To Get Medicaid in Kentucky, Many Will Have to Work


From the New York Times

Kentucky will be the first state to require many of its Medicaid recipients to work or face losing their benefits after the Trump administration approved its plan on Friday.

Advocates for the poor threatened lawsuits, while Gov. Matt Bevin, a Republican, celebrated the approval as “the most transformational entitlement reform that has been seen in a quarter of a century.”

The plan calls for most Medicaid recipients who are not disabled and aged 19 to 64 to work at least 20 hours a week, beginning in July. In addition to paid jobs, they could meet the requirement through volunteer work, job training, searching for a job, taking classes or caring for someone elderly or disabled.

Pregnant women, full-time students, primary caretakers of dependents and the chronically homeless will be exempt from the work requirement, as will people deemed medically frail. But the Bevin administration still expects about 350,000 people to be subject to the requirement, which will be phased in around the state starting in July. About half of them already meet it, according to the administration.

“We are ready to show America how this can and will be done,” Mr. Bevin said at a news conference in Frankfort. “It will soon become the standard and the norm in the United States of America, and America will be better for it.”

Roughly 500,000 adults have joined Kentucky’s Medicaid rolls since the state expanded the program under the Affordable Care Act in 2014. Mr. Bevin has consistently attacked the expansion as a waste of money, questioning why “able-bodied” adults should be given free government health care that used to be largely limited to children, the elderly and the disabled.

He filed for federal permission to impose work requirements in 2016 — notably, instead of seeking to end the state’s Medicaid expansion altogether. And since then, more than a dozen other states have also sought work requirements or said they plan to. Several sought Medicaid work requirements during the Obama administration but were rebuffed.

The approval came just a day after the Trump administration gave states the O.K. to impose work or other “community engagement” requirements as a condition of getting Medicaid. According to the nonpartisan Kaiser Family Foundation, 60 percent of working-age Medicaid recipients who aren’t disabled already have full- or part-time jobs.

Under its plan, Kentucky will also require many adults who aren’t elderly or disabled to pay premiums of $1 to $15 a month, depending on their income. And it will disenroll people from Medicaid for up to six months if they fail to report changes in income or work status. Those who qualified for Medicaid under the Obamacare expansion will also have to “earn” dental and vision benefits, which they have been able to access freely until now, through activities like taking a financial literacy course or getting a GED.

The Bevin administration has estimated that the plan will result in 100,000 fewer Medicaid recipients after five years and save $2.4 billion, mostly in federal Medicaid funds. But Mr. Bevin couched the policy change as a moral rather than a fiscal decision, saying he did not care about the savings and saw it as an opportunity for Kentucky’s poor “not to be put into a dead-end entitlement trap but rather to be given a path forward and upward so they can do for themselves.”

Advocates for Medicaid beneficiaries said they disagreed with the Trump administration’s assertion, in approving Kentucky’s plan, that work requirements were consistent with the goals of Medicaid because work could improve people’s health.

“Considering that it will seriously harm over 100,000 Kentuckians, in violation of numerous provisions of Medicaid law, we are very seriously considering taking legal action — and as we analyze the meager legal rationale in the approval itself, it seems inevitable,” said Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for the poor.

Emily Beauregard, the executive director of Kentucky Voices for Health, an advocacy group, said the state had provided little information about how it would make sure people were complying with work requirements, how exemptions would be determined and other details.

“We’re anticipating Kentuckians by and large are going to be extremely confused and worried about what they’re going to face and whether or not they’ll continue to have coverage,” Ms. Beauregard said. “They’ll be looking to advocates and enrollment assisters and their providers for answers, and at this point we don’t have any.”

She added, “The idea that we are encouraging work and independence, then taking away the health care that makes people more employable and better able to function — none of this adds up to something that’s going to be good for Kentuckians or our economy.”

But Hal Heiner, Kentucky’s Education and Workforce Development secretary, said during Mr. Bevin’s news conference that there was “an abundance of jobs” available to Medicaid recipients, as well as resources to prepare them.

“We have the jobs, we have the tuition resources, we have the job coaches in our career centers all across the state,” he said, “and now we’ll be able to connect the dots.”

Other state officials said the state was building an IT system to track people’s compliance with the work and premium requirements and participation in activities, like taking the financial literacy course, that would earn them points toward dental and vision care. They did not, however, provide a cost estimate for building and maintaining the administrative infrastructure necessary to monitor compliance with the new requirements.

Kentucky’s uninsured population has dropped more than almost any other state’s under the Affordable Care Act, and several studies have found significantly increased access to primary care, preventive screenings and care for chronic conditions there since the Medicaid expansion. But the state’s population remains unhealthy overall, which Mr. Bevin pointed to as proof that the Medicaid expansion was not working.

“The idea that we should keep doing what we’re doing is an insult to the people of Kentucky,” he said.

Sheila Schuster, a longtime health care advocate in the state, said she saw it differently.

“The administration has their chicken-and-egg story completely wrong — they say people need to work to get healthy,” she said. “We all know that health is the foundation from which people go to school, go to work and keep their employment. So I’m afraid the administration is not only going backward, but doing it for completely the wrong reasons.”

Such opposing views were evident in comments people posted on Mr. Bevin’s Facebook page during his news conference, which was livestreamed there. “ABOUT TIME to get others to pull their weight!” one viewer in favor of the new requirements wrote.

“I feel this is wrong,” another said. “Wouldn’t they not be in Medicaid if they could get a job?”






Forget baby showers. There’s a proposal to give every newborn in the United States a Baby Bond account with somewhere between $500 and $50,000 in cash. Neither the kids nor their parents would be able to touch the money until the child turned 18. Then the young adult could spend the trust fund on attending college, buying a home or starting a business.

The whole point of Baby Bonds would be to dramatically lessen wealth inequality in America, according to the economist who came up with the idea, Darrick Hamilton of The New School and William Darity of Duke University.

“The key ingredient of how successful you will be in America is how wealthy your family is,” Hamilton says. Baby Bonds are one way to change that, he argues. He presented the idea at the American Economic Association conference in Philadelphia this weekend.

Under the proposal, kids of incredibly rich parents such as Bill and Melinda Gates or Beyoncé and Jay-Z would get the lowest amount of $500 while babies born into extremely poor families would get the highest amount of $50,000. There would be a sliding scale to determine how much each baby would received based on their parents’ wealth. A typical middle-class baby would receive around $20,000.

While there are a number of criticisms about Baby Bonds, especially how to pay for it, presidents and prime ministers around the world are trying to figure out ways to reduce inequality. In the United States, inequality is back at the levels of the 1920s Gilded Age. It’s gotten so bad that Wall Street firms are warning their clients to pay attention to it because inequality is driving the rise of populism. Torsten Slok, Deutsche Bank’s chief international economist, says the United States and other nations are going to need creative thinking to address this. He called Baby Bonds an “intriguing” idea.

Nearly a third of American households now have $0 in wealth, according to Deutsche Bank, the worst situation since the U.S. government began keeping track of that statistic (wealth outside of a home) in the early 1960s.

Families of color have struggled especially hard to try to move up the socio-economic ladder. The median net worth of white households is 10 times the size of African-American households.

“People like to argue if only poor black and Latino families were more responsible and made better decisions, then inequality could be dramatically reduced,” says Hamilton. But years of data and real-life evidence don’t support that. Hamilton points to the fact that most college-educated African Americans have less net wealth than whites who dropped out of high school.




The city of Berkeley, California, where the police department doesn’t have a gang task force, drug task force, special investigations unit, canine officer, DARE officer, vehicle dash camera or taser, is losing officers by the bundle. In 2017, 26 members of the force quit.

In 1999, there were 215 cops on the beat; that number may soon diminish to less than 140. Meanwhile the city’s population has grown from 108,000 to 121,000.

As Blue Lives Matter notes,In 2016, Berkeley cops responded to 78,000 incidents, conducted over 3,200 arrests, issued 5,600 citations and reported only 32 uses of force … in 2006, Youth Services was staffed with 3 School Resource Officers, 3 Youth Services Detectives, 1 Youth Services Sergeant, and 1 citizen Youth Counselor – 8 people working on the problems and the concerns regarding our Berkeley youth. Now, that same unit operates with only two Detectives.”

In mid-December, Berkeley Police Chief Andrew Greenwood told the Police Review Commission, “We’re descending to a critical period and it has gotten worse rather than better. We have lost so many officers that we’re going to have to rethink a bit of how we do business.”

“We’re going to have to figure out how we retain our ability to handle some of the most critical aspects of that while having them work on patrol,” he said, adding that one or more area coordinators from the Community Services Bureau might have to return to patrolling. “There are no other areas for us to pull people from,” Greenwood concluded.

The Berkeley Police Association stated, “BPD is no longer competitive in hiring. Most neighboring departments offer incentives to prospective officers, including opportunities to work in specialized investigative units, such as a drug or gang task force. They offer the opportunity to work as a canine officer, a bicycle officer or as a traffic officer. They have the industry standard tools such as in dash cameras, body cameras and tasers. And they also offer hiring bonuses. BPD offers NONE of those.”






Burglaries, thefts and some assaults are being ignored unless a victim report identifies a suspect.

Top cops have decided to stop probing hundreds of thousands of crimes in an effort to save money

It was revealed to the Met’s 30,000 officers last month in a £400million cost-cutting move.

A former police chief said: “No consideration is being given to victims.”

Critics say the Met is failing taxpayers by refusing to detect a range of offences.

They fear the worst criminals will evade justice — and force the public to turn vigilante.

Critics fear that the worst criminals will not face justice and could force the public to become vigilantes

Changes to the way victims’ reports of a crime are assessed are expected to see 150,000 fewer offences being investigated each year. The new guidelines say:

  • BURGLARIES should only be probed if culprits have used violence or tricked their way in;
  • CRIMES involving a loss of under £50 should not be investigated unless there is an identified suspect;
  • OFFICERS need not probe low-level incidents of grievous bodily harm or car crime unless there is an identifiable suspect;
  • CCTV should only be analysed if the crime occurs in a 20-minute time frame and sharp images showing a suspect can be collected immediately.

Guidelines released to 30,000 officers change the way victims’ reports of a crime are assessed

The Met aims to save £400million by 2020. That comes on top of £600million it has already lost from its £3.7billion annual budget due to Government curbs on public spending.

Ex-Met Det Chief Insp Mick Neville said: “This is justice dreamed up by bean counters in shiny suit land.

“No consideration is being given to victims. The new principles will focus police attention on easy crimes where there is a known suspect.

“Few professional criminals target people who know them, so the worst villains will evade justice. Not investigating high volume crimes like shoplifting with a loss of under £50 will give junkies a green light to thieve.”

Officers will not probe low-level incidents of harm or car crime unless the culprit can be identified

Ken Marsh, of the Met Police Federation, added: “The public are getting a raw deal. And officers will be under immense pressure if a criminal who should have been caught goes on to commit a serious crime.
“I see people taking the law into their own hands.”

Met chiefs believe they will reduce the overall number of investigations by a third without affecting detection figures, which are currently at 16.72 per cent.

A list of serious crimes including murder, sex offences and terrorism will still receive mandatory investigations.

By the end of 2018 officer numbers will have fallen to 28,000 from 32,000 12 months ago, says Mr Marsh.

In the new guidelines CCTV will only be analysed if the crime occurs in a 20-minute time frame

Recorded crime in the capital rose by 5.7 per cent to 774,737 offences in the year to April 1. Gun crime was up 42 per cent and knife crime by a quarter.

Earlier this year The Sun revealed the Met solved eight per cent of 493,257 recorded burglaries from 2011-16.

It failed to identify a suspect in 85 per cent of those cases.

Deputy Assistant Commissioner Mark Simmons said: “Serious crime and calls are up while officer numbers are down. The only solution is to prioritise things.

“We want officers focused on the more serious crimes where there is a realistic chance we can solve it.”

The new guidelines say that certain crimes do not need to be investigated unless a suspect can be identified.