FRANKFORT, Ky. - A "real mess." That's how one health-care advocate describes Kentucky's transition to a single system to determine eligibility for health insurance and other social services.

People who depend on kynect – the state health-insurance exchange that was hailed as a model for the nation – have been especially concerned about the transition, although Gov. Matt Bevin's office said his plans to dismantle kynect have nothing to do with the current technical problems.

Emily Beauregard, executive director of Kentucky Voices for Health, said she has heard numerous reports of people being "mysteriously dis-enrolled" from Medicaid, errors on applications and long waits for help.

"The wait time for the people who stay on the line is over two hours, but 6,000 to 7,000 calls a day go unanswered," said Beauregard. "That's a lot of people who can't get assistance."

She cited glitches in the system and not enough workers to handle the job, and said assistance from the folks known as "kynectors" is not always possible.

Cabinet for Health and Family Services spokesman Doug Hogan acknowledged the difficulties and said the cabinet is "working diligently with the contractor to correct problems and make the system perform as was intended."

In the meantime, Pikeville resident and Medicaid recipient Connie Holt, who has many chronic health conditions, said her efforts to change her insurance provider became a daily nightmare.

"I was in tears by the end of the day," said Holt. "I would make calls until my battery went dead on my phone, and I'd have to plug it in to charge. Back and forth, all day long."

Cara Stewart, who was Holt's kynector in the process, said it took her over two weeks of nearly daily efforts to get the change made for Holt – which she added would have taken "five minutes last fall," under kynect.

Transitioning from kynect to a federal insurance exchange continues to be controversial.

State representatives in the Democrat-controlled House are expected to vote soon on legislation (HB 5 and HB 6) that would keep kynect and protect Medicaid expansion. Supporters say these have led to a sharp decline in uninsured rates, fewer emergency room visits and more preventive care.

According to Beauregard, 'yes' votes from the House would make a strong statement.

"We know from a recent Kaiser Family Foundation poll that 72 percent of Kentuckians want to keep Medicaid expansion without any changes," she said. "And twice as many Kentuckians want to keep kynect."

However, Gov. Bevin and many Republican lawmakers say the state health insurance exchange is too expensive, and think the way Medicaid is delivered to 1.3 million Kentuckians should be restructured.



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In rural Arkansas, access to healthcare can be a distant dream - literally - as almost 60 counties in the state do not have enough providers to serve their populations. A new initiative with the Health Resources and Services Administration is working to improve access in these areas, through telehealth.

Heather Dimeris, director, Office for the Advancement of Telehealth at the Health Resources and Services Administration, said delivering care remotely online fills a crucial gap. Arkansans can visit telehealth.hhs.gov to explore their options, including behavioral and mental-health services.

"You can look at anxiety or depression screening through telehealth," she said. "You can also receive treatment for your anxiety or depression and other mental health needs, through one-on-one therapy as well as group therapy. And telehealth has also been extremely helpful in treating patients with substance-use disorders."

Dimeris noted 40% of all behavioral healthcare is now done virtually, including therapy, addiction counseling, and mental-health screening. She adds HRSA also provides telehealth services for treatment of chronic diseases, like diabetes, and information for healthcare providers.

However, the growth of telehealth spotlights another challenge for rural Arkansas - the lack of reliable, affordable internet service. Dimeris added some people can use their cell phones for telehealth services. Or they can apply for discounted internet access through two programs offered by the Federal Communications Commission.

"The Affordable Connectivity Program, as well as the Lifeline Program," she continued. "Both of these programs have eligibility requirements. But if you meet them, you really are able to access either free or reduced cost for broadband services and cell phone services."

Lower-income households can get up to $30 a month off their internet service bill, or $75 a month if they live on tribal lands, according to the FCC.

California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.

Open enrollment begins soon for employer-sponsored health insurance for coverage starting Jan 1.

Most people will have multiple options to choose from. Some are complex, so now is the time to do your research. According to the website USA Facts.org, about 7.5% of Indiana residents do not have health insurance. Experts say it is important to shop for plans, see exactly what they offer, and if a choice fits a family's needs and budget.

Dr. Rhonda Randall, chief medical officer of Employer and Individual for UnitedHealthcare, said understanding some of the basic insurance jargon is a good place to start.

"Things like deductibles, copays, coinsurance, premiums, etc.," Randall outlined. "Be familiar with what those terms are and what the costs associated with each one is for the plans that you're offered and the plans that you're considering."

Randall advised paying close attention to out-of-pocket costs and monitoring changes which can occur within a plan each year. She suggested the online health insurance glossary Just Plain Clear, which UnitedHealthcare has compiled. In 2021, more than one-third of Indiana's population was covered by public health insurance funded by governments at the federal, state or local level.

Nearly 17% of Indiana's population is 65 or older and eligible for Medicare. But it does not cover everything, so most people also buy a supplemental policy for added coverage, and a prescription drug plan. The Medicare annual enrollment period starts Oct. 15 and ends Dec. 7, when people can get new coverage or change what they've had.

Randall noted UnitedHealthcare has also compiled an online guide to help people navigate those plans.

"Medicare beneficiaries want to make sure they're understanding and learning the difference between original Medicare -- Medicare Parts 'A' and 'B' -- and Medicare Advantage, Medicare Part 'C' and 'D,' the prescription drugs," Randall explained.

Randall encouraged Hoosiers to consider insurance plans including coverage for telehealth -- virtual 24-hours-a day, 7-days-a-week mental and behavioral health services, or management of chronic conditions, such as migraines, plus physical therapy and wellness visits.