Interim Joint Committee on Health and Welfare


Minutes of the<MeetNo1> 1st Meeting

of the 2009 Interim


<MeetMDY1> June 11, 2009


The<MeetNo2> 1st meeting of the Interim Joint Committee on Health and Welfare was held on<Day> Thursday,<MeetMDY2> June 11, 2009, at<MeetTime> 2:00 PM, at Northern Kentucky University<Room>. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.


Present were:


Members:<Members> Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Tom Buford, Julian M. Carroll, Perry B. Clark, Denise Harper Angel, Alice Forgy Kerr, and Katie Kratz Stine; Representatives Scott W. Brinkman, John "Bam" Carney, Jim Glenn, Brent Housman, Joni L. Jenkins, Tim Moore, Susan Westrom, and Addia Wuchner.


Guests:  Mary Pat Behler for North Key Community Care; Eric Clark for the Kentucky Association of Health Care Facilities; Peggy Williams for the Legislative Research Commission; Bill Doll for the Kentucky Medicaid Association; Murray Wood for the Cabinet for Health and Family Services; Robin Kinney for the Finance and Administration Cabinet; Diane Brumback for Kentucky Women; Gretchen Brown for Hospice of the Bluegrass; Tammy Weidinger for Brighton Center, Inc.; Berlinda Bazzell for Oakwood; Pat Dressman for the Campbell County Fiscal Court; Chris Gibson for Enterprise; Dave Bezanson for Northern Kentucky University; Stephen Penrose for Boone & Gallatin County Family Court; Amy Yumyk, Nathan Hater, Kelly Fitz, Bethany Jarboe, Fidelis Sangyn and Scott Rawlings, Northern Kentucky University students; Tom Kometz for Kosair Children’s Hospital; Jim Cole for Northern Kentucky CLC; David Bailey and Jennifer Zelensky for St. Elizabeth; Nora Putnam and Don Putnam for Oakwood; Owen Nichols for Northern Kentucky Community Care; Shawn Carroll for NKEY; John Cora for KHC; Evelyn Tackett for Northern Central Area Health Education Center; Douglas Perry for Northern Kentucky University; Franklin Losky for the Kentucky Initiative for Quality Nursing Home Care; and Sarah Nicholson for the Kentucky Hospital Association.


LRC Staff:  DeeAnn Mansfield, CSA; Mike Bossick, Amanda Dunn, Miriam Fordham, Ben Payne, Jonathan Scott, and Cindy Smith.


The first item on the agenda was Legislative Review of Executive Order 2009-363 relating to the Cabinet for Health and Family Services.  There was a motion by Senator Buford, seconded by Senator Clark and adopted by voice vote to approve Executive Order 2009-363.


The next item on the agenda was a Legislative Review of Executive Order 2009-513 relating to the Statewide Trauma Care Program Advisory Committee.  There was a motion by Senator Buford, seconded by Representative Wuchner and adopted by voice vote to approved Executive Order 2009-513.


The next item on the agenda was a Legislative Review of the FFY 2010-2011 Child Care and Development Fund Plan Block Grant.  There was a motion by Senator Buford, seconded by Representative Wuchner and adopted by voice vote to approve the FFY 2010-2011 Child Care and Development Fund Plan Block Grant.


The next item on the agenda was a Legislative Review of the SFY 2010 Social Services Block Grant.  There was a motion by Senator Buford, seconded by Representative Carney, and adopted by voice vote to approve the SFY 2010 Social Services Block Grant.


The next item on the agenda was the consideration of referred Administrative Regulations, 201 KAR 20:225 – establishes procedures for reinstatement of a license that has lapsed or has been subject to disciplinary action by the Kentucky Board of Nursing; 201 KAR 20:270 – establishes procedures and requirements for site visits to programs of nursing; 201 KAR 20:290 – establishes standards for the development and approval of secondary or distance learning programs by the Kentucky Board of Nursing.  There was a motion by Senator Buford, seconded by Senator Harper Angel, and adopted by voice vote to approve the referred administrative regulations.


The next item on the agenda was a discussion on the Impact of Federal Stimulus Funds on Health &Welfare Programs by Beth Jurek, Executive Director, Office of Policy and Budget, Cabinet for Health and Family Services.  Ms. Jurek reported that the following department/offices are not affected by the American Recovery and Reinvestment Act: Department for Mental Health Developmental Disabilities and Substance Abuse; Commission for Children with Special Health Care Needs; Department for Family Resource and Youth Services Centers; and the Office of the Ombudsman.   In the Senior Community Service Employment Program, there has been subsidized employment for seniors who are unemployed, have low income and are over 55 years of age; an additional 37 employment slots have been funded with green jobs and jobs in growth industries being preferred; the funds are limited to existing programs; and are distributed based on the existing federal formula.  In the Senior Nutrition Program, there is funding for congregate meals in senior centers; funding for home delivered meals for the Meals on Wheels Program; and funding is limited to existing programs.  In the Department for Community Based Services funds will be used for the Child Care Development Fund, the Supplemental Nutrition Assistance Program, and for the Temporary Assistance for Needy Families Program.  In the Department for Public Health, funding will cover increasing eligibles in the WIC program and funding will increase availability and use of the EBT card for the WIC program.  In the Department for Medicaid Services there is an increase in the Federal Medical Assistance Percentage and an increase in Disproportionate Share Hospital Payments.  Under health related opportunities, there is $10.4 billion to HHS and NIH.  There will be $1.1 billion available nationally for two years and grants are available to any public or private entity.  There is $2 billion available for Community Health Care Services.  Kentucky’s Community Health Centers are expected to receive $10 million to serve more patients and support capital renovations and repairs over the next two years. There are also funding opportunities for the planning/implementation grant program for states to plan and build a health information exchange infrastructure; there are competitive grants to operate loan programs may be administered or awarded to the state to help providers and hospitals purchase technology to participate in health information exchange; and financial assistance to Medicaid providers for purchase and use of health information technology with no matching funds required. 


Sen. Stine said that in Judiciary there was testimony about a pilot project in Northern Kentucky which is under the Community Corrections Program, that would encourage folks to actually pay their child support.  She asked if those sorts of things are eligible for this category.  Ms. Jurek said she would have to see if that fits under the guidelines, and she would check with the folks in Child Support and get back with Senator Stine.  She said it is limited to be used for administration, since child support is basically an administrative program. 


Senator Stine asked if there is anything in there for physical activity, encouraging physical activity in the schools.  Ms. Jurek said that is one of the areas that can be pursued, but they are still waiting guidance from the CDC and HHS on that particular funding pot.


Representative Moore asked about the use of the phrase “encouraging changes in the program”, versus “dictate” and asked if the state is being encouraged to make changes or are we being dictated policy.  Ms. Jurek said that it depends on the particular funding stream.  For certain programs the language is very specific.  There are different federal agencies administering some of these programs and they have different requirements and some of them are more flexible than others.


Rep. Moore asked how much the programs have grown in terms of percentage  and how much money is being talked about.  Ms. Jurek said some of the dollars are part of national programs, those are dollars that are available to all states and they would have to apply for them.  Some of the dollars that flow through the Cabinet are a set pool and state how much is given.  In other cases, you can get different amounts depending on what your experience is and how it is evaluated on a quarterly basis.


Representative Moore asked if there is an incentive for Kentucky to actually actively or correctively seek new enrollees.  Ms. Jurek said the problem is when programs like food stamps are being looked into, because food is a basic need and the Federal Government pays those benefits at 100 percent.  The benefit portion of food stamps flows directly to recipients.  Stimulus funds are a blessing because Kentucky desperately needs the funds to serve people.  The problem is that if you start seeking to serve new populations, you have to be concerned with what happens when the federal stimulus dollars go away.  In most cases the Cabinet is using the dollars to try to continue programs at the current levels.


Senator Buford asked if some states are choosing not to go to 200 percent of the poverty level.  Ms. Jurek said she can check but thinks some states are choosing not to.


Senator Buford asked about funds for the child care and child support.  He asked if this money will allow Kentucky to hold this rate to child care services to possibly May of next year.  Ms. Jurek said this will get us through the stimulus period, through Sept. 30, 2010.


Senator Buford asked if that number is based on the number of children in care currently, and not what the number might increase to.  Ms. Jurek said the department is looking at some opportunities while they have this money to build additional community supports so that Kentucky might not need quite as much in-home care.  There might be more options out there so that you can transition children back to the community sooner or you can possibly avoid bringing them into a foster care setting to begin with.


Senator Harper Angel asked if in the areas like WIC and First Steps fund amounts will be posted on the website.  Ms. Jurek said those will be available. She said that each week information is listed that we sent to the finance and administration cabinet on what stimulus dollars we have pulled down by appropriation unit by program. 


Senator Harper Angel asked if the dollars to those programs come immediately or by increments.  Ms. Jurek said a lot of it will depend on if Kentucky is pulling down the food stamp dollars in FY '09, but knows the state will be pulling them down for sure in 2010.  Some of the stimulus dollars are almost identical to the way the program dollars in the regular program are used.  In some cases you really will not be able to tell any difference between the two, except stimulus dollars will be spent first.


 Representative Carney said that in his district commodities have become a huge issue with senior citizen funds, and he noticed the estimate for commodities was nearly $2.5 million dollars but then the amount that would come through the Kentucky state government was $829,000.  He asked if the monies would be coming later.   Ms. Jurek said the Commodities Food Program that used to be administered by the Cabinet, is now administered by the Department of Agriculture, and they would have to answer those questions. 


The next item on the agenda was comments by Dr. Jim Votruba, President, Northern Kentucky University (NKU), and Steve Stevens, President, Northern Kentucky Chamber of Commerce.  Dr. Votruba said that NKU is currently one of the two fastest growing universities in the Commonwealth of Kentucky.  They have seen 28 percent growth in the number of students over the last decade.  Currently, NKU has 15,300 students and they are slated to grow to more than 26,000 students by 2020.  As an economic strategy to reach 50,000 new jobs by 2015, and to maintain Northern Kentucky’s growing percent of revenue production for the state, NKU has placed a priority on supporting the healthcare and information technology industries and services in the Northern Kentucky region for the foreseeable future.  He said that the healthcare industry is an important driver for the local economy.  In 2005, healthcare companies in the regions made over $2.2 billion dollars of capital investment, with over $315 million dollars going into Northern Kentucky.  Also in 2005, the tax revenue brought into Kentucky by the new jobs and investment from the industry topped $2.4 million. 


In regard to e-Health related opportunities, Kentucky needs an effective e-Health Information Network to reduce healthcare costs, lower benefits costs, and increase the quality of healthcare delivery for Kentucky’s citizens.  He believes that the partnership with other universities has the potential to cause Kentucky to capture a national leadership role by providing applied research, training and technological resources. 


He said that the College of Health Professions is focused on meeting the need for more than 200,000 health information workers in order to meet 2015 goals.  The partnership with regional healthcare organizations has already positioned the region to move aggressively toward interoperability. 


He said that NKU is experiencing the greatest space challenge since its creation 41 years ago.  To reach the average of the regional comprehensive universities, NKU would need 550,000 net square feet of new educational and general space.  Because of the space shortage, NKU has had to turn away 400 potential nursing and allied health students every year.


NKU is planning to address the challenges by building a Health Innovations Center and renovating an existing building.  The investment will be $92.5 million and will provide 250,000 square feet of space. 


Next, Mr. Stevens said that the Northern Kentucky Chamber of Commerce is an organization of 2,000 member firms from all across this region.  These firms represent more than 230,000 employees in the region. The Northern Kentucky Chamber is celebrating its 40th anniversary this year. Prior to that time, there were two organizations.  Visionary leaders made the decision to create a regional organization and from that point, a subsequent series of mergers and consolidations began to occur across the region which has been a benefit.


Next, he highlighted a few of the significant initiatives that the Northern Kentucky Chamber of Commerce has undertaken in the area of health care.  In September 2007, the then incoming chair of the board, Richard Robinson pledged to elevate health care initiatives as a stand-alone program area of the chamber with its own vice chair for Health Initiatives that would serve in an Executive Committee position on our board of directors.  This was the beginning of an entire council within this chamber that consolidated many of the existing health care-related activities already being undertaken by the Chamber, as well as to house the many new initiatives to come.


Since the creation just two years ago, a $350,000 grant has been secured from the Health Foundation of Greater Cincinnati for a Medical Navigator project.  A two-year project was launched to study emergency department misuse at St. Luke and St. Elizabeth Hospitals.  Just a few months ago the Chamber was the recipient of another grant from the Health Foundation of Greater Cincinnati to do research for one year on the feasibility of developing a defined benefit plan in Northern Kentucky.  The idea for this work came from our knowledge of health insurance plans available in other communities across the country that are focused at the health insurance needs of citizens within those communities who are currently employed, yet whose employer is not or cannot provide health insurance coverage to their employees. 

The next item on the agenda was Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Dental care requirements by Betsy Johnson, Esq., Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services.  Commissioner Johnson reported that from 1999 to 2006 dental coverage of low-income children nationally has changed.  In 1999, 51 percent of low-income children were covered by Medicaid/CHIP dental.  In 2006, 69 percent of low-income children were covered by Medicaid/CHIP dental. Nationwide in 2006, 43 percent of low-income children were covered by Medicaid/CHIP dental.  Two provisions of CHIPRA are designed to improve dental access for children: states are required to include dental coverage in the CHIP benefit package (Kentucky has always included); states are allowed the option of offering dental coverage to children enrolled in private or job-based plans that do not provide dental coverage, as long as children are otherwise eligible for CHIP.  In the current Medicaid program, dental program expenditures are approximately 2 percent of the mandatory services budget; and 1 percent of the total Medicaid budget.  In 2008, dental expenditures totaled over $68 million.  In 2008, 28 percent of all Medicaid recipients utilized dental services; 38 percent of Medicaid children age 18 and underutilized dental services; and 48 percent of KCHIP children age 18 and underutilized dental services.  Kentucky Medicaid has participating dentists in 115 counties and 42 counties have more than 1,500 Medicaid recipients per Medicaid enrolled general dentist.  Approximately 52 percent of the state’s dentists are enrolled as Medicaid providers. Kentucky increased reimbursement for most dental procedure codes for children by 30 percent in July 2006.  Kentucky dental rates are comparable to surrounding states.  Kentucky Medicaid covers orthodontic procedures. Many other states do not.  Kentucky pays $48.10 for a dental cleaning for children, compared to the average $37 in surrounding states.


Senator Denton asked what will be different in the CHIP program than what is being done now since the dental benefit has already been put into it.  Commissioner Johnson said that currently Kentucky is in a great place with its CHIP.  Kentucky has been asked to give guidance to other states that do not have as robust of a program as Kentucky.  At this time, the Cabinet feels like the CHIP program is sufficient, and being aware of the dollar issue, there are not any plans to expand it at this time.


Lisa Lee said the CHIPRA legislation had several mandates.  Kentucky was far ahead of the game and was meeting all those mandates before the CHIPRA legislation went into effect.  Kentucky has been asked to participate in several work groups and offer guidance to some other states who do not have some of their programs implemented and who are looking for guidance to help build their programs up and comply with the CHIPRA legislation.


Representative Burch asked who is monitoring the condition related to the bill he passed that said that dentists would treat 12,000 children who had no access to dental care.  Commissioner Johnson said there was a requirement in the legislation that the Department of Education would monitor it.  Commissioner Johnson said they will work with their dentists and do anything they can to make sure that our Medicaid and CHIP children are getting those screenings as required by state law. 


Representative Wuchner said that the utilization is down whether they have coverage or Medicaid or not.  She said that when she has talked to dentists about covering children that are provided Medicaid, normally they say they would almost rather do pro-bono work because of all the paperwork.  She asked if that process has been streamlined, or if it has been looked into.  Commissioner Johnson said that they talked to several dentists about why they do not want to participate.  Some concerns were about no shows, and that individuals may be seeking drugs rather than treatment.  She thinks it is a matter of education, as far as educating parents to the importance of dental health for their children. 


The next item on the agenda was Pediatric Private Duty Nursing Care Shortage by Carrie Banahan, Office of Health Policy, Cabinet for Health and Family Services.  Ms. Banahan reported that private duty nursing services may be provided by an entity who has a Certificate of Need (CON) for either private duty nursing services or home health services.  The criteria for private duty nursing services include providing licensed nursing care in a home setting; providing nursing care in 4 hour increments; and supervising private duty nursing service. 

Under the current criteria for a new application there cannot be an existing private duty nursing provider or home health agency in the county.  The proposed criteria would allow a CON for private duty nursing service in a county if an existing home health agency does not provide private duty nursing services. There are currently 11 private duty nursing agencies in Kentucky serving 70 counties.  Home health services provided include a combination of health care and social services provided to individuals in their homes or in other community and home like settings pursuant to 902 KAR 20:081.  The need is determined by the county. A facility may establish a new home health agency in a county; or an existing home health agency can expand into a contiguous county. They must meet projected need requirements and be consistent with the State Health Plan.  CON applications fall into one of two categories:  Formal Review or Non-Substantive Review.  Unless specifically exempted by statute or regulation, all applications to establish or expand one of the 25 various facility and service categories contained in the State Health Plan (SHP) are processed under formal review.  Private duty nursing and home health services are classified under formal review.


Senator Denton said there are providers who provide private duty nursing services in Jefferson County, but there is not enough.  Ms. Banahan said there is one provider in Jefferson County, VNA, who does provide private duty nursing services.  She said they have not received any complaints specific to private duty nursing services.


Senator Denton said it is her understanding that the Cabinet has been in contact with Kosair and they have talked to you about the fact that they are unable to release children from the hospital because of the inability to find adequate numbers of private duty nurses available to provide those services.  Commissioner Johnson said she did receive the email from Kosair, but has not spoken to them.  They were requesting an emergency CON for Maxim for private duty nursing because they could not discharge children in a timely manner.  That email was referred to Carrie Banahan.  She also noted that the Cabinet does not enroll private duty nursing agencies in the Medicaid program.


Senator Denton said she thought it was a CON issue.  Ms. Banahan said that Maxim has a CON for private duty nursing.  They applied for a home health certificate of need for Oldham and Fayette Counties last July and they were denied in December.


Senator Denton asked about the status of the company that has been trying 6 or 8 months to get a CON to do the private duty nursing for pediatrics in Jefferson County.  Ms. Banahan said she was not aware there was another private duty nursing agency in Jefferson County that wanted to apply for CON, and asked if she was referring to Maxim Health Care.  If so, Maxim already has a CON for private duty nursing services in Jefferson County, but they do not have a CON in Jefferson County for home health services.  Right now Jefferson County is not eligible for approval for any more health agencies based on CON methodology.


Sen. Denton asked the Cabinet to work with Kosair on this issue.


Senator Stine asked if there are agencies out there that are wanting to work in this capacity.  Ms. Banahan said it is a two-fold problem.  There are counties with need and for whatever reason the home health agencies, maybe because of their business plans, are not willing to go into a county.  There are other counties like Jefferson, where based on the need methodology, it has been determined there is no need.   The need methodology is a formula that has been established by the Cabinet.


Senator Stine asked when the formula was established or when it was updated.  Ms. Banahan said the last time that the need methodology was changed was 3 or 4 years ago.  That is something the CON Work Study Group is looking at.


Senator Buford said the Legislature should tamper with the formula, even though the Cabinet will object.  This problem is everywhere, not just in Jefferson County. The groups that have been given CONs do not have the personnel capacity to deal with it.


Next, a motion was made by Senator Harper Angel, seconded by Senator Clark, and approved by voice vote asking the Cabinet to expedite the Work Study Group, update the formulas and present the findings to the Interim Joint Committee on Health and Welfare during its September meeting.


The next item on the agenda was an update on Oakwood including Recertification of Units and Community Placements by Betsy Dunnigan, Acting Deputy Commissioner, Department for Mental Health, Developmental Disabilities, and Addiction Services, Cabinet for Health and Family Services.  Ms. Dunnigan reported that on August 28, 2008 the Cabinet submitted new applications for certification of Oakwood as four separate units.   From September 15-19, 2008, the first unannounced reasonable assurance surveys were conducted for each of the four units. Deficiencies were noted in three of the four units requiring submission of a Plan of Correction. Unit 1 did not pass the initial survey. Follow-up surveys were conducted in Units 2, 3, and 4 resulting in certification of these three units.  Federal funding was restored for three units between February 5, 2009 and March 13, 2009.  There was a new application submitted April 29, 2009 for certification of Unit 1.  Unit 1 underwent the unannounced initial survey June 3-5, 2009 with no deficiencies cited.  CHFS now awaits CMS notification of the reasonable assurance timeframe required for maintaining compliance with the federal requirements for federal funding of Unit 1 to be reinstated. Reasonable assurance timeframes can be 30-120 days as determined by CMS.  Progress continues to be made toward compliance with the Department of Justice Settlement Agreement.  A Court Monitor conducts a week long monitoring visit each April and October and a 2 day monitoring visit each February and July.  Substantial progress was noted by the Court Monitor and his team during the April 27-May 1, 2009 site visit.  Compliance with the Settlement Agreement is to be attained by September 2011.  Oakwood Bluegrass staff continues to implement the statewide transition process that has been in place since 2005.  The current census is 196.  Treatment teams continue to identify barriers to community placement for each individual residing at Oakwood.  Clients continue to receive education regarding community support options and the needed training to remove the barriers to community placement.  As appropriate, clients continue to transition from Oakwood into community-based settings through a comprehensive and planned transition process.  Parents and guardians continue to be educated regarding community-based support options in an effort to assist them so that their loved ones can reside in the least restrictive environments to meet their needs.  Current census is 196; 26 individuals have moved to community placements since July 2008; 22 individuals are in the transition process; 12 of the 22 have selected a community provider.  All but 4 of these individuals are utilizing the Money Follows the Person (MFP) option for community services.  An additional 22 individuals have treatment team recommendations for community placement with the guardian considering placement options.


Senator Buford noted that provisions in the last budget provided that the funding would not be recovered, and asked if some adjustment in the budgetary item will be made when they fully recover.  Ms. Dunnigan said they are currently working through all of the paper work that needs to occur when the facility lost its certification, some of the individuals lost their Medicaid, or Long-Term-Care, so they have to go back through the Medicaid process of changing their cards. 


Senator Buford asked if it was approximately $40 million dollars.  Ms. Dunnigan said the total contract is $74 million.


Senator Buford asked if the state will recover the amount lost.  Ms. Dunnigan said the state will ultimately recover funds by next year, only going back to the date that the facility was finally certified. 


Don Putnam, President of PROOF, and father of a son at Oakwood thanked the Cabinet and the staff at Oakwood for working so hard toward certification and said that Oakwood is a tremendous asset. 


The next item on the agenda was a discussion on the Cincinnati Children's Hospital Medical Center by Gerry Fairbrother, PhD, Director, Child Policy Research Center, Department of Pediatrics, University of Cincinnati.  Dr. Fairbrother said that the Cincinnati Children’s Hospital (CCH) has about 80 percent of children hospitalized in Northern Kentucky, but CCH is a provider of care for children throughout Kentucky.  She reported that CHIPRA calls for new efforts to enroll eligible children in Medicaid and SCHIP, has funds for outreach, offers a bonus if enrollment targets are met and has new provisions for reporting on enrollment stability as well as quality of care.  These provisions will need to be implemented in the context of an extreme, nationwide economic downturn and budget crisis in many states.  To help Ohio Medicaid with its efforts to enroll and retain eligible children and to target outreach, they have developed a system to monitor enrollment and retention and to show where the problem spots are.  They used Medicaid eligibility files to do the analysis and similar analyses could be done in Kentucky.   They have also developed a process for looking at turnover rates of how many children come on in a given month and how many drop off.  Some children drop off and other come on each month and at the end of the year about 25 percent of the children who started the year have left the program.  In turn, another almost 25 percent have come on.  Findings show that African American children are least likely to drop out of the program, while white, Hispanic and Asian children were more likely.  All of their findings will help Ohio Medicaid design the most efficient outreach programs and monitor the effects of the programs.  Another study found that there were about 16.2 percent of Ohio children with special needs in 2005–2006, compared with about 13.9 percent nationwide.  Most special needs children are insured, either through public or private programs, but stability is still a problem, in that 12 percent were uninsured for some time in the year. Insurance does not solve all problems.  About one-third have coverage that is not adequate to meet their needs and the problem is most acute for privately insured children.  Not surprisingly, special needs children have higher medical costs than other children.  Parents of these children also have high out-of-pocket costs.  The uninsured have even higher costs.  Data shows that most insured children with special health care needs are covered by Medicaid and that Medicaid has the sickest children and more of those with mental, emotional, behavioral or developmental problems.  This highlights the role of Medicaid in providing care for children with special health care needs and the importance of policies to monitor care and costs in Medicaid.  Data also points to the inadequacy of private coverage in fully meeting the needs of these children. 


In closing she said that Cincinnati Children’s Hospital serves Kentucky children and the hospital has a vested interest in the well-being of those children.  She said that Ohio has a unique opportunity to work in partnership with Kentucky and she hopes that this presentation leads to more conversations about that.


Representative Burch asked if there is a common thread that causes the increase.  Dr. Fairbrother said she thinks it is a bit statistical, but she thinks it is because the children are aging.  She said they have fewer young children and more older children.  And, the special health care needs children tend to get diagnosed at school.  They have the conditions before hand but they tend to get diagnosed when they go into school.  Many policy makers say this indicates a need to focus on the young children to get these conditions diagnosed and begin treatment before they exacerbate. 


Senator Denton asked if there is any collaboration between University of Cincinnati Children's Hospital and Kosair Children's Hospital in Louisville.


Blair Shrader, who handles government relations for the children's hospital, said they partner with Kosair on many issues especially pertaining to research, because they do receive a great deal of funding for research, and they want to share that. 


Senator Kerr asked if they collaborate with the University of Kentucky Children's Hospital.  Mr. Shrader said they do and they partner on a range of different issues.  He said they have doctors that collaborate with them because they have a positive relationship with those hospitals.  Many times those patients are referred to us and vice-versa.  They have to collaborate with them to help the patients.


Senator Buford asked if Dr. Fairbrother has done any studies or has any statistics from Ohio pertaining to individuals that are in the high risk pool and have children.  Dr. Fairbrother said they look at the needs of the uninsured and as the data shows, parents of uninsured children pay over $1,000 out of pocket in a year for their cost in just one year.


The meeting was adjourned at 5:08 p.m.