Beshear administration issues regulations to restore expansion of Medicaid dental, vision and hearing benefits legislature nixed

Family Health Centers in Louisville serves many
Medicaid patients. (FHC Louisville website photo)

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear has again proposed regulations to expand dental, vision and hearing benefits for  Kentucky adults on Medicaid, after the legislature found similar regulations deficient, thus ending the benefits. 

Each regulation says why it is "substantially different" from the original regulation. Most of the reasons have to do with changes in the services offered under the original and new regulations. This language was necessary because the bill that quashed Beshear's original regulation to expand dental, vision and hearing services for Medicaid adults requires any new regulation to be "substantially different."

The bill had an emergency clause, so it became law as soon as the legislature overrode Beshear's veto. But it also told the Medicaid program to reimburse health-care providers "for services rendered or initiated prior to the effective date of this act," which was March 29.

The proposal is open for public comment through the end of May. 

"The legislature needs to hear from people about whether dental, vision and hearing services do make a difference in their life, if in the past there have been times when they needed additional hearing care or hearing aids or additional dental work," Cara Stewart, policy-advocacy director for Kentucky Voices for Health, which favors expansion of such benefits, told Kentucky Health News.

Anyone interested in participating in a Zoom hearing at 9 a.m. ET May 22 should notify the Cabinet for Health and Family Services in writing by May 15.  Those who have made this request will have a Zoom invitation emailed to them the week before the scheduled hearing. If no requests to attend the public hearing are received by May 15, the hearing may be canceled. 

The cabinet is accepting written comments on the regulations until May 31. Comments should be sent to Krista Quarles, Policy Analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort KY 40621. Her phone number is 502-564-6746; her fax is 502-564-7091; and her email is CHFSregs@ky.gov.

Kentucky Voices for Health will also be collecting comments from anyone who would like to make a public comment on these regulations, as they have done before for other rules.  Stewart said KVH will include these comments in their written public comment submission to the health cabinet. 

Stewart said the purpose of their easy-to-use comment collector is to be able to hear people's "real voices" tell what these policies mean in their "real lives because that's what matters most." 

Each of the new regulations addressing expanded dental, vision and hearing services for adults on Medicaid starts by giving reasons they are needed, including concern that failure to implement these services, which have gained federal approval, could result in the loss of federal funds. 

They say the regulations are needed to be able to pay providers for these services, and as a way to ensure that appropriate services are being offered in appropriate settings, instead of emergency rooms. 

Stewart also noted that it is especially important for people to get dental care from an appropriate provider because dental pain in the emergency room is a gateway "to addiction to pain medication." 

"Offering better and more comprehensive dental services is a way to stop that," Stewart said. "So literally, it's a way to save lives and save suffering." 

The regulations say these services will help more than 900,000 Medicaid recipients in Kentucky who are 21 and older return to the workplace.

The governor's veto of Senate Bill 65 said the dental expansion had served "more than 1,000 Kentuckians in all 120 counties" with "nearly 3,330 dental services, including from a dentist in Clay County, who . . . has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester.

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place."

Stewart said that having access to dentures and hearing aids will make the biggest difference because many of the managed care organizations already offer glasses as an extra benefit, but not the others. As an example, she noted that many domestic-violence survivors and crime victims have lost teeth and need access to dentures.

"And that really affected their recovery and their ability to feel great about themselves," she said. "And also, every time they open their mouths to smile, they have memories of being abused. . . . There are so many populations for where this is a really big deal." 

State Sen. Stephen West, R-Paris, the sponsor of the bill, has not responded to a request for comment. Legislators complained that Beshear, without consulting them, funded the expansion through savings that Medicaid achieved by having only one pharmacy benefit manager, a middleman between drug manufacturers and the managed-care organizations that deal with Medicaid beneficiaries.

UPDATE, April 26: In a statement to Kentucky Health News, the heath cabinet said the bill affected Medicaid members treated by providers that the state reimburses through fees for services. "Managed-care organizations have the flexibility to continue to provide the extra dental, hearing and vision services referenced in Senate Bill 65 as a value-added benefit to plan enrollees," the cabinet said.