In a marathon day of passing bills, last-minute committee hearings and sweeping language substitutions, Kentucky lawmakers delivered 56 bills and five joint resolutions, which carry the weight of law, to the governor Friday.
Those bills are essentially veto-proof — Democratic Gov. Andy Beshear has 10 days to either veto, sign or let them become law without his signature. Then, the Republican-controlled legislature will reconvene for a final two days in late March, in which they need only a constitutional majority of each chamber to override any veto he might issue.
With their final hours ahead of the veto period, state lawmakers pushed through several controversial bills that restrict the use of public funds on gender-affirming transgender medical care and make last-minute changes to the state’s Medicaid system.
The last-minute changes to Medicaid would put in place mandatory work requirements for able-bodied Kentuckians without dependents, requiring Kentuckians to demonstrate “community engagement” in order to receive health benefits.
House Democrats also begged lawmakers to stop targeting the transgender community by banning spending on gender-affirming hormone therapies in prisons and on Medicaid. Republicans cut off debate and questions on each bill before wielding their super majority to easily pass them on mostly party-line votes.
“There’s so many better things that we could be focused on right now, but we’re not,” said Rep. Sarah Stalker, a Louisville Democrat. “We’re continuing to pick apart vulnerable, small communities. And you’re being controlled to think that these are the real issues.”
Medicaid and Work Requirements
At roughly 9:15 p.m., Senate Republicans called a special committee hearing of the Appropriations and Revenue committee to make changes to the state’s Medicaid program, hours before they would send it to the governor for a signature.
They took action on House Bill 695, with a freshly substituted version layered on top of another recently adopted substitute. The appropriations committee met for five minutes to discuss the substituted bill that added 10 new pages and several changes to the other 17.
HB 695 combines the bill’s original provisions — requiring the state Medicaid program create large demographic reports for the General Assembly and stopping the Beshear administration making any changes to eligibility, coverage or benefits — with another priority bill creating the Medicaid Oversight and Advisory Board.
But the version that came before the full Senate for a vote just minutes after a committee adopted it also included a notable change to an existing “community engagement program.” A program which essentially encourages people on Medicaid to gain employment morphed into one that enforces work requirements for able-bodied adults.
Sen. Chris McDaniel, a Republican from Ryland Heights, shepherded the newly-amended bill through the Senate. He confirmed the program is meant to require all able-bodied people on Medicaid who don’t have a dependent, like children or an elderly parent, to fill out additional paperwork specifying their “community engagement,” which would require people to either find work, do job training or do volunteer work to be eligible for medical benefits.
With the addition of two words, the program became a “mandatory community engagement waiver program.” Community engagement refers to a section of federal regulations defining work requirements. The Beshear administration would be required to ask the federal government for permission to set up the new eligibility requirements within 90 days.
Democratic Sen. Cassie Chambers Armstrong from Louisville criticized the process, describing the freshly printed substitute as “life or death.”
“I don't know about y'all, but I believe that when someone is sick, that they should be able to access the care they need to save their life and have health insurance to do that, whether or not they're able to fill out some sort of reporting form that we have put into place that may or may not be meaningful in any way at all,” Chambers Armstrong said.
Work requirements for Medicaid certainly aren’t a new proposition for Kentuckians. In 2018, a federal judge blocked former Republican Gov. Matt Bevin’s plan to implement such work requirements. Under the proposed plan, an estimated 95,000 Kentuckians could have lost coverage.
When HB 695 made its way over to the House, Democratic Rep. Tina Bokanowski of Louisville said she feared for people like her own son, who works but doesn’t always keep up with his paperwork. She said working Kentuckians could get kicked off Medicaid because they are unaware of the new waiver requirements.
“My heart is breaking for the young people who are working who are doing community service just like this bill needs them to be and because of the additional paperwork that this will lead to, may end up leaving them not having insurance,” Bojanowski said. “When they lose their insurance and they get sick, they don’t go to the doctor. And we know what happens then.”
House Republicans moved to limit discussion on the bill after just six minutes of questions and debate.
The legislation also puts back in place “prior authorization requirements” for behavioral health services, which typically include mental health and substance abuse treatments. That means providers would have to request if Medicaid providers will cover a service before providing it.
Anti-Trans Bills
House Republicans ended debate early for two bills that would limit gender-affirming health care in the state after Democrats begged their colleagues not to vote for the legislation. Senate Bill 2 would end hormone treatments for 67 transgender inmates in Kentucky prisons and House Bill 495 would undo Beshear’s executive order to limit conversion therapy and, thanks to a late addition in the Senate — ban Medicaid from paying for gender-affirming transgender treatment and procedures.
Democratic Rep. Lisa Willner of Louisville said ending Medicaid coverage for gender-affirming care would put patients already receiving treatment in medically dangerous situations, including withdrawal symptoms and severe mental health repercussions, with some treatments requiring patients gradually wean off the medication over a multi-month period.
Some Republicans have said that they do not believe any state Medicaid providers currently cover such therapies, but Willner said she knows that is not the case. State Medicaid covers hormone replacement therapy that a doctor deems medically-necessary, and Willner said she has personally spoken with some recipients.
“People are begging us for their lives, for their children's lives. Please, I beg you,” Willner said. “Please understand that these folks we’re talking about who we may be right now about to deliver a death sentence to — they’re somebody's child, they're somebody's siblings, they're someone's parents … Please, folks, please, let's show some mercy.”
HB 495 has changed significantly over its trajectory through the House and Senate. Initially a bill to explicitly protect providers of conversion therapy, it morphed into a bill that undid Beshear’s executive order via a floor amendment. Next, the Senate added the Medicaid rider in a committee substitute Wednesday. It gained final passage when the House agreed with the changes in a 67-19 vote.
SB 2 was the last bill the House voted on ahead of the midnight deadline. It bans the use of gender-affirming hormone treatments or gender reassignment surgeries in state correctional facilities, labeling such a treatment as a “cosmetic service or elective procedure.” The bill apparently targets 67 incarcerated trangender people undergoing hormone treatments, with Republicans acknowledging there is no evidence that any gender reassignment surgeries have taken place in state prisons or jails.
GOP Rep. Kim Moser from Taylor Mill said the state shouldn’t have to pay for what she dubbed “personal choice” and a “cosmetic preference.”
“This is a misallocation of resources, which ultimately hinders our ability to address more pressing societal needs and the very systems that are meant to rehabilitate individuals,” Moser said.
Major medical and psychological associations consider gender-affirming hormones to be medically necessary in many cases.
The legislation also requires people currently on such hormones to be cycled off, with no particular time frame specified, which can create significant physical and mental health implications.
State government and politics reporting is supported in part by the Corporation for Public Broadcasting.
