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HARI SREENIVASAN: On Friday, Kentucky became the first state granting permission to mandate work requirements for those receiving Medicaid benefits. The new requirements affect approximately 350,000 adult recipients in this state aged 19 to 64. About half of them already have jobs. The changes do exempt certain groups including pregnant women, full time students and the medically frail and the state will also begin charging recipients a monthly premium based on income. For more on what this means for Medicaid recipients in Kentucky and other states, I'm joined from Washington, D.C. by Amy Goldstein of The Washington Post. You've been reporting on this, Amy. First, what's the impetus behind this? Why make these changes? Why was Kentucky first in line?
AMY GOLDSTEIN: Well, the idea of requiring people on Medicaid to work or do some other kind of community engagement, as the term of art goes, has been something that many Republicans and other conservatives have been eager to do for years. It started with welfare reform 20 years ago and then moved into food stamps now called “SNAP”. The notion that people who receive certain government benefits have to do something in exchange for getting that help. But that's never been part of Medicaid before, which is of course health insurance for low income people in this country. And a number of states had asked for federal permission to do this during the Obama administration and always been rejected. But under the Trump administration there's been much more sympathy for this idea and as you said Kentucky just became the first state to get permission on Friday.
HARI SREENIVASAN: There was a Medicaid expansion in several states so that increased the number of people in states so I can tell you that we're receiving Medicaid so I'm assuming that also costs the state more. Is this partly motivated by the state wanting to try to decrease those costs?
AMY GOLDSTEIN: It absolutely is. Governor Matt Bevin, when he was running for office in 2015 campaigned on this issue to a large degree and he said that the Medicaid expansion should be reversed. Kentucky had been one of the states, the only Southern state that had seriously embraced the Affordable Care Act and had expanded Medicaid. And a lot of people, now close to a half million people have joined as a result. So first Governor Bevin thought that he would get rid of that expansion. They decided instead, to keep the expansion but require people in that group and other able bodied adults in the traditional Medicaid group to work or go to school or do volunteer work or otherwise engage in their communities in order to keep those benefits. And they estimate that there will be a reduction in people in the Medicaid rolls as a result of saving the state money. Now whether that's a good thing or a bad thing really depends on your point of view. Governor Bevin says that people will be leaving Medicaid because they'll be working their way out of poverty and won't need the program anymore. However, the critics of this idea say that people will be bounced off Medicaid for either not meeting the requirements or meeting the requirements. But failing to document to the state that they do so.
HARI SREENIVASAN: Roughly how many people do the critics say would be bounced off the Kentucky Medicaid rolls?
AMY GOLDSTEIN: Well I haven't seen any projections as to how many will be bounced off this by the critics. The state itself estimates that by the end of five years, which is the length of this experiment that the federal government is letting Kentucky try, there will be perhaps 95, 000 fewer people on Medicaid than there are today.
HARI SREENIVASAN:All right. As you said this is an experiment the federal government is letting them try. What about the other states that are in line with some ideas of their own or ones that might not be aligned now but are watching Kentucky closely?
AMY GOLDSTEIN: Well, it's interesting because when the Federal Government announced on Thursday that they were going to allow this kind of work requirement in Medicaid there were already nine or 10 states that had submitted applications to be allowed to do this. So Kentucky is the first and the expectation is that there'll be others. Perhaps the next will be Indiana as what I'm hearing that soon will be allowed to follow suit. And even in the day after this was permitted, there were two more states that said you know, we're interested too. So there could be quite a wave of predominantly Republican-led states that are thinking about doing the same thing.
HARI SREENIVASAN: Amy Goldstein of the Washington Post. Thank you so much for joining us.
AMY GOLDSTEIN: Glad to be with you.
