Invisible radon gas is the No. 2 cause of lung cancer in Kentucky but only 0.13% of houses in the state have been tested for it

Radon potential is measured in becquerels per cubic meter; a becquerel is one radioactive decay per second. Generally, the rate depends on the geology of a location and how much uranium and thorium are in the rocks, but levels in individual buildings vary depending on construction and exact location.

Three of every seven buildings in Kentucky have elevated levels of a colorless, odorless gas that is a significant cause of lung cancer, reports Bill Estep of the Lexington Herald-Leader. That rate of 42% is six times the national rate of 7%, according to the Kentucky Association of Radon Professionals.

But only 13 of every 10,000 houses in Kentucky have been tested for radon, says Ellen Hahn, a professor in the University of Kentucky nursing professor who runs BREATHE, which stands for for Bridging Research Efforts and Advocacy Toward Healthier Environments.

Kentucky has the nation's highest age-adjusted rate of lung cancer, mainly because it has the nation's second-highest smoking rate, but some people who have never smoked or have little exposure to indoor tobacco smoke get lung cancer. Radon is the No. 2 cause of lung cancer, and a combination of radon and smoking create an even higher risk of the disease, Estep reports.

Lindi Campbell (Breath of Hope KY photo)

"Lindi Campbell, 58, was fit, active and had never smoked, but had to have two lobes of her right lung removed in December 2017 as a result of developing lung cancer. Campbell said she grew up in Lexington in a house where she was exposed to secondhand cigarette smoke and radon," Estep reports. "After she was diagnosed with cancer, she had her childhood home tested. The results showed a radon level that was the equivalent of smoking 40 cigarettes a day, she said."

Campbell is president of Breath of Hope KY, which tries to raise awareness about lung cancer, reduce stigma surrounding it, and raise money for research.

Radon is a product of the natural decay of uranium and thorium, another radioactive element. "As it breaks down, it releases radioactive particles that can be inhaled and damage lung tissue over time," Estep notes. Newer homes are more likely to have a buildup because are more tightly sealed.

Estep offers ways to take action to protect yourself: "Radon information is available through several sources, including BREATHE; the Kentucky Geological Survey; the Kentucky Radon Program; the U.S. Environmental Protection Agency; and the American Lung Association. Health officials also recommend testing your home."

“Everyone needs to test,” Hahn said. “There’s no risk-free level of radon.”

"Free test kits are available at many county health departments, and people can also request a kit through the Kentucky Radon Program," Estep reports. "People in Pulaski, Rowan, Logan and Christian counties can check out test kits at public libraries, with a valid library card, as part of an on-going study by BREATHE. People can also buy test kits at home-improvement stores or online. Companies that install systems to pull radon out of homes can also test for the gas."

And how much do those systems cost? "Tracy Howard said it cost $1,300 to have Alpha Radon Remediation install an exhaust system in the basement of her house in Stanford on May 24," Estep writes. "Howard got a free test kit from the local health department and the results showed a radon level of 4.2, just over the limit at which the EPA recommends installing a system to reduce the radon level. Howard, a nurse who works from home to do remote patient monitoring, shares the house with her husband and their daughter and 4-year-old grandson. She wanted to reduce their risk of exposure to the cancer-causing substance. To her, it was worth $1,300 to accomplish that."

“I know how dangerous it is,” Howard told Estep. “Consider the cost of installing the system vs. the cost of getting lung cancer later in life.”

Read More

Lt. Gov. Jacqueline Coleman announces $40 million in federal funds for Kentucky schools to provide mental-health services

Lt. Gov. Jacqueline Coleman (Image from Facebook)

Lt. Gov. Jacqueline Coleman announced $40 million in federal funding is coming to Kentucky schools to support and expand access to school-based mental health services, Tom Latek reports for Kentucky Today. 

Coleman said this is important because "Students are six times more likely to access mental-health services when they are offered in schools." 

Coleman was speaking May 30 in the Capitol rotunda, where she and and other advocates gave an update on the student mental-health initiative that she began nearly two years ago. 

Coleman said the plan is for regional educational cooperatives, comprising school districts, to give the money to "major universities" in their area to be used to recruit, train and educate mental health professionals for grade school children in each region, Munashe Kwangwari reports for WLKY.

"We are building the workforce while providing services to the kids who do not have access right now," Coleman said, adding that the issue remains important in Kentucky and across the rest of the nation. She pointed to several studies to back up this claim, Latek reports, quoting her at length:

“A Pew Research internet poll reported earlier this year, 40% of U.S. parents of children under 18 say they are extremely or very worried that their children may struggle with anxiety or depression, while 36% indicated they were somewhat worried about this," Coleman said. 

She also quoted from a 2021 Kentucky Incentives for Participation program survey: “Twenty-two percent of the students in grades 6, 8, 10, and 12, reported serious psychological distress in the past 30 days. In a 2021 Kentucky Youth Behavior Risk survey, 9.8% of Kentucky middle school students, and 9.5% of Kentucky high school students attempted suicide, over the previous 12 months.”

The issue of youth mental health is so prevalent that U.S. Surgeon General Vivek Murthy issued a public-health advisory in December 2021 that said there is an urgent need to address a mental-health crisis among the nation's youth. In may, he issued another advisory drawing attention to the dangers of social-media use to children's mental health. 

Coleman also noted that all three branches of state government have put forth initiatives to prioritize student mental health, including a three-day mental health summit held by the Kentucky Supreme Court this week, Latek reports. 

Coleman added, “Now is the time to act. It is incumbent upon all of us to work together on this critically important issue, the number one issue here and across the country. This isn’t about right or left, it’s about doing what’s right, to make sure no student gets left behind.”

Read More

New Kentucky website provides data, maps and charts on how the environment affects human health, county by county

The website's address is Healthtracking.ky.gov.

The state Department for Public Health has launched a new resource for tracking a variety of topics that affect health in Kentucky. 

The website Healthtracking.ky.gov not only includes information and data about how the environment affects human health in a number of ways, but also presents data in map, chart or table formats for subcategories in each topic area. 

For example, under the category of heart disease and stroke, the site also provides information about the age-adjusted rate of hospitalization for heart attacks in each county, the crude rate of hospitalizations for heart attack in each county, and the number of hospitalizations for heart attack in each county. 

Other topics include: air quality, asthma, birth defects, cancer, childhood lead poisoning, chronic obstructive pulmonary disease (COPD), carbon-monoxide poisoning, climate and weather, drinking water, heat-related illness, radon (a naturally occuring, cancer-causing gas) and reproductive and birth outcomes. 

Data on the new site comes from several counrse, including the Centers for Disease Control and Prevention, the Environmental Protection Agency, the Kentucky Cancer Registry, state and local Health Departments and many others. Data can be examined at a state or county level.

The site also offers online maps with information about local health departments, prescription assistance, social vulnerability, and community vulnerability to Covid-19. It is managed by the health department's Environmental Public Health Tracking Program.

Read More

Rep. Guthrie's bipartisan bill to increase access to breakthrough therapies for people on Medicaid advances out of committee

Rep. Brett Guthrie addresses the House Energy
and Commerce Committee May 24. (Screenshot) 

U.S. Rep. Brett Guthrie's bipartisan bill to help Medicaid patients access breakthrough therapies, including gene therapies, to treat and cure rare diseases was approved by the House Energy and Commerce Committee on Wednesday, May 24.

The bill would allow access to innovative treatments and cures by enabling states to voluntarily enter into value-based purchasing (VBP) agreements for drugs, which ties the cost of treatments to patients' clinical outcomes. 

The bill, H.R. 2666, has been dubbed the Medicaid VBPs for Patients Act, or MVP Act. It was one of 19 pieces of legislation considered by committee on May 24, many of them aimed at increasing transparency and competition in the health-care industry.

Guthrie, a Republican from Bowling Green who represents the Second Congressional District, chairs the committee's Health Subcommittee, which approved the bill May 17. He issued a statement saying:

“The Medicaid VBPs for Patients Act would help get life-saving treatments to the most vulnerable patients across the country. With the flexibility this legislation provides, states can make high-cost therapies and cures for rare diseases available without raising taxes or cutting other state programs. Value-based payments ensure states are not on the hook for paying a drug manufacturer for a high-cost treatment if it is not effective and can even save states money in the long-term in caring for a patient.”

Guthrie added, “I will continue pressing for this legislation that better aligns incentives in health care and helps people have a better life.”

The other sponsors of the bill are Democratic Reps Anna Eshoo of California and John Auchincloss of Massachusetts and Republican Reps. Mariannette Miller-Meeks of Iowa and Dr. John Joyce of Pennsylvania.

Read More

Hospital group honors health-care leaders at annual convention

By Melissa Patrick

Kentucky Health News

Larry Gray of Baptist Health Louisville and Carl Herde of the Kentucky Hospital Association were awarded the KHA's Distinguished Service Award at the association's 94th annual convention in Lexington May 17. 

The award, considered the association's highest honor, is given to individuals who have given untiring and exceptional service to their hospital, community, the state and KHA, according to a news release. 

Larry Gray accepts Distinguished Service Award
from KHA President Nancy Galvagni (Photo provided)

Gray is president of Baptist Health Louisville and has served in the Baptist Health system for more than 35 years. A hospital news release in February said he plans to retire this year.

The KHA release notes that Gray led the hospital through the Covid-19 pandemic and that Louisville Business First named him a Healthcare Hero for his extensive Covid-19 vaccine outreach and his leadership abilities. 

Prior to his role at the Louisville hospital, Gray served as the director of pastoral care in 1988, the vice president for System Support and Administrative Services at Baptist Health Lexington and president of Baptist Health Corbin. 

Carle Herde accepts Distinguished Service
Award from Nancy Galvagni (Photo provided)

Herde, vice-president of financial policy at KHA, also received the Distinguished Service Award. 

Herde started at Touche Ross & Co., the predecessor firm of Deloitte & Touche in Louisville. He joined Baptist Health in 1984 as a controller and eventually served as the chief financial officer and vice president during his 23 years with the system. He also served on multiple boards throughout his career. After retiring, Herde joined the KHA in 2016.  

During his time at the association, Herde led the charge to secure funding for Kentucky’s hospitals with the Hospital Rate Improvement Program. A KHA release said the program has helped keeping hospitals open during a financially difficult time.

KHA gave the late Thomas "Tommy" Elliott of LOuisville its Health Care Governance Leadership award, for individuals who make a positive and sustainable impact on the quality of care in their communities through their work as governing-board members. Elliott was killed in the mass shooting at Old National Bank in Louisville on April 10.

The KHA release says Elliott was committed to providing health equity for the people of Kentucky while serving on the boards of Baptist Health Louisville, the Baptist Health System and the Greater Louisville Foundation from 2008 to 2022. He also served on several charitable organizations’ boards.

Read More

Surgeon general issues public-health advisory that warns about the dangers of social-media use to children's mental health

CNN image

By Melissa Patrick

Kentucky Health News

Concerns about the effects of social media on youth mental health prompted America's top public-health official to issue a rare public-health advisory that calls for a multifaceted approach to find ways to minimize the harm. 

"The bottom line is we do not have enough evidence to conclude that social media is sufficiently safe for our kids. In fact, there is increasing evidence that social media use during adolescence — a critical stage of brain development — is associated with harm to mental health and well-being. In light of the ongoing youth mental health crisis, it is no longer possible to ignore social media’s potential contribution to the pain that millions of children and families are experiencing," Surgeon General Vivek H. Murthy writes in an op-ed about the advisory for The Washington Post. 

Social media use among teens is pervasive, with 95 percent of U.S. teenagers using the platforms and more than one-third saying they use social media "almost constantly," the report says. And this isn'y just a teenage phenomenon; nearly 40% of children 8 to 12 years old use social media. 

The advisory walks through the benefits and harms of social media for children. 

It says social media may benefit children by allowing them to connect easily with friends and family or those who share abilities interests and identities, and a space to express themselves and find support when they need it. 

But it also says social media use can result in reduced sleep among youth, and expose them to extreme, inappropriate content and online bullying. One study has found that youth who spend more than three hours a day on social media face double the risk of experiencing poor mental health, including symptoms of depression and anxiety. This is of great concern because on average, one survey found that eighth and 10th graders spend about three and a half hours a day on social media, says the report.

"More research is needed to fully understand the impact of social media," says the 19-page advisory, titled "Social Media and Youth Mental Health." Current evidence "indicates that while social media may have benefits for some children and adolescents, there are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents."

The advisory lays out steps that policymakers, technology companies, researchers, families and young people can take to make social media safer for youth. Following are some of the suggestions for various interests. 

Policymakers are encouraged to strengthen safety protections for children interacting with social media platforms and to develop age-appropriate health and safety standards. They are also called on to require higher safety standards of data privacy for children. 

Technology companies are urged to create safety standards for social media that protect youth from exposure to harmful content and online harassment. They are encouraged to limit features that manipulate youth into excessive and unhealthy use of social media. The report also calls on them to be transparent and to share their assessment findings and data with independent researchers. 

Families are asked to model responsible social-media behavior and to create a family media plan. It also asks families to create tech-free zones that encourage other activities. 

Youth are reminded that they can reach out for help if they are negatively affected by social media and to be cautious about what they share.

The American Psychological Association recently issued a health advisory on social-media use in adolescence that included 10 research-based recommendations.

Read More

Rabbi at dedication of pandemic memorial says 'Denial can never cure disease, and ... distortions can never change facts'

Rabbi David Wirtschafter

Wednesday's dedication of the state's pandemic memorial closed with a prayer from Rabbi David Wirtschafter of Lexington's Temple Adath Israel, who first read his adaptation of Archibald MacLeish's poem "The Young Dead Soliders Do Not Speak," written about World War I. MacLeish had the soldiers say, "We leave you our deaths. Give them their meaning. Wirtschafter said sculptor Amanda Matthews' work "challenges us to answer the question: 'What will these Covid deaths mean?' Whether they are for a new hope, or for nothing, is tragically not up to those who died, but it is up to us." Then he read his adaptation of MacLeish's work:

"The casualties of Covid do not speak.
Nevertheless, they are heard in the still houses. Who has not heard them?
They have a silence the speaks for them at night, and when the clock counts.
They say, 'We were your fellow Kentuckians, your neighbors, your countrymen, your co-workers, your family, your friends. We have died. Remember us.
They say, 'We weren't allowed to finish our lives. Covid finished them.
They say, 'We lost our lives, but who will bear witness to those who were lost?'
They say, 'Our deaths are not ours, they are yours. They will mean what you make them.'
They say, 'Whether our lives and our deaths will lead to real change and a new hope, or for nothing, we cannot say. It is you who must say this.'
They say, 'We leave you our deaths, Give them their meaning. We were your fellow Kentuckians, your neighbors, your countrymen, your friends, your co-workers, your family. 'We have died,' they say. 'Remember us.' "

In his closing prayer, Wirtschafter asked God to "guide our deeply divided state in the sacred cause of reclaiming our sense of common humanity. Teach us to overcome the anger, fear, hatred and recklessness that all too often made the hospitalizations and deaths higher than they had to be. Remind us that denial can never cure disease, and that distortions can never change facts."

Read More

Pandemic memorial at Capitol to be dedicated Wednesday

The memorial is pictured on Monday, after the final sod had been laid and watered. The Capitol steps are in the background on the right. (Kentucky Health News photo by Al Cross; click on it to enlarge)

The state's permanent memorial to Kentucky vicims of the Covid-19 pandemic will be dedicated at 2 p.m. Wednesday on the grounds of the state Capitol.

The memorial – titled “United We Stand. Divided We Fall,” after the state motto – was designed and sculpted by Kentucky native Amanda Matthews, artist and chief executive officer of Lexington's Prometheus Foundry.

“This phenomenal new memorial honors the 18,653 Kentuckians lost during this once-a-century pandemic,” Gov. Andy Beshear said in a press release. “It will stand in a place of prominence in the Capitol Monument Park for generations to come so that they might learn about the great challenges we faced and how Kentuckians came together during this crisis.”

Matthews said her work "captures the ideals and visual symbols of our state motto and seal in three-dimensional form. Most important to the concept are the diverse people of Kentucky and their fear and grief during the time of Covid, yet their strength and hope for better days."

The memorial's center is encircled by green lights, symbolizing empathy and compassion for the Kentuckians lost throughout the pandemic; white lights shine through the night until sunrise.

The memorial has several semi-abstract human figures
of varying sizes. (Commonwealth of Kentucky photo)

The human figures in the memorial each have a small bell in a cutout where the heart would be. The dedication will begin with the chiming of bells by Kandie Adkinson, a longtime employee in the secretary of state’s office, recalling Beshear's request early in the pandemic that Kentuckians ring bells at 10 a.m. each day "so that those who were feeling alone would know we were with them," the release says. For months, each weekday at 10 a.m. in the Capitol rotunda, Adkinson rang her father’s bell 120 times to honor those lost in each county. 

The memorial's final design was selected by an advisory panel of health-care workers, Covid-19 survivors, and family members and loved ones of victims.

“The Covid-19 Memorial is a beautiful way to honor all those we loved dearly,” panel member Jacqueline Woodward said. “It will ensure future generations remember the dedicated Kentuckians we lost during this tragic pandemic that impacted so many lives. May the memorial be another means to bring comfort and peace to those who lost a loved one. I feel truly blessed to be a part of this project.”

Woodward will speak at the dedication, along with Dr. Jason Smith, chief medical officer at UofL Health, who will talk about the impact of Covid-19 in the state and the memorial’s creation.

“This memorial honors the thousands of Kentuckians we lost throughout the pandemic,” Smith said in the release. “It also represents the strength of our commonwealth and our citizens to join together, support each other and persevere. The pandemic revealed many heroes. In particular, it shines a light on the incredible work of our health-care workers, who put themselves on the front line to protect and heal our community. This memorial is a symbol of hope and stands as a reminder that our work towards keeping our state safe is not done.”

Beshear will speak about the two main legacies of the pandemic in Kentucky, the release said, quoting him in advance: “One is loss. In a little more than three years, this evil virus caused the deaths of more than 1.1 million Americans, including more than 18,600 Kentuckians. But this memorial also reflects a second legacy of Covid, and that’s the unity and coming together that saved tens of thousands of lives and ultimately allowed us to end the pandemic. We, as Kentuckians, answered the call in times of tragedy and lived out our faith and values: living for one another, loving our neighbors as ourselves and being the Good Samaritans helping those in need.”

The release said "the primary donors" to the memorial fund were most of the state's leading hospital systems: Norton Healthcare, Baptist Health, St. Elizabeth Healthcare, King’s Daughters Health System, UofL Health, University of Kentucky and Pikeville Medical Center. It concludes, "Numerous private donations rounded out the funding and no tax dollars were used."

Read More

Ky. kids still aren't as immunized as they were before pandemic; pertussis threat rises; cancer-preventing vaccine rates still low

Slide from state epidemiologist's presentation at Immunize Kentucky's Immunization Summit shows Kentucky's overall rate of immunization against childhood diseases is lower than all bordering states.

By Melissa Patrick
Kentucky Health News

The Immunize Kentucky Coalition's Immunization Summit, held May 10 in Lexington, opened with a warning that Kentucky's children fell behind on their immunizations during the pandemic and still haven't caught up. 

State Epidemiologist Kathleen Winter
(Photos by Melissa Patrick)

Citing 2021-22 school immunization data, State Epidemiologist Kathleen Winter said Kentucky is behind all its bordering states in routine childhood vaccination rates and is well below the national average. 

The greatest concern right now is kindergartners, she said, because their measles-mumps-rubella vaccination rate has dropped in the last two school years. (MMR rates among seventh and 11th-graders remained about the same, but that's no surprise, since two doses of the vaccine are recommended before a child turns 6.) 

"We really need to focus on this particular age group that maybe has missed vaccines . . . because of the pandemic," Winter said. 

Winter said Kentucky's kindergarten two-dose MMR rate of 86.5% ranks in the bottom five states nationally. The national rate is 93.5%. The National Immunization Survey by the Centers for Disease Control and Prevention, which runs behind school data, shows that Kentucky's decline in immunization is similar to a national decline.

Regular well-child visits help parents and health-care providers keep children current on immunizations. Winter said one study found that 41% of Kentucky parents of children 12 and younger reported their child had missed a well-child visit during the pandemic. This rate was even higher among Hispanics (48%). 

"We're getting back on track with routine visits now, but we still have not caught up for where we had this big decline during the pandemic months," Winter said. 

Winter said there are "dramatic differences" in immunization rates between those who have private health insurance, publicly paid insurance, and those who are uninsured.

The National Immunization Survey for the recommended seven-vaccine series for children under 2 shows that 78% of children with private insurance had received all of them, but only 64.3% of those on Medicaid had received all of them, and only 45.2% of uninsured children had. 

"There's some real work to be done with these vulnerable populations, not just here in Kentucky, but nationwide," Winter said.

Pertussis concerns

Since 2018, fewer Kentucky children have received the DTap or Tdap vaccines, which protect against tetanus, diphtheria and pertussis (whooping cough). Rates among kindergarteners and 11th graders have been "pretty stable," but there has been a steady decline among seventh graders since 2018, with rates between 80% and 85%, Winter said.

The United States has a spike in pertussis about every five years, Winter said, noting there was a "major epidemic" in 2012 and "We are well positioned to have another one." 

She added, "We are concerned about this in particular because we have had outbreaks of pertussis reported this year; several counties have already noticed outbreaks. . . . So this is the time we really need to focus on getting kids vaccinated for pertussis."

Cancer-prevention vaccine rates are low

 

According to the CDC, human papillomavirus (HPV) is a very common virus that can cause cancer -- and the HPV vaccine can prevent more than 90% of cancers caused by it, including cervical cancer. But only 57% of Kentucky teens have taken it. 

"Kentucky is another state that really needs to be worried about HPV," Winter said. "We have some of the highest rates of cervical cancer here in Kentucky."

Even more concerning, said Winter, is that fewer than half Kentucky females are up-to-date on HPV vaccines and two-thirds of them haven't gotten a single dose of the vaccine, which is given in a three-dose series. Kentucky ranks 37th among the states for this measure. 

HPV can also cause cancers of the vagina, vulva, penis, anus, rectum, throat and the back of the tongue. The CDC reports that each year, about 47,199 new cases of cancer are found in parts of the body where HPV is often found. Of those, about 37,300 of them are caused by HPV.

Covid-19 vaccines still available and free

Winter noted that the end of the national public-health emergency for Covid-19 means that getting Kentuckians vaccinated against the disease has become normalized.

And because the now single-dose bivalent vaccine is recommended for everyone 6 months and older, Winter said it needs to be considered a routine childhood vaccination. 

"We have to routinize it in every way possible, routinize it for our conversations with parents and for routine childhood visits, getting it incorporated fully into the childhood schedule," she said. 

That's not not being done yet, the data shows.

"When we look specifically at children, 94% of those under the age of 5 have never been vaccinated against Covid and 74% of children in the 5- to 11-year age group have never been vaccinated," Winter said. "So we are still not making this routine for children. It's not being offered and provided in the settings that it  needs to be offered and provided." 

Winter also stressed that Covid-19 vaccines are still readily available and free, even though the commercialization of the vaccine is expected to come in late summer or fall. 

"This is why we need to work now to get this routinized as much as we can into clinics and settings where people are routinely getting vaccinated," she said. 

She added that the latest guidance is for people 65 and older to get an additional booster and that guidance for everyone else is likely coming. 

Vaccinations work

Winter said the measles exposure that thousands of people had in February at the spontaneous revival at Asbury University in Wilmore turned out to be a public-health success story.

An unvaccinated Jessamine County resident who attended the revival in Februrary had Kentucky's third reported case of measles in three months, but Winter said there has not been one secondary measles case from that exposure. She noted that the person with measles wore a surgical-type mask at "a lot" of the events. 

"The reality is, most people are immune to measles," Winter said. "Most people are fully vaccinated or had measles as a child. So we do not have this crisis of a population-level issue. What we have are targeted individuals and ages where we need to get back on track. So, this is where we need to focus."

Even with this public-health victory, Winter cautioned that without a high level of population immunity, the potential for a super-spreading event would remain. 

Organizers of the summit hope it will be an annual event. Amber Malott, chair of the Immunize Kentucky Coalition, which is part of the Kentucky Rural Health Association, said its mission is to "create equitable access to vaccinations across the commonwealth." As part of that mission, she said they will hold free pediatric immunization symposiums in Morehead June 20 and Owensboro June 29.

Read More

Meet some of the Kentuckians answering the new 988 crisis line: they're first responders driven by empathy

Sunshine Randolph, an engagement specialist for New Vista in Lexington, answers calls to the 988 suicide prevention line. (Kentucky Lantern photo by Carter Skaggs)

This story discusses suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.

By Sarah Ladd
Kentucky Lantern

When Sunshine Randolph was an undergraduate student, her stepfather died by suicide.

“It really does kind of rock your world,” she said of the experience, which drew her to work in suicide prevention. “I know what it can do to a family.”

Randolph now answers 988, the suicide prevention lifeline in Kentucky, for the Lexington-based New Vista. She draws on her personal experience to help people get through some of their most challenging moments.

“We kind of have these backgrounds in psychology,” said Randolph, whose bachelor's degree is in psychology. “We maybe are more familiar with (mental health) – but experiencing it is something a little different.”

Still, she tries to empathize while not projecting her own experiences on others. “No one death by suicide or or suicidal ideation is the same,” she said.

Calls and texts to the crisis hotline rose after 988 launched in July 2022, replacing a 10-digit number. Experts said the simplification of the lifeline would save more lives.

Gov. Andy Beshear said in January that overall, the state saw a 26% increase in calls to 988 in the second half of 2022, with fewer calls dropped as well.

There were 708 more communications in August that year — the month after the launch — than in June, state data shows.

There were 646 crisis text messages from Kentuckians from January and June of 2022, the Lantern previously reported. Then, after 988 launched, that jumped to 2,286 crisis messages — an increase of 254%.

In February, 727 texts and 634 calls came in, according to a Cabinet for Health and Family Services report. In the past year, there was a 30% increase in Kentucky-based calls overall.

People who answer the line said that since the launch of 988, calls have expanded beyond suicidality. Sometimes, people are calling 988 just to talk and de-stress at the end of the day or middle of the night.

Roughly 138 Kentuckians answer the crisis line at Kentucky’s 13 participating call centers.

In March, there were 112 full-time and 26 part-time employees answering 988, according to estimates from Kentucky’s chapter of Mental Health of America.

Those Kentuckians spend their shifts saving lives behind the scenes. They also, sometimes, just listen.

Marcie Timmerman, the executive director for MHAKY, said the folks who answer 988, which was first proposed in 2019, are “first responders.”

“They’re really the first people who can respond to a mental health crisis,” Timmerman said. “They’re really crucial to the system.”

Driven by empathy

Randolph isn’t alone in pulling from personal experiences to help others who call or text 988.

Her colleague, Abby King, grew up hearing her mother advocate for mental health. That’s because before she was born, her grandmother died by suicide.

“Suicide” and “mental health” were “vocabulary words that I knew from a very, very young age,” the Bowling Green woman said. “So I think that that may have just made me more compassionate and understanding to the world at a really young age.”

King never got to meet her grandmother, but said she’s always had compassion for her, which she tries to extend to people who call the line.

That’s also made her anxious on some calls. “I know that suicide is real and does happen,” she said. “No one’s immune to it.”

It’s also difficult, once a call is over, to let go. Many times, King and Randolph said, they don’t know what happened with a caller once they hang up.

“I definitely think to myself, ‘how did this turn out?’” Randolph said. “You have to have hope and faith in the system … but yeah, I think about certain or really impactful, emotional calls all the time.”

The most important thing when taking a 988 call or text is to make sure the person reaching out is safe and feels heard, answerers say.

“The number-one priority is making sure they’re safe in that moment,” said Randolph.

Responders will balance listening to a caller vent while doing a risk assessment to see if the caller has hurt themself or plans to, if they have a suicide plan, and more.

“We have processes and protocols, like the risk assessment and then safety planning,” King explained. “But really, it’s just that natural human interaction that makes the call successful.”

Once the caller is safe and hangs up, responders may need to decompress and process what they’ve just heard.

King keeps her workspace calm, she said, for that reason. She may have essential oils or incense out or keep a virtual fireplace crackling on her TV.

Sometimes, decompressing is as simple as walking outside and feeling cool air on her cheeks.

“It can be as simple as taking a step outside, letting my dogs out,” Randolph added. “Touch the grass so to speak. Just making sure I’m reminding myself that I’m doing good work is really important. And a good face mask never hurt anyone after shift.”

 

Holliss Williamson at River Valley Behavioral Health
in Owensboro (Photo by Arden Barnes via Kentucky Lantern)

Holliss Williamson, a triage specialist in River Valley Behavioral Health in Owensboro, said she turns to her coworkers for support after especially difficult calls.

Her team of eight fills in for each other when one needs a mental health day or to just walk away from the desk for a while. They each know the toll crisis response can take on a person.

“We take secondary traumatic stress, vicarious trauma and burnout very seriously,” said her coworker Gerrimy Keiffer, a social worker at River Valley. “Working a crisis line is incredibly stressful because, in some cases, you don’t know if that person actually got help or if they got better when that phone call ends.”

River Valley crisis workers also have access to an app called Heroes Health, which lets them track their mental health and access resources.

King said she compartmentalizes her feelings while on calls.

“While I’m on the call, my main priority is to make sure that they’re safe. And that’s the perspective I try to keep to keep me calm throughout the call, even if I’m … even relating to some of the pain that they’re talking about,” she said. “It’s just reminding myself that I’m currently in a safe environment, and they’re not. So I have to make sure to provide that safety.”

A self-care action plan can also help when dealing with a lot of trauma. That can include asking:

• What brings me joy?
• What helps me reset?
• Am I getting tense?
• Am I having trouble breathing?

The effect of Covid-19 and anti-LGBTQ laws

The Covid-19 pandemic, Keiffer said, has “caused a lot of stress and unsurety” among the community, resulting in more calls to crisis lines.

“Combine that with loss of jobs for many, unstable employment, unstable economic environment that we’re entering right now, as well as a lot of the political and cultural strife we’re experiencing,” he said. “Within the last few months, we’ve also seen an uptick in individuals experiencing issues related to gender identity and LGBT concerns.”

He pointed to legislation targeting transgender Kentuckians as being a stressor for many.

River Valley has also seen an uptick in calls from youth, particularly those re-entering a public school setting after learning at home for so long because of the pandemic.

The Centers for Disease Control and Prevention reported in February that more young girls are feeling depressed.

Almost 60% of teenage girls “felt persistently sad or hopeless in 2021,” the CDC said. About 30% of teenage boys felt that way. Teens in the LGBTQ+ community suffered “ongoing and extreme distress.”

The CDC also reported that about 1 in 3 teen girls seriously considered attempting suicide in 2021.

“Add on the stressors that normally would be experienced as a youth like bullying, the anxiety of tests and just your own interpersonal issues, and then we throw on top of that the emotional triggers that you deal with that are exclusive to living during a pandemic, and that kind of unsurety,” Keiffer said. “It’s very difficult for kids, especially because that ability to emotionally regulate hasn’t fully formed. It is absolutely a concern.”

 
Will the police get involved if I call 988?

Several folks who answer 988 in Kentucky said police would be involved only as a last resort. For example, police may be called if a person admits to having a weapon and wanting to harm others.

Keeping everyone safe can be a balancing act.

“We don’t want to criminalize mental health,” Keiffer said. “If (people are) experiencing a mental health challenge, I want them to feel secure and safe to reach out for help.”

“Involving law enforcement immediately makes that person feel more stressed out,” Keiffer explained. “Having a police officer knock at your door when you’re having, for many, the worst moment in their life … we want to avoid that if we can.”

No wrong door

People who answer 988 aren’t just there to save lives. They provide an anonymous listening ear for people who just need to vent or maybe don’t have a support system.

“You can’t get to the saving,” Randolph explained, “without first listening to the client.”

They’re also focused on getting everyday resources to people in need. They may help a caller find food banks or places that can help with rent or housing. Lacking transportation or internet access, too, can lead to suicidal ideation. For teenagers, it’s often an issue of parents not supporting them or listening to them.

At River Valley in Owensboro, staff can direct callers to gambler’s addiction help, a sexual assault support line and more.

Basically, there is “no wrong door,” Keiffer said.

“I think of 988 as suicide prevention, but also a helping line,” Randolph said. “If you call me I might be able to connect you with several different things all at once or give you resources and advice on where to get those things.”

‘Please don’t prank-call 988’

Several 988 responders said they get prank calls, often from kids.

“I kind of just laugh a little bit,” King said, “because it comes from a place of: ‘I’m happy that these resources are available now.’”

Still, experts say mental health should be taken seriously.

“Mental health is not something we joke about,” said Timmerman, of Kentucky’s chapter of Mental Health of America.

So: “Please don’t prank-call 988.”

In the 2024 legislative session — a budget year — Kentucky’s chapter of Mental Health of America and the American Foundation for Suicide Prevention will be asking the General Assembly to allocate general fund dollars to 988.

“We need to fund” 988, Timmerman said, “as equally as we do 911.”

Just start with hello

Beyond funding, crisis workers say they need more awareness of the 988 number and education surrounding stigma.

“We’ve taken callers who were leery about even calling in,” Williamson said. “even some callers will hang up because … there’s a stigma … or they just don’t feel comfortable and never had to address their issues in that way.”

Some also recommended embedding social workers with police so when they do have to respond, trained mental health professionals are on hand.

Keiffer said if you don’t know where to start when calling 988, just start with hello. And: “If you don’t feel comfortable calling right away, that’s okay,” he said. “But do try again.”

Read More

Boyle County named Kentucky's first Recovery Ready Community

Boyle County Judge-Executive Trille Bottom accepts the Recovery
Ready Community certificate from Gov. Andy Beshear. (Screenshot)

Boyle County is Kentucky's first Recovery Ready Community, a designation that reflects commitment to providing residents with access to addiction treatment and recovery support and removing barriers to the workforce. Applications for the designation opened in January.

The certification is designed to encourage communities to provide transportation to and from employment services and job interviews, allowing people to make positive changes while filling the state's need for workers at a time of record-low unemployment, said a news release from Gov. Andy Beshear.

“Boyle County has set a strong precedent that can serve as a model for the rest of Kentucky’s communities,” Beshear said in the release. “I continue to encourage each of the commonwealth’s counties and communities to apply for certification. If we work together to build a safer, healthier commonwealth, we can rise above drug and alcohol addiction in our state once and for all.”

Beshear said at his weekly press briefing that more communities are soon to follow. He was joined at the announcement by several leaders from Danville and Boyle County. Their efforts include free training for overdose response and Narcan distribution, hiring a social worker as an opioid-outreach coordinator to make EMS runs involving suspected overdoses to connect the individuals with treatment, counseling and other addiction support services.

Boyle County (Wikipedia map)

“When we came face to face with the effects of the opioid crisis on our families, institutions and workforce, we got to work to be informed, responsive and proactive,” Judge-Executive Trille L. Bottom said in the release. “We started a harm-reduction syringe-exchange program. We took a hard look at our jail becoming a place of rehabilitation. We encouraged new treatment and transitional living providers to come to Boyle County, and we trained a lot of citizens in saving lives from overdoses.”

Pam Darnall, chair of the state Recovery Ready Communities Advisory Council, which apprpoved the designation, said “We are inspired by Boyle County’s commitment to continue strengthening its local recovery-oriented system of care through persistent cross-agency collaboration and a willingness to try innovative programs and interventions aimed at increasing positive public health and safety outcomes.”

To learn more about the program and apply for certification as a Recovery Ready Community, click here.

Read More

Hazard-area facilities, which offer a wide range of services, show that rural health clinics can be more than mere safety nets

One of the clinic's locations (Photo by Taylor Sisk)

By Taylor Sisk, The Daily Yonder

At just five weeks old, Waylon Williams is a trailblazer. He’s the first baby born in Primary Care Centers of Eastern Kentucky’s new women's residential center. The facility, called Beacons of Hope, offers temporary housing for women confronting substance-use disorder.

That recovery housing for women is available in a rural, financially challenged community is noteworthy. That it’s available for women with babies is remarkable. Equally so is the fact that PCCEK is a rural health clinic, and recovery housing is not among the services rural health clinics typically offer. A men’s residential center is soon to open.

Beacons of Hope is an extension of PCCEK’s Pregnancy & Beyond, an addiction-treatment program that offers obstetric services, medication for substance-use disorder, prenatal education, pediatrics, and counseling – services that in so many rural communities nationwide are in critically short supply or entirely absent. 

Hazard, where the largest of PCCEK’s four clinics is located, is in Perry County, which ranks 117th among Kentucky’s 120 counties in health outcomes. Life expectancy at birth is 67, as compared with 78.5 in the U.S. 

Addressing such challenges requires the full force of a health-care ecosystem that includes hospitals, clinics, private practices, public-health agencies, and a range of support services. Rural health clinics play a critical role in this ecosystem.

RHCs are safety-net providers whose original federal mandate was maionly to increase access to care for those on Medicaid or Medicare. They provided primary care and perhaps a few other services. But the Rural Health Clinic program has evolved over the years, and some clinics, like Primary Care Centers of Eastern Kentucky, have expanded their roles quite considerably.

Among the health care services, PCCEK offers are dentistry, a diabetes center, a women’s health center, extensive radiology and imaging, a range of behavioral-health services, a pharmacy, and a hospice care center. It offers a sliding scale for fees.

PCCEK has nurses in each school in the county system. It has an event space where it hosts maternity fairs and Easter, Halloween, and Christmas gatherings, and which in the wake of the region’s catastrophic flooding last July served as a distribution center for food and supplies.

Barry Martin, CEO of Primary Care Centers
of Eastern Kentucky (Photos by Taylor Sisk)

And with such a wide array of services, CEO Barry Martin contends, PCCEK is addressing arguably the greatest challenge to rural health care: a shortage of health care professionals. 

Gale said the projection is that there’ll be a shortage of 50,000 or more primary care providers nationwide by 2032, and that the majority of those available aren’t likely to want to practice in rural areas, said John Gale of the Maine Rural Health Research Center.

It’s taken some time, Martin said, to impress upon newly minted health care professionals that Perry County is a promising place to build a career, but his message appears to be resonating. He’s especially focused on enticing young people from the region to head back home and hang a shingle at PCCEK.

“Come back here,” Martin urges them. “Look at what we’ve built. It’s not a double-wide on the side of the road.”

Meeting needs, steady growth

The number of RHCs has grown significantly over the past decade or so. In 2010, there were fewer than 4,000; today, there are 5,270. They’re in every state except Alaska.

The Rural Health Clinic program was launched in 1977 as a Carter administration initiative. The impetus was to make it more viable for rural providers to stay in business with a relatively heavy load of Medicaid and Medicare recipients and few patients with private insurance by offering higher reimbursement for those federal programs.

RHCs must be in a health professional shortage area. They must take a team approach to care: physicians working with a staff of nurse practitioners, physician assistants, certified nurse midwives, and others.

RHCs differ from federally qualified health clinics in that FQHCs can’t be for-profit providers and must be governed by a board of directors of which the majority of members are patients of the clinic and demographically representative of the community. FQHCs must offer primary care and preventive and enabling service,s such as case management and transportation. In meeting these stipulations, they receive higher reimbursement from the federal government.

PCCEK is a for-profit entity. It launched in October of 2003 in a 6,700-square-foot facility with 15 employees offering family medicine, pediatrics, simple X-rays, ultrasounds, and a lab. In 2008, it expanded into a 30,000-square-foot building, and in 2015 into its present Hazard location, a 60,000-square-foot complex, formerly a discount department store. It also has clinics in nearby Hindman, Hyden, and Vicco.

More than 39,000 unique patients came through PCCEK’s doors last year, Martin said, for a total of 180,000 encounters. The clinic employs more than 400 people.

‘Ease a little bit of the burden’

“I like to say that we provide services from the head to the toe and the womb to the tomb,” Martin said. “And that is true.”

Care for diabetics is an urgent need in this region. In 2021, Kentucky had the sixth highest diabetes death rate in the country. The state Department for Public Health reports that between 2000 and 2018, the number of diabetes diagnoses had doubled. Perry County has among the highest incidence rates in the state. 

PCCEK operates the Mary E. Martin Diabetes Center for Excellence (named in honor of Martin’s mother). It’s the only diabetes facility affiliated with the University of Kentucky’s Barnstable Brown Diabetes Center. It offers comprehensive case management. 

Martha Bailey, diabetes educator

“We try to ease a little bit of the burden,” said Martha Bailey, a registered nurse and licensed diabetes educator from adjoining Letcher County. “We’re doing preventive maintenance. We’re talking to them about their diabetes.” 

Before PCCEK opened its diabetes center, people routinely drove 250 miles roundtrip to Lexington to see a doctor for it. Many simply went unexamined and undiagnosed.

“They may come in here and have an ulcer they didn’t even know they had,” Bailey said. “We’ve had patients come in that had tacks in their feet. They didn't know it until we did the exam.” 

PCCEK is the only place in Eastern Kentucky offering pedicures specifically for diabetics. “When they do the foot care here,” she said, “that’s their time to be pampered.”

The center also provides $10 vouchers for the local farmers’ market. “With the people on fixed incomes, that helps them eat a little bit healthier,” Martin said. 

Immersion in a community

John Jones, PCCEK’s medical director, oversees the diabetes center and Beacons of Hope. He’s a Hazard native, and while he believes that being homegrown certainly helps in most effectively reaching his patients – “We just know each other; the trust is there” – he hastens to add that trust can likewise be built in those who come from elsewhere, assuming you’re willing to make yourself known in the community.

“I think it’s a little different than the stereotype,” Jones said. “They’ll accept you with open arms. It’s just about being out there.”

Trust was of the essence after the July flooding. Jones tells of a father, mother, and daughter who were swept from their home, strapped themselves to a power pole, and hung on. The family now lives with relatives. 

When it rains, Jones said, the child is terrified; she has nightmares and flashbacks. When he talks to the dad about exploring counseling, “I think he doesn’t hear that from me as a doctor; he hears it from me as a friend.” 

Dealing with such issues – or dealing, on a day-to-day basis, with a patient who’s homeless with no way to refrigerate their insulin, or one with no transportation to make an appointment – such things aren’t taught in medical school. You learn through immersion in a community.

Martin trusts he’s creating an environment that will draw young professionals into his community.

He said the benefits of a comprehensive rural health clinic to a region and state are clear. “The governor is looking for people like us to help develop a second-chance workforce,” Martin said, “and that’s what we’ll be doing with Beacons of Hope.” 

The big-picture objective for all stakeholders is a continuum of care: health, housing, employment, well-being. 

“I got lucky,” Brittany Williams said of finding a temporary home at Beacons of Hope for herself and her son Waylon. “They’ve taught me self-control,” she said, “and structure. They’ve helped me structure my life.” She’s hopeful about the futur    e.

This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.

Read More

After three years of Medicaid enrollments piling up to a record number, those on the program must go through a renewal process

By Melissa Patrick
Kentucky Health News

Kentuckians on Medicaid need to pay attention to any correspondence from the state's Medicaid program. The Department for Medicaid Services has resumed its annual renewal process for Medicaid members because the pandemic rules that allowed continuous enrollment have ended. 

The process that allows Medicaid agencies to restart the annual renewals -- and kick off those who no longer qualify -- has been dubbed "Medicaid unwinding," a process that will take 12 months to complete, since it will use each Medicaid member's renewal month.

"We are currently outreaching to individuals with a May 31 renewal date. This means those individuals have until that date to renew with Medicaid," Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, said in an email.

"The most important thing Kentuckians on Medicaid need to be doing right now relating to the unwinding includes making sure we have up-to-date contact information," Dunlap said. "That way, Medicaid can contact members about renewing, if needed. We are telling all our members to visit their account at kynect.ky.gov to review their information and make sure everything is correct. If they do not have an account, we recommend they create one." 

At a monthly stakeholder meeting in April, Deputy Medicaid Commissioner Veronica Judy-Cecil encouraged Kentuckians to use their Kynect health-benefits account for renewal. "It is going to be the fastest and easiest way for redetermination to be processed," she said.

Cabinet for Health and Family Services table; click on it to enlarge

If not signed up for Kynect, Medicaid members can complete and return forms via mail or fax, Judy-Cecil said. They can also call Kynect (1-855-459-6328) or the Department for Community-Based Services, or visit a DCBS office, a licensed insurance agent, or a Kynector, who helps Kentuckians enroll in coverage through Kynect.

As the Medicaid rolls have piled up with automatic renewals and additional enrollments, a record number of Kentuckians were enrolled in the program on April 1: 1,725,467. But on that day, the state could resume removing people from the program, and enrollment for May declined to 1,712,381. (For county-by-county enrollment numbers, click here.)

In April, the Medicaid department "estimated approximately 240,000 may lose eligibility" in the unwinding, health-cabinet spokesman Brice Mitchell said in an email. "However, until someone goes through redetermination, it is impossible to accurately forecast who will lose eligibility."

Of that 240,000, an estimated 75,000 have incomes over 138% of the federal poverty level, the Medicaid limit, and are likely to qualify for federally subsidized health insurance through Kynect.

Judy-Cecil said the state will reach out to Medicaid members about 90 days before their Medicaid renewal end date. Members will also get a notice about 60 days before their renewal end date and if there is no response by the 15th of their renewal month, they will get another notice. Members will get a renewal packet or a request for more information.

As of May 9, about 69,000 outreach calls had been made and over 17,791 calls had been received related to renewals, accoridng to the Public Health Emergency Unwinding website.

Judy-Cecil said Medicaid has prioritized contacting the Medicare-eligible population, since many Kentuckians stayed on Medicaid when they turned 65 instead of switching to Medicare. That's because the national public-health emergency rules required the state to continue coverage to get extra federal funds.

The priority from July until the end of the unwinding will be to reach out to those on Medicaid who make too much money to stay on the program. Judy-Cecil said it's important to make sure this group is aware of the ability to get federally subsidized health insurance to maintain their coverage. 

Cecil also wants providers to help out by reminding their Medicaid patients of their renewal date, which is available on each patient's KYHealthNet webpage. 

For a detailed explanation of the unwinding, see Medicaid’s response to frequently asked questions about member renewals.

Read More

New UK medical-school graduate plans to pay it forward with a career in rural Kentucky, which needs many more physicians

Dr. Shelley Stiltner (UK photo)

By Melissa Patrick

Kentucky Health News

The University of Kentucky's Rural Physician Leadership Program is designed to increase the number of doctors in rural Kentucky, with graduates like Pike County native Shelley Stiltner.

After earning a UK undergraduate degree in nutrition, Stiltner graduated from the College of Medicine May 13. She is a first-generation college student who attended UK on a full scholarship, which she said she considered not only an investment, but also a thank-you to all of the people who helped her on her way, according to UK Medicine magazine.

Stiltner said she plans to embark on a career in rural medicine, not only to care for patients in need but to help inspire the next generation of rural physicians. 

She added that she worried when she started college and at times, even now, that the stereotype that is often applied to Eastern Kentuckians will overshadow who she is. 

"I spent so much time worrying that being from Eastern Kentucky would be my weakness, but it was my strength all along," she said.

Stiltner said she chose UK for medical school because of its "unwavering dedication to rural medicine" and called her decision to join the Rural Physician Leadership Program "one of the most rewarding decisions of my lifetime." 

" I have gained unmatched experience in rural health care and feel confident in my ability to take what I have learned and truly make a difference in a rural community," she said. "UK saw a grave health care need in rural Kentucky, which I call home, and developed a program to bridge the gap. For that, I am grateful." 

The need for more rural physicians is real and UK's RPLP program appears to be working. 

According to the federal Healthcare Provider Shortage Area tool, every rural county in Kentucky has a shortage of primary health-care providers.

And, according to a January 2020 report on the primary-care workforce shortage compiled by multiple authors at UK, "Kentucky produces and retains only about 55 new PC [primary-care] physicians per year, recruiting 55 to 60 more from out of state. This total of 110-115 new physicians falls short of the 124 PC physicians that must be added annually to avoid worsening our shortage, and far below the 246 PC physicians that Kentucky would need to add each year to reach the U.S. median in the coming decade."

The RPLP program began in 2009 and with this year's class, it has graduated 110 physicians who are well-versed in rural medicine, with their top three residency choices being areas of primary care, Allison Perry of UKnow reported in April. Two of every three RPLP alums are practicing in the state, and 92% of the participants from Kentucky now practice in rural Kentucky.

One is Stiltner. Asked what comes next, she listed several goals such as focusing on women's health, getting involved in providing medication-assisted treatment to women with substance-use disorders during pregnancy, and making an investment in the next generation of rural physicians by serving as a mentor. 

"There is no way I’d be where I am today without the help of mentors along the way," she said. "A promise I made to each of them was that I would pay it forward, and that is a promise I plan to keep. If I can inspire at least one budding rural physician that they have what it takes to make it in medicine, I will consider my career a success."

Stiltner advised future first-generation college students to "proudly be the first" in their family though it will be scary and come with a lot of uncertainty. She encouraged the students to find others who have been first-generation students and to lean on each other in that shared experience. 

"When things get hard, and you feel like giving up," she said, "remind yourself who or what your purpose is in chasing this dream."

Read More

Questions and answers about end of public-health emergency

By Kate Yandell
SciCheck, a service of FactCheck

May 11 marked the end of the federal public health emergency for Covid-19, bringing changes to health care and public benefits. These differences include changes in the cost of Covid-19 tests and treatments and the potential loss of access to free Covid-19 vaccines for people who are uninsured.

The biggest change originally tied to the emergency designation has already gone into effect. The public-health emergency allowed states to keep millions of people on Medicaid regardless of eligibility in exchange for extra federal aid. But this continuous enrollment requirement ended March 31, and states are asking Medicaid members to reconfirm their eligibility.

The emergency began in January 2020 and was renewed every 90 days after that by the secretary of the Department of Health and Human Services. Following pressure to end the emergency with the introduction of the Pandemic is Over Act in January, the Biden administration announced on Jan. 30 that it would let the emergency declaration expire May 11.

The end of the public-health emergency is not the definitive end of pandemic-related policies. Some, including some changes to telehealth coverage and expanded access to free vaccines, are still in effect.

A declaration allowing the Food and Drug Administration to grant and maintain emergency-use authorizations for measures to combat COVID-19 has no stated end date. This means that authorized treatments and vaccines, such as Paxlovid and the bivalent Moderna and Pfizer/BioNTech vaccines, can remain in use.

How will this affect Covid-19 testing?

Costs of Covid-19 testing for individuals will rise, which the Kaiser Family Foundation called the “widest ​​ranging impact” directly resulting from the end of the public health emergency.

People on Medicaid will still be able to get free at-home or health care provider-ordered tests through September 2024, before potentially facing costs. However, the requirement that insurers cover eight at-home Covid-19 tests per month ended for most other people on May 11. Private insurers and Medicare Advantage plans could decide to keep offering this coverage, while traditional Medicare will no longer offer free at-home tests.

Tests ordered by health care providers will also get more expensive for individuals. As of May 11, private insurers and Medicare Advantage plans will be able to charge patients for these tests and related visits, following the normal rules of their health care plan. People on traditional Medicare will still be able to get provider-ordered tests for free, but they may pay for visits associated with the tests.

Depending on funding and supplies, other government programs offering free tests will continue, including a Centers for Disease Control and Prevention program designed for uninsured and other disadvantaged people. AHHS says says that the mail-order at-home test program will continue through the end of May.

How will it impact Covid-19 vaccines and treatments?

The end of the public-health emergency will not immediately change the availability and costs of Covid-19 vaccines or oral antiviral treatments. This is because the emergency constituted just one of multiple layers of laws and policies that make vaccines and some treatments free.

Currently, Covid-19 vaccines and oral antiviral drugs, such as Paxlovid, are sourced from the federal government’s own supply. These doses must be offered at no cost regardless of whether there is a public-health emergency.

However, the government supply of vaccines is only expected to last through the summer or early fall, depending on demand. It is also possible that a new version of the Covid-19 vaccine will come out, and these will be provided commercially rather than through government purchases.

Even after the federal vaccine doses run out, most people with insurance will still get recommended Covid-19 vaccines for free. Some laws requiring free vaccines for Medicaid and Medicare recipients were enacted during the pandemic, while requirements for no-cost coverage of any recommended vaccines from in-network providers were already in place for people with private insurance.

“It’s really the uninsured who will be the most challenged because there’s no permanent guarantee,” said Jennifer Kates, senior vice president and director of global health and HIV policy at the KFF.

To fill this gap, the Biden administration has proposed a Vaccines for Adults program, similar to the Vaccines for Children program, which provides free vaccines to children whose families couldn’t otherwise afford them. Congress has not been willing to enact this program, however.

On April 18, the administration announced the Bridge Access Program, which will temporarily provide vaccines and treatments to the uninsured. This depends in part on the government purchasing vaccines and treatments, but also on pharmaceutical companies being willing to provide them for free. “It’s not permanent and it’s unclear how far it will go,” Kates said.

The federal supply of Paxlovid will be depleted by early fall, Kates said, and some people with private insurance or Medicare will face cost sharing, just like with other drugs. As with Covid-19 tests, people on Medicaid will continue to have access to free Covid-19 drugs through September 2024.

Vaccine mandates and other changes

The Biden administration has announced it will lift most federal vaccine mandates. These mandates are winding down around the same time as the public health emergency but were ended by a separate action.

Mandates for health-care workers at facilities that treat patients on Medicare and Medicaid will end soon, with more details to come. The administration also announced an end to vaccine requirements for Head Start and federal workers, although these mandates had already been blocked by courts.

Some other policies and changes allowed during the public-health emergency will remain. For instance, many telehealth-related changes for people on Medicaid and Medicare have been made permanent or extended through the end of 2024, Kates said. Changes to rules about limits on take-home doses of methadone and access to controlled substances via telehealth will also be extended, with the intention to eventually make some permanent.

Many changes will not be immediately obvious to the public, although they could have an indirect impact. Just to name a couple examples, hospitals will no longer receive extra money from Medicare for treating hospitalized COVID-19 patients and a number of waivers are ending, such as relaxed rules on what types of care different providers can give.

Read More