O’care-Hating Kentucky Guv Comes Around On Medicaid Expansion

It looks like Kentucky Gov. Matt Bevin (R) will be sticking to the promises about Medicaid he made towards the end of his gubernatorial campaign, instead of those made at its beginning. The Tea Party candidate laid out Wednesday his plans to “transform” — rather than entirely dismantle — the Obamacare Medicaid expansion.

“We are going to transform the way Medicaid is delivered in Kentucky and this transformation I think will be a model to the nation,” Bevin said at a press conference Wednesday.

By continuing Medicaid’s expansion under Obamacare, Bevin will join a long line of GOP governors who have railed against the program but eventually come around to supporting it. The pattern is well-established and often includes negotiating with the federal government a special carve-out for a state-specific version of the program, a way to save political face by not seeming to have caved and become an Obamacare supporter.

Bevin said he and U.S. Health and Human Services Sylvia Burwell had a “very extensive and substantive conversation” in recent weeks, and that she was “very committed to this.”

Bevin didn’t go much into detail about what sort of changes he would be pursuing. But he stressed having a dialogue with the Centers for Medicare and Medicaid Services to come up with a program “to make people as un-dependent as possible.”

“By the middle of next year, we will have an opportunity to know whether this is going to work or not,” Bevin said.

He also introduced the two state leaders who will be helping shape the reform: Mark Birdwhistell, an administrator at the University of Kentucky HealthCare and Vickie Glisson, the state’s new human services secretary.

“We have looked at models in other states,” Birdwhistell said, citing specifically Indiana’s system. “My personal preference is we need a Kentucky model.”

Back in February at the outset of his campaign, Bevin promised to “reverse … immediately” the Obamacare Medicaid expansion, which had been pushed through in an executive order by Kentucky’s outgoing Democratic Gov. Steve Beshear.

Though Kentuckians aren’t fans of Obamacare in general, nearly two-thirds of them favor the Medicaid expansion. Facing a backlash that included a segment on John Oliver’s “Last Week Tonight,” Bevin walked backed the promise in the days preceding November’s election, settling on the approach that he is pursuing: changing some aspects of the state’s Medicaid expansion program with the approval of the federal government, via HHS’s 1115 or 1332 waiver programs (the latter of which won’t even be available until 2017).

As health care policy experts told TPM after Bevin’s election, HHS’s Centers for Medicare and Medicaid Services won’t just grant any changes sought to Medicaid programs.

“CMS has been relatively conservative in not granting wide scale modifications to the program under the waivers,” Caroline Pearson, the vice president of the health care consulting firm Avalere Health, told TPM in November.

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