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A
A
We
do
have
a
quorum
Duty,
constituting
conduct
business
next
order
business
approval
of
minutes
they
have
been
previously
distributed.
Is
there
a
motion
to
approve
motion
motion
by
representative
Hebron?
Second
Advantage
Center,
Frankie
frohmeyer,
also
in
favor,
vote
I
voice,
any
opposition
there
being
none
and
it's
passed
and.
A
For
sure
being
glad
that
you're
with
us
this
afternoon
before
we
get
into
just,
let
me
kind
of
remind
folks
about
what
we're
trying
to
accomplish
here.
I
get
a
lot
of
text
and
emails
about
this
after
our
meetings
and
a
lot
of
different
opinions
about
what
we're
trying
to
accomplish
is
very
straightforward:
it's
how
can
we
better
Serve
the
People
of
Kentucky?
It's
not
a
gotcha
kind
of
task
force.
A
It's
really
trying
to
do
an
in-depth
analysis
of
all
different
functions
of
the
Cabinet
for
Health
and
Family
Services,
and
hope
that
we
can
identify
some
opportunities.
Maybe
for
increasing
efficiencies,
certainly
be
more
responsive
to
our
constituents
and
just
send
some
candid
open
dialogue,
and
one
thing
I've
enjoyed
most
about
this
task
force
this
year
and
in
previous
year
is
a
learning
experience
for
all
of
us
and
again
I
want
to
commend
Secretary
of
Freelander
for
allowing
such
great
access
to
his
personnel
and
being
open
and
honest
with
us
about
everything.
A
C
Good
afternoon
Senator
Mr
chair,
so
I've
got
with
me
two
colleagues
today,
Jan
chamness
and
Sarah
Joe
best
and
in
their
remarks
they
have
their
own
introductions
and
they're
going
to
talk
for
10
to
12
minutes
and
provide
context
and
then
leave
the
balance
for
the
Q.
A
as
you
guys
did.
D
Good
afternoon
my
name
is
Jan
chamness
and
I
serve
as
a
public
health
transformation
director
for
the
Kentucky
Department
for
Public
Health.
My
primary
role
in
this
current
position
is
to
serve
as
a
liaison
between
the
Kentucky
Department
for
public
health
and
all
61
of
our
local
Health
departments
across
the
state.
D
Prior
to
my
current
position,
I
served
as
the
public
health
director
for
the
Montgomery
County
Health
Department
for
nearly
23
years.
Many
during
my
tenure,
the
state
mandated
that
we
provide
many
state
and
federally
funded
programs
for
which
they
oversee
more
often
than
not.
This
presented
a
financial
hardship
on
many
local
Health
departments,
because
the
program
allocations
rarely
covered
the
expenses
needed
to
provide
these
programs
in
our
communities.
D
Our
local
Health
departments
are
insured
to
be
offered
to
every
Kentuckian
funding
is
now
aligned
with
the
foundational,
Public,
Health,
Services
and
equally
important
in
all
of
this.
Local
Health
departments
have
the
autonomy
and
flexibility
to
provide
local
public
health.
Priority
programs
like
diabetes,
prevention
and
management,
cancer,
screening
and
school
health
based
on
the
unique
needs
of
their
communities,
as
well
as
their
available
resources.
D
While
all
public
health
programs
are
important.
Local
Health
Department's
ability
to
select
programs
based
on
community
need
and
available
resources
ensures
a
higher
potential
to
positively
impact
Health,
behaviors
and
health
outcomes
among
the
populations
they
serve
and
speaking
of
community
needs.
I'm
happy
to
report.
We
conducted
a
survey
recently
among
our
61
local
Health
departments
regarding
their
local
needs
assessments.
All
61
local
Health
departments
responded
to
the
survey
48
out
of
61.
Of
those
have
a
current
local
needs
assessment.
D
D
New
federal
funding
presented
an
opportunity
for
the
Kentucky
Department
for
public
health
to
expand
collaboration
and
continue
to
strengthen
communication
with
our
local
Health
departments
by
providing
resources
to
build
the
Kentucky
Health
Department
Association
infrastructure
in
areas
like
human
resources
and
financial
and
budget
expertise
employ
Regional
Liaisons
engage
with
experts
to
provide
technical
support
for
conducting
local
needs,
assessments,
offer
tuition
reimbursement
and
Leadership
and
staff
training.
There
is
still
much
work
to
be
done,
however.
D
E
Good
afternoon
my
name
is
Sarah
Joe
best
I'm,
the
public
health
director
at
Lincoln,
Trail
District,
Health,
Department
I've,
been
there
for
22
years,
I
had
in
the
last
10
I've
been
serving
as
their
Public
Health
director
I'm.
Also
the
president
of
the
Kentucky
Health
departments,
Association,
that
represents
all
61
local
Health
departments
across
the
Commonwealth.
E
Today,
I'll
describe
some
Services
provided
by
the
local
Health
departments
and
as
well
as
how
that
local
and
the
State
Health
Department
collaborate
to
provide
those
services.
The
Kentucky
public
health
system
is
a
decentralized
shared
governance
system.
This
means
that
oversight
of
Public
Health
Services
occurs
at
both
the
state
department
for
public
health,
as
well
as
the
local
level
through
our
governing
Boards
of
Health.
E
E
E
E
This
often
requires
a
strong
Community,
Partnership
understanding,
local
needs
and
resources
and
engagement
with
local
leaders
and
policy
and
planning.
As
Jan
mentioned,
Public
Health
transformation
has
defined
Public
Health
Services,
creating
a
consistent
Baseline
of
services
across
all
local
Health
departments,
while
also
allowing
flexibility
for
those
local
needs
that
we
identify
through
the
assessment
process.
E
She
referenced
three
Priority
Health
Program
areas,
so
I'm
going
to
focus
on
foundational
or
statutory
required
Services,
as
well
as
our
core
public
health
programs,
foundational
public
health
programs
or
Services,
provided
by
our
environmental
preparedness,
Health
strategy
epidemiological
and
clinical
programs.
Our
environmental
programs
ensure
food
safety
as
well
as
safe
disposal
of
Wastewater.
They
also
work
closely
with
our
epidemiology
departments
for
quick
identification
of
potential
sources
of
foodborne
illness
or
other
contaminants
to
mitigate
risk
to
the
public.
E
F
E
E
There
are
103
reportable
diseases
as
well
as
conditions
such
as
waterborne
foodborne
illness
that
may
be
reported
to
our
epidemiology
staff.
Their
job
is
to
reach
out
to
those
affected
and
facilitate
treatment
and
identify
if
the
risk
still
exists
for
others.
Our
Clinical
Services
help
control
communicable
disease
through
immunizations
testing
and
treatment
of
sexually
transmitted
infections,
as
well
as
tuberculosis.
E
Core
services
are
the
women,
infant
and
children
program
or
WIC
hands
and
harm
reduction
services.
Wic
is
an
education
and
supplemental
nutrition
program
to
prevent
low
birth
weight,
preterm
delivery
and
infant
malnutrition
WIC
also
provides
support
for
breastfeeding
mothers,
Health
screenings
and
referrals
into
other
forms
of
treatment
and
services.
E
The
hands
program
uses
an
evidence-based
curriculum
that
focuses
on
six
protective
factors
to
promote
healthier
children
and
healthier
childhoods
families
and
hands
experience,
fewer
premature
infants,
fewer
low
birth
weight,
babies
and
fewer
developmental
delays.
Harm
reduction
refers
to
policies,
programs
and
practices
that
aim
to
reduce
risk
associated
with
the
use
of
psychoactive
substances.
E
C
Health
departments
used
to
be
more
heavily
involved
in
Clinical
Services
years
ago,
and
that
has
evolved
not
just
in
Kentucky
but
Nationwide,
where
Public
Health
focuses
in
the
newer
iteration
of
it
more
on
population
Health,
preventing
harms
creating
conditions
and
environments
where
people
can
Thrive
and
are
less
likely
to
be
at
risk
for
bad
things
to
happen,
and
so
the
house
bill,
129,
Public,
Health
transformation,
Bill
essentially
outlines
three
circles.
The
inner
circle
is
foundational
Services.
C
The
next
one
out
is
core
services
and
the
next
one
out
from
that
is
what
we
call
local
Health
priorities.
Many
of
the
clinical
things
that
you're
familiar
with
like
colon
cancer
screening,
breast
and
cervical
cancer
screening,
Family
Planning,
diabetes,
education
and
there's
a
slew
of
other
ones.
Those
reside
in
local
Health
priorities.
So
these
Community
Health
assessments
that
Jan
was
talking
about
every
one
of
these
Health
departments
is
required
by
House
Bill
129.
To
do
a
community
health
assessment
and
we've
set
the
goal
that
they
keep
it
current
every
five
years.
C
That's
probably
often
enough,
and
so
this
is
a
huge
accomplishment,
that,
by
the
end
of
this
state
fiscal
year,
we
believe
all
61,
Health
departments
will
have
completed
that
that's
a
big
deal.
That
was
nowhere.
We
were
nowhere
near
that
in
2020.,
but
that
helps
to
have
an
idea.
What
does
the
local
community
uniquely
need
and
then
there's
variation
in
those
local
priorities,
so
some
participate
in
some
services
and
some
participate
in
others
and
they're,
not
the
same,
because
the
needs
and
I
think
there
was
chain
rock
down
there
from
Pineville.
C
So
the
needs
in
Bell
County
are
not
the
same
as
in
Jefferson,
County
necessarily,
and
so
they
have
the
ability
to
tailor
what
they
provide
within
that
in
the
state
department
for
public
health.
We
Believe
supports
over
150
different
programs,
not
all
of
which
the
local
Health
departments
each
individually
participate
in,
but
across
all
those
Health
departments
they
participate
in
most,
if
not
all,
of
those,
and
so
Jan
and
Sarah
Joe
gave
this
overview
for
the
structure
within
which
Public
Health
operates.
C
But
really
your
questions
will
probably
better
inform
now
what
you'd
like
to
learn
more
about.
So
we
can
do
that.
One
thing
I'd
like
to
draw
your
attention
to
is
a
senator.
The
chair
kindly
invited
me
to
come,
and
it
was
the
natural
extension
to
invite
my
counterpart
for
this
local
Health
Department.
So
we
have
a
much
better
relationship
in
these
last
few
years
and
they
can
speak
to
that
directly.
C
Jan
was
on
the
other
side
of
this
before
when
she
was
the
public
health
director
of
Montgomery
County,
but
we
have
a
much
better
collaboration
now
than
we've
had
in
previous
times
and
I
think
we
are
well
poised
now
to
try
to
accomplish
Goods
good
things
for
kentuckians,
as
we've
strengthened
the
public
health
system,
the
workforce
and
tried
to
put
us
on
a
better
Foundation
going
forward.
So
back
to
you
senator.
A
Thank
you
and
I've
been
here
for
seven
legislative
sessions
and
seen
a
lot
of
bills
come
across
our
desk,
but
I
think
House.
Bill
129
is
one
of
the
strongest
pieces
of
legislation
that
we've
passed
since
I've,
been
here
and
I.
Commend
representative
Moser
for
taking
the
initiative
on
that
particular
Bill.
A
I
think
it
really
helped
our
local
Health
departments,
but
the
other
thing
that
that
helped
it
ironically
was
covered
and
I
think
it
elevated
the
the
position
of
Health
departments
I
think
before
that
they
were
kind
of
an
afterthought
and
people
Now
understand
how
important
they
are.
I.
Think
that's
where
my
line
of
question
would
go
was
what
does
the
future
look
like?
Do
we
need
to
to
go
beyond
129
I?
Think
there's
tremendous
potential
there.
You
know
129
addressed
part
of
the
revenue
issue,
but
I'm
concerned
about
what
the
future
looks
like.
A
Are
there
other
areas
we
can
look
at
for
Revenue
increases
for
health
departments,
but
taking
on
additional
responsibilities
and
again
I
think
the
problem
we
have
before
129
too
many
requirements
to
do
things
without
the
appropriate
funding.
We
don't
want
to
get
in
that
situation,
but
again
I
think
this
could
be
an
opportunity
for
us
in
the
future.
A
Another
thing
I'd
like
to
know
you
from
Dr
stack,
is
what
you
see
the
future
of
Public
Health
to
be
I.
Think
we
Tennessee
had
a
very
narrow
population,
that's
served
and
it
shouldn't
be
public
health
is
Public
Health
and
you've
heard
me
talk
before
about
my
disappointment,
in
particular
Managed
Care
organizations
for
Medicaid
program
that
we
have
not
improved
the
health
of
our
population
and
whose
responsibility
is
that
whose
responsibility
should
it
be
in?
Could
Public
Health
play
a
greater
role
in
that,
but
I
guess
I
would
just
summarize
about
asking
you.
F
C
Region,
four
of
the
U.S
health
and
human
services
map
in
region.
Four
and
six
has
13
states
in
it
and
that's
everywhere
from
the
Atlantic
Ocean
to
Texas
and
New
Mexico
and
we're
the
northernmost,
and
we
just
had
10
of
those
13
State
Health
officials
visit
us
a
week
and
a
half
ago
for
spend
two
days
in
Kentucky
and
have
a
tour
of
the
capital
and
see
the
work
we're
doing
here
in
Kentucky
and
it's
it's
nice
to
see
Kentucky
being
perceived
as
a
leader
in
some
of
these
things,
which
is
a
real
treat.
C
C
So
don't
hold
me
to
this
part,
but
but
roughly
half
of
it
is
General
funds,
and
that
supports
you,
know
core
staff
and
and
people
that
have
to
be
there,
regardless
of
the
program
they
do
and
then
the
other
half
of
the
state
funds
is
fees,
so
there's
fees
for
pools
and
first
septic
systems
and
for
restaurants
and
a
whole
variety
of
things,
and
also
the
local
Health
departments,
which
are
our
citizen-facing
layer
for
most
of
our
programs.
C
They
provide
services,
so
they
provide
hand,
services
and
home
visitations,
and
then
they
can
bill
Medicaid
for
they
bill
us
and
then
directly
Medicaid.
We
then
invoice
Medicaid,
but
they
provide
services
to
the
community
and
then
they
invoice
for
the
services
provided,
so
that
25
percent
is
essential.
We
couldn't
survive
without
it,
but
it
still
means
three
quarters
of
all
the
resources
are
federal
in
Supply
and
we
are
constrained
by
what
the
grant
requirements
are
and
what
the
scope
of
work
is
for
those
grants.
C
And
so
it
is
a
challenge
and
funding
is
never
unlimited
and
all
of
us
are
struggling
and
trying
to
figure
out.
So
what
is
the
sustainability
path?
Because
what
ends
up
happening
is
with
these
crises
that
unfold
covid
was
horrible
in
so
many
ways,
but
it
wasn't
all
horrible
I
mean
it.
It
brought
us
together
as
a
Public,
Health
Community.
C
It
brought
scrutiny
for
public
health
too,
but
it
enabled
us
to
get
to
know
each
other
a
lot
better
and
see
each
other
as
a
team
and
find
more
strength
and
commonality
than
and
tearing
ourselves
apart,
and
so
we
do
a
lot
better
on
that,
the
the
funding
that
we
got
for
some
of
these
other
grants,
the
workforce
and
infrastructure
grants
that
we
got
and
that
the
other
states
got
have
enabled
us
to
do
stuff.
C
We
take
that
for
granted,
but
the
ability
for
someone
to
actually
write
good
copy
before
it
reaches
my
staff
or
me
at
the
commissioner's
level,
makes
our
work
so
much
better.
So
those
things
strengthen
the
workforce,
improve
morale
and,
of
course,
the
salary
increases
were
essential
as
well,
because
now
we're
actually
finding
people
applying
for
our
jobs
and
we're
filling
vacancies
and
our
turnover
rate
is
going
down
significantly.
C
So
we're
having
the
possibility
to
succeed
now
and
I
think
most
people
who've
run
big
Enterprises
know
you
get
to
Excellence
by
retaining
good
people,
not
by
constantly
hiring
and
firing
or
hiring
and
churning
people
and
I
say
all
of
that
to
build
up
to
what
your
central
question
is.
So
what
can
Health
departments
really
do?
How
can
what
can
they
do
additionally
to
help
support
their
communities?
C
It
largely
follows
the
context
or
the
Contour
of
what
public
health
3.0
or
modern
Public
Health
would
be,
which
is
the
healthcare
delivery
system
takes
para
folks
when
their
diabetes
is
out
of
control
and
when
they
have
pneumonia
and
they
have
a
urine
infection.
The
public
health
system
wants
to
try
to
help
it
so
that
the
community
is
livable.
You
feel
safe
outside
you
can
walk
in
your
environment.
C
It
was
an
uncommon
instance
of
both
branches
of
legislature.
You
know
the
house
and
the
Senate
and
the
executive
branch
and
state
and
local
government
all
coming
together
and
saying.
So
what
do
we
do?
It's
created
the
conditions
now,
even
though
covet
intervened.
C
We
are
convening
at
the
Kentucky
historical.
What
do
you
call
it?
The
History,
Center
or
historical
society
downtown
we're
convening
multi-stakeholder
group
of
our
public
and
private
Partners
from
across
the
state
to
do
the
State
Health
Improvement
plan.
So
we've
already
done
the
State
Health
assessment
to
identify
the
burden
of
disease
and
opportunities
for
improvement.
But
now
we're
going
to
start
the
process
tomorrow
with
with
a
large
collection
of
people
downtown
about.
So
what
do
we
do
about
it?
C
So
where
are
the
areas
we
can
actually
have
impact
to
make
a
difference
and
it's
hard,
but
we're
going
to
do
our
dog
on
best
to
try
to
build
on
the
foundation
that
we've
now
shored
up
and
then
from
a
position
of
strength.
Try
to
do
better
things,
so
I'll
pause
and
then
I'm
sure
Sarah,
Joe
and
Jan
may
have
things
to
add.
If
you
would
like.
A
Well,
certainly,
it's
hard
one
thing
that
concerns
me
is
I.
Don't
think
people
recognize
what
a
crisis
we
have
in
this
country
related
to
health
care
and
I'm?
Going
to
tell
you
statistics
you
already
know
we
spend
two
to
three
times
more
than
other
industrialized
nations
per
capital
spend
about
13
000
per
person.
Next
closest
is
Germany
at
seven
thousand
and
are
as
a
percentage
of
gross
national
product
that
continues
to
increase
every
year
in
I,
believe
it
ever
exceeds
20
percent.
A
It
may
collapse
the
economy
in
this
nation,
so
it's
got
an
implications,
Beyond
Health
the
economy,
and
how
can
we
be
competitive
in
a
global
market
when
we
have
such
high
health
care
costs,
and
so
poor
Healthcare
outcomes
and
folks
are
always
saying
we
need
more
money,
the
money's
there
within
the
system,
if
we
focus
on
the
right
things,
such
as
improving
the
health
of
the
population?
Again,
we
know
the
60
70
Healthcare
problems
are
based
on
social
determinants.
A
Should
Public
Health
departments
play
a
greater
role
in
addressing
those
particular
needs?
Another
issue
we
have
is
we
we
still
live
in
working
silos
in
health
care.
We
don't
have
a
central
repository
for
accountability,
I'll
call
it,
but
that's
one
of
the
biggest
challenges
who's
going
to
be
responsible
for
the
health
or
population,
and
how
do
we
measure
it?
How
we
move
it
forward
and
I?
A
Don't
think
we
have
a
good
mechanism
for
that
I
think
Public
Health
can
play
that
role
should
play
that
role,
but
I'm
not
sure
how
much
responsibility
we
want
to
take
on
a
specifically
Kentucky,
with
1.7
million
of
our
population
on
Medicaid
and
some
of
the
worst
Health
Care
outcomes
there.
A
A
But
again
it's
who's
going
to
drive
the
train
and
I
think
we
have
advocated
that
to
the
insurance
companies
for
the
most
part
and
that's
a
conflict
in
itself
because
they
have
a
legal
responsibility:
increased
stockholder
equity,
it's
not
improve
the
health
of
the
population.
So
again,
there's
a
fundamental
question:
is
who's
going
to
be
responsible
for
the
health
of
the
state
and
who's
going
to
have
that
accountability?
C
Well,
I,
ultimately
the
legislature,
as
is
the
case,
is
going
to
set
the
overarching
priorities
through
legislation
and
through
law,
and
is
you
know
how
I
would
imagine
it
should
happen
in
our
structure?
But
then
you
know
I.
Think
secretary
friedlander
in
the
cabinet
certainly
are
quite
open
to
ongoing
discussions
about
the
role
and
and
I'll
just
say:
I
I
try
to
be
positive
as
much
as
I
can
I
hope
that
comes
across,
but
but
I
don't
restrain
myself.
Sometimes
from
saying
you
won't
and
I.
C
Think
I've
said
this
at
multiple
hearings
in
front
of
you:
I
will
never
be
the
one
who
defends
the
mcos.
Okay
I
mean
for-profit,
Health
Care
is
I.
I
think
it
is.
One
of
I
am
a
fan
of
Industry
because
it
is
incredibly
Innovative
and
does
wonderful
things
in
so
many
ways,
but
I
have
I
have
failed
to
see
how
all
of
the
profit
extracted
has
added
value
in
improved
performance.
C
I
just
have
not
personally
witnessed
it,
I'm
sure
they
would
have
examples,
but
if
they
have
not
been
persuasive
as
far
as
I
have
seen
so,
but
that's
a
discussion,
you
know
that
the
secretary
has
I
think
been
having
and
is
quite
open
to
having
you
know
with
you
and
the
members
of
the
committee
and
he's
in
a
better
position
as
the
leader
of
the
cabinet
I
think
it
really
requires
the
broad
broadness
of
the
cabinet
to
have
these
bigger
discussions.
You
know,
there's
Give
an
example.
There's
a
real
Behavioral
Health
need.
C
C
Well,
I
can
work
in
great
partnership
with
my
colleagues
at
Behavioral
Health.
We
get
along
very
well
and
we
collaborate
on
a
wide
array
of
things,
but
but
Public
Health
itself
would
not
take
on
the
behavioral
health
Duty
because
there's
a
whole
other
state
level
cabinet
for
that.
As
far
as
what
the
local
Health
departments
could
do
they
recognize
that
there
is
a
need
they
raise
this
as
a
concern.
C
My
one
hesitation
on
the
public
health
side,
I
think
Jan
and
Sergio
may
have
thoughts
or
perspectives
to
add
on
this,
too,
is
I'm,
not
confident
that
it's
widely
understood
that
local
Health
departments,
if
you
went
into
a
health
department
in
1965,
probably
at
that
time
there
were
a
whole
bunch
of
nurses
and
there
are
people
running
clinics
and
doing
well
child
checks
and
different
things
like
that.
That's
not
what
happens
in
most
public
health
departments.
C
In
fact,
in
most
States
Most
states
don't
operate
medical
clinics
as
part
of
the
public
health
system,
anymore
fqhcs
and
you
know
so
federally
qualified
Health,
Care,
Centers
and
Rural
Health
Centers.
Those
have
really
grown
in
Kentucky
has
a
really
vibrant,
fqhc
and
rhc
Community.
They
provide
a
lot
of
that
clinical
care
that
the
health
departments
may
be
used
to
do
so.
The
health
departments
do
have
a
role,
but
the
question
is:
is
the
decisions
are?
C
C
How
do
we
find
ways
to
change
our
community
in
Kentucky
so
that
the
combination
of
physical
activity
and
and
better
diets
help
to
prevent
people
from
becoming
obese?
If
you
just
lose
six
to
seven
percent
of
your
weight
and
engage
in
moderate
activity
a
few
days
a
week,
you
can
dramatically
lower
your
likelihood
of
ever
becoming
a
type
2
diabetic.
C
I
will
tell
you
right
now:
Sarah
Joe
Bast
sitting
here
from
Lincoln,
her
role
in
Lincoln,
County
or
Lincoln
Trail
District,
which
has
six
counties
in
it
that
her
knowledge
and
the
p
and
the
knowledge
of
her
peers
of
their
local
community
businesses
and
the
people
who
live
and
work.
There
is
absolutely
staggeringly
impressive
when
I've
traveled
around
and
seen
them
so
I
think
we've
got
61
people
here
who
know
a
heck
of
a
lot
about
their
community
and
I
share
your
confidence
that
they
have
something
to
offer
in
the
discussion.
I.
A
Would
agree
with
that
statement
and
that's
what
I'm
trying
to
capitalize
on
is:
how
can
we
leverage
that
expertise
and
improve
the
health
of
their
population
and
I?
Think
legislature
will
step
up
and
feel
like
leadership
void,
but
I
don't
know
that
we
should
be
in
the
starting
point.
You
know
I
use
something
very
simple,
such
as
a
discussion
about
hepatitis
C
in
in
screening,
for
that
you
know
that
had
to
come
that
legislation
had
to
come
from
us
and
it
shouldn't
have
should
have
come
from
the
health
care
provider.
A
Community
saying
you
need
to
do
this,
but
we
don't
hear
that
and
so
many
things
that
that
we
pursue
this
shouldn't,
be
the
starting
point:
I'm
looking
for
somebody
to
craft
a
vision
for
health
for
Kentucky
is
what
do
we?
What
should
it
look
like
and
again
we're
struggling
with
improving
the
healthier
population?
A
We
need
some
bold
vision
for
health
care
in
Kentucky
and
who's
going
to
drive
that
train
and
again
I
think
we've
advocated
that
responsibility
and
that's
why
I
think
we
can
leverage
our
health
departments
to
provide.
Some
of
that
should
provide
some
of
that.
But
again
it's
purpose
discussion,
Senator
funky
from
our
you
have
a
question
comment.
G
G
His
knowledge
mystifies
me
so
recognizing
thank
you
so
much
and
Sarah
Joe.
You
used
the
Upstream
approach.
Terminology
I,
love
that,
because
I
do
think
we
need
a
Wellness
Revolution,
but
it's
it's.
You
know
perhaps
maybe
at
our
school
district
level.
So
that's
kind
of
a
question
that
I
had
for
you
is
what
collaboration
do
you
have
relative
to
the
nutrition
offered
at
the
school
district
level?
That's
where
people
are
learning
how
to
eat
and
then
with
the
nurses.
G
E
So
I
would
start
by
saying
that
we
really
focus
on
nutrition
and
nutrition
habits
at
conception,
if
possible,
through
our
week
program.
We
we
want
expected
parents
and
in
our
hands
program
as
well,
so
both
of
those
programs
have
a
component
to
that.
E
That
specifically
deals
with
nutrition,
then
moving
on
through
the
life
cycle,
I
just
think
about
public
health
and
how
really
we
we
start
at
conception
and
we
go
all
the
way
to
grave
right,
and
so
we
try
to
Target
individuals
within
our
community
on
health
programming
throughout
that
life
cycle,
and
so
during
the
school
part
of
that
I
would
say
that
our
health
education
and
our
health
strategy
programs
partner
with
our
schools.
So
we
do
programming
at
the
request
of
the
school
through
our
health,
education
programs.
E
Time
is
tight
and
time
is
limited,
but
there's
there
are
different
educational
programs
that
we
can
do
that.
We
try
to
use
evidence-based
programming
so
because
we
don't
have
unlimited
resources
and
we
want
to
get
the
outcomes
that
we
want.
So
we
can
move
through
that
now.
School
nursing
is
one
of
those
things
that
Jan
mentioned.
That
can
be
a
local
Health
priority,
so
that's
not
always
in
conjunction
with
the
health
department.
Fqhcs
can
provide
those
services
in
our
schools.
School
districts
like
Louisville
Metro
I
mean
in
Louisville
Jefferson
County.
E
They
may
employ
their
own
nurses.
That's
the
case
in
one
of
my
counties
in
Meade
County,
so
that
can
be
different
people
within
that,
and
then
the
school
system
sets
what
the
delivery
of
those
Services
looks
like
so
Does.
It
include
an
educational
component.
Is
it
for
medication?
Dispensing?
Is
it
for
you
know
six
Services
Emergency
Services
those
those
types
of
things
so
really
that's
defined
by
what
the
school
district
wants,
but
there
is
definitely
a
re,
a
relationship
between
the
local
health
department
and
our
school
systems
in
an
advisory
capacity.
E
Our
environmentalists
inspect
the
schools
for
school
safety.
We
look
at
everything
from
gymnasiums
to
their
food
service
to
their
playground,
equipment
assuring
that
it
is
a
safe
environment,
but
so
we
interact
with
them
through
health
education.
We
interact
with
them
through
environmental
health,
their
integral
parts
of
our
community
health
assessment
process.
So
we
work
with
the
Friskies
a
lot
workers
so
and
through
our
hands.
They
will
refer
into
different
programs
like
that,
but
specifically
on
nutrition.
G
E
C
So
we've
done
all
of
these
things
and
now
we're
starting
to
meet
with
Community
Partners
and
talk
about
now
that
we
have
and-
and
we
provided
the
first
rate
increase
for
over
20
years.
So
the
program
had
been
in
place
for
more
than
two
decades
and
had
the
same
compensation
two
years
ago
that
it
had
for
20
years.
It
was
incredible
so
now
that
we've
done
those
things
now.
C
C
We
know
this
program
helps
to
improve
that
situation,
to
reduce
those
adverse
childhood
events
and
make
stronger
healthier
childhoods.
Those
are
the
kind
of
things
that
we
you
and
I
will
along
be
out
of
our
roles.
If,
if
we're
successful
but
I'd
love
to
see
us
double
the
size
of
that
program
over
the
next
two
or
three
years,
and
have
many
many
more
people
benefiting
from
that
and
I
think
we
can
I
think
it's
possible,
but
we're
going
to
have
to
we're
going
to
be
real
intentional
about
it
and
really
try
to
pull
it
off.
H
H
Do
you
see
anything
now
I'm
going
to
preface
this
with
I
just
got
back
from
the
Milbank
Fellowship,
so
now
I'm
talking
about
population
Health
right
so
I'm
I'm
pretty
excited
about
it,
and
thanks
for
the
recommendation,
it's
a
great
group,
but
anyway
during
the
process
of
of
convening
all
the
stakeholders
and
talking
about
House,
Bill
129
and
what
we
were
doing,
how
how
we
were
working
on
things
like
the
Staffing
formula
and
and
so
forth.
We
we
we're
having
conversations
about
what
else
can
we
do
to
Senator
Meredith's
point?
H
H
You
know:
inspection
fees,
for
example,
who
who
collects
those
and
and
the
way
that
they
went
back
to
the
local
Health
Department.
It
just
seemed
like
a
a
lot
of
bureaucracy,
or
do
you
I
mean
you've
had
some
experience
now.
H
Are
you
seeing
any
areas
that
we
can
create
efficiencies
within
the
department
itself
or
you
know,
and
again
maybe
that
needs
to
come
from
you
and
not
the
legislature,
but
I'm
just
curious.
So.
C
I
think
Sarah
Joe
would
comment
on
that,
maybe
too,
and
then
also
on
our
work
with
things
like
OPF
or
the
accreditation
work
and
the
Strategic
plan
and
kind
of
how
we've
organized
that
work
and
how
that
may
play
into
I
think
we've
had
areas,
we've
improved
our
efficiencies,
but
if
you
could
put
that
provide
that
backdrop,
I'm
just
I
think
you'd
like
to
hear
for
some
people
other
than
just
me.
So
let
me
Jen,
you
know.
D
Well,
and
certainly
thank
you
again,
representative
Moser
for
the
you
know
just
the
whole
house
bill,
129
and
public
health
transformation
and
and
when
Dr
stack
asked
me
if
I
would
take
the
lead
on
that
at
the
state
level.
D
I
could
not
have
been
more
excited
about
that
just
to
be
part
of
it,
but
I
think
that
one
of
the
things
when
we
sort
of
relaunched
the
whole
public
health
transformation
initiative
back
in
2020
and
organized
our
work,
we
insisted
and
I
and
I
continued
to
this
day
when
I
talk
about
public
health
transformation,
that
is,
it
is
not
just
a
local
Health
Department
transforming
Public
Health
in
the
state
of
Kentucky,
and
so
I
think
that
the
efficiencies
and
the
strength
and
communication
that
Dr
stack
is
talking
about
again.
D
I
would
go
back
to
just
some
of
the
things
that
we've
done
to
really
try
to
make
more
consistent
communication
and
streamline
communication
between
local
Health
departments
and
all
of
the
programs
that
we
provide
in
the
state
and
really
focus
on
responsiveness
and
collaboration
and
partnership
between
that
and
I.
Think
you
know
talking
about
just
what
we're
doing
tomorrow
with
the
state
health
Improvement
plan.
D
We
really
empowered
local
Health
departments
to
do
that
through
the
public
health
transformation
bill
by
saying
that
they
all
needed
a
local
needs
assessment,
which
in
turn
requires
that
they
also
need
a
local
needs,
Improvement
plan
and
within
the
law.
We
expect
that
they
they
will
reach
out
to
their
stakeholders
and
do
that
there
are
many,
many
local
Health
departments
that
do
that
already,
and
certainly
covid
added
to
that
very
much.
D
But
now
we
work
with
local
Health
departments
to
help
them
facilitate
and
convene
their
stakeholders,
because
when
we're
talking
about
changing
Health
outcomes-
and
you
know
former
commissioner
Dr
Davis
I
always
talked
about
where
you
know
we're
getting
the
getting
this
the
juice
out
of
the
squeeze,
you
know
we
know
that
so
much
of
that
has
to
happen
at
the
local
level.
It
has
to
happen
among
those
local
partners
and
knowing
that
public
health
does
not
happen
within
the
four
walls
of
the
health
department.
E
I
would
just
say
that
first
of
all,
representative
mozier
a
rock
star
in
my
eyes
forever
because
of
Public
Health
transformation.
E
E
Let
the
Staffing
levels,
like
Dr
stack,
said:
there's
been
a
joint
effort
between
the
local
and
the
State
Health
Department,
in
building
our
Workforce
capacity
and
training
them
and
assuring
competencies
in
these
programs.
The
dph
the
other
thing
about
it.
Where
do
we
go
next
right?
That's
that's!
What
Senator
Meredith
wants
to
know
so
one
of
the
things
I'll
say
I
said
I'd
been
here
for
22
years,
I
came
in
as
an
mph
student
health
education
background.
E
First
thing,
I
asked
for
when
I
walked
in
the
door
of
the
health
department
is
where's
your
community
health
assessment.
It
was
22
years
ago.
They
said
yeah,
we
should
be
doing
those,
but
we
don't
really
have
one.
So
I
did
my
own
research
to
figure
out
what
I
should
be
doing.
What's
Monumental
about
this
legislation
is
now
every
local
Health
Department
is
going
to
know.
Where
should
we
be
going?
E
What
are
the
needs
of
our
community
and
that
data
can
be
collected
as
a
state
and
we
can
identify
common
themes,
the
the
taking
the
services
and
really
prioritizing
them
and
and
demonstrating?
We
were
all
over
the
board.
When
you
talk
about
a
mile
wide
and
an
inch
deep
right,
we
were
all
scattered
all
over
the
place
and
we
were
doing
services
that
weren't
necessarily
based
on
the
needs
of
our
community.
E
Now
we're
all
going
to
have
a
community
health
assessment,
we'll
be
able
to
look
at
that
across
the
Commonwealth
of
Kentucky,
identify
common
themes
and
we
can
really
resource
and
bring
and
because
of
the
funding
formula,
bring
back
critical
employees
to
be
able
to
execute
what
we
need
to
do.
But
we
are
in
the
very
beginning
of
that.
E
So
when
I
say
that
I
sit
here
representing
61
local
Health
departments,
all
the
way
from
Jefferson
Person,
County,
Louisville,
Metro,
Health
and
Wellness
to
Todd
County,
those
look
very
different
and
their
resources
and
their
capacities
and
their
Staffing
levels
are
very
different.
So
there
would
def,
you
know.
Yes,
we
are
ready
and
we
are
excited
about
this
Baseline
that
we've
been
able
to
do,
but
now
we
we
do
need
that
it's
strategic
planning
right.
Where
do
we
want
to
go
next
and
what's
exciting
about
strategic
planning
too?
Is
kata's?
E
Do
we
ran
out
of
plan?
We
we
succeeded,
we
ran
out
of
plan,
we
accomplished
our
goals,
and
so
we
went
into
the
next
round
of
strategic
planning
and
we
wrote
into
that
strategic
plan.
What
we
wanted
to
see
from
dph
and
dph
crosswalked
and
said:
okay,
we're
going
to
do
these
things
and
we're
going
to
write
in
on
ours.
So
you
have
Unity
now
and
a
collaboration
because
I
think
of
this
Baseline
that
we've
never
had
before.
So
we
can
do
great
things
and
I
think
that
we
do
need
to
have
those
discussions.
I.
A
Think
that
is
great.
You
know
strategies
plans
have
value
if
they're
used
and
with
having
Health
departments
throughout
the
state.
All
health
is
local.
So
when
this
thing's
fully
implemented
kind
of
put
you
on
the
spot
here
we
can
look
for
you
to
improve
the
health
of
your
population
in
measurable
terms.
E
A
G
C
For
the
Commonwealth
of
Kentucky
and
I
have
a
wonderful
rapport
with
secretary
Freelander
and
he
engages
and
makes
use
of
me
where
I
can
be
helpful,
but
there's
also
a
lot
of
structural
economic
management,
bureaucratic
stuff
that
has
to
go
with
those
big
programs
and
he
builds
a
team
that
helps
to
bring
those
other
things
so
I'm
happy
to
engage
in
any
discussion
where
you
or
the
secretary
brings
me
to
be
part
of
it,
but
I
think
that
public
health.
We
have
to
be
careful
how
we
Define
what
public
health
does
versus.
C
The
community
relies
on
the
Disaster
Response
work
that
we
do
during
floods
and
tornadoes
and
other
problems
and
I
wanted
to
give
you
a
few
concrete
things,
because
we're
talking
about
it's
easy
to
sit
here
and
talk
about
the
foundational
stuff
harder
to
do
it
than
to
talk
about
it,
but
I
think
we're
doing
it,
but
Medical
Reserve
Corps.
This
is
our
volunteer
core
that
we're
supposed
to
rely
on
during
times
of
need.
It
could
be
a
disaster
like
the
tornadoes
or
floods,
but
it
could
also
just
be.
C
We
need
to
do
some
kind
of
Mass
medical
thing,
there's
hepatitis
A
outbreak
for
food
and
we
need
to
have
people
in
the
community
to
help
get
vaccinated.
You
know
a
homeless
population
or
or
certain
vulnerable
population
that
was
scattered
across
a
variety
of
counties,
many
of
whom
who
didn't
have
a
registered.
It's
a
federal
program,
a
registered
Medical
Reserve
Corps,
some
who
did
some
that
were
robust
most
that
were
not.
C
It
was
very
unevenly
executed
and
kind
of
fallen
and
disappeared
disrepair
because
we
have
good
relationships
in
the
partnership
now
with
the
local
Health
departments
in
the
state
we
have
decommissioned
all,
but
one
of
of
the
local
health
department
mrcs,
and
we
now
have
eight
regions
for
the
state
and
we
will
have
eight
federally
registered
Medical
Reserve
cores.
That
means
in
those
regions,
when
one
county
has
a
disaster
that
Regional
have
other
counties
and
volunteers
registered.
C
Who
then,
we've
got
to
build
the
training
for
them
so
that
they
don't
meet
each
other
for
the
first
time
at
the
disaster,
but
now
we'll
have
an
MRC
for
a
region
and
some
kind
of
standardized
approach
across
the
state
where
there's
an
organization,
a
structure
to
it,
and
we
actually
use
Federal,
grant
funding
to
purchase
workers
comp
insurance
now
so
that
they
come
because
in
a
39a
emergency
they
get
covered
a
different
way,
but
if
we
call
them
up
for
some
other
smaller
non-39a
emergency,
they
were
uncovered.
C
If
they
got
hurt,
there
was
their
private
insurance
or
nothing,
and
that
just
doesn't
seem
right
for
a
volunteer
who's
trying
to
respond
to
help
support
the
state
at
our
request.
So
we
now
have
workers
comp
coverage
for
those
folks.
We
created
a
different
way.
We
took
the
state
and
divided
into
five
regions,
and
we
have
five
Area
Health
Liaisons.
These
are
people
who
I
would
like
to
say
is
White
Glove
service
for
between
the
local
Health
departments
and
the
state,
so
we're
looking
for
efficiencies
well,
one
taking
this
scattered
unorganized
MRC.
C
Now
it's
an
organized
eight
region
system.
There
should
be
efficiencies
in
there
with
the
area
healthy
Liaisons
a
lot
of
times.
We
have
over
3
500
public
health
workers
across
the
120
counties
and
another
600
plus
at
the
state
there's
over
four
thousand
people
in
this
public
health
system,
people
change
and
turn
over
over
time.
They
don't
know
who
to
go
to
where
to
get
an
answer.
Well,
now,
there's
a
one
person.
C
C
With
our
program
for
our
support
for
them,
I
mean
it
goes
to
show
The
Virtuous
cooperation
across
this
they've
already
received
and
resolved
more
than
800
different
concerns
that
have
brought
to
them
in
like
the
first
year
of
the
program.
So
these
are
things
where
there's
efficiencies,
because
if
people
wander
in
the
desert
out
there
for
a
month
or
two
and
they
stew
about
it,
like
I,
can't
believe
this
stupid
state
can't
give
me
an
answer
and
blah
blah
blah.
C
Well,
that
is
inefficiency,
well
we're
trying
to
shorten
that
cycle
time
so
that
problems
get
resolved
more
quickly
and
we
can
spend
more
time
productively
doing
work
instead
of
moaning
about
it
and
being
frustrated
and
I.
Think
that
the
fact
that
the
local
Health
Department
Association
mirrored
its
strategic
plan
based
on
that
model,
that
our
team
put
into
place
shows
how
we're
both
responding
to
each
other
and
this
logo
that
you
see
me
wear
around
the
local
Health
Department
Association
NATO
made
this
years
ago.
But
this
is
recognized
as
the
public
health
logo
Nationwide.
C
Our
logo
says
Kentucky
public
health
prevent
promote,
protect
underneath
it,
and
you
may
have
seen
that
on
our
letterheads.
It
used
to
be
used
as
the
state
department
for
public
health
logo,
and
they
said
it
doesn't
say
Department
in
there
anywhere.
It
just
says:
Kentucky
public
health,
Kentucky,
public
health
is
the
state
and
the
locals,
but
we
have
a
shared
governance
model
guaranteed
to
frustrate
all
of
us
because
we
all
are
we're
all
accountable,
but
none
of
us
really
have
authority
a
lot
of
times
to
compel
the
other
to
do
something.
C
So
it
really
requires
people
to
act
like
adults
and
and
collaborate
together
to
try
to
achieve
a
shared
common
goal
and
I
think
we're
doing
that
and
I
think
you'll
see
in
some
of
these
programs
that
we
will,
when
Sarah
Joe
comes
back
and
testifies
another
day
about
public
health
transformation,
how
we've
are
strengthening
the
workforce,
reducing
turnover
and
growing
into
this
I
think
it's
making
a
difference
now.
I
will
say
two
things,
because
I
don't
want
to
lose
these
opportunities.
C
C
Our
Public
Health
lab
is
a
dump
and
it
is
an
invaluable
asset
and
representative
Mosher
had
the
chance,
along
with
a
few
other
members
of
the
legislature,
to
come
and
visit
it.
I
will
just
implore
you.
We
really
need
that
Capital
project
in
the
next
budget,
because
it'll
be
a
40
year
old,
lab
by
the
time
a
new
one
was
occupiable
and
we
already
don't
have
the
space
to
do
things.
We're
required
to
do,
and
so
it's
already
a
problem
so
I.
A
We
have
one
more
question
about
I'm,
going
to
entertain
questions
from
the
legislators
who
said
on
my
right
side.
So,
representative
stalker,
you
have
a
question.
K
Thank
you,
chair,
I
wanted
just
to
go
back
to
our
earlier
conversation,
particularly
around
WIC
curious.
Do
we
have
any
data
and,
if
not
hardcore
data,
just
a
sense
of
of
how
many
people
might
be
eligible
but
are
not
participating.
C
There
there
is
there
I,
we
can
I,
don't
have
it
off
top
my
head,
but
I
I,
recall
a
statistic
when
we
were
doing
this
last
year,
I
think
that
there's
like
an
over
80
participation
right.
So
there
is
some
portion
that
we
probably
don't
reach.
One
of
the
things
we're
trying
to
do
is
update
the
information
system,
we're
in
dialogue
with
the
US
Department
of
Agriculture
for
the
funding
and
approval
to
do
this,
because
it's
a
federal
partnership
program.
So
we
have
to
follow
their
parameters.
C
C
If
someone
qualifies
for
one
program,
they
may
well
qualify
for
another
and
they
may
not
know
that
if
we
get
the
WIC
program
in
that
integrated
system,
it
has
the
opportunity
for
us
to
hopefully
make
sure
we're
driving
even
lower
the
people
who
just
don't
know
if
they
choose
not
to
participate,
that's
their
choice,
but
we
definitely
want
to
make
sure
they
know
they're
eligible
for
a
benefit
if
they
can
receive
it.
So
we
can
get
back
to
you
with
that
answer,
but
I,
don't
know
the
exact
number
or,
if
it's
precisely
known,
okay,.
K
And
then
follow-up
question,
please
curious
about
any
sort
of
limitations
on
purchases
that
families
can
make
with
WIC
I
know,
there's
limitations
with
SNAP
as
far
as
what
what
people
can
and
cannot
purchase,
and
sometimes
that
can
look
like
I
mean
something
as
simple
as
Sanitary
products
right
are
not
eligible.
I.
K
Think
under
you
know
snap,
but
it's
something
that
somebody
might
need
in
that
household
and
so
I'm
just
wondering
if
there's
particular
things
that
we
would
see
that
are
really
essential
for
for
folks
in
their
home
that
maybe,
if
maybe
there's
an
opportunity
to
make
some
allowances
for
expanding
what
people
can
and
cannot
purchase.
I
think
on
the
on
your
website,
specifically
around
Wicket,
said
something
around.
Only
a
certain
type
of
formula,
for
example,
is
now,
and
so
I
just
I
worry
about
that.
K
C
So,
in
order
to
come
so
the
federal
government
in
order
to
comply
with
Federal
procurement
rules
requires
that
state
governments
do
competitive
bidding
for
formula
suppliers
and
there's
only
a
handful
of
large
formula
suppliers
that
hold
all
these
contracts
across
the
country.
So
we
did
that
and
we
have
a
contract
with
a
single
formula
provider
which
one
is
it
Sarah
gel.
Do
you
know
yeah,
but
who's,
the
bigger
the
bigger
yeah,
but
the
bigger
manufacturer,
the
bigger
company?
It's
the
one
that
had
the
recall,
Abbott
Ernest
is
Abbott
right.
C
They
have
the
recall
so
so
we
have.
So
that
is
our
preferred
vendor
and
that's
the
one
we
have
to
use,
because
that's
what
the
procurement
produced
and
that's
pretty
common.
It's
the
most
common
used
vendor
across
the
country
and
then
the
federal
government
defines
what
the
benefit
limits
are.
So
how
many
it's
precise,
it's
how
many
ounces
or
how
many
you
know.
Whatever
milliliters
of
stuff
you
can
get
depending
on
the
formula,
and
so
there
are
specific
Federal
requirements
spelled
out
for
what
your
eligible
benefit
level
is.
So
that's
not!
C
That
is
overwhelmingly
not
at
the
level
of
State
discretion.
The
federal
government
specifically
describes
what
what
the
rules
are
for
that
program,
but
we
can
I
think
there's
got
to
be
some
information,
so
when
we
follow
up
with
you
about
the
participation
right
I'll
see
if
we
can
find
any
guidance
that
talks
about
that
too,
the.
E
The
list
of
approved
food
items
is
created
by
the
USDA
and
then
sent
down
to
us,
so
it
is
all
healthy,
nutritious
foods
that
are
eligible
for
purchase
and
there's
actually
an
app
that
participants
can
get
on
their
phone
to
help
them
through
that
process.
Now
Dr
sack
mentioned
the
formula
recall
during
that
time.
E
We
we
were
giving
given
some
guidance
from
the
federal
government
through
the
state
where
we
can
make
some
modifications
to
that
to
deal
with
that
that
short
term
issue,
and
we
were
doing
formula
changes
for
our
individuals
on
the
WIC
program,
while
they
were
literally
in
the
grocery
store,
based
on
what
what
was
available.
C
So
the
competitor,
no
I'm
gonna
I,
can
answer
that
question.
I'm
gonna
qualify,
I'm,
not
a
procurement
specialist
and
it
is
complicated,
there's
a
whole
glorious
other
committee.
We
get
to
talk
to
the
gcrc
where
you
get
to
quiz
us
on
these
things,
but
we
are
not
required
to
follow
the
lowest
bid.
You
have
to
have
a
scoring
Paradigm,
and
so
you
have
to
Def,
but
this
is
where
it
gets
really
difficult.
C
Unlike
Private
Industry,
you
could
go
out
and
ask
for
three
bids
and
then
pick
the
one
you
like
the
best
we
have
to
Define
in
advance,
specifically
what
it
is
we
seek.
Then
we
have
and
we
have
to
Define
in
advance
a
point
system
that
scores
for
those
things,
and
then
we
have
to
have
a
committee
that
reviews
those
and
then
scores
them,
and
then
the
the
end
result
for
the
scoring
is
what
determines
what
the
successful
bidder
is.
Price
is
often
weighted
heavily.
C
C
But
it
is
not
common
that
you
pick
the
highest
bidder
either
and
the
lowest
bidder
kind
of
usually
goes
into
these
things
with
a
little
bit
of
an
advantage,
because
price
is
often
perceived
to
be
of
a
particular
Sensitivity
I
think
in
government.
But
the
procurement
people
could
answer
that
more
accurately
and
probably
are
cringing
as
I
describe
it.
The
way
I
perceive
it.
A
A
A
L
Thank
you,
I'm,
just
going
to
briefly
go
over
the
programs
that
we
determine
eligibility
for,
and
one
of
those
is
our
child
care
assistance
program
and
that
one
is
designed
to
assist
families
in
obtaining
child
care.
We
have
four
different
categories:
four
different
main
categories
for
that,
and
that
is
assistance
to
low-income
families
that
meet
certain
requirements.
They
need
to
be
employed,
they
could
be
full-time
college
or
in
education.
Programs
participate
in
the
snap
ENT
program
or
in
a
job
search.
L
L
Of
course,
our
biggest
program
is
the
supplemental
nutrition,
Assistance
or
snap,
which
you
know,
of
course,
helps
families
to
buy
food
or
supplement
their
income
to
purchase
food
items
for
their
home.
A
lot
of
people
still
refer
to
that
as
food
benefits
or
EBT,
the
Kentucky,
Transitional,
Assistance,
Program
or
ktap
is
our
cash
program
and
that
can
be
for
low-income
children
for
their
parents
and
caretakers
just
to
help
them
out
and
those
are
funds
just
to
supply
their
basic
needs
or
to
help
Supply
basic
needs.
L
Of
course,
we
have
Medicaid,
and
that
covers
various
programs
from
newborns
to
elderly.
There's
plenty
of
different
types
of
assistance
in
the
Medicaid
Program,
and
then
we
also
have
state
supplementation,
which
is
a
money
payment
made
to
age,
one
disabled
individuals
and
that
helps
to
have
income
to
pay
for
care
that
they
may
need
to
keep
them
from
being
institutionalized.
F
All
of
our
programs
are
open
for
anyone
in
the
state
of
Kentucky
or
I'm.
Sorry
Commonwealth
of
Kentucky
to
apply
for
all
programs
have
a
technical
income
and
resource
eligibility
factors
that
must
be
met.
What
we
do
is
Family
Support
is
we
interview
and
get
the
verifications
and
enter
the
verifications
on
the
system
and
run
eligibility
based
upon
federal
guidelines,
state
and
federal
guidelines,
ways
that
people
can
apply
they
can
apply
in
person.
F
F
They
can
also
do
a
paper
application.
So
if
they
come
into
a
local
office
or
go
online
to
the
Cabinet
for
Health
and
Family
Services
website,
they
can
print
out
a
paper
application,
fill
it
out,
drop
it
off
in
any
local
office,
and
then
they
can
also
call
and
do
a
application
over
the
phone.
We
have
a
1-800
number
in
which
they
can
apply
over
the
phone.
F
All
of
our
programs,
except
for
Medicaid,
require
an
interview.
So
if
they
apply
for
child
care,
Tana
or
I'm,
sorry,
child
care,
ktap,
snap
or
state
supplementation,
they
must
complete
an
interview
within
30
days
of
their
application.
Their
application
date
is
saves,
the
time
frame
of
when
we
run
the
eligibility
from
so
if
they're
eligible,
they
can
be
eligible
from
the
date
of
application
going
forward
if
they
meet
all
the
income
resource
and
Technical
eligibility
factors,
interviews
must
be
complete
within
30
days.
F
Any
verifications
that
are
needed
for
each
program
are
then
sent
requests
are
sent
to
the
client
at
which
time
they
have
30
days
to
get
that
verification
back
to
us
so
that
we
can
process
it
and
determine
their
eligibility.
A
Thank
you
and
you
folks
certainly
have
an
awesome
responsibility,
in
particular
folks.
We
have
on
public
assistance
in
this
state,
but
so
make
sure
I
understand
the
process.
In
theory,
once
somebody
submits
an
application
regardless
as
online
in
person,
they
should
have
an
answer
in
60
days.
F
At
this
time,
with
the
public
health
unwinding
and
other
factors
we
are
behind
in
the
processing,
but
everything
goes
back
to
any
benefits
that
they're
eligible
for
will
go
back
to
the
date
of
application.
I
F
A
F
I,
don't
have
that
figure
as
far
as
any
numbers
I
think
Laura
can
probably
get
that
to
you.
F
Well,
okay:
I'll
go
over
so
first
off
we've.
Just
recently:
we've
eliminated
the
requirement
for
SNAP
recertification
interviews,
so
once
your
recertification
was
up,
you
would
have
to
then
do.
Another
interview
have
wait
the
30
days
to
get
that
information
in
the
process.
F
We've
eliminated,
that
where
we
are
sending
out
a
form,
it's
basically
a
quick
review
where
they
answer
five.
The
household
answer
five
questions:
if
there
are
no
changes
to
the
household
situation
such
as
resources,
income
household
size,
then
what
will
happen
is
we
have
what
is
called
the
optical
character?
Recognition?
It's
an
OCR.
It's
been
used
by
the
U.S
post
Office
for
years
now,
reading,
basically
reading
information
and
an
AI
will
then
say:
okay,
there's
no
changes
on
this
and
we
don't.
We
as
a
worker,
wouldn't
have
to
review
that.
F
So
the
optical
recognition
can
alleviate
some
of
those
tasks
that
we
have
to
look
at
for
these
reviews.
Also,
with
the
Medicaid
unwinding,
the
resources
are
no
longer
for
the
recertifications.
The
resources
are
never
not
don't
have
to
be
verified
so
right
now
people
would
for
Medicaid
recertification.
They
would
send
in
their
form
they
would
put
on
there.
Okay,
my
resources
are
this
and
we
would
have
to
then
verify
that
information.
If
we
can't
verify
it
electronically,
then
we
have
to
get
that
verification
in.
F
Of
the
interview
is
to
determine
what
factors
is
to
determine
the
household
size
who
actually
lives
in
the
household
their
situation
as
far
as
what
income
they
have
where
their
income
is
coming
from,
how
they're
meeting
their
basic
needs.
If
they
have
report
that
they
have
no
income,
how
are
you
meeting
your
basic
needs
or
how
have
you
been
meeting?
Your
basic
needs?
F
It's
to
look
at
your
expenses,
because
when
snap
is
run,
when
the
supplemental
nutritional
program
is
run,
we
look
at
all
this
and
there's
a
formula
in
order
to
determine
what
amount
of
benefits
you
may
receive.
If
any.
So
we
take
a
look
at
household
size,
how
many
people
are
in
the
household,
the
income
level,
the
resource
level
and
any
expendances
expenses
that
the
federal
government
allows,
such
as
your
shelter
expense,
any
utility
expense?
F
So
then
you
run
that
and
you
then
determine
what
benefit
amount,
because
you
don't
always
get
the
maximum
benefit.
I
know
people
think
well
they're
on
Snap
they're
on
Snap,
they're,
gonna
they're,
getting
you
know
500
a
month
because
that's
a
maximum
amount
for
a
household
size
of
three
or
whatever.
It's
not
that
they
may
only
be
getting
fifty
dollars,
because
it's
a
supplemental
to
whatever
income
they
may
have
to
get
them
to
where
they
can
meet
the
needs
of
their
family
for
food.
F
F
We
need
to
question
them
verify,
because
not
all
the
time
are
they
are
people
putting
down
the
exact
information
they
might
want
to
put
down
themselves,
but
yet
they
might
be
a
20
year
old,
living
with
their
parents.
According
to
policy,
they
have
to
be
on
the
same
case
as
their
parents.
A
G
L
Have
the
answer
to
that
either
I
know
the
long-term
care
and
States
up
those
are
more
in
depth
as
far
as
resources
and
stuff,
so
they
do
interview
for
those
like
the
Magi
Medicaid.
We
take
client
statement
for
most
things
and
if
it
passes
The
Hub,
then
they
can
be
approved.
If
there's
any
question,
if
it
doesn't
match
those
programs
that
we're
running
against,
then
we
would
ask
for
verification
of
those.
L
I
don't
know
we
have
a
direct
answer
of
what
particip
or
precipitate
of
that
Laura
may
have
a
better
answer,
but
I
think
it's
just
the
fairness
of
processing,
Statewide.
L
A
L
That
interview,
no,
it
can
be
done
over
the
phone
or
they
can't
drop
off
a
paper
application,
and
then
we
would
contact
them.
You
know
to
complete
the
interviews
if
they
needed
one.
We
have
a
Statewide,
of
course,
call
service,
so
anyone
in
the
state
can
answer
their
calls
and
then
now
we
also
have
statewide
processing.
So
when
we
pull
Kate
like
our
workers,
will
pull
cases
from
the
dashboard
and
those
are
going
to
be
based
on
the
time
frames
that
they
should
have
been
or
need
to
be
worked,
and
those
will
be
Statewide
also.
A
F
Not
I've
not
had
anyone
that
has
not
been
able
to
call
in.
We
have
people
on
the
phones.
Every
day
the
staffing
has
increased
on
the
phones.
We
even
for
the
lunch
hour,
which
is
probably
the
highest
peak
time
from
12
to
1
30.
We
even
put
other
additional
people
on
the
phone
when
we
have
those
people
that
are
on
phones
assigned
the
phones
on
lunch,
so
we're
never
like
short
staffed
on
the
phone,
we're
always
replacing
people
that
are
on
the
phone
and
they're
on
lunch.
F
J
Thank
you,
Mr
chairman
I,
just
have
one
quick
question
with
going
away
from
the
county
model
and
going
to
a
Statewide
approved
model
for
approvals
is
that
that
would
seem
to
me
to
create
a
little
bit
of
confusion
and
possibly
a
higher
error
rate.
Are
you
seeing
any
of
that
with
that
process?.
L
I,
don't
have
the
error
rates,
of
course,
I
don't
have
those
numbers
we
could
get.
Those
I
think
it
may
cause
more
errors
just
due
to
the
different
different
resources
in
those
areas
or
just
like
you
know
your
local
community.
You
know
you
know
if
the
person
signing
these
forms
is
from
the
health
department
or
I'm.
Sorry,
not
the
health
department,
the
housing
authority
and
can
verify
that
rent
where
somewhere
else.
You
may
not
know
that.
J
Thank
you,
that's
that's
kind
of
what
I
was
getting
at
is
my
area.
Of
course.
It's
a
smaller
rural
area
and
and
that
office
is
going
to
know
most
of
those
folks
and
know
the
situations
and
I
would
just
in
my
mind,
I
would
just
envisioned
that
we
are
going
to
see
a
few
more
errors
and
and
a
little
bit
of
confusion
in
there.
But
thank
you.
G
Yes,
thank
you.
This
is
an
eye-opener,
so
I'm
grateful
to
learn
a
bit
I
understood
from
a
recent
conversation
from
the
Northern
Kentucky
area
development,
District
that
we
have
around
77
000
people
between
the
age
of
16
and
22
that
are
not
working.
Actually,
it
might
be
16
and
24.
There's
an
eight
year
range
between
16
and
24.,
and
how
would
that
person
then
perhaps
be
looking
for
some
assistance?
F
So
the
northern
Bluegrass
region,
we
do
have
the
snap
employment
and
training
program
in
which
people
can
voluntarily
participate
and
if
they're,
what
we
call
is
able-bodied
adults
without
dependents.
These
are
people
age,
16
to
52
that
don't
have
anyone
in
the
that
aren't
caring
for
anyone
under
the
age
of
18
in
the
household
they
have
to
be
meeting
20
hours
a
week,
either
volunteer
work
or
paid
work
in
order
to
maintain
their
SNAP
benefits.
F
Otherwise
they
only
get
three
what
we
call
bad
months
in
a
36
month
period
and
then
their
benefits
will
stop,
because
what
the
government,
what
the
U.S
department
of
Agriculture
is
saying,
is
these
people
are
able
to
work
they're
in
an
area
that
doesn't
have
a
waiver,
because
there's
enough
jobs
or
there's
enough
resources
for
them
to
work
or
volunteer
to
work
that
they
need
to
be
doing
something.
In
order
to
get
these
benefits,
they
can't
just
be
sitting
around
doing
nothing.
F
F
I
know
that
the
snapping,
T
coordinators
or
career
coaches
in
our
area
do
work
with
Gateway
in
the
northern
Bluegrass
region
to
facilitate
education
courses.
Also,
Job
searches
help
them,
maybe
even
retrained
for
something
else,
because
they
might
be
trained
in
one
thing
and
the
jobs
just
aren't
there.
For
that
so
I
know:
there's
a
big
push
during
covid
to
get
truck.
Drivers
and
Gateway
was
in
our
office
and
they
were
like
well.
Can
we
post
these?
F
F
Might
I
add
one
thing
with
in
reference
to
the
wick
question
earlier
so
with
WIC
with
our
SNAP
program?
There's
a
question
on
our
screening
process.
If
someone
reports
that
they
are
pregnant,
where
we
do
answer
that
question
that
we
do
send
a
referral
over
to
Wix,
so
I
don't
know
where
that
were
how
that
referral
gets
sent
over
but
electronically.
We
put
that
and
it's
supposed
to
send
a
referral
over
to
the
public
health
department,
so
that
someone
will
contact
the
individual.
F
That's
probably
that's
reporting
that
they're
pregnant,
so
we
kind
of
do
work.
However,
we
don't
have
a
specific
application
on
our
connect
website
for
just
WIC
program,
so
I
hope.
M
L
Kind
of
have
a
difference
of
opinions
on
the
Statewide
processing.
I
understand
that
no
one
client
is
better
than
another
Statewide,
but
I
feel
that
it
is
not
working.
I
feel
that
we
are
farther
behind
than
we
were
I
know
as
a
region
and
I
can't
speak
for
other
regions,
but
I
know
our
region.
Once
we
were
caught
up
for
the
day,
then
we
would
be
directed
to
go
help
the
bigger
regions
and-
and
like
I
said
this
is
just
my
opinion.
M
Right
sure,
what
do
you
what's
happening
with
Working
Families,
who
are
not
getting
their
child
care
applications
processed
timely?
Is
that
affecting
their
ability
to
retain
their
jobs?
It.
L
L
I
know
we
are
behind
in
our
in
our
region,
and
that
was
very
rare
for
us,
because
we
are
a
smaller
region.
I
would
my
opinion
would
be
over
half,
but
that's
just.
A
An
opinion:
okay,
what's
your
leadership
telling
you
about
the
feature
when
when
and
if
folks
get
caught
up
when
we
go
back
to
County
Processing
or
it's
a
long-term
plan
to
keep
it
Statewide
as.
F
Think
one
of
the
things
we
need
to
look
at
is
whether
I'm
a
dcbs
family
support
person
in
Boone,
County,
Jefferson,
County
Carlisle
anywhere
in
the
state
I'm
supposed
to
have
in
theory
the
same
training,
the
same
skills
given
the
same
skill
set
as
anyone.
So,
therefore,
why
should
I
be
in
maybe
Carlisle
County
or
another
County,
just
helping
those
citizens,
those
residents
versus
another
area?
That
may
need
my
assistance?
It
would
be
like
you
know,
Mayfield
getting
hit
with
the
tornado
Why.
Should
they
have
to
deal
with
that
in
their
own
County?
F
Why
can't
we
pull
people
from
other
counties
to
help
that
so
I
think
you
know
if
we
can't
get
the
staff
in
other
counties,
we
need
to
assist.
You
know
because
we're
all
supposedly
this
trained
the
same
way.
We
have
the
same
background.
We
know
the
same
policy
we're
following
the
same
policy.
It's
not
like
you
know.
We
have
a
different
policy
for
Boone
County
versus
Jefferson
County.
You
know
we're
following
the
same
guidelines.
We're
following
the
same
program.
F
So
I
believe
that
you
know
it's
not
fair
for
anyone
living
in
another
part
of
the
county.
That
turns
their
stuff
in
three
months
ago
and
I'm.
Just
using
this
as
an
example
three
months
ago,
their
stuff
isn't
process
yet,
but
yet
I
turn
my
stuff
in
in
let's
say:
Owen
County
today
and
it's
processed
by
tomorrow.
A
I
think
we're
making
a
very
broad
assumption
that
again,
if
half
the
counties
are
behind
right
now,
it's
because
the
shortage
of
personnel
I'd
buy
that
for
the
most
part,
but
not
everybody
works
at
the
same
pace
and
some
officers
are
more
efficient
than
others
and
if
another
office
just
isn't
efficient,
they're
not
doing
a
very
good
job,
then
those
applications
have
to
roll
over
to
another
candidate
who's,
doing
a
very
good
job,
so
I'm
curious.
What
kind
of
accountability
is
built
into
this
whole
process?
F
I,
don't
know
how
to
you
know
account,
you
know,
hold
someone
accountable
in
other
regions,
and
you
know
I
just
know
that,
where
most
of
our
past
due
tasks
were
coming
from
was
Jefferson
was
Warren
and
as
you're
processing
those
tasks,
then
you
know
it
has
a
trickle
effect.
These
other
counties
are
going
to
fall.
F
I
want
to
say,
maybe
December
of
last
year,
I'm,
not
sure
we
were
asked
to
process
Warren
County
in
Boone
after
we
got
done
with
ours
because
they
were
behind
why
they
were
behind
I
have
no
clue
it
was.
You
know
it
wasn't
something
that
I.
Could
you
know
point
my
finger
at
but
Jefferson,
you
know
they're,
just
largely
populated
I,
don't
think
they
have
the
staff
or
retain
the
staff.
Hello.
A
F
A
I
think
it's
proportional.
You
know
if
you're
a
larger
County,
you
get
more
people
to
pick
from
smaller
County.
You
have
fewer
people
pick
from,
but
that's
when
I
believe
with
that
point
representative
Hebron,
you
have
a
question.
Yes,.
N
L
I
think
the
excuse
me,
the
in-person
traffic
and
the
calls
have
increased
because
you're
not
getting
their
cases
worked
so
they're
continuously
calling
they
they
shouldn't
be
continuously
calling.
We
should
be
processing
them,
but
I'm
just
saying
you
know,
they're
they're
calling
wanting
to
know
why
their
case
isn't
worked.
When
is
it
going
to
be
worked?
I
know,
like
I,
said:
I
live
in
a
smaller
County
and
a
lot
of
our
office
traffic.
Is
people
coming
in
to
get
their
cases
fixed
because
you
know
they're
there
and
they
want
to
know
you
know.
L
I
did
everything
I
was
supposed
to.
Why
isn't
my
case
worked
yet
so
we
go
ahead
and
see
them
and
get
those
worked.
So
it
it
has
increased
I
know
like
I
said:
I
can
only
speak
for
our
office,
but
it
has
increased
the
foot
traffic
in
the
local
office
and
then
all
of
those
people
are
calling.
So
it
does
increase
the
calls
too.
N
F
So,
prior
to
the
OCR
being
instituted
and
the
everyone
had,
you
know
you
had
to
look
at
each
and
every
document.
F
Now
the
OCR
can
handle
many
of
those
documents,
such
as
the
review
forms
for
SNAP
any
driver's
license
or
ID
cards
also
undeliverable
mail,
which
you
know
during
covet
a
lot
of
people
weren't
changing
their
mailing
address
because
again,
that
was
the
least
of
their
worries
during
that
I
mean,
let's
be
honest,
so
a
lot
of
the
those
tasks
are
now
done
automatically
and
only
a
certain
percentage
then
has
to
be
a
small
percentage,
then
have
to
be
reviewed
by
an
actual
worker
to
make
sure
that
the
AI
technology
is
working
correctly.
F
N
Thank
you.
Can
you
tell
us
what
happens
when
an
elderly
person
who's
Medicaid
savings
plan
is
either
discontinued
in
error
or
is
not
processed
at
all,
and
then
how
does
this
affect
the
client's
monthly
money
payment
and
their
medical
expenses.
L
Okay
on
those
the
Medicare
Savings
Program,
we
do
try
to
focus
on
those
to
keep
those
from
closing,
but
of
course
they
do
and
what
they
will
do
is
take
I,
believe
it's
two
months
at
once
of
that
Medicare
premium
out
of
their
check
after
that
case
closes
once
we
get
that
put
back
on,
we
then
have
to
send
forms
if
it's
appropriate
to
back
that
up.
We
have
to
send
forms
to
msbb
and
it
can
take
them.
I
believe
it's
three
to
six
months
to
get
that
money
back.
M
I
do
Medicaid
research
specifically
for
long-term
care.
Do
you
know,
are
those
behind
as
well.
F
That's
one
of
my
areas
where
I
work
a
lot:
they
are
not
as
far
behind
anymore.
They
are
behind,
but
I
would
say
they're,
probably
only
about
maybe
three
weeks
behind
and
those
are
just
research,
the
applications
we
try.
We
take
care
of
within
that
time
frame,
but
the
actual
research
are
slightly
behind
again
they'll
work,
we've
instituted
where
they
don't
have
to
verify
the
resources
at
research.
So
that's
going
to
lessen
that
backlog.
Okay,.
F
No,
what's
happening
is
the
if
it's
not
processed
and
it's
registered.
The
case
is
not
closing.
It's
just
extending
the
research
of
a
recertification
period.
So
let's
say
the
recertification
was
this
month
and
if
it
doesn't
get
as
long
as
it's
registered
before
the
end
of
the
month,
then
it'll,
if
it's
not
processed
until
next
month,
it'll
carry
over
and
they'll
still
get
those
benefits
for
next
month,
as
if
it
never
stopped.
Yet
as
if
the
recertification
was,
you
know,
October
versus
September
sure.
M
F
A
But
as
you
already
have
long,
Jefferson
County's
been
behind,
you
said
forever.
Could
you
kind
of
put
in
that
contact?
Is
it
well
five
years,
six
years,
seven
years.
F
I've
been
here
since
the
December
of
2019
working
for
the
cabinet,
and
it's
always
been
since
then
I
mean
I,
don't
know
how
far
behind.
A
I
F
I'm
not
quite
sure,
if
I
understand
that
question
100
percent
I
don't
see
anything
as
far
as
you
know
knowing
well,
this
county
is
30
days
behind
this
county.
Is
you
know,
20
days
behind
I,
don't
know
if
that
number
can
even
be
pulled,
that
data
can
be
pulled,
but
if
it
can
I'm
sure
Laura
can
pull
it
per
County
as
far
as
what
the
furthest
back
task
is
for
that
County
or
for
each
County
I.
Think
that
answer
that's
what
you
were
asking
like
30
day.
I
L
Maybe
some
numbers
but
I
know
any
cases
we
generally
have
up
to
30
days
to
process
a
case
just
depending
on
the
type
of
action
you've
taken
that
can
be
different,
but
so
once
that,
if
they've
turned
everything
in
and
we've
gone
past
that
30
days
and
not
process
that
case,
then
it's
behind,
so
it
is
30
days
generally,
like
I
said
there
can
be
some
differences
depending
on
actions
you
take
on
a
case.
There
can
be
some
differences
in
that,
but
it
is
generally
30
days
from
the
date
they
apply.
L
F
I'm
not
sure
I
haven't
pulled
any
data
before
I
came
here
to
look
at
each
County,
but
as
of
like
this
well,
does
it
work
going
back?
This
is
probably
February
or
March.
We
stopped
Pros
Boone
County,
stop
processing,
Warren,
County,
okay,.
A
Head
of
Warren
County
resolve
their
issue.
Hiring
people
is.
A
To
get
back
to
you
on
that,
thank
you.
I
appreciate
that
does
Jeff's
kind
of
have
a
plan.
F
A
O
You
Mr
chairman,
it's
kind
of
frustrating
because
we're
we're
asking
questions,
but
you
didn't
pull
the
data,
we're
asking
questions,
but
there's
no
plan
we're
asking
questions.
O
You
don't
really
have
any
answers
and
so
I'm
kind
of
frustrated
at
the
presentation,
myself
and
being
from
Jefferson,
County
and
and
kind
of
the
silliness
and
how
you
answered
those
questions,
because
these
are
serious
issues
that
we're
talking
about
and
it's
it's
not
to
joke
around
about,
and
so
Mr
chairman
I
would
request
that
he
we
do
pull
the
data
and
we
do
see
how
Behind
These
counties
are.
We
do
see
what's
going
on
on
the
issues
surrounding
this
and
and
quite
honestly,
report
back
to
us.
Please.
A
Certainly,
that's
a
reasonable
request.
I
appreciate
that
appreciate
you
all
being
here
this
afternoon
been
available
to
us
and
no.
We
have
some
tough
questions,
but
they're
tough
issues,
and
we
just
want
what's
best
for
people
Commonwealth,
just
as
you
do
but
appreciate
it.
I'm
sure
we'll
be
talking
more
in
the
future.
Thank.