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From YouTube: Budget Review Subcommittee on Human Resources (9-21-22)
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A
A
As
a
reminder,
we
have
new
meeting
protocols
in
place
for
2022
interim
session.
No
remote
attendance
by
members
is
permitted
by
the
2022
interim
session.
All
members
must
attend
in
person
to
be
recorded.
As
present
the
meeting
materials
were
put
online
earlier
this
week
and
made
available
for
downloading.
C
A
President,
so
we
have
enough
for
Quorum
representative
Westrom
said
she
had
a
flat
tire,
so
she'll
be
here
in
a
few
minutes.
Next,
we'll
have
the
approval
of
minutes
from
an
August
17th
meeting.
Do
I
hear
a
motion
in
a
second.
We
have
a
motion
and
a
second
all
in
favor
say
aye
aye.
Thank
you.
Yeah.
The
approval
of
the
meetings
is
approval
of
the
minutes
are
done
so
this
morning
we're
going
to
have
a
presentation
from
commissioner
Lee
and
Steve
Bechtel
Chief
Financial
Officer,
with
the
Department
of
Medicaid
services.
A
D
D
I
would
like
to
point
out
that
that
916
000
does
include
children
who
are
enrolled
in
Medicaid,
so
in
total
we
have
over
600
000
children
enrolled
in
the
department
for
Medicaid
services,
that's
more
than
half
of
the
children
in
this
state,
and
when
we
discuss
our
numbers,
we
say
that
it's
definitely
nothing
to
boast
about,
because
that
means
that
over
1.6
million
individuals
in
Kentucky
live
at
or
below
the
poverty
level.
We
currently
have
69
000
enrolled
providers
to
deliver
services
to
our
Medicaid
members
and
our
budget
in
state
fiscal
year.
D
E
Good
morning
for
today,
we
were
asked
to
provide
an
overview
of
how
we
closed
out
fiscal
year.
22
I
know
the
last
time
that
we
met
I
believe
was
in
June
I,
believe
we
gave
you
through
May
at
the
end
of
May,
and
then
we
projected
out
what
we
thought
was
going
to
happen
in
June.
E
So
this
is
today
is
pretty
much
some
of
the
same
slides
that
we
presented
back
in
the
June
meeting,
but
that
we
have
updated
with
actual
closed
out
information,
but
I'm
going
to
try
just
to
touch
on
the
on
the
high
point
to
conserve
time
for
the
questions
and
any
comments
that
you
all
may
have
afterwards.
But
you
can
see
there
on
this
slide.
E
It's
a
side
by
side
comparison
by
Fun
source
and
what
I
mean
by
that
is
general
fund,
restricted
funds
and
and
federal
funds
Appropriations
and
we've,
provided
you
the
actual
expenditures
for
State
fiscal
year,
21
and
22.
how
how
both
years
ended
up
with
23
and
24.
What
we've
listed
there
is
the
budgeted
Appropriations,
as
listed
in
house
bill
one
from
the
session,
and
you
can
see
there
on
state
fiscal
year.
22,
our
actual
expenditures
came
up
just
just
short
of
14.9
billion
dollars.
E
This
slide
kind
of
shows
you
where
that
14.9
billion
dollars
went
you're
familiar
with
this,
with
this
pie
chart
before
the
biggest
piece
of
this.
If
I
can,
if
I
can
just
show
you
there's,
if
you
look
at
it,
there's
kind
of
two
pieces
of
this
pie,
two
big
pieces
and
that's
the
fee
for
service,
which
is
the
multi-colored,
and
then
the
big
blue
is
from
the
Managed
Care
organizations
now
of
the
fee
for
service.
That's
only
what
we've
spent
through
fee
for
service
is
what
I've
listed
here.
It
is
not
including
those
service.
E
Some
of
those
services
that
are
paid
through
the
Managed
Care
capitation
payments,
the
on
the
fee
for
service
you'll,
look
and
you
can
see
a
nursing
facility
was
the
highest
at
1.2
billion,
followed
by
the
alternative,
Community
Care
that
alternative
Community
Care
includes
our
six
waivers
as
well
as
home
health
and
Money
Follows.
The
person
program,
the
there
I
will
point
out
again.
The
all
other
is
just
everything
other
than
these
main
kind
of
High.
E
Point
services
are
listed
out:
Nursing,
Facility,
hospitals,
Pharmacy
Dental,
ICF,
idd,
Transportation,
Physicians
and
Clinics,
because
those
are
some
of
the
high
topics
that
we
have
going
on
right
now.
So
I
wanted
to
point
those
out,
but
I
bucketed
everything
else
in
the
all
other,
and
the
reason
why
that
all
other
is
a
negative
is
because
of
drug
rebate.
Drug
rebate
is
an
offset
of
expenditures,
so
that
brings
that
down
to
a
negative
amount
there.
So
you'll
see
that
of
our
population.
E
E
E
Some
of
those
payments
are
directed
payments
that
we
pay
through
the
mcos
as
well,
that
that's
included
in
that
11.8
billion
dollars
in
that
pie.
Chart
a
lot
of
the
about.
22
percent
of
that
amount
is
associated
with
those
directed
payments
and
I've,
provided
you
there
some
hot
some
of
the
amounts
for
the
University
directed
payments.
The
hospital
rate
Improvement
program,
which
we've
we've
discussed
in
this
in
this
setting
before,
as
well
as
the
ambulance
provider,
Assessment
program
and
I,
provided
you
the
amounts
that
we
paid
in
state
fiscal
year
22.
E
for
each
one
of
those
programs.
The
other
thing
there
at
the
bottom
I
just
wanted
to
point
it
out
again.
The
urban
versus
rural
on
the
hospital
rate
Improvement
program
is
63
percent
of
that
payment
went
to
Urban
and
37
percent
went
to
rule
of
the
total
1.1
billion
that
was
paid
out
in
a
trip.
The
the
hospitals
did
pay
an
assessment
of
about
199
million,
which
the
net
benefit
to
them.
The
net
amount
coming
to
them
after
you
reduce
it
for
the
for
the
assessment
that
they
paid
is
about
946
million.
E
We
are
looking
like
I
said
in
the
June
I
believe
it
was
in
June
that
we
we
met
and
I
mentioned,
that
we
were
looking
at
adding
outpatient
to
the
out
to
the
atrip
program.
I
call
it
a
trip,
I
apologize
if
the
hospital
rate
Improvement
program
is,
is
currently
just
inpatient
claims.
So
we
are
looking
to
expand
that
to
outpatient
early
indications.
Is
that
it'll
be
another
1.2
billion
again
on
top
of
this
1.14
that
we
have
here?
E
This
slide
just
breaks
it
down
a
little
bit
more
about
showing
you
the
the
increase
and
decrease
from
2001
to
2000
2001
2021
State
fiscal
year
to
2022
State
fiscal
year.
You'll
see
that
our
state
fiscal
year,
2022
expenditures
increased
by
close
to
507
million
over
2021.
That's
a
three
and
a
half
percent
increase.
E
Some
of
the
things
that
that
are
noted
in
here
is
the
nursing
facility.
29
add-on
was
first
implemented
just
for
calendar
year,
2021,
which
that
goes
across
2021
budget
as
well
as
2022.
But
then
we
extended
that
if
you
recall
in
this
last
budget
so
to
include
count
your
22
and
Beyond.
So
that's
why
there's
a
bit
there
is
an
increase
in
in
the
29
add-on
for
that
state
fiscal
year.
It's
not
146
million
146
is
comparing
to
2020..
If
you
compare
it
to
2021
it's
about
half
of
that.
E
It's
about
same
it's
about
the
73
million
dollar
Mark
that
we
paid
more
in
22
than
we
did
in
2021
on
the
nurse
on
the
Managed
Care
payments
you'll
see
that
that's
nine,
a
nine
percent
increase
in
22
over
2021
and
I,
provided
you
some
of
the
the
causes
of
that
increase.
Some
of
that
is
due
to
increase
enrollment
as
well
as
program
programmatic
changes
and
then,
but
then
I
listed
out.
E
The
increase
there
for
the
atrip
program,
364
million
for
a
trip
was
paid
more
in
in
22
than
was
paid
in
21.
264
million
was
paid
more
in
the
University
directed
payment
as
well
as
15
million
in
that
in
the
ambulance.
E
So
in
21
you
had
three
quarters,
whereas
in
22
you
had
four
quarters
worth
because
of
that
timing
and
shift
there
on
the
the
same
thing
goes
for
the
ambulance
directed
payment.
It
was
implemented
in
21
calendar
year
21,
so
you
had
two
quarters
and
21,
whereas
you
had
four
quarters
and
22,
which
is
why
you
have
the
increase
there
on
the
University
payment,
there
was
additional
providers
that
qualified
for
the
payment
that
was
brought
into
the
university
program.
So
that's
why
that
was
an
increase
on
this
last
slide.
E
I
just
wanted
to
provide
you
a
kind
of
similar
look
between
21
and
22
across
our
six
waivers.
What
was
spent
on
those
waivers
in
in
state
fiscal
year
21,
as
well
as
what
was
spent
in
22..
You
can
see
that
we
had
an
overall
an
aggregate,
an
increase
of
about
91
million
dollars,
a
nine
about
a
9.14
increase
in
total
expenditures.
E
There
was
one
waiver,
the
brain
injury
waiver
that
had
a
decrease
and
when
I
talked
with
the
the
director
over
the
waiver,
she
said
it
was
due
to
decreased
utilization
due
to
covid
in
early
part
of
State
fiscal
year
22.
But
since
then
it
has
started
coming
back,
but
so
that
that
was
the
the
explanation
I
got
for
that,
but
that
was
the
only
one
that
had
a
decrease.
E
The
last
bullet
is
to
address
the
10
rate
increase
that
was
in
house
bill,
one
across
the
those
waivers
we
are
in
the
process
we've
submitted
to
CMS
the
spending
plan.
As
you
recall,
we
had
a
spending
plan
but
to
spend
arpa
dollars
on
other
items,
but
we
had
that
approved.
But
then,
during
the
budget
we
were
asked
to
use
those
funds
for
a
10
rate
increase
to
help
fund
for
those
10
rate
increases
across
the
board
on
on
all
those
waivers.
So
we
had
to
update
that
spending
plan.
E
It
has
been
sent
to
CMS
and
my
understanding
we're
getting
close
to
an
approval
on
that,
but
we
have
to
have
that
approval
before
we
can
reallocate
those
funds.
We
have
to
have
cms's
approval
on
on
how
we
allocate
those
HCBS
dollars
before
we
can
Implement
that,
so
we
once
we
do
that
it
will
be
back
dated
to
7-1
and
we'll
be
updating
that
all
the
way
back
to
the
to
the
7-1
on
those
rates.
So,
oh
23,
you
asked
representative
Bentley
about
projections,
I,
provided
you
the
house
bill
one.
E
We
have
not
done
our
projections.
If
you
recall
last
time,
I
said
we're
gonna
wait
till
after
the
end
of
the
first
quarter,
and
then
we
were
going
to
be
getting
together
and
doing
an
exercise
with
the
budget
director's
office
to
try
to
do
a
reforecast
and
see
how
we
are
lining
up
on
our
23
budget.
E
two.
So
we
we
assumed
that
those
dollars
would
go
away.
But
since
we've
it's
been
extended,
those
additional
Federal
fund
appropriation
will
be
needed,
but
we'll
be
doing
that
during
the
session
and
coming
to
you
guys
on
that,
as
well
as
any
any
increase
Appropriations
necessary
for
for
the
atrip
program.
By
going
to
the
outpatient.
If
that,
if
that
passes
through
through
y'all's.
E
We
should
have
that
we're
going
to
start
working
on
our
projections
in
Let's
see
mid-october.
We
should
have
that
sometime
in
November,
okay,
I
would
say
my
goal
is
to
have
it
to
you
all
before
or
have
it
completed
before:
Thanksgiving
holidays,
yeah,
great
yeah.
C
Thank
you,
Mr
chair
on
the
waiver,
the
10
rate
waiver
increase,
so
we
the
state,
submits
that
request
to
CMS
and
then
CMS
issue,
approves
it
or
disapproves
it.
For
whatever
reasons,
when
does
the
State
actually
go
about
like
submitting
that?
Do
you
all
have
to
wait
till
the
fiscal
year
to
start
you
have
to
wait
till
7
1
before
you
actually
submit
that
or.
D
That
was
submitted
shortly
after
the
budget
bill
was
passed,
and
so
CMS
has
a
certain
amount
of
days.
Typically,
it's
90
days
to
approve
or
disapprove
or
they
come
back
with
requests
for
additional
information,
and
they
have
come
back
to
the
state.
D
With
with
additional
questions
that
we
have
to
answer-
and
we
are,
we
believe
that
we're
close
to
to
getting
that
approval
and
we've
had
a
couple
of
really
good
calls
with
them
the
past
few
months,
and
we
can
definitely
keep
you
posted
on
when
we
get
that
approval
and
start
fencing
those
payments
to
the
providers.
Okay,.
C
But
it
the
what
I
guess
the
request
was
submitted
before
our
I
guess
shortly
after
session
ended
right.
Yes,
okay
and
I'm
just
trying
to
get
a
timeline
because
a
lot
of
times
we'll
go
out
and
tell
our
providers
like
hey.
You
can
expect
this.
It's
in
the
budget.
You
know
as
long
as
everything
looks
good,
you
know
seven
one.
You
should
be
good
to
go
and
then
that
doesn't
happen
and
they
come
back
and
say
what's
going
on.
You
know
why.
C
D
And
we
think
this
is
it's
going
pretty
good,
given
the
newness
of
the
arpa
funds
and
the
requests
that
we've
made,
we
think
it's
going
really
good.
We
do
have
town
halls
and
we
do
meet
with
their
members
and
our
providers
to
keep
them
updated
and
posted
on
activities.
We
do
have
a
timeline
that
we
can
send
to
this
committee.
That
is
I
believe
it's
posted
online,
but
we
do
have
all
of
our
activities
and
we
have
routine
email
blast
air
providers
to
give
them
additional
information.
Okay,.
B
D
We
have
not
submitted
a
1915
C
waiver
for
assisted
living.
We
did
have
some
conversations.
We
do
currently
cover
assisted
living,
a
small
percentage
in
some
of
our
other
1915c
waivers,
but
we
have
not
started
working
on
an
assisted
living
waiver,
but
would
be
more
than
happy
to
have
some
off
some
offline
meetings
with
you
to
kind
of
discuss.
If
you
want
to
do
that,
that
would
be.
B
B
D
F
Thank
you,
Mr
chairman
commissioner,
can
you
do
a
give
us
a
quick
update
on
the
wavery
design
and
also
on
the
rate
study
for
waivers?
We.
D
Believe
that
the
rate
study
will
be
con
concluded
later
this
fall,
we
do
continue
to
have
a
waiver
redesigned
meetings
with
various
stakeholders
and
again
we
have
a
site.
A
website
specifically
devoted
to
airwaver
redesign
activities
would
be
more
than
happy
to
give
you
a
link
to
that
site
or
give
you
a
timeline
of
some
of
the
activities
that
we
have
done
included,
including
provider
Communications.
We
could
give
you
some
of
that
information.
D
I
think
that
the
first
step
is
definitely
the
rate
study
and
that
again
we
believe
that
is
going
to
be
completed.
This
fall,
maybe
November
I
can
get
a
def
a
definitive
date
and
give
it
to
you
but
I.
We
believe
that
we're
on
track
to
get
that
rate
study
completed
this
fall
and
okay,
probably
November
time
frame.
F
And
and
throwing
you
a
curveball
right
now,
any
idea
the
cost.
If
we
were
to
eliminate
the
waivers
Michelle
P
SEL,
to
cover
all
of
those
folks.
How?
How
much
the
hit
would
be
to
the
state
budget
to
do
that,
to
eliminate
to
to
give
everyone.
The
waiver
who,
who
is
eligible
for
the
waiver
and
do
away
with
the
waiting
list.
D
I,
don't
have
that
number
specifically
with
me.
We
could
do
some
projections
based
on
the
number
currently
on
the
waiting
list.
I
think
the
last
time
I
looked,
we
had
at
least
nine
I
think
a
little
over
nine
thousand
individuals
on
the
Michelle
P
waiting
list,
but
we
can
give
you
some
sort
of
a
ballpark
figure.
If
you
would
like
us
to.
D
F
Lists
I,
just
at
some
point,
we've
got
to
take
a
big
chunk
out
of
this
they're
I
mean
there
are
families
that
are
struggling.
This
is
a
Workforce
issue.
Kids
coming
out
of
high
school,
don't
have
access
to
Services
can't
get
the
waiver
mom
has
to
stay
home,
dad
has
to
stay
home
and
it's
you
know.
We've
got
to
take
some
steps
on
this
at
some
point
and
and
stop
this.
You
know
just
picking
at
it
every
budget
cycle
and
and
really
making
a
difference
on
it.
Mr
chairman,
if
I
might
one
more
question.
D
F
And-
and
it's
still
a
third
of
the
overall
population,
do
you
have
the
difference
in
that?
How
how
much
of
that?
Third,
how
much
of
the
total
population
is
children.
D
We
have
currently
in
Kentucky
a
little
over
one
million
children
under
the
age
of
18,
in
the
state
of
Kentucky
and
of
those
little
over
a
million
children
over
six
hundred
thousand
of
those
are
enrolled
in
Medicaid
or
k-chip,
and
then
going
back.
If
I
may
send
her
Carol
to
your
question
about
individuals
and
the
waivers
and
being
enrolled,
we
definitely
want
to
make
sure
that
we
can
provide
services
to
all
those
individuals
who
qualify,
Fair
waivers
and
currently,
if
they're,
on
a
waiting
list
and
they
do
qualify
for
Medicaid.
D
F
Just
think
it's
a
good
time
to
really
as
we're
we
we
did.
The
reimbursement
increases
the
10
and
10
and
and
the
other
rate
increases
and
then
we're
looking
at
the
rate
study
so
likely.
This
will
result
in
more
incentive
to
open
for
providers
to
open
more
facilities,
so
it
you
know
it
might
be
a
good
time
to
look
at
next
budget
cycle,
increasing
those
numbers
and
taking
a
big
chunk
out
of
that
and
I
know,
that's
something
that
would
be
on
our
shoulders
to
to
approve
the
funding
for
that.
F
But
we
got
to
take
care
of
that
population.
It's
what
Medicaid's
for
and
we're
just
I
just
we
just
pick
at
it
and
it's
not
being
effective
and
families
are
really
struggling.
The
last
question
has
to
do
with
what
I
had
just
asked
about.
Medicaid:
do
you
all
maintain
Geographic
maps
to
look
at
where
the
the
densest
populations
for
overall
Medicaid
and
for
children,
and
do
you
all
have
something
like
that
available?
Yes,.
D
We
do
we
and
we
do
notice
that
we
do
have
a
higher
concentration
in
the
eastern
part
of
the
state.
So
Eastern
Kentucky
has
a
higher
concentration
in
the
farther
west.
You
go,
the
the
concentration
is
is
a
little
bit
less
dense.
We
have
one
County,
which
has
less
than
five
percent
of
the
population
enrolled
in
Medicaid,
which
is
Oldham
County,
but
we
do
have
those
maps
and
we'll
be
more
than
happy
to
share
those
Maps.
F
You
know
if
we,
if
we
really
want
to
solve
the
Medicaid
issue,
it's
all
about
jobs
and
if
we
focus
economic
development
in
the
areas
of
the
State
that
need
the
jobs
that
have
the
highest
Medicaid.
You
know
we.
We
could
accomplish
a
couple
things
with
that.
But
are
you
all
do
you
all
ever
work
with
economic
development?
Do
they
ever
approach
you
about
things
like
this
I.
D
Have
not
worked
directly
with
economic
development.
I
do
know
that
there
are
conversations
between
our
cabinet
and
there's
specifically
related
to
House
Bill.
Seven
I
believe
I've
got
that
one
right
with
relate,
as
it
relates
to
Workforce
and
and
sharing
of
data
and
information
for
those
individuals
who
are
enrolled
in
Medicaid.
Okay,.
E
And
I
will
say
that
we
we
do
feel
like
we
are
an
economic
engine
for
the
state
for
as
much
money
as
we
are
sending
out
into
this
we're
covering
a
third
of
the
population
hospitals.
It's
not
I
mean
it's
been
well
known,
been
well
documented
minute
that
we
would
have
had
several
hospitals
to
close
if
it
wasn't
for
the
atrip
program.
So
we
we
feel
that
we
are
an
economic
engine.
A
F
That
that
really
shouldn't
have
happened
because
its
insurance
is
now
required
to
cover
Autism
Services.
Our
our
Center
is
getting
ready
to
open
an
Autism
Center
early
next
year
and
we've
We've
ran
the
numbers
and
and
the
inch
private
insurance
covers
it.
Medicaid
covers
it.
So
we
we
expect
a
very
small
portion
of
our
population
to
actually
be
waiver.
F
G
You're
going
to
see
this
part
of
the
strange
comment
coming
from
me,
but
take
a
little
bit
of
issue
with
your
statement
about
the
Medicaid
being
the
economic
engine,
I
think
for
Rural
communities,
it's
a
economic
Mainstay
or
economic
insurance
policy,
but
look
at
these
numbers.
You
know
this
is
the
the
sixth
year
I've
been
here
and
looking
at
the
trajectory
of
the
Medicaid
Program.
When
I
came
in
2017,
it
was
10
billion
dollars.
Now
we're
looking
at
15
billion
dollars
and
when
you
double
a
program
in
about
five
years
time.
G
That's
that's
something
I
think
warrants
some
review
and
every
dollar
we
had
to
put
in
the
Medicaid
Program
means
less
dollars
to
put
someplace
else
like
economy
development.
G
Programs
like
the
waiver
program,
which
certainly
needs
and
that's
most
needus,
that
that
we
have
but
I
think
we've
got
to
be
careful
in
looking
at
the
Medicaid
Program
as
a
economic
engine.
Again
we
can't
survive
without
it,
but
I
don't
think
it
gets
us
the
return
on
investment
that
we
really
need
if
we
could
redirect
them
someplace
else.
So
I'm
just
got
to
be
careful
with
that.
G
But
do
we
really
have
a
focus
upon
moving
people
out
of
Medicaid
to
gain
flow
employment
in
Insurance
under
those
programs
in
improving
the
health
of
our
population,
because
we
just
don't
seem
to
be
moving
that
bar
at
all?
You
know:
we've
had
discussion
before
again
back
in
2017
we
had,
we
were
47th,
I,
think
in
health
care
outcomes
and
now
we're
44,
but
I
think
it's
because
we
have
increased
people's
access
to
care
to
some
degree
but
to
truly
say:
we've
improved
the
health
of
population.
G
It
just
hasn't
happened
so
I'm
not
sure
how
to
how
to
move
this
needle,
but
just
won't
share
that
concern,
then
just
to
see.
Keep
growing
and
growing
is
a
little
bit
problematic.
For
me,
I
know
we
need
to
have
rate
increases
still
for
some
other
providers.
G
We
hadn't
provided
for,
and
we've
got
to
ask
where's
those
funds
come
from
again
I
think
the
funds
are
there,
it's
just
how
they
are
prioritized,
and
could
we
not
redirect
some
of
these
things
if
we're
truly
focusing
on
moving
people
off
of
Medicaid
in
improving
the
health
of
population,
so
I
guess
I'm.
Looking
more
long
term,
like
you.
E
Know
so,
if
I
may
comment
on
that,
certainly
the
the
trend
that
you're
seeing
a
lot
of
it,
you
know
we
have
2.6
billion
of
the
15-
is
related
to
directed
payments.
E
That
is
due
to
maybe
us
being
the
lower
payer.
But
a
lot
of
Provider
networks
come
to
con
to
Kentucky
Medicaid
versus
going
to
the
commercial
insurances
to
solve
their
financial
woes.
So
we
have
done
a
lot
of
EX
expanding
of
benefits
through
the
legislators.
You
know
you
all
have
have
have
have
expanded
benefits
on
some
things.
E
Each
one
of
those
that
you
all
approve
has
a
dollar
a
cost
tag
to
it
and
that's
you
know
we're
just
implementing
it
and
we're
advising
you
how
much
it
cost,
but
it's
still
passed,
but
we
still
have
to
have
the
you
know.
The
budget
has
to
be
there
to
satisfy
the
law.
That's
been
passed
by
you
guys
and
I'm,
just
being
honest
and
transparent,
with
their
Senator
Meredith
that
you
know
we're
just
implementing
the
lost
it
or
some
of
the
benefits
that
that's
been
passed
or
the
rate
increases.
E
That's
been
passed
through
through
budget
bills,
but
at
this
time
we've
also
have
due
to
inflation
due
to
everything.
Every
provider
Network
that
we
have
with
the
with
the
exception
of
podiatrists,
have
reached
out
to
us
wanting
a
rate
increase
and
then,
if
we
don't
get
it,
if
we
say
well,
we
don't
have
the
budget,
then
they
come
to
you
guys
and
they
get
it
implemented
through
through
legislation.
E
G
E
Get
this
other
way,
you'll
notice
there.
When
you
look
at
the
state
funds-
which
is
you
add,
the
general
fund
and
restricted
fund,
we
had
a
decrease
in
state
funds
in
in
22
over
21..
The
biggest
part
of
the
increase
was
those
was
those
federal
dollars
that
you're
talking
about
you'll
see
that
we
increased
600
million
dollars.
We
only
increased
a
total
of
400,
but
600
million
dollars
of
that
was
in
federal
funds.
Now
I
understand
those
are
still
tax
dollars
and
I'm,
not
here
to
sit
there
and
and
hide
behind
that
I'm.
E
Just
telling
you
those
are.
The
federal
funds
is
the
600
million.
That's
where
the
biggest
increase
is
in
our
budget
for
this
year.
E
But
you're
right,
you're
right,
restricted
funds,
that's
where
the
atrip,
the
hospitals,
pay
the
assessment.
We
have
a
new
provider
tax
for
the
ambulance
for
at
five
and
a
half
percent
that
tax
funds,
the
ambulance
provider,
a
payment,
the
APAP
payment
that
I
mentioned
University
direct.
The
universities
pay
a
IGT
which
is
a
intergovernment
transfer
where
they
pay
the
state
match
of
those
payments.
But
you
know
we
still
have
to
have
the
Appropriations
to
even
though
they're
putting
up
some
of
that
is
hidden
in
those
Appropriations.
You.
G
E
The
well,
if
I
made
on
this
slide,
you'll
see
the
drug
rebates
right
there
in
2021
was
827
million
in
2022,
it
was
1.2
billion
was
what
we
received
in
drug
rebates.
Now
understand
it's
kind
of
a
seesaw
effect
here,
because
not
I
don't
want
you
thinking.
We
just
got
400
million
dollars
extra,
because
in
order
to
get
that
400
million
dollars
extra
we've
moved
from
General
I
mean
from
generic
drugs
to
brand
name
drugs,
because
that's
all
we
can
get
the
rebate
on
is
brand
name
drugs.
D
Senator
Meredith
I
believe
that
your
comment
about
how
do
we
improve
the
health
status
of
this
state
is
one
that
can't
be
addressed
simply
by
Medicaid.
It's
going
to
take
a
bigger,
bigger
body
than
Medicaid,
but
I
do
believe
that
the
money
that
we
pay
out
into
the
communities
in
the
form
of
payments
to
Providers
does
help
spur
the
economy
in
those
areas.
D
How
do
we
use
our
information
to
actually
improve
the
health
status
of
this
state
because,
with
Medicaid
being
one
of
the
largest
payers
or
the
largest
payer
of
Health
Care
Services
in
the
state,
if
we
can
just
harness
their
data
and
get
it
in
usable
format
to
find
out
how
we
can
change
our
policies
to
to
improve
the
health
status
of
those
that
we
serve?
While
you
know
when
we
start
moving
monies
around,
how
what's
the
impact
going
to
be?
D
Not
only
how
are
we
going
to
improve
that
status,
but
what's
the
impact
going
to
be
in
the
provider
community
and
how
do
we
work
with
again
the
data
that
we
have
and
the
information
to
start
to
start
changing
those
policies
or
identifying
which
specific
policy
needs
to
be
changed?
Well,.
G
It
goes
back
to
Senator
Carroll's
comment,
which
I
think
was
very
well
said.
G
But
we
don't
ever
direct
those
funds
to
that
area
and
I
think
it
makes
great
sense
to
have
some
kind
of
correlation
between
economic
development
and
our
Medicaid
Program
and
I'm,
not
suggesting
you
folks
start
having
weekly
conferences
with
those
people
but
I
think
as
a
legislative
body.
We
start
have
to
start
formulating
policy
to
address
those
particular
issues,
and
a
couple
of
us
went
to
a
seminar
back
in
April
they're
talking
about
payments
based
on
you
know,
deprivation,
values
and
I.
G
Think
that's
something
that
ties
into
what
Senator
Carol's
saying
as
well,
that
the
economic
development
of
this
state
really
should
be
directed
towards
our
poorest
communities
and
given
the
opportunity
to
lift
those
people
out
of
poverty,
and
when
that
happens,
everybody
benefits
from
it,
because
we
we
lift
the
people
out
of
Medicaid
and
it
makes
funds
available
for
their
purposes.
But
we
don't.
We
don't
think
that
way.
It's
almost
like
it's
upside
down
and
that's
that's
your
fault.
That's
more
I!
G
H
Thank
you
Mr
chairman.
Do
you
all
have
a
this?
Is
a
follow-up
to
Senator
Meredith's
question
I
sent
excluding
the
children?
Obviously,
what
percentage
of
the
Medicaid
population
in
this
state
is
employed.
H
Think
that's
a
really
important
number
to
know
for
the
purposes
of
this
discussion,
because
I
can
promise
you
that
every
30
year
old,
I
know
who
is
fully
employed
is
now
covered
under
Medicaid.
These
kids
cannot,
they
can
no
longer
afford
to
pay
for
private
insurance.
So
you
know
when
we're
talking
about
Economic
Development.
You
know.
H
One
of
the
things
we
have
to
think
about
is:
are
the
jobs
that
we're
offering
in
this
state
good
enough
for
these
younger
people
to
be
able
to
cover
their
own
health
insurance
costs,
or
is
that
something
that's
going
the
way?
Because
in
my
experience
it's
going
the
way
so
I
would
really
like
to
know
how
many
of
the
people
that
we
cover
under
Medicaid
in
this
state
adults
are
either
unable
to
work
due
to
medical
or
you
know,
psychiatric
whatever
or
are
actually
fully
employed,
because
the
majority
I
know
are
fully
employed.
I
And
I
appreciate
this
discussion.
I
think
that
you
know
we're
all.
We
all
have
the
same
goal
here
and
I
think
we're
we're
having
some
really
good
points
that
are
being
discussed.
I
agree
completely
with
the
economic
development
connection.
I've
said
for
a
long
time.
If
we
don't
have
a
healthy
population,
we
really
can't
grow
economically.
It
affects
everything
we
do.
It
affects
our
education,
our
obviously
our
health
care,
System,
our
criminal
justice
system
and
so
forth.
I
Workforce
one
two
I
I'd
like
to
make
two
points
and
and
there's
probably
a
question
in
here
somewhere,
but
we're
talking
about
a
lot
of
different
things.
I
mean
rebates
were
brought
up
and
that's
the
340b
program
and
you
know
we
have
to
spend
more
to
get
more
and-
and
you
know
it
doesn't
really
make
sense,
but
you
talked
a
little
bit
about
the
data
that
the
cabinet
collects.
Is
there
an
audit
that
you
all
do
on
a
regular
basis
to
kind
of
address
some
of
these
questions?
I
You
know
joblessness
or
you
know
how
do
we?
How
do
we
look
at
this
and
tie
it
together
other
with
our
lack
of
Health
here
in
the
in
the
Commonwealth?
You
know,
I
mean
we.
We
have
passed
to
your
point
about
expanding
Medicaid
we've
ex
we've
passed
some
legislation
that
I
think
targets
our
Medicaid
dollars
toward
programs
that
really
work,
and
it
may
take
some
time
to
really
see
the
return
on
investment.
I
So
I
don't
want
to
say
you
know
that
we're
expanding
Medicaid,
because
the
whole
point
is
to
get
people
back
to
work,
to
make
sure
that
they
are.
You
know
that
we
have
a
healthier
population,
and-
and
so
you
know,
if,
if
there's
an
audit
of
some
sort,
that
the
cabinet
could
take
on
to
really
help
us
prioritize,
what
we
spend
our
Medicaid
dollars
on
what's
working
and
what
isn't-
and
there
are
a
lot
of
factors
that
go
into
that
I
understand.
I
But
I
I
think
that
that
would
be
important
because
you
know
we,
we
had
House
Bill
525
last
year,
which
are
community
health
workers
which
we,
you
know
are
probably
likely
on
the
front
end
spending
more.
But
the
whole
point
is
to
get
the
the
spend
down
on
Medicaid
in
the
long
run.
House
Bill
7
addresses
some
of
the
the
eligibility
requirements
and
ensures
that
Medicaid
is,
is
the
safety
net
for
the
population
who
really
needs
it?
And
so
you
know
that
all
ties
to
the
waiver
programs
and
how
much
we
can
spend.
I
So
you
know
again
I
think
you're
right,
commissioner
Lee,
that
we
need
to
really
look
at
our
data
and
and
have
it
work
for
us.
But
we
need
to
do
that
together
and
I.
Think
you
know,
the
economic
development
cabinet
should
absolutely
be
part
of
this
conversation
and
then,
if
I
may
Mr
chair
I've
got
one
more
point.
I
We
we
had
a
work
group.
We
established
a
work
group
last
year
to
talk
about
Bridge
insurance
and
the
whole
point
was:
how
do
we
really
operationalize
some
State
dollars
with
a
a
private
sector
match
through
employers?
And
so
we
started
talking
about
you
know
whether
or
not
we
can
use
Tana
funds
or
you
know,
to
to
kind
of
create
a
pass-through
through
employers
and
getting
people
back
to
work,
so
that
folks,
you
know
are,
were
not
fully
subsidizing
with
Medicaid
dollars,
but
we
we
can.
I
You
know
I
I'm,
just
trying
to
figure
out
a
way
to
get
creative
with
a
public
private
partnership
to
get
people
back
to
work,
to
provide
benefits
and,
at
the
same
time,
I
think
we
could
really
use.
We've
talked
about
the
benefit.
Cliff
I,
think
that
plays
a
big
part
in
in
whether
or
not
folks
can
and
move
ahead
in
their
employment
they
can
get
raises
without
losing
all
of
their
benefits.
I
think
there
are
ways
and
we've
seen
I
mean.
I
We've
talked
to
the
you
know,
Georgia
Center
for
opportunity
and
some
other
organizations
who
have
modeling
programs
that
can
really
help
identify
when
an
individual
is
about
to
fall
off
that
benefit
Cliff.
Are
there
ways
to
stair
step
this
so
that
we
don't
have
that
benefit
Cliff?
We
allow
people
to
get
back
to
work
and
stay
employed
and
move
ahead
in
their
employment
and
eventually
move
to
Independence
and
self-sufficiency.
I
think
that's
got
to
be
our
goal.
We
have
the
marketplace
now,
and
so
you
know
the
question
is:
how
is
that?
I
How
would
that
be
different
from
the
marketplace?
I
guess
I
see
it.
As
you
know
a
P3
and
it
would,
it
would
absolutely
move
people
off
of
Medicaid
eventually
I
mean
that
would
be
the
point
right
now.
I,
don't
see
that
there's
a
real
mechanism
in
the
marketplace
to
move
people
off
of
Medicaid,
so
I
hope
that
made
sense.
Somehow
we
ended
up.
We
landed
on
a
basic
health
care
plan
and
that
wasn't
really
my
goal.
I
E
Well,
if
I
may
comment
one
thing
when
you
your
very
first
comment
of
spending
more
to
get
more
on
the
drug
rebates,
we
are
looking
into
a
report
doing
an
analysis
of
Senate
Bill
50..
We
should
have
that
report
done
soon,
I'm,
not
sure
a
timeline
on
that,
but
it
should
be
within
the
next
four
to
six
weeks.
We
should
have
that
completed
to
kind
of
show
the
the
savings,
because
I
don't
want
you
to
think
there's,
not
a
savings.
E
What
I
meant
by
saying
is
that
we
would
there's
a
kind
of
a
seesaw
effect
like
I
said
that
some
of
the
expense
I
don't
want
you
thinking
that
full
amount
of
the
400
million
of
drug
rebate
is
all
savings,
because
there
is
an
expense
tied
to
that
that
amount
as
well.
Okay,
I
just
want
to
clarify
that
make
sure
everybody
was
clear.
J
Thing
was
chairman:
I've
got
a
few
questions
if
you'll
indulge
me
in
just
a
few
comments.
So,
first
of
all,
commissioner,
thank
you.
I
also
want
to
appreciate
the
fact
you're
very
prompting
your
response,
as
always
Todd,
and
you
get
a
lot
of
my
little
semi
Rants
and
complaints
from
providers
you're,
always
very
prompting
your
responses,
and
you
always
follow
up.
I
really
appreciate
that.
So
thank
you.
J
Okay.
So
a
few
things
on
this
one
of
the
first
and
some
comments
on
the
things
that
have
been
discussed
here
today.
J
We
know
that
we
have
extra
enrollees,
obviously
from
the
state
of
emergency
federally,
as
is
that
going
to
affect
the
budget
numbers
that
we
see
here
as
those
get
disenrolled
has
that
been
put
into
the
numbers
and
the
pie
charts
you've.
Given
us,
it's
just
a
closeout
I
know
from
last
year,
but
I
guess
going
forward.
J
Is
there
a
projection
as
to
when
they
decide
again,
there's
some
confusion,
even
at
the
federal
level
as
to
whether
or
not
we're
still
in
a
state
of
emergency
or
not
so,
assuming
that
determine
that
hey
we're
going
to
remove
that
and
all
these
enrollees
now
come
off
the
rolls?
How
much
of
that
affect
our
budget
from
what
we
can
estimate.
E
When
we
did
the
budget
projections
back
in
October
of
20,
when
was
it
that
I
did
that
20
21
I
think
you
all
voted
on
the
budget
in
in
this
past
session.
So
I
did
we
had
to
have
those
done
by
November
and
we
made
the
Assumption
at
that
time
that
the
phe
would
end
March
31st
of
2022,
and
at
that
time
we
would
have
a
one-year
time
frame
of
doing
redeterminations
where
those
people
would
come
off
the
roads
that
had
so
that's.
E
That's
what
one
of
our
goals
our
task
in
that
re
calculation
that
we're
doing
in
October,
and
we
should
have
to
you
all
by
the
middle
of
a
middle
of
November.
J
So
I
I
know
it's
I
mean
roughly
what
we
pay
per
member
and
again,
the
number
that
always
goes
through
my
head
is
about
600
per
member
per
month,
roughly
200
000
you're.
Looking
you
know,
it'll
be
in
the
billion,
probably
over
a
billion
dollars
for
the
year
I
mean
it
could
be
a
significant
impact,
ultimately
total.
E
E
Looking
at
total
but
I
broke
it
up
on
those
other
Pages
by
the
state
and
federal,
but
but
until
we
do,
we
do
get
a
6.2
percent,
not
on
just
those
200
000
members,
but
we
get
to
6.2
percent
on
all
members.
The
members
in
the
program
of
the
traditional
program.
We
don't
get
it
on.
We
get
a
little
bit
a
bump
on
chip
like
4.34
percent,
but
expansion.
Expanded
adults
is
all
at
90
10,
but
we
do
get
a
6.2
percent.
J
And
that
so
and
had
a
question
at
an
earlier
committee
meeting
last
week,
I
believe
with
commissioner
Cecil
and
asking
is
this
a
mandate
from
the
federal
government?
It
isn't
necessarily
a
mandate,
we
can
say
we
don't
want
to
do
this,
but
we
it's
profitable
for
us
effectively.
The
best
way
to
put
it
is
that
there's
more
money
coming
from
the
feds
to
keep
a
lot
of
these
folks
enrolled
until
they
tell
us
they've
got
to
be
off
off
the
book,
so
they're
no
longer
going
to
cover
it.
J
D
That
be
fair
to
say
what
we
we
did
after
your
question.
At
the
last
committee
meeting,
we
did
go
back
and
research
to
make
sure
that
we
had.
Our
understanding
was
correct,
with
the
public
health
emergency
ending
and
the
6.2.
So
we
have
to
keep
everyone
enrolled
until
that
Public
Health
Emergency
ends
in
order
to
maintain
that
6.2
and
if
we
for
example,
said
well
we're
just
going
to
start
disenrolling
now,
we
would
have
to
go
back
to
the
beginning
of
the
public
health
emergency
and
give
those
funds
back
for
the
6.2.
J
Okay,
so-
and
that's
that
was
what
I
was
trying
to
get
at
was
I,
wasn't
sure
it
was
a
federal
mandate
like
you
have
to
you
don't
have
to,
but
it's
obviously
made
it
very
difficult
not
to,
in
fact
at
least
the
way
I
want
to
put
it
there
from
a
financial
angle.
Okay,
on
the
pharmacy
costs,
I
know
that
you've
got
kind
of
in
your
pie.
J
Chart
there
of
122.9
million
on
Pharmacy
is
that
is
that
lower
higher
than
what
we've
seen
in
the
past
after
we've
kind
of
brought
a
single
PBM
into
I
would
imagine
that
reflects
a
lot
of
that
cost
for
Medicaid?
Is
it?
Is
that
a
higher
amount
lower
amount,
since
we've
done
that.
D
J
So
that
amount
is
buried
into
the
blue
under
the
MCO
amount
there.
Okay,
the
and
you
I
think
you
mentioned
about
the
rebates
and
how
again
there's
a
higher
amount
again.
Is
that
something
that
we
were
even
in
the
past
prior
to
the
single
PBM?
Is
that
different
since
we've
gone
to
that
model
or
the
rebates?
Yes,.
E
Are
all
offset
of
expenditures,
so
we
have
to
pay
the
federal
share
back.
C
E
Those
so
it's
about
80
percent
goes
back
to
the
feds
and
about
20
percent
stays
here.
So
we
use
that
20
to
offset
where
it's
an
offset
of
expenditures.
It's
just
that
we're
we're
not
using
our
general
fund
or
restricted
funds
as
much
got.
J
It
and
the
point
I'm
getting
at
is
those
rebates
were
going
to
our
mcos.
Before
often
weren't
reported
in
I
mean
weren't
reported
in
medical
loss
ratios
I
would
imagine
that
was
the
issue
that
we
had
was
there's
an
mlr
of
10
percent
and
we
had
those
folks
here
before
us
in
the
past.
You
know
they
said.
Well,
we
don't
know,
we
turn
it
over
to
a
PBM,
the
PBM
I
don't
have
to
answer
to
you
and
those
are
savings
that
were
going
to
some.
J
E
We're
hoping
that
the
the
report
that
I
mentioned
on
the
Senate
bill
50
the
analysis
that
we're
doing
will
kind
of
help.
You
show
illustrate
some
of
that.
J
D
We
currently
so
part
of
the
single
PBM
and
Senate
bill.
50
we
pay,
we
increase
the
dispense
fee
to
the
pharmacies.
It
moved
from
a
varying
rate
that
the
mcos
paid
to
a
flat
1064
for
each
prescription,
so
they
are
getting
more
money
in
that
we
do.
I
mean
it's
a
very
complex,
complicated
program,
but
they
are
receiving
more
money
in
dispense
fees
than
they
were
under
the
old
old
formula.
J
J
I'm
sorry,
thank
you,
Mr
chairman,
so,
to
that
point
of
increased
savings
when
we
brought
things
back
underneath
our
own
tent.
J
It
prompts
me
to
ask
the
question
and
I
think
the
commissioner
knows
where
I'm
going
with
this
I've
got
a
lot
of
providers
who
are
looking
back
with
some
Nostalgia
of
how
things
used
to
be
prior
to
our
mcos
being
part
of
our
process
and
I
know:
we've
had
the
discussions
of
well
boy.
This
would
be
so
much
administrative
costs
and
I.
You
know
we
it's
just
easier
to
give
it
to
a
big
group
and
to
manage
a
lot
of
this
and
I
often
talk
about
them,
not
managing
care.
J
They
manage
money
more
than
they
manage
care.
Our
Department
of
Medicaid
I
think
tries
to
manage
care
truly
and
they
have
to
manage
funds
as
well.
That's
part
of
it,
but
there
is
an
attempt
to
try
to
improve
care
and
provide
that
for
folks,
so
it
prompts
made
a
question:
I
mean
we're.
Looking
at
a
you
know,
the
budget
now
I
mean
the
amount
that
goes
to
Managed.
Care
is
11.8
billion
dollars.
They
have
a
10,
mlr
and
medical
loss
ratio,
they're
allowed
for
administrative
costs
and
to
administer
the
program.
J
J
Would
that
be
something
we
could
do
because
I
mean
I
have
to
wonder
if
we
found
savings
when
it
comes
to
Pharmacy,
we
wouldn't
probably
realize
very
similar
savings
when
it
comes
to
managing
of
care
for
the
system
and
that's
what
we're
paying
a
lot
of
these
companies
on
an
annual
basis
is
1.18
billion
dollars
to
manage
this
with
the
complaints.
Commissioner,
with
the
emails
you
get
from
me
from
lots
of
different
folks
and
and
problems
that
continue
to
happen
there
and
that's
what
I'm
wondering
is.
J
D
D
The
other
thing
that
the
mcos
have
is
flexibility.
Some
of
them
do
cover
value-added
services
and
they
have
ways
to
to
communicate
with
their
members
and
get
those
members,
for
example,
pregnant
women.
A
lot
of
the
mcos
give
car
seats
and
strollers
to
their
members
as
something
Medicaid
and
a
fee-for-service
world
would
not
be
able
to
do
the
other
thing
that
we
would
not
be
able
to
do.
D
That
would
be
a
Major
Impact
is
the
a-trip
and
the
program,
so
we
would
not
be
able
to
do
those
directed
payments
and
we
so
again,
not
something
that
I
could
answer
would
be
comfortable
answering
without
a
more
in-depth
study
to
look
at
other
states
and
have
other
states
gone
from
a
managed
care
to
a
fee
for
service
Arena,
and
if
so,
how
does
that
look?
And
what
were
the
implications
and
the
unintended
consequences?
Maybe,
but
something
definitely
I
would
think
that
a
study
would
wouldn't.
E
D
E
Mean
interrupted,
but
the
the
part
of
the
directed
payments
is
the
average
commercial
rate.
If,
if
we
pull
everything
back
in
the
fee
for
service,
there's
a
UPL
not
for
payment
limit
that
we
cannot
exceed,
we
can
only
pay
up
to
the
Medicare
amount.
Some
providers
have
negotiated
successfully
with
mcos
to
negotiate
a
rate
higher
than
our
fee
for
service
rate
schedules.
Some
have
not
most
have
not,
but
there
are
some
that
have
they
would
have.
They
would
experience
a
rate
decrease
as
well
as
we
would
not
be
able
to
like.
E
She
said
on
the
a
trip
and
the
university
directed
payments.
We
do
those
at
average
commercial
rates.
Those
would
be
a
substantial
decrease
in
those
payments,
because
it'll
go
back
to
the
Medicare
UPL.
J
Yeah,
maybe,
and
and
again
I
I
tell
you
I,
know
a
lot
of
providers
who
remember
how
it
was
in
the
old
days
and
they
might
they
and
they
complained
back
then
believe
me,
I
know
how
providers
are
I'm
one
of
them,
but
it
was
a
lot
less
than
what
we're
encountering
now.
Just
the
efficiencies
were
different
and
and
it's
again,
we've
created
I
mean
and
again
we've
been
Innovative
in
creating
our
single
PBM
Model
A
lot
of
states
are
looking
at
what
we're
doing
here
saying
you
know.
J
Maybe
we
need
to
do
the
same
thing.
I,
don't
mind
trying
to
be
a
leader
and
try
new
things,
it'd
be
worth
looking
at
I.
Think
really
just
for
more
things
have
gone
because
we've
had
many
bills.
Have
we
passed
here
as
a
general
assembly
to
try
to
bring
in
business
partners
that
we've
partnered
with
to
do
the
right
thing
and
they
just
try
to
find
ways
around
it
and
don't
follow
those
things?
J
That's
not
something
I
like
to
do
business
with
I
mean
I,
wouldn't
be
doing
business
with
them
and
I
think
if
the
state
can
do
it
better
and
we've
done
it
better
when
it
comes
to
Pharmacy,
I
think
it'd
be
worth
looking
into
and
especially,
if
you
could
say
hey
you
know,
maybe
you
get
a
single
single
repository
of
someone
who
can
do
a
lot
of
the
things
you're
talking
about,
but
for
1.18
billion
it's
a
lot
of
money
to
be
able
to
manage
a
system
that
often
has
to
come
back
to
you
while
they
try
to
figure
out
and
kind
of
do
those
things.
J
I
just
think
it's
worth
the
discussion
worth
looking
into,
but
maybe
what's
old
is
new
again,
it
might
be
worth
looking
into
just
from
from
that
standpoint.
I
know
we
were
talking
about
rate
to
Providers.
Also
that
you
know
that's
obviously
a
big
thing.
I
know:
we've
had
I
think
some
of
the
discussion
we've
had
an
increase
in
probably
a
25
increase
in
overall
budgetary
expenditures
for
Medicaid
in
the
last
three
to
four
years.
J
J
So
it
isn't
I
think
we're
very
careful.
There's
a
lot
of
programs
I'd
like
to
expand
and
do
things
with,
but
once
I
get
my
fiscal
note
I'm
quickly.
My
legs
are
taken
out
from
underneath
me
because
we
can't
afford
it
is
often
the
commentary
where
you're
going
to
get
that
money
from,
but
so
a
lot
of
it
hasn't
necessarily
come
from
us.
J
There's
other
factors
that
have
increased
those
as
well,
and
then,
commissioner,
to
your
point
about
collecting
data
I
mean
we
had
having
some
discussions
about
all
payers
claims
database
And
discussing
what
that
would
look
like
I
understand
that
there
is
a
an
organization
that
currently
has
a
lot
of
that
information
for
Medicaid,
which
is
Greenwell
Technologies
my
understanding.
J
If
they
have
a
lot
of
it,
they
don't
gather
it
and
compile
it
in
a
way
that
can
be
read,
but
that
they
have
kind
of
that
data
in
a
kind
of
a
jumbled
it
kind
of
like
how
it
was
when
we
try
to
get
the
PBM
bill,
they
reported
all
the
data
to
the
jumbled
mess
and
we
had
to
try
to
figure
it
out.
It's
in
that
kind
of
a
state.
J
So
there's
been
some
discussion,
saying:
hey,
look:
the
data
is
somewhere,
it's
just
a
matter
of
compiling
it
in
a
way
that
we
can
report
it
that
our
data
people
can
interpret
that
our
universities
can
look
at
and
interpret
for
the
purposes
of
trying
to
drive
better
medical
care.
I
know
we've
had
that
discussion
with
our
mcos
here
before
and
when
we
said
show
us
what
you've
given
us
for
the
billions
of
dollars.
J
We
spent
with
you
for
improvements
in
our
overall
outcomes
and
they
struggled
to
come
up
with
any
kind
of
viable
numbers,
and
then
afterwards
the
discussion
was
well.
You
tell
us
doctor
you,
you
guys
General
Assembly,
tell
us
what
you
want
us
to
improve
on
I
said:
well,
you
all
are
the
ones
that
are
managing
the
care.
You
know
if
you're
going
to
have
us,
do
it
I
often
question:
why
are
they
there?
J
But
if
they're
wanting
us
to
tell
them
what
to
drive
for
care,
then
we
need
that
data
to
your
point
and
so
I
think
we're
working
on
some
of
that
and
we're
going
to
be
we're
going
to
get
some
language
together.
Try
to
get
input
from
the
cabinet
from
Medicaid
as
well.
We
may
have
to
start
in
baby
steps,
maybe
start
with
Medicaid.
First
to
help
us
drive
a
lot
of
that
and
collect
it.
But
those
are
the
things
I
wanted
to
just
comment
and
throw
out
there.
J
I
appreciate
you
all
coming
with
this,
and
you
know,
like
I,
said,
I
appreciate
your
responsiveness
of
a
lot
of
the
issues.
Commissioner,
I
really
do
appreciate
that.
Thank
you.
Mr
chairman.
K
Wow
I
wish
I
hadn't
had
a
flat
tire
this
morning
you
guys
always
have
so
much
important
information.
I
walked
in
when
we
were
talking
about
providing
jobs
to
more
people
in
the
state
of
Kentucky,
which
would
reduce
the
Medicaid
budget
and
I
know.
The
Medicaid
budget
has
continued
to
rise.
I
also
know
that
when
I
first
moved
to
Kentucky
30
some
years
ago,
I
lived
in
the
sixth
poorest
county
in
the
state,
and
if
you
talk
to
an
em
person
at
that
time,
they
just
couldn't
wait
to
get
out.
K
So
I
am
wondering
you
probably
have
the
information,
but
I
don't
know
if
you've
sought
it
out
to
look
at
it
diagnostically.
But
what
has
the
population
shift
been
from
some
of
these
rural
counties
that
really
have
not
had
the
opportunity
to
have
very
strong
employment
numbers,
because
there
is
nothing
and
how
has
that
shifted.
The
Medicaid
budget
in
those
areas.
D
Is
a
very
simple
job?
We
we
I
think
Senator
Carroll
asked
the
question
too.
D
If
we
have
the
the
Medicaid
population
mapped
out
by
county
and
the
density,
and
we
do
we
can
look
at
that
and
we
can
also
look
at
because
we
have
that
information
already
the
population
density
and
I'm
not
sure
when
you
say
the
shift
by
County
over
time,
if
you're
looking
for
you
know
a
five-year
10-year
look
back
and
how
that
population
has
changed,
but
just
based
on
my
personal
experience,
I,
don't
think
that
the
population
density
changes
that
much.
D
We
continue
to
have
the
largest
population
in
Eastern
Kentucky,
but
we
could,
you
know,
definitely
pull
together
a
map
of
the
employment
of
the
state
to
try
to
see.
But
we
do
know
that
the
the
population
is
the
the
highest
population
is
in
Eastern
Kentucky
of
the
Medicaid
population
and
again
you
know,
coming
from
Eastern,
Kentucky
I
know
a
lot
of
the
challenges
they
face
in
that
area,
with
access
to
Care
Transportation
other
things
like
that.
But
we'll
be
more
than
happy
to
get
that
map.
So
you
can
see
the
population
density.
G
Thank
you,
sir.
Just
a
quick
comment
and
a
question
commissioner
Lee
temporarily,
you
kind
of
had
that
deer
in
the
headlights.
Look
whenever
Central
Alvarado
talked
about
bringing
this
back
under
Medicaid
and
just
wonder
if
you
think
maybe
might
be
able
to
limit
the
number
of
mcos
likes
a
whole
lot
more
attractive.
Now,
okay,.
D
I
think
that
you
that
you're
sure
that
the
the
number
of
mcos,
as
is
important
as
how
we
hold
them
accountable
and
making
sure
that
we're
getting
our
return
on
our
investment
and
we
have
something
to
measure
their
success
and
I.
Think
that
that's
one
thing
that
has
been
lacking
quite
a
bit
is
we.
We
don't
have
a
baseline
to
measure
where
we
were
and
where
we're
going.
G
I
would
agree
and
I
appreciate
that
the
question
I
had
for
Steve.
Actually,
you
made
a
comment
earlier
and
I'm
kind
of
paraphrasing
you
about
how
the
Insurance
commercial
insurance
Market
has
now
kind
of
relied
on
Medicaid
to
kind
of
subsidize
the
system
and
I'm
kind
of
paraphrasing
this.
But
you
know
back
in
the
old
days
we
did
call
shifting.
G
Everybody
knows
that
that
Medicare
and
Medicaid
didn't
pay
the
full
amount,
and
you
expect
the
commercial
insurances
to
pick
up
that
difference,
and
nobody
argued
for
that
for
years
until
we
got
a
very
competitive
market
and
folks
that
we're
not
going
to
do
that
anymore.
So
now,
you've
got
situations
where
there's
nobody
to
do
cost
shift
too,
and
that's
caused
a
lot
of
demise
of
the
financial
positions,
rural
hospitals,
but
it
goes
back
to
I,
think
access
to
the
insurance
market
and
that's
to
Senator
Berg's
question
earlier
about.
G
D
They
do
yes,
I
believe
they
do
and
I
think
I
want
to
have
to
to
get
my
poker
face
when
I
come
into
these
meetings.
D
But
I
think
what
we're
talking
about
with
with
Medicaid
Medicaid
has
come
has
become
the
go-to
program
to
solve
some
Health
Care
issues
that
commercial
carriers
either
will
not
or
cannot
I
mean
we
cover
more
than
half
of
the
children
in
this
state.
Our
child
benefit
package
is
so
robust
that
you
know
we
cover
so
much
that
private
insurance
doesn't
cover.
We
don't
have
limitations
because
of
our
early
periodic
screening
and
Diagnostic
and
treatment
benefit.
D
We
don't
have
limitations
for
our
children
and
some
of
the
saddest,
saddest
stories
that
I
heard
was
when
I
was
working
on
our
member
services
call
line.
You
know.
Medicaid
is
based
on
a
poverty
scale
and
that
one
dollar
means
you
don't
qualify
for
Medicaid,
and
you
can't
go
from
that.
One
dollar
and
having
your
insurance
to
not
having
any
and
the
saddest
calls
I
had
were
from
parents
who
are
working
and
their
children
were
on
Medicaid.
D
They
either
had
autism
or
they
were
asthmatic
and
they
could
not
afford
to
get
off
of
of
Medicaid
because
they
had
to
keep
those
services
that
Medicaid
was
providing
because
number
one
they
couldn't
afford
commercial
and
if
they
could
afford
commercial,
there
were
limitations
and
hire
out-of-pockets
that
they
couldn't
afford
the
the
the
payments
but
private
insurance.
We
have
ins,
we
have
children
who
are
on
private
insurance,
who
are
who
do
not
qualify
for
Medicaid
but
are
on
waiver
programs,
because
private
insurance
does
not
cover
the
services
those
children
need.
D
We
cover
70
percent
of
the
long-term
care
costs
in
this
state.
We
are
the
only
program
that
covers
those
home
and
community-based
waiver
services
to
allow
individuals
to
remain
in
their
in
their
home
and
Community
rather
than
going
to
a
long-term
care
facility.
So
when
we
talk
about
Medicaid
being
the
go-to
to
solve
those
issues
that
commercial
carriers
either
will
not
or
cannot
that's
what
we're
talking
about
and
that's
why
we
see
a
large
I
think
increase
in
use
and
utilization
in
Services,
because
because
we
cover
so
much
that
commercial
carriers
can
or
won't
and.
G
I
think
that's
what
I
was
trying
to
make.
We
didn't
ask
the
question
very
well.
I
think
we've
got
to
find
some
way
to
make
distinction
between
they
won't
or
they
can't
and
I
think
it's
more
that
they
won't
and
it
shouldn't
fall
back
to
the
Medicaid
Program
to
provide
that
service,
and
maybe
that
should
be
a
condition
of
participation
in
the
the
MCO
program.
Is
you
get
off
for
something
comparable
on
the
commercial
side,
but
thank
you
appreciate
it.
F
F
I
may
be
wrong,
but
I
know
we're
communicating
with
them
and
which
is
a
whole
different
conversation
trying
to
get
contracts
with
private
insurance
carriers.
F
The
question
on
that
the
benefits
Cliff
with
Medicaid
that
that's
every
year
that
I've
been
here
that's
been
a
source
of
conversation
and
I
know
we
passed
I
think
last
session,
where
it's
like
extended
a
year.
Maybe
there
is
some
some
assistance
in
that
area.
Do
we
do
we
maintain
numbers
as
far
as
each
year
of
the
the
people
that
are
right
on
that
edge?
That
is
there
any
way
to
get
data
like
that
to
really
determine
you
know.
F
I
know:
I
have
employees
that
they
don't
want
to
raise
because
that's
going
to
put
them
over
the
edge
and
they
they
lose.
Their
benefits,
can't
blame
them
for
that
they
got
to
take
care
of
their
kids,
but
do
we
do
we
have
any
idea
what
those
numbers
are
in
the
Commonwealth,
how
much
benefit
it
will
be
if
we
did
put
in
some
type
of
step
away
from
Medicaid
where
it
was
a
gradual
process
rather
than
a
cliff?
Have
we
studied
it
that
closely
I.
D
Don't
think
we
have
studied
it
that
closely-
and
you
know
Medicaid
is
of
course
an
income-based
program,
so
we
do
have
information
on
household
income
in
our
system.
Some
of
those
numbers
fluctuate,
for
example,
individuals
who
are
self-employed.
You
know,
sometimes
you
know
they're
they're
a
very
we
we
were
concerned.
We
can
we're
concerned
about
our
self-employed
because
their
income
fluctuates
on
a
monthly
basis
and
depending
on
how
their
income
flows,
they
could
be
on
Medicaid
one
month
or
two
months
and
then
off
and
then
back
on.
D
They
that's
the
churn
that
we
talk
about
in
the
Medicaid
Program
and
there
are
policies
that
we
could
put
in
place
to
prevent
that
churn.
That
would
help
individuals,
maybe
move
out
such
as
a
continuous
or
12
months,
continuous
enrollment,
those
sorts
of
things
that
we
could
look
at,
but
again
that
12
months,
continuous
enrollment
means
12
months,
continuous
enrollment.
F
You
know
we've
seen,
even
though
there
has
not
been
a
formal
increase
in
the
minimum
wage.
There
without
question
has
been
an
informal
increase
in
the
minimum
wage
for
to
be
able
to
get
any
employees,
so
you
know
figuring
that
in
I'm
curious,
if
you
know
how
many
more
people
that
that
put
on
that
edge
by
instead
of
you
know,
eight
dollars
an
hour.
F
It's
now
11
12
13
is
is
what
they're
starting
everyone
at
and
and
I
wonder
if
we
created
more
issues
by
doing
that,
but
that's
just
a
whole
whole
line
of
thought
and
and
that
phasing
out
Medicaid
that
I
think
at
some
point.
That's
really
something
that
we've
got
to
take
a
a
close
look
at
and
make
some
apps
permanent
changes
on
that
where,
where
people
can
phase
out
of
it,
because
we
talk
about
that
all
the
time
that
getting
them
employed
and
then
getting
them
to
work
up
that
ladder
where
they
are
independent.
F
But
we
really
don't
give
them
we
don't.
We
say
we
want
them
to
do
that,
but
the
system
is
not
set
up
to
encourage
that,
but
because
they
don't
want
to
lose
the
benefits
because
they
have
to
take
care
of
their
families
and-
and
you
know,
there's
a
lot
of
industry
in
the
in
the
Commonwealth.
That
is
at
that
level,
where
you
know
you're
right
on
that
Verge
based
on
what
they
pay
and
one
final
question
that
I
have.
F
F
Do
you
have
over
what
I
see
seems
to
be
more
programs
to
encourage
it's
more
marketing
efforts
and
I'm,
not
saying
that
in
all
cases
there
there
are
some
really
good
programs
out
there
that
are
really
beneficial,
that
the
mcos
do,
but
a
lot
of
it
is
is
geared
towards
marketing
and
do
we
do
we
dictate
or
do
we
approve,
or
do
we
discuss
with
them?
What
programs
they
Implement
outside
of
paying
the
providers
to
to
improve
the
health
care
within
the
Commonwealth
and
the
outcomes.
D
D
We
have
a
quality
improvement
strategy
that
they
have
to
you
know
we
we
pick
certain
programs
or
certain
projects
that
we
want
all
five
mcos
to
work
on
together
and
then
we
have,
for
example,
an
asthma
or
diabetes
program,
Improvement
program
that
we
ask
them
to
work
on,
and
then
they
have
some
that
they
can
work
on
themselves
that
they
can
choose
to
work
on.
So
we
do.
E
F
Thank
you
and
I
I
love
these
discussions.
I
just
wish
we
could
get
the
Reds
rest
of
the
legislature
in
line
with
what
we
discuss
in
here
to
get
some
things
done,
but
really
good
discussions
and
I.
There
are
Pathways
forward
to
improve
this
Commonwealth
and
a
lot
of
it's
on
our
backs
to
to
make
those
changes
and
and
to
be
bold
and
make
decisions
that
are
going
to
change
us
because
it's
you
know
the
time
I've
been
here.
F
It's
not
changing
and
we
to
the
spot,
and
it's
no
criticism
on
you
all
you'll
do
a
great
job,
but
we
we've
got
to
look
at
the
whole
picture
in
this,
and
we've
got
to
make
some
substantial
changes
to
get
on
the
right
path,
to
truly
make
a
difference
and
and
again
stop
picking
away
at
it.
Thank
you,
Mr
chairman.
A
I
Thank
you.
I
just
had
a
quick
question
about
the
12
months
of
continual
or
continue
coverage.
Is
that
a
federal
requirement.
D
I
But
is
this
for
the
eligibility
for
the
individuals
who
kind
of
churn
in
and
out
of
Eligibility?
Is
this
I'm
trying
to
decipher
who
this
is
so.
D
Apparently
it's
for
currently
when
an
individual
enrolls
in
Medicaid
they
become
eligible
for
Medicaid.
If
anything
in
their
household
income
changes,
they
have
to
report
that
to
the
department
and
if
it
their
income
increases
over
the
limit,
then
they
would
be
disenrolled
and
there's
no
specific
time
frame
for
that
with
continuous
eligibility.
Regardless
of
that
change,
they
would
remain
enrolled
and
that
would
reduce
the
churn
in
and
out
of
Medicaid,
particularly
for
individuals
who
may
have
fluctuating
income
throughout
the
year.
So.
I
If
I
may,
one
ask
just
to
follow
up,
so
does
the
when,
when
the
eligibility
or
or
when
the
income
is
fluctuating,
does
that
change
the
amount
of
Medicaid
dollars
that
that
person
is
eligible
for?
Is
it's
just
a
basic,
a
basic
flat
you're
enrolled
right.
I
So
I
I'm
I'm,
you
know
back
to
the
benefit
cliff
and
this
modeling
program
that
I
think
would
be
really
beneficial
if
it
were
internal.
I
know
that
there
are
some
other
organizations
who
kind
of
look
at
the
the
information
about,
maybe
General
pockets
of
of
the
population
who
fall
in
and
out
of
Eligibility,
but
we
don't
have
an
internal
system
that
really
models
that
the
programmer
doesn't
look
individually
on
an
individual
basis
at
what
a
person's
dealing
with
in
the
you
know.
I
As
far
as
the
benefit
Cliff
like
where
they
are,
and
that's
why
I
you
know
I
brought
you
know
and
Georgia
Center
for
opportunities,
probably
one
example
of
of
a
few
operations
or
organizations
who
do
this
sort
of
modeling,
but
I
just
think
it's.
It
would
be
so
helpful
to
to
take
a
look
at
what
individuals
are
really
dealing
with
and,
and
you
know,
we
could
probably
adjust
our
Medicaid
subsidies.
Our
benefit
subsidies,
I
I.
Just
think
that
we
need
to
to
get
creative
around
this.
This
population.
B
So
speaking
of
the
benefits
Cliff
issue,
Kentucky
has
the
kki
hip
Integrated
Health
insurance
premium
payment
program,
which
is
offered
to
eligible
policyholders
to
help
pay
for
the
cost
of
an
employer-sponsored
insurance
plan.
So
is
that
something
that
is
offered
frequently
or
or
is
it
proliferating
or
is?
Can
that
be
a
key
in
helping
us
transitioning?
These
people
to
private
employer
sponsored.
D
Plans,
yes,
so
the
the
kai
hip
I,
don't
know
if
I
call
it
Kai
hip
or
k
hip
sometimes,
but
that
is
a
program
that
Medicaid
will
pay
insurance
premiums
for
individuals
who
have
insurance
through
their
employer.
We
pay
their
premium
for
them
and
then
we
will
pay
any
wrap
around
services
that
that
insurance
doesn't
cover.
But
we
have
been
promoting
that
we
promoted
it
across,
of
course,
at
the
at
the
State
Fair
we
had
information.
D
We
do
reach
out
to
individuals
who
are
employed
to
find
out
if
they
have
health,
insurance
or
opportunity
for
health
insurance.
So
we
can
pay
their
premium
because
it
does
reduce
costs
for
Medicaid
when
we
pay
their
premium.
So
we
do
have
active
Outreach
campaigns
for
individuals.
So
one
of
the
issues
that
we
find
is
even
though
some
individuals
are
employed,
they
may
be
employed
at
a
part-time
basis,
so
they
don't
have
access
to
the
insurance
or
their
their
employer
doesn't
offer
health
insurance.
D
A
Okay,
we've
had
13
people
ask
questions
today,
isn't
that
great
I'm,
the
14th
and
then
we're
going
to
adjourn
yeah
I,
don't
want
to
leave
on
13.
I
have
a
micromanagement
question
on
University
directed
payments.
Is
that
like
going
to
a
UK
hospital
yep.
E
A
E
They
do
not
get
through
the
hatred
program,
they
they
can't
get
both.
So
they
they
do
not
get
the
Atria
program,
but
they
do
get
through
the
university
directed
payment
program.
So.
E
A
A
I
was
in
business,
I
deal
with
three
medicaids
Kentucky
Ohio
and
West
Virginia
and
they're
all
were
different,
and
it's
good
to
look
at
other
states
and
see
what
they're
doing.
Also
okay
before
we
adjourn
members,
please
note
that
the
next
scheduled
meeting
is
October,
the
19th
with
chairman
Meredith.