Early in May, both Kentucky and West Virginia received approval from the federal Centers for Medicare and Medicaid Services (CMS) to move forward on plans to redesign their Medicaid programs. Taking advantage of the flexibility outlined by the 2005 Deficit Reduction Act, both states utilized the state plan amendment process.
Both Kentucky and West Virginia have looked to expand beneficiary choice and encourage patient responsibility in the Medicaid program by utilizing consumer-directed benefit designs. Their plans include the use of some type of personal account that is generally designed to encourage Medicaid enrollees to use preventive services and make healthy lifestyle decisions.
Kentucky’s KyHealth Choices program, will offer four different benefit packages tailored to specific populations (a general Medicaid population, children, the elderly and disabled, and beneficiaries with mental retardation) and their unique needs. The program also calls for the creation of Get Healthy benefits which allow individual members with specific diseases to access certain additional benefits such as vision, dental, smoking cessation, and nutrition visits if they participate in certain healthy practices identified by the Commonwealth.
The cornerstone of West Virginia’s plan is the Healthy Rewards account which is intended to foster and reward healthy choices among Medicaid beneficiaries. For those beneficiaries that sign a ‘personal responsibility contract’ outlining a plan to improve their health (developed in conjunction with their primary care providers), a fixed amount of credits per quarter is deposited into their accounts. The credits can be used to cover medical and pharmaceutical co-pays and bonus credits are added for meeting health goals. Individuals choosing not to sign the contract or who do not meet the goals outlined in their contract will face reduction of or caps on certain benefits. The state plans on implementing the newly redesigned plan over the course of four years. As of July 1, 2006, the program will be available for children and adults with children.
For more information on Kentucky’s program please visit: http://chfs.ky.gov/NR/rdonlyres/70AC8C04-BDEF-4A64-AB06-45FEE8285A04/0/medicaidTransformationInitiative.pdf
To learn about West Virginia’s program, please visit: http://www.wvdhhr.org/bms/
