Call to Order and Roll Call
Thefifth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 19, 2016, at 10:00 a.m., in Room 129 of the Capitol Annex. Senator Julie Raque Adams, Co-Chair, called the meeting to order at 10:05 a.m., and the secretary called the roll.
Members:Senator Julie Raque Adams, Co-Chair; Representative Tom Burch, Co-Chair; Senators Ralph Alvarado, Julian M. Carroll, David P. Givens, Jimmy Higdon, Alice Forgy Kerr, Reginald Thomas, and Max Wise; Representatives Robert Benvenuti III, George Brown Jr., Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Phil Moffett, Tim Moore, Russell Webber, Susan Westrom, and Addia Wuchner.
Guests: Terry Brooks, EdD, Executive Director, Kentucky Youth Advocates; Grant Smith, PhD, Bellarmine University; Clifford Maesaka, DDS, President and CEO, Delta Dental of Kentucky; Tammy York Day, Chief Operating Officer, Delta Dental of Kentucky; Bob Babbage, Babbage Cofounder; Phil Poley, Managing Director, Accenture; Paula Saenz, Out of Home Care Branch Manager, Division of Protection & Permanency, Department for Community Based Services, Cabinet for Health and Family Services, and Project Manager of the Fostering Success Program; Glenda Wright, Graduate, 2016 Fostering Success Program; Eric Clark, Executive Advisor and Legislative Director, Office of the Secretary, Cabinet for Health and Family Services.
Making Smiles Happen: 2016 Oral Health Study of Kentucky's Youth
Terry Brooks, EdD, Executive Director, Kentucky Youth Advocates, stated that oral health of children is a gateway to in finding other health issues. Delta Dental of Kentucky partnered with the Kentucky Youth Advocates and the University Louisville School of Dentistry through the Making Smiles Happen initiative to conduct a new statewide survey of children’s oral health. A dentist went to 60 schools across five regions of the Commonwealth to directly observe the mouths of 2,000 third and sixth graders. The study found the percentage of third and sixth graders in need of dental care had increased since the first study conducted by the University of Kentucky in 2001. Geography and socioeconomic status are significant factors for oral health. Children in low-income families are more likely to not have visited a dentist in a year or more, to experience a toothache, to have tooth decay, and to have urgent dental care needs. Oral health is a significant issue for young people in Kentucky. Access to oral health has increased, but oral health outcomes have declined.
Grant Smith, PhD, Bellarmine University, stated that the data collected included a self-administered questionnaire completed by parents and an in-person oral screening of students by a dentist and assistant. Two out of five third and sixth graders had untreated cavities, and over half of them do not have sealants.
Clifford Maesaka, DDS, President and CEO, Delta Dental of Kentucky, stated that recommendations from the study are to 1) develop comprehensive goals and objectives for a statewide oral health plan; 2) launch regional networks to develop local, data-driven solutions; 3) establish school-based sealant programs in all high needs schools; 4) promote oral health literacy campaigns; and 5) collect state and county-level oral health data regularly. Everyone needs to recognize there is a need for better oral health before it becomes a priority. Even though children may have health coverage, children who were part of the survey may not have had a local dentist who accepted Medicaid because of low reimbursement rates that have not changed in years.
Tammy York Day, Chief Operating Officer, Delta Dental of Kentucky, stated that a statewide plan will not help, because there are different needs in different regions of the Commonwealth. It takes everyone collaborating to find solutions.
In response to a question by Senator Adams, Dr. Brooks stated that there would not be a mandate to require children’s teeth be sealed, but the goal is to make it accessible for children who would otherwise not have access to dental care. Ms. York Day stated that parents need to be educated about the benefits of good oral health.
In response to questions by Senator Julian Carroll, Dr. Brooks stated that in 2000, the Children’s Health Insurance Program (CHIP) started covering dental benefits for children eligible for Medicaid. The Medicaid expansion does not cover dental benefits for children. More dental problems are being detected because of better access to dental care. The 2016 study was based on the same specifications of the 2001 oral health study. One way legislators can help is by adopting the CDC standards for an oral health plan.
In response to questions by Representative Westrom, Dr. Maesaka stated that dentists are not the only ones who have put sealants on teeth. There is a need to educate everyone about good oral health for the entire mouth. There are a lot of underserved areas of the Commonwealth.
In response to questions by Senator Givens, Dr. Smith stated that parents reported if their child had access to dental care and an oral exam was physically done on children. The oral exam would have more conclusive evidence of dental issues.
In response to a question by Representative Jenkins, Dr. Smith stated that the correlation between a parent who visits a dentist and a child who visits the dentist because a parent is seen visiting a dentist was not part of the study. Dr. Maesaka stated that the value a parent sees in dental care affects a child’s value in seeing a dentist.
In response to a question by Senator Alvarado, Dr. Maesaka stated that dental varnishings are a great temporary solution, and parents need to be educated about the value of fluoride varnish. Ms. York Day stated that people trust someone locally who would recommend better dental care.
In response to a question by Representative Wuchner, Dr. Brooks stated that more needs to be done to make sure parents know about dental issues and the importance of getting good dental care. The Health Access Nurturing Development Services (HANDS) program is a good way to educate new parents about the importance of getting good oral health care for a child as early as possible.
Senator Higdon stated that low-income children are affected more by bad oral health because parents buy more soda with SNAP benefits. SNAP benefits should not be given to recipients all at once, because it does not last the entire month.
In response to a question by Senator Thomas, Dr. Brooks stated that the Rural Health Coalition is looking at career options to expand oral health professions and to help incentivize dentists to practice in rural areas.
Representative Burch stated that local health departments need to be funded to help with better dental access.
Approval of Minutes
A motion to approve the minutes of the September 21, 2016, meeting was made by Representative Burch, seconded by Senator Julian Carroll, and approved by voice vote.
Consideration of Referred Administrative Regulations
The following administrative regulations were referred to the committee for consideration: 201 KAR 22:045 – establishes continued competency requirements and procedures by the Board of Physical Therapy; 201 KAR 32:030 – establishes fees for licensure as a marriage and family therapist or marriage and family therapist associate; 910 KAR 1:210 – establishes a statewide Long-term Care Ombudsman Program; and 921 KAR 1:420 – establishes procedures for distribution of child support payments. A motion to accept the administrative regulations was made by Representative Burch, seconded by Representative Marzian, and accepted by voice vote.
Diabetes Issues Update
Representative Joni Jenkins stated that according to the Institute for Alternative Futures (IAF), Projected Percentage of Population in Kentucky with Diagnosed Diabetes, 2015-2030, 11.2 percent of Kentuckians were diagnosed with diabetes in 2015. The total will rise to 12 percent in 2020 and 13 percent in 2025. The CDC concludes that 35 to 37 percent of adults age 20 or older have prediabetes. According to the IAF, Projected Economic Impact in Kentucky, 2020, medical costs and non-medical costs including lost productivity will cost Kentuckians $6.5 billion. Bob Babbage, Babbage Cofounder, stated that the Kentucky Diabetes Prevention Program (DPP) was allocated $2.475 million from the Department for Public Health within the Cabinet for Health and Family Services. Diabetes Self-Management Education (DSME) shows economic benefit and merits major support. Major increase in diabetes screening in health plans and Medicare will identify new cases. Kentucky’s Licensed Diabetes Educator law has been successful. Provider reimbursement is a key issue for the General Assembly and the Governor. Senator Alice Forgy Kerr stated that in 2011, Licensed Diabetes Educators (LDEs) were established in the Kentucky Revised Statutes. There are over 600 diabetes education professionals with 334 being LDEs. Mr. Babbage stated that more Kentuckians are now eligible for diabetes screening and prevention programs.
Transitioning to the Federal Health Benefit Exchange
Phil Poley, Managing Director, Accenture, stated that in 2011, Accenture worked closely with the Cabinet for Health and Family Services to design and establish and develop a comprehensive operating health benefit exchange, managed the grant and budget process, procured a technology vendor, and manage the overall project. Accenture worked with the Department for Community Based Services to reengineer its business processes across all 133 DCBS field offices. In 2012, Accenture was hired by Covered California to design, develop, implement, and operate the California exchange. In 2013, Accenture was hired by the Your Health Idaho exchange to manage implementation of third party software to support its transition from the federal market base to a state base market place. In January 2014, Accenture took over from another vendor to stabilize, enhance, and operate healthcare.gov and remain as the federal technology vendor. Accenture has worked with nine states, the District of Columbia, and the federal government and remain an exchange leader. In the last open enrollment period, 88 percent of all exchange plan selections in the United States happened on Accenture systems. Ninety-seven of 100 clients have remained with Accenture ten years or more. Accenture serves more than 40 states across a wide variety of domains including integrated eligibility, Medicaid claims processing, child welfare, child support enforcement, pension management, and financial management. Regardless of the client, Accenture approaches exchange work without a policy position on exchanges or the Affordable Care Act (ACA). The goal is to help clients achieve their goals regardless of whether a state based exchange is being established or transitioning to the federal market place.
Communications, seamlessness, and Centers for Medicare and Medicaid Services (CMS) engagement are important when transitioning from a state-base exchange to a federal-base exchange. Any major transition requires concise, tailored, and extensive communications. Health insurance is confusing and the complexity is multiplied for individuals enrolled in exchange plans who must also understand both insurance and the intricacies of subsidy eligibility. Current kynect enrollees must complete the eligibility enrollment process on the federal market place in order to retain coverage. States have not been given the opportunity to automatically enroll state-base exchange consumers in federal exchange plans. Kentucky must develop and disseminate messages tailored to specific consumer scenarios and targeted where most effective. Messages must be succinct, easy to understand, and with a clear call to action. Medicaid adds complexity to the communications task. Kentucky must make sure consumers know how to access benefits and management of the benefits will change as a result of the transition.
The transition to the federal exchange should be seamless as possible. With the move to the federal market, Kentuckians seeking coverage will first be screened for Medicaid eligibility. If someone qualifies for Medicaid, the case will be transferred to the Cabinet for Health and Family Services. Some Kentuckians who come to CHFS seeking benefits will be deemed ineligible for Medicaid but potentially eligible for federal exchange subsidies will need to be referred to the federal exchange to apply for benefits. Both of these circumstances represent a disruptive change from the existing process. A mitigation for this disruption is to collaborate with CMS on establishing the smoothest possible transfers between Kentucky and CMS to do as much as possible to minimize the efforts consumers must take on their own behalf to access benefits while moving from one system to another.
Efforts to establish clear and effective communications and seamless transitions will help consumers access and retain coverage, but only if Kentucky and CMS are on the same page. The lack of alignment leads to consumer confusion and potential coverage interruptions. In addition, lack of alignment could also lead to inaccurate Medicaid eligibility screening by the federal exchange which would add to consumer confusion. It is important for states to establish working relationships at the data and operations level which will support a smoother transition while establishing the foundation needed going forward to manage the ongoing Medicaid account transfer from the federal exchange to Kentucky.
In response to questions by Senator Julian Carroll, Mr. Poley stated that currently Accenture does not have any contracts in Kentucky. Accenture has not responded to any recent procurement request, but are available to the Commonwealth given its prior history with CHFS.
In response to questions by Senator Thomas, Mr. Poley stated that he did not have data on how many consumers will lose coverage when Kentucky transitions to the federal exchange. Transitions can be disruptive and cause people to fall through the cracks.
Paula Saenz, Out of Home Care Branch Manager, Division of Protection & Permanency, Department for Community Based Services, Cabinet for Health and Family Services, and Project Manager of the Fostering Success Program, stated that Fostering Success is a statewide employment initiative to hire and empower current and former foster youth funded through the federal Temporary Assistance for Needy Families (TANF) block grant. Forty-nine young adults completed the initial ten-week summer program to become an Office Support Assistant in a local DCBS office. The salary is $10 per hour and requires a high school diploma or GED. In 2016, the National Youth Transitional Database identified 297 eligible youth eligible for the Fostering Success program. Eighty-one young adults were hired between June 1, 2016 and July 1, 2016, and 34 were able to extend their employment up to nine more months because supervisors rated them equivalent to or higher than other Office Support Assistants. Of the 81 participants, 50 are currently committed to the cabinet, 6 were adopted, and 25 exited foster care on or after their 18th birthday.
Glenda Wright, Graduate, 2016 Fostering Success Program, stated that she is getting ready to graduate from Murray State University with a Bachelor’s degree. She has learned a lot from everyday experiences working at the DCBS office and has a brighter outlook on the future. The program helps build a better relationship with the cabinet because some are hardened by bad experience with the cabinet. She said people need to believe in foster youth so they can believe in themselves.
Eric Clark, Executive Advisor and Legislative Director, Office of the Secretary, Cabinet for Health and Family Services, said that the cabinet collaborates with the Workforce Development Cabinet, Labor Cabinet, Xerox, Kentucky Youth Advocates, and True Up. True Up is a groundbreaking initiative to empower young people in foster care to gain the critical life skills they need to make a successful transition from a structured environment to self-sufficiency in our communities. True Up, founded in 2011, is a landmark partnership among foster care agencies that serve as surrogate parents for hundreds of children and teens in Kentucky who are committed to help youth transition from agency care to independent living. True Up is a caring family of foster care alumni who have faced the challenges of getting jobs, continuing their education, starting lives and building families who have succeeded and are giving back. Key barriers of the Fostering Success program are transportation, financial literacy training, and job readiness training.
The next steps are to design and pilot a match savings program in conjunction with the Fostering Success Program, implement statewide job readiness and financial literacy trainings to Fostering Success employees, continue to coordinate resources with the Labor Cabinet and Workforce Development Cabinet, and partner with private employers to participate in the Foster Success program.
Senator Adams stated that foster children are not kids to be thrown away, and the stigma needs to be lifted about them.
In response to a question by Representative Jenkins, Ms. Saenz stated that the cabinet would follow the graduates to see if this program made a difference in their lives.
In response to questions by Representative Westrom, Ms. Wright stated that her brothers were two of the 34 youth whose employment was extended and both cars have been paid off.
There being no further business, the meeting was adjourned at 11:50 a.m.