UK doctor points to treatment for 'hidden disability' of hearing loss

Hearing loss is so often an invisible disability

with treatment options that should be more well

known, said Dr. Beth McNulty, UK HealthCare

neurotologist. (Photo provided by McNulty)

By Rick Childress

University of Kentucky

Forty years ago, there was no effective treatment for deafness.

Now, a nine-month-old infant can get a cochlear implant — a procedure that first got Food and Drug Administration approval in 1984.

“In my opinion, it is one of the greatest achievements of modern medicine,” said Dr. Beth McNulty, a UK HealthCare neurotologist — a doctor who specializes in the ears, nose and throat, commonly known as an ENT.

In the inner ear, a cochlear implant converts acoustic energy into electric energy, stimulating the auditory nerve electrically. It may restore hearing in those born with congenital deafness, as well as patients with slowly progressive hearing loss for whom hearing aids no longer work.

“Cochlear implants are performed on infants up to 103-year-olds,” McNulty said. "I always counsel patients that there's no age limit. We treat each patient individually as far as candidacy for surgery.”

The sense of sound can help a deaf mother hear her crying infant, or help a baby born deaf learn to speak. In honor of World Hearing Day Sunday, March 3, McNulty wanted to highlight how the gift of hearing can connect people and change lives.

“As the hearing loss progresses to the point of cochlear implantation, a lot of patients feel isolated, they feel like they have no hope,” McNulty said. “Communication is what ties you to the world.”

World Hearing Day brings awareness for hearing loss — so often an invisible disability. That became particularly apparent during the Covid-19 pandemic and patients who were hard of hearing couldn’t read the lips of masked people.

“It caused frustration for them, for those trying to communicate with them, like, ‘Why can't you get this?’” McNulty said. “Because they don't have a sign on their forehead that says, ‘I have hearing loss’ or ‘I have deafness.’”

Many of McNulty’s patients are in their mid-life and have had hearing loss that has progressed to where their hearing aids are no longer effective. Sadly, in some places in Kentucky, those individuals aren’t referred for cochlear implantation because of a lack of awareness of the treatment options.

“Through World Hearing Day we want to bring awareness to hearing loss as a disability, an often hidden disability, and bring awareness to the fact that nowadays we have options for treatment,” McNulty said.

Starting in 2019, the surgery can also be performed on those who are deaf in one ear.

Candidates for the surgery often score less than 50% of word understanding during audiology testing. After the surgery, average word recognition increases to 70-80%.

Before surgery, McNulty speaks directly and slowly or uses dictation software when talking with a patient. On activation day, she loves to “test the water” and speaks normally to see if the patient responds. While speech clarity may take time, often, they do respond and describe hearing sounds they haven’t heard in years.

“It’s opening closed doors for patients, bringing back the connection to their loved ones, their friends and family,” McNulty said. “It is such a rewarding part of my job.”

An infant who is born deaf would start with hearing aids by the time they’re six months old, then get a cochlear implant before their first birthday.

“If we do all those things, they will have speech,” McNulty said. “They will be in a regular classroom and may progress like nothing ever happened.”

Few in Kentucky perform the surgery; the state has only six neurotologists. Four work at UK, which also has pediatric otolaryngologists who perform cochlear implants on children, as well as audiologists who are specially trained for cochlear implantation. The audiologists are key members of the team.

“This is their passion,” McNulty said. “They work with these individuals about once a month for a whole year, programming and reprogramming to try to get this to sound just right.”

The team also consists of two cochlear-implant coordinators who help schedule appointments, answer questions and are adept at working with deaf individuals and their families.

McNulty recommends considering getting your hearing checked starting at age 50 — based off data that shows getting hearing loss treated at that age can help slow the onset or progression of dementia.

Other reasons to get your hearing checked:

• Family history of hearing loss
• History of noise exposure like in construction or the military
• Asking people to repeat themselves
• Struggling with background noise
• Tinnitus (Hearing ringing, buzzing, crickets in your ears)

Cochlear implants are a treatment option for nerve hearing loss, but hearing loss may also be conductive, or due to a mechanical problem such as a hole in the eardrum, or a bad infection. Sometimes this can also be treated surgically and reversed.

What causes hearing loss, and when and how it can be treated

Photo by stefanamer/iStock/Getty Images Plus

By Jennifer Shinn
University of Kentucky

Hearing loss can occur when any part of the ear or hearing system is not working correctly. The National Institutes of Health (NIH) estimates that 37.5 million American adults ages 18 and older report some trouble hearing.

It’s important to know the different types of hearing loss and when to seek medical care for hearing.

Conductive hearing loss occurs when sound is unable to travel correctly from the outer ear through to the inner ear. This can be caused by wax, ear infections or other issues like a hole in the eardrum or abnormalities of the bones within the middle ear.

Sensorineural hearing loss involves damage to the inner ear, hearing nerve and/or brain. This type of hearing loss is often caused by aging or noise exposure.

Patients who have a combination of both conductive and sensorineural are considered to have mixed hearing loss.

Hearing loss is usually gradual but in certain instances can be sudden. If sudden, a patient should seek medical care immediately.

Leading causes of hearing loss

For children, genetics accounts for 50 percent of hearing-loss cases. It can also be caused by intrauterine infections such as cytomegalovirus, lack of oxygen at birth, severe jaundice, extended stay in a neonatal intensive care unit, chronic middle ear fluid and infections, meningitis, and chemotherapy.

Adult hearing loss is often age-related. The NIH determines age as the strongest predictor of hearing loss among adults aged 20 to 69. The greatest amount of hearing loss is seen in the 60-69 age group.

There are many things that may cause hearing loss. Common factors that may cause hearing loss include noise exposure, genetics, viral infections and damage to the eardrum.

Common signs and symptoms of hearing loss

Hearing loss can occur in different ways, but some common symptoms may include the following:

• Asking people to repeat themselves.
• The perception that people are mumbling.
• Difficulty hearing in noisy environments.
• Listening to the television or radio at increased levels.
• General increased difficulty with communication.
• Social isolation.
• Ringing in the ears (tinnitus).
• Sensitivity to loud noises.

Anyone who suspects a decline in hearing should be evaluated by a specialist. An audiologist is the primary health care provider who evaluates, diagnoses and manages hearing loss and hearing balance disorders. Audiologists will diagnose the type and degree of hearing loss and provide recommendations for treatment options.

Hearing loss treatment

When medical and surgical management is not indicated, treatment for a patient’s hearing loss can often be managed by hearing aids. This is a non-surgical option. The NIH reports that 28.8 million U.S. adults could benefit from using hearing aids.

Cochlear implantation is a surgical option for patients who don’t benefit from hearing aids.

If you suspect you have hearing loss, contact an audiologist for a hearing evaluation.

Jennifer Shinn, Ph.D., is chief of audiology and professor in the UK Department of Otolaryngology. 

Frankfort power struggle, too few dentists and low Medicaid pay are all barriers to healing the pain in poor Kentuckians' mouths

Dr. Bill Collins treats a patient at the Red Bird Mission
dental clinic in Clay County. (Photo by Deborah Yetter)

By Deborah Yetter
Kentucky Lantern

RED BIRD, Ky. — At the Red Bird Mission dental clinic in southeastern Kentucky, patients with few or no teeth now are eligible for dentures through an expansion of the state’s Medicaid dental services for adults.

“People are tickled to death,” said Dr. Bill Collins, the dentist at the United Methodist Church mission in a remote corner of Clay County. “We get patients who haven’t had teeth for 20 years.”

Dentures and other services newly covered by Medicaid have the potential to remake Kentucky’s image as a state of “toothless hillbillies,” said Collins, who has treated patients in the region for decades. “I hate that image.”

But a political fight in Frankfort over who has the power to enact the new benefits — that also expand vision and hearing services — could end the extra coverage advocates say is desperately needed.

Already the new benefits have started, stopped and started again amid a tussle between Republicans who control the General Assembly and Gov. Andy Beshear, a Democrat who enacted them Jan. 1.

Lawmakers have scheduled a hearing Thursday, July 13 on the new benefits, but already expressed their disapproval at a meeting in May, where Republicans who control the legislature said Beshear usurped their authority over Medicaid, the federal-state health plan for low-income people.

“I’m not necessarily opposed to doing this,” said Rep. Derek Lewis, R-London. “There’s a lot of people in my district that could benefit from this. But the process matters.”

His southeastern Kentucky district usn't the only one. The state ranks 49th in oral health and consistently ranks among the top states in the number of adults with no teeth.

“We really wish that the governor’s office and the legislature, working together, could find a way to get this done instead of being adversarial,” said Dr. Stephen Robertson, executive director of the Kentucky Dental Association.

Since lawmakers have the power to kill the expansion when they next meet in 2024, there’s no guarantee the benefits will last beyond this year.

Samone Gist, a Louisville woman suffering from multiple dental problems, says she just wishes someone would establish consistent, accessible dental care for people like her, who rely on Medicaid for health coverage.

A shortage of dentists — especially a lack of those who accept Medicaid, due to its notoriously low reimbursement rates — makes it difficult to find an appointment, health advocates say.

Recently, Gist said she managed to get one decayed tooth pulled but has others that need treatment. “I was in so much pain, it was unbelievable,” she said. “The pain is unbearable.”

Dental disease is linked to a host of health problems including infection, diabetes complications, heart disease and premature births — all significant health issues in Kentucky. It also is linked to addiction among those prescribed painkillers for dental abscess and decay, problems that too often send people to emergency rooms, advocates say.

Kentucky spends about $9 million a year in Medicaid funds on patients visiting the emergency room for dental pain, according to the Cabinet for Health and Family Services. In such cases, patients generally are prescribed antibiotics for infection and painkillers but don’t get dental care.

By contrast, the expansion of dental, vision and hearing benefits is expected to cost about $36.5 million a year, with $31 million covered by the federal government, which pays most of the state’s share of Medicaid. Beshear has said the state’s costs will be covered from savings in other areas in Medicaid.

Advocates argue that dental health, as well as good vision and hearing, also are essential in helping people get and keep jobs.

“Kentuckians need teeth. They need glasses. They need hearing aids,” said Cara Stewart, director of policy advocacy for Kentucky Voices for Health, a coalition of health groups. “It’s just a no-brainer.”

Gist, who recently attended a job-training program and is looking for work, agrees.

With bad teeth, “It’s embarrassing to do an interview or try to get a job,” she said. “It will definitely hold you back.”

There seems to be little dispute in Frankfort about the need for the expanded dental and other services for the 900,000 adults covered by Medicaid who could benefit.

But that’s where agreement ends.

‘We’re number one’

For decades, adults covered by Medicaid were eligible only for an annual cleaning and tooth extraction. In a poor state where nearly 1.7 million people get care through the federal-state health plan, that led to inevitable results, said Robertson, the dental association executive.

“When the only benefit you’ve got is to have a tooth removed, that’s what the outcome is going to be,” Robertson said, adding that a recent study ranked Kentucky first in the number of toothless, older adults: “We’re number one”

So last October, citing the need, Beshear announced he was using executive authority to expand Medicaid dental, hearing and vision benefits for adults in the program.

Adults can now get dentures, fillings, crowns, and two checkups a year — as well as eyeglasses and hearing aids.

Children enrolled in Medicaid, currently about 637,000, already are eligible for a full range of dental, vision and hearing services.

Republican lawmakers objected to Beshear's move, saying he should have sought legislative approval. They passed Senate Bill 65 to stop the new benefits. But after the legislature adjourned, Beshear issued a new set of emergency regulations to again provide the expanded dental, vision and hearing services.

That restored the benefits but set up a new confrontation with Republicans who hold a supermajority in the General Assembly.

'Groundhog Day'

GOP lawmakers were swift to react, taking up the new version of the benefits at the May 9 meeting of the joint Administrative Regulations Review Subcommittee. They complained the new version looked much like the old version they had already rejected.

“I half expected Bill Murray to come to the table today because I feel like this is ‘Groundhog Day’,” said Senate Majority Floor Leader Damon Thayer, referring to the movie where Murray plays a TV news personality caught in a time loop. “The same thing kept happening over and over again.”

Beshear administration officials, including Medicaid Commissioner Lisa Lee, insisted the plan was within the bounds of a law that prohibits enacting regulations that have been rejected.

Besides, Lee said, with Kentucky’s abysmal ranking in oral health, it’s time to break out of the groundhog mode.

Since 2014, after Kentucky expanded access to Medicaid under the Affordable Care Act to include more low-income adults, the state has moved from 47th to 43rd in overall health rankings. “But we remain 49th in oral health care,” Lee said. “We have got to get something done here.”

Rep. Daniel Grossberg, a Louisville Democrat, agreed.

“Something has got to change,” he said. “We may be having an element of ‘Groundhog Day’ here but we’re living it over and over because neither side’s willing to give.”

Cabinet numbers show that the expanded benefits so far have resulted in dental, vision and hearing services for 196,000 people and about $12 million in payments to providers. About 4,000 adults have received dental services including 2,500 sets of dentures.

Republicans say they don’t necessarily dispute the need for those services, they fault the Beshear administration for failing to work with them.

“You kept coming back after we said no,” said Rep. Randy Bridges of Paducah. “We said no. We said no. You don’t want no. You’re going to do what you dang well please.”

Lewis, co-chair of the committee, said benefits aren't the point. “I think every single person on this committee would be in favor of expanded dental services,” he said. “But our job on this committee is to protect the legislative process.”

The committee voted 5-2 to find the regulations “deficient,” with Democrats casting the two no votes, but the legislature can’t actually block them until it meets again in session in 2024 and enacts legislation to do so.

‘Last bastion of small business’

Meanwhile, Kentucky needs to work on other problems plaguing dental services throughout the state, especially in rural areas, dental officials said.

Medicaid reimbursement rates for dental services have not increased for 30 years to the point where costs of dental care exceed what the program pays, Robertson said: “For an office to decide to participate in Medicaid, they have to agree to operate at a loss.” 

Of the state’s 3,200 licensed dentists, about 57% are signed up to treat Medicaid patients, but many either don’t accept them or limit those they see because of low reimbursement, he said.

The Medicaid reimbursement of $656 for dentures doesn’t cover the Red Bird clinic’s base cost of $1,100, meaning the nonprofit clinic has to make up the difference from other sources, Collins said.

“People tend to forget dentists are the last bastion of small business in Kentucky,” Robertson said. “When you are asked to operate at a loss, that’s not a sound business plan.”

The state’s latest proposed regulations include increased reimbursements for dentists.

The state also doesn’t have enough dentists and other staff, such as dental hygienists, to meet demand.

Even federally qualifed community clinics, long considered the medical safety net, have extended waits for dental care and few openings for patients, said Melissa Mather, chief communications officer for Family Health Centers in Louisville.

Collins, the Red Bird Mission dentist, agrees all those problems must be addressed. But he said another concern is whether the legislature will even allow the expanded benefits to survive.

“I am for this Medicaid expansion big-time,” he said. “But when Jan. 1 hits, they’re going to come in here and stop it.”

Robertson thinks all these problems have solutions, but it’s going to take a concerted effort in a state that ranks 49th in oral health and first in the rate of older adults with no teeth.

When it comes to overall health, “The mouth is the gateway to everything,” he said. “We’re for finding the best way to move forward.”

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

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

By Melissa Patrick

Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

The expanded services cover 900,000 adults on Medicaid. 

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

Just a few more days remain for Kentuckians to offer public comment about the new regulations. The cabinet is accepting written comments until May 31. Comments should be sent to Krista Quarles, policy analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort KY 40621. Her phone number is 502-564-6746; her fax is 502-564-7091; and her email is CHFSregs@ky.gov.

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

May is Better Hearing and Speech Month; state says 700,000 Kentuckians have some degree of hearing loss; here are signs

From a Commonwealth of Kentucky press release

With approximately 15% of American adults reporting difficulty hearing, state officials are encouraging people to learn the signs of hearing loss—and to seek care during Better Hearing and Speech Month in May.

“We know that more than 700,000 Kentuckians of all ages are experiencing some degree of hearing loss. We encourage people to have a professional check their hearing and also to protect their hearing from loud noises,” Gov. Andy Beshear said.

Signs of hearing loss in adults include the following:

• Difficulty following conversations
• Difficulty hearing in noisy environments
• Hearing ringing, roaring or beeping in one or both ears
• Failure to respond to spoken words
• Muffled hearing
• Constant frustration hearing speech and other sounds
• Avoidance of conversation

“Our hearing is key to so many aspects of our lives, but it’s something that many people undervalue until they are having severe hearing difficulties,” said Virginia Moore, executive director of the the Kentucky Commission on the Deaf and Hard of Hearing. “Even then, some people wait years to receive treatment, if ever. This is despite the fact that audiologists can help people in many different ways.

“Hearing loss is much more than a simple nuisance. Left unaddressed, it can affect us in a variety of ways, including increased risk for physical danger such as falling or missing warning signals like a fire alarm; mental health problems, including social isolation and depression; and cognitive decline, including earlier onset of dementia. Our personal relationships, career success and health-care costs can be affected as well.”

As a first step, Moore urged anyone concerned about their own hearing or that of a loved one to seek an evaluation from a certified audiologist. Private insurance, Medicaid and Medicare generally cover such evaluations. People can take this step even if they think they cannot afford hearing aids or other hearing services. Audiologists can advise people on ways to make hearing aids more affordable. In addition, various organizations offer financial assistance.

Aside from hearing aids, audiologists can identify other ways to improve a person’s listening and communication skills. They also can help families support loved ones affected by hearing loss.

If you are experiencing any of the signs above or if you think you have hearing loss, see your doctor or a licensed audiologist to assess the degree of your hearing loss, treat it and develop a plan to prevent further loss. There are several assistive technologies available through KCDHH’s Telecommunications Access Program, which can help you stay connected to emergency information and health-care providers. For more information, visit the KCDHH website.

This article was written and published several days before the May 6 death of KCDHH Executive Diretcor Virginia Moore.

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

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Legislature nixes Beshear's expansion of Medicaid dental, hearing and vision benefits; dentists' lobby says it took no stand on the bill

By Melissa Patrick
Kentucky Health News

The Republican-controlled General Assembly stood by its repeal of Democratic Gov. Andy Beshear's expansion of dental, hearing and vision benefits for 900,000 Kentucky adults on Medicaid.

Beshear expanded the benefits in October through an executive order and regulations that have been in effect since January. Senate Bill 65 declares the regulations deficient, which kills them because the legislature overrode Beshear's veto of the bill March 29 on party-line votes, 30-7 in the Senate and 75-20 in the House.

The bill allows providers to get paid for services initiated before its effective date, which was March 29 because the bill declared an emergency. Bills normally take effect 90 days after a legislative session ends.

Sen. Stephen West

While presenting SB 65 earlier in the legislative session, Sen. Stephen West, R-Paris, said the regulation was deficient because funding for it came from the $38 million in savings that came when the state moved to a single pharmacy benefit manager, a middleman between drug manufacturers and companies that manage Medicaid. West said lawmakers should  have been involved in how those savings were spent. 

Beshear's veto message said SB 65 "will harm Kentuckians and frustrate efforts to increase Kentucky's workplace," noting that research shows that on average nearly 100 million work hours are lost annually in the U.S. because of emergency dental care, that coverage of adult vision services increases a person's likelihood of working full time and that about 16% of Kentuckians have some degree of hearing loss."

Beshear wrote, "Since the regulation, more than 1,000 Kentuckians in all 120 counties have received nearly 3,330 dental services, including from a dentist in Clay County, who since January 1, 2023, has provided four sets of dentures for patients and has 44 more sets of dentures in progress." Clay County is the home of Senate President Robert Stivers, R-Manchester. 

Beshear added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place." He also contended that the regulation-deficiency law is unconstitutional.

Beshear said at a news conference March 23, "I believe a new regulation will allow for the continuation of vision, dental and hearing benefits." That said, SB 65 requires any new regulation to be substantially different from the original.

The Kentucky Dental Association said it took no position on the bill.

Asked if the association supported SB 65, KDA President Don Heine gave Kentucky Health News a letter to KDA members that said, "It doesn’t serve our members or their patients to opine upon the political question of whether a regulation is deficient or not. Accordingly, we took no position on that political question." 

Heine said KDA would like to see both an expansion of basic dental services in Medicaid and larger reimbursements for providers, saying, "I don't think there's been a reasonable increase in Medicaid fees in 20 years."

Low reimbursement rates are often cited as a reason dentists won't accept Medicaid patients, but Heine said, "I think we have plenty of providers." At other points in the interview, he said dental providers "will accommodate far more Medicaid patients when they're at least not losing money" and "We've got to get the legislature to work with Medicaid providers to at least make the funding where people can be seen and we can prevent them from going to the emergency room."

He cited a Texas A&M University study that found patients who go to the emergency room to treat preventable dental conditions costs U.S. taxpayers, hospitals and governments about $2 billion a year. 

Earlier, KDA Executive Director Richard Whitehouse told Kentucky Health News, "We are not opposed to expanding Medicaid services. However, to expand those services and meet the needs of that population, we need to expand the network. We believe incentivizing more providers to join that network and enabling those already in to take on more patients does that. It also lowers the cost of health care by detecting disease earlier and avoids more costly emergency room visits."

When the Senate initially passed the bill, Sen. Stephen Meredith, R-Leitchfield, said a reimbursement increase is especially needed in medically disadvantaged areas. In explaining his vote for SB 65, he also said the money could have been used to help the 5,000 children who are waiting for services from one of the state's special Medicaid waiver programs. 

In the House, as he supported Beshear's veto, Rep. Chad Aull, D-Lexington, said, "We know that Kentucky has many challenges when it comes to some of our health outcomes. Why do we continue to shoot ourselves in the foot by taking away the opportunity to pay for health care for our citizens? I do not understand this legislature's motive in trying to override this veto."

Cabinet for Health and Family Services spokeswoman Susan Dunlap told the Courier Journal in October that federal funds would cover 90% of the expansion's cost. Medicaid is primarily funded by the federal government.

Legislature takes away Medicaid dental, vision and hearing benefits Beshear granted; he indicates he will do it another way

By Melissa Patrick
Kentucky Health News

In October, Democratic Gov. Andy Beshear announced the expansion of dental, vision and hearing benefits for 900,000 Kentucky adults on Medicaid. On March 16, 2023, the Republican-controlled General Assembly took a final vote to take those benefits away, calling the regulation used to install them deficient. Beshear said Thursday that he will find a way to keep them in place.

Sen. Stephen West, R-Paris

In presenting Senate Bill 65, Sen. Stephen West, R-Paris, said the regulation Beshear issued to expand these services was deficient because the funding came from the $38 million in savings that came when the state moved to a single pharmacy benefit manager, a middleman between drug manufacturers and companies that manage Medicaid.

West said using these savings amounted to the governor "appropriating money" and that lawmakers should have been involved in how it was spent.  

"It was a huge change, really that should have been done through, we felt, through statute through involving the legislature," West said at the Feb. 15 Senate State and Local Government Committee meeting.

In October, Cabinet for Health and Family Services spokeswoman Susan Dunlap told the Courier Journal that federal funds would cover 90% of the expansion's cost. She said the state's move to one pharmacy-benefits manager last year "has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward."

As SB 65 went through the legislature, it was amended to extend dental, vision and hearing services through June 30 to allow people already getting the services to receive them and allow providers to be paid. 

The amendment also says nothing in the bill should be construed to prohibit the state Medicaid department from increasing reimbursement rates, long a goal of health-care providers. The Kentucky Oral Health Coalition says Medicaid's dental provider rates have been stagnant for more than 20 years.

Sen. Stephen Meredith, R-Leitchfield, said a rate hike is especially needed in medically disadvantaged areas. In explaining his vote for SB 65, he also said the money could have been used to help the 5,000 children who are waiting for services from one of the state's special Medicaid waiver programs. 

"I just want to remind folks that what we're asking here is for some involvement from the legislature," Meredith said. "Talk to us. Let us have some input in this." 

What's next? 

Before the expansion of these services, they were offered on a limited basis. 

Dental services for adults were limited to an annual cleaning and extractions linked to certain medical conditions. Adult fillings were not covered. The expansion allowed coverage for fillings, dentures, implants, root canals, extractions, restorations, periodontics and an additional cleaning each year.

Also, under the old rules, a Medicaid enrollee could be evaluated for hearing loss only on referral from their primary-care doctor; and glasses and contact lenses were not covered, though exams were. Some managed-care firms offered some of these services as an incentive to get people to enroll with them.

Asked at his weekly news conference Thursday if there is a way to maintain the benefits, Beshear said, "I believe a new regulation will allow for the continuation of vision, dental and hearing benefits. The expansion of those benefits, the funding coming from the federal government is an executive branch function. But even at the hearing, I believe . . .  one of the legislators said it looks like you'll need a new regulation."

SB 65 requires any new regulation to be substantially different from the original. If Beshear vetoes the bill, the legislature could easily override the veto.

Beshear called the need for dental, vision and hearing benefits for people on Medicaid a "no-brainer" because "This is what gets people back to work." He elaborated:

"There's a study that talks about over 100 million work hours lost due to dental, emergency dental procedures that if you have coverage you avoid. Now there are studies out there about the number of people that can't go to work because we don't cover getting them a pair of glasses. And then think about safety on the job site. You know a ton of Americans . . . suffer from hearing loss. And to be able to get to the job and to do it correctly, you need to have that type of coverage. Again, if we care about the workforce, right, let's take the basic steps to get more people healthy [and] back to work." 

Access to providers

West also argued that health-care providers tell lawmakers that even if these services are permitted in Medicaid, the program's reimbursements are so low that it will be hard for the patients to find providers. 

That said, the health cabinet says thousands of Kentuckians on Medicaid have already taken advantage of these services since they became available Jan. 1.

"As of Feb. 22, more than 8,000 Kentuckians – across all 120 counties – have already received dental, vision, and hearing services they need under these regulations," the cabinet said. "More than 1,000 Kentuckians received nearly 3,330 dental services under these regulations – in all 120 Kentucky counties – including from a dentist in Clay County who since Jan. 1, 2023, had provided four sets of dentures for patients and has 44 more sets of dentures in progress."

Clay County is the home of Senate President Robert Stivers, R-Manchester.

The cabinet added, "Nearly 7,000 Kentuckians have received vision services under these regulations, with nearly 43,000 services provided. And 40 Kentuckians have received hearing services with these regulations in place. . . . Providers have received over $1 million in reimbursement for the services."

Health advocates push back 

Health advocates were disappointed in the bill's passage and called for legislators to reinstate thes services. 

"The genesis of this unfortunate piece of legislation is a raw partisan battle between the General Assembly and the governor," said Terry Brooks, executive director of Kentucky Youth Advocates. "Both branches of our government should be holding each other accountable when one thinks the other overstepped its bounds. Yet, there should also be no doubt that neither providers nor Kentucky families should pay the price for a political food fight. SB 65 has providers left holding the bag with more Kentuckians losing dental benefits than the total population of Alaska. It's as unwise as it is unfair." 

In a statement about the passage of SB 65, the Oral Health Coalition cited the great need for comprehensive dental services in Kentucky, noting that the state ranks among the bottom five states on several oral-health indicators and has more seniors with no natural teeth than any other state. 

"While it was a worthy debate about the process to expand services, the reality now is that 900,000 low-income, disabled, and other vulnerable Kentucky adults must once again go without critical dental care," the coalition said. "By no means is this expansion the answer to the growing oral health crisis in Kentucky, but it can offer a first step toward providing comprehensive dental care for Kentuckians. The Department for Medicaid Services and the General Assembly must reach an agreement in the immediate aftermath of the legislative session so our Commonwealth can be back on track to providing folks with the health care they need to be healthy, work, and thrive." 

Emily Beauregard, executive director of Kentucky Voices for Health, an advocacy group, told Kentucky Health News in an e-mail, "Regardless of the politics, it's clear that Kentuckians don't have enough access to the dental, vision, and hearing care they need to be healthy. We've made progress in recognizing that mental health is health and we need to do the same for our mouths, eyes, and ears."  

She added, "Whether it's through regulation or legislation, we need policymakers to increase access to these services to improve population health and build a stronger workforce," she added. With the passage of SB 65, "I hope legislators will take action to increase services through legislation instead."

Beshear announces initiative that will expand Medicaid dental, vision and hearing benefits for more than 900,000 Ky. adults

Dept. for Medicaid Services graphic

By Melissa Patrick

Kentucky Health News

Pitching it as a way to expand the state's workforce, Gov. Andy Beshear announced Thursday the expansion of dental, vision and hearing benefits for 900,000 Kentucky adults on Medicaid.  

"One of the major obstacles in getting some people into the workforce is they're simply not healthy enough to do it. Challenges in their health are preventing them from either looking for or securing a job," Beshear said at his weekly news conference.

"These are really basic things, folks. If  you can't see, it's really hard to work. If you can't hear the instructions that you're getting, it's really hard to work. If you have massive dental problems that are creating major pain or other complications, it's really hard to work.. . . Today, we're announcing that for many Kentuckians, we're removing the roadblocks that they face in accessing dental, vision and hearing care." 

Beshear said the vast majority of the program will be paid by the federal government and the rest of it will be absorbed into the existing Medicaid budget. "It will require no changes to our budget in this next session," he said. "In other words, it is easily affordable, which means we absolutely should do it."  

Susan Dunlap, spokeswoman for the  Cabinet for Health and Family Services, told the Louisville Courier Journal that federal funds would cover 90% of the estimated $36 million annual cost for the expansion, with the state covering the rest. She added that the state's move to one pharmacy benefit manager last year "has resulted in significant ongoing savings to the Medicaid program that will provide enough funding for this program moving forward."

Medicaid is a state-federal program that provides health insurance for low-income adults and pregnant women, the disabled, and families with incomes at or below 138% of the federal poverty level, which amounts to about $18,700 per year for an individual or $38,200 for a family of four. Youth 21 and under who are enrolled in Medicaid already qualify for dental, vision and hearing services.

Kentucky adults on Medicaid already have access to some dental and vision benefits; the hearing benefits are very limited. Starting on Jan. 1, those benefits will be greatly expanded.

For example, the only dental services Medicaid now covers for adults are an annual cleaning a year and extractions based on certain medical conditions. Dunlap said fillings are not covered for adults, but the expansion will add coverage for fillings, dentures, implants,  root canals, extractions, restorations, periodontics and an additional cleaning each year. 

Dunlap said the new hearing benefits will cover screening tests and hearing aids for adults. Now an adult can be evaluated only if they had a referral from their primary doctor. 

The vision changes will cover eyeglasses and contacts for adults. Now, vision exams are covered by Medicaid, but glasses and contact lenses are not. 

Managed-care organizations, which provide care for Kentuckians on Medicaid, were already offering some of these services as extra benefits to incentivize beneficiaries to choose their company. 

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded Beshear's decision to expand benefits, noting the value of employment as one of the most important "social drivers of health." 

“All of the data shows that when you work, you've got a much better chance of having good health," he said. "So, it's a circular thing. You have to have good health to be able to work and you have to be able to work to have good health.”

One of the challenges that people on Medicaid already have when it comes to getting dental care is that there aren't enough dentists who will accept Medicaid insurance, mainly because the rates are so low. 

Asked about this, Beshear said, "We are going to have to make sure that there is access all across Kentucky," he said. "When you think of health care, it has to be affordable. . . . So it's going to be hard work. We're going to see what those barriers are, but it's about commitment and being intentional to make sure we get health care to those folks. " 

Dunlap said Kentucky is submitting the state Medicaid plan amendment to make these changes to the Centers for Medicare and Medicaid Services and that they do not anticipate any issues with approval. 

Open enrollment for Medicaid members runs through Dec. 1 for coverage beginning Jan. 1. Medicaid open enrollment gives Medicaid members a chance to change the insurance company that manages their care.  Medicaid members who chose to not participate in open enrolment will keep the same managed care organization, or MCO, that they are currently enrolled in.

The coronavirus may be able to infect the inner ear

Image: Christine Daniloff, MIT

Covid-19 may be able to infect the inner ear and cause auditory and balance problems.

A study published in Communications Medicine examined 10 patients from Massachusetts Eye and Ear specialty hospital who were experiencing hearing problems, such as hearing loss and tinnitus, and who had tested positive for the coronavirus. Study co-lead Konstantina Stankovic, who was working with patients with hearing problems said, "It was very unclear at the time whether this was causally related or coincidental, because hearing loss and tinnitus are so common."

Possible routes to the inner ear include a tube from the nose to the ear in which the virus could travel, or through small openings in nerves that would allow the virus "to enter the brain space and infect cranial nerves," including ones that lead to the inner ear, the study says.

The researchers developed models of various inner-ear cells, and they found that that the virus was capable of infecting two types of cells, one of which aids in "sensing head movement and maintaining balance," they report.

“Having the models is the first step, and this work opens a path now for working with . . . other viruses that affect hearing,” said Lee Gehrke, the study's other co-lead. The researchers also said the models may help to test future possible inner ear treatments for various viral infections.

TVs in public places need closed captioning turned on, especially during breaking news, to help the deaf or hard of hearing

By Melissa Patrick
Kentucky Health News

For the nearly 700,000 Kentuckians who are deaf or hard of hearing, breaking news stories on television, like those about the new coronavirus, are often only pictures on a screen, The fix for this problem is sometimes as easy as turning on the closed captioning option on the remote, especially in public venues.

Closed-caption symbol
(Image from Wikipedia)

Closed captioning displays the audio portion of a television program as text on the TV screen for those who are deaf or hard-of-hearing. It can be accessed through the television's remote.

Virginia Moore, executive director of the Kentucky Commission on the Deaf and Hard of Hearing, said to alleviate misinformation and fear, it is important to make sure information about the cornavirus and other breaking news is being communicated clearly, including to those who are deaf or hard of hearing.

"Just imagine not being able to get the correct information and how that escalates fear," she said.

Moore said public entities, like airports, doctor's offices and restaurants need to do their part to make sure they are using closed captioning if they have a public TV, especially if there is breaking news.

"If they have breaking news, that needs to be captioned," she said. "It's very easy. It's a button on your remote; push that button, have the captioning available so that those individuals with a hearing loss will be able to see the important information coming across, just like everyone else who is sitting there." 

Virginia Moore is the sign-language interpreter at Gov. Andy
Beshear's coronavirus press conferences. (WKRC image) 

And while hearing loss is often associated with aging, Moore said loud music and listening to music at unsafe volumes with ear buds has resulted in one in five American teens experiencing some type of hearing loss.

Moore pointed to WDRB-TV in Louisville as a great example of a station that offers real-time closed captioning. She said WDRB has been able to offer this service because of its partnership with Norton Healthcare, which underwrites the cost.

Because real-time captioning can be costly, Moore encouraged stations across the state to seek out similar partnerships, calling it a "win-win,"  since the station gets more devoted viewers and the partner gets advertising.

It's important to note that while some stations may have closed captioning, it is sometimes limited to whatever is on their scripts and does not include anything that is ad-libbed, and some stations may not offer any captioning for live broadcasts.

Another reason to not ignore hearing loss: Study shows it will likely cost you more in health-care expenses

Untreated hearing loss in older adults affects more than just their ability to communicate. It can also increase their health-care expenses.

Medical News Today photo

A Johns Hopkins Bloomberg School of Public Health study found that older adults with untreated hearing loss pay an average of 46 percent more -- or $22,434 more -- for health care over a decade, compared to those who have no hearing loss.

“Knowing that untreated hearing loss dramatically drives up health-care utilization and costs will hopefully be a call to action among health systems and insurers to find ways to better serve these patients,” lead author Nicholas Reed said in a news release.

Reed is a member of the core faculty of the Cochlear Center for Hearing and Public Health at the Bloomberg School and an instructor of audiology in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine.

The study, published in JAMA Otolaryngology-Head and Neck Surgery, saw differences as early as two years after diagnosis, with the patients who had untreated hearing loss showing a 26 percent increase in total health-care costs, more than half the difference found after 10 years. Of the 46 percent increase after 10 years, an average $20,403 of it was incurred by the patient's health insurer and $2,030 by the patient in out-of-pocket costs, the study found.

The findings "add to a growing body of research from Johns Hopkins and elsewhere showing the detriments of untreated hearing loss, which include a higher risk of dementia and cognitive decline, falls, depression and lower quality of life," says the release. It notes that hearing loss affects 38 million Americans, a number that’s expected to double by 2060. One in three Americans between 65 and 74 has hearing loss, and two-thirds of adults 70 and older have a clinically significant loss.

Nearly 700,000 Kentuckians have hearing loss, or about 16 percent of the commonwealth's citizens, according to the Kentucky Commission on the Deaf and Hard of Hearing. Click here to see how many people in your county have hearing loss.

How the study was done, and what might be done in response

Using data from OptumLabs Data Warehouse, the researchers identified more than 77,000 patients with likely age-related untreated hearing loss, excluding those who used a hearing aid or whose hearing loss was secondary to another condition.

An in-depth analysis found that after 10 years, "Patients with untreated hearing loss experienced about 50 percent more hospital stays, had about a 44 percent higher risk for hospital readmission within 30 days, were 17 percent more likely to have an emergency department visit and had about 52 more outpatient visits compared to those without hearing loss," the release says. And of the extra $22,434 in total health care costs, only about $600 was due solely to hearing loss-related care.

The study did not indicate why untreated hearing loss drives up health-care costs, but the release notes that a companion paper using the same data found that hearing loss is independently associated with "significantly greater" incidence of disease.

"For example, compared to those without hearing loss, those with untreated hearing loss had 3.2 more dementia diagnoses, 3.6 more falls and 6.9 more depression diagnoses per 100 people over 10 years.
Over 10 years, those with untreated hearing loss had an estimated 50 percent greater risk of dementia, 40 percent greater risk of depression, and almost 30 percent higher risk for falls compared to those without hearing loss," says the release.

“We don’t yet know if treating hearing loss could help prevent these problems,” Jennifer A. Deal, co-author and assistant scientist in the Bloomberg School’s Department of Epidemiology, said in the release. “But it’s important for us to figure out, because over two-thirds of adults age 70 years and older have clinically significant hearing loss that may impact everyday quality of life."

Deal also said poor communication could play a role in the higher costs for patients with hearing loss, noting that they may have trouble communicating their symptoms or hearing what their provider is saying about their care. One solution, she said, is increased access to "amplification devices," which the release notes will become more readily available in 2020, when a federal law authorizing certain types of over-the-counter hearing aids will go into effect.

The study was done in collaboration with AARP, the University of California San Francisco, and OptumLabs.

Hearing loss can lead to cognitive decline or even dementia, but is often unaffordable, and financial aid for it is shrinking

By Trudy Lieberman
Rural Health News Service

Nearly two-thirds of adults over age 70 have hearing loss that doctors consider “clinically meaningful.” In plain English that means as people age, they are likely to become hard of hearing. Many of those people, however, don’t get the help they need, often because they simply cannot afford it.

“The prevalence of hearing loss almost doubles with each age decade of life,” says Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, but for older people, he adds, “there are multiple barriers that prevent individuals from getting their hearing loss addressed.”

Lin spoke about the subject to a group of journalists in a recent phone conference sponsored by a Washington, D.C., advocacy group the National Committee to Preserve Social Security and Medicare. He is a co-author of a June report issued by the National Academies of Sciences, Engineering, and Medicine that recommends better access and support for treating hearing loss.

Lin told the group that although hearing loss is a normal part of the aging process, “hearing care is inaccessible” to many seniors. He said studies over the last five years have shown that such loss “can increase the risk of cognitive decline.”

Using data from a longitudinal study (one that tracks data from the same people repeatedly over many years or decades) that began in 1958, Lin and his colleagues at Johns Hopkins found that those with hearing loss had a higher probability of developing dementia. The more severe the loss, the more likely the dementia.

Photo from howmanyarethere.net

That isn’t the only problem. Hearing loss is also associated with a greater risk for falls and other accidents because a person can’t hear traffic or a smoke alarm in their home. Furthermore, those with hearing loss often feel isolated and shun normal social contacts because they can’t hear others speak. That’s a blow to productive aging, the goal promoted by the late Dr. Robert Butler, a well-known gerontologist who fought against ageism.

So why, then, is hearing care so inaccessible? Cost may be the major barrier. Nearly all expenses for hearing care must be paid out-of-pocket, and for many seniors on fixed incomes, that’s sometimes hard to do. Lin told me the average cost of two hearing aids is $4,700 and rarely covered by insurance.

Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams, but only if your doctor orders those tests to see if you need medical treatment. In that case, if a person has traditional Medicare and a Medicare supplement policy, often called a Medigap, he or she has to pay 20 percent of the approved amount for the exam. Some Medicare Advantage plans may include hearings tests as part of the extra benefits they offer.

The National Committee and other advocacy groups are campaigning to add a hearing benefit to Medicare’s benefit package. Their campaign is bucking a trend in Washington to cut Medicare benefits by raising the age of eligibility, making richer seniors pay more, and requiring those with traditional Medigaps to have more skin in the game.

Politicians have already begun redesigning Medigap policies to make seniors pay more out of pocket for their care. Beginning in 2020, for example, insurers will not be allowed to sell Medigap policies that cover the deductibles for Medicare Part B that pays for physicians’ services, lab tests and hospital out patient care. The theory behind this shift is that seniors will pay more and the government less, thus helping to save Medicare money.

I asked Dan Adcock, the National Committee’s policy director, about the chances of adding benefits to treat hearing loss, or for that matter vision and dental care, when the focus has been on cutting benefits of all kinds. He said one major source of funds to pay for hearing aids could come from lowering the price of what Medicare pays for drugs. The 2003 legislation that gave seniors a drug benefit also prohibited the government from negotiating prices for the drugs it buys. Drug makers strongly oppose such negotiations.

Adcock said he remains hopeful. If better hearing means a decrease in dementia, falls and accidents, fewer people would need treatment for those conditions. The savings could potentially “pay” for the hearing aids, he said.

For now, though, seniors and their families are on their own. The National Academies offer an "Action Guide for Individuals and Families" that suggests actions people can take to prevent hearing loss, and strategies for families to cope with it when it occurs. It’s available at www.nas.edu/hearing.

What experiences have you or a family member had with hearing loss and obtaining treatment? Write to Trudy at trudy.lieberman@gmail.com.

Ear, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children

Dr. Matthew Bush, an otolaryngologist at the University of Kentucky, is working to reduce the state's high rate of hearing loss, especially in Appalachia and among children. He was born in Charleston, W.Va., and attended medical school at Marshall University in Huntington. "In the course of his extensive training, Bush 'fell in love' with hearing health care, ear surgery and technologies like cochlear implants that offer revolutionary opportunities for people who are deaf or hard of hearing to rejoin or enter the hearing world," Mallory Powell writes for UK. 

"It was the clinic setting that informed and fueled my efforts and interests because the patients that we see have some tear-jerking stories," Bush said. "They didn't have access to services, or they were totally unaware that there were options to help their hearing impaired child. So they show up at the clinic very delayed, well past the optimal age for intervention, and the child has already lost a lot of language development potential."

About 1 in 1,000 children experience pediatric hearing loss, and Bush said the rate is much higher in Kentucky, 1.7 out of 1,000 in Kentucky. Though hearing loss isn't life-threatening, it can greatly impact the quality of life, influencing speech, language and cognitive development in children. Early detection is important for successful treatment. "The consequences of delaying care in the first few years of life are amplified dramatically," Bush said.

Rural residents deal with many health disparities, and "delays in pediatric hearing health care are unfortunately common," Powell writes. "Children with hearing loss in rural areas are diagnosed later than children in urban areas and subsequently receive interventions like hearing aids and cochlear implants at a later age."

This rural hearing-health disparity results from factors such as distance from health-care facilities and inadequate knowledge of the importance of timely care for pediatric hearing loss. Bush says he hopes to employ telemedicine to reduce the effects of distance from facilities, with "diagnostic testing, patient counseling and hearing loss rehabilitation with hearing aids and implants. These services have not been offered before in Appalachia."

Bush is also working to increase parental knowledge about pediatric hearing loss and educate rural primary-care physicians in diagnosing and treating pediatric hearing loss. "This is not something that they're seeing on a daily basis, so provider knowledge about next steps and resources is limited," Bush said. He and his colleagues have created online educational modules that will be circulated to providers.

"In an ideal world . . . there would be a seamless transition from the birthing hospital to resources for hearing testing and treatment, whether face-to-face or via telemedicine. We'd like the quality of care and access to care to be the same for all children. That's really what our passion is," Bush said. (Read more)

Hey, fans! Lower your voice and protect your ears; your hearing might be at stake

Ray Hull (Wichita State Univ. photo)

December is the cruelest month, basketball fans -- in more ways than one. Witness this news out of Kansas.  Yes, Kansas: Loud basketball games can often generate deafening noise that result in real hearing loss. So says Wichita State University audiologist Ray Hull, who found that gymnasiums and arenas are built like reverberating echo chambers that can wreak havoc on ears by amplifying noise to dangerous levels.

Hull says the intensity level at some basketball games -- even at middle and high school games -- can reach 115 decibels. "We can stand that noise without permanent damage to our hearing for approximately seven and half minutes," he explained. "Those who are most susceptible to damage to their hearing are those who are sitting, for example, near the pep band or, of course for those in the pep band, because intensity levels can reach 125 to 130 decibels. At that intensity level, you are susceptible to permanent damage to your hearing after about a minute and a half of exposure."

Noise-reducing plugs, available in most grocery or sporting goods stores, would provide the protection necessary to prevent this kind of injury. (Read more)

Kentucky parents' overall perception of Kentucky children's health doesn't match the statistics, foundation survey finds

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)