by Boris Ladwig
Kentucky’s Medicaid expansion is building a strong foundation for a healthier state, and this is showing up in the research. When considering changes laid out in the recently proposed Medicaid demonstration waiver, it is important to keep in mind the evidence that backs the state’s current approach.
Kentucky’s current approach to Medicaid expansion is resulting in progress
A new study led by researchers at Harvard’s School of Public Health shows progress on a number of measures in Kentucky and Arkansas, another state that expanded Medicaid, compared to Texas, a state that did not expand Medicaid. Low-income adults in the two expansion states are:
- More likely to have a personal physician.
- More likely to have a usual source of care.
- Less likely to delay getting care due to cost.
- Less likely to skip medication because of cost.
- Less likely to use the ER as a usual source of care, or use the ER at all.
- Less likely to report trouble paying medical bills and report spending less out of pocket.
- More likely to get a check-up.
- More likely to get glucose testing, especially when they already have diabetes.
- More likely to get regular care for a chronic condition.
- Less likely to report receiving poor quality care.
- More likely to report having excellent health.
The Foundation for a Healthy Kentucky has been conducting quarterly snapshots of the impact of the Affordable Care Act since the beginning of 2015. Their most recent report estimated that 478,848 Kentuckians between 19 and 64 have coverage because of the Medicaid expansion. They also found that from January through March of this year Medicaid beneficiaries received:
- 6,304 colorectal cancer screenings
- 5,451 Hepatitis C screenings
- 9,567 breast cancer screenings
- 12,837 substance use treatments
- 46,668 dental treatments, 76 percent of which were people covered under the Medicaid expansion (as opposed to traditional Medicaid)
States that chose to expand Medicaid see budget savings and economic gains
The Robert Wood Johnson Foundation looked at 11 states including Kentucky and found that:
- Spending on Medicaid grew more slowly in expansion states than non-expansion states between FY 2014 and FY 2015 (3.4 percent compared to 6.9 percent).
- In 2014, health sector jobs grew 2.4 percent in expansion states, whereas they grew 1.8 percent in non-expansion states.
- Uncompensated care for hospitals dropped far more in expansion states (26 percent) than in non-expansion states (16 percent) during 2014, and rural hospitals were twice as likely to be at risk of closure in non-expansion states compared with their counterparts in expansion states.
The Kaiser Family Foundation found hospitals in states that expanded Medicaid saw an even greater decrease of 35 percent in uncompensated care.
Indiana’s waiver model — which influenced Kentucky’s waiver proposal — is coming under scrutiny
Kentucky’s Medicaid waiver design is heavily influenced by Indiana’s waiver program, but according to the Center on Budget and Policy Priorities initial data is showing:
- The premiums in Indiana’s program are resulting in a drop in Medicaid enrollment, partially due to cost, and largely because the complexity of the plan itself is keeping some people away.
- Few people are participating in preventive care incentives because they are not clearly understood.
- Although a central part of Indiana’s plan is to charge premiums that rise with income, the number of people being charged the lowest amount is likely overstated, hiding the full impact that premiums have on enrollment levels. The state is claiming an improbably large population at or below 5 percent of the federal poverty level, making them eligible for $1 premiums, rather than more expensive premiums owed under the parameters of the program.
A work requirement tied to Medicaid would be a barrier to coverage without boosting employment
While the Centers for Medicare and Medicaid Services have never allowed a state to create a work or community service requirement for Medicaid eligibility, experience with other safety net programs provides a warning for their use in Medicaid. According to the Center on Budget and Policy Priorities, previous work requirements haven’t resulted in increasing long-term employment, and in some cases have worsened deep poverty (people living at or below half the federal poverty line). While programs that provide voluntary access to training and other work supports can help increase employment, requirements can make people less likely to be employed by forcing them to lose coverage and see their health deteriorate as a result. The report notes that most Medicaid beneficiaries who can work already do so.
The evidence is heavily stacked in favor of the state’s current approach to the Medicaid expansion and its impact on Kentucky’s economy and health. People have been able to engage their health, in some cases for the first time, exactly because they have coverage. Without insurance, low-income Kentuckians would be back where they were prior to expansion – uninsured and getting sicker. It is imperative that we build on the successes of our recent health policy, rather than create barriers that would move us backward.
Policy discussions around the need for criminal justice reform like those happening in our state right now often feature the term “recidivism.” While the concept is central to this topic, it’s a somewhat wonky term that may be useful to unpack. So what is recidivism? And what can be done to reduce it in Kentucky?
What is recidivism?
Recidivism is the share of inmates released from prison who are reincarcerated within a particular period of time — for instance two or three years after leaving — either for committing a new crime or for violating a condition of parole such as failing to report to a parole officer or engaging in substance abuse while on parole. The recidivism rate in our state has been rising steadily. According to the most recent data available, 40.7 percent of inmates released in 2013 were reincarcerated within 2 years, and 43.3 percent of inmates released in 2012 were recincarcerated within three years.
Source: Kentucky Department of Corrections.
What can be done to reduce recidivism?
Kentucky’s high recidivism rates contribute to its growing inmate population. Although the state has made some important steps toward reducing inmates’ likelihood of returning to prison there is more that can be done.
2011’s HB 463 – or the Public Safety and Offender Accountability Act — included some important provisions such as requiring the state’s criminal justice system to implement treatment and intervention programs as well as supervision policies and procedures shown to help reduce recidivism. In addition, the passage of felony expungement legislation during the 2016 General Assembly provided some Kentuckians who were previously convicted of a nonviolent felony offense with a better chance of getting a job, decreasing their likelihood of recidivism as a felony conviction can be a significant barrier to employment.
There are many policies and actions that can help reduce recidivism. Here are a handful of ideas, some of which are being discussed at meetings of the state’s recently formed Criminal Justice Policy Assessment Council (CJPAC):
Improving job options: A key way to keep former inmates from returning to prison is to improve their chances of getting a good job that will enable them to support themselves and their families.
Increasing educational attainment is often an important step toward greater employability and is associated with a decreased likelihood of recidivating. While access to adult education in prison is now better than what was described in our previous report, there are challenges with a new, more rigorous GED exam. There are certain aspects of GED credential attainment that are now especially difficult for those who are incarcerated — for instance, having to do with the computer-based aspect of the test. In addition, state budget cuts to adult education also can make it hard for the state to increase or even maintain access to adult education outside of prison, including for those who were formerly incarcerated. Access to postsecondary education for inmates and those in the reentry process also continues to be limited due to declining college affordability in our state. Greater investments in these areas could help to reduce recidivism.
Job training is another way to promote employment during reentry. As discussed in the July CJPAC meeting, Kentucky’s Labor Cabinet is relaunching an apprenticeship program in the state’s prisons.
Ensuring that those released on probation don’t return for minor technical violations: HB 463 included graduated sanctions for those who commit technical, non-violent violations of parole — rather than automatically reincarcerating a parolee for a minor violation. However, these graduated sanctions are frequently not being followed, and too many people are being sent back to prison for relatively minor infractions. The state could require courts to first consider graduated sanctions when considering revoking parole and to have clear and convincing evidence for revocation.
Reforming some sentencing policies: As emphasized in a presentation at the first CJPAC meeting in June, time in prison can actually result in an increased likelihood to commit crimes when released. There is evidence that imprisonment does not reduce the likelihood of reoffending more than other alternative sanctions, is likely “crime generating,” and low-risk offenders are most likely to experience the increase in recidivism associated with the negative impact of incarceration. Some common sense sentencing reforms are described here.
Increasing access to felony expungement: The passage of felony expungement legislation this year is an important policy change in Kentucky that can help those who commit crimes to get their lives back on track. At the same time, there are a few revisions to the law that could greatly increase the number of Kentuckians who are able to apply. Currently the fee required to complete the felony expungement process is $500, which is higher than all but one other state’s; reducing the fee would make expungement possible for more Kentuckians. In addition, the list of eligible felonies could be expanded to include several common charges — including bail jumping, fraudulent use of a credit card and low level drug trafficking charges. Making a felony eligible for expungement does not mean expungement would necessarily be granted as a court ultimately reviews each case and determines if expungement is appropriate or whether the felon’s record should stand.
by Ohio Valley ReSource
by Roxanne Scott
by Thomas Huelskoetter
by Ryland Barton
When it comes to a secure retirement many Kentuckians are in danger in part because they lack access to a retirement account at work that can help them save, new research by the Kentucky Center for Economic Policy shows.
The population is aging in Kentucky and across the country as the baby boomers reach retirement age, with the share of Kentuckians over the age of 65 expected to grow from 15 percent today to 20 percent by 2030. Yet too many in the state are deeply underprepared for financial security in retirement. The growing elimination of more secure defined benefit plans in the private (and more recently the public) sector has worsened the problem, and the current level of Social Security benefits is not adequate for a decent standard of living. The average defined contribution account (such as a 401(k)) balance for current workers in Kentucky was only $32,499 in 2012, and many workers have jobs where no type of plan is offered at all. More must be done at all levels of government to promote a more secure retirement for the sake of retirees and the economy as a whole.
To read the report in PDF form, click here.