►
Description
No description was provided for this meeting.
If this is YOUR meeting, an easy way to fix this is to add a description to your video, wherever mtngs.io found it (probably YouTube).
A
A
She
probably
took
a
pretty
healthy
pay
cut
to
come
back
here,
as
did
I,
as
did
many
of
your
commissioners
that
will
be
coming
before
you.
A
We,
the
reason
we
do
this
is
just
I
wanted
to
give
you
a
little
bit
of
a
of
an
introduction
and
then,
as
you
know,
medicaid
is
the
biggest
part
of
the
cabinet
for
health
and
family
services,
often
complex.
You
know
somehow
we're
able
to
expend
billions
of
dollars
and
make
everybody
upset,
but
that
seems
to
be
what
we
do
so
with
that.
I
will
turn
it
over
to
commissioner
lee.
B
Thank
you.
Thank
you
secretary.
I
think
some
of
you
know
that
when
I
first
came
back
to
the
department
for
medicaid
services,
I
gave
kind
of
the
same
little
background
about
myself
and
one
of
the
reasons
that
I
came
back.
The
main
reason
is,
I
really
believe
in
this
program.
I've
worked
in
it
over
20
years.
I
think
we
do
some
wonderful
stuff
in
in
this
state
for
the
members
that
we
serve
for
our
providers.
B
B
That
medicaid
is
the
go-to
program
to
solve
health
care
issues,
that
commercial
insurers
are
unwilling
or
unable
to
solve
number
one
affordability,
insurance
premiums
are
are
out
of
reach
for
so
many
individuals,
even
individuals
who
work
for
state
government
qualify
for
medicaid
soldiers
qualify
for
medicaid
based
on
their
income.
So
again,
medicaid
is
actually
the
go-to
program
to
solve
a
lot
of
these
health
care
issues.
B
We
also
cover
70
percent
of
all
long-term
care.
Again,
commercial
carriers
are
either
unwilling
or
unable
to
address
that
issue.
We
have
personal
supports
that
we
cover
in
our
waiver
programs
that
we'll
talk
about
later,
and
we
also
have
a
child
specific
benefit
and
for
those
of
you
who
may
not
be
familiar
with
the
epsdt
benefit.
That
means
early
periodic
screening,
diagnosis
and
treatment.
B
It
actually
gets
its.
It
was
actually
created
during
or
previous
close
to
the
vietnam
war.
Individuals
were
going
up,
mainly
young
males
were
going
up
for
for
exams
before
they
entered
the
military,
and
it
was
noticed
that
a
lot
of
these
individuals
were
very
poor.
They
were
on
medicaid,
but
they
still
had
issues
and
health
care
concerns
that
they
could
not
enter
the
military.
B
So
the
epsdt
benefit
was
created
to
say
that
anything
that
a
child
needs
that's
medically
necessary,
must
be
covered
under
the
medicaid
program.
So
that's
why
we
have
that
very
robust,
rich
program
today
for
our
children
under
the
age
of
21.,
so
again,
medicaid
just
at
a
glance.
Today
we
cover
1.6
million
kentuckians,
that's
one
out
of
every
three
in
this
state
and
we
cover
over
half
of
kentucky's
children
and
one
of
the
reasons
that
we
do
cover
kentucky's
children,
a
large
percentage.
Of
course
they
live
in
poverty.
B
We
always
say
that
the
1.6
million
is
nothing
to
boast
about,
because
that
means
1.6
million
individuals
in
this
state
live
in
poverty,
including
those
children.
However,
children
are
covered
under
the
k-chip
program
up
to
200
percent
of
the
federal
poverty
level,
so
we
do
cover
those
individuals
at
a
little
bit
of
a
higher
income
and
I'm
not
going
to
go
over
all
of
these
covered
populations.
B
We
just
wanted
to
put
these
covered
populations
up
here,
just
to
show
you
it's
not
just
the
aged
blind,
disabled
pregnant
women,
children
and
individuals
under
138
percent
of
the
federal
poverty
level.
Each
type
of
assistance
has
it
has
their
own
federal
poverty,
level
limits
and
requirements.
So
you
can
see
on
this
chart
here.
These
are
types
of
assistance
for
children,
and
this
just
goes
on
to
talk
about
some
of
the
other
programs.
B
As
you
know,
thanks
to
legislation
that
that
has
been
extended
to
12
months,
which
is
going
to
be
very
great
for
our
families,
particularly
our
women
and
children
who
who
need
those
services,
you
know
pregnant
women
after
they
have
their
babies,
they're
still
mothers
and
so
cutting
their
eligibility
for
medicaid
off
at
60
days
did
not
make
sense.
B
So
we're
very
thankful
for
that
that
year
we
also
have
a
spin
down
criteria
and
what
a
spin
down
card
is
is
we
may
have
some
individuals
who
technically
don't
require
or
don't
meet
eligibility
requirements
based
on
their
income.
However,
they
may
experience
some
medical
emergencies,
they
may
have
a
large
medical
debt
and
they
can
use
that
debt
to
spend
down
to
qualify
for
medicaid
for
a
very
time
limited
period.
Let's
go
to
the
next
one
and
again
we're
not
going
to
go
through
all
of
these.
B
You
go
to
the
next
one
too
that
next
one
just
wanted
to
point
out
and
show
that
there's
at
least
25
or
26
categories
of
eligibility
in
the
medicaid
program,
which
makes
it
a
little
bit
difficult.
Sometimes,
when
you
look
at
an
application,
it's
not
just
yes,
you
meet.
No,
you
don't
there's
a
lot
of
other
criteria
that
have
to
be
considered
and
we
do
cover,
for
example,
individuals
who
are
also
covered
by
medicare.
Some
of
these
individuals
receive
only
assistance
with
paying
their
premiums
and
their
co-insurance
and
deductible.
B
They
don't
receive
the
full
medicaid
benefit
package
and
recently
we
have
gone
through
a
reorganization,
and
the
senior
deputy
commissioner
has
been
very
instrumental
in
pulling
that
all
together
and
making
it
very
successful.
So
I
will
turn
it
over
to
her
to
talk
about
the
organizational
structure.
C
Thank
you.
So
this
presentation
is
very
timely.
We
just
completed
a
reorganization,
and
this
is
a
very
high
level
of
some
of
the
changes
that
we
made.
We
went
from
five
divisions
to
seven.
Two
divisions
had
no
changes
and
those
are
the
ones
highlighted
in
gold.
There
that's
program
integrity
and
fiscal
management,
but
where
we
really
did
try
to
reorganize
is
to
think
about.
C
Where
does
the
the
program
need
to
go?
And
some
of
that
is
informed
by
what
we've
heard
from
the
legislature
in
terms
of
oversight
of
our
managed
care
organizations
focusing
more
on
quality
services
and
outcomes,
and
so
that's
what
we
are
trying
to
achieve
with
our
current
reorganization
under
commissioner
lee's
leadership,
she
is
very
much
focused
on
us
becoming
more
than
a
payer
and
instead
being
a
driver
of
the
healthcare
quality
and
outcomes
in
the
state,
since
we
do
cover
1.6
million
people
just
to
just
to
highlight
a
couple
of
things
from
this.
C
We
do
know
that
we
need
to
be
looking
at
our
data.
We
need
to
be
determining
what
is
the
health
status
of
the
people
that
we
serve
and
we
want
to
change.
We
want
to
turn
that
into
that
information
into
focusing
our
policies
to
drive
that
quality
and
that
takes
not
just
fee
for
service
but
managed
care,
so
it's
across
across
the
whole
population
and
also
then
we
could
align
with
efforts
that
are
going
on
statewide.
C
We
are
just
one
third
of
the
population,
so
we
have
to
see
what
is
the
two
of
the
other
two-thirds
what's
going
on
with
that
population
and
where,
as
a
state,
should
we
be
aligning
some
of
our
efforts
so
we're
very
excited
about
that
new
division?
C
We
renamed
our
policy
and
operations
to
healthcare
policy,
they're
going
to
be
focused
primarily
again
on
on
just
the
health
care
services
that
we
cover
and
help
us
identify
working
with
our
other
divisions,
help
us
identify
what
what
other
services
should
we
be
covering?
What
should
we
expand?
You
know
we've
heard
from
folks
about
dental.
What
should
we
be
doing
more
in
dental?
There
are
other
services
we
could
potentially
cover.
So
the
whole
point
of
this
is
to
again
focus
a
division
solely
on
the
services
that
we
cover.
C
C
We
under
that.
We
also
moved
our
eligibility
enrollment
to
that
division,
so
that
those
folks
can
understand,
regardless
of
the
program
that
we
might
be,
covering
that
what
are
the
eligibility
enrollment
pieces
to
that,
whether
it's
under
fee
for
service
or
managed
care
or
some
other
program
down
the
line
that
we
might
end
up
covering?
And
then,
lastly,
we
created
an
information
systems
division
and
what
we
did
at
the
end
of
last
year
was
move
over
staff
and
a
sister
agency
over
to
medicaid.
C
These
are
folks
who
were
working
on
the
medicaid
it
systems
and
what
we
needed
to
do
was
ensure
that
we
were
the
medicaid
priority
was
first
and
foremost
in
the
decisions
we
were
making
about
the
investment
in
our
in
our
it
systems.
So
we
created
a
division
focused
on
that.
C
This
is
just
a
little
deep
dive
into
the
two
new
ones.
Like
I
said,
health
plan
oversight
becomes
the
new
managed
care
oversight.
We
created
appeals
and
complaints,
so
we're
focusing
on
this
is
both
for
providers
and
for
members
again
our
eligibility
eligibility
enrollment
was
there
and
then
contract
monitoring.
D
E
E
So
we
know
right
now:
let's
just
take
maternal
health,
for
example.
We
know
right
now
that
we
have
too
many
c-sections
in
this
state.
We,
our
our
maternal
mortality
rates,
are
higher
than
other
states.
We
have
some
real
problems.
E
C
You're
right
on
the
whole
point
of
this
is
for
us
to
be
able
to
do
that
surveillance
and
then
turn
that
into
actionable
policies
and
to
hold
the
managed
care
organizations
accountable
to
it.
So
we
would
look
at
and
by
the
way,
right
now
we
are
doing
dr
judy
terrio.
Our
medical
director
is
doing
a
deep
dive
into
maternal
health,
and
you
know
one
of
the
things
again
we
got
to
do
was
extend
to
12
months
postpartum,
we're
very
happy
about
that.
C
There
are
some
other
things
we're
looking
at
around
maternal
health
that
we
want
to
do
and
she's
working
with
the
medical
directors
of
each
mco
to
do
that.
They
meet
monthly
and
maternal
health
was
sort
of
the
the
number
one
kind
of
issue
they
wanted
to
look
at
first,
but
the
whole
purpose
of
that
is
for
us
to
bring
them
to
the
table
and
create
that
expectation
and
what
are
those
measures
and
then
hold
them
accountable
to
it?
Okay,.
A
E
A
And
had
when
I've
been
in
secretary's
offices
before
we
had
like
one
person,
one
guy,
we
called
dad
of
dan
used
to
work
over
here,
and
so
now
we
have
a
group
that
that's
working
on
this,
because
we
we
need
to
change
how
we
use
data.
A
Another
piece
that
we're
working
on
is
with
the
university
partnerships
that
was
set
up
in
the
previous
administration,
where
university
of
kentucky
university
of
louisville,
all
of
the
regional,
all
of
the
universities
had
formally
just
been
sending
what
they
wanted
to
to
study,
what
their
graduate
students
were
working
on
and
and
what
we'd
like
a
month
ago,
we
said:
here's
what
we
need
to
see
to
the
universities,
here's
what
we're
trying
to
look
at
what
are
impacts
of
covid.
What
are
you
know?
What
have
been
the
impacts
on
on
health,
emergency
room
usage?
A
A
It's
still
probably
going
to
be
a
year
out,
but
certainly
as
we
get
proposals
from
the
universities,
we
can
share
them
with
with
you
all
what
we
get
I'm
more
than
happy
to
do
that
so
you'll
you'll
see
what
we're
looking
at,
and
I
just
think
it's
it's
senator
meredith.
You
talk
about
this
all
the
time.
Are
we
getting
the
bank
for
our
buck
in
medicaid,
right
and
and
senator
adams?
A
You
know
I
I
could
go
on
and
on
about
you
know
vaccination
rates
in
our
mcos
and
how
we're
doing
better
in
fee
for
service,
but
I
won't
want
to
embarrass
the
mcos
in
that
way,
but
so
we
we
see
this
right
and-
and
we
know
we
need
to
focus
on
this-
I'm
sorry
lisa.
F
Thank
you,
mr
chair,
and
I
just
thank
you
for
this
presentation.
I
I
love
working
on
this
stuff,
so
this
is
my
my
thing
and
and
to
senator
adam's
point
I
would
just
like
to
say
you
know.
F
Some
of
what
we've
looked
at
is
is
falling
in
line
with
with
what
this
plan
is
to
to
collect
more
data,
to
really
look
at
what
works
and
what
doesn't-
and
I
think,
a
good
example
of
that
is
the
community
health
worker
legislation
that
we
passed
in
looking
at
some
of
those
home
place,
studies
and
understanding
the
roi
to
be
something
like
11
and
a
half
dollars
to
one
I
mean
that
is
a
very
targeted
use
of
our
medicaid
dollars,
and
I
think
we
are
stewards
of
taxpayer
dollars
and
we
need
to
make
sure
that
we
have
this
safety
net
in
place
for
those
who
really
need
it,
and
that's
that's
a
very
good
way
to
to
kind
of
address
that
now
I
mean
how
it
how
it
gets
implemented
is,
is
maybe
a
different
kind
of
question.
F
It's
it's
complex
in
the
and
the
medicaid
for
postpartum
women
too.
So
I
look
forward
to
to
working
on
this.
This
is
exciting
stuff.
A
The
other
thing
that
I
failed
to
mention
is
the
other
piece
of
the
reorganization
that
that
for
the
from
the
cabinet
level,
but
you
see
it
reflected
in
the
medicaid
presentation-
we
don't
have
folks
in
our
departments
like
we
have
somebody
who's
who
works
on
hr.
We've
got
somebody
who
works
on
budget.
We've
got
folks
that
work
on
contracts.
A
We
don't
necessarily
have
people
in
the
department
dedicated
to
data
analytics,
which
I
know
might
be
boring,
but
but
we
don't
have
that
so
so
we're
creating
a
couple
of
positions,
one
for
data
analytics
and
one
for
kind
of
strategic
plan
or
implementation
policy
around
sort
of
how
you
have
a
project
manager
when
you're
trying
to
implement
legislation
right.
A
How
do
we
follow
that
through
so
we're
going
to
create
within
each
of
the
departments
in
the
cabinet
that
person
who's
responsible
for
looking
at
their
data
and
then
coordinating
with
the
office
of
data
analytics
in
the
secretary's
office?
So
all
of
this
should
be
working.
Hopefully,
once
we
get
it
all
set
up
should
be
working
together
to
get
us
and
you
all
better
information.
B
And
I
think
the
only
thing
that
I
would
like
to
add
is
you
know
I
keep
asking:
what's
our
baseline,
you
know
senator
rocky
adams,
you
see,
you
know
we're
not
getting
healthier
and
how
are
we
going
to
measure
that?
What's
our
baseline,
what
do
we
want
to
look
at
and
once
we
get
a
report
that
says
here
is
where
the
medicaid
population
is
now.
This
is
where
we
want
to
go.
We
not
only
want
to
look
at
our
population
in
aggregate.
B
We
want
to
compare
those
mcos
against
each
other,
because
we
don't
want
one
mco,
bringing
the
others
up.
We
want
them
to
have
to
look
at
these
measures
and
increase
the
health
status
of
the
individuals
that
we
serve
so
again,
getting
our
baseline
and
developing
a
report
that
we
can
report
out
on
to
this.
B
This
committee,
or
whichever
committee
would
like
to
see
that
report,
but
that
constant
reporting
out
on
a
routine
basis
so
that
we
can
measure
the
the
impact
of
anything
that
we
do
and
not
only
those
measuring
the
impact
of
those
policies,
but
actually
taken
a
really
good
hard.
B
We
definitely
want
to
take
care
of
our
providers,
but
we
also
want
to
make
sure
that
they're
taking
care
of
our
members-
and
sometimes
it's
not
just
the
money,
that's
going
to
increase
access
to
care
or
improve
our
outcomes.
We
actually
need
to
look
at
the
data
and
we
need
to
see
where
we're
making
those
improvements.
If
we're
not
making
those
improvements,
we
have
to
go
back
and
reevaluate.
A
Yeah-
and
you
obviously
have
hit
a
place
that
excites
us
right
now
we
compare
mcos
and
a
lot
of
times
you
compare
plants,
it's
called
hedis
measures
and
they've
been
around
for
a
while,
and
I
I'm
I'm.
G
Thank
you,
mr
chairman.
You
know
I've
been
I've
been
thinking
a
whole
lot
on
this
subject,
particularly
this
last
week,
because
you
know
senator
meredith
did
make
it
really
clear
last
week
that
he
expects
our
mcos
to
be
able
to
step
up
and
improve
healthcare
outcomes
in
this
state,
and
you
know
that
brings
up
a
whole
myriad
of
of
questions,
most
important
of
which,
for
me,
is
what's
your
baseline.
G
G
G
How
capable
are
they
of
actually
getting
to
a
doctor's
appointment
of
understanding
the
doctor's
instructions
of
filling
a
prescription
and
being
able
to
take
it
on
a
routine
basis?
These
are
things
that
our
managed
care
organizations
are
not
going
to
be
able
to
do
for
us,
and
I
just
want
to
put
that
out
for
people,
because
this
is
such
a
multi-factorial
problem
that
to
choose
one
pillar
and
say
you're,
responsible
you're
not
going
to
get
the
outcomes
you
want.
It
will
not
happen
because
it
is
not
the
only
variable
affecting
the
system.
H
Thanks,
sir-
and
I
know
what
a
big
task
this
is-
and
data
concerns,
because
it's
always
subject
to
interpretation
from
someone
and
I'll
share
a
war
story
very
quickly
with
you,
you
know
my
hospital,
which
I
ceo
for
30
years,
county
was
26
thousand
population
services
about
a
hundred
thousand
people
said
I
couldn't
recruit
physicians,
but
I
did
one
in
particular
was
an
ent
from
canada,
great
doctor
trained
at
mcgill,
and
he
came
from
nova
scotia
population
nova
scotia
at
the
time
was
right
at
1
million.
So
what
are
you
coming?
H
The
united
states,
for
he
was
one
of
three
for
the
whole
province
and
he
was
just
overworked
and
targeted
bureaucracy
of
a
federal
system.
So
that's
why
he
came
to
the
united
states,
but
at
that
time
we
had
67
ent
in
kentucky,
but
the
majority
of
them
were
in
the
urban
areas.
He
was
one
of
the
real
extremes
that
were
in
the
rural
area,
so
a
lot
of
this
goes
back
to
distribution
of
resources,
which
I
don't
think
we've
ever
had
an
equitable
means
of
doing
that.
H
H
And
one
of
the
things
that
I've
really
looked
at
last
few
months
is
the
states
are
using
deprivation
index
for
allocation
of
resources,
which
makes
sense
to
me,
but
there's
so
many
other
elements
of
this?
Another
thing
I'm
very
curious
about
is
yeah.
I
bash
the
mcos
all
the
time
and
I'm
sure
we
get
a
value,
but
part
of
our
issue
is
access
to
care,
which
means
access
to
insurance
got
a
third
of
our
population.
That's
under
medicaid
now
we're
looking
at
another
program.
H
We
need
a
healthy
state
and
if
you
don't
have
access
to
insurance,
you're
not
going
to
be
able
to
accomplish
that.
So
to
me,
that
looks
like
it'd,
be
a
matter
of
health
policy
too,
that
if
you're
going
to
participate
on
our
medicaid
managed
care
program,
you
also
have
to
offer
a
commercial
insurance
program
to
employers.
So
again,
it's
I
know
we're
going
to
have
a
lot
of
these
conversations,
the
next
four
or
five
months.
H
D
Actually,
I
apologize.
I
have
one
question
now
that
I
think
of
it.
It's
actually
more
of
a
request
than
anything
last
meeting
representative
bentley
did
a
terrific
job
of
giving
us
a
spreadsheet
and
layout
of
the
structural
organization
of
the
entire
cabinet,
and
I
I
understand
that
some
of
that
I
believe
the
data
from
that
was
from
2021,
and
I
know
there's
been
a
lot
of
changes
in
that
time
period.
Could
you
all
give
us
an
updated
flow
chart
of
with
with
every
where
we
stand
today
with
that?
C
So
this
is
just
a
snapshot
of
the
personnel
at
the
time
we
we
took
this.
You
know
a
state
government,
we
have
people
come
and
go,
but
146
full-time
employees,
71
vacant
positions,
approximately
15
temporary
employees
and
then
nine
the
94
contractors.
The
reason
really
for
the
contractors
is
mostly
around
the
I.t
systems.
It's
it's
incredibly
difficult
to
recruit
and
retain
qualified
staff
in
the
area
of
I.t,
and
so
that
expertise
is
just
really
best
to
get
through
a
contractor
situation.
C
I
do
want
to
acknowledge
our
employees
appreciated
and-
and
I
did
as
well
the
raise
that
we
got
on
july
1st-
we
heard
from
employees
how
much
they
appreciated
that.
So
I
do
want
to
take
a
moment
and
say
thank
you
for
that.
C
We
are
also
looking
at
as
part
of
our
reorganization's
ways
to
recruit
and
retain
employees
and
to
diversify
our
skill
set
so
to
the
point
of
equity
and
determinants
of
health
and
the
role
they
play
in
somebody's
health.
We're
with
with
our
reorganization,
we'll
now
have
the
ability
to
bring
on
staff
that
has
expertise
in
that
area.
So
you
know
again
with
our
reorganization.
We
are
thinking
more
about
the
knowledge
base
and
the
expertise
that
we
have
and
what
can
we
bring
on
to
help
us
get
to
where
we
all
want
to
go.
D
Sorry
to
interrupt
you,
commissioner,
can
you
check
just
make
sure
your
mic
is
on
there?
It.
B
B
B
We
do
coordinate
and
provide
administrative
support
for
a
for
our
medicaid
advisory
council,
that
is
a
22-member
panel,
representing
various
provider
groups
throughout
the
state
and
that
are
enrolled
in
medicaid
and
underneath
the
medicaid
advisory
council.
We
have
17
technical
advisory
committees,
here's
a
list
of
all
of
those
committees,
and
I
will
let
you
know
that
this
is
the
only
format
in
the
nation
like
this.
Most
medicaid
agencies
have
just
a
medicaid
advisory
council
that
meets
and
discusses
policies.
Procedures
related
to
the
medicaid
program.
A
There
are
two
things:
if
you
go
back
two
slides.
There
are
two
things
I'd
like
to
expand
upon
just
to
touch
how
we
relate
to
the
center
for
medicare
and
medicaid
services
cms.
A
When
we
put
a
state
plan
amendment
in
when
we
ask
for
a
waiver,
you
all
have
been
following
the
15
on
on
howard,
the
11
15
waiver
and
they're
1915
b
c.
I
11
15.
You
know
we
could
we
could
list
a
whole
bunch
of
alphabet
soup
for
you.
But
what
happens?
Is
we
put
it
into
the
federal
government
they're
on
a
clock
they're
supposed
to
answer
us
in
90
days?
A
They
they
come
back
with
a
question
and
then
we
have
like
45
days
to
respond
and
then
we
send
it
back
and
then
they
get
another
90
days
and
they
get
to
ask
us
another
question,
and
so
last
time
I
talked
a
little
bit
about
the
1115
and
and
being
able
to
expand
some
on
on
some
of
our
substance,
use
services
and
transition
from
corrections
facilities
into
community.
That's
been
on.
We've
been
on
the
clock
there
for
two
years:
you
they
can
run
the
clock
for
a
while.
A
So
I
just
I
just
want
to
put
that
out
there
for
you
all
to
know
that
that
it,
it
is
not
from
a
lack
of
trying.
Often
the
the
the
second
piece
was
commissioner.
Lee
talked
about
the
integrated
eligibility
system.
Iees
ours
is
big.
It's
it's
different
because,
because
medicaid's
in
the
cabinet,
it
includes
other
programs.
So
so,
when
you
apply
for
medicaid,
you
know
we
can
also
use
some
of
that
data
in
snap.
We
can
also
use
some
of
that
data
in
tana.
A
Some
states
have
it
like
that
right,
but
but
ours
is
pretty
big
and
that
integrated
system
means
that,
as
you
build
that
gigantic
system,
a
lot
of
it
is
funded
by
medicaid,
because
that's
the
lion's
share
of
folks
who
are
getting
eligibility
through
the
system,
but
it
actually
helps
the
cabinet
function
across
across
the
entire
cabinet
for
that
eligibility
piece.
So
I
just
I
just
wanted
to
make
those
two
kind
of
so
you
can
kind
of
understand
some
of
that
back
and
forth.
D
All
right,
we
can
pause
real,
quick
for
some
questions.
Chairman
meredith.
H
Thanks
sir
last
meeting,
which
senator
adams
and
representative
mosher
were
not
here,
we
had
a
lot
of
discussion
about
the.
H
A
A
But
that's
where
a
lot
of
the
administration
comes
from
as
well
as
then
medicaid
when
we
start
pulling
by
program
and
and
the
ies
sorry
for
the
initials.
That's
one
that
we
pull
by
program
so,
depending
upon
the
program,
it
will
either
pull
85
percent
for
medicaid
or
more
like
20
30
percent,
and
I
there
are
examples
of
programs
where
we,
where
we
more
pull
like
30
and
their
example
of
programs,
where
we
more
pull
like
85
percent
and
and
that
really
the
main
way
it
happens
for
cabinet
cost.
A
Allocation
for
administrative
costs
really
was
set
to
personnel
many
years
ago,
and
that
is
it's
an
approved
way
to
do
it.
It
is
a
it's
a
it's
a
really
good
way
to
distribute
costs
from
the
cabinet
based
on
administration
but
yeah.
I
I
think
the
number
of
personnel
in
medicaid
is
awfully
small
for
a
program
as
big
as
it
is.
H
Well
and
that's
what
confuses
me-
and
I
just
want
to
say
again
once
you
said
the
last
meeting
I
personally
and
I
don't
think
co-chair
mead-
does
either
has
a
predetermined
agenda
and
outcome
for
this
task
force.
A
lot
of
people
spoken
about
the
previous
experience
of
splitting
the
cabinet.
You
know
I'm
not
suggesting
that,
but
in
the
same
token,
I'm
not
saying
that
I
wouldn't
want
to
take
a
look
at
that,
but
in
order
to
make
that
determination,
I
think
we
have
to
have
a
better
understanding
of
what
these
numbers
actually
look
like
right.
H
H
So
I
think
we
got
to
look
at
it
differently,
because
my
motivation
for
this
is
make
sure
we're
being
as
efficient
and
effective
and
responsive
as
possible
to
providers
and
recipients,
but
I
don't
know
in
their
current
structure
if
we're
able
to
do
that
and
another
thing
that
bothers
me
since
we've
had
this
conversation
last
minute.
This
one
is:
how
much
are
we
allowing
federal
payment
policy
to
determine
this
structure?
H
And
you
know
this
is
obviously
intimidating,
but
certainly
looks
like
federal
government
too,
and
I'm
just
concerned
that
are
we
letting
medicaid
policy
drive
the
structure
of
our
cabinet
in?
If
we
are,
are
we
really
looking
in
the
most
cost,
effective
manner
possible?
Because
we've
got
all
these
subs
sections?
H
That
is
there
a
possibility
to
bring
it
inside
and
consolidate
it.
So
rather
you
bring
them
bust.
The
cabinet,
apart,
I'm
thinking,
maybe
you
can
consolidate
and
condensing
it
more
by
truly
identifying
the
resources
used
and
needed
for
each
of
these
functions
and
also
build
accountability
in
because
I
think
that's
something
we
all
agree
in
there's
just
not
enough
accountability.
H
H
B
Cms
funds,
a
large
portion
of
the
medicaid
program,
as
you
know,
and
we
have
to
be
accountable
to
cms
and
we
submit
routine
reports
and
every
report
that
we
submit
to
cms
has
to
be
validated.
And
they
have
to
know
that
every
dollar
that
we're
claiming
from
cms
to
run
the
medicaid
program
is
actually
going
to
the
medicaid
program
and
benefiting
the
medicaid
program
going
forward.
A
B
We
do,
for
example,
if
we
have
we
when
we
talk
about
our
I.t
system,
for
example,
we
have
to
develop
a
very
detailed
advanced
planning
document,
an
apd
that
outlines
every
bit
of
the
dollars
and
the
the
services
that
we're
going
to
be
delivering
with
that
information
technology
system.
B
So,
in
addition
to
having
oversight
with
at
the
state
level,
we
have
a
lot
of
oversight
at
the
federal
level
with
cms
and
they
do
ask
a
lot
of
questions
and
they
ensure
that
all
of
the
dollars
that
they're
providing
to
the
medicaid
program
are
going
to
the
operation
of
the
medicaid
program.
A
A
A
That
last
week,.
H
A
So
some
of
that
does
influence
structure
right.
I
think,
that's,
I
think,
that's
true,
but
then
I
think
some
is
just
how
you
divide
programs,
sometimes
like
to
say,
I
think,
of
reorganizations
and
structures
as
like,
where
you
like
the
couch
in
the
living
room.
You
know
everybody's
got
a
different
opinion,
but
there's
some
of
that
right
in
the
cabinet,
where
we're
we're
organized
to
to
maximize
the
federal
dollar,
actually
a
counter-example
that
whole
I.t
piece.
C
A
Sure
it
was
fine
that
I
could
say
everything
that
was
happening
in
that
unit
related
directly
to
medicaid.
So
we
we
took
that
unit
and
put
it
in
medicaid,
because
we
needed
to
feel
confident
that
when
we
said
turned
to
cms
and
said
yeah
everything's
happening
everything
that's
happening
here
is
legitimate,
medicaid
expense.
H
Well
again,
I'm
not
questioning
the
legitimacy
of
the
expense,
I'm
questioning
the
the
the
efficiency,
the
effectiveness
of
the
expense
and
again
without
knowing
how
these
dollars
or
allocate
these
respective
departments
it's
proverbial.
You
can't
serve
two
masters
if
you've
got
a
medicaid
responsibility,
but
you've
got
other
responsibilities
as
well,
which
master
are
you
serving,
and
if
this
is
a
small
percentage
of
my
section,
then
I'm
not
going
to
pay
the
attention
to
that
that
I
am
my
other
functions.
H
So
a
very
basic
question
is
well,
then:
do
we
need
to
move
that
someplace
else
right,
but
what
complexity
makes
any
more
complex
for
me
is
approximately
94
contractors
again.
Sorry,
I
didn't
tell
them
anything.
Was
that
a
good
number
is
that
a
bad
number?
Maybe
we
should
have
120
contractors
and
shift
those
resources
from
one
side
to
the
other,
so
I
think
we're
just
going
to
have
to
drill
down
on
this
information
more
than
what
what
I
have
here
to
understand,
what
we're
trying
to
accomplish
and
how
we
get
there.
H
C
A
A
C
Any
overlap
so
we're
you
know
grateful
to
have
the
division
of
information
systems
now
that
can
focus
on
those
things
and
make
sure
that
we
are
getting
return
on
on
that
investment.
E
C
For
continuity
to
to
have
the
knowledge
in-house,
I
don't
I
don't
again,
I
think
in
the
area
of
I.t.
That's
that's
nearly
impossible,
because
we
just
can't
compete
with
you.
H
I
think
it's
a
fair
statement
on
your
part,
but
I
guess
I'd
have
to
ask
what
other
functions
within
the
academy.
Could
we
do
maybe
on
a
contractor
basis,
rather
than
do
it
internally,
because
we've
already
knowledged
with
the
mcos
that
supposedly
they
do
it
better,
then
we
can
do
it
ourselves.
So
what
are
the
functions
are
out
there
that
somebody
else
can
do
better
and
do
it
cheaper.
H
G
Thank
you
again,
I'm
going
back
15
minutes
into
the
conversation
where
we
were
talking
about
eligibility-
and
I
do
have
a
question
about
this
because,
first
of
all,
I'm
going
to
explain
to
you
how
I
see
this
you're
going
to
tell
me
how
I'm
wrong
and
then
you're
going
to
answer
my
question.
If
you
can
so
my
understanding
about
presumptive
eligibility
for
medicaid
comes
from
my
background
as
being
a
hospital-based
physician.
G
G
G
And
that's
how
I'm
used
to
we've
always
done
it
and
then
last
session
because
of
concerns
for
fraud
in
this
system
we
changed
the
rules
a
little
bit.
My
understanding
of
what
we
did
is
we
kept
that
in
place
for
the
hospitals,
even
though
originally
we
were
trying
to
take
that
away
from
the
hospitals,
they
so
desperately
needed
that
presumptive
eligibility
that
we
left
it
in
place
for
them,
but
we
took
it
away
for
post
hospital
like
we
basically
required
patients
to
apply
on
their
own.
G
They
couldn't
just
get
that
eligibility
that
they
had
received
in
the
hospital.
Take
it
with
them
now
you're
looking
perplexed,
so
I'm
hoping
so
I'm
wrong.
My
question
was:
what
is
the
additional
cost
to
ural's
cabinet
based
on
this?
Are
you
all
having
to
go
back
and
re-certify
patients
eligibilities?
G
B
B
That
was
simply
for
pregnant
women
and
the
providers
that
are
eligible
to
grant
presumptive
eligibility
for
pregnant
women,
our
local
health
departments,
fqhcs
obgyns,
and
then
in
2014
we
created
hospital
presumptive
eligibility,
which
is
the
process
that
you
know
so.
Presumptive
eligibility
is
temporary.
It
just
gets
somebody
in
the
front
door
until
we
can
complete
that
full
application,
it
allows
the
provider
to
get
paid
and
it
allows
the
member
to
receive
services.
B
So,
during
covid
at
the
height
of
covid,
we
were
very
concerned
about
individuals
not
being
able
and
to
go
to
a
physician,
to
seek
treatment
for
for
covid
and
for
other
issues.
So
the
cabinet
was
authorized
by
cms
to
be
a
presumptive
eligibility
eligible
agency
to
be
able
to
grant
presumptive
eligibility.
So
we
had
a
simple
form
online
that
individuals
could
fill
out.
B
Our
system
would
would
look
at
that
form
and
grant
that
presumptive
eligibility
if
that
individual
qualified,
but
we
never
stopped
the
presumptive
eligibility
for
hospitals
or
the
pregnancy
pe,
so
so
the
presumptive
eligibility
that
was
during
covid
was
a
simple
process
that
individuals
could
go
online
themselves
and
now
july,
17
14
that
form
has
been
taken
down.
The
hospital
presumptive
eligibility
and
the
pregnancy
presumptive
eligibility
is
still
as
it
always
was,.
A
And-
and
I
I
can
do
just
a
little
more
and
we
can
get
you
the
dollar
figures,
although
I
can't
quote
them
to
you
now,
but
we'll
get
them
to
you.
We
did
we
expanded
presumptive
eligibility
during
covet.
We
did
it,
we
we
we,
we
determined
ourselves
as
the
agency
and
and
we
we
covered
a
lot
of
people.
We
we
also
did
stop
it.
We
were
covering
at
a
run
point
about
120
000
people,
and
they
were
not
because
we
were
doing
it
under
presumptive.
A
They
didn't
fall
under
the
public
health,
emergency
and
maintenance
of
effort.
So
actually
you
you
can
actually
look
at
our
eligibility
statistics
and
you
can
see
where
we
took
them
off
because
you
see
it
drop
but
but
we're
still,
we
basically
got
back
to
where
we
were,
but
not
on
presumptive
eligibility.
So
presumptive
eligibility
still
exists
at
the
hospitals,
they
have
to
complete
a
process,
and
that
was
negotiated
through
house
bill
7.,
and-
and
thank
you
for
that
and
nursing
facilities
can
do
some
of
that
too.
That
was
a
new
presumptive
eligibility.
A
We
we
did
during
covid,
but
that's
one
that
that
we're
allowing
to
move
forward
where
you
saw
those
categories
of
eligibility
right
there.
There
are
a
bunch
of
them
and
the
one
that's
most
complex
is
called
adult
medical
and
it's
when
you're
getting
eligible
for
a
nursing
facility
that
can
take
months.
A
You,
you
know,
you're,
what's
the
value
of
your
home?
What's
do
you
have
stocks?
What's
the
value
of
your
car?
Do
you
have
jewelry?
I
mean
it
gets
to
the
point
of
like.
What's
what
are
your
assets
and
that
takes
a
long
time
to
do
and
can
sometimes
delay
eligibility
for
nursing
facilities
for
months
and
and
the
nursing
facilities
were
struggling.
At
that
point
right,
we
were
trying
to
make
sure
in
many
ways
how
we
can
get
people
in
more
quickly.
A
We
did
a
29
add-on
that
didn't
add
up
to
really
much
of
anything
for
them,
because
medicare
pays
so
much
better
than
medicaid
just
a
true
statement
so,
but
that
probably
that
that
presumptive
for
nursing
facilities,
we
think
help
them
some
again.
That
might
be
a
little
hard
for
us
to
quantify
we'll
work
on
it.
But
but
that's
that's
one
again
through
house
bill
7
that
we're
able
to
to
continue
some
but
they're,
still
responsible
for
completing
the
full
medicaid
application
and-
and
that's
that
was
part
of
that
house-
bill
7
requirements.
G
B
When
an
individual
completes
a
presumptive
eligible
application,
they
have
a
short
term
limit
time,
limited
eligibility
if
they
don't
complete
a
full
application.
They
drop
off
if
they
do
complete
a
full
application
and
they
are
granted
medicaid
eligibility.
They
just
go
on
to
the
medicaid
eligibility
roles.
The
individuals
who
completed
presumptive
eligibility
a
lot
of
those
individuals
just
needed
short-term
insurance.
Maybe
they
were
laid
off.
Maybe
they
didn't
have
any
any
source
of
insurance.
B
B
They
are
not
included
in,
as
the
secretary
said,
in
the
maintenance
of
eligibility
that
is
required
under
the
affordable
under
the
the
public
emergency.
So
we
still
get
our
6.2
enhanced
af
map,
which
is
our
federal
share
for
our
medicaid
program
through
the
public
health
emergency.
So
I
think
to
answer
your
question.
They
came
on
those
individuals
that
had
temporary
eligibility
may
have
received
a
few
services.
They
are
no
longer
eligible,
so
our
administrative
costs
related
to
them
has
has
ended.
A
A
I
think,
by
the
way,
by
the
time
people
got
application
right.
It
was
about.
It
was
around
80
000.,
I'm
close
when
the
public
health
emergency
ends,
because
those
people
who
come
through
and
done
the
full
enrollment
or
in
medicaid,
but
maybe
have
a
new
job,
so
they're
they're
above
income
guidelines,
the
public
health
emergency.
Where
we
get
the
extra
6.2
percent,
they
can't
come
off
the
rolls
until
the
public
health
emergency
ends.
Now
we
think
there
are
170
000
of
those
folks.
A
We
think
there's
somewhere
in
that
neighborhood
of
that
many
people
now
will
170
000
come
off
the
rolls
over
over
over
a
period
of
time.
They
will
either
be
eligible
for
medicaid,
and
you
know
we
just
don't
know
or
they
will
come
off
the
rolls,
and
so
that's
when
the
public
health
emergency,
it's
just
been
extended,
so
we
think
it's
going
to
go
through
december.
Now
we
just
heard
like
last
week,
so
we
think
it's
going
to
go
through
at
least
december.
A
We
think
so.
A
That's
big!
That's
big!
That's
big
on
budget,
but
when
that
ends,
then
we
have
to
start
the
process
of
taking
them
off.
The
rolls.
C
So
somebody
is
eligible
and
for
some
reason
can't
get
their
paperwork
in
or
we
want
to
make
sure
they
stay
on,
and
then
our
other
goal
is
to
people
who
truly
should
no
longer
be
covered
under
medicaid
that
they
get
transitioned
to
a
qualified
health
plan,
as
if
their
income,
you
know,
has
increased,
then,
hopefully
they
can
qualify
for
that
and
get
access
to
a
qualified
health
plan.
So
those
are
our
two
primary
goals
with
unwinding
of
the
public
health
emergency
is
to
help
those
folks
and
make
sure
that
they
have
access
to
coverage.
A
And
we'll
do
it
within
the
provisions
of
house
bill
7
and
within
what
cms
allows.
That's
just
those
are
just
true
statements
and
that's
how
we'll
do
it
so
probably
there'll
be
more
folks
coming
off
in
in
the
beginning
than
probably
at
the
end,
but
but
that
that's
just
how
it's
gonna.
That's
how
it's
gonna
roll
out.
I
believe.
D
Well,
thank
you
all
for
that
answer
and
I
think
the
takeaway
from
that
is
to
to
realize
that
this
is
not
the
way
presumptive
eligibility
was
always
done.
There
was
a
vast
expansion,
yes
during
coven,
and
it
was
moe.
Maintenance
of
effort
was
a
game
changer
a
a
on
the
outlook
of
this
entire
medicaid
plan.
D
With
with
this
federal,
this
federal
administration,
not
allowing
the
removal
of
those
folks
during
moe
as
it
is
in
effect,
so-
and
it's
also
important
that
to
take
away
from
this-
that
it
is
not
just
a
state
requiring
you
to
clear
those
roads.
The
federal
government
will
require
you
to
do
that
as
well.
Once
moe
is
lifted.
D
Money
to
be
good
stewards
of
that
taxpayer
money
and
even
though
these
are
federal
dollars,
the
people
of
kentucky
are
still
paying
some
of
those
federal
tax
dollars
so
that
we
we
must
make
sure
that
we
are
utilizing
that
in
the
best
way
possible
and
not
over
utilizing
it.
I
guess
you
would
say,
but
I
also
have
a
a
question
for
you
on
slide
11.
D
C
They
are
primarily
in
our
information
technology,
so
they
work
in
our
systems.
We
have
a
few
that
are,
for
instance,
we've
had
difficulty
recruiting
nurses
just
because
of
the
salary,
and
so
we
have
had
to
contract
with
some
for
some
nurses
to
help
us,
but
it
is
the
line.
Share
of
that
is
absolutely
I.t.
D
C
So
we
really
do
try
to
use
temporary
employees
temporarily,
and
so
these
are
folks
that
come
on
and
help
us
with,
for
instance,
if
we're
trying
to
prepare
our
records
for
archiving
or
you
know
it
really.
The
whole
point
of
that
is
to
bring
somebody
on.
We
were
having
a
lot
of
difficulty,
filling
administrative
positions,
and
so
we
have.
We
have
had
to
sometimes
utilize
temporary
employees
to
come
on
board
and
help
with
some
of
our
administrative
functions
for
filing
and
that
sort
of
thing.
C
So
we
do
still
have
a
couple
of
our
temporary
employees
are
in
our
provider,
con
contact
center
and
but
we
have
been
able
to
with
our
online
provider
enrollment
system
and
maintenance
system.
We've
been
able
to
reduce
the
number
of
contemporary
employees
around
there,
but
we
still
have
a
few
to
help
with
the
workload
and
so
those
are
the
the
buckets
of
temporary
employees.
A
Within
the
cabinet,
mostly
temporary
employees
are
those
administrative
positions.
The
other
place
we
started
started
using
temporary
positions
is
the
hiring
process,
particularly
within
dcbs,
we're
able
to
get
people
on
board
more
quickly,
using
the
temporary
process
and
then
leading
them
through
that
process
to
be
get
permanent,
so
that
not
here
not
in
medicaid,
but
in
dcbs
we
use
some
of
that
temporary.
As
that
bridge
of
yeah.
We
can
offer
you
a
job
now,
hang
with
us,
while
we
go
through
the
the
personnel
process
and
then
we
convert
you
to
a
full-time
employee.
E
It's
it's
an
easy
one,
but
it's
kind
of
along
the
same
lines
as
senator
meredith
was
asking
about.
You
know,
maximizing
these
federal
dollars
and
is
everything
where
they're
supposed
to
be
so
that
we
can't
maximize
those
dollars
and
then
he
kind
of
morphed
into
a
consolidation
type
of
inquiry,
and
it
brought
me
back
to
the
1915
c
task
force
that
we
started
on.
And
you
know
some
of
those
programs
are
not
housed
within
medicaid
they're
in
you
know,
department
for
behavioral
healthy
id.
E
A
If
I
may
yeah
this
is,
I
think
one
of
those
really
really.
You
said
it's
an
easy
question.
It's
not!
It
is
such
a
difficult
question
because
my
experience
in
the
cabinet-
and
I
think
this
will
be
whoever.
A
That
is
always
a
push
and
pull.
There
have
been
times
when
all
of
the
waivers
and
all
the
waiver
personnel
has
been
in
medicaid.
There
have
been
times
when
almost
all
the
waiver
personnel
have
been
in
behavioral
health
or
date
or
are
aging
independent
living.
We
we've
got
a
little
bit
of
a
balance.
Now
I
will
tell
you
what
my
philosophy
is:
okay
and
we
don't
always
agree,
but
this
is
my
philosophy,
I
believe
the
programmatic
expertise
right.
The
folks
who
know
id
developmental
intellectual
disability
reside
in
that
department.
A
I
believe
that
the
folks
who
substance
use
and
and
severe
mental
illness
reside
in
that
department.
I
believe
that
real
substantive
aging
experience
resides
in
that
department.
A
The
challenge
is
right:
it's
medicaid
that
ends
up
with
the
bill
right,
so
so
medicaid's
like
no.
We
need
to
control
this
right.
I
think
I'm
portraying
that
correctly
and
so
there's
always
this
tension
within
the
cabinet
always
and
since
I've
been
there,
I
actually
wrote
going
back
to
like
I've
been
every
place.
The
the
original
waiver
for
individuals
with
developmental
intellectual
disability
was
called
the
a
I
s
m
r
waiver.
The
r
is
a
word,
we
don't
say
anymore,
that's
how
old
it
is
right.
A
We
could
so
there's
always
been
this
tension
in
the
cabinet
of
where
is
the
programmatic
expertise,
and
where
is
the
fiscal
responsibility,
and
how
do
you
parse
that
and
I
I
don't-
I
don't
think
I
actually
don't
think
it's
an
easy
answer
and
I'm
not
sure
that
there's
a
right
or
100
right
or
100
wrong
answer.
It
really
is
that
that
back
and
forth
and
that
tension
and
it
it
is
tension.
It
is
tension.
B
And
I
think
all
I
would
add
is
going
back
to
the
responsibilities
of
the
medicaid
program
is
medicaid?
Is
the
single
state
agency
authorized
by
cms
to
operate
the
program,
so
the
department
for
medicaid
services
has
to
be
responsible
and
is
held
responsible
by
cms
for
all
of
those
functions?
But
I
do
agree
with
the
secretary
that
we
have
expertise
in
the
department
for
behavioral
health,
for
example.
B
A
H
E
That
was
why
it
kind
of
sparked.
Why
are
we
doing
it
this
way,
but
thank
you.
I
appreciate
that
answer
or
as
best
you
can
answer
right.
Yeah.
B
And
so
continuing
on,
if
we,
unless
there
are
any
more
questions,
we'll
continue
on
with
the
services
and
the
responsibilities
of
the
medicaid
program,
of
course,
our
primary
responsibilities
are
ensuring
that
we're
providing
medically
necessary
individuals,
their
enrolled
members.
We
do
have
mandatory
services
and
optional
services,
and
I
apologize.
I
have
a
note
here
to
refer
to
the
latest
lrc
report,
which
was
just
finished
today.
That's
a
legislative
research
commission
report
for
medicaid
that
is
submitted
to
lrc
on,
I
think,
a
quarterly
basis
that
outlines
every
single
service.
That's
mandatory.
B
It
outlines
the
optional
services.
It
also
has
our
capitation
payments
to
the
managed
care
organizations,
the
number
of
individuals
enrolled
in
the
medicaid
program
during
the
reporting
period
and,
for
example,
some
of
our
mandatory
services,
of
course,
are
hospital
services,
physician
services,
long-term
care
services,
optional
services,
surprise,
surprise.
Pharmacy
is
an
optional
service,
but
that
is
only
you
know.
In
in
theory,
I
mean
it
cannot
be
an
optional
service
because
without
medications,
individuals
would
not
be
healthy.
B
Dental
services
and
vision
services
are
optional
for
individuals
over
21.
So
when
you
look
at
that
lrc
report-
and
we
can
send
you
a
copy
to
this
committee
later
this
this
week,
once
you
look
at
those
services,
anything
that
is
optional
is
mandatory
for
a
child
over
the
under
the
age
of
21,
and
that
goes
back
to
that
epsdt
benefit,
so
no
service
on
that
lrc
report
that
says
optional
is
optional
for
under
21..
B
So
some
of
the
services
that
we
provide
that
are
administered
by
other
agencies,
for
example,
is
our
non-emergency
medical
transportation.
This
program
actually
operates
very
similar
to
the
mco,
in
that
it
is
a
capitated
payment
model.
The
department
pays:
the
office
of
transportation
delivery,
a
capitation
a
per
member
per
month,
dollar
figure
for
everyone
enrolled
in
the
medicaid
program.
With
a
few
exceptions,
then
the
office
of
transportation
delivery
contracts
with
brokers
who
then
deliver
services
to
our
medicaid
population.
B
School-Based
services
are
another
program
that
we
cover
school-based
services,
even
though
they
are
in
the
medicaid
program.
They
are
not.
The
the
costs
of
the
school-based
services
do
not
really
impact
the
medicaid
budget,
because
the
department
of
education
pays
the
state
share
on
those
programs.
So
we
have
two
forms
of
payment
to
our
school
forest
school-based
services.
B
One
is
administrative
claiming
so
schools
that
have
individuals,
for
example,
that
help
children
or
help
their
families
do
outreach
or
they
complete
applications
for
eligibility
for
medicaid
are
able
to
claim
a
certain
percent
of
those
costs
as
administrative,
and
we
can
draw
down
some
federal
dollars
to
give
to
the
department
of
education
to
disperse
throughout
the
schools
that
are
doing
that.
That
service
we
also
pay
for
direct
services
such
as
therapies
and
some
nursing
services
in
our
schools.
B
Prior
to,
I
think,
2020.
All
services
that
were
delivered
the
medical
services
delivered
in
schools
had
to
be
delivered
to
a
child
who
had
an
individualized
education
plan
or
an
iep
beginning
in
2020.
We
expanded
that
service.
So
now,
children
in
schools
can
receive
any
medically
necessary
service
that
the
school
has
a
qualified
health
care
provider
to
deliver
and
that
child
does
not
have
to
have
an
iep.
B
That
means
that
we
can
now
reach
out
this
broader
to
a
broader
audience
of
children
in
school
and
make
sure
that
they
receive
medically
necessary
services.
We
still
that
program
is
in
is
in
play.
We
do
have
approval
for
it,
but
covid
came
along
and
it
kind
of
interrupted
some
of
the
planning
and
the
processes
and
education
that
we
were
working
with
some
of
our
schools.
So
we
hope
to
take
that
up
again
soon
and
make
sure
that
the
schools
and
know
exactly
what
they
can
bill
for
under
those
school-based
services.
B
Our
health
access
nurturing
and
development
services
is
our
hands
program.
We
contract
with
the
department
for
public
health.
This
is
a
school-based.
I
mean
this
is
a
home
visitation
program,
that
is
for
first-time
mothers
or
fathers
or
at-risk
parents,
and
it's
only
for
children
under
the
age
of
three
very
similar
to
first
steps,
which
is
an
early
intervention
service
program
for
children
under
the
age
of
three,
and
we
also
administer
that
through
the
department
of
public
health
and
on
both
of
those
programs,
both
hands
and
first
steps.
B
The
department
for
public
health
pays
the
state
match
and
we
draw
down
those
service,
those
federal
dollars
for
those
programs
go
to
the
next
and
when
we
get
into
our
funding.
Of
course,
we've
talked
about
the
federal
state
partnership.
Approximately
70
percent
of
our
funds
are
for
our
traditional
medicaid
population.
We
get
80
match
rate
you'll,
hear
it
referred
to
as
f
map
or
match
rate
barricade,
chip
population,
90
percent
for
medicaid
expansion,
and
our
administrative
expenses
are
about
50
percent.
They
we
receive
50.
B
Currently,
3
percent
of
our
total
budget
is
on
our
administrative
costs.
We
also
get
enhanced
funding,
for
example,
for
it
projects
when
we
are
in
our
planning
phase
and
design
and
development
phase
of
a
it
project
and
we're
developing
a
system.
We
get
about
90
percent,
that
amount
of
funding
eventually
is
reduced.
Once
we
get
in
operations
and
maintenance,
it
can
go
to
75
percent.
C
So
some
of
you,
this
may
look
familiar
that
you've
seen
it
before,
but
this
is
just
the
pie
chart
of
of
the
breakdown
of
where
our
our
dollars
go
and,
as
you
can
see,
the
majority
of
that
is
for
managed
care,
managed
care.
Capitation
payments
make
up
79.21
percent,
but
keep
in
mind
that's
for
over
90
percent
of
our
population,
so
we're
spending
almost
80
percent
for
about
91
to
92
percent
of
our
population.
C
The
other
bucket
there
for
fee
for
service
is
our
nursing
facility
and
1915
c
waiver.
So
that's
the
intellectually
and
developmentally
disabled
population
is,
is
what
makes
up
fee
for
service
and
there's
about
26
000
26
to
27
000
people
that
are
in
the
waivers.
So
again
a
lot
of
that
is
nursing
facility.
C
B
We'll
go
on
to
types
of
waivers,
I
think
we've
talked
about
waivers
a
little
bit
here.
Section
1115
waivers
are
often
referred
to
as
demonstration
waivers.
This
allows
us
to
just
test
out
new
approaches.
I
think
you
know
that
we
have,
for
example,
a
pending
waiver
with
cms
and
11
15,
that
is,
to
cover
services
for
individuals
who
are
incarcerated.
We
want
to
cover
substance,
use
disorder
services
for
those
individuals.
B
We
also
have
1915
b
waivers,
which
are
called
freedom
of
choice,
waivers
and
that
just
allows
us
to
deliver
services
via
managed
care
delivery
systems,
and
we
can
go
to
the
next
one.
So
we
have
a
little
evolution
of
medicaid
waivers
in
here.
I'm
not
sure
we
need
to
go
through
all
of
this,
but
basically
again,
this
is
an
example
of
medicaid
being
the
go-to
program
to
solve
those
health
care
issues
that
private
insurers
either
cannot
or
will
not
provide.
B
So,
for
example,
where
hcbs
waivers
came
about
in
the
1980,
they
provide
specific
services
to
help
individuals
remain
in
the
home
and
community,
for
example,
case
management,
homemaker
services,
home
health
aid,
personal
care.
Those
are
all
services
that
commercial
carriers,
particularly
personal
health,
personal
care,
do
not
cover
for
individuals
that
are
very
vital
to
them
staying
in
their
community
rather
than
having
to
stay
in
a
long-term
care
facility.
B
So
we
talked
a
little
bit
about
this
just
a
second
ago,
but
we
do
have
six
1915
c
waivers
and
our
department
of
aging
and
independent
living
helps
us
with
the
administrative
functions
related
to
home
and
community-based
waivers,
as
well
as
supporting
of
our
pds,
which
is
referred
to
as
participant
directed
services
we'll
get
into
that
in
just
a
little
bit
now
later,
but
for
all
of
our
waivers
and
our
department
for
behavioral
health
and
intellectual
disabilities
shares
operating
functions
for
the
scl,
michelle
p
wavers.
They
pro
they
help
us
administer
those
programs.
B
This
is
just
a
listing
of
our
1915
c
waivers
and
it
just
kind
of
gives
you
an
overview
of
those
individuals
who
are
in
those
waivers.
I
would
the
supports
for
community
living
waiver
is
the
only
waiver
that
does
have
a
residential
component
to
that
waiver.
B
It
allows
them
more
choice,
flexibility
and
control
over
their
supports
they
in
order
to
be
eligible
for
the
pds.
The
individuals
have
to
be
receiving
services
through
the
acquired
brain
injury
waivers
the
long-term,
both
the
the
regular
abi
and
the
long-term
care
abi
michelle
p
or
the
scl
supports
for
community
living
waiver
and
their
providers
can
be
family
members
neighbors
and,
and
that
again
helps
us
with
expanding
that
workforce
shortage
area.
B
Kentucky
transitions
used
to
be
called
money
follows
the
person
you
may
have
heard
that
referred
to
as
mfp.
That's
just
a
demonstration
grant
that
gives
the
state
money
to
assist
individuals
from
moving
from
long-term
care
communities
out
into
community
settings
again.
Qualified
individuals
are
elderly,
disabled.
They
have
to
have
a
mental
illness
or
an
acquired
brain
injury
and
they
have
to
reside
in
a
nursing
facility
and
have
been
there
for
at
least
60
days.
B
Again,
as
the
senior
deputy
said,
we
have
almost
27
000
individuals
in
our
1915
c
waivers.
We
do
have
for
our
michelle
p
and
our
sel.
We
do
have
a
waiting
list.
Currently,
those
are
two
pro
two
waivers
that
deliver
services
to
individuals
and
we
have
again
a
waiting
list.
We
do
break
out
michelle
p
of
under
18
and
over
18.
B
those
individuals
on
the
waiting
list.
I
think
there's
almost
almost
about
10
000,
on
that
michelle
p
waiting
list
and
about
half
of
them
are
children
and
in
that
michelle,
p,
18
or
above
the
majority
of
those
individuals
came
in
under
age
18
and
are
still
residing
in
the
program.
And
again
I
just
point
this
out
because
most
of
the
services
that
the
children
receive
in
these
waiver
programs
are
therapy
services.
B
C
I
think
I
just
want
to
add
one
thing.
I
don't
think
we've
discussed
this
and
one
of
the
values
that
managed
care
brings
to
the
state.
Is
that
oh,
thank
you
so
for
managed
care.
One
of
one
of
the
values
that
they
bring
to
the
state
is:
is
the
ability
to
do
things
that
we
can't
do
at
the
department
in
fee
for
service?
C
They
can.
They
have
value-added
programs,
so
they
can
provide
cribs
and
car
seats.
They
do
a
lot
of
gift
cards
for
incentive,
especially
to
access
preventive
care.
So
there's
a
lot
of
value-added
services
that
they
they
are
able
to
do
that.
We
just
can't
do
they
help
cover
housing
and
rent
and
electricity
again
things
that
we
can't
do
as
a
department.
C
So
you
know
when
you,
when
you
think
through
what
all
they
do
do
there.
There
is
a
lot
that
they
can
accomplish.
They
can
they
can
do
pilots
that
we
can't
do
without
having
to
go
through
a
major
request
for
a
waiver
they
can.
They
can
pay
a
provider,
they
can
enter
into
a
contract
with
a
provider
to
deliver
value-based
services
value-based
payment
program.
B
B
We
also
have
substance,
use
disorder
program
under
1115
waiver
for
all
medicaid
members
and
it
also
waives
the
non-emergency
medical
transportation
for
methadone
treatment
services.
We
align
our
medicaid
member
redeterminations
with
their
employer-sponsored
insurance
during
open
enrollment.
This
waiver
does
expire
on
september
2023
and
we
are
currently
amending
it
to
include
that
sud
for
the
incarcerated,
sud
treatment
for
incarcerated
individuals.
B
We
talked
a
little
bit
about
our
medicaid
funding
initiatives
and-
and
this
is
just
gives
you
just
a
little
overview
of
some
of
our
current
applications
and
systems
that
we
currently
currently
use.
We
talked
about
our
integrated
eligibility
and
enrollment
system,
but
we
also
have
a
model
waiver
management
application
that
our
providers
use.
We
can
put
case
management
notes
in
there
lots
of
information
to
help
deliver
the
care
for
individuals
once
they
have
a
plan
of
care.
In
their
waiver
program,
we
also
have
a
managed
care
organizational
pharmacy
benefit
manager.
B
That
was
the
result
of
senate
bill
50..
We
do
have
one
single
pharmacy
benefit
and
benefit
manager
for
all
managed
care
organizations,
but
each
of
these
are
different
I.t
systems
and,
as
you
can
see,
they
all
have
to
talk
to
each
other,
and
so
you
can
see
how
complex
some
of
our
our
planning
and
our
operations
are.
B
When
we
look
at
our
I.t
functions,
some
of
those
that
you
see
in
purple,
for
example,
where
they're
in
a
planning
phase
once
we
once
we
get
those
operational,
they
will
move
to
maintenance
and
operation
phase,
and
that's
when
I
was
talking
earlier
about,
our
funding
from
cms
will
be
reduced
a
little
bit.
We
have
some
that
are
currently
in
procurement
that
we
can't
discuss,
and
we
also
have
some
in
those
planning
phases
that
that
we're
still
kind
of
talking
about
and
again
just
planning
and
again
just
our
I.t
initiatives.
B
B
A
A
What
was
determined-
and
this
is
absolutely
what
we
were
talking
about
and
actually
what
this
community
is
looking
at.
It
was
determined
that
the
people
who
knew
how
to
do
transportation
were
in
transportation
and
so
a
it
was
designed
that
this
non-emergency
health
transportation
would
be
administered
by
department
of
transportation
because
they
knew
what
they
were
doing,
and
so
that's
since
that
time
this
has
been
the
model.
That's
been
used
to
do
the
non-emergency
health
transportation
program
and
there's
always
tension
there.
You
know,
as
in
any
capitation
model,
is
it
enough?
A
Are
providers
getting
paid
enough
to
for
runs
and
you'll,
hear,
I'm
sure
you
all
hear
from
from
your
local
non-emergency
health
transportation
providers?
It's
it's
too
much
or
somebody
else
can't
get
in
get
in
because
it's
decapitated
model,
but
but
that's
it
started
back
under
governor
patton.
H
B
Well,
the
office
of
transportation
delivery.
They
do
make
sure
that
all
the
vehicles
meet
code.
They
do
the
inspections.
They
make
sure
that
the
drivers
are
all
eligible
to
to
be
drivers.
They
do
background
checks
they
for
that
administrative
cost.
They
do
a
lot
of
informa
a
lot
of
tasks
that
the
transportation
does
routinely
and
we.
We
definitely
think
that
this
model
has
been
working
for
kentucky
and
it's
one
of
the
most
popular
models
across
the
nation.
H
Maybe,
but
I
guess
it's
more
basic
is
what
what
do
we
hope
to
accomplish
through
providing
non-emergency
medical
transportation?
It's.
B
A
required
benefit
cms
requires
us
to
to
to
provide
that
that
service
to
individuals
who
do
not
have
a
vehicle
in
the
household.
So
it
is
a
mandatory
service
that
we
have
to.
B
H
A
And
I
think
it's
one
that
we
can
ask
and
look
at
what
I
will
say
to
you
is
this
anytime.
We
talk
to
anybody
in
rural
kentucky
or
we
talk
about
services
in
rural
kentucky.
Transportation
is
always
the
number
one
barrier,
it
is
always
transportation,
and
so
that's
why
I
think
it's
critical.
We've
always
heard
that.
I
also
think
that's
why
it's
critical
that
we
we
move
as
much
as
we
can
as
much
as
rational.
H
A
Telehealth-
and
I
know
that
that's
also
not
available
in
in
some
of
our
rural
areas,
but
but
we've
got
to
keep
pushing
so
between
that
between
telehealth
and
and
really,
I
think,
providing
us
as
much
as
we
can
as
much
as
rational
for
getting
people
to
health
care
appointments.
I
think
you
know
we
we
see
too
often
one
of
the
complaints.
I
think
I
don't
remember
if
it
was
you
and
I
that
talked
about
it
are
senator
alvarado,
and
I
I'm
sorry
about
that.
A
But
we
talked
about
telehealth
in
some
ways:
helped
some
providers,
their
no-show
rates,
went
down
because
they
were
able
to
engage
in
telehealth,
well,
non-emergency
health
transportation.
I
think
supports
people
getting
there.
I
would
think
like
no-show
rates
would
be
worse
and
I
think
so
probably
some
health
outcomes
would
be
worse
but,
as
I
say
that
any
time
we
ask
the
question
like
on
a
needs.
Assessment,
transportation
always
comes
up
number
one.
E
H
A
H
Ask
that,
specifically,
with
this
program,
it's
great
that
we
provided
it's
needed.
But
how
do
we
measure
success
just
like
telemedicine?
It's
we,
we
kind
of
did
it
by.
I
think
we
have
to
admit
by
default
because
of
coven.
It
expedited
the
need
for
that
and
the
importance
of
that,
so
we
kind
of
jumped
into
it,
and
we
anticipate
that
it's
going
to
save
us
money
in
the
future,
how
much
money?
How
much
impact
is
it
going
to
have
on
non-emerging
medical
transportation
and
who's
going
to
take
ownership?
For
that?
H
A
A
A
Maybe
we
needed
to
triple
what
we're
doing
in
non-emergency
health
transportation,
and
that
would
have
a
tremendous
impact
on
health
problem.
Is
I
can't
tell
you
that.
H
Well,
I
think
that
was
evident
in
passing
senate
bill
50,
and
that
was
in
the
previous
administration
before
first
started.
Having
that
discussion
to
go
into
single
source
from
bbm
is
no,
it's
going
to
cost
it's
going
to
cost
our
program,
millions,
millions!
Well,
in
fact,
it
saved
our
program,
millions
and
millions
and
with
the
savings
of
those
millions
and
millions
now
we're
have
those
funds
gone
too
who's.
Getting
the
the
benefit
of
those
and
that's
what's
missing
from
us.
H
Whole
thing
is:
how
are
we
measuring
success
for
each
one
of
these
areas,
because
you
can't
have
accountability
if
you've
got
no
measurement
of
success,
and
I
think
this
non-emergency
transportation
is
a
good
example
super
great
idea,
but
what
impact
is
telehealth
going
to
have
on
it?
What
impact
is
high
gap?
Price
is
going
to
have
on
it.
So
a
lot
of
moving
parts
here,
but
I
think
that's
that's
pivotal
to
really
making
sure
we're
spending
our
dollars
as
effectively
as
we
could.
G
If,
instead
of
providing
continual
non-emergent
education,
we
set
up
a
family
with
a
computer
and
zoom
links
and
they
are
able
to
complete
those
visits
by
telehouse.
What
are
we
saving?
How
much
should
we
spend
to
begin
with,
and
what
are
we
saying
over
the
long
term
little
pieces
like
that
we
can
measure
we
can
validate
and
would
be.
You
know
exciting
data
to
know
thanks.
E
Thank
you.
I
had
a
quick
question
on
page
23,
which
is
on
the
kentucky
transitions.
How
many
people
do
we
have
participating
in
kentucky
transitions,
and
can
you
give
me
maybe
an
example
of
how
we're
using
that.
B
A
It's
not
a
big
number
is
you
know,
since
2008
senator
750
people
and
what
that
does?
Is
it
it
somebody
who's
in
a
nursing
facility
who
wants
to
live
in
in
community?
A
The
challenge
is
this:
once
they've
been
in
a
nursing
facility
for
six
months
and
at
least
60
days
most
times,
they've
got
rid
of
their
home
right.
So
how
do
you
transition
back
out?
It's
it's
a
tough!
A
That's
the
much
tougher
piece,
but
we
just
our
first
pace,
rollout's
going
to
be
this
this
year,
and
I,
since
I
was
in
the
inspector
general's
office,
so
95
we've
been
talking
about
pace
since
then.
We've
we're
finally
going
to
be
able
to
implement
and
that
I,
like
the
school-based
claiming
for
services
outside
the
iep.
Sorry,
I'm
using
initials
again
that
was
actually
started
in
the
previous
administration.
A
E
And
I'll
tell
you
what
my
interest
is
is
because
we
do
have
a
population
of
kids
that
are
aging
out
and
aging
through.
G
E
D
E
This
money
follows
the
person
is,
I
think,
the
right
path
for
them
to
go
through,
and-
and
so
I
might
be
following
up
with
you
all
on
this,
because
I
have
a
real
interest
in
me
in
this.
Thank
you.
E
Thank
you,
mr
chairman.
I
have
two
or
three
questions
for
start.
If
you
go
to
slide
four,
the
definition
of
low
income
children
versus
kchip
is
that
only
dependent
upon
education.
B
Children
in
medicaid
have
to
be
in
school
or
have
to
be
I'm
trying
to
look
at
the
at
the
right
and
there's
it's
kind
of
casper.
But
there
is
an
educational
requirement
for
for
children
enrolled
in
medicaid
children
in,
and
there
is
also
that
that
federal
poverty
level
limit
that
designates
those
individuals
so
children
in
k-chip.
Again
the
program
is
administered
through
title.
B
21
has
a
few
different
rules,
and
so
an
educational
component
is
not
one
for
the
k-chip
program
and
of
course
that
was
created
after
the
medicaid
program,
and
I
guess
the
the
rules
for
the
medicaid
program
have
never
been
aligned
with
the
chip
program.
E
Okay,
that's
one!
The
other
question
I
have
is
with
the
open
gate
policy
we
have
now
with
people
coming
into
the
country.
Do
you
know
how
many
immigrants
on
our
medicaid
in
kentucky.
B
You
have
to
in
order
to
qualify
for
medicaid.
There
is
an
immigration
status.
You
have
to
be
a
legally
residing
immigrant.
Just
individuals
who
are
in
the
country
that
are
are
not
that
are
not
here.
Legally,
cannot
qualify
for
medicaid.
C
We
are
we're
digging
into
that
right
now
we're
trying
to
do
a
report
that
shows
an
analysis
of
all
all
the
different
components
that
includes
a
single
preferred
drug
list,
which
actually
probably
is
the
biggest
return
on
investment
there,
where
we've
moved
from
you
know,
preferred
to
non-preferred
or
non-preferred
to
preferred,
but
we're
doing
that
analysis
right
now.
A
A
C
I
think
if
I
could
just
follow
up
on
that
for
just
one.
B
C
The
the
thing
to
remember-
and
I
think
this
is
the
challenge
of
trying
to
convey
what
exactly
in
our
analysis,
you
know
what
what
are
the
savings
or
what
is
the
cost
is
that
we
have
to
front
load
into
the
capitation
payments,
the
cost
of
the
higher
non,
the
higher
preferred
drug,
because
in
in
a
lot
of
circumstances,
it's
the
brand
name
drug
and
it's
the
more
expensive
drug,
even
though,
on
the
back
end
we're
getting
such
an
amazing
rebate
from
that
it
makes
sense
for
us
to
do
that.
So
you
know
it.
A
Yeah,
if
I
could
even
go
a
little
more
on
that,
the
mcos
will
tell
you
and
they
will
tell
you
rightly,
their
costs
for
prescription
medications
have
gone
up.
They
have
they're
they're,
paying
for
more
they're
paying
for
things
that
we
are
maximizing
our
rebate
on.
So
not
only
are
they
paying
more
they're,
not
seeing
the
rebates
themselves,
so
their
cost
of
medication
when
they
come
and
tell
you
their
costs
for
prescriptions
have
gone
up.
It's
true,
it's
true!
A
It's
that
the
program
overall
is
saving
because
we're
maximizing
the
rebates,
so
you
have
to
you,
have
to
balance
those
two
out
which
is
what
is
complicated,
but
that
that's
just
the
true
statement
of
it.
C
There's
the
intrinsic
piece
there,
which
is
full
transparency.
You
know
what
we
do
know
now.
Is
we
you
everybody
can
see?
What
do
we
pay
for
a
dispense
fee?
What
do
we
pay
for
a
drug
ingredient
and
so
there's
full
transparency
which
you
didn't
get
you
know
previously.
F
Thank
you,
mr
chair.
This
is
a
big
conversation
I
feel
like
we're
all
over
the
place.
I
mean
there's
so
many
things
to
talk
about,
and
thanks
for
your
comment
about
the
transparency
in
the
and
the
rebates,
because
I
think
that's
really
been
been
lacking
and
I
I
would
like
to
somehow
highlight
that
so
that
folks
can
really
see
what
the
true
costs
are
and
because
the
whole
340b
program
is
it
who
set
that
up.
My
gosh,
it's
like
so
complicated
and.
F
And
and
a
complete
lack
of
transparency,
I
mean
it
just
so
anyway,
a
different
discussion.
I
I
have
a
question
on
slide
back
on
slide
15,
just
the
school-based
services.
I've
always
had
a
great
interest
in
this,
and
I
just
wonder
what
the
utilization
is.
If
you
know-
and
you
know,
obviously,
all
the
need
for
health
data
and
the
return
on
investment
and
understanding,
baselines
and
kind
of
outcomes
is
going
to
help
inform
us
make
all
of
these
decisions.
But
you
know
how
robust
is
this.
B
F
A
We
provided,
I
believe
we
provided.
I
think
we
provided
where,
where
we
have
our
different
counties
and
what
what
the
services
are,
so
we
in
medicaid
we
break
down
for
each
county
like
the
top
ten
services
paid
for
for
adults
and
the
top
10
services
paid
for
for
children.
It's
it's
really
an
interesting,
read
and,
and
we
look
at
different
counties,
there
are
different
pieces
that
are
up
top
and
it
just
it.
Kind
of
some
of
that
depends
on
what
facilities
are
in
the
county,
but
but
I
it.
C
F
It's
real,
I
mean
it
tells
us
what's
going
on
and
then,
if
I
may
one
one
more
quick
question,
you
were
talking
about
the
transitions
program
and
I
hadn't
really
thought
about
it
in
terms
of
foster
children
and
aging
out.
But
that's
an
interesting
kind
of
you
know
program.
I
guess
to
think
about.
I
don't
know
that
it's
traditionally
meant
for
that
population,
but
we
do
need
to
think
about
those.
F
Those
kids
and
I
know
that
we
spent
a
lot
of
time
talking
about
a
potential
bridge
program
and
kind
of
morphed
into
a
basic
health
plan,
and
I'm
not,
I,
I
think
it's
on
just
kind
of
standby
for
right
now
and
I
do
think
that
we
need
you
know
to
really
get
a
handle
on
the
data
before
we
you
know,
can
move
forward
on
anything
like
that.
But
is
there
anything
in
place
for
kids?
Who
are
aging
out?
I
mean
other
than
just
traditional
medicaid
is
it
I
mean
they.
A
The
two
pieces-
I
would
say-
and
you
all
can
tell
me
if
I'm
missing
something
one
is
our
other.
Our
11
15-
that
we
have
in
place
now
allows
foster
children
to
receive
services
through
26
if,
okay,
if
they
opt
into
the
system
and
then
a
bill
that
was
passed
recently
in
the
last
session,
allows
those
folks
to
come
back
in
senate
bill
8
right
that
allows
those
kids
to
come
back
in
after
a
longer
period
of
time
than
we
had
formally.
A
So
I'm
hoping
that
the
the
combination
of
that
1115
and
that
bill
will
allow
more
folks
to
to
access
services
when
I
was
doing
homeless
services
in
in
louisville.
When
I'd
see
a
young
person
on
the
street,
a
youth
on
the
street
there
that
invariably,
they
came
through
our
foster
system.
A
So
can
I
do
it
go
again?
Okay,
thanks!
So
we
were,
we
were
proceeding
with
it.
Basically,
we
were.
We
were
proceeding
with
a
basic
health
plan.
We
had
talked
to
our
mcos.
There
was
some
reluctance
on
the
part.
Just
like
you
mentioned
for
folks,
going
into
the
private
side.
There
was
some
reluctance
on
the
part
of
the
mcos
to
proceed.
A
There
was
we
can
have
a
lovely
discussion
about
what
was
in
the
budget.
What
wasn't
in
the
budget
what's
allowed,
what's
not
allowed,
but
it's
sort
of
water
under
the
bridge.
I
think
at
this
point
where
we
went
to
was
it
then
we
started
talking
to
other
providers.
A
If
we
move
forward,
will
you
participate
and
the
hospitals
really
weren't
and
I'm
not
I'm
not
trying
to
say
nancy
galvani,
I'm
not
saying
anything
bad
about
you,
but
you
know
if
the
hospitals
aren't
going
to
participate,
then
there's
kind
of
no
sense
moving
forward,
which
is
where
we
ended
up
as
as
well
as
then.
You
know
it
was
going
to
be
conflict
with
you
all.
A
So,
with
all
those
factors,
we're
we're
on
hold
we're
still
developing
the
parameters
of
the
program,
we're
still
looking
at
how
we
develop
the
parameters
of
the
program
and
what
that
might
look
like,
but
best
case
scenario
we're
a
year
and
a
half
out.
So.
H
That's
that's
right
from
time
for
discussion.
That's
the
reason
for
my
question
is
I
thought
the
legislation
we
passed
said
we
wouldn't
proceed
with
this
until
legislation
develops
the
proposal
for
this
plan,
but
yet
it
looks
like
we're
we're
proceeding
so
how
we're
going
to
back
up
and
make
sure
that
it
reflects
legislative
intent.
E
H
E
H
H
A
Well,
I
think
again
this
we
can
have
the
discussion.
Unfortunately
we
don't
have
to,
but
the
the
way
I
look
at
it
there
was.
There
was
funding
in
the
budget
right
and
what's
the
last
piece,
what's
the
last
expression
of
legislative
will
and
at
that
point.
H
A
Like
it's
the
budget
but
anyway,
I
I'm
sure
we've
had
a
lovely
go
around
about
it,
I'm
glad
we
don't
have
to.
D
Thank
you
all
one
follow-up
to
that
secretary,
and
I
I
I
don't
want
to
be
in
conflict
with
you
at
all,
and
you
have
been
very
good
to
give
me
information
with
that
basic
health
plan
and
as
as
we've
had
some
discussions,
I
think
the
cabinets
wants
to
use
the
basic
health
plan
as
more
of
a
bridge
insurance
program.
D
However,
our
thoughts
on
a
bridge
insurance
program
are
different
than
that.
Ours
are
that
it
would
be
for
someone
who
hits
that
cliff
after
they've
advanced
themselves
through
employment,
they're
already
on
medicaid
they're,
already
eligible
for
medicaid,
they
hit
that
cliff
and
then
they
would
transition
over
into
that
program,
not
an
expansion
of
any
kind.
Also
you.
I
know
that
the
governor
had
mentioned
that
there
was
from,
I
believe,
from
the
press
conference
that
day
when
he
was
asked
about
the
basic
health
plan
that
he
mentioned.
D
There
was
230
million,
or
something
like
that
in
the
budget
for
the
basic
health
plan,
which
we
never
earmarked
anything
for
that
we've
combed
back
through
that
budget.
We
don't
see
anything
that
points
to
that
amount
of
money.
D
But
I
will
also
say
that
what
we
passed
were
two
bills
plus
the
budget
with
language
in
it
saying
that
the
best
basic
health
plan
would
not
be
moved
forward
would
not
be
developed
without
the
legislature.
Developing
that
plan
themselves,
which
is
now
what
the
public
assistance
task
force
is
starting
to
look
at
as
well.
D
And
so
I
would,
I
would
just
say
that,
from
our
standpoint
as
leadership
in
the
house
that
the
government's
the
the
governor's
comments
are
not
correct
with
us
that
there
are
many
times
we
budget
for
things
and
then
later
on
down
the
line
we
say.
Okay,
now
you
can
spend
it
his
analysis
of
that
the
money
is
there.
So
it
was
our
intent
to
spend.