Medicaid work requirement delayed again as court mulls case

Facing another legal challenge to its revised Medicaid program, the administration of Gov. Matt Bevin has delayed implementation of its "community engagement" requirements for "able-bodied" beneficiaries to work, volunteer, attend school 80 hours a month unless they are a primary caregiver or in drug treatment.

The requirements were supposed to begin April 1 in Campbell County and gradually spread to other counties. Now they "will begin no sooner than July 1," and the "rollout schedule is still being finalized," the Cabinet for Health and Family Services said Thursday.

The revised Medicaid program was originally supposed to begin July 1, 2018, but a federal judge in Washington, D.C., threw out its approval by the Trump administration. It has been re-approved, but is facing another lawsuit from Medicaid beneficiaries that won't be decided until March, if then.

In a news release, cabinet officials said the delay will give them more time to create “consistent customer service and high-quality services” and help people comply with the new rules. A spokesman told The Associated Press that the court case and the partial federal-government shutdown contributed to the delay.

The cabinet still plans to implement other elements of the revised program on April 1. On that date, people covered by the 2014 Medicaid expansion would have to earn vision and dental services. On May 1, and most would have to start paying monthly, income-based premiums.

The cabinet had planned to start premiums April 1, but now says it is waiving the payment for April. "This will give beneficiaries an opportunity to become familiar with the program prior to being required to make their first monthly premium payments," the cabinet said in a news release.

"The Foundation for a Healthy Kentucky is currently working on setting up a premium payment assistance program for Medicaid enrollees who will have to begin making monthly payments," WFPL's Lisa Gillespie reports. "Foundation Vice President for Policy Veronica Cecil said they’re trying to make it as easy as possible for people to request financial assistance for Medicaid enrollees."
The program is called Kentucky HEALTH, for Helping Engage and Achieve Long Term Health. More information about its implementation timeline is at www.KentuckyHEALTH.ky.gov.

1 in 5 Kentucky households delay or forgo medical care due to cost; higher co-payments and deductibles may be a factor

One in five Kentucky households delay or forgo medical care because of the cost, according to the latest Kentucky Health Issues Poll, taken Aug. 26 through Oct. 21.

The overall share of 21 percent was about the same as in 2014, the last year the poll asked the question. That was also the first year that Kentucky expanded Medicaid to households with incomes up to 138 percent of the federal poverty level.

Interestingly, the poll found more difference between people with incomes above and below 200 percent of the poverty line, about $50,000 for a family of four. Among those with higher incomes, the share delaying or forgoing care rose to 20 percent, from 14 percent in 2014. Among those with lower incomes, the delay-or-forgo share declined to 25 percent, from 29 percent in 2014.

Why would people with higher incomes report more trouble paying for medical care, while those with lower incomes were reporting less trouble? Perhaps because co-payments and deductibles in private insurance plans have increased, while those in Medicaid and other government insurance plans have remained stable or nonexistent, said Ben Chandler, CEO of the Foundation for a Healthy Kentucky, co-sponsor of the poll.

"The Affordable Care Act and Medicaid expansion in Kentucky significantly reduced the percentage of uninsured Kentuckians, but many still struggle with other cost barriers," Chandler said in a foundation news release. "We need to find a way to bridge those gaps to improve health and to reduce the higher health-care costs that result when we delay or forgo essential and preventive care."

The poll also found that more Kentucky adults do not use a regular doctor, health clinic or other appropriate source of health care than they reported in 2009, the first time the poll asked such questions, "but that hasn't necessarily translated into more visits to inappropriate sources such as emergency room or urgent-care-clinic visits," the foundation said.

In the poll, 24 percent of Kentucky adults said they do not have a usual place to go for health care, compared to 18 percent in 2009. "About 8 percent of Kentucky adults said they go to the emergency room or an urgent-care center when they need care, a figure that has remained steady since 2009," the foundation said.

Kentucky adults without health insurance were nearly twice as likely to lack a usual source of health care as those with coverage, the poll found.

"Going to the same place for medical care, a place that knows you and your medical history, is key to maintaining good health and preventing chronic disease," Chandler said. "You're more likely to have regular wellness visits, immunizations and health screenings and to avoid dangerous medication interactions and preventable hospital admissions when you have both health insurance and a regular care provider. The fact that those living on low incomes are less likely to have either of these is another example of how poverty often leads to poorer health."

The telephone poll of Kentucky adults is also funded by Interact for Health, a Cincinnati-area foundation. Its margin of error is plus or minus 2.5 percentage points.

How to stay safe in bitterly cold weather

Kentucky Cabinet for Health and Family Services news release

With zero to sub-zero temperatures predicted later this week around the state, many Kentuckians could be exposed to harsh winter elements. To prepare for these conditions, Department for Public Health officials are emphasizing the importance of limiting exposure to the cold and taking necessary steps to prevent hypothermia.

“When the thermometer drops, people are at increased risk for hypothermia,” said DPH Commissioner Jeff Howard, M.D. “Hypothermia occurs when an individual’s body temperature drops below what is necessary to achieve normal metabolism and other bodily functions. In severe cases or when the body is not properly warmed, death can result.”

The condition occurs most often when an individual is submerged in icy waters. However, people exposed to cold weather who aren’t sufficiently prepared also are at an increased risk for the condition.

To prevent hypothermia, DPH advises Kentuckians to:

• Wear appropriate clothing. Layer clothes made of synthetic and wool fabrics, which are best for keeping warm. Always remember to wear hats, coats, scarves and gloves. 
• Avoid consuming alcohol if outdoors. Alcohol can actually speed the loss of heat from the body. 
• Avoid overexertion from activities that cause excessive sweat. This can lead to damp clothing, which causes chills. 
• Stay as dry as possible. 

Warning signs of hypothermia in adults include shivering, exhaustion, confusion, fumbling hands, memory loss, slurred speech and drowsiness. In infants, bright red/cold skin and very low energy are present.

If you notice any of these signs, take the person’s temperature. If it is below 95° F, the situation is an emergency – get medical attention immediately.

If medical care is not available, begin warming the person as follows:

• Get the victim into a warm room or shelter. 
• If the victim is wearing any wet clothing, remove it. 
• Warm the center of the body first – chest, neck, head and groin using an electric blanket if available. You can also use skin-to-skin contact under loose, dry layers of blankets, clothing, towels or sheets. 
• Warm beverages can help increase body temperature, but do not give alcoholic beverages. Do not try to give beverages to an unconscious person. 
• After body temperature has increased, keep the person dry and wrapped in a warm blanket, including the head and neck. 
• Get medical attention as soon as possible. 

Individuals working outside during this time of year should pay extra attention to these guidelines, particularly those susceptible to overexertion. Outdoor workers should make sure they are appropriately dressed and take frequent breaks to warm up and make sure their clothes are sufficient to keep them warm and dry.

“Be sure to check on your neighbors, especially if you have older adults living near you, to make sure they are okay during these frigid temperatures,” concluded Dr. Howard. “And take steps to protect your pets, livestock and farm animals from the cold too.”

To learn more, go to our website: www.chfs.ky.gov and type in “hypothermia” in the “What can we help you find?” search tool. More information on hypothermia is at https://www.cdc.gov/disasters/winter/staysafe/hypothermia.html.

Ambulances report fewer overdose calls, say trend is partly due to availability of drug antidote Narcan and increased use of meth

Your local ambulances may be getting fewer calls for drug overdoses, but that doesn't necessarily mean that your local drug problems are decreasing.

The Anderson News found that OD ambulance calls in the Central Kentucky county fell 20 percent from 2017 to 2018, from 95 to 77 -- but the county's emergency director, Bart Powell, "said he and others in emergency management attribute the decline in ambulance calls to the widespread availability of Narcan, the drug used to revive overdose victims," Publisher-Editor Ben Carlson reports. Also, "Addicts are turning to other sources to get high."

“Meth is more common and generally doesn’t lead to overdose. It’s cheaper, too,” Paul Barrick, leader of the local HEROES (Helping Educate, Reaching Out, Ending Stigma) organization, told Carlson, who writes: "Powell agreed that it appears meth is being used in place of heroin, in part because of changes in the law that make obtaining it more expensive and difficult."

Powell said other ambulance services in Kentucky have seen similar declines in OD calls and attribute them to the availability of Narcan, the commonly used brand of the drug naloxone, which counteracts opiates and opioids.

"Narcan, which previously was administered only by medical care providers, has in recent years been made available to police officers and the general public," Carlson notes. "As a result, those who overdose on opioids can be revived by family members, friends or responding police officers if they arrive ahead of an ambulance."

Powell said, “The introduction and availability of Narcan to the general public has resulted in a slight reduction on our runs because they are self-treated at the scene,” Powell said. “That’s backed up by other EMS providers in the state.”

Barrick, "who for years has helped raise awareness of opioid addiction and education, said there are some encouraging signs. “Families are much more educated regarding treatment options,” he said. “The stigma regarding addiction has changed, and schools and churches are also more willing to help with support and education.”

Are you struggling with addiction, or know of someone who is? Here is expert advice for finding quality treatment

By Anne M. Herron
Director, Center for Substance Abuse Treatment,U.S. Substance Abuse and Mental Health Services Administration

It can be overwhelming and confusing to know where to start if you need to find treatment for an alcohol or drug addiction. Addiction touches nearly everyone in some way, yet, like all health care, effective treatment must be tailored to the needs of the individual.

Autospost.com

With many addiction treatment options, finding a program that will provide the quality care you or your loved one needs to address the specific addiction issues can be challenging. These steps will help you know what to look for to find a treatment program that is high quality and tailored to your needs.

How do you find treatment? If you have insurance, a good first step is to contact your insurer. Ask about your coverage and whether they have a network of preferred providers. If you don’t have insurance, you still have access to quality care. Each state has funding to provide treatment for people without insurance coverage.

What should you look for in a program or provider? Quality treatment programs offer a full range of services which have been shown to be effective in treatment and recovery from addiction. Keep these points in mind when weighing your options.

Accreditation: Make sure the treatment program is licensed or certified by the state. This ensures the provider meets basic quality and safety requirements. You should also check that the program is accredited, which means it meets standards of care set by a national, compliance organization. Be sure to ask the program to show you how people using their services have rated them.

Evidence-based treatment: Check to determine if the program offers effective and proven substance use disorder treatments, such as medication management, cognitive behavioral therapy, drug and alcohol counseling, education about the risks of drug and alcohol use, and peer support. Quality treatment providers or programs offer more than one form of effective treatment. Effective programs will also be mindful of or address mental health and physical disorders that will affect substance use treatment.

Medication: Confirm whether the program offers FDA approved medication for recovery from alcohol and opioid use disorders. However, keep in mind that currently, there are no FDA approved medications to help prevent relapse from other problem substances.

Families: Family members have an important role in understanding the impact of addiction on families and providing support. Make sure the treatment program includes family members in the treatment process.

Continuing care: For many people addiction requires ongoing medication and supports. Quality programs provide treatment for the long term, which may include ongoing counseling or recovery coaching and support, and helps in meeting other basic needs like sober housing, employment supports, and continued family involvement.

Once you’ve identified a treatment program that meets the criteria above, call for an appointment. Many programs provide walk-in services. If they can’t see you or a family member within 48 hours, find another provider. (It is important that the provider or program connect you to care quickly.) You can find more information about finding treatment at https://findtreatment.samhsa.gov/ or calling the National Helpline at 1-800-662-HELP (4357).

Managed-care firms and legislators do another Groundhog Day, but changes might be coming; Passport objects to recent cuts

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Medicaid managed care organizations and others in the health-insurance industry spent the first half of a three-hour meeting bragging about their work, and the second half being told by lawmakers that their version of events isn't reality.

"All these numbers and all these rosy pictures that you've been painting -- that's not the reality of where we are with the MCOs, and the most vulnerable people are the ones paying the price for this," Sen. Danny Carroll, R-Paducah, said at the Feb. 23 meeting of the legislature's interim joint health committee. "You can tout how great you are all you want, it's not reality and we have got to do better and you have got to do better in your organizations."

Kentucky has five MCOs that manage care for most of the 1.4 million Kentuckians on Medicaid, which has a $11.5 billion annual budget. They are: Aetna, Anthem Blue Cross Blue Shield Medicaid, Humana Caresource and WellCare, all part of the for-profit health-insurance industry; and the Louisville-based nonprofit Passport Health Plan, which voiced concern at the meeting about the state's recent cuts in its reimbursements.

Passport CEO Mark Carter said "the elephant in the room" was that his company could be facing bankruptcy by the middle of the year if Kentucky does not reverse the cuts. The state cut Passport's reimbursements by 4.1 percent, while increasing others' an average of 2.2 percent. The company has filed an appeal, but told the lawmakers they would prefer to work with the Cabinet for Health and Family Services to find a solution.

"It makes no sense for us to be in conflict with our primary customer," Carter said. Passport provides Medicaid to more than 300,000 low-income people in Jefferson and surrounding counties. It has 65 percent of the market share in its region.

Sen. Ralph Alvarado, R-Winchester, co-chair of the committee, said Health Secretary Adam Meier would join Passport at the next meeting to discuss this issue. (Friday afternoon, Gov. Matt Bevin announced that Alvarado would be his running mate for lieutenant governor.)

Since 2011, Kentucky has used managed care, which pays participating organizations a set rate per member as an incentive to limit claims from members. Before then, outside the Louisville area, providers who cared for Medicaid patients were paid on a fee-for-service basis, meaning they billed for each service they provided. Since managed care replaced that, providers have complained about delayed and denied payments from the MCOs.

During the first half of the meeting, Stephanie Stumbo, acting executive director of The Kentucky Associations of Health Plans, a health-insurance lobby, told lawmakers that managed-care organizations have saved taxpayers upwards of $1.2 billion, including about $350 to $400 million in state dollars.

She said MCOs also better manage Medicaid members' use of health services, and improve health-care quality and the coordination and integration of care.

Lawrence Ford and Sen. Stephen Meredith, R-Leitchfield

Lawrence Ford, chairman of the association and senior director for government relations for Anthem, said 90 percent of the money insurers get for patient care is spend on medical claims and quality improvement. He said 9 percent goes toward non-medical expenses, like technology, wages and administrative costs, and when appropriate, only 1 percent goes toward their profit margin.

"Kentucky is getting a better return today on its investment and its Medicaid program with its MCO partners than it was previously," he said.

The second half of the meeting wasn't so upbeat, with one lawmaker after the other either ranting about their issues with the managed care organizations or asking pointed questions that few stepped up to answer.

Sen. Stephen Meredith, R-Leitchfield, a former hospital administrator who has been vocal about his dislike for the managed-care model, was the first to rant, as Alvarado called it.

Meredith lectured the MCOs on the administrative burdens they place on providers; the lack of "fair and equitable" pay to their providers, particularly to rural hospitals; the length of time it takes for providers to become credentialed to participate in their programs; and the challenges of getting providers to work in rural communities, which he largely blamed on poor pay.

"You're not doing things to reduce the regulatory burden for health-care providers at all, " he said.

Ford said he agreed with many of the points Meredith raised, but reminded Meredith that they have "constraints" and are required to work within the rules set forth by the state and federal governments. He began to say that they would need more money in the budget to pay providers more, but Meredith interrupted him saying, " I don't think we have to put more money in Medicaid. I think the Medicaid budget is as big as it ever needs to be if we are spending our monies appropriately, but we're not doing that."

The discussion continued in the same vein for about an hour and a half.

Sen. Morgan McGarvey, D-Louisville, who is new to the committee but has spent four years on the Medicaid Oversight and Advisory Committee, said, "It feels like Groundhog Day," the movie in which the same day was redone over and over, He said every year, MCOs make the same "infomercial" presentations and lawmakers say that's not the reality, but nothing gets done about it.

McGarvey said what he hears from his providers and constituents is that "they are not getting payments and they are not getting their services."

He said it's past time to find out what the real story is, meaning that they all need to have honest conversations with each other. But when he asked, "Is there something different we can do that will help this problem out?" no one stepped up to answer.

Sen. Max Wise, R-Campbellsville, brought up the low rates that pharmacy-benefit managers, which contract with MCOs, are paying independent pharmacists. A report is expected to be released soon to detail these practices.

Carroll, who deals daily with MCOs through his non-profit agency that provides therapy and medical-based child care, came with a list of questions. He said that he, as a provider, has had to deal with the same issues of delayed and denied payments "over and over" again and that this is standard.

"You know, all the MCOs paint a rosy picture, and the reality of how the system is actually working is that that is a false picture," he said.

Carroll asked the highest-ranking person from each MCO to stand up to answer the question, "Is there a systematic approach to delaying or denying claims on a regular basis to manage your cash flow, to manage your revenue?" All said no.

Committee Co-Chair Rep. Kim Moser, R-Taylor Mill, said that if these issues can't be worked out behind the scenes then, "My solution will be to file legislation to hold the providers accountable."

So far, two bills that deal with MCOs have been filed, both by Meredith.

Senate Bill 42 would cut the number of MCO contracts in the state to three. It would also require that rural health-care providers be reimbursed at least at the median amount paid to urban providers in the nearest metropolitan area, with penalties for noncompliance.

Senate Bill 39 would require all MCOs to provide quarterly all payment schedules for reimbursements to the Medicaid Oversight and Advisory Committee.

Alvarado, a family physician who has been vocal about his frustrations with MCOs was unusually quiet during the meeting. He said that in the interest of time, he would submit his concerns in writing.

But he did say there had been improved transparency and responsiveness from MCOs over the years and they and the state have made real changes. He asked the MCOs to be good partners to make the changes that still need to be made so that legislation doesn't have to be filed.

"Things have gotten better," he said. "But we're still a long way from where we need to be."

Specialists give parent-education campaigns credit for big decline in Sudden Infant Death Syndrome in Kentucky

Fewer babies in Kentucky are dying from Sudden Infant Death Syndrome, and wellness specialists are crediting a multi-pronged educational campaign by hospitals and other health-care providers, reports Ann Bowdan of Louisville's WLKY-TV.

In 2016, 103 Kentucky children died of SIDS. By 2018 the number had dropped by more than half, to 49.

"We have done everything from teaching in our prenatal classes, there is literature that goes home, it’s on our website," Norton's Children's Hospital wellness specialist Erkia Janes told Bowdan. "It’s seeped through every class we have."

For many years, parents were given the wrong advice, "For decades, it was thought a baby sleeping on its back could choke on reflux, or vomiting," Bowdan reports. "But in 1994 the American Academy of Pediatrics reversed that way of thinking," based on research. Janes said, "The research clearly shows that a baby on their belly is desperately as risk for SIDS."

The educational materials use "ABC" to describe how a baby should sleep: "alone, on your back, in a safe crib," Janes said. "Meaning no blankets, bumpers, and no sleeping in a bed with parents."

Fewer Kentuckians worry about losing health insurance, and more of them are covered by employer-sponsored plans, poll finds

By Melissa Patrick
Kentucky Health News

About 90 percent of Kentucky adults have health insurance and fewer of them are worrying that they might lose it, according to the latest Kentucky Health Issues Poll. It also found that the number of Kentuckians getting insurance through their employer went up, while the number of them getting it through public insurance went down, perhaps a reflection of better economic conditions.

“Health insurance coverage opens a door to the health-care system,” Dr. O’dell Moreno Owens, president and CEO of Interact for Health, which co-sponsors the poll with the Foundation for a Healthy Kentucky, said in a news release.

“A lack of adequate insurance makes it difficult for people to get the health care they need and, when they do get care, burdens them with large medical bills,” Owens said. “People with coverage are better equipped to promote and maintain health, prevent and manage disease, and reduce unnecessary disability and premature death.”

The survey, taken by telephone Aug. 26 through Oct. 21, found that 16 percent of Kentucky adults with health insurance, or one in six, worry that they could lose their health coverage. That was down from one in four in last year's poll.

Kentucky adults with lower incomes were more likely to be concerned that they would lose coverage. The poll found that 32 percent of those earning less than 138 percent of the federal poverty level (those eligible for Medicaid) expressed concern, compared to 17 percent of those making between 138 percent and 200 percent of the poverty level and only 9 percent of those above 200 percent.

Some of the worries of those with lower incomes, especially if they gained their health insurance through the expansion of Medicaid to the 138 percent level, could be due to the changes to the program that are set to kick in on April 1. They will require many of them to work or do community engagement 80 hours a month, with strict reporting requirements if they want to keep their coverage. More than 18,000 people have lost coverage in Arkansas since September 2018 due to failing to meet such requirements, according to the Kaiser Family Foundation. 

The poll found that the share of Kentuckians with public insurance (such as Medicaid, Medicare or veteran's benefits) in 2018 dropped to 27 percent, down from 35 percent in the prior year's poll. This number has bounced up and down generally between these two numbers since 2015. The poll's margin of error is plus or minus 2.5 percentage points.

The share of Kentuckians with employer-provided insurance jumped to 48 percent from 39 percent last year. This rate has also bounced around since 2014, when the rate was 50 percent. Another 14 percent of Kentuckians said they either purchased their own plan, were covered by a parent's plan or another source, or weren't sure how they were covered.

In 2014, when then-Gov. Steve Beshear expanded Medicaid, the share of Kentuckians without health insurance dropped from 25 percent to 12 percent. This rate was 11 percent in the latest poll, down from 15 percent last year

About two in 10, or 19 percent, of the poll respondents said they had unstable insurance; that number has been about the same since 2015. Eight percent said they were insured, but went uninsured at some point in the past year.

The poll surveyed a random sample of 1,569 adults via landlines and cell-phones. The poll was given only to adults ages 18-64, because nearly all adults 65 and older are insured.

KentuckyOne Health in Central and Eastern Kentucky reverts name to Saint Joseph and adds 'CHI' to reflect parent firm

The brand was removed from University of Louisville Hospital
last year, and will be removed from other facilities in the city
once they are sold or closed. (Image from WDRB-TV)

The nine hospitals and associated facilities in Central and Eastern Kentucky that have borne the name KentuckyOne Health since 2012 have been renamed, signaling the eventual end of the short-lived KentuckyOne brand, Chris Otts reports for Louisville's WDRB.

The operations of Denver-based Catholic Health Initiatives in Lexington, Nicholasville, Berea, London, Mount Sterling and Bardstown are now known as parts of the “CHI Saint Joseph Health System,” using the brand of the large Lexington hospital. 

"Jewish Hospital and the other Louisville facilities KentuckyOne owns will retain the KentuckyOne brand as the organization continues efforts to sell them," Otts reports.

The renamed facilities are "Saint Joseph and Saint Joseph East hospitals in Lexington, Saint Joseph Berea, Saint Joseph Jessamine, Saint Joseph London, Saint Joseph Mount Sterling, Flaget Memorial Hospital in Bardstown, Women’s Hospital at Saint Joseph East and Continuing Care Hospital," Cheryl Truman reports for the Lexington Herald-Leader. "Saint Joseph Health Partners Clinically Integrated Network and Saint Joseph Medical Group provider practices in Central and Eastern Kentucky will also be part of CHI Saint Joseph Health, but will retain their individual names.

Read more here: https://www.kentucky.com/news/business/article224746115.html#storylink=cpy

The KentuckyOne Health brand "was created in 2012 when the Lexington-based Saint Joseph Health System merged with Jewish Hospital & St. Mary’s Healthcare in Louisville," WDRB notes. Once the Louisville facilities are sold, “We expect that the new organization will rebrand after the sale,” KentuckyOne spokesman David McArthur told the station.

Is this the year Ky. lawmakers throw tobacco and e-cigarettes out of schools? Advocates see more hope, and rally for their bill

Rep. Kim Moser spoke at the tobacco-free-schools rally.
(Photo by Charles Bertram, Lexington Herald-Leader)

At a Jan. 22 rally in the state Capitol, students, educators and health advocates asked Kentucky lawmakers to pass a law to make all schools in the state 100 percent free of tobacco and electronic cigarettes.

Terry Brooks, executive director of Kentucky Youth Advocates, said passing such a law should be a "no-brainer" for state elected officials who are committed to kids.

"Many issues that confront the Kentucky General Assembly are complex and complicated; the issue of tobacco-free schools is not one of them," Brooks said in a news release."Every young person deserves protections against exposure to secondhand smoke and to the dangerously high nicotine levels of e-cigarettes. Strong school campus policies on a statewide basis deliver those kinds of safeguards for all kids in every school."

Kentucky's high-school students smoke at a much higher rate than their peers across the nation, 14.3 percent compared to 8.8 percent. Almost as many, 14.1 percent, use e-cigarettes, which is a bit above the 13.2 percent nationally, according to the 2017 Youth Risk Behavior Survey, a national poll.

Health experts have warned that the e-cigarette rates are probably higher now because Juul sales have surged since the survey. A federal report released in November found that in 2018, one in five high school students and one in 20 middle school students are now using e-cigarettes in the U.S, representing a a 78 percent increase for high schoolers and a 48 percent increase among middle schooers in less than a year.

Passing a statwide tobacco-free school law could stop nearly one in three Kentucky students from smoking, according to the advocates. "This is an issue that should move ahead with speed, ease and consensus," Brooks said. "There is no excuse or rationale for any other outcome."

Two bills have been filed to make all Kentucky schools tobacco-free: House Bill 11, sponsored by Rep. Kimberly Moser, R-Taylor Mill, and Senate Bill 27, sponsored by Sen. Ralph Alvarado, R-Winchester and co-sponsored by Sen. Stephen Meredith, R-Leitchfield. Both would bar the use of tobacco products, including e-cigarettes, on all school properties and at all school events that are on school-owned property.

"Tobacco-free schools policies set a healthy example for students by de-normalizing tobacco use at school, where our children and teens spend a third of their waking hours," said Moser. "In one Juul we have about the same amount of nicotine as one pack of cigarettes. That is crazy."

Alvarado, a physician, said, "Most tobacco use starts while kids are still school-aged, a time when their brains are still developing and nicotine can hinder that development and cause lasting damage."

He added, “The tobacco-free schools bill we’ve introduced is all about prevention,” stating that 90 percent of tobacco use starts before the age of 18, reports The Lane Report.

Fewer than half of Kentucky school districts have enacted such policies. As of July, 72 of the 173 districts had adopted 100 percent tobacco-free school policies, covering 734 schools and 57 percent of the state's students. Federal law only prohibits smoking inside schools that receive federal funding.

In past legislative sessions, bills to require all school properties and school events to be tobacco-free have gained little to no traction. Two were introduced in the last session, but were not called up in the legislature's education committees. The Senate passed one in 2017, but it died in the House.

Prospects look better this year. The House version of the bill has already been posted in the House Health and Family Services Committee, which Moser chairs. The bill also has the "newfound support" of the The Kentucky School Boards Association and the Kentucky Association of School Superintendents, says the news release.

"We have cautiously waited to see how effective and workable these policies have been in the numerous districts that have adopted them. We believe the policies are working because enforcement has been crafted to fit each district's needs, an approach which will continue with HB 11 and SB 27," Kerri Schelling, executive director of the school boards association, said in the release.

Such a bill also has the support of 87 percent of Kentucky adults, according to the most recent Kentucky Health Issues Poll, which has shown consistent support for such policies since 2013.

And it also has the lobbying support of the Coalition for a Smoke-Free Tomorrow, which is made up of about 180 organizations across the state. The coalition has made a statewide tobacco-free school law its highest priority this year, says the release.

Ben Chandler, the coalition's chair and the president and CEO of the Foundation for a Healthy Kentucky, stressed that it's important to pass this law now to recover the progress that has been made in reducing teen tobacco use that is steadily being lost because of the explosion in teen vaping.

"We're coming up on half of Kentucky's school districts that already have enacted these policies to reduce tobacco use by teens and to protect them from the significant health dangers of secondhand smoke and e-cigarette aerosol," he said in the release. "Now is the time to extend those protections statewide, before we lose any more ground."

Counties where drug makers did more marketing had higher rates of overdoses from prescription painkillers, national study finds

Counties where doctors got more attention and favors from drug manufacturers were more likely to have a higher rate of overdoses from prescription opioids a year later, says a new study, published in the American Medical Association journal JAMA Network Open, looked at $40 million in marketing to 67,500 U.S. physicians from mid-2013 through 2016.

For larger maps, click on them or download the study.

The study stops short of finding a cause and effect. But it "offers some of the strongest evidence yet of the connection between the marketing of opioids to doctors and the nation’s addiction epidemic," writes Abby Goodnough of The New York Times. "It found that counties where opioid manufacturers offered a large number of gifts and payments to doctors had more overdose deaths involving the drugs than counties where direct-to-physician marketing was less aggressive." The payments included trips, meals and consulting fees. Meals seemed especially influential, the study said.

The researchers from New York University and Boston Medical Center "found that for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids there a year later were 18 percent higher," Goodnough reports. "The authors acknowledged several caveats in the study, including that it could not differentiate between overdose deaths involving painkillers that are prescribed versus illicitly acquired."

The researchers wrote, "Prescription opioids are involved in 40 percent of all deaths from opioid overdose in the United States and are commonly the first opioids encountered by individuals with opioid use disorder. It is unclear whether the pharmaceutical industry marketing of opioids to physicians is associated with mortality from overdoses. . . . Amid a national opioid overdose crisis, reexamining the influence of the pharmaceutical industry may be warranted."

The study found that opioid prescribing rates were somewhat higher outside metropolitan areas, but the non-metro mortality rate from overdose deaths was somewhat lower than in metros. "The study found that opioid-related spending on doctors was most highly concentrated in counties in the Northeast; the Midwest had the lowest concentration," Goodnough notes. "Areas with large numbers of payments and high overdose rates included four cities in Virginia — Salem, Fredericksburg, Winchester and Norton — as well as Cabell County, W.Va., which has one of the highest overdose death rates in the nation." 

Federal shutdown delays lawsuit against state Medicaid changes

The acronym in the name of the state's plan stands for
Helping to Engage and Achieve Long-Term Health.

The partial shutdown of the federal government has slowed the lawsuit challenging Gov. Matt Bevin's plan to revamp Kentucky's Medicaid program with work requirements and premiums starting April 1.

The judge handling the case in Washington, D.C., gave federal lawyers an extra week to file briefs, after denying their motion for an indefinite stay.

The Justice Department lawyers told District Judge James Boasberg that they had done very little work on the case because the department has been without funds since the shutdown started Dec. 22. They had asked him to delay the case until the department is funded, or at least delay briefings for 10 days.

Boasberg first "said he would delay the case only if Kentucky agrees to delay its overhaul of Medicaid, scheduled to begin April 1. Kentucky did not agree," Deborah Yetter reports for the Louisville Courier Journal. "In a motion filed Thursday, lawyers for Bevin said the plan is still scheduled to begin April 1 and "the Commonwealth is actively working toward that go-live date." Only one county, Campbell, would do that on April 1; others would follow gradually.

The state Cabinet for Health and Family Services did support a 10-day delay, but said it “prefers that this action, and any appeal, be resolved sooner rather than later.” Cabinet Secretary Adam Meier told Insider Louisville that the Department for Medicaid Services would keep working toward implementation of the plan, starting in Campbell County on April 1.

Lawyers for the plaintiffs, 16 Kentucky Medicaid clients, also argued against an indefinite stay. One of them, Cara Stewart of the Kentucky Equal Justice Center, told Insider Louisville's Darla Carter that Boasberg’s “concern in not allowing an indefinite stay shows he understands the risks in allowing the defendants to push closer to their proposed implementation date.”

"A larger problem is looming," reports John Cheves of the Lexington Herald-Leader. "The federal court system is preparing to burn through its current reserve funds within two weeks if the shutdown does not end, The New York Times reported Friday. When the courts’ roughly 33,000 employees are furloughed, the judicial branch will be reduced to 'mission critical' operations, putting most cases on hold, the Times said."

University of Louisville in talks with Nashville hospital firm to partner in buying, perhaps saving Jewish Hospital and its affiliates

Jewish Hospital casts a shadow across Louisville's Interstate 65. University Hospital is to the east.
(Google Maps image, looking south; for a larger version of the picture, click on it)

The University of Louisville is talking with a Nashville health-care firm to "prevent a catastrophic health-care shakeup in Louisville," the closure of Jewish Hospital, reports Louisville's WDRB-TV. The potential deal is "offering a new survival scenario for the university's medical services" at Jewish and Frazier Rehabilitation Institute, the Louisville Courier Journal reports.

After those stories were published, U of L President Neeli Bendapudi confirmed that the university is in talks with Ardent Health Services, which has 31 hospitals in seven states, as well as other potential partners. On Dec. 21, she sent Jewish's parent company a non-binding letter of intent to purchase, according to an email WDRB obtained through the Kentucky Open Records Act. Bendapudi said the university would “absolutely” need a financial partner to do the deal.

"The disclosure comes as hopes fade for a New York hedge fund to buy Jewish and other Louisville facilities owned by cash-starved KentuckyOne Health," the CJ's Grace Schneider and Morgan Watkins report. Those are Frazier, Sts. Mary and Elizabeth Hospital, Jewish Hospital Shelbyville and four outpatient medical centers, notes Chris Otts of WDRB.

"KentuckyOne lost $57 million operating that group of facilities in the year ending June 30, 2018, and another $18 million in the three months ending Sept. 30, according to financial reports from KentuckyOne’s parent company, Colorado-based Catholic Health Initiatives," Otts reports. "More than a year ago, KentuckyOne identified New York private equity firm BlueMountain Capital Management as the likely buyer of its Louisville assets, but protracted negotiations have failed to result a deal," and BlueMountain has stopped talking to journalists.

In approaching Ardent, Bendapudi is dealing with a player familiar to her. "In 2017, the company formed a joint venture with the University of Kansas – where Bendapudi was provost before she came to U of L last year – to buy a struggling hospital in Topeka, Kansas, that was near closure," Otts reports. "U of L is believed to be looking into a 'joint venture' in which a partner would provide much-needed capital to update Jewish Hospital and the other aging facilities, as well as operational expertise. Ardent has undertaken a number of similar deals."

The CJ reports, "The fate of Jewish and Frazier is critical to U of L because the hospital and rehab facility have been the home of groundbreaking research and the city's only adult organ transplant center. More than 50 U of L medical residents and dozens of doctors associated with U of L work at those facilities under a contract between KentuckyOne and the university." Jewish and Frazier are near University Hospital, of which U of L regained control from KentuckyOne last year.

Lexington Herald-Leader wins grant for reporter to cover health and social services, monitor big state agency that handles them

The Lexington Herald-Leader has won a grant to hire a reporter to cover health and social services in Kentucky, with special attention to the state agency "that wields enormous power over Kentucky’s most vulnerable citizens with frighteningly little scrutiny and transparency," the newspaper says.

The grant comes from Report for America, which places talented emerging journalists in local newsrooms to report on under-covered topics and communities. It is the latest initiative of the Ground Truth Project, a nonprofit funded by several foundations and other phuilanthropies. Last year it funded an Eastern Kentucky reporter for the Herald-Leader, and has renewed that grant.

Read more here: https://www.kentucky.com/news/state/kentucky/article224586210.html#storylink=cpy

The new grant is also for a year, and is renewable. The newspaper will take applications for the job through Feb. 8, and plans to put the reporter on the payroll June 1.

John Stamper, the paper's accountability and engagement editor, writes that the reporter "will focus on the region’s health problems, expose flaws in Kentucky’s social-services programs, give voice to people struggling to care for themselves and their loved ones, and offer potential solutions to problems that have plagued the area for a century.

"In particular, this reporter will serve as a watchdog of the Kentucky Cabinet for Health and Family Services," which gets relatively little journalistic attention because of the decline in the number of newspaper reporters, especially in Frankfort. The reporter will spend much in the state capital, especially during sessions of the legislature, and also report from Eastern Kentucky.

Most Ky. adults for statewide smoking ban and raising legal age to buy tobacco to 21, but movement on either issue is unlikely soon

A majority of Kentucky adults continue to support a comprehensive statewide smoke-free law and favor raising the legal age to buy tobacco products from 18 to 21 years, according to the latest Kentucky Health Issues Poll.

The telephone survey, taken Aug. 26 through Oct. 21, found that 66 percent of Kentucky adults support a comprehensive statewide smoke-free law, down from 71 percent in the last two polls, but generally about the same since 2013. The poll's margin of error is plus or minus 2.5 percentage points for each number.

The poll found about the same support as last year, 56 percent, for raising the legal age to buy tobacco products in Kentucky to 21.

"Neither proposal is the subject of a bill in the 2019 legislative session, but it's important for policymakers to recognize both that these laws work, and that the public strongly supports them," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll.

This year, bills have already been introduced in the House and Senate to prohibit the use of tobacco products, including the highly popular electronic cigarettes, on school properties. The latest poll on this topic shows that 87 percent of Kentucky adults would support such a law.

The Kentucky Health Issues Poll found that a statewide smoking ban still has strong bipartisan backing, but since the 2016 poll was taken support has dropped among Republicans, to 62 percent from 72 percent, and among independents, to 55 percent from 68 percent.

Kentuckians who say they have never smoked continue to voice the greatest support for a statewide smoking ban, at 75 percent, followed by former smokers, at 67 percent. And nearly half of current smokers, 46 percent, favor such a law.

A statewide smoke-free law would prohibit smoking in public places, including workplaces, public buildings, offices, restaurants and bars throughout Kentucky. About 35 percent of Kentuckians live in cities or counties that have adopted such laws. Nationwide, 28 states and the District of Columbia have passed statewide smoke-free laws.

The state House passed a statewide smoking ban in 2015, but its takeover by Republicans after the election of a Republican governor has dimmed prospects for such a law. Gov. Matt Bevin has said it is a matter for local governments, not the state.

As with support for a smoke-free law, the percentage of Kentucky adults who favor raising the minimum legal age to purchase tobacco in Kentucky to 21 has held steady for the past three years, with six in 10 Kentucky adults in favor of making this change.

Such a law is often referred to as a "Tobacco 21" law. According to the Campaign for Tobacco-Free Kids, six states and at least 430 cities and counties have adopted such a policy.

According to a 2015 Institute of Medicine report, a Tobacco 21 law would reduce the smoking rate by about 12 percent and smoking-related deaths by 10 percent over the long term. The report adds that among teens ages 15 to 17, such a law would decrease initiation of tobacco use 25 percent, says the release.

"Kids today are the primary feeder market for the nicotine-addicted tobacco customers of tomorrow," Chandler said. "Most youth who experiment with tobacco products start at about age 13 or 14, and they often get their tobacco products from older teens. Between the ages of 18 and 21 is when youthful experimentation turns into adult addiction. Tobacco 21 laws reduce both experimentation and addiction at a time when young brains are vulnerable to irreparable damage from nicotine."

The poll is funded by the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,569 adults via landlines and cell-phones.

UK removes dean who was defendant in suit ending in payment of $620,000 to professor who objected to Bevin's Medicaid plan

Stephanos Kyrkanides (University of Kentucky photo)

The University of Kentucky has removed the dental-school dean whose alleged retribution to a faculty member resulted in a $620,000 settlement with the professor and his restoration to the payroll.

Dr. Stephanos Kyrkanides ended the post-retirement employment of Dr. Raynor Mullins in 2017, after Mullins and other College of Dentistry faculty members objected to the withdrawal of dental and vision benefits from the state's standard Medicaid plan, as part of a package of changes advocated by Gov. Matt Bevin.

A federal whistleblower lawsuit by Mullins initially alleged that the move was prompted by a call Kyrkanides received from Bevin, an administration official, or Mark Birdwhistell, the UK HealthCare vice president who helped the administration draft the plan; and that Kyrkanides told Mullins to make no more public statements about the plan, and "communicated that this direction came from 'up top'." Bevin's office denied any knowledge of the allegations.

A revision of the suit dropped Birdwhistell and an unnamed Bevin administration official, identified only as "John Doe," as defendants. They were later dismissed, but without prejudice, meaning they could have been reinstated. That left Kyrkanides as the only defendant. In December, as the case was heading to trial, UK and Mullins settled the matter and issued a statement saying they would have no further comment on it. Mullins has been rehired to run a new oral-health program.

On Wednesday, Provost David Blackwell, the university's chief academic officer, sent an email to faculty and staff in the dental school, saying:

As of this morning, Dr. Kyrkanides is no longer the Dean of the College of Dentistry. He will begin a 1-year sabbatical/administrative leave immediately, but remains a faculty member in the College. I thank Dr. Kyrkanides for his service to the College and University during his time as Dean.

I will soon be meeting with the leadership team of the College to discuss interim leadership. During this time of change, I urge each of you to stay focused on your excellent work in teaching, research, service, and patient care.

We will be arranging meetings with faculty and staff in the near future to discuss next steps for the College. Thank you very much for your contributions to the Commonwealth, UK, and the College of Dentistry.

Asked if the move was voluntary or involuntary on the part of Kyrkanides, who had been dean since 2015, Blackwell referred the question to university spokesman Jay Blanton, who declined to comment, other than to say Kyrkanides would be paid $287,760, 75 percent of his dean's salary, while on leave.

Mullins' suit roused concern among UK faculty, even though post-retirement positions do not have traditional protection of tenure for professors. At the December meeting of the University Senate, the faculty's governing body, fine-arts professor Herman Farrell noted the settlement and told UK President Eli Capilouto that the claim of a "response coming from the governor's office" with "consequences to that faculty member . . . really does affect academic freedom, and it frightens me as a faculty member." He asked Capilouto if "at some point in the future that you would take a sort of a more sort of proactive approach to what was implicated there."

Capilouto said, "There was a contention in this case about intervention by governmental officials. That part of the case was thrown out. I know no circumstance where the governor or anybody in the governor's administration said anything to undermine academic freedom. I've been here seven and a half years. I've never had an elected official -- I've served under two governors -- tell me anything about someone's employment, period. Especially no one has ever said anything to me, employment-related, to what someone said -- and you say controversial things, and it is my responsibility to defend you when you say, and that's where I stand on it."

Shortly after the suit was filed, Capilouto said in a university-wide email that UK "has a deep and enduring commitment to academic freedom. Our regulations protect it, and our values hold it sacred. No member of our community will be punished for expressing their views on matters of public concern."

Foundation for a Healthy Ky. adds 28 new members to its Community Advisory Council, most from Friedell Committee

The Foundation for a Healthy Kentucky has added 28 new members to its Community Advisory Council, bringing its total up to 49.

Of the new members, 27 were formerly members of the Friedell Committee for Health System Transformation, which united with the foundation in December.

The Community Advisory Council advises the foundation's board of directors on overall policy and strategic direction. Members also serve as liaisons with Kentucky communities, putting the council at the center of a strategy shared by both the foundation and the Friedell Committee to expand community engagement statewide.

LeChrista Finn, an associate professor at Kentucky State University in Frankfort, is the newly named chair of the council. The new vice chair is Tim Marcum, regional director of planning at Baptist Health in Louisville. Both have served on the council since 2014.

"Council members, new and existing, are among the most mission-minded health- and health-policy advocates in the Commonwealth of Kentucky," Finn said. "I am grateful that members of the Friedell Committee have stepped up, once again, to work toward a healthier Kentucky."

The 28 new council members are: Constance Alexander, Murray, writer, consultant, and civic journalist; Charlotte Beason, Louisville, retired executive director of the Kentucky Board of Nursing; Dennis Chaney, Bowling Green, Barren River District Health Department director; Tracey Clark, Hopkinsville, executive director of the Jennie Stuart Health Foundation; Danny Duncan Collum of Shelby County, a writer and professor at Kentucky State; Al Cross, Frankfort, journalist and University of Kentucky professor and director of its Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News; Colette Crown, Lexington, former administrative coordinator for the Friedell Committee; Barbara Hadley-Smith, Frankfort, retired government and private sector communications executive; Ann Hagan-Grigsby, Louisville, chief executive officer of the Park DuValle Community Health Center, Inc.; Richard Heine, Lexington, former executive director of the Friedell Committee; the Rev. Nancy Jo Kemper, Lexington, retired executive director of the Kentucky Council of Churches; Rev. Terry Lester, London, retired pastor at First Baptist London; Sylvia Lovely, Lexington, president of, Sylvia Lovely & Associates and former executive director of the Kentucky League of Cities; Kathryn Mershon, Louisville, independent hospital and health care professional; Dr. J.D. Miller, Lexington; retired Appalachian Regional Healthcare executive; M. Raynor Mullins, Lexington, emeritus faculty, dental public health, University of Kentucky; Judy Myers, Lexington; faculty member at Indiana University Southeast School of Nursing; Mark Neikirk, Highland Heights, executive director of the Scripps Howard Center for Civic Engagement at Northern Kentucky University; Marty Newell, Whitesburg, chief operating officer, Center for Rural Strategies; John Rosenberg, Prestonsburg, director emeritus of Appalachian Research and Defense Fund of Kentucky and vice chair of the Kentucky Public Advocacy Commission; Sheila Schuster, Louisville, executive director of the Advocacy Action Network; Dr. Doug Scutchfield, Lexington, emeritus professor at UK College of Public Health; Rich Seckel, Lexington, executive director of the Kentucky Equal Justice Center; Susan Stokes, Louisville, owner Access Community Assistance and former state representative; Lisa Tobe, Louisville, executive director of Wildflower Consulting; Tom Walton, Louisville, executive in residence, University of Louisville School of Public Health and Information Sciences; Dr. Pat Withrow, Paducah, cardiologist and director of outreach at Baptist Health Paducah (the only new Council member who did not come from the Friedell Committee); Charlotte Whittaker, Hartford, president of AARP Kentucky and former executive director, Ohio County Senior Services.

These members join Finn, Marcum and the following existing Council members: Nancy Addington, Elizabethtown, retired director of the Area Agency on Aging at the Lincoln Trail Area Development District; Tracey R. Antle, Russell Springs, chief operating officer of Cumberland Family Medical Center; Angela Carman, Berea, assistant professor in the UK College of Public Health; Roger Crittenden, Frankfort, retired circuit and district court judge; Sandra Duverge, Louisville, Health Equity Program Manager at Passport Health Plan; Fran Feltner, Hazard, director of the UKCenter of Excellence in Rural Health; Deborah S. Fillman, Owensboro, retired director of the Green River District Health Department; Liz Durst Fowler, Lexington, president and CEO of Hospice of the Bluegrass; Amanda Goldman, Lexington, system director of quality and wellness for Catholic Health Initiatives and director of diabetes and nutrition care at KentuckyOne Health; Randy Gooch, Nicholasville, director of the Jessamine County Health Department; Laura Hancock Jones, Morganfield, dentist at Union County Family Dental; Michael Keck, Science Hill, vice president at Five Talents Financial Group; Keith Knapp, LaGrange, associate professor at Bellarmine University; Sherry Lanham, Beattyville, director of the Lee County Family Resource Center; Matthew Minier, Louisville, director of student success at the Southern Baptist Theological Seminary; Wynn Radford, Hopkinsville, retired insurance agent; Robert Slaton, Georgetown, health-care consultant; Melissa Slone, Hazard, research interdisciplinary director for the UK Center of Excellence in Rural Health ; and Johnny White, Russellville, organizational development manager at Constellium.

16 Kentuckians on Medicaid sue Trump administration again over re-approved Medicaid program, say it still violates federal law

By Melissa Patrick
Kentucky Health News

Kentucky's new Medicaid program, which includes controversial work and community engagement requirements was recently re-approved by the Trump administration after a judge rejected it. Now the plan is back in federal court after 16 Kentucky Medicaid enrollees filed an amended complaint to the original class-action lawsuit.

The 88-page amendment, filed Monday night, says nothing of substance was changed when federal officials re-approved the plan, so many of its new requirements continue to violate federal law.

The plan website: https://kentuckyhealth.ky.gov/Pages/FAQ.aspx

The state's new program, called Kentucky HEALTH for Helping to Engage and Achieve Long Term Health, includes, among other things, work or other community engagement requirements; monthly reporting; lock out periods for failure to comply; and income-based premiums. It is set to launch April 1.

Just days before the program was originally set to roll out in July, U.S. District Judge James Boasberg of Washington, D.C. vacated it and sent it back to the U.S. Department of Health and Human Services for review, ruling that, among other things, HHS Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

Boasberg found the approval of Kentucky HEALTH "arbitrary and capricious" because the federal government had "never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid."

The amended lawsuit has been filed in Boasberg's court, despite Gov. Matt Bevin's efforts to have it moved to Kentucky. Defendants and interveners have until Jan. 28 to respond, including motions for dismissal or summary judgment.

The Southern Poverty Law Center is among the counsel for the plaintiffs. Samuel Brooke, the center's deputy legal director, said in a news release, “The Trump administration’s desire to explode Medicaid and transform it into a work program seems to have no limits. After being declared arbitrary and capricious last year, the administration has now issued a virtually identical re-approval letter; it should face a similar fate and be declared illegal,"

The plaintiffs' lawyers argue that the work and community-engagement requirements, income-based premiums, cost-sharing for non-emergency use of emergency rooms, lockout penalties for violators, removal of retroactive coverage, and removal of non-emergency medical transportation -- and Kentucky HEALTH as a whole -- don't promote the objectives of the 54-year-old Medicaid program.

They argue that each of those measures is "categorically outside the scope" of what is allowed under the guidelines for a waiver of the Medicaid rules; that these new requirements don't qualify as "experimental, pilot or demonstration project(s), nor (are they) likely to promote the objectives of the Medicaid Act;" and that the federal government has "relied on factors which Congress has not intended them to consider, entirely failed to consider several important aspects of the problem, and offered an explanation for their decision that runs counter to the evidence."

In addition, the lawyers claim that a Jan. 11, 2018 letter from the Centers for Medicare and Medicaid Services to all states' Medicaid directors. laying out a path for approval of work and community-engagement requirements under a waiver of the original Medicaid rules, should not have been issued without a formal hearing process.

The suit also notes that the state has said it seeks to "comprehensively transform Medicaid" through Kentucky HEALTH, that the director of CMS has stated the need to "fundamentally transform Medicaid" and the Trump administration has "repeatedly expressed its hostility to the Affordable Care Act and its desire to undermine its operation," violating the constitutional requirement that the president "take care that the laws be faithfully executed." The suit says "The power to 'transform' a congressional program is a legislative power vested in Congress."

The Bevin administration has long said the goal of Kentucky HEALTH is not to kick people off of Medicaid, but to empower individuals to improve their health and help them shift to employer-sponsored coverage, and to ensure the program's financial stability. The state has estimated that it would save about $2.4 billion over five years.

Adam Meier, secretary of the state Cabinet for Health and Family Services, said in an e-mail, “The cabinet is not surprised by the refiling and will continue to work toward implementation of the Kentucky HEALTH waiver. Kentuckians, and specifically our Medicaid members, deserve a Medicaid program that will improve health outcomes and provide paths for employability, long-term stability, and future success while also ensuring the long-term sustainability of Medicaid for those who need it most."

The lawyers disagree, saying in their preliminary statement: "Purporting to invoke a narrow statutory waiver authority that allows experimental projects 'likely to assist in promoting the objectives' of the Medicaid Act, the [HHS] secretary is working to effectively rewrite the Medicaid statute, ignoring congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country."

Medicaid covers 1.4 million Kentuckians, including almost half of a million under the previous administration's 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty level.

Only four of the 16 Medicaid enrollees listed on the amended complaint were part of the original lawsuit; 12 new plaintiffs have been added. The amendment describes each one's situation in detail. They are represented by the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center; and the Southern Poverty Law Center.

The defendants are HHS, CMS and their top officials. It also names the Commonwealth of Kentucky, which filed an unopposed motion for intervention, which was granted on March 30, 2018, as a "defendant-intervenor."

Boasberg's original 58-page decision is at: https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv0152-74.

Kentucky abortion-bill backers hope their measures might lead the U.S. Supreme Court to end legalized abortion

State Sen. Damon Thayer (Northern Kentucky Tribune photo)

Kentucky legislators' recent filing of anti-abortion bills isn't just about the state; they hope the bills could make national impact.

"Emboldened by two conservative justices added to the U.S. Supreme Court in the past two years, a top Republican legislator believes Kentucky could be at the forefront of an effort to end legalized abortion nationwide,"Deborah Yetter reports for the Louisville Courier Journal.

"I would be proud if it's Kentucky that takes it up to the Supreme Court and we change Roe v. Wade," the 1973 decision that created a right to abortion, said Sen. Damon Thayer, the majority floor leader in the Kentucky Senate. Such a feat would be "the pinnacle of my career."

Yetter notes that Kentucky lawmakers have said they aren't worried about the costs of litigation that would likely result if a bill to ban abortion once a fetal heartbeat is detected, around six weeks of pregnancy, is passed into law.

"I don't think you can put a price on the life of the unborn," Thayer told Yetter.

Such legislation, Senate Bill 9, sponsored by Sen. Matt Castlen, R-Owensboro, has already passed out of the Senate and now resides in the Republican led House. Yetter reports that supporters anticipate a quick final passage of the bill, which has an emergency clause that would allow it to take effect immediately.

Opponents of the "fetal heartbeat bill" say it amounts to an unconstitutional ban on abortion, since most women don't know they are pregnant until after six weeks of pregnancy and ultrasounds to determine the health of the fetus aren't typically done until the 14th week of pregnancy.

Brigitte Amiri, deputy director of the American Civil Liberties Union Reproductive Freedom Project, told Yetter that such efforts are deliberate: "This is to take a direct challenge of Roe v. Wade to the Supreme Court in light of changes to the Supreme Court."

President Trump's appointments of Justices Neil Gorsuch and Brett Kavanaugh have led many to believe that the court has a solid 5-4 conservative majority, that is primed to overturn the 1973 decision and others stemming from it.

But James Bopp Jr., a prominent conservative lawyer based in Terre Haute, Ind., who regularly tries cases before the Supreme Court and who served as general counsel to National Right to Life, a leading opponent of abortion, disagrees.

Bopp and associate Corrine Youngs wrote in an Oct. 19 memo to Indiana Right to Life's legislative committee that the recent appointment of Kavanaugh "is not a guarantee" that Roe will be overturned and that "of the nine Supreme Court justices, only Clarence Thomas has stated in a judicial opinion that Roe v. Wade should be overturned and that a "major obstacle" is the general reluctance of the high court to overturn cases it already has decided," Yetter reports.

Bopp, in the memo, urges abortion opponents to set "realistic goals" for legislation and to avoid "problematic" legislation like the fetal heartbeat bills, which under current law is unconstitutional and if struck down comes at a high costs to states that challenge them.

That said, passing bills like those pending in Kentucky seems to be a national trend. Yetter reports that similar measures are under consideration in about half a dozen other states, even though "the Supreme Court has consistently ruled that states may not ban abortion before fetal viability, the point at which a fetus could survive outside the womb, considered to be about 24 weeks."

Yetter notes that two abortion laws in Kentucky have recently been struck down by federal judges: one that required abortion clinics to have signed agreements with a hospital and ambulance service, and another to require providers to perform an ultrasound, describe it and show it to the patient prior to an abortion. The state has appealed both of these cases.

A third case involves a 2018 law that would ban the most common type of abortion, known as "dilation and evacuation" at roughly 11 weeks of pregnancy or after. This case was heard in the U.S. District Court in Louisville last year and awaits a decision from the judge.

The fetal heartbeat bill is just one bill in a package of anti-abortion bills that the state's pro-life caucus introduced last week at a news conference.

Senate Bill 50, sponsored by Sen. Robby Mills, R-Henderson, which would require doctors to report all prescription drugs written for the purpose of abortions, passed the Senate 30-6 on Jan. 11. House Bill 5, sponsored by Rep. Melinda Prunty, R-Greenville, would ban abortion in Kentucky for women seeking to terminate a pregnancy "because of an unborn child's sex, race, color, national origin or disability." House Bill 148, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would ban all abortions in Kentucky if the high court overturns Roe v. Wade.

Fischer said, "As we continue with this great battle, let us pray for Senator [Mitch] McConnell and President Trump to bolster our federal judiciary with men and women who will reverse the ruling in Roe v. Wade and restore the commonwealth's ability to end abortion in our lifetime."