- Associated Press - Tuesday, November 29, 2016

LOUISVILLE, Ky. (AP) - Gov. Matt Bevin acknowledged Tuesday his plan to overhaul Kentucky’s Medicaid program got a boost with fellow Republican Donald Trump’s election, improving odds his proposal eventually wins federal approval while health insurance for more than 400,000 people hangs in the balance.

Bevin told reporters his administration has had “very good and substantive” discussions with Democratic President Barack Obama’s administration about his proposal for a federal waiver to reshape Medicaid in Kentucky.

Medicaid is paid for by state and federal funds, so the federal government must approve Bevin’s proposal.

But the governor sounded more upbeat about his chances if the decision is still pending when Trump takes office in January. Asked if he thought the outcome of the presidential election affected his waiver request, Bevin replied: “You betcha.”

“I think the odds of this being approved have gone up dramatically,” he said.

Bevin said he’s had discussions with Trump and Vice President-elect Mike Pence on broader policy issues, including the federal government giving more responsibility and authority to states in carrying out health care policies.

Bevin’s Medicaid proposal, dubbed Kentucky HEALTH, was submitted earlier this year to the federal Department of Health and Human Services.

The stakes are high. If the federal government does not approve a proposal to Bevin’s liking, the governor has said he would repeal the state’s expanded Medicaid program, causing more than 400,000 people to lose their health benefits.

Bevin has said the current program is too expensive. He wants to change it so those 400,000 people, mostly able-bodied adults, have to pay monthly premiums and must either have a job or volunteer for a charity to remain eligible for health benefits, with some exceptions.

Health and Human Services spokeswoman Marjorie Connolly declined to comment Tuesday on the review of Kentucky’s proposal.

In September, she said the agency was prepared to negotiate “for as long as it takes to find a solution that builds on the historic progress Kentucky has made under Medicaid expansion and avoids moving backward.”

Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups, said Tuesday she remains concerned that Bevin’s proposed changes would cut off coverage for tens of thousands and make coverage more expensive for others.

With Republicans about to consolidate power in Congress and the White House, she had wondered about the waiver’s viability.

“We’ve all been wondering whether or not the waiver will move forward because there will now be attempts to completely repeal the Affordable Care Act,” Beauregard said in a phone interview. “And in that case, there would be other changes to the Medicaid program. I don’t know that the waiver would necessarily fit into that. But in any case, I think we can expect to see fewer people having access to coverage.”

Under former Democratic Gov. Steve Beshear, Kentucky was among states that expanded its Medicaid program through the Affordable Care Act. The additional coverage cut the state’s uninsured rate to 7.5 percent from more than 20 percent - among the largest such drops nationally.

Bevin has said his plan would be transformative and sustainable, encouraging Kentuckians to get healthier and transition to the commercial health insurance model to become independent of the government program.

Bevin highlighted one segment of his plan - aimed at combating drug abuse - that he hopes gets fast-track approval. That proposal would have Medicaid pay for drug addicts to get inpatient treatment for up to 30 days at a mental health facility.

State Health and Family Services Cabinet spokesman Doug Hogan later said that proposal “stands to make the most meaningful impact” on Kentucky’s efforts to combat drug abuse.

On another subject, Bevin said Tuesday that changes are coming to help fix Kentucky’s troubled pension systems.

“Exactly what it looks like is going to be largely driven by the legislative process,” he said.

Kentucky’s pension systems continued their downward slide in 2016, with plans covering teachers and state employees losing more than $1.8 billion in value while obligations are increasing.

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