The6th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 16, 2005, at 1:00 PM, in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 1:12 PM, and the secretary called the roll.
Members:Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Denise Harper Angel, Alice Kerr, Joey Pendleton, Richard "Dick" Roeding, Ernesto Scorsone, Katie Stine, and Johnny Ray Turner; Representatives Bob DeWeese, David Floyd, Mary Lou Marzian, Stephen Nunn, Darryl Owens, Ruth Ann Palumbo, Jon David Reinhardt, Kathy W Stein, and Addia Wuchner.
Guest Legislator: Representative Jimmie Lee.
Guests: Glenna Taylor, Parent, ARC of Kentucky; Laurel True, Bill Harner, Sherman Colvin, American Association of Retired Persons; Marilyn Minnick, KIPDA; Sue Billings, Department of Agriculture; Jim Graves, Office of Attorney General; George Parsons and David Allgood, Center for Accessible Living; Elizabeth Croney, Croney & Clark, Inc.; Natalie Tinsley, Kentucky Board of Licensure of Occupational Therapists; Chris Cecil, Department for Mental Health and Mental Retardation Services, Cabinet for Health and Family Services; Shirley Eldridge, Department for Human Support Services, Division of Aging Services, Cabinet for Heath and Family Services; Willa Thomas, Division of Aging Services, Cabinet for Health and Family Services; Mike Wooden, Eli Lilly & Company; Ruby Jo Lubersky, Kentucky Association of Health Care Facilities; Jason Dunn, Cabinet for Health and Family Services; Anne Joseph; Kentucky Task Force on Hunger; David Gayle and Commissioner Tom Emberton, Department for Community Based Services, Cabinet for Health and Family Services; Amy Watts and Michal Mello, Kentucky Long-Term Policy Research Center; Irene Centers, Department for Public Health, Cabinet for Health and Family Services; Mary Crawley-Smith and Bert Sisk, Bluegrass Area Agency on Aging; Bruce Lucas, M.D., Paul E. O'Flynn, and Jenny Miller Jones, Kentucky Organ Donor Association; Ralph Brewer, Executive Director, Robert Pendleton, Ron McDale, Potter Children's Home and Family Ministries; Sheila Schuster and Debra Miller, Kentucky Medicaid Consortium; Jim Hilborn and Judy M. Campbell, Franklin County Council on Aging; John Parrish, Division of Occupations and Professions, Finance and Administration Cabinet; Michael Samuels, University of Kentucky; Trudy Abshire and Gayla Hayes, parents; Jan Gould, Kentucky Retail Federation, Commissioner Shannon Turner, Department for Medicaid Services, Cabinet for Health and Family Services; Mark Birdwhistell, Undersecretary for Health, Cabinet for Health and Family Services; Kevin Payton, Legislative Director, Cabinet for Health and Family Services; and Scott Jones, Speaker Pro Tem's Office.
LRC Staff: Murray Wood, CSA, Barbara Baker, Tyler Campbell, Eric Clark, Miriam Fordham, DeeAnn Mansfield, Gina Rigsby, and Cindy Smith.
A report on expanding services to older adults was given by Bert Sisk, Chair of the Franklin County Council on Aging, and Chair of the Special Advisory Commission of Senior Citizens, and Mary Crawley-Schmidt, State President of the American Association of Retired Persons, a case manager of the Bluegrass Area Agency on Aging, and an advocate for the Center for Accessible Living. Ms. Crawley-Schmidt testified there are over 4,000 seniors on waiting lists for programs that enable them to maintain themselves in the community. The wait for personal care assistance can be as long as 15 years. Accessible housing, employment, transportation, and availability of direct care professionals were identified as significant issues for the near future. Mr. Sisk reported that the Special Advisory Commission on Senior Citizens adopted one priority recommendation for the 2006 General Assembly: a 20 percent increase in state funding for Area Agencies on Aging for each year of the biennium.
Representative Palumbo asked if there was a Center in Lexington comparable to the Center for Accessible Living. David Allgood, an advocate for the Center for Accessible Living in Louisville, said that the Independence Place was the same.
Senator Roeding asked about accountability for funds and competitive bids for services. Ms. Crawley-Schmidt stated the Division for Aging Services has contracts with the Area Development Districts to administer programs. The programs are monitored on a yearly basis and monthly financial reports are required. She said that service providers are monitored so services to make sure services are provided as economically as possible. Case managers make sure if an individual qualifies for any other services, they are enrolled in those first.
Irene Centers, Team Leader of the Tobacco Prevention and Control Team in the Chronic Disease Prevention and Control Branch within the Department for Public Health testified that 72 percent of adults in Kentucky do not smoke, and almost one-half of those that do smoke tried to quit last year. Over 8,000 Kentuckians die each year of tobacco-related diseases. The rate of smoking among pregnant women has increased slightly over the past year and is costly in terms of neonatal health care. It was reported that studies show that state Medicaid programs can increase quit rates by 30 to 70 percent for pregnant women by offering counseling.
She said that the Centers for Disease Control and Prevention recommend evidence-based practices involving media messages, increasing the unit price for tobacco products, health care provider education, and telephone counseling. Kentucky is using these strategies with the Legacy Foundation, KIDS NOW, family youth resource service centers, coordinated school health programs, and local health departments.
Representative Burch asked if all health departments offer smoking cessation programs, and Ms. Centers said yes. Representative Burch asked about the cost of the classes, and she said the tobacco cessation classes are free. If nicotine replacement is offered, sometimes it is free and some insurance plans offer it at a reduced rate. He asked about measurements of success rates. She said that the success rate for the Cooper/Clayton method is about 45 to 50%, which is a 12 week behavioral modification program with nicotine replacement therapy. She said that the other effective strategy is Kentucky's Tobacco Quit Line: 1-800-QUIT NOW (784-8669). He asked if the number of people enrolled had increased or remained the same. She said that the classes are high January through March because of New Year's resolutions. He asked if the health departments dispensed nicotine patches. She said that both nicotine gum and patches are recommended for the Cooper & Clayton program, and if the health department has additional funds from the tobacco settlement or from KY-ASAP, health departments will purchase these products. Sometimes health departments buy the products and then sell it back to participants a week at a time.
Representative Wuchner asked about the percent of an individuals in the Cooper and Clayton program who returned to smoking. Ms. Centers stated that the individuals in the Cooper and Clayton program were studied for a year and it varied by age, race, economical and educational background.
A motion to approve 201 KAR 8:180, 201 KAR 8:225, 201 KAR 8:265, 201 KAR 28:190, 202 KAR 7:031E, 902 KAR 4:035 & E, 902 KAR 22:040, 921 KAR 3:020, 922 KAR 1:010, and 922 KAR 1:530 was made by Senator Roeding, seconded by Representative Wuchner, and approved by voice vote.
A motion to approve the minutes of the October 19, 2005 meeting was made by Representative Owens, seconded by Senator Roeding, and approved by voice vote.
A motion to approve the FFY 2006-07 Temporary Assistance for Needy Families Block Grant was made by Representative Owens, seconded by Representative Nunn, and approved by voice vote.
Ralph Brewer, Executive Director, Potter Children's Home and Family Ministries, discussed a "no-dollar contract" with the state in order to accept the placement of children committed to the state's custody in their facility. Discussion was held about their policies on corporal punishment and attendance at church services. The program representatives discussed an Arkansas law that provides licensing exemptions for church-related child welfare agencies. No such exemption currently exists in Kentucky law. Representative Nunn stated that the state cannot place children anywhere without giving state funds. He said that Potter Children's Home is willing to take children without taking state funds.
Representative Stein asked if Potter Children's Home received federal funding, Mr. Brewer stated some children receive a medical card, but the Home did not receive federal funds directly. She asked about Potter Children's Home policies on corporal punishment. He stated that corporal punishment is permitted in the policy but is almost never used and offered to provide a copy of the policy to members. Representative Stein asked if it was against policy for women to serve on the Board of Trustees, and Mr. Brewer stated no. She asked if it is a requirement that a child and/or the families would have to attend church. Mr. Brewer stated the children placed at Potter Children's Home would have to attend services three times a week, twice on Sunday and once on Wednesday. He said that it is discussed during the in-take process and if someone refuses to agree to attend church, they would not be accepted to stay at Potter Children's Home. Representative Stein stated that, unfortunately, children placed with the state are in crisis and attending church would not be a priority when looking for placement for the child.
Senator Kerr asked if Potter Children's Home was a member of the Children's Alliance, and Mr. Brewer stated that because some issues do not apply to them, they are not regular members. She asked about the severity of behavior in children at Potter Children's Home, and he stated that there is no structure provided for children with severe behavior problems. Senator Kerr asked if therapeutic training is provided for staff. Mr. Brewer stated that the direct care staff is trained annually.
Representative Owens asked if there is a list of criteria or guidelines on who would be accepted. Mr. Brewer said they cannot take children who are sexual perpetrators, drug addicts, psychotic, pregnant, and others. Representative Owens asked about security, and Mr. Brewer stated that while there are security measures, it is not tightly guarded.
Senator Denton asked why corporal punishment was part of the discipline code. Mr. Brewer stated that in certain cases "one swat on the bottom" is the option of last resort with a young child to show there is a consequence for bad behavior. One swat is not seen as corporal punishment. She asked for a scenario when this would occur and what would be used. If the need should arise, it would be a team decision with the house parent, counselor, and other staff. He said that a paddle would be used over the child's clothing with witnesses. The only individuals allowed to paddle a child are the director and the minister of family services who is in charge of all direct care staff.
Senator Denton asked if the organization would eliminate corporal punishment if this would allow them to receive children from the state. Mr. Brewer stated that he would have to discuss that with the board. She said that currently the statutes and regulations there is nothing that provides for a no fee contract, and asked what need to be changed for Potter Children's Home to be able to receive children from the state. He said regulations stated a child has to be provided a way to attend worship wherever they want to go and a child cannot be forced to pray. Potter Children's Home wants the children attending their services. While they would never force a child to pray, they would expect them to be respectful during a prayer. He indicated that he would provide the committee past correspondence from the cabinet that indicated problems when they tried to do this before.
Representative Marzian stated that corporal punishment is an unacceptable policy and it would cause concern if children were placed at a facility that condoned this behavior. She said that in Potter Children's Home mission it states "to deliver God's justice" and asked what this meant. He said that it meant to provide structure, accountability, and consequences for behavior.
Representative Burch stated that corporal punishment is a particular issue for children who have been abused, and said that it should be taken out of the policy. He also said that it is wrong to force a child to go to church. He said having witnesses to corporal punishment does not justify the action. Representative Burch asked why Potter Children's Home wanted to accept children without receiving any financial compensation. Mr. Brewer said to help them become productive citizens and because it is the right thing to do.
Representative Stein stated that Section 5 of the Constitution states in part "No preference shall ever be given by law to any religious sect, society, or denomination. No person shall be compelled to attend any place of worship, to contribute to the erection or maintenance of any such place, or to the salary or support of any minister of any religion."
Commissioner Tom Emberton and Kathy Adams from the Department of Community Based Services stated that children placed in residential care have significant emotional and behavioral issues and need specific structured treatment, and they expressed concern that Potter Children's Home does not have a treatment license.
The first prefiled bill to be considered was Bill Request 323, AN ACT relating to organ and tissue donation, sponsored by Representative Steve Nunn. Representative Nunn explained the prefiled bill request. Bruce Lucas, M.D., and Paul E. O'Flynn, Kentucky Organ Donors Association, spoke in support of the prefiled legislation. A motion was made by Representative Nunn and seconded by Representative Stein that Bill Request 323 as amended be passed out. After a roll call vote of 10 yes votes, 0 no votes, and 0 pass votes, Bill Request 323 as amended was passed out favorably.
The last prefiled bill to be considered was Bill Request 113, AN ACT relating to caregivers, sponsored by Representative Larry Clark. Scott Jones, Chief of Staff, Speaker Pro Tem's Office, explained the prefiled bill request. A motion was made by Representative Owens and seconded by Representative Stein that Bill Request 113 be passed out. After a roll call vote of 19 yes votes, 0 no votes, and 0 pass votes, Bill Request 113 was passed out favorably.
Dr. Michael E. Samuels, Endowed Chair/Distinguished Scholar in Rural Health Policy, Professor of Family Practice and Community Medicine, University of Kentucky, and Michal Smith-Mellow, Kentucky Long-Term Policy Research Center, presented the results of its Health Insurance Research Project, a state planning grant funded by the U.S. Health Resources and Services Administration. The purpose of the grant was to determine the number of uninsured in Kentucky, why they are uninsured, how long they have been uninsured, and how best to address their needs. The project investigators conducted public forums and small group meetings, conducted surveys, and analyzed data to recommend policies to increase the number of insured people in Kentucky.
The public forums revealed that most participants believe that the nation's health care system is in crisis; that cost is the main obstacle to obtaining health insurance; that cost-shifting in hospitals is significant and there are many ongoing problems with private and public insurers; and that community institutions such as community hospitals, nonprofit organizations, health departments, employers, and local governments face risks from rising costs and uncompensated care.
Over 28 percent of Kentuckians reported being uninsured for some part of the last year, and over 13 percent reported being uninsured at the time of the survey. Almost 50 percent reported being uninsured for more than three years. About 75 percent of the uninsured have an annual household income of less that $30,000. One-half to one-third of the uninsured reported they did not seek care, missed a diagnostic test, did not fill a prescription, or did not see a specialist because of cost; about one-fourth of the insured reported the same.
The majority of the uninsured are employed. Of the small employers (less than 50 employees), 57 percent did not offer health benefits. Small employers that offer health insurance reported a 30 percent median increase in premiums and other cost-sharing policies since 2002.
Amy Watts, Ph.D., Policy Analyst, Kentucky Long-Term Policy Research Center, stated it was estimated that uncompensated care and out-of-pocket costs for the uninsured cost Kentucky about $811 million in 2004 and medical spending for the uninsured would increase about $552 million if they had full coverage. It was stated that the benefits of full coverage for the uninsured outweigh costs at a ratio of approximately 1.7 to 1.
Representative Owens asked if the uninsured and underinsured were lumped together, and Ms. Watts said no.
Representative Palumbo asked health characteristics of the uninsured on the survey. Ms. Watts said smoking, diseases, chronic diseases, and others.
Representative Wuchner asked if the 71 percent of uninsured individuals, as opposed to 20 percent of insured individuals, who were sick but did not see a doctor because of cost had an acute or a long-term illness. Dr. Samuels stated that it was a general question on the survey and they were unable to make that determination.
Dr. William Hacker, Commissioner of the Department for Public Health, testified that a pandemic is a severe outbreak of the flu that involves all parts of the world. Although the virus genes of the avian flu have not mutated yet, there is potential for it to become a human-to-human contagion. Each year, 36,000 U.S. deaths are reported from pneumonia, secondary bacterial pneumonia, and encephalitis due to the flu. The pneumococcal vaccine is an important prevention strategy. The avian flu could also have a major agricultural impact as Kentucky is the eighth largest producer of broiler chickens in the U.S., a $600 million business. None of the avian flu virus has been found in people or in birds in the U.S. Based on a research model of attack rates of 15 to 35 percent, it is estimated that the U.S. could suffer between 89,000 to 207,000 deaths; 314,000 to 734,000 hospitalizations, and have an economic impact of $71 to $166 billion. In Kentucky, the estimates are 3,000 to 7,000 deaths, and 9,200 to 21,400 hospitalizations.
The department developed state and local pandemic influenza response plans in 2002 and the workgroup continues to meet monthly. The plan is more than mass vaccinations. It also involves surveillance, quarantine and isolation procedures, medical surge capacity, personnel and staffing, and strategies for priority populations. No vaccine against a pandemic virus would be available for the first six months or so because of the production methods. There is a worldwide shortage of antivirals. It was recommended that every person can help by using prevention strategies of frequent hand washing, covering one's mouth when coughing, avoiding crowds, and staying home if sick.
Senator Denton asked if the avian flu could mutate and spread from human to human. Commissioner Hacker said that we need to respect the threat, take it seriously, and be prepared.
Representative Stein asked if any screening is being conducted on individuals traveling outside of the United States, and Commissioner Hacker said there is no screening in place because there has not been any cases of human-to-human transmission.
Representative Burch stated all deaths that had occurred was because someone had handled birds. Commissioner Hacker stated there is no evidence of any human-to-human transference. The agriculture community monitors bird migration carefully.
Shannon Turner, Commissioner of the Department for Medicaid Services, Cabinet for Health and Family Services, stated that the department would convert the claims payment system, UNISYS, to the Electronic Data Systems (EDS) on Thanksgiving Day, and the first payment cycle will be December 2, 2005. All the 800 numbers have remained the same to ensure a seamless transition. She said that the Kentucky Medicaid Administrative Agent (KMAA) took over the call center last month and implementation is going as planned. There is a full customer service call center and nurse hotline. First Health, the Pharmacy Benefit Administrator, started December, 2004 and is doing a good job. The following changes have been made: 1) implemented the 3-brand name allowance policy; 2) expanded the preferred drug list drug classes; 3) added co-payments; and 4) changed pricing structure. There has been a savings of $102 million in the pharmacy program as a result of the changes. She said that a big part of the savings was shifting to generic drug preference and in counting generic substitution.
Commissioner Turner stated that the 1115 waiver was submitted to the Centers for Medicare and Medicaid Services (CMS) on November 4, 2005 for the official review process to begin. Meeting are planned with CMS between November 29 to December 2 to work on the waiver. The waiver is available at http://chfs.ky.gov/dms and commentary and summary of changes to the waiver will be posted on the website. The waiver has four distinct benefit groups: 1) optimum choices to serve individuals with mental retardation and developmental disabilities; 2) comprehensive choices to serve individuals who are nursing facility level of care; 3) family choices to serve the healthy Medicaid and KCHIP children; and 4) global choices to serve SSI individuals, TANF individuals, and children in the state foster care system. The cost sharing amount and program options differ in the four plans. Commissioner Turner stated without the flexibility of the 1115 waiver, everyone in the Medicaid program, except for a few who are considered an optional population, have to be treated the same.
Representative Burch asked if the cabinet was moving Medicaid, except Passport, to a managed care program. Commissioner Turner stated the department is incorporating some managed care principles in plan designs, but they will be administering it from the state standpoint. Passport is paid a capitated fee for each member served. Family Choices, the part that covers children, could be bid to a managed care company if it is cost effective. He asked how mental health services would be handled, and she stated through the community mental health centers. He asked if Seven Counties participated in the design of mental health services. Commissioner Turner stated that the cabinet had met with the community mental health centers.
Representative Owens asked that once the changes had been made after meeting with CMS, would the waiver would be finished. Commissioner Turner said it would be an on-going process. He asked about co-payments on prescription drugs for children. She said that in the Family Choices package there is no co-payment on anything except prescription drugs and emergency room visits. She said that the traditional Medicaid eligible children will not be subject to these amounts. For the KCHIP children the co-payment limits are $1 for generic drugs, $8 for preferred drugs, and $15 for brand name drugs. He asked if it only applied to KCHIP children ages one to six years in the Family Choice package. She said that Family Choice includes children of caretaker relatives, KCHIP children, and categorically needy and these groups will have co-payments. The traditional Medicaid children will have different cost sharing. He asked about co-payments for prescription drugs for pregnant women. Commissioner Turner said that there will be $1, $2, and $3 co-payments for prescriptions drugs for pregnant women. Representative Owens stated that sometimes co-payments decrease the number of individuals who can afford medication.
Representative Owens stated that given the extent of the waiver, whatever is done will reflect the policy of the state, and he is not sure what oversight responsibilities, if any, legislators would have. Commissioner Turner stated that the flexibility of the waiver allows regulations to be implemented for every aspect of the process. Senator Denton stated that legislators would be able to have input into regulations at meetings of the Administrative Regulation Review Subcommittee, and when they are referred to the Health and Welfare Committee. Representative Owens said that legislators should be involved in setting policy.
Representative Floyd asked if the cabinet had worked with the pharmacy association. Commissioner Turner stated that Chris Stewart, the Medicaid pharmacy contact, met with pharmacy work groups once a month since session. Representative Floyd asked if any of the suggestions had been implemented, and she said that some have been and she plans to meet with them about specific waiver language concerns.
Representative Burch reported the Families and Children Subcommittee agenda focused on adult substance abuse issues. The committee first heard from Mike Townsend and Tammy Stansbury, Kentucky Housing Corporation, Finance and Administration Cabinet, regarding Recovery Kentucky. The Governor and Lt. Governor have an initiative focused on substance abuse prevention and treatment issues that often lead to chronic homelessness. One part of this initiative is the Recovery Kentucky Initiative which will provide ten 100-bed treatment and recovery units across the state, two per congressional district, one for men and one for women. The Kentucky Housing Corporation will be building the structures and other funding will come from the Community Development Block Grant and the Department of Corrections. The estimated cost per facility is $3.6 million. Placement at these adult facilities will be voluntary. The recovery model includes the 12-steps of Alcoholics Anonymous and recovery dynamics. Residents may live up to 24 months in the supportive housing recovery program.
The subcommittee also heard from Jay Davidson, President and CEO, Rodney Brannon, Vice President for Programs, Jim Evans, Director of Development and Communications, Kelley Abell, Board of Directors of The Healing Place.
The subcommittee then heard a presentation on substance abuse treatment from Robert Walker, M.S.W., L.C.S.W., Center on Drug and Alcohol Research, University of Kentucky. Dr. Walker presented data from the Kentucky Treatment Outcome Study. This is a state-mandated study conducted by UK since 1996. Data are collected on almost 10,000 clients per year and follow-up is conducted on 10% of the clients. The study estimates that the cost/benefit ratio of substance abuse treatment is 4.52 to 1 (for every $1 spent on treatment, taxpayers save an estimated $4.52). Kentucky saved $.52 for every dollar spent on treatment during 2003. Reductions are estimated in the cost of crime, jail time, and increased employment is also reported.
Robert J. Illback, Executive Director of REACH of Louisville presented data on substance abuse across Kentucky as part of the Strategic Prevention Framework State Incentive Grant. This is a large-scale competitive federal grant that awarded approximately $12 million to Kentucky for a five to seven year prevention effort in targeted communities. One of the major goals of the program is to prevent the onset and reduce the progress of substance abuse, including childhood and underage drinking.
Sarah Trainor, an Americore volunteer placed with the Kentucky Youth Advocates, and Ashley Mann, a Northern Kentucky student volunteer with the Kentucky Youth Advocates, discussed the positive aspects of improvements to the Graduated Driver's License bill. A motion to adopt the report was made by Representative Burch, seconded by Representative Marzian, and approved by voice vote.
Laurel True, volunteer of the American Association of Retired Persons and Advocates for Restoring Medicaid Services (ARMS), stated that AARP is in support of the Medicaid waiver proposal. AARP feels it addresses issues and uses proven approaches for improving service delivery, quality, and patient satisfaction. ARMS is comfortable with philosophy and the concepts in the application and it provides valuable options to medical consumers. He was thankful that Commissioner Turner involved advocates in the process, but there are still some concerns. When work started on the waiver, Commissioner Turner said that Governor Fletcher declared there would be no cuts in consumers served and there should be no expectations for substantial new dollars. He said that there are four important pillars of the waiver: 1) personal responsibility; 2) prevention; 3) consumer empowerment and choice; and 4) community solutions. The three things needed from the General Assembly are participation, support of the regulations, and savings reserved for the Medicaid program.
George Parsons, employee for the Center for Accessible Living, and member of the Advocates for Restoring Medicaid Services (ARMS), said that Medicaid needs some revision and could be operated more efficiently. The center supports health accounts, education and choice counseling, and disease management and care, all of which are consistent with the independent living philosophy of self-help and self-determination. The center supports the concept of long-term care redesign, consumer-directed options, self-determination, integrated care delivery, provider education accountability, and termination for fraud and the illegal selling of prescription drugs. Concerns are the varying benefit packages, revised income eligibility requirements, limitations on covered services, and co-payments. He said that the center would like to continue to work with the department and continue to have input on the regulations and manuals.
Dr. Sheila Schuster, member of the Medicaid Consortium, stated that the Consortium began in 2001 and is currently made up of more than 70 organizations. The Consortium endorses quality, affordable, accessible, health care for all Kentuckians. She said that the Consortium is not opposed to the waiver because members have expressed concerns, asked questions, and raised issues at meetings. The Consortium has not taken a stance one way or the other on the waiver. The cabinet formed a waiver work group and invited advocates to be a part of the planning process. She said that the conceptual outlines drafts were available to the public, but the waiver work group honored a confidentiality agreement that prevented them from disclosing the content of the waiver to anyone else. She said that this did not allow the input, expertise, and perspectives of all the individuals and organizations that make up the Consortium. The Consortium members of the work group urged the cabinet to give everyone an opportunity to read through the waiver and ask questions before it was submitted to CMS.
Dr. Schuster said that the process was not perfect, but it reflected more openness from the cabinet for input from advocates on a extremely complex and critically important policy initiative than ever before. There are still concerns about the lack of opportunity for consumers, family members, advocates, and provides to review the actual waiver document before it is submitted to CMS. Lack of opportunity can create a perception there is something in the waiver that would not stand up to scrutiny. She said that the Consortium knows this is not the case and hopes that ongoing discussions about into the waiver as it is developed and implemented will dispel any misperceptions.
Debra Miller, advocate for the Kentucky Youth Advocates, and member of the Medicaid Consortium, said the Consortium had the following three concerns: 1) cost sharing; 2) benefit limits; and 3) money.
Trudy Abshire said her two adopted autistic sons are on the Supports for Community Living waiver. She said that she is please with the 1115 waiver. She said one concern is that individuals need to be educated about the waiver to empower them to make informed decisions. She was happy that there would be 100 pilot programs for adolescent substance abuse statewide. She commended the cabinet on the dedication and hard work that has been put into the waiver by Commissioner Turner, Undersecretary Birdwhistell, and other staff.
There being no further business, a motion to adjourn at 4:26 p.m. was made by Representative Marzian, seconded by Representative Floyd, and approved by voice vote.