Sunday, October 23, 2016

Kentuckians who qualify for tax-subsidized health plans will sign up on this year; open enrollment begins Nov. 1

By Melissa Patrick
Kentucky Health News

Kentuckians who qualify for health plans subsidized by tax credits, called Qualified Health Plans, will sign up on instead of Kynect during the open enrollment that begins Nov. 1.

Some Kynect advocates have voiced concern that the changeover will be troublesome, but Cabinet for Health and Family Services spokesman Doug Hogan said in an e-mail, "We expect a smooth transition to People should be aware that Kynect is not health insurance, it is a website. This transition changes the web portal people use to enroll."

Hogan said the state has sent letters about the transition to Kentuckians who have previously applied or been enrolled in health coverage through Kynect, to guide them through the process. He said the state will continue to send informational postcards throughout open enrollment, which ends Jan. 31.

"Only about 2 percent of Kentucky’s population purchases a QHP in a given year, so targeting resources to this group and doing it in the final month leading up to open enrollment and continuing through open enrollment is the most effective use of resources," Hogan said.

Hogan said that starting Nov. 1, Kynect's website will offer detailed messages about the transition and directions on when and were to apply for coverage. The website also has messages for Kentucky residents.

Where to get answers to your questions

The Kynect call center (855-459-6328) will remain available to help tell Kentuckians where to go for coverage, answer questions, pre-screen for program eligibility, and assist with Medicaid applications. The customer service call center (800-318-2596) is also available to help and is open 24 hours a day, seven days a week.

Hogan said insurers are also sending notices to their enrollees about the changes; insurance agents and application assisters have advertising tool kits for their outreach efforts; and agents and assisters have been given lists of their QHP enrollees. Also, social media campaigns, media advertising and other measures have different start times around the state in strategically placed target areas with the highest uninsured rates and QHP eligible populations, he said.

If you qualify for a QHP in 2017, which is a plan that offers a tax credit to help cover out-of-pocket costs, you must sign up for your health insurance through this year instead of Kynect, as you have in the past.

"Kentuckians can only get the tax credit, called APTC or Advanced Premium Tax Credit or a Cost Sharing Reduction that helps cover out-of-pocket costs, by enrolling through," Hogan said.

Open enrollment for these plans is Nov. 1 through Jan. 31, but to get coverage on Jan. 1, you must enroll by Dec. 15.

Why aren't there as many choices as last year?

In 59 of the state's 120 counties, residents will have only one health insurance option on the exchange. Anthem Health Plans of Kentucky is the only company offering coverage on the exchange in every county for 2017. CareSource will offer plans in 61 counties, up from 46 in 2016 and Humana Health Plan will offer exchange plans in nine counties, down from 15 in 2016.

Baptist Health Plan, United HealthCare, WellCare and Aetna, which offered plans on the exchange in 2016, will not in 2017. Most have cited unsustainable losses.

"People should know that this transition to did not affect plan choice," Hogan said. "All insurers made the same offerings regardless of the enrollment website we selected which is the same as in prior years."

Hogan added, "Cost increases were not driven by the transition to" He said premiums on exchange policies are increasing by more than 20 percent.

People whose current insurers are not offering a plan in 2017 on will be given more time to choose a plan for 2017 due to a "special enrollment period for loss of minimum essential coverage," Hogan said.

Do we still have Kynectors?

The state has extended contracts with the same organizations that provided Kynectors, which are now called "application assisters," Hogan said. Application assisters work with Kentuckians either in person or over the phone to answer questions or get assistance with the application and enrollment process.

"We are confident our assister agencies will have the ability to provide the same exceptional service," Hogan said. "Every county in Kentucky is served by a contracted organization for in person assistance. Kynectors have a very active outreach program that includes sign up events, advertising, and education opportunities. They will continue to be very active in the communities they serve."

You can find an Application assister in your area by using the "search" function on the Kynect website or by calling Kynect's customer service.

Many Kynectors are still in the process of being trained to help clients on the federal marketplace, so Hogan said there isn't a firm number of participating application assisters for 2017.

What about Medicaid?

The Medicaid program for low-income and disabled people, and its application process, will stay the same. It was moved from Kynect earlier this year.

Medicaid-eligible Kentuckians can apply anytime during the year through Benefind, a one-stop-shop website for public benefits. But if you are already enrolled, you don't need to do anything until your renewal or recertification date.

"If a citizen believes they may be eligible for Medicaid (any type), we would recommend that they apply through Benefind," Hogan said. "This would be the quickest route to receive Medicaid eligibility."

Benefind also has an anonymous pre-screening tool to assist in determining if you are eligible for Medicaid or a QHP.

Consumers may ask, "What happens if I apply for the wrong type of coverage?" Hogan answered, "Consumers cannot apply in the wrong way or place." He said if an application is started in Benefind, but the applicant is over the income limit, the application will be transferred to the federal marketplace and Benefind will send a notification letter to the participant indicating Medicaid eligibility was denied and that the client information was sent to

If a consumer submits an application to, it will be entered, but if the applicant is deemed Medicaid-eligible, the application will be transferred to the state for final eligibility determination. If the participant is determined eligible, Benefind will notify the participant. If more information is needed, Benefind will ask the participant for it, indicating the next steps to take.

Friday, October 21, 2016

UK center promotes at-home test for colorectal cancer, reports on efforts to get young women vaccinated for cervical cancer

More people in Appalachian Kentucky die from colorectal cancer than in any other region of the state. A screening project of the Rural Cancer Prevention Center at the University of Kentucky is working to decrease those rates.
Cancer Registry maps show in color Kentucky counties served by the Appalachian Regional Commission,
and rates for invasive cancer and cancer mortality in Appalachian Kentucky and the balance of the state.
In July 2014, the center received a $3.75 million, five-year grant renewal from the federal Centers for Disease Control and Prevention for a colorectal cancer at-home screening prevention project in Central Appalachia and other rural areas. The UK Center is one of 26 CDC-funded Prevention Research Centers in the country.

Tom Collins, associate director of the RCPC, gave an update on its project at a Center for Clinical and Translational Science clinical research update meeting at UK Oct.18. Robin Vanderpool, associate professor in the College of Public Health, discussed the results and successes of its completed cervical-cancer screening project.

Early screening and prevention are key to surviving colorectal cancer. The CDC says that most deaths caused by colorectal cancer could be prevented if everyone over the age of 50 got screened. And if detected early, treatment for colorectal cancer is highly effective.

In 2013, the last year for which data is available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

The project's title and motto is "I did FIT." FIT stands for fecal immunochemical test, an at-home test that allows a person to collect a small stool sample in the privacy of their home and mail it in a provided kit to the lab for testing. The FIT test must be done every year.

Since June 2015, the UK center has distributed more than 700 kits, with a 60 percent return rate in the eight-county Kentucky River Health District. Those with a positive test result, about one in six, have been offered a colonoscopy with follow-up; the rest have been invited to be part of the research, which is ongoing.

To help determine the best way to get people to do a yearly test, researchers divided the volunteer participants into two groups: one that gets social media and personal messages about it along with the traditional standard of care and another that gets standard of care alone. A year and a half remains in this portion of the research.

Cervical cancer and the HPV vaccine

Collins said they are trying to build on the success of the UK Center's previous prevention program for cervical cancer prevention and screening, called "1-2-3 Pap."

Prevention Research Center graphic; click on it to view a larger version
This UK center study promoted the human papillomavirus vaccination to prevent cervical cancer in Appalachia, which also has a higher incidence and mortality rate for cervical cancer than the rest of the state.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. It is approved for females between 9 and 26 and is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

An earlier study of adult Appalachian women aged 18-26 that were offered the first HPV vaccination free found that 45.1 percent got the first dose, 13.8 percent got the second dose and only 4.5 percent got all three doses. This and other formative research prompted the UK Center to start a two-stage HPV vaccine promotion program for women aged 19-26 in the Kentucky River Health District.

First, researchers launched a marketing campaign to recruit the women in for the first dose. Then, participants were asked to participate in the study, which was designed to promote adherence to doses two and three. The volunteer participants were randomly separated into two groups; one participated in an informational video-based intervention that was made using local people along with the traditional standard of care; the other was offered standard of care alone.

The study found that 43.3 percent of the young women who watched the DVD completed the three-dose HPV vaccine series, while 31.9 percent of the women in the comparison group completed the series.

Vanderpool said the "take-home message" was that women were two and one-half times more likely to complete the series if they watched the DVD.

Since the completion of the study, 18 Kentucky health departments now use the DVD to promote completion of the three-dose HPV series, and it has also been adapted for use in North Carolina and West Virginia.

Thursday, October 20, 2016

U.S. Rep. John Yarmuth says Bevin's Medicaid plan won't be approved, should be withdrawn; Bevin aide says call is political

U.S. Rep. John Yarmuth
Democratic U.S. Rep. John Yarmuth of Louisville called on Republican Gov. Matt Bevin to withdraw his proposal to reshape Kentucky's Medicaid program at a news conference Oct. 18 in Frankfort, saying the proposal in its current form will be denied.

Yarmuth said it's clear the Department of Health and Human Services will reject the plan because the agency recently rejected similar changes proposed by other states, Deborah Yetter and Tom Loftus report for The Courier-Journal.

"There is no longer any argument about the outcome of your strategy," Yarmuth told Bevin in a letter. "It will fail."

Yarmuth noted that Ohio's plan was rejected for its premium charges without respect to income and because it would create a large loss of coverage and that parts of Arizona's plan were rejected because of its premium requirements for individuals living below the poverty line, work requirements and its six month lock-out period for non-payment of monthly premiums. He said all of these rejected provisions are in Bevin's plan.

The plan, submitted under a waiver from federal rules that allows demonstration waivers, focuses on "able-bodied adults" who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty level.

The changes are meant to increase participants engagement in their health care through things like monthly premiums of $1 to $37.50, requirements that those who aren't primary caregivers work or volunteer up to 20 hours a week to keep coverage and "lockouts" of coverage for some who fail to pay.

Yarmuth said federal officials have told him that they will not accept this plan, citing the recent rejections of similar proposals. "There's no chance they are going to approve this waiver," he said.

Bevin has said the state cannot afford to have 1.4 million people on Medicaid. Of those, 440,00 are covered through the expansion. The expanded population is paid in full by the federal government through this year. In 2017, the state will be responsible for 5 percent of the cost, rising in annual steps to the reform law's limit of 10 percent in 2020.

And though Bevin has said he is willing to negotiate, he has also said that he would end the expansion if the federal government does not approve his changes.

Yarmuth implored him not to do that. "We want to make sure that Kentuckians understand exactly what's at stake – 10 percent of the people of this commonwealth who now have coverage are going to lose it," Yarmuth said.

Bevin's press secretary, Amanda Stamper, said in a statement that federal officials have "full authority" to approve Kentucky's waiver and Yarmuth's news conference was politically motivated.

"While Congressman Yarmuth plays politics three weeks before an election, Gov. Bevin and his team have spent several months developing a transformative and financially sustainable Medicaid plan that will actually improve health outcomes for Kentuckians and encourage self-sufficiency," Stamper said. "Gov. Bevin remain committed to working with the Centers for Medicare and Medicaid Services as long as it takes to transform Kentucky's Medicaid program to achieve these vital goals."

Yarmuth acknowledged that Bevin's actions represent what he promised during his election last year, but said he doubted voters believed he would do it, The Courier-Journal reports. A poll taken shortly after the election shows that most Kentuckians did not want the expansion scaled back.

Yarmuth also said if Bevin does make good on his promise to take away health coverage from 440,000 Kentuckians, he should "pay some political price. ... But that's not why we're here. We're here because our citizens will pay the price."

Cancer, and death from it, rose in rural Appalachia from 1969 to 2011; Appalachian Kentucky's cancer-death rate was 36% higher

Appalachian Regional Commission service area
From 1969 to 2011 the cancer death rate in rural Appalachia went from the nation's lowest to its highest, says a study at the University of Virginia researchers, published in the Journal of Rural Health. The study, which used data from 23,565 men and 37,847 women first studied in 1999, found that cancer mortality rates were higher in every rural Appalachian area—except in Maryland—than in urban areas.

From 1969 to 2011, "Cancer incidence declined in every region of the country except rural Appalachia, where it increased," Josh Barney reports for UVA Today. "In the rural Appalachian areas of Kentucky, mortality rates were 36 percent higher. People in Appalachia are more likely to die within three to five years of their cancer diagnoses than people in urban areas outside Appalachia."

One possibility for higher rural cancer death rates is a lack of screening, researchers said. Among people 50 or older living in Appalachia, 16.2 percent of rural residents received a fecal occult blood test in the past year, compared to 22 percent in urban areas. Also, 28.2 percent of rural residents had a colonoscopy in the past five years, compared to 35.2 percent in urban areas.

Researchers said other factors affecting rural areas include a lack of health care, transportation hurdles to seek care, higher poverty, smoking and obesity rates and a rural attitude of fiercely independent people who refuse to seek care.

Study: Ky. kids have more access to oral health care, but still have poor outcomes; 1/2 in Appalachia have untreated cavities

By Melissa Patrick and Traci Thomas
Kentucky Health News

The oral health of Kentucky's school children is getting worse, even though access to oral health care is better now than it was 15 years ago, says a study by Delta Dental of Kentucky and Kentucky Youth Advocates.

The report, "Making Smiles Happen: 2016 Oral Health Study of Kentucky's Youth," is the first oral health study of Kentucky's children since 2001, and was presented to Kentucky lawmakers Wednesday at the Oct. 19 Interim Joint Committee on Health and Welfare.

"What leaps out in the report are two big issues," said Dr. Terry Brooks, executive director of Kentucky Youth Advocates. "One is the paradox that more kids have coverage and yet outcomes are worse and the second is that we have factors that kids can't control -- where they live, the color of their skin, how much money their parents make -- and those are real determinants on the state of kids mouths. None of those are easily solved, but they are challenges that we have to tackle."

Delta Dental of Kentucky and Kentucky Youth Advocates study.
(Lexington Herald-Leader map)
Researchers worked with the University of Louisville's School of Dentistry to analyze the mouths of 3rd and 6th graders across the state. The study also asked parents about family oral health history, resulting in the collection of data for over 2,000 students.

The report had four key findings.

First, it found that more 3rd and 6th graders are in need of early or urgent dental care since 2001, rising to 49 percent in 2016 from 32 percent in 2001. It noted that Hispanic or Latino students are "significantly less likely" to have dental insurance than their peers and that children who live in the Appalachian region have the greatest need for urgent dental care, 20 percent compared to 8 percent overall.

Another key finding was that two out of five 3rd and 6th graders have untreated cavities. This measure was also "significantly greater" in the Appalachian region, where more than half of the children in the study had untreated cavities.

"We know in a very pragmatic way that a person with a tooth-ache is probably not paying attention to their multiplication tables at school, so oral health is a significant issue for children in Kentucky," Brooks said.

And despite a 14 percent increase in the number of 3rd and 6th graders with dental sealants on at least one permanent molar between 2001 and 2016, more than 50 percent of the children in the study didn't have them. African-American children in the study were the most likely to not have any sealants.

It also found the 3rd and 6th graders eligible for free or reduced lunch (more than half of students in the study) were more likely to have recently experienced a toothache, have visited a dentist more than a year ago, have untreated decay or be in need of urgent dental care.

The report points out that "there was no significant differences in the presence of tooth decay by race/ethnicity, giving further evidence that socioeconomic status is in the strongest determinant of a child's oral health status."

Delta Dental President Clifford Maesaka said the report recommends the data be used to make a comprehensive statewide plan and that regional coalitions should be formed to find local solutions. The report also recommends school-based sealant programs, oral health literacy campaigns and points out that the state should continue to gather data.

"We need a plan," Maesaka said. "If we don't recognize the need for preventive and diagnostic care in our kids, we are probably not going to make it a priority." He added, "We need our parents, our school administrators, our legislators, everybody to recognize that the mouth is part of the body and things that go on in the mouth have an effect on the rest of the body and vice-versa." If the message can be conveyed, "We will have a better chance of succeeding."

Kentuckians can submit comments about Gov. Matt Bevin's Medicaid plan until federal officials render a final decision

The 30-day federal public comment period for Gov. Matt Bevin's new Medicaid plan ended Oct. 8, but the U.S. Department of Health and Human Services says it will continue to accept comments until it renders a final decision.

"While our rules do not provide for formally extending the federal comment period, as a matter of practice CMS has generally reviewed and considered all public comments received prior to rendering a final decision," Eliot Fishman, director of the state demonstrations group at the Centers for Medicare and Medicaid Services, wrote in a letter dated Oct. 19 to Kentucky Insurance Commissioner Stephen P. Miller.

The changes in Bevin's proposed Medicaid plan largely target "able bodied adults" who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty level. The governor's new plan is designed to encourage participants to have what he calls "skin in the game" through things like monthly premiums, health savings accounts and work and volunteer requirements for those who aren't primary caregivers. Critics of the plan say it is too complicated and creates barriers to health care.

Bevin has said the current Medicaid plan is unsustainable and that the new plan will save an estimated $2.2 billion over the five-year waiver period, of which the state portion would be $331 million. The federal government is paying the full cost of Medicaid expansion through this year; next year the state will start paying 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Nearly 1,800 comments were submitted by the Oct. 8 deadline and the vast majority of them opposed it. The Kentucky Center for Economic Policy, after removing repeated comments under the same names and removing blank comments and those not related to the issue, counted 1,643 individual comments. Of those, they found 90.1 percent were "unfavorable," 8.4 percent were "favorable" and 1.5 percent were "mixed."

Fishman says it will take time to "carefully consider" the "large volume" of public comments. He also added that they are "prepared to continue our dialogue for as long as it takes to find a solution that continues progress for the people of Kentucky."

In a statement made in response to U.S. Rep. John Yarmuth's call for the governor to withdraw his proposal  since similar request from Arizona and Ohio were rejected, Bevin press secretary Amanda Stamper said that the governor was committed to work with the federal government "as long as it takes to transform Kentucky's Medicaid program to achieve these vital goals." Bevin has said that if his plan is not approved, he will not continue the expansion.

Click here to read the proposal. Click here to submit comments. 

Wednesday, October 19, 2016

Pikeville Medical Center hires 3,000th employee

Pikeville Medical Center (Photo:
Pikeville Medical Center said it reached a milestone Monday when it welcomed its 3,000th employee: information systems project manager Judy Lawson.

The center is the region's largest employer and has added 930 jobs this year, according to a report in Pikeville's Appalachian News-Express.

The report cites a $48 million boon to the local economy from the employment boom.

"With coal jobs disappearing at an alarming rate, our region depends on PMC to contribute to our local economy," Juanita Deskins, chief operating officer, told the newspaper.

"We are seeing patients come from further distances than ever before," said President and CEO Walter E. May, who led the facility's transformation from Pikeville Methodist Hospital. "People in our region recognize that PMC is providing quality healthcare closer to home. We will continue increasing our number of employees to meet the demand for our services."

Monday, October 17, 2016

Paducah Sun editor calls for higher cigarette tax in Kentucky

The executive editor of a West Kentucky newspaper known for its conservative editorials is taking a stand against cigarette taxes, but not in the way you might expect.

In a Sunday column, Steve Wilson of The Paducah Sun lambasted the state's low cigarette tax of 60 cents per pack.

"The average tax in all states is now $1.65 a pack. The tax in neighboring Illinois is $1.98. New York has the nation's highest at $4.35," Wilson writes. "With a tax so much less, Kentucky is not doing right by its citizens in terms of revenue, public health and health-care costs."

Noting that Kentucky has the second-highest smoking rate in the country, 26.5 percent, Wilson suggests that a higher cigarette tax would generate greater revenue for the state and would spark a decline in smoking.

"If people have to pay more for cigarettes, they are less likely to buy them. That's especially true for younger smokers who have lower incomes and are less addicted. And when people smoke less, the benefits to their health and the state's health care costs are huge," he says.

Wilson cites research indicating that health-care costs directly related to smoking in Kentucky are nearly $2 billion a year. He says the state's annual Medicaid costs related to smoking are almost $600 million and paid by taxpayers.

The state set up a Blue Ribbon Commission on Tax Reform in 2012. It spent nearly a year evaluating Kentucky's tax policies and recommended a 40-cent raise, to $1 a pack, which would have brought the state an extra $120 million a year, but the General Assembly didn't bite. Wilson advocates passing that 40-cent increase now and committing a portion of the revenue to smoking-cessation programs.

"Given the staunch anti-tax attitude of the legislature and governor, an increase of any amount is a long shot in the next session," he writes. "It's so much easier for the lawmakers to do nothing and proudly say they stand firm against all tax increases. What they don't say is that such a low tax helps maintain a high rate of smoking, the nation's highest rate of smoking illness and ever-increasing medical bills pushed on the backs of taxpayers."

Sunday, October 16, 2016

90% of public comments opposed Bevin's Medicaid plan, but some tell feds that Ky. voted for him to get rid of Obamacare

By Melissa Patrick
Kentucky Health News

Nearly 1,750 Kentuckians submitted comments about Gov. Matt Bevin's plan for Medicaid during the federal public comment period that ended Oct. 8 and the vast majority of them opposed it.

Source of data and chart: Kentucky Center for Economic Policy
The Kentucky Center for Economic Policy, after removing repeated comments submitted over the same names, and the responses that were left blank or were not related to the issue, counted 1,643 individual comments. Of those, they found 90.1 percent were "unfavorable," 8.4 percent were "favorable" and 1.5 percent were "mixed," according to KCEP's KY Policy Blog. These findings were similar to a cursory analysis by Kentucky Health News.

To put this in perspective, Ohio and Arizona, the last two state to have Medicaid waivers considered by the U.S. Department of  Health and Human Services, only drew 103 and 97 comments, respectively.

In response to KCEP's analysis, Bevin' spokeswoman Amanda Stamper told Louisville's WFPL that "Gov. Bevin campaigned on reforming Medicaid expansion and was shown overwhelming support by Kentucky voters who elected him to do just that." However, a poll taken shortly after the election showed most Kentuckians did not want the expansion scaled back, as Bevin wants to do.

The governor's plan focuses on able-bodied adults who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty level. The new plan is designed to encourage participants to have what Bevin calls "skin in the game" through premiums and a higher level of involvement in their care.

Bevin has said the state cannot afford to have 1.32 million people, nearly 30 percent of Kentucky's estimated population, on Medicaid. About 430,000 are covered through the expansion.

The proposal expects to save taxpayers $2.2 billion over the five-year waiver period by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs. The expansion population is paid for through 2016, but next year the state begins paying 5 percent of the costs, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin has said that if federal officials don't approve this proposal, he would end the expansion, but has said he is willing to negotiate.

The plan is called Kentucky HEALTH, standing for Helping to Engage and Achieve Long-Term Health. It seeks a waiver from federal rules, under a section of law allowing demonstration waivers.

Commenters tell personal stories

Many of the unfavorable comments came from Kentuckians who told personal stories about how Medicaid expansion had benefited them, their loved ones and their neighbors.

"I have never used Medicaid coverage, but I have seen both children and the elderly in my community utilize the services. The residents of Kentucky deserve healthy neighbors and I'm willing to use my taxes to do so," said one comment. (#224665)

Health-care professionals also chimed in with how Medicaid expansion had helped their patients.

"I'm a physician. It's greatly reduced the stress of my patients to have comprehensive coverage, which has thus improved their health: lower blood pressures, better medication adherence, better follow up," said one. (#224169)

Many pleaded with Bevin to not make good on his promise to get rid of the expansion if his plan is not approved.

"Expanded Medicaid is the only reason some of us can see a dentist; it's the only reason we can get a check up, birth control, an antibiotic for a sickness. The expansion made it so that even male members could be covered. Please don't take it away!" one commenter said. (#224745)

Other comments suggested that the plan has political motives.

"For many Kentuckians, Medicaid is the difference between life and death. Holding the health of our citizens hostage for purely political reasons is vicious and despicable, since the people on Medicaid for the most part have no other recourse," said one comment. (#224317)

Many unfavorable comments pointed out specific issues with the plan, including: premiums, other costs, work and volunteer requirements, the lock-out for non-payment, the administrative complexity of the proposed program, removal of automatic renewal, removal of non-emergency medical transportation, the removal of retroactive eligibility, and the loss of dental and vision in the base plan, to name a few.

"The complexity of the program creates unnecessary barriers for individuals to maintain health insurance coverage and manage the benefits. The waiver includes maintenance of a health savings account, health rewards accounts in addition to work, volunteer and health education requirements. This creates a very confusing system with multiple barriers to keeping coverage. that needs to be navigated. The purpose of an 1115 Waiver is to improve access to health care, not create roadblocks," said one comment. (#219253)

Many of the comments also voiced concerns about the removal of dental benefits. The new plan requires participants to earn dental benefits through a rewards program.

M. Raynor Mullins, professor emeritus at the University of Kentucky College of Dentistry, noted in his personal comments that it is well-documented that Kentuckians' access to dental care has improved since the implementation of Medicaid expansion. He said the plan "includes no supporting dental science or detailed dental or cost information or a solid rationale for the dental design and benefit changes," though such information is "readily available."

Mullins questions whether HHS should approve a plan that, in his words, would increase state dental expenses, remove an important health benefit from more than 400,000 Kentuckians, negatively affect rural economies, reduce dental access and ignores the inter-relationship between oral health, diabetes, obesity and heart disease.

Many national and state organizations submitted detailed comments opposing the proposal, including Save Kentucky Healthcare, founded by former Gov. Steve Beshear, who expanded Medicaid. It said that despite Bevin's claims that the expansion is not affordable, "numerous studies show that Medicaid expansion is financially sustainable, and is in fact beneficial both for the state budget and the Kentucky economy as a whole." It also pointed out that most of the savings in the new plan will come from a reduction in enrollment.

HHS's consideration of this waiver is also important to other states.

The policy director of Alabama Arise, a health-advocacy group, wrote that Southern states look to Kentucky as a "beacon for the region," considering it "one of the great hopes of the South for its highly successful Medicaid expansion." And said that if HHS approves this waiver it "would be a backward step not only for Kentuckians but for all Southerners . . . and would send a clear message to reluctant but interested states not to move boldly and affirmatively but to hedge and whittle away the most meaningful provisions of expansion." (#225401)

Fewer than 10 percent of the comments supported the plan

Many of the 8.4 percent of comments in favor of the plan reiterated the governor's stance that the state cannot afford Medicaid as it currently exist; that "able-bodied" Kentuckians need some some "skin in the game," that the plan would promotes self-sufficiency by "helping those who help themselves;" that it would discourage people from taking advantage of the system, and increase a person's dignity by allowing them to pay something for their health care.

"I support Governor Bevin's plan to replace the expensive and one-size-fits-all Obamacare expansion with a plan that requires personal responsibility and meets the unique needs of Kentucky," one commenter said. "I, as a Kentucky taxpayer, expect able-bodied adults to work or volunteer in order to receive taxpayer funded health care and that it should be transitional coverage, not permanent." (#222221)

At least one person told HHS that Bevin was elected to get rid of Obamacare. "Please pass Gov. Bevin's plan and do away with Obama's plan. Plain and simple, this is one of the things we elected you for," they wrote. (#222785)

KCEP noted that only three organizations wrote in support of the waiver, including: Health Management Systems, Inc.; St. Elizabeth Healthcare; and the Kentucky Chapter of the Association of American Physicians and Surgeons, which is skeptical of government involvement in health care.

KCEP said, "The waiver would not likely save the money it claims, would cover fewer people, and would roll back the historic health care gains we’ve made as a commonwealth. As negotiations begin between officials from Kentucky and Washington, the outpouring of concern should be a key factor to consider."

One comment suggested that Kentucky's current Medicaid plan should be allowed to develop for five years before any changes are made, just like the five year demonstration waiver will require if approved.

"Shouldn't the massive change we made to our Medicaid program in January 2014 be allowed to be evaluated for effectiveness, efficiencies, and health outcomes for at least as long as CMS would consider allowing Governor Bevin's proposal?" said one comment, in part. (#222385) CMS stands for the Centers for Medicare and Medicaid Services.

Information for this story was also gathered by Traci Thomas of the University of Kentucky. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in UK's School of Journalism and Media, with support from the Foundation for a Healthy Kentucky.

National Drug Take-Back Day is Oct. 22; Ky. has 194 prescription drop boxes and many State Police posts will participate

Kentuckians are encouraged to turn in any unused or expired prescription drugs Saturday, Oct. 22, from 10 a.m. to 2 p.m. as part of National Drug Take-Back. The service is free and anonymous.

There are now 194 prescription drop boxes available across Kentucky in 116 counties, with more being added daily, according to the state Office of Drug Control Policy. Click here to find a prescription drug disposal location nearest you. In addition, many Kentucky State Police posts will be collecting unused and expired drugs.

"The goal of this effort is to reduce the volume of drugs that could end up on the streets and then used illegally," says the ODCP website.
National Drug Take Back Day: Kentucky annual collection totals in pounds
In all, Kentucky has collected a total of 59,719 pounds of unused and/or unwanted prescription medications at all Drug Take Back events and locations since October 2011, according to ODCP.

For more information about the Take-Back program, visit or visit for updated collection sites near you.

Saturday, October 15, 2016

Ky. tops nation in share of kids ever diagnosed with Attention Deficit Hyperactivity Disorder; here are facts and fiction about it

While almost one in five of Kentucky's children have been diagnosed with attention deficit hyperactivity disorder, myths and misinformation about the condition are common.

Percent of Youth Aged 4-17 Ever Diagnosed with ADHD
National Survey of Children's Health
ADHD is a common condition. The latest data from the U.S. Centers for Disease Control and Prevention show that 19 percent of Kentucky's children have ever been diagnosed with it, the highest rate in the nation. The national average is 11 percent. The data also show that 14.8 percent of Kentucky's children are currently diagnosed with ADHD, compared to 8.8 percent nationally.

ADHD is a behavioral condition characterized by difficulty focusing, acting without thinking, and hyperactivity.

In a news release, Dr. Joshua Cabrera, clinical psychiatrist and assistant professor at Texas A&M College of Medicine, distinguishes between what is fact and what is fiction when it comes to ADHD.

Fiction: Just because a child is hyper they have ADHD: Cabrera points out that children are "inherently energetic" and if this is the only symptom, then it would be difficult for a professional to diagnose the child with ADHD. He adds that the main symptoms of ADHD are inattention, hyperactivity and impulsivity and says that "Diagnosis (would) require observations of numerous symptoms in multiple settings and evidence of significant impairment.”

Fact: ADHD diagnosis is on the rise: A recent study showed that ADHD diagnosis has gone up 43 percent from 2003 to 2011. Cabrera said that the study did not determine the reasons for this increase, but noted his concerns that it could be because of over-diagnosis, which he says could overlook possible stressors the child is dealing with like anxiety, home conflicts and learning disorders.

Fiction: People with ADHD are only affected in the classroom: Cabrera says that while children with this condition are at a higher risk for reduced school performance, their inattentiveness, hyperactivity and impulsivity also affect their social relationships, increase their chances for developing a conduct disorder and increase their chances for substance use and incarceration later on.

Fiction: ADHD is caused by bad parenting: The general consensus is that ADHD is likely the result of both genetic and environmental factors, says Cabrera.

Fiction: Children on ADHD can seem “drugged": “The common way that the term ‘drugged’ is used suggests lethargy and loss of capacity,” Cabrera says. “Stimulants, the most commonly prescribed medication, typically do not have this effect.” According to the CDC, between 70 to 80 percent of children with ADHD have fewer symptoms when they take prescribed stimulants.

Fact: ADHD can be treated: Cabrera says this depends on the individual. “Many people with easier to treat ADHD can successfully manage their symptoms,” he said. “Unfortunately, many others will struggle with ADHD in all aspects of their life despite the best possible treatment.”

Friday, October 14, 2016

Children and teens should see the doctor for any signs of a concussion; sometimes symptoms don't show up for several days

A person doesn't have to be knocked unconscious to have a concussion, so it's important to recognize the symptoms and seek medical attention quickly if warning signs appear.

Children hit their heads fairly often and are usually able to bounce back quickly, but that is less likely the older they get, according to Harris Health System, located in Texas.

“Children’s brains have the ability to regenerate after a concussion (or less serious head injury),” Dr. Shankar Gopinath, chief of neurosurgery at Ben Taub Hospital and associate professor of neurosurgery at Baylor College of Medicine, said in the news release. “Which is advice to be taken with a grain of salt, since parents should still consult their physician after an incident involving a head injury.”

Common Symptoms of a Concussion
graphic: The Children's Hospital of Philadelphia
A concussion is a mild form of a traumatic brain injury that occurs from a mild blow, bump or jolt to the head. Some people lose consciousness, but most do not. The leading causes of concussions are falls, motor-vehicle-related injuries, unintentionally being hit in the head with an object, assault or playing sports, says the Brain Injury Alliance of Kentucky website.

Concussion symptoms are similar in infants, children and adolescents, but there are some differences.

The most obvious symptom in infants is a loss of consciousness, but other signs include crying inconsolably, vomiting and excessive sleepiness. Refusing to eat, prolonged irritability or unusual or prolonged periods of quietness or inactivity are also signs of a concussion or a more serious injury, says the release. All of these symptoms call for an immediate trip to the doctor.

In addition to loss of consciousness, concussion symptoms in older children include severe headache, difficulty with bright lights or loud noises, blurred vision, trouble walking, memory loss, feeling mentally "foggy," confusion and saying things that don't make sense, slurred speech and unresponsiveness, irritability, sadness or nervousness and changes in sleep patterns, says the Brain Injury Alliance of Kentucky.

“Repeated concussions can cause permanent changes neurologically,” Dr. Asim Shah, chief of psychiatry, Ben Taub Hospital and professor at the Menninger Department of Psychiatry Baylor College of Medicine, said in the Harris Health release. “Sometimes even the ability to learn something new [cognition] lowers significantly.”

WebMD notes that symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. And while most children and teens recover quickly from concussion, some symptoms, like memory loss, headaches and problems with concentration, may linger for weeks or months. You should also contact your doctor if symptoms are lingering.

Experts at Harris Health emphasized the importance of children and teens being treated quickly and checked by a physician when warning signs of a concussion appear. WebMD says: "An undiagnosed concussion can put someone at risk for brain damage and even disability."