A change in Medicaid will expand access for patients on blood thinners

What would have been an outpatient hernia repair for most people kept Bobby Patton in the hospital for 12 days in November.

A few months before his procedure, Patton had a heart attack that resulted in a left ventricular assist device, or LVAD, to keep his heart pumping. With the machine came a blood thinner prescription.

For the heart device to work properly, Patton has to keep a close eye on the consistency of his blood. If it gets too thick, he might throw a clot. If it’s too thin, he could bleed excessively from a minor scrape.

As a Medicaid patient at the time of his hernia repair, Patton didn’t have access to at-home blood testing kits, called International Normalized Ratio (INR) kits, to monitor his anticoagulation levels. Instead, he had to spend over a week at the University of Kentucky hospital to complete his tests on site.

Patton and many other Kentuckians, an estimated 3,000 reported by the Kentucky Lantern, who are on Medicaid rely on blood thinners to keep their hearts working.

Medicaid doesn’t cover at-home blood testing kits, but it does pay for in-person testing. That all changes later this summer when Kentucky House Bill 31 goes into effect.

At-home tests are less-invasive, give quicker results and cost less. Patients who get their anticoagulation levels checked in a clinic have blood drawn through an intravenous needle. Results take anywhere from hours to days.

“It would be like a diabetic going to the doctor and getting their blood sugar checked and then not getting their results back until the next day,” said Amanda Crabtree, a registered nurse at UK who helped draft HB 31.

A change to Medicaid

Crabtree and her colleague, UK cardio-thoracic surgeon Dr. Tessa London-Bounds, worked together, combing through research and meeting with state representatives, to get the law changed. After two unsuccessful attempts at finding a bill sponsor, they met their match.

Rep. Deanna Frazier Gordon, R-Richmond, introduced HB 31 on the first day of the 2024 legislative session. It passed the House and Senate unanimously and was signed April 4 by Kentucky Gov. Andy Beshear.

The new law, requiring Medicaid to cover at-home blood testing for anticoagulation management, goes into effect in July.

“We have a lack of transportation options in the state, as well as a worker shortage. As explained to me, these patients would have to travel for labs and sit there for a considerable time waiting for the results so medication could be adjusted as needed,” Frazier-Gordon said.

She called the legislation a “common sense” issue, and pointed out at home blood-testing kits cost less than lab testing, which will save the state money.

How to use an INR kit

At home INR kits are used similarly to glucose monitors used by diabetics to check blood sugar. A simple prick of the finger is enough blood to get your results, which are displayed almost instantly.

INR levels are affected by diet and lifestyle, Crabtree said, so instant results help patients make adjustments throughout the day to manage better. Patients who use at-home tests stay at “therapeutic levels,” or the target result range, for 70% longer than those who have blood drawn at a lab, she said.

Crabtree started advocating for the change in coverage after London-Bounds pointed out Medicare covered at home INR kits, but Medicaid didn’t. Both are government health programs, but Medicaid covers low-income populations and Medicare covers the elderly.

“A lot of our patients, especially our patients who are on Kentucky medicaid, have a lot of barriers to get to those facilities, They don’t have transportation, they live two hours away from some place,” London-Bounds said.

The lack of access is a national problem, not just a Kentucky problem, she said.

Almost a full year after Patton’s heart surgery, he still goes to the clinic up the road from his house at least once a week to have his blood levels checked, which he said “burns up his gas.”

“If I could just sit in the comfort of my own home and do this stuff, it’d be probably a lot cheaper,” he said.

“Sometimes, if my INR is really high, they’ll change my (blood thinner) and make me go back later in the week and do it again. If I could do that at home it’d be nice.”

A few months after his hernia repair, Patton stopped qualifying for Medicaid and now has private insurance. He is working on getting an at-home kit, but wishes the device had been covered by Medicaid when he needed it most.