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NOVEMBER 13, 2017

Move paves way for Bevin's revamping of program, including premiums...

The Trump administration has announced rules changes for the Medicaid program that allow states to require some enrollees to work or volunteer – changes that likely pave the way for Kentucky's new Medicaid plan to be approved.

Seema Verma (US News photo)Seema Verma (US News photo)"Let me be clear to everyone in this room, we will approve proposals that promote community engagement activities, " Seema Verma, director of the Centers for Medicare and Medicaid Services, said in a speech to state Medicaid directors Nov. 7.

Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago.

The proposal largely targets "able-bodied" adults who qualify for Medicaid under the expansion of the program under the Patient Protection and Affordable Care Act – those with household incomes up to 138 percent of the federal poverty level.

If approved, the plan would require such beneficiaries who are not "medically frail" or primary caregivers to work or volunteer 20 hours a week to keep their coverage. Work requirements for Medicaid recipients have historically not been approved because they didn't line up with the program's mission to provide medical assistance to low-income people; now the rules are different.

Kentucky Medicaid Commissioner Stephen Miller said at the directors' meeting that Kentucky hopes to implement the state's work requirements by July, Lisa Gillespie reported for Louisville's WFPL.

At the Nov. 6 meeting of Kentucky's Friedell Committee for Health System Transformation, Dr. Gil Liu, the state's medical director for Medicaid, said the state will initially implement work requirements in regions that have the most jobs available, and will then figure out how to implement them in other parts of the state where fewer jobs are available.

The plan would also require most Kentuckians on Medicaid to pay small monthly premiums, initially $1 per person to $15 per family, depending on income. People with disabilities, pregnant women, children and caregivers would not have to pay.

"Miller said the administrative costs of collecting those premiums would be higher than the actual amount of premium collected. But he said the point of the change isn’t to make money — it’s to encourage enrollees to transition out of Medicaid and into private coverage," Gillespie reports.

Critics of the plan, called Kentucky HEALTH, say that won't work because employers don't offer health insurance as a benefit nearly as much as they used to, and the state has many working poor who can't afford private insurance. Most covered by the Medicaid expansion work.

Miller said he expects about 200,000 Medicaid enrollees will be affected by the changes, Gillespie reports. The expansion covers about 478,000 Kentuckians; Medicaid as a whole covers about 1.4 million. For a spreadsheet of enrollment by county in June 2017, click here.

If federal officials approve the waiver, as expected, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted. The state estimates that will save the state and federal government $2.4 billion over the next five years.

The state pays 30 percent of traditional Medicaid costs. The federal government paid all the expansion costs for the first three years, but this year the state is paying 5 percent, and that will rise in annual steps to the law's limit of 10 percent in 2020.

Bevin has said the state cost is "unsustainable," and rejects arguments that the multi-billion-dollar expansion has generated state tax revenue by boosting employment in health care.

Commissioner Stephen MillerCommissioner Stephen MillerThe governor's lieutenants also make the argument that the expansion hasn't improved Kentucky's health. Miller did that at the Medicaid directors' meeting.

"He said that even though the state’s Medicaid rolls have soared to cover 33 percent of residents, Kentucky still has high rates of cancer, smoking and obesity," Phil Galewitz of Kaiser Health News reports, quoting Miller directly: “We have to try something else. We need to do more than just help people access health care.”

Officials of then-Gov. Steve Beshear's administration said when they expanded Medicaid that it would take several years to change the state's health status, and that it might even decline temporarily as people who hadn't received care for many years were diagnosed with health problems.

Tens of thousands of Kentuckians have used their new Medicaid benefits to get screened for cancer and other health problems, or get treatment for substance abuse or other issues. A three-year study of the expansion in Kentucky and Arkansas found a 23 percent increase in the share of people in federal surveys who reported that their health is excellent.

Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of pro-Obamacare organizations, wrote in an op-ed that Bevin's changes are designed to "remove people from the rolls, rather than to promote health and access to affordable care."

Verma, who played an active role in designing Kentucky's waiver request, told the Medicaid directors that the new rules are "ushering in a new day for Medicaid" that will increase states' flexibility while improving accountability and integrity.

"We owe our fellow citizens more than just giving them a Medicaid card. We owe a card with care, and more importantly a card with hope," Verma said. "Hope that they can achieve a better future for themselves and their families. Hope that they can one day break the chains of generational poverty and no longer need public assistance, and the hope that every American, no matter their race, creed, or origin, can reach their highest potential. We will approve proposals that accomplish this goal."

Verma also said, "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration."

Seven other states — Arizona, Arkansas, Indiana, Maine, New Hampshire, Utah and Wisconsin — have submitted varying requests to CMS that would require non-disabled Medicaid enrollees to either work or provide community service.
Posted by Melissa Patrick at 9:35 PM


Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky



Date: 11-09-2017

Insider Louisville

According to a report in Nature, the Environmental Protection Agency told the Lexington (Ky.) - based startup MosquitoMate that “it could release the bacterium Wolbachia pipientis into the environment as a tool against the Asian tiger mosquito (Aedes albopictus).”

The lab-grown mosquitoes developed by MosquitoMate seek to eliminate the disease-carrying Asian tiger mosquito. (Aedes albopictus, shown here) | Courtesy of NatureThe lab-grown mosquitoes developed by MosquitoMate seek to eliminate the disease-carrying Asian tiger mosquito. (Aedes albopictus, shown here) | Courtesy of Nature

Translation: The company can release lab-grown, bacteria-infected, so-called killer mosquitoes in 20 states and Washington, D.C., Nature reported. As described by MosquitoMate, “Our ZAP male mosquitoes (non-biting!) are released prior to the mosquito season to begin the suppression of the mosquito breeding season.”

According to Quartz, “When bacteria-infected males mate with uninfected females, the females produce eggs that don’t hatch. In addition, infected mosquitoes are less likely to spread disease.”


November 6, 2017

191 Kentucky fatal drug overdoses in 2016 related to oxymorphone


FRANKFORT, Ky. (Nov. 6, 2017) – In 2016, more than 190 Kentuckians died from a drug overdose caused by a powerful prescription opioid three times stronger than morphine.

Many of those victims were service members or veterans.

OPANA EROPANA ERThe drug is Opana ER (oxymorphone hydrochloride extended release), manufactured by Endo Pharmaceuticals and Endo Health Solutions, against who, Attorney General Andy Beshear today filed suit for violating state law and directly contributing to these as well as other opioid related deaths and overdoses in Kentucky.

“Today we are taking action to hold Endo responsible for unlawfully building a market for the chronic use of opioids in the name of increasing corporate profits, knowing all along the dangers of Opana ER that led to devastating effects on the Commonwealth,” Beshear said. “My office refuses to sit back and watch families be torn apart while opioid manufacturers like Endo line their pockets at the expense of our communities and our future.”

The potential for abuse by Kentuckians from Opana ER has been of concern to Beshear since he took office.

In February 2017, Beshear expressed his concerns to the U.S. Food and Drug Administration (FDA) during an open comment period, saying that the drug’s reformulation that allegedly made it tougher to abuse “has merely been found to impede one of many means of abuse and approving labeling Opana ER as ‘abuse deterrent’ may mislead patients and providers.”

The FDA requested June 8 that Endo remove Opana ER from the market. The company announced July 6 that it would no longer sell the drug.

Beshear said the removal of Opana ER from the market was an important step in battling the state’s drug epidemic but that the damage from Endo’s practices has already harmed the people of Kentucky.

Louisvillian Emily Walden lost her son, T.J., as a result of an Opana ER overdose in 2012. T.J., who was in the Kentucky National Guard, overdosed on Opana ER and died shortly before he was to deploy overseas.

Emily emailed Endo asking for help when her son became addicted to Opana ER. One month after T.J.’s death – a full year after she reached out to Endo about his addiction – the company finally responded to ask her for information so that it could file a report with the FDA.

“Oxymorphone was removed from the market in 1979, denied approval by the FDA in 2003 and ultimately approved in 2006 after Endo played a role in changing the clinical trial design,” Walden said. “It’s time these drug companies are held accountable for what they’ve done. This bunch has literally caused death and destruction in communities like Louisville all across the United States. My hope is that lawsuits like this will finally hold them accountable for their unethical marketing and promotion of these drugs, so that no other mother will have to walk through the fire they’ve caused me to endure.”

Endo especially targeted Kentucky veterans in its promotion of Opana ER, according to the AG’s complaint.

Beshear said Endo’s blind eye to the abuse of its drug also led to a surge of HIV cases in Scott County, Indiana in 2015 and put more than 50 Kentucky counties at risk for a similar outbreak.

The Centers for Disease Control and Prevention tied the 2015 HIV outbreak specifically to the injection of Opana ER. In doing so, the federal health agency identified 220 counties across the country at the greatest risk for similar outbreaks. Fifty-four of those counties, roughly 25 percent, were in Kentucky – the majority being in the eastern part of the state.

Beshear’s lawsuit, one of many to be filed by his office against rogue pharmaceutical companies, shows how the actions of Endo directly violate numerous Kentucky laws. It seeks civil penalties and compensatory and punitive damages for the Commonwealth.

As part of Beshear’s multifaceted strategy to combat the opioid crisis, on Sept. 22, 2017, Beshear’s office awarded a contract to the legal team his office will partner with in the investigation and prospective litigation against opioid drug manufacturers distributors, and retailers. Beshear plans to seek compensation on behalf of the Commonwealth where there is evidence that bad actors contributed to the opioid epidemic by illegally marketing, distributing and selling opioids to Kentuckians.

Beshear said the contract, which still has not been approved by the Kentucky Finance and Administration Cabinet, provides that the contracting law firms – and not the Commonwealth – will pay the costs of any litigation.

Beshear emphasized the importance of the timely approval of the contract and noted that Kentucky needs the experience of local and national attorneys who have the resources and knowledge to help this office secure funds for the Commonwealth and to help repair the harm caused by those who have played a role in Kentucky’s opioid crisis.