Kentucky’s implementation of health reform led to a 4.9 percentage point drop in its uninsured rate to 8 percent in 2014, significantly lower than the national rate of 11.6 percent. A new brief from the Kaiser Commission on Medicaid and the Uninsured identifies the factors that were key to Kentucky’s success, the most significant being its integration of Medicaid and marketplace coverage in a single eligibility system, known as kynect. Unfortunately, Kentucky’s governor, Matt Bevin, has made changes to the eligibility process that already have disrupted coverage for many consumers, and additional changes will further undermine Kentucky’s success.
Kynect allowed people to easily apply and move among Medicaid, the Children’s Health Insurance Program (CHIP), and marketplace coverage as their situations changed. Families with children eligible for Medicaid or CHIP and parents eligible for marketplace coverage received a single notice explaining their eligibility for the different programs.
But the success of this streamlined eligibility process is already threatened. Gov. Bevin is dismantling kynect and switching to the federal marketplace, called Healthcare.gov, for the 2017 open enrollment period. In late February, Kentucky launched Benefind, a new online portal for enrollment in Medicaid, SNAP (formerly food stamps), and other public benefit programs. Benefind wasn’t originally designed to replace kynect, but the state has shifted Medicaid eligibility determinations to the system, and it’s been a bumpy transition. The change has disrupted “health coverage for scores of Kentuckians who use kynect,” who must now get their coverage through the new system.
Under the plan to transition marketplace enrollment to Healthcare.gov, people who apply and appear eligible for Medicaid or those who report income changes that make them eligible for Medicaid will be transferred to Benefind. That transfer has the potential for delays and coverage gaps, as we’ve noted. Moreover, families with members eligible for different types of coverage will have to straddle two systems when they report changes or renew their coverage.
This plan also risks undoing other factors that have led to Kentucky’s success, including broad outreach and marketing efforts and an extensive network of enrollment assisters. A statewide advertising campaign designed to raise awareness of the availability of health coverage ended in December 2015. Assisters and brokers who used kynect to enroll consumers in all forms of coverage have limited access to the Benefind system, and they don’t have a dedicated line to get help for consumers as they have under kynect. Moreover, it isn’t clear whether there will continue to be state funding for robust support of enrollment assisters who can enroll consumers in Medicaid through Benefind, as well as marketplace coverage through Healthcare.gov.
The Centers for Medicare and Medicaid Services has given the Bevin administration a June 1 deadline to show sufficient progress to transition to Healthcare.gov for 2017. If the state doesn’t meet the deadline, it will need to take immediate action to reinstate kynect and maintain its success in getting its residents covered.