00:00 - Gloria gilligan fiscal management director

00:03 - in attendance in the audience

00:05 - we have wafa

00:06 - fam deputy secretary of the office of income maintenance

00:10 - laval Miller Wilson deputy secretary office of children youth and families

00:14 - Juliet more solid deputy secretary office of long term living

00:18 - Christian heirs deputy sacrum Terry office of developmental programs

00:22 - shantae brown deputy secretary office of child development and early learning

00:27 - Sally kozak deputy director office of medical assistance programs

00:31 - Stephanie shell deputy secretary office of administration

00:34 - and gen Smith deputy secretary the office of mental

00:36 - health and substance abuse services welcome to you aw

00:40 - can I ask that each of you please stand to be sworn in.

00:47 - If you please raise your right hand

00:48 - do you swear that the testimony you're about to give is the truth the whole truth and

00:51 - nothing but the truth so help you god and if so indicate by saying I do.

00:55 - Thank you very much.

00:57 - As reference for members of the audience the budget for the department of human

01:00 - services is sixty seven point two billion dollars in total funds

01:04 - out of way which twenty one point nine billion is state funds

01:08 - I will lead off with some questions today

01:11 - first thank you both for being here today it's good to see

01:13 - you and thank you for all of you that are in attendance

01:16 - and

01:17 - I like to first talk about childcare.

01:20 - There's been obviously a

01:21 - lot of national headlines that have brought fraud and child care to the forefront and

01:26 - I think now is the appropriate time to ask

01:28 - the department any pertinent questions related to the topic

01:32 - to make the public aware of the actions of the department

01:35 - to undertake or identify or root out fraud.

01:38 - So madam secretary can you highlight the differ ounces between Pennsylvania

01:42 - and Minnesota and how they provide oversight of child care programs.

01:46 - Good morning mr chairman and combining members of the

01:49 - Canadian a pleasure to be here with all of you today

01:51 - and I do just want to highlight that

01:53 - you should all have it your thief a chart

01:56 - that we put together for you

01:58 - that highlights some of the differences between.

02:02 - The state of Pennsylvania and the state of

02:04 - Minnesota and some of the very important steps that

02:08 - we take to ensure that

02:10 - we.

02:12 - Do everything that we can to eliminate fraud in the system or prevent fraud in the

02:16 - system and make sure that taxpayer dollars are being spent

02:20 - so

02:20 - First of all here in the commonwealth the only licensed providers can participate in

02:25 - child care works childcare works is the program

02:29 - that is for low income working parents

02:32 - and that is the program through which federal funds flow

02:35 - and those were the funds that were

02:37 - somewhat in question in Minnesota

02:39 - so here you might to be a licensed provider we have very high licensing standards

02:46 - and

02:47 - we are.

02:49 - We do frequent inspections

02:50 - we are

02:52 - always ready to

02:54 - cite

02:54 - providers that are not compliant

02:56 - we will downgrade certifications as we see fit

03:00 - so we have very key close eye on these providers

03:03 - we have been working for twenty years in very collaborative systems

03:09 - and the system in Minnesota is much more dispersed

03:12 - it is much more run from the county level

03:16 - here we have eighteen early learning resource centers

03:20 - that each had to aren't catchment areas that the state

03:23 - and then they report out to us at oxtail

03:26 - and again very close supervision of what goes on in their particular regions

03:31 - and then.

03:34 - We continue to just constantly provide professional development

03:39 - and licensing resources

03:41 - and other opportunities for the providers of these child care centers to make sure

03:45 - they're following all rules and regulations

03:48 - so it is

03:49 - doesn't actual dhs

03:50 - dhs employee that is in charge of licensing they they go out

03:54 - annual early on site that is correctly the facility at

03:56 - a minimum they will go annually if there is a complaint

04:00 - they would go more quickly or they would go more frequently than that

04:03 - is part of that

04:04 - and

04:05 - whether you called inspection or review isn't is it the

04:09 - do they ensure that what they put down at the time of operations in

04:14 - the the population that they may serve

04:16 - that those are the hours that

04:18 - they are actually serving

04:19 - the public

04:20 - yup that's correct

04:21 - so just to give you some context

04:23 - we regulate six thousand five hundred and ten

04:26 - licensed childcare providers who serve

04:28 - four hundred and eight thousand children across the commonwealth

04:31 - and

04:32 - one of the things that

04:33 - we do require higher here in Pennsylvania is attendance records

04:38 - so when a family who is receiving subsidized child care enters into the facility and

04:43 - rows their child in a facility they.

04:47 - Outline

04:48 - when that child is going to attend that facility

04:51 - the e I r sees as early learning resource centers that I mentioned

04:55 - have those records

04:56 - the only person that can change that record is the parent

04:59 - so in other words a childcare operator cannot call up and say

05:03 - oh.

05:04 - Valerie's going to come four days a week instead of three

05:07 - that has to come from the parent

05:09 - and then that is all part of the inspection process

05:11 - is to make sure that all those records sync up

05:14 - and as providers are paid every month

05:17 - there's a reconciliation of those records.

05:22 - I'm glad you brought that up because I think it's under the twenty twenty for child

05:25 - care and development fund final rule

05:27 - states that

05:28 - states must pay child care providers prospectively

05:31 - in advance or at the beginning of service delivery

05:34 - rather than after services are rendered

05:36 - in this policy encourage states to pay based on child

05:39 - enrollment rather attendance but you're safe that you do it

05:42 - based on attendance

05:43 - that's correct mr chairman so when that rule came out

05:46 - there were four main components of it three of which with your

05:50 - the general assembly's cooperation we have put into place

05:53 - we did not put into place the rule

05:57 - about paying

05:58 - providers prospectively

05:59 - we had heard as the admit industry was changing

06:02 - that that was something that might be rolled back by

06:05 - the trump administration so we put a pause on that work

06:08 - historically we have always paid based on attendance

06:11 - and that continues to be the case today.

06:14 - So it sounds like you can tell Pennsylvania that the department

06:17 - does proper oversight

06:19 - of childcare and that they're doing their best to fight fraud mod

06:22 - potentially in that absolutely I'm very confident in the work that our team does and

06:25 - we're very proud of this system they've worked hard to

06:28 - make sure that the system is very tight

06:30 - and to absolutely minimize any opportunity for fraud

06:33 - how often does that occur for any fraudulent activity that you guys have uncovered.

06:39 - In the childcare system it's extremely rare fair

06:42 - but if we did

06:43 - believe that we saw evidence of fraudulent activity

06:47 - we are not an

06:48 - agency with investigatory authority

06:50 - so we would refer either to the office of state inspector

06:54 - general or the attorney general's office depending on the

06:57 - concern for the particular fraud

06:59 - and then it would be up to them to investigate

07:01 - to make my final question related

07:03 - to childcare because as you know it's a very important

07:05 - subject for a lot of families out there and a gateway

07:08 - to for them to participate in the economy as well.

07:12 - Is there a certain

07:14 - threshold that has to be crossed on the attendance world

07:17 - where that would impact

07:19 - the department paying to have that child there

07:21 - if they're enrolled

07:23 - but

07:23 - you know they only show up you know once a week even though

07:26 - they they claim they're supposed to be there five days.

07:29 - Yeah that's an excellent question

07:31 - so we we are under federal rules around that particular issue

07:36 - I believe the number is and

07:39 - they have to reach a total of forty days of not attending a program

07:44 - before we would look at removing that family

07:47 - from the child care works program

07:49 - but it is prescribed.

07:52 - Perfect thank you.

07:54 - Switching gears a little bit

07:55 - looking a little bit at your projection years is

07:58 - getting that some of the financials.

08:00 - The general fund revenue request.

08:03 - From the department is one point four billion from twenty point five billion to

08:07 - twenty one point nine billion this year

08:10 - do you know how much of that growth relates to your costs to carry

08:14 - including the impact of the snap administrative cost sharing reduction.

08:18 - Sure

08:19 - so we are starting to see some of the

08:23 - immediate impacts are the first I should say tangible impacts of

08:28 - some of the provisions that were passed in

08:31 - hr one or sometimes known as a president trump's one big beautiful bill back in July

08:36 - and.

08:38 - Two of the things that we are seeing this year

08:41 - are

08:42 - the

08:43 - cost shift onto Pennsylvania and

08:45 - have twenty five percent of the snap administrative fee.

08:50 - Historically in the snap program.

08:53 - States have only had to pay fifty percent of that administrative fee

08:57 - but in hr one they increase that to seventy five percent so in this year's budget.

09:04 - Because we don't have the full impact of the federal fiscal year

09:07 - it's eighty seven million dollars

09:09 - once that's fully the annualized it will be

09:11 - closer to one hundred and twenty million dollars

09:14 - and I want to be just real clear

09:16 - this has nothing to do with a snap error rate

09:19 - all fifty states are required to

09:21 - pay the seventy five percent now

09:23 - that's the biggest one there's some other smaller ones which I'd be happy to mention.

09:28 - So

09:28 - The

09:29 - the increase is approximately one point three billion.

09:33 - How much of the growth relates to costs to carry and also the impact of the snap

09:38 - administrative cost sharing reduction.

09:40 - I'll have to

09:41 - address the cost to carry specifically.

09:45 - I don't have a breakdown in front of me for the planning years which is really what

09:48 - you're talking about beyond twenty six twenty seven budget

09:51 - but what I'll say is that with regards to hr one impacts as a secretary talked about

09:57 - we have the snap administration change

09:59 - or the snap admin change and then we also have this.

10:03 - Page

10:04 - decrease in enrollment that will occur

10:06 - from the continuous eligibility requirements and

10:09 - that's in the medicaid space but that is not shown.

10:13 - In the twenty six twenty seven years separate from savings related to minimum wage

10:18 - because that would be duplicative

10:20 - so I think in the out years we were very judicious and held that very low about why

10:24 - one percent because there will be a significant change

10:27 - related to enrollment from medicaid

10:30 - continuous eligibility requirements.

10:32 - Do you know how much the change of f map reduced your general fund request.

10:39 - We did have all she's looking we did

10:41 - have a.

10:42 - I think it was a

10:43 - scent

10:44 - maybe a little over a cent increase in f map but given

10:46 - the size of our programs that is actually quite impactful.

10:51 - So the f map changes from twenty five twenty six available to twenty six twenty seven

10:56 - or about five hundred and seventy million.

10:58 - Okay so yeah just shy of

11:00 - six hundred million dollars

11:01 - without significant changes

11:03 - to the budget and not including change to f map the gym reform budget

11:07 - could have increased by one point nine billion is that

11:10 - true state had the f map not changed think then you'd have to take into consideration

11:13 - what other payments might have potentially

11:15 - adjusted as well so the growth from fiscal year twenty four twenty five twenty five

11:19 - twenty six was about one point five billion.

11:22 - Yes

11:22 - okay

11:23 - do you know the average growth that is projected for each of the next

11:27 - four.

11:28 - Projected years.

11:30 - In capitation.

11:32 - Chc our largest programs with about one per cent in each planning year

11:36 - and most of the other appropriations are held flat which is

11:40 - in line with how we've traditionally budgeted

11:42 - and then we generally don't assume growth and administration of preparations

11:45 - to the

11:45 - the average that the administration projections about two hundred million a year

11:49 - that.

11:50 - Sound correct.

11:51 - Now

11:52 - looking back from I think going back to I think governor wolf's two thousand and

11:55 - fifteen sixteen budget to the current budget for

11:57 - for dhs

11:58 - which is

11:59 - twelve fiscal years

12:01 - do you know how much the average state fund budget increased each year.

12:05 - I bet you do

12:06 - I do not have it in front of me.

12:11 - Dhs estate

12:12 - fund budget increase an average of nine

12:14 - hundred million a year over those twelve years

12:17 - and so increasing the the twenty six twenty seven budget request by the actual

12:21 - average increase instead of the the unrealistic two hundred billion

12:25 - we're left with a seven billion dollar hole over those planning years

12:29 - and.

12:31 - Why why is that

12:32 - as as we look at projections and and anyone who runs budgets and obviously.

12:37 - All the folks up here care very much about appropriations and and looking at that.

12:42 - Why why the underestimating of of spending

12:45 - yeah I can appreciate that question

12:47 - I think one is important to point out there were trying to finalize the twenty six

12:50 - twenty seven budget and then planning years

12:52 - absolutely are important which is why represent them

12:54 - there are so much uncertainty at the federal level to assume that we will continue to

12:59 - grow at the rates that we've seen in prior years

13:02 - I think is unrealistic

13:03 - so

13:04 - One percent I know you feel may be low I think it's reasonable.

13:08 - It's possible that there will be other changes at the federal level that impact what

13:12 - that final number looks like in those out years

13:16 - but do you understand the concern over the fact that it is as we look to try to grow

13:20 - the state and become more competitive and have fiscal stability with the commonwealth

13:25 - that if we're telling people that

13:27 - will next year is only gonna be a two hundred million inc Greece

13:30 - I forget what it was last year what the projection was.

13:34 - A couple of hundred million dollar increase

13:36 - and yet there's another turn around and say we need another one point six billion

13:39 - dollars whatever whatever the number is

13:41 - you can understand why that causes a lot of budget heartburn

13:45 - and doesn't truly reflect the commonwealth when fiscal dear section

13:50 - it's another scenario that could certainly occur.

13:53 - Okay

13:53 - I appreciate that.

13:57 - Eleven fifteen waivers

13:58 - I see the governor is again included in his

14:01 - request for the LeBron fifteen waiver in the budget

14:04 - in the past you guys have agreed that you would not implement any components of this

14:07 - waiver without legislative approval do you guys still stand behind that commitment

14:11 - yes that's why the governor has it in his proposed budget

14:13 - as

14:14 - a

14:14 - Thank you for that.

14:16 - Switching gears

14:18 - and

14:19 - you've probably heard

14:20 - this is the first time I brought this up this time in this grow pa.

14:24 - It gives me sketchy

14:25 - give these guys a nervous tic hear me talk about it but

14:29 - it's very important to the data from a very

14:31 - successful year one of grow pa speaks for itself and

14:34 - I'm sure you may have heard we've had over eleven thousand applications.

14:38 - From

14:39 - one hundred and sixty two schools and

14:41 - there's been about five thousand seven hundred recipients

14:44 - two thousand and forty eight attended four year private colleges and universities

14:48 - another nineteen hundred attended apache school

14:51 - and seven hundred and ninety attended a state related university

14:54 - and

14:55 - approximately eighty eight percent of recipients are full time students nearly half

14:58 - of all the recipients in their first year

15:00 - of study

15:01 - interestingly enough.

15:04 - The top program that was signed up for was nursing and allied health

15:08 - and I think we all can appreciate that it's

15:10 - definitely a high demand need in this commonwealth

15:13 - as we looked for a year or two

15:15 - and obviously we need things to work their way

15:17 - through the system and get folks into the workforce

15:20 - or there are other other ways that

15:22 - Pennsylvania can be advertising partnering that we can continue to tell young people

15:26 - about this opportunity not only for their own benefit

15:29 - of being honest where the good family jobs are

15:31 - but also help them reduce debt

15:33 - but get critical needs filled in a lot of

15:36 - programs a lot of which

15:38 - fall under the purview dhs throughout the commonwealth and services

15:42 - and

15:42 - any ideas on how we can partner further to

15:45 - grow that

15:45 - yeah I appreciate that question

15:47 - ended

15:48 - the

15:49 - fishy now.

15:50 - We have a lot of workforce needs in our programs

15:52 - across the commonwealth that dhs touches and so

15:55 - I'm thrilled to hear that the numbers

15:57 - ended up so high in that program

15:59 - so

16:00 - For us we are very excited about several opportunities one

16:04 - you heard the governor mentioned in his budget address that he is helping to ease the

16:08 - pathway for social workers to become licensed here in the commonwealth

16:12 - that would be really helpful for us here at dhs

16:16 - many of the individuals that provide know how services in our programs are licensed

16:20 - social workers so anything we can do to help ease that

16:24 - there's also a to bills working their way up through for interstate compacts

16:28 - one for physician assistants and I believe the other is also for licensed social

16:32 - workers to be able to accept those credentials in this state again increasing that

16:36 - workforce we've got a real opportunity through

16:38 - some of the world house transformation funds

16:41 - to provide new federal dollars to our rural community these

16:46 - to

16:46 - Train folks from local communities that then we hope will stay there and provide

16:52 - services in those local communities

16:54 - so we have scholarship funding

16:56 - and we have some ability to support some short term

16:59 - housing while people are students

17:02 - as some of those other pieces that we're very hopeful folks were find attractive

17:06 - so that we can fill some of those

17:08 - quite critical workforce needs in our rural hospitals and

17:12 - other rural clinic settings

17:13 - too cause those are just a few that come to the top and nine

17:16 - so

17:16 - I've been aware for many years of some of the difficulties

17:19 - where

17:20 - folks needed to find

17:22 - master level clinicians

17:24 - in social work

17:25 - and

17:26 - where's the the the best Avenue to find out

17:29 - because obviously the one thing about this programs

17:31 - every year if you have a good run on something but you

17:33 - have a shortfall somewhere else

17:35 - that we need to be better investors of those dollars

17:38 - is they're worth the tried and true best way in terms of in the social work front

17:43 - defined the the needs of the workforce.

17:46 - I'm not an expert in that particular area

17:48 - but we would be happy to get back to you with

17:50 - some ideas around that that's great thank you very much

17:53 - while I'm going to pause for right now and

17:55 - turn it over to member questions.

17:58 - We're going to proceed to members of the committee and standing committee chairs

18:00 - standing committee chairs will have ten minutes for questions

18:03 - the committee members will have a five minute period for quest kitchens

18:06 - like to remind members and testify as to be

18:09 - brief and direct in your questions and answers

18:11 - so that all members can have an opportunity to present their questions

18:15 - obviously we do have a long day today so there will be

18:18 - another round at least of of questions to ask

18:22 - and we

18:23 - also just a point of housekeeping you know yesterday we had issues.

18:27 - Trying to figure out how to get that yellow thing the

18:29 - morning to do

18:30 - I think we have it fixed and you will be more so.

18:34 - So with that we are going to Turner turf

18:36 - standing committee chair sen Haywood.

18:39 - Thank you so much chairman

18:40 - and thank you so much for about all your team.

18:44 - You

18:44 - were last year

18:45 - a year ago

18:47 - can you share some updates what's happening in the department

18:50 - in the last year.

18:51 - Yeah sure thank you senator Haywood

18:53 - and.

18:54 - You have my testimony which I hope you'll take a minute

18:56 - to look at I obviously don't have time to go through it

18:59 - but I do want to just point out a couple quick

19:01 - things about how the department of human services

19:04 - has been working to solve pain points

19:06 - further people that we

19:07 - we

19:08 - Serve all across this child.

19:10 - All across this

19:11 - commonwealth one of the big ones is with your work

19:15 - help we have been able to now reduce the adult emergency waiting list for

19:20 - individuals who have an intellectual disability or autism that emergency waiting list

19:25 - is now been reduce asked by thirty percent since February of two thousand twenty four

19:30 - again with your encouragement we've been working very closely with counties

19:35 - to improve data collection on their behavioral

19:38 - health work and how they use those county based funds

19:41 - and I have some great data to share about that if you're interested

19:45 - again with your help we have eliminated all the

19:48 - barriers to telehealth here in the commonwealth

19:51 - that is going to have an extremely important impact

19:54 - on folks being able to receive mental health services as well as all kinds of other

19:58 - health services particularly in our rural communities

20:01 - and

20:02 - we have been expanding care options and reducing wait times for youth adjudicated to

20:07 - sure juvenile treatment centers

20:09 - you remember three years ago

20:11 - there was way a waiting list in the one hundred and

20:13 - seventies that waiting list is now down to single digits

20:17 - and most of these

20:18 - youth are placed within two weeks of being adjudicated

20:21 - we've been monitoring modern modernizing our I t systems across the board

20:26 - in

20:27 - Our state hospital centers and in all of our public facing work that we do

20:32 - and

20:33 - we have been working very hard

20:36 - to ensure that

20:39 - older adults which is the biggest largest fastest growing part of our population

20:44 - are able to age in place in the communities that

20:47 - they love

20:48 - we now have seventy nine percent of nursing facility eligible individuals

20:53 - receiving home and community based services

20:55 - in the community.

20:57 - Were interested results

20:59 - so

21:00 - You know we've had some challenges here in the

21:02 - general assembly in terms of helping people

21:04 - lift themselves up hardworking people so they have a better chance

21:08 - now we have the lowest minimum wage in the nation

21:11 - we have one of the highest student loan rates.

21:15 - For students making it more difficult to get access to higher education to

21:19 - move up the ladder of opportunity.

21:22 - We have unfortunately adopted some very onerous.

21:26 - Requirements for people too

21:28 - who are working to keep food assistance and

21:31 - it looks like we are going to have some more onerous

21:33 - reporting requirements so people can get healthcare

21:36 - recently saw a report one hundred thousand pennsylvanians lost healthcare

21:40 - as a result of new funding angele.

21:43 - Would

21:44 - withdraw

21:45 - financial assistance.

21:46 - So it would like to know if you can provide us an update

21:49 - on snap enrollment

21:51 - given the new

21:54 - reporting requirements for the national government

21:57 - sure I'd be happy to do that

21:58 - so.

22:00 - The

22:01 - the impacts of the one big beautiful bill

22:04 - which was

22:05 - signed into law in July

22:07 - have gotten the most attention

22:09 - and that will lead to expiration of some waivers of work

22:13 - requirements that it existed across the commonwealth

22:18 - since covert

22:19 - but.

22:20 - Actually before that we had some other waivers expire

22:24 - back in June first

22:27 - and so since June first what we have seen in total

22:31 - is about eighty nine thousand individuals lose access to snap

22:36 - and since September the first

22:39 - there's fifteen about fifty nine thousand of that eighty nine thousand is a result

22:43 - out of those changes on September the first.

22:46 - It is very concerning so we understand that there

22:48 - may be some new requirements coming for access to

22:52 - healthcare so people can get the care they need so they won't be sick and

22:56 - actually spread illnesses across the commonwealth.

22:59 - What can you tell us about how your

23:02 - but

23:03 - the

23:03 - possible likely impacts may be

23:06 - what the department is doing to

23:08 - reduce the impact of

23:10 - folks getting sick.

23:12 - So we've been working hard to create a number of

23:15 - public facing tools for the folks we serve

23:18 - as well as tools for our own workforce to make their jobs a little bit easier

23:23 - we have been building them around this new snapper rico wire mints but everything

23:27 - that we're building for snap will be available for the medicaid population

23:31 - the medicaid changes will start in January of two thousand twenty seven

23:35 - when individuals who are in the medicaid expansion population

23:39 - which currently in the commonwealth totals.

23:44 - Seven hundred

23:47 - and sixty seven thousand as of December

23:49 - I will have to do two things

23:52 - one they will have to read determine their eligibility and medicaid every six months

23:57 - and they will also be

23:59 - required to meet community engagement requirements

24:01 - or work requirements unless there are they are exempt

24:05 - so we have put together a number of tools you can

24:08 - see a lot of it at dhs dot pa dot gov slash work

24:12 - where we've made it much easier to upload documents

24:16 - we have itemized

24:18 - some processes so people can go online without having to make a phone call

24:22 - and track the status of their applications changed their path words

24:26 - we have a system that we're very excited about called consent based verification

24:30 - where a worker can give us permission to

24:34 - access their most recent pay stub

24:37 - and upload all the data that we need in real time

24:40 - so that we have exactly what we need to make

24:43 - proper eligibility determination ns for them

24:46 - so those things are all in place right now for

24:48 - snap and then will be extended into medicaid

24:51 - and then for our own workers again just some of the.

24:55 - Document upload improvements had made their lives so much easier it was a huge

25:00 - pain point for our staff

25:02 - that they would get documents that weren't readable

25:05 - and

25:06 - we've also put in some place some additional oversights as eligibility goes through

25:11 - different processes to

25:13 - make sure that it's being done accurately

25:16 - so we're very hopeful that as we continue to

25:19 - expand out these tools

25:21 - it helps both our teams do their work better

25:23 - and makes it a little bit easier for foe folks to meet these requirements

25:27 - we know from other states that have tried to impose these requirements historically

25:31 - that most of the people who end up losing their

25:35 - benefits are actually still eligible for the benefit

25:39 - they're meeting the requirements

25:41 - but they get caught up in the red tape

25:43 - on how to report those requirements

25:45 - so it's both they have to be meeting the requirements

25:48 - and they have to report their requirements

25:50 - and that is what we're trying to make as easy as we possibly can.

25:54 - Thank you so.

25:56 - It was previously stated that the one percent growth was anticipated is that because

26:02 - a number of people will be losing

26:05 - access to food a number of people are losing access to healthcare

26:09 - is that the basis for the one percent growth that you shared with the chairperson.

26:14 - You know I think ink that right now senator there is so much

26:16 - uncertainty about what's going to happen next federally.

26:20 - Hr one or the one big beautiful bill will

26:22 - have some very consequential impacts on the commonwealth

26:26 - first of all it is going to increase the number of uninsured in Pennsylvania we've

26:31 - already seen through Kenny which I think he referenced a few minutes ago

26:35 - and

26:35 - somewhere between ninety and one hundred thousand people have had to give up their

26:38 - penny plans because they're no longer affordable

26:41 - we have the impact of continuous eligibility

26:44 - we also are going to see starting this fall and we've

26:47 - seen a little bit now but there'll be more this fall

26:50 - decrease coverage of lawful immigrants

26:53 - lawful immigrants who were previously allowed legally to have medicaid

26:58 - are being descent rolled from medicaid

27:00 - so we have a number of things that are going to increase the

27:04 - the level of uninsured coupled with that will be an increase in food insecurity

27:09 - and we know from prior studies of what's happened here

27:12 - in Pennsylvania when work requirements were in hands

27:16 - when people lose access to their snap benefit

27:19 - it increases the spending

27:21 - in our medicaid programs particularly for people with conditions like diabetes that

27:25 - are very food sensitive this is part of why the

27:27 - governors promoting these investments in health

27:29 - and health

27:30 - to help mitigate

27:31 - some of that impact

27:33 - so we also know that things could change in Washington

27:37 - and that this bill could be mitigated in some way

27:40 - and you know as the chairman pointed out our federal budget the entire dhs budget

27:46 - right now is about sixty four billion dollars

27:49 - while we talk about the state spend here which is the most appropriate

27:53 - our budget is actually bigger than the state's budge shit

27:56 - and so what happens in Washington will have an enormous impact on how this is

27:59 - ultimately all going to play out.

28:01 - Last question one on yellow.

28:04 - Were concerned about rural and urban hospitals

28:07 - that have a significant number of folks who.

28:12 - Are relying on public assistance

28:14 - medicaid and

28:15 - medicare.

28:18 - What would you say

28:19 - that we are doing if anything to

28:22 - make it more likely that a rural hospitals kids continue an operation in some of the

28:29 - medicaid

28:30 - urban hospitals can do so as well.

28:35 - Triads are.

28:36 - Ok

28:37 - So

28:38 - And I'm sure we'll probably talk about this more later I we can certainly get into

28:41 - the opportunities that are in the rural health transformation fund

28:44 - but those cuts that I mentioned earlier

28:47 - from hr wine

28:48 - in the worst case scenario

28:50 - we could see a twenty billion dollar cut to our medicaid program

28:55 - starting in two thousand and twenty eight

28:57 - we're hopeful we'll be able to push that out

28:59 - a little bit further but worst case scenario

29:02 - starting in two thousand twenty eight we'll begin to see what would total up over the

29:05 - next decade twenty billion dollars of cuts

29:08 - those cuts will fall primarily the way hr one is structured

29:13 - they will fall primarily on our world hospitals

29:16 - and to some extent in our urban hospitals

29:18 - both of which have very tenuous operating margins today

29:22 - many of which are in negative operating margins

29:26 - on most days

29:27 - and so

29:28 - there is going to be.

29:30 - Very little that we can do if these kinds of funding cuts come into play

29:36 - and less the state decides to somehow try to back fill some of these cuts

29:41 - the money for the rural health transformation project is

29:45 - specifically prohibited from being used

29:48 - on operating costs of hospitals and so

29:52 - it will be able to do a lot of other really great things that we're excited about

29:56 - it is not going to be able to say save these rural hospitals

29:59 - so we're we're really at a very difficult spot in

30:01 - terms of our hospitals I don't want to sugar coat it.

30:05 - If if h r one is not mitigated in some way

30:08 - it will be quite difficult for us to back fill these levels of cuts.

30:16 - Thank you senator

30:17 - I'm going back to the snap

30:18 - cause some of the questions yet you mentioned that you're asking snap recipients

30:22 - to allow access to to the paychecks and payroll

30:25 - how are you guys doing that do you have agreements with employers or yeah

30:29 - yeah so there are

30:31 - agreements

30:32 - it's all done on the I t side if

30:34 - the federal government is actually working

30:37 - on a national system to do this that we would

30:39 - very likely participate in

30:41 - but we just got ahead of the game indebted our south

30:44 - and so the way it works is that if it's time

30:46 - for an individual to determine their eligibility

30:50 - they have an option to check a box

30:52 - and say yes I agree the person degree trees to consent based verification

30:56 - they log in

30:58 - to their payroll processor like an atp for

31:00 - instances when most people are familiar with

31:03 - and gives us permission to just pull that data

31:06 - so we don't have ongoing access or anything like that it's a one time consent based

31:12 - opportunity

31:13 - but the the

31:14 - butte eighty of it is

31:15 - what we have seen and this

31:17 - actually plays into error rate reduction

31:20 - sometimes a person

31:21 - inadvertently

31:22 - gives us the paycheck from a month ago

31:25 - and in that month

31:26 - there's been a slight alteration in their pay

31:29 - up or down

31:30 - and because we did not have the most recent paycheck

31:36 - that has the potential to turn into an error rate to an error

31:40 - and so by creating this system

31:42 - we get exactly what we need

31:44 - everything is kept secure and again it is only with the

31:46 - consent of the individual so that they can still just

31:49 - upload their paycheck if that is

31:51 - their preference.

31:53 - Of funnel funnel point visual

31:55 - that last exchange

31:56 - and

31:57 - I believe you said it would

31:58 - be the twenty eight twenty nine budget that you are concerned about in terms of

32:02 - potential

32:03 - increase without changes to

32:05 - the federal level

32:06 - or without changes to anything on the state level

32:08 - that you could see I think use the number twenty

32:11 - so this is entirely federal cuts that would happen through h our one.

32:16 - It would start in federal fiscal year twenty eight

32:20 - so for us it would be twenty eight twenty nine

32:23 - and

32:24 - and

32:24 - because of the way that it is

32:28 - restricting the use of assessments

32:31 - which is you know

32:32 - we have several that we used to have thunder medicaid program

32:35 - and to.

32:36 - Support

32:37 - quality improvements in our hospitals

32:40 - and the limited use the state directed payments and some other changes that hr one

32:45 - makes to how we run our medicaid program here in the commonwealth

32:48 - we could be looking worst case scenario

32:51 - over that decade from twenty eight to thirty

32:54 - have a

32:54 - twenty billion dollar cut

32:56 - total.

32:58 - Okay.

32:59 - Thank you for the information

33:01 - we're going to move on to members now five minutes apiece

33:03 - first up we have center or Phillips hill followed by senator carney.

33:09 - Secretary are kush thank you to you and your team for being here today.

33:15 - The governor in his budget address and you madam

33:18 - secretary during your budget stakeholder briefing

33:22 - highlighted the false claims act

33:25 - and stated that passing it was important to route able to reduce

33:31 - and prosecute fraud

33:33 - in Pennsylvania.

33:35 - Several years ago

33:37 - I believe it was

33:38 - around twenty nineteen twenty twenty then attorney

33:40 - general Josh shapiro stated at a news conference

33:44 - that Pennsylvania likely has upwards of three billion dollars in fraud

33:51 - and improper payments within our medicaid program

33:55 - alone.

33:56 - Do you agree with that assessment.

33:59 - Well I was not here in twenty nineteen and so

34:02 - I can't speak to that number or that comment

34:05 - what I can tell you is that our program integrity team works extremely hard.

34:10 - In this past year

34:12 - we have four hundred and eighty six million

34:15 - dollars in cost recoveries or cost avoidance is

34:18 - and a week continue to be very aggressive in that work

34:22 - we are regularly referring

34:25 - a

34:26 - Behavior that looks suspicious to us

34:28 - too oh sig or to the attorney general's office because as I mentioned earlier we

34:32 - don't have the ability to investigate

34:34 - and this is something that we take very seriously

34:38 - we also recently we

34:40 - had the most recent payment error rate

34:44 - report for the medicaid program published

34:46 - it was literally just published last week it

34:48 - normally comes out every three years in the fall

34:51 - but it was delayed because of the.

34:55 - The federal budget impasse

34:57 - and.

34:58 - That report show showed

35:00 - that

35:01 - our error rate for the review year of twenty twenty five and or medicaid program

35:06 - was zero point two six percent.

35:10 - The national standard

35:12 - was six point one two percent so.

35:18 - In the time that I have been here sen I

35:20 - this is the work that my team and I are doing.

35:24 - I appreciate that

35:25 - and

35:26 - we all understand and we know

35:27 - that when

35:29 - taxpayer dollars.

35:31 - For improper payments of course improper payments for those who don't know what they

35:36 - are mean that people are receiving benefits who are not eligible for benefits which

35:41 - means that the people who need the benefits

35:43 - aren't getting them

35:44 - so that's really

35:46 - really

35:47 - concerning

35:48 - and so those numbers

35:51 - and.

35:53 - That's.

35:55 - Numbers sound very good which industries do you expect

35:59 - there to be fraud which industries

36:01 - have you targeted.

36:03 - In

36:04 - In your with your department in your tenure as secretary I was actually just going to

36:09 - go in that same direction.

36:11 - I think was really important for folks to understand

36:13 - is that the majority of free fraud that is committed

36:16 - is by providers.

36:18 - It is by providers it is not by recipients

36:21 - the amount of recipient fraud is pretty small.

36:24 - Relatively it it may be

36:27 - higher actual numbers but.

36:29 - Literally people

36:30 - but the dollar value

36:32 - is

36:33 - Really modest compared to prevail voter fraud

36:36 - and

36:37 - some of the areas where we're very very focused is on

36:41 - our efforts to

36:43 - enact.

36:45 - The

36:46 - electronic visit verification in our home and community based services we now have.

36:52 - Pretty good compliance with that

36:54 - this is a system that requires the home care worker

36:57 - to document that they are physically in a place

37:00 - when they say they are they are doing those services and we are already

37:05 - had then able to use that system to find

37:07 - where people are saying are in two places at the same time

37:11 - and started to crack down on that so

37:13 - that's just one example of a system that is now

37:15 - up and running that was not couple of years ago

37:18 - and we were going to continue to enhance systems like that

37:22 - to make sure that

37:24 - we are

37:25 - catching every bit that we possibly can I wish people were more honest

37:29 - unfortunately there are always going to be people who try to commit fraud

37:32 - and if I could

37:33 - really see something it's always so important to save them oh absolutely

37:38 - it is really incumbent on all of us and

37:40 - I have limited time as noted by the.

37:43 - Little clock in front of you.

37:45 - I think thank you

37:46 - I appreciate the document that you provided to each of us here today

37:50 - in light of what we have seen occurring in

37:52 - Minnesota with those billions of dollars in fraud.

37:56 - Fake daycare centers and.

38:01 - We're we're seeing this happen different places around the country has your

38:05 - department done an analysis on how the legislation that I'm working on with senator

38:10 - Lindsey Williams and sen Chris stuff that

38:13 - would create a false claims act in Pennsylvania

38:17 - have you

38:17 - contemplated how it would reduce fraud in your your department across

38:22 - a whole wide swath of programs that you are responsible for

38:26 - and administer and

38:27 - so I I personally have not had a chance to do a deep

38:30 - dive into the proposed legislation but I will say

38:33 - that we welcome

38:35 - all tools to help reduce fraud in our programs

38:38 - do you.

38:40 - If you can get to that point it would be really helpful

38:43 - and very much appreciated because

38:45 - I think it would be good for us to understand.

38:48 - The estimated amount of savings that could be achieved

38:52 - with such legislation and with that I will

38:55 - turn it back to the chairman thank you very.

38:59 - Fact that Harry

39:00 - chairman could clarify something

39:02 - so just to just to make sure we're on the same page to improper payments

39:06 - are not necessarily reflection just have

39:07 - eligibility determinations that are made incorrectly

39:10 - they can mean that a payment was too high or too low

39:14 - in our.

39:15 - Payment error rate measures that will be there I think they're published now

39:19 - the eligibility rate

39:20 - error was zero

39:22 - point zero one percent.

39:25 - Thank you very welcome.

39:28 - Sorta ricordi followed by sen Dutch

39:30 - to German.

39:32 - Or to our coach great to see you

39:34 - thank you for being here today and thank you for all the

39:36 - amazing work that you and your

39:37 - your department do for the people of the commonwealth

39:40 - I want to

39:41 - put back over to child welfare real quick.

39:45 - Last year the legislature passed act twenty three

39:47 - of twenty twenty four legislation that prime sponsored that required the department

39:52 - to load children victims and witnesses to provide

39:55 - alternate methods of testimony in administrative hearings

39:59 - and to have the support of the child advocate

40:01 - can you talk about how the department has implemented this change in this process

40:04 - there are procedures in any guidance has been provided to

40:07 - administrative judges in these cases.

40:10 - I'm going to ask deputy secretary shall to come up and give you the specifics of that

40:14 - that

40:14 - our bureau of hearings

40:15 - and appeals is under her

40:17 - purview.

40:20 - Thank you for the opportunity to

40:22 - to talk about this so

40:24 - do

40:24 - We I think it's been about

40:26 - two years ago we put in place the procedures in response to act twenty three.

40:31 - So we have

40:33 - trained all of our administrative law judges the

40:36 - folks who work in staff are bureau of hearings and appeals.

40:39 - So that when a request comes in

40:41 - for support in a hearing where there is a child who will be

40:45 - testifying either as a witness or as a party in that hearing.

40:50 - The family the involved parties are able to request support for that child

40:54 - in the form of several things the most important of which

40:58 - is an actual adult to occur company them to the hearing

41:01 - and we have worked with

41:04 - partners across the commonwealth to sort of root out where there are those volunteers

41:08 - and adults supportive adults who are

41:10 - ready and available to do that so in some instances

41:13 - there's

41:14 - an adult already there and involved who's able to serve in that capacity

41:17 - in other situations

41:19 - we are a able to connect them with an adult we have not gotten many requests for an

41:24 - unknown adult to accompany a child

41:26 - but certainly are working with certain situations where there's

41:30 - adults already party

41:31 - in in the mix that are able to be there and I think we've already talked about some

41:34 - of the other things we've we've changed the way our

41:36 - hearing rooms are set up we all have our locations now have

41:40 - side rooms where children are able to wait so they're not in the same waiting areas

41:44 - with adults who might be involved in the same hearings where they are

41:47 - they're able to bring in stuffed animals other other sort of comfort items of comfort

41:51 - into the hearings I think we've done a lot of work

41:53 - to create safe spaces for our child witnesses but

41:56 - that's that's really good to hear.

41:58 - She continued her

41:59 - constituents and organizations who are concerned about the due process

42:03 - of individuals were placed on the child abuse registry.

42:07 - Many individuals report they're placed on the registry before they can

42:10 - contest the ceo's decisions

42:12 - a decision that places them on the list

42:15 - for life regardless of the type of accusation

42:18 - when these individuals do contested decisions they report long wait times before they

42:22 - even receive a hearing.

42:24 - In front of the department

42:26 - along these lines lines or other or concerns about

42:28 - the overall staffing in case goes with individuals

42:31 - within the bureau of hearings and appeals

42:33 - can you outline the current budget and staffing

42:35 - levels of the bureau of hearing and appeals.

42:38 - We.

42:39 - Got

42:40 - while Gloria is looking at up as precisely I can

42:43 - give you the current.

42:46 - Situation at the ha

42:48 - so as you are probably aware sen we are involved in litigation around

42:54 - this type of activity and whether or not

42:56 - pre deprivation hearings should be required

43:00 - prior to anyone being placed on the child abuse registry

43:04 - at the

43:05 - initial case that was decided

43:07 - was narrowly around teachers

43:10 - and while that case is

43:12 - being appealed that appeal is on hold

43:15 - there is another case that is looking at

43:19 - to have a much broader odor impact

43:21 - anyone to include anyone who would be placed on a child abuse registry

43:25 - having a full

43:26 - to.

43:27 - A pre full merits hearing prior to being placed on the list

43:31 - so while that is happening and

43:34 - we can't really get into a lot of the specifics

43:36 - of

43:37 - What may or may not ultimately

43:39 - come from those suits as they are active litigation that we have begun

43:44 - doing the pre deprivation hearings for teachers

43:48 - and on average they do take about two and a half hours some take longer some take less

43:54 - and so there is no question

43:56 - that should the courts find that

44:00 - every individual

44:01 - needs a full merits hearing

44:03 - prior to be

44:04 - being placed on the child abuse registry list

44:08 - that would increase the caseload at the ha

44:11 - by over four thousand hearings a year

44:15 - and so that would be

44:16 - really

44:17 - quite difficult for us to manage and we would probably have to

44:20 - look at some

44:21 - additional options for that but

44:23 - Gloria can give you the and

44:25 - so the bhs staff are part of the gender the government

44:28 - operations administration lines we have one thousand sixty

44:32 - positions as our compliments ceiling

44:34 - we do have vacancies in that appropriation but

44:37 - I did want to highlight that in twenty five twenty six budget

44:41 - the compliment

44:42 - and

44:42 - ceiling was increased by sixteen positions for bhs specifically related to

44:47 - their

44:48 - assuming work related to medicaid.

44:50 - From a contracted entity

44:52 - so there

44:53 - is additional resources planned to be filled unfortunately we were not able to get

44:57 - them filled yet because we had the budget impasse at the state level

45:00 - that delayed our ability to do so.

45:03 - Too as it is.

45:05 - As part of it's staffing and funding in terms of

45:08 - trying to get to a point where you could

45:10 - be holding these pre deprivation hearings for

45:12 - everyone involved.

45:14 - Yeah what's fair to say

45:15 - absolutely.

45:16 - Senator we're being

45:17 - thoughtful about making any

45:19 - are too many permanent changes as we await the outcome of these lawsuits because

45:24 - we really don't know

45:25 - how it's going to go and so we want to be careful that we

45:28 - wait and then whatever is needed then we will work to accomplish that

45:33 - okay

45:33 - thank you very much I see my terms of.

45:35 - Surrender Dutch followed by so enter penny cook.

45:38 - Thank you chairman.

45:40 - Secretary

45:41 - thank you for being here during the

45:43 - governor's budget address he looked straight at the republican says

45:46 - and said

45:47 - just because you say it

45:48 - doesn't make it true.

45:50 - He was saying that in relation to our project.

45:53 - Concerns over.

45:55 - The debt that we saw have seen for years on the horizon and talking about what kind

45:59 - of signify the current patch increases

46:02 - it's going to take or draconian cuts.

46:05 - If we stay on this track.

46:08 - Article.

46:10 - Eight section twelve of the Pennsylvania constitution requires

46:13 - requires

46:15 - the governor

46:16 - to provide a financial plan for not less than

46:18 - the next succeeding five years

46:21 - in the fiscal fiscal years

46:22 - which plan shall include in each fiscal year

46:25 - projected expenditures for capital projects

46:28 - specifically itemized by purpose and the purpose

46:30 - proposed sources of financing.

46:33 - Every year.

46:35 - Since I've been on this committee.

46:37 - We have asked for those projections.

46:40 - Every year

46:41 - we get.

46:42 - Excuses about why

46:44 - those projections cannot be provided

46:47 - and every year in the governor's outlying years

46:50 - we get

46:51 - zero were minimal

46:53 - increases in the expenses even though there are

46:55 - contracts that have compounding increases in those.

47:02 - Yet the ifo

47:05 - and our

47:07 - senate republican.

47:09 - Fund.

47:10 - Appropriations committee

47:12 - have given us projections

47:14 - that pretty much fall in line with where.

47:17 - Your department and every other department

47:20 - have come

47:21 - we've been pretty close to the Mark.

47:24 - But

47:24 - every year we are failing to

47:27 - see from the governor and from

47:29 - your departments

47:30 - those projections.

47:33 - Can you give us an update and a change

47:37 - to the

47:37 - report that shows us actually what the projections are

47:41 - because we've got we've been pretty

47:42 - pretty much on the Mark

47:44 - and it is going to cause

47:46 - draconian cuts or.

47:48 - Significant increases in taxes.

47:51 - How do we address that if you're not giving us the numbers.

47:55 - Since Saturday I think that

47:56 - that the gist of your question is really best

47:59 - addressed by the budget secretary at we follow

48:02 - do you not.

48:04 - See that you are

48:05 - required to do in the ways that we prevent the budget and this is the way we've been

48:09 - presenting these budgets now for years and I'm frustrated every four years every year

48:13 - because the requirement is your department has to submit the information to the

48:18 - budget office of the budget office

48:19 - can actually give us those projections

48:22 - why are

48:22 - why is that where's the

48:24 - where's the.

48:26 - The fault line.

48:28 - You know I think senator right now in particular for our department

48:32 - as as you heard earlier there are a lot of moving parts right now

48:36 - said that for years now.

48:38 - What are our projections and the I ufos are falling are pretty accurate

48:43 - but years have not they've been dramatically different.

48:46 - Route

48:46 - through I think that again the way the budget is

48:48 - presented is a question for the budget secretary.

48:52 - Do not provide them with the outlier or outlying years do you give 'em projections

48:56 - for the outlying years and if you did I would like to see them

48:59 - that's the question for the budget secretary.

49:02 - Can you give us the projections that you've given us

49:04 - or given the government the budget office

49:07 - you have our projections as best we have them

49:09 - with a great deal of uncertainty that we're faced with right now

49:13 - we have assumed reductions.

49:16 - In the medicaid program due to increasing the minimum wage.

49:21 - Ok that by assuming others the Terry I I

49:24 - get that but I'm not going to

49:26 - hurried up my time on that

49:27 - when.

49:28 - I find it unacceptable the congress or the

49:31 - constitution requires you to do this is all being done

49:34 - and I say that for all the departments it's not just your own.

49:38 - Madam secretary and reviewing the transcript

49:40 - from your budget briefing to stakeholders you

49:42 - talk about each

49:43 - one stating that under this law

49:45 - medicaid financing rules will change

49:47 - how dhs

49:48 - will be able to draw federal matching funds

49:51 - beginning in two thousand twenty eight

49:52 - I believe you stated those changes will remove twenty billion from the federal share

49:56 - of the medicaid program over the following

49:58 - decade I know

50:00 - the chairman

50:01 - has

50:01 - addressed this but one part that I don't.

50:04 - I did not get any clarification

50:06 - those changes

50:08 - are.

50:09 - Are those financial responsibility going to be on

50:11 - the state or are they going to be on the hospitals.

50:18 - Well it's it's a little bit of a complicated answer

50:20 - and those changes will primarily be

50:25 - in the way or the amount

50:28 - of assessment that we are able to collect and then

50:33 - draw down federal matching funds.

50:36 - Assessments

50:37 - have different purposes.

50:39 - The mc o assessment in particular does

50:42 - go to help fund our medicaid program.

50:46 - The hospital assessment actually

50:49 - largely is reinvested in hospitals to help with

50:52 - quality improvement programs and other priorities that

50:56 - they have and we have together to help improve the health of Pennsylvania ns

50:59 - and so.

51:03 - If we if those

51:04 - funds are cut

51:06 - then there will have to be

51:08 - corresponding cuts unless the general assembly

51:11 - finds a way to back fill them

51:14 - which of course given the enormity

51:15 - of what we're talking about here would be exceptionally difficult

51:19 - and so

51:20 - we are continuing to look at at.

51:23 - Every aspect of our program we made some changes to our program this year

51:28 - in

51:28 - Once hr one passed and we saw some of the pressures that were going to be on

51:33 - our medicaid budget we were able to make some changes

51:35 - before the two thousand and twenty six contracts were signed

51:39 - had the budget been on time we

51:41 - potentially could have made even more contract

51:43 - cuts

51:44 - or changes to those contracts we didn't have time by the time we got the final budget

51:49 - but it is a very serious situation senator I don't want to sugarcoat it.

51:54 - Wouldn't want you to

51:55 - if you wouldn't mind I won't

51:56 - give you anything here but please

51:58 - if you can forward us the plans and stuff that you have or

52:02 - synopsis

52:03 - or

52:04 - Those plans I'd appreciate it.

52:05 - Now well we don't there's nothing

52:07 - done yet we're working with stakeholders to think about that but we can certainly.

52:11 - Share with you what we know about each or one I understand the mp contingency plans

52:15 - but I'd like to have a little bit of

52:16 - we would I think

52:18 - appreciate having a little bit of heads up on what might be on the horizon.

52:22 - Sure.

52:24 - Center penny cook fall by sen Kim.

52:27 - Thank you mr chair and

52:29 - secretary are kush we were just chatting about

52:31 - the.

52:32 - Challenges

52:33 - in healthcare and pottstown hospital recently

52:37 - closed several departments and I'm really worried

52:39 - about having a healthcare desert in Montgomery county

52:42 - which when I say it sounds absurd

52:44 - it really does.

52:47 - At the same time the federal rural health transformation program

52:51 - identifies full practice authority for nurse

52:53 - practitioners as a factor in their funding formula

52:57 - have you analyzed how allowing nurse practitioners

53:00 - to practice to the full extent of their license

53:03 - could impact our ability to draw down additional

53:06 - rural

53:07 - health transformation dollars.

53:10 - So I'm going to I'm going to answer your question in two parts

53:13 - the first part is

53:14 - that Gavin shapiro has called for expanding practice authority for nurse

53:19 - practitioners I believe he did that last year

53:21 - and

53:22 - and and should the general assembly choose to do that

53:25 - we are

53:26 - ready to participate in that

53:28 - separately

53:29 - the r htp required

53:31 - that

53:32 - that expansion authority.

53:35 - Be

53:36 - Committed to.

53:38 - When we submitted our application.

53:41 - So in other words if estate did not have that particular provision

53:45 - enacted in their state are active in there state.

53:48 - We could have committed to that provision

53:52 - and we would have been awarded a few more points for having done so.

53:57 - The concern was and and we were guided by all of you

54:01 - unless there was a commitment from the general assembly to pass that expansion

54:07 - we would then be at risk

54:09 - for having the amount of dollars that

54:12 - we

54:12 - We received

54:14 - based on getting that done

54:16 - actually reduced

54:18 - from our out year awards

54:20 - because we didn't actually get it done

54:22 - so you didn't you

54:24 - you had to commit to doing it.

54:27 - As and after lots of consultation

54:30 - with the general assembly

54:31 - and

54:32 - by

54:32 - Others we were told to not put that provision into our application.

54:37 - Is there any ability to.

54:41 - Join now or

54:42 - we asked all those questions and the answers that we got from cms at least

54:47 - through the fall were know

54:49 - that what you submit it's a one and done.

54:52 - Maybe they'll change their mind over time what what we are very aware of and what

54:57 - we're aiming for with those dollars is

54:59 - we knew that we were now not likely to get the full two hundred million

55:03 - we are not a frontier state

55:05 - and there are other things that we just weren't

55:07 - going to get the maximum number of points

55:09 - but what we've committed to is whatever dollars we got

55:13 - really executing well

55:15 - on these dollars spending every dollar as we committed

55:18 - to spend it and the ways we allowed to spend it

55:21 - at and then

55:22 - when they do the re budget every year

55:24 - my hope is that we'll be able to make a very strong case to bring additional funds to

55:29 - Pennsylvania because we've been very responsible and

55:31 - how we've managed the first tranche that we received

55:34 - so that's our hope that we're going to actually be able to get more in the out years.

55:38 - Do you support

55:40 - and.

55:41 - Allow

55:41 - nurse practitioners to have full practice authority as a

55:44 - stopgap measure if you will for our

55:47 - areas that don't have the infrastructure.

55:51 - I think that it's very important that people

55:53 - be allowed to practice to their full training

55:56 - and I do believe that it is

55:58 - absolutely a way to help mitigate some of our workforce shortage just

56:02 - in in all areas of the commonwealth

56:04 - urban and rural

56:05 - so yeah the governor calls for this as I mentioned

56:08 - and again it's nothing that we can do at dhs

56:12 - this requires the general assembly to act

56:14 - great thank you

56:15 - I'm switching gears I looked at your budget

56:18 - material and there was a significant loss of revenue

56:22 - and

56:22 - in the calculation appropriation you request eighty four million dollars

56:27 - in state funds to back fill a reduction in pharmacy rebates yes

56:31 - can you explain what caused this reduction and.

56:35 - What's going on there sure a one million is a lot of money

56:39 - yes

56:39 - so

56:40 - We the medicaid for grandma just give me some background information the medicaid

56:44 - program negotiates pharmaceutical rebates

56:46 - on

56:47 - All the medications that we

56:49 - have that run through our medicaid program

56:51 - and those rebates actually come to the state

56:53 - up until a few years ago those rebates went to managed care organizations and frankly

56:58 - were profit for the managed care organizations I think

57:02 - in two any nineteen twenty twenty something like that

57:04 - the medicaid program pulled those back so we get those here at the state

57:08 - what happened this year

57:09 - and so there's always some churn around that number goes up it goes down

57:13 - but this year an important amount of that

57:17 - eighty million plus amount and I don't know what the exact number is

57:21 - is related to to the fact

57:23 - that as you know

57:24 - we have eliminated the coverage of glp ones

57:28 - for obesity alone

57:31 - in our medicaid program starting January first or twenty twenty six

57:35 - and as a result of that

57:37 - we will lose the rebates that we.

57:41 - Would have received

57:42 - for

57:43 - that portion of glp one prescribing we will still get

57:47 - rebates for the others

57:49 - allowed uses of glp ones

57:51 - but we will not be getting rebates for that particular use

57:55 - but would you say that you are saving money in that

57:59 - you're not prescribing that

58:01 - it is still a net savings despite that reduction in the rebates

58:05 - okay and how does the.

58:08 - Trump.

58:09 - President trump's drug negotiations and his new ability to

58:14 - the lower cost of some of these drugs I know.

58:18 - Eli Lilly

58:19 - has dropped their prices on glp ones to seventy five a month how

58:24 - is that cost-savings been

58:26 - injected into your

58:28 - budget

58:29 - yet

58:29 - not yet

58:30 - because we haven't actually gotten anything official from cms

58:34 - we are

58:34 - anxiously waiting to see

58:36 - what the opportunities would be for us but we haven't gotten anything official yet

58:40 - and I also do just want to point out because I I've been asked many times

58:43 - people have asked about trump r x

58:45 - the new website that

58:47 - went live I think two weeks ago or so

58:49 - it does specifically

58:51 - require

58:52 - a person.

58:54 - I have no government insurance

58:57 - in order to purchase medications from trump r x

59:01 - so to medic

59:03 - if you have medicaid you are not allowed to purchase drugs

59:06 - and trump are acts so that is not going to be of any help.

59:10 - I

59:11 - Apologize for going over my time.

59:14 - Center Kim followed by senator Vogel.

59:18 - Good morning

59:19 - director gilligan and dr kush

59:21 - just want to thank you

59:22 - madam secretary for being so present in my district

59:25 - you know I see you at the food banks at a ribbon cutting for affordable housing unit

59:30 - and just grateful for

59:31 - your presence.

59:33 - So I represent a urban suburban district

59:36 - but I am very concerned about what's happening and the rural hospitals.

59:40 - I hospitals are telling me that we are seeing

59:42 - more and more patients striving longer ways to us

59:46 - and it's going to.

59:49 - Affect us.

59:50 - I know that when you swore in.

59:53 - For.

59:54 - Your position three years ago you didn't expect hr one to be here

59:59 - 452 and I appreciate all the ssh

01:00 - 05.052 pivoting and shifting that you have to do to accommodate what's coming out of DC.

01:00 - 08.832 My question is if you can look into your crystal ball

01:00 - 13.112 with the vulnerability of rural hospitals how was that going to affect

01:00 - 14.472 all of us

01:00 - 18.032 and also in hr one there's a fifty billion dollar

01:00 - 19.562 rural health fund

01:00 - 21.432 all that help.

01:00 - 24.882 Alleviate some of the pain that we're going to be saying.

01:00 - 25.952 Thank you

01:00 - 27.072 thank you senator cam

01:00 - 30.728 so I'm going to answer the second part of your question first so that fifty billion

01:00 - 32.962 dollar fund is that rural health transformation

01:00 - 34.832 program that we were just talking about

01:00 - 37.452 and as I did mentioned earlier.

01:00 - 39.552 When the actual

01:00 - 45.272 requirements around that program were released by cms it explicitly says

01:00 - 46.452 that we are not

01:00 - 50.612 use that funding to assist with operating expenses at a hospital

01:00 - 52.412 there are other things we can assist with

01:00 - 53.252 but not

01:00 - 55.142 operating expenses and so

01:00 - 56.682 we have put together

01:00 - 00.182 you all have a hand out on the r http that one is two-sided

01:01 - 01.884 and you can take a look to see it all the

01:01 - 05.232 pillars of that and what we'll be focusing on.

01:01 - 09.642 I think your your bigger question though is a very very important one.

01:01 - 13.602 Regardless of hospital location.

01:01 - 18.372 There are going to be impacts from h r one that we're already seeing.

01:01 - 19.532 Evidence

01:01 - 21.962 first and foremost by what's happened with penny

01:01 - 25.952 the inability to continue the enhanced premium tax credits

01:01 - 27.422 has meant that

01:01 - 30.728 I think we're up to about one hundred thousand people now have that found that they

01:01 - 34.172 just simply cannot afford to continue their penney plans

01:01 - 35.312 so that is

01:01 - 37.712 one quarter cohort of people who are now

01:01 - 39.882 at least for now uninsured

01:01 - 43.412 and then as these work requirements continue to go on

01:01 - 47.192 earth begin to go into place for medicaid beginning in two thousand and twenty seven

01:01 - 49.502 medicaid has never in it's history

01:01 - 52.862 had any key kind of community engagement or work requirement

01:01 - 55.712 so this is a brand new requirement for medicaid

01:01 - 59.723 and of the seven hundred and sixty some thousand folks

01:01 - 03.032 in the expansion population who will be impacted by that

01:02 - 04.302 we know that

01:02 - 04.862 how

01:02 - 08.408 even if they're working some of them are probably going to get disconnected from

01:02 - 10.112 their benefits just because of the

01:02 - 12.182 admins straight of complexities of it

01:02 - 15.872 so we're going to see an increase in our uninsured from that reason

01:02 - 20.642 and then we're already starting to see a reduction in the ability of lawful

01:02 - 24.722 immigrants and certain refugees that will mostly come in October

01:02 - 28.452 to also be covered by medicaid again these are still people.

01:02 - 31.292 Who get sick and are in car accidents and have heart attacks

01:02 - 32.102 and

01:02 - 32.492 when

01:02 - 34.340 any of these individuals that I just described

01:02 - 36.912 describes you come to any of our hospitals.

01:02 - 38.942 The law of the land

01:02 - 41.552 is emtala our emergency medical treatment act

01:02 - 46.212 those folks will be cared for if they're having any kind of an emergency

01:02 - 50.172 and so it is going to increase pressure on our.

01:02 - 53.042 Hospitals tremendously

01:02 - 54.602 to cover

01:02 - 56.742 individuals who are uninsured

01:02 - 57.632 and

01:02 - 02.082 it will take what is already a quite challenging situation and make it more so.

01:03 - 05.552 Thank you and I know that when families love to live

01:03 - 06.672 somewhere

01:03 - 08.772 they want healthy hospitals

01:03 - 09.942 and.

01:03 - 12.812 I'm proud that cumberland and dauphin counties are growing

01:03 - 14.042 car mill a and more so

01:03 - 16.992 but if the hospitals aren't there.

01:03 - 19.632 Depopulation is going to continue to happen.

01:03 - 21.842 This is very much an economic issue

01:03 - 24.002 and and I I and I say that as a doctor

01:03 - 25.622 I mean it is

01:03 - 31.142 so critical to the economic vitality of our communities that our hospitals are strong

01:03 - 35.402 in many of our rural communities it is the largest employer in the region

01:03 - 38.972 and when that starts to falter it has a

01:03 - 41.432 really big impact on the communities

01:03 - 44.012 it's also quite different cult to attract a new business

01:03 - 45.949 governor shapiro has done a phenomenal job of

01:03 - 49.322 bringing manufacturing back into the commonwealth but

01:03 - 50.132 those

01:03 - 53.252 businesses want to know that they've got a place for their

01:03 - 55.112 employees to get healthcare

01:03 - 59.858 and so this is as much an economic issue for the future growth of our commonwealth as

01:03 - 02.612 it is a health issue they are inextricably entwined

01:04 - 05.612 and I just hope we can all continue to work together

01:04 - 06.092 this

01:04 - 08.972 absolutely has to be a bipartisan issue

01:04 - 10.682 that we have to find ways

01:04 - 13.392 to stabilize and secure our hospitals

01:04 - 14.562 thank you so much

01:04 - 15.792 mr chairman.

01:04 - 18.204 Centre use.

01:04 - 21.942 Thank you mr chairman secretary good to see you as well.

01:04 - 23.772 As as well.

01:04 - 25.742 Just to follow up on that.

01:04 - 27.032 Question

01:04 - 28.352 sir can raise

01:04 - 29.892 just

01:04 - 31.502 reviewing my notes

01:04 - 34.662 res excuse me Tuesday seventeenth.

01:04 - 36.912 Bradford Pennsylvania.

01:04 - 39.272 Hospital announce

01:04 - 41.112 closing down.

01:04 - 42.552 I.

01:04 - 44.682 What what happens

01:04 - 46.502 to those folks there and

01:04 - 48.402 I have to admit.

01:04 - 49.022 That

01:04 - 50.382 the.

01:04 - 53.312 It was very alarming that the fund that you

01:04 - 55.172 announced that the federal government

01:04 - 56.502 created.

01:04 - 00.362 Could not be utilized for costs

01:05 - 01.982 for hospitals but could

01:05 - 03.422 be utilized for services

01:05 - 06.002 probably nice stuff that should be done

01:05 - 06.872 but it

01:05 - 08.642 presents an either or situation

01:05 - 10.122 what happens

01:05 - 10.442 to.

01:05 - 12.302 The folks up in Bradford

01:05 - 13.422 yeah.

01:05 - 14.472 So that that

01:05 - 16.112 situation and

01:05 - 17.552 what I know of it

01:05 - 20.192 it was particularly complex because that hospitals

01:05 - 22.562 actually owned by a hospital in new York right

01:05 - 24.212 and I

01:05 - 25.782 kalita kalita.

01:05 - 26.762 In Olin

01:05 - 27.572 so

01:05 - 34.838 Folks will go to lin and they are also making contingency plans for other hospitals

01:05 - 36.602 none of which are terribly close by

01:05 - 37.712 but

01:05 - 40.509 it is a really unfortunate situation and it is

01:05 - 42.932 going to mean that people have to drive further

01:05 - 44.972 and particularly if you're

01:05 - 48.752 experiencing a medical emergency like a heart attack or stroke obviously

01:05 - 51.162 every minute counts and.

01:05 - 54.842 It is a very very difficult situation in some of these communities

01:05 - 58.032 and to go to the last point around.

01:05 - 03.642 The economic driver of the community peers.

01:06 - 05.592 To be that

01:06 - 06.852 bad hospital.

01:06 - 10.382 I would assume so and

01:06 - 13.382 I do know there are very important employer in that region

01:06 - 16.652 and I would assume that it will have some very

01:06 - 20.622 substantial impacts on the entire community beyond the healthy.

01:06 - 21.902 Ecosystem of

01:06 - 23.982 muted because it's all.

01:06 - 24.872 Interrelated

01:06 - 26.052 obviously

01:06 - 27.884 you and I are from

01:06 - 28.592 and

01:06 - 29.922 a

01:06 - 31.862 Healthcare rich environment

01:06 - 33.282 in the southeast

01:06 - 36.902 and we know the vitality and what that drives in terms of the

01:06 - 38.552 the economics and the

01:06 - 40.152 social system

01:06 - 41.922 in in the region.

01:06 - 43.632 But.

01:06 - 46.782 It's gotta be a big challenge

01:06 - 47.732 and the fact that

01:06 - 50.232 that the little bit of.

01:06 - 51.522 Support

01:06 - 52.842 provided.

01:06 - 56.052 By the federal government by the trump administration

01:06 - 58.662 cannot go to maintaining.

01:06 - 00.902 Support for

01:07 - 01.592 that

01:07 - 02.922 particular hospital

01:07 - 05.102 or other similar suits weird because it's.

01:07 - 06.822 Predict.

01:07 - 08.432 This this will not be the

01:07 - 08.712 the

01:07 - 11.592 last just the first of many.

01:07 - 14.288 That's really problematic and

01:07 - 15.152 I don't want to

01:07 - 17.982 the chairman was was kind enough to.

01:07 - 20.252 Allow me to jump in here in the middle of the

01:07 - 22.032 course of questioning and I don't want to

01:07 - 23.312 take up all the time

01:07 - 24.242 but

01:07 - 25.572 it's just.

01:07 - 26.982 Very disconcerting.

01:07 - 29.852 For those folks in that community

01:07 - 31.532 to now be in a situation

01:07 - 32.772 where there

01:07 - 34.812 likely will be no hospital.

01:07 - 36.972 So thank you thank you madam.

01:07 - 39.042 Thank you senator

01:07 - 43.090 up next we have senator Vogel followed by senator kappa letty.

01:07 - 47.742 Thank you chairman good morning secretary of the morning

01:07 - 51.322 I could go on for an hour or two myself just about the hospital closings and stuff we

01:07 - 53.162 heard in western Pennsylvania situation but

01:07 - 54.642 I'll say that for

01:07 - 56.382 maybe next time around.

01:07 - 58.262 In your budget request of theirs

01:07 - 58.652 the

01:07 - 02.322 u of pa navigate vs two one one

01:08 - 05.588 and could you explain the difference between these two systems a while you have two

01:08 - 07.592 systems I mean it looks like in the budget like

01:08 - 10.292 two one one gets about two hundred fifty thousand dollars but

01:08 - 11.162 what does

01:08 - 12.812 Pierre navigate do I guess yeah

01:08 - 13.652 so

01:08 - 14.162 There's

01:08 - 16.748 actually some very important differences between the two of them

01:08 - 20.702 so Pierre navigate is a system that has been built

01:08 - 24.692 through Pennsylvania's health information organs stations

01:08 - 25.322 of

01:08 - 27.362 The h I o's are

01:08 - 29.072 there five of them currently

01:08 - 30.572 and they

01:08 - 31.172 are

01:08 - 32.352 it is like the.

01:08 - 33.882 Think of it as like the

01:08 - 35.022 t network

01:08 - 39.062 that connects hospitals and the data about their Patience with each other

01:08 - 42.962 so that if you get your care in one hospital

01:08 - 47.222 but you go go to an urgent center in another part of the state

01:08 - 48.782 they if ever if

01:08 - 52.718 all those folks are connected they can look up your medical records in that urgent

01:08 - 55.472 center know what you're allergic to all of that so that's

01:08 - 57.272 what pa navigate does

01:08 - 00.312 pa navigate is also

01:09 - 03.178 what we're calling a closed loop referral system so

01:09 - 06.032 if you're in India digital who has a particular need

01:09 - 07.742 like housing or food

01:09 - 10.322 and you're in an emergency room or in a

01:09 - 11.552 doctor's clinic

01:09 - 14.918 they can gone to pay a navigate and literally refer

01:09 - 18.062 you to a community based provider in your community

01:09 - 23.112 who can help you with some of your other needs like food or housing or transportation

01:09 - 27.812 and then that prove rider can let the doctor know they can send a message back

01:09 - 31.832 that oh we saw mrs Smith and here's the plan so it's

01:09 - 35.972 it's actually extending the ability of providers to provide care

01:09 - 40.202 into the community and work on the holistic approach to how to make sure

01:09 - 40.832 patients have

01:09 - 42.242 everything that they need

01:09 - 44.672 so that's what pa navigate allow

01:09 - 47.702 it's a very exciting opportunity and

01:09 - 49.960 anybody can go and pay navigate it's not just limited to

01:09 - 53.412 health care providers then we have people I think we had

01:09 - 57.332 almost a million queries and to pa navigate last year

01:09 - 00.212 so it is really growing quite successfully with various

01:10 - 00.752 people

01:10 - 01.802 started

01:10 - 03.062 it started

01:10 - 07.632 we we funded it was some dollars from arpa-e

01:10 - 12.062 and it went live in the spring of twenty four I think it

01:10 - 13.622 went live since I've been here

01:10 - 16.394 but it was something as both a physician and as a county

01:10 - 19.202 commissioner I would have dreamed of having like such a

01:10 - 20.252 ethics up

01:10 - 21.402 if that's what that is

01:10 - 23.252 two one one has been around

01:10 - 27.212 for a very long time in the ca commonwealth run through the united way

01:10 - 30.782 and they provide a service that

01:10 - 33.722 pa navigate does not which is a call center

01:10 - 36.362 so people can call to one one

01:10 - 40.982 we don't have any plans for people to be able to call pa navigate

01:10 - 43.842 it is something that can be accessed online

01:10 - 46.532 through a providers office that sort of thing but not

01:10 - 47.972 not doing a call center

01:10 - 48.662 so

01:10 - 51.482 Two on one still does provide that important

01:10 - 54.272 call function because some people do want to make a call

01:10 - 55.812 and

01:10 - 58.422 there's nothing that stops the two one one.

01:10 - 03.520 From actually looking at pa navigate to figure out what's available in that person's

01:11 - 07.114 area if two one one doesn't have any information for that area

01:11 - 08.134 and then

01:11 - 10.564 we have also partnered with two-in-one

01:11 - 12.764 in some of our recent

01:11 - 16.304 emergencies some of the flooding events and some of the other.

01:11 - 18.634 Natural disasters they have some

01:11 - 21.094 great folks on the ground in certain communities

01:11 - 24.364 and were able to partner with them in response to certain situations

01:11 - 25.804 so they are actually

01:11 - 26.494 different

01:11 - 29.144 and they are filling different needs.

01:11 - 31.594 So on the p navigate

01:11 - 33.944 that is run by the doctors

01:11 - 35.644 basically do that then or is that

01:11 - 36.974 any person can.

01:11 - 38.944 Any person can just get on to

01:11 - 40.154 navigate site and

01:11 - 42.184 do it themselves it yeah anybody can get on it

01:11 - 45.344 it's paid for by our health information organizations

01:11 - 48.082 which are funded by a whole bunch of hospital

01:11 - 50.794 systems almost every hospital in the commonwealth

01:11 - 52.034 think we're down to about

01:11 - 52.654 twelve

01:11 - 53.404 and

01:11 - 55.084 are part of pa navigate now

01:11 - 59.320 and we're trying to get that last group in with our rural health funding because most

01:11 - 01.810 of the ones that aren't on yet are rural and we want to give them

01:12 - 03.724 the dollars to be able to make that connection

01:12 - 07.754 so it is a very different much more robust

01:12 - 08.984 system and

01:12 - 10.684 it's the type system

01:12 - 12.220 if you want me to give you one

01:12 - 14.524 quick example about how we've put it to use

01:12 - 15.424 and

01:12 - 19.480 some of our providers are using already using medically tailored meals some of our

01:12 - 23.254 managed care organizations this is why the governors calling for investments in health

01:12 - 25.354 and with pa navigate

01:12 - 26.344 the

01:12 - 31.210 provider of those medically tailored meals can get alerted that if a patient that

01:12 - 34.544 they're making meals for for next week has now been hospitalized

01:12 - 35.614 so they don't

01:12 - 37.084 try to deliver those meals

01:12 - 41.440 and then when that person gets discharged they can get pinged back so they know to

01:12 - 43.384 restart those meals or if there's been any update

01:12 - 46.915 so it's like that type of work and we've already proven

01:12 - 50.074 it saves money it saves emergency room visits it's been

01:12 - 53.594 real the wildly successful so we're really excited about it.

01:12 - 56.350 Thank you very much without a goal amount of time so

01:12 - 56.974 comfortable of course

01:12 - 57.784 thank you

01:12 - 59.414 thank you cetera.

01:13 - 03.374 We have center of the capital Eddie followed by senator brown.

01:13 - 10.244 Thank you German art.

01:13 - 11.894 Thank you.

01:13 - 13.114 For being here today

01:13 - 14.864 we've had a lot of questions.

01:13 - 16.994 Really important issues.

01:13 - 18.514 That

01:13 - 21.614 it's really important to me as a.

01:13 - 22.864 Moms

01:13 - 25.638 are fucking a fucking one.

01:13 - 27.154 Shortly here so.

01:13 - 28.054 I

01:13 - 29.074 Childcare

01:13 - 31.634 and specifically our.

01:13 - 32.524 Recruitment

01:13 - 34.594 retention grandma we've created

01:13 - 36.904 last year in our last year's budget of

01:13 - 42.674 twenty five million and this year we're looking to increase that to thirty.

01:13 - 43.994 Where.

01:13 - 44.854 Could you

01:13 - 48.764 tell us a little bit about the implementation of the.

01:13 - 50.354 Challenges that

01:13 - 51.944 result from.

01:13 - 53.344 Sure well

01:13 - 55.868 it's good to see you senator and I wish you the best

01:13 - 59.324 here in these next few weeks I hope everything goes well.

01:13 - 03.464 We were so grateful for the general assembly please.

01:14 - 06.979 Support in creating the twenty five million dollar

01:14 - 10.114 recruitment and retention fund for our childcare workforce

01:14 - 14.734 as we've already talked about today this workforce is essential to our economy

01:14 - 16.144 and we know that

01:14 - 19.154 we need to make sure that people can.

01:14 - 22.774 Put their child in a safe secure place while they are at work work

01:14 - 25.874 and we know that our child care providers

01:14 - 30.694 have been slowly steadily recovering since coven but they're still not

01:14 - 32.104 one hundred per cent back

01:14 - 34.619 so we've been very pleased to take a number

01:14 - 37.244 of proactive steps under this administration

01:14 - 39.184 as you know and again with your

01:14 - 41.956 support we've increased the base rates that child

01:14 - 44.614 here http providers and child care works are paid

01:14 - 45.854 to the seventy

01:14 - 48.214 fifth percentile of private pay

01:14 - 50.954 that is in line with the federal standards.

01:14 - 53.294 This year through.

01:14 - 54.994 Our block Grant

01:14 - 58.127 we were able to issue eighty six start-up and

01:14 - 01.084 expansion grants to providers across the commonwealth

01:15 - 02.344 and we've created

01:15 - 02.944 multiple

01:15 - 05.584 professional development opportunities for this worker

01:15 - 06.764 these workers

01:15 - 10.594 we had a very robust response to these retreat tension

01:15 - 12.244 recruitment and retention grants

01:15 - 16.744 of forty three hundred child care providers applied for these grants

01:15 - 20.404 and we're still working through sort of how that all

01:15 - 22.414 plays out with final numbers

01:15 - 25.225 but we are hoping to start having those

01:15 - 29.104 retention and recruitment dollars go out the door

01:15 - 34.124 hopefully in march or April so we are well underway.

01:15 - 36.590 We you know again because of the budget impasse

01:15 - 38.884 we didn't have a lot of time to get this done

01:15 - 43.240 so my team has really been scrambling to get these dollars out as quickly as possible

01:15 - 44.704 we know they're needed on the ground

01:15 - 46.414 and we're very confident

01:15 - 48.274 that if we are able to

01:15 - 51.244 add to that twenty five million in this

01:15 - 54.994 upcoming year and have a total of thirty five million dollars available

01:15 - 58.354 that that will be extremely well received by

01:15 - 00.164 these childcare providers.

01:16 - 04.694 So it sounds like it would be fair to say I can't really tell.

01:16 - 07.384 The success rate of really recruiting

01:16 - 10.294 and retaining the workers and the specific

01:16 - 11.074 workforce

01:16 - 15.784 just because we're still driving the dollars out there that's correct yes because we

01:16 - 18.274 just have that very limited time frame and

01:16 - 18.754 the

01:16 - 21.134 from when the budget actually passed.

01:16 - 23.854 So we'll have more information once we

01:16 - 26.204 actually start to get the money out the door.

01:16 - 27.334 Not at

01:16 - 29.104 all I'm grateful that

01:16 - 32.650 our child care provider is working to take advantage

01:16 - 35.494 of this program for her workers and those who care for

01:16 - 36.334 my daughter

01:16 - 38.054 to be children.

01:16 - 43.520 To talk about a little bit more he mentioned about how we've lost some of our

01:16 - 46.334 childhood providers and how they're trying to

01:16 - 48.224 recover from here.

01:16 - 53.374 I know that it has been has been really difficult for many of them

01:16 - 55.304 I am just wondering.

01:16 - 55.927 What I

01:16 - 59.554 hear says that there have been more than two twenty two hundred

01:16 - 03.214 care programs that oppose and twenty nineteen and I'm sure many of

01:17 - 04.294 you

01:17 - 04.834 with the

01:17 - 05.584 time

01:17 - 07.264 and

01:17 - 08.744 or the employment rate

01:17 - 09.388 followed by

01:17 - 13.294 ball by about forty percents I'm just wondering are there

01:17 - 14.414 other ways that

01:17 - 19.534 dhs is doing to help reverse this trend the recruitment and retention graph

01:17 - 20.914 yeah definitely

01:17 - 24.454 so I will say we have seen kind of an interesting trend

01:17 - 25.384 in that

01:17 - 28.900 it is absolutely correct that the number of licensed

01:17 - 31.954 providers his down post pandemic from pre pandemic

01:17 - 34.924 but the ones that are licensed are

01:17 - 36.764 offering more capacity

01:17 - 42.004 so we are seeing signs that they are able to actually expand the programs that they

01:17 - 44.554 that they do have so that's terrific news.

01:17 - 48.124 I did mention one of the things that we're really excited about

01:17 - 53.404 are these eight eighty six startup and expansion grants that we were able to put out

01:17 - 54.394 I am

01:17 - 59.620 very sad to say that this was another thing we we had planned around two of these

01:17 - 01.671 startup and expansion grants but unfortunately

01:18 - 03.904 because of the budget impasse we were not

01:18 - 08.084 able to get that done in time to meet a federal.

01:18 - 09.064 Deadline

01:18 - 10.354 but nonetheless

01:18 - 12.514 we did get eighty six of them out there

01:18 - 16.964 and we are currently in the midst of a statewide needs assessment

01:18 - 20.314 we are partnering with penn state Harrisburg to conduct that

01:18 - 21.784 and it will be

01:18 - 24.214 looking to map everything from

01:18 - 27.064 where we have child care deserts across the state

01:18 - 30.054 which is obviously extremely important for many of our rural communities

01:18 - 33.244 as well as other staffing and training needs

01:18 - 36.754 we continue to support our child care providers

01:18 - 37.934 with.

01:18 - 41.074 A rap rapid response teams

01:18 - 45.524 when childcare providers have particularly challenging situations

01:18 - 48.544 in their classrooms we have folks that they can call

01:18 - 51.602 who can bring long term expertise to bear to give

01:18 - 54.514 them ideas on how to manage certain situations

01:18 - 56.164 so we're really just trying to

01:18 - 59.032 put everything we can in place to support these

01:18 - 01.844 providers and enable them to be successful.

01:19 - 05.534 Wonderful thank you so much doctor.

01:19 - 09.814 Levi been told off about my mind so I laugh and you'll

01:19 - 10.864 be here

01:19 - 12.074 thank you.

01:19 - 13.484 Thank you senator

01:19 - 17.264 up next we've sen brown followed by senator kovar.

01:19 - 21.614 Thank you mr chairman thank you both for being here this morning.

01:19 - 26.944 Dhs is one of the largest sectors of our state budget as we know

01:19 - 32.044 and the vast amount of what you cover is quite amazing

01:19 - 35.044 and even the knowledge base that you have as wonderful

01:19 - 37.144 as we ask our questions so thank you

01:19 - 38.564 and.

01:19 - 40.924 I've asked many agencies already this

01:19 - 42.727 in just the second day and I continue to

01:19 - 45.644 want to ask this question as we move forward.

01:19 - 49.244 As legislators but especially even the public.

01:19 - 51.974 What could you tell us today.

01:19 - 54.184 There's a lot out of your control

01:19 - 56.474 there's a strong cost to carry

01:19 - 57.364 about what

01:19 - 00.164 is in your control to initiatives

01:20 - 02.414 that you have done specifically

01:20 - 05.144 that have been cost cutting measures

01:20 - 07.294 and then also one initiative

01:20 - 08.014 that you're

01:20 - 09.374 putting in play

01:20 - 12.274 this year that is a cost cutting cutting measure

01:20 - 13.664 as well thank you.

01:20 - 17.354 Can I beg your indulgence and give you more than two.

01:20 - 20.014 I would love that

01:20 - 21.394 I have as long as

01:20 - 23.044 you know endless and I think

01:20 - 25.947 you know for for us and for the amount that we

01:20 - 28.354 deal with and also what the public wants to hear

01:20 - 31.414 is clear and concise as you can be now I don't mean to be

01:20 - 33.104 cute and annoying.

01:20 - 34.484 Serious wonderful

01:20 - 37.600 so let me just run through a couple of things that I think have been extremely

01:20 - 40.054 important for us and that my team has been focusing on

01:20 - 44.584 so one of the things that doesn't get a lot of attention and you do have again

01:20 - 46.594 at your desks you have a

01:20 - 49.124 little chart about how we.

01:20 - 54.100 Put together our managed care capitation rates and one of the things that as in there

01:20 - 59.254 is something called we call efficiency adjustments and efficiency adjustments

01:20 - 01.684 are the the term that we use

01:21 - 05.164 to hold our em CEOs accountable for the fact that

01:21 - 07.444 we expect them to manage care

01:21 - 08.176 and

01:21 - 12.694 provide that care in the most efficient way possible and so every year

01:21 - 13.844 we look

01:21 - 15.080 efficient

01:21 - 17.480 they were in terms of things like

01:21 - 19.530 pharmaceutical services.

01:21 - 22.170 Emergency room visits that would not have been

01:21 - 24.890 necessary if that patient had been managed differently

01:21 - 27.870 and we literally pull money out.

01:21 - 29.280 From the

01:21 - 31.220 that capitation calculation

01:21 - 32.720 acknowledging that

01:21 - 34.340 so for calendar year

01:21 - 36.140 these contracts are in calendar years

01:21 - 38.270 so for calendar year twenty six

01:21 - 43.590 we pull the efficiency adjustment exceeded three hundred and fifty million dollars.

01:21 - 47.360 One hundred and thirteen million of which were state dollars

01:21 - 51.900 across physical health behavioral health and community health choices

01:21 - 53.662 and just to give you a sense one hundred and

01:21 - 56.450 forty nine million none of that was pharmacy costs

01:21 - 00.800 and twenty nine point seven million was emergency visits that we felt

01:22 - 01.940 could have been avoided

01:22 - 03.240 so that's one

01:22 - 06.930 I mentioned earlier the pharmacy changes that we made.

01:22 - 09.210 Four twenty five twenty six

01:22 - 11.000 the savings from

01:22 - 14.291 not only job he wants with some other pharmacy changes we

01:22 - 17.850 made allow biosimilars and some other steps that we took.

01:22 - 22.020 Is the savings of three hundred and forty eight million dollars total.

01:22 - 25.280 Two hundred and sixty six point six eight of that estate

01:22 - 29.280 from where we would have been had we not made those changes

01:22 - 33.290 and I mentioned also earlier of your bureau of program integrity

01:22 - 33.890 has

01:22 - 37.640 totaled four hundred eighty six million dollars in costs recoveries and avoidance is

01:22 - 39.716 for the twenty four twenty five budget year

01:22 - 42.170 that's obviously the most recent year that we have

01:22 - 44.640 so that's on this sort of the.

01:22 - 47.240 You know really cost management side I

01:22 - 53.186 want to highlight very quickly to programs to help people one that we're very happy

01:22 - 56.550 about is in our adult protective so services area.

01:22 - 58.700 Working with the department of aging

01:22 - 02.303 we were able to obtain a Grant to hire two case

01:23 - 06.680 managers to oversee complex unresolved expensive

01:23 - 11.790 cases in in the adult protective services area so those are folks.

01:23 - 13.914 Nineteen to sixty four before or nineteen to

01:23 - 17.670 sixty I think it is before dia de away kicks in

01:23 - 18.870 and out

01:23 - 22.106 we we notice there were these open cases they weren't being

01:23 - 24.860 resolved so we brought people in specifically for that

01:23 - 27.920 within four months the monthly management fee

01:23 - 30.317 which is related to the number of open cases dropped

01:23 - 33.420 by three hundred and fifty five thousand dollars

01:23 - 35.570 and then another program that I I am

01:23 - 40.526 very excited about is a program in our office of developmental programs that focuses

01:23 - 43.680 on individuals with intellectual disabilities and autism

01:23 - 45.110 so as you know

01:23 - 49.137 many of these individuals are not verbal or minimally

01:23 - 52.160 verbal they express their concerns in different ways

01:23 - 56.306 and it's very difficult when a provider who's not famille we're with them needs to

01:23 - 58.168 interact with them particularly in an emergency

01:23 - 01.880 department or other setting that is not conducive to

01:24 - 03.300 a calm

01:24 - 05.610 sort of therapeutic environment

01:24 - 08.990 and so deputy secretary errands and her team

01:24 - 13.700 put into place a service that allows.

01:24 - 18.230 A telehealth console on-demand twenty four seven

01:24 - 20.610 with a physician specialized.

01:24 - 21.380 In

01:24 - 23.270 With specialized training in

01:24 - 25.430 working with patients with ID a

01:24 - 27.290 this can be initiated by

01:24 - 30.080 the family or caregiver from home

01:24 - 31.910 and that's really kind of the goal here

01:24 - 33.740 to help them decide

01:24 - 35.690 does my family member

01:24 - 38.240 need to go to the emergency department or not

01:24 - 41.360 and and the good news is that census service began

01:24 - 43.250 nearly five thousand

01:24 - 43.730 fifty

01:24 - 46.370 five thousand five hundred individuals have received

01:24 - 49.430 eight thousand nine hundred and forty three telehealth visits

01:24 - 52.410 ninety four percent of those individuals will be

01:24 - 55.340 eight were able to be treated in place in their home

01:24 - 56.720 but have to leave

01:24 - 57.710 and

01:24 - 01.340 to date we believe we have avoided over seven thousand

01:25 - 05.990 emergency department or urgent care visits so that is

01:25 - 07.190 a size able in terms of

01:25 - 09.630 so those are the types of things that we've been working on

01:25 - 11.960 great thank you very much for a few of those and

01:25 - 13.663 as we go on throughout the day might have a little

01:25 - 16.890 bit more every day Mark thank you so much thank you.

01:25 - 18.920 Of coville followed by

01:25 - 20.610 Sandra Robinson

01:25 - 23.300 thank you mr chairman and thank you secretary

01:25 - 24.740 being here with your team

01:25 - 27.690 a lot of things we're covering today.

01:25 - 31.130 I'm going to dive into the child care development fund

01:25 - 33.620 and Pennsylvania's latest federally

01:25 - 35.300 required improper payment

01:25 - 36.050 report

01:25 - 40.730 shows a twenty three percent case error rate and an improper payment rate

01:25 - 42.500 of about eleven percent

01:25 - 43.890 which roughly

01:25 - 47.160 equates to about seven point three million dollars.

01:25 - 49.287 What were the main drivers behind the missing

01:25 - 52.200 performance targets in this review cycle.

01:25 - 53.910 Yeah I'm actually going to s

01:25 - 55.790 deputy secretary brown to come up and

01:25 - 57.900 assist with that answer.

01:25 - 02.816 That was actually not I think our final numbers were more on the order of two percent

01:26 - 07.130 and and were very low and did not require corrective action plan but.

01:26 - 08.930 Deputy secretary brown can

01:26 - 11.780 yeah I have explained that reporter because I know it's a

01:26 - 12.800 but I think

01:26 - 15.074 overall total because some of it is broken

01:26 - 17.360 down I think the two per sent would have been

01:26 - 21.440 percent of total amount of payments for the sample that are improper payments

01:26 - 26.400 but the current cycle data sits at around twenty three point one nine percent.

01:26 - 28.380 So.

01:26 - 31.040 So our team actually

01:26 - 31.580 do

01:26 - 33.600 Is monitor by

01:26 - 38.340 goes through federal monitoring every three years and that federal monitoring

01:26 - 38.930 and

01:26 - 45.236 actually came out with only a two percent error rate so I'm not really sure what that

01:26 - 47.180 document that you're referring to is it

01:26 - 49.260 that you're referring to is.

01:26 - 50.580 Noted but

01:26 - 52.280 we did go through

01:26 - 55.280 the document as the state improper payments report

01:26 - 56.000 would

01:26 - 59.190 have come from your department I think to the federal government.

01:27 - 03.570 Yes but that.

01:27 - 05.570 When we went through the

01:27 - 06.140 the

01:27 - 08.480 reporting overall were actually

01:27 - 10.800 in the space and place where.

01:27 - 16.200 We receive a lot of great feedback from the feds around our

01:27 - 16.700 our

01:27 - 21.110 our reporting and when we do come in contact with a

01:27 - 25.670 provider that has some challenges we will refer that provider to owes it

01:27 - 27.093 to the office of

01:27 - 28.950 the state general

01:27 - 30.110 but we would not

01:27 - 31.460 necessarily

01:27 - 32.730 do.

01:27 - 38.880 Be in a place where the error rates are very concerning the last

01:27 - 39.920 well let me just

01:27 - 41.480 because I don't know that I'm

01:27 - 42.740 here to argue about what the

01:27 - 43.640 percentage was

01:27 - 47.395 ok I'm just telling you what I was told sure I guess the question I actually ask are

01:27 - 49.100 what were the main drivers behind

01:27 - 51.890 the missing performance targets and reviews cycle

01:27 - 54.290 because regardless of data I would assume

01:27 - 56.820 that information would be the same.

01:27 - 58.860 And we can if you want to

01:27 - 59.480 discuss.

01:28 - 01.170 Sounds like we might have

01:28 - 02.240 got some would you have it

01:28 - 06.770 or know I just I think it's it will be helpful to file what because we

01:28 - 11.100 we have consistently demonstrated strong performances with our.

01:28 - 14.000 Federal federal reviewed improper payment rates

01:28 - 18.830 so we have no history of a corrective action plan when it comes to

01:28 - 21.514 our error rates and our reporting so I think

01:28 - 24.110 I would just have to talk to the team about

01:28 - 25.700 what specifically

01:28 - 29.550 is referred to in that report I think I'm looking at the.

01:28 - 31.130 Not the dollar error rate

01:28 - 34.200 but the full case error rate.

01:28 - 36.913 Or the payment error rate not just that one

01:28 - 39.380 little area I'm looking at the whole picture

01:28 - 41.990 but again yes editor why don't we sync up with you after

01:28 - 44.996 I don't I don't think either one of us are exactly sure what you're looking at so

01:28 - 48.350 will absolutely we can sit down with you and and so yeah I think I was looking at

01:28 - 51.590 what were the main drivers behind the missing performance targets

01:28 - 54.950 and looking ahead how can we change that for the next cycle oh

01:28 - 57.980 sure I would have to get their feedback directly from our team

01:28 - 59.640 that's fine.

01:29 - 02.480 So I dunno the next question I have goes

01:29 - 03.260 with the

01:29 - 06.600 childcare inspection and enforcement reporting

01:29 - 10.706 of a department previously provided quarterly reports on child care inspections and

01:29 - 13.272 enforcement actions but those resp report stopped

01:29 - 15.860 being published in two thousand and twenty two

01:29 - 18.750 why were the quarterly reports discontinued.

01:29 - 19.689 I think

01:29 - 21.820 are the ones that got moved to a different yes yeah

01:29 - 23.178 there actually were

01:29 - 24.260 the

01:29 - 29.186 the childcare inspection so the inspections of every license provider in the

01:29 - 30.920 commonwealth is actually available

01:29 - 32.700 in our.

01:29 - 34.160 Online

01:29 - 35.460 in our system

01:29 - 36.690 and the

01:29 - 41.396 what you're referring to just move to a different space I think it's actually called

01:29 - 44.450 a different report so it is still publicly available

01:29 - 47.330 it's just not listed on the

01:29 - 49.070 I guess the data website

01:29 - 53.210 so it seems like those things are no longer being reported but that is not true

01:29 - 58.770 every license provider and all of their licensing information is available publicly.

01:29 - 01.050 For the duration of their license that's something

01:30 - 03.900 though that we could still report to the legislature.

01:30 - 08.276 Yes so that data is still available it's just it's just

01:30 - 10.910 listed in a different way and in a different report

01:30 - 15.330 I think we have received that feedback and we actually updated that information

01:30 - 17.600 so it it should be updated now

01:30 - 21.830 but I think there was just a lapse in the name and the type of report

01:30 - 22.610 okay

01:30 - 24.240 and.

01:30 - 26.540 I'm not sure who's answering this question

01:30 - 30.840 the governor has eliminated degree requirements for most state positions

01:30 - 36.128 why does the department still require degrees for certain programs specials roles and

01:30 - 39.740 and if providers can apply for a waiver why maintain a requirement

01:30 - 42.090 that often ends up being waived

01:30 - 45.380 and what would it take to remove that jury requirement or allow allow

01:30 - 48.169 commensurate experience as an alternative qualification

01:30 - 50.150 now I think that's a very good question I think

01:30 - 51.686 we're always trying to work with our childcare

01:30 - 54.930 providers to make sure that they can hire as.

01:30 - 57.575 The most appropriate and and as many staff

01:30 - 01.200 as they are need and want to be able to hire.

01:31 - 04.860 You know i.

01:31 - 05.910 Our early learning

01:31 - 06.260 for

01:31 - 09.020 childcare providers are highly skilled

01:31 - 12.270 very well educated many of them have masters degrees

01:31 - 14.750 and those degrees are very very important

01:31 - 15.500 and

01:31 - 16.760 this is not

01:31 - 17.630 babysitting

01:31 - 19.200 this is

01:31 - 19.880 early

01:31 - 21.230 childhood education

01:31 - 22.910 and we know all the data

01:31 - 24.170 center you know the data

01:31 - 25.470 that.

01:31 - 27.158 From early childhood education

01:31 - 29.963 really correlates with school readiness and then

01:31 - 32.738 school completion and then jobs success down the road

01:31 - 34.178 and so I think that

01:31 - 37.624 it is our way of acknowledging the importance of this

01:31 - 41.448 workforce the importance of these highly educated workers

01:31 - 44.618 and where necessary if a provider wants to

01:31 - 47.168 apply for a wage ever have some of these requirements

01:31 - 48.908 were willing to Grant that waiver

01:31 - 50.148 but.

01:31 - 55.278 At least for now and this is obviously always something that we can discuss but

01:31 - 56.978 our goal has been

01:31 - 01.148 to treat these professionals with the professionalism that they deserve

01:32 - 03.968 and this workforce has not always been treated that way

01:32 - 06.368 and I think that has contributed to some one of the

01:32 - 08.738 challenges in hiring for this workforce

01:32 - 09.608 and so

01:32 - 11.588 from where we sit I think it's

01:32 - 13.748 incumbent that these workers know

01:32 - 17.618 how much we respect them and and the educational levels that they've attained

01:32 - 20.598 but we're always willing to work with a provider

01:32 - 24.158 to make sure that they can get their team properly staffed

01:32 - 27.278 okay thank you I think this merits further conversation with you

01:32 - 28.578 because I've had some.

01:32 - 30.818 Concerns from child care providers

01:32 - 32.128 so thank you for your time

01:32 - 33.768 thank you mr chairman.

01:32 - 35.028 Thank you.

01:32 - 36.309 Thank you

01:32 - 37.668 just to go back

01:32 - 38.198 to

01:32 - 41.048 Her opening question so that that's actually based on

01:32 - 42.318 this report that

01:32 - 47.088 you guys sent me and senator Brooks in response to our letter about the subject.

01:32 - 50.468 No I just had the name of it here

01:32 - 54.288 it was an attachment to the look the responses that were given.

01:32 - 57.847 It marks for the current cycle data the percentage

01:32 - 00.848 of cases with an error twenty three point one nine

01:33 - 04.598 percentage of cases with an improper payment ten point eight seven

01:33 - 07.235 and in the percentage of total amount of payments

01:33 - 09.338 for the sample that are improper payments

01:33 - 12.168 two point two six per cent.

01:33 - 14.018 I don't have that

01:33 - 16.218 report in family center I'm sorry.

01:33 - 20.240 Will definitely have to follow up with you on that but we'd be happy to do that I

01:33 - 23.241 just wanted you guys to indicate that's what you got.

01:33 - 25.368 Yeah we'll get a little get.

01:33 - 27.228 Yup.

01:33 - 30.438 And if we can talk about maybe in the afternoon

01:33 - 30.818 that'd be

01:33 - 32.088 very good.

01:33 - 35.924 Next we have senator Robinson followed by sen per cozy.

01:33 - 39.578 Thank you mr chairman thank you madam secretary

01:33 - 40.728 nice to see you again

01:33 - 42.138 and.

01:33 - 42.938 The

01:33 - 48.308 proposed budget projects that as of July first two thousand and twenty six

01:33 - 52.598 four hundred and ten people will be living at Pennsylvania's remaining two

01:33 - 54.848 state centers at

01:33 - 56.558 a purse a person

01:33 - 58.298 per person the annual cost

01:33 - 59.498 of nearly

01:33 - 02.538 six hundred and sixteen thousand dollars.

01:34 - 06.518 However the projected bed capacity for those states centers

01:34 - 09.618 is eight hundred and seventy five.

01:34 - 12.938 Which means less than fifty percent of the beds will be filled

01:34 - 17.108 and the projected budget calls for an increase of sixteen points point

01:34 - 17.558 eight

01:34 - 18.458 million

01:34 - 20.718 for those two states centers.

01:34 - 24.408 Can you explain why the two state centers will be.

01:34 - 26.498 Allocated more than sixteen million

01:34 - 28.728 while their bed capacity

01:34 - 31.098 is dropping below fifty percent.

01:34 - 34.478 Let's enter as I'm sure you're you're very aware

01:34 - 38.618 that department over these years has closed the number of state centers

01:34 - 40.968 and these are the two remaining

01:34 - 42.168 and.

01:34 - 42.788 Where

01:34 - 44.858 they are certainly not staffed

01:34 - 46.298 for that number of beds

01:34 - 49.328 obviously they are staffed to meet the needs of the

01:34 - 52.728 number of individuals who are in those states centers.

01:34 - 53.498 The

01:34 - 54.618 average.

01:34 - 59.564 Length of stay for many of the individuals that are currently in our state centers is

01:34 - 04.568 on the order of thirty plus years these are individuals who in many cases

01:35 - 05.798 have spent their entire

01:35 - 08.228 lives or a good portion of their lives

01:35 - 10.578 in our state centers.

01:35 - 12.248 We as you know now

01:35 - 18.788 our our program today is entirely oriented at enabling people to stay in the community

01:35 - 22.778 and we have done that very successfully as evidenced by the fact that

01:35 - 24.308 there's very few people

01:35 - 26.688 in our state centers currently

01:35 - 30.638 to make changes in those state centers is

01:35 - 31.788 a

01:35 - 36.668 Process that requires a lot of stakeholder and community engagement

01:35 - 39.607 when I first got here in two thousand and twenty three

01:35 - 43.008 we were on the tail end of polk and whitehaven clothing

01:35 - 44.138 and

01:35 - 49.088 boy that was a really difficult situation in a whoville righty of ways and so.

01:35 - 55.724 As we consolidated folks from that centre to one of these two locations those that

01:35 - 58.518 wanted to continue in a residential setting.

01:35 - 01.338 It was a very major undertaking.

01:36 - 04.375 At this juncture and of course obviously this is

01:36 - 06.998 always something that we can talk about with you

01:36 - 12.344 next steps for our two centers but at this juncture there's no plans to close either

01:36 - 17.358 of those centers there are families involved there are local community

01:36 - 20.868 stakeholders involved it's rough really quite.

01:36 - 22.398 Complicated.

01:36 - 25.653 So but again if that is the conversation that you're

01:36 - 28.388 interested in having we'd be happy to discuss that we were

01:36 - 30.158 just wondering where the money

01:36 - 31.208 is

01:36 - 33.078 Budgeted for.

01:36 - 34.538 I would imagine

01:36 - 35.898 applications.

01:36 - 38.738 Yeah awesome I want to make sure we're

01:36 - 42.248 clear of twenty five twenty six available is one hundred and eight million

01:36 - 46.448 for state ID centers up to one hundred and ten million and twenty six twenty seven

01:36 - 49.088 so that's an increase of one point nine million

01:36 - 49.928 and

01:36 - 52.961 that change is largely staffing changes and benefits

01:36 - 56.288 other salary changes heating fuel medical drugs fuel

01:36 - 57.968 costs attracted staffing

01:36 - 00.008 costs it's it's largely just

01:37 - 04.038 the folks who are running the facility to keep individuals safe.

01:37 - 06.408 Okay.

01:37 - 06.938 I.

01:37 - 09.108 Appreciate it.

01:37 - 16.214 Your proposed budget calls for an increase in state funds of seventy six point eight

01:37 - 20.108 million for the office of developmental programs community waiver

01:37 - 21.348 program.

01:37 - 27.374 Odp is proposing to allocate thirty million dollars to serve an additional four

01:37 - 30.188 hundred individuals with a consolidated waiver

01:37 - 34.328 and an additional eight hundred and fifty individuals with a community

01:37 - 35.868 living waiver.

01:37 - 39.608 According to dp as of November two thousand and twenty five

01:37 - 41.088 there were

01:37 - 45.048 seven thousand two hundred and three adults on the waiting list

01:37 - 46.398 and

01:37 - 49.808 if the thirty million dollars as part of the

01:37 - 52.328 seventy six point eight million

01:37 - 55.688 what will the remaining forty six point eight

01:37 - 58.068 million be allocated for.

01:38 - 05.438 If you have a copy of the dhs blue book

01:38 - 09.848 the explanation of changes in the state ID waiver or preparation are laid out but

01:38 - 14.504 we really have changes in the utilization of services to how many people are taking

01:38 - 17.888 advantage of which services that is a part of the increase

01:38 - 18.878 you have have

01:38 - 22.598 annualisation of rates adjustments that have been made in the prior year

01:38 - 26.318 you have already I cf base transitions that are occurring

01:38 - 28.818 changes in f map is a number of things but they

01:38 - 31.938 are all laid out in the explanation of changes.

01:38 - 32.768 I

01:38 - 34.238 Thank you I appreciated

01:38 - 37.583 changing gears a little bit too abt security

01:38 - 39.548 and your

01:38 - 42.548 during your budget presentation the stakeholders you mentioned

01:38 - 43.998 adding.

01:38 - 46.658 Security features to protect a b d

01:38 - 48.948 e b t cards

01:38 - 50.318 could you provide us

01:38 - 52.668 more details on this because.

01:38 - 57.978 I know my district office you know we're still receiving calls from constituents

01:38 - 59.178 who have had their

01:38 - 00.318 benefits stolen

01:39 - 00.968 yeah

01:39 - 03.128 yeah this has been such a frustrating thing

01:39 - 04.328 so

01:39 - 07.401 As you know more than one point eight million Pennsylvania

01:39 - 09.078 receive snap benefits

01:39 - 10.368 every month

01:39 - 11.418 and

01:39 - 17.148 we have had had a significant issues over the years with theft of those benefits

01:39 - 22.958 we currently have cards that have only a magnetic stripe on the back

01:39 - 25.668 and given that constraint

01:39 - 26.528 and

01:39 - 30.348 those cards are prone to these skimmers

01:39 - 34.244 so we are all very aware and I mean every one of you has had folks in your districts

01:39 - 35.648 that have had this happen to them

01:39 - 39.188 so we have taken a number of steps and

01:39 - 41.468 including educating our

01:39 - 44.185 grocers and retailers who participate in this program

01:39 - 46.688 we asked them to literally check their point of sale

01:39 - 49.139 machines every day for skimmers they they are

01:39 - 51.308 actually quite subtle when they're on there

01:39 - 52.508 and

01:39 - 58.208 veg very importantly we have given participants the ability to lock their card

01:39 - 00.938 so we have an app

01:40 - 01.418 that

01:40 - 04.388 most people ours seem pretty comfortable using

01:40 - 07.178 and we encourage all snap recipients to lock

01:40 - 09.878 their card unless they are actually using it

01:40 - 11.408 and they can literally

01:40 - 14.128 unlock it while they're standing in line at the girl esri store

01:40 - 14.768 pay

01:40 - 16.148 and then lock it again

01:40 - 18.428 and so that prevents any

01:40 - 19.728 items.

01:40 - 21.668 Theft of benefits

01:40 - 24.258 even if their card would be skimmed.

01:40 - 28.688 If their card is locked then the thief cannot

01:40 - 30.488 access those benefits

01:40 - 35.258 and recipients also have the option to turn off the ability to use their

01:40 - 36.668 benefit out of state

01:40 - 37.358 now

01:40 - 39.608 people are allowed to order food

01:40 - 42.908 and so some people want to be able to order like

01:40 - 44.828 from a delivery service that type of thing

01:40 - 48.638 by but otherwise they can turn it off for that as well so there's a

01:40 - 51.788 we've given tools to our recipients to do that

01:40 - 52.778 the

01:40 - 57.398 next step that we have been exploring together is to consider whether or not

01:40 - 59.198 we should move to a chipped

01:40 - 59.888 card

01:41 - 04.628 and there are currently three states that are working on this

01:41 - 10.274 it has it's been a very really frustratingly slow roll out in these states they have

01:41 - 12.968 run into a number of technical difficulties there are only

01:41 - 14.658 two vendors

01:41 - 16.538 there are federally procured

01:41 - 20.588 that we can choose from to actually run these cards so

01:41 - 21.738 there's two people

01:41 - 23.119 and.

01:41 - 25.178 It's been there's been a lot of challenges

01:41 - 26.768 that keeping a close eye on it

01:41 - 31.334 and we are hopeful that we might be able to move toward a chip card down the road

01:41 - 34.028 again with your support because there is a cost to it

01:41 - 36.308 one of the really sad thing

01:41 - 37.608 is that

01:41 - 38.928 previously

01:41 - 42.314 the federal government would have paid fifty percent of the cost to move to these

01:41 - 45.728 cards and now because of this seventy five percent admit

01:41 - 47.312 shift.

01:41 - 50.896 We would have to pay seventy five percent of the cost and the federal government

01:41 - 52.240 would only pay twenty five percent

01:41 - 55.120 but I think it was about a seventeen million dollar total cost

01:41 - 57.830 so that'll be a decision that we have to make.

01:41 - 00.117 If you want in terms of moving forward in that

01:42 - 03.160 direction was a seventy million dollar total costs to

01:42 - 05.480 update the cards what.

01:42 - 07.240 How much have we last so far

01:42 - 07.930 ff

01:42 - 08.620 Well

01:42 - 12.760 as you probably remember during covert and for a couple of years past covered

01:42 - 15.160 we were able to reimburse people's benefits

01:42 - 17.440 and so we actually would get

01:42 - 19.600 claims of theft and then we would

01:42 - 20.980 as best we could

01:42 - 22.270 validate those

01:42 - 24.627 claims and make sure they weren't duplicated

01:42 - 27.130 etc before we actually repaid someone benefits

01:42 - 29.590 the federal government stopped for that program

01:42 - 31.540 and so now we don't

01:42 - 32.810 actually.

01:42 - 34.720 Keep track really

01:42 - 38.330 because we can't we don't have the bandwidth to then.

01:42 - 42.250 Ensure that those claims are all valid claims so we've kind of stopped tracking

01:42 - 46.690 I will tell you though that oh sig has been an incredible partner in this work

01:42 - 50.980 this is another set of information that we refer to them regularly

01:42 - 54.130 and they have been going hard against some of these death

01:42 - 57.235 and they have busted and there was one ring in

01:42 - 00.220 particular it was a multi-state rang that they helped

01:43 - 00.820 best

01:43 - 02.927 so they're on it and we are sharing information

01:43 - 05.897 with them all the time when we get it.

01:43 - 07.820 That's good to know.

01:43 - 09.080 I see the

01:43 - 10.640 way over time.

01:43 - 14.754 I do appreciate your testimony so thank you thank you

01:43 - 18.740 was the German baker center and the close out from one side of the cozy.

01:43 - 20.630 Thank you mr chairman

01:43 - 22.540 secretary thank you for coming to you today

01:43 - 23.410 for all the

01:43 - 24.250 materials are

01:43 - 27.850 here for us as well specifically for our districts is incredibly helpful to all of us

01:43 - 29.540 thank you very much.

01:43 - 32.480 I wanted to start by talking about the child line initiative

01:43 - 36.706 and your general government operations appropriation there's a six hundred and fifty

01:43 - 38.650 eight thousand for an initiative to provide

01:43 - 41.800 child line enhancements which includes twenty new positions

01:43 - 44.411 accused when the details of this proposal to the committee

01:43 - 45.520 short be happy to.

01:43 - 51.130 Childline is our twenty four seven reporting line for

01:43 - 53.080 suspicion of child abuse

01:43 - 57.400 and this is a group of incredible workers again

01:43 - 58.780 they work twenty four seven

01:43 - 59.680 they.

01:43 - 00.326 I

01:44 - 05.650 Have to intake information on a lot of really difficult

01:44 - 06.220 and

01:44 - 07.970 horrible situations

01:44 - 09.260 and then

01:44 - 10.120 decide

01:44 - 12.260 where to go next with that information.

01:44 - 16.107 As you may be aware we have been taking lots of

01:44 - 19.490 discussion and input from folks around the commonwealth

01:44 - 24.550 about about how we can continue to improve our office of child welfare

01:44 - 28.000 very much with the goal of keeping kids safe across the commonwealth

01:44 - 30.394 and one of the things that came out of those

01:44 - 34.070 conversations was the opportunity to enhance child line

01:44 - 37.960 to improve some of the training that that those workers get

01:44 - 39.430 make sure that those.

01:44 - 42.010 Positions are fully staffed

01:44 - 45.790 so those child line workers can actually spend a little bit more time

01:44 - 47.350 with these reports

01:44 - 48.920 and be.

01:44 - 53.740 Very thoughtful about where those reports get triaged in terms of next steps

01:44 - 54.700 and so

01:44 - 58.690 we're very very hopeful that this is an initiative that you will support

01:44 - 01.300 I think this will go along long way to

01:45 - 04.390 improving the training and the staffing

01:45 - 05.920 for this group of people

01:45 - 09.670 and again will then have the the downstream impact

01:45 - 15.160 of hopefully reducing some of the work that our county children news agency see

01:45 - 18.070 because there would be a better tree aage

01:45 - 21.190 at the state level before a law all of that work just

01:45 - 21.790 kind of

01:45 - 24.350 routinely gets passed down.

01:45 - 26.961 That was actually going to be my next question

01:45 - 28.576 can you talk a little bit more about some of the

01:45 - 31.180 cost savings or potential cost savings at the county level

01:45 - 31.720 yeah

01:45 - 36.400 so as as you know our counties are absolutely essential partners in this work

01:45 - 38.110 we are a

01:45 - 42.730 county administered state supervised child welfare system and so

01:45 - 45.430 we are in constant communication with our cat counties

01:45 - 49.210 and they all go through a needs based budget process

01:45 - 54.076 to work with us with the state for a lot of the funding in this space and then the

01:45 - 57.340 counties of course have some funding as well that they put to this.

01:45 - 00.400 I think the really important opportunity here

01:46 - 03.430 is that as we've talked about in prior hearings

01:46 - 06.610 many of our county children and used agencies are

01:46 - 08.500 understaffed since coven

01:46 - 12.766 this was a group of workers that had to go into homes during coven before people had

01:46 - 16.930 p p e and it was really a stressful time for them they were very much an

01:46 - 19.030 unsung heroes in this work

01:46 - 20.390 during covert

01:46 - 24.370 and they've never really recovered staffing and many of our counties

01:46 - 25.910 and so.

01:46 - 29.390 Anything that we can do to reduce appropriately

01:46 - 32.403 the volume of cases that don't actually need

01:46 - 36.020 to be handled at that level of the county.

01:46 - 38.600 Would be helpful to our counties

01:46 - 41.120 and their staffing needs and requirements

01:46 - 41.860 are said thank you

01:46 - 44.419 you're changing gears a little bit the office of children

01:46 - 46.840 youth and families preview easily committed to a rage study

01:46 - 49.613 to understand the gap in child welfare state approve

01:46 - 52.030 rates in the actual routes counties are paying providers

01:46 - 53.834 especially in light of the financial challenges

01:46 - 55.870 that providers in the system are presently facing

01:46 - 57.908 can you provide an update on how that study

01:46 - 59.800 is progressing and where is it in the process

01:47 - 00.520 yeah.

01:47 - 03.249 I don't have that at my fingertips I asked deputy

01:47 - 06.682 secretary the Von Miller wasn't as he does does.

01:47 - 14.421 Border.

01:47 - 15.800 It was

01:47 - 17.030 was.

01:47 - 19.880 Buyers.

01:47 - 24.020 We're in the process.

01:47 - 26.920 Pcc wireless

01:47 - 28.040 providers.

01:47 - 30.380 About.

01:47 - 34.700 Thank you for the update.

01:47 - 36.844 Changing gears a little bit more in the recent

01:47 - 39.190 past Pennsylvania with behavioral health challenges

01:47 - 41.015 and intellectual disabilities have been accommodated

01:47 - 43.460 with door to door transportation services

01:47 - 45.830 to make appointments and receive treatment.

01:47 - 48.084 Recent changes have led to widespread service problems

01:47 - 50.910 ranging from ms pickups and miscommunication to drop offs of

01:47 - 52.700 entire merely wrong locations

01:47 - 54.770 what can be done to correct some of these problems

01:47 - 56.120 yeah.

01:47 - 58.022 So I think our our.

01:47 - 02.596 Medical transport system or or non emergent medical transport system has been a

01:48 - 05.440 challenging situation in the commonwealth for many many years

01:48 - 09.940 and we are continuing to work with providers to improve this system

01:48 - 14.290 and again this is a system that is county administered

01:48 - 17.000 so it is our counties that.

01:48 - 22.300 Put out a request for proposals and ultimately decide who to contract with

01:48 - 26.470 we are always happy to be a resource for those counties to help

01:48 - 29.890 share ideas for how that work could be done better

01:48 - 30.670 but

01:48 - 32.050 again is something that

01:48 - 34.060 is at the county level currently

01:48 - 36.427 it's probably pretty important to stay at the county

01:48 - 38.890 level given the size and complex the city of this state

01:48 - 42.470 but we are always here as a resource in that work.

01:48 - 43.966 Are still well thank you very much moms

01:48 - 45.650 thank you thank you.

01:48 - 47.650 Meme secretarial on

01:48 - 50.830 his line of questioning related to the child line in a tree dodging

01:48 - 51.250 yeah

01:48 - 52.120 in terms of

01:48 - 54.670 how would you define the triaging would they

01:48 - 57.820 the the the these child line workers also be tests

01:48 - 02.620 with some investigations and under the same reporting requirements and deadlines

01:49 - 03.830 or is this more to

01:49 - 05.420 sift through

01:49 - 08.278 and more detail any investigations will still

01:49 - 10.390 be at the county level could you explain

01:49 - 12.040 it would be the latter mr chairman

01:49 - 12.580 right

01:49 - 16.480 actually doing a better job of sifting I think is a great way of thinking about it

01:49 - 17.230 and

01:49 - 19.850 like one way to think about this is that.

01:49 - 21.340 We have children

01:49 - 23.830 like let's say we have two children who are both hungry

01:49 - 27.520 and one of those children they're fat family just needs some food

01:49 - 29.630 you know they're low income.

01:49 - 31.360 Maybe they lost their snap whatever

01:49 - 34.210 that is a child who could actually be referred

01:49 - 34.990 to

01:49 - 37.826 A county human resources department or community

01:49 - 40.360 based organization in that community to help

01:49 - 45.520 versus a child whose family was purposely withholding food from that child

01:49 - 47.020 that his child abuse

01:49 - 49.545 and that is something that we want to make sure

01:49 - 52.330 the county children and youth agency can focus on

01:49 - 55.216 rather than having to do the work of like finding the

01:49 - 58.240 community based pantry to get this other family some food

01:49 - 01.480 we think there could be a bifurcation of some of that work potentially

01:50 - 01.960 okay

01:50 - 03.530 thank you very much for that

01:50 - 05.090 you have something to determine.

01:50 - 06.130 Real quick thank you

01:50 - 07.670 mister German.

01:50 - 12.430 Madam secretary what relief is provided to the child mine workers you mentioned

01:50 - 13.820 how.

01:50 - 15.410 How intense

01:50 - 16.870 this work is

01:50 - 18.940 in taking all this

01:50 - 20.690 kind of information

01:50 - 23.080 how do we help them just manage that

01:50 - 24.500 they help with ray

01:50 - 27.850 yeah it's a lot I mean I think anyone who's familiar with this area

01:50 - 29.500 now knows how deeply

01:50 - 31.780 difficult some of this information is

01:50 - 34.000 so I think there's a couple of things one

01:50 - 34.840 and

01:50 - 39.556 deputy secretary Miller Wilson and his team have done a great job in recruiting we

01:50 - 42.490 are actually now down to pretty low vacancy rate

01:50 - 45.898 on that team which is fantastic but we went through a

01:50 - 48.940 very prolonged period of mandatory overtime time and

01:50 - 53.840 other things that were really difficult for these folks as you can understand

01:50 - 54.400 so

01:50 - 57.650 Making sure that we can maintain this staffing

01:50 - 59.000 and then.

01:50 - 00.470 Giving these

01:51 - 03.970 workers by having a few more staff on every shift

01:51 - 06.130 a little more breathing space

01:51 - 07.120 to

01:51 - 08.800 Process what they've heard

01:51 - 13.893 make sure that they are trashing it to law enforcement to the county to

01:51 - 16.965 wherever the most appropriate places we want to

01:51 - 19.750 enhance their professional development again and

01:51 - 22.161 we want to invest in them as a sign of how

01:51 - 25.060 important and professional we know their jobs are

01:51 - 30.992 it is I think that whole package it's a message of support to these workers and and

01:51 - 34.306 we're hopeful that you will support it I think that this is an area where we can make

01:51 - 38.690 some real improvements in our child welfare system just processing

01:51 - 40.850 what there must be be like.

01:51 - 45.550 Calls and information on a daily basis and in trying to

01:51 - 47.030 manage that

01:51 - 48.200 internally

01:51 - 50.560 and then figure out how to get the best help

01:51 - 53.860 to the right places and the right services to read places

01:51 - 55.340 that that

01:51 - 56.660 you know that we

01:51 - 00.010 you and I've always talked about for years healing the healers right

01:52 - 01.550 how do we make sure to

01:52 - 05.602 add those kinds of services to make sure these folks are taken care of.

01:52 - 08.302 Cause that's gotta be.

01:52 - 09.932 Real rough stuff

01:52 - 11.212 so thank you for that

01:52 - 12.422 I think

01:52 - 14.462 and he's grabbing.

01:52 - 16.732 I know that

01:52 - 19.022 thank you for acknowledging the workforce

01:52 - 20.242 they are a bit of

01:52 - 21.832 the analogy I'd make

01:52 - 25.132 is a bit of air traffic controllers and you know before you put

01:52 - 25.732 folks

01:52 - 27.182 in the seat

01:52 - 29.422 and they go through a tremendous amount of training

01:52 - 34.678 so before they start answering their calls at all hours of the day is the secretary

01:52 - 39.322 noted twenty four seven there's about three or four months of just

01:52 - 41.332 what do you need to do

01:52 - 43.072 to receive the call

01:52 - 45.322 and then the referral system

01:52 - 46.702 that exists in the county

01:52 - 47.912 with county children and

01:52 - 49.112 youth or

01:52 - 50.582 or law enforcement.

01:52 - 54.512 Those before they start answering those calls from the public.

01:52 - 58.271 What do you need to do so we take the training very

01:52 - 01.442 very seriously before and then they're quite supervised.

01:53 - 06.722 That's the fifteen positions plus the five to make sure they're well supervised.

01:53 - 09.452 It is a very demanding job

01:53 - 12.238 and I think like one last thing that we didn't touch on that

01:53 - 15.422 and I know senator Martin you'll remember this from being a county commissioner.

01:53 - 17.935 The other thing that we hope to achieve with this

01:53 - 20.582 is greater consistency across the commonwealth

01:53 - 24.932 because we'll be taking more of that tree as work at the state level.

01:53 - 26.102 Right now so

01:53 - 26.782 really

01:53 - 28.792 there's no other option but just continue to

01:53 - 30.442 to move things to counties

01:53 - 32.152 and and then

01:53 - 36.172 there isn't always consistency in how things are heard or in interpreted

01:53 - 37.792 and so part of this

01:53 - 41.111 is to also just professionally the entire system create

01:53 - 44.032 consistency no matter where you're calling in a report from

01:53 - 48.652 you'll get a similar type of response from the state's child welfare system

01:53 - 49.492 in terms of

01:53 - 52.162 how it's triaged and handled at least initially

01:53 - 54.532 I think that's really important for our state

01:53 - 56.700 that was one of the things that we heard in some of

01:53 - 58.852 the feedback that we've gotten over the last year

01:53 - 02.482 is how important it would be to enhance consistency and so

01:54 - 04.794 it's nobody's fault it's just the way our system

01:54 - 07.072 currently works and it's an area where I think we can

01:54 - 07.672 do better

01:54 - 09.212 do better by our kids

01:54 - 10.822 worked at this

01:54 - 11.602 unit

01:54 - 12.722 and.

01:54 - 14.452 Everyone

01:54 - 15.922 in your department is doing

01:54 - 17.432 very much front line

01:54 - 19.063 it has pressures.

01:54 - 21.482 Increase.

01:54 - 23.732 Because

01:54 - 25.172 you know.

01:54 - 27.602 It's getting tougher to provide services

01:54 - 28.492 and

01:54 - 30.022 how we take care of our

01:54 - 31.336 our workforce

01:54 - 33.472 we take care of the folks who are on the front line

01:54 - 36.022 providing help to our constituents right

01:54 - 37.172 yeah right I mean

01:54 - 39.922 you all the folks that when the call comes in our office

01:54 - 42.502 you are the folks that we call to try to figure out

01:54 - 45.682 how do we get help to somebody we gotta make sure we

01:54 - 49.412 as I said healing the healers here helping the helpers.

01:54 - 50.182 Because

01:54 - 51.142 they deserve it

01:54 - 53.038 thank you mr chairman thank you thank you

01:54 - 53.302 too

01:54 - 54.992 he got his chance to get his

01:54 - 56.342 questioning.

01:54 - 59.012 We're a good team.

01:54 - 00.242 Thank you.

01:55 - 01.192 We're not going to

01:55 - 02.812 we're going to keep plodding forward with

01:55 - 04.558 round two to see how much we can get done right

01:55 - 05.242 right now

01:55 - 07.398 I think we're going to do seven minutes for standing

01:55 - 09.992 committee chairs and five minutes for members.

01:55 - 15.362 So I will turn it over to senator Haywood thank you chairman thank you all again.

01:55 - 16.942 I want to give a special

01:55 - 19.312 thanks to deputy secretary phone

01:55 - 22.252 she went to several counties with me

01:55 - 25.893 during the fall to let people know about the new.

01:55 - 26.512 Food.

01:55 - 28.652 Reporting requirements

01:55 - 29.062 and

01:55 - 33.352 she's the it was fantastic representative of the department and the commonwealth

01:55 - 34.802 of Pennsylvania.

01:55 - 36.962 I've got three questions

01:55 - 40.712 hopefully that can be managed in a time that I have allocated

01:55 - 42.262 the first one is

01:55 - 43.792 how did you

01:55 - 46.642 achieve that fantastic error rate

01:55 - 50.582 when the average across the nation is ten times

01:55 - 51.692 the air rate

01:55 - 53.792 one point six two.

01:55 - 55.022 Second.

01:55 - 56.692 I

01:55 - 01.202 Think we may need to look at remapping patient access

01:56 - 05.542 given the hospital closures I dunno if that's more for the department of health

01:56 - 07.052 but given what

01:56 - 09.112 senator Kim mentioned about

01:56 - 10.232 more

01:56 - 16.072 individuals coming to her area hospitals from surrounding counties there's some the

01:56 - 17.272 remapping

01:56 - 21.452 patients are already doing the remapping are going to different places so.

01:56 - 23.932 I think that might be helpful for

01:56 - 26.512 hospitals to have a little bit more prediction of

01:56 - 32.062 where foles may come from India demands therefrom and then the last thing is the

01:56 - 35.482 investments in health initiative from the governor

01:56 - 37.582 pudding three million dollars in

01:56 - 39.872 be interested to understand

01:56 - 40.642 what

01:56 - 43.462 is the likely impact of those investments

01:56 - 44.002 sure

01:56 - 44.452 okay

01:56 - 45.898 do you mind if I do them in

01:56 - 47.362 a different order if that's okay

01:56 - 48.052 and

01:56 - 51.311 so to your second question on that kind of this idea

01:56 - 54.752 of remapping I think you're absolutely right that.

01:56 - 57.962 Hospitals are definitely going to have to.

01:56 - 02.032 See what their catchment their new catchment area might look like

01:57 - 06.562 where that is going to have enormous impact design our emergency medical services

01:57 - 08.770 and I think that that is where you're going to really

01:57 - 12.292 see a lot of impact in terms of ns folks having to drive

01:57 - 13.342 much further

01:57 - 16.082 which then makes that truck not available.

01:57 - 16.942 Four

01:57 - 19.912 status happening at home right they gotta get way

01:57 - 21.152 wherever and back

01:57 - 24.472 one of the focuses of the rural health transformation plan

01:57 - 28.918 is to help ans agencies maybe even buy more trucks and things like that right these

01:57 - 32.392 are things that we can do with that money so we're very focused on that

01:57 - 35.062 we will always in the medicaid program

01:57 - 39.602 hold our mc he owes to network adequacy standards

01:57 - 42.712 and so again this is going to put pressure on them as well

01:57 - 46.445 as facilities close they're going to also have to work to

01:57 - 49.192 figure out and we have obviously we'll do this together

01:57 - 50.582 to.

01:57 - 52.912 Maintain network adequacy and we have some

01:57 - 55.792 pretty strict requirements about network adequacy so

01:57 - 00.508 this is gone to be a very iterative process as this as this plays out over time and d

01:58 - 01.680 o h will be very involved with it obviously

01:58 - 04.262 the department of health will be very involved

01:58 - 04.792 and.

01:58 - 11.098 So to the payment error rate measurement again this is something that we just have

01:58 - 14.992 put a lot of processes and procedures in over the years

01:58 - 18.382 to ensure that that we do this well

01:58 - 21.022 and you may remember me talking

01:58 - 22.972 years maybe two years ago

01:58 - 26.092 that we were getting ready to initiate a fraud capture as

01:58 - 27.952 it's an AI module that

01:58 - 32.062 that looks for payments that theme out of whack or

01:58 - 32.812 that don't

01:58 - 34.792 make sense in the context of it

01:58 - 38.242 it's the type of thing where you know with three million people in this program

01:58 - 39.982 and all the claims that come in

01:58 - 43.732 no human can really necessarily see patterns but

01:58 - 45.692 an AI fried capture.

01:58 - 46.372 Thinking

01:58 - 51.418 that the data that it collects is not personally identifying data it just pulls out

01:58 - 55.882 cases so it all stays inside dhs so there's no risk of any of that data going elsewhere

01:58 - 59.050 but it's just something that we take very seriously and

01:58 - 02.032 obviously when you put attention onto something you can

01:59 - 03.592 get results so that's just

01:59 - 06.872 been one of our top focuses we know every dollar.

01:59 - 08.332 We don't have enough dollars

01:59 - 11.992 and so we need to make sure that every dollar is going to where it needs to go

01:59 - 12.832 in

01:59 - 16.232 And as it was appropriately allocated to go.

01:59 - 19.402 Investments in health and thank you so much for asking about that

01:59 - 22.072 it is really an opportunity

01:59 - 26.242 particularly in the context of everything that we've been talking about today

01:59 - 30.682 in terms of what is cut coming in terms of cuts to medicaid program

01:59 - 34.282 to make some really smart investments

01:59 - 36.782 that will save money.

01:59 - 41.722 Each of these programs the reentry services the housing and the food

01:59 - 44.332 are time limited programs

01:59 - 45.602 they are all

01:59 - 50.032 pilots and in fact we've significantly scaled down the housing and the food

01:59 - 53.762 pilots to address some prior concerns that we heard.

01:59 - 55.738 They will be independently evaluated to make

01:59 - 57.772 sure they are actually doing we think that

01:59 - 59.102 they're doing

01:59 - 00.422 but

02:00 - 03.122 very similar programs that our own managed care

02:00 - 06.022 organizations are running and other states have run

02:00 - 08.692 are showing significant cost savings

02:00 - 11.300 I'll give you one recent example in north Carolina

02:00 - 14.242 they were doing a very similar food as medicine program

02:00 - 15.362 as we are

02:00 - 19.822 and in the catchment area areas where they were piloting it in the first year

02:00 - 22.252 they saved a thousand dollars

02:00 - 23.432 per year

02:00 - 26.272 per member of the people that were engaged in that pilot

02:00 - 27.412 and

02:00 - 28.532 that was

02:00 - 30.202 only going to go up they

02:00 - 36.148 took out the administrators startup costs and they still saved a thousand dollars per

02:00 - 38.452 person who was approached discipline in this program

02:00 - 40.282 per over the course of that year

02:00 - 41.812 so this

02:00 - 43.222 is a way

02:00 - 45.956 of looking at the challenges that are facing us

02:00 - 48.742 in our medicaid program over these next few years

02:00 - 51.184 and doing smart strategic investments that

02:00 - 54.526 will actually help keep pennsylvanians healthy

02:00 - 55.642 help them

02:00 - 57.542 help reduce recidivism

02:00 - 00.802 help people who are UN housed actually

02:01 - 05.398 follow treatment plans because now they have housing and they can go somewhere other

02:01 - 08.612 you know they don't have to go to an emergency room to get their care

02:01 - 10.252 and these are

02:01 - 15.572 proven approaches that will help reduce the spend in our medicaid program.

02:01 - 16.522 That

02:01 - 20.222 that obviate the need for the spend in the first place.

02:01 - 22.832 That is our

02:01 - 26.932 far preferred route to go here as much as we possibly can

02:01 - 30.602 to mitigate potential spending cuts that are coming.

02:01 - 32.872 Rather than just

02:01 - 34.922 look at the alternatives none of which are

02:01 - 37.192 going to be great for the people that we serve

02:01 - 40.417 so I'm very hopeful that this will be something

02:01 - 43.132 that we can work on together and support

02:01 - 44.602 because it is the

02:01 - 48.543 this is the most essential time to make these types of smart

02:01 - 52.022 investments in food and in housing and reentry services.

02:01 - 54.482 Thank you so much.

02:01 - 56.582 Jeremy.

02:01 - 01.892 Thank you senator up next we have center Phillips hill followed by senator carney.

02:02 - 04.838 Thank you mister chairman

02:02 - 05.348 or

02:02 - 06.768 Madam secretary.

02:02 - 10.547 Back in October the governor went on a full PR

02:02 - 13.748 campaign to weigh in on the federal budget battle

02:02 - 19.248 specifically with how it impacted snap benefit recipients

02:02 - 23.528 he then declared an emergency over snap benefit Fitz

02:02 - 25.988 joined a lawsuit with other states

02:02 - 32.108 put up social media posts specifically targeting some republican members of congress

02:02 - 34.248 about the federal budget impasse.

02:02 - 39.164 Then on November first the governor posted to accent I quote today two million

02:02 - 41.984 pennsylvanians will not receive the federally funded snap

02:02 - 45.108 benefits they use to feed themselves and their families

02:02 - 47.955 Donald trump and congressional Republicans are more focused

02:02 - 50.948 on using food assistance as a political bargaining chip

02:02 - 54.798 than making sure families and children get fed.

02:02 - 56.238 Up end quote.

02:02 - 57.218 However

02:02 - 01.778 according to the Philadelphia inquirer it was roughly a month before anyone noticed

02:03 - 05.018 that more than three point four million pieces of mail

02:03 - 06.638 were sitting in trucks

02:03 - 10.568 not going to Pennsylvania recipients from November third

02:03 - 12.398 to December third

02:03 - 13.848 of last year

02:03 - 21.188 those may all pieces included renewal notices for snap benefits and I will admit

02:03 - 23.558 that the governor had been very timely

02:03 - 26.558 with his updates criticizing the federal officials

02:03 - 29.348 but this massive issue under

02:03 - 31.128 his purview

02:03 - 32.408 impacted

02:03 - 34.808 millions of Pennsylvania ones

02:03 - 37.478 and was not uncovered for a month

02:03 - 42.284 Philadelphia inquirer reported that your agency had one point seven million pieces of

02:03 - 44.468 mail impacted by the mail failure

02:03 - 48.168 from November third to December third is that correct.

02:03 - 51.818 So sen you raised to vary

02:03 - 52.388 and

02:03 - 54.438 theme I need to know.

02:03 - 55.748 Is

02:03 - 56.318 If

02:03 - 57.438 You

02:03 - 00.458 your agency had one point seven million pieces

02:04 - 03.128 of mail impacted by the mail failure remember was

02:04 - 06.068 while I'm turning to tell you what the exact number is I just

02:04 - 07.578 point out

02:04 - 10.718 that both of those things were related to budget and passes

02:04 - 12.638 when at the federal level and one at

02:04 - 13.838 madame secretary

02:04 - 14.988 late by just telling me

02:04 - 15.575 have

02:04 - 18.218 places impacted by the mail failure

02:04 - 19.568 one point seven is correct

02:04 - 24.398 so the enquirer profiled Eliana Shania cuff sky

02:04 - 25.988 she had spinal bifida

02:04 - 30.704 and they talked about how her twenty four hour state funded care was cut off as well

02:04 - 34.338 as her meal provider her nurses worked without pay or assurances

02:04 - 38.328 that they would get paid because of the state's mail failure.

02:04 - 43.285 Ninety point five w e s they shared the story of Raymond zhang he lost his medical

02:04 - 45.858 health insurance and support services

02:04 - 50.388 like a job coach that helps him with his job at a senior living center

02:04 - 53.558 and the letter from your agency was received on

02:04 - 56.228 December twelfth dated no November tenth

02:04 - 58.628 indicated his benefits would be cut off

02:04 - 01.758 by November twenty third now these are just two examples

02:05 - 05.163 during that month how many people were impacted

02:05 - 08.778 to the point of temporarily losing their benefits.

02:05 - 12.128 So as you know we did extend Bennett

02:05 - 15.578 appeal deadlines and response deadlines once the the

02:05 - 16.958 male situation

02:05 - 18.228 became known

02:05 - 20.628 I want to be clear that dhs.

02:05 - 24.218 When we when we send out our mail

02:05 - 26.528 it is picked up by the vendor

02:05 - 27.918 at the time

02:05 - 32.078 and for us it's no different than putting a piece of mail into a mailbox

02:05 - 33.248 and so

02:05 - 37.428 from my team's perspective the mail I had been set

02:05 - 43.008 and in terms of the medicaid program there were two hundred and forty nine thousand

02:05 - 46.998 individuals in medicaid whose mail was delayed

02:05 - 48.218 and again

02:05 - 51.158 we meant we as soon as we were aware

02:05 - 53.198 we manually assessed

02:05 - 55.238 every one of those cases

02:05 - 58.068 to action if possible to.

02:05 - 02.088 Do whatever was the appropriate next step in terms of eligibility

02:06 - 05.018 and we kept

02:06 - 06.138 a

02:06 - 09.108 Twenty seven thousand one hundred and sixty four

02:06 - 10.748 individuals open

02:06 - 14.108 awaiting for additional information back from them

02:06 - 16.907 and all of that as steps were done under the

02:06 - 19.478 federal guidelines for a situation like this

02:06 - 24.558 so how many people were impacted to the point of temporarily losing

02:06 - 25.938 their benefits.

02:06 - 27.918 So.

02:06 - 31.930 In medicaid no one should have temporarily lost their

02:06 - 36.158 benefits because all of those cases were kept open.

02:06 - 38.078 I am aware of the

02:06 - 39.008 one

02:06 - 41.538 article that you cite from the enquire.

02:06 - 45.998 It is my understanding that that may not have actually been related to

02:06 - 47.628 the male situation.

02:06 - 52.394 And I don't I don't have any more specific info how many administrative hearings had

02:06 - 56.294 to be rescheduled because of the failure to get administrative hearing notices to

02:06 - 01.968 recipients we had to reschedule I believe thirteen hundred approximately.

02:07 - 06.758 Thank you very much

02:07 - 07.598 thank you

02:07 - 09.138 mr chairman.

02:07 - 10.308 Thank you senator

02:07 - 14.018 up next we have Sandra corny followed by sen de she

02:07 - 15.618 was determined.

02:07 - 17.894 There's not a lot to talk about this

02:07 - 19.538 impending disaster referral

02:07 - 21.158 hospitals I would be

02:07 - 24.998 remiss if I didn't point out that that's actually happening right now in real time

02:07 - 27.018 in Delaware county.

02:07 - 30.198 We've lost four out of our six hospitals.

02:07 - 33.438 You can go into the reasons for that and everything else

02:07 - 34.568 but you quite rightly

02:07 - 36.858 point out the effects on vms

02:07 - 38.528 I mean our municipalities

02:07 - 39.368 have

02:07 - 42.348 worked in many cases together and.

02:07 - 44.798 Definitely in overtime to make sure that those

02:07 - 47.148 services are still provided

02:07 - 48.338 but we run into the same

02:07 - 50.538 problem you discuss where.

02:07 - 52.838 Instead of a ten minute ride to

02:07 - 53.858 to a hospital

02:07 - 55.478 in Chester it's a

02:07 - 56.876 an hour ride to

02:07 - 57.248 two

02:07 - 58.238 hours is the

02:07 - 00.198 closest to.

02:08 - 02.838 A trauma center that we have and we have several.

02:08 - 05.858 Stories of people dying in the ambulances and that

02:08 - 07.118 you know as you

02:08 - 11.028 as you know the golden hour or so important in terms of.

02:08 - 13.338 The first hour in terms of getting.

02:08 - 13.988 Treatment

02:08 - 16.407 I don't really have a question with that I just wanted to

02:08 - 17.431 know.

02:08 - 19.398 Perhaps we could.

02:08 - 23.348 Get the president to send the hospital ship to Delaware county instead of to

02:08 - 25.778 to to Greenland and.

02:08 - 28.328 I do want to go back to

02:08 - 30.188 talking about the kids stuff again and

02:08 - 33.038 I know you're familiar with the child advocacy owners

02:08 - 34.548 unless you're.

02:08 - 35.318 You're

02:08 - 38.558 used to express your support for the services that they

02:08 - 41.388 provide nearly fifth eighteen thousand.

02:08 - 44.508 Pennsylvania child victims of abuse.

02:08 - 47.018 As the twenty five twenty six budget

02:08 - 49.337 is being negotiated I wanted to remind dhs

02:08 - 53.088 and my fellow legislators that currently chcs

02:08 - 56.348 receive only forty seven thousand dollars per center

02:08 - 58.028 from the two point two billion

02:08 - 01.458 dollar birth certificate allocate when that was established.

02:09 - 02.948 In two thousand and fourteen

02:09 - 04.508 over eleven years ago

02:09 - 07.568 and that dollar amount is barely enough to cover

02:09 - 08.808 one for as a

02:09 - 10.578 forensic interviewer.

02:09 - 15.168 A victim advocate or a trauma therapist position PR center

02:09 - 19.448 and actually will be reduced a piece of the pie will be reduced as more chcs

02:09 - 20.258 or

02:09 - 22.418 Or introduced into underserved

02:09 - 23.718 areas.

02:09 - 27.278 By contrast the twenty twenty three report produced at the request

02:09 - 29.708 of the senate aging and use committee revealed

02:09 - 33.278 a funding gap of fourteen point five million dollars needed

02:09 - 35.198 for cac to provide

02:09 - 37.898 the full array of services for child abuse victims

02:09 - 39.258 in the state

02:09 - 40.488 is there anything that

02:09 - 42.338 that use or anything that we

02:09 - 43.868 can do to

02:09 - 45.578 guarantee that substantial subs

02:09 - 48.308 sustainable funding for child advocacy centers

02:09 - 50.508 is included in this budget.

02:09 - 54.438 Authentic carne I really appreciate those comments and.

02:09 - 55.688 As you now I've

02:09 - 57.498 been a long time fan.

02:09 - 58.778 Of rcs Eve

02:09 - 59.828 and

02:10 - 01.028 there it is

02:10 - 06.798 not part of the dhs budget obviously as you as you pointed out but I do think that.

02:10 - 11.348 As other resources become more scarce and when I say other resources is

02:10 - 16.364 whether it's actual hospital services whether it's the stretching of our law

02:10 - 19.638 enforcement responders to some of these situations

02:10 - 21.348 having a cac

02:10 - 24.948 who can create a one time

02:10 - 29.948 forensic interview for a child and get all parties

02:10 - 32.318 together in that way one time

02:10 - 36.308 helps law enforcement it helps our district attorneys it helps

02:10 - 40.998 our public defenders it helps the medical personnel and most importantly

02:10 - 42.548 it helps the child

02:10 - 44.888 to only have to go through that one time

02:10 - 45.968 and so

02:10 - 49.118 as all of these other things that I and my budget

02:10 - 51.666 get tighter and tighter and as we know that

02:10 - 54.428 resources in our rural communities are going to get

02:10 - 55.638 more scarce

02:10 - 59.738 I think that anything that we can do to make it easier and more efficient

02:11 - 04.208 for everybody in the community that is engaged in a situation like this

02:11 - 05.568 to.

02:11 - 07.988 Come together efficiently

02:11 - 11.548 and that of course obviously the impacts on the children are minimized in that way.

02:11 - 14.838 These are things that are very important to consider.

02:11 - 17.048 Dr a coach I appreciate that

02:11 - 17.888 I'll

02:11 - 20.748 hold off for the afternoon thank you mr chairman.

02:11 - 25.008 At your center up next senator Dutch followed by centre street.

02:11 - 26.648 Banking chairman dr kush

02:11 - 30.044 thanks to the bill passed by the Republicans in congress Pennsylvania received

02:11 - 31.780 hundreds of millions of dollars for rural health this

02:11 - 33.968 year through the rural health transformation plan.

02:11 - 37.513 You said that the state will operate a rapid response access

02:11 - 38.858 stability program

02:11 - 40.178 in the first two years

02:11 - 43.218 to preserve a central hall spit on the m s capacity.

02:11 - 46.578 Which facilities have been identified as eligible

02:11 - 48.458 how much funding will be available and when will

02:11 - 51.468 the funds be released to prevent near term closures.

02:11 - 54.065 So love to be able to answer those questions I'm

02:11 - 56.738 hoping I'll be able to answer those questions in about

02:11 - 00.818 two to three weeks and we are

02:12 - 05.858 finished bring up our contracting with cms and we're very close to being done

02:12 - 09.297 and then we are working on our own internal

02:12 - 12.728 processes with the comptroller's office to set up the

02:12 - 15.288 mechanism for those

02:12 - 18.128 access stabilization funds to go out

02:12 - 21.728 our plan is to have a very

02:12 - 22.774 webinar

02:12 - 26.960 as soon as I can give firm answers to those questions

02:12 - 30.424 in the next hopefully within the month at the latest

02:12 - 35.050 I will make sure all of your offices know about that obviously it will be recorded so

02:12 - 37.444 that anybody who can't get to it can access it

02:12 - 41.414 and will go through all of the mechanisms that.

02:12 - 43.234 Will be in place for people to

02:12 - 44.734 apply for that funds

02:12 - 46.864 and do you have an estimate on the

02:12 - 50.204 timeline on when the hospitals might be able to apply.

02:12 - 52.654 It'll be as soon as we're we're up

02:12 - 55.864 like as soon as we have that webinar will be able to we believe

02:12 - 57.784 we should then be able to go live like we

02:12 - 59.974 we want to just have it ready to go

02:13 - 01.334 and then hit go

02:13 - 02.044 that's our goal

02:13 - 04.994 I know the chairwoman and I both would appreciate.

02:13 - 07.004 Notification absolutely

02:13 - 08.204 absolutely.

02:13 - 11.284 Because funds are distributed through the prep regions

02:13 - 13.934 that include both rural and urban regions.

02:13 - 16.049 What safeguards are in place to ensure

02:13 - 18.604 that funding which is specifically allocated

02:13 - 20.834 by the federal government for rural.

02:13 - 22.504 Oregon to urban

02:13 - 23.314 areas

02:13 - 27.724 so couple of things so there has been a slight

02:13 - 31.474 one of the things that we get back from cns is a slight change in

02:13 - 35.104 how we will establish the relationship with the prep agents

02:13 - 37.894 so we are still going to use the region

02:13 - 40.144 like that we had originally outlined in the Grant

02:13 - 41.644 by the way everybody has some of this

02:13 - 42.634 and

02:13 - 44.974 we will be working with their teams

02:13 - 49.174 to help convene these rural care collaboratives that will meet regionally to

02:13 - 51.124 prioritize the needs for that region

02:13 - 54.994 there will not be funding going through the prep https

02:13 - 57.574 cms has told us that is not allowed

02:13 - 01.840 so they'll be working with the regional care collaborative and a staff person that

02:14 - 04.024 we're going to hopefully co-locate with all the perhaps

02:14 - 06.184 so we'll be very much working together

02:14 - 09.244 but the money is going to have to come through dhs so

02:14 - 10.964 there's that piece.

02:14 - 13.624 The point here I'm not against the rural or

02:14 - 14.434 urban

02:14 - 16.965 hospitals I know we've been the canary in the coal mines

02:14 - 20.444 are we getting the shutdowns a lot brighter and earlier

02:14 - 21.704 but.

02:14 - 23.224 That's why it

02:14 - 24.465 wouldn't let me.

02:14 - 25.864 Answer that part of your question

02:14 - 27.274 so the

02:14 - 29.943 notice of award and well actually the original funding

02:14 - 32.224 opportunity prescribed where this money could go

02:14 - 35.374 which is then these hoes the designated rural regions

02:14 - 36.614 and then we could

02:14 - 39.364 if there was a hearse a designated rural region we could

02:14 - 41.954 also include that whole county

02:14 - 43.094 so so

02:14 - 46.064 that is basically what we did with some exceptions

02:14 - 50.169 for a hospital that it is in an urban area the way

02:14 - 53.284 that they could potentially participate in this

02:14 - 57.018 would be if a hospital in a rural community

02:14 - 59.584 initiated a request to say

02:14 - 02.764 hey you do really good remote patient monitor during

02:15 - 04.894 we would like to contract with you

02:15 - 09.544 to do remote patient monitoring in our emergency department or I see you

02:15 - 10.444 and the

02:15 - 14.764 and they could contract with an urban hospital who provides that service

02:15 - 18.664 but it would have to come from the rural hospital requesting it

02:15 - 18.964 and

02:15 - 21.124 the only those services would be.

02:15 - 22.594 Correct so

02:15 - 27.134 an urban hospital can only participate at the request of a rural entity.

02:15 - 33.854 For a service that the Grant covers green conducted in a rural community.

02:15 - 36.284 Nursing homes.

02:15 - 39.514 Right now and Bradford encounters port I'm down to just one

02:15 - 40.724 in each.

02:15 - 43.774 Other the last standing logs on the communities and it's

02:15 - 44.794 again rural

02:15 - 46.984 impacts have just been horrendous

02:15 - 50.294 what percentage of the dollars that we have.

02:15 - 53.704 We appropriate for long term care actually make it to

02:15 - 57.314 those facilities and how much is actually held by medicare.

02:15 - 59.234 Medicaid brokers.

02:15 - 01.024 It's important to me because it

02:16 - 02.444 just.

02:16 - 04.654 I'm not sure what you mean about

02:16 - 06.014 by the brokers.

02:16 - 06.904 Like

02:16 - 09.345 the funding goes directly to nursing facilities

02:16 - 11.824 for any medicaid patient that they have

02:16 - 14.894 that meets eligibility for nursing home.

02:16 - 16.244 Care.

02:16 - 17.704 The funding to

02:16 - 21.104 the nursing home gets paid directly for that patient.

02:16 - 23.734 For the folks that are

02:16 - 27.824 in our community health choices program who are all nursing facility eligible.

02:16 - 32.560 They seventy nine percent of them are being managed in the community with home and

02:16 - 36.124 community based services but that's a choice that the patient has made

02:16 - 36.904 there's not

02:16 - 38.723 that we do have the independent enrollment

02:16 - 40.924 brokers maybe that's what you're referring to

02:16 - 41.554 are

02:16 - 43.294 they they do not get

02:16 - 45.094 funding for

02:16 - 46.244 the.

02:16 - 49.634 Way they just get paid a flat.

02:16 - 51.364 Basically it's a flat rate

02:16 - 52.444 they don't get

02:16 - 55.444 bonuses for sending anybody any which way

02:16 - 58.851 and they are just independent arbiters of sharing

02:16 - 02.714 information with the folks who are eligible for the service.

02:17 - 03.854 Answer your question

02:17 - 05.764 just how is that fee set up is that

02:17 - 08.854 there's none of that taken out of the money for the nursing home

02:17 - 10.514 and.

02:17 - 11.924 Nope.

02:17 - 12.304 Alright

02:17 - 13.694 thank you.

02:17 - 17.654 Sen street followed by senator Kim.

02:17 - 22.214 Good morning morning one thanks for your services.

02:17 - 23.714 We appreciate

02:17 - 25.354 the very challenging

02:17 - 27.224 job you have particularly

02:17 - 28.904 in light of.

02:17 - 30.414 The myriad of fear of

02:17 - 31.234 federal cuts

02:17 - 32.564 especially in medicaid

02:17 - 35.134 and they impact so many different

02:17 - 36.674 services.

02:17 - 40.114 Can you discuss the implication of the federal medicaid cuts

02:17 - 45.874 on resources available to high medical utilization hospitals like temple and Einstein

02:17 - 47.044 in Philadelphia

02:17 - 49.114 and I guess imagine even the university of penn

02:17 - 49.894 which is

02:17 - 54.134 probably doing better economically limp is still impacted by those cuts.

02:17 - 55.504 Yes certainly senator

02:17 - 56.104 good morning

02:17 - 57.184 so

02:17 - 58.394 What.

02:17 - 01.701 What we are likely to see play out if there

02:18 - 05.804 are no changes to hr one as it currently exists

02:18 - 06.514 as you

02:18 - 08.524 are all guessing I'm holding out hope here

02:18 - 09.754 that something will change

02:18 - 11.804 but if nothing changes

02:18 - 12.394 us

02:18 - 14.314 As soon as twenty twenty eight

02:18 - 16.024 that's kind of worst case scenario

02:18 - 19.304 it may be that we're able to push it to twenty thirty

02:18 - 23.224 we will see requirements of hr one

02:18 - 28.024 reducing the amount of assessments that we can collect

02:18 - 30.394 from our managed care organizations

02:18 - 31.484 and

02:18 - 33.224 from our hospitals

02:18 - 37.684 in the case of the managed care organizations those assessments which we

02:18 - 39.934 pulled down federal matching funds for

02:18 - 45.754 that those dollars go straight to the bottom line of our program and are

02:18 - 50.674 about two billion yeah that two billion dollars a year that fund

02:18 - 53.149 the medicaid program in total federal and

02:18 - 56.104 state and then the hospital assessment money as

02:18 - 57.724 you're very familiar with

02:18 - 59.054 is.

02:19 - 05.374 Focused on quality improvements at our hospitals and other programs that help support

02:19 - 09.154 the health of medicaid patients that are using those hospitals

02:19 - 10.294 and so

02:19 - 13.544 those are the areas that will be impacted

02:19 - 16.424 and our urban hospitals

02:19 - 23.050 benefit not only from the quality assessment but also from certain state directed

02:19 - 28.814 payments that maintain access for medicaid patients in high medicaid

02:19 - 33.724 population areas and those state directed payments it will also be.

02:19 - 37.174 Potentially impacted by some of these changes

02:19 - 39.094 so it's going to be kind of a

02:19 - 41.134 potentially start in twenty eight

02:19 - 44.894 for sure by twenty thirty depending on how cms.

02:19 - 46.834 Decides to roll this out

02:19 - 51.424 and it will just steadily reduce our funding

02:19 - 53.974 between twenty two ninety eight and twenty thirty eight

02:19 - 56.224 yeah it's very disturbing that the

02:19 - 57.614 current.

02:19 - 00.074 President administration are.

02:20 - 03.884 Cutting services to some of our most vulnerable populations.

02:20 - 05.294 Some of the other things

02:20 - 08.594 I imagine this is going to impact childcare subsidies as well.

02:20 - 14.644 Not that we're aware of as of yet that has been one area that they're

02:20 - 15.854 not.

02:20 - 16.774 Focused on

02:20 - 19.114 what about long term services for seniors

02:20 - 19.714 and are

02:20 - 23.894 right now that is also spared okay.

02:20 - 27.214 So how about the that.

02:20 - 27.844 I

02:20 - 30.764 Understand that there were some reductions in.

02:20 - 37.154 In the federal government's willing to pay the administrative costs related to

02:20 - 37.714 snap

02:20 - 39.904 the supplemental nutrition assistance program

02:20 - 40.534 and

02:20 - 44.221 how much more what what are likely cost burdens of the federal

02:20 - 46.394 that the federal government is cost shifting

02:20 - 50.884 onto the taxpayers of Pennsylvania and how will that impact services from some of the

02:20 - 52.384 most vulnerable pets millions yeah

02:20 - 56.186 so that is a very tangible impact of h r one that we're

02:20 - 59.224 seeing in our proposed twenty six twenty seven budget

02:20 - 01.834 so historically snap and

02:21 - 04.491 snap administrative costs have been shared fifty

02:21 - 06.904 fifty between the states and the federal government

02:21 - 10.904 and again I just want to remind everyone this has nothing to do with the error rate.

02:21 - 13.832 Under hr one now states are required to pick up

02:21 - 16.564 seventy five percent of those administrative costs

02:21 - 17.764 so for

02:21 - 20.704 us here in the commonwealth for twenty six twenty seven

02:21 - 25.364 it's an eighty seven million dollar cost shift on to Pennsylvania taxpayers

02:21 - 28.554 once it's a fully annualized costs because remember the

02:21 - 31.174 federal fiscal year doesn't start till October first

02:21 - 33.514 so we don't have the full impact of it

02:21 - 36.574 in twenty six twenty seven but in twenty seven twenty eight

02:21 - 40.444 we anticipate that that'll be closer to one hundred and twenty million dollars

02:21 - 42.484 every time I talk to you or something

02:21 - 45.314 so it's another back in.

02:21 - 48.514 Tax cut tax increase to Pennsylvania and

02:21 - 50.314 coming out to hr one

02:21 - 51.464 and.

02:21 - 53.584 So that I guess they could give tax cuts to their

02:21 - 54.674 print.

02:21 - 55.934 Billionaire front.

02:21 - 59.114 Can you discuss the implications of.

02:21 - 03.764 The reduction in the aggregate medicaid dollars on potential

02:22 - 08.204 services that are related to substance abuse and addiction services.

02:22 - 10.534 So Saturday I really

02:22 - 12.284 appreciate your question

02:22 - 15.994 we're not in a position yet to start to discuss that

02:22 - 18.184 this is an area where

02:22 - 20.824 we have done a couple of things

02:22 - 22.094 proactively

02:22 - 24.754 one is and and as you've seen in our

02:22 - 25.234 our

02:22 - 26.594 budget for this year

02:22 - 29.104 we have already begun to be very though

02:22 - 32.869 where we could use reduce some costs in our medicaid

02:22 - 36.082 program and the governor's proposing investments in house

02:22 - 40.528 which will help reduce the spend in our medicaid program those events are top

02:22 - 44.308 priorities let's actually do preventive care keep people healthier let's make sure

02:22 - 46.882 they don't need as much care in our medicaid program

02:22 - 49.342 that is a very real way to reduce costs

02:22 - 51.322 so so that's been our focus right now

02:22 - 53.242 as time goes on

02:22 - 57.482 goes by we will start to be looking at additional

02:22 - 58.282 options

02:22 - 01.282 we are about to convene a work group

02:23 - 07.282 made up of a very wide swath of stakeholders in this space folks from our

02:23 - 09.952 medicaid advisory committees we have several

02:23 - 13.168 and groups like Pennsylvania health access network and

02:23 - 18.032 just a whole host of folks that work in this space to

02:23 - 20.332 to make sure they understand

02:23 - 21.532 what is coming

02:23 - 23.512 if nothing changes with hr one

02:23 - 27.832 and really listen to them and hear from them what their thoughts are

02:23 - 29.572 on where

02:23 - 32.743 if if we get to the point where we have to make some very

02:23 - 36.332 difficult choices how we should prioritize those choices.

02:23 - 36.982 See I'm not

02:23 - 40.342 alone affect you for the work you're doing in a very difficult environment

02:23 - 43.252 the federal government's cutting so much

02:23 - 45.892 of the services to vulnerable Pennsylvania

02:23 - 47.012 that you provide

02:23 - 47.392 are

02:23 - 51.298 and I appreciate your proactive work and trying to make sure we can still get those

02:23 - 54.652 services to our vulnerable populations despite the fact that

02:23 - 57.932 there's some folks in Washington that don't have your level compassion.

02:24 - 01.532 Senator Kim.

02:24 - 07.142 Talked to our coach the governor proposed a fifteen dollar minimum wage in his budget

02:24 - 10.862 and he says he predicts that they'll be some savings

02:24 - 12.842 will there be any savings

02:24 - 14.432 in your department.

02:24 - 17.806 This is another great example of how we can reduce

02:24 - 21.182 spending in medicaid in a way that is positive

02:24 - 25.282 so so we do anticipate that approximately.

02:24 - 27.302 Forty nine thousand

02:24 - 28.412 fifty thousand

02:24 - 29.522 individuals

02:24 - 31.672 if we did increase the minimum wage

02:24 - 35.282 would no longer be eligible for medicaid

02:24 - 36.562 I view that as a

02:24 - 41.188 as a much better reason for not being eligible for medicaid than some of the other

02:24 - 42.892 reasons that we I've talked about today

02:24 - 44.552 and so.

02:24 - 49.312 We are all committed to making sure that Pennsylvania can become self sufficient

02:24 - 52.552 we have multiple job training programs and other.

02:24 - 54.892 Things like that to help make that happen

02:24 - 01.232 and a fifteen dollar minimum wage would be so impactful for so many people and would.

02:25 - 03.735 Reduce that we have actually budgeted some savings

02:25 - 06.532 in our medicaid program for twenty six twenty seven

02:25 - 09.202 on the assumption that the minimum wage will go up

02:25 - 13.922 and that there would be a reduction in enrollees because of that.

02:25 - 17.235 In the capitation line we're reflecting a savings of

02:25 - 20.122 about fifty nine million in the twenty six twenty seven

02:25 - 22.442 and that would analyze and twenty seven twenty

02:25 - 24.892 eight to three hundred and six point three million

02:25 - 26.885 that's the total funds for the state share is

02:25 - 29.152 obviously less than the b twelve and sixty five

02:25 - 30.692 and that.

02:25 - 32.372 As people.

02:25 - 35.372 Who achieve that minimum wage and it actually has

02:25 - 38.062 the effect of moving them from the medicaid rolls

02:25 - 39.472 some of those are children

02:25 - 42.352 so they'll move to the chip line where they can be served

02:25 - 46.858 so we actually have an increased cost in the chip line in childcare services and

02:25 - 50.572 childcare assistance as you raise that's really the only place where we see workers

02:25 - 53.182 projected to not be over fifteen dollars an hour

02:25 - 54.652 by January twenty seven

02:25 - 55.952 so they have cost

02:25 - 59.032 very minor cost and in the childcare provision in the

02:25 - 00.622 chip or preparation but the

02:26 - 03.153 savings is on the computation line.

02:26 - 04.652 Thank you my last

02:26 - 07.882 question is doctor cause I think you mentioned this last year

02:26 - 11.812 that some states to our south did a work requirement

02:26 - 12.682 and they

02:26 - 16.462 had problems or issues or didn't want it can you just.

02:26 - 18.012 I'm just trying to project

02:26 - 19.648 what's going to be happening at our future

02:26 - 20.302 sure of course

02:26 - 21.662 so.

02:26 - 24.352 So why work requirements and snap

02:26 - 25.192 are not

02:26 - 25.792 new

02:26 - 30.472 and there have been efforts over the years to have

02:26 - 33.772 work requirements put into medicaid medicaid is never actually had them

02:26 - 35.132 until now

02:26 - 40.252 but there have been states who have received waivers to pilot them in their states

02:26 - 43.042 much like where we want to pilot investments and how both

02:26 - 44.662 other states have piloted

02:26 - 50.032 work requirements and the two states that really took the lead on this

02:26 - 52.282 about two years ago maybe three years ago now

02:26 - 54.592 they both took a step back

02:26 - 58.412 because so many people were becoming disenrollment

02:26 - 59.982 and.

02:27 - 02.992 In one case it was trying to get people they promise

02:27 - 05.092 they would get medicaid if they worked

02:27 - 06.812 and that.

02:27 - 08.152 Did not I dunno how they

02:27 - 13.408 set it up but it was not successful and then in the other case they were losing way

02:27 - 16.802 more people than they anticipated from their medicaid rolls

02:27 - 17.912 and.

02:27 - 22.492 The issue was not necessarily that people weren't

02:27 - 25.282 let's say working let's say the requirement was to work

02:27 - 27.862 it was that they couldn't necessarily navigate

02:27 - 28.982 the red tape

02:27 - 33.178 and so one of the things that we've been really focused on was doing everything that

02:27 - 36.302 we can to make sure that Pennsylvania can navigate

02:27 - 38.122 the reporting requirements

02:27 - 39.022 as and

02:27 - 41.872 we've put a number of things in place I mentioned them earlier

02:27 - 44.122 to make it easier for people to report

02:27 - 48.298 this is where all of you can be incredibly helpful to us you know as we've developed

02:27 - 51.598 these materials we are going to be asking you to send them out in your district

02:27 - 54.322 newsletters and all those communication tools that you have

02:27 - 56.152 we're going to need all hands on deck

02:27 - 57.142 because

02:27 - 59.542 if people who are meeting the Rick environments

02:27 - 01.442 can't report.

02:28 - 01.912 You

02:28 - 03.232 just don't get it done

02:28 - 05.552 that we're going to have to just enroll them and then

02:28 - 06.724 just further

02:28 - 08.662 there's another uninsured person

02:28 - 10.702 that our hospitals are going to have to see

02:28 - 14.212 and so we'd need everybody working on this together

02:28 - 17.362 to be as successful as we possibly can but we know

02:28 - 20.372 that eligible people are going to lose their benefits

02:28 - 23.272 I have a problem or doing my driver's license every four years.

02:28 - 25.192 I can't imagine twice a year

02:28 - 27.212 thank you thank you mr chairman.

02:28 - 28.432 Thank you

02:28 - 28.942 almost

02:28 - 29.662 close up

02:28 - 31.162 very briefly before we

02:28 - 33.152 take the lunch break here.

02:28 - 34.892 Very curious

02:28 - 39.542 obviously usual were coming out of coven and especially because of our demographics

02:28 - 41.932 we're seeing workforce shortages and we've seen

02:28 - 42.742 a

02:28 - 43.372 Lot of

02:28 - 47.916 entities and businesses around the state that have actually increased wages

02:28 - 51.031 to significant amounts in order to compete from work

02:28 - 53.452 for service jobs other types of jobs and whatnot

02:28 - 57.472 using the same logic that was used applied that raising the minimum wage

02:28 - 00.242 would lower medicaid expenses.

02:29 - 03.772 How come we haven't seen medicaid enrollments go down

02:29 - 06.302 with those other big jumps.

02:29 - 10.492 In hourly rages wages probably beyond the minimum wage

02:29 - 13.132 we're not seeing that reflected in the rules why why

02:29 - 15.302 I'm trying to mirror up that logic.

02:29 - 16.372 Yeah

02:29 - 17.062 so

02:29 - 18.502 It kind of depends on where those

02:29 - 21.812 jobs are and where those people started

02:29 - 22.982 and.

02:29 - 26.422 I think what you're asking is

02:29 - 28.402 given that we've already seen some

02:29 - 29.612 jobs.

02:29 - 32.852 Or wage growth across the commonwealth

02:29 - 34.252 yeah why haven't we see

02:29 - 35.872 we have actually seen

02:29 - 37.612 medicaid enrollment

02:29 - 38.762 dropping.

02:29 - 41.632 It started last spring march April

02:29 - 43.912 and it has been

02:29 - 46.012 kind of a drip drip drip drip

02:29 - 49.292 of our medicaid enrollment falling.

02:29 - 53.642 So we are actually I think starting to see that.

02:29 - 56.492 That's an interesting dynamic we should look at to be

02:29 - 59.362 because where you have jobs that are actually currently

02:29 - 01.232 at minimum wage.

02:30 - 03.292 At at seven twenty five

02:30 - 05.162 twenty five yeah.

02:30 - 08.512 Versus the jump we've seen cause that's a smaller percentage of

02:30 - 10.582 in those industries and a lot of cases

02:30 - 15.152 we've seen this uptick in in wages in order to compete

02:30 - 16.522 an hourly rate right

02:30 - 21.052 there should be some sort of correlation know if if the theory is correct that

02:30 - 24.602 raising the minimum wage is going to get people off of medicaid

02:30 - 27.082 given that historic job that we had

02:30 - 29.032 over the last five six years

02:30 - 29.842 that should

02:30 - 33.508 have a significant and then we can run some battle I mean I think we are seeing

02:30 - 35.332 decreases in our medicaid population

02:30 - 35.902 yeah

02:30 - 36.592 and

02:30 - 38.512 separate from the unwinding to be clear

02:30 - 41.182 like right we went through the unwinding but since then

02:30 - 45.872 we haven't we are we're seeing a little bit of a drip drip drip drip down yeah.

02:30 - 48.502 The second question just because it was brought up

02:30 - 53.042 multiple times here and I think everyone understands the gravity of childcare

02:30 - 56.132 and for me there's there's nothing more frustrating

02:30 - 56.932 than

02:30 - 59.697 if there's you know people who do not have access

02:30 - 03.082 whether it's childcare whether it's pre hey slots

02:31 - 04.462 and I see

02:31 - 07.001 resources not being used or not being used

02:31 - 09.472 correctly I'm just posing this question to you

02:31 - 10.432 and

02:31 - 15.898 I can't get out of my head that if a child in Pennsylvania whom taxpayers help fund

02:31 - 18.142 go to school does not show up for

02:31 - 21.082 a significantly less amount of time

02:31 - 24.712 that I believe the number you're used was forty missed the days forty

02:31 - 27.009 and I'm thinking I think there's kids in pa that

02:31 - 29.872 there's a letter sent to a magisterial district judge

02:31 - 34.652 if they've been out what ten unexcused absences maybe less might even be six.

02:31 - 41.092 Are those guidelines set by the feds or do we have an opportunity to

02:31 - 46.112 at least seek a tighter framework because there can be nothing more frustrating

02:31 - 48.632 secretariat we're going to pay for childcare

02:31 - 51.892 but you consistently aren't showing up and then you'll have a family that's

02:31 - 53.192 denied

02:31 - 55.131 yeah these are these are federal guidelines let

02:31 - 58.562 me just say I dunno if we have any ability to.

02:32 - 03.634 The requirement for the forty days I believe is

02:32 - 06.592 actually a federal requirement but I'm getting

02:32 - 07.952 I'm getting.

02:32 - 08.842 I.

02:32 - 12.332 Make my team is making sure that I'm actually

02:32 - 13.222 accurate

02:32 - 15.382 but I'm almost certain that the forty days

02:32 - 19.672 it will be for the entire year or desire to the program

02:32 - 20.212 but

02:32 - 23.512 I believe that the forty days is a requirement and they've never

02:32 - 28.072 come forward with any sort of waiver or opportunity that we're aware of to

02:32 - 29.222 be infamous you'd have

02:32 - 31.622 to ensure that frustration

02:32 - 34.383 if there was a chance that we could to

02:32 - 35.592 make the commitment to you

02:32 - 37.732 but the commitments gotta go both ways

02:32 - 38.942 so anyways I

02:32 - 39.532 do

02:32 - 41.222 With that.

02:32 - 44.008 Winter.

02:32 - 48.048 We will take a break it's currently twelve o two will take a break till one thirty

02:32 - 50.058 to allow for walking time for all of us

02:32 - 50.955 and

02:32 - 53.696 appreciate the dialogue and we'll be back to

02:32 - 57.118 finish round two when we return thank you everyone.

02:32 - 58.548 Brake

02:32 - 59.688 and

02:32 - 02.058 wishing the best for keeping your eyes open

02:33 - 04.078 hopefully you have a lot of caffeine

02:33 - 06.683 but they're very important subjects for discussion

02:33 - 09.418 and we ended up closing the morning session.

02:33 - 12.538 Talking about childcare and I'm.

02:33 - 13.938 Going to turn it over to

02:33 - 16.018 secretary our coach.

02:33 - 21.258 There we go

02:33 - 21.948 alright

02:33 - 23.368 thank you mr chairman

02:33 - 24.708 we've got a couple of

02:33 - 27.770 clarifications to address that report and also I just

02:33 - 30.498 want to correct something that I said this morning

02:33 - 33.798 on that forty days of time

02:33 - 39.198 that a family has over the course of a year of child care

02:33 - 42.605 to ensure that their child ten fifty if they miss

02:33 - 45.978 more than forty days then they are at risk from being

02:33 - 48.058 separated from the program

02:33 - 52.644 and that I had said this morning that that was a federal requirement it's actually in

02:33 - 55.498 our state regulatory requirements

02:33 - 58.698 those requirements were updated in two twenty twenty three

02:33 - 03.894 and prior to that apparently was twenty five days days and so there must have been

02:34 - 07.578 some discussion about why twenty five perhaps was too little

02:34 - 09.648 but the rags that passed in twenty

02:34 - 10.788 twenty twenty three

02:34 - 13.048 were to Dakota forty

02:34 - 13.788 and just to

02:34 - 15.738 give some examples and

02:34 - 19.018 so again it is over an entire twelve month period

02:34 - 24.378 a family who wished to pull their child out for say a religious holiday

02:34 - 25.488 that would be

02:34 - 27.198 counted in that forty days

02:34 - 30.230 if a family was actually able to take a couple of days

02:34 - 32.778 of vacation that would be counted in that forty days

02:34 - 35.148 if a parent I

02:34 - 38.388 could not bring their child to child care

02:34 - 39.918 because maybe they had a

02:34 - 43.128 sibling homesick and they didn't feel comfy but leaving the house like

02:34 - 46.258 it's all of those types of reasons

02:34 - 48.948 that go into that forty day count

02:34 - 51.778 so I just wanted to clarify

02:34 - 53.598 that it is something that

02:34 - 57.048 you know again no one's ever excited to reopen rags

02:34 - 58.498 but if there was an

02:34 - 59.028 you know a

02:34 - 02.358 strong feeling about it certainly it's a conversation that we could

02:35 - 02.658 I'd

02:35 - 06.018 love to continue to dialogue with you in conversation because certainly

02:35 - 06.648 and again

02:35 - 09.834 to use the example I did with with a squirrelly you think they're certainly

02:35 - 12.238 differential between excused absences.

02:35 - 12.888 An

02:35 - 14.638 Unexcused absences.

02:35 - 17.338 I'm more concerned on the side of.

02:35 - 19.262 The the unexcused side of thing as opposed to

02:35 - 21.618 someone say hey we're going to go visit my in-laws

02:35 - 23.536 on the other side of the country for a week

02:35 - 25.998 or something but would love to have that th is.

02:35 - 29.718 I just feel that strongly with given the importance of this subject and

02:35 - 31.758 in the need for it and communities

02:35 - 34.728 and I think I heard the term earlier a child care desert

02:35 - 36.208 you know where people

02:35 - 37.998 are looking for investment

02:35 - 41.574 or you know if it's on the pre k side looking for slots you know and they won't do

02:35 - 42.888 anything we can to get people off

02:35 - 45.678 the list of waiting to get in the door so

02:35 - 48.413 I appreciate that and then you had another yes and then

02:35 - 51.528 we did want to address that report center recover we

02:35 - 53.368 have determined

02:35 - 54.258 that

02:35 - 56.958 the two percent payment error rate is accurate

02:35 - 01.100 and that is below the national payment error rate which we think is three points

02:36 - 03.318 something we couldn't track down the exact number

02:36 - 04.308 but

02:36 - 07.504 the other percentage that you referenced is an

02:36 - 10.278 administrative error rate and deputy secretary brown will

02:36 - 12.138 tell you a little bit more about that

02:36 - 15.918 sure so the administrative error refers to to

02:36 - 20.298 do that maybe the misapplication of a policy a rule or rag

02:36 - 23.538 but it does not necessarily result in any

02:36 - 25.218 change to the payment amount

02:36 - 27.358 issued to the recipient.

02:36 - 30.036 The most common cause I think that was the other part

02:36 - 33.138 of your question the most common administrator error

02:36 - 36.228 that we saw was failure to process the case

02:36 - 38.308 within a thirty day window.

02:36 - 44.784 Which is really timing so although not required by the feds we actually do require

02:36 - 46.428 our early learning resource centers

02:36 - 49.728 or Arielle our seas to actually complete a plan of correction

02:36 - 51.438 if they have an administrative

02:36 - 52.278 error rate

02:36 - 54.178 above ten percent.

02:36 - 57.668 Well thank you very much for that

02:36 - 01.998 what we're gonna do is we're going to continue into round two where we had members

02:37 - 03.678 up for five minutes a piece

02:37 - 08.458 up next we're going to start off with senator penny cook followed by senator Vogel

02:37 - 09.648 thank you mr chair

02:37 - 10.518 and

02:37 - 13.677 I see that the governor keeps your operating fund level.

02:37 - 15.168 In the out years is

02:37 - 17.538 pretty level which is great because we're

02:37 - 19.608 a state that unfortunately has some

02:37 - 20.968 budgeting issues

02:37 - 22.938 we're spending more than we're bringing in

02:37 - 24.418 and.

02:37 - 25.578 If

02:37 - 28.158 You only were to receive

02:37 - 30.468 the one hundred and forty eight point two million

02:37 - 32.058 for your g geo

02:37 - 35.598 and didn't receive the increase of fifteen point five purse

02:37 - 37.678 fifteen point five million.

02:37 - 40.428 What would you be able to do

02:37 - 43.098 and what would you have to cut to stay within that

02:37 - 43.664 that

02:37 - 45.448 financial frame.

02:37 - 48.138 And this is specifically for judea

02:37 - 49.068 that you're asking

02:37 - 50.398 me.

02:37 - 58.438 Video is an administrative appropriation obviously you talked about that.

02:37 - 03.054 So a lot of the costs that are incorporated into that change from twenty five twenty

02:38 - 07.098 six to twenty six twenty seven is really related to staffing so we

02:38 - 10.528 if we didn't receive the amount that were requesting.

02:38 - 13.961 Outside of the initiative which is for the child line staff

02:38 - 16.065 for twenty staff six hundred and fifty eight thousand

02:38 - 20.668 everything else is to maintain staffing levels as they are and to fill vacancies.

02:38 - 22.018 So that means

02:38 - 23.808 we might not be able to

02:38 - 27.178 do some of the work that we're currently doing today.

02:38 - 29.628 How many vacancies do you have currently

02:38 - 30.648 on your books

02:38 - 32.641 in gg oh I think there's one hundred vacancies

02:38 - 35.158 out of one thousand and sixty positions

02:38 - 36.538 but.

02:38 - 42.148 Of those sixty one of them were not able to be filled because we had a late budget.

02:38 - 45.208 Okay

02:38 - 48.178 and the other forty have been vacant for how long.

02:38 - 50.028 In general are vacancy

02:38 - 52.078 turn is pretty

02:38 - 53.458 pretty frequent.

02:38 - 56.568 So I don't have specifics on all forty but we could certainly provide it

02:38 - 58.048 okay.

02:39 - 02.201 As in you've already spoken about some of the efficiency

02:39 - 06.058 things that you guys are doing which I absolutely love.

02:39 - 10.338 Do you have any other ideas of how your agency can you

02:39 - 12.228 become lean more efficient

02:39 - 16.228 more effective with every little taxpayer dollar that you get.

02:39 - 19.648 Yeah yeah that is something that we're always looking at.

02:39 - 21.768 Some of the other efficiencies that

02:39 - 24.588 I didn't have a chance to get into earlier today

02:39 - 27.598 are things as simple as

02:39 - 29.568 we are consolidating our space

02:39 - 31.758 we've had multiple

02:39 - 32.908 departments.

02:39 - 33.779 Are

02:39 - 35.784 sorry multiple program offices moved together

02:39 - 41.668 consolidate space and in any way that we can we are

02:39 - 45.138 and this is going to sound crazy but when you're as big as we are

02:39 - 48.836 we are saving five million dollars in furniture

02:39 - 51.948 costs because we are repurposing existing

02:39 - 52.518 deep

02:39 - 55.288 existing commonwealth furniture.

02:39 - 58.248 Remember we have facility he's everywhere right we have

02:39 - 02.538 county assistance offices in every county some have multiple and

02:40 - 05.208 we have staff all over the place and so

02:40 - 09.168 we have sixteen thousand people that work for us and so it

02:40 - 11.578 when we can repurpose furniture.

02:40 - 15.288 Everything big and small and I use that as an example of things that

02:40 - 16.908 we are doing

02:40 - 19.788 just make sure we're turning over every single leaf

02:40 - 25.074 does that mean you go to that warehouse over I you know I I'm afraid to actually know

02:40 - 28.158 the answer to that question I have a deputy secretary

02:40 - 29.432 who actually.

02:40 - 32.248 I only ask because when i.

02:40 - 34.228 After the hearing.

02:40 - 35.958 The number of desks and

02:40 - 39.268 stuff they have and it was really surprising.

02:40 - 41.884 Cinders you know many other things but that

02:40 - 43.788 kind of gives you the sense of we're looking at

02:40 - 45.588 well five million dollars is a lot of money

02:40 - 48.978 if we're not spending on furniture could go to helping

02:40 - 49.848 Pennsylvania

02:40 - 51.658 so I'm all about that.

02:40 - 53.942 We routinely see that some agencies hold onto the

02:40 - 56.838 money that was appropriate in a prior fiscal year

02:40 - 58.288 and.

02:40 - 00.959 Then you need to ask for a waiver did you request a

02:41 - 05.098 waiver to hold onto last year's prior money's we did.

02:41 - 06.178 Yes we did

02:41 - 08.968 and could you tell me how much that was.

02:41 - 13.018 In the.

02:41 - 18.598 Do you just blue book we actually have an entire section on waived funds.

02:41 - 20.358 And it

02:41 - 25.018 is by fiscal year so it starts on page eleven of your budget materials

02:41 - 26.878 through page fifteen.

02:41 - 29.638 And the total.

02:41 - 33.508 That's waved across all of the appropriations

02:41 - 35.488 and this would include federal.

02:41 - 39.148 Is two point nine billion.

02:41 - 42.388 Yeah two point nine billion.

02:41 - 43.498 Including federals.

02:41 - 44.388 Okay

02:41 - 49.068 and so you knew last year we were able to claw back three

02:41 - 52.098 billion dollars from different agencies and in

02:41 - 54.348 different monies that were sitting in these accounts

02:41 - 58.428 do you expect to have any extra funding this year that we can maybe

02:41 - 00.268 potentially help.

02:42 - 04.468 The budget deficit that we're walking into this year.

02:42 - 08.244 I think it's something we'll have to continue to monitor as we get through the end of

02:42 - 11.724 the fiscal year and it's certainly something we take into consideration when we make

02:42 - 14.928 the request to hold funds through a three ten three waiver

02:42 - 16.198 into the next year

02:42 - 18.438 but right now the funds that were holding

02:42 - 21.988 we have specific purposes that were holding them for.

02:42 - 23.808 Okay great thank you you're welcome

02:42 - 25.828 thank you mr chairman.

02:42 - 32.308 Up next we have senator Vogel fall by sen brown.

02:42 - 35.274 Thank you good afternoon again secretary.

02:42 - 39.564 I'm going to talk about the increased in federal funds as part of the discussions in

02:42 - 43.434 last year's budget it was recommended a dhs request approval for the federal funds

02:42 - 46.218 participation in the workers with job success component of

02:42 - 48.768 the medical assistance for workers with disabilities act

02:42 - 49.948 program.

02:42 - 51.318 Did you reapply for that

02:42 - 52.278 program

02:42 - 55.758 we did and I believe we were not able to achieve

02:42 - 56.208 any

02:42 - 57.640 imagine that

02:42 - 01.410 it has to do with the structure of the program I'm not exactly sure what the

02:43 - 03.730 specific issues are

02:43 - 06.190 but I believe we did reapply.

02:43 - 12.576 We are planning to send another request based on the fiscal code language that was in

02:43 - 15.270 the twenty five twenty six six fiscal fiscal code

02:43 - 16.830 but I the

02:43 - 18.240 overarching issue

02:43 - 20.912 is really that workers with job success can't have

02:43 - 24.700 different requirements than the mod program as a whole.

02:43 - 26.640 It'll be interesting to see if the

02:43 - 29.148 federal administration has a different view but

02:43 - 31.500 we are not optimistic that that will be the case

02:43 - 35.256 when do when is the application when you reapply I guess so it's not really a

02:43 - 38.250 reapplication what we'll do is likely just send them on

02:43 - 40.930 a formal request to reconsider

02:43 - 41.520 okay

02:43 - 42.940 okay.

02:43 - 44.290 Very good thank you

02:43 - 45.460 and also.

02:43 - 48.630 Secretary Kennedy made it a big deal about

02:43 - 49.870 the junk food

02:43 - 53.520 and junk food waiver I mean she eighteen states have already passed

02:43 - 54.690 the restrictions on.

02:43 - 59.490 Candies and sodas and stuff like that with snap benefits you have an opinion

02:43 - 02.560 you in favor of something like that or.

02:44 - 04.753 He was talking earlier before lunch with the

02:44 - 06.810 secretary of central street I guess about no.

02:44 - 11.020 Good food eating nutrition all that kind of stuff and I'm just wondering.

02:44 - 12.610 Yeah.

02:44 - 14.350 It's a great question.

02:44 - 17.366 So this is something that we've been keeping a really close

02:44 - 22.060 eye on in terms of what is going on in other states and

02:44 - 23.170 we

02:44 - 26.350 Just recently end of February I think.

02:44 - 28.260 My staff are part of a

02:44 - 33.220 webinar with several other states who are working to implement these waivers.

02:44 - 34.140 So

02:44 - 36.180 There's been a couple of

02:44 - 38.760 important take home points that we've heard so far

02:44 - 42.791 number one the way that the food and nutrition services

02:44 - 46.110 section of the us department of ag is rolling this out

02:44 - 48.480 is they're putting the entire onus

02:44 - 50.700 of this onto retailers

02:44 - 51.970 and grocers

02:44 - 54.280 and so yeah

02:44 - 54.990 so

02:44 - 56.410 In other words

02:44 - 01.650 it is the retailers that are being held accountable for making sure

02:45 - 06.280 that an individual does not purchase something that is on the prohibited list

02:45 - 07.110 and

02:45 - 10.770 so these other states are saying you know it's really putting a lot of pressure

02:45 - 15.840 they're not doing it through the abt system I guess that's a decision sns has made

02:45 - 17.965 is going they're putting it on the retailers and so

02:45 - 20.520 they and they have been very clear that they will

02:45 - 24.070 distant rural retailers who they believe are not.

02:45 - 25.420 Complying.

02:45 - 27.630 Another big challenge has been when

02:45 - 31.230 that somebody has to decide what's on or off the list

02:45 - 32.590 and.

02:45 - 33.120 That would

02:45 - 34.710 have to be all of you no doubt

02:45 - 37.740 and it is really difficult and

02:45 - 40.480 I'll give you one example some states.

02:45 - 44.460 How you can get coffee in a can very common at the store now right

02:45 - 48.990 if it has sugar in it they don't allow it but if it has sugar in it and milk

02:45 - 50.230 they do allow it

02:45 - 51.510 because there's milk in it.

02:45 - 53.700 So I'm just I'm just telling you

02:45 - 55.210 this is what

02:45 - 55.860 I do

02:45 - 57.160 also

02:45 - 03.490 and this would be very germane to us retailers and grocers that are near borders

02:46 - 04.620 every state

02:46 - 05.400 is different

02:46 - 06.730 that has done this

02:46 - 10.210 and so these retailers have to run two different systems

02:46 - 12.070 and they're are going to be held accountable

02:46 - 12.870 so

02:46 - 16.780 Just making this up let's say west Virginia did it and we did it.

02:46 - 19.830 Anybody on the border who had people shopping first they'd

02:46 - 22.840 have to see are you from west Virginia or Pennsylvania

02:46 - 26.200 and then they would have to make sure that they didn't buy anything.

02:46 - 27.870 Depending on their

02:46 - 28.410 state

02:46 - 29.920 so.

02:46 - 34.680 It is very complicated in the way that this is being rolled out

02:46 - 39.090 I think if the federal government and the secretary really feel strongly about this

02:46 - 42.870 they should do this at a national level so that all the states are the same

02:46 - 44.520 and there's a set of criteria

02:46 - 46.140 that everybody can do

02:46 - 46.980 but

02:46 - 51.186 what I do want to take this opportunity to do is to thank you all because as part of

02:46 - 53.340 the twenty five twenty six budget you

02:46 - 56.970 put funding towards food box I think it was two million dollars

02:46 - 02.130 and food backs has been shown to actually improve the

02:47 - 04.740 composition of food that people with snap by

02:47 - 07.680 and the reason is that when you use food backs

02:47 - 09.210 it gives you a discount

02:47 - 11.460 on fresh fruits and vegetables

02:47 - 12.330 and

02:47 - 14.963 one of the primary reasons people with snap don't

02:47 - 17.880 buy a lot of healthy food is it's just too expensive

02:47 - 20.140 they can buy a lot more calories.

02:47 - 22.000 When they're buying chips

02:47 - 23.530 and so

02:47 - 27.726 I would encourage us at least for now till we have a better sense of how this is

02:47 - 30.370 going to impact our grocers in particular.

02:47 - 33.722 Let's double down on things like food bucks those

02:47 - 36.930 are well proven well studied programs that we now

02:47 - 38.080 do improve

02:47 - 39.780 the healthy food that people eat

02:47 - 43.980 and of course obviously the governor is doing his own doubling down and and

02:47 - 46.560 supporting or investing in investments for health

02:47 - 49.470 which would get medically tailored meals to people who have

02:47 - 52.470 diet sensitive conditions to try to maintain their health

02:47 - 54.420 that I think is the best way to go

02:47 - 55.110 ok

02:47 - 58.900 Thank you for your opinion and your some clarity on the situation appreciate.

02:47 - 59.220 This

02:47 - 59.790 is very

02:48 - 01.170 confusing sounds like

02:48 - 04.351 yeah it's tough when the real Taylor I mean it's really tough for the.

02:48 - 06.070 Vegetarian.

02:48 - 07.720 Thank you senator

02:48 - 10.843 next week senator brown followed by center recover.

02:48 - 14.430 Thank you mr chairman thank you again for both being here

02:48 - 16.000 and.

02:48 - 17.860 Boy that whole conversation

02:48 - 18.840 with

02:48 - 23.166 the u PC system and all of that it doesn't seem like it should be that difficult but

02:48 - 24.690 I can understand what you're saying

02:48 - 25.740 there by

02:48 - 29.610 the retailer but that's something I think will follow pretty strongly

02:48 - 32.460 and obviously you have seen

02:48 - 35.910 the statistics of the senior population growing

02:48 - 38.813 and the numbers the last I heard was one in three

02:48 - 42.190 pennsylvanians will be seniors by twenty thirty.

02:48 - 44.500 So as that is happening

02:48 - 48.060 we are seeing closures and consolidations

02:48 - 49.020 of

02:48 - 50.820 Nursing homes and skilled

02:48 - 51.630 you know

02:48 - 54.220 skilled nursing homes long term care

02:48 - 55.330 and.

02:48 - 57.210 When we really should be

02:48 - 58.590 improving them

02:48 - 00.460 and building them.

02:49 - 03.340 As a department do you have

02:49 - 07.860 recommendations for the legislature even for yourself on ways that we can

02:49 - 09.280 incentivize

02:49 - 12.250 the highest quality providers

02:49 - 15.180 and in nursing and long term care homes

02:49 - 20.736 where we recognize them in Pennsylvania where we know that they are high quality we

02:49 - 23.490 know what they're doing is there any suggestions that you have.

02:49 - 25.180 Yeah.

02:49 - 28.060 I appreciate that question and.

02:49 - 28.590 Just

02:49 - 29.790 to add to the

02:49 - 31.500 sort of data around this

02:49 - 32.580 and

02:49 - 35.397 people with disabilities and older pennsylvanians

02:49 - 38.950 constitute just thirty percent of our medicaid population

02:49 - 43.110 but they account for seventy eight percent of our medicaid spend

02:49 - 47.800 so this is something that we're obviously keeping very very close eye on.

02:49 - 51.930 I also just want to state

02:49 - 53.140 that

02:49 - 54.750 when we look at

02:49 - 59.140 the entire universe of care available to older adults.

02:49 - 06.516 It is most cost effective if individuals can age in their communities with home and

02:50 - 10.060 community based services compared with.

02:50 - 12.330 Being in a nursing facility

02:50 - 13.570 and again I just want to

02:50 - 14.650 reiterate that.

02:50 - 17.666 The folks that qualify for home and community based

02:50 - 21.270 services they are nursing facility clinically eligible

02:50 - 25.810 they have needs that would absolutely allow them to be in a nursing facility

02:50 - 27.930 but most of them choose

02:50 - 29.370 to stay in their community

02:50 - 30.210 and

02:50 - 32.777 are able to to do so with home and community

02:50 - 35.830 based services which remain less expensive

02:50 - 38.290 than moving into a nursing facility.

02:50 - 41.580 In fact we are incentivized to move people

02:50 - 44.028 out of nursing facilities by a number of

02:50 - 47.290 programs because they are more cost effective.

02:50 - 47.910 I

02:50 - 52.120 I want to point to something that has been extremely succeed Asheville.

02:50 - 54.240 Which is a a new model

02:50 - 58.540 that is a nursing facility that has started a program

02:50 - 00.690 and now they're expanding to a second site

02:51 - 02.170 to.

02:51 - 08.350 Bring individuals with serious mental illness into their nursing facility

02:51 - 11.020 often these people have prior.

02:51 - 14.440 I have served prior incarceration

02:51 - 16.343 periods of incarceration and they're very

02:51 - 19.540 complicated individuals to care for and house

02:51 - 21.420 and they have decided to actually take this

02:51 - 23.310 an affirmative way

02:51 - 25.230 and have been

02:51 - 28.992 incredibly successful with no issues of

02:51 - 33.010 escalations of behavior requiring intervention

02:51 - 36.390 reduced trips to emergency rooms things like that

02:51 - 41.826 so from where I sit today and in the context of this and hot tire conversation about

02:51 - 46.600 the importance of making sure we're spending every dollars wisely as we can.

02:51 - 47.800 I think that we

02:51 - 49.660 should be looking at.

02:51 - 51.120 Everything that we can

02:51 - 52.710 are doing and continue to do to

02:51 - 54.300 care for people in the community

02:51 - 57.510 and then thinking about nursing facilities

02:51 - 58.140 and

02:51 - 00.600 and working with them to take on some of these

02:52 - 06.696 more nuanced programs that are serving individuals who are probably never going to be

02:52 - 08.130 able to be served in the community

02:52 - 12.690 that that is going to be where I am see our need growing over the next decade

02:52 - 14.190 those more targeted