Kentucky can soon provide Medicaid coverage to people nearing release from prison or juvenile detention; jails might come later

By Melissa Patrick
Kentucky Health News

Kentucky is one of five additional states that will soon provide Medicaid health coverage for people nearing release from prison or juvenile detention, according to the U.S. Department of Health and Human Services. 

"We've been eagerly anticipating CMS's approval of Kentucky's healthy re-entry demonstration for years now," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

The program started as a demonstration focused on treatment for substance-use disorder during incarceration and "has expanded to focus on putting in place all of the physical and behavioral health treatment, care coordination, and wrap-around supports justice-involved Kentuckians need to successfully return to their communities and thrive," Beauregard said in an email. 

This demonstration program is operated under a partial waiver of the Medicaid program's inmate-exclusion policy, which prohibits paying for services to inmates unless they are admitted to a hospital.

"Providing avenues for greater health outcomes is always the right thing to do, and this program does just that," state Cabinet for Health and Family Services spokesman Brice Mitchell said in an email.

Before the state can start the coverage, it must submit an implementation plan to the Centers for Medicare and Medicaid Services, Mitchell said: "Upon receiving implementation approval from CMS, Kentucky will cover a select set of pre-release health-care services through Medicaid and the Kentucky Children’s Health Insurance Program for up to 60 days before an individual’s expected date of release."

Kentucky didn't take full advantage of the waiver, which allows states to provide coverage up to 90 days before the expected release date. Eligibility is based on income; the limit is 138 percent of the federal poverty level.

Mitchell added, "The individual must be eligible for Medicaid or KCHIP to qualify and must be a state inmate housed in one of Kentucky’s 14 prisons or a post-adjudicated juvenile in the custody of the Department for Juvenile Justice."

Mitchell provided data from the state Department of Corrections, which said "There are 19,220 individuals serving felony convictions in state prisons or jails, as well as an additional 49,700 on active supervision with the Division of Probation and Parole. At least 95% of the state inmate population will be released from incarceration at some point." 

Kentucky's waiver doesn't allow inmates in jails to participate, because its jails are operated by counties, not the state. Beauregard said, "We've advocated for allowing jails to opt in, if they are willing to meet requirements and participate fully." She said the state Department for Medcaid Services "has said they will consider [jails] as a future phase of this project."

Coverage will be available not only to adult prisoners, but incarcerrated youth, under the Children's Health Insurance Program, called KCHIP in Kentucky. Beauregard praised the inclusion of youth in the coverage, which was not part of the original demonstration program for substance-use-disorder treatment and not part of the orignal application for its expansion. 

"Another important expansion from the original waiver is that youth who are in detention facilities will also get these services and wrap-around supports, which has the potential to reduce recidivism," Beauregard said.

 

A July 2 news release from HHS noted that incarcerated people often report higher levels of substance-use disorders, chronic health conditions and other health concerns, and that people transitioning out of jail or prison can experience delays in obtaining access to Medicaid or CHIP. 

HHS Secretary Xavier Becerra said in the release, "For people involved in the justice system, ensuring a successful transition back into the community includes having the health-care supports and services they need."

Kentucky is the first Southern state in the program. The other newly approved states are Illinois, Oregon, Utah and Vermont; California, Massachusetts, Montana and Washington had already been approved.

Kentucky first state with automatic Medicaid renewal for children

By Melissa Patrick

Kentucky Health News

Kentucky has received federal approval to automatically renew coverage for children in Medicaid or the Kentucky Children's Health Insurance Program for 12 months. 

" Kentucky is the first state in the country to implement this kind of flexibility," Lt. Gov. Jacqueline Coleman said in making the announcement Thursday. "It went into effect on Oct. 1, and remains effective through the end of Kentucky's unwinding period, which is April of 2024."

The "unwinding" is the gradual resumption of annual Medicaid renewals now that the pandemic rules that allowed for continuous enrollment have ended. The first renewals began in April.

Brice Mitchell, spokesman for the state Department for Public Health, explained in a Nov. 14 email how Kentucky handled this change: "The Consolidated Appropriations Act of 2023 requires all states to implement continuous coverage for children effective Jan. 1, 2024. Kentucky decided to implement it in April 2023 as part of the restart of renewals. However, the child still had to go through a renewal first, and was granted continuous coverage if determined eligible. With the new flexibility in place, we are able to automatically extend children’s coverage for 12 months without them needing to go through the renewal process."

In other words, Kentucky started continuous coverage three months before all states must do so, and before any other state, according to Coleman.

She said this new flexibility means that more than 600,000 Kentucky children on Medicaid and KCHIP will get streamlined access to the extended coverage. She said it also frees up resources for the state to concentrate on contacting adults who will again be subject to the more rigorous process of applying for Medicaid.

A state news release says the only way a child can be disenrolled during the 12-month continuous coverage period is if the child turns 19, a parent or guardian requests disenrollment, or the child moves out of state.

Coleman also reminded Kentuckians that they have until Jan. 16 to shop and enroll for health and dental coverage on the state-based marketplace, Kynect. To see plan options, visit kynect.ky.gov or call 855-459-6328.

63 percent of Kentucky's children get their health insurance through Medicaid or the Children's Health Insurance Program

By Melissa Patrick
Kentucky Health News

More than 60 percent of American children are enrolled in Medicaid or the Children's Health Insurance Program, according to the Centers for Medicare and Medicaid Services data.

Photo: thenationalcouncil.org

Kentucky's numbers were just a bit higher, with 63 percent of the state's 1 million children enrolled in one of the two programs. That amounts to 642,364 children. Nationally, the programs cover 46.3 million of more than 74 million children.

"Kentucky leaders have taken several steps in recent years to make it easier for children to enroll and stay enrolled in health coverage, which has led to vast increases in the number of children with health insurance," Terry Brooks, executive director for Kentucky Youth Advocates, said in an email.

Brooks added, "Research shows us that, in addition to making it easier for children to enroll in coverage, providing affordable health coverage for parents is an important way to improve overall family health and reduce the number of uninsured children."

Children are eligible for Medicaid if they are between the ages of 1 and 18 with a family income up to 159 percent of the federal poverty level. They are eligible for CHIP, as the Children's Health Insurance Program is commonly called, with a family income between 160 percent and 213 percent of the poverty level.

The two programs have the same benefits, including doctor visits, dental care, hospitalization, outpatient services, psychiatrists, laboratory tests and X-rays, vision exams, hearing services, mental health services and prescription medicines.

Nationally in 2017, about four times as many children were enrolled in Medicaid as in CHIP, 36.9 million and 9.5 million, respectively. In Kentucky, nearly six times as many children were enrolled in Medicaid as in K-CHIP in 2017, 545,985 and 96,379 respectively.

Kentucky has a relatively high share, 25 percent, of children living in poverty (annual income of $24,036 or less for a family of four); 12 percent are in deep poverty (annual income of $12,018 or less for a family of four), according to the 2017 Kentucky Kids Count report.

In 2016, the most recent year for which state-by-state age population data are available, 38 states had more than half of their children enrolled in one of the programs at some point during the year, Philip Bump of The Washington Post reports.

Bump notes that North Dakota was the only state that had fewer than one-fourth of its children enrolled in either CHIP or Medicaid at some point during the year; and New Mexico, with more than 80 percent of its children enrolled in one of the two programs at some point, had the highest percentage of enrollment.

Kentucky will run out of its KCHIP money in about six months; meanwhile Congress inches toward funding the program

By Melissa Patrick
Kentucky Health News

As Congress works to fund the Children's Health Insurance Program days after the Sept. 30 deadline for reauthorization passed, Kentucky officials are confident their funding will be renewed before the federal money runs out.

"Without funding reauthorization on the federal level, we have enough money to maintain CHIP services for about six months," Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail. "We fully expect federal funding to be renewed."

An estimated 11 states are expected to run out of federal CHIP money by the end of the year, and 21 more by March 2018, according to a study by the Kaiser Family Foundation. A separate foundation report shows that the federal budget for CHIP was about $14 billion in 2016 and Kentucky's federal share was around $243 million.

CHIP and its funding vary by state with some states sharing the program's expense with the federal government. Hogan said Kentucky's program, called KCHIP, is largely funded by federal dollars.

Kentucky's program covers uninsured children younger than 19 who live in families with income at or below 218 percent of the federal poverty level, $53,628 for a family of four). The program serves about 83,000 children in Kentucky and almost 9 million nationwide.

The historically bipartisan program was initially passed in 1997, renewed in 2015 and was set to be renewed on Sept. 30 -- but Congress failed to act, instead spending its time on a second attempt to repeal and replace Obamacare which fell short a few days before the Sept. 30 deadline.

Both the Senate and House have passed bills out of committee to refund CHIP, but the Senate bill doesn't specify how the program will be paid for, and the House bill includes funding offsets that involves taking money from an Obamacare prevention fund and charging seniors who make more than $500,000 a year higher Medicare premiums. These offsets were a source of contention for Democrats, and the bill passed on a party-line vote, reports the Washington Examiner.

Since, Republicans on the House committee have agreed to return to negotiations with Democrats in hopes of reaching a bipartisan agreement, Jessie Hellmann reported Oct. 10th for The Hill.

However, the chairman of the committee, Greg Walden (R-Ore.) warned in a statement that if they can't reach a deal by the end of this week, the marked up bill will be taken up by the House when they return from their recess Oct. 23.

Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in an Oct. 2 statement that while he understands the "partisan toxicity and ambiguity" around Obamacare, "kids should not pay the price for partisan politics" and called for a bipartisian effort to extend the program's funding.

“Though leaders in Washington may assert that states should shoulder this vital coverage for children, the federal government cannot expect an already strapped state budget to absorb the costs of the program,” he said. “And Washington cannot turn its back to the families counting on CHIP to ensure better health outcomes for their sons and daughters."

He added, “Senate Majority Leader Mitch McConnell has a track record of standing tall for kids. We need him to protect CHIP – and our kids – from being a casualty in the never-ending Washington D.C. health care debate. Congress must extend CHIP funding with declarative and immediate action!”

Kentucky Voices for Health sent a letter Oct. 4 to leadership of the aforementioned House and Senate committees that had more than 100 "sign-ons" urging Congress to "quickly pass a clean extension of CHIP and continue the bipartisan commitment to this successful program." The letter noted that KCHIP had contributed to the state's uninsured rate of less than 7 percent, with the rate of uninsured children falling to 3.2 percent.

No final congressional action is expected until late October at the earliest, when the House gets back from its recess.

Kentucky's share of people with health insurance goes up again, giving state most-improved status, but future remains uncertain

By Melissa Patrick
Kentucky Health News

In the third full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance continued to shrink, giving the Bluegrass State a larger drop in its uninsured rate than any other state.  So says a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

Census Bureau map; click on it to view a larger version

Kentucky's uninsured rate dropped to 5.1 percent in 2016, down from 6.1 percent in 2015 and 8.1 percent in 2014. In 2013, the year before the ACA was implemented, the rate was 14.3 percent.

Put another way, 95 percent of Kentuckians had health insurance in 2016, compared to 86 percent in 2013.

That gain came mainly because then-Gov. Steve Beshear expanded Medicaid under the ACA to those who earn up to 138 percent of the federal poverty line, adding about 470,000 Kentuckians to the free health-insurance program.

“It’s clear beyond a shadow of a doubt the Affordable Care Act is working. It has helped Kentuckians get the care they need to improve their health, work and take care of their families. It has created jobs in our state and kept many more Kentuckians from being an illness or accident away from financial ruin,” Kenny Colston, communications director for the liberal-leaning Kentucky Center for Economic Policy, said in a news release.

The survey also found that 96.7 percent of Kentucky's children had health insurance in 2016, up from 93.6 percent in 2013. Kentucky Youth Advocates estimates this represented an increase of 37,000 children. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program K-CHIP.

Medicaid and K-CHIP funding uncertain 

The recent gains aren't guaranteed to continue, with changes looming on both the state and federal level for both the adult and children's insurance programs.

Gov. Matt Bevin has submitted a proposal to overhaul the state's Medicaid program that largely targets "able-bodied" adults without dependents who qualify for Medicaid under the expansion. Bevin says the state can't afford to pay for this expanded population; the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020.

Bevin's plan is designed to encourage participants to have a higher level of involvement in their care through premiums and work or volunteer requirements. If approved, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted by federal officials. They are expected to approve Bevin's request, and perhaps allow other changes.

The Bevin administration has said that the goal is for these able-bodied adults without dependents to move to higher-paying jobs that offer employer-provided health insurance. Opponents of the plan say these higher-paying jobs are scarce in Kentucky, and note that many in this group already work at low-paying jobs that don't offer health insurance -- or if it's offered, it's not affordable.

KYA Executive Director Terry Brooks said some of the recent changes in Bevin's proposal could create "very real barriers to coverage" for adults, which research shows could result in fewer children being covered. "We also know that kids are more likely to have health insurance when their parents do," he said in a prepared statement.

Bevin spokesman Woody Maglinger told The Associated Press, "It may be a fact of life in Terry Brooks' alternate universe, but it is not a fact in Kentucky," Maglinger said. He noted that Bevin's plan would not change Medicaid eligibility requirements for children.

Last-ditch ACA repeal pushed; Bevin favors, Paul opposes

In Congress, Republican Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina are pushing a last-ditch effort to repeal the ACA and redistribute its funding from states that expanded Medicaid to states that did not, Sarah Kliff of Vox reports.

The bill would block-grant Medicaid money but would not allow states to re-enroll people now covered by the Medicaid expansion, reports Ed Kilgore of New York magazine: "They’d have to cover them some other way, presumably via private insurance."

The bill would reduce federal funding of Medicaid in Kentucky by more than $3 billion over the next 10 years, but Graham told Fox News that Bevin has endorsed his bill.

Graham also said Senate Majority Leader Mitch McConnell "needs to be as committed to repealing Obamacare as [Democratic predecessor] Harry Reid was to passing Obamacare, and Harry Reid had us in on Christmas Eve on Obamacare passage. . . . We had a lot of time off in August when we should have been here, repealing and replacing Obamacare."

McConnell told Kentucky Health News that the bill will come to the floor if there are 50 votes for it, which would put Vice President Mike Pence in position to break the 50-50 tie and pass it. "There’s a lot of discussion, but the time is running on that," McConnell said Thursday afternoon. "It could well come up. If we have 50 votes, we’ll go to it." The deadline to pass the bill with 50 votes, under budget-reconciliation rules, is Sept. 30.

Cassidy told The Washington Post that the bill has "48 or 49" votes, but it has not been vetted for passage under reconciliation, and the Congressional Budget Office has not said how the bill would affect the federal budget or the insurance-coverage rate. McConnell has asked the CBO to "quickly score" the bill, the Washington Examiner reports.

The Examiner adds: "Sen. Rand Paul, R-Ky., announced he would not be in favor of the legislation, which he called 'Obamacare lite'." Graham said on Fox that he would tell Paul that he should trust Bevin to provide "state-run health care." Paul was among the 49 votes for McConnell's last repeal-and-replace bill.

Congress also faces a Sept. 30 deadline to extend funding for CHIP, which provides health coverage for roughly 9 million children. The Senate Finance Committee has agreed on a plan to extend the program for five years, but phase out federal funding in 2021.

Bevin administration is working to fix Benefind's technical glitches; 51,000 Kynect clients blocked from working with Kynectors

Update: 4/8/16 This story has been updated with comments from the Cabinet for Health and Family Services. 

By Melissa Patrick
Kentucky Health News

On Feb. 29, Gov. Matt Bevin's administration launched a new one-stop-shopping website for state benefits that was designed to make life easier for the one-fourth of Kentuckians eligible to use it. Instead, it caused an unprecedented disruptions of services after thousands received erroneous letters notifying them they would no longer receive their benefits.

Deborah Yetter of The Courier-Journal has reported extensively on the problem, with stories of Kentuckians who have lost their benefits and found it nearly impossible to get help because of hours-long waits in the state benefits offices and a phone system that tells them to call back later.

The website, called Benefind, can be used to apply for Medicaid, the Kentucky Children's Health Insurance Program (KCHIP), the Supplemental Nutrition Assistance Program (SNAP, once known as food stamps) and Kentucky Transitional Assistance Program (KTAP).

The problem goes beyond those programs. The 500 paid Kynectors, who help Kentuckians use the Kynect health-insurance exchange, have not been able to help because federal regulations require participants who use multiple services to first go though the Department of Community Based Services, the state agency that manages Benefind. As of now, Kynectors can only help Kentuckians who have never received other state benefits.

Health advocates have called the launch of Benefind a "disaster." At a March 31 news conference, Bevin, along with health officials from the Cabinet for Health and Family Services and a Deloitte Consulting official, acknowledged the widespread problems and said they were working tirelessly to correct them.

“Our primary focus is to ensure that we deliver, as seamlessly as possible, as safely as possible, as expediently as possible all the benefits that folks expect and need from the Commonwealth of Kentucky," Bevin said.

State officials at the news conference said they had worked with federal officials to extend benefits through April, so that no one should be cut off from Medicaid or SNAP if they qualified for those benefits in March. The state has also stopped automatic letters generated by Benefind.

In addition, they have updated websites and changed the phone message to better explain what is going on; extended the re-certification time frame for SNAP benefits from six months to 12 months, allowing those cases to continue with a simple review instead of a client interview; hired an additional 185 people to help with the deluge of telephone calls and visits to the local state benefit offices; and Deloitte has assigned trainers to every county to help the DCBS staff.

Officials have encouraged the public to log on to the Benefind self-service portal at https://benefind.ky.gov/ to ease the burden on processing centers.

So, what happened?

Deloitte built Benefind under the administration of Gov. Steve Beshear at a cost of $101.5 million to replace an outdated eligibility system. Deborah Sills of Deloitte said at the news conference that they believed the system was ready to launch at the end of February, but "there were some issues that didn't present themselves until after the system went live."

However, Ryland Barton of Louisville's WFPL reported that on Feb. 25, a 27-page "Worker Portal Defect Workaround Guide" was distributed to DCBS staff showing that the administration knew there would be problems with the rollout.

But the cabinet says a guide like this is standard procedure.

"Deloitte says a guide like that is standard operating procedure when you’re dealing with a huge system rollout like this," Doug Hogan, spokesman for the cabinet said in an e-mail. "It’s a new system and (this was) a guide to help staff navigate the system better and help them work though issues they might encounter. Additionally, there were these same types of documents for the original rollout of Kynect."

Bevin's administration explained that the problem has been caused by an automatic review of cases where information from Kynect and the old eligibility system didn't match.

“Cases where information between the Kynect case and legacy case did not match (for example, household composition or income) are required to be managed by a state agent before they can be acted upon by agents or Kynectors,” Jessica Ditto, Bevin’s communications director, told WFPL in an e-mail. “This constraint has been placed to protect program and data integrity — plus, this is required by federal law.”

Ditto told Barton about 51,000 cases are under review, and noted that once the conflicting data has been reconciled, "the cases will become open for Kynectors and agents again, just as before.”

Sills told reporters that Benefind had not been altered in any way from its original 2014 design and affirmed Bevin's stance that the move to Benefind had nothing to do with his administrations decision to close Kynect and move to the federal exchange.

"None of these issues are caused by any changes the current administration has made to the system's purpose or design," Sills said.

However, Beshear said in a news release that Kynect and Benefind were meant to work together, not for Benefind to take over signing people up for Medicaid.

"The Benefind program was developed to complement Kynect, the state-run exchange," Beshear said in the release. "Although he attempts to blame the 'prior administration,' Governor Bevin’s administration mismanaged the launch of this new system, and in doing so, created a disastrous situation for thousands of families in Kentucky."

Bevin and Deloitte say the system was always designed to support Medicaid enrollees. "Benefind is Kynect, Kynect is Benefind," Bevin said at the news conference.

Not really, says Kentucky Voices for Health, a coalition of groups supporting Kynect,  "For people needing Medicaid coverage and other social benefits right now, there is no right door for access, let alone 'one door'," the group said in a press release Wednesday. "Kynect was built to provide access to health insurance and Medicaid enrollment; and Benefind was built to enhance Kynect with additional social services benefits. While they’re part of the same system, they provide different essential functions."

However, Hogan noted  in the e-mail that page 15 of a training document for Kynectors originally posted November 2015 "clearly shows that Benefind was intended to process all Medicaid plans, even Qualified Health Plans...it was truly designed to process all benefits."

Beshear and his advocacy group, Save Kentucky Healthcare, have also released a one-minute video entitled "If It Ain't Broke Don't Fix It" criticizing the Bevin administration's rollout of the system.

Laurel True, longtime advocate for health, education and human services, dies suddenly at 80

Laurel W. True, who continued his public service for health and other causes long after leaving state government, died suddenly Saturday at his home near Waddy in Shelby County. He was 80.

"For the past five decades, Mr. True worked tirelessly to improve the health and welfare of Kentuckians," The Courier-Journal said in an editorial. In the 1970s True was the first secretary of the old Cabinet for Human Resources and executive director of Kentucky Health Systems Agency-West, a state health-planning organization, and was an assistant superintendent of public instruction. Earlier, he helped start Medicaid in Kentucky and the conversion of United Mine Workers hospitals into Appalachian Regional Hospitals.

In retirement he continued as an advocate for health, education and human services as a member of the National Policy Council of AARP, vice chairman of the board of Seven Counties Services, secretary of Kentucky Voices for Health, a member of the Friedell Committee for Health System Transformation and as a trustee of Georgetown College, his alma mater. Under the aegis of the Freidell Committee in 2009, True conducted a study of the Kentucky Children's Health Insurance Program in Anderson County, which helped lead to policy changes designed to ease and encourage enrollment in KCHIP.

“He was a wonderful champion all of his life,” Sheila Schuster, a longtime mental health advocate, told The Courier-Journal. “He was never boastful or self-serving.”

Visitation will be from 3 to 8 p.m. Tuesday and 9 to 10 a.m. Wednesday at Immanuel Baptist Church in Frankfort, where True was a deacon and Sunday School teacher. The funeral will follow at 10 a.m., with internment in Frankfort Cemetery and arrangements by LeCompte-Johnson-Taylor Funeral Home. Donations are suggested to the Infant Resource Center at Immanuel Baptist Church, 1075 Collins Lane, Frankfort KY 40601. (Read more)

Essential-benefits rule expands mental-health and substance-abuse coverage; Ky. needs more facilities to treat newly eligible

The Department of Health and Human Services has defined the 10 "essential health benefits" insurance plans must provide, and it included benefits for mental health and treatment of substance-abuse disorders..

Nearly 20 percent of Americans don't have access to mental-health services and over 30 percent have no coverage for substance-abuse treatment. This rule will expand mental health and substance-abuse treatment benefits to 62 million Americans, according to HHS.

Expanded coverage for mental health and substance abuse treatment programs in Kentucky could bring about a dramatic shift in the delivery of these services. There is already a shortage of treatment options and centers for Kentuckians, and those suffering from addiction have not had coverage for such treatment; the proposed rule will change that.

Recovery Kentucky, a public-private partnership with residential facilities, was created to help Kentuckians recover from substance abuse. It has 10 centers, in Campbellsville, Erlanger, Florence, Harlan, Henderson, Hopkinsville, Morehead, Owensboro, Paducah, and Richmond, according to the 2012 Justice & Public Safety Cabinet report, which included the map below. 

Health-insurance plans must cover the 10 essential benefits beginning in 2014, so the state must prepare for the newly insured in addition to newly covered services. The rule defines what must be covered in insurance plans and bans discrimination based on age or pre-existing conditions. Among the core package of items and services, known as “essential health benefits" are items and services in the following categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

States are given flexibility in implementing the federal health-care reform law with a benchmark approach. The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange. HHS will review the recommendation and accept public comments prior to making a final decision. (Read more)

Anthem PPO plan chosen as 'benchmark' for state's Kentucky Health Benefit Exchange

The Kentucky Department of Insurance has recommended that the Anthem Preferred Provider Organization (PPO) plan serve as the “benchmark” plan for the Kentucky Health Benefit Exchange, as well as for plans offered outside the exchange. The statement issued by the department states that "Anthem PPO is the largest small group plan currently offered in Kentucky and includes coverage for all state mandates and the 10 essential health benefits, or categories of care, specified by the federal government under the Patient Protection and Affordable Care Act. The benchmark plan sets the minimum level of benefits offered in the individual and small group markets beginning Jan. 1, 2014."

According to the release, the Anthem PPO plan "is the most cost-effective of the 10 plans reviewed, will not create additional costs for the state and should not increase the price for those who have coverage today. Since the Anthem PPO plan does not offer the minimum requirements for pediatric vision and dental services, Kentucky has recommended that the benefits in the Kentucky Children’s Health Insurance Program (KCHIP) be substituted in the benchmark plan."

Some background, also provided by the Dept. of Insurance: One of the goals of the Affordable Care Act is to ensure that Americans will have access to quality, affordable health insurance. To achieve this goal, the law ensures health plans offered in the individual and small group markets offer a comprehensive package of items and services, known as Essential Health Benefits. The act provides that the EHBs include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care. For more on Essential Health Benefits, go here.

The U.S. Department of Health and Human Services will review the Athem recommendation and accept public comments prior to making a final decision on the matter.

Flexibility Act would give states more Medicaid authority, but it could mean that fewer children would have health coverage

MEDICAID PERCENTAGE OF TOTAL STATE SPENDING

Children's advocates are concerned the proposed State Flexibility Act would result in more children living without health insurance in Kentucky.

The act "would repeal protections put in place for states to maintain current eligibility and enrollment requirements for Medicaid and the Children's Health Insurance Program, known in Kentucky as K-CHIP," Renee Shaw of the Public News Service reports.

The goal of the act, its sponsors say, is to give states more flexibility so they can balance their own budgets. "The onerous federal mandates on states today make it especially challenging for states to solve the unprecedented budget crises, and governors have asked Washington for relief from these excessive constraints," the act reads. In Kentucky, there is a a projected budget shortfall of $780 million for Fiscal 2012, $166.5 million of which is due to a gap in Medicaid funding.

But Lacey McNary, deputy director of Kentucky Youth Advocates, say the move would only further burden families. "Children who in Kentucky are up to 200 percent of the poverty level can enroll, and they're eligible for K-CHIP," she said. "In order to save some money, the state could say, 'We're only going to cover kids up to 150 percent of poverty' — thus, covering less children and saving money."

Estimates show almost half of Kentucky's children have government-supported health insurance. About 60,000 kids are enrolled in K-CHIP every month and another 386,000 Kentuckians are enrolled in Medicaid, which serves low-income and disabled Americans, including children. "It's been proven that K-CHIP is a very successful program to get kids covered," McNary said. "This bill is a permission slip for governors to reduce coverage for kids, to balance the budget."

If the bill passes, about 14 million children nationwide could be at risk for losing their health insurance, Shaw reports. (Read more)

More Kentucky children are insured under KCHIP, Medicaid; groups commend effort, ask for improvements

In the two years since the national Children's Health Insurance Program was reauthorized, about 51,700 children have been enrolled in Kentucky CHIP and Medicaid. Three advocacy groups -- Covering Kentucky Kids and Families, Kentucky Youth Advocates and Kentucky Voices for Health -- commended that effort and asked for greater efficiency in KCHIP.

"The number of uninsured children in Kentucky has dropped despite the loss of jobs and employer-sponsored coverage in our state," the three groups said in a statement Feb. 3. They asked that KCHIP be made more efficient by "allowing continuous eligibility, matching application information with existing databases, and developing web-based applications."

In Kentucky, kids up to age 19, with family incomes up to 200 percent of the federal poverty level, are eligible for KCHIP. That equates to an annual earnings of $44,000 for a family of four. (Read more)