(The author, Karen Tran-Harding, is a physician at University of Kentucky Chandler Hospital)
In January, Kentucky became the first state in the U.S. to impose requirements on Medicaid enrollees. Those “able-bodied” adults on Medicaid will be required to work or perform job-related activities — volunteer work, employment, job searching or training, education, or caring for a non-dependent relative or person with a disabling chronic condition — for at least 80 hours a month. Patients will have to renew annually and if they do not revalidate their eligibility on time, they can be “locked out”, or denied benefits for 6 months. Frighteningly, many other state Republican leaders including those from Arizona, Arkansas, Indiana, Kansas, Maine, Wisconsin, and Utah have filed similar applications.
Exemptions to the new Medicaid requirements include children, pregnant women, and the “medically frail” – those in hospice, with HIV/AIDS, receiving disability and other individuals that have not been formally defined yet. But what the new Medicaid policies do not take into account are the “able-bodied” adults with substance abuse disorders. Kentucky is one of the states hit the hardest by the opioid crisis and is ranked 2nd in the nation for drug related deaths, with fatalities increasing 85% in the last ten years with overdoses claiming 1,404 lives in Kentucky in 2016.
As physicians practicing at Kentucky’s busiest hospital, we know how detrimental the new Medicaid eligibility requirements can be to the large population of drug addicted residents. *Andrew was a 22-year-old young man that was involved in a major car accident years ago that left him with back pain leading to opioid use and an eventual heroin addiction. He presented to the hospital with life threatening diabetic complications and bacteria in his bloodstream. It was discovered that he had type I diabetes that had gone undiagnosed for some time. And if *Andrew doesn’t get treatment for his substance abuse and continues to inject drugs, he is at risk for a serious infection of the heart and infectious blocking of vessels leading to strokes and other complications including disability and death.
These patients addicted to drugs are very vulnerable to the new Medicaid requirements. As many employers perform regular drug testing, it is very difficult for this population to get a job or even be able to volunteer. Both physically and mentally, these patients may not be capable of attending classes, training for jobs, or caring for others. But these are the people of Kentucky that need Medicaid the most – not just for treatment to prevent potential overdoses but as well as preventative care to combat health complications. *Andrew will need health insurance for his office visits, medications and supplies for his serious health conditions but likely won’t be able to meet the new Medicaid waiver requirements.
Clearly, taking away the safety net of Medicaid – limiting preventative care and treatment and support for patients with substance abuse disorders – can only lead to harm. The purpose of government healthcare programs is to provide the governed with healthcare and none of the patients with mental and physical health problems deserve to lose their insurance. And the opioid catastrophe is not Kentucky’s alone, it is a serious national crisis killing roughly 64,000 people in the United States in 2016, a rise of more than 22 percent over the 52,404 drug deaths recorded the previous year.
Interestingly, governor Matt Bevin created a “Don’t Let Them Die” website that provides information about substance abuse treatment programs by county. But he and other legislators all over the country seem to be doing the opposite – worsening the opioid crisis and potentially allowing thousands of people to die.