Kentucky Spirit can't terminate its Medicaid contract with the state a year early without facing fines, judge rules

By Molly Burchett
Kentucky Health News

A Frankfort circuit judge ruled Friday that Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients, cannot pull out of its contract with the state a year early with no financial penalty.

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, but the company could face fines if it terminates its three-year contract before expiration in July 2014, Franklin Circuit Judge Thomas Wingate said in his ruling.

Kentucky Spirit argued in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two MCOs, Coventry Cares and WellCare.

The Cabinet for Health and Family Services replied that Kentucky Spirit had breached its contract with the state. Wingate said it had not, because it gave notice of early termination, but it will be subject to fines if it pulls out of the state before July 2014, reports Beth Musgrave of the Lexington Herald-Leader.

Kentucky Spirit had argued that its contract allows it to to be terminated with six months notice. The six-month provision could only be interpreted to mean six months prior to the end of the three-year contract, said Wingate, because there has to be enough time for the state to move hundreds of thousands of Medicaid patients from Kentucky Spirit to another managed-care provider.

Jill Midkiff, a spokeswoman for the cabinet, told Musgrave that state officials were thrilled with Wingate's decision. "The cabinet's priorities are the members who receive health care through Medicaid and the taxpayers who pay for the program," she told Musgrave. "This is the right decision for both."

Friday's decision came three days after another Franklin Circuit Court judge ruled that Kentucky Spirit must reimburse health departments for services provided by school nurses to Medicaid-eligible children, which is estimated include about $8 million in back payments.

Centene officials say they are considering options for both cases, which include appeals.

Kentucky Spirit's legal battles are part of ongoing tensions between health-care providers and managed-care companies, and providers have repeatedly complained that the companies are delaying payments for services. The cabinet is hosting a series of forums across the state designed to help providers resolve such issues with the managed care companies.

By Molly Burchett
Kentucky Health News

A Frankfort circuit judge ruled Friday that Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients, cannot pull out of its contract with the state a year early with no financial penalty.

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, but the company could face fines if it terminates its three-year contract before expiration in July 2014, Franklin Circuit Judge Thomas Wingate said in his ruling.

Kentucky Spirit argued in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two MCOs, Coventry Cares and WellCare.

The Cabinet for Health and Family Services replied that Kentucky Spirit had breached its contract with the state. Wingate said it had not, because it gave notice of early termination, but it will be subject to fines if it pulls out of the state before July 2014, reports Beth Musgrave of the Lexington Herald-Leader.

Kentucky Spirit had argued that its contract allows it to to be terminated with six months notice. The six-month provision could only be interpreted to mean six months prior to the end of the three-year contract, said Wingate, because there has to be enough time for the state to move hundreds of thousands of Medicaid patients from Kentucky Spirit to another managed-care provider.

Jill Midkiff, a spokeswoman for the cabinet, told Musgrave that state officials were thrilled with Wingate's decision. "The cabinet's priorities are the members who receive health care through Medicaid and the taxpayers who pay for the program," she told Musgrave. "This is the right decision for both."

Friday's decision came three days after another Franklin Circuit Court judge ruled that Kentucky Spirit must reimburse health departments for services provided by school nurses to Medicaid-eligible children, which is estimated include about $8 million in back payments.

Centene officials say they are considering options for both cases, which include appeals.

Kentucky Spirit's legal battles are part of ongoing tensions between health-care providers and managed-care companies, and providers have repeatedly complained that the companies are delaying payments for services. The cabinet is hosting a series of forums across the state designed to help providers resolve such issues with the managed care companies.

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

Beshear looks likely to announce that he will expand Medicaid

Gov. Steve Beshear appears likely to announce tomorrow that he will expand Kentucky's Medicaid program to people in households with incomes up to 138 percent of the federal poverty level, under federal health-care reform.

The notice of the governor's news conference about "Decision regarding Medicaid expansion" says it will be held in the ornate State Reception Room on the second floor of the state Capitol, an unlikely venue for an announcement that would disappoint so many of his natural allies in the Democratic Party. And Rep. Tom Burch, D-Louisville, chairman of the House Health and Welfare Committee, reiterated his February prediction that Beshear would expand Medicaid, cn|2 reports.

Under health reform, the federal government would pay all the cost of the estimated 400,000 newly eligible Kentuckians in Medicaid in 2014, 2015 and 2016. The state would pay 3 percent of the added cost in 2017, rising to 10 percent in 2020. Beshear has said the state should expand Medicaid if it can afford it.

Some Republicans have said the state can't afford it, but national research has estimated that the state's cost for Medicaid would increase only 5 to 6 percent over the amount it would pay if the program were not expanded. The federal government now pays more than 70 percent of the program's cost in Kentucky.

More background on Mediaid in Kentucky is available from a PowerPoint presentation that Deputy Medicaid Commissioner Lisa Lee gave yesterday at a meeting sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association. It can be downloaded here.

Gov. Steve Beshear appears likely to announce tomorrow that he will expand Kentucky's Medicaid program to people in households with incomes up to 138 percent of the federal poverty level, under federal health-care reform.

The notice of the governor's news conference about "Decision regarding Medicaid expansion" says it will be held in the ornate State Reception Room on the second floor of the state Capitol, an unlikely venue for an announcement that would disappoint so many of his natural allies in the Democratic Party. And Rep. Tom Burch, D-Louisville, chairman of the House Health and Welfare Committee, reiterated his February prediction that Beshear would expand Medicaid, cn|2 reports.

Under health reform, the federal government would pay all the cost of the estimated 400,000 newly eligible Kentuckians in Medicaid in 2014, 2015 and 2016. The state would pay 3 percent of the added cost in 2017, rising to 10 percent in 2020. Beshear has said the state should expand Medicaid if it can afford it.

Some Republicans have said the state can't afford it, but national research has estimated that the state's cost for Medicaid would increase only 5 to 6 percent over the amount it would pay if the program were not expanded. The federal government now pays more than 70 percent of the program's cost in Kentucky.

More background on Mediaid in Kentucky is available from a PowerPoint presentation that Deputy Medicaid Commissioner Lisa Lee gave yesterday at a meeting sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association. It can be downloaded here.

Read More

Weekly paper in Hazard says Beshear should expand Medicaid

Gov. Steve Beshear should expand the Medicaid program for the poor under federal health reform to improve the health and welfare of Kentuckians, The Hazard Herald said in its editorial this week.

"We’re tired of reading report after report listing the health of Kentucky’s people at the bottom nationally," the weekly newspaper said. "That is especially the case in Eastern Kentucky, where here in Perry County we ranked as the 119th unhealthiest county out of 120, according to a recent study. In fact, the vast majority of the bottom 20 counties are here in Eastern Kentucky. There are many dire needs in our region of the state, from jobs to education to better access to health care. Here is one instance where our government, which the people fund, can opt to very possibly improve the lives of its citizens."

The federal government would pay the costs of expanding Medicaid to people in households with incomes up to 138 percent of the poverty level from 2014 through 2016. The state would pay 3 percent in 2017, rising to 10 percent in 2020. The editorial noted critics' warnings about costs, and a study predicting that expansion would increase the state's total Medicaid costs only 6.3 percent. "But, in truth, this is simply a monetary argument from interests on both sides of the debate," the paper said. "We feel the greatest interest belongs to the people of Kentucky. We feel the greatest priority should be placed on improving the health and welfare of our people." (Read more)

Gov. Steve Beshear should expand the Medicaid program for the poor under federal health reform to improve the health and welfare of Kentuckians, The Hazard Herald said in its editorial this week.

"We’re tired of reading report after report listing the health of Kentucky’s people at the bottom nationally," the weekly newspaper said. "That is especially the case in Eastern Kentucky, where here in Perry County we ranked as the 119th unhealthiest county out of 120, according to a recent study. In fact, the vast majority of the bottom 20 counties are here in Eastern Kentucky. There are many dire needs in our region of the state, from jobs to education to better access to health care. Here is one instance where our government, which the people fund, can opt to very possibly improve the lives of its citizens."

The federal government would pay the costs of expanding Medicaid to people in households with incomes up to 138 percent of the poverty level from 2014 through 2016. The state would pay 3 percent in 2017, rising to 10 percent in 2020. The editorial noted critics' warnings about costs, and a study predicting that expansion would increase the state's total Medicaid costs only 6.3 percent. "But, in truth, this is simply a monetary argument from interests on both sides of the debate," the paper said. "We feel the greatest interest belongs to the people of Kentucky. We feel the greatest priority should be placed on improving the health and welfare of our people." (Read more)

Read More

Bankruptcy filing by mental-health agency is a loser for Kentucky, where such services can be scarce and little used

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

Read More

W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

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

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

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

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

Beshear says he will decide in four to five weeks, or July 1 at the latest, whether or not to expand Medicaid

By Al Cross
Kentucky Health News
This story has been updated.

Gov. Steve Beshear said Monday that he will decide within the next four to five weeks, or maybe by July 1, whether to expand the Medicaid program under federal health-care reform.

Beshear, who has said he would expand Medicaid if the state can afford it, told reporters that he is considering other factors, which he did not name. He said his administration has not calculated the cost of expansion, which the state would not pay immediately.

The federal government pays about 71 percent of Medicaid's cost in Kentucky, and would pay the full cost of covering those newly eligible in 2014-16. The state would have to pay 3 percent in 2017, rising to 10 percent by 2020.

About 830,000 Kentuckians are covered by Medicaid, and at least 400,000 more could be added if Beshear expanded it to include households earning up to 138 percent of the federal poverty level, as required by the reform law.

Another possibility is that Beshear would seek approval from the federal government to use federal money to subsidize purchase of private health insurance by the poor, which has been approved in Arkansas but not in Tennessee.

The governor's office, asked if the administration was considering that option and what other factors Beshear is considering, has not responded had this response: "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."

That is also the case with There has still been no response from Humana Inc., which does much of its business through government-financed health plans. The Louisville-based insurance company was asked if it has had discussions with the Beshear administration about the idea of a Medicaid expansion that would use federal money to buy, or subsidize the purchase of, private health insurance.

"Beshear said Monday that he is getting a lot of pressure from the medical field – particularly hospitals – to green-light the expansion," Beth Musgrave of the Lexington Herald-Leader writes. "Hospitals will lose additional money they receive through Medicaid on Jan. 1 as part of the Affordable Care Act. Hospitals in Ohio and other states have also put pressure on state governments to expand Medicaid rolls."

Beshear said, “I think they look at the expansion as a means to at least replace some of that (money) that they are going to lose.”

Many Republicans have opposed expansion, "saying that the state could not afford it," Musgrave writes. "The Republican-led state Senate passed a bill during the legislative session that would have required that the two-term Democratic governor get legislative approval before expanding the health care program. But the measure died in the Democratic-controlled House. Beshear could expand the program via executive order."

Beshear said today, “We have a very large uninsured population and we have a very unhealthy population. Anything that we can do — that we can afford — to make our population more healthy, I”m certainly in favor of doing.” He added, “We are looking long-term as well as short-term from a financial standpoint to see if it makes sense for us.”

While he said he would act within four to five weeks, Beshear gave himself some wiggle room, saying also that he would make the decision by July 1, the beginning of the state's fiscal year. (Read more)

By Al Cross
Kentucky Health News
This story has been updated.

Gov. Steve Beshear said Monday that he will decide within the next four to five weeks, or maybe by July 1, whether to expand the Medicaid program under federal health-care reform.

Beshear, who has said he would expand Medicaid if the state can afford it, told reporters that he is considering other factors, which he did not name. He said his administration has not calculated the cost of expansion, which the state would not pay immediately.

The federal government pays about 71 percent of Medicaid's cost in Kentucky, and would pay the full cost of covering those newly eligible in 2014-16. The state would have to pay 3 percent in 2017, rising to 10 percent by 2020.

About 830,000 Kentuckians are covered by Medicaid, and at least 400,000 more could be added if Beshear expanded it to include households earning up to 138 percent of the federal poverty level, as required by the reform law.

Another possibility is that Beshear would seek approval from the federal government to use federal money to subsidize purchase of private health insurance by the poor, which has been approved in Arkansas but not in Tennessee.

The governor's office, asked if the administration was considering that option and what other factors Beshear is considering, has not responded had this response: "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."

That is also the case with There has still been no response from Humana Inc., which does much of its business through government-financed health plans. The Louisville-based insurance company was asked if it has had discussions with the Beshear administration about the idea of a Medicaid expansion that would use federal money to buy, or subsidize the purchase of, private health insurance.

"Beshear said Monday that he is getting a lot of pressure from the medical field – particularly hospitals – to green-light the expansion," Beth Musgrave of the Lexington Herald-Leader writes. "Hospitals will lose additional money they receive through Medicaid on Jan. 1 as part of the Affordable Care Act. Hospitals in Ohio and other states have also put pressure on state governments to expand Medicaid rolls."

Beshear said, “I think they look at the expansion as a means to at least replace some of that (money) that they are going to lose.”

Many Republicans have opposed expansion, "saying that the state could not afford it," Musgrave writes. "The Republican-led state Senate passed a bill during the legislative session that would have required that the two-term Democratic governor get legislative approval before expanding the health care program. But the measure died in the Democratic-controlled House. Beshear could expand the program via executive order."

Beshear said today, “We have a very large uninsured population and we have a very unhealthy population. Anything that we can do — that we can afford — to make our population more healthy, I”m certainly in favor of doing.” He added, “We are looking long-term as well as short-term from a financial standpoint to see if it makes sense for us.”

While he said he would act within four to five weeks, Beshear gave himself some wiggle room, saying also that he would make the decision by July 1, the beginning of the state's fiscal year. (Read more)

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

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

State Auditor Edelen says state must fix managed-care issues that have put rural hospitals and providers on brink of survival

State Auditor Adam Edelen said last week that shoring up the financial base for rural hospitals in Kentucky is the number one challenge to the state's Medicaid managed-care system.

The managed-care system has left rural hospitals at a tipping point that determines whether or not they will survive, which is deeply disconcerting when considering access to quality health care for Kentuckians in rural areas, Edelen said in a cn|2 "Pure Politics" interview. The state has a significant rural population, and "you can't overstate the importance of these rural hospitals," he said.

Hiring private companies to manage Medicaid has helped Kentucky slow cost increases in the $6 billion program, but the system has serious structural issues, and hospitals, doctors, dentists and other providers say the managed-care organizations (MCOs) are not paying them for treating Medicaid patients, Jacqueline Pitts of cn|2 reported.

There are many stories "about providers who have submitted claims and all of sudden, these MCOs change the rules, and so these claims are deemed unclear or improper and they are sent back," House Speaker Greg Stumbo said.

Edelen said the problem is that there is no consistent oversight in the claims process from the cabinet, and there is no opportunity for the provider to respond. "Right now we have our providers up against such a wall that the choice is to do one of two things," he said. "It's either to opt out of Medicaid, which is not something we want to do considering we have one of the largest percentage of population on Medicaid anywhere in the country, or go to the courts," which is inefficient and expensive.

“You have good people in the cabinet trying to manage it, you’ve got providers that are just trying to provide services to people, but we’ve got to have a better system of oversight and accountability because if that happen and we begin to lose hospitals in rural Kentucky then we have significantly reduced the level of quality of life for the people of Kentucky,” Edelen said.

Fixing the system for those hospitals and doctors is what is so important to the state as a whole, he said. He said the state and MCOs have had enough time to work out glitches with doctors and hospitals, and they must make some substantial changes before medical care for Kentucky’s neediest suffers any more.

State Auditor Adam Edelen said last week that shoring up the financial base for rural hospitals in Kentucky is the number one challenge to the state's Medicaid managed-care system.

The managed-care system has left rural hospitals at a tipping point that determines whether or not they will survive, which is deeply disconcerting when considering access to quality health care for Kentuckians in rural areas, Edelen said in a cn|2 "Pure Politics" interview. The state has a significant rural population, and "you can't overstate the importance of these rural hospitals," he said.

Hiring private companies to manage Medicaid has helped Kentucky slow cost increases in the $6 billion program, but the system has serious structural issues, and hospitals, doctors, dentists and other providers say the managed-care organizations (MCOs) are not paying them for treating Medicaid patients, Jacqueline Pitts of cn|2 reported.

There are many stories "about providers who have submitted claims and all of sudden, these MCOs change the rules, and so these claims are deemed unclear or improper and they are sent back," House Speaker Greg Stumbo said.

Edelen said the problem is that there is no consistent oversight in the claims process from the cabinet, and there is no opportunity for the provider to respond. "Right now we have our providers up against such a wall that the choice is to do one of two things," he said. "It's either to opt out of Medicaid, which is not something we want to do considering we have one of the largest percentage of population on Medicaid anywhere in the country, or go to the courts," which is inefficient and expensive.

“You have good people in the cabinet trying to manage it, you’ve got providers that are just trying to provide services to people, but we’ve got to have a better system of oversight and accountability because if that happen and we begin to lose hospitals in rural Kentucky then we have significantly reduced the level of quality of life for the people of Kentucky,” Edelen said.

Fixing the system for those hospitals and doctors is what is so important to the state as a whole, he said. He said the state and MCOs have had enough time to work out glitches with doctors and hospitals, and they must make some substantial changes before medical care for Kentucky’s neediest suffers any more.

Read More

Legislature eases physician assistant rules; nurse practitioners' prescription power, Medicaid prompt-payment bills, others linger

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

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 and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

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

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

Bill encouraging schools to stock EpiPens to stop deadly allergic reactions will become law

A bill encouraging Kentucky schools to stock EpiPens, or epinephrine auto-injectors, to stop anaphylaxis, a life-threatening allergic reaction, has passed will soon be signed into law by Gov. Steve Beshear.

When someone has anaphylaxis, the sooner you use an EpiPen, the better the outcome can be, said Thomas Sternberg, an allergist at Graves-Gilbert Clinic in Bowling Green, told Alyssa Harvey of the Daily News.

Under House Bill 172, schools could keep at least two EpiPens in case of emergency, and school boards would develop and approve policies and procedures for managing a student’s life-threatening allergic reaction, reports Harvey.

The bill also helps schools receive or buy the auto-injectors through local health departments and directs the state Department for Public Health to develop clinical protocols for using the auto-injectors in schools. Harvey reports that EpiPens can be donated to schools, and the EpiPens for Schools Program will provide up to four free auto-injectors per school year; if more are needed, they can be purchased at a discounted rate.

"You don’t know when someone could have an anaphylactic reaction,” Rep. Addia Wuchner, R-Florence, who sponsored the bill, told the Daily News. She alluded to an incident in Virginia, where a 7-year-old student died last year after an anaphylactic reaction, and no medications were available at the school to treat her. "There could be a hero in the school who was able to reach for that epinephrine pen and save a child’s life and not a tragedy like in Virginia,” Wuchner said. She filed the bill late in the 2012 session, but the language has been revised for this year's session to encourage rather than mandate schools to stock EpiPens.

Amy Wallace, treasurer and former president of the Bowling Green area's Food Education Allergy Support Team, told Harvey she was disappointed schools will not be required to make necessary provisions, but said advocates of the bill are happy to see that the problem is being addressed. (Read more)

A bill encouraging Kentucky schools to stock EpiPens, or epinephrine auto-injectors, to stop anaphylaxis, a life-threatening allergic reaction, has passed will soon be signed into law by Gov. Steve Beshear.

When someone has anaphylaxis, the sooner you use an EpiPen, the better the outcome can be, said Thomas Sternberg, an allergist at Graves-Gilbert Clinic in Bowling Green, told Alyssa Harvey of the Daily News.

Under House Bill 172, schools could keep at least two EpiPens in case of emergency, and school boards would develop and approve policies and procedures for managing a student’s life-threatening allergic reaction, reports Harvey.

The bill also helps schools receive or buy the auto-injectors through local health departments and directs the state Department for Public Health to develop clinical protocols for using the auto-injectors in schools. Harvey reports that EpiPens can be donated to schools, and the EpiPens for Schools Program will provide up to four free auto-injectors per school year; if more are needed, they can be purchased at a discounted rate.

"You don’t know when someone could have an anaphylactic reaction,” Rep. Addia Wuchner, R-Florence, who sponsored the bill, told the Daily News. She alluded to an incident in Virginia, where a 7-year-old student died last year after an anaphylactic reaction, and no medications were available at the school to treat her. "There could be a hero in the school who was able to reach for that epinephrine pen and save a child’s life and not a tragedy like in Virginia,” Wuchner said. She filed the bill late in the 2012 session, but the language has been revised for this year's session to encourage rather than mandate schools to stock EpiPens.

Amy Wallace, treasurer and former president of the Bowling Green area's Food Education Allergy Support Team, told Harvey she was disappointed schools will not be required to make necessary provisions, but said advocates of the bill are happy to see that the problem is being addressed. (Read more)

Read More

Legislature sends fix of last year's pill-mill bill to Beshear

"After more than a year of debate, a bill that would revamp Kentucky’s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor’s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

"After more than a year of debate, a bill that would revamp Kentucky’s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor’s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

Read More

Bill for statewide smoking ban appears to have been extinguished

The bill to enact a statewide smoking ban in Kentucky appears to be dead for this session of the General Assembly.

The House sent House Bill 190 back to committee today, and "House Speaker Greg Stumbo said he doesn't expect the bill to make it back to the full House," Sam Dick reported for WKYT-TV.

Rep. Bob Damron, D-Nicholasville, an opponent of the bill, told Kentucky Health News on Feb. 21 that he did not think it had more than 41 votes in the 100-member House.

The bill to enact a statewide smoking ban in Kentucky appears to be dead for this session of the General Assembly.

The House sent House Bill 190 back to committee today, and "House Speaker Greg Stumbo said he doesn't expect the bill to make it back to the full House," Sam Dick reported for WKYT-TV.

Rep. Bob Damron, D-Nicholasville, an opponent of the bill, told Kentucky Health News on Feb. 21 that he did not think it had more than 41 votes in the 100-member House.

Read More

House panel approves bill easing rules of 2012's pill-mill bill

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

Read More

Medicaid expansion brings primary care access to the forefront

The federal health reform law will usher at least seven million more Americans into Medicaid, and as states like Kentucky debate Medicaid expansion, policymakers are struggling with the question of whether there will even be enough primary care doctors to provide care, reports Michael Ollove of Stateline.

The country is already short of primary-care doctors. Although many primary-care physicians would take on new Medicare or privately-insured patients, only two out of three primary-care physicians surveyed in 2011 were willing to accept new Medicaid patients.

Why? Poor compensation is one reason; on average, Medicaid pays physicians 59 percent of the amount Medicare pays for primary care services, reports Ollove. Many Kentucky primary-care providers are also deterred by existing Medciaid problems. Providers report being burdened by a lack of or delayed payments from the new managed-care system.

Congress hopes to lure practitioners to primary care with a provision that raises primary-care providers' Medicaid fees to Medicare levels. This is only a temporary fix, which went into effect at the beginning of the year and will remain in effect for two years, reports Ollove.

The impact in Kentucky remains uncertain. Lawrence Kissner, Kentucky's commissioner for health and family services, says the state’s Medicaid pay raise in 2005 resulted in a 36 percent increase in the number of primary care doctors accepting Medicaid patients, reports Ollove. This is precisely what the health-law authors hope will happen now.

Kentucky is addressing the health coverage issue in other ways.  The General Assembly is considering a bill that would repeal a burdensome supervision requirement and encourage more independent physician assistants to remain in Kentucky to serve medically underserved areas.

Although Kentucky already allows nurse practitioners to practice independently, the Medicaid rate increase applies only to physicians who provide primary care services. It does not apply to nurse practitioners, who have been touted as a potential solution to the primary care problem and often provide care in underserved areas of the state. (Read more)

The federal health reform law will usher at least seven million more Americans into Medicaid, and as states like Kentucky debate Medicaid expansion, policymakers are struggling with the question of whether there will even be enough primary care doctors to provide care, reports Michael Ollove of Stateline.

The country is already short of primary-care doctors. Although many primary-care physicians would take on new Medicare or privately-insured patients, only two out of three primary-care physicians surveyed in 2011 were willing to accept new Medicaid patients.

Why? Poor compensation is one reason; on average, Medicaid pays physicians 59 percent of the amount Medicare pays for primary care services, reports Ollove. Many Kentucky primary-care providers are also deterred by existing Medciaid problems. Providers report being burdened by a lack of or delayed payments from the new managed-care system.

Congress hopes to lure practitioners to primary care with a provision that raises primary-care providers' Medicaid fees to Medicare levels. This is only a temporary fix, which went into effect at the beginning of the year and will remain in effect for two years, reports Ollove.

The impact in Kentucky remains uncertain. Lawrence Kissner, Kentucky's commissioner for health and family services, says the state’s Medicaid pay raise in 2005 resulted in a 36 percent increase in the number of primary care doctors accepting Medicaid patients, reports Ollove. This is precisely what the health-law authors hope will happen now.

Kentucky is addressing the health coverage issue in other ways.  The General Assembly is considering a bill that would repeal a burdensome supervision requirement and encourage more independent physician assistants to remain in Kentucky to serve medically underserved areas.

Although Kentucky already allows nurse practitioners to practice independently, the Medicaid rate increase applies only to physicians who provide primary care services. It does not apply to nurse practitioners, who have been touted as a potential solution to the primary care problem and often provide care in underserved areas of the state. (Read more)

Read More