LEXINGTON, Ky. - Changes in Kentucky's telehealth regulations are now making it easier for more providers to deliver more health-care services to Medicaid patients by video link. Kentucky has had a telehealth network since 2000, but according to Rob Sprang, the network's co-manager and director of Kentucky TeleCare, the old regulations limited what could be done with it.

"The previous regulations were very restrictive on who could see a patient on television, what services they could deliver on TV, and where those services could be delivered," he said.

Sprang said telehealth regulations were already better for those with third-party insurance and Medicare.

Now the list of providers who can see Medicaid patients has expanded "dramatically," he said, now "including people like social workers, speech language pathologists, physical therapists, occupational therapists, a very broad group of providers outside of just physicians."

Sprang said the new regulations also lift strict limits on both the types and number of services that can be provided through telehealth.

The Foundation for a Healthy Kentucky has endorsed the change, saying "it has the potential to help make quality specialty health services more accessible throughout Kentucky."

Sprang remarked that Kentucky has overcome a significant hurdle to delivering health care, especially to rural parts of the state.

"It's not rocket science," he said. "You know, if you look at where providers are located today, there are no nephrologists, no kidney doctors, in most of our small communities. There are no child psychiatrists, there are no psychiatrists. There's so many medical specialties that are not available in our rural communities."

And, Sprang said he believes telehealth will play a "vital role" in national attempts to reform health care.



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It is not a pandemic yet, but eye doctors worry the constant use of digital devices could eventually result in long-term health problems for many Texans.

Problems can include age-related macular degeneration, disrupted sleep cycles, and digital eyestrain.

Dr. Jacob Moore, president of the Texas Ophthalmological Association, said it can start with dry eyes after spending hours on digital screens.

"Probably the number one reason people have dry-eye-related symptoms when they use the computer a lot, is because is when we're actively reading, we blink less," Moore explained. "Just the fact that we're working and that our minds are active, we blink less."

He pointed out the average American logs 13 hours a day watching screens, up from between seven and 10 hours per day before the COVID-19 pandemic began.

Dr. Scott Edmonds, chief eye care officer for UnitedHealthcare Vision, said eye specialists became concerned during the pandemic about the dangers of blue light emitted by digital devices, especially because people needed them for school and work, more than ever before.

"Kids were learning remotely, using screens and laptops and cellphones; workers had moved away from the office, working from home," Edmonds recounted. "We know that the millennial generation, in addition to school and work and social media, they also play a lot of games, which emit very high levels of blue light."

In addition to dry eyes, or eyes that feel scratchy or burning, people who log excessive screen time often notice the print goes in and out of focus and complain of headaches or brain fog.

Jacobs offered tips for anyone trying to protect their eye health.

"I would recommend that people wear sunglasses when they're outside. They should wear safety glasses when they're hammering a nail or doing anything that has a risk of eye injury. People need to stay away from smoke, and secondhand smoke."

Eye specialists also recommend those who use digital screens a lot follow the 20-20-20 rule: Take a 20-second break and look at something at least 20 feet away, every 20 minutes.

A bill that would expand Medicaid coverage for some 19,000 Wyoming workers who earn too much to qualify for standard Medicaid, but can't afford private insurance, is making its way through the state Legislature.

Ana Marchese - director for the group Healthy Wyoming - said expansion would bring millions of federal tax dollars back to the state, and would largely help women working at jobs that pay low wages and offer no health benefits, including restaurant, construction, agriculture and retail.

"In Wyoming, more than half of those covered by Medicaid expansion would be low-income women," said Marchese. "Wyoming has one of the highest uninsured rates for women of childbearing age. This has big consequences for the health of mothers and infants."

Wyoming is one of just 11 states that have not expanded Medicaid coverage. The most recent American Cancer Society poll found that nearly two-thirds of Wyoming voters across the political spectrum support expansion, including 66% of Republicans.

Critics have long warned about the potential costs, and some lawmakers are leery of entering into a deal with the federal government.

House Bill 80 cleared the Joint Revenue Interim committee, but has not yet been scheduled for a hearing.

Expansion has been a lifeline for rural hospitals, according to a Families USA report, lowering the likelihood of closure by 62% - largely by reducing losses when people without insurance can't pay.

Wyoming hospitals spend $120 million a year in uncompensated care.

Marchese pointed to hospitals in Kemmerer and Rawlins that recently closed labor and delivery services due to financial struggles.

"After Montana expanded Medicaid, uncompensated care went from $143 million to $89 million in 2019," said Marchese. "And that's a big deal, that keeps hospitals open."

Marchese said expanding coverage will also boost Wyoming's economy.

People with insurance tend to be healthier, more productive workers with fewer sick days. Insurance also gives workers access to less costly preventive care.

"When people lack coverage they often seek treatment at the emergency room, which comes with a hefty price tag," said Marchese. "Having health insurance, and being able to take care of your own physical and mental health, has a positive impact on your ability to work."

Many Kentuckians who have affordable employer health coverage for themselves but not for their dependents and spouses now qualify for financial assistance in the form of tax credits through the Affordable Care Act.

The Henry J. Kaiser Family Foundation estimates more than five million people nationwide are affected by the now-fixed "Family Glitch."

Priscilla Easterling, outreach coordinator for Kentucky Voices for Health, advises families to assess how much they're spending each month on health insurance. She emphasized that previously ineligible families may now qualify, and said the special enrollment period is available year-round.

"The first thing that I would suggest for people when they're getting started," said Easterling, "is just to look at the cost of their employer plan, and do the math about how expensive it is."

Under the new change, if an individual's employer-based coverage offered costs more than around 9% of their household income to cover all family members, the employer-based coverage will be considered "unaffordable" and the employee's family members will be newly eligible for premium federal tax credits to help cover their costs.

Easterling explained that if an individual has already enrolled in employer health coverage, they should reach out to their employer to explore options.

She pointed out that if employees aren't able to get out of their employer-sponsored health care this year, they should mark calendars for next year, and plan to shop for affordable options for 2024.

Easterling said the glitch fix is a game changer for low- to mid-income workers who typically have access to employer-sponsored coverage but cannot afford to cover the cost of insuring their families.

"It gives families more opportunity to shop around for coverage," said Easterling, "and more choice about what they're spending and how they're spending it and how they want to cover their family."

According to an Urban Institute report, the family glitch fix opens coverage options for around 72,000 Kentuckians.

Visit kynect.ky.gov or call 1-855-306-8959 to speak with an expert who can help break down health plans and options.