By John Cheves

Gov. Matt Bevin says he will end Kentucky's expanded Medicaid program that provides health coverage for more than 400,000 low-income people if a court blocks the work requirements, premiums or other changes that he wants to impose later this year.

In an executive order signed Friday, Bevin said he is directing the Health and Family Services Cabinet to terminate expanded Medicaid if any part of his Medicaid waiver -- approved last week by the federal government -- is successfully challenged in court and he can't get an unfavorable final judgment overturned on appeal.

Several national health advocacy groups have said they will sue the first state to implement a so-called "Medicaid 1115" waiver if that waiver either reduces the scope of health coverage or involuntarily cuts people from the program. Kentucky is the first to win approval from the U.S. Centers for Medicare and Medicaid Services.

Bevin's threat "will have no impact on litigation whatsoever, full stop," said Leonardo Cuello, director of health policy at the National Health Law Program in Washington. Cuello's group is one of those discussing a lawsuit over Medicaid waivers.

"It's not my place or policy to get into a back-and-forth with the governor of a state," Cuello said. "So let me just ask a question instead. Is the governor of Kentucky saying that if he is caught doing something illegal by a court and ordered to stop, that he will then take health care away from hundreds of thousands of Kentuckians who have done nothing wrong?"

Bevin's order declares his threat to be necessary because "the commonwealth has invested significant resources in preparing for the implementation" of the waiver, and "any delay in the implementation of the waiver due to judicial action will cause harm to the commonwealth and will prevent Medicaid beneficiaries from realizing the benefits under the waiver."

"Gov. Bevin has consistently said since submitting the 1115 application that these are the terms under which Kentucky will maintain expanded Medicaid," Bevin spokesman Woody Maglinger said Tuesday, after the order was made public. "Accordingly, he has signed an executive order to terminate Kentucky's Medicaid expansion in the event that a court decision prohibits one or more of the components of the Section 1115 waiver from being implemented."

Traditionally, Medicaid covers the poor and disabled. Under former Democratic Gov. Steve Beshear, Kentucky participated in the federal expansion of Medicaid during the Great Recession to cover the "working poor" -- people living at up to 138 percent of the federal poverty level. As a result, Kentucky's uninsured rate plummeted to 5 percent, but nearly one-third of the state's 4.4 million people are now enrolled in Medicaid.

Bevin, a Republican, said Friday that the changes he expects to impose starting July 1 include requiring able-bodied adults between the ages 19 and 64 to complete 80 hours a month of "community engagement" in order to keep their coverage. That could mean a job, attending school, vocational courses or community service.

"There is dignity associated with earning the value of something that you receive," Bevin said at the time. "The vast majority of men and women, able-bodied men and women ... they want the dignity associated with being able to earn and have engagement."

The changes also require people to pay premiums of up to $15 a month for their insurance. Basic dental and vision coverage is eliminated, but people can earn those benefits back through a rewards program. That includes doing things like getting an annual physical, completing a diabetes or weight management course or participating in an anti-smoking program.

The majority of adult Kentuckians enrolled in expanded Medicaid already work, but they often hold low-wage jobs that don't offer health insurance or other benefits, according to the Kentucky Center for Economic Policy in Berea.

For critics of Bevin's Medicaid waiver, one concern is that many of these low-income workers don't have time to keep filing government paperwork so they can officially prove where, when and how they're employed. Such lapses could cost them.

"Failing to fill out your forms properly will cause people to get locked out of Medicaid for six months at a time," said Eliot Fishman, senior director of health policy at Families USA in Washington.

"I think with this threat today, Matt Bevin exposes what the real agenda behind his waiver has been this whole time," Fishman said. "It has nothing to do with work. Many of these people are working. It has nothing to do with community engagement. It's all about attacking Medicaid. He doesn't like Medicaid."

(c)2018 the Lexington Herald-Leader (Lexington, Ky.)