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From YouTube: Medicaid Oversight and Advisory Committee (9-15-22)
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A
Did
under
HCBS
services
and,
as
you
all
may
know,
a
lot
of
the
things
we
did
there
was
to
ensure
payments
for
our
providers
so
that
the
safety
net
remained.
It
increa
included
some
additional
flexibility
so
that
they
could
continue
to
serve
our
members
and
they
could
continue
to
receive
services.
We
have
what's
called
1135
waivers.
Those
are
waivers
where
CMS
has
the
discretion
to
exercise
sort
of
blanket
waivers
to
the
states
for
some
flexibilities
that
were
implemented.
A
That's
where
we
were
able
to,
for
example,
change
the
Platforms
in
which
Telehealth
could
be
delivered
because
otherwise
they
were,
you
know
very
stringent,
but
with
the
1135
flexibility
we
currently
have
in
place,
we
were
able
to
open
up
access
for
Telehealth
on
various
platforms
that
also
allowed
us
some
flexibilities
around
provider.
Enrollment
again,
you
know
just
anything
we
could
do
to
to
reduce
the
administrative
burdens
to
providers
so
that
they
could
be
directing
their
attention
to
care,
so
that
included
The
Five-Year
renewal.
A
That
providers
have
to
do
that's
required
under
federal
law,
so
it
relaxed
that
those
are
currently
on
hold
and
it
relaxed
some
of
the
licensure
requirements.
So
we
allowed
for
alternative
settings
a
provider
already
licensed
in
another
setting
and
was
in
the
process
of
Licensing
a
separate
setting.
We
were
allowed
to
allow
services
at
that
location,
so
those
were
some
of
the
flexibilities
under
the
1135
and
then
some
additional
flexibilities.
A
A
So
for
the
public
health
emergency
unwinding,
we
have
three
primary
goals:
one
is
to
stay
compliant
with
CMS
requirements
very
important.
The
second
is
to
prevent
unnecessary
administrative
terminations.
So
we
want
to
make
sure
that
people
who
have
to
go
through
an
active
enrollment.
They
have
additional
information
that
we
need,
so
we
can
verify
their
eligibility.
We
want
to
make
sure
that
that
we're
helping
them
through
that
process,
so
they
don't
get
terminated
when
they're
actually
eligible
and
third,
we
really
want
to
make
sure
that
we
can
transition.
A
So
this
I
know
is
a
bit
overwhelming,
but
that's
because
it's
this
is
a
very,
very
complex
process,
so
we
wanted
to
kind
of
throw
it
all
at
you
and
just
show
at
a
high
level
and
again
I
know
you
all
have
this,
but
just
at
a
high
level
what
that
timeline
would
look
like
if
we
started
to
unwind.
This
reflects
an
anticipation
of
a
public
health
emergency
through
January.
So
if
that's
the
case,
we
would
receive
that
60-day
notice
in
November.
A
We
we
received
that
notice
and
that
will
then
kick
off
or
or
we
will
switch
our
system
to
start
to
restart
those
redeterminations.
So
in
November
we
will.
The
system
will
start
working
through
those.
Those
then
who
would
be
renewed
in
if
January
is
when
the
phe
ends.
Then
renewals
the
first
month
that
we
could
terminate
somebody
for
being
ineligible
would
be
February.
A
So
this
just
contemplate
contemplates
what
you
all
can
see
that
there's
been
a
lot
of
work
going
on
that
continues
up
until
that
60-day
notice.
So
right
now
we
we
are
still
our
system.
Changes
are
pretty
much
all
done,
like
they're
they're
ready.
We
just
need
to
flip
the
switch
when
we
get
the
notice
what
we've
been
working
on.
In
addition
to
that
is
communication,
we
want
to
make
sure
that
we're
working
with
all
the
stakeholders
and
that's
advocacy
groups-
that's
our
mcos
members.
A
You
know
we
want
to
make
sure
we
have
a
very
comprehensive
communication
strategy
so
that
we're
we're
keeping
everybody
informed
about
what's
going
on,
but
that
it's
you
know
to
the
to
the
extent
that
we
can
do
it
to
make
it
less
complicated,
simple
understood.
You
know
a
message,
that's
understandable
and
that
we
give
to
everybody.
A
So
everybody
knows
exactly
what
to
do
during
this
period
of
time,
so
that
communication
strategy
is
is
still
being
developed
and
we
are
in
the
process
of
meeting
with
various
stakeholder
groups
to
make
sure
that
we
understand
what
they
need,
the
population
they
work
with,
and
so
we
can
tailor
that
message
and
that
communication
to
fit
that
so
I'll
go.
There's
another
slide.
That
kind
of
goes
in
to
look
like
what
that
renewal
process
really
looks
like,
but
this
this
is
the
work.
That's
going
on
right
now
to
get
us
to
that
point
in
February.
B
And
I'll
add
the
another
thing:
that's
already
prepared
and
ready
to
go
waiting
that
60-day
notification,
yeah.
C
B
B
Another
thing
that's
prepared
and
ready
to
go
is
training
for
dcbs
field
staff.
We
have
a
training
that
is
prepared
once
we
receive
the
60
down
notification
that
will
be
made
available
to
those
staff
to
give
them
just
in
time,
training
to
to
basically
be
prepared
to
do
work.
I
haven't
done
since
before
the
pandemic.
So,
along
with
that
other
resources
and
things
they
may
need,
that
will
be
helpful.
We
work
with
program
specialists
in
the
field,
get
their
input
on
that,
so
that
we
can
have
those
things
ready
as
well.
A
I
do
do
want
to
make
sure
you
understand
that
once
phe
ends
on
that
date,
our
flexibilities
end,
except
for
appendix
k
for
those
those
HCBS
flexibilities
they
extend
six
months
beyond
the
phe
end,
which
we're
grateful
for
because
that
gives
us
time
a
little
more
time
to
unwind
those
flexibilities
and
keep
those
members.
You
know,
as
you
and
you
understand,
they're
they're,
definitely
some
of
our
most
vulnerable
members
that
will
give
us
more
time
to
unwind
those
flexibilities
for
them.
A
So
what
are
we
doing
to
prepare
for
the
renewal
We've
you
know,
CMS
has
issued
guidance,
we've
had
several
State
Health
LED
official
letters,
there's
been
webinars,
there's
a
regular
monthly
meeting
with
all
the
states.
We
have
a
one-on-one
meeting
with
CMS
to
go
through
how
we
prepared
and
what
are
we
doing
and
what's
it
look
like,
and
what
do
we
need?
They
want
to
make
sure
that
we
understand
what
are
all
the
flexibilities
are
that
we
can
utilize
for
unwinding,
because
there's
there's
additional
flexibilities
available
to
States.
A
We
are,
we
are
reviewing
every
single
one
of
those
to
see.
Are
they
applicable
to
Kentucky?
Is
it
something
that
we
need
to
utilize
we're
trying
to
be
very
thoughtful
and
intentional
about
whether
or
not
it's
something
that
will
benefit
us
and
if
so,
then
we're
implementing
it?
So
there's
a
lot
there.
It's
a
it's,
a
very
long
spreadsheet,
of
what
those
flexibilities
are
and
they
come
under
various
buckets
and
authorities
under
CMS,
so
we're
just
again
making
do
making
sure
we're
doing
our
due
diligence
on
what
those
are
and
what
can
we
do?
A
We've
been
doing
a
lot
of
internal
review,
so
our
team
has
been
meeting
regularly
all
of
our
agencies,
our
sister
agencies,
so
the
department
for
community-based
services,
the
office
of
application
technology
Services
systems,
which
is
oats
our
sister
agency,
that
does
that
helps,
helps
us
with
our
I.T.
So
we're
all
meeting
together
regularly
to
make
sure
we
we
understand,
what's
going
on
with
unwinding
and
do
we
have
everything
covered
as
as
part
of
it
as
part
of
our
initiative.
A
To
do
that,
we
are
again
looking
at
that
renewal
process
and
making
sure
that
we
have
every
piece
of
that.
The
communication
to
the
member,
the
the
resources
available.
A
You
know
we
are
going
to
have
to
rely
on
not
only
DCS
dcbs
workers,
but
our
connectors
and
others
to
help
us
make
sure
that
member
you
know
understands
what's
happening,
especially
if
it's
an
active
renewal
and
I
talk
a
little
bit
about
that
in
a
minute,
but
we
just
want
to
make
sure
people
have
access.
Our
members
have
access
to
the
resources
they
need
to
get
through
that
redetermination
process.
A
So
this
is
the
Medicaid,
a
very
simple
high
level
of
the
Medicaid
renewal
process.
What
happens
is
we
do
every
everybody
who
would
be
subject
to
that
that
renewal
in
a
month?
So
not
our
entire
1.6
million
people,
but
that's
broken
up
over
it'll,
be
broken
up
over
12
months
so
that
that
the
renewal
gets
processed.
So
everybody
goes
through
this
process
and
then
what
happens
is
there
are
people
that
can
be
what's
called
passively
renewed?
That
means
we
have
enough
information,
we're
able
to
go
out
and
ping
the
federal
Hub.
A
We
can
verify
income,
we
can
verify
everything,
and
so
they
can
be,
they
can
be
determined,
renewed,
and
so
that's
a
passive
renewal.
They'll
get
a
notice
of
renewal
and
they're
done.
It's
the
active
renewal
so
that
top
workflow.
That
we're
most
focused
on
so
those
who
have
to
be
actively
renewed
means
that
there's
something
we
could
not
verify,
so
we
will
send
out
a
letter
to
them.
We
will
let
them
know
what
it
is
that
we
need
and-
and
then
you
know
they
have
to
take
the
action
to
submit
that
information
to
us.
A
There
are
various
ways
they
can
do,
that
they
can
do
it
on
their
mobile
phone.
They
can
get
online
to
connect,
they
can
go
to
connect
or
dcbs
local
office,
so
there
are
various
ways
that
they
can
work
through.
Whatever
it
is
that
we
need,
and
then
once
we
receive
that
information
we
can
make
a
determination
and
after
that,
if
they're
still
not
determined,
we
still
can't
determine
eligibility
or
we've
determined
they
are
ineligible.
Then
they'll
get
a
notice
of
that
ineligibility.
They
can
appeal
that
notice,
so
they
do
have
appeal
rights.
A
We
are
trying
to
be
very
flexible
on
on
the
length
of
time
they
can
appeal.
So
we
we're
giving
them
120
days
to
appeal.
They
can,
you
know,
come
back
if
they
get
that
letter,
they
can
come
back
and
just
ask
for
us
to
to
take
another
look
at
that
without
a
formal
appeal,
so
so
we're
giving
them
every
opportunity
to
make
sure
that
they
can.
You
know,
demonstrate
to
us
that
they're
they
are
eligible
if
they
don't
return
any
information
to
us.
A
A
The
individuals
going
through
that
that
we're
going
to
you
know
work
with
our
advocacy
organizations
with
connectors
with
dcbs
workers,
we're
going
to
have
our
Managed
Care
organizations
reach
out
to
their
members,
because
they,
you
know,
are
often
communicating
with
them
more
than
we
are
directly
and
we're
going
to
communicate
with
providers
and
as
providers
and
make
sure
they
understand.
How
can
they
help
this
individual?
That's
come
into
their
office
and
you
know,
especially
if
they've,
just
if
they
look
up
in
Kentucky
Health
Net,
which
shows
our
eligibility
and
it
shows
they
just
became
ineligible.
A
You
know
that's
a
great
conversation
for
a
provider
to
ask
somebody:
did
you
just
go
through
the
the
unwinding?
Did
you
just
you
know,
lose
your
eligibility
and
and
refer
them
over
to
connector
to
a
connector,
so
we're
hoping
like
all
hands
on
deck
approach,
to
making
sure
that
our
members
have
access
to
the
information
and
the
resources
they
need
through
this
process.
A
So
this
just
takes.
We
get
that
notice
in
November,
and
this
breaks
down
a
little
bit
into
more
detail
of
what
that
process
looks
like
for
someone.
So
this
presumes
that
we've
got
that
November
12th
60-day
notice.
Our
system,
then,
is
going
to
excuse
me
in
December
automatically
start
processing
those
February
renewals,
that's
in
the
background.
It's
gonna
they're
gonna
go
ahead
and
and
the
system's
going
to
look
through
those
people
that
would
be
subject
to
a
February
renewal
date
in
January.
The
active
renewals
will
get
that
issue.
A
That
excuse
me,
the
passive
renewals
will
get
that
notice
of
renewal.
There's
nothing
else
they
need
to
do.
The
active
renewals
will
get
that
letter
saying
what
it
is
that
we
need
from
them
and
then
in
January
the
March
renewals
will
start
processing
in
the
background,
so
then
come
February
if,
by
the
end
of
the
month,
we've
no,
we
do
not
receive
the
information
or
we've
received
the
information
and
we've
made
a
determination
of
what
that
looks
like
you
know
whether
or
not
they're
ineligible.
A
So
that's
just
a
kind
of
a
snapshot
of
what
it
would
look
like.
Come
November,
12th,
phe,
end
notice,
so
this
is
a
snapshot
as
of
September
1st
I
I
do
want
to
say
that
this
is
constantly
changing,
because
our
system
is
constantly
processing
those
renewals
in
the
background.
Now
it's
doing
it
and
we're
not
doing
anything
about
them,
but
it's
allowing
us
to
at
least
get
a
sense
or
an
idea
of
what
that
population
is,
that
might
come
become
subject
to
you
know
that
may
be
ineligible
either
due
to
income
or
some
other
reason.
A
So
so
we've
been,
you
know
our
system's
been
able
to
give
us
that,
but
it
changes
every
month
because
it
just
depends
on
when
somebody's
come
on
and
we've
done,
that
background,
processing
and-
and
even
maybe
somebody
who's
been
in
this
bucket
of
of
potentially
might
lose
eligibility.
Maybe
the
next
month
were
you
able
to
identify
the
information
that
we
need
and
we've
been
able
to
verify
it
so
so
that
bucket
of
the
estimated
total
to
lose
eligibility
which
shows
210
000
that
changes
every
month
for
us.
So
this
is
just
a
snapshot.
A
A
We
can
see
that
their
income
would
qualify
them
for
at
least
a
qualified
health
plan
with
an
advanced
premium
tax
credit-
a
PTC,
so
that
you
know
again
this
this.
This
75
000
people
will
will
could
move
over
to
a
qhp
plan
and
they
could
have
access
to
tax
credit
to
make
that
more
affordable
to
them.
A
This
snapshot
of
what
the
age
group
looks
like
and,
as
you
can
see,
25
of
them
are
18
and
under
that
concerns
us-
and
you
know,
we're
we're-
definitely
interested
in
making
sure
that
those
folks
that
the
the
determination
we
make
for
them
is
accurate,
because
we
certainly
don't
want
to
lose
somebody
who
may
actually
be
eligible
for
Medicaid
and
we're
going
to
again
focus
on
those
individuals
to
make
sure
that
if
they
do
qualify
and
can
move
over
to
a
qualified
health
plan,
for
example,
that
we're
taking
those
actions
to
help
with
that.
A
This
is
what
the
case
load
looks
like
by
month.
Right
now,
again,
this
is
a
snapshot
as
of
today
as
of
September
1st,
a
caseload
means
a
case.
So
this
is
not.
These
are
not
individuals.
These
are
cases,
and
the
case
can
have
maybe
two
people
in
it
could
have
four
people
in
it.
It
just
depends
based
on
household,
so
these
are
the
cases
that,
if,
if
we
were
to,
if
we
were
to
unwind
right
now,
this
is
what
our
caseload
would
look
like
for
our
dcbs
workers
and
our
connectors.
A
Keep
in
mind
that
this
this
is
total
caseload.
You
know
we
think
that
maybe
75
of
these
cases
would
probably
passively
passively
renew.
So
that's
that's
what
we're
looking
at
right
now.
A
So
obviously
our
priorities
are
making
sure
we
have
an
unwinding
plan
which
we
do
and
that
we're
able
to
communicate
that
plan
with
CMS
they
they
have
we're
going
to
have
to
once
we
get
that
notice,
we're
going
to
have
to
provide
them
a
Baseline
and
a
monthly
report,
so
they
can
see
they
want
to
know
how
the
states
are
doing
with
their
caseload
work,
so
we'll
be
doing
that
we're
doing
stakeholder
engagement,
making
sure
all
the
system
updates
are
are
ready
to
go
still.
A
Making
decisions
again
about
the
flexibility
is
still
coming
through.
Those
so
make
sure
that
we're
taking
advantage
of
of
all
those
that
would
make
it.
You
know
the
best
process
for
our
our
members
and
just
lots
of
coordination
across
our
sister
agency
and
training.
A
A
It's
an
amazing
system
because,
as
it
notes,
it's
integrated,
it
has
all
of
our
benefit,
most
all
of
our
benefit
programs
in
it.
So
our
snap
TANF,
so
we're
able
to
to
show
we
can
determine
eligibility
across
all
those
programs
for
in
for
our
members.
A
So
that's
the
system
that
the
changes
will
have
to
be
made
in
what
we
again
have
been
doing.
Is
we
took
a
look
of
everything
we
did
to
the
system
to
start
phe
and
now,
we've,
you
know,
put
into
place
everything
that
we
need
to
do
to
unwind,
that
we
have
changed
just
I'm
going
to
touch
on
a
couple
of
things:
I'm
not
going
to
go
through
them
all,
but
we
have
changed
for
our
automatic
re-enrollment
into
a
Managed
Care
Organization
to
120
days.
A
We
did
that
because
that
allows
if,
if
somebody
drops
off
and
they
go
through
an
appeal
or
we
can
get
their
information
and
get
them
redetermined
they're
not
going
through
the
the
problem
of
of
getting
a
new
MCO
assigned
to
them,
they
can
go
back
to
their
old
MCO.
So
I
think
that's
something
that's
important
for
continuity
for
someone.
If
they
had
an
MCO,
that's
part
of
the
MCO
they
want.
We
didn't
want
that
to
become
a
barrier
to
them.
A
You
know
through
that
redetermination
process,
so
that
that
is
one
thing
that
we
took
into
account.
Again.
We
extend
extended
the
time
frame
for
administrative
hearings
to
120
days,
to
give
everyone
enough
opportunity
to
provide
that
information
and-
and
of
course,
that's
really
critical
for
those
who
are
in
Eastern
Kentucky
and
the
disaster
Zone.
You
know
finding
the
information
that
we
might
the
documentation
we
might
need
they
need
that
time.
A
So
you
know
that.
Can
it
definitely
takes
that
into
account?
I
think
a
couple
of
things
here,
so
what
we've
been
doing
every
month
is
what's
called
a
special
circumstance
for
these
folks
that
fall
into
the
probably
likely
likely
ineligible.
That's
what's
called
a
special
circumstance.
So,
every
month
we've
just
been
moving
them
over
to
keep
their
eligibility
we'll
stop.
That
process
come
the
phe,
so
that'll
stop
we've
been
creating
the
template
that
we
have
to
do
the
reporting
to
to
CMS.
So
the
system
has
to
be
able
to
do
that.
A
That
can't
be
a
manual
effort.
It
needs
to
be
something
that
can
come
out
of
the
system
automatically.
So
we've
been
doing
that
and
Outreach.
So
you
know
we
have
been
trying
right
now
just
to
we
don't
want
to
put
fear
and
anxiety
unnecessarily
out
there.
So
what
we've
just
been
trying
to
do
is
just
tell
people
to
update
your
contact
information
because,
first
of
all
the
unwinding,
the
the
PHD
in
date
has
changed
so
many
times.
So
that's
you
know
a
critical
piece
to
that.
A
We
don't
want
to
go
out
there
and
tell
everybody
you're
about
to
be
renewed
when
you're
not,
and
it
goes
over
12
months.
So
when
somebody
gets
renewed,
that's
you
know
going
to
be
different
depending
on
when
the
the
end
date
comes.
So
so
we've
been
trying
to
make
sure
that
people
understand
right
now,
just
keep
your
information
updated,
but
once
the
phe
ends
we
will
want
them
to
know.
A
A
One
of
the
flexibilities
we're
utilizing
is
for
managed
care
organizations
to
be
able
to
utilize
their
information
to
update
mailing
addresses
right
now.
We're
allowed
to
do
that,
but
we
have
to
then
go
back
and
verify
that
information
which
is
a
bit
redundant
because
the
MCO
has
that
it
has
that
new
information
and
so
for
them
to
be
able
to
share
it
with
us
and
we
can
consume
it
and
and
then
move
forward
and
utilize
that
it
is
often
almost
99.9
of
the
time.
A
The
most
current
information
for
that
member,
so
us
being
able
to
utilize
that
information
is
helpful.
The
other
thing
we're
we're
doing
is:
we've
we've
implemented
a
new
system
change
that
allows
that
if
we
get
mail
back
returned
mail,
it
will
automatically
check
that
because
the
Postal
Service
notice
is
on
there
it'll
check
that
it'll
automatically
update
our
system,
and
then
we
can.
We
send
the
notice
that's
a
huge
new
innovation
for
our
system.
A
We
are
you
know
we
were
again
because
the
IES
has
the
snap
eligibility
too.
That's
helpful.
We
can
check
both
those
that
all
that
information
to
determine
the
Medicaid
Eligibility
along
with
that
as
long
as
it's
verified,
so
there's
again
did
not
go
into
all
of
them,
but
there's
a
bunch
of
system
changes
that
that
have
to
be
taken
into
account.
A
C
A
C
A
That
algorithm,
that
has
helped
us
identify
those
people
and
I
just
want
to
emphasize
potential,
because
it's
just
what
our
system
is
seeing
right
now
in
terms
of
their,
for
instance,
let's
say:
we've
gone
and
pinged
the
federal
Hub
and
we
can
see
what
their
income
is,
and
so
it's
showing
that
they
may
be
above
income,
but
but
until
we
send
out
that
notice
and
they
go
through
an
actual
renewal
process,
we
don't
we
don't
fully
know
so
that
it
just
again
identifies
it,
has
all
the
rules
of
Eligibility.
A
C
Thank
you,
co-chair
Meredith,
you're
recognized.
D
Thank
you,
chair
and
Veronica.
Thank
you
for
your
presentation.
You
always
do
an
excellent
job,
really
appreciate
it.
Thank
you
got
two
questions
for
you
possibly
three.
This
looks
like
a
Herculean
effort,
I'm
sure
you're
overwhelmed
I'm
overwhelmed
by
it.
You
identify
these
inefficiencies
are
going
to
be
a
problem,
but
what
other
obstacles
to
success?
Do
you
envision
and
I'm?
Not
it's
not
a
leading
question,
but
I
I'm
concerned
that
do
you
have
enough
resources
to
effectively
do
this
I.
A
I
think
we
have
to
be
honest
to
say
that
we're
concerned
about
that
as
well.
We're
doing
our
best
to
make
sure
that
we're
retaining
and
recruiting
we
I
think
and
I'm
not
here
to
speak
on
behalf
of
dcbs,
but
you
know
I
I
think
we've
had
a
vacancy
issue
in
the
last
I'd
say:
probably
six
months
due
to
efforts
of
com,
the
commissioner
for
dcbs
on
increasing
salaries,
I
know
our
our
cost
of
living
or
our
increase
on
July
1
was
extremely
helpful
in
in
retaining
and
recruiting.
A
B
Would
agree
with
that
I'm
sorry,
oh
I,
I
agree
with
that.
The
staff
turnover
and
staff
retention
are
a
part
of
this
as
well,
and
so
we're
just
trying
to
address
that.
As
we
have
been
over
the
last
couple
of
years,
I
think
the
staff
raises
absolutely
have
helped
I
think
staff
morale
is
on
the
rise,
so
I
think
that's
a
positive.
A
And
I
will
say
that
a
CMS
has
given
States
some
flexibility
on
how
to
allocate
the
population
across
the
12
months
and
that's
helpful
to
us
and-
and
we
can
also
then
create
a
case
mix
each
month
that
isn't
as
overwhelming,
because
you
know
some
cases
take
more
effort
than
others,
and
so
that's
going
to
be
helpful
to
us.
So
we
have.
We
have
some
tools
available,
but
I
think
we're
going
to
stay
concerned
about
you
know.
Do
we
have
enough
folks
on
the
ground
that
can
help
process?
The
renewals.
D
I
know
this
is
coming
very,
very
quickly
and
possibly
co-chair.
We
may
need
you
to
have
come
back
in
November
to
kind
of
give
us
a
state
of
the
nation
address
as
where
we
are
with
this,
because
we
can't
afford
to
to
fail
on
this.
But
I
appreciate
your
efforts
today,
the
the
200
000
again,
not
holding
you
to
that
number.
We
understand
that's
kind
of
flexibility,
but
if,
if
that's
a
true
number,
it
doesn't
get
us
back
to
pre-covered
numbers
in
terms
of
eligibility.
A
D
A
D
My
last
question:
it's
not
to
Blindside
you,
but-
and
we
may
need
to
talk
about
this
next
month,
but
kind
of
prepare
you
forward
is
the
court
of
appeals
decision
regarding
anthem's
participation
in
the
MCO
program.
I'm,
not
sure
whether
you
all
have
had
time
to
analyze
that
and
review
it.
But
you
got
a
gut
reaction
to
that.
Because
is
it
going
to
create
chaos
within
the
system
and
if
it
is,
how
are
we
going
to
deal
with
that.
A
So
while
we
are
reviewing
it
and
and
looking
through,
you
know
what
are
we
going
to
do
next,
if
it,
if
it
ends
up
happening
right
now
that
appeal
time
is
still
running
and
so
we're
not
taking
any
action
until
that
happens,
our
contract
with
Anthem,
we
put
a
provision
in
there
for
this
specific
situation,
and
that
is
to
allow
a
transition
time
so
that
we
can
make
sure
that
we
are
thoughtfully
transitioning,
those
members
and
it's
not.
It's
not
abrupt.
A
It's
not
going
to
happen
the
day
that
that
that
order
gets
issued,
it's
going
to
happen
over
a
three-month
period,
so
we
you
know
will
have
the
ability
to
notify
members.
We
can
give
them.
The
they'll
always
have
the
option.
Even
if
we
assign
an
MCO,
they
always
have
the
option
to
choose
a
new
MCO.
That
choice
is
always
available
to
a
member,
it's
required
by
federal
law.
A
So
so
we
we
do
have
a
plan
in
place
for
when
this
was
going
to
happen,
if
it
happened,
we're
just
you
know,
waiting
for
that
period
of
time
to
to
expire
before
taking
any
action.
Well,.
D
D
A
D
Again,
I
would
think
just
backing
it
up
and
that's
the
math
I'm
going
from
backing
it
up
that
wouldn't
have
to
do
this
in
Earnest,
sometime
in
2023
and
so
I'm
sure
we'll
have
additional
dialogue
with
that.
But
again,
thank
you
for
the
presentation.
You've
all
done
an
excellent
job
and
appreciate
you
being
here
this
morning,
but
I
think
we
do
need
to
have
you
back.
E
Thank
you
Mr
chairman
and
Veronica.
Thank
you
for
the
presentation.
I
want
to
make
sure
that
I
understand
the
timeline
of
this.
So
if,
if
the
the
health
emergency
is
lifted
in
November,
then
three
months
later,
these
folks
that
are
the
extended
Medicaid
population,
the
match
from
the
federal
government,
would
stop
at
three
months.
A
So
a
couple
of
things
just
to
make
sure
it's
clear:
the
notice
will
come
in
November
for
the
PHD
to
end
in
January.
We
have,
if
that's
the
case.
Let's
say
it
does
happen.
In
January
we
have
the
6.2
fmap
the
additional
fmap
and
hand
staff
map
through
the
first
quarter,
so
we'll
have
that
additional
funding
that
percentage
through
the
first
quarter
is
the
way
that
works.
So
it's
it's
quarter,
pure.
E
A
E
B
E
A
They
no
they're
they're,
really
keeping
it
guarded.
It's
really
hard
to
know.
It's
really
hard
to
know,
I
think
what
we'll
we
probably
will
likely
know
towards
the
end
of
next
month.
E
Do
you
all
have
a
running
kind
of
tab,
I
guess
on
what
this
extended
population
as
far
as
State
dollars,
that
it
has
cost
through
the
federal
health
emergency
I'm.
F
Think
of
Mr
chairman
and
commissioner
I
appreciate
your
guys's
presentations.
Thorough
I
have
a
few
questions
on
on
this
phe.
Is
this
a
federal
requirement
for
us
to
participate
in
this
because
I
mean
the
wording
in
the
slides?
Was
that
it's
permissive
for
states
to
do
this?
Are?
Is
the
federal
government
requiring
us
to
have
all
these
flexibilities
and
to
have
this
extension.
A
Has
required
us
to
to
handle
it
this
way
for
the
6.2
percent
fmap,
however,
the
enhanced
fmap,
that's
where
the
continuous
coverage
is
required,
but
I
will
tell
you
that
you
know
CMS
is
I,
think
pretty
pretty
much
given
us
the
belief
that
it's
still
it's
still
expected
so.
F
Because
I
mean
your
first
slide,
is
the
PHA
allowed
States
several
flexibilities?
Oh
so,
I
mean
are
these
things,
I
mean
that's.
What
I'm
wondering
is
okay,
if
we're
going
to
say
we
have
to
have
this
expanded
medicaid
from.
Is
this
a
federal
order?
Saying
You
must
extend
all
of
these
benefits
to
all
these
people
to
this
level
and
states
you
have
to
do
it.
A
So
the
flexibilities,
though,
are
different
states
did
not
have
to
implement
every
flexibility,
and
there
are
flexibilities
we
did
not
take
advantage
of
and
of
course,
I
cannot
think
of
them
at
the
top
of
my
of
my
head.
But
what?
What
that?
What
that
language
meant
to
convey
is
that
CMS
issued
all
these
flexibilities,
the
ones
that
I
showed
you
the
appendix
K
the
1135s,
and
then
there
are
some
emergency
state
plan
amendments
that
we
could
have
implemented.
A
F
What
what
are
they
requiring
us
to
do
then?
I?
Guess
that's
the
because
the
reason
I've
got
the
question
is
this:
is
a
cost
of
the
state
200
000,
more
people
every
month?
What's
a
premiums
are
on
six
hundred
dollars
per
person
is
about
120
million
dollars
a
month
just
to
have
them
on
Medicaid,
not
to
mention
all
the
other
things
that
we're
expanding
this
for
there's
a
cost
to
the
taxpayers
of
Kentucky.
For
this,
and
if
the
federal
government's
saying
you
have
to
do
this,
that's
a
federal
mandate,
saying
Kentucky
taxpayers!
F
You
will
pay
for
this.
This
legislature
has
ended
the
state
of
emergency.
This
past
legislative
session
we've
said
there
is
no
longer
a
public
health
emergency,
and
if
the
feds
are
saying
well,
we
think
there
is
even
though
I
think
all
of
us
agree
that
there
isn't
at
least
the
legislature
does
it's
a
cost
on
us.
I
need
to
I
kind
of
like
to
know
that.
How
much
is
that
costing
taxpayers
to
comply
with
a
federal
mandate
for
an
emergency
that
this
legislature
doesn't
think
actually
exists?
Anymore?
F
That's
a
concern
for
me.
We've
got
what
100
plus
thousand
job
openings
in
the
state
and,
if
we're
saying
hey,
even
when
we
come
out
of
this,
a
hundred
thousand
more
people
that
are
going
to
be
on
it
when
we
have
that
many
at
least
job
openings
out
there.
Those
are
major
concerns.
I've
got
I,
mean
I'd
like
to
know
exactly
what
the
feds
are
saying.
F
You
have
to
do
as
a
state
or
if
a
lot
of
this
is
permissive,
because
if
it's
permissive
I
think
we've
decided
this
no
longer
exists,
we
should
be
making
that
transition
now
and
not
wait
until
the
feds
give
us
or
allow
us
to
make
it
and
say:
well
all
the
things
we're
requiring
from
you
or
or
that
you
were
permitting
from
you
have
to
go
away.
That's
something
I
think
we
need
to
know
because
I
think
again,
the
slides
I
was
seeing
was
like
a
Blog.
This
is
real
being
allowed
to
do
these
things.
F
F
If
they
were
giving
us
a
saying,
here's
all
the
money
you're
going
to
expand
it
fine,
okay,
then
we
can
say
we'll
take
it
I
suppose,
but
I
suspect
they're
not
doing
that
they're
making
us
pay
a
lot
of
that
and
if
it's
a
choice
from
us
or
from
the
executive
branch
saying
well,
we
think
we
need
to
do
this.
We've
already
made
a
determination
that
that
no
longer
exists.
That's
a
concern
for
me,
the
other
one!
F
Is
this
I've
had
a
lot
of
people
I've
gotten
a
lot
of
emails
from
folks
that
when
they
lost
their
jobs
during
the
pandemic,
were
automatically
enrolled
in
a
Medicaid
for
coverage
for
health
care
and
then
they've
gotten
other
jobs
after
during
this
time
they
had
never
signed
up
for
Medicaid,
don't
not
accustomed
to
government
kind
of
involvement
with
their
health
care
or
anything
else,
and
when
they
got
the
new
job
did
not
know
that
they
had
a
disenroll
from
Medicaid
and
now
we're
getting
bills.
F
Saying
you
owe
us
six
thousand,
seven
thousand
ten
thousand
dollars
for
the
premiums
that
you've
accumulated
over
the
last
year,
because
you
were
getting
Medicaid
coverage
and
you
got
another
job,
and
you
have
this
as
well,
and
a
lot
of
people
saying
well,
they
were
enrolled
in
both
and
they
said
well,
I
didn't
sign
up
for
the
first
I
mean
I
lost
my
job
and
it
was
kind
of
part
of
the
whole
pandemic.
I
got
my
job
I'm
concerned.
F
That's
going
to
happen
here
that
a
lot
of
folks
as
they
get
this
and
we'll
have
other
jobs
and
then
they're
going
to
get
a
bill
from
the
state
government
saying
you
owe
us
for
paid
premiums
in
the
past
because
we
were
paying
it
for
you
and
you
didn't
tell
us,
you
got
a
new
job
and
they
didn't
know
because
they
never
asked
to
be
signed
up
to
begin
with.
I,
don't
know
if
you
can
address
that
issue.
A
So
what
I'd
like
to
do-
and
perhaps
it's
coming
back
next
month
or
sending
you
a
communication
to
really
delineate
through
the
lens
that
you've
asked
which
is
what's
mandated
and
what's
not
because
I,
don't
I,
don't
want
to
misspeak
to
that.
But
for
the
other
issue
you
talked
about.
Nobody
automatically
gets
enrolled
into
Medicaid.
A
You
have
to
file
an
application,
I
think
what
you're
talking
about
is
when
somebody
is
on
the
qualified,
because
we
don't
have
premiums,
but
the
health
exchange
does
so
if
they
were
enrolled
in
a
qualified,
Health
Plan
and
they
had
premiums
and
then
may
have
been
dually
somehow
enrolled
in
Medicaid.
I
do
know
that
there
were.
You
know,
a
handful
of
situations
where
that
happened
and
people
can
request
to
not
pay
back
that
premium
for
any
conflict
between
those
two
programs.
A
If
somebody
has
gone
out
and
has
gotten
employee
during
this
period
of
time
and
their
income
has
increased,
which
again
is
potentially
that
210
000
bucket
210
000
person
bucket
and
they've,
maybe
they're
accessing
coverage
through
something
else
like
their
employer
coverage.
A
We
require
third
party
liability
so
that
information
and
we
go
out
and
we
find
that
if
they
don't
report
it
to
us,
we
find
it
and
we
put
it
on
there.
So
so
I
will
say
that
within
this
bucket
are
people
that
have
third
party
liability,
and
so
they
are
primary
and
we're
secondary.
F
B
F
F
That
was
what
he
was
being
charged
back.
He
had
a
job,
he
lost
his
job.
He
qualified
for
Medicaid
received
Medicaid
got
a
new
job
within
a
matter
of
months.
Six
months
had
a
new
job
during
the
pandemic
was
getting
that
didn't.
I,
know
to
disenroll
and
then
was
getting
a
charge.
Saying
here
is
what
you
owe
the
state
of
Kentucky
for
what
we've
paid
for
your
health
insurance.
That's
happened,
I've
got
emails
and
I've
sent
them
on
so
there's
people
that
are
being
charged
for
that
issue.
So
that's
the
concern
that
I've
got.
F
It
says
we
start
to
disenroll
200
000
people.
Many
of
these
are
not
going
to
know
they're
not
going
to
they're
going
to
be.
You
know
naive
to
how
government
works
and
how
this
stuff
works
and
all
of
a
sudden
they're
going
to
get
stuck
with
potential
bills.
You're
saying
you
owe
us
money,
that's
my
fear,
because
it's
happened
to
people
that
I've
received
and
I
have
forwarded
those
emails
to
you
all
to
review,
to
say
well,
there's
he's
required
to
do
this
and
the
guy
says:
look
I,
don't
never
applied
for
Medicaid.
F
In
my
life,
I've
always
worked.
I've
always
provided
for
myself
now
I
have
to
rely
on
government
and
now
you're
charging
me
for
something
that
I
had
no
idea
about.
That's
a
worry
with
200
000
people
coming
off
the
service,
but
the
the
true
concerns
I've
got
is
cost
per
month
for
this
state.
Is
it
fairly
required?
What
do
they
if
we
have
to
participate
in
this?
If
there's
a
federal
requirement?
Fine,
what?
If
not,
we
should
be
just
enrolling
in
that
stuff
now,
because
we've
already
made
that
determination
as
a
general
assembly.
G
Thank
you,
Mr
chairman.
Thank
you
for
the
presentation.
This
is
really
daunting.
What
you
guys
are
facing
I
just
actually
Senator
Meredith
asked
my
Workforce
capacity
question
already.
So
thank
you
for
that
response.
If,
if
I'm,
a
Medicaid
recipient
am
I
aware
that
this
unrolling
is
is
coming.
A
Again,
we've
been
a
little
hesitant
to
send
out
Communications
directly
to
members
to
talk
about
you're
going
to
be
subject
to
Renewal,
because
we
want
to
do
that
for
the
month
that
they're
going
to
be
renewed,
but
we
have
been
communicating
with
them
through
various
texts
and
and
email
and
and
other
communication
that
this
you
know
this
is
going
to
happen
and
that's
that's
our
campaign
with
make
sure
your
contact
information
is
updated
and
we've
also
been
working
very
closely
with
the
the
advocacy
organizations
and
and
what
the
different
community-based
organizations
that
are
out
there
working
with
members
to
to
make
sure
that
they
are
aware
and
they
they
are
helping.
A
G
You
quick
quick
follow-up
if
I
may,
just
once,
we
start
hearing
from
our
constituents
and
I
expect
that
we
will
I've
been
kicked
off.
My
Medicaid
I've
lost
my
Medicaid.
How
can
we
best
help
and
how
can
we
direct
them
to
get
the
assistance
that
they
need.
A
I
I
think
connectors
and
the
dcbs
local
offices
and
and
I
know
what
I'm
saying,
because
you
know
our
call
center
can
get
overwhelmed
and
they
could
get
overwhelmed,
but
that
those
are
the
best
resources.
A
The
other
thing
is:
if
there's
somebody
that
can,
if
they
don't
have
the
ability
to
access
the
internet
and
they're
connect,
because
because
every
every
Medicaid
member
can
access
their
account
on
connect
our
system,
you
know,
maybe
somebody
can
help
them
access
it
to
see
what
is
going
on
with
their
with
their
eligibility.
You
know,
maybe
there
is
a
piece,
that's
missing,
or
maybe
they
if,
if
they
have
received
the
you
know
the
notice
of
denial,
perhaps
you
know
they
can
help
them
with
an
appeal
during
that
time,
you're
welcome.
H
Thank
you,
Mr
chairman
Carol
asked
one
of
my
questions,
but
this
is
a
lot
of
work
for
what
ifs,
if,
if
it's
not
definitely
in
January,
can
this
work
be
just
automatically
moved
forward?
Yes,.
A
That's
what
we've
been
doing
basically,
is
because
this
is
I,
don't
know
like
the
fifth
or
sixth
extension.
G
A
Probably
maybe
more
than
that,
but
but
we
just
you
know,
we
continue
to
sort
of
put
the
system
changes
on
hold
again
they're
kind
of
they're
waiting
for
us
to
flip
the
switch
for
us.
The
additional
time
is
helpful.
One
is
to
make
sure
we
have
enough
staff
to
handle
it
our
call
center
and
our
application,
processors
and
connectors
and
they're
trained
and-
and
that
gives
us
more
time
to
communicate
with
stakeholders
to
make
sure
that
we're
really
focusing
on
the
populations.
A
We
we
just
met
with
some
folks
around
maternal
and
child
health
who
are
advocating
on
behalf
of
pregnant
women
and
children,
and
it
was
very
helpful
for
us
to
get
their
perspective
because
now
we
can
maybe
have
additional
resources
of
community.
You
know
Outlets
of
communication
that
we
didn't
have
before,
so
we
just
continued
to
keep
working
on
that
to
make
sure
that
we're
we're
prepared
well.
H
C
Senator
Higdon,
thank
you
Mr
chairman,
and
you
certainly
have
a
daunting
task
with
one-third
of
kentuckians
on
Medicaid.
It's
a
that's
a
big
task
and
and
I
know
you,
the
mcos
and
and
the
cabinet
depend
a
lot
on
electronic
communication
with
a
lot
of
these
recipients,
and
you
know
out
in
the
real
world
they're
not
all
connected
and
and
even
those
that
are
connected
to
the
to
the
internet
and
they're,
not
computer
savvy.
C
They
just
don't
understand
a
lot
of
them
so
that
that
adds
to
your
to
your
complication
but
I,
guess
my
my
question
is:
you
know
I've
heard
rumors
before
and
I've
asked
this
question
about.
You
know.
Kentucky
was
one
of
the
original
expanded
medicaid
States
and
we
had
a
lot
of
always
heard
rumors
that
they
were
out
of
state
folks
that
cross
we.
C
We
have
a
lot
of
borders
with
other
states
that
are
not
participating,
that
we
had
out-of-state
folks
somehow
come
up
with
a
Kentucky
address,
so
they
could
participate
in
Medicaid
so
and
I'm
sure
you're
as
you
go
through
this
one-third
of
kentuckians.
That
is
something
that's
verified
that
you
look
for.
Yes,.
A
Absolutely
we
verify
addresses,
you
know,
I
think.
The
other
thing
that
I
always
like
to
remind
folks
is
that
it's
our
providers,
Who
deliver
services
to
these
individuals,
they're
the
ones
seeing
them
in
the
office,
they're
the
ones
providing
services
to
them
and
and
that's
an
I
think
another
conduit
in
terms
of
as
I
mentioned
earlier.
You
know
making
sure
our
providers
know
and
understand.
A
What's
going
on
as
well,
you
know
we
we
do
often
hear
when
there
are,
when
they
check
eligibility
and
there's
eligibility,
issues
and
retro
terminations
and-
and
you
know,
and
and
that
comes
from
our
system
and
our
due
diligence
to
make
sure
that
it
is
a
person
in
Medicaid,
that's
being
covered
and
they're
eligible
and
sometimes
that
that
takes
time
to
to
verify
and
again
we
may,
we
may
be
sending
people
notice
of
denial
that
are
truly
eligible,
but
because
we
didn't
get
any
information
from
them.
We
can't
make
that
determination.
A
I
C
D
I
appreciate
it
just
very
quickly:
we've
had
some
discussion
about
Personnel
needs
and
glad
to
hear
that
the
actions
we
took
last
session
will
help
improve
that
I,
don't
know
of
any
of
us
are
at
the
point
that
we've
tilted
the
table
back
to
where
it
needs
to
be
yet
and
again.
That
is
a
major
concern
with
your
presentation
today,
but
I'm
just
curious
as
to
whether
the
recent
change
in
the
telecommute
policy
has
had
any
impact
on
the
Personnel
in
in
your
also
areas.
A
Mccabe
Services
perspective
telecommuting
has
allowed
us
to
recruit
and
retain
a
lot
of
folks,
but
you
know
the
return
to
work
policy.
We've
been
working
with
our
staff
on
how
you
know
how
best
to
roll
that
out
and
trying
to
keep
in
mind
their
specific
situation
and
be
as
flexible
as
we
can
with
that,
including
you
know
what
days
they
come
into
the
office
flexible
hours,
so
you
know
it.
It
is
what
it
is
we're
just
dealing
with
it.
D
Well,
I
think
that's
what
concern
for
me
that
it
is
what
it
is
I'm,
not
sure
that
it
is
what
it
is
and
I
think
all
of
us
are
getting
just
just
tons
of
emails
from
concerned
employees
and
it
looks
like
a
one
situation
fits
all
and
it
doesn't.
I
could
see,
particularly
for
for
Medicaid,
where
working
at
home
could
be
a
very
productive
Venture
for
folks
and
if
you're
used
to
doing
that
for
the
last
year
or
two
years
and
now
that's
being
disrupted,
I'm,
not
sure.
D
That's
in
the
best
interest
of
anyone
and
I
just
encourage
people
again
take
a
hard
look
at
that
policy
and
make
sure
it's
it's.
It's
more
cabinet
revision
specific,
rather
than
just
a
broad-based
statement,
a
policy
that
here's
what
we're
going
to
do
yeah.
You
know
the
flexibility
that
you're,
giving
that's
great,
but
I,
guess
we're
not
yielding
on
you
got
to
have
three
days
in
office
in
two
days
that
you
can
work
from
home.
I.
D
A
I
do
know
that
they
there
has
been
some
changes,
for
example,
for
our
cabinet,
based
on
the
building
itself.
A
There's
been
an
extension
until
January,
at
least
for
us,
to
return
to
three
days
so
they've,
given
us
some
discretion
and
flexibility
with
our
employees
and
and
even
again,
with
the
return
to
three
days,
I
mean
I.
Think
we
had
some
flexibility
around
that
so
we're
just
trying
to
work
within.
You
know
the
the
parameters.
D
Well,
you
know
we,
we
don't
live
in
a
bubble.
We've
been
state
government
and
we're
in
competition
with
the
private
sector
for
the
same
employees
and
if
they're,
allowing
them
to
have
that
flexibility
and
can
truly
be
productive
and
I
think
we're
remiss
if
we
don't
take
a
look
at
that
and
make
sure
that
we're
being
creating
competitive
work
environment
for
them.
But
thank
you.
Thank
you.
Mr
chair.
E
Just
quickly,
Mr,
chairman
and
I
I
agree
with
Senator
Meredith
to
appoint
a
customer
service.
Jobs
need
to
be
done
in
the
office
and
and
that's
my
experience,
what
I'm
hearing
that's
just
not
working
at
all,
but
my
question
is-
and
we've
got
to
the
Personnel
cabinet
coming
this
afternoon,
to
testify
on
the
telecommuting
and
help
help
me
understand.
My
understanding
is
that
the
Personnel
cabinet
makes
these
decisions
and
then
it's
it's
pretty
much
across
the
board
and
and
whatever
latitude
you
all
get
comes
from
them.
Is
that
correct.
A
I
honestly
can't
answer
that
question.
I'm
sorry
I
mean
that's.
My
understanding
is
the
Personnel
cabinet
makes
the
rules
and
we
implement,
but
how
that
process
works.
I,
I'm
not
familiar
with
okay,.
C
Thank
you,
so
is
that
decision
made
by
the
secretary
of
the
cabinet
is
is
of
the
Personnel
cabinet.
C
J
Very
good
Mr,
chairman
and
committee
members
thanks
a
lot
for
having
us
here,
inviting
us
back
to
speak.
We'll
have
got
a
number
of
agenda
items
here
to
walk
through
and
then
I
want
to
make
sure
we
start
with
a
remember
the
member,
and
this
is
something
that
we
challenge
our
team
to
do.
I
just
think
it's
important.
We
talk
so
much
about
the
business
of
Medicaid,
but
it's
important
to
remember
that
we're
taking
care
of
these
patients
and
a
third
of
Kentucky.
Really.
J
J
You
know
in
transition
of
a
inpatient
stay
she
was
assigned
to
transition
of
care,
coach,
Cara
who's,
an
employee
of
Molina,
and
our
job
right
is
to
manage
her
Services
after
an
event
to
help
make
sure
that
she's
got
access
to
services
and
care
that
she
needs
to
avoid
going
back
into
the
to
the
hospital
or
to
another
admission,
it's
to
make
sure
that
her
transition
is
as
successful
as
possible.
Again,
this
is
not
a
a
front-end
Health
Care
Service
right.
J
It's
about
that
sort
of
wraparound
care
to
make
sure
that
the
patient
and
members
are
taken
care
of.
So
in
the
process
of
this
Linda
Cara
understood
that
Linda
has
been
having
a
number
of
manic
episodes.
She's
lost
her
children,
she's
lost
her
job.
Her
father
has
requested
a
mental
inquest
warrant,
essentially
to
get
CPS
to
take
care
of
the
kids
in
the
interim.
J
So
as
part
of
this
process,
our
staff
working
with
her
and
her
providers
were
able
to
get
her
access
to
Abilify
or
you
know,
drug
therapy.
In
order
to
help
you
know
manage
this
condition.
This
is
a
real
life
scenario.
J
Right
so
Linda
is
got
she's
apprehensive
about
taking
medication,
she's
apprehensive
about
an
injection,
and
for
me
or
you,
you
know,
maybe
that's
not
such
a
big,
but
for
her
it's
the
difference
of
her
getting
her
children,
it's
the
difference
of
her
getting
her
job,
and
so
our
staff's
able
to
kind
of
hold
her
hands
coach.
J
Her
talk
through
the
process
and
eventually
get
her
comfortable
with
having
an
injection
not
only
that,
but
through
the
process,
eventually
coming
to
terms
that,
in
fact,
maintaining
some
sort
of
compliance
with
her
drug
therapy
is
what's
going
to
make
the
difference
of
her
being
able
to
manage
her
family
enter,
enter
her
challenge
with
bipolar
disorder,
so
long
story
in
the
end.
J
This
is
just
a
good
example
of
where
we're
able
to
coach
her
through
the
process
of
being
able
to
take
her
medication
and
therapy,
ultimately
resulting
in
a
good
outcome
in
the
scenario
where
she's
getting
custody
of
her
children
and
regaining
her
her
job.
Now
this
is
not
really
a
Molina
story
per
se.
J
It's
really
a
Managed
Care
story
and
I
say
that,
because
all
of
us
do
similar
types
of
services
and
offerings
to
make
sure
that
we're
taking
care
of
our
members
and
hopefully
avoiding
unnecessary
care,
which
would
have
been
certainly
another
inpatient
admission.
So
in
any
case,
it's
helpful
to
remember
that
we're
focused
our
job.
The
whole
purpose
of
our
being
is
to
make
sure
that
we're
taking
care
of
our
members
just
a
couple
comments
here.
I
think
you've
seen
most
of
this,
but
I
just
want
to
comment
on
a
couple
things
here.
J
One
the
the
word
Hospital
in
the
bottom
right
is
a
little
bit
of
a
misnomer.
It's
more
like
facilities
than
I'd,
say
hospitals,
but
we
have
a
little
over
700
employees
and
that's
important
for
a
couple
reasons,
but
mainly
the
main
point
I
want
to
make
sure
you
guys
know
is
that
we're
hiring
Molina
is
hiring
we're
hiring
hundreds
of
additional
folks.
J
You
may
have
seen
some
of
this
I'll
make
sure
that
you
get
the
notices
of
our
job
fairs,
that
we're
doing,
but
in
particular
a
number
of
our
folks
can
work
remote
and,
as
a
result,
it's
a
great
opportunity,
particularly
for
our
folks
in
rural
Kentucky,
that
have
now
have
an
opportunity
to
work
for
our
organization
that
maybe
didn't
have
that
opportunity
before
so.
I
want
to
make
sure
that
our
people
outside
of
Louisville
appreciate
the
opportunity
here
to
work
for
the
managed
care
companies
and,
in
particular,
Molina
go
ahead.
J
Finally,
just
a
little
snapshot,
so
you
know
a
little
bit
about
where
we
are.
As
you
see,
some
67
68
of
our
membership
is
in
and
around
Region
Three
and
in
particular
the
greater
Louisville
area.
I.
Think.
As
you
know,
this
has
been
a
historical
footprint
for
passport,
and
then
you
know
really
where
we're
trying
to
go
Is
our
commitment
to
the
Commonwealth
to
get
outside
of
Louisville
and
grow
further
out
into
the
more
rural
parts
of
the
state.
J
I
just
want
to
comment
that
I
personally
have
an
obligation
and
feel
a
sense
of
commitment
to
get
out
of
Louisville,
not
because
there's
any
ill
will
with
Louisville.
But
the
fact
of
the
matter
is
we
provide
excellent
service
to
our
folks
in
Louisville
and
I
expect
that
every
person
in
this
Commonwealth
deserves
the
same
access
to
this
to
the
pro
to
the
services
that
we
provide,
whether
they
be
in
Louisville
or
east
or
west
Kentucky.
J
So
we'll
run
through
the
agenda
questions
just
as
the
other
mcos
have
done,
and
I'll
turn
it
over
now
to
Nicole
who
handles
all
of
our
Network
and
operations.
H
Thank
you
Ryan,
as
Ryan
said,
I'm,
the
vice
president
for
network
and
operations,
and
we
appreciate
the
opportunity
to
be
here
and
talk
to
you
today
a
little
bit
about
what
we
do
every
day
in
the
trenches
network.
Adequacy
is
one
of
the
top
priorities
for
our
plan
and
since
we
purchased
passport
and
began
implementation
on
Molina's
systems
in
2020,
our
philosophy
is
around
securing
our
Network.
Around
Security
in
our
network
has
been
to
secure
a
dynamic
Network
that
provides
quality
care
for
our
members.
H
It's
really
important
that
we
focus
on
the
quality
of
care
for
the
members
that
we
have
to
successfully
achieve
this.
We
must
keep
a
few
principles
in
mind
that
I
have
my
staff
in
the
back
of
their
mind
every
day
as
they
work,
the
network
has
to
be
Broad
and
serve
the
diverse
population
that
we
have
in
this
state,
both
from
rural
and
urban
settings.
The
relationship
with
providers
must
go
beyond
securing
a
signature
on
a
contract.
It's
really
important
that
we
don't
just
get
signature
contract
and
move
on
from
there.
H
H
Any
credential
provider
is
welcome
in
our
Network.
We
don't
have
any
any
restrictions
other
than
you
have
to
be
credentialed
to
participate,
Molina
actively,
analyzes
the
end,
every
indicator
which
highlights
any
potential
Gap
or
opportunity
that
we
may
have
to
enhance
our
Network.
The
graphic
you
see
on
the
right
of
the
PowerPoint
is
just
an
abbreviated
outline
of
the
ongoing
monitoring
activities
that
we
do.
H
These
are
just
a
few
of
the
levers
that
we
pull
every
month
and
again,
there's
some
frequency
to
them,
so
they
get
pulled
at
different
intervals,
but
these
are
just
a
few
of
the
levers
I'm
going
to
just
highlight
just
a
few
of
them.
The
first
one
is
looking
at
provider
out
of
network
treatment,
single
case
agreements
looking
at
both
of
those
helps
us
determine
whether
again
there's
a
potential
Gap
in
service
for
a
particular
area
or
whether
we
need
to
help
a
member
get.
You
know,
redirected
to
another
service.
H
H
We
look
at
geoaccess
reports
which
plots
members
and
providers
across
our
state
to
see
it
gives
a
pretty
evident
picture
of
where
there
could
potentially
be
gaps
and
then
the
last
one
I'll
point
out
is
our
cap
survey
again.
There's
many
levers,
but
I
wanted
to
point
out
the
cap
survey,
because
that's
a
member
satisfaction,
survey
around
provider
appointment
times
and
provider
interactions
with
members
and
their
satisfaction
with
that
on
our
last
cap
survey
passport
achieved
an
overall
star
rating
of
4.5.
H
You
know
what
I'll
say
is
you
know
nobody
really
wants
to
show
your
Awards,
but
the
the
bottom
line
is
utilizing.
These
members
helps
us
identify
the
gaps
and
just
for
an
example,
last
month
in
Region
8,
because
of
some
of
these
levers,
we
were
able
to
identify
a
gap
in
it
for
oral
surgeons
in
Bell,
County
and
addiction,
ology
aprns
in
Floyd
and
Pike,
both
of
which
we've
been
able
to
address
by
going
out
and
getting
new
new
contracts
for
providers
in
those
areas
that
hadn't
before
been
a
challenge.
For
us.
H
What
I'll
say
to
you
is
these
levers
are
not
unique
to
Molina
I'm,
not
up
here
telling
you
anything
about
some
Secret
Sauce.
That
Molina
has
every
MCO
uses
these
levers
and
should,
in
some
version
to
identify
gaps,
I
believe
what
is
unique
to
passport,
and
what
sets
us
apart
is
our
engagement
of
a
team.
We've
stood
up
called
a
concierge
team,
which
is
out
there
to
remove
barriers
for
both
providers
and
members
when
special
needs
arise.
H
We
had
a
situation
with
a
member
who
needed
a
stretcher
to
be
transported,
as
you
know,
during
the
covid
period
Staffing,
just
just
like
the
cabinet
and
everybody
else.
Staffing
was
a
concern
for
all
of
us
and
as
it
is
for
our
partners,
and
so
they
had
a
staffing
shortage,
which
meant
a
scheduling
issue
for
getting
non-emergent
transportation
for
this
particular
member
to
their
treatment.
Very
significant,
important
treatment,
non-emergent,
obviously-
and
so
our
concierge
team
was
able
to
do
all
the
coordination
and
I
call
it
the
dance.
H
They
did
the
dance
to
make
sure
this
member
ever
got
to
their
appointment
and
that's
the
specialized
treatment.
This
team
does
to
overcome
those
types
of
barriers
and
make
sure
and
again
then
we
have
to
go,
look
and
see.
How
else
can
we
support
them?
So
we've
handled
this
instance,
but
then
what
do
we
do
in
the
long
term?
And
that's
the
piece
that
continues
to
be
a
part
of
our
conversations?
H
H
So,
as
I
said
earlier,
it
can't
just
be
about
the
ink
on
the
paper
for
providers
in
gaining
and
network
access
and
checking
the
box
that
were
sufficient.
Our
approach
to
network
adequacy
isn't
limited
to
a
partnership
in
the
traditional
sense.
It's
not
enough
to
contract
with
a
provider.
We've
got
to
continue
to
maintain
these
relationships.
H
We
focus
on
delivering
the
basics.
We
want
to
make
sure
payments
are
prompt
that
we're
doing
direct
and
supplemental
payments
that
we're
submitting
encounters
properly.
So
our
fqhcs
and
rhcs
can
get
their
wrap
payments
and
addressing
issues
as
they
come
up.
I'd
like
to
say
everybody's
perfect,
but
it
just
isn't
the
case.
Issues
are
going
to
arise,
the
difference
I
think
for
us
and
for
us
you
know,
as
it
relates
to
some
of
our
peers,
is
our
ability
to
rectify
that
in
a
timely
manner.
H
H
We
actually
have
partnered
with
other
mcos,
to
participate
in
joint
wrap
meetings
so
that
we
can
collaborate
for
a
more
streamlined
solution
for
these
wrap
payments
for
fqhcs
and
rhcs
I.
Think
we
all
understand.
That's
been
a
challenge
for
a
while
for
the
state
and
I
was
previously
to
another
MCO.
It's
not
new
news.
We
just
have
to
get
a
better
solution
at
the
end
of
the
day.
For
those
this
year,
passport
by
Molina
has
implemented
a
PCP
focused
performance-based
agreement.
We
implemented
models,
including
some
shared
savings
models
which
are
heavily
geared
towards
providers.
H
H
The
agreements
we
already
have
in
place,
which
are
today
covers
about
51
percent
of
our
membership,
is
already
seeing
some
improvements
around
medication,
adherence
and
I
think
in
the
in
the
world
of
covid.
That's
that's
a
pretty
spectacular
Improvement
again
and
that's
about
the
partnership
between
us
and
the
providers
with
those
agreements.
H
These
models
are
most
specifically
important
to
our
rural
communities,
our
partnership
with
kpca,
which
I'm
sure
you're
all
familiar
with.
Will
it
ensures
the
inclusion
of
key
fqhc's
rural
clinics,
dental
schools
and
then
other
school-based
providers
with
kpca.
It
offers
a
performance-based
model
with
the
goal
of
encouraging
and
preventing
wellness
and
prevent
preventative
activities,
improving
outcomes
and
managing
costs.
It
incorporates
education
programs
for
both
our
providers
and
members.
We
engage
as
a
partner
data
analysis
and
data
sharing
in
support
of
better
outcomes.
H
We
offer
this
kpca
example.
It
is
just
an
example,
but
the
performance
strategy
is
foundational
to
to
passports,
provider,
experience
and
again
we're
in
the
very
early
stages
of
the
execution.
We're
excited
to
see
where
these
are
going
and,
finally,
I
will
mention
our
One-Stop
shops.
We
have
six
across
the
Commonwealth
Lexington
Covington,
Louisville,
Owensboro,
Bowling,
Green
and
Hazard
Dr
Hannah
will
provide
more
insight
into
these
centers.
But
briefly,
our
One-Stop
centers
serve
to
augment
the
rural
communities
by
offering
us
a
host
of
resources
both
for
members
and
providers.
H
H
I
know
we
may
be
running
a
little
short
on
time,
so
I'll
just
briefly
talk
about.
You
know:
we've
chosen
to
engage
with
these
organizations
because
of
their
diligent
work
in
the
communities,
their
goal.
In
a
mission
that's
aligned
with
us
to
address
social
determinants
of
health
and
food,
such
as
food
insecurities
and
Rural
health
challenges,
our
Partnerships
go
beyond
a
financial
contribution,
it's
important
to
Ryan,
as
he's
you
know
shared
with
all
of
us
in
leadership
that
we
must
contribute
not
only
our
time
and
talent
in
addition
to
the
dollars.
H
You
know
we
acknowledge
that,
even
though
we
have
a
strong
Network
that
we
still
have
challenges
across
the
state
in
especially
in
our
rural
areas,
around
Physicians
or
sorry
should
provider
shortages
in
oral
surgeons,
dental
and
Behavioral
Health.
We
continue
to
try
to
solve
for
those
issues
it's
going
to
take
all
of
us.
You
know,
probably
all
the
mcos
at
the
table
to
work
together
to
address
these
shortages
in
the
rural
communities,
and
you
know
passport
continues
to
seek
additional
innovative
ideas
with
our
partners
in
support
of
this
growth.
J
K
So
the
the
next
question
that
you
asked
were
what
specific
initiative
initiatives
are
we
undertaking
to
improve
the
health
of
the
Medicaid
population
in
Kentucky?
I
want
to
talk
about
two
things:
our
community
outreach
team,
Community
engagement,
team,
our
Specialized,
Care,
Management,
Programs
education
is
sort
of
a
basic
building
block
for
improving
People's
Health
and
we
deliver
health
information
at
things
like
health
fairs
and
similar
activities
across
the
state.
K
But
in
addition
to
that,
we
conduct
member
specific
health
education
classes
that
address
things
like
Diet
exercise
and
disease
management
in
person,
and
then
we
offer
those
on
a
daily
basis,
virtually
they're
offered
in
both
English
and
Spanish
and
Nicole's
already
mentioned
our
One-Stop
Health
Centers
to
make
Services
more
accessible.
We
have
information
there
where
people
can
learn
more
about
their
health
coverage.
Government
services
Community
Resources,
but
we
also
are
helping
people
with
job
applications
and
job
opportunities.
We
provide
free
computers
and
Wi-Fi
access
to
our
members.
K
There
are
programs
in
really
across
the
state,
Nami
and
Kentucky
Refugee,
Ministries,
Catholics,
Charities,
and
so
on
that
we
work
with
in
Partnership
to
address
needs
mostly
around
things
like
food
insecurity,
housing
and
other
concrete
needs
that
people
have
and
and
then
we
have
Specialized
Care
Management
Programs,
and
these
are
our
programs,
where
we
reach
out
to
members
with
our
clinical
staff
with
people
who
have
identified,
needs
that
increase
the
health
risk
for
them,
and
we
do
things
like
we
identify
people
who
are
using
the
emergency
department,
a
lot
and
Outreach
them
to
see
if
we
can
help
get
them
connected
with
appropriate
care,
and
we
have
what
we
call
models
of
care.
K
These
are
where
case
managers
with
specialized
training
and
things
like
high
risk,
pregnancy
or
severe
mental
illness
where
they
can
excuse
me
reach
out
to
people
with
special
resources
to
help
them
in
managing
their
condition,
and
to
give
you
just
one
example,
and
we
can
move
that
forward.
I,
don't
have
the
mouse
here,
but
we
of
what
we've
been
able
to
do
with
using
both
our
community
based
staff
and
our
clinical
programs.
We
have
been
quite
successful
in
seeing
the
number
of
Medicaid
members
get
their
coveted
vaccinations.
K
J
I
could
just
interrupt
real
quick.
That
number
is
actually
just
gotten
over
47,
so
I'm
actually
excited
to
see.
There's
ongoing
uptick,
despite
the
fact
that
we
are
well
removed
from
the
sort
of
heightened
sense
of
urgency
for
vaccines,
but
it's
something
we
continue
to
pound
on,
because
we
do
think
it's
important
and
you
know
it's
not
it's
not
gone
from
us.
Yet.
J
K
It
is
the
reality
is
that
on
average,
14
of
our
members
leave
within
three
days
of
starting
substance.
Use
treatment
and
only
25
percent
Who
start
make
it
to
two
weeks.
But
as
I
said,
this
is
an
average.
In
fact,
when
we
look
at
our
data,
we
see
some
providers
doing
an
excellent
job
of
engaging
members
in
treatment
and
others
are
struggling
in
that
area
and
we
we
are
able
to
use
that
to
help
direct
people
to
places
where
they
have
a
better
chance
of
being
engaged
in
treatment
and
across
all
the
sud
Services.
K
We
cover
we
use
things
like
lengths
of
stay.
Whether
individuals
are
stepping
down
to
lower
levels
of
care
as
they
complete
more
intense
treatment,
whether
or
not
they're
returning
for
the
same
treatment
service
right
after
discharge
to
monitor
the
effectiveness
of
the
services
we
cover
and
second
there's
utilization
management.
Now
I
work
for
a
Community
Mental,
Health
Center
for
nearly
30
years
and
before
I
came
to
work
for
a
managed
care
company.
K
I
thought
that
the
only
purpose
of
was
to
limit
services
in
an
attempt
to
limit
the
dollar
spent,
but
I
thought
that,
because
I
didn't
actually
know
what
was
being
done
inside
a
managed
care
company,
our
staff
are
in-house
at
Molina
and
fully
integrated
with
our
clinical
team
and
because
we
only
conduct
utilization
Management
on
the
most
intense
Services
has
become
an
important
tool
for
identifying
members
who
are
not
benefiting
from
routine
levels
of
care
and,
furthermore,
utilization
management
requires
providers
to
do
an
assessment,
identify
a
clinical
plan
and
be
accountable
for
obtaining
outcomes.
K
According
to
that
plan
and
and
I
know,
this
is
a
pain
point
for
a
lot
of
people,
but
a
sound
function
gives
us
a
direct
line
of
sight
on
the
quality
of
care
that
our
members
are
receiving,
and
third,
there's
provider
and
member
relationships.
It's
harder
to
quantify
this.
K
Knowing
providers
gives
direct
information
on
the
quality
of
the
work,
that's
being
done,
and
similarly
our
case
management
staff
and
our
community
engagement
staff
talk
to
our
members
and
and
about
their
experiences
with
treatment
and
treatment
providers,
and
they
share
that.
We
share
all
that
internally
with
each
other
to
try
to
identify.
Where
is
the
best
place
for
people
to
get
care?
K
And
third,
you
ask:
what
are
the
strategies
for
ensuring
equity
in
health
care
delivery?
Equity
refers
to
making
sure
that
all
of
the
members
get
equal
benefit
from
our
coverage
and
services,
regardless
of
their
personal
characteristics
and
I
want
to
just
mention
four
things
that
we
do
in
this
area:
Care,
Connections
and
I'm,
going
to
come
back
to
that.
In
just
a
moment.
K
K
They're,
not
maybe
the
best
places
to
go
and-
and
one
of
our
peers
said
to
me
she
said:
I
will
go
anywhere
because
I
know
what
it's
like
to
be
in
a
place
where
I
couldn't
get
myself
where
to
a
place
where
I
could
get
help,
and
then
we
have
data-driven
Equity
focused
quality
initiatives.
I've
already
talked
a
little
bit
about
how
we
use
data
and
I'm
just
going
to
note
that
we
can
similarly
look
at
personal
characteristics
of
our
members
to
identify
whether
or
not
we're
getting
Equitable
outcomes.
K
It's
just
one
example:
we
have
a
project
underway
right
now
addressing
Diabetes
Care
among
individuals
with
substance
use
disorders,
because
we
noticed
that,
even
though
the
members
were
getting
connected
with
substance
use
treatment,
there
didn't
seem
to
be
the
kinds
of
changes
in
there,
a
diabetes
management
that
we
would
have
expected
when
they
got
connected
with
care,
and
so
we're
we're
focused
on
that
and
we
can
go
into
the
next
slide.
I'm
going
to
tell
you
a
little
bit
more
about
our
Care
Connections
program.
K
This
provides
services
in
members,
homes
or
other
convenient
locations
to
address
gaps
in
care.
Now,
to
be
sure,
our
preference
is
always
to
connect
people
to
local
providers,
but
when
that's
not
possible,
this
team
can
help
fill
in
gaps.
You
can
see
that
we
have
nurse
practitioners
located
across
the
state
from
Owensboro
and
Litchfield
to
Ashland
and
there's
more
information
on
the
slide.
K
K
We
have
a
team
of
four
and
soon
to
be
five
housing
support,
Specialists,
they're
handling
about
75
housing
referrals
a
month
in
Louisville,
where
you
know
we
have
a
large
membership.
We've
developed
our
unique
partnership
with
the
local
Housing
Authority
that
has
allowed
us
to
use
emergency
housing
vouchers
to
house
51,
passport
households,
and
we
are
now
exploring
how
we
can
expand
that
model
across
the
state,
we're
having
some
conversations
down
in
Bowling
Green
and
we're
excited
about
how
that
might
move
forward.
And
so
thank
you
for
your
time
and
I'll
turn.
J
If
it's
all
right,
I'll,
just
close
briefly
and
then
happy
to
take
any
questions
you
may
have.
The
first
thing
I
wanted
to
mention
relative
to
Health
Equity
is
just
I
want
to
call
out
some
of
the
great
services
that
the
mcos
have
been
doing,
particularly
around
our
Disaster
Recovery
efforts
and
in
particular,
most
recently
in
Eastern,
Kentucky
I.
Just
I
want
you
to
know.
J
Unfortunately,
a
number
of
times
just
in
the
last
couple
of
years
here,
but
when
bad
things
happen,
your
mcos
go
to
work
and
it's
not
it's
not
just
Molina
I
mean
it
is
a
shared
effort
and
we're
able
to
you
know
waive
prior
authorizations
immediately
we're
able
to
allow
for
emergency
refills
when
people
are
losing
medications
and
we're
calling
and
outreaching
to
folks
that
are
taking
that
have
refrigerated
drug
products,
because
you
know
if
they
lost
their
power,
then
they
may
lose
their
drug
product.
J
We're
able
to
deploy
all
sorts
of
resources,
whether
it
be
office,
supplies
or
or
just
a
helping
hand,
not
to
mention
our
staff.
The
thousands
of
staff
that
work
in
Managed
Care
in
the
state
are
able
to
be
deployed
and
go
support,
folks,
whether
it's
just
cleaning
up
debris
or
whether
it's
you
know
filling
out,
applications
for
FEMA
support
and
the
like.
J
So
I
just
want
you
to
know
that
not
only
Molina,
but
all
the
mcos
are
committed
to
doing
their
part
to
support
this
community
and
make
sure
that
that
Equity
is
connected
and
and
finally
I'll
mention
it's
not
lost
on
us
that
we
at
Molina
work
for
the
administration.
We
work
for
the
cabinet,
we
work
for
you
and
it's
an
honor
to
be
here
at
this
table.
It's
a
privilege
and
it's
not
something
that
we
take
lightly.
It's
not
always
perfect,
but
I
want
you
to
know.
J
You've
got
a
partner
in
us
that
you
can
trust
to
do
the
right
thing
and
to
take
care
of
the
members
that
we
serve
and
I
hope.
We
continue
to
earn
that
opportunity.
So
in
my
last
comment,
just
as
a
follow-up
Senator
Meredith,
we
had
spoken
last
week
about
an
emergency
room
project
that
we're
doing
and
I
wanted.
To
give
you
a
brief
update
on
that.
J
So
two
things
one
is
that
this
has
been
a
collaborative
process
with
the
providers
with
the
department
and,
of
course,
our
own
organization
trying
to
understand
which
claims
and
which
services
are
emergent
or
non-emergent.
And,
as
we
talked
about
the
the
focus
is
making
sure
that
we're
changing
this
systemic
cultural
Habit
of
Medicaid
patients
consistently
getting
care
in
the
ER
right.
And
so
we've
got
to
do
something
about
that.
J
And
so
one
of
the
things
that
we're
looking
at
in
this
process
is
how
do
we
make
sure
that
emergency
rooms
are
are
reserved
for
emergency
care,
and
so
anyway,
we're
just
going
through
that
audit
process.
Now
and
again
we're
working
collaboratively
with
the
parties
to
try
to
figure
out
what
is
emergency
care
and
what
is
not,
and
the
most
recent
part
of
that
process
is
that
the
department
asked
us
to
put
that
on
hold.
While
we
further
investigate
and
regroup
to
figure
out
the
right.
J
C
You
very
much
we
appreciate
your
time
co-chair
Meredith.
D
Thank
you,
culture,
Elliott,
and
appreciate
your
presentation.
As
Mr
Sadler
said,
we
had
a
conversation
last
week
about
this
initiative,
I'm
glad
to
hear
that
you're
putting
it
on
hold
and
we
talked
about
doing
a
reboot
on
this
and
I.
Don't
think
we
can
fairly
say
that
it
was
a
collaborative
relationship
in
the
beginning
and
to
bring
everybody
up
to
speed.
I
think
there
was
a
quest
request
for
something
between
16
and
20
000
reviews,
retrospective
reviews
of
of
er
visits,
CD
visits
in
obviously
that's
concerning.
You
know.
D
Since
I
came
to
this
committee,
I've
preached
that
I
truly
believe
there's
enough
money
in
the
health
care
delivery
system
in
the
United
States
to
take
care
of
a
man
and
woman
child
in
this
country.
We
spend
it
most
effectively
and
one
of
the
issues
that
that
drives
inefficiencies
is
the
bureaucracy
around
Health
Care
president
we're
spending
16
cents
of
every
dollar,
just
on
Administration
double
what
other
nations
are
doing,
and
this
particular
issue
that
you're
talking
about.
D
If
we're
asking
hospitals
to
retrospectively
pull
charge
for
16
to
20
000
visits,
that's
a
tremendous
bureaucratic
burden,
particularly
for
small
rural
hospitals
and
I.
Don't
understand
why
this
can't
be
a
a
concurrent
review
rather
than
a
retrospective
many
many
months
afterwards
and
I.
Think
it's
interesting
that
you
know
the
letter
that
was
sent
out
to
Providers
came
from
Washington
DC.
The
cost
Recovery
Unit
I
would
think
the
more
appropriate
places
should
come
from
is
a
utilization
review
group,
because
I
mean
just
just
the
very
entitle
of
that
division.
D
Cost
recovery
says
we're
going
to
take
money
back
and
again.
It
concerns
me
that
we're
not
doing
this
kind
of
concurrent
review,
like
other
mcos,
have
put
in
place
and
it's
going
to
place
a
tremendous
burden
on
providers
that
have
to
do
this,
particularly
if
they
have
to
appeal
those
claims
so
many
months,
possibly
even
years
in
in
retrospecting,
and
that's
just
not
a
good
process.
So
again,
I
appreciate
your
your
hearing.
Our
providers
I
appreciate
you
you're
hearing
me,
but
it's
those
type
of
measures
that
concern
me
I.
D
Think
I
speak
on
behalf
of
everybody
in
this
committee.
We
want
a
symbiotic
relationship
with
our
mcos
and
it's
no
secret
that
I
have
preached
since
I've
been
here.
I
think
we
have
too
many
I'll
still
yield
to
that.
But
if
you
folks
are
doing
a
good
job
which
should
be
measured
by
improving
the
health
of
our
population,
then
we're
going
to
see
benefits
from
that
I,
don't
think.
D
Historically,
we
have
I
think
we've
gotten
people's
attention
from
the
presentations
we've
heard
during
this
intercession
that
we
are
doing
things
differently,
but
I
think
we're
going
to
raise
the
bar
just
a
little
bit
more.
You
know,
I
appreciate
you
saying,
remember
the
member,
but
I
think
you
guys
also
have
remembered
the
provider,
because
that's
your
partner,
you
don't
deliver
care,
they
do
and
I.
D
Don't
think
that
anybody
truly
recognizes
a
disparity
between
Urban
Health,
Care
and
Rural
Health
Care,
Now
I
know
you
got
pockets
in
urban
areas
that
are
truly
medical
deserts,
but
it's
even
more
pronounced
in
rural
communities
and
to
say
that
one
size
fits
all.
It's
never
an
appropriate
assessment
situation.
There
are
unique
situations
in
rural
communities
that
keep
us
from
improving
the
health
of
population.
Unless
we're
really
willing
to
look
at
that,
I,
don't
know
where
we're
going
to
move
the
bubble
on
this.
D
I
think
there
may
be
stronger
measures
for
that,
but
I
don't
think
that
the
10-year
history
we've
seen
with
our
Managed
Care
Organization,
truly
supports
that
Managed
Care
has
done
a
good
job
in
Kentucky.
Now
again,
I
see
a
renewed
effort
to
try
to
do
better
and
I'm
optimistic
that
we
will,
but
we
can't
ignore
the
problems
that
continue
to
exist,
particularly
in
our
medical
deserts,
both
urban
and
rural
and
I'm
curious.
You
made
a
comment
about
it:
I
think
it
was
region.
Eight
you
were
able
to
bring
some
providers
to
the
table.
D
You
haven't
proved
I'm
curious
how
you
did
that,
because
I
again
I
think
that
the
providers
are
there
and
they're
hesitant
to
participate,
as
we
particularly
saw
Dental
Services
is
poor
reimbursement.
We
haven't
seen
an
increase
in
20
years.
Yeah
nobody's
going
to
do
that
business.
So
how
were
you
able
to
change
that
dynamic
in
that
particular
area?.
H
Yeah,
that's
just
one
area
that
we
were
able
to
secure
a
provider
in
in
that
region
that
we
had
not
previously
contracted
with
to
be
able
to
supplement
that
I
think
your
thoughts
are
spot
on
that
we
still
have
some
work
to
do
about
being
creative.
You
know
we
are
currently
looking
at
a
mobile
behavior
health
services
provider
who
can
go
around
to
some
of
the
areas
who
don't
have
that
in
their
region,
but
I
think
we
have
to
continue
those
conversations
about.
How
do
we
get
better
at
serving
those
areas?
H
Better
Telehealth,
you
know
better
internet,
so
people
can
get
Telehealth
ours.
You
know,
One-Stop
shops
are
able
to
provide
at
least
that,
but
then
you
have
to
again,
but
you
know
our
concierge
team
will
tell
you
you
got
to
make
sure
they
can
get
there.
You've
got
to
make
sure
they
get
feel
comfortable
coming
there
and
so
I
think
we
have
a
ways
to
go.
You
know
we
have
plans
to
kind
of
change.
H
The
landscape
I
hear
you,
you
know
I've
been
in
Medicaid
for
a
long
time
and
there's
been
an
evolution
of
change
on
focusing
you
know.
In
addition
to
Providers,
you
know
because
I
have
Network
and
Ops
I've
got
kind
of
a
unique
perspective
on
I've
got
to
get
them
contracted
I've
got
to
keep
them
happy
and
I've
got
to
make
sure
the
claims
are
paid.
You
know
when
the
disaster
hit
in
Eastern,
Kentucky
and
Western.
H
Frankly,
both
of
them
my
staff,
called
every
provider
affected
in
those
regions,
every
single
one
and
kept
calling
until
we
got
a
hold
of
somebody
not
just
because
you
know
we
wanted
to
make
sure
they
were
up
and
because
we
needed
to
tell
our
members
if
they
had
service.
But
how
are
you
doing?
What
can
we
help
you
with
you
know
and
as
we
went
through
especially
Eastern
Kentucky
went
through,
you
know
Mountain
comp
losing
every
piece
of
their
facility.
H
Yes,
people
needed,
you
know
life-sustaining
things,
water
and
blankets
and
food,
but
you
know
what
else
they
needed.
They
needed
office
supplies
to
be
able
to
do
charts
on
paper,
because
the
electronics
were
gone.
They
needed
solar
chargers
for
their
phones,
so
in
a
because
we
have
that
relationship
with
them
and
we're
able
to
call
and
say
what
do
you
need?
You
know
you're
going
to
get.
You
know,
Red
Cross
is
there
and
we've
already
sent
water
I
mean
day
one
Ryan
had
people
on
the
ground.
H
Helping
you
know,
try
to
establish
what
you
know
the
basic
needs
were
you
know
we
went
another
step
above
and
said:
what
else
do
you
need
and
we've
we
got
many
compliments
back
from
providers
saying
thanks
for
asking
about
me
and
it's
important
to
us
that
they
are
just
as
important
you're.
Absolutely
right.
We
don't
deliver
the
clinician
side
of
health
care,
but.
B
D
And
I
think
part
of
that
support
comes
from.
We've
got
a
thing
outside
the
box.
We
can't
do
things
the
traditional
ways:
we've
done
it.
You
know.
Folks
mobile
services
are
great,
but
it's
not
always
timely
and
from
what
I
hear
one
of
the
biggest
issues
that
Healthcare
Providers
have
is
transportation
for
patients
in
our
current
system.
You
know
you're
going
to
have
72
hours
notice
before
you
can
schedule
something
things
have
changed
a
lot
in
72
hours
and
is
there
a
different
way
to
do?
That
is
a
better
way
to
do
that.
I.
D
H
G
Thank
you,
Mr
chairman,
thank
you
for
the
presentation
and
I
the
news
about
housing
support
and
that's
news
to
me.
I
didn't
realize
that
you
guys
were
involved
in
that
we
heard
last
year
on
the
severe
mental
illness
task
force.
We
know
that
housing
is
such
a
tremendous
issue
for
folks
with
SMI
and
so
I'm
just
curious.
What
population
you're
serving
with
that
particular
part
of
your
work,
yeah.
J
I'll
teed
up
and
then
turn
it
over
to
Dr
Hannah
I.
So
we
have
housing,
Specialists
that
work
for
us
and
that's
the
job.
J
J
You
know
to
make
sure
that
they're
they
have
the
resources
and
environment
in
which
they
can
actually
focus
on
their
health
care
needs.
You
want
to
talk
a
little
bit
more
about
what
we've
done
and
by
the
way
I'm
super
proud
of
this,
because
we
have
helped
put
a
lot
of
people
into
a
in
an
environment
where
they
can,
for
the
first
time
in
a
while,
have
had
a
roof
over
their
head.
K
Yes,
I
I
have
to
say
for
I'm
not
doing
this
at
my
current
role,
but
last
year
before
I
became
the
BH
director
I
actually
sat
in
when
we
were
reviewing
the
housing
support.
Referrals
and
I've
worked
in
a
publicly
funded
health
care
for
40
years
and
I
I
wouldn't
have
thought.
I
was
naive,
but
the
the
housing
crisis
across
the
state
is
just
astonishing
to
me,
and
we
have
really
worked
to
for
our
staff
to
understand
what
that
system
is
and
how
to
help
people
get
housed.
K
And
then
we
we
accept
referrals
on
any
member
there's
where
it's.
This
is
not
targeted
only
to
people
with
a
certain
category
of
illness.
People
have
a
housing
need,
they
can
get
connected
with
a
housing
support,
specialist
and
we're
trying
to
work
with
Community
organizations
to
develop
housing
options.
Now
you
know
we're
not
building
housing,
obviously,
and
in
many
places
there
are
serious
obstacles
to
finding
something.
But
but
we
have
been
successful
and
you
know
you're
always
trying
to
figure
out.
K
I
think
all
of
the
the
mcos
were
given
an
opportunity
to
get
involved
in
that,
but
we
stepped
up
with
staff
who
would
actually
help
work
with
the
member
to
get
through
the
housing
process
and-
and
that's
why
we
have
this
relationship
with
the
Housing
Authority
in
Louisville,
because
we've
been
willing
to
put
people
on
the
street
to
actually
walk
people
through
the
process,
and
we
want
to
work
with
other
people
in
other
parts
of
the
state
to
develop
that
that
model,
so
that
we
can
help
people
get
housing
because
we
I
I
mean
there's
just
no
doubt
that
once
people
are
housed,
lots
of
problems
go
away.
K
We've
tracked
I
mentioned
earlier.
We
track
emergency
room
usage
closely
and
there's
lots
of
reasons
why
people
don't
use
the
emergency
room
appropriately.
But
one
of
those
reasons
is
that
it's
cold
outside
and
they're,
hungry
and
and
I
actually
have
I
can't
remember
where
this
happened.
But
sometime
in
the
past
year,
I
was
talking
to
somebody
who
didn't
know
what
I
did
and
he
told
me
how,
when
he
was
homeless,
how
he
would
go
to
the
emergency
room
to
get
warm
and
I
thought.
C
G
G
G
Okay,
I'm
gonna
try
to
do
two
things
at
once
here,
so
thank
you
again
for
the
invitation
to
just
come
and
talk
about
the
center,
and
these
were
the
questions
that
you
gave
me
that
you
wanted
me
to
talk
about
today
and
as
we
go
through
the
slides,
I
hope
we
can
hit
each
and
every
Point
and
then
take
questions
that
you
might
have
for
us.
G
G
It
was
very
important
to
hire
community
health
workers
from
the
community
that
they
were
going
to
serve
so
that
they
understood
the
community.
They
knew
how
to
talk
to
the
community.
They
were
of
that
community
and
understood
where
people
were
coming
from
very
important
that
they
served.
G
There
I
think
it's
very
important
to
note
that
we
call
them
community
health
workers
for
a
reason
they
are
of
the
community
for
the
community
and
as
some
of
the
language
that
we
are
hearing
now
in
the
bill
that
was
passed,
I
don't
want
us
to
take
the
community
out
of
community
health
workers.
So
that's
what
I'm
going
to
talk
about
here,
so
we
are
located
in
Eastern
Kentucky
and
at
one
time
we
were
across
the
state.
We
were
at
the
other
end
in
West
Kentucky.
G
We
also
I
wanted
to
bring
a
point
that
where
we
are
located
is
where
the
floods
hit
so
hard
in
Eastern
Kentucky,
our
community
health
workers
were
the
first
ones
on
the
ground
to
assist
people
that
were
flooded.
They
needed
many
things
and
they
couldn't
wait
for
others
to
come.
They
needed
their
eyeglasses
when
you
go
to
sleep
at
night
and
you
put
your
eyeglasses
on
your
night
table
or
your
dentures
or
things
like
that.
That
are
that
you
need
to
do
for
daily
living
when
the
waters
came
in
so
quickly.
G
Nobody
thought,
let's
get
our
glasses.
Let's
get
this.
Let's
get
that
it's,
let's
get
out
of
the
house
so
that
we
can
survive.
It
was
very
rushed
and
and
very
needed.
Community
health
workers
immediately
went
to
the
shelters
to
see
who
lost
their
medicine
to
see
who
lost
their
wheelchair,
who
lost
their
medical
equipment
that
they
needed
to
be
able
to
take
care
of
themselves,
and
they
did
a
great
job
doing
that
they
went
in
teams.
G
G
You
really
don't
know
how
that
affects
a
person
and
their
ability
to
be
healthy.
Most
important
is
that
communication
that
is
given
between
them
to
coordinate
their
care
between
them
and
the
provider.
It
might
be
that
you
tell
them
to
take
care
of
their
diabetes
they're,
a
new
diabetic.
They
didn't
hear
anything.
You
said,
except
I'm,
going
to
have
lose
my
vision,
my
I'm
going
to
lose
my
feet,
my
kidneys,
those
kind
of
things
they
didn't
hear
how
important
it
was
to
manage
their
diabetes.
G
So
the
other
side
of
that
is
just
to
be
an
advocate
for
the
person
that
they
serve
and
I
do
have
to
say
that
this
is
in
person
during
covid
or
chw's
had
to
adopt
a
way
to
be
safely
serving
the
people
that
they
served.
But
until
you
can
look
into
someone's
eyes
and
help
them
with
their
needs,
they
don't
necessarily
walk
into
the
doctor's
office
and
say:
hey
I,
don't
have
running
water.
I,
don't
have
food
in
my
refrigerator.
G
G
Look
at
that
to
see
what
the
trends
are
and
how
we
need
to
help
the
individuals
and
what
the
community
needs
are
at
that
time
and
again,
I
want
to
make
sure
that
we
don't
take
the
community
out
of
the
community
health
worker
and
how
important
that
is
so
with
the
Medicaid
clients,
out
of
the
5
000
that
we
saw
last
year
that
we
served
over,
half
of
them
were
insured
through
Kentucky
Medicaid
Kentucky
Home
places,
Services
more
than
half
of
the
services
were
provided
to
Kentucky
Medicaid
members
through
Kentucky
Home,
Place
three-point,
3.5
million
dollars
in
service
value
to
our
our
Kentucky
Home
Place
clients.
G
More
than
half
of
that
was
Kentucky
Medicaid
members.
The
time
spent
through
coordination,
the
hours
more
than
half
the
hours
were
spent
on
Medicaid
members,
Kentucky
Home
Place,
provided
over
9.9
million
in
medication
values.
Over
half
of
that
was
with
Kentucky
Medicaid
members.
I
just
want
to
make
sure
that
we
receive
referrals
from
all
of
the
mcos
to
do
the
work
in
the
community
as
far
as
accessing
the
things
that
people
need.
I
want
to
make
sure
that
that
is
shown
here,
that
over
half
the
members
receive
those
care
that
care.
I
So
our
our
training
has
been
25
years
in
the
making
and
it's
evolving,
as
as
the
changes
in
health
care
come
about.
Not
only
do
we
train
our
internal
folks,
but
we
train
people
across
the
state
with
different
different
agencies,
so
it
was.
It
was
developed
in
consultation
with
health
providers
and
and
experienced
chws,
so
the
center's
role
in
training
community
health
workers.
We
actually
serve
as
one
of
the
two
tier
one
Community
Health
worker
training,
centers
recognized
by
the
State
Office
of
community
health
workers
in
Kentucky.
I
It's
us
and
a
can
and
like
I
mentioned,
we
train
people
with
a
lot
of
a
lot
of
different
agencies.
Health
departments,
mcos
clinics
will
send
community
health
workers
to
us
for
training
and
once
they
complete
our
training,
then
they
can
sit
for
apply
for
state
certification
and
then
also
new
to
us.
We're
working
on
having
external
agencies
come
in
and
do
the
mentorship
with
our
experienced
community
health
workers
and
some
of
our
community
health
workers
have
been
with
the
program.
Over
25
years.
I
We've
got
two
that
have
been
with
the
program
25
years,
so
there's
a
wealth
of
knowledge
that
they
have
to
share.
One
tried
to
retire
and
I'm
I'm,
not
letting
her
so.
I
So
our
additional
trainings
there
on
our
community
health
workers
receive
in
along
with
that
is
chronic
disease,
self-management,
training
and
diabetes
self-management
and
that's
through
self-management,
Resource
Center
used
to
be
Stanford,
University,
Mental,
Health,
First,
Aid,
training,
Suicide,
Prevention,
CPR,
Wellness,
Recovery
plan
tobacco,
cessation
programs,
and
then
they
go
through
a
lot
of
training
with
the
Kentucky
prescription,
assistance
program
so
and
and
then
lastly,
there
they
all
serve
as
connectors.
I
So
that's
a
that's
a
big
help
when
a
lot
of
people
you
know,
maybe
they
they
want
to
see
that
person
in
person
to
to
help
with
their
insurance
needs.
They
can
come
into
our
offices
and
work
with
somebody
right
there
locally.
G
I
do
want
to
add
to
that
base
that,
during
the
time
of
the
emergency
sign-in
for
people,
you
know
we
serve
those
counties
that
I
showed
you
on
the
map,
but
during
the
time
of
the
emergency
and
people
got
emergency
Medicaid.
We
also
trained
our
community
health
workers
to
do
that
for
the
state
and
they
did
not
just
keep
it
in
that
part
of
the
the
state
we
anyone
that
come
across
that
system
that
needed
that
service
home
place
did
provide
that
outside
air
service
area.
Due
to
the
emergency
and.
I
And
during
that
year
we
worked
remotely
during
that
year.
Actually
our
services
went
up
higher
than
the
year
previously,
so
they
bumped
up
a
little
bit
because
there's
a
lot
of
different
things
that
they
were
able
to
help
people
with
that
they're
just
not
able
to
navigate.
You
know
we
helped
with
with
PE
Medicaid
the
pandemic.
Food
benefits,
help
with
the
census,
help
with
just
a
lot
of
different
things,
stimulus
payment,
so
things
that
I
think
Senator
Carroll
mentioned.
I
G
Me
talk
just
a
little
bit
about
chronic
disease
F
Management
program.
They
are
when
they
finish
their
training
in
this.
They
are
certified,
lay
leaders.
That
means
they
can
conduct
the
classes
for
people
in
the
community,
and
we
get
many
referrals
from
the
hospitals,
the
clinics,
the
health
department,
different
folks
to
come
in
and
do
that
and
they
can
be
in
classes
of
six
to
12
people,
and
they
come
six
weeks
in
a
row
and
most
the
time
we
are
able
to
provide
like
Transportation
costs
for
them
to
come
and
do
those
trainings.
G
But
it
is
in
person
they
get
to
almost
learn
from
each
other
of
how
they
manage
their
diseases
and
particularly
with
diabetes
theft
management
program.
They
are
also
certified
lay
leaders
they
are
able
to
help
them,
make
sure
that
they
have
the
supplies
that
they
need
to
take
care
of
their
diabetes,
make
sure
they
have
their
medicine,
that
they
need
make
sure
they
understand
about
taking
care
of
Foot
Care
Eye
Care,
all
those
things
that
improve
their
health
outcomes.
I
Go
the
next
slide,
okay,
so
so
the
center's
role
in
training,
community
health
workers,
another
component
that
we're
doing
we've
taken
this
training
that
we
did
for
you,
know
Health
departments
and
things
like
that.
We've
taken
it
to
the
Community
College
level.
So
so
we've
have
students
that
come
over
to
the
vocational
school
they're
in
Hazard
and
they
go
through
this
same
training.
It's
just
a
little
more
drawn
out
and
we've
actually
had
during
the
pandemic.
I
We
had
two
graduates
and
then
this
most
recently
this
year,
we've
had
six
graduates
of
that
of
that
program
and
so
I
serve
as
adjunct
faculty
at
the
college
and
and
as
well
as
another
person
there
at
the
center
does
some
I.
G
I
And
this
is
a
continuation
of
that
slide.
That's
the
name
of
the
program
student
students
driving
toward
better
health
for
in
self
and
community,
and
you
can
see
our
partners
down
there
across
the
bottom:
Home
Place,
the
center
United
Healthcare
at
the
college
and
then
K-Tech,
and
so
they
they
receive.
This
is
tuition
free
for
the
students
and
once
they
complete
that,
then
they
can
apply
for
the
state
certification
for
chw.
So
we've
actually
got
one.
That's
came
back
last
year
and
was
working
for
us
just
right
now.
Currently.
G
I
do
want
to
say
the
important
thing
about
this
project
here
is
when
I
talk
to
some
people
about
how
we
can
improve
the
health
in
rural
Kentucky
I
said
we
have
to
start
somewhere
with
our
youth.
You
know
to
know,
if
preventative
Services
to
know
Prevention
Services,
because
their
grandparents
may
have
diabetes
their
parents
may
have
diabetes
for
an
example,
but
if
we
can
teach
our
high
school
students
how
to
manage
diabetes,
how
to
prevent
diabetes,
how
to
eat
properly,
how
to
exercise
those
things
that
can
improve
their
health.
G
Maybe
this
next
generation
won't
be
as
sick.
Maybe
we
can
reverse,
instead
of
parents
kids
dying
before
their
parents
do.
Maybe
we
can
turn
that
around
where
our
kids
are
living
longer
than
their
parents
again
and
it
it
seems
to
be
working?
They
some
of
the
feedback
I
got
from
the
students
when
they
graduate
was.
G
We
had
no
idea
that
we
could
prevent
this
or
that
we
could
do
this
and
how
important
it
is
to
eat
correctly,
how
important
it
is
to
and
when
you
look
at
poverty
and
and
how
you
can
take
advice
about
nutrition
and
how
you
can
stretch
those
dollars
to
eat,
eat
healthy,
that's
a
challenge
in
itself
and
I
have
many
stories.
I
could
tell
you
there.
We
don't
have
the
time
today,
but
we'll
move.
G
G
We've
been
members
of
that
of
the
community
health
worker
State
program
now,
as
it's
called
The
State
Office
of
community
health
workers
to
take
the
knowledge
and
skill
that
we
have
developed
over
the
last
27
years
to
be
able
to
not
start
from
the
beginning
of
things
to
build
upon.
What
we
know
has
worked
and
what
may
not
work.
G
I
do
have
some
concerns
here
in
the
bill,
as
far
as
it
is
reimbursable
to
community
health
workers
that
are
in
the
clinics
or
that
are
in
the
hospitals,
those
kind
of
things
that
will
help
with
improving
outcomes
that
help
the
clinics
improve
their
outcomes,
their
measures
that
they
need
to
do.
But
if
we
home
place,
would
not
be
considered
in
that
because
we
are
not
a
Medicaid
provider.
G
So
the
community
and
the
community
health
workers
are
needed
desperately.
Not
just
in
the
clinic,
so
that
is
one
concern.
I
have
about
the
reimbursement.
Where
does
that
lie,
and
how
do
we
get
people
still
in
the
system
to
get
them
to
the
clinics
to
get
them
to
the
places
that
they
need
to
be
without
doing
the
direction
that
we
do
in
home
place?
So
I
do
I
want
to
make
sure
that
that's
there
and
I'll
take
any
questions
after
after
this
in
a
minute
about
that.
L
I
want
to
thank
you
all
for
the
opportunity
to
kind
of
talk
a
little
bit
about
our
ship
program
and
that's
our
small
rural
Hospital
Improvement
program,
I.
Think
oftentimes.
Some
of
the
federal
programs
were
too
busy
doing
the
work
and
we
don't
really
explain
sort
of
what
we're
doing
and
what
what's
out
there.
So
I
do
appreciate
the
opportunity
here
to
sort
of
kick
it
off.
I
want
to
talk
a
little
bit
about
the
ship
program
in
general,
so
there's
an
annual
program
that
our
office
administers.
L
It's
funded
through
the
federal
office
of
rural
Health
policy
through
hersa,
and
it's
it
predates
me
so
it's
been.
This
program
has
been
funded
for
probably
up
to
20
years,
and
this
provides
small
rural
hospitals,
49
beds
or
less
with
an
allocation
of
funding
that
we
we
allocate
for
each
of
the
the
participating
hospitals
and
then
they
are
reimbursed.
L
So
if
we
look
back
in
the
last
round,
there
were
43
hospitals
across
the
state
they
each
applied
for
and
were
granted
around
10
grand
for
an
investment
of
around
433
000..
It
doesn't
sound
like
a
lot
of
money,
ten
thousand
dollars,
but
for
these
small
rural
hospitals,
the
way
that
they're
using
these
Investments
is
remarkable.
L
We
do
work
with
those
hospitals
to
look
at
approved
expenses.
On
page
two
of
document
one.
There
is
a
list
of
the
hospitals
that
are
currently
participating,
the
allowable
expenses.
We
can't
do
salaries,
we
can't
do
travel,
so
it's
really
into
increasing
operational
effectiveness
and
quality
at
those
smaller
facilities.
It
breaks
on
down
into
what
those
those
Investments
look
like
on
pages
three
and
four.
So
because
we
had
this
program
in
place
when
covid
hit,
there
was
a
mechanism
in
place
to
get
these
funds
out
to
the
rural
hospitals.
L
So
when
the
federal
office
of
rural
Health
policy
received
their
allotment
through
the
cares
act,
they
said
so
okay.
So
this
is
great.
We
have
these
funds,
so
how
are
we
going
to
get
those
out
to
the
hospitals
that
need
them,
and
these
hospitals
were
already
contacting
our
office
saying
we
need
help,
I
mean
we're
already
in
bad
shape
and
but
but
now
we're
you
know,
censuses
are
going
up
workforces
going
down.
We
need
help.
So
we
were
able
to
reach
out
to
all
eligible
hospitals
those
that
were
participating.
L
Hospitals
in
the
past,
plus
those
that
were
had
not
participated
in
the
program
in
the
in
previous
years
and
come
up
with
46
hospitals,
so
added
about
a
dozen
11
or
12
hospitals
to
the
mix
and
they
each
were
able
to
be
allotted
around
seventy
three
thousand
dollars
again.
This
was
money
that
that
came
through
the
University
to
our
office
and
we
were
able
to
push
out
immediately
to
the
hospitals.
So
this
was
not
something
that
took
six
months
a
year
to
get
to
the
hospitals.
L
This
was
in
a
matter
of
weeks
that
the
hospitals
received
these
checks
page
two.
The
document
two
lists
those
hospitals
that
were
participating.
That
program
has
since
closed
and
I'm
glad
to
say
a
hundred
percent
of
those
funds
were
spent
so
that
there
was
none
that
were
turned
back.
Those
expenses
were
broken
down.
We
had
a
menu
of
sorts
plus.
We
could
have
some
leverage
to
work
with
facilities
to
meet
their
immediate
needs
in
the
form
of
safety
response
and
maintenance
of
operations.
L
So
those
were
worked
brought
down
into
35
percent
in
safety,
42
percent,
in
a
response
and
23
percent
in
maintenance
of
operations.
Again
we
had
very
little
notice
if
it
hadn't
been
for
our
relationship
with
these
hospitals.
It
would
have
been
very
difficult
to
to
get
this
money
out
in
the
time
frame
that
we
did.
L
It
went
about
a
year
later
and
we
received
notice
again
in
a
expedited
fashion
in
July
of
21,
that
there
was
another
pot
of
funds
going
to
be
released,
and
so
we
reached
out
once
again
to
all
eligible
hospitals,
those
that
had
participated
in
the
past
and
those
that
hadn't
and
we
came
up
with
a
list
of
47.
This
was
in
about
a
week's
time
frame
that
we
received
commitment,
an
interesting
commitment
from
the
hospitals
to
participate.
L
Each
Hospital
received
around
a
quarter
million
dollars
that
that
was
sent
out
to
them
again
in
an
expedited
fashion.
It
was
prescriptive,
so
it
was
faced,
is
sort
of
limited
to
those
areas
of
testing
and
mitigation.
L
So
no
funds
could
be
used
for
the
purchase
of
vaccines
because
there
were
already
so
many
other
allocations
that
were
going
to
towards
vaccine
through
that
vaccine
hesitancy
and
such
we
are
finishing
up
that
project
right
now.
As
of
last
quarter,
32
percent
of
the
hospitals
have
fully
expended
those
funds
and
for
an
overall
66
percent
of
the
investment
has
been
spent
expended
at
this
time,
with
the
intent
that
all
funds
will
be
spent
by
the
end
of
the
calendar
year
again.
L
These
documents
are
here
for
a
little,
a
little
better,
deeper
overview,
I'm,
a
man
of
limited
words
and
so
I
think
Dr
Alvarado
can
attest
to
that
I'm,
I'm,
quick
and
to
the
point,
but
so
glad,
though,
to
be
able
to
share
this
program
and
would
love
to
to
share
additional
programs
that
we
offer
through
our
office.
The
collaboration
that
we
have
being
situated
in
the
Center
for
Rural
health
is
phenomenal.
Many
of
the
State
offices
of
rural
Health
Across,
the
Nation,
are
very
isolated
and
it
may
be
two
or
three
staff.
C
G
G
Some
of
our
counties
are
really
huge
and
there's
only
one
Community
Health
worker
in
that
county.
They
do
a
phenomenal
job,
but
it
is
a
big
burden
on
one
to
do
and
if
I
had
the
funds
there'd
be
community
health
workers
everywhere
that
work
in
the
community
to
help
the
people
like
home
places,
Never
Enough,
community
health
workers.
D
Thank
you
for
presentation
and
in
the
entrance
of
time
I'm
going
to
be
very
direct
with
you.
It's
going
to
sound
very
harsh
I,
don't
mean
it
to
be
very
critical,
but
you
know
in
looking
at
when
this
office
was
established
in
1991
I.
Think
your
best
responsibility
being
the
voice
for
Rural
health
care,
I,
look
at
your
website
and
what
we
do
list
and
I
see
a
lot
of
programs
that
are
certainly
great
programs,
but
they
seem
to
be
more
reactive
than
proactive
and
I
would
think.
D
If
you're
going
to
be
divorced
for
Rural
Health
Care,
it
needs
to
be
the
voice
of
real
Health
Care.
You
know
we
talk
about
things
like
direct
the
coordination
of
efforts
across
the
state
and
improval
health
I've
been
here
six
years
and
I,
don't
know
that
we've
ever
talked
about
that
before
participate
in
Statewide
planning
efforts
and
policy
analysis
specific
to
rural
health.
I,
don't
know
that
I've
ever
seen
any
type
of
report
on
that
act
as
a
liaison
between
state
and
federal
agencies.
D
You've
touched
on
that
a
little
bit
today
regarding
but
National
rural
health
issues,
but
I
haven't
seen
any
recommendations
as
how
to
address
those
issues.
You
know
recommended
actions
facilitate
rural
health
program,
development,
implementation
again,
I've,
never
seen
any
reported
recommendations
to
to
address
that
search
for
new
ways
to
help
recruit
and
retain
high
quality
health
care,
professional
rural
areas.
D
You
know
what
you
folks
are
doing,
certainly
good,
but
it's
it's
not
she'll,
say
Innovative
is
now
sat
out
of
the
box
and
I
guess
what
I
would
expect
is
I
want
you
folks
to
be
more
of
a
voice
if
you're
limited
because
of
the
lack
of
funds
and
again
it
does
bother
me
a
little
bit
because
I'm
from
Western,
Kentucky
and
I
tell
you
those
those
Healthcare
deserts
or
is
prominent.
There
is
there
in
Eastern
Kentucky,
but
we're
not
seeing
anything.
D
I
was
a
hospital
CEO
for
40
years,
don't
recall
ever
having
any
interaction
with
you
folks.
If,
if
you're
going
to
be
the
voice
for
Rural
Health
Care,
you
need
to
be
the
voice
and
right
now,
I
think
at
best
you
may
be
a
whimper,
and
if
that
goes
back
to
the
lack
of
funds,
then
you
need
to
advocate
for
more
funds.
I
understand
that
we
only
allocate
maybe
a
million
dollars
over
a
two-year
period
to
this
area,
but.
E
D
That's
causing
you
to
fail
I
would
strongly
encouraged
to
be
a
much
more
stronger,
Advocate
and
ask
for
more
dollars,
but
in
turn
be
able
to
show
the
return
on
the
dollars.
Again,
you
see
the
return
on
investment
that
you
showed
us
earlier,
that's
great,
but
in
30
years
have
we
really
improved
the
health
of
Kentucky
I?
Don't
think
that
we
have
have
we
addressed
the
help
man
power
shortage
in
rural
Kentucky,
I,
don't
think
we've
have
you
know.
Maybe
we've
touched
on
it,
but
I
think
we've
got
to
be
much
more
aggressive,
Progressive.
D
You
know
when
you're
going
to
be
the
voice
for
Rural
health
care.
I,
look
at
your
mission
statement
said,
makes
aware
of
the
needs
of
rural
communities,
our
committees
on
Health
and
Welfare,
which
many
of
us
serve
on.
You
know.
We've
heard
from
from
various
groups
about
here's
things
that
they've
been
laying
here
for
20
30
years.
I
would
really
think
those
recommendations
should
be
coming
for
you,
folks.
You
heard
the
presentation
earlier
about
Eastern
Kentucky
and
the
lack
of
oral
Dental
surgeries.
D
You
know
we
heard
a
presentation
from
those
folks
back
there
in
the
regular
session,
haven't
seen
an
increase
in
20
30
years,
I.
Think
if
you
are
going
to
be
the
voice
of
rural
Health,
then
you
folks
need
to
be
coming
to
our
Health
and
Welfare
committee
and
say
this
is
a
problem
that
we're
having
with
dental
health.
This
is
probably
having
all
these
services
and
you
folks
are
too
quiet.
I'm,
sorry,
I
don't
mean
to
be
overly
critical,
but
again,
I
want
you
to
be
the
voice
of
rural
health.
G
A
G
Do
have
the
workforce
studies
documents
on
there
that
we
do
on
the
website.
I,
don't
know
if
you
found
those
or
not
that
show
what
we
need
in
the
next
20
years,
exactly
with
our
Primary
Care
Providers,
those
kind
of
things
those
briefs
are
shared
through
the
University
of
Kentucky
and
other
colleges.
G
The
academic
programs
that
I
have
at
this
Center
are
based
on
what
the
University
of
Kentucky
has
to
bring
to
Rural
and
I
have
Advocate
to
bring
Public
Health
I
have
Advocate
to
bring
PA
program
the
nursing
program,
all
kinds
of
things
there.
It
does
take
dollars.
We
our
tuition
dollars
that
we
get
for
the
programs
that
are
there
or
what
we
run
the
center
with
some
of
the
things
that
you
just
read
was
through
our
federal
programs.
The
emissions
of
the
federal
program
with
with
the
center
education
is
a
big
part
of
that.
G
G
So
I
I
hear
what
you're
saying
I
really
do,
but
my
hands
are
tied
with
funding
when
you,
when
it
comes
down
to
it,
there's
about
300
000
of
State
funding
that
comes
to
the
center.
The
rest
of
that
is
tuition
dollars
and
grants,
and
through
those
about
15
million,
is
Grants
and
actually
with
those
grants.
We
have
to
do
what
those
outcome
measures
are
called
for
in
those
grants
and
a
lot
of
those
are
federal
grants.
D
G
G
D
G
G
It
is
not
one
of
the
programs
that
I
have
at
the
center
there's
two
different
sides
of
this
inner
two
there's
the
clinic
side
for
The
Residency,
that
is
a
Federal
grant
that
comes
through
through
it's
an
fqhc.
That
is
not
under
my
control.
G
As
far
as
that
goes,
it
is
a
way
to
give
the
poorest
of
the
poor
access
to
care
because
of
the
sliding
fee
skill
that
is
not
my
program,
bringing
the
academic
programs
all
I
can
do
is
say
here
is
the
need
to
the
university
that
we
need
this
and
work
with
them
to
bring
those
programs
to
us
that
you
know
the
funds
is
a
a
huge
issue.
E
Thank
you
Mr
chairman,
and
thank
you
all
for
what
you
do.
What
funds
were
lost
that
required
you
to
pull
out
of
Western
Kentucky
when.
G
Kentucky
Home
Place
was
first
funded.
It
was
funded
at
1.9
million.
We
are
now
at
9
million
right
at
nine
I'm,
sorry,
900,
000,
I'm,
sorry,
1.9
million
is
what
we
had.
900
000
is
what
we
have
now
and
that
is
reduced
every
just
about
every
year.
We
supplement
that
with
grant
funding
that
I
can
write
a
grant
to
do
for
an
example.
The
work
that
we're
doing
in
the
community
now
to
give
coveted
vaccine
and
those
things
is
a
Federal
grant
that
I
wrote
to
keep
more
of
our
community
health
workers.
G
So
each
year
that
goes
down,
however,
increases
in
salary
goes
up.
Benefits
goes
up
all
those
things
and
I
end
up
cutting
community
health
workers
and
I
basically
have
cut
Administration
to
the
Bone,
because
I
feel
like
it's
more
important
to
have
a
chw
in
the
field
than
it
is
to
have
an
administrator
in
the
office.
Okay,.
G
E
G
E
Okay,
I
just
I,
guess
I,
just
see
the
value
of
people
at
front
doors
and
directly
I
mean
that's
to
me.
That's
the
key
of
figuring
out
what's
wrong
with
our
Health
Care
system,
because
there
are,
we
have
all
kinds
of
great
programs.
We
hear
mcos
every
month
coming
here
and
talk
about
all
the
great
stuff
they're
doing
and
all
the
Innovative
things
that
they're
doing
and
but
nothing
changes,
we're
not
getting
any
healthier,
so
I
mean
it's
I
think
the
answers
are
in
the
rural
areas.
E
That's
that
seems
to
be
where
we're
struggling,
the
most
and
in
the
types
of
services
you
are
providing
I
think
are
crucial
to
us.
Moving
that
bar
in
the
future.
So
I
would
ask
that
if
you
all
could
get
some
figures
together
on
cost
and
what
you
might
need
out
of
the
next
budget
to
be
able
to
open
the
west
Western
Kentucky
office,
I.
C
Thank
you,
I
think.
That's
all
the
questions
we
have.
So
thank
you
for
your
presentation.
We
appreciate
your
time
today
and
I
wanted
to
also
note
that
I
think
the
passport
Molina
presentation
was
cut
short.
So
if
any
member
had
a
question
they
would
like
to
submit
in
writing,
they
could
do
that
to
our
staff
and
then
we
would
submit
that
to
Molina
and
then
disseminate
that
answer
among
the
committee.
So.
C
So
if,
if
there's
no
other
business
to
come
before
the
committee,
the
next
meeting
will
be
Thursday
October,
the
13th
2022
at
10
A.M.
So
thank
you.
So
much
and
committee
stands
adjourned.