Timeline:

The Department for Medicaid Services provided a “Presumptive Eligibility” application that is significantly simplified and allows individuals to get health coverage through June 30 without having to complete the entire standard application.

An emergency regulation was filed to reverse the 2018 decision to make co-pays mandatory for Medicaid members.

In an unanimous decision, the DC Circuit Court of Appeals affirmed a lower court ruling that struck down Arkansas’ plan to take coverage away from people who didn’t meet a work requirement.

Kentucky’s similar plan was considered alongside Arkansas’ but the opinion did not address Kentucky because the case was withdrawn after Governor Beshear rescinded the waiver.

Governor Beshear signed executive order 2019-005, which rescinded a previous executive order that would end Kentucky’s Medicaid expansion entirely in the event of a final court ruling against the 1115 waiver. During the press conference for this signing, the governor also announced that his office was sending a letter to CMS to withdraw the waiver entirely.

The U.S. Circuit Court of Appeals hears oral arguments on Kentucky’s Medicaid 1115 waiver. A recording of the arguments can be heard here.

The Department of Justice appeals the federal decisions striking down Kentucky and Arkansas’ Medicaid waiver programs.

Judge Boasberg vacates and remands Kentucky’s waiver back to HHS, on the grounds that its approval was “arbitrary and capricious.” Implementation of the waiver is immediately suspended.

The Cabinet for Health and Family Services pushes back the revised start date for the Medicaid waiver, with various requirements taking effect on April 1, May 1 and July 1. The cabinet also acknowledges the Medicaid program is sufficiently funded through fiscal year 2020.

Kentucky Medicaid enrollees re-start the legal challenge to block the Medicaid waiver.

Most adults enrolled in Medicaid begin paying co-pays for a broad range of medical services, including to fill prescriptions.

CMS approves the remainder of the Medicaid waiver with minimal changes and an explanation of their consideration of the administrative record. They give a start date of April 1, 2019.

CMS approves the Substance Use Disorder portion of the 1115 waiver request.

CHFS announces mandatory copays beginning January 1, 2019.

Officials from the Cabinet for Health and Family Services describe the difference between the estimated need (developed by the Office of the State Budget Director and the Department for Medicaid services) and what they were budgeted by the legislature as a “shortfall” for fiscal years 2019 and 2020. This is used to justify a need for cuts to enrollment through the Medicaid waiver.

The federal public comment period ends with 11,561 comments, of which 9,397 were unique. By a margin of 20 to 1 the unique comments were opposed to the changes or supportive of Medicaid as is.

Medicaid copays that had become mandatory on July 1 were made optional again by the state.

Dental, vision and NEMT coverage is reinstated and the State Plan Amendment is withdrawn.

Health advocacy groups send a letter to CMS urging them to reject the State Plan Amendment (SPA) ending dental, vision and NEMT coverage on the grounds that the process they used was not in line with the federal regulations for changing an SPA.

An altered State Plan Amendment is submitted to CMS and posted on the CHFS website to end dental and vision coverage for those on the Alternative Benefits Plan. It claims to have originally been filed in April with modifications made at the end of June.

The state suspends dental and vision coverage for those who would have had to use a MyRewards account to pay for services had the court not halted implementation.

Judge Boasberg of the D.C. District Court remands Kentucky HEALTH back to HHS for further review after he found that Secretary Azar violated the Administrative Procedures Act by failing to consider the administrative record in light of the primary purpose of the Medicaid program. Implementation of the waiver is immediately and indefinitely halted.

Eligibility notices are sent out letting Medicaid members know if they would be placed under the State Benefits Plan or the Alternative Benefits Plan.

The Kentucky Medicaid Administrative budget was doubled for fiscal year 2018 and substantially increased in fiscal years 2019 and 2020, largely to support the implementation of the Medicaid waiver.

“My Rewards” accounts go live and in addition to credit accrued from check-ups earlier in the year, members can begin accumulating credit for other activities.

The state begins a monthly “Stakeholder Advisory Forum” to present on the changes and answer questions from the community.

Initial notice of Medicaid changes are sent to Kentucky Medicaid enrollees.

16 Kentucky Medicaid enrollees, represented by the Kentucky Equal Justice Center, the National Health Law Project and the Southern Poverty Law Center sue CMS to stop the waiver from being implemented.

Kentucky’s 1115 Medicaid waiver request is granted approval by CMS. The same day, Governor Bevin signs an executive order that would end Medicaid expansion in Kentucky if the waiver is legally barred and all appeals are exhausted.

CMS sends a letter to state Medicaid directors, encouraging them to apply for 1115 waivers that would take Medicaid coverage away from enrollees who do not meet a work requirement.

CMS makes major changes to the 1115 waiver approval process, including outlining new purposes and goals for state waiver requests.  

State and federal concurrent comment period on Kentucky’s changes to Medicaid ends with a total of 1,273 comments submitted.

Kentucky seeks to modify its original request primarily by choosing an immediate 20 hours per week of work required instead of a ramp- up of required hours and by creating a lock-out period for people who fail to report relevant changes in circumstances within 10 days of the change.

March 13 – Seema Verma is confirmed as CMS director in a 55-43 vote. During her confirmation hearings, she says Medicaid needs a full overhaul.

HHS Secretary Tom Price and CMS Director Seema Verma send a letter to governors encouraging them to seek additional flexibility in their Medicaid programs, including policies to encourage “community engagement.”

Seema Verma is nominated to run the Centers for Medicaid and Medicare Services, which has the authority to approve state Medicaid waivers. Verma helped develop Kentucky’s Medicaid waiver after her plan for Indiana (a model for Kentucky’s waiver) was approved by the Obama administration.

Donald Trump wins the presidential election after vowing to repeal the ACA, including Medicaid expansion.

HHS re-opens the comment period due to unprecedentedly large numbers of comments. The last comment is submitted January 4, 2017.

The federal comment period for the Medicaid waiver closes. Of the 1,643 comments posted by that date, over 90 percent were opposed to the changes.

The federal government gives Kentucky approval to move from Kynect to Healthcare.gov for health insurance signups, effectively dismantling it as an enrollment platform.

Kentucky submits the waiver request to the U.S. Department of Health and Human Services (HHS), and estimates within the proposal suggest the changes will cover nearly 88,000 fewer Kentuckians by the fifth year.

The state comment period closes.

Despite efforts from the state, many with Medicaid and food assistance still faced problems with their benefits stemming from the problematic Benefind roll-out.

At the state hearings from June 28 – July 6 on the Medicaid waiver, officials face stiff criticism.

Governor Bevin proposes sweeping changes to Medicaid through an 1115 waiver. The state opened a public comment period through July 22, and scheduled three public hearings – Bowling Green on June 28, Frankfort on June 29, and Hazard on July 6.

In a press conference, the Bevin administration admits they knew about the issues with Benefind, and had put together some workarounds for case workers. Thousands of Medicaid enrollees had been sent letters erroneously notifying them that their coverage was ended, and some actually did have coverage cut off.

The first reports of problems with Benefind surface. The call-lines for people with difficulty have back-ups of several hours. It is reported that the Department of Community Based Services help lines are open from 8:30 AM to 2:30 PM. Some with Medicaid report problems with their coverage.

Executive Director of the Cabinet for Health and Family Services Ombudsman’s Office Norman Ward is fired after warning about problems with Benefind.

Benefind, the online platform for Kentucky’s benefit programs, is launched. Medicaid applications and enrollment, though not originally planned for the platform, is moved from Kynect to Benefind.

Governor Bevin announces his intention to make changes to Medicaid, rather than end the expansion, and appoints Mark Birdwhistell to develop the proposal.

Governor Bevin sends a letter to the U.S. Department for Health and Human Services Secretary Sylvia Burwell notifying her of his intention to end the state-based exchange and enrollment platform for Medicaid known as Kynect.

Then candidate Matt Bevin rolls out his campaign platform, which included rescinding Medicaid expansion, saying it was too expensive for the state to afford (even while the Federal Government was paying for 100 percent of the costs).

The first ACA Open Enrollment period ends on February 15 (though there were subsequent extensions), and Medicaid enrollment in Kentucky grew 33% over the average month the previous year, reaching 1,125,964 in March.

Kentucky begins open-enrollment for those eligible under Medicaid expansion for the first time through Kynect, a state-based health care marketplace.

Then Governor Steve Beshear announces that Kentucky will expand access to Medicaid coverage to Kentuckians under the ACA.