Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

The state’s largest provider of drug and alcohol treatment is making further cuts in staff and facilities as it faces steep cuts in Medicaid payments from the government health plan that covers nearly all its clients.

Addiction Recovery Care, or ARC, based in Louisa, said it will temporarily close four programs and reduce staff as it plans for cuts of 20% or more from some of the private insurance companies that process and pay most of the state’s Medicaid claims.

The cuts to ARC programs in Boyd, Jackson, Fleming and Pulaski counties follow ARC’s announcement last month it was restructuring some programs and laying off staff after the insurance companies, known as managed care organizations, or MCOs, first notified ARC of the pending cuts.

In a statement, ARC said it remains committed to providing substance use disorder treatment across Kentucky.

“These decisions were not made lightly, and we are dedicated to supporting our team members and communities affected by these changes,” said Vanessa Keeton, ARC vice president of marketing. “Above all, the safety and care of our clients remains our top priority. We are still available 24/7/365 for patients and families in need.”

The cuts come as the MCOs, including Wellcare of Kentucky Inc., are announcing broader reductions in Medicaid reimbursement to other addiction and behavioral health programs that will limit their ability to provide care, said Frankfort lawyer Anna Stewart Whites, who represents about 20 smaller treatment providers.

For example, one of her clients, a small children’s therapy program in Berea, was recently notified of cuts, she said.

“It appears to be very much across the board,” she said.

Wellcare is the largest of six MCOs that manage Medicaid claims for Kentucky, with about 418,000 enrollees.

It did not immediately respond to a request for comment.

ARC’s cuts are the latest setback for the fast-growing, for-profit company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was?investigating ARC?for possible health care fraud and asking anyone with information to contact the federal agency. ARC said it stands by its services and is cooperating with the investigation.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

ARC and its founder and CEO Tim Robinson have emerged as prolific political donors in recent years.

A?Lantern analysis?by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in contributions to Kentucky political causes and candidates over the past decade as his company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

ARC said it has provided treatment for 75,000 people over the past 15 years.

‘Set back addiction treatment?’

The MCOs contract with the state to manage most of its $1.5 billion a year Medicaid program and have broad latitude in setting rates with providers. They are? paid a fixed rate per member and reimburse providers for care.

In July, ARC was among providers who testified before a legislative committee, warning that cuts by MCOs in payments for addiction treatment could hamper progress Kentucky has made in treatment for several decades of widespread addiction and overdose deaths.

An expansion of treatment services was fueled by expanded Medicaid payments in 2014 for substance use disorder under the Affordable Care Act.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told the interim Health Services Committee. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Last month, Frontier Behavioral Health, based in Prestonsburg, filed suit against Wellcare over rate cuts of 20% and a new requirement that it review all services before agreeing to pay for them. That lawsuit is pending.

Its lawsuit said that when Frontier tried to follow up with Wellcare over an August letter notifying it of cuts, the number provided in the letter for questions had been disconnected.

‘Booting’ out clients

Whites said some providers she represents have had similar experiences — or worse.

When some providers tried to contact Wellcare about rate cuts, it responded by canceling their contract altogether.

That forced clients in the midst of treatment to find another provider or switch to another MCO, both of which mean delays in care. Some providers have continued to offer treatment without reimbursement until clients can make the necessary changes, she said.

“The risk of booting someone out of your program and finding someone who can take them is just too much of a risk,” Whites said.

ARC’s Brown didn’t immediately identify how many employees will be affected by the reductions announced Wednesday. Prior to the staff cuts last month, it employed 1,350 people.

Programs to be closed temporarily are: Sanibel House in Bloyd County; Beth’s Blessings in Jackson County; Belle Grove Springs in Fleming County, and Lake Hills Oasis in Pulaski County.

Brown said clients will be offered placement in other ARC programs or the option to change to a different provider to continue treatment.

Meanwhile, he said ARC continues to negotiate over the pending rate cuts.

“We are very hopeful to have these negotiations done soon,” he said.

He said lawmakers, state officials and providers are working “to create a solution that preserves access to treatment and long-term recovery.”

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

An Eastern Kentucky provider of addiction services has filed a lawsuit challenging cuts in Medicaid payments that it says threaten its business.

The lawsuit, filed Tuesday in Jefferson Circuit Court by Frontier Behavioral Health Center, is against Wellcare of Kentucky Inc. — one of six private insurance companies that handle most of the state’s Medicaid claims and establish rates for health providers.

The lawsuit is the latest development as providers and some insurance companies spar over cuts in payment. A week ago, Addiction Recovery Care, or ARC, the state’s largest provider of substance use disorder treatment, said it is laying off staff and reorganizing programs because of the reductions.

In July, ARC executives testified before a legislative committee in Frankfort to protest the cuts it said affected it and a handful of other providers.

Lawmakers join KY’s largest addiction treatment provider to oppose Medicaid payment cuts

Frontier, a for-profit company based in Prestonsburg, said in its lawsuit that cuts of 20% in payment for addiction treatment that took effect last month threaten its ability to care for patients and pay its 94 employees.

An additional, new requirement that Wellcare review services before agreeing to pay for them will further hinder operations, the lawsuit said.

“Frontier must pay its employees for their work,” it said. “Frontier does not have the luxury of delaying payroll and operational expenses until Wellcare decides whether it will pay Frontier for the medically necessary services Frontier provides to Eastern Kentucky’s vulnerable health behavioral health patients.”

Frontier sees about 50 patients a day, according to the lawsuit.

Frontier CEO Randy Hunter declined to comment on the case. Officials with Wellcare, based in Louisville, did not immediately respond to a request for comment.

Expanded Medicaid funds for addiction services that became available in 2014 have fueled rapid growth in treatment programs amid decades of growing addiction to opioids, methamphetamine and other substances in Kentucky.

Last year, Kentucky spent $130 million in Medicaid funds on addiction treatment, with most of the money from the federal government.?

Kentucky Gov. Andy Beshear has cited the growth as important in battling addiction.

As an indicator of success, the Beshear administration points to the?decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

But the business of addiction treatment has brought complaints about high costs from the six private managed care organizations, or MCOs, that handle most of the state’s $1.6 billion a year Medicaid business. The companies contract with the state and receive a fixed amount per member to cover health costs.

And it has invited federal scrutiny.

In July, the FBI announced it was investigating ARC for possible health care fraud and asked anyone with information to contact them through the agency’s website. ARC, in a statement, has said it is confident in its services and is cooperating with the investigation.

Frontier provides services in Prestonsburg, Salyersville, Paintsville and Harlan, according to its website.

It said in the lawsuit the company first learned in August of a 20% rate cut being imposed by Wellcare.

Wellcare is the largest of the MCOs that oversee health care for most of the 1.5 million Kentuckians covered by Medicaid, with around 418,000 members enrolled in its plan. The other members are divided among the other five MCOs.

The lawsuit alleges when Frontier sought to question Wellcare about the cuts, the MCO claimed it sent Frontier a letter in March 2024 notifying it of the new rates.

“Frontier did not receive any letter from Wellcare notifying it of a rate cut in March 2024,” the lawsuit said.

It said that in August, Wellcare also began sending letters notifying Frontier it was placing its services on “prepayment review,” meaning it would have to review services before deciding whether to pay for them.

The lawsuit said the letters provide a telephone number to call Wellcare with any questions or concerns.?

“The phone number has been disconnected,” the lawsuit said.

Frontier asks the court to find Wellcare in breach of its contract. It also asked for a temporary order barring the MCO from imposing “prepayment review” on Frontier services.

Claims in a lawsuit provide only one side of a case. Wellcare has not yet responded.

The case has been assigned to Jefferson Circuit Judge Annie O’Connell.

EMW Women's Surgical Center before it closed. (Photo by Deborah Yetter)

Franklin Circuit Judge Phillip Shepherd has scheduled a hearing Sept. 27 on whether to unseal a case that appears to involve efforts by the Kentucky attorney general’s office to subpoena employment records of two University of Louisville physicians who previously provided abortion services at a private clinic in Louisville.

Shepherd’s order Thursday comes a month after the Kentucky Court of Appeals rejected the attorney general’s efforts to obtain the employment records through a grand jury subpoena, calling it a “fishing expedition.”

Kentucky appeals court rejects AG’s efforts to get employment records in abortion case

While the appeals court identified the plaintiffs only by pseudonyms Jane Doe 1 and Jane Doe 2, and the employer as John Roe, the Kentucky Lantern, citing sources with knowledge of the case, reported Aug. 9 that the case involved two U of L physicians, and their part-time employer, EMW Women’s Surgical Center, where the physicians provided abortion care and trained medical residents.

Parties have not commented on the details of the case, which remains sealed.

Abortion services have been largely banned in Kentucky under state law since the U.S. Supreme Court in 2022 overturned the 1973 landmark Roe v. Wade decision which had established abortion as a constitutional right. Kentucky law now permits abortion only to save the life of a patient or prevent disabling injury.

Shepherd’s order Thursday said secrecy prevented the press or public from getting involved in the proceedings because “they had no knowledge of the pendency of the case.”

“Members of the public or press who might have objected to the sealing of the record had no notice or opportunity to be heard … nor was any party who might have objected to the sealing of the record able to participate in the appeal,” he said.

Shepherd has directed that any party, including the press or public, who wants to intervene in the case or be heard over the matter of keeping the record sealed, file a motion with the court by Sept. 20.

“The Kentucky Supreme Court has held that the public and the press have a right to be heard in connection with any decision to close judicial proceedings,” his order said.

The dispute arose last year under former Attorney General Daniel Cameron, an anti-abortion Republican, who sought a subpoena for employment records of Jane Doe 1 and 2. The effort followed a call from some Republican legislators for an investigation into whether the public salaries of the doctors, on the faculty at U of L medical school, overlapped with any payments they received for their work at EMW.

But the clinic and the doctors went to Franklin Circuit Court to quash the subpoenas as improper, initially asking the case be sealed to protect their privacy. Cameron’s office also asked that it be sealed to protect the secrecy of the investigation.

The judge agreed to quash, or reject the subpoenas, but the attorney general appealed the decision and also asked the appeals court to order that the case remain sealed while an appeal was pending.

Shepherd’s order notes that the parties — Jane Does 1 & 2 and the employer — took no position on whether the records should remain sealed at that point.

Meanwhile, Cameron left office? at the end of 2023 and Republican Russell Coleman took over as attorney general in 2024, taking over the case.

On Aug. 9, the appeals court rejected the attorney general’s efforts to obtain the employment records of the two Jane Does with a subpoena, saying it was outside the scope of his office.

It also sent the case back to Shepherd to determine whether the case should now be unsealed, which he will take up at the hearing Sept. 27.

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of drug and alcohol treatment is cutting staff and restructuring some services, citing significant cuts in Medicaid reimbursement from the government health plan that covers almost all of its clients.

Addiction Recovery Care, or ARC, based in Louisa, said in a statement Thursday that, as a result of cuts in payment for addiction and mental health services, “we have had to make difficult decisions impacting some of our staff members.”

The staff cuts come after a dispute with the private insurance companies that process and pay most of Kentucky’s Medicaid claims.

ARC declined to say how many of its 1,350 employees would be affected but said “we are doing everything we can to support the affected individuals during this transition.” It provided no further details.

“Out of respect for our employees we do not discuss personnel matters,” the company said.

ARC also is reorganizing some of its operations in Louisa, the small Eastern Kentucky town where the for-profit company is based and the home of its founder and CEO, Tim Robinson.

Robinson, a lawyer and recovered alcoholic who started the company that became ARC in 2010, has emerged as a politically well-connected figure and major political donor.

A Lantern analysis by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

Except for money given to political committees supporting Gov. Andy Beshear, a Democrat, virtually all of the rest went to Republicans like former Gov. Matt Bevin, Attorney General Russell Coleman, U.S. Rep. Hal Rogers and candidates for the Kentucky legislature.

Beshear has praised ARC for its role in helping the state deal with the wave of addiction that engulfed Kentucky in recent decades.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at a ribbon-cutting in March for a new ARC facility in Greenup County at the former Our Lady of Bellefonte Hospital in Ashland.

A spokesman for the state Cabinet for Health and Family Services, which administers Medicaid, said that the Beshear administration supports Medicaid services for those in need of addiction or mental health treatment and is seeking ways to expand them.

As for the rate dispute between ARC and the managed care companies, those companies “are contractually obligated to ensure members have access to appropriate medical care,” the spokesman said in a statement, adding: “We have no comment on the operational structure of Addiction Recovery Care (ARC) but these provider types are an essential resource to help individuals break the cycle of addiction.”

Robinson, a lifelong Republican, has praised Beshear as a skilled political leader saying, “I hope he runs for president.”

Enter the FBI

The cuts are the latest setback for the fast-growing company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was investigating ARC for possible health care fraud and asking anyone with information to contact the federal agency.

An FBI spokeswoman in a statement Tuesday said it has no new information to share about the status of the investigation but said the agency is still accepting information through an online site on its website.

ARC has said it is cooperating.

“We are confident in our program and in the services we offer,” the statement said. “We, and our legal counsel, are cooperating fully in the investigation.”

A few days before news of the FBI investigation became public, Coleman, the attorney general and law school classmate of Robinson at the University of Kentucky, said he was recusing himself from any investigation of ARC, according to Louisville Public Media. It reported Coleman’s top deputy, Rob Duncan, a childhood friend of Robinson who previously has done legal work for ARC, also was recusing himself.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Coleman’s office investigates Medicaid fraud.?

Robinson, his corporations and employees gave at least $37,700 to Coleman political committees since late 2022.

‘Significant strides’ threatened

News of the FBI investigation became public just a few days after ARC executives appeared before a Kentucky legislative committee to protest cuts in reimbursement from some of the six national health insurance companies known as managed care organizations, or MCOs, that oversee most of the state’s $1.6 billion a year Medicaid program.

ARC, in a statement, stressed that cuts in reimbursement are driving the staff reductions and facility reorganizations.

“These difficult decisions are a direct result of impending and significant reimbursement cuts for many addiction and mental health service providers in Kentucky,” it said.

The MCOs contract with the state to manage care and provide payments for health services for most of the state’s around 1.5 million residents insured through Medicaid, which gets most of its money from the federal government.

In turn, the MCOs are paid a fixed rate per Medicaid member for overseeing that care.

People with knowledge of the situation have told the Lantern insurers had become concerned about aggressive billing practices and rising costs associated with some addiction treatment companies including ARC.

At the July hearing, ARC officials told lawmakers they and a handful of other providers in Kentucky had been notified they faced cuts of 15% to 20% in reimbursement from some of the MCOs.

Increased access to Medicaid funds and a growth in the treatment industry have helped Kentucky expand to the most treatment beds per resident in the country, an accomplishment touted by Beshear.

That progress could be threatened by the pending cuts, Matt Brown, ARC’s chief administrative office, told members of the interim joint Health Services Committee on July 30.

“Kentucky has made significant strides in access to treatment,” Brown said. “With these cuts it could completely set back addiction treatment in our state 20 years.”

This story has been updated with a response from the Beshear administration.

As Attorney General Dan Cameron sought to get the employment records of two University of Louisville physicians who performed abortions at the EMW Women's Surgical Center in Louisville. (Kentucky Lantern photo by Deborah Yetter)

FRANKFORT — The Kentucky Court of Appeals has rejected efforts by the office of the state Attorney General to use a Franklin County grand jury subpoena to get employment records in a case that appears to involve two University of Louisville physicians who performed abortions at EMW Women’s Surgical Center and trained residents at the clinic.

Because the case is sealed, the appeals court decision does not identify the parties by name, using pseudonyms Jane Doe 1 and 2 and the employer, Roe, as those seeking to quash the subpoena.

But the details closely track a dispute that arose in 2022 when Republican lawmakers sought an investigation of whether the public salaries of physicians at U of L overlapped with their work at EMW, which paid them separately.

Sources with knowledge of the case told The Lantern the appeals decision involved the attorney general’s efforts to obtain the physicians’ employment records including personnel files, job descriptions and payroll records from EMW.

The appeals court, in an order issued Friday, rejected those efforts as a “fishing expedition” and said further, that the subpoena filed by former Attorney General Daniel Cameron, is outside the scope of the Franklin County grand jury because the information and records the attorney general sought are from another county.

The matter should be left to prosecutors in the county where the records and activities occurred, the order said.

“While we do not wish to overuse the hackneyed phrase of a ‘fishing expedition,’ we reiterate that the (attorney general) was fishing in the wrong pond,” the order said.

The appeals court upheld the decision of Franklin Circuit Judge Phillip Shepherd to quash the subpoena but ordered the case to remain sealed pending his further review.

Since leaving office at the beginning of this year Cameron has been working as chief executive of 1792 Exchange, a nonprofit that says it aims to “steer public companies back to neutral on divisive, idealogical issues.” He did not respond to requests for comment about the case that Kentucky Lantern sent to that organization on Friday and in a phone message.

Kevin Grout, the spokesman for Attorney General Russell Coleman, who is now handling the case, said “We have received the opinion. We are reviewing it to decide next steps.” Grout declined to respond to questions seeking details about the case.

William Brammell Jr., identified in the opinion as an attorney representing Jane Doe 1, said, “We appreciate and agree with the court’s thoughtful opinion.”

But because the case remains under seal, Brammell said he could make no further comment. Other lawyers representing parties in the case did not respond to requests for comment.

Abortions largely ended in Kentucky after the June 2022 Supreme Court ruling overturning the landmark, 1973 Roe v. Wade decision returned control to the states. Kentucky already had laws on the books banning all or most abortions except in life-threatening circumstances.

GOP lawmakers called for investigation

But some Republican lawmakers had questioned the role of U of L physicians at EMW, citing U of L’s public funding, and called for an investigation.

“If university funds are used for abortion,” said Rep. Jason Nemes, R-Louisville at a legislative hearing in 2022, “the taxpayers ought to know, and the legislature should take that into account when we’re talking about funding the university and other things.”

Nemes and other lawmakers said further investigation was warranted.

Cameron filed a grand jury subpoena in June 2023 seeking payroll and personnel information of the two Jane Does, the appeals opinion said. At the time, Cameron, a Republican, was running for governor against incumbent Gov. Andy Beshear, a Democrat, who won a second term.

Through the subpoena, the attorney general “sought to compare the employees’ records for evidence that unspecified and indirect state funds may have been related to some malfeasance connected with their work,” the opinion said.

In July 2023, the Jane Does and Roe asked the Franklin circuit judge to quash the subpoena and in September, the judge did so, the appeals opinion said

But the judge also unsealed a portion of the record, it said.

The attorney general appealed the decision and asked that the case remain sealed, which the appeals court agreed to do, it said.

Friday’s 23-page opinion is the first public record in the case filed more than a year ago, and said it tries to strike a balance between “the necessary secrecy of grand jury proceedings and the right of the public to know what its government is doing.

“We conclude that the public issuance of this opinion with appropriate pseudonyms for most participants will achieve the proper balance,” it said.

But in its description of the case, the appeals court leaves clues that indicate the conflict pits the Attorney General’s Office against EMW and its doctors. For instance, it states that the doctors have two employers, and the second employer gets a small percentage of its funding from the state.

U of L gets some, though not the majority, of its funding from the state. EMW, a private clinic, received no public funds.

The attorney general had argued it should have access to the information it sought through subpoena because state funds may be involved.

The appeals court rejected that argument, saying of the Jane Does, “They are employees, and their employers, not the Commonwealth, are responsible for their paychecks.”

The Appeals court order is written by Judge Kelly Mark Easton with Judges Glenn Acree and Pamela R. Goodwine concurring in the decision.

It vacates the order by Shepherd, the trial judge, to unseal some of the records in the case and sends the case back to him “for further proceedings on the sealing of the record.”

“All of this court’s record, except for this opinion, will remain sealed recognizing the authority of the circuit court to first decide what, if any, further information should be made public,” the order said.

Abortion ban factors into governor’s race

EMW was one of two Louisville clinics that provided abortions in Kentucky until the U.S. Supreme Court struck down Roe v. Wade and a pair of laws passed by the state’s Republican-controlled General Assembly took effect, banning almost all abortions in Kentucky.

The two laws, one the “trigger law” banning abortion and the other, banning abortions after six weeks — before many women realize they are pregnant — took effect after the high court ruling.

They permit abortions only to save the life of or prevent disabling injury to a patient, with no exceptions for rape or incest — which became a heated issue in Cameron’s unsuccessful run last year for governor against Beshear.

Cameron, an anti-abortion Republican who defended the laws in court, was criticized in a Beshear campaign ad by a young woman who had been raped and impregnated at age 12 by her stepfather and said laws Cameron defended would have forced her to bear the child.

Hadley Duvall, an Owensboro native who is now in her early 20s, told?the Kentucky Lantern last year that she began sharing her story about the sexual abuse she experienced as a child after the U.S. Supreme Court overturned Roe v. Wade in 2022.

She recently went national with her story through a campaign ad supporting President Joe Biden on the same issue. Biden dropped his bid for re-election July 21 and his vice-president and abortion rights advocate Kamala Harris is now seeking the Democratic nomination for president.

In 2020, the conservative Family Foundation of Kentucky questioned U of L’s arrangement with EMW, suggesting public money might be going to fund abortions services.

They called on Cameron to investigate and a spokeswoman for Cameron said at the time he would consider doing so.

The spokeswoman said Cameron was committed to enforcing the state’s laws, “which prohibit the use of public funds for abortions. We will review any information provided to determine whether a further inquiry is warranted.”

At the time, then-U of L President U of L President Neeli Bendapudi firmly rejected such allegations, saying “we comply, not just in this program, but in every program with all federal and state laws.”

Former Gov. Matt Bevin, shown at a campaign rally for then U.S. President Donald Trump on Nov. 4, 2019 in Lexington, Kentucky. (Photo by Bryan Woolston/Getty Images)

The adopted son of former Kentucky Gov. Matt Bevin is back in the United States — after he was removed earlier this year from an allegedly abusive Jamaican youth facility and left in care of that country’s child welfare system.

The boy, 17, is in a placement worked out with help of Jamaican children’s authorities after his adoptive parents, Matt and Glenna Bevin, did not immediately respond to inquiries about his situation, said advocates working behalf of him and seven other boys removed from the facility in February.

“He is safe,” said Rebecca Growne, a representative of a child advocacy foundation created by hotel heiress Paris Hilton, who has used her celebrity to shed light on conditions in so-called “troubled teen” facilities.

“He is in an appropriate placement.”

The Bevins, Growne said, are not involved in the matter.

Hilton’s foundation, 11:11 Media Impact, is a non-profit organization which advocates on behalf of children in allegedly abusive residential settings.

Hilton herself traveled to Jamaica in April to meet the boys and offer her organization’s support, a visit she mentioned in June testimony before Congress over her concerns about such residential programs.

Hilton said she, as a teenager, was placed involuntarily in several such facilities she said were highly abusive.

The Bevins did not respond to repeated queries about their son as officials and advocates sought to find a custodian for him, according to advocates with the Hilton foundation. As a result, he was placed in custody of the Jamaican child welfare system.

“They were not communicating with us,” said Chelsea Maldonado, also with the Paris Hilton foundation, who went to Jamaica to assist in the case. “Everyone has tried. No one has had success.”

Neither Matt Bevin, who served as Kentucky governor from 2015 through 2019, nor his lawyer responded to a request for comment.

Glenna Bevin, who is seeking a divorce from her husband, did not respond to a request for comment through her lawyer.

Matt Bevin, a conservative Christian, ran a campaign based in part on improving adoption services in Kentucky and reducing the number of children in foster care. In a 2017 interview on KET he called his desire to reform the system “the driving reason I made the decision to run.”

The Bevins are the parents of five biological children and four children they adopted from Ethiopia in 2012, including the youth who was sent to the Atlantis Leadership Academy in Jamaica last year.

Matt Bevin often cited the adoption in his political campaign and after he was elected in calling on members of Kentucky’s faith community to provide adoptive homes for children in need.

‘The perfect location for healing’

On its website, the Atlantis Leadership Academy describes itself as a “the perfect location for healing,” and an ideal place for youths who have cycled though other treatment programs without success.

But on Feb. 8, officials with the Jamaican Child Protection and Family Services Agency found otherwise when they conducted an unannounced welfare check on the eight teenage boys, ages 14-18, all U.S. citizens, according to a press release from the agency.

“During this visit, signs of abuse and neglect were observed, leading to the immediate removal of the teens from the facility for their safety,” it said.

The U.S. Embassy, in a statement, said it takes the welfare of U.S. children abroad “very seriously” and works closely with Jamaican child protection officials in such matters.

The Jamaican children’s agency did not elaborate on the abuse it observed at the academy but a lengthy story July 13 in the Sunday Times of London said the teens removed from the academy described beatings, violent treatment, isolation, lack of food, filthy, unsanitary conditions and cruel punishments such as being forced to lie face down on the floor for hours.

“I’d rather die than go back,” one boy said, according to the Sunday Times.

The case was also referred to criminal authorities which resulted in charges of assault and child cruelty against five former staffers.

‘He was just so dejected’

The removal of the teens from the academy set off a flurry of activity to identify the boys and find their families.

Dawn J. Post, a New York lawyer who specializes in family law and failed adoptions, was among lawyers who traveled to Jamaica to volunteer their help with the boys’ cases.

The U.S. embassy and child welfare officials were able to confirm the identity of the youths and begin searching for relatives who might take custody of those under 18, she said. Representatives of Hilton’s foundation joined the effort.

The 18-year-old, no longer in the family court’s jurisdiction, was returned to the United States in coordination with the U.S. Embassy and the youth’s family, the children’s agency press release said.

Custody arrangements were made for four more.

Ultimately, three boys ended up in the custody of Jamaica child welfare when no relatives stepped forward, Post said.

Post said she was able to meet and speak with the boys, who signed agreements to accept her voluntary legal services — including the Bevins’ son.

“This young man was the one I was most worried about,” she said. “He seemed the most dejected, with very little belief that anyone was coming for him or even knew he was missing. He was just so dejected and depressed after everything he had gone through.”

Post said she was able to make telephone contact with Glenna Bevin once, who said she needed to consult with her husband before discussing her son’s care. Post said Glenna Bevin cut off contact after that. The Bevins’ son returned to the U.S. in May.

One of the eight boys remains in Jamaica as officials and advocates try to work out arrangements for his return to the United States, Growne said.

The Atlantis Leadership Academy was closed in March by officials, according to a statement from the U.S. Embassy. It was not licensed as a school and had moved locations several times, finally to a small, two-bedroom cottage, the Sunday Times story said.

Most youths got classes online, intermittently, Maldonado said.

Families paid $8,000 to $10,000 a month in fees, she said.

‘Terrifying, clickbait headlines’

Atlantis Leadership Academy has not responded to requests for comment through its website and a toll-free line it lists is not accepting calls.

The Sunday Times story said its founder and director, an American named Randall Cook, did not appear at court hearings over the facility and is believed to have returned to the United States.

Meanwhile, the academy, though closed, appears to be pushing back on some of the allegations.

On its website, under the heading Media and FAQ, it accuses some outlets of “terrifying clickbait headlines” with “horrific, pre-determined narrative attacks.”

Its comments do not directly address the allegations but rather, question the media outlets that reported them.

“Do you feel as though what you receive from the media is a narrative or genuine, honest reporting?” it asks. “It is no surprise that as a direct result of lazy reporting, half-truths and craving for sensationalism above dignity and the public common good, most media houses have continued losing massive amounts of trust among their consumers.”

It also defends parents who place their children in facilities that purport to help difficult youths, saying they in most cases are well-meaning individuals, desperate for help.

“Parents are in a place of devastation,” the academy website said. “…There is virtually no compassion for a parent that is experiencing this situational trauma in their home and lives.”

Going forward, Growne said Hilton and the foundation remain focused on advocacy meant to bring awareness of the proliferation of such facilities, both in the United States and abroad. Their foundation currently is looking into conditions at another facility in Jamaica that houses more than 150 youths.

It also is looking for stronger federal and state laws regulating such facilities and more resources to help children in the community, rather than institutions.

Children’s residential facilities, including those promising help for troubled teens, have become a multibillion-dollar industry, often with little oversight, Growne said.

Marketing often is aimed at parents of adopted children and may paint a glowing picture of substandard facilities that some parents send children to sight unseen, Growne said. Some parents use “transport teams,” hired workers, to collect their children and take them to a facility, she said.

“I think it needs to be well-known that these facilities are out there,” she said. “The marketing does not live up to the reality.”

]]> https://www.on-toli.com/2024/08/08/former-ky-gov-matt-bevins-son-back-in-u-s-after-being-removed-from-abusive-facility/feed/ 0 https://www.on-toli.com/2024/08/04/former-ky-gov-matt-bevins-adopted-son-reportedly-removed-from-abusive-facility-in-jamaica/ https://www.on-toli.com/2024/08/04/former-ky-gov-matt-bevins-adopted-son-reportedly-removed-from-abusive-facility-in-jamaica/#respond [email protected] (Deborah Yetter) Sun, 04 Aug 2024 22:52:46 +0000 https://www.on-toli.com/?p=20652

Then-Gov. Matt Bevin, speaking to a National Rifle Association event in Louisville in 2016, was an ardent advocate for adoption and critic of the adoption system. (Photo by Scott Olson/Getty Images)

As Kentucky governor, Matt Bevin said his overriding goal was to reform what he said was the state’s “broken machine” of an adoption and foster care system.

“This is the driving reason why I made the decision to run, because it needs to be fixed,” Bevin said in a 2017 interview on KET.

In that same interview, Bevin and his wife, Glenna, said their adoption of four children from Ethiopia grew from their faith-driven desire to provide homes for children in need.

“It is our desire to make Kentucky a model for the nation and the world,” said Matt Bevin, a conservative Christian and Republican who served as governor from 2015 through 2019.

But now, one of those adopted children, a 17-year-old boy, is at the center of international attention after he and seven other boys were removed from the Atlantis Leadership Academy in Jamaica in February, where authorities found horrific conditions, according to a lengthy article published July 13 in the Sunday Times of London.

In a case that has attracted the attention of hotel heiress Paris Hilton, an impassioned advocate for youths held in substandard treatment facilities around the world, Bevin’s adopted son is among those who endured unspeakable conditions, according to the Times story.

The Times story said the boys placed there, some from the United States, reported beatings, cruel punishments, lack of food and filthy, unsanitary conditions. They also reported lack of communication with families who had placed them there, going for months with no contact.

Academy rules “forbade telephone contact until a boy had advanced to a level that earned telephone privileges,” the Sunday Times story said.

Matt Bevin did not respond to an email request for comment nor did his lawyer. Glenna Bevin did not immediately respond to a request for comment through her lawyer, Mark Dobbins.

The Bevins, the parents of five biological and four adopted children, are in the midst of a contentious divorce after Glenna Bevin in May 2023 filed a petition to dissolve the marriage of 27 years she said was “irretrievably broken,”

‘The perfect location’

Located on an idyllic beachfront in Jamaica, the academy on its website promises a safe and structured environment for youth with a past history of behavioral or emotional problems.

“The perfect location for healing,” it said.

But the Times story reported a much darker picture of violence, abuse and isolation with one youth proclaiming “I’d rather die than go back.”

The academy did not respond to the Lantern’s request for comment through the website. The toll-free number it lists is out of service.

The Times said Jamaican authorities have not been able to locate the academy’s former director but reports that four staffers have been arrested and charged with child cruelty and assault.

The Times story said a boy it called “Noah,” a pseudonym, is the adoptive son of Matt and Glenna Bevin and he was placed in the school last year. The Times story, which used pseudonyms for other boys, reports that while some parents traveled to Jamaica to collect their children after the authorities intervened and closed it, no one immediately showed up for Noah or two other boys, also adopted.

When the reporter asked Noah why Matt Bevin had adopted him, the teen replied, “public image,” the Times story said.

The Times does not say how it confirmed Noah’s identity or who placed him at the academy.

Matt Bevin frequently mentioned the adoption of the four children from Ethiopia during his 2015 run for governor and after he was elected? as a reason for reforming the state’s adoption system.? An evangelical Christian, he also called on fellow members of Kentucky’s faith community to adopt and appointed a Baptist pastor as his adoption “czar,” reporting directly to him.

Bevin, after a controversial four years as governor, was defeated for a second term in 2019 by Democrat Andy Beshear.

Wards of the state

After a court hearing in Jamaica in April, the three remaining teens, including Noah, were made wards of the Jamaican state, the Times story said. It’s not clear where the Bevins’ son is now.

A staff member of the Paris Hilton foundation, 11:11 Media, which intervened in the Jamaica court proceedings on behalf of the youths and was able to arrange a custody arrangement for one, told the Lantern last week? that Bevin’s son is no longer in Jamaica but didn’t provide further information.

The U.S. Embassy in Jamaica, which initially was involved in the removal of youths from the academy, did not respond to a request for comment.

The Bevins are in the midst of a contentious divorce sought by Glenna Bevin in May 2023.

?In April 2024, Glenna Bevin obtained a court order barring Matt Bevin from her home after she claimed he kept entering her house without permission, refusing to leave. The couple have been separated for about two years, according to the divorce records.

Matt Bevin’s wealth, developed from a career in finance, was estimated in excess of $13 million when he ran for governor in 2015. He and Glenna Bevin live in separate houses in Anchorage, an affluent enclave east of Louisville.

The divorce filing indicates they have nine children, two of them minors. Glenna Bevin is seeking joint custody of the two youngest, with her as “primary residential parent.”

‘Shipped them off’

Hilton traveled to Jamaica in April for a court hearing to show support for the eight boys removed from the academy. She said it is part of her work through her foundation to draw attention to what Hilton said is a growing industry of abusive residential programs for so-called troubled children and teens.

Hilton said she is a survivor of such programs after she was placed in several in the United States starting at age 16 where she was treated violently, sexually abused, forcibly medicated and isolated.

She testified before a Congressional committee in June in support of federal legislation to provide resources meant to keep children out of institutions, citing her trip to Jamaica as an example of what can go wrong when parents send their children to such places with little information and limited or no contact.

Youths at the Jamaica academy were abused,? beaten, “waterboarded” and held in solitary? confinement, Hilton said in her testimony before the House Ways and Means Committee. Some were from adoptive families, she said.

“Their parents had adopted them when they were young, promised them a better life, and then shipped them off to an international facility to be warehoused there until they turned 18,” she said.

Her appearance at the Jamaica court hearing created a sensation when her motorcade pulled up at the courthouse, according to the Sunday Times story. It made the story front-page news in Jamaica.

“Every head turns as a blue-light police motorcade pulls into the car-park,” the story said. “A vision of blonde perfection emerges from a car, wearing the serious expression of a woman who means business. The boys get out of their bus, stunned, and one by one Hilton hugs them. She listens as they tell their stories about what they suffered at (the academy) before they are filed into the courtroom.”

No one showed up on behalf of three of the eight boys including Bevin’s son, the story said.?

Afterwards, the three are sent away with Jamaican child protection officials who try to reassure them.

“The boys stare at their feet, broken and lost,” the Times story said.

The ’broken machine’

In his campaign for governor, Bevin early on attacked the state’s adoption and foster care system, calling the agency within the state Cabinet for Health and Family Services, a “convoluted, backward, broken machine.”

Bevin’s chief complaint, one he cited often during his campaign and after he was elected governor, was that he and his wife were rejected as potential adoptive parents by cabinet social service officials because they already had five biological children at home.

The decision came, he said, after the Bevins sought state approval as adoptive parents in hopes of adopting a young girl in foster care their children had met on a local playground.

After the Bevins went through extensive work including background checks, home inspections and parenting classes at their own expense, they were rejected, Matt Bevin said,

“It was ultimately determined by someone with a clipboard and a notebook that having a sixth child in a family would not afford her with enough attention,” Bevin told a reporter in 2015 while he was running for governor. “I could not believe it.”

So the Bevins decided on an international adoption, the couple told KET host Renee Shaw in the 2017 interview after he was elected governor.

Initially, the Bevins had arranged to adopt a single child from Ethiopia but then changed their plans after learning of three siblings from that country also in need of a home. The adoption of all four children took place in 2012.

“Suddenly we had nine children,” Bevin said.

The four adopted children had no difficulty assimilating into the Bevins’ household—even though they were a different race and spoke a different language, the couple said in the KET interview.

“It really wasn’t a big adjustment,” said Glenna Bevin, who as Kentucky’s first lady took on improving adoption and foster care as her primary cause.

“Kids are amazing,” Matt Bevin said. “It really has been a very, very seamless transition.”

At some point? after Bevin lost his bid for a second term as governor in 2019, his teenage adopted son was sent away to a school in Florida, the Times story said. Last year, it said, the youth was moved to the facility in Jamaica.

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an? FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency’s Louisville office.

ARC, which is funded almost entirely through Kentucky’s Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form “if you believe you were victimized by ARC or have information relevant to this investigation.”

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

“We have recently learned that there is a federal investigation into ARC,” the statement said. “As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation.”

Collier directed further inquiries to ARC’s chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state’s largest provider of substance use services.

Robinson and? his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said.

He also praised Robinson, ARC’s founder, in his State of the Commonwealth speech in January.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus’ analysis in the Kentucky Lantern of campaign finance records.?

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to?Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers including some who wrote recent letters on ARC’s behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

The rate cuts of 15% to20% proposed by three of the six private insurance companies that process state Medicaid claims became public this week at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky’s efforts to turn the tide of addiction to drugs and alcohol.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state’s $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members?“are proud to work collaboratively with quality, trustworthy?providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

Addiction Recovery Care and its owner Tim Robinson have rebuilt a block in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space. (Kentucky Lantern photo by Matthew Mueller)

FRANKFORT — The state’s largest provider of drug and alcohol treatment is warning that looming cuts in Medicaid reimbursement to some providers could damage efforts to curb addiction that has engulfed Kentucky — just as the state is showing improvements.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

A handful of companies that provide substance use disorder treatment, including ARC,? have been notified they face cuts of 15% to 20% from some private insurers that handle most Medicaid claims, Brown told the committee.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Brown was joined by Deron Bibb, chief financial officer for Stepworks, a recovery program based in Elizabethtown, and ARC executive John Wilson, also executive director of the Kentucky Association of Independent Recovery Organizations, speaking to the interim joint Health Services Committee about the cuts.

“This will likely result in higher overdose rates, higher recidivism, more crime and incarceration,” Bibb said. “We need to understand the full scope and impact of these cuts.”

The cuts have been announced by three of the six managed care organizations, or MCOs, private insurance companies that handle claims for most of the state’s $16 billion-a-year Medicaid program, Brown said.?

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

Under their contracts with the state, the MCOs generally have authority to set rates they pay providers. The state pays MCOs a fixed amount per member to cover Medicaid costs.

One company also has begun notifying patients it will no longer cover addiction services at ARC effective Sept. 30, Brown said.

He did not identify the MCOs that have announced cuts and declined to do so after the hearing, saying ARC and other companies are still attempting to negotiate with them.

Sen. Stephen Meredith, R-Leitchfield and co-chairman of the health committee, said Tuesday the lawmakers likely would seek more testimony on the subject, including from the MCOs.

“I know there’s two sides to every story,” he said.

Wellcare, with 420,000 members, is the largest of the six MCOs followed by Passport by Molina, Aetna, Anthem, Humana and United HealthCare. Together they oversee payment of Medicaid claims for about 1.4 million Kentuckians.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Wilson said the recovery organization he represents wants to make sure lawmakers are aware of the situation and already has asked them to voice concerns.

“There’s going to be real world consequences and I think it’s important to let legislators know what’s taking place,” he said.

Some defenders benefitted from owner’s largesse

Several lawmakers have signed letters urging that the MCOs suspend any cuts to substance use treatment until the General Assembly can further review the matter. They include some in key leadership positions and some who have benefited from campaign donations from ARC founder and owner Tim Robinson and his employees.

ARC, a for-profit company based in Louisa, has emerged as the state’s largest and fastest growing provider of addiction services, financed largely by Medicaid, the government health plan with the majority of funds from the federal government. Growth took off after 2014 when substance use treatment was included in the Medicaid expansion authorized by the Affordable Care Act.

The Lantern reported the company took in about $130 million last year in Medicaid funds and was by far the largest recipient of the about $1.2 billion the state spent on substance use treatment.

The company and Robinson also have become among Kentucky’s major political donors with more than $500,000 in contributions over the last decade — with funds divided among Republican causes and those of Gov. Andy Beshear, a Democrat, the Lantern reported earlier this month, citing campaign finance and other public records.

Sen. Phillip Wheeler, R-Pikeville, who has received $19,900 in contributions from Robinson, his wife Lelia and ARC employees since 2016, on July 9 sent a letter to Kentucky Medicaid Commissioner Lisa Lee urging the cuts for addiction services be suspended “until the legislature fully understands the reasons behind them.”

“Kentucky has made great progress in tackling the addiction crisis that has touched so many of our constituents, neighbors, colleagues, friends and family members,” Wheeler said.?

Cutting reimbursement now “could negatively affect some of our most vulnerable citizens and prevent us from seeing these positive trends continue,” his letter said.

A similar letter addressed to “to whom it may concern” was signed by Rep. Patrick Flannery, R-Olive Hill, who has received about $17,000 in campaign contributions from Robinson and ARC employees.

Another letter was signed jointly by Senate President Robert Stivers, R-Manchester, House Speaker David Osborne, R- Prospect, Rep. Kimberly Moser, R-Taylor Mill and Meredith. Moser and Meredith are co-chairs of the joint Health Services Committee which heard from ARC and other treatment officials Tuesday.

Republican supermajorities control the Kentucky House and Senate.

Robinson has given $10,000 to the Kentucky House Republican Caucus, and $15,000 to the Kentucky Senate Republican Caucus in the last four years.

Robinson also has given other contributions to campaigns of Republican state legislators in the past decade including $4,100 to Moser and $2,000 to Osborne.

From 2021 through 2023, ARC companies and employees gave about $252,000 to a political committee supporting Beshear, whom Robinson, a Republican, has said he admires and would like to see run for president.

Bibb, Stepworks’ chief financial officer, gave $500 to Flannery in December 2023 and $2,500 to the Kentucky House Republican Caucus in October 2022, according to Kentucky Registry of Election Finance records.

Not asking for more money, just no cuts, says company official

Brown said that one concern of the MCOs is the cost of treatment, in particular long-term treatment for addiction.

ARC understands concerns about costs, but experience shows people with addiction benefit the most from long-term services, Brown told the committee.

“It is not just about surviving from their addiction but thriving in their communities,” he said. “Long-term treatment is vital.”

Without quality treatment, costs to the state will rise elsewhere, Bibb said.

“These costs will not go away,” Bibb said. “They simply will shift back to the emergency room, the judicial system, foster care, homelessness.”

ARC is willing to work with the MCOs and the state to ensure it is using money efficiently and effectively, Brown said after the hearing.

“Everybody’s got to be good stewards,” he said. “We’re committed to helping provide a solution.”

Brown and Wilson said representatives of treatment providers plan to meet with MCOs and state officials in coming weeks to try to resolve their differences.

“We’re not asking for more money,” Brown said. “We’re asking for no cuts.”

Wheeler, in an interview, said he appreciates the support of Robinson, a longtime friend since college together at the University of Kentucky, but that’s not why he sent the letter.

Rather he’s concerned about the impact of cuts of up to 20% on ARC’s services, which he said have helped many people in the region including a brother who benefited from its treatment program.

Also, he said, ARC is a major employer in the area where jobs have been scarce and also trains its clients for jobs.

This story has been updated with a statement from the Kentucky Association of Health Plans.

Michelle Tynes, of Hickory, in Graves County with her grandson, Ashton. (Photo provided).

Increasingly worried about suspected abuse of her young grandson, Michelle Tynes said she battled for years with Kentucky social service workers to act on what she said was the deplorable situation in the Western Kentucky home where he and four other children lived.

“I made multiple reports,” said Tynes, who eventually won full custody of her grandson in 2019 after a lengthy court battle. “I reported and reported. They would do nothing.”

So Tynes, who lives in Graves County, turned to the ombudsman within the Cabinet for Health and Family Services — an office supposed to investigate and resolve complaints about cabinet agencies including child welfare services.

“I made multiple reports to the ombudsman’s office about them not doing anything,” Tynes said.

The result?

“Nothing. I never did get a call back,” she said. “Nothing.”

Tynes, based on her experience, said she’s glad that the Kentucky General Assembly enacted a law to move the ombudsman’s office from inside the cabinet to the office of the state Auditor of Public Accounts, effective July 1.

The move was meant to provide outside oversight and end “the practice of the cabinet investigating itself,” said Sen. Stephen Meredith, R-Leitchfield, the sponsor of the 2023 bill to make the change.

But nearly a month after state Auditor Allison Ball’s office was supposed to launch the new ombudsman’s office, the Republican auditor is at an impasse with the administration of Gov. Andy Beshear, a Democrat, over access to a central computer system known as TWIST the cabinet uses to house confidential records of child abuse and neglect cases.

TWIST (short for The Workers Information System) contains reports of suspected child abuse or neglect, records of investigations and findings, and extensive and often sensitive information about families’ histories, medical records, mental health, substance use and criminal histories. It also contains similar details of cases involving suspected abuse or exploitation of vulnerable or elderly adults.

Access to TWIST is strictly limited by state law to cabinet social service officials? under Kentucky Revised Statute 620.050, with some exceptions for certain parties within the cabinet, law enforcement and prosecutors, outside medical or social service officials and the parent or guardian of the child in question.

The state auditor’s office is not among those parties allowed access to TWIST under current statute, Beshear’s administration said.

“The cabinet supports the auditor’s office desire to have full access to the system, but current statutes passed by the General Assembly prohibit it,” a cabinet spokeswoman told the Lantern in a statement.

Auditor’s ‘demand letter’

On July 9, Ball fired off a “demand letter” to Eric Friedlander, secretary of the Cabinet for Health and Family Services, insisting that the law does allow her newly-established ombudsman’s office access to TWIST.

Ball’s letter cites a section of Senate Bill 48, the 2023 law moving the ombudsman to her office that requires that all “staff, personnel, files, equipment, resources, funding and administrative resources” be transferred to the auditor.

Lawmakers who approved the legislation “unequivocally expressed that their intention was to provide the ombudsman with full, direct and real-time access to iTwist,” Ball’s letter said.

But what SB 48 does not do is amend the separate law that governs the confidentiality of TWIST, KRS 620.050.

One example of how that was done was in 2013, when the legislature approved a law to create an independent panel to review all cases of deaths or serious injuries from child abuse and neglect.?

The enabling legislation, House Bill 290, amended the law governing access to the TWIST system specifically to include members of the External Child Fatality and Near Fatality Review Panel.

First Amendment lawyer Michael Abate, who is familiar with the TWIST statute, said that while it allows access to confidential records by some agencies, the language does not appear to include the state auditor.

“It might make sense to allow the auditor to have access to those records if they want to fill the ombudsman’s role,” he said.

But the bill moving the ombudsman to the auditor doesn’t change the language of the statute restricting access to TWIST.

“That seems like a real oversight in drafting the bill,” he said.

In comments to reporters on July 11, Beshear said the law needs to be changed if the auditor wants access to TWIST, suggesting such changes could be made when the General Assembly next meets in January.

“I’m sure the General Assembly intended for the ombudsman to be able to do what they need to do and I support them having the access, but we have a written statute that is on the books that says we can’t provide certain access,” Beshear said.

Ball has not received a reply to the demand letter, a spokeswoman for Ball, Joy Pidgorodetska Markland, said Tuesday. Markland said Ball is scheduled to update lawmakers on the situation July 30 at the interim joint Committee on Families and Children.

TWIST records ‘mind-blowing’

Meanwhile, Tynes, the Graves County grandmother, said she doesn’t see how the new ombudsman’s office can investigate any complaints about child abuse or neglect without access to TWIST.

She was able to obtain the TWIST file for her grandson and other children in the? home as part of her court fight to get custody of her grandson, which she won in 2019.

Tynes said the file was voluminous.

“I have nine years’ worth of TWIST reports,” she said. “I still have it in a storage box and it’s not a little box.”

When she was able to obtain the file, through the legal case she pursued in family court, she was shocked at the multiple reports of child abuse or neglect not only from herself but from school and day care workers, medical providers and others.

“It was mind-blowing,” she said. “It was just astounding, the amount of evidence.”

Tynes said she believes that, had an outside ombudsman been able to get a look at the case, it would have taken far less time than the nine years and prolonged legal battle it took for her to get custody of her grandson and have the other children removed from the home.

“They (the cabinet ombudsman) never did do anything about it,” she said.

Among supporters of moving the ombudsman outside the cabinet was Kentucky Youth Advocates, which said it would “create an independent place for people to contact with concerns and reduce potential conflicts of interest.”

A ‘deep, dark hole’

Norma Hatfield, a longtime advocate for “kinship care” relatives — grandparents or other family members who take in children in cases of abuse or neglect — said she too believes the state needs an outside ombudsman to investigate complaints.

Hatfield said she has worked with multiple relatives, including Tynes, to file complaints with the cabinet’s ombudsman.

Often, she or the families never get a response — let alone results.

“I would send something in and it would be like some deep, dark hole,” she said. “You never even get any confirmation.”

As for access to TWIST, Hatfield said that is vital to any meaningful investigation about complaints of how the cabinet handles abuse or neglect cases of children or vulnerable adults.

“They have to have access to that information,” Hatfield said. “If they can’t get access to the files they need, they’re not going to be able do an investigation.”

Hatfield said she can’t speak to the dispute between the cabinet and the auditor over the law governing access to TWIST but said the parties need to get it resolved.

“It has to change, it really does,” she said. “Hopefully, it’s about doing the right thing regardless of political issues and organizational charts.”

Tim Robinson, CEO of Kentucky's largest substance treatment provider, photographed June 27 at Addiction Recovery Care's headquarters in Louisa. (Kentucky Lantern photo by Matthew Mueller)

LOUISA — Around the office at Addiction Recovery Care, or ARC, Vanessa Keeton is still known as “Client One” — marking her status as the first client of the first recovery center the organization opened as a group home in Lawrence County.

But her official title is vice president of marketing for ARC, where she has worked since 2012, a little more than a year after she entered the program known as Karen’s House — choosing it over jail for a string of drug and alcohol-related offenses.

“Dec. 2, 2010, that was my first day,” she said. “That’s a day I’ll never forget as long as I live. That’s the day that everything changed.”

ARC, too, has changed dramatically since it started as a treatment home for women run by volunteers, based largely on Bible study and prayer.

It now operates as a for-profit company paid $130 million last year by Medicaid, ?the government health plan which in 2014 expanded access to addiction treatment, or substance use disorder, as it’s now known.

Gov. Andy Beshear has praised ARC for helping Kentucky — ravaged in recent years by addiction and overdose deaths — become the state with the most treatment beds per resident in the nation, according to an East Tennessee State University study.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at an ARC ribbon-cutting for a new facility in March.

Owned by founder and CEO Tim Robinson and his wife, Lelia, the company provides the couple an annual income of about $533,400, according to a 2022 tax-filing by Odyssey Inc, a non-profit affiliated with ARC.

Robinson said he and his wife struggled financially for years while establishing the treatment business — facing potential foreclosure on their home and repossession of their car. He doesn’t think that income is unreasonable.?

“We took a lot of risks,” said Robinson, 48, a lawyer and recovered alcoholic who has been sober since 2006 — two years before he started building the faith-based treatment business that would become ARC. “I’m living the American dream. I’m doing better than I ever thought I could be doing financially.”

Kentucky’s largest provider

The fast-growing company is by far the state’s largest substance treatment provider, with 1,800 residential beds in 24 Kentucky counties, and reaches hundreds more clients through outpatient services. ARC, which estimates it provides 75% of treatment beds in Kentucky, also is planning programs in Ohio and Virginia.

Earlier this year, ARC opened a 40-bed behavioral health unit with plans to expand to 300 at the former Our Lady of Bellefonte Hospital in Ashland, which closed in 2020. In 2020, ARC opened its largest center — with a capacity for 700 — on the campus of St. Catharine College in Springfield, which closed in 2016.

ARC is no longer simply a treatment organization, said Matt Brown, a former ARC client who overcame addiction and now serves as ARC’s chief administrative officer and president of ARC Healthcare.

“We view ourselves as a behavioral health system,” Brown said.

While Christian faith remains at the heart of its mission, ARC relies on professional therapists, medical specialists including nurses and doctors, a structured treatment program and medication such as Suboxone to reduce the cravings of some patients for drugs and help them maintain sobriety, Robinson said.

Its religious component — which includes tracking how many clients decide “to follow Christ” (1,320 in 2023) — is strictly voluntary, according to Robinson, who said he was able to get sober in 2006 with the help of a local pastor and friend who “led me to the Lord.”?

More importantly, he said, is that the number of clients who agree to stay in long-term treatment up to six months has increased steadily, which he thinks is the best indicator of effectiveness of the program.

Medicaid, which funds the majority of substance treatment, doesn’t require programs to measure outcomes.

But ARC measures its own outcomes, which it reports to Medicaid quarterly, Robinson said. That includes a retention rate of around 70% of its clients in treatment for up to six months and even longer through periodic contact with a case manager.

“I’ve been in this a long time,” Robinson said. “Long-term residential treatment is the reason people recover.”

As an indicator of success in addressing addiction, the Beshear administration points to the decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

But Beshear said the fight must continue.

“We recognize that even while we celebrate progress, there’s a lot of heartbreak and pain because of this epidemic that continues,” Beshear said.

Last year, ARC received about $130 million in payments from Kentucky’s Medicaid program — more than double the amount of its closest competitor, Spero Health, a Nashville- based company that received $60 million in Medicaid funds in 2023, according to the Cabinet for Health and Family Services, which licenses and oversees treatment facilities.

ARC accepts private insurance, but Robinson and Brown said that almost all of the company’s revenue is from Medicaid since their clients generally have lost jobs and any health insurance because of addiction.

Overall, the state spent $1.2 billion on substance use disorder services in fiscal year 2023, with the majority of funds coming from the federal government, according to the cabinet.

Robinson, a former county prosecutor who started his business from a home office in Louisa, has emerged as a major political donor and well-connected business leader, last year appointed to the Kentucky Chamber of Commerce board.

Beshear singled out Robinson for recognition in his State of the Commonwealth speech in January, calling him “an essential partner in our fight against addiction.”

Robinson, a lifelong Republican, is effusive in praise for Beshear, a Democrat, in part because of the governor’s emphasis on addiction treatment and the governor’s frequent references to his own religious faith.

“I’ve never been for anybody like I’ve been for Andy Beshear,” Robinson said. “I hope he runs for president.”

‘Treatment on demand’

ARC employs 1,350 people with 500 based at its headquarters in tiny Louisa (population 2,600) perched on the edge of the Big Sandy River next to West Virginia. The company is Lawrence County’s largest employer, ahead of the school system and local hospital.

About 40% of its workers are “graduates” of its treatment program, Robinson said, and most of its upper management — himself included — are in recovery from addiction.

ARC promises “treatment on demand,” and operates a 24-hour hotline people can call to identify help within 15 minutes, including transportation, if needed, to one of its centers. Last year it served more than 12,000 individuals from 119 of Kentucky’s 120 counties.

It has developed a network of job-training programs including welding, automotive repair, lawn service, culinary arts, chaplaincy and food service. As part of that, ARC has rebuilt more than a block of rundown buildings in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space.

It offers clients a chance to get certification toward a trade and get college credit for some training.

ARC owns a pharmacy used to provide medication to clients, a laboratory for medical testing and operates a health clinic in Louisa. Also, Tim and Lelia Robinson founded the private Millard School, a Christian academy in Louisa attended by some children of their employees.

Vanessa Keeton’s husband, James Keeton, a 2011 ARC graduate, manages the Second Chance garage which repairs and restores autos for the public as well as maintaining an ARC fleet of about 200 vehicles.

“We restore cars and we restore lives,” he said.

The Keetons live in Louisa and their son attends the Millard School.

And ARC runs a sophisticated marketing program complete with a website, billboards, television and radio commercials, a social media presence, sponsorships and news releases, contracting with the Louisville-based public relations firm, RunSwitch. Scott Jennings, CNN commentator and Republican political consultant, is one of RunSwitch’s founding partners. ARC spends about 4.5% of its revenue, or about $5.8 million a year on marketing.

Vanessa Keeton said the marketing is important to promote awareness of its services to those in need, “to meet people where you are.”

‘Buying influence?’

Some outsiders criticize ARC for its rapid growth, its size and Robinson’s political giving, including Mark La Palme, the founder and former CEO of Isaiah House, a treatment program based in Harrodsburg.

La Palme, now retired, said he worked with Robinson on a project in the mid-2000s but parted ways over disagreement with practices including designating clients as “interns” in ARC programs for low pay while in treatment, saving the company the cost of paying a regular employee.

He calls ARC “huge,” has called it a “bully” in a social media post and questions its rapid expansion. La Palme also questions the prolific giving of Robinson and ARC entities, which rank among the state’s major political contributors.

“It seems like you’re buying political influence,” he said.

But he allows Robinson has been highly effective in building ARC into the state’s largest treatment system.

“He’s dangerously brilliant,” he said.

Robinson considered La Palme a friend and colleague but said they parted ways after a proposed collaboration fell through. Robinson said ARC’s programs meet all state standards, are accredited and the company works to provide high quality care.

He said internships are a way of introducing people to job skills they will need to succeed once they leave treatment and interns in various job training programs receive a paycheck either through ARC or an outside employer.

Robinson said he doesn’t apologize for political giving, seeing it as a way to support causes and politicians he believes in.

And he doesn’t think ARC is too big, saying that the company had to expand to remain viable within the constraints of Medicaid reimbursement, which pays for most of its clients.

“We had to grow to survive,” he said.

Robinson’s employees who spoke with Kentucky Lantern, including Brown, are highly enthusiastic about the boss.

Brown, trained as a physical therapist, battled addiction for 18 years before coming to ARC as a patient and remaining as an employee.

Robinson is “a visionary,” Brown said during a tour of ARC properties in Louisa, “He sees things in people before they see it in themselves.”

‘Papaw taught me’

Robinson said he grew up next door to Louisa in Martin County, his home in “the poorest part” of a poor county.

His introduction to business came from his grandfather who owned a country store.

“He put me on a pop carton to run the cash register,” he said. “Papaw taught me about business.”

Another boyhood business venture of Robinson’s — selling baseball cards — would provide a life-changing entrée into college and law school, when he was befriended by Inez banker and businessman Mike Duncan, a power player in Republican party politics and former chairman of the Republican National Committee.

Robinson said he and Duncan crossed paths when he began selling baseball cards to his young son, Robert M. “Rob”? Duncan, who also would become a lawyer and, under former President Donald Trump, was appointed U.S. Attorney for the Eastern District of Kentucky.

Rob Duncan now serves as the top deputy to Kentucky Attorney General Russell Coleman.

Robinson considers both the father and son friends but said he remains closest to Mike Duncan, a trusted friend and adviser.

Mike Duncan, Robinson said, showed interest in his boyhood baseball card venture and became a mentor, encouraging Robinson to go to college — a prospect he hadn’t considered.

“Nobody in my family ever went to college,” Robinson said.

But with Duncan’s encouragement, Robinson graduated from the University of the Cumberlands in Williamsburg, earned a law degree from the University of Kentucky and was elected student body president at both institutions.

Good times and bad times

“He helped me through the good times and the bad times,” Robinson said.

Among the worst times: Robinson’s 2003 indictment for felony vote fraud while he was student body president at UK, after some 750 voter registration cards collected during a student government drive were never turned in. Apparently forgotten, they were later found in a student government office, according to a 2003 Lexington Herald Leader story.

“It was devastating,” Robinson said. “I thought my whole life was over.”

Instead, with the help of his lawyers, Robinson pleaded guilty to a lesser misdemeanor charge of failing to turn in the registration cards and paid $90 in restitution. Robinson said he dropped out of law school during the legal case, but was readmitted and graduated.

But that ordeal, plus the death of his mother while he was at UK, “finished my mental health off,” Robinson said.

He returned home to Eastern Kentucky to work but alcohol by then had a powerful hold on his life.

‘A raging alcoholic’

Back in Lawrence County, Robinson joined in law practice with a friend and became an assistant county attorney but by then said he had become a “raging alcoholic” though still somehow able to perform his job.

He would drink on weekends, come to work on Mondays hung over and avoid alcohol on days he had to be in court. Toward the end of the week, Robinson said, he’d resume drinking and stay drunk till the following Monday.

“I was leading kind of a double life,” he said.

That continued until a deputy sheriff at the courthouse where Robinson worked intervened. The deputy, also a pastor and a recovering alcoholic, helped Robinson stop drinking through prayer and support — taking him with him to nightly events where he would preach and play Bluegrass music.

Though Robinson said he knew nothing about treatment or programs such as Alcoholics Anonymous, he decided he needed to expand services in the region that in the mid-2000s offered little.

“I was convinced God was calling me to stop practicing law and start a recovery center,” Robinson said.

So he did, leaving his law job and starting out of a home office on Nov. 3, 2008.

Robinson got help from? Rev. Ralph Beiting, a Catholic priest who founded the Christian Appalachian Project based in Paintsville and together they opened a recovery house for women in Lawrence County called Karen’s House.

It was a makeshift operation run by volunteers with donated goods, including some old Army cots. Meanwhile, Robinson was taking men to the closest treatment center, Chad’s Hope in Clay County, getting occasional funding from Operation UNITE, launched in 2003 by U.S. Rep. Hal Rogers to help Kentucky battle rising addiction — in particular the tide of opioid pain pills engulfing the state.

But broke and discouraged, Robinson was close to quitting when he contacted a consultant who suggested he expand by opening a second recovery center for men. He located a site in Fleming County and in 2013, Belle Grove Springs was opened by the company that would become ARC.

Brown, now ARC’s chief administrative officer, was among the first clients admitted to the men’s center.

The following year, under the Medicaid expansion authorized by the Affordable Care Act, the government health plan began funding substance use disorder services and a reliable funding stream opened. Kentucky was among the first states to include addiction as a service covered by Medicaid.

While the income was welcome, it wasn’t enough to finance ARC’s operation and Robinson said the company’s only choice was to expand and recoup more money through a higher volume of clients.

“People thought we were growing because we were booming but we had to grow to survive,” he said. “You cannot make it on a couple of small facilities.”

ARC didn’t show a positive cash flow until 2019, he said.

‘Take our time’

While ARC expansion has slowed, Robinson said the company is still looking at other opportunities, including expansion into Virginia, which has far fewer treatment beds than Kentucky.

“We’re going to take our time,” he said.

ARC also was flagged in a budget item this year by the state General Assembly with a $12 million allocation over two years directed to the Life Learning Center in Covington, an organization aimed at helping people develop skills to improve their lives “through gainful employment.”

The budget line says the funds are to be distributed to the center to support “treatment, rehabilitation, and community reintegration in partnership with Odyssey Inc.”

Odyssey is the non-profit arm affiliated with ARC.

Robinson said he expects Odyssey to submit a proposal as treatment provider for a program the center plans to establish in Somerset.

And while his work has expanded statewide and beyond, Robinson said he’s committed to staying in Louisa and keeping his company headquartered there.?

“I’m where I’m going to be,” he said. “This is my adopted hometown.”

Wielding the ceremonial scissors, Gov. Andy Beshear helps cut the ribbon on the Yellow Banks Recovery Center in Owensboro. Beshear is flanked by Tim Robinson, founder and CEO of Addiction Recovery Care, third from left in the photo, and Rocky Adkins, senior adviser to Beshear, Aug. 3, 2023. The center was ARC's first in Western Kentucky. (Photo courtesy of ARC)

FRANKFORT — In his State of the Commonwealth speech in January, Gov. Andy Beshear took a moment to address the scourge of addiction in Kentucky, singling out for praise the state’s largest provider of treatment services.

Addiction Recovery Care, or ARC, the Eastern Kentucky-based company — with about 75% of the state’s treatment beds — has grown rapidly over the past decade to dominate the treatment business, financed mostly through Medicaid.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

But as he worked to open more addiction recovery beds, Robinson was doing something else that surely didn’t hurt his chances of winning such high praise from the governor during the speech televised statewide on KET.

Robinson was donating big to Beshear.

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to Kentucky Lantern’s analysis of online government databases of political contributions.

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He even gave big to? Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients. That care is mostly financed through Medicaid, the government health plan that expanded care for substance use disorder in 2014.

Except for the money given to Beshear political committees, virtually all of the rest went to Republicans like Bevin, Attorney General Russell Coleman, U.S. Rep. Hal Rogers and candidates for the Kentucky legislature.

In an interview Robinson explained, “I’ve never been for anybody like I’ve been for Andy Beshear,” saying that of all the public officials he has met, Beshear has a unique ability to bring people together.

“I hope he runs for president,” Robinson said. “I’m a Republican and I don’t care who sees that.”

Total giving: $570,838

The Lantern found 266 contributions totaling $570,838 over the past decade from Robinson, his companies and his employees listed in online databases of the Kentucky Registry of Election Finance, Federal Election Commission, and the Internal Revenue Service.

Of that total, Robinson made 92 contributions totaling $262,405. (Included here are a few donated by his wife Lelia.)

A huge share of the donations — $216,050? — came from Robinson corporations.

And the remaining $92,383 came in scores of mostly small contributions from officials and employees of Robinson’s companies primarily Addiction Recovery Care, the Kentucky Lantern analysis shows.

Robinson said that the total of more than $570,000 “seems high to me.” But he added, “Whatever the record is, the record is.”

Robinson, a recovering alcoholic who grew up poor, said he has no compunctions about his political donations, after years of struggling financially to build ARC from a single halfway house to a statewide network of treatment centers with an annual revenue of about $130 million a year.

Biggest share to Beshear

Kentucky Lantern’s analysis showed that Robinson employees began donating relatively small amounts to Beshear’s campaign committee at the very outset of his reelection campaign in late 2021.

Before the election was over, Robinson and his employees and a small political action committee he funded donated $26,525 to the Beshear campaign, the Kentucky Democratic Party and other political committees backing Beshear.??

That’s a modest amount, but what made Robinson a major donor to Beshear were the larger contributions his corporations made to the Democratic Governors Association. The corporations — primarily London Valu-Rite Pharmacy — donated $197,000 to the Democratic Governors Association (DGA) in 2022 and 2023.

The DGA financed a $19 million independent campaign last year to reelect Beshear. The DGA is a tax-exempt 527 organization that can accept contributions of unlimited amounts from people, corporations or labor unions.

Robinson said he gives through companies he controls, including the pharmacy and health clinic, for the obvious reason that there is no legal limit on how much a donor can give to such groups. (State and federal law limit how much a person can give to a candidate for statewide office per election to $2,100 and limit to $15,000 how much a person can give to a state political party. Corporations are forbidden from contributing to a campaign for state office or to a state political party.)

Robinson giving to Beshear political causes continued last December when Robinson gave $29,000 to the committee that paid for Beshear’s inauguration celebration. Inaugural committees are allowed to take contributions of unlimited amounts and Robinson’s is the largest contribution by any individual to Beshear’s inaugural committee.

?Support for Russell Coleman, Republicans

The biggest Republican beneficiary of Robinson contributions in the last election cycle has been Attorney General Russell Coleman, who now holds an office that is second only to the governor in setting and enforcing policy in Kentucky’s fight to reduce substance abuse and addiction.

Robinson, his corporations and employees gave at least $37,700 to Coleman political committees since late 2022.

Robinson gave $10,416 to a super PAC supporting Coleman called Safer Kentucky in late 2023. He also gave $6,000 to the committee that financed Coleman’s inauguration celebration.

His London Valu-Rite Pharmacy also donated $10,000 in 2023 to the Safer Kentucky PAC. Contributions from Robinson and his employees to Coleman’s campaign bring the total contributions from the Robinson group to Coleman to about $37,700.

Robinson said he has known Coleman for years, respects Coleman’s background as a U.S attorney and FBI agent, and agrees with Coleman’s stance on policy and enforcement.

“I went to law school with Russell. He and I have been friends since then,” Robinson said. “I think he’s probably the most qualified person we’ve ever had as attorney general.”

Kentucky Lantern’s analysis shows Robinson has supported many Republicans through the past decade.

Besides his big support for Bevin in 2019 and Coleman in 2023, he has long been a donor to the political committees of U.S. Rep. Hal Rogers. He regularly donates to the Republican caucuses of the Kentucky House and Senate as well as individual Republicans running for seats in the General Assembly.

He and his employees have been particularly persistent donors who have provided a strong and reliable flow of campaign dollars to three eastern Kentucky legislators: Sen. Phillip Wheeler of Pikeville, Rep. Patrick Flannery of Olive Hill? and Rep. Danny Bentley, of Russell.

And recent contributions show that for the first time Robinson is reaching beyond Kentucky’s borders. Early this year he and ARC employees gave at least $20,000 to a political committee of Patrick Morrisey, West Virginia’s attorney general and Republican nominee for governor in this fall’s election.

A teacher waves to her students as they get off the bus at Carter Traditional Elementary School in Louisville on Jan. 24, 2022, in this file photo. (Photo by Jon Cherry/Getty Images)

Two parents have filed a federal lawsuit challenging Jefferson County Public Schools’ plan to drop bus service to most magnet schools this fall, claiming it violates the rights of their children to continue education at schools they currently attend.

The lawsuit, filed in U.S. District Court in Louisville Thursday, comes two months after the board of the state’s largest school system, in a highly controversial move, voted to end transportation to most magnet programs because of a shortage of bus drivers. The vote followed the chaotic beginning to the 2023 school year in which students waited hours for their school buses or missed service altogether because of a restructured transportation system.

JCPS was forced to temporarily suspend the start of classes to try to fix the system.

A JCPS spokesperson did not immediately respond to a request for comment.

Thursday’s lawsuit echoes concerns of Louisville civil rights leaders who have argued that ending school bus service to magnet schools — which provide specialized programs or training — would disproportionately affect Black and low-income students whose families lack means to transport them to schools outside their home districts.

Overall, up to 15,000 students at nearly 30 schools could be affected although JCPS has said it is working on plans to try to restore some service for magnet schools.

The JCPS action could adversely affect up to 14,000 Black students, said the lawsuit filed by Louisville lawyer Teddy Gordon, a longtime legal adversary of the school system.

“I have come out of retirement and am in poor health in order to right the terrible wrong of JCPS current actions, especially the hardship that JCPS has placed on African American students,” Gordon said in a statement.

The lawsuit claims the JCPS transportation plan violates the rights of Black students, including the plaintiffs. It also claims that JCPS violated the state open meetings law through the hastily called meeting in April when the board adopted the plan.

And it notes the plan was adopted on vote of 4-3, with four white members voting for it, and the three Black members voting no.?

The lawsuit is filed by Mary Bledsaw, of Valley Station, and Taryn Bell, of West Louisville, and claims the lack of bus service would make it impossible for their children to attend their current schools.

Bledsaw has two sons in high school magnet programs, one at Male High and the other at Central High. Neither is close to their southwest Jefferson County home and likely would force both to attend Valley High, which the lawsuit calls “one of the worst high schools in Kentucky.”

Bell has a son enrolled in a magnet program at Whitney Young Elementary and without school bus service, could not attend it any longer, the lawsuit said. Instead, he would have to attend his home school, Martin Luther King Elementary, which the lawsuit also describes as “one of the worst schools in Kentucky.”

The lawsuit asks that a judge find the transportation plan violates the civil rights of students and block the district from implementing it.

JCPS spokesman Mark Hebert said, “We just received a copy of the lawsuit and are reviewing it,”

A new middle school will rise in West Louisville on the site where Passport Health had once intended to build its headquarters. (Photo by Deborah Yetter/Kentucky Lantern)

A new middle school is planned for a long-vacant site in West Louisville where Passport Health, the state’s first Medicaid managed care company once hoped to build its corporate headquarters.

The news was celebrated at a press conference Friday by a host of state and local officials and representatives of the predominantly Black area of Louisville who have long lobbied for development of the 20-acre site at 18th and Broadway.

Molina Healthcare is donating the site it acquired in 2022 for about $7 million after it bought out Passport, which ceased construction of its headquarters amid financial problems brought on by changes in state Medicaid policies.

It will be first new middle school to be built in the predominantly Black community in 90 years, said school Superintendent Marty Pollio, who spoke at the event that also included Gov. Andy Beshear and Louisville Mayor Craig Greenberg.

“We thought this would be a great place for a new middle school in West Louisville,” Pollio said. “I never in my wildest dreams thought they would donate this plot of land.”

Ryan Sadler, president of the company now called Passport by Molina HealthCare, said the decision comes after several years of meeting with community groups to determine the best use for the site.

“We are all here today for West Louisville,” he said.

Molina also plans to open a “one-stop” health and wellness center on the site to serve area residents, Sadler said.

Molina, a Fortune 500 company based in Long Beach, California, serves about 296,000 Kentucky Medicaid members, making it the second largest of the six managed care companies, or MCOs that oversee health services for Medicaid enrollees. It is the single largest Medicaid MCO for patients in West Louisville.

Pollio also included a surprise announcement: JCPS will consider locating a new headquarters on the West Broadway site, replacing its aging building in southeast Jefferson County, he said.

But the first step is to begin construction on what he described as a “state of the art” middle school as a home for the Dr. J. Blaine Hudson Middle School opened last year temporarily in a former elementary school. The new school is expected to open in 2026 and is named for Hudson, a longtime Louisville scholar, educator and Black activist who died in 2013.

Development of the site has been long sought by community leaders as a source of jobs and economic growth for the historically disadvantaged West Louisville.

Vacant for 20 years, it had been a symbol of promise for leaders in the largely Black community who were excited about Passport’s plan to locate its headquarters there. But they grew increasingly concerned after construction ceased amid Passport’s financial problems.

Passport had proposed its headquarters and a health and wellness site at 18th and Broadway but was forced to suspend construction in 2019 amid a revenue shortfall it blamed on Medicaid rate cuts enacted by the administration of former Gov. Matt Bevin.

Bevin, a Republican and critic of Medicaid expansion under the Affordable Care Act, had proposed limiting benefits and restructured how his administration paid MCOs — which Passport, as the largest provider in Louisville, claimed unfairly cut its reimbursement for health claims.

The Bevin administration at the time denied the rate cuts were unfair to Passport.

Beshear, a Democrat who defeated Bevin in the 2019 governor’s race, in comments Friday alluded to the dispute.

“A little over six years ago, a previous governor stopped a $100 million construction of this building,” said Beshear, now in his second term. “I made you a promise that if I were elected, we would develop this property.”

Among those in the crowd was Rev. Charles Elliott, whose King Solomon Missionary Baptist Church is near the site and who once led a prayer delegation to Frankfort in support of the Passport project.

Beshear directly addressed Elliott, a prominent West Louisville pastor.

“Pastor Elliott, I remember looking at you and saying, ‘West Louisville deserves better,’ ” Beshear said as Elliott nodded.

Other speakers echoed enthusiasm over the plan for the site.

Jefferson County School Board chairman Corrie Shull called Friday “an awesome day to be alive.”

“We are incredibly grateful for this day,” added Hudson school principal Jeronda Majors.

Passport faced potential demise after it failed to get its contract renewed with the state in 2019, but was saved by the sale to Molina, which was a successful bidder for Kentucky’s Medicaid business.

Kentucky’s $1.5 billion-a-year Medicaid program covers about 900,000 low-income and disabled adults and about 600,000 children, with most of its money coming from the federal government.

Passport was established in 1997 as a non-profit company designed as a pilot project to try to control rising Medicaid costs in the Louisville area, a model officials hoped to take statewide. It was Kentucky’s first Medicaid MCO.

But efforts to create such entities in other parts of the state failed and the state in 2011 began awarding its Medicaid business to Passport and outside, for-profit companies.

Friday, with the rusting steel beams of the former Passport site in the background, officials were ready to look ahead.

“Congratulations to everyone involved,” Beshear said. “We look forward to cutting the ribbon on these amazing projects.”

This article and headline have been corrected. An earlier version said the project would be the first new middle school in Jefferson County in 90 years. It will be the first new middle school in West Louisville in 90 years.?

Hopscotch House, established in 1987 as a retreat for women writers and artists, is located off Wolf Pen Branch Road in eastern Jefferson County. (Photo from Salliebingham.com)

LOUISVILLE — Tucked away on a 412-acre farm in eastern Jefferson County, Hopscotch House, a rambling, five-bedroom farmhouse dating to 1848, was envisioned as a peaceful sanctuary for women artists and writers when the Kentucky Foundation for Women acquired it in 1987.

But its plan to sell the house has triggered an acrimonious battle with philanthropist Sallie Bingham, who launched the non-profit foundation to support female writers and artists in Kentucky and has filed a lawsuit to try to block the sale.

“There didn’t seem to be any way of persuasion,” said Bingham, who founded the foundation nearly 40 years ago with proceeds from the sale of her family’s media companies including The Courier-Journal and the Louisville Times newspapers.

A major complication: Hopscotch House, on a 10-acre site, is surrounded by Wolf Pen Branch Mill Farm, owned by Bingham, who placed the entire farm in a conservation easement to bar development.

The farmhouse, off Wolf Pen Branch Road on a small island of land inside her farm, is listed for sale at $2.75 million.

“I don’t want to see it broken up and some strip mall put in or houses or whatever,” said Bingham, who now lives in New Mexico and operates the farm primarily as a wildlife refuge.

Bingham filed a lawsuit in March in U.S. District Court, demanding that the foundation drop the planned sale and honor her initial vision for Hopscotch House as a retreat for women artists and writers.?

“Creativity demands that women be allowed to retreat, at times, from their world and their obligations,” said the lawsuit, quoting Bingham, who was the foundation’s first executive director. “Hopscotch provides the setting for such retreats.”

As an alternative, her lawsuit proposes the foundation be ordered to turn Hopscotch House over to her or to a Kentucky charity of her choosing.

Complicated tax rules governing nonprofit foundations prevent her from buying the property herself, Bingham said.

There is no contract specifying the use of the farmhouse the foundation owns. Bingham said her original plan for establishing the foundation was by agreement among “friends who understood what I was talking about.”

‘Lacks basic amenities’

The foundation, which no longer uses Hopscotch House for workshops and retreats, has fired back, in a counterclaim calling Bingham’s lawsuit a “malicious, coordinated effort” to block the sale, discourage potential buyers and diminish the property’s value.

The aging farmhouse, which the foundation bought in 1987, needs extensive renovation and its isolated location deters some women from attending events out of safety concerns, its lawsuit claims. Further, lack of reliable internet and water service have become increasingly problematic.

“The house lacks basic amenities that female artists use in the 21st century,” the lawsuit said.

Internet access is outdated and spotty and the farmhouse has no outside water source; it relies on a cistern with water supplied by truck. Upgrades would be extremely costly and likely impossible because the conservation easement protecting the farm restricts construction, digging or disruption to the surrounding property, it said.

Bingham’s true motivation, the counterclaim says, is to block the sale and potential development of the Hopscotch House property, which she has proposed placing in a conservation easement that would enhance the value of her surrounding farm.

The counterclaim, filed by lawyers with Wyatt, Tarrant and Combs, accuses Bingham of defamation through comments and posts on her website, SallieBingham.com, and of breaching her duty as a former executive director of the foundation.

In a reply filed by her lawyers with the Denton Bingham Greenebaum firm, Bingham denies the allegations, dismissing them as a “kitchen sink full” of meritless claims.

“This lawsuit concerns the foundation’s brazen attempt to sell off for its own financial gain certain real property located in the middle of Ms. Bingham’s historic Wolf Pen Branch Mill Farm,” the lawsuit said, property intended to be used for “retreats and residencies for women artists.”

The case, assigned to Senior U.S. District Judge Charles R. Simpson III, is pending.

Meanwhile, efforts to sell the property have stalled, said Sharon LaRue, executive director.

Bingham controls access to the site and informed the real estate agent she did not have permission to drive through the farm property to show the home, the foundation’s lawsuit said. This caused the agent to cancel one showing and has left potential buyers in doubt about access to the property, it said.

Further, the legal battle is interfering with the foundation’s main purpose — to use proceeds from the endowment from Bingham to fund the work of women writers and artists throughout Kentucky, LaRue said.

The foundation awards about $350,000 a year in grants, sponsors artists and writers and hosts workshops and retreats.

“This process is keeping us from doing our mission,” LaRue said.

Bingham acknowledged it may be a protracted battle.

“I think we’re in for a long process of legal maneuvering to try to force the foundation to do what it was intended to do,” she said.

The Bingham break-up

The year was 1986 when Barry Bingham Sr., the head of the family-owned Kentucky media empire, shocked the community and made national headlines with the news he was putting the companies — which included two newspapers, WHAS TV and radio stations and Standard Gravure printing — up for sale.

The year before, Sallie Bingham — one of three Bingham siblings who held shares in the family-owned companies — began planning the foundation, which she expected to fund with her share from the sale. She already had been attempting to sell her 15% share in the company, which media watchers said helped trigger the sale.

In a piece on her blog, Bingham said it was her time at the newspaper that inspired her to create the foundation.

“I was aware from my years as book editor at the Courier-Journal of the amount of work that women did at the Bingham companies; almost entirely in lower-paid jobs such as distributing mail, cooking and serving in the company cafeteria, working as secretaries, or cleaning,” Bingham wrote. “These women were about to lose their jobs with the sale of the company.”

Bingham decided to create and endow a foundation that would support and help fund women artists working for social change.

Bingham served as the foundation’s first director from 1985 until her 1991 move to New Mexico.

Bingham, in an interview, said she relinquished management to the board and a new executive director.

“I felt it was better, since I was not going to be living in Kentucky, not to be hovering over the foundation,” she said.

Meanwhile, Bingham had begun acquiring two tracts that make up her Wolf Pen Branch farm.?

When the farmhouse and five acres of land became available, the foundation, under her direction, bought it from the owners with the intent of making it a retreat for women artists and writers. Later, Bingham said five acres and a smaller house? contiguous to the farmhouse became available, which she bought and donated to the foundation.

Bingham, in a blog post, said she named the farmhouse Hopscotch House “because I want the women there to have fun.”

Changing mission

The foundation initially was started with a plan to “spend down” its funds in order to help as many writers and artists as possible, the foundation’s court filing said.

But Bingham later changed the mission to one of maintaining and investing the endowment and using proceeds to fund individuals, it said. The endowment has grown to about $16 million and gives away about 5% of its income annually.

Hopscotch House was meant to be the center of its activities but over time, began to be less feasible as a site for hosting women from across the state, LaRue said.

The 2020 COVID pandemic forced it to suspend hosting group events at the site and because of the need for repairs and other limitations, the foundation ended use of the site in 2022.

It instead has been hosting workshops and retreats through a partnership with the Sisters of Loretto on their campus in Marion County, which LaRue said is more suitable for its participants with lodgings, a dining hall, internet access and other amenities.

In a newsletter sent to members in March 2024, the foundation staff and board members said the foundation had sought professional advice on possible upgrades and repairs to Hopscotch House and learned they would be very costly and difficult to achieve.?

The foundation also surveyed participants for their opinions.

Some mentioned concerns about personal safety, because of the remoteness of the site. Others, including women of color, mentioned not feeling comfortable in the affluent, Eastern Jefferson County neighborhood. Others said they preferred a site in closer driving distance.

“Everyone wanted updated electricity, a sustainable water source, better internet/Wifi options” and other improvements, it said.

After considering these and other factors, the board decided to sell the property, it said.

LaRue said the foundation is seeking to further its mission while adjusting to changing times and needs of artists and writers it supports.

For example, contemporary philanthropy promotes meeting needs of recipients rather than dictating terms. That might involve funding someone’s trip to a conference or providing a grant for an artist or writer to choose a location to work.

“Trust-based philanthropy is the big thing right now,” she said. “People know what they need. We want our community to be part of the decision making.”

LaRue said she and the board remained focused on that mission, but the lawsuit has complicated it, blocking access to funds from the potential sale of Hopscotch House and causing it to spend money on costly legal fees.

“We are still giving out grants, but we are blocked from any action on the house,” LaRue said.

The Adair Youth Detention Center, site of a riot in late 2022, is one of the Kentucky facilities under investigation by the U.S. Justice Department. (Kentucky Justice and Public Safety Cabinet)

The mood was celebratory as Kentucky and federal officials crowded into the Capitol Rotunda on a cold January day in 2001 to announce the end of five years of federal oversight of the state’s problem-ridden juvenile justice system.

“We’re never going to slide back to where we were in 1995,” said then-Juvenile Justice Commissioner Ralph Kelly. “We know we’re on the road to victory.”

But slide back Kentucky has — despite sweeping reforms enacted under a 1995 federal consent decree that advocates say, by the early 2000s, made it a national model for rehabilitating young offenders.

Now, Kentucky faces the threat of renewed federal oversight after the U.S. Justice Department announced May 15 it is opening an investigation into whether conditions at eight juvenile detention centers and one residential center for offenders violate civil rights of youths.

In a letter to Gov. Andy Beshear, the department said it is investigating possible excessive use of chemical force (pepper spray) and physical force by staff, failure to protect youths from violence and sexual abuse, overuse of isolation and lack of mental health and educational services

And longtime observers of the system who have watched the downward slide — including Earl Dunlap, a juvenile justice expert appointed by the federal authorities? to monitor Kentucky’s compliance with the 1995 consent decree — say it didn’t have to happen.

“Disgusting and sad,” is how Dunlap described it. “You had people in leadership in Kentucky who should not have allowed this to happen. You went from nothing to something and then right back to nothing.”

Dunlap, who is semi-retired and lives in Illinois, said he became so concerned about reports of problems in juvenile justice that in March 2023, he wrote to Beshear warning him of the risk of failing to fully address problems.

While congratulating Beshear on efforts to reform juvenile justice, Dunlap added in his letter he feared such efforts might fall short of federal standards and result in future litigation.

Dunlap said he offered to provide the administration with assistance for reform efforts but did not get a reply.

Beasher’s office did not immediately respond to a request for comment about Dunlap’s letter.

But Terry Brooks, executive director of Kentucky Youth Advocates, said his organization has found the Beshear administration uninterested in outside input when it comes to juvenile justice, calling it a “closed shop.”

“Not only has there not been any outreach, there has not been a response to folks trying to reach out,” he said.

Problems build for years

Brooks said while problems have been building over the years in juvenile justice, Beshear, now in his second term, and lawmakers ultimately bear responsibility.

“This is clearly on the Beshear administration and the General Assembly,” he said. “Clearly the governor and the General Assembly abrogated their responsibility.”

Beshear defended his administration’s efforts to upgrade juvenile justice in a statement released Tuesday by Morgan Hall, spokeswoman for the Cabinet for Justice and Public Safety.

“In response to violent outbreaks and to enhance security for staff and youth, the Beshear-Coleman administration developed an aggressive plan starting in December 2022 to implement sweeping improvements to Kentucky’s juvenile justice system, for the first time since its creation nearly 25 years ago,” it said.

In December, Beshear announced the state would open a detention center for females only in Campbell County following the sexual assault of a female detainee in Adair County.

Beshear also has sought to address acute staffing shortages by increasing starting pay for youth workers to $39,127 a year and the General Assembly approved about $138 million a year each year in additional juvenile justice funds for fiscal years 2023 and 2024.

It also has worked to upgrade medical and mental health services, the statement said.

Efforts also are underway to reopen the Jefferson County Youth Detention Center, which Louisville Metro Council decided to stop funding in 2019 after operating it for nearly 40 years. That forced the state to take on housing juvenile detainees, some in distant counties at understaffed facilities, far away from families and requiring long drives back and forth for court appearances.

Dunlap calls that a huge blunder.

“The ramifications were that the largest volume of kids in the state had to be transported elsewhere,” he said. “It was just plain ridiculous.”

‘Take the initiative’

The legislature, under pressure from the 1995 consent decree, in 1996 created the Department of Juvenile Justice to oversee youths charged with and convicted of offenses, which previously had fallen under the Cabinet of Health and Family Services.

While the previous federal investigation focused on residential centers, where youths found guilty of offenses were sent for treatment, the state also elected to create a system of new regional detention centers to hold children with pending charges. Previously, in many counties, children were held in adult jails, generally in separate units.

Masten Childers II, health cabinet secretary for former Gov. Brereton Jones, said the state went beyond requirements of the consent decree.

Childers, who? oversaw negotiation of the 1995 consent decree with federal authorities, said he was “surprised and disappointed” to learn Kentucky once again is subject to a civil rights investigation of its juvenile facilities.

“If our consent decree had been followed, we would not be talking about this,” he said.

Still, he thinks the Beshear administration can use the investigation to improve the system should it result in federal enforcement.

“Kentucky needs to take the initiative,” he said. “This is not the time to be defensive.”

‘No win here’

Sen. Whitney Westerfield, R-Fruit Hill and longtime proponent of juvenile justice reform, said he’s concerned that the state’s system is becoming more like an adult prison model instead of one focused on rehabilitation and treatment of youths, many of whom have experienced significant trauma and have mental health issues.

The current Juvenile Justice Commissioner, Randy White, appointed by Beshear in March, is a 27-year veteran of the state adult prison system.

“The extent to which we make our system for kids more like a corrections facility and less a place for opportunities for kids, the more harm we’re going to do in the long run,” Westerfield said. “The more we approach it as a baby prison, the more damage we’re going to do.”?

Westerfield said he’s saddened that problems with Kentucky’s juvenile justice system have attracted attention of federal authorities but hopes it results in improvements.

“If this is what it takes, then that’s a good thing,” he said.

Meanwhile, he said, he’s concerned that the juvenile justice system is struggling even as Kentucky lawmakers enact tougher laws on juvenile offenders, citing misleading claims that today’s youths are more violent or that juvenile crime is increasing.

“Juvenile crime is not worse. It’s dropping,” he said. “Adult crime is dropping.”

Juvenile crime has been falling steadily and in 2020, was at its lowest level since 2005, according to a U.S. Office of Juvenile Justice and Delinquency Prevention report last year.

Still his fellow lawmakers rely on anecdotal events or a headline-grabbing crime as a reason to enact tougher laws, including one that takes effect July 1 to require mandatory, 48-hour detention for youths charged with serious crimes, Westerfield said. That has the potential to send an additional 400 youths a year into state juvenile detention facilities even as those facilities come under investigation by federal authorities.

“There’s no win here except the political victory for the sponsors and for the people who voted for it,” Westerfield said. “They’s going to get to say they’re tough on crime.”

‘Damn pepper spray’

The current federal investigation focuses on the eight detention centers and one residential center, the Adair Youth Development Center, the site of a November 2022 riot, resulting in a serious injury to staff and sexual assault of a female youth. In addition to those facilities the state operates five other youth development centers, eight group homes for juveniles and six nonresidential day-treatment programs.

In recent years, allegations of abuse, solitary confinement, overuse of force and overuse of adult corrections-type measures such as pepper spray have dominated headlines — initially in reporting by John Cheves of the Lexington Herald Leader — and more recently, outlined at legislative hearings including allegations of? sexual misconduct and disproportionate treatment of Black and multiracial youth.?

In January, state Auditor Allison Ball released a report requested by lawmakers detailing a series of serious problems with the system’s detention centers including overuse of force, significant understaffing, lack of clear policies of managing youth behavior and misuse of isolation.

The report, by the consulting firm CGL Management Group, also expressed concern about the Beshear administration’s introduction of pepper spray and tasers into juvenile centers, saying they are largely unnecessary.

“Current nationally recognized best practices do not support the widespread deployment of chemical agents or the use of electroshock devices (such as Tasers) within juvenile detention and instead recommend strategies to reduce or eliminate these uses of force,” it said.

The Justice Cabinet, in a statement, defended the use of pepper spray, also known as oleoresin capsicum, or OC spray.

“Pepper spray is a non-lethal, effective tool for both staff and juveniles, and is issued by adult and juvenile facilities across the country,” it said.

Further, it said, the legislature has mandated that pepper spray and tasers be issued to staff at juvenile justice facilities.

The outside audit warned use of pepper spray is especially risky for children with asthma or other health conditions or those on certain medications.

“As staffing levels improve, further consideration should be given to entirely removing pepper spray,” it said.

Dunlap, the former federal monitor, said he was shocked when Beshear authorized the use of pepper spray in juvenile detention centers last year, calling its use “old school.”

“The first thing I would do is get rid of that damn pepper spray,” he said. “They’re gonna kill someone with it.”

The U.S. Department of Justice has launched an investigation into the conditions at eight of the youth detention centers and one development center in the Kentucky Department of Juvenile Justice.?(Getty Images)

The U.S. Department of Justice has launched a civil rights investigation into the conditions at eight of the youth detention centers and one development center in the Kentucky Department of Juvenile Justice.?

“The investigation will examine whether Kentucky protects children confined in these facilities from harm caused by excessive force by staff, prolonged and punitive isolation and inadequate protection from violence and sexual abuse,” the Justice Department said in a statement. “The investigation will also examine whether Kentucky provides adequate mental health services and required special education and related services to children with disabilities.”?

U.S. Attorney Mike Bennett for the Western District of Kentucky said in a statement that he “stands ready to protect the rights of all children in Kentucky, including those who end up in juvenile detention” and will work to “conduct a fair and thorough investigation of these allegations.”

Justice and Public Safety Cabinet Secretary Keith Jackson said in a statement Monday afternoon that “every juvenile placed in the custody of the state deserves to be safe. We have made progress on the security of our juvenile facilities; we have trained our personnel, protected juveniles and staff against violent attacks and taken corrective action against employee misconduct.”?

“We look forward to being able to talk to the Department of Justice, because as of today, no members of our leadership have been interviewed, and we have not had the opportunity to discuss any incident, policy or issue with the Department of Justice,” Jackson said.?

In a video posted to the Justice website Wednesday, Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said the investigators will “review whether there are unconstitutional conditions including use of unreasonable physical and chemical force by staff, inappropriate use of isolation, failure to protect children from physical and sexual abuse and adequate mental health care.”

Ahead of the 2023 legislative session,?reports of violence?in Kentucky’s juvenile justice system regularly made headlines, including a riot in Adair County during which?a girl in state custody?was allegedly sexually assaulted and?employees were attacked?at a youth detention center in Warren County. DJJ has also faced persistent?staffing issues, the Lantern has reported.?

This session, West Kentucky Republican Sen. Danny Carroll asked his colleagues to build a $22 million special mental health juvenile detention facility as well as create a process to test and treat such children. His bill also would have delayed a requirement for a 48-hour mandatory detention, which came out of 2023 legislation. (The 48-hour hold for some juveniles charged with violent crimes is set to go into effect this July).

Carroll’s proposal did not make it into the final two-year state budget.

“While the General Assembly has provided some help, it recently failed to fund two needed detention facilities, as well as a specialized residence for juveniles with extensive mental illness,” Gov. Andy Beshear said in a statement reacting to the Justice investigation. “Funding was also denied for additional safety improvements. The Department of Juvenile Justice will cooperate with the Department of Justice while also strongly advocating for the safety of its staff.”??

Sen. David Givens, R-Greensburg, said “the Senate remains committed to addressing these serious issues” in DJJ.

“Our consistent advocacy for policy reforms and budget enhancements aims to rectify the ongoing crisis within the Department of Juvenile Justice,” Givens said in a statement.?“It is disheartening that such measures are necessary, but we hope the impending federal investigation will serve as a crucial wake-up call for the Beshear administration. This is an opportunity to reaffirm commitment to the welfare of Kentucky’s troubled youth and to ensure the safety of the staff in these facilities.”

Second time feds involved?

The investigation is the second time federal justice authorities have examined conditions in Kentucky’s juvenile justice system after allegations of serious abuse and mistreatment of youths.

In 1995, after an extensive review of conditions in the state’s system for housing and treating youths found guilty of crimes, the U.S. Justice Department found the state had violated their civil rights and placed the state under a federal consent decree aimed at reforms.

The investigation followed months of reports of mistreatment of youths and other problems by the Courier Journal and other news outlets.

Violations federal officials cited at the time included abuse and mistreatment of youths housed in centers, poor or no investigations of complaints, overuse of isolation cells, lack of adequate medical and psychiatric treatment and aging, run-down facilities.

The 1995 federal investigation focused mainly on treatment facilities where youths were sent after a judge had determined they had committed offenses, while the investigation announced Wednesday focuses largely on detention facilities where youths are held while charges are pending.

But the resolution of the 1995 investigation led to sweeping changes in both the state’s juvenile treatment and detention systems, hailed at the time as a major advance in reforms.

Under pressure from the consent decree, in 1996, the Kentucky General Assembly created the Department of Juvenile Justice to oversee treatment facilities, pumping millions of dollars into upgrades. Previously, the Cabinet for Health and Family Services had overseen care of youths who committed offenses.

And the state undertook a separate upgrade of the detention system where many youths previously had been held in adult jails in violation of federal guidelines, instead creating a separate system of regional detention centers for youths.

In 2001, then U.S. Attorney General Janet Reno held a press conference in Frankfort to announce her department was lifting the 1995 consent decree, citing the substantial improvement to the system.

Kentucky, at the time, had created “an example for the rest of the nation,” said Reno, who served as attorney general under President Bill Clinton.

But at the time, officials warned Kentucky must work to avoid a return to the problems of the early 1990s through vigilance and adequate resources.

“Being uninsured is bad for a child’s health and exposes the family to large medical bills they can’t afford,” said Joan Alker, executive director of the Georgetown University Center for Children and Families. Two-month-old Karina receives drops of children’s Tylenol after getting a vaccination at a low-cost clinic in Aurora, Colorado. (Photo by John Moore/Getty Images)

Kentucky is among a handful of states that lost only a small percentage of children from its Medicaid program in 2023 even as the number of kids cut from coverage soared elsewhere under annual renewal requirements that had been suspended during COVID-19.

Overall, 4.16 million children were dropped from the government health plan that covers more than half of all U.S. children, according to a new report on the process dubbed the “Medicaid unwinding.”

About 10% of 43 million children nationwide lost coverage, according to the report by the Georgetown University Center for Children and Families, with some states reporting enrollment declines of 25% or more.

Authors of the report said it’s likely many of those children remain eligible for Medicaid but lost coverage for “procedural reasons,” such as incomplete paperwork or failure to receive a renewal notice.

“There are reasons to worry that a high number of children are going uninsured,” Joan Alker, executive director of the Georgetown center, said on a press call Thursday. “Being uninsured is bad for a child’s health and exposes the family to large medical bills they can’t afford.”

Kentucky lost 10,477 children, a reduction of about 2%, from its Medicaid program that covers nearly 640,000 kids, the report said. It was among a half-dozen states with children’s enrollment declines of 2% or less.

“This is a good news story,” said Emily Beauregard, executive director of the advocacy group Kentucky Voices for Health.

Kentucky, she said, took deliberate steps to avoid cutting off children for procedural reasons as it began renewing Medicaid for adults.

“I think we’re one of the few states in the nation that hasn’t seen this decline in enrollment,” Beauregard said.

Kentucky Medicaid officials early on announced they would seek to protect children’s health coverage.?

They delayed, with federal permission, requiring children to renew coverage under the process the state began in May 2023. As a result, children won’t be required to begin renewing coverage until September.

And Kentucky was the first state to adopt an option offered by the federal government to provide 12 months of “continuous coverage” for children and teens, guaranteeing enrollees under 19 would retain coverage for at least a year — rather than being required to renew on the anniversary of their enrollment.

“The state sought this flexibility to ensure our children kept access to the coverage they need and deserve,” Brice Mitchell, a spokesman for the Cabinet for Health and Family Services, said in an email.

Medicaid officials also launched an information blitz, with letters, calls, text messages and other means to contact enrollees to try to make sure they understood the need to renew coverage and respond to requests for information from the state.

Kentucky currently has about 638,400 children enrolled in Medicaid or its companion Children’s Health Insurance Program (CHIP), out of a total enrollment of about 1.5 million. CHIP covers children whose families may earn too much for adults to qualify for Medicaid but are still considered low-income.

The greatest declines in children’s coverage came in Texas, Florida, Georgia and California, according to the Georgetown report. Those states alone account for a loss of about 2.1 million kids — around half of the children’s enrollment decline nationwide.

Some families may have moved to employer-based health insurance or purchased individual plans but the numbers of children dropped from Medicaid overall are too high to account for those getting private coverage, Alker said.

“We don’t know how many of these children are uninsured or had a gap in coverage,” she said.

Dr. Kimberly Avila Edwards, a Texas pediatrician who spoke on the call, said the impact of her state’s cut of 1 million children from Medicaid is “painfully obvious” among her patients — some whose parents discover their children have lost Medicaid only when they show up for an appointment.

“Medicaid is not a luxury,” she said. “It’s a vital program for tens of thousands of children, their families and their communities.”

During the three years of the pandemic, states got extra money for Medicaid costs but had to agree not to cut people off the health plan. Beginning in April 2023, the federal government — which provides the majority of funds for Medicaid — required states to resume asking people to provide proof of eligibility.

Under that requirement, families each year must provide income and other documentation to show they are eligible for the health plan for low-income children and adults.

Some states moved more aggressively than others to drop children from the federal-state health plan — in some cases, cutting children who likely remain eligible, the Georgetown report found.

“Stark differences have emerged in how states have responded to this enormous administrative challenge,” Alker said.?

Overall, Kentucky’s Medicaid enrollment peaked in May 2023 at 1.75 million but has declined to about 1.5 million individuals currently.

Health activist Kay Tillow led a protest over Medicare Advantage plans last year outside Humana's downtown Louisville headquarters. (Photo by Deborah Yetter)

Baptist Health and Humana have ended a months-long standoff over Kentuckians with health coverage through Medicare Advantage and commercial insurance plans, the two companies announced Thursday.

Effective April 1, Baptist physicians again will accept those patients as “in network”— meaning they would not be subject to potentially higher costs or limits on services.

The news, which affects tens of thousands of Kentuckians including many state retirees, was announced through separate press releases.

“After several months of productive negotiations, Humana is pleased to have reached a new, multi-year agreement with Baptist Health Kentucky,” Eric Bohannon, Humana Medicare regional president, said in the release.

Baptist hailed the move as good for patient care.

“We are committed to improving the health of our communities and our goal is to ensure every patient the high-quality, timely care needed,” said Dr. Isaac J. Myers II, chief health integration officer for Baptist Health.

The news releases didn’t detail how the two resolved differences that led Baptist Health to drop Humana as a network provider for its physicians on Sept. 22.

But Medicare Advantage plans, which oversee health care for many Medicare enrollees, including around 102,000 Kentucky state government retirees, have been a growing source of contention between health providers and the private insurance companies that offer them.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in an email statement in January.

Effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network.

Barry said Thursday Baptist has not reached agreements with United or Wellcare.

The growth of Medicare Advantage plans, which now cover about half of those 65 or older nationwide, has been a source of increasing concern to health advocates who argue the patients suffer through practices such as denials of care, delays while care is authorized and other restrictions.

Among them is longtime Louisville health reform activist Kay Tillow who told the Lantern in January that such plans are sacrificing the benefits of Medicare for seniors.

“The profit motive is destroying patient care,” Tillow said.

Insurance companies that provide Medicare Advantage plans argue they offer better care at less cost and, in some cases, extra benefits to seniors.

The Senate budget is good news for Medicaid funding, although it funds fewer waiver slots than the House budget for Kentuckians with disabilities. (Getty Images)

The Kentucky Senate has largely eliminated cuts to Medicaid that were proposed in the House budget. A top state official had warned the House plan would create a hole next year in the federal-state health plan that covers 1.5 million low-income Kentuckians.

“We are pleased that the Senate’s proposed budget restores funding to Medicaid so patients can continue to access the necessary health care services they’re accustomed to,” said a statement from the Cabinet for Health Services, which manages the $15 billion a year federal-state program.

Cabinet Secretary Eric Friedlander appeared before the Senate Appropriations and Revenue Committee last month, along with John Hicks, budget director for Gov. Andy Beshear, asking the Senate to consider restoring the funds the House cut for the 2025 fiscal year that begins July 1.

“This creates a hole in the Medicaid budget for Fiscal Year 25,” Hicks told the committee.

Advocates worry the House plan could force cutbacks in Medicaid services through more than $900 million in cuts to the amount sought by Beshear, a Democrat.

Republicans hold supermajorities in both the House and Senate and generally have expressed support for the Medicaid program that pumps money into hospitals, clinics, pharmacies and other medical services throughout the state—with 70% to 80% of the funding provided by the federal government.

But some have expressed concern it has grown so large.

The Kentucky Center for Economic Policy told the Lantern last month that overall, the House plan cut about $139 million in state funds Beshear sought for Medicaid in FY 2025, which would cause the state to forfeit another $783 in federal matching money for a total of around $922 million.

The Senate moved its budget bills through committee ?and to a final vote on Wednesday.

Dustin Pugel, policy director for the center, said Thursday it appeared the Senate had restored most of the funds but made some cuts including a reduction in “waiver programs” for people with disabilities.?

Kentucky legislature asked to end long, worrying wait lists for adults with disabilities

The House plan ?included about $200 million — about $143 million of that in federal funds — for 2,550 new slots in?Medicaid “waiver” programs?such as Michelle P. that provide housing, therapy or other supports for people with disabilities.?

Waiting lists for such services number in the thousands for programs that generally have been increased by 50 or so a year.

The Senate version reduces the number of slots over the next two budget years to 1,925.

And the Senate? did not fund a proposed “mobile crisis unit,” also left out of the House budget that would provide an alternative to police intervention when someone is experiencing a mental health crisis.

But the Senate did include an increase in Medicaid payments for dental services, which oral health advocates say is urgently needed to attract more dentists to the program in a state with high rates of dental disease.

Overall, Pugel said, the Senate plan is “good news for the Medicaid budget.”

However, the budget process is far from over. The Senate changes must be approved by the House — and could end up in a conference committee to try to work out differences — before the current legislative session ends April 15.

Kentucky Supreme Court, from left, back row, justices Christopher Shea Nickell, Kelly Thompson, Robert B. Conley, Angela McCormick Bisig. From left, front, Debra Hembree Lambert, Chief Justice Laurance B. VanMeter, Michelle M. Keller, Jan. 11, 2023, in the Supreme Court chambers at the state Capitol. (AOC photo/Brian Bohannon)

In a quick turnaround, the Kentucky Supreme Court has upheld a lower court ruling that five insurance companies will retain the right to oversee most of the state’s $15 billion annual Medicaid business, appearing to end a long-running court fight.

Anthem Kentucky, which had challenged the contract award, will be excluded, according to a Supreme Court order issued Thursday.

The decision comes just one week after the Supreme Court heard arguments on the complex contract dispute and is the result of a tie vote among the six justices who heard the case.

Kentucky Supreme Court hears from insurers fighting over share of state’s Medicaid business

Because the justices were divided 3-3, no opinion was issued on the merits of the case. Instead a single page order stated that court rules dictate that in the event of a tie vote, the 2022 Kentucky Court of Appeals decision will stand.

The order stated that justices Angela McCormick Bisig, Robert B. Conley and Michelle Keller voted to affirm the appeals court ruling, while Debra Hembree Lambert, Christopher Shea Nickell and Chief Justice Laurance B. VanMeter voted to overturn the lower court. The seventh member, Justice Kelly Thompson, did not hear the case and did not vote.

Anthem, which had remained as a sixth provider known as a managed care organization, or MCO, while the case was pending, had argued bidding irregularities and other flaws meant the contracts should be rebid.

But the successful bidders argued at the March 7 hearing? that the contracts dating back to 2019 are valid with no significant flaws in the bidding process.

“The problem is that Anthem lost,” said lawyer Michael Abate, who represents Humana Health Plan, one of the five successful bidders. “It’s time for this case to end.”

Lawyers for the state Cabinet for Health and Family Services, which oversees Medicaid, and the Finance and Administration Cabinet, which handles contract awards, also argued the appeals court decision should be affirmed.

Wesley Duke, general counsel for the cabinet, said the state had decided on a maximum of five MCOs.

“The 1.5 million members of Medicaid are best served by five MCOs,” he said. “The Court of Appeals decision should be affirmed.”

The ruling means five companies originally awarded the business in 2019 will remain in change of care for most of the 1.5 million people enrolled in Medicaid, a federal-state health plan.?

Kentucky Supreme Court, from left, back row, justices Christopher Shea Nickell, Kelly Thompson, Robert B. Conley, Angela McCormick Bisig. From left, front, Debra Hembree Lambert, Chief Justice Laurance B. VanMeter, Michelle M. Keller, Jan. 11, 2023, in the Supreme Court chambers at the state Capitol. (AOC photo/Brian Bohannon)

FRANKFORT — A dispute involving six insurance companies over a share of Kentucky’s $15 billion a year Medicaid business moved to the state Supreme Court Thursday where justices tried to sort out a long running battle over the lucrative contracts.

Litigation has stretched on several years, largely over Anthem Kentucky’s claim it was unfairly shut out of the contract award to five other insurance companies to oversee health care for most of the 1.5 million Kentuckians enrolled in Medicaid.

In arguments before the justices, lawyers for successful bidders asked them to uphold a 2022 state Court of Appeals ruling that the state’s selection of the five companies in 2020, with Anthem excluded, was valid.

“The problem is that Anthem lost,” said lawyer Michael Abate, who represents Humana Health Plan, one of the five successful bidders. “It’s time for this case to end.”

Anthem has been allowed to retain a share of Medicaid business while the legal dispute is pending under a 2020 ruling from Franklin Circuit Court, adding it as a sixth company serving as a managed care organization, or MCO.

Wesley Duke, general counsel for the Cabinet for Health and Family Services, which administers Medicaid, agreed, saying the state had decided on a maximum of five MCOs.

“The 1.5 million members of Medicaid are best served by five MCOs,” he said. “The Court of Appeals decision should be affirmed.”

Duke said his cabinet and the Finance and Administration Cabinet, which oversees contract awards, handled the matter appropriately.

But Anthem disagreed, citing alleged irregularities in the bid evaluation process as well as its claim raised in earlier litigation that a member of Gov. Andy Beshear’s transition team for health services later became a consultant for successful bidder Molina HealthCare of Kentucky during the bidding process, creating a conflict of interest.

“This is important,” said lawyer James A. Washburn, representing Anthem. “It’s important to get it right.”

Washburn argued the justices should overturn the Appeals Court decision and send the case back to Franklin Circuit Judge Phillip Shepherd for further action.

Shepherd in 2021, citing flaws in the bidding process, ordered the Medicaid contracts thrown out and rebid. Meanwhile, he allowed Anthem to remain as a sixth contractor while the case was pending.

But before the state could rebid the contracts, Shepherd’s ruling was appealed by several companies involved in the case.

In addition to Anthem, Humana and Molina (which acquired Passport Health Plan, a previous MCO), Aetna Better Health of Kentucky, WellCare and UnitedHealthcare also serve as Medicaid MCOs.

The dispute dates to 2019, when the administration of former Gov. Matt Bevin, awarded the Medicaid contracts to five MCOs. The award came shortly before Bevin, a Republican, left office after losing to Democratic challenger Beshear.

Anthem, which was excluded, objected.

When he took office, Beshear directed his administration to review the contract award and ultimately, ordered a new round of bidding that resulted in contracts being awarded to the same five companies that won the first round.

Objections led to further litigation in the case that ended up before the Supreme Court Thursday.

Justices asked several questions, mainly focused on the mechanics of the contract awards and, also, how Medicaid managed care functions. Under managed care, most enrollees in the federal-state health plan, including about 600,000 children sign up with one of the six companies which oversee care and process claims.

The fact that six MCOs currently handle care for nearly 1.5 million Kentuckians has long irked some lawmakers, including Sen. Stephen Meredith, R-Leitchfield, a former hospital CEO who argue the number adds to complexity and cost for health providers.

Meredith’s Senate Bill 24 , which he has filed several years without success, would limit the state to contracting with no more than three outside companies to manage Medicaid.

At the end of the hour-long Supreme Court hearing, Chief Justice Laurence B. VanMeter thanked participants and said the court “will attempt to get an opinion as soon as possible.”

Three women challenging Kentucky's abortion law with their lawyers: From left, Aaron Kemper, Jessica Kalb, Sarah Baron, Lisa Sobel and Benjamin Potash. (Photo provided)

For Lisa Sobel and her husband, being able to have a child through in vitro fertilization, or IVF, was “a dream come true.”

“For us, this really is a joy,” Sobel, of Louisville, said. “We want for there to be other families to be able to have this joy.”

But the recent state Supreme Court ruling in Alabama defining frozen embryos as live children — effectively suspending IVF in that state — has sent shock waves through the IVF community nationwide.?

That includes Sobel and her lawyers, who believe Kentucky’s laws on abortion — one virtually identical to Alabama’s — jeopardize IVF here because they define life as starting at fertilization.

“We read the laws and saw that what happened in Alabama could happen in Kentucky,” said Aaron Kemper. “We’re in trouble.”

He and lawyer Benjamin Potash represent Sobel, the lead plaintiff of three Jewish women suing over Kentucky’s abortion laws, in part because of the potential impact on IVF. They also allege the laws violate their rights under the state’s Religious Freedom Restoration Act because the abortion laws state life begins at the moment a human egg is fertilized, a Christian religious belief not shared by Jews.

In Alabama, several clinics, including one at the University of Alabama at Birmingham, stopped IVF services after the Feb. 16 ruling that frozen embryos are “extrauterine children” and thereby are entitled to protection as a human life.

Alabama Gov. Kay Ivey late Wednesday signed a measure the Republican-controlled legislature rushed into law meant to shield health providers from prosecution or lawsuits, which could allow IVF services to resume. But critics said the measure? fails to address the state’s Supreme Court finding that frozen embryos are children and merit protection as human life, allowing likely further legal disputes.

Sobel and her lawyers say the Alabama ruling heightens the urgency for a ruling in their lawsuit which was submitted to Jefferson Circuit Judge Brian Edwards nearly a year ago for a decision. The lawsuit, asking the judge to find the laws violate Kentucky’s Constitution, was filed in the wake of the 2022 U.S. Supreme Court ruling ending the federal right to abortion.

“We’re waiting on a decision, that’s where we are,” Kemper said.

Claims ‘hypothetical’

The Kentucky Attorney General’s office, which is defending the abortion laws, agreed to seek a decision, or summary judgment, from the judge in a May 2023 filing, asking Edwards to rule in its favor.

It argues the laws are constitutional and said the women’s claims of harm are “hypothetical.”?

The filing, under former Attorney General Daniel Cameron, a Republican, also argues the laws have no impact on IVF. Republican Attorney General Russell Coleman, who took office in January, is now handling the case.

Coleman, in a statement, called on state officials to focus on “safeguarding access to IVF,”? which he described as “an incredible blessing for so many seeking to become parents.”

Under IVF, a woman’s eggs are extracted and fertilized in the lab to be implanted in the uterus; unused embryos may be frozen for future use, donated for research or “adoption” by other parents or discarded.

“The plain language of Kentucky’s laws makes it clear that neither IVF nor the disposal of embryos created through IVF and not yet implanted are prohibited,” the attorney general’s filing said.

The women’s lawyers disagree, saying that Kentucky’s laws explicitly state human life begins at fertilization, leaving the door open for a challenge to IVF for the potential loss or destruction of embryos.

“The previous attorney general said until he was blue in the face that IVF is not illegal,” Potash said. “It’s come to pass.”

That leaves health providers scared of lawsuits or prosecution, they said.

That’s what happened in Alabama after three couples whose frozen embryos were accidentally destroyed in a fertility clinic filed a lawsuit under the state’s “wrongful death of a child” law. The high court ruled in their favor, saying state law “applies to all children, born and unborn, without limitation.”

The Sobel lawsuit challenges a pair of Kentucky laws that took effect after the U.S. Supreme Court in June 2022 struck down Roe v. Wade, ending the federal constitutional right to abortion. One, the “trigger law,” ended abortion upon such a decision; the other bans abortion after about six weeks, once embryonic cardiac activity is detected and before many women realize they are pregnant.

Both laws permit very narrow exceptions, allowing abortion only to save the life of or prevent disabling injury to a patient. The laws have no exemptions for rape or incest.

“Word for word, the law in Alabama is identical to the law in Kentucky,” Potash said, referring to the trigger law.

The Alabama law banning abortion even has the same title as Kentucky’s “trigger” law, the “Human Life Protection Act,” and both were passed in 2019, Potash said.

“In all likelihood, this is part of a larger concerted effort by conservatives,” Potash said.

Sobel and plaintiff Jessica Kalb both had children through IVF after struggling with fertility. A third plaintiff, Sarah Baron, was considering the procedure, said the lawsuit filed in October 2022.

A ruling in their favor would protect IVF — as well as restore the right to abortion, Potash said.

“We’re hoping we can get a ruling here in Kentucky,” he said.

The lawyers said they don’t know why Edwards hasn’t yet ruled.

Lawmakers scurry to save IVF

The potential threat to IVF has sent lawmakers scurrying to protect the procedure.

Three Kentucky lawmakers have filed such bills.

Senate Bill 373, filed by Sen. Whitney Westerfield, R-Fruit Hill, would protect health care providers from liability or prosecution over the loss of a human embryo.

Westerfield is a staunch opponent of abortion and has supported state laws pushed through by the legislature’s Republican supermajority that ban the procedure in almost all circumstances.

But he is an outspoken supporter of IVF.

Westerfield’s filing comes as he and his wife are?expecting triplets, he announced in January. He said on the Senate floor that they adopted and transferred embryos for the pregnancy. His 6-year-old son is an “embryo adoption” baby, he said.?

Sen. Cassie Chambers Armstrong, D-Louisville, filed Senate Bill 301, which would protect? from “criminal liability” IVF health care providers who meet a “professional standard of care.”

And Rep. Daniel Grossberg, D-Louisville, filed House Bill 757, which would prohibit state or local authorities from trying to limit or interfere with reproductive technology.?

It also calls for a new provision in state law declaring that a fertilized human egg or embryo in any form outside the uterus “shall not be considered an unborn child.”

The bills follow a recent flurry of action in the Alabama legislature which has advanced bills meant to shield IVF providers following a public outcry over that state’s Supreme Court decision.

Alabama Gov. Kay Ivey, a Republican who opposes abortion, said she supports such legislation.

Kentucky Gov. Andy Beshear, a Democrat and supporter of abortion rights, last week blasted Republicans for the current predicament over IVF.

“This is what happens, though, when you embrace extremism,” Beshear said.

In the U.S. Senate, a bill to establish national protections for IVF was blocked by Republicans last week.

Potash and Kemper, the lawyers for the women seeking to overturn Kentucky’s abortion ban, said the problem with most such efforts at the state level is that they try to sidestep laws that say human life begins at fertilization.

“These people want to pass an IVF law while maintaining that a fertilized egg is a human being and I don’t see how that’s possible,” Kemper said. “I don’t see how they’re ever going to be able to enact a law that protects IVF while maintaining that a fertilized embryo is a human being.”

The best outcome to clarify things in Kentucky would be a ruling in the pending lawsuit, the lawyers said.

“We’re hoping we get a decision on our case before someone sues for wrongful death in Kentucky,” Kemper said.

Sobel said the delays are frustrating for her and others in her position considering? IVF. The procedure is expensive — costing couples tens of thousands of dollars — and takes an emotional toll, she said.

It’s especially frustrating that the decision rests largely with male officials including a judge, she said.

“Women can only have children for so many years,” she said. “The older you get the more complicated your pregnancy is.”

Pharmacy entrepreneur Mark Cuban had nothing good to say about pharmacy benefit managers, who also are the subject of a Kentucky bill filed by state Sen. Max Wise. (Getty Images)

Kentucky Gov. Andy Beshear joined a White House roundtable discussion Monday on prescription drug costs that also featured U.S. Health and Human Services Secretary Xavier Becerra, pharmacy entrepreneur Mark Cuban and several community pharmacists from around the country.

The main topic was insurance industry middlemen known as pharmacy benefit managers, or PBMs, and panelists were unsparing in their criticism, using terms like “price gouging” and trying to “kill off community pharmacies” to describe the practices of some.

PBMs “are sh- – -ing on independent pharmacists,” said Cuban, the colorful and plainspoken former owner of the Dallas Mavericks who founded CostPlus Drug Co. to try to provide affordable prescription medicine to consumers.

In Kentucky, Beshear said the state has saved around $300 million by eliminating outside PBMs from its Medicaid program in 2021 and instead hiring a single company to manage the $1.2 billion a year prescription drug business.

His advice to other states seeking to cut prescription drug costs: “You ought to have one PBM for your state plan, one PBM for your Medicaid plan and they ought to report to you,” Beshear said.

The Pharmaceutical Care Management Association, which represents the PBM industry, released a statement on its website Monday accusing the panel of including those with “vocal anti-PBM agendas.”

PBMs work to try to reduce drug prices and ensure quality patient care, the statement said.

Reprieve for Kentucky’s independent pharmacies is saving Medicaid millions

“We share the administration’s goal of lowering prescription drug costs and would welcome the opportunity to work together to make prescription drugs more affordable for patients and employers,” it said.

Panelists were unmoved by such claims, focusing on the PBMs that dominate the prescription drug insurance business.

“The big three PBMs are everything that is wrong with this industry,” Cuban said.

He didn’t name them but they are Caremark, owned by CVS Health; Express Scripts, owned by Cigna, and Optum Rx, a subsidiary of UnitedHealth, according to drugchannels.net, a pharmaceutical business publication.

Two community pharmacists on the panel said the deep cuts and reimbursement below costs from PBMs threaten their livelihoods and service to their patients.

“If community pharmacies like me go out of business, what options do those patients have?” asked Pennsylvania pharmacist Chichi Ilonzo Momah.

Panelists urged officials at Health and Human Services and the Federal Trade Commission to do more to crack down on unfair practices of PBMs.

FTC Chairwoman Lina Khan said her agency is looking into the matter.

“If we find evidence of illegal practices, we will not hesitate to act,” she said.

In Kentucky, PBMs have come under fire in recent years from lawmakers fielding complaints from their local pharmacists alleging predatory business practices.

Bill would save Kentucky consumers money, help independent pharmacies survive, says sponsor

In 2020, the General Assembly enacted Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, that directed the state to cut out multiple PBMs from its Medicaid program and instead hire a single company to report directly to the state.

The result was nearly $300 million in savings — despite claims from PBM representatives it would cost the state money, state Medicaid officials told lawmakers in October.

SB 50 was signed into law by Beshear, a Democrat, who Monday hailed it as an example of bipartisan cooperation with the General Assembly, dominated by a Republican supermajority.

Wise now is sponsoring Senate Bill 188, meant to reform practices of PBMs in the commercial insurance market in Kentucky.

Benjamin Mudd, executive director of the Kentucky Pharmacists Association, said further controls on PBM practices could help Kentucky’s struggling, independent pharmacists, some of whom have been forced to close.

“They just continue to siphon money out of the system,” he said.

Wise’s SB 188, he said, “is a last-ditch effort to help a lot of pharmacists barely scraping by.”

Dr. Bill Collins, dental director at Red Bird Mission in Eastern Kentucky, said too many children in rural areas on well or cistern water lack access to fluoridated water and suffer much more from dental decay as a result. (Photo by Deborah Yetter for Kentucky Lantern)

As a dental hygienist working with low-income schoolchildren in Louisville, Jennifer Hasch said the untreated tooth disease she saw was shocking.

Some teens had decay so severe they had to have all their teeth pulled and be fitted with dentures. Middle school kids reported being unable to sleep because of pain from infected and abscessed teeth. First and second-graders required in-patient oral surgery under anesthesia because of the severity of tooth and gum disease.

“It was heart-wrenching,” said Hasch, who’s on the steering committee of the Kentucky Oral Health Coalition.

Adults don’t fare much better.

Kentucky ranks 49^th in overall oral health and is among the top states in the number of toothless, older adults. And last year, a University of Kentucky oral health physician described to legislators patients being air-lifted to the UK hospital because of life-threatening infections from dental disease.

Yet a group of lawmakers led by Rep. Mark Hart, R-Falmouth, is pushing a bill to make fluoridation optional for local water districts, despite what Hasch and others, including the American Dental Association and the Kentucky Dental Association, say is overwhelming evidence fluoride safely helps reduce tooth decay.

“It’s a bill that will undo an unfunded mandate and return the issue to local control,” Hart said, speaking before the Feb. 7 meeting of the House State Government Committee in support of House Bill 141.

Hasch and other oral health professionals are fighting HB 141, which would eliminate the water fluoridation mandate established in 1954.

“There are kids that already are suffering,” Hasch said. “Water fluoridation protects that from getting worse.”

Dr. Stephen Robertson, executive director of the state dental association, urged lawmakers to reject HB 141, saying “Kentucky is not in a position to take a step backward in oral health.”

“Please listen to our professional advice and continue to provide consistent fluoride access to our patients in community water supplies,” urged Mary Ann Burch, representing the Kentucky Association of Dental Hygienists.

They didn’t.

Instead, the committee approved HB 141 by a vote of 16-1, framing it not as a public health issue but rather one of local autonomy. The bill now is pending in the House.

“This is a local control issue,” said co-sponsor Rep. William Lawrence, R-Maysville. His city was the first in Kentucky to add fluoride to its drinking water supply in 1951.

“Local control — that’s what this bill is about,” said Rep. Steve Rawlings, R-Burlington, also a co-sponsor.

“Let’s just leave it to local control,” said Rep. Kevin Bratcher, R-Louisville.

In all, six members of the committee cited “local control” as grounds for passing HB 141. Rep. Keturah Herron, D-Louisville, cast the only no vote.

‘Setting my hair on fire’

The prospect of allowing local water districts to eliminate fluoride from drinking water has Kentucky dental and public health officials frantic.

“Other than setting my hair on fire, there’s not enough words I can say that this is a critically important step, if Kentucky takes it, to harm developing teeth, children’s teeth and adult teeth,” Dr. Connie White, Kentucky’s deputy public health commissioner, said on a recent call with health advocates.

Fluoride reduces cavities by 25%, White said.

Not only will it lead to even more tooth decay than Kentucky already has, White said, it will drive up costs of Medicaid, a government health plan for low-income individuals that covers nearly half of Kentucky’s children.

Filling one cavity in a child costs Medicaid about $250, which could add million of dollars to the cost of the program, White said.

Already facing a shortage of dentists in the state, especially pediatric dentists, removing fluoride from community water supplies will mean longer delays in care, Hasch said.

“We don’t have the resources to handle that increase,” Hasch said. “All these dental providers are desperately trying to catch up with the current need.”

Dr. Bill Collins, a longtime dentist in Eastern Kentucky, said too many children in rural areas on well or cistern water already lack access to fluoridated water and suffer much more from dental decay as a result. Compounding the problem is high use of sugary sodas and lack of access to oral health care throughout the state.

He said he’s baffled about why lawmakers want to remove the fluoride mandate.

“They don’t see the need for fluoride because they haven’t experienced the decay that we have out in the rural areas,” said Collins, director of the Red Bird Mission dental clinic in Beverly. “If this happens, they’re going to experience it and they should be held responsible.”

‘Grounded in science’

Fluoride, hailed as one of the major public health advances of the past century by the U.S. Centers for Disease Control and Prevention, was first introduced in Kentucky in the early 1950s and its statewide adoption has made Kentucky a national leader, advocates said.

A naturally-occurring mineral, added to water in small amounts, it helps strengthen tooth enamel and prevent decay, said Hasch. It helps when children’s teeth are developing but the main benefit is topical exposure to fluoride from drinking treated water.

The recommended level is .7 parts per million, which Hasch said is comparable to adding one drop of fluoride to around 11 gallons of milk.

The Louisville Water Co., the state’s largest public water provider, has been adding fluoride to water it gets from the Ohio River since 1951, said spokeswoman Kelley Dearing Smith.

The river water already contains some natural fluoride and the water company adds enough to bring it to the recommended level, she said.

“We are grounded in public health,” she said. “Everything we do is grounded in science.”

The Louisville Water Co. joined insurer Delta Dental of Kentucky, the dental and dental hygienists associations, the Oral Health Coalition and the Kentucky Primary Care Association in a letter to legislators urging them to reject HB 141.

“Community water fluoridation is a safe, reliable cost-effective prevention measure to keep teeth strong and reduce cavities by at least 25%,” the letter said. “…We are deeply concerned about any efforts to make water fluoridation programs optional in our communities.”

‘Forced medication’

Yet questions about fluoride’s safety and efficacy have persisted over the years, despite evidence to the contrary.

Four rural water districts submitted letters in support of HB 141: the Grayson County Water District, Irvine Municipal Utilities, the Martin County Utility Board and the McCreary Water District.

“The facts are out there proving fluoridation of water is dangerous to human health,” said the letter from Craig Miller, division manager for the Martin County water utility.

He also said it would save Martin County about $14,000 a year in fluoride costs, money he said could be better spent upgrading the problem-plagued water system.

Nina McCoy, a longtime activist for better water in Martin County and a member of the utility board said she wasn’t consulted on HB 141 and the board didn’t vote on the matter.

She suggested legislators defer to public health officials.

“I don’t pretend to be an expert in this at all,” she said.

A letter from Stephen Whitaker, superintendent of the McCreary water district, cited potential “adverse effects of fluoridation” including thyroid, tooth and bone problems.

Lawrence, a co-sponsor of HB 141, called adding fluoride to water “forced medication.”

Hasch, with the Oral Health Coalition, dismissed claims of studies linking water fluoridation to health problems as “junk science” and said the overwhelming body of research supports it as safe and effective.

Collins, who has practiced dentistry in Eastern Kentucky for more than three decades, said he doesn’t understand persistent distrust of fluoride.

“I really don’t understand why they are so adamant about removing this,” he said. “It’s something that’s time-tested and shown to be a good thing and it’s safe. It’s just mind boggling.”

After a public outcry, Rep. John Hodgson says he will revise his bill that would have drastically dimmed the lights on public access to government records in Kentucky. (Getty Images)

A Kentucky lawmaker says he plans to revise a bill rewriting the state’s open records law after it ignited protests from open government advocates and the Kentucky Press Association who warned it would “eviscerate” access to public records.

Rep. John Hodgson, R-Fisherville, said in an email he plans to eliminate a section redefining public records after hearing from advocates he had challenged to provide examples of how House Bill 509 would block access to government information previously considered public.

“A number of involved private citizens and constituents took me up on that offer and we had some very constructive dialog about dozens of specific examples in their experience base,” Hodgson’s email said.

Among Hodgson’s promised changes: HB 509 would no longer try to shield personal cell phones and emails of state employees or board and commission members when used to conduct official business.

That comes amid an ongoing court battle over access to such communications from the Kentucky Fish and Wildlife Commission by a group seeking texts or emails related to the 2021 controversial contract renewal of Rich Storm, its executive director.?

At the time, the nine commission members, appointed by the governor to oversee the state agency, did not have official email or cell phones. They now have state email accounts but use personal phones, according to the commission website.

Court: Texts about public business on officials’ personal cell phones can be public record

Amye Bensenhaver,?co-director of?the Kentucky Open Government Coalition, which filed suit over access to records related to Storm’s contract, greeted the proposed changes to HB 509 with relief, calling it a “teachable moment.”

“I hope the coalition helped by explaining to them how the changes to the definition of public record were destructive of existing public rights,” she said in an email.

Michael Abate, a First Amendment lawyer who represents the press association and the Open Government Coalition, also welcomed Hodgson’s proposed changes.

The coalition maintains — and the courts so far have ruled — that communications about public business, even if on personal accounts or devices, are considered public records, Abate said.

“We would strongly oppose making those off-limits,” Abate said in an email. “If public business is being conducted, citizens have a right to see it regardless of where it is being done.”

Fish and Wildlife lawyers have asked the state Supreme Court to review an October decision by the Court of Appeals in favor of the Open Government Coalition’s access to the cell phone and email records involving commission business.

As for changes to HB 509, Hodgson said he plans to eliminate a section of the bill that imposed new limits on what constitutes a public record and leave only the first section of the bill that requires state email accounts for state employees and members of boards and commissions. It would require those individuals to use those accounts for any public business conducted through email.

Hodgson said that requirement should protect “privacy rights of individuals with their personal cell phones and emails.”?

The proposed changes would no longer bar access to information on a phone or email account that is the “personal property” of current or former employees, board members or others who served in an official position, as the original bill does.

In filing HB 509, Hodgson cited concerns about the pending Supreme Court case that could put all “executive branch employees at risk for losing their personal privacy regarding text messages and emails on their personal devices.”

Abate said the court case has never been about getting private information from state officials.

“The Fish and Wildlife case has never required anyone to turn over their personal messages, or their devices,” Abate said. “It simply requires public officials and employees to search for and produce any government documents they choose to create on their personal phones or devices.”

Concerns date to 2019 hiring of Fish and Wildife chief

That case dates back to 2021 after the commission voted to award a four-year, $140,000 contract to Storm as executive director of the agency amid a dispute with Gov. Andy Beshear, a Democrat, whose administration had stopped payments to Storm under his previous contract.

Storm was named executive director in January 2019 under the administration of former Gov. Matt Bevin, a Republican. His selection came after the commission voted to bypass other candidates for the job and hire Storm, who previously served as one of the volunteer commissioners including as chairman.

In January 2020, the commission voted to extend Storm’s contract for two years. By then, Beshear was in office and objected, citing multiple critical audits of the agency including one in 2018 by state Auditor Mike Harmon, which recommended a “change in culture” at the agency.?

The commission’s role, under state law, is to keep a “watchful eye” on the Fish and Wildlife Department, which oversees about $68 million a year in funds generated from hunting and fishing licenses and federal grants. It represents about 800,000 sportsmen and women statewide.

The ongoing dispute over Storm’s contract attracted attention of critics of the commission including Brian Mackey, a Hardin County farmer and longtime sportsman.

In 2021, Mackey filed the original records request, seeking? to learn more about the commission’s 2020 decision to renew Storm’s contract.

Since the commissioners at that time didn’t have state cell phones or email addresses, he filed an open records request asking for such information from their personal cell phones or email accounts related to the contract.

“All this stuff made me wonder what’s going on here,” he said. “My gut was telling me these people have got to be talking about this.”

Fish and Wildlife denied his request. Mackey did not pursue the case after then-Attorney General Daniel Cameron ruled in favor of Fish and Wildlife, saying they did not have to produce the records.

But the Open Government Coalition then took up the case, pursuing the current legal challenge.

In October, the state Appeals Court issued a 32-page opinion finding such communications about Fish and Wildlife business clearly are public records — even if conducted on personal cell phones or email accounts.

To hold otherwise, the opinion said “would certainly defeat the purpose of the Open Records Act as public officials could easily evade disclosure of public records by simply using their personal cell phones.”

“Additionally, in this case, commission members were not provided with official email accounts or cell phones, thus necessitating the use of their personal phones for commission business,” it said.

Mackey, who served seven months on the commission, until the Senate — at the urging of Senate President Robert Stivers, R-Manchester — refused to confirm him in 2022, said his concerns with the commission go beyond Storm’s contract.

“They’re kind of a rich, good old boys club,” said Mackey who said he questioned the lack of detail in financial statements and other items the commission was routinely asked to approve.

Stivers, in urging Senate members to reject Mackey, argued he was a disruptive influence at the Fish and Wildlife commission, which he defended as a vital body that effectively oversees hunting, fishing and wildlife protection in Kentucky.

“I cannot in good conscience say this individual should be confirmed,” he said.

Mackey said he still follows commission business and attends its quarterly meetings.

As for Hodgson’s proposal to revise HB 509, he said he’s encouraged but waiting to see the final version of a bill? co-sponsored by House Speaker David Osborne, R-Prospect and Rep. Jason Nemes, R-Middletown, the House majority whip.

The House and Senate are controlled by Republican supermajorities.

“Hodgson may be trying to fix it but if the GOP really wants this to become law, they’ve got the ability to change it at the 11th hour,” Mackey said.

The light could go out on many public records in Kentucky, experts warn, under House Bill 509. Above, the Kentucky Capitol at dusk, Jan. 4, 2023. (Kentucky Lantern photo by Arden Barnes)

FRANKFORT—A newly-filed bill one expert said “would eviscerate access to public records” in Kentucky is drawing fire from news organizations and open records advocates even as its sponsor says such claims are untrue and overblown.

“Access by the public to disclosable public records will not be hindered in the least,” Rep. John Hodgson, R-Fisherville, said in an email. “Every record that is disclosable now remains disclosable.”

But critics fiercely attacked House Bill 509, filed Monday and co-sponsored by House Speaker David Osborne, R-Prospect, and Rep. Jason Nemes, R-Middletown.

HB 509 would destroy what has long been a model law when it comes to public access to government records, the Kentucky Press Association said in a statement Wednesday.

“This bill can only be described as an all-out assault on transparency, and any person that cares about the power of the people to know what their government is up to must oppose this bill,” it said.

First Amendment lawyer Michael Abate, who represents Kentucky news organizations and the press association, blasted HB 509 in comments on X, formerly Twitter.

“Louisville citizens/media: this is not a drill. HB 509 would eviscerate access to public records in the Commonwealth, and it has the support of House leadership,” Abate said. “Claims that it puts nothing new off limits are dead wrong.”

In an interview, Abate said Hodgson’s claim the bill doesn’t change access to public records is false

“This notion that it doesn’t change anything is incredibly dangerous,” he said. “That is an incorrect statement.?

Amye Bensenhaver, co-director of?the Kentucky Open Government Coalition, described HB 509 in an email as a major attack on the open records law.

“The annual legislative assault on Kentucky’s open government laws has commenced in earnest, but this year with a vengeance,” said Bensenhaver, a former Kentucky assistant attorney general who wrote open records opinions. “It is no exaggeration to suggest that the future of the Kentucky Open Records Act is at stake.”

HB 509 would:

Place new limits on what the law defines as a public record and exempt many items critics say are now subject to disclosure.

Hodgson maintains it would not change? access to such material but critics said the wording of HB 509 could block access to items such as personnel records, emails, police records and donations to public agencies such as university foundations.

‘It narrowly redefines public records in a way that puts off limits the things people seek every single day,” Abate said.

The press association said HB 509 would “replace a well-functioning system with chaos and confusion.”

Require the executive branch to provide all employees with state emails and require them to use them for state business. Such emails would be subject to open records requests.?

“With this process in place, the employees’ personal privacy on their devices should be shielded from public disclosure,” Hodgson said.

But the press association said HB 509 creates “a glaring loophole” by then adding protections for private devices, such as cell phones or email accounts from public disclosure even if used to conduct or discuss state business.

“Indeed, board members or commissioners could flagrantly violate the Open Meetings Act by conducting their substantive discussions by email or text, and reaching consensus on how to proceed, and the evidence of those violations would be completely off limits to the public because they were not done on ‘government’ devices,” the press association said.

Bar disclosure of preliminary drafts, discussions, or recommendations regarding official actions that now are subject to disclosure once a final action is taken.

For example, the state now must disclose all records in a personnel case once the matter is closed.

The press association said that could “massively erode” the public’s access to information about areas including misconduct by state employees and how the state handles allegations.

It cited as an example the 2011 death of?Amy Dye, 9, who was beaten to death in her adoptive home in Todd County. Her death sparked extensive press coverage into the role of the Cabinet for Health and Family Services, which had placed her in the home.

The cabinet first denied having records, then refused to release any of its voluminous records in the case — which included extensive allegations of abuse it had failed to investigate or substantiate — until ordered to do so by a court. Disclosures in the case helped result in a landmark open records ruling that the public has access to state records of child abuse and neglect that results in the death or serious injury of a child.

HB 509 would undermine vital access to such records created by the court decision, the press association said.

“It is exactly what happened when the Cabinet for Health and Family Services falsely denied possessing ‘public records’ related to the tragic death of Amye Dye, a child under its supervision,” it said. “The resulting litigation was one of the most important open records cases in Kentucky history, and led to substantial sanctions against the agency and important legal reforms to the child welfare system.”

Personal devices, public business

The provision regarding state emails and exempting personal electronic communications of employees drew particular concern.

Hodgson said the intent is to ensure access to public information but protect privacy of individuals.

?“There has been some debate for years about whether personal devices should be exempt from (open records),” he said in an email.

Further, he said, a pending state Supreme Court case could force employees to disclose such information, saying it “may put all executive branch employees at risk for losing their personal privacy regarding text messages and emails on their personal devices.”

The email provision drew the support of Gov. Andy Beshear.

“As the former attorney general, the governor understands the importance of open records laws and transparency in government,” his spokeswoman, Crystal Staley, said in an email. “The proposed law requires everyone doing state business to have a state email or other means of official communication, and that they must conduct their official business using it. That is a step forward that addresses recent challenges and should be acknowledged.”

Staley did not address other provisions of HB 509.

Abate said he doesn’t dispute that state employees should have work emails to use for state business.

“That’s actually a good idea,” he said.?

But the bill also provides new protections shielding government workers or officials from having to provide communications from personal emails or phones even when they involve state business—which would lead to abuse and secrecy, he said,

“It’s going to be a disaster,” he said.

Kentucky lawmakers agree health care costs are too high but disagree on the effects of certificate of need laws on cost and access to medical care. (Getty Images)

FRANKFORT — The state Senate began its review of the House two-year budget proposal Wednesday, starting with Medicaid, a $15 billion a year program that provides health coverage and other services to about 1.5 million low income, disabled or other Kentuckians.

The Senate Appropriations and Revenue Committee heard from Eric Friedlander, secretary of the Cabinet for Health and Family Services, and John Hicks, budget director for Gov. Andy Beshear — chiefly about their concerns over cuts in the state’s share of the program that gets 70-80% of its money from the federal government.

“This creates a hole in the Medicaid budget for Fiscal Year 25,” Hicks told the committee.

Fiscal year 2025 begins July 1. Hicks said the House’s proposed budget for FY 2026 does not cut Medicaid.

Advocates worry the House plan could force cutbacks in Medicaid services in FY 2025 through more than $900 million in cuts to the amount sought by Beshear, a Democrat, in his budget proposal.

Republicans, who hold supermajorities in both chambers of the General Assembly, will enact the final budget.

Jason Bailey, executive director of the Kentucky Center for Economic Policy, told the Kentucky Lantern that overall, the House plan cuts about $139 million in state funds Beshear sought for Medicaid in FY 2025, which would cause the state to forfeit another $783 in federal matching money for a total of around $922 million.

Rep. Jason Petrie, R-Elkton and chairman of the House budget committee, has said the House budget presumes fewer people are enrolled in Medicaid, now that the federal government is requiring enrollees to recertify annually that they are eligible. That requirement was dropped during the public health emergency of the COVID-19 pandemic.

But Hicks said state budget forecasters worked hard to project how many people will leave Medicaid—so far, around 200,000—and develop an accurate count for the governor’s budget proposal.

“We’ve incorporated those numbers into the budget forecast,” he said. “I’m here to tell you that they are.”

Advocates are hopeful the Senate will restore the state’s share of funds for Medicaid.

Committee members made few comments yesterday as they listened to the Beshear administration officials.

Sen. David Givens, R-Greensburg, expressed concern about the growth in Medicaid, which now covers about a third of Kentuckians, including more than a half million children and the majority of nursing home residents.

He asked how to reduce the number of Kentuckians enrolled in Medicaid.

Friedlander said most adults who are covered by Medicaid and not disabled or elderly are working at low-wage jobs that don’t provide health coverage.

“Getting higher wage jobs, that’s the way that you work on having fewer people eligible for Medicaid,” Friedlander said. “I think that will make as big a difference as anything else.”

Givens suggested a committee meeting during the interim after the legislative session ends to discuss specific ways to achieve that goal, noting that Medicaid has grown significantly during his 15 years as a legislator.

“We’ve got to get a handle on this,” he said.

Rep. Jason Petrie, R-Elkton, left, and House Majority Floor Leader Steven Rudy, R-Paducah, look over various proposals for the state’s next biennial budget, Jan. 16, 2024. (LRC Public Information)

Advocates and state officials, alarmed about cuts to Medicaid in the budget proposal approved by the Kentucky House Feb. 1, hope to make their case for changes as the Senate takes up the approximately $60-billion-a-year spending plan.

That begins Wednesday, with the Senate Appropriations and Revenue Committee scheduled to hear from Eric Friedlander, secretary of the Cabinet for Health and Family Services, and John Hicks, budget director for Gov. Andy Beshear.

“I’m quite nervous,” Friedlander said speaking during an online meeting Monday of the human service advocacy group ThriveKY. “Very nervous about Medicaid. … It looks like it’s going to be tough for us in ’25.”

Advocates worry the House plan could force cutbacks in Medicaid services or enrollment in the 2025 fiscal year that begins July 1 through more than $900 million in cuts to the amount sought by Beshear, a Democrat, in his budget proposal.

They also question whether it’s part of a broader plan Republican lawmakers, who hold a supermajority in the General Assembly, enacted in 2022 to phase out the state income tax as long as it meets goals including limits on spending.

“I don’t know of any other explanation,” said Jason Bailey, executive director of the Kentucky Center for Economic Policy, a non-partisan research and policy group. “Where do you find the money? Where do you cut? Now we’re seeing budget gimmicks.”

Bailey said that overall, the House plan cuts about $139 million in state funds Beshear sought for Medicaid in FY 2025, which would cause the state to forfeit another $783 in federal matching money for a total of around $922 million.

Rep. Jason Petrie, R-Elkton and chairman of the House budget committee, said in a Feb. 5 interview on KET’s “Kentucky Tonight” that triggering more income tax cuts is not the motive when it comes to funding state programs through House Bill 6, the budget bill.

Rather, he said, the key question is, “Is it a legitimate purpose of limited state government to take it on?” And if so, “What’s the optimal amount to make sure we have optimal and efficient services rendered to constituents?”

Beshear vowed to keep working with lawmakers to restore Medicaid funding. “We believe health care is a basic human right and we have worked to make sure all our families have access to care,” the governor said in a statement. “We will continue to work with lawmakers to restore the funding cut to this critical program, which supports our hospitals and provides health care services to more than 1.5 million Kentuckians, with more than half of those being children.”

One bright spot

The state’s $15 billion a year Medicaid program? provides health coverage for about 1.5 million low-income Kentuckians, individuals with disabilities and the majority of nursing home residents.

Kentucky legislature asked to end long, worrying wait lists for adults with disabilities

One bright spot in the House budget noted by advocates: It includes about $200 million — about $143 million of that in federal funds — for 2,550 new slots in Medicaid “waiver” programs such as Michelle P. that provide housing, therapy or other supports for people with disabilities.?

Waiting lists for such services number in the thousands for programs that generally have been increased by 50 or so a year.

Advocates are “very excited” to see that significant expansion in the House budget, said Sheila Schuster, executive director of the group Advocacy Action Network.?“That’s a whole lot more than we’ve ever seen.”

Mobile crisis cut ‘heartbreaking’

But the House budget plan also cuts $2.7 million in funds to launch a “mobile crisis” system for Kentuckians experiencing a mental health crisis, which means the state also would lose about $7.8 million in federal matching Medicaid funds.

Friedlander called that cut from the governor’s proposed budget “heartbreaking.”

Throughout Kentucky, he said, people have identified such a system to be urgently needed.

“I think it’s really important that we respond in local communities to folks who are in some behavioral health or substance abuse crisis,” Friedlander said.

But his major concern is the overall loss of funding for basic Medicaid health services in the first year of the two-year budget the General Assembly must approve.

Petrie, presenting the budget on the House floor, said that? it? assumes a decline in Medicaid enrollment following the COVID-19 pandemic and federal rules that required states to resume requiring annual recertification for enrollees. State figures show around 210,000 people have left Medicaid, some because they’ve found other coverage and others because they didn’t follow rules to recertify.

“We have less people that we’re serving,” Petrie said.

But Bailey said that the governor’s office, in its budget request to the legislature, already assumed a decline in Medicaid enrollment and he’s not sure whether the House estimate assumes even greater declines.

“Basically, they have not shared an explanation of what assumptions they used,” he said.

Petrie, in response to a question on the House floor, said he did not have the exact information available but said he was confident in the proposal.

No Medicaid cuts in FY 2026

The budget doesn’t propose any Medicaid cuts for Fiscal Year 2026.

Petrie said the House budget planners believe Medicaid enrollment will begin to increase after an initial decline and “we want to make sure that we’re fully funding for the services that are needed.”

But cutting that much in the upcoming budget year from the $15 billion a year program, which gets up to 80% of its funding from the federal government, would leave the state with few options for paying for health care, Bailey said.

“They’re going to face a choice,” Bailey said. “Do they reduce provider payments, do they cut services or do they reduce enrollment in some way to stay within the budget they’ve been given?”

Friedlander put it this way, speaking at Monday’s online meeting:

“If there’s not enough money for Medicaid, there’s not enough money for Medicaid and where does that money come from?”?

Sen. Max Wise (LRC Public Information)

Four years after leading the effort to cut corporate middlemen out of the prescription drug business for Kentucky’s Medicaid program, Sen. Max Wise now is taking aim at those same companies’ role in private health insurance.

Noting his Senate Bill 50, enacted in 2020, resulted in millions of dollars in savings to Kentucky Medicaid, Wise, R-Campbellsville, has filed a measure meant to restrict the role of companies known as pharmacy benefit managers, or PBMs, in commercial health insurance.

Reprieve for Kentucky’s independent pharmacies is saving Medicaid millions

The Kentucky Lantern last year reported state officials estimated Wise’s bill eliminating outside PBMs from state Medicaid resulted in about $283 million in savings between 2021 and 2022—savings plowed into expanded Medicaid dental benefits for adults.

Wise, in a news release, said he believes Senate Bill 188, filed Feb. 8, will aid many more Kentuckians’ access to prescription medication and help struggling local pharmacies.

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said.

The news release said it would also help the state’s around 500 independently owned drugstores, with at least 64 having closed in the past two years.

Pharmacists throughout Kentucky have complained that PBM’s extreme cost-cutting measures have reduced their revenue and left them struggling to survive, as PBMs kept a share of proceeds for themselves.

PBMs, many owned by large pharmacy chains, have argued they save money by processing prescription drug claims more efficiently and at better prices.

CVS Health says on its website that its PBM business, CVS Caremark, helps “increase access to care, deliver better health outcomes and help lower overall health care costs” for consumers.

CVS and other national PBMs unsuccessfully fought Wise’s 2020 bill which eliminated their role in Kentucky’s $15 billion a year Medicaid program and instead directed the state to hire a single, independent PBM to oversee Medicaid’s about $1.2 billion a year prescription drug business.

They likely will oppose Wise’s bill but lawmakers in recent years have expressed increased skepticism about the role of PBMs in Kentucky and other states including Ohio and West Virginia.

Monday’s news release said SB 188 “builds on the success” of Wise’s legislation affecting Medicaid prescription drugs.

Among the drugs Kentucky children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or products containing THC, the main chemical in marijuana.(Getty Images)

Kentucky’s youngest children continue to be at risk of drug overdoses from accidental ingestion — with the number of fatalities and the strength of the drug, or combination of drugs, increasing.

Eight children died from ingesting drugs and another 47 suffered an overdose in fiscal year 2022 among cases reviewed by the Child Fatality and Near Fatality External Review Panel, which released its annual report Thursday.?

The majority of overdose victims in the report were age 4 or younger.

Five years ago, by contrast, one child died among the 32 overdose cases it reviewed, the panel reported.

And just a fraction of child overdoses in Kentucky are identified in the report since the panel reviews only cases where abuse or neglect is suspected in the death or near-death of a child.

In 2022, 721 children were treated in Kentucky hospital emergency rooms for drug ingestion, with 72 requiring hospitalization, according to emergency department data, the report said.

Dr. Melissa Currie, a forensic pediatrician and founding member of the panel, said such cases are among her greatest concerns.

“I do believe ingestions are a major problem and it’s getting worse rapidly,” said Currie, a professor of medicine with Norton Children’s Hospital and the University of Louisville medical school. “We need to do a better job of educating parents about how dangerous that is.”

Drug use in the home presents the greatest risk, the report said.

“Children living in a home with a caregiver using illicit or other dangerous substances are at a higher risk of accidental ingestion,” the report said. It said children also are at risk of ingesting drugs used to treat opioid use disorder, such as buprenorphine.

Among the drugs children are ingesting: opiods, fentanyl, drugs used to treat opioid use disorder, and increasingly, cannabis or products containing THC, the main chemical in marijuana.

Often such cases involve a combination of drugs.

One example it cited: A 19-month-old who died tested positive for fentanyl and morphine in a home where an adult overdose death had occurred just two months before and where both parents reported using heroin. Two other children in the home tested positive for fentanyl, a powerful, synthetic opioid.

Cannabis products were linked to the deaths of two children who ingested them, the report said.

Currie said the public doesn’t realize the risks even of legal products derived from hemp, such as gummies.

“It can still put kids in the ICU,” she said.

Most deaths or injuries preventable

Created in 2012 to conduct comprehensive reviews of child deaths and serious injuries from abuse or neglect, the independent panel of physicians, judges, lawyers, police, legislators and social service and health professionals meets regularly throughout the year to analyze such cases.

It is charged with producing an annual report to detail its findings to the governor, lawmakers and other officials along with recommendations for improving conditions for children in a state that has long ranked high for its rate of child abuse and neglect.

State Sen. Danny Carroll, R-Paducah, and a member of the panel, said he has not had an opportunity to review the final report but a spokesman said Carroll and the General Assembly generally consider its findings in crafting public policy.

The 2024 report includes cases from July 1, 2021 to June 30, 2022, and examines 202 cases in which 68 children died and 134 suffered life-threatening injuries.

Of the deaths, the majority were from neglect and 10 from physical abuse.

It found that nearly all — 90% — of the deaths and injuries could have been prevented with appropriate precautions, such as safely storing medications or securing firearms.

Areas the panel examined this year included drug overdoses, physical abuse, neglect, firearm deaths including suicide and the role of the Cabinet for Health and Family Services in responding to reports of child abuse and neglect.

Common factors in child deaths and injuries included household financial stress, mental illness, family violence and addiction.

Here are some of the key findings and recommendations:

Overdose and ingestion cases

In light of a rise in such cases over the past five years, the panel recommends better education for all professionals involved in medication assisted treatment for adults with addiction.?

Among child ingestion cases the panel studied, 37% of their caregivers were receiving such treatment including medication for opioid misuse.

That training should stress reminding patients to safely store medication and for health professionals to report when a parent relapses.

It also recommends the Kentucky Board of Medical Licensure provide more continuing education to doctors on opioid ingestion in children.

The report also recommends training for medical marijuana providers. The Kentucky General Assembly in 2023 approved the use of medical marijuana for certain serious conditions though the law does not take effect until 2025.

It also urges more public education on safe-sleep practices and the dangers of a child sleeping with an adult, especially one who is impaired.

“Drinking and drug use (even prescribed) impair our ability to care for a child, making bed-sharing and other unsafe sleep practices even more dangerous,” the report said.

The panel, for the seventh year in a row, asked lawmakers to fund family recovery courts statewide, now offered only in Jefferson and Clay counties.

And it urges a statewide system to create a “Plan of Safe Care,” a federally required system to track and assist families with children at risk, particularly infants born exposed to drugs.

Despite the federal requirement,? Kentucky — and most states — have not fully implemented such a system with responsibility not clearly defined.

“We need to put this on everyone’s radar,” Currie said. “Somebody needs to step in and take responsibility or the legislature needs to assign responsibility.”

Firearms a ‘deadly means’

The report notes access to firearms continues to put children at risk.

In one case, a 4-year-old playing with a loaded handgun he found in the glove compartment of a car fatally shot himself. In another, a 14-year-old was fatally shot in the head by a friend while handling a loaded firearm in the parents’ bedroom.

It also factors in child suicides, the report citing the death by suicide of a 14-year-old boy who had access to unsecured firearms in the home.

The panel reviewed seven suicide cases from 2022, five fatal — four involving a firearm — and two attempts resulting in serious injury. The average age of the child was 13.

Sadly, the panel reports, the cases? it reviewed were just a portion of all suicide deaths of youths in Kentucky for 2022, when a total of 29 children under 18 died by suicide..

The report cited “a significant increase” in firearm injuries in cases it reviewed for the past five years involving 48 deaths and 24 near fatalities.

The panel classified such cases as “access to deadly means” that were largely preventable. In many cases, parents had told children not to handle firearms or thought they had hidden the weapon, the report said.

“Contrary to the beliefs of many parents, research demonstrates most children know where guns are stored and will touch a firearm if provided the opportunity despite education not to touch the firearm,” it said.

The panel recommends the legislature research national models and develop legislation to promote safe storage of firearms.

Currie said she understands firearms legislation is controversial but said it shouldn’t be when it comes to child safety.

“It should be a non-issue,” she said. “That should be something we can all agree on.”

Then-gubernatorial candidate Daniel Cameron speaks during the 143rd Fancy Farm Picnic on Saturday, Aug. 5, 2023. (Kentucky Lantern photo by Austin Anthony)

Former Kentucky Attorney General Daniel Cameron’s office agreed to pay $99,750 to settle a long-running open records dispute in December just days before Cameron left to become CEO of an organization devoted to combatting “woke capitalism,” among other objectives.

American Oversight, an open records advocacy group based in Washington D.C., had sued Cameron’s office in 2020 soon after he became attorney general, alleging his office was refusing to release records related to a “ballot integrity” task force he co-chaired, the Kentucky Lantern reported last year.

The request was part of a broader inquiry American Oversight was conducting in multiple states regarding such task forces.

The lawsuit, filed in Franklin Circuit Court, alleged Cameron initially refused to release records it sought, then failed to fully comply after a judge ruled he must provide them.

The case became a battle over how the Kentucky Attorney General — who is the primary arbiter of open records disputes involving all state and local agencies — must handle requests for records from its own office.

American Oversight “got stonewalled by the attorney general,” said Amye Bensenhaver, co-director of the Kentucky Open Government Coalition, which tracks access to public information.

Cameron’s office entered the settlement with American Oversight, which sought compensation for legal costs and penalties for withheld records, nine days before his term as attorney general ended.

The Dec. 22 settlement agreement, provided by the office of Russell Coleman who succeeded Cameron as attorney general, denies any liability and said the sole purpose is to? settle the dispute and avoid further litigation.

Cameron did not respond to a request for comment through his new employer, the The 1792 Exchange.

That group, which hired Cameron, a Republican, after he lost the 2023 governor’s race to Democratic incumbent Andy Beshear, is dedicated to opposing “woke capitalism” and defending “free exercise, free speech and free enterprise,” according to its website. It is named after the year the first American stock exchange was founded.

After Cameron refused the initial records request from American Oversight, the group, under state law,? appealed to Cameron’s office which upheld its own decision. American Oversight then challenged the denial in court.

Bensenhaver said she was pleased by the outcome.

Court fight raises doubts about Cameron’s commitment to transparency

“The chief takeway from the settlement,” Bensenhaver said in an email, “is the affirmation that the attorney general is subject to the same standard of strict open records compliance when he receives a request for records of his agency that his office applies to all other public agencies in adjudicating disputes involving discharge of their public records duties.”

However, Besenhaver, who previously worked for 25 years in Kentucky as an assistant attorney general reviewing open records cases and writing opinions, said it’s unfortunate that taxpayers bear the cost, noting the nearly $100,000 payment “is not insignificant.”

And Bensenhaver said it’s also unfortunate the case won’t set a legal precedent since it was resolved through a settlement before a final court ruling.

Still, she said she hopes Coleman, a Republican who became attorney general in January, considers the case in future open records decisions from his office, saying “General Coleman should embrace the lessons this case imparts.”

Bensenhaver called “groundbreaking” an opinion in the case by Franklin Circuit Judge Phillip Shepherd in which he said agencies must make an effort to locate and produce public records and not demand specific “search terms” or the location of documents.

“To place the burden on the requestor is to invite the agency to hide relevant records that are obscurely labeled or stored in deep recesses of its bureaucratic records system,” Shepherd’s opinion said. “It is the duty of the agency to conduct an open, thorough and good faith search of its records in response to an open records request.”

The settlement agreement doesn’t specify the purpose of the payment but American Oversight had been seeking lawyers’ fees, costs and penalties for what it said were violations of Kentucky’s open records law.

The agreement says the parties would ask the court to dismiss the lawsuit as settled once the funds were paid to American Oversight.

Court records in the case show such a request was filed and the case dismissed Jan. 22.

Bensenhaver said she never understood why Cameron’s office fought against release of routine records, such as schedules and records of meetings, from the Ballot Integrity Task Force, which serves as an advisory commission to monitor elections.

“I think it’s kind of fascinating that he’s going to erect these barriers to fairly innocuous records,” she told the Lantern last year.

Heather Sawyer, executive director of American Oversight, said records the group obtained in Kentucky showed the “ballot integrity” task force produced? no evidence of any widespread election problems that had been alleged in Kentucky and other states after the 2020 presidential election in which Joe Biden defeated Donald Trump.

“It’s unfortunate that Kentucky officials falsely claimed widespread voter fraud to justify a toothless ‘task force’ and then wasted thousands of taxpayers dollars before conceding that it was only ‘a discussion group’ that did ‘not take actions or implement policy,’” Sawyer said in a statement. “Thanks to Kentucky’s Open Records law, Kentuckians now know that this so-called task force was nothing more than an expensive political stunt.”

Kay Tillow, with Kentuckians for Single Payer Health Care, led a rally against Medicare Advantage plans Oct. 11, 2023 outside the Humana headquarters in Louisville. (Photo by Deborah Yetter)

A stalemate between one of Kentucky’s largest health care providers and three major health insurers is affecting thousands of Kentucky retirees enrolled in Medicare Advantage plans.

Baptist Health last fall ended its contract agreement with Humana for physician services covered by Medicare Advantage, the Kentucky Lantern reported in October. That means doctors’ visits are considered “out of network” and patients would have to pay more for services.

And effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network.

Baptist has cited denials of care and delays in payment which the Medicare Advantage companies dispute.

Health care choices narrow for Kentuckians in Medicare Advantage plans

The changes affect around 102,000 retired public employees enrolled in such plans in which a private company manages health coverage for those 65 or older enrolled in Medicare.

Louisville-based Humana, one of the nation’s largest providers of Medicare Advantage plans, covers some 64,000 state and local government retirees who get health coverage through the Kentucky Public Pension Authority.

Another 38,000 retired teachers have Medicare Advantage plans with United through the Kentucky Teacher’s Retirement System though under terms of their plan they won’t pay more to see Baptist providers.

Kay Tillow, a longtime crusader for single-payer health coverage, said the result of the contract dispute is a loss of access to physicians and other services retirees depend on. She also said the increased privatization of Medicare is damaging the federal government plan she and other advocates see as a model for public, single-payer health coverage.

“The profit motive is destroying patient care,” she said in an email.

Medicare Advantage customers may be eligible for special enrollment period

Other Kentucky retirees have Medicare Advantage plans assigned to them by their unions or former employees such as United Auto Workers union members who may choose either Humana or United, Tillow said.

Together, Humana and United account for nearly half of all Medicare Advantage coverage in the nation, according to KFF, an independent health news site.

Medicare Advantage plans, which now cover more than half of enrollees in the government health plan, tout their role as one of providing more efficient care at lower costs.

“Medicare Advantage organizations approach health care holistically,” a Humana spokesman said last year. “At Humana, we prioritize preventative care and offer expansive supplemental benefits to keep seniors healthy.”

A United spokesman cited “Baptist Health’s repeated demands for changes to our contract” as the reason for the end of its affiliation with the health system.

“While we remain open to continued discussions, our focus now is ensuring the people we serve have access to the care they need through either continuity of care or a smooth transition to one of more than 90 hospitals or 14,000 physicians and practitioners remaining in our Medicare Advantage network in Kentucky,” spokesman Spencer Leuning said in an email.

Wellcare did not immediately respond to a request for comment.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute with Medicare Advantage plans.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in an email statement Monday.

The practice costs time and money and leaves patients “caught in the middle,” she said.

However, Barry, public relations director for Baptist Health, said Baptist is in “active discussions” with Humana about a new contract.

Overall, about 53% of the 950,000 Kentuckians covered by Medicare are insured through Medicare Advantage plans.

Many are, in effect, captive customers since the state or private retirement system selects the Medicare Advantage company and provides it as part of retiree benefits. The retiree pays Medicare premiums to the government and the employer pays the private insurer’s charge.

For those seeking to change Medicare plans, the government’s open enrollment period ended Dec. 7.

However,? Medicare Advantage enrollees who would like to make a change to another plan may be eligible for the “special enrollment” period open to those because of a change in circumstances.

Information about that is available on the Medicare.gov website.

People with individual? Medicare Advantage plans have the option of changing plans between now and March 31. Consumers also may change from Medicare Advantage to original Medicare and join a separate Medicare drug plan (Part D) during this open enrollment period. Coverage begins the first day of the month after the change.

Kim Thompson worries what will happen when she can no longer be there for her son, Forest Thompson-Bell. (Photo provided)

Kim Thompson is happy her adult son, who is intellectually disabled, lives with her.

“I want him at home,” the Louisville woman said of her son, Forest Thompson-Bell, 27. “I want to be very clear about that.”

But Thompson, 54, is among thousands of Kentucky parents or other caregivers who worry about what will happen when they die or become unable to care for disabled adult children because of age or infirmity.

“It’s a constant worry,” Thompson said. “As we all age, we tend to think about what’s going to happen when we are no longer capable of working or supporting them.”

Now, Thompson and other advocates are joining a fight to end long wait lists for help through Kentucky Medicaid for programs that provide activities, personal care, daily living assistance, and, when needed, residential care in a supervised setting such as a group home.

Their goal: convince the Kentucky General Assembly to fully fund such programs over the next eight years and eliminate the wait list that now numbers nearly 13,000 individuals, some who face decades waiting for aid.

For example, at the current rate, it would take 168 years to serve the more than 8,000 people waiting for the program known as “Michelle P.,” which pays for day programs, supported employment and other activities.

“These are people with disabilities who deserve to have these services and the state is not making them available to them,” said longtime human needs advocate Sheila Schuster.

The programs currently serve about 33,000 people and openings are rare, usually occurring when a client dies.

To start cutting the wait lists, the proposal’s price tag for the next two budget years alone is $211 million — $60 million in state money and the rest from the federal government which provides about 70% of the funding, according to projections worked out by advocates.

That would add 3,180 new slots over the next two years, with more slots contemplated in every biennial budget through 2032.

Schuster acknowledges it could be a “big fight” for that amount of money in the current legislative session where lawmakers will adopt the state’s next two-year budget.

But with the state sitting on a record budget surplus of $3.7 billion, Schuster said she and a group called Advocates for Reforming Medicaid Services, or ARMS, believe it’s time to start.

“We do have the money if we’re willing to spend it,” said Schuster, executive director of the group Advocacy Action Network.?

Parents afraid to die

Currently, 12,723 people are on wait lists for six state Medicaid programs, known as “waivers,” that provide special services for individuals with intellectual, physical or developmental disabilities, brain injuries or other limitations.

The longest: 8,398 are waiting for a slot in the “Michelle P. waiver,” named for a young woman who served as the lead plaintiff in a federal lawsuit that successfully led Kentucky in 2008 to expand such Medicaid services.

Mary Hass, an advocate for individuals with brain injuries, said older parents are afraid of dying without a plan to care for disabled children.

She recently spoke with one mother, 92, whose daughter, in her 50s, is on a wait list for help. Another parent’s young adult son will be in his 90s before he’s eligible for help, based on the current wait list, said Hass, chair of the Brain Injury Association of America-Kentucky chapter.

“None of us is going to live forever,” Hass said.

The ARMS group has found an ally in state Sen. Whitney Westerfield, a Christian County Republican, who adopted its proposal in his Senate Bill 34, a sweeping measure to provide more services to help families, especially with young children.

Westerfield said he included the ARMS proposal after learning about the lengthy wait lists for individuals with disabilities.

“I had no idea until about a year ago that we had waiting lists that were many, many, many years long,” he said. “That’s unconscionable that there are Kentuckians who need this help, deserve this help and who are eligible for this help that aren’t getting it for most of their lives or all of their lives.”

And Gov. Andy Beshear, a Democrat, announced last month he is including 750 new slots to reduce the wait list in his two-year budget proposal to the General Assembly — a significant increase over the 50 or so slots per year the state has added in recent budgets.

Advocates said Beshear’s plan is a start but much more is needed to make a meaningful dent in the lengthy wait lists.

And with a Republican supermajority in control of both chambers, it’s unclear how much legislative leaders are willing to commit even as they try to limit spending to allow for a third cut in the state income tax in future years to eventually eliminate Kentucky’s income tax.

Schuster said advocates are preparing to make their case to lawmakers.

“I’m going to say we have a fighting chance,” she said. “We know they have the money.”

‘What’s the plan?’

Advocates also say they are seeking better management of the wait lists spread among six different programs.

They acknowledge there likely is some duplication among the 12,723 people now waiting for slots in the various programs administered by the Cabinet for Health and Family Services.

Some families sign up for several waiting lists in hopes of getting services through one.

For example, they may sign up for the Michelle P. program which pays for services in the community, such as adult day centers or supported employment.

Meanwhile, they sign up for a separate program known as Supports for Community Living which pays for full-time residential living in a small group home or assistance in the individual’s home.

And some may already be getting help through the Michelle P. waiver while waiting for the residential program.

“There are people in that waiver whose needs are being met,” said Steve Shannon, a mental health advocate and member of the ARMS coalition. “However, they are living with aging parents who at some point can no longer provide the support. What’s the plan at that point?”

“Most folks would feel better knowing they have an option,” added Shannon, who represents Kentucky’s community mental health centers.

Advocates say lawmakers question the accuracy of the wait list numbers because of potential duplication and they agree the state needs a better system of keeping track.

“I think we have to do a better job of waiting list management,” Shannon said.

‘Why can’t Kentucky keep up?’

In Louisville, Forest Thompson-Bell leads a busy life, said his mother, Kim Thompson.

With financial help from the Michele P. waiver he attends a day program. He’s learning job and life skills.?

He’s in a choir for individuals with disabilities and participates in Special Olympics, where he excels in competitive cheerleading, his mother said.

He’s also enrolled in a performing arts program where he’s learning the basics of theater, playwriting, acting and directing.

“He’s quite busy,” Thompson said.

Thompson said she’s grateful to have a flexible schedule that allows her to get her son to all his activities and medical appointments as well as advocate for her son and others with special needs.

But Thompson said her ongoing concern is what happens when she can’t do that anymore.

An assurance Forest has a slot in the program that covers residential care would ease that concern for her and many other parents, Thompson said.

“Ideally, I would like the waiting list to end today,” she said. “As an advocate, I would say we really do need to look at how this got backlogged in the first place. Why can’t Kentucky keep up?”

Sen. Whitney Westerfield shared polling results with his colleagues in the state Senate Friday night. (LRC Public Information)

A Republican legislator from Western Kentucky has filed a sweeping measure to provide more support for families through a major financial boost to child care, education, housing, health services and other measures aimed at pregnant individuals and women with children.

Senate Bill 34, filed Tuesday by Sen. Whitney Westerfield, carries a $551 million price tag in state spending over the next two years with an influx of cash into services such as child care, food assistance, college tuition, housing and other needs. It would draw another estimated $112 million in federal funds.

Westerfield, a staunch opponent of abortion, said that now that the procedure is essentially banned in Kentucky, lawmakers must address ways to meet the needs of women who continue their pregnancies as well as encouraging them to do so.

Abortion is outlawed in Kentucky, except in rare, life-threatening circumstances, under laws that took effect after the U.S. Supreme Court in 2022 struck down Roe v. Wade, the 1973 decision that established abortion as a constitutional right.

“We’re 50 years too late in doing this,” said Westerfield, of Fruit Hill in Christian County. “We need to do a whole lot more investing in the lives of the women involved and the children involved.” Westerfield, an attorney and chairman of the Senate Judiciary Committee, was elected to the legislature in 2012 and is not seeking reelection this year.

The breathtaking price tag of the measure may give some lawmakers pause in the General Assembly where Republican supermajorities control both the House and Senate, Westerfield? acknowledged.

But he hopes it will garner support among legislators who have supported Kentucky’s abortion ban and consider themselves “pro-life.”

“I think there’s broad support for doing something like this,” said Westerfield, who has described SB 34 as a “pro-life” measure on his website. “I just don’t know if some of this or all of this is what they want to spend the money on.”

With Kentucky sitting on a record budget surplus of $3.7 billion, Republican House Speaker David Osborne has expressed a willingness to dip into some of the money, also known as the “rainy day” fund, as lawmakers fashion a new, two-year budget.

At the same time, Republican lawmakers have called for spending restraint to position Kentucky to afford a third cut in the state income tax in future years as part of their plan to eventually eliminate Kentucky’s income tax.

Still, Sheila Schuster, who has been advocating in Frankfort for human needs for nearly five decades, said the time is now if lawmakers want to do something meaningful for low-income or disadvantaged Kentuckians.

“I’ve been asking legislators for money for 46 years,” Schuster said. “Most of the time they would say, ‘We just don’t have the money.’ Truly, they cannot say that this session.”

Schuster said she is delighted with Westerfield’s bill but she acknowledges it will need some help amid other competing demands in the 2024 legislative session.

“I think it will be an uphill battle but it’s good, sound policy,” she said. “I’m going to say we have a fighting chance. We know they have the money.”

Among provisions of SB 34:’

• $495 million in child care assistance for low-income parents, the highest-ticket item of the bill. The lack of affordable child care and the decline in the industry since the COVID pandemic has been identified as a growing crisis in Kentucky, one that prevents parents with young children from working.
• Free tuition at Kentucky’s public four and two-year post-secondary institutions for students who meet entrance requirements, are pregnant or have a child under 18 and who have incomes at or below 150% of the federal poverty level.?
• Expanding health insurance enrollment options for pregnant individuals and mandating inpatient hospital care for the mother and newborn for 48 hours for a regular delivery and 96 hours after a Cesarean delivery.
• Requiring Medicaid to cover lactation services and breastfeeding resources in order to encourage breastfeeding. Medicaid, the federal state health plan for low-income individuals, covers around half of all births in Kentucky.
• Improving access to healthy foods through local farmers markets, the Supplemental Nutrition Assistance Program (formerly food stamps) and the Women, Infants and Children, or WIC, program.
• Pumping about $90 million over the next two years for Medicaid “waiver” services for individuals with disabilities in an effort to start reducing the long waiting lists that many Kentuckians face in getting help with therapy, housing, supervision and other aspects of daily life.

Westerfield said he was shocked to discover such individuals, most adults living with aging parents or other caregivers, face years-long waiting lists for services to which they are entitled.

“I’m ashamed that I didn’t know,” he said. “It’s unconscionable that we have let that happen.”

Schuster said money to cut those waiting lists that number in the thousands could make a huge difference for many disabled individuals and their families.

“I think it’s exciting,” she said. “To see it in a bill is pretty damn exciting for people who have been on a waiting list for umpteen years.”

Westerfield said he plans to request a committee hearing on the bill as soon as possible.

In response to questions about Westerfield’s proposals, Senate President Robert Stivers told reporters late Wednesday that he had “yet to see the bill” and spoke about victims of rape and incest.

“Those individuals adversely impacted — the trauma, everything around that, surrounding it. That instance, we need to give it as much support to them as possible. And so mental health, access to preventative health care. I’m not getting into that abortion issue, but into health care to make sure the mother has everything they need for health care is available. Those are the types of things I think we will hear discussion,” Stivers said.

Michelle Tynes, of Hickory in Graves County, with her grandson, Ashton, whom she is raising. (Photo provided)

For Barry Shrout, raising four granddaughters is a role he willingly took on — and that he acknowledges is exhausting and expensive.

“The financial part of it is a big thing with me,” said Shrout, 66, a single grandfather from Maysville who has custody of the girls ages 10, 11, 13 and 17. “I have to daily watch every nickel and dime I spend.”

Grandparents like Shrout have prompted Norma Hatfield, of Elizabethtown, to renew her near-decade-long crusade for more help for such relatives, mostly grandparents, who are raising an estimated 59,000 Kentucky children in what’s commonly called “kinship care.”

Hatfield, president of Kinship Families Coalition of Kentucky, acknowledges Kentucky has adopted some changes meant to aid relatives raising children whose parents are unable to care for them or have lost custody because of neglect or abuse with addiction often a factor.?

But Hatfield, who is raising two grandchildren, said more is needed to aid the many older relatives who have stepped in to raise children who likely would otherwise end up in foster care — at significant expense to the state.

“I communicate with so many caregivers and I keep hearing the same issues, the same struggles, and I don’t see a lot of change,” Hatfield said. “It’s been nine years. Why can’t we do better?”

Kentucky Youth Advocates, while commending state social services for changes meant to aid such caregivers, continues to seek more help for those, many on fixed incomes, who have taken children into their homes.

Shannon Moody, chief policy and strategy officer for the nonpartisan advocacy group, said recent reports of children sleeping in state social services offices in Kentucky for lack of a suitable placement as well as others sent out of state to residential centers or psychiatric hospitals suggest a “crisis” in the system.

Placing children with relatives or caregivers known as “fictive kin” — adults known and trusted by the child such as a neighbor or friend — could ease the strain, she said.

“Some of the recommendations we are making are making sure kids are with family or family-based care,” Moody said.

Moody and Hatfield appeared in August before the General Assembly’s joint Committee on Families and Children to recommend proposals they said would aid kinship caregivers.

But Rep. Samara Heavrin, R-Leitchfield and committee co-chair, expressed reservations about more financial assistance to such caregivers without more oversight.

“It’s a very big ask for the General Assembly to give money out without any strings attached,” Heavrin said. “I understand your story… but we can’t just write a blank check, either.”

Hatfield and Moody said no one is asking for a blank check but said it’s clear more work is needed to help caregivers understand what they are taking on, what assistance is available and the expense involved.

“We can’t just leave them drained, completely drained,” Hatfield said.

‘Dropped like a hot potato’

Until 2013, the state offered a monthly payment of $300 per child to kinship care providers who took in children. By contrast, state-certified foster parents are paid about $750 a month.

But the state closed the kinship program to new applicants 10 years ago, citing budget pressures.

Since then, Kentucky has restored some assistance, prodded in part by a class-action lawsuit that successfully argued kinship caregivers were providing essentially the same services for free that foster parents provided for $750 or more per child per month.

Now, relatives can receive foster care payments if they agree to train and become certified by the state. Monthly payments range from the full amount per child to partial pay if the relatives can’t meet all requirements — for example, if the house isn’t large enough to meet state specifications.

But when the child moves from foster to permanent status, should the relative adopt or gain permanent custody, the payments stop.

“They are dropped like a hot potato,” Hatfield said. “You take what you can when you can.”

Good news for family, foster caregivers

One bright spot: a recent federal rule change will allow relatives to get full foster pay even if their homes don’t meet all licensing standards.

Hatfield said Kentucky officials are reviewing how to implement the change that would be “huge” for relative caregivers.

In more potential good news for such caregivers, Gov. Andy Beshear, in his Dec. 18 budget proposal, included $10 million a year over the next two years to increase money available to relatives who agree to take children in care of the state social service system. And his budget proposes another $9.8 million a year each year to increase foster care rates by 12% for all foster caregivers.

Hatfield said both steps would be enormously helpful in relieving the financial strain for families.

“I’m so grateful to the governor for the proposed funding in the budget for kinship and foster families,” she said. “It gives me and many others a renewed sense of hope.”

Hatfield said she and other advocates will work to convince lawmakers of the need for the funds as legislators begin drafting the state’s next two-year budget in the upcoming legislative session.

Other aid available to caregivers includes the Kentucky Transitional Assistance Program, which provides a modest monthly payment per child, Medicaid health coverage for the children, Supplemental Nutrition Assistance Program, or food stamps, and a “Kentucky Caregiver” program which offers an annual payment of $500 per child for expenses such as furniture, school supplies, clothes or other needs.

The child’s parents also may be required to pay child support to caregivers, though advocates say that can be hard to collect in cases where parents are experiencing addiction, are incarcerated or have left the state.

All of those are important, Hatfield said, but more ongoing aid is needed to help relative caregivers with costs. And she said much better communication is needed for relatives who often are forced to make snap decisions in a moment of crisis about children abruptly removed from homes by authorities.

An uninformed decision — such as agreeing to take temporary custody of children — can force relatives to forfeit aid such as foster payments available only to those who agree to accept them under a foster care arrangement with the state, she said.

And state officials don’t allow any changes after that initial decision.

Workers with the Cabinet for Health and Family Services are supposed to explain options and the cabinet has information, including a video on its website, but families need better, simple and clear explanations, Hatfield said.

“People are caught up in a time of stress and all they hear is, ‘You can take temporary custody or we can put them in foster care,’” Hatfield said. “They say, ‘Of course we’ll take custody.’ Once you check the box, you can’t change it.”

Hatfield and Kentucky Youth Advocates are urging several changes they believe would help.

Mileage reimbursement

Relatives who take in children, often from abusive or neglectful situations, find they are required to take children to a host of appointments for medical care and therapy for the trauma many have experienced. They also are required to take children to any visits with parents ordered by the court, which can be weekly.

While foster parents get mileage reimbursement, relative caregivers do not, even as they are required to drive children many miles per week for appointments.

Michelle Tynes, who lives in Graves County in Western Kentucky, said she had to drive hundreds of miles back and forth to Louisville with no reimbursement after one of several grandchildren she took in temporarily needed multiple medical procedures at Norton Children’s Hospital.

She was able to pay for it, but Hatfield said buying gasoline is a hardship for many relatives.

“This one is really a big deal for a lot of families,” Hatfield said.

Respite care

Relative caregivers are not eligible for outside care for children for their medical appointments or just a needed break for errands or other events although foster parents do get reimbursed for respite care.

Shrout, the Maysville grandfather, said a trusted woman from his church cared for his granddaughters when he had to stay overnight in the hospital for a heart procedure.

He said he’s grateful for the support from his church friends but said he wishes he had some of the same help as foster parents.

“The legislature seems to be bending over backwards to help foster parents instead of kinship parents like me,” Shrout said. “We’re treated differently than those people are and it’s not fair.”

Guardianship payments

Relatives often take children under temporary arrangements in which they can get foster payments. But if the court determines the child can’t return to the parents, the relative then may adopt or obtain permanent custody.

That stops foster payments.

Advocates would like to see the state take advantage of federal funds available through a guardianship arrangement where the relative is eligible for payments as a guardian until the child turns 18.

Hatfield said state social service officials have told her they are investigating this possibility and she hopes it will become available in Kentucky.

Also, while foster children are eligible for free tuition at a state college in Kentucky, kinship children are not.

Hatfield said that would be a big help to caregivers of children nearing college age.

Opioid settlement funds?

Hatfield says she doesn’t know how much all these proposals would cost or how they would be implemented.

For that reason, she said, she’s urging lawmakers to create a task force that would study the situation and try to get a handle on the scope of the need and money required to pay for any changes.

“As much as we’ve been talking for the last nine years about kinship care, why wouldn’t we have a task force to see what the needs are,” she said.?

And Hatfield said she has one final thought: Why not use some of the millions of dollars Kentucky has recovered in settlements with pharmaceutical companies over the opioid addiction crisis?

Addiction is what caused many parents to lose custody of their children, Hatfield said, asking:

“Why are we not using some of these opioid settlement funds for kinship caregivers?”

The news was happier for supporters of reproductive rights in Kentucky as they celebrated the defeat of an anti-abortion constitutional amendment in November 2022. Less than five months earlier the Dobbs decision has allowed a near-total ban on the procedure to take effect in Kentucky. (Photo for Kentucky Lantern by Arden Barnes)

Standing before cheering supporters on election night, Kentucky Gov. Andy Beshear, a Democrat, wrapped up his reelection celebration with a round of thanks.

“First to my parents,” he said, embracing Jane and Steve Beshear — his father himself a former, two-term governor.

Andy Beshear, who defeated his Republican opponent, Attorney General Daniel Cameron, with about 52.5% of the vote, next thanked his wife, Britainy and their children, Will and Lila.

Then Beshear thanked a young woman in the crowd who appeared in a television ad that became the flashpoint of his campaign — describing her childhood rape and pregnancy and blasting Cameron for his support of Kentucky’s near-total ban on abortion.

“To tell a 12-year-old girl she must have the baby of the stepfather who raped her is unthinkable,” she says in the ad.

“Hadley is here tonight,” Beshear said of Hadley Duvall, a 21-year old from Owensboro who appeared in what political observers say was a devastatingly effective ad. “Because of her, this commonwealth is going to be a better place and people are going to reach out for the help they need. Thank you, Hadley.”

Abortion remains essentially illegal in Kentucky under a pair of laws enacted by the Republican-controlled General Assembly that provide no exceptions for pregnancies from rape or incest — laws Cameron, as attorney general, has defended.

The laws took effect after the U.S. Supreme Court last year struck down the landmark Roe v. Wade decision of 1973, establishing abortion as a constitutional right.

And the Republican supermajority in the state legislature has shown little interested in changing Kentucky’s laws, even to add exemptions for rape or incest.

But supporters of abortion rights are hopeful that Beshear’s reelection in a deep red state marks a turning point in attitudes about access to abortion as well as an awakening among voters about the real-life impact of laws that ban it.

“I think it is very obvious that abortion has become an issue that people are not afraid to talk about any longer and that certainly does drive people to the polls,” said Angela Cooper, communications director for the American Civil Liberties Union of Kentucky.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates Kentucky, noted that the Nov. 7 reelection of Beshear, a supporter of abortion rights, came the same day?voters in Ohio,?also a conservative state, approved a ballot measure establishing abortion as a state constitutional right.

And Beshear’s win comes one year after Kentucky voters rejected a ballot measure that would have declared Kentucky’s Constitution contains no right to abortion.

About 52% of the state’s voters opposed the measure — about the same share of voters who elected Beshear to a second term, Wieder said.

“I don’t think it’s a coincidence that those numbers are the same,” Wieder said. “Abortion is a winning issue.”

Who’s on offense?

Political observers say it’s likely Beshear would have won for other reasons — his overall popularity, his advantage as the incumbent,? and his management of crises in his first term including the COVID-19 pandemic and devastating tornadoes of December 2021 followed by deadly flooding the following year in Eastern Kentucky.

But the abortion issue — in particular, the ad featuring Duvall — deepened the contrast between Beshear and Cameron.

While Beshear has said he supports abortion access previously conferred by Roe v. Wade, he has focused in recent months on the fact current law contains no exemptions for rape or incest, which he has called “cruel.”

Cameron, who has defended Kentucky’s laws, was left struggling to explain his stance, giving conflicting responses to the issues raised in the ad.

And that worked to Beshear’s benefit, said Danny Briscoe, a long-time Democratic consultant from Louisville.

“You can’t say she won the campaign for him but you can say she played an awfully valuable role,” Briscoe said. “They put the ball in Cameron’s court and he never really got rid of it.”

Tres Watson, a GOP campaign consultant, said Republicans who once confidently campaigned on ending abortion are in an awkward spot now that it is effectively banned in 14 states and restricted in 11 more.

“I think it’s a new reality,” said Watson, a co-host of the Kentucky Politics Weekly podcast. “I don’t think the general public has changed. Who’s on the offense and who’s on the defense have changed.”

Briscoe was blunt about the impact on Republicans, who were responsible for appointing the justices who tipped the U.S. Supreme Court in favor of overturning the almost 50-year-old Roe v. Wade, “a huge mistake,” Briscoe said, for the GOP. “It’s haunting them.”?

A majority of Americans oppose the 2022 decision overturning Roe v. Wade and a majority continue to support at least some measure of access to abortion, according to a Marist poll in April.

Duvall ad ‘outstanding’

Both Briscoe and Watson thought the ad featuring Duvall was impressive.

“I think it will be remembered as the most outstanding ad of this election without question,” Briscoe said.

“I thought it was very effective,” Watson said. “It’s certainly a very emotional ad.”

The enthusiasm is not shared by Addia Wuchner, executive director of Kentucky Right to Life, which endorsed Cameron through its Victory PAC as “an unwavering defender of Kentucky’s pro-life laws.”

Wuchner, a nurse and health educator, said she found the Beshear ad “concerning and disappointing.”?

“We always hope that sexual violence is rare but using it to commercialize a campaign to his benefit is very concerning,” she said.

All other five constitutional offices on the Nov. 7 ballot were won by Republicans and all were endorsed by Right to Life, including Russell Coleman, who will replace Cameron as attorney general.

As for the outcome of the governor’s race in Kentucky, Wuchner said, “We’re still trying to evaluate everything.”

Kentucky’s laws ‘extreme’

Whether the Kentucky General Assembly will consider adding exemptions to the state’s stringent abortion laws remains in question.

Two laws are in in effect: A ?“trigger law” that banned all abortions once Roe v. Wade was overturned and another that bans abortions after six weeks, before many women realize they are pregnant. Neither law has exemptions for rape or incest and allow abortion only in rare instances to save the life or prevent disabling injury of a pregnant patient.

Beshear, the day after the election called on lawmakers to add exceptions for rape or incest, calling Kentucky’s laws among the “most extreme” in the nation.

Rep. Jason Nemes, R-Louisville, previously filed such a measure only to have it ignored by lawmakers in the 2023 legislative session.

He told the Lantern on election night that the matter deserves consideration.

“I think our people believe in the exemptions,” Nemes said. “And at some point, we’re representatives of the people, and we have to do what their demands are.”??

Wuchner said Right to Life is focused on pushing for more supports for women and children in the 2024 legislative session.

“When we look at the moms and young children in the state, can we do better?” she asked. “That’s the next step for the Kentucky General Assembly.”

Advocates for reproductive rights say they will continue to press on for full access to abortion in Kentucky.

“Exceptions for rape and incest are the minimum,” said the ACLU’s Cooper. “It’s really not enough.”

Wieder, with Planned Parenthood, agrees.

As part of that, Planned Parenthood will continue work to educate voters that the decision now rests with state lawmakers.

“People think the bans are national,” Wieder said. “They don’t realize it’s their local leaders.”

Kay Tillow, with Kentuckians for Single Payer Health Care, led a rally against Medicare Advantage plans Oct. 11, 2023 outside the Humana headquarters in Louisville. (Photo by Deborah Yetter)

LOUISVILLE — With open enrollment underway, older Americans are getting barraged with television ads, mailings and online notices hawking a variety of Medicare Advantage plans for health coverage.

But many Kentuckians, including thousands of state retirees, are largely captive customers with such plans selected by their employer as part of health coverage promised for those 65 or older — an increasingly popular means to cover retirees.

And members of such plans may have fewer choices for care because of ongoing contract disputes between Baptist Health and three national companies that offer Medicare Advantage plans in Kentucky including Louisville-based Humana, which covers most state retirees.

Already, the dispute has limited access of Humana enrollees to Baptist Health physicians and could affect enrollees covered by UnitedHealthcare, which covers retired public school teachers, and Wellcare.

“They’re taking away the freedom of people to choose their physicians,” Kay Tillow, a long-time crusader for single-payer health care, said at a recent rally in Louisville protesting the proliferation of Medicare Advantage plans. “It is causing havoc.”

In Kentucky, about 53% of the about 950,000 Medicare enrollees are in Medicare Advantage plans, according to KFF, an independent health policy research organization.

Nationally, one in five Medicare enrollees are in a group plan offered by an employer or union, according to Medicare Advantage plans, touted as a way to make health plans more efficient and save costs, have grown rapidly over the past two decades and now account for just over half the 60 million people enrolled in Medicare, reports KFF.

Under such plans, the consumer pays Medicare premiums and the employers pays a private insurer a fixed amount per enrollee to provide health benefits. Medicare Advantage plans also promote additional benefits, such as prescription drug coverage or fitness programs.

Enrollees in traditional Medicare must pay premiums, purchase a Medicare D plan for drug coverage and often purchase a “Medigap” policy to cover extra health costs.

AHIP, an insurance industry organization, said on its website that Medicare Advantage plans deliver “better services, better access to care and better value,” describing it as a “prime example of the government and free market working together.”

But critics said the private plans have grown increasingly profitable at the expense of taxpayers and retirees, many of whom have no choice in the matter.

‘Follow the money’

“I follow the money,” said Kirk Gillenwaters, president of the Kentucky Alliance for Retired Americans, who joined Tillow and others at the Oct. 11 rally in downtown Louisville outside the Humana headquarters.

Gillenwaters pointed to the $959 million in profits Humana reported in August, up 38% from the same time a year ago, as well as the $17 million annual compensation of its CEO, Bruce Broussard.

“We know that’s coming off the backs of seniors who are in the Medicare system,” said Gillenwaters, a Ford retiree in Louisville. “That’s what the for-profit system is doing for us in this country.”

Pointing to Humana’s 26-story, award-winning pink granite skyscraper on West Main Street, he added, “All we’ve got to do is look at this shrine in front of us.”

A Humana spokesman did not directly address the criticisms of the protesters but said that Baptist Health and Humana were unable to reach an agreement after “several months of negotiations.”

“Humana will continue to have discussions with Baptist Health in the hope of ultimately reaching an agreement,” Mark Taylor, corporate communications director, said in an email.

Taylor described Medicare Advantage programs as being highly popular with seniors and individuals with disabilities, providing better health outcomes at reduced costs.

“Medicare Advantage organizations approach health care holistically,” he said in an email. “At Humana, we prioritize preventative care and offer expansive supplemental benefits to keep seniors healthy.”

Supplemental services include meal delivery, transportation and vision and dental benefits not covered by traditional Medicare, Taylor said.

‘Deny or delay’

A statement released by Baptist Health regarding the dispute cited ongoing problems with approval for care as well as reimbursement.

“It is our experience — and the experience of other health care providers across the country that many Medicare Advantage plans routinely deny or delay approval or payment for medical care recommended by a patient’s physician or provider,” the statement said. “We think the need for medical care should be determined by a patient and his or her doctor, not an insurance company.”

Baptist spokeswoman Rebecca Brown said more detailed information for patients is available on the Baptist Health website dealing with Medicare Advantage plans.

Last year, a federal investigation found that Medicare Advantage plans too often deny necessary medical care or decline to pay for it.

The report by the inspector general for the U.S. Department of Health and Human Services recommended Medicare increase oversight of the private plans and increase enforcement for violations, according to the New York Times

Humana and Baptist Health physicians cut ties Sept. 22, meaning that Baptist patients with Humana plans must find other doctors or face higher, out-of-network costs. The change doesn’t affect patient access to Baptist Health hospitals.

More recently, Baptist Health notified patients with UnitedHealthcare and Wellcare ?Medicare Advantage plans that all of its? health services will be out-of-network for those two plans Jan. 1 unless the parties can reach agreements on new contracts.

Humana holds a contract with the Kentucky Public Pension Authority through 2025 to provide Medicare Advantage coverage for retirees from state and local government and state police. The contract includes options for renewals through 2029, according to a press release from the pension authority.

Unitedhealthcare covers about 38,000 retirees through the Teachers’ Retirement System.

‘Everybody is? covered’

Tillow and about two dozen others who gathered outside the Humana building recently, said the problems with Medicare Advantage plans underscore their ongoing call for a single-payer system in which individuals are guaranteed care.

They represented several labor unions and groups such as Kentuckians for Single Payer Health Care and Physicians for a National Health Plan.

Harriette Seiler, 83, and a native of Canada, said Americans should look north of the border to that country’s government-run health plan as an example.

“Everybody is covered,” she said. “Nobody ever gets a bill in the mail.”

Meanwhile, advocates urge everyone to review their Medicare health plans carefully before making a selection, if possible for 2024. Some employee retirement plans offer members several options for insurance companies.

Any changes must be made by Dec. 7. More information is available at Medicare.gov.

A teacher waves to her students as they get off the bus at Carter Traditional Elementary School in Louisville on Jan. 24, 2022, in this file photo. (Photo by Jon Cherry/Getty Images)

The Kentucky Court of Appeals has rejected a 2022 state law aimed at curbing powers of the Jefferson County school board because it singles out the school district for special treatment, which the judges said violates Kentucky’s Constitution.?

The decision could hamper efforts by Republicans who control the General Assembly and who have been highly critical of the Jefferson County Public Schools (JCPS) in recent years. Republican lawmakers from Louisville recently announced an interest in splitting up the state’s largest school district and other changes.

“I’m really hoping this will encourage them to put the brakes on,” said Rep. Lisa Willner, D-Louisville and a former member of the Jefferson County school board. “I certainly hope that it will.”

The Oct. 6 appeals court decision upheld last year’s ruling by Jefferson Circuit Judge Charles Cunningham Jr. striking down portions of Senate Bill 1 aimed at JCPS as “special legislation” affecting schools, something Kentucky’s Constitution expressly forbids.

JCPS board vice-chairman Corrie Shull said he hopes the decisions send a message to state lawmakers.

“Two courts have now ruled in JCPS’ favor on the Kentucky General Assembly’s decision to unconstitutionally target Jefferson County Public Schools,” he said in a statement. “My hope is that, in the future, Kentucky lawmakers will be more thoughtful about proposed legislation and work collaboratively with all stakeholders to create and pass bills that are constitutional, equitable and in the best interests of ALL Kentucky schoolchildren as well as the boards, teachers, staff and administrators who serve them.”

But Rep. Jason Nemes, R-Louisville, who is among the House Republicans who have? announced a checklist of changes they are seeking at JCPS, said he has no plans to change course.

“We will be undeterred,” said Nemes, House majority whip, who represents eastern Jefferson County and portions of Shelby and Oldham counties. “We remain undeterred that we have to improve our school system.”

GOP lawmakers cite concerns about academic performance, safety and, most recently, the transportation fiasco which forced JCPS to temporarily suspend the start of school to reconfigure bus routes.

A spokesperson for Attorney General Daniel Cameron, who is handling the case, said his office will appeal to the state Supreme Court.

“The Court of Appeals made several fundamental errors in its opinion about the constitutionality of 2022 Senate Bill 1,” the spokesperson said. “We intend to promptly ask the Supreme Court of Kentucky to hear this case.”

Nemes said it should be appealed because the decision could affect other laws that involve Louisville.

“It’s a very important case,” he said. “If you say you can’t treat Jefferson County differently in any way, that means you can’t treat Jefferson County differently in any way.”

‘War’ on Louisville and education

The case dates back to the 2022 session of the General Assembly in which the Senate introduced SB 1, which incorporated a host of academic and administrative changes statewide but also took aim at the management of JCPS.

The JCPS provisions included limiting meetings of the board to once every four weeks, assigning broader power to the superintendent, requiring a two-thirds vote of the board to overrule any action of the superintendent and requiring the board to let the superintendent authorize purchases up to $250,000.

Provisions in the bill affecting all Kentucky schools established guidelines on addressing controversial topics such as race and required schools to incorporate 24 historical documents into their curriculums, many of which were? already taught, such as the U.S.? Constitution and the Gettysburg Address — but also Ronald Reagan’s “A Time for Choosing” speech of 1964, widely considered to have reinvigorated the Republican Party.

The bill was controversial but easily passed by the Republican supermajority with Willner among critics who referred to SB 1 as a “war” on Louisville and public education.

After JCPS challenged the law in court, the provisions affecting its board were struck down before the law went into effect and were never enforced.

JCPS ‘plainly singled out’

While the law does not mention Jefferson County by name, “the provisions plainly singled out counties with a certain type of governance that exists only in Jefferson County,” said the appeals court decision.

The decision was written by Judge Annette Karem, joined by judges Sara Combs and Jacqueline Caldwell.

The law applies only “in a county school district with a consolidated local government,” the opinion said. “The only school district which meets this description is that of Jefferson County.”

And that conflicts with Section 59 of the state C0nstitution which “expressly forbids local or special legislation relating to the management of public schools,” the opinion said.

As evidence the legislation was aimed at Jefferson County, the opinion cited a brief supporting it filed by Senate President Robert Stivers, R-Manchester, which said the purpose of SB 1 was to address concerns that JCPS was “failing too many of its students, especially students of color and those living below the poverty level.”

And it cited as evidence of legislative intent, comments by former Rep. Ed Massey, a Boone County Republican, who said the provisions in question specifically related to Jefferson County and a “power struggle that existed between the board and the superintendent.”

Meanwhile, GOP lawmakers remain critical of JCPS.

At a recent debate before the Louisville Forum with Shull, the JCPS board vice-chairman, Nemes claimed academic problems and school safety are prompting families to flee nearby counties.

“JCPS is running people out of our county,” he said.

Shull sharply disputed that claim, suggesting that perhaps people are moving to avoid diversity of JCPS. He also suggested proposed changes, including dividing JCPS into smaller districts, would resegregate the system that desegregated in the 1970s when the Louisville and Jefferson County schools merged.

Nemes sharply objected.

“We don’t want a black school district and a white school district,” he said.

Nemes said lawmakers still intend to pursue changes affecting JCPS when the General Assembly next convenes in 2024, including seeking a study on whether JCPS should be divided into smaller districts.

Republicans also want a return to neighborhood schools, reorganized over the years into broader districts, in part to meet diversity goals. And they want an audit of JCPS.

“We’ve got to do better,” Nemes said. “I think the parents are demanding it.”

Joel Thornbury, a Pikeville pharmacist, receives a flu shot in his NOVA Pharmacy. (Provided by Joel Thornbury)

Pharmacist Joel Thornbury said his role is far more than filling prescriptions at the NOVA Pharmacy he owns in Pikeville — he’s a readily accessible source of health services and advice in his community.

“When you call me, you get me,” said Thornbury, a third-generation pharmacist in practice for more than 30 years. “I see you on the street. I’m not some big corporation.”

And Thornbury said his job has become far more manageable, following the state’s decision in 2020 to eliminate multiple corporate middlemen that previously managed the state’s Medicaid prescription drug business — taking a big cut of the proceeds.

“It’s phenomenal,” Thornbury said of the state’s decision to cut out the brokers known as pharmacy benefit managers, or PBMs — private entities that work as subcontractors to health plans and decide how much to pay pharmacies and which drugs to cover.

“You just make my life easier and cut down on the number of people I have to talk within the insurance industry.”

What’s more, it’s saving the state money — a lot of money — by putting Medicaid prescription management under single vendor, Medicaid officials recently told a state legislative committee.

Savings since the change took effect in 2021 amount to about $283 million through 2022, $56.6 million of that in state money, officials told the committee. The rest is savings to the federal government, which pays most of the costs of the federal-state health plan that covers 1.6 million low-income Kentuckians.

Medicaid, with annual expenditures of about $15 billion, is Kentucky’s largest health plan and a major source of income for health providers including hospitals, doctors and pharmacies. It spends about $1.2 billion a year on prescription drugs.

The elimination of outside PBMs brought dire warnings of soaring costs from companies that previously managed Medicaid’s prescription drug business and claimed to keep down expenses. But a state analysis found the opposite, state Medicaid officials Veronica Judy-Cecil and Steve Bechtel told the legislative Health Services Committee on Sept. 27.

As a result, the state? has been able to plow some of its savings back into this year’s expansion of Medicaid dental, vision and hearing benefits for adults, Cecil said.

Advocates have said the expanded benefits, especially in dental care, are sorely needed in a state that ranks 49th in oral health.

The new dental, vision and hearing benefits have been controversial with Republican lawmakers who control the legislature and claim Gov. Andy Beshear, a Democrat, exceeded his authority by enacting them.?

But lawmakers, who had been increasingly hostile toward the PBMs that handled? Medicaid prescription drugs — and enacted legislation to abolish their role — are delighted with the savings.

“Today’s a great day for the Commonwealth of Kentucky,” said Sen. Max Wise, R-Campbellsville, during the legislative committee meeting. Wise sponsored ?Senate Bill 50, the 2020 law that ended Medicaid work for the six PBMs.?

“SB 50 truly saved jobs,” Wise said. “It kept a lot of pharmacies open.”

Committee co-chairman Sen. Steve Meredith, R-Leitchfield, who has been highly critical of the PBMs’ role in Medicaid, recalled warnings from national insurance companies that previously held the contracts, including Caremark, an affiliate of the CVS drugstore giant.

Many PBMs are affiliated with pharmacy chains.

Caremark, after the bill won final passage in 2020, issued a statement warning eliminating PBMs would cost Kentucky millions of dollars in increased prescription drug expenses.

“It’s going to cost our Medicaid program more?” Meredith said, recalling the warning. “Obviously, that’s not the case.”

Benjamin Mudd, executive director of the Kentucky Pharmacists Association, said the changes have been enormously popular with the state’s pharmacists.

“I think it’s been a? phenomenal experience for everyone involved except maybe the PBMs,” Mudd said. “I would say Senate Bill 50 has undoubtedly kept some pharmacies from closing in our state.”

‘Squeeze and buy’

Pharmacists, mostly independent community pharmacists, had become increasingly critical of the PBMs in the years since 2011 when the state switched most of its Medicaid business to outside managed care organizations or MCOs — private insurance companies to handle claims for Medicaid enrollees.

In turn, the MCOs hired PBMs as sub-contractors to manage pharmacy benefits.

That led to vocal complaints from pharmacists that the aggressive price-cutting of PBMs in payments for prescriptions they dispensed were threatening their business. Meanwhile, PBMs charged higher rates to state Medicaid programs and kept the difference as profit, a practice known as “spread pricing,” critics told Kentucky lawmakers.

Another problem: Because Kentucky currently contracts with six MCOs to operate most of its Medicaid program, pharmacists had to deal with six separate PBMs for reimbursement and six different formularies of approved drugs they would cover.

That added to frustration, extra work and costs, said pharmacists including Pikeville’s Thornbury, who said the extra layers of seeking approval and payment for drugs was maddening.

“It’s a gigantic shell game,” he said.

Pharmacies foundering financially were often met with offers from pharmacy chains to buy their business. It especially hurt small, community pharmacies, the owners said.

In Kentucky about 500 of the state’s more than 1,300 drugstores are independently owned.

“I just call it ‘squeeze and buy,’” Rosemary Smith, an independent pharmacist from Eastern Kentucky told legislators in 2018. “They are trying to put us out of business.”

Meanwhile, lawmakers found it deeply frustrating that Kentucky Medicaid officials had virtually no control over the PBMs because they reported to the outside managed care companies that hired them rather than the state.

Complaints, mostly from their hometown pharmacists, resonated with lawmakers even as PBMs were facing scrutiny and new restrictions in other state Medicaid programs including West Virginia and Ohio.

After several years of investigations and review, the General Assembly enacted Wise’s SB 50, which eliminated the role of PBMs as subcontractors in the state Medicaid program.

Instead, it directed the state to hire a single PBM to report to the state Medicaid program, giving it more control over reimbursement to pharmacists and ability to more quickly work out any problems, questions or delays.

“It’s much easier for us to work through a single entity,” Thornbury said. “I call one location. If I have a problem, I call one person.”

The change also put all drugs on the same formulary, meaning pharmacists now can determine immediately which drugs are approved for all Medicaid members. And it eliminated the “spread pricing” critics said enriched PBMs at pharmacists’ expense.

‘Smooth transition’

Judy-Cecil, the state Medicaid deputy commissioner, said Kentucky launched its new system in July 2021 and hired MedImpact, an independent PBM not affiliated with any pharmacy chain, to run its prescription drug business.

“I believe it was a very smooth transition,” she said.

Medicaid expects to release a report soon with more details on the impact of the changes and savings.

Another benefit to pharmacists: SB 50 set a base reimbursement model in which pharmacists get a $10.64 dispensing fee plus the costs of the medication.

Previously, pharmacists had no such guarantee and could end up barely breaking even or losing money on prescriptions they dispensed, Mudd said.

“Stores that were facing closure or were right on the fence. . . that little bump may have helped them stay open,” Mudd said.

That doesn’t mean the outlook is rosy for pharmacists, Mudd and others said.

They are still facing cost pressures from commercial insurance and Medicare. And a handful have closed or sold their businesses, Mudd said.

But changes of the last two years offered a much-needed lifeline, he said.

“Without a doubt, a much larger number of pharmacies would have closed if it weren’t for Senate Bill 50,” he said.

Meanwhile, lawmakers say they will continue to examine the role of PBMs in other health coverage, including the Kentucky employee state health plan.

And Meredith, a former hospital CEO who has long complained the state’s six MCOs are too many — adding to complication, cost and confusion — threw out this idea:

“If we went from six PBMs to one and we save money, do you think there’s any potential to save money if we have fewer MCOs?” he asked. “Just a rhetorical question.”

University of Kentucky dental school Dean Jeffrey Okeson (left) spoke to a legislative committee in August. He was joined by Dr. Margaret Hill (center), dean of the University of Louisville dental school and Dr. Pamela Stein, dental dean at University of Pikeville. (Photo by Deborah Yetter)

Around 400 patients per week, most covered by Medicaid, flood the University of Kentucky’s dental clinic seeking care they can’t find elsewhere for advanced tooth decay or other oral disease.

Some are in such critical condition they must be airlifted to UK, Dr. Melvyn Yeoh, the university’s chairman of oral health science, recently told a legislative committee.

Swelling from dental infection threatens patients’ airways, leaving them unable to survive an hours-long ambulance ride to Lexington from rural Kentucky, Yeoh said. Others arrive with advanced oral cancers that could have been detected and treated sooner with regular dental care.

“Bad teeth cause life-threatening infections,” said Yeoh, who testified Sept. 12 before a legislative committee in support of expanded Medicaid dental benefits.

“With late-stage oral cancer diagnosis, people can die,” Yeoh added, noting that Kentucky has the nation’s second highest rate of oral cancer. It ranks 49th in overall oral health.

Some patients wind up in intensive care for days or weeks. Such cases run up hundreds of thousands of dollars in medical bills, often paid by Medicaid, in cases that might have been addressed earlier at far less cost in a dentist’s office, Yeoh said.

“It’s actually driving up the costs of health care,” he said.

Yeoh became one of the latest health professionals to speak on behalf of regulations to enhance Medicaid dental services, as well as hearing and vision care, introduced this year by Gov. Andy Beshear, a Democrat.

“I am extremely excited about it,” Yeoh told the committee. “We think it can do a lot for us as providers of dentistry in Kentucky.”

But the changes have run into a wall of opposition from Republican legislators who hold a super-majority in the General Assembly and claim the governor usurped their authority over Medicaid by enacting the expansion through executive order.

Lawmakers can’t take any action to override the expanded benefits until they meet in the next legislative session in January but some continue to blast them and Beshear, who is seeking a second term as governor.

‘At home on their couch’

Rep. Randy Bridges, R-Paducah, and an outspoken critic, at the Sept. 12 hearing called Beshear’s effort “a loophole or political move” to avoid going through proper legislative channels.

Sen. Damon Thayer, the powerful Senate Republican majority leader, complained Medicaid — which covers health care for some 1.6 million low-income Kentuckians, about one-third of the state’s population — has grown too large and may include enrollees simply unwilling to work.

“When I continue to see these stories about 18 to 34-year-old white men who’d rather sit at home on their couch with their Netflix remote and their DoorDash, it really aggravates me that they are living on the taxpayers’ money when they are able-bodied and should be out there working,” Thayer said.

Thayer didn’t cite any source for that claim. Advocates who spoke that day described the characterization as inaccurate, saying most people covered through Medicaid who are not disabled work at low-wage jobs that don’t include health coverage.

To get better jobs, they need better health benefits, they said.

“We’re talking about workforce readiness here,” said Sheila Schuster, executive director of the Kentucky Mental Health Coalition. “If we want people to get back, as Sen. Thayer has suggested, into the real workforce, the full-time workforce, we need to make sure they can see and hear and are not suffering from dental pain.”

Advocates say the newly expanded dental benefits are urgently needed. They include services such as dentures, fillings, root canals, and crowns not previously covered by Medicaid, which for years covered only one annual checkup and tooth extraction for adults.

A shortage of dentists and the low reimbursement rates Medicaid pays providers, causing many to opt out of the federal-state health plan, has created an oral health crisis in Kentucky, they say. Even with the expanded benefits introduced this year, patients can’t find providers who take Medicaid.

“It’s an enormous problem that we have here and it’s not getting any better,” Dr. Jeffrey Okeson, dean of the UK dental school, told lawmakers at a hearing in August before the Administrative Regulation Review Subcommittee, which has held several meetings on the Medicaid benefits.

Okeson was joined by the deans of the University of Louisville dental school and a new one planned at the University of Pikeville in urging support for the expansion of Medicaid dental services.

One patient ‘alive today’

Meanwhile, advocates say such services are especially needed for vulnerable adults struggling to escape circumstances including domestic violence and addiction.

Ann Perkins, executive director of Safe Harbor of Northeast Kentucky, one of the state’s 15 regional domestic violence shelters, said dental as well as vision and hearing services are essential for clients who need them to succeed in school, job-training and employment.

“This is how our state can actually do something productive,” she told legislators. “Your money will never be better spent.”

Some of her clients are in dire situations, including a woman suffering from lung cancer who could not undergo chemotherapy until she got treatment for infected, abscessed gums. The client had called every dentist in the region but none who accepted Medicaid could fit her in, Perkins said.

Perkins used $500 in Safe Harbor funds to pay for the dental treatment, which the woman later repaid, she said.

“She’s doing great,” Perkins said. “She’s just one example of how important dental care was for her to be alive today.”

John Bowman, Kentucky coordinator for Dream.org, a national non-profit that works for criminal justice reform, said such benefits are “huge” for people recovering from addiction including himself.

“It gives people a sense of self-worth,” he said. “If we want people to be productive members of society, we need to back them with these services.”

‘To us, it was a win’

Lawmakers took no action on the regulations at the September meeting, though they could have found them “deficient,” setting them up to be voted down when the legislature next meets.

But it appears an effort to keep the benefits in place is underway.

Committee Co-Chairman Derek Lewis, R-London, said that discussions have begun with Beshear administration officials, following complaints by lawmakers they had not been consulted. Lewis said he and Sen. Stephen West, committee co-chairman, recently were contacted by Eric Friedlander, secretary of the Cabinet for Health and Family Services, and Medicaid Commissioner Lisa Lee, to discuss the benefits.

“I think that goes a long way toward working this out,” he said.

Instead, rather than voting to disapprove the regulations expanding Medicaid benefits on Sept. 12, lawmakers transferred them for further review to the joint Health Services Committee, which is unlikely to take them up for several months.

Yeoh, the UK dental official, said he views it as a good sign the committee didn’t reject them outright.
“To us it was a win,” he said. “We’re extremely happy about that.”

Louisville Forum's Sept. 13 debate on the future of Jefferson County Public Schools featured Corrie Shull, left, vice chairman of the JCPS board, and Rep. Jason Nemes, R-Louisville, right. Louisville Forum President Iris Wilbur Glick moderated the discussion. (Kentucky Lantern photo by Deborah Yetter)

As Kentucky’s Republican legislators step up pressure on Jefferson County Public Schools, the Louisville Forum on Wednesday hosted a debate between Rep. Jason Nemes, a Louisville Republican and an outspoken JCPS critic, and Corrie Shull, the school board’s vice chairman.

The discussion — focused on GOP lawmakers’ interest in overhauling Kentucky’s largest school system and possibly dividing it — at times turned heated, including when Nemes said some Jefferson County parents are fleeing the school system for nearby counties out of frustration.

“They left for one reason, to get the hell out of JCPS,” said Nemes, who represents eastern Jefferson County and portions of Oldham and Shelby counties. “JCPS is running people out of our county.”

But Shull suggested there may be another reason.

“Could it be that some people who chose to go to Oldham County are doing so to outrun some of the diversity that is found in JCPS?” Shull asked. “Maybe some of what we’re seeing is people moving to Oldham County supposedly for better schools but maybe it is for their own particular reason.”

The suggestion prompted an angry retort from Nemes. “I think that saying that people are moving to Oldham County because they are racist and they want to get rid of diversity is outrageous,” Nemes said. “Diversity is one of our most important assets in Jefferson County.”

How to maintain that diversity in the face of Republican legislators’ interest in dividing the district into two or more pieces took up much of Wednesday’s discussion before the Louisville Forum, a nonpartisan group that hosts a monthly discussion of public affairs.

Republican lawmakers, who hold a supermajority in the legislature, have proposed a study on whether to split up JCPS — with its 165 schools, about 96,000 students and more than $2 billion budget — to, they claim, make it more manageable.?

GOP legislators have been scrutinizing JCPS for several years, seeking, among other things, more “neighborhood schools” and “school choice” to provide financial assistance to parents seeking private school education for children.

Their concerns escalated in August when the system’s plans for new bus routes failed and the system was forced to cancel school temporarily to revise a system they said was plagued with too few bus drivers to handle multiple routes.

JCPS Superintendent Marty Pollio asked for public patience, acknowledging the botched school start was a “transportation disaster.”?

Twelve Republican lawmakers from Louisville, including Nemes, demanded Gov. Andy Beshear, a Democrat, call a special legislative session to review JCPS and consider major changes including restructuring the school board and studying whether to split up the district. Beshear has not acted on the request.

GOP lawmakers also have asked state Auditor Mike Harmon to audit the school system. A Harmon spokesman said the request is under review.

Return to segregation?

JCPS was created in the 1970s when the predominantly white Jefferson County schools merged with the largely Black Louisville city schools to create a single school system.

Shull on Wednesday said that splitting up JCPS would have a predictable outcome.

“Our size is our strength,” he said. “Dividing the district will only ensure that we resegregate the district, that we limit options for students.”

Further, he said, there’s no way that smaller districts could each have schools such as Dupont Manual High School, an elite JCPS magnet school that has been at the center of debates over limited access to such programs by most students.

Nemes, a graduate of Manual who said two of his sons attend the school, disagreed, saying he believes there are ways to divide the district without resegregating the system or losing access to elite magnet programs.

“What does that mean for schools like Manual, that’s a discussion we need to continue to have,” he said.

Nemes said that while there’s no specific proposal for dividing JCPS, it merits a study.

“If you do split it up it has to be racially fair,” he said. “We don’t want a black school district and a white school district.”

Meanwhile, Nemes said he thinks a significant problem in schools is discipline and lack of consequences for serious violations, such as bringing a weapon to school.

For example, he said he contacted 12 of the more than 120 teachers who took early retirement last year to ask why.

“Every one of them said, ‘I’m leaving because I’m scared of the kids and I know central office won’t back me up,’’’ Nemes said.

Also, he cited poorer achievement among Black students.

Shull said JCPS is working to make schools safer including adding a new system to screen for firearms. And it has? introduced a new curriculum district-wide aimed improving student achievement.

But one of the district’s biggest challenges, he said, is getting adequate funds from the General Assembly, including the SEEK funding formula it uses to allocate money to school districts.

“Dollars are the problem,” Shull said. “There’s no way you can have a robust public education system when you have not fully funded it.”

Nemes disagreed, saying lawmakers are doing the best they can given other costs, including funding the chronically underfunded teacher pension system.

“Dollars are not the problem,” he said.

The hour-long debate drew an enthusiastic crowd including some current and former JCPS school board members.

Linda Duncan, who has served on the JCPS board for 29 years, said she appreciated the discussion but isn’t sure lawmakers understand the complexity of JCPS and its challenges. Breaking it up is not a solution, she said.

“They think it’s so simple,” she said. “Dividing it — it’s the worst thing you can do. It’s easy to sit in the background and make those kind of statements.”

State workers are staffing a booth at the Kentucky State Fair to help people understand Medicaid changes and how to apply for the program or other health coverage. (Kentucky Lantern photo by Deborah Yetter).

Some patients find out they’ve been dropped from Medicaid when they come in to pick up a prescription.

Others, when they arrive for a doctor’s appointment at one of the Family Health Centers’ Louisville clinics.

And some are struggling to cope with paperwork or documentation required to prove eligibility for Medicaid under new rules that require such information for the first time in three years.

Ashley Shoemaker, director of outreach for the clinics, recalls the relief one man expressed when he was contacted as part of an effort to alert patients about the Medicaid changes.

“He said, ‘I’ve been trying to do this on my own and I don’t know where to start,’” Shoemaker said. “He’s eligible, he just didn’t know where to begin.”

Staff was able to help him complete his application.

But around 70,000 people in Kentucky have been terminated from the health plan for low income and disabled individuals through June, the latest numbers available from the state.

The majority lost coverage for? not responding to or not properly completing? paperwork.

Health advocates in Kentucky — as well as nationwide — are watching and working to ensure people who are eligible remain insured as states transition back to yearly recertification for Medicaid, a federal-state health plan for low-income adults and children.

The state began sending the first notices in May.

“For three years, people didn’t need to respond to notices they received because their coverage was going to continue,” said Emily Beauregard, executive director of Kentucky Voices for Health, which is closely monitoring the situation.

During the COVID pandemic that began in 2020, the federal government suspended the annual requirement that people prove they are eligible for the coverage which is based largely on income.

Kentucky’s $15 billion-a-year Medicaid program covers 1.6 million people including adults, children and individuals in nursing homes, with the federal government covering 70% to 80% of the costs.

With the recent decision to lift the federal public health emergency, the states must again begin requiring annual renewal by members.

And that’s proving difficult among people who aren’t used to the annual requirement, may not understand the process or don’t have access to technology required to complete online applications and upload documents, such as income verification, advocates said.

70,000 Kentuckians terminated through June, some moved into other coverage

“It’s hard to know if people understand what they need to do and are taking those steps, Beauregard said.

Molly Lewis, CEO of the Kentucky Primary Care Association, said she’s worried that people who have benefited from expanded mental health and addiction treatment in recent years could suffer if they inadvertently lose Medicaid coverage.

“I am most concerned about all those who have benefited from behavioral health services,” said Lewis, who represents a network of clinics that see about one million patients a year.

Through June, 70,000 of the around 900,000 Kentucky adults covered by Medicaid have been dropped from the health plan, most losing coverage for “procedural reasons,” such as failing to respond to a renewal notice sent by the state.

Other states are posting similar numbers, with 75% of disenrollments nationwide due to procedural reasons, according to the Kaiser Family Foundation, a non-partisan health policy organization which offers a Medicaid enrollment tracker on its website.

That doesn’t mean all Kentuckians who lose Medicaid lack health coverage.

Eric Friedlander, secretary of the Cabinet for Health and Family Services, which administers Medicaid, said Kentucky deliberately structured its 12-month recertification plan to first target those most likely to have obtained other health coverage. That includes individuals who have reached age 65 and qualify for Medicare, the government plan for older Americans, or who have obtained coverage through employment.

“We put them up front,” Friedlander said in an interview last month.

Advocates agree with the approach but still worry that too many people who are eligible are losing coverage for failing to receive or respond to notifications from the state. With only a few months of data available, it’s hard to tell, said Beauregard.

“At this point, it’s too soon to know how many people are walking around uninsured and either don’t know it or think they are not eligible,” she said.

Preliminary numbers show as many as 40% of those losing Medicaid coverage may have obtained other health insurance. And about 3,000 people who lost coverage have been reinstated once they provided applications or documentation, such as proof of income or address, Friedlander said.

Meanwhile, about half of those targeted each month for Medicaid recertification don’t have to do anything at all — they are deemed eligible through “passive” renewal in which the state is able to validate information such as income, household size or other details by checking state and federal databases.

And those whose income has increased, making them no longer eligible for Medicaid, may be eligible for low-cost, federally-subsidized private plans through kynect, Kentucky’s online health insurance exchange, said Medicaid Commissioner Lisa Lee.

“There really is something for everyone,” Lee said.

Stakes high for kids

So far, Kentucky has avoided cutting children from Medicaid. Advocates have sounded sound the alarm about other states where high numbers of children are losing coverage — most often for procedural reasons.

The tens of thousands of children losing coverage in some states prompted one group that monitors Medicaid to suggest states suspend terminating kids to determine what’s going wrong.

In Idaho, for example, around 23,000 children have been removed for failing to return recertification forms, according to the Idaho Capital Sun. Arkansas also has moved aggressively to cut people, including children, from Medicaid.

“The stakes are high,” said a blog post on the Georgetown University’s Health Policy Institute Center for Children and Families. “Gaps in coverage are problems for anyone — but especially for children, who, while not expensive, are regular users (or should be) of health care.”

Children and adults in rural states including Kentucky are especially dependent on Medicaid for health care, the blog reported.

Nationwide, seven rural counties have half or more of their adults covered by Medicaid and six of those counties are in Kentucky, it said.

Around 600,000 Kentucky children have health coverage through Medicaid or the Children’s Health Insurance Program, known as CHIP, a Medicaid program for children whose parents earn too much to qualify but are still considered low income.

That’s more than half the state’s children.

They will be among the last to be recertified under the 12-month process Kentucky began in May, Friedlander said.

‘Health care is expensive’

Meanwhile, state officials, advocacy groups, community clinics and others are working to alert Medicaid patients to the changes through notices, fliers, mail, phone calls, text messages and other means.

State officials set up an exhibit at the Kentucky State Fair that runs through Aug. 27 to inform the public about changes. It includes private booths where state workers can help people apply for or renew coverage.

Advocates are especially concerned about those who might unknowingly lose coverage by not receiving or responding to a notice.

“It is important that individuals have insurance coverage because health care is expensive,” Lewis said. “A medical bill for something that’s not covered can be really debilitating.”

It could also affect community clinics that serve a high percentage of Medicaid patients and operate on tight budgets.

“It definitely can affect us from the bottom-line standpoint,” said Kirstie Matzek, CEO of the Shawnee Christian HealthCare Center, a federally authorized community health service in Louisville.

Matzek said her clinic staff has been attending events such as festivals and church picnics to hand out information. Staff also has been notifying patients about the Medicaid changes, she said.

“I know there’s a level of responsibility for the patient,” Matzek said. “But I think we have a responsibility as well.”

Dr. Pamela Stein (right), dean of the University of Pikeville dental school, spoke in Frankfort Tuesday about the need for expanded Medicaid dental benefits, joined by Dr. Margaret Hill, interim dean of the University of Louisville dental school, and Dr. Jeffrey Okeson, dean of the University of Kentucky dental school. (Photo by Deborah Yetter)

Working at a public “safety net” dental clinic in rural Western Kentucky, Dr. Pamela Stein routinely saw a heartbreaking sight.

“It was not unusual at 6 o’clock in the morning to see 10 or 15 people standing in line waiting to get in because they had tooth aches, because they couldn’t find anyone else to care for them,” said Stein, appointed last year as dean of a new dental school being formed at the University of Pikeville.

Some patients at the Marshall County clinic were in tears after having diseased, throbbing teeth removed at the clinic operated by the University of Kentucky, she said.

“People would actually cry, they were so relieved,” Stein said, speaking before a legislative committee Tuesday in Frankfort.
She and others spoke in support of the state’s recently expanded Medicaid dental services for adults to include dentures, fillings, root canals and crowns. Medicaid previously paid only for one annual cleaning and tooth extractions for adults though children get a full range of services.

Stein joined the deans of dental schools at the universities of Kentucky and Louisville to urge continuation of the dental services authorized by Gov. Andy Beshear that have ignited a partisan political fight in Frankfort.

Republicans who control the General Assembly are seeking to block Beshear, a Democrat, from expanding Medicaid dental coverage, as well as vision and hearing benefits, arguing he usurped power that rests with lawmakers.

Officials with the Beshear administration disagree, saying they had the authority because the $39 million expansion is paid for through savings in Medicaid and doesn’t require allocation of new money. The federal government covers 85% of the costs.

But the dental school deans, as did other witnesses who appeared, avoided politics, instead focusing on Kentucky’s abysmal oral health — it ranks 49th in the nation — as well as low reimbursement rates that keep many dentists from treating Medicaid patients.

As a result, many patients living with untreated dental disease can’t find a dentist, especially in rural areas, or often find long waiting lists. And oral infection is linked to a host of other health problems that plague Kentucky, including heart disease, stroke, diabetes and premature births.

“It’s an enormous problem that we have here and it’s not getting any better,” said Dr. Jeffrey Okeson, the UK dean.?Okeson said Medicaid doesn’t cover costs of dental care.

For example, he said, UK last year billed Medicaid $14.2 million to treat 37,000 patients but was reimbursed only $4.1 million, about 30% of its costs. UK makes up the difference but can’t do so indefinitely if it begins cutting into the academic budget, he said.

His counterpart at U of L agreed, noting that together UK and U of L treat around 90,000 Medicaid dental patients a year, many of whom can’t find care elsewhere.

“These folks would probably not be able to receive dental care if it wasn’t for dental schools acting as a safety net,” said Margaret Hill, interim dean of U of L’s dental school.

“Today we are here before you, speaking on behalf of our patients and our students who would like to do the right thing, and ask that the Medicaid expansion of dental services continue and that rates of reimbursement be more reasonable,” Hill added.

Several witnesses described the enormous suffering of patients who previously lacked dental coverage and now, even if covered under the expanded benefits, can’t find a dentist.

“I don’t mean to tug on your heart strings but I really hope that I do,” said Tiffani Hays, a social worker who works with cancer patients in Winchester, many in dire need of dental treatment. “Oral health is probably one of the most common problems in our patients.”

It was the first opportunity for public comment on the dental benefits expansion enacted by Beshear in April after the lawmakers voted down his first, Jan. 1 expansion in the 2023 legislative session. Beshear reinstated them, with some changes, after lawmakers adjourned.

The stop and start nature of the expanded benefits has patients scared, said Missy Newland, a Louisville woman who gets health coverage through Medicaid and needs ongoing dental care.

“The political tug of war has always had me worried about staying eligible,” said Newland, who works cleaning homes and testified by video. “I fear my access to health care will be taken away and with my health issues, that’s scary.”

The current benefits — which also include expanded benefits for items such as eyeglasses and hearing aids — are good through the end of the year. While Republican lawmakers have objected, they don’t have the power to block them till they meet in 2024 in the next legislative session.

Meanwhile, tens of thousands of Kentuckians have received benefits such as dentures, crowns, fillings, hearing aids and eyeglasses, said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

“These services are life-changing for people,” said Beauregard, adding that with better vision, hearing and teeth, people are more likely to find jobs.

But GOP legislators object even as some acknowledge the benefits are sorely needed for the about 900,000 adults who get health coverage from Medicaid, a federal-state health plan for low income and disabled individuals.

Rep. Randy Bridges, R-Paducah, and a vocal critic of Beshear’s expanded Medicaid services, accused officials with the Cabinet for Health and Family Services of making “end runs” around lawmakers who, he argued, hold the sole power to fund such programs through its budget committee.

“To come in here and pull at our heartstrings, to say we are the keepers of the purse — we aren’t the keeper of the purse,” he said of the Administrative Regulation Review Subcommittee holding Tuesday’s hearing.

“You’re doing end runs and you want to make us appear to be the villains and we’re not,” Bridges added. “We just want to do it in the proper manner.”

But Sen. David Yates, a Louisville Democrat, argued it’s the health needs of constituents rather than legislative procedure that should matter.

“It did in fact pull on my heartstrings as it should any Kentuckians,” Yates said. “Forget the partisan politics and political games, I think everyone agrees that something has to be done.”

Bridges also complained that witnesses who appeared in support of the expanded benefits were misled by state officials about the legislative process.

“I feel like you have inappropriately led them with some wrong ideas on how this works,” Bridges said.

That prompted a heated retort from Lisa Lee, state Medicaid commissioner, who also spoke Tuesday.

“I have never, ever misled anyone in my 23 years in Medicaid and I will not do so,” Lee told Bridges. “And I really don’t appreciate the fact that you indicated that we have been misleading people.”

As for the witnesses who spoke, Lee said, “They are here because they are concerned that people are going to lose their benefits.”

They included Dr. Bill Collins, a dentist at the Red Bird Mission dental clinic in Clay County who said he constantly seeks grants to cover the costs of dental care for patients Medicaid doesn’t fully cover.

Kentucky has one of the highest rates in the nation of adults with no teeth and patients are flocking to get dentures newly covered under the expanded Medicaid rates, Collins said.

But Medicaid covers only about half the costs, he said.

“When the grant money runs out it has to stop,” he said.

Collins was among witnesses urging lawmakers to continue expanded services and increase payments to dentists.
“You can make it a reality,” he said. “That’s what I beg you to do.”

The committee took no action Tuesday. It already has found the regulations Beshear issued to enact the expansion “deficient,” meaning lawmakers could strike them down when they meet next year.

But Rep. Derek Lewis, R-London, committee co-chair, ended the meeting on a conciliatory note, saying he’s willing to work with everyone involved to find a solution.

“I know we’re in an election year,” Lewis said, alluding to the fact Beshear is seeking a second term as governor. “What I don’t want to see is this made to be a political football, I don’t want to poison the well and leave patients and providers holding the bag.”

“I think we can make a difference,” he said. “We need to make a difference.”

Attorney General Daniel Cameron addressed supporters at the Galt House in Louisville after easily winning the Republican nomination for Kentucky governor on May 16, 2023. (Kentucky Lantern photo by Austin Anthony)

Denied records it sought in 2020 from Attorney General Daniel Cameron about a Ballot Integrity Task Force he co-chairs, American Oversight, a national advocacy group, pressed on.

And that set up an ongoing legal battle that open records advocates say was unnecessary and shows Cameron is unwilling to release even the most routine documents related to his office.

American Oversight “got stonewalled by the attorney general,” said Amye Bensenhaver, co-director of the Kentucky Open Government Coalition, which tracks access to public information on its Facebook page.

Under Kentucky law, the attorney general is the first stop for anyone who believes they were wrongly refused public records. It’s up to that office to review the dispute and issue a formal legal opinion.

That means that after Cameron’s office refused to provide records of the task force, American Oversight had to appeal to Cameron’s office, asking it to overturn its own decision.

It declined, responding to American Oversight with an attorney general’s opinion declaring Cameron’s office did not violate the state open records law in refusing to release the records.

Now a court battle over the records is ongoing and the outcome could have a significant impact on which records the attorney general must release when it comes to his own office, Bensenhaver said.

“Is this an important case? You bet,” said Bensenhaver, a lawyer who previously worked as an assistant attorney general in Kentucky for 25 years reviewing open records cases and writing opinions.

“They are establishing a scenario in which they are not accountable,” Bensenhaver said of Cameron’s office.

A Cameron spokeswoman did not respond to requests for comment.

Jon Fleischaker, a Kentucky First Amendment lawyer with decades of experience in open records, said that as attorney general for the past 3 ? years, Cameron has established a poor track record when it comes to upholding public access to government information.

“Anyone who suggests he is a proponent of transparency is just wrong,” said Fleischaker, whose clients include The Courier Journal and the Kentucky Press Association. “He is an opponent of transparency.”

Meanwhile, the dispute continues in Franklin Circuit Court more than a year after Judge Phillip Shepherd ruled Cameron must produce nearly all documents sought by American Oversight, an open records advocacy organization based in Washington D.C.

Its request was part of a broader effort by the group to examine records of similar election task forces around the country, some looking into largely unfounded allegations of fraud and misconduct swirling around the 2020 presidential election in which President Joe Biden defeated Donald Trump.

In Kentucky, the “attorney general’s office fought our efforts to shed light on the task force’s activities and priorities,” American Oversight spokesman Jack Patterson said in an email. “It took American Oversight’s lawsuit and a court order to compel the disclosure of public records.”

Documents Cameron eventually released included routine records of scheduling meetings and absentee ballot tracking —“nothing to indicate the task force was anything more than a publicity stunt,” Patterson said.

The dispute continues, with American Oversight arguing Cameron’s office has not searched for and produced all records required under Shepherd’s order.?

Cameron’s office insists it has.

While Cameron’s office did not agree with Shepherd’s ruling, it has elected to comply, it said in a filing in April.

“Although the office maintains it was correct in withholding various records . . . it chose to comply with the court’s opinion and order by providing all records the court ordered it to produce,” Heather Becker, a lawyer for Cameron’s office said in the filing.

Bensenhaver said she can’t figure out why Cameron initially objected to releasing seemingly routine documents sought by American Oversight, such as communications, schedules, agendas and minutes of meetings of the task force set up to review conduct of elections and investigate irregularities.

“I think it’s kind of fascinating that he’s going to erect these barriers to fairly innocuous records,” she said.

Patterson, the American Oversight spokesman, said the records showed that Kentucky’s task force, like others established in other states, ended with the same findings.

“None of these task forces found any evidence of widespread fraud and Kentucky’s Ballot Integrity Task Force was no different,” he said.

American Oversight also requested similar records from Secretary of State Michael Adams, a task force co-chair, who complied with the request, according to court records.

But Cameron’s office has established a pattern of denying requests for its records even while ruling in favor of those seeking information from other state agencies or offices, Bensenhaver said.

Track record ‘untarnished’

In a January post on the Kentucky Open Government site, Bensenhaver noted that Cameron’s office in recent months had ruled against several state officials who denied records requests including the agriculture commissioner and the state treasurer.

“But in at least 12 open records appeals of his office’s handling of requests for public records of his own agency, Attorney General Danial Cameron found no violation of the law,” said Bensenhaver, who sarcastically observed: ?“His track record is virtually untarnished.”

The 12 cases are from 2020 to 2022 and cover topics ranging from a pending prosecution to records sought by the Kentucky Democratic Party of Cameron’s communications with other Republican attorneys general.

Cameron, a Republican, is running against Gov. Andy Beshear, a Democrat, in the 2023 governor’s race.

Bensenhaver noted that in two opinions in January, Cameron found that Beshear’s office had violated open records law by denying in part requests from the Republican Party of Kentucky for records of communications between officials about unemployment claims and school closures during the COVID pandemic.

‘No exceptions’

When American Oversight first requested documents about the task force from Cameron, the attorney general’s office responded by claiming it had identified 14 items but refused to release all but one — a single page of a meeting agenda.

American Oversight then appealed to the attorney general and received the opinion upholding the refusal. In Kentucky, attorney general open records opinions have the force of law unless appealed to circuit court.

So the group filed a lawsuit challenging the opinion, and in July 2022 Shepherd ruled in favor of American Oversight’s right to the records and also directed the attorney general to search for additional records.

“This court is doubtful that a mere 14 records in possession of the (attorney general) are responsive to the plaintiffs open records request,” Shepherd said in the order.

After searching again, Cameron’s office turned over 395 pages of records, American Oversight said in a court filing. Of those, 85 were new and 310 pages were records previously identified but withheld.

The newly-discovered records consisted of calendar invitations, emails and records related to absentee ballots, the filing said.?

Whether any more material remains is the subject of the ongoing dispute.

Shepherd on July 18 ordered American Oversight to question representatives of Cameron’s office in depositions for purposes of “fact finding.”?

The two sides then agreed to ask for additional time to resolve the dispute, which Shepherd granted.

Meanwhile, Shepherd’s ruling of July 2022 establishes two important limits on the attorney general’s power to withhold records, Bensenhaver said.

Cameron’s office, in initially refusing to release all but one page of the task force records, cited two exceptions:?

One, the records withheld might relate to a criminal investigation and therefore were exempt from disclosure; and two, items such as emails about meetings, schedules and agendas were preliminary and therefore exempt.

Shepherd rejected both claims, saying that neither appeared to apply to a public task force created to monitor elections that was announced through a press release.

“The public already knows that the task force exists,” his order said.

According to Shepherd’s order, “no exceptions apply,” Bensenhaver said.

Meanwhile, the task force has conducted little activity in recent months and hasn’t issued any findings about its work, Michon Lindstrom, a spokeswoman for the secretary of state said in an email.

It “typically meets before and sometimes after an election,” Lindstrom said. “But it is a discussion group; it does not take actions or implement policy — so it does not issue reports.”

U.S. Health and Human Services officials say it is necessary to specify increased protections for the private health information of patients who seek care including abortions in states where such procedures are legal. (Getty Images)

Calling it “a disgusting overreach of government authority,” Planned Parenthood officials in Kentucky are denouncing an effort by Republican attorneys general to block a federal expansion of medical privacy protections for patients who seek reproductive care.

The rule change proposed by the U.S. Health and Human Services Department would enhance protections for patients who seek services out of state if abortion or other reproductive care is illegal in their own state.

Kentucky Attorney General Daniel Cameron and Indiana Attorney General Todd Rokita are among the 19 GOP attorneys general — led by Mississippi’s Lynn Fitch — who sent the June 16 letter to Xavier Becerra, secretary of the federal agency, objecting to the change.

“Why would Cameron, Rokita or any attorney general be seeking private medical information related to abortion patients if not to prosecute them for obtaining care?” asked Tamarra Wieder, Kentucky state director for the Planned Parenthood Alliance Advocates. “Anti-abortion lawmakers like Cameron and Rokita seem willing to go to any extent to scare patients out of obtaining abortions.”

Planned Parenthood stressed there is no prohibition against a patient seeking care in another state.

“Let’s be perfectly clear,” it said in a news release. “It is legal for anyone in the United States, no matter what state they are from, to access abortion care in a state where that care is legal.”

Kentucky is among 16 states with a near total ban on abortion since the U.S. Supreme Court struck down the 1973 Roe v. Wade decision that had established it as a federal constitutional right. Indiana is poised to ban abortions following a recent state Supreme Court ruling.

Cameron, in a June 19 news release, called the proposed federal rule change to health privacy law an “intrusion on state sovereignty,” adding it could “incentivize providers to break state laws on everything from protecting unborn life to gender-altering surgeries.”

Rokita said the change would put “many of Indiana’s laws at risk.”

In their letter, the GOP attorneys general said the change “would unlawfully interfere with states’ authority to enforce their laws and does not serve any legitimate need.”

But in a discussion that accompanies the proposed rule change published April 14 in the Federal Register, the agency noted that since the U.S. Supreme Court ruling, known as Dobbs, some states have outlawed abortion and added or discussed increasingly stringent laws to restrict access to reproductive care.

For that reason, HHS officials said, it is necessary to specify increased protections for the private health information of patients who seek care including abortion, in states where such procedures are legal.

“After Dobbs, the department has heard concerns that civil, criminal, or administrative investigations or proceedings have been instituted or threatened on the basis of reproductive health care that is lawful under the circumstances in which it is provided,” the agency said.

Without such additional and more specific privacy protections, patients may be afraid of seeking care in another state or be reluctant to provide full medical histories to providers for fear of prosecution in their home state. And providers might be reluctant to provide care or fully document care for the same reason, it said.

“These proposed modifications would provide heightened protections for individuals’ health information privacy under the defined circumstances; foster an open and honest exchange of information between the individual and health care provider, who — with that information — could employ evidence-based clinical practice guidelines; and increase access to high-quality, lawful health care,” the agency said.

A group of Democratic attorneys general, in a June 16 letter to the agency, agreed that more privacy protections are needed to protect patients seeking care outside their states.

Citing a “drastically shifting legal landscape,” the 23 Democratic state attorneys general led by New York Attorney General Letitia James, forcefully endorsed the proposed changes.

The letter notes that one state, Idaho, already has enacted a “trafficking law” aimed at restricting access of some patients to out of state care and Texas and Oklahoma have enacted “vigilante laws” allowing civil lawsuits against those aiding an individual in obtaining an abortion.?

Increased medical privacy protections could shield patient information from those seeking to prosecute or sue individuals, the letter said.

“The hostile and fragmented reproductive health care landscape heavily burdens patients in need of health care,” their letter said. “Reports continue to emerge — even in states with abortion bans that include exceptions for the health or life of the pregnant person — of patients with serious pregnancy complications being denied care or forced to wait until they are ‘sick enough,’ and often enduring unnecessary pain and life-threatening complications, to justify pregnancy termination.”

The Democratic attorneys general urged HHS to move “expeditiously” to adopt a final rule and enforce it within the standard 180 days afterwards.

Dr. Bill Collins, a supporter of the Medicaid dental expansion, treats a patient at the Red Bird Mission dental clinic in Clay County. (Photo by Deborah Yetter)

A public hearing on Gov. Andy Beshear’s plan to have Medicaid cover more dental, vision and hearing services for adults scheduled Friday, July 14, has been canceled.

The hearing by the Administrative Regulation Review Subcommittee was to have been held at 1 p.m. in Frankfort for comments on Beshear’s plan that expands Medicaid to pay for additional health services including dentures, fillings, crowns and root canals as well as vision and hearing benefits such as glasses and hearing aids.

The cancellation was confirmed by a spokesman for the Legislative Research Commission.

About 900,000 Kentuckians who get health coverage through Medicaid are eligible for the new dental, vision and hearing benefits.

Medicaid is the federal-state health plan that provides coverage for about 1.7 million children and adults in Kentucky.

The next meeting of the committee is Aug. 8, according to the legislative website.

Dr. Bill Collins, a supporter of the Medicaid dental expansion, treats a patient at the Red Bird Mission dental clinic in Clay County. (Photo by Deborah Yetter)

A public hearing on Gov. Andy Beshear’s plan to have Medicaid cover more dental, vision and hearing services for adults has been rescheduled from Thursday, July 13, to Friday, July 14.

The hearing by the Administrative Regulation Review Subcommittee will be held at 1 p.m. July 14 in Frankfort at the Capitol Annex in Room 149.

At the hearing, legislators will hear comments on Beshear’s plan that expands Medicaid to pay for additional health services including dentures, fillings, crowns and root canals as well as vision and hearing benefits such as glasses and hearing aids.

Medicaid is the federal-state health plan that provides coverage for about 1.7 million Kentuckians.

The hearing is open to the public.

Dr. Bill Collins, a supporter of the Medicaid dental expansion, treats a patient at the Red Bird Mission dental clinic in Clay County. (Photo by Deborah Yetter)

At the Red Bird Mission dental clinic in Southeastern Kentucky, patients with few or no teeth now are eligible for dentures through an expansion of the state’s Medicaid dental services for adults.

“People are tickled to death,” said Dr. Bill Collins, the dentist at the United Methodist Church mission in a remote corner of Clay County. “We get patients who haven’t had teeth for 20 years.”

Dentures and other services newly covered by Medicaid have the potential to remake Kentucky’s image as a state of “toothless hillbillies,” said Collins, who has treated patients in the region for decades.

“I hate that image,” he said.

But a political fight in Frankfort over who has the power to enact the new benefits — that also expand vision and hearing services — could end the extra coverage advocates say is desperately needed.

Already the new benefits have started, stopped and started again amid a tussle between Republicans who control the General Assembly and Gov. Andy Beshear, a Democrat who enacted them Jan. 1.

Lawmakers have scheduled a hearing July 13 on the new benefits, but already expressed their disapproval at a meeting in May where Republicans said Beshear usurped their authority over the federal-state health plan for low-income individuals.

“I’m not necessarily opposed to doing this,” said Rep. Derek Lewis, R-London. “There’s a lot of people in my district that could benefit from this. But the process matters.”

Since lawmakers have the power to kill the expansion when they next meet in the 2024 legislative session, there’s no guarantee the benefits will last beyond this year.

That’s unfortunate in a state that ranks 49th in oral health and consistently ranks among the top states in the number of adults with no teeth, according to health advocates.

“We really wish that the governor’s office and the legislature, working together, could find a way to get this done instead of being adversarial,” said Dr. Stephen Robertson, executive director of the Kentucky Dental Association.

Samone Gist, a Louisville woman suffering from multiple dental problems, says she just wishes someone would establish consistent, accessible dental care for those including herself who rely on Medicaid for health coverage.

Even if it survives, expansion might not be enough unless Medicaid pays Kentucky dentists more

With demand high for dentures now that Kentucky’s Medicaid program has agreed to cover them for adults, Dr. Bill Collins, the dentist at Red Bird Mission dental clinic in Clay County, is providing them as fast as he can.

But the Medicaid reimbursement of $656 for dentures doesn’t cover the clinic’s base cost of $1,100, meaning the nonprofit clinic has to make up the difference from other sources, he said.

“We take Medicaid and try to help as many people as we can help,” Collins said.

Not all dental practices — many of them small businesses — can afford to do that, said Dr. Stephen Robertson, executive director of the Kentucky Dental Association.

“For an office to decide to participate in Medicaid, they have to agree to operate at a loss,” Robertson said.

Gov. Andy Beshear has tried to address the problem by directing Medicaid to pay for more adult dental services previously not covered by the federal-state plan. The future of that expansion, caught up in a partisan fight in Frankfort, is uncertain.

30 years without a raise

But should the expanded services survive, they may not be enough to address deeper problems in a system beset with a complicated reimbursement system where payment for the few services adults previously received hasn’t been increased for 30 years, Robertson said.

“What it really needs is a significant increase,” he said.

By contrast, Medicaid dental services for children received a boost in 1997 that advocates say has led to improved oral health and more regular treatment for kids.

Moreover, dentists must deal with a complex network of six separate managed care organizations,? known as MCOs, hired by the state to oversee health care for most of the 1.6 million Kentuckians enrolled in Medicaid.

They in turn subcontract with dental MCOs who negotiate rates with dentists and pay them, not always as much as the state Medicaid program recommends in its fee schedule. Also, rates may vary from one dental MCO to another.

Robertson said the dental association would like to see the MCOs required as part of their contract with the state, to use standard rates specified by the state Medicaid Department.

“That’s one of the things we are pushing for,” he said.

‘Gateway to everything’

So far, state officials have not required that to avoid conflict with rules from the federal government, which covers 70 to 80% of the state’s Medicaid costs, that require flexibility in managed care.

Kentucky also faces a shortage of dentists, especially in rural areas, and many do not take Medicaid because of the historically low reimbursements, Robertson said.

Robertson thinks all these problems have solutions, but it’s going to take a concerted effort in a state that ranks 49th in oral health and first in the rate of older adults with no teeth.

When it comes to overall health, “The mouth is the gateway to everything,” he said. “We’re for finding the best way to move forward.”

A shortage of dentists — especially those who accept Medicaid because of notoriously low reimbursement rates — makes it difficult to find an appointment, health advocates say.

Recently, Gist said she managed to get one decayed tooth pulled but has others that need treatment.

“I was in so much pain, it was unbelievable,” she said. “The pain is unbearable.”

Dental disease is linked to a host of health problems including infection, diabetes complications, heart disease and premature births — all significant health issues in Kentucky. It also is linked to addiction among those prescribed painkillers for dental abscess and decay, problems that too often send people to emergency rooms, advocates say.

Kentucky spends about $9 million a year in Medicaid funds on patients visiting the emergency room for dental pain, according to the Cabinet for Health and Family Services. In such cases, patients generally are prescribed antibiotics for infection and painkillers but don’t get dental care.

By contrast, the expansion of dental, vision and hearing benefits is expected to cost about $36.5 million a year, with $31 million covered by the federal government, which pays most of the state’s share of Medicaid. Beshear has said the state’s costs will be covered from savings in other areas in Medicaid.

Advocates argue that dental health, as well as good vision and hearing, also are essential in helping people get and keep jobs.

“Kentuckians need teeth. They need glasses. They need hearing aids,” said Cara Stewart, director of policy advocacy for Kentucky Voices for Health, a coalition of health groups. “It’s just a no-brainer.”

Gist, who recently attended a job-training program and is looking for work, agrees.

With bad teeth, “It’s embarrassing to do an interview or try to get a job,” she said. “It will definitely hold you back.”

There seems to be little dispute in Frankfort about the need for the expanded dental and other services for the 900,000 adults covered by Medicaid who could benefit.

But that’s where agreement ends.

‘We’re number one’

For decades, adults covered by Medicaid were eligible only for an annual cleaning and tooth extraction.

In a poor state where nearly 1.7 million people get care through the federal-state health plan, that led to inevitable results, said Robertson, the dental association executive.?

Kentucky consistently ranks at or near the top in the nation in the? number of adults with no teeth, a condition known as edentulism.

“When the only benefit you’ve got is to have a tooth removed, that’s what the outcome is going to be,” Robertson said, adding that a recent study ranked Kentucky first in the number of toothless, older adults.

“We’re number one,” he said.

So last October, citing the need, Beshear announced he was using executive authority to expand Medicaid dental, hearing and vision benefits for adults in the program.

Adults could get dentures, fillings, crowns and two checkups a year as well as eyeglasses and hearing aids.

Children enrolled in Medicaid — currently about 637,000 — already are eligible for a full range of dental, vision and hearing services.

The new adult benefits, introduced through emergency regulations, began Jan. 1.

But Republican lawmakers objected, saying the governor should have sought legislative approval for the changes.

They included Sen. Stephen West, of Paris, who sponsored Senate Bill 65 in the 2023 session to stop the new benefits.

“It was a huge change, really that should have been done through, we felt, through statute, through involving the legislature,” West said.

The bill passed in late March, stopping the new benefits after just three months, but it was amended to extend them until June 30 for people already getting services, such as dentures.

But on April 12, after the legislature adjourned and lawmakers left town, the Beshear administration issued a new set of emergency regulations to again provide the expanded dental, vision and hearing services.?

That restored the benefits but set up a new confrontation with Republicans who hold a supermajority in the General Assembly.

Groundhog Day

GOP lawmakers were swift to react, taking up the new version of the benefits at the May 9 meeting of the joint Administrative Regulatory Review Subcommittee, which examines regulations enacted by the administration.

They complained the new version looked much like the old version they had already rejected.

“I half expected Bill Murray to come to the table today because I feel like this is ‘Groundhog Day,’” said Sen. Damon Thayer, majority floor leader, referring to the movie where Murray plays a TV news personality caught in a time loop. “The same thing kept happening over and over again.”

Officials with the Beshear administration, including Medicaid Commissioner Lisa Lee, insisted the plan had been changed to meet legal requirements that prohibit offering regulations that already had been rejected.

Besides, Lee said, with Kentucky’s abysmal ranking in oral health, it’s time to break out of the groundhog mode.

Since 2014, after Kentucky expanded access to Medicaid under the Affordable Care Act to include more low-income adults, the state has moved from 47th to 43rd in overall health rankings.

“But we remain 49th in oral health care,” Lee said. “We have got to get something done here.”

Rep. Daniel Grossberg, a Louisville Democrat, agreed.

“Something has got to change,” he said. “We may be having an element of ‘Groundhog Day’ here but we’re living it over and over because neither side’s willing to give.”

Cabinet numbers show that the expanded benefits so far have resulted in dental, vision and hearing services for 196,000 individuals with about $12 million in payments to providers.

About 4,000 have received dental services including 2,500 sets of dentures.

But Republicans said that while they don’t necessarily dispute the need for those services, they fault the Beshear administration for failing to work with them.

“You kept coming back after we said no,” said Rep. Randy Bridges, of Paducah. “We said no. We said no. You don’t want no. You’re going to do what you dang well please.”

Committee co-chair Derek Lewis said benefits from the expansion isn’t the point.

“I think every single person on this committee would be in favor of expanded dental services,” Lewis said. “But our job on this committee is to protect the legislative process.”

The committee voted 5-2 to find the regulations “deficient,” with Democrats casting the two no votes.

But the legislature can’t actually block them until it meets again in session in 2024 and enacts legislation to do so.

That leaves the Beshear administration free to offer the expanded benefits through at least the end of the year.

‘Last bastion of small business’

Meanwhile, Kentucky needs to work on other problems plaguing dental services throughout the state, especially in rural areas, dental officials said.

Medicaid reimbursement rates for dental services have not increased for 30 years to the point where costs of dental care exceed what the program pays, Robertson said.

Of the state’s 3,200 licensed dentists, about 57% are signed up to treat Medicaid patients but many either don’t accept them or limit those they see because of low reimbursement, he said.

“People tend to forget dentists are the last bastion of small business in Kentucky,” Robertson said. “When you are asked to operate at a loss, that’s not a sound business plan.”

The state’s latest proposed regulations include increased reimbursements for dentists.

The state also doesn’t have enough dentists and other staff, such as dental hygienists, to meet demand.

Even federally-established community clinics, such as the Family Health Centers in Louisville, long considered the medical safety net, have extended waits for dental care and few openings for patients, said Melissa Mather, chief communications officers.

“There has been a significant atrophy in the dental safety net here in Louisville,” Mather said. “We desperately need dental staff.”

Collins, the Red Bird Mission dentist, agrees all those problems must be addressed.

But he said another concern is whether the legislature will even allow the expanded benefits to survive.

“I am for this Medicaid expansion big-time,” he said. “But when Jan. 1 hits, they’re going to come in here and stop it.”

Protesters and clinic escorts gathered outside EMW Women's Surgical Center in Louisville last year before abortion was banned in Kentucky. (Photo by Deborah Yetter)

LOUISVILLE — A judge has dismissed a lawsuit challenging the constitutionality of two Kentucky laws that together ban nearly all abortions, a week after the state’s two licensed abortion providers signaled they planned to drop the case — for now.

Jefferson Circuit Judge Mitch Perry on Tuesday signed an order the parties submitted agreeing to dismiss the case.

EMW Women’s Surgical Center and Planned Parenthood said in a June 20 filing that they would drop the case in light of a state Supreme Court ruling earlier this year that to pursue it, they must find a patient to serve as a plaintiff.

But they have not given up, Amber Duke, executive director of the American Civil Liberties Union of Kentucky, said at a news conference Saturday.

“It’s very difficult to find someone to come forward,” Duke said. “We stand ready to file and immediately go back in court when we have someone who is in a position to take on the lawsuit.”

The ACLU represents EMW, and Duke was speaking at a news conference called to commemorate the one-year anniversary of the U.S. Supreme Court decision that struck down the federal right to abortion.

Access to abortion ended immediately in Kentucky after the June 24, 2022, ruling because of a “trigger law” on the books to ban the procedure should the high court overturn Roe v. Wade, the landmark 1973 case establishing it as a federal constitutional right.

EMW and Planned Parenthood had challenged that law in state court, arguing Kentucky’s Constitution provides a right to abortion. They also had challenged a second law, a ban on abortion once cardiac impulses are detected in an embryo, at about six weeks and often before most women know they are pregnant.

But the state Supreme Court curtailed their right to challenge the laws, ruling that the clinics lacked “standing,” or the right to sue without a patient as a plaintiff who had been affected by the laws, even though providers have often been granted standing to pursue such cases by the courts.

Kentucky Attorney General Daniel Cameron, an anti-abortion Republican who is defending the two laws, signed off on Tuesday’s agreed order.

Cameron is running in this year’s gubernatorial race against Gov. Andy Beshear, the Democratic incumbent who supports abortion rights. Cameron previously had praised news the clinics had agreed to drop the case.

“My office will always defend and enforce Kentucky’s pro-life laws passed by our General Assembly,” he said in a statement.

Kentucky Right to Life, which had supported the laws, celebrated the decision of the plaintiffs to end litigation.

“They have walked away from their own case,” said Addia Wuchner, executive director, in a post on the organization’s website. “Today, every word of every pro-life law is intact.”

However, abortion rights supporters vowed to continue the fight, speaking at Saturday’s news conference held at Planned Parenthood’s clinic in Louisville.

U.S. Rep Morgan McGarvey, who represents Kentucky’s 3rd Congressional District based in Louisville, said he is among a group of House Democrats pushing a measure called the Women’s Health Protection Act to restore abortion as a federal right.

“Right now, no woman in Kentucky can receive an abortion even in cases of rape or incest,” McGarvey said. “Abortion is health care. We must make sure that that health care continues to be available in a safe and legal way.”

Kentucky laws make no exception for pregnancies resulting from rape, incest or in cases of serious fetal abnormality. Nor do they make allowances for the age of the patient where, in Kentucky, the two youngest patients in the last two years abortion was legal were age 9.

Meanwhile, abortion rights advocates say they will remain active in Kentucky and keep fighting for women seeking abortions in other states. Both EMW and Planned Parenthood are taking calls and providing information to such patients.

“We aren’t going anywhere,” said Tamarra Wieder, Kentucky state director of Planned Parenthood Alliance Advocates. “These doors stay open. Through thick and thin, we’ll be fighting for the future we know is possible.”

Planned Parenthood's Louisville health clinic. (Kentucky Lantern photo by Deborah Yetter)

In a surprise move, Kentucky’s two licensed abortion providers have asked a judge to dismiss their case seeking to overturn the state’s near-total ban on abortion.

The joint motion on behalf of Planned Parenthood and EMW Women’s Surgical Center comes on the eve of the first anniversary of the June 24, 2022, U.S. Supreme Court decision to strike down Roe v. Wade, the landmark 1973 decision establishing abortion as a federal constitutional right.

Their motion, if granted by Jefferson Circuit Judge Mitch Perry, would for now bring an end to the clinics’ efforts to restore abortion rights in Kentucky. It was filed by Planned Parenthood and the American Civil Liberties Union, which represents EMW.

Still, “the fight is far from over,” a Planned Parenthood official said Tuesday.

The clinics are seeking to reserve the right to pursue the case, when appropriate.

“It’s unfortunate that it falls upon the anniversary of Roe v. Wade,” said Tamarra Wieder, public affairs and policy director for the Planned Parenthood region that includes Kentucky. “That hurts a little bit more.”

Attorney General Daniel Cameron, an anti-abortion Republican who has been defending the two state laws under challenge, said in a statement that his office was “gratified” by the abortion providers’ motion to dismiss and added that “the elective abortion industry is out of business” in the state.

“A society is judged by how it treats its most vulnerable — especially the unborn,” he said. “Today is a reminder that every life deserves to live. My office will always defend and enforce Kentucky’s pro-life laws passed by our General Assembly.”

The parties in the case had been scheduled to return to court June 28 to update Perry on their progress.

The U.S. Supreme Court decision last year ended access to almost all abortion services in Kentucky, where a “trigger law” took effect banning the procedure in the event of such a ruling. A second state law banning abortion after about six weeks also took effect.

EMW and Planned Parenthood filed a lawsuit last June in state court arguing that the state constitution provides reproductive rights to women including to terminate a pregnancy.

But a state Supreme Court ruling earlier this year sharply limited the providers’ right to pursue the case, finding they lack “standing” to purse some of their claims, a finding that meant they had to find a patient affected by the law and willing to sue.

In a news release Tuesday, EMW and Planned Parenthood said they asked the court to dismiss their challenge to the two laws restricting abortion because of that ruling.

“We moved to dismiss this case because earlier this year, the Kentucky Supreme Court issued an extraordinary ruling that took away health care providers ability to defend the rights of their patients, upending decades of precedent,” the two health providers said in a statement.

The state Supreme Court decision that the plaintiffs lacked standing left them searching for a patient who had been adversely affected and who was willing to join the lawsuit challenging Kentucky’s abortion laws.

In previous litigation, courts generally have allowed abortion providers to bring cases on behalf of patients.

In a joint statement, Planned Parenthood and EMW said they have not given up and will continue seeking such a patient willing to come forward, allowing them to file a new challenge to the laws.

“We remain open to hearing from patients who are in Kentucky and need access to abortion,” the statement said.

It added that “our phone lines are open” and urged potential plaintiffs to call or text 617-297-7012.

Kentucky’s two abortion laws permit no exceptions for pregnancies from rape or incest or severe fetal anomalies in which a fetus is unlikely to survive. They allow abortion only to save the life of the pregnant patient or prevent disabling injury.

Last year, Perry agreed Kentucky’s constitution appears to protect a woman’s right to abortion and agreed to temporarily block enforcement of the two laws while the lawsuit was pending.

However, an appeals court judge reversed the decision and the case moved to the state Supreme Court, which in February declined to block enforcement of the two laws. The high court sent the case back to Perry for further action.

ACLU lawyer Heather Gatnarek told Perry at a hearing in April the plaintiffs were having difficulty finding a patient willing to join the case.

The Kentucky Supreme Court ruling on standing left the providers in the difficult spot of finding a patient seeking to end a pregnancy and willing to join a major lawsuit even while seeking abortion care in another state, Wieder said.

“They are in a medical crisis and trying to get care,” Wieder said. “It is outrageous.”

While dismissal of the case would end, for now, Planned Parenthood and EMW’s challenge to the law, another remains pending in Jefferson Circuit Court.

Three Jewish women from Louisville have filed a lawsuit challenging Kentucky’s abortion ban, which states life begins at conception, arguing it violates their religious freedom under state law.

In the lawsuit, they argue that the abortion laws — one of which defines life as beginning at conception — clash with Jewish teaching that life begins at birth. They also argue it limits their right to other care, such as in-vitro fertilization.

The boundaries of Kentucky's six congressional districts, redrawn in 2022, are being challenged before the Kentucky Supreme Court, which will hear arguments in the case Sept. 19. Of special interest is what political scientist Stephen Voss calls the "Comer hook," extending the 1st Congressional District from the Mississippi River to Frankfort. (Kentucky Legislative Research Commission)

A fight over Kentucky’s state House and U.S. congressional districts is now before the state Supreme Court, more than a year after new maps were adopted by the Republican supermajority that controls the General Assembly.

On March 23, the high court agreed to take the challenge by state Democrats, bypassing the state Appeals Court, “in the interests of judicial economy.”

Now it’s up to the Supreme Court to decide whether the maps established through redistricting — which a lower court judge already found to be gerrymandered, or manipulated to favor one party — also are unconstitutional.

“This is purely a legal question, not a factual one on whether the maps are unfair,” said Joshua Douglas,? a University of Kentucky law professor who studies election and constitutional law.

The Supreme Court has scheduled a hearing in the dispute on Sept. 19.

Districts, which define the area an elected official represents, are adjusted every 10 years by the legislature to reflect changes in population and generally favor the party in power.

The legal fight comes in advance of next year’s primary and general elections in which all 100 House races and Kentucky’s six congressional seats could be contested.

Two days after the Nov. 8, 2022 general election, Franklin Circuit Judge Thomas Wingate ruled that the state House and congressional districts enacted earlier that year resulted from “partisan gerrymanders” but he declined to find them unconstitutional.

The case wound up before the Supreme Court after Kentucky Democrats appealed the decision.

They argued the Republican maps split up many more counties in House districts than allowed by the state constitution.

Democrats also objected to the 1st Congressional District based in Western Kentucky, reconfigured to include Franklin County — an alleged move to dilute its Democratic votes and accommodate incumbent U.S. Rep. James Comer, a Republican who hails from Tompkinsville in Monroe County but owns a home in Frankfort.

Republicans have scoffed at the challenge, with a spokesman for the state GOP previously calling it a “frivolous lawsuit.”

A spokesman for the Republican Party of Kentucky recently called the legal challenge a “desperate move by Andy Beshear and the Democrats to manipulate the political process,” adding that Democrats in past years have controlled the redistricting process, yet “Republicans achieved supermajorities on maps drawn by the Democrats.”

Democrats called on the Supreme Court to reject maps that resulted from Republicans working “behind closed doors to draw districts that cut up communities for partisan gain,” Anna Breedlove, a spokeswoman for the Democratic Party of Kentucky, said in a statement.

“If this isn’t stopped now, Republicans will only grow bolder in their partisan gerrymandering in coming decades allowing Frankfort politicians to decide who they represent, picking easier paths to power and reelection, rather than allowing Kentuckians to decide who represents them,” her statement said.

Douglas said he believes Democrats stand a chance, based on Wingate’s finding that both the House and congressional districts are gerrymandered.

“I think there’s a decent chance of success for the plaintiffs,” said Douglas, who is considering filing a brief in the case urging the court to “robustly construe the state constitution to protect against extreme partisan gerrymandering.”

D. Stephen Voss, an associate professor of political science at UK, declined to speculate on the possible outcome of the case. But he said Republicans may find it difficult to defend what he called the “Comer hook,” in which the 1st Congressional District was stretched to reach into Franklin County, presumably to benefit the incumbent.

The reconfiguration makes no sense and doesn’t comport with the accepted standard that congressional districts are supposed to be compact, Voss said.

“Almost any realistic solution has Jamie Comer losing Franklin County,” he said.

Voss said one theory about adding Franklin County, which tends to vote Democratic, to Comer’s district is that it was to remove it from Republican Rep. Andy Barr’s 6th District to protect him in future elections.

But if that were the goal, Voss said, it would have made more sense to add Franklin County to Republican Rep. Thomas Massie’s 4th District which includes Northern Kentucky.

That makes more sense geographically than the Comer “hook,” he said. “That was just a liability for the Republicans,” Voss said. “It gave them congressional districts that were hard to defend.”

Still, there’s no guarantee another version of the district maps, especially for the state House seats, will help Democrats in a state so heavily dominated by the GOP, Voss said.

Should the Supreme Court throw out the current maps and order the General Assembly to start over, “they can come back with a map that is no better for the Democrats,” Voss said.

“Indeed, they could come back with a map that’s worse,” said Voss, who testified as an expert witness at the trial last year on behalf of Kentucky Attorney General Daniel Cameron, a Republican defending the redistricting plans.

And it’s uncertain whether the Supreme Court will rule before the Jan. 5 filing deadline for candidates who wish to run in the May 2024 primary election.

A change to the maps could affect the decision of candidates about the district in which to seek office.

A decision sooner than later is better for Democrats when it comes to planning campaigns, Voss said.

“If Democrats are going to have any hope of clawing back territory, the earlier they know what the districts are going to be, the better,” Voss said. “The longer this takes, the more likely Democrats are going to suffer what they suffered last time.”

Last year, Democrats faulted the new districts for their loss of several House seats in the November election, increasing the Republicans’ supermajority to 80 out of 100 representatives.?

And the 2024 election features a number of races that could be affected by any changes to districts with all 100 House and Kentucky’s six congressional seats up for election.

The presidential race also on the 2024 ballot will heighten interest among voters, said Michon Lindstrom, communications director for the Kentucky Secretary of State.

“In presidential years, we have the best turnout,” Lindstrom said. “There will be a lot of interest next year.”

Douglas, the law professor, said he believes the case could be decided before the January filing deadline as well as in time for the legislature to act on new maps when it convenes in 2024, if necessary.

“I do think there’s time for the court to rule and, if it strikes down the maps, for the legislature to redraw the maps — even next January,” he said. “It passed the current maps in a matter of days.”

Wingate ruled in favor of Republicans after deciding that the House and congressional districts, though gerrymandered, were not necessarily unconstitutional.

“The Kentucky Constitution does not explicitly prohibit the General Assembly from making partisan considerations during the apportionment process,” Wingate’s order said.

He added: “The court understands that partisan gerrymandering challenges have been sweeping the nation and that plaintiffs want this court to look at and rely upon decisions made by other states’ high courts, but this court is only concerned with the Kentucky Constitution and what is permitted under it.”

This story has been updated with a statement from Republican Party of Kentucky spokesman Sean Southard.

Prior to the abortion ban, volunteer escorts in orange vests waited outside EMW Women's Surgical Center to help patients get past anti-abortion protesters who regularly gathered at the clinic. (Photo by Deborah Yetter)

After more than four decades of providing abortion and contraceptive services, EMW Women’s Surgical Center is selling its downtown Louisville building.

The move by EMW comes nearly a year after the U.S. Supreme Court struck down abortion as a federal constitutional right and it became virtually illegal in Kentucky under existing state laws.

At the time of the court ruling, EMW was one of only two abortion providers in Kentucky. The other was Planned Parenthood, which suspended abortion care but has remained open for other health services at its downtown Louisville clinic.

EMW co-owner Ona Marshall said in an email the owners are not commenting on the sale of the building. She owns the clinic with her husband, Dr. Ernest Marshall, one of the physicians who founded it in 1981.?

“However, EMW and the Kentucky Reproductive Freedom Fund remain committed and engaged in restoring access to abortion and contraceptives in Kentucky and nationally,” her email said.

The Marshalls founded the Reproductive Freedom Fund, a volunteer organization that supports reproductive rights.

EMW remains a plaintiff along with Planned Parenthood in a lawsuit in Jefferson Circuit Court challenging two state laws that together ban almost all abortions in Kentucky except to save the life of a patient or prevent disabling injury.

A milestone

While no abortion services have been available in Kentucky for the past 11 months, the sale of the EMW building marks a milestone for opponents of abortion rights who fought to enact the laws.

“For years Kentucky Right to Life and our members, faithful pro-life advocates and prayer warriors have stormed Heaven for those who had no voice,” Addia Wuchner, Right to Life executive director, said in a post on the organization’s website. “We waited, trusted, and advocated that one day we would see EMW shut down. Well, that day has come!”

“Yes, we know that Planned Parenthood still stands, but optimism is in the air,” she added. “Let’s continue to pray and stand against abortion.”

The sale of EMW is a sad occasion for abortion rights supporters, including Ashley Jacobs, who served for eight years as a clinic escort.

As an escort, she joined dozens of volunteers who would stand outside EMW in orange vests to help people get safely into the facility past anti-abortion protesters — who often shouted at and swarmed around patients, trying to discourage them from entering.

Jacobs said she valued her work assisting patients.

“It was definitely rewarding,” she said. “If someone got into the clinic and wanted to be there, you felt like you helped someone get access to care they wanted.”

Her volunteer work “made me a better person,” Jacobs said. “I met some of the best and worst people in the world.”

EMW’s 14,124-square-foot building on West Market Street is listed for sale for $3.5 million by a commercial real estate agency. The listing describes it as a “free standing medical building” in a prime downtown Louisville location, suitable for a health clinic or outpatient surgical center.

The site is close to the Kentucky International Convention Center, several hotels and a nearby medical complex anchored by University of Louisville Health.

Court fight continues

Meanwhile, a court fight continues in Jefferson Circuit Court in which EMW and Planned Parenthood are challenging the current laws that block abortion in Kentucky.?

Assisted by lawyers for the American Civil Liberties Union, they argue that the Kentucky Constitution provides a right to abortion and have asked a judge to strike down two laws.

One, the “trigger law,” banned abortion should the U.S. Supreme Court overturn Roe v. Wade, the landmark 1973 decision establishing it as a federal constitutional right. It took effect immediately after the high court’s June 24, 2022 decision.

Another law prohibits abortion once cardiac activity is detected in an embryo, generally at about six weeks of pregnancy and often before a woman realizes she is pregnant.

Neither law permits any exceptions for rape, incest or fetal anomalies nor makes any allowance for the age of the individual who is pregnant.

In Kentucky, in the two years before abortion was banned, the two youngest patients were age 9 which would classify them as rape victims under state law.

Kentucky Attorney General Daniel Cameron is defending the two laws and is asking the court to uphold them.

Judge Mitch Perry has scheduled a hearing June 28 to determine how the case will proceed.

Meanwhile, a separate lawsuit challenging the laws is pending in Jefferson Circuit Court. Filed by three Jewish women. It argues the laws violate their rights under Kentucky’s Religious Freedom Restoration Act.

They argue that Kentucky’s abortion laws are based on Christian orthodoxy and conflict with Jewish teachings that generally uphold abortion rights and prioritize the pregnant patient’s life over that of the fetus.

Cameron also is defending the laws in that lawsuit which has been submitted to Judge Brian Edwards for a decision.

Receiving the Jewish Voice for Choice award in March from the Louisville Section of the National Council of Jewish Women, from left, Jessica Kalb, Lisa Sobel and Sarah Baron. At the lectern is Linda Engel, a council member who presented the awards. (Photo courtesy of National Council fo Jewish Women, Louisville Section)

LOUISVILLE — Enacted in 2013, Kentucky’s “Religious Freedom Restoration Act,” has been used to champion conservative causes ranging from tax incentives for a Noah’s Ark theme park in Grant County to the right of churches to stay open during the pandemic shutdown.

Now, three Jewish women from Louisville argue that same law protects their reproductive rights as they seek to overturn two state laws that together essentially ban abortion in Kentucky.

In the lawsuit, they argue that the abortion laws — one of which defines life as beginning at conception — clash with Jewish teaching that life begins at birth.

“Jews do not consider life to begin at conception; this religious belief is forced on them by the government,” their lawyers said in a recent court filing. “Kentucky’s laws are Christian in origin and design and impugn the faith of Jewish? Kentuckians.”

But Republican Kentucky Attorney General Daniel Cameron, who is defending the abortion laws — and who has invoked the religious freedom act in other cases including to challenge pandemic restrictions on churches and Christian schools — argues it doesn’t apply in this case.

“Kentucky’s abortion laws are not specifically directed at religious practice,” said a recent court filing on behalf of Cameron, who is a GOP candidate for governor.? “Even if abortion is allowed by some religious denominations, abortion is not a religious practice.”

The three women, all mothers, say they would like to have more children but fear the potential impact of Kentucky’s laws on needed fertility treatments or prenatal care in case of complications that could disrupt a pregnancy or force them to carry to birth a malformed fetus at personal risk.

“Kentucky law forces a mother to give birth to a child who will immediately die, perhaps painfully, instead of allowing the fetus to be medically removed,” said the court filing on behalf of Lisa Sobel, Jessica Kalb and Sarah Baron.

One of the laws known as the “trigger law,” banned abortion once the U.S. Supreme Court overturned the federal constitutional right to abortion, which it did last year in striking down the 1973 Roe v. Wade decision. The other bans abortion after about six weeks of pregnancy, once cardiac activity is detected in an embryo.

The laws permit abortion only to save the life of a pregnant patient or prevent disabling injury.

Jewish teaching “prioritizes the mother’s life over the potential life of a fetus,” said the women’s lawsuit.

A separate challenge to the two abortion laws is nearing its 12th month in Jefferson Circuit Court, with no immediate resolution. In that case, Kentucky’s two former abortion providers, EMW Women’s Surgical Center and Planned Parenthood, argue abortion rights are protected by the state constitution and seek to overturn the trigger law and six-week ban.

The state Supreme Court in February sent that case back to circuit court after refusing to block enforcement of the abortion laws and also, narrowing grounds on which EMW and Planned Parenthood may challenge them.

Meanwhile, the Jewish plaintiffs are proceeding on a separate track based on claims of religious freedom though their lawsuit also argues Kentucky’s “slapdash” compilation of abortion laws created in recent years is vague and contradictory.

That case was filed in October and recently picked up steam amid a flurry of motions from both sides asking Jefferson Circuit Judge Brian Edwards to rule in their favor. The judge has given parties until May 17 to submit further pleadings.

Cameron has cited the religious freedom act in challenges to pandemic orders of Gov. Andy Beshear, a Democrat, that temporarily closed churches and Christian schools, as well as other legal actions including a Louisville photographer seeking the right to refuse to take photos at same-sex weddings.

In a recent court filing, lawyers for Cameron said the purpose of the abortion laws is to “protect human life.”

A spokeswoman for Cameron’s office declined to comment on the case, other than to say “our filing speaks for itself.”

Lawyers for the women who filed the lawsuit have asked the judge to rule in their favor, arguing state abortion laws are problematic for reasons beyond religious freedom.

The more than a dozen state laws meant to ban or limit abortion “contain multiple contradictions, omissions and ambiguities” that make them impossible to understand or follow, said the filing by lawyers Aaron Kemper and Benjamin Potash.

Beth Salamon, state policy advocate for the Louisville chapter of the National Council of Jewish Women, said religious freedom should apply to reproductive rights.

“The faith-based narrative has been monopolized by Kentucky Right to Life,”? Salamon said. “There’s a different narrative out there.”

Her organization supports the women who filed the lawsuit — and recently awarded them the “Jewish Voice for Choice Award” for stepping forward as plaintiffs.

“They are putting a name on this case and I think that’s incredibly brave,” she said.

Samuel Marcosson, a constitutional law professor at the University of Louisville Brandeis School of Law, said the challenge based on religious freedom raises interesting issues.

“It’s clever,” he said of the legal strategy. “It flips the burden on the state to justify its law.”

But first, he said, the plaintiffs must establish “standing,” the legal right to pursue the lawsuit.

That has become an obstacle in the other lawsuit by Planned Parenthood and EMW after the state Supreme Court found they lacked standing as clinics to challenge the six-week ban on abortion without adding a client who had been affected by the law.

Cameron’s office, in its recent motion, argued in the case based on religious freedom, that the three women lack such standing and therefore, the judge should rule against them through a summary judgment.

“None of the plaintiffs have constitutional standing,” it said. “Their only alleged injuries are hypothetical.”

Their lawyers disagree.

“Plaintiffs’ injuries are that they are prevented from having more children,” their filing said. “No rule of law requires plaintiffs to undergo an abortion for religious reasons, or be jailed or sued, before bringing this action.”

Protesters and safety escorts for patients gathered last year outside EMW Women's Surgical Center in Louisville. (Photo by Deborah Yetter)

LOUISVILLE —With Kentucky’s abortion ban now in its 10th month, advocates have returned to court to argue that abortion is a right under the state constitution after the U.S. Supreme Court last year struck it down as a federal constitutional right.

But a February ruling by the Kentucky Supreme Court curtailed the ability of abortion rights lawyers to make their case in state court.

“A very narrow opening for a very narrow claim,” is how Samuel Marcosson, a constitutional law professor at the University of Louisville, described prospects for the case brought by Kentucky’s two abortion providers, Planned Parenthood and EMW Women’s Surgical Center.

The state Supreme Court ruling cut off the right of providers to challenge a law banning abortions after about six weeks of pregnancy, once cardiac signals from an embryo are detected. It does allow them to challenge the state’s “trigger law,” a measure enacted in 2019 to ban all abortions in Kentucky should the Supreme Court end the federal constitutional right to abortion.

Lawyers for the American Civil Liberties Union, representing Kentucky’s abortion providers, say they are seeking ways to bolster their case, possibly by adding an individual affected by the ban. That would give them a new opening to challenge the six-week ban as well as the trigger law.

“We are working on it,” ACLU lawyer Heather Gatnarek told Jefferson Circuit Judge Mitch Perry at an April 24 hearing he scheduled to determine how to proceed in light of the state Supreme Court decision.

But it’s been difficult, Gatnarek said, “to find a plaintiff with standing who is willing to be involved in issues like this.”

Christopher Thacker, representing Kentucky Attorney General Daniel Cameron, who is defending the laws, said he would object to adding a plaintiff at this point and said the only issue left is whether to uphold the trigger law.

“This case is simply about the trigger ban,” he said.

Perry gave parties two months to work on the case and asked them to return to court June 28.

Abortion is now banned or restricted in roughly half the states, according to the Kaiser Family Foundation, following the June 2022 U.S. Supreme Court decision to strike down Roe v. Wade, the landmark 1973 case that established pregnancy termination as a constitutional right.

Kentucky’s laws allow abortion only when it is deemed medically necessary to save the life of or prevent disabling injury to the patient. The laws provide no exceptions for fetal defects or pregnancies from rape or incest.

Abortion providers filed an immediate challenge last year after the laws took effect in June upon the U.S. Supreme Court ruling. In July, Perry ruled in their favor, temporarily barring enforcement of the Kentucky laws while the challenge proceeded in state court.

That allowed abortion services to briefly resume for about a week until a state Court of Appeals judge overruled Perry. The case eventually made it to the state Supreme Court, which declined to block enforcement of the laws and sent the case back to Perry to decide within new limits it imposed.

Patients still call

Meanwhile, demand for the procedure continues.

Patients still regularly contact Kentucky’s two abortion providers, both in Louisville, in hopes of scheduling the procedure or finding out where abortion care is available. Not all realize abortion is banned in Kentucky, though that is changing.

“There is a diminishing number of people that know don’t know it’s illegal,” said Jessica Carpenter, manager of Planned Parenthood’s health center. “A lot of the confusion comes in as to where they can access abortion in states surrounding us.”

EMW continues to field calls from patients although it has been unable to provide care, said co-owner Ona Marshall.

“We are still answering the phone and we are still hearing from people,” Marshall said. “We get calls every week and every month.”

Based on EMW’s number of patients in the year prior to Kentucky’s abortion ban, Marshall estimates about 3,000 people have been denied abortion services in Kentucky, many likely seeking care in other states.

Marshall called the restrictions “an affront” to those seeking to end a pregnancy. “It’s causing a lot of harm to people,” she said.

Abortion opponents, who celebrated the end of Roe v. Wade, see it differently.

“It’s saving lives of the unborn children,” said Addia Wuchner, executive director of Kentucky Right to Life, adding her organization values “the life of the mother and the unborn child.”

‘Absolutist positions, they don’t work in medicine’

But Dr. Anna Feitelson, a Louisville obstetrician and gynecologist, said absolute bans on abortion don’t take into account complications that may arise in a pregnancy, including fetal abnormalities that mean little chance of the fetus surviving, or conditions that could threaten the health of the pregnant patient.

“Too many people see this as black or white, right or wrong,” she said. “Absolutist positions, they don’t work in medicine. There are always going to be areas of gray.”

For example, Feitelson said one of her patients had a fetus with severe abnormalities that could not survive. She had to leave the state to end the pregnancy because Kentucky’s law provides no exceptions for such conditions.

“She had to drive to Illinois,” Feitelson said. “It was a highly desired pregnancy but the fetus was not going to survive.”

Another dangerous condition is when the patient’s water breaks too early in a pregnancy, causing the loss of amniotic fluid that surrounds and protects the fetus, increasing the risk of infection.

Some years ago, Feitelson said she had a patient who experienced that condition but tried to continue the pregnancy. She experienced severe infection and died.

Several lawmakers in Kentucky’s General Assembly, controlled by a Republican supermajority, expressed concern about the laws’ lack of exceptions for fetal anomalies or pregnancies from rape or incest.

But measures including one filed by Rep. Jason Nemes, R-Louisville, to allow abortions in such cases got no attention in the 2023 legislative session and died without hearings.

Supreme Court stopped short of ruling on abortion bans’ constitutionality

Advocates for abortion rights still hope to prevail in state court.

But they will have to overcome the ruling from the state Supreme Court that found abortion providers who brought the case lack “standing,” or the right to challenge the six-week ban.

The majority opinion by Justice Debra Lambert gave the abortion rights advocates limited standing to challenge the trigger law on grounds that it is unconstitutional.

In doing so, the court stopped short of ruling on whether the laws themselves are constitutional.

“To be clear, this opinion does not in any way determine whether the Kentucky Constitution protects or does not protect the right to receive an abortion,” it said.

By reaching that conclusion, it saved the majority from having to reach any decision about the laws, said Marcosson, the constitutional law professor.

“I’m not surprised the court was anxious to find a way not to rule on the merits,” he said.

Marshall had a more pointed take. “They took the easy way out, which is really an affront to women, decency and personal liberty,” she said.

The decision drew several sharply worded dissents including one from Justice Angela McCormick Bisig who argued the majority erred by failing to evaluate whether the laws may be unconstitutional, saying justices were “remiss for refusing to do so.”

She also said the majority erred in denying standing to the abortion providers to challenge the six-week ban.

Bisig noted that Kentucky voters in November rejected a ballot measure that would have changed the state constitution to specifically state it includes no right to abortion.

And Bisig said the abortion providers might resolve the lack of standing by adding a patient as plaintiff to the case to challenge the six-week ban.

Overturning the trigger law, which bans all abortions from the moment of fertilization, could restore some access to abortion in Kentucky.

About 40 percent of abortions are performed by six weeks of gestation, according to the Kaiser Family Foundation.

Marcosson said the only way he believes the abortion providers could strengthen their right to challenge the six-week ban on abortions is by adding to their lawsuit a patient who was affected in some way.

“If they don’t,” he said, “the six-week ban is off the table.”

Brennan Long continues to be a blessing and inspiration to many, says his father. (Long family photo)

Almost nine years after a 16-year-old boy with autism suffered two fractured legs — a near fatal injury — at the hands of a teacher’s aide with Jefferson County Public Schools, the state’s top human services official has upheld a finding of child neglect in the case.

In a March 16 written order, Eric Friedlander, secretary of the Cabinet for Health and Family Services, ruled that teacher’s aide Sherman Williams committed neglect in 2014 when he physically restrained Brennan Long, then 16, at the Binet School for children with disabilities.

In doing so, Friedlander upheld a 2017 finding of neglect by the cabinet Williams had appealed.

The case attracted widespread attention after it was first reported in The Courier Journal in 2016, with the boy’s parents expressing outrage that no abuse or neglect had been cited in initial investigations by the cabinet and JCPS. And Louisville police found no criminal wrongdoing over the incident that left Brennan in intensive care with two shattered femurs.

Public attention also triggered several outside investigations raising questions about the case and a review by the state Department of Education of JCPS’ use of restraint and seclusion of students.

Brian Long, Brennan’s father, said he and his wife, Kim, are glad the cabinet has reached a decision after their frustrating, years-long fight for an explanation of how a supposedly safe physical restraint left their son critically injured.

“This is a huge victory and should serve as a proof point that we will never stop fighting for justice for Brennan and special needs children in Kentucky,” Brian Long said in an email.

The Longs, who now live in North Carolina, reached a $1.75 million settlement in 2016 with JCPS over Brennan’s injuries but continued to question how authorities handled the case.

Brian Long said he’s glad the case appears resolved with a decision that would keep Williams from working in a classroom with children. The neglect finding prevents him from such employment.

“JCPS leadership should have made this decision eight-plus years ago,”? Brian Long? said, adding that he, his wife and Brennan are grateful? the cabinet and Friedlander “had the tenacity and courage to get to this outcome.”

Williams continued work as a teacher’s aide until 2017 when he was reassigned after the state, following a second investigation, substantiated neglect against him.

But the case may not be over.

Williams, who now works for JCPS as a warehouse worker, could appeal the decision to Franklin Circuit Court. He has 30 days to do so.

His lawyer, Oliver H. Barber Jr., said he found Friedlander’s order “atrocious” and his client is considering an appeal.

“I think the order is wrong,” Barber said.

Brian Long said he understands the importance of due process but he and his wife don’t believe Williams should prevail on appeal.

“In our opinion, the data and facts are quite compelling and certainly not in his favor,” he said.

Barber said Williams is satisfied with his current job and isn’t seeking a return to the classroom.?

If upheld, Friedlander’s finding would place Williams on the state registry of those found to have committed child abuse or neglect and would bar Williams from working with children.

Friedlander’s order was obtained through the state open records law. While records of child abuse and neglect cases generally are confidential, cases that result in the death or life-threatening injury of a child are considered public record.?

The records ?in Brennan’s case shed light on the generally secretive process whereby anyone found to have committed child abuse or neglect may appeal a decision and get the results overturned with little outside scrutiny.

In Williams’ case, he initially persuaded a state hearing officer to overturn the state’s finding of child neglect.

But Friedlander’s ruling reverses that finding.

Friedlander, in his order, found the decision of the hearing officer — a state lawyer assigned to conduct the review — riddled with errors and said it ignored key evidence. In particular, it disregarded the “spiral,” or twisting fractures to Brennan’s legs, that would have required an immense amount of force —a t odds with Williams’ account, his order said.

Williams had claimed he used an approved restraint method to lower the boy to the floor with his legs in front of him. Several other JCPS staff in the classroom claimed either not to have witnessed the incident or backed Williams’ account.

But a former teacher’s aide not interviewed until two years after the event, reported Williams grabbed the boy from behind and the two fell forward.

Williams, whose weight was estimated at around 300 pounds, fell on top of Brennan, whose legs were crisscrossed under him, the aide said. She reported hearing a loud popping sound.

Friedlander’s order said Williams’ claim he used a safe method of restraint was impossible.

“The medical evidence is clear that the hold could not have been applied appropriately as the spiral fractures of both femurs, the strongest bones in the human body, could not have occurred through the manner described,” his order said.

Friedlander’s order cited the findings of Dr. Melissa Currie, a pediatrician and child abuse and neglect expert with Norton Children’s Hospital and the University of Louisville.

Currie, in a 2016 report, found Brennan’s injuries “consistent with acute physical assault” and called for further investigation of the case by the cabinet and police.

Currie cited an independent review by a biomedical engineer hired by the Longs who found that it would have required up to 500 pounds of pressure per leg to fracture each femur.

State social service officials with the cabinet failed to substantiate abuse or neglect after an initial investigation the Longs criticized as inadequate. But after they reopened the case, officials did substantiate neglect by Williams.?

The cabinet said its investigators did not substantiate abuse in the second investigation because they lacked evidence of an assault, but did document neglect for misuse of a restraint that ended in physical injury.

Louisville police who initially investigated the case did not seek criminal charges.

They agreed to reopen the case, but again, did not find evidence of criminal wrongdoing, Jefferson Commonwealth’s Attorney Tom Wine told the Longs in a 2018 letter.

However, Wine was highly critical of police, noting that they lost valuable time from the outset by not attempting to interview anyone at Binet School until two weeks after Brennan was injured.

They didn’t attempt to interview Williams for more than a month but by then, Williams had hired a lawyer and declined to speak with police.

Wine also said the Binet staff interviewed by police may have “colluded” in providing similar accounts, “engaging in the subterfuge that Brennan’s legs had been broken for some unknown reason or unexplained force.”

Brian Long, a chemical industry executive, said he hopes the lengthy ordeal is over for his family. He said Brennan, 24, is doing well and has recovered from the broken legs, commenting:

“Brennan continues to be a blessing and inspiration to many.”