In wake of Trump's election, Bevin administration says it will keep negotiating with Obama officials about Medicaid waiver request

Donald Trump and President Obama met Thursday.
(Photo: Michael Reynolds, European Pressphoto Agency)

By Al Cross
Kentucky Health News

The administration of Gov. Matt Bevin says it will continue negotiations with federal officials about its requested waiver of some Medicaid rules despite the election of Republican Donald Trump, who vowed in his campaign to "repeal Obamacare" but now says he will keep parts of it.

“Until changes occur at the federal level, the Bevin administration will continue to work within the confines of federal law as written,” said Doug Hogan, spokesman for the Kentucky Cabinet for Health and Family Services. “To that end, the Bevin administration will continue to negotiate in good faith with the U.S. Department of Health and Human Services."

It remains unclear what effect the election might have on HHS officials, who have often cited Kentucky as an Obamacare success story and might be motivated to preserve as much of it as possible. But the election may create a better negotiating position for the Republican governor, who has said he is ready to end his Democratic predecessor's expansion of Medicaid to about 440,000 people.

Bevin's waiver request asks for permission to require premiums to those with incomes below the poverty level and require work or training for able-bodied adults who aren't primary caregivers, both conditions that HHS Secretary Sylvia Burwell has said she would not approve.

Trump will take office Jan. 20. Hogan said that when things change at the federal level, "We will respond accordingly."

Bevin has said that the state cannot afford to have 1.32 million people, nearly 30 percent of its population, on Medicaid. His proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

The federal government is paying the full cost of the expanded Medicaid population through this year. Next year the state will be responsible for 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The state pays about 30 percent of the cost of traditional Medicaid participants.

Republicans have long proposed that Medicaid funding change to block grants, which would give the states certain amounts of money and more flexibility to write rules. That seems likely to be a part of any replacement of the 2010 Patient Protection and Affordable Care Act. But that will be a complicated task.

“It’s anybody’s guess what President Trump and a Republican Congress will do. Just repealing the Affordable Care Act is not a serious option unless they have something to replace it with,” former 6th District U.S. Rep. Ben Chandler, who voted against the law and now heads the Foundation for a Healthy Kentucky, told John Cheves of the Lexington Herald-Leader.

“The reality on the ground is that Gov. Bevin won his election in Kentucky and Donald Trump has now won his election nationally,” Chandler said. “It is incumbent on the rest of us to work with them in any way that we can to see that whatever they propose will hopefully make our people healthier. And I’ve got to believe that they want that same result.”

Trump reiterated Friday that he wants to keep the part of the law that prevents insurance companies for denying coverage because of pre-existing conditions. "But the insurance industry has long said it would have a hard time abiding by this rule unless virtually all Americans are required to have insurance," reports Amy Goldstein of The Washington Post.

Post business reporter and columnist Steven Pearlstein explains,  "To guarantee that people with pre-existing conditions can get affordable health insurance, you need to have rules requiring guaranteed issue and community rating," charging roughly the same prices in a geographical area. "To keep insurance companies in business because of guaranteed issue and community rating, you need to have an individual mandate" for everyone to buy insurance. "And because poor people can’t afford health insurance, you need subsidies. Combine all three, and what you have, in a nutshell, is ... Obamacare.

"Yes, it’s a bit more complicated than that, but not much. It’s possible to allow insurance companies charge twice or three times as much, to people who are older or sicker. You can let healthy people buy somewhat more bare-bones 'catastrophic' policies to satisfying their obligation under the individual mandate. You could even avoid community rating by sending sick people into 'high risk pools' where their premiums would be subsidized by a tax on everyone else’s health care premiums.

"But at the end of the day, once you decide that everyone, regardless of age or medical condition, should be able to buy health insurance at an affordable price, you have essentially bought into the idea that young and healthy people have an obligation to subsidize the older and sicker people in some fashion. And once you do that, it’s sort of inevitable you end up where every health reform plan has ended up since the days of Richard Nixon. You end up with some variation on Obamacare."

McConnell wants to pass bill to spur medical research before Congress adjourns; measure has big supporters and critics

Senate Majority Leader Mitch McConnell says he has two main priorities as Congress wraps up its business: funding the government and passing a bill called the 21st Century Cures Act, which would boost funding of research at the National Institutes of Health.

"You haven't heard much about it yet, but it's extremely important, McConnell said at his post-election news conference in Louisville. "We need to take advantage of today's technology to really jump-start the medical field."

McConnell said President Obama and Vice President Biden, who will leave office Jan. 20, want to get the bill passed because "The president's particularly interest in precision medicine," and Biden wants more cancer research because his son, Delaware Attorney General Beau Biden, died of cancer last year.

"I'm interested in regenerative medicine," McConnell said. "Unless you can get in a clinical trial, you can't get stem cells from your own body to treat another part of your body. He said he was motivated by the experience of a Tennessee man whose blindness was cured by stem-cell treatment.

The NIH budget has stagnated because of automatic budget cuts known as sequestration. A study published last year in Health Affairs concluded that most transformative drugs come from federally funded research, not from drug manufacturers, which cite research costs as a reason they need to make their higher profits than most other industries.

Still, makers of drugs and medical devices are strong supporters of the bill, because it would expedite regulatory approval of them new drugs and medical devices. That has drawn criticism from the industry's lobbying adversaries.

The consumer lobby Public Citizen says the House-passed bill would "undermine the FDA's ability to ensure the safety and efficacy of medical devices ... effectively lower FDA approval standards for antibiotics and antifungals ... weaken reporting requirements of the Physician Payment Sunshine Act, allowing for secret influence by pharmaceutical and medical-device companies ... hasten the rise of resistant superbugs by giving hospitals incentives to use new antibiotics rather than conserving them for appropriate use" and bar generic entry of medicines into the market for longer periods."

Randy Gooch named deputy health commissioner

Gooch, right, with Jessamine County Judge-Executive David West

Randy Gooch, public health director in Jessamine County for the last four years, is the new deputy commissioner of the state Department for Public Health. Gooch says one of his main tasks will be to improve relations between the department and county and district health departments.

"While in Jessamine County Gooch implemented a needle exchange program, supported the development of a trails network, helped to secure funding for a bike and pedestrian path, and modernized the health department’s website," the Lexington Herald-Leader reports.

Read more here: http://www.kentucky.com/news/local/counties/jessamine-county/article113037523.html#storylink=cpy

3 ET Monday is deadline to register for Covering Health: A News Workshop, to be held Friday, Nov. 11, at Natural Bridge; it's FREE

Natural Bridge State Resort Park is near the Mountain Parkway.

Kentucky faces many unique health challenges, but they don't get enough news coverage, which hamstrings the state and its communities from fully addressing their health problems. These challenges and how to tackle them from a news perspective will be addressed at Covering Health: A News Workshop, Friday, Nov. 11 at Natural Bridge State Resort Park at Slade.

The conference is free, but registration is required; the deadline is noon 3 p.m. Eastern Time Monday, Nov. 7. To register for the workshop, complete this registration form.

The workshop is open to any Kentucky journalist, from those who are just starting to cover health issues to those with years of experience in the subject matter, and it offers something for everyone: reporters, editors, news directors, publishers, photojournalists and everyone in between. The workshop is sponsored by the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News, and the Foundation for a Healthy Kentucky.

Specific health topics will include oral health, smoking, obesity and cancer, where to find information on these issues and how to localize it for your audience. Building revenue and delivering health information to under-served populations through special health sections will also be addressed.

Several guest speakers will discuss their areas of specialization. Van Ingram, of the Kentucky Office of Drug Control Policy, and Kentucky Health News Senior Reporter Melissa Patrick will talk about how to cover one of Kentucky’s biggest, most complicated problems: opioid dependency and the consequences that follow.

Al Cross, director of the Institute for Rural Journalism and Community Issues, will discuss several topics, including proposed Medicaid changes and their implications for your readers, as well as the basics of managed care organizations that handle Medicaid for the state.

Jennifer P. Brown of the Kentucky New Era in Hopkinsville and Sharon Burton of the Adair County Community Voice in Columbia will discuss, respectively, how a small newspaper can cover health and how newspapers can use health sections to gain revenue and serve readers who need more health information.

Cynthia Lamberth of the Kentucky Population Health Institute will talk about how to look for health policy in all stories. The workshop will conclude with a roundtable session to discuss story ideas, sources and approaches.

Questions about the workshop can be directed to Danielle Ray at dnray2@g.uky.edu.

One pediatrician says vaccines are the most important thing she does; another says providers' recommendations are key

By Melissa Patrick
Kentucky Health News

One of the most important things a provider can do to get children vaccinated is to offer clear recommendations for their parents.

Dr. Ari Brown

So said Dr. Ari Brown, a pediatrician and author of the "411" parenting book series, in Lexington on Nov. 3, the second day of the 2016 Kentucky Immunization Conference.

"The number one reason why (vaccinators) chose to vaccinate is because they trusted their health-care provider," Brown said, citing a study that asked parents who chose to vaccinate why they did so.

Brown said parents need to depend on reliable sources for immunization information when they are making the decision to vaccinate their child, like cdc.gov; immunize.org; healthychildren.org; vaccine.chop.edu; or baby411.com. And that providers need to actively direct parents to these sources.

Brown listed several myths that are perpetuated on websites with unreliable sources.

"There is no link between vaccinations and autism," she said, noting that the study that is often cited linking the measles-mumps-rubella vaccine to autism has been proven false and "should have never been published." She noted that the study has been removed from medical literature and the author, Dr. Andrew Wakefield, has lost his medical license.

She also pointed out that thimerosal, a mercury-based preservative that some think causes autism, was removed from vaccines in 2001, but autism rates are still rising.

She said risk factors for autism include genetics, mature parents, closely spaced pregnancies, obesity in pregnancy, taking certain medications during pregnancy, having flu during pregnancy, not enough folic acid, and extreme prematurity.

Brown, who is also a spokeswoman for the American Academy of Pediatrics, said there is no "alternative" vaccination schedule; there is either a recommended schedule or a delayed schedule, and studies show there is no benefit to delay.

"You are delaying your child's vaccine protection. And when you delay shots, you are leaving the most vulnerable children at risk. If your child is under six months of age and they get whooping cough, that is pretty serious," she said. "You are not going to wait to put your child in a car seat for the first six months of life, so why would you wait to protect yourself against these diseases."

Infants are recommended to receive their first dose of pertussis vaccine, in combination with diphtheria and tetanus, at 2 months, 4 months ,6 months and 15 months of age. Another dose is recommended between 4 and 6 years of age. New recommendations call for mothers to get the vaccine during pregnancy, which offers protection to the child until it is old enough to be vaccinated.

Pertussis, or whooping cough, is a highly contagious respiratory disease caused by bacteria transmitted by droplets from sneezing, coughing or close contact. Infected people are most contagious up to about two weeks after the cough begins.

Margaret Jones, manager of the Kentucky Immunization Program, said the state has had 430 confirmed or probable cases of pertussis this year, 150 percent more than all of last year.

Dr. Rebecca Bakke

Also at the conference, Dr. Rebecca Bakke, a pediatrician at Sanford Health in Fargo, N.D., shared her story of infecting her 5-week-old daughter with whooping cough, and spoke of the fear she had for her child because she knew that between 1 and 2 percent of babies infected with the disease die. Her baby survived and is now six.

Bakke, who is also a member of the American Board of Pediatrics and a Fellow of the American Academy of Pediatrics, said she has taken care of a child that has almost died of chicken pox; cared for several children who now have severe brain damage from meningitis; bagged air into the exhausted bodies of babies with pertussis; and cared for many children in the ICU battling the flu. And said that though most children are resilient, "Not all stories have a happy ending."

"I vaccinate children every single day in my office and I know without a shadow of a doubt that it is the most important thing that I do at work. It has the most impact," Bakke said. "Vaccines matter."

Nursing homes say Ky. has highest malpractice insurance costs and needs lawsuit review panels to keep providers and facilities

By Melissa Patrick
Kentucky Health News

The state's nursing-home lobby is renewing its effort to get legislative insulation from lawsuits, a prospect that could improve if Republicans control the state House after Tuesday's election.

Kentucky needs medical liability reform to stay competitive with its surrounding states, all of which have enacted some form of it, representatives of the Kentucky Association of Health Care Facilities told a legislative committee.

"It makes us not a friendly state to operate long-term care services," Betsy Johnson, president of the association, said at the Nov. 2 meeting of the Interim Joint Committee on Health and Welfare, held during the association's annual meeting in Louisville. "Providers are leaving Kentucky and new companies will not even consider locating in our commonwealth because of the high cost of health-care liability."

Kentucky has at least one nursing home in every county, with a total of 281 nursing homes and 88 personal care homes. Combined, these facilities care for over 36,000 people, provide over 30,000 jobs and provide $200 million in state and local taxes, the group said.

Graphic Aon 2015 Long Term Care report

Citing a recent study, Johnson said Kentucky's long-term care providers are paying $9,350 per bed in liability insurance, the highest of any state. The study found Kentucky paid over $400,000 per claim in 2015, "the highest claims severity of all the states profiled in the Aon study," Johnson said. Aon Risk Solutions is a risk-management and insurance company.

Kentucky also had the highest loss rate of Medicaid dollars in the study, which means that "14.66 percent of Medicaid reimbursement dollars that facilities receive end up going back out to cover losses," Johnson said. "That is money that is not being used to provide care to the residents that we are committed to serving."

Aon said in a statement, "Kentucky's high cost of liability may be related to its lack of restrictions on tort actions. The state constitution prohibits limits on non-economic damages and there are no statutes concerning qualifications of expert witnesses, certificates of merit, pre-trial alternative dispute resolution or limits on attorney's fees."

For several years, nursing homes have been trying to get the legislature to require that medical-malpractice lawsuits be reviewed by a three-person panel to determine if a case has merit before the suit could proceed. Panel findings would be admissible in court, but not legally binding. The legislation has passed the Republican-led Senate, but has not been heard in the Democrat-led House.

Sen. Ralph Alvarado, R-Winchester, a physician, said after the meeting that he will likely introduce the bill again, pointing out that 43 other states have some sort of tort reform.

"The motivation for me to run for office to begin with was tort reform," he said. "It is kind of what has gotten me here. So this is the big white whale that I am chasing and if I harpoon it and I get voted out of office, I can leave with a smile on my face. So, I am really hoping to get this accomplished."

Another Senate bill, sponsored by Sen. Danny Carroll, R-Paducah, called the "truth in advertising" bill, would require advertisements of nursing-home inspection results to prominently include the date the deficiencies were found, the plan to correct them and whether they were corrected. It too passed the Senate, but was not heard in the House.

Such bills are opposed by the Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys, a group comprised mainly of plaintiffs' lawyers.

Maresa Fawns, CEO of the group, said in an email, "Restrictions on free speech that inform the public of negligence aren’t in the public's interest. Neither is restricting the rights of individuals and businesses to seek redress in the courts. Both are protected by our constitution. The heart of the matter is that less negligence through higher standards will result in fewer lawsuits. An ounce of prevention is worth a pound of cure and the solution is better staffing, better care, and less harm to our seniors."

Medicaid approval delays

Johnson also said the association is working with the Cabinet for Health and Family Services and its Department of Community Based Services to get nursing-home patients approved for Medicaid more quickly. If a person hasn't already qualified for Medicaid, they can't apply for it until they have been admitted and because Medicaid will not pay for services until a resident has completed a 30-day stay, they will not process the application until the 31st day, she said in an e-mail. In addition, she added that it is "extremely difficult" to discharge a patient from a nursing home for "any reason, including non-payment" without an appropriate and safe discharge plan. The group said application approvals often take more than 90 days, with some taking more than a year.

As a result, nursing homes are caring for patients without being paid. This has amounted to an average balance of $170,093 per facility in September of 2016, according to a KAHCF survey for cases over 90 days. This problem is so bad that the survey found that a few facilities have stopped admitting Medicaid patients altogether and many more are considering it, Johnson said. The problem escalated in 2014 as a result of legislation that shifted the workflow to a centralized system, instead of the local DCBS offices, though that issue has recently been rectified, Johnson said.

State settles dispute with former Medicaid managed-care company, will get $7.5 million from former actuarial firm

The state and St. Louis-based Centene Corp. have settled their lawsuits and other disputes stemming from the 2013 departure of Centene's Kentucky Spirit Health Plan from the state Medicaid managed-care program.

Centene said in a press release, "Kentucky Spirit will receive an immaterial cash payment from the Commonwealth's actuarial firm and each party will dismiss all claims related to the litigation with prejudice," meaning that it cannot be refiled.

The amount of the payment was not disclosed. It will come from PriceWaterhouse Coopers, which was the state's Medicaid actuary until 2014. The state will get $7.5 million from the firm in return for dismissing its claims against it, said Doug Hogan, spokesman for the state Cabinet for Health and Family Services.

Last year, the cabinet "ruled that the insurer owed the commonwealth $40 million plus prejudgment interest," Erica Teichert reports for Modern Healthcare. Kentucky Spirit had made $110 million in claims against the state, Hogan wroite.

"So, the Commonwealth will get out of this litigation receiving $7.5 million and without making any payment to any party as a result of the settlement," he wrote. "This settlement will save the Commonwealth hundreds of thousands of dollars in attorney fees and expenses.  Based on the potential liability in this case and potential burden to taxpayers, and the significant litigation expenses associated with this case, this is an excellent outcome for the Commonwealth of Kentucky."

The Centene release added, "In addition, the parties agree that neither party acted in bad faith, that they took reasonable positions in light of the applicable contractual language and that the parties acted in good faith in attempting to address a difficult situation."

The release thanked Gov. Matt Bevin "for taking the initiative to resolve this longstanding issue."

Increasing Kentucky's cigarette tax by $1.50 a pack would decrease youth smoking, Cancer Society lobbyist writes

To decrease youth smoking in the state, the Kentucky director of the American Cancer Society Cancer Action Network is calling for an increase of $1.50 per pack of cigarettes and all other tobacco products, which would raise the 60-cent tax on each pack to $2.10.

"In the first full year following an increase in the tax by $1.50 per pack, it’s estimated that youth smoking would be reduced by about 17 percent and nearly 38,000 kids would never become adult smokers because most would never start," Erica Palmer Smith, said in a statement.

She noted that research finds that the increase in the price of tobacco products must be high enough to deter use and that tax increases of less than a dollar a pack are easily absorbed by the tobacco industry through things like discount programs.

Kentucky has the third highest youth smoking rate in the nation, with 17 percent of its high school students smoking. Palmer Smith, who is an aunt to four high schoolers, writes that an estimated 3,200 of Kentucky's youth under the age of 18 will become daily smokers.

"Almost all people who become lifetime tobacco users begin before graduating high school," she said. "And, almost nobody tries smoking for the first time after the age of 18."

A $1.50 increase "would convince approximately 45,000 current adult smokers to quit, generate more than $327 million in new revenue and save an estimated $9.28 million in Medicaid costs over a five-year period," she writes. "Tobacco remains the number one cause of preventable death in Kentucky. . . . The best way to reduce death and disease caused by tobacco use is to keep kids from ever starting to smoke in the first place."

Kentucky’s tobacco tax hasn’t been raised since 2009. The tax ranks 43rd among the states; the average tax is $1.65 per pack.

First day of open enrollment on federal health-insurance exchange got off to a rough start for some Kentuckians

The first day of open enrollment to sign up for health insurance on the federal health exchange, Nov. 1, got off to a rough start for some Kentuckians.

Sharon Bush, an application assister, told Lisa Gillespie of Louisville's WFPL that she had spent half an hour helping her 60-year-old client sign up for an e-mail account, which is required on HealthCare.gov if you don't want to call the federal help center to sign up. Then they spent another 45 minutes waiting because the website was down, before finally giving up and rescheduling for the following week.

“In southeastern Kentucky, there are a lot of people who don’t have and/or use technology,” Bush said, noting that it took longer to sign up for the e-mail account than she realized it would.

Bush works at Grace Community Health Center in Manchester. She’s a former Kynector, a person who helped people sign up for health care on Kynect, the state-based exchange, which has been dismantled. She is now trained an application assister for the federal exchange, HealthCare.gov.

Susie McConkey, vice president of business development for agent services at AgentLink, a company that acts as a go-between for insurance brokers and clients, told Gillespie that she had run into similar problems in Louisville. The agency will likely enroll 10,000 people before open enrollment ends Jan. 31, 2017, Gillespie reports.

More than 100,000 Kentuckians had signed up for health insurance on Kynect and must now re-enroll on HealthCare.gov because none of the enrollment information from Kynect was transferred.

McConkey said she was concerned some brokers might become frustrated and give up using the site.

“We anticipate, even though this is day one, some people are going to try and give up,” she said. “And the more difficulties, if the Healthcare.gov is down more, we need to be in a position to help them.”

Another challenge is that brokers and application assisters can no longer get into the system to enroll their clients as they could on Kynect. Instead, consumers have to do it themselves, or brokers can use purchased software that interfaces with HealthCare.gov that allows them to enroll people -- but the software is expensive, Gillespie reports.

McConkey also told Gillespie that limited doctor networks in insurance plans are also a big issue for people trying to enroll.

Residents in 59 of the state's 120 counties will have only one health insurance option this year, Anthem Health Plans of Kentucky. And many of its plans are health maintenance organization plans, which only pay for doctors in the network, Gillespie reports.

“The big issue is that you’re not covered outside the network," McConkey said. “In a PPO [preferred provider organization], you can go outside the network and it might cost more. The only thing offered in Jefferson County is an HMO,” or health maintenance organization, which generally doesn't pay for care outside its network of providers.

Open enrollment runs through through Jan. 31. For coverage starting Jan. 1, 2017, consumers must sign up by Dec. 15, 2016.

Noted heart surgeon found guilty of health care fraud; exaggerated patient conditions to get Medicare payments

UPDATE, July 11, 2018: A federal appeals court reinstated the conviction but left open the possibility of a new trial, Bill Estep reports for the Lexington Herald-Leader. (Earlier update: Judge Bunning overturned the conviction and the government appealed his ruling, Mike James reports for The Independent.)

Dr. Richard Paulus
(Ashland Independent photo)

In the latest judgment of health-care fraud in Kentucky, a well-respected cardiologist in Ashland was found guilty last week of performing unnecessary heart procedures on patients. From 2006 to 2012, Dr. Richard E. Paulus at King's Daughters Medical Center billed Medicare "for more heart procedures than any other cardiologist in Kentucky and was fifth in the nation in the amount paid by Medicare for stent procedures," Andrew Wolfson reports for The Courier-Journal.

"Attorneys for Paulus have asked U.S. District Judge David L. Bunning to acquit Paulus, arguing that, at most, the evidence showed only honest mistakes or disagreements among cardiologists," Rachel Adkins reports for The Independent of Ashland. If Bunning refuses, Paulus lawyer Robert Bennett of Washington, D.C., said they will appeal.

A Covington jury convicted Paulus "after a seven-week trial and four days of deliberations . . . of performing numerous invasive heart procedures on patients who did not need them from 2008 to 2013, and to justify the procedures, falsifying their medical records to exaggerate their medical condition so he could qualify for government payments," Wolfson writes. "Ten cardiologists testified on behalf of the United States, and Paulus was convicted on 11 counts and acquitted on five counts."

Paulus, for whom the hospital's vascular center is named, is the third Kentucky cardiologist to be convicted of health-care fraud. Published reports say he earned $2.6 million in 2011 alone. He was specifically convicted for placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in patients, Wolfson writes, noting that stents "can save lives of heart-attack victims, but their use in stable patients has been disputed by medical researchers."

Hospital vascular center named for Paulus (Independent photo)

Paulus retired last summer. The hospital said in a statement: "Since the beginning, King’s Daughters has stood behind our cardiac program. Our heart program has continued to meet or exceed national performance standards. Independent experts have been reviewing our cases and agree that the heart care we provide is excellent."

In 2014 King's Daughters agreed to pay the federal government $40.9 million to settle civil allegations that it made millions of dollars by falsely billing federal health programs for performing heart procedures on patients who did not need them, Wolfson notes. He also recounts other recent health-care fraud cases.

Paulus faces a maximum of 20 years for health care fraud and up to five years for making false statements. His sentencing is scheduled for April 25. About 100 people attended a Sunday prayer service for Paulus, Adkins reports.

Opioid epidemic has increased number of grandparents raising grandchildren; 21 percent in U.S. are in poverty

An increasing number of grandparents are raising their grandchildren, largely because many of the children's parents are addicted to heroin or prescription drugs, both increasing problems in rural areas, Teresa Wiltz reports for Stateline. In 2015, 2.9 million kids were living with their grandparents, up from 2.5 million in 2005.

"Child welfare officials say drug addiction, especially to opioids, is behind much of the rise in the number of grandparents raising their grandchildren, just as it was during the crack cocaine epidemic of the 1980s and ’90s," Wiltz writes. That has led to a growing number of children being neglected or abandoned and for caseworkers to turn to grandparents for help, largely because the foster care system is already overcrowded with children of addicts.

"Federal law requires that states consider placing children with relatives in order to receive foster care and adoption assistance," Wiltz writes. "And grandmothers and grandfathers often are the first—and best—choice when state and local caseworkers have to take a child out of a home and find someone else to take custody, said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child-safety agencies in the state."

Generations United, a group that works to improve the lives of youth and older adults, says that grandparents and other relatives raising children save taxpayers $4 billion each year by keeping the children out of the foster care system, Wiltz reports. But some of those grandparents might not be equipped to handle raising a child. Generations United says that 21 percent of grandparents caring for grandchildren live below the poverty line, 39 percent are over 60 and 26 percent have a disability. "And because many are not licensed in the system, they are not eligible for the same services and financial support as licensed foster parents." (Read more)

Nationally, poisonings of youth from opioids rose 165% from 1997 to 2012, 205% among those aged 1 to 4

More than 13,000 Americans age 19 and under were hospitalized for opioid poisonings from 1997 to 2012, says a study at the Yale School of Medicine, published in JAMA Pediatrics. The incident rate rose from 1.4 per 100,000 people in 1997 to 3.7 per 100,000 in 2012, an increase of 165 percent. The study found that 176 of the victims died during hospitalization. (Yale graphic: Hospitalizations for opioid poisonings for people under 20 from 1997-2012)

The study, which analyzed U.S. pediatric hospital discharge records every three years from Jan. 1, 1997, through Dec. 31, 2012, found 13,052 instances of opioid poisoning for people between the ages of 1 to 19. Hospitalization rates were highest in older adolescents 15 to 19—they increased from 3.69 per 100,000 to 10.17 per 100,000—but the largest increase was among toddlers, with incidences among those 1 to 4 years old increasing 205 percent, from 0.86 to 2.62 per 100,000, for a total of 1,531.

Epidemiologist Julie R. Gaither, the study's lead author, said research points to the likelihood that the majority of incidences among those 1 to 4 were accidental, from children getting into drugs prescribed to their parents, Ariana Eunjung Cha reports for The Washington Post. There were few cases of poisonings among those 5 to 9, with researchers saying children at these ages were able to tell the difference between candy and a dangerous drug. But once children hit 10, incident rates began to climb, and are more likely attributed to suicide or self-inflicted injury, Gaither said.