Patients who qualified for Medicaid as a result of the Affordable Care Act (ObamaCare) will not be able to get vision and dental care after June without “earning” dollars for them, under a Medicaid waiver pushed by Gov. Matt Bevin and approved earlier this year by the Trump administration.
Mountain Comprehensive Health Corporation is advertising the changes to its patients, encouraging them to come in before the new rules take effect. The healthcare organization has about 16,000 patients who are on Medicaid.
Under the new rules, CEO Mike Caudill estimated the company could lose up to 50 percent of its Medicaid expansion patients — those who earn up to 139 percent of the poverty line. Caudill said MCHC has not kept track of the number of traditional Medicaid and Medicaid expansion patients, who only came into the program when the Affordable Care Act (ObamaCare) took full effect, because there has been no need to make a distinction in the past.
Caudill said the nonprofit healthcare organization did not have the ability to influence the decision to create the waiver program, so instead has been working with Bevin and his team to transition to the new system.
“We felt by working with them, we could best protect the interests of our patients,” Caudill said.
He said annual eye exams are part of the treatment regimen for diabetic patients, but won’t be covered under the new plan. Oral health is also important for employment, Caudill said, noting that it is “hard to come to work when your teeth hurt.”
But patients will be required to work, either in paid employment or community service, in order to receive benefits, according to the Kentucky Cabinet for Health and Family Services.
Patients will have to take educational classes, perform community service, have preventive care visits or perform other tasks in order to earn money in their “My Rewards” account to pay for dental and vision visits.
The new rules also require Medicaid Expansion recipients to pay from $1 to $15 per month premiums, and a $1,000 deductable. The state will place the $1,000 deductible into an account for recipients, which the state says “exposes members to the cost of care and encourages cost-conscious healthcare decisions.” Up to half of the unused amount will be transferred to recipients “My Rewards” at the end of the year. People who become 60 days late on a premium payment will be removed from Medicaid, and will be ineligible to rejoin for six months.
The rules do not affect children, pregnant women, those who are “medically frail,” chronically homeless, or eligible for traditional Medicaid.
Patients who are in Medicaid Expansion but have employer-based insurance available will have to join those plans, and can add their families to it. Medicaid will pick up part of the premium, and cover out-ofpocket expenses.
MCHC has been expanding vision and dental clinics in the areas it serves, and plans to add an optometry program in Whitesburg in partnership with the University of Pikeville School of Optometry. The new program will begin in June.
Asked whether the cuts to vision and dental care will affect the new program, Caudill said, “We will see what happens with that.”
The company also bought a dental practice in Cumberland recently and added a medical clinic on to the existing building.