Top senators, one of whom lost both parents to smoking, say no advocates spoke to them about increasing anti-tobacco spending

By Al Cross
Kentucky Health News

Kentucky's top two state senators said Tuesday that none of the advocates for more funding of tobacco prevention spoke to them about it during the legislative session that ended Monday night.

"I never heard from those advocates. They never came to meet with me, and they probably should've. . . . I was in the room where it happened, and nobody ever spoke to me," Majority Floor Leader Damon Thayer of Georgetown said in response to a question from Kentucky Health News.

Thayer spoke at a Capitol rotunda press conference where leading Senate Republicans discussed what they considered to be the session's accomplishments. Senate President Robert Stivers told Kentucky Health News afterward that no one ever spoke to him about the proposal to increase tobacco-prevention spending to $10 million a year from $2 million.

Letter to senators (For a larger version, click on it.)

The proposal came from the American Cancer Society and several other groups interested in better health, including the Kentucky Chamber of Commerce. In a letter to senators, they said smoking is the No. 1 cause of preventable death in Kentucky and causes $2.23 billion in health-care costs, including $634 million in the federal-state Medicaid progam that covers more than one in three Kentuckians.

"A well-funded, fact-based tobacco control program is needed to counteract the $251 million per year that tobacco companies are spending to market their deadly and addictive products in Kentucky," the letter concluded. "As Big Tobacco has been working hard to addict future generations with e-cigarettes and other tobacco products, the need for more funding for tobacco-prevention programs has never been greater."

Thayer said after the press conference, "I get stacks and stacks of budget requests, and if they say, "I sent him a letter or an email,' that's not effective."

Kentucky Health News asked Doug Hogan, the Kentucky lobbyist for the cancer society, what legislators the advocates spoke with and why Stivers and Thayer were not included. He replied with this email:

“The American Cancer Society Cancer Action Network (ACS CAN) is proud to have advocated for the health of Kentuckians during this General Assembly session by asking for an increase in funding for the state’s tobacco prevention and cessation program. ACS CAN staff and volunteers were able to contact Senate and House offices to share the importance of this funding. ACS CAN is disappointed that our message was not heard, and a significant investment was not made in programs to help prevent kids from starting to use tobacco products, including e-cigarettes, and help those already addicted to quit.”

Neither side noted that the administration of Gov. Andy Beshear didn't ask for more money, either. Asked why, Cabinet for Health and Family Services spokeswoman Stephanie French said in an email that the legislature "reduced the tobacco prevention and cessation budget by more than $2.6 million" in the previous state budget, and "after flat-funding at $2 million" a year in the current budget, "The legislature has further reduced the tobacco prevention and cessation budget by another $130,700 in the recently enacted ... biennial budget. Both of these reductions were significantly lower than what Governor Beshear proposed in his Executive Branch budget."

French said Beshear put nearly $1 million extra into tobacco control due to increased receipts from the Master Settlement Agreement with cigarette manufacturers. "This was a doubling of the budget for tobacco cessation and prevention investment for this year and that money is being deployed now."

At the press conference, Stivers was asked if tobacco-control spending would be a good investment in the long term, by reducing health-care costs. He gave Thayer the microphone.

Asked if he thinks the current $2 million tobacco-control budget doesn't work, Thayer said, "I honestly don't know that it does. Honestly. I mean, how much money can you spend trying to dissuade people from doing something that everybody knows is unhealthy?"

Earlier, he said, "Everybody knows that smoking cigarettes is bad for you. . . . My dad knew the health risk his whole life and he never quit." Earlier, he said, "Both my parents died of cancer from the fact that my father was a multi-pack-a-day smoker, so this is an issue that's a little sensitive to me."

Thayer told Kentucky Health News after the press conference he believes that smoking killed his father, who died of esophageal cancer, and that secondhand smoke in their home killed his mother, who died first, of multiple myeloma: "I never saw her smoke a cigarette in my life." He acknowledged that more education on the risks of seocndhand smoke is needed.

When the final budget was released, Kentucky Health News asked Senate budget committee Chair Chris McDaniel of Northern Kentucky why there was no increase in tobacco-control spending. He said, "We kind of distributed it more broadly, with increases in funding for cancer research."

Stivers said likewise at the press conference, adding that health departments also got more funding. "What we are trying to do in all areas is to encourage people to have better and healthier lifestyles," he said.

Despite waiting list, a shortage of nurses and plenty of money, governor and legislature don't fund new building for KSU nursing

Kentucky State University’s nursing program has outgrown the Betty White Health Center, opened in 1971. Nursing classes are spread in buildings across campus. (Kentucky Lantern photo by Jamie Lucke)

By Sarah Ladd
Kentucky Lantern

Kentucky State University requested $50 million this year to build a nursing school for its growing class of future health care providers. The governor and legislature rejected the request, even though the KSU program has a waiting list and Kentucky suffers from a shortage of nurses but enjoys a record surplus.

“The real tragedy is that we had the money to do it,” Rep. George Brown Jr., a Lexington Democrat, told the Lantern last week. He called the omission “a travesty.” Brown and other lawmakers said the decision is part of a long pattern of neglect and underinvestment in historically Black colleges and universities (HBCUs) — a disparity the Biden administration also has highlighted.

It’s “always been the history,” said House Democratic Floor Leader Derrick Graham, a KSU alum who urged Republican legislative leaders to fund the nursing building.

During House debate, Black lawmakers pointed out that Kentucky’s only public HBCU was being denied $50 million for a project they deem critical to its future, while $125 million was quickly found for Northern Kentucky University and the University of Kentucky to open a biomedical center in downtown Covington, where plans also call for NKU to move its law school.

The Senate added the Covington project to House Bill 1, which moves $2.7 billion from the Budget Reserve Trust Fund into one-time spending over the next two years. HB 1 includes other higher education projects: $60 million for a veterinary tech facility at Murray State University, $25 million for a UofL Health cancer center in Bullitt County and $22 million for a livestock innovation center at a UK research farm.

“Kentucky State always seems to suffer and always has to wait,” Brown said March 29 on the House floor. “‘You have to wait your time; it’s not your time.’ … So the question is, when will it be Kentucky State’s time?”

When budget negotiators met in a free conference committee on March 26, Graham asked why KSU’s “top priority” was not included in budget legislation. Graham represents Frankfort where KSU sits on a hill overlooking the capital city. Sen. Chris McDaniel, chairman of the Senate budget committee, said KSU had also revised its budget request by asking for money to deal with failing infrastructure and other maintenance needs.

House Bill 6, the budget bill, sets aside $60 million in bonding for “asset preservation,” described by McDaniel as “cleaning up campus.” House Bill 1 includes $5 million to design a Health Science Center for the nursing program but nothing to build it. McDaniel vowed “full intent” to pay for construction of KSU’s nursing building in the 2026 budget bill. McDaniel’s district includes Covington; he was instrumental in obtaining the $125 million for the downtown project involving NKU.

“We have a great deal of confidence in the new president of Kentucky State,” McDaniel said in the March 26 meeting. He was speaking of Koffi Akakpo, who became KSU’s 19th president last year on July 1. Before that, he was president of Bluegrass Community and Technical College.

HB 6 provides all the public higher-ed institutions with asset preservation funding pools for renovation and maintenance of buildings and other infrastructure.

During the free conference committee meeting, Democratic Senate leaders Gerald Neal of Louisville and Reggie Thomas of Lexington, both of whom are Black, said that expanding KSU’s nursing program is critical to the school’s rebound from recent troubles. The construction delay will cost KSU new students and needed tuition revenue and disrupt Akakpo’s plan for the future, said Neal.

Neal and Thomas urged the budget negotiations to reconsider. Thomas suggested spending less on restoration and maintenance at KSU in this budget to free up $50 million over the next two years to design and build the nursing building.

Senate Republican Floor Leader Damon Thayer of Georgetown responded ​​that KSU was “probably lucky that they get the taxpayer money that they have been getting and continue getting. With the recent numbers and results that have come from K-State, I think we should be dubious moving forward.” He said the “numbers have been pretty embarrassing.”

KSU has faced a series of controversies, including misused funds under a former administration and a 2023 warning from its accreditation body. In 2022, the legislature put KSU under a management improvement plan and provided $23 million to help it recover from a budget deficit.

In an interview with the Lantern last week, Akakpo said he is “grateful” for the $60 million in bonding but that it will “go quickly” as he tackles a list of maintenance needs.

The HVAC system, he said, is “not quite up to par” and the dorms are “in really bad shape.” Sidewalks and entryways need fixing, he said, and “leaky roofs” have caused damage that needs attention. The $60 million does “not quite” cover these needs, he said. “But we will try the best we can.”

A new building for nursing students and money to address maintenance needs were “both equally crucial for us to move forward,” Akakpo told the Lantern.

KSU's 342 nursing students make up 24% of the university's enrollment, and the program is “only going to grow,” said Akakpo. Nursing students study in three separate buildings because no designated building is large enough.

The Betty White Health Center, which is 53 years old, has administrative offices and a learning lab. Students take classes in Bradford Hall, Carver Hall and Hathaway Hall. “The building is needed because the building that is assigned to the nursing program is too small,” Akakpo said. It’s also already full.

Kentucky is thousands of nurses short of what it needs. The state is short 5,391 registered nurses and licensed practical nurses, according to the Kentucky Hospital Association. And, the students going into nursing school aren’t enough to replace those retiring and leaving the workforce.

Brown said KSU’s backlog of maintenance needs stems from historic underinvestment. The historically Black university, he said, is “the redheaded stepchild, if you will” of Kentucky higher education.

The Biden administration last year documented roughly $12 billion in underfunding for HBCUs nationwide when compared with state funding of similar predominantly white institutions.

The study compared land-grant institutions created by Congress in the 19th century, first for white students and later for Black students. KSU and UK are Kentucky’s land-grant universities. In Kentucky the disparity in per student state funding from 1987 to 2020 was $172 million.

U.S. Education Secretary Education Miguel Cardona and Agriculture Secretary Tom Vilsack sent letters to governors, including Kentucky’s, asking for states to right the “historical underinvestment.”

A letter from Cardona to Gov. Andy Beshear cited “unbalanced funding” and “longstanding and ongoing underinvestment” as reasons KSU “has not been able to advance in ways that are on par with University of Kentucky.” It added that “unequitable funding” of KSU put it $172.1 million short of what it would have received in the last 30 years.

The budget Beshear introduced in December did not include money for the KSU nursing building. It did ask lawmakers to allocate about $1.2 million to KSU for nursing and social-work scholarships in 2024-26.

State Senate restores most Medicaid cuts made in the House

Dr. Bill Collins treats a patient at the Red Bird Mission dental

clinic in Clay County. The Senate budget would increase

dentists' Medicaid fees. (Ky. Lantern photo by Deborah Yetter)

By Deborah Yetter

Kentucky Lantern

The state Senate has largely eliminated cuts to Medicaid that were proposed in the House budget. A top state official had warned the House plan would create a hole next year in the federal-state health plan that covers 1.5 million low-income Kentuckians, a third of the state's population.

“We are pleased that the Senate’s proposed budget restores funding to Medicaid so patients can continue to access the necessary health care services they’re accustomed to,” said a statement from the Cabinet for Health Services, which manages the $15 billion a year federal-state program.

Cabinet Secretary Eric Friedlander appeared before the Senate Appropriations and Revenue Committee last month, along with John Hicks, budget director for Democratis Gov. Andy Beshear, asking the Republican-majority Senate to consider restoring the funds the House cut for the fiscal year that begins July 1.

“This creates a hole in the Medicaid budget for Fiscal Year '25,” Hicks told the committee.

Advocates worry the House plan could force cutbacks in Medicaid services through more than $900 million in cuts to the amount sought by Beshear.

Republicans generally have expressed support for the Medicaid program that pumps money into hospitals, clinics, pharmacies and other medical services throughout the state—with 70% to 80% of the funding provided by the federal government. But some have expressed concern it has grown so large.

The Kentucky Center for Economic Policy told the Lantern last month that overall, the House plan cut about $139 million in state funds Beshear sought for Medicaid in fiscal 2025, which would cause the state to forfeit another $783 in federal matching money, for a total of around $922 million.

The Senate moved its budget bills through committee and to a final floor vote on Wednesday. Dustin Pugel, policy director for the center, said Thursday it appeared the Senate had restored most of the funds but made some cuts including a reduction in “waiver programs” for people with disabilities.

The House plan included about $200 million — about $143 million of that in federal funds — for 2,550 new slots in Medicaid “waiver” programs such as "Michelle P." that provide housing, therapy or other supports for people with disabilities.

Thousands of people are on waiting lists for such services, which generally have been increased by only 50 or so each year.

The Senate version reduces the number of slots over the next two budget years to 1,925.

The Senate did not fund proposed “mobile crisis units,” which were also left out of the House budget. They would provide an alternative to police intervention when someone is experiencing a mental-health crisis.

But the Senate did include an increase in Medicaid payments for dental services, which oral-health advocates say is urgently needed to attract more dentists to the program in a state with high rates of dental disease.

Overall, Pugel said, the Senate plan is “good news for the Medicaid budget.”

However, the budget process is far from over. The House will consider the Senate changes, and if it disagrees, as is usually the case, the budget will bedecided by a House-Senate conference committee.

Beshear lieutenants tell Senate that the House didn't budget enough for Medicaid, based on enrollments they have projected

By Deborah Yetter
Kentucky Lantern

The state Senate began its review of the House two-year budget proposal Feb. 14, starting with Medicaid, which spends $15 billion a year to provide health coverage and other services to about 1.5 million Kentuckians who are low-income, disabled or meet other criteria.

The Senate Appropriations and Revenue Committee heard from Eric Friedlander, secretary of the Cabinet for Health and Family Services, and John Hicks, budget director for Gov. Andy Beshear — chiefly about their concerns over cuts in the state’s share of the program that gets 70%' to 80% of its money from the federal government.

Health Secretary Eric Friedlander said the best way to cut Medicaid

rolls is to attract better-paying jobs with health coverage. State Budget

Director John Hicks is at his right. (Kentucky Lantern photo by Deborah Yetter)

“This creates a hole in the Medicaid budget for Fiscal Year '25,” which begins July 1, 2024, Hicks told the committee. He said the House’s proposed budget for FY 2026 does not cut Medicaid.

Advocates worry the House plan could force cutbacks in Medicaid services in FY 2025 through more than $900 million in cuts to the amount sought by Beshear, a Democrat, in his budget proposal.

Republicans, who firmly control both chambers of the General Assembly, will enact the final budget.

Jason Bailey, executive director of the Kentucky Center for Economic Policy, told the Kentucky Lantern that overall, the House plan cuts about $139 million in state funds Beshear sought for Medicaid in FY 2025, which would cause the state to pass up, another $783 million in federal matching money for a total of around $922 million.

Rep. Jason Petrie (R-Elkton), chairman of the House budget committee, has said the House presumes fewer people will be enrolled in Medicaid, now that the federal government is requiring enrollees to recertify annually that they are eligible. That requirement was dropped during the public health emergency of the Covid-19 pandemic.

But Hicks said state budget forecasters worked hard to project how many people will leave Medicaid—so far, around 200,000—and develop an accurate count for the governor’s budget proposal. “We’ve incorporated those numbers into the budget forecast,” he said.

Advocates are hopeful the Senate will restore the state’s share of funds for Medicaid.

Committee members made few comments as they listened to the Beshear administration officials.

Sen. David Givens, R-Greensburg, expressed concern about the growth in Medicaid, which covers about a third of Kentuckians, including more than a half million children and most nursing-home residents.

Givens asked how to reduce the number of Kentuckians enrolled in Medicaid. Friedlander said most adults who are in the prohgram and not disabled or elderly are working at low-wage jobs without health insurance.

“Getting higher-wage jobs, that’s the way that you work on having fewer people eligible for Medicaid,” Friedlander said. “I think that will make as big a difference as anything else.”

Givens suggested a committee meeting during the interim after the legislative session ends to discuss specific ways to reduce the Medicaid rolls, noting that Medicaid has grown significantly during his 15 years as a legislator. The big jump was in 2014, when the state expanded it under the 2010 Patient Protection and Affordable Care Act to households with incomes up to 138 percent of the federal poverty threshold.

American Cancer Society wants state to spend $10 million a year on smoking cessation and prevention; current budget is $2 million

Graph from Broken Promises to Our Children: A State-by-State Look
at the 1998 Tobacco Settlement 24 Years Later; click on it to enlarge.

By Melissa Patrick
Kentucky Health News

The American Cancer Society Cancer Action Network will ask legislators in the upcoming General Assembly session to spend a lot more on tobacco prevention and cessation, with a focus on how decreasing smoking and vaping rates would improve Kentucky's economy and its workforce.  

Doug Hogan, the group's government-relations director for Kentucky and West Virginia, told Kentucky Health News that Kentucky's high smoking rates come with great cost to people's health, health-care systems and the economy. 

"From a business perspective, businesses are losing thousands of dollars each month because of lost productivity and also on increased health-care costs for their employees who smoke," Hogan said. "This is a huge cost factor for our businesses and it's also a healthy-workforce issue." 

In a news release, Hogan said "Smoking is estimated to cost Kentucky $2.23 billion in direct health-care costs, including $634 million in Medicaid costs annually. Additionally, smoking costs the state an estimated $6.3 billion in productivity costs annually." 

Doug Hogan (LinkedIn photo)

Hogan praised state officials for creating in the last several years environments that are conducive to expanding businesses and creating more jobs, but he told KHN, "If there's not a healthy workforce to fill in those jobs, then a lot of that is for naught. And so we want to take a look at the economics of this and say, we need to focus on a healthy workforce." 

The cancer society's ask of $10 million a year for tobacco cessation and prevention is $8 million more than the state is spending now. 

This increase would prevent 2,400 Kentucky teenagers from growing into adults addicted to deadly nicotine products, Hogan said in an email. 

"We want to use the additional funding for prevention so that our next generation of young people don't grow into adults who are addicted to deadly nicotine products," he said. "And then the other part of that is to provide the tools and the resources that adults need, who want to quit, to be able to be successful and move toward a smoke-free lifestyle." 

In Kentucky, the release said, “22.5% of high school students currently use tobacco products, including e-cigarettes, and 17.4% of adults in Kentucky smoke, which is over 40% higher than the national average.”

Hogan said in the release, "Kentucky has the opportunity to turn these numbers around with the 2024 budget. For every $1 spent on comprehensive prevention and cessation programs, states receive up to $55 in savings from averted tobacco-related health-care costs. So, a $10 million investment would be a great step toward a healthier workforce and could save up to $550 million." 

The University of Kentucky's Markey Cancer Center will evaluate the program to ensure the state is getting the maximum return on its investment, Hogan said.

He added, "We know that kids who experiment with electronic cigarettes are much more likely to experiment with other tobacco products and more likely to become addicted to deadly nicotine products."

A document presented to the legislature's Tobacco Settlement Agreement Fund Oversight Committee in September showed the estimated monthly and annual costs to employers from cigarette smoking, by county. In Adair County, where 26% of the adult population smokes, the annual cost to the workforce for the estimated 1,138 adults in the workforfce who smoke is $7.9 million. 

The 2024 legislative session convenes Jan. 2 and must adjourn by April 15. The deadline for filing for legislative seats and other partisan offices in the 2024 primary elections is Jan. 5. 

Lawmaker on key committees supports an increase in funding

Sen. Amanda Mays Bledsoe

Sen. Amanda Mays Bledsoe, R-Lexington, vice-chair of the Senate Appropriations & Revenue Committee and co-chair of the House-Senate tobacco committee, said she agrees with the cancer society's argument that reducing the number of people who smoke will save money in the long run and would create a healthier workforce. 

"I think their plan is on the right track," she said. 

However, she added, that she'll have to wait and see what is in the House budget before before she can react to this request. The budget must start in the House. 

"I'm not really sure where that's gonna land," Mays Bledsoe said, "but I am supportive of their ask."

She added that it's important to recognize that the tobacco-settlement money touches several pieces of the budget, with half of it allocated for agriculture diversification. 

"I was really surprised over the years of where they've used program money," she said. "And my biggest surprise was how much of it was not used on specifically tobacco cessation." That was one of the big arguments for the states' 1998 settlement with cigarette manufacturers, but states have spent relatively little on it.

Kentucky 43rd in smoking cessation and prevention funding

While $10 million would be a huge jump from the current $2 million in tobacco prevention and cessation spending, it would still fall far short of the $56.4 million advised by the federal Centers for Disease Control and Prevention.

According to a report titled Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 24 Years Later,  Kentucky ranks 43rd among states in funding tobacco prevention and cessation programs, down five slots from 2020, when it spent $3.3 million.

Meanwhile, the tobacco industry spends $251 million for tobacco marketing in the state, says the report, issued by the cencer society, the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association, the Truth Initiative and Americans for Nonsmokers’ Rights.

Quit help for Kentucky smokers

Kentucky smokers have several tools to help them quit.

The state runs a 1-800-QUIT-NOW hotline that offers free tobacco-cessation services 24 hours a day, seven days a week. Coaching is available by phone or online chats. .

And while Quit Now Kentucky provides free services to people of all ages, middle- and high-school students may want to try "My Life, My Quit," a free, confidential quitline for Kentuckians 17 and younger to help them stop smoking or vaping. Teens can text "Start My Quit" to 36072, or click on the live chat button on the My Life, My Quit website to chat with a coach.

A 2017 law requires insurers, including Medicaid, to cover all seven tobacco-cessation medications approved by the U.S. Food and Drug Administration, and counseling services recommended by the U.S. Preventive Services Task Force. It also eliminated co-payments for medication and counseling, requirements tying medication coverage to counseling, and limits on the length of treatment.

The cancer society also offers a list of resources to help you quit using tobacco products.

Hogan said many Kentucky smokers still don't know what quitting resources are available to them, even though research shows that more than two-thirds of smokers say they want to quit.  

"But it's very difficult," he said. "If we increase the tobacco prevention, cessation programming, and the investment that we're making there, we can have more of an impact on the folks to get them the resources they need to quit."

UK cancer center gets top U.S. designation, shared by 55 others

UK wasted no time promoting the new designation Friday on its
Cornerstone display on Limestone Street. (Photo by Al Cross)

Kentucky Health News

The University of Kentucky's cancer center has received the highest designation from the National Cancer Institute, making it the first such center in Kentucky, it announced Friday. The United States has 56.

In 2013, the Markey Cancer Center received its initial NCI designation, held by 72 centers in the nation. It worked for a decade to get the higher designation, based on research, treatment, diagnosis and prevention.

“It’s really the gold standard of clinical care, research and community outreach,” said Dr. Mark Evers, who has been director of the center since 2009, when the university started trying for NCI designation.

UK President Eli Capilouto said, “To truly be the University for Kentucky, we raised the stakes and decided that UK will continue to be a leader in cancer research by becoming a comprehensive cancer center.”

That required hundreds of millions of dollars in investment from UK and the state legislature, which put in $135 million in 2013 and another $20 million this year, state Senate President Robert Stivers said.

Kentucky has the nation's third highest rate of death from cancer, behind West Virginia and Mississippi, and cancer is the state's second most common cause of death, next to heart disease. 

The closest comprehensive cancer center to Lexington is nearly 200 miles away, a UK press release noted without mentioning the one at Vanderbilt University in Nashville, which competes with UK for patients living in Western Kentucky. Indiana University has a comprehensive cancer center in Indianapolis.

"The elevation to an NCI-designated comprehensive cancer center will further enhance Markey's ability to attract top-tier researchers and clinicians, secure additional research funding, collaborate with national and international partners, and give patients access to leading-edge treatments and clinical trials – resulting in better patient care and health outcomes for Kentuckians," the release said. "Numerous studies show that patients treated at NCI-Comprehensive Cancer Centers have better survival and recovery rates."

In addition to the comprehensive designation, NCI awarded the center $13.5 million through a five-year renewal of its grant for research programs, shared equipment and resources.

Since 2013, more than 100 cancer researchers have been recruited to UK and external funding to Markey researchers has more than doubled, the release said. Markey’s outpatient visits have increased by 69% and the number of new patients has gone up 75%.

The center's growth prompted UK to start work on a new treatment center and advanced ambulatory complex that will bring Markey's outpatient services under one roof. It is expected to open in 2027.

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.

Opinion: U of L Health should repay all its state loan, not just half

By Jim Waters
Bluegrass Institute for Public Policy Solutions

The University of Louisville Cardinals men’s basketball squad gave its fans a timely stocking stuffer Dec. 14 with the team’s first win of the season, beating the Western Kentucky Hilltoppers at the KFC Yum Center.

U of L’s health-care system should follow suit and offer taxpayers some Christmas joy by fully repaying the $35 million borrowed from the Commonwealth under the auspices of needing the money to purchase Kentucky One Health’s assets, including Jewish Hospital.

The money was neither needed nor used for these purchases.

In previous columns, we urged lawmakers to “invite the university to either pay for this project out of its already-flush-with-cash pockets or seek a loan from the private sector.”

Kentucky’s taxpayers “should be outraged that U of L lobbied heavily for this loan even though the university is flush with hundreds of millions in cash and is more than capable of making this acquisition without one red cent from Frankfort’s coffers,” we opined.

But taxpayers’ voices were drowned out by the Santa-sized claims of former U of L President Neeli Bendapudi, who doubled down on her assertions that the loan was “vital” to purchasing the additional facilities and that there was no other way for the university to absorb Kentucky One Health’s operating losses.

Documents obtained by the Bluegrass Institute Center for Open Government reveal that not only was U of L capable of acquiring the funds to make needed improvements to the previously faltering Kentucky One Health system without the government loan, but that the monies were used for a variety of capital purchases, including upgrades to the system’s emergency medical records platform, computer replacement/remediation and even a new roof at Jewish Hospital.

Such outlays can improve a hospital’s ability to provide quality care, but were they so “vital” that UofL needed a subsidized, partially forgivable taxpayer-backed loan from state government to purchase them?

“Partially forgivable”? This health-care giant is only required to pay back half the loan even though the enterprise reaped year-over-year total operating revenues of $2.2 billion while holding more than $1 billion worth of total assets during the most recent fiscal year, according to audited financial statements obtained by the Center for Open Government via the open-records law.

In their annual report to the Legislative Research Commission, officials indicated they anticipated paying back “the obligated portion of the loan” ($17.5 million) ahead of schedule.

Bluegrass Institute Visiting Policy Fellow Andrew McNeill instead urges the company to “meet this moment by respecting Kentucky’s working families and taxpayers who ponied up for what has proven to be an unnecessary loan” by going beyond what’s statutorily required and repaying the entire loan.

New U of L President Kim Schatzel, whose administration officially begins in February and who has extensive business and private sector experience, should appreciate what a welcome gift that would be for the Commonwealth. Perhaps she could help spread some needed holiday cheer by voicing her own support for full repayment.

McNeill wrote in a letter to Interim Joint Appropriations and Revenue Committee members that such a gesture “would make an immediate and positive impression with Kentucky’s taxpayers, especially those from outside of Jefferson County.”

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.

CDC says 108 counties have elevated Covid-19 risk; Ky.'s new-case rate ranks 2nd; Beshear urges use of new booster vaccine

CDC map, adapted by Kentucky Health News

By Melissa Patrick

Kentucky Health News

The pandemic in Kentucky remains on a rough plateau, but it's a high plateau.

Seventy of Kentucky's 120 counties have a high level of Covid-19 risk and 38 have a medium level, with very little change in the last two weeks, according to the latest Centers for Disease Control and Prevention's risk map. 

Only 12 counties show a low level of risk, and The New York Times ranks Kentucky's seven-day new-case rate second among the states, so most Kentuckians still need to take some level of precaution to avoid the virus. 

Last week, the CDC map, which is based on new coronavirus cases, hospital admissions and hospital capacity, showed 70 counties in orange, at high risk; 42 in yellow, at medium risk; and eight in green, at low risk. 

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Some of the counties in which the risk of coronavirus grew in the past week were in Western Kentucky: Hickman, Ballard, McCracken, Graves, Livingston, Crittenden, Marshall and Lyon. Counties showing improvements included a cluster around Louisville that moved from orange to yellow, and a cluster around Christian County that moved from orange to green. 

Jefferson County's move to the yellow zone means masks will no longer be required in its public schools, starting Monday. District policy requires universal masking if the county is at high risk. (Olivia Krauth of the Courier Journal notes that the district has not made an official announcement of the change.) 

The best way to protect yourself from the coronavirus is to get fully vaccinated and boosted. 

The new, updated Covid-19 booster shot that targets the original strain of the coronavirus and major Omicron subvariants has already been distributed to some parts of the state and will soon be available statewide. The new booster is recommended for all persons 12 years and older who had their last dose two months ago. 

"It doesn't matter if you've had three or four shots, you need to get this one if it's been at least two months since you got your last one," Gov. Andy Beshear said at his weekly news conference. 

He added that he and his family will get the new booster: "It is safe and it is going to protect us from, or better protect us from, the variant that is out there." 

Asked if funding or programs are scheduled to promote the booster, the Democratic governor said there would not be because "most if not all of the funding that would support that has either been cut or not provided in the current budget" by the Republican-controlled legislature.

He said others must pick up the slack.

"Now is an important time for everybody that's out there with any type of megaphone, whether that's business leadership or running for office, to say very clearly that these new Omicron booster shots are safe, are effective, and people should get them. It's part of our civic duty to protect one another," Beshear said. "And the fastest way to get out of this pandemic -- because we all want it to end -- is for people to get out there and get boosted."

State data shows that only 67% of Kentuckians have received at least one dose of a Covid-19 vaccine;  58% have been fully vaccinated and 46.6% of those who are fully vaccinated have been boosted.

In abortion ruling's wake, Senate GOP caucus chair says Ky. must see to adoption and human services, protect jobs in pregnancy

Senate Majority Caucus Chair Julie Raque Adams (LRC photo)

By Al Cross

Kentucky Health News

The U.S. Supreme Court's reversal of its Roe v. Wade decision means more work for the Kentucky General Assembly, a leading state senator said in a Lexington television interview broadcast Sunday.

"That issue will probably take up a lot of space in this upcoming session," Majority Caucus Chair Julie Raque Adams, a Louisville Republican, told Bill Bryant on WKYT-TV's "Kentucky Newsmakers."

"It's important for the legislature to make sure we have adequate resources for adoption care," that the state is "fully implementing" the two-year-old Pregnancy Protection Act for workers and "make sure that the human services end of things are funded so we are helping families and helping women," she said.

The extent of activity on the issue will likely depend on what the courts do between now and convening of the session in January, Raque Adams said: "We'll probably take our lead from the courts."

A Louisville judge is considering a lawsuit arguing that the state constitution's implied grant of privacy rights, which the state Supreme Court extended to strike down a law banning sexual relations between people of the same sex, creates a privacy right to abortion. Whatever his ruling, an appeal is certain.

Not so certain is whether, during appeal, courts will continue to block state laws that ban abortion after the sixth week of pregnancy and ban all abortions except those needed to save the woman's life or keep her from becoming disabled. The latter law was written to take effect if Roe v. Wade was overturned. 

Raque Adams noted that the Nov. 8 ballot includes a constitutional amendment that would negate the lawsuit's argument by saying that the state constitution does not create a right to abortion or government funding of it. She said she is telling people on both sides of the issue that debating the amendment is "a great way" for people to engage with the issue.

Democratic Gov. Andy Beshear has said he opposes the amendment, calling it "extreme" because it has no exceptions for rape or incest. Asked if she supports the amendment, Raque Adams did not answer directly: "Yes, I voted to put that on the ballot."

Asked if the legislature might try to ban abortion medication, the most common method of abortion, or restrict Kentuckians' travel to states with less restrictive abortion laws, Raque Adams said she had not heard such legislation mentioned for Kentucky.

Owensboro Health plans education facility for health professions

Google map locates business center where health-professions training facility will be housed.

Owensboro Health, which operates the largest hospital in Western Kentucky and owns two others in Greenville and Leitchfield, is planning to build a training facility for nurses and other medical professions.

The Commonwealth West Healthcare Workforce Innovation Center will be funded with $38 million in the state budget through the work of Rep. Suzanne Miles of Owensboro, chair of the House Republican Caucus, reports James Mayse of the Owensboro Messenger-Inquirer.

President and CEO Mark Marsh said his hope is to have the center ready to start operating by January in the company's business center at 25th and Frederica streets. It will train nurses, radiologists and professionals in fields such as behavioral health and community health, a press release said.

"Roughly, there area about 30 different disciplines" that will be taught at the facility, Marsh told the Messenger-Inquirer.

Courses will be taught by faculty members from nine colleges and universities, including Kentucky Wesleyan College and Brescia University of Owensboro, Owensboro Community and Technical College, Western Kentucky University and the University of Louisville's nursing school.

Marsh said the institutions will create the curriculum with the advice of Owensboro Health, and students will get degrees from their parent universities. He said it could be possible for students to get degrees or certifications from more than one university.

The center will include both classroom space and "simulation labs," where students will practice being in patient rooms and operating rooms, Marsh said.

He said the facility "will also offer mathematics and science instruction to high school students, and it can teach classes through remote learning to high schools across western Kentucky," Mayse reports. "Marsh said the center will be a way for high school students to learn about health-care careers."

"I think a lot of kids slip through the cracks," he said. "It is imperative on us to create the enthusiasm and create the pathway" to a healthcare career.

The center is an effort to address anticipated shortages in healthcare workers. Its operations will be headed by Bart Darrell, former Kentucky Wesleyan president. "Darrell, an attorney who led KWC for five years until 2019, was named vice president" of the center, Mayse reports.

Ky. Nurses Assn. and its school-nurse task force aren't happy with the lack of state funding to reduce the nursing shortage

Centers for Disease Control and Prevention photo

May is National Nurses Month, a reminder of the essential services that nurses have always provided, but especially during the pandemic, which has been so stressful that many have left the profession.

To address the nursing shortage in Kentucky, the General Assembly passed a bill that has both short-term and long-term solutions, but the Kentucky Nurses Association and its school-nurse task force aren't happy with it. 

"If anyone thinks the nursing shortage in Kentucky was addressed by the governor or the legislature during this current session, they are certainly misguided. At best, it has been window dressing by the governor and an attempted appeasement by the legislature to show they were doing something for nursing," Lois Davis, Pat Burkhart and Carol Komara, members of the KNA school nurse task force, wrote in an op-ed.

In a separate statement, the nurses' association said: "Despite the herculean efforts of the Kentucky Nurses Association and nurse leaders across the state that included lobbying, a massive letter-writing campaign, a statewide press conference, state and national news coverage and multiple testimonies in front of lawmakers, Kentucky’s budget did not include any of KNA’s detailed $100 million ask to combat the critical nursing shortage in the commonwealth." 

Delanor Manson, the association's chief executive officer, said in a news release, "While we are devastated by this development, National Nurses Month gives us the opportunity to show our appreciation for nurses by letting them know we will not waver in our commitment to recruiting and retaining more Kentucky nurses."

Manson added that the association will pursue other funding streams and collaborative relationships, calling on businesses, industries and regional organizations to contribute to the cause. KNA says Kentucky will need an additional 16,000 nurses by 2024.

“We encourage all Kentucky residents to reach out to their lawmakers now to solidify relationships that will help us secure funding in the 2023 session and beyond," Manson said. "The conversation about this critical issue must continue – lives are depending on it."

KNA says the association's initial recommendations included "securing private grants, corporate sponsorships for nurse retention bonuses, nursing scholarships and emeritus programs to entice retired nurses to re-enter the profession. In addition, KNA leaders invite organizations dedicated to workplace safety to provide funding and collaborative programming to benefit nurses and those in their care." 

Senate Bill 10, sponsored by Sen. Robbie Mills, R-Henderson, and Senate President Robert Stivers, R-Manchester, is designed to help out-of-state and foreign-trained nurses to practice in Kentucky without compromising standards of care; improve access to nursing education by removing "arbitrary" enrollment limits, without compromising the quality of the programs; and adding term limits and geographic requirements for the state Board of Nursing.

After pointing to the impact of the pandemic on nursing staffing, and education and the verbal praise they received by the governor and the legislators for their sacrifice, the school-nurse task force also criticized the legislature's lack of funding to decrease the nursing shortage in Kentucky. 

"Did our governor or the legislature think it might need to show some appreciation to nurses by allocating some of the Covid dollars to assist with retention of those tireless professionals?" they asked. "No. Instead, their solution was to recruit nurses from other states and foreign territories through licensure endorsement with minimum requirements. Did they not have the foresight to recognize that there are approximately 89,000 licensed nurses in the state of Kentucky and that, with some creative efforts, could recruit some that are licensed but not currently practicing?" 

The task force said incentive scholarships could have been have been created to attract more nurses into practice, and into higher education as nursing faculty. Or, they wrote, money could have been allocated to provide a nurse in every school, all day, every day. 

"Instead, the legislature created SB 10 and the governor signed it, shifting the burden and responsibility for alleviating the nursing shortage to the Kentucky Board of Nursing," they write. "To declare an emergency during a pandemic and then try to solve it by increasing enrollment for the future, without funding, is both a simplistic and unrealistic solution." 

KNA's school-nurse task force said Gov. Andy Beshear and legislators failed to listen to qualified nursing representatives on the governor-appointed task force, "who provided an in-depth analysis and offered realistic solutions to the nursing shortage. Instead, they chose to rush their decisions and legislate another unfunded mandate, SB10, without allocating any funding to combat the nursing shortage." 

Burkhart, Davis and Komara wrote, "The public needs to stand in support of the nursing profession. Your vote counts in every election."

Not only is this month National Nurses Month, May 6-12 is National Nurses' Week. Nurses will be marching to Congress May 12 at the National Nurses March in support of fair, realistic wages; including no caps; safe staffing patient ratios; no violence against healthcare workers; and changing the culture of the biases and discriminations in the nursing profession.

Senate passes its version of state budget with many health items; $100 million would 'support a response to the nursing shortage'

By Melissa Patrick
Kentucky Health News

The state Senate passed its version of a two-year state budget by a 30-6 vote Wednesday, the same day it passed out of committee. The bill will soon head to a House-Senate conference committee that will write the final version.

The Senate-revised House Bill 1 has a number of health provisions, with some variations from the House version and Gov. Andy Beshear's proposals.

The Republican-controlled chambers and the Democratic governor have three different approaches to addressing the nursing shortage, which has been exacerbated by the coronavirus pandemic. 

Photo from American Nurses Association

The Senate allocated $100 million of federal relief money in the first year of the budget, starting July 1, "to support a response to the nursing shortage," without giving any details. The House included no money for the retention and recruitment of nurses.

Beshear, who said Thursday that the focus needs to be on retention, called for $6 million each year from the General Fund for nursing scholarships; and from relief funds, $5 million a year for five years to create a new student loan-forgiveness program and $2 million for a marketing and outreach campaign.

The House budget and Beshear's budget both include $17.7 million in the first fiscal year and $19 million in the second fiscal year to cover the costs of local health departments required services, but the Senate's budget only allocated money for the second fiscal year in the amount of $19 million. 

Randy Gooch, executive director of the Jessamine County Health Department, said the Kentucky Health Department Association isn't sure why the Senate would have left out an allocation for fiscal year 2023 and Sen. Chris McDaniel, R-Ryland Heights, who crafted the Senate budget has not yet returned a call for clarification. 

The Senate budget includes Beshear's wish for for 500 new Michelle P. waiver program slots for people with intellectual or developmental disabilities; the House provided for 100. The Senate added 200 slots to the Supports for community Living waiver program for similar beneficiaries, double what Beshear and the House proposed. Both programs have thousands of Kentuckians on their waiting lists.  

The Senate agreed with the House on extra funding for domestic-violence shelters, rape crisis centers and child-advocacy centers, allocating $500,000 more for each in each fiscal year. Beshear proposed a 36% increase each year for each type of organization: $2.5 million, $1.78 million and $1.3 million, respectively.

And while the Senate and House budgets both would fund 200 more social workers, Beshear's budget proposal would have funded an additional 350. 

To implement the new 988 suicide hotline, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024, the Senate budgeted $3.37 million in the first year and $9.9 million in the second, the amounts Beshear recommended. The House allocated much more: $12.4 million in the first year and $17.6 million in the second, but directed that the money also be used to create more mobile crisis units. 

The Senate allocated $500,000 in each year for the Lung Cancer Screening Program that would be established with the passage of HB 219. The bill passed the House in late January and in the Senate Appropriations and Revenue Committee, which wrote the revised budget. 

The Senate budget also says that each Medicaid managed-care organization that has a participating contract with Kentucky in the next contract renewal will cover lung-cancer screenings.  

Here are some other health-related provisions in the Senate budget. 

From the Tobacco Settlement Fund:

• $500,000 in each fiscal year to support the Kentucky Rural Mental Health, Suicide Prevention and Farm Safety Program, titled the "Raising Hope Initiative."
• $1.4 million each year for substance-abuse prevention and treatment for pregnant women with a history of substance-use disorders;
• $7 million each year for the Health Access Nurturing Development Services Program (HANDS) for poor families with young children;
• $900,000 per year for the Healthy Start initiatives;
• $900,000 a year for early-childhood mental health;
• $900,000 a year for early-childhood oral health;
• $2 million a year for smoking cessation. Advocates have long asked for more smoking cessation funding, asking recently on a Kentucky Educational Television lung-cancer forum that this amount, at minimum, go back to the pre-pandemic level of $3.3 million.
  

From the General Fund:

• $6.25 million in each fiscal year for cancer research and screening to be equally shared by the University of Kentucky and the University of Louisville;
• $500,000 in the first year and $493,500 in the second year for spinal-cord and head-injury research (an amount that was previously taken from the Tobacco Settlement Fund); 
• $93,700 in each year for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma;
• $500,000 each year for the Kentucky Colon Cancer Screening Program;
• $100,000 per year for The Hope Center of Lexington for addiction recovery;
• $900,000 a year for The Healing Place, a Louisville recovery program;
• $1,495,000 a year to support the Lee Specialty Clinic, which provides specialty medical services for individuals with moderate developmental and intellectual disabilities living in residential and community settings. 
• $7.2 million in the first year and $14.48 million in the second fiscal year to expand the senior citizens' meal program. The appropriation will come from federal relief funds. 
• $1 million in the first year to support external performance reviews of substance-use treatment programs administered or funded by the health cabinet. 
• $2.5 million in each year to the Kentucky Pediatric Cancer Research Trust Fund; Beshear's proposal provided $3.75 million in each fiscal year. 
• $750,000 per year for the Kentucky Poison Control Center, unless federal emergency relief funds become available;
• $1 million a year for the Ovarian Cancer Screening Outreach Program at the University of Kentucky; the House budget had $500,000 a year. 
• Federal and state funds are allocated in both years to maintain the pandemic-elevated reimbursement of $29 per day per Medicaid patient in nursing homes.
• Money is provided to support expansion of of a pilot program for Tim's Law to additional locations as a way to ensure statewide access. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door them going in and out of jails and state psychiatric hospitals.

Senate bill to address the state's nursing shortage passes its first hurdle, but some say it wouldn't do enough

Photo illustration via Nolan Group Media

UPDATE, March 1: The Senate passed the bill 36-0.

By Melissa Patrick
Kentucky Health News

A bill to address the nursing shortage in Kentucky passed out of a legislative committee Wednesday, but the state nursing association and several lawmakers said more needs to be done to keep nurses in the profession.

"This is not just related to hospitals, it's related to long-term health-care facilities and anybody else who relies on nursing," Senate President Robert Stivers, a co-sponsor of the bill, told the Senate Health and Welfare Committee. 

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, offers four key measures: licensing reciprocity between other states and nations, higher enrollment caps, looser nursing-instructor qualifications and restructuring the state Board of Nursing.

The panel approved the bill after rewriting it to address issues involving temporary work permits and credentialing requirements for nurses with degrees from foreign nursing schools, and saying a nursing program's students must have an 80% pass rate on the licensure exam over three years, instead of five. 

Delanor Manson, CEO of the Kentucky Nurses Association, told the committee, "Senate Bill 10 and the revisions are going in the right direction, but it doesn't go far enough." She presented a five-point plan that called for spending $100 million in state funds to address the nursing shortage. 

First, she called for repeal of Kentucky's requirement that advanced-practice registered nurses have a collaborative agreement with a physician to prescribe narcotics and some other controlled substances. 

"There are approximately 2000 APRNs who are practicing outside Kentucky because they cannot practice to the full extent of their licensure and experience and education," Manson said. "We need to bring those nurses home."

Manson estimated that other parts of her plan would bring about 1,500 of the 5,000 retired nurses in Kentucky back into the workforce, through education and retraining. It also calls for expanded training through increased faculty salaries and loan forgiveness; recommends a campaign to make sure nurses know they are appreciated; and offers retention bonuses for nurses who stayed in their communities throughout the pandemic.

Several legislators also called for more efforts to keep nurses on the job. 

"I do think the greatest improvement could be if we had some retention money set aside in our budget to really work toward keeping our nurses long term in Kentucky," said Democratic Sen. Denise Harper Angel of Louisville. "But this is an excellent first start." 

Sen. Stephen Meredith, a Leitchfield Republican and former hospital administrator, praised the bill but said, "I'm a little bit concerned that we don't have more focus on the retention side of it. . . I don't think people understand how demanding nursing has become." 

Nancy Galvagni, president of the Kentucky Hospital Association, spoke in favor of the bill, saying the nursing shortage has been building for years and has placed great stress on hospitals. She said hospitals are burning through reserves to hire traveling nurses to fill the gaps, at of $200 to $250 per hour. 

"These expenses are not sustainable and they could easily lead to cuts and services," Galvagni said. "And we know that hospitals are already looking at what services they may need to discontinue." 

Sen. Ralph Alvarado, a physician who works in long-term care facilities, called the situation "dire."

"We have a lot of facilities that are shutting down wings, because they don't have adequate nursing staffing," said Alvarado, R-Winchester. "We know that our hospitals haven't been able to operate at its fullest capacities, because we don't have nursing staff to manage a lot of those wings in our hospitals." 

Democratic Gov. Andy Beshear declared an emergency in mid-December, allowing the state to take special measures to educate and license more nurses.

His order requires the nursing board to approve requests for enrollment increases if a school has sufficient resources; requires schools to report vacant student seats to the board monthly to post online, and send the board a list of needed faculty; allows a school to open new campuses more quickly; and improves reciprocity with other states. Beshear's budget proposal also included scholarship and loan-forgiveness money to attract and retain nurses.

School nurse advocates disappointed that the House didn't fund a nurse for every school, but say they will lobby the Senate for it

By Melissa Patrick
Kentucky Health News

Representatives of the Kentucky Nurses Association's School Nurse Task Force were disappointed that the state budget that passed the House Jan. 20 did not include their requested funding for a full-time nurse in every Kentucky school every day, but said they would take their request to the next step.

"We definitely will carry the fight into the Senate, as we think that the time has never been better to make this investment in students’ health – physical and mental – and in school safety," Sheila Schuster, KNA policy consultant and a longtime mental-health advocate, told Kentucky Health News.

The House budget is in a committee substitute for House Bill 1, which passed out of committee and the full House on the same day, and went to the Senate on an 85-8 vote.

Nurse Vicki Williams worked at a school
in Calloway County in this 2017 photo.

The House left more than $1 billion unappropriated, and even more in the budget reserve or "rainy day" fund. Legislators are planning a tax-reform package that would reduce revenue during the biennium that starts July 1.

Schuster and Eva Stone, a nurse practitioner who is the health services manager for Jefferson County Public Schools, had asked a House budget subcommittee Jan. 18 for $18 million over the next two years to ensure that every Kentucky school building has a full-time nurse in it – all day, every day. 

This amount was based on a survey of school-nurse salaries in bordering states and other Southern states, said Schuster. The total salary and benefits, for each full-time school nurse would be $56,598. 

Schuster said the advocates hope that the benefits of placing a nurse in every Kentucky school would be researched by the University of Kentucky College of Nursing.

Stone pointed out that Kentucky is in the bottom 10 states for multiple health conditions in children, including mental health, diabetes, asthma, obesity and oral health, and that having a full-time nurse in the building would help to address these conditions.

“With all these negative health indicators we have in the state of Kentucky, having some systems in place to try and address these things early on can have a big impact for children, both educationally and for their long-term health," she said. 

Stone added that research shows that schools with nurses have improved attendance rates with lower absenteeism, higher high-school graduation rates, decreased use of local emergency department services, reduced transmission of infectious diseases, earlier diagnosis and treatment of physical, mental and academic problems, better management of chronic health conditions and better mental physical and mental health screening. 

"A child's ability to learn is directly related to health status," she said, adding that more than 120,000 of the 638,236 children in Kentucky's public schools have a chronic health condition. 

Stone said 29 of the state's 171 school districts have no school nurses, and many more have part-time nurses or nurses who are shared among several schools. 

Schuster said that having a part-time nurse is better than no nurse, but is not optimal: "The ability of the students to really relate to and get to know the nurse, and for the nurse to get to know those students, when she's spread across several buildings on campus is just not the most effective."

Stone said the school secretary often ends up taking care of nursing issues when a school does not have a full-time nurse, and is more likely to send a student home than a nurse would. 

Rep. Tina Bojanowski, D-Louisville, a teacher, said she wasn't sure how we got to a place where we don't have a full-time nurse in every building.

“Let me just explain to you what happens when you don't have a school nurse,” she said. “All of the 'Band-Aid and boo-boo' issues are brought to the school secretary. . . . but all of those other areas that would really help our students become more healthy and to be more in the position where they can be learning won’t be happening.”

Schuster said that in the many years the task force has been working to get a nurse in every school, they haven't heard from a lawmaker who doesn't support the idea, but they also haven't been able to put money in the budget to make it happen – but now is the time. 

"Covid has brought out all of these issues and exacerbated them and shown the inequities, and shown the mental health and its effect on academics and physical health," she said. "We plead with you to really strongly consider putting this money in the budget."