Among all states, Kentucky has had the most successful implementation of the Affordable Care Act. Since 2014, the state developed its own state-based marketplace (Kynect) and expanded Medicaid to include low-income adults ( Grant, 2018) . Due to the Medicaid expansion, there have been gains in coverage, positive fiscal impact, improved health care access, and better healthcare utilization. Although Governor Bevin had promised to dismantle and put an end to Medicaid expansion during his campaigns in 2015, he changed his mind and decided to seek a waiver to make particular changes to the program ( Grant, 2018) . On June 1, 2016, the Centers for Medicare and Medicaid (CMS) approved Kentucky’s plans to make a transition to healthcare.gov from Kynect ( Grant, 2018) . On June 2017, the state also released Section 1115 demonstration waiver proposal known as Kentucky Health as a better and more effective alternative to Medicaid expansion in the state ( Grant, 2018) . The assignment will evaluate Kentucky's Medicaid health care program, how it was passed, funding structure, and its importance.
The Kentucky Medicaid waiver was modeled mainly from a similar waiver in Indiana. The program modified Kentucky's Medicaid expansion and made various changes that affected both traditional Medicaid enrollees and new enrollees as well ( Norris, 2018) . However, CMS indicated that it would not accept new waivers similar to Indiana’s until they evaluated the program. Kentucky’s waiver program includes similar features as Indiana’s and other features not approved or passed in other states such as graduated premiums according to the length of program and employment requirements. During a press conference, Governor Bevin had insisted that he would end the Medicaid expansion if the waiver proposal were not approved by CMS ( Norris, 2018) . The waiver plans could only be passed if they aligned with Medicaid goals of increasing quality and efficiency of care, enhancing health care access, improving health outcomes, and increasing coverage.
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Both the federal and state government funds Kentucky's Medicaid health care program. Other than the federal government's share of Medicaid funding, the state also uses provider tax to supplement the amount of money they receive from the federal government. Currently, the federal government funds about 80% of Kentucky's Medicaid budget ( Grant, 2018) . Kentucky's Medicaid budget is about 11 billion. Kentucky plans to review its provider tax so that the state can have more resources for the Medicaid program. Regardless of the expansion of Medicaid in 2014, Kentucky's provider has not changed even though hospitals' provider tax has not changed ( Grant, 2018) . Provider tax has not changed since 2016. Governor Bevin believes that the proposal could allow the state to have solid funding for their healthcare program. The alternative to increasing provider tax has been enrolling more people with jobs into the program. However, the work requirement in the program has been heavily criticized because it required all ‘able-bodied adults' to work at least 20 hours weekly ( Grant, 2018) .
Since the implementation of the program in 2013, the uninsured rate for the elderly in Kentucky reduced to 6.8% from 18.8% ( Huberfeld, 2018) . The reduction was one of the highest in the country, and it is attributed to the gains in Medicaid coverage and Medicaid eligibility. Before the expansion plans were implemented, parent's eligibility was about 57%, and adults without dependent children were not covered ( Huberfeld, 2018) . However, after the ACA Medicaid expansion, adult’s eligibility expanded to about 138% of the poverty level ( Huberfeld, 2018) . By 2016, the Medicaid enrollment in Kentucky had increased to over 95% ( Huberfeld, 2018) . About 33% of Medicaid enrollees were new enrollees ( Huberfeld, 2018) . If the Medicaid expansion were not implemented, about 80% of the new enrollees would have lacked insurance coverage because they lived below the poverty level ( Huberfeld, 2018) .
Additionally, the positive cumulative impact of Kentucky's Medicaid health care program is estimated at $820 million by 2021. Furthermore, the program created over 12000 jobs in the state including 5400 jobs in the healthcare industry and social services. It is expected that the program will create over 40000 jobs by 2021 with an average income of about $41000 ( The Henry J. Kaiser Family Foundation, 2018) . Although Kentucky had poor health status indicators according to history, the Medicaid expansion allowed the state to improve access and quality of healthcare significantly. Studies also showed that patients in Kentucky had reduced difficulties paying medical bills and there was a significant reduction in patients who skipped medications. In the first year of expansion, over 13000 people with substance abuse disorders got treatment ( The Henry J. Kaiser Family Foundation, 2018) . Moreover, the state achieved significant savings by transitioning people to the new eligibility group from the pre-ACA eligibility categories. All in all, the program has had a substantial impact on Kentucky's economy.
The assignment has evaluated Kentucky's Medicaid health care program, how it was passed, funding structure, and its importance. To date, Kentucky has had a successful ACA implementation. The significant rise in enrollment caused a considerable reduction of the uninsured and robust coverage gains. Additionally, the program offered financial protection for low income earning families. The net fiscal benefit of Kentucky’s Medicaid expansion program has been reduced numbers of uncompensated patients in hospitals and increased jobs. Furthermore, over 72% of Kentucky residents prefer the current Medicaid program that enrolled more people than the period when there were few people ( The Henry J. Kaiser Family Foundation, 2018) . Also, over two-thirds of Kentucky residents are confident that the Medicaid program has had a positive impact on low-income earners: moreover, the share increases to over 84% among adults covered by the Kentucky Medicaid program ( The Henry J. Kaiser Family Foundation, 2018) . Altering or ending the current Medicaid expansion program could adversely affect the fiscal, coverage, and access gains that have been achieved to date under the healthcare program.
References
Grant, R. (2018). In Kentucky's New, Medicaid Plan Evidence Takes A Back Seat . [online] Healthaffairs.org. Available at: https://www.healthaffairs.org/do/10.1377/hblog20160825.056232/full/ [Accessed 10 Oct. 2018].
Huberfeld, N. (2018). Can Work Be Required in the Medicaid Program?. New England Journal of Medicine , 378 (9), 788-791.
Norris, L. (2018). Kentucky and the ACA's Medicaid expansion: eligibility, enrollment, and benefits . [online] Available at: https://www.healthinsurance.org/kentucky-medicaid/ [Accessed 10 Oct. 2018].
The Henry J. Kaiser Family Foundation. (2018). What’s At Stake in the Future of the Kentucky Medicaid Expansion? . [online] Available at: https://www.kff.org/medicaid/fact-sheet/whats-at-stake-in-the-future-of-the-kentucky-medicaid-expansion/ [Accessed 10 Oct. 2018].
