Tracking the Policy Response to COVID-19 in Kentucky

The COVID-19 pandemic threatens the lives and well-being of Kentuckians and the resulting closure of large sectors of the economy affects jobs, income and the ability to meet basic needs. Proactive state and federal policy responses are crucial to save lives and protect economic security. In the short term, the response should focus on combating the virus, safeguarding Kentuckians’ health and well-being and making sure they can make ends meet. In the longer-term, it should support the economy in getting back on its feet. And to be effective, it must address existing racial, geographic, gender and economic disparities that the pandemic will worsen without direct action.

Check back here regularly for the latest on state and federal policy developments in response to the pandemic and what’s still needed.

Limiting the Spread and Harm of COVID-19

The most important and immediate policy response involves directly reducing the spread of COVID-19 and treating those who are diagnosed with the disease. Social distancing, wearing face coverings, stay-at-home orders and necessary business closures and reopening requirements are essential to reducing the disease’s spread, as are testing, tracking, quarantining and contact tracing for those who contract COVID-19. Kentucky’s health sector needs adequate data management, equipment, supplies and facilities, including ventilators and personal protective equipment (PPE). It will also be important to give attention to particular places where spread is likely, including prisons and jails, nursing homes, schools and businesses that reopen. And for those who are not laid off but continue to work and provide vital services, access to supports and paid leave are essential.

Federal

  • April 24: The Paycheck Protection Program and Health Care Enhancement Act was signed into law, providing $75 billion for an emergency fund for hospitals and other health care providers and $25 billion for COVID-19 testing.
  • March 27: The Coronavirus Aid, Relief and Security (CARES) Act was signed into law, providing additional dollars for hospitals, public health agencies, purchase of personal protective equipment, and related expenses.
  • March 18: The Families First Coronavirus Response Act was signed into law, providing paid family and medical leave (up to 12 weeks) and sick leave (up to 80 hours) for workers affected by coronavirus and related closures. It applies to businesses with less than 500 employees, and the federal government will reimburse for a portion of the costs. Paid leave provided by the Families First Coronavirus Response Act will expire on December 30.
  • March 13: President Trump declared a national state of emergency based on the U.S. Department of Health and Human Services (HHS) determination of a Public Health Emergency effective January 31. The HHS renewed this determination on April 21 to expire July 25, and then again on July 23 to expire October 21. This renewal will enable hospitals and health care systems to continue combating the pandemic.
  • March 11: The ­World Health Organization declared the novel COVID-19 disease a global pandemic.
  • March 6: The Coronavirus Preparedness and Response Supplemental Appropriations Act provided $8.3 billion in emergency funding nationwide, including grants to state and local public health agencies.

State

  • July 27: The court updated its orders relating to court proceedings and safety measures with the resumption of criminal jury trials beginning August 1, and civil jury trials beginning October 1, at the discretion of the trial judge. The order on court proceedings permits the filing of some eviction actions and judicial sales, which were suspended by the prior order. The safety measures order requires face coverings and social distancing, and establishes cleaning protocols. Both orders require each chief district and circuit judge to develop additional protocols around safety and process.
  • July 9: Governor Beshear signed an executive order requiring Kentuckians to wear face coverings in public for the next 30 days. Exemptions apply, including for children younger than 5 and those with a disability or respiratory condition than may prevent them from safely wearing a face covering.
  • June 15: The administration announced testing of all incarcerated individuals and staff members at the Kentucky Correctional Institute for Women in Shelby County.
  • May 29: The Kentucky Supreme Court extended an order originally issued in April with no end date. It continues the expansion of categories of individuals to be released while awaiting trial, although it does narrow the qualifying categories and circumstances from the original order. The Court also issued an order establishing health and safety measures for opening of the courts and expanding court proceedings beginning June 1.
  • April 20: The governor advised P-12 public schools to remain closed to in-person instruction for the remainder of the school year. Previously, he had recommended ceasing in-person classes beginning March 16 and extended that recommendation until May 1. Healthy at School recommendations were established June 24 and on July 27 the governor recommended that schools postpone reopening until the third week in August. 
  • April 14: The Kentucky Supreme Court temporarily (through May 31) required that most people who are arrested be administratively released pre-trial, and directed that individuals not be incarcerated for failure to appear in court or for nonpayment of fines, fees and child support.  The Court also extended the cessation of most in-person court proceedings through May 31.
  • April 5: Governor Beshear announced the state has entered a new agreement with Gravity Diagnostics to provide up to 2,000 COVID-19 tests a day. As of April 24, testing sites have since expanded to include drive-thru testing locations with free COVID-19 tests for anyone. As of May 5, additional testing is made available
  • April 3: The state announces a new hotline (1-833-GIVE PPE) and website (giveppe.ky.gov) to streamline the donation process for PPE to healthcare providers.
  • April 2: The governor announced early release and commutation for 186 individuals in prison with high-risk medical conditions and plans to commute sentences for another 743 people who are due to complete their sentences in the next 6 months. On April 26 the governor announced that an additional 352 sentences would be commuted.
  • April 1: The Chief Justice issued an order suspending in-person services at court facilities and requiring court proceedings be conducted remotely through May 1 (replacing an earlier order issued March 26).
  • March 30: The governor issued an order restricting out-of-state travel. On May 6, the Governor established new travel restrictions to reflect the court ruling that the previous order was too broad. As of May 22 the interstate travel ban has been lifted. However, a new travel advisory issued July 20 recommends a 14-day self-quarantine for those who have traveled to states with a positivity rate of 15% or higher.
  • March 24 and before: The governor closed restaurants except for take-out and delivery (March 16) and closed all non-life-sustaining businesses to in-person traffic (March 24).
  • March 24: The governor signed SB 177, which provides relief to school districts regarding scheduling, the use of nontraditional instruction plans, the use of emergency leave, testing, and other relief measures to assist them in addressing COVID-19.
  • March 23: The governor ceased all elective medical procedures. Elective medical procedures resumed April 27 .
  • March 20: Kentucky’s Chief Supreme Court Justice issued a statement instructing judges to reduce incarceration right away to avoid COVID-19 outbreaks in Kentucky’s county jails. Efforts are underway at least in some counties to release individuals awaiting trial (who cannot afford bail).
  • March 19: The governor issued guidance for partnerships between health care facilities and child care programs to support child care for health care workers, first responders, corrections officers and social workers.
  • March 13: The governor announced that Kentucky Employers’ Mutual Insurance (KEMI) will provide wage replacement benefits for first responders and medical personnel who have been quarantined for COVID-19.
  • March 7: The governor adjusted the state government sick leave policy including allowing new hires without accrued leave time to take leave, and encouraged other businesses to do the same.
  • March 6: Governor Beshear declared a State of Emergency in Kentucky.

Still Needed

  • Take additional action to produce and distribute greater resources for testing, PPE, ventilators, hospital surge capacity and other supplies and equipment.
  • Provide additional support to essential workers including health care, first responders, child care and grocery store workers through hazardous pay supplements, expedited access to protective equipment and testing, and additional occupational safety and health protections.
  • Increase access to paid leave to more employees and for a longer period of time, and enact state paid sick days legislation.
  • Take additional actions to reduce crowding in prisons and jails including measures to be taken by the Parole Board, Department of Corrections and law enforcement to release certain individuals, reduce intake and improve conditions.

Obtaining Adequate Public Resources

The recession currently underway will deeply reduce state tax receipts as employment declines and Kentuckians have less money to spend. At the same time, state expenses will increase as more people qualify for programs like Medicaid due to lower incomes, among other reasons. State resources are also limited because Kentucky’s rainy day fund is inadequate and revenues were tight even before COVID-19 hit. The most important way Kentucky can obtain resources now is through direct aid from the federal government. The state should also utilize its rainy day fund to meet current needs, avoid enacting additional tax cuts or breaks and consider new state tax revenue options that focus on those at the top who are most able to pay.

Federal

  • March 27: The CARES Act will provide an estimated $1.7 billion to Kentucky in its Coronavirus Relief Fund, $410 million for K-12 and higher education and monies for childcare, public transportation and other areas.
  • March 18: The Families First Act increased the federal match on traditional Medicaid temporarily by 6.2 percentage points, which will provide assistance to Kentucky’s budget amounting to approximately $480 million on an annual basis (though it ends in the quarter when the public health emergency is declared over). It also indirectly increases the share of costs the federal government pays for the Children’s Health Insurance Program (CHIP).

State

  • June 15: Over 600 local contact tracers have been hired to provide patient support in calling and providing resources to people who may have been exposed to COVID-19 to mitigate further spread.
  • May 20: Beshear announced a $300 million award to city and county governments as part of the CARES Act, which established the Coronavirus Relief Fund to reimburse local governments for a specific set of expenses incurred between March 1 and Dec. 30, 2020 in response to the COVID-19 public health emergency.
  • April 15: The Kentucky General Assembly overrode gubernatorial line-item vetoes to pass a one-year budget that provides some targeted monies for COVID-19 (such as monies for the Poison Control Hotline that is being used for COVID-19 calls); it does not appropriate pending federal relief funds, and its accompanying revenue bill raises only $5 million.

Still Needed

  • Provide substantially more state and local fiscal relief from the federal government, including flexible grant funding like the State Fiscal Stabilization Fund in the Great Recession and a further increase in the share of Medicaid costs paid by the federal government.
  • Additional financial assistance should be large and tied to the state of the economy rather than the status of the emergency declaration. Enact additional revenue-raising tax changes at the state level that ask more of those at the top most able to pay.
  • The expired $600 a week in federal supplemental unemployment benefits benefits should be renewed and tied to the state of the economy so that it doesn’t expire again until the economy has recovered.

Helping the Unemployed

Business closures and a fall in consumer spending are leading to massive layoffs across the Kentucky economy. Unemployment insurance (UI) is the most important tool to help those laid off make ends meet and eventually stimulate the economy once restrictions are lifted. But UI in Kentucky only reaches 1 in 5 unemployed Kentuckians and replaces only 45% of lost wages. Kentucky has not previously adopted many of the improvements other states have made under which more people are eligible for UI including more part-time, seasonal and low-wage workers who are disproportionately people of color and women. Nor ­­­­has the state previously adopted work sharing, which allows more workers to be eligible for UI when businesses reduce their hours. Additionally, independent contractors and the self-employed are not typically eligible for unemployment insurance.

Federal

  • July 25: Pandemic Unemployment Compensation (PUC), the federal program providing $600 per week in supplemental unemployment benefits, expired.
  • March 27: CARES will increase (and fully pay for) unemployment benefits by $600 a week for 4 months, lengthen the time an unemployed person can receive benefits by 13 weeks and make benefits available to workers not normally eligible including the self-employed, furloughed, those seeking part time employment, independent contractors and gig economy workers. CARES also provides funds to support state work sharing programs.
  • March 18: The Families First Act provided $6.3 million to Kentucky to help with extra administrative costs and the rise in unemployed and made that assistance contingent on states eliminating the waiting week and work search requirements and not charging employers in industries experiencing high layoffs.

State

  • March 26: The Kentucky legislature passed SB 150 authorizing a number of important changes to the unemployment insurance system including work sharing so fewer Kentuckians are laid off and the adoption of the alternative base period so an unemployed worker’s last 3-6 months of work history count in considering whether they are eligible for benefits. These changes help Kentucky maximize the federal aid received that will come through CARES.
  • March 25: Governor Beshear announced unemployment insurance will be extended to independent contractors, gig economy workers, the self-employed, substitute teachers, freelance and child care workers.
  • March 16: The Governor waived the one-week waiting period and removed the work search requirements in unemployment insurance.

Still Needed

  • Create a trigger tied to the state of the economy that would allow a potential federal extension beyond July 31 of the $600 a week in supplemental unemployment benefits.
  • Make federal changes to provide access to unemployment benefits for laid-off immigrant workers without Social Security numbers.
  • Continue to increase state capacity to handle and process unemployment claims and to implement new programs like work sharing and the federal Pandemic Unemployment Assistance.

Providing Basic Assistance and Help with Bills

Due to the collapse in the economy, Kentuckians need help making ends meet and dealing with bills in the face of lost jobs, hours and income. People first and foremost need cash assistance that can be used for a variety of purposes, as well as shelter for those who are homeless. They also need help with rent and mortgage payments, utility bills, student loans and other payments to avoid losing basic services in the short-term and facing unaffordable increases in debt down the road.

Federal

  • March 27: CARES will provide one-time checks (“rebates”) of $1,200 for individuals making up to $75,000, $2,400 for a married couple making up to $150,000 and $500 per child. Payments are phased out above those income levels to a maximum of $99,000 for individuals and $198,000 for married couples.

State

  • April 1: The Kentucky Supreme Court issued an order that eviction filings would not be accepted by the circuit court clerk until 30 days after the expiration of the order. A new Kentucky Supreme Court order on July 27 allows evictions to be filed starting August 1. Further, according to the CARES Act, evictions were prohibited in rental properties with federally-backed mortgages nationwide but this provision expired July 25.
  • March 25: Governor Beshear announced an eviction moratorium that will prevent people from losing shelter during the crisis. Though backed up rent payments will still be due, the federal CARES Act would provide more than $12 billion in emergency funding for Housing and Urban Development (HUD) programs – some of which may be used to help alleviate the strain on family budgets from rent during the crisis.
  • March 18: The Department of Community Based Services announced an extension of certification periods for all public assistance programs (SNAP, KTAP, CCAP, Medicaid, and State Supplementation) so that participants maintain benefits during this time without the need to reenroll.
  • March 16: The governor announced a three month extension on driver’s license renewals to reduce household costs (renewals cost $20 and reinstatement costs are $40) and prevent a trip to the department of motor vehicles.

Still Needed

  • A federal extension on the rent-based eviction moratorium is needed, as well as additional federal funding to states to help people keep shelter in the pandemic.
  • Make federal rebate checks recurring based on the state of the economic recovery.
  • Expand access to federal rebate checks to adults claimed as dependents and immigrants who file taxes using Individual Taxpayer Identification Numbers, and increase the number of children per family eligible for stimulus payments (which was two children set by the CARES Act) and increase the amount of the stimulus payment for children from $500 per dependent to $1,200..
  • Provide additional federal assistance to low-income individuals and families through bringing back the TANF emergency fund established during the Great Recession.
  • Change state rules on use of K-TAP to prevent loss of benefits and provide greater cash assistance to more families.
  • Increase funding for emergency shelter and transitional housing to help with homelessness and housing insecurity.
  • Though people cannot be evicted for late rent during the state of emergency, they could be charged late fees. Federal rental assistance is needed to help people afford housing and avoid prohibitive fees.
  • Expand access to financial assistance and debt suspension for costs like rent, mortgages, utilities, medical debt, consumer debt and student loans.

Helping Put Food on the Table

Help paying for groceries and continuing to provide meals normally available at school will be crucial to families struggling to get by with fewer jobs and less income. The Supplemental Nutrition Assistance Program (SNAP) is the nation’s the most important nutrition policy, helping put food on the table and also freeing up family income for other needs. Additionally, SNAP is an anti-recession program that improves health and local economies. But it only provides modest support and more is needed. Nutrition and hunger policies and efforts will also need to target populations at particular risk and vulnerability during this time, including seniors, children who are out of school and child care and the homeless.

Federal

  • March 20: Nationwide waivers provided for school nutrition programs to allow flexibility around meal times, to allow for pick-ups or deliveries and to allow snacks and meals that would be given in an afterschool program to be utilized.
  • March 18: The Families First Act increased the resources available for emergency supplemental food assistance and for children who attend a school that is now closed, and suspended the SNAP work reporting requirement for certain adults.

State

  • June 11: Famers Market Nutrition Programs (FMNP), which provide benefits to The Women, Infants and Children Nutrition Program (WIC) participants and seniors with low incomes that can be used to purchase healthy foods at farmers markets, has received waivers from the USDA to ensure flexibility in annual staff training and monitoring processes until September 30 to ensure agencies and farmers markets can continue to implement the FMNP program across the state.
  • May 21: The Department for Community Based Services (DCBS) has been approved by the USDA for a Pandemic EBT (P-EBT) program to provide up to $313.50 per child in additional benefits to families with children who were eligible for free and reduced price meals in schools that they were unable to receive while schools have been closed since March 16. As of June 8, a total of 458,330 kids eligible for free and reduced price school meals have received P-EBT benefits. Thousands more are eligible and the P-EBT application deadline has been extended to August 31; those who haven’t automatically received benefits should apply at benefind.ky.gov or by calling 1-855-306-8959.
  • April 30: Kentucky announced it will participate in a new pilot project to allow SNAP benefits to be used to purchase groceries online through Amazon and Walmart.
  • April 1: The Kentucky National Guard deployed 70 members to regional food bank warehouses in Louisville, Elizabethtown, Wilder and Lexington to distribute food bank resources including those from The Emergency Food Assistance Program (TEFAP) funds provided by the Families First Act.
  • April 1: The Kentucky Department of Agriculture relaxed income requirements for food bank assistance from 130% to 185% of the poverty line through April 30.
  • March 28: The USDA approved Kentucky’s request for the emergency SNAP allotment provided by the Families First Act of $28.7 million in extra benefits for April and May. This means 154,000 households participating in SNAP, or 67% of all SNAP households in Kentucky, will receive the maximum amount of benefits for their household size (normally SNAP benefits are reduced as household incomes rise). Additional Emergency SNAP allotments have been approved for June, July and August.
  • March 21: The USDA approved Kentucky’s waiver for the WIC nutrition program to remove the requirement for physical in-person interviews and in-person supply pick-ups. As of March 26, there is also additional flexibility around nutrition requirements as some approved items are difficult to access. On April 7, Kentucky received permission from the USDA to waive medical documentation in WIC to ensure mothers with low incomes have access to infant formula and food.
  • March 18: Governor Beshear extended by three months the requirement to recertify for SNAP and other public benefits, waived the work reporting requirement to SNAP adults without a disability or children. and announced that DCBS will accept client self-attested income verification. As of March 30, Kentucky was approved by the USDA to extend certification periods an additional 3 months, to 6 months (re-certification due March, April and May is extended to September, October and November).
  • March 14: Kentucky’s waiver to be able to serve meals to students during Non-Traditional Instruction (NTI) was approved by the USDA.Additional waivers to provide flexibility to pick up meals for kids, in lieu of congregate in-person meals, have passed and have been extended until August 31.

Still Needed

  • Temporarily increase the maximum SNAP benefits in the next round of federal economic relief legislation, and maintain until the economy has recovered.
  • Extend the federal Pandemic EBT program to continue to provide families with children who would have participated in free and reduced school meals while in-person instruction is closed.
  • Make additional federal changes that provide SNAP support to those with the lowest incomes, increase the federal cost share of SNAP administrative expenses.
  • Make additional state changes to SNAP and WIC including waiving and creating greater flexibility in reporting requirements and eliminating the SNAP bans for people with a drug-related felony conviction.

Ensuring Health Coverage and Access to Care

Now more than ever, Kentuckians need access to health care to prevent the spread of COVID-19 and to save lives. Kentucky needs to make testing free (along with making it widely available) and those getting care and treatment for COVID-19 shouldn’t face costs (including surprise medical bills). With incomes falling, many more Kentuckians will lose employer-based health coverage and we should make it as easy as possible for them to obtain coverage.

Federal

  • March 27: CARES does not count its temporary boost in unemployment benefits of $600 a week as income for the purposes of determining eligibility for Medicaid and the Children’s Health Insurance Program, helping protect eligibility for those programs. It also requires private insurance plans cover testing and any future vaccine without cost sharing.
  • March 18: The Families First Act provision to increase the share of traditional Medicaid and CHIP costs paid by the federal government will ease the strain of increasing enrollment on Kentucky’s budget, indirectly preserving coverage.

State

  • June 17: Governor Beshear announces that he will bring back Kentucky’s state-based health insurance marketplace called kynect. Utilizing a fully state-based exchange (as opposed to a state-based, federally-facilitated exchange as we have now) will allow Kentucky much more flexibility in normal and special enrollment periods, customization of health plans and innovations through special waivers.
  • June 8: In an effort to address the disproportionate rate of COVID-19 deaths for black Kentuckians, Governor Beshear committed to ensuring that all black Kentuckians have health insurance coverage.
  • April 2: Governor Beshear announced plans to move ahead with converting the state fairgrounds in Louisville into a 2,000-bed makeshift hospital.
  • March 31: The Department for Medicaid Services provided a “Presumptive Eligibility” application that is significantly simplified and allows individuals to get health coverage through June 30 without having to complete the entire standard application. Presumptive Eligibility was set to expire June 30; however, coverage has been extended 90 days through September 28. 
  • March 25: Kentucky passed an 1135 waiver that expands Medicaid eligibility to people with higher incomes, allows flexibility for provider enrollment, allows providers to use telehealth, and gives Department of Medicaid Services authority to increase reimbursement rates paid to providers.
  • March 14: Governor Beshear guaranteed that COVID-19 testing would be free to all Kentuckians, even if they are uninsured. On July 9, an order was issued providing guidance to insurers – defining what is covered under testing and clarifying that a prescription or clinician’s order is not required.
  • March 13: Governor Beshear reversed an administrative regulation that required Medicaid MCOs to charge co-pays to their members for most services.
  • March 10: Governor Beshear issued an executive order to allow pharmacists to refill prescriptions for up to 30 days. The executive order allowing emergency refills and for pharmacists to work in non-traditional settings has been extended to July 7 and could be further extended.
  • March 9: Governor Beshear issued an executive order waiving all cost sharing for screening and testing of COVID-19 and prior authorization requirements.

Still Needed

  • Require health insurers to cover treatment for COVID-19-related illness without cost sharing.
  • Further expand emergency access to Medicaid to cover testing and treatment for COVID-19.
  • Provide additional assistance in obtaining affordable coverage for newly uninsured individuals not eligible for Medicaid.
  • Increase the federal share of Medicaid costs (known as FMAP), lowering Kentucky’s share of Medicaid spending to protect health care for Kentuckians as well as other critical services provided by the state.

Supporting Small Businesses

Kentucky small businesses that have been forced to close or whose sales are falling dramatically need assistance to meet cash flow and weather the crisis. To restart the economy once restrictions are eventually limited, it is important that small businesses are able to sustain themselves. Otherwise, the recovery becomes harder due to lost capacity and families and individuals lose what they have worked to build.

Federal

  • April 24: The Paycheck Protection Program and Health Care Enhancement Act includes $310 billion to replenish the small business loan program that was created as part of the CARES Act but ran out of money, and an additional $60 billion for a separate small business emergency disaster loan program.
  • March 27: CARES provides $349 billion in loans to small businesses with less than 500 employees that can be forgivable if businesses agree not to lay off employees.

State

  • March 20: The state qualified for Small Business Administration disaster certification, meaning small businesses, for-profit contractors and private non-profits anywhere that have been harmed by the COVID-19 pandemic are eligible to apply for low-interest SBA Economic Injury Disaster Loans.
  • March 17: The state announced it is working with federal partners to continue making payments through the Child Care Assistance Program (state payments as well as family co-pays) to child care centers shuttered by the pandemic.

Still Needed

  • Provide additional resources in the form of forgivable debt to small businesses and assistance with meeting cash flow demands so they can remain in business.
  • Provide financial assistance tailored to the needs of frontline businesses including hospitals, child care centers and grocery stores.

Protecting Kentuckians During Phased Reopening

The healthier and more financially stable Kentuckians are through the pandemic, the greater our economic potential will be once it is safe to fully reopen businesses and schools. Making sure it is safe to return to work in some sectors and financially possible for other workers to stay healthy at home are critical to protecting people and the economy. Public health actions to closely monitor the spread of COVID-19 and continue successfully reducing cases are essential as healthy at home measures are lessened. They must also be paired with policy choices to expand and extend temporary boosts to paid leave, nutrition assistance, health coverage, unemployment insurance and more. Our economy will suffer long term if Kentuckians are forced to choose between their health or their ability to keep food on the table and pay bills.

State

  • June 29: Gatherings up to 50 people or fewer, swimming pools and additional youth sports and bars open at 50% capacity. Due to increases in COVID-19 cases and severity of the outbreak in Kentucky, on July 28 capacity for gatherings was reduced to 10 people, bars were closed, and restaurant capacity was reduced to 25%.
  • Between June 18 and June 25, government agencies and retail – including funeral homes, massage therapy, barbershops and salons – are opened at 50% capacity.
  • June 15: Some child care centers and day camps are now open in addition to low-touch youth sports.
  • June 8: Some child care providers are now able to provide in-home care, educational and cultural activities are open such as museums, libraries and aquariums, by June 10 places of worship can operate at 50% capacity and by June 11, the Kentucky Horse Park and state park campgrounds are open.
  • June 1: Additional entertainment activities are open such as auctions, track racing, movie theaters and aquatic and fitness centers.
  • May 22: Phase 2 of Healthy and Work began, with additional openings being established through June 15. On May 22, restaurants could open at 33% capacity if they met minimum healthy at work and social distancing guidelines. On May 25, social gatherings of no more than 10 people with social distancing were authorized, and public facing businesses including barbers, hair salons, tattoo parlors and tanning salons could reopen.
  • May 11: Phase 1 of Healthy at Work was issued including 14 minimum guidelines such as continued telework where possible, enforced social distancing, universal mask wearing, and temperature and health screenings. Specific reopening dates and guidelines were issued for houses of worship (May 9); manufacturing, construction, office buildings, vehicle services, horse racing, and pet grooming and boarding (May 11); government offices/agencies (May 18); and retail businesses, funeral and memorial services (May 20).
  • In early May, Governor Beshear announced the Healthy at Work initiative for reopening some Kentucky businesses between May 11 and June 29, though some high-risk businesses entailing close proximity and large crowds, for instance, will remain closed.

Still Needed

Other Resources

Why the Senate COVID Proposal Fails to Meet Kentucky’s Economic Needs

The new Senate aid proposal, known as the Health, Economic Assistance, Liability and Schools (HEALS) Act, falls far short of the breadth and depth of aid needed to fight the COVID-19 pandemic and weather the deep economic downturn. By including only 1/3 of the funds contained in the HEROES Act passed by the U.S. House of Representatives back in May, it leaves out critical assistance aimed at helping laid off workers, holding off a wave of evictions, fighting hunger, and preventing harmful cuts to state and local governments. Providing inadequate aid will ultimately exacerbate racial and economic inequities and prolong and deepen the recession.

Deeply cuts vital unemployment insurance benefit

The CARES Act’s $600 per week in jobless benefits (known as Pandemic Unemployment Compensation or PUC) expired in Kentucky on July 25 even as the pandemic is resurging and many remain jobless. Rather than extending this emergency boost until it’s safe to go back to work and jobs are returning to the state, the HEALS Act would reduce it to $200 per week until October when states would need to change their systems to provide 70% of past wages, with a cap at $500 beyond the regular state monthly benefit.

For the 200,000 Kentuckians receiving jobless benefits, cutting PUC benefits by 2/3 (to $200 from $600) would mean an average 42.9% hit to their income. Kentuckians receiving Pandemic Unemployment Assistance (PUA) – who are part-time workers, small business owners, freelancers, and people who left their jobs due to care responsibilities like child care being closed or caring for family members with COVID-19 – would see their benefit reduced by approximately half (to an average weekly unemployment insurance benefit of roughly $180 plus just $200 in PUC instead of the $600).

The $600 PUC weekly benefit has done much to brace the economy, but cutting it to $200 will weaken that effect. By allowing people to continue buying the things they need to make ends meet, the emergency aid is keeping up aggregate demand. Cutting the benefit to $200 would pull $70.6 million out of our economy each week. By reducing demand through this benefit cut alone, Kentucky could lose over 33,000 jobs through the middle of next year, or 1.7% of our workforce (this estimate is based on the cut in the benefit to $200).

 

 

Fails to provide adequate aid to states and localities

No new funding would be allocated to state or local governments by the HEALS Act. Rather, it would only give state and local governments the ability to use remaining CARES Act funds to cover shortfalls in the 2020 and 2021 fiscal years to maintain spending levels from the 2019 fiscal year. Previously, the CARES Act only allowed states to spend this funding on new expenses directly related to COVID-19, and had to be spent by the end of 2020. In order to use these funds for revenue shortfalls, states have to distribute 25% of what they receive to local governments to help them with their own shortfalls.

This added flexibility for CARES Act funding will not sufficiently protect state and local governments from deep cuts in the coming years. Kentucky received $1.6 billion in CARES Act funding, but has faced major expenses fighting COVID-19. Officials say Kentucky could face a state budget shortfall of 16% – 29% this year and a collective city government shortfall of an additional $180 million in the 2021 fiscal year, to say nothing of county governments and special districts providing critical community services. Recent jobs data already shows Kentucky had 30,000 fewer state and local government jobs in May compared to February. Deeper revenue shortfalls in in the 2021 fiscal year­­­­ will add more public workers to the unemployment lines, and deepen and prolong the recession Kentucky faces.

HEALS provides limited additional funding to education. Nationwide, the proposal allocates $105 billion to schools. K-12 schools would receive $70 billion (with most all of the remainder to higher education), of which 2/3 is targeted toward reopening schools and only available if the school meets certain state criteria for opening to in-person instruction, regardless of whether it’s safe to return or not. In addition to making the K-12 funding contingent upon potentially dangerous conditions and therefore making it unavailable to many schools, this funding could not be used to preserve the jobs of teachers, counselors, and other employees if revenue shortfalls necessitate layoffs.

In contrast, the HEROES Act provided $1 trillion in direct, flexible grants to state and local governments, including a total of $7.4 billion for Kentucky’s state budget and $4.4 billion for Kentucky’s city and county governments. These resources are needed to safeguard students and teachers, support learning in a variety of educational settings, and protect social services, fire departments, public health, health care and other critical public services during the pandemic and recession.

Another critical aspect of the HEROES Act missing from HEALS is the additional 7.8 percentage point increase above the existing 6.2 percentage point temporary increase in the federal government’s share of Kentucky’s traditional Medicaid program costs. HEROES would have brought the federal share of Medicaid spending up to 86%, for a combined boost in federal funding in Kentucky of $1.7 billion over two years. This is especially important as state revenues shrink and Medicaid enrollment grows with Kentuckians losing employment and job-based coverage; enrollment is already up 187,800 or 14.3% since February.

Lacks sufficient aid to families struggling to meet basic needs

Though the HEALS Act does provide another round of stimulus payments, its overall approach to helping families get through the pandemic and recession is deeply inadequate.

The HEALS Act follows the same model as the CARES Act for an additional round of recovery rebates, or “stimulus checks.” The Act would provide $1,200 for individuals making up to $75,000, $2,400 for a married couple making up to $150,000 and $500 per child. Payments are phased out above those income levels to a maximum of $99,000 for individuals and $198,000 for married couples. The only difference is that, unlike CARES, this round of payments would also include dependents over age 16.

However, although it expands stimulus payments to adult dependents, it doesn’t increase the number of eligible children per family (HEROES allowed for up to three children, rather than two in the CARES and HEALS Acts), include immigrant families who pay taxes with an Individual Taxpayer Identification Number or “ITIN,” or increase the amount of the payment. The first round of stimulus payments through the CARES Act  helped halt the economic slide – success that should be expanded upon.

And despite the fact that 1 in 4 Kentucky renters are unsure they’ll be able to make their next rent payment, HEALS fails to extend a nationwide moratorium on rent-based eviction and leaves out over $100 billion in funds provided in the HEROES Act to help people stay in their homes and address housing-related debt. A looming eviction crisis will disrupt families and cause extensive hardship unless Congress extends the moratorium and provides much more in aid, including short-term rental assistance and emergency housing vouchers.

HEALS also fails to address worsening hunger in Kentucky and across the nation. As a growing share of Kentuckians face food insecurity – 1 in 4 Kentucky households in May up from 15% in February – the HEALS Act does not increase Supplemental Nutrition Assistance Program (SNAP) benefits. Nor does it extend a very successful program known as Pandemic EBT, which provides $313 per child who qualifies for free school lunch. The House-passed HEROES Act would have increased the maximum SNAP benefit by 15%, reaching Kentuckians with very low incomes who were left out of a previous SNAP increase in the Families First Act, and also included an extension of Pandemic EBT.

Creates new risks for workers

The HEALS Act creates much higher barriers to litigation for individuals who get infected with COVID-19 at schools, hospitals and businesses. Individuals seeking a remedy in the courts for being infected would need to prove both gross negligence and that the business was in violation of state and local public health guidance before they could even bring suit – an extremely high bar. This “shield” lasts for five years.

Workers already have a limited set of opportunities to hold employers accountable for putting them in harm’s way. Preventing Kentuckians from being able to seek remedy in the courts further exposes them to dangerous conditions amid a global pandemic. And with outbreaks in COVID cases among employees in industries such as long-term-care, meat processing and child care, leaving workers vulnerable runs counter to the fight against the pandemic. Workers’ health is public health.

And where the HEROES Act provided a pay increase for essential workers – in recognition of their added risk of exposure and additional expenses from working while many schools and child care centers are closed – the HEALS Act does not. Nor does it provide an extension of the Families First Coronavirus Act’s paid leave program as was proposed in the HEROES Act.

Kentucky needs a bold economic and health response

Many economists believe that, just to keep from losing economic ground, the federal government needs to invest several times what the HEALS Act would provide. The HEALS Act leaves a broad scope of vital aid to Kentucky families and communities off the table. Kentuckians are already facing a massive loss of income, work and health insurance, and the threat of hunger and eviction looms for many. Until an effective vaccine or treatment is widely available and an economic recovery takes hold, Congress needs to deploy the kind of robust aid only it can. Without it, the pain from the pandemic and recession will be much deeper and longer than necessary.

Half of Kentuckians Report Losing Household Employment Income, and Sources They’re Relying on Are Running Out

Half of Kentucky adults say they or someone in their household have lost employment income since the COVID-19 crisis began, according to new Census data. The sources they’re relying on to make ends meet, including enhanced unemployment insurance, stimulus payments and more personal debt, are either running out or limited.

These numbers spell trouble for Kentucky’s economy and families unless federal policy action is taken. As long as the pandemic persists — and especially since prematurely reopening the economy without controlling the disease first is proving to be a growing disaster across the nation — the responsibility lies with the U. S. Senate to agree with the House and provide much more in federal aid.

Employment-related income loss is widespread, and threatens to worsen existing inequities

In a Census survey of Kentucky adults for the week ending June 30, 50% said their household had experienced a loss of employment income since March.

The data also shows these losses are hurting certain Kentuckians to a greater degree. The loss of employment income is more prevalent among people with kids in the household (55%),  Kentuckians with poor health (64%) and people with lower incomes — 63% of those with incomes from $25,000-$34,999 have lost household employment income, compared to just 18% of those with incomes of $200,000 and above. A total of 59% of Kentuckians in Black households and 88% in Hispanic households have lost employment income, compared to 49% in white households.

Strategies to make ends meet are limited without more federal aid

Kentuckians report using a variety of strategies to make ends meet in the survey. Federal and state aid are at the top of the list: 28% are relying on unemployment insurance (UI) benefits, and 27% on the stimulus payments provided in the CARES Act. Many are also drawing down savings or selling assets (27%); relying on credit cards or loans (23%), and borrowing from friends or family (14%).

All of those strategies face limitations. The state and federal government have opened up unemployment insurance to more people, but recipients will lose a devastating 64% of their weekly benefits on average if the U. S. Senate allows the supplemental $600 a week provided under the CARES Act to expire as scheduled on July 25. That will leave unemployed workers with an average of just $332 a week in UI benefits. The stimulus checks of $1,200 per adult and $500 per child were a one-time payment, and the Senate has not agreed to additional rounds of payments. Families only have so many assets to sell and savings to draw down, and doing so can make economic prospects more difficult in the future. And additional personal debt can be hard to get and can worsen financial well-being.

The continuing weak economy means much more in aid must be provided

Far from a quick recovery some suggested would happen if we just let businesses begin reopening, the rise in COVID-19 cases across the country is creating deep trouble for the economy and for unemployed workers. The economic gulf won’t go away until the disease is under control, and the economic disruption it has caused means some challenges will persist even after the pandemic is behind us. Until it is no longer necessary, the federal government must provide ongoing aid to help families make ends meet and protect the economy from further harm.

The U. S. House has passed the HEROES Act, which continues the supplemental $600 in unemployment benefits, provides another round of stimulus payments and includes other forms of aid many people need (including help with housing and food). Now the Senate must agree to a robust aid package, or a Kentucky already rocked by the economic crisis will face new and deeper problems.

 

Policy Changes to Address Police Violence

With the recent police killings of Breonna Taylor, George Floyd and David McAtee – in a long history of state-sanctioned violence against Americans who are Black – protests are occurring in the commonwealth and across the nation. Conventional reforms such as the use of body cameras have been inadequate in stopping police violence and there is a growing discussion about reallocating public resources toward more effective investments that address the root causes of challenges facing communities. In addition to immediate justice for the victims of police violence, their families and communities, Kentucky must make policy changes that prevent future harm and invest in the systems that all communities rely on to thrive.

What is happening?

Sparked by recent police killings, since May 28, communities across Kentucky and nationally have seen daily rallies, events and protests in response to the failures of a justice system that disproportionately polices communities of color. Louisville is the site of two of the high-profile recent police killings. Breonna Taylor was killed on March 13 when police entered her home with a “no-knock” warrant. On June 1, as communities across the country were protesting such violence, David McAtee was killed by the National Guard in his restaurant in Louisville.

These killings are not isolated incidents. According to the Mapping Police Violence Project, 1,098 people in the US were killed due to police use of force in 2019. Between 2013-2019, out of the 120 police killings of civilians in Kentucky, 19 were Black Kentuckians. At 15.8%, that’s nearly twice the share of Kentucky’s population who are Black (8.3%).

Across the state, protestors are seeking changes to prevent violence. Though the legislature is not in session, some members are seeking to pre-file legislation in the interim addressing police issues including no-knock warrants – a practice that ACLU Policy Strategist Keturah Herron said is used to “terrorize and harm black and brown communities.” The response in Louisville to protestors’ policy demands has included the suspension of no-knock warrants, creation of a Civilian Review Board Work Group and removal of Chief Conrad as the Chief of Police by the Louisville Metro Government. A Metro Council committee has moved forward an ordinance that would permanently limit the use of no-knock warrants and ensure the use of body cameras, scheduled to go before the full Council for a vote tonight.

Why now?

In addition to enduring a disproportionate share of police violence, Black Kentuckians are more likely than white Kentuckians to be incarcerated, and also face barriers to education and employment and receive lower pay on average. State Representative Attica Scott recently described “inequities we experience every single day” in an interview on NPR: “You can see it when you drive through the neighborhoods – abandoned and vacant properties, boarded up buildings, the lack of economic development and investment.”

For these and other reasons that are rooted in historical, structural barriers to educational opportunity, economic security, wealth accumulation and health and well-being, Black Kentuckians are dying at a higher rate from COVID-19 and are being laid off from work at higher rates due to the pandemic. The toll of the crisis, and widespread awareness of police brutality as a result of cell phone cameras and social media, may be factors that have contributed to a tipping point for concerted calls for change.

Historian Dr. Ibram X. Kendi wrote in his 2019 book How To Be An Antiracist that “Racism is a powerful collection of racist policies that lead to racial inequity and are substantiated by racist ideas. Antiracism is a powerful collection of antiracist policies that lead to racial equity and are substantiated by antiracist ideas.” Applying this lens to the over-policing of and violence towards communities of color shifts the focus from the ideas substantiating these outcomes to the systems and policies shaping them.

Why do people want to shift resources to non-policing approaches?

A lack of public safety is often a result of social conditions, and policing responds to the symptom but not the root cause. In fact, criminalization of social inequities can inhibit public safety. Strong evidence supports putting resources toward solutions for housing, mental health, food insecurity, unemployment and other factors known as social determinants of health – and targeting those resources to communities that have faced systematic underinvestment. As NAACP Legal Defense and Educational Fund President Sherrilyn Ifill explains, “movements to drastically reduce police funding are at the core of a revised vision of public safety that prioritizes social services, youth development, mental health, re-entry support, and meaningful provisions for homeless individuals that strengthen community resources to proactively address underlying factors that can contribute to public safety concerns.”

Some communities are beginning to question whether police are being given too many responsibilities, and are taking steps to redirect funding to community services. Localities like Nashville Metro Council have seen proposals in the last week to reduce their police department budget in order to pay for a chronically underfunded education system and to increase government and teacher salaries. LA City has proposed an ordinance reducing the police department’s budget by $100-150 million and diverting a total of $250 million to jobs, education, health and healing focused in the city’s Black community. And the Minneapolis City Council plans to replace their existing police department with a more community-based approach to public safety.

There is growing rethinking about the role of policing in other institutions as well. School leadership in Portland, Oregon has announced the removal of School Resource Officers in the city’s public schools. A proposal from Superintendent Guerrero would redirect those resources to counselors, social workers and culturally-specific partnerships throughout the education system. While there is no evidence that school violence has been reduced by the presence of school resource officers, the implementation of restorative justice in school settings is associated with reduced suspensions, expulsions and referrals to law enforcement.

What other changes are being called for?

Other more incremental policy changes are also being explored. Many of these are based on ending practices that disproportionately target communities of color and on restricting use of force – and are thus in sync with shifting resources away from policing and toward community-based services.

For example, many are calling for a halt to stop-and-frisk policing, which allows police to intervene based on suspicion, leading to profiling on the basis of race, immigration status, housing status, religion, gender, sexual orientation, etc. Examples include being stopped, questioned or arrested for furtive movements (such as reaching for waistband or acting nervous), for being in a high crime area or matching generalized description of a suspect. Many advocates are also calling for the end of broken windows policing – a term used to describe criminalizing activities shaped by poverty, structural racism, homelessness and other social inequities. That would include decriminalizing non-violent acts such as disorderly conduct, trespassing, loitering, disturbing the peace, jaywalking, bicycling on the sidewalk, possession and substance use.

Other such changes include ending ticket and arrest quotas, banning officers from taking or destroying phones or other recording devices without a warrant or consent, banning chokeholds and strangleholds, requiring officers to establish an objective justification for making a stop, ending the use of data and software that may enable profiling, prohibiting local police involvement in immigration enforcement, requiring officers to attempt to stop a colleague in an inappropriate use of force situation, banning shooting at moving vehicles and eliminating the use of no-knock warrants. Many legal experts say these practices violate people’s rights, with the most well-known current example being that no-knock warrants violate the constitutional right to reasonable search and seizure.

Harmful practices such as these – in the context of profiling people and criminalizing activities based on race and income – are made even more dangerous by the militarization of police departments, which precipitates greater use of violence by law enforcement. Through the weakening of the Posse Comitatus Act, the passage of the National Defense Authorization Act and the U.S. Department of Defense 1033 program, which distributes surplus military equipment to state and local police departments, localities have access to more military equipment and training than ever before. According to the Marshall Project, Kentucky received over $46 million in military-grade equipment between 1995 and 2014 through the 1033 program. The Kentucky State Police Department alone has received $12 million in equipment, with the remainder going to county-level sheriff and police departments. Ending the flow of military equipment to state and local departments, the deployment of SWAT teams, no-knock warrants, military-style raids and use of force against protestors are important de-militarization efforts.

Other policy changes focus on police accountability for excessive use of force. Currently, police departments across the nation investigate their own complaints on use of force and determine what, if any, disciplinary action should be taken. Nationally, according to the Department of Justice, only 1 in 12 complaints of police use of force results in any disciplinary action, and much use of force goes unreported. So that more complaints are sustained through investigation, some are calling for more independent, transparent and accountable investigative processes such as community review boards to create a mechanism for community members to provide input to police departments through investigation, review and disciplinary recommendations.

States could also require independent investigation and prosecution in cases of police violence. Local prosecutors and police typically work together, making it difficult for prosecutors to bring charges against and conduct investigations on officers. A permanent special office at the state level could be established to investigate and prosecute such cases.

The standards of police union contracts could also be changed, as research suggests those containing barriers to misconduct investigations are more likely to be associated with the killing of unarmed civilians. Sherrilyn Ifill notes that these contracts “often contain provisions that shield officers from accountability… [and] any obligation to report or intervene.’” Kentucky’s Police Bill of Rights results in more disqualified complaints, delays in interrogations and limited oversight. Louisville’s police contracts include the full array of measures that make it more difficult to hold police accountable for misconduct.

Federal intervention has helped reduce violence somewhat in the past. Before the current administration’s Department of Justice announced in 2017 its intent to scale back federal intervention, police departments that received intervention resulting in either collaborative policy change or order by a judge – in which the federal government requires states to make a policy change – had 25-30% fewer police shootings than those that did not.

Unfortunately, evidence is mounting that some reform interventions that have become more common in recent years are not working. For instance, a recent study shows body cameras do not meaningfully affect police behavior, including misconduct or use of force (the use of body cameras has played a role in increasing public awareness about police brutality and through additional policy changes can help hold police accountable). Similarly, providing law enforcement with implicit bias training has generally been shown to be ineffective when not accompanied by other policy changes. According to social psychologist Dr. Calvin Lai, who studies the efficacy of implicit bias training, “changing social environments may be more effective in reducing discrimination than attempting to change individual attitudes within a setting.”

To Protect Kentuckians from COVID-19, State Needs to Build on Already Significant Declines in Incarceration

In recent weeks, important steps have been taken to address the public health crisis posed by incarceration in Kentucky’s jails and prisons during the COVID-19 pandemic, resulting in historic declines in incarceration in county jails and some modest declines in prisons. Yet all Kentuckians deserve to be healthy and safe, and more progress is needed to limit the spread of the disease. This analysis looks at the significant progress that has been made so far and what more needs to be done.

Precautions such as frequent hand washing and social distancing are especially difficult in jails and prisons, making decarceration a critical component of the state’s public health strategy. Kentuckians who are incarcerated are at an increased risk for infection, and spread in the community in which the facility is located is also of concern. Many people – staff and those who are arrested and quickly released – move in and out of prisons and especially local jails on a daily basis. The issue has become even more pressing with the deaths of two individuals in a Kentucky prison due to COVID-19, and over 70 confirmed cases. Alarming reports of the virus spreading throughout facilities in other states add urgency to the situation. In a Marion, Ohio prison more than 80% of incarcerated individuals have tested positive for COVID-19, as have 160 corrections officers. The Cook County jail in Chicago is another example of a rapid outbreak of the virus that has already resulted in seven deaths.

Kentucky’s decarceration progress during COVID-19 is significant

Decarceration efforts in Kentucky amidst the COVID-19 public health crisis have occurred at both the state and local levels, resulting in a 29% decline in the number of people incarcerated in Kentucky’s county jails and a 4% decline in prisons (April 23 compared to March 12).

In order to discuss the progress that’s been made so far, and what remains to be done, it’s important to understand who is held in Kentucky’s jails and prisons. The more than 17,000 Kentuckians incarcerated in jails are either being held for counties while awaiting trial or serving relatively short misdemeanor sentences, in state custody serving lower-level (Class D or C) felony sentences, or held pretrial on federal charges through agreements with the U.S. Marshal’s Service (USMS) or U.S. Immigration and Customs (ICE). The approximately 11,700 individuals in the state’s prisons are serving sentences for higher-level felony convictions.

Here are the decarceration actions that have been taken so far:

  • On March 22, Kentucky’s Chief Supreme Court Justice issued a statement instructing judges to reduce incarceration right away to avoid COVID-19 outbreaks in the state’s county jails. In the following weeks, judges, prosecutors and public defenders worked closely together in many counties to release people being held pretrial who were unable to afford bail as well as those serving sentences for misdemeanors.
  • On April 2, Governor Beshear issued an executive order commuting the sentences of 186 people being held in jails or prisons for non-violent, non-sexual Class C or D felonies with less than five years left to serve who are “at higher risk for severe illness or death due to their medical conditions.”
  • On April 14, the Kentucky Supreme Court issued an order (amended on April 23) temporarily requiring (through May 31) that most people who are arrested be administratively released so that fewer people will be incarcerated while awaiting trial. It also directs that individuals not be incarcerated for nonpayment of fines and fees, for failing to appear in court, or for nonpayment of child support or restitution.
  • On April 24, Governor Beshear commuted the sentences of 352 additional people who were identified as being “particularly vulnerable to the effects of COVID-19 due to age and/or medical conditions” identified as serving sentences for non-violent, non-sexual offenses with fewer than five years remaining on their sentences.

The reduction in county-level incarceration in Kentucky has been significant since the court issued its first order to reduce incarceration in the context of COVID-19. The number of people in county custody (held pretrial and serving misdemeanor sentences) in local jails has plummeted by nearly 50%, from 11,500 people on March 12 to 5,916 on April 23. And the number of pretrial defendants in custody is the lowest it’s been in decades – a critical improvement that will result in fewer Kentuckians being put at risk of infection just because they can’t afford bail. As shown in the graph below based on an analysis by the Vera Institute, persistent jail overcrowding is also improving (although some individual jails remain over capacity).

Data is not available on the racial breakdown of releases, but a racial impact analysis should drive the conversation going forward. Black Kentuckians are overrepresented in the state’s jails and prisons, and COVID-19 has hospitalized and killed a disproportionate number of black Americans. A third of individuals incarcerated at Green River, where the virus has been spreading, are black. Decarceration efforts must seek to mitigate the devastating toll that structural racism is having on black Kentuckians in this public health crisis.

Majority of decarceration has been for people held in county custody

The graph below – based on an interactive dashboard produced by the Vera Institute – shows that the majority of decarceration in county jails this year has been for those held in county custody. The further reduction in the county jail population based on Governor Beshear’s April 24 commutation is not yet reflected in the data.

The overall decline of incarcerated individuals in county custody shown above has largely been driven by reductions in rural counties, where incarceration rates have historically been higher than those in urban areas. As a result, rural county-level incarceration rates are now in line with Jefferson County’s, as shown in the graph below based on an analysis by the Vera Institute (historically, the rural rates were about 33% higher than in Jefferson County).


As of April 23, 2020, 65% of people in Kentucky’s jails are now held for the state (55%) or federal (10%) government. As shown in the middle graphic above, the reduction of individuals in county jails who are held for the state has been much lower than the reduction in individuals held under county jurisdiction — a 13% drop between March 12 and April 23, compared to a 49% drop, respectively. The process for releasing people held by the state who have been convicted and sentenced is longer and more involved, requiring action in many cases by the governor or the parole board in conjunction with the Kentucky Department of Corrections. In addition, the state prison population has declined by approximately 500 individuals since mid-March, or 4%. Further action is therefore needed to release Kentuckians in state custody in both jails and prisons.

In recent weeks, the population of people held for the USMS and ICE has held steady at approximately 1,700 people. Some of the jails that remain overcrowded have high numbers of people held on federal detainers. For example, on April 23, the Grayson County Jail was at 128% of capacity, with 82% of the people being held in federal custody. In Crittenden County, the jail was at 109% of capacity, with people being held in federal custody making up 47% of the total population.  And in Carter County, the jail was at 118% of capacity with 46% in federal custody. People held on federal detainers make up 28% of the overall jail population in the 19 counties that have agreements to hold them.

The pretrial release of federal detainees requires action by the court that ordered the person held, and the guidance provided by the U.S. Attorney General regarding COVID-19 release is changed little from pre -COVID-19 practices, making decarceration of this group of people based on federal action unlikely. However, because the relationship under which local jails incarcerate individuals in federal custody is contractual, local jails could further reduce their overall populations by refusing to accept additional federal detainers as Boone County recently did with regard to ICE detainers.

State needs to reduce incarceration and increase safety for those who remain behind bars

Kentucky’s progress in decarceration, especially in local jails, is significant and demonstrates the power of cooperative efforts in the pandemic. However, with more than 28,800 people still incarcerated in Kentucky jails and prisons during the COVID-19 pandemic there is more work to do, especially in terms of additional releases for individuals in state custody in jails and prisons.

Here are some additional actions that can be taken:

  • The governor’s office should continue to review individuals serving felony sentences in prisons and jails, with additional commutations.
  • The parole board should exercise its authority for releases by amending its eligibility policy on an emergency basis to allow for immediate parole consideration for some groups of incarcerated individuals and by automatically releasing others.
  • Jails should reduce the number of, or stop accepting, individuals in federal custody.
  • Data should be collected on the racial breakdown of decarceration efforts.
  • The state needs to increase safety for those who remain incarcerated, including by testing staff and incarcerated people for infection on a widespread basis, providing sanitary masks to all, making soap and hand sanitizer readily available to all in every facility and enhancing cleaning/sanitizing practices in all facilities.
  • More transparency around safety measures is needed in local jails.

Furthermore, people being released need transitional plans and support, as the many challenges associated with reentry into communities are made even more difficult during the COVID-19 pandemic. For instance, the Justice Cabinet Secretary should pursue solutions for individuals who need new photo IDs to secure housing and employment when they leave jail. While this is not a new barrier to successful reentry, it is even more of a problem now because County Clerks offices are closed due to COVID-19.

 

Kentucky Response to COVID-19: Inadequate Rainy Day Fund Heightens Need for Federal Aid and More State Revenue

States set aside rainy day funds to draw on when economic downturns or crises hit. Governor Beshear may well need to tap the state’s rainy day fund to deal with the costs of directly addressing the COVID-19 pandemic, which he has the authority to do after declaring a State of Emergency.

But Kentucky has among the most depleted rainy day funds in the country, with only enough money for the equivalent of 4 days of state budget needs (and 10 days by the summer, after additional dollars are scheduled to be deposited). Because a possible economic downturn from the COVID-19 pandemic would mean less revenue and rising budget demands, that won’t be enough money to prevent more cuts to services and resulting economic harm.

The Kentucky House budget proposed to add more money to the fund over the next 2 years, but that will only bring the balance to the equivalent of 12 days of state budget needs by June of 2022. In contrast, the median state across the nation had 40 days of savings in its rainy day fund back in 2018.

Lessons from the Great Recession

The experience of the Great Recession shows how important rainy day funds are. Kentucky’s rainy day fund balance was just $232 million in 2007, or 2.7% of revenue. Two things happen when a downturn hits: Revenue goes down, and expenditures go up — especially for programs like Medicaid, for which more people become automatically eligible because of lost jobs and income.

In Kentucky between 2008 and 2010 as the Great Recession occurred, General Fund revenues fell by $439 million — more than the $232 million the state had in its rainy day fund. At the same time, as unemployment rose and the economy sank nearly 100,000 more Kentuckians became eligible for Medicaid, and that program’s expenditures grew by 20% over just that two-year period.

While the Great Recession set in motion consecutive rounds of budget cuts, the state budget would have been completely overwhelmed if the federal government hadn’t stepped in with major financial assistance. Through the American Recovery and Reinvestment Act (ARRA, or the “stimulus”), the federal government increased the share of Medicaid cost it paid, known as the Federal Medical Assistance Percentage (FMAP).

As a result, federal spending on Medicaid in Kentucky rose by $1.3 billion between 2008 and 2010 but state General Fund spending actually declined by $291 million — saving Kentucky over $1 billion in state funds in 2010. The federal government also shored up the state budget through large, flexible grants from ARRA’s State Fiscal Stabilization Fund, and provided assistance in a variety of other ways. All support to Kentucky’s state budget through ARRA totaled $3.4 billion over just 3 years.

By protecting against even deeper budget cuts, this assistance prevented steeper job loss that would’ve been an additional drag on the state economy.

Aggressive and quick federal and state action are needed  

An economic downturn from the COVID-19 pandemic may or may not be shallower than the Great Recession, but either way the weakness of our rainy day fund makes Kentucky vulnerable. And unlike at the beginning of the Great Recession, Kentucky’s budget has since been depleted through 20 rounds of cuts, which the legislature hasn’t yet begun to restore. COVID-19 and a resulting downturn will not only increase demand for programs like Medicaid, but also add strain to our public health system and other state services.   

Serious and fast action is needed especially at the federal level but also by the state in light of the concerning economic picture, including the following:

The federal government should immediately expand the FMAP and should then move on to enacting other forms of state fiscal assistance. Increasing the FMAP not only protects the state budget from rising Medicaid costs, ensures protection of eligibility and benefits and frees up the state budget for other expenses, but it can also be designed to directly help address the spread of COVID-19 by covering public health expenses related to testing and other needs. An increase in the FMAP is part of the Families First Coronavirus Response Act proposed in the House.

The state should include new revenue in the budget it will soon pass to help meet immediate needs, shore up the rainy day fund and better prepare for a potential downturn. In this blog post, we outline a set of commonsense revenue-raising measures — most all of which have already been introduced as legislation in the General Assembly — that can be tools to help protect against harmful cuts to core services.

Our Commonwealth: A Primer on the Kentucky State Budget

Click here for: A Primer on the Kentucky State Budget (PDF).

Every two years, the Kentucky General Assembly passes a budget in the form of four separate bills for the executive branch, legislative branch, judicial branch and the Transportation Cabinet. This budget establishes how the state will invest in education, health, transportation, public safety, human services and other areas that help build a strong state economy. However, the budget is only half of the picture: Equally important in building a strong state economy are the revenues that pay for these investments. Although there are many players involved in the process, the ultimate constitutional responsibility for both raising revenues and appropriating funds rests with the General Assembly. In fulfilling these two responsibilities, the General Assembly establishes the blueprint for Kentucky — who we are, what we value, what we aspire to be, and how and whether our communities prosper and flourish. The budget is the primary policy document of the commonwealth, and revenues provide the means by which those policies are carried out.

This primer provides a basic, high-level overview of how the budget is developed, considered, and enacted, and where the resources that support it come from. The primer also examines Kentucky’s fiscal health and makes the case that our current revenues are not sufficient to pay for the high quality public services that help to make Kentucky a good place to live, work and raise families; that empower homegrown entrepreneurs; and attract people to our state.

InsureKY Reacts to Withdrawal of Barriers to Medicaid

The InsureKY campaign and our partners commend Governor Beshear for taking swift action to withdraw the 1115 Medicaid Waiver known as Kentucky HEALTH. The waiver would have created numerous barriers for low-income families and underpaid workers of all ages, races and areas of the state who rely on Medicaid for affordable, quality healthcare, but a federal court blocked its implementation, finding that the federal government failed to adequately examine its effect on Medicaid coverage.

Governor Beshear’s decision to reverse course on the Bevin administration’s Kentucky HEALTH waiver comes nearly two years after it was first approved by the Centers for Medicare & Medicaid Services (CMS). The waiver, with its work requirements, high premiums, lock out periods and complicated paperwork, has been the subject of a federal lawsuit brought by sixteen Kentuckians who would have been directly affected by a number of policies largely considered to be illegal in the Medicaid program. Had the waiver been implemented, it would have resulted in an estimated 136,000 Kentuckians losing healthcare coverage in the first year alone.

Certain elements of Kentucky HEALTH did not require an 1115 waiver. The expansion of substance use disorder services implemented prior to the waiver’s approval can remain intact, as well as the ability to use federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds.

“This is a huge victory for consumer health advocates and the thousands of Kentuckians who raised their voices to oppose harmful barriers to care,” said Emily Beauregard, executive director for Kentucky Voices for Health. “More than 400,000 Kentuckians can breathe easier today, knowing that they won’t be at risk of losing access to the healthcare services they need to maintain their health, can go to work without worrying about an illness or injury, and can take care of their families.” 

Debra Wittig, a plaintiff in the case arguing the legality of the waiver, has struggled with rheumatoid arthritis, psoriatic arthritis, and osteoarthritis since her 20s. Trying to manage these chronic conditions without health insurance was impossible and her career in health care fell apart because of her health problems.”I am one of the almost half a million Kentuckians who have health insurance because of Medicaid Expansion,” said Ms. Wittig. “For me, it is no exaggeration to say that former Governor Steve Beshear’s decision to expand Medicaid in Kentucky saved my life. Before getting health insurance in 2014 through Medicaid expansion, I had lived for 20 years without health insurance.” Since having Medicaid coverage, Debra has been able to get regular treatments for chronic health conditions. After getting the health care she needed, she was able to return to work.

“Medicaid is a great deal for the state and a boon to our economy,” said Dustin Pugel, policy analyst with the Kentucky Center for Economic Policy. “This decision to abandon costly and harmful barriers to Medicaid not only ensures that our historic gains in coverage can continue, but that billions in federal dollars, thousands of new jobs, and a healthier workforce can remain intact; this is good news for the commonwealth.” 

“It is heartening to see that expanded substance abuse services provision and a waiver of IMD exclusion in many cases were able to happen without a Kentucky HEALTH waiver,” said Marcie Timmerman, executive director for Mental Health America of Kentucky. “Kentuckians are unified in their goals to increase access to mental health care and substance use disorder treatment. Mental Health America of Kentucky looks forward to working with the Beshear administration and legislators to eliminate barriers to coverage and care.”

Betsy Davis Stone, Health Law Fellow at Kentucky Equal Justice Center, commented, “The proposed waiver wasn’t just illegal; it was also a bad idea. We’re pleased to see Governor Beshear and his administration take Kentucky in a new direction.” 

Sheila Schuster with the Advocacy Action Network said, “Governor Beshear’s commitment to making healthcare a human right for all Kentuckians is a game changer for our Commonwealth, We’re excited to work with the new administration to further reduce barriers to care and increase the reach of our community safety-net, particularly for our most vulnerable Kentuckians with behavioral health issues and other disabling conditions.”

“Throughout the Kentucky HEALTH waiver process, we have been concerned that undermining health coverage reduces housing security,” said Adrienne Bush, executive director for the Homeless and Housing Coalition of Kentucky. “With this executive order, we expect that our neighbors experiencing housing insecurity will be able to access care with certainty and stability moving forward, and we look forward to making improvements to align Medicaid with supportive housing in the future.”

About InsureKY – InsureKY is a statewide coalition of nonprofits formed to promote more affordable health insurance, better care, and stronger consumer protections for all Kentuckians.

Kentucky Equal Justice Center

Kentucky Voices for Health

Kentucky Center for Economic Policy

Homeless and Housing Coalition of Kentucky

Mental Health America of Kentucky

SNAP Is Good for Kentuckians’ Health

Click for a PDF version of SNAP Is Good for Kentuckians’ Health.

Everyone knows that food is essential to well-being, but less widely understood is the power of direct food assistance in improving health. A growing body of research shows the Supplemental Nutrition Assistance Program (SNAP) is an effective tool for addressing health problems that stem from food insecurity.

SNAP improves access to nutrition, increases the share of meals eaten at home and frees up dollars for other family needs that can improve health like better housing, utilities and prescription medicine. Research suggests it can actually contribute to lower health care spending, including by the state. By directly reducing hunger and combating poverty, SNAP helps people get and stay healthy. These findings are especially crucial in a state like Kentucky, where much has been made of our historically poor health — and for good reason.

SNAP’s importance relates in part to its broad reach: today roughly one in nine Kentuckians purchases groceries with assistance through SNAP and far more do during economic downturns including the most recent recession.[1] Yet SNAP’s ability to improve health is limited by state and federal policy decisions that are reducing SNAP participation. As research demonstrates SNAP’s power as an important health intervention, improving health in Kentucky means finding ways to ensure it is available to all Kentuckians who need it, rather than restricting its use.

SNAP Is a Needed Health and Hunger Intervention in Kentucky

Need to Address Health and Health Equity in the Commonwealth

Kentucky’s starting point for health is low relative to most other states. In 2018, the state ranked 45th in the nation for overall health outcomes.[2] Less than half of Kentuckians over the age of 25 report being in very good or excellent health, as shown in the graph below. And due to a long history of systemic racism that is a barrier to good health (entrenched through policies and practices such as slavery, Jim Crow laws, racial redlining, and discrimination in schools and the workplace), black Kentuckians have even poorer health outcomes than white Kentuckians on average.[3]


Underlying Kentucky’s poor health indicators are factors that shape the opportunities to be healthy such as income, poverty, access to exercise opportunities and exposure to pollution.[4]  Similarly, a lack of high-quality jobs, safe housing and clean water — for instance, in rural and especially the eastern parts of the state — mean that some Kentucky communities especially struggle with poor health. 

These “social determinants of health” are incredibly important to well-being, and while overall Kentucky is a high-poverty, low-income state, economic opportunity is not equally available to all Kentuckians. Historical barriers to good health have left Kentuckians of color, especially black Kentuckians, with higher rates of unemployment, lower wages and higher rates of poverty (which is 16.3% for white Kentuckians compared to 24.7% for African-American Kentuckians according to 2017 Census data).[5] While 76% of SNAP recipients in Kentucky are white, SNAP utilization rates are higher among black, Hispanic and other Kentuckians of color compared to white people, making the program a critical tool for mitigating the harmful consequences of systemic racism and promoting health equity.


There are also disparities for rural Kentuckians, particularly in the eastern part of the state that have not recovered from the Great Recession, and where historical economic hardships persist. The relatively higher rates of SNAP usage in eastern Kentucky counties are linked to longstanding structural challenges in a regional economy built around extractive industries that have now faded dramatically.[6] Consequentially, both unemployment and poverty levels – and therefore SNAP participation – remain higher than the rest of the state.

Food Insecurity is Pervasive in Kentucky, Especially in Economically Distressed Areas

Kentucky has the 8th-highest rate of food insecurity among states, with 14.7% of households being food insecure compared to the national average of 12.3%.[7] The U.S. Department of Agriculture (USDA) defines food insecurity as simply not having enough food to eat, or having inadequate resources for food that reduce the quality, variety or desirability of the food purchased.[8] Within the state, the percent of the population that struggles with food insecurity ranges from an estimated 8% in Oldham County to 23.9% in Magoffin County. Nine of the top 10 most food insecure counties in Kentucky are in the rural eastern part of the state, with Fulton County in far western Kentucky being the one exception.[9]  

Many studies have demonstrated the relationship between various economic factors and food security.[10] Most importantly, rates of food insecurity drop as the income-to-poverty level rises and even more so as rates of unemployment fall.[11] So for the same reasons SNAP participation rates are higher in eastern Kentucky counties, food insecurity also occurs at a higher rate.

Food Insecurity Is Bad for Health

There is an abundance of research showing that food insecurity contributes to poor health. Many studies show poor results for the food insecure generally, including higher rates of diabetes, stress and anxiety. A review of recent studies by Craig Gunderson from the University of Illinois in Urbana and James Ziliak from the University of Kentucky broke these findings down by age group, and found multiple health conditions closely linked to insufficient food.[12]

  • Children – The findings from multiple studies showed that children who were food insecure were more likely to have anemia, tooth decay, asthma, behavioral problems, anxiety, depression and suicidal ideation than their peers who were not food insecure. Mothers who struggle to get enough food experience higher rates of depression and iron deficiency (among pregnant women), and their children tend to have higher rates of behavioral problems whether or not they themselves are food insecure. As of 2017, 258,000 Kentucky children participated in SNAP.
  • Non-elderly adults – The reviewed studies showed that nonelderly adults who are food insecure tend to have a decreased nutritional intake and higher risks of mental health problems, diabetes, hypertension, hyperlipidemia, poor sleep and poor oral health. In 2017, 317,000 non-elderly Kentucky adults participated in SNAP.
  • Older adults – The three existing studies on how food insecurity affects the health of seniors found that food insecure seniors report comparatively lower nutrition intakes and higher likelihood of depression, limitations in activities of daily living and being in poor or fair health. One study showed that food insecure seniors had roughly the same quality of life as someone 14 years older. There were 63,000 Kentuckians over 60 years old in 2017 who participated in SNAP. [13]

A separate study of adults ages 18-64 who earn at or below 200% of the poverty level found that food insecurity is closely related to the likelihood of having chronic illnesses, and the number of chronic illnesses a person has. In fact, across each level of food insecurity, the likelihood of having each of 10 chronic illnesses (listed below) increased.[14]

Food Insecurity Increases Health Care Costs

Though many harmful health effects of food insecurity are well documented, understanding how these effects are indicated in related health care costs was only recently estimated on the state and county level. According to estimates from the Centers for Disease Control and Prevention, food insecurity was associated with $1,834 in health care spending per food insecure adult nationally in 2016.

Kentucky alone spent $854.7 million on food insecurity-related health care that year. Kentucky’s per-capita health care spending related to food insecurity was 6th highest in the country at $194, but varied widely from county to county – from $98 in Oldham County to $400 in Clay County. The authors of the CDC report point out that only 40% of food insecure adults have private health insurance, so the remainder are covered by public health programs such as Medicaid or are uninsured altogether. Because food insecurity-related costs comprise 3%-6% of health care costs, the authors suggest that states could improve health and lower expenses in programs like Medicaid by making SNAP — which unlike Medicaid, is entirely federally funded — more widely available.[15]

SNAP Helps Put Food on Kentuckians’ Tables, Improving Food Security and Health

SNAP Participants Buy Groceries

In their report, Gunderson and Ziliak said “the most direct way to ameliorate the health consequences associated with food insecurity is to reduce food insecurity.” Because receiving food assistance helps families purchase groceries more consistently, SNAP-participating households tend to have more food security than similar households without the assistance – which contributes to their ability to get and stay healthy.

A 2013 USDA report followed households during their first 6 months of using SNAP and found that food insecurity decreased by 16.3%.[16] A different study used data from the Survey of Income and Program Participation from the 1990s and 2000s to determine that participating in SNAP reduced the likelihood of being food insecure by 31.2% and the likelihood of being very food insecure by 20.2%.[17]  

Not only does SNAP reduce food insecurity, but it may even improve the quality of food being purchased. Food prepared and eaten at home tends to be more nutrient-dense and healthier (based on federal nutrition guidelines) than eating out at restaurants.[18] There is evidence to suggest that when households receive SNAP, their overall food budget increases some, but their food at home budget increases substantially. According to a national study by the U.S. Department of Agriculture (USDA), SNAP-participating households spend an average of $80.87 per week on groceries, of which $51.18 is through SNAP. These same households spend a greater share of their food budgets on groceries than eating out – 75% for SNAP participating households – compared to  64% for SNAP-eligible, non-participating households (and compared to 62% for SNAP ineligible households).[19]

According to survey data, people who live in SNAP-participating households are less likely to have purchased meals prepared outside the home such as deli, carry-out, delivery or fast food meals in the previous week (43.4%) than low-income SNAP nonparticipants (49.8%) and far less than the average adult (58.2%).[20]

Contrary to stereotypes, the kinds of groceries for meals prepared at home that SNAP participants purchase (the only kinds of food that can be purchased through the program) largely reflect the grocery purchases made by the general public. The top ten food categories purchased by SNAP participants and non-SNAP participants are the same, but are not necessarily in the same order.[21]

SNAP Participation Can Reduce the Need for Health Care

There is an increasing body of evidence at the national level that shows a relationship between participating in SNAP and reduced health care costs. It is likely that SNAP lowers those costs in part by freeing up household resources for other expenses that contribute to better health, such as housing, utilities and prescriptions to manage chronic conditions. For example, evidence suggests that SNAP participation leads to a 30% reduction in the likelihood that seniors will cut back on needed medications.[22]

One study assessed SNAP participants’ self-reported health status. It found that, after adjusting for other factors shaping health, adults who participated in SNAP, compared to those who did not, were more likely to report having excellent or very good health, and less likely to report good, fair or poor health. They were less likely to stay home sick, visit the doctor or forgo care because of cost.[23]


Research has shown that after controlling for other factors, SNAP participants spend 25% less (around $1,400) on health care annually than similar non-participating adults. Those savings are even greater among individuals with more significant health conditions.[24] Another study found that increased SNAP benefits resulted in a decline of Medicaid cost growth by 73% through a reduction in hospitalizations and treatment for chronic illnesses.[25]

A 2018 study of older adults concluded SNAP receipt was associated with reduced hospitalization (-14%) and emergency room use (-10%). Additionally, “SNAP participants had a 10% lower likelihood for each additional inpatient day if hospitalized and a 4% lower likelihood of each additional emergency department visit if they utilized [SNAP].”[26] A separate study of older SNAP participants that compared them to other eligible but non-participating older adults showed an even more dramatic reduction in the likelihood of being hospitalized (-46%).[27]

There is even evidence that states with higher ratios of spending on social services like SNAP to spending on health care services like Medicare and Medicaid have better health outcomes. The study specifically looked at rates of adult obesity, asthma, mentally unhealthy days, days with activity limitations and mortality rates for lung cancer, heart attacks and type 2 diabetes. While the study didn’t suggest an ideal ratio, it did suggest that policy-makers need to think of social service spending as a form of public health intervention.[28]

SNAP Policy Choices Can Help or Hinder Health in Kentucky

To optimize SNAP as a tool for supporting and improving health in Kentucky, it needs to be robust, easily available to those who qualify and simple to use for those who participate. Regarding SNAP’s ability to reduce poverty, and thus improve health, one report on the health benefits of SNAP put it this way:

No other program for the nonelderly does such a great job preventing poverty or alleviating poverty’s weight on those who remain poor. We should be heralding and celebrating this success, not trying to reduce the program.[29]

SNAP enrollment in Kentucky has declined over 40% since the high point of July 2013 for a number of reasons, some of them concerning. Because SNAP is income-based (net income must be below the poverty level), it responds well to changes in the economy. As Kentucky continues to experience a historically long economic expansion and household finances marginally improve, enrollment has naturally declined. But participation has also dropped as the result of harmful policy choices the state has made.

Current and Potential Hindrances to SNAP in Kentucky Could Worsen Health

Recent administrative changes to SNAP have led to tens of thousands losing assistance and have likely increased food insecurity. The negative health impacts especially harm people of color and economically distressed communities facing other barriers to food security.

Specifically, two changes have led to nearly 25,000 people losing SNAP. First, state officials reinstated a strict work reporting requirement; between February and May 2018 this requirement was rolled out, and to date, 21,400 childless adults without a disability have lost food assistance.[30] Second, the state introduced an administrative regulation stripping food assistance from 3,500 non-custodial parents who were late on their child support payments.[31] Among those who lost benefits because of child support arrearages, 90% were in households where other members were still eligible for food assistance.[32] This meant that the overall food budget for those households shrunk, making it harder to afford food and dampening the health-boosting effect of SNAP in those homes.

Kentucky has also experienced a decline in the share of people technically eligible for SNAP who are actually receiving the benefit. That decline is the highest in the nation, according to a USDA analysis. From 2014 to 2016, the SNAP usage rate among eligible Kentuckians dropped from 85% to 74% — landing Kentucky at the tenth lowest participation rate in the country.[33] The state is doing a poorer job making sure that who should be receiving those benefits are actually doing so.

Other proposals have been floated in the legislature, in some cases repeatedly over the years, that would further undermine SNAP’s ability to promote good health in the commonwealth. Several proposals that would make it harder for Kentuckians to access SNAP were included in a recent bill – 2019’s House Bill 3 – but have long been debunked as effective policy: 

  • Requiring “workfare” for parents aged 19-64 with children over the age of 5 in order to receive SNAP benefits. Workfare is essentially an unpaid internship, which has no evidence of improving participants’ employment outcomes, but can reduce SNAP participation and leave individuals more food insecure.
  • Requiring photographs of the SNAP user on the electronic benefit transfer (EBT) card. Photo IDs have been tried and abandoned in several states because they make it more difficult for family members to purchase household groceries and are a liability for grocery store employees who have to then check photo IDs for every customer using a card for purchases.
  • Mandatory drug testing for anyone with a felony or misdemeanor history of substance abuse. The most recent version of this measure would have required participants to pay up front, and only be reimbursed if they passed the test. Effectively, this creates an application fee, possibly cost-prohibitive, for individuals who are already so low-income that they are seeking help to buy food.[34]

These proposals may continue to be considered in Frankfort for the foreseeable future. None of them would give low-income Kentuckians the tools necessary for good health, and by making it harder to buy food, would actually contribute to poorer health.

Recent federal SNAP policy proposals also jeopardize the health of Kentuckians by increasing food insecurity.

  • The USDA has recently proposed to make it harder for states to waive the SNAP work reporting requirement, a change that would reduce the current number of Kentucky counties eligible for a waiver from 117 to 25.[35]
  • The USDA also proposed a rule essentially bringing back an asset test through restricting the use of Broad-Based Categorical Eligibility (BBCE). Doing so would penalize Kentuckians who have acquired a modest amount of savings, thereby making it harder for SNAP participants to dig out of a financial hole. In Kentucky, 42,000 people would likely lose food assistance under this rule.[36]
  • The Office of Management and Budget proposed to slow the inflation adjustment measure for the poverty line, which would gradually lower the eligibility threshold for many programs, including SNAP. If this lower rate of inflation had been used over the past 15 years, 4,000 fewer Kentuckians would have been participating in SNAP.[37]

Improving Access to SNAP Would Improve Health

To improve health in the commonwealth, Kentucky should begin by reversing harmful policies recently enacted and abandon attempts to erect new barriers to food security. We can also improve on Kentucky’s SNAP program in other ways:

  • Kentucky has for a long time banned people from participating in SNAP if they have a drug-related felony conviction on their record. Individuals can have the ban lifted if they prove they had an addiction that has been treated, but it is not clear how many do. In 2018, 1,273 Kentuckians lost their food assistance due to this rule (many more may have been denied SNAP due to this rule while applying). Among those who lost SNAP, 965 lived in a household with other people, meaning the entire household had less money for groceries overall.[38] A universal end to the ban would ensure that more people re-entering society have enough to eat and can build a healthy life for themselves and their families.
  • Currently Kentuckians must go through a SNAP eligibility redetermination process every 4 to 12 months, depending on age and if the work reporting requirement applies. But the USDA gives states the option of requiring redetermination every 12 months for all Kentucky households and up to 24 months for households where elderly people and people with disabilities live. Such a change would provide for as little disruption as possible when using SNAP, and could provide longer periods of food security. More food security means more opportunity for good health.
  • The state also has more stringent penalties for people who lose their SNAP benefits because of the work reporting requirement, which could be re-set to the federal minimum. In doing so, some of the harshness inherent in Kentucky’s decision to reinstate the time limits for all but a handful of counties would be reduced, allowing low-income Kentuckians to begin using food assistance again more quickly.
  • Kentucky could also extend BBCE to apply to gross income (the net income standard wouldn’t change) in addition to assets, as is currently the case. This would allow more people to be screened for eligibility, and phase out benefits starting from a higher income, allowing people to earn more without losing benefits as quickly.[39]

[1] Data from the Kentucky Cabinet for Health and Family Services (CHFS).

[2] United Health Foundation, “American’s Health Rankings 2018 Annual Report,” https://www.americashealthrankings.org/explore/annual/measure/Overall/state/KY.

[3]N. Siddiqui et al, “The HOPE Initiative: Appendix,” National Collaborative for Health Equity, July 2018, http://www.nationalcollaborative.org//www/wp-content/uploads/2018/07/HOPE-Appendix-Final-07.24.2018.pdf.
Office of Health Equity, The Department for Public Health, The Kentucky Cabinet for Health and Family Services, “2017 Kentucky Minority Health Status Report,” http://www.astho.org/Accreditation-and-Performance/Documents/HE-Issue-Brief/KY-2017-Minority-Health-Status-Report/.

[4] County Health Rankings and Roadmaps, “Kentucky: 2019 County Health Rankings Report,” March 2019, http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR2019_KY.pdf

[5] Dustin Pugel, “Systemic Barriers Continue to Hold Back Wages and Employment for Kentuckians of Color,” Kentucky Center for Economic Policy, Jun. 19, 2019, https://kypolicy.org/systemic-barriers-continue-to-hold-back-wages-and-employment-for-kentuckians-of-color/.

[6] Jason Bailey, “The State of Working Kentucky,” Kentucky Center for Economic Policy, Aug. 28, 2018, https://kypolicy.org/the-state-of-working-kentucky-2018/.

[7] Alisha Coleman-Jensen, “Household Food Security in the United States in 2017,” United States Department of Agriculture Economic Research Service, September 2018, https://www.ers.usda.gov/webdocs/publications/90023/err-256.pdf?v=0.

[8] Christian Gregory and Alisha Coleman-Jensen, “Food Insecurity, Chronic Disease, and Health Among Working-Age Adults,” United States Department of Agriculture Economic Research Service, July 2017, https://www.ers.usda.gov/webdocs/publications/84467/err-235.pdf?v=42942.

[9] Data from Feeding America’s 2016 county-level estimates of food insecurity, https://www.feedingamerica.org/research/map-the-meal-gap/by-county.

[10] Craig Gundersen, Brent Kreider and John Pepper, “The Economics of Food Insecurity in the United States,” Applied Economic Perspectives Volume 33, Issue 3, 2011, https://academic.oup.com/aepp/article/33/3/281.

[11] Craig Gundersen et al, “Map the Meal Gap 2018: Technical Brief,” Feeding America, 2018, https://www.feedingamerica.org/sites/default/files/research/map-the-meal-gap/2016/2016-map-the-meal-gap-technical-brief.pdf.

[12] Barbara Laraia, “Food Insecurity and Chronic Disease,” Advances in Nutrition, Mar. 1, 2013, https://academic.oup.com/advances/article/4/2/203/4591628.

Craig Gundersen and James Ziliak, “Food Insecurity and Health Outcomes,” Health Affairs, November 2015, https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645.

[13] United States Department of Agriculture, “Characteristics of Supplemental Nutrition Assistance Program Households: Fiscal Year 2017,” February 2019, https://fns-prod.azureedge.net/sites/default/files/ops/Characteristics2017.pdf.

[14] Christian Gregory and Alisha Coleman-Jensen, “Food Insecurity, Chronic Disease, and Working-Age Adults.”

[15] Seth Berkowitz et. al, “State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecuirty,” Centers for Disease Control and Prevention, Jul. 11, 2019, https://www.cdc.gov/pcd/issues/2019/18_0549.htm#Appendix.

[16] James Mabli et al., “Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP) Participation on Food Security,” U.S. Department of Agriculture Economic Research Service Food and Nutrition Service Office of Policy Support, August 2013, https://fns-prod.azureedge.net/sites/default/files/Measuring2013.pdf.

[17] Caroline Ratcliffe et al., “How Much Does the Supplemental Nutrition Assistance Program Reduce Food Insecurity?” American Journal of Agricultural Economics, Jul. 12, 2011, https://academic.oup.com/ajae/article-abstract/93/4/1082/203719?redirectedFrom=fulltext.

[18] Michelle J. Saksena et al., “America’s Eating Habits: Food Away from Home,” U.S. Department of Agriculture Economic Research Service, September 2018, https://www.ers.usda.gov/webdocs/publications/90228/eib-196.pdf?v=1045.6.

[19] Shaheer Burney, “In-kind Benefits and Household Behavior: The Impact of SNAP on Food-away-from-home Consumption,” Food Policy, February 2018, https://doi.org/10.1016/j.foodpol.2018.01.010.

[20] Eliana Zeballos and Brandon Restrepo, “Adult Eating and Health Patterns: Evidence From the 2014-16 Eating & Health Module of the American Time Use Survey,” U.S. Department of Agriculture Economic Research Service, October 2018, https://www.ers.usda.gov/webdocs/publications/90466/eib-198.pdf?v=2608.6.

[21] Steven Garasky et al, “Foods Typically Purchased by Supplemental Nutrition Assistance Program (SNAP) Households,” U.S. Department of Agriculture Food Nutrition Service, November 2016, https://fns-prod.azureedge.net/sites/default/files/ops/SNAPFoodsTypicallyPurchased.pdf.

[22] Mithuna Srinivasan and Jennifer Pooler, “Cost-Related Medication Nonadherence for Older Adults Participating in SNAP, 2013-2015,” American Journal of Public Health, Oct. 9, 2017, https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304176.

[23] Steven Carlson and Brynne Keith-Jennings, “SNAP is Linked with Improved Nutritional Outcomes and Lower Health Care Costs,” Center on Budget and Policy Priorities, Jan. 17, 2018, https://www.cbpp.org/sites/default/files/atoms/files/1-17-18fa.pdf.

[24] Seth Berkowitz et al., “Impact of Food Insecurity and SNAP Participation on Healthcare Utilization and Expenditures,” University of Kentucky Center for Poverty Research, 2017, https://uknowledge.uky.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1105&context=ukcpr_papers.

[25] Rajan Anthony Sonik, “Massachusetts Inpatient Medicaid Cost Response to Increased Supplemental Nutrition Assistance Program Benefits,” American Journal of Public Health, March 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880217/.

[26] Laura Samuel et al., “Does the Supplemental Nutrition Assistance Program Affect Hospital Utilization Among Older Adults? The Case of Maryland,” Population Health Management, Apr. 1, 2018, https://www.liebertpub.com/doi/10.1089/pop.2017.0055.

[27] J. Kim, “Are Older Adults Who Participate in the Supplemental Nutrition Assistance Program Healthier Than Eligible Nonparticipants? Evidence from the Health and Retirement Study,” The Gerontologist, Nov. 1, 2015, https://academic.oup.com/gerontologist/article/55/Suppl_2/672/2489236.

[28] Elizabeth Bradley, et al., “Variation in Health Outcomes: The Role of Spending on Social Services, Public Health, And Health Care, 2000-09,” Health Affairs, May 2016, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2015.0814?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed.

[29] Laura Tiehen et al. “SNAP Matters: How Food Stamps Affect Health and Well Being,” Stanford University Press, 2016, p. 68.

[30] Dustin Pugel, “Reinstating Time Limits for Food Assistance Will Hurt Low-Income Kentuckians and Local Economies,” Kentucky Center for Economic Policy, Feb. 26, 2018, https://kypolicy.org/reinstating-time-limits-food-assistance-will-hurt-low-income-kentuckians-local-economies/.

[31] Darla Carter, “More than 21,000 Kentuckians Lose Food Aid Due to Work Requirement, Groups Say,” Insider Louisville, May 16, 2019, https://insiderlouisville.com/government/more-than-21000-kentuckians-lose-food-aid-due-to-work-requirement-groups-say/.

[32] Jason Dunn, “Death By a Thousand Cuts: 3,500 Lost Food Benefits So Far in 2019 for Being Behind in Child Support,” Kentucky Voices for Health, Jun. 11, 2019, https://www.kyvoicesforhealth.org/single-post/2019/06/11/Death-by-a-Thousand-Cuts-3500-lost-food-benefits-so-far-in-2019-for-being-behind-in-child-support.

[33] Karen Cunnyngham, “Reaching Those in Need: Estimates of State Supplemental Nutrition Assistance Program Participations Rates in 2016,” U.S. Department of Agriculture Food and Nutrition Service, March 2019, https://fns-prod.azureedge.net/sites/default/files/resource-files/Reaching2016.pdf.

[34] Dustin Pugel and Ashley Spalding, “HB 3 Proposes Massive, Expensive and Ineffective Bureaucracy That Will Hurt Kentucky Families and Open State to Legal Problems,” Kentucky Center for Economic Policy, Mar. 4, 2019, https://kypolicy.org/hb-3-proposes-massive-expensive-and-ineffective-bureaucracy-that-will-hurt-kentucky-families-and-open-state-to-legal-problems/.

[35] Dustin Pugel, “Evidence from Kentucky Should Serve as Warning Against Food Assistance Restriction Rule,” Kentucky Center for Economic Policy, Apr. 4, 2019, https://kypolicy.org/evidence-from-kentucky-should-serve-as-warning-against-food-assistance-restriction-rule/.

[36] Jessica Klein, “Eliminating SNAP Broad-Based Categorical Eligibility Increases Inefficiencies and Hunger for Working Families, Older Adults and Persons with Disabilities,” Kentucky Center for Economic Policy, Sep. 24, 2019, https://kypolicy.org/eliminating-snap-broad-based-categorical-eligibility-increases-inefficiencies-and-hunger-for-working-families-older-adults-and-persons-with-disabilities/.

[37] Dustin Pugel, “Change to Poverty Measure Would Mean Hardship for Many Kentuckians,” Kentucky Center for Economic Policy, Jun. 20, 2019, https://kypolicy.org/change-to-poverty-measure-would-mean-hardship-for-many-kentuckians/.

[38] Data from an open records request to the Kentucky Department for Community Based Services fulfilled on May 14, 2019.

[39] USDA Food and Nutrition Service, “State Options Report: Supplemental Nutrition Assistance Program, Fourteenth Edition,” May 2018, https://fns-prod.azureedge.net/sites/default/files/snap/14-State-Options.pdf

Lopsided Recovery Continues to Leave Out Eastern Part of State

A recovering economy since the Great Recession has bypassed much of rural Kentucky and especially the eastern and northeastern regions of the state. Those conditions magnify the harm from current and proposed cuts to safety net programs like nutrition assistance and Medicaid, and make critical the need for new policies that effectively create jobs.

The graph below shows the percent change in the number of people employed compared to 10 years ago in each of the state’s workforce development areas (map of those areas here) and the United States as a whole. While central and northern Kentucky are performing above or near the U. S. average, rural districts have lagged behind. That is especially the case for the 23 counties of the Eastern Kentucky Concentrated Employment Program (EKCEP) workforce area and the 10 counties in northeastern Kentucky (TENCO). 

In addition to the economic harm caused by the recession, southeastern Kentucky has seen remaining coal employment collapse due to competition from cheaper natural gas and other alternatives. The northeastern region has lost manufacturing jobs due primarily to trade pressures and policies. Budget cuts at the state and federal levels have also forced cuts in local public sector employment. The drop in spending from paychecks has had a ripple effect in job loss at businesses serving the local economy. Thousands of people have fallen out of the labor force as a result and therefore are not counted in the unemployment rate, or have moved away.

There is no recent improvement in these numbers, either. From June 2018 to June 2019, employment in the EKCEP region fell 2.5% and in the TENCO region 1.4%. And the region may not have hit rock bottom yet, as suggested by the recent, high-profile coal company bankruptcies. The state has touted several announcements of new manufacturing projects in east Kentucky, but they have largely failed to materialize or are of questionable viability.

Despite this evidence of economic hardship in big swaths of the state, Kentucky is moving forward with new requirements that for the first time mandate adults without dependents in every county report work in order to continue receiving SNAP benefits. As a result, over 21,000 people have already lost food assistance. The administration is seeking similar barriers to Medicaid that will lead to loss of health coverage and a reduction in regional health care spending. There are also legislative proposals to severely restrict access to unemployment insurance and other aspects of the safety net. By taking dollars out of communities, these policies further weaken local economic conditions.

Instead, the region needs policies that support local job creation. While the broader U. S. economy benefited greatly from the coal and manufacturing produced by eastern and northeastern Kentucky, their decline has been met with too little in the way of governmental transition assistance. Initiatives like the POWER grants through the Appalachian Regional Commission have helped support new ideas, but the scale of public investment so far is a fraction of the disinvestment the region has been facing.