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From YouTube: Medicaid Oversight and Advisory Committee (10-26-21)
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H
A
A
J
J
K
J
So
I
have
several
definitions
for
you.
The
substance
abuse
mental
health
services
administration,
known
as
samhsa,
has
a
definition
there's
also
one
in
kentucky
statute,
and
what
you'll
find
is
that
both
of
them
include
an
age
of
onset.
So
we're
talking
about
adults
here,
we're
talking
about
a
diagnosis
and
there
are
probably
four
or
five
that
we
think
of
as
being
the
smi
diagnoses,
there's,
definitely
an
impact
on
functional
activities
and
there's
a
time
frame.
So
this
is
not
a
a
one-time
and
gone
kind
of
thing.
J
J
We
think
of
them
as
having
what
we
used
to
call
psychotic
disorders
or
a
psychosis
which
breaks
their
ability
to
be
able
to
understand
the
difference
between
what
they
are,
perhaps
hallucinating
or
having
delusions
about
and
what
the
reality
is,
and
that
is
a
lifelong
situation
for
them.
So
in
2020
the
cmhc
served
and
supported
approximately
43
000
people
diagnosed
with
smi.
J
J
So
you
all
have
heard-
and
some
of
you
serve
on
the
hcb
waiver
task
force,
which
also
has
gotten
a
lot
of
attention
during
this
interim
session.
So
the
home
and
community-based
waivers,
many
of
which
have
been
in
existence
for
a
number
of
years,
include
these
six
and
they're
for
the
acquired
brain
injury,
short
term
and
then
also
the
acquired
brain
injury
long
term
and
those
are
the
most
recent
ones
to
have
been
added.
We
have
the
hcb
waiver,
which
is
the
basic
hogan
community-based
waiver.
J
We
have
a
very
small
what
they
call
model
2,
which
is
for
people
that
are
ventilator
dependent.
Then
we
have
the
michelle
p
waiver,
which
is
serving
a
number
of
of
people
not
with
a
residential
option.
However,
and
then
we
have
the
supports
for
community
living
or
the
scl,
which
has
a
residential
option
and
that's
going
to
be
important
in
our
later
discussion
about
cost
and
also
what
we
think
should
be
in
this
waiver
for
folks
with
severe
mental
illness.
J
J
So
look
at
who's
covered
in
this
and
then
ask
yourself
what
group
is
not
there
and
that
group
is
the
smi
group.
So
that's
the
one
group
of
people
with
disabilities
in
this
commonwealth,
who
have
never
had
a
waiver
specifically
designed
for
them
and
remember
a
waiver-
is
that
you're
waiving
the
usual
medicaid
services
to
add
services
for
a
defined
population
and
a
defined
set
of
services.
J
So
why
do
we
want
to
do
an
smi
waiver?
Because
there
are
services
that
these
folks
need
that
are
not
available
through
traditional
medicaid
and
again
for
those
of
you
who
have
been
on
the
smi
task
force.
You've
heard,
I
think,
every
meeting
a
consistent
message.
Those
two
are
supported,
housing
and
supported
employment.
J
So
it's
a
great
deal
if
you
think
about
any
kind
of
investment
that
you
would
wanna
make
if
you
could
put
up
thirty
dollars
and
know
that
you
were
going
to
get
a
hundred
dollars
worth
of
services
or
goods,
you
take
it
in
a
minute.
So
it's
it
is
a
good
deal
financially.
J
So
here
are
the
services
that
we
think
are
the
most
needed,
and
that
is
supported
housing.
We
know
that
folks,
with
severe
mental
illness
get
involved
in
what
we
call
the
revolving
door.
J
They,
for
whatever
reason
and
the
most
typical
pattern,
is
that
they
quit
taking
their
medications,
often
because
of
side
effects,
sometimes
because
they
go
to
the
pharmacy
and
there's
been
some
kind
of
screw-up
and
the
prior
off
didn't
get
done
or
the
pharmacy
doesn't
have
the
medication
and
they
say
you
know
nature
gonna
have
to
come
back
next
time.
Well,
unfortunately,
our
folks
with
severe
mental
illness
hear
that,
as
that
voice
told
me,
I
shouldn't
take
that
medication
and
they
go
and
they
don't
come
back.
J
We
have
a
mom
kelly
gunning,
who
many
of
you
have
met
who's,
so
active
with
nami
lexington
and
that's
what
happened
to
her
son
six
months
later,
the
police
in
chicago
called
her
and
said.
We
have
your
son
here
and
she
had
to
go
and
get
him
and
bring
him
back.
He
was
under
charges
there
for
disturbing
the
peace
I
mean.
Unfortunately,
it
was
not.
J
J
So
what
you
get
in
housing
is
you
get
somebody
who's
monitoring
that
and
what
you
get
in
the
waivers
is
if
somebody
misses
their
medication,
that's
reported
if
they're
out
on
their
own,
if
they're
on
the
streets
they're
living
with
family-
even
you
know
if
they
miss
their
medication.
Nothing
happens
at
that
point.
So
there's
no
record
and
no
act
team
that
goes
to
them
and
so
forth.
So
there
are
a
number
of
residential
services
that
could
be
offered
three-person
staffed
residents.
J
I
know
senator
higdon
is
familiar
with
those
for
people
with
intellectual
and
developmental
disabilities.
There
are
people
with
severe
mental
illness
that
might
fit
into
that
model.
Others
are
going
to
need
something
very
different.
You
could
have
a
family
home
provider,
we
want
to
teach
people
about
being
a
good
tenant,
so
they
can
keep
housing
and
remain
in
their
housing.
J
And
finally,
then-
and
I
know
this
is
of
interest
to
senator
alvarado,
especially-
we
have
supported
employment
down
here.
We
want
our
folks
to
have
meaningful
employment
at
market
rates.
We
want
them
to
be
in
competitive
workplace
environments
and
for
them
to
be
able
to
do
that.
They're
going
to
need
a
lot.
A
lot
of
support,
voc
rehab,
does
a
good
job.
We
have
job
coaches,
we've
heard
from
some
of
our
community
providers
that
they're
doing
that,
but
we
want
our
folks
to
to
feel
like
they
have
some
purpose
in
life.
J
K
K
Florida
and
hawaii
have
used
an
11
15
waiver
mechanism,
there's
primarily
three
11
15
1915
c,
which
is
the
waivers
that
we
currently
have
the
six
that
dr
schuster
mentioned.
Then
a
1915,
I
waiver
mechanism
as
well,
but
florida
hawaii
has
done
this
and
they
have
supportive
housing
in
their
programs
as
well.
K
Looking
at
smi
populations,
maybe
smi
and
homeless,
smi
and
sud,
but
they
exist,
are
those
two
mechanisms.
The
other
piece
is
four
states
have
a
1915
sea
waiver
and
those
are
colorado,
connecticut,
massachusetts
and
montana.
So
again,
other
states
have
done
this.
They've
figured
out
the
service
and
those
look
at
those.
They
have
support
employment.
They
have
pre-vocational
services
home,
delivered
meals,
so
they
have
a
residential
habilitation
option.
They
have
services
that
we're
talking
about
and
the
value
is.
Other
states
have
done
this.
K
K
Thirteen
out
of
ten
thousand,
I
contend
if
someone
owed
me
ten
thousand
dollars
and
they
gave
me
nine
thousand
nine
hundred
eighty
seven
dollars
I'd,
take
it
and
be
happy
and
forfeit
to
thirteen
dollars
the
amount
of
dollars
spent
on
waiver
services.
Heb
waiver
services
is
almost
found
in
the
cushions
of
the
sofa
1915i
12
states.
Do
this?
Okay,
it's
a
mental,
ill
substance
abuse
it's
not
quite
the
same
as
acb
waiver,
but
it's
a
way
to
provide
services.
K
Again.
I
don't
know
if
I
have
a
preference.
I
like
the
hcb
waiver
mechanism,
I'm
familiar
with
it,
but
we
can
move
forward
and
do
a
waiver.
So
what's
this
going
to
cost?
And
that's
really
what
I'm
going
to
talk
about
at
the
end
here,
but
the
one
message
is:
we
know
what
people
need
heard
that
from
dr
schuster.
Two
other
states
have
done
this.
Let's
see,
we
can
replicate
that
here
and
move
forward
we're
looking
at
the
biennium
of
23
24
fiscal
years
july
1
of
22
through
june
30
of
24..
K
I
contend
year.
One
this
is
going
to
take
a
lot
of
work
to
get
done
and
planned.
You
know
we
got
to
figure
out
who's
covered.
I
said
43
000
people
with
smi
we're
not
proposing
a
waiver
for
43
000
people,
let's
figure
out
who
needs
it
figure
out
the
details
of
it,
get
it
approved
by
cms.
We
have
regulatory
processes
to
go
through
things
like
that
so
year.
One
the
expense
is
going
to
be
staff
at
the
cabinet.
K
Other
folks
may
participate,
they
won't
be
paid
for
that,
but
the
cabinet
staff-
and
I
can't
tell
you
what
that
number
is,
but
that
needs
to
be
part
of
the
deal.
But
the
real
message
is
in
year,
two
of
the
biennium
fiscal
year,
24
july
1
of
23
to
june
30
to
24.
Looking
at
a
hundred
people
served
that
year.
Okay,
the
next
slide
shows
you
a
breakdown
of
what
that
100
people
looks
like
we
expanded
the
scl
in
2000.
Maybe
it
was
sheila,
you
didn't
serve
everybody
the
first
day.
K
So
when
you
have
the
waiver
in
place
for
100
people
in
fiscal
year,
24
you're
not
going
to
serve
100
people
for
the
whole
year,
it's
going
to
take
a
while
to
get
there
done.
So
all
I've
done.
This
is
my
model,
not
modeled
anybody
else,
not
taking
everybody
else.
Eight
people
a
month
for
the
first
eight
months.
It's
got
you
to
64.
K
K
You
have
nine
new
people,
91
existing
people
at
the
bottom
of
the
slide,
so
you
have
634
months
of
service
for
those
hundred
people
as
opposed
to
1200,
okay,
so
you're
going
to
phase
it
in
it's
going
to
take
time
and
some
months
we'll
hit
eight
some
months
we
won't,
but
this
is
a
way
to
project
how
we're
going
to
get
to
that
number.
Without
planning
for
1200
months
of
service
for
100
people,
that's
not
going
to
happen
just
phased
in
again.
K
Then
I
looked
at
a
model
and
the
seo
waiver
that
dr
schuster
mentioned
has
a
robust
residential
options.
Okay,
so
I
looked
at
a
2019
number
annually.
It
was
78
603
dollars
for
the
seo
waiver,
okay
and
that
not
everyone
gets
residential.
Some
do
some,
don't
so
using
that
we're
going
to
look
at
fiscal
year,
24.,
so
we're
five
years
down
the
road
from
that
number,
so
I
bumped
it
by
10
percent
just
to
cover
the
cost,
what's
going
to
happen
over
the
5
year
period.
K
That
gets
me
to
about
and
you
look
at
that
slide.
86
463
a
year.
Okay,
that's
what
I'm
projecting
the
cost
to
be
again.
All
my
assumptions
manipulate
it
any
way
you
want.
The
78
dollars
is
a
solid
number
based
on
the
cost
that
we've
seen
in
the
hcb
task
force,
senator
meredith!
That's
how
we
got
to
that
number.
K
K
K
Okay,
that's
what
it
costs
in
fiscal
year,
24
the
second
year
of
biennium
and
as
we
said
earlier,
dr
schuster
said
we
have
a
30-70
match
rate.
So
you
end
up.
Kentucky
needs
to
put
forth
about
1.3
million
dollars
and
24
to
roll
out
the
waiver,
and
the
feds
will
give
us
3.1
million
and
our
match
rate
is
actually
better
than
30-70.
K
But
for
this
purpose
that's
what
we're
going
to
use
the
30-70
to
get
the
4.4
million
dollars
for
the
biennium,
the
next
biennium
25-26
it's
more
expensive.
Obviously,
because
those
folks
will
get
a
full
year
of
service
we'll
have
1200
months.
I
would
encourage
people
to
expand
it
again
and
go
forward
and
even
that
kentucky
would
spend
about
9.2
million
in
the
next
biennium.
But
this
coming
biennium
1.3
million
dollars
plus
cabinet
expenses
can
serve
100
people
in
the
first
year.
K
Okay,
1915
c
1959
1115,
whatever
the
and
you
know,
medicaid
knows
these
waivers
they'll
make
the
decision.
That's
the
most
appropriate
need
residential
options,
support
employment,
good,
safe
home
and
a
good
job.
It's
not
really
a
high
bar,
it's
not
really
exceptional
services
and
I
believe
kentucky
can
do
better
and
must
do
better
questions.
A
A
A
I
Certainly,
I've
been
privy
to
it
over
the
last
several
months,
with
the
being
on
appropriation,
revenue
and
budget
review
for
human
services
and
the
two
task
force
you
made
reference
to,
and
I
think
part
of
the
reason
we've
seen
a
shift
in
emphasis
to
to
groups
like
this,
that
return
on
investment
has
become
part
of
our
lexicon,
which
we
haven't
seen
in
state
government
before
yeah,
but
I
think
there's
a
realization
and
kind
of
an
epiphany
that
it
costs
us
more
to
do
nothing
than
try
to
do
something.
K
I
I
think
your
numbers
bear
that
out
yeah
and
this
increases
in
your
presentation,
but
I
think
what's
lacking
from
it
is
whenever
we
present
this
to
appropriations
revenue,
what
they're
going
to
see
is
1.3
million
dollars
that
we
don't
have,
but
they'll
say
we
don't
have
well.
We
do
if
you
look
at
in
terms
of
return
on
investment,
but
we
don't
do
a
good
job
of
documenting
that
right
and
I
think,
potentially,
by
doing
this,
we're
going
to
save
it
to
probably
20
30
times
over.
K
K
K
I
K
I
You
mean
yeah,
I
asked
three
times,
where's
the
savings
and
finally,
they
said
well,
there's
not
really
any
cause.
It's
going
to
be
absorbed
in
the
system.
I
think
that's
another
epiphany
I've
had
this
this
this
year
is
that
we
have
so
many
services
that
are
underfunded,
that
whatever
savings
we
realize
are
just
used
to
make
up
those
funding
shortfalls
and
I'm
not
sure
that's
appropriate
either,
but
without
really
identifying
where
this
return
on
investment
is,
I
think
it's
a
very
difficult
sale
because
we
don't
have
a
commensurate
reduction
in
someplace
else.
I
J
H
J
Times
what
do
you
think
it
cost
us
for
her
to
go
down
to
the
court
system
and
file
that
warrant
get
a
sheriff
over?
Take
this
guy
over
to
the
old
eastern
state
hospital
and
hold
him
there
three
days,
seven
days,
14
days,
21
days,
so
part
of
your
savings
is
that
revolving
door
back
to
the
hospital
as
well.
L
I
L
I
K
I
K
A
A
I
I
have
a
client
now
who
was
suffering
from
severe
mental
illness
and
unfortunately,
when
you
file
these
mental
inquest
warrants
a
lot
of
times
after
72
hours,
they're
released
and
sometimes
they
act
out
very
quickly
after
they've
been
released,
yeah,
and
so
I
know
I've
had
conversations
with
the
jailer
in
my
home
county
and
he
often
tells
me
that
the
county
jails
are
now
being
used
and
are
facilitating
as
hospitals
for
the
mentally
ill.
Because
of
our
unwillingness
to
deal
with
with
the
issue.
Gentlemen,.
A
J
A
I
think
that
we
have
to
do
more
than
we're
doing,
but
but
we
have
to,
we
have
to
also
do
it
in
a
way
that's
effective
and-
and
I
and
I,
but
I
appreciate
the
presentation
that
you've
given.
M
A
As
a
matter
of
fact,
and
so
I
I
think
that
this
you
know.
J
A
So
representative
prenty
is
recognized,
I
think,
is
she
on
zoom.
D
Thank
you,
mr
chairman.
My
question
has
to
do
with
the
age
the
18
can.
Can
people
not
be
identified
before
18?
I
understand
that's
legal
age,
but
what
why
18
and
why
not
before.
J
Typically,
under
18,
we
call
that
severe
emotional
disturbance
sed,
and
so
it's
just
a
difference
in
diagnostic
category
and
there
are
special
services
for
youth
under
18.
So
that's
why
they
use
the
18.
Yes,
we've
identified
them
and
many
of
those
kids
end
up
then
as
adults
with
an
smi
diagnosis,
but
they're
called
yeah
children
with
sed
or
severe
emotional
disturbance.
Yes,
ma'am.
D
You
may
have
told
that
in
our
first
presentation
I
remember
that
I
remember
sed,
but,
mr
chairman,
if
you
could
indulge
me
a
few
comments.
D
I
serve
on
the
smi
task
force
as
well
and-
and
it
just
so
happens,
I
feel
like
we
live
in
this
world,
where
we
bowing
from
one
extreme
to
the
other,
and
I'm
reflecting
back
on
your
initial
presentation
to
smi
dr
schuster
about
how
you
know
that
the
institutions
were
open
and
everybody
was
let
out
and
it's
like.
How
can
we
find
the
middle
where
they
get,
what
they
need
and
have
some
housing
and
are
not
that
they
can
be
stable.
So
hopefully
we
can
get
to
the
middle
with
all
this.
D
But
I
I
toured
the
circuit
court
in
hopkins
county
yesterday
and
I
spent
about
an
hour
and
a
half
hour
an
hour
and
a
half
judge
david
massmore,
and
he
was
talking
about
you
know
they.
They
got
their
own
samsung
grant
and
did
drug
court.
D
He
talked
about
how
drug
court's
really
working
there
and
it's
got-
goes
from
seven
thousand
dollars
per
year
for
treatment
versus
thirty
three
thousand
dollars
per
year
in
incarceration,
and
he
talked
about
dual
diagnosis
and
and
that
sort
of
thing
and
he
he
talked
about
putting
more
funds
into
treatment
versus
incarceration,
which
I
know
we've
got
talk
about
judith,
you
know
judicial
reforms
and
that
sort
of
thing
I
just
I
feel,
like
all
these
things
overlap,
and
hopefully
somehow
we
can
get
those
figures
from
you
all
about
the
where
the
cost
savings
are,
and
I
mean
I
feel
like
a
waiver
is
due
and
I
think
it's
doable
and
I
would
support
that.
D
I
feel
like
we
just
need
to
be
talking
like
the
judicial
system
needs
to
be.
On
this
conversation
and
on
the
smi
conversation.
Mr
chairman,
my
jailer
presented
in
committee
smi
committee,
I
hear
the
same
thing
from
my
jailer,
my
sheriff
my
police
chief,
you
know
so
we
just
need
to
these.
Aren't
individual
issues,
they're
all
overlapped,
so
somehow
we
need
to
make
them
all
integrate
to
get
the
the
best
solution.
So
thank
you
for
your
presentation.
D
Your
continued
passion
and
work
on
this
issue
and
we'll
reach
out
to
you
if
I
have
further
questions.
Thank
you,
mr
chairman.
J
Thank
you.
I
just
want
to
say
that
we
had
a
judge
from
lexington's
mental
health
court
and
I've
forgotten
his
name,
but
he
may
have
some
figures
for
us
because
that's
a
new
mental
health
court,
where
they
are
keeping
people
out
of
incarceration
and
he
presented
to
the
smi
task
force.
So
we
will
get
in
touch
with
him
through
kelly
gunning
at
tommy
likes.
He
did.
Thank
you.
L
L
Unfortunately,
if
you
look
at
the
number
of
mental
health
folks
that
we
would
need
to
to
house
you,
you
know
if
at
1.4
percent
the
low
end
of
your
spectrum
at
67
000
at
five
percent,
you
said
it
could
be
as
high
as
five
percent.
That's
225
000
people,
you
know
if
if
we
do
a
waiver
for
and
allow
a
hundred
people,
it'd
take
us
67
years,
because
I
know
what
you
know
every
year,
you'll
be,
you
know
be
back
when
that
you
know
need
to
add
a
hundred
to
it
every
year.
L
So
it's
a
daunting
task.
It's
you
know
it's
just
you
know
it's.
I
don't
know
it's
it's
depressing
to
think
that
that
there
we
have
that
many
mentally
ill
people
in
kentucky
that
need
this
program.
But
I
guess
you
know
it's.
We
get
a
lot
of
calls.
I
think
everybody
on
this
panel
never
ever
remember
the
general
assembly
every
year
for
the
michelle,
p
waver
and
the
other
waivers
people
begging.
You
know
saying
they've
been
on
the
waiting
list
for
years
and
years
and
years
and
it's
it's.
L
You
know
it's
a
sad
situation,
but
I
wish
we,
if
I
had
a
silver
bullet,
we'd,
be
able
to
find
the
money
to
do
all
these,
but
unfortunately
there's
no
silver
bullets
right.
K
And
in
the
idd
intellectual
disability,
world,
the
michelle
p
and
the
in
the
seo
waiver,
I
mean
that
population
is
maybe
three
percent
of
the
population,
it's
a
big
number
and
they
serve
combined
about
13
000
people.
So
we
have
no
expectation
of
serving
43
000
people
in
a
residential
setting
in
this
waiver,
but
let's
identify
who
needs
it
the
most
and
grow
it
from
that
perspective
and
and
the
smi
population's
a
bit
different
than
other
wafer
populations,
maybe
at
12
months
18
months
they
can
transition
to
their
own
apartment
with
supports
so
you're.
K
J
L
Obviously,
a
hundred
won't
do
it.
No
200,
probably.
L
K
No,
I
don't
know
she'll
a
thousand
five
thousand,
michelle
p
started
at
ten
thousand
and
it
took
like.
I
think
it
was
four
years
six
years
to
get
to
ten
thousand.
You
know
so
they
phase
it
in
over
time.
To
get
to
that
number.
The
scl
was
3500,
it
was
about
1
500
for
about
15
years.
There
was
no
movement
on
that
whatsoever
and
it's
been
added
to
since
then,
and
that's
how
many
I
think
is
in
the
sel
program
now
getting
a
residential
option.
K
So
you
know
I
wish
I
could
tell
you
the
43
000
who
would
need
this,
but
it's
you're
right.
It's
not
100..
This
is
to
start
it
figure
out
how
to
do
it
and
then
come
back
and
and
show
the
effect
and
show
the
outcome.
Center
merit
talked
about
and
the
savings
from
other
places,
and
I
really
think
there
will
be.
I
think
people
won't
be
at
places
that
are
more
expensive
and
not
nearly
as
therapeutically
valuable.
You
know
jail's.
J
L
J
You
you
know,
the
other
thing
is
that
we
are
constantly
developing
new
medications
for
the
smi
population,
which
you
don't
have
in
the
igd
population,
and
we
had
wonderful
testimony
actually
from
communicare
from
dr
carmen
pinto,
who
you
know,
I
think
senator
higdon
talking
about
long-acting
injectables
one
shot
for
six
months
could
give
people
the
amount
of
medication
that
they
need
to
deal
with
their
psychotic
condition.
Now
that
doesn't
mean
that
they've
learned
skills
or
that
they've
been
able
to
socialize
and
learn
some
of
the
other
things
that
they
need
the
tendency.
J
C
Thank
you,
mr
chairman,
I'm
taking
notes
here
all
the
things,
because
we
start
talking
about
these
topics
and
everything
my
brain
starts
to
flow
with
all
the
different
ideas
and
thoughts
just
for
the
sake
of
education.
I
think
for-
and
I
mentioned
this
in
our
last
meeting,
I
think
in
terms
of
our
nursing
homes.
C
I
just
had
a
discussion
with
one
of
our
admissions
coordinators
at
one
of
my
quality
meetings,
one
of
my
facilities
yesterday
talking
about
this
because
quality
measures,
you
know
if
people
get
treated
with
any
psychotics
in
an
outpatient
setting
or
in
a
hospital
setting.
You
can
write
as
many
of
those
as
you
want
no
one's
concerned
about
quality,
but
for
some
reason
in
our
nursing
home
settings,
people
have
perceived
that
if
you
use
an
antipsychotic
for
people
that
it's
you're
trying
to
snow
people
and
knock
them
out,
you're
hurting
them
and
you're
a
bad
facility.
C
If
you
do
it,
what
we're
getting
now
is
almost
I'd
say:
probably
half
of
the
patient
emissions
I
get
or
more
are
not
little
folks
with
dementia
for
a
hip
replacement
or
something
like
that.
People
with
schizophrenia
people
with
mental
illness,
they
have
nowhere
to
send
them.
They've
been
in
the
hospital
for
four
to
six
months.
Let's
just
send
them
to
a
nursing
home
and
beds.
Go
down.
We've
had
a
lot
of
covid
desks.
We
need
to
fill
the
beds
just
take
them,
I'm
not
a
psychiatrist
all
right.
C
We
have
very
limited
specialists
available
in
this
realm
and
they
come
in
and
then
I'm
tasked
with
hey
you've
admitted
somebody.
Yes,
they've
got
a
diagnosis,
yes
or
an
antipsychotic,
but
it
counts
against
your
numbers
and
therefore
the
more
antipsychotics
you
prescribe
the
lower
your
quality
rating
is
for
your
nursing
home
and
you
wind
up
getting
dinged
and
you
lose
points
and
you
get
labeled.
A
lower
star
facility,
which
you
see
in
the
newspaper,
is
an
attorney
sue
for
and
all
kinds
of
fun
things.
C
So
you
can
imagine
what's
happening
now
is
a
lot
of
these
folks
are
getting
backed
up,
they
have
nowhere
to
go
nursing
homes
are
saying:
are
you
on
an
anti-psychotic,
maybe
completely
legitimately
and
doing
well
on
that?
We
don't
know
if
we
want
them,
because
it's
going
to
hurt
our
quality
measures
and
it's
going
to
affect
us.
This
is
the
kind
of
stuff
that
we're
encountering
in
healthcare.
All
the
time
really
really
frustrating
a
couple
of
things.
C
The
other
thing
I'm
going
to
bring
up
also
and
I've
I've
kind
of
broached
it
and
I'm
having
a
bill
prepared.
Many
of
you
have
heard
of
the
super
speeder
bill
we've
seen
in
in
georgia.
Maybe
some
of
you-
and
I
have
the
chairman
of
transportation
here,
but
we've
struggled
in
the
past
with
certain
medical
costs
in
our
health
care
system,
many
of
them
related
to
trauma
and
different
things.
There's
a
trauma
network.
C
We
never
fund
I'm
looking
at
using
that
super
speeder
to
help
you
know
if
we
can
get
it
past
the
general
assembly
to
start
using
those
funds,
particularly
to
fund
trauma
networks.
We
see
acute
brain
injuries
and
we
see
people
that
have
you
know
those
are
very
expensive
slots.
I
want
to
say
90
000
per
year
we
struggle
and
get
it.
C
We
might
approve
eight
per
year
and
we're
lucky
if
we
get
that
in
our
budget
to
say:
hey,
let's
dedicate
funds
from
things,
people
that
are
speeding
at
20
miles,
with
a
speed
limit
to
use
those
funds
to
help
fund
certain
things
in
our
health
care
system,
abi
being
one
of
those.
If
you
can
free
up
some
of
the
monies
from
that
to
be
able
to
dedicate
for
programs
like
this,
so
there's
different
ideas
and
thoughts,
I'm
trying
to
think
outside
the
box
of
finding
other
ways
of
funding
systems.
C
We've
talked
about
every
year
that
I've
been
here
that
we
have
a
hard
time
finding
ways
to
find
when
we
add
this
in,
it's
clearly
needed
so
there's
two
things
I
wanted
to
broach
with
that.
Little
preamble,
mr
chairman,
one
thing
is
the
cost.
I
know
you
mentioned
on
page
13
and
14
of
the
presentation
there
about
a
projected
adjusted
annual
per
person,
cost
of
sixty
86463,
so.
N
C
It
to
say
we
would
say
if
we're
gonna
fund
a
hundred
slots
you're
looking
at
about
eight
point,
six
million
dollars
as
far
as
total
cost
there's
a
70
30
match.
Would
that
be
accurate?
So
the
number
you
give
in
the
next
page
about
the
4.468,
that's
for
an
actual
per
person
over
their
lifespan
or
over
the
time.
C
Okay,
so
that
was
the
one
thing
I
think
we
need,
because
if
we're
going
to
request
that
we
need
to
make
sure
we
have
an
idea
of
what
that's
going
to
cost
us
down
the
line
as
far
as
annual
costs.
The
other
thing
we
talked
about
was
employment
that
you
broached.
Obviously
it's
near
and
dear
to
my
heart.
I
filed
a
bill
every
year
for
the
last.
C
Yes
and-
and
I
know
a
little
bit
of
discrepancy
with
both
presenters
on
this,
but
I
think
everybody
wants
to
see
the
same
objective
down
the
line
in
terms
of
that
and
we've
got
something
that
people
call
different
things.
Sheltered
employment
is
a
term
and
lots
of
different
terms.
They
have
out
there
for
it.
People
with
disabilities
in
particular
are
hired.
They
might
be
over
the
years
over
a
long
period
of
time.
C
We've
established
programs
that,
were
you
know,
supported
by
government,
to
allow
individuals
with
disabilities
to
be
mainstreamed
into
the
work
environment
and
they're
getting
paid
a
lot
of
time,
saying
well,
they're,
not
as
productive
as
an
individual
without
the
disability,
and
so
they
have
lesser
work
and
they
multiply
that
factor
by
minimum
wage
and
say
we're
going
to
pay
you
less
than
minimum
wage.
So
a
lot
of
individuals
are
out
there
and
a
lot
of
families
love
the
programs.
Then
people
do
very
very
well
in
them.
We
have
very
responsible
employers
who
are
employing
them.
C
K
K
We've
had
this
conversation
before
one
support
of
employment
is
not
sub-minimum
wage
support.
Employment
is
at
least
minimum
wage.
That's
part
of
the
definition
of
the
service.
The
programs
you're
talking
about
are
traditional
day
programs
that
initially
do
do
piece
rate
work
and
they
pay
sub
minimum
wage
under
a
certificate
from
the
united
states
department
of
labor.
That
permits
them
to
do
that
and
if
they're
doing
it
in
the
community,
they
have
a
contract
to
do
it
through
their
license.
K
Okay
and
and
we've
had
this
conversation,
the
the
concern
that
I
have
and
I've
expressed
is
the
last
count
was
about
4
000
people
in
day
programs
or
maybe
more
than
that.
What's
the
plan
for
those
people
what's
going
to
happen,
will
there
be
opportunities
for
them
about
30
hours
a
week
monday
to
friday,
right
and
folks
will
say?
Yes,
there
will
be.
I
just
don't
know.
I
also
don't
know
if
there's
sufficient
staffing
for
that.
K
Many
people
in
you
know
to
move
transition
out,
but
I
understand
your
bill
is
not
closing
the
program.
It's
not
enrolling
new
people,
and
I
think
you
know,
and
even
last
bill
you
filed.
There
was
a
five-year
period
before
that
would
start,
so
we
all
knew
would
know
the
transition
and
and
go
from
there.
So
I
think
you
know
that's
been
the
concern
some
of
my
members
have
expressed
because
they
have
programs
that
serve
a
fair
number
of
people.
K
What's
going
to
happen
going
from
there
interesting
during
kobe,
there's
folks
who
are
begging
to
be
able
to
go
back
to
work
because
one
center
in
bardstown
they
operate
the
recycling
center
and
you
know
they
couldn't
have
their
day
program
and
folks
are
going
to
recycle,
saying
making
more
than
minimum
wage
they're
not
submitting
wage
workers
and
they
couldn't
do
it
and
the
recycling
centers
get
a
little
frustrated.
K
So
I
think
we
understand
where
you're
coming
from
we
get
that
it's
just.
What's
the
plan
for
these
folks
and
again,
it's
not
closing
the
program,
and
I've
said
this
before
over
time.
It
will
close
the
program.
You
know
at
some
point
the
the
economic
principles,
the
critical
mass
wouldn't
be
there
to
sustain
it
and
you
go
from
there.
But
I
think
that's
where
we're
at
but
supported
employment
in
this
waiver
is
not
a
sub-minimum
wage
service.
K
People
make
whatever
is
made
in
the
community
the
job
they
are
placed
at
they'll,
get
that
hourly
rate
and
they
get
supports
from
from
a
job
coach.
You
know,
and
I
know
what
a
job
coach
is
because
one
point
I
was
a
job
coach,
you
know-
and
I
did
actually
went
to
a
training
in
auburn
joined
the
american
associations
for
person
support
employment.
The
next
month,
tennessee
had
a
member.
K
I
may
have
been
the
first
member
to
support
employment
in
tennessee
1987.,
but
that's
where
we're
at
that's
the
concern
3
000
people,
but
this
is
supported
employment.
It's
not
some
minimum
wage.
It's
not
a
day
program.
There
is
a
day
program
now
from
lsmi.
That
is
not
work,
related
skill,
related
therapeutic
rehabilitation,
good
question.
A
A
M
A
Going
on
he,
this
was
his
agenda
item
today,
and
I
think
he
has
some
opening
comments.
I
I
do
coach
here
eileen.
Thank
you
for
the
opportunity.
We
did
hear
this
presentation
last
week
in
budget
review
as
a
budget.
I'm
sorry
I
lose
track
of
my
committee,
health
and
welfare.
Excuse
me
senator
alvarado,
whose
chair
is
that
committee
co-chairs
of
committee
was
kind
of
added
this
to
agenda,
and
obviously
here
today
to
talk
about
its
impact
on
the
medicaid
program,
and
I
personally
think
it's
a
great
program.
I
It
was
mentioned
earlier
about
our
severe
mentally
handicapped
individuals,
that's
a
kind
of
forgotten
population,
and
I
think
our
our
young
people
with
autism
that's
kind
of
forgotten
as
well.
A
lot
of
things
have
been
overshadowed
over
the
last
couple
years
because
of
covid,
but
this
certainly
is
a
needed
population
in
services
opening
system
with
warranted.
I
But
I
thought
this
was
such
a
unique
program
when
I
first
heard
about
it
that
I
thought
it
warranted
hearing
being
heard
by
our
health
and
welfare
as
well
as
medicaid
oversight,
because
I
think
it
can
impact
it
and
after
the
presentation
we
talked
again
about
how
there
could
be
a
return
on
investment
on
this
program.
But
I
appreciate
you
folks
being
here,
and
I
thank
committee
members,
if
you've
not
heard
this
before,
I
think
you'll
be
excited
about
this
program,
see
it
has
tremendous
potential.
So
thank
you
for
being
here.
M
M
My
name
is
dr
mary,
lloyd,
moore
and
I'm
executive
director
of
the
suzanne
vitale
clinical
education
complex
in
bowling
green,
and
this
is
mr
david
wheeler-
he's
the
executive
director
of
the
lifeworks
at
wku
program
and
he's
got
over
25
years
of
experience
with
life
skills
incorporated
where
he
worked
with
state
general
fund
dollars
through
his
entire
tenure
and
the
michelle
p
waver
for
for
13
years,
and
we
also
have
mr
john
kelly
with
us
who
is
the
founder
of
our
kelly
autism
program
and
and
parents
of
an
adult
daughter
with
autism.
M
M
N
Sure
thank
you
and
thank
you
for
allowing
us
to
be
here
this
afternoon.
I'll
tell
you
that
the
lifeworks
wku
program
is
kentucky's,
only
independent
transition
program
of
its
type
that
allows
young
adults
with
autism
to
learn
the
skills
they
need
to
live
independently
and
to
obtain
and
maintain
employment.
And
so
we
have
a
brief
video
here.
That'll
give
you
a
good
overview
of
what
the
campus
and
what
a
day
looks
like
there.
So.
G
G
The
lifeworks
campus
is
situated
on
half
a
city
block
at
the
foothill
of
western
kentucky
university
and
is
within
walking
distance
of
beautiful,
downtown
bowling
green.
The
complex
consists
of
a
centralized
community
building
and
three
newly
renovated
apartment
buildings,
known
as
the
julie
and
gary
randsdell
living
and
learning
community
participants
of
the
two-year
lifeworks
transition
academy
reside
in
modern
townhouse
style
apartments
that
are
comfortably
furnished
and
feature
a
fully
equipped
kitchen
and
laundry
facilities.
Our
participants
live
independently
or
with
a
roommate
and
are
supported
by
24-hour
access
to
the
lifeworks
staff.
G
The
multi-functional
community
building
is
where
participants
gather
to
take
classes
and
enjoy
hanging
out
with
friends.
The
common
areas
include
a
comfortable
sitting
area
and
a
spacious
communal
kitchen,
perfect
for
preparing
and
enjoying
group
meals
together.
The
large
multi-purpose
rooms
are
where
friends
gather
for
game
nights
and
other
fun
activities
in
our
state-of-the-art
classroom.
Participants
gather
daily
to
receive
instruction
in
the
areas
of
career
readiness,
independent
living
skills
and
social
engagement.
The
community
building
also
houses,
multiple
meeting
room
spaces,
private
study
areas
and
our
staff's
administrative
offices.
G
Life
works
at
wku
is
a
supportive
living
and
learning
community
where
individuals
are
empowered
to
realize
their
full
potential
and
successfully
transition
to
living
lives
of
independence.
Self-Direction
and
employment
come
discover
what
life
has
to
offer
at
lifeworks
at
wku,
your
bridge
to
independence.
N
Our
participants
are
there
for
about
24
months,
they're
there,
through
the
summer
and
winter,
there's
not
a
break
and
a
typical
profile
as
you'll
see
on
the
screen.
It's
a
young
adult
from
ages,
21
to
30,
young
man
or
woman
with
autism.
Their
intelligence
levels
range
from
low
average
to
well
above
average,
and
their
socioeconomic
and
educational
backgrounds
are
varied.
A
program
is
not
a
group
home
or
24-hour
staff.
Presidential
program
and
participants
begin
living
in
an
apartment
on
their
own
upon
enrollment.
N
A
lot
of
them
have
some
have
attended
college
and
some
haven't,
but
something
they
share
in
common
is
that
they've
returned
home
unemployed
with
no
relationships,
their
skills
have
regressed
and
self-confidence,
and
sense
of
direction
is
non-existent.
Another
shared
commonality
is
something
that
we
hear
from
their
parents
who
have
voiced
concerns
about
what
will
they
do?
How
will
they
manage
when
the
parents
no
longer
are
available
or
have
the
capacity
to
provide
care
for
them?
N
N
She
graduated
from
college
in
2015,
returned
home
and
remained
stagnant,
no
job,
few
personal
relationships,
yeah
low
self-confidence,
and
then
she
enrolled
at
life
skills
in
september
of
2020.
When
we
launched-
and
I
look
at
her
now-
it's
12
months
later-
she's
living
on
her
own
with
her
cat
and
she's
employed
25
to
35
hours
a
week,
she's,
making
new
friends
she's
driving
independently
serving
as
a
role
model
for
other
participants
and
pursuing
her
art.
Something
she
really
wants
to
to
make
a
living
of
is,
is,
is
creating
and
selling
her
own
art.
N
This
is
how
we
do
it
for
someone
like
joy
and
others.
We
provide
instruction
in
the
classroom
and
hands-on
training
and
support
outside
the
classroom
in
their
apartment
in
the
community
and
on
the
job
site.
We
require
and
support
individuals
to
participate
in
community
service
learning,
volunteerism
and
employment,
we've
partnered
with
area
businesses
and
industries
to
help
boost
the
ongoing
workforce,
development
initiatives
across
our
region
and
the
state.
We
facilitate
growth
in
the
areas
of
confidence,
building,
social
and
interpersonal
skills
and
relationship
building.
N
And
lastly,
I
want
to
point
out
that
we
we
provide
an
option
for
individuals
in
our
region
who
want
to
commute,
and
that's
called
the
bridge
program
and
they're
able
to
participate
in
our
classes.
We
have
a
32
course
curriculum
that
we
teach
over
the
24
months.
Each
class
is
17
weeks
long
and
if
individuals
want
to
not
necessarily
live
and
receive
the
full
package
of
services,
their
life
works,
they
can
commute
and
attend
these
classes.
N
M
David,
so
I
would
like
for
us
now
to
turn
to
a
few
statistics,
and
I
think
you
have
those
in
your
packet,
but
I'll
go
through
them
anyway.
The
incidents
now
is
the
incidence
of
autism
is
1
in
54.
According
to
the
centers
for
disease
control,
there
are
an
estimated
82,
000
plus
autistic
individuals.
In
kentucky
there
are
50
000,
plus
individuals
with
autism
in
kentucky
between
the
ages
of
18
and
64,
which
is
the
population
that
we
serve
there
at
lifeworks
for
your
reference.
M
That's
10
000,
more
people
than
in
the
entire
city
of
covington
and
10
000
less
than
the
folks
in
owensboro,
pretty
good
segment
of
of
our
commonwealth.
The
lifetime
cost
for
individuals
with
autism
is
ranges
from
3.5
to
5
million
dollars
across
the
life
lifespan
and
families.
M
M
M
So
we
are
in
a
state
of
crisis
in
terms
of
support
for
autistic
adults
and-
and
I
am
here
to
sound
the
alarm
and
offer
a
solution.
I
hate
to
sound
an
alarm
without
offering
a
solution,
but
the
alarm
is
sounding
by
age:
22,
public,
funded,
publicly
funded
education
and
services
cease
to
be
available
as
families
reach.
What
has
been
called
the
great
service
cliff.
You
all
are
aware
this
I
know,
and
the
lack
of
support
services
available
for
adult
individuals
with
autism.
M
We
have
a
unique
need
for
a
unique
population
that
has
not
yet
been
addressed
here
in
kentucky,
we
get
calls
from
all
over
the
state
inquiring
about
our
program.
Life
works
these.
These
calls
these
people,
these
families
are
starved
for
our
services
and
when
they
learn
about
the
program
specifics,
they
say
this
is
too
good
to
be
true
and
exactly
what
we've
been
looking
for.
M
M
Our
capacity
for
the
transition
academy
is
28
participants
with
the
actual
cost
per
participant
being
forty,
nine
thousand
five
hundred
and
fifty
five
dollars.
As
you
heard
previously,
we
we
serve
individuals
in
the
bridge
program
and
our
capacity.
There
is
about
a
hundred
a
hundred
participants,
but
I'm
really
focusing
on
our
transition
program.
Today
there
is
no
wiggle
room
in
in
our
budget.
M
The
the
tuition
of
fifty
thousand
dollars
is
necessary,
but,
as
you
all
know
it
is,
it
is
more
than
most
families
are
able
to
afford
and
we
do
not
intend
to
be
an
elitist
program
and,
and
we've
got
to
find,
a
source
of
support
for
our
life
works
program.
M
The
cost
of
funding
a
participant
for
two
years
is
a
hundred
thousand
dollars
subtract.
The
state
income
tax
from
successful
participants,
which
is
30,
they're
earning
36
000
a
year
times
our
five
percent
income
tax
rate
times
of
42
work,
life
and-
and
I
got
that
by
ages,
25
to
67
being
a
42
year.
Work
life
gives
you
a
total
of
seventy
five
thousand
six
hundred
dollars.
M
We
gotta
subtract
ten
percent
to
account
for
the
ten
percent,
who
will
not
work
for
a
total
of
sixty
eight
thousand
forty
dollars,
so
the
total
cost
of
a
hundred
thousand
dollars
for
the
two
year
program,
less
the
reduction
in
cost
of
sixty
eight
thousand
forty
dollars
gives
us
a
total
of
thirty
one
thousand.
M
And
then
we
get
the
the
expected
success
rate
for
lifeworks
participant
allows
for
a
reduction
in
the
above
cost
of
22
million
four
hundred
thousand
dollars
per
person
to
one
million.
Seven
hundred
and
sixty
eight
thousand
forty
dollars
across
the
life
span.
M
So
that's
a
pretty
good
return
on
the
rate.
It
seems
the
the
support
provided
by
a
three
by
three
two
year.
Budget
periods
will
allow
us
to
put
in
place
our
plan
for
sustainability
that
includes
individual
participant
tuition
contributions,
office
of
vocational
rehabilitation,
funding
for
some
participants,
michelle
p
waiver
funding
for
some
participants,
charitable
gifts
from
both
corporate
and
private
entities,
and
grant
funding
to
cover
these
costs.
M
We're
also
hopeful
to
create,
with
your
help
and
approval
and
autism
waiver
for
such
services
in
the
commonwealth
of
kentucky.
We
we
need
time
to
work
out
the
details
of
this
plan.
So
I'm
not
going
to
ask
to
present
that
today,
but
but
that's
on
our
list
of
things
and
on
our
list
of
of
sus,
of
our
how
we're
going
to
create
sustainability
for
this
program.
M
M
We
need
a
line
item
budget
of
2
million,
800
thousand
over
three
budget
periods
to
provide
for
the
life
works
program.
It's
a
it's
a
finite.
It's
finite
support.
We
will
be
financially
viable
and
and
feasible
with
a
runway,
but
what
we
need
is
two
million
eight
hundred
thousand
over
three
budget
periods,
and
this
dollar
amount
will
provide
a
a
runway
for
84
individuals
in
the
transition
program.
M
In
addition
to
a
hundred
more
participants
in
the
bridge
program
to
be
productive
members
of
society
and
potentially
save
the
commonwealth,
one
million
seven
hundred
and
sixty
eight
thousand
forty
dollars
over
their
lifetime,
we
can
help
them
to
be
contributing
members
of
our
commonwealth,
able
to
pay
back
some
of
the
cost
invested
in
them
by
the
dollars.
They
will
return
based
on
the
salaries
they
they
earn
when
employed
and
lessen
state
and
federal
dollars
spent
in
their
support
over
a
lifetime.
M
We
have
the
opportunity.
Not
only
do
we
have
the
opportunity
here,
I
feel
like
we
have
the
responsibility
to
provide
assistance
for
this
growing
segment
of
the
population
to
become
more
self-sufficient,
but,
as
I've
said,
the
tuition
of
50
000
is
too
steep
for
most
families
to
afford
without
help
and
we've
got
to
create
a
vehicle
for
that
help.
M
So
would
you
please
help
us
to
offer
them
a
chance
at
a
more
independent
productive
life
at
the
same
time,
providing
a
cost
savings
for
the
commonwealth
of
kentucky,
as
well
as
to
create
a
roadmap
for
other
kentucky
communities
that
need
such
a
program?
As
I've
mentioned,
it's
a
it's
a
model
program,
it's
a
replicable
program
and
we
could
serve
serve
that
model
across
the
commonwealth.
M
So
please
come
and
visit
us
at
lifeworks.
In
bowling
green,
we
would
love
to
have
you
come
and
and
show
you
exactly
what
we
what
we've
got
in
in
the
works
and
and
again
let
me
thank
you
for
the
opportunity
to
be
with
you
all
today.
We
certainly
appreciate
the
the
opportunity
to
describe
what
we
have.
F
Just
to
to
reinforce
two
points
that
you
you
mentioned,
but
I
think
are
important.
Lifeworks
is
very
much
a
person-centered
plan.
This
is
not
a
a
one
program
fits
all.
It's
a
great
deal
of
time
and
effort
is
put
with
the
individuals
at
the
front
end
to
be
able
to
identify
capabilities
likes
and
and
developing
a
transition
plan
that
will
get
them
to
that
point
of
successful
employment
to
a
career.
F
It's
it's,
not
here's
our
package,
here's
our
program
common!
At
the
end
of
it,
you
get
a
little
certificate
and
away
you
go,
there's
a
great
deal
of
of
intricate
detailed
job
support
that
goes
on
in
the
in
the
process.
F
It's
part
of
a
continuum
of
services
that,
as
marie
lloyd
mentioned,
starts
with
our
kids.
That
are,
I
think,
our
youngest
in
the
big
red
school
is
just
a
little
over
12
months
old,
realizing
as
they
age.
We
have
to
develop
programs
for
them.
That's
why
we
got
a
college
program
for
those
individuals
that
had
those
resources,
but
the
college
program
again
is
limited
to
a
group,
intellectually,
financially
socially,
that
are
able
to
handle
a
university
environment.
Far
greater
percentage
of
those
individuals
cannot
without
a
great
deal
more
support.
F
Lifeworks
provides
to
those
individuals
who
have
the
raw
capability
for
us
to
be
able
to
help
mold
with
the
support
of
the
personnel
and
the
curriculum
and
the
environment
that
we
have
the
social
skills
that
are
necessary
to
be
able
to
function
live
independently.
F
That's
the
focus
of
this
from
the
very
beginning
is
to
be
able
to
make
that
transition
from,
as
you
saw
individuals
in
our
program
that
come
in
and
are
unable
to
work
or
are
living
at
home
and
don't
have
those
resources
to
be
able
to
go
out
and
successfully
handle
a
job
and
the
responsibilities,
pressures
and
obligations
and
opportunities
of
a
of
a
career
career
is
the
key
that
we're
talking
about
here.
It's
not
just
getting
a
job,
it's
developing
a
career
based
on
their
skills,
capabilities,
likes
and
opportunities.
F
F
I
think
your
point,
coming
back
on
return
was
very
important
for
us
here
to
be
able
to
say
upfront
dollars
here
for
a
limited
amount
of
time
which
affords
us
a
runway
to
establish
the
momentum
of
building
the
corporate
and
private
support
to
generate
the
endowment
base
to
support
these
scholarships
long
term.
A
Well-
and
we
thank
you
for
the
excellent
presentation-
and
I
think
it's
quite
extraordinary
that
this
is
one
of
11,
I
think,
as
I
counted
programs
in
the
country,
so
it's
very
unique
and
and-
and
I
have
appreciated
your
presentation
very
much-
do
you
have
any
questions?
I
Thank
you
again
for
your
presentation
and
just
for
the
committee's
information
and
benefit
I'm
going
to
ask
he's
supposed
to
do
it
one
more
time
at
our
budget
review
for
human
services.
I,
like
the
first
program,
the
first
time
I
heard
about
it.
I
loved
your
presentation
last
time
and
I
love
it
even
more
today,
because
it
is
consistent
with
my
philosophy
of
what
we
need
to
do
with
the
medicaid
program
and
again,
committee
members.
I
A
I
have
a
question:
do
you
anticipate
if
you
get
this
budget
request
that
you
would
have
a
lot
of
out
of
state
interest
based
upon
the
11
of
these
programs
nationwide?
And
I
know
you
you
mentioned
there
weren't
any.
I
didn't.
I
didn't
look
at
the
various
states,
but
there
aren't
any
in
the
surrounding.
M
E
M
We
will
get
the
inquiries,
but
because
there
are
no
programs
in
kentucky,
you
know
if
we
could
develop
our
program
and
then
pepper
them
across
kentucky.
We
could
serve
kentucky
folks.
E
M
So
do
I
anticipate
those
inquiries?
Yes
with
funding,
you
know
we
we
can,
we
can
say
we're
serving
our
our
kentucky
brothers
and
sisters,
I'm
sure
if,
if
that
makes
sense,.
D
D
Thank
you
so
much.
I
heard
your
presentation
before
I
you
know.
I
really
appreciate
this
second
time.
I
guess
the
question
a
couple
questions
I
have
one
is:
why
are
these
young
people
not
identified
earlier
and
why
why
do
they
not
get
those
skills
k
through
12
before
they
become
young
adults?
Is
it
a
matter
of
maturation,
or
can
you
speak
to
that.
M
I
think
that
the
effort
is
made
for
them
to
get
the
the
supports
that
they
need,
but
maturation
is
one
you
know
it
takes
a
while
to
mature.
It
takes
a
while
to
focus
on
the
job
that
you
are
meant
to
have
the
ability
to
move
into
housing
on
your
own
and-
and
I
think
that
we
we
we
provide
the
person-centered
planning
in
a
very
concentrated
way
that
it
is
not
available
prior
to
this
point,
what
we
offer
would
help
any
would
have
helped
me
when
I
graduated
from
college.
M
We
won't
talk
about
me,
but
I
graduated
in
75,
and
you
know
I
could
have
used
this
support.
I
think
that
when
you
focus
on
moving
to
an
apartment
and
getting
a
job
and
and
and
receiving
the
supports
necessary
to
live
and
to
be
a
contributing
community
member,
you
know
that
that's
that's
different
and
it
comes
at
a
time
in
their
lives
when
it
is
necessary
david.
Would
you
like
to
add
to
that.
N
Yeah,
that's
a
very
good
question.
The
good
thing
you've
pointed
out
these
students
or
these
participants,
these
individuals
that
come
to
us.
They
come
with
a
lot
of
skills
already
and
they've.
N
They've
acquired
a
lot
of
skills
from
school
and
from
neighbors
and
family
grandparents,
sunday
school
teachers,
they
they
come
and
they
just
haven't
really
had
the
opportunity
or
the
organic
environment
or
the
accountability
to
hell
to
that
to
practice
these
things,
and
so
they
come
to
us
with
skills,
and
we
help
them
learn
to
generalize
those
skills
in
all
areas
and
to
develop
new
skills.
N
It's
really
something
different,
we'll
have
parents
come
and
visit
and
then
they'll
think
about
it
and
they'll
call
us
back
several
months
later
and
and
they'll
say
well,
we've
thought
about
this.
What
we're
doing
our
home
is
not
working
and
so
everybody's
a
year
older
and
and
it's
like
with
joy's
family.
N
You
know,
and
she
went
home
for
six
years
after
graduating-
no
job,
no,
not
even
that
first
part-time
job
like
we
had
when
we
were
teenagers,
and
so
you
know
for
her
to
to
make
that
step
has
been
huge
for
her
and
a
lot
of
it
is
maturity
and
confidence
building,
but
until
they're
put
in
that
situation,
where
they're
living
on
their
own
there's
three
apartment
buildings
right
behind
our
classroom,
administrative
building
and
and
they're
living
on
their
own
and
and
we
provide
support.
N
But
it's
not
it's
a
little
bit
different
than
like
in
the
seo
program
or
other
programs
where
it's
24-hour.
You
know,
supervision,
those
kinds
of
things
and
they're
held
accountable
for
those
things.
And
so
it
is
like.
We
talked
about
a
living
learning
environment,
but
they
do
come
with
a
lot
of
skills.
It's
just
being
able
to
you
know
with
their
executive
functioning
level
and
cognitive
rigidity
and
those
things
we
kind
of
work
on
all
those
things
together
and
yeah.
It
seems
to
be
working.
D
M
D
Thank
you.
Thank
you.
I
mentioned
having
a
conversation
with
judge
massmore
from
hopkins
county
yesterday
in
a
previous
present
during
a
previous
presentation,
and
he
said
his
drug
court
is
two
years
as
well
to
you
know
for
addict
to
get
rid
of
addictions.
That
two
years
is
just
kind
of
popping
up
as
a
as
kind
of
a
standard
measuring
stick.
So
that's
why
I
wanted
to
ask
about
that
and
then
finally
do
y'all
have
any.
M
You
know,
that's
a
that's
a
fascinating
question.
I
used
to
think
that
we
were
just
diagnosing
better
I'll,
speak
and
then
the
rest
can
speak.
I
used
to
think
well.
We
just
have
a
better
way
to
diagnose
autism,
but
every
year
we
see
more
and
more
and
more,
and
that
could
be
a
part
of
it.
M
I
think
our
environment
plays
a
big
piece
in
the
development
of
autism,
we're
ingesting
what
what
we
eat,
what
we
take
in
what
we
breathe
in,
and
I
think
that
has
an
impact,
and
I
think
that
sets
up
the
the
perfect
conditions
for
autism.
I
hope
I
live
long
enough
to
find
exactly
what
the
cause
is,
but,
but
I
do
I
have.
I
have
watched
myself
change
over
time
thinking.
Oh
our
banks
are
just
wider
than
they
used
to
be,
but
I
do
think
that
there
is.
M
There
is
more
more
there
and
I
hope
I
live
long
enough
to
find
out
exactly
what
it
is
david.
Do
you
have
thoughts
on
that.
N
I
don't,
I
just
know
that
it
is
increasing
and
I
did
michelle
p
waiver
assessments
from
2007
to
2019
and
I
went
into
more
and
more
homes
to
where
I
saw
two
kids
with
autism
in
the
same
family
and
instead
of
one
and
so
I
just
it
seems
like
it's.
It's
not
going
away
and
they
are
getting
older
and
and
and
need
to
transition
to
the
next
phase.
And
so
I'm
just
excited
that
this
opportunity
has
been
created
and
I'm
glad
to
be
a
part
of
it.
So.
A
M
Hopefully,
in
the
event
that
there
is
state
funding
that
would
support
folks
who
needed
it,
I
I
don't
think
that
that
we
envision
it
to
be
across
the
board.
If
a
family
can
can
afford
the
fifty
thousand
dollars
just
like
they
afford
some
colleges
in
kentucky,
they
would
be
expected
to
pay,
but
we
certainly
don't
want
to
set
up
a
program
that
we
know
works
that
families
who
cannot
afford
it
are
not
able
to
come.
F
Representative,
that
was
your
question
coming
back
relative
to
the
participants
in
the
program
being
from
the
state.
We
we
want
to
make
it
as
ecumenical
as
we
possibly
can
across
the
state
where
the
the
focus
is
on
the
individuals
and
their
opportunities
and
being
able
to
tie
those
individuals
to
a
better
life
in
the
future
and
not
to
have
it
driven
by
the
income
of
their
families
or
the
resources
that
they
necessarily
have.
So
at
one
end,
we
don't
want
to
limit
ourselves
by
individuals
who
don't
have
the
resources
to
come.
F
We
want
this
to
be
a
kentucky
program
and,
as
we
said,
we
know
the
individuals
in
this
part
of
the
state
as
part
of
the
country,
the
numbers
that
are
there,
the
individuals
that
need
this
type
of
a
program
and
the
reckless
the
ability
to
replicate
this
throughout
the
state
to
be
able
to
address
it
on
a
very
cost,
effective
basis.
We
want
it
to
be
a
kentucky
program.
A
Well,
thank
you.
We
have
senator
alvarado.
C
Just
really
briefly,
I
know
that
representative
prenty
had
commented
on
sources
and
causes,
and
that
sort
of
thing,
obviously,
as
I'm
a
pediatrician,
this
is
important
for
me.
We've
seen
a
lot
more
of
it.
I
can
tell
you
I've
I've
done
missions
trips
overseas
to
eastern
africa,
where
I
think
the
the
first
place
we
went
to
to
do.
Physical
examinations
were
72
children,
all
with
autism
spectrum
disorder
of
some
sort,
a
lot
of
them
kind
of
undiagnosed.
But
that's
what
we
saw
and
there
is
something
I
don't.
C
I
don't
know
what
it
is.
I
just
had
a
very
good
friend
of
mine
who's,
a
physician
who's
had
a
child
who's
kind
of
put
into
that.
Pdd.
Didn't
really.
You
know
just
pervasive
developmental
disorder.
We
don't
really
know,
but
something
has
been
diagnosed
genetically
with
an
anomaly
because,
as
we've
learned
from
the
human
genome
too,
since
the
90s
we've
had
it
mapped,
but
we're
still
learning
all
the
time
about
you're
missing
a
little
piece
of
it
here
and
a
few
kids
have
that
and
they
all
have
very
similar
symptoms.
C
There's
things
that
we're
learning
along
the
way.
But
to
your
point
I
think
it
might
be
something
that's
environmental.
The
day
we
figure
that
out
will
be
a
great
day
I'll,
be
able
to
hopefully
identify
what
we
can
do
for
it.
The
one
thing
I
do
want
to
clarify,
especially
in
today's
climate,
a
lot
of
folks
are
focused
on
vaccinations
and
that
sort
of
stuff
that's
been
dispelled,
and
I
want
to
get
that
on
the
record.
Let
people
know
that
that
was
something
that
was
concerned.
C
I
think
the
university
of
kentucky
did
those
studies
to
actually
take
about
ten
thousand
children
reviewed
it
that
there's
no
connection
to
that.
But
you
guys
do
tremendous
work
and,
as
senator
meredith
says,
you
know
the
return
on
investment,
something
that
we
often
when
we
get
budget
items
that
we
request.
Our
chairman
typically
ask
for
hey.
We
need
to
have
some
kind
of
proof,
and
if
we
don't
have
proof
it's
tough,
when
we
have
programs
like
this,
I
mean
it's
already
proven
it
makes
it
easier
to
make
those
requests.
C
A
And
thank
you
for
being
here
today.
We
we
appreciate
it
so
much.
Our
next
item
is
medical
respite
care
for
individuals
experiencing
homelessness.
We
have
adrian
bush
and
tom
walton.
If
you
would
come
forward-
and
you
may
begin.
B
Elliott
sander
meredith,
chairman
meredith,
my
name
is
adrian
bush,
I'm
the
executive
director
of
the
homeless
and
housing
coalition
of
kentucky
or
hhck,
and
I
also
represent
the
kentucky
interagency
council
on
homelessness
or
kitsch.
Hhck
works
to
end
homelessness
and
fulfill
the
promise
of
home
for
all
kentuckians
and,
as
part
of
our
policy
work.
B
B
B
Yesterday,
one
of
our
staff
told
me
that
we
had
lost
a
man
after
he
was
discharged
from
the
hospital
another
man
prior
to
his
entry.
We
had
been
working
with
him
on
a
re-housing
voucher,
as
well
as
starting
the
paperwork
with
the
state
public
housing
authority
for
obtaining
a
mainstream
housing
choice
voucher,
but
with
no
good
options.
The
man
had
been
discharged
and
vanished.
B
In
the
second
case,
we
have
no
quick
resolution
forthcoming.
Whatever
work,
we've
done
to
get
him
stably
housed
we're
going
to
have
to
start
from
scratch
whenever
he
resurfaces
and
what
we
know
from
the
work
we've
done
over
the
past
two
years
is
that
he
is
most
likely
to
resurface
through
a
hospital
readmission
within
the
next
30
days.
B
As
mr
shannon
said
earlier,
we
we
agree
with
that.
You
know
people
don't
totally
vanish,
they
will
resurface
in
other
places.
B
This
is
where
medical
respite
for
people
experiencing
homelessness
or
respite
to
residents
could
be
the
difference
as
a
housing
organization.
The
residence
piece
is
central
to
the
whole
concept.
From
our
perspective,
from
2006
to
2016,
I
worked
for
an
organization
in
eastern
kentucky
that
operated
a
homeless
shelter.
So
I
was
no
stranger
to
hospital
discharge
practices
for
people
experiencing
homelessness.
B
In
2019,
I
was
introduced
to
tom
walton,
who
was
working
to
expand
medical
respite
for
homeless
patients
in
louisville
and
as
a
statewide
organization.
I
think
it's
important
to
lift
up
the
experiences
and
concerns
of
our
rural
communities,
so
we
convened
a
meeting
where
we
heard
from
our
partners
in
bowling
green
barberville,
moorhead
others
about
the
issues
that
their
people
were
facing.
B
This
began
a
collaboration
to
obtain
hospital
discharge
data,
readmission
rates
and
a
coordinated
effort
to
improve
health
and
housing
incomes
for
kentuckians,
experiencing
homelessness.
With
that
I'll
turn
it
over
to
my
colleague
to
introduce
himself
for
the
record
and
his
role
with
the
louisville
health
advisory
board.
Community
coordination
of
care
committee.
E
So
I'm
tom
walton,
I
co-chair
the
community
coordination
of
care
committee
and
our
committee
has
three
work
streams.
One
to
increase
screening
for
the
social
determinants
of
health,
two
is
to
increase
navigation
to
those
resources
and
three
to
increase
communities
capacity
to
meet
the
needs
in
the
areas
of
food,
housing
and
transportation.
E
E
E
We
realized
again
that
this
was
a
statewide
problem,
so
we
have
again
expanded
our
efforts
when
people
the
this
slide
talks
about
the
expenses
per
day
in
the
u.s
hospital
versus
medical
respite
care,
I'm
going
to
talk
a
lot
about
the
return
on
investment
as
we
move
through
the
slides.
I
know
that
every
the
data
has
to
be
indexed
to
individual
hospitals
and
regions.
E
So
just
keep
that
in
mind,
I'm
going
to
use
you
know,
sort
of
large
numbers
but
know
that
it
has
to
go
back
in
and
be
indexed
today,
we're
going
to
go
ahead
and
talk
about.
If
you
want
me
to
go
back,
no
you're
good,
okay.
So
so
I'm
going
to
go
through
and
walk
through.
You
know:
we've
had
a
lot
of
conversation
about
cost
savings.
So
what
I'm
going
to
do
is
talk
about
where
that
data
actually
comes
from.
E
In
2012,
I
served
on
a
population
health
committee
at
university
hospital
we
university
of
louisville
hospital.
We
went
back
and
looked
at
our
most
frequent
utilizers
of
the
emergency
department.
The
highest
utilizer
was
an
individual
who
all
called
joe
and
joe
visited
the
er
223
times
in
one
year.
He
was
experiencing
homelessness,
he
had
a
substance,
use
disorder
and
an
alcohol
disorder.
E
So
what
we
did
is
we
convened
a
community-wide.
We
called
it
the
complex
case,
treatment
planning
conference
and
we
had
housing
providers
there.
We
had
emergency
medical
services,
the
police
department,
our
psychiatric
hospital
lots
of
people
were
there
and
we
developed
a
plan
to
invited
joe
to
go.
The
transitions
treatment
center
in
northern
kentucky
the
hospital
agreed
to
pay
five
thousand
dollars
for
his
time
there.
E
He
was
there
for
three
months
and
while
he
was
there,
the
committee
continued
to
plan
about
how
he
could
be
reentered
into
the
louisville
community
with
permanent
support
of
housing.
After
the
stay
joe
did
return.
So
in
the
subsequent
year
he
had
10
emergency
department
visits.
The
committee
used,
which
is
sort
of
a
back
of
the
envelope
return
on
investment
calculation.
E
We
used
675
dollars
as
a
cost
of
an
emergency
room
visit,
so
223
visits
in
the
base
year
yielded
costs
of
around
150
000
10
visits
and
the
what
we
call
the
intervention
year
after
he
returned
from
transition
costs
about
sixty
seven
hundred
dollars.
So
the
hospital
with
a
five
thousand
dollar
investment
avoided
spending.
Approximately
a
hundred
and
forty
three
thousand
dollars.
E
If
a
medical
respite
program
was
available
at
that
time,
joe
would
have
been
discharged
from
the
emergency
room
to
the
medical
respite
program,
and
then
they
would
have
done
the
plan.
The
long-term
planning,
a
theme
that
you're
going
to
hear
throughout
our
presentation
is
intense.
It's
a
period
of
intense
care
coordination,
okay,
okay,
the
housing
and
homeless
coalition
asked
the
cabinet
for
data
from
the
health
resource
health
services
and
facilities
data
for
the
number
of
people
experiencing
homelessness.
E
E
E
I'll
get
into
that
we're
glad
to
get
into
the
details
of
how
it
was
constructed,
but
again
to
protect
confidentiality
if
any
hospital
had
five
or
fewer
admissions
that
data
was
suppressed.
So
it's
not
in
the
the
totals
when
we
saw
this
chart.
So
you
just
to
highlight
a
few
things.
In
there
there
were
over
11
000
discharges,
the
readmission
rate
of
33
just
sort
of
an
index
rate,
that's
a
very
high
readmission
rate.
E
Again,
I
don't
know
exactly
what
it
is
kentucky,
but
generally
you're
going
to
see
like
a
14
percent,
16
percent
readmission
rate
for
medicaid
beneficiaries-
and
I
do
want
to
highlight
that
the
293
million
dollars
is
charges.
It's
not
reimbursement
again,
that
reimbursement
data
is
not
available
in
the
health
facilities
and
services
data.
E
The
other
thing
I
want
to
note
and
again
this
sort
of
interface
is
what
sheila
and
steve
were
talking
about.
Is
the
number
of
people
with
a
psychiatric
diagnosis,
so
we
have
over
60
percent
with
a
psychiatric
diagnosis,
the
two
largest
being
psychosis
and
alcohol
drug
dependents.
Okay.
Next,
one
of
the
reasons
we're
testifying
today
is
you
can
see
that
67
of
the
over
4
100
people
that
generated
these
11
431
discharges
are
covered
by
medicaid.
So
we
see
this
a
significant
opportunity
for
to
deliver
better
care
to
medicaid
beneficiaries.
E
Okay.
Next,
when
an
unhoused
person
again,
this
goes
back
to
the
return
on
investment
calculation
when
a
an
unhoused
person.
Typically
they
stay
in
the
hospital
two
days
more
for
a
variety
of
reasons.
Sometimes
it's
difficulty
in
discharge
planning,
so
those
two
days
typically
don't
generate
any
additional
reimbursement
for
a
hospital,
particularly
since
they're
paid
with
the
drgs
under
increased
post
hospital
discharge.
E
E
E
E
These
are
I'm
going
to
talk
about
four
potential
models.
The
hope
recuperative
care
washing
care
center
is
in
wilmington
net
delaware.
It's
a
five
bed
center
project
partners
include
new
hanover
regional
medical
center,
anchor
united
methodist
church
winter
park,
baptist
church
and
the
disability
center.
In
addition
to
providing
respite
care
post
hospital,
they
also
provide
care
for
people
undergoing
chemotherapy.
E
E
E
I
don't
have
time
to
talk
about
all
of
the
spokes
of
this
particular
wheel,
so
I'm
just
going
to
make
a
comment
on
a
few
of
them
post
hospital
care.
What
we're
talking
about
is
really
what
we
call
a
non-medical
home-like
model
that
will
work
well
in
kentucky
if
it's
staffed
by
nursing
assistants
under
the
supervision
of
an
rn
who
follows
guidelines,
direct
developed
by
a
medical
staff,
the
connection
to
ambulatory
offices
is
really
key
to
reducing
admissions
and
improving
the
long-term
health
of
the
people.
E
The
national
institute
of
medical
respite
care,
which
was
cited
on
an
earlier
slide,
mentioned
the
92
percent
attendance
rate
for
follow-up
care.
If
a
person
was
living
in
medical
respite,
this
is
particularly
important
to
avoiding
readmissions
for
people
with
cardiovascular
disease
and
diabetes,
which
are
two
conditions
that
are
very
prevalent
in
people
experiencing
homelessness,
housing
and
other
basic
needs.
Often
people
don't
move
directly
from
medical
respite
care
to
a
state,
stable
housing
situation,
because
those
kind
of
units
are
just
not
available.
E
So
many
of
the
medical
respite
programs
focus
on
getting
with
people
ready
what
they
call
document
ready,
resolving
any
kind
of
outstanding
legal
issues
applying
for
benefits
etc,
so
that
when
a
unit
does
become
available,
they're
able
to
occupy
it
in
a
short
amount
of
time.
Okay,
next
excellent.
Okay,
there
are
really
two
core
issues
on
this
slide.
One
is
the
financial
sustainability
for
the
medical
respite
program.
The
other
is
the
return
on
calculation.
E
B
Sure
so
we
would
like
this
committee
to
consider
funding
for
medical
respite
and
other
flexible
housing
supports
in
a
medicaid
waiver,
for
kentuckians
with
severe
mental
illness
could
be
section
1115
or
1915,
as
mr
shannon
testified
earlier,
we're
not
really
particular
about
the
authority.
We
just
think
it
it
can
be
done,
and,
secondly,
I
think
before
I
move
on
to
the
next
bullet
point,
I
just
want
to
say
I
think
to
I
have
listened
to
this
committee's
meetings
over
the
past
year
and
before
that,
and
we
agree
with
you
on
wanting
to
capture
outcomes.
B
Secondly,
I
want
to
say
we
want
to
encourage
the
development
of
whole
person
care
pilots.
I
think
it's
really
important
when
we,
you
know
when
you
were
when
tom
was
talking
about
the
wheel
and
the
different
spokes
and
listening
to
other
presentations,
that
we
are
talking
about
these
other
it
spokes
that
that
support
folks,
where
they
are
that
all
of
these
systems,
like
representative
parente,
said
they're
not
operating
in
silos,
that
they
interact
with
each
other
and
whole
person.
B
The
last
piece
that
I
will
just
mention
the
hotel
inc
member
organization
in
bowling
green
is
one
of
our
members
and
the
way
they
have
supported
their
medical
respite
has
been
through
a
partnership
through
the
well
care
managed
care
organization.
So
at
least
one
of
our
mcos
are
finding
that
this
is
actually
a
good
return
on
investment.
They
wouldn't
be
doing
it,
otherwise
they
would
not
be
doing
it
out
of
the
goodness
of
their
hearts,
so
just
wanted
to
throw
that
out
there
for
consideration,
and
with
that
I
will
turn
it
back
to
you.
A
I
know
coming
from
a
rural
district
in
kentucky,
I
have
been
astounded
by
the
number
of
homeless
people
that
live
in.
My
district
is
when
I'm
out
and
about
you
think,
typically
of
issues
of
homelessness
being
in
urban
parts
of
the
state,
but
but
it's
unfortunately
becoming
more
of
a
problem
everywhere,
and
so
with
that
being
said,.
E
A
And
how
the
hospital
went
on
its
own
there
to
get
him
the
appropriate
care
and
also
save
hundreds
of
thousands
of
dollars,
is
a,
I
think,
a
wonderful
example
of
of
this
issue
in
this
problem.
So
I
I
appreciated
that
example.
Representative
gooch
has
a
question.
H
Don't
always
have
questions
so
understand,
go
ahead.
Let
me
just
say
thank
you
for
all
the
work
that
you
do
and
and
everyone
that's
presented
here
today
and
and-
and
I
really
believe
that
there's
no
question
that
you
know
we
can
make
investments
and
those
investments
can
save
us
money
on
the
on
the
on
the
other
end,
and
you
know,
certainly
we
all
worry
about
our
homeless
population.
H
Many
of
those
people
are
veterans,
people
who
lived
here
and
worked
and
for
whatever
reason,
can't
now
or
families
that
have
you
know
problems
because
they
have
children
that
have
conditions
and
that
they
can't
can't
afford
those.
You
know
the
treatments
and
those
sort
of
things,
and,
and
certainly
we
can
invest
in
in
those
things
and
and
save
money
and
and
we're
all
okay
with
doing
that
for
for
people
that
that
that
live
here
and
our
citizens
and
many
times
veterans.
H
I
know
this
is
not
what
we're
talking
about
here
today,
but
but
I
think,
as
general
assembly
members
who
are
going
to
have
to
pay
the
bills
we
one
thing
is
there
is
no
way
we
can
save
enough
money.
I
don't
care
how
creative
you
guys
get.
H
It's
unconscionable
that
that
we're
allowing
this
to
happen
in
in
this
country,
and-
and
I
don't
want
to
put
a
damper
on
this-
but
we
have
to
think
about
that,
because
there's
going
to
be
huge
costs
to
pay
because
those
folks
are
coming
here,
many
of
them
are
going
to
be
homeless
and
are
at
least
in
the
short
term,
going
to
require
at
least
temporary
assistance.
H
You
know,
hopefully,
that
at
some
point
they
will
be
able
to
you
know,
get
jobs
and
and
be
productive
citizens
whatever
and
then
alex,
as
I
said,
apologize
to
the
chairman.
That's
not
what
we're
talking
about
today,
but
that
is
an
800-pound
gorilla
in
this
room
that
this
general
assembly
will
have
to
deal
with
at
some
point.
So
sorry
about
my
rant,
mr
chairman,
but
I
just
had
to
get
that
off
my
chest.
A
B
Sure
there's
a
couple
of
different
methodologies
used
to
account
persons
experiencing
homelessness.
One
is
called
the
point
in
time
count
that
is
mandated
by
the
u.s
department
of
housing
and
urban
development.
Kentucky
does
do
one
every
year.
We
don't
have
the
2021
figures
it
is
conducted
in
the
last
week
of
january
annually,
and
so
this
year
was
a
little
bit
odd,
because
vaccines
were
not
readily
available,
and
so
the
street
count
the
unsheltered
count.
B
Peace
was
just
kind
of
limited,
so
kentucky's
figures
from
about
2013
have
gone
down.
We
have
decreased
our
rate
of
homelessness,
relatively
speaking
through
the
point
in
time.
Count
methodology
from
about
six
thousand
down
to
about
four
thousand
now
keep
in
mind.
It's
just
one
snapshot,
not
a
cumulative
count
of
all
people
experiencing
homelessness
within
that
4
000
figure
generally
about
600
folks
report
severe
mental
illness,
but
also
that's
that's
severe.
That
is
self-reported.
B
Then
there's
also
substance
use
disorder.
They
may
report
that,
generally
speaking
on
a
national
on
a
national
nationwide
basis,
we
estimate
that
about
half
of
folks
experiencing
homelessness
may
be
experiencing
mental
illness
that
that
percentage
goes
up
when
we're
talking
about
people
experiencing
chronic
homelessness,
a
long
at
least
a
year
of
homelessness.
Over
a
three
year
period
and
like
tom,
the
person
tom
was
talking
about
joe.
That
would
be
an
example
of
someone
who
would
fall
into
that
category.
L
Thank
you,
mr
chairman,
and
adrian
you
brought
up
a
question
to
me
the
other
day.
It's
probably
it
deal
dealt
with
homeless
folks,
but
I'll
change,
hats
and
talk
about
transportation,
and
let
you
know
that
I'm
concerned
about
your
issue
about
ids,
and
I
brought
this
up
to
the
transportation
cabinet
when
we
first
started
working
on
on
the
new
driver's
license
and
and
how
to
handle
or
how
to
make
available,
ids
to
homeless
and
and
those
who
could
not
find
transportation
to
the
regional,
regional
centers.
B
We
are
very
much
looking
forward
to
working
with
you
chairman,
edmund
higdon,
just
quick
psa.
If
you
will
indulge
me
chair,
we
are
working
on
a
piece
of
legislation
with
representative
bridges
in
paducah
to
kind
of
reform.
The
way
that
we
that
people
experiencing
homelessness
can
obtain
an
id
a
low-cost
id
in
2011.
The
general
assembly
created
a
legal
pathway
for
folks
to
be
able
to
do
that.
D
Thank
you,
mr
chairman,
and
adrian
always
good
to
hear
from
you.
Don't
forget
you
I'm
glad
you
mentioned
paducah,
because
there's
a
lot
more
western
kentucky
past
bowling
greens.
D
My
question
is:
you
know
the
the
medical
rest,
but
is
there
a
way
that
you
all
dovetail
with
the
services
like
if
they
do,
if
someone
does
have
severe
mental
illness
it?
What
I
heard
in
your
testimony
was
if
somebody
goes
in
the
hospital
for
a
surgery
or
some
other
medical
condition
and
you're
trying
to
transition
them
out
and
keep
reading,
keep
from
readmitting
et
cetera
if
they
have
a
several
severe
mental
illness
or
other
issues.
Do
you
all?
Is
there
a
way
you
all
dovetail
with
other
services
or.
B
This
is
tom's,
this
is
tom's
favorite
topic,
oh,
go
for
it.
E
As
you
might
tell,
I've
been
35
years
in
healthcare,
mostly
in
hospitals,
the
the
and
again
we
look
a
lot
to
the
national
institute
on
medical
respite
care,
which
is
par
as
a
special
initiative
of
the
health
care
for
the
homeless
council,
which
is
nash
and
they're,
actually
funded
by
cms,
to
study
homelessness
and
specifically
these
days
medical
respite.
E
But
yes-
and
let
me
draw
a
flow
chart
mentally
for
you,
so
the
person
could
this
would
be
a
pretty
typical
pathway.
The
person
would
be
admitted
to
or
present
to
the
emergency
department
again
university
hospital
had
an
emergency
psychiatry
department
where
they
did
quick
assessment.
So
I'm
real
familiar
with
their
work.
The
person
would
be
seen
like
in
an
emergency
room.
Then
they
would
be
admitted
to
an
inpatient
unit
like
for
a
drug
overdose,
septic,
a
drug
overdose.
E
Then
what
would
happen
is
they
would,
instead
of
being
discharged
to
the
streets,
they
would
be
discharged
to
the
medical
respite
program,
while
in
the
medical
respite
program,
think
that
now
becomes
the
hub
and
they
reach
out
to
a
recovery
housing
they
reach
out
to
whatever
services,
appropriate
transportation
services,
benefit
eligibility
etc
to
make
sure
that
they
qualify
so
in
the
then
they
would
work
on
actually
discharging
from
the
medical
respite
program
into
another
program.
It
could
be,
you
know,
community-based
housing
and
again.
E
What
sheila
and
steve
were
talking
about
would
be
another
like
a
housing
option
that
would
come
be
created
to
them.
We
are
paying
a
lot
of
attention
to
navigation
services
again,
the
community
coordination
of
care
did
a
lot
of
work
from
the
health
care
sector
sector
thinking
of,
and
then
it
resulted
in
metro,
united
way,
creating
an
effort
called
united
community
which
uses
that
unite
us
platform,
so
that
we
can
make
electronic
referrals
for
social
services,
transportation,
housing,
a
food,
etc
electronically,
and
that
enables
us
to
actually
track
the
impact
like.
E
How
doesn't
long
does
it
take
to
accompany
to
of
referring
agency
to
respond
to
services
like
that?
So
no,
it's
very
much
the
the
medical
respite
is
is
really
a
period
of
very
intense
care
coordination.
I
I
You
know
we
don't
have
good
coordination
amongst
our
healthcare
community
and
other
community
providers.
And,
yes
again,
we
know
67
of
healthcare
issues
are
based
on
social
determinants
and
we
don't
intertwine
that
in,
and
this
is
a
way
to
do
it.
We
think
there's
a
better
model
delivery
than
what
we
personally
have.
So
I
like
that
support
that
would
like
to
see
that
advance,
but
I'll
finish
with
miss
bush.
I'm
just
surprised
that
you're
still
cynical
when
it
comes
to
mcl's
doing
something.
I
No,
no
no
need
to
truly,
but
I
want
to
commend
well
care
for
that.
That's
the
kind
of
thinking
that
we've
been
looking
for.
You've
got
to
think
outside
the
box.
They
are
responsible
for
the
care
of
these
patients.
This
is
one
of
the
elements
they
should
step
up
and
do
this,
so
I
commend
them
and
the
first
time
I
have
an
opportunity
to
talk
to
them.
I'll
tell
them
so,
but
I
appreciate
you
bringing
that
to
our
attention.
Thank
you.
Thank.
B
A
B
So
in
2020
we
were
able
to
tom
really
organized
a
series
of
learning
calls.
We
had
three
or
four
in
the
fall
of
2020
and
he
invited
all
of
the
mcos
that
have
plans
in
kentucky
to
participate
and
talk
about
how
they
were
addressing
people
experiencing
homelessness,
their
social
determinants
of
health
and
then,
if
they
had
medical
respite
models
in
maybe
other
states
that
they're
operating
in
to
share
about
those
and
tom.
I
don't
know
if
you
want
to
add
anything,
but
tom
was
really
the
driving
force
behind
that.
E
Yeah,
so
all
six
of
them
are
interested
in
housing
and
specifically
medical
respite
and
again,
what
we
wanted
them
to
do
was
to
basically
identify
programs
that
they
that
were
successful
in
other
states
and
then
think
of
ways
to
customize
them
to
various
communities
throughout
kentucky
so
and
some
have
actually
hired
housing
specialists
again,
not
specifically
necessarily
focused
on
medical
respite,
but
on
housing.
Their
members,
okay,.
C
You,
mr
chairman,
question:
you
know
really
good
stuff.
This
intrigues
me
in
a
bit
had
a
lot
of
discussions
with
our
mco
partners
in
the
past
about
you
know
that
the
large
percentage
of
your
medicaid
costs
are
consumed
by
a
very
small
population
of
people,
and
so
how
do
we
find
a
way
to
keep
those
folks
out
of
the
hospital
I've?
Had
these
discussions
multiple
times
and
I've
had
a
lot
with
wealth
care
in
the
past
as
well.
They
they
have
them
to
their
credit.
C
I
C
Is
physicians
who
don't
want
to
necessarily
contract
with
medicaid
or
have
and
don't
contract
with
any
insurance
companies,
but
are
willing
to
take
care
of
a
subsidy
population
of
patients?
I
would
think
this
would
be
right
for
someone
like
that.
You
could
hire
a
practitioner
if
they
were
going
to
pay
you
a
fee
per
person,
you're
going
to
manage
all
their
care
and
so
they're
in
respite
care
programs.
C
They
can
kind
of
help
manage
that
a
couple
things
I
was
as
you're
presenting
you
put
up
the
insurance
breakdown
because,
as
you
were
starting
the
presentation,
I
thought
well,
not
everybody
here
is
under
medicaid,
and
I
was
impressed
that
we
actually
had
eight
percent
under
commercial
plans,
which
I
find
surprising
with
people
that
are
homeless.
I'm
wondering
if
you
can
explain
some
of
that.
C
How
many
of
these
are
medicare
makes
me
wonder
how
many
of
these
folks
are
over
the
age
of
65
or
62
in
some
cases
that
require
medicare
and
are
if
even
if
the
state
says
hey
we're
willing
to
do
this
with
medicaid?
Are
those
commercial
plans
and
medicare
willing
to
provide
care
for
these
programs.
E
So
I'll
try
and
remember
all
those
and
tell
me
if
I
don't
so
number
one
what
this
is
a
true
speculation
that
those
people
are
covered
by
the
commercial
plans
they're
being
uncovered
up
to
age
26
under
their
parents
plan.
That's
what
we
think
that
that's
happening
there.
E
We
did
go
back
and
it
actually
varies
significantly
by
regions
and
again
I
didn't
analyze
all
of
the
area
development
districts,
but
in
the
louisville
market
it
really
is
a
very
heavy
medicaid
market.
As
you
move
away
from
the
downtown
you're
starting,
you
see
the
number
of
medicare
patients
actually
increasing.
E
C
So
a
lot
of
those
folks
who
are
being
signed-
I
mean
I
don't
know
if
they're
being
signed
up
at
the
point
of
care
or
if
they've
been
signed
up
or
maybe,
if
you
repeat,
customers
are
coming
in
pretty
regularly.
I
would
imagine
if
there's
veterans
va
medical
center.
I
don't
know
if
you're
putting
that
in
a
commercial
or
not
if
there
may
be
a
larger
group
of
that
as
well.
C
E
I
think
they
are
and
the
reason
for
that
again,
if
I
was
a
hospital
administrator
with
a
large
medicare
population,
I
would
be
very
concerned
about
my
readmission
rates,
so
that
would
be
their
financial
to
incent
to
become
involved
and
again
the
medicare
advantage
plans
are
risk-based
contracts
so
again,
they're
doing
a
lot
of
things
specifically
in
the
area
of
you
know,
value-added
benefits
now,
which
certainly
might
fall
under
this.
E
But
the
way
that
we
had
that
really
deep
insight
into
the
patterns
at
university
hospital
was
by
looking
at
our
own
billing
data
and
again
that
would
answer
chair
elliott's
offers
all
you
know
observation
all
about
the
the
actual
diagnoses
that
were
driving
the
disease.
I
mean
the
the
readmissions
and
all
threat
and,
again
that's
why
we
intervened
so
intensely
and
again
we
had
actually
a
cohort
of
120
patients
that
we
worked
with.
The
total
savings
was
around
seven
hundred
thousand
dollars.
It
says
that
joe
was
the
most
significant
driver
of
that
savings.
C
It
makes
total
sense
two
other
quick
questions.
I
know
you
mentioned
675
dollars
for
an
average
er
visit.
That's
that's
on
the
lower
side.
I
would
argue
it's
probably
a
higher
savings
than
that.
That
might
just
be
the
getting
checked
in
some
of
the
fees,
and
you
know
I
mean
really
by
time
you
run
tests
and
in
the
world
that
we're
we're
in
right
now
with
healthcare
with
it
with
a
person
who
might
be
living
on
the
street
or
might
be
you
don't
have
a
lot
of
records
to
depend
on
tests
abound.
C
C
So
you
think
about
a
ct
scan.
Is
the
radiation
from
a
ct
scan
from
one
is
equivalent
to
a
full
year's
radiation
exposure
from
the
sun
so
multiply.
E
C
Mean
that's
incredible.
The
other
thing
33
return
a
hospital
rate
for
the
members
of
the
committee.
Anything
above
15
is
considered
to
be
poor,
so,
most
again
in
a
nursing
home
setting,
that's
being
tracked
for
us
anything
above
15
is
kind
of.
You
know
frowned
upon
you're,
not
doing
a
good
enough
job.
33
is
well
over
double.
What's
expected
from
a
lot
of
those,
the
other
ques,
the
last
question
I
have:
how
long
does
somebody
remain
in
a
respite
program
if
they
get
admitted
to
a
let's
say
they
have
like
you
mentioned
earlier.
C
E
E
I
think
that
when
you
get
into
like
chemotherapy
and
some
of
the
iv
antibiotics
that
which
is,
I
really
can
also
be
a
very
significant
cost
saver
for
a
hospital.
Then
that's
when
you
might
have
the
more
extended
stays
again,
another
reason
for
each
hospital,
each
mco
to
kind
of
model
their
own
data,
but
there
is
really
a
lot
of
variability
and
some
of
the
there
was
a
random
random
clinical
trial
study
done
in
denmark.
They
used
14
days
as
their
benchmark.
C
And
again,
a
lot
of
these
folks
come
to
our
nursing
homes
right
now
for
a
lot
of
this
care,
obviously-
and
they
don't
get
discharged
back
to
the
streets,
they
they
wind
up.
If
they
make
sure
you
have
a
secure
home
environment,
so
a
lot
of
them
will
come
in
recover,
they'll
stay
with
us
and
I'll
see
them
and
they're
walking
around
they're
normal,
I'm
like.
Why
is
this
person
here?
They
go?
C
They
have
nowhere
to
go
and
they'll
stay
in
a
nursing
home
setting
where
we're
paying
for
those
costs
for
three
four
six
months
until
they
find
them
a
stable
home
environment
once
they
reach
that
point.
For
you
all
what
happens
if
they've
met
their
medical
goals,
everything
is
stable.
If
you
don't
have
a
home
environment,
do
they
ever
get
discharged
into
a
non-stable
home
environment.
E
Yes,
and
since
you
brought
nurse
incomes
out,
I
want
to
address
something
there.
What
we
also
believe
is
that
nursing
homes
will
be
more
willing
to
take
people
for
rehab
care
if
they
knew
they
can
go.
The
pathway
was
from
hospital
nursing
home
to
respite
care.
What
we're
hearing
now
is
a
lot
of
nursing
facilities
are
reluctant
to
take
people
experiencing
homelessness
because
they're
afraid
they're
going
to
get
stuck
with
them.
E
So
we
think
that
that
will
actually
work
in
decreasing
the
hospital
length
of
stay
than
the
appropriate
medical
nursing
care
setting
and
then
us
actually,
some
people
are
when
they
leave
respite
care.
They
have
recovered
enough,
they
do
go
back
to
the
streets,
but
the
ideal
is
that
they
have
established
enough
of
a
care
plan
and
and
enough
relationships
again.
E
That's
one
of
the
reasons
for
this
connection
back
to
primary
care
is
so
that
that
those
medical
gains
will
be
sustained,
and
you
know,
they'll
know
how
to
fill
the
prescriptions
et
cetera,
et
cetera,
to
keep
them
more
medically
stable
again
until
a
more
permanent
supportive
housing
arrangement
can
be
arranged.
A
Well,
thank
you
for
your
presentation
and
I
don't
think
we
have
any
more
questions
or
comments,
but
we
appreciate
it
and
we're
now
down
to
item
six
on
the
agenda
and
update
on
establishment
of
a
provider
credentialing
alliance
which
is
house
bill,
438
from
the
20
20
regular
session,
and
we
have
nancy
galvani,
brian
brzezowski,
brzezowski,
probably
brazoski.
Yes,
sir
and
justin
guilford
who's
on
zoom.
So
the
floor
is
yours
and
you
may
begin
all.
G
Right
well,
thank
you
so
much
for
inviting
us
co-chairs,
elliott
and
meredith
we're
very
pleased
to
be
here
to
update
you
on
the
implementation
of
a
credentialing
alliance
under
house
bill,
438
that
you
all
passed
earlier
this
year,
and
so,
as
you
know,
this
alliance
recognized
the
opportunity
for
a
new
partnership
between
the
mcos
and
certain
provider
associations
to
us
to
solve
this
long-standing
problem
with
credentialing.
G
It's
really
important
that
we
have
provider
friendly
and
timely
credentialing,
because
a
provider
cannot
be
reimbursed
by
an
mco
until
they're,
fully
credentialed
and
just
kind
of
as
a
reminder
to
everyone.
Credentialing
really
involves
a
two-step
process.
First
is
a
verification
of
a
provider's
training,
education,
licensure
and
then
a
panel
of
professionals,
reviews
that
information
and
makes
a
final
determination.
G
And
the
issue
has
been
that
you
know
we
have
have
had
five
mcos.
Now
we
have
six
mcos
and
each
mco
had
its
own
separate
process,
separate
committees.
So
you
can
see
how
that
could
entail
a
lot
of
problems
for
providers,
and
this
has
been
a
long-standing
pain
point
for
our
members
since
managed
care
was
initiated,
and
that
is
really
why
kha
has
had
an
interest
in
in
trying
to
solve
the
problem.
I
will
say
for
the
last
two
years,
kha
has
had
a
very
successful
partnership
with
aetna.
G
In
fact,
we've
been
their
delegated
credentialing
agent,
and
that
has
worked
very
well
and
so
what
is
allowed
under
house
bill?
438
really
allows
us
to
expand
our
program
that
we've
had,
as
I
said
very
successfully,
with
aetna.
We
have
partnered
with
aperture
to
be
our
credentialing
verification
organization.
G
Aputure
is
a
conduct,
a
kentucky
based
company
that
has
wide
experience
in
doing
credentialing
across
the
nation
and
has
been
very
involved
in
credentialing
alliances
in
other
states,
and
so
they
are
our
partner
in
setting
up
our
kentucky
credentialing
alliance,
and
I
would
like
to
publicly
recognize
and
thank
the
leadership
of
the
three
largest
mcos
aetna
molina
and
wellcare,
who
have
all
agreed
to
join
our
credentialing
alliance.
So
we're
very,
very
happy
with
that.
At
this
time.
G
H
Okay,
fantastic,
I
nancy
really
spelled
it
out
best.
H
We
aperture
has
been
involved
in
credentialing
pretty
much
throughout
the
country
for
over
20
years,
we're
originally
out
of
out
of
humana,
but
we've
grown
from
from
that
stage
up
to
where
we
are
now-
and
you
know,
we
were
looking
to
to
help
what's
what's
a
clear
problem
for
the
providers
in
this
state
in
our
home
state,
where
we're
actually
based
provide
a
solution
that
you
know
that
will
work
to
get
rid
of
a
lot
of
the
problems.
H
Nancy
was
just
just
talking
about
there,
streamlining
things
to
where
you
don't
have
to
fill
out.
You
know
five
applications
and
go
through
five
separate
processes
and
go
through
five
separate
committees
just
to
get
to
the
the
same
place
that
you're
you're
looking
to
go
so
it's
it's
just
been.
It's
been
a
real
pleasure
to
kind
of
build
this
with
kha.
H
I
want
to
commend
the
kha
for
taking
a
leadership
stance
concerning
this
problem
in
the
commonwealth
and
also
want
to
commend
the
the
three
mcos
that
have
stepped
up
to
the
plate
right
off
the
bat
two
of
which
are
actually
all
three
are
existing
clients
of
ours
and
some
in
some
capacity.
H
So
we
we
are
we're
very
excited
for
the
opportunity
to
to
to
provide
this
solution
and
we
are,
as
nancy
said,
hard
at
work
getting
into
the
implementation
of
of
the
kentucky
alliance.
That's
that's
going
to
be
a
very
good
thing
for
the
providers
here,
just
as
it's
been
a
very
good
thing
for
the
providers
in
the
other
states
where
we
we
provide
the
the
same
services
for
for
this
type
of
alliance
system.
G
So
we
also
wanted
you
to
hear
from
brian
brzezovsky
he's
our
general
counsel.
Kha
and
brian
has
really
taken
the
leadership
in
putting
the
alliance
together
working
closely
with
justin
and
the
mcos,
and
we
think
we
actually
have
a
very
unique
program
and
brian's
going
to
tell
you
just
a
little
bit
about
that.
H
Sure,
thanks
nancy,
so
under
the
bill
the
providers
are,
are
the
cvo
is
required
to
provide
outreach
and
help
desk
services
during
common
business
hours
and-
and
we
see
kha's
role
going
forward
as
sort
of
a
provider
outreach
on
steroids.
So
we
have
a
full-time
employee
who
does
nothing
but
work
applications
which
may
be
submitted
incomplete?
They
may
need
verifying
tax
id
numbers.
H
So
so
we
chase
those
those
applications
down.
Our
employee
meets
with
those
people
and
we
have
helped
over
the
past
18
months.
As
nancy
said,
working
with
aetna,
we
have
helped
chiropractors
doctors,
dialysis,
centers,
home
health
services,
hospice
care
on
and
on,
not
just
hospitals.
So
the
list
goes
on
so
everyone
that
needs
to
be
credentialed.
A
B
G
Well,
we've
had
multiple
meetings
with
all
the
parties
and
we
had
reached
out
when
we
had
the
invitation
to
testify
to
find
out
kind
of
where
everyone
was,
and
so
humana
has
said.
They
are
declining
to
join
the
alliance
united
said
they're
declining
at
this
time,
but
they
might
be
open
to
it
later.
On
and
anthem
has
not
yet
answered
us.
I
I
I
Related
to
this
folks,
but
why
would
have
you
here
and
I
appreciate
the
testimony
you've
given
that
appropriation
of
revenue
and
other
committee
meetings
we
had
but
certainly
very
concerned
about
the
future
of
rural
healthcare,
particularly
rural
hospitals,
and
I
know
before
the
pandemic
that
we
had,
I
think,
there's
something
like
68
rural
hospitals
in
kentucky
and
a
quarter
of
those
were
viewed
as
financially
distressed
and
now
we're
at
50
has.
Has
that
worsened
since
over
the
past
few
months
or
are
we
kind
of
stabilizing
or
can
you
give
me
a.
G
I
think
we're
still
in
the
process
of
analyzing
that
I
know
we're
trying
to
look
at
what
revising
our
report
on
covid
losses,
because
our
data
only
went
through
the
end
of
2020
and,
of
course,
that
didn't
account
for
the
huge
increase
that
we've
seen
in
staffing
costs
vaccine
distribution.
You
know
just
a
whole
host
of
costs
that
have
happened
this
year
and
again
there
hasn't
been
any
more
federal
funds
coming
out
to
help
the
hospital.
G
G
You
know,
utilization
has
still
not
bounced
back
to
pre-covered
levels
and
what
the
hospitals
tell
us
is
that
the
patients
that
are
now
in
the
hospital
are
sicker
than
ever.
The
acuity
level
is
out
out
the
charts
and,
as
you
know,
senator
meredith
from
run
the
hospital.
You
know
you
get
a
fixed
drg,
you
know,
and
yet
so
our
costs
are
higher,
so
sicker
patience
doesn't
mean
you're
going
to
profit
more
for
sure.
G
It
just
means
you
know
it's
costing
us
more
to
take
care
of
these
patients
and,
of
course,
that's
draining
our
workforce
as
well,
because
you
know
every
patient
just
requires
so
much
care.
So
it's
it's
a
very
concerning
situation,
but
we
we
can
get
back
to
you
more
on
the
financials,
but
that's
something
that
we're
monitoring.
Certainly
and
again,
we
want
to
thank
you,
know
the
general
assembly
for
approving
that
a
trip
program.
G
I
G
G
I
Well,
the
reason
I
ask
is
you
know
the
saying
that
a
lot
depends
on
who's,
hogs
and
who's
cabbage
patch
and
for
a
lot
of
people.
It's
well.
You
know
the
hospital's
in
trouble,
but
that's
not
my
hospital.
Well,
maybe
your
hospital,
you
may
not
even
be
aware
of
it
and
I
think,
there's
just
some
communication
needs
to
be
had
to
express
express
the
urgency
of
this
situation.
As
you've
heard
me
say
before
a
rule,
community
loses
a
hospital,
it's
like
louisville,
losing
ford
or
ge
or
ups.
I
It
has
that
kind
of
economic
impact,
and
I
think
we
are
all
a
little
bit
surprised
on
what
happened
with
our
lady
of
elephant
a
couple
years
ago,
and
many
of
us
didn't
see
that
coming
and
with
a
thousand
employees
in
that
community.
That
was
obviously
devastating
and
I
know
they're
trying
to
recover
using
some
alternate
and
delivery
methods,
but
I
think
we
need
to
have
more
information
about
this.
So
thank
you.
I'd
appreciate
that.
L
Thanks,
I
know
the
hours
late,
but
just
you
kind
of
touched
on
something
that
sparked
something
that
I've
been
curious
about.
I
saw
a
report
not
long
ago
that
only
about
30
of
medicaid
recipients
are
vaccinated.
L
Have
you
and
you
talked
about
the
the
patients
you
have
now-
are
sicker
and,
and
is
there
a
disproportionate
amount
of,
I
guess
medicaid
patients
now
versus
a
normal
time?
Are
you
know
historic
times
as
you
look
at
as
you
look
at
your
patients
now.
L
G
In
terms
of
acuity,
the
thing
that
we're
seeing
and
there's
a
lot
of
national
reports
about
people
foregoing
care,
you
know
people
were
afraid
to
come
to
the
hospital
due
to
covid
and
we're
not
sure.
If
that
that's
we
think
there
may
that
still
may
be.
People
still
may
be
cons,
afraid
now,
that's
something
that
you
know
we're
trying
to
get
more
information
on.