Health portion of Beshear's budget would help nursing homes, fund training and retention of nurses; mental health, and more

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear previewed the health portion of his budget plan Wednesday, with new money for nursing homes, retention and recruitment of nurses, along with funding for senior hunger and mental health. 

Beshear will deliver his budget address at 7 p.m. ET Thursday, Jan. 13. In an unprecedented move that he called a stunt, Republicans who control the House filed their own version of the budget Friday. 

There are many differences in the plans for spending the state's money from July 1, 2022 to June 30, 2024, but Beshear said, "Any of our values that they fund more than we do, we're in favor of it."

The legislature makes the final decisions on the budget. The Democratic governor can remove line items with vetoes, but Republicans can override him with simple majorities in the House and Senate.

Nursing home relief: Both plans would keep paying nursing homes the additional $29 a day they have been getting for each of their Medicaid patients during the pandemic. 

The money comes mainly from the federal Centers for Medicare and Medicaid Services. The normal federal match rate for Medicaid is 72%, but that has been increased 6.2% during the pandemic.

The state is asking CMS to re-approve this additional funding retroactive to Jan. 1 and until the end of the federal health emergency, which is expected to be extended at least one more time, said Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the nursing-home lobby.

"We are very grateful that it appears that both the Kentucky General Assembly and Governor Beshear are both on the same page with regard to the needs of skilled nursing facilities in Kentucky."

Johnson said she also was pleased to hear the governor say that the rate increase will be re-evaluated at the end of 2024. (Voters will decide in November 2023 if Beshear gets a second term.) 

"I believe the Kentucky General Assembly realizes that we're not going to ever be able to go back to pre-Covid days," Johnson said. "Our costs have gone way up, so this $29 add-on really should continue because that's just the reality of operating a skilled nursing facility today."

Money to retain and recruit nurses: Beshear said his budget will include scholarship money to recruit nursing students and loan-forgiveness money to keep nurses in the profession and in Kentucky. 

He said it will have $6 million a year to "significantly increase" scholarships, doubling the maximum award to $3,000 per semester. "That is a huge difference to students who want to pursue this path, but worry about the cost of doing so," Beshear said. Currently, about 150 students get scholarships funded by nursing-license fees.

To keep nurses on the job, Beshear's budget would create a five-year student-loan forgiveness program with up to $3,000 annually for each year a nurse or faculty member is employed in and stays in their job in Kentucky.

"We love our Kentucky nurses," Beshear said. "We want to support them and we want more people to join the ranks."

Lerae Wilson of St. Claire Regional Medical Center (Image from video)

Lerae Wilson, chief nursing officer and vice-president of patient services for St. Claire Regional Medical Center in Morehead, thanked the governor in a video. 

"Nurses are warriors," she said. "We are fighting for the lives of those we serve. . . . but these warriors are tired. They're exhausted. The pandemic has shown us that while we're good at what we do, mandatory overtime can only continue for so long. And with the shortage like it is we have got to have people who are willing to step into those shoes and continue that fight. . . . We have to have replacements." 

The Kentucky Nurses Association projects that the state will need more than 16,000 more nurses by 2024 to replace those who will retire or leave the profession, as many have during the pandemic.

A KNA survey of 850 nurses in October found that one-fourth said it was likely or extremely likely that they would leave their job in the next three months, and 16% said they were likely to leave nursing.

Beshear also wants to use $2 million of federal pandemic relief money for a marketing and outreach program for the profession, and includes nurses in his proposed $400 million "hero bonuses" for pandemic through-work.

In December, Beshear signed an executive order allowing the state to take special steps to educate and license more nurses. Among other things, it requires the state Board of Nursing to approve requests for enrollment increases in schools that show sufficient resources to handle more students; requires schools to report vacant student seats to the board each month; and requires the board to post them online, allowing schools without vacancies to refer applicants to the open slots. 

Senior hunger: Using pandemic money, Beshear said, Kentucky eliminate a waitlist of about 7,000 seniors to receive free meals. 

"I'm bit ashamed that I did not know before this pandemic that we had a waiting list for seniors that were going hungry in Kentucky," he said. "That's right. We had a list of how many seniors couldn't afford regular meals and needed our help and we weren't reaching all of them."

So that never happens again, Beshear said, he wants $36.2 million over the next two and a half years for an additional 49,000 meals for seniors per week, which fully meets the current needs of Kentucky’s citizens.

"We should never have a waiting list for seniors who are going hungry to get help ever again," he said. 

Mental health: Beshear's plan includes several boosts for mental health: 

• $3.4 million in fiscal year 2023 and $9.9 million in fiscal year 2024 to phase in 170 additional staff to Kentucky's Community Mental Health Centers, which offer support 24-huors a day, seven-days a week. 
• Implementation of the new 988 crisis support line, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024.
• Funding to expand Tim's Law to two other psychiatric hospitals in the state: Eastern State Hospital and the Appalachian Regional Hospital system. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door of these individuals in and out of jails and state psychiatric hospitals. 

Also proposed in Beshear's health portion of the budget:

• Full funding of Medicaid, which covers one in three Kentuckians, including more than 650,000 children. 
• Money for 500 more slots in the "Michelle P." waiver program and 100 more slots in the Supports for Community Living waiver program, both for people with intellectual or developmental disabilities. Thousands of Kentuckians are on the programs' waiting lists. 
• More than $36 million for health departments, which are shifting to a new funding model. The money can be used to help with staffing and operations. 
• A 34% increase in funding for domestic violence centers, rape crisis centers and child advocacy centers; an additional $19.6 million a year to sustain and expand prevention services; and a 17% rate increase for residential and therapeutic foster-care providers. 
• A $2 per-child, per-day increase in the child-care assistant program reimbursement rate, using federal relief funds.
• Various funds to help veterans' causes, including $1 million in fiscal year 2024 to phase in operations at the newest state veterans center in Bowling Green.
• Funding of the Pediatric Research Trust Fund, which organizes all Kentucky research on pediatric cancer, would rise to $3.75 million a year from $2.5 million.