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B
B
Thank
you
all
for
your
willingness
to
serve
on
this
task
force.
As
you
well
know,
the
cabinet
for
health
and
family
service
is
the
largest
and
most
complex
cabinet
and
state
government
serving
thousands
of
families
throughout
our
commonwealth,
and
the
complexity
is
certainly
reflected
in
the
agendas
of
our
committees
of
health
and
welfare
and
medicaid
oversight,
child
welfare
oversight
and
our
budget
review
subcommittees,
and
we
never
seem
to
be
at
a
loss
for
agenda
items
discussed
during
those
meetings.
B
B
We're
going
to
do
all
this
in
six
meetings.
Well,
obviously,
you
know
we're
not
it's
quite
a
chore
that
we're
undertaking.
But
again
I
commend
each
of
you
for
wanting
to
participate
in
this
process,
but
today
our
starting
point
is
the
review
of
the
organizational
structure
of
the
cabinet,
I'm
very
pleased
to
have
our
guest
with
us.
If
you,
gentlemen,
you
know
our
routine,
if
you
want
to
introduce
yourself
for
the
record,
feel
free
to
proceed.
D
C
D
C
Is
jackie
richardson,
my
chief
of
staff
for
the
cabinet
health
and
family
services
welcome?
First,
I
want
to
start
by
saying
thank
you
for
the
opportunity.
C
The
cabinet
is,
as
you
have
said,
large
complex,
perplexing
frustrating,
but
in
the
end,
what
I
hope
we
do
is
is
good
work
on
behalf
of
the
citizens
and
the
communities
across
the
commonwealth,
and
I
want
to
try
to
give
an
overview
as
quickly
as
I
can
around
the
structure
and
operations.
C
We
have
tried
to
boil
this
down
as
far
as
possible
to
a
couple
of
slides
per
department
and
so
happy
to
take
questions
along
the
way.
Otherwise,
I'm
going
to
be
talking
a
long
time,
but
please
feel
free
to
ask
me
questions
at
any
point
and
of
course,
we'll
we'll
potentially
leave
time
at
the
at
the
end
of
the
presentation.
Hopefully
it's
not
seven
o'clock
so
to
begin
it.
B
Let
me
interrupt
just
briefly
say
that
we
have
a
copy
of
this
organizational
chart.
So
again
this
itself
is
kind
of
overwhelming,
but
you
folks
will
have
a
chance
to
review
that
in
more
detail,
but
I'm
sure
you're
going
to
cover
as
many
points
you
can.
But
yes
just
want
the
committee
members
to
know
that,
then
this
is
kind
of
our
starting
point.
Right
thanks,
sir.
C
And
and
we
have
provided
a
bunch
of
information-
and
hopefully
this
will
allow
you
all
to
figure
out
where
you
want
to
point
within
the
cabinet
and
and
with
that
information
that
we
provide
I'll
begin
with
this
and
end
with
this
in
any
transition.
C
Any
transition,
new
cabinet
leadership,
new
administration,
whatever
and
I've
been
through
a
few.
What
I
always
suggest
folks
do
is
look
at
our
budget
narratives,
because
we
we
supply
them
to
the
general
assembly
every
two
years.
Look
at
what
are
called
the
f
forms,
which
our
federal
fund
talks
about
federal
funds,
what
they
are,
what
they
go
to
and
then
the
g
forms
which
is
really
kind
of
the
agency
fund
sort
of
grant.
That's
the
quickest
way.
It's
still
a
long
way,
that's
not
a
small
amount
of
paper,
but
it's
the
shortest
cut.
C
B
C
I'm
planning
on
that
and
this
presentation,
the
the
reorganization,
will
go
into
effect
on
the
july
14th,
but
this
presentation
kind
of
incorporates
what
that
reorganization
would
look
like
so
without
if
it's
all
right
to
proceed.
C
So
we've
come
up
with
basically
an
infographic
for
each
of
our
departments.
This
is
an
infographic
for
the
cabinet
and
and
what
we're
trying
to
get
across
here
is
that
the
cabinet's
big
that
one
in
three
kentuckians
receive
their
health
care
coverage
through
medicaid
that
we
probably
touch
every
life
in
kentucky.
If
you
start
to
look,
if
you
just
look
at
birth
and
death
certificates
right,
we
we
essentially
have
an
interaction
with
the
general
every
person
in
the
commonwealth.
C
C
Please
pull
your
counties
and
see
because
what
we
like
to
talk
about
and
I'll
get
into
this
later
in
the
conversation
when
we
get
into
the
departments,
but
you
know
what
does
medicaid
mean
for
a
local
hospital?
What
does
medicaid
mean
for
for
a
nursing
facility
or
physicians
right?
What
does
that
mean
for
community
infrastructure
same
for
grocers,
wic
and
snap,
and
what
does
that
mean
for
a
local
grocer
and
what?
What
does
that
mean
for
support
child
care?
What
does
that
mean
for
that
kind
of
infrastructure?
C
I'm
I'm
of
the
opinion,
and
I
believe
it's
correct-
that
we
through
medicaid
and
again
I'll,
get
this
when
we
get
there.
You
know
a
lot
of
the
infrastructure.
Support
really
comes
through
some
of
the
programs
and
and
what
I
hope
if
we
do
it
right
and
again,
that's
that's
what
we're
here
to
talk
about,
and
that's
what
we're
trying
to
do.
I
promise
you:
if
we
do
it
right,
it
should
be
supportive
to
our
communities.
C
So
I
I
did
talk
about
medicaid
first,
because
medicaid's,
the
the
the
giant
piece
of
the
cabinet
right.
You
can't
talk
about
the
cabinet
without
talking
about
medicaid
and
the
other
reason
that
the
cabinet
is
structured
in
the
way
that
it
is
is
that
that
medicaid
is
able
and
I'll
show
this
as
we
go
through
the
individual
departments.
C
C
That
has
always
been
a
one
of
the
things
that
the
cabinet
tries
to
do
and
I'll
give
you
some
statistics
over
the
years
and
if
I
forget
them,
eric
will
correct
me,
but
you'll
see
an
agency
fund
when
we
get
to
different
departments
agency
funds,
if
there's
a
large
agency
fund
proportion
in
in
a
department
that
is
oftentimes
a
lot
of
that
ends
up
being
medicaid
dollars
and
I'll
point
it
out
when
that's
not
the
case,
but
you
can
see
medicaid's
alliance
here
department
of
community-based
services,
because
that's
where
most
of
the
employees
are
that's
our
eligibility
side
again
I'll
cover
that
a
little
more
later
is
the
next
largest.
C
It
used
to
be
that
behavioral
health
was
the
third
largest
department,
but
because
of
kovid
and
the
influx
of
federal
funds,
that's
actually
shifted
so
that
public
health
became
the
second
largest
department.
I
expect
in
the
next
couple
of
years
that
will
shift
back
again.
A
lot
of
that
is
because
behavioral
health
operates
facilities.
That's
really
employee
intensive.
C
C
72
over
the
years
we
have
actually
the
past
four
or
five
years,
probably
shifted
out
of
general
fund
into
some
of
the
restricted
funds
in
our
federal
funds.
Over
the
past
seven
years,
six
seven
years,
we
probably
increased
that
about
ten
percent
in
terms
of
the
federal
funding
participation
and
decreased
general
fund
about
four
or
five
percent,
which
I
think
should
be
the
goal
right
to
decrease.
C
The
the
reliance
of
the
cabinet
on
state
general
funds
and
and
we've
been
somewhat
successful
in
that
I'd-
love
to
take
all
the
credit
for
it,
but
that
would
not
be
accurate.
The
the
public
health
emergency
that
extended
what
is
called
the
fmap
breach,
which
is
the
the
amount
the
federal
government,
participates
in
the
medicaid
program.
C
That
shift
probably
caused
what
you
see
there
that
that
is,
I
think,
whenever
that
ends
not
ended
yet
don't
I
can't
tell
you
when
it's
gonna
end,
because
I
don't
know
but
the
longer
it
goes
on
the
better
off
it.
We're
all
gonna
be.
C
One
other
thing
I
wanted
to
say
here-
and
this
is
an
important
thing
to
understand
from
a
structural
financial
perspective,
eric
lowery's,
a
genius
with
the
g
and
he
he
has
worked
over
the
years
on
making
sure
that
we
maximize
our
federal
funds
and
there
is
something
called
the
cost
allocation
system,
so
the
secretary's
office.
Primarily.
I
know
this
is
a
little
bit
in
the
weeds,
but
it's
really
important
to
understand.
We
allocate
our
crop
costs
like
our
administrative
costs
across
all
departments.
C
That's
really
based
on
number
of
personnel,
so
dcbs
picks
up
the
the
bigger
part
of
that.
But
that's
the
way
kind
of
the
administrative
piece
is
funded.
So
all
of
the
federal
grants
all
of
the
agency
funds,
all
of
the
some
of
the
general
funds-
are,
are
cost
allocated
across
the
cabinet.
That's
why
you
don't
really
have
a
large
general
fund
appropriation,
large
general
fund
appropriation
to
the
secretary's
office.
C
So
just
I
want
to
give
you
that,
because
it's
it's
really
important,
that
financial
structure
that
how
the
cabinet's
woven
together
through
that
cost
allocation
system
through
really
applying
costs
based
on
personnel
and
through
how
medicaid
comes
into
the
cabinet.
That's
really
an
important
piece
of
kind
of
why
the
cabinet's
structured
the
way
it
is
and
why
we're
so
big.
D
C
So
how
do
we
spend
about
eight
percent
on
personnel,
one
percent
on
operating
and
then
grants
loans
and
benefits?
What
the
heck
is
that
that
really
would
think
of
that
as
payments,
primarily
payments
to
providers,
that's
medicaid:
that's
hospitals,
nourishing
facilities,
community
action
agencies,
grocers
conference
of
chaos,
local
health
departments
utilities
for
the
la
heap
program.
That's
that's
where
this
goes.
C
Some
of
that
comes.
You
know.
Hospitals,
emergency
management
and
I'll
talk
a
little
more
about
what
that
looks
like
and
how
that
how
some
of
those
funds
process
through
the
cabinet,
but
the
vast
majority,
it's
contracts,
senator
meredith!
As
you
know,
a
lot
of
this
is
where
the
funding
of
the
cabinet
goes.
So
nine
percent's
not
banned,
but
that's
that's
how
the
cabinet
funds
are
spent.
A
Thank
you,
mr
chairman,
sir,
when
we
do
these
contracts
is
the
price
set
by
medicaid,
or
do
we
set
that
in
this
state.
C
I
don't
almost
so
medicaid
medicaid
is
set,
it's
a
it's
a
fee.
That's
set
the
vast
majority
of
medicaid
providers
work
within
the
managed
care
organization
framework,
so
some
of
those
fees
are
negotiated
through
the
managed
care
organization.
Oftentimes,
the
managed
care
organization
uses
the
fee
schedule
set
by
medicaid
they're
not
required
to,
but
frankly,
when
it's
convenient
for
them
to
use
it
they
do
and
when
it's
not,
they
don't.
C
I
think
that's
the
accurate
way
to
say
that
relative
to
other
contracts,
the
answer
is,
and
it
will
always
depend
in
the
cabinet
of
it
depends.
A
lot
of
contracts
are
done
through
a
request
for
a
proposal
where
somebody
comes
back.
The
bids
are
scored,
that's
how
the
managed
care
organizations
are
are
awarded,
but
some
of
I
think,
senator
meredith's
fa,
other
favorites
might
be
deloitte,
and
who
else
would
I
say
that?
C
Would
you
know
raise
ire,
but
but
but
what
should
happen
is
that
that
gets
put
out
in
a
request
for
proposal.
Those
requests
come
back
and
we
score
those
requests.
The
other
side
of
that
is
then
to
a
non-profit
or
like
a
quasi
governmental,
local
health
department.
Comprehensive
care
center
community
action
agency,
those
are
you,
can
contract
more
directly
with
them.
That's
as
fast
as
I
can
do.
It.
A
Can
I
follow
up
sir?
Yes,
please.
Thank
you.
The
one
thing
in
in
my
years
of
practice,
particularly
at
the
veterans
administration,
their
contracts
were
extremely
overpriced,
much
higher
than
the
going
community
rates,
which
was
very
good
for
the
providers
who
could
get
those
contracts,
but
actually
for
the
federal
government,
very
bad,
because
we
were
sometimes
paying
two
thousand
dollars
to
outsource
a
procedure.
We
could
do
for
two
hundred,
so
we're
just
paying
careful
attention.
That's
my
only
question.
C
C
Depending
upon
which
provider
group
you
ask
right,
we
are
either
barely
adequately
paying
or
we
are
underpaid
right.
I
I'm
not
picking
on
anybody.
I'm
just
giving
an
example.
Dentists
right
came
to
us
during
the
last
session
and
said
they
were,
you
know
and
we're
kentucky
we
we
don't
have
good
teeth.
C
How
do
we
you
know?
Do
we
pay
for
the
things
we
need
to
pay,
for
that
is
always
a
conversation,
and
I
I
think
in
some
ways
it
depends
on
who
you
ask
if
you
ask
your
nursing
facilities,
they're
not
getting
paid
enough.
If
you
ask,
I
mean
pretty
much,
everybody
we
pay
tells
you
that
we're
not
paying
enough
okay,
but
but
you
know
what
is
that
correct
rate
is
always
extremely
difficult
to
come
up
with.
D
B
Something
I
haven't
considered
before,
because
you
said-
and
please
correct
me
if
I'm
wrong-
that
part
of
the
reason
the
cabinet
is
as
large
as
it
is,
is
we
have
put
call
centers
under
the
cabinet
if
that's
correct,
so
that
we
can
take
advantage
of
the
indirect
cost
allocation?
And
I
assume,
when
you
do
this,
it's
sort
of
like
a
cost
report
in
itself.
That's
step
down
cost
allocation,
yeah
you're,
using
the
same
kind
of
methodology
or
similar
methodology
that
we
would
use
for
caution
boards
for.
D
Well
somewhat,
so
we
have
a
federally
approved
cost
allocation
plan
and
to
put
in
simple
terms,
this
is
so
that
we
can
capture
indirect
costs
on
these
various
federal
grants,
a
cabinet
as
large
as
ours,
winds
up
being
expensive.
When
you
consider
the
I.t
support
the
personnel
support,
the
accounting
support
the
the
administration
in
each
of
these
divisions.
D
So
with
that
federal
cost
allocation
plan,
it's
primarily
based
on
salaries,
a
statistical
analysis
is
done
on
what
our
employees
have
charged
over
the
course
of
a
month,
and
we
do
this
monthly.
But
over
a
course
of
a
month
what
programs
have
been
charged
and
then
a
a
pro
rata
allocation
is
done
against
those
grants
and
we
are
able
to
capture
the
indirect
costs
which
again
allows
us
to
further
our
operations.
D
Sir,
for
the
last
few
years
and
part
of
it
has
increased
because
of
covet
we're,
certainly
aware
of
that,
but
for
fiscal
year
19
through
fiscal
year,
22
we've
gone
up
from
50
to
54
million
dollars.
B
And
again,
if
and
we're
not,
we
don't
have
a
preconceived
notion
of
what
this
task
force
outcomes
going
to
be,
but
I
know
previously
that
the
the
cabinet
was
split
and
without
much
success.
So
that's
always
on
on
people's
horizon
to
look
at
that
again.
B
D
Well,
I
started
fresh
out
of
college,
but
when
I
went
back
as
far
as
2007
in
our
current
accounting
system
and
looked
we
one
of
our
metrics,
we
really
look
at
is
how
many
of
our
general
fund
dollars
are
tied
to
a
federal
dollar
to
make
sure
that
we're
maximizing
our
federal
funds.
Today
and
for
the
last
couple
of
years,
we've
said
that
about
86
percent
of
our
general
fund
dollars
is
tied
to
a
federal
dollar
in
2007.
That
was
76
percent.
D
C
I
also
I
was
going
to
say
this
to
the
end,
but
since
we're
here,
I
I
also
lived
through
the
cabinet
split
and
the
cabinet
being
put
back
together
by
the
way
it
was
a
democratic
governor
that
split
them
and
a
republican
governor
that
put
it
back
together.
Just
you
know
for
your
information,
but
it
yeah,
I
wouldn't
want
to
live
through
it
again.
It
was.
It
was
difficult.
C
It's
it's
hard!
Speaking
as
a
secretary,
it
is
hard
enough
to
get
departments
to
collaborate
and
work
together
when
we
were
split
it.
It
was,
it
was
very,
very
difficult
and
then
the
cost
allocation
system,
as
eric
was
talking
about
the
cabinet
for
families
and
children,
which
had
dcps
really
had
sufficient.
C
At
that
point,
because
of
the
way
we
did
cost
allocation
had
sufficient
administrative
funds,
the
cabinet
for
health
services,
which
is
where
I
was
so
I'm
biased,
was
starved
for
administrative
funds,
because
since
we
did
it
on
salaries,
it
really
split
the
administrative
side
to
the
what
was
called
the
cabinet
for
families
of
children.
At
that
time,
two
longest
serving
secretaries
in
the
history
of
the
cabinet
were
survived
because
I
think
the
cabinet
split,
but
anyway
that
set
aside,
but
it
it's
a
very
difficult
thing
to
do.
C
It
can
be
done,
but
it
is.
It
is
difficult
hard,
so
within
the
secretary's
office,
so
we're
still
in
the
secretary's
office
before.
A
Just
a
brief
since
we're
on
the
topic,
I
mean,
as
far
as
I
mean
you're
saying
we
went
from
77
to
86.
How
much
would
you
all
estimate
we
leave
on
the
table?
I
mean,
I
know,
there's
a
lot
of.
I
mean
we've
proposed
bills
that
haven't
made
it
through
to
try
to
draw
down
more
federal
funds,
but
how
high
can
we
get
that
number
two?
Do
you
think
if
we
were
maximizing
all
of
our
opportunity
to
draw
down
federal
funds,
how
many
of
our
dollars
could
be
tied
to
federal?
C
We
always
seem
to
find
someplace
else
right
if
it
took
us.
A
D
You
know
we're
we're
always
looking.
We
do
have
several
programs
that
are
100
percent
state
funded,
I
think
of
our
frisky
centers,
for
instance,
or
our
home
care
program
or
heart
support
living
things
that
are
100
funded,
and
maybe
we
haven't
figured
out
how
to
match
that
up
to
federal
dollars,
and
maybe
one
day
we
will
right
now.
I
think
we're
bumping
up
against
the
current
ceiling,
but
we're
always
looking
to
raise
that
ceiling.
A
C
I
I
don't
know
if
it
was
last
health
and
well
for
our
last
moab
sorry,
hospital
association,
work
right,
yeah
and
and
talked
about
the
h,
the
hospital
reimbursement
program
where
we
now
have
in
inpatient
we're
up
to
what
is
called
the
average
commercial
rate
which
is
great
for
hospitals.
I
think
it's
you
know:
we've
had
a
few
rural
hospital
closures,
but
you
just
don't
see
it
like
you
see
in
other
states,
and
I
think
that
goes
a
long
way
towards
that.
C
Most
of
the
inpatient
beds
are
in
urban
centers
talk
with
nancy.
What
can
we
do?
Why
are
there
possibilities
to
expand
and
she
talked
about
outpatient
right?
We
do
impatient
and
outpatient
with
uofl
it's
what
I've
said
to
a
lot
of
providers,
because
I
think
the
atrip
program
is
so
good.
If
you
can
tell
us
or
you
can
provide
the
agency
funds.
Remember
that's
what
we
talked
about.
If
you
can
provide
us
the
agency
funds.
C
You
probably
won't
like
the
way
I
say
this,
but
we
can
reimburse
you
much
better
as
long
as
you're
not
putting
it
on
the
general
fund
dollar
right,
but
so
so
it
really
is
a
how
creative
can
we
be,
particularly
in
medicaid,
with
working
with
our
provider
communities,
particularly
those
that
are
in
associations
and
and
can
can
bring
some
of
that
together,
an
agreement
right
again,
I
I
know
this
is
a
a
bad
way
to
say
this,
but
the
whole
provider
tax
piece
years
and
years
ago
was
just
done
to
maximize
medicaid
the
hrip
program
or
the
hospitals
help
us
pay
right
for
the
inpatient.
C
That
was
an
additional
billion
dollars.
You
know,
that's
great,
that's
good!
I
I
think
it
supports
communities,
but
how
we
do
that
and
maximize
that.
I
don't
know
what
that
limit.
Is
I
really
I
really
don't
at
this
point,
but
always
looking
for
creative
ways
to
particularly
in
medicaid,
because
that's
where
you
get
three
or
four
to
one
right
out
of
the
box,
how
do
we
do
that
in
a
way?
That's
sustainable
in
a
way,
that's
sustained.
C
Is
that
helpful,
yeah
excuse
me
under
the
secretary's
office
and
then
I'm
going
to
get
out
of
the
secretary's
office.
Finally,
we
have
budget.
We
have
legislation,
we
have
information
technology,
we
have
our
health
health.
I
mean
our
data
analytics
group.
C
We
have
our
inspector
general's
office,
I'm
going
to
pause
on
the
inspector
general's
office
for
a
second
because
they're
more
external
facing
than
any
of
these
others.
All
these
others
are
internal
procurement,
all
of
that,
it's
all,
mostly
internal,
and
so
that
was
covered
kind
of
what
we
talked
about
the
central
office
piece.
But
the
one
piece
also
that
sits
in
the
secretary's
office
is
the
inspector
general's
office,
and
so
just
to
give
you
an
idea
again,
this
infographic
is
hopefully
helpful.
C
You
know
they
do
all
the
inspections,
child
care,
health
care,
long-term
care
all
of
the
different
pieces
that
they
do
there.
But
what
I
hope
is
helpful
because
we
we
had
discussion
last
last
general
assembly
right.
What
are
we
doing
about
fraud
and
abuse
right?
A
very,
very
good
question,
so
in
this
infographic
we
talk
about.
You
know
what
we,
what
we
have
put
out
in
terms
of
recovery
from
providers
which,
which
is
where
you
know,
fraud,
can
occur
there
or
what
you
know.
C
What
is
medicare
billing
and
accurate
medicaid
billing
and
we
can
get
into
all
those
arguments,
but
also
then
our
recipient
fraud.
Our
our
investigations
group
sits
in
the
inspector
general's
office.
So
if
somebody
calls
and
says
we
think
somebody's
committing
fraud
right
on
snap
or
or
medicaid
or
any
of
our
programs,
we
actually
have
investigators.
C
Most
of
them
are
former
law
enforcement.
Who
will
go
out
and
try
to
track
that
down,
and
I
just
wanted
to
give
you
a
sense
of
the
scale.
You
know
about
nine.
Nine
thousand
five
hundred
calls.
We
we
think
it's
maybe
around
five
million,
that
we
try
to
recover
from
them.
And
so
that's
that's
a
part
of
really
the
inspector
general's
office,
and
I
don't
quite
like
it
when
I
say
this
really
is
sort
of
that
enforcement
piece.
C
I
won't
say,
law
enforcement
piece
is
the
enforcement
piece,
but
they
do
have
badges
and
special
investigations.
I
was
very
disappointed.
I
started
not
started,
but
I
worked
for
10
years
in
the
inspector
general's
office
and
I
never
got
a
badge
it
made
me
very
sad,
but
also
within
snap
right
within
the
southeast
region.
C
We
believe
when
we
look
at
this
is
the
universe
of
the
snap
population.
This
is
not
total
population,
but
in
the
universe
of
the
snap
population
we
believe
we
lead
our
southeast
region
in
in
folks
that
we
disqualify
from
snap
because
of
intentional
program
violations
and
that
can
be
over
income.
It
can
be
there's
another
adult,
that's
in
there.
It
can
be
well
all
the
intentional
program
violations.
They
don't
report
income
to
us
and
we
find
they
had
income.
C
We
think
in
terms
of
taking
people
off
the
snap
roll
we
we
do,
leave
the
southeast
region
on
a
per
capita
snap
population
basis.
So
I
just
I
wanted
to
to
say
that,
because
I
I
don't
think
I
got
a
chance
to
articulate
that
really-
and
I
don't
know,
as
I
knew
that-
and
they
had
to
coach
me
on
how
to
exactly
say
that
so
I
do
want
you
to
know
that
we
take
take
fraud
and
abuse.
Very
seriously
and
the
the
main
group
that
does
that
is
the
inspector
general's
office.
C
Dcbs
does
some
of
that
too.
Like
I
say,
if
they
find
a
you
know,
it's
it's
obvious.
When
they're
looking
at
income
that
somebody
hasn't
reported,
then
then
we'll
do
that.
So
I
just
I
wanted
to
that's.
That's
where
this
kind
of
thing
happens
as
well
as
then
all
our
licensure
inspections.
We
are
understaffed
in
the
inspector
general's
office.
I
will
tell
you,
you
know
we're
competing
for
nurses
too,
we're
competing
for
inspectors,
we're
and
it's
a
it's
a
challenge
to
recruit.
C
C
So
we'll
continue
to
try
to
work
on
salaries
there
as
we
can
within
the
context
of
our
budget,
and
we
are,
and
the
inspector
general's
office
is
one
that
that
we
really
need
to
work
on
and
we're
planning
on
working
on
again,
you
can
sort
of
see
just
sort
of
how
the
the
inspector
general
is
is
about
half
a
little
less
than
half
of
what
we
call
our
general
administration
and
support.
Again,
you
see
the
restricted
here.
C
Quite
a
bit
of
it
is
a
bit
of
its
medicaid,
but
this
is
more
cost
allocation
than
than
than
medicaid
here.
So
that's
quick
on
the
inspector
general's
office,
so
the
big,
the
the
giant
program
is
medicaid
and
we've
already
talked
quite
a
bit
about
it.
So
I'll
try
to
go
more
quickly
through
this,
but,
as
I
said,
1.6
million,
we
think
we're
going
to
receive
actually
in
excess
of
827
million
on
the
drug
rebates.
C
The
senate
bill
50.,
not
this
last
session,
but
the
previous
session
that
that
asked
us
to
go
to
a
single
pbm
pharmacy
benefits
manager.
So
we
pulled
pharmacy
out
of
the
managed
care
organizations
we
probably
within
the
next
month.
We'll
have
a
nice
report.
I
will
tell
you
it
looks
like
we
save
money.
The
place
we
save
money
is
that
we
increase
the
amount
of
our
drug
rebates
through
our
pharmacy
benefit
manager.
C
It
it.
If
you
talk
to
the
mcos,
they
will
tell
you
that
their
pharmacy
costs
went
up
and
they
didn't
because
they
don't
get
the
they
don't
get
the
rebate
anymore.
We
do,
and
so
we
were
able
to
maximize
that
rebate.
So
I
think
it's
going
to
be
a
really
good
news
story.
It's
kind
of
preview
coming
attractions,
but
senate
bill
50,
which
I
think
we
work
very
well
together
on,
I
think,
is
going
to
be
a
net
benefit
to
medicaid
and
I'm
actually
excited
about
that.
C
We're
hoping
that
it
it
it
sets
up
because
we're
the
first
state
in
the
country
to
do
this.
We
hope
it
sets
up
some
other
states
looking
at
what
we're
doing.
Actually,
our
our
our
pharmacist
in
medicaid
is
now
doing
national
consulting
that's
the
price
of
success.
B
That
is
good
news,
particularly
since
going
back
very
early
on
the
conversation
about
the
pbm
and
it
was
nearing
a
previous
cabinet
secretary.
We
talked
about
going
single
pbm
and
they
said
it
cost
the
state
millions
we
couldn't
afford
to
do
that
or
surposition
was
supported
by
the
the
mcos
and
this
office
says
as
to
why.
But
at
that
time
we
we
couldn't
account
for
250
to
over
half
a
billion
dollars
in
drug
cost,
and
we
thought
it
was
there
and
this
kind
of
verifies
that.
B
C
Yes,
sir,
yes,
sir,
the
and
and
at
the
same
time
we
were
able
to
increase
the
dispensing
fee
for
all
pharmacies.
I
I
do
want
to
get
back
to
a
tiered
dispensing
fee,
but
it'll
take
a
year,
so
that's
even
with
an
increased
dispensing
fee
and
helping
independent
pharmacists
right
who
who
came
and
said
that
they
needed
help,
and
we
were
able
to
do
that.
And
now
I
feel
like.
Maybe
we
we.
We
perhaps
went
too
high
on
that
when
I
saw
a
name
brand
chain,
advertising
for
medicaid
patients,
but.
A
Has
a
just
really
briefly,
I
know
we
talked
earlier
one
in
three
kentuckians
we've
got
about.
I
was
looking
it
up
about
1.022
million
kids.
Sixty
percent
of
our
kids
are
covered
on
medicaid
in
this
state
and
I
think
it's
an
important
statistic
for
us
to
remember.
We
talk
about
one
in
three
kentuckians
overall,
but
sixty
percent
of
our
children
are
covered
by
that
program.
I
just
think
it's
important
for
us
to
remember
that
statistic.
When
we
talk
about
that
going
forward.
C
And
I
I
really
you
know
we
really
have
kids,
I
mean
we
just
do
and
we
were
able
again
through
through
legislation
the
general
assembly
extended
pregnant,
postpartum
women
up
to
a
year.
We
were
wanting
to
do
that,
got
that
you
know
you
all
passed
that
and
instructed
us
to
do
it.
C
We
were
happy
to
you
know
it's
one
of
those
things
that
we
agree
on
hooray
and
I
think
that
that's,
I
think,
that's
very
important
and
when
you
look
at
what's
called
the
chip
program,
I'm
sorry,
that's
that
covers
children
and
pregnant
women.
The
number
one
and
we're
working
on
a
medicaid
report
for
everybody
and
we're
close
the
number
one
expenditure
within
the
chip
program
are
uncomplicated
deliveries.
C
So
we
cover
we
think
over
half
of
the
deliveries
in
this
state
today,.
C
So
the
medicaid
budget
is
is
all
benefits
right.
The
benefit
side
in
particular.
Obviously
it
is
97
of
the
budget.
That's
benefits
go
to
health
care
providers
period.
C
That's
where
benefits
go
admin,
your
favorite,
senator
meredith
deloitte
falls
in
admin
so
and
and
also
all
the
medicaid
I.t
pieces
fall
there,
but
but
the
but
the
benefits
piece
there
that
you
see
is
is
really
all
going
to
health
care
providers.
C
What
you
see
in
the
next
pie
chart
there
are
different
f
map
rates
for
different
populations
in
medicaid,
the
I'm
not
gonna,
I'm
not
gonna,
get
it
quite
right,
but
the
regular
medicaid,
mostly
what's
called
age
blind,
disabled,
traditional
medicaid.
That's
a
70.
C
It's
a
huge
difference
gigantic
on
the
magnitude
of
almost
50
million
a
month.
As
long
as
that,
public
health
emergency
is
extended.
Chip
kchip,
that's
80,
20.
and
expansion's
90
10..
So
those
are.
Those
are
the
three
basic
rates.
There
are
some
differences
now
on
the
waiver
side
because
there's
a
little
bump
there,
a
10
bump
there,
but
but
this
is
close
to
what
the
medicaid
rate-
it's
probably
a
percent
or
two
less.
If
you
did
blended
without
the
without
the
enhanced
match,.
B
C
It
is
not
the
the
the
mcos
I'm
going
to
say
something
good
about.
C
What
they
were
designed
to
do
was
give
us
budget
predictability
and-
and
if
you
look
back
over
the
years,
they
have
done
that
right,
that's
the
largest
portion
of
the
medicaid.
I
would
love
to
tell
you
that's
not
the
case,
but
I
looked,
and
it
is
right
so
gotta
say
that
well.
B
That
was
part
of
commissioner
lee's
testimony
this
last
session
on
my
mco
bill
was
it
gives
you
predictability
and
I
certainly
think
that's
certainly
valuable
to
to
our
budgeting
process,
but
I
think
we
also
have
to
recognize
the
implications
of
that
as
well
and
yes,
sometimes
it's
it's
adverse.
C
B
C
The
mcos,
the
mcos,
the
payments
to
the
mcos
are
considered
to
be
benefits
by
and
large.
So
yes,
that's
a
that's
an
accurate
point.
C
C
At
one
point,
when
I
was
with
the
city
of
louisville,
I
was
the
community
action
director
there,
so
I
got
familiar
with
those
programs.
I
forgot
to
say
how
many
places
I'd
already
worked
in
the
cabinet,
the
inspector
general's
office
and
other
things
never
worked
in
dcbs,
but
did
work
in
community
action
and
so
lie
heat
again.
Where
does
that
funding
go?
It
goes
to
utilities.
Where
does
where
does
the
l
what's
called
the
water
program?
C
Let's
just
say
it
that
way
that
goes
to
water
and
sewer
across
the
commonwealth,
so
those
programs,
that's
where
they
go
and
so
individuals
receive
receive.
The
individuals
are
eligible
for
the
program
and
the
funding
goes
to
the
provider.
C
Same
with
snap
goes
to
grocers.
Child
care
goes
to
child
care
like
no
one
gets
a
specific
check.
Really
the
only
place
where
you
can
talk
about
that.
A
little
bit
is
snap.
Where
you
get
a
benefits
card
right
and
to
some
ex
to
some
extent,
dana
if
we
have
some
emergency
programs
under
there,
where
we
can
help
folks
with
very
specific
emergencies,
it's
it's
pretty
limited.
As
of
the
printing
of
this
slide,
which
was
about
a
month
ago,
there
were
9
100
children
in
foster
care
we're
under
9
000.
C
C
We
didn't
just
try
to
throw
it
out
willy-nilly,
but
focusing
on
prevention
right
and
the
family
first
prevention
act,
which
I
eric
could
tell
you
all
about,
focusing
on
that
and
trying
to
provide
additional
services
to
families
and
support,
because
really,
if
you
can
keep
a
family
together,
that's
what
you
want
to
do.
I
hate
to
think
about.
C
If
I
were
a
kid
in
foster
care,
I
just
you
know
and
when
I
was
doing
homeless
services
in
new
louisville,
that
the
kids
you
saw
on
the
street
had
usually
come
through
foster
care
right,
and
I
can't
imagine
being
18.
right
without
any
family
and
trying
to
to
negotiate
my
way
around.
I
I
can
guarantee
you
I
wouldn't
have
done
well.
I
had
enough
challenges
with
a
good
family,
so
it's
just
it
is.
I
think
it
is
our
greatest
challenge.
C
I
think
it
is
our
greatest
challenge
to
try
to
keep
families
together
during
an
opioid
epidemic
and
we'll
talk
about
that
later,
that
that
that
goes
years
right.
C
We
talk
about
what
we've
seen
in
child
protective
services
coming
out
of
covid
is
not
necessarily
more
abuse,
but
what
we
find
is
much
worse
and
I
think
you
could
talk
to
any
provider
who
would
tell
you
the
same
it
is.
It
is
much
worse,
so
those
those
kids
that
were
in
bad
situations
and
didn't
have
eyes
on
them
for
a
year
two
years
it
it's
it's
horrendous.
C
It's
just
no
other
way
to
say
it.
Those
kids
that
were
in
either
a
neutral
or
a
good
situation,
you
know
more
time
with
family
has
not
been
bad.
I
think
that's
why
we're
not
seeing
increasing
rates,
but
but
we
are
seeing
increasing
severity
that
that
that's
just
true
so
offices
in
120
counties.
We
we
answer
the
phones,
we
try
to
have
people
go
through
our
connect
website.
C
I
will
tell
you
there
were
there
were
times
when
we
were
doing
much
better,
answering
phones.
C
At
one
point
we
we
were
lucky
to
answer
a
hundred
thousand
calls
a
month,
we're
now
answering
probably
two
hundred
thousand
a
month,
but
unfortunately
our
wait
times
are
back
up
and
when
you
get
advocates,
who
will
come
in
here
and
tell
you
that
people
wait
on
the
phone
a
long
time?
Yes,
they
do
and
we
are
trying
to
work
on
getting
those
wait
times
down.
But
it's
still
a
long
wait
now
an
hour
away
time
on
the
phone
versus
waiting
four
hours
in
a
waiting
room.
C
I
was
speaking
with
somebody
who
we
were
talking
about
something
else.
We
were
talking
about
community
grocery
store
right,
and
I
said
you
know
we
we
have
the
lnn
building,
which
is
at
ninth
and
broadway.
In
louisville
we
have
a
gigantic
waiting
room
right,
really
well
done
beautifully
appointed
architecture.
C
The
architect
did
exact
brought
light
in
it's
new.
It
looks
great,
but
it's
giant.
It's
three.
Two
stories
of
three
quarters
of
a
block-
long,
I
was
talking-
I
said
you
know
we're
trying
to
go
to
the
phone
we're
trying
to
go
to
the
internet
and
and
the
person.
I
was
talking
to
almost
started
to
cry
and
said.
Thank
you
for
not
making
me
come
in
and
beg
for
scraps,
so
we
are
trying
to
alter
that.
We
are
trying
to
alter
how
we
interact
with
the
public
on
eligibility.
C
We've
actually
in
the
energy
assistance
program,
started
what
we're
calling
a
cooling
period
so
we're
extending
it
used
to
be
just
really
mainly
the
winter.
For
that,
what's
called
la
heap
the
energy
assistance
program,
we
now
have
a
full
program
that
we're
running
in
the
summer,
all
right
today's
an
indication
I
I
I'm.
C
I
will
not
win
this
argument,
but
I
almost
think
the
cooling
period
is
more
important
than
the
than
the
heating
period
and
and
it
you
know,
that's
just
the
way
we're
going
so
we're
actually
going
to
use
some
tanf
funds
this
time
to
help
us
complete
the
summer
cooling
period,
but
I
think
it's
I
think
it's
just
as
important.
I
really
do
so.
Yes,
there's
increase.
There's
increased
demand.
Yes,
sir,
thank
you.
I
think
yeah.
C
Those
are
the
pieces
that
I
I
wanted
to
make
and
how
important
prevention
is
it
is.
It
is
very
important.
You
see
again
the
fund
splits
general
tobacco
restricted
that
it's
a
lot
of
medicaid
funding
in
that
restricted
in
dcbs.
A
lot
cost
settlements,
services
case
management.
A
lot
of
this
is
medicaid
funding.
I'd
say
most
of
it.
D
C
80
yeah
80
yeah
80.,
so
that
just
kind
of
showing
how
medicaid
runs
through
that's
how
medicaid
runs
through
it's,
it's
a
it
just
shows
how
it
does
and
then
you
can
see
kind
of
the
splits
again
the
grants.
Loans
benefits.
That's
community
actions,
that's
child
care,
that's
child,
caring
right,
the
facilities,
that's
that's!
What
most
of
that
is
there,
and
then
you
can
just
kind
of
see
how
it's
how
it's
divided
out
across
programs.
C
C
It
increased
the
size
of
public
health
to
the
point
where
it
overtook,
behavioral
health,
and
you
know
I'm
not
going
to
talk
about
covid
because
we
all
know
coven,
I'm
glad
we
had
public
health,
but
you
know
they
do
lots
of
things
their
prescription
assistance
program.
I
think
they
presented
on
that
in
northern
kentucky-
is
a
is
a
great
unheralded
program.
We
we
need
to
do
more
to
promote
that
the
I
started
actually
again
another
place
where
I
worked.
I
started
in
in
public
health
and
certificate
of
need
and
state
health
planning
in.
C
I
did
get
out
of
there
quickly
so
radon.
I
think
there's
some
legislation
to
move
some
of
the
radon
program
to
to
another
agency,
fine
and
then
really
what
I
think
folks,
don't
understand
a
lot
about
some
of
the
biggest
programs
in
public
health
hands
program.
The
home
visitation
program
really
has
an
impact
on
abuse
and
neglect
in
families
you
have
a
healthcare,
professional
or
semi-professional
go
in
and
work
with
parents
who
are
you
know
just
needing
help
and
basic
parenting
pieces
first
steps.
C
I
used
to
be
over
first
steps
again.
You
know
I've
been
over
everything,
that's
early
intervention,
it's
the
it's
what's
called
part
c
to
part
b,
so
part
b
is
idea
and
special
education
right.
Part
c
is
before
kids
get
to
school.
So
it's
it's
birth
to
three
and
it's
it's
services
to
help
the
child
get
back
on
a
developmental
pathway
that
hopefully
gets
them
caught
up
before
they
enter
school,
particularly
if
they
have
some
developmental
or
of
intellectual
delays.
C
Great
program
serves
a
lot
of
kids
hard
to
keep
in
budget
often,
but
it
is
about
again
it's
another
one
of
those
things
that
we
should
be
doing
done
right
like
hands
but
done
right.
First
step
should
be
about
teaching
parents
how
to
teach
the
kid,
and
they
may
have
a
kid
with
special
needs.
How
do
we
support
them?
Doing
that?
That's
how
we
should
do
it
well,.
B
You
know
if
there's
anything
good
that
came
out
of
colbit
and
I
know
that's
a
very
loose
word,
but
it's
raising
the
stature
of
our
public
health,
I
think
before
cover
they
were
pretty
much
an
an
afterthought
and
quite
truthfully,
there
predominantly
to
serve
then
the
truly
indigent
which
I
think
is
a
real
disservice
to
those
folks
and
I
think,
there's
an
opportunity
now
to
to
elevate
those
those
folks.
B
I
think
they
should
be
the
ones
that
are
responsible
for
really
the
health
of
our
entire
population,
just
not
the
medicaid,
but
we
need
someone
who
says
we're
going
to
improve
the
health
of
the
population,
and
these
folks
could
be
the
driver
of
that
system.
So
I
would
hope,
we've
learned
from
colby
that
these
folks
have
a
very
strong
role
and
really
commit
some
resources
to
it,
and
maybe
that's
one
of
the
things
that
will
come
out
of
this
task
force
is.
We
need
to
understand
how
important
they
are
to
our
communities.
C
And
we
talk
about
the
cabinet
having
a
kind
of
broad
umbrella,
public
health,
radiation,
restaurant
inspections,
milk,
we
we,
we
say
it's
from
moo
to
you
so
from
the
farm
to
to
the
groceries
right
and
every
step
in
between
inspection
of
of
septic
systems.
I
mean
the
state
veterinary
is
there
so
investigating
rabies
outbreaks.
I
I
always
like
to
say
at
4
30
on
a
friday,
there's
a
rabbit
bet
somewhere
right,
so
it
just
it
just
it
just
happens
and
it's
a
lot
of
times.
C
It's
public
health
right,
but
that's
because
what
they
do
is
so
broad
and
you're
absolutely
right:
the
local
health
departments
on
the
local
level
in
the
counties,
the
regional
health
departments.
They
do
a
lot
for
public
health
and
keeping
it
safe.
C
So
thank
you
for
that.
One
piece
you
brought
up
kovid
and
I
met
to
do
this
under
dcbs.
How
important
do
we
all
know
now?
How
important
is
child
care?
C
And
again
you
all
passed
house
bill
499,
which
is
which
we're
working
on
implementation
it's
next
year,
but
where
we
can
work
with
employers
to
help
support
folks
getting
child
care.
C
The
benefits
task
force
working
through
that
the
biggest
piece
of
the
benefits
cliff
is
child
care,
and
so
that's
a
great
bill
excited
to
implement
it
and
we
think
it'll.
We
think
it'll
make
a
difference
and
and
and
again
child
care
being
important,
not
just
for
the
folks
getting
child
care,
but
for
the
employers
and
for
the
community
and
and
being
able
to
articulate
that.
C
Now
that
you
know
I
mean
I
think
the
chamber
helped
with
that
bill,
fantastic
and
being
able
to
recognize
that
through
this
that's
another,
I
think
kind
of
benefit
of
covet.
If
you
would
I'm
hesitant
to
say
that,
but
I
think
it
is.
I
think
it
is
just
like
in
medicaid.
B
C
We've
done
with
telehealth,
we've
we've
been
needing
to
do
that
for
20
years,
and
we
probably
are
where
we
should
have
been
20
years
ago
today,
because
we
had
to
I'm
not
sure
we
would
have
if
we
didn't
have
to.
C
C
C
Local
health
departments
there
there's
some
back
and
forth
with
medicaid
there's
a
cost
settlements
here.
So
a
lot
of
the
restricted
fund
here,
although
quite
a
bit
of
the
restricted
fund
here-
are
fees
right,
birth
certificates,
death
certificates,
frozen
food,
lockers,
those
kinds
of
things.
So
there's
a
there's
a
piece
of
this:
that's
fees
absolutely,
but
there's
also
there's
also
ada
ate
up
right
right.
C
So
this
isn't
this
restricted
piece
isn't
as
heavily
dependent
on
medicaid
as
some
of
the
others.
But
there
is
a
piece
of
medicaid
in
here
that
that's
up
that
that
supports
public
health.
Again,
you
can
see
sort
of
where
their
programs
go
and
and
and
how
they're
funded
laboratory
services.
I
hope
next
time
we
can
do
a
capital
budget,
the
lab's
old,
it's
not
as
old
as
me,
but
whatever
we're
probably
gonna
need
a
new
lab
coming
up.
C
It's
it's
just
antiquated
and
you
you
know
how
fast
medical
equipment
goes
out
of
date
that
lab's
what
13
15
years
old,
at
least
so
it
it's
just
kind
of
out
of
date.
So
that's
my
plug
for
next
time,
so
the
department
for
behavioral
health-
I
was
acting
there
acting
commissioner.
There
you're
gonna
hear
more
about
this.
If
you
haven't
heard
988,
which
is
a
suicide
prevention
hotline,
it's
you
know
attempting
to
make
it
more
like
9-1-1.
C
I
think
it
gives
us
some
really
interesting
opportunities
that
implementation
of
senate
bill
90,
how
we
integrate
9-1-1
and
988.
I
think
going
to
be
really
critical.
We're
talking
about
mobile
crisis
services,
senate
bill
90
talks
about
pre-adjudication
services
to
keep
people
out
of
going
into
the
jails
and
trying
to
provide
services,
particularly
on
the
substance,
use
and
behavior
health
side.
C
I
think
how
this
marries
together,
there's
so
many
overlapping
pieces
on
this,
but
I
think
this
is
going
to
be
one
of
those
places
where,
if
we
do
it
right,
not
saying
it's
going
to
be
simple
at
all,
but
if
we
do
it
right,
we
should
be
able
to
bring
some
of
these
services
together.
How
do
we
support
law
enforcement
right
when
they're
responding
to
a
behavioral
health
or
substance
use
crisis
right?
C
We
do
cit
training,
which
is
that
kind
of
behavioral
health
training
for
officers
who
come
through
a
program,
but
that's
asking
a
lot:
it's
asking
a
lot,
so
within
behavioral
health
we
have
facilities
which
we
don't
really
talk
about
here.
I
will
tell
I'll
show
you
on
the
next
slide,
where,
where
I
think
we
should
be
a
little
more
balanced,
but
also
your
core
program.
Your
substance
use
program
flows
through
behavioral
health.
Now,
we've
seen
a
overdose
spike
right
again,
that's
one
of
the
negatives
of
kovid
right,
your
isolation
and
economic
uncertainty.
C
I
mean
that
that's
a
perfect
storm
for
folks
to
relapse
and
we've
seen
it
also
fentanyl.
If,
if
van
ingram
were
sitting
here,
he
would
tell
you
that
that
increase
in
use
and
use
or
or
fentanyl
in
the
supply
chain
has
had
a
significant
impact
on
overdoses
across
the
state,
but
the
local
communities
there's
so
many
initiatives
here.
I
can't
even
begin
to
cover
it's
called
healing
communities.
C
There's
a
couple
of
phases
of
that
the
attorney
general
funding.
I
sit
on
that
task
force.
I
think
our
first
meeting
is
on
the
12th.
So
look
forward
to
that,
because
we've
got
to
get
our
hands
around
this
some
way
it
is
tearing
families
apart.
It's
ruining
lives.
I
doubt
there's
anybody
even
in
this
room
that
doesn't
know
somebody
that
hasn't
been
impacted
by
substance,
use
right
or
has
a
child
or
had
a
child
or
know
somebody's
had
a
child.
That's
how
rampant
it
is
across
the
commonwealth.
C
So
we
we've
got
a
lot
of
work
to
do.
There's
just
there's
just
no
way
around
that
the
behavioral
health
program
also
supports
folks
with
developmental
intellectual
disabilities.
Both
they,
this
behavioral
health
and
dale
I'll
get
to
them.
Department
of
aging
and
independent
living.
We
really
went
out
and
aggressively
got
folks
vaccines
in
people's
arms
who
had
developmental
intellectual
disabilities,
who
were
probably
most
vulnerable
to
covid,
even
if
they
were
in
some
of
the
small
what
are
called
supports
for
community
living
homes.
C
I
I
think
we
did
a
credible
job
there
lots
of
workforce
initiatives.
We
don't
have
enough
behavioral
health
professionals
in
this
state.
We
need
to
work
on
that.
That
crisis.
I
won't
say
it's
as
cute
as
the
nursing
crisis,
but
it's
it's
awfully
close.
We
just
don't
have
enough
providers
in
the
state
to
meet
the
behavioral
health
needs
coming
out
of
covet
tremendous
behavioral
health
needs
in
western
kentucky
right
folks.
You
know
when
I
was
down
there.
C
Folks
are
telling
me
you
know
we
hear
a
thunderstorm
roll
through
and
and
I've
got
anxiety
right.
So
we
we've
got
a
lot
of
work
to
do
there
and
hopefully
there's
some
more
funding
coming
from
the
federal
government
and
and
we'll
do
the
best
we
can
to
to
make
sure
that
we
have
as
much
as
we
can
put
in
community
as
possible.
You'll
see
residential.
C
That
means
outward.
Oakwood
are
three
psychiatric
hospitals.
Four.
If
you
count
arh
our
two
nursing
facilities,
our
facilities
take
up
over
half
behavioral
health
budget.
We
we
should
be
completely
rebalanced
in
this.
It
is
it's
difficult.
These
facilities
sit
in
communities,
I'm
not
so
many
secretaries
have
washed
up
on
the
shores
of
you
know
this
facility
or
that
facility.
I'm
not
I'm
not
saying
that,
but
we
have
to
rights.
C
We
have
to
think
about
what
we
need
in
our
communities
and
what
what's
needed
in
our
communities,
and
I
think
I
think,
as
much
money
as
we
can
push
to
community
supports
to
keep
people
in
their
local
communities
and
in
their
homes
the
better
off
we're
all
going
to
be.
C
Oh
restricted
funds
here
that
is
medicaid,
probably
90
of
that's
medicaid,
if
it's
not
all
medicaid.
So
that's
again
what
funds,
the
behavioral
health
department
in
a
lot
of
ways?
C
C
You
all
might
have
heard
of
the
heart
supported
living
program,
a
lot
of
those
state-funded
programs
where
folks
really
don't
want
to
become
eligible
for
medicaid
or
may
not
be
eligible
for
medicaid,
but
still
need
services
because
they
have
disabilities,
significant
disabilities.
Those
programs
run
through
the
aging
and
independent
the
department
for
aging
and
independent
living.
We
just
again
legislation
from
last,
not
this
one
but
the
last
one.
C
We
started
our
office
of
of
alzheimer's.
It
had
been
on
the
books,
but
nobody
had
actually
put
it
together.
Legislation
came
through
last
the
last
session
and
we
now
have
an
office
of
of
alzheimer's
we've
needed
it.
We're
rapidly
aging
population
we're
going
to
see
as
we
age
it's
just
more
alzheimer's,
more
dementia.
C
More,
that
is
what
we
are
going
to
see
so
so
we're
aggressively
trying
to
find
grants
for
that
department
to
build
it
out
a
little
bit,
but
that's
a
that's
a
piece
that
we're
we're
implementing
within
aging
and
independent
living
senior
meals.
C
We
provided
more
meals
last
year
than
we'd
ever
had
again
kudos
to
community
partners
what
are
called
triple
a's.
They
sit
with
the
area,
development,
district
offices
and
they
provide
a
lot
of
services
for
seniors
in
in
local
communities
and
and
they
they
they
do
a
good
job.
We
have
what's
called
a
aging
disability
resource
and
it's
just
a
one-stop
shop
like.
Even
if
you
have
a
question
about
medicare,
you
can
call
up
dale
and
get
some
answers.
C
There
are
folks,
it's
called
the
ships
program
and
they're
folks
that
were
there
to
help
so
aging
independent
living
has
I'll.
Do
it
in
the
next
slide.
C
You'll
see,
there's
this
tiny
slice
of
agency
and
aging
and
independent
living.
That's
because
we
were
able
to
actually
started
the
previous
administration
access
medicaid
for
guardianship.
Those
so
guardianship
is
at
aging
and
independent
living
those
people
who
can't
care
for
themselves.
In
a
court-ordered
into
guardianship
that
sits
at
aging
and
independent
living,
so
the
piece
of
that
that
you
can
account
to
health
care,
right,
coordinating
visits
and
all
those
kinds
of
things
and
and
supporting
an
individual
to
live
on
to
live
in
community.
C
That
little
slice
is
the
beginning
of
accessing
medicaid
funds
for
this
program
and
are
able
to
get
more
guar
folks
in
guardianship
hired
as
guardians
right
because
of
that
three
million.
Yes,
that's
an
additional
three
million
within
the
program.
So
that's
why
that
slice
is
small.
But
that's
why
that
slice
is
there.
C
C
A
C
So,
as
two
of
my
favorite
programs
serve
kentucky
and
frisky,
I
was
over
frisky
for
a
little
bit
serve.
Kentucky
is
volunteerism
americorps!
C
Think
of
it
as
joe
bringgarden
is
not
gonna
like
me
for
saying
it
this
way,
but
think
of
it
as
peace
corps
within
within
the
united
states,
so
really
serving
communities.
Folks
who
get
a
stipend
to
to
do
a
lot
of
work.
These
folks
do
great
work.
They
all
respond
to
emergencies.
C
They
work
in
schools
right.
They
work
to
like,
like
this
top
line.
They
work
with
students
in
schools.
They
they're,
not
they're,
not
teach
kentucky,
but
they're
teach
america,
but
you
know
it's
that
kind
of
concept
where
folks
are
actually
working.
It's
called
our
frisky
core.
C
It's
how
these
two
programs
get
tied
together,
so
the
the
folks
who
are
can
work
in
in
family
resource
centers,
who
then
help
the
family
resource
centers
help
students
in
schools,
and
so
this
kind
of
thing
that
they
do
and
they
get
folks
to
they
sponsor
volunteerism
across
the
straight
state.
Senator
alvarado-
and
I
were
talking
about
some
of
the
difficulties
in
finding
some
volunteers.
Now
it's
more
in
specific
areas,
but
but
this
is
a
group
that
helps
us
with
that,
and
they
they
they
do.
C
They
do
a
a
really
good
job
and
bring
more
programs
into
kentucky
joe
bringartner,
who
served
through
three
administrations.
Now
in
this
position,
has
really
done
a
great
job
of
increasing
the
size
of
the
program,
increasing
the
numbers
of
programs
we
have
in
the
state,
and
so
that's
why
you
see
some
of
the
value
that
you
see
here
the
so
these
infographics
we
were
going
by
department,
so
we
hadn't
gotten
to
family
resource
shedders
yet,
but
I
wanted
to
slide
on
them
because
I
used
to
be
over
there.
They
do.
C
I
know
you
all
know
this,
and
I
know
I
don't
have
to
sell
it,
but
the
concept
of
removing
non-academic
barriers
to
learning
was
was
probably
one
of
the
best
things
that
came
out
of
kira
in
1990.
And
yes,
I
was
here
so
the
having
somebody
who's
really
concerned
with
what
that
looks
like
in
schools-
and
I
can
tell
you
during
the
pandemic-
they
were
delivering
food
and
supplies
to
folks
who
were
not
able
to
be
in
school.
C
Tornado
that
western
kentucky
tornado
some
of
those
centers
really
work
with
getting
supplies
out.
We
had
a
couple
of
really
nice
collaborations
with
with
folks
that
that
wanted
to
help
us
the
shabbat
center,
who
was
a
who
they
get
like
returns
from
amazon,
and
they
help
spread
that
out
to
the
family,
resource
centers
and
we're
working
on
expanding
that
program,
but
they
do
so
many
things
and
and
the
thing
that
I
love
about
family
resource
centers,
is
they
they're
designed
to
respond
to
local
needs?
C
They
have
to
have
a
plan,
that's
that's
locally,
driven
that
responds
to
the
needs
on
the
ground
within
certain
parameters
and
that's
what
they
do,
and
so
they
they
fit
within
the
schools
and
the
systems.
Not
you
know,
sometimes
you
get
into
arguments,
principles
rule
the
school
in
case
you
didn't
know
so,
but
but
they've
learned
and
adapted,
and
I
think
they
do
an
amazing
job
in
schools
across
the
commonwealth.
I
was
happy
to
be
there
early.
You
can
see.
C
This
is
one
that
it's,
it's
all
general
and
a
little
bit
of
federal.
There's
no
medicaid
here
because
it
really
because
we
haven't
figured
out
how
and
I
think
it'd
be
very
difficult
and
if
you're
locally
driven,
I
think
that
goes
against
the
concept
of
what
these
these
programs
are.
C
She
likes
that
I'm
the
secretary,
because
I
know
that
I
can't
say
to
her
family
resource
centers
will
do
this
because
family
resource
centers
have
to
want
to
do
it
right,
and
so
we
can
say
here
are
opportunities
for
you
to
participate
in,
but
the
the
gear
program,
the
the
education
piece
that
came
through
through
kovid
that
they
had
to
apply
to
get
that
money.
They
had
to
want
it
and
they
it
wasn't
like.
We
said
you're
gonna,
do
this.
For
this:
that's
not
how
this
program
works.
C
If
you
think
I'm
an
apostle,
I
am,
I
think
this
is
a
fantastic
program,
so
so
at
department
of
income
support.
I
was
acting
here
too.
C
These
two
programs
child
support
enforcement,
which
is
you
know,
that's
kind
of
the
enforcement
side
of
when
somebody
owes
child
support.
This
is
the
group
that
goes
out
and
enforces
that
they
have
an
antiquated
system.
Thank
you
for
a
capital
improvement
piece
here.
The
the
child
support
enforcement
system
is
the
back
end
of
the
unemployment
system.
C
It's
blue
screen.
It's
it's
old,
it's
mainframe!
It's!
I
think
it's
cobalt
or
something
like
that.
I
believe
so
so
I
mean
it's
it's
it's
as
old
as
I
am
it's
terrible
so
within
the
capital
budget,
this
time,
there's
funding
for
a
replacement
system.
Thank
you
long
needed
and
we
think
we'll
be
able
to
do
more
in
terms
of
helping
families
get
child
support,
that's
what
we
should
be
doing:
disability
determinations.
C
This
is
an
odd
program,
so
that's
kind
of
why
these
two
programs
are
together
because
they're
like
the
last
two
they're,
just
kind
of
don't
know
where
they
fit.
Sorry,
commissioner,
vino
but
disability
determination
is
we're
a
contractor
to
social
security,
so
we
do
we're
contractors
for
them.
So
we
do
all
the
work
of
determining
whether
somebody
is
determined
disabled
and
gets
social
security,
disability
payments.
That's
what
this
group
does.
I
will
tell
you
because
I
think
so
that
they
do
a
really
good
job
here.
C
It's
we've
had
some
challenges.
You
all
know
that
eastern
kentucky
unscrupulous
attorneys
and
physicians
working
some
physicians
working
together
right
and
it's
kind
of
like
pain,
clinics
right,
there's,
unscrupulous
everywhere
this
that
was
caught,
but
it's
it's
had
its
negative
impact.
There's
just
no
way
to
to
gloss
over
that.
It
has-
and
I
think
part
of
that
has
has
had
to
do
with
some
of
the
problems
we've
seen
across
the
state.
I
think
legitimate
folks
who
need
this.
They
need
it.
C
They
really
need
it,
but
there
are
redeterminations
that
are
done.
I
I
can't
so
it's
just
these
two
programs
sit
there
again.
You
will
see
a
little
bit
of
restricted
fund.
I
don't
think
that's
medicaid
yeah!
I
don't
think
any
of
that's
medicaid,
so
you
see
most
of
that
goes
to
child
support.
Disability
is
like
all
federal
funds,
essentially
almost
all
I'm
getting
close
to
the
end.
I
promise.
B
Before
you
continue,
representative
mead
has
a
question
comment.
Thank
you,
mr
chairman.
Mr
secretary,
did
you
make,
I
think
you
made
the
statement
that
56
percent
of
child
support
was
collected.
Is
that
what
you
said.
C
I
don't
think
I
can
give
you
a
figure
other
than
the
332
million
that's
been
collected
through
this
program.
This
this
program
is
administered
on
the
county
level
by
county
attorneys
and
through
their
offices
again
most
have
been
fantastic.
I
think
there's
some
high
profile
cases
of
of
where
this
hasn't
worked
terribly
well,
but
it's
like
it's
like
every
other
program.
There
are
places
where
it
works
great
and
there
are
always
you
know,
there's
one
or
two
that
don't
work
out.
Well
is.
C
And
one
of
my
favorites
I
was
commissioned
for
offices,
children
with
special
healthcare
needs.
I
was
the
director
there
for
about
seven
or
eight
years,
so
it's
a
place
close
to
my
heart,
the
thing
that
is
not
understood
about
this
organization,
and
I
think
it
is
the
best
thing
they
do.
Newborn
hearing,
screening
newborn
hearings,
newborn
newborns
with
hearing
issues
like
one
like
the
number
one
disability
in
the
country
and
in
the
state
every
child
that
is
born,
gets
a
hearing
screening.
The
commission
follows
up
now.
C
There
are
always
some
that
are
lost
to
follow
up,
but
when
you
look
at
other
states,
we
do
really
well
on
that
measure
of
making
sure
that
we
get
kids
who
are
not
lost
to
follow
up
if
they
fail
that
initial
hearing
screening
to
get
them
into
an
audiology
booth
and
and
try
to
locate
where
that
hearing
disability
is,
we
have
55
000
children
born
in
the
state
we
pretty
we,
we
do
49
000
screenings
through
the
commission
that
that
tells
you.
You
know
pretty
good
job
there.
C
Now
that's
over
a
couple
of
years,
so
I
just
copy
out
that
and
then
some
of
the
specialty
clinics-
these
are
kids,
I'm
going
to
talk
about
500,
kids,
right,
craniofacial
anomaly!
These
are
kids
that
are
probably
going
to
have
cleft
lip
and
palate.
C
Skulls
that
aren't
completely
formed
all
sorts
of
different
things.
These
are
kids
that
are
probably
by
the
time
they're
18
are
gonna,
have
20
surgeries,
and
this
is
plastics.
It's
dental,
it's
ent!
It's
it's!
It's
a
whole
bunch
of
different
specialists
that
have
to
come
around.
It's
it's
feeding,
specialists!
It's
a
lot
of
different
folks,
the
transformation
it's
my
favorite
day
when
we
review
the
pictures
of
like
here's,
a
kid
that
came
to
us
and
here's
a
kid:
that's
18.
right!
It's
it's
anyway!
C
I
think
it's
amazing,
neurology,
always
very
difficult
to
get
pediatric
neurology.
We
in
a
lot
of
these
areas.
We
are
collaborating
with
the
university
of
louisville
and
university
of
kentucky,
primarily
because
that's
where
the
medical
schools
are,
and
so
that
that's
the
collaboration
that
occurs
also
within
the
commission.
They
have
what's
called
a
family
to
family
program.
C
C
When
I
was
there,
we
have
a
youth
advisory
council
and
we
had
a
parent
advisory
council
and
we
actually
had
a
parent
on
each
one
of
our
interviews,
they're
kind
of
opportunities
that
you
can
do
there,
because
it's
not
you
know
it's
not
a
gigantic
agency
within
the
cabinet,
even
though
it's
before.
C
Continue
and
just
again
the
age
restricted
fund
here,
that's
medicaid,
almost
all
very
little
sliver
might
be
what
they
collect
for
hearing
aids,
but
that's.
This
is
all
this
again,
just
kind
of
giving
you
the
examples
of
where
how
this,
how
everything
kind
of
is
financially
taught
with
that,
you
heard
me
talk
about
how
the
federal
funds
flow.
C
C
A
You,
mr
chairman,
and
just
when
you
talked
about
the
volunteers,
I
guess
I
never
had
you
learned
something
new
all
the
time
I
didn't
realize
that
we
had
a
department.
I
always
thought
friskies
was
its
own
department,
but
it's
it's
that
and
volunteer
services.
Yes,
we've
had
a
discussion
just
recently
about
the
ombudsman
office
and
how
that
structure
and
I've
spoken
to
some
of
the
ombudsman
agencies
and
their
struggle
with
getting
volunteers.
A
Have
we
thought
about?
I
mean,
I
know
that's
kind
of
under
oig
a
bit
and
they're,
and
I
know
they're
kind
of
a
quasi
federal
requirement.
We
don't
have
any
oversight
over
them,
but
has
there
been
any
thought
about
consolidating
different
organizations
that
require
volunteers
to
do
those
and
place
them
underneath
that
volunteer
services,
because
some
of
these
folks
might
be
able
to
say
if
they're
wanting
to
volunteer
and
they're
willing
to
volunteer,
which
is
the
tough
part?
A
Can
they
not
provide
services
across
various
different
aspects
under
the
same
department,
because
I
never
had
realized
that
they
were
underneath
that
department
specifically?
So
maybe
just
the
thought
is
if
we
have
some
that
are
struggling
to
find
them.
I
know
the
ombudsman
agencies,
I've
talked
to
them
they're,
asking
for
more
responsibility.
They
want
to
provide
more
oversight,
but
at
the
same
time
say
we
don't
have
enough
people
to
provide
the
oversight
we
have
now.
So
would
that
be
a
concept?
I
don't
know
if
it
would.
A
C
Actually
think
that
that's
an
interesting,
interesting
point
and
worthy
of
pursuit,
because
within
that,
when
I
was
at
the
at
louisville
at
what
was
called
resilience
and
community
services,
my
favorite
title,
you
know,
chief
resilience
officer
was
great,
but
we
had
a
volunteerism
program.
It
was
called
retired,
senior,
vol,
rsvp,
retired
senior
volunteer
program
and
those
folks
would
would
you
know,
sit
at
front
desks
or
they
would
sit
in
schools
and
and
act
kind
of
as
a
a
grandparent
to
a
child
in
a
school.
B
Yes,
please
thank
you,
chairman
secretary
first,
thank
you
for
your
great
presentation.
It
was
lengthy
but
well
needed.
A
And
thank
you
for
your
years
of
service.
I
had
no
idea
that
you
have
been
in
pretty
much
all
the
things,
so
I
think
that
we
should
be
listening
to
your
expertise.
I
do
have
one
question.
I
think
I
may
have
just
missed
it
in
the
public
health
piece.
As
far
as
the
the.
A
It
says
that
public
health
protection
and
safety
is
seven
percent.
Can
you
talk
a
little
bit?
What
is
in
that,
and
I
can't
remember
if
you
did
and
I
dismissed
that
piece.
C
C
That's
probably
the
inspector,
so
that's
probably
the
milk
inspection
branch,
the
radiation
inspection
branch,
there's
a
lead
paint
group,
that's
there!
That
is
that's
gotta,
be
rest.
Well,
the
restaurant
inspections
are
better
under
general
health,
maybe
under
general
health,
but
yeah
restaurant
inspections.
That
probably
is
environmental.
That
does
look
right.
So
it's
it's
the
folks
that
do
those
inspections.
Okay.
If,
if
I
am
wrong,
I
will
I
will-
I
will
send
that
back
but
yeah.
I
think
that
that
that
looks
like
the
right
percentage
for
that.
C
So
it
also
then,
but
I'll
bet
it's
more
in
aligned
with
with
milk
radiation.
D
C
That
kind
of
stuff
that
they
inspect,
and
so
I
think,
that's
where
that
is
okay,.
B
Let
me
ask
you
a
couple
of
questions
if
I,
if
I
may,
senator,
go
ahead
and
feel
free
to
go
first
now,
please,
okay,
thank
you
great
presentation
today,
great
introduction.
This.
I
sincerely
appreciate
it.
Obviously
we're
going
to
have
a
lot
of
focus.
I
think
on
medicaid,
because
this
is
a
big
part
of
the
budget
and
one
of
the
things
that's
always
concerned
me
as
well.
C
B
Know
it's
it's!
It's
a
lot
like
just
hearing
the
presentation
in
this
certain
criticism,
but
we
could
say
one
of
our
goals
is
increase
the
our
federal
dollars
yeah.
We
want
to
do
that,
but
if
we're
not
moving
the
needle,
then
we
haven't
been
successful
in
in
our
efforts,
but
I
think
particularly
for
not
improving
the
health
of
population.
C
I
can
paraphrase
it
because
I'm
embarrassed
that
I'm
not
going
to
be
able
to
say
it
just
like
that,
but
the
paraphrase
is
this:
we
we
believe
in
the
cabinet
that
what
we
should
be
doing
is
helping
all
individuals
and
all
communities
that
we
work
with
to
live
to
their
full
full
potential
individuals
to
their
full
human
potential
communities
to
their
full
p
potential.
That's
what
we
should
be
doing.
We
we
do
that
through
what
we
call
different
lenses.
C
We
do
look
at
equity
right,
you've
got
to
you
see,
differences
between
urban
and
rural.
We
see
racial
differences
in
terms
of
outcomes.
We
we
see
it.
We
should
figure
out
how
to
address
it.
C
I
told
you
I
was
chief
of
resilience
for
for
the
city
of
louisville,
so
our
second,
what
I
call
pillar
is
our
resilience
pillar,
but
but
that's
the
stalking
horse
for
trauma
you,
don't
you
don't
lead
with
a
negative
pillar
right,
but
but
the
thread
that
runs
through
so
many
of
the
families
that
we
serve
and
individuals
that
we
serve
is
is
just
direct
straight
up
trauma.
C
C
My
deepest
regret
was
that
we
didn't
do
enough
to
address.
What's
called
secondary
trauma.
You
see
trauma
all
the
time
law
enforcement
sees
it
too
right,
you're,
always
like
entering
somebody's
life
at
the
worst
possible
time,
and
if
you
don't
address
secondary
trauma,
you
get
horrible
outcomes
both
for
the
individual
worker
and
for
the
folks
they're
trying
to
assist
you
have
to
do
that.
That's
our
second
pillar,
our
third
one
is
you'd.
C
Be
surprised,
is
economic
support,
because
I
think
we
have
never
talked
enough
about
what
we
do
to
support
our
local
communities:
local
pharmacists,
local
physicians,
nursing
facilities,
hospitals,
child
care
gross.
We
just
don't
talk
about
that
enough,
a
giant
cabinet,
it's
a
19
billion
dollar
cabinet.
We
do
support
our
communities,
we
do
support
our
counties.
I
I
would
venture
to
say
that
supporting
that
network
and
infrastructure
helps
our
communities
and
then,
of
course,
how
can
you
do
what
the
cabinet's
supposed
to
do,
which
is
health
and
wellness?
C
If
you
don't,
if
you
don't
get
those
other
three
right
and
so
that
that's
kind
of
how
we
talk
about
what
that
those
visions
are
and,
of
course,
then
the
ubiquitous
operational
excellence,
you
can't
do
it
if
you're
not
doing
it
well
right.
So
those
are
the
the
lenses
that
we
use.
When
we
talk
about
mission
and
every
department
does
some
of
that.
B
It's
going
to
result
from
it,
and
we
don't
do
that,
so
they
just
sit
there.
You
may
mention
one
that
20
years
we
we
knew
it
was
there.
We
need
to
do
something.
Well,
why
didn't
we?
Because
we
don't
have
the
money,
we
do
have
the
money.
Yes,
and
I
think
when
we
look
at
the
medicaid
budget,
we're
still
too
focused
on
treating
sick
people.
We
know
that
60
70
percent
of
the
health
care
problems
are
based
on
social
determinants.
Why
aren't
we
addressing
those?
We
don't
have
any
money?
B
We
do
have
money
this
time
we
got.
You
know
15
billion
dollars,
so
we
had
the
money
and
maybe
that's
another
fundamental
shift.
I
think
we're
going
to
have
to
have
is
how
we're
going
to
use
these
funds,
and
I
don't
think
it's
going
to
be
to
anybody's
detriment
if
we
focus
more
on
those
social
determinants
than
we
do.
Instead
of
taking
care
of
sick
people.
C
C
It
is
something
that
I've
tried
to
work
on
within
the
cabinet,
because
that's
always
the
answer,
we
don't
ask
ask
any
secretary
any
time
any
question
and
the
secretary's
answer
to
you
is
going
to
be.
We
don't
have
the
money
right
well,
what's
the
program
that
we
want,
let's
figure
out
how
to
fund
it
right,
let's
figure
it
out,
but
don't
say
we
can't.
We
can't
we
can't,
but
that
is
such
a
shift
in
thinking
it.
It
really
is
even
in
a
19
billion
dollar
cabinet.
C
B
Well,
I
think
another
problem
we
have
is
it
takes
a
lot
of
courage
to
do
that.
I
recognize
that,
particularly
in
a
governmental
entity
and
another
thing,
that's
missing
from
state
government
is
we
never
want
to
recognize
return
on
investment?
You
know,
if
you
come
to
me
and
say
we're
going
to
start
this
program
and
it's
going
to
cost
this,
but
we're
going
to
we're
going
to
get
this
kind
of
return
on
investment
and
we
actually
track
that
and
do
it.
B
You
know
kudos
to
you,
but
we
don't
have
enough
of
that
in
within
our
system,
and
I
think
it's
it's
caused
us
a
problem.
I
think
another
thing
we
have
to
really
understand
is
the
relationship
between
all
these
things
that
we're
doing
the
common
denominator
is
poverty
and
we
never
had
a
centralized
united
policy
on
how
we're
going
to
address
poverty
and
that's
urban
end.
That
is
rural
and
it's
time
to
stop
that,
but
senator
berger,
I
knew
you
had
something
I
just
knew
it.
A
As
a
follow-up,
sir,
if
you
would
indulge
me,
you
know
some
of
what
you're
talking
about
as
far
as
determinants
and
the
outcomes
of
care,
I
am
sure,
are
completely
outside
of
your
purview
to
a
fact.
A
So
what
I
would
like
to
ask
is
when
we
come
back
together
at
some
point
in
the
future,
if
you
had
three
wishes,
three
wishes
that
you
think
could
significantly
impact
the
care,
the
quality
of
care
and
outcomes
for
people
in
the
state
that
require
legislation
that
require
us
to
do
something
to
support
you.
What
would
that
be?
I
mean,
I
know
from
my
own
personal
experiences.
A
A
C
You
know
it's
when,
when
I
worked
under
the
fletcher
administration,
an
appointed
position
and
when
I
was
interviewing
right,
everybody
got
interviewed,
and
I
was
at
at
health
services
at
that
point
had
been
put
back
together
and
somebody
asked
me:
what
do
you
think
the
most
important
thing
is
for
government
for
for
us
to
do
here?
What
is
the
most
important
thing
we
can
do
and
my
answer
was
education?
C
That's
the
first
answer.
The
second
answer
is
wages
and
living
wage
jobs.
That's
the
second
answer
and
the
third
answer:
all
of
these
things,
conveniently
outside
of
my
control
by
the
way,
is
housing
right,
it's
so
difficult
to
get
people
services
until
you
get
them
into
stable
housing.
So,
probably
not
the
answer
you
expected,
but
if
there
were
three
things,
those
are
the
three
things
I
look
at.
C
I
think
they
are
for
life
span
right
for
service
provision,
for
making
a
difference
in
health
care
that
there's
nothing
like
that
and
and
and
the
family
you're
born
into
the
zip
code.
You're
born
into
the
county
you're
born
into
shouldn't,
have
the
impact
it
has
on
people's
lifespan
that
it
does
it
just
shouldn't.
B
Starting
point
is
obviously
this
task
force
again
part
of
this
mission.
This
potential
reorganization
is
how
we
can
use
our
dollars
most
efficiently
effectively
and
I
think,
there's
some
opportunities
we
didn't
find
today.
But
to
that
end,
if
there's
any
function
of
the
cabinet,
which
any
of
our
committee
members
would
specifically
like
to
look
into
in
more
depth,
please
let
myself
know
our
representative
meet
and
we'll
try
to
have
them
in
the
future
agenda.
But
I
think
it's
a
great
first
start.
B
I
promise
you
will
never
go
beyond
two
hours,
but
just
like
to
reserve
the
right
to
say
that
we
may
extend
at
some
time,
but
a
good
first
meeting
and
appreciate
both
you
being
here
today
and
I
look
forward
to
working
with
you
as
we
move
forward.
There
are
no
other
questions
comments
and
this
meeting
will
stand
adjourned.