Kentucky Might Cut Costs by Gamifying Medicaid Benefits

Want healthcare? Better earn those points!

Today in TERRIBLE IDEAS:

Gov. Matt Bevin’s likely Medicaid shake-up scares Kentucky patients

Kentucky is moving closer to an overhaul of the state’s Medicaid program [Gov. Matt Bevin] has said is aimed at controlling costs and encouraging more personal responsibility in consumers, changes that include elimination of basic dental and vision benefits for most “able-bodied” adults who instead would have to earn them through a “rewards” program.

As a reminder: Medicaid is a federal program designed to provide healthcare to people who might not otherwise be able to access it. People with disabilities, people with low incomes, senior citizens who are no longer in the workforce, etc.

The Kentucky state government wants to take Medicaid and gamify it.

The state proposal also includes a “My Rewards” account where people can accumulate points for activities such as passing a GED exam, completing job training or completing wellness activities such as stop-smoking classes, points that go toward the purchase of services such as dental or vision care.

But Medicaid members also would have points deducted from their rewards account for infractions such as failing to pay premiums or “inappropriate” use of emergency rooms up to a negative balance of $150.

Now, just so we’re clear on this: the “My Rewards” system is not designed to give more people access to healthcare. It is designed to cut costs by putting barriers between people and healthcare, and giving the barriers positive names like “passing a GED exam!”

People are already making the obvious criticism: what if you already have a high school diploma or a college degree? What if you already have a job? (Many people who receive Medicaid benefits are employed, often in low-wage jobs that do not provide health insurance.) What if you never started smoking? Are you still going to need to sit through a stop-smoking class in order to earn points to visit the dentist?

This story is starting to go viral, which might mean that we’ll get a response along the lines of “okay, we didn’t really mean it, we’ll find a different solution.”

But who knows. Maybe Kentucky residents on Medicaid should buy a couple packs of cigarettes now, so they can be ready to take a stop-smoking class when it’s time for their annual eye exam.

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