Princess Health and UK pays big to settle a health-care debacle but keeps almost all details under wraps; Herald-Leader says trustees should worry. Princessiccia

Princess Health and UK pays big to settle a health-care debacle but keeps almost all details under wraps; Herald-Leader says trustees should worry. Princessiccia

hospitals Medicaid Medicare open government open records University of Kentucky

Gusty 05:37 Add Comment

"The University of Kentucky has spent more than $5 million in the last year to fix federal billing issues involving a Hazard cardiology practice it acquired three years ago, but UK officials have declined to provide documents detailing problems that led to the payments," including an audit of the Appalachian Heart Center that UK calls "preliminary" though the issue has been resolved, Linda Blackford reports for the Lexington Herald-Leader.

Most of the money went to Medicare and Medicaid, but $1 million went to a Washington lawyer whose billing records the university largely refused to release, citing attorney-client privilege. The university's trustees were told about the matter at a dinner meeting, which the Herald-Leader said it didn't cover because the agenda for the meeting did not include the matter. UK says no minutes were taken at the meeting, normally a social event that precedes formal meetings the next day.

The Herald-Leader said it would file an appeal with the attorney general, whose decisions in open-records and open-meetings matters have the force of law unless a court rules to the contrary. �We have strong concerns about the overall lack of transparency by the university in this case,� Editor Peter Baniak said. �Records about the issues involving this clinic should be public, as should the information presented and discussion that took place in an open meeting of the board of trustees.�

In an editorial, the newspaper attacked UK officials' secrecy about the case and other health-care issues, such as appealing an AG's decision that that the Kentucky Medical Services Foundation isn't a public agency. "Their imaginative legal arguments and bizarrely incomplete responses to requests for information by the Office of the Attorney General, this newspaper and a private individual should embarrass and trouble the trustees," it said, noting that a UK official said the university paid back "more than what was required."

"Who pays an attorney $1 million to settle a dispute by paying more than was owed?" the editorial asked. "If this were a one-off we might think that UK HealthCare and KMSF, which handles billing for UK physicians, are just muddling around to avoid admitting their deal went bad. But it�s only the latest in a series of stories that indicate a pattern of secretiveness in UK�s vast health-care empire."

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

health insurance Kynect Medicaid obamacare state government

Gusty 16:00 Add Comment

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Princess Health and Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

Princess Health and Health advocacy group says revised Medicaid program should improve health and manage cost, without creating barriers. Princessiccia

health care costs health insurance insurance coverage Medicaid

Gusty 14:16 Add Comment

By Melissa Patrick
Kentucky Health News

A health-care advocacy group says the redesign of the Medicaid program should build on the expansion of eligibility and not include any more costs for patients.

�Kentucky has made tremendous gains in improving the health of its people since the expansion of Medicaid. More Kentuckians are receiving preventive services, substance use treatment and other critically needed care than ever before,� Emily Beauregard, executive director of Kentucky Voices for Health, said in a news release. �Any changes to the program should build on this success.�

Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to households with incomes up to 138 percent of the federal poverty level, which added about 400,000 more Kentuckians to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020. In all, about 1.3 million Kentuckians get free health care through Medicaid.

Gov. Matt Bevin has said the state can't afford to have more than a fourth of its population on Medicaid and has charged his administration to come up with a revised program that will improve health outcomes while making the expansion financially sustainable. Bevin hopes to accomplish this through a waiver from the federal government.

Bevin has said he favors a waiver program like Indiana's, which includes premiums and co-pays in some tiers of coverage, but has also said that he is not limited by this model and will develop a waiver to best fit the needs of Kentucky.

Kentucky Voices for Health is a coalition  of organizations that favor federal health reform, some of of which lobby the government. It said changes should engage consumers in their care and develop new ways to deliver care, without any obstacles to coverage such as premiums.

�Coverage is foundational,� Rich Seckel, executive director of Kentucky Equal Justice Center, said in the release. �It empowers us with tools to achieve and maintain health.�

The coalition also said the program should focus on coordination of care in areas with high use, and build on Kentucky's Health Data Trust, which provides complete and transparent information about healthcare utilization and outcomes to improve public health and quality of care delivery. Click here for the full report.

The group stressed the importance of meaningful stakeholder input to ensure the waiver is designed to meet the unique needs of Kentucky. So far, the administration has had no formal stakeholder meetings on the issue.

Under federal law, states seeking a waiver must hold at least two public hearings; one before it is submitted to the Centers for Medicare and Medicaid Services and the second after CMS accepts the application.

Amanda Stamper, press secretary to Bevin, told The Courier-Journal that the administration welcomed "this sort of thoughtful input," and when asked if the waiver would include any premiums or co-pays said, "Everything is on the table and no decisions have been finalized."

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

Princess Health and State Medicaid boss says program won't charge premiums but may have fewer benefits; Bevin's office says all is still on the table. Princessiccia

governor health insurance health reform Medicaid obamacare politics state budget state government

Gusty 19:05 Add Comment

The state's revised Medicaid program won't require any beneficiaries to pay premiums, but it may offer fewer benefits, Medicaid Commissioner Stephen Miller told Adam Beam of The Associated Press.

But Gov. Matt Bevin's office told Beam that Miller's comments were preliminary: "Everything is on the table and no decisions have been finalized," spokeswoman Jessica Ditto told him.

Bevin has said Medicaid recipients should have some "skin in the game" and has pointed to Indiana, which received a federal waiver allowing it to charge premiums based on income levels to people who want benefits beyond the basic Medicaid program.

The idea drew strong opposition from health-care providers, consumer advocates, public-health professionals and representatives of higher education in a May 12 meeting, according to the Foundation for a Healthy Kentucky, which convened the gathering.

"Miller said negotiations with officials at the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, indicate they will not approve a plan that requires Kentucky's expanded Medicaid population to pay for a portion of their health insurance," Beam reports.

Miller told him, "That, today, is not part of the plan. That is something that's going to be a tough sell."

Bevin is seeking changes that will save the state money. Starting Jan. 1, it will have to pay 5 percent of the costs of those who have joined Medicaid under the expanded eligibility created by the federal health-reform law. Its share will rise in annual steps to the law's limit of 10 percent in 2020. The state's expected bill for 2017 and the first half of 2018 is $257 million.

Now it seems that savings are likely to come by cutting benefits. "Miller said some Medicaid recipients could see fewer benefits under the new plan," Beam reports. "He said the health insurance plan for the state's Medicaid recipients is better than the basic plan offered to state employees. He said the new plan will likely bring the Medicaid plan more in line with the health plan offered to state workers." Miller said, "That would be a reduction in some benefit levels, such as in vision, dental."

Also, Miller said the program could encourage healthier behaviors by funding health savings accounts if they did such things as participating in smoking-cessation and weight-loss programs. "It may sound like we are rewarding them for that, but the long-term effect is it makes their health care coverage less expensive,"  Miller told Beam.

He said the state hopes to submit its waiver application in September. HHS spokesman Ben Wakana, told Beam that any changes "should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care, and financial security." Before the expansion; 20 percent of Kentuckians had no health coverage; now the figure is 7.5 percent.

Princess Health and Clark County schools to provide mental health services via contract with agency that can bill Medicaid or private insurance. Princessiccia

Princess Health and Clark County schools to provide mental health services via contract with agency that can bill Medicaid or private insurance. Princessiccia

behavioral health children's health education Medicaid mental health schools teenagers teens youth

Gusty 06:22 Add Comment

Facing a surge in behavioral health cases among students, the Clark County Board of Education has contracted with a mental-health agency services for all preschool through high school students in the district.

Mountain Comprehensive Care will place a mental health therapist in every school to address issues immediately, at no cost to the district, Whitney Leggett reports for The Winchester Sun: "In the past three years, the district has seen the number of students in the home-hospital program because of mental-health issues surpass those with physical ailments."

Greg Hollon, director of pupil personnel and support services, told Leggett, �Previously, about 80 percent of home-hospital students were for physical ailments and 20 percent for mental. Fast forward a couple of years later, and that has switched to 65 percent mental, 35 percent physical.�

Hollon said the therapists at each school will help the district stay on top of problems. �This puts someone in the buildings full time to be there to address issues as they occur,� rather than requiring staff to call Mountain or some other agency.

Mountain, based in Prestonsburg, is able to provide the service without charge because it can bill Medicaid or private insurance.

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

federal spending health care costs health insurance insurance coverage managed care Medicaid obamacare Patient Protection and Affordable Care Act state government

Gusty 13:11 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Groups of people concerned about changes in Kentucky's Medicaid program are open to the state offering incentives for healthy behaviors, but they don't want to penalize recipients who can't or won't pay premiums, deductibles or co-payments.

So reports the Foundation for a Healthy Kentucky, which convened a meeting May 12 to hear from people with stakes in the program: individual health-care providers, health systems, consumers, consumer advocates, payers, public-health professionals and representatives of higher education.

�Participants were unified in opposing penalties to enforce cost-sharing provisions� such as premiums, deductibles or co-payments, the foundation's consultant said in a report on the meeting.

However, they supported cost sharing for procedures not deemed medically necessary and �had diverse perspectives on this matter, ranging from opposing any cost-sharing in Medicaid to proposing specific premium and co-payment amounts,� such as $5 monthly premiums.

Also, �Participants were generally very supportive of implementing incentives for healthy behaviors such as smoking cessation and health risk assessments,� the report said. �Incentives might be reductions in the amount of cost-sharing or themselves supportive of healthy behavior,� such as gym membership.

Gov. Matt Bevin has said he wants Medicaid recipients to have "skin in the game" through cost-sharing, arguing that Kentucky can't afford to have more than a fourth of its population getting free medical care.

Under federal health reform, then-Gov, Steve Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level, adding more than 400,000 more people to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin's administration is working on getting a waiver from the federal Centers for Medicare and Medicaid Services to create new ways to cover those in the expansion. Six states have such waivers, including Indiana, which Bevin has cited as an example of how Kentucky might change its program.

In Indiana, recipients who pay premiums based on income levels, ranging from $1 a month to 2 percent of income ($27 a month for those at 138 percent of poverty) get expanded benefits and are charged co-payments only for non-emergency use of emergency rooms, according to the Kaiser Family Foundation. Those above the poverty level who fail to pay are disenrolled and barred from re-enrolling for six months, in what is known as a "lock-out" rule.

Bevin has indicated that he wants to announce his plan this summer. By law, states that seek a waiver must hold at least two public hearings: one at least 20 days before submitting the application to CMS, and the second after CMS accepts the application.

Stakeholders who attended the foundation's May 12 convening wanted to make sure their voices were heard early on in the process.

"Our goal is to help inform the process of changing the way Kentucky provides Medicaid services to ensure that we maintain the gains achieved under the Affordable Care Act, while also enabling the state to try new methods of ensuring access to affordable quality health care for Medicaid beneficiaries," Foundation President and CEO Susan Zepeda said in a news release.

"The biggest takeaway for me was the energy and commitment in the room," Zepeda said in a telephone interview. "A lot of thoughtfulness clearly went into sharing their experience and making suggestions on how to make the system more cost effective."

Before breaking into groups to offer their imput, stakeholders were given an overview of the state's Medicaid expansion and an overview of an issue brief created by the State Health Access Data Assistance Center at the University of Minnesota that looked at how waiver provisions are set up in five other states. Foundation staff wrote the 25-page "Stakeholder Input Report" that summarized suggestions and concerns and broke them into eight areas:

Cost-sharing and penalties: Health-care providers strongly opposed any cost-sharing, and uniformly opposed to any measure that involved "lock-out" penalties for failure to pay premiums, co-pays or deductibles.

"Our shared experience has been that we�ve been prohibited from denying care if a patient refuses or is unable to pay," the Physical and Oral Health Provider group said. "Therefore, the desired behavior isn�t actually enforced."

The Behavioral Health Provider group offered a compromise: �If the administration chooses to explore lock-outs we recommend that lock-outs be immediately lifted (upon payment) and payment be retroactive to the date the consumer re-enrolls.�

Participants in general were open to the idea of low co-payments, cost-sharing for non-medically necessary services, using Medicaid dollars to pay premiums for employer-sponsored insurance plans and charging co-payments for non-emergency use of the ER. They also agreed that certain groups, like those with chronic illnesses or disabilities, should be exempted.

Incentives: Most post-ACA waiver programs have implemented incentives for healthy behavior, and those at the meeting generally supported implementing evidence-based incentives, such as smoking cessation and health-risk assessments.

Zepeda said that most of the stakeholders wanted to see healthy behavior incentives used as credits against premiums, especially for recipients who can't afford them. "There is a recognition that people have a role to play in their own health care and the health decisions that they make," she said.

Benefits: Benefits include services covered under the health insurance plan. Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits like housing. All agreed that medically necessary services should be covered for all enrollees.

Reimbursement: Kentucky shifted Medicaid in 2011 to managed care, in which managed-care organizations (usually insurance-company subsidiaries) are paid a flat fee per person as an incentive to limit claims. Providers have complained about the slow and low reimbursement, and participant suggestions included streamlining and accelerating the reimbursement process, increasing provider reimbursement rates, and adding new categories of reimbursed services and providers, like telehealth.

Systems improvement: Participants suggested simplifying administrative processes for providers; expanding providers' scope of practice; adding review panels; reducing the number of managed-care organizations; and creating a single list of drugs for all MCOs.

Health system transformation: Waivers allow states to explore ways to provide care differently through various transformation approaches. Suggestions included creating price transparency, through an all-payer, all-claims database; improving consumer health literacy; and moving beyond coverage issues to addressing access and quality.

�There was also interest among our group in examining a PCMH (patient-centered medical home) or health homes model to promote care coordination, and we feel strongly that pharmacists are essential part of the team and should be used in novel and more expansive ways,� the Colleges and Universities group said.

Evaluation: Waivers require states to perform an evaluation and make it public. Participants agreed that the process should include stakeholders and that findings should be made public periodically.

The Physical and Oral Health Provider group suggested the evaluation should answer the questions, �Have we maintained coverage levels? Have we improved access to care?�

Overarching themes: Many of the stakeholders mentioned two issues that were not included in the issue brief or discussion: integrating behavioral, physical and oral health services, and addressing the wide set of social factors that shape Kentucky's relatively poor health.

�Waivers should include methods to address social determinants of health as these areas are proving most effective in improving outcomes and reducing cost,� the Physical and Oral Health Provider group said. �We encourage inclusion of community health workers, peer support, medical respite care and other innovations to support social needs of patients.�

Zepeda said the Medicaid waiver drafting team faces many challenges. "We consider the rich conversation that happened on May 12 to be the start of the conversation," she said. "We have to find the cost effective win/win strategies that can reduce the cost of Medicaid going forward and let us continue to serve this expanded number of Kentuckians who now have health insurance."

Princess Health and Bevin says he will transform programs for kids with special health needs constructively and in a 'forward-thinking way'. Princessiccia

Princess Health and Bevin says he will transform programs for kids with special health needs constructively and in a 'forward-thinking way'. Princessiccia

children Medicaid state government youth

Gusty 11:46 Add Comment

Gov. Matt Bevin told stakeholders for children and youth with special health-care needs May 25 that his administration  is �committed to transforming, in a positive, constructive, proactive and forward-thinking way, the services you provide. We truly are grateful for what you do day in and day out.�

A state press release said almost 100 doctors, public-health specialists, insurers, health-care providers, state and federal officials, family members and others attended the Kentucky Summit on Access to Care for Children and Youth with Special Health Care Needs, cosponsored by the Commission for Children with Special Health Care Needs.

�There is an absolute need for us to take care of these children,� Bevin said. �We owe them that as a society, as Kentuckians, as human beings. It�s our obligation.�

CCSHCN Executive Director Jackie Richardson said Kentucky is estimated to have 197,916 children and youth with special health-care needs, a rate higher than the national average. Children and youth with special health care needs are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond what is generally required.

The summit in Frankfort was part of a learning collaborative sponsored by several national groups, including the National Governors Association and the National Conference of State Leguislatures. �We wanted this summit to provide a national perspective on the access to care provided through the commission,� she said. �With the group discussions we had today, we identified strategies to improve access to care and increase awareness of our programs.�

The commission has clinics that help with conditions like otology, orthopedics, severe cleft lip and palate and cerebral palsy. The commission also has a growing neurology program and has introduced autism clinics to improve access to diagnostic and medical resources for families in Eastern and Western Kentucky. �Many of them will need a lifetime of special care, and summits like today's help ensure they will have consistent, coordinated and comprehensive access for as long as they need it,� Richardson said. For more information about the commission's programs and services, see chfs.ky.gov/ccshcn.

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

economy federal spending health reform jobs Medicaid obamacare Patient Protection and Affordable Health Care Act politics prevention state budget state government

Gusty 13:15 Add Comment

By Danielle Ray

Kentucky Health News

A research group with a liberal outlook warned Monday that Republican Gov. Matt Bevin should be careful in changing the state Medicaid program.

The Kentucky Center for Economic Policy said the state�s expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has increased health screenings and job growth in health care.

Tobacco counseling and interventions increased 169 percent from 2013 to 2014, the first year of the expansion, the report noted. Influenza vaccinations went up 143 percent and breast cancer screenings increased 111 percent, it noted.

In addition, Medicaid expansion brought Kentucky health-care providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job growth in the health-care sector from 2014 to 2016, according to the report.

�No matter how you look at Medicaid expansion in Kentucky, it�s clear it has had a positive effect on access to health care that will improve our state�s economy and quality of life,� Jason Bailey, executive director of KCEP, said in a news release.

However, Bevin says the state can�t afford to have more than a fourth of its population on Medicaid and is seeking a waiver from the federal government to make changes in the program, such as �skin in the game� for beneficiaries: co-payments, deductibles or health savings accounts, as used in a year-old experiment in Indiana, which he has cited as an example.

The KCEP reports says the Medicaid waiver Bevin is seeking could result in additional costs to recipients and benefit changes. Arkansas was the first state to design a Medicaid expansion using such a waiver. So far, five other states have implemented similar waiver-based programs.

Waiver programs differ from standard Medicaid expansion in that they utilize some or all of the following: health savings accounts, a cost-sharing account to be used for health care expenses; lockouts, periods in which recipients who have been dis-enrolled for failure to pay premiums are barred from re-enrolling; and premium assistance, the use of Medicaid funds to buy private insurance plans.

These waivers are designed to grant states the freedom to enact experimental programs within Medicaid, so long as the programs continue to reflect the overall goal of Medicaid, increasing coverage of low-income individuals and improving overall health care, as well as efficiency and stability of health care programs that serve that population.

The Foundation for a Healthy Kentucky, which convened a meeting of Medicaid stakeholders last week, is holding off on making judgments of the proposed waiver program. �We believe that diverse input is essential to sustaining these gains, and to continue improving our health care system and health outcomes in Kentucky,� said Susan Zepeda, president of the foundation.

Zepeda said research the foundation has funded has shown a greater decrease in the number of Kentuckians who lack health insurance than any other state, which she attributes largely to Medicaid expansion adding about 400,000 Kentuckians to the rolls.

More than 1.4 million Kentuckians are enrolled in Medicaid, 39 percent of whom are children. Nearly 32 percent are enrolled under the expansion: childless adults in households that earn less than 138 percent of the federal poverty line, currently $33,000 for a family of four.

The KCEP report also asserts that Kentucky�s Medicaid benefits are on par with those of other states, specifically that 12 out of 13 of Kentucky�s optional benefits are also covered in at least 40 other states and territories. Kentucky Medicaid only covers services that are deemed medically necessary.

KCEP noted that Medicaid is a partnership in which the federal government funds a minimum of half of traditional Medicaid spending in each state, with poorer states receiving a larger federal match. In Kentucky, the federal share is about 70 percent. For people covered by the expansion, the federal government is paying the full cost through this year, but the state will pay 5 percent in 2017, rising in annual steps to the law�s limit of 10 percent in 2020.

The full KCEP report is at http://kypolicy.org.

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Princess Health and Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care. Princessiccia

Foundation for a Healthy Kentucky health care access health insurance insurance coverage Kynect Medicaid prevention research

Gusty 13:54 Add Comment

By Melissa Patrick
Kentucky Health News

The share of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform's impact in the state.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the Patient Protection and Affordable Care Act is affecting Kentuckians.

The report found that the rate of people without health insurance in Kentucky continues to drop.

In December 2015, the uninsured rate was 7.5 percent, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the PPACA, Kentucky's uninsured rate was 20.4 percent.

Since December 2013, Kentucky's uninsured rate has dropped 12.9 percentage points, more than double the national decline of 5.6 percentage points, says the report. Uninsurance rates can vary depending on how they are measured. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.

"Lack of insurance is a significant barrier to getting necessary health care and preventive services timely," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions."

Kentucky also continues to have a lower uninsured rate than its eight nearest surrounding states, although Ohio (7.6 percent) and West Virginia (7.7 percent) are catching up. Missouri (11.6 percent), Tennessee (13 percent) and Virginia (12.6 percent), the three states surrounding Kentucky that did not expand Medicaid, have the highest uninsured rates. (SHADAC map)

And while the state saw a smaller share of new health-insurance customers than the country overall (20 percent versus 39 percent), Kentucky had the largest percentage of re-enrollees (59 percent) return to Kynect, the state's health insurance marketplace, to select plans compared to the rest of the nation (36 percent). Twenty-two percent of Kentuckians were automatically re-enrolled in plans.

Kynect, created by the Democratic administration of Steve Beshear, is in the process of being dismantled by the administration of Republican Gov. Matt Bevin, so Kentuckians will have to sign up for their health insurance through the federal exchange, healthcare.gov, during the next enrollment period which begins Nov. 1, 2016 and runs through Jan. 31, 2017.

Traditional Medicaid enrollees will sign up through Benefind, the state's new one-stop-shop website that can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

Expansion of Medicaid added about 400,000 Kentuckians to the program, and many of them have taken advantage of its free services to get screened for diseases and have physical or dental examinations.

Dark blue: traditional Medicaid enrollees
Light blue: Medicaid expansion enrollees

The latest report, which covers the fourth quarter of 2015, says 823 traditional Medicaid enrollees got screened for diabetes, compared to 2,959 Medicaid expansion enrollees. This was also true for colorectal screenings (see graph).

Overall, the study found that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance-abuse treatment services, and 5,589 colorectal-cancer screenings to enrollees aged 19-64.

Under federal health reform, Beshear expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

However, the future of the expansion is uncertain. Bevin has said that the state cannot afford its Medicaid population of about 1.3 million, and has charged his administration with designing a new Medicaid program, which will require federal government approval. He told reporters in early May that he was optimistic that the Centers for Medicare and Medicaid Services will approve the state's new plan, but if they don't it will be because "CMS does not want to see expanded Medicaid continue in Kentucky."

The study found that Medicaid enrollment continues to be the highest in Eastern Kentucky with 31 percent participation, followed by Western Kentucky at 26 percent participation.

It also notes that while levels of uncompensated care have dropped for both urban and rural hospitals since 2013, rural hospitals saw slight increases in uncompensated care in 2015. (SHADAC graphic)

For the full report, click here.

Princess Health and Beshear calls for transparency as Bevin and feds work on Medicaid changes and stakeholders prepare to meet Thursday. Princessiccia

Princess Health and Beshear calls for transparency as Bevin and feds work on Medicaid changes and stakeholders prepare to meet Thursday. Princessiccia

Foundation for a Healthy Kentucky health reform legislation Medicaid obamacare Patient Protection and Affordable Care Act

Gusty 18:40 Add Comment

By Melissa Patrick
Kentucky Health News

Former Gov. Steve Beshear sent an open letter to Gov. Matt Bevin and Health and Human Services Secretary Sylvia Burwell May 9, accusing his Republican successor and President Obama's appointee of working "in secret" and with "no public input of any kind" to change the Medicaid program that Beshear expanded under Obama's reforms.

"On behalf of all who care about the health of Kentuckians, we demand the Bevin and Obama administrations pull back the curtain, stop the back-room deals, and allow for full disclosure and transparency throughout the development of this Medicaid waiver proposal that will impact the lives of hundreds of thousands of Kentuckians, and the future of the entire commonwealth," Beshear wrote.

Beshear asked Bevin to release the details of his plan before Thursday, May 12, when the Foundation for a Health Kentucky is scheduled to host a stakeholders' meeting to discuss what they would like to see in the plan. He also asked Burwell to "demand" that Bevin provide details of the plan before any "formal or informal" decisions are made.

"This meeting of stakeholders should mark the beginning of the the process to solicit input from as many Kentuckians as possible, and the Bevin administration must create future opportunities for other interested stakeholders to weigh in before taking any next steps in the process," he wrote.

Bevin's office declined to comment, but told Kentucky Health News that stakeholder meetings have occurred and more formal ones are in the works. Bevin has said that he wants to announce his plan this summer.

According to the website on the type of waiver Kentucky is seeking, states are required to post their proposed plans for a 30-day comment period before sending them to the federal government. Once the Center for Medicare & Medicaid Services accepts the application, it is required to post the proposal for another 30-day comment period.

Under federal health reform, Beshear expanded Medicaid to Kentuckians with incomes up to 138 percent of the federal poverty level, adding about 400,000 people. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin told reporters in early May that he had "gone to the mat" with federal officials but remains optimistic they will agree. "If it does not happen it will be because CMS does not want to see expanded Medicaid continue in Kentucky," he said.

Burwell's press secretary, Ben Wakana, "indicated any changes to Kentucky's Medicaid plan should not weaken it," Deborah Yetter reports for The Courier-Journal. Wakana told her, "Kentucky's Medicaid expansion has led to one of the biggest reductions of uninsured people in America, and any changes to the program should maintain or build on the historic improvements Kentucky has seen in access to coverage, access to care and financial security."

Read more here: http://www.kentucky.com/latest-news/article76530622.html#storylink=cpy

Bevin has said many times that the state can't afford its Medicaid population. He appointed Mark Birdwhistell, a University of Kentucky health executive and former state health secretary, in December to help his administration design a new Medicaid program.

Since then, no details have been released, but Bevin has said Kentucky's revised program should require its members to have "skin in the game" and that the state cannot continue to pay for the health insurance of "able-bodied adults."

He has also referred to Indiana's plan, which has monthly fees, co-payments and refers its participants to a work program, as a model for Kentucky. However, spokeswoman Jessica Ditto told Kentucky Health News in March that, "The Indiana model is just one of many models that we are looking at for influence in crafting a plan that is specifically tailored for the needs of Kentucky."

Beshear said evidence suggests a move to a plan like Indiana's will "lead to increased cost for enrollees, and less access to healthcare for the most vulnerable Kentuckians."

He noted that "federal rules prohibit waivers for the sole purpose of saving money or shrinking the size of the program, both of which Gov. Bevin has publicly stated are his goals." He suggested that it is "precisely these types of changes" that are in the proposal, and calls again for "public review and debate." In addition, he calls for CMS to not approve changes that "would leave beneficiaries worse off than they are under a state's existing Medicaid program."

Beshear writes in conclusion, "Transparency, openness and honest conversation with the people of Kentucky is not only the right thing to do on such a critical decision, the people demand it."

Princess Health and Poll finds many Kentuckians continue to struggle with cost of health care, though fewer are uninsured and struggling. Princessiccia

Princess Health and Poll finds many Kentuckians continue to struggle with cost of health care, though fewer are uninsured and struggling. Princessiccia

Foundation for a Healthy Kentucky health care costs health insurance health reform Medicaid poll

Gusty 17:21 Add Comment

While having health insurance certainly eases the cost burden of health care, nearly one-third of Kentucky adults struggle to pay their medical bills whether they have health insurance or not, and two in 10 say they often delay or skip needed medical care because of the cost, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 17-Oct 7, found that in 28 percent of Kentucky households, someone had trouble paying medical bills in the previous 12 months. This didn't vary much between those with or without insurance, and was about the same as in 2014.

However, fewer Kentucky adults without insurance said they had difficulty paying their medical bills in 2015 than in 2014: down to 31 percent from 47 percent. In 2014, the Patient Protection and Affordable Care Act was fully implemented in Kentucky with expansion of the federal-state Medicaid program to people with incomes up to 138 percent of the federal poverty level.

According to the Kaiser Family Foundation, the average annual out-of-pocket cost per person for health care in the United States in 2014 was $1,036,which includes costs for any expenses not covered by insurance, says the report.

The Kentucky Health Issues Poll also found that 20 percent of Kentucky households did not get the medical care they needed, or delayed care because of the cost, in the past 12 months. This was more common among Kentucky's uninsured (27 percent) than those with insurance (19 percent).

However, these figures were an improvement from 2009, when 58 percent of uninsured Kentucky adults said they delayed or didn't get needed care, and from 2014, when 38 percent said so.

Poorer adults, those eligible for Medicaid, were more likely to forgo health care because they can't afford it; 29 percent of them said they had in the previous year, while only 16 percent of people with higher incomes said so.

"Being able to access medical care and being able to afford that care are two important factors to improve health in Kentucky," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "KHIP data indicate that fewer Kentucky adults are delaying medical care. This helps Kentuckians get and stay healthier, getting timely preventive services and early help with management of chronic conditions like diabetes and asthma and with smoking cessation counseling."

The poll was conducted by Institute for Policy Research at the University of Cincinnati and for the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,608 adults via landline and cell phone, and has a margin of error of plus or minus 2.4 percentage points.

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

Princess Health and Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors. Princessiccia

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Gusty 07:47 Add Comment

Update: 4/8/16 This story has been updated with comments from the Cabinet for Health and Family Services. 

By Melissa Patrick
Kentucky Health News

On Feb. 29, Gov. Matt Bevin's administration launched a new one-stop-shopping website for state benefits that was designed to make life easier for the one-fourth of Kentuckians eligible to use it. Instead, it caused an unprecedented disruptions of services after thousands received erroneous letters notifying them they would no longer receive their benefits.

Deborah Yetter of The Courier-Journal has reported extensively on the problem, with stories of Kentuckians who have lost their benefits and found it nearly impossible to get help because of hours-long waits in the state benefits offices and a phone system that tells them to call back later.

The website, called Benefind, can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

The problem goes beyond those programs. The 500 paid Kynectors, who help Kentuckians use the Kynect health-insurance exchange, have not been able to help because federal regulations require participants who use multiple services to first go though the Department of Community Based Services, the state agency that manages Benefind. As of now, Kynectors can only help Kentuckians who have never received other state benefits.

Health advocates have called the launch of Benefind a "disaster." At a March 31 news conference, Bevin, along with health officials from the Cabinet for Health and Family Services and a Deloitte Consulting official, acknowledged the widespread problems and said they were working tirelessly to correct them.

�Our primary focus is to ensure that we deliver, as seamlessly as possible, as safely as possible, as expediently as possible all the benefits that folks expect and need from the Commonwealth of Kentucky," Bevin said.

State officials at the news conference said they had worked with federal officials to extend benefits through April, so that no one should be cut off from Medicaid or SNAP if they qualified for those benefits in March. The state has also stopped automatic letters generated by Benefind.

In addition, they have updated websites and changed the phone message to better explain what is going on; extended the re-certification time frame for SNAP benefits from six months to 12 months, allowing those cases to continue with a simple review instead of a client interview; hired an additional 185 people to help with the deluge of telephone calls and visits to the local state benefit offices; and Deloitte has assigned trainers to every county to help the DCBS staff.

Officials have encouraged the public to log on to the Benefind self-service portal at https://benefind.ky.gov/ to ease the burden on processing centers.

So, what happened?

Deloitte built Benefind under the administration of Gov. Steve Beshear at a cost of $101.5 million to replace an outdated eligibility system. Deborah Sills of Deloitte said at the news conference that they believed the system was ready to launch at the end of February, but "there were some issues that didn't present themselves until after the system went live."

However, Ryland Barton of Louisville's WFPL reported that on Feb. 25, a 27-page "Worker Portal Defect Workaround Guide" was distributed to DCBS staff showing that the administration knew there would be problems with the rollout.

But the cabinet says a guide like this is standard procedure.

"Deloitte says a guide like that is standard operating procedure when you�re dealing with a huge system rollout like this," Doug Hogan, spokesman for the cabinet said in an e-mail. "It�s a new system and (this was) a guide to help staff navigate the system better and help them work though issues they might encounter. Additionally, there were these same types of documents for the original rollout of Kynect."

Bevin's administration explained that the problem has been caused by an automatic review of cases where information from Kynect and the old eligibility system didn't match.

�Cases where information between the Kynect case and legacy case did not match (for example, household composition or income) are required to be managed by a state agent before they can be acted upon by agents or Kynectors,� Jessica Ditto, Bevin�s communications director, told WFPL in an e-mail. �This constraint has been placed to protect program and data integrity � plus, this is required by federal law.�

Ditto told Barton about 51,000 cases are under review, and noted that once the conflicting data has been reconciled, "the cases will become open for Kynectors and agents again, just as before.�

Sills told reporters that Benefind had not been altered in any way from its original 2014 design and affirmed Bevin's stance that the move to Benefind had nothing to do with his administrations decision to close Kynect and move to the federal exchange.

"None of these issues are caused by any changes the current administration has made to the system's purpose or design," Sills said.

However, Beshear said in a news release that Kynect and Benefind were meant to work together, not for Benefind to take over signing people up for Medicaid.

"The Benefind program was developed to complement Kynect, the state-run exchange," Beshear said in the release. "Although he attempts to blame the 'prior administration,' Governor Bevin�s administration mismanaged the launch of this new system, and in doing so, created a disastrous situation for thousands of families in Kentucky."

Bevin and Deloitte say the system was always designed to support Medicaid enrollees. "Benefind is Kynect, Kynect is Benefind," Bevin said at the news conference.

Not really, says Kentucky Voices for Health, a coalition of groups supporting Kynect,  "For people needing Medicaid coverage and other social benefits right now, there is no right door for access, let alone 'one door'," the group said in a press release Wednesday. "Kynect was built to provide access to health insurance and Medicaid enrollment; and Benefind was built to enhance Kynect with additional social services benefits. While they�re part of the same system, they provide different essential functions."

However, Hogan noted  in the e-mail that page 15 of a training document for Kynectors originally posted November 2015 "clearly shows that Benefind was intended to process all Medicaid plans, even Qualified Health Plans...it was truly designed to process all benefits."

Beshear and his advocacy group, Save Kentucky Healthcare, have also released a one-minute video entitled "If It Ain't Broke Don't Fix It" criticizing the Bevin administration's rollout of the system.

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

accountability drug abuse economy health care access Medicaid obesity Patient Protection and Affordable Care Act rural health rural hospitals

Gusty 18:04 Add Comment

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

�We're able to do more for Kentucky patients,� Christy Elliott, the hospital's case management supervisor, told Meyer. �For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.�

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

�The care here is excellent,� a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. �Whatever you need, they are right at the door, and everyone is really friendly.�

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

�A lot depends on economic development in these communities,� Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. �What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.�

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

�There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,� Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. �You can't draw more patients if you don't have enough people to take care of them.�

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, �People would die for lack of health care if we didn't have a hospital in this community.�

Princess Health and Bevin gets bill to create third-party appeals process for denied Medicaid claims, which sponsor says are all too common. Princessiccia

Princess Health and Bevin gets bill to create third-party appeals process for denied Medicaid claims, which sponsor says are all too common. Princessiccia

behavioral health doctors General Assembly health insurance hospitals insurance legislation legislature Medicaid physicians

Gusty 16:05 Add Comment

By Melissa Patrick
Kentucky Health News

A bill to create an independent process for Kentucky health-care providers to appeal claims denied by Medicaid managed-care organizations is on its way to the governor's desk for his signature.

Sen. Ralph Alvarado

The only appeals process for providers now is through the MCOs themselves, and the only recourse for denied claims is through the courts.

"We are looking at almost 20 percent of the claims that are out there through Medicaid being denied to providers," the bill's sponsor, Republican Sen. Ralph Alvarado of Winchester, told Kentucky Health News. "So with that there are millions of dollars that all of those providers are losing out on. This finally gives them an opportunity to keep the MCOs accountable."

WellCare of Kentucky, one of the MCOs Alvarado targeted last year while trying to get a similar bill passed, denied that it has so many disputed claims, but says it will work with the Cabinet for Health and Family Services if Senate Bill 20 is enacted.

"WellCare of Kentucky rarely disputes claims for medical necessity, with only 1 percent of claims being denied for this reason," spokesperson Charles Talbert said in an e-mail. "We are supportive of initiatives that help to ensure our members get the right care, at the right time, in the right setting."

Another MCO that Alvarado targeted last year as having a high rate of denied claims, Aetna Better Health of Kentucky, formerly CoventryCares, said in an e-mail, "We work tirelessly, along with our network of providers to improve access to and quality of care for our Medicaid members and we are committed to continuing these valuable collaborations."

CareSource, another MCO, declined to comment.

Kentucky implemented managed care in 2011 mainly as a way to save money. In managed care, an MCO gets a lump sum per patient, a system that encourages them to limit payments to providers. Providers have complained about denied claims and slow payments, causing some to suggest that managed care creates an incentive to deny care.

"Kentucky Medicaid MCOs have a denial rate that is four times the national average," Alvarado said in an e-mail. "These MCOs, in general, are garnering massive profits on the backs of our providers by simply not paying for services; and then claiming that they are 'managing care'."

MCOs serve about 1.1 million Kentuckians and account for about 69 percent of the state's Medicaid budget, according to a state news release.

Last year the state renegotiated all MCO contracts in hopes of decreasing the number of disputes over rejected claims, but health-care providers told the Senate Health and Welfare Committee Jan. 13 that this is still an ongoing problem, especially with behavioral health.

Nina Eisner, CEO of The Ridge Behavioral Health Systems, told the committee that there are examples all over the state of patients with homicidal thoughts unable to get their care paid for by MCOs.

Senate Bill 20 says that after providers exhaust an MCO's internal appeals process for denied claims and a final decision has been made, the provider can then seek a third-party review from an administrative hearing tribunal in the cabinet. The appeals process would apply to all contracts or master agreements entered into or renewed on or after July 1, 2016.

Alvarado said the proposed appeals structure is very similar to the one for commercial insurance appeals at the Department of Insurance. He noted that Kentucky's commercial denial rates are around 6 percent, which are close to the national average, and said he hopes this independent appeals process will bring the MCO denial rates more in line with this.

"If we go from 20 percent to 6 percent, I think most providers will accept that," he said. "This is fair. It is fundamentally American to have an appeals process and it is needed."

Alvarado sponsored a similar bill last year, but it died in the House. A similar bill passed both chambers in 2013, but then-Gov. Steve Beshear vetoed it. Alvarado said he is confident Gov. Matt Bevin will sign this year's version.

Alvarado said that once this "fractured relationship between providers and Medicaid" has been mended "it might actually open up the door for more providers to participate with Medicaid."

Sheila Schuster, a Louisville mental-health advocate, agreed, and said that while Medicaid reimbursement rates are "not great," not being paid at all for services rendered is not acceptable and has been a deterrent for providers to participate.

She said the Kentucky Mental Health Coalition and the National Alliance on Mental Illness support SB 20 because "they want providers to be fairly treated and to be able to provide the services that they need."

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

cancer colorectal cancer health reform lung cancer Medicaid obamacare Patient Protection and Affordable Care Act rural health rural-urban disparities smoking smoking bans

Gusty 09:11 Add Comment

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Princess Health and Ky. Republicans like Indiana Medicaid plan, but head of Medicaid directors' group says Ind. isn't far enough along to be a model. Princessiccia

Princess Health and Ky. Republicans like Indiana Medicaid plan, but head of Medicaid directors' group says Ind. isn't far enough along to be a model. Princessiccia

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Gusty 15:31 Add Comment

Gov. Matt Bevin and other Republicans have said they want to make Kentucky's version of Medicaid look like Indiana's, but a leading Medicaid official says that Indiana's program hasn't proven itself to save money or improve health, so it's unlikely other states will be allowed to use it as a model, Phil Galewitz reports for Kaiser Health News and The Washington Post.

Matt Salo, executive director of the National Association of Medicaid Directors, told Galewitz, �Other states have looked at it, but the Obama administration has made it pretty clear that Indiana is going to be a test case and much evaluation will need to be done before they approve any more like it.�

Now Bevin's office says it is looking at other states, too, as it negotiates with the U.S. Department of Health and Human Services, trying to come up with a revised program to save money, perhaps by August.

"The Indiana model is just one of many models that we are looking at for influence in crafting a plan that is specifically tailored for the needs of Kentucky," Bevin spokeswoman Jessica Ditto said in an e-mail. "We are working closely, and in good faith, with HHS as this process moves forward and have confidence that what we offer for their consideration will be a thoughtful, deliberate and unique plan that will improve health outcomes in a sustainable manner."

Under federal health reform, then-Gov. Steve Beshear expanded Medicaid to those in the state with incomes up to 138 percent of the federal poverty level, adding 400,000 people. The federal government pays for this expanded population through this year, but then the state will be responsible for 5 percent of the expansion, rising to the reform law's limit of 10 percent in 2020.

Bevin has said that Kentucky's revised program should require its members to have "skin in the game," and that the state cannot continue to pay for the health insurance of "able-bodied adults."

Healthy Indiana Plan

That sounds like Indiana, which has monthly fees and co-payments and refers its participants to a work program.

Even if it is just a dollar, everyone on Medicaid in Indiana pays something, whether it's through a monthly fee or through co-payments.

The Healthy Indiana Plan has two levels, HIP Plus and HIP Basic. Both plans offer incentives for using preventive services, but HIP Plus, which requires a monthly fee, also includes dental and vision services.

Those fees go into an account that is like a health savings account and is used for the first $2,500 of medical expenses each year. The state of Indiana pays the bulk of the $2,500 and if the participant's health-care expenses exceed this amount, the state will pay for the additional care at no cost to the individual.

HIP Plus is considered the best value and is available to everyone in the state with income below 138 percent of the federal poverty level. The consequences for not paying the required monthly fee vary by income level.

Those in HIP plus who make at or below the poverty level and fail to pay the fee are moved down to HIP Basic plan, which requires co-payments of up to $8 per service and $75 for each inpatient hospital stay. Both plans have a co-payment for using the emergency room for non-emergency reasons, $8 the first time and then $25 per visit thereafter.

HIP Basic members who make more than the poverty level are locked out of coverage for six months if they fail to make their monthly payment.

"No other program has been allowed to require health spending accounts, much less threaten to yank coverage for a person not paying in," Galewitz writes, paraphrasing Salo.

HIP members who are unemployed or work less than 20 hours a week are referred to available employment, work search and job training programs to help them gain employment or find better employment. This is a free and voluntary program and does not affect the receipt of benefits.

All members of HIP Plus must pay something. About half of Indiana Medicaid members have annual incomes below $600; they must pay a $1 monthly premium.

The monthly fee adjusts with income and family size. For example, a single person who makes $16,242, the maximum for expanded Medicaid, pays $27.07 per month to get HIP Plus, or $324.85 per year. A family of two could make as much as $21,983 and would pay $36.64 or $439.68 per year; and a family of four could make $33,465 and would pay $55.78, or $669.36 per year. Information comes from the eligibility calculator on the Healthy Indiana Plan website.

Is Indiana's plan working?

Indiana health officials told Galewitz that 94 percent of those who have signed up for HIP Plus continue to pay their fees.

Michelle Stoughton, senior director of government relations for Indianapolis-based Anthem Insurance Cos., called that a success. She said nearly 75 percent of Anthem's members on this HIP Plus have visited a dentist, and 65 percent sought vision care in the first three months of coverage. Anthem is one of three private insurers providing coverage under the Healthy Indiana Plan.

�What we heard for years .?.?. is that these people won�t pay and don�t have the ability to pay,� Stoughton told Galewitz. �But this has turned those arguments around and been able to show that people do want to be engaged.�

Indiana's hospitals and doctors support the Healthy Indiana Plan, mostly because the state increased their Medicaid rates, hospitals by an average of 20 percent and doctors' reimbursements by an average of 25 percent, Galewitz reports.

"As a result, Medicaid has gained more than 5,300 providers in the past year, and patients report few problems getting care," he writes. But he also noted that about 2,200 members have lost coverage since it began in May 2015 because they didn't pay their monthly fees.

Critics of Indiana's plan worry that the monthly payments and complicated structure will keep the poor from getting care. which goes against the core goal of Medicaid expansion, Galewitz writes. In addition, some conservative groups say the program may be more expensive than traditional Medicaid, because it provides dental and vision care and pays providers more. Others say that the red tape in the plan exceeds that of any state's Medicaid expansion.

The state had also hoped third parties would step up and help the poor pay for their monthly contributions, but this hasn't happened, Joan Alker, executive director of the Georgetown University Center for Children and Families, told Galewitz. She said, �It�s premature for Indiana to take a victory lap.�

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

Princess Health and At top legislative Republican's invitation, Democrats embrace Obamacare, or at least Kynect and Beshear's Medicaid expansion. Princessiccia

elections governor health insurance insurance exchange Kynect legislation Medicaid obamacare Patient Protection and Affordable Care Act politics

Gusty 16:01 Add Comment

By Melissa Patrick
Kentucky Health News

With a verve for Obamacare most had not publicly demonstrated, state House Democrats passed bills March 22 to preserve the Kynect health insurance exchange and the state's expansion of the federal-state Medicaid program.

The almost entirely party-line votes were a response to Republican Senate President Robert Stivers, who had challenged the House to act on the bills so the public will know where legislators stand on health reform.

The Senate is not expected to pass House Bills 5 and 6, but may use them as a device for debate of an issue on which Republicans seem to think they have had the upper hand. Democrats appear to think otherwise.

"This is a political issue, we all know that," House Speaker Greg Stumbo said. "The president of the Senate wanted to challenge us to talk about it, so I think we ought to talk about it because . . . Kynect is working."

(The debate begins four minutes into the following KET video. The continuation of the debate can be seen here.)

Kynect, where Kentuckians can sign up for Medicaid or buy federally subsidized health insurance, was established under executive order with federal grant money by then-Gov. Steve Beshear, a Democrat. It is paid for by a 1 percent assessment on all insurance policies sold in the state. The fee formerly funded a pool for high-risk insurance, which health reform made unnecessary.

Gov. Matt Bevin and other Republicans say Kynect is not necessary because the federal exchange, used by most states, does the same thing. "We will still be providing Kentuckians with access to care," said Rep. Addia Wuchner, R-Florence. "It will be as easy as going to a different website."

Democrats say using the federal exchange will leave Kentuckians without enough of the assistance needed by people who are unfamiliar with health insurance. More than 400,000 Kentuckians have used Kynect to sign up for Medicaid and about 100,000 have used it to get health insurance, many with the help of Kynect-paid "Kynectors."

Rep. Darryl Owens, D-Louisville, the bills' sponsor, said many people in Kentucky don't have access to the Internet and that many who do are not "tech savvy." He said that a decrease in the number of helpers, who are available to meet clients after hours and at convenient locations, will create additional barriers to access for many Kentuckians.

Rep. Kelly Flood, D-Lexington, told the House about one of her constituents who learned in the middle of a family medical crisis that they had been dropped from Medicaid. Flood said the woman told her she could not "reach that wonderful Kynector who used to tell me what was going on."

The Kynector later told her that "she had been swamped with others like her who wanted to know what was happening to the stability of their health care that they had just secured," Flood said. "It is so much more complicated than just going to a new website. I am wanting us to understand the people whose lives are on the line."

The state, completing a plan put in place by the Beshear administration, recently shifted Medicaid users of Kynect to a new system called Benefind that handles most public-assistance programs.

Emily Beauregard, executive director for Kentucky Voices for Health, told Greg Stotelmyer of Public News Service that the wait times on Benefind are two hours and 6,000 to 7,000 calls are going unanswered each day. Advocates have said that the average wait time on Kynect is two minutes.

Cabinet for Health and Family Services spokesman Doug Hogan told Stotlemyre that there had been "difficulties" with the transition and the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

The House voted on the bills separately but the main debate touched on both Kynect and Beshear's expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. The federal government is paying for the expansion until next year, when states will begin paying 5 percent, rising to the law's limit of 10 percent in 2020.

Bevin and other Republicans say that is not sustainable, and he is negotiating with federal officials to change Medicaid to save money and add more personal responsibility, such as premiums, co-payments and deductibles.

Rep. Joni Jenkins, D-Louisville, chair of the House Budget Subcommittee on Human Services, said most Kentuckians who get insurance through Kynect and expanded Medicaid work in low-income jobs and without the program cannot afford insurance.

"With all of this great news -- more people covered, profitable hospitals, more jobs, better health care and wellness -- I believe the evidence is overwhelming that Kentucky must keep Kynect and expanded Medicaid," Jenkins said.

At times the debate was more about federal health reform in general than about the specifics of Kynect or Medicaid expansion.

Rep. Jim Gooch, a Providence insurance agent who recently became a Republican, said many Kentuckians have been helped by Obamacare, others have been hurt. He said many can't afford their co-payments and deductibles, and he said President Obama lied when he said people could keep their old health plans and doctors if they wanted after the reform law passed in 2010.

Another insurance agent, Rep. Jeff Greer, D-Brandenburg, argued the other side. He said the Patient Protection and Affordable Care Act had brought many people their first affordable health insurance, especially those with pre-existing conditions, and relieved many farmers of the need to to work another job to get insurance.

"What I see is that we have something that is working, and I'm in a field where I see it work and yet we want to dismantle it and go to something that we're not sure is gong to work or not, Greer said. "I just don't get it."

House Minority Leader Jeff Hoover, R-Jamestown, said using the federal exchange "will not cause a single policy to be canceled or a single person to lose coverage." He said 36 other states now use the federal exchange "seamlessly."

Hoover and other Republicans said the debate was overdue, referring to Beshear's executive actions that the legislature was unable to block.

The Kynect bill passed 52-46, followed by a 54-44 vote for the Medicaid expansion, with Republican Reps. Jim DuPlessis of Elizabethtown and Jim Stewart of Flat Lick joining the Democrats. Reps. Gerald Watkins, D-Paducah, and David Floyd, R-Bardstown, did not vote on either bill.

All House seats are on the November ballot. House Democratic Caucus Chair and state party Chair Sannie Overly was asked how a vote for Obamacare might affect the election. "I think that House Bill 5 and 6 are simply a message to others that we stand by our commitment to providing access to healthcare to all Kentuckians," she said. "We've seen that our constituents support making sure that their friends and neighbors and relatives have access to health care."

To the same question, Rep. Robert Benvenuti, R-Lexington, said, "I think the voters have already thoughtfully evaluated that and cast a strong vote for Gov. Bevin, so I do think it will come up again in these November elections."

Princess Health and Republicans accuse Beshear of holding down failed co-op's premiums to make Obamacare look good; he denies the charge. Princessiccia

Princess Health and Republicans accuse Beshear of holding down failed co-op's premiums to make Obamacare look good; he denies the charge. Princessiccia

federal spending General Assembly governor health insurance health reform insurance Kynect legislature Medicaid obamacare Patient Protection and Affordable Care Act politics state government

Gusty 13:09 Add Comment

By Al Cross
Kentucky Health News

Did Kentucky's government-sponsored insurance company fail because then-Gov. Steve Beshear and federal officials kept its rates artificially low to make Beshear's embrace of federal health reform look better?

Sen. Ralph Alvarado

That's what Republican state Sen. Ralph Alvarado of Winchester, using documents provided by Gov. Matt Bevin's office, suggested or claimed March 14 in a Senate floor speech about the Kentucky Health Cooperative.

"It appears that rates for the co-op may have been purposely kept down for the sake of optics, to make the rollout of the ACA in Kentucky appear successful when it clearly was not," Alvarado said, citing "multiple meetings between the co-op, the governor's office and CMS," the federal Centers for Medicare and Medicaid Services, which oversees the state-based co-ops created under the reform law, in the fall of 2014.

"Somewhere along the way rates were kept down despite these actuarial recommendations," which said the money-losing cooperative should increase its rates 35 to 40 percent for the 2015 plan year, Alvarado said. The co-op's average increase, announced in late October 2014, was 15 percent. In November, CMS expanded the co-op's $47 million solvency loan to $125 million "to try to sustain this company," he said.

Beshear denied the charges through a spokeswoman, Hayley Prim. She said in an email, "Rates were set by the co-op, which was a privately run insurance plan. Like all other insurance plans, the rates must be certified by the Department of Insurance and actuarially sound. The state did not hold rates artificially lower to improve optics."

CMS officials encouraged co-ops "to price their plans low and grow as fast as they could," Adam Cancryn reported for SNL Financial in November 2015, in a long article that is widely regarded as the best written about the failure of the co-ops. Twelve of the 23 have closed or plan to.

The insurance co-op's offices are in eastern Jefferson County.

In December 2014, the Kentucky Health Cooperative reported a loss of $50 million, "with several hazardous financial conditions indicated," Alvarado said, but that year its chief executive officer, chief financial officer and member-services vice president got bonuses of $50,000, $40,000 and $40,000 on top of their salaries of $250,000, $179,000 and $131,000.

"This company had no money, was in deficit, and yet funds were being used clearly for bonuses," Alvarado said. Its CFO, Leonard Sherman, left the company in December 2014, according to a document filed by its liquidators.

Joe Smith of Frankfort, who was chair of the cooperative's now-dissolved board, said in an interview that the salaries and bonuses were "probably a little bit less" than typical in the insurance industry. He said bonuses were paid because the co-op enrolled many more customers than expected, but no bonuses were paid after the first year.

Smith blamed "the Republican Congress" for killing the co-op and those in many other states by limiting the "risk corridor" subsidies paid to insurance companies for covering sicker-than-average populations.

He acknowledged that the Obama administration largely abandoned the co-ops, making them "a sacrificial lamb," but he said they could not effectively compete with large insurance companies, mainly because the reform law prohibited them from advertising, as the big insurers wanted. The law created funding for the not-for-profit cooperatives as a way to provide competition with for-profit insurers and hold premiums down.

Janie Miller, who was Beshear's first health secretary, resigned as CEO of the Kentucky Health Cooperative in June 2015. That October, the co-op said it had largely eliminated its losses but would close because it was getting only a $9.7 million of a $77 million risk-corridor subsidy that it needed to stay afloat. It is now in liquidation, supervised by Franklin Circuit Court.

Alvarado said Miller and her successor, Glenn Jennings, refused to appear at a legislative budget subcommittee meeting in November. He said the Insurance Department "gave us very limited answers about what happened, [which] made me wonder if any wrongdoing was involved."

Alvarado said the legislature's Program Review and Investigations Committee should examine the co-op's finances and the Senate should issue a subpoena requiring Miller and Jennings to appear.

Then-Gov. Steve Beshear,
discussing health reform at the
Brookings Institution in D.C.

Prim, Beshear's spokeswoman, said, "While it is unfortunate the co-op did not succeed, an overwhelming majority of Kentuckians have a positive view of Kynect," the online exchange where Kentuckians can buy federally subsidized health-insurance policies. "It has succeeded by providing low-cost health insurance options and creating a competitive marketplace for private insurers that have kept rates low for everyone."

In his speech, Alvarado incorrectly referred to Kynect policies as Medicaid, the federal-state health plan for the poor and disabled. Beshear expanded Medicaid eligibility to Kentuckians in households with incomes up to 138 percent of the federal poverty level.

Alvarado declined to give Kentucky Health News the documents to which he referred in his speech, saying he got them from Bevin's office, which could be asked for them.

Bevin's office provided the liquidators' first report, filed Dec. 31; an actuarial report on small-group plans for 2016, submitted in July 2015; an actuarial report on individual plans for 2015, filed in August 2014; and a February 2015 letter from Miller responding to the Insurance Department's request for a "corrective action plan." None of the documents mention the meetings Alvarado said occurred among CMS, the co-op and the governor's office.

The August 2014 actuarial report said, "The financial viability of KHC is in question. . . . KHC's projections reflect very aggressive assumptions, albeit within a reasonable range, and may result in a very optimistic view of future experience."

The co-op's members used medical services more often than it expected. In the second quarter, there were 263 hospital patient days per 1,000 members, higher than the pricing assumption of 184 per 1,000 but a still a "significant decrease" from the first quarter, for which the report did not give a figure.

The co-op was also having trouble dealing with members and health-care providers. Its corrective plan filed in February 2015 addressed complaints about such things as slow payment standards, paid premiums not being posted to members' accounts, complaints from in-network providers about being processed as out-of-network, and long waits for customer service, with supervisors not being available.

The liquidators' report to the court estimated that the co-op still owes about $80 million in claims, and their financial analysis left unclear whether all those claims would be paid. The balance sheet in the liquidators' statement, dated June 30, said the co-op had $117 million in assets and $128 million in liabilities, and the liabilities included only $67.7 million in unpaid claims. However, the co-op's biggest federal loan, of $125 million, is "subordinate to policyholder obligations, claimant and beneficiary claims, operating expenses and state reserve and solvency requirements," the report said. CMS, the federal agency, has asked an independent actuary to provide its own estimate of unpaid claims.