►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
City
on
Health
Services,
everyone
knows
I
think
that
we
had
a
name
change
and
a
new
committee
that
was
that
was
established.
So
we
are
the
house
standing
committee
on
health
services.
This
is
meeting
one
and
I
just
like
every
to
thank
everyone
for
being
here
today.
We
will
go
ahead
and
have
the
secretary
take
the
role
and
then
we
will
allow
new
members
to
briefly
introduce
themselves
for
everyone's
knowledge,
so.
D
E
A
F
It
was
a
recommendation
that
came
out
of
our
task
force
this
summer
on
the
regularization
of
Health
and
Welfare,
and
we'll
talk
about
that
more
detail
later,
but
very
pleased
that
we're
able
to
have
this
meeting
today
and
in
large
measure,
because
we
have
so
many
new
members
of
our
committee,
that
we
want
to
try
to
bring
up
to
speed
and
be
prepared
for
this
next
session.
So
with
that,
we
will
proceed
with
roll
call.
H
I
A
Okay,
at
this
point,
I
would
like
to
give,
as
Senator
Meredith
said,
our
large
number
of
new
house
members
and
actually
all
members
just
a
a
moment
to
quickly
introduce
yourself
for
the
record
and
for
everyone
here
in
the
audience
to
to
kind
of
get
to
know
one
another.
We
have
put
this
meeting
together
to
to
to
just
increase
everyone's
kind
of
general
knowledge
of
the
cabinet,
inner
workings
and
funding
streams.
So
I
will
I'm
going
to
start
with
representative
Bentley.
A
If
you
can
just
tell
us
where
you're
from
and
a
maybe
a
20-second
little
bio.
D
O
M
E
P
Q
A
Okay,
thank
you.
So
much
and
I
am
chairwoman.
Representative
Kim
Mosher
I
represent
the
64th
District
in
Northern.
Kentucky
I
have
served
in
the
legislature
since
2017
and
have
been
on
this
committee.
The
entire
time
and
I
have
chaired
since
2019
and
my
past
life.
I
I
was
a
neonatal
intensive
care
and
flight
nurse
for
a
lot
of
years
and
served
as
the
executive
director
for
the
Northern
Kentucky
office
of
drug
control.
A
F
You,
madam
chair,
let
me
start
with
the
members
who
are
not
here
because
you'll
see
them
throughout
the
session,
just
sure
you're
familiar
with
the
names
and
have
to
be
Senator,
Judy,
Rocky,
Adams
who's,
all
also
our
caucus
whip,
Senator,
Karen,
Berg
and
Center
Max
wise,
but
members
who
are
in
attendance.
Let's
start
with
the
greatest
of
all
time:
Senator
Douglas!
If
you
would
sir.
H
Good
afternoon
folks,
I'm
Senator
Don
Senator
Dr
Don
Douglas
I
represent
the
22nd
District,
which
includes
Fayette
County
Jessamine
County
and
Garrett
County
I'm,
an
anesthesiologist
I've,
been
in
healthcare
over
30
years,
and
it
is
entirely
my
pleasure
to
be
a
part
of
this
committee
now.
Thank
you.
S
F
I
have
been
in
the
legislature
since
2017
and
had
the
honor
to
serving
you
know
what
was
the
health
and
services
committee
and
working
with
co-chair
Moser
and
I'm
looking
forward
to
some
some
of
those
great
things
and
as
we
get
into
this
agenda,
I
think
we'll
talk
a
little
bit
more
about
the
the
task
forces
somewhere
on
the
reorganization
efforts
and
again.
Obviously,
this
committee
was
one
of
the
efforts
that
came
out
of
that.
So
with
that
Madam
chair
back
to
you.
A
Thank
you,
Senator
Meredith,
and
at
that,
at
this
point,
since
we
have
established
a
quorum
in
both
the
house
and
the
Senate
I
think
we
will
take
an
opportunity
to
go
ahead
and
consider
the
administrative
regs
that
we
have
on
the
agenda
today.
There
are
18
of
them.
All
members
have
received
these
regs
and
summaries,
and
we
do
have
one
regulation
which
we
will
talk
about
in
a
second.
But
did
everyone
on
the
committee
have
a
chance
to
read
the
regulations?
A
We
do
have
9
10,
Kar
001090,
a
proposed
regulation
related
to
personal
care,
attendant
programs
and
assistance.
Services.
We
do
have
an
amendment
which
we
will
need
to
take
action
on,
but
at
this
time
I
would
like
to
invite
I
think
Victoria
Eldridge.
Commissioner
Eldridge
are
you
here?
Thank
you.
If
you
wouldn't
mind
just
talking
explaining
the
regulation
and
the
amendment
before
we
address,
this
I
would
appreciate
that.
B
Good
morning,
good
morning
afternoon,
my
name
is
Victoria.
Elridge
I'm,
the
commissioner
for
the
Department
for
aging
Independent
Living.
The
personal
care
attendant
program
is
a
program
to
serve
kentuckians
with
severe
physical
disabilities.
The
regulation
was
updated
to
go
from
what
was
written
in
statute
to
change
the
pay
from
725
at
federal
minimum
wage
to
up
to
eleven
dollars.
Was
there
a
specific
piece
within
the
event
within
the
regulation
that
you
wanted
additional
information
on.
A
I
don't
but
I
will
ask
the
committee
if
there
are
any
questions
or
concerns,
okay,
hearing
none
and
thank
you
for
that.
Explanation
and
I
will
entertain
a
motion
on
approving
the
amendment
on
this
regulation.
A
F
E
F
F
Most
certainly
will
and
chairman
Mosher,
chairman,
Mosher
and
I
talked
about
putting
this
together.
It
was
trying
to
give
everyone
an
overview,
particularly
new
members,
as
to
what
our
the
largest
cabinet
in
state
government,
and
this
will
be
like
drinking
from
a
fire
hose
but
I'm,
confident
that
secretary
Freelander
and
his
people
will
do
a
great
job
of
giving
us
an
overview
of
the
cabinet
and
then
probably
we'll
get
into
some
discussion
about
the
recommendation
of
the
task
force.
F
U
U
You
so
always
appreciate
the
opportunity
to
talk
about
the
Cabinet
for
Health
and
Family
Services
as
a
whole.
Oftentimes
folks
come
to
the
cabinet
and
see
pieces
right,
they'll
see
Medicaid
they'll
see
Child
Protective
Services.
Let
me
see
if
I
can
do
this
you're
happy
to
drive.
So
this
is
this
is
what
I
want
to
kind
of
convey
is
that
the
cabinet
is
a
a
very
large
organization,
6
000
folks,
the
the
budget
is
18
billion
with
a
B,
so
most
of
that
is
Medicaid
about
15
of
that.
U
So
you
have
somebody
from
Medicaid
who'll,
be
after
me
to
to
go
more
in
depth
into
Medicaid.
Trying
to
do
the
cabinet
of
Health
and
Family
Services
in
a
quick
and
efficient
way
is
what
I'm
going
to
try
to
do
today
or
otherwise.
We'd
be
here
until
tomorrow.
So
for
new
members,
I
want
to
say
please
reach
out
I'm
happy
to
meet
with
anybody.
U
I
think
the
the
chairs
and
some
of
your
other
folks
here
will
tell
you
I'm
absolutely
willing
to
meet
and
would
love
to
do
that
and
love
to
go
down
and
and
talk
about
specific
concerns.
I
think
it's
important
that
you
get
to
know
me.
You
get
to
know
the
cabinet,
you
get
to
know
our
different
programs,
so
I'm,
looking
forward
to
that
and
looking
forward
to
the
to
today
I'm
going
to
try
to
run
this
oops,
he
says
now,
I
just
knocked
it
all
out.
Oh
look
at
that.
U
This
is
going
to
be
the
better
way
to
do
it.
So,
as
Senator
Meredith
said,
the
Cabinet
for
Health
and
Family
Services
is
currently
configured
in
this
way.
There
is
a
bill
that
has
been
filed
that
would
change
this
sum.
I
began
at
the
cabinet
in
1985,
maybe
some
of
you
weren't
born
yet,
and
so
yes,
Senator
Meredith.
Yes,
so
the
I
have
been
in
various
Departments
of
the
cabinet.
One
of
the
running
jokes.
We
had
at
the
task
forces
I've
been
over
a
lot
of
these
programs.
U
I'll
highlight
that
for
you
as
you
go
through,
I
was
what
I
referred
to
as
the
utility
infielder
for
the
cabinet.
Those
of
you
that,
like
baseball
the
three
of
you
left
and
that
is
that
I
would
they
set
me
about
to
to
go
into
departments
to
to
kind
of
hold
the
space
until
they
were
able
to
get
somebody
permanent,
so
I
learned
a
lot
about
different
parts
of
the
cabinet
and
so
hopefully
I
bring
that
full
experience.
U
I
learned
something
every
place:
I
went
full
experience
to
the
entire
cabinet,
so
Health
and
Family
Services
cabinet.
You
all
can
see
for
yourselves
all
of
the
different
programs
that
we
have
there.
There
are
what
I
call
the
big
five
departments:
that's
public
health,
Medicaid,
aging
and
independent
living
dcbs
and
Behavioral
Health
and
developmental
intellectual
disabilities.
Those
are
our
five
biggest
departments.
U
The
rest
are
are
small
in
comparison,
but
do
very
important
things
like
Family
Resource
Centers.
So
these
are.
These
are
the
components
of
the
cabinet.
Many
states
have
these
kind
of
cabinets
broken
up
into
different
pieces.
We
in
Kentucky
have
done
that
once
we
broke
the
cabinet,
this
cabinet
into
two
big
different
pieces.
I've
served
through
the
breakup.
The
reunion
and
I
will
tell
you,
as
I,
have
looked
at
other
states
and
talked
to
other
states.
U
I
I,
firmly
believe
that
having
the
cabinet
as
as
a
whole
as
one
piece,
because
so
many
of
these
programs
over
that
and
you'll,
you
may
hear
a
little
bit
of
that
as
I
go
through,
but
I
think
they're
about
a
little
over
a
dozen
states
that
have
big
conglomerate
cabinets
like
this.
There
are
also
other
states
that
really
work
more
at
the
county
level,
but
those
would
be
big,
States,
New
York.
Does
that
Texas?
Does
that
California
does
that
our
closest
state
is
Ohio,
that
is
a
county-based
system,
we're
a
state-based
system
and
I.
U
It
would
take
me
too
long
to
fully
explain
that,
but
I'm
happy
to
do
that.
One-On-One,
but
I
just
want
to
say
that
that
within
state
governments
we
are
fairly
unique
in
how
we
approach
how
we
do
these
programs
a
lot
of
times.
Medicaid
and
you'll
see
it's
so
big
that
it
sits
by
itself
often
or
sits
with
Finance,
or
something
like
that,
but
but
because
Medicaid
is
such
an
important
part
of
all
these
other
programs.
Again,
I
feel
it's.
It
makes
sense
to
have
that
a
part
of
an
individual
cabinet.
U
U
U
Volunteerism
hours
I'm
going
to
get
into
a
lot
of
these
pieces
later
in
more
depth,
but
this
just
gives
you
sort
of
an
overview
we
have
for
you
if
you
are
interested
kind
of
the
impact
on
the
county
level
and
that's
the
way
we've
been
able
to
break
it
down
of
programs
like
Medicaid
and
TANF
and
snap
and
child
care.
So
if
you
are
interested
in
that,
we
have
those
for
you
to
say
what
does
that
look
like
in
my
individual
County?
U
How
much
of
snap
and
I
like
to
say
snap
goes
to
your
Grocers,
your
local
Grocers
Medicaid
there.
There
are
no
benefits
really
to
go
to
individuals.
It
goes
to
health
care
providers.
So
what
does
that
impact
on
Health
Care
providers
as
we
go
through
those
processes?
So
most
of
these
programs
serve
and
we
talk
about
providers
or
Grocers.
A
lot
of
this
funding
then
goes
to
them.
So
I
just
want
to
make
that
point
as
well
So
within
the
secretary's
office.
U
At
this
point
in
time,
the
office
of
the
Inspector
General
really
does
the
health
care
survey
licensure
reviews
all
of
that
so
they're,
the
ones
that
do
the
inspections
of
nursing
facilities,
as
well
as
child
care
hospitals,
basically
the
health
care
side.
This
is
the
group
that
does
the
vast
majority
of
of
inspections.
U
When
we
did
this
slide,
it
was
1.6
million
folks
who
were
enrolled
in
Medicaid
and
what
was
that
four
or
five
months
ago,
the
numbers
now
1.7,
so
that
32
000
providers
again
what
I
like
to
say
is
without
Medicaid,
even
though
we
can
have
concerns
about
the
the
level
and
and
the
reimbursement
level
of
Medicaid
and
how
sustainable
it
is
for
all
of
our
providers
across
Kentucky
without
Medicaid
who
wouldn't
have
any
without
hospitals,
nursing
facilities,
child
care.
U
A
lot
of
that
basic
infrastructure,
not
Child
Care,
is
supported
by
Medicaid.
So
just
kind
of
a
little
overview
of
that
Medicaid
is
one
of
the
more
complicated
programs.
You'll
have
a
much
longer
presentation
on
that
coming
up
right
after
me,
but
know
that
when
you
see
that
again,
14
billion
dollars
with
a
B
of
What
flows
through
Kentucky
and
really
again
the
way
I
like
to
think
about
it,
goes
to
Providers
of
Kentucky.
That's
who
receives
this
funding.
U
Community-Based
Services,
that's
Child,
Protective
Services.
It
is
our
eligibility
programs.
They
do
all
of
the
eligibility
pieces
that
snap
that's
child
care,
that's
TANF
and
then
child
protective
services
and
Adult
Protective
Services.
So
our
social
workers
are
there
and
we
continue
to
have
tremendous
challenges
on
attracting
folks
to
be
social
workers.
I
talk
about
social
workers
as
like
the
everyday
Heroes
that
you
don't
read
about
in
the
newspaper.
They
go
into
the
toughest
situations,
sometimes
where
law
enforcement
doesn't
want
to
go,
particularly
if
it's
domestic
violence
or
child
removal
it
is.
U
It
is
a
tremendously
stressful
job.
One
of
the
reasons
I
came
back
to
the
state
of
Kentucky
after
working
for
Louisville
Metro
Government
for
a
little
bit
was
I
knew
that
we
had
social
workers
and
we
had
never
addressed
really
secondary
trauma.
What
that
experience
is
of
actually
being
a
social
worker
and
really
trying
to
figure
out
how
to
support
and
say
it
in
a
way
that
makes
a
difference
and
makes
their
lives
easier.
Much
much
easier
said
than
done.
U
There
are
issues
within
chfs
within
dcbs
that
roll
back
20
30
years
Eric
Clark,
was
briefly
Commissioner
of
dcbs
and
did
a
fantastic
job
and
really
I
used
Eric.
As
an
example
of
you,
don't
have
to
come
from
the
same
place
in
order
to
Be
an
Effective
leader
of
an
organization
like
dcbs.
So
that's
that's
the
important
piece
in
dcbs.
We
have
that
number's
a
little
less
than
that
9100
again.
This
was
from
the
chfs
task
force
presentation,
but
thousands
of
children
whom
we
are
saying
to
them.
U
We
are
going
to
do
a
better
job
than
your
biological
parents.
All
too
often
that
is
not
the
case.
That's
been
documented
across
the
country.
It's
been
documented
here.
So
what
can
we
do
together
to
make
this
better
and
I'm
pledged
to
do
that?
You
all
have
been
pledged
to
do
that.
I
wish
Senator
Adams
were
here
because
she
sponsored
Senate
Bill
8,
which
which
really
helped
how
we
think
about
abuse
and
neglect
really
trying
to
say.
Poverty
is
not
neglect
which
which
our
statutes
say.
U
It's
I
think
one
of
the
reasons
we've
been
number
one
in
child
care,
abuse
and
neglect,
because
sometimes
we
equate
poverty
with
neglect
and
so
trying
to
work
our
way
through
that.
What
does
that
mean?
How
do
we
make
sure
that
we're
supporting
families
and
children
so
that
they
can
stay
together?
I
can't
imagine
turning
18
and
not
having
any
parental
support
and
family
support
it.
U
Just
it
boggles
my
mind
that
folks
are
able
to
do
that,
but
unfortunately
we
see
negative
outcomes
from
that
all
the
time
I
can
go
on,
and
on
about
that,
we
also
provide
snap
assistance
for
hundreds
of
thousands
of
people
across
the
Commonwealth.
So
those
are
the
kinds
of
programs
that
we.
E
U
Tend
to
think
of
these
programs
now
and
we
try
to
say
them
while
I'm,
while
I'm
talking
about
snap
and
tana
as
prevention
programs
supporting
families,
hopefully
will
help
them
stay
together,
and
some
of
these
minimal
Financial
supports
assist
with
that.
U
So
when
we
talk
about
public
health,
this
is,
as
you
know,
we've
come
through
covid,
but
but
there
have
been
years
of
under
investment
in
some
of
these
local
Health
departments.
Those
of
you
I
hope
we'll
talk
with
your
local
Health,
Department
directors,
they're
fantastic
people
and
they've
been
strong
folks
for
several
years
now,
and
so
chairman
Moser.
U
Thank
you
for
your
legislation
on
public
health
transformation
trying
to
get
Public
Health
out
of
the
direct
service
role
into
one
more
of
a
population,
health
and
prevention
role,
so
that
we
can
really
work
on
population
Health
as
a
and
and
leave
the
individual
health
pieces
to
health
care
providers.
So
really
working
on
that.
The
last
General
Assembly
actually
put
some
funding
for
that
again.
Very
appreciative
of
that
and
appreciative
of
the
partnership,
because
it
is
when
we
work
together,
we
get
good
outcomes
and
so
I
I
always
welcome
that
opportunity.
U
Public
health
does
so
many
things
that
you
don't
think
about.
I
I
call
it
the
4
30
on
Friday
call
when
there
is
a
a
group
of
kids
that
have
been
touring
someplace
and
there
were
bats
in
the
Belfry
of
the
place
that
they
were
Church
touring
and
we
have
to
go
through
all
sorts
of
rabies
protocols.
It
always
happens
a
radiation
that
comes
through
the
state.
We
have
a
radiation
Branch,
they
know
and
get
notified
and
oftentimes
accompanying
those
kinds
of
shipments
that
go
across
the
state.
U
It
is
they
local
septic
systems
with
local
Health
departments.
The
folks
that
do
the
the
restaurant
inspections,
those
are
in
your
local
Health
departments.
U
It's
a
little
mind-boggling
the
breadth
that
public
health
covers
so
in
the
recent
floods
of
water
testing
that
they
were
doing
all
across
Eastern
Kentucky,
making
sure
that
there
were
tetanus
shots
available.
These
are
the
kinds
of
things
that
public
health
does
every
day
in
our
local
communities.
So
if
you've
not
had
an
opportunity
to
talk
or
or
visit
with
your
local
Health
Department
director
I
encourage
you
to
do
that.
U
You'll
be
amazed
by
everything
that
they
do
and
I
am
also
a
Dr
stack
fan
because
I
like
his
hair,
so
Behavioral
Health.
These
are
your
local,
comprehensive
care.
Centers
is
one
way
to
that.
That's
one
piece
of
Behavioral
Health,
but
this
is
the
group
that
works
on
substance
use,
Behavioral,
Health,
Developmental,
intellectual
disabilities.
This
is
the
group
that
really
works
on
those
issues
across
the
Commonwealth
I.
Think
next
week,
you'll
have
a
presentation
on
core,
which
is
the
the
really
in
partnership
with
a
lot
of
folks.
U
But
it's
part
of
the
substance,
use
effort
and
the
substance
use
money
that
comes
through
the
federal
government
flows
out
through
this
department
oftentimes.
It's
in
concert
with
folks,
like
van
Ingram,
who
I
think
you'll
have
next
week
and
others
annual
as
we
try
to
address
what
has
been
an
incredible
scourge
of
opioids.
U
Certainly
there
we
had
a
corporate
issues
there
that
that
have
driven
us
to
to
a
place:
that's
horrible
and
you
you
look
across
the
Commonwealth,
and
you
see
that
and
now
we
are
now
we're
seeing
the
impacts
of
fentanyl,
just
incredible
numbers
of
overdoses
resulting
in
deaths.
So
how
we
work
through
that
we
we
do
talk
about
harm
mitigation.
U
How
do
we
make
sure
people
stay
safe
with
Narcan
so
that
they
can
live
to
get
into
recovery
so
that
those
are
the
kinds
of
things
we
try
to
work
on
on
on
the
substance,
use
side
and
then
severe
folks
with
severe
mental
illness?
U
Again,
sometimes
you
see
some
of
those
folks
on
on
the
streets,
how
we
engage,
how
we
work
with
with
folks
like
that,
because
it
was
really
I'm
going
to
bring
up
what
we
talk
about
throughout
the
cabinet,
but
I
think
it's
particularly
poignant
here:
individuals
who
had
severe
amount
illness
20
years
ago,
the
the
clinicians
didn't
believe
that
recovery
in
any
way
was
possible.
Just
wasn't
possible.
Well,
families
spoke
up,
an
individual
spoke
up
for
themselves
and
said
no,
no,
you
got
this
wrong.
Recovery
is
possible.
U
Yes,
we
can
so
I
I
use
that
as
a
as
an
example
of
of
why
listening
to
constituents,
as
you
well
know,
oftentimes
they're
closer
to
what's
happening
in
local
communities
and
local
neighborhoods,
and
they
can
oftentimes
provide
us
insight.
That
is
important
for
how
we
practice.
U
Aging
Independent
Living-
you
just
had
commissioner
Eldridge
up
here
speaking
about
what
she
does
senior
meals
is
the
one
I
always
like
to
start
with
when
I
was
with
Louisville
Metro
Government
I
was
a
community
action
director,
the
only
governmental
one
in
the
state
and
we
had
senior
meals
and
those
programs
are
so
very
important,
because
what
is
a
challenge
is
social
isolation
and
so
in
our
seniors
that
maybe
don't
have
transportation
or
can't
get
out
having
the
opportunity
to
get
senior
meals
or
in
a
congregate
setting
at
an
adult
day
Center.
U
These
are
really
important
lifelines
for
our
seniors.
In
the
past
several
years,
we
have
eliminated
waiting
lists
for
seniors
and
Senior
meals,
some
of
that
due
to
some
of
the
extra
Aid
that
we
received.
But
right
now
it
is
due
to
additional
funding
with
that.
The
general
assembly
provided
us
to
make
sure
that
we
don't
have
waiting
lists
because
a
senior
on
a
waiting
list
who
needs
food
just
shouldn't
happen.
Department
of
Aging
Independent
Living.
U
We
recently
established
an
office
of
Alzheimer's
and
Dementia
I
said
this
at
the
task
force
my
mother
suffered
from
that
passed
about
a
year
ago,
and
so
it's
kind
of
near
and
dear
to
my
heart.
We
we
need
to
understand
what
the
resources
are,
the
secretary
at
the
Cabinet
for
Health
and
Family
Services,
and
struggled
finding
resources
and
struggled
making
the
connections
about
now,
which
one
am
I
going
to
and
who
am
I
talking
to
and
can
I
get
this
person
in
and
how
do
I
pay
for
them?
U
I
mean
it's
daunting
and
so
having
somebody
that
can
help
answer.
Questions
is
really
important
and
there
are
some
private
Brokers
out
there,
but
we
need
to
provide
that
support
as
well
and
so
the
office
of
Alzheimer's.
Dementia
is
really
really
working
on
this.
U
The
other
big
piece
that
we
have
there
and
I'm
skipping
over
several
big
pieces,
but
another
one
I
want
to
highlight,
is
the
guardianship
program,
so
those
folks
who
can
be
declared,
incompetent
and
assigned
to
the
cabinet
right
because
you
can
be
declared
and
and
have
a
private
Guardian
but
we're
the
public
Guardians.
So
we're
short
of
your
last
stop
I
hate
to
say
it
that
way,
but
it's
true,
so
we
have
more
and
more
folks
who
are
in
our
guardianship
program
who
are
responsible
for
financial
case
management,
make
sure
they're
safe.
U
This
is
a
program
that
has
grown
over
time.
The
previous
administration
started
down
the
road
of
making
that
piece
that
was
Health
Care
related
in
the
guardianship
program,
Medicaid
reimbursable
and
so
we've
been
able
to
expand
the
program
start
to
bring
our
caseloads
to
a
rational
level
for
our
guardianship
program.
We've
got
a
long
way
to
go
in
dcbs,
but
it
has
it.
U
It
really
has
made
a
difference
for
the
folks
we're
trying
to
serve
and
I
think
it
does
make
a
difference
a
lot
of
times
those
programs
kind
of
get
a
bad
rap,
but
they're
really
important
to
support
individuals
and
communities
and
and
the
guardianship
caseworkers
also
do
a
fantastic
job
like
social
workers.
Sometimes
they
get
into
situations
and
with
individuals
who
are
not
completely
stable
in
a
way
that
is
safe
and
yet
they
go
and
they
do
their
job.
So
it
is.
U
It
is
something
that
that
I
always
like
to
lift
up
in
the
cabinet
that
that
we
we
walk
into
bed
and
tough
situations,
and
yet
we
do
so
that's
over
a
million
meals
served
and
it
it
is
also
through
your
local
Triple
A's.
Your
area
aging
area
aging
on
living
I'm
gonna,
get
that
wrong.
Occasionally,
I
get
my
initials
wrong
because
we
use
so
many
of
them,
but
through
your
local
area,
development
districts.
U
There's
an
aging
component
they're
also
really
an
interesting
group
to
to
get
to
know
so
what
they
do
every
day
and
a
lot
of
times
the
local
communities
respond
in
local
ways.
So
I
it's
it's
a
really
interesting
program
to
see
across
the
state
and
I
I
I'm
I'm
pleased
with
some
of
the
creativity
that
we've
been
doing
there
within
the
reorganization
bill.
U
There
there's
an
address
of
of
Adult
Protective
Services,
which
sits
in
the
Department
of
community-based
Services
and
guardianship,
which
sits
in
Office
of
Aging
and
that
that's
a
part
of
the
reorganization
bill.
That's
that's
coming
forward
and
then
a
personal
favorite
of
mine,
I,
I,
didn't
do
I've
been
over.
That
program
did
I.
So,
there's
shovel
that
we've
gone
through
that
I've
been
over
at
one
point
in
time,
but
Family
Resource,
Centers
I,
know
you
all
know
this
program
started
in
in
in
the
90s.
U
I
was
briefly
over
this
program.
This
is
a
great
program.
This
is
about
Social
Services
in
schools,
and
this
was
placed
in
the
Cabinet
for
Health
and
Family
Services.
As
you
see
a
lot
of
our
programs,
it
relates
to
a
lot
of
our
programs,
and
so
it
it
really
is
a
great
bridge
between
the
cabinet
and
education
and
Family
Resource
Centers.
U
Again
during
the
tornadoes
during
the
floods,
they
were
able
to
provide
support
for
their
local
communities
and
with
the
tornadoes
had
Partnerships
with
making
sure
that
folks
were
safe,
were
able
to
to
gather
what
was
coming
into
community
entities
in
terms
of
resources
and
and
individual
items
to
which
of
things
and
and
really
kind
of
assist
the
community
and
be
a
local
hub
for
that
Community
to
to
to
get
some
of
that
actual
physical
assistance.
U
They
do
a
lot
of
different
things
across
many
different
schools,
we're
in
most
of
the
schools.
It's
based
on
the
amount
of
free,
School
meals,
that's
the
per
pupil
and
again
through
the
collaborative
work
of
the
general
assembly.
We've
been
able
to
increase
that
per
pupil
up
to
a
point
where
I
think
it
really
is
more
sustainable
within
local
school
districts.
U
So
again,
just
another
example
of
how
we
can
partner
together
serve
Kentucky,
another
another,
really
great
program,
I
I
like
to
say
we
have
really
two
really
just
just
kind
of
pure
good
news
programs
in
the
cabinet
and
that's
frisky
in
this
one.
So
this
group
goes
out
and
solicits
volunteers
they've
been
going
out.
The
Serb
Corps,
where
they
go
out
and
they've
actually
been
assisting
in
flood
cleanup
and
tornado.
U
Cleanup
folks
can
come
into
this
program
and
get
stipends
and
begin
to
get
the
work
experience.
If
again,
if
you
all
ever
get
the
chance
to
either
kickoff
for
serve
Kentucky
in
Americorps
or
their
graduation
ceremonies,
they
are
fantastic
and
a
lot
of
fun
and
please
don't
miss
them.
Joe
bringardner,
who
is
currently
over,
served
Kentucky.
U
We
call
them
the
most
interesting
man
in
the
Cabinet
for
Health
and
Family
Services,
but
he
has
tremendous
energy
and
is
a
is
a
great
advocate
for
the
program
not
only
locally
here
but
Nash
nationally
as
well.
U
Child
Support
Enforcement-
that
is
the
group
that
actually
works
with
local
County
attorneys
and
collects
child
support
across
the
state.
A
lot
is
collected.
We
had
a
whole
discussions
about
challenges
with
arrearages,
which
is
a
a
real
thing,
but
it
really
is
at
its
core
making
sure
that
children
get
the
support
that
they
need
and
get
the
financial
support
that
they
need.
U
I'm
going
to
go
back,
one
I
see
there's
a
second
program
in
in
this
department
and
it
is
disability
determinations.
It's
it's
a
unique
program,
we're
a
contractor
for
Social
Security,
so
those
folks
who
get
disability
Social
Security.
It's
this
group
in
Kentucky
that
that
gets
goes
to
the
eligibility
Process
reviews
their
cases
determines
if
their
eligibility
eligible
or
not
I
will
tell
you
we've.
This
is
probably
this
program
is
considered
to
be
the
best
in
the
Southeast
one
of
the
best
in
the
country.
U
We
we
we've
worked
long
and
hard
on
getting
caseloads
down.
We've
increased
some
of
the
salaries
and
recruitment
in
in
disability,
determinations
they're
really
doing
a
great
job
and
they
are
being
recognized
really
across
the
country
and
particularly
in
our
region.
It's
called
region,
four,
it's
the
kind
of
the
southeast
as
really
being
a
leader
there.
When
we
presented
to
the
the
task
force,
we
weren't
able
to
really
talk
about
this
program.
U
So
I,
just
I
wanted
to
give
some
a
little
bit
of
kudos
to
these
folks
because
they
do
a
very
good
job.
It's
the
Social
Security
Administration.
The
way
that
we
contract
is
like
I
say
unique,
it
is
very
how
to
put
it
it's.
The
only
program
we
have
that
is
is
really
truly
percent.
100
percent
Federal
in
terms
of
all
of
the
employ
everything
about
the
program
from
from
the
person
that
runs
it
to
everything
that
we
do.
It's
it's
100
federally
reimbursed.
U
We
use
a
federal
program
like
they
don't
even
use
the
state
email
system,
they
have
to
use
the
federal
email
system
and
it's
because
they
get
into
people's
Social
Security.
So
the
the
Privacy
requirements
around
this.
We
actually
have
to
run
a
separate
data
line
like
physical
data
line
into
our
our
disability,
determination
offices,
because
we
can't
even
run
our
state
line
and
the
federal
line
together.
So
I
mean
it
the
the
way
that
it
is
separated
is
it
makes
it
makes
it
unique.
U
I
also
used
to
be
over
this
office.
I
was
also
both
the
offices
we
had
passed.
The
office
of
children
with
special
Health
Care
needs
is
a
really
aligned
with
public
health.
It
has
been
it's
been
in
public
health,
I
think
in
the
70s.
It's
out
so
I
think
that's
part
of
the
reorganization
bill.
One
of
the
recommendations
there
it
is,
it
is
more
Direct
Services
than
public
health.
There
are
we
run
clinics.
U
My
favorite
Clinic
was
called
the
cranial
facial
anomaly
Clinic,
where
you
had
neurologists
who
working
with
dentists,
working
with
Physical
Therapy
occupational
therapy,
a
whole
group
of
folks
plastic
surgeons,
who
come
around
a
child
who
may
have
gosh
before
their
18
20
30
40
surgeries
because
of
either
a
cleft
lip
cleft
palate.
U
Think
impactful
thing
we
do
is
the
what
we
call
our
Eddie
program,
which
is
early
hearing
detection
program
and
so
in
Kentucky
we
have
a
requirement
that,
before
child
leaves
a
hospital
they
get
tested
for
hearing.
If
they
fail
that
initial
test,
then
they
go
for
further
audiological
screening
and
commission
offices.
We
employ
audiologists,
although
we
are
having
trouble
hiring
audiologists,
but
we
have
hearing
booths.
We
provide
that
service
to
kids
and
and
really
we're
very
good,
because
a
lot
of
states
have
a
lot
of
folks
who
are
lost
to
follow-up
right.
U
In
other
words,
they
get
that
hearing
test.
They
fail.
The
hearing
test,
and
then
we
don't
see
them
until
they
enter
School.
We
really
are
good
about
making
sure
that
those
folks
get
hearing
tests,
so
they
can
get
into
early
intervention,
and
so
that's
a
program.
That's
at
this
little
commission
I
call
it
the
little
commission
and
they
they
do
a
very
good
job
with
that.
U
So
we
we
partner
with
a
lot
of
different
folks
across
the
Commonwealth
on
that
so
I've
been
talking
a
lot
and
gone
through
a
lot
of
different
things
and
I
honestly,
just
scratched
the
surface
and
I
wanted
to
do
this
as
quickly
as
possible,
but
again
what
I
would
like
to
invite
any
of
you
to
do.
U
Please
reach
out
I'm
happy
to
meet
at
any
time.
If
you
have
specific
programs
that
you
are
interested
in
I'm
happy
to
go
through
them
as
well,
and
what
I
will
tell
you
and
and
I
hope
again,
the
chairs
know
this
I
won't
shy
away
when
I
think
it's
something
we're
not
doing
right.
I
will
tell
you
when
I
think
we're
we're
having
challenges.
I
think
as
I
just
did
with
social
work,
hiring
and
retention.
U
Those
are
real
challenges
we
are
seeing
as
children
come
into
our
system,
we're
not
what
I've
said
before
here.
Is
that
we're
not
seeing
more
children
who
are
suffering
from
abuse
and
neglect,
but
the
abuse
and
neglect
that
we
are
seeing
is
more
severe
and
you
could
get
any
partner
up
here.
U
I
think
who
would
say
that,
so
you
know
when
we
when
we
have
challenges
we
work
together
and
when
we
work
together,
we
make
a
difference,
so
I
I
think
when
we've
done
that-
and
we
have
done
that
a
lot
I
know:
we've
made
a
difference.
F
And
we
will
continue
to
and
I
really
appreciate
the
overview
we
provided.
I
hope
that
our
committee
members
can
appreciate
that
when
we
had
our
task
force,
we
met
six
times
and
not
to
be
redundant
but
bear
in
mind
again.
This
is
93
age
disease
with
over
almost
7
000
employees.
You
mentioned
a
19
billion
dollar
budget,
but
that
really
doesn't
factor
in
the
Medicaid
as
well.
That's
another
just
15
billion
States
portions
about
2
billion.
F
So
it's
a
massive
cabinet
and
I
want
to
thank
secretary
Freelander
for
the
unparalleled
access
he
gave
us
to
his
his
cabinet.
His
folks
have
met
with
us
and
what
we
learned
very
early
on
is
this
is
a
big
big
test
to
undertake
and
I'd
like
to
cover
very
quickly
what
the
the
recommendations
of
our
task
force
are:
there's
only
nine.
So
this
shouldn't
take
us
very
long
and
then
we'll
entertain
questions
from
the
committee
members,
but
again
want
to
thank
you
for
your
cooperation.
F
It
was
tremendous
and
I'll
probably
start
with
our
last
recommendation
in
first,
because
it
became
the
most
obvious
and
that
being
that
we
can't
do
this
in
a
year's
time.
So
one
of
our
recommendations
is
that
the
task
force
will
continue
at
least
into
2023,
and
possibly
even
beyond
that,
but
I
want
to
emphasize
again
when
we
did
this
reorganization,
it's
intent
really
find
my
notes.
Here.
F
The
objective
of
our
task
force
and
the
recommendations
you're
going
to
hear
is
not
to
reduce
the
number
of
departments,
divisions
or
programs
in
the
cabinet,
nor
is
it
to
eliminate
invaluable
programs
and
services.
Rather,
the
objective
is
to
streamline
programs,
reduce
bureaucracies,
eliminate
redundancy
to
create
efficiencies
within
the
cabinet,
and
state
government
as
a
whole
and
I
would
add
increased
accountability
for
everyone
and
I
think
that
helps
all
of
us
serve
our
constituents
better
with
that.
The
first
recommendation,
as
I
mentioned,
was
to
continue
the
task
force
through
2023.
F
F
I,
don't
expect
you
to
be
able
to
give
any
kind
of
detailed
explanation
as
to
whether
you
agree
or
disagree,
but
just
get
your
your
good
reaction
to
this,
but
first
and
was
the
Child
Support
Enforcement
program,
which
we
had
a
lot
of
discussion
on
and
the
reason
we
had
that
discussion
in
great
detail
is
that
at
that
time,
56
percent
of
the
total
amount
of
current
child
support
has
been
collected,
which
I
guess
the
converse
of
that
is
almost
47
percent
had
not
been
collected
and
which
represents
44
percent
and
present.
U
Well,
of
course,
I
will
take
a
look
and
we'll
have
more
of
a
discussion
about
it.
I'm
sure
what
I
can
say
about
the
child
support
enforcement
program
is
it's
it's
a
big
program.
There
are
quite
a
few
employees
with
the
Attorney
General's
office.
I
think
it
would
maybe
almost
double
their
size
and
working
with
County
attorneys
is
oftentimes
a
challenge
and
I
think
part
of
the
recommendation.
If
I
remember
it
right
was
maybe
even
looking
at
privatization
do
I.
U
So
I
pretty
much
my
reaction
to
all
of
this
is
it's
worthy
of
discussion.
You
you
have
the
task
force
looked
at
spots
and
programs
that
that
I
think
are
are
worthy
over
you
and,
and
is
it
the
is
this
the
right
way
to
do
it?
Is
it
right
in
the
cabinet
so
not
giving
a
yay
or
an
a,
but
certainly
this
is
something
that
we
we
should
look
at
I.
Think
for
the
Attorney
General's
office.
U
This
is
how
to
put
it
well,
I,
don't
know
it's.
It's
almost
like
be
careful.
What
you
asked
for,
but
you
and
I
have
had
that
discussion.
It's
it's
a
tough
program.
It's
a.
F
Tough,
it
certainly
is-
and
you
know
this
was
not
just
a
whim
of
our
committee
right
I-
think
the
foundation
is.
This
was
the
the
audit
our
state
author
did
back
in
2019,
and
it
was
from
one
of
the
term
a
very
damning
report
that
we
could
do
better
and
we'd
like
to
see
some
substantive
changes,
and
we
think
the
best
way
to
do
this
is
to
move
it
to
the
area
that
has
some
legal
teeth
to
it.
So
that's
the
basis
of
our
termination.
U
Again,
this
is
a
a
program
that
is,
is
pretty
isolated
in
terms
of
you
know
how
it
how
it
works
within
the
cabinet.
One
of
the
things
we
talked
about
was
the
way
that
we,
it's
our
it's
how
we
do
our
accounting,
our
inner
accounting
and
it's,
how
we
kind
of
fund
some
of
the
the
central
functions,
this
being
100
Federal
program.
U
There
may
be
some
small
implications
and
and
we'll
communicate
about
that.
F
All
right,
thank
you.
Third
recommendation
is
the
officer
children.
The
special
Health
Care
needs
would
be
better
served
in
the
Department
of
Public
Health.
You
know
it's
a
director's
position
and
it
certainly
aligns
with
public
health.
So,
with
your
nodding,
I
assume
that
you
are
an
agreement.
It's.
U
It's
been
there
in
the
70s
I
think
was
the
last
time
we
were
there.
We
I
still
consider
myself
as
being
there
and
so
I
think
the
challenges.
The
only
challenge
there
that
I
see
is
that
they
do
more
direct
direct
service
than
perhaps
the
public
health
transformation
piece,
but
again
a
right
thing
to
look
at.
F
Thank
you,
sir
next
recommendation
is
to
move
the
Family
Resource
and
youth
services
when
we
looked
at
two
different
options,
one
being
that
it
could
be
placed
within
education
and
labor
cabinet
and
the
other
option
that
it
could
go
to
in
dcbs
or
Department
of
behavioral
behavioral
health
and
the
bill
as
filed.
Has
it
going
to
DCB
BS.
But
that's,
not
my
preference
I'm
going
to
submit
a
an
amendment
to
that
bill,
to
move
it
to
education,
Workforce,
Development
and
my
rationale
for
that.
F
It
goes
back
to
original
intent
of
the
program
to
help
our
educational
system
by
reducing
truancy
and
absenteeism,
but
I
think
it
has
a
an
added
benefit
that
it
can
help
Working
Families
and
certainly
that
goes
back
to
Workforce
Development
again,
but
also
focuses
on
accountability
of
of
the
system
and
so
in
the
early
questions
that
I
had
is:
how
do
we
ensure
accountability
is
in,
and
these
folks
do
a
fantastic
job
and
I
appreciate
Minister
goings's
testimony
as
well,
and
she
even
knows
she
said
you
know
we
can
go
anywhere
because
we're
going
to
do
a
great
job
and
we
know
we
will,
but
we
think
this
gives
new
new
opportunities
for
them
for
the
future.
F
U
What
I
think
I've
said
to
you
is
this
I've
been
in
the
cabinet
when
I
think
they're
being
in
the
secretary's
office
was
a
problem
and
I've
been
at
the
cabinet
when,
when
there
being
there
didn't
cause
a
problem,
so
it
it
really
is
a
structural
decision.
F
Thank
you,
sir.
Next
recommendations
require
Department
of
Medicaid
services,
department
of
aging,
independent
living
in
the
department
for
Behavioral
Health,
to
identify
and
eliminate
redundancies
and
barriers
to
administering
the
1915c
Medicaid
waiver
programs.
Initial
report
continued
filing
recommendations
to
the
legislative
recent
commission
by
December,
2023
and
I.
Think
we've
all
tried
to
wrestle
with
the
issue
the
number
of
people
on
the
waiver
program
and
we
know
that
we're
having
a
great
disservice
to
many
of
our
constituents
because
we
haven't
been
able
to
fill
those
slots.
F
Next
recommendations
require
the
office
of
human
resource
management
to
work
with
a
Personnel
cabinet
to
identify
systemic
barriers
and
redundancies
that
are
preventing
an
effective
And,
Timely,
hiring
outboarding
process
for
executive
employees,
and
it's
part
of
our
discussion.
We
realized
that
we
had
kind
of
created
the
department
within
the
department
to
hire
people
and
it
was
creating
a
barrier
to
getting
people
on
board
quickly.
So
that's
why
that
one
was
presented.
F
The
state
guardianship
program
with
Department
of
Asian
Independent
Living
assists
vulnerable
to
adults,
which
can
be
administered
as
an
extension
function
of
adult
protection
services
from
the
jurisdiction
of
dcbs
and
last
I've.
Already
I
think
I
may
mention
two:
is
that
given
the
growth
of
the
Medicaid
Program,
as
you
acknowledge,
I
was
surprised
by
that
1.7
million
people
that
are
there
in
a
15
billion
dollar
budget,
but
because
of
that
increased
demand
for
public
assistance
and
social
and
Human
Services.
F
Task
Force
and
knowledge
need
to
reevaluate
the
committee
structure
of
the
general
assembly
in
order
to
adequately
serve
the
needs
of
kentuckians,
and
that
was
a
driving
force
as
to
why
we
now
have
health
services
and
we
have
another
Committee
of
Family
and
Children's
Services,
and
so
we've
taken
our
action
there.
But
any
other
comments
with
regard
to
them.
No.
U
U
So
I
I
really
think
that
that's
great
the
only
the
only
thing
other
thing
you
didn't
ask
me
about
I
think
was
Family
Resource,
Centers
and
volunteerism,
and
the
only
thing
I
have
an
emotional
reaction
to
that,
because
they
are
good
and
there
are
only
good
news.
You.
K
F
Their
cabinet,
but
just
trying
to
realign
the
goals
and
accountability
and
just
thinking
personally
I
think
it
needs
to
be
in
education
in
the
labor
cabinet,
but
there'll
be
ongoing
discussion
about
this.
But
of
all
these
recommendations,
I
believe
the
issue
with
child
support
are
probably
the
most
pronounced
in
terms
of
what
we
need
to
address,
because
there
are
tremendous
problems
and
I'd
like
to
share
our
our
task
force
Report
with
arrested
committee
members,
so
you're
familiar
with
it
and
with
their
findings
as
well,
but
some
significant
issues
in
that
area
alone.
P
Thank
you,
Mr,
chairman
secretary
friedlander,
thank
you
for
the
presentation
this
afternoon.
I
want
to
talk
for
a
moment
about
the
electronic
health
records
system.
A
little
bit
of
background
for
new
members
on
this
committee
that
was
a
cabinet
requested,
upgrade
to
support
all
the
agencies
within
the
cabinet
last
budget
process.
We
allocated
50
million
dollars
for
that
system.
Two
questions
here:
when
will
the
cabinet
issue
the
RFP
for
that
system?
And
what
is
the
timeline
for
its
implementation?.
U
Those
are
two
good
questions.
I
know:
we've
been
working
on
the
RFP
I,
don't
believe
it
is
out
yet,
but
I
expect
it
to
be
out.
Probably
within
the
quarter
is
my
guess:
I'll
have
to
get
back
to
you
to
make
sure
I
have
the
right
time,
time
frame,
you're
really
looking
at
an
implementation
of
best
case
scenario,
I
think
18
months,
18.,
yeah
and
I
I.
Think
I'm,
probably
optimistic
on
that.
But,
okay,
all.
R
Thank
you,
Mr
chairman
Mr
secretary,
you
said
something
a
few
minutes
ago
that
kind
of
caught
my
attention
in
relation
to
to
child
abuse
and
neglect
and
and
once
the
the
definition
change
would
dealing
with
poverty.
Do
you
all
have
any
numbers?
Do
you
have
any
idea
what
the
impact
of
that
will
be.
U
I
think
we're
going
to
have
to
watch
it
over
time.
We
I
don't
think
we
know
exactly
so.
U
Not
now,
no
okay,
no
and
I
think
well
you've,
you've
already
seen.
If
you
look,
you
know
we
we've
moved
out
of
the
number
one
position
and
the
country's
still
way
too
high
any
any
abuse
and
neglect
is
too
much,
but
I
think
that
may
some
of
that
movement
May
have
something
to
do
with
that
as
well.
It's
got
to
be
adding
to
it.
I'm,
not
sure
that
that
change.
U
The
numbers
that
are
being
reported
now
would
have
been
impacted
by
that
change,
but
I
think
it's
something
to
watch
and
I.
Think,
as
you
see
what
happens
across
the
time
across
time,
the
next
couple
of
years
as
we're
Kentucky
ranks,
I
think
you're
going
to
be
see
some
hope,
you're
going
to
see
some
change.
That
is
actual
change,
but
you're
going
to
see
some
change
because
we're
changing
definitions.
A
Do
thank
you
Mr
chairman,
thank
you
secretary
and
I.
I.
Just
have
a
couple
of
comments.
I
would
really
encourage
all
of
the
members,
especially
new
members,
to
get
to
know
secretary
friedlander
and
the
various
Commissioners
with
whom
we
work.
It
is
critical
that
we
get
to
know
what
what
who
works
on
what,
because
we
will
have
questions
you
will
have
questions
from
constituents
and
the
cabinet
is
a
wealth
of
information.
A
I
have
a
regular
meeting
and
it
is
it's
a
great
way
to
touch
base
and
really
talk
about
some
of
the
issues
that
are
important
to
not
just
our
constituents
but
on
a
more
Global
level
to
to
really
talk
about
some
of
the
issues
that
affect
our
policies.
So
they
are
great.
Everyone
I've
worked
with
at
the
cabinet
has
been
really
wonderful,
very
helpful.
A
Most
of
you
and
many
are
in
the
room
today
have
just
a
lot
of
institutional
knowledge
and
we
can
really
learn
a
lot
from
from
everyone
at
the
cabinet
and
I.
I
have
a
second
comment
that
and
I
know
that
you've
taught
you've
touched
on
the
healthcare
worker
shortage.
We've
all
experienced
it.
We
we
discussed
this
often
and
the
social
worker
issue
in
the
cabinet
I
mean
it
just
keeps
coming
up
we've
given
raises.
A
We
are
acutely
aware
of
of
the
situation
when
we
talk
to
our
residential
providers
of
of
care
for
children
and
out
of
hand
placement.
So
you
know
I.
If
there
are
any
recommendations
for
from
the
cabinet
to
us.
You
know
if
there's
some
way,
that
you
think
that
we
can
help
I
I
know
that
this
is
a
critical
problem.
In
my
area
we
are
having
difficulty
hiring
individuals
paying
individuals,
reimbursements
are
low,
so
this
is
an
ongoing
conversation.
A
I
don't
want
to
necessarily
ask
you
for
numbers
today,
because
I
know
that
this
is
something
that
waxes
and
wanes,
and
retention
and
recruitment
are
an
issue.
I
know
that
commissioner
Straub
is
is
leaving
and
that
we're
getting
someone
new
and
we'll
need
to
get
to
know
that
person,
but
there
I
know
that
there
were
some
programs
and
projects
that
she
was
working
on
to
help
with
retention.
Do
you
have
any
comments,
just
broadly
on
the
situation
with
the
social
worker
issue.
U
Sure
and
Lisa
Dennis
will
be
the
acting
commissioner
coming
forward
years
and
years
of
experience
within
dcbs
and
some
lived
experience
as
well.
U
So,
yes,
we've
we've
tried
salaries,
we're
trying
different
recruitments,
we're
actually
going
to
hire
a
recruiter
who
will
actually
go
out
to
the
schools
of
social
work
we
for
years,
because
it
was
such
a
hard
job
that
I've
some
of
our
schools
of
Social
Work
and
some
of
the
professors
there
would
say
yeah
the
last
place
in
the
world
you
want
to
work
is
dcbs,
so
we
are
trying
to
turn
that
perception
around
a
couple
of
things
that
we've
done
we've.
U
We
just
like,
within
the
past
year,
worked
that
out
with
the
Personnel
cabinet
what
that
looks
like,
and
it
was
due
to
a
lot
of
advocacy
on
the
on
the
on
the
part
of
social
workers,
one
of
the
things
that
we're
it's
just
a
brand
new
experiment,
but
we
as
we
looked
at
why
people
left.
U
U
It's
more
in
the
idea
phase
than
the
implementation
phase,
but
as
we
move
forward
with
that,
I'm
going
to
be
happy
to
bring
some
of
that
back
and
then
it
is.
How
do
we
provide
support?
What
does
that
look
like?
We
are
down
hundreds
across
the
state,
so
we've
got
a
lot
of
work
to
do
and
what
I
would
say
anybody
watching
this
who
would
perhaps
want
to
come
work
for
us.
U
The
fact
that
you
can
make
a
difference
in
a
child's
life
any
day
that
you
wake
up
and
come
and
work
for
the
cabinet
and
make
that
kind
of
difference
for
a
child
and
a
family.
I
hope
that
that's
inspirational
for
folks
to
come
to
work
for
the
cabinet.
F
Secretary,
just
the
last
couple
of
last
comments:
I'll,
let
you
leave
so
we
can
move
on
the
agenda,
but
I
failed
to
mention
that
serve
Kentucky,
which
you
talked
about
in
certainly
follows
that
some
category
is
the
Friskies
in
terms
of
kind
of
feel-good
programs.
Is
our
recommendation
is
to
move
that
to
education,
Workforce
Development
as
well,
because
we
think
it's
a
good
channel
for
future
Workforce
for
Kentucky.
So
thank
you.
Last
thing.
I
just
want
to
follow
up
again
on
this
child
protection
services.
F
At
very
disturbing
situation,
I
made
reference
to
the
report
that
auditor
Harmon
did
in
2019.
F
Reported
Kentucky's
Child
Support
Enforcement
program,
and
you
know
he
specifically
cited
that
lack
of
monitoring
oversight
of
the
department
in
this
2019.
Have
there
been
any
substantive
actions
taken
to
try
to
address
that
particular
component
of
that
report.
I.
U
Think
we're
working
on
it
I
think
the
the
Committee
hearing
that
you
held
got
some
folks
attention.
I
will
tell
you
that
I've
reached
out
to
some
of
the
County
attorneys
that
were
called
out
kind
of
pretty
specifically
and
said
you
know
you
got
to
perform
so
I
I
believe
that
that
you
put
them
on
notice,
we
put
them
on
notice
and
I
I
think
this
legislation
will
put
them
on
notice.
If
we
don't
get
better
performance,
something
dramatic
is
going
to
happen.
F
Well,
I'll
talk
about
that
same
time.
We
had
a
inspector
in
General's
investigation
into
Davies
County.
You
know,
apparently
there's
some
significant
problems
there
and
a
river
hasn't
that
a
whistleblower
involved
and
was
demoted
in
his
position
is.
Is
there
something
that's
changed
the
culture
there
or
is
this
just
kind
of
an
ongoing
situation
that
we
need
to
look
further
into
I'm.
U
Not
really
aware
of
that,
so
I'm
not
we're
aware
of
that
piece
within
demoted
within
Davies
County
or
within
the
state
system.
U
Okay,
yeah
yeah
I'm
I'm,
not
aware,
but
that
doesn't
mean
you
know
that
that
didn't
happen
with
any
County
system.
All.
F
Right,
thank
you.
You
know,
for
the
questions
comments
appreciate
your
participation,
I'm
sure
you're,
going
to
hang
around
for
this
next
presentation
as
well
and
I'm.
F
F
F
That's
a
17,
that's
as
large
as
the
Medicaid
budget
should
ever
be
by
improving
the
health
or
population
and
getting
people
back
in
Game
of
employment.
We
can
save
the
in
Commonwealth
a
substantial
amount
of
dollars,
but
here
we
are
20
23
24
and
looks
like
1.7
million
of
our
populations
on
Medicaid
and
we're
going
to
have
15
billion
dollars.
So
with
that
enthusiastic
intro,
please
identify
yourself
for
the
record
and
feel
free
to
proceed.
Thank.
V
And
let
me
say
so:
Medicaid
commissioner
Lisa
Lee
is
unable
to
be
here
today.
She
sends
her
regrets
and
she
is
very
much
as
we
are
looking
forward
a
lot
of
familiar
faces,
but
we're
looking
forward
to
meeting
and
getting
to
know
the
other
members.
We
are
public
servants
we
are
here
to
serve.
We
want
to
work
with
you
on
the
program
and
help
you
understand
it,
so
we
look
forward
to
that
as
we
go
forward.
V
This
is
a
a
Medicaid
101
which
so
I
have
three
hours
is
that
is
that
correct
to
touch
the
surface?
Medicaid
is
a
very
large
and
complex
program
and
we're
going
to
do
our
best
to
really
highlight
obviously
not
get
into
too
much
detail
at
this
point,
but
happy
to
come
back
and
or
meet
with
you
all
individually
to
to
talk
more
about
programs.
V
You
may
be
interested
in
as,
as
we
have
spoken,
approximately
1.7
million
we
have
grown
a
part
of
that
is
as
a
result
of
the
pandemic
and
the
public
health
emergency
and
continuous
coverage.
That's
been
mandated
for
us.
We'll
talk
about
that.
A
little
further
on
into
the
presentation.
Over
half
of
Kentucky's
children
are
covered
by
Medicaid.
We
have
both
traditional
population,
that's
mandated
that
we
cover
and
we
have
other
optional
programs
like
our
expansion
population.
V
We
like
to
show
because
we
talk
a
lot
about
federal
poverty
level,
and
that
is
what
definitely
is
in
income
is
one
of
the
components
of
an
eligibility
requirement
and
so
138
percent
is
our
adult
expansion.
That's
the
max
of
income
that
somebody
could
have
we're
talking.
Eighteen
thousand
seven
hundred
dollars.
We
do
so.
We
are
here
to
serve
the
Medicaid
member.
That's
the
reason
the
program
was
created,
but
we
can't
do
that
without
providers,
so
we
do
have
over
69
000
providers.
These
our
hosts,
the
secretary
mentioned
several
of
them
nursing
facilities.
V
So
we
have
a
bunch
of
facilities.
We
have
individual.
It
goes
anywhere
from
physical
health
to
behavioral
health,
so
a
very
wide
provider
type
we
have.
In
fact
we
have
over
90
provider
types
in
Medicaid
I
want
to
emphasize
that
we
are
a
federal
state
program.
So
most
of
the
requirements
come
down
from
the
federal
law
and
regulations.
We
are
created
under
the
Social
Security
Act
title
19,
that's
where
primarily
our
requirements
come
from,
so
we
do
have
to
comply
with
those
our
regulatory
Authority.
Our
agency
is
the
centers
for
Medicare
Medicaid
services.
V
V
I
also
want
to
just
note
sorry
a
couple
of
things
just
note:
there
is
a
difference
between
Medicare
Medicaid,
so
Medicare
is
a
federal
insurance
program
generally
for
those
age,
65
and
older.
We
are,
as
I
mentioned,
federal
states,
so
the
state
does
pay
a
share,
but
the,
but
the
majority
of
our
costs
are
covered
by
the
federal
program
by
by
CMS.
So
we
do
have
what
we
we
call
dual
eligibles
so
just
to
make
it
even
more
complicated.
V
There
are
people
who
can
qualify
for
both
Medicare
and
Medicaid,
so
we
do
have
some
classifications
that
fall
under
that.
But
Medicaid
really
is
the
kind
of
go-to
state
program
that
can
cover
people
and
services
that
aren't
covered
anywhere
else
not
covered
by
Medicaid,
not
Medicare
not
covered
by
commercial
insurance,
and
so
that's
when
the
State
Medicaid,
insurance,
State,
Medicaid,
agency
and
program
comes
into
to
account
and
when
you
see
one
State,
Medicaid
agency,
you've
seen
one
State
Medicaid
agency.
Every
state
has
different
programs
and
populations
and
services
that
they
cover
Beyond,
what's
mandated.
V
So
while
we
may
cover
something
another
state
may
not,
so
you
have
to
keep
in
mind
that
when
you
do
compare
Kentucky
to
other
State
Medicaid
agencies
that
there
are
some
differences
and
you
have
to
take
that
into
account
so
very
quickly
our
department
at
a
glance.
We
have
seven
divisions
now
and
we
we
or
we
did
a
reorganization
last
year
and
the
reason
we
did.
V
That
is
because
we
wanted
to
refocus
the
program
to
where
we
think
the
priority
needs
to
to
be,
and
that
is
the
creation
of
equality
and
population
Health
division.
We
previously
had
quality
as
part
of
our
Managed
Care
oversight
and
decided.
We
needed
to
separate
that
out
and
focus
specifically
on
quality,
so
this
is
again
a
very
new
division.
We
are
starting
to
staff
up
that
Division
and
start
looking
at
quality
and
metrics,
and
how
can
we
improve
the
health
of
our
members,
and
that
includes
working
with
providers
on
value-based
payment
programs?
V
You
know
trying
to
drive
and
incentivize
outcomes
through
various
types
of
programs.
I
would
like
to
say
that
we
we
have
been
able
to
our
rate
of
vacancies,
has
slowly
declined
and
I
know.
That's
due
to
the
salary
increases
the
general
assembly
budgeted
for
us
and
the
support
of
governor
beshear,
and
so
we've
been
able
to
actually
fill
vacancies.
V
It
could
be
age,
it
could
be
income,
it
could
be
resources,
and
so
it's
it's
very
complex
and
very
complicated,
and
so
we
have
to
make
sure
our
system
is
able
to
when
somebody
applies
for
Medicaid
is
able
to
determine
appropriately
and
accurately
whether
or
not
they
qualify
so
it
it
can
be
a
challenge
and
then
again,
I
mentioned
on
the
right
hand,
side
you
see,
we
do
cover
some
Medicare
populations.
Those
are
our
dual
eligibles
generally.
What
we
cover
are
their
premiums
or
their
cost
sharing,
but
again
very
complex
program.
V
Foreign
services,
so
we
have
what's
called
a
state
plan.
Our
state
plan
is
the
approval
from
CMS
that
both
make
sure
that
the
services
we
cover,
who
can
provide
that
services
and
what
we
pay
them
is
approved
by
CMS.
So
the
Federal
Law
requires
services
and
Medicaid
to
only
cover
medically
necessary
services,
and
there
are
ways
to
determine
that,
but
primarily
there
are
there's
criteria
that
has
to
be
met
to
make
sure
that
the
service
is
is
medically
necessary.
For
that.
V
For
that
person
we
do
only
pay
for
services,
so
we
don't
pay
for
room
and
board,
and
a
lot
of
people
don't
understand
that,
so
we're
only
allowed
to
pay
for
health
care
services.
So
you
may
see
that
we're
providing
we're
covering
services
in
a
residential
facility,
we're
not
paying
for
the
room
and
board
there
we're
paying
for
the
services
that
are
being
and
provided
within
that
residential
facility.
V
We
also
children,
there's
another
provision
in
federal
law
called
epsdt,
and
you
will
hear
sometimes
a
lot
about
epsdt
that
stands
for
early
and
periodic
screening,
Diagnostic
and
treatment.
What
that
does
is
requires
us
to
pay
for
any
medical
medically
necessary
service
for
a
child,
even
if
it's
not
covered
in
our
state
plan.
So
we
have
providers
that
are
enrolled
specifically
as
an
epsdt
provider,
and
they
may
be
providing
something
that's
only
available
to
those
children.
That's
not
available
to
the
rest
of
the
of
the
population.
U
And
may
I
just
for
a
second,
because
epsdt
is
such
an
interesting
history.
It
really
came
out
of
when
really
the
draft
and
so
few
adults
being
physically
able
to
be
drafted
because
of
all
sorts
of
physical
health
issues.
So
this
epsdt
program
was
put
in
place
that
whatever
the
child
might
need
from
a
medical
perspective
they
should
receive,
but
it
was
really
about
National,
Defense
and
making
sure
that
our
population
was
healthy
enough
to
serve.
So
it's
just
it's
it's
a
really.
It's
an
odd
piece
of
History
because
it's
like.
U
Why
does
this
program
exist
and
and
sometimes
when
you
trace
these
programs
back?
It
goes
back
to
things
like
that.
So
I
just
wanted
to
sorry
for
a
little
interjection,
but
I
just
think
it's
one
of
the
an
interesting
piece
appreciate.
V
That
history,
as
the
secretary
mentioned
previously,
we
pay
providers
and
we
have
again
our
covered
Services
range
from
physical,
preventive,
Behavioral,
Health
substance
use
treatment,
so
just
a
wide
range
of
the
services
that
we
provide
under
that
I
wanted
to
hear
just
talk
briefly
about
a
couple
of
other
things:
non-emergency
medical
transportation.
So
these
are,
if
an
individual
needs
transportation
to
a
doctor's
appointment
to
the
pharmacy
they
can
get
if
they
don't
have
a
car,
they
can
get
access
to
that
Transportation.
V
Through
this
program,
the
department,
the
cabinet,
transportation
cabinet
office
of
Transportation
delivery
is
who
administers
that
on
our
behalf.
We
have
a
contract
with
them
school-based
services,
so
you
may
be
familiar
with
IEPs
or
individual
educational
plans.
If,
if
one
of
our
Medicaid
members
has
an
IEP,
we
are
able
to
cover
the
services,
the
medicliness
services,
to
support
that
child
in
the
school.
We
work
with
the
Department
of
Education
for
that
all
of
all
of
the
claims
and
the
administration
of
that
comes
through
the
Department
of
Education.
V
We
now,
though,
thankfully
also
have
available,
what's
called
expanded
care
and
schools
now
where
they
were
limited
to
providing
services
within
the
IEP.
They
now
can
provide
services
outside
the
IEP
to
any
Medicaid
child,
and
so
we
have
been
working
on
encouraging
that
it
is
something
we
just
launched
in
2019
and
then
the
pandemic
hit,
and
so
it
kind
of
slowed
adoption
of
that.
But
we're
going
to
be
working
and
trying
on
right
now
we're
working
on
a
plan
to
work,
to
reach
back
out
to
schools
and
make
them
aware
that
this
is
available.
V
That
includes
Behavioral
Health
preventive
care.
So
we're
excited
about
refocusing
efforts
around
that
area.
The
other
is
the
Health
Access
nurturing
and
development
services,
otherwise
known
as
hands.
This
is
through
our
department
for
public
health,
and
this
is
a
voluntary
home
visit
program
for
any
new
or
expecting
families.
V
This
is
a
snapshot,
and
hopefully
you
all
can
see
it.
I
know
it's
kind
of
small,
but
the
the
state
represents
the
percentage
of
Medicaid
members,
Per
County.
V
So,
for
instance,
if
you
take
Franklin
County,
it's
blue
or
the
percentage
of
the
population
on
Medicaid
is
from
21
to
40
percent
on
the
right
is
our
demographics,
so
by
Race,
by
gender
and
by
age
group.
I
will
note
that
race
is
not
a
required
field
for
somebody
applying
to
Medicaid.
So
what
this
shows
is
the
number
is
the
percentage
based
on
those
who
reported
their
race.
V
V
And
this
is
a
Kentucky
Medicaid
enrollment
by
plan
and
by
plan
we
mean
Managed,
Care
Organization
and
we'll
talk
about
that
a
little
bit
more
in
a
minute.
We
do
have
six
Managed
Care
organizations
and
then
what's
ffs,
there
is
fee
for
service.
Those
are
the
ones
that
we
that
the
department
takes
care
of
directly
the
others.
The
six
mcos
are
what
it
the
individuals
are
in
managed
care.
So
they
are
the
ones
that
that
manage
the
the
care
of
our
members.
V
V
So
fee
for
service
versus
Managed,
Care,
I,
will
say:
41
states
have
managed
care.
Most
states
have
moved
that
way
and
the
primary
reason
for
that
is
budget
predictability.
They
manage
the
organization,
assumes
the
risk,
so
the
state
pays
the
Managed
Care
Organization
and
they
have
to
provide
services
within
that
payment
and
they're
at
risk.
If
the
cost
exceeds
the
payment.
There
is
for
a
Managed
Care
Organization,
a
minimum
medical
loss
ratio.
So
you'll
hear
us
talk
a
lot
about
the
mlr.
V
If
they
do
not,
then
we
have
within
our
contract.
We
claw
back
the
difference
if
they
do
not
spend
that.
So
we
you
know
the
state
and
fee
for
services.
State
pays
the
provider
directly
in
Managed
Care,
the
Managed
Care
Organization
have
provider
networks
and
they
pay
the
provider.
The
population
for
fee
for
service
is
generally
the
age,
so
people
in
long-term
care
are
part
of
the
fee
for
service
in
Kentucky.
V
We
in
fee
for
service
are
not
able
to
offer
what's
called
value-added
benefits,
but
in
managed
care
you
are
able
to.
So
what
does
that
mean?
Well,
I
have
a
long
list
of
all
of
the
value-added
benefits
that
mcos
provide
to
members,
and
that
includes
cribs.
V
They
pay
for
the
cost
of
GED
classes
and
the
test
they
cover.
They
give
incentives
for
to
go
to
a
preventive
treatment
or
to
go
to
the
dentist
so
there's
they.
They
have
cell
phones
available,
especially
in
the
rural
areas.
They
have
Internet
available
for
members.
So
there's
this
they
each
have
a
program
that
offers
what's
called
value
added.
So
these
are
things
outside
of
what
we
pay
the
Managed
Care
organizations.
In
fact,
they
cannot
Count
Their
value-added
benefits
into
their
mlr.
V
So
really
these
are
extra
things
that
are
offered
to
our
members
that
we
cannot
do
you
in
fee
for
service
pilot
programs.
We
hear
all
the
time
well.
Can
we
just
pilot
this
this
new
idea?
We
can't
do
that
in
fee
for
service
without
going
to
CMS
and
getting
approval
and
generally
that
requires
a
waiver
which
we'll
talk
about
but
managed
care
organizations
can
immediately
enter
into
pilot
programs.
They
can
innovate,
they
can
contract
with
providers
and
with
vendors
and
try
new
and
different
things
to
drive
outcomes,
so
we're
Limited
in
fee
for
service.
V
It's
just
not
as
easy
for
us
to
innovate
and
then
directed
payments.
So
directed
payments
are
where
we
direct
the
a
sub.
What's
called
a
supplemental,
so
we
give
providers
either
more
money.
You
know
based
based
on
a
set
of
rules
or
requirements
or
their
reimbursement
is
tied
to
something
different
than
what
we
we
traditionally
would
pay
for.
So
in
in
fee
for
service
directed
payments,
supplemental
payments
can
only
go
up
to
what's
called
the
upper
payment
limit
under
managed
care.
V
We're
able
to
go
up
to
what's
called
the
average
commercial
rate
and
if
you
have
questions
about
that,
that's
why
Steve
bechtel's
here,
but
it's
it
is
a.
It
is
a
difference.
It's
a
higher
reimbursement
to
go
to
the
average
commercial
rate
than
it
is
to
go
to
the
upper
payment
limit.
So
we
couldn't
do
that
if,
if
we
didn't
have
managed
care,
so
that
is
a
very
high
level
just
to
try
to
help
you
understand
what
is
fever
service
and
what
is
Managed
Care.
V
So
these
are
when
I
talk
about
our
state
plan
and
the
federal
rules
and
regulations
that
were
required
to
operate
under.
We
do
have
the
ability
to
to
do
different
things
and
to
get
CMS
approval
for
that
and
those
are
what
are
called
waivers.
So
we're
asking
them
to
waive
something.
V
That's
already
in
federal
law
or
regulation,
and
this
the
secretary
for
Health
and
Human
Services
is
the
only
person
that
can
approve
something
like
that
and
it
still
has
to
align
with
the
intent
of
the
Medicaid
Program,
which
is
to
provide
health
care
services
for
members
for
for
low-income
individuals.
So
there
are
three
primary
waivers:
11
15
waivers.
That
is
what
I
I
talked
about.
V
You
know
if
we
wanted
to
innovate
or
do
do
what's
called
a
demonstration,
we
would
file
and
let
15
waiver
with
CMS,
and
they
would
have
to
approve
that
it
has
to
be
budget
neutral.
It
has
to
track
outcomes.
It's
generally
five
years
years
in
length,
it
can
be
extended,
there's
a
great
deal
of
work
that
goes
into
an
11
15.,
there's
monitoring
and
an
intense
evaluation.
V
V
But
it
does
allow
us
to
be
more
flexible
in
the
services
that
we
can
cover
they're
outside
of
the
state
plan
and
they're
more
to
meet
the
needs
of
keeping
somebody
at
their
home
or
in
their
community
and
out
of
facilities,
and
then
the
1915b
or
what's
called
Freedom
of
Choice
waivers.
So
our
Managed
Care
organizations,
for
example.
We
are
waving
seen
laws
that
allow
us
to
then
put
people
into
a
Managed,
Care
Organization.
V
So
just
to
talk
about
the
the
waivers
that
we
do
have
currently
in
Kentucky
we
have
Team
Kentucky,
11,
15
waiver.
This
is
primarily
has
to
do
with
substance
use
disorder.
We
wanted
to
waive
some
requirements
so
that
we
could
innovate
around
substance,
use
disorder
here
in
Kentucky
and
do
some
some
really
great
things.
For
example,
we
there
is
what's
called
an
IMD
limit.
V
That's
institutions
of
mental
disease.
We
can't
pay
for
services
and
for
individuals
in
an
IMD,
so
we
have
been
able
to
waive
the
requirement
that
that
allows
us
to
pay
for
folks
that
are
in
in
facilities
that
are
over
16
beds,
because
otherwise
we
would
not
be
allowed
to
do
that.
So
we
waived
the
the
bed
limit
and
we
can
cover
people
up
to
95
beds.
We
also
so
wave
the
length
of
stay
in
an
IMD.
It's
right
now
under
law.
It's
15
days.
V
We
have
an
average
of
30
so
because
honestly,
I
think
what
we
can
all
acknowledge
is
that
15
days
isn't
long
enough
for
some
individuals.
So
this
gives
us
some
more
flexibility
that,
as
long
as
we're
meeting
the
average
of
30
days,
people
can
be
treated
longer,
which
we
think
is
very
important.
There
were
some
other
components
to
the
limb
15
that
we
waived
that
were
non-sud
related
one
was
to
cover
former
foster
care
if
they
were
in
foster
care
in
another
state.
It's
it's
a
law
and
we
do
mandate.
V
Coverage
for
Kentucky
foster
care
kids,
but
this
allowed
us
to
also
cover
people
from
other
states.
We
do
wave
non-emergency
medical
transportation
for
methadone
treatment
services.
One
of
the
reasons
for
this
is
that
is
a
daily
service
and
primarily
in
individuals
that
are
seeking
the
service
do
have
their
own
transportation.
So
we
did
waive
that
we,
for
we
did
a
one-time
aligning
of
Med
Medicaid
redeterminations
to
their
employer
sponsor
plan.
V
That's
called
Kentucky
Health
Integrated,
it's
K
hip
premium
payment
program,
so
we
will
pay
the
premium
of
somebody's
employer
plan
that
qualifies
for
Medicaid,
because
we'll
do
our
cost
analysis.
If
it's
cheaper
for
us
to
pay
their
premium
than
to
pay
for
the
services
ourselves,
then
you
know
it's:
it's
a
good
cost
efficiency
for
us,
so
we
wanted
to
align
those
enrollment
periods.
This
current
waiver
expires
in
September
were
required
by
CMS
to
file
an
extension
a
year
in
advance,
so
we
have
already
gone
through
that
process.
We've
posted
it
for
public
comment.
V
We
got
public
comments,
we
send
it
on
to
CMS
on
September
30th
last
year,
and
so
it
is
pending.
The
extension
is
pending
with
CMS
at
this
time
and
then,
while
we
had
our
original
M15,
we
did
file
an
amendment
in
November
of
2020.
We
and-
and
many
of
the
the
current
members
know
about
this,
but
it's
it
was
to
cover
it's
a
very
Innovative
first
first
in
the
country
plan
to
cover
folks
going
through
incarceration.
V
It
both
allowed
would
allow
for
us
to
cover
some
spots
within
somebody,
who's
incarcerated,
which
the
federal
law
doesn't
allow
us
to
do
as
well
as
people
that
might
be
in
custody
and
awaiting
their
trial.
It
would
give
us
some
flexibility
to
cover
those
folks
and
hopefully
get
them
into
treatment
and
maybe
take
care
of
the
you
know
the
addiction
that
may
be
underlying
their
criminal
actions
and
then
it
would
allow
us
some
post,
as
as
someone's,
getting
ready
to
be
discharged
from
a
facility
a
correctional
facility.
V
It
would
have
allowed
us
to
pay
the
Managed
Care
Organization
to
work
with
that
facility
for
that
person
to
so
when
they
get
discharged,
they
immediately
have
access
to
the
the
prescriptions
and
or
treatment
that
they
need
so
and
all
that's
arranged
in
advance.
So
there's
a
smooth
transition
so
that
that's
for
that
115
waiver.
U
If
I
might
at
this
point,
the
point
on
that
was,
it
was
submitted
in
2020
and
we're
still
waiting
to
hear
so
sometimes
when
we
submit
things
the
way
they
tell
us,
no
is
to
not
tell
us
anything.
I've
given
up
I
have
at
times
given
up
hope
on
this,
but
I
think
there
is
more
interest.
Now
at
the
federal
level,
we
hear
that
other
states
are
perhaps
going
to
be
able
to
proceed
through
this,
so
I
haven't
given
up
hope,
but
sometimes
these
things
can
take
a
while.
V
And
we
have
CMS
has
initiated
conversations
with
recently
with
us
to
to
talk
through
the
waiver,
so
we
are
we.
We
remain
optimistic
that
that
we'll
be
able
to
get
it
approved.
I
mentioned
Managed
Care
is
already
1915
B.
The
non-emergency
transportation
is
also
a
1915b,
and
the
reason
that
is
because
it
could
be
a
state
plan
service
is
that
in
Kentucky,
with
the
rural
nature
of
our
state,
we
do
have
to
sometimes
the
broker
who
arranges
for
the
driver.
V
The
broker
provides
the
service
because
of
a
limit
or
a
difficulty
in
finding
drivers.
So
because
of
that,
we
have
to
have
a
waiver
to
allow
the
broker
to
do
that,
and
that
is
also
no
you're.
Fine,
it's
also
a
risk-based.
So
we
pay
a
per
member
per
month
like
we
do
to
the
mcos.
We
pay
a
per
member
per
month
for
non-emergency
transportation,
so
they
have
to
deliver
the
services
within
that
payment.
V
And
then
1915
C
waivers
as
I
mentioned,
so
they
do
get
access
to
all
the
state
plan
services,
but
then
they
get
access
to
additional
services
to
meet
their
needs
list.
Some
of
them
here
case
management,
Homemaker,
Personal,
Care
adult
day.
So
there
are
a
lot
of
other
services
they
have
access
to.
They
also
I
noted
on
their
participant
directed
services.
V
So
while
we
have
providers
enrolled
in
Medicaid
a
member
otherwise
known
as
a
participant
can
employ
someone
else,
they
can
find
somebody
else
that
they
want
to
employ,
and
so
we
will
work
with
them
to
have
that
person
provide
services
for
them.
It's
a
level
of
comfort.
You
know
these
are
folks
who
are
intellectually
into
developmentally
disabled,
sometimes
having
people
that
they
feel
comfortable
with,
and
they
know
and
are
qualified
and
let
me
say
they
still
have
to
meet
qualifications.
V
You
know
for
them
to
be
able
to
to
direct
some
of
their
care
and
who
provides
that
so
these
are.
We
have
six
1915c
HCBS
waivers
first,
two
acquired
brain
injury,
injury
and
acquired
brain
injury,
long-term
care.
Those
are
for
individuals,
age,
18
or
older-
that
have
our
acquired
brain
injury.
The
department
for
Medicaid
services
operates
those
to
to
programs.
V
Then
we
have
modeled
what's
called
model,
two,
that's
for
individuals
dependent
on
a
ventilator
for
12
or
more
hours
or
who
may
be
weaning
from
a
ventilator
that
is
also
operated
by
the
department,
directly
Home
and
Community
Based,
which
is
kind
of
confusing,
because
that's
the
name
of
the
waiver.
But
there
is
a
specific
Home
and
Community
Based.
Those
are
for
individuals,
aged
65
and
older,
or
in
any
individual,
with
any
age,
with
a
physical
disability
that
is
operated
by
our
department
for
aging
and
independent
living
and
because
of
their
expertise
on
Aging
individuals.
V
The
department
for
aging
Independent
Living
also
operates
the
participant
directed
services
for
all
the
waivers
that
have
PDS
as
part
of
their
program
and
then
Michelle
P
waiver
and
our
supports
for
Community
Living
waiver.
Those
are
for
individuals
with
intellectual
and
developmental
disabilities
and
our
department
for
Behavioral,
Health,
Developmental
and
intellectual
disabilities
operates
those
two
programs
on
our
behalf.
V
This
is
a
current
snapshot.
This
is
as
of
like
January
4th
of
the
members
that
are
in
each
of
the
waiver
and
I
believe
you
might
have
heard
that
there
are
waiting
lists,
so
we
do
have
waiting
lists
for
Michelle,
P
and
scl.
The
sports
for
Community
Living
I
think
it's
important
to
understand
that,
just
because
somebody's
on
a
waiting
list
does
not
mean
they're
eligible
for
the
program,
we've
not
made
a
determination
as
to
whether
or
not
even
if
you
know
a
spot
becomes
available
for
them
that
they're
going
to
qualify
for
it.
V
So
so
you
know
that's
important
to
understand.
As
as
the
waiting
list
May
grow,
people
may
be
sitting
on
it
that
aren't
eligible.
The
other
thing
is
that
people
may
be
on
one
of
those
waiting
lists,
but
they
might
also
already
be
in
the
Home
and
Community
Based
waiver
program
in
receiving
some
kind
of
service.
So
so,
please
know
that
you
know,
even
if
somebody's
on
the
waiting
list,
they
are
accessing
Services
through
maybe
another
waiver
and
receiving
state
plan
Services.
As
a
result
of
that.
W
So
I
think
it's
a
timing
that
can
we
come
to
time
of
our
presentation
where
we
allow
Veronica
to
get
her
breath
a
little
bit
and
maybe
take
some
oxygen
in
for
for
a
little
bit,
and
but
you
know,
as
Financial
people
we
we
tend
to
get
a
lot
deep
in
the
weeds
and
we
time
and
we
tend
to
get
a
little
weedy,
so
I'm
going
to
do
my
best
to
keep
it
at
a
high
level
on
the
budget
as
possible,
but
just
like
secretary
said,
as
well
as
as
Veronica
I'm,
I'm,
open
and
I.
W
Think
some
of
you
I've
worked
with
I'm
open
to
discussion,
I'm
open
for
to
answer
any
questions
that
you
may
have
what
you
see
before
you
we
in
our
budget
in
Medicaid.
We
have
actually
two
appropriation
units.
We
have
the
administrative
approach
appropriation
unit
and
we
have
a
benefits.
The
the
benefits
is
the
majority
of
our
budget.
It's
about
97
of
our
total
budget
is
the
in
our
is
the
appropriation
for
for
the
benefit
program.
So
today,
I
just
want
to
briefly
talk
about
the
benefits
appropriation
unit.
W
Like
Veronica
said,
you
know,
we
have,
10
percent
of
our
population
is
in
fee
for
service
that
are
carved
out
of
the
Managed
Care
Program
and
90
is
in
the
Managed
Care
program,
but
of
the
10
percent.
They
we
spend
approximately
20
to
30
percent
on
those
10
percent
members.
Those
hundred
and
seventy
thousand
members
are
just
about
170
000
members.
W
Is
we
spend
about
20
to
30
percent
of
our
budget
on
those,
but
it
should
be
because
they
are
our
most
vulnerable
they're,
the
sickest
population
and
the
ones
that
we
need
to
focus
on,
but
you'll
see
on
this
spreadsheet.
On
this
slide,
I
presented
you
the
what
we've
actually
spent
in
21
State
fiscal
year,
21
and
22..
Those
are
actual
expenditures
and
I
broke
it
out
by
the
appropriation
units,
the
by
the
funding
and
by
general
fund
restricted
agency
funds,
as
well
as
federal
funds.
W
All
the
way
across
you'll
see
that
majority
of
our
funding
comes
from
the
feds
from
CMS
we're
about
80
percent
of
our
funding
comes
from
CMS,
while
the
remaining
20
percent
is
either
state
general
funds
or
through
restricted
agency
funds.
Those
restricted
agency
funds
are
funded
through
provider.
Taxes
as
well
as
what
we
call
enter.
Igts
is
short,
but
it's
intergovernmental
transfer,
Arrangements
that
we
have
with
providers
of
that
are
governmentally
owned,
so
I,
provided
you
also
on
what
we
are
budgeted
for
23
and
24.
W
That's
that's
directly
out
of
house
bill
one
from
last
year
and
you
can
see
what
our
Appropriations
are
for
that
the
to
I
believe
Senator
Meredith
said
earlier:
15
billion
you
can
see
across
there
are
were
budgeted,
15.3
and
23.
So
far
in
23.
We
do
believe
that
we
will
meet
that
budget.
We've
done
a
done,
a
review
on
that
so
24
we
are
budgeted.
15.8
billion.
W
I
mentioned
about
the
Managed
Care
payments
they're
about
where
they
cover
about.
Well,
we,
the
percentage
of
the
spend
on
managed
care,
is
about
70
to
80
percent
of
our
budget.
Now,
I
want
to
remind
you
that
there's
two
things
there
and
Veronica
touched
base
on
it
earlier
is
the
directed
payments.
Those
those
payments
are
above
and
beyond
the
rates
in
which
the
Managed
Care
organizations
pay
we're
directing
them
to
pay
additional
funds.
W
So
we
have
three
directed
payments
and
it
accounts
for
about
22
percent
of
the
total
spend
that
we
spend
that
we
send
to
the
Managed
Care
organizations
and
it
operates
much
like
a
like
a
pass-through
payment.
Cms
doesn't
like
the
term
pass
through,
but
but
that's
pretty
much.
What
it
is
is
we're
we're
giving
the
money
than
mcos
to
to
then
direct
those
funds
to
to
those
providers.
We
have
three
like
I
said
you
have
House
Bill,
you
have
the
hospital
rate
Improvement
program,
which
is
the
atrip
program.
W
We
we
pay
up
to
the
average
commercial
rate
for
for
the
inpatient
Services
as
of
right
now
and
I
do
believe.
You
all
have
House
Bill
75
on
the
table
to
discuss
adding
outpatient
to
that.
We
also
have
the
ambulance
provider
Assessment
program,
those
two
programs,
the
the
a-trip
and
the
APAP.
If
I
may
use
the
acronyms
there,
those
two
are
provider
tax
based
and
those
are
where
we
use
provider
taxes
to
fund
those.
W
So
the
state
funds
is
paid
through
the
provider
tax
and
we
use
restricted
fund
Appropriations
to
to
process
those
payments
on
the
state
side.
But
we
do
draw
in
the
federal
share
of
those
funds,
the
university
directed
payment,
those
are
payments
to
our
universities
for
inpatient,
outpatient
and
Professional
Services.
So
you
can
see
that
over
from
State
fiscal
year,
20
up
through
and
that's
through
December
of
2022
on
that
last
column.
So
far
since
State
fiscal
year
20
we
have
spent
6.7
billion
dollars
in
total
funds.
Through
these
three
directed
payment
programs.