Princess Health and Princess Health andObamacare raised woman's premium 74% but she's thankful it has extended health care to those who didn't have it.Princessiccia

Princess Health and Princess Health andObamacare raised woman's premium 74% but she's thankful it has extended health care to those who didn't have it.Princessiccia

community health centers health insurance health reform Medicaid poverty primary care

Gusty 09:24 Add Comment

"Beneath the loud debate" about the Patient Protection and Affordable Care Act, it is "quietly starting to change the health care landscape," writes Abby Goodnough of The New York Times, in the latest installment of her series looking at the law through the lives and businesses of Kentuckians.

"In Kentucky alone, more than 350,000 people � about 8 percent of the state�s population � have signed up for coverage," Goonnough notes. "Insurers and medical providers are reporting steady demand from the newly covered for health care, ranging from basic checkups to complex surgical procedures." About 80 percent of the signups in Kentucky are for Medicaid, and that number is likely to increase, because while open enrollment in private plans for 2014 closes tonight at midnight, Medicaid accepts enrollees year-round.

Goodnough's story looks at a new Medicaid enrollee, a man who is having difficulty affording his subsidized policy, and a woman whose income is so high that she couldn't even get subsidies for a new policy through the state health-insurance exchange � but who, like the other two, came to one of the Family Health Centers in Louisville because her doctor wasn't in the network for her new policy. The centers "primary and preventive care in low-income neighborhoods where private doctors are scant," and just over half their patients last year had no coverage, Goodnough reports.

New York Times video; to play it, click on image

Donna Morse, 61, is a widow who "lost her insurance last year because it did not meet the new law�s standards. Now she has a new plan with much higher premiums, and which few doctors and hospitals will accept," Goodnough writes. "She is paying $448 a month for a new Humana plan, up from the $258 monthly premium she paid before," an increase of 74 percent. And when she took her prescription to her neighborhood Walgreens, she "discovered that the chain did not accept her new Humana policy, a so-called narrow network plan with a limited number of providers."

Nevertheless, Morse, a dental hygenist, told Goodnough that she was �very pleasantly surprised� by her experience at the clinic and �I�m really thankful that a lot of people are getting health care that couldn�t have it in the past.�

That describes David Elson, 60, "a self-employed businessman with a multitude of health problems and medical bills," and forgot to pay the first month's premium for his subsidized policy; and Tamekia Toure, 40, a diabetic and single mother who moved to Louisville from Alabama and got on Medicaid but found a job at Amazon soon after her clinic appointment. "She was elated to find work so quickly . . . but also a little scared," Goodnough writes. "Would her new income make her ineligible for Medicaid, so soon after she had signed up? With the expanded program, this so-called churning in and out of Medicaid, based on changes in income, is expected to be common, and for many, problematic." (Read more)

Princess Health and Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes.Princessiccia

Princess Health and Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes.Princessiccia

community health centers health care managed care Medicaid mental health mental illness

Gusty 19:33 Add Comment

"Kentucky mental health centers are cutting back services and struggling to assist patients the first time they�re admitted because of ongoing struggles with Medicaid managed care," Don Weber reports for cn|2. "At the same time, they�re losing out on federal grants because of red flags caused by their administration costs being inflated by increasing contributions to the public pension system."

NorthKey Community Care Mental Health Center in Northern Kentucky, which serves eight counties, had to close its adult day-treatment programs for the seriously mentally ill. Dr. Owen Nichols, the president and CEO, told Weber, �I get calls periodically from elderly parents in the community wanting help with their adult child that suffers from schizophrenia because they�re now wandering the streets, having some difficulties with local authorities.�

A recent editorial in The Courier-Journal addresses Kentucky's need for better mental health treatment, saying that Kentucky has "an underfunded, fragmented and now �thanks mostly to Medicaid managed care �hopelessly complicated system of mental health care."

The editorial notes last week's C-J articles in which reporters Laura Ungar and Chris Kenning uncovered the problems families face when navigating a fragmented mental-health system while trying to provide appropriate treatment for a loved one suffering form a severe mental illness, in addition to the "F" grade Kentucky received for its poor mental-health funding.

The editorial also describes how structural issues with managed care, which began in November 2011, have complicated the state's mental-health system. It notes the community mental-health centers asked to be left out of managed care, "pointing out they already operate efficiently and amount to only about 3 percent of the state�s $6 billion a year Medicaid program."

In addition, the editorial notes, "State Auditor Adam Edelen recommended the Cabinet for Health and Family Services take mental health out of managed care and let the state resume running it." Against his advice and the requests of community mental-health centers, the state expanded managed care of mental health. Now some haven�t been paid for Medicaid services since January, when managed care took effect, the editorial says.

"The nightmare needs to end for the many Kentuckians who need basic mental health services," says the editorial. "It�s time for the state to fully explore this system and, if folks are serious about improving it, fix the problems and find the money to fund it." (Read more)

Princess Health and Kentucky hospitals gave $1.96 billion to communities in 2011, including $576.7 million cover of Medicare, Medicaid shortfalls.Princessiccia

Princess Health and Kentucky hospitals gave $1.96 billion to communities in 2011, including $576.7 million cover of Medicare, Medicaid shortfalls.Princessiccia

community health centers hospitals Kentucky Hospital Association Medicaid Medicare University of Louisville

Gusty 15:31 Add Comment

In 2011, despite economic and financial obstacles, Kentucky hospitals' estimated value of benefits to their communities up 17 percent from the year before, to $1.96 billion. So says the Kentucky Hospital Associated 2011 Community Benefits Report, compiled by the Kentucky Hospital Association with data submitted by hospitals. (Chart gives a breakdown of hospitals' total community benefits and services expenditures in 2011.)

Kentucky hospitals say they absorbed $576.7 million in 2011 shortfalls from Medicaid and Medicare, which cover 19 and 55 percent of Kentucky hospital patients; those losses were 26 percent larger than 2010, and may nearly double under federal health reform, to an estimated $852 million by 2019.

Bridging gaps created by Medicaid and Medicare underpayment is only one example of how the 131 Kentucky hospitals demonstrate their commitment to local communities by investing in community needs, the report says. In addition to covering government shortfalls, community benefits include providing charity care, forgiving bad debt and supporting medical research.

In 2011, the reports says, Kentucky hospitals financed $451 million in charity care, which means they cared for the sick and injured even if those patients could not afford care.

In Glasgow, T.J. Sampson Community Hospital and Dr. Bharat Mody (left), a general surgeon, have teamed up to fulfill the unmet health care needs of low-income, working, uninsured or under-insured adults of Barren County through a charity program called Community Medical Care. The program provides assistance with basic coverage for those who qualify, in addition to helping cover the cost of medications, glasses or hearing aids.

In 2011, Kentucky hospitals absorbed $426.5 million in bad debts, losses due to patient non-payment that often occur in hospital emergency rooms. Dennis Manners, who had a $500,000 medical bill and sometimes visited the ER 25 times a month, is one patient out of the total 22 percent of University of Louisville patients who cannot afford care and often cannot even afford their $15 co-pay. Highlighting its efforts to give back to the community, the reports says U of L developed a new treatment plan for Manners, which included sending him to a treatment center outside of Cincinnati.

Many health-improvement services in Kentucky communities, such as health fairs, screening programs, immunization clinics, health needs assessments and community planning, are financed by Kentucky hospitals. According to the report, $43.7 million was spent by these hospitals on such outreach programs that serve all ages and a number of special needs populations. For example, Northern Kentucky's St. Elizabeth Healthcare is fighting against cardiovascular disease, diabetes and stroke with its Cardiovascular Mobile Health Unit that brings vascular services to the community for easy access, screenings, risk appraisals and education.

Hospitals also spend a lot of money, an estimated $127.5 million in 2011, to ensure health professionals are properly educated -- a great need in Kentucky, where 59 of the 120 counties are designated as health professional shortage areas. One effort, the Rural Physician Leadership Program on the campus of St. Claire Regional Medical Center in Morehead, addresses this shortage by training physicians to serve in rural areas of Kentucky and the nation.

Other community benefits include subsidized health services, estimated at $32.3 million, to support programs like Highlands Regional Medical Center's Highlands Center for Autism in Prestonsburg (left). The center is the first of its type in the state and was created in 2009 to address autism in Kentucky, which is estimated by the Center for Disease Control to be diagnosed in one out of every 88 children, says the report. Each child at the Highlands center has a customized treatments plan involving psychologists, educators, behavior analysts, speech pathologists, pediatricians and neurologists, who collaborate to help children with autism reach their full potential.

The annual KHA report reminds people what hospitals do for the state and provides education about ongoing efforts. A more recognizable contribution is that Kentucky hospitals had a combined spending of $6.4 billion in 2011 on staff salaries, purchases or supplies and services that create a�ripple effect� in the overall economy to generate state businesses, jobs, and tax revenue. The reports says St. Joseph Mount Sterling, for example, provided 213 jobs and generated about $12 million in annual local payroll in 2011. Kentucky hospitals' compensation comprises 5.8 percent of all wages and salaries in the state.

The reports says hospitals are more important than ever to the overall economic health of Kentucky communities. This is the fourth year for the report, generated by the voluntary KHA survey and other data sources, including the annual survey by the American Hospital Association; Kentucky Hospital Statistics, 2013; and Kentucky Hospitals� Economic Importance to Their Communities, 2011. The KHA report covers community benefit expenditures made in 2011, which is the most recent year for which statewide data is available.

Princess Health and Local health care centers in Ky. get $16.5 million in federal grants.Princessiccia

Princess Health and Local health care centers in Ky. get $16.5 million in federal grants.Princessiccia

community health centers federal grants health care access health reform Patient Protection and Affordable Care Act primary care

Gusty 06:17 Add Comment

Kentucky recently received $16.5 million in grant for health care centers as part of the Affordable Care Act.

Recipients include Family Health Center Inc. in Louisville ($5 million); Cumberland Family Medical Center in Burkesville ($4.86 million); Grace Community Health Center Inc. in Knox County ($4.33 million); and Big Sandy Health Care Inc. in Prestonsburg ($977,375). The grants were made through a building-capacity program, reports Greg Kocher for the Lexington Herald-Leader.

Grants given under the "immediate facility improvement program" include $425,000 for Mountain Comprehensive Health Corp. in Whitesburg; $380,000 for Family Health Center Inc. in Louisville; $360,863 for Cumberland Family Medical Center in Burkesville; and $216,543 for Big Sandy Health Care in Prestonsburg.

The awards will help serve about 29,475 new patients, states a news release from the U.S. Department of Health and Human Services. Nationwide, $728 million was awarded for renovation and construction projects. (Read more)