Vaccination rate of Kentucky Medicaid members is about half the overall rate; even $100 incentives seem to have little effect

One of the biggest obstacles to protecting Kentucky from the coronavirus is Kentuckians on Medicaid, who make up about a third of the state's population.

"Of the 1.6 million people in Kentucky covered by the government health plan, only 27% of those eligible have received at least one dose of the vaccine, compared to about 51% of Kentuckians overall," based on state data, reports Deborah Yetter of the Louisville Courier Journal.

"That means more than 870,000 adults and children 12 or older covered by Medicaid remain unvaccinated," Yetter reports, using figures from the state Cabinet for Health and Family Services. "The current COVID-19 vaccines are not approved for children under 12. A little more than 320,000 Medicaid enrollees have received the vaccine, according to the cabinet."

Most Medicaid members' care is overseen by insurance-company subsidiaries known as managed-care organizations, or MCOs. The other 141,500, including nursing-home residents and people with certain disabilities in special programs, have a 55% vaccination rate. Nursing homes had top priority for vaccination.

Eric Friedlander, secretary of the state Cabinet for Health
and Family Services, and Gov. Andy Beshear (file photo)

Low vaccination rates among Medicaid enrollees pose obstacles in many states, but Cabinet Secretary Eric Friedlander has warned the MCOs that "I expect them to do better," he told Yetter. "The MCOs, in the most important public-health crisis of our time, are underperforming."

The six MCOs "say they are trying through outreach, incentives and other efforts to increase vaccinations," Yetter reports. "They say they are calling, texting and mailing information to try to reach members and offering incentives, including gift cards."

Joseph Goode, a spokesman for for CVS Health, told Yetter that its Aetna subsidiary was the first MCO in Kentucky to offer $100 gift cards for getting vaccinated, but only 22% of members 12 or older have received at least one dose of a vaccine.

Anthem is also offering a $100 incentive, and has a vaccination rate of about 25%, it told Yetter. Louisville-based Humana, has a 28% rate, she reports, and "The other companies, Wellcare, United Healthcare and Passport by Molina report similar efforts and said they are continuing to try push vaccination numbers higher." 

But "where skepticism remains high about the vaccine and misinformation abounds," people on the front lines of health care said the MCOs' impact will be limited. Yetter reports. She quotes Dr. John Jones, who treats Eastern Kentucky Medicaid patients, some of whom continue to refuse a coronavirus vaccine: "I don't know how much sway some insurance company's going to have over the phone. It usually takes someone you know to persuade you."

Also, in the counties of Perry, Leslie and Knott, where Jones works, "There's just a distrust of outsiders in general," he told Yetter.

"That distrust isn't limited to rural Kentucky, said E. Ann Hagan-Grigsby, CEO of Park DuValle Community Health Center, which is based in west Louisville and sees a large share of Medicaid patients," Yetter reports, quoting her: "We've hit a wall. The people who really wanted the vaccine have found where to get it and are getting it. The others who have not gotten it need some convincing."

"Friedlander said the state hired the MCOs to oversee health care and improve outcomes for Medicaid enrollees and he expects better results when it comes to the Covid-19 vaccine," Yetter reports.

"The MCOs ought to be really pushing hard to get these folks," Ben Chandler, president of the Foundation for a Healthy Kentucky, told Yetter. "You'd think it would be in their interest to get everybody vaccinated."

The chair of the legislature's Medicaid oversight committee told Yetter he was disappointed by the low vaccination rate of Medicaid enrollees. "I thought they would have been reasonably close to the state's average," said Sen. Steve Meredith, a Republican from Leitchfield.

Jones told Yetter that vaccine demand at his clinic had dwindled in recent weeks, "with unvaccinated patients expressing doubts or worries about the vaccine," she reports. "Often, they report anecdotal information shared by others or seen on social media, such as one patient who cited a case of a healthy young adult dying after being vaccinated, a report Jones said he could not verify."

"Some of it's directly linked to social media," Jones said. "The stories, there's no way to confirm them." He told Yetter that he has persuaded some patients to get vaccinated, but "Sometimes, they refuse to talk about it."