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A
A
C
A
Present
we
do
have
a
quorum
to
conduct
business,
so
we
will
proceed
first.
Let
me
thank
your
one
for
your
willingness
to
serve
on
this
task
force.
This
is
the
inaugural
meeting,
but
in
a
sense
it's
not
inaugural
meeting,
because
the
continuation
in
the
work
we
did
in
2022
with
our
task
force
for
reorganization
of
Health
and
Family
Services.
That
task
force
was
a
result
of.
A
Concurrent
resolution
20
and
the
work
for
that
committee
resulted
in
Senate,
Bill
48,
which
we're
going
to
cover
in
some
detail
today,
so
this
is
actually
a
continuation.
What
we
realized
last
year,
almost
to
the
inaugural
meeting
of
the
committee,
was
it
was
too
big
of
an
animal
to
take
on
it
in
one
interim
session.
A
Personally,
thank
secretary
friedlander
for
his
willingness
to
cooperate
with
us
and
and
this
he
was
instrumental
in
our
last
task
force
session
in
providing
information
providing
these
people
to
make
them
available
to
us
and
the
wealth
of
information
they
have
provided.
Unfortunately,
you
new
members
are
not
going
to
be
privy
to
a
lot
of
that
information.
What
we
try
to
cover
in
the
session
last
year
was
focus
on
the
organization
itself
and
again
possibly
we
want
to
provide
you
with
those
organizational
charts,
because
it's
a
it's
a
massive
Department,
that's
grown
over
many
many
years.
A
We
think
that
this
session,
this
task
force
here
in
the
intern,
will
focus
more
on
operational
issues
again
trying
to
provide
a
means
to
improve
how
the
services
are
delivered
within
that
particular
cabinet
and
with
that
again,
I
want
to
thank
each
and
every
one
of
you.
We
want
to
participate,
it's
going
to
be
like
drinking
from
a
fire
host
a
little
bit,
but
just
ask
you
to
be
impatient
with
us,
but
with
that
I'd
ask
you
to
take
a
look
at
the
organizational
task
force
final
report,
which
we
provided
to
you.
A
A
As
you
see,
the
first
recommendation
was
that
we
continue
the
task
force
through
interim
2023,
which
we
have
done
By
Appointment
of
this
task
force.
Second
recommendation
dealt
with
child
support
enforcement
program
and
we
recognize
there
was
quite
a
deficiency
there
in
trying
to
collect
those
funds.
So
if
Senate
Bill
48
calls
for
those
functions
to
be
moved
to
the
office
of
Attorney
General
with
a
very
extended
timeline,
it
won't
happen
until
January
of
2025
to
give
everyone
a
plenty
of
time
to
prepare.
For
this.
A
A
Recommendation
four
was
to
take
the
Family
Resource
Centers
and
voluntary
services,
or
serve
Kentucky
and
move
those
to
the
educational
labor
cabinet
through
intensive
lobbying
and
negotiation
and
discussion.
That
recommendation
was
not
included
in
the
final
passage
of
Senate
Bill
48,
but
it
is
something
I
think
we
need
to
take
a
look
at
once
again,
because
what
we're
attempting
to
do
is
align
responsibilities
with
accountabilities
and
I.
A
Think
there's
a
good
argument
to
be
that
those
could
be
better
served
through
the
education
and
labor
cabinet,
but
again
point
for
discussion
later
the
office
of
budsman
administrative
review
in
the
office
of
Inspector
General.
We
had
a
lot
of
discussion
about
this
during
the
last
session
after
the
bill
had
already
been
filed,
and
the
final
decision
was
made
that
we
would
not
act
on
that
at
this
important
time.
So
that'll
be
another
point
of
discussion.
A
A
It
require
the
human
office
of
human
resource
management
to
work
with
the
Personnel
cabinet,
the
device,
systemic
barriers
and
redundancies.
I'll
talk
about
this
just
a
little
bit.
We
have
some
problems
of
trying
to
getting
people
on
board
untimely
fashion
and
we
kind
of
have
secretary
for
a
better
one
of
a
better
description
and
almost
like
two
Personnel
cabinets.
We
have
the
Statewide,
but
then
we
have
that
function
within
the
cabinet
itself
and
there
is
some
redundancy
there
so
we're
looking
at
how
maybe
we
can
eliminate
that
redundancy
and
get
people
hired
quicker?
A
We
suggested
that
those
should
be
in
the
jurisdiction
of
dcbs
and
last
but
not
least,
is
that
because
of
the
growth
in
the
Medicaid
Program
the
demand
for
public
assistance
that
we
need
to
reevaluate
the
community
structure
of
our
general
assembly,
which
we
did
and
quite
truth,
I
think
that's
one
of
the
most
impactful
recommendations
that
we
made
you
folks
know
before
this
bill
was
passed.
We
had
a
committee
for
Health
and
Family
Services
in
the
house
in
the
Senate.
We
split
that
function.
A
Now
we
have
health
services
and
we
have
family
and
children's
services
and
part
of
the
problem
for
our
new
members
was
that
so
much
legislations
comes
to
that
committee
because
you
expect,
since
this
is
our
biggest
cabinet,
this
is
also
one
of
the
biggest
committees
in
terms
of
responsibilities.
So
we
wanted
to
buy
those
functions
out
and
I
think
the
success
we
saw
in
the
last
legislative
session
was.
It
was
indicative
of
the
need
for
the
split
of
that
within
our
legislative
bodies.
It's
worked
very
well.
A
Quite
candidly,
I
think
that
the
issues
of
Children
and
Family
Services
had
a
tendency
to
take
a
back
seat
to
Health
Care
issues
and
that's
where
we
gave
our
primary
focus,
and
that
was
not
intentional,
not
just
the
nature
of
the
beast.
But
now,
since
we've
divided
those
issues,
I
think
it's
going
to
make
us
much
more
responsive
to
the
issues
that
we
face
with
that.
Unless
it's
very
brief,
but
are
there
any
questions
or
discussions
about
any
of
those
recommendations?.
A
D
D
D
Obviously,
there
there's
for
lack
of
a
better
but
I'm
just
gonna
my
firm
grasp
for
the
obvious,
with
what
will
probably
be
within
the
Attorney
General's
office,
a
new
attorney
general.
They
wanted
to
make
sure
that
we
had
a
transition
book
that
was
written
with
everything
that
will
be
in
about
the
transition
on
child
support
enforcement
and
hearings
coming
out
of
the
ombudsman's
office.
So
we
we
had
started
talking
with
County
attorneys
a
little
bit
and
they
really
wanted
us
to
slow
down.
A
A
Was
the
County
Attorney
Association
was
very
instrumental
in
getting
this
legislation?
Finally
passed,
they
actually
hadn't.
Did
his
study
I?
Think
it's
back
in
2015
about
this
particular
issue
had
recommended
that
those
functions
go
the
Attorney
General's
office,
but
they
wanted
to
make
sure
that
we
did
it
in
a
very
stepwise
fashion.
They
were
the
ones
that
originally
threw
out
the
date
of
I,
think
I
said:
January
warm
I,
believe
it's
July,
1
2025
and
the
reason
they
asked
for
that
extension
was
because
that's
when
the
contracts
with
County
attorneys
are
written.
A
D
Absolutely
and
the
number
of
employees,
just
the
raw
number
of
employers,
is
actually
as
big,
if
not
bigger
than
the
current
attorney
general's
office.
So
it's
a
big
deal.
It's
a
big
deal,
it's
a
very
complicated
program
around
child
support
and
collecting
child
support
right
now
through
the
county
attorney's
office.
D
So
it's
it's
a
complicated
program
and
a
big
program,
and
so
absolutely
we
need
to
take
our
time
and
make
sure
we
do
it
right
relative
to
there
was
an
office
of
the
Ombudsman
recommendation
that
many
of
those
functions
move
to
the
auditor's
office.
We've
also
had
a
sit
down
with
folks
from
the
auditor's
office,
including
the
the
deputy
auditor,
and
also
had
a
similar
discussion
about
more
in
depth
around
the
functions
of
the
ombudsman's
office.
D
What
What
In
the
bill
we're
talking
about
to
transfer
it.
It
was
I.
Guess
it's
not
funny,
but
we
were
talking
about
all
the
programs
at
the
cabinet
and
one
of
the
folks
from
the
auditor's
office
said:
what's
this
about
radiation
and
are
like
well,
you
know
we
do
do
some
regulation
of
radiation
and
radioactive
materials
as
they
come
through
and
as
a
part
of
the
cabinet
program.
D
Somebody
could
call
into
the
ombudsman's
office
and
and
and
have
concerns
so
I
think
that
to
your
earlier
Point
chairman
Meredith,
the
breadth
of
the
work,
that's
done
in
the
cabinet,
including
Public
Health,
sometimes
is
surprising.
So
again
we
sort
of
ended
up
in
the
same
spot,
where
we're
going
to
make
sure
we
have
good
transition
documents
written
so
that
nothing
gets
lost
in
in
any
transfer
that
may
or
may
not
occur
beyond
that.
D
There
have
been
numerous
meetings
between
our
department
for
public
health
in
the
office
of
children
with
special
Health
Care
needs
in
terms
of
what
that
might
look
like
we're,
still
not
in
complete
agreement
about
what
the
budget,
how
we
will
display
the
budget
in
the
next
budget
session
and
then
but
you'll
you'll,
see
well
we're
working
on
what
those
details
are.
We're
working
we're
going
to
begin
work
on
the
Personnel
crosswalk
that
will
I
think,
because
some
of
that
reorg
language
is
interesting.
D
We'll
we'll
make
sure
that
we
present
that
that
reorg
crosswalk
for
the
Attorney
General's
office
for
the
auditor's
office
and
then
internally
within
the
cabinet.
We
we
have
just
had
some
very,
very
even
more
initial
than
anything
else.
I've
described
between
Department
of
Aging
and
independent
living
and
our
dcbs
I
still
think
we'd
love
to
have
a
conversation.
But
we
started
that
discussion
around
what
that
would
look
like,
but
I'd
say
that's,
probably
the
the
the
least
full
conversation
we've
had.
C
Is
that
just
do
those
payments
only
include
payments
from
one
biological
parent
to
another,
or
does
that
also
include
payments
that
biological
parents
might
be?
This
is
the
Assumption
I'm
under
that
biological
parents
if
they
have
lost
custody
of
their
children
and
they
are
in
foster
care
out
of
Home
Care
placement
that
they
are
being
billed
while
their
child
is
out
of
the
home
and
is
needing
to
pay
the
state
back
as
part
of
their
plan
to
get
their
child
back.
D
D
So
court
ordered
child
support
if,
if
somebody
gets
in
arrears
or
or
any
kind
of
payment
for
children
right,
so
some
of
that
comes
to
us,
the
the
cabinet's
responsible
for
trying
to
figure
out
how
to
establish
paternity,
how
to
keep
up
and
and
sometimes
transfer
those
payments
from
from
non-custodial
parent
to
custodial
parent.
So,
yes,
all
of
that
occurs.
D
Oftentimes
people
get
in
arrears,
particularly
relative
to
the
population
served
through
through
child
support
enforcement,
and
that
can
cause
all
sorts
of
challenges,
particularly
people
as
they
re-enter
from.
If
they
happen
to
be
incarcerated,
it
might
be
why
they
were
incarcerated
it.
There
are
lots
of
levels
of
complexity
to
this.
Our
collections
are
are
behind
and
so
the
challenges
of
performance
of
different
county
attorney's
offices
that
all
of
this
comes
to
play,
and
so
it's
a
it's
a
hunger
answer.
D
A
Just
a
brief
comment
about
that.
You
know:
we've
made
a
bunch
to
do
about
the
fact
that
1.4
billion
dollars
in
the
rear
just
like
to
caution
our
task
force.
Members
just
bear
in
mind.
That's
a
number.
What
we're
looking
at
is
to
improve
upon
that.
We
think
there's
opportunity
how
much
we
can
improve
I,
don't
think
anyone
can
speculate,
but
we
have
120
counties
and
each
one
has
different
situations
and
the
ability
to
protect
or
to
collect
these
payments
are
different
in
Jefferson
County
than
they
are
Estill,
County
Kentucky.
A
So
it's
a
challenge,
but
we
think
about
moving
it
to
Attorney
General's
office
will
be
a
better
communication
between
the
attorney
general
and
the
County
local
County
attorneys
and
possibly
what
we've
seen
in
the
past.
So
it's
established
just
trying
to
make
a
situation
better,
but
appreciate
that
exactly
you
know
the
questions
comments.
G
Thank
you,
Mr
chairman,
and
thank
you
secretary
for
being
here
today
appreciate
all
the
work
that
you
do
and
your
Communications
with
us
just
a
couple.
Quick
questions
with
that
transition
to
the
Attorney
General's
office,
with
the
child
support
I
know
that
initially
there
was
some
plans
on
on
making
some
changes
to
the
current
system.
Since
this
change
is
taking
place
and
this
move
is
taking
place
so
have
those
changes
been
put
on
hold
until
that
gets
moved
over
there.
D
The
system
is,
what's
called
a
green
screen
system,
it
is
a
Dos
based
system.
We
basically
have
to
go
to
retirement
communities
to
find
programmers
and
I'm
I'm,
not
I'm
a
little
funny,
but
I'm
not
really
funny.
It
is
the
back
end
of
the
old
unemployment
system,
so
we
feel
like
we
have
to
move
forward.
D
Any
system
that
will
will
move
towards
will
move
from
that
green
screen.
Dos
based
system
into
just
something
that
that
is,
is
yeah,
more
modern
and
so
I
think
I,
don't
think
we'll
do
anything
that
would
make
it
any
more.
Actually
I
think
what
I'll
do
is
make
it
easier
for
the
Attorney
General's
office
to
take
it
over
they're,
really
it's
ex
it's
expensive
being
on
the
Mainframe
from
a
cot
perspective,
and
so
I
I
really
think.
D
If
there's
data
transition
and
migration
issues,
it
might
be
good
for
us
to
try
to
deal
with
them.
So
so
we
are
still
trying
to
move
forward.
We
just
we
think
it's
the
right
decision
and
we
think
it'll
actually
be
helpful
for
transitions,
so
that
somebody
doesn't
have
to
try
to
transition
and
data
migrate.
All
at
the
same
time,
from
A
system
that
nobody
knows
how
to
write
code
for
anymore.
G
G
D
So
this
next
presentation
is
really
about
the
impact
of
the
end
of
the
public
health
emergency,
we'll
we'll
go
through
some
slides.
If
there's
already
one
that's
changed,
but
we'll
explain
that
as
we
go
and
some
of
the
challenges
we're
seeing
as
we
move
forward.
So,
let's
begin
the
first
is
just
sort
of
a
representation
of
Medicaid
enrollment
over
the
years.
You
can
look
at
really.
This
is
basically
over
the
public
health
emergency.
You
can
see
a
pretty
big
dip
around
June,
June
and
July
of
20
21.
D
Isn't
that
right?
Okay
and
it's
when
we
really
stopped
the
major
presumptive
eligibility
piece
and
so
you'll
see
what
what
happened
there
was
we
just
we
rolled
presumptive
eligibility
folks
off,
primarily
so
the
ones
that
we
had
signed
up,
we
rolled
them
all
off
and
and
since
then
I
think,
we've
got
about
500.
D
We
had
gone
up
to
to
like
our
120
000
during
the
during
the
teeth
of
the
pandemic,
and
then
we
we
backed
that
off,
really
where
we
really
felt
we
were
coming
out
and
so
that
what
you
see
there
is
really
sort
of
just
the
the
hospital
presumptive
eligibility
and
Nursing
Facility
presumptive
eligibility,
and
that's
why
the
numbers
so
low
this.
This
is
a
caseload
distribution
and
at
least
I'm
going
to
let
you
talk
a
little
bit
about
this,
but
but
you
see
these
caseload
distribution
counts.
D
D
These
are
projections,
as
we
run
our
systems
so
know
that
what
I'm
going
to
talk
about
today
is
today's
number:
that's
probably
going
to
change
as
it
goes
forward,
but
I
just
I
just
wanted
to
let
you
know
you'll
see
they're
all
within
range,
but
they're
all
a
little
bit
different
and
that's
just
kind
of
how
how
this
how
this
process
is
going
to
work
so
I
just
I,
want
to
say
that
up
front
and
and
you'll
see
as
we
move
forward
Lisa.
So.
F
Typically,
during
traditional
Medicaid
operations,
individuals
have
to
renew
their
eligibility
every
year.
They
have
to
do
a
recertification
packet
during
the
public
health
emergency.
In
order
for
us
to
receive
that
additional
6.2
percent
increase
in
our
funding,
we
could
not
disenroll
anyone
from
the
Medicaid
Program
beginning
in
April.
We
started
renewing
individuals,
the
annual
recertification
period,
so
we
took
all
of
our
cases
and
we
have
12
months
now
to
get
individuals
recertified
in
that
year
period,
so
we
have
taken
all
of
our
cases
and
because
we
had
not
recertified
individuals.
F
During
the
past
three
years,
our
caseload
for
eligibility
workers
have
increased
by
about
20
percent,
so
the
caseload
distribution
count
that
you
see
on
this
slide
represent
about
a
20
percent
increase
in
workload
for
our
workers
and
as
we
go
forward
as
we
get
to
the
end
of
the
public
health
emergency
in
cases
are
recertified.
Those
caseloads
will
be
going
down.
D
So
typically
Medicaid
recertifies
folks
on
an
annual
basis.
We
had
several
years
where
we
didn't
so
we
now
have
case
workers
and
dcbs
who've,
never
done
a
Medicaid
recertification,
and
we
we
so
this
is
this
is
when
Lisa
says
it's
a
20
increase.
It
really
is
over
what
they've
been
doing
around
snap
and
child
care
and
tana
all
of
those
similar
kinds
of
programs.
So
this
just
gives
you
an
idea
of
the
number
per
month,
we're
essentially
re-enrolling
a
big
piece
of
Medicaid.
D
D
So
in
the
end
it
was
about
74,
000
renewals,
and
we
we
really
the
number
of
folks
who
were
reapproved
for
Medicaid
right
and
that's
those
who
have
applied
gone
through
the
entire
RFI
process
got
their
information
in
or
we
were
able
to
do.
Some
passive
enrollment
is
really
about
50
percent.
So
of
that,
well,
a
little
more
than
that,
but
of
that
of
that
74
000
we've
had
about
43
approved
43
000
approved
for
Medicaid.
So
that's
we
were
expecting
that
to
be
higher
I'll.
D
Just
be
frank:
we
thought
that
was
going
to
be
a
higher
number.
It
just
hasn't
been,
and
so
we
think
about
34
000
at
this
point
in
time
are,
are
going
to
be
terminated,
but
there's
another
about
6
000
that
are
eligible
for
qualified
health
plan.
On
the
exchange
we
don't
have
a
number
of
that
group
that
has
signed
up
you'll
see.
D
We
shifted
that
data
I
thought
it
was
more
clear
on
this
slide
to
show
you
how
many
folks
actually
have
not
re-enrolled
or
are
not
eligible
to
be
enrolled
in
Medicaid,
and
that's
that
34
000
number
that's
about
46
percent,
so
I
just
I
want
to
be
clear,
they're
eligible
for
other
health
care,
but
they
may
or
may
not
sign
up
for
that
Health
Care.
They
know
they're
eligible.
D
We
get
them
with
a
connector
or
an
agent
to
be
able
to
sign
up,
but
it's
it's
not
Medicaid,
there's
going
to
be
a
cost
in
in
many
cases.
So
we
don't
know
that
number.
Yet
that's
one
of
the
numbers
that's
going
to
change
basically
every
day,
particularly
if
we
were
able
to
figure
out
how
many
of
these
folks
actually
signed
up
for
a
qualified,
Health,
Plan
you'll
see
we
have
like
about.
D
If
you
combine
a
couple
of
the
numbers
about
110
folks
who
wish
we
still
have
to
process,
but
that
was
as
of
last
Friday.
That
number
has
probably
changed
they're
about
another
2600
where
we
have
rfis
out,
meaning
we've
asked
them
they
sent
something
in
and
we
needed
more
information.
So
we
sent
it
out.
D
We're
probably
going
to
have
to
give
you
a
couple
of
months
before
we
have
a
really
at
least
better
handle
on
it,
but
I
didn't
we
have
these
preliminary
numbers.
Please
take
them
as
preliminary
because
they
change
from
this
morning
to
be
frank
with
you,
so
it
these
are
just
this
is
this
is
going
to
be
close
right.
D
D
We
won't
be
too
we'll
be
a
few
percentage
points
here
and
there,
but
but
we'll
be
really
close
to
this,
and
then
what
will
happen
and
what
I'm
afraid
is
going
to
happen
is
some
of
those
folks
who
dropped
off
are
going
to
go
to
the
pharmacist
they're
going
to
go,
see
their
doctor
they're
going
to
find
out.
They
don't
have
coverage
and
they're
going
to
re-sign
up,
and
we
saw
this
with
a
snap
when
we
started
doing
recertification.
D
What
happens
is
folks
will
drop
off
then
they'll
come
back
on
and
and
unfortunately,
these
first
several
months
and
we've
tried
to
be
really
clear
about
how
we
communicate
the
Managed.
Care
organizations
are
reaching
out
the
hospitals
are
reaching
out
we're
reaching
out.
We've
had
the
experience
of
reaching
out
to
folks
who
said
stop
calling
me
too
many
people
are
calling
me
about
signing
up.
I
know,
I
need
to
sign
up
so
I
know,
we've
reached
people,
but
it's
like
it's
like
everything
else.
D
B
F
The
secretary
touched
on
this
just
a
little
bit
on
the
previous
slide.
We
talked
about
passive
and
active
renewals.
Passive
renewals
simply
means
that
we
have
enough
information
in
our
system
or
we
have
enough
data
sources
that
we
can
determine
an
individual
remains
eligible
and
that
individual
does
not
have
to
take
any
action.
F
We
look,
for
example,
if
someone
starts
an
application
or
starts
to
logs
onto
our
connect
system,
that's
our
eligibility
in
enrollment
system.
If
they
log
on
to
connect
to
start
an
application
or
to
try
to
upload
their
information,
they
don't
complete
that
process.
We
give
them
a
little
nudge.
A
nudge
is
just
something
to
say:
Hey.
You
started
this
application,
but
you
didn't
finish
it.
We,
you
want
to
go
ahead
and
finish
it.
We
also
have
sent
out
alert
messages.
F
Just
saying
hey
it's
time
for
you
to
renew,
we
have
made
791
alert
calls
and
you
can
see
the
almost
17
000
nudges
that
we've
done
that
we
have
completed.
So
we
have
the
just
the
number
of
applications
that
we
have
send
out
the
renewal
notices.
This
is
just
to
engage
our
members
to
make
sure
that
they
respond
to
us
and
one
of
the
other
reasons
that
we
do.
D
F
F
Typically,
a
provider
enrolled
in
the
Medicaid
Program
has
to
revalidate
their
information,
no
no
less
than
every
five
years
or
so
so.
During
the
public
health
emergency,
we
did
suspend
those
those
provider.
Revalidations
will
now
have
to
be
completed.
We
are
no
longer
using
unlicensed
facility
as
alternative
locations.
Of
course,
that
was
a
flexibility
that
early
on
in
the
public
health
emergency.
We
thought
we
may
need
some
facilities
to
accommodate
overflow
of
individuals.
In
case
we
had
a
huge
increase
or
a
huge
surge
in
covid
individuals
who
needed
to
be
treated.
F
We
did
give
hospitals
a
20
add-on
for
their
diagnosis,
related
related
grouper
code,
that's
just
20
percent
add-on
to
their
payments
for
any
patient.
That
was
coveted,
19
positive
or
had
a
diagnosis
that
also
went
away.
May
11th,
our
Nursing
Facility
270
per
diem
add-on
also
for
covid
positive
patients
that
ended
on
May,
11th
and
the
second
presumptive
eligibility
period
in
a
calendar
year
also
ended
some
things
that
we're
extending
as
long-term
Long-Term
Care
Resource
disregard
during
the
public
health
emergency.
F
We
we
disregarded
some
in
resources
for
individuals
who
are
in
long-term
care
facilities
to
help
facilitate
their
application.
We
do
go
back
and
recheck
those
resources
later,
but
we
make
sure
that
individuals
who
are
in
long-term
care
facilities
can
get
their
eligibility
determined.
We
also
are
taking
implementing
our
90-day
period
for
individuals
to
file
an
appeal
and
for
the
state
to
make
a
decision
prior
to
the
public
health
emergency
that
was
60
days.
Telephone
Telehealth,
Audio,
Only,
We
Are.
Remaining,
we
are
keeping
that
in
place.
However,
non-hippo
platforms
have
been
extended
only
through
August.
F
F
Typically,
if
an
individual
disenrolls
or
does
exits
the
Medicaid
Program,
when
they
re-enroll
they
can,
we
will
assign
them
to
a
new
Managed
Care
Organization.
If
they
do
not
choose
one,
we
will
now
allow
120
days
for
them
to
re-enroll.
We
will
automatically
re-enroll
them
in
the
last
Managed
Care
Organization.
They
were
in
when
they
exit
the
program
some
permanently
implemented
flexibilities
include
our
nurses
aid
application.
Instead
of
using
a
social
security
number
or
requiring
a
social
security
number,
we
will
use
their
I-9
and
expansions
of
Telehealth
outlined
in
our
regulation.
F
So
in
during
the
public
health
emergency,
the
department,
as
all
state,
a
all-state
Medicaid
agencies,
received
an
enhanced
Federal
match.
We
call
this
our
F
map,
so
we
received
that
during
the
public
health
emergency
as
part
of
the
unwinding
Medicaid
directors
were
very
concerned.
That
elimination
of
the
public,
health,
emergency
or
termination
of
the
public
health
emergency
would
result
in
a
huge
fiscal
impact.
If
that
Federal
match
just
completely
went
away
on
the
day
that
the
public
health
emergency
ended.
F
There
are
lots
of
conversations
with
their
National
Association
of
Medicaid
directors
and
others
with
Federal
officials
and
during
the
the
unwinding
period
during
the
rules,
they
have
allowed
states
to
phase
down
that
fmap,
rather
than
taking
it
away
completely.
So
this
just
tells
you
how
we're
how
we
will
be
will
be
transitioning
that
fmap
phase
down.
F
We
do
have
some
criteria
that
we
have
to
abide
by
in
order
to
get
that
enhanced
fmap
through
through
December
31st
of
2023,
which
is,
we
cannot
have
any
eligibility
guidelines
that
are
more
stringent
than
we're
in
place
before
the
public
health
emergency.
We
have
to
make
sure
that
we
help
individuals
update
their
contact
information
and
we
cannot
enroll
anyone
who
had
been
who
did
not
return
their
mail
without
first
making
a
good
faith
effort
to
contact
contact
them
using
more
than
one
modality.
For
example,
text
email
phone
call.
D
F
A
Let
me
start
if
I
could
you've
done
an
excellent
job,
as
always,
but
I'm
trying
to
figure
out
what
Medicaid
looks
like
in
the
future.
You
know
my
first
session
was
2017.
At
that
time
we
had
1.3
million
kentuckians
on
Medicaid
budget
was
10
billion
dollars
and
I
said
then
so
I
think
it's
as
large
as
it
ever
should
be,
because
if
we're
getting
people
back
to
gainful
employment
and
we're
improving
the
health
of
the
population,
the
funding
is
to
be
sufficient.
A
D
D
So
I
think
it's
going
to
take
time
for
us
to
to
realize
that,
because
the
number
of
folks
on
Medicaid
and
what
that
fmap,
that
those
impacts
go
like
this,
and
so
we're
really
struggling
with
figuring
out
how
to
give
you
an
accurate
projection.
It
is
we
we
just
if
we
gave
you
one
before
this
month.
That
would
have
said.
Probably
one
thing:
if
we
gave
you
one
after
this
month
and
just
based
on
this
month,
it
would
be
another
thing
completely
I,
just
I,
don't
know
we
just
don't
know
at
this
point.
D
A
I'm
just
trying
to
figure
out
you
know
where
we're
going.
You
would
think,
with
supposed
largest
economic
expansion
we've
seen
in
in
the
state's
history,
we
would
see
more
people
within
the
private
sector
getting
their
insurance.
That's
not
coming
to
a
fruition
at
this
point
in
time
and
is,
is
the
issue
is
that
these
are
jobs
that
aren't
providing
Health
and
Care
benefits
or
or
we're
not
getting
people
back
to
work
as
we
anticipated
or
is
Healthcare
just
so
expensive
that
people
have
no
other
alternative
at
this
point
in
time,.
D
It's
like
I,
say
these:
these,
these
numbers
are
surprising
it
and
so
I'm,
asking
the
same
questions.
You
just
asked
me
who,
on
this
transition
to
Private
health
insurance,
and
how
can
we
figure
that
out
or
can
we
figure
it
out?
How
many
folks,
who
are
eligible
for
the
qualified
Health
Plan,
have
actually
gone
on
ahead
and
signed
up
or
are
they
waiting
to
find
out
that
they
don't
have
any
and
that
this
is
their
only
option?
I
think
we're
going
to
see
some
of
that.
D
I
can't
tell
you
how
much
so
most
people
on
Medicaid
well,
most
of
the
folks
on
the
expansion
piece
of
Medicaid
have
jobs
that
are
not
paying
them
enough
right
in
order
for
them
not
to
receive
Medicaid
or
they
have
a
number
of
children
that
makes
them
eligible
and
certainly
can
show
you,
those
numbers
I
think
we've
talked
about
it
before
so
so.
There's
that
piece
as
well
and
then
in
terms
of
increased
spending
by
Medicaid.
D
D
D
A
Discussions
on
this
I
know
with
budget
reviews
coming
up
that
you
folks
will
be
testifying
numerous
times.
We
may
not
have
this
opportunity
to
go
into
details.
We
did
in
the
past
because
we
don't
have
Medicaid
oversight
any
longer.
We
may
have
to
do
within
Health
Services
committee
meeting,
but
that's
wonder
you
know:
are
there?
Are
there
any
goals
and
there's
a
reasonable
goal
as
to
where
we
should
be
in
terms
of
the
health
of
our
population?
You
know
when
you
talked
in
in
nauseam
about,
we
were
47
forever
now,
I
think
around
44..
A
That's
still
nothing
to
brag
about
I
think
that's
the
direct
result
of
people
having
access
to
insurance
that
they
haven't
had
before,
but
we're
really
not
moving
that
needle
a
whole
lot.
Additionally,
getting
people
off
of
Medicaid
into
game
for
employment.
Do
we
have
any
Targets
for
that,
because
you're
taking
sick
people
is
not
a
good
economic
model
right
it
just
it
may
create
jobs,
but
there's
a
cost
associated
with
that.
So
again,
I
think
to
sustain
the
program
in
the
future.
A
D
The
the
two
pieces-
I'll
I'll,
talk
about
and
commissionally
you
can
chime
in
one
of
the
things
that
is
also
excited
about
that
a
trip
piece
right,
sorry
to
abbreviate.
The
additional
payments
to
hospitals
is
there's
a
quality
piece
to
that
and
I
talked
with
the
hospital
Association.
They
are
excited
about
how
how
quality
is
working.
I
I
really
want
to
well
before
now,
but
I
think
it
would
be
wise
to
bring
folks
together.
D
Fqhcs
I'll
put
this
to
you
all
fqhcs
hospitals
mcos
together
who
should
should
have
the
same
goals
of
getting
people
healthier
and
now
we
have
funded
right
in
hospitals
and
there's
certainly
more
funding
that
can
be
done,
but
within
the
hospital
structure,
a
quality
piece
that
I
hope
moves
us
forward.
I
think
in
in
terms
of
Medicaid
enrollment
numbers
we're
going
to
see
what
this.
D
What
unwind
us
to
us
I
expect
it
to
be
less
than
I
know
it's
going
to
be
less
than
when
we
started,
and
then
what
some
of
the
pieces
that
I'm
excited
about.
Senate
Bill
90,
chairman
Moses
Community
Health
worker
bill
that
we're
getting
ready
to
implement
next
year,
as
well
as
then
some
pieces
around
mobile
crisis,
which
should
help
with
with
homeless
and
and
First
Responders
I
hope.
Those
things
help
us
move
towards
quality,
particularly
in
folks
that
are
that
are
have
probably
the
most
significant
health
issues.
D
The
same
is
true
in
in
child
welfare.
The
other
thing
that
keeps
me
up
at
night
is
is
our
high
Acuity
Youth
and
and
not
having
good
placement
for
them.
That's
that's.
Just
that
really
worries
me.
It
worries
me
for
our
social
workers.
It
marries
me
for
for
for
our
kids
and
and
we've
had
hundreds
of
kids
and
we've
tried
thousands
of
placements,
so
it
is
we've
got.
We've
got
some
work
to
do
there
around
where
and
how
we
we
can
work
with
that
particular
population.
D
It
we
are
seeing
I
I've
testified
here
before
what
we're
seeing
are
are
kids,
who
are
more
acute
in
terms
of
their
behavioral
health
challenges.
You
even
heard
it
on
the
Juvenile
Justice
side
right.
There
are
significantly
greater
challenges
and
finding
good
placement
and
good
services
for
those
kids
has
been
a
continuous
challenge.
D
D
A
F
I,
don't
think
I'm
ready
to
comment
on
that
yet,
but
I
think
what
I
would
like
to
add
to
secretary's
comments
related
to
Quality.
All
of
our
directed
payments
for
our
providers
do
have
a
quality
measure
in
it.
There's
something
we're
working
very
closely
on
to
monitor.
We
also
our
Managed
Care
organizations
have
value-based
payments
with
some
of
their
providers.
We
are
amending
our
MCO
contract
to
have
value-based
purchasing
with
their
mcos.
F
We
are
going
to
have
a
withhold
and
we
are
going
to
expect
them
to
improve
the
quality
of
services
that
they
provide
to
our
members,
or
we
will
withhold
that
funding
from
them.
So
definitely
looking
at
everything
we
can
related
to
Quality
and
value-based
payments,
but
we
also
need
to
look
at
our
Prevention
Services.
We
need
to
focus
a
lot
on
on
prevention.
D
A
Specifically
that
there
are
safeguards
in
place
to
make
sure
that
if
they
receive
a
reduction
in
their
payments,
that
that
doesn't
filter
down
to
provider
payment
schedule
correct,
so
there
are
safeguards
in
place.
Yes,
you
know
what
keeps
me
awake
at
night
is
access
to
care
and
I'm,
not
talking
about
having
health
insurance,
because
you
can
have
health
insurance
still
not
have
access
to
care,
and
we
heard
testimony
last
summer
from
all
the
mcos
at
their
credibility.
Providers
is
like
the
provider.
Networks
are
like
95
percent,
and
we
know
that's
not
true.
A
H
Do
thank
you
chair.
Thank
you,
Mr
secretary,
this
might
be
a
native
question
since
I'm
new
back
on
page
or
slide
three
talk
about
the
renewal
case,
distribution
and
I'm
just
curious
about
the
data.
Is
there
a
cyclical,
month-to-month
nature
or
trend
of
how
those
go
up
and
down
year
over
year
month
by
month?
And
if
so,
can
you
explain
why.
D
I'm
gonna,
let
Lisa
explain
why,
but
really
it
does
have
to
do
with
some
of
the
cyclical
nature,
of
that
it
also
has
to
do
with
availability
of
Workforce.
So
just
straight
up
the
dip
you
see
after
the
first
couple
of
months
is
to
give
us
an
opportunity
to
to
really
retool
a
little
bit
as
well
as
Workforce,
and
then
people
come
into
our
systems
at
different
times.
D
When,
when
open
enrollment
occurs
oftentimes,
we
see
a
an
increase
in
folks
who
come
into
Medicaid
through
through
trying
to
get
just
health
insurance
on
on
our
exchange.
So
you'll
see
there
is
some
cyclical
nature
to
it,
and
then
it's
also
we
sort
of
front
loaded
a
little
bit
and
with
folks
we
thought
were
going
to
be
ineligible.
So
that's
that's
why
you
see
that,
but
all
those
things
are
factors.
H
E
C
F
We
have
our
income
tax
information,
so
we
have
all
we
can
ping
all
of
those
data
sources
and
we
we
do
that
periodically
through
the
year
too,
just
to
make
sure
that
everyone
remains
eligible.
So
we
have.
We
have
those
data
sources,
we
ping
those
data
sources
and
if
our
system,
the
information
that
the
member
has
input
into
our
system
matches
those
data
points,
then
we
do
not
have
to
ask
for
additional
verification.
D
C
One
more
question
on
this:
updated
slide
that
you
provided
for
us
and
you
might
have
said
it
and
I
just
didn't
catch
it,
but
I'm
looking
for
some
clarification.
So
the
number
of
individuals
terminated
that
34
000
and
change
number
that
am
I
correct
in
understanding
that
that
is
a
combination
of
people
who
may
not
be
eligible
anymore
for
Medicaid,
because
they
have
transitioned
into
a
qualified
health
plan
as
well,
as
maybe
other
things
like
they
just
didn't
renew
or
what.
D
I
A
I
For
the
end
of
the
public
health
emergency,
this
is
a
welcome
time
for
all
of
us.
It's
certainly
a
welcome
time
for
the
Public
Health
Community.
That's
had
to
work
so
hard
during
the
pandemic,
so
most
of
our
federal
grants
have
run
their
course
and
or
the
federal
funding
that
we
receive.
So
you
look
at
cares
funding.
That's
long
done,
arpa
funding!
That's
long
done!
We
have
special
and
designated
funding
for
laboratory
for
Disaster
Response
for
Health
Equity
work.
Those
grants
were
supposed
to
end
most
of
them
at
the
end.
I
June
30th
2023
give
or
take
a
month,
and
they
were
extended
a
number
of
them
to
have
extended
spending
period
till
next
summer,
so
the
spending
plan
for
those
has
already
been
introduced
and
we're
really
largely
in
final
execution
and
wind
down
for
those
grants.
So
that's
what
the
first
bullet
mentions
up
there
at
the
top.
One
thing
you
might
notice
for
those
of
you
who
cross
over
when
you
do
the
budget
next
year,
this
last
year
is
the
final
year
getting
money
out.
I
So
this
would
be
the
last
year
that
public
health
budget
is
larger
than
what
it
might
normally
otherwise
be
for
fy24,
and
when
we
get
to
fy25
the
next
biennium
we're
going
to
recede
back
into
more
of
what
our
normal
footprint
would
be.
If
that
helps,
one
of
the
many
big
things
we've
done
is
provide
a
lot
of
testing
for
covet,
particularly
earlier
in
the
pandemic
and
throughout
almost
all
actually,
all
of
the
regular
Laboratory
Testing
is
largely
gone
at
this
point,
except
for
our
ongoing
support
for
long-term
care
facilities
for
the
nursing
homes.
I
A
I
We
have
distributed
a
large
portion
of
the
tests,
we
have
on
hand
we're
continuing
to
try
to
distribute
the
ones
we
have
remaining.
Those
are
ones
that
the
federal
government
purchased
at
this
point
that
were
given
out
to
the
states,
and
then
we
have
a
small
amount
of
money
still
remaining
over
the
next
fiscal
year.
So
the
state
fiscal
year
24,
where
we'll
be
able
to
continue
to
provide
tests
for
the
health
departments,
and
then
they
can
use
those
within
their
communities
to
support
high
priority
areas.
I
The
correctional
facilities,
the
school
testing
support,
will
dissipate
and
that
that
won't
be
there
anymore.
We
we
found
that
there
were
a
number
of
schools
and
districts
this
year
who
were
interested,
but
there
were
quite
a
few
who
didn't
want
the
test,
even
though
we
offer
them
repeatedly.
So
it's
just
run
its
course.
We're
getting
to
the
end
of
that
Journey.
I
Most
responsibilities
for
the
kova,
19
vaccines
and
Therapeutics
either
have
ended,
have
transitioned
or
are
transitioning
so
give
you
examples.
Rem
desevere
was
the
very
first
medication
that
was
approved
for
use
for
covet,
that's
all
on
the
commercial
marketplace.
Now
it's
a
regular
medication,
fully
approved
and
and
it's
purchased
and
provided
at
the
discretion
of
Physicians
if
they
feel
it's
appropriate,
monoclonal
antibodies
that
got
a
lot
of
attention
during
parts
of
the
Pandemic
those
are
gone.
There
are
no
more
monoclonal
antibodies.
Every
time
the
virus
changed
substantially.
I
You
had
to
design
a
new
antibody
for
the
new
virus
and
there's
just
not
the
demand
for
it
at
this
point
and
the
combination
of
the
number
of
people
who
have
some
immune
protection
because
they've
been
infected
plus
the
number
of
people
who've
had
the
vaccination,
plus
the
the
large,
probably
majority
of
Americans
who've,
been
both
infected
and
vaccinated
that
in
the
changing
of
the
virus,
has
made
those
Therapeutics
no
longer
economically
needed
or
just
sustainable
or
needed.
The
oral
antiviral
medications
Pax
lovid.
I
You
see
that
commercial
on
commercials
and
TV-
that's
largely
commercialized
at
this
point,
but
the
federal
government
still
has
a
supply
of
that,
and
so
that's
available
still
at
no
charge
for
the
medication.
You
may
have
to
pay
the
pharmacy
fee
to
have
expense
but
available
at
no
charge
for
medication
for
many
people,
but
that
will
all
be
commercial
here
very
very
shortly,
as
supplies
run
out
and
as
far
as
the
vaccines.
The
federal
government
has
the
most
current
bivalent
vaccine
and
still
has
supply
of
that.
I
So
you
can
still
go
get
your
bivalent
vaccine
at
no
charge
right
now
for
the
vaccine
itself
and
again
now
that
the
emergency
has
ended,
you
may
have
to
pay
a
pharmacy
administration
fee
which
your
insurance
company
would
typically
cover.
This
fall,
if
there's
a
new
or
revised
vaccine,
that'll
all
be
the
commercial
marketplace
with
very
scant
exception.
I
So
really,
all
of
this
has
been
mainstreamed
into
the
regular
Health
Care
system
for
the
most
part,
and
what
tail
part
has
not
been
is
in
the
process
of
transitioning
and
then
another
huge
task
that
we
did
very
early
in
the
pandemic
and
throughout
the
peak
parts
of
the
pandemics,
was
data,
collection
and
Analysis,
and
that
has
also
largely
normalized
into
routine
approaches
that
we
use
for
other
diseases
so
that
we
every
year
provide
a
flu
report
during
flu
season.
We
don't
typically
provide
an
RSV
report.
I
We
have
provided
really
substantial
analysis
in
public
reporting
for
the
covet
pandemic,
but
now,
if
you
go
to
the
website
like
has
happened
in
States
all
over
the
country
that
has
largely
Consolidated
to
very
few
data
points,
because
the
hospitals
just
aren't
being
overburdened
by
covet
right
now,
so
it's
no
longer
necessary
and
the
data
is
not
actionable
in
the
way
that
it
was
earlier
in
the
pandemic.
So
it's
not
over
covid
still
exists.
Covet
is
still
out
there.
I
Unobligated
funds
are
going
to
be
taken
back
to
the
treasury,
and
so
we
have
to
see
how
they
Define
obligated,
whether
it's
when
they
assign
it
to
us
when,
when
we
spent
it
or
when
we
have
it
budgeted
in
that
nobody
knows
the
answer
to
and
the
president
just
signed
that
into
law.
Yesterday,
I
think
and
so
we'll
find
out
in
the
weeks
ahead,
what
the
implications
of
that
are
and
do
our
best
to
adapt,
and
so
that's
all
I
have.
D
D
My
eye
right
look
to
me
to
be
too
small
to
be
a
huge
take
back
from
the
states,
but
again
I,
don't
know
what
unobligated
means.
I
mean.
I
know
what
the
word
means,
but
I
don't
know
what
it
means
in
federal
speak,
so
we're
still
monitoring
what
that
impact
is
going
to
be,
and
we
think
we
might
know
but
I
we
don't
know,
and
it's
it
is
it's
a
profound
difference
not
only
for
public
health
but
for
the
Department
of
community-based
Services,
which
you'll
hear
from
next.
I
A
I
think
there's
tremendous
potential
for
them,
particularly
in
in
the
area
of
improving
the
health
of
the
population,
but
that's
not
a
responsibility.
We've
necessarily
delegated
them
as
a
priority.
I
think
it
could
be
should
be,
but
you've
already
acknowledged
that
we're
probably
going
to
see
a
contraction
in
our
labor
force.
Within
Public,
Health
Department-
can
that
be
mitigated
to
some
degree
by
again
expanding
the
Rose
responsibility
of
Public
Health.
B
I
Urge
the
legislature,
you
still
have
you've,
done
a
great
job
and
you
still
have
important
work
to
do
in
the
next
pineal
session
for
the
the
next
biennial
budget.
The
public
health
transformation
dollars
you've
given
in
this
funding
period
have
been
really
really
important
to
helping
to
sustain
Public
Health
transformation
going
forward
so
remember
in
2020,
House
Bill
129
passed
and
that
structurally
changed
how
funding
would
be
done
for
public
health
departments.
But
the
funding
didn't
come
because
the
session
got
cut
short.
I
But
then
all
this
coveted
money
came
in
so
it
largely
kept
everything
afloat,
but
we
kept
everything
afloat
because
the
entire
Public
Health
System
really
focused
on
one
problem.
Then
the
legislature
came
through
and
appropriated
money,
17
or
so
million
one
year,
19
or
so
million
another
year
to
help
support
the
local
Health
departments
to
do
corn
foundational
Public,
Health
Services,
as
well
as
the
local
Health
priorities
that
are
part
of
the
transformation
effort,
so
that
work
is
well
underway.
I
Right
now,
I
would
say
covet
has
obviously
been
disruptive
for
all
of
us,
I
mean
that's
undeniable
I
mean
there's
no
one
in
the
planet
really
who
hasn't
been
touched
by
this?
Probably,
but
it
wasn't
all
bad
for
public
health.
It
was
horribly
stressful
and
it
burned
people
out
and
of
course,
there
was
division
within
Society
about
perspectives
about.
I
It
should
be
Kentucky
public
health
and
behind
the
scenes
we
work
together.
The
public
health
transformation
dollars,
along
with
our
efforts
to
continue
to
transform
Public
Health,
will
help
and
it
is
helping
now
the
local
Health
Department's
to
be
more
solidified
more
stable.
We
did
rate
increases
for
the
salaries
for
the
state
health
for
the
public
health
workers
in
the
State
Health
System,
the
last
three
months
of
last
year
that
people
haven't
seen
in
a
very
long
time
and
we've
got
stories
about
people
who
thought
they
would
lose
their
house.
I
People
who
were
worried,
their
husband
was
going
to
die
or
their
spouse
because
they
had
a
terminal
illness
that
they
wouldn't
be
able
to
support
themselves
after
they
they
passed
on.
People
had
been
in
public
health,
15
20
or
more
years,
and
not
seeing
those
kind
of
salary
increases
that
they
now
have
a
wage.
I
That
makes
it
possible
to
continue
to
do
that
and
be
sustainable
and
it's
helping
recruitment,
because
you
know
when
you
can
make
15
an
hour
to
work
in
a
fast
food
service
industry,
and
you
were
going
to
get
paid
eleven
dollars
to
work
at
the
health
department.
It
made
more
sense
to
go
work
in
the
service
industry.
Economically
for
families,
so
we
are
much
more
stable,
I
I'm,
absolutely
confident
that
Kentucky
public
health
is
better
at
this
stage
than
it
was
three
plus
years
ago.
I
I
They'll
watch
very
carefully
and
see
if
the
continued
support
for
public
health
transformation
continues
in
the
next
biennium,
which
will
help
to
make
that
possible.
But
I
think
you
should
feel
very
proud
and
I
I
hope.
You'll
take
a
moment
when
you
have
a
chance
to
thank
the
public
health
directors
that
are
in
your
jurisdictions
in
your
districts,
they
really
are
leaders
in
their
communities
and
have
done
a
wonderful
job
and
weak
dialogue
and
communicate
so
much
better
than
we
did
before.
Plus
and
I
know.
I
This
is
a
long
answer,
Mr
chair,
but
we
have
done
other
things
that
have
been
good.
We
onboarded
hundreds
and
hundreds
of
additional
labs
and
Decay
High
the
Kentucky
Health
Information
exchange
that
now
electronically
report,
their
Laboratory
test
results
for
reportable
diseases
and
and
some
of
them
and
More
in
an
ongoing
basis,
doing
electronic
case
reporting,
which
is
when
they
have
to
report
clinical
data
for
folks
who
have
reportable
diseases.
I
This
is
where
the
electronic
health
records
help
to
save
time
for
clinicians,
who
are
burned
out
themselves
and
overworked,
but
also
for
public
health
to
get
more
quickly
more
accurately
more
efficiently
that
data.
We
have
a
warehouse
that
now
has
gowns
and
gloves
and
masks
in
and
new
ventilators
and
resources
we
did
not
have,
and
those
can
help
for
floods
and
tornadoes
and
Ice
storms
and
wind
storms,
not
just
for
Global
pandemics.
We
also
have
invested
in
oh
what
I'd
like
there's
there's
at
least
two
other
things.
I
was
going
to
share.
I
Oh
some
of
our
disease
management
teams.
We
hope
this
fall
will
have
a
new
respiratory
disease
dashboard.
So,
instead
of
just
doing
influenza,
we
can
look
at
influenza
covet
RSV
to
try
to
give
a
more
useful
view
of
the
impact
of
respiratory
illnesses.
In
the
fall
and
winter
and
and
stuff
that
the
public
can
actually
see
on
a
website
and
actually
use
if
they,
if
they
choose
to
do
that,
so
we
are
better
and
we
are
stronger,
but
I
agree
with
you
Senator.
I
What
we
need
to
see
now
is:
can
we
have
a
stronger
public
health
system,
help
to
improve
and
strengthen
the
health
of
the
public,
and
that
is
the
mission
of
both
the
department
and
the
cabinet
is
to
have
healthier
people
and
healthier
communities.
So
everybody
can
reach
their
full
human
potential
and
we're
committed
to
doing
that.
But
we
had
a
lot
of
rebuilding
to
do
and
I
think,
despite
and
because
of
covid
the
Kentucky
public
health
system
is
better
off
today
than
it
was
a
few
years
ago.
A
Thank
you
I'm
curious
as
to
what
happens
with
the
next
communicable
disease
outbreak,
whatever
it
may
be,
or
we
we
have
to
admit,
we
were
kind
of
reactionary
because
nobody
knew.
What
we
were
dealing
with
is.
Is
that
an
kind
of
an
indictment
of
this
system
because
we're
dealing
with
communicable
diseases
does
it
have
to
be
so
coveted
specific?
Should
we
have
processes
in
place
that
regards
to
what
it
is
if
it's
covered
29
that
we're
better
prepared
next
time
than
we
were
this
time
so
do
have?
I
Well,
covid
was
unprecedented
in
our
any
of
our
living
history,
because
all
of
humanity
had
no
immune
exposure
to
it.
It
was
a
brand
new
disease
that
we
had
nothing
prepared
for
it.
So
we
had
no
testing,
no
treatments,
no
vaccines,
nothing
so
that
that's
what
made
that
so
seismically
different.
If
we
were
to
have
a
hepatitis
outbreak-
or
you
know,
we
actually
have
unfortunately
increasing
syphilis,
we
have
multi-drug
resistant
gonorrhea.
We
have.
We
have
yeast
infections
that
are
alarmingly
dangerous
and
difficult
to
treat
and
hit
vulnerable
folks
in
institutionalized
settings.
I
Those
those
are
really
really
serious
problems
that
require
antimicrobial
stewardship,
the
pharmaceutical
industry
to
develop
new
and
better
drugs
that
respond
to
the
situation,
but
I
think
for
those
I
think
we
have
a
better,
a
more
strengthened
network.
If
we
had
another
brand
new
infection
that
all
of
humanity
had
never
seen
again,
I
hope
we
would
do
better,
but
I
I
would
just
say
what
really
was
difficult.
Then
was
not
just
the
lack
of
knowledge.
I
It
was
just
we
we
many
of
us
look
at
the
world
and
we
just
see
it
differently
and
it
was
so.
It
becomes
divisive
if
not
in
the
beginning,
like
in
the
first
few
months,
but
very
quickly
thereafter,
because
the
types
of
actions
that
had
to
be
taken
were
so
substantial
because
the
risk
was
so
substantial,
so
I
think
as
a
society.
We
we
just
have
to
continue
to
continue
to
try
to
do
the
best
we
can
to
recognize
what
are
those
moments
that
really
rise
above
the
typical
differences
of
you
to
like
this?
I
Really
this
really
threatens
us
all.
It
places
a
real.
You
know
real
danger
to
so
many
people
that
that's
why
things
are
done
differently.
I
I
wish
I
could
say
we're
going
to
do
better
if
that
were
to
happen
again,
but
I
think
human
I
study
history
Humanities
and
has
been
Humanity
for
a
very,
very
long
time
and
all
I
can
say,
is
I
think
in
Kentucky,
where
we
still
have
difference
of
opinion.
I
I
Some
nice
woman
with
her
two
middle
school
kids
that
I
feel
like
I,
should
say.
Thank
you,
which
I
thought
was
very
courteous
and
I
said
now,
I'm
embarrassed
because
look
at
the
example
I'm
setting
as
a
health
commissioner,
but
it's
all
I
had
time
for
before
I
came
over
here
so
but
the
point
I
would
say
is
as
I
travel
around
the
state
people
say.
Thank
you
all
all
over
the
place
and
people
say
thank
you
regardless
of
party
and
even
identify
party
and
I.
Don't
think
that
means
they
agreed
with
everything.
I
I,
don't
think
that
for
one
minute,
I
think
they
recognize
God
that
really
looked
terrible.
It
was
terrible
and-
and
thanks
for
at
least
trying
and
so
I
think.
If
we
continue
to
find.
Where
can
we
cooperate
on
things?
I
think
we
would
do
better
Senator,
but
I
also
am
saying
one
about
it.
It'll
continue
to
be
a
challenge
because
humanity
is
just
humidity.
A
D
D
A
I
would
agree
any
questions
comments
from
committee
members,
if
not
I,
think
all
of
you
for
your
present
stations
today,
invaluable
information,
good
start
for
us
and
I'm
sure
we'll
be
inviting
you
back
to
feature
meetings
as
well.
But
thank
you
for
your
time
and
thank
you
for
your
job
that
you've
done.
J
Okay,
so
for
dcbs,
we'll
be
talking
about
three
different
program
areas
and
the
impact
at
the
end
of
the
public
health,
emergency,
Child
Care,
our
child
welfare
programs
and
public
assistance.
So
we'll
begin
with
child
welfare,
I'm,
sorry,
Child,
Care,
Child
Care.
So
with
the
end
of
the
public
health,
emergency
dcbs
anticipates
a
decrease
in
the
child
care
and
development
block
grant
funding,
as
a
lot
of
that
was
one-time
funding
provided
through
Krista
and
arpa,
and
that
has
to
be
liquidated
by
September
of
2024.
J
areas
or
programs
that
we,
that
will
that
we
will
not
be
able
to
support
with
with
the
child
care
development
development
block,
grant
funding
going
forward.
You
see
here
on
the
screen,
the
transitional
funds,
the
the
transitional
child
care
assistance
program,
which
is
a
program
that
we
began
to,
because
we
know
that
child
care
is
the
biggest
one,
the
biggest,
if
not
the
biggest
benefit,
Cliff,
that
our
families
experience
when
they
increase
their
their
wages
and
income.
J
So
we
we
began
that
program
and
which,
which
allow
families
to
continue
to
receive
50
percent
of
their
child
care
payments
as
they
as
they
transitioned
as
they
transition
from
In
from
from
with
increased
income
and
work
requirements.
Work
so
that
transitional
child
care
assistance
program
will
not
be
able
to
continue
after
September
of
2024
unless
additional
funding
is
provided
and
then
our
child
care
sustainability
payments
will
end.
J
Kentucky
was
awarded
763
million
dollars
in
arbit
funds
and
dedicated
to
child
care,
and
470
million
of
those
funds
were
designated
for
sustainability
payments
and
those
have
been
issued
to
child
care
providers
over
nine
quarterly
payments.
We've
issued
seven
of
those,
and
we
have
two
remaining.
Those
will
end
at
the
with
the
end
of
the
public
health
emergency
and
then
our
startup
grants
for
child
care.
Centers
and
homes.
D
And
I
of
all
the
places
that
we've
talked
about,
this
is
the
cliff.
This
is
the
Fiscal
Cliff.
It's
going
to
be
tremendously
challenging
for
the
entire
industry.
As
these
payments
come
to
an
end,
I'm
worried
about
it.
You
will
hear
from
Child
Care
Providers
you'll,
because
they're
worried
about
this
too
we're
going
to
extend
as
far
as
we
possibly
can
with
existing
funds.
But
at
some
point
that's
got
to
end
the
other
piece
that
last
piece
on
here
is
a
piece
that
I
happen
to
love.
D
We
have
really
been
able
to
start
some
small
centers
we've
been
able
to
support
some
a
few
big
centers
and
it
it
really
has
what
about
40
of
the
family
child
somewhere
in
that
number,
and
those
are
all
like
the
little
family
child
three
three
and
below
in
terms
of
caring
for
children,
but
it's
sort
of
the
start
of
a
ladder
of
Entrepreneurship
and
support
for
for
a
child
care
for
folks
getting
back
to
work
and
I'd
love
to
figure
out
how
to
that's
a
small
one.
But
these
are.
These
are
important.
D
D
This
is
it
it's
childcare,
and
so
what
we
do
here
is
probably
going
to
have
the
greatest
impact
I
think
on
folks
being
able
to
go
to
work.
The
infrastructure
for
our
counties,
I
think
those
are
the
challenges
that
we're
gonna,
we're
gonna,
see
and
I.
Guess
we
can
do
them
one
at
a
time,
since
this
is
the
big
one.
A
H
D
H
Here's
a
medium,
here's
worst
case
scenario
and
how
you're
looking
at
that
Domino
from
a
funding
and
then
from
a
holistic
care.
If
you
will
Workforce
Place
daycare,
all
those
kinds
of
things
together
in
kind
of
a
helping
us
understand,
some
of
those
Cliff
options
and
I'm
sure
you're
working
on
that.
J
But
I'm
in
our
extended
commitment,
youth
during
the
pandemic,
there
were
simplified
processes
for
states
to
provide
assistance
to
those
youth
allowing
flexibilities
around
some
of
the
secondary
education
work
program
and
or
employment
requirements
for
those
youth
and
again,
with
the
end
of
the
PhD.
Those
flexibilities
will
be
going
away.
J
And
then
also
with
regards
to
child
welfare,
we
had
flexibilities
around
virtual
visits
with
our
children
out
of
Home
Care.
The
Federal
Federal
Law
requires
that
case
workers,
our
social
workers
visit
with
their
children
and
out
of
Home
Care
face-to-face
monthly,
and
during
the
pandemic
there
was
increased
flexibility
around
that
requirement,
allowing
allowing
caseworkers
to
visit
with
children
virtually
when
it
was
determined
to
be
safe.
To
do
so.
So
we
we
did
exercise
that
flexibility
during
the
pandemic,
and
there
was
a
lot
of
benefit.
J
Bound,
To,
That
on
behalf
of
both
children,
as
well
as
to
our
social
workers.
Increased
contact,
Our,
Youth
and
out
of
Home
Care
are
very
Adept
at
using
Face,
Time
and
other
other
virtual
methods
of
communication
and
find
it
sometimes
more
comfortable,
and
we
found
they
were
more
willing
to
open
up
and
talking
share
with
us,
even
in
some
of
those
platforms.
So,
but
with
the
end
of
the
public
health
emergency
that
flexibility
will
end
as
well,
and
social
workers
will
be
required
to
resume
those
face-to-face
monthly
visits.
And
again
we
were
doing.
J
C
J
Have
to
be
in
compliance
with
the
requirements
of
the
national
finger
print
background
check.
We
also
passed
legislation
I
believe
in
2020
to
support
to
align
with
the
federal
requirements
requiring
all
of
our
our
child
care
providers,
as
well
as
our
own
staff
within
dcbs
to
be
fingerprinted,
and
so
we've
been
working
with
to
expand
our
our
platform
on
cares.
J
The
don't
ask
me
what
care
stands
for
right
now,
but
that
that
that
system
that
we
utilize
with
KSP
and
the
FBI
to
to
bring
us
up
to
standards,
the
national
standards
of
being
in
compliance
with
that
with
that
law.
So
again,
we
we
have
until
June
June
30th
to
be
in
compliance.
Okay,
okay
and
we've
been
working
on
this
throughout
the
pandemic,
with
implementation
and
development
of
that
those
that
program.
Here's
program.
C
What
is
the
average
time
that
it
takes
someone
to
go
through
that
process,
and
particularly
what
I'm
curious
about
is
how
that
holds
up
other
components
of
whether
that
be
Workforce
Development
right
getting
new
workers
on,
but
also
our
foster
parents
right.
So
as
a
former
foster
parent
with
the
state
and
somebody
who
still
does
mentorship
through
the
University
of
Kentucky
I
just
talked
to
a
family.
J
So
we
have
been
actually
working
during
during
all
along
to
build
our
capacity
within
their
within
the
care
system
to
make
that
process
easier
and
more
quicker.
If
it's
an
in-state
background
check,
those
are
done.
I,
say
relatively
quickly,
but
within
two
to
five
days,
usually
within
a
week's
time
frame.
But
if
it's,
but
if
it's
and
that's
like
I
said
that's
our
average
turnaround
time.
J
But
if
it's
an
out-of-state
request,
then
that's
where
we
have
to
involve
KSP
and
some
of
the
FB
that
you
know
those
pieces
and
those
can
take
longer.
So
if
an
individual
has
lived
out
of
state
within
the
last
five
years,
then
we
have
to
complete
the
out-of-state
background
check
and
that
that
can
be
a
longer
take
longer
to
give
back
more
dependent
upon
other
agencies.
C
Will
individuals
continue
to
have
to
come
to
their
headquarters
so
for
in
Jefferson
County?
That's
the
lnn
building
right!
That's
where
I
did
my
fingerprinting
many
moons
ago,
or
do
we
have
any
sort
of
flexibility
to
be
able
to
have
people
dispatch
to
individual?
You
know
you're
doing
your
your
I've
blanked
on
the
word,
but
basically
your
your
home
inspection
or
your
home
check
right
where
your
social
worker
is
coming
in.
C
D
J
The
supplemental
nutrition
assistance
program,
the
snap
time
time
limit
so
adults,
ages,
18
to
49,
who
are
subject
to
the
general
work
requirements
and
who
do
not
have
dependents,
who
we
refer
to
as
abod's
able-bodied
adults
without
dependents
can't
receive
SNAP
benefits
for
more
than
three
months
within
a
three
year
period
unless
they
are
participating
in
an
ENT
or
other
educational
or
work,
either
paid
or
volunteer
for
for
work
requirement
for
at
least
20
hours
per
week
on
average.
So
those
time
limits
and
requirements
I
will
be
back
in
place.
J
We
also
have
increased
Kentucky
work
program,
Outreach
and
engagement
to
increase
work
participation
ahead
of
the
unwinding
work
requirements
for
ktap
recipients
who
are
work,
eligible,
went
back
into
place
last
July
and
recipients
had
until
November
to
meet
requirements
or
would
experience
penalties
or
disqualifications
beginning
in
December,
and
then
lastly,
I
just
want
to
mention
again.
The
lack
of
child
care
options
has
has
been.
We've
talked
about
that
repeatedly
as
a
barrier
and
one
of
our
biggest
benefit
Clips
benefit.
Cliffs
and
that
continues
to
be
a
barrier
to
work
participation.
D
A
Any
questions
comments
get
a
little
premature
earlier,
but
again,
thank
you
for
your
presentation
today
and
the
valuable
information
you
provided.
This
I
think
it's
already
helped
us
put
some
things
into
Focus
as
it's
what's
going
to
be
a
priority
for
us
this
next
legislative
session,
but
this
is
a
work
in
progress,
and
so
we
move
on
to
next
steps
and
just
a
reminder
that
our
next
meeting
is
July
24th,
2023
I
would
encourage
our
committee
members
to
look
at
the
charge
of
this
committee.
A
I
think
is
what
you
provided,
because
it
can
be
kind
of
why
kind
of
unwielding,
but
specifically
not
to
preach
to
you.
But
our
task
force
should
examine
the
structure
operations
program
policy
procedure
when
the
Cabinet
for
Health
and
Family
Services
determine
if
or
how
service
can
be
delivered
more
effectively
and
efficiently,
examine
Kentucky's
benefit,
Cliffs
and
continuing
the
work
of
the
power
benefits,
Cliffs
task
force,
so
a
a
wide
charge
that
we
had
before
us
to
that
end
between
now
and
the
next
time
we
meet.
A
If
you
have
any
particular
areas
that
you
would
like
us
to
take
a
look
at
or
concentrate
on,
please
let
myself
know
or
co-chair
Mead
and
we'll
try
to
incorporate
that
into
a
future
meeting,
but
with
that
we'll
be
working
on
the
agenda,
get
it
out
to
you
just
as
soon
as
possible.
With
that
any
other
questions
comments
for
the
good
of
the
calls,
if
not,
then
we'll
stay
in
adjourned
thanks
everyone
for
your
participation
today.
Thank
you
represent
me.