Legislators nix Beshear's 2nd regulation to expand Medicaid dental, vision and hearing services, but it'll remain in place for now

Kentucky Voices for Health graphic supports the expansion,
which legislators say they oppose on procedural grounds. 

By Melissa Patrick

Kentucky Health News

The legislature's Administrative Regulation Review Subcommittee voted May 9 to find Gov. Andy Beshear's new regulations to expand Medicaid's vision, dental and hearing services deficient, based largely on process. 

"This deficiency vote has nothing to do with the regulation itself," said Co-Chair Sen. Steve West, R-Paris. "As far as expanded dental services, I think every single person up here on this committee would be in support of expanded dental services. I don't think there's any question about that. But our job in this committee is to protect the legislative process and protect the legislative branch and our role in the process. I don't think we would be here if there was some level of effort from the cabinet to meet us halfway, to discuss it, to show up in our office and work through this thing together. But in my case personally, there has been none of that." 

Beshear, asked what the deficiency means for Kentucky adults who are receiving these new services under the regulation that was recently found deficient, said, "They're still in place, at least until the next legislative session." 

At his weekly news conference, Beshear also talked about how important these basic services are to getting Kentuckians back into the workforce.

"This is about helping people with very basic needs . . . being able to see, being able to hear, being able to get the dental appointment, because we lose millions of productive hours at work due to emergency dental procedures that could otherwise be prevented," he said. "So this is a no brainer when you look at the low costs versus the number of people we can get back into the workforce."

This is the second set of regulations aimed at expanding these Medicaid services to be found deficient by the subcommittee. 

The original set was also found deficient by the 2023 General Assembly in Senate Bill 65, thus ending the benefits. SB 65 also stated that the Cabinet for Health and Family Services was prohibited from promulgating any new regulations unless they were "substantially different" from the original one. 

Within two weeks of SB 65 becoming law, the health cabinet filed the new regulations to expand vision, dental and hearing services for people on Medicaid, with each of the regulations stating the reasons that they were "substantially different" from the original regulation. 

West said in a news release, “What we are witnessing here from CHFS is an overt effort to ignore duly enacted legislation and, to make it worse. It is a poor administration of the Medicaid program and those it serves. We want to provide the highest-quality services to the most people we can, but this isn’t the appropriate way to achieve that goal. We can’t afford the current Medicaid program, so why would we expand services in an already unsustainable program? The regulation discussed today is irresponsible, strains the system, and picks winners and losers. Taxpayers and Kentucky residents deserve better.”

Officials from the state Department for Medicaid Services told the committee that the new regulations were in compliance with SB 65. Medicaid Commissioner Lisa Lee said the new regulations were "substantially different" because they added services and increase fees for a number of services in each category. 

Lee also called the expansion of these benefits a great "return on investment" because federal funds will cover $31 million of the $36 million total cost. The state's share is coming from savings that Medicaid achieved by moving to only one pharmacy benefit manager, the middleman between drug manufacturers and the managed-care organizations that deal with Medicaid beneficiaries. 

Several subcommittee members voiced concern that Kentucky’s Medicaid program does not adequately cover behavioral-health services, emergency medical services and other services, and that those programs should have been considered when deciding how this money is spent.  

"What we should be doing is having a holistic conversation about how do we appropriately raise rates to take care of our most vulnerable population, so that we don't just have one winner, that we can have a lot of different winners," said Sen. Julie Raque Adams, R-Louisville. 

The expanded services cover 900,000 adults on Medicaid. 

Rep. Daniel Grossberg, D-Louisville, noted that because of these expanded services, "We've gotten 60,000 Medicaid members who have received glasses who would not have otherwise received glasses, 932 dentists have received reimbursement for crowns on more than 5,600 individual members who would not have otherwise been reimbursed or received crowns. We have nearly 1,200 members who have received dentures who would not otherwise receive dentures. And providers have received over $11 million that would have not otherwise yet received." 

Just a few more days remain for Kentuckians to offer public comment about the new regulations. The cabinet is accepting written comments 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.

Meanwhile, Kentucky Voices for Health is still collecting comments from anyone who would like to make a public comment on these regulations, as they have done before for other rules. KVH will submit the comments for anyone who fills out one of their comment forms.