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From YouTube: 4/15/2021 - Senate Finance and Assembly Ways and Means, Subcommittees on Human Services
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A
A
Well,
welcome
everybody
to
the
first
in-person
meeting
of
a
subcommittee.
We
are
all
learning
together
how
this
works,
but
from
my
understanding
from
a
couple
of
other
committees,
who've
gone
before
us
that
we
are
getting
pretty
good
at
doing
the
in-person
and
the
virtual.
A
So
thank
you,
everyone
for
your
participation
and
for
your
patience
if
we
run
run
up
against
any
glitches,
we're
going
to
be
doing
both
a
work
session
today
on
the
department
of
healthcare
financing
and
policy
and
closing
some
budgets
for
the
division
of
welfare
and
supportive
services
right
now,
we
are
going
to
go
ahead
and
take
a
short
recess
to
give
those
members
who
are
not
with
us
in
person
an
opportunity
to
download
the
closing
document.
So
for
now
we
will
be
in.
A
A
Hello,
everyone
just
so
those
of
us
who
are
those
of
you
who
are
watching
know
what's
happening,
we're
having
a
few
technical
difficulties,
getting
the
document
documents
available
to
the
public,
so
we'll
just
be
in
a
continued
recess
until
we
get
that
figured
out.
Thank
you.
A
C
Brady.
Thank
you,
madam
chair,
for
the
record.
My
name
is
colby
nichols
I'm
a
program
analyst
with
the
lcd
fiscal
analysis,
division
and
I'll
be
going
over
the
closings
for
two
division
of
welfare
and
supportive
services
budgets,
the
first
of
which
is
the
temporary
assistance
for
needy
families.
Budget
information
regarding
this
begins
on
page
three
of
your
closing
packet.
C
There
are
two
major
closing
issues
associated
with
this
account.
The
first
is
case
load
changes.
This
is
for
the
tan
of
cash
assistance
program,
which
is
the
cash
assistance
program
for
families
with
a
work
eligible
adult
in
the
household,
as
well
as
various
other
programs
related
to
caregiver
and
kinship
guardian
assistance.
C
As
you
can
see,
the
additional
months
of
data
have
continued
the
trend
of
a
decline
in
tanf
cash
assistance
recipients.
C
In
addition,
the
subcommittee
also
asked
whether
the
number
of
tanf
recipients
that
were
exiting
the
program
due
to
meeting
the
five-year
lifetime
cap
on
benefits
was
contributing
to
this
projected
declining
caseload
and
the
agency
responded
that
it
did
not
see
any
major
changes
in
the
number
of
people
who
were
exiting
the
tanf
program.
Due
to
that
five-year
cap
and
again
indicated
that
the
agency
believed
enhanced
unemployment
insurance
benefits,
particularly
those
for
gig
economy
workers,
was
the
major
factor
contributing
to
the
projected
declining
caseload
based
on
those
updated
caseload
projections.
C
C
you'll
see
a
table
at
the
bottom
of
page
five
of
your
closing
packet
again,
comparing
the
funding
amount
for
tan
of
cash
assistance.
Payments
between
the
figures
included
in
the
gov
wreck
budget
and
those
included
with
the
march
caseload
update
and
the
net
impact
of
those
is
listed
in
the
difference
column
of
the
total
row.
C
E
A
C
Yes,
that's
correct
the
adjustments
in
this
as
a
part
of
the
caseload
update.
These
adjustments
are
not
affecting
the
overall
amount
of
tanf
grant
funding
that's
being
awarded
to
the
state.
It's
the
amount
of
funding
that
is
going
to
be
cash
assistance
program.
The
overall
level
of
funding
for
the
tanf
block
grant
is
not
affected
by
the
caseload
update.
C
F
Figure
out
how
to
do
this.
Thank
you,
madam
chair,
just
a
clarification.
If
I
might
on
the
funds,
I
think,
during
testimony
we
heard
that
there
was
already
almost
a
16
million
dollar
reserve
in
the
tanf
funds.
So
with
these
new
projections,
that's
going
to
increase
the
amount
of
reserve.
Is
that
correct.
C
C
E
C
Information
based
on
the
march
caseload
update
the
fiscal
year,
2023
ending
tanf
reserve
level
is
estimated
to
be
about
38.8
million,
as
opposed
to,
I
believe
it
was
approximately
22
million
when
included
in
the
government
budget.
F
And
just
for
clarification,
thank
you
for
that.
Follow
up
on
that,
I'm
sure.
So
we
heard
darn
testimony
these
funds
have
very
limited.
You
other
programs
that
they
may
be
used
for
is
so
they
don't
revert,
because
these
are
federal
grant
funds.
They
don't
revert
to
our
general
fund.
There's
they
have
specific
requirements
to
be
used
in
certain
manners.
C
Yes,
that
is
correct.
There
are
four
primary
purposes
for
tanf
and
in
order
for
use
of
tana
funding
to
be
allowable,
you
have
to
establish
a
nexus
between
those
four
primary
purposes
in
the
program
that
that
is
being
proposed
to
be
funded
with
payment
funding.
F
C
For
the
record,
I
am
not
I'm
not
aware
of
any,
but
I
would
defer,
perhaps
with
your
permission,
madam
chair,
perhaps
somebody
from
the
agency
could
address
that.
A
So
I'm
going
to
interrupt
here,
if
I
may
so
just
by
way
of
process.
These
are
updated.
Projections
based
on
a
caseload
adjustment
and
the
decision
in
front
of
us
here
today
is
whether
or
not
we
agree
with
these
updated
projections
as
we
move
through
the
process.
This
is
april.
15Th.
There's
still,
I
believe,
50
days
left
before
us,
there
will
be
the
opportunity
for
other
conversations
about
what
might
be
allowable,
but
I
think
we
need
to
stay
focused
today
on
the
decision
that
is
before
us.
If
that's
okay
with
folks.
F
B
I
A
Second,
I
have
a
motion
from
assemblywoman
ro
moreno,
a
second
from
marilyn
dondero
loop,
so
we're
going
to
give
it
a
shot
of
just
actually
doing
our
votes.
The
way
we
used
to
do
make
sure
that
we
can
record
it
and
then
I'll
take
a
anybody
who's
not
in
the
room,
a
verbal,
so
all
in
favor
signify
by
saying
aye
hi,
madam
majority
leader.
How
do
you
vote
aye?
H
C
Chair
again
for
the
record,
colby
nichols
lcv
fiscal
analysis.
The
second
major
issue
associated
with
this
budget
is
the
youth
vocational
training
program.
The
executive
budget
recommends
tanf
funds
of
approximately
600
000
in
each
year
of
the
biennium
to
support
a
youth
vocational
training
program
for
low-income
students.
C
In
response,
the
agency
testified
that
it
had
developed
this
recommendation
after
a
series
of
discussions
with
the
agency's
federal
partners
with
the
goal
of
addressing
second
generation
recipients
in
tanf
households.
The
goal
of
ending
the
dependence
on
government
assistance
by
helping
teenagers
and
tanf
households
break
the
property
cycle
and.
J
C
The
agency
acknowledged
that
other
programs
providing
these
services
were
available,
but
clarified
that
it
anticipated
awarding
the
funding
to
expand
an
existing
program
similar
to
the
approach,
that's
included
in
the
e350
enhancement
for
the
nurse
family
partnership
program.
The
agency
also
indicated
the
grant
civil
war
could
be
split
between
multiple
organizations.
If
needed.
C
A
Hey
chair,
carlton.
E
Thank
you
very
much,
madam
chair.
I
had
concerns
about
this
when
we
we
first
heard
it
those
of
you
that
have
been
around
me
for
a
while
know
how
protected
my
I
am
of
those
tanf
dollars
that
grant
has
not
changed
since
1999
the
year
that
I
came
into
this
building.
It's
very
limited.
It's
really
there
to
help
families
make
it
over
that
that
bump
in
the
road
and
become
self-sufficient.
E
I
really
appreciate
the
agency
wanting
to
do
more
and
help
second
generation
and
get
into
that,
but
we
have
so
many
workforce
dollars
in
this
state
that
I
I
have
concerns
that
these
dollars
could
have
a
higher
and
better
purpose.
When
I
see
the
cash
amounts
awarded
child
care,
it
is
it's
a
pie
and
every
time
we
take
a
slice
out
of
that
pie,
another
slice
gets
smaller.
E
So
I
have
real
concerns
about
adding
a
new
program
at
this
time
in
this
when
we
know
that
getting
back
to
work
for
folks
it's
going
to
be
difficult
over
the
next
year
and
that
one
of
the
major
components
is
child
care
and
some
of
those
I
believe
some
of
those
dollars
would
be
a
higher
use
in
the
child
care
area.
So
I
would
not
be
supportive
of
this
program
at
this
time.
E
K
Thank
you,
madam
chairwoman.
I
appreciate
that
and
I
appreciate
mr
fisher
and
all
the
work
that
his
staff
does.
I
know
that
they've
done
a
lot
to
think
about
how
we
can
end
generational
poverty,
and
I
I
appreciate
that
conversation.
I
want
to
make
sure
that
I
have
that
on
the
record
that
there's
an
appreciation
for
that
kind
of
work.
I
think
what
I
see
here
is
a
plan
to
plan
with
these
dollars
and
it
it
doesn't
quite
feel
like
we're
at
the
spot
where
we
could
press
a
button
and
say
go.
K
I
hear
that
we're
going
to
do
like
a
request
for
information
to
do
a
request
for
proposals
to
then
set
up
a
plan
to
then
set
up
dollars
or
sub-grantees,
and
so
to
me
it
just
feels
kind
of
far
away
from
the
goal
line.
It
feels
feels
it
feels
like
these
dollars
probably
might
not
get
used
in
this
biennium.
Just
because
there's
such
a
process
to
figure
out
what
exactly
these
dollars
would
look
like
in
the
ground,
but
I
appreciate
so
much
these
these
conversations
to
talk
about
generational
poverty.
A
I'll,
second,
that
the
motion
by
assemblyman
monroe,
moreno,
a
second
by
senator
dan
darrell
loop,
we'll
go
ahead
and
all
those
in
favor
signify
by
saying
aye
aye.
C
Thank
you,
madam
chair
again,
this
is
colby
nichols
of
the
lcb
fiscal
analysis
division.
There
is
one
other
closing
item
associated
with
this
budget.
This
is
the
nurse
family
partnership
program.
The
executive
board
recommends
the
transfer
of
tana
funds,
totaling
848
840
in
fiscal
year
22
and
791
441.
I
C
C
Hearings,
the
interim
finance
committee
approved
work
programs
at
its
april
1st
meeting
that
funded
both
agencies.
That
would
be
the
division
of
welfare
and
supportive
services
in
the
division
of
public
behavioral
health
that
would
effectively
allow
them
to
begin
this
program
in
fiscal
year
2021
in
testimony
that
was
provided
to
the
ifc.
C
A
C
Unanimously,
thank
you,
madam
chair
again,
this
is
colby.
Nichols
we'll
be
moving
on
to
the
child
assistance
and
development
budget
budget
account.
3267
and
discussion
of
this
budget
begins
on
page
nine
of
your
closing
packet.
C
There
are
three
major
closing
issues
associated
with
this
account,
the
first
of
which
is
again
caseload
changes,
so
you'll
see
another
table
towards
the
bottom
of
page
11.
again,
this
is
a
comparison.
C
This
table
is
showing
the
average
monthly
child
care
assistance,
caseload,
actuals
for
fiscal
year
2020,
and
then
a
comparison
of
the
projections
that
were
included
in
the
govrak
budget
versus
those
that
were
included
in
the
march
2021
caseload
update,
as
you
can
see,
based
on
those
updated
case
load
projections.
The
case
load
for
this
program
is
still
projected
to
increase
over
the
2021-23
biennium.
J
C
The
government
budget,
the
net
the
net
impact
of
those
updated
caseload
projections,
is
a
decrease
in
federal
child
care.
Development
fund
block
grant
revenues,
totaling
3.32
million
in
fiscal
year
22
and
4.2
million
fiscal
year
23.
When
you
compare
to
those
amounts
in
the
executive
budget,
as
recommended
by
the
governor
again.
C
C
C
This
work
program
gave
the
agency
authority
to
receive
92.7
million
in
federal
coronavirus
response
and
relief.
Supplemental
act
grant
funding
to
allow
the
agency
to
continue
its
efforts
in
mitigating
the
impact
of
the
pandemic
on
program
and
child
care
businesses.
Among
other
purposes.
This
funding
will
be
used
to
continue
to
provide
payments
to
providers
based
on
enrollment
in.
C
Additional
policy
changes
included
the
waiving
of
co-pays
for
households
whose
parents
who
have
lost
jobs
due
to
the
pandemic
on
a
case-by-case
basis
and
the
waiving
of
the
program
waitlist
for
frontline
and
essential
workers,
and
I
would
just
note
that
those
additional
federal
dollars
included
in
the
coronavirus
response
and
relief
supplemental
act
are
not
included
in
the
executive
budget
or
included
in
those
tables.
Above
per.
D
C
D
C
D
So
if
a
waiver
is
completed,
if
there's
a
waiver
for
redetermination,
does
that
then
does
that
waiver
carry
for
an
entire
calendar
year.
C
I
apologize
senator.
I
don't
have
that
information.
Perhaps
we
could
have
somebody
from
the
agency
address
how
the
suspension
of
redeterminations
is
going
to
work
and
what
would
happen
once
that
waiver
is
finished.
H
D
Thank
you
so,
and
when
does
that
does
does
eligibility
kick
in
based
on
sort
of
their
enrollment
into
the
system,
or
does
it
extend
out
for
the
for
a
fiscally
on
a
fiscal
year
basis
or
how
does
that
work.
H
H
D
If,
if
we
sort
of
suspend
everybody
everyone's
going
to
be
up
for
redetermination
at
the
same
time,
ultimately
based
on
the
date
of
the
extent
of
the
waiver
right.
H
H
So
anybody
who
came
up
for
redetermination
between
march
and
june
of
2020
would
just
skip
a
year,
so
they,
if
they
stayed
on
the
program
and
were
made
eligible
again,
they
would
have
had
a
redetermination
at
the
same
time
a
year
later
anyway.
So
we
just
skipped
that
redetermination
just
for
those
families
that
came
up
for
it
during
those
months,
not
not
for
all
families
on
the
program
does
that
help.
G
A
G
A
For
the
offer,
but
we'll
to
make
life
easy
for
the
committee
and
our
secretaries
and
make
sure
it's
all
in
the
right
place,
we'll
wait
until
we're
in
the
medicaid
section.
Thank
you.
B
Thank
you,
madam
chair.
I
move
that
the
subcommittee
recommend
the
approval
for
the
decreasing
total
child
care
development
fund
grant
revenues
by
3.3
million
in
fy
2022
and
4.2
million
in
fy
2023
to
align
funding
in
the
m
200
and
m
201
decision
units
with
the
march
2021,
updated
caseload
projections.
A
C
Thank
you,
madam
chair,
for
the
record
colby
nicholls
field,
skill
analysis
division.
The
second
major
issue
associated
with
this
account
is
the
child
care
case
management
system.
Modernization
project
executive
budget
is
recommending
additional
child
care.
Discretionary
grant
funds,
3.5
million
in
fiscal
year
22
and
3
million
in
fiscal
year,
23
for
contract
costs
for
a
modernization
project
for
the
agency's
child
care
case
management
system.
C
C
I
would
note
that
the
agency
anticipates
all
costs
associated
with
this,
including
ongoing
subscription
and
maintenance
costs
would
be
fully
funded
by
the
child
care
development
block
grant
revenues
in
response
to
fiscal
staff
questions.
The
agency
indicated
that
it
anticipated
beginning
the
solicitation
process
in
fiscal
year.
2021
pending
approval
of
this
enhancement
during.
C
C
C
C
C
B
A
B
C
Thank
you
again.
This
is
colby
nichols.
I
I
don't
have
specifics
at
this
time
again,
with
your
permission,
madam
chair,
perhaps
somebody
from
the
agency
can
speak
to
that.
H
This
is
christelle
asking
for
the
record.
We
actually
plan
to
have
it
roll
out
in
phases,
and
so
we
expect
it
to
go
live
a
little
bit
earlier
than
that.
We're
hoping
the
first
phase
goes,
live
in
state
fiscal
year
23,
and
that
would
be
the
eligibility
for
subsidy
that
piece
of
things
and
then
the
case
management
and
other
pieces
would
roll
out
after
that,
so
we're
hoping
for
completion
by
that
longer
term
date.
But
yes,
it's
going
to
be
a
role
that
phases.
A
B
A
I'll
second,
that
motion
mushroom
from
assemblywoman
monroe
moreno
vice
chairman
moreno.
I
should
be
calling
you
this
entire
time.
Second,
from
senator
don
darrell
loop,
any
discussion
me
none
all
those
in
favor
signify
by
saying
I,
I
majority
leader,
aye,
any
opposed
motion
passes
unanimously.
C
D
C
Expand
access
to
quality
child
care
providers
by
focusing
on
outreach
and
community
partnerships,
as
well
as
improving
the
program's
strategic
planning.
These
positions
would
be
fully
funded
by
child
care.
Discretionary
block
grant
revenues,
totaling
135
812
in
fiscal
year,
22
175
243
in
fiscal
year
23.
C
during
the
budget
hearing
the
agency
provided
some
additional
information
regarding
the
need
for
the
proposed
new
positions
and
indicated
that
the
child
care
assistance
and
development
program,
scope
and
activities
have
expanded
over
time
from
just
issuing
subsidy
payments
to
providing
other
services,
including
child
care,
quality
ratings,
child
care,
workforce
development
identifying
what
are
known
as
child
care
deserts,
where
the
agency
is
seeking
to
improve
the
access
to
quality,
child
care,
including
infants
and
toddlers,
and
then
education
and
outreach
regarding
trauma-informed
care
and
specialized
care
for
children
with
disabilities.
C
D
C
Finally,
the
subcommittee
asked
the
agency
to
destroy
to
distinguish
the
duties
of
these
recommended
new
positions
from
those
of
two
similar
positions
that
were
approved
during
the
current
biennium's
interim.
The
agency
indicated
the
recommended
new
positions
would
have
similar
duties.
However,
the
increase
in
caseload
over
recent
fiscal
years,
as
well
as
the
additional
duties
previously
discussed,
led
the
agency
to
make
this
request
for
additional
staff
resources.
C
Following
the
budget
hearing,
the
agency
provided
clarification
to
staff.
These
recommended
new
positions
would
essentially
serve
under
those
positions
that
were
approved
during
the
1921
biennium
and
would
be
focused
more
on
direct
outreach
and
communication.
C
B
Thank
you,
madam
chair.
I
move
that
the
subcommittee
recommend
approval
of
the
two
new
social
service
program,
specialist
positions
and
associated
costs
funded
with
federal
child
care,
discretionary
block
grant
funds
of
eight
hundred
dollars
in
fy
twenty
twenty
two
and
one
hundred
seventy
five
thousand
two
hundred
forty
three
in
fy,
twenty
twenty
three.
A
C
A
A
C
A
A
J
Thank
you,
madam
chair
kathy,
crockett
physical
analysis,
division
for
the
record.
Today
I
will
be
walking
the
subcommittee
through
three
work
session
items
for
the
division
of
healthcare
financing
and
policy,
and
those
items
are
the
federal
medical
assistance
percentage
rates,
the
medicaid
caseload
and
the
checkup
case
load.
The
first
issue
relates
to
the
federal
medical
assistance
percentage.
The
fmap
rates,
the
federal
government
pays
states
for
a
certain
percentage
of
medicaid
and
backup
program
costs
known
as
the
upmap
rates
remaining
portion
of
program.
J
Expenditures
must
be
provided
by
a
non-federal
funding
source
such
as
general
fund
appropriations
or
transfers
from
local
governments.
The
amount
of
general
fund
included
in
the
division's
budgets
is
directly
related
to
projected
fmap
rates,
with
limited
exceptions.
The
fmap
rate
used
to
determine
the
funding
split
of
program
expenditures
is
based
on
the
eligibility
group
of
the
participant.
J
The
standard
and
checkup
fmap
rates
are
calculated
by
the
federal
centers
for
medicare
and
medicaid
services
annually,
based
on
a
three-year
average
of
state
per
capita
personal
income
compared
to
the
national
average.
The
newly
eligible
fmap
rate,
which
does
not
vary
based
upon
changes
in
per
capita
income,
will
remain
at
90
percent
throughout
the
upcoming
biennium.
J
The
federal
funds
information
for
states
is
an
independent
organization
that
tracks
reports
on
the
fiscal
impact
of
federal
budgetary
and
policy.
Decisions
on
state
budgets
and
programs
provides
information
on
final
and
estimated
fmap
rates
for
each
federal
fiscal
year,
and
these
rates
are
typically
used
by
the
legislature
to
determine
the
amount
of
general
funds
to
appropriate
the
support
of
the
medicaid
and
check-up
programs.
J
The
ffis
released
the
final
federal
fiscal
year,
2022
at
map
rates
in
september
2020,
and
these
are
reflected
in
the
executive
budget.
As
discussed
during
the
budget
grain.
The
family's
first
coronavirus
response
act
authorizes
a
temporary
6.2
percentage
point
increase
in
the
standard
fmap
rate
recorders,
in
which
a
public
health
emergency
is
in
effect,
as
declared
by
the
federal
government.
J
The
calculation
of
the
checkup
f
map
rate
is
based
on
the
standard
f
map
rate
and
the
increase
in
the
standard.
Fmap
rate
leads
to
a
4.34
percentage
point
increase
in
the
check-up
rate
when
the
public
health
emergency
is
in
effect,
a
temporary
increase
does
not
apply
to
the
newly
eligible
fmap
rates.
J
At
this
time
a
public
health
emergency
has
been
in
effect
since
january
27th
2020
and
is
currently
extended
through
april
21st
2021,
meaning
that
temporary
increases
in
nap
rates
are
currently
effective.
At
january
1st
2020
through
june
30th
2021,
the
executive
budget
recommends
that
map
rates
for
the
upcoming
biennium,
assuming
the
expiration.
E
J
J
A
J
Increase
through
september
30
2021,
if
extended
prior
to
closing
the
medicaid
and
check
out
budgets,
the
subcommittee
may
wish
to
consider
approving
the
temporary
up
map
rate
increases
through
september
30th
2021.
The
fiscal
impact
of
this
has
not
yet
been
calculated
by
the
agency,
but
as
a
general
rule
of
thumb,
the
agency
estimates
that
each
quarter
of
the
f
map
rate
increases
extended
results
in
about
a
30
million
dollar
general
fund
savings.
J
There's
a
table
on
a
page
two
of
the
base
package
which
displays
the
projected
standard
and
check
out
map
rates
if
the
temporary
increase
were
to
be
extended.
So
for
the
standard
fmap
rate
the
governor's
recommended
budget
includes
62.77
percent
and,
if
extended
through
january
or
september,
30th
2021,
the
revised
rate
would
be
64.32.
J
Additionally,
as
discussed
at
the
february
26
budget
hearing
in
january
22nd
2021
a
letter
to
state
governors,
the
acting
secretary
of
the
federal
department
of
health
and
human
services
indicated
that
a
public
health
emergency
was
likely
to
remain
in
place
through
the
entirety
of
calendar
year.
2021
suggesting
a
public
health
emergency
expiration
of
january
16
2022
unless
terminated
earlier,
meaning
that
the
temporary
increase
in
fat
rates
may
be
available
through
december
31st,
2021
or
march
31st
2022.
J
As
an
initial
estimate,
the
department
of
health
and
human
services
has
prepared
fy,
23,
f
map
projections,
using
moody's,
analytics
projections
of
personal
income
and
state
demographers
march
2021,
nevada
population
projections
and
based
on
those
calculated
rates,
the
fy
2023
fmap
rates
are
projected
to
be
lower
than
recommended
in
the
governor's
recommended
budget.
J
J
If
the
ffis
fy
23
projection
is
available
prior
to
closing
staff,
we'll
present
that
for
the
committee's
consideration
at
closing,
and
in
summary,
there
is
much
more
uncertainty
surrounding
projected
aftermath
rates
than
is
typical.
During
a
legislative
session.
J
Decisions
to
be
made
include
whether
to
include
approved
fmap
rates
recommended
by
the
governor,
which
assumes
the
public
health
emergency
expires
june.
30Th
2021
and
the
temporary
atmosphere
increase
does
not
continue
into
the
upcoming
biennium,
whether
to
approve
the
temporary
increase
in
fmap
rates
through
september
30th
2021.
J
If
a
public
health
emergency
is
extended
prior
to
closing
the
budget,
whether
to
approve
the
temporary
increase
in
fmap
rates
through
december
31,
2021
or
march
30th
2022,
based
on
the
heiden
administration's
letter
to
state
governors,
indicating
that
the
state
public
health
emergency
is
likely
to
be
in
place
throughout
calendar
year.
2021.
J
for
fy23
of
the
decision
would
be
whether
to
approve
updates
to
the
fy
23
f
map
rates
based
on
the
department
of
health
and
human
services
deduction
or
the
federal
funds.
Information
for
states
protection,
if
available
when
the
budgets
are
closed
and
for
the
biennium
overall,
whether
to
provide
one-time
authority
for
the
agency
to
accept
additional
federal
funds
without
requiring
an
offsetting
decrease
to
general
funds
through
language
in
the
2021
authorizations
act.
J
A
Thank
you,
ms
crockett,
so
just
for
the
members
and
really
for
the
public,
just
a
reminder
that
this
is
a
work
session
where
we
won't
be
making
any
final
decisions.
Today
we
use
work
sessions
to
do
a
deeper
dive
into
some
of
the
more
complex
issues
with
that
based
on
miss
crockett's
presentation.
Does
anybody
have
any
comments
that
they
would
like
to
make
or
clarifying
questions.
D
D
I'd
be
curious
to
hear
from
the
agency
if
they
could
about
what
other
states
are
doing
on
this.
I
know
that
there's
a
medicaid
association
that
includes
all
50
states
and
if,
if
other
states
are
anticipating
this
extension
to
come
through
and
if
they're
budgeting
for
it,
that
could
be
helpful
for
us.
I
Renee
suzanne
biermann
for
the
record.
Thank
you
for
the
question.
Senator
kikefer,
our
national
association,
the
national
association
of
medicaid
directors,
to
which
you
eluded,
has
been
working
very
hard
on
this
issue
for
a
long
time,
and
this
was
actually
one
of
their
highest
priorities
and
discussions
with
the
biden
transition
team,
which
I
think
in
large
part,
led
to
the
letter
that
mrs
crockett
did
a
great
job
of
summarizing.
So
we
did
reach
out
through
our
national
association
to
pull
other
states.
Unfortunately,
we
didn't
get
a
response
from
from
all
50.
You
know.
I
Typically,
some
states
respond
and
others
don't
but
did
get
10
responses
from
other
states.
One
state
was
only
counting
the
additional
fmap
through
quarter
two
of
this
year.
One
was
counting
it
through
quarter
three
and
the
remaining
eight
states
indicated
that
they
planned
to
budget
the
money
for
the
full
calendar
year
of
2021.
D
Thank
you,
mr
spearman,
so
the
the
issue
over
so
we
know
they're
going
to
extend
through
the
end
of
the
current
fiscal
year
for
for
our
purposes
right,
but
it
seems
like
also
this
sort
of
60-day
notice
requirement
is
sort
of
verging
on
a
trigger
for
the
first
quarter
of
our
next
fiscal
year.
D
I
Thanks
for
the
the
question
senator
kitchefer
suzanne
biermann
for
the
record-
and
my
expectation
is
that
we
would
know
within
five
days
as
the
current
public
health
emergency
is
set
to
expire
on
april.
20Th
did
reach
out
to
our
national
association
just
for
some
clarification
on
that
last
piece
of
the
the
60
days
notice
prior
to
termination.
I
think
there
are.
You
know
two
ways
to
possibly
interpret
that
one
that
it's
referring
to
the
termination
of
the
public
health
emergency
declaration.
The
other
you
know,
would
be
the
end
of
the
enhanced
death
map.
I
Those
do
have
different
days
as
the
enhanced
death
map
runs
through
the
end
of
the
quarter
in
which
the
public
health
emergency
expires.
So
that
would
be
june
30th,
but
we
do
expect,
and
in
every
case
we
have
up
to
this
point,
seeing
an
extension
before
the
expiration
date
of
the
public
health
emergency.
So
would
certainly
expect
and
based
on
history,
so
far
to
see
that
renewed
declaration
in
the
next
five
days.
D
Thank
you
very
much,
mr
spearman
I'll
have
probably
questions
on
other
subjects,
but
I'll
stop.
There.
A
Okay,
thanks
for
sharing
time,
assemblywoman
carlton.
E
Thank
you,
madam
chair,
and,
and
I
appreciate
the
the
walkthrough
from
ms
crockett.
This
is
there's
a
lot
of
moving
pieces
when
it
comes
to
medicaid,
and
I
guess,
with
the
comfort
level
that
I'm
getting
is,
is
with
the
letter
and
with
this
administration
it's
it's
a
little
bit
different
than
in
the
special
session
when
we
were
having
this
conversation,
because
there
were
a
lot
more
unknowns
at
that
time.
E
You
know,
I
would
love
to
say
we
could
go
to
march
30
of
2022,
but
I
don't
think
that
would
be
responsible
on
my
part
but
boy
I
would
love
to
put
that
on
the
sheets,
but
knowing
that
we'd
have
to
deal
with
the
consequences.
If
we
did
I,
I
would
be
very
comfortable
with
the
december
31st
date
on
that
and-
and
you
know,
and
as
far
as
the
authority
goes,
we've
had
this
conversation
numerous
times
about
federal
dollars
offsetting.
E
You
know
general
funds,
and
you
know
the
the
basic
policy
principle
behind
that
for
fmap
only.
I
would
be
comfortable
with
this.
I
don't
think
we
want
to
open
the
door
that
if
any
federal
funds
come
in,
they
just
get
to
be
kept,
and
we
don't
have
the
discussion
about
general
funds,
but
as
far
as
fmap
goes,
I
think
we
give
them
the
authority
to
do
whatever
they
need
to
do,
because
I
see
the
caseload
in
medicaid
still
growing
through
the
rest
of
this
year.
E
So
with
that,
I
believe
the
third
check
mark
is
where
I'm
I'm
kind
of
heading
with
the
december
31st.
First
2021
date.
A
Before
we
change
subject
just
to
make
this
a
little
easier
on
the
team
that
has
to
keep
track
of
what
we're
doing
staying
on
the
box
on
page
four
they're
sort
of
three
distinct
decisions,
so
I
think
we
just
heard
from
the
committee
on
bullet
number
one,
which
is
the
conversation
about
setting
it
to
december
31st
for
the
expiration
of
the
f
map,
and
we
heard
about
bullet
number
three,
which
is
the
one-time
authority
for
requiring
an
offsetting
decrease
in
general
funds
that
there
was
a
general
comfort
level
there.
A
D
Yeah,
thank
you.
Thank
you
about.
I
appreciate
that,
so
I'm
trying
to
understand
the
sort
of
factors
that
went
into
the
department's
projections
of
the
decrease.
I
guess
I'm
I'm
thinking.
Usually
I
think
I've
met
set
on
a
three-year
rolling
average
of
you
know:
statewide
personal
income
right
or
something
to
that
effect,
and
knowing
that
we
were
one
of
the
hardest
hit
states
due
to
the
pandemic.
I
Helen
christelias
actuarial
economist
for
nevada
medicaid,
so
the
projections
that
we
did
for
federal
fiscal
year,
23
they're,
based
on
the
average
per
capita
personal
income
for
2018,
2019
and
2020..
I
I
used
the
preliminary
numbers
from
the
bureau
of
economic
analysis
and
what
they
showed
was
that
nevada's
personal
income
actually
increased
in
2020,
and
so
a
lot
of
us
are
skeptical
about
that,
because
we
know
how
the
state
has
struggled
during
the
pandemic.
And
so
my
expectation
is
that
that
2020,
personal
income
per
capita
will
probably
be
revised
down.
When
we
get
the
new
information
in
the
fall.
D
Okay,
but
I
mean
we've
seen
I've
seen
those
those
numbers
too,
that
our
personal
income
has
grown
right,
but
it's
fake
right.
I
mean
it's
because
it's
most
mostly
federal
stimulus,
money
and
unemployment
and
money
that
wasn't
you
know
traditionally
earned
through
employment.
So
are
all
of
those
factors,
sort
of
certainly
included
in
the
calculation.
That's
done
for
personal
income
for
this
purpose,
or
do
those
things
potentially
get
excluded
when
considering
income
for
fmap
consideration.
I
Ellen
crystal
is
for
the
record.
I
believe
that
those
are
included
but
they're
also
included
for
the
the
nation,
so
both
nevada's
number
and
the
national
number
they're,
both
reflecting
about
three
to
four
thousand
dollar
increase
in
personal
income
per
capita
between
2019
and
2020..
So
it
is,
it
is
included
in
those
fmap
calculations
and
we've
used,
like
I
said,
the
bureau
of
economic
analysis,
preliminary
numbers
for
this,
and
so
I'm
hesitant
to
tweak
tweak
those
since
they're
coming
out
from
the
source.
That's
used
for
the
final
calculations.
A
And
just
so
everybody's
on
the
same
page
in
terms
of
process.
This
is
a
question
for
me.
Our
expectation
is
that
we're
going
to
see
that
federal
data
that
we
typically
use-
we
just
don't
have
it
this
year
this
year
at
this
time,
which
is
abnormal,
but
we're
going
to
we're
thinking,
we're
going
to
see
it
in
april.
Is
that
correct.
J
A
J
Thank
you,
madam
chair.
The
next
work
session
item
relates
to
medicaid
projected
caseload
consistent
with
past
legislative
sessions.
The
agencies
reprojected
the
medicaid
budget,
using
the
most
recent
actual
case
load
and
cost
data.
These
revised
projections
are
typically
used
as
a
guide
to
make
adjustments
to
the
medicaid
budget,
as
recommended
by
the
governor
during
the
budget
hearing,
the
agency
testified
that
the
march
2021
case
lottery
projections
would
be
based
on
the
public
health
emergency
continuing
through
december
2021..
J
Recognizing
that
this
would
require
additional
general
funds
in
the
budget
and
fiscal
staff
had
asked
the
agency
to
provide
an
alternate
caseload
projection,
aligning
the
public
health
emergency
terminating
in
june
2021,
as
recommended
by
the
governor,
the
agency
provided
the
fiscal
analysis,
division
with
three
case
load:
nf
mac
rate
scenarios
for
the
2021
through
2023
biennium,
with
caseload
projections
prepared
by
the
department
of
health,
human
services
office
of
analytics
based
on
february,
2021,
actual
load
and
cost
data.
J
A
In
I
think,
there's
been
some
interest
in
the
committee
from
how
the
caseload
projections
were
calculated.
So
let's
focus
there
at
this
point
just
again
for
the
ease
of
our
team
to
be
able
to
track
it
senator
kiker.
Do
you
want
to
restate
your
question
on
the
caseload
projections?
I
think
this
is
the
right
time
for
that
question.
D
I
appreciate
it,
you
know
my
first
concern
was
making
sure
that
we
were
going
to
be
consistent
with
the
assumptions
that
we
used
for
fmap
and
caseload.
So
if
we're
assuming
that
caseload
needs
to
be
extended
or
that
the
fmap
is
going
to
extend
due
to
the
public
health
emergency
through
december
31st
that
the
moe
requirement
is
also
carried
through.
So
we
would
see
that
under
which
of
the
three
scenarios.
That
would
be
scenario
three.
Is
that
right.
D
Okay
and
then
so,
there
are
basically
under
that
scenario
zero
redeterminations
conducted,
so
everyone
who's
on
medicaid
now
will
automatically
stay
on
the
rolls
until
at
least
december
31st,
unless
they
voluntarily
drop
out
move
pass
away.
Something
to
that
effect
is
that
correct.
A
I
appreciate
the
question
and
based
on
our
prior
conversation
agency.
If
you
could
kind
of
at
the
front
end,
is
that
a
hard
stop
and
everybody
gets
a
new
redetermination
date
or
is
it
a
rolling
redetermination
which
I
think
is
a
place
we
I
I
personally
got
a
little
hung
up
on
the
last
last
round
of
these
questions.
G
So
robert
thompson,
for
the
record,
with
the
division
of
welfare
and
supportive
services,
the
division
has
not
stopped
conducting
redeterminations.
We
are
monthly
doing
our
normal
redeterminations.
If
a
family
is
found,
a
person,
family
or
entire
caseload
is
found
eligible
under
normal.
What
I'll
call
normal
prior
to
phe
budgeting
processes?
G
G
So
as
the
public
health
emergency
ends,
we
will
continue
working
those
cases
and
we're
already
reworking
those
cases,
because
it's
been
more
than
six
months.
The
center
for
medicaid
and
medicare
services
notified
us,
and
we
had
a
conversation
yesterday
that
indicates
they've.
They
are
giving
us
a
six-month
time
frame
to
work
all
of
our
cases
which,
coincidentally,
worked
out
to
how
we
set
up
our
processes.
G
G
We
have,
we
consistently
receive
responses
from
our
customers
on
75
percent
of
the
redeterminations
were
mailing
out,
so
we
are
working,
those
75
percent,
the
25
percent-
that
don't
respond.
We
are
not
allowed
to
shut
down,
but
we
push
them
out
for
the
six
months,
so
we
do
not
anticipate
having
any
difficulty
working.
This
small
population,
the
additional
workload
that's
going
to
come
in
because
we
are
able
to
spread
it
out
over
a
six-month
process
with
60
days
notice
to
kick
that
in
did.
I
explain
that
all
well
enough.
D
Thank
you.
That
was
very
helpful.
I
appreciate
it
mr
thompson,
based
on
the
the
data
that
you've
collected
so
far.
How
many
individuals
have
been
kicked
out
the
six
months
for
redetermination,
so
they
would
have
been
ineligible
under
the
redetermination
process
or
potentially
ineligible.
G
The
re-application
count
has
gone
to
zero
because
we're
not
shutting
anybody
down
as
soon
as
we
start
shutting
those
individuals
down,
they
will
start
reapplying
and
there
is
no
way
for
us
to
run
data
analytics
on
those
individuals
that
may
or
may
not
still
be
living
here
or
may
or
may
not
plan
on
doing
their
paperwork
once
they're
not
able
to
access
their
medical
care.
Yeah.
D
D
We've
seen,
unemployment
numbers
fall
and
obviously
we're
not
seeing
caseload
fall
because
of
the
moe
requirement.
So
I'm
just
trying
to
get
a
picture
if
it's
possible
to
understand
the
impact
of
the
moe
on
our
budget,
as
we,
you
know,
fund
a
lot
of
these
folks
through
through
the
mco
program
and
just
trying
to
get
a
get
a
snapshot
of
it.
But
maybe
it's
not
we're
not
able
to
put
that
together.
G
Robert
thompson
for
the
record,
we've
been
working
on
that
question.
For
six
months
we
have
not
been
able
to
come
up
with
a
number
that
is
more
than
a
guess
to
give
to
our
partners.
The
division
of
healthcare,
finance
and
policy
center
of
medicaid
and
medicare
services
have
had
that
same
question
monthly
for
us
and
we've
we've
exhausted
all
efforts
to
come
up
with
a
number
that
we
would
feel
comfortable,
testifying
with.
D
I
appreciate
that
and
look
the
flip
side
is
that
we
get
the
enhancement
fmap.
So
thank
you,
madam
chair.
I
appreciate
the
leeway.
A
Okay,
I
do
want
to
appreciate
the
explanations.
I
think
that
they
were
incredibly
helpful
and
I
I
would
just
comment
that
it's
a
we
do
our
best
to
always
make
sure
that
we're
taking
care
of
people,
but
sometimes
the
rules
of
the
program
make
it
more
challenging
to
do
so,
and
I'm
just
so
grateful
that
in
this
time,
when
so
many
families
are
struggling,
that
we
do
have
flexibility
in
a
program
to
not
kick
people
off
of
health
care
in
the
middle
of
a
pandemic.
A
So
just
taking
a
little
moment
to
celebrate
that
win
that
there's
a
whole
bunch
of
people
out
there
who
are
still
going
to
get
access
to
health
care
when
they
need
it
in
a
pandemic,
and
while
the
projections
may
be
difficult,
I
feel
good
about
that's
what
we
were
able
to
do
with
our
federal
partners.
So
with
that,
I
don't
think,
there's
necessarily
any
guidance
that
we
needed
to
give
on
this
one.
Ms
crockett,
do
you
want
to
get
us
on
track.
J
No
matter
would
you
like
me
to
walk
through
some
of
the
caseload
numbers
and
general
fund
impact,
and
there
were
also
a
couple
of
other
changes
to
the
budget.
Yes,
that
might
be
helpful
to
make
them
so
anywhere.
I'm
part
of
closing,
absolutely
okay.
So
moving
to
page
five
of
the
packet
there's
a
table
that
compares
governors
recommended
that
a
case
load
with
the
public
health
emergency
ending
december
31st
2021
caseload
in
fy
2022,
the
governor's
recommended
case.
So
it
was
approximately
773
000
with
the
public.
J
Expiring
in
december,
caseload
is
projected
to
be
about
831
000,
and
that
is
about
58
000
higher
than
in
the
governor's
recommended
budget
in
fy
2023.
The
governor's
recommended
budget
have
protected
about
767
000
participants
with
the
updated
case
of
projections
expiring
december
2021,
the
public
health
emergency,
a
caseload
is
projected
to
be
about
822
000,
which
is
about
26
000
higher
than
the
governor's.
J
I'm
sorry
about
55
000
higher
than
the
governor's
recommended
budget.
There
is
a
table
on
page
six
that
lists
the
general
fund
impact
of
the
caseload
reproductions
scenario.
Three
on
that
table
displays
the
total
estimated
general
fund
need
for
medicaid
budget,
and
that
would
be
about
880
million
in
fy
2022,
which
is
about
a
59
million
decrease
from
the
governor's
recommended
budget
of
about
939
million
in
fy
2023.
J
The
total
general
funding
is
projected
to
be
1.054
billion,
which
is
a
27
million.
Approximately
increase
from
the
1.027
billion
projected
in
the
governor's
recommended
budget
overall
across
the
biennium.
It
would
be
a
net
general
fund
decrease
of
about
32.4
million
staff
would
also
like
to
make
the
subcommittee
aware
of
a
couple
of
moving
pieces
in
the
agency's
budget
that
are
updates
from
what
was
discussed
at
the
budget
hearing.
J
The
first
item
relates
to
prescription
drug
inflation
in
the
m101
decision
unit,
the
executive
budget
recommended
annual
fee
for
service
prescription
drug
inflation
of
5.5
per
year.
However,
backup
calculations
contained
an
error
in
the
agency's
updated
march.
2021
productions
include
prescription
drug
inflation
of
2.71
in
fy,
2022
and
3.48
in
fy,
2023,
based
on
moody's,
analytics
prescription,
drug
and
medical
supplies
february
2021
inflation
productions.
J
These
projections
have
typically
been
used
in
medicaid,
as
well
as
the
public
employees
benefits
program
and
preservatives
and
medical
care
budgets.
Blind
medical
inflation
rates
across
state
agencies,
inflation
for
managed
care
organization,
prescription,
drug
coverage
is
included
in
managed
care
organization,
inflation
rates,
which
is
budgeted
to
death
and
moody's
analytics
rate
for
medical
care.
J
On
march
29
2021,
the
agency
sent
a
memo
to
fiscal
staff
and
the
governor's
finance
office
expressing
concern
with
revised
prescription
drug
inflation
rate
and
requested
a
rate
of
6.62
per
year,
based
on
a
four-year
average
increase
in
the
overall
fee
for
service
prescription.
Drug
expenditure
by
the
agency,
the
agency
has
indicated
the
higher
rate
might
account
for
increased
utilization
trends
of
certain
high
cross
drugs.
J
J
The
agency
has
indicated
that
the
higher
inflation
rate
would
require
general
funds
of
about
13
million
over
the
biennium,
and
this
amount
is
not
included
in
the
agency's
updated
protection.
So
if
the
subcommittee
wished
to
consider
increasing
that
rate,
that
would
require
13
million
additional
general
fund
beyond
the
amounts
presented
in
the
people
earlier
in
the
document,
there's
also
a
change
related
to
managed
care
organization
directed
payment
program.
J
According
to
the
agency,
following
discussions
with
clark,
county
and
the
university
medical
center,
it
was
determined
that
clark
county
is
not
anticipated
to
have
sufficient
funding
to
provide
the
non-federal
share
of
the
recommended
level
of
supplemental
payments.
Additionally,
the
recommended
level
of
supplemental
payments
and
would
reduce
umc's
uncompensated
care,
which
could
potentially
lead
to
a
reduction
in
umc's
disproportionate,
shared
hospital
payments.
J
Fy
2021
supplemental
payments
would
be
reduced
by
about
5.9
million,
which
would
have
the
5.9
million
decrease
in
the
state
that
benefit
which
would
reduce
the
agency's
projected
fy
2021
surplus.
J
As
a
result,
the
recommended
60
million
dollar
balance
forward
of
state
net
benefit
from
fy
2021
to
2022,
which
is
recommended
as
a
budget
savings
measure
would
be
reduced
by
2
million
to
58
million,
which
requires
a
two
million
dollar
general
fund
increase
in
the
medicaid
budget.
J
In
total,
the
change
to
the
managed
care
organization
program
results
in
a
general
fund
increase
of
15.6
million
over
the
biennium,
and
this
amount
is
reflected
in
the
agency's,
updated
caseload
production
and
so
in
summary,
the
decision
to
be
made
at
closings
in
the
box
on
the
bottom
of
page
seven
and
based
on
the
agent
or
the
subcommittee's
previous
discussion
of
bullet
three
reflecting
updated
case
load
productions
based
on
the
public
health
emergency
expiring
december
31st
2021
would
align
with
the
subcommittee's
previous
discussion
regarding
the
factory
and
I'm
happy
to
answer
any
questions.
A
Thank
you,
ms
crockett.
Well
done,
let's
go
ahead
and
kind
of
put
these
in
buckets,
so
I
know
there's
some
questions
about
the
prescription,
drug
inflation.
So
let's
start
there
chair,
carlton.
E
E
So
we've
had
a
lot
of
conversations
about
this
over
the
last
couple
of
of
sessions
and
if
I
remember
right
1921,
we
actually
went
with
a
little
bit
higher
number
than
what
we
were
looking
at,
because
we
didn't
know
where
we
were
going.
But
now
I'm
seeing
that
we
had
an
original
calculation.
E
E
E
So
I
guess
what
I
really
want
to
know
in
plain
english
from
somebody
is
why
they
think
the
6.62
number
is
the
number
that
we
really
need
to
go
with,
because
this
will
have
an
impact
on
the
general
fund
and
if
we
miss
we're
putting
money
someplace
that
we
could
be
using
for
other
programs.
So
can
someone
give
me
a
level
of
comfort
on
this
6.62
number.
L
Madam
sorry,
assembly,
wellness
carlton.
To
answer
your
question.
The
division
does
feel
strongly
that
the
six
point
percent
would
be
more
appropriate
than
the
current
inflation
rates
from
economy.com
just
for
some
context.
The
actual
inflation
rates
that
the
division
has
experienced
were
6.06
in
2017
5.12
in
2018,
6.08
percent
in
2019
and
9.22
in
state
fiscal
year
2020..
L
Additionally,
we
we
did
begin
coverage
on
one
of
the
highest
cost
drugs
out.
There
is
old,
sorry
and
we
did
receive
our
first
claim.
Coverage
actually
started
for
that
in
2019,
but
we
just
received
our
first
claim
in
2021.
L
The
cost
of
that
one
dose
is
actually
about
two
and
a
half
million
dollars
per
dose,
and
so
we
do
feel
strongly
that
the
prescription
drugs
the
division
is
currently
paying
for
does
not
necessarily
cleanly
align
with
the
economy.com
inflation
factors
that
have
historically
been
used
in
the
division's
budget.
E
I
know
I
just
I,
I
feel
like
we're
pegging
a
number
based
on
a
significant
outlier,
so
you're
talking
about
one
drug
and
one
dose
that
cost
a
couple
million
dollars.
E
L
Melissa
law
for
lewis,
for
the
record,
you
know,
obviously
this
information
does
change
on
a
regular
basis.
I
think
more
consistently.
In
the
last
several
years
we
are
seeing
that
trend
go
up
a
little
bit.
I
mean
in
state
fiscal
year,
2020
we're
at
9.22.
L
So
you
know
my
personal
opinion
would
be
that
the
6.62
may
not
be
accurate.
It
may
actually
be
understated
compared
to
the
20
actuals,
but
at
least
to
that
would
generate
sufficient
funding
to
continue
to
pay
for
those
prescription
drugs.
I
think
that
this
is
definitely
something
that
needs
to
be
monitored
a
lot
more
closely,
rather
than
just
the
once
a
year
that
we're
currently
doing,
but
we
definitely
need
to
provide
more
actuals
to
the
committee
so
that
you
guys
can
make
better
informed
decisions
on
this
particular
item.
B
Testing
done
for
the
gene
therapy
drug
through
charitable
organizations.
This
will
now
be
done
as
part
of
the
newborn
screening
process
in
the
next
year.
So
we
know
that,
while
those
cases
are
rare,
we
will
pick
them
up
as
medicaid
covers.
B
A
very
expensive
drug
that
we
want
to
ensure
that,
even
if
we
get
an
additional
two
cases,
the
division
can
cover.
E
And
thank
you
very
much,
madam
chair,
and
and
thank
you
to
the
agency,
for
you
know
just
laying
it
all
out
on
the
table.
That's
what
we
need
to
hear
to
be
able
to
to
make
some
of
these
decisions
when
you
just
read
percentages
and
history
in
in
your
notes,
being
able
to
hear
exactly
what's
happening
on
the
ground
in
the
agency
is
always
very
helpful.
So
with
that
I'm
a
little
more
comfortable
with
the
six
percent.
Thank
you,
madam
chair.
A
K
Thank
you
so
much
I
I
will
say
just
as
a
follow-up
comment
to
assemblywoman
carlton's
response,
I
just
we.
We
use
moody's
analytics
for
a
lot
of
different
references,
and
I
worry
about
setting
up
a
precedent
of
moving
away
from
from
from
the
folks
who
do
these
kind
of
analytics
to
our
own,
and
so,
if
we're
gonna,
it
feels
like
it
feels
like
that.
I
I
do
worry
about
that.
I
just
kind
of
want
to
put
that
on
the
record.
K
I
don't
think
it's
not
that
we
don't
have
great
thinkers
and
smart
intelligent
people
who
aren't
trying
to
problem
solve.
I
just
worry
about
saying
the
precedent
of
saying
we're:
gonna
deter
we're
going
to
decide
what
medical
inflation
is
on
our
own
and
versus
really
relying
on
the
experts
in
the
field
who
look
at
trends
across
states.
So
I'll
just
say
that
I
just
I
think
I
needed
to
clarify
on
the
the
this
is
the
so
that
the
balance
forward,
the
60
million
balance
forward.
K
So
I
believe,
is
this
still
part
of
the
conversation
that
we
were
having
at
the
beginning
of
the
year
about
kind
of
prepayments
for
the
mcos
and
instead
of
prepayments
we're
just
talking
now
about
a
balance
forward.
So
we're
keeping
things
on
the
dollars
on
our
sheets
in
our
hands.
Is
that
right.
J
There
are
a
couple
of
different
proposals
for
budgetary
savings
measures.
Some
of
those
proposals
were
to
move
fy
2022
payments
into
2021
and
as
a
separate
proposal
there
was
a
recommendation
to
balance
forward.
State
net
benefit
from
fy
2021
through
2022,
so
this
is
part
of
the
governor's
recommended
savings
for
this
budget,
but
it
is
separate
from
the
movement
of
managed
care
payments.
F
Thank
you,
madam
chair,
so
when
we
balance
forward
these
payments
to
the
managed
care
organizations,
this
does
not
take
away
the
payments
to
the
actual
providers
giving
care.
Because
one
of
the
and
that's
a
question
I
have
because
one
of
the
things
I'm
hearing
is
that-
and
I've
pointed
out
in
the
past,
that
we
have
this
increased
medicaid
people
who
have
signed
up
for
medicaid.
F
So
we
have
this
increased
case
load,
but
that
doesn't
mean
these
folks
actually
have
had
increased
access
to
care.
So
I
want
to
make
sure
that,
although
we're
signing
folks
up
we're
not
actually
giving
them
this
false
narrative
that
they
actually
have
increased
care
because
I'm
not
sure
I'm
seeing
those
numbers,
I
just
want
to
make
sure
providers
aren't
being
penalized.
If
we
extend
these,
this
monies
out.
M
Assembly,
women,
titus
cody,
finney,
deputy
administrator
for
the
record,
and
I
I
will
defer
to
my
fiscal
partners
in
in
just
a
moment,
but
the
the
purpose
of
these
actions
is
certainly
not
to
penalize
providers.
M
M
They
do
have
the
the
benefit
when
they
come
on
that
plan
of
being
assigned
to
a
primary
care
provider
and
also
the
benefit
of
having
that
coverage
so
that
if
if
they
should
be
injured
or
fall
ill,
there
is
that
coverage
available
to
them.
M
If
nothing
else,
the
peace
of
mind
of
having
coverage
and
a
system
that
can
support
them
to
access
that
care.
But
these
balance
forwards
should
not
penalize
the
providers
and
with
that
I'll
I'll,
let
our
fiscal
folks
add
their
peace.
L
Good
morning
for
the
record
melissa
law
for
lewis,
so
the
the
58
million
dollar
decision
unit
that
ms
crockett
alluded
to
is
actually
the
state
savings
portion
of
our
supplemental
payment
programs
that
offsets
the
general
fund.
So
within
the
governor
recommends
budget
we
did
indicate
that
that
figure
would
be
60
million
dollars.
However,
with
some
of
the
changes
to
the
managed
care
directed
payment
program,
we
are
going
to
experience
a
lesser
state
net
benefit.
A
All
right
any
additional
questions
on
the
managed
care
piece:
okay,
any
additional,
clarifying
questions
on
any
of
the
pieces.
Up
to
this
point,
all
right,
scene:
nine.
We
have
the
box
at
the
bottom
of
page
seven,
and
so
we
had
a
good
conversation
about
caseload.
I
think
we
probably
have
the
information
that
we
need
there.
A
I
think
the
conversation
was
also
making
sure
that
our
caseload
projections
match
our
ending
of
the
public
emergency
numbers.
So
aligning
everything
to
the
december
number
was
how
I
heard
the
conversation,
and
I
didn't
hear
a
request
for
a
different
caseload
scenario.
So
is
everybody
comfortable
with
where
we
are
on
the
conversation?
J
J
There
is
a
table
on
page
eight
that
shows
the
governor's
recommended
un
case
load
was
about
a
30
000
in
fy
2022,
and
about
30
600
in
fy
2023,
assuming
the
subcommittee
would
like
to
adopt
the
same
caseload
production
and
methodology
for
backup
as
for
medicaid,
and
that
would
be
scenarios
two
and
three
on
the
one
page
topic
page
eight
and
that
case
loan
would
be
a
slight
decrease
to
about
twenty
eight
thousand
four
hundred
in
fy
2022
and
about
29
000
in
fy
2023.
J
This
is
lower
than
the
governor's
recommended
budget.
The
agency
has
indicated
that
check-up
caseload
tends
to
decline
when
medicaid
explode
increases
as
unfavorable
economic
conditions
may
result
in
participants.
Shifting
from
checkup
to
medicaid,
which
has
lower
eligibility
requirements
as
caseload
would
be.
Lower
costs
would
also
be
lower
compared
to
cost
recommended
in
the
governor's
budget.
J
The
table
on
the
bottom
of
page
nine
scenario,
three
describes
the
general
fund
need
of
the
checkout
budget
based
on
the
updated
case,
load
and
f
map
rates
expiring
december
31st
2021.
in
fy
2022.
The
general
fund
need
would
be
about
11.2
million,
which
is
about
a
1.9
million
decrease
from
the
13.2
million
recommended
by
the
governor
in
fy
2023,
with
the
case
load
updates.
The
general
fund
needed
to
be
about
13.3
million,
which
is
about
a
835
000
reduction
from
the
14.2
billion
recommended
by
the
governor
over
the
biennium.
C
J
A
E
Tur
carlton
and
thank
you
very
much,
madam
chair,
I
think
just
we've
kind
of
picked
this
december
31st
date
and
I
think
it
would
be
really
be
a
very
good
plan
for
us
to
kind
of
just
true
up
check
up
with
with
everything
else
that
we've
done.
I
I
know
they're
looking
at
at
the
caseload
on
this,
and
I
know
we've
said
many
many
times
about
where
we
think
that
caseload
could
possibly
be
in
the
future.
A
A
Very
good
moving
along.
Thank
you
all
right,
the
just
for
the
record.
The
letter
from
the
secretary
of
health
and
human
services
about
the
public
health
emergency
is
in
the
packet.
If
any
members
of
the
public
are
looking
to
see
that
I
I
believe
that
concludes
our
business,
not
seen
anything
else
with
that,
we
will
go
ahead
and
ask
to
open
up
public
comment.
F
B
With
the
last
three
digits
zero
four
four,
please
slowly
state
and
spell
your
name
for
the
record.
You
will
have
two
minutes
and
may
begin
dr
tiffany
tyler,
garner
t-I-f-s-a-n-y
t-y-l-e-r
hyphen
g-a-r-n-e-r
good
morning,
esteemed
chair
and
members.
I
am
calling
on
behalf
of
the
children's
advocacy
alliance
and
the
strong
start
nevada
prenatal
to
three
collaborative
just
to
thank
you
for
the
consideration
you
gave
today,
particularly
as
it
relates
to
investments
in
child
care,
home,
visiting
and
medicaid.
B
B
So
as
we
pivot
toward
recovery
and
see
a
greater
need
for
resources
like
investments
in
child
care
subsidy
or
have
opportunities
to
cover
more
families
that
maybe
aren't
covered
now,
particularly
continuous
eligibility
for
children
or
presumptive
eligibility
or
prenatal
and
post
medicare
for
families
that,
as
we
find,
these
silver
linings
in
the
recovery
ensues
that
we
can
revisit
some
of
the
things
that
maybe
have
felt
untenable.
Now,
as
we
worry
about
what
the
progress
or
pace.
A
B
F
A
Time,
thank
you
bps
for
your
support.
Thank
you
to
all
the
staff
in
all
of
the
different
places
in
the
building.
I
know
that
this
impacted
our
sergeant-at-arms,
our
law
enforcement,
our
all
of
the
staff
and
all
the
roles
to
get
us
back
in
person.
So
I
just
want
to
thank
everybody
for
their
hard
work,
their
flexibility,
their
patience
and
grace
with
that
we
are.