Kentucky is one of only two southern states, at the time of this writing, to have expanded Medicaid under the Affordable Care Act. The expansion raised Medicaid eligibility levels as a means to make coverage more accessible and make health care more affordable for a population likely to face financial barriers in using medical care. This article examines the first-year impact of Kentucky's Medicaid expansion on insurance coverage and access to care. Focusing on Kentucky's low-income population, we observed large reductions in the low-income uninsurance rate from 35 percent at the end of 2013 to just below 11 percent by the end of 2014. Other findings revealed declines in unmet medical needs because of cost and declines in the number of people without a readily identifiable source of regular care among low-income groups. While our results are limited to Kentucky's experience with Medicaid expansion, they may hold lessons for other states looking to address health care access issues among their historically vulnerable and low-income populations.

This project was supported by the Kentucky Cabinet for Health and Family Services, Department for Medicaid; Norton Healthcare; and the School of Medicine, Department of Pediatrics; School of Public Health and Information Sciences; and Kent School of Social Work at the University of Louisville. Kentucky Medicaid approved the use of the data and granted permission to publish but played no role in the interpretation of data. Lui is employed by Kentucky Medicaid. The other authors report no potential conflicts of interest. An earlier version of this study was presented at the Pediatric Academic Societies' Annual Meeting in Baltimore, MD, on April 30-May 3, 2016. A poster presentation was given at the Society for Developmental and Behavioral Pediatrics in Cleveland, OH, on October 14-16, 2017.

Late onset and progressive hearing loss is seen in children who develop hearing loss from cCMV. Frequent audiologic follow-up is necessary considering the natural history of cCMV hearing loss. Universal screening should be pursued due to the number of asymptomatic children, at birth, who develop late onset/delayed hearing loss. CI is an effective means of improving speech and language in this population.

Objectives To assess the efficacy of a patient navigator intervention to decrease non-adherence to obtain audiological testing following failed screening, compared to those receiving the standard of care. Methods Using a randomized controlled design, guardian-infant dyads, in which the infants had abnormal newborn hearing screening, were recruited within the first week after birth. All participants were referred for definitive audiological diagnostic testing. Dyads were randomized into a patient navigator study arm or standard of care arm. The primary outcome was the percentage of patients with follow-up non-adherence to obtain diagnostic testing. Secondary outcomes were parental knowledge of infant hearing testing recommendations and barriers in obtaining follow-up testing. Results Sixty-one dyads were enrolled in the study (patient navigator arm=27, standard of care arm=34). The percentage of participants non-adherent to diagnostic follow-up during the first 6 months after birth was significantly lower in the patient navigator arm compared with the standard of care arm (7.4% versus 38.2%) (p=0.005). The timing of initial follow-up was significantly lower in the navigator arm compared with the standard of care arm (67.9 days after birth versus 105.9 days, p=0.010). Patient navigation increased baseline knowledge regarding infant hearing loss diagnosis recommendations compared with the standard of care (p=0.004). Conclusions Patient navigation decreases non-adherence rates following abnormal infant hearing screening and improves knowledge of follow-up recommendations. This intervention has the potential to improve the timeliness of delivery of infant hearing healthcare and future research is needed to assess the cost and feasibility of larger scale implementation.