United States: Governor Proposes New State Medicaid Program Through Waiver

On June 22, 2016, Governor Matt Bevin introduced Kentucky HEALTH, a new comprehensive health care program designed to transform the Commonwealth’s existing Medicaid program. Governor Bevin announced that Kentucky HEALTH, or “Helping to Engage and Achieve Long Term Health,” will simultaneously empower individuals to take control of their health and ensure the future financial sustainability of Kentucky Medicaid. Governor Bevin intends to implement Kentucky HEALTH through a Section 1115 waiver.

Section 1115 of the Social Security Act1 allows states to make requests to the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services concerning changes and revisions to a state’s Medicaid program. While such waivers require approval from the Secretary of Health and Human Services, the waivers, if approved, provide states additional flexibility to design and improve their own health programs. Each 1115 waiver must satisfy the following requirements in order to be approved: (1) the waiver must increase and strengthen overall coverage of low income individuals; (2) it must increase access to, stabilize, and strengthen providers and provider networks available to serve Medicaid and low-income populations in the state; (3) it must improve health outcomes for Medicaid and other low income populations, and (4) it must increase efficiency and quality of care for Medicaid and other low income populations through initiatives to transform service delivery networks. These waivers must also be budget neutral, meaning the expenditures of the proposed projects must not be more than federal spending. Once approved, a waiver remains for a five-year period although it can be extended another three years if the state requests such an extension. 

According to Governor Bevin, Kentucky HEALTH satisfies each of these requirements and will result in increased financial stability for the Commonwealth. Kentucky HEALTH is estimated to save Kentucky taxpayers $2.2 billion over the proposed five-year period. The new program targets and covers adults up to 138% of the federal poverty level, which includes non-disabled adults already covered by traditional Medicaid, low-income parents and caretakers, individuals eligible for transitional assistance, and pregnant women. 

Kentucky HEALTH offers two pathways to coverage for Medicaid members: either an employer premium assistance program or a high-deductible consumer-driven health plan. Under the employer premium assistance program, members are allowed to enroll their families into Kentucky HEALTH through their employer-sponsored health insurance. The premiums for this program are usually taken out through payroll, and are later reimbursed, ranging from of $1-$15 a month, less the member’s required contribution. The members will receive all of the benefits of the employer’s plan as well as aspects covered by Kentucky HEALTH that the employer’s plan does not cover. Kentucky HEALTH will also cover out-of-pocket expenses. 

For the high-deductible consumer-driven health plan, a member will pay a premium based on family income from a range of $1-$15 a month, however, pregnant women and children are exempt from the cost-sharing. If a member does not pay his or her premium within 60 days, he or she will be locked out of their insurance coverage for a six-month period. The member can return to the program if he or she pays two months of missed premiums plus an additional premium payment. The member must also complete a financial or health literacy class in addition to the payments to regain their insurance. 

This plan also creates a rewards account, which allows members to purchase additional, enhanced health benefits. In order to accrue funds in the rewards account, members must complete health related activities, such as taking a disease management class, or participate in community engagement activities, such as community service or job training. However, funds can be taken out of the account every time a member goes to a hospital emergency room for a nonemergency condition. These additional benefits include dental, vision, and over-the-counter medications. The decision to remove dental and vision benefits from regular benefits packages has been the source of much of the criticism directed toward the new program. Kentucky HEALTH does not cover non-emergency medical transportation for members, but state representatives have indicated that alternative transportation has been contemplated. The plan will also include all current mental health and substance use disorder benefits in their existing packages to help combat the rising number of overdoses in the state.  

Before the Section 1115 waiver can be approved by the federal government, the state must open the proposal to public comment, as per the rules of the Affordable Care Act. The period for public comment must be open for 30 days to allow the public to offer their opinions on the proposed program and offer any critiques they may have. Three public hearings have been scheduled for public comment, with the first two having taken place on June 28th in Bowling Green and June 29th in Frankfort. The third and final public hearing will occur on Wednesday, July 6th from 11 a.m. to 1 p.m. at the Hazard Community and Technical College Campus in Hazard, Kentucky. Once the public comment period closes, the comments will be reviewed and summarized, and the Commonwealth will incorporate any necessary revisions. All comments must be received by July 22nd at 5 p.m. After the revisions are made, Governor Bevin has stated that he intends to send his proposal to Washington by the beginning of August, in the hopes of getting a response from the federal government by September. For additional details surrounding Kentucky HEALTH and the time and location of the final public hearing on the state’s proposed plan, visit http://chfs.ky.gov/dms/kh


1 42 U.S.C. 1315

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.