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Kentucky Gov. Bevin: Key to Medicaid work requirement is community engagement

Kentucky will become the first state in the U.S. to require an estimated 350,000 Medicaid recipients to work, get job training, volunteer or care for a family member in order to qualify for benefits. Gov. Matt Bevin, whose office estimates the plan will save the state almost $2.5 billion, joins Judy Woodruff to discuss its implementation and its predicted effects.

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  • Judy Woodruff:

    Kentucky will be the first state in the country to require some Medicaid recipients to work in order to qualify for benefits.

    In July, an estimated 350,000 people aged 19 to 64 who don't have disabilities or other disqualifying circumstances will be required to work at least 20 hours each week. Work can be a paying job or taking part in a job training program, volunteering, or caring for the elderly or a family member with a disability.

    Pregnant women, full-time students, and the medically frail will be exempted.

    Governor Matt Bevin's office estimates the plan will save Kentucky almost $2.5 billion over five years, and reduce the Medicaid rolls by some 100,000 people.

    I spoke with Governor Bevin a short time ago and I asked him how large Kentucky's Medicaid program is, and what problem this change would fix.

  • Gov. Matt Bevin:

    We currently have nearly one-third of our population — we're 4.5 million people, and we have just short of about — we're about 1.5 million of us right now are on Medicaid.

    Now, there was already probably 20 percent of our population, 20 to 25 percent, on traditional Medicaid, and that is for the medically frail, the aged, the infirm, pregnant women, children, those for whom the program was originally designed.

    Since the expansion of Medicaid to able-bodied people of low financial means, we have seen that number go from 20, 25, 30 and now fully a third of our population. So what is it we're looking to change is, we simply want, for those that are able to be engaged in their own health outcomes, we want them to be, because there's dignity and self-respect that is offered to people through the ability for people to do for themselves.

  • Judy Woodruff:

    How will you determine who is actually physically able to work, people who don't have a genuine disability that prevents them from working, or people who have a genuine need to stay home to take care of children?

  • Gov. Matt Bevin:

    Sure. This is — it's important. And I'm glad you asked that question, because this program is not intended, this expansion of the requirements, is not intended for those for whom Medicaid was originally designed, those that we just mentioned.

    It's not intended for those who are primary caregivers or those who are students. And, in fact, if people are already working, then they have met the requirement. It isn't just a requirement simply to work. If they are not working, they also could take classes toward certifications and education that would allow them to find jobs. They could also volunteer in their community.

    The key is to have them engaged in their communities, because it is through that engagement that people have healthier outcomes. They have an interaction with people. They become a part of the fabric of their community. It's better for them, and their health, and for their children and their families as well.

    So, how many of them it will apply to? A subset of those that are part of what is known as the expanded Medicaid population. The intent isn't to try to find big numbers or big savings. It's to create opportunity for people to pursue the American dream.

  • Judy Woodruff:

    Well, that's what I wanted to ask you, because the research that I have seen, Kaiser Family Foundation, says that of those able-bodied adults right now, or at least as of 2016, who are on Medicaid, that 60 percent of them are already working.

    How much higher do you want that percentage to go?

  • Gov. Matt Bevin:

    Should it be anybody who's able-bodied and not working and capable of working who's not working.

    Why should anyone in America — and think about this, Judy? Why should somebody have to go to work every day and pay taxes to provide something to someone who could do the same thing, but chooses not to? That's very un-American.

    So, how much higher? I would love it to be 100 percent for those who could do it, and, if not working, again, volunteering or providing a way to pursue higher education or training for jobs that exist.

    In Kentucky, we have more than 200,000 jobs right now waiting for somebody to fill them. I want to get people connected with that.


  • Judy Woodruff:

    I'm sorry to interrupt. That's another question I have, because in this high employment economic environment we're in, where the unemployment rate is very low, how do you find jobs for these people? What do you do if there aren't jobs for them?

  • Gov. Matt Bevin:

    There's millions of them in America. And it's important to understand — and it's probably worth it for another time to have this conversation — the unemployment number is irrelevant if the statistics aren't valid.

    And if you don't count those people who are capable of working who choose not to in those numbers, then the numbers are irrelevant. So, while they're low, again, in Kentucky, 200,000 jobs, millions of them in America, you can't go into any town in America without seeing a help-wanted sign.

    And, again, if there were not a job, people also could volunteer, be involved in community involvement or education. There are many different on-ramps to give people a chance not to be dead-ended into these programs like Medicaid, but to have them be a way station on the way to pursuing the American dream.

    I am such a person. I grew up in poverty. I grew up with no access to health care ever. I had no health care of any kind until I was an active-duty Army officer in my 20s.

    I know from personal experience that people like me don't want to be treated, as Seema Verma has said, with the soft bigotry of low expectations, that we're capable of more than that. And while it may only be a small subset, truth be told, think about how transformative it could be for people like me who are now in that same stage in their lives.

  • Judy Woodruff:

    Seema Verma, of course, being the head of the Medicare/Medicaid office.

    It sounds as if your underlying assumption is that many, many of these people who are on Medicaid who are able-bodied are really trying to avoid work. Is this your belief?

  • Gov. Matt Bevin:

    No, I think, again, this will be a very small subset.

    As you noted, and all statistics show, the vast majority of those who can work are already working, so it doesn't apply to them. This is for those who are not working and maybe want the opportunity.

    I got an including anecdote from the largest Goodwill in the largest city in our state. And the head of that organization said that, as this word has come out just in recent days, a number of their customers, who are people who are on Medicaid, are excited at the idea that jobs will now not be only made available, but will be made available to them because the dots will get connected.

    And so this woman was surprised and reached out to our office and said many of our Medicaid customers who don't have jobs are excited at the possibility of the state helping to facilitate their connection to a job.

    Human beings want to be treated with dignity and respect. They do. And we're going to give them that opportunity.

  • Judy Woodruff:

    Governor Matt Bevin of Kentucky, thank you very much.

  • Gov. Matt Bevin:

    Thank you.

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