Kentuckians are invited to virtual June town-hall meetings on helping families with complications from substance use

By Sarah Ladd

Kentucky Lantern

Kentuckians with ideas to improve outcomes for children placed in foster care because of substance use complications will get the chance to share them during a series of town halls this June, the Administrative Office of the Courts announced Wednesday.

Registration is required for the four virtual town halls, which Citizen Foster Care Review Boards are hosting on June 3, 5, 11 and 14.

“Community input is vital to identifying needs in each area of the state,” the AOC said in the release. “Due to confidentiality, specific cases will not be discussed.”

The town halls will seek to answer the following questions, and findings will be reported back to the Citizen Foster Care Review Board:

•  Do families and children in your community have equitable and timely access to substance use disorder assessment and treatment services?
• What are the barriers to accessing treatment for substance use disorder?
• What solutions could be identified to remedy barriers to access and treatment and lead to resilience and recovery?

The four town hall dates and locations are as follows: 

June 3, 11 a.m.-noon CT/12-1 p.m. ET. Register for this town hall at kcoj.info/June32024 if you live in Allen, Ballard, Barren, Breckinridge, Butler, Caldwell, Calloway, Carlisle, Christian, Crittenden, Daviess, Edmonson, Fulton, Graves, Grayson, Hancock, Hardin, Hart, Henderson, Hickman, Hopkins, LaRue, Livingston, Logan, Lyon, Marshall, McCracken, McLean, Meade, Metcalfe, Muhlenberg, Nelson, Ohio, Simpson, Todd, Trigg, Union, Warren or Webster Counties.

June 5, 11 a.m. – noon CT/12-1 p.m. ET. Register for this town hall at kcoj.info/June52024 if you live in Adair, Bath, Bell, Boyd, Breathitt, Carter, Casey, Clay, Clinton, Cumberland, Elliott, Floyd, Green, Greenup, Harlan, Jackson, Johnson, Knott, Knox, Laurel, Lawrence, Leslie, Letcher, Lewis, Magoffin, Marion, Martin, McCreary, Menifee, Monroe, Montgomery, Morgan, Perry, Pike, Powell, Pulaski, Rockcastle, Rowan, Russell, Taylor, Washington, Wayne, Whitley or Wolfe Counties.

June 11, 11 a.m.-noon CT/noon-1 p.m. ET. Register for this town hall at kcoj.info/June112024 if you live in Bullitt, Fayette or Jefferson counties.

June 14,11 a.m.-noon CT/noon-1 p.m. ET. Register for this town hall at kcoj.info/June142024 if you live in Anderson, Boone, Bourbon, Boyle, Bracken, Campbell, Carroll, Clark, Estill, Fleming, Franklin, Gallatin, Garrard, Grant, Harrison, Henry, Jessamine, Kenton, Lee, Lincoln, Madison, Mason, Mercer, Nicholas, Oldham, Owen, Owsley, Pendleton, Robertson, Scott, Shelby, Spencer, Trimble or Woodford counties.

More than 1/3 of Kentuckians are enrolled in Medicaid. How many in your county? How many kids? What are their big health issues?

Screenshot of health portion of Cabinet for Health and Family Services report on Clay County

By Al Cross

Kentucky Health News

Most Kentuckians probably don't know much about Medicaid, but for more than one in three people in the state, it is a lifeline. In some counties, more than half the residents are Medicaid beneficiaries. But Medicaid runs somewhat under the radar, because many Kentuckians frown on the receipt of public assistance -- even though Medicaid benefits come only with demonstrated medical need.

Medicaid is a combined federal-and-state program, created in 1965 by the law that created Medicare. Originally it was for the very poor, the disabled and the pregnant, but in 2014 expanded to households with incomes up to 138 percent of the federal poverty level because then-Gov. Steve Beshear embraced the 2010 Patient Protection and Affordable Care Act, better known as Obamacare.

The federal government pays 90 percent of the cost for people covered by the expansion, and about 72 percent of others' costs. The state pays the rest, which means Kentucky taxpayers put billions of dollars a year into it. It's not the sort of program that needs to run under the radar; if we are paying the freight, we need to know what's in the haul, and it helps to know it at the local level.

That's easier now that the state Cabinet for Health and Family Services, which runs Medicaid in Kentucky, has posted monthly Medicaid enrollment reports on its website.

These county-by-county reports are more useful than the annual reports that the cabinet circulates more more to show the local impact of its programs. The Medicaid figure on those reports is the number of people in the county who received Medicaid benefits at any time during the program's fiscal year (April to March). That number overstates the rolls at any particular time, because many people go on and off Medicaid each month.

For example, the Fiscal 2022 report for Clay County, one of the nation's poorest, shows 15,922 total beneficiaries in the year, but only 12,815 in the month of June. That is still 62.6 percent of the county's estimated population of 20,484.

That said, the annual reports provide much more information about Medicaid than the monthly reports; among other things, they:

• Break down Medicaid enrollment into types of enrollees: traditional, expansion, children in foster care, and "presumptive eligibility," people who have been enrolled during the pandemic without all the usual checks for eligibility, under legislation passed by Congress. Starting April 1, states will have to start running all the usual checks, and many people will no longer be eligible. In Clay County, for example, 2,842 presumptive eligibles were on the rolls in fiscal 2022, or 18% of the total enrollment.
• Give the number of children who were beneficiaries at any time during the year; in Clay County, 4,612 kids were helped by Medicaid in fiscal 2022. 
• Give the top five diagnoses for adults and children on Medicaid, which can vary widely from year to year. In another poor county, Clinton, the top five diagnoses for adults in fiscal 2021 were chronic obstructive pulmonary disease, hypertension, unspecified illness, opioid dependence and diabetes, in that order. In fiscal 2022, they were hypertension, Covid-19, contact with and suspected exposure to Covid, myopia (nearsightedness) and "other fatigue."
• Give the top five procedures performed on beneficiaries and the top five medications prescribed for beneficiaries. In both Clay and Clinton counties in the last two fiscal years, the most-prescribed drug was naloxone, which reverses the effect of a drug overdose.
• Show the number of health-care providers who served residents of the county and the total they were paid. For example, in Clinton County in fiscal 2022, residents were served by 48 providers who were paid $33 million; $14.3 million of that went to local providers.
• Show the number of newborn screenings and other figures on programs for children, including the percentages of foster children who had an official goal of adoption, and the number with other official goals, such as reunification with their birth families.

The annual reports give much information on programs other than Medicaid, such as the Supplemental Nutrition Assistance Program (once known as food stamps), behavioral-health services (including syringe exchanges), other services by local health departments, health-insurance assistance, child-care assistance, child-support enforcement, social services (such as meals, home care and other services to seniors), and funding of Family Resource and Youth Service Centers, which serve public-school students and their families. The reports also list the number of cabinet employees working in each county.

Cabinet for Health and Family Services promotes health and wellness at state fair, and collects duffel bags for foster kids

helpourkidsinc.org

The Kentucky State Fair is not just a great place to support Kentucky's agriculture or to spend the day on the midway; it's also a great place to learn about some of the state's health and wellness initiatives and to donate a new duffel bag or backpack to a foster child.

“Often times, when children are removed from their home and placed into state care, all their belongings are literally stuffed into a black garbage bag,” Health Secretary Vickie Yates Brown Glisson said in a news release. "This effort changes that. Donating a duffel bag or backpack is a small but meaningful way to help foster children and give them the dignity of carrying their possessions in a new bag that is all their own.”

New duffel bags and backpacks will be collected at the Cabinet for Health and Family Services' exhibit in the Health Horizons area of the South Wing B. The fair runs through Aug. 27 at the Kentucky Exposition Center in Louisville.

The cabinet's exhibit will offer daily interactive displays that features learning activities for children and adults, free health screenings and on-site health educators who can speak to individuals about wellness and prevention. It will also offer free dental screenings for children with signed consents who are entering public school kindergarten or first grade from 10 a.m. to 2 p.m. daily.

In addition to these daily health initiatives, they will also have special "focus days," including:

• Tuesday, Aug. 22: Services for Seniors, including Adult Protective Services, Aging and Independent Living/Long Term Care Ombudsman, and the Kentucky Prescription Assistance Program
• Wednesday, Aug. 23: Focus on Foster Care and Adoption, 10 a.m. to noon
• Thursday, Aug. 24: Focus on Zika Education and Mosquito Control, 10 a.m. to noon
• Friday, Aug. 25: Focus on Substance Use Disorder Strategies and Services, 10 a.m. to noon

Exhibit buildings are open daily from 9 a.m. to 9 p.m. Sunday through Thursday and until 10 p.m. Friday and Saturday. Admission at the gate is $10 for adults, seniors and children; free for children 5 years and under. Parking at the gate is $10 per car.

Bevin appoints Louisville health lawyer Vickie Yates Brown Glisson secretary of the Cabinet for Health and Family Services

Vickie Yates Brown Glisson

Gov.-elect Matt Bevin has appointed Louisville lawyer Vickie Yates Brown Glisson to oversee the Cabinet for Health and Family Services, which employs about 7,500 people statewide and includes the state's Medicaid program and human service agencies.

“The appointment of the secretary of the Cabinet for Health and Family Services is one of the most critical decisions I will make as governor,” Bevin said in a release announcing Glisson’s appointment. “We have one in four of our citizens enrolled in Medicaid and the financial costs to the commonwealth are growing exponentially. We must be innovative in our efforts to improve health outcomes for Kentuckians but do so in a prudent and sustainable manner. I am highly confident that Vickie is the right person to lead this effort.”

Bevin, who will be inaugurated Dec. 8, has vowed to scale back the expansion of Medicaid eligibility that allows those with incomes up to 138 percent of the federal poverty line to join the program, and to dismantle Kynect, the state's health insurance exchange, which is also in the cabinet.

The Courier-Journal reports Bevin also "has his sights on the cabinet's Department for Community Based Services, which oversees social services, including foster care and adoption in Kentucky," In an interview earlier this year with The Courier-Journal, Bevin called the department " "a convoluted, backward, broken, machine," citing the unsuccessful experience he and his wife, Glenna, had trying to adopt a foster child in Louisville.

Glisson is a health insurance lawyer with the Louisville law firm Frost Brown Todd, where she specializes in health care, health insurance law, government affairs, informatics and mediation. She is the past chair of the Health Law Section of the American Bar Association. She was named president and CEO of Nucleus, an economic-development arm of  the University of Louisville, in 2008 and advised the school about health, life sciences and research. Glisson served on the Advisory Council for the Human Genome Project and National Institute of Diabetes, Digestion and Kidney Disease.

"Vickie Yates Brown Glisson brings a wealth of experience to her new position as Secretary. We look forward to working with her in exploring innovative approaches to assuring access to affordable quality care and improving the health of Kentuckians," Susan Zepeda, President/CEO, Foundation for a Healthy Kentucky, said in a statement.

Sheila Schuster, a longtime advocate for health care, told The Courier-Journal that "she believes Glisson is "very bright" and familiar with health law, but also noted that this top cabinet job comes with a "huge learning curve" and she hopes Glisson is willing to benefit from the experience of others."

Glisson lives in Louisville with her husband (Ret.) Col. Shawn D. Glisson, an oncologist and hematologist with Norton Healthcare in Louisville. She is a native of Spencer County,

"It is an honor to serve my home state and Gov. Bevin," Glisson said in the release. "I look forward to working with stakeholders as, together, we find solutions to the challenges facing Kentucky families, the health care industry and our most vulnerable citizens."

Kids Count report says hard times in early childhood are more likely in Ky. than rest of U.S.; bad times have long-term effects

By Melissa Patrick
Kentucky Health News

One of every five children in Kentucky, by the time they are 5 years old, has experienced two or more adverse childhood experiences such as child abuse, economic hardship, exposure to violence, living in a household with mental illness or substance abuse, or where a family member has been incarcerated.

That is one of the major points of the 24th annual Kids Count report, released Tuesday by Kentucky Youth Advocates. The report is part of a state-by-state effort with county-by-county data; nationally, only one in eight children by age 5 have had two adverse experiences, defined as events or circumstances that can affect the quality of the child's adult life, including their health and length of life.

"The higher the total number of these events a child experiences, the higher the risk of obesity, chronic illness, substance abuse, smoking and mental health problems," the report says. Another study cited in the report found that "Children who had experienced four or more adverse events had lower incomes, lower education attainment and lost more days of work or school as adults due to problems with physical or mental health."

“We know when children experience traumatic events such as abuse and neglect or having an incarcerated parent, it negatively impacts their health and often causes barriers to success later in life. Kentucky leaders need to enact solutions to prevent these experiences in the first place and when they do happen, help children successfully recover,” Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a press release.

This report by Kentucky Youth Advocates measures 16 indicators to determine the overall well-being of children in Kentucky counties and focuses on four areas considered critical to well-being: economic security, education, health, and family and community strength.

The Kentucky counties with the highest overall child well-being rankings are Oldham, Boone, Spencer, Woodford, and Calloway; the lowest are Martin, Owsley, Wolfe, Clay and Elliott.

Overall Child Well-Being, based on four factors:
economic security, education, health, and family and community.

The 2011-12 survey said that Kentucky children are more likely to experience two or more adverse events  (30 percent) than children are nationally (22.6 percent). The four most common adverse events among Kentucky's children, says the report, are economic hardship, living with a parent or guardian who got divorced or separated, living with anyone who had a problem with alcohol or drugs, and living with a parent or guardian who was incarcerated.

This study evaluated four indicators of health: smoking during pregnancy, low-birthweight babies, children and young adults without health insurance and teen births.  Oldham and Boone counties scored higher than the other counties on health and Elliott County ranked last.

Overall Health: County Comparisons.  Based on county
scores for the four indicators in the report.  

The study found Kentucky has the highest rate of mothers who smoke during pregnancy, one in five, compared to states with comparable data, reporting that the county rates varied widely in this area with less than 14 percent of expectant mothers in Fayette, Jefferson, and Oldham counties smoked, compared to 40 percent or more of mothers in Clay, Elliot, Lee, and Owsley counties.

The percentage of low-birthweight babies in Kentucky, often a result of smoking during pregnancy, between 1994-2012 (8.7 percent) was found to be consistently higher than the U.S. percentage (8.0 percent).

“All parents want what is best for their children, and we know that smoke is bad for kids,” Bethany Hodge, a pediatrician in Louisville, said in the release. “Kentucky needs an indoor smoke-free law so working mothers-to-be do not have to choose between their jobs and protecting their unborn babies.”

One in eight under 26 lacked health insurance in this study, but this number is expected to decline.

“Kentucky has effectively connected young people to health insurance, especially with the outreach efforts of KCHIP over the past few years and kynect over the past year,” Brooks said in the press release. “It’s important to build on those successes with innovative ways to connect all young people to coverage. One solution is to automatically enroll youth aging out of foster care in Medicaid to make sure they maintain health insurance as they leave the state’s care.”

As for teen births, in 2012, Kentucky's rate of births to teen mothers (42 per 1,000) "substantially" exceed the national rate (29 per 1000).

Many of Kentucky's children face adverse childhood experiences related to economic security.

According to the report, Kentucky has now had four consecutive years in which more than one in every four children lives in poverty, which is consistently higher than the national average. It also reports that more than two in every five Kentucky children live in a high-poverty area.

The report says, " A family's earnings and its poverty status, the level of poverty in its neighborhood and the affordability of housing can all affect how a child grows, learns and ultimately succeeds as an adult."

Boone, Oldham and Spencer counties have the highest scores for economic security, while Lee, Martin and Wolfe have the lowest.

Economic security, based on scores for the four indicators in the report.

The results of the well-being of Kentucky's children around education are concerning.

More than half (51 percent) of Kentucky's children entering kindergarten are not adequately prepared for school and more than half  (51 percent) of its fourth graders are not proficient in reading and "therefore not on the path to high school graduation," according to the report. The study also found that over half (55 percent) of Kentucky eighth graders are not proficient in math and that one in seven Kentucky high school students did not graduate on time.

Oldham and Lyon counties "stand apart" at the top of the  education county comparison, with Clinton, Knox, Menifee and Clay counties ranking last.

Education, based on scores for the four indicators in the report. 

Family and community indicators in the report found that Kentucky is not putting as many youth in jail as in previous years; nearly one in five births were to moms without a high school degree; the number of children living in a single-parent home has grown to 37 percent from 35 percent; and over the course of 2013, over 12,700 children were placed in foster care due to abuse or neglect.

Oldham, Boone, Carlisle, Ballard and Spencer counties rank at the top of the family and community county comparisons, with Powell, Clay, Elliott, Owsley and Carroll counties ranked at the bottom.

Family and Community, based on scores for the four indicators in the report. 

The report recommends implementation of strong policies to combat children's exposure to adverse childhood experiences. "The best option for Kentucky is to find ways to prevent adverse childhood experiences. Ensuring safe, stable and nurturing environments will shield children from toxic stress and its deleterious effects," says the report.

Click here for the Annie E. Casey Foundation Kids Count Data Center, which includes current and historical data. Note that the indicators included in the 2014 rankings are different than those included in the 2013 County Data Book. Therefore, current rankings should not be compared to last year’s county rankings.

More N. Ky. kids taken from homes due to parents' drug use

An increasing number of children in Greater Cincinnati are being taken from their homes because their parents are drug users.

In Campbell County, Kentucky, 68 children were removed from their homes last year compared to 49 in 2008, a 39 percent increase in two years, The Cincinnati Enquirer's Barrett J. Brunsman reports. In the same period in Boone County, the number increased by 34 percent, from 38 to 51. In Kenton County, 346 children were taken last year compared to 286 in 2008, a 21 percent increase.

Ohio counties near Cincinnati showed larger increases and also showed that children are increasingly being removed because their parents are using heroin and other opiates. Kentucky does not track what substances parents use, and doesn't keep statistics on the number of babies who are born addicted, but Anya Weber, a spokeswoman for the Kentucky Cabinet for Health and Family Services, said drug or alcohol abuse by a parent or guardian is a factor in 80 percent of all cases of children who are removed.

Because of the increases, foster parents such as Mark and Denise Strimple (Enquirer photo by Carrie Cochran) are needed. "We always need more," said Brian Gregg, a spokesman for the Hamilton County Department of Job and Family Services. "Not just us, the whole region. I can't put a number on it. A lot of foster parents end up adopting children in their care, and that takes them out of the mix." (Read more)