The 2021 General Assembly passed several measures that will improve the affordability and accessibility of health care in the commonwealth. These improvements come amidst the worst public health crisis in generations, and include a ban on co-pays in Medicaid, a permanent approval of telehealth services and a requirement that private insurers treat mental health care the same way they treat physical care.
Other health care legislation that passed had previously been under consideration, such as a cap on the out–of–pocket costs for insulin and making treatment for substance use disorders (SUDs) more readily accessible. Perhaps least noticed but most important is the continued full funding of Kentucky’s Medicaid expansion, a historic policy that has provided life-saving coverage to over half a million Kentuckians. Here is a brief description of a selection of Senate Bills (SB) and House Bills (HB) related to health care that passed this year.
SB 55: Bans co-pays for Medicaid enrollees
In January 2019, the state began requiring co-pays from most adult Medicaid enrollees earning above the poverty line. Many patients could not afford these payments and were turned away for needed health care and prescriptions. In 2020, the state filed a regulation ending Medicaid co-pays, but the legislature found it deficient, saying the Cabinet for Health and Family Services didn’t have the statutory authority to do so. Senator Steve Meredith filed SB 55 in response to permanently fix this issue. Moving forward, Medicaid managed care organizations will no longer charge co-pays for care or medication, which will enable Medicaid-participants in Kentucky with limited financial resources access to care without that barrier.
HB 140: Makes telehealth option permanent
At the outset of the pandemic in Kentucky, the governor signed an executive order allowing medical and mental health care providers to meet with patients remotely as a way of ensuring access to care while reducing the spread of COVID-19. Patients and providers alike have come to value this option independent of the public health crisis. Representative Deanna Frazier and 11 other bipartisan sponsors brought this bill to make telehealth a permanent option for Medicaid and state-regulated private insurance plans. The legislation also requires that services provided through telehealth are reimbursed at the same rate as the same services provided in-person so there is no financial disincentive that leads providers to stop offering either option.
A key component to making telehealth a successful and equitable option for providing care is the availability and affordability of broadband internet service. While projects in recent years have helped advance broadband access, the new funding through the American Rescue Plan Act, appropriated through HB 320 and HB 382, will accelerate the opportunity for all Kentuckians to have fast and reliable internet service.
HB 50: Creates mental health care parity with medical care
The Affordable Care Act (ACA) required that mental health care be covered to the same extent as medical care, but insurers across the nation and in Kentucky have found ways around that requirement, leaving barriers in place for many people seeking the mental health treatment they need. This problem became even more critical when the pandemic and economic downturn led to increased isolation, depression, anxiety and other mental health challenges. To protect patients’ rights to mental health treatment, HB 50 adds state requirements to make sure insurance companies use similar medical necessity criteria for approving patients’ mental health treatments compared to medical care, bans insurance companies from limiting the scope or duration of mental health treatments that doesn’t also apply to other kinds of care and requires insurance companies to annually report on their adherence to state and federal requirements.
State measures such as HB 50 are important to supplement the protections in the ACA and to ensure they remain a state-based protection if critical protections in the ACA are later repealed. The recent California v. Texas case before the U.S. Supreme Court made clearer how much is at stake in Kentucky if the coverage and patient protections in the ACA are rolled back. HB 11, sponsored by Representative Patti Minter — along with 22 bipartisan cosponsors — would have advanced such protections much further but did not receive a hearing this session.
HB 95: Caps out–of–pocket insulin costs for some Kentuckians with diabetes
Insulin is necessary for many Kentuckians with diabetes, particularly those with type 1 diabetes, to manage their disease and go about their daily lives. But it can be prohibitively expensive for patients, leading to rationing medicine and other dangerous practices that result in using too little insulin. Between 2012 and 2016, insulin prices at the point of sale more than doubled in Kentucky, growing from $352 to $721 for a 30-day supply. Representative Danny Bentley filed HB 95 to address this problem by capping the out-of-pocket cost for insulin to $30 per 30–day supply for anyone privately insured by a carrier that is regulated by the Kentucky Department of Insurance. Although the new law only covers a minority of privately insured Kentuckians, it is a helpful protection that could save an estimated average of 78% of the cost of their insulin.
SB 51: Makes medication for SUD treatment more quickly available for patients
A common practice for insurance companies known as “prior authorization” often leads to a delay in a patient receiving a treatment or medication while the insurance company determines if it is medically necessary or if there is a cheaper option for the condition being treated. While there can be good reasons for this practice, when it comes to patients with SUD a delay in treatment can cause serious consequences like health complications and disruptions to recovery. To address this gap, Senator Ralph Alvarado introduced a bill that specifically prohibits insurance companies and Medicaid from requiring prior authorization for any medication that treats alcohol or opioid use disorders so there is less delay between when such services are being sought and when they can be delivered.
HB 192: Fully funds Medicaid expansion
While not a new health care policy, the budget bill continued to fully pay for the expansion of Medicaid eligibility to all Kentuckians under 65 who earn less than 138% of the poverty level (or $17,775 for an individual). Kentucky accepted the option to expand Medicaid in 2014 under the ACA, and despite an attempt to cut the program through work requirements, has operated without significant barriers since then. Because of this program, Kentucky receives just under $3 billion every year to cover over half a million Kentuckians — a population that has since swelled to 650,000 as of February 2021 because many have turned to Medicaid after losing their job and their employer-sponsored insurance in the COVID-19 pandemic. While Medicaid enrollment will likely begin to fall as the recovery continues, ensuring this health care safety net is in place both helps patients receive care without falling into financial ruin, and will help health care providers, especially rural hospitals, stay afloat.
Despite these modest but meaningful advancements in health care policy in the 2021 session, gaps in health care coverage and affordability persist. Policies in other states that have helped address these gaps include reinsurance that drives down premiums for those who purchase insurance on the exchange; adding higher guardrails to short-term, limited-duration plans and giving the Kentucky Department of Insurance regulatory power over them; or making the transition smoother from Medicaid to commercial insurance through bridge plans or by requiring Medicaid managed care organizations to offer plans on the exchange that mirror their Medicaid plans in benefit structure and provider networks. In the interim, the General Assembly should explore these and other options for improving health care, so that in the 2022 session they can be ready to quickly act on them.