Medical News: How has the expansion of Medicaid affected your ability to provide care to the people you serve at Family Health Centers (FHC)?

William Wagner: The Medicaid expansion has had a positive impact on FHC and the patients we serve. Over the past three years, we have been able to serve more patients, add additional services, expand and modernize facilities, grant salary increases to be more competitive, reduce uncompensated care, eliminate an operating deficit and build financial reserves for future capital projects and contingencies.

More of our patients are receiving preventive health screenings and we can more easily make referrals for specialty care. This in turn has helped our patients follow through on important health issues that they may have otherwise ignored because they did not have the money to pay for services up front.

MN: Has Medicaid expansion had a different impact on rural vs. urban Federally Qualified Health Centers (FQHC)?

WW: Both rural and urban FQHCs have benefited from the Medicaid expansion. The increased Medicaid revenues and decreased uncompensated care have helped stabilize the financial performance of health centers and allowed them to expand services and see more patients.

MN: Will the changes proposed by the Bevin administration set back your efforts to provide care?

WW: The changes proposed in Gov. Bevin’s Medicaid waiver, known as Kentucky HEALTH, would reverse much of the progress we have made in the past three years. As currently proposed, the changes would create significant barriers to insurance coverage and reduce access to services, while creating costly administrative red tape for providers. We know from experience that the best way to keep people covered is to make the process simple, and Kentucky HEALTH is a complex program. People will fall off their coverage because the process will be too much for them to manage.

MN: What changes would you like to see to the proposed waiver to help protect your ability to provide care?

WW: While I share the goal of encouraging Medicaid recipients to take a more active role in their own health and
healthcare decisions, I would like to see changes made to the proposed waiver. These changes include: the elimination of monthly premiums for low income adults and the lockouts for failure to pay; elimination of the work and community engagement requirements; elimination of the annual recertification and lock-outs; and restoration of vision, dental and non-emergency medical transportation benefits for adults. These are but a few of the issues and concerns that I have with the proposal.

I anticipate that many of the patients we serve will lose their Medicaid coverage because of these changes. Our health centers serve many high risk/high need patients including the homeless, immigrants and refugees and persons suffering from mental health and substance abuse problems. These patients would have a difficult time satisfying the complex requirements necessary to maintain coverage over time, which will ultimately lead to increased morbidity and mortality.

MN: What changes to the overall Medicaid system would you propose to improve access to care for all Kentuckians?

WW: First and foremost, I would propose that the Medicaid expansion under the Affordable Care Act be continued. The expansion of health insurance to nearly 440,000 adult Kentuckians presents an unprecedented opportunity to improve the health and well-being of Kentucky’s families and workforce.

Healthy parents help children remain healthy and succeed in school, and healthy employees contribute to the economic prosperity of the commonwealth. The expansion needs to be continued to reap the long-term benefits of the new federal investment in Kentucky’s health.

Second, I would simplify the administration of the Medicaid program by reducing the number of Medicaid Managed Care Organizations (MCOs). Having five MCOs in Kentucky increases red tape and complexity for providers, causing higher administrative costs and reducing effectiveness. Patients and the commonwealth would have adequate choice and competition with two to three MCOs.

Third, I would encourage the MCO’s to develop value-based payment mechanisms that recognize and incentivize patient centered medical homes and improved quality outcomes. I would encourage Medicaid to reimburse for community health workers and lay health navigators that help address the social determinants of health that lead to higher costs and poor health outcomes.