FRANKFORT, Ky. - A "real mess." That's how one health-care advocate describes Kentucky's transition to a single system to determine eligibility for health insurance and other social services.

People who depend on kynect – the state health-insurance exchange that was hailed as a model for the nation – have been especially concerned about the transition, although Gov. Matt Bevin's office said his plans to dismantle kynect have nothing to do with the current technical problems.

Emily Beauregard, executive director of Kentucky Voices for Health, said she has heard numerous reports of people being "mysteriously dis-enrolled" from Medicaid, errors on applications and long waits for help.

"The wait time for the people who stay on the line is over two hours, but 6,000 to 7,000 calls a day go unanswered," said Beauregard. "That's a lot of people who can't get assistance."

She cited glitches in the system and not enough workers to handle the job, and said assistance from the folks known as "kynectors" is not always possible.

Cabinet for Health and Family Services spokesman Doug Hogan acknowledged the difficulties and said the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

In the meantime, Pikeville resident and Medicaid recipient Connie Holt, who has many chronic health conditions, said her efforts to change her insurance provider became a daily nightmare.

"I was in tears by the end of the day," said Holt. "I would make calls until my battery went dead on my phone, and I'd have to plug it in to charge. Back and forth, all day long."

Cara Stewart, who was Holt's kynector in the process, said it took her over two weeks of nearly daily efforts to get the change made for Holt – which she added would have taken "five minutes last fall," under kynect.

Transitioning from kynect to a federal insurance exchange continues to be controversial.

State representatives in the Democrat-controlled House are expected to vote soon on legislation (HB 5 and HB 6) that would keep kynect and protect Medicaid expansion. Supporters say these have led to a sharp decline in uninsured rates, fewer emergency room visits and more preventive care.

According to Beauregard, 'yes' votes from the House would make a strong statement.

"We know from a recent Kaiser Family Foundation poll that 72 percent of Kentuckians want to keep Medicaid expansion without any changes," she said. "And twice as many Kentuckians want to keep kynect."

However, Gov. Bevin and many Republican lawmakers say the state health insurance exchange is too expensive, and think the way Medicaid is delivered to 1.3 million Kentuckians should be restructured.



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Some Kentucky lawmakers want to make it mandatory for some Medicaid participants in Kentucky to work, but experts say that would disproportionately affect people with mental health or substance use disorders.

House Bill 695 would require able-bodied adults with no dependents to work - and prove it - to receive health care.

Kentucky currently has a voluntary program, with job training and opportunities for community engagement, but Emily Beauregard - executive director of Kentucky Voices for Health - explained it isn't required for Medicaid eligibility.

"The majority of Kentuckians with Medicaid coverage are already working," said Beauregard. "They're working full time, part time. They're students, they're caregivers, taking care of children or older family members, people with disabilities."

Supports of work requirements argue the current system incentivizes people not to work, and argue the change will help alleviate staffing shortages.

Meanwhile, Congress is considering deep cuts to Medicaid, around $880 million over the next decade.

Groups like the Kentucky Center for Economic Policy say that would disproportionately affect Kentucky, which is one of the top ten states for the share of its population covered by Medicaid.

Valerie Lebanion teaches local parenting classes in Whitley County. She said most of her clients rely on Medicaid for health coverage.

She said she believes increased red tape around the program would end up hurting families.

"When moms and dads are sick, they can't take care of their children," said Lebanion. "They can't take their children to school, get their children off to where they need to be, or even to take care of their children."

Beauregard said the state would also end up paying more for the administrative work needed to track and document mandatory work requirements.

"It doesn't make sense economically," said Beauregard, "and it puts an additional burden on hard-working Kentucky families who are doing everything right and end up falling through paperwork cracks."

A recent poll from the health policy and research organization KFF found 96% of participants said Medicaid is either important or very important to their community - and 82% said lawmakers should leave Medicaid spending unchanged or increase funding.

Tensions are rising in Ohio between doulas and the state Board of Nursing, as only a small number of doulas have been able to be certified for Medicaid reimbursement - despite a statewide push to reduce infant mortality.

More than 60,000 births in Ohio each year are covered by Medicaid. Research shows having a doula can lower risks for both moms and babies.

But only 132 doulas statewide are certified to receive Medicaid payments.

Dr. Marie McCausland, who chairs the state's Doula Advisory Group, said to meet the demand, about 3,000 need to be certified.

But she contended the certification process has been anything but collaborative - and called it "top-down and exclusionary."

"Day one, the first meeting, they already had almost all the rules written," said McCausland. "They sent it to us and we were supposed to start there, versus any sort of collaborative writing of the rules."

She said she recently discovered she's being removed as chair after a quiet legislative change that stripped doulas of their ability to lead the advisory group, effective April 9.

The Ohio Board of Nursing said in a statement the leadership change was made for consistency with other professions.

But McCausland said even doulas serving non-Medicaid families are sometimes being turned away, because they don't hold the new certification.

Guillermo Bervejillo, research manager with Children's Defense Fund Ohio, said the governor made doula access a priority, but the Board of Nursing may be undermining that effort.

"Gov. DeWine made it a priority to reduce infant mortality, especially amongst Black children," said Bervejillo. "He created a doula advisory group. The doula advisory group has faced obstacle after obstacle. It's been kind of wild. It feels like the governor doesn't even know what's going on."

McCausland said there also are concerns about racial bias and representation.

She said Black voices on the advisory group have been ignored, even scrubbed from official meeting records - prompting the group to hire a court reporter.

"Doulas are happy to come into hospital systems and work with doctors and nurses," said McCausland. "We want to be able to work as a team for our client success."

The Board of Nursing says it values the input of doulas and that the advisory group includes health professionals from a range of backgrounds.

The board says it is committed to improving maternal health outcomes and continuing to refine the certification process.

This week, workers who provide in-home and nursing home care rallied against cuts to Medicaid.

Washington's Medicaid, known as Apple Health, covers nearly 2 million low-income people in the state, including the majority of nursing home residents. Service Employees International Union Local 775 is the union representing long-term care workers who assist seniors and people with disabilities, in their homes and in nursing facilities.

Adam Glickman, secretary-treasurer of SEIU 775, said caregivers help with such essential tasks as cooking, bathing, medication management and transportation. He emphasized cutting Medicaid would mean many would not get the care they need.

"That could mean they're left alone in their homes, without care," Glickman pointed out. "For many people, it'll mean ending up in emergency rooms."

President Donald Trump and House Republicans are proposing $880 billion in cuts from the Energy and Commerce Committee, most of which would come from Medicaid. Critics said the goal of the plan is to help pay for tax cuts that would largely benefit the wealthiest Americans.

Kandie Luo, a caregiver and union member who depends on Medicaid for her own family's health care, as well as for her income, emigrated from China 40 years ago and thinks cuts to Medicaid would especially harm immigrant communities.

"This is not just about the number, it's about the real people," Luo stressed. "About the family, like me, depending on the Medicaid to survive."

The Trump administration said Medicaid cuts would focus on reducing waste and fraud in the program. Glickman contended it is an issue that has been blown out of proportion.

"I think this has become a red herring or kind of smoke screen by people who just really don't want to admit that what they're doing is cutting people's health care," Glickman argued.

A new poll from the health research organization KFF confirmed Medicaid's popularity across the country, with only 17% of Americans supporting cuts to the program.