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From YouTube: Budget Review Subcommittee on Human Resources (8-4-21)
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A
A
Members
were
provided
a
zoom
leak
to
access
the
meeting
remotely
the
meeting
materials
were
put
online
earlier
this
week
and
made
available
for
downloading.
At
this
time.
We'll
have
the
secretary
call
the
row
members.
You
will
need
to
indicate
whether
you
are
present
in
person
remote
from
district
or
remote
from
office.
C
A
President
of
the
room
for
people
who
are
remote,
please
mute
your
microphones.
We
had
a
little
background
there.
So
we'll
do
it
now.
We
have
to
worry
about
that
later.
So
after
calling
the
road
we
need
to
approve
the
minutes
from
the
july
7th
meeting.
G
A
A
A
Dr
van
over,
please
identify
yourself
for
the
record.
Members
hold
your
questions
until
after
the
presentation
please
and
each
presentation
today
gets
30
minutes,
so
we
ought
to
be
out
here
before
12
30..
So
if
we
do
30
minutes
each
and
some
questions,
it'll
probably
be
an
hour
and
a
half
correct.
Okay,
so
overview
of
the
american
rescue
plan
act.
F
Thank
you
so
much.
My
name
is
dr
sarah
van
over
and
I'm
the
director
for
the
division
of
child
care,
part
of
dcbs
and
the
cabinet
for
health
and
family
services.
I'm
also
kentucky
state
administrator
for
the
child
care
and
development
block,
grant
funding
that
we
receive
from
the
federal
government
every
year.
F
F
During
the
pandemic,
the
american
rescue
plan
has
given
more
funds
to
child
care
than
we
have
ever
seen
in
the
state
of
kentucky
where,
throughout
the
u.s
in
the
in
one
single
stream
of
funding,
so
kentucky
was
awarded
just
over
763
million
dollars
that
is
specifically
designated
to
go
to
child
care.
These
funds
came
through
two
different
pots
of
money
and
had
very
specific
restrictions
on
how
those
funds
were
to
be
spent.
F
Of
course,
we
receive
annual
child
care
and
development
block
grant
funds
that
the
primary
purpose
of
those
funds
is
to
support
at-risk
families
and
to
run
the
programs
that
we
already
have
established
within
the
division
of
child
care,
such
as
our
cares
background
check,
program
and
things
like
that.
But
these
one-time
funds
have
been
given
separate
goals.
F
The
goals
of
the
federal
funds
for
the
stabilization
payments
is
very
focused
on
supporting
the
programs
that
have
survived
the
hardship
of
the
past
17
months.
There
was
a
cutoff
date
for
those
funds
and
when
the
programs
had
to
be
open-
and
it
really
is
looking
at
child
care
programs
that
were
open
during
the
this
time
period
and
suffered
loss
because
of
the
pandemic
and
different
things
that
that
they
have
been
through
the
one
time
ccdbg.
A
F
F
Okay,
the
one-time
ccdbg
funds.
We
were
given
very
specific
goals
from
the
federal
government,
and
that
includes
increasing
provider
payments,
improving
payment
policies,
increasing
wages
for
our
child
care
providers,
specifically
in
centers
and
in
family
child
care
homes
and
building
the
supply
of
child
care
for
underserved
communities,
and
this
is
kind
of
a
broad
terminology,
but
it
includes
children
in
these
underserved
populations
by
race,
ethnicity,
children,
who
are
diagnosed
with
a
disability.
Children
who
have
experienced
trauma
infant
toddler
care
families
experiencing
homelessness,
lots
of
populations
that
are
at
risk.
F
Starting
four
months
ago
myself
and
the
assistant
director
of
the
division
of
child
care
meet
with
our
federal
liaisons
monthly
to
describe
how
much
of
the
funds
we
have
spent,
what
types
of
projects
have
gone
to
that
and
how
many
children
we
anticipate
were
served
by
that
we
will
be
audited
throughout
the
three
year
time
period
pending
the
funding
goes
to
the
expenditures
all
right.
F
Let
me
rephrase
that
we'll
be
auditing
child
care
providers
throughout
the
three
year
time
period
to
make
sure
that
funding
is
being
used
for
the
allowed
expenditures,
we're
also
collecting
monthly
data
that
will
be
used
for
the
federal
office
of
child
care.
Liaisons.
Looking
at
things
like
the
overall
anticipated
budget
of
the
centers,
and
there
will
be
federal
audits
eventually
that
will
include
review
of
the
funds
and
audit
of
random
child
care
providers.
F
So
here's
more
information
on
the
stabilization
funds.
We
are
anticipating
nine
stabilization
payments,
two
child
care
programs
throughout
kentucky,
beginning
in
november
2020,
pending
the
approval
of
the
third
party
contract.
We
currently
are
putting
out
a
request
for
proposal
to
to
help
us
find
a
third
party
company
that
will
distribute
all
these
payments,
particularly
because
of
the
workload
associated
with
it
right
now.
F
Now
in
order
to
participate
in
this,
the
child
care
programs
had
to
be
open
and
serving
children
prior
to
march
11
2021
and
it's
any
regulated
program,
so
it'd
be
licensed,
centers
or
certified
registered
family
child
care
homes.
They
do
have
to
participate
in
the
all-stars
program.
They
can
be
at
a
level
one
which
just
means
that,
as
a
level
one
child
care
provider,
they
they
meet.
F
The
main
reason
for
that
is
that
these
funds
must
be
used
for
centers
that
are
eligible
to
accept
children
in
the
subsidy
program
and
in
kentucky
to
accept
subsidy
children.
You
have
to
be
part
of
the
all-stars
program
as,
according
to
the
regulations,
we're
looking
at
a
multi-tiered
system
for
how
to
distribute
these
funds
throughout
the
pandemic.
Up
to
this
point,
we
have
used
the
maximum
building
capacity
as
the
main
tool
to
divide
the
funding
and
we're
still
going
to
use
that
as
a
base.
F
But
during
this
funding
process,
we're
also
going
to
try
and
stimulate
wage
growth
or
to
support
programs
that
spend
higher
wages
on
their
programs
by
giving
those
programs
additional
funding,
because,
as
we
know,
if
the
program
pays
higher
wages
to
their
employees
and
they're,
obviously
going
to
spend
more
so
the
base
tier
tier
one
means
they
meet.
Labor
cabinet
requirements,
minimum
child
care
requirements
and
they
participate
in
the
all-stars
program
from
level.
F
It
also
has
to
do
with
the
fact
that,
right
now,
the
staffing
shortages
across
the
country
are
primarily
attributed
to
the
fact
that
child
care
is
a
very
low
wage
field,
despite
the
fact
that
it
is
an
essential
service
and
that
our
teachers
do
a
great
deal
of
work.
Many
of
them
in
kentucky
still
make
close
to
minimum
wage,
and
we
need
to
be
able
to
stimulate
those
wages
higher
in
order
to
attract
the
employees
to
the
field
that
we
need
in
order
to
support
the
workforce
throughout
the
state
of
kentucky.
F
So
stabilization
funds,
according
to
the
federal
government,
have
been
broken
down
into
six
different
allowable
expenditures,
the
primary
expenditure
that
we
are
encouraging,
centers
to
utilize.
These
funds
for
includes
personnel
costs,
employee
benefits,
premium,
pay
and
cost
for
recruitment,
or
attention.
So
right
now,
while
we're
struggling
so
desperately
with
getting
the
staff
that
we
need
throughout
kentucky,
these
funds
can
be
used
for
hiring
bonuses,
retention
bonuses.
You
know,
congratulations!
F
You
have
worked
with
us
through
the
whole
pandemic.
Here
is
a
bonus
to
tell
you,
we
appreciate
you
you've
been
here
five
years
ten
years.
Thank
you
for
your
service
and,
of
course,
hiring
bonuses.
Right
now
can
be
a
great
way
to
get
people
in
the
door
and
get
them
in
the
center
to
work
and
let
them
see
how
much
they
enjoy
working
with
the
children
and
being
a
part
of
their
care
and
education.
F
So
this
really
relates
to
food
expenditures
in
order
to
feed
children.
Consumables
construction
paper
glue
scissors,
the
things
that
children
need
as
part
of
their
learning
environment,
and
then
this
is
new
this
time.
This
round
of
funding
and
really
a
great
need
is
mental
health
supports
for
children
and
employees.
F
So
this
could
include
curriculum
very
specific
to
social
and
emotional
growth
for
the
children
within
the
centers,
but
also
mental
health
supports
for
employees
bringing
in
somebody
to
to
do
training
with
the
staff
on
how
to
to
cope
with
the
stress
that
they've
maintained
or
teaching
resiliency
those
types
of
efforts
that
would
help
employees
feel
safer,
staying
in
their
position
and
support
the
children
that
may
have
elevated
stress
levels
themselves.
After
the
past
year
and
a
half.
A
F
F
This
particular
round
of
funding
is
focused
on
helping
all
child
care
programs
through
efforts
like
serving
those
underserved
population,
increasing
wages
for
child
care
providers
and
and
and
getting
payments
higher.
So
there
are
several
projects
enlisted
throughout
this
funding,
the
293
million,
and
I'm
going
to
give
you
a
brief
description
of
these
projects.
One
of
them
is
a
preschool
partnership
program
that
we
will
be
doing
in
in
partnership
with
kde.
F
Now
we
did
something
similar
to
this
in
kentucky.
Several
years
ago,
the
general
assembly
put
money
in
the
budget
for
kde
to
do
a
preschool
partnership
program
and
where
we
look
at
the
public
school
system
has
three
hours
of
preschool
service
per
day,
typically
for
their
programs
for
children
who
have
low
income
or
children
that
have
a
diagnosed
disability
and
already
have
an
individual
education
plan.
F
However,
that
three
hours
can
be
very
challenging
for
working
parents,
because
many
of
them
don't
have
the
ability
to
leave
work
in
the
middle
of
the
day
and
relocate
their
child
to
another
area.
So
the
last
preschool
partnership
grant
gave
the
public
school
system
the
ability
to
partner
with
local
child
care
programs
that
would
extend
the
full
day
care
for
the
children
so
that
they
would
have
the
support
that
they
needed
and
the
partnership
with
the
public
school
system.
This
is
really
essential
for
a
lot
of
our
kids
with
disabilities.
F
Many
children
with
disabilities
do
not
get
the
support
that
they
need
from
kentucky's
child
care
programs,
because
the
teachers
are
not
necessarily
trained
as
in
depth
as
the
public
school
personnel
are
so
working
in
conjunction
with
them
and
having
the
public
school
system
provide
them
with.
Professional
development
can
be
a
huge
asset
to
the
child
care
programs
and
to
the
children.
F
F
We're
also
looking
to
address
the
benefit
cliff
by
extending
the
window
of
time
period
that
some
families
will
receive
ccap.
So
currently,
families
graduate
out
of
receiving
subsidy
when
they
hit
the
federal
poverty
limit,
200
of
the
federal
poverty
limit
and
they
go
from
receiving
a
large
amount
of
subsidy
to
none
within
a
month
time
period.
F
We're
going
to
extend
a
benefit
cliff
for
three
months,
where
the
families
that
graduate
out
would
receive
50
of
their
typical
reimbursement.
Before
going
to
zero.
That
way,
the
family
can
ease
out
of
the
program,
learn
how
to
do
that
budgeting
and
potentially
not
immediately
return
to
the
subsidy
program
within
months
after
not
being
able
to
handle
the
large
adjustment.
F
Another
subsidy-based
program
that
we're
looking
at
is
an
infant
toddler
pilot
program
currently
within
the
state
of
kentucky.
Our
subsidy
program
allows
a
family
to
receive
a
certificate
of
eligibility
for
subsidy,
and
then
they
go
to
a
center
and
try
and
find
a
center
that
will
accept
subsidy
and
then,
if
there's
an
available
slot,
they
can
try
and
get
in
many
times.
F
High
quality
programs
are
already
full
and
so
children
in
the
subsidy
program
they
struggle
to
get
in,
and
this
is
really
the
case
with
infant
toddler
program,
since
it
is
very
challenging
to
find
infant
toddler
programs
in
general
senators,
typically
because
the
ratio
is
lower
in
kentucky.
For
example,
one
adult
may
watch
up
to
four
infants,
whereas
one
adult
can
watch
up
to
twelve
three-year-olds,
so
infantile
rooms
are
smaller.
It's
hard
to
reserve
those
spots.
F
Other
states
have
been
very
successful
at
having
contract
slots
within
an
infant
toddler
program
where
the
state
contracts
five
slots
in
that
program.
They
pay
for
those
five
slots
each
month
and
they
must
be
reserved
for
children
who
are
on
the
subsidy
program
and
when
one
child
leaves
they
bring
in
another
child
who
is
on
subsidy?
It
wouldn't
be
the
entire
enrollment
of
the
center,
but
it
would
reserve
high
quality
spots
for
children
who
are
already
at
financial
risk.
F
Wasted
another
program
that
we
are
looking
at
with
the
ccdbg
funds
is
facility
repair.
This
is
something
that
often
child
care
programs
do
not
have
the
ability
to
do
they
don't
have
refund
funds
reserved
for
facility
repair,
particularly
when
it
can
be
a
large
one-time
fund.
Many
of
the
facility
repairs
things
like
roof
repairs,
hvac
system
issues,
hot
water
heaters-
can
be
a
health
and
safety
risk
to
the
children
that
are
in
care.
F
Another
project
we
have
several
projects
that
are
going
to
focus
on
workforce
development
as
we
try
and
make
sure
that
child
care
providers
make
higher
wages.
One
of
the
things
that
we
also
need
to
do
is
to
stimulate
their
education
and
expertise
in
the
area.
So
we
have
several
workforce
projects
that
we're
going
to
launch
with
this
money.
One
of
them
is
a
trainer
academy.
F
We
are
going
to
be
creating
two
trainer
academies
for
these
credential
trainers
up
to
50
credential
trainers
can
participate
in
each
training
academy
and
they
will
each
have
a
very
specific
training
focus.
One
is
going
to
focus
on
skills
on
how
to
be
a
director
things
like
marketing:
how
to
use
the
federal
food
program
interviewing
and
which
questions
you
are
allowed
to
ask
which
questions
you're
not
allowed
to
ask
going
through
a
lot
of
the
basics
that
directors
need
in
the
field
of
child
care.
F
And
again,
this
could
vary
from
children
and
families
experiencing
homelessness.
Children
that
have
mental
health
needs,
children
with
specific
disabilities
and
the
trainers
will
really
become
experts
in
this
area.
They'll
be
given
a
lot
of
resources,
and
then
they
will
go
out
and
train
the
child
care
population
when
they
submit
their
application
to
be
in
the
training
academy.
They
are
signing
on
to
do
two
years
full
of
training
in
their
area
in
their
region
and
to
make
sure
that
these
trainings
are
financially
accessible
to
all
people
in
that
area.
F
This
program
is
actually
supervised
through
the
governor's
office
of
early
childhood,
so
we
will
be
contributing
funds
to
their
program
that
is
supervised
by
brenda
hagen
and
she
will
be
finding
ways
to
support
and
grow
the
kentucky
apprenticeship
program
right
now.
Their
office
is
looking
at
apprenticeships
for
preschool
teachers
and
the
toddler
teachers
and
director
apprenticeship
programs.
F
The
money
that
we
are
giving
to
them
will
assist
with
all
the
fees
for
the
certifications
they'll
get
during
the
two-year
apprenticeship
program.
Things
like
a
child
development,
associate
certificate,
orientation
fees,
first,
aid
and
cpr
fees
or
any
other
certification
in
their
program.
Now,
currently,
we
have
both
youth
and
adult
apprenticeships
that
we're
looking
for
in
this
area.
Youth
apprenticeships
are
partnered
with
high
school
students,
juniors
and
seniors
in
high
school.
F
F
The
funds
will
also
be
utilized
to
develop
a
coaching
model,
a
unified
coaching
model
throughout
the
state,
so
that
all
of
our
apprentices
are
getting
the
same
content
curriculum
and
coaching
as
they
go
through
this
program.
Kentucky's
early
childhood
apprenticeships
are
very
new
they're.
They
really
have
just
started
to
be
developed
in
the
past
couple
years,
and
this
is
a
great
way
to
get
in
on
the
the
groundbuilding
of
this
and
make
it
a
successful
program
for
students
to
graduate
from
high
school
ready
to
enter
the
workforce
and
for
adults
to
specialize
their
skills.
F
The
other
workforce
program
that
we
are
dedicating
money
to
is
the
kentucky
scholarship
program
for
early
childhood
educators.
Now
this
has
been
a
program
that
has
been
in
place
many
years.
I
can
remember
it
being
in
place
when
I
first
started
in
the
field.
23
years
ago,
it
was
started
with
the
kids
now
program
that
governor
patton
put
in
place.
Our
office
has
house
this
program
and
we've
typically
used
tobacco
master
settlement
funding.
F
For
this
with
the
next
two
years
and
the
funding
that
we've
received,
we
can
increase
the
amount
of
scholarships
and
increase
the
amount
of
funding
the
the
scholarship
money
that
was
initially
put
in
place,
the
rate
that
we
reimburse
that
really
has
not
changed
in
the
past
23
years.
Although
college
tuition
has
gone
up
significantly
so
during
the
next
two
years,
we
are
going
to
look
toward
covering
the
full
cost
of
candidates
in
this
program,
whether
they
are
getting
a
non-college
child
development,
associate's
degree
or
getting
an
associate's
or
bachelor's
in
early
childhood
education.
F
We're
also
looking
at
finding
a
way
to
help
administrators
in
the
field
of
early
childhood
education
pursue
a
master's
in
early
childhood.
Special
ed
or
early
childhood
education
throughout
kentucky
state
programs.
The
current
requirements
for
this
do
require
that
a
child
care
provider
work
in
the
center
at
least
20
hours
a
week
which
often
meets
their
curriculum
and
observation.
Our
requirement
to
be
in
these
programs,
but
this
would
help
a
lot
of
our
providers
to
really
increase
their
education.
F
Therefore,
benefiting
our
children
a
great
deal
and
helping
these
providers
stay
in
the
field
longer
because
they're
well
trained.
One
of
the
reasons
that
we
see
a
lot
of
turnover
aside
from
wages
is
that
providers
often
don't
feel
prepared
to
deal
with
a
classroom
full
of
children,
many
of
which
may
have
special
needs,
so
this
workforce
development
can
can
help
assist
them
in
feeling
more
prepared,
as
well
as
stimulate
wages
for
them
because
of
their
new
education
level.
F
One
of
the
things
that
the
federal
government
highly
encouraged
with
these
ccdbg
funds
was
increase
of
data
and
technology
systems,
so
there
are
several
different
projects
that
we're
looking
after
this
right
now.
The
division
of
child
care
has
four
data
systems
that
we
use
on
a
regular
basis.
One
is
the
care
system
that
does
our
national
background
check
program.
F
We
have
the
system
through
the
state,
kentucky
connect
that
helps
families
apply
for
subsidy
and
then
gives
us
the
necessary
information.
We
need
to
know
who
is
in
the
subsidy
system,
and
then
we
also
have
a
system
that
has
all
of
our
licensed
and
certified
programs
listed
in
it
and
helps
parents
look
and
see
what
kind
of
ratings
those
programs
have
gotten
and
gives
us
basic
information
on
hours
of
operation.
F
How
long
they've
been
licensed?
You
can
look
at
what
past
licensing
reports
all
kinds.
A
couple
of
these
systems
talk
to
each
other.
The
the
eku
database
communicates
with
the
background
check
database
and
the
kentucky
connect
communicates
with
our
child
care
licensing
database,
but
all
four
do
not
communicate
together
and
because
of
that,
there
are
some
data
holes
that
we're
missing.
F
Currently
right
now
there
are
data
holes
like
being
able
to
pull
information
on
the
racial
ethnic
background
of
all
the
children
we're
serving
through
subsidy.
Are
we
reaching
at
risk
populations?
Are
we
serving
all
the
children
to
the
best
of
our
ability,
and
also
we
have
holes
on
the
providers
that
we're
working
with?
Who,
who
are
the
providers
that
we
know
are
making
low
wages
working
in
these
jobs?
Is
it?
Is
it
just
minority
populations?
Are
they
the
vast
majority?
F
Another
technology
update
that
we're
looking
at
is
to
buy
to
provide
all
family
child
care
homes
and
centers
in
kentucky
with
a
computerized,
enrollment
and
billing
system.
So
we
know
from
research
that
one
of
the
main
reasons
that
centers
are
financially
unstable
in
child
care
is
that
many
child
care
providers
feel
uncomfortable
collecting
tuition.
F
Many
of
us
went
in
the
field
because
we
want
to
help
families.
I
know
that
was
my
my
initial
goal
and
going
to
a
family
and
asking
them
for
money
when
you
know
that
they're
struggling
with
it
can
be
a
very
difficult
thing
for
many
providers.
F
Other
things
that
we
need
to
consider
is:
if
we
do
all
these
technology
updates.
Many
of
our
child
care
providers
do
not
have
a
computer
system
that
is
up
to
date.
That
could
participate
in
these
types
of
new
systems
and
that's
a
need.
Many
of
our
child
care
providers
throughout
the
state
still
use
paper
and
pencil
this
past
year,
we've
seen
the
need,
for
you
know.
Paperless
billing
paperless
attendance,
different
things
that
child
care
providers
could
access
if
they
had
up-to-date
technology,
and
so
a
lot
of
these
technology
needs.
A
F
Okay,
the
last
area
that
we're
looking
at
is
startup
fund
grants
and
we're
looking
at
startup
fund
grants
not
only
for
family
child
care
homes,
but
also
for
potential
new
businesses.
If
they
wanted
to
start
an
employee-based
child
care,
we
could
do
a
financial
match
with
them
up
to
a
hundred
thousand
and
the
same
for
new
centers
in
child
care
deserts.
F
I
did
want
to
give
you
just
some
brief
information.
We
began
the
pandemic
with
the
idea
that
national
data
showed
that
we
could
lose
up
to
40
of
our
child
care
programs.
F
We
started
the
pandemic
with
about
29
000
children
enrolled
in
sea
cap.
There
was
a
huge
drop
in
the
middle
when
families
lost
jobs.
The
numbers
are
now
climbing
again
and
we
have
about
25
000
programs
in
the
subsidy
program,
which
means
those
parents
are
re-entering
the
workforce
because
they
have
to
work.
At
least
20
hours
a
week
in
order
to
receive
subsidy,
so
that's
a
good
sign.
F
On
our
end,
we
have
temporary
regulations
that
have
been
put
in
in
place
to
increase
the
c-cap
rate
that
was
passed
by
the
general
assembly
and
also
her
the
2021
senate
bill
148.
We
have
new
emergency
licensure
regulations
coming
to
play
so
that
we
can
be
more
prepared
in
the
case
of
regional
or
statewide
disasters
in
the
future,
and
we
have
increased
our
number
of
family
child
care
programs
and
are
working
to
help
lessen
zoning
barriers
for
starting
up
new
programs
throughout
the
state.
F
Like
I
said,
the
c-cap
increase
went
into
effect
july
1
and
we
are
now
billing
for
that
increase
this
month.
Providers
will
see
that
new
increase
challenges
moving
forward.
Our
biggest
challenge
is
increasing
wages
so
that
we
can
acquire
the
staff
that
we
need
also
providing
high
quality
programs
for
children
with
special
needs
like
in
the
preschool
partnership
areas.
A
That's
good,
thank
you,
doctor
for
your
presentation,
we'll
take
questions
from
the
people
in
the
room
first
and
then
members
participating
remotely.
Please
use
the
chat
function
available
on
your
screen
and
the
staff
will
notify
the
chair
that
you
have
a
question
so
now,
let's
start
with
senator
meredith.
B
B
F
The
base
payment
will
be
the
same
now
because
we
don't
know
yet
which
tier
everybody
will
apply
for
we
don't
know
what
the
base
payment
will
be
once
the
applications
come
in
and
we
see
where
the
the
different
tiers
are
we'll
be
able
to
divide
the
base
payment.
I
can
say
that
the
largest
payment
we've
distributed
rate
lately
was
three
hundred
dollars
per
child
at
the
beginning
of
the
cresa
act
and
that
cost
42
million
to
do
that,
we're
starting
off
with
49.6
million.
F
F
A
lot
of
other
states
are
only
allowing
some
programs
to
apply
or
they're
only
approving
some
programs.
They
have
to
write
essays
and
narratives.
We
are
really
trying
to
support
all
kentucky
child
care
providers
so
that
we
preserve
all
enrollment
and
capacity
throughout
the
state
and
the
the
capacity
based
system
we've
used
to
distribute.
The
funding
has
really
supported
that,
but
also
we
know
that
if
the
center
is
paying
nine
dollars
an
hour
versus
a
high
quality
program,
that's
paying
13
an
hour.
B
Yeah,
I
think
we
certainly
do,
and
you
know
I
think
you've
got
a
very
ambitious
plan
here
and
I'm
very
supportive
of
it.
I
think
there's
got
to
be
some
recognition,
though,
that
urban,
rural
disparity,
you
know
the
fact
that
rural
providers
may
be
paying
less
doesn't
mean
they're,
offering
less
quality
service.
It's
just
that
the
economics
of
the
situation
dictates
something
entirely
different
and
I
certainly
understand
this,
but
I
am
curious
as
to
what
your
thinking
is
in
terms
of
long-term
financial
stability
once
these
federal
dollars
disappear.
B
If
folks
have
increased
your
wages
and
suddenly
they
can't
sustain
that
long
term.
What
happens
then?
So?
Have
you
all
given
any
thought
is
what
the
budget
indications
are.
That's
going
to
be
long
term,
because
again,
this
is
budget
review
for
human
services
and
again
I
applaud
your
initiatives,
but
want
to
make
sure
that
going
forward
that
we've
got
some
long-term
financial
stability
or
at
least
some
plan,
for
that.
So
is
there
a
plan.
F
Well,
first
of
all,
let
me
say
that
rural
programs
will
not
be
penalized
by
this,
because
the
same
rate
is
going
to
be
used
throughout
the
state.
So
if
nothing
else,
world
programs
will
get
the
same
amount
of
funding
that
an
urban
program
will
and
it
could
easily
help
stimulate
those
programs
that
may
have
suffered
other
financial
loss
in
the
past.
F
F
F
73
percent
of
early
childhood
educators
said
that
they
would
want
the
compensation
to
increase
temporarily
for
the
next
one
to
two
years,
even
if
they
knew
that
it
would
not
be
able
to
be
sustained
and
would
burn
because
most
of
them
are
experiencing
additional
financial
hardship
at
this
point
in
time
that
they
need
to
recover
from.
The
other
thing
to
consider
is
that
we
are
collecting
a
lot
of
data
during
this
progress
during
this
process.
F
We're
asking
centers
as
they
get
these
sustainability
payments
to
return
data
to
us
on
their
enrollment,
their
turnover
and
several
different
key
pieces
of
information.
That
will
give
us
a
lot
of
traction
with
federal
government
with
state
information
to
show
that
when
wages
are
higher,
the
providers
are
more
likely
to
stay
and
benefit
children
long
term,
and
if
we
can
use
that
data
to
continue
to
talk
to
the
federal
government
about
long-term
infrastructure,
then
that
can
help
programs
sustain
these
higher
funds
for
a
longer
period
of
time.
B
F
All
the
stipends
are
allowed
as
part
of
that
retention,
stipend
or
the
initial
hire
stipend,
and
some
senders
are
purposely
choosing
to
do
that.
They're
not
going
to
be
penalized
for
that.
They'll
still
be
reimbursed
at
their
program
capacity
but
centers
who
are
already
paying
their
staff
at
higher
wages.
We
know
that
they
have
more
expenses
because
of
that,
and
so
we
want
to
reimburse
them
accordingly.
But
if
centers
want
to
take
the
opportunity
now
to
increase,
they
can
do
so
now.
The
federal
government
is
requiring
us
to
have
a
rolling
application
date.
F
So
if
a
center
applied
to
be
at
tier
two
and
then
they
realized
a
couple
of
payments
in
that
that
was
going
to
be
too
hard
of
a
financial
burden
for
them,
then
they
could
revert
back
to
tier
one,
so
once
they're
in
the
system,
they
don't
have
to
stay
at
that
tier.
During
the
nine
payments
they
can
choose
to
move.
B
H
F
H
F
It
is,
it
is
across
the
state,
but
there
is
higher
concentrations
in
rural
areas
predominantly
because
child
care
centers
do
not
do
as
well
there,
since
families
are
spaced
so
far
apart.
It's
hard
for
many
families
to
drive
to
a
center
and
it
be
financially
successful,
and
so
in
a
lot
of
those
areas.
We
we
don't
have
as
many
programs
as
needed.
They
often
need
to
be
placed
closer
to
businesses
in
order
to
be
successful,
but
family
child
care
homes
are
are
much
more
successful
in
those
areas.
A
G
Thank
you,
mr
chairman,
and
dr
van
over
appreciate
the
testimony.
You
know
the
the
child
care
model
is
broken,
it
doesn't
work
and
in
my
biggest
fear-
and
I
think
it's
just
been
touched
on
is-
is
in
2024
we're
going
to
be
right
back
where
we
are
now
and
I'm
afraid
that,
depending
on
the
federal
government
or
the
state
government
to
sustain
these
dollars
coming
into
programs,
that's
that's
not
a
very
good
business
model.
I'm
not
sure
a
bank
would
would
loan
money
based
on
that
business
model.
G
We
have
already
gone
through
some
of
these
motions
and
and
as
far
as
raises
as
far
as
bonuses,
sign-on
bonuses,
we've
already
done
it
all
and
they're
still
not
coming,
and
it
is
concerning,
and-
and
we
can
we
can-
I'm
just
not
sure
this
is
and
very
grateful
for
the
funding
and
believe
me
it's
going
to
help,
but
I'm
not
sure
that
this
is
a
problem
that
we
can
buy
ourselves
out
of.
As
far
as
the
staffing
issue,
you
know,
I
think
I
told
you
we
had
a
job
fair.
G
The
other
day
we
had
10
people
show
up
for
it
and
we
we
were
already
at
the
high
end
of
pay
for
our
part
of
the
state
and
now
we're
way
above
everybody
else
and
we're
still
not
getting
them
so
there.
There
are
many
layers
to
this
issue
and
even
though
this
is
very
much
appreciated,
it
is
the
basic
child
care
model
in
this
commonwealth
that
we
need
to
take
a
strong
look
at
and
if
we're
going
to
be
serious
about
early
childhood
education-
and
we
know
that
the
data
is
there,
that
tells
us.
G
We
have
no
choice.
If
we
want
our
kids
to
be
successful
when
they
grow
up,
we've
got
to
start
at
early
childhood
and
it
has
got
to
be
an
ongoing,
committed
investment.
It
has
got
to
be
a
firm
structure
that
is
built
to
allow
it
to
be
a
profession
to
allow
it
to
be
affordable
to
allow
it
to
be
consistent
across
the
state
as
far
as
quality,
otherwise
we're
just
throwing
money
away.
G
You
know
there
are
still
centers
that
are
babysitters
and
we've
got
to
get
away
from
that
model,
and
there
has
got
to
be
an
expectation
that
this
is
not
we
we
call
ours.
Early
childhood
education
center
we've
got
to
as
a
society
within
our
state.
They've
got
to
be
schools,
it's
got
to
be
a
school,
it's
not
child
care.
It's
a
school
and
the
kids
are
getting
a
an
education.
G
We
get
my
grammar
right
and
education
while
they're
at
that
school,
and
so
so.
The
problem
is
this.
This
is
short
term
and
I
think
everyone
needs
to
understand
that,
but
in
moving
forward
we
have
got
to
put
some
serious
discussions
into
the
model
of
child
care
and
we've
got
to
reform
that
in
our
commonwealth
and
and
it's
going
to
pay
dividends,
not
just
in
the
child
care,
but
in
our
high
school
success
rates.
Graduation
rates,
our
testing
rates
college,
I
mean
everything,
it's
got
to
start
and
we
know
it.
G
The
data
is
there,
as
I
said
so,
just
just
a
little
a
few
of
my
thoughts
on
that
two
quick
questions:
the
starting
pay
for
the
tiers.
Does
that
just
include
the
early
childhood
educators,
or
does
it
approve
include
other
staff
within
the
facility.
F
It
would
include
everyone
working
in
the
facility
because
everyone
there
supports
the
children,
whether
they're
a
teacher
assistant
teacher
working
in
the
kitchen,
we're
looking
at
stimulating
the
entire
workforce
of
early
childhood.
Even
if
they
are
not
the
person
who's
solely
responsible
for
the
curriculum.
G
And
then
we
had
talked
about
like
outdoor
play
areas,
playgrounds.
Will
the
grant
money
cover
items
like
that?
I
haven't
seen
that
specifically
listed.
F
You
know
it
if
there's
a
facility
repair
issue,
then
that
could
be
included
for
health
and
safety.
If
not,
then
you
know
we
encourage
providers
to
think
well
you're
using
this
to
simulate
your
income,
where
how
do
you
use
your
your
other
revenue
funds?
So
so
there
can
be
things
that
that
can
be
tweaked.
We
do
have
within
family
child
care.
F
Fencing
for
outdoor
area
could
be
utilized
for
that,
but
as
far
as
learning
materials
and
things
that
that
can
be
used
to
think
about
non-traditional
classrooms
because
again
outdoor
play,
we
know
right
now
is
a
greater
health
and
safety
environment
than
than
indoor
play
too.
Okay.
G
And
I
appreciate
the
work
you
do.
I
don't
know
how
many
of
our
legislators
realize
that
dr
van
over
has
a
very
clear
vision
for
early
childhood
education
in
our
state,
and
we
are
fortunate
to
have
her.
She
is
always
accessible
and
that's
as
a
provider
and
as
a
legislator,
and
we
have
a
lot
of
work
to
do
and
I'm
glad
you're
there,
and
I
appreciate
your
vision
and
the
work
that
you
have
put
in
on
it.
Thank
you,
mr
chairman.
C
Thank
you,
mr
chairman.
I'm
going
to
follow
up
first
of
all,
dr
vanover.
Thank
you
so
much
for
the
work
that
you
do.
It
does
not
go
unnoticed
and
we're
very
appreciative
of
that
on
this
important
issue,
but
to
kind
of
fall
in
line
with
senator
meredith
on
the
tier
system
back
to
slide
seven,
I
am
worried
about
that
that
rural
urban
divide
as
well.
I
know
I
heard
you
say
that
it
will
have
no
effect
on
rural
providers,
because
they'll
be
in
that
first
tier.
C
However,
when
you
have
a
finite
amount
of
money,
I
mean,
and
you
have
x
amount
of
dollars
going
out
to
fund
that
extra
20
and
x
amount
of
dollars
going
out
to
fund
that
extra
10
percent
at
the
end,
you're
gonna
have
to
lower
the
base.
F
Well:
here's
what
I
meant
with
rural
environments!
So
if
we
set
an
amount
and
say
this
round
of
money,
everybody
is
going
to
get
300
per
child
based
on
their
capacity,
so
that
doesn't
go
as
far
in
urban
centers,
but
in
rural
centers.
It
goes
much
further
because
you
may
have
for
infant
care
in
lexington
northern
kentucky
louisville.
It
may
be
235
a
week
for
an
infant
and
maybe
155
in
rural
areas,
so
we're
we're
seeing
that
the
capacity
system
as
a
whole
is
benefiting
our
rural
providers.
F
F
But
there
are
other
programs
that
are
going
to
assist
them
a
great
deal
through
this
process
as
well
like
a
c
cap
rate
increase,
it
may
go
a
lot
farther
in
in
rural
areas
than
in
in
urban
areas,
so
the
system
between
the
variety
of
packages
can
kind
of
even
out
how
the
rural
and
urban
communities
are
going
to
benefit.
C
Okay,
thank
you
and
one
more
question:
I'm
just
I'm
not
familiar
with
you'd
mention
that
there'll
be
audits
both
from
the
on
the
state
level
and
then
from
the
federal
government
as
well.
What
normally
goes
on
when
you
find
that
the
funds
have
been
misused?
You
know
what
is
what
is
the
action
taken?
What
is
the,
where
is
the
accountability
on
that.
F
Okay,
so
when
all
these
funds
have
been
given
out
to
the
providers
through
stabilization
payments
started
with
cares.
Chris
now
american
rescue
plan
each
provider,
the
director
of
the
facility
or
the
owner
signs
a
contract
saying
that
these
are
the
legal
intentions
of
the
funding,
and
then
you
know
it
can't
be
transferred
to
a
third
party.
If
you
choose
not
to
spend
it
all,
you
have
to
return
it
and
that
they
can
only
be
spent
on
these
purposes.
F
The
division
of
child
care
has
a
claims
department
that
specifically
works
on
misuse
of
funding
predominantly
for
our
ccap
program.
But
now,
as
we
move
through
this
new
round
of
federal
funding,
if
we
find
that
somebody
has
taken
the
funds
and
not
using
them
appropriately,
then
that
would
go
into
the
claims
department.
They
would
be
able
to
audit
the
information
and
potentially
have
a
claims
hearing
for
the
amount
that
was
misused
and
then
they
would
be
responsible
for
repaying
that
amount.
I
Thank
you,
mr
chair.
Thank
you
very
much
for
this
presentation.
This
has
been
immensely
helpful
in
understanding
where
all
these
funds
are
going.
I
I
appreciate
all
the
all
the
comments
from
my
colleagues
about
the
sustainability
and
I
think
those
questions
have
largely
been
answered.
I
I
really
like
this
plan.
I
think
that
this
is
lofty.
I
I
I
love
the
preschool
partnerships
and
I
think
it
really
speaks
to
to
the
one-time
funding
which
we
know
this
is
and
and
how
do
we
best
utilize
this
in
in
terms
of
increasing
or
improving
our
infrastructure,
and
I
think
that
this
plan
addresses
that
in
the
partnerships
in
the
infant
toddler
project,
pilots
and
then
the
training
academies,
I
I
really
like
the
idea
of
of
being
able
to
recruit
and
retain
our
our
workforce
and
and
provide
them
with
some
really
good
training,
and
I
think
that
that
is
is
a
great
incentive
for
for
really
retaining
quality
staff.
I
So
it
do
you
foresee
any
sort
of
legislation
or
any
assistance
that
the
cabinet
will
will
need
to
to
address
how
to
how
to
really
put
some
of
these
programs
codify
some
of
these
programs
moving
forward,
there's
always
a
sustainability
question
and
funding.
But
what
do
you
see
kind
of
coming
down
the
pike
in
terms
of
what
you
need
from
us.
F
We
will
be
doing
another
update
to
the
child
care
subsidy
regulation
because
the
reimbursement
rates
are
within
the
regulation
and
so
we'll
have
to
update
that
again
in
order
to
increase
the
rates
and-
and
they
will
be
significantly
increased
for
the
next
two
years
again-
child
care
programs
would
rather
have
the
increase.
Families
would
rather
have
the
increase
for
a
short
amount
of
time
than
than
not
have
it
at
all.
If
you
say
hey
for
the
next
two
years,
you
have
to
pay
very
little
in
child
care.
F
Most
everything
else
is
policy
change.
We
are
going
to
be
collaborating
with
both
the
kentucky
education,
the
kentucky
higher
education
association
to
with
the
scholarships
we're
collaborating
with
govc
the
governor's
office
of
early
childhood
with
the
apprenticeships
and
we're
collaborating
with
kde
on
the
preschool
partnership.
F
So
those
will
be
some
policies
that
we'll
work
through
with
outside
organizations,
we're
doing
a
lot
of
requests
for
proposals
and
a
lot
of
requests
for
application
to
make
sure
that
the
contract
agencies
we
partner
with
through
this
or
the
organizations
that
apply
for
these
fundings
is
done
strictly
by
the
books.
And
so
we
have
a
lot
of
those
rfps
and
rfas
that
are
going
through
process
right
now.
F
So
so
there
is
a
lot
of
policy
involved
in
in
getting
these
things
into
place,
especially
since
we
have
a
time
frame
with
which
we
have
to
spend
the
money,
and
we
want
to
make
sure
that
we
are
as
efficient
as
possible
that
I
can
say
right
now
that
kentucky
is
doing
a
great
job
in
comparison
to
other
states
who
might
not
have
even
announced
their
plan
and
still
have
that
deadline
looming.
Two
years
from
now.
I
Okay,
thank
you,
and-
and
it's
probably
too
soon
to
to
ask
this
question
and-
and
I
know
that
the
funding
is
really
slim
when
it
comes
to
child
care.
But
you
know
any
sort
of
offsets.
Are
there
any
programs
that
you
foresee
that
have
been
funded
in
the
past?
That
will
no
longer
be
needed
as
we
move
kind
of
forward
into?
F
At
this
point,
I
do
not,
you
know
the
programs
that
we
have
are
all
set
in
place
by
federal,
federal
mandates
by
the
child
care
and
development
block
grant.
So
the
problem
crimes
we
have
been
funding
will
stay
in
place
with
our
annual
distribution
from
ccdbg,
and
these
will
just
be
in
addition
to.
D
A
First
of
all,
we
have
some
young
leaders
of
our
country
in
our
audience
the
law
clerks.
So
if
you
all
wave
at
us
you're
welcome
to
our
committee-
and
we
know
you're
the
leaders
of
tomorrow
and
we're
glad
to
have
you
here.
So
thank
you
for
coming
next,
we'll
take
a
update
from
commissioner
stack
and
others
about
the
implementation
of
house
bill
129
from
the
2020
session
and
funding
for
foundational
public
health
programs.
A
Commissioner
and
other
presenters.
Please
identify
yourselves
for
the
record
realize
that
you
only
got
about
7
to
10
minutes.
Each
and
again,
members
hold
your
questions
until
after
the
presentations
please.
So
now
we
have
an
update
on
implementation
of
the
2020
house,
bill,
129
and
funding
for
foundational
public
health
programs.
Thank
you.
C
Mr
chair,
thank
you
for
the
opportunity
to
speak
on
this
important
topic
today.
I'm
just
going
to
introduce
myself
and
the
panelists
and
then
they're
going
to
do
the
presenting
we
have
president
miss
chamnis,
miss
jan
chamnis,
who
is
the
public
health
transformation
project
leader
here
at
the
kentucky
department
for
public
health
over
the
last
year.
She
has
collaborated
with
local
state,
national,
public
and
private
partners
to
advance
the
critical
work
of
public
health
transformation.
C
She
is
also
our
director
for
the
division
of
women's
health
at
kdph,
and
she
was
previously
the
local
public
health
director
for
madison
county
for
approximately
23
years.
We
also
have
miss
sarah
joe
best,
who
is
the
local
public
health
director
for
lincoln
trail
district
health
department
serving
hardin
larue,
marion,
mead
nelson
in
washington
counties.
Miss
best
is
the
president
of
the
kentucky
health
department's
association,
representing
all
61
local
health
departments,
serving
all
120
counties
in
kentucky.
She
served
in
numerous
roles
in
public
health
throughout
her
19-year
career
and
then
additionally,
in
the
room.
C
C
All
three
of
these
leaders
are
are
women
and
the
man
with
whom
I
have
had
the
great
privilege
to
serve,
and
I
look
forward
to
the
presentations
that
jan
and
sarah
joe
best
will
give
you
and
then
all
four
of
us
will
be
here
for
your
questions.
So
if
I
can
hand
this
over
to
miss
chamnis
she'll
start
with
the
first
presentation.
Thank
you.
E
E
C
E
Well,
thank
you
again
for
allowing
us
to
provide
this
update
on
the
public
health
transformation,
and
I
want
to
start
by
going
back
to
just
a
review
of
the
purpose
of
public
health
transformation.
E
I
think
that
most
of
you
all
are
probably
familiar
with
this
original
map.
Seen
in
multiple
news
feeds
across
the
state
back
in
2018,
which
represents
the
pension
crisis,
which
is
basically
when
the
employer
pension
contribution
rose
exponentially,
forcing
many
of
our
local
health
departments
to
react
through
layoffs
or
eliminating
programs
or
face
the
risk
of
actually
closing
their
doors.
E
But
there
were
other
changes
that
really
led
to
this
financial
crisis.
In
our
local
health
departments
across
the
state,
there
were
federal
and
state
policies
which
allowed
more
americans
and
thus
kentuckians
to
have
access
to
health
care
coverage
with
both
the
affordable
care
act
and
medicaid
expansion
and
with
such
policies,
while
generally
very
good
for
our
communities
and
our
individuals.
E
It
redirected
many
of
our
individuals
to
a
medical
home
or
primary
care
provider
for
many
of
those
services
once
provided
in
the
local
health
departments
like
well,
child
exams,
family
planning,
women's
cancer
screening,
just
some
of
the
unintended
consequences
that
we
we've
been
faced
with.
The
second
reason
that
we
want
to
move
toward
public
health
transformation
is
this
idea
of
public
health
modernization
over
25
years
ago.
E
These
rankings
knew
in
2020's.
Annual
report
of
america's
health
rankings
show
that
we
are
48th
in
health,
behaviors
and
46th
in
health
outcomes,
and
so
we
all
know
that
these
are
not
acceptable
rankings
for
our
state
and
for
our
communities,
and
so
public
health
transformation
is
really
our
own
call
to
action
to
really
work
together
to
create
a
more
efficient,
sustainable
and
accountable
public
health
system
focused
on
producing
better
health
outcomes
for
all
kentuckians,
and
so
it's
really
time
for
us
to
begin
to
simplify,
focus
and
prioritize
public
health.
E
I
think
that
house
bill
129
helped
us
do
just
that.
It's
also
known
as
the
public
health
transformation
bill
it
led
to
amendments
in
krs-211
185,
which
prioritize
specific
programs
into
core
programs.
Programs
like
wic
and
hands
which
health
departments
have
traditionally
offered
in
health
departments,
programs
relating
to
harm
reduction
and
substance
use
disorders
that
are
plaguing
our
state
and
then
also
under
core
public
health.
E
Some
of
these
additional
programs,
another
part
of
house
bill
129,
were
amendments
to
krs-211
187,
which
led
to
further
definition
of
these
local
public
health
priorities
and
really
establish
this
whole
set
of
criteria,
and
these
key
terms
identified
in
statutes
where
we
would
have
to
provide
some
level
of
criteria
or
guidance
for
local
health
departments
to
choose
to
provide
some
of
these
local
public
health
priorities.
We
now
are
looking
for
what
is
the
data
to
support
the
need
for
these
programs
in
communities?
E
E
Are
these
programs,
part
of
the
local
health
department's
performance
and
quality
management
plans,
and
this
notion
of
an
exit
strategy
should
the
should
the
local
health
department
determine
that
a
program
is
either
a
no
longer
needed
within
that
community
or
b?
The
local
health
department
can
no
longer
sustain
that
program.
What
is
the
plan
in
order
to
continue
that?
To
offer
that
program?
Is
it
partnering
with
other
community
providers
to
assure
that
those
services
are
available?
E
We've
been
very
busy
in
since
house,
bill,
129
was
passed
and
one
of
the
big
challenges
that
we
needed
to
really
define
for
for
the
department
for
public
health,
as
well
as
local
health
departments,
were
what
are
those
programs
that
fall
into
what
we
now
refer
to
as
the
green
box
programs,
this
local
public
health
priorities-
and
I
want
to
make
this
clear
right
now-
don't
misunderstand
that
these
programs
that
are
listed
here
are
not
important,
because
they're
all
important.
It's
just
that
we
had
to
begin
to
prioritize.
E
E
But
a
public
health
transformation
relaunch
occurred
last
year
in
october
of
2020,
and
yes,
that
was
at
the
height
of
the
pandemic
and
and
perhaps
even
in
spite
of
the
pandemic,
because
we
recognized
that
we
had
to
push
forward
for
this
type
of
change.
E
So
we
also
wanted
to
make
sure
that,
when
we
relaunched
public
health
transformation
last
year,
that
everyone
understood
that
this
was
not
an
initiative
targeted
to
local
health
departments
alone
that
we
are
all
in
this
together
as
far
as
moving
public
health
transformation
forward
that
this
is
both
a
statewide
initiative,
as
well
as
an
initiative
intended
to
assist
local
health
departments.
I'm
happy
to
report
that
we
really
just
concluded
this
very
intensive
planning
phase,
resulting
in
many
successful
changes
as
I'll
review.
E
I'm
hopeful
that
the
implementation
phase
will
kick
off
later
this
month
or
in
early
september
we
will
have
a
new
strategic
plan
that
really
guides
us
into
the
next
five
years,
using
public
health
transformation
tools
in
order
to
map
out
our
strategic
plan
and
moving
forward,
and
all
of
this
keeping
in
mind
that
we're
trying
to
create
this
culture
of
change
where,
where
we're
embracing
change
and
not
fearing
change
and
where
we're
really
encouraging
and
welcoming
collective
input
and
not
dismissing
people's
ideas
again,
this
is
just
a
visual
of
the
organizational
structure
that
we
used
and
the
relaunch
of
public
health
transformation.
E
I
think
it
shows
how
comprehensive
and
and
collaborative
we
have
really
tried
to
be.
It
was
not
intended
to
be
an
organizational
chart
or
a
hierarchy
per
se,
but
just
a
description
of
how
we're
managing
the
process.
It
is
a
work
in
pro
progress
when
we
first
started,
we
didn't
have
a
budget
subcommittee.
We
recognized
very
early
on
that.
We
needed
that
because
of
some
urgency
in
looking
at
the
way
local
health
departments
submit
their
budgets
in
order
to
comply
with
public
health
transformation
house
bill
129.
E
We
anticipate
that
in
moving
forward
with
implementation
that
we'll
see
work
groups
come
we'll
see
additional
ones
added
based
on
what
we're
looking
at
and
we
may
see
some
go
away
because
they've
completed
their
goals
and
their
action
plans.
E
I
wanted
to
show
just
you
do
have
this
in
your
packet,
because
I
know
it's
difficult
to
read,
but
I
just
wanted
to
emphasize
here
that
kentucky's
department
of
public
health
has
really
experienced
a
rich
history
focused
on
strategic
planning.
E
This
actual
map
was
adopted
in
2011
2012
and
has
been
tweaked
over
the
years,
but
I
want
I
want
you
to
know
that
the
mission
and
vision
has
never
changed.
The
four
areas
of
people,
quality,
efficiency
and
effectiveness
and
building
public
health
capacity
remain
the
four
cornerstones
of
our
strategy
and
moving
forward
and
and
with
integrating
public
health
transformation
into
that.
E
We
did
tweak
it
a
little
bit
to
provide
just
an
emphasis
of
this
overarching
principle
of
promoting
health
equity
and
all
we
do
just
recognizing
that.
That's
that's
an
important
part
of
moving
forward
and,
lastly,
I
just
wanted
to
go
over
some
key
highlights
of
some
of
the
work
that's
been
done
since
house
bill
129
was
signed
into
law.
E
This
is
not
an
exhaustive
list
but,
as
I
said,
as
I've
indicated,
we've
finalized
work
plans
during
this
intensive
nine
nine
months,
12-month
planning
phase
that
we've
been
in
I'm
humbled
to
say
that
we
had
over
a
hundred
staff,
representing
both
the
department
for
public
health
and
local
health
departments
across
the
state
involved.
In
this
planning
phase,
we
identified
the
local
public
health
priority
programs,
and
the
next
thing
we'll
do
is
further
refine.
E
What
those
look
like
in
terms
of
that
local
needs
assessment
and
all
of
those
key
terms
and
key
criteria
that
that
need
to
be
further
defined.
We
revised
the
local
health
department
budget
review
process
for
this
year.
Local
health
departments
are
have
most
most
of
them,
have
submitted
their
fiscal
year
22
budget
for
next
year,
and
we
are
beginning
the
process
of
further
refining
and
defining
the
process
for
fiscal
year
23..
E
As
I've
stated
earlier,
we've
updated
our
strategic
plan
that
really
provides
a
map
for
how
we
go
about
providing
public
health
for
the
next
five
years.
We
have
ongoing
public
health
transformation
initiatives,
really
taking
each
program
and
being
very
intentional
about
just
peeling
back
the
onion
of
the
programs
that
we've
offered
traditionally
for
years
and
determining
their
relevance.
E
E
What's
going
on
in
public
health
transformation
and
we're
working
on
a
video
that
we
hope
to
have
ready
within
the
next
month,
or
so,
we've
designated
a
public
health
transformation
team
with
a
focus
on
performance
management,
accountability
and
transparency,
which,
after
all
this
is
you
know
this
is
a
quality
improvement
project
of
immense
magnitude,
and
so
we
really
want
to
be
transparent
as
we
move
forward.
E
We've
not
only
enhanced
partnerships
but
we've
forged
new
partnerships
with
new
external
partners
like
the
kentucky
primary
care
association
and
many
of
its
members
who
represent
rural
health
clinics
and
fqhcs
across
the
state.
We've
increased
partnerships
with
university
and
hospital-based
primary
care
clinics,
and
that
list
is
continuing
to
evolve.
E
I
know
I've
gone
through
this
really
fast
and
I'll
be
glad
to
entertain
questions
after
sarah
joe
gives
her
presentation,
but
at
this
point
I'll
go
ahead
and
turn
it
over
to
sarah
joe.
H
All
right,
I
will,
I
will
go
through
this
very
quick.
My
name
is
sarah,
jo
best
and-
and
I
noticed
in
the
audience,
I
want
to
give
a
shout
out
to
representative
mosher,
because
public
health
transformation
would
not
be
where
it
is
without
all
of
her
work
and
her
support.
I
also
believe
I
saw
senator
alvarado
and
senator
meredith,
who
are
also
instrumental
in
this.
I
want
to
thank
them
right
off.
The
bat
kentucky
health
department
association
is
a
professional
association
of
health
department
directors
across
the
commonwealth.
I
currently
serve
as
the
president.
H
As
dr
stack
mentioned.
We
also
have
gone
over
the
fact
that
public
health
transformation
was
born
out
of
necessity,
both
financial
and
the
fact
that
we
could
no
longer
accept
the
fact
that
our
health
outcomes
and
our
health
behaviors
were
not
moving
the
public
health
needle.
If
you
will
so
when
we
worked
on
public
health
transformation,
we
really
focused
on
three
legs
of
the
the
public
health
transformation,
stool.
If
you
will,
the
first
was
really
the
focused
services
introducing
that
simplified
public
health
model
that
we
mentioned
before.
H
This
also
created
collective
impact,
which
will
help
with
some
of
those
the
the
fact
that
you've
seen
one
health
department
in
kentucky
you've
seen
one
health
department.
How
many
times
have
we?
We
heard
that
the
focus
services
assures
every
kentuckian
that,
when
they
walk
into
a
local
health
department,
they're
assured
at
least
the
basic
packages
of
services.
H
So
not
only
did
this
simplify,
focused
methodology
of
providing
services
increase
our
efficiencies,
but
they
also
ensure
that
our
resources
went
to
these
services
first.
So
before
we
were
a
mile
wide,
we
were
an
inch
deep.
We
were
trying
to
be
everything
to
everyone.
H
We
could
no
longer
do
that,
and
so
we
had
to
make
sure
that
our
funding
or
our
resources,
funding
and
human
were
put
into
these
areas
first
and
then,
as
grants
and
things
allowed,
we
could
do
these
and
then,
as
we
had
funding
and
people
and
needs
in
our
community,
we
could
focus
on
those
green
box
items
and
so
there's
been
a
lot
of
work
done
in
legislation
specifically
krs
211
185,
which
jan
has
mentioned
before.
H
But
the
other
thing
I
want
to
draw
your
attention
to
that
was
work
accomplished
in
this
was
the
community
health
assessment.
The
requirement
of
community
health
assessment
was
long
overdue
and,
as
a
result
of
this,
work
is
now
included
in
902k
ar
8160.
That
really
provides
accountability
for
programs
outside
the
core
package
of
services.
H
Health
departments
must
evaluate
the
need
in
the
community
through
an
assessment
process
using
both
qualitative
and
quantitative
data,
as
well
as
community
input,
and
that
helps
drive
our
resources
go
and
ensuring
that
the
statutory
required
services
are
done.
First.
H
So,
as
you
know,
every
fall
krs.
We
crunch
the
latest
numbers
and
determine
how
large
the
liability
was,
and
as
a
result
of
that,
they
would
come
up
with
a
percentage
of
payroll
that
we
would
need
to
pay
to
keep
the
pension
system
liable
for
another
year.
So
many
public
health
or
many
public
employers
really
responded
by
decreasing
their
payroll,
thus
controlling
their
pension
costs,
and
you
can
see
that
local
health
departments
did
that
that
same
thing,
there
was
over
a
51
decrease
in
staffing
and
local
health
departments
from
2008
to
2020..
H
So
household
8
was
a
component
of
this.
It
froze
the
cos
the
pension
contribution
rate
in
statute
and
that
enabled
local
health
departments
to
better
forecast
operational
costs
and
the
pension
contributions
for
decades
to
come.
This
eliminated
the
constant
uncertainty
of
the
ever
changing
arc
stabilize
the
quasi
issue.
It
also
provided
the
opportunity
for
us
to
bring
new
employees
on
and
normalize
cost,
but
what
I
want
you
to
know
is
while
house
bill
8
did
provide
for
better
budgeting.
It
was
financially
beneficial
for
33
local
health
departments.
H
There
were
27
local
health
departments
that
saw
their
rates
increased
to
85
percent
or
above
these
range
anywhere
from
85
percent
to
300
percent.
So
it
should
be
noted
that
there
are
health
departments
that
will
not
be
able
to
support
the
increase,
even
after
the
loss
of
having
the
subsidy
even
through
taxation.
H
Rural
counties,
some
of
which
have
declining
property
assessment
rates
due
to
losing
populations
and
valuations
associated
with
unmined
minerals,
ledger
county,
is
an
example
of
that.
H
H
Amendments
were
made
to
ks211
180
to
allow
for
improved
alignment
of
fees
with
actual
cost
of
providing
services,
and
so
that
reduced
the
amount
of
public
health
tax
dollars
that
were
being
used
to
support
privacy.
Private
business
permits,
public
health
transformation
identified
a
funding
formula
based
on
the
cost
of
providing
foundational
services.
It
wasn't
intended
to
cover
all
of
the
health
department
costs
only
those
statutorily
required
costs
associated
with
those
dark
blue
box
services.
H
The
calculation
is
based
on
the
absolute
minimum
number
of
employees
needed
to
conduct
statutorily
required
services
and
that's
based
on
the
population
size
of
the
service
area.
Funding
is
based
on
average
costs
identified
by
the
cabinet
for
health
and
family
services
through
the
kentucky
department
for
public
health
in
relation
to
health
department
coding
and
include
average
expenses
directly
linked
to
providing
foundational
services
such
as
salary
benefits
and
operations.
H
It
also
depends
on
the
evaluation
of
the
actual
retirement
costs
for
foundational
employees,
so
after
this
total
cost
is
determined,
it
requires
that
the
minimum
public
health
tax
be
dedicated
to
foundational
services.
It
requires
that
the
90
of
the
fees
retained
by
the
local
health
departments
for
environmental
permitting
and
inspections
be
subtracted
from
this
cost
and
also
subtract
out
any
federal
preparedness
dollars
received
by
the
local
health
departments.
The
remaining
expenses
which
should
be
included
is
an
individual
budget
allocation
within
the
state
budget
to
each
local
health
department
in
accordance
with
krs-21186.
H
Without
this
funding,
these
services
become
unfunded
mandates
and,
as
health
departments
need
to
further
streamline
services.
Lack
of
this
funding
may
lead
to
the
inability
to
provide
core
foundational
services.
I've
included
on
this
slide
an
example
of
what
this
formula
looked
like
for
fiscal
year
22..
H
Please
keep
in
mind
that
these
changes,
these
changes
and
per
krs
211
186
shall
be
determined
on
or
before
may
1st
of
each
year
preceding
a
bi-annual
budget
session
of
the
general
assembly.
I
also
wanted
to
demonstrate
the
commitment
from
the
local
level
in
assuring
that
foundational
services
are
provided.
You
can
see
that
in
this
example,
83
of
the
funding
for
operational
costs
are
locally
funded.
H
H
A
B
Thank
you
chair.
I
appreciate
the
presentation
you
know
personally,
my
five
years
here
I
think
house
bill
129
is
one
of
the
best
pieces
of
legislation
that
we
passed
and
I'm
I'm
very
thrilled
to
see
that
department
of
public
health
is
taking
this
seriously
in
in
using
the
tools
we've
given
to
them.
B
B
I
always
find
it
curious
that
we
talk
about
funding
for
these
things,
but
medicaid
alone
we're
going
to
spend
14
billion
dollars
this
next
this
next
year,
and
that's
that's
phenomenal.
We
know
automatically
ten
percent
of
that's
going
to
go
to
the
mass
care
organizations
for
the
administration
and
profit
portion.
That's
1.4
billion.
We
can
fund
a
lot
of
things
there.
B
B
One
group
and
I
think
the
department
of
public
health
has
that
opportunity
who's
going
to
drive
the
train
for
improving
health
care
in
kentucky
we've
kind
of
delegated
that
in
large
measures
of
the
mcos
in
the
now
over
a
decade
they
have
done
that
they
have
not
improved
the
health
of
the
population
at
all.
They
barely
moved
the
the
needle
in
center
alvarado.
We've
had
newest
conversations
about
this.
B
Why
shouldn't
the
department
of
public
health
be
the
managed
care
organization
for
the
state,
invest
and
then
the
responsibility
for
improving
the
health
of
their
population
and
bringing
everybody
else
in
line?
You
know
the
mcos
still
have
a
role
not
as
mcos,
but
the
traditional
role
as
insurance
companies
process
the
claims,
but
give
accountability
for
improving
the
health
back
to
the
people
who
should
be
responsible
for
it
and
that's
our
department
of
public
health
that
we
can
monitor
on
a
local
level
with
our
local
health
departments.
B
Why
should
we
not
do
that?
That's
not
a
rhetorical
question.
I
want
to
know
why
can't
we
change
this
whole
model
to
building
that
accountability,
that
we're
talking
about
and
have
a
better
coordination
of
services
than
we've
had
in
the
past.
Have
one
centralized
focus
for
improving
the
health
should
be
the
department
of
public
health?
So
why
not.
C
A
Conversation
before
too,
I
agree,
it's
all
local
and.
C
A
C
A
Together,
so
we
we
stand
willing
and
ready
to
to
work
with
the
department.
B
B
Part
of
the
issue
is
with
the
data.
Everybody
collects
data,
we're
drowning
in
it.
But
what
are
we
doing
with
it
very
little,
at
least
not
on
a
centralized
basis
that
goes
back
again
to
the
department
of
public
health
and
again
we
have
120
counties
and
I'm
sure
you
every
county
probably
has
a
higher
or
a
different
priority
for
health
care
issues
than
others.
B
That's
not
to
minimize
the
other
health
care
issues
that
we
have
to
deal
with,
but
until
we
take
a
laser,
focused
approach
on
this
to
truly
improve
the
health
of
our
population.
We're
just
going
to
have
these
discussions
year
in
and
year
out,
and
quite
truthfully,
I
don't
have
the
patience
for
that.
So
we
know
there
are
other
models
out
there,
they're
very
successful
central
alvarado
and
have
had
some
several
conversations
about
this.
B
B
C
Thank
you
senator.
I
appreciate
that
and
I
think
the
discussions
that
said
secretary
friedlander
and
commissioner
lee
you
know
have
through
some
of
the
other
committees,
and
obviously
those
of
us
is
a
is
a
coordinated
leadership.
Team
at
chfs
are
are
happy
to
have
those
discussions
and
dialogue.
So
thank
you
very
much.
B
You
got
five
because
deciding
to
do
something
is
not
the
same
as
doing
it.
We
gotta
quit
talking
about
it
and
do
it
there's
enough
money
there.
Our
state
can't
continue
to
sustain
this.
This
growth
in
in
expenses,
neither
can
our
business
community.
We
have
an
opportunity
to
not
only
address
the
the
reduction
in
the
medicaid
expense,
but
also
make
it
health
friendly
for
employers
in
this
state.
B
That
would
be
a
great
recruitment
tool
for
kentucky.
If
we
can
show
that
we
have
really
developed
a
process
that
improves
the
health
of
our
population
reduces
their
health
care
expenses.
That
could
be
a
major
selling
point
for
bringing
new
companies
to
to
kentucky,
but
we
can't
keep
doing
what
we're
doing
and
sorry.
Mr
chair,
I
go
off
on
that
rant,
but
it's
just
tired
of
talking
about
it.
Thank.
I
Thank
you,
mr
chair.
I
I
really
appreciate
senator
meredith's
comments.
I
I
too
believe
that
this
is
a
real
opportunity,
and
maybe
this
is
the
jumping
off
point.
You
know.
We've
started
a
really
great
conversation
through
dph
transformation,
and
I
think
this
is
really
an
opportunity
to
to
be
innovative
and
and
really
have
those
conversations
about
what
is
quality
improvement?
How
do
we
get
there?
I
Kentucky's
health
metrics
certainly
have
nowhere
to
go,
but
up-
and
so
you
know
all
of
that
being
said-
I
we
had
a
great
work
group
for
dph
transformation,
maybe
it's
time
to
bring
all
those
folks
back
together
and
have
a
deeper
conversation.
I
I'm
certainly
willing
to
do
that.
I
I
know
all
of
the
experts
to
bring
to
the
table.
So
you
know
we.
We
have
a
great
starting
point,
but
I
want
to
thank
all
of
you
for
for
really
working
so
hard
to
implement
and
and
really
have
the
hard
conversations
about
what
the
dph
transformation
meant.
I
It
was
one
thing
to
pass
the
bill,
but
a
whole
a
whole
another
thing
to
to
really
get
down
into
the
details,
and-
and
we
certainly
turned
to
all
of
you-
our
public
health
experts-
to
do
that,
and
I
just
want
to
say
thank
you.
Hopefully,
this
is
just
the
beginning
of
of
a
larger
conversation.
So
thanks
for
everyone's
work
on
this.
C
If
we
want
to
improve
the
health
of
kentuckians,
we
have
to
have
a
sustainable
and
successful
public
health
system
that
gives
every
kentuckian
a
fair
shake,
whether
they
live
in
a
rural
community
or
an
urban
center,
and
no
matter
what
their
circumstances
are,
gives
them
a
chance.
And
so
I
really
do
look
forward
to
working
with
you,
representative,
mosher
and,
and
the
others,
and
we're
happy
to
dialogue.
A
Thank
you,
representative
moser
senator
alvarado.
D
Thank
you,
mr
chairman,
and
first
of
all,
thank
you
all
for
your
presentation,
senator
meredith
kind
of
stole
my
thunder,
but
I'm
gonna
jump
on
and
be
the
lightning
behind
him.
First
of
all,
jan
it's
good
to
hear
from
you.
I
appreciate
you
being
on.
I
I
missed
talking
with
you
and
we've
had
a
lot
of
discussions
in
the
past.
I
know
scott
and
I
have
had
a
lot
of
discussions
and
and
you're
right
janet.
I
was
gonna.
I'm
glad
you
corrected.
Montgomery
is
not
madison
county.
D
So
I
appreciate
that
I
take
a
lot
of
pride
representing
montgomery
county
and
love
that
community
and
the
health
department
that
works
so
hard
there
to
keep
people
healthy.
Jan.
I
know
you
had
your
presentation
and
I
was
just
gonna
again.
I
think
reiterate
what
senator
meredith
said.
Maybe
senator
meredith.
What
we
need
to
do
is
take
it
upon
ourselves
to
start
drafting
legislation.
I
know
we
often
talk
about.
We've
talked
to
a
few
administrations.
Now
about
these
ideas.
D
D
I
think
we
were
47th
is
what
I
can
find.
We've
gone
up,
one
slot
we've
rolled
out
the
aca,
a
bunch
of
mcos
paid
them
billions
of
dollars
with
the
promises
that
this
is
going
to
drive
our
health
outcomes
in
a
better
way.
We're
going
to
do
better,
we're
going
to
be
moving
up
in
those
rankings.
People
are
going
to
live
longer
in
kentucky
30
000
new
jobs.
D
I
remember
all
those
promises
when
that
was
rolled
out
and
you
see
what
we've
gone
in
10
years,
we've
gone
up,
one
slot
not
much
has
changed
mcos,
who
are
claiming
to
do
things
to
manage
a
lot
of
the
things
and
again
sarah
joe
in
your
presentation.
D
I
think
you
also
put
up-
or
maybe
it
was
in
confusing
presentations.
It
was
one
here
about
the
issues
that
are
important.
The
local
health
priority
is
what
jan
had
presented.
Also
all
the
local
public
health
priorities
in
slide
number
seven
about.
You
know
diabetes
and
nutrition
and
staying
well
biometric
screenings.
These
are
the
things
that
health
departments
prioritize
what
our
mcos
are
prioritizing
and
for
10
years,
and
billions
of
dollars
have
done
nothing
to
move
those
numbers
up
for
us
in
managing
our
health
care.
D
So
I
think
senator
meredith's
point
is
correct.
It's
time
for
us
to
stop
talking
about
this.
We
have
rfp
proposals
that
are
being
proposed
right
now.
Maybe
it's
time
to
change
our
structure
since
we've,
given
a
10-year
trial
and
it
hasn't
worked,
we're
not
seeing
things
improve
in
the
state
of
kentucky.
D
The
other
thing
also
sorry
joe.
I
know
you
you
presented
also
on
the
three
kind
of
parts
of
the
stool
and
I
would
propose
maybe
a
different,
a
little
bit
of
a
different
thought
on
one
of
those
legs.
I
know
we
look
at
stabilized
pension
and
focused
services
and
funding.
I
think
that
one
of
those
legs,
probably
the
focus
services,
should
be
the
seat
of
the
stool.
That's
all
these
things
are
propping
those
services
up
to
make
sure
they're
offered
to
our
community.
D
One
of
those
legs
is
to
be
the
people
and
the
staff,
and
I
know
we're
trying
to
attract
more
staff
and
we're
having
discussions
in
other
committees
about
the
struggles
that
staff
are
going.
The
burnout
that's
going
on
right
now
in
the
world
of
medicine,
the
struggle
to
find
providers
willing
to
come
in
and
provide
care.
We've
got
to
find
a
way
to
recruit
more
people
into
public
health,
which
is
not
the
sexiest
of
of
avenues
of
health
care,
not
the
most
highest
paid.
D
I
know
if
you
all
could
request
it
from
your
respective
leadership
that
we
need
to
prioritize
this
to
make
it
go
forward,
but
I
think
I
think
senator
meredith
and
I
need
to
sit
down,
maybe
it's
time
to
start
putting
pen
to
paper
and
it
would
be
a
massive
bill,
massive
huge,
but
having
to
start
requiring
this
of
our
administration
to
start
looking
at
a
different
model,
and
I
think
it
would
be
to
incorporate
our
mcos
and
require
them
to
partner
with
our
health
departments,
because
the
mcs
are
good
at
data
collection,
but
not
at
healthcare
management.
D
Our
health
departments
are
really
good
at
healthcare
management.
Maybe
they
don't
have
the
resources
for
the
data
collection,
but
you
know
locally.
Who
has
the
needs
where
the
issues
are
where
the
resources
are
to
start
teaming
up
both
of
those
together
to
start
providing
a
better
outcome
for
the
state,
maybe
start
seeing
that
go
from
46th
to
36th
to
26th,
maybe
even
hopefully,
and
maybe
high
aspiration,
be
the
top
10
in
the
state
in
terms
of
healthcare
outcomes.
D
So
I
want
to
thank
you
all
for
your
sacrifice
for
the
time
for
the
even
when
you
retire
scott,
you
can't
stay
away.
I
know
you
have
to
keep
coming
back
and
that's
just
kind
of
the
nature
of
the
beast
for
those
of
us
who
are
involved
in
this.
So
thank
you
all
for
the
efforts
that
you
put
forward
and
maybe
see
if
we
need
to
start
talking
about
looking
at
putting
something
together.
Thank
you,
mr
chairman,
for
the
rant
thank.
A
H
Yes,
my
short
answer
for
that
is
is
yes,
because
of
you
know,
I
would
just
say
that
the
health
departments
were
very
supportive
of
house
bill
a,
but
not
in
an
up
by
itself.
One
of
the
things
that
we
were
very
honest
about
in
the
beginning.
Is
we
really
needed
house
bill
129
to
go
through
with
the
funding
formula
in
conjunction
with
house
bill
8.
we
needed
both
of
those
things,
so,
yes,
that
that
was
still
really
something
that
we
would
need
in
the
future.
A
Thank
you
very
much
now.
My
comments
are
going
back
to
senator
carroll.
I
had
three
grandsons
that
went
through
day
care
in
japan
and
they
think
of
education.
That
little
is
an
education,
as
you
say,
I
think
we
need
to
change
your
mindset
on
that,
for
they
were
taught
how
to
clean
the
room
and
they
were
taught
how
to
cook
for
themselves.
A
So
when
they
came
to
the
united
states,
they
were
ahead
of
their
peers,
so
I
had
three
grandsons
were
educated
over
there,
so
I
do
know
that
and
represent
moser.
I
never
really
ever
give
you
a
comment
in
public,
but
I
do
want
to
now.
129
was
an
excellent
bill.
It
was
a
privilege
to
work
on
that
committee.
United
states
senator
mayor
there's
many
times
when
we
talked
about
it
and
dr
alvarado.
A
I
think
that's
one
of
the
best
bills
that
I'm
like
senator
meredith
has
helped
the
state
of
kentucky,
especially
in
my
region,
in
eastern
kentucky
and
those
rankings.
Ever
since
I
graduated
from
uk
in
1973,
we've
always
been
in
the
40s.
That's
one
of
the
reasons
I
wanted
to
be
a
representative
and
I
carry
that
on
my
shoulders.
Every
day
at
home,
I
I
went
back
to
northeastern
kentucky
to
be
a
health
care
provider
and
educate
the
people
up
there.
A
You
know
people
coming
to
diabetes,
going
out
the
door,
they
buy
a
milky
way
and
a
pepsi
we've
got
to
do
better,
and
so
I
thank
all
of
you-
and
I
thank
all
of
you
for
being
here.
I
mean
this
is
really
a
great
committee.
We've
talked
about
a
lot
of
great
things
today
I
agree
with
senator
meredith
or
senator
alvarado,
and
so
just
make
sure
we
got
good
minutes
from
today.
A
You
know
my
heart
is
in
eastern
kentucky
and
is
for
the
whole
state
of
kentucky
to
improve
their
health.
I
mean
what
else
could
what
else
could
you
really
have?
If
you
really
love
your
fellow
kentuckians
in
better
health?
So
with
that
we'll
have
zoom
link
next
time,
remote
will
always
be
x,
act
to
be
able
to
be
accessed,
and
the
next
scheduled
meeting
is
september
8th,
and
so
I
asked
for
a
motion
to
adjourn
thank.