An executive order issued by Kentucky Gov. Matt Bevin (R) would end the state’s Medicaid expansion if any part of the state's newly-approved Medicaid overhaul is struck down by a court.
If the expansion were to end, nearly 500,000 people would lose Medicaid coverage.
The waiver, which was approved on Friday, will allow Kentucky to impose strict work requirements on some Medicaid beneficiaries, as well charge monthly premiums and lock beneficiaries out of coverage if they don’t pay.
Bevin’s executive order would instruct the secretary of the Cabinet for Health and Family Services and the Medicaid commissioner to "take necessary steps to terminate Kentucky's Medicaid expansion" if any part of his plan is struck down in court.
The order, which was also issued on Friday, calls for the expansion to start being dismantled “no later than six months” after all appeals are exhausted.
Bevin ran on a platform of ending the expansion, which was enacted by the state’s previous governor, Democrat Steve Beshear.
Bevin has repeatedly said the Medicaid expansion is not fiscally sustainable, and the waiver is needed to bring down the costs of covering so many new individuals.
According to state officials, Kentucky’s waiver will save the state $2 billion over the course of the five-year project.
As a result of the Medicaid expansion, the state’s uninsured rate has fallen from about 20 percent in 2013 to less than 8 percent by 2016, among the largest coverage gains in the country. About 480,000 people have gained coverage.
Kentucky’s waiver would also eliminate dental and vision coverage for the "able-bodied" population, but beneficiaries would be allowed to earn “reward” points for such services by volunteering, attending classes or other types of activities.
The executive order said that if any of the provisions of the state’s waiver are struck down, the expansion will no longer be affordable.
In a statement provided to The Hill, a Bevin spokesman said that continuing the expansion has always been contingent upon the waiver’s approval.
“Gov. Bevin has consistently said since submitting the [waiver] application that these are the terms under which Kentucky will maintain expanded Medicaid,” Woody Maglinger said.
“Accordingly, he has signed an executive order to terminate Kentucky’s Medicaid expansion in the event that a court decision prohibits one or more of the components of the ... waiver from being implemented.”
No legal challenges to the waiver have been filed, although advocacy groups are gearing up for a fight on both the federal and state level.
The groups say that many of the changes approved in Kentucky by the Trump administration — like requiring “able-bodied” adults to work or volunteer 20 hours a week — violate federal law.
Kentucky was the first state to get a waiver with work requirements and a lengthy lockout period approved. Nine other states are waiting to hear back on their applications, and the Trump administration has indicated approval could come quickly.
Advocates say the waivers will result in massive losses of Medicaid coverage, and are essentially a back-door way for the Trump administration to repeal Medicaid expansion.