Fewer families report having trouble paying medical bills; near-poor struggle more than poor families

Fewer American families are having problems paying medical bills, but 20 percent of them, particularly those without insurance and those that are "near poor" but not :poor," still struggle with health costs, says a study released Tuesday by the National Center for Health Statistics.

The report says 54.2 million people, or 20.3 percent of families headed by someone under the age of 65, had difficulty covering medical expenses in the first half of 2012. During the first half of 2011, 21.7 percent of families, or 57.8 million people, found it difficult to pay medical bills.

Hispanics (25.2 percent) and blacks (27.9 percent) were more likely than whites (20.1 percent) or Asians (10.3 percent) to report trouble paying their medical bills, says the report. It says families with incomes from 100 to 199 percent of the poverty line were most likely to have difficulty paying medical bills, probably because those below the poverty line qualify for Medicaid. State income limits vary; in Kentucky, income-based Medicaid is available to those with incomes less than 70 percent of the poverty line.

'Poor' are below the poverty line. 'Near poor' had incomes of 100 to 199 percent of the poverty line. 

Among families with insurance, 14 percent of those with private insurance and 25.6 percent  with Medicaid or other public insurance had similar problems paying bills in the first half of 2012, which represents a 1.7 percent and 2.5 percent decrease from 2011, respectively. For a report on the study, click here.

Fewer American families are having problems paying medical bills, but 20 percent of them, particularly those without insurance and those that are "near poor" but not :poor," still struggle with health costs, says a study released Tuesday by the National Center for Health Statistics.

The report says 54.2 million people, or 20.3 percent of families headed by someone under the age of 65, had difficulty covering medical expenses in the first half of 2012. During the first half of 2011, 21.7 percent of families, or 57.8 million people, found it difficult to pay medical bills.

Hispanics (25.2 percent) and blacks (27.9 percent) were more likely than whites (20.1 percent) or Asians (10.3 percent) to report trouble paying their medical bills, says the report. It says families with incomes from 100 to 199 percent of the poverty line were most likely to have difficulty paying medical bills, probably because those below the poverty line qualify for Medicaid. State income limits vary; in Kentucky, income-based Medicaid is available to those with incomes less than 70 percent of the poverty line.

'Poor' are below the poverty line. 'Near poor' had incomes of 100 to 199 percent of the poverty line. 

Among families with insurance, 14 percent of those with private insurance and 25.6 percent  with Medicaid or other public insurance had similar problems paying bills in the first half of 2012, which represents a 1.7 percent and 2.5 percent decrease from 2011, respectively. For a report on the study, click here.

Read More

State officials tell health-care providers to meet with managed-care companies to get paid, say new system is improving health

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state’s solutions to providers' problems with the companies aren’t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance.  One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren’t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention  the monetary amount of the denied or suspended claims.

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, “There are some providers around the state that have been quite vocal about how much we owe them, but when there’s been an attempt to sit down and work it out with them, they will not make an appointment.” She said it is a provider’s responsibility to reach out to MCOs about the payments they are owed.

“It is about you going to each one of them and setting an appointment for them to work out with them you’re accounts receivable," Haynes said. “If you really want to get paid and if you are really owed, and I believe most of you are, then let’s get an appointment set” with the MCO.

“We want this worked out,” said Haynes. “The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.”

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.
  
Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care.  Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:

• Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge   Road., Dawson Springs) 
• Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville) 
• Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia) 
• Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights) 
• Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray) 

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state’s solutions to providers' problems with the companies aren’t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance.  One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren’t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention  the monetary amount of the denied or suspended claims.

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, “There are some providers around the state that have been quite vocal about how much we owe them, but when there’s been an attempt to sit down and work it out with them, they will not make an appointment.” She said it is a provider’s responsibility to reach out to MCOs about the payments they are owed.

“It is about you going to each one of them and setting an appointment for them to work out with them you’re accounts receivable," Haynes said. “If you really want to get paid and if you are really owed, and I believe most of you are, then let’s get an appointment set” with the MCO.

“We want this worked out,” said Haynes. “The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.”

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.
  
Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care.  Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:

• Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge   Road., Dawson Springs) 
• Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville) 
• Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia) 
• Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights) 
• Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray) 

Read More

Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. “Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,” Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. “It’s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,” Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had “sought a loophole” in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. “Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,” Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. “It’s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,” Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had “sought a loophole” in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Read More

Beshear announces launch of Kynect, the state's new online shop for health insurance; open enrollment starts Oct. 1

Gov. Steve Beshear has announced the launch of Kentucky’s Healthcare Connection, which is referred to as Kynect and is Kentucky's one-stop onlineshop for the state's new health insurance exchange.

Beginning next year, most Americans will be required to have health insurance, and Kynect is designed to help an estimated 640,000 uninsured Kentuckians get coverage through private insurance plans, Medicaid or the Kentucky Children’s Health Insurance Program. The online service is also aimed to promote public education and awareness about the health benefit exchange, says a recent press release.

“When I issued an executive order last year creating a state-based health benefit exchange, I did so to ensure that our health benefit exchange would be designed to best meet the unique needs of Kentuckians,” Beshear said. “Individuals, families and small businesses will be able to use kynect for one-stop shopping to find health coverage and determine if they are eligible for payment assistance or tax credits to help cover costs.”

During open enrollment, which begins Oct. 1, Kentuckians and small businesses can compare and select health insurance plans using the Kynect website, a toll-free contact center, a mail-in application or in person, says the release. People can also use the website to find out if they qualify for payment assistance and special discounts on deductibles, co-pays and co-insurance.

For example, the website indicates that a family of four making $48,000 will receive a tax credit that can be used to pay insurance premiums, which is estimated to be $252 per month, in addition to government subsidies for medical care. A family of four making $80,000 will a receive tax credit too, and insurance premiums are estimated to be $634 per month. Small businesses can also use the website to see if they qualify for specific tax credits (Click here for a PDF fact sheet about payment assistance)

“Starting today, we are undertaking a major education and awareness campaign to ensure that all uninsured Kentuckians understand how Kynect can help them and their families find affordable health coverage,” said Audrey Haynes, secretary for the Cabinet for Health and Family Services, which will oversee Kynect along with the Kentucky Office of the Health Benefit Exchange.

Beshear created the health exchange by an executive order in July 2012. A recent lawsuit alleges this action was not authorized and should first be approved by the General Assembly. To date, Kentucky has received about $250 million in federal grants to cover the initial costs of exchange, but the state will be responsible for all funding for the exchange beginning in 2015. Kentuckians can visit the service's website or watch the video below to learn more about the program. 

Gov. Steve Beshear has announced the launch of Kentucky’s Healthcare Connection, which is referred to as Kynect and is Kentucky's one-stop onlineshop for the state's new health insurance exchange.

Beginning next year, most Americans will be required to have health insurance, and Kynect is designed to help an estimated 640,000 uninsured Kentuckians get coverage through private insurance plans, Medicaid or the Kentucky Children’s Health Insurance Program. The online service is also aimed to promote public education and awareness about the health benefit exchange, says a recent press release.

“When I issued an executive order last year creating a state-based health benefit exchange, I did so to ensure that our health benefit exchange would be designed to best meet the unique needs of Kentuckians,” Beshear said. “Individuals, families and small businesses will be able to use kynect for one-stop shopping to find health coverage and determine if they are eligible for payment assistance or tax credits to help cover costs.”

During open enrollment, which begins Oct. 1, Kentuckians and small businesses can compare and select health insurance plans using the Kynect website, a toll-free contact center, a mail-in application or in person, says the release. People can also use the website to find out if they qualify for payment assistance and special discounts on deductibles, co-pays and co-insurance.

For example, the website indicates that a family of four making $48,000 will receive a tax credit that can be used to pay insurance premiums, which is estimated to be $252 per month, in addition to government subsidies for medical care. A family of four making $80,000 will a receive tax credit too, and insurance premiums are estimated to be $634 per month. Small businesses can also use the website to see if they qualify for specific tax credits (Click here for a PDF fact sheet about payment assistance)

“Starting today, we are undertaking a major education and awareness campaign to ensure that all uninsured Kentuckians understand how Kynect can help them and their families find affordable health coverage,” said Audrey Haynes, secretary for the Cabinet for Health and Family Services, which will oversee Kynect along with the Kentucky Office of the Health Benefit Exchange.

Beshear created the health exchange by an executive order in July 2012. A recent lawsuit alleges this action was not authorized and should first be approved by the General Assembly. To date, Kentucky has received about $250 million in federal grants to cover the initial costs of exchange, but the state will be responsible for all funding for the exchange beginning in 2015. Kentuckians can visit the service's website or watch the video below to learn more about the program. 

Read More

Medicaid expansion could change Kentucky's course, big time

NEWS ANALYSIS

By Al Cross

Kentucky Health News

"Today we change the course of Kentucky's history."

It is not often that a public official can say such a thing with a large measure of credibility, but Gov. Steve Beshear legitimately raised that hope Thursday, as he announced that he would expand Kentucky's Medicaid program under federal health reform.

Beshear with graph predicting positive impact on budget

If Beshear's vision is fulfilled, Kentucky will no longer have one of the unhealthiest populations of any state, a change that will make it more attractive to employers, and any Kentuckian who wants health insurance will be able to get it.

It is in large measure the realization, in the state where all President Harry Truman's grandparents were born, of his 68-year-old dream of national health insurance. The statue of Truman's vice president, Alben Barkley of Paducah, seemed to shine a little more brightly than usual in the Capitol rotunda as the press-conference crowd dispersed.

But this is a project with many moving parts -- billions of dollars, thousands of health-care providers, hundreds of thousands of Medicaid beneficiaries, and scores of political and bureaucratic decisions -- and much could go wrong.

Skeptics point to the problems with the managed-care Medicaid system that Beshear implemented too hurriedly, apparently to avoid complicating his November 2011 re-election, and argue that the program needs fixing before adding 300,000 new enrollees to the 825,000 already on the rolls. Beshear says he's tackling the problems, the program is "working pretty well" and the managed-care companies can handle the influx.

The skeptics also question whether the state can afford the match for the federal funds. "Broad and vague anxieties," Beshear called them, and he came armed with two studies concluding that expansion would actually gain the state money -- mainly because of the billions it will send to the state's health-care providers, creating more jobs, but also because many of the 300,000 or so newly eligible people are not expected to enroll, based on a Price Waterhouse Coopers study drawing on research by the Congressional Budget Office.

University of Louisville research

Preliminary estimates were that expansion would add 400,000 Kentuckians to the Medicaid rolls. However, the study estimated that only 308,000 will become eligible and that only 188,000 will enroll, thus costing the state much less than some expected when it has to match federal funds beginning in January 2017. The initial match will be 5 percent, rising to 10 percent in 2020. The estimated cost for the newly eligible in fiscal 2020-21 is $151 million, in a state budget that is likely to exceed $10 billion. (The state's current share of Medicaid costs, 29.5 percent, is about $1.5 billion a year.)

Those are just estimates. "I believe reality will dwarf those numbers on the spending side," Tea Party activist David Adams, who says he plans to challenge the plan in court, told reporters. But for the time being at least, Beshear has the numbers on his side, and he said they are "very conservative."

The governor said opponents of the plan "fall back on national politics" and say expansion means that Kentucky, a state that President Obama lost big both times, will be "supporting Obamacare. To them I say, 'Get over it.' . . . I'm going to do what's best for Kentucky's people, period." Asked why so many governors have rejected expansion, he said it was mostly "partisan politics."

Conservative columnist John David Dyche cites an Oregon study saying Medicaid is ineffective, but a Harvard School of Public Health study in three other states showed that expansion of Medicaid improves health and saves lives.

Beshear said the expansion, along with health insurance and subsidies available through a state-run exchange that is also part of health reform, would give the state a healthier workforce because studies show that people with health insurance are less likely to skip exams and let health conditions worsen and become costlier and more difficult to treat. "The lack of early care is one reason that Kentucky's health picture is so horrendous," he said.

Kentucky's workforce is one of the nation's least healthy, and the state has a disproportionate number of working-age people who are not in the workforce because of health problems. The state ranks first in smoking, cancer deaths and preventable hospitalizations; second in heart disease and poor physical-health days; third in heart attacks and poor mental-health days; and in the top 10 in diabetes,  cholesterol and sedentary lifestyles. That hurts the state's image as well as its economy, Beshear said. "There will be a huge economic effect for a healthier Kentucky."

He said most of the newly eligible people are not "freeloaders asking for a handout," but people who are working at jobs without health insurance. He said another 332,000 Kentuckians will get insurance through the state exchange, 276,000 of them with subsidies available to people with incomes up to 400 percent of the poverty level. Without Medicaid expansion, he said, 206,000 would not be eligible for Medicaid or a subsidy, and "We cannot leave those people stranded."

The health-reform law tried to force states into expanding Medicaid, but the U.S. Supreme Court ruled that the states should make the choice without fear of financial penalties. The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

Republicans can do little to stop the expansion. They control the state Senate, but Medicaid eligibility and benefit decisions belong to the executive branch, and even if a bipartisan legislative committee were to block the implementing regulations, Beshear could override it.

Or perhaps we should say he would override it. Emotional at times, Beshear called the move "the single most important decision of our lifetime for improving the health of Kentuckians" but said it was easy to make. As a governor who has failed to win his main campaign promise, expanded gambling, and has had relatively little money to spend because of the Great Recession, this is likely to be his largest legacy.

For details and background from the governor's office, click here. For Beshear's YouTube commentary on the issue, click here.

NEWS ANALYSIS

By Al Cross

Kentucky Health News

"Today we change the course of Kentucky's history."

It is not often that a public official can say such a thing with a large measure of credibility, but Gov. Steve Beshear legitimately raised that hope Thursday, as he announced that he would expand Kentucky's Medicaid program under federal health reform.

Beshear with graph predicting positive impact on budget

If Beshear's vision is fulfilled, Kentucky will no longer have one of the unhealthiest populations of any state, a change that will make it more attractive to employers, and any Kentuckian who wants health insurance will be able to get it.

It is in large measure the realization, in the state where all President Harry Truman's grandparents were born, of his 68-year-old dream of national health insurance. The statue of Truman's vice president, Alben Barkley of Paducah, seemed to shine a little more brightly than usual in the Capitol rotunda as the press-conference crowd dispersed.

But this is a project with many moving parts -- billions of dollars, thousands of health-care providers, hundreds of thousands of Medicaid beneficiaries, and scores of political and bureaucratic decisions -- and much could go wrong.

Skeptics point to the problems with the managed-care Medicaid system that Beshear implemented too hurriedly, apparently to avoid complicating his November 2011 re-election, and argue that the program needs fixing before adding 300,000 new enrollees to the 825,000 already on the rolls. Beshear says he's tackling the problems, the program is "working pretty well" and the managed-care companies can handle the influx.

The skeptics also question whether the state can afford the match for the federal funds. "Broad and vague anxieties," Beshear called them, and he came armed with two studies concluding that expansion would actually gain the state money -- mainly because of the billions it will send to the state's health-care providers, creating more jobs, but also because many of the 300,000 or so newly eligible people are not expected to enroll, based on a Price Waterhouse Coopers study drawing on research by the Congressional Budget Office.

University of Louisville research

Preliminary estimates were that expansion would add 400,000 Kentuckians to the Medicaid rolls. However, the study estimated that only 308,000 will become eligible and that only 188,000 will enroll, thus costing the state much less than some expected when it has to match federal funds beginning in January 2017. The initial match will be 5 percent, rising to 10 percent in 2020. The estimated cost for the newly eligible in fiscal 2020-21 is $151 million, in a state budget that is likely to exceed $10 billion. (The state's current share of Medicaid costs, 29.5 percent, is about $1.5 billion a year.)

Those are just estimates. "I believe reality will dwarf those numbers on the spending side," Tea Party activist David Adams, who says he plans to challenge the plan in court, told reporters. But for the time being at least, Beshear has the numbers on his side, and he said they are "very conservative."

The governor said opponents of the plan "fall back on national politics" and say expansion means that Kentucky, a state that President Obama lost big both times, will be "supporting Obamacare. To them I say, 'Get over it.' . . . I'm going to do what's best for Kentucky's people, period." Asked why so many governors have rejected expansion, he said it was mostly "partisan politics."

Conservative columnist John David Dyche cites an Oregon study saying Medicaid is ineffective, but a Harvard School of Public Health study in three other states showed that expansion of Medicaid improves health and saves lives.

Beshear said the expansion, along with health insurance and subsidies available through a state-run exchange that is also part of health reform, would give the state a healthier workforce because studies show that people with health insurance are less likely to skip exams and let health conditions worsen and become costlier and more difficult to treat. "The lack of early care is one reason that Kentucky's health picture is so horrendous," he said.

Kentucky's workforce is one of the nation's least healthy, and the state has a disproportionate number of working-age people who are not in the workforce because of health problems. The state ranks first in smoking, cancer deaths and preventable hospitalizations; second in heart disease and poor physical-health days; third in heart attacks and poor mental-health days; and in the top 10 in diabetes,  cholesterol and sedentary lifestyles. That hurts the state's image as well as its economy, Beshear said. "There will be a huge economic effect for a healthier Kentucky."

He said most of the newly eligible people are not "freeloaders asking for a handout," but people who are working at jobs without health insurance. He said another 332,000 Kentuckians will get insurance through the state exchange, 276,000 of them with subsidies available to people with incomes up to 400 percent of the poverty level. Without Medicaid expansion, he said, 206,000 would not be eligible for Medicaid or a subsidy, and "We cannot leave those people stranded."

The health-reform law tried to force states into expanding Medicaid, but the U.S. Supreme Court ruled that the states should make the choice without fear of financial penalties. The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

Republicans can do little to stop the expansion. They control the state Senate, but Medicaid eligibility and benefit decisions belong to the executive branch, and even if a bipartisan legislative committee were to block the implementing regulations, Beshear could override it.

Or perhaps we should say he would override it. Emotional at times, Beshear called the move "the single most important decision of our lifetime for improving the health of Kentuckians" but said it was easy to make. As a governor who has failed to win his main campaign promise, expanded gambling, and has had relatively little money to spend because of the Great Recession, this is likely to be his largest legacy.

For details and background from the governor's office, click here. For Beshear's YouTube commentary on the issue, click here.

Read More

Half-day seminars on health reform's impact on business Wed. and Thur.; journalists invited

Experts on the impact of federal health-care reform on business will give advice to Kentucky companies at half-day seminars in Lexington and Louisville on Wednesday and Thursday of this week. Presentations about the Patient Protection and Affordable Care Act will include discussions of expected cost increases and tax implications for businesses.

The Kentucky Health Care Reform Seminar will be presented by The Iasis Group, The Lane Report and the Kentucky Chamber of Commerce. The seminar is part of a statewide partnership that includes Commerce Lexington, Greater Louisville Inc., the Kentucky Society for Human Resource Management and the Northern Kentucky Chamber of Commerce.

The Lexington seminar will be held Wednesday, May 8, at the Griffin Gate Marriott Resort, with registration starting at 12:30 p.m. The Louisville seminar will be held Thursday, May 9, at the Louisville Marriott Downtown, with registration beginning at 8 a.m.

Members of the news media are invited to attend the seminars at no cost. For more information or details about covering the event, contact the Kentucky Chamber's Jessica Fletcher at 502-848-8731.

Experts on the impact of federal health-care reform on business will give advice to Kentucky companies at half-day seminars in Lexington and Louisville on Wednesday and Thursday of this week. Presentations about the Patient Protection and Affordable Care Act will include discussions of expected cost increases and tax implications for businesses.

The Kentucky Health Care Reform Seminar will be presented by The Iasis Group, The Lane Report and the Kentucky Chamber of Commerce. The seminar is part of a statewide partnership that includes Commerce Lexington, Greater Louisville Inc., the Kentucky Society for Human Resource Management and the Northern Kentucky Chamber of Commerce.

The Lexington seminar will be held Wednesday, May 8, at the Griffin Gate Marriott Resort, with registration starting at 12:30 p.m. The Louisville seminar will be held Thursday, May 9, at the Louisville Marriott Downtown, with registration beginning at 8 a.m.

Members of the news media are invited to attend the seminars at no cost. For more information or details about covering the event, contact the Kentucky Chamber's Jessica Fletcher at 502-848-8731.

Read More

Poll shows more than half of Ky. adults have no dental insurance and many go without essential dental care

Routine dental care is essential to overall health, but a new poll shows 1.7 million Kentucky adults do not have dental insurance. That is more than times the number of people who will be at Churchill Downs for the Kentucky Derby, notes the Foundation for a Healthy Kentucky, which co-sponsored the poll.

The poll also showed that many Kentucky adults are going without the dental care they need. While the poll found that few owe money for dental bills, only 61 percent said they visited a dentist or dental clinic within the past year. The national figure is 70 percent.

“Oral health is essential to overall health,” said Dr. Susan Zepeda, president and CEO of the foundation. “Yet, our research indicates a majority of Kentuckians do not have dental coverage, so it is not surprising that a large number of adults do not have a personal dentist or oral health provider.”

Poor oral health or oral pain can lead to poor nutrition and can reduce someone's quality of life by making it difficult to sleep, work or interact with others, and having dental insurance is an important factor in determining whether someone is getting the dental care they need.  More than 50 percent of poll respondents indicated not having dental insurance of any kind, and almost half of that group said they skipped getting dental care or check-ups in the past year due to its cost.

Whether or not someone has a normal source of care is also an important factor in determining health care outcomes because those with a personal dentist or doctor are more likely to seek care. Almost 40 percent of poll respondents, however, said they do not have a personal dentist or oral health provider, and almost 80 percent of those respondents said its been more than five years since they last visited a dentist or dental clinic.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted last year from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 points.

Routine dental care is essential to overall health, but a new poll shows 1.7 million Kentucky adults do not have dental insurance. That is more than times the number of people who will be at Churchill Downs for the Kentucky Derby, notes the Foundation for a Healthy Kentucky, which co-sponsored the poll.

The poll also showed that many Kentucky adults are going without the dental care they need. While the poll found that few owe money for dental bills, only 61 percent said they visited a dentist or dental clinic within the past year. The national figure is 70 percent.

“Oral health is essential to overall health,” said Dr. Susan Zepeda, president and CEO of the foundation. “Yet, our research indicates a majority of Kentuckians do not have dental coverage, so it is not surprising that a large number of adults do not have a personal dentist or oral health provider.”

Poor oral health or oral pain can lead to poor nutrition and can reduce someone's quality of life by making it difficult to sleep, work or interact with others, and having dental insurance is an important factor in determining whether someone is getting the dental care they need.  More than 50 percent of poll respondents indicated not having dental insurance of any kind, and almost half of that group said they skipped getting dental care or check-ups in the past year due to its cost.

Whether or not someone has a normal source of care is also an important factor in determining health care outcomes because those with a personal dentist or doctor are more likely to seek care. Almost 40 percent of poll respondents, however, said they do not have a personal dentist or oral health provider, and almost 80 percent of those respondents said its been more than five years since they last visited a dentist or dental clinic.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted last year from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 points.

Read More

Business leaders discuss possibility of expanding Medicaid through private insurance

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."

Read More

Baucus sees a health-reform 'train wreck,' fearing insurance exchanges won't be ready

Max Baucus (J. Scott Applewhite, AP)

Senator Max Baucus, who as Senate Finance Committee chair helped write the health-care reform law, has become the highest-ranking Democrat to publicly voice concerns about its implementation, saying he thinks it’s headed for a collision with itself.

“I just see a huge train wreck coming down,” the Montanan told Health and Human Services Secretary Kathleen Sebelius during a budget hearing.

Matt Gouras of The Associated Press notes that polls show that Americans are confused by the complex law, which is designed to cover about 30 million uninsured people through a mix of government programs and tax credits. Baucus told Sibelius he’s “very concerned” that new health insurance exchanges will not open on time in every state and residents will not have enough information to make choices even if they do open on time, as Kentucky's seems likely to do.

"The administration’s public-information campaign on the benefits of the Affordable Care Act deserves a failing grade,” Baucus lectured. “You need to fix this.” Baucus’ office later told Gouras that the senator still thinks the Affordable Care Act is a good law, but questions its roll-out.

Sebelius said that the administration is on track to fully implement exchanges in January, and to be open for open enrollment on Oct. 1, 2013, reports Gouras. Kentucky is among the states that have chosen to build a fully state-based exchange. Others have chosen a state-federal partnership exchange, or defaulted into a federally facilitated exchange. The map below shows the lay of the land about that decision. Yellow states have defaulted to a federal exchange, light blue states are planning for a partnership and blue states have chosen a state-based exchange.

Map provided by the Kaiser Family Foundation

Max Baucus (J. Scott Applewhite, AP)

Senator Max Baucus, who as Senate Finance Committee chair helped write the health-care reform law, has become the highest-ranking Democrat to publicly voice concerns about its implementation, saying he thinks it’s headed for a collision with itself.

“I just see a huge train wreck coming down,” the Montanan told Health and Human Services Secretary Kathleen Sebelius during a budget hearing.

Matt Gouras of The Associated Press notes that polls show that Americans are confused by the complex law, which is designed to cover about 30 million uninsured people through a mix of government programs and tax credits. Baucus told Sibelius he’s “very concerned” that new health insurance exchanges will not open on time in every state and residents will not have enough information to make choices even if they do open on time, as Kentucky's seems likely to do.

"The administration’s public-information campaign on the benefits of the Affordable Care Act deserves a failing grade,” Baucus lectured. “You need to fix this.” Baucus’ office later told Gouras that the senator still thinks the Affordable Care Act is a good law, but questions its roll-out.

Sebelius said that the administration is on track to fully implement exchanges in January, and to be open for open enrollment on Oct. 1, 2013, reports Gouras. Kentucky is among the states that have chosen to build a fully state-based exchange. Others have chosen a state-federal partnership exchange, or defaulted into a federally facilitated exchange. The map below shows the lay of the land about that decision. Yellow states have defaulted to a federal exchange, light blue states are planning for a partnership and blue states have chosen a state-based exchange.

Map provided by the Kaiser Family Foundation

Read More

Poll shows health care costs are a burden for many Kentuckians

A recent statewide survey shows health-care costs are a burden for many Kentuckians, especially for those who are poor and don't have insurance and put off getting care they need because they can't afford it.

More than 60 percent of Kentucky adults in the poll said high costs forced them or a family member living in their home to delay getting care in the past year. Not surprisingly, almost 90 percent of uninsured respondents reported going completely without care in the past year.

The Kentucky Health Issues Poll also showed that 48 percent have relied on home remedies when they are sick instead of going to a doctor, 43 percent have postponed care they needed, 37 percent have not filled a prescription or skipped a dental visit or checkup, 36 percent skipped a recommended medical test or treatment, and 16 percent have cut pills in half or skipped doses of medicine for financial reasons. Overall, 64 percent answered "yes" to at least one of those questions.

“Although our economy is improving, many Kentucky families are still struggling financially. Our research shows healthcare costs have a significant impact on Kentuckians’ actions,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Timely access to quality, affordable healthcare is important to restore and maintain Kentuckians’ health and productivity. When we delay or go without care, illness severity and costs can escalate. Based on the KHIP results, many Kentuckians are taking risks with their overall health because of the expense.”

Rising costs of health care do not affect all Kentuckians in the same way; almost 40 percent of Kentucky adults reported that paying for health care and health insurance is not a financial burden. Those who did say costs were a burden said they were burdened equally by the costs of doctor visits, prescription drugs and insurance premiums or deductibles.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted Sept. 20 and Oct. 14 of last year by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or 2.5 points.

A recent statewide survey shows health-care costs are a burden for many Kentuckians, especially for those who are poor and don't have insurance and put off getting care they need because they can't afford it.

More than 60 percent of Kentucky adults in the poll said high costs forced them or a family member living in their home to delay getting care in the past year. Not surprisingly, almost 90 percent of uninsured respondents reported going completely without care in the past year.

The Kentucky Health Issues Poll also showed that 48 percent have relied on home remedies when they are sick instead of going to a doctor, 43 percent have postponed care they needed, 37 percent have not filled a prescription or skipped a dental visit or checkup, 36 percent skipped a recommended medical test or treatment, and 16 percent have cut pills in half or skipped doses of medicine for financial reasons. Overall, 64 percent answered "yes" to at least one of those questions.

“Although our economy is improving, many Kentucky families are still struggling financially. Our research shows healthcare costs have a significant impact on Kentuckians’ actions,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Timely access to quality, affordable healthcare is important to restore and maintain Kentuckians’ health and productivity. When we delay or go without care, illness severity and costs can escalate. Based on the KHIP results, many Kentuckians are taking risks with their overall health because of the expense.”

Rising costs of health care do not affect all Kentuckians in the same way; almost 40 percent of Kentucky adults reported that paying for health care and health insurance is not a financial burden. Those who did say costs were a burden said they were burdened equally by the costs of doctor visits, prescription drugs and insurance premiums or deductibles.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati. The poll was conducted Sept. 20 and Oct. 14 of last year by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or 2.5 points.

Read More

Lawsuit alleges state health insurance exchange is unauthorized

Tea Party activist David Adams filed a lawsuit Monday challenging Gov. Steve Beshear's legal authority to create Kentucky's health insurance exchange without approval from the General Assembly. The governor created the exchange by executive order to offer health insurance plans for Kentuckians under federal health reform, but did not ask the legislature to approve it.

Adams claims state law requires the exchange to get legislative approval, and he seeks an injunction against it. The law allows the governor to temporarily reorganize units of state government and calls for them to be approved by the General Assembly.

Beshear's office says he exercised his constitutional authority to meet the requirements of federal law, reports Jack Brammer of the Lexington Herald-Leader.

Adams said in a telephone interview, "There is nothing in the constitution that allows him to set up a new bureaucracy that taxes, gains fees or spends money without legislative approval." He added, "This isn't about politics. It is simply about gubernatorial authority in the absence of legislative approval."

Kentucky has received about $250 million from the federal government to cover the initial costs of exchange, but Adams said that is being spent rather quickly and funds will be exhausted by 2014, he said. The state will be responsible for all funding for the exchange beginning in 2015; it plans to fund it with fees from participating insurance companies.

Kentucky is one of 17 states that the federal government approved to build its own exchange, which will be operated by the Cabinet for Health and Family Services and is expected to help insure more than 600,000 Kentuckians. (Read more)

Tea Party activist David Adams filed a lawsuit Monday challenging Gov. Steve Beshear's legal authority to create Kentucky's health insurance exchange without approval from the General Assembly. The governor created the exchange by executive order to offer health insurance plans for Kentuckians under federal health reform, but did not ask the legislature to approve it.

Adams claims state law requires the exchange to get legislative approval, and he seeks an injunction against it. The law allows the governor to temporarily reorganize units of state government and calls for them to be approved by the General Assembly.

Beshear's office says he exercised his constitutional authority to meet the requirements of federal law, reports Jack Brammer of the Lexington Herald-Leader.

Adams said in a telephone interview, "There is nothing in the constitution that allows him to set up a new bureaucracy that taxes, gains fees or spends money without legislative approval." He added, "This isn't about politics. It is simply about gubernatorial authority in the absence of legislative approval."

Kentucky has received about $250 million from the federal government to cover the initial costs of exchange, but Adams said that is being spent rather quickly and funds will be exhausted by 2014, he said. The state will be responsible for all funding for the exchange beginning in 2015; it plans to fund it with fees from participating insurance companies.

Kentucky is one of 17 states that the federal government approved to build its own exchange, which will be operated by the Cabinet for Health and Family Services and is expected to help insure more than 600,000 Kentuckians. (Read more)

Read More

Beshear vetoes prompt-pay bill but takes several steps to address problems in Medicaid; he and Haynes say it's working

Gov. Steve Beshear has vetoed the bill designed to make Medicaid managed-care firms pay health-care providers more quickly, but is taking administrative steps to address the issue.

Beshear said he agreed with the intent of House Bill 5 but it might have interfered with the contractual relationship between the state and the four managed-care companies. The bill would have subjected that relationship to the state Department of Insurance's review and investigation process for private-insurance payment complaints. 

"That language would have resulted in excessive costs for state government and taxpayers due to the expansion of the review process beyond the current parameters used for private insurance," Beshear's office said in a press release.

Instead, Beshear ordered the department to take over responsibility for review of prompt-payment complaints from the Department for Medicaid Services. "If improper payment practices are discovered, DOI can impose sanctions," the release said. He also ordered the department to audit each of the managed-care firms operating statewide – Wellcare, Coventry Cares, and Kentucky Spirit – at their cost.

Meanwhile, the firms have agreed to meet with every hospital they have under contract to reconcile outstanding accounts.  "This effort will begin immediately and continue until every hospital’s accounts receivable has been reconciled," the release said.  "The results will . . . be made public, in order to provide transparency and accountability." The firms have  agreed to meet with any other provider who wants a meeting.

Also, the Cabinet for Health and Family Services will hold eight regional forums for providers, managed-care firms, and Insurance Department representatives to discuss concerns and how to improve the system. Part of this effort will focus on "emergency room management that meets community needs without an ER operating as a de facto primary-care office," the release said. "A key component of controlling costs and improving health in a healthcare system is to provide the right treatment in the most cost-effective setting."

CHFS Secretary Audrey Tayse Haynes said the switch to managed care, made in November 2011, is working. “We are already seeing a tremendous increase in the use of preventive services, which improve health-care outcomes, while also reducing the enormous costs for treating chronic health conditions” such as diabetes-related amputations, she said.

Beshear said his plan would solve "lingering implementation problems" with managed care "while preserving the significant improvements in patient care and health care cost savings."

"Getting our people healthy and keeping them that way is not just good health policy, it’s good economics," Beshear said. "That’s why we will never return to the old fee-for-service system.  This is a significant cultural shift in medical care that has already happened across the country in both the private insurance market and in the Medicaid system."

Gov. Steve Beshear has vetoed the bill designed to make Medicaid managed-care firms pay health-care providers more quickly, but is taking administrative steps to address the issue.

Beshear said he agreed with the intent of House Bill 5 but it might have interfered with the contractual relationship between the state and the four managed-care companies. The bill would have subjected that relationship to the state Department of Insurance's review and investigation process for private-insurance payment complaints. 

"That language would have resulted in excessive costs for state government and taxpayers due to the expansion of the review process beyond the current parameters used for private insurance," Beshear's office said in a press release.

Instead, Beshear ordered the department to take over responsibility for review of prompt-payment complaints from the Department for Medicaid Services. "If improper payment practices are discovered, DOI can impose sanctions," the release said. He also ordered the department to audit each of the managed-care firms operating statewide – Wellcare, Coventry Cares, and Kentucky Spirit – at their cost.

Meanwhile, the firms have agreed to meet with every hospital they have under contract to reconcile outstanding accounts.  "This effort will begin immediately and continue until every hospital’s accounts receivable has been reconciled," the release said.  "The results will . . . be made public, in order to provide transparency and accountability." The firms have  agreed to meet with any other provider who wants a meeting.

Also, the Cabinet for Health and Family Services will hold eight regional forums for providers, managed-care firms, and Insurance Department representatives to discuss concerns and how to improve the system. Part of this effort will focus on "emergency room management that meets community needs without an ER operating as a de facto primary-care office," the release said. "A key component of controlling costs and improving health in a healthcare system is to provide the right treatment in the most cost-effective setting."

CHFS Secretary Audrey Tayse Haynes said the switch to managed care, made in November 2011, is working. “We are already seeing a tremendous increase in the use of preventive services, which improve health-care outcomes, while also reducing the enormous costs for treating chronic health conditions” such as diabetes-related amputations, she said.

Beshear said his plan would solve "lingering implementation problems" with managed care "while preserving the significant improvements in patient care and health care cost savings."

"Getting our people healthy and keeping them that way is not just good health policy, it’s good economics," Beshear said. "That’s why we will never return to the old fee-for-service system.  This is a significant cultural shift in medical care that has already happened across the country in both the private insurance market and in the Medicaid system."

Read More

Will Kentucky expand Medicaid, and if so, how?

By Molly Burchett
Kentucky Health News

Kentucky is one of the last states to decide whether to expand Medicaid under federal health reform, and now that the General Assembly has gone home, Democratic Gov. Steve Beshear can turn his attention to the many questions that linger. Some Republican legislators think he will expand the program, but they worry about the cost when the state would have to start helping cover the new expenses, beginning in 2017.

Republican Gov. Bill Haslam of Tennessee decided Wednesday that he will not pursue Medicaid expansion, saying that it could put hospitals in financial jeopardy by giving them more patients on which they lose money, reports Michelle Kaske of Bloomberg. If he is right and the same logic applies to Kentucky, Medicaid expansion in the state could harm the rural hospitals and providers -- some of whom are already squeezed by the issues with the new managed-care system.

Along with Kentucky, 10 other states are undecided about Medicaid expansion: Alaska, Indiana, Kansas, Nebraska, New York, Oregon, Utah, Virginia, West Virginia and Wyoming. The map by The Advisory Board Company shows the lay of the land; for an interactive picture that outlines the research behind the map, click here.

Red=Not participating; Pink=Leaning toward not participating;
Gray=Undecided; Blue=Participating; Light Blue=Leaning toward participating

Only three states with Democratic governors are undecided; 18 Republican governors have rejected expansion. Kentucky is shown as leaning for it because Beshear has repeatedly said that he will expand Medicaid if the state can afford it. He has also mentioned that the state can reserve the right to pull out of the deal in 2017, when it must paying 3 percent of the cost of covering the newly insured, reaching 10 percent in 2020. Still, the questions about cost and affordability remain, and Beshear could be considering another option.

Tennessee has joined Ohio and Arkansas in negotiating with the Obama administration over plans to use federal Medicaid money to purchase private insurance for those who can't afford it but don't qualify for Medicaid now. However, Haslam's plan has been held up because the administration placed too many conditions on the money, writes Kaske. Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in this option since Gov. Mike Beebe of Arkansas, a Democrat, ignited the wildfire of creating a hybrid of the two alternatives, reports Robert Pear of The New York Times.

The idea of privatizing Medicaid expansion appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid. However, many Kentucky hospitals and providers are concerned about the managed-care program that is run by three private organizations, and are calling for immediate action. Beshear has not said whether he will sign or veto a bill that would subject the managed-care firms to the prompt-payments and dispute-resolution rules of the state Department of Insurance.

"Action is needed to address the problems that patients and hospitals are experiencing with Medicaid managed care and to make the system work properly," wrote Harold "Bud" Warman, chair of the Kentucky Hospital Association, and Charles Lovell, chair-elect of the association, in a recent Herald-Leader article that laid out the various problems with the system. "And with the possibility that Medicaid will be expanded in Kentucky to include an additional 350,000 people, it is critical that these issues be addressed right away to avoid even greater problems in the future."

Either using federal dollars to buy private insurance in order to cover newly qualified individuals (the hybrid plan) under the health law's expansion  or expanding in the "traditional" way will not change the current managed care structure of Medicaid in Kentucky. Yet, it would mean that 350,000 more Kentuckians would be covered under managed care; Medicaid would cover those earning up to 138 percent of the federal poverty level, currently up to $15,856 a year for an individual.

The money that the federal government offers for expansion is very tempting. The question then may be, how will it be used?

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

By Molly Burchett
Kentucky Health News

Kentucky is one of the last states to decide whether to expand Medicaid under federal health reform, and now that the General Assembly has gone home, Democratic Gov. Steve Beshear can turn his attention to the many questions that linger. Some Republican legislators think he will expand the program, but they worry about the cost when the state would have to start helping cover the new expenses, beginning in 2017.

Republican Gov. Bill Haslam of Tennessee decided Wednesday that he will not pursue Medicaid expansion, saying that it could put hospitals in financial jeopardy by giving them more patients on which they lose money, reports Michelle Kaske of Bloomberg. If he is right and the same logic applies to Kentucky, Medicaid expansion in the state could harm the rural hospitals and providers -- some of whom are already squeezed by the issues with the new managed-care system.

Along with Kentucky, 10 other states are undecided about Medicaid expansion: Alaska, Indiana, Kansas, Nebraska, New York, Oregon, Utah, Virginia, West Virginia and Wyoming. The map by The Advisory Board Company shows the lay of the land; for an interactive picture that outlines the research behind the map, click here.

Red=Not participating; Pink=Leaning toward not participating;
Gray=Undecided; Blue=Participating; Light Blue=Leaning toward participating

Only three states with Democratic governors are undecided; 18 Republican governors have rejected expansion. Kentucky is shown as leaning for it because Beshear has repeatedly said that he will expand Medicaid if the state can afford it. He has also mentioned that the state can reserve the right to pull out of the deal in 2017, when it must paying 3 percent of the cost of covering the newly insured, reaching 10 percent in 2020. Still, the questions about cost and affordability remain, and Beshear could be considering another option.

Tennessee has joined Ohio and Arkansas in negotiating with the Obama administration over plans to use federal Medicaid money to purchase private insurance for those who can't afford it but don't qualify for Medicaid now. However, Haslam's plan has been held up because the administration placed too many conditions on the money, writes Kaske. Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in this option since Gov. Mike Beebe of Arkansas, a Democrat, ignited the wildfire of creating a hybrid of the two alternatives, reports Robert Pear of The New York Times.

The idea of privatizing Medicaid expansion appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid. However, many Kentucky hospitals and providers are concerned about the managed-care program that is run by three private organizations, and are calling for immediate action. Beshear has not said whether he will sign or veto a bill that would subject the managed-care firms to the prompt-payments and dispute-resolution rules of the state Department of Insurance.

"Action is needed to address the problems that patients and hospitals are experiencing with Medicaid managed care and to make the system work properly," wrote Harold "Bud" Warman, chair of the Kentucky Hospital Association, and Charles Lovell, chair-elect of the association, in a recent Herald-Leader article that laid out the various problems with the system. "And with the possibility that Medicaid will be expanded in Kentucky to include an additional 350,000 people, it is critical that these issues be addressed right away to avoid even greater problems in the future."

Either using federal dollars to buy private insurance in order to cover newly qualified individuals (the hybrid plan) under the health law's expansion  or expanding in the "traditional" way will not change the current managed care structure of Medicaid in Kentucky. Yet, it would mean that 350,000 more Kentuckians would be covered under managed care; Medicaid would cover those earning up to 138 percent of the federal poverty level, currently up to $15,856 a year for an individual.

The money that the federal government offers for expansion is very tempting. The question then may be, how will it be used?

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Read More

Senate sends bill for prompt payment by managed-care firms to Beshear, who won't say whether he will sign or veto it

A bill aimed at resolving payment disputes between medical providers and Medicaid managed-care companies passed unanimously Monday in the Senate, and has been sent to Gov. Steve Beshear for his consideration.

House Bill 5, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, would apply existing prompt-payment laws to managed-care firms and would set up an appeal process in the Department of Insurance to handle disputes between them and medical providers. Those claims are now handled by the Cabinet for Health and Family Services, which administers Medicaid and has had some problems with the bill.

Hospitals, doctors and other health-care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms, putting many rural hospitals, clinics and health departments in serious financial binds.  Mental health centers have also reported cutting back services.

Asked last night what he would do with the bill, Beshear said the cabinet "has worked with the managed-care organizations and health-care providers to reduce problems during the change, and many concerns have been addressed.  However, I recognize that some issues persist.  I will review this bill carefully.”

Beshear has 10 days, excluding Sundays, to decide whether to veto the bill, sign it into law or allow it to become law without his signature. Stumbo said that if bill is vetoed it would likely be House Bill 1 in the 2014 session, reports Jessie Halladay of The Courier-Journal. The bill is a top priority for many health-care providers.

A bill aimed at resolving payment disputes between medical providers and Medicaid managed-care companies passed unanimously Monday in the Senate, and has been sent to Gov. Steve Beshear for his consideration.

House Bill 5, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, would apply existing prompt-payment laws to managed-care firms and would set up an appeal process in the Department of Insurance to handle disputes between them and medical providers. Those claims are now handled by the Cabinet for Health and Family Services, which administers Medicaid and has had some problems with the bill.

Hospitals, doctors and other health-care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms, putting many rural hospitals, clinics and health departments in serious financial binds.  Mental health centers have also reported cutting back services.

Asked last night what he would do with the bill, Beshear said the cabinet "has worked with the managed-care organizations and health-care providers to reduce problems during the change, and many concerns have been addressed.  However, I recognize that some issues persist.  I will review this bill carefully.”

Beshear has 10 days, excluding Sundays, to decide whether to veto the bill, sign it into law or allow it to become law without his signature. Stumbo said that if bill is vetoed it would likely be House Bill 1 in the 2014 session, reports Jessie Halladay of The Courier-Journal. The bill is a top priority for many health-care providers.

Read More

Newly formed Kentucky Health Cooperative gets OK to offer plans in state's health insurance exchange

The new Kentucky Health Cooperative's health-insurance plans have received approval from the state Department of Insurance and will be available on Kentucky's insurance exchange market when it opens in October.

“This is a red-letter day for Kentuckians,” Janie Miller, CEO of the cooperative, said in a news release. “Although health-care cooperatives have offered quality care and lower overhead expenses to members since the 1930s, they’re the ‘newest kid’ on Kentucky’s health insurance block. Efforts are underway to help the public become familiar with the cooperative concept.” The cooperative was formed with a mixture of private capital and federal loans.

Miller, a former secretary of the state Cabinet for Health and Family Services, said the cooperative is like member-owned and member-operated credit unions, rural electric cooperatives and food co-ops. “Think agriculture cooperative extension offices, and consider the impact such organizations have made,” she said. “Doing so makes it easy to imagine the potential, similar value to the citizens of our Commonwealth offered by a health cooperative.”

Joe Smith, chair of the cooperative's board of directors, said “A gateway has been opened to individuals and small businesses seeking more affordable, consumer-friendly, quality-driven health insurance options.”

Details about the cooperative plans offered to individuals and businesses with 50 or fewer employees on the nw state insurance exchange will be announced in the coming months. (Read more at the KYHC website)

The new Kentucky Health Cooperative's health-insurance plans have received approval from the state Department of Insurance and will be available on Kentucky's insurance exchange market when it opens in October.

“This is a red-letter day for Kentuckians,” Janie Miller, CEO of the cooperative, said in a news release. “Although health-care cooperatives have offered quality care and lower overhead expenses to members since the 1930s, they’re the ‘newest kid’ on Kentucky’s health insurance block. Efforts are underway to help the public become familiar with the cooperative concept.” The cooperative was formed with a mixture of private capital and federal loans.

Miller, a former secretary of the state Cabinet for Health and Family Services, said the cooperative is like member-owned and member-operated credit unions, rural electric cooperatives and food co-ops. “Think agriculture cooperative extension offices, and consider the impact such organizations have made,” she said. “Doing so makes it easy to imagine the potential, similar value to the citizens of our Commonwealth offered by a health cooperative.”

Joe Smith, chair of the cooperative's board of directors, said “A gateway has been opened to individuals and small businesses seeking more affordable, consumer-friendly, quality-driven health insurance options.”

Details about the cooperative plans offered to individuals and businesses with 50 or fewer employees on the nw state insurance exchange will be announced in the coming months. (Read more at the KYHC website)

Read More

Kentucky families struggle to care for violent, mentally ill children, and say their plight has been made worse by managed-care firms

Kentucky families struggle to care for violent, mentally ill children, and say their plight has been made worse by managed-care companies that fragment mental-health care and make it harder to find appropriate, stable treatment, which ultimately places the larger public at risk, Laura Ungar reports for The Courier-Journal.

Ungar writes that the lives of these Kentucky families resemble in part the one that lead to a devastating outcome in Newtown, Conn., where 20-year-old Adam Lanza, who had poor mental health and was under his mother’s care, went on a shooting rampage in an elementary school and killed 20 students and six staff members.

To represent the Kentucky families fighting, this battle, Ungar tells the story of the Davies family, who battle to keep themselves safe from the violent rage of their 14-year-old daughter, Lucy, while struggling to find the help she needs. Lucy has threatened to kill her 16-year-old sister, Katie, and herself, she’s tried to throw Katie and her father Dan down the basement stairs, and she’s been abusive to her mother.

Lucy suffers from a long list of disorders: neurological problems from fetal alcohol spectrum disorder, a mood disorder, post-traumatic stress disorder, and cognitive difficulties, Ungar reports. "Since Lucy was adopted at age 9, she’s received fragmented treatment in more than six facilities and doctors’ offices, none of which have been able to stop her violent outbursts," Ungar writes. Now, her Medicaid managed-care insurer, Coventry Cares, won’t cover her treatment in an Illinois facility called NeuroRestorative, which Ungar says offers her the best chance at improvement.

"The care tracking is just so fragmented, and we have managed-care companies that determine from afar what care people can get. They go from provider to provider. It’s a tragedy," said Louise Howell, president of Buckhorn Children and Family Services, where Lucy was treated briefly before becoming too violent for the staff. “This child is a perfect example of someone in need of a strong therapeutic community," Howell said. "And there’s so many of them."

Before going to Buckhorn, Lucy was at Rivendell Behavioral Health Services in Bowling Green, where she received brief treatment after threatening to kill her sister. From Buckhorn she got an emergency transfer to Our Lady of Peace in Louisville, which could handle her high level of violence. She was released when she moved from the Medicaid plan Kentucky Spirit, which plans to break its contract with the state, to Coventry Cares, with which Our Lady of Peace had severed ties.

Lucy's mother told Ungar that every switch of caregiver and facility increases the trauma to her daughter, who desperately needs stable care. Lucy’s parents say she would have such stability at NeuroRestorative, where her fetal alcohol syndrome could be addressed on a long-term basis. But two doctors working for Coventry, who have never examined Lucy, told her parents that Conventry "won’t cover the placement because there’s no evidence that inpatient care for brain trauma is medically necessary," Ungar reports.

Her eyes full of tears, Cynthia Davies told Ungar, “You cannot look into my daughter’s eyes and tell me she doesn’t deserve care. She’s a human being.” (Read more)

Kentucky families struggle to care for violent, mentally ill children, and say their plight has been made worse by managed-care companies that fragment mental-health care and make it harder to find appropriate, stable treatment, which ultimately places the larger public at risk, Laura Ungar reports for The Courier-Journal.

Ungar writes that the lives of these Kentucky families resemble in part the one that lead to a devastating outcome in Newtown, Conn., where 20-year-old Adam Lanza, who had poor mental health and was under his mother’s care, went on a shooting rampage in an elementary school and killed 20 students and six staff members.

To represent the Kentucky families fighting, this battle, Ungar tells the story of the Davies family, who battle to keep themselves safe from the violent rage of their 14-year-old daughter, Lucy, while struggling to find the help she needs. Lucy has threatened to kill her 16-year-old sister, Katie, and herself, she’s tried to throw Katie and her father Dan down the basement stairs, and she’s been abusive to her mother.

Lucy suffers from a long list of disorders: neurological problems from fetal alcohol spectrum disorder, a mood disorder, post-traumatic stress disorder, and cognitive difficulties, Ungar reports. "Since Lucy was adopted at age 9, she’s received fragmented treatment in more than six facilities and doctors’ offices, none of which have been able to stop her violent outbursts," Ungar writes. Now, her Medicaid managed-care insurer, Coventry Cares, won’t cover her treatment in an Illinois facility called NeuroRestorative, which Ungar says offers her the best chance at improvement.

"The care tracking is just so fragmented, and we have managed-care companies that determine from afar what care people can get. They go from provider to provider. It’s a tragedy," said Louise Howell, president of Buckhorn Children and Family Services, where Lucy was treated briefly before becoming too violent for the staff. “This child is a perfect example of someone in need of a strong therapeutic community," Howell said. "And there’s so many of them."

Before going to Buckhorn, Lucy was at Rivendell Behavioral Health Services in Bowling Green, where she received brief treatment after threatening to kill her sister. From Buckhorn she got an emergency transfer to Our Lady of Peace in Louisville, which could handle her high level of violence. She was released when she moved from the Medicaid plan Kentucky Spirit, which plans to break its contract with the state, to Coventry Cares, with which Our Lady of Peace had severed ties.

Lucy's mother told Ungar that every switch of caregiver and facility increases the trauma to her daughter, who desperately needs stable care. Lucy’s parents say she would have such stability at NeuroRestorative, where her fetal alcohol syndrome could be addressed on a long-term basis. But two doctors working for Coventry, who have never examined Lucy, told her parents that Conventry "won’t cover the placement because there’s no evidence that inpatient care for brain trauma is medically necessary," Ungar reports.

Her eyes full of tears, Cynthia Davies told Ungar, “You cannot look into my daughter’s eyes and tell me she doesn’t deserve care. She’s a human being.” (Read more)

Read More

Kentucky receives an F grade for its low funding of mental-health services; supply falls short of demand

Kentucky's supply of mental-health services is much lower than demand for those services, in terms of state funding, and the state spends only 45 percent of the national average in mental-health funding per person.

In 2010, Kentucky dedicated about $232 million to mental-health services, according to the Kaiser Family Foundation, which is $54 per person, compared with a U.S. average of $121 that year. That ranks Kentucky among the bottom 10 states without including individual mental health reimbursements for Medicaid, reports Chris Kenning of The Courier-Journal.

The state's Medicaid rates for mental-health services haven't been raised substantially in years, and only a fraction of mental-health facilities offer residential treatments, reports Kenning. He also reports the most recent “Grading the States” report of the National Alliance on Mental Illness gave Kentucky an F in 2009. The group considered measures such as the number of programs using evidence-based practices and the number of psychiatric beds.

Kentucky officials cite new efforts to improve care, such as partnering with the University of Kentucky at a new Eastern State Hospital that will open soon, and pursuing a change to allow Medicaid funding of community outpatient teams, reports Kenning. Kentucky also funds 14 regional community mental-health centers, which served 160,000 people last year, and there are 179 mental-health facilities, which include 40 offering residential care, reports Kenning.

Yet, these efforts fall short of providing mental health services for those Kentuckians in need.  In 2011, a surprisingly high 42 percent of Kentucky adult females and 31 percent of Kentucky males reported having poor mental health. Experts estimate that one in four people will suffer from some form of mental illness in a given year, which is nearly 1.1 million people in Kentucky, Kenning reports. 

It is critical for Kentucky officials to examine this issue in light of the Department of Health and Human Services rule that included mental-health benefits and treatment of substance-abuse disorders as part of the 10 "essential health benefits" insurance plans must provide when federal health reform takes full effect next year. HHS estimates it will expand mental-health and substance-abuse treatment benefits to 62 million Americans, and there is already a shortage of such services in Kentucky.

Kentucky's supply of mental-health services is much lower than demand for those services, in terms of state funding, and the state spends only 45 percent of the national average in mental-health funding per person.

In 2010, Kentucky dedicated about $232 million to mental-health services, according to the Kaiser Family Foundation, which is $54 per person, compared with a U.S. average of $121 that year. That ranks Kentucky among the bottom 10 states without including individual mental health reimbursements for Medicaid, reports Chris Kenning of The Courier-Journal.

The state's Medicaid rates for mental-health services haven't been raised substantially in years, and only a fraction of mental-health facilities offer residential treatments, reports Kenning. He also reports the most recent “Grading the States” report of the National Alliance on Mental Illness gave Kentucky an F in 2009. The group considered measures such as the number of programs using evidence-based practices and the number of psychiatric beds.

Kentucky officials cite new efforts to improve care, such as partnering with the University of Kentucky at a new Eastern State Hospital that will open soon, and pursuing a change to allow Medicaid funding of community outpatient teams, reports Kenning. Kentucky also funds 14 regional community mental-health centers, which served 160,000 people last year, and there are 179 mental-health facilities, which include 40 offering residential care, reports Kenning.

Yet, these efforts fall short of providing mental health services for those Kentuckians in need.  In 2011, a surprisingly high 42 percent of Kentucky adult females and 31 percent of Kentucky males reported having poor mental health. Experts estimate that one in four people will suffer from some form of mental illness in a given year, which is nearly 1.1 million people in Kentucky, Kenning reports. 

It is critical for Kentucky officials to examine this issue in light of the Department of Health and Human Services rule that included mental-health benefits and treatment of substance-abuse disorders as part of the 10 "essential health benefits" insurance plans must provide when federal health reform takes full effect next year. HHS estimates it will expand mental-health and substance-abuse treatment benefits to 62 million Americans, and there is already a shortage of such services in Kentucky.

Read More

Feds letting Arkansas privatize Medicaid expansion; idea could spread like wildfire, as in Florida, but cost questions remain

Arkansas has turned heads nationally with its preliminary plan to expand Medicaid using the private insurance market, showing that the Obama administration is willing to give states more flexibility than expected in expanding the program.

Health and Human Services Secretary Kathleen Sebelius has agreed to a proposal by Arkansas Gov. Mike Beebe to reject the Medicaid expansion but use federal money to buy private health insurance for the 200,000 people who would have been covered under ordinary expansion, reports Sandhya Somashekhar of The Washington Post.

States that have come down on either sides of the Medicaid-expansion issue may reconsider their decision in light of the Arkansas proposal, said Sara Rosenbaum, a health law professor at George Washington University. "If Arkansas is allowed to do this, I expect it to spread like wildfire," Rosenbaum told the Post.

The first place could be Florida, where a state Senate committee rejected Republican Gov. Rick Scott's expansion plan and proposed a privatization plan like that in Arkansas. Last week, a House committee voted to reject any expansion of the program. Scott "made it clear he was not going to lobby the Legislature on Medicaid," preferring to emphasize other issues, The New York Times' Lizette Alvarez reports. For coverage from the Tampa Bay Times and The Miami Herald, click here.

Could the wildfire spread all the way up to Kentucky?

Gov. Steve Beshear has said he wants to expand Medicaid in Kentucky if the state can afford it, but many Republican lawmakers oppose the idea, saying it would not be fiscally responsible. On the national level, 26 states and the District of Columbia have expressed a desire to expand Medicaid, 17 have said they reject it and seven are undecided, according to the nonpartisan Kaiser Family Foundation.

A more flexibile arrangement could be a game changer because it makes expansion more appealing, especially for states where expanding Medicaid has been politically unpopular and polarizing. in Arkansas, which has a Democratic governor and a Republicna legislature, officials say that from an ideological standpoint, using private insurance appeals to lawmakers from both parties, reports Somashekhar. She reports that even Democratic-led states might prefer this arrangement because it gets rid of some bureaucratic hurdles.

However, there are questions about cost. The Congressional Budget Office estimates that private insurance plans cost $3,000 more per person than Medicaid, reports Somashekhar. On the other hand, Arkansas officials say the move could ultimately save money in administrative charges along with other cost-control measures.

Although the Arkansas proposal is not concrete, it provides proof that the Department for Health and Human Services encourages innovative, state-based approaches to promote expansion. Many states may develop a new route best suited to their specific needs, without having to leave federal money on the table. (Read more)

Arkansas has turned heads nationally with its preliminary plan to expand Medicaid using the private insurance market, showing that the Obama administration is willing to give states more flexibility than expected in expanding the program.

Health and Human Services Secretary Kathleen Sebelius has agreed to a proposal by Arkansas Gov. Mike Beebe to reject the Medicaid expansion but use federal money to buy private health insurance for the 200,000 people who would have been covered under ordinary expansion, reports Sandhya Somashekhar of The Washington Post.

States that have come down on either sides of the Medicaid-expansion issue may reconsider their decision in light of the Arkansas proposal, said Sara Rosenbaum, a health law professor at George Washington University. "If Arkansas is allowed to do this, I expect it to spread like wildfire," Rosenbaum told the Post.

The first place could be Florida, where a state Senate committee rejected Republican Gov. Rick Scott's expansion plan and proposed a privatization plan like that in Arkansas. Last week, a House committee voted to reject any expansion of the program. Scott "made it clear he was not going to lobby the Legislature on Medicaid," preferring to emphasize other issues, The New York Times' Lizette Alvarez reports. For coverage from the Tampa Bay Times and The Miami Herald, click here.

Could the wildfire spread all the way up to Kentucky?

Gov. Steve Beshear has said he wants to expand Medicaid in Kentucky if the state can afford it, but many Republican lawmakers oppose the idea, saying it would not be fiscally responsible. On the national level, 26 states and the District of Columbia have expressed a desire to expand Medicaid, 17 have said they reject it and seven are undecided, according to the nonpartisan Kaiser Family Foundation.

A more flexibile arrangement could be a game changer because it makes expansion more appealing, especially for states where expanding Medicaid has been politically unpopular and polarizing. in Arkansas, which has a Democratic governor and a Republicna legislature, officials say that from an ideological standpoint, using private insurance appeals to lawmakers from both parties, reports Somashekhar. She reports that even Democratic-led states might prefer this arrangement because it gets rid of some bureaucratic hurdles.

However, there are questions about cost. The Congressional Budget Office estimates that private insurance plans cost $3,000 more per person than Medicaid, reports Somashekhar. On the other hand, Arkansas officials say the move could ultimately save money in administrative charges along with other cost-control measures.

Although the Arkansas proposal is not concrete, it provides proof that the Department for Health and Human Services encourages innovative, state-based approaches to promote expansion. Many states may develop a new route best suited to their specific needs, without having to leave federal money on the table. (Read more)

Read More

Survey finds employees pay greater share of health costs, and most large employers penalize them for using tobacco

As large employers respond to changes influenced by health care reform and rising costs of care, employees are paying a greater portion of their health-care costs. That trend that is likely to continue over the next few years, says a new report on employer-based health plans.

Although employers cover most costs of work-based plans, employees contribute 42 percent more for health coverage than they did five years ago, while employers paid 32 percent more, according to the study from the benefits consultant Towers Watson and the National Business Group on Health. Overall, costs went up 34.4 percent.

When employers were asked if they thought health plans would change by 2018, which is the year the excise tax on high-cost plans takes effect, 92 percent said plans would be different, and nearly half said they expect a significant or transformative change. Such change will increase both accountability and engagement for employees.

% of large employers saying they were "very confident" they would offer health benefits in 2022

Nearly two-thirds of employers surveyed offer employees financial rewards to encourage participation in health programs, according to the report, which said tying employee contributions to successful completion of specific tasks, such as health assessments and screenings, remains the most popular contribution strategy. Growth in the use of penalties to engage employees in health-program participation has slowed over the last two years, but the use of surcharges for tobacco use continues to grow. By 2014, 62 percent of surveyed companies are expected to apply tobacco-use surcharges.

"While U.S. employers remain committed to health care benefits for active employees over the next five years," the report says, "they are redifining their financial commitment in the short run and are more reluctant to commit to coverage for employees over a longer period."

The 18th annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers' strategies and practices. It was completed by 583 employers,between November 2012 and January 2013. The report says it identifies the actions of the best performing companies as well as current trends in health-care benefit programs of U.S. employers with at least 1,000 employees. Survey respondents collectively employ 11.3 million full-time employees and have 8.5 million employees enrolled in their health care programs. Download a report PDF by clicking here.

As large employers respond to changes influenced by health care reform and rising costs of care, employees are paying a greater portion of their health-care costs. That trend that is likely to continue over the next few years, says a new report on employer-based health plans.

Although employers cover most costs of work-based plans, employees contribute 42 percent more for health coverage than they did five years ago, while employers paid 32 percent more, according to the study from the benefits consultant Towers Watson and the National Business Group on Health. Overall, costs went up 34.4 percent.

When employers were asked if they thought health plans would change by 2018, which is the year the excise tax on high-cost plans takes effect, 92 percent said plans would be different, and nearly half said they expect a significant or transformative change. Such change will increase both accountability and engagement for employees.

% of large employers saying they were "very confident" they would offer health benefits in 2022

Nearly two-thirds of employers surveyed offer employees financial rewards to encourage participation in health programs, according to the report, which said tying employee contributions to successful completion of specific tasks, such as health assessments and screenings, remains the most popular contribution strategy. Growth in the use of penalties to engage employees in health-program participation has slowed over the last two years, but the use of surcharges for tobacco use continues to grow. By 2014, 62 percent of surveyed companies are expected to apply tobacco-use surcharges.

"While U.S. employers remain committed to health care benefits for active employees over the next five years," the report says, "they are redifining their financial commitment in the short run and are more reluctant to commit to coverage for employees over a longer period."

The 18th annual Towers Watson/National Business Group on Health Employer Survey on Purchasing Value in Health Care tracks employers' strategies and practices. It was completed by 583 employers,between November 2012 and January 2013. The report says it identifies the actions of the best performing companies as well as current trends in health-care benefit programs of U.S. employers with at least 1,000 employees. Survey respondents collectively employ 11.3 million full-time employees and have 8.5 million employees enrolled in their health care programs. Download a report PDF by clicking here.

Read More

Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as “essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as “essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

Read More