Open enrollment for federally subsidized health insurance ends Tuesday, Jan. 16; Ky. enrollment is already ahead of last year's

Image from Facebook

By Melissa Patrick
Kentucky Health News

Kentuckians can still shop for and enroll in federally subsidized health insurance coverage on the state-based marketplace, Kynect, though Jan. 16 for coverage starting Feb. 1. That will be the end of open enrollment for 2024.

To sign up, Kentuckians can visit kynect.ky.gov or call 855-459-6328. They can also get help at a local Department for Community-Based Services office from a Kynector or a licensed health insurance agent at no cost. 

"They'll guide you through the process of finding quality, affordable health care coverage that's best suited for you and your family," Gov. Andy Beshear said Thursday at his weekly press conference. 

Kentuckians who don’t have coverage through an employer, Medicare, Medicaid, the Kentucky Children’s Health Insurance Program, or the Pentagon's Tricare program can shop for individual coverage on Kynect.

The Kynect website also provides a prescreening tool to see if your family may be eligible for benefits. 

A Kentucky Voices for Health blog post about the open-enrollment process said four of five Kentuckians are eligible for tax credits that can make premiums less than $10 a month, and many are eligible for $0 monthly premiums.

As of Jan. 4, Beshear said 71,414 Kentuckians have signed up for health insurance through Kynect, 8,852 more than last year. "This, I believe, is our strongest year, at least since the relaunch" of the state-based exchange, he said. 

“Three years ago, I made it a priority to relaunch Kynect, because I believe health care is a basic human right,” said Beshear. “Today, I’m pleased to see so many Kentuckians taking advantage and receiving the benefits they deserve.”

Four carriers offer health-insurance plans through Kynect: CareSource, Passport by Molina Healthcare, WellCare of Kentucky and Anthem. All counties have at least two carriers to choose from, with most counties having three carriers and many with four. 

All plans offered on the marketplace cover 10 essential health benefits, including emergency services, hospitalization, lab services, prescription drugs and certain no-cost preventive services.

Health-care leaders urge Kentuckians to act now to secure 'life-changing' insurance coverage before it's too late; help available

By Dr. Lori Caloia, Dr. Jason Smith and Dr. James Frazier

Access to health-care services, doctors, vaccines, medications, therapies and guidance can have life-changing consequences. Health-care coverage is not a "nice to have." It’s a must-have. And it’s available for Kentuckians of all ages. And for those enrolled in Medicaid, action is required to stay covered.

During the pandemic, the federal government enacted a Public Health Emergency, which meant that individuals covered by Medicaid were allowed to stay in the program regardless of whether their eligibility had changed. This was to prevent coverage gaps during the health crisis. But renewals have now restarted, and people covered by Medicaid must act to keep coverage or find a new health plan.

Action must be taken to ensure coverage

Medicaid renewals in Kentucky began again last April, and 1.6 million Kentuckians – 37% of our state’s population – are being asked to show their eligibility for Medicaid and the Children’s Health Insurance Program.

Acting now is critical. Many people are unaware that their coverage may be ending, or may have already ended. Data from Kentucky and across the country shows that millions have lost Medicaid coverage but have not transitioned to other health insurance plans through an employer or Kynect, Kentucky’s state Health Benefit Exchange. Of course, going without health insurance is dangerous medically and financially, and it’s unnecessary when Affordable Care Act plans are available for as little as $0.

Take steps now to make sure you have coverage. Even if you’re not enrolled in Medicaid, affordable health insurance for you and your family is available.

What to know about renewing and enrolling in health-care coverage

Many resources have been made available to help Americans understand and take advantage of options to stay covered. In fact, the Commonwealth of Kentucky and Anthem Blue Cross and Blue Shield in Kentucky both offer tools and resources to help people easily understand their options and access the coverage that meets their needs. Anthem offers MyHealthBenefitFinder.com, a self-service tool allowing anyone to answer a few, simple questions, and get information that helps them understand the types of health coverage they may be eligible for. The tool then provides clear steps on how to access that coverage. Anthem also offers a dedicated call center for those who have questions about navigating the Medicaid renewal process. Call 1-855-690-7784 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m.  

The Kentucky Health Benefit Exchange, at khbe.ky.gov, is full of information, resources, agents, and health coverage guides called Kynectors who can answer questions and help you understand your coverage options. HealthCare.gov is another warehouse of information, quick start guides as well as connections to healthcare navigators and brokers in each community.

Affordable, accessible coverage is available for people of all ages and most circumstances. It just takes action to secure that coverage. That’s why Anthem is urging Kentuckians to start the new year by spending time following up on where they, their loved ones, and acquaintances stand with their healthcare coverage. If help is needed, take advantage of the resources that are available. Taking just a few minutes could make a life-changing difference.

Dr. Lori Caloia is the medical director for Anthem Blue Cross and Blue Shield in Kentucky. Dr. James Frazier is chief medical officer at Norton Healthcare. Dr. Jason Smith is chief medical officer at University of Louisville Health and p rofessor at the University of Louisville.

Beware of scams citing Medicare, Medicaid, other health plans

By Kentucky Voices for Health

Fall brings open enrollment season, and while this year looks a little different with the ongoing renewals for Medicaid enrollees, scammers are still busy targeting Kentuckians looking for Medicare, Medicaid, or marketplace plans.

Medicare open enrollment runs through Dec. 7. There are a number of things to be excited about this year including a new cap on insulin costs, more covered vaccines (including the updated 2023 Covid-19 vaccine and the new RSV vaccine for seniors), and a cap on out-of-pocket drug costs that will start when coverage begins in 2024. But misleading marketing and unsolicited calls continue to plague members. Fortunately the Centers for Medicare and Medicaid Services is enforcing new advertising rules that are designed to cut down on the confusion.

We also continue hearing about increased scam attempts since Medicaid renewals returned earlier this year. With redeterminations on hold since the pandemic began, many members are new or unfamiliar with the renewal process and scammers are looking to take advantage. While it’s very possible that Kentucky Medicaid will need new information from you to complete your renewal, remember you will never have to pay to complete your renewal.

Lastly, open enrollment for health coverage from the Kynect marketplace begins Nov. 1. With Medicaid disenrollments, this will likely be a big year for enrollment in Kynect's qualified health plans. Beyond scam attempts, marketplace enrollees should also take careful consideration of so-called “junk plans.” These short-term plans are intended to fill temporary coverage gaps, but some exploit this loophole to offer cheap plans that come with usage restrictions, hidden fees, and major coverage limitations. It’s always important to do your research and remember that if something sounds too good to be true, it probably is.

Regardless of coverage, all enrollees need to be on guard for outright fraud and identity theft. If someone calls claiming to be from the government, but lacks your Medicare, Medicaid, or Social Security numbers or asks for credit card or banking info, it’s probably time to hang up. If something seems off, it's always best to make contact yourself through a verified channel and make changes directly rather than offering your personal info immediately to someone you don’t know.

Community professionals who work with Kynect have a new online resource to connect them with resources and each other

By Melissa Patrick
Kentucky Health News

A new website called KyLoop has launched to provide an online connection space for community professionals who work in outreach and enrollment through Kynect, the state's health insurance website that also provides help with food, cash and childcare assistance and employee child care assistance partnerships.

The aim is to help more consumers enroll in health coverage and other public benefits that are offered on Kynect. It was developed by Kentucky Voices for Health, which advocates for health benefits.

The site not only provides a centralized hub of  resources, but also offers an interactive space for its members to ask questions and share experiences. 

KVH Outreach and Enrollment Director Priscilla Easterling said their ongoing "ThriveKY Roadshows" across the state, which provide updates on state and federal policies that impact health, have revealed just how diffiicult it can be for some people to find resources.

Easterling said the website's two main features have been designed to help combat this. 

One is a resource repository that has a curated list of resources and an option for its members to suggest and share resources that have worked for them. 

"We want this to be as reciprocal as possible . . . so we also have an option for people to suggest resources," Easterling said. "If there's something like a resource in their community that they use, that's really helpful in their work, they can suggest that to us and then we will also post that as well, so that everyone is sort of sharing their collective knowledge and also learning from each other." 

The other feature is a forum that allows the members to "share information, ask questions, report problems, report best practices and just share . . . personal experiences," Easterling said. 

The forum will be searchable, and connected to team of subject-matter experts from KVH's partner organizations who can answer questions that come up on the forum, she said: "If you ask a question and you get an answer, that post stays active for other people to search and find later." 

Easterling also noted that the website can help policy advocacy organizations track and report the problems that people report. 

Membership in the program is limited and the siteg will, not be open to journalists or state officials, so "everyone feels safe and comfortable sharing their experiences and asking questions,"  Easterling said.

"But also, we want to be able to offer that sort of follow-up, so if . . . people report technical barriers, or enrollment barriers, or just things that we're not necessarily aware of, we can still follow up with people and take that information directly to the state, and let them know what's going on and hopefully we can address those issues."

Easterling said the federal healthcare.gov site had a similar program to deal with technical issues when the Patient Protection and Affordable Care Act rolled out. It has been disbanded, but Massachusetts and Illinois have similar programs and have helped with the Kentucky project, she said. 

KVH has three more ThriveKY Roadshows this year. The next one will be held Tuesday, Sept. 19, at the Foundation for a Healthy Kentucky offices at 1640 Lyndon Farm Ct. in Louisville. Meetings will also be held Oct. 17 in Lexington and Nov. 28 in Paducah. You can register for the meetings online. 

After three years of Medicaid enrollments piling up to a record number, those on the program must go through a renewal process

By Melissa Patrick
Kentucky Health News

Kentuckians on Medicaid need to pay attention to any correspondence from the state's Medicaid program. The Department for Medicaid Services has resumed its annual renewal process for Medicaid members because the pandemic rules that allowed continuous enrollment have ended. 

The process that allows Medicaid agencies to restart the annual renewals -- and kick off those who no longer qualify -- has been dubbed "Medicaid unwinding," a process that will take 12 months to complete, since it will use each Medicaid member's renewal month.

"We are currently outreaching to individuals with a May 31 renewal date. This means those individuals have until that date to renew with Medicaid," Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, said in an email.

"The most important thing Kentuckians on Medicaid need to be doing right now relating to the unwinding includes making sure we have up-to-date contact information," Dunlap said. "That way, Medicaid can contact members about renewing, if needed. We are telling all our members to visit their account at kynect.ky.gov to review their information and make sure everything is correct. If they do not have an account, we recommend they create one." 

At a monthly stakeholder meeting in April, Deputy Medicaid Commissioner Veronica Judy-Cecil encouraged Kentuckians to use their Kynect health-benefits account for renewal. "It is going to be the fastest and easiest way for redetermination to be processed," she said.

Cabinet for Health and Family Services table; click on it to enlarge

If not signed up for Kynect, Medicaid members can complete and return forms via mail or fax, Judy-Cecil said. They can also call Kynect (1-855-459-6328) or the Department for Community-Based Services, or visit a DCBS office, a licensed insurance agent, or a Kynector, who helps Kentuckians enroll in coverage through Kynect.

As the Medicaid rolls have piled up with automatic renewals and additional enrollments, a record number of Kentuckians were enrolled in the program on April 1: 1,725,467. But in April, the state started informing people with May renewal dates that they needed to renew their membership and while we don't know all of the reasons for the drop, enrollment for May has already declined to 1,712,381. (For county-by-county enrollment numbers, click here.)

In April, the Medicaid department "estimated approximately 240,000 may lose eligibility" in the unwinding, health-cabinet spokesman Brice Mitchell said in an email. "However, until someone goes through redetermination, it is impossible to accurately forecast who will lose eligibility."

Of that 240,000, an estimated 75,000 have incomes over 138% of the federal poverty level, the Medicaid limit, and are likely to qualify for federally subsidized health insurance through Kynect.

Judy-Cecil said the state will reach out to Medicaid members about 90 days before their Medicaid renewal end date. Members will also get a notice about 60 days before their renewal end date and if there is no response by the 15th of their renewal month, they will get another notice. Members will get a notice of eligibility, a renewal packet or a request for more information.

As of May 9, about 69,000 outreach calls had been made and over 17,791 calls had been received related to renewals, according to the Public Health Emergency Unwinding website.

Judy-Cecil said Medicaid has prioritized contacting the Medicare-eligible population, since many Kentuckians stayed on Medicaid when they turned 65 instead of switching to Medicare. That was allowed because the national public-health emergency rules required the state to continue coverage to get extra federal funds.

The priority from July until the end of the unwinding will be to reach out to those on Medicaid who make too much money to stay on the program. Judy-Cecil said it's important to make sure this group is aware of the ability to get federally subsidized health insurance to maintain their coverage. 

Judy-Cecil also wants providers to help out by reminding their Medicaid patients of their renewal date, which is available on each patient's KYHealthNet webpage. 

For a detailed explanation of the unwinding, see Medicaid’s response to frequently asked questions about member renewals.

Fewer Kentuckians enrolled in federally subsidized health plans for 2023, likely because many of them could remain on Medicaid

By Melissa Patrick

Kentucky Health News

Fewer Kentuckians signed up for a government-subsidized health plan on Kynect, the state-based marketplace, in 2023 than in the previous two years, likely because more of them qualified for Medicaid during the pandemic and were still covered by it. 

The final Centers for Medicare & Medicaid Services 2023 open enrollment report shows 62,562 Kentuckians signed up for health insurance on Kynect through Jan. 15, which was the last day to enroll.  That's a 15% drop from 73,935 in 2022 and a 19% drop from 77,821 in 2021, according to last year's report. 

"Our best guess is that more Kentuckians are currently covered by Medicaid right now because of the continuous-eligibility provision that's been in place during the pandemic," Emily Beauregard, executive director at Kentucky Voices for Health, said in an email. "When renewals begin this spring, we expect some Kentuckians enrolled in Medicaid to move" to a private but federally subsidized Qualified Health Plan. 

Beauregard referred to the end of a federal program that kept people continuously enrolled on Medicaid during the pandemic without the need to re-enroll and certify their incomes to qualify. This program will end March 31, under an end-of-year omnibus law that requires Medicaid agencies to restart their annual renewal process. This process has been dubbed "Medicaid unwinding." 

At a Jan. 12 state Senate and House Joint Health Services Committee meeting, Veronica Judy-Cecil, senior deputy commissioner of the state Department for Medicaid Services, gave a snapshot of how many Kentuckians this will affect.

She said the state estimates that of the 1.7 million Kentuckians on Medicaid, 243,368, about 14%, will lose eligibility during the unwinding. Slides presented at Beshear's Feb. 2 news conference indicated that the estimated number of people impacted by the unwinding has gone up to 260,000.

Of that group, an estimated 85,400 have incomes over 138% of the federal poverty level, the Medicaid limit, and will qualify for a qualified health plan with federal tax credits through Kynect. 

Private insurance plans purchased on Kynect offer significant tax subsidies to offset insurance costs for people earning between 100% and 400% of the federal poverty level, or between $13,590 and $54,360 for an individual. About 80% of enrollees nationwide qualify for subsidies that reduce their monthly payments to less than $10, according to the federal Department of Health and Human Services.

Enrollment for subsidized health insurance begins Nov. 1 on Kynect; 'family glitch' fix makes plans available to many more

Kynect illustration

By Melissa Patrick
Kentucky Health News

Open enrollment for federally subsidized health insurance plans starts Nov. 1 and runs through Jan. 15, for coverage that begins Jan. 1. 

Kentuckians can sign up for a qualified health plan on the state-based marketplace, Kynect, at Kynect.ky.gov. On the site, Kentuckians can compare options, apply for coverage and complete all enrollment on one platform. 

"Kynectors," who help Kentuckians sign up for coverage on Kynect, are available at no charge in every county to answer questions and help people sign up for coverage.

Federal subsidies for the plans were expanded during the pandemic, and some of them have been  extended through 2025, including the removal of the "subsidy cliff," allowing people with incomes above 400% of the poverty line to qualify for a subsidy if the full price of the benchmark plan is more than 8.5% of their income.

A Centers for Medicare and Medicaid Services fact sheet says the extension of benefits will continue to be money-savers for people who purchase marketplace plans, noting that "Consumers in these plans saved an average of $800 on their premiums in 2021 as a result of the American Rescue Plan," the first big spending bill passed by Democrats in Congress. 

The Biden administration has also removed what is called the "family glitch," which prevented some families from buying subsidized plans because their employer-based insurance was deemed affordable even though the affordability was based only on the cost of employee' coverage, not the extra premium required to cover dependents.

"This left millions of people, mostly women and children, stuck between being unable to afford unsubsidized coverage from a family member's existing policy while also being deemed ineligible to receive more affordable coverage through the marketplace," Kentucky Voices for Health said in an e-mail.

The Internal Revenue Service now looks at the affordability of an employer's plan by considering premium costs for the entire family. 

The Kaiser Family Foundation estimates that 5.1 million Americans have fallen into the family glitch. KVH estimates the change could affect as many as 72,000 Kentuckians.

Statewide, Kaiser reports that 73,935 people enrolled in individual or family plans during the open enrollment period for 2022 coverage. That was a little lower than 2021, when nearly 78,000 people enrolled.

Open enrollments for Medicaid, Medicare and federally subsidized health-insurance plans will be available very soon

Graphic by Ky. Voices for Health, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

Open enrollment to make changes to Medicaid, Medicare or federal-state subsidized Marketplace health-insurance plans is just around the corner. 

Experts encourage participants in each of these programs to review their health-care and prescription-drug coverage yearly to make sure their plans still meet their health-care needs.

Medicaid: Medicaid open enrollment gives Medicaid members a chance to change the insurance company that manages their care, called a managed-care organization or MCO. Open enrollment for Medicaid opens Oct. 15 and runs through Dec. 1, for coverage starting Jan. 1.

Medicaid members who chose to not participate in open enrolment will keep the same MCO that they are currently enrolled in. 

Kentuckians can enroll in Medicaid through their local Department for Community Based Services office or through Kynect.ky.gov, the state-run insurance marketplace. 

Medicaid is a state and federal program that provides health insurance for low-income adults and pregnant women, the disabled and children who meet certain income qualifications.  

Kentucky Medicaid covers more than 1.6 million people, more than half of them children who are covered under Medicaid or the Kentucky Children’s Health Plan, or KCHIP. About 625,000 Kentuckians are covered by Medicaid expansion under the Patient Protection and Affordable Care Act. 

Medicare: Medicare open enrollment starts Oct. 17 and runs through Dec. 7 (not the date shown in the accompanying graphic). To compare your current coverage with other options go to Medicare.gov/plan-compare. Medicare also offers a publication called Medicare and You Handbook 2023 for more information.

Medicare open enrollment allows those covered by original Medicare to reevaluate their existing coverage and make changes if they want to do so. Those who choose to not make any changes will keep their existing coverage in 2023. 

Medicare is the federal health insurance program for people who are 65 and older. and certain younger people with disabilities. 

Open enrollment for private Medicare Advantage Plans runs Jan. 1 to March 31, 2023. 

Marketplace: Open enrollment for a federally subsidized health insurance plan, often called Obamacare, is available through Kynect beginning Nov. 1 and runs through Jan. 15, for coverage that starts Jan. 1.  

Marketplace coverage is available to people who don't have health insurance through a job, Medicare, Medicaid or the Kentucky Children's Health Insurance Program, or another source that provides qualifying health coverage, with a few exceptions. 

Plans and prices for 2023 will be available to preview shortly before Nov. 1.

Kynect health-insurance open enrollment extended to Jan. 31

Map shows choice of health insurance companies offering federally subsidized plans in each county. 

The deadline to sign up for federally subsidized health insurance through kynect.ky.gov , the state's online portal, has been extended to Jan. 31. The previous deadline was Jan. 15.

The system that many call "Obamacare" has two more insurers than this year, and its first coverage for vision care. Also, some people will find coverage less expensive, thanks to greater federal subsidies.

On the site, Kentuckians can compare options, apply for coverage and complete their enrollment all on one platform, even if they qualify for Medicaid, which covers about a third of Kentuckians.

"Kynectors," who help Kentuckians sign up for coverage on Kynect, are available for free in every county to answer questions and help people sign up for coverage.

The major insurers offering subsidized plan are Anthem, in every county, and CareSource, in 100 of the 120 counties. A few counties have new insurers; Ambetter from WellCare, in six western counties, and Passport Health Plan by Molina in Jefferson, Oldham and Bullitt counties.

Fourteen counties have only Anthem plans to choose from, down from 26 last year. Most are small and rural, but they include Warren County, the core of metropolitan Bowling Green, the state's third-largest city. Warren and eight neighboring counties also had Anthem as their only choice this year.

For the first time, Kynect has a vision plan. VSP Individual Vision Plans offers a comprehensive eye exam from an in-network doctor, an eyeglass-frame allowance and lens enhancements, such as progressive lenses.

Enrollment for subsidized health insurance is open on Kynect

Update Nov. 1, 2021: This story has been updated with more detailed enrollment dates related to coverage. 

State Cabinet for Health and Family Services map, adapted by Kentucky Health News

Enrollment is now open on Kynect, the state's revived health-insurance marketplace, for federally subsidized health insurance for 2022.

The system that many call "Obamacare" has two more insurers than this year, and its first coverage for vision care. Also, some people will find coverage less expensive, thanks to greater federal subsidies.

Open enrollment on kynect.ky.gov runs through Jan. 15. Enrollments received through Dec. 15 will qualify for coverage that begins Jan. 1, 2022. For Kentuckians who enroll between Dec. 16 and Jan. 15, 2022, coverage will start Feb. 1, 2022. Enrollment in a commercial plan will remain open on kynect.ky.gov through Jan. 15, 2022.

On the site, Kentuckians can compare options, apply for coverage and complete their enrollment all on one platform, even if they qualify for Medicaid, which covers about a third of Kentuckians.

"Kynectors," who help Kentuckians sign up for coverage on Kynect, are available for free in every county to answer questions and help people sign up for coverage.

In addition to Anthem’s statewide coverage and CareSource, which is offering health plans in 100 of the state's 120 counties, a few counties have new insurers; Ambetter from WellCare, in six western counties, and Passport Health Plan by Molina in Jefferson, Oldham and Bullitt counties.

Fourteen counties will have only Anthem plans to choose from, down from 26 this year. Most are small and rural, but they include Warren County, the core of metropolitan Bowling Green, the state's third-largest city. Warren and eight neighboring counties also had Anthem as their only choice this year.

And for the first time, Kentuckians will be able to purchase a vision coverage plan through Kynect. VSP Individual Vision Plans will offer enrollees a comprehensive eye exam from an in-network doctor, an eyeglass-frame allowance and lens enhancements, such as progressives.

Kynect open to preview federally subsidized health plans, with more options and bigger subsidies; enrollment open Nov. 1

By Melissa Patrick

Kentucky Health News

Open enrollment for federally subsidized health-insurance coverage beginning in January will be offered through Kynect, the state's insurance exchange, which is now online for Kentuckians to explore their options.

The revived Kynect will replace the state's use of the federal exchange, and will have two more insurers in 2022 than this year -- and its first vision coverage. It will also offer less expensive coverage to some people, thanks to greater federal subsidies.

Open enrollment on kynect.ky.gov runs from Nov. 1 through Jan. 15. Enrollments received through Dec. 15 will qualify for coverage that begins Jan. 1, 2022. For Kentuckians who enroll between Dec. 16 and Jan. 15, 2022, coverage will start Feb. 1, 2022. Enrollment in a commercial plan will remain open on kynect.ky.gov through Jan. 15, 2022. (Dates updated Nov. 1, 2021)

Cabinet for Health and Family Services map, adapted by Kentucky Health News

Gov. Andy Beshear and U.S. Health and Human Services Secretary Xavier Becerra officially launched the reopening of Kynect as the portal for state-managed health care options Friday at an online news conference.

Becerra called Kynect "Kentucky-made, Kentucky-driven and Kentucky-based" and said the advantages of having a state-based marketplace is that it can be tailored to the needs of Kentuckians. 

"I don't think anyone in Washington, D.C., knows the state of Kentucky and its people better than the governor of Kentucky," Becerra said. "So his team is going to be able to tailor their marketplace to meet the needs of all the different communities rural, urban, poor, middle class, disabled, you name it, they're going to know where they need to go, and how to go there better than folks in Washington." 

Kynect was re-launched last year on a limited basis, as a one-stop shop for Kentuckians to apply for Medicaid and connect qualified families to other resources, including the Supplemental Nutrition Assistance Program (formerly known as food stamps) and family and child-care assistance programs.

Now, the platform will again allow Kentuckians to access and compare state-managed insurance options, apply for coverage and complete their enrollment all on one platform, which was its original intent when it was created in the governorship of Beshear's father, Steve Beshear.

"That makes it a lot easier," said Priscilla Easterling, outreach coordinator for Kentucky Voices for Health, an umbrella organization of lobbying groups that support continuation and expansion of programs under the 2010 Affordable Care Act, which created federal subsidies for qualified health plans. 

Easterling said Kynect allows Kentuckians to access just one platform to determine if they qualify for a qualified plan with income-based subsidies, or for Medicaid, in addition to the other services offered on the site. 

"As people's jobs change or their incomes change, it makes it much simpler to be able to move back and forth between Medicaid and the marketplace, without having to go back and forth between the state and the federal" platforms, she said. 

Easterling encouraged Kentuckians without coverage to explore their options on kynect.ky.gov -- especially those who looked at plans in the past and found them unaffordable.

That's because the latest pandemic relief bill, the American Rescue Plan Act, increased the subsidies, and most of its provisions will remain in place through 2022. Easterling said people generally saw a 48% savings on their health-insurance plans with the enhanced subsidies, or an average of $75 a month. 

"It doesn't hurt to just check out what your options are and [find out] what's going to be available for you and your family," Easterling said. "You might be surprised, but it's more affordable than you thought and it's worth looking into."  

Some small additional savings will result because people who buy health plans through the federal site pay a surch`1arge on premiums, which Kynect will not do. Beshear said it will pass along those savings to consumers.

Easterling reminded Kentuckians that Kynectors, who help Kentuckians sign up for health coverage through Kynect, are available for free in every county to answer questions and help people sign up for coverage. 

"Kynectors are a priceless resource that everyone should take advantage of," said Easterling, who is a Kynector. "If you're nervous about anything, if you're confused about any of this process, just call a Kynector because they can walk you through it and will be happy to do so."

In addition to Anthem’s statewide coverage and CareSource, which is offeing health plans in 100 of the 120 counties, consumers can shop for plans available in select counties from two new health insurers; Ambetter from WellCare of Kentucky, in six western counties, and Passport Health Plan by Molina, in Jefferson, Oldham and Bullitt counties.

Fourteen counties will have only Anthem plans to choose from, down from 26 this year. Most are small and rural, but they include Warren County, the core of metropolitan Bowling Green, the state's third-largest city. Warren and eight neighboring counties also had Anthem as their only choice this year.

And for the first time, Kentuckians will be able to purchase a vision coverage plan through Kynect. VSP Individual Vision Plans will offer enrollees a comprehensive eye exam from an in-network doctor, an eyeglass-frame allowance and lens enhancements, such as progressives.

Kynect was closed in 2017 by Republican Gov. Matt Bevin, who said the site was too expensive to maintain and was redundant. Beshear, a Democrat, said the return to the state-based exchange is expected to save Kentuckians about $15 million a year.

Beshear said Kentucky is getting $650,000 in ARPA funding through the Centers for Medicare and Medicaid Services to help pay for the reopening of Kynect. 

He said 280,000 Kentucky adults and 45,000 Kentucky children remain uninsured, and that the goal is to get all of them signed up for health insurance. 

Calling Kynect the "gold standard," Beshear said with Kynect being a one-stop-shop for so many services that provides local supports, a brand that remains strong across the state and the state's commitment to address any challenges that may come up,  "We believe it's going to be successful." 

Kentucky is among three states to transition from healthcare.gov to their own state-based exchange for 2022 coverage, along with Maine and New Mexico.

Kentucky ditches federal exchange and moves back to Kynect, which will have two more insurers and its first vision-care plan

Cabinet for Health and Family Services map, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

Kentucky is reopening Kynect, the state's health-insurance exchange, as the portal for Kentuckians to purchase low- or no-cost insurance, and the site will have two more insurers and its first vision plan.

Open enrollment on kynect.ky.gov runs from Nov. 1 through Jan. 15, 2022 for health insurance coverage beginning in 2022. Kentuckians can start browsing and comparing 2022 insurance plans on Oct. 15.

Kynect was re-launched last year as a one-stop shop for Kentuckians to apply for Medicaid and connect qualified families to other resources, including the Supplemental Nutrition Assistance Program (formerly food stamps) and family and child-care assistance programs. 

Now the platform will again allow Kentuckians to access and compare state-managed insurance options, apply for coverage and complete their enrollment all on one convenient platform, which was its original intent.  

In addition to Anthem’s statewide coverage and CareSource, which offers health plans in 100 of the 120 counties, consumers can shop for plans available in select counties from two new health insurers; Ambetter from WellCare of Kentucky, in six western counties, and Passport Health Plan by Molina, in Jefferson, Oldham and Bullitt counties.

Fourteen counties will have only Anthem plans to choose from, down from 26 this year. Most are small and rural, but they include Warren County, the core of metropolitan Bowling Green, the state's third-largest city. Warren and eight neighboring counties also had Anthem as their only choice this year.

Beshear also announced that for the first time, Kentuckians will be able to purchase a vision plan through Kynect. VSP Individual Vision Plans will offer enrollees a comprehensive eye exam from an in-network doctor, an eye frame allowance and lens enhancements, such as progressives.

Kynect was created by Beshear's father, then-Gov. Steve Beshear, in 2013 under the 2010 Affordable Care Act. It was closed in 2017 by Republican Gov. Matt Bevin, who said the site was too expensive to maintain and was redundant. Beshear, a Democrat, said the return to the state-based exchange is expected to save Kentuckians about $15 million a year.

"We encourage everyone to look at their quality health-care options, which we consider to be a basic human right," Beshear said at Monday's news conference. "Never has a need for quality health care been more evident than during the Covid-19 global health pandemic."

Touting the benefits of using a state-based exchange over the federal one, which Kentuckians have used since Kynect was shut down, Beshear said Kynect will have more options for consumers and offer the ability to tailor coverage to address Kentuckians' unique needs. 

Beshear noted that people who buy commercial health plans through the federal site pay a surcharge on premiums, which Kynect will not do. He said those savings will be passed on to Kentuckians who buy coverage through the state-based exchange.

The governor announced that Kentucky will receive $650,000 in American Rescue Plan Act funding through the Centers for Medicare and Medicaid Services to support the reopening of Kynect. 

Since Kynect re-launched in October 2020, the portal has been logged into more than 2.3 million times by more than 1.8 million visitors. Nearly 105,000 applications for benefits have been submitted, and nearly 1 million supporting documents have been uploaded. This is a 180% increase over the daily average noted last year from January through September, said Beshear.

“Kynect is truly a one-stop shop for consumers in need of health coverage, whether it’s Medicaid or a private insurance plan,” Cabinet for Health and Family Services Secretary Eric Friedlander said in the news release. “With its convenient, mobile-friendly option, it’s also the place to go for access to other resources that you or someone you know may need, including food assistance, transportation, employment, job-training and veterans’ benefits. It will also connect Kentuckians with community services in partnership with Kentucky United Way chapters through all the organizations available on their statewide 211 platform, including: clothing, transportation, housing and more.”

Kentucky is among three states to transition from healthcare.gov to their own state-based exchange for 2022 coverage, along with Maine and New Mexico.

Beshear says he will restart Kynect, the health-insurance marketplace his father launched as part of embracing Obamacare

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear said Wednesday that he will restart the state health-insurance exchange that his father, then-Gov. Steve Beshear, began in 2013 under the Patient Protection and Affordable Care Act. Kynect was dismantled in 2017 by Republican Matt Bevin, who served between the two Democrats.

Beshear announced that he had told federal officials of his intent to move to a state-based exchange, beginning Jan. 1, 2022. The exchange is a marketplace for health-insurance policies that meet ACA requirements and a portal for buyers to get tax credits to reduce premium costs. Kentucky also used it for Medicaid enrollment as it expanded Medicaid to more of the working poor.

"Kynect was one of the most successful exchanges in the country, and because of it we reduced our uninsured Kentuckians at the highest rate in the country for several straight years," Beshear said. "It was the right thing."

Beshear did not explain in detail how the exchange would be funded, but said moving to it would save money. He said its annual costs would be $1 million to $2 million, rather than the current $9.8 million that is paid for by a 3 percent user fee.

A news release from Beshear said reinstating a state exchange will save the state system $2.8 million to $3.8 million the first year, and $7.8 million to $8.8 million a year thereafter.

He said it will only cost the state a one-time $5 million fee to reinstate and upgrade Kynect because the system was not eliminated, but just basically turned off. "We can save significant dollars that we can use to offset the cost of health care," he said.

Kynect was funded by a 1 percent fee on health-insurance policies sold in the state. Bevin said it wasn't fair for everyone to pay for an exchange used by fewer than 100,000 Kentuckians, but he ended up keeping the fee to pay for the transition to the federal exchange, to fund the Kentucky Health Information Exchange, and to fund the remaining costs of Kentucky Access, the high-risk insurance pool for which the fee was levied long ago.

Bevin moved Kynect's function to a federal website, healthcare.gov, and moved the Medicaid program, for low-income and disabled people, to Benefind, a one-stop-shop for public benefits, a program that was originally designed to complement Kynect.

"In the last four years, we moved backwards on health care," Beshear said, noting that the percentage of people without health insurance went up while insurance shoppers had fewer options for coverage.

He said going back to a state exchange offers many benefits. He said it will reduce the the cost of premiums, be more efficient, and offer "single-door" access for Medicaid users and private plans, helping continuity of coverage as people move between those systems -- which many Kentuckians do, especially if they have jobs with fluctuating incomes.

Beshear said it will also allow greater flexibility and autonomy than the federal exchange, enabling the state to extend the annual open-enrollment period and offer special open-enrollment periods.

The federal government has not allowed a special enrollment period for those who have lost coverage during the coronavirus pandemic, but a state-based exchange could do that. "This pandemic shows us that the lack of good health care options makes us more vulnerable and less resilient," Beshear said.

He added that this was just the first of a larger set of announcements that his administration will be making in the fall.

"We have an opportunity to be better, to get healthier, to save money and ultimately to provide that basic human right that is health care," he said. "I believe we can do this much better than the federal government." He added, "I'm committed to getting every Kentuckian signed up for health care."

Ky. enrollment in Obamacare plans slightly less than last year

About the same number of Kentuckians signed up for subsidized health insurance on the federal health-insurance exchange as bought coverage on the state's Kynect exchange last year, state health officials announced Tuesday.

The Cabinet for Health and Family Services said 81,155 Kentuckians enrolled in federally qualified health plans on www.healthcare.gov during the three-month enrollment period that ended Jan. 31. That was 1.8 percent less than the year before, when 82,681 Kentuckians bought a plan on Kynect.

“These numbers clearly show the transition to the federal marketplace was a success,” cabinet Secretary Vickie Yates Brown Glisson said in a news release. “We have worked very hard to make sure this change produced minimal impact on consumers so that, at the end of the day, someone purchasing insurance through the federal marketplace was simply moving from one website to another.”

Gov. Matt Bevin pledged to close Kynect, but didn't go quite that far. He kept the exchange for insurance companies, which wanted a state-based exchange, but shifted consumers' enrollment to the federal exchange.

Under that setup, the federal government handles consumers' eligibility appeals, but the state reviews insurance companies' plan offerings and handles insurance-company grievances. Consumer grievances are handled by a state-federal partnership.

Kynect was funded by a 1 percent fee on all health-insurance policies sold in the state. Bevin said it wasn't fair for all insurance customers to pay for an exchange that 82,000 people use. However, his administration left the the fee in place, saying it is needed to help pay transition costs, fund the Kentucky Health Information Exchange and fund "legacy costs" of Kentucky Access, the high-risk insurance pool for which the fee was originally established – and transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

Ben Chandler, president of the Foundation for a Healthy Kentucky, hailed the enrollment numbers, but noted implicitly that the main impact of Obamacare in Kentucky has been Beshear's expansion of Medicaid to people with household incomes up to 138 percent of the federal poverty level.

“It's great news that enrollment in marketplace health plans this year is comparable to last year,” Chandler said. “The idea is to get more people insured, and this news is evidence that's happening. Toward the same goal – getting more people covered – we are pleased that Gov. Bevin is working to keep Medicaid expansion in Kentucky. Our research shows that the number of Kentuckians covered by Medicaid has increased by more than 500,000 people since 2010.”

Kentuckians are likely to need help signing up for health insurance on the federal exchange, especially in east and south

Kentuckians looking for a 2017 health plan on the federal exchange will likely need some help signing up, if a study of last year's need for support on the former Kynect exchange is any indication.

The Foundation for a Healthy Kentucky study found that more than half of Kentuckians (52.3 percent) who got their health insurance through Kynect last year worked with a kynector, a person who helped them sign up. The study also found that 41.7 percent contacted the Kynect call center and 38 percent visited the Kynect website.

"As the commonwealth transitions away from Kynect and into a supported state-based marketplace using the federal portal Healthcare.gov, this report tells us that more than half may be reaching out for one-on-one assistance, either in person or by phone, during the process," Ben Chandler, president and CEO of the foundation, said in a news release.

The report comes from the State Health Access Data Assistance Center at the University of Minnesota, which the foundation is paying more than $280,000 to study the impact of the Patient Protection and Affordable Care Act over three years. This study shows a quarterly snapshot of April, May June 2016.

Kentuckians who qualify for insurance subsidized by federal tax credits, called qualified health plans, are signing up on HealthCare.gov during this year's open enrollment, which began Nov. 1 and goes through Jan. 31. (Individuals must sign up by Dec. 15 to get coverage that begins Jan. 1.)

The state has extended contracts with the same organizations that provided kynectors for Kynect, but they are now called "application assisters" and every county in Kentucky is served by one of these organizations, according to the Cabinet for Health and Family Services. You can find an application assister by clicking on a search button on the Kynect website or by calling Kynect's customer services at 855-459-6328.

Use of Kynect was higher in Eastern and Southern Kentucky.

Chandler said the need for assistance "is likely to be greatest in Eastern Kentucky, where a larger proportion of residents accessed their 2016 coverage through Kynect."

The report found that the highest rate of Kynect enrollment in 2016 was in Eastern Kentucky, at 33.9 percent, and the lowest was in Northern Kentucky at 16 percent. Western Kentucky (27.8 percent), greater Louisville (22.5 percent), and greater Lexington (21.9 percent) were all closer to the state average of 25.8 percent.

Of the nearly 26 percent of Kentucky adults who got their health coverage for 2016 through Kynect, just 5 percent enrolled in private individual-market coverage and 95 percent enrolled in Medicaid, the report said.

WFPL of Louisville reported in early November that an application assister in Manchester, Sharon Bush, said many people in southeastern Kentucky don't have or use information technology, adding to the challenge of getting people signed up in the region. For example, HealthCare.gov requires an e-mail account to sign up. Another challenge is that application assisters can no longer get into the system to enroll their clients as they could on Kynect, so consumers must be able to do it themselves or work with a company that has bought the software to do so.

Health Status of Kynect Enrollees

Kentuckians who used Kynect tended to have poorer health. "If last year's numbers hold true, those looking to buy insurance or sign up for Medicaid via the federal portal will have poorer health than their counterparts who already have insurance," Chandler said.

The report said 45 percent of those who enrolled through Kynect said they were in fair or poor health, compared to 28 percent of Kentucky's non-elderly adult population.

Click here for tips on picking a health plan on Healthcare.gov, including the types of plans available and quality ratings.

Kentuckians who qualify for tax-subsidized health plans will sign up on HealthCare.gov this year; open enrollment begins Nov. 1

By Melissa Patrick
Kentucky Health News

Kentuckians who qualify for health plans subsidized by tax credits, called Qualified Health Plans, will sign up on HealthCare.gov instead of Kynect during the open enrollment that begins Nov. 1.

Some Kynect advocates have voiced concern that the changeover will be troublesome, but Cabinet for Health and Family Services spokesman Doug Hogan said in an e-mail, "We expect a smooth transition to HealthCare.gov. People should be aware that Kynect is not health insurance, it is a website. This transition changes the web portal people use to enroll."

Hogan said the state has sent letters about the transition to Kentuckians who have previously applied or been enrolled in health coverage through Kynect, to guide them through the process. He said the state will continue to send informational postcards throughout open enrollment, which ends Jan. 31.

"Only about 2 percent of Kentucky’s population purchases a QHP in a given year, so targeting resources to this group and doing it in the final month leading up to open enrollment and continuing through open enrollment is the most effective use of resources," Hogan said.

Hogan said that starting Nov. 1, Kynect's website will offer detailed messages about the transition and directions on when and were to apply for coverage. The HealthCare.gov website also has messages for Kentucky residents.

Where to get answers to your questions

The Kynect call center (855-459-6328) will remain available to help tell Kentuckians where to go for coverage, answer questions, pre-screen for program eligibility, and assist with Medicaid applications. The HealthCare.gov customer service call center (800-318-2596) is also available to help and is open 24 hours a day, seven days a week.

Hogan said insurers are also sending notices to their enrollees about the changes; insurance agents and application assisters have advertising tool kits for their outreach efforts; and agents and assisters have been given lists of their QHP enrollees. Also, social media campaigns, media advertising and other measures have different start times around the state in strategically placed target areas with the highest uninsured rates and QHP eligible populations, he said.

If you qualify for a QHP in 2017, which is a plan that offers a tax credit to help cover out-of-pocket costs, you must sign up for your health insurance through HealthCare.gov this year instead of Kynect, as you have in the past.

"Kentuckians can only get the tax credit, called APTC or Advanced Premium Tax Credit or a Cost Sharing Reduction that helps cover out-of-pocket costs, by enrolling through HealthCare.gov," Hogan said.

Open enrollment for these plans is Nov. 1 through Jan. 31, but to get coverage on Jan. 1, you must enroll by Dec. 15.

Can I preview the 2017 plans and prices?

HealthCare.gov offers a user-friendly tool to preview 2017 plans and prices. Access the tool by clicking on the bright green "Preview 2017 Plans and Prices" button on the HealthCare.gov website and follow the prompts.

To fill in the prompts you will need to know your ZIP code, your county, whether you have enrolled in a 2016 Marketplace plan, the ages and the sex of those in your household, your marriage status, and your expected income. It will also request some other information, including whether you are eligible for health coverage elsewhere, if you are a parent of a child under 19, or if you are pregnant or a tobacco user.

After answering these prompts, the website will tell you what your estimated premium tax credit is if you qualify for one. A tax credit is how much you can save on your premium each month and not the amount of the premium itself.

The next portion of the website tool takes you to your plan choices available based on the information provided. It will ask a few questions to help narrow your choices and will then ask you to choose a bronze, silver or gold plan. After choosing a plan type, it will bring all of the plans in that category up for you to review and choose from. Your exact premium, reduced by the tax credit you qualify for, will be stated when you complete or update your application.

Why aren't there as many choices as last year?

In 59 of the state's 120 counties, residents will have only one health insurance option on the exchange. Anthem Health Plans of Kentucky is the only company offering coverage on the exchange in every county for 2017. CareSource will offer plans in 61 counties, up from 46 in 2016 and Humana Health Plan will offer exchange plans in nine counties, down from 15 in 2016.

Baptist Health Plan, United HealthCare, WellCare and Aetna, which offered plans on the exchange in 2016, will not in 2017. Most have cited unsustainable losses.

"People should know that this transition to HealthCare.gov did not affect plan choice," Hogan said. "All insurers made the same offerings regardless of the enrollment website we selected which is the same as in prior years."

Hogan added, "Cost increases were not driven by the transition to HealthCare.gov." He said premiums on exchange policies are increasing by more than 20 percent.

People whose current insurers are not offering a plan in 2017 on HealthCare.gov will be given more time to choose a plan for 2017 due to a "special enrollment period for loss of minimum essential coverage," Hogan said.

Do we still have Kynectors?

The state has extended contracts with the same organizations that provided Kynectors, which are now called "application assisters," Hogan said. Application assisters work with Kentuckians either in person or over the phone to answer questions or get assistance with the application and enrollment process.

"We are confident our assister agencies will have the ability to provide the same exceptional service," Hogan said. "Every county in Kentucky is served by a contracted organization for in person assistance. Kynectors have a very active outreach program that includes sign up events, advertising, and education opportunities. They will continue to be very active in the communities they serve."

You can find an Application assister in your area by using the "search" function on the Kynect website or by calling Kynect's customer service.

Many Kynectors are still in the process of being trained to help clients on the federal marketplace, so Hogan said there isn't a firm number of participating application assisters for 2017.

What about Medicaid?

The Medicaid program for low-income and disabled people, and its application process, will stay the same. It was moved from Kynect earlier this year.

Medicaid-eligible Kentuckians can apply anytime during the year through Benefind, a one-stop-shop website for public benefits. But if you are already enrolled, you don't need to do anything until your renewal or recertification date.

"If a citizen believes they may be eligible for Medicaid (any type), we would recommend that they apply through Benefind," Hogan said. "This would be the quickest route to receive Medicaid eligibility."

Benefind also has an anonymous pre-screening tool to assist in determining if you are eligible for Medicaid or a QHP.

Consumers may ask, "What happens if I apply for the wrong type of coverage?" Hogan answered, "Consumers cannot apply in the wrong way or place." He said if an application is started in Benefind, but the applicant is over the income limit, the application will be transferred to the federal marketplace and Benefind will send a notification letter to the participant indicating Medicaid eligibility was denied and that the client information was sent to HealthCare.gov.

If a consumer submits an application to HealthCare.gov, it will be entered, but if the applicant is deemed Medicaid-eligible, the application will be transferred to the state for final eligibility determination. If the participant is determined eligible, Benefind will notify the participant. If more information is needed, Benefind will ask the participant for it, indicating the next steps to take.

Feds allow Bevin to dismantle Kynect and use federal exchange, but express concerns echoed by health-reform advocates

It's official. Kentuckians will sign up for health insurance on HealthCare.gov instead of Kynect during this year's open enrollment, which begins Nov. 1. But there are questions about how smooth the transition will be.

Centers for Medicare and Medicaid Services Acting Director Andrew Slavitt said in a letter dated Oct. 4 to Gov. Matt Bevin that Kentucky had met all of the necessary requirements to make the transition and granted its approval to make the change.

"This transition will allow Kentucky to achieve substantial cost savings while still allowing citizens to enroll in qualified health plans," Amanda Stamper, press secretary for Gov. Matt Bevin's administration, asserted in an e-mail.

Kynect was created with a federal grant and funded by a 1 percent tax on all insurance policies sold in the state, both on and off the exchange.This revenue had previously funded Kentucky Access, the high-risk insurance pool that federal health reform made unnecessary.

The 1 percent tax will continue, and be used to help pay for transition costs, fund the Kentucky Health Information Exchange and "legacy costs" of Kentucky Access, the Bevin administration told a legislative committee in March.

Bevin has said it is unfair for all insurance customers to pay for an exchange that fewer than 100,000 people use. He does not include the 425,000 Kentuckians who used Kynect to sign up for Medicaid year-round.

The fee for using the federal exchange will be 1.5 percent, plus a proposed 0.5 percent state fee to cover outreach and plan-management functions.

Despite CMS's approval, the bulk of Slavitt's letter expressed concerns about the change.

"We remain concerned that Kynect's transition to the federal platform may disrupt the seamless system of coverage that Kynect established. As a result, eligible people may face delays in or lack access to the coverage for which they are eligible," Slavitt wrote.

Slavitt called Kentucky's transition timeline "aggressive" and said "key milestones" remain. He added that such a major transition creates "significant risks."

The approval comes less than one month before open enrollment will begin on Nov. 1. (It ends Jan. 31, but to get coverage starting Jan. 1 enrollees must sign up by Dec. 15.) Stamper told Lisa Gillespie of WFPL that the state will be able to make the switch in time.

“We’ve also been working with [the Centers for Medicare and Medicaid Services] and stakeholders to develop a comprehensive outreach plan to ensure people have the information they need well before open enrollment to know when and how to enroll,” Stamper told Gillespie.

But Cara Stewart, a health-law fellow at the Kentucky Equal Justice Center, said there isn't enough time to make the transition before Nov. 1. One reason, she said, is Kentucky hasn't conducted the same level of outreach that it has in years past because Kynectors who help people navigate the system didn't know what to tell people until today. She also noted that Kynectors must go through training to assist people on the federal exchange.

"And yet this is a change as big as the change the very first year of Medicaid expansion," said Stewart, who is also a Kynector. "And so we are looking at a tremendous amount of information that is not being pushed out there. And on HealthCare.gov, every single person has to create a new account and start from complete scratch, and this system is more cumbersome and more difficult to use than Kynect."

Stewart noted that assisters on the federal exchange are limited in how much they can help their clients because the system doesn't offer a shared dashboard, and without that dashboard they can't help help their clients fill out their applications or check on the application's status.

"We are choosing to set ourselves up for failure," she said. "I don't see any way that we won't have access issues."

Slavitt also noted that on the federal exchange many Kentuckians will have to manipulate two systems instead of just one, as they do now on Kynect, to maintain their health insurance.

Slavitt emphasized the importance of making sure Kentuckians are informed about these changes.

"Changes in system functionality may result in confusion for Kentucky consumers," he wrote. "It is therefore essential that the transition be clearly and effectively communicated to Kentucky consumers to ensure that they have the information they need to enroll in coverage on HealthCare.gov starting Nov. 1, 2016."

Save Kentucky Healthcare, a non-profit founded by former Gov. Steve Beshear, who created Kynect, noted the warnings in Slavitt's letter, including "the high risk of user delays, gaps in coverage, and anticipated confusion as Kentuckians attempt to adjust to a more complicated system." It also asserted that "study after study has found the current system sustainable and affordable."

"It is disappointing that Gov. Bevin is once again putting his rigid right wing ideology ahead of the health and well-being of Kentuckians," Beshear's group said in a press release.

Kentuckians increasingly covered by high-deductible health plans

Six times as many Kentucky workers were enrolled in high-deductible health insurance plans in 2014 as in 2006, reflecting a national trend, says a report for the Foundation for a Healthy Kentucky. As a result, the average amount they had to pay before their insurance kicked in more than doubled, from $1,178 in 2006 to $2,738 in 2014.

Most of the 93,666 people enrolled in the Kynect health-insurance exchange, where premiums are federally subsidized, chose high-deductible plans for this year.

"Employers and consumers often choose high-deductible health plans in return for lower monthly premiums," said Susan Zepeda, president and CEO of the foundation. "Research shows that these plans lead to decreased health-care spending as consumers who have to pay up front for care become more conscious of costs. But consumers on high-deductible plans also tend to use fewer preventive services, such as vaccinations and cancer screenings, that save money -- and lives -- in the long run. And these plans can make it more difficult for Kentuckians with low incomes or chronic conditions to pay their medical bills, leading them to delay or skip essential health care."

In 2014, 38.6 percent of the 2.4 million Kentuckians who get health coverage at work were enrolled in plans considered "high deductible" by the Internal Revenue Service: $1,250 for single and $2,500 for family coverage in 2014. In 2006, high-deductible plans covered 6.6 percent of enrollees. Nationally, enrollment in high-deductible plans rose from 8.6 percent in 2006 to 35.2 percent in 2014.

Figures are for Open Enrollment Period 3, for this year.

In Kentucky, 60 percent of this year's Kynect enrollees chose the "Silver" plan, which has a median deductible of $3,500 for an individual and $7,000 for a family, with median monthly premiums of $255 and $585.

"While the percentage of U.S. employees on health insurance plans with deductibles at any level grew from 66.4 percent in 2006 to 83.9 percent in 2014, the percentage of such plans in Kentucky was much higher than in the country as a whole in 2006, but has remained relatively stable since then (90 percent in 2006, 90.3 percent in 2014)," the foundation said in a news release.

The report was created by the State Health Access Data Assistance Center at the University of Minnesota as part of a 34-month study of the impacts of federal health reform in Kentucky.

Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

“To be successful, we need to take our time and make absolutely sure we’re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, “These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.”

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

“Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,” Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect’s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Study shows uninsured rate keeps falling, preventive services are popular and rural hospitals have more uncompensated care

By Melissa Patrick
Kentucky Health News

The share of Kentuckians without health insurance continues to drop, and new Medicaid enrollees continue to take advantage of free preventive health services, according to an ongoing study of federal health reform's impact in the state.

The Foundation for a Health Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 for a three-year study of how the Patient Protection and Affordable Care Act is affecting Kentuckians.

The report found that the rate of people without health insurance in Kentucky continues to drop.

In December 2015, the uninsured rate was 7.5 percent, down from 9 percent in June 2015. The national rate in December was 11.7 percent. In 2013, before the implementation of the PPACA, Kentucky's uninsured rate was 20.4 percent.

Since December 2013, Kentucky's uninsured rate has dropped 12.9 percentage points, more than double the national decline of 5.6 percentage points, says the report. Uninsurance rates can vary depending on how they are measured. This study used data from the Gallup-Healthways Well-Being Index, which produces state-level estimates of coverage twice a year.

"Lack of insurance is a significant barrier to getting necessary health care and preventive services timely," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "Tracking this and other key information about access to and cost of care in Kentucky helps to inform health policy decisions."

Kentucky also continues to have a lower uninsured rate than its eight nearest surrounding states, although Ohio (7.6 percent) and West Virginia (7.7 percent) are catching up. Missouri (11.6 percent), Tennessee (13 percent) and Virginia (12.6 percent), the three states surrounding Kentucky that did not expand Medicaid, have the highest uninsured rates. (SHADAC map)

And while the state saw a smaller share of new health-insurance customers than the country overall (20 percent versus 39 percent), Kentucky had the largest percentage of re-enrollees (59 percent) return to Kynect, the state's health insurance marketplace, to select plans compared to the rest of the nation (36 percent). Twenty-two percent of Kentuckians were automatically re-enrolled in plans.

Kynect, created by the Democratic administration of Steve Beshear, is in the process of being dismantled by the administration of Republican Gov. Matt Bevin, so Kentuckians will have to sign up for their health insurance through the federal exchange, healthcare.gov, during the next enrollment period which begins Nov. 1, 2016 and runs through Jan. 31, 2017.

Traditional Medicaid enrollees will sign up through Benefind, the state's new one-stop-shop website that 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).

Expansion of Medicaid added about 400,000 Kentuckians to the program, and many of them have taken advantage of its free services to get screened for diseases and have physical or dental examinations.

Dark blue: traditional Medicaid enrollees
Light blue: Medicaid expansion enrollees

The latest report, which covers the fourth quarter of 2015, says 823 traditional Medicaid enrollees got screened for diabetes, compared to 2,959 Medicaid expansion enrollees. This was also true for colorectal screenings (see graph).

Overall, the study found that Medicaid covered 41,493 dental preventive services, 9,708 breast cancer screenings, 8,276 substance-abuse treatment services, and 5,589 colorectal-cancer screenings to enrollees aged 19-64.

Under federal health reform, Beshear expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level. The federal government pays for this expanded population through this year, but next year the state will be responsible for 5 percent of the expansion, rising in annual steps to the reform law's limit of 10 percent in 2020.

However, the future of the expansion is uncertain. Bevin has said that the state cannot afford its Medicaid population of about 1.3 million, and has charged his administration with designing a new Medicaid program, which will require federal government approval. He told reporters in early May that he was optimistic that the Centers for Medicare and Medicaid Services will approve the state's new plan, but if they don't it will be because "CMS does not want to see expanded Medicaid continue in Kentucky."

The study found that Medicaid enrollment continues to be the highest in Eastern Kentucky with 31 percent participation, followed by Western Kentucky at 26 percent participation.

It also notes that while levels of uncompensated care have dropped for both urban and rural hospitals since 2013, rural hospitals saw slight increases in uncompensated care in 2015. (SHADAC graphic)

For the full report, click here.