While too much of the 2021 General Assembly was focused on limiting executive powers in the face of a public health crisis and economic recession, multiple bills passed that are hugely impactful in engineering state law towards health justice and health equity. Here are a few of the achievements, benchmarks, and new precedents passed this year, and what they mean to everyday Kentuckians:
Mental Health Parity
HB50, sponsored by Rep. Kimberly Moser (HD64) defines “classification of benefits” and “non-quantitative treatment limitation”, and requires health insurance to provide comprehensive mental health coverage without arbitrary limits on treatment.
What does this really mean? It means Kentucky law finally complies with the 2008 federal Mental Health Parity and Addiction Equity Act (MHPAEA) that orders health insurers to not only treat mental health conditions and substance use disorders under the same scope and interpretation they use for coverage of physical health treatments and conditions, but to also file annual compliance reports with the Kentucky Department of Insurance.
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2019 behavioral health barometer, Kentucky’s rankings continue to be compelling and alarming. Half of Kentucky’s children aged 12-17 (approx. 19K kids) who experienced a major depressive episode have also received continued depression care. This is higher than the regional averages of 40.2% and the national average of 41.8%.
Mental healthcare is healthcare. HB50 makes a significant step in addressing the lack of mental health support in Kentucky’s healthcare system, fighting back and even preventing the scourge of substance use by using every tool in the toolbox.
Consumer Representation Matters
Rep. Kimberly Moser (HD64) also sponsored HB53, increasing the membership for Kentucky’s Technical Advisory Councils or “TACs”. These TACs act as advisors to the Advisory Council for Medical Assistance (MAC). Each TAC represents a specific provider type or is made up of stakeholders representing Medicaid beneficiaries. HB53 expands the MAC, Consumer Rights & Client Needs TAC, Behavioral Health TAC, and creates a new “Reentry TAC” for Persons Returning to Society from Incarceration.
This may seem minimal or even administrative in nature, but expanding the number of seats at the table promotes transparency and responsive health policy. TACs are the sounding boards to state officials who develop forms and regulations, determine eligibility, oversee the provision of Medicaid services, process appeals, and more. Through TACs, stakeholders identify opportunities for state government to work smarter, not harder, for its people. The addition of a Healthy Reentry TAC is also one of many steps legislators have taken recently to promote successful reentry and reduce recidivism for Kentuckians being released from incarceration.
Huge Victory for Many Diabetics in Kentucky
Rep. Danny Bentley (HD98) sponsored HB95 alongside primary co-sponsor Rep. Patti Minter (HD20), capping insulin cost-sharing to $30 per 30-day supply for Kentuckians primarily on the Kentucky Employee Health Plan (KEHP). HB95 also requires these benefit plans to provide equipment, supplies, and training to further assist diabetic Kentuckians in staying healthy.
Reps. Bentley and Minter are more than just empathetic on the issue; they share lived experience in the battle against insulin costs. Rep. Bentley is a diabetic, and Rep. Minter has raised a son with diabetes. Although 10.5% of the U.S. population is estimated to have diabetes, Kentucky’s crude estimates are more serious – 13.7% have diabetes, and an additional 11.8% have prediabetes.
Even with rebates, coupons, and other discounts, the American healthcare system is guilty of charging its patients 8 times more for insulin when compared to other high-income nations. The drug’s manufacturing price tag per patient is estimated to be $48-$71 for an entire year’s supply – roughly $2.28-$3.42 per vial to produce – yet it is not uncommon for Kentuckians to be charged thousands of dollars per month for insulin in order to live.
The discovery of insulin in 1921 was an incredible milestone in the history of medicine, and this year we celebrate 100 years of its life-saving, breakthrough scientific achievements. Insulin price gouging is a cruel injustice and consumer safeguards are long overdue. The horror stories are real – people become desperate, ration insulin doses to try and make them last longer or go without. Complications result in everything from bankruptcy and homelessness to premature death.
Although HB95 is a step in the right direction for the more than half a million Kentuckians who need insulin to regulate their blood glucose levels, it unfortunately does not include self-insured ERISA plans and other government plans (e.g. universities, city/county governments) in insulin cost-sharing caps. All Kentuckians deserve the same insulin cost-sharing safeguards. We must fight to ensure not only that, but also continue addressing the underlying causes of Kentucky’s health disparities, which are too often rooted in poverty and racism.
Embracing Healthy Reentry & Reducing Recidivism
Rep. Kimberly Moser (HD64) sponsored HB497, a healthy reentry bill many years in the making. HB497 establishes work supports for those leaving incarceration in the form of photo IDs and employability certificates, and significantly, HB497 lifts the SNAP and TANF drug felony ban. If the state’s 1115 Waiver Amendment to provide federal Medicaid matching funds for the treatment of substance use disorders (SUD) is approved, HB497 has already paved the way for faster access to the necessary SUD treatments many incarcerated individuals truly need, and, the groundwork has also been laid for those leaving incarceration to have access to Medicaid coverage without delay.
HB497 offers meaningful reentry support to those who left incarceration years ago, too. For Kentuckians who got caught with too much marijuana in the 1980s – or whatever the exact drug felony charge may have been – if you have struggled to make ends meet and put food on the table the entire time you’ve been home, we encourage you to reapply for SNAP/TANF benefits later this year when the law goes into effect.
Homeless Youth Mental Health Protections
Sen. Ralph Alvarado (SD28) sponsored SB21 to address a transportation problem for youth to go to a hospital with psychiatric services. SB21 also gives permission for all Licensed Mental Health Professionals to provide service to “unaccompanied” (i.e. homeless) youth, ages 16-17, without needing written consent from a parent or guardian.
The Advocacy Action Network and Kentucky Mental Health Coalition have been working for years to open access for youth to mental health services. Although SB21 is specific and limited in scope, it is a positive first step in opening that door.
Prevent Copay Accumulator Adjustments
SB45, also sponsored by Sen. Ralph Alvarado (SD28), protects Kentuckians from a costly and burdensome health insurance practice called “co-pay accumulator adjustments”. In practice, these “adjustments” let insurers refuse to count third party assistance toward annual deductibles and the impact on struggling Kentucky families can be devastating.
Let’s say a Kentuckian has insurance with a $1,000 deductible. The individual has a $250 prescription, but with a manufacturer coupon, it knocks the out-of-pocket price down to $115. Copay accumulator adjustment policies have allowed insurance companies to deny the out-of-pocket expenses in these scenarios, meaning the full $1,000 deductible would still need to be met before insurance would cover the cost of healthcare needs.
SB45 requires health insurers to count all payments made by patients directly or on their behalf toward their overall deductible and maximum out-of-pocket costs, unless a generic drug is available. This will be a huge cost-savings for thousands of Kentucky families.
Addiction Treatment Protections & Solutions
SB51, another bill sponsored by Sen. Ralph Alvarado (SD28) creates consumer safety guardrails for individuals being treated for alcohol and opioid use, prohibiting insurers from requiring utilization reviews, a.k.a. “prior authorizations”, for certain prescription drugs (Buprenorphine, Methadone, and Naltrexone) when used to treat alcohol or opioid use disorder.
When an individual seeks help for their addiction, any delay in treatment can be detrimental to their recovery. Prior authorizations that take 3-7 days clearly delay care and disrupt treatment plans for those already in recovery. SB51 removes a significant barrier for treating alcohol and opioid use disorders that will support recovery for thousands of Kentuckians.
Eliminate Copay Burdens for 1.6 Million Kentuckians
Sen. Steve Meredith (SD5) sponsored SB55, removing the requirement that Medicaid charge copayments or other types of cost-sharing to any Medicaid and KCHIP recipient. Executive Order 2020-220 issued early in the COVID-19 pandemic directed insurers to waive all copayments, co-insurance, and deductibles for patients seeking any form of care related to COVID-19, and 907 KAR 1:604 additionally waives all forms of cost-sharing expenses for Medicaid beneficiaries in response to a declared emergency related to healthcare or public health. In effect, SB55 makes permanent these temporary measures to waive cost-sharing, even after the COVID-19 orders are lifted.
Co-pays and other out-of-pocket expenses often prevent people from seeking the care they need, even if that care can prevent more serious and costly health complications down the road. SB55 eliminates co-pay burdens for Kentuckians with Medicaid coverage and reduces administrative costs in the healthcare system, making it easier for Kentuckians to get the care they need to stay healthy and thrive.
Protect the Life of Incarcerated Babies & Parents
Sen. Julie Raque Adams (SD36) sponsored SB84 as the “Dignity Bill Part 2”, specifically addressing issues that the growing population of pregnant incarcerated people face. SB84 provides 6-weeks of postpartum care and ends solitary confinement during pregnancy. In the postpartum period, it expands pregnancy medical release to include community based treatment options, provides social workers who can work with pregnant people, and requires the KY Dept. of Corrections to report to the Legislative Research Commission regarding solitary confinement of Kentucky’s incarcerated population.
The design of Kentucky’s correctional system has historically centered on how to manage male-only incarceration. But more and more women and pregnant people are finding themselves bound by incarceration in Kentucky, being shackled at 8-months pregnant, or forced into solitary confinement during some part of their pregnancy. Horror stories continue to happen. SB84 protects the lives of these babies, their parents, and opens the door to more comprehensive healthcare.
Not the “Rest of the Story”
These bills and others were a part of our KVH Health Justice Bill Tracker this year. They don’t reflect all the good legislation that passed into law this year, but they are long overdue health equity measures and important steps that build on the Affordable Care Act (ACA) as we continue to advocate for policies that make healthcare accessible and affordable for every Kentuckian. Unlike the representative democracy we deserve, access to the Capitol and Annex was extremely limited, yet advocacy persisted and policies that have been years in the making were successfully pulled across the finish line.
Healthcare is a human right. Although there continue to be too many injustices and bureaucratic obstacles preventing Kentuckians from achieving their optimal wellness, democracy is never a “one and done”. We will continue the work, especially as we turn our attention to the 2021 legislative interim and prepare for the 2022 Regular Session. Hat tip to every phone call, letter, zoom meeting, remote testimony, virtual rally, or email that helped advocacy prevail for these 2021 health justice measures.
To learn more about the author, visit: https://kyvoicesforhealth.org/our-team/.