By Norma Hatfield

Kentucky Lantern

In September, two short notice reductions were announced affecting at-risk populations. One was the Kentucky Transitional Assistance Program (KTAP) under the Department for Community Based Services (DCBS); the other a senior citizen meal program under the Department for Aging and Independent Living. Both agencies fall under the purview of the Cabinet for Health and Family Services (CHFS). 

Things feel flawed. Maybe it’s short notice reductions. Maybe lack of public discussion in legislative or other forums; maybe lack of stakeholder opportunities to provide impact statements on the how/who will be affected. Maybe because we have months before we get a new state budget. What’s not a “maybe” is that vulnerable Kentuckians often suffer silently. For me, silence isn’t an option as it feels we are cutting the “families” out of family services.

Three weeks ago, a single grandmother tearfully asked, “Can you help me? I need financial assistance.”   Her daughter struggled with opioids and was incarcerated; her granddaughter is now in her care. None of this was planned.

This grandmother is one of thousands in Kentucky caring for kids in kinship care. Kinship is when a relative (other than biological parents) or family friend steps in and cares for a child. 

One assistance option for Kentucky kinship families comes from a federally funded grant known to us as KTAP.  It’s managed by CHFS. Typical recipients are 25% or more below poverty level.

In December 2022, during an Administrative Regulation Review Subcommittee meeting, I sat alongside CHFS requesting a KTAP increase. Families hadn’t seen a KTAP cost of living adjustment since 1995, though inflation had increased 92%! Given that Kentucky had millions of dollars of unobligated federal funds,  legislators consented to the CHFS proposed rates which were doubled.

Last week, CHFS announced a KTAP reduction effective this November. Reasons such as more kids in foster care, social worker overtime and rising costs, etc. CHFS didn’t publicly share the reduction rate but one caregiver’s letter reflected approximately a 35% loss.

Sadly, that grandmother who called for help was already receiving KTAP. KTAP typically helps with shelter, food, gas, insurance and all things to raise a child. In about a month, her assistance will decrease while the granddaughter’s odds of going to foster care will  increase because her grandmother will not be able to support her. The grandmother cried before, she will probably cry again.

I’ve got so many questions: Shouldn’t legislators be involved as they were in 2022? Where’s our Kentucky “situation room” bringing in stakeholders (legislators, nonprofits and others) to assess impacts, tradeoffs and options first? Where were the public alarms targeting KTAP? Are decisions only made within closed off buildings without voices of those affected? Are we robbing one child for another?

Shifting to another recent reduction — senior citizen meals. On Sept.12, The News- Enterprise of Elizabethtown published “Funding shortfall forces cuts to local senior citizen meals.”

The article reports that CHFS insisted it had correct funding projections of approximately $10 million for the senior meal program; legislators were willing to fund up to $14.5 million.

Daniel London, the Lincoln Trail Area Development District’s (ADD) executive director, said that area development districts were notified at 4:30 on Sept. 8 to immediately begin cutting meals. Their regional reduction is estimated at a loss of 600-800 “Grab and Go Meals” for seniors. There are 15 area development districts statewide resulting in the loss of thousands of meals. An empty plate for a senior citizen is not trivial.

State Sen. Matt Deneen said in the News-Enterprise article that lawmakers “were willing to bring the funding up to $14.5 (million) based on the data from the districts but we were told the funding was not needed. It’s disappointing to learn that the Cabinet’s number appears not to (have) been correct. I hope the Cabinet rethinks their formulas.”  

I absolutely understand that if the checkbook starts to get low, action is warranted. However, it doesn’t feel like we are doing our best in the current approaches. Many seniors, children and families might agree.

I believe that whoever is budgeting and forecasting in CHFS needs to get a new calculator and practice using a megaphone. Consider more voices in the room before proclaiming decisions. This work impacts the lives of thousands of vulnerable human beings. Don’t cut the “families” out of family services.

Originally published by the Kentucky Lantern, republished under Creative Commons license. 

By Dr. Gary Grosel

Chief Medical Officer, UnitedHealthcare of Kentucky

The latest data from the Centers for Disease Control and Prevention (CDC) show 35,939 cancer cases were reported in Kentucky in 2022.

About 1 in 3 people in the U.S. are affected by cancer and about 2 million new cases of cancer are diagnosed each year.

Breast and colorectal cancer diagnoses, in particular, have been on the rise since the mid-2000s, and these cancers are being diagnosed more often at younger ages.

A cancer diagnosis can impact people’s lives in many ways. Early cancer detection may play a key role in helping to improve health outcomes and lower health care costs.

The five-year survival rate for colorectal cancer when caught in its early stages is over 90%, for example. At the most advanced stages, the five-year survival rate for this type of cancer is 13% and treatment may result in long-term side effects.

So, what can you do to help potentially reduce your cancer risk? Here are three things to consider:

Understand your cancer risk factors

Knowing your risk factors of developing cancer or other chronic conditions is an important step in helping to protect your health.

Some cancer risk factors, like age, genetics and family history, are out of your control. Tell your doctor about your family health history to help determine if you may have a higher risk of developing certain cancers. 

Understanding your risk can help you and your doctor decide when to begin certain preventive screenings and diagnostic services that may help detect any issues early when treatment may be more effective.

While there’s no way to prevent all cancers, there are some lifestyle choices you can make that may support your overall health and potentially help reduce cancer risk as well.

Choose a healthier lifestyle

In the United States at least 18% of cancers are related to excess body weight, physical inactivity, alcohol consumption, and poor nutrition, according to the American Cancer Society.  

There are some lifestyle modifications people can make that may result in better overall health and reduced risk for cancer and other chronic conditions.

Eat a balanced diet. Focus on vegetables, fruits, whole grains and lean protein. A healthy diet can help to support your overall well-being. In fact, research shows that people who eat a “Mediterranean diet” have a lower risk of breast cancer, for example.

Prioritize movement and maintain a healthy weight. Regular exercise is good for your overall health and physical activity has been shown to help reduce the risk of certain types of cancer.

Limit alcohol consumption and avoid tobacco and smoking. Alcohol abuse is linked to some types of cancer like those of the oral cavity, esophagus, and liver. Smoking can increase the risk of developing many types of cancer including colon and lung cancers. Chewing tobacco is also linked to cancer, especially head and neck cancers.

Kentuckians and cancer screenings

In Kentucky, 69 percent of women ages 40-74 report receiving a mammogram in the past two years, while 64 percent of people ages 45-75 report receiving one or more of the recommended colorectal cancer screening tests within the recommended time intervals.

Keeping up with doctor visits, preventive screenings and diagnostic services can be an important part of overall health.

Remember to schedule your annual wellness exam and preventive screenings. Health plans usually cover preventive care, and you may pay $0 out-of-pocket for certain covered preventive services if you go to a network provider.

Talk to your employer and health plan

Check with your employer and health plan to see what benefits are available to help support your health and well-being.

Timely diagnoses may improve health outcomes and help with medical expenses, especially when it comes to cancer. Screenings may include physical exams, lab tests, and imaging, many of which are used in cancer detection and may be covered by health plans.

Taking proactive steps to protect your health today may help you reduce the risk of cancer and other chronic conditions tomorrow.  

By Melissa Patrick

Kentucky Health News

“With food insecurity rising, Kentucky continues to aggressively investigate individuals on fraud allegations, with some legal experts claiming they rely too much on faulty evidence,” Sylvia Goodman reports for Kentucky Public Radio.

Goodman writes about a single mother from Salyersville who relied on federal food assistance, known as the Supplemental Nutrition Assistance Program or SNAP. She lost her benefits in 2020 after Kentucky state investigators concluded she’d committed fraud based on her shopping patterns.

“The state alleged she’d made multiple same-day purchases, tried to overdraw her account a few times, entered a few invalid PINs and sometimes made ‘whole-dollar’ purchases that are unlikely during typical grocery runs,” Goodman reports.

The woman’s explanation: “She worked at the store. She would sometimes buy lunch there and then get groceries after work. Her child would also occasionally use her card,” Goodman writes, adding that she sued and she won.

“It is draconian to take away SNAP benefits from a single mother without clear and convincing evidence that intentional trafficking was occurring during a time when food scarcity is so prevalent,” Franklin County Judge Thomas Wingate said in his 2023 decision.

Over the last five years, Goodman reports that the Kentucky Cabinet for Health and Family Services has brought hundreds of fraud cases that are heavily reliant on transactional data, despite judges, lawyers and legal experts telling KPR that such evidence proves little.

“Kentucky is so aggressive in disqualifying people from SNAP benefits that the state has the second-highest number of per-capita administrative disqualifications in the nation, behind Florida, according to the most recent federal data from 2023. In the last decade, disqualifications in Kentucky rose from fewer than 100 in 2015 to over 1,800 in 2023. And more than 300 others have been accused of selling or misusing their benefits since January 2024, according to records obtained by Kentucky Public Radio,” Goodman reports.

Goodman explains how people are informed of their alleged fraud: “Kentuckians receive notice of their alleged suspicious activity through mailed letters, in which they’re asked to voluntarily waive their right to a hearing and automatically accept the punishment. On first offense, that’s generally a one-year SNAP ban. They’re also required to pay back the full amount the state says they misused.” Often, Goodman reports, the lawsuits state that people don’t understand the consequences of that waiver.

Goodman reports that Kendra Steele, a spokesperson for CHFS, declined to schedule an interview with cabinet officials after multiple requests. “Steele said in an email that ‘we have never’ brought trafficking cases based solely on transactional data and acknowledged it would not be sufficient to prove intent,” she writes. Steele added that fraud allegations look into income, living situations and “patterns of spending that are indicative of trafficking.” Also, Steele told KPR that they interview vendors and SNAP recipients.

In her story, Goodman digs into the impact of food insecurity in Kentucky and what’s going on in other states, writing that “in 2020, Michigan state court of appeals judges decided transactional data alone is never sufficient to prove that a business — or a person — fraudulently used SNAP benefits.” University of Kentucky law professor Cory Dodds told Goodman that he believes that should be the standard for all states, including Kentucky.

Goodman also explains that “when Kentuckians receive the formal notice of accusations, they also receive a waiver asking that person to voluntarily forgo their right to a hearing and automatically accept the punishment.”

But legal experts told KPR that “there’s no benefit to signing the waiver — the punishment isn’t lessened, nor does refusing to sign lead to criminal prosecution,” she writes.

Another challenge for rural Kentuckians is that there are fewer lawyers with expertise in this type of law in rural Kentucky, Kristie Goff, an AppalRed legal aid lawyer in Prestonsburg in southeast Kentucky, told KPR.

“I imagine for every one person who walks through my door to get a hearing,” Goff said, “there’s probably five more that have never known that they could call us or known that they could get an attorney.”

Associated Press data reporter Kasturi Pananjady contributed to this report. This reporting is part of a series called Sowing Resilience, a collaboration between the Institute for Nonprofit News’ Rural News Network and The Associated Press.