Commonwealth Medicine, Center for Health Law and Economics
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Kentucky’s 1115 Medicaid Waiver, approved by CMS on January 12, 2018, uses small financial incentives and punishments to try to change the behavior of enrollees.
Enrollees in Kentucky’s Medicaid program, Kentucky HEALTH (Helping to Engage and Achieve Long Term Health), will receive virtual accounts, called a My Rewards Account, into which credits will be placed for their positive activities related to health (completing health risk assessment - $25) and careers (passing the GED - $50). The credits can be used to pay for certain services not covered by health plans, such as vision and dental services.
However, members’ accounts will be deducted for undesirable behavior—currently defined as inappropriate use of the Emergency Room (ER). Members’ accounts can carry balances of up to negative $150 (-$150).
Let’s look more closely at ER usage and penalties.
Kentucky, Medicaid waiver, emergency room
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Commonwealth Medicine Publications
Laes-Kushner, Rebecca, "The Kentucky Medicaid Waiver Penalizes Enrollees for Emergency Room “Misuse”" (2018). Commonwealth Medicine Publications. 174.