Appalachian Health and Well-Being Forum to be held at extension office in Whitesburg Monday evening, July 25

A July 25 forum in Whitesburg will give residents of southeastern Kentucky a chance to tell four health experts their concerns about health issues and possible solutions, and share success stories and plans for future work.

The Appalachian Health and Well-Being Forum will be held from 6:30 to 8 p.m. at the Letcher County Cooperative Extension Office at 478 Extension Drive.

Dr. Linda Birnbaum

Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences, will join a panel of local community and health leaders who will highlight model programs and activities, then hear from the audience. The program is sponsored by NIEHS and the University of Kentucky.

Others on the panel will be Mike Caudill, CEO of Mountain Comprehensive Health Corp. in Whitesburg; Dawn Brewer, assistant professor in UK's Department of Dietetics and Human Nutrition; and Fran Feltner, director of UK's Center of Excellence in Rural Health in Hazard.

The forum will also include a variety of exhibitors who will share information about health-related programs and activities in the area. It is designed in part to connect individuals and groups working in overlapping areas to improve the overall health and well-being of Eastern Kentucky.

“Too often, individuals and organizations work in overlapping areas to promote positive lifestyle behaviors but are not fully aware of each other's work. This forum will provide an important opportunity to build such awareness across the region, with participants sharing and learning from each other,” said UK professor Lindell Ormsbee, who has received many NIEHS grants. He led a team of community members in Perry and Letcher counties, plus UK faculty and students, in planning the event.

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Some comments on Medicaid plan will be adopted, and federal officials will approve revised plan, state officials say on KET

L-R: Host Bill Goodman, Brinkman, Glisson. (KET photo)

By Al Cross
Kentucky Health News

Some of the comments about proposed changes in the state Medicaid program will be included in an "improved" plan to be submitted to federal officials in about two weeks, Health Secretary Vickie Yates Brown Glisson said Sunday on KET's "One to One."

"We got some great comments; we got some very thoughtful comments" on ways the plan can be improved, Glisson said. "We are anxious to take some of those comments and incorporate them." She did not elaborate.

Glisson and State Cabinet Secretary Scott Brinkman also touched on what they said were some misconceptions about the plan – which Gov. Matt Bevin has proposed to reduced costs and increase involvement of Medicaid recipients who are covered by the 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty threshold.

For example, Brinkman said the proposed removal of dental and vision services applies only to adults in the expansion population who are not medically frail. "We're very comfortable with that decision," he said. Such recipients could earn dental and vision care by doing such things as taking a health literacy course.

The plan also requires able-bodied adults who are not primary caregivers of a dependent to have a job, look for one, take job training or do volunteer work. "We're talking about volunteerism," Brinkman said. "We know that once people are engaged they tend to grow in self-esteem, self-satisfaction" and have better lifestyles.

Glisson said the rule would apply to 215,000 people, "a very small segment" of the overall Kentucky Medicaid population of 1.2 million. The expansion population is about 430,000, so the rule would apply to about half of those in the expansion.

The plan would require almost all Medicaid recipients to pay premiums of $1 to $15 a month, another feature that has brought objections from the poor and their advocates. Brinkman said $180 a year for people above the poverty line "is a pretty good deal."

Glisson said advocacy groups "didn't care so much for the co-pay system," now in place for traditional and expansion Medicaid, and "liked the idea of a cost sharing being more like a premium. . . . It's very budgetable."

Managed-care companies that handle Medicaid have been waiving the co-payments, primarily as a way to get Medicaid recipients to choose them, but state officials have said they will stop that.

Glisson said traditional Medicaid recipients who don't pay premiums would be required to make co-payments. Expansion recipients who failed to pay would be dropped from the system but could get back in if they paid up and took a financial- or health-literacy course.

Some critics of the plan have said it is designed to be rejected by federal officials, allowing Bevin to return to his initially stated campaign goal of abolishing the expansion. Brinkman denied that and said he was "convinced" that the Centers for Medicare and Medicaid Services will approve the revised request for a waiver of federal rules to allow the plan to proceed.

"There are some things they have not approved in the past [in other states] but they haven't been structured like they have been" in Kentucky's plan, Brinkman said. "At the end of the day I'm convinced CMS will see that and approve our waiver."

The comment period on the initial plan ends at 5 p.m. ET July 22. Comments can be emailed to kyhealth@ky.gov. "Please write and give us your comments and your thoughts," Glisson said. "We would really welcome that."

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House Task Force on Vulnerable Kentuckians hears complaints about proposed changes to Medicaid program

By Melissa Patrick
Kentucky Health News

BEATTYVILLE, Ky. – Several speakers at the July 15 meeting of the House Task Force on Vulnerable Kentuckians said Gov. Matt Bevin's proposed changes to the Medicaid program would be too complicated for the most vulnerable Kentuckians and will create barriers to care on several fronts.

Mary Mead-McKenzie, executive director of the Kentucky River Community Center, which offers behavioral and addiction services to eight of Kentucky's poorest counties, said the work-or-volunteer requirements for able-bodied adults who aren't primary caregivers of dependents are not feasible in areas where there are no jobs. "Are we going to say that we are going to punish you because of the economy?" she asked.

Mead-McKenzie also opposed the proposed monthly premiums for most Medicaid recipients that would initially range from $1 to $15 per person. She painted a picture of what coming up with an extra dollar means for many of the families she serves.

"A dollar is a lot to some people," she said. "Look at people who have to dig in their cushions to get enough money to buy one gallon of gas to get to work and back . . . and then you add on a $5 premium. . . . Yes, it does impact people and these are the most vulnerable people in our state."

The bipartisan task force, formed by House Speaker Greg Sumbo, D-Prestonsburg, will hold meetings in each of the state's six congressional districts this year to study issues facing the state's poorest citizens and make recommendations to the 2017 legislative session. The first meeting was held in Louisville and focused on the lack of affordable housing.

Mary Lee Underwood of the Commonwealth Council on Developmental Disabilities voiced concern about how the plan, for a waiver of normal Medicaid rules, would impact those with disabilities.

She said some individuals with disabilities and their families under the new plan will be considered able-bodied because they don't receive any Social Security or disability benefits and have been able to get health insurance only through the expansion of Medicaid eligibility to those with incomes up to 138 percent of the federal poverty level. She said one-third of Kentucky adults with disabilities live in poverty.

"We can guarantee that there will be a disparate impact on people with disabilities and their family members because they are so highly represented in the population of people who are living at or near the poverty level," Underwood said.

Underwood also noted that while those who are deemed "medically frail" are "somewhat protected" from the proposed changes, they will have to pay premiums and are subject to the penalties associated with the plan if they don't. She said that the "scary part" is that managed-care organizations, which have a "history of inconsistent application of standards with other Medicaid waivers," will decide who is medically frail.

She and other speakers stressed that the proposal is too complicated. "That complexity will create barriers, especially to those with disabilities who are already struggling to understand multiple systems and to comply with the demands that those systems place on them," Underwood said.

Democratic Rep. Terry Mills of Lebanon said he spent 35 years processing Social Security and disability claims, and "We need to acknowledge that able-bodied is so subjective, it can be dangerous." He also said,  "I sort of formed an opinion during that time that if you want to keep people from asking, make it so complex that barriers are created."

Bill Dolan and Kevin Fleming, lawyers from Kentucky Protection and Advocacy, a government-sponsored group that serves people with disabilities, said they were aggressively seeking clarification from the Cabinet for Health and Family Services to determine which disabled populations would be covered and which would be exempt.

Dolan did offer one of the few positive comments at the meeting, saying that the increased funding for inpatient substance-abuse treatment was a "great thing."

Emily Beauregard, executive director of Kentucky Voices for Health, disputed Health Secretary Vickie Yates Brown Glisson's assertion that the expansion has done nothing to improve the health of Kentuckians.

"It is worth remembering that in 2014 alone, preventive screenings for diabetes and cholesterol doubled, trips to the emergency room decreased, tens of thousands more Kentuckians invested in early detection, treatment and disease management – and that's good for all of us," she said.

Rep. Cluster Howard, D-Jackson, acknowledged surveys that show most Kentuckians want to keep the expansion as it is, but noted that Bevin won by a "substantial margin" in the district he represents and  clearly campaigned on changing Medicaid. "Where did the disconnect occur?" he asked.

Cara Stewart of the Kentucky Equal Justice Center said people vote on more than one issue, and won a laugh when she said, "Also, a lot of people don't pay attention to what people say when they are running."

Beauregard said, "I remember clearly during the election that Governor Bevin said no one is going to lose their coverage. ... When you hear that you feel comfortable, you feel secure with your coverage and you go on to worrying about other things in life."

Rep. Darrell Owens, D-Louisville, passionately pointed out that 70 percent of registered voters did not vote in the governor's race. "The reality is that citizens went to sleep," he said. "So it's an indication to me that we need to be a little more concerned about voting and understanding the issues."

Owens said he thinks the federal government will reject this proposal as it stands now, and Bevin will do what he said he would do: end the expansion, leaving more than 400,000 Kentuckians without health insurance, which is "more folks than voted for him."

Mahak Kalra and Stephen Lin of Kentucky Youth Advocates were glad to see that the plan would not directly affect children and pregnant women, but voiced concerns about parents and children having different benefit packages. "We believe that parents may become confused about the differences in requirements and also the coverage for themselves and their children," Kalra said.

Nicole Huberfeld, a University of Kentucky associate law dean, discussed findings from her paper, "Health Care and the Myth of Self Reliance," which explains why Americans believe what they do about health care access to the poor, and why a single government program for the poor would be more economically and administratively efficient. A report on her views will appear later.

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Health cabinet says it will seek heavy penalties for dumping in Estill and Greenup of radioactive brine from oil and gas drilling

State health officials say they will "seek significant civil penalties" against companies "responsible for the illicit dumping" of radioactive waste in Estill and Greenup counties.

The Cabinet for Health and Family Services, which has authority over radioactive waste, “intends to impose the harshest civil penalties available under the law against all those responsible for the illegal dumping of waste in the Commonwealth,” Secretary Vickie Yates Brown Glisson said in a press release. “We will not tolerate any actions that threaten the health and well-being of our citizens.” She said there are no immediate threats to public health.

One company named in the release is Advanced TENORM Services of West Liberty, which disposed of radioactive brine from oil and gas drilling at the Blue Ridge Landfill in Estill County. (TENORM stands for "technologically enhanced, naturally occurring radioactive material.") The other is Fairmont Brine, which sent similar but less potent waste to the Green Valley Landfill in Greenup County.

Tests at Blue Ridge "showed no evidence that the TENORM dumping led to radiation or radioactive contamination above federal and state safety limits," the release said. It said the cabinet is "working with the Energy and Environment Cabinet and Blue Ridge’s attorney and management to remediate and/or manage the landfill property and ensure that the property remains safe for workers and the general public, regarding both in-state and out-of-state (illegal) TENORM waste," and is "working with outside entities to perform dose assessments on the workers at the landfill. The preliminary results indicate that the workers are not at risk for any negative outcomes."

Democratic Attorney General Andy Beshear decided not to seek criminal penalties against either dumper, citing "insufficient evidence." Beshear said he asked the health cabinet for authorization to seek civil penalties, but the cabinet declined, saying it would handle that.

Under Beshear's father, then-Gov. Steve Beshear, and for a shorter time under Republican Gov. Matt Bevin, the Energy and Environment Cabinet took "seven months to alert Kentucky landfill operators to be on the lookout for illegal shipments of radioactive drilling waste and that they should not accept any it," Jim Bruggers reported in April for The Courier-Journal. "The health cabinet waited another three weeks – until March 4, two days after The Courier-Journal first reported the dumping – to order the company alleged to have quietly brought the waste into Kentucky to stop, and for landfills to stop accepting it."

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Kentucky Oral Health Coalition will host a regional meeting on oral health July 29 in Hazard

July 27, 2016: An updated graphic sent by Kentucky Voices for Health has been added.

The Kentucky Oral Health Coalition and its partners from across the state will host a regional oral health convening Friday, July 29 in Hazard to increase dental awareness and develop strategies to address the widespread dental access issues in Eastern Kentucky, says the Kentucky Rural Health Association.

This is the third of four regional meetings this year, welcoming local policymakers, health advocates, health professionals, educators and students.

Dr. Daria "Nikki" Stone, associate professor at the University of Kentucky College of Dentistry and director of the Ronald McDonald Care Mobile program in Hazard, will speak at the convening about the dental status of the Eastern Kentucky region.

A study on the oral health of Kentucky released this year indicates there is much to convene about. The good news is that the report found that more Kentuckians than ever had access to dental care because of Medicaid eligibility for dental insurance. Eastern Kentucky has 31 percent of the total Medicaid enrollment.

However, dental coverage for much of this population will be threatened if Gov. Matt Bevin's new Medicaid plan is approved because it will remove this benefit for all people covered by the 2014 expansion of Medicaid eligibility and require it to be earned back through a rewards program.

Initial graphic released by KVH

Kentucky Voices For Health put together a chart that shows what an individual on the new Medicaid plan would have to do to get dental (and vision) benefits. They have strongly opposed this proposed change.

Dental leaders have also opposed this change saying in a news release that the removal of these benefits, "interrupts enrollment of a vulnerable Medicaid population, at the expense of quality health for the population and under the guise of controlling state expenditures," noting that "adult dental expenditures comprise less than 2 percent of the cost drivers for the state share" of Medicaid.

Updated graphic, provided by KVH

The study also noted that despite more people having access, finding a dentist can still be a problem, especially in rural Kentucky where 24 Kentucky counties had fewer than 1.7 dentists per 10,000 population. It also found that even though children on Medicaid have dental insurance, more than half of them don't get any dental care.

In addition, the report found that Kentucky ranks 10th in the percentage of adults who haven't been to the dentist in the past year (39.7 percent); eighth in adults with permanent teeth extraction because of tooth decay or gum disease (50.3 percent); fifth in adults having six or more permanent teeth extracted (51.5 percent); and fifth in adults ages 65 and older who had all their natural teeth extracted (24.8 percent).

The convening will be at the University of Kentucky Center for Excellence in Rural Health in Hazard, from 10 a.m. to 3 p.m. It is free and open to the public, but registration is suggested. Click here to register.

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Cabinet says kinks are worked out of the state's new public benefit system, but Republican lawmaker calls for contract review

Health officials assured lawmakers on Thursday that they had worked through the issues that led to the  rocky rollout of the state's new public benefit system, but lawmakers pushed back with harsh criticism, with one Republican calling for the state attorney general's office to examine the contract with the company who built it, Deborah Yetter reports for The Courier-Journal.

"It seems like our most vulnerable populations are the ones who have paid for the shortcomings," Sen. Danny Carroll, R-Paducah, said of the system that caused "massive disruptions in public benefits such as Medicaid and food stamps earlier this year," Yetter writes. "Maybe that's something the attorney general should take a look at," he said.

Carroll, co-chairman of the joint Program Review and Investigations Committee, which held Thursday's hearing, suggested that Attorney General Andy Beshear look into whether the state could recoup some of the funds it paid Deloitte Consulting, the company that built the $100-million system known as Benefind, Yetter writes.

Benefind is meant to be a one-stop shop website for public benefits, like food stamps and Medicaid. It was initiated under former Gov. Steve Beshear. Its launch was delayed twice, once on Dec. 4, under Beshear and again on Dec. 28, under Gov. Matt Bevin. It went live on Feb. 29 and ended up causing a "massive disruption" in public benefits that has taken months to rectify. Kentucky paid Deloitte $3.5 million for the delays,  Kevin Wheatley reports for CN|2 Pure Politics.

Deloitte principal Kevin Pollari said the firm has "stepped up the best we can" to fix the problems, offering 120 employees to help train cabinet staff, providing staff to help the cabinet process the 50,000 backlogged cases that were disrupted during the launch, and implementing a rapid-response team for cases that required urgent attention, Wheatley reports.

"Some lawmakers said they had been inundated with complaints from people who lost health coverage, food stamps or other important public assistance," Yetter reports. In an earlier story, she wrote about one case:

  Good, affordable health insurance was essential for Harry Mudd when he retired in January.
  And he found it. Using Kynect, Kentucky's health insurance exchange, Mudd, 61, and his wife, Ginger Owen, bought a high-quality plan for about $560 a month, the additional cost offset by a tax subsidy under the federal Affordable Care Act.
  But after Kentucky launched benefind, a new public benefit system, their coverage was disrupted and the Louisville couple was startled to find that they had been enrolled in Medicaid – the public health plan for low-income and disabled Kentuckians. And they lost the $637 federal subsidy that helped pay for their private plan.
  Mudd and Owen, after repeated attempts, got Medicaid canceled. But they now must pay $1,200 a month for their private health coverage – more than double what they had budgeted – and despite multiple calls, lengthy waits on hold and complaints to various officials, they could not get the tax credit restored.

Rep. Jeff Taylor, D-Hopkinsville, wondered why state officials didn't have a contingency plan when they realized soon after the launch of Benefind that it was resulting in widespread problems.

Cabinet officials said the scope of the problems with Benefind weren't immediately apparent to the new administration, though they made it a priority once they realized it, Yetter reports.

Bernard "Deck" Decker, the cabinet's technology director, agreed, saying,"It probably took us a month and a half to get an idea of the magnitude of how bad this was. It was extremely bad."

Decker noted that the backlog of some 50,000 cases waiting to be processed has been cleared, hours-long wait times for calls have been cut to an average of 20 to 25 minutes, and state workers have reviewed and addressed some 200,000 letters (many wrongly sent) that were generated by the system that told consumers they were loosing benefits or demanding information already provided, Yetter writes.

Two health advocates agreed that many of the problems have been corrected, but said others persist, Yetter reports. Consumers are still getting letters with misinformation, still having difficulty accessing benefits, and still spending hours on the phone trying to get to a person with appropriate knowledge to help them, said Cara Stewart, a lawyer with the Kentucky Equal Justice Center.

Sen. Stephen West, R-Paris, defended the administration, saying the system has the potential to be more efficient and save the state money, despite current criticisms.

"I think you guys are to be commended," he told the officials. "There would have been a lot of second-guessing of Dwight D. Eisenhower when he stormed Normandy."

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Illinois Needs to Protect Consumers in Wake of Land of Lincoln Debacle

The liquidation of Land of Lincoln Health is just the first of mounting hurdles for Illinois consumers and small-business owners shopping for health insurance coverage in the Affordable Care Act marketplace.

Not only do Illinois consumers wait longer than others across the country to see annual rate increases, but they also have fewer resources to help navigate the marketplace. The state's budget morass means the two state agencies charged with protecting consumer interests and helping consumers connect with coverage options—the Department of Insurance and Get Covered Illinois—are underfunded and ill-prepared to serve the public.

Who will protect consumers' interests in the demise of Land of Lincoln? We keep hearing that the state's insurance department doesn't have the staff to provide information on rate increases to the public until Aug. 1 (even though the department received them from insurers in April). If regulators can't meet the requirements of the ACA in a timely manner, how will they manage the liquidation details for Land of Lincoln? Can consumers count on them to answer critical questions about their now-defunct Land of Lincoln plans?

Questions like: Should I keep paying my premiums to Land of Lincoln? (Yes, you should if you want to be eligible for the special enrollment period plan holders will be offered.) Will I be able to find another plan with my providers in the network at the same price point? What happens if I already met my deductible with Land of Lincoln? Will that carry over to the new plan? And, who will help me find a new plan? Because Get Covered grant funding to help consumers is gone, and insurance carriers reduced or eliminated broker commission for working with clients, Illinois consumers are left with fewer resources when faced with complex health insurance decisions.

We should all be watching how the Department of Insurance addresses the needs of Land of Lincoln policyholders. When Blue Cross & Blue Shield narrowed its networks offered in the marketplace, thousands migrated to Land of Lincoln because of its broader networks with academic medical centers like the University of Chicago. The loss of Land of Lincoln leaves consumers and small-business owners worrying about continuity of care—for themselves and their employees.

This development ensures one thing for the upcoming open enrollment season: Illinois consumers and small businesses will have even less choice, and fewer affordable options that cover a broader network of health care providers.

How the Department of Insurance responds to this crisis is important for all Illinois consumers. We only hope the Rauner administration redirects resources to make sure the Department of Insurance can do its job and do it well.


Barbara Otto and Michelle Thornton Health & Disability Advocates

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Reprinted with permission from Crain's Chicago Business

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