As the feds crack down on opioid prescriptions, patients are taking their own lives, doctors are losing their jobs and overdose rates continue unabated.

The Government’s Solution To The Opioid     Crisis Feels Like A War To Pain Patients

By Art Levine

Meredith Lawrence's late husband died by suicide after his opioid pain prescription was severely restricted.

Jay Lawrence, an energetic truck driver in his late 30s, was driving a semitrailer across a bridge when the brakes failed. To avoid plowing into the car in front of him, he swerved sideways and slammed the truck into a wall, fracturing his back. For more than 25 years, he struggled with the resulting pain. But for most of that time, he managed to avoid opioid painkillers.

In 2006, his legs suddenly collapsed beneath him, due to a complex web of neurological factors related to his spinal cord injury. He underwent multiple surgeries and tried many medications to alleviate his pain.

The next year, he began to experience some semblance of relief when his doctor prescribed morphine, one of a class of opioid drugs. By 2012, he was taking 120 milligrams per day.

But this isn’t a story about opioid addiction. Lawrence managed a relatively productive, happy life on the medication for the better part of 10 years.

“This isn’t the life I thought I’d have,” he told his wife, Meredith Lawrence, in December 2016. “But I’m all right.”

Living on disability payments, he could still walk around their two-bedroom trailer home using his cane, take a shower on his own and, on his good days, even help his wife make breakfast.

Then, in early 2017, the pain clinic where he was a patient adopted a strict new policy, part of a wide-ranging national effort to respond to the increase in opioid overdose deaths. 

Citing 2016 guidelines from the U.S. Centers for Disease Control and Prevention, her husband’s doctor abruptly cut his daily dose by roughly 25 percent to 90 mg, Meredith Lawrence said. That was the maximum dose the CDC recommends, though does not mandate, for first-time opioid patients. 

The doctor also told Jay Lawrence that the plan was to lower his dose to 45 mg over the next two months, a cutback of more than 60 percent from what he had been taking.

At the end of that traumatic visit, his wife said, Jay Lawrence’s doctor dismissed their concerns and shared his own fear about losing his license if he continued to prescribe high doses of opioids. (When HuffPost followed up, the doctor declined to comment on the case, citing patient privacy.)

For a month, Lawrence suffered on the 90 mg dose. At times, his pain was so bad that he needed help to get out of the recliner, and when his wife looked over, she sometimes saw tears streaming down his face.

He dreaded his next appointment when his dose would be slashed to 60 mg. In the weeks before that scheduled visit on March 2, 2017, Lawrence came up with a plan.

On the day of his appointment, on the same bench in the Hendersonville, Tennessee, park where the Lawrences had recently renewed their wedding vows, the 58-year-old man gripped his wife’s hand and killed himself with a gun.

Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband's death

Dustin Chambers for HuffPost Meredith Lawrence sits in the living room of the home in Gainesville, Georgia, that she bought after her husband’s death.

There are at least nine million chronic pain patients in the United States who take opioid painkillers on a long-term basis. As law enforcement and medical regulatory bodies try to curb the explosion in opioid deaths and the rise in illegal opioid use, they have focused on reducing the overall opioid supply, whether or not the drugs are provided by prescription. 

There’s mounting evidence this won’t work ― that curbing patient access to legal prescription opioids does not stem the rate of overdoses caused primarily by illegal drugs ― and that patients are being denied desperately needed relief. There are also troubling indicators that cutting back on opioids increases the risk of suicide among those with chronic pain.

Some chronic pain patients and advocates have even begun compiling lists of individuals they know who have died by suicide after they were no longer able to treat their pain with opioid medication.

“There is no doubt in my mind that forcibly stopping opioids can destabilize some of the most vulnerable people in America,” said Dr. Stefan Kertesz, a professor of medicine and an addiction researcher at the University of Alabama at Birmingham. “And the outcomes for those folks include suicide, overdose and falling apart medically.”

I mean, people need to take some aspirin sometimes and tough it out a little. Attorney General Jeff Sessions

For a decade or so, government officials in the U.S. have sought to drive down the opioid supply through a range of tactics ― from increased seizures of diverted opioid medications to state crackdowns on “pill mills.” The Trump administration has embraced the hard-line approach.

In late January, Attorney General Jeff Sessions announced a “surge” in Drug Enforcement Administration activity targeting pharmacies and physicians that, in the agency’s view, oversupply opioids. In February, the Justice Department doubled down with the announcement of a new task force that would focus on manufacturers and distributors of opioids. In March, President Donald Trump unveiled a plan to lower opioid prescriptions by a third within three years. And in late June, the federal government arrested 600 people, including 165 medical professionals, for allegedly participating in $2 billion worth of fraud schemes involving opioids.

The Trump administration’s efforts are dramatic even within the context of the CDC’s opioid dose guidelines. The guidelines were originally intended to advise primary care physicians treating chronic pain patients and other pain sufferers. They were urged to exercise caution in prescribing opioids, to use alternatives whenever possible and to prescribe daily doses of no more than 90 morphine milligram equivalents (MME) for new opioid users.

For pain patients like Jay Lawrence who had already been on opioids for years, however, the guidelines simply recommended regularly assessing the harms and benefits of the dosage. They didn’t advise either mandatory cutoffs or any set limits. (The Tennessee Department of Health’s guidelines would also have allowed Lawrence to stay at 120 mg of morphine when prescribed by a pain specialist.)

But “the CDC guidelines have been weaponized,” said Kertesz. The ramped-up enforcement by the DEA and state regulators has led some doctors to choose caution and to overcorrect in their prescribing, lest they lose their ability to practice medicine at all. Kertesz decried these policies as “simplistic” in a definitive new article published last week in the journal Addiction.

In February, Sessions struck a particularly harsh tone by suggesting that the fate of chronic pain patients was not high on his list of concerns. “I am operating on the assumption that this country prescribes too many opioids,” the attorney general said. “I mean, people need to take some aspirin sometimes and tough it out a little.”

Attitudes like that are based on a series of mistaken assumptions about pain, according to Dr. Thomas Kline, a North Carolina-based family practitioner and former Harvard Medical School program administrator. Kline regularly updates a list of pain patients, published on Medium, who’ve killed themselves in the wake of draconian restrictions on pain medication.

“I ask people to imagine the very worst pain they’ve ever experienced in their lives,” Kline said. “And then that they’re denied relief by a doctor with the one medicine proven effective for pain control for 50 centuries.” (Historical records show that people in ancient Mesopotamia cultivated the poppy plant for medical use.)

The CDC guidelines have been weaponized. Dr. Stefan Kertesz

The government’s aggressive focus on doctors and patients is unlikely to address the very real menace of opioid-use disorders and sharply escalating overdose deaths. Fraud ― driven by pharmaceutical company policies ― and diversion ― the phenomenon of prescription medications being sold as street drugs ― initially spurred a wave of opioid abuse in the late 1990s, as some doctors turned their practices into pill mills. But new reports by the CDC and a drug data firm, the IQVIA Institute for Human Data Science, suggest that prescription drugs play a much smaller role in today’s crisis.

The reports show that total opioid prescriptions dropped 10 percent in 2017 ― the sharpest annual decline in such prescribing in 25 years. While opioid prescriptions peaked back in 2010, the studies found that growth rates in opioid-linked deaths, overwhelmingly due to illegal fentanyl and heroin, have skyrocketed in the last seven years.

Indeed, although two-thirds of the 64,000 overall drug overdose fatalities were linked to opioids in 2016 ― the most recent year for which there is data ― more than 80 percent of those opioid drug deaths came from illegal street drugs such as heroin and fentanyl. Prescription opioid drug deaths alone ― excluding methadone ― amounted to less than 15 percent of all drug overdose deaths, or about 9,500 fatalities.

Still, the CDC’s guidelines have triggered restrictive laws in at least 23 states that mandate ceilings on opioid dosage. (Oregon, in fact, is moving to taper dosages down to zero for all Medicaid chronic patients over a year.) That makes relief less attainable for pain patients and threatens the practices of doctors who treat them. These laws have been augmented by the growth of state prescription monitoring programs that use the software NarxCare, which is designed to flag addiction but can also rope in pain patients based on their prescription history and use of multiple doctors.

And in June, the House of Representatives passed over 50 bills that would establish dramatic new restrictions on opioid prescribing, eliciting alarm among patients and some disability rights groups.

The side effects of the current enforcement efforts are disturbing enough, from patients denied relief to drug shortages to suicides.

No health agency has kept track of all pain-related suicides that may be linked to doctors cutting back on prescriptions. But some preliminary findings from Department of Veterans Affairs researchers indicate that VA pain patients deprived of opioids were two to four times more likely to die by suicide in the first three months after they were cut off, compared to those who remained on their pain medications.

“To protect people, you have to take care of the patient, not the pill count,” said Kertesz, who worked on the VA’s April 2017 study but spoke to HuffPost only as an independent researcher. “The findings suggest that the discontinuation of opioids doesn’t necessarily assure a safer patient.”

Even terminally ill cancer patients are increasingly getting less relief, and there are growing shortages of injectable opioids at local hospitals and hospices, spurred in part by DEA-ordered reductions in opioid manufacturing quotas.

Leah Ilten, a 53-year-old physical therapist who lives in Kennewick, Washington, told HuffPost that as her 86-year-old father lay dying of pancreatic cancer in a hospice, the medical staff ignored her pleas to provide appropriate opioid pain relief, even cutting his dosage in half on the last day of his life. A few days earlier, when he was in the hospital, one nurse explained to her that opioids could lead to an overdose or could potentially cause the man, who lay moaning in pain, to “get addicted.”

“I was horrified,” Ilten said.

In mid-April, the DEA responded to the injectable opioid shortage by lifting production quotas. An agency spokesman told HuffPost that it was “a manufacturers’ problem, not the quotas,” while asserting that progress is being made.

There have been production issues, including Pfizer’s foul-ups with a plant in Kansas. But the DEA’s delay in taking action ― shortfalls were flagged in February in a letter from the American Society of Anesthesiologists and other health groups ― definitely contributed to the shortage, according to Dr. James Grant, president of the ASA. He told HuffPost that quotas were among the factors creating the crisis.

I’m not willing to go back to the state I was in before I started treatment. Anne Fuqua

Faced with the hardline national crackdown on opioid prescriptions, people with chronic pain are trying to raise awareness of the suffering caused by the loss of medications. Some are gathering the names of those patients who ended up taking their own lives, both as a memorial to those who died and as a protest against the health establishment that has seemingly abandoned them. Others are seeking comfort from each other on social media.

Lelena Peacock, who declined to name her southeastern city of residence for fear of retaliation from doctors, is struggling with how to treat the pain associated with fibromyalgia. The 45-year-old found that her social media posts drew other pain patients who turned to her for help.

By her own count, Peacock has thus far convinced more than 70 chronic pain patients to call 911 or suicide prevention hotlines instead of killing themselves.

For Anne Fuqua, a 37-year-old former nurse from Birmingham, Alabama, the motivation for compiling a list of chronic pain-related suicides is to track the damage done by what she sees as policies that have left people like her behind. 

“There’s so many people who have died,” she said. “We have to remember them.”

Fuqua has an incurable neurological illness known as primary generalized dystonia that causes Parkinson’s-like involuntary movements and painful muscle spasms. She started taking about 60 mg of Oxycontin a day in 2000. Her doctor began to limit her access to high doses of opioids in 2014, the same year she started chronicling those friends who had killed themselves or otherwise died after being denied pain medications. Her informal list is now up to roughly 150 people, augmented by lists that other pain patient advocates have compiled.

On July 9, Fuqua joined other chronic pain patients at a meeting at the Food and Drug Administration campus in Maryland to express their fears and outrage at the cutbacks. Sitting in the front row in her wheelchair, she told FDA officials about that list and declared, “I’m not willing to go back to the state I was in before I started treatment.”

Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Courtesy of Anne Fuqua Anne Fuqua needs exceptionally high doses to manage her pain because of opioid malabsorption.

Fuqua’s own difficulties are compounded by the fact that her body does not respond to even large doses of opioids the way others do ― she suffers from severe malabsorption that hampers her ability to benefit from everything from opioids to vitamin D. Since 2012, she has relied on a strikingly high daily regimen of 1,000 MME of opioids, including fentanyl patches, to manage her pain.

But her physician, Dr. Forrest Tennant, was driven to retire this year after a DEA raid and investigation. The Los Angeles-area physician mailed her a final series of prescriptions, which will run out at the end of July.

“It’s terrifying,” she said looking at her future. “If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen.”

Another doctor has quietly stepped forward to continue treatment for Tennant’s remaining patients, Fuqua said, although there’s no assurance that this physician won’t also be investigated in the future.

If these were people who had asthma or diabetes and weren’t stigmatized because of opioids, this wouldn’t be allowed to happen. Anne Fuqua

The raid on Tennant’s home and office last November illustrates the hard-line regulatory and enforcement approach that critics say doesn’t distinguish between pill-mill doctors who deserve to be shut down and legitimate pain doctors who use high-dosage opioids. The wide-ranging search warrant served to Tennant essentially accused him of drug trafficking even though he’d earned a national reputation for deft treatment of ― and research about ― pain patients.

“He’s highly respected and prominent in pain management,” said Jeffrey Fudin, a clinical pharmacy specialist who heads the pain pharmacy program at the Albany Stratton VA Medical Center in Albany, New York, and serves as an associate professor at the Albany College of Pharmacy and Health Sciences. “Most of his patients had no other options, and they came from around the country to see him.”

Tennant was known for taking on difficult-to-treat patients, including those suffering from pain as a result of botched surgeries and other forms of malpractice. His research included innovations in the use of hormones to alleviate pain and lower opioid use up to 40 percent, as well as work on genetic testing for enzyme system defects that lead to opioid malabsorption.

“The DEA can trigger an investigation every time they misapply the CDC guidelines without paying attention to the population the physician treats or issues of medical necessity,” said Terri Lewis, a patient advocate and a Ph.D. clinical rehabilitation specialist with Southern Illinois University who trains clinicians on how to manage seriously ill patients with incurable pain.

Special Agent Timothy Massino, a spokesperson for the DEA’s Los Angeles division, declined to comment on the agency’s approach to Tennant. “It’s an ongoing investigation,” he noted.

Tennant’s isn’t alone. Physicians must now balance their prescribing obligations to their patients with legitimate fear for their livelihoods.

DEA enforcement actions against doctors have risen some 500 percent in recent years ― from 88 in 2011 to 449 last year, according to an analysis of the comprehensive National Practitioners Data Bank by Tony Yang, a professor of health policy at George Washington University. Even though that’s a relatively small number of arrests compared to the roughly one million physicians in the country, such arrests can have an outsized impact.

“They make big news, and they serve as a deterrent for physicians whose specialties require them to use a lot of pain medications,” Yang said. “It makes them think twice before prescribing opioids.”

Meredith Lawrence shows the tattoo she got after her husband'€™s death. The bluejay represents her husband, Jay; a cup of cof

Dustin Chambers for HuffPost Meredith Lawrence shows the tattoo she got after her husband’€™s death. The bluejay represents her husband, Jay; a cup of coffee is the way she loves to start her day; and the quote is “Sail away with me, what will be will be.”

Dr. Mark Ibsen of Helena, Montana, found himself in a five-year battle against the state licensing board that’s still not over ― even though a judge last month reversed the board’s decision to suspend his license because of due process violations. The court has remanded the case back to the licensing board for potential further investigation of his opioid prescriptions, but Ibsen has decided he won’t resume his medical practice.

That’s bad news for Montana, which has the highest rate of suicide in the country, according to the CDC. What’s more, chronic pain-related illnesses account for 35 percent of all the state’s suicides, as a recent state health department study found.

In the course of his fight with the medical board, the 63-year-old doctor said three of his former chronic pain patients have killed themselves after he and other doctors stopped prescribing opioids. The first of those patients died shortly after attending a hearing to show his support for Ibsen.

The deaths of pain patients haunt those who treated them and loved them. Meredith Lawrence, who sat with her husband to the very end, said, “It was as horrifying as anything you can imagine.”

“But I had the choice to help him or find him dead someday when I came home,” she added.

Lawrence was arrested and sentenced to a year’s probation for assisting a suicide. Now her goal is to fight restrictions on opioid prescriptions.

“If we don’t stand up, more people will die like my husband.”

If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. You can also text HOME to 741-741 for free, 24-hour support from the Crisis Text Line. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.

Art Levine is the author of Mental Health, Inc: How Corruption, Lax Oversight, and Failed Reforms Endanger Our Most Vulnerable Citizens.

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That study isn’t without flaws. Veterans die by suicide at higher rates than average ― currently accounting for 20 suicide deaths a day ― so they are not a nationally representative sample. And the VA study, which was released at a national opioid summit in early April, has not yet been submitted for peer review.

But another study, published last year in the peer-reviewed journal General Hospital Psychiatry, looked at nearly 600 veterans who in 2012 were cut off from dosages after long-term opioid use and found similar results. Twelve percent of the vets showed suicidal ideation or took violent action to harm themselves ― a rate nearly 300 percent higher than the overall veterans community.

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Feds want to know what you think about Bevin plan to overhaul Medicaid & Kentucky makes Medicaid copays mandatory ‘under the cover of darkness’

Feds want to know what you think about Bevin plan to overhaul Medicaid

Deborah Yetter, Louisville Courier Journal Published 3:05 p.m. ET July 20, 2018

The federal government, once again, wants to know what people think about Gov. Matt Bevin’s plan to overhaul Kentucky’s Medicaid.

Less than a month after a federal judge struck down Bevin’s plan that includes work requirements and premiums for some Kentuckians who get health coverage through Medicaid, the U.S. Centers for Medicare and Medicaid Services (CMS) is seeking public comments on the exact same plan, known as a “waiver.”

The public comment period began July 19 and ends Aug. 18.

Health advocates who are concerned about the changes say it’s important that people take advantage of the public comment period, as they did last year when CMS previously reviewed Bevin’s plan before approving it in January.

“It really matters that people speak up,” said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of organizations. “This is the exact same waiver.”

During the previous public comment period, about 3,000 people responded, the majority opposed to the waiver, Beauregard said.

Read more: Bevin official rips Democrats, Courier Journal over his dental care cuts

It’s not clear why CMS is seeking comments on the same plan that was rejected June 29 by U.S. District Judge James Boasberg, of Washington D.C. The judge vacated CMS’ previous approval of the plan and sent it back to the agency for further review, finding among deficiencies that the agency did not fully consider previous public comments.

A CMS statement said the agency is seeking more comments “to ensure that interested stakeholders have an opportunity to comment on issues raised in the litigation and the court’s decision.”

Some health advocates have speculated it’s part of an effort by the Trump administration to push through work requirements for people enrolled in Medicaid, following public comments by CMS administrator Seema Verma at a July 17 Politico event.

“We are very committed to this,” Verma said, according to Politico. “We are looking at what the court said. We want to be respectful of the court’s decision while also wanting to push ahead with our policy initiatives and our goals. … We are trying to figure out a path forward.”

Adam Meier, secretary of the Cabinet for Health and Family Services, told a legislative committee Wednesday that Kentucky Medicaid officials are working with CMS to enact the plan.

“Our position is that we’d like to gain re-approval as quickly as possible,” he said.

Health law advocates who successfully challenged Kentucky’s plan in federal court said they intend to argue that, as the judge found, the plan does not conform with the federal Medicaid law, which is to improve access to  health care for vulnerable citizens.

Medicaid is a federal state health plan for low-income and disabled individuals.

“We continue to take the position that work requirements are illegal because they are inconsistent with the Medicaid Act,” said Jane Perkins, legal director of the National Health Law Program in Washington.  “We will certainly be commenting during this re-opened period.”

Perkins’ group has posted additional information about the importance of public comments on its website, www.healthlaw.org.

Kentucky was the first state to win CMS approval of Medicaid work requirements.

They have already been approved in Arkansas, Indiana and New Hampshire, while Arizona, Maine, Wisconsin and Utah are waiting to hear from CMS, Politico reported.

Under Bevin’s plan, “able-bodied adults” among the about a half-million people added to Medicaid under the Affordable Care Act would be subject to “community engagement” requirements that they work or volunteer at least 20 hours a week. They also would pay premiums of $1 to $15 per month and could be subject to a “lock-out” of coverage up to six months for failing to meet requirements.

Basic vision and dental benefits would be eliminated for that group though they could earn points to purchase such services through a “My Rewards” account through activities such as volunteering or taking online self-improvement classes.

Kentucky officials said in a statement Thursday that the Cabinet for Health and Family Services has “been working with CMS on details of the re-approval process, including the status of dental and vision benefits.”

The abrupt decision of the Bevin administration to cut dental, vision and non-emergency transportation benefits July 1, two days after the judge rejected the plan, sparked an uproar among patients and health care providers across Kentucky.

On Thursday, the state announced it was reinstating the benefits while it works toward federal approval of its plan.

Here is a link to the public comment page on the CMS website: https://public.medicaid.gov/connect.ti/public.comments/viewQuestionnaire?qid=1897699.

Beauregard said Kentucky Voices for Health will also begin collecting comments on its website, https://www.kyvoicesforhealth.org/, starting July 23 that it will forward to state and federal officials.

Deborah Yetter: 502-582-4228; dyetter@courierjournal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/deborahy.

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Kentucky makes Medicaid copays mandatory ‘under the cover of darkness’

Deborah Yetter, Louisville Courier Journal Published 1:43 p.m. ET July 27, 2018 | Updated 1:48 p.m. ET July 27, 2018

After three weeks of turmoil in Kentucky’s Medicaid program, a new complication — the state’s abrupt enactment of copays ranging from $1 to $50 for medical services — has triggered more confusion among patients, some afraid they can’t afford items such as essential medication for diabetes and asthma.

“It seemed to have been slipped in under the cover of darkness,” said Bill Wagner, CEO of Family Health Centers, a network of community clinics in Louisville. “Even though this went into effect July 1, the instructions have not come out.”

At the University of Louisville medical school, Dr. Barbara Casper, an internist, worries state officials didn’t consider the impact of the new copays on the very poor patients she treats in an outpatient clinic, many of them seriously ill.

“Some of our patients can’t even pay $1,” said Casper, who credits Kentucky’s 2014 expansion of Medicaid under the Affordable Care Act for providing health coverage for many of the low-income patients U of L sees at its clinics.

“This was a problem before we had the Medicaid expansion,” she said. “We had a $2 copay for our patients to be seen and some of them couldn’t even come up with that.”

The clinic does not turn away patients who can’t pay, she said.

Related: Feds want to know what you think about Bevin plan to overhaul Medicaid

While small copays have long been allowed by Medicaid, Kentucky hasn’t required them in recent years. The sudden announcement that copays were mandatory July 1 caught many health providers and advocates off guard.

“Complete confusion,” is how Sheila Schuster, a longtime mental health advocate described it. “It’s not entirely clear what copays are charged for certain services.”

Adam Meier, secretary of the Cabinet for Health and Family Services, speaking at a legislative committee meeting July 18, said his agency is “still clarifying” some aspects of the copays. The cabinet did not respond to a request for information for this story.

Health providers say they aren’t sure who has to pay, who is exempt, how to collect the copays and what to do when patients can’t pay.

For example, pregnant women and children generally have been exempt from such requirements. But several health providers say it appears that children covered through Children’s Health Insurance Program, a Medicaid program for children of low-income parents, must now pay copays.

In Kentucky, about 90,000 children are covered by CHIP.

Background: Bevin will reverse cuts to Medicaid dental, vision services, state says

Some health providers are reassuring patients they will still get care if they can’t pay, including Bridgehaven, a day program in Louisville for people with serious, disabling mental illnesses.

“I worry about it causing them additional stress and anxiety when they’re already trying to cope with mental illness and trying to live on an extremely limited income,” Bridgehaven CEO Ramona Johnson said.

The copays come in the midst of upheaval in the Kentucky Medicaid program, which covers about 1.4 million people, including more than 600,000 children.

The state launched the copays on the same day it had planned to launch Gov. Matt Bevin’s sweeping plan to overhaul Medicaid, adding work requirements, premiums and other new rules aimed at “able-bodied” adults.

But a federal judge struck down the plan June 29, forcing the state to abruptly halt the changes that could affect nearly half a million Kentuckians.

Meanwhile, in a separate move effective July 1, the Bevin administration abruptly announced it had eliminated basic dental and vision coverage for up to 460,000 Kentuckians, creating an uproar particularly among patients who arrived at dentists’ offices only to discover they had no Medicaid coverage.

The administration quickly backtracked and on July 19 said it was rescinding the cuts to dental and vision benefits for now.

But the copays remain in place, leaving bewildered health providers trying to figure out with little guidance how to apply them. If the patient can’t pay, it comes out of the Medicaid reimbursement and the provider takes the loss.

“It could become a big issue for providers that operate with a very slim margin,” Johnson said.

Read this: ‘I want to have my teeth’: Bevin’s Medicaid cuts leave Kentuckians in pain

She said that includes her organization, Bridgehaven, whose clients typically visit the center three times a week and may receive three or more services per day, such as a visit with a therapist, a support group and a peer counseling session.

The state says providers must charge $3 per office visit for a service, so that means clients could end up owing $9 a day, Johnson said.

“Three times a day, three times a week, that’s $27 a week,” Johnson said. In addition, Bridgehaven clients will have to pay $3 for visits to a primary care physician or psychiatrist and copays for medication of up to $8 per prescription — medication she said is essential for people with mental illness to remain stable.

“Of course they don’t have that kind of money,” she said. “They struggle to pay their rent, their utilities, buy their groceries.”

Johnson said Bridgehaven will still provide services for clients for now regardless of ability to pay the copay, but the organization could lose up to $100,000 a year from an already tight budget by doing so.

She’s also worried copays will discourage people from seeking treatment.

And in the mental health area, if people don’t get regular services, they wind up homeless, in jail or in far more costly psychiatric hospitals — at state expense, according to mental health advocates.

Casper, the U of L physician, said that also holds true for patients she sees with serious conditions including diabetes, high blood pressure, congestive heart failure, asthma and emphysema.

She worries the patients will wind up in the emergency room or hospital if they skip office visits or cut back on medication because they can’t afford a copay. Copays for Medicaid range from $1 for generics to $4 or $8 for some name brand drugs.

Watch: ‘It’s just wrong:’ Susan Wells talks about how Medicaid cuts affected her

And while physicians try to prescribe generic drugs, some medications — such as insulin for diabetes and inhalers for asthma or other breathing disorders — mostly are available only as name brand drugs, she said.

“It’s not uncommon for some of our patients to be on 10 different medications,” Casper said. “They’re going to be back in the circumstances they were in previously. Do they eat, pay rent, their electric bill, take care of children or get their medicine?”

Casper said the new copays are especially frustrating because they come as patients now receiving regular care through Medicaid are beginning to make important changes in their lifestyles, losing weight, monitoring blood pressure and getting treatment for chronic illnesses.

“It kind of breaks my heart,” she said. “I’ve seen a lot more engagement in their health care by our patients. They’re doing all we want them to to stay healthy.”

Health providers said they are trying to explain the changes to patients and let them know what to expect but are having a hard time doing so absent clear guidance from state Medicaid officials.

“There’s no rhyme or reason as to how co-pays are coming through,” said Michael Lin, pharmacy director for Family Health Centers. “They’re so inconsistent.”

The state has sent out information to people on Medicaid but several providers say patients have brought it to them, unable to understand the complicated, bureaucratic language.

At the Family Health Centers pharmacy in Portland, patients are worried about whether they can afford new Medicaid copays, especially if they have multiple prescriptions for essential medications such as inhalers for asthma or insulin for diabetes.

“They worry about what’s going to happen if they don’t have the money,” Lin said.

The latest: Bevin shrugs off questions about his plans, draws comparison to Trump

Lin and Wagner said the Family Health Centers won’t turn away people who can’t pay, because as a federally recognized “safety net”  health service, their agency is able to get other funding to try to defray the costs.

But they said health care providers in private practice don’t have the ability to sustain losses from patients who can’t pay the copay.

And Wagner said making up the difference will still be a hit to the budget at Family Health Centers and other health care providers.

“It’s going to come off the bottom line,” he said.

Deborah Yetter: 502-582-4228; dyetter@courierjournal.com; Twitter: @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/deborahy.

Medicaid copays

Here are some of the new copays some people covered by Medicaid are being charged, effective July 1.

>> Office visits for physician, dentist, vision care, behavioral health or other health provider:  $3

>> Prescription drugs: $1 for generic drugs, $4 to $8 for name-brand medication.

>> Outpatient hospital service: $4

>> Emergency room visit for non-emergency: $8

>> Hospital admission: $50

>> Durable medical equipment: $4

>> Laboratory or X-ray services: $3

>> Physical, speech or occupational therapy: $3

>> Chiropractor: $3

>> Podiatrist: $3

Source: Kentucky Cabinet for Health and Family Services

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Kentucky drug overdose deaths jump 11.5 percent in 2017

FRANKFORT, Ky. (AP) – Drug overdose deaths in Kentucky are increasing despite a drop in opioid prescriptions and heroin use.

A new report from the Kentucky Office of Drug Control Policy says 1,565 people died from drug overdoses in 2017. That’s an 11.5 percent increase from 2016. Kentucky overdose deaths have increased by more than 40 percent since 2013.

Opioids are the main culprit in most deaths. Deaths attributed to heroin have declined. But more than half of the overdose deaths in 2017 were caused by fentanyl, a synthetic opioid.

Every year, Kentucky lawmakers have been passing more laws designed to address the epidemic. Anti-drug advocates celebrate those changes, but their celebration is tempered once a year when the new numbers come out detailing how many more have died.

Nationally, opioids accounted for more than 42,000 deaths in 2016.

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One could theorize that the passage of HB50 which included a provision to “provide funding for the purchase and administration of naltrexone for extended-release injectable suspension”,   for Heroin overdoses was a calculated response to what they knew was going to happen when they discontinued “narcotics” at the Doctor’s office…more Heroin deaths.   Per the Interim Joint Committee on Judiciary on July 27, 2015…  LINK

All roads in Kentucky lead you through Hell

The Kentucky Justice and Public Safety Cabinet and Operation UNITE are launching a new substance abuse call center that will connect people across the state with drug treatment, Gov. Matt Bevin announced today

FOR IMMEDIATE RELEASE

Contact: Woody Maglinger
502-564-2611
Woody.Maglinger@ky.gov

*Correction: The helpline will go live on Dec. 1, 2017.

Gov. Matt Bevin, Justice Cabinet and Operation UNITE Unveil New Drug Treatment Helpline

The KY Help Call Center will connect people with resources statewide

FRANKFORT, Ky. (Nov. 17, 2017) – The Kentucky Justice and Public Safety Cabinet and Operation UNITE are launching a new substance abuse call center that will connect people across the state with drug treatment, Gov. Matt Bevin announced today.

Beginning Dec. 1, Kentuckians struggling with a substance use disorder, either themselves or within their families, can call 1-833-8KY-HELP (1-833-859-4357) toll-free to speak with a specialist about treatment options and available resources. The specialist will conduct a brief screening assessment in order to connect callers with the most relevant treatment services as quickly as possible.

“This epidemic is gripping people in every corner of our state and every part of our society,” said Gov. Bevin. “If people don’t know about the ability to get help, then help is not going to be given to people. This phone number will connect callers to a live person who understands this exact issue and will link them to community resources that can help.”

Operation UNITE already fields about 1,000 inquiries each month from desperate residents seeking help with a substance use disorder. The new KY Help Call Center will provide referrals across the state to both public and private treatment providers.

Options will include everything from medication-assisted treatment to faith-based care, and the live specialist will help callers work through all the variables, such as location and cost.

“There are so many people across the commonwealth who have nowhere to turn when confronted with their own addiction or that of a loved one,” said Nancy Hale, President/CEO of Operation UNITE. “They are desperate for answers. They are desperate for help. This call center will guide people toward recovery. It will give them hope.”

The partnership with Operation UNITE is the latest initiative in the state’s “Don’t Let Them Die” campaign. Gov. Bevin unveiled that campaign earlier this year, encouraging all Kentuckians to take proactive steps to combat the lethal opioid crisis, which claimed more than 1,400 lives in 2016.

Kentucky Justice Secretary John Tilley said those in the grip of addiction often have brief moments of clarity when they are most receptive to help.

“We must seize on those rare opportunities to save lives,” Secretary Tilley said. “This call center brings us closer to on-demand treatment than ever before, and it allows callers to locate the resources that work best for them. The bottom line is that recovery happens, and I’m grateful that our state is leading the charge against this national pandemic.”

UNITE is staffing the KY Help Call Center with specialists in Prestonsburg, Ky., and the Kentucky Justice Cabinet is funding it through anti-drug appropriations in the current budget — approximately $500,000 per year for the next two years.

Callers can speak to a specialist from 8:30 a.m. to 5:30 p.m. (ET), Monday through Friday. During non-business hours, callers may leave a message and the call center staff will get back in touch with them.

More information is available at DontLetThemDie.com and OperationUNITE.org.

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In chaotic scene, Rand Paul demands to see the House GOP’s Obamacare repeal bill

By Lauren Fox and Phil Mattingly, CNN

Updated 3:25 PM ET, Thu March 2, 2017

Rand Paul 3.2.17

Senator demands to see ‘secret’ Obamacare bill 01:59

Story highlights
  • Some House Republicans were being granted a chance to review an Obamacare repeal draft
  • GOP leadership has taken a new level of caution with their Obamacare legislation

(CNN)  Kentucky Republican Sen. Rand Paul marched to the House side of the Capitol Thursday morning, knocked on a locked door and demanded to see a copy of the House’s bill to repeal and replace the Affordable Care Act, which he believed was being kept under lock and key.

Aides in the room told the senator — before dozens of reporters in a crowded hallway — that there was no bill to see. In fact, it wasn’t the room where GOP members of the Energy and Commerce Committee were told to meet with staff to review the current draft of their bill at all. But that did little to dissuade Paul, openly critical to the House Republican leadership’s preferred path on the process, from making his underlying point.

“This should be an open and transparent process,” Paul said. “This is being presented as if it were a national secret, as if this was a plot to invade another country, as if this were national security. That’s wrong.”

    Paul ventured to the House Thursday afternoon after reports surfaced that House Republicans on the Energy and Commerce Committee were being granted an opportunity to review the current draft of the Obamacare repeal legislation and ask questions behind closed doors.

    Opposed to the House legislation’s principles, Paul said he wanted to see the bill himself even though he didn’t serve on the committee.

    “I’m not allowed to read the working product so I can comment on it?” he said.

    Outside the small House office, the chaotic scene continued with a handful of Democrats demanding they, too, see the legislation, which aides continued to say was not even in the room. Two Democrats on the Energy and Commerce Committee and House Minority Whip Steny Hoyer, a Democrat from Maryland, asked aides if the bill was ready, only to be rebuffed.

    “I want to see the bill. I want to read the bill,” New York Democrat Paul Tonko said, noting that as far as he knew, Republicans were still planning to move forward with a markup on the legislation next week.

    At one point, the GOP staff allowed Hoyer, Rep. Joe Kennedy and a dozen or so reporters into the room to inspect it themselves. It was, in fact, bill-less.

    Hoyer proceeded to hold an impromptu news conference near a bust of President Abraham Lincoln a few feet away from the misidentified room. He then held an imaginary conversation with the 16th president about what Hoyer said was the poor state of the Republican Party.

    Rep. Greg Walden, the chairman of the Energy and Commerce Committee, downplayed perceptions of secrecy in a statement Thursday.

    “Reports that the Energy and Commerce Committee is doing anything other than the regular process of keeping its members up to speed on latest developments in its jurisdictions are false. Simply put, Energy and Commerce majority members and staff are continuing to discuss and refine draft legislative language on issues under our committee’s jurisdiction.”

    Leadership has taken a new level of caution with Obamacare repeal and replace reconciliation drafts after a leaked version of the bill in progress was circulated to news outlets last week.

    House aides told CNN that the review process was simply part of regular procedure of giving their members an opportunity to review the current draft and ask committee staff questions. The committee — along with a second panel responsible for the repeal legislation — is tentatively shooting to consider their respective pieces of legislation as soon as next week.

    The leaked draft — which aides say was outdated — drew condemnations from conservatives who pledged to oppose any final bill and set off a new round of internal divisions that threatened to endanger the repeal process before it even gets off the ground.

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    In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks

     

    November 19, 20166:00 AM ET

    Phil Galewitz

     

    For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America’s poorest places, the Affordable Care Act was life altering.

    The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

    “It’s been a godsend to me,” said the former Ohio school custodian who moved to Kentucky a decade ago.

    Lockaby finally got treated for a thyroid disorder that had left her so exhausted she’d almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

    But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state’s Republican governor has submitted to the Obama administration.

    Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare’s repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbia that has led to health coverage for an estimated 10 million people.

    What Happens If Kentucky Dismantles Its Health Insurance Exchange?

    Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can’t afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky’s enrollment has doubled since late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state’s uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.

    Kentucky’s achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin’s Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.

    Bevin has threatened to roll back the expansion if the Obama administration doesn’t allow him to make major changes, such as requiring Kentucky’s beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

    Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

    In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin’s view — $1.2 billion from 2017 to 2021, according to the waiver request he’s made to the Obama administration to change how Medicaid works in his state.

    Trump’s unexpected victory may help Bevin’s chances of winning approval. Before the election, many analysts expected federal officials to reject the governor’s plan by the end of the year on the grounds that it would roll back gains in expected coverage.

    A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

    “I think it’s much more likely that a waiver could be approved under the Trump administration,” she said. “On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed.”

    Lockaby is watching with alarm: “I am worried to death about it.”

    Life already is hard in her part of Kentucky’s coal country, where once-dependable mining jobs are mostly gone.

    In Clay County where Lockaby lives, 38 percent of the population live in poverty. A fifth of the residents are disabled. Life expectancy is eight years below the nation’s average.

    Clay’s location places it inside an area familiar to public health specialists as the South’s diabetes and stroke belt. It’s also in the so-called “Coronary Valley” encompassing the 10-state Ohio/Mississippi valley region.

    About 60 percent of Clay County’s 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.

    Still, the increase in insurance coverage hasn’t made Clay’s people healthier yet. Local health officials here say achieving that will take a decade or more. Instead, they cite progress in smaller steps: more cancer screenings, more visits to mental health professionals and more prescriptions getting filled. Harder lifestyle changes that are still ahead — such as eating better, quitting smoking and regular exercise — will take more than a couple years to happen, said Aaron Yelowitz, associate professor of economics at the University of Kentucky.

    One hopeful spot is the Grace Community Health Center in downtown Manchester, where patient visits are up more than 20 percent since 2014. Those without insurance pay on a sliding scale, which can mean a visit costs $50 or more.

    That was too much for Ramiro Salazar, 47, who lives with his wife and two children on a $733 monthly income. With Medicaid, he sees a doctor for his foot and ankle pain, meets regularly with a psychologist for anxiety and gets medications — all free to him. Medicaid even covers his transportation costs to doctors, vital because a specialist can be 40 miles away.

    Salazar is worried about Bevin’s plans, especially the additional costs. “I probably couldn’t afford it as I’m unemployed,” he said. “It would hurt me pretty bad.”

    Any development that could take away health coverage from people with mental health issues worries Joan Nantz, a psychologist who works part time at Grace and whose appointment calendar is booked three weeks out because of patient demand. More than 90 percent of her clients are on Medicaid.

    “If something happens to this program, I can’t begin to think what impact it would have on society,” she said. Without counseling, people with mental health issues will resort to illegal drugs and be more likely to commit crimes and domestic violence, Nantz said.

    Just five primary care doctors in Manchester treat adults in Clay and surrounding counties. Manchester Memorial Hospital has tried to recruit more without success.

    “We had a painful primary care shortage here five years ago and now it’s worse,” said Dr. Jeffrey Newswanger, an emergency room physician and chief medical officer at the hospital. “Just because they have a Medicaid card doesn’t mean they have doctors.”

    The emergency room is busier than ever seeing patients for primary care needs, he said.

    Newswanger sees both sides to the debate over Medicaid. The hospital gained because more patients are now covered by insurance, and the ER’s uninsured rate dropped to 2 percent from 10 percent in 2013.

    “Eliminating the expansion altogether would be painful for the hospital and a disaster for the community,” he said.

    But, Newswanger also appreciates some of Bevin’s proposals.

    “No one values something that they get for free,” he said, and incentives are needed to make people seek care in doctors’ offices instead of expensive ERs.

    Christie Green, public health director of the Cumberland Valley District Health Department that covers Clay County, said making the poor pay more or scrapping Medicaid’s expansion would be a setback to improving people’s health.

    Last year, Green helped Manchester build a three-mile trail along a park and install a swinging bridge across a small creek. Both additions were intended to promote physical fitness in a place where more than a third smoke — both far above national averages.

    Progress is slow. The path is used regularly. But drug addicts congregate daily by the bridge and it rarely gets traffic.

    “There is a lot to overcome here,” Green said.

    This story was produced through collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. You can follow Phil Galewitz on Twitter: @philgalewitz.

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    Proposed Medicaid Changes in Kentucky – Tell us what you think about Governor Bevin’s proposed Medicaid changes

    Proposed Medicaid Changes in Kentucky – Tell us what you think about Governor Bevin’s proposed Medicaid changes – LINK

    PLEASE FOLLOW LINK ABOVE TO COMPLETE THIS IMPORTANT SURVEY!  YOUR HEALTHCARE IS AT RISK IN KENTUCKY!  NOW IS THE TIME TO SPEAK UP!

     


     

    United 874K Members and Supporters –
    The three public hearings on the proposed Medicaid waiver have been completed, with approximately 400 individuals in attendance in Bowling Green, Frankfort and Hazard, KY and nearly 100 individuals who spoke. 98% of those who spoke expressed concerns about the proposed waiver. Concerns were expressed about requiring the “medically frail” to pay monthly premiums; about a work or volunteer requirement of 20 hours/week for those on the Medicaid Expansion; loss of retroactive eligibility which could cause a lapse in coverage or a delay in beginning Medicaid coverage; increasing premiums over several years for some Medicaid members, with a 6-month lock-out from services if the premium is not paid; eliminating annual dental and vision check-ups and routine care for the Medicaid Expansion folks
    Clearly those Medicaid members who are deemed to be “medically frail” (by a process yet to be determined, but ostensibly those with SMI. Chronic SUD, complicated medical conditions, are on SSI, or have a disability that interferes with a task of daily living) will be charged a monthly premium, probably in the range of $1 – $8 / month. We are concerned both by the financial burden, but also by the administrative burden created by this requirement. If the premium is not paid, then the medically frail individual will have to pay a copay for every service and every medication! While the 1915 C Waivers are exempt from this current 1115 Waiver Proposal from the Administration, we are concerned about individuals who are currently covered by Medicaid while waiting for a 1915 waiver slot. They would likely be classified as “medically frail” and would be subject to a monthly premium; if not paid, then they would be charged a copay for each health service and each medication they receive.
    Medically frail individuals will not have a work or volunteer requirement and will have the full range of current benefits, including dental and vision. These latter benefits (annual check-up, routine cleanings, etc.) are being removed from the benefit package for all other Medicaid members (excluding children and pregnant women); those basic health benefits will have to be “earned” by the member through their Rewards Account.
    I urge you to spread the word and to encourage those affected by these waiver changes, their families, providers and advocates to submit comments! I am available to answer questions or to be of assistance, if you will contact me.
    I have attached a flyer which gives information about writing or emailing your comments about the waiver to Medicaid Commissioner Miller. THE DEADLINE FOR RECEIPT OF WRITTEN COMMENTS IS 5:00 P.M. ON FRIDAY, JULY 22, 2016! Volume is important, so please encourage everyone to write in. And send a copy of your comment to kymedicaidchanges@gmail.com so we can be sure that your voice is heard!
    I have also attached a brief description of the waiver proposal and how it would affect various groups of people who are now Medicaid members.
    KY Voices for Health is conducting a very short SURVEY about the proposed changes in Medicaid. Please distribute this link and ask folks to complete the survey! It takes less than 3-4 minutes.