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From YouTube: Budget Review Subcommittee on Human Resources (6-2-21)
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C
C
G
G
Thank
you
all
for
having
us
today
appreciate
the
opportunity
to
present
on
on
what
we
know
and
and
some
of
what
we
don't
know.
First,
I
just
want
to
clarify
that
what
we're
presenting
on
today
are
are
really
what
the
cabinet
has
received.
I
I
saw
this
as
kind
of
separated
into
two
agenda
items,
but
I
hate
to
tell
you
all,
but
it's
kind
of
together,
because
it's
so
hard
to
separate
where,
where
really
kind
of
the
the
covenant
begins
and
and
where
some
of
this
other
aid
begins.
G
So
this
is
this
is
together
in
one
the
other
thing
I
want
to
make
sure
again
just
getting
us
all
on
the
same
page.
This
is
this.
Is
the
money
that's
that's
directed
specifically
to
programs.
I
I
really
can't
speak
to
all
of
the
funding.
That's
coming
to
state
government,
but
I
I
am
able
to
speak
to
what's
coming
to
the
cabinet
for
health
and
family
services
and
where
we
are
today.
Please
understand
that
that
there
are
some
evolution
that
is
continuing
to
happen.
G
So,
even
as
I
describe
programs
to
you,
I
will
be
giving
you
where
we
are
today.
So
if
that's
helpful
to
you,
I
just
kind
of
wanted
to
say
that
from
the
beginning,
because
I
I
know
it
gets,
I
get
confused
by
all
the
different
funding
streams
and
we
get
letters.
We
got
a
letter
today
on
on
the
water
program,
so
we're
we're
still
getting
award
letters
and
understanding
exactly
how
much
we're
receiving
so
this
is
again.
I
just
want
to
be
clear.
This
is
the
best
to
our
understanding.
A
G
So
you
all,
I
think
the
budget
staff
is
controlling
my
slides.
Is
that
correct.
G
A
G
I
have
them
well,
if
I
don't
know
if
I
have
control
either.
So
what
I'm
gonna
do
is.
G
So
we
can
just
go
right
to
page
two
actually
and
really
it
talks
about
the
overall
of
funding.
What
that
looks
like,
I
think
we
have
billion
down,
but
we
met
trillion,
but
this
is
this
is
for
everything
right.
This
is.
These
are
all
the
different
pots
that
are
coming
into
the
state.
Obviously,
there
are
pieces
here
that
I
I
cannot
speak
to,
but
those
pieces
that
relate
to
the
cabinet.
G
Again,
we
will
address
as
we
go
through
this
presentation,
but
this
just
kind
of
gives
you
the
the
broad
scope
of
the
funding
that's
coming
to
the
commonwealth,
so
I
just
I
wanted
to
give
you
all
that
that
overview
as
we
started,
I'm
going
to
turn
it
over
to
eric
for
page
three
and
he'll.
Take
us
through
page
three
and
page
four.
B
Thank
you
on
slide
three.
Ultimately,
there
have
been
six
bills
that
have
been
passed
through
congress
to
address
the
current
virus
pandemic.
That
has
resulted
in
funds
coming
through
to
our
cabinet,
just
to
kind
of
compare
the
american
rescue
plan
with
the
other
bills
that
have
come
through.
The
american
rescue
plan
provides
for
1.1
billion
dollars
to
the
cabinet
alone,
funds
that
the
cabinet
will
administer.
B
This
is
quite
significant
compared
to
some
of
the
previous
bills.
The
first
bill
that
was
passed,
the
coronavirus,
preparedness
and
response
supplemental
act.
We
received
a
seven
and
a
half
million
dollar
grant
for
department
of
public
health.
The
second
bill
that
passed,
we
received
3.2
million
under
the
family's
first
chronovirus
contact
for
home
and
congregate
meals,
which
we've
spent
just
about
all
of
those
funds.
B
That
bill
was
also
significant
to
us
because
it
provided
our
enhanced
f
map
rate,
of
which
we
have
realized,
roughly
800
million
dollars
to
date
and
enhance
fmap.
So
that
has
been
very
significant
for
us
to
address
the
pandemic.
B
B
It's
kind
of
dwarfed
in
comparison
to
the
last
two
bills
that
have
been
passed.
The
paycheck
protection
program
provided
98
million
dollars
to
public
health
on
a
lab
testing
grant
and
then
the
current
virus
relief
response
and
relief.
Supplemental
appropriations
act,
which
came
out
of
the
consolidated
appropriations
act
provided
563
million
dollars
to
the
cabinet.
A
large
portion
of
that
was
getting
into
vaccinations,
further
testing
and
some
child
care
dollars.
B
As
you
can
see,
out
of
the
almost
1.1
billion
the
cabinet
is
receiving.
Roughly
750
million
is
specifically
in
child
care.
The
remainder
of
the
dollars
are
split
out
amongst
multiple
programs
such
as
heat,
such
as
more
services
for
seniors
with
congregate,
home
delivery,
meals,
preventive
services,
family
caregiver.
B
There
are
dollars
for
mental
health
block,
grant
substance
abuse
fault
grant.
There
are
also
dollars
for
screenings
to
help
reopening
schools,
so
there's
a
wide
variety
of
funding.
We
have
not
spent
any
of
the
american
rescue
plan
dollars,
yet
these
these
awards
have
just
been
coming
in
over
the
last
few
weeks.
The
bill
was
passed
in
march
and
the
actual
grant
awards
have
just
started
coming
in.
So
we
anticipate
these
dollars
to
be
to
start
spending.
These
dollars,
probably
in
july,
will
be
the
first
expenditures
that
we'll
have
so
I'll
turn
it
back
over.
G
To
you
all
right
and
we'll
now
we'll
head
to
page
five
to
talk
a
little
bit
about
some
of
the
specific
programs
and
and
where
we
are
with
with
planning
and
what
our
thoughts
are
currently
and
again,
these
are
all.
As
eric
talked
about,
you
got
two
eric,
so
you
know
we
get
to
blame
each
other
when
we
make
a
misstatement,
but
we
so
what
we're
talking
about
now
are
sort
of
how
we're
how
we're
discussing
what
our
plans
are.
G
I
don't
think
there
should
be
any
surprises
to
anybody
in
in
the
field.
At
this
point,
at
least,
I
hope
not
that's,
not
our
intent,
so
we
just
want
to
make
sure
you
all
understand
where
we
are
so
with
that
the
child
care
development
block
grants
really
the
the
top
priorities
in
there
are
going
to
be
some
support
for
subsidies
we
for
years.
I
I
I
think
you
all
know
I
used
to
be
over
the
place.
That's
called
the
office
of
children
with
special
health
care
needs.
G
We
really
need
to
look
really
strongly
at
what
we're
doing
with
kids
with
disabilities,
and
so
we're
gonna
be
able
to
use
some
of
that
funding
to.
We
hope
to
support
some
of
those
programs,
and
you
know
really
work
on
our
pipeline
of
professionals
coming
into
the
system,
the
stabilization,
the
child
care
stabilization.
G
We
really
we're
going
to
send
that
out
as
payments
to
child
care
providers.
Obviously
they
need
the
support
this.
This
is
really
targeted
towards
some
special
salaries,
some
fixed
expenses.
G
You
know
some
of
the
facility
needs
that
that
really
you
know
that
kind
of
really
more
it'll
it'll
be
dispensed
after
the
child
care
centers.
But
we're
really
hoping
to
you
know
really
build
up
and
and
support
from
all,
even
an
operational
standpoint,
those
those
facilities,
the
the
child
care
match
increase.
That's
that's
really
pretty
typical.
That's
the
that's!
The
matching
funds
that
we'll
have
and
the
child
care
subsidies
that
we
have
through
that
through
that
match
enhancement,
which
is
again
good.
G
It'll
help
support
our
providers,
the
lie
heat
program,
that's
the
what
has
been
mostly
the
weatherization
and
and
help
and
assistance
with
utility
bills.
For
those
who
need
assistance
on
that
is
administered
primarily
through
community
action,
my
brief
stint
in
louisville,
I
was
over
the
community
action
agency
there
and
what
we'll
hope
to
use
these
funds,
for
we
may
be
able
to
look
at
some
eligibility
limits
may
be
very
limited,
but
the
other
big
thing
we're
thinking
is
provide
some
support
for
summer
cooling
program.
G
As
you
all
know,
some
of
the
heat
waves
we've
seen
in
recent
years
have
had
some
really
negative
impacts
on
our
population,
particularly
those
folks
who
are
elderly.
So
we
want
to
make
sure
that
we're
providing
some
support
during
the
the
summer
months
as
well
pandemic.
Ebt,
we
are
going
to
examine
if
we
can,
what
that
summer
pandemic
ebt
needs
to
look
like.
We
need
to
put
a
plan
into
the
federal
government
but
similar,
I
think
the
last
ebt
pandemic,
ept
piece
that
we
did.
G
The
emergency
assistance
that
is
really
those
folks
who
receive
our
kentucky
transitional
assistant
payment
program,
maybe
some
additional
support.
They
are
looking
at,
hopefully,
some
creative
ways
that
that
we
can
use
those
funds
and
then,
in
adult
protective
services,
we're
working
again
through
community
actions,
been
they've,
been
a
great
partner
and
we'll
continue
to
to
partner
with
them.
So
community
action-
that's
la
heap!
G
That's
some
of
this
protection
service
program
for
some
additional
funding
for
folks
to
be
able
to
support
people
in
the
field
and
particularly
vulnerable
adults,
and
then
child
abuse
prevention.
G
Those
are
all
our
primary
and
secondary
child
abuse
prevention,
programs
we'll
be
able
to
fund
them
a
little
better,
and
hopefully
you
will.
You
will
see
some
of
the
fruits
of
that
labor
as
we
as
we
move
forward.
So
that's
been
a
way
that
we've
been
able
to,
in
some
ways
decrease
our
out
of
home
child
care
and
we're
going
to
continue
to
try
to
try
to
do
that.
It's
really
important
that
prevention,
primary
prevention
focus
on
supports
for
those
vulnerable
families.
G
You
know
a
kid
if
at
all
possible
is
is
better
off
with
their
families.
You
know
that
that's
something
that
we're
going
to
focus
on
and
if
we
can
support
the
families
and
strengthen
families,
that's
exactly
what
we
want
to
do.
Those
are
the
right
decisions
that
that
I
think
we
should
all
support
and
then
the
the
captive
funds,
the
the
child
abuse
prevention
treatment.
G
G
We're
we're
gonna,
see,
I
don't
think,
there's
any
question
increases.
We
saw
a
decrease
in
our
reporting
when
schools
get
back
in
when
communities
open
up,
which
I'm
very
excited
about
the
the
negative
side
of
that
is,
is
we're
going
to
see
some
some
behavioral
health
issues
and
substance
use
issues,
neglected,
abuse
issues,
there's
just
there's,
there's
no
way
that
that's
not
going
to
happen.
G
So
we
need
to
be
prepared
for
that
and
be
prepared
to
support
our
communities
as
we
as
we
move
forward
the
the
next
page.
Six,
I'm
sorry,
I'm
going
to
try
to
speed
up
our
senior
supportive
services,
our
concrete
meals.
We
work
with
the
area.
Aging
aaa's
is
what
they're
called
and
they're
really
through
our
ad
districts
associated
with
our
ad
districts.
G
We've
been
really,
I
think
it's
a
powerful
thing
to
say
that
we
have
actually
been
able
to
eliminate
any
waiting
lists
for
folks
who
need
food,
probably
since
over
a
year's
time,
we've
provided
at
least
an
additional
million
meals
to
seniors
we're
still
up
in
terms
of
percentages
on
providing
meals.
G
There
are
lots
of
great
stories
there.
I
know
commissioner
anderson
would
would
be
excited
to
present
about
really
some
of
the
creativity
right.
This
is
not
about
us.
This
is
about
the
creativity.
That's
come
through
communities,
restaurants
that
helped
out
food
producers
that
helped
out
that
really
made
a
difference
in
our
communities
to
address
some
of
the
some
of
the
feeding
issues
within
our
senior
population.
G
We
will
also,
then
use
some
preventative
services
again,
those
those
are
exactly
what
they
sound
like
some
family
caregiver
supports.
We
know
that
there
have
been
some
real
challenges
there.
I
could
attest
to
that
personally
and
then
some
additional
funding
for
our
long-term
care
ombudsman
who've
been
really
important
in
making
sure
that
as
they
work
with
facilities
and
families
that
they
know
what
what
they're
going
to
see
in
these
long-term
care
facilities
moving
forward.
G
So
so
those
are
really
critical
and
important
areas
for
us,
the
next
page
on
page
seven,
these
are
our
block
grants.
G
These
are
additional
funds
again
for
the
for
the
behavioral
health,
mental
health
and
substance
abuse
block
grant.
These
are
important
programs
for
by
and
large,
these
are
dollars
that
we
use
and
we
partner
with
the
community
mental
health
centers
across
the
commonwealth,
and
these
funds
support
those
efforts.
G
So
you
know
it
really
does
look
at
treatment
services
for
those
who
are
uninsured
and
then
really
some
of
the
some
of
the
pieces
that
we've
been
doing
around
evidence-based
and
best
practices
again
goes
back
years
now
what
what
those
programs
and
which
ones
have
been
effective,
and
how
do
we
support
more
services
in
our
communities?
And
we
are?
We
are
looking
into
that
particularly
around
pilots
that
we
then
may
may
be
able
to
fund
using
medicaid
as
as
our
partners.
So
those.
G
We
know
we're
gonna,
see
more,
we've
seen
some
some
unfortunate
spikes
throughout
our
programs,
so
we
know
we
need
to
be
prepared
for
that
in
terms
of
public
health.
G
Some
of
these
grants
really
start
so
the
health
equity
vaccination
grant.
We
just
we
just
put
that
in
and
just
received
notice
that
we
would
be
receiving.
I
think
yesterday,
a
day
before
so
all
of
this
is
is
pretty
new.
The
school
screenings
there
should
be.
G
I
don't
know
if
I
get
to
say
it,
but
we've
been
working
on
an
rfp
and
we
hope
to
have
it
out
very
soon
on
really
folks
being
able
to
provide
services
to
schools
the
home
visiting
program.
We
know
that
we've
had
some
learnings
through
this
pandemic
and
what's
best
virtual
and
what's
best
in
person,
and
how
to
support
all
those
options
for
families
and
kids,
and
this
this
funding
will
help
us
do
this
and
then
this
public
health
workforce
initiative,
I
think,
is
we've
all
learned.
G
I
think
how
important
our
our
public
health
departments
are
and
responding
to
all
sorts
of
diseases,
and
so
this
is
to
support
that
that
workforce
moving
forward
and
it
we've
got
to
support
all
the
the
career
pipelines
which
a
lot
of
these
funds
address,
where
we
have
shortage
in
providers
and
again
that's
true
from
child
care
to
behavioral
health,
to
substance
use
to
public
health.
G
We
need
to
make
sure
that
we
provide
career
pathways
for
folks
so
that
they
can
come
and
and
help
us
when
we
need
to
respond
in
in
a
crisis
and
in
some
of
these,
where
we
need
to
respond
in
general.
That's
a
very
quick
overview,
and
I
think
I
just
made
it
within
my
time
limit.
A
You
did
very
well
thank
you
very
good
presentation
and
now
we'll
have
well.
I
want
to
thank
you
for
your
presentation
for
secretary
and
mr
lowry
too,
but
for
those
members
with
questions
for
our
presenters
we'll
take
questions
from
the
members
here
in
the
room
first,
so
we
got
okay,
representative
pronti,.
A
E
Thank
you
secretary
for
your
presentation
on
slide
five
on
the
child
care
stabilization.
Could
you
elaborate
a
little
bit
more
on
how
specifically
those
funds
are
going
to
be
used?
Besides
just
sending
money
out
to
the
facilities.
G
And
getting
there
so,
basically,
all
the
all
the
child
care
facilities,
including
certified,
licensed
and
registered,
there's
actually
really,
if
I'll
take
one
second
and
tell
you
a
good
story
and
then
I'll
come
right
back
to
your
question,
we've
been
able
to
surprise
supply
some
one-time
funds
for
those
really
small
child
care
facilities.
G
We
may,
at
the
end
of
this
end,
up
with
more
of
those
kind
of
certified,
really
small
family
home
sort
of
things.
We
had
a
deficit
in
that
we're.
We
really
are
making
an
effort,
because
I
I
feel
very
strongly
that
it's
it's
an
entrepreneurial
path,
right,
we're
gonna,
try
to
support
folks,
opening
up
small
businesses
and
this.
G
This
is
one
way
to
do
that,
not
necessarily
with
these
funds,
but
these
funds
can
free
up
some
more
so
that
we'll
be
able
to
provide
some
support
to
folks
to
to
begin
to
open
some
centers.
So
this
can
go
for
salaries.
This
can
go
for
fixed
expenses.
We're
going
to
ask
for
some
of
that
again
for
the
behavioral
health
side
of
it.
Some
some
support
for
for
training
for
providers,
particularly
around
social,
emotional
health,
for
these
youngest
kids
going
in,
we
know
we're
going
to
see.
G
We
know
we're
going
to
see
some
some
increasing
needs
for
that,
and
then
some
of
the
this
money
can
go
for
some
of
the
supports
right
if
they
need
some
ppe
supplies,
some
additional
supports
and-
and
maybe
even
some
structural
changes
to
allow
some
better
ventilation.
G
So
so
again,
these
these
are
the
kinds
of
funds
that
can
support
some
of
these
providers
and
that's
that's
what
we
will
be
using
them
for
us.
Does
that
help.
E
Yes,
yes
and
mr
chairman,
can
I
continue
with
another
you
mentioned
in
the
pandemic
emergency
systems,
the
tan
of
funds
that
you
might
have
creative
ways
to
support?
Can
you
elaborate
what
those
creative
ways
would
be,
and
I
guess
the
reason
I'm
asking
is:
are
that?
Would
they
be
creative
ways,
because
I'm
for
keeping
the
families
together
family
first
and
that
sort
of
thing,
but
they
are?
Are
they
empowering
creative
ways?
Are
they
enabling
creative
ways.
G
G
I
want
to
encourage
folks
to
be
able
to
you
know,
there's
some
some.
It's
called
micro
business
right.
How
do
we
encourage
that?
G
Because
I
think
some
folks
will
have
the
opportunity
to
start
some
of
these
really
small
businesses,
but
my
experience
when
working
in
community
action
in
louisville
they
needed
support
to
get
to
a
place
where
they
could
be
entrepreneurs,
understanding
that
folks
need
a
checking
account
understanding
that
the
credit
score
is
important
and
then
providing
that
support
that
beginning
support
either
through
a
grant
or
repayable
loan
and
their
reasons
to
do
both
of
them
to
really
help
folks
who
who
want
to
begin
that
small
business
and
I
think
the
the
trick.
G
The
tricky
part
there
is
that
handoff
from
that
kind
of
micro
business
to
getting
something
a
little
bit
bigger.
But
we
want
to
encourage
as
much
as
we
can
and
that's
the
creative
piece
that
I
wanted
to
talk
about
with
these
funds
is
looking
at
how
we
can
encourage
the
creation
and
then
support
of
folks
who
may
have
some
micro
business
ideas,
and-
and
so
we
want
to
figure
out
how
to
use
these
funds.
For
that.
G
The
other
thing
that
we
want
to
look
at
is
then
how
we
are
able
to
use
these
tana
funds,
and
I
think,
there's
a
study
study
group
on
this.
So
I
might
be
tipping
my
hand,
but
it
is
then,
how
do
we
use
these
funds
like
in
support
with
some
of
our
snap
education
and
training
funds
again
to
support
some
of
that
career
pathway,
because
we
really
want
to
get
people
thinking
about
that
and
and
if
we
can
get
them
to
an
entrepreneurial
space
or
in
a
career
pathway?
G
That's
what
we
want
our
focus
to
be.
It's
gonna
take
a
little
tweaking
of
our
programs,
but
that's
something
I
look
forward
to
to
talking
with
you
all
about
and
presenting,
but
that
that's
the
kind
of
direction
that
we're
heading
in.
E
Okay,
thank
you.
I
like
what
I'm
hearing
so
and
last
question
quickly.
Is
there
I
don't
see
it
anywhere
anywhere
here
and
I
don't
think
it
could
be
hidden
anywhere,
but
could
any
of
these
funds
been
used
to
support
abortion
clinics
at
all
throughout
from
the
pandemic?
Okay.
Thank
you.
Thank
you,
mr
chair.
E
Thank
you,
mr
chairman.
Thank
you
secretary
for
being
with
us
today.
Providers
in
the
home
and
community
based
waiver
program
have
not
received
any
communication
on
potential
assistance
or
relief
and
adult
health
care.
Centers
continue
to
be
hit
very
hard
and,
in
fact,
active
day
located
in
my
district
in
richmond
announced
last
week
that
it
was
closing
its
doors
permanently.
G
Certainly
so,
commissioner,
lee
is
coming
on
after
me
to
talk
about
waiver
providers
and
some
of
the
additional
supports
that
that
there's
an
additional
some
additional
funds
coming
in
through
medicaid.
We
are
currently
we
have
received
some
proposals,
so
I
don't
want
to
get
too
far
in
front
of
her,
but
we've
received
some
proposals
from
the
provider
community
about
how
they'd
like
to
see
some
of
those
funds
dispersed,
we're
certainly
willing
and
are
working
and
communicating
with
the
the
the
communities
they've
sent
us
their
proposals.
G
G
So
we
need
to
make
sure
you
all
pass
something
for
nursing
facilities
which
really
went
along
with
the
increased
death
map
rate,
that's
being
put
into
place
now,
and
so
we
have
to
be
careful
about
what
what
would
be
ongoing
funds
versus
some
of
those
one-time
funds,
but
we
certainly
are
are
looking
at
that
now
and
hope
to
that.
Commissioner,
lee
will
have
a
little
bit
more
on
this,
but
we're
still
working
on
what
that
plan
needs
to
be.
G
E
Thank
you,
mr
chair.
Thank
you
secretary
for
your
presentation.
That
was
pretty
weighty,
so
I
know
that
we've
got
a
lot
of
a
lot
of
things
to
really
dig
into.
I
I'll
have
a
lot
of
questions
and
I
know
we
have
a
meeting
later
so
you
know
we
can
talk
about
this,
but
on
the
you
you
talked
a
little
bit
about
the
cdc
health,
equity
and
vaccine
program.
Can
you
elaborate
on
that
and
determining
eligibility
or
what
exactly
that
looks
like.
G
You
are
going
to
love
this
answer.
Okay,
we're
putting
a
lot
of
funds
in
community
health
workers,
we're
going
to
support
around.
We
think
around
50
across
the
state
again,
some
as
a
pilot
to
figure
out
how
what
the
costs
are,
so
that
we
can
look
at
what
it
would
take
for
for
additional
support
of
that
kind
of
program
through
medicaid.
We
are
then
looking
at
what
we
can
do
with
some
of
our
community-based
providers
to
help
support
them
in
their
outreach
and
that's
across
the
state
as
well.
G
So
those
are
those
are
the
two
two
major
pieces
in
there.
So
it's
it's.
It's
really
about
making
sure
that
we
have
as
much
outreach
into
the
community
as
we
can
possibly
get
and-
and,
like
I
say,
a
major
portion
of
that
is
going
to
be
looking
at
community
health
workers.
E
Okay,
thank
you.
Yes,
you're
right.
I
do
like
that
answer.
It
really
kind
of
leads
to
my
next
question.
If
I
may,
and-
and
you
know,
there's
so
many
uses
for
community
health
workers,
I
I
look
forward
to
to
really
digging
into
that
on
the
public
health
workforce
initiatives.
E
Is
that
also
looking
at
community
health
workers
as
a
career
pathway
and
and
then
you
know,
I
know
that
there
are
a
lot
of
ways
that
we
can
use
community
health
workers.
So
I
don't
know
if,
if
we've
considered
replacing
the
connectors
with
community
health
workers,
if
we
have
kind
of
one
bucket,
if
you
will
of
of
health
assistance,
you
know
the
community
health
assistance.
You
know
I,
I
know
it's
com,
it's
it's
complicated
because
you
know.
E
G
There
are
really
the
the
community
health
workers
primarily
are
in
the
equity
side
of
this.
This
is
more
support
for
what
you
might
think
of,
as
who
you
might
normally
see
within
a
public
health
department
like
environmentalists
and
things
like
that
as
well
as
then.
Some
of
that
infrastructure
support
right.
We
have
several
different
it
providers,
it
kind
of.
G
We
have
realized
that
we
have
a
a
little
bit
of
a
disjointed
system
as
as
we've
gone
through
this
we've,
we've
put
it
together
with
us,
I
like
to
say
duct
tape
and
and
twine,
but
we
need
to.
We
need
to
come
up
with
something
a
little
more
substantial
as
we
proceed,
so
it
really
is
more
focused
on
that
typical
pipeline
for
public
health
workers.
In
this
case,.
E
Okay,
thank
you.
That
makes
sense
it
does.
I
mean
I
we've
had
a
lot
of
these
conversations,
so
I
appreciate
the
ongoing
work
and
I
think
it.
I
think
it
could
really
help
us
create
a
sustainable
program
so
especially
for
navigation.
G
D
D
You
know
I
talked
to
an
owner
a
couple
days
ago
that
has
been
in
the
business
for
about
20
years
and
she's
about
ready
to
get
out
struggling
to
survive
and
the
infusion
of
money
and
the
training.
Those
things
are
all
great,
but
there
is
still
a
long-term
issue
that
we
have
to
deal
with
and
not
just
providing
funds
for
entrepreneurs
to
start
a
new
business,
but
to
set
up
a
structure
where
they
can
sustain
the
business
over
the
long
haul.
D
G
Senator
carol,
thank
you,
as
you
know,
that
is
an
excellent
question
and
a
difficult
one.
What
so
the
piece
on
the
entrepreneurial
piece
also
providing
some
some
one-time
funds
for
folks
who
may
want
to
set
up
through
an
employer.
I
think
folks
understand
now
better
that
better
than
ever,
I
think
the
importance
of
child
care
to
community
to
work
force
and
how
critical
that
is.
G
I
will
the
only
way
I
can
answer
that.
So
some
of
the
support,
some
of
the
training
support
some
of
the
one-time
funding
for
setting
up
facilities
and
and
some
of
the
payments
that
will
help
with
help
defray
some
of
those
costs.
G
But
the
real
answer
is
a
continued
discussion
with
you
all.
The
real
answer
is
how
we,
as
a
state,
decide
and
to
what
extent
we
decide
we
can
support
our
child
care
providers.
I
think
it's
critical.
I
I
think,
if
we
just
depend
on
on
on
federal
funds,
we're
we're
going
to
be
really
challenged,
so
I
I
think
it's
I
think
it's
going
to
have
to
be
an
ongoing
discussion
between
between
you
and
us
and
then
and
then
what
we
do
with
funding
headed
down
the
road,
not
just
federal
funds,.
D
Okay,
thank
you,
sir,
and
just
just
quickly
some
priorities.
The
mass
mandate
needs
to
go
away.
It
is
having
an
impact
on
behavioral
issues
within
child
care,
and
I
think
at
this
point
it's
doing
far
more
damage
than
it
is
good.
I
would
recommend
as
quickly
as
we
can
make
that
happen.
It
needs
to
go
away.
D
D
Mr
secretary,
there
are
empty
and
I'm
sure
you're
aware
there
are
classrooms
empty
in
this
all
over
this
entire
state
in
child
care.
Simply
because
we
cannot
get
enough
employees,
there
is
no
incentive
for
people
to
go
back
to
work
in
that
pay
range
and
despite
efforts
or
sign-on
bonuses,
you
name
it
it's
being
attempted
throughout
the
state
with
very
little
success,
and
you
know
we
can
infuse
a
lot
of
money,
but
if
we
don't
have
workers
to
take
care
of
these
kids,
it's
a
wasted
investment.
D
I
Thank
you,
mr
chairman.
Thank
you.
Secretary,
freelander,
you've
touched
on
this
a
little
bit,
but
just
like
elaborate
a
little
bit
more
a
lot
of
money
here,
it's
kind
of
like
drinking
from
a
fire
hose
right
now,
but
I'm
having
a
hard
time
determining
whether
we're
focusing
on
supporting
existing
systems
or
restructuring
systems
in
building
a
level
of
care
that,
while
commendable,
we
may
not
be
able
to
sustain
in
the
future,
and
I
really
it's
no
criticism
the
presentation
day.
I
You
guys
have
done
a
great
job,
but
I
don't
have
a
good
sense
for
that.
You
know
I
really
would
like
to
know
what
we're
going
to
look
like
post
covert
like
five
years
from
now
and
everybody's
identified
a
lot
of
different
issues,
different
providers.
We
know
we
need
to
address,
but
I
would
like
some
sense
of
security
that
we're
not
currently
building
a
system,
a
restructuring
system
that
we're
going
to
have
almost
impossible
to
finance
in
the
future.
G
That
is
another
great
question,
so
I
I'm,
I
will
tell
you
been
in
a
budget
position
with
the
cabinet
I'm
very
sensitive
to.
We
should
not
commit
ourselves
to
future
spending
that
we
can't
sustain.
G
I
think
my
hope
is,
and
this
this
gets
down
a
rabbit
hole
that,
I
think
is
probably
you
know,
maybe
a
little
better
at
a
longer
presentation,
but
my
hope
is
that
we'll
be
able
to
use
these
funds
to
find
some
other
dollars
that
we
can
leverage
for
for
some
of
the
programs
where
we
can,
we
can
show
that
it's
going
to
be
sustainable
ongoing
if
we
can't
show
it
sustainable.
G
I
don't
think
we
should
bring
it
to
you
and
I'll
just
be
plain
about
that.
I
don't
think
we
should
be
coming
forward
with
programs
now.
G
Some
of
this
funding
goes
out
three
years
right,
so
we
do
have
a
quite
a
bit
of
it,
so
we
will
have
a
planning
horizon
where
we
can
have
the
discussion,
particularly
through
a
budget
process,
about
what
we
may
or
may
not
want
to
support
child
care
is
a
great
example,
but
that's,
I
think,
that's
that's
a
continuing
conversation
with
you
all
right
and
and
and
this
committee
and
a
r.
G
What
is
it
that
we
think
we
can
should
do
moving
forward
that
is
sustainable
from
a
budget
perspective,
because
if,
if
it's
not
sustainable,
then
it
doesn't,
it
doesn't
have
that
impact
long
term.
So
we
have
to
focus
on
those
things
that
are
that
are
that
are
one
time
or
those
things
that
you
know.
Maybe
there's
a
cost
for
for
doing
some
restructuring
now
now's
our
opportunity
right
now,
it's
our
chance.
G
This
funding
will
allow
us
to
do
some
restructuring,
but
if
we
do
that
restructuring
it
has
to
be
sustainable
over
the
long
term.
So
it's
you
make
a
very
good
point
and
we
have
to
be
cognizant
of
that,
but
I
think
that's
this
continuing
conversation
that
we
have
with
you
all.
I
And
I
appreciate
I
appreciate
that
again,
I
don't
have
a
good
sense
today,
of
which
direction
we're
heading
and
that's
again,
no
criticism
of
anyone,
but
that's
part
of
the
discussions
for
future
meetings
in
this
group,
as
we
try
to
figure
this
out.
But
right
when
we
look
at
the
you
know
future
funding.
I
hope
we
really
give
a
priority
to
things
that
I've
embraced
before,
one
being
that
we
improve
the
health
of
our
population.
I
I
don't
think
our
mcos
have
done
a
very
good
job
of
that
with
our
systems
and,
secondly,
reducing
other
people
who
have
to
rely
upon
medicaid
by
improving
our
economy.
Of
course,
we've
got
to
work
hand
in
hand
with
our
cabinet
for
economic
development
and
certainly
department
of
education,
but
to
me
that
should
be
two
of
the
strongest
measures
to
success
in
any
program
we
do
have
we
improved
the
health
and
have
we
removed
people
off
of
medicaid
through
gainful
employment.
G
And
yes,
sir,
completely
agree-
and
I
hope
you
heard
through
this-
that
we're
talking
about
some
career
pipelines
to
getting
people-
you
know
two
through
two
careers,
some
of
that
entrepreneurship
right,
we
do
in
all
of
this
funding.
I
think
we
have
to
be
cognizant
of
right
now.
We
have
some
broken
pipelines
right,
so
we
have
to
figure
out
how
to
make
those
connections
so
that
so
that
folks
can
progress
right
through
higher
paying
jobs
in
an
economy
that
we
hold
and
we
think
it
is
really
positioned
to
to
boom.
I
Well,
I
would
agree
with
you
that
a
lot
of
this
seems
to
be
held
together
by
twine
and
duct
tape,
and
I
would
suggest,
having
a
little
wd-40
to
your
toolbox
and
we'll
see
if
we
can
get
through
this
thanks.
Sir
appreciate
your
time,
thank
you.
We're.
A
Going
to
shift
to
remote
now
and
senator
berg
are
you
there.
F
A
F
All
right
very
interesting
discussion.
I
think
it
in
part
it
goes,
and
I
want
to
make
sure
this
point
is
made
loudly
and
clearly
it
goes
to
the
fact
that
we
have
undervalued
child
care
in
this
country
for
ever
ever
so
you
know
when
I
hear
you
saying
that
you're
trying
to
promote
entrepreneurship
and
people
with
you
know
private
day
cares.
F
So
one
of
the
things
I
would
like
us
to
consider
going
forward
is
legislation
that
actually
would
help
us
and
help
working
parents
cover
the
cost
of
reasonable
child
care,
which
is
something
you
know
that
as
a
working
mother
was
never
available
to
me
in
the
past
and
should
be
available
to
working
families
in
this
commonwealth
in
the
future.
That's
one
one
comment
I
wanted
to
make.
So
thank
you.
A
Thank
you,
senator
berg
is
that
all
the
remotes
okay,
I
have
a
question
and
then
we'll
go
into
the
next
subject.
My
question
is:
we've
used
contact,
tracing
and
testing,
and
this
has
had
an
overall
cost
associated
with
it.
G
Now
the
the
the
covid
tracking
tracing
testing-
that's
pretty
much
all
been
federal
dollars.
We,
it
is
so
big
we
don't.
I
don't.
We
haven't
been
able
to
repurpose
those
dollars,
particularly
in
those
areas.
Eric
do
you.
B
No,
we
have
used
coronavirus
relief
funds
for
testing
and
then
what
specific
federal
grants
that
we've
received
and
now
that
testing
and
tracing
has
is
on
the
downward
slope.
The
dollars
that
have
been
passed
are
moving
into
vaccinations
and
that's
that's
the
direction
that
things
are
going,
but
we
had
not
supplemented
any
general
fund
dollars
with
our
testing.
All
the
testing
has
been
focused
on
coronavirus
and
they've,
been
supported
with
federal
funds.
G
Let
me
give
you
a
little
example:
nursing
facilities
right.
G
We
have
probably
provided
well
over
100
million
dollars
worth
of
of
testing
and
supplies
to
nursing
facilities
across
the
commonwealth,
and
that's
true
for
a
lot
of
folks,
but
that
just
kind
of
gives
you
a
an
idea
of
the
scope
and
really
that's
not
something
we
were
doing
before
at
all,
and
we
wouldn't
be
able
to
do
without
the
federal
funding
support.
So
that's
all!
That's
all
like
100
federal
funds.
A
Okay,
thank
you
secretary
and
mr
lowery
for
your
presentation.
Next
we're
going
to
hear
from
commissioner
lee
on
implementation
of
hb
183
the
hospital
funding
bill.
Commissioner,
are
you
out
there
and
please
identify
yourself
for
the
record
and
again
members
hold
your
questions
till
after
the
presentation.
Please.
C
Hello-
I
am
I'm
here.
I
am
commissioner
lee
lisa
lee.
I
am
the
commissioner
for
the
department
for
medicaid
services
and,
if
you
have
your
presentation
in
front
of
you,
we
have
a
combined
presentation
with
implementation
of
health
bill
183
and
also
michelle
p
and
scl
weber
program
information
in
that
presentation.
But
if
you
go
to
slide
7,
that's
where
the
183
begins
and
on
slide
7,
we
just
want
to
point
out
a
few
little
things
about
managed
care,
directed
payments
so
house
bill.
C
We
actually
have
to
submit
a
pre-print
to
cms
and
in
this
pre-print
we
have
to
outline
the
payment
methodology,
how
how
the
mcos
are
going
to
be
paying
the
the
payments
to
the
providers,
and
we
also
have
to
list
out
quality
measures
that
will
be
evaluated
during
the
course
of
the
of
the
payment,
the
enhanced
payments.
C
Typically,
these
the
pre-prints
are
submitted
on
an
annual
basis.
However,
we
have
worked.
H
C
The
kentucky
hospital
association
to
submit
a
three-year
pre-print
for
the
a-trip
program,
which
we'll
get
into
a
little
bit
more,
but
the
main
reason
for
talking
about
the
directed
payments
is
just
to
give
you
an
understanding
of
the
process
and
that
cms
doesn't
just
allow
us
to
mandate,
managed
care
organizations
to
pay
a
specific
amount
to
provider
types.
Unless
we
have
those
quality
measures
in
place
and
we're
monitoring
going
forward
of
the
impact
on
the
program
so
house
bill.
183
is
the
hospital
rate
improvement
program
or
hrip.
C
We
on
january,
14th
of
2021
cms
approved
a
revision
to
hr
which
significantly
significantly
increases
medicaid
reimbursement
to
private
kentucky
hospitals.
We
will
be
paying
them
the
average
commercial
rate,
rather
than
the
upper
payment
limit
methodology
that
we've
used
in
the
past.
C
We
have
a
continued
goals
of
improved
access
to
care
and
lowered
hospital
admissions,
but
we've
also
expanded
the
quality
measures
to
include
two
two
opioid
related
metrics,
because
we
know
that
the
opioid
epidemic
is
still
a
major
issue
in
in
the
commonwealth
and
does
dramatically
impact
a
large
number
of
medicaid
members
h
bill
house
bill.
183
cms
did
approve
our
acr
reimbursement
methodology
retroactive
to
july
1st
of
2020..
C
It
is
currently
approved
through
june
30th
of
2021
and,
however,
we
have
collaborated,
as
I
said
earlier,
with
kha
kha
and
submitted
a
request
for
a
three-year
approval
process
and
that
was
submitted
may
of
2021
and
again,
the
the
cabinet.
All
of
our
medical
professionals
in
the
cabinet
did
collaborate
with
kha
to
develop
those
quality
measures
in
the
pre-print
to
make
sure
that
we're
moving
forward
in
a
manner
that
it's
going
to
improve
the
health
status
of
individuals
in
the
commonwealth.
C
We
have
made
payments
for
the
2021
a
trip,
as
you
can
there,
and
in
april
we
paid
246
million
and
and
on
april
15th
I
mean
we
paid
256
and
then
on
april
30th
we
paid
another
248
million,
recently
paid
another
250
million
and
have
an
estimated
250
million
payment
that
will
be
going
out
in
august
and,
as
you
can
see,
this
is
quite
a
significant
amount
of
money
that
we
believe
is
going
to
have
a
positive
economic
impact
in
our
communities.
C
A
We
take
questions
from
the
room.
First,
senator
meredith.
I
C
They
they
will
put
up
the
state
share
which
is
or
their
assessments
they
pay
assessments.
But
if
you
look
at
about
a
billion
dollars
that
will
be
getting
in
in
from
federal
government
they'll
pay
about
10.
Of
that,
I
believe
but
I'll
double
check
with
my
chief
financial
officer
and
get
that
information
back
to
you.
C
It's
based
on
their
discharge
basis,
but
it's
paid
on
a
per
discharge
basis.
Now
it's
calculated.
I
A
Chair,
commissioner,
your
microphone
is
just
off
just
a
little
bit
there.
We
can't
hear
you.
A
A
C
They
I'm
not
sure
if
it
depends
on.
If
they
have
specific
questions
they
come
back.
We
have
been
having
conversations
with
cms.
We
don't
anticipate
any
issues
with
it
and
as
the
example
from
the
2021s
you
can
see,
it
was
retroactively
approved.
So
there
shouldn't
be
any
issues
with
the
break-in
service.
If
you're
concerned
about
the
june
2021
end
date
of
the
current
approval
process,.
A
C
H
Thank
you,
commissioner.
I
am
pam
smith,
I'm
the
division
director
of
community
alternatives
and
we
are
responsible
for
the
oversight
of
our
1915
sea,
home
and
community-based
waivers
on
slide.
Two.
We
highlight
some
information
on
the
four
other
waivers.
I
realized
this
specifically
and
was
about
michelle
p
and
scl,
but
wanted
to
highlight
some
information.
Just
about
the
other
waivers
as
well
and
of
note,
we
now
do
not
have
a
waiting
list
for
any
waiver.
H
With
the
exception
of
sco
and
michelle
p,
we
worked
very
hard
to
act
to
allocate
those
slots
in
the
brain
injury
waivers
to
get
rid
of
those
weighting.
Those
waiting
lists
on
slide
three.
We
go
into
more
detail
about
michelle
p
and
scl.
H
Michelle
p.
As
you
know,
we
have
10
500
funded
slots.
Our
wait
list
at
this
point
is
above
7
000..
At
the
time
of
this
presentation,
when
we
were
gathering
the
data
we
were
at
74
41..
We
are
in
the
process
of
allocating
175
additional
slots.
Those
we
hope
to
have
them
sent
out
this
week.
There's
a
large
process
that
goes
into
that
with
verifying
addresses
and
making
sure
that
those
actually
get
to
the
recipient.
H
So
it
takes
a
little
bit
of
time
for
that
process
to
completely
work
through,
but
we
are
allocating
those
we
have
been
allocating
slots
for
michelle
p,
every
90
days
for
over
the
last
year
to
try
to
get
us
up
to
that
point.
As
you
can
see
right
now,
we're
serving
actively
10
156
individuals,
those
149
slots
that
are
reserved
are
actually
individuals
that
a
slot
has
been
allocated
to,
but
they
have
not
received
an
assessment.
Yet
they
have
not
reached
out
to
one
of
our
cmhcs
to
conduct
that
assessment.
H
We
provide
follow-up
on
that
for
90
days
after
we
issue
the
slot
and
if
we
are
not
able
to
locate
the
individual
or
if
they
decline
wanting
an
assessment
at
this
time,
we
are
able
to
allocate
that
slot
back
out
again
once
they
have
an
assessment
and
access
even
one
day
of
services,
then
that
slot
is
used
for
the
rest
of
the
waiver
year.
So
our
plan
is
to
continue
allocating
those
slots
every
90
days
for
scl.
H
H
We
still
have
a
zero
on
the
emergency
waiting
list,
there's
121
on
the
urgent
waiting
list
and
2765
on
future
planning.
It's
important
to
note
and
I'll
talk
a
little
bit
more
about
the
wait
list
on
the
next
slides,
but
those
that
are
in
future
planning
really
are
those
sometimes
that
sign
up
even
when
they're
a
toddler,
and
they
know
at
some
point
in
time
in
their
life,
they
are
likely
to
need
waiver
services.
But
at
any
point
in
time,
anyone
on
the
urgent
or
future
planning
wait
list
can
request
review
for
emergency
status.
H
On
slide,
four
to
talk
about
just
some
generals
about
our
waiting
list,
so
for
michelle
p,
the
average
age
of
the
individual
on
the
wait
list
is
16
73,
so
over
5000
of
the
individuals
are
less
than
21
years
of
age.
15
of
the
individuals
that
are
on
the
waiver
are
accessing
services
in
another
waiver
and
the
majority
of
those
are
in
the
home
and
community-based
waiver
at
this
time.
H
Although
we
do
have
some
that
are
on
scl,
but
have
chosen
to
remain
on
on
the
wait
list
for
michelle
p,
the
average
time
on
the
waiting
list
is
three
years.
However,
the
oldest
that
anyone
has
been
waiting
at
this
point
is
six
years
we
add
an
average
of
78
individuals
to
the
waiting
list.
Each
month
since
the
beginning
of
2021
we've
already
allocated
350
individuals,
and,
as
I
mentioned,
we
are
in
the
process
of
allocating
another
175
individuals.
H
When
we
look
on
slide
5
some
additional
details
about
our
seo
waiting
list,
so
the
average
age
of
the
individual
on
that
wait
list
is
30
years.
Old
90
of
the
individuals
are
accessing
services
in
another
waiver
and
the
average
time
on
the
waiting
list
is
seven
years
for
seo.
We
add
an
average
of
about
30
individuals
each
month
to
the
waiting
list
and
since
the
beginning
of
2021
we
have
allocated
13
emergency.
H
Slots
and
to
wrap
up,
I
want
to
talk
a
little
bit
about
our
ongoing
work
that
we're
doing
for
the
1915
sea
waivers
I'm
going
to
come
back
to
appendix
k
and
talk
about
it
last,
but
we
our
model
2
waiver
renewal.
H
It
was
at
the
end
of
its
five
years
and
had
to
be
submitted
for
renewal.
It
actually
is
with
cms
for
review,
following
its
formal
request
for
additional
information,
and
we
actually
are
meeting
with
cms.
H
Excuse
me
on
friday
to
discuss
that
waiver,
our
home
and
community-based
waiver
renewal
again
this
is,
it
was
had
ran
through
its
five
full
years,
and
so
it
was
due
for
a
renewal.
H
We
have
it
right
now
and
are
working
through
responding
to
the
formal
request
for
additional
information
with
the
target
date
to
return
it
to
cms.
Hopefully,
by
the
end
of
this
week,
evv
implementation
has
continued
and
monitoring
has
continued.
We
see
we've
seen
anywhere
from
26
to
50
to
60
percent
adoption
rate
of
providers.
It
depends
right
now
a
lot
on
the
providers
and
the
populations
they
serve.
Many
of
our
participant,
directed
providers
have
been
using
it.
H
100
percent,
with
oliver
all
of
their
participants
for
at
least
30
to
60
days
now
we
are
beginning
our
plans
to
resume
our
on-site
provider
certification
visits
during
covet,
and
especially
during
its
peak,
we
were
very
careful
about
the
sites
that
we
would
visit.
We
only
went
on
site
if
there
was
a
health
safety
welfare
concern.
H
All
other
certification
events
took
place
virtually
and
we
did
a
lot
of
desktop
reviews.
So
the
team
now
is
just
getting
ready
to
go
out
to
finish
those
things
that
must
be
done
on
site
and
in
person.
And
lastly,
I
want
to
talk
about
appendix
k
flexibilities,
so
our
last
renewal
was
cms.
We
received
approval
for
that
to
remain
in
effect
until
six
months
after
the
end
of
the
public
health
emergency,
so
once
that
is,
that
has
been
declared
over.
H
A
E
Thank
you,
mr
chairman,
and
thank
you
for
your
presentation
on
slide.
Five.
You
mentioned
that
ninety
percent
of
the
individuals
are
accessing
services
in
another
waiver.
Can
you
elaborate
on
that
like
what
other
services
might
they
be
getting?
Are
they
medicaid
funded
waivers?
What
what
would
be
the?
What
constitute
them
do
they
need
both?
I
mean:
what
can
you
give
us
an
example.
H
Right
so
some
of
the
individuals
in
particular
that
are
on
the
future
planning
wait
list,
may
be
receiving
home
and
community-based
services,
so
they
have
family
they're,
still
able
to
be
involved
that
are
still
able
to
provide
some
natural
supports
and
some
care
for
them
to
a
point
that
they
don't
need
residential
or
their
their
needs
are
being
met
without
meeting
that
emergency
seo
slot
many
times.
They
also
are
accessing
state
plan
services,
but
the
majority
of
those
individuals
are
receiving
hcb,
which
means
they
have
us.
H
In
addition
to
an
id
or
dd
diagnosis,
they
have
a
medical
comorbidity,
that's
being
that's
being
treated.
There
are
a
few
individuals
that
are
on
michelle
p,
that
have
elected
to
stay
on
michelle
p,
because
again
they
have
family
or
natural
supports
that
are
able
to
meet
their
needs
right
now,
and
they
do
not
need
that.
E
Okay,
thank
you,
and
can
I
follow
up
more
on
the
evv?
Are
those
are
there
trainings
for
those
folks,
because
I
had
one
constituent
who
was
actually
a
former
patient?
The
caregiver
was
not
tech
savvy
and
if
the
home
health
nurse
hadn't
been
there
to
help
her
with
the
phone,
she
might
have
quit
the
job.
So
I
just
wondering
if
the
evv,
if
there's
supports
there
for
those
individuals
to
learn
how
to
use
that
the.
H
E
H
There
is
a
specific
employee
training
that
was
done
for
kentucky
individuals,
specifically
some
of
the
other
trainings
that
our
evv
vendor
has
done
were
more
just
global,
so
it
went
over
just
basic
functionality,
but
we
realized
early
on
that
number
one.
H
Our
our
individuals
are
used
to
a
very
hands-on
approach
to
training,
so
we've
developed
a
lot
of
quick
reference
guides
that
we've
actually
shared
with
other
state
and
they're
using,
but
we
also
offer
one-to-one
sessions
with
either
individuals
or
providers
where
we're
able
to
actually
look
at
their
data,
look
at
the
application
and
go
through
specific
scenarios
for
them
to
help
them
to
walk
through
it.
So
if
you
hear
of
any
of
that,
you
know
encourage
them
to
if
they
will
reach
out
to
us.
We
do
offer
that
one-on-one
support.
D
Thank
you,
mr
chairman,
pam
in
in
specifically
addressing
michelle
p
waver,
have
have
you
all
done
any
data
collection
in
relation
to
the
the
types
of
services
that
let's
say,
recipients
below
the
age
of
18
and
then
above
the
age
of
18,
on
on
what
services
are
primarily
being
used
and
then,
along
with
that,
have
you
all
considered
any
discretion
in
perhaps
giving
adults
a
more
of
a
preference
in
certain
situations
to
to
get
the
waiver
services?
D
And
I
know
and
reason
I
ask
that's
more.
You
know
with
younger
kids,
especially
those
that
have
more
family
supports
the
the
waiver,
may
not
be
as
critical
as
it
as
it
would
be
for
some
of
the
older
people
who
apply
what
what
conversations
have
you
all
had
in
that
area?.
H
So
absolutely
understand
your
question,
so
we
are
in
the
process
right
now
of
evaluating
the
services
in
each
waiver
and
the
utilization.
H
So
we're
looking
at
that
part
of
waiver
redesign
when
we
are
able
to
resume
that
when
we
do
look
at
that,
we
had
talked
about
just
in
general,
looking
at
the
whole
weightless
process
there-
and
you
know
scl
right
now-
is
the
only
one
that
really
has
a
triage
of
you
know
of
different
levels.
So,
looking
at
really,
how
do
we
roll
that
out
to
other
waivers
and
looking
at
again,
as
you
mentioned,
what
services
are
those
children
receiving
and
are
they?
Is
there
a
different
way
for
them
to
receive
those
services?
H
If
they're
medicaid
eligible?
Are
they
available
through
state
plan
and
just
maybe
the
providers
aren't
aware
so
really
focusing
too
on
provider
education
to
make
sure
that
they
understand?
You
know
if
you
have
an
individual
who
is
eligible
for
waiver?
It's
not
just
the
waiver
services
they're
eligible
for
that
they
need
to
look
at
them
holistically
and
also
look
at
what
services
in
the
state
plan
could
meet
their
needs.
Okay,.
D
And
as
we
look
at
more
of
a
a
la
carte
type
services
that
are
more
specific
to
the
needs
of
each
individual,
will
that
create
any
savings
where
we
might
be
able
to
perhaps
serve
more
people
if
we're
being
more
specific
on
the
services
more
efficient
in
the
application.
H
Honestly,
it
it's
too
early
in
the
research
to
tell,
but
that
is
that
is
the
intent.
As
we
look
at
this
to
understand,
how
can
we
begin
to?
Is
there
a
way
that
we
can
begin
to
serve
more
individuals
that
are
on
that
wait
list?
We,
though,
we're
still
very
early
into
looking
at
the
reporting,
so
I
don't
want
to
make
any
wrong
assumptions
until
I've
had
time
to
completely
look
at
the
data.
Okay,.
C
And
this
is
commissioner
league
and
if
I
could
just
add
to
that
senator
carol,
you
know
that
we
have
a
lot
of
interest
in
the
10
funding
that
is
going
to
be
coming
through
the
department,
as
it
relates
to
hcbs
spending.
C
We're
also
looking
at
ways
that
we
can
have
short
and
long-term
goals
to
improve
the
the
waiver
programs,
the
services
that
we
provide-
and
I
think
this
is
just
a
first
step
in
actually
taking
a
really
good,
look
and
and
a
deep
dive
into
those
programs
to
find
out
how
we
can
strengthen
those
and
make
them
sustainable
in
the
future,
because
their
waiver
programs
are
the
the
trajectory
of
the
of
the
cost
for
the
waiver.
Programs
continues
to
increase
for
that
population.
C
So
I
think
it's
a
really
good
idea
to
take
a
step
back.
As
you
know,
the
previous
administration
started
the
waiver
redesign
and
we
we
put
a
pause
on
it,
because
we
had
a
lot
of
concerns
from
providers
within
the
community
related
to
the
the
way
that
we
were
going
to
restructure
the
program
to
make
it
budget
neutral.
C
So
as
part
of
our
enhanced
the
enhanced
funding
that
we're
going
to
receive,
we
are
looking
at
the
waiver
redesign
to
see
if
there's
hits
and
pieces
that
we
can
pull
out
and
implement
with
that
one-time
funding
that
we
have
to
strengthen
these
programs
and
again,
our
overall
objective
and
goal
is
to
make
this
person-centered
planning
so
that
each
individual
gets
the
necessary
supports
and
services
that
they
need,
and
it's
just
not
carte
blanche
for
everyone.
Just
because
you
can
have
so
many
therapies
doesn't
mean
that
you
require
it.
A
E
Thank
you
chairman.
This
is
a
question
that
I'd
asked
secretary
friedlander
earlier
and
he
thought
that
you
all
might
be
the
better
ones
to
answer
it.
But
providers
in
the
home
and
community-based
waiver
program
have
not
received
any
communications
on
potential
assistance
or
relief
and
there's
several
active
day.
Centers
once
closed
in
richmond
and
apparently
two
others
in
rural
areas,
mainly
because
of
lower
reimbursement
and
strict
delivery
method.
C
I
can
defer
to
pam,
but
I
believe
that
we
issued
a
total
of
about
five
million
dollars
in
retainer
payments
to
adult
day
centers
and
an
adult
day
treatment
center.
So
I'm
not
sure
you
know
which
facilities
your
you
know
have
been
reached
out.
You
have
reached
out
to
you,
but
we
have
issued
retainer
payments
and
pam
can
speak
a
little
bit
more
about
appendix
k
and
how
that
assisted
those
providers
during
the
coven
period.
H
So
we
we
did
your
right,
commissioner,
it
was
about
5
million
dollars
in
retainer
payments.
A
large
bit
of
that
went
to
actually
went
to
active
day
providers.
I
it.
H
It
makes
me
sad
to
hear
any
time
that
we're
we
are
losing
a
provider
and
encourage
them
to
reach
out
to
us
to
see
if
there's
anything
that
we
can,
that
we
can
do
the
other
thing
that
we've
done
for
the
adult
day
providers
is
we
allowed
them
to
branch
out
into
both
telehealth
services
and
providing
services
in
the
home?
H
We
do
have
actually
our
largest
in-home
provider
for
hcb
is
an
adult
day
group
and
I
believe,
actually
in
the
top
five,
that
three
of
them
are
adult
day:
health
care
groups
that
are
actually
providing
in-home
services
to
individuals.
So
we're
continuing
to
try
to
expand
the
services
that
they
also
are
able
to
offer
to
allow
them
to.
You
know,
have
additional
input
in
sort
or
additional
inputs
for
revenue
additional
ways
really
to
serve
our
individuals.
I
Thank
you,
mr
chair.
Just
two
brief
questions
and
they're
going
to
sound
rhetorical.
I
don't
mean
to
be,
but
covet
certainly
has
wreaked
havoc
on
our
workforce
and
healthcare
is
not
an
exception,
but
do
you
have
any
anecdotal
experiences
of
people
having
disruption
of
service
because
the
lack
of
personnel.
H
We
actually
in
the
recent
surveys
that
the
commissioner
mentioned.
We
targeted
that
question
specifically
and
we
required
critical
incident
reports
to
be
submitted
to
us.
H
If
there
was
services,
if
there
was
service,
interruption
or
if
individuals
tested
or
were
exposed
to
covid,
and
we
from
the
response,
the
overwhelming
response
we
received
from
the
participants
themselves
is,
they
did
not
feel
like
that.
It
had
impacted
them.
H
Some
of
them
felt
like
there
were
a
mild
service
disruption,
but
not
that
it
impacted
their
ability
to
feel
safe
or
taken
care
of,
and
that
was
something
that
we
were
concerned
about
because,
honestly,
a
lot
of
our
individuals,
the
waiver
staff,
are
their
natural
supports,
they're
their
only
support.
So
it
was
something
that
we
kept
a
very
close
eye
on
and
that
we
worked
to
help
them,
get
access
to
vaccines
and
allowed
our
case
managers
additional
units
to
be
able
to
help
find
vaccine
locations
to
help
find
transportation.
H
To
help
with
that.
So.
I
H
H
A
Okay,
thank
you,
commissioner,
and
ms
smith
amy.
If
you'd
like
to
come
up
and
introduce
yourself
amy
stay,
is
the
executive
director
of
kentucky
association
of
private
providers
and
she's
going
to
speak
here
and
speak
in
a
r
also
so.
J
Yes,
thank
you.
So
much
is
this.
Is
the
mic
on?
Can
you
hear
me?
Okay,
thank
you
so
much
for
allowing
me
to
be
here.
My
name
is
amy
stade.
I
am
the
executive
director
of
the
kentucky
association
of
private
providers.
We
are
a
trade
association
representing
providers
of
1915,
c
waiver
services
to
individuals
with
intellectual
and
developmental
disabilities.
J
We
have
over
a
hundred
provider
members
in
our
trade
association
and
collectively
we
support
10,
000
individuals
with
intellectual
and
developmental
disabilities
in
the
commonwealth.
I
am
coming
back
at
one,
so
I'm
going
to
go
through
some
of
this
pretty
quickly,
especially
because
director
smith
addressed
kind
of
a
lot
of
what
I
wanted
to
talk
about,
but
I
did
want
to
hit
a
c
up
upon
a
couple
things
that
have
come
up.
J
Prior
to
the
pandemic,
1915
c
waiver
providers
they've
struggled
for
a
long
time
to
recruit
and
retain
employees.
It's
always
been
a
struggle,
but
the
pandemics
made
it
a
lot
worse
and
so
cap,
as
a
provider
association
did
a
survey
in
may
2021
and
it
revealed
two
things:
providers
have
been
significantly
impacted
in
revenue
and
workforce,
so
91.3
percent
of
percent
of
respondents
reported
that
they'd
experience
a
significant
reduction
in
revenue
directly
related
to
the
pandemic.
J
The
average
lost
revenue
is
682
000..
These
are
waiver
providers,
they're,
not
billing,
hundreds
of
millions
of
dollars
per
year,
so
682
thousand
dollars
for
a
provider.
That's
operating
on
paper,
thin
margin
and
generally
has
less
than
10
percent
capital
in
the
bank
is
significant
and
to
your
point.
This
is
why
we
have
seen
providers
close
up
shop.
J
So
54
percent
of
respondents
reported
that
the
greatest
challenge
that
they're
currently
facing
is
recruiting
and
retaining
staff
86
of
those
respondents
reported
that
they've
had
difficult,
recruiting
or
containing
staff.
Despite
offering
enhanced
wages,
overtime
bonuses,
they've
used
their
ppp
funds
for
this
they've
done
everything
possible
to
try
to
keep
these
staff
and
it's
not
gone
well
so
of
that
eighty-six
percent
seventy-seven
percent
of
residential
providers.
This
is
significant
because
our
residential
providers
have
literally
been
providing
24
hour
a
day,
seven
day
a
week
care
since
the
beginning
of
the
pandemic.
J
These
are
these
are
this
is
shift
work
and
to
pam's
point
ms
smith's
point
about
the
survey
they
sent
out.
They
asked
the
question:
have
you
been
unable
to
either
access
or
provide
a
service
because
of
staffing
issues,
and
I'm
going
to
tell
you?
J
Most
providers
are
going
to
answer
no,
because
they're
required
to
provide
a
service,
especially
residential
providers,
if
they
they've
made
it
work
despite
the
short
staffing,
despite
the
critical
understaffing,
they
are
required
to
have
staff
there
for
these
individuals
they
could
be
charged
with
abandonment
if
they
just
left
someone
unattended
and
without
staff.
So
I
don't
know
if
the
responses
to
that
question
are
completely
paint
the
full
picture,
but
only
2.8
of
respondents
to
our
survey
said
that
they're
fully
staffed
2.8
percent
of
all
waiver
providers.
J
50
are
critically
understaffed
and
the
rest
are
understaffed,
but
making
it
work.
Because
of
this
understaffing,
we've
had
significantly
increased
overtime
providers
reported
an
average
of
22
thousand
dollars
in
overtime
alone,
just
during
their
last
pay
period.
Their
last
two
week
pay
period.
J
So,
as
I
said,
dsp
turnover
has
been
a
problem:
direct
support,
professional,
that's
our
caregiver
staff.
It's
been
a
turn.
It's
been
a
problem
for
a
while,
but
it's
gotten
worse
because
of
covid.
Why
is
that?
Well,
one
is
low
wages
and
two
is
the
emotionally
demanding
nature
of
the
work.
It's
hard
work,
it's
emotional,
it's
exhausting
and,
unfortunately,
waiver
providers
because
they
are
100
medicaid
reimbursed.
They
can
only
pay
what
the
rate
supports.
J
The
navigate
survey
that
you've
all
you
know
heard
about
revealed
that
about
ten
dollars
an
hour
was
the
going
rate
that
was
in
2018
and
I'll.
Tell
you
since
then:
it's
actually
gone
down,
because
providers
are
so
understaffed,
they're
having
to
implement
lower
starting
wages,
knowing
and
understanding
that
their
everybody's
going
to
get
overtime,
so
they're
implementing
the
starting
lower
starting
wages
because
of
the
significantly
reduced
overtime
costs,
and
it's
it's
a
huge
burden.
J
J
It
results
in
increased
critical
incidents,
hospitalizations
er
visits,
which
we
all
know
are
very
costly,
and
it
does
especially
in
our
consumer
driven
options.
It
affects
individuals
ability
to
recruit
and
retain
their
own
staff
in
impacts
providers.
As
I
said,
we've
got
critical
staffing
levels.
We've
got
significantly
increased
overtime
costs
and
there's
significant
costs
in
this
program
with
onboarding
new
hires,
which
is
something
that's
not
talked
about.
J
This
also
has
an
impact
on
wait.
Lists
providers
right
now
have
reported
to
me
that
they
are
turning
down
referrals
despite
having
capacity
because
they
do
not
have
the
staff
to
care
for
people,
so
we're
never
going
to
meaningfully
address
our
wait
list.
If
we
don't
first
address
our
workforce
crisis,
we
have
to
build
out
the
workforce
infrastructure
if
we're
ever
going
to
address
these
wait
lists
and
make
sure
that
the
individuals
that
are
most
vulnerable
citizens,
you
know,
get
the
care
that
they
need.
J
So
just
some
policy
considerations,
as
we
think
about
moving
forward
workforce,
is,
are
the
critical
most
critical
portion
of
our
hcbs
infrastructure.
If
you
think
about
a
bridge
workforce
are
the
is
the
pillars
that
holds
the
bridge
up
without
the
direct
support
professional
workforce,
there
can
be
no
community-based
hcbs
services,
it's
as
simple
as
that
institutional
care
is
costly.
J
The
per
diem
the
the
average
per
diem
for
institutional
care
is
about
1200
a
day.
Community-Based
care
is
215
dollars
a
day,
so
we
are
saving
a
lot
of
money
and
we're
providing
better
care
in
the
community
and
again,
the
most
prominent
contributor
to
our
hcbs
workforce
crisis
is
wages
again.
Are
these
providers
are
100
medicaid
funded?
It
is
impossible
for
them
to
just
raise
wages
without
a
corresponding
rate
increase.
They
can't
do
it.
My
providers
would
love
to
pay
their
employees
15
an
hour
20
an
hour
they'd.
J
Actually
be
able
to
recruit
and
retain
qualified,
highly
skilled
employees
to
provide
this
care,
but
they
can't
pay
that
much.
The
rate
simply
does
not
support
it.
Additionally,
1915
c
waver
reimbursement
rates
are
rarely
ingested
for
inflation.
In
fact,
they've
never
been
ingested
for
inflation.
Only
one
waiver
has
ever
gotten
a
rate
increase
and
that
that's
that's
not
to
place
blame
anywhere.
We
understand
that
funding's
tight,
but
we
have
got
to
add
a
wage
component
onto
our
rates
that
adjust
for
inflation
so
that
these
con
providers
can
raise
wages
right
now.
J
What
we're
seeing
is
throughout
all
workforce,
every
mcdonald's
is
raising
wages,
walmart's
waging
wages
to
keep
up
and
recruit.
These
providers
can't
do
that.
These
are
not
minimum
wage
jobs,
they're
highly
skilled
care
positions
and
right
now,
they're
only
able
to
pay
about
minimum
wage,
and
so
no
one,
of
course,
no
one
wants
to
work
in
that
stressful
environment
provide
working,
long
shifts
working
mandatory
over
time
when
they
can
go
work
at
starbucks
for
twenty
dollars
an
hour
and
get
free
coffee.
J
So
here
are
our
recommendations,
number
one.
We
need
to
utilize
these
one-time
hcbs
arpa
funds
to
invest
in
the
workforce.
We
agree
that
there
need
to
be
some.
You
know
long-term
system
investments
and
some
one-time
uses
of
the
money
that
can
make
some
system
fixes.
But
if
we
don't
save
this
workforce
and
invest
in
the
workforce,
there's
not
going
to
be
a
care
system
to
invest
in
in
the
future,
and
then
we
need
to
implement
a
long-term
funding
strategy
in
the
next
budget
that
targets
the
workforce.
J
We
have
budget
language
to
do
that
that
I'm
happy
to
talk
more
about
in
depth.
At
another
time
we
have
budget
language
that
we
have
put
together.
That
would
specifically
issue
rate
increases
to
specific
targeted
services
where
this
workforce
is
a
problem
and
require
a
pass
along
of
75
percent
to
the
employees
and
even
to
satisfy
you
all
and
help
you
know
making
sure
our
dollars
are
being
used.
Well,
even
have
a
reporting
and
oversight
mechanism
built
into
that,
so
that
we
ensure
providers
really
are
passing
along
the
money.
A
You
did
very
well
yeah,
I'm
presenting
thank
you.
We
have
about
five
minutes
left
for
questions,
representative
weber,.
E
Would
you
say
that
the
300
additional
of
pandemic
unemployment
assistance
that
folks
are
receiving
in
the
state
is?
Is
that
contributing
to
your
inability
to
recruit
and
bring
in
workers.
E
Okay,
I
want
to
ask
that,
mr
chairman,
to
get
that
on
record
when
I
was
when
I
was
working
on
a
bill
during
the
last
session
on
unemployment
taxes
that
would
be
paid.
I
met
with
you
to
discuss
the
impact
it
would
have
on
non-profits
generally.
E
E
I
think
this
is
something
that's
that's
important
and-
and
I
just
wanted
to
get
that
on
record
because
we
need
we
have
to
do
something
in
this
state
to
get
people
to
return
to
work,
and
I
know
that
it
has
been
suggested
by
the
governor
that
that,
when
chairman
pratt-
and
I
submitted
a
letter
to
him,
asking
him
to
end
that
program-
that
that
we
would
cut
that
off
immediately
and
leave
kentuckians
with
no
option.
We've
never
suggested
that,
but
we
have
to
have
a
plan
and
right
now
I
don't
see
a
plan
moving
forward.
E
E
Yes,
thank
you,
mr
chair.
Thank
you
amy
for
your
presentation.
I
appreciate
that
you
came
with
recommendations
and
we're
happy
to
look
at
that.
I
have
a
question
that
hasn't
really
come
up,
but
it
just
occurred
to
me.
You
know
we're
talking
about
a
lot
of
nonprofits
in
this
space,
but
these
are
state
mandated
services
and
so,
when
they're
not
able
to
when
our
providers
are
not
able
to
adequately
hire
or
staff,
these
positions
and
care
for
these
really
high
need
individuals
who
accepts
the
liability.
E
J
Unfortunately,
the
liability
falls
on
the
provider,
so,
for
example,
if
we
have
a
residential
provider
who
has
ten
houses
and
five
staff,
they
can't
they
can't
get
any
more
staff
in
and
they
can't
find
they
can't
borrow
staff
from
another
agency
and
they
have
to
make
the
tough
choice
to
leave
someone
alone
or
unsupervised
for
an
hour
and
something
happens
that
provider
would
likely
be
shut
down,
likely
be
charred,
probably
charged
criminally.
E
D
Thank
you,
mr
chairman
amy.
I
think
it's
safe
to
say
that
it
is
it's
the
residential
providers
who
are
struggling
the
most
right
now,
the
24
7.
the
day,
program's,
probably
somewhat
fairing
better,
and
I
know
with
ppp
and
all
that
stuff
with
our
organization.
That's
really
helped
to
get
us
through,
but
we're
different,
because
we
provide
a
lot
of
different
services
for
children
and
adults.
So
that's
kind
of
a
different
scenario,
final
question
with
the
the
waiting
list
for
the
waivers,
especially
michelle
p.
D
We
have
noticed
in
the
past
that
one
of
the
biggest
issues
we
face
is
a
lack
of
a
new
population
coming
up
coming
into
our
facility.
Are
we
still
seeing
that
throughout
the
state
and
how
much
of
a
financial
impact
do
you
think
that
in
itself
is
I
mean
there
these
slots?
We,
we
have
so
many
people
on
a
waiting
list
that
can't
get
the
services.
Therefore
they're
not
getting
in
to
see
these
providers
and
it's
affecting
the
business.
J
It
definitely
has
a
significant
impact
and
just
to
address
kind
of
the
two
comments
that
you
made.
First,
I
would
say:
yes:
residential
providers
are
struggling
the
most
with
the
staffing
portion.
Our
day,
service
providers
are
struggling
tremendously
with
revenue,
they've
been
the
ones
who
have
hit
hardest
with
revenue.
J
Initially
they
had
been
closed
at
the
beginning
of
the
pandemic,
and
we
proposed
actually
to
medicaid
in
a
coalition
letter
that
significant
funds
be
set
aside
for
lost
revenue
for
these
types
of
providers
and
specifically
10
million
dollars
for
adult
day
health
care
centers
to
help
them
to
address
the
second
portion
of
your
question.
J
Yes,
so
as
you
allocate
more
slots,
you
increase
a
provider's
ability
to
see
more
people
to
to
touch
more
lives
which
can
increase
revenue
and
help
with
staffing
et
cetera.
You
know
things
like
that,
but
in
order
to
meaningfully
address
these
wait
lists
and
get
more
blood
and
get
more
people
into
the
programs
touch
more
lives,
help
more
people.
We
have
to
have
the
workforce,
so
you
have
to
address
it's
you.
It's
a
two-pronged
approach.
Almost,
for
example,
in
a
budget
cycle
take
a
two-year
budget
year.
J
One
you
use
the
money
to
address
the
workforce.
You
build
up
the
workforce
while
also
allocating
slots,
but
you
hold
off
the
allocation
of
the
slots
until
six
months
later,
when
you've
built
up
the
workforce
and
can
actually
have
the
space,
and
you
actually
have
the
manpower
so
that
people
can
access
services
because
you
don't
want
to
get
into
a
situation
where
you're
accessing
allocating
slots
that
no
one
can
access.