnam said.

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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.