Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Sarah Wackerbarth

Committee Member

Dr. Richard Ingram

Committee Member

Dr. Julia Costich


In January 2018, the Centers for Medicare & Medicaid Services approved Kentucky’s Section 1115 Medicaid demonstration waiver, which gave the state approval to require work/community engagement as a condition of Medicaid eligibility, charge premiums of up to 4% household income, and add an incentive account for dental and vison services. The waiver projected nearly 100,000 fewer enrollees and $2.4 billion less in spending over the five-year demonstration period. Two days short of the waiver July 1st implementation date a federal judge ruled the waiver invalid. This finding held that the Health and Human Services Secretary’s judgement was arbitrary and capricious.

This capstone project was a prospective policy analysis to determine the potential impact of the Kentucky HEALTH demonstration waiver and assess alternatives to the policy. A criteria-alternatives matrix was used to evaluate the policy alternatives. The most viable policy option at this time is for the state to continue Medicaid expansion. While the results are subjective the analytic method can be adjusted as data becomes available.

Included in

Public Health Commons