Like many rural states, Kentucky struggles with issues surrounding social determinants of health, including food insecurity,
The Kansas Department of Health and Environment’s Division of Health Care Finance aims to improve Kansans’ health by increasing the quality, efficiency and effectiveness of health services and public health programs. Little information is publicly available on the division’s current efforts – for example, although the agency’s Health Data Consortium produced a series of reports using data from the state’s all-payer claims database, the group appears to have been inactive since 2011. In 2014, the state piloted a “health home” program that put community mental health centers in charge of coordinating care for Medicaid patients with severe mental illnesses, however the program ended before producing significant results.
In 2018, Kansas enacted legislation to bar pharmacy benefits managers from prohibiting or penalizing pharmacists for informing patients of lower cost options. The state has introduced, but not passed, legislation to increase price transparency and has no protections against surprise medical bills as of 2019.
Three out of four Kentuckians (77 percent) are worried about affording healthcare, according to a survey conducted by the Healthcare Value Hub in collaboration with the ThriveKY campaign. Kentucky adults reported numerous affordability problems. Almost a third of respondents delayed going to the doctor and 1 in 5 rationed medicine in the past year due to cost. Additionally, dissatisfaction with the current healthcare system is both statewide and bipartisan. The majority of respondents (71 percent) agreed or strongly agreed that the healthcare system needs to change, and 69 percent of respondents identified healthcare as the priority issue the government should focus on. Respondents endorsed a number of strategies to lower healthcare costs, but the clear front-runner, at 91 percent, was to “expand health insurance options so that everyone can afford quality coverage.”
Kentucky passed a law to provide financial aid to rural hospitals struggling to stay afloat while the state is battling COVID-19, according to Kentucky Today. The legislation allows the Cabinet for Economic Development to provide loans to struggling hospitals for a variety of purposes, including upgrading facilities, maintaining or increasing staff levels and providing healthcare services not currently available. The action follows reports that many rural hospitals in Kentucky are in poor financial health.
An arrangement between UK HealthCare and the Kentucky Department of Revenue has come under scrutiny amidst reports that patients with unpaid medical bills are falling prey to predatory debt collection practices, according to WFPL. The Department of Revenue uses a number of methods to collect payment for UK HealthCare patients’ outstanding medical bills that private bill collectors are unable to use without a court order. Strategies include seizing state tax refunds, confiscating lottery winnings and garnishing paychecks. Additionally, the Department of Revenue adds a 25 percent collection fee to the original balance that patients are required to pay, as well as interest ranging from 5-7 percent. State data show that interest payments alone have added $4 million to the commonwealth’s general fund since 2009.
Roughly half of rural hospitals across Kentucky are in poor financial health – 16 of which are at high risk of closure, according to The Lane Report. Ten of the 16 hospitals are essential their communities, based on an analysis of trauma status, service to vulnerable populations, geographic isolation and economic impact. The financial strain on rural hospitals results from a number factors, including decreased demand for inpatient care and a loss of agricultural and manufacturing jobs in rural communities, leaving them with a shrinking population that tends to be older and poorer (and, therefore, more likely to be uninsured or on Medicaid or Medicare, which don’t pay for the total cost of care). Closures cost communities their immediate access to emergency and acute care and can also bring economic hardship from loss of employment.
An analysis conducted by the Henry J. Kaiser Family Foundation found that Kentucky has one of the lowest rates of surprise medical billing in the nation, reports Louisville Business First. The state has the eighth lowest rate for inpatient hospital stays and ninth lowest rate for emergency room visits with unexpected out-of-network charges in 2017, at 7 percent and 8 percent respectively. However, unlike other states, Kentucky lacks protections for residents who receive surprise medical bills as of 2019.
A federal judge says Kentucky can't require poor people to get a job to keep their Medicaid benefits, chastising President Donald Trump's administration for rubber-stamping the new rules without considering how many people would lose their health coverage. According to Fox News, the decision is a setback for the Trump administration, which has been encouraging states to impose work requirements and other changes on Medicaid, the joint state and federal health insurance program for the poor and disabled. Kentucky was the first state in the country to get that permission, and the new rules were scheduled to take effect Sunday in a northern Kentucky suburb of Cincinnati.
After learning that nearly three-fourths of Kentucky adults reported having had one or more problems affording health care in the past year, two Democrats and one Republican in the legislature found they had much to agree on when it came to finding ways to address this problem, according to an article in Kentucky Health News. The lawmakers were part of a legislative panel at a Kentucky Voices for Health forum to discuss the results of the new healthcare affordability survey conducted by Altarum’s Healthcare Value Hub. The survey found that the 72 percent of Kentucky adults who struggled to pay for health care in the past year reported that their affordability issues largely centered on not being able to afford insurance, delaying or foregoing care because of cost, and struggling to pay medical bills. One in four participants said they had been contacted by a collection agency. The regional results showed that 80 percent of adults in Eastern Kentucky said they had had affordability burdens in the past year, the highest rate of any region.
The University of Kentucky has received almost $5 million to expand and improve a program to help pregnant women with opioid dependence problems before, during and after delivery, according to an article in Lexington Herald Leader. The Perinatal Assistance and Treatment Home (PATHways) program is currently based in Lexington, helping pregnant women with medication, peer support and health services to reduce the number of babies born with an opioid addiction. The program continues after birth with peer counseling and health services. Kentucky has one of the highest rates in the nation of babies born with neonatal abstinence syndrome (NAS), a rate that has climbed from 46 babies in 2001 to 1,115 in 2016, according to hospital discharge data collected annually by the Kentucky Cabinet for Health and Family Services. Between 2014 and spring 2017, more than 150 women received treatment through PATHways. Of those, 77 percent were admitted to labor and delivery without any illicit drugs in their systems.
According to an article in the Courier Journal, under Bevin's plan, it actually will cost Kentucky more to provide health coverage to people affected by the Medicaid changes than if the state did nothing. Cost savings come from the assumption that nearly 100,000 people will drop out of Medicaid by the end of the five-year project recently approved by the federal government. For those who remain, the monthly cost of care increases faster than it would have had the state made no changes, according to the administration's projections. Kentucky has added $186 million to the current budget and proposes $187 million in the next budget year starting July 1 for administrative costs, most of the money associated with the Medicaid changes. Part of the administrative costs added to this year's budget would go toward creating a Medicaid computer system required by the federal government.
Federal health officials granted Kentucky permission to impose work requirements. Becoming the first-in-the-nation state to move forward with the profound change to the safety-net health insurance program is a victory for Kentucky’s Republican governor, according to an article in The Washington Post. Since Kentucky expanded Medicaid under the ACA four years ago, to include people with incomes of up to 138 percent of the federal poverty level, nearly half a million newly eligible residents have joined the program. Aides to the governor estimated that about half of 350,000 able-bodied, working-age Medicaid recipients subject to the “community engagement” requirement already meet its terms to work at least 80 hours per month, volunteer or be in job training. Individuals will need to send documentation to prove their compliance.
Kentucky has been hugely affected by the opioid abuse epidemic. Last year, 623 state residents died from the opioid fentanyl, up 6% compared with 2015. In 2015, the state experienced the third-highest rate of drug overdose deaths in the country, according to an article in Modern Healthcare. WellCare, one of the state's Medicaid insurers, has created a program that monitors members who are prescribed opioids.
Program participants are connected to one physician, one pharmacy and then a social worker who can help with addiction treatment and support services. The hope is to tackle pharmacy shopping, which is when patients use multiple pharmacies and prescriptions to obtain the same opioids.
Kentucky became the first state to announce both the closure and restructuring of a state health insurance marketplace and Medicaid expansion. Kentucky might be the test model for the rest of the nation for reversal of ACA-related health policies. A report published in the Journal of Health Politics, Policy and Law examines the potential short-term and long-term impacts that may occur following changes in state health policy. The report offers potential strategies to ameliorate the expected negative impacts of disruption of both Kynect and Medicaid expansion.
Rural Western Kentucky is one of only a handful of U.S. regions to improve on a majority of measures tracked by the Commonwealth Fund’s Scorecard on Local Health System Performance. The most striking gains were tied to the state’s Medicaid expansion, which added nearly 500,000 low-income adults to the program, according to a report by the Commonwealth Fund. The coverage expansion helped recruit federally qualified health centers to the region. In addition, hospitals and other providers enhanced access through school-based clinics, offering urgent and behavioral health services.
The annual Kentucky Health Issues Poll revealed the cost of healthcare continues to prevent a significant number of Kentucky adults from obtaining needed medical care, as reported in the Lane Report. The poll found that 22 percent of adults in the state reported that a person in their household delayed or missed needed care due to cost. The rate has been essentially unchanged for the past three years.
A study conducted by the University of Kentucky found that a community awareness program increased use of low-dose CT scans and prompted individuals to consider tobacco cessation, according to Kentucky Health News. A low-dose CT scan is able to detect early signs of lung cancer and is recommended for people aged 55 to 77 who are at high risk such as current smokers. Kentucky has the highest smoking rate in the country.
WFPL Public Radio: A new poll shows more lower-income adults have become eligible for insurance since the implementation of the Affordable Care Act and the expansion of Medicaid. In 2013, before the expansion took effect, more than three in 10 adults earning less than 200 percent of the federal poverty level were uninsured.Uninsured rates are now about the same for all Kentucky adults regardless of income, according to the poll.
Kentucky Health News: As the new administration of Gov. Matt Bevin continues to move toward dismantling the state's Kynect health-insurance exchange, it has launched an online portal for Kentuckians to apply for Medicaid and other public assistance called Benefind. Benefind also provides an access point for the Kentucky Children’s Health Insurance Program.
The Atlantic: Matt Bevin campaigned on a health-care pledge that would undo the work of his predecessor: to dismantle Kentucky’s popular insurance exchange and change up the even more popular Medicaid expansion. But as the Republican governor’s campaigning morphs into actual governing, he could find that pledge hard to stick to: not only because hundreds of thousands of Kentuckians now have insurance but also because his plans could be costly—and no one seems to know who would pay for all of it.
Health Affairs Blog: The Foundation for a Healthy Kentucky held its second healthcare price transparency symposium on October 16. This convening occurred a year after the foundation’s first symposium, in which state and national speakers discussed the need for price transparency in the collective effort of healthcare leaders to meet the unmet healthcare needs of Kentuckians through policy work. These symposia are part of the foundation’s broader Promoting Responsive Health Policy initiative, which has the goal of making policy more responsive to the health and healthcare needs of Kentuckians. Since the first price transparency symposium, the state of Kentucky has engaged the University of Kentucky in a process of creating a Kentucky-based and -designed all-payer claims database (APCD).
Kentucky Health News: A report released by the Foundation for a Healthy Kentucky and the University of Kentucky College of Public Health examined the relationship between health, income and education and found that poverty and lower education was consistently associated with poorer health outcomes.
The State Journal: According to a report released by KYHealthNow, more Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services since the launch of kyhealthnow. The report showed Kentucky is moving towards meeting the wide-ranging goals laid out in the initiative, which was launched in February 2014.
In October 2014, the Foundation for Healthy Kentucky convened over 60 Kentucky leaders in government, business, policy and healthcare, along with experts from national organizations , including Consumers Union, to explore ways to bring credible, objective cost and value information to consumers and others. This Foundation’s report recommends that the Commonwealth of Kentucky establish an All-Payer Claims Database as a necessary tool to change the way healthcare is delivered. Click here for the full report and executive summary.