00:01 - Morning welcome to day three of week two

00:04 - of our budget hearings were glad today to be joined.

00:08 - By the largest department in our state government department of

00:11 - human services so glad to have

00:14 - secretary and all.

00:17 - Have her team here especially those teammates

00:20 - that live in the one hundred and eighty six legislative districts.

00:24 - I will not embarrass her

00:25 - this year.

00:27 - But it is

00:28 - definitely a blessing

00:29 - to have you all here to answer questions

00:32 - about

00:32 - honestly

00:33 - some of our most vulnerable populations.

00:36 - In the commonwealth of Pennsylvania before we begin to miss druzy

00:39 - any introductory comment yes thank you chairman Harris

00:41 - good morning secretary our cushion your your team

00:44 - dhs all day today

00:46 - we're excited

00:47 - and so the governor is proposing a total general

00:50 - fund spend of twenty one point nine four billion

00:54 - dollars forty two percent

00:55 - of.

00:56 - That is roughly forty two percent of the overall general fund

01:00 - spending proposal

01:01 - representing a one point three six billion deal dollar or six point six percent

01:06 - increase over the current fiscal year.

01:09 - I think we eat we should note though that one point zero seven billion of that or

01:13 - seventy nine percent is attributed to the

01:15 - tribble to medical assistance capitation in medical assistance

01:19 - community health choices line items

01:21 - I think it's also important to note that that

01:24 - ge general fond request could have been larger

01:26 - if not for the increase in the the federal f map

01:30 - funding so

01:31 - we are able to

01:32 - effectively reduce the appropriation fraught by about five hundred and seventy

01:36 - million thanks to that increase in the f map

01:38 - which is the federal medical assistance percentage for people that

01:42 - don't know what that is

01:44 - and

01:44 - last year's budget I think we we we made some progress with some program integrity

01:48 - measures and we're anxious to hear you know

01:50 - how

01:50 - those are being implemented if those have been effective

01:53 - we also

01:54 - look forward to hearing about the the snap error rate and

01:58 - your efforts to try and reduce that

02:00 - so that we're not penalised federally.

02:03 - So there's a lot to get through today off obviously.

02:06 - We're look forward to hearing your testimony and that of your team

02:09 - and without further delay let's get started thank you.

02:13 - Thank the gentleman

02:14 - in the middle of the table is our timekeeper.

02:18 - We're going to be strict today.

02:21 - With everybody.

02:23 - On our timekeeper.

02:25 - Because

02:26 - we have a lot of questions on both sides I'm pretty sure

02:29 - and so we want to

02:30 - get as many questions in as possible

02:32 - when the light turns green

02:34 - that will mean that our members will be able to commence with their questioning

02:38 - when a light turns yellow

02:40 - on the news that there's thirty sec his left

02:42 - and when the light turns red we would accept folks will conclude.

02:46 - Before we begin if we could get everybody to stand up so we could swear by it

02:50 - because many of you are going to come up and ask questions.

02:54 - Do you solemnly swear that the testimony you're about

02:57 - to give is the truth the whole truth so help you god.

03:01 - Thank you.

03:04 - Secretary I'm told that you have

03:06 - introductory comments that you would like to make

03:08 - as thank you mr chairman and good morning

03:10 - everyone it's a pleasure to be here with my team

03:13 - and I appreciate just a couple of brief moments

03:16 - to share some introductory comments with you

03:18 - that first of all I do hope that you take a chance to read the testimony that we

03:22 - shared with you because on the first page of that.

03:25 - Testimony and into the second page

03:27 - are a long list of accomplishments that have

03:29 - happened here at the department of human services

03:32 - at most of them together with all of you for

03:36 - initiatives that you have supported

03:38 - that greatly benefit residents of the commonwealth of Pennsylvania so I really do

03:42 - hope that you take them on to look at this.

03:45 - At most of those

03:47 - accomplishments are around solving pain points and we're very very proud of that work

03:51 - but of course we are also looking forward continuously

03:54 - and we have some real challenges on our horizon

03:58 - as you

03:59 - know

03:59 - congress

04:01 - passed the one big beautiful build this summer side and by

04:04 - president trump on July the fourth

04:06 - and it is going to have a number of very direct impacts on the programs that we run

04:11 - here at the department of human services

04:13 - at first of all we're going to see an increase

04:15 - in the number of uninsured Pennsylvania once

04:17 - we've already started to see that with the loss of the enhance premium tax credits to

04:22 - help make penny plans more affordable

04:24 - a penny is now up to one hundred and four thousand people who have dropped their

04:28 - penny plants we have the institution of community engagement requirements

04:34 - we are going to see decreased coverage of lawful immigrants

04:38 - who previously have had access to medicaid

04:41 - coverage

04:42 - these are individuals here with lawful status for most

04:45 - of them that is going to be ending on October the first

04:49 - we're going to see an increase in food insecurity

04:52 - also related to some of this community engagement requirements

04:56 - and not on really

04:57 - what might we see an increase in hunger but

05:00 - we know from prior experience that when people lose access to snap

05:04 - it increases their spend in medicaid particularly for individuals who have diet

05:09 - sensitive conditions like medicaid.

05:11 - I

05:12 - Like diabetes

05:13 - so that is something we're extremely concerned about and

05:17 - we also have looming

05:19 - possibly as early as twenty twenty eight

05:22 - that would be the kind of worst case scenario

05:24 - at.

05:25 - Up to a twenty billion dollar cut over that next decade

05:29 - to our medicaid program

05:31 - that is the worst case scenario but it's a

05:33 - scenario that we need to be mindful of.

05:36 - So.

05:37 - We are very focused on looking at twenty six twenty seven

05:41 - and taking advantage of every opportunity that we can

05:44 - to reduce medicaid spending

05:47 - in way that actually helps Pennsylvania is

05:50 - and the governor has proposed

05:51 - several initiatives

05:53 - with that very set of goals in mind

05:55 - so first of all

05:57 - he has proposed investments in health

05:59 - these are a set of three programs that focus on

06:02 - food as medicine

06:04 - housing support for an housed people with significant medical conditions and a

06:08 - package of reentry programs all three of these

06:11 - have been shown to reduce spending in medicaid

06:15 - this is exactly what we want

06:17 - we want to have

06:18 - a reduction in the spend of medicaid by doing affirming things

06:22 - people that keep people healthy in the first place

06:24 - not just

06:25 - trying to cut services in some way

06:28 - secondly he has proposed increasing minimum wage

06:32 - I cannot think of a better way

06:34 - to have people

06:36 - move off of programs like medicaid and snap

06:39 - because they have earned their way off

06:41 - and so I just wanted to quadruple down on the governor

06:44 - his full throated call to increase the minimum wage

06:48 - we have net savings in our budget for twenty six twenty seven

06:52 - of about fifty million dollars based on

06:55 - that increase in minimum wage.

06:57 - Investing in our child care workforce is going to be essential to achieving this

07:02 - because we know that people can't go to work

07:04 - if they do not have a place

07:06 - for their children to be that is safe and healthy

07:09 - so the

07:10 - governor has continued to.

07:12 - At.

07:13 - Promote or

07:14 - to propose additional investments in our child care workforce

07:17 - and of course we always want to keep kids safe

07:20 - and

07:20 - one of the ways that we want to do that is enhance child line

07:24 - and enhance it in a way that not only are there more individuals there with better

07:27 - training and more support and more supervision

07:30 - but move toward a program where

07:32 - they can entry ies

07:34 - individuals who

07:35 - just need some simple help with certain support services in the community

07:40 - to that

07:40 - kind of help

07:41 - rather than full involvement in our child welfare system

07:44 - so I think what you'll hear today as we go through

07:47 - there's a lot of very forward looking smart investments

07:51 - that will produce safe savings

07:53 - and at the same time

07:55 - and I'm sure there'd be lots of questions about this

07:57 - we are taking our role

07:58 - as very careful stewards of taxpayer dollars so seriously

08:03 - and I'm happy to talk about all the work that we're doing

08:06 - to.

08:07 - Monitor our programs

08:09 - to monitor for fraud

08:11 - we work extremely closely with

08:13 - the office of the state inspector general

08:15 - and the attorney general

08:17 - and the department of state

08:19 - to refer suspicious activity

08:21 - for hopeful

08:22 - investigation and then prosecution were warranted

08:25 - and so we have a very tight partnership with all three of

08:27 - those entities I'm happy to get into more of that today

08:30 - sounds chairman thank you and appreciate the opportunity to be here

08:34 - thank you secretary we're

08:35 - going to start with representative con.

08:38 - Thank you chairman Harris

08:40 - thank you secretary or cushion thank you to your

08:42 - staff for your great work in the commonwealth.

08:44 - You mention in your testimony

08:47 - about the

08:48 - hr why the big bill that was passed

08:51 - on July fourth two thousand and twenty five a lot of

08:53 - my constituents were very concerned about this bill

08:55 - not only did it explode the federal debt

08:58 - huge tax cut for millionaires and billionaires

09:00 - but also the effects on human services programs

09:04 - that we minister here in Pennsylvania

09:06 - can you talk first about.

09:09 - How much of your budget actually is coming

09:12 - from the federal government

09:13 - dhs.

09:15 - Yeah well and what we typically talk about in these

09:18 - hearings is the state portion of the budget which

09:20 - for twenty six twenty seven the governor has

09:22 - proposed about twenty one billion dollars

09:25 - but

09:26 - if you add the federal dollars that come in through

09:28 - all of our programs our total budget right now

09:31 - is about sixty four billion in that range it's actually larger than the state budget

09:36 - and.

09:38 - How many people are currently enrolled in medical assistance and snap.

09:42 - So we have just under three million people enrolled in medicaid

09:46 - we have just under two million people that are enrolled in snap

09:50 - and my agency touches

09:52 - literally thousands of other Pennsylvania and

09:55 - at one example is

09:56 - that is our incredible licensing teams

09:59 - license eleven thousand ninety three total facilities across the commonwealth

10:04 - so this work supports.

10:06 - Almost cradle to grave from

10:08 - childcare

10:09 - all the way to.

10:10 - Nursing home assistance

10:12 - of

10:12 - Pennsylvania at every stage of life.

10:15 - Can you talk about

10:16 - the impact

10:17 - of hr.

10:19 - On these programs medical assistance and snap here in Pennsylvania sure

10:23 - so we're going to see the first tangible impacts of hr

10:27 - one in our budget in this twenty six twenty seven budget

10:30 - and I'm scenario

10:31 - starting with snap because those are the things that are impacting first

10:35 - so.

10:36 - Every state in the country

10:38 - will now now have to increase the share of the snap

10:41 - administration rate that they pay to seventy five percent

10:45 - historically it's been a fifty fifty sharing of those administrative costs between

10:50 - the state and the federal government

10:52 - and I just want to make clear this has nothing to do with the error rate

10:55 - this is a cost that

10:56 - is being pushed onto the taxpayers of every state in the country

11:00 - here in Pennsylvania

11:02 - in this first year

11:04 - it will increase our budget by eighty seven million dollars

11:08 - you'll see the lion's share of that in the ceo line and

11:11 - then it spread out in a few other places and that is.

11:15 - Only a partial federal fiscal year because you

11:17 - know the federal fiscal years hearts October first

11:20 - so next year when we have to bear the full brunt of this

11:23 - it will be about one hundred and twenty million dollars

11:26 - to go from that fifty percent of the admin share

11:28 - to the seventy five percent of the admin share.

11:31 - The other costs that we're going to see directly

11:33 - this year is in our emergency medicaid program

11:36 - emergency medicaid is required by the federal gov't

11:39 - payment of any state that runs a medicaid program

11:42 - this is how we pay hospitals for care that is provided in an emergency

11:48 - to an individual here without any legal status of any

11:52 - type and.

11:54 - Shows up

11:54 - in an emergency

11:56 - and

11:57 - the f map for that

11:59 - is being decreased so historically since the affordable care act passed

12:03 - if a person qualified for emergency medicaid

12:06 - because they were in the medicaid expansion population

12:10 - we got that ninety percent f map that anybody in medicaid expansion

12:14 - receives but

12:16 - hr one has drop that down to the regular f map

12:19 - that is going to cost us eighteen million dollars this year

12:23 - and about twenty four point three million dollars next year

12:26 - there's also a number of ity changes

12:29 - right now total it's about two point one million dollars

12:32 - those

12:33 - costs will continue to grow as we have to ramp up our systems to

12:37 - deal with community engagement and things like that

12:39 - then there's some other costs but I

12:41 - don't know how much time I have left but

12:43 - those are the things that we're going to see

12:45 - in this twenty six twenty seven budget

12:47 - it's pretty

12:47 - pretty devastating for

12:49 - people who rely on their services just when my

12:52 - last question is wanted to ask you you talked about a

12:55 - twenty billion dollar hole

12:57 - because of this medicaid financing role as part of this hr one

13:01 - over the next decade in Pennsylvania twenty

13:04 - billion dollar hole

13:05 - in our budget here in Pennsylvania over the next decade can you talk a little

13:09 - little bit about what that is correct

13:11 - that that is the worst case scenario potentially

13:13 - beginning and twenty twenty eight we're hoping we might

13:16 - be able to push off until twenty thirty

13:19 - but we won't really know until it gets closer

13:21 - and that is coming from

13:23 - a couple of places number one

13:25 - the

13:27 - hr one

13:28 - ratchet down the amount of funding that can be obtained through provider assessments

13:34 - and that right there is the lion's share of those cuts

13:38 - the other really important thing is state directed payments will be limited primarily

13:44 - one of the biggest hits will be that currently most hospitals are getting paid the

13:48 - average commercial rate through medicaid

13:50 - by the addition of state directed payments the hr one requires that we cap at medicare

13:57 - rates

13:58 - and medicare rates

14:00 - are are

14:01 - not

14:01 - close to average commercial rates for most services and so that total of that

14:07 - is where that twenty billion dollars comes

14:09 - and you know frustratingly

14:12 - the lion's share of those cuts are going to fall

14:14 - on our hospitals particularly our rural hospitals

14:17 - because they benefit the most from some of these

14:20 - assessments and other state directed payments

14:22 - thank you madam secretary thank you for sharing

14:24 - thank the gentleman representative mo Stella

14:27 - thank you mister chairman.

14:29 - Or madam secretary as part of the big beautiful

14:31 - bill that we were just discussing hr one

14:33 - Pennsylvania was awarded one hundred and ninety three million dollars to strengthen

14:38 - and modernize healthcare in rural communities

14:40 - and I know you were a county commissioner for

14:43 - quite some time

14:44 - and I don't know throughout your travels in Pennsylvania if you've ever discussed

14:48 - with other county commissioners and some of the more rural areas

14:51 - of Pennsylvania

14:52 - and the decline in rural healthcare and we talk about vulnerable population

14:59 - we talk about maternal health care where.

15:02 - That

15:03 - is happening right now in rural Pennsylvania

15:07 - and I think it's very encouraging to see

15:10 - the new administration in Washington DC recognizing this as a problem

15:14 - because it seems it's been neglected for years in Pennsylvania

15:17 - that there's some focus on it with one hundred and ninety three million dollars

15:21 - being infused into Pennsylvania to help that vulnerable population in those.

15:26 - You know women who are pregnant

15:28 - and need the maternal health care that is not being provided to them in these areas

15:33 - so with that

15:34 - we saw the budget

15:35 - or the the governor's address

15:37 - kind of layout broad categories

15:40 - of how this money is to be spent

15:42 - and

15:42 - where it's to be spent

15:44 - can you please provide us more details on that and what to

15:47 - what you're proposing to do with that

15:49 - shirt

15:50 - and first of all just want to make sure there's a packet of papers on your desk

15:53 - and everyone's got this one

15:55 - that is all about real health transformation so

15:58 - I don't I know I have very limited time so I just

16:00 - want to make sure I draw your attention to this

16:02 - so I think what's most important to understand about our rural health transformation

16:06 - plan is that rural health has been something that governor shapiro

16:09 - and this entire administration has been focused on since we walked in the door

16:13 - and the reason is I think I'd been here about three weeks

16:16 - when we heard from see him am I that they were no longer going to continue that

16:20 - Pennsylvania rural health model they were ending it that was a federal decision so we

16:25 - have been focused on rural health from sick

16:27 - at day one

16:28 - we had the first convening that the governor pulled together

16:32 - in I think the fall of two thousand and three or early part of twenty four

16:35 - and then since then we have now held I believe ten or twelve world health summits

16:41 - each of those summits

16:43 - involved all

16:45 - multiple counties and all the local folks including the county commissioners I mean I

16:49 - really tried to get them to come because they're integral to this

16:52 - and this entire plan

16:54 - has been built on what we heard at those rural health summits

16:58 - and so this plan is very locally driven it is

17:01 - not going to be driven from here in Harrisburg

17:03 - there'll be eight rural care collaboratives that

17:06 - will be set up along the lines of the existing

17:10 - some places call them prep some people call

17:12 - them local development districts but existing.

17:16 - County boundaries that already are counties working together in economic development

17:20 - and they will be able to prioritize

17:23 - the spending of the dollars

17:26 - the the dollars will be allocated to each region

17:29 - using a formula allocation and then they'll be able to

17:32 - prioritize

17:33 - how those dollars are spent in their region

17:35 - bay based on what is allowed in this rant

17:38 - and you'll see on the back of this the things that

17:40 - are being prioritized maternal health being one

17:44 - and

17:45 - so you've been working on this for three years now

17:47 - how many closures have we had especially

17:49 - in this northwest in the north central

17:52 - I mean

17:53 - in these areas

17:54 - there have just been closures all over the place so

17:57 - do you mean okinawa.

17:58 - Metrics or actual hospital

18:00 - hospitals.

18:02 - At all.

18:04 - Just hospitals three that have stopped doing obstetrics

18:07 - alcorn

18:08 - and

18:09 - and they cover a lot of counties I mean it's not

18:11 - just

18:12 - and then of course Bradford just clothes

18:14 - announced that they are

18:15 - reading and they were doing ob

18:16 - and that one was particularly complicated because of their relationship

18:21 - their

18:21 - their

18:22 - owner relationship with a hospital in new York

18:25 - and that native solution very

18:26 - okay

18:27 - and when do you when will you start when will dhs start

18:31 - meeting with these

18:33 - areas

18:34 - with the stakeholders and

18:36 - how closely are you going to listen to them

18:38 - and making sure that.

18:40 - You know sometimes the bigger providers

18:43 - may get

18:44 - that's a very good question when we were very thoughtful yeah

18:47 - so let me tell you first of all I think there's one thing that

18:50 - has not been widely understood about this Grant.

18:53 - The Grant specifically says that we cannot use this money to help operating expenses

18:59 - of hospital and that was devastating for the

19:01 - hospitals when the Grant actually came out

19:03 - cause I think hospitals have been given a very different message

19:07 - but that was that is the Grant we cannot use money

19:09 - we can use money to help buy a mobile Van to do

19:13 - telehealth you know they have houses

19:15 - that we can't so that's number one

19:16 - number two is I will be announcing shortly hopefully a date in early April

19:22 - for a webinar that we incur urge everyone

19:25 - to watch that will talk about our first year

19:28 - of our rapid

19:29 - stabilization fund and how people will be able to apply for money right away

19:34 - for things that are eligible under the Grant

19:37 - and at the same time we'll be hiring the staff for the rural care at the rural care

19:41 - collaboratives and working on that

19:43 - in parallel so all of that is going to start

19:46 - a.

19:46 - Pretty quickly we've been working out all the final details with cms

19:50 - and how many

19:51 - how many of your team members will be.

19:54 - I haven't asked at all for the past two weeks.

19:57 - How many members of your team will be conducting

20:00 - these interviews do you already have those.

20:03 - The member set from your team who are

20:05 - doing this

20:06 - internally we have.

20:09 - Four three full time staff on this Grant as well as one of my special

20:14 - really one full time special adviser and one part time special adviser working on

20:17 - rural health and a whole bunch of

20:19 - other members of my team and then each rural care collaborative will have.

20:24 - Ask the person that will be hired by dhs

20:26 - we're hoping to co-locate them with their prep or ltd in their region

20:31 - and then they'll be convening tables and the tables will be all the folks you

20:35 - mentioned at the beginning of your quest okay go.

20:38 - Out and I just have to get if you wouldn't.

20:40 - Mister

20:41 - Herman

20:41 - and the grants specifically says

20:44 - that if a hospital is owned

20:47 - I some other entity

20:48 - the people at the table at the rcc

20:52 - must be local hospital leadership

20:55 - and we wrote that into the Grant

20:56 - or all the concerns I know we are

20:58 - great I just worry about rural Pennsylvania thank you.

21:01 - Hey most

21:02 - get your sad face for the day.

21:05 - Yeah.

21:08 - Representative friel.

21:09 - Thank you chairman

21:10 - and

21:11 - secretary are crushed thank you for coming here today

21:14 - last week we had.

21:15 - Our insurance commissioner here and talking about

21:18 - how the cuts have impacted Patti

21:20 - and and we've seen that and

21:22 - I think as you just testified in their opening

21:24 - remarks over one has one thousand people

21:26 - have

21:27 - been elected office

21:29 - have elected to get off a penny because they

21:30 - cannot afford it are often making choices between

21:33 - feeding themselves were paying for a roof over their head and

21:37 - medical insurance

21:38 - and then

21:39 - we add to that that there's three hundred

21:42 - thousand people are going to be

21:44 - lost in Pennsylvania

21:45 - off of medicare medicaid eligibility

21:48 - we're going to have I think about a half a million more

21:52 - uninsured Pennsylvania is

21:55 - because of the big

21:56 - beautiful bill.

21:57 - We already have six hundred and ninety four

22:00 - thousand people who are uninsured in Pennsylvania

22:04 - and where we're looking at billions of dollars in cuts over the next couple of years.

22:09 - My concern is the business side of this is how this affects hospitals

22:14 - and our

22:15 - our network of providers for healthcare because

22:18 - all those dollars are going to a hospital

22:21 - and I believe federal law.

22:23 - Hospitals have to

22:24 - provide uncommon conceited care for those insurance

22:28 - for those uninsured

22:30 - can you

22:31 - tell us about your concerns on how this is going to impact healthcare providers in

22:35 - Pennsylvania and their ability to stay open.

22:39 - Yeah so

22:40 - we're deeply concerned

22:42 - and

22:43 - as we've already talked about a little bit it's really going to be our rural

22:46 - hospitals that bear the brunt of this

22:48 - so many of our rural hospitals

22:50 - and on if you look at any third quarter of their business

22:54 - are

22:54 - with a negative operating margin or break even

22:57 - almost none are positive operating margins right now

23:01 - so we when I say that the brunt of these cuts are going to fall on those hospitals

23:05 - that is part of that statement is they're

23:07 - already hanging on by a thread in many cases

23:11 - and i.

23:13 - I think that

23:14 - anything that the general assembly can look at

23:17 - I know commissioner humphries has talked about the state stabilization plan

23:21 - a way to

23:22 - even partially back fill some of those enhance premium tax credits

23:26 - that

23:27 - have been taken away federally

23:29 - would be something that is worthy of conversation and discussion

23:32 - anything that week do to help keep people insured

23:35 - insured will be helpful

23:37 - and then finally I would

23:38 - point you to a report that the hospital and

23:40 - health system of Pennsylvania recently put out

23:43 - that did a very careful analysis of

23:46 - current state of hospital finances and I believe that reports

23:50 - suggested that at twelve hospitals are really close to having to close

23:55 - with these types of impacts that we're talking about.

23:58 - Yeah I'm I'm very concerned about not just you know some of the rural hospitals but

24:01 - also in our suburban centers where we're seeing really tight cash flow and

24:06 - as the uninsured population goes out we know that

24:08 - medicare medicaid is only paying cents on the dollar

24:11 - and we're also seeing that.

24:13 - As the just

24:14 - as he's consolidation happenings we see

24:17 - patient care shifting too

24:18 - because of the reimbursement indexes to the city hospitals first seemed level of care

24:23 - maybe forty five minutes away

24:25 - were seen as a cash crunch on on hospitals local to me in pottstown

24:29 - our local hospital laid off two hundred workers

24:31 - closed the maternity ward

24:33 - your cancer infuse the center

24:34 - closed the I see you

24:36 - and.

24:37 - That's no longer

24:38 - care so it's it's not even if you

24:41 - have insurance or

24:43 - that you can get it we're going to lose

24:45 - care

24:46 - givers so even folks with insurance will not be able to be

24:50 - to find providers.

24:52 - What

24:52 - what can we do

24:54 - besides fun the current system to

24:57 - to.

24:58 - Deliver health care to both our suburban communities

25:01 - and our our rural communities in the future.

25:05 - It is a it is a difficult problem

25:07 - representative and I think that.

25:10 - The more that we can

25:12 - double down on some of these programs that help keep people healthy in the first

25:16 - place you know that is just a step right it's a piece of this puzzle

25:20 - investments in half

25:21 - making sure that people

25:23 - need less care because they're doing well.

25:26 - Raising the minimum wage so that people have a few more bucks in their pockets to

25:30 - make sure that they can stay healthy.

25:32 - I think I know the house passed this already

25:34 - by the private equity

25:36 - bill is extremely important

25:38 - at.

25:38 - The last thing that we need in Pennsylvania is any more private

25:42 - equity acquisitions of our hospitals and these leaseback arrangements that they put

25:46 - into place where they sell the land under the hospital and then start

25:51 - requiring that entity to lease it back

25:53 - that just starts the clock toward bankruptcy so

25:56 - I just want to thank the house for passing that

25:58 - and again anything that we can do to help keep

26:02 - people insured

26:03 - is something that we should be very focused on right now

26:06 - is going to be tough going these next few years

26:09 - know and I

26:10 - hear it I think

26:11 - I think you said it earlier one of the most important ways we can keep people healthy

26:14 - is.

26:16 - Diet the snap benefits but we're getting a double whammy

26:18 - from that big beautiful bill that's cut people's food

26:22 - and we're often now making choices between

26:24 - healthcare food

26:26 - housing

26:27 - and every Pennsylvania

26:29 - is paying for that

26:30 - in the lab lack of access to care so thank you for the work you're doing thank you

26:34 - gentlemen representative all summer.

26:37 - Thank you mr chairman.

26:39 - Madam secretary thank you for being here this morning

26:41 - and the entire team.

26:44 - Madam secretary under the one big beautiful bill

26:48 - and

26:49 - established

26:50 - an.

26:51 - Hr one.

26:54 - Pennsylvania is slated to receive approximately one hundred and ninety three million

26:58 - to strengthen rural healthcare access.

27:01 - In rural counties like pike county.

27:04 - Which currently has no full service hospital.

27:08 - Community leaders back home are working to establish a micro hospital model

27:13 - to imp proof.

27:15 - Emergency services

27:17 - and.

27:19 - Limited

27:19 - inpatient beds.

27:21 - Diagnostic

27:23 - imaging and stabilized patients patients locally

27:26 - instead of transporting them long distances

27:29 - can you clarify

27:31 - whether the new rural micro hospital proj Jack particularly.

27:36 - In.

27:37 - A federally designated rural or underserved county.

27:41 - Would qualify as an allowable use

27:45 - of rural health

27:46 - transformation fund dollars

27:48 - under cms guidance yeah

27:51 - great question

27:52 - so pike county obviously

27:54 - on the map here anything that's

27:56 - colored in is eligible.

27:59 - So I'd I'd need a few more details but I can give you some

28:03 - rod comments

28:04 - the hospital itself

28:06 - like for instance the construction of the hospital

28:09 - operating expenses of the hospital would not be eligible.

28:13 - There's a there's a little bit of funding but it's cats

28:16 - that can be put towards an electronic health rep heard

28:19 - but

28:20 - they're really trying to discourage use of the funds to like pay for the initial

28:24 - installation of the electronic health record.

28:27 - That there is funding that we can put into connect

28:31 - that dhr to our health information exchange

28:34 - so that that micro hospital could become connected to

28:37 - our whole health information info restructure across

28:40 - estate which I would encourage.

28:42 - If that micro hospital wanted to.

28:45 - Set up opportunities for patients to have telehealth

28:49 - maybe they wanted to create a wellness hub near the hospital

28:52 - which would be a place where people could go to have a secure telehealth visit

28:56 - those types of things we can put money to

28:59 - we can put money toward buying a telehealth mobile Van

29:03 - so that services could be taken to where people

29:05 - are behavioral health or maternal services

29:08 - those are the types of things and there's some detail on the back of the sheet here

29:12 - but we're also very happy to sit down

29:14 - with any

29:15 - folks like this who want to go through and see

29:17 - if there's things that would be allergy apple.

29:20 - Is the spirit

29:21 - specific criteria already baked in as to what the

29:26 - requirements are and that the state needs to demonstrate

29:30 - in the rural health transportation plan to secure federal approval for such a project

29:36 - yes so we were basically handed those criteria yeah

29:40 - I cms

29:41 - so this is entirely federal money

29:43 - and they that all the rules and all the criteria and so

29:47 - we wrote a proposal based on the notice of funding

29:52 - opportunity that came from cms to meet those deadlines

29:56 - and then they're actually going one step further

29:59 - before sure they actually release any funds

30:02 - we will

30:02 - effectively be invoicing them for funding

30:05 - and then they'll have to sign off and then they'll release the money

30:09 - so they're monitoring this very closely to make sure that

30:12 - all of the expenditures are aligned with what's allowed.

30:16 - Okay

30:16 - thank you very much appreciate it thank you mr chairman

30:19 - thanks the gentleman you get a

30:21 - gold star alright.

30:24 - Representative

30:26 - mullins.

30:28 - Thank you mr chairman I'm

30:29 - trying for one of those too.

30:33 - I

30:33 - Good morning.

30:35 - Madam secretary thank you for being here.

30:37 - I've got real concerns

30:39 - about the loss of snap benefits

30:41 - for my residents and.

30:44 - People across

30:45 - hardworking people across Pennsylvania

30:47 - and then the impact that would have

30:48 - the downstream impacts that would have especially on the charitable food nowhere.

30:52 - As.

30:53 - My colleagues have and will continue to point out.

30:57 - So many of our.

30:58 - Constituents

30:59 - will

31:00 - be impacted by these

31:02 - federal changes and

31:04 - I'm worried that many of them don't even know they're happening.

31:07 - Or won't know how to meet the new requirements.

31:12 - Which brings up a question to mind.

31:14 - Are there already work search requirements for

31:17 - to to receive snap benefits.

31:20 - So the snap

31:22 - changes have been

31:24 - evolving over time.

31:26 - Back in June actually before hr one passed

31:29 - we had expiration of a few waivers that we had been carrying since

31:34 - covered I would add that

31:37 - waived work requirements and those expired because

31:40 - of employment rates had come way down so we just didn't qualify for this anymore

31:44 - but we still had another fairly sizable number of waivers

31:48 - that were due to expire September first

31:51 - and some of those waivers

31:53 - prior to hr one

31:54 - would have been eligible to be renewed

31:57 - that hr one changed the requirements for getty a waiver

32:01 - and now to get a waiver there has to be a ten percent unemployment rate

32:06 - in a region

32:07 - obviously governor shapiro has done a pretty good job of attracting businesses and

32:11 - growing jobs here so we don't have a ten percent unemployment rate thankfully

32:15 - anywhere in the commonwealth

32:17 - so the remainder of the waivers that we had expired on September the first

32:22 - so some of those folks and at this point

32:25 - we believe the numbers right around fifty nine

32:28 - thousand have already lost their snap benefits

32:31 - as of January the first then on November the first because of hr one

32:37 - there is an expanded set of requirements for people who may just work

32:42 - it can be work

32:43 - volunteer in the community or be in school for

32:45 - a certain number of hours around each of those

32:48 - and.

32:50 - It is a

32:51 - it is a list that is going to be very tough for a lot of folks

32:55 - have

32:55 - previously

32:56 - fifty four was the age where you topped out now it's sixty four

33:00 - and the job job market for fifty four to sixty four year olds is

33:03 - tough

33:04 - and many people are already retired

33:06 - correct

33:07 - at that point

33:08 - also if you have a child in the home previously under

33:11 - eighteen you were exempt now that's dropped down to fourteen.

33:16 - Interestingly and incomprehensible to me

33:19 - are people exiting foster care young adults x s

33:23 - exiting foster

33:24 - care between nineteen and twenty four years of age must work

33:27 - veterans must work

33:29 - and homeless individuals must work although I will say

33:33 - we did we do have some discretionary waivers as a state

33:36 - and we have chosen to use them for an housed individuals because it is

33:40 - very hard

33:41 - to get and keep a job if you are on housed and so we want to

33:44 - do some of this other work to get those folks housed and that

33:47 - help them get back into the workplace.

33:50 - That's what we're looking at right now I really appreciate the

33:52 - thoughtful answer and

33:53 - and

33:54 - reminding everyone

33:56 - just how stringent

33:57 - the existing work permits already were.

34:00 - And can you just talk about how.

34:03 - Top dhs is pursuing what are your efforts to

34:06 - make sure

34:07 - people

34:07 - are aware of these changes and

34:09 - remain enrolled because

34:11 - you all of us have our work cut out for us.

34:14 - So there's been a couple of things that we're doing first of all

34:17 - on the back end

34:18 - where we can match ap somebody who is a current recipient of snap

34:23 - and it's also in our medicaid program

34:25 - if we can document that they have a valid exemption to the work requirement

34:30 - then we just take care of that on the back end so that is not someone that we

34:35 - we reach out to

34:36 - for instance if we can document that they have a disability

34:39 - and that would exempt them from the snap work requirements we're trying to take care

34:42 - of as much of that pat on the back and as we can

34:45 - and then we are communicating to people extensively

34:49 - this has also increased our costs in terms of mailings

34:53 - that were unanticipated mailings because of hr one

34:56 - we've had to send notifications to these folks

34:58 - we have to do mail if people want mail

35:01 - we do text messages we do email we

35:03 - kind of constant communication we've been doing

35:05 - public events we've been doing social media

35:07 - this is a place where we're asking all of you to please use your district newsletters

35:12 - to communicate with your constituents

35:14 - that these changes are

35:15 - here in some cases are coming in other cases

35:19 - we have a website which is dhs dot pa dot gov slash work

35:24 - and we have frequently asked questions there

35:26 - we have social media graphics you can download

35:29 - we have videos for how people can actually go about uploading their

35:34 - documentation that they've been volunteering

35:36 - or they are in school or they are working

35:38 - so we have just been pushing

35:41 - information out

35:42 - but we don't have a budget for that

35:44 - and so so anything that you all can do to help us

35:46 - amplify these messages we would be deeply grateful for.

35:49 - The risk of losing my gold stardust chairman

35:51 - just a few

35:52 - it's.

35:53 - Either yes or no question do.

35:55 - Do you anticipate or you're already seeing.

35:58 - A

35:59 - Heavy.

36:00 - Increased burden placed on our charitable food network

36:03 - absolutely

36:04 - and in fact we saw

36:06 - a little glimpse of what that could look like during the federal shutdown and

36:10 - they are already burdened overburdened in many cases and it's only going to get worse

36:14 - thank you

36:15 - very much

36:15 - thanks for the latitude extreme.

36:17 - Sad face for mullins.

36:21 - Or positive reichert

36:23 - thank you mr chairman

36:24 - thank you secretary

36:25 - just rolling up a little bit off of what the

36:27 - gentleman was just talking about was snap

36:29 - of your listing a bunch of

36:31 - folks that now have work requirements and everything like that when you say must work

36:35 - that's shorthand for much work

36:38 - must volunteer in the community

36:40 - must not meet any of the other exemptions right I mean

36:42 - there there there it's not just you must work it just

36:45 - for twenty hours a week you have to be doing something if you are quote unquote

36:50 - an able bodied citizen right

36:52 - yes that's

36:52 - in fact you can add those things together

36:55 - so if you have an hourly job and you're only able to

36:57 - get fifteen hours a week at that job and they don't have

37:00 - any more hour to offer you

37:02 - you could volunteer for five hours a week and report both of those

37:06 - and meet the requirement

37:07 - and I just want to underline that word report

37:09 - because

37:10 - it's

37:11 - a lot of extra steps to have to report this and we're

37:14 - doing everything we can to make it easier as easy as possible but we've seen in other

37:18 - states who tried to do work requirements that

37:20 - allow lot of the people that lose their benefit

37:23 - are actually

37:24 - meeting the eligibility requirements but they don't

37:26 - they can't get through the red tape of reporting them

37:30 - and I appreciate your flexibility is an hr one's flexibility with

37:33 - trying to get as many people as possible qualified

37:35 - a minute if you're working or volunteering or

37:37 - or things along that line

37:39 - you know you meet those requirements

37:41 - but changing gears a little bit

37:43 - within snap hr one also has

37:46 - a requirement or an exemption in there if your error rate is at six percent or below.

37:51 - There there aren't any

37:52 - sliding scale penalties and I think ours was listed at

37:58 - ten point six or seven six percent

38:00 - last year ally and obviously that was six months ago

38:04 - just curious secretary where where do we stand on

38:07 - on beating that and what is what is your department doing to get us

38:10 - below that six per cent

38:11 - yeah

38:12 - so this has been an absolute priority for us it was before hr one to be clear

38:18 - of our error rate for a variety of reasons once came out of covert and what we all

38:24 - considered an unacceptably high place

38:27 - and so that ten percent that you quote is actually from federal fiscal year

38:32 - twenty four it lags considerably but when

38:35 - before food and nutrition services reports that

38:39 - so that is the last publicly available data

38:42 - what I can tell you is that for federal fiscal year twenty twenty five

38:47 - we have calculated our payment error rate at eight point seven one percent

38:53 - and I remind you these are administrative errors

38:55 - these are not about eligibility these are missing signatures

38:58 - somebody didn't give us their most recent pay stub

39:02 - so we underpaid them by two dollars or we overpaid them

39:04 - by two dollars like that's what we're talking about

39:07 - during clamping down on administrative issue though administrative yeah

39:10 - yeah and so our fiscal federal fiscal year twenty twenty five we are we're I are

39:15 - calculation eight point seven one percent

39:18 - and then of course federal fiscal year twenty

39:20 - twenty six started this path last October first

39:23 - this is the year that counts for us

39:26 - and we have been tracking under six per cent extra

39:29 - however there's a lot of things that could change that and

39:33 - there's

39:34 - you know

39:34 - a lot of.

39:36 - Changing directions from Washington literally every couple of weeks

39:40 - but we are doing everything we can can to make sure we continue to track under six

39:44 - so we shall we are at six percent currently

39:46 - currently

39:47 - okay good

39:48 - congratulations thank you for your hard work on that.

39:51 - Because I believe the penalty is would be something like

39:54 - six hundred and seventy five million dollars so.

39:57 - Is that is that

39:58 - penalty budgeted in is that part of your appropriations request are you anticipating

40:02 - keeping under that six percent.

40:05 - So we don't need we won't be responsible for that

40:07 - that additional

40:08 - that additional.

40:10 - Appropriation on our side.

40:12 - The governor has been very clear that that is not a sum of money that we could

40:15 - back fill so it is not in the budget

40:18 - okay so if if we don't we would be coming back essentially for

40:21 - a supplemental appropriation then

40:23 - or we would exit the snap program

40:25 - those would be the options

40:27 - okay

40:27 - thank secretary appreciate.

40:30 - And the gentleman representative Flemming.

40:34 - Thank you mr chairman.

40:36 - Good morning

40:37 - doctor secretary our coach

40:39 - and the rest of the dhs team

40:42 - thank you for being here today.

40:44 - So I'm going to start with an issue that's near and dear to my heart childcare

40:48 - which is so.

40:51 - Needed for us to have a workforce and so necessary.

40:56 - For the development of children quite frankly to have

40:59 - a safe high quality

41:01 - child care

41:02 - and I am really proud standing here today that this body last year in our in our

41:08 - prior year's budget

41:09 - passed twenty five million dollars in recruitment and retention grants

41:14 - for our child care workers who are woefully underpaid I think your point in your

41:19 - introduction in in your introduction about raising the minimum wage

41:23 - would help lift that tide and that

41:26 - pay scale for our child care workers

41:28 - but it included twenty five million

41:30 - to provide a four hundred and fifty dollar payment to recruit and retain

41:33 - child care workers here in Pennsylvania

41:35 - how many child care work occurs

41:37 - up to this point do we know have received that payment

41:40 - and how much is available to recruit new workers in this area

41:45 - well first of all just want to thank all of you for supporting that

41:49 - addition to our budget

41:50 - and the demand has been overwhelming we have had

41:53 - more than forty three hundred child care providers

41:57 - Ty for that Grant

41:58 - now because of the budget impasse we couldn't get started until January

42:02 - so we're still working through all of those applications

42:06 - that we hope to have that money going out and

42:09 - fairly short order

42:10 - excellent.

42:13 - And like I said.

42:15 - It is it is an indispensable part having childcare

42:18 - having affordable childcare is an indispensable part

42:21 - of how people get to work.

42:23 - How do you expect the additional ten million dollars that the governor proposed

42:27 - in this year's budget to further address the ongoing childcare staffing issue.

42:31 - So I think it's really important to think of out with this funding is that.

42:36 - These are all small businesses

42:37 - right and they're often women owned small businesses and they don't have a lotta.

42:43 - Unspent funding in fact a lot of these owners don't even pay themselves

42:47 - or.

42:47 - Certainly don't pay themselves every single month

42:50 - and so they just don't have the wherewithal

42:52 - to give their stay staff any kind of extra

42:56 - yeah and so this is just such a great opportunity for them to be able to thank their

43:01 - staff or to help recruit new staff in this way

43:05 - and with the extra ten million dollars

43:07 - we should be able to offer at least

43:10 - about a six hundred and fifty dollar bonus depending upon how many people actually

43:14 - apply that might even be a hair more than that

43:17 - and again just a way for these

43:19 - childcare providers to thank their staff

43:22 - and and send the message to their staff that

43:24 - we care about their staff to

43:26 - the governor on down

43:28 - that everybody here in the commonwealth knows how

43:30 - important they are how important they are to our kids

43:33 - and how important they are to our economy

43:35 - and so I'm very very hopeful that you will

43:37 - agree to that additional ten million dollars

43:40 - I think it will make a meaningful difference for these providers

43:43 - to both be able to retain and to recruit staff

43:47 - yeah and I I want to say

43:49 - after last year's budget proposal and I appreciated you and the guy governor or

43:54 - attending an event at cross point child care center in my district so

43:58 - it's really important switching gears really quickly to glp once

44:02 - and glp one.

44:05 - Specifically for for medicaid

44:07 - patients and

44:08 - those on medical assistance.

44:12 - Glp ones are not currently covered

44:14 - has there ever been a time when glp ones were covered under medical assistance.

44:19 - So.

44:20 - Glp ones

44:21 - are currently covered for a number of indications okay

44:26 - and

44:27 - those indications include diabetes

44:29 - obstructive sleep apnea heart failure you're

44:32 - and mash which is that I'll spare you the medical name of it it is a

44:37 - it is a liver condition I'll just leave it at that

44:39 - and

44:40 - and

44:41 - we have been covering glp once for

44:45 - those indications as they've come on board since really the early two thousands

44:49 - yet

44:49 - we added the coverage

44:51 - of g lp ones just for weight loss

44:55 - a couple of years ago

44:56 - and it quickly

44:58 - spiraled into a significant amount of use this past spring we were already as you're

45:06 - very aware getting ready to put into play some pretty stringent prior authorizations

45:11 - for the year use of those glp ones

45:14 - and then hr one passed and we saw some of the budget

45:18 - pressures that we'd be facing in these next years

45:21 - and simultaneously our state budget was caught up

45:24 - in some pretty

45:25 - tense negotiations and so

45:28 - we took.

45:31 - We took efforts

45:32 - to get our medicaid budget aligned with what we were we thought

45:37 - the twenty five twenty six budget was going to land okay

45:40 - the the challenge for us is always is that our

45:43 - medicaid contracts run on the calendar year right

45:46 - and of course our budget does not our state budget

45:48 - does not have to are always three or six months

45:51 - lying behind are playing catch up

45:53 - well then

45:53 - they did take a look at the use of glp ones for that purpose

45:58 - and by taking them out

46:00 - instead of our program costs going up

46:03 - at three point eight percent they would have gone up eleven and a half percent

46:07 - and so these are just some of the tough choices we were faced I do appreciate that

46:11 - and I'm working to ensure that people have access to safe

46:14 - glp ones f d a approved so

46:16 - thank you so much I think when really frustrating

46:18 - thing for me is that trump our acts has been

46:21 - you know

46:22 - put out with lots of fanfare and we thought this might be an option

46:26 - unfortunately when you go to the trump rx website

46:29 - if you are taking medicaid if

46:31 - are a medicaid recipient or a medic care recipient

46:33 - you are not allowed to purchase drugs on trump r x.

46:37 - Thank you madam sector.

46:41 - Yeah yeah next representative brow.

46:46 - Thanks

46:46 - with me I'll take her

46:47 - out the

46:48 - on that one.

46:49 - Thank you chairman

46:50 - madam secretary

46:52 - in your budget hearing with the senate

46:56 - there was some discussion

46:57 - about staffing ratios.

47:01 - In skilled nursing facilities and you had commented that at.

47:06 - Staffing in these facilities is not necessarily a focus of your department as a

47:11 - significant portion of the long term care

47:14 - supports and services population

47:16 - is being served in the community.

47:20 - However these folks served in your program and

47:23 - are

47:24 - not able to be safely served

47:26 - sometimes in their communities and I believe they

47:29 - should still have quality care.

47:32 - So while I understand part of this responsibility

47:34 - does sit with the health department.

47:38 - Will you commit to working on solutions to improve

47:41 - care delivery for these residents in particular.

47:45 - Yeah I

47:46 - don't recall talking about staffing ratios and nursing facilities in the senate but

47:50 - perhaps we did but

47:51 - I do want to point out to

47:53 - one very important thing which was there was a

47:55 - federal final rule under the biden administration

47:58 - that was going to increase staffing ratios in nursing facilities

48:02 - and the trump administration did reason that rule

48:05 - so I think that many of our nursing facilities were

48:08 - pleased

48:08 - to hear that.

48:10 - We are always happy to focus on quality

48:13 - and one of the programs I neglected to mention

48:15 - when I was testifying in front of the senate

48:18 - is that the department of health has a fantastic program called the

48:21 - long term care quality transformation program and this was the program that grew out

48:26 - of some of the challenges that we all experienced during covert I certainly

48:29 - experienced them as a county commissioner

48:31 - trying to help our county nursing facilities

48:34 - and they have got some fantastic data and information and I hope that that is a

48:38 - program that we can all get behind and support because.

48:41 - They're doing it I think probably exactly what you would want to see

48:44 - providing additional to training to staff making sure they have the proper supplies

48:48 - and all sorts of things to help improve quality.

48:52 - Yeah and again that's the health department and despite what the trump administration

48:56 - is doing we still have the ability to do things in pa

49:00 - to make a difference so

49:01 - I just hope that you'll be able to work in unison

49:04 - with the department of health to ensure these

49:07 - staffing levels because it's a big problem

49:10 - yeah we have certainly put into our rates funding to cover

49:14 - the state staffing levels as were

49:17 - created under the wolf administration

49:19 - and if

49:20 - there's other specifics that you'd like to talk

49:22 - about we're always happy to talk about that

49:23 - wonderful.

49:25 - So let's pivot to maternity

49:28 - care and maternity health to deserts which we did talk about last year.

49:34 - It could potentially get worse now that

49:36 - the

49:37 - Bradford regional medical center has.

49:40 - Closed which you alluded to earlier

49:43 - can you provide an update on what the department's

49:45 - doing to ensure access to maternity care

49:48 - particularly in rural areas of which I represent

49:52 - yeah

49:53 - so.

49:54 - We have a number of initiatives in place.

49:58 - I do want to just level set a bit

50:00 - that the medicaid program only pays for one third of

50:05 - the births in the commonwealth including in rural areas

50:09 - so two thirds of the birth are being paid for by other payers

50:13 - and so I just you know we're not the majority

50:16 - but

50:17 - nonetheless we're doing everything that we can and

50:19 - obviously this has been a real priority for us so I

50:22 - earlier I mentioned our world summit

50:24 - that had been bringing together local leaders and they've

50:27 - been brainstorming ideas about what they can do to

50:30 - support maternal care in every rural community in the commonwealth.

50:34 - One very important initiative that we've been able to start

50:38 - with an appropriation that was initially led by the senate but has now continued.

50:44 - For two years now and it is in the governor's budget

50:47 - proposed budget

50:48 - is a ten million dollar allocation

50:51 - that is funding for rural hospitals

50:54 - it comes to dhs

50:56 - we are able to draw down federal match for that money

50:59 - and turn ten million into about thirty five million

51:02 - and we distribute that money to our rural hospitals

51:06 - using an allocation formula

51:08 - and the number one thing on that formula that you get

51:11 - points for as a hospital

51:13 - is doing obstetric care

51:15 - so we're very much trying to put our money where our.

51:18 - Priorities are

51:20 - so hopefully that will

51:21 - be in the governor's

51:22 - continued in the governor's budget we'll be able to do that for a third year

51:25 - that's good to hear and I was

51:27 - fortunate enough to

51:29 - attend one of the rural summits with the mommy bus and

51:32 - there was a lot of good information that came out of that but

51:35 - just real quickly

51:36 - and you know we always hear about

51:38 - liability insurance since for specialty providers

51:42 - like ob g lands

51:44 - and the impact.

51:46 - Of.

51:47 - Keeping these practitioners in underserved

51:49 - communities do you have a professional opinion

51:52 - on this challenge and how we serve it

51:55 - yeah it's definitely a challenge

51:57 - and I think it's one that.

51:59 - You should

52:00 - speak with your local hospitals about how they

52:03 - see that challenge and what the impact is for them

52:06 - we have been looking at workforce.

52:10 - Issues across the board

52:11 - as part of developing the real health transformation

52:13 - plan and what we can put dollars toward

52:15 - and one of the things that we have

52:17 - uncovered is that

52:19 - obstetricians can be be employed

52:21 - I federally qualified health centers and we are very fortunate to have fq hcs in most

52:25 - of or near many of our rural counties

52:28 - and if an obstetrician works for an f q h c

52:31 - it's like working for the da you are protected

52:33 - from being sued because it's considered

52:36 - a government entity

52:37 - but that doesn't protect the hospitals

52:40 - and so I think that.

52:42 - Sitting down with hats sitting down with your local hospitals

52:45 - to strategize over what would actually be most helpful for

52:49 - them I think is where this conversation needs to go next

52:52 - ok thank you thank the gentle lady representative young.

52:57 - Good.

52:58 - Morning I dunno

52:59 - good day happy Wednesday everybody.

53:02 - Warning.

53:04 - In the current budget

53:06 - the general assembly provided funding to increase rate for home care workers

53:10 - that are directly employed by the person that needs the care

53:14 - can you tell us the status of this rate increase.

53:18 - Yes.

53:19 - We actually

53:20 - published so let me just.

53:23 - Take one step back

53:24 - so you are referring to the participant directed program.

53:29 - This is the program where an individual who

53:32 - qualifies for

53:34 - or I should say is a

53:36 - nursing facility clinically eligible meaning that they have care needs that would.

53:41 - Potentially allow them to go into a nursing home

53:43 - and they are or they can choose to hire

53:47 - a direct care worker themselves directly and they become the common law employer

53:51 - or they can choose to go with an agency

53:54 - and so we

53:56 - the governor proposed in his budget for this year to increase the funding for those

54:00 - participant directed workers as we call them

54:04 - at and it was very important because those workers don't work for an agency

54:08 - so they didn't get any benefits and and they often made less money on average than

54:13 - some of the agency employed workers

54:15 - and so this increase was an effort to start to get them closer to some parity

54:20 - with workers who work for an agency.

54:24 - On Friday we published the bulletin

54:26 - for in fee for service

54:29 - about what that would look like for workers who

54:32 - are in the act when fifty or the over programs

54:36 - and it's about an eleven point four percent increase for those workers

54:39 - and then we've been working with our three m

54:42 - CEOs our community health choices mc he owes

54:45 - at giving them all this information and data

54:48 - and working with them on a communications plan

54:51 - to each of these participants and making sure that service coordinators go out and

54:56 - and work with those participants that so they understand how they can

54:59 - effectuate this pay raise for the folks that.

55:03 - Are part of a managed care organization plan.

55:05 - Okay thank you

55:07 - I also see that in the proposed budget did not include a proposed rate increase

55:12 - for the home care agencies.

55:15 - We know that it is getting more difficult for home

55:18 - care agencies to recruit and maintain staffing

55:21 - at the current rate levels

55:24 - so you think by increasing the home care agency rates

55:28 - this will help to recruit and retain

55:30 - staff that provides these services

55:32 - and what other ways should we consider addressing the stewardess she

55:36 - the shortages

55:37 - and home care

55:38 - agencies yeah

55:40 - yes so I very much understand that many of them are struggling to hire employees

55:46 - at we continue to encourage agencies to negotiate with managed care organizations

55:53 - they have every right to do so

55:55 - the managed care organizations are not held to fee for service rates

55:59 - and

55:59 - agencies always

56:01 - have the opportunity to negotiate with managed

56:03 - care organizations so we always encourage that

56:07 - and

56:08 - if the general assembly wants to bring the

56:11 - plan to the conversation for this budget

56:14 - about how to take steps to potentially increase that

56:18 - I think everyone would be happy to look at that plan

56:21 - it is

56:22 - a costly

56:23 - undertaking and there are so many pressures

56:25 - under our budget right now that I think it's

56:27 - an area where we really need a lot of

56:30 - agreement across aisles and across chambers that this is a priority

56:34 - but if you want to bring us that I think we

56:36 - every one would be happy to take a look at it

56:38 - okay thank you for that

56:39 - I'm going to switch gears a little bit around human

56:41 - trafficking inquiry and coordination of services.

56:45 - We know that when individuals are saved from trafficking

56:48 - they often need a they often need a lot of different services it's very complex

56:53 - and nuance

56:54 - as they're trying to transition back back into the community

56:58 - how does

56:59 - dhs help

57:00 - survivors

57:01 - like those of human trafficking get their trauma informed services they need

57:06 - and how are you working with providers to ensure that these survivors

57:10 - get coordinated services met.

57:13 - Specifically for their individual needs.

57:17 - So obviously this is an extremely

57:19 - vulnerable population and one that we do everything that we can to help.

57:24 - From our standpoint

57:26 - usually we become aware of these individuals because somebody has

57:31 - called child line or there's been a referral from a local

57:35 - law enforcement agency se or sometimes the district attorney

57:39 - sometimes

57:40 - it's a potential the child line could get the first call and child line then actually

57:45 - refers to local law enforcement or the county district

57:47 - attorney you know depending upon the situation

57:50 - and then.

57:52 - This is one of those areas where.

57:55 - It can

57:56 - quickly get complicated.

57:58 - A number of these individuals are unaccompanied minors

58:02 - or their unaccompanied minors from other countries

58:04 - and don't have any status in this country

58:07 - and some of that

58:08 - care and support we've been able to provide is now under question due to h r one

58:14 - so those p aces are of concern to us and we're

58:16 - not exactly sure how that's going to sort out

58:19 - but if it's a child that is an American citizen

58:22 - then we work with all local resources

58:26 - to make sure

58:27 - that ideally their interview is conducted in a way

58:31 - maybe through a child advocacy center

58:33 - where it is a trauma informed interview huh it's done one time and it's recorded to

58:37 - minimize the re dramatizations from multiple interviews

58:41 - and then we try to find an appropriate home.

58:44 - Either through foster care or through our kinship program

58:47 - to get that child stapley housed

58:50 - and then we just kind of go from there so they would

58:52 - come into our system the way any child would and we were

58:55 - provide all resources that were able to provide

58:58 - very helpful thank you so much I look forward to continuing working with you.

59:02 - Thanks a gentle lady representative melson.

59:06 - Thank you mr chair

59:07 - and welcome secretary

59:09 - before we get into the.

59:10 - Questions I just wanted to give a huge thanks both to the

59:13 - staff behind you and your additional staff in the back

59:16 - really we've

59:17 - helped a lot of families

59:19 - you know navigate what can be a really challenging.

59:22 - Situations at times and so thank you for the good work that you're doing.

59:26 - I'd like to

59:27 - start out digging a little bit deeper

59:29 - in the maternal care

59:31 - area

59:32 - you know and.

59:34 - I appreciate

59:35 - the

59:36 - handout with the rural

59:37 - health transformation in those grid lines you know I do have

59:41 - concerns that

59:42 - you know are cities

59:43 - made more politically powerful cities may try to gobble up some of those

59:48 - transformation dollars.

59:50 - In the effort

59:51 - an area of maternal health

59:54 - but specifically can we

59:56 - talk a little bit more about

59:58 - the liability

59:59 - 252 issue

01:00 - 01.582 you know.

01:00 - 03.322 Right now

01:00 - 05.652 in Pennsylvania center for rural health said

01:00 - 06.862 twenty two

01:00 - 07.602 counties

01:00 - 11.862 no longer have obstetric services I think that's between ninety and one

01:00 - 14.802 hundred and twenty thousand birthing age women that are

01:00 - 16.882 impacted by this

01:00 - 19.132 but all the money.

01:00 - 20.662 In the world.

01:00 - 24.072 Isn't good going to help

01:00 - 28.812 if hospitals are stepping away from maternal care because of the

01:00 - 30.702 concern about medical liability

01:00 - 31.362 can you

01:00 - 35.542 touch on that a little bit because we're seeing them voluntarily close.

01:00 - 38.242 You know really I think.

01:00 - 39.672 In listening to the hospitals

01:00 - 42.742 this liability issue is much more serious.

01:00 - 45.394 Driver in some of those decisions.

01:00 - 47.008 So representative

01:00 - 50.404 I appreciate your comments and I'm sure you know that dhs.

01:00 - 53.824 Really doesn't have a role in terms of liability

01:00 - 56.231 but but what I can share with you is a couple of

01:00 - 59.104 things that I think are important to this conversation

01:00 - 03.084 so I agree that that is one factor and part of a hospice oodles

01:01 - 05.754 business decision but there's other factors too

01:01 - 09.150 and some of those other factors are some of the things that we're hoping we can

01:01 - 12.354 mitigate a little bit through the rural health transformation funding

01:01 - 14.784 for instance we know that

01:01 - 16.314 deliveries are down

01:01 - 18.894 in the commonwealth our population is aging

01:01 - 21.204 and birth rates are falling and

01:01 - 24.990 and I hope through some of the other initiatives that the governor's proposing like

01:01 - 26.724 our housing action plan right we have a

01:01 - 27.624 desperately

01:01 - 30.354 desperate need of housing everywhere in the commonwealth

01:01 - 32.334 rural suburban urban communities

01:01 - 34.156 that will be able to get more people to move

01:01 - 35.820 here and maybe some of them will have kids

01:01 - 36.174 so.

01:01 - 36.561 As.

01:01 - 37.854 To stay in

01:01 - 39.154 now.

01:01 - 40.504 Area.

01:01 - 42.124 When this.

01:01 - 43.074 Decision

01:01 - 45.784 when the supreme court five the two.

01:01 - 47.424 You know Democratic controlled

01:01 - 49.684 supreme court overturned

01:01 - 52.164 what was bipartisan tort reform

01:01 - 56.430 it really allowed you know now our rural hospitals

01:01 - 59.544 to be sued in Philadelphia and Pittsburgh

01:01 - 00.754 I mean as a

01:02 - 03.804 as a physician you know which is very impressive

01:02 - 05.994 I think you may have worked a little bit in

01:02 - 07.264 obstetrics.

01:02 - 11.724 Is it time that this chamber revisits tort reform

01:02 - 14.584 or some type of carve-out or protection

01:02 - 17.134 you know for maternal health neurology

01:02 - 18.114 because it's

01:02 - 19.234 it's really

01:02 - 21.004 I mean it's it's a

01:02 - 22.164 it's big concern

01:02 - 25.714 for our rural hospital systems this liability issue.

01:02 - 30.954 Yeah I think that that conversation is best held with your hospitals and with

01:02 - 32.934 a hospital association of Pennsylvania

01:02 - 36.444 they're the experts on that not us and

01:02 - 39.114 I think that those would be good conversations to have

01:02 - 41.794 okay great great I'd like to.

01:02 - 44.164 Pivot to hr one.

01:02 - 48.954 One of the benefits one of the great things that I felt is included in hr one is

01:02 - 49.824 that they're

01:02 - 51.294 beginning to address

01:02 - 52.644 double and triple

01:02 - 53.634 dippers

01:02 - 54.744 and who are

01:02 - 56.664 you know concurrently enrolled

01:02 - 58.734 in medicaid in multiple states

01:02 - 59.884 you know I think

01:02 - 00.624 they record

01:03 - 02.814 recognized over a million people

01:03 - 04.674 every month are receiving

01:03 - 05.944 payment

01:03 - 07.434 in multiple states

01:03 - 08.854 and I

01:03 - 11.274 just wanted to see you had mentioned earlier

01:03 - 12.664 the.

01:03 - 14.284 Tight partnership

01:03 - 16.584 you know that your agency has

01:03 - 18.634 you know pursuing fraud.

01:03 - 20.514 What what can we do

01:03 - 21.754 now

01:03 - 22.674 to.

01:03 - 25.684 Address these double and triple dippers.

01:03 - 26.934 Well

01:03 - 30.624 we already and have been for quite a while

01:03 - 33.954 we currently connect or check

01:03 - 35.104 fifteen

01:03 - 36.874 data exchanges

01:03 - 39.616 when we are determining whether or not a person

01:03 - 42.354 is eligible for our medicaid programs or for snap

01:03 - 47.154 and if there is any discrepancy some of those our federal

01:03 - 48.744 some of those are state

01:03 - 51.710 and if there's any discrepancy in the data that

01:03 - 54.844 we're seeing across those fifteen databases

01:03 - 59.004 then we need to go back to the individual who's applying

01:03 - 00.504 and ask for

01:04 - 04.504 hard confirmation of wherever we see a discrepancy

01:04 - 08.724 and so we're doing everything we can can to make sure that that doesn't happen

01:04 - 12.484 there are sometimes some complicated situations

01:04 - 14.434 around say.

01:04 - 18.894 Parents who divorce and have joint custody of a child

01:04 - 20.094 and sometimes

01:04 - 21.214 there's some

01:04 - 23.704 fluidity between states particularly if the

01:04 - 26.274 child is moving back and forth between parents

01:04 - 29.574 there's some unusual situations like that that do come up

01:04 - 30.964 but.

01:04 - 31.494 We're

01:04 - 32.544 very

01:04 - 37.444 committed to making sure that those things do not happen.

01:04 - 38.004 Thank you

01:04 - 38.844 thank mr

01:04 - 40.144 thank the gentleman

01:04 - 41.464 representative

01:04 - 42.724 causa roski

01:04 - 43.644 thank you

01:04 - 47.004 thank you doctor crews for being with us today and your team no

01:04 - 51.624 it is not easy to navigate healthcare these days especially here in our commonwealth

01:04 - 53.574 so I give your team a lot of credit

01:04 - 54.754 they were very helpful

01:04 - 58.284 specifically to representative mullins myself and representatives Donohue

01:04 - 00.414 in lack a wanna county and Scranton with the

01:05 - 01.914 navigating a hospital

01:05 - 04.824 on the verge of closing so I am very grateful for your team

01:05 - 06.154 also mr chairman

01:05 - 08.964 I am a nurse I deserve a gold star automatically

01:05 - 10.234 thank you

01:05 - 10.794 thank you

01:05 - 11.604 and

01:05 - 14.964 my question you have spoken quite a bit about the rural health

01:05 - 16.494 transformation fund

01:05 - 19.974 the Grant the criteria around the Grant and

01:05 - 22.401 I think it was one of I think was represented a frill

01:05 - 24.714 that said how do we help you like what can we do

01:05 - 26.987 to help the hospitals to help and we talk about

01:05 - 29.914 one of my favorite words is preventative care.

01:05 - 32.994 Making people healthy so they don't have to access care

01:05 - 37.824 certainly those that will potentially be uninsured and that uncompensated a group of

01:05 - 39.474 Pennsylvania that may

01:05 - 41.694 access care write an emergency rooms

01:05 - 43.054 so.

01:05 - 45.324 Our governor is proposing to spend

01:05 - 49.534 about three million dollars and in investments in health initiatives

01:05 - 52.584 these investments are housing food as medicine

01:05 - 55.474 a health coverage for the post incarcerated

01:05 - 58.224 and you mentioned in your budget testimony this morning

01:05 - 59.934 with us here today

01:06 - 01.014 about

01:06 - 02.164 this how these

01:06 - 03.744 investments can lead to savings

01:06 - 05.244 and what do these investments

01:06 - 07.024 you know how do these investments.

01:06 - 09.384 How much will they and these investment costs

01:06 - 10.044 us.

01:06 - 11.404 Less over time

01:06 - 15.054 and specifically to one program that medically tailored meals

01:06 - 16.074 and

01:06 - 17.724 to address food insecurity

01:06 - 20.254 for certain medically vulnerable individuals.

01:06 - 22.674 So that that's kind of where I would like you to

01:06 - 24.954 talk about I'd like you to talk about that that

01:06 - 26.694 that cause as a preventative I mean

01:06 - 29.874 you're patient popular and that you took care of as an o b g y n

01:06 - 34.254 o b g y n anesthesiologists that that patient population is most important

01:06 - 37.824 for training and preventative care to have a healthy outcome for the mom and baby

01:06 - 40.344 but sometimes people have diagnostic disease

01:06 - 42.114 that medicine actually is

01:06 - 42.654 food

01:06 - 46.064 so if you could talk a little bit about that yeah sure thank you for the question

01:06 - 50.550 so to your point a specific plea for food is medicine the governor's proposing a nine

01:06 - 52.974 hundred million dollar investment estate dollars

01:06 - 55.611 that would allow us to draw down federal funding

01:06 - 58.164 for a total of two point three million dollars

01:06 - 01.284 to provide medically tailored meals

01:07 - 05.764 to individuals that have diet sensitive health conditions

01:07 - 09.304 and also tend to receive a lot lot of care.

01:07 - 13.620 Many of these individuals end up in hospital emergency rooms because they become

01:07 - 17.124 unstable particularly individuals with diabetes or heart failure

01:07 - 22.674 one emergency room visit on average costs fifteen thousand dollars and so

01:07 - 24.804 if we can start to

01:07 - 26.754 reduce those emergency visits

01:07 - 29.874 reduce those hospitals they patients that are associated with that

01:07 - 32.034 that is where we start to see savings

01:07 - 34.644 specifically around food and medicine we've been

01:07 - 39.450 have been tracking a program that was initiated in north Carolina very similar to

01:07 - 42.174 ours also a pilot in three regions of the state

01:07 - 45.274 and in the first year of that program

01:07 - 47.844 and including the administrative

01:07 - 51.479 start it costs the individuals who were enrolled in that

01:07 - 54.984 they were saving a thousand dollars a year per member

01:07 - 57.939 just in year one and they fully expected that

01:07 - 00.684 to go up because the they took the admin hit

01:08 - 02.034 you know in that first year

01:08 - 05.403 and so we've got some nationally recognised providers

01:08 - 07.914 of medically tailored meals here in the commonwealth

01:08 - 10.944 we have p pa navigate that is connecting these folks

01:08 - 13.049 so we're really ready to hit the ground running

01:08 - 16.114 on this and we believe it will produce savings.

01:08 - 19.134 Yeah but sometimes that's what we don't do that preventative care part

01:08 - 23.100 that ends up in the long run keeping patients out of the hospital whether it's a slip

01:08 - 26.734 and fall whether it's safety let me know being their home but certainly.

01:08 - 28.314 Healthier living choices

01:08 - 31.984 we don't end up having that kind of cost so thank you very much.

01:08 - 35.254 Thanks generally.

01:08 - 37.264 Representative flood.

01:08 - 39.214 Good morning thank you for being here

01:08 - 45.030 madam secretary shortly after last year's budget presentation in February your home

01:08 - 47.994 and community based services h CBS

01:08 - 52.344 rate and wage steady in the office of long term living was released

01:08 - 57.964 demonstrating rate and I got adequacy is that exist in h CBS.

01:08 - 04.260 Specifically it showed that a forty four per cent rate increase was necessary for

01:09 - 06.534 residential habilitation services

01:09 - 08.704 which are services utilized

01:09 - 10.979 by individuals with brain injuries to help

01:09 - 13.864 them live independently in their communities.

01:09 - 16.616 These specialized services empower individuals

01:09 - 19.534 with developmental or intellectual disabilities

01:09 - 20.394 to achieve

01:09 - 24.414 greater independence in their life richer participation in their communities

01:09 - 30.294 and tailored support promoting health safety and personal growth can you tell me

01:09 - 33.684 how many individuals in the ch c program

01:09 - 36.711 have a brain injury and how many are receiving

01:09 - 38.874 residential habilitation services cause

01:09 - 40.174 because I think it's

01:09 - 41.334 very helpful

01:09 - 44.892 to get a better understanding of the scope of individuals

01:09 - 47.514 that are being served sure yeah thank you for that question

01:09 - 52.260 so as of June twenty twenty five we have one thousand eight hundred and eighty nine

01:09 - 54.707 individuals those who are identified with a brain

01:09 - 58.144 injury in the community health choices program

01:09 - 00.504 and looking at encounter data

01:10 - 06.420 we have that two hundred and thirty seven of them chose to receive services through

01:10 - 09.204 one of our residential habilitation service providers

01:10 - 10.684 so why.

01:10 - 14.261 Aren't the entirety of the HP population

01:10 - 17.514 within the chc identified with brain injuries

01:10 - 20.854 receiving these services is it a lack of capacity

01:10 - 24.444 no not at all we have no evidence that any waiting list or anything like that

01:10 - 28.024 brain injury is a spectrum of.

01:10 - 29.124 Outcomes

01:10 - 33.924 and so some people may need a residential habilitation level all of care

01:10 - 36.454 others may have a relatively

01:10 - 39.868 minor injury that can be managed with outpatient

01:10 - 43.074 physical therapy speech therapy occupational therapy

01:10 - 47.790 and they don't require that kind of much more intensive services that are provided

01:10 - 49.794 through a residential habilitation provider

01:10 - 52.983 we also have cognitive rehabilitation providers

01:10 - 55.932 and ninety locations who are providing work so

01:10 - 58.092 there's many many ways

01:10 - 02.452 that someone with a diagnosis of a brain injury can get services

01:11 - 06.582 there's there's not distinct brain injury provider

01:11 - 07.602 types

01:11 - 09.432 in our program it is

01:11 - 14.262 really about services that are provided to people with a brain injury three

01:11 - 17.057 and we have a very comprehensive set of services

01:11 - 19.722 in fact it's more comprehensive than it was

01:11 - 21.492 under the calm care waiver

01:11 - 23.622 that community health choices replace

01:11 - 26.184 so it's my understanding that rates for these

01:11 - 29.542 services have not increased in over a decade

01:11 - 33.352 and it's becoming increasingly difficult to find providers.

01:11 - 39.082 Who prefer vide these services about twenty five percent have turned away referrals

01:11 - 41.602 are you aware of those challenges

01:11 - 44.232 so I think that this is this is where the

01:11 - 46.492 the history here is important

01:11 - 51.642 and before community health choices existed and it's in it's sixth year now

01:11 - 54.432 there was there were five

01:11 - 56.662 different waiver programs

01:11 - 01.218 one of them was called the comm care waiver and that was specifically for people with

01:12 - 03.942 a brain injury and that had been around for a long time

01:12 - 07.402 and so I think that providers built.

01:12 - 11.032 These brain injury services

01:12 - 13.392 to take advantage of that waiver

01:12 - 16.492 and then when chd was created

01:12 - 22.872 that waiver and four others were rolled into any health choices and so the way that

01:12 - 27.762 some of our providers continue to think about these services doesn't exist any more

01:12 - 28.882 than at that

01:12 - 32.722 provider type does not exist in our system anymore

01:12 - 34.512 but all the services exists

01:12 - 39.528 and those services have been getting as the rate increases through managed care

01:12 - 42.532 organizations year over year over time.

01:12 - 44.472 They may need to

01:12 - 47.792 and we're always happy to sit down with providers and talk this through with them

01:12 - 50.022 they may need to think about how they

01:12 - 51.412 are.

01:12 - 54.852 Qualifying themselves as residential habilitation providers

01:12 - 56.622 how they are billing for these things

01:12 - 59.752 we have urged many to enroll in medicare

01:12 - 03.942 because many of the services medicare will reimburse that sometimes medicaid won't

01:13 - 07.968 you know there's there's a way to go about this and we're happy to talk with anyone

01:13 - 09.592 who'd want to have that conversation.

01:13 - 12.852 What is your department doing

01:13 - 16.122 to provide the needed increases in rates

01:13 - 20.682 to ensure individuals with brain injuries are getting the services that they need

01:13 - 23.001 since your own study showed significant

01:13 - 26.722 deficiencies are you planning for a future increase

01:13 - 28.422 well we first of all I just

01:13 - 31.488 wanted to just address one of the things that you just that is we don't have any

01:13 - 34.932 evidence that these individuals are not getting the services that they need.

01:13 - 39.312 We've been carefully looking for any evidence of weightless or unmet needs

01:13 - 40.582 we don't see them

01:13 - 42.472 and anyone

01:13 - 46.252 in most of our folks are are part of a managed care organization

01:13 - 47.982 they have service coordinators

01:13 - 50.832 who if a participant was having unmet needs

01:13 - 52.242 we would know about it

01:13 - 54.202 and so again.

01:13 - 56.772 The providers are always

01:13 - 02.598 available or able to negotiate with m CEOs the m CEOs are not bound to fee for

01:14 - 05.322 service rates providers can always negotiate with them

01:14 - 06.972 and we are always

01:14 - 10.062 help happy to sit with providers and help them

01:14 - 13.070 maybe look at this program in a different way than

01:14 - 15.492 it used to be when there was the calm care waiver

01:14 - 17.032 thank you.

01:14 - 19.912 Thank you gentle lady representative at me.

01:14 - 23.532 Thank you mr chairman darcie madam secretary and your staff are being here

01:14 - 25.722 we talked a little bit today about

01:14 - 27.202 food security.

01:14 - 29.232 We talked a little bit about healthcare

01:14 - 30.233 I want to touch a

01:14 - 31.782 little bit on housing

01:14 - 36.772 and we know that the governors recently rolled out his action housing plan

01:14 - 38.015 and

01:14 - 38.502 it.

01:14 - 41.332 Cuts across initiatives that cuts across multiple

01:14 - 42.162 departments

01:14 - 47.122 and in the budget proposal I believe there was a million dollars set aside.

01:14 - 50.722 For a housing initiative to be funded through medical assistance

01:14 - 52.692 can you talk a little bit more about

01:14 - 54.372 really broadly the

01:14 - 00.352 the health impacts for folks who are dealing with a lack of access to stable housing.

01:15 - 02.102 Thank you for that question representative

01:15 - 05.262 so we're very we're all very excited about the housing action plan

01:15 - 08.442 and it was a joint effort between DC e

01:15 - 11.583 dhs phs a

01:15 - 16.518 several others we again had listening sessions all over the state and housing is a

01:15 - 19.372 problem in every single community in our commonwealth

01:15 - 21.042 and specifically really

01:15 - 24.472 what dhs is bringing as part of the solution

01:15 - 27.042 is to pilot this program

01:15 - 31.182 that with a one million dollar state investment we could bring

01:15 - 34.182 additional federal money to a total of two and a half million

01:15 - 38.636 to address the needs of individuals who are on housed

01:15 - 42.162 and are frequent users of hos capital emergency rooms

01:15 - 44.082 because they have nowhere else to go

01:15 - 47.412 and really no other way to manage their disease so

01:15 - 50.315 these will be individuals that have serious medical

01:15 - 52.902 conditions diabetes heart failure things like that

01:15 - 56.052 imagine trying to follow a treatment plan

01:15 - 59.045 that maybe requires multiple medications maybe one

01:15 - 01.512 of those medications needs to be rift originated

01:16 - 06.522 and you are literally living in your car or in a tent somewhere

01:16 - 08.152 and so

01:16 - 10.182 the goal here is to help these

01:16 - 12.852 high utilizes the emergency department

01:16 - 14.802 become stable the house

01:16 - 17.532 reduced that emergency room use

01:16 - 18.222 which will

01:16 - 18.822 you know how

01:16 - 20.862 the crowd our emergency rooms

01:16 - 21.852 and

01:16 - 25.812 get folks back on their feet enable them to actually follow a treatment plan

01:16 - 26.992 and then hopefully

01:16 - 29.526 stabilize them and then they would be able to

01:16 - 32.292 then get back to work in a meaningful way so

01:16 - 35.592 it's all part of this preventive strategy I mentioned earlier

01:16 - 37.362 that some people are just stuck

01:16 - 42.228 and they're going to need some help to get unstuck and this is a very tangible way

01:16 - 45.802 that we can do it while simultaneously saving money and medicaid.

01:16 - 47.724 Are there any benchmarks that you are trying to

01:16 - 51.612 hit in terms of how many folks you you want to to

01:16 - 54.532 to impact or to help throughout the year.

01:16 - 58.302 I don't know if I have that number in front of me do you have it okay glorious

01:16 - 59.232 gotcha

01:16 - 02.448 yeah I think we do have that and also I did want to point out and I haven't had a

01:17 - 04.952 chance to mention this in any of the other questions about this

01:17 - 08.182 these pilots will be independently evaluated

01:17 - 11.472 by the medicaid research center at university of pitt

01:17 - 15.378 and so you won't have to take my word for the fact that we believe these things will

01:17 - 18.078 save money we're going to actually have an independent

01:17 - 21.712 set of researchers that will be evaluating savings.

01:17 - 26.838 Does start off relatively low but in fiscal year twenty six twenty seven we predict

01:17 - 29.208 that we could impact two hundred and forty million individuals

01:17 - 29.982 I'm sorry so they wouldn't get

01:17 - 32.332 to one hundred and forty nine individuals

01:17 - 34.153 and if when the

01:17 - 37.392 the research is done if you can kind of give give us that data back it'll be

01:17 - 39.162 it'll be required so yeah

01:17 - 41.082 cause this is the federal pilot

01:17 - 41.772 Grant

01:17 - 43.812 and so it will be very public

01:17 - 45.702 and we will be happy to share that with you

01:17 - 47.682 want to transition a little bit

01:17 - 48.522 in the same

01:17 - 50.412 spirit but talk about homelessness

01:17 - 52.002 and so in this budget

01:17 - 56.872 maintains level funding for homelessness assistance program

01:17 - 58.602 this is a program that

01:17 - 59.202 serves

01:17 - 01.332 preside services like case management

01:18 - 04.612 rental assistance and emergency shelter

01:18 - 09.652 what are your your thoughts on the growing need for the services as we know.

01:18 - 13.392 Many more of our families across the commonwealth are struggling with

01:18 - 14.812 housing insecurity

01:18 - 15.492 yeah

01:18 - 22.368 so we were really pleased to get the increase in the homeless assistance program last

01:18 - 24.882 year of I believe it was five million dollars

01:18 - 27.972 and we have been able to use that money

01:18 - 29.832 very effective way

01:18 - 31.162 and.

01:18 - 34.272 We have been able to provide emerged see rent

01:18 - 36.772 an emergency shelter

01:18 - 37.972 and help

01:18 - 40.872 provide services to connect people with housing

01:18 - 41.802 so.

01:18 - 44.712 That dollar is getting put to very very good use

01:18 - 46.962 and has been able to help you know

01:18 - 49.702 many many many people across the commonwealth.

01:18 - 53.047 Total served I think last year was sixty thousand

01:18 - 55.932 an eight hundred and fifty eight Pennsylvania ins

01:18 - 59.872 which was the two and a half percent increase from the prior year.

01:19 - 02.992 Almost twelve thousand got rental assistance

01:19 - 05.622 almost thirteen thousand got emergency shelter

01:19 - 08.862 so and then we were able to provide some rental assistance as well

01:19 - 10.072 so.

01:19 - 14.202 We really appreciate that funding and hope it will continue it's essential

01:19 - 14.772 that keep

01:19 - 18.012 documentary secretary for your work on documents German for to appreciate it

01:19 - 20.452 thank the gentleman representative maiko.

01:19 - 24.312 Thank you mr chairman and madam secretary thank you for being here

01:19 - 25.212 and

01:19 - 26.512 so.

01:19 - 28.152 I have a question on

01:19 - 30.532 your over your spending

01:19 - 30.882 your

01:19 - 32.952 budget continues to increase

01:19 - 33.852 year over year

01:19 - 35.902 and based on my calculations

01:19 - 39.318 of recent history the department of human services

01:19 - 42.492 budget has increased at least five percent annually

01:19 - 47.208 the twenty six twenty seven budget is an increase of one point three six billion

01:19 - 49.462 dollars in our state general fund.

01:19 - 53.122 Monies that's a six point six percent increase this year

01:19 - 56.063 and I understand that that increases statutory

01:19 - 58.512 requirements federal requirements as well

01:19 - 01.332 but as we look at the budgetary out years and.

01:20 - 03.012 Don't get me wrong I

01:20 - 04.943 think your department is extremely important

01:20 - 06.972 and you're taking care of some of the most

01:20 - 09.162 vulnerable populations that we have

01:20 - 12.472 and that's where my concern comes with this question.

01:20 - 15.702 The department's budget is a concern

01:20 - 19.122 the twenty six twenty seven budget budget presentation

01:20 - 20.932 the governor touted.

01:20 - 23.502 Balanced budgets through twenty three

01:20 - 24.892 or twenty thirty

01:20 - 26.422 to thirty one

01:20 - 27.222 and

01:20 - 29.504 it's saying that this spending growth is

01:20 - 31.932 only point seven eight percent in your budget

01:20 - 33.683 ie twenty.

01:20 - 37.252 Twenty seven deaths thirteen of the governor's executive budget.

01:20 - 38.872 In my opinion

01:20 - 44.122 continues this unrealistic unrealistic growth rate by estimating that your departure.

01:20 - 46.722 Your department's budget

01:20 - 48.742 can't read my own writing here.

01:20 - 51.042 Grows by less than one percent annually

01:20 - 52.662 through twenty thirty

01:20 - 53.412 and thirty one

01:20 - 56.958 do you feel that this is realistic that your department's only going to grow by one

01:20 - 00.532 percent even though up until this point it's been five percent.

01:21 - 01.962 So as you know

01:21 - 02.832 this is

01:21 - 04.002 the way that

01:21 - 05.142 Pennsylvania does

01:21 - 09.312 budgets and has done for many many years it's very consistent with the rest.

01:21 - 10.420 I

01:21 - 12.620 Propose budget constructions

01:21 - 14.890 we account for statutory mandates

01:21 - 16.130 we.

01:21 - 19.630 Account for existing collective bargaining agreements

01:21 - 21.520 and major known costs

01:21 - 23.110 like medical assistance

01:21 - 24.410 and then all the

01:21 - 25.990 non mandatory spend

01:21 - 27.190 is level funded

01:21 - 28.700 we.

01:21 - 30.970 In particular or right now

01:21 - 32.300 are faced with

01:21 - 33.220 just

01:21 - 34.340 unrelenting

01:21 - 38.090 changing guidance from the federal government I mean like.

01:21 - 42.256 They do say one thing one week and then two weeks later they pull that back and tell

01:21 - 45.520 us something different so it's been a really difficult time for us to

01:21 - 47.570 predict the future.

01:21 - 49.540 So we are

01:21 - 50.530 unc clear

01:21 - 54.850 exactly where medicaid enrollment is going to be even two years from now

01:21 - 58.180 but as you know these are entitlement programs

01:21 - 01.630 and if you qualify if you're eligible we must

01:22 - 02.750 enroll you

01:22 - 04.220 and our biggest

01:22 - 06.820 spend right now the biggest driver

01:22 - 10.240 is the fact that Pennsylvania's population is aging

01:22 - 12.958 and we have plenty older adults that are qualifying for

01:22 - 17.440 our community health choices program and many of them

01:22 - 20.142 would potentially be in nursing facilities or

01:22 - 22.600 many of them are nursing facility eligible and

01:22 - 25.786 one of the ways that we're actually controlling costs is to care for them in the

01:22 - 29.060 community which is less expensive than a nursing facility

01:22 - 29.650 and

01:22 - 29.929 and

01:22 - 31.450 I get that madam speaker

01:22 - 33.770 or madam secretary my bad

01:22 - 34.480 and

01:22 - 35.691 I just.

01:22 - 37.700 You know at the end of the day though

01:22 - 42.430 you understand that we're trying to budget for an extremely large organization and

01:22 - 43.240 department

01:22 - 45.587 and trying to really get these costs under

01:22 - 48.130 control and understand what's happening and I get

01:22 - 51.250 the pastor through the federal government and what's going on with that

01:22 - 54.100 but wouldn't that be more beneficial to

01:22 - 55.400 have

01:22 - 57.460 a more realist dick numbers set of

01:22 - 58.580 one percent

01:22 - 59.290 because I believe

01:22 - 02.090 the other day at the senate you said that.

01:23 - 05.150 Being level funded is just not feasible

01:23 - 08.140 and at less than one percent that's

01:23 - 10.580 pretty much been level funded correct.

01:23 - 11.350 So.

01:23 - 15.466 Of course being level funded wouldn't be feasible but questions about the budget

01:23 - 17.823 construction are really ones that need to be answered

01:23 - 20.110 by the budget secretary okay we'll push that off to him

01:23 - 21.710 and then.

01:23 - 25.750 At the end of the day if you are at the one percent as

01:23 - 26.800 being showed

01:23 - 28.570 what services would be

01:23 - 30.280 you're looking at being cut what.

01:23 - 32.470 If you had to prioritize what

01:23 - 34.870 I guess obviously the mandated ones but.

01:23 - 36.490 I'm not going to

01:23 - 38.420 comment on hypotheticals.

01:23 - 40.670 Know it just.

01:23 - 43.390 Looking at the budget I had another question and then

01:23 - 44.380 hearing your

01:23 - 48.320 initial statement you were talking about an increase in snap from.

01:23 - 52.070 Twenty seven to twenty eight that's one hundred and twenty million I think you said

01:23 - 53.290 is an increase that's

01:23 - 57.230 already blowing through half the one percent so that's a concern of mine.

01:23 - 58.210 So.

01:23 - 02.980 Well that's thanks to hr one and you know hr wine could be amended or pulled back

01:24 - 05.399 so that the first time the states have had to pay

01:24 - 07.510 seventy five percent of the administrative cone

01:24 - 11.206 I'm not on the federal level I'm on the state level so just trying to figure this out

01:24 - 14.710 well the other thing I would clarify is the one hundred and twenty million is

01:24 - 17.573 the total impact of snap.

01:24 - 19.720 Admin change from fifty to seventy five percent.

01:24 - 23.986 Really the difference would occur between twenty six twenty seven and twenty seven

01:24 - 25.690 twenty eight would be about thirty million

01:24 - 26.870 okay.

01:24 - 27.550 Thank you ladies

01:24 - 28.510 thank you mr chairman

01:24 - 31.010 thank the gentleman representative melgar.

01:24 - 33.820 Thank you mr chairman and great to see

01:24 - 37.876 you again sector or cushions your entire team thank you for being here with us today

01:24 - 40.520 I've I've a lot of questions so bear with me

01:24 - 43.576 but I'll start off with county based mental health services the service kind of

01:24 - 45.610 commissioner before Montgomery county great to

01:24 - 47.920 great to have some from Marco back here

01:24 - 49.280 at the helm again

01:24 - 50.080 do.

01:24 - 53.180 So with the increase of uninsured individuals

01:24 - 55.978 do you think that there is likely to be an increase

01:24 - 58.420 in reliance on county based mental health services

01:24 - 59.050 yeah

01:24 - 01.750 yeah I really appreciate your asking this representative

01:25 - 03.460 so as you know

01:25 - 07.037 the governor has over the first three years I am I

01:25 - 10.390 asked for a total increase of sixty million dollars

01:25 - 12.310 to county based funds

01:25 - 13.570 county based funds

01:25 - 15.400 had not been increased

01:25 - 18.976 since like two thousand and seven or eight and in fact they were even cut in two

01:25 - 21.050 thousand and twelve under the corbett administration

01:25 - 22.720 had were very

01:25 - 28.090 so happy that the general assembly has awarded forty million of that at sixty million

01:25 - 33.730 and the consideration for our counties is going to be more important than ever

01:25 - 37.430 county based funds are used to

01:25 - 43.690 care for individuals who are uninsured or under-insured that is one of their uses and

01:25 - 45.708 I think what's very important is I want to

01:25 - 48.340 highlight that the counties I have really stepped up

01:25 - 50.620 working with our own sas team

01:25 - 55.840 they put together our team put together a consolidated community reporting initiative

01:25 - 59.296 because one of the criticisms that we heard from the general assembly was they didn't

01:25 - 04.214 understand how this money was being spent by counties and between the leadership from

01:26 - 07.330 my team and the county stepping up as of December two

01:26 - 08.050 twenty five

01:26 - 11.140 ninety seven percent of the counties or joiners

01:26 - 13.090 have submitted encounter data

01:26 - 15.880 for dates of service in twenty twenty five

01:26 - 18.340 and that includes everything from client level

01:26 - 22.546 level data that includes dates of service procedure codes diagnosis codes

01:26 - 25.360 demographics billing and rendering providers etc

01:26 - 27.520 so if if anyone is interested

01:26 - 30.630 exactly how that money is being spent we can give you a lot more detail and

01:26 - 31.700 I appreciate that

01:26 - 34.210 and we already are seeing that counties are continuing

01:26 - 37.330 to see that increased need for services do you think that.

01:26 - 40.300 They'll be able to actually manage this with

01:26 - 41.570 this increase

01:26 - 44.930 in need with the level funding as proposed in the budget.

01:26 - 45.610 It is

01:26 - 48.040 likely to be challenging for them

01:26 - 52.426 particularly as we've seen already one hundred and four thousand people having to

01:26 - 54.879 give up their penney plans we know that there's going

01:26 - 57.370 to be many more uninsured in the commonwealth this year

01:26 - 00.313 there are other steps that we've been implementing

01:27 - 04.370 around this including all of our crisis response services

01:27 - 06.190 as well as nine eight eight

01:27 - 09.340 I am very happy to tell you that nine eight eight has

01:27 - 10.700 become just

01:27 - 12.500 wildly successful.

01:27 - 14.847 So successful that we're actually asking for an

01:27 - 17.530 additional ten million dollars to support nine eight eight

01:27 - 18.920 the.

01:27 - 23.770 Text and chat alone has seen a forty percent increase at

01:27 - 26.770 between in the calendar year of twenty twenty five so

01:27 - 29.072 we're really seeing those services ramp up and

01:27 - 31.420 that's important to this conversation because

01:27 - 32.900 the majority

01:27 - 35.067 ninety three percent of the contacts to nine

01:27 - 38.480 eight eight are able to be resolved on the call

01:27 - 40.376 and now that doesn't mean that that person

01:27 - 42.460 isn't the next day going to get some help and

01:27 - 42.940 need

01:27 - 44.290 a way to pay for that

01:27 - 46.960 but at least we're offloading a little bit on

01:27 - 50.230 police response nz and also emergency room use

01:27 - 52.310 for folks that are going through nine eight eight.

01:27 - 53.960 Can you tell me

01:27 - 57.490 how those that ten million that you mentioned would be

01:27 - 59.860 distributed to the participating call centers

01:28 - 02.260 that work out so we currently have

01:28 - 04.840 fourteen call centers in state

01:28 - 07.686 and with that number of call centers we've been able

01:28 - 10.750 able to handle about ninety percent of the calls

01:28 - 15.130 the other ten percent do get sent to the national hotline

01:28 - 17.343 we really want to minimize that because when

01:28 - 19.810 the call is answered by somebody in state

01:28 - 22.540 they have visibility into every county

01:28 - 24.470 and they can literally

01:28 - 26.270 work with local.

01:28 - 28.480 Mobile crisis responses to

01:28 - 31.810 play somebody to see the person if that's what they need

01:28 - 34.866 so again we're offloading nine one one we're offloading

01:28 - 37.660 our emergency rooms and police responses with that.

01:28 - 40.871 It would be distributed across and specifically

01:28 - 43.780 we need to beef up our text and chat responders

01:28 - 45.860 because those take longer

01:28 - 47.410 than calls do but like

01:28 - 48.520 young adults

01:28 - 50.650 they're not calling they're all texting

01:28 - 54.040 so we need to make sure we can answer those thank you for that I'm going to

01:28 - 57.466 pivot now to nursing home rates I want to talk about that real quick so we know that

01:28 - 00.670 older pennsylvanians are the fastest growing demographic that we have here

01:29 - 03.572 that means that we're going to need at least as many nursing

01:29 - 06.800 home beds and facilities that we have now if not more.

01:29 - 09.250 Can you explain what the department is due doing

01:29 - 11.451 to address the long term care issues that we

01:29 - 14.480 will be facing the next five to ten years.

01:29 - 16.180 So.

01:29 - 17.330 Representative.

01:29 - 22.210 I just want to push back a little bit on the assumption

01:29 - 25.330 of how many more nursing facility beds we're going to need

01:29 - 28.810 and and let me just sort of share some data with you

01:29 - 29.710 and

01:29 - 32.330 in January of twenty eighteen

01:29 - 33.610 we had eight

01:29 - 37.636 eighty thousand seven hundred individuals in home and community based services and

01:29 - 40.460 fifty cents one thousand in nursing facilities

01:29 - 41.780 today

01:29 - 45.970 we have one hundred and fifty thousand people in home and community based services

01:29 - 49.220 and only forty two thousand in nursing facilities.

01:29 - 52.260 Because of the success of community health choices

01:29 - 55.310 and the ability to serve people in the community

01:29 - 57.340 older adults are voting with their feet

01:29 - 01.930 and in fact fact we have programs in place that are actually transitioning folks

01:30 - 03.640 from nursing facilities

01:30 - 06.132 back into the community I think last year we had

01:30 - 08.770 about fifteen hundred or seventeen hundred of those

01:30 - 12.420 so I don't know that I would necessarily agree with you

01:30 - 16.490 that we're going to need more nursing facility beds.

01:30 - 18.490 For I appreciate that yeah

01:30 - 19.270 okay

01:30 - 22.660 well I thank you for your responses and look forward to.

01:30 - 24.100 Later questions

01:30 - 24.610 thank you

01:30 - 26.990 thank the gentleman representative rig by.

01:30 - 28.100 Chairman hairs.

01:30 - 30.950 That is that of secretary for being here.

01:30 - 33.340 It's my understanding the taxes that the exceptions

01:30 - 35.950 to the community engagement requirements still exist

01:30 - 38.740 including living in a household with a child

01:30 - 40.180 one hundred and fourteen

01:30 - 42.530 to clarify in theory

01:30 - 45.166 could several adults who are not the parents

01:30 - 47.980 or direct caregivers of the dependent child

01:30 - 51.430 be exempt from these community engagement requirements

01:30 - 53.050 simply because they live

01:30 - 54.980 in the same household.

01:30 - 02.080 I'm going to aztec be the secretary fan to come up

01:31 - 04.930 and say I don't know if we have an answer to that

01:31 - 05.710 just

01:31 - 06.890 yet.

01:31 - 08.570 That's a good question.

01:31 - 09.740 I.

01:31 - 16.586 It's not

01:31 - 18.906 it's not that Mike's not on.

01:31 - 22.866 Nope.

01:31 - 26.166 Maybe in the

01:31 - 27.781 end when needed.

01:31 - 32.586 Let's try that again

01:31 - 33.696 alright

01:31 - 35.749 I've been accused of many things but being not loud

01:31 - 38.766 enough for people to hear me is not one of them.

01:31 - 42.332 I appreciate your question represent original and make sure that I'm understanding

01:31 - 44.537 correctly you're referring to community engagement

01:31 - 46.766 requirements in this in the snap program correct

01:31 - 47.156 yes

01:31 - 48.446 okay and

01:31 - 54.266 your question specifically is whether or not caregivers within the household

01:31 - 56.666 may qualify for an exemption

01:31 - 58.896 not necessarily caregivers

01:31 - 01.446 others living in that household.

01:32 - 06.966 Okay so I I would answer it in this way for snap

01:32 - 10.626 we are determining eligibility for the household

01:32 - 12.236 so individuals.

01:32 - 15.344 Within a household who may be applying there

01:32 - 18.236 are some people who are direct beneficiaries.

01:32 - 20.426 Of that snap benefit

01:32 - 25.086 it is very possible that there may maybe individuals residing in the household

01:32 - 27.986 that may become a part of our calculation for eligibility

01:32 - 32.526 determination but may not be direct benefit recipients

01:32 - 36.872 so in the case that you're describing is it possible that you may have an individual

01:32 - 39.066 in the household that's providing care giving

01:32 - 40.776 to an individual.

01:32 - 44.246 It may very well be the case that they are not a direct snap

01:32 - 45.966 recipient themselves.

01:32 - 48.996 Therefore would not be subject to the work requirement.

01:32 - 53.096 The def the slightly different interpretation I think I hear you asking is

01:32 - 53.846 and please

01:32 - 57.156 don't wanna put words in your also to tell me if I've got this wrong.

01:32 - 00.246 Is there a scenario where

01:33 - 04.416 there is an individual in the household that is providing care giving to

01:33 - 05.586 a.

01:33 - 10.086 A dependent who is receiving snap benefit.

01:33 - 12.367 Can they can they provide coverage essentially

01:33 - 15.516 for the other adult who is receiving snap.

01:33 - 17.226 That adult

01:33 - 19.166 still would be subject to the work requirement

01:33 - 23.346 depends on whether or not the dependent is claimed within that household.

01:33 - 24.666 As a part of the benefit

01:33 - 26.036 the concern is that

01:33 - 27.156 we could have

01:33 - 29.786 adults in this house where there is a fourteen year old.

01:33 - 30.602 That

01:33 - 32.186 may not qualify or

01:33 - 34.926 could be fraudulent by using the address

01:33 - 37.116 of that person to be a to receive the benefits that

01:33 - 40.386 would be my concern if they're not a direct caregiver

01:33 - 41.276 to that

01:33 - 42.236 to that

01:33 - 43.416 individual

01:33 - 44.796 under forty.

01:33 - 48.176 I'm not sure I'm tracking your example so that

01:33 - 51.002 again please I do not want to put words in your mouth please tell me if I'm

01:33 - 52.346 not characterizing this correctly

01:33 - 54.236 example you're describing is

01:33 - 56.336 if we've got a snap household

01:33 - 00.956 let's say there's you know three adults and two children one of which is determined

01:34 - 02.466 is a dependent.

01:34 - 06.126 In your example are you describing

01:34 - 08.816 all adults being a part of the

01:34 - 09.996 snap.

01:34 - 12.276 Benefit receipt.

01:34 - 16.626 And not being direct caregivers or parents yes.

01:34 - 18.996 Right so.

01:34 - 21.306 Each.

01:34 - 22.526 Adult

01:34 - 24.576 able bodied adult.

01:34 - 30.236 Would be evaluated if they are subject to the work requirement

01:34 - 32.366 if they are receiving the snap benefit

01:34 - 34.226 so they each have their own

01:34 - 35.406 criteria

01:34 - 38.462 that we would carefully evaluate to determine whether or not they're subject to the

01:34 - 40.326 work requirement whether or not they are medium

01:34 - 42.116 and that is again specific to you

01:34 - 45.512 if they are members of the household that are counted as a part of the eligibility

01:34 - 46.536 termination.

01:34 - 48.456 Thank you very much.

01:34 - 50.106 I.

01:34 - 51.516 Thank the gentleman

01:34 - 52.856 representative

01:34 - 54.486 gene occurred.

01:34 - 56.196 Thank you chairman.

01:34 - 57.756 Hello.

01:34 - 01.476 Thank you for being here today it's always good to see you and your staff

01:35 - 03.246 I have a question

01:35 - 07.206 around mental health and substance abuse services.

01:35 - 09.626 This morning and it's

01:35 - 11.736 particularly regarding.

01:35 - 14.136 A program

01:35 - 15.416 or a work group

01:35 - 18.336 that is referred to as the Pennsylvania's

01:35 - 21.666 lakh youth suicide prevention work group.

01:35 - 25.946 I'm concerned about the troubling rise in suicide rates

01:35 - 31.116 suit suicidal ideations and attempts among black youth.

01:35 - 33.519 Could you discuss what species epic actions or

01:35 - 37.146 programs have resulted from the work group's efforts

01:35 - 37.856 and

01:35 - 42.606 how is dhs ensuring that the voices of black youth families

01:35 - 47.186 and trusted community organizations are not only represented in the work group

01:35 - 51.036 but also meaningfully shaping the programs

01:35 - 54.546 and services being implement and before you answer

01:35 - 56.828 I do want to say thank you for the responses that you

01:35 - 00.426 gave on the nine eight eight I've been looking into that.

01:36 - 03.296 Program and I see that it's up about

01:36 - 05.607 one on my statistics for the one hundred and

01:36 - 08.006 sixty fourth legislative district in the county

01:36 - 11.886 that I serve in it's up about forty nine percent

01:36 - 13.146 in calls

01:36 - 14.966 so I

01:36 - 18.596 am really curious about the work group and what they're finding

01:36 - 21.506 but I'm also want to mention the

01:36 - 24.266 legislative efforts in house bill

01:36 - 30.176 five sixty four around education and public awareness it's out here so that we can

01:36 - 33.336 really understand what this looks like.

01:36 - 34.016 Thank you rep

01:36 - 35.906 I appreciate the question and I

01:36 - 36.326 as.

01:36 - 39.051 Deputy secretary Smith's to come up around some of the

01:36 - 41.456 specifics but I also just want to say broadly that.

01:36 - 46.196 This is an area that we're very invested in across our entire agency

01:36 - 49.496 and one of my team actually helps co lead at.

01:36 - 53.846 Suicide prevention task force that is multi agency c

01:36 - 57.539 and is working to address multiple aspects

01:36 - 00.656 of suicide prevention across the commonwealth

01:37 - 01.956 so.

01:37 - 05.282 It is something that we're deeply committed to not let the deputy secretary talk more

01:37 - 07.926 about the specifics of the program you mentioned.

01:37 - 12.186 Yeah.

01:37 - 15.086 Sure

01:37 - 15.776 so

01:37 - 19.652 I'll be brief because I know we don't have a lot of time but would be happy to have a

01:37 - 24.036 meeting with you or provide you some additional information after this hearing.

01:37 - 28.556 We've been working on black youth suicide prevention specifically for the last

01:37 - 30.506 approximately three years

01:37 - 35.912 with some Grant funds that we've received and we've done partnerships with a couple

01:37 - 38.826 of organizations one of those was Lincoln university

01:37 - 44.376 where we hosted some roundtable discussions with black youth.

01:37 - 49.596 That included high school students that included college students and young adults

01:37 - 54.872 where they were carefully facilitated sessions where we created one open environments

01:37 - 59.522 for the youth to provide honest feedback with us about what were some of the

01:37 - 04.136 challenges that they were facing as as children youth and young adults

01:38 - 06.764 so we've hosted one of those just as recently

01:38 - 09.326 as as about a month ago a couple of weeks ago

01:38 - 12.476 and we're hearing a lot of the same themes

01:38 - 14.636 coming out of those work groups

01:38 - 18.722 and some of them are things that we've already talked about here today in terms of

01:38 - 23.906 lack of access to some of those social determinants of health things like

01:38 - 25.226 housing access

01:38 - 26.726 food security

01:38 - 27.846 challenges

01:38 - 31.536 equity and discrimination in different settings.

01:38 - 36.276 So nothing really shocking in turn one of the things that we're hearing

01:38 - 41.276 what we plan to do then is take all that information that we've gathered from those

01:38 - 46.207 round tables that have been hosted in several different geographic areas and pull

01:38 - 50.732 together some concrete recommendations around what we could do to address the

01:38 - 52.480 concerns that we're hearing which could

01:38 - 54.716 include some things that we could partner with

01:38 - 59.576 the department of education on in our school systems it could include partnering with

01:38 - 02.936 some of our county partners to do community based

01:39 - 03.986 type work

01:39 - 07.286 or lots of other things so if you're interested in more we're happy to

01:39 - 10.836 know absolutely I I also before my time.

01:39 - 14.936 Is up I want to talk really quickly about the crisis centers

01:39 - 17.876 the accessibility to the crisis centres

01:39 - 19.916 for families and

01:39 - 22.466 really when we're looking at those families

01:39 - 24.636 were culturally responsive

01:39 - 27.566 prevention strategies are necessary and we're

01:39 - 31.016 looking at high school students or middle school students

01:39 - 31.886 and

01:39 - 37.322 where do you think the current funding level we are sufficient to sustain and expand

01:39 - 40.136 culturally responsive suicide prevention programs

01:39 - 41.756 across the commonwealth

01:39 - 42.296 yeah

01:39 - 43.776 yeah I think and

01:39 - 44.876 again I'll just do

01:39 - 45.176 a.

01:39 - 48.216 Second and let jenn take the respite

01:39 - 52.592 we have been working to expand crisis response services across the commonwealth

01:39 - 55.826 that's been a priority since I've gotten here and I'm very very happy to say that

01:39 - 00.386 all sixty seven counties have some kind of mobile crisis response now

01:40 - 02.126 it's not always twenty four seven

01:40 - 04.026 but we've made huge

01:40 - 05.346 strides there

01:40 - 08.876 and I think that this is an entire system that we're hoping to build

01:40 - 09.446 out

01:40 - 11.546 somewhere to call nine eight eight

01:40 - 13.766 as someone to respond

01:40 - 15.716 and then somewhere to go

01:40 - 19.406 and to go could be a crisis stabilization center

01:40 - 24.092 or other higher level of care if that's what the person needs but we find that if we

01:40 - 26.216 do number one and number two well

01:40 - 29.126 we don't need much of number three because

01:40 - 30.836 situations can be handled

01:40 - 34.706 and escalated either on the phone or by a mobile crisis team

01:40 - 35.216 then

01:40 - 37.720 for that my time is up but I definitely want

01:40 - 40.286 to you know come to you and find out more

01:40 - 43.253 and thank you for all the work that you're doing around our youth and

01:40 - 44.846 and mental health issues thank you

01:40 - 45.806 thank you chair

01:40 - 48.056 thank the gentle lady representative goods

01:40 - 50.040 beggar chairman good morning secretary thank

01:40 - 51.986 you so much for being with us this morning

01:40 - 54.875 as you know this year brings a major change in how

01:40 - 57.776 Pennsylvania calculates medicaid nursing facility rates

01:40 - 01.016 and at the same time the budget adjustment factor

01:41 - 05.126 the statutory reduction applied to those rates is up for reauthorization

01:41 - 07.372 given that timing is only for him to make sure

01:41 - 10.016 the final rage nursing facilities actually receive

01:41 - 13.776 continue to support access and quality statewide.

01:41 - 16.362 Dhs estimate once

01:41 - 21.102 the bath is this is applied about half of nurse nursing facilities would actually see

01:41 - 26.313 lower final payment rates under the new methodology than they receive today

01:41 - 30.462 so I'm curious what analysis if any did your department do

01:41 - 31.992 to ensure that those

01:41 - 35.394 final rates won't reduce access or harm quality

01:41 - 38.812 and why warning signs or specific thresholds

01:41 - 41.592 would prompt dhs to tell the general assembly

01:41 - 44.152 if the basket is getting too deep.

01:41 - 47.088 So thank you for that question representative and going to

01:41 - 49.482 I'm going to unpack your question a little bit

01:41 - 50.322 so.

01:41 - 51.522 The bath which

01:41 - 53.262 we made a handout because

01:41 - 55.132 at this camp.

01:41 - 57.732 I urge you to take a look at this and I'm happy to talk about it

01:41 - 59.512 is separate

01:41 - 02.262 from what I think that you are talking about

01:42 - 06.432 with the new federal the mandated change

01:42 - 09.202 to the patient driven payment model

01:42 - 12.222 that we are now required federally to use

01:42 - 18.112 that moves us away from the prior resource utilization group calculation

01:42 - 20.832 that to put that into just plain language

01:42 - 22.762 the new system

01:42 - 25.302 Hayes for the acuity of pain oceans

01:42 - 27.852 the easiest way to think about this is

01:42 - 29.722 in this new paradigm

01:42 - 33.912 a hospital that takes care of a whole bunch of people who are on ventilators who have

01:42 - 36.988 tracheostomy and require ventilator to breathe

01:42 - 40.762 they're now going to get money under this new paradigm

01:42 - 42.672 the old paradigm really pay

01:42 - 45.352 hate for the volume of care.

01:42 - 46.782 Rather than

01:42 - 49.362 how complicated the patients were

01:42 - 51.192 in any given facility

01:42 - 54.134 so this is an important change it will actually

01:42 - 57.312 support our nursing facilities that are taking care of

01:42 - 02.022 our most complicated patients and it is federally mandated that

01:43 - 04.132 is going to change

01:43 - 06.232 somewhat it's.

01:43 - 07.752 Funding that different

01:43 - 11.862 nursing facilities are going to get depending upon the acuity of their patients

01:43 - 15.832 that's what I want that's why dive into a little bit there.

01:43 - 19.782 Is that that that's Wii software consider the net result here some

01:43 - 20.932 I'm just curious

01:43 - 22.902 if your department did any sort of.

01:43 - 27.402 Analysis to ensure that as these rates are are changing

01:43 - 30.942 we maintain that access to to quality is there any internal

01:43 - 33.012 processes that your your department did

01:43 - 33.942 so.

01:43 - 37.572 That those calculations are totally separate from the bath

01:43 - 41.202 and the bath is simply an adjustment factor

01:43 - 45.022 based on the budget that you all appropriate

01:43 - 48.172 to dhs for this purpose.

01:43 - 52.732 Generally speaking the costs of the nursing facilities

01:43 - 54.372 are come in

01:43 - 56.542 and they re determined regularly

01:43 - 59.122 higher than the money that's been appropriated

01:43 - 01.602 and so the budget adjustment factor

01:44 - 04.272 reduces that to make sure

01:44 - 05.982 that we stay within budget

01:44 - 06.762 that's what the

01:44 - 10.578 correct so so I guess sector what I'm getting at because I understand what the bath

01:44 - 12.792 does and how it's operated and everything is that

01:44 - 16.632 as we're seeing nursing facilities close and more and more boomers are

01:44 - 17.752 our aging

01:44 - 19.362 into needing nursing care

01:44 - 20.692 and I know

01:44 - 22.628 and your response to the senate last week was trying

01:44 - 24.582 to push more people into home and community care

01:44 - 26.742 and I understand that that is

01:44 - 30.232 an easier way to do things that are still going to individuals who need the nursing

01:44 - 34.152 care so these facilities I I guess what I'm getting at is

01:44 - 36.822 wanting to ensure that as we are

01:44 - 38.482 changing this methodology

01:44 - 41.892 that we don't harm access or quality to care

01:44 - 45.132 whether that be in rural parts of the state suburban parts of the state

01:44 - 46.612 so

01:44 - 51.252 I'm just I'm just curious if there are warning signs or specific thresholds

01:44 - 53.292 from your department standpoint

01:44 - 55.932 that would trigger you to tell the general assembly

01:44 - 58.552 if if we knew to make changes.

01:44 - 00.342 So I think that

01:45 - 01.842 as I mentioned to

01:45 - 02.202 rep

01:45 - 03.412 Gary.

01:45 - 05.950 The actual demand for nursing home beds is

01:45 - 09.172 not going up with the aging of our population

01:45 - 09.792 and as

01:45 - 11.442 I said you know we've seen

01:45 - 13.302 I think we went from about

01:45 - 16.009 almost sixty thousand people down to forty two thousand

01:45 - 18.222 people in nursing facility eighties over the last

01:45 - 20.002 and plus years.

01:45 - 23.530 Just because that just medicaid medical system yeah

01:45 - 25.782 those are medicaid gripes doesn't advocate numbers

01:45 - 27.552 but our job is medicaid

01:45 - 31.392 our job is not to ensure that nursing facilities are there for

01:45 - 31.842 you know

01:45 - 35.952 what I guess I'm getting at is that just looking at the medicaid picture doesn't

01:45 - 38.202 doesn't look at the whole picture for

01:45 - 42.072 nursing demand and that's what I think maybe we can get into that a little bit

01:45 - 44.052 this afternoon and

01:45 - 47.542 there are private you know there are people that are self paying

01:45 - 49.212 it's not the role of driver.

01:45 - 52.075 Most people who self pay are going to run out

01:45 - 54.492 of money and then medicaid is going to kick in

01:45 - 57.792 and then we're required to offer their services so

01:45 - 59.122 the.

01:45 - 01.662 I'll wrap up with this is my time expired

01:46 - 05.982 the concern is that as people transition to medicaid as most will

01:46 - 08.022 that the facilities under the new

01:46 - 09.792 new methodology.

01:46 - 12.322 Who are already seeing

01:46 - 14.772 and not dollar for dollar return

01:46 - 16.872 are now going to face deeper cuts

01:46 - 17.472 as.

01:46 - 19.578 Their facilities are going to be closing I guess

01:46 - 20.602 you have to ask then

01:46 - 23.962 what's going to incentivize people to operate nursing facilities.

01:46 - 26.472 If they continue to receive less and less but

01:46 - 29.782 my time's fired I'll follow up in the afternoon and I appreciate the term.

01:46 - 30.550 Thank

01:46 - 32.782 the gentleman to share mcneil.

01:46 - 36.282 Thank you chairman Harrison dr kush

01:46 - 41.892 dhs oversees and funds a lot of childcare programs and county administer programs

01:46 - 46.752 county behavioral health programs candies children and youth agencies and many others

01:46 - 51.442 how did the twenty twenty five budget impasse affect these programs.

01:46 - 53.112 Well

01:46 - 53.802 let's see

01:46 - 55.152 I'll start with childcare

01:46 - 55.962 and

01:46 - 56.742 we have a

01:46 - 00.612 wonderful opportunity to continue and actually grow

01:47 - 05.538 the very successful recruitment and retention bonuses that you are supported in the

01:47 - 06.972 current budget year that we're in

01:47 - 09.452 I was twenty five million dollars in this budget

01:47 - 11.982 and we're hoping to add an additional ten to that

01:47 - 14.366 we I've had over forty three hundred childcare

01:47 - 17.052 providers apply for that funding that will allow them to

01:47 - 21.462 give their employees a little bonus or a recruitment bonus if

01:47 - 22.662 they choose to come and

01:47 - 26.452 get as many childcare rooms open as we possibly can.

01:47 - 30.224 In our office of children and youth which is focused on

01:47 - 33.492 keeping kids safe and our entire child welfare system

01:47 - 37.272 the governor has proposed a six hundred and eighty five thousand dollars

01:47 - 39.792 to enable us to enhance child line

01:47 - 44.478 child line is the number that are mandated reporters and and anyone else who wants to

01:47 - 46.752 report a concern about abuse call balls

01:47 - 50.442 and this funding will allow us to better staff that group

01:47 - 56.442 or provide better training more sophisticated training bring in more supervisors

01:47 - 58.342 and really just.

01:47 - 02.772 Acknowledge the incredibly difficult work these folks do twenty four seven

01:48 - 04.962 taking some really difficult

01:48 - 06.552 phone calls as I'm sure you can

01:48 - 09.282 imagine so we want to continue to strengthen that group

01:48 - 10.762 and

01:48 - 13.068 what was the other category that you asked about

01:48 - 14.092 I'm sorry.

01:48 - 15.172 You said.

01:48 - 17.142 Behavioral health programs yeah

01:48 - 19.242 so enter behavioral health programs

01:48 - 20.392 you heard already

01:48 - 21.192 about

01:48 - 23.834 the support for nine eight eight and continuing to

01:48 - 27.082 grow that program which has been very successful

01:48 - 30.442 we've also asked for funding for some really critical.

01:48 - 35.472 Programs that help people transition out of our state

01:48 - 36.312 facilities

01:48 - 39.342 both those that are just and

01:48 - 41.652 both those that have justice involvement

01:48 - 44.296 they've been perhaps sent to state hospital

01:48 - 46.812 for determination of competency or other issues

01:48 - 49.692 or individuals with serious mental illness

01:48 - 53.202 who no longer need to be in a state nursing hospital

01:48 - 55.152 so we've asked for

01:48 - 56.562 funding to

01:48 - 59.232 continue to grow those community programs

01:48 - 03.792 that frees up space in our state hospitals for folks that really need that

01:49 - 05.022 level of care

01:49 - 06.472 and.

01:49 - 07.662 You know we're

01:49 - 11.418 really hopeful that we can get funding and all of these areas they're quite essential

01:49 - 13.852 to continue to grow in these programs.

01:49 - 17.043 Thank you are you aware of any counties that were more

01:49 - 19.812 adversely affected with our budget and pests than others

01:49 - 20.892 and

01:49 - 23.108 I don't know about specific counties I can

01:49 - 26.242 tell you that certainly every single county.

01:49 - 29.082 Involved in any those things that I just told you about

01:49 - 29.592 was

01:49 - 33.528 absolutely impacted by the impasse I think as you know I was a county commissioner

01:49 - 36.652 for eight years I was a commissioner in two thousand and fifteen

01:49 - 40.362 when we didn't get a final budget until December and actually

01:49 - 40.662 as.

01:49 - 42.462 The fiscal code until march

01:49 - 43.692 and

01:49 - 45.904 we spent every penny of our fund balance down and

01:49 - 48.892 we're getting ready to borrow my need to make payroll.

01:49 - 53.478 Counties were faced with those kinds of decisions laying off staff cancelling

01:49 - 56.622 contracts did they continue to do meals on wheels are not

01:49 - 57.942 late budgets

01:49 - 00.612 really have consequences for our counties

01:50 - 05.032 they have very little ability to manage around a budget impasse.

01:50 - 08.862 Thank you and what can the general assembly do due to improve

01:50 - 10.582 our county programs.

01:50 - 11.992 Well.

01:50 - 14.292 Passing on time budget is always a good thing

01:50 - 15.402 and

01:50 - 17.454 and you know I really encourage every one of

01:50 - 19.602 you to meet with your county commissioners

01:50 - 22.178 I know some counties do this fairly regularly but

01:50 - 24.852 I get the impression that not every county does

01:50 - 28.182 and if you haven't sat down with your county commissioners later really.

01:50 - 28.842 I

01:50 - 31.152 Really hope that you will go home and do that

01:50 - 34.095 you know I have spent so much time all across the

01:50 - 36.762 commonwealth between the rural healthcare summit

01:50 - 39.582 the housing action plan listening summit

01:50 - 42.504 our maternal action plan which we're about to announce

01:50 - 45.282 we have a number of listening sessions around that

01:50 - 46.732 and every

01:50 - 47.812 is a little bit different

01:50 - 51.648 and the strengths and the needs are a little bit different and sitting down with your

01:50 - 56.148 own county commissioners is the best thing that you could do to really understand

01:50 - 58.342 what their priorities and needs are.

01:50 - 00.162 Thank you I have one more question

01:51 - 01.422 switching topics

01:51 - 05.202 the governor mention enhancing child line in his budget address

01:51 - 07.062 can you share what that will look like

01:51 - 10.212 yeah so to give you some more specifics around that

01:51 - 13.132 it would allow us to hire

01:51 - 14.982 twenty additional staff

01:51 - 16.402 and.

01:51 - 20.320 I think five of those would be supervisors

01:51 - 23.680 and it would enable us to have enhanced training.

01:51 - 25.350 And

01:51 - 27.562 make sure that they have the support that they

01:51 - 30.240 needed for that twenty four seven work that they do

01:51 - 33.630 it would also help us move toward a system

01:51 - 37.870 that is looking at the needs of a child a little more holistically

01:51 - 41.530 and to consider whether or not in a particular circumstance

01:51 - 45.510 a child could be referred to a county human services team

01:51 - 48.750 or a community based organization because of the child

01:51 - 50.460 really just needs food

01:51 - 52.667 the parents aren't withholding food the parents

01:51 - 55.630 just aren't able to provide enough food.

01:51 - 58.860 That doesn't need to go into child welfare now Sara Lee

01:51 - 01.196 of parent that was withholding food from their

01:52 - 03.390 child that's a very different circumstance

01:52 - 05.910 and that child should go into child welfare

01:52 - 09.480 so we're trying to also take some of the burden off of our county

01:52 - 11.310 offices of children and youth

01:52 - 14.400 by making sure that the cases that are referred to them

01:52 - 19.240 are really the cases that require that level of expertise and engagement.

01:52 - 20.220 Thank you

01:52 - 20.760 thank you

01:52 - 22.480 thank you generally.

01:52 - 29.080 Chairman heavily.

01:52 - 31.150 Take a German

01:52 - 32.350 and.

01:52 - 34.240 Thank you madam speaker

01:52 - 35.730 as we know

01:52 - 37.230 dhs is a

01:52 - 38.410 very large

01:52 - 39.550 part of our

01:52 - 40.630 state budget

01:52 - 43.530 I think their proposal for this year's twenty one point nine four

01:52 - 44.800 billion dollars

01:52 - 47.910 when I first came in that was about the entirety of the state budget

01:52 - 49.120 so.

01:52 - 52.240 These are a lot of dollars and we do a lot of good work.

01:52 - 53.040 In this commonwealth

01:52 - 56.165 I think both sides of the aisle are very committed to making sure that those

01:52 - 58.680 that rely on these services that rely on these

01:52 - 59.830 this funding get

01:53 - 01.500 get the services that they need

01:53 - 02.880 and also

01:53 - 04.500 at the same time we wanna make sure

01:53 - 06.600 that these services are provided to the people

01:53 - 08.220 that are entitled to them

01:53 - 09.750 and we cut out that

01:53 - 11.530 waste fraud and abuse.

01:53 - 12.670 In the system

01:53 - 13.800 so we that said.

01:53 - 18.160 I recently learned about some challenges at some of the providers are experiencing

01:53 - 18.630 when

01:53 - 20.610 submitting clinical information

01:53 - 22.470 from meta for medicaid assistance

01:53 - 23.950 or medical assistance

01:53 - 28.200 and it really comes down to a fax machine I guess we still use them in

01:53 - 29.680 in the commonwealth

01:53 - 31.600 which is kind of.

01:53 - 32.850 You know a little bit of a

01:53 - 35.280 step back from where we could be especially

01:53 - 35.655 when

01:53 - 37.390 we have the governor talking a lot about

01:53 - 40.360 efficiencies and opportunities and transformation.

01:53 - 41.190 So

01:53 - 44.880 I guess the issue is as these providers are providing these services

01:53 - 48.547 and we talk about hospital and provider struggling

01:53 - 49.780 in closing

01:53 - 50.920 to make sure

01:53 - 52.090 that when they're submitting

01:53 - 53.440 the paperwork

01:53 - 53.790 that.

01:53 - 57.936 It that we're getting it done properly so that they're getting the proper

01:53 - 59.490 reimbursement and we're not creating

01:53 - 01.500 additional administrative hurdles

01:54 - 04.700 of where that person is sitting at a desk for hours working on something

01:54 - 07.180 that could have been approved and I guess it has to do with

01:54 - 08.440 the facts is

01:54 - 10.740 not going through properly and then

01:54 - 12.180 the claims being denied

01:54 - 13.680 and then there's really is

01:54 - 17.530 is the appeal process is cumbersome and pretty much non existent.

01:54 - 19.450 Does that something I know.

01:54 - 22.896 That's something that we're working on to try to cut down on the on those

01:54 - 23.920 administrative

01:54 - 24.660 burdens

01:54 - 26.070 to our providers that can we

01:54 - 27.370 can we.

01:54 - 30.550 Scan and email vs faxing.

01:54 - 32.430 So prior off

01:54 - 34.650 is the bane of every provider

01:54 - 40.266 and it's not just medicaid program many insurance companies are still using faxes I

01:54 - 42.760 just want a level set with everybody that.

01:54 - 44.200 It's not just us

01:54 - 47.100 however this is the year that we start to fix that

01:54 - 49.956 and we're really excited about some of the steps that

01:54 - 54.240 are being taken in our medicaid program we have been

01:54 - 59.610 in a process of replacing and modernizing our promise system

01:55 - 01.060 as and

01:55 - 01.830 the

01:55 - 03.280 and.

01:55 - 04.750 That is are.

01:55 - 11.346 The medicaid management information system and we are getting a new module that is

01:55 - 15.966 going to let us streamline the prior authorization functions which is what you're

01:55 - 18.630 talking about that's what these providers are complaining about.

01:55 - 22.665 How the next phase which is currently in a pilot

01:55 - 25.620 is will provide a prior authorization pa portal

01:55 - 29.640 to allow providers to enter and manage their authorization requests

01:55 - 31.779 so to your point there'll be able to just

01:55 - 34.840 actually go online when this is fully implemented

01:55 - 37.529 and they will be able to put in that request they

01:55 - 41.170 will not have to fax or call like they do today

01:55 - 46.930 so that Cornell is scheduled to be released in the summer of two twenty twenty six

01:55 - 51.750 and then we're in the final procurement phase for a new provider management system

01:55 - 55.133 that would allow providers to enroll revalidate change

01:55 - 58.450 your address and check on the status of applications

01:55 - 04.740 resulting in less need to interact with staff or that hole hosted in our actions and

01:56 - 09.450 there'll be a p all of that that we hope will be able to actually actually automate

01:56 - 12.120 some of those prior authorizations so

01:56 - 16.206 once they input the data will be able to cross check that patient and if that is

01:56 - 18.270 something that will be authorized for that patient

01:56 - 20.460 it'll just happen automatically so

01:56 - 22.692 we hear your providers and we're in the process of

01:56 - 26.110 fixing it in the interim is there a way that we could.

01:56 - 29.010 Kind of help those providers to recoup some of the cost

01:56 - 29.820 that they had

01:56 - 31.530 that they laid out and

01:56 - 33.300 and that they weren't reimbursed for

01:56 - 37.080 because of that as we talked I mean obviously reimbursement rates are low

01:56 - 38.680 for medicaid

01:56 - 40.470 medicare reimbursement rates were cut

01:56 - 43.830 when obamacare was implemented to pay for medicaid which has lower

01:56 - 45.040 reimbursement rates

01:56 - 48.000 so with all that said private insurance has to pay more for all that

01:56 - 50.700 is there a way that we can try to at least get these dollars

01:56 - 53.130 to these providers as as best we can

01:56 - 56.790 you know if you've got providers that have specific issues that

01:56 - 58.561 for some reason had trouble with the appeal

01:56 - 00.385 process we'd be happy to meet with you and get

01:57 - 00.870 this effect

01:57 - 01.707 and then.

01:57 - 02.760 One of

01:57 - 06.420 the act forty five of twenty twenty five included sick different

01:57 - 08.050 permitting reforms.

01:57 - 10.030 Which placed every

01:57 - 12.120 additional requirements on the agencies

01:57 - 14.370 and I know we've recently penned a letter

01:57 - 16.840 myself and several of the committee chairs.

01:57 - 19.120 Asking dhs.

01:57 - 22.530 What they're doing to comply with that act forty five

01:57 - 23.800 and I believe that these

01:57 - 26.490 according the office of transformation opportune unity

01:57 - 27.930 I think there's quite

01:57 - 29.230 a long list

01:57 - 30.090 of of

01:57 - 33.810 for the under dhs that would be dealing with permitting reform

01:57 - 35.830 is that something that.

01:57 - 36.510 You can

01:57 - 38.580 shed a little bit of light on now are

01:57 - 42.306 you I'm guessing that for us they're really talking about like licensing and

01:57 - 44.507 certifications yeah I mentioned earlier that we do

01:57 - 47.800 license eleven thousand and ninety the three facilities

01:57 - 53.440 and we as far as I'm aware we are meeting all the metrics

01:57 - 57.990 that the governor laid out with that permitting reform on timeliness and we have not

01:57 - 00.838 had to give any refunds you know that was part of that the

01:58 - 03.300 program was that you would actually have to pay somebody

01:58 - 04.140 back

01:58 - 09.880 if you weren't done timely and I I am not aware that we've had to refund anybody.

01:58 - 13.488 If there's particular programs you have questions about or

01:58 - 14.310 we'd be happy to

01:58 - 18.030 I think was just overall like the setup at how it how it's going to be.

01:58 - 18.870 How

01:58 - 20.128 they're going to comply

01:58 - 20.640 with

01:58 - 24.456 each one of our program offices is in charge of different things and each of those

01:58 - 27.730 things like childcare providers have different licensing requirements

01:58 - 28.470 than

01:58 - 29.010 the

01:58 - 30.550 people that serve

01:58 - 33.150 looks within to intellectual disabilities and autism so

01:58 - 35.490 like if you have specific questions we can

01:58 - 36.670 we'd be happy to share

01:58 - 38.919 what those requirements look like and how we meet those.

01:58 - 42.150 They just want to thank you know we have our quarterly meetings and

01:58 - 43.200 it is important we

01:58 - 44.730 may not agree on all the issues

01:58 - 46.996 but it's important that we work together to provide the

01:58 - 49.116 services for those that depend on them and our community

01:58 - 49.470 thank you

01:58 - 51.070 appreciate it.

01:58 - 52.050 Thank you

01:58 - 53.530 Cheryl Williams.

01:58 - 55.830 Chairman thank you and dr

01:58 - 56.950 kush.

01:58 - 59.670 Thank you and your staff will your presentation today.

01:59 - 02.800 I'm just saying on a personal level how much I appreciate

01:59 - 05.580 the work your organization does your department does

01:59 - 08.040 particularly on behalf of those

01:59 - 11.260 often referred to as the least of these.

01:59 - 14.250 I think we've already heard though that the federal changes to

01:59 - 16.870 the snap program have resulted

01:59 - 18.070 in people being

01:59 - 19.230 distant road

01:59 - 21.250 due to work requirements

01:59 - 24.150 and so my question is what processes

01:59 - 25.870 are in place

01:59 - 30.720 to help individuals who lose benefits solely due to

01:59 - 34.390 paperwork issues regain their coverage.

01:59 - 36.190 So.

01:59 - 40.350 That's a great question tion and I I'd love to just take a minute to tell you

01:59 - 43.468 some of the work that we've done to try to prevent

01:59 - 45.870 people from losing those benefits in the first place

01:59 - 48.720 and right now it's just about snap

01:59 - 53.610 it's it's the medicaid changes don't start until January of twenty twenty seven

01:59 - 58.140 but we have done a number of things to make it easier for people snap

01:59 - 00.803 we've enhanced document upload capabilities

02:00 - 03.540 so the documents they send us are readable

02:00 - 05.430 we let them know if they're not so they can

02:00 - 07.300 resend them immediately

02:00 - 09.732 we've enhanced the public's ability to track

02:00 - 12.540 the status of benefit applications or renewals

02:00 - 16.830 people can now change their password online without having to contact us

02:00 - 17.880 at and

02:00 - 22.090 we've also started something called consent based verification

02:00 - 24.812 which is a process where an individual who

02:00 - 28.000 needs to provide us with payroll information

02:00 - 29.920 can give us permission

02:00 - 33.970 and then log in they log into their payroll provider

02:00 - 37.230 and we can then pull from that what we need

02:00 - 42.270 to determine their eligibility so again all of these things have been designed to

02:00 - 47.650 make it much easier for people to meet these requirements if somebody in snap.

02:00 - 49.980 Has not been able to report

02:00 - 52.720 adequately that they're meeting these requirements

02:00 - 58.380 they can come back anytime and so once they get to that eighty hours at weather it's

02:00 - 59.850 going to school part time

02:01 - 02.220 working part time volunteering part time

02:01 - 03.780 they can always come back

02:01 - 06.850 and we have worked hard to get people information

02:01 - 10.560 we have created away through pa navigate for people

02:01 - 14.130 to look for volunteer opportunities in their zip code

02:01 - 15.430 and these are

02:01 - 18.240 nonprofits that have raised their hand and saying hey we have

02:01 - 19.810 the shifts.

02:01 - 22.680 Do us and you can get five hours a week with us

02:01 - 23.980 and we'll document that

02:01 - 24.300 you know

02:01 - 25.620 all like we're just

02:01 - 28.579 throwing everything at this we need your help

02:01 - 31.590 to help publicizes to the folks in your district

02:01 - 33.990 and we welcome ideas

02:01 - 37.710 for anything more that we can be doing to help get the word out.

02:01 - 40.270 Approved issued their response

02:01 - 44.130 let me add then given the risk that similar federal reporting

02:01 - 45.990 requirements could cause

02:01 - 48.190 eligible individuals

02:01 - 50.520 to lose medical assistance coverage

02:01 - 52.540 beginning in January.

02:01 - 56.230 What steps is the department taken to minimize

02:01 - 58.560 administrative disenrollment

02:01 - 01.530 and what actions can the legislature take

02:02 - 04.510 to help ensure eligible individuals

02:02 - 06.340 maintain that coverage.

02:02 - 10.626 So one of the first things that you all can do as I've mentioned is just help us get

02:02 - 14.580 the word out you know people consume information in all different ways

02:02 - 19.710 so your newsletters your social media might be something your constituents look at

02:02 - 21.120 they never look at ours

02:02 - 26.557 so we've got graphics available to you all this stuff in our that dhs that gate at

02:02 - 28.680 gas sash work we encourage you to go there

02:02 - 31.890 we are about to convene starting tomorrow afternoon

02:02 - 34.080 and h r one work group

02:02 - 36.750 and we do have legislative representation on that

02:02 - 37.410 and

02:02 - 38.760 we are up to about

02:02 - 39.660 I do dunno

02:02 - 40.810 thirty five

02:02 - 42.070 plus folks

02:02 - 47.706 are representing all kinds of different entities community based organizations legal

02:02 - 52.050 services all of our medicaid advisory groups a whole host of folks

02:02 - 54.815 and we're going to be working with them and meeting

02:02 - 57.360 with them regularly and sharing information with them.

02:02 - 00.690 We have a sub stack that ps apple can sign up for

02:03 - 02.980 and we are pushing out weekly

02:03 - 05.070 updates through the sub stack channel

02:03 - 09.426 about what actions folks can take to help get the word out and giving people

02:03 - 11.190 actionable things that they can do.

02:03 - 15.060 We are doing everything that we can think of to help get the word out

02:03 - 19.386 of the volunteer community has been great we've had so many nonprofits raise their

02:03 - 22.830 hands to be listed on pa navigate we are

02:03 - 26.250 about to announce in fact I think we've actually gone live now

02:03 - 29.920 governor shapiro gave us our office of information.

02:03 - 32.760 Our office of income maintenance

02:03 - 34.060 permission

02:03 - 39.460 to broaden out the number of programs that are certified as meeting snap.

02:03 - 40.500 Training

02:03 - 42.160 program requirements

02:03 - 46.260 so we have a desert a group of programs that are employment training programs

02:03 - 50.076 designated under snap that if you enroll in one of those you automatically meet the

02:03 - 54.000 requirements but there's a lot of other job training programs out there

02:03 - 58.800 and so we are about to undertake a whole process to contact them all

02:03 - 01.474 and the ones that offer programs that meet the

02:04 - 04.290 snap requirements were going to certify them in a

02:04 - 06.840 one page process that they have to do

02:04 - 09.300 and we'll be listing those on our website so

02:04 - 10.260 we're just

02:04 - 13.620 anything that we can think of to create more opportunities for people were doing.

02:04 - 16.410 This and I appreciate the coverage of the initial

02:04 - 17.770 responses

02:04 - 19.800 my time has run out chairman thank you.

02:04 - 21.720 Madam secretary thank you

02:04 - 22.140 thank you

02:04 - 23.290 thank the gentleman

02:04 - 24.730 cheer clunk.

02:04 - 28.260 Thank you mr chair and thank you secretary for joining us here today

02:04 - 33.300 we talked earlier about childcare staff or crew shipment and the retention program

02:04 - 35.430 and as a young mom with many friends

02:04 - 39.780 who have young children at home this is a very important issue of child care

02:04 - 41.500 to those families

02:04 - 46.026 you stated that four thousand three hundred providers applied for the twenty five

02:04 - 48.070 million dollars that was appropriated.

02:04 - 51.730 So my questions go to the oversight of this.

02:04 - 55.230 Once a provider submits their final expense report

02:04 - 58.080 by July thirty first twenty twenty six

02:04 - 02.261 will dhs be providing the statistical information from

02:05 - 05.500 these reports to the public and to the legislature

02:05 - 06.540 and if yes

02:05 - 07.500 when can be the

02:05 - 11.460 when can they be expected and I ask because these are taxpayer dollars

02:05 - 13.410 and our taxpayers would like to know

02:05 - 14.970 if those taxpayer dollars

02:05 - 16.090 are actually working

02:05 - 20.790 so your question is will we give you an accounting of

02:05 - 24.630 where each of the dollars went which child care providers

02:05 - 25.840 correct

02:05 - 30.270 yes we can we can do that we can provide that is that is great thank you so very much

02:05 - 31.260 so then

02:05 - 34.150 are you are you going to be tracking

02:05 - 36.960 and if the child care staff will be.

02:05 - 40.170 Maintaining their employment at that particular

02:05 - 41.950 child care provider

02:05 - 45.750 who participated in the program after they've received that bonus

02:05 - 46.800 and then

02:05 - 48.840 how were you checking to ensure

02:05 - 51.780 that those child care providers are retaining

02:05 - 56.040 those employees that are receiving that bonus will we have data on that

02:05 - 57.280 yeah I'm going to f

02:05 - 59.233 deputy secretary brand to come up I don't know that

02:05 - 02.370 we've put in place an actual tracking system just yet

02:06 - 06.010 honestly representative because we didn't have a budget.

02:06 - 09.400 We have been one hundred per cent laser focused

02:06 - 10.890 since January one

02:06 - 11.820 on.

02:06 - 17.520 Yet the process in place for these providers to actually apply that's been job one

02:06 - 19.690 and so we.

02:06 - 22.810 I will turn over sexually around but we haven't

02:06 - 25.570 quite gone into that okay then what.

02:06 - 30.726 Yes so representative we actually will be providing a report that you asked for so

02:06 - 33.119 that is actually a requirement to those funds

02:06 - 35.670 will be providing a report at the end of it

02:06 - 41.350 what is not included in our report is any tracking of the funding to be able to

02:06 - 43.450 and figure out.

02:06 - 48.070 Where the staff is once they've received those awards.

02:06 - 52.180 That is not a part of the recruitment and retention.

02:06 - 53.710 Report.

02:06 - 55.815 Okay well I think you know since the governor

02:06 - 58.290 is asking for additional funding in this area

02:06 - 59.670 and that as we

02:06 - 02.728 continue these talks as we head into next year's budget

02:07 - 05.910 if additional funding is allocated and if we decide to

02:07 - 08.850 continue this funding that we have additional

02:07 - 11.640 safeguards on this to make sure that we know

02:07 - 13.360 are we recruiting

02:07 - 16.950 and retaining these individuals are they staying in child care

02:07 - 21.300 how long are they staying and really truly are these bonuses actually working

02:07 - 23.040 because if they're not working

02:07 - 26.610 we need to figure out a way to keep these people in this workforce

02:07 - 29.910 and maybe shift those dollars into areas in childcare

02:07 - 34.780 where those dollars can work better for Pennsylvania families and our kids.

02:07 - 38.290 My next my next question goes to child care regulations

02:07 - 39.000 and

02:07 - 42.210 you know we've been hearing about the child care a regulation rewrite

02:07 - 44.850 since the fall of twenty twenty one

02:07 - 48.480 I've been hearing about it since I became the chair last year

02:07 - 52.230 and back in twenty twenty two represented have to lose your

02:07 - 55.380 had a hearing on these regulations

02:07 - 59.340 and it has been over four years now since that initial

02:07 - 01.200 discussion about their rewrite

02:08 - 03.870 so what is the status of those child care

02:08 - 07.239 regulations yet the deputy secretary can.

02:08 - 08.680 Post timeline

02:08 - 13.446 for where we are are are at right now and where we're going absolutely so the

02:08 - 18.220 original time frame for the certification rewrite.

02:08 - 20.460 Was amended and shared

02:08 - 24.480 it has been updated on our website as you noted yes.

02:08 - 24.990 I

02:08 - 27.855 Think when we started this project I was actually the

02:08 - 31.350 director of certification and now I'm the deputy of ok though

02:08 - 33.000 so there has been some time

02:08 - 34.650 but that time has

02:08 - 38.241 been necessary as this is a full rewrite this isn't us

02:08 - 41.730 changing a few things this is actually us going from

02:08 - 44.830 I think it's about three different chapters.

02:08 - 47.540 So thirty two seventy eighty and ninety two

02:08 - 51.430 two separate chapters one that will focus on.

02:08 - 56.646 Childcare that takes place in a home or residence vs childcare that is taking place

02:08 - 01.530 in a commercial space on right now we are in the stages of internal

02:09 - 02.770 review

02:09 - 03.525 and

02:09 - 08.500 with the intention that these regulations will be released

02:09 - 09.780 for a final comment

02:09 - 13.680 I'm probably in this we're in winter now so

02:09 - 15.600 I'm probably in the spring

02:09 - 19.588 with the expectation that once these are shared and

02:09 - 22.950 they are pass through the regulatory reform commission

02:09 - 25.993 that you will have one year of of implementation

02:09 - 28.980 so they're not going to immediately go into effect

02:09 - 31.306 once they go through or you will get an additional

02:09 - 34.090 year to be able to implement these regulations

02:09 - 38.110 the other reason why it has taken us an a number of time.

02:09 - 41.440 Is we wanted to be very intentional about the resources

02:09 - 44.950 and the technical assistance that goes with these regulations

02:09 - 51.490 so not only are we rewriting the entire or regulatory package for these two.

02:09 - 53.050 These two

02:09 - 54.370 facility types

02:09 - 56.820 but we are also putting together some

02:09 - 59.714 ongoing resources and some technical assistance

02:09 - 03.540 to be able to share with these providers and our

02:10 - 07.050 our advocates and stakeholders so that they really understand these new

02:10 - 08.220 regulations

02:10 - 11.280 right now we don't have any supplemental

02:10 - 14.880 resources that actually coordinate with the

02:10 - 18.810 childcare regulations and we wanted to be able to share something publicly

02:10 - 22.770 so that folks really have an understanding of what these and

02:10 - 26.220 these new regulations are all about and what the expectations are

02:10 - 28.110 when you have a licensing inspector

02:10 - 29.890 come and see your facility.

02:10 - 31.150 Thank you mr brown

02:10 - 32.460 thank you secretary

02:10 - 33.300 for those

02:10 - 35.580 responses I know my time is up

02:10 - 38.832 I do want to implore the department though to listen

02:10 - 41.520 to the providers I've been hearing from these providers

02:10 - 45.360 please listen to their concerns as you're continuing these rewrites

02:10 - 48.390 I thank you for trying to give them additional guidance

02:10 - 51.602 I do do worry though that some of what we've heard in the

02:10 - 54.300 past could potentially put some of these smaller providers

02:10 - 55.600 out of business

02:10 - 57.480 and that believe our parents

02:10 - 00.630 in the lurch trying to find childcare for their children so

02:11 - 02.700 please listen to those concerns

02:11 - 05.910 happy to continue the conversation so that we can work together

02:11 - 07.860 for Pennsylvania families and kids

02:11 - 08.980 and thank you.

02:11 - 11.500 Thank the gentle lady and.

02:11 - 13.290 We are going to

02:11 - 14.988 with that.

02:11 - 16.240 Break.

02:11 - 17.860 For lunch

02:11 - 21.280 and then we will come back at one o'clock.

02:11 - 23.706 As they want fifteen

02:11 - 26.016 will cut back at one fifteen

02:11 - 27.366 and

02:11 - 29.466 commence with our afternoon

02:11 - 32.066 session with the department of human services

02:11 - 33.516 and so this

02:11 - 35.436 budget hearing will recess

02:11 - 36.836 until one fifteen

02:11 - 37.436 p m

02:11 - 39.006 thank you.

02:14 - 13.057 The.

02:28 - 01.998 The.

02:31 - 45.026 The.

02:32 - 35.226 The.

02:33 - 36.476 Yeah.

02:35 - 50.976 The.

02:39 - 01.146 The.

02:39 - 50.166 The.

02:40 - 49.956 The.

02:41 - 10.806 The.

02:44 - 59.782 The.

02:54 - 19.926 The.

02:54 - 58.592 The.

02:57 - 54.231 The.

03:01 - 57.604 The.

03:09 - 00.320 The.

03:14 - 36.022 Yeah.

03:20 - 14.792 Yeah.

03:21 - 02.702 The.

03:37 - 44.654 Yeah.

03:45 - 21.880 The.

03:51 - 25.480 Yeah.

03:55 - 02.729 The the.

03:56 - 27.412 The.

04:04 - 43.218 The.

04:06 - 13.510 The.

04:07 - 45.490 The.

04:07 - 47.980 The.

04:16 - 34.649 The.

04:16 - 55.660 The.

04:19 - 22.926 The.

04:22 - 14.920 Yeah.

04:22 - 40.600 Yeah.

04:25 - 19.272 Yeah.

04:31 - 32.592 The.

04:32 - 07.782 The.

04:32 - 13.122 The.

04:40 - 15.280 So.

04:42 - 21.910 The.

04:46 - 52.330 The.

04:46 - 54.880 The.

04:49 - 36.280 Yeah.

04:50 - 22.120 Yeah.

04:56 - 40.124 The.

05:00 - 10.649 Yeah.

05:03 - 37.769 Yeah.

05:07 - 55.860 The.

05:11 - 04.548 The

05:11 - 05.893 the.

05:12 - 35.447 The.

05:13 - 47.820 The.