KY HEALTH Under Review

On January 12, 2018, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 Demonstration Waiver in Kentucky entitled, “Kentucky Helping to Engage and Achieve Long Term Health” or Kentucky HEALTH. The waiver has two main components: (1) the Kentucky HEALTH program that modifies the state’s existing Medicaid expansion and applies new policies to the current Medicaid expansion population, as well as most other adults covered by Medicaid; and (2) a Substance Use Disorder (SUD) program available to all Medicaid enrollees.

The proposed Kentucky HEALTH program requires “able-bodied” Medicaid recipients to pay premiums and have a certain number of “community engagement” hours per week, which includes work, volunteering or training.

After the waiver was approved, 15 Kentuckians filed a lawsuit in the Federal District Court of the District of Columbia alleging that the waiver violates federal law.

In June, an opinion was issued by Judge James Baosberg explaining that his review revealed “that the Secretary never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This single omission renders his determination arbitrary and capricious.”

In response to the Court’s ruling, a review process is now being conducted. Kristi Putnam, Deputy Secretary of the Cabinet for Health and Family Services, gave an update during a stakeholder advisory forum today in Frankfort and took questions about the Section 1115 Medicaid waiver that is under federal review.

Putnam indicated that the Cabinet is “working with CMS and will provide them with any information they request.” However, “they have not requested any changes nor have we made any changes to the plan for Kentucky HEALTH, so everything is the same as it was when we received approval before. But CMS has to take the comments into consideration and then provide us with any questions that they have to clarify. We don’t think it’s going to take a long time.”

More Information about the proposed overhaul can be found on the Cabinet’s website.

Weber Rose represents Healthcare organizations in a variety of matters, including Medicaid and Medicare compliance. Shareholder Darryl Durham has over 30 years of business litigation and healthcare litigation experience. Mr. Durham’s experience includes many facets of health law and the creation of health maintenance organizations. He has represented healthcare plans and long-term disability plans in ERISA actions and has represented healthcare providers before administrative boards. Mr. Durham has also served as a Medicare Part B hearing officer and provided representation before the Provider Reimbursement Review Board.

Contact Weber Rose to learn more.