What Does ‘Medically-Frail’ Mean? Kentucky Medicaid Official Offers Clues Wednesday, Nov 8 2017 

The insurance program that provides health insurance to almost a third of Kentuckians — Medicaid — will soon change. Kentucky Governor Matt Bevin is awaiting approval from the federal government on his proposed reforms. But even if Bevin gets everything he asked for, Medicaid providers and advocates say there are still a lot of unknowns to how Kentucky will manage the program.

In Kentucky, Medicaid used to just cover pregnant women, children or people who were disabled or living in poverty. Under President Barack Obama’s Affordable Care Act, former Governor Steve Beshear expanded the insurance program to include people living outside of poverty – up to about $33,000 a year for a family of four. The program now covers about a third of Kentuckians, many of whom got on Medicaid through the expansion.

But Bevin has proposed scaling the program back. His plan would establish monthly premium payments and co-pays for people based on income. And it would also require many Medicaid recipients to either work, take GED classes, volunteer, among other things, for 20 hours a week to keep their health coverage. This concept was embraced by the Trump administration on Tuesday.

But  there are groups of people that will be exempt from these payments and work or volunteer requirements: pregnant women, children, caregivers, former foster kids up to age 26 and ‘medically-frail’ people. How the latter will be defined is still unclear.

What Does ‘Medically-Frail’ Mean?

The federal government defines ‘medically-frail’ as people with serious physical, mental, substance abuse or behavioral health conditions.

That’s a pretty big group in Kentucky. For instance, alcohol and drug use treatment services claims increased seven-fold after Medicaid expanded. And nationwide, more than one-third of Medicaid enrollees report having one or more chronic conditions like diabetes.

Jill Hunter, deputy commissioner of the Kentucky Department of Medicaid Services, said her office estimates about 10 percent of Medicaid recipients in Kentucky will get a ‘medically-frail’ designation and be exempt from the premiums, copays and work/volunteer requirement.

Hunter also said there will be a few ways people will be designated medically-frail: through a diagnosis, health insurance claims, or a doctor or the enrollee attesting to the medically-frail status.

“Recipients will be able to attest to it themselves,” Hunter said at the Kentucky Primary Care Association Conference in Lexington on Wednesday. “They’ll be able to fill out a document to say, ‘I encounter these things, whatever the diagnosis may be.’”

“It won’t be folks just sitting in Frankfort trying to make decisions. This will be based on clinical health evaluated appropriately,” she added.

Hunter also said many people’s status will be reevaluated every year.

Though this process might sound cut and dry, one conference attendee who works with the homeless population said many Medicaid enrollees are often hard to track and might not want to go through the designation process. That might apply to people with unmanaged mental health issues or people who are homeless.

Hunter said the state will take other information into account like information from social service agencies on housing status.

“That will be the intent — to take other collateral information that we may have from social service agencies, where we will have to err on the side of the person,” Hunter said.

Feds Will Allow Medicaid Work Requirements. Here’s What It Means For Kentucky Tuesday, Nov 7 2017 

Despite numerous failed legislative attempts to repeal and replace the Affordable Care Act, the Trump administration is rolling out regulatory changes that are likely to clear the way for Kentucky’s plan to remake its Medicaid system.

At a National Association of Medicaid Directors conference in Arlington, Virginia on Tuesday, Trump administration official Seema Verma said the government will give states more freedom over their Medicaid programs, including allowing states to require Medicaid enrollees to work or volunteer to keep their coverage.

These work requirements are a key part of Kentucky Governor Matt Bevin’s plan to overhaul the state’s Medicaid expansion. Bevin is currently waiting for federal government approval on those changes, and Verma’s comments suggest the Trump administration is likely to sign off.

“Believing that community engagement requirements do not support the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration,” Verma said. She is the head of the federal agency that creates rules for state Medicaid programs.

Kentucky Work Requirements Could Begin In July

In 2013, former Governor Steve Beshear expanded Kentucky’s Medicaid program under the Affordable Care Act. The move meant Kentuckians making up to 138 percent of the poverty line could get on the federal insurance program. But the federal government only paid for the full cost of the additional program for three years. In July, Bevin introduced a plan to roll the expansion back.

The expansion was too costly for Kentucky, he said. His new plan is estimated to trim the Medicaid rolls by nearly 100,000 people, and the state estimates it will save $2.4 billion over the next five years.

And one of Bevin’s provisions includes requiring people to work or volunteer in order to stay on Medicaid — something that wasn’t allowed under the Obama administration.

These work requirements, which Verma and Bevin call a “community engagement” requirement, would mean “able-bodied” adults will either have to work or volunteer for 20 hours a week to keep their Medicaid coverage. Pregnant women, children and caregivers would be excluded from this requirement, and the government has yet to define what an “able-bodied” adult is.

Kentucky Medicaid Director Stephen Miller said at the conference that he was pleased with Verma’s comment and hopes to implement the state’s work requirement by July.

“We are in sync with what she had to say [on work requirements],” Miller said.

Dustin Pugel with the Kentucky Center for Economic Policy said allowing a work requirement will only push people off Medicaid.

“They have disregarded [previous rules], effectively taking down the guardrails meant to protect Medicaid enrollees and put up new criteria that I think is really going to hurt people,” Pugel said.

Miller said he anticipates around 200,000 Medicaid enrollees would be affected by the new rules overall. He said work requirement would help save money for the state by lowering its Medicaid rolls.

“We don’t think of this as punitive,” he said of the work requirements. “We need to do more than give enrollees access to health care and access to an insurance card.”

Medicaid Cuts Would ‘Free Up Dollars’

Almost a third of Kentuckians are covered by the state Medicaid program. And while three-fourths of those people are children and adults, a little over half of the state’s Medicaid spending is for people with disabilities and the elderly. Miller said more needs to be spent on groups of people who were covered by Medicaid before expansion.

“All this new Medicaid expansion spending [for non-disabled adults] has crowded out spending on the other side of the house for other Medicaid populations,” Miller said. “We are hoping this helps free up dollars.”

Kentucky is also looking to add monthly premiums, similar to what the Indiana Medicaid program did in 2015.

Monthly premiums would range from $1 per person to $15 per family, depending on income. But other than people with disabilities, pregnant women, children and caregivers, no one will be excluded from paying some sort of premium.

At the conference, Miller said the administrative costs of collecting those premiums would be higher than the actual amount of premium collected. But he said the point of the change isn’t to make money — it’s to encourage enrollees to transition out of Medicaid and into private coverage.

In Indiana, Pugel said the policy has had mixed results.

“In Indiana, a lot of folks above the poverty line that were covered by Medicaid lost coverage because they couldn’t comply with a lot of the requirements, and only about half of them ended up with coverage elsewhere,” he said.

Miller also reiterated the timeline set out in a Medicaid hearing earlier this year. He’d like the work and volunteer requirements to go into effect starting July 2018 in regions where the state finds it feasible.

Phil Galewitz of Kaiser Health News contributed to this story.

This story has been updated to correct the government’s expected cost savings and the number of Kentuckians on Medicaid.

Kentuckians Can Now Sign Up For Health Insurance For 2018 Wednesday, Nov 1 2017 

Open enrollment begins today, which means it’s the first day Kentuckians can sign up for health coverage under the Affordable Care Act for 2018. Plans can be purchased at Healthcare.gov. And according to some experts, for about 80 percent of Kentuckians who buy a plan on the individual market, their prices could actually go down.

Yet there’s still some confusion about whether Healthcare.gov is operating and whether premiums have gone up, said Melissa Mathers, director of communications at Family Health Centers in Louisville. That could be because of the many attempts this summer by Republicans in Congress and President Trump to repeal and replace the Affordable Care Act. Even though their repeal efforts have failed, Trump and Republicans have continued to say that the ACA markets are failing, and that premiums have risen.

“There’s a lot of confusion because of all the activity over the summer trying to repeal and replace, and the big question is whether the ACA is still around and if I can afford my insurance anymore,” Mathers said.

Healthcare.gov is still up and running and the ACA is still law. And for many Kentuckians, insurance will be cheaper, according to Emily Beauregard, executive director of Kentucky Voices for Health. She said 80 percent of Kentuckians who buy insurance on Healthcare.gov will qualify for financial help to pay for their premiums. In some cases, insurance plans that offer better benefits, like lower copays, may also charge lower monthly payments.

But, Beauregard adds, there’s a stark difference between those who qualify for financial help and those who earn too much and do not.

“For 20 percent of Kentuckians that make a little too much to qualify for a subsidy, they’ll see a rate increase,” Beauregard said.

For example, a 50-year-old in Louisville who qualifies for a subsidy – $48,240 a year for a single person – would pay $67 a month, at most, for a bronze level plan. But for someone earning over that limit, the cost shoots up to almost $400 a month for the same plan. Louisville Metro government has list of Healthcare.gov 2018 sample rates here.

Other things to know:

  • There are four levels of insurance plans. Bronze plans pay 60 percent of covered medical expenses on average; silver plans pay 70 percent of medical costs; gold plans pays 80 percent; and platinum plans pay 90 percent.
  • There are limited insurance company options this year. Anthem remains in about half of Kentucky counties, while CareFirst is in the other half.
  • If you purchased a plan on Healthcare.gov last year, you’ll be automatically re-enrolled. However, double check what plan you have, as there could be a cheaper and better plan that you can enroll in.
  • The enrollment period ends Dec. 15, 2017. Open enrollment is a couple weeks shorter than previous years, so make sure you enroll before the deadline. You could possibly be permitted to enroll after this date, but only in some cases like moving, and divorce.
  • If your current plan is going away, you get more time. If you enrolled in a plan that will not be available next year, you’ll have until March 1, 2018 to enroll in a new plan.

Kentucky Health Officials Offer New Weekly Flu Report Monday, Oct 23 2017 

Kentuckians should have a better idea about where flu outbreaks occur this winter. Officials with the Kentucky Department for Public Health will publish an online weekly influenza surveillance report, to be updated each Friday before noon.

The most recent report shows 18 confirmed cases of the flu in eight counties — found mostly in northern Kentucky. There have been four confirmed cases of the flu in Jefferson County.

Most flu occurrences have been found in people ages 81 to 90 and 1 to 10, according to the report. There have been five cases of the swine flu. The report shows no deaths in Kentucky due to the flu this year.

The data does not include all flu cases in the state, but a portion from doctors’ offices, hospitals and health departments that voluntarily report flu cases to the state.

State officials say they expect there will be enough flu vaccines for various strains this season, according to a news release.

Experts recommend that everyone 6 months of age and older should be vaccinated against the flu but it is especially important for certain people to be vaccinated due to high risk of having serious flu-related complications. This includes:

  • Children younger than 5 years, but especially children younger than 2 years
  • Pregnant women
  • People 65 and older
  • People of any age with certain chronic medical conditions
  • Residents of nursing homes and other long-term care facilities
  • People who live with or care for those at high risk for complications from flu, including: health care workers, household contacts of persons at high risk for complications from the flu, household contacts and out-of-home caregivers of children younger than 6 months of age (these children are too young to be vaccinated)

Keep in mind that flu season usually reaches the most people in January. And it can take almost two weeks for the vaccine to kick in.

On average, the CDC says flu kills about 24,000 Americans each year. That included 105 children during the last flu season.

Kentucky Group Renews Push For Higher Cigarette Tax Wednesday, Oct 18 2017 

A renewed effort to get people to quit smoking in Kentucky is launching Wednesday in Frankfort. Led by the Kentucky Chamber of Commerce, Foundation for a Healthy Kentucky and Baptist Health, at the top of the coalition’s to-do list is to raise the cigarette tax to $1.60 a pack. That’s a $1 increase over the current rate.

“The whole idea is to cut this terribly damaging smoking rate that we’ve got in Kentucky,” said Ben Chandler, chair of the newly formed Coalition for a Smoke-free Tomorrow. “We’re 70 percent above the national average, and [smoking] has tremendous economic damage.”

Generally, a 10 percent increase in the price of a pack of cigarettes could result in a 2.5 to 5 percent decline in overall smoking, according to a policy brief last month in the journal, Health Affairs. That means increasing the tax even by 6 cents could potentially mean 220,000 Kentuckians would stop smoking.

The Coalition for a Smoke-free Tomorrow estimates its proposed tobacco tax of $1.60 would raise $266 million in new state revenue each year. Kentucky’s current cigarette tax is the 43rd lowest in the nation, and even raising it to to $1.60 would put the state below the national average of $1.71 a pack.

The Kentucky Farm Bureau is a main opponent of increasing the state cigarette tax. KFB argues that increasing the tax would mean less revenues for Kentucky because smokers might go to neighboring states to buy cheaper cigarettes.

Neighboring Missouri has the lowest cigarette tax in the U.S. at 17 cents per pack. Virginia’s tax is the second lowest at 30 cents. Thirty-four states have a cigarette tax of $1 or more, including West Virginia, Ohio and Illinois.

Meanwhile, cigars, pipe tobacco, e-cigarettes and “roll-your-own tobacco” are not taxed.

But besides the additional revenue that could come from raising the tax, Chandler said there would be other benefits to the state. He said many companies don’t locate in Kentucky because of the likelihood of having many employees who smoke.

“Businesses lose money on the front end with a lack of productivity and the back end having to pay health care costs,” Chandler said.

According to the Kentucky Chamber of Commerce, companies pay $5,800 more in costs for employees who smoke versus employees who do not. The group says illnesses related to tobacco use and secondhand smoke cause 9,000 deaths each year, and cost $1.92 billion in health care expenditures. Nearly $590 million of those annual costs are covered by Medicaid, the state’s insurance program for low-income and disabled people that is funded through taxpayer dollars.

In 2014, Kentucky spent $39.2 million on tobacco control programs like the toll-free hotline, cessation classes and anti-smoking marketing. That’s almost $20 million less than the Centers for Disease Control recommends the state spend.

Chandler said the group would also like to see a statewide law to ban smoking in the workplace or indoor public places, but such a move is unlikely to get legislative approval. So instead, the group will push counties and cities to enact smoke-free laws.

Law Gives New Tool To Doctors Treating Drug Dependent Babies Tuesday, Sep 19 2017 

Cameron McCoy is a very happy baby. He likes to smile, clap his hands and sit on his mom, Teosha McCoy’s, lap. McCoy is 27 and used heroin for eight months while she was pregnant with Cameron. But Cameron wasn’t born dependent on drugs.

McCoy lives in temporary housing run by Volunteers of America Mid-States for new and pregnant moms in recovery.

“It’s God’s grace and mercy that he didn’t withdraw, and I used the whole time,” McCoy said.

But many babies in Kentucky are not so lucky. Data from the Kentucky Cabinet for Health and Family Services show that last year, 1,200 babies were born with neonatal abstinence syndrome, or NAS, because of opioid drug exposure during pregnancy.

Lori Devlin faces the challenge of treating those babies often in her job as a neonatologist at University of Louisville Physicians practice. She recently helped push through a new law that she said will help her and other physicians better determine if a mother used drugs during pregnancy.

“It’s access to be able to know what the baby has been exposed to,” Devlin said. “Because of all the legal implications, oftentimes we end up not getting the truth, or at least not the whole truth.”

Treating a baby who has the symptoms of NAS isn’t easy; they often suffer from seizures and fever, among other problems. But it’s a little easier if the health provider knows what the baby is detoxing from, or even whether they’re detoxing in the first place. There are many other conditions that have the same symptoms of NAS.

Devlin said there are reasons a pregnant woman would take opioids outside of addiction, including conditions that require pain management, like sickle cell disease, cancer and chronic back issues.

Doctors treating those babies have relied on the mothers to give them that information. But finding out whether someone is using drugs illegally can be tricky.

“It’s a scary situation that if you’re a mom that has just delivered, to say how and when you’ve obtained drugs. You might be thinking clearly or remember, ‘Oh yea, I was on this last month from this doctor,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. “Rather than to rely on mom’s corporation, it’s a much better situation to look at the actual documents and know.”

And that data is available via the Kentucky All Schedule Prescription Electronic Reporting, or KASPER. This is a database where health providers legally have to report what controlled substances they prescribe patients.

But until now, access was limited to doctors treating a patient. This didn’t help doctors like Devlin, because her doctor-patient relationship was with the infant. The new law allows Devlin–or any doctor treating a baby they suspect of having NAS–to pull the mother’s report.

Van Ingram said even if a mother doesn’t have a KASPER report, that could be telling, too. And he added the information doctors get from KASPER can’t be used to criminally prosecute a mom.

“Or say it’s a NAS baby but there’s no KASPER report,” Ingram said, “that may be an indicator that mom was using heroin or other drugs off the street.”

Devlin said the opioid epidemic has been a much bigger issue than previous years when other drugs were widely used.

“We had cocaine in the 80s but that didn’t lead to massive withdrawal problems,” Devlin said.

There’s also the question of what the long-term impact will be on babies born with NAS. Researchers know the effect fetal alcohol exposure has on those babies later on in life. But with opioids, it’s a big question mark. Devlin said more research is needed to study the long-term effects.

Corinne Ellis Our New Hero! Tuesday, Aug 29 2017 

Corinne Ellis email reply to Kentucky Governor Matt Bevin: “Do not ever fucking email me again.” … Continue reading →

The post Corinne Ellis Our New Hero! appeared first on Hillbilly Report.

Question For Congressman Brett Guthrie. Friday, Aug 11 2017 

Republican Congressman Brett Guthrie held an event at the Elizabethtown, Kentucky Police Department Community Room and took questions from constituents. … Continue reading →

The post Question For Congressman Brett Guthrie. appeared first on Hillbilly Report.

Anti-Abortion Conference Begins With Tame Protests At Louisville Clinic Saturday, Jul 22 2017 

It was surprisingly quiet outside of the EMW Women’s Surgical Center in downtown Louisville Saturday.

Hundreds of anti-abortion activists were expected in front of Kentucky’s last remaining abortion clinic Saturday as far-right fundamentalist Christian group Operation Save America began its weeklong conference with the stated goal of shutting down the clinic. U.S. District Judge David Hale granted a temporary restraining order on Friday establishing a buffer zone around the clinic to keep protesters from blocking its entrance.

The order affects 10 individuals associated with Operation Save who were arrested at the EMW clinic after protesting in May, as well as any of their associates.

Lisa Gillespie | wfpl.org

Buffer zone outside EMW clinic in Louisville.

The buffer zone isn’t a large area — 15-feet by 7.5 feet — and the only breach of the boundary by anti-abortion protesters was to walk from one side of the clinic to the other. Protesters were set up in front of the buffer zone to the street.

Sarah Dugan, a volunteer who helps escort women between their cars and the entrance of the clinic, said the unusually quiet day was due to increased law enforcement presence. Eight U.S. Marshalls and 15 Louisville Police officers were stationed outside.

“Today was quieter than most Saturdays,” Dugan said. “With the police presence there, everyone was way more cognizant about behavior that could be seen as escalating.”

On a typical Saturday morning, Dugan said there’s at least one Louisville police officer who observes from a parked car across the street from the clinic. She said with more officers on site today, the process was smoother for patients approaching the clinic.

“The police were telling people to ‘move, move, get out of the way,’ when people — some people were trying to get through and there was blocking happening,” Dugan said. “Which is amazing. It’s a luxury for us because typically we don’t have that sort presence at all, and the sidewalk gets very congested and very blocked.”

Jonese Franklin

Law enforcement officials keep the peace as anti-abortion activists protest at the EMW clinic.

Brian Parrish, the chief deputy of the U.S. Marshalls Western Kentucky district, said marshalls will be posted there as long as the temporary restraining order — which created the buffer zone — remains in place.

“We’ve had no issues,” Parrish said. “We’re here to make sure everyone’s rights are preserved, and maintain the integrity of the court order.”

In May, 10 people associated with Operation Save America — formerly Operation Rescue — were arrested for blocking the door to the clinic. The group changed its name to Operation Save America after reports of violence against abortion providers and at clinics were tied to the organization.

Ante Pavkovic, an organizer with Operation Save America, drove from Charlotte, North Carolina to attend the weeklong conference that kicks off Saturday night. He said the buffer zone isn’t necessary because his group and other local anti-abortion protesters will still approach women walking toward the clinic to stop them from going in.

“Our weapons are prayer, speaking, and just being out there where things are happening,” he said. “It’s persuasion and that’s as far as it can go.”

Some protesters just pray, others silently hold signs. Some hand out pamphlets and talk at the patients walking toward the clinic. But Sarah Dugan, the clinic escort, said anti-abortion protesters commonly try to intimidate her and the other volunteers.

Pavkovic acknowledged he does this as well.

Lisa Gillespie | wfpl.org

An anti-abortion protester holds a sign outside the EMW clinic in Louisville.

“Yes, there’s rebukes,” he said. “I preach against this sin. I hate abortion. So the preaching is often fiery, but if babies are actually being killed, it should be.”

About 15 minutes before the clinic opened and patients walked the block toward the clinic, Pavkovic approached a clinic escort wearing a purple vest, standing on the same corner.

“You shouldn’t be working here,” he said to the escort. “Take that dumb purple thing off or better yet, join us. Don’t you care about babies? Do you at least know what abortion really is? And do you actually support murdering and dismembering little babies?”

Most Operation Save conference attendees were due to arrive on Saturday and Sunday, according to Pavkovic. And Dugen said the clinic escorts expect next Saturday to be the most active day of protests.

Ahead Of Anti-Abortion Conference, Louisville Clinic Beefs Up Security Thursday, Jul 20 2017 

The founder of Kentucky’s last abortion clinic said the facility is increasing security ahead of anti-abortion protests that will start Saturday.

EMW Women’s Surgical Center founder Dr. Ernest Marshall said he and other staff have been in close contact with the Louisville Metro Police Department and the U.S. Marshall Service. In a conference call Thursday, Marshall described the difficulty surrounding the choice women make to have an abortion. This, he said, is coupled with the logistical problems for some in getting transportation to the clinic, which in many cases is hours away from their homes.

“After overcoming so much to come to our clinic, our patients are forced to face a final obstacle: the excessive bullying and harassment outside the clinic,” Marshall said. “They come to us already made their decision, and it’s awful that they’re then subjected to the surveillance and humiliation outside our doors.”

Far-right religious group Operation Save America will hold its annual conference in Louisville beginning Saturday, and is organizing protests outside the clinic July 22 and 29.

Anti-abortion group Created Equal also has a permit to play footage of a “live” abortion on a large “JumboTron” screen outside City Hall on July 26, according to the group’s Facebook page.

Vicki Saporta with the National Abortion Federation said it will be critical that police enforce the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits people from blocking access to the EMW Center.

“They’re trying to shut down this clinic and I think they’ll go to whatever extremes they think they need to [and] that they think they can get away with,” Saporta said.

While the FACE Act will technically apply no matter what, currently there’s no buffer zone restriction to limit protesters from filling the public sidewalks in front of the clinic.

In a motion pending in U.S. District Court, U.S. Attorney John Kuhn asked a judge to grant a temporary restraining order under the FACE Act. If the judge grants the motion, it would implement a buffer zone and would mean any violation of the buffer zone would carry with it stricter federal penalties.

A similar measure has been informally discussed in Louisville’s Metro Council, though no official ordinance has been proposed. At a committee meeting Wednesday, members were told LMPD is not planning on using extra police or barriers outside the clinic.

Meg Sasse Stern, an escort who aids women in entering the clinic, said 2,658 patients entering the clinic in the past year took surveys asking for their reactions to the protests outside. Eighty-six percent of patients said they were “disturbed,” in some way, including being blocked, intimidated, shoved or touched. Half felt threatened, unsafe or scared. A third of respondents reported considering confronting anti-abortion protesters.

“Anti-abortion extremists emboldened by the prospect of ending legal abortion in Kentucky are marshalling to stage a massive disruptive action that could threaten patient access to the clinic,” Stern said.

Abortion appointments will go on both Saturdays as planned, despite the protests, according to Ernest Marshall.

In May, 10 people associated with Operation Save America were arrested for blocking the door to the clinic. A Louisville Metro Police Department officer told Metro council members Wednesday that besides those arrests and some property damage last week, there haven’t been any recent incidents at the abortion clinic.

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