Remote Area Medical to offer free medical services, inlcuding dental and vision care, at clinic near Hazard Saturday and Sunday

Kentucky Health News

Remote Area Medical, a nonprofit group that provides free medical care, including dental and vision care, will hold a clinic Saturday and Sunday at East Perry Elementary School, 301 Perry Circle Road, Hazard, in collaboration with the University of Kentucky Center for Excellence in Rural Health.

The clinic will be open from 6 a.m. to 5 p.m. Saturday, 6 a.m. to 12:00 p.m. Sunday. The patient parking lot will open no later than 11:59 p.m. Friday night, June 7, and remain open. As patients arrive at the parking lot, they will be given information about the clinic.

Patients should be prepared with their own food, water, medicines, and clothing when arriving early. Bathrooms will be provided.

Health services are provided on a first-come, first-served basis. Due to time constraints, attendees should be prepared to choose between detal and vision services. Medical services are offered to every patient. All services are free and open to the public. No identification is required.

Given the possibility of inclement weather, volunteer cancellations, or other circumstances outside of RAM’s control, RAM encourages everyone who would like services, especially dental services, to arrive as early as possible. The clinic closing time may vary based on each service area’s daily capacity. Please check RAM’s clinic FAQ page for more information.

UK College of Dentistry faculty, residents, and dental students will provide serves including dental exams and cleanings, fillings, and extractions. The college has previously supported the dental care needs of Kentuckians at other RAM event locations, including Mayfield, Hazard, and Bowling Green.

Founded in 1985, RAM has treated more than 940,000 individuals with $200 million worth of free health-care services. More than 212,000 volunteers – licensed dental, vision, medical and veterinary professionals, as well as general support staff – have supported RAM’s mission.

Online vision retailer Warby Parker will pay Ky. civil penalty for letting 69 Kentuckians to take its online vision test, illegal in Ky.

Image on Warby Parker's "Get a Prescription" page

Kentucky Health News

Warby Parker, an online retailer of prescription glasses, contact lenses and sunglasses, has agreed to pay at least $55,200 to the Commonwealth of Kentucky for allowing 69 Kentuckians to take its online vision test, contrary to state law, Attorney General Russell Coleman's office said in a news release Friday.

Coleman's office alleged that from July to October 2021, 69 Kentuckians were improperly given Warby Parker’s online test. "When the attorney general’s Office of Consumer Protection alerted Warby Parker of the problem, the company cooperated with the investigation and took the test offline," the release said. "Following a voluntary settlement process, Warby Parker will be penalized $138,000. If there are no further violations for five years, the amount will be reduced to $55,200."

The "Get a Prescription" page on Warby Parker's website says the online vision test is available to people who "reside in an eligible state, due to state-level regulations," and disqualifies residents of Alaska, Connecticut, the District of Columbia, Georgia, Idaho, Kentucky, New Mexico, South Carolina, South Dakota, Washington and West Virginia, using their two-letter postal abbreviations.

Kentucky consumers may complain about a business operating in the state to Coleman’s office at https://www.ag.ky.gov/Resources/Consumer-Resources/Consumers/Pages/Consumer-Complaints.aspx.

How to protect your eyes while watching Monday's solar eclipse

NASA map, adapted by Kentucky Health News

Journal of the American Medical Association

On Monday, April 8, a solar eclipse will pass over Mexico, the U.S., and Canada. The eclipse will be total in parts of Kentucky along the lower Ohio and Mississippi rivers. In Paducah, totality will last about 1 minute and 45 seconds, starting just after 2 p.m. Central Time; in Henderson, it will last 2 minutes and 10 seconds, starting at 2:02 p.m. CT. Maximum totality, at the center of the eclipse path, will exceed 4 minutes. A NASA map is here.

A total solar eclipse occurs when the moon completely blocks the view of the sun in a narrow path across the earth’s surface. In a partial solar eclipse, the moon only partially blocks the sun, so it can be observed an area that is thousands of miles wide. But clouds can obscure it; the National Weather Service is updating Monday's cloud forecast daily.

What Are the Dangers of Watching a Solar Eclipse? Watching a solar eclipse without proper eye protection can cause vision loss, including blindness, due to burning of the macula, which is part of the retina, the light-sensitive tissue at the back of the eye that enables people to read and recognize faces. Some individuals mistakenly believe that it is safe to view a total eclipse without eye protection during the time when the moon completely blocks the sun. However, totality of this eclipse will last from a few seconds to more than 4 minutes, based on geographic location, and bright sunlight will suddenly appear as the moon moves. Even a few seconds of viewing the sun can temporarily or permanently burn the macula. Once retina tissue is destroyed, it cannot regenerate, resulting in permanent central vision loss.

Safe Ways to Watch a Solar Eclipse: Exact times and locations of the upcoming solar eclipse can be found at science.nasa.gov/eclipses/future-eclipses/eclipse-2024/where-when/. Worldwide, 8 total solar eclipses will occur in the next decade.

Never view the sun or a total solar eclipse with the naked eye or by looking through binoculars, telescopes, or a phone camera. Sunglasses alone also are not safe. Make sure to supervise children using solar filters. Some safe ways to view an eclipse include:

• Direct viewing through shade No. 14 welder’s glasses
• Direct viewing through aluminized Mylar filters: These plastic sheets can be used for viewing an eclipse but should be used only if totally intact, with NO scratches.
• Pinhole projector: Make a pinhole in a piece of cardboard; hold it in front of the sun just before the eclipse. With your back to the sun, focus the light going through the pinhole onto another piece of cardboard beyond the pinhole so that you see the sunlight focused onto the second piece of cardboard. As the eclipse occurs, you can see the focused sunlight become blocked by a dark circle (the shadow of the moon). Look only at the image on the paper. Do not turn around and view the eclipse with the naked eye.

A list of recommended solar filter vendors can be found at the American Astronomical Society’s website.

If Vision Loss Occurs After Viewing a Solar Eclipse: Individuals with vision loss after viewing a solar eclipse should promptly visit an ophthalmologist, an eye doctor who can recognize symptoms and signs of solar burns on the retina. The diagnosis might be made on clinical evaluation or with diagnostic tests such as optical coherence tomography, a noninvasive imaging technique that can identify solar damage to the retina. There is no definitive treatment other than observation; sometimes individuals have partial recovery of vision.

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.”

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 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."

Big health-insurance company and major health-care foundation among lead investors in Invest Appalachia venture-capital fund

Kentucky Health News

Two big players in health care are the major financiers of a venture-capital firm that calls itself "a regional social investment platform" for Eastern Kentucky and most of Appalachia. Invest Appalachia says it "has secured $19 million of new investment" and is already investing in projects.

ARC.gov map, adapted by Kentucky Health News

The fund's press release says 90% of the money is "new capital from outside the region," which it defines as as the Appalachian counties of Kentucky, West Virginia, Virginia, Tennessee, North Carolina and Ohio, and it has a target of $40 million by November. The lead investors are UnitedHealth Group, a big insurance company, which has put in $10 million; the Robert Wood Johnson Foundation, a major funder of health research and projects; and the Appalachian Regional Commission, a federal-state agency that serves 54 of Kentucky's 120 counties. The release did not list ARC's and RWJF's amounts.

Andy McMahon, a vice president of UnitedHealth, said, “Advancing health equity and addressing social needs like housing and access to health care in rural and underserved areas is an integral part of making the health-care system better for everyone. We are fortunate to work with partners like Invest Appalachia, who really understand the rich culture of Appalachia and are creating new ways to address community needs to improve quality of life and health.”

Zoila Jennings, impact investment lead with the foundation, said “Invest Appalachia is pioneering regionally controlled creative capital solutions in Appalachia that support inclusive economic growth for the region and offer new opportunities for national investors. We see the Invest Appalachia Fund as an innovative model for foundations and other impact investors who want to get capital to the people and places that need it most.”

CEO Andrew Crosson told The Rural Blog that his fund has invested in real estate for downtown revitalization, "support for consumer and business lending for flood-impacted communities" in Eastern Kentucky, "solar and energy efficient equipment for a rural grocery store, and expansion of rural eye care clinics." He said in an email that he couldn't give specifics because "these deals aren't public yet" but said his priorities are "downtown revitalization/community-focused real estate, solar and energy efficiency for rural businesses and institutions, and community health facilities and social enterprises."

Free dental, health and vision clinic comes to Hazard June 11-12

Free dental, vision and medical care will be provided in Hazard on a first-come, first-served basis on the second weekend in June.

The clinic will open at 6 a.m. Saturday, June 11 and Sunday, June 12 at East Perry Elementary School at 301 Perry Circle Rd. in Hazard. The clinic's closing time may vary, based on the service area’s daily capacity.

All of the services are free and no identification is required, but patients will be required to wear a face covering and must undergo a Covid-19 screening before entering the clinic. Patients are also asked to bring a list of their medications, or pictures of the bottles with the label visible, and to take their medications on the morning of the clinic as directed. 

The patient parking lot will open no later than midnight on Friday night, June 10, and remain open for the duration of the clinic. Once in the parking lot, additional information will be provided regarding next steps.

Photo provided

RAM encourages everyone who would like services, especially dental services, to arrive as early as possible. 

Due to time constraints, patients should be prepared to choose between dental or vision services. Medical services will be offered free to every patient attending the clinic. 

"Services include dental cleanings, dental fillings, dental extractions, dental x-rays, eye exams, glaucoma testing, eyeglass prescriptions, eyeglasses made on-site, women's health exams, general medical exams and mental health services. Free take-home colon cancer screening test kits will also be available," says the news release. 

The clinic is sponsored by Remote Area Medical Volunteer Corps, a nonprofit provider of free pop-up health clinics, and the Hazard-based University of Kentucky Center for Excellence in Rural Health. 

For more information or to donate or to volunteer, please visit www.ramusa.org or call 865-579-1530. Click here for RAM's webpage of frequently asked questions. 

Remote Area Medical and health insurers serve more than 180 people at free clinic in tornado-devastated town of Mayfield

Remote Area Medical workers do a vision exam.
(Photo from Kentucky Association of Health Plans)

More than 180 people received free medical treatment or vision exams and glasses this weekend at a two-day clinic in Mayfield, the West Kentucky town devastated by the massive December tornado.

The clinic was sponsored by Remote Area Medical, which specializes in such clinics, and the Kentucky Association of Health Plans, the trade association representing all commercial insurers and Medicaid managed-care organizations in the state.

Free glasses were made on-site at Mayfield Middle School. Attendees also received free, take-home colon-cancer screening tests. Children received free coats and shoes from Operation Warmth, and snow cones.

“Probably half of our patients have brought children with them and some families,” Nicole Yates of Passport Health Plan told Paducah's WPSD-TV. Most patients didn't have primary-care health providers.

Yates says told the station that vision issues are often forgotten about in disasters. “During the disaster, everybody thought, bring water to Mayfield, right? But no one thought about if they were going to be able to get their prescription filled. What if they lost their glasses in the tornado?”

Yates says many patients came in with problems they didn't know they had: “Cataracts, other vision issues, diabetes. We had someone here who . . . were having chest pains.” She said many requested dental services, and "They hope to be able to bring a free dental clinic to Mayfield later this year," WPSD reports.

KAHP Executive Director Tom Stephens said in a news release, “We said back in December we wanted to help through all stages of the recovery and that is exactly what we are doing. There is still a great need for support.”

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

By Melissa Patrick

Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bevin wants 'inaccurate and defamatory' Democratic ad taken down; Frankfort paper finds it lacks context, but isn't baseless

Gov. Matt Bevin has asked TV stations to take down what his campaign calls a "factually inaccurate and defamatory" commercial that says Bevin has tried to take health care away from children and people with pre-existing conditions.

The Bluegrass Values ad, funded by the Democratic Governors Association, features Hoppy Henton, a Democratic activist fromVersailes, who says Bevin has tried "to take away health-care coverage, including vision and dental, from children" and has sued "in court to take away protection now that people have for preexisting conditions."

Davis Paine, Bevin’s campaign manager, said in a press release, “A look at the facts shows that every claim made in this ad is false,”

However, The State Journal of Frankfort reports, "Several claims made in the ad lack context, but they are not baseless."

The crux of the matter is Bevin's efforts to change Medicaid to require, among other things, "able-bodied" adults who are not primary caregivers to work, attend school, take job training, search for a job or volunteer 80 hours a month, if they don't qualify for an exemption or are in drug treatment. The plan has been blocked twice by a federal judge in Washington, D.C.; his rulings will be considered by three appellate judges on Oct. 11.

After the plan was vacated the first time, the Bevin administration moved to end free dental and vision benefits from about 460,000 Medicaid patients who gained their health insurance through the expansion of Medicaid to those with incomes up to 138 percent of the federal poverty line.

The cuts did not apply to pregnant women or children, but for several weeks in July 2018, "The new system — reportedly through a glitch — also led to multiple children and pregnant women being denied vision and dental care, as reported by several independent news outlets," Emily Laytham writes for The State Journal.

The Bevin administration eventually restored dental and vision benefits to the expansion population, as well as those unintentionally affected by the system glitch.

In its press release, the Bevin campaign does not mention the events of last summer, but cites a November letter from the U.S. Department of Health and Human Services saying: “Beneficiaries receiving state plan benefits will continue to receive covered vision services, dental services, and over-the-counter medications . . . all beneficiaries under 21 years of age receiving services through the demonstration will continue to receive all early and periodic screening, diagnostic, and treatment services.”

The ad also suggests that Bevin is suing to “take away protections … for pre-existing conditions.”

In June, Bevin and 14 other state officials appealed a federal judge's decision that limited access to association health plans, a type of insurance that makes it easier for small employers to band together, free of many of the requirements of the Patient Protection and Affordable Care Act. Such plans are intended to reduce small business owners' cost of providing coverage.

The U.S. Department of Labor says association plans "may not charge higher premiums or deny coverage to people because of pre-existing conditions," but Laytham reports, "Workarounds exist."

According to the American Medical Association, “There is a significant risk that AHPs could disproportionately impact individuals with pre-existing conditions” by charging “based on factors that are not explicitly defined in terms of health or medical conditions, but that closely track those forbidden factors."

The AMA notes that association plans are permitted to vary premiums by age, gender, industry and geography, factors that can be used to predict or anticipate pre-existing conditions.

Bevin’s campaign did not respond to The State Journal's request for comment.

Attorney General Andy Beshear, the Democrat running against Bevin in the Nov. 5 gubernatorial election, says he would immediately rescind Bevin's Medicaid plan if elected.

State restores dental, vision and non-emergency transportation benefits for 460,000 people covered by 2014 Medicaid expansion

Susan Wells of Louisville, who lost her dental benefits during a
series of extractions of decayed teeth, got them out at Shawnee
Christian Healthcare. (Photo: Mike Clevenger, Courier Journal)

By Al Cross
Kentucky Health News

State officials reversed course Thursday and said they would resume paying dental, vision and non-emergency medical transportation costs for 460,000 Kentuckians on expanded Medicaid.

The benefits were supposed to become optional July 1, under a new Medicaid plan in which those members could regain the benefits by participating in certain self-improvement activities, such as such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion, which began in 2014, work.

On June 29, two days before the overall plan was to take effect, a federal judge in Washington, D.C., blocked it, and state officials said that left no way for people to earn the benefits, or for the state to keep providing them.

The abrupt change created confusion, chaos and complaints. Democrats demanded that the administration of Republican Gov. Matt Bevin restore the benefits. At 5:40 p.m. ET Thursday, the Cabinet for Health and Family Services issued a press release saying that it would.

In a statement that quoted no one directly, the cabinet said "We had hoped for a quick federal re-approval" of the plan, which it calls Kentucky HEALTH for "Helping Engage and Achieve Long-Term Health." However, this week federal officials said they would not act for at least 30 days, as they sought more public comment on the plan. That move that could allow them to submit evidence aimed at overcoming the judge's concerns that they had not addressed the state's forecast that the plan would cause tens of thousands of people to lose their medical coverage.

Since "the program will not begin as soon as we hoped," the cabinet said, "In order to mitigate the consequences of the judge’s ruling, and avoid a prolonged coverage gap prior to the re-approval of Kentucky HEALTH, we have begun the process to reinstate vision and dental coverage, as well as non-emergency transportation services, for those whose benefits were affected by the June 29 court action."

The cabinet said it had "spent the last few weeks working on a temporary solution for restored benefits to be implemented by Aug. 1," and "is close to completing a manual system work-around that will allow payment of claims incurred by any eligible Medicaid beneficiary for dental, vision, and non-emergency transportation services incurred during the month of July."

The issue arose in the latest skirmish between Bevin, who has not said whether he will seek re-election in 2019; and Democratic Attorney General Andy Beshear, who announced his candidacy for governor this month, and Beshear's father, who expanded Medicaid under the Patient Protection and Affordable Care Act when he was governor in 2014.

When Bevin doubled a $500,000 contract with a Cincinnati law firm to investigate Steve Beshear's administration, the ex-governor said Bevin “has now decided to waste another half a million dollars and another two years to continue his fruitless search. Mind you, a million dollars wasted at a time when he is ripping vision and dental care away from hundreds of thousands of Kentuckians.”

State officials have said that about 10 percent of the eligible beneficiaries use those benefits.

"Advocates were delighted with the prospect that dental benefits would be restored," Deborah Yetter reports for the Louisville Courier Journal, quoting Jennifer Hasch, manager of dental services for the Shawnee Christian Healthcare Center in West Louisville: "That is such good news. I think people are going to be thrilled. I think it's weight lifted for our office, both for our patient population and our team."

Yetter writes, "While health advocates say all three services cut—dental, vision and transportation are important—the loss of dental services were most critical because of the very poor dental health of some Kentuckians and the fact that dental abscesses and infection can be life-threatening."

The legislature's top Democrat, House Minority Leader Rocky Adkins, told the Lexington Herald-Leader, “The governor and his administration were wrong to blame this cruel action on the federal court ruling . . . but I’m glad they appear to be back on the right track. I’m hopeful that our citizens will not be faced with the devastation of losing these benefits again.”

Medicaid dental and vision cuts worry patients and health-care providers; Democrats want answers, restoration of benefits

Kentucky Health News

Kentucky is in the third week without dental, vision or non-emergency transportation benefits for 460,000 Kentucky adults on Medicaid, and Democratic lawmakers, health advocates and dentists are continuing to voice their concerns, prompting the state health cabinet to respond online, including a Facebook video that cites "misinformation that is circulating in the media."

The 460,000 who lost their benefits are people covered by the state's 2014 expansion of Medicaid, under the 2010 Patient Protection and Affordable Care Act, to those who earn up to 138 percent of the federal poverty level.

Under a Medicaid plan that was vacated by a federal judge in Washington, this expansion group was supposed to move to a "My Rewards" program that allowed them to earn dental and vision benefits by participating in certain activities, like self-improvement classes or wellness activities or passing a GED exam. But when the plan was vacated two days before it was to take effect, the state says this left this group without any way to earn these benefits.

The abrupt removal of benefits created confusion among providers and beneficiaries, and prompted Democrats to hold news conferences questioning the reasons for the action and its legality.

Jessica Clark-Boyd, manager of the Healthy Smiles clinic in
Prestonsburg, told the Lexington Herald-Leader that half its
appointments were canceled after the state limited coverage
for some on Medicaid. (Photo by Silas Walker, Lexington Herald-Leader)

Will Wright reported for the Lexington Herald-Leader July 10 that the schedule of a Prestonsburg dentist showed five and a half hours of vacancies because more than half of her patients had lost their dental benefits.

Misty Clark, the dentist and owner of Healthy Smiles Family and Cosmetic Dentistry, told Wright that she normally has three patients per hour. The office manager, Jessica Clark-Boyd, told Wright that they have rescheduled dozens for appointments next month, hoping their insurance will be restored by then. "If not, Healthy Smiles could be in big financial trouble," he writes.

Wright also tells the story of Lynda Joseph of Pikeville, a Healthy Smiles patient who was scheduled to get a tooth pulled this month, but is one of those who lost dental benefits. Joseph wondered why the Bevin administration would cut benefits to people who are so close to the poverty level.

Joseph, who works part-time at Walmart, told Wright that she doesn't know when she'll be able to get the extraction. "I don’t mind paying the premium," she said. "Even if the premiums became higher, I wouldn’t mind that. The question is, am I going to be able to pay for it out-of-pocket?"

Democratic legislators from Eastern Kentucky, and a few others, held a news conference July 10 to "criticize both the moral and economic impacts" of these cuts, and called on Republican Gov. Matt Bevin to reinstate the benefits. The lawmakers said the cut "unnecessarily strips health-care benefits from working families and could hurt the state economy, particularly in Eastern Kentucky," Wright reports.

He adds that a report from the left-leaning Kentucky Center for Economic Policy found that the Medicaid expansion "has pumped billions of dollars into the economy and created thousands of jobs -- half of the net job growth in Kentucky since December 2007 came from the health care sector."

At a time coal has declined, "The industry that we have seen in our region that has actually been able to grow some, to be able to invest in its infrastructure, to be able to provide quality health care throughout our region, has been the health-care industry because of the expansion of Medicaid," House Minority Floor Leader Rocky Adkins said at the news conference in Pikeville.

Rep. Chris Harris of Forest Hills and other Eastern Kentucky
lawmakers, and former state auditor Adam Edelen, left, spoke
at a news conference against the cut of dental and vision cuts
to those on expanded Medicaid. (Image from WYMT-TV)

Rep. Angie Hatton of Whitesburg said, "We can't stand to lose more jobs, and our health- care industry will lose jobs because of this," reports Christina Bates of Hazard's WYMT-TV.

Bates also tells the story of Cory McCauley, who said she was one who lost her dental and vision benefits, and that she had learned about it on the news. "We got no notification in the mail whatsoever," she said. McCauley told Bates that she and her husband have relied on the program while he is in medical school.

"I actually had an appointment because I have a cavity . . . so now I can't keep that appointment because I'll have to pay for it out of pocket, which is just not realistic for us right now with no income," said Bates.

Kentucky Voices for Health has a video of the news conference, and a blog post about the recent changes, by KVH policy analyst Jason Dunn.

William E. Collins, a dentist in Pike County, wrote an opinion piece for the KVH blog that says the cuts are so harmful to "the working poor." He notes the hundreds of appointments he and his colleagues had to cancel last week because the online benefit system listed patients' benefits as "no current coverage" or "alternative benefits." But he also says that through a team effort between providers and the state, part of the eligibility issues were resolved.

"This is not about politics. This is about humanity," Collins wrote. "Placing blame seems to be necessary for some, but finding and correcting the problem is what the enrollees need."

All 37 members of the state House Democratic Caucus sent a letter July 10 to Health Secretary Adam Meier asking him to answer a long list of questions about the process used to remove the benefits; how the new benefit structure is affecting recipients and providers; the expected impact of removing the benefits; and how premiums already collected will be returned.

Democratic U.S. Rep. John Yarmuth of Louisville sent a letter to Alex Azar, secretary of the U.S. Department of Health and Human Services, that also included a list of pointed questions that asked for "clarification regarding these changes."

“Given that the federal government covers 94 percent of all Medicaid expansion costs in Kentucky, the dysfunction Gov. Bevin has brought to this critical health care system should be of great concern to you and your agency," Yarmuth wrote. "Health care coverage for the people of Kentucky is too important to be jeopardized by politics and dysfunction."

Meanwhile, the Poor People's Campaign protesters, who were finally allowed entry into the Capitol July 10 for the first time since a judge ruled police broke the law by denying them entry, delivered toothbrushes to the governor's office in protest of the dental and vision cuts, WKYT reports.

In a July 6 letter to the Centers for Medicare and Medicaid Services, three advocacy groups asked the agency to disapprove the withdrawal of dental and vision benefits, saying the state failed to comply with procedural requirements, including an appropriate public-notice period or a 30-day public comment period required by federal law. They also cite that the judge's intent was that the program remain status quo until after Azar's further review of the plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health."

In a July 10 Facebook video, Kristi Putnam, deputy secretary for the health cabinet, says there has been a "good deal of confusion and misinformation" about Kentucky HEALTH since the federal judge "temporarily stopped its implementation."

Putnam who is also the program manager for Kentucky HEALTH, asks "media partners" to call the cabinet if they learn about beneficiaries or providers who are having issues, explaining that the Pikeville dentist who spoke to the Louisville Courier Journal last week had his problems resolved within two hours, but this wasn't reported in the article. "Please let us help," she said.

Putnam added that Medicaid systems have been checked and are running properly, and that eligibility was in place for pregnant women, children and foster children up to the age of 26. She said the kentuckyhealth.ky.gov website has been updated with new resource pages and the computer screens used by providers have been improved to allow for better understanding of who qualifies for dental and vision benefits and who doesn't.

Groups that blocked Medicaid plan ask feds to restore related dental, vision cuts; cabinet addresses service-denial claims

By Melissa Patrick
Kentucky Health News

Three advocacy groups have asked the Centers for Medicare and Medicaid Services to reject recent changes to Kentucky's Medicaid program that took dental, vision and non-emergency medical transportation benefits from 460,000 Kentuckians.

In a letter to CMS, the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center, and the Southern Poverty Law Center say the state failed to comply with procedural requirements, including an appropriate public-notice period or a 30-day public comment period required by federal law.

The letter also says the state's official request to remove these services, called a state plan amendment (SPA), was never approved, noting that it is not on CMS's online list of approved SPAs, so "We have concluded that CMS has not approved this SPA."

The 460,000 people are covered by the state's 2014 expansion of Medicaid, under the 2010 Patient Protection and Affordable Care Act, to those who earn up to 138 percent of the federal poverty level. Under a state Medicaid plan that was vacated by a federal judge, those covered by the expansion could "earn" dental and vision benefits by participating in certain self-improvement activities, such as passing a GED exam, completing job training, or completing wellness activities such as stop-smoking classes, weight-loss programs or diabetes education. They could also earn credits by working; most on the expansion work.

When U.S. District Judge James Boasberg of Washington, D.C., vacated the state's new overall plan for Medicaid, that left the 460,000 people without a way to earn the benefits. The three groups, which filed the lawsuit, argue in their letter to CMS that the state's denial of benefits violates Boasberg's order because "The court expressly intended to maintain the status quo." The letter urges CMS to "act quickly" to reject these changes," which they say "are causing great confusion and harm."

As an example, the letter says an employee of a Kentucky Medicaid managed-care organization said one of its members had been told they couldn't have a "medically necessary" surgery until some of her teeth were pulled, but her dental benefits had been denied because of the cutback.

Cabinet blames reported denials of service on providers

Deborah Yetter of the Louisville Courier Journal reported "widespread concern and confusion about the cuts," including patients showing up at dental clinics who should have been covered, like children and pregnant women, but were showing up in the state's system as having no coverage. The Kentucky Oral Health Coalition has also reported similar denials to eligible children and pregnant women.

Doug Hogan, a spokesman for the Cabinet for Health and Family Services, told Yetter that it was the Courier Journal and the advocacy groups who were perpetuating confusion, noting that pregnant women and children are exempt from the cuts.  He also blamed health-care providers who "have misinterpreted computer-screen eligibility information and turned away some patients."

Hogan told Kentucky Health News that the office of a Floyd County dentist who had told Yetter he had turned away about 10 children had, it turned out. misread information on a computer screen. "Our records show that the concerns were sent to the cabinet at 12:45 p.m. on Tuesday, and by 2:45 p.m. Tuesday we had confirmed their eligibility for full dental and vision services."

Hogan also wrote, "We have identified examples where providers have misinterpreted computer-screen eligibility information and turned away some patients, despite them having active coverage. To eliminate any further confusion, we have created several documents aimed at educating Medicaid recipients about their benefits and outlining for providers the beneficiaries who have routine vision and dental coverage. Over the last few months, numerous provider trainings were held."

Hogan concluded, "We appreciate everyone’s help in making sure our beneficiaries are receiving the services and support they need. If you think you have been incorrectly identified in a different eligibility group, you can call 800-635-2570 for assistance." Hogan supplied an emendated computer-screen grab as an example of problems and the cabinet's action:

Click on the image to view a larger version

The Kentucky Equal Justice Center has filed an open records request seeking more information on the state plan amendment that was submitted to CMS in April. Hogan said in an e-mail, “We are still reviewing the letter, but we have been in contact with CMS throughout the state plan amendment process going all the way back to April and will continue to work with them through the approval process.”

The vacated plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," was set to launch July 1. It included requirements for work, volunteering, job training or drug treatment; monthly reporting; lock-out periods for failure to comply; and small premiums based on income.

On June 29, Boasberg sent the plan back to the U.S. Department of Health and Human Services for review, ruling that Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.