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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September is Health Literacy Month, and a Denver-based group is working to help health professionals break a persistent pattern of discrimination linked to high disparities in maternal death rates.

Danyelle Gilbert, CU Nursing alumna and a member of the Colorado Council of Black Nurses, points to research showing that between 2016 and 2020, nearly all pregnancy-related deaths of Black women could have been prevented through timely interventions - at the patient, provider or system level.

"That report specifically found that discrimination played a role in over half of pregnancy-associated deaths. And approximately 90% of those pregnancy-related deaths were identified as preventable," she said.

Black women in Colorado are twice as likely to die - during their pregnancy, or within one year of giving birth - than the state's overall pregnant population. The leading cause of maternal death overall is self-harm and unintentional overdose. But for Black women, the number one cause of death is heart failure.

Gilbert added that common forms of discrimination facing Black women include simply being dismissed, or not being taken seriously, by health care providers. She says their pain and symptoms are routinely minimized, and there are delays in their care.

"They may face a lack of shared decision making, and poor communication from their health care provider. They just don't feel educated, they are not able to make informed decisions. And all of that is leading to negative health outcomes," she continued.

Gilbert recalls one Black woman experiencing contractions who was turned away to fill out paperwork, even though her information was already on file, and ended up giving birth in a hallway. She said health professionals can do better, in terms of showing patients they are valued.

"And when we value someone, we pour life into them. So when caring for a Black woman, see her. Empathize with her, connect with her. Feel her pain, her joys, her cries. Hear her, because she is both strong and fragile," she added.


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In North Carolina, the gap between Medicaid reimbursement rates and the actual cost of dental care has reached a crisis point, impacting both patients and providers.

Dr. Rafael Rivera, a member dentist with the North Carolina Dental Society and owner of Smile Starters, said the gap is impacting quality dental care around the state.

"It's about 30 cents on the dollar, about 30% of what we should be getting paid for the procedures. And that's not exact, but 30 to 35% somewhere in that range. It's actually a lot worse if you're an oral surgeon in the state treating the patient population," he said.

Those reimbursement rates haven't been updated since 2008. Rivera added that a lack of funding hinders dental practices from attracting and retaining skilled professionals. He said as a result, Medicaid patients often resort to emergency rooms for dental issues-an option that is both more expensive and less effective.

To address these challenges, Rivera suggested expanding the network of Community Dental Health Coordinators. He believes these coordinators could play a crucial role in bridging the gap between patients and dental providers, particularly for those who face language barriers or lack knowledge about available services. He also called for increased funding and safeguards that help dental offices keep up with inflation.

"Our legislator ideally will find a way to not only just put an increase in place, but more importantly have a mechanism that requires them to reevaluate it on a regular basis so that we don't have to go another 16 years before an increase is in place again," he said.

Rivera underscored that this issue extends beyond just dental care, pointing out that data show strong dental health is linked to better overall well-being. Since the expansion of Medicaid, the program has enrolled over 500,000 people.

September is Self-Care Awareness Month and the American Heart Association in Missouri is urging caregivers to take some much-needed time for themselves.

Missouri has around 600,000 family caregivers, many of whom provide unpaid care to loved ones with heart disease, cardiac events and other debilitating illnesses. The emotional and physical toll can be severe, with 21% of caregivers reporting their own health has declined.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare and a board member of the American Heart Association of St. Louis, wants caregivers to understand proper self-care is not selfish.

"It's really important that after an acute event, whenever you've had a chance to kind of catch your breath, sit down and think about exactly what they need and exactly what you need and how much you can give," Johar recommended. "That's not being selfish. That's not, not taking care of them. That's doing the right thing for both of you."

According to the American Heart Association, it is important for caregivers to have someone they can confide in about their fears and doubts; a person who can offer reassurance and emotional support.

A 2023 AARP survey showed nearly 40% of family caregivers spend more than 20 hours a week assisting their loved ones from driving to appointments to providing direct care, many while also working and raising children. Johar stressed the importance of caregivers using time off from work wisely, which includes new mothers with babies in neonatal intensive care.

"The baby's getting the best care in the hospital and there's nothing you can do to help," Johar pointed out. "Go ahead and go back to work. Save that time, go in every evening. Spend all night or as much time as you want with the baby. But save your time off, because when this baby comes home, then you're really going to need to be there."

Doctors also emphasized the critical role of regular exercise, like brisk walks and the need for caregivers of all ages to maintain a heart-healthy diet. The habits help manage stress and boost energy levels.