[♪♪] >> Renee: GOOD EVENING WELCOME TO "KENTUCKY TONIGHT" I'M REN GLAD TO BE BACK WITH YOU.

OUR TOPIC IS MEDICAID.

LAST WEEK, THE U.S. HOUSE AND SENATE PASSED AND PRESIDENT DONALD TRUMP SIGNED A BUDGET RECONCILIATION MEASURE THAT HE CALLS THE BIG, BEAUTIFUL BILL.

BRETT GUTHRIE A REPUBLICAN FROM KENTUCKY'S SECOND DISTRICT IS CHAIR OF THE HOUSE COMMERCE AND ENERGY COMMITTEE.

THE COMMITTEE THAT DEALS WITH HEALTHCARE AND MANY OTHER IMPORTANT ISSUES.

THIS IS WHAT HE SAID AFTER PASSAGE OF THE BILL LAST WEEK.

>> THIS GUTS TAXES NO TAX ON TIPS, NO TAX ON OVERTIME.

NO TAX ON SENIOR CITIZEN.

WE ALSO MAKE SURE WE UNLEASH AMERICAN'S ENERGY DOMINANCE MY COMMITTEE'S PORTION OF THE BILL.

WE SECURED THE BORDER AND BUILD THE WALL AND CONTINUE THE EFFORT AT THE BORDER TO KEEP ILLEGALS FROM FLOWING INTO OUR COUNTRY.

WE ALSO MAKE SURE THAT ABLE-BODIED AMERICANS WHO GET FREE HEALTHCARE IF THEY ARE ABLE TO WORK, WORK FOR IT.

LIKE EVERY OTHER AMERICAN HAS TO GET UP AND GO TO WORK FOR THEIR HEALTHCARE IT'S ONLY FAIR AT THAT TIME PEOPLE ABLE TO WORK DO WORK.

THE BILL HAS BEEN PASSED AND GOES TO THE PRESIDENT'S DESK AND LOOK FORWARD TO CONTINUED GROWTH AND PROSPERITY IN OUR GREAT COUNTRY.

>> Renee: AND THE BILL WAS SIGNED FRIDAY.

THE BILL IS MORE THAN 900 PAGES LONG AND IT DEALS WITH EVERYTHING FROM IMMIGRATION, TAXES AND MORE.

OUR FOCUS TONIGHT IS ON THE MEDICATED PROVISIONS.

SUPPORTERS OF THE BILL SAY IT WILL CUT, WASTE, FRAUD AND ABUSE FROM THE PROGRAM AND REQUIRE ABLE-BODIED FOLKS TO WORK IN EXCHANGE FOR MEDICAID BENEFITS.

BUT CRITICS OF THE BILL SAY CUT ALSO DEPRIVE MILLIONS OF PEOPLE OF THEIR HEALTHCARE AND FORCE RURAL HOSPITALS TO CLOSE.

MORGAN MCGARVEY AND GOVERNOR BESHEAR BOTH DEMOCRATS APPEARED THIS WEEKEND ON "CNN".

>> DO YOU THINK THAT HE MAYBE ABLE STILL TO SELL THIS TO THE AMERICAN PEOPLE AND CONVINCE THEM THAT THIS IS SOMETHING THAT THEY SHOULD BE HAPPY WITH?

>> WHAT HE SOLD TO THE AMERICAN PEOPLE HE WOULDN'T TOUCH MEDICAID THAT WAS HIS CAMPAIGN PROMISE NOW HE IS GIVING THE LARGEST MEDICAID CUT IN HEALTH IT WILL TAKE HEALTH INSURANCE AWAY FROM KIDS.

46% OF KENTUCKY'S KIDS ARE ON MEDICAID.

>> Gov.

Andy Beshear: THIS LAW IS DEVASTATING THE SINGLE WORST PIECE OF LEGISLATION I'VE SEEN IN MY LIFETIME IT IS A ATTACK ON RURAL AMERICA.

200,000 PEOPLE IN MY STATE WILL LOSE THEIR COVERAGE THOSE ARE 200,000 KENTUCKIANS THAT DESERVE TO SEE A DOCTOR WHEN THEY ARE SICK.

20,000 HEALTHCARE WORKERS ARE GOING TO LOSE THEIR JOBS AND WE HAVE UP TO 35 RURAL HOSPITALS THAT ARE THE SECOND BIGGEST EMPLOYER IN THEIR COMMUNITIES, THAT MAY CLOSE THEIR DOORS.

AND WHAT THAT MEANS, IS OUR ECONOMY TAKES A HUGE HIT AND THEN WHETHER YOU HAVE PRIVATE INSURANCE OR MEDICAID IF YOU LIVE IN RURAL AMERICA YOU HAVE TO DRIVE HOURS JUST TO SEE THE DOCTOR THAT USED TO BE IN YOUR COMMUNITY.

IT IS AWFUL.

>> Renee: WEAN'S JOINED BY MARK BIRDWHISTELL, SENIOR VICE-PRESIDENT FOR HEALTH AND PUBLIC POLICY FOR THE UNIVERSITY OF KENTUCKY.

STATE SENATOR JULIE RAQUE ADAMS, A LOUISVILLE REPUBLICAN AND CO-CHAIR OF THE KENTUCKY GENERAL ASSEMBLY'S MEDICAID OVERSIGHT AND ADVISORY BOARD.

NANCY GALVAGNI, PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE KENTUCKY HOSPITAL ASSOCIATION.

AND ANNE-TYLER MORGAN HEALTHCARE LAW ATTORNEY AND MEMBER OF THE LAW FIRM McBRAYER PLLC.

AND DUSRIN PUGEL, POLICY DIRECTOR AT THE KENTUCKY CENTER FOR ECONOMIC POLICY.

WE CERTAINLY WANT TO HEAR FROM YOU TONIGHT YOU CAN SEND YOUR QUESTIONS AND COMMENTS BY X AT PUB AFFAIRS KET.

SEND AN E-MAIL TO KY TONIGHT AT KET.ORG.

OR USE THE WEB FORM AT KET.ORG/KY TONIGHT OR GIVE US A CALL AT 1-800 494-7605.

WELCOME AND THANK YOU FOR BEING PART OF THIS CONVERSATION.

TIMELY INDEED.

AS YOU HEARD THE GOVERNOR SAY IN THE LAST SOUNDBYTE HOW 35 HOSPITALS COULD CLOSE AND 200,000 KENTUCKIANS COULD LOSE ACCESS TO HEALTHCARE COVERAGE UNDER MEDICAID BECAUSE OF THE BIG BEAUTIFUL BILL AND THE PROVISIONS PROVIDED IN IT.

DO YOU AGREE WITH THAT?

WE'VE HEARD WHAT THE KENTUCKY HOSPITAL ASSOCIATION HAS TO SAY WE WANT TO GIVE YOU LONGER TIME TO EXPLAIN THE POSITION OF THE KHA.

>> THANK YOU, KENNY.

CONGRESSMAN GUTHRIE WORKED CLOSELY WITH US.

HE UNDERSTOOD IMPORTANCE OF OUR HOSPITALS AND THE PAYMENTS THAT OUR HOSPITALS ARE RECEIVING TO COVER THE COST OF CARE FOR MEDICAID PATIENTS.

AND WE ACTUALLY CAME OUT IN SUPPORT OF THE HOUSE BILL BECAUSE CONGRESSMAN GUTHRIE WAS GIVEN A TALL TASK TO REACH CERTAIN SAVINGS WITHIN MEDICAID BUT HE DID IT, WE SAY, WITH A SCALPEL NOT A SLEDGEHAMMER BECAUSE HE PROTECTED OUR KENTUCKY HOSPITALS WHILE MAKING CHANGES AS HE DISCUSSED IN YOUR OPENING.

AND WE FELT LIKE HE HAD A GOOD BALANCE AND UNDERSTOOD THE NEED TO PRESERVE HEALTHCARE IN OUR STATE.

AND WE'RE A VERY RURAL STATE AND HIGHLY DEPENDENT ON MEDICAID.

AND WE WANT TO THANK OUR OTHER CONGRESSMAN WHO VOTED FOR THAT BILL, BECAUSE THEY WERE ALL WORKING TO SAVE OUR HOSPITALS.

UNFORTUNATELY, THAT IS NOT WHAT HAPPENED WHEN THE BILL LEFT THE SENATE AND CAME BACK TO THE HOUSE.

AND WE UNDERSTAND THE HOUSE MEMBERS DIDN'T HAVE AN OPPORTUNITY TO MAKE CHANGES.

BUT WE ARE VERY CONCERNED WITH HOW THE SENATE CHANGED THE FUNDING OF HOSPITALS.

AND VERY DIFFERENT FROM WHAT CONGRESSMAN GUTHRIE HAD PUT IN HIS MARK.

>> Renee: THERE WAS MEDICAID ELIGIBILITY TWEAKS FOR THOSE WORK REQUIREMENTS PART OF THAT KHA WAS NOT OPPOSED TO THAT PART HOW IT WOULD AFFECT PROVIDERS.

>> OUR STATE HAS SPOKEN ON HAVING A WORK REQUIREMENT, WE WANT PEOPLE TO BE COVERED AND WE WILL WORK WITH THE STATE TO IMPLEMENT THAT TO THE BEST OF OUR ABILITY.

THE PROBLEM IS THE SENATE BILL CUT VERY ESSENTIAL ADDITIONAL FUNDING THAT OUR STATE HAD ACTUALLY BEEN USING AND WAS APPROVED BY THE FIRST TRUMP ADMINISTRATION TO BRING ACTUALLY BILLIONS OF DOLLARS IN ADDITIONAL PAYMENTS INTO OUR STATE AND THAT IS BECAUSE MEDICAID WITHOUT THESE ADDITIONAL PAYMENTS DOESN'T COME CLOSE TO COVERING WHAT IT COSTS HOSPITALS TO DELIVER CARE.

AND I DON'T MEAN THE CHARGE BUT THE COST WHAT WE HAVE TO PAY THE NURSES AND THE LAB TECHS AND THE RESPIRATORY THERAPISTS AND SUPPLIES.

IT'S ONLY COVERING 80% OF THAT COST AND THAT IS NOT SUSTAINABLE.

THE FIRST TRUMP ADMINISTRATION HAD ALLOWED KENTUCKY TO GET ADDITIONAL FUNDING THAT BROUGHT IT REALLY THOSE PAYMENTS CLOSER TO WHAT AVERAGE COMMERCIAL PAYERS PAY THE HOSPITALS.

AND WHAT HAPPENED IN THE SENATE BILL, IS THE SENATE BILL SAID WE'RE NOT GOING TO ALLOW THAT ANYMORE AND THEY PUT NEW REQUIREMENTS TO WHERE THE PAYMENTS NOW CANNOT EXCEED THE MEDICARE RATE.

AND PEOPLE DON'T UNDERSTAND MEDICARE AND SOME PEOPLE THINK EVERYBODY GETS PAID THE SAME BY MEDICARE WHICH IS NOT TRUE.

OUR STATE HAS A VERY, VERY LOW PAYMENT BY MEDICARE AND IT ACTUALLY IS VERY MUCH THE SAME AS MEDICAID.

SO IT BASICALLY IT'S DIFFERENT TO SAY WE'RE GOING TO CUT A PROGRAM, I'M GOING TO CUT YOU 10%, 20%, THE CUTS UNDER THE SENATE BILL WHEN THEY TAKE EFFECT AND THEY DON'T TAKE EFFECT TOMORROW THAT WILL CUT OUR PAYMENTS BY 90%.

IF YOU HAVE A 90% CUT, THAT IS THE SAME AS ELIMINATING A PROGRAM.

AND WHEN YOU CUT HOSPITALS, YOU CUT PEOPLE.

YOU CUT BENEFITS.

BECAUSE HOSPITALS PROVIDE SERVICES TO PEOPLE.

AND SO IF HOSPITALS CAN NO LONGER DO THAT BECAUSE REIMBURSEMENT HAS BEEN CUT THE EXPENSES AREN'T GOING DOWN.

WE CAN'T TELL THE WORKERS IN THE HOSPITAL WE'RE GOING TO CUT YOUR PAY BY 90%.

WE STILL HAVE TO BUY MEDICATIONS, SUPPLIES, NOBODY IS GIVING US A COST REDUCTION.

THE COSTS ARE THERE AND THE REIMBURSEMENT IS GOING AWAY.

WHAT DOES A HOSPITAL HAVE TO DO BUT LOOK HOW IT CAN CUT AND LABOR IS A BIG COST OF HOSPITALS.

60% OF THE COST.

AND SO IT'S VERY DIFFICULT OBVIOUSLY FOR TAKING $2 BILLION AWAY FROM HOSPITALS, WHETHER THEY GO -- >> Renee: AND THERE WAS NO HOSPITAL STABILIZATION FUND APPROVED.

THE STABILIZATION FUND IS A RURAL FUND.

THE PAYMENTS DON'T HAVE TO GO SPECIFICALLY TO RURAL HOSPITALS.

AND IT'S UNCLEAR WHAT OUR STATE WILL GET FROM THAT FUND.

PART OF THE MONEY IS DIVIDED EQUALLY AMONG ALL STATES WE WILL GET ABOUT $100 MILLION A YEAR JUST FROM THAT AND THERE IS A PORTION THAT IS DISCRETIONARY THAT THE CMS ADMINISTRATOR WILL DECIDE WHO IS GETTING WHAT.

>> Renee: MEDICAID SERVICES FOR THOSE WHO WE'LL TALK IN ACRONYMS.

>> WE ARE NOT SURE WHAT KENTUCKY IS GOING TO GET.

I WILL TELL YOU THIS...

THROUGH THE PROGRAM WE HAD IN PLACE OUR RURAL HOSPITALS WERE GETTING ABOUT A BILLION DOLLARS.

100 MILLION DOLLARS IS NOT GOING TO CUT IT.

IT'S NOT GOING TO BACKFILL THE LOSSES.

>> THE IMPACT ON U.K. HEALTHCARE IF RURAL HOSPITALS CLOSE AND YOU ARE A LARGE FACILITY THAT TAKES A LOT OF TRANSFER PATIENTS YOU CAN TALK ABOUT THAT PUT IN THE CONTEXT WHAT THE IMPACTS COULD POTENTIALLY BE FOR U.K. HEALTHCARE.

>> THANK YOU, RENEE AND THANK YOU FOR THIS OPPORTUNITY TO EXPLAIN A PROGRAM.

I THINK BEFORE I DIRECTLY ADDRESS THE QUESTION, I WANT TO TALK ABOUT THIS HAS BEEN MY LIFE'S WORK.

AND I'VE BEEN THROUGH SIX OR SEVEN OMNIBUS BUDGET RECONCILIATION BILLS.

EACH AND EVERY TIME WE HAVE WORKED THROUGH IT WITH PARTNERSHIPS, WITH THE GENERAL ASSEMBLY, WITH THE STATE GOVERNMENT, AND WE'LL DO THE SAME THING WITH THIS BILL.

SO I'M NOT QUITE AS FATALISTIC AS MY COLLEAGUE NANCY IS.

I AM WORRIED THAT DOWN THE ROAD WE NEED TO FOCUS ON ACCESS.

WE NEED TO MAKE SURE THAT THERE IS COVERAGE IN THE RURAL HOSPITALS.

I THINK THE RURAL HOSPITAL FUND WILL GO A LONG WAY TO DO THAT.

WILL IT BE THE ANSWER?

WHO KNOWS.

BUT THAT IS TWO-AND-A-HALF YEARS AWAY.

>> Renee: YEAH, AND TOO, WE SHOULD SAY THIS IS NOT HAPPENING TOMORROW OR THIS YEAR IT'S BEEN PHASED IN.

GIVE US THE TIMELINE HERE?

>> AND THAT IS NOT DISSIMILAR FROM OTHER BUDGET RECONCILIATION BILLS.

IT IS A PROCESS AND THERE'S OPPORTUNITIES TO TWEAK.

THERE'S OPPORTUNITIES TO SHOW DIFFERENT SOLUTIONS.

AND I THINK THE UNIVERSITY OF KENTUCKY STANDS READY TO PARTNER AND TO LOOK AT CREATIVE SOLUTIONS HOW WE CAN ENSURE THAT THE RURAL HOSPITALS THAT DO PROVIDE CARE ARE THERE FOR THE PEOPLE THAT NEED TO GET CARE CLOSE TO HOME.

>> Renee: AND WE'LL COME BACK AND TALK MORE ABOUT PATIENT TRANSFERS AND GET INTO THE WEEDS.

DUSRIN PUGEL THE KENTUCKY CENTER FOR ECONOMIC POLICY HAS WRITTEN ABOUT THIS AND YOU IN PARTICULAR HAVE.

WHAT HAVE YOU WRITTEN ABOUT THE CONCERNS ABOUT THIS AND WHO COULD LOSE ACCESS TO COVERAGE AND ARE YOU CONCERNED ABOUT THE ADMINISTRATIVE COSTS OF TRYING TO IMPLEMENT AND FOLLOW THESE TYPES OF NEW FEDERAL RULES ON KENTUCKY AND IN THE STATE BUDGET?

>> YEAH, THANK YOU, RENEE.

I THINK IT'S IMPORTANT TO STEP BACK AND I THINK ACKNOWLEDGE THE ROLE THAT MEDICAID PLAYS IN KENTUCKY OVERALL.

WHEN WE EXPANDED MEDICAID 11 YEARS AGO, IT WAS A PHENOMENAL MOVE TO HEADACHE SURE THAT HALF A MILLION KENTUCKIANS WERE ABLE TO GET CARE MANY FOR THE FIRST TIME.

AND THIS WAS LIFE-SAVING IN MANY CASES.

EVEN OUT OF THE UNIVERSITY OF KENTUCKY A STUDY SHOWED THAT HUNDREDS OF LIVES WERE SAVED FROM EARLY DETECTION OF COLON CANCER AND YOU CAN GO ON AND ON.

THE CUTS ARE CONCERNING.

THE BEST ESTIMATES I'VE SEEN SHOW THAT 210,000 KENTUCKIANS ARE LIKELY TO LOSE HEALTH INSURANCE.

THE MAJORITY WILL BE OUT OF THAT SAME EXPANSION POPULATION THAT I MENTIONED.

ANOTHER 47,000 ACCORDING TO URBAN INSTITUTE ARE LIKELY TO LOSE CONNECT COVERAGE THE INDIVIDUAL MARKETPLACE WHERE PEOPLE CAN BUY SUBSIDIZED INSURANCE.

WE ARE TALKING ABOUT A QUARTER MILLION KENTUCKIANS WHO ARE POSSIBLY GOING TO LOSE THEIR HEALTH INSURANCE WHICH IS TO SAY NOTHING IN THE REDUCTION OF PAYMENTS TO HOSPITALS.

>> Renee: ADULTS OR ADULTS AND CHILDREN?

>> PRIMARILY ADULTS.

THERE ARE WAYS IN WHICH CHILDREN COULD POTENTIALLY LOSE IT WE ARE TALKING ABOUT ADULTS HERE.

AND THE MAIN WAY THAT HAPPENS IS THROUGH PAPERWORK.

THERE IS THIS WORK REPORTING REQUIREMENT THAT THE PEOPLE ARE TALKING ABOUT.

AND WHAT WE KNOW ABOUT THE REQUIREMENTS FROM 30 YEARS IN ANOTHER PROGRAM FOOD ASSISTANCE SNAP, IS THAT THEY ARE INEFFECTIVE AT INCREASING EMPLOYMENT, INEFFECTIVE AT INCREASING WAGES AND INEFFECTIVE AT REDUCING POVERTY.

THEY ARE EFFECTIVE IS TRIPPING PEOPLE UP IN RED TAPE AND THAT IS WHAT WE'RE CONCERNED ABOUT.

FOLKS ENDING UP WITH EXTRA PAPERWORK NOT JUST THE REPORTING REQUIRE THES BUT VERIFICATION REQUIREMENTS PLACED ON.

THERE IS AA SIX MONTH REDETERMINATION PROCESS FOLKS WILL HAVE TO HAVE ON THE MARKETPLACE.

THERE IS A VERIFICATION PROCESS PEOPLE HAVE TO GO THROUGH BEFORE THEY ARE ABLE TO APPLY.

THERE IS A LOT OF NEW FORMS THAT PEOPLE WILL HAVE TO GO THROUGH AND WHAT WE KNOW IS WHEN YOU INCREASE THE AMOUNT OF FORMS PEOPLE HAVE TO FILL OUT, YOU DECREASE THE NUMBER OF FOLKS THAT ARE LIKELY GOING TO BE COVERED.

COUPLE YEARS AGO, WE HAD SORT OF SAFETY MEASURE IN PLACE FOR FOLKS DURING COVID THEY WERE NOT ALLOWED TO BE DISENROLLED FROM MEDICAID.

WE RESTARTED THAT ENROLLMENT PROCESS AND WHAT HAPPENED WAS 60% OF THE FOLKS WHO ENDED UP LOSING COVERAGE DIDN'T LOSE COVERAGE BECAUSE THEY WERE FOUND INELIGIBLE OR THEY TOLD THE STATE THEY WERE NOT GOING TO NEED THAT COVERAGE THEY LOST COVERAGE BECAUSE OF PAPERWORK ERRORS, DELAYED PAPERWORK, TYPOS OR ISSUES ON THE STATESIDE.

SO THAT IS PRIMARILY WHAT WE'RE WORRIED ABOUT IS A LOT OF ELIGIBLE FOLK ALSO LOSE COVERAGE.

AND WE KNOW FROM THE DATA THE MAJORITY OF FOLKS ON MEDICAID ADULTS, ARE EITHER WORKING THEY ARE ILL OR DISABLED OR NOT WORKING FOR RETIREMENT OR SCHOOL.

YOU TAKE OUT THE FOLKS WHO ARE DISABLED IN MEDICAID, TWO-THIRDS ARE WORKING AND THE REMAINDER HAVE A GOOD REASON NOT TO BE.

FROM PLACES LIKE GEORGIA AND ARKANSAS WHERE THIS HAS BEEN TRIED WE KNOW THAT FOLKS HERE IN KENTUCKY WHO SHOULD BE ELIGIBLE WILL LOSE HEALTH INSURANCE.

>> Renee: YOU WOULD SAY THE WASTE, FRAUD AND ABUSE ARGUMENT TOUTED IS NOT FOUNDED, RIGHT?

THERE IS NOT WASTE, FRAUD AND ABUSE HAPPENING FROM THOSE ELIGIBLE OR THE MEDICAID BUT ON THE PROVIDER SIDE.

JULIE RAQUE ADAMS YOU HAVE BEEN DEALING WITH THIS ISSUE FOR A LONGTIME AND CO-CHAIR OF THE MEDICAID ADVISORY AND OVERSIGHT BOARD WHEN YOU HEAR THE FATALISTIC VIEW WHAT IT COULD MEAN FOR RURAL HOSPITALS AND PROVIDERS AND OTHER SERVICES, WHAT IS YOUR RESPONSE?

>> SURE.

AND RENEE, THANK YOU FOR HAVING ME ON TONIGHT.

BUT I THINK ONE OF THE THINGS THAT WE NEED TO TAKE A DEEP BREATH AND THINK ABOUT IS THE GENERAL ASSEMBLY UNDERSTOOD MONTHS AGO THAT STATUS QUO WAS NOT GOING TO BE ACCEPTABLE ANYMORE.

WE WERE GOING TO HAVE TO BE PROACTIVE IN THIS SPACE BECAUSE WE KNEW THE FEDERAL GOVERNMENT WAS GOING TO COME DOWN WITH CHANGES.

HENCE THE ESTABLISHMENT OF THE MEDICAID OVERSIGHT AND ADVISORY BOARD.

THE MEMBERSHIP OF THE MOAB IS NOT ONLY MEMBERS OF THE GENERAL ASSEMBLY THAT HAVE ARE EITHER ON THE BUDGET COMMITTEE OR THE HEALTH COMMITTEE, BUT IT ALSO HAS STAKEHOLDERS LIKE THE HOSPITALS ARE REPRESENTED ON IT.

UTILIZERS OF THE SYSTEM, THE ASSOCIATION OF HEALTH PLANS THE MCO'S HAVE A SEAT AT THE TABLE.

SO WHAT WE DECIDED TO DO IS IF THERE'S GOING TO BE CHANGES FROM THE FEDERAL GOVERNMENT, KENTUCKY NEEDS TO BE AT THE FOREFRONT OF LOOKING AT WHAT THAT MEANS FOR THE PEOPLE IN THE STATE, THE CLIENTS THAT RECEIVE MEDICAID.

AND SO WE'RE GOING TO HAVE ROBUST DISCUSSIONS ON WHAT ALL OF THESE POLICY CHANGES COMING DOWN FROM THE FEDERAL GOVERNMENT WITH DELAYED IMPLEMENTATION, SO KENTUCKY HAS TIME TO UNDERSTAND WHAT THE FEDERAL BILL IS.

KENTUCKY HAS TIME TO COME UP WITH REALLY THOUGHTFUL AND CREATIVE SOLUTIONS TO MAKE SURE THAT WE DON'T LOSE THAT COVERAGE THAT IS REALLY VITAL IT IS A SAFETY NET.

BUT IT ALSO HAS TO HAVE SOME COMPONENT OF SUSTAINABILITY FOR THE PROGRAM.

THE PROGRAM HAS GROWN FROM ABOUT $10 BILLION WHEN I FIRST STARTED IN THE GENERAL ASSEMBLY TO $20 BILLION.

>> Renee: AND THAT IS HOW MUCH OF THE OVERALL GENERAL FUND OF THE STATE BUDGET.

>> I THINK THE MEDICAID BUDGET IS ABOUT 23% OF THE OVERALL BUDGET IF I'M CORRECT.

MARK, YOU MIGHT BE ABLE -- I THINK IT'S AROUND THERE.

WE HAVE A VALUES QUESTION BEFORE US.

THAT WE HAVE TO PROVIDE THE SAFETY NET FOR THOSE THAT ARE REALLY VULNERABLE.

AND WE ALSO HAVE TIME IN ORDER TO UNDERSTAND WHERE ALL THE STAKEHOLDERS ARE IN THIS PROCESS AND TO HELP US COLLABORATE WHAT IS REALLY GOOD POLICY GOING FORWARD.

ARE WE SPENDING TOO MUCH IN ADMINISTRATIVE COSTS THAT COULD BE PUT BACK INTO CARE.

DO WE NEED TO LOOK AT MCO CONTRACTUAL OBLIGATIONS TO THEIR CLIENTS?

LIKE WHAT ARE ALL THOSE ISSUES THAT WE NEED TO TAKE A LOOK AT.

I REALLY THINK, RENEE, AS WE MOVE FORWARD IN THIS PROCESS, UNDERSTANDING THESE DELAYED IMPLEMENTATION DATES THAT KENTUCKY HAS TIME TO BE REALLY THOUGHTFUL IN THIS SPACE.

>> Renee: AND THE END OF 2026 IS WHEN THIS COMPONENT GOES INTO EFFECT, CORRECT?

>> YES.

>> AND THEN THE HOSPITAL COMPONENT IS JANUARY, 2028.

>> Renee: STAGGERED AND SOME PEOPLE SAY THAT SEEMS INTERESTING THE TIMING WHICH AFTER THE MIDTERMS AND SO THE POLITICAL MOTIVATIONS ANNE-TYLER MORGAN COME INTO PLAY IN THIS DISCUSSION WITHOUT A DOUBT?

>> SURE AND THIS HAS BEEN A DISCUSSION THAT THE KENTUCKY GENERAL ASSEMBLY AND CERTAIN MEMBERS HAVE BEEN THINKING ABOUT FOR A LONGTIME.

AS WELL AS OTHER STATES, GEORGIA AND ARKANSAS WHICH HAVE BOTH TAKEN A STAB THE WORK IN COMMUNITY AND ENGAGEMENT REQUIREMENTS AND THERE'S COMMENTARY AVAILABLE HOW THAT HAS WORKED.

THE FEDERAL GOVERNMENT HAS RESPONDED TO THAT GROWING SWELL OF SUPPORT FOR WORK AND COMMUNITY ENGAGEMENT REQUIREMENTS.

BUT I DO THINK AS MY CO-PANELISTS MENTIONED TIME TIME IS OF THE ESSENCE IN ENSURING THAT PROACTIVE STEPS ARE TAKEN TO MAKE SURE THAT THERE'S ACTUALLY SOMEWHERE FOR BENEFICIARIES TO GO IF THEY ARE INDEED TO LOSE COVERAGE.

A LOT OF TALK IS HAPPENING AROUND WHO MAY COME OFF OF THE MEDICAID ROLLS AS A RESULT OF RED TAPE.

BUT I'M ASKING THE QUESTION WHERE NEXT?

WHERE WILL THEY GO AND WE'VE TALKED ABOUT IN THE CONTEXT OF THE BENEFIT CLIFF AND WHAT PEOPLE DO IF THEY ARE NO LONGER ELIGIBLE FOR MEDICAID THE CONVERSATION IS THE SAME HERE.

IT WOULD BE PIE IN THE SKY TO THINK THAT SUDDENLY BECAUSE PEOPLE ARE DISENROLLED THEY ARE SUDDENLY IN A COMMERCIALLY INSURED ENVIRONMENT HEALTHIER THAN THEY ARE NOW AND SOMEHOW UTILIZING CARELESS OFTEN THAN THEY ARE NOW.

WHAT DRIVES MEDICAID COSTS IS HIGH UTILIZATION OF MEDICAID SERVICES AND THAT USUALLY COMES FROM A COUPLE OF PLACES.

ONE IS UNDER EDUCATION OF HOW TO PROPERLY UTILIZE HEALTHCARE SERVICES, PREVENTATIVE CARE ONGOING CARE.

AND THE OTHER IS BEING UNHEALTHY.

SO NEEDING MORE EXPENSIVE CARE AS A RESULT OF HEALTH CHALLENGES.

AND THERE'S BEEN A LOT OF WORK ON THE MANAGED CARE SIDE IN OUR MEDICAID SYSTEM TO WORK TOWARD BETTER HEALTH AND BETTER EDUCATION AROUND UTILIZATION.

BUT WE HAVE TO CONTINUE NOW TO REALLY THINK CREATIVELY AROUND HOW TO PROMOTE THOSE EFFORTS AND HOW TO PROMOTE A THRIVING WORKFORCE IF WE WERE TO ACTUALLY SEE THIS BE A POSITIVE MOVE AND SEE PEOPLE LEAVE MEDICAID IN A BETTER PLACE AND ACTUALLY HAVE A TRAJECTORY FOR COVERAGE GOING FORWARD.

>> Renee: THE KENTUCKY GENERAL ASSEMBLY TALKED ABOUT THE BENEFITS CLIFF JUST ENOUGH OR TOO MUCH TO NOT BE ELIGIBLE FOR MEDICAID YET YOU ARE STILL YOU LANGUISH SOMEWHERE.

THAT'S BEEN A CONVERSATION FOR SEVERAL YEARS NOW?

ANY SOLUTIONS THERE.

>> YOU ARE RIGHT.

WE'VE TALKED ABOUT IT IN TERMS MAINLY OF CHILDCARE, AND SNAP BENEFITS AND NOW MEDICAID IS GOING TO BE A BIG PIECE OF THAT.

AND I WANT TO REFER BACK TO SOMETHING THAT DUSTIN SAID, YOU KNOW, THE RED TAPE AND THE PAPERWORK AND THOSE TYPES OF THINGS THOSE ARE AREAS THAT WE CAN FIGURE OUT A BETTER PATH FORWARD.

BECAUSE NOBODY SHOULD BE CUTOFF BECAUSE OF A PAPERWORK ERROR.

THE STATE SHOULDN'T BE PINGED BECAUSE WE HAVE AN ERROR RATE IN OUR SNAP APPLICATIONS.

THESE ARE THINGS THAT ADMINISTRATIVELY WE CAN TAKE A HARD LOOK AT AND FIX.

SO THAT WE DON'T HAVE THOSE PEOPLE THAT ARE FALLING THROUGH THE CRACKS BECAUSE THAT IS NOT FAIR.

>> Renee: IS IT THE GOAL, IS IT THE GOAL OF REPUBLICANS TO CUT PEOPLE OFF OF MEDICAID TO REDUCE THE ROLLS, TO HAVE WORK REQUIREMENTS AND PAPERWORK OWN RUGS THEY CANNOT COMPLY IS THAT THE GOAL BECAUSE THE WEIGHT IT HAS ON THE STATE BUDGET?

>> LET ME TELL YOU, RENEE, THE REPUBLICAN GENERAL ASSEMBLY HAS NEVER HAD A PRIORITY WHERE WE WANT TO CUT ANYBODY OFF THAT IS NOT WORTHY.

>> Renee: HOW DO YOU DEFINE WORTHY?

>> WE WANT TO FOLLOW THE RULES.

IF YOU LOOK AT MY BODY OF WORK IN THE GENERAL ASSEMBLY I HAVE DONE NOTHING EXCEPT TRY TO ENGAGE UNDERSERVED POPULATIONS AND GET THEM COVERAGE.

THAT IS EVERY MEMBER OF THE GENERAL ASSEMBLY'S GOAL.

IS TO MAKE SURE THAT WE TAKE CARE OF THOSE PEOPLE IN OUR STATE THAT NEED TO BE TAKEN CARE OF.

100%.

SO, NO, I DON'T ACCEPT THAT PREMISE THAT REPUBLICANS ARE TRYING TO THROW ANYBODY OFF THE ROLLS.

REPUBLICANS ARE TRYING TO MAKE SURE THAT WE RUN AN EFFICIENT PROGRAM THAT HAS BETTER HEALTH OUTCOMES THAN WE HAVE RIGHT NOW.

BECAUSE THE CITIZENS OF OUR STATE DESERVE A PROGRAM THAT IS EFFICIENT AND GIVES THEM BETTER HEALTH OUTCOMES.

>> I THINK BEFORE WE GET TOO FAR DOWN INTO THIS HOLE ABOUT CUTTING PEOPLE OFF, I THINK WE NEED TO TAKE A MINUTE AND SAY WHAT DID NOT HAPPEN.

IN JANUARY OF THIS YEAR, WE WERE TALKING ABOUT PER CAPITA CAPS.

WE WERE TALKING ABOUT BLOCK GRANTS.

WE WERE TALKING ABOUT CHANGING FEDERAL PARTICIPATION, FEDERAL FUNDING.

WITH BOTH THE HOUSE AND THE SENATE NEITHER ONE OF THOSE THINGS HAPPENED.

AND I THINK WHAT CAME OUT IS A BILL THAT GIVES A PRIORITY ON WHAT MEDICAID WAS INTENDED TO DO TO TAKE CARE OF WOMEN AND YOUNG CHILDREN ELDERLY FOLKS AND THOSE WITH DISABILITIES.

AND THOSE ARE LEFT INTACT.

AND I THINK WE NEED TO GIVE A LITTLE CREDIT TO OUR CONGRESSIONAL DELEGATION FOR LISTENING TO US.

BECAUSE THOSE PROVISIONS WOULD HAVE IMPACTED THE WHOLE GAMUT.

>> Renee: ARE THERE ANY CHANGES TO THE WORD OR THE MEANING OF DISABILITY?

>> I DON'T SEE THAT THERE IS A CHANGE IN THIS -- >> Renee: CURRENTLY ARE.

>> ABSOLUTELY.

THOSE WHO ARE CURRENTLY IN TRADITIONAL MEDICAID COVERAGE CATEGORIES WILL CONTINUE TO HAVE THAT COVERAGE.

THEY WILL NOT BE IMPACTED BY THIS.

AND I THINK THAT'S SOMETHING THAT WE NEED TO BE MINDFUL OF AND I HAVE TO SAY IT, AN APPRECIATION TO CONGRESSMAN GUTHRIE, CONGRESSMAN ROGERS, CONGRESSMAN COMER AND THE ENTIRE DELEGATION AND CONGRESSMAN BARR, THEY ALL LISTENED.

BECAUSE IN JANUARY WE SPENT A LOT OF TIME SAYING OKAY, THIS IS EXTREMELY IMPORTANT.

SO I THINK WHAT WE'VE GOT IN THE BILL THAT PASSED, WE WERE ABLE TO PUSH THE DEADLINES TO GIVE US TIME, TIME IS OUR FRIEND HERE.

SO THAT WE CAN CONTINUE TO WORK, WE FOCUS ON HOW DO WE BUILD PARTNERSHIPS WITH THE GENERAL ASSEMBLY, WITH THE ADMINISTRATION, AND WITH THE FEDERAL GOVERNMENT.

>> Renee: PUSHING MORE OF THE DECISION MAKING ON TO THE STATES, DUSTIN DO YOU FEEL YOU GOT A BETTER DEAL THAN WHEN YOU STARTED OFF FIVE MONTHS AGO?

>> THERE WAS CERTAINLY DIRE POLICIES BEING PROPOSED EARLY ON AND I THINK IT'S LAUDABLE THEY DIDN'T GO DOWN THE ROAD OF BLOCK GRANTING OR USING A PER CAPITA CAP.

THE TRUTH IS AT THE END OF THE DAY THIS IS A $38 BILLION TO KENTUCKY'S MEDICAID PROGRAM OVER 10 YEARS.

AND WHILE I DO THINK TIME IS ON OUR SIDE, WE DO HAVE OPPORTUNITY TO USE THE MOAB AND OTHER MEANS TO TRY AND GET OUR ARMS AROUND IT.

MONEY IS NOT ON YOUR SIDE HERE THESE CUTS ARE REAL.

THEY ARE GOING TO BE FELT.

AND I THINK IT'S ALSO IMPORTANT TO SAY THAT THEY ARE NOT JUST GOING TO BE FELT FOR THE FOLKS THAT ARE SURE TO LOSE COVERAGE AND NOT BE ABLE TO FIND IT ON A MARKETPLACE, BECAUSE WE'RE ALSO CUTTING THERE, EVERYONE IS GOING TO FEEL THIS.

SO IF YOU LOOK AT THE VALUE OF MEDICAID PAYMENTS TO LOCAL ECONOMIES, AND YOU JUST LOOK AT FOR EXAMPLE HAL ROGERS FIFTH DISTRICT IN EASTERN KENTUCKY MEDICAID PAYMENTS TO PROVIDERS AND HOSPITALS AND PHARMACIES AND OTHER PROVIDERS THAT MAKES UP 13.5% OF GDP.

WHEN YOU START CUTTING AT THE LEVEL WE'RE TALKING ABOUT PARTICULARLY TO HOSPITALS, THOSE ARE GOING TO HAVE SEVERE RIPPLING EFFECTS THROUGHOUT COMMUNITIES.

SO I DON'T THINK ANY HOSPITAL WANTS TO CLOSE ITS DOOR.

I DON'T THINK ANY KENTUCKY LAWMAKER WANTS TO KICK PEOPLE OFF.

BUT AT THE END OF THE DAY YOU CAN'T LOSE THAT MANY PEOPLE OR LOSE THAT MUCH MONEY AND NOT HAVE AN IMPACT ON VITAL SERVICES THAT ARE ALSO VITAL TO LOCAL ECONOMIES.

>> I WOULD AGREE WITH THAT I AGREE WITH BOTH HERE.

I THINK WE HAVE TIME WHICH IS GOOD.

BUT WE DON'T HAVE A LOT OF TIME.

BECAUSE 2028 IS NOT THAT FAR OFF AND I CAN TELL YOU, I'VE BEEN OUT I MEET WITH C.E.O.S ALL OVER THE STATE AND ASKING THEM IF IF WE GET THESE CUTS WHAT WILL YOU HAVE TO DO?

AND IT'S THE SAME ANSWER.

WE'RE GOING TO HAVE TO LAYOFF STAFF AND LOOK AT EVERY SERVICE WE OFFER BECAUSE MOST SERVICES THAT HOSPITALS PROVIDE CAN'T STAND ON THEIR OWN.

HOSPITALS CROSS SUBSIDIZE THINGS LIKE MATERNITY CARE AND EMERGENCY ROOMS THERE'S LOTS OF OTHER SERVICES.

SO WHAT THEY ARE SAYING WE HAVE TO SEE IF WE CAN STILL CONTINUE TO OFFER IT.

BECAUSE WE MIGHT NOT HAVE THE FUNDS TO BE ABLE TO COVER THE COSTS.

SO NOT TODAY, NOT TOMORROW, BUT HOSPITALS ARE PLANNING NOW FOR WHAT THEY ARE PROBABLY GOING TO HAVE TO CUT ONCE THESE REDUCTIONS START.

AND SO WE'RE NOT GOING TO SEE CHANGES TOMORROW.

BUT WE'RE GOING TO START TO SEE CHANGES.

BECAUSE NOBODY IS GOING TO HAVE TO WAIT UNTIL THE LAST-MINUTE TO MAKE THESE DECISIONS.

AND IF THAT HAPPENS, AND IF THE SERVICE IS CUT, AND I DON'T HAVE TO SPECULATE I GET LOTS OF NEWSLETTERS AND I READ WHAT IS GOING ON IN OTHER STATES AND YOU CAN SEE THE TYPES OF SERVICES THAT ARE CLOSING.

>> Renee: WHAT SERVICES ARE CLOSING?

>> MATERNITY THAT HAS BEEN GOING ON FOR YEARS.

THERE'S MORE MATERNITY DESERTS AND EMERGENCY ROOMS ARE CLOSING.

THAT IS HAPPENING IN OTHER STATES.

AND IF THAT HAPPENS HERE I'M NOT SAYING IT'S GOING TO FOR EVERY HOSPITAL IT WILL BE DIFFERENT AND HOSPITALS WILL HOLD OFF CLOSING THINGS AS LONG AS THEY CAN.

BUT IF A SERVICE CLOSES THAT DOES AFFECT EVERYONE NOT JUST PEOPLE ON MEDICAID.

>> Renee: THIS QUESTION FROM PERCY STONE FOR PEOPLE THAT HAVE BOTH MEDICARE AND MEDICAID AS PART OF THE COMPLETE PLAN HOW WOULD THIS NEW BILL AFFECT THEM?

>>LOOKING AT YOU.

>> I CAN SEE THAT.

>> WE'RE ALL LOOKING AT YOU.

>> I DON'T SEE THAT THE NEW BILL WOULD DIRECTLY IMPACT FOLKS COVERED BY BOTH MEDICARE AND MEDICAID.

AS DUSTIN TALKS ABOUT THE WORK REQUIREMENTS THE COMMUNITY ENGAGEMENT REQUIREMENTS THAT APPLIES TO THE MEDICAID EXPANSION POPULATION, WHAT IS CALLED THE ABLE ABLE-BODIED ADULTS MANY OF WHOM ARE WORKING ALREADY.

FOR THOSE THAT WE CONSIDER DUE ALI ELIGIBLE, I THINK IT SHOULD BE MEDICAID AS USUAL FOR THEM.

>> Renee: ANYTHING TO ADD-ON THAT?

>> YEAH, ONE OF THE POLICIES THAT THIS BILL CHANGES IS THIS ESSENTIALLY FREEZES WHAT IS CALLED THE ELIGIBILITY AND ENROLLMENT RULE THAT THE BIDEN ADMINISTRATION PUT OUT IS NOW BEING FROZEN IN PLACE.

AND PART OF WHAT THAT RULE DOES IT MAKES IT EASIER FOR FOLKS TO BECOME DUALLY ELIGIBLE, ENROLLEES WHO NEED HELP PAYING FOR LONG-TERM CARE, DOCTOR BILLS THE RULE EASES THE OPPORTUNITY TO ALSO GET MEDICAID.

BY FREEZING THAT IT'S GOING TO MAKE IT MORE DIFFICULT FOR FOLKS THAN IT WOULD HAVE BEEN OTHERWISE.

YOU KNOW, WHEN CBO CAME.

>> Renee: CONGRESSIONAL BUDGET OFFICE.

>> CAME UP WITH COVERAGE THEY SUGGESTED THAT MANY POTENTIALLY DUALLY ELIGIBLE FOLK ALSO NOT HAVE THAT MEDICAID COVERAGE BECAUSE OF FREEZING THAT ROLL.

>> Renee: IT'S VERY COMPLICATED.

ANY RESPONSE TO THAT YOU WANT TO FOLLOW-UP WHAT HE HAD TO SAY?

LIKE HE COVERED IT.

>> I NEVER CHALLENGE HIM.

>> Renee: THAT IS RIGHT.

LET'S TALK A LITTLE BIT MORE ABOUT THE IMPACT ON HOSPITALS AND YOU MENTIONED THAT THE TIME NOW IS TO ACT AND I WANT TO ASK SENATOR ABOUT CAN WE EXPECT LEGISLATION TO COME OUT OF THE NEXT SESSION A 60-DAY BUDGET SESSION IN 2026 TO BE PREPARED TO RAMP UP FOR 26 AND 28?

>> AND THAT IS A GREAT QUESTION.

IF YOU LOOK BACK AT WHAT WE PASSED HOUSE BILL 695 WHICH ESTABLISHED MOAB.

>> Renee: THE MEDICAID OVERSIGHT ADVISORY BOARD.

>> ONE OF THE THINGS THAT WE SPOKE TO IN THAT BILL WAS KIND OF ENGAGING THE GENERAL ASSEMBLY MORE WITH THE CABINET FOR HEALTH AND FAMILY SERVICES AND UNDERSTANDING WHAT IS ACTUALLY HAPPENING IN THE MEDICAID PROGRAM.

MARK TALKED ABOUT PARTNERSHIPS.

AND SO WE'RE ENGAGING MORE IN A PARTNERSHIP ON THAT CHFS LEVEL.

WE ARE REQUIRING THAT ANY MONIES THAT RESULT FROM REBATES IN THE PHARMACY BENEFIT MANAGER IN THE PHARMACY SPACE IS SEQUESTERED SO WE CAN SEE WHERE THE DOLLARS COME.

THAT IS A MEDICAID SAVINGS.

WE WANT TO LOOK AT STATE HEALTH PLAN AMENDMENTS SO THAT WE CAN SEE IF THERE'S ANY SAVINGS THERE.

SO WE'RE REALLY THE GENERAL ASSEMBLY IS REALLY THROUGH THIS 695 TRYING TO ENGAGE INTIMATELY ON THAT FISCAL COMPONENT OF THE PROGRAM.

SO WHEN WE FAST FORWARD TO JANUARY, WHEN WE GO INTO SESSION, WE'LL HAVE A BETTER UNDERSTANDING OF THE DOLLARS WHERE THE DOLLARS ARE GOING, WHERE THE SAVINGS ARE WITHIN THE PROGRAM, WHAT NEEDS TO BE SHORED UP, WHAT MAYBE NEEDS TO BE PULLED BACK WE'LL HAVE A BROADER UNDERSTANDING.

BUT WE WILL GO IN TO THAT SESSION KNOWING THAT WE'RE GOING TO HAVE TO HAVE FORWARD LOOKING POLICIES WE HAVE TO ENGAGE PEOPLE SO THAT THEY FILL OUT THE PAPERWORK CORRECTLY.

HOW WE OUTREACH GIVEN THE OUTREACH DURING THE REDETERMINATION.

WE ARE GOING TO HAVE TO LOOK AT CREATIVE WAYS TO INVEST IN WORKFORCE IN RURAL AREAS.

HOW DOES THE STATE OF KENTUCKY MAKE SURE THAT WE STILL HAVE A ROBUST PROVIDER NETWORK ALL ACROSS THE STATE.

I MEAN WE'RE GOING TO BE LOOKING -- >> Renee: WHICH COULD BE ANTITHETICAL TO WHAT NANCY GALVAGNI IS SAYING WHAT IS GOING TO HAPPEN?

>> IS THIS NOW A STATE INITIATIVE THAT WE HAVE TO MAKE SURE THAT WE'RE LOOKING AT A ROBUST EMPLOYMENT NETWORK FOR HEALTHCARE?

SOME OTHER IDEAS IS BEHAVIORAL HEALTH.

HOW IS THIS GOING TO IMPACT BEHAVIORAL HEALTH?

WE HAVE A TERRIBLE SUBSTANCE USE DISORDER PROBLEM ACROSS THE STATE.

WHAT DOES THIS MEAN.

ARE WE GOING TO HAVE TO COME UP WITH SOMETHING CREATIVE TO MAKE SURE THOSE FOLKS STILL HAVE COVERAGE AND STILL HAVE SUPPORT ON THEIR JOURNEY TO RECOVERY?

AND, AGAIN, I GO BACK TO THIS IS A REAL VALUES BASED QUESTION.

AND MY COLLEAGUES IN THE GENERAL ASSEMBLY ARE REALLY COMMITTED TO MAKING SURE THAT WE PROTECT THOSE MOST VULNERABLE.

THAT IS OUR COMMITMENT AND I THINK YOU WILL SEE AS THE DIALOGUE AND THE CONVERSATION PROGRESSES, THAT WE HAVE A HEART AND WE WANT TO MAKE SURE THAT WE PROTECT THOSE FOLKS THAT NEED IT.

>> Renee: AND YOUR PARTNER WILL BE THE KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES.

>> ABSOLUTELY.

>> Renee: DO YOU THINK THEY ARE STAFFED AND RESOURCED RIGHT NOW TO TAKE ON THE EXTRA ADMINISTRATIVE DUTIES THAT WILL BE REQUIRED OF THEM TO MAKE SURE YOU ARE IN COMPLIANCE WITH THE FEDERAL LAW?

>> AND RENEE, I THINK YOU CAN LOOK AT THAT QUESTION TWO WAYS ARE THEY ADEQUATELY STAFFED?

OR SHOULD WE EMPLOY RESOURCES DIFFERENTLY WITHIN THE CABINET?

PART OF WHAT WE'RE GOING TO DO ON MEDICAID OVERSIGHT IS ASK REALLY HARD QUESTIONS TO MAKE SURE THAT HOW WE ADEQUATELY FUND THE CABINET FOR HEALTH AND FAMILY SERVICES IS THE BEST WAY FOR US TO PROCEED IN THIS NEW WORLD ORDER THAT WE FIND OURSELVES IN FROM FEDERAL LEGISLATION.

>> Renee: ANNE-TYLER MORGAN?

>> I WOULD ECHO IT'S IMPORTANT FOR EVERYONE WHO IS RESPONSIBLE FOR FUNDING THE MEDICAID PROGRAM AND EVERYONE WHO IS A STAKEHOLDER WITHIN THE PROGRAM TO BE WORKING TOGETHER AND EDUCATED ON WHAT THE PROGRAM ENTAILS.

YOU KNOW, I'VE WORKED FOR BOTH THE LEGISLATURE AND THE DEPARTMENT FOR MEDICAID SERVICES, AND I WORK WITH MEDICAID EVERYDAY, AND I CAN SAY IT STILL TAKES DAILY EFFORT TO UNDERSTAND THE NUANCE OF THE PROGRAM THE MORE STAKEHOLDERS CAN TALK TO EACH OTHER AND UNDERSTANDING THE SYSTEMATICALLY WITHIN THE DEPARTMENT FOR MEDICAID SERVICES IS VITAL AND TO SENATOR'S POINT IT'S REALLY IMPORTANT TO THINK OF CREATIVE SOLUTIONS PARTICULARLY AROUND TECHNOLOGY WITHIN THE CABINET.

KENTUCKY COMMONWEALTH OFFICE OF TECHNOLOGY IS VERY OVERBURDENED AS IT IS.

BUT IT'S REALLY IMPORTANT TO UTILIZE THE MOST UP-TO-DATE TECHNOLOGY AVAILABLE TO MAKE SURE THAT EVERY SIX MONTHS THIS REDETERMINATION PROCESS IS HAPPENING LIKE CLOCKWORK.

>> Renee: AND EXPLAIN THAT REDETERMINATION PROCESS WHAT DOES THAT MEAN?

>> THE DEPARTMENT FOR MEDICAID SERVICES HAS ALWAYS BEEN RESPONSIBLE FOR DETERMINING ELIGIBILITY FOR INDIVIDUALS WHO QUALIFY FOR MEDICAID.

PRIMARILY FOR THE EXPANSION POPULATION AND ASSET TEST.

AND THERE IS A CERTAIN AMOUNT OF WORK THAT GOES INTO THAT FOR THE STAFF.

AND THEY HAVE TO UTILIZE TECHNOLOGY THAT IS PROVIDED BY THE STATE GOVERNMENT AND I KNOW FORMER SECRETARY CAN SPEAK ON THIS TOPIC I WILL LOOK TO HIM.

I WOULD SAY NOW THAT THAT'S HAPPENING EVERY SIX MONTHS AS A RESULT OF FEDERAL LAW THAT WORK IS ON THE UPTICK AND I ARGUE CURRENT DEPARTMENT FOR MEDICAID SERVICES STAFF IS UNDER RESOURCES IN THEIR ABILITY TO DO THAT.

SO THERE WILL NEED TO BE CAPACITY ADDED EITHER ADDITIONAL STAFF OR MORE CREATIVE TECHNOLOGY OR LIKE SENATOR SAID, MORE CREATIVE REALLOCATION OF RESOURCES WITHIN THE CABINET I WOULD BE SKEPTICAL AS TO HOW MUCH THAT WILL PROVIDE.

>> Renee: DO YOU THINK THAT THE SIX-MONTH REDETERMINATION IS AN ONEROUS REQUIREMENT?

A LITTLE TOO MUCH?

>> YES, THAT IS AN EXTREMELY STERN REQUIREMENT WE DO NOT SEE THAT IN COMMERCIAL MARKETS.

IT'S UNPRECEDENTED IN THE INSURANCE MARKET.

I HESITATE TO SAY THAT.

>> Renee: I KNOW YOU MAY NOT KNOW.

>> I DON'T KNOW.

>> ARRIVING AT SIX MONTHS?

>> I DON'T KNOW IT CERTAINLY ADDS A STRINGENTSY FOR THE CABINET THAT WILL HAVE TO BE ANSWERED FOR AND ADDS STRINGENTSY FOR INDIVIDUALS THE GOAL WAS TO ENSURE THAT ANY WASTE, FRAUD AND ABUSE IN THE SYSTEM IS ELIMINATED AS QUICKLY AND OFTEN AS POSSIBLE BUT IT ALSO HAVE THE RESULT OF ENSURING ANYONE WHO WOULD BE UNCOVERED BY THE PROGRAM OR DISENROLLED FROM THE PROGRAM WOULD BE DISENROLLED MORE FREQUENTLY.

>> MEDICAID ENROLLEES ARE REQUIRED TO REPORT CHANGES THEY EXPERIENCE IN-BETWEEN DETERMINATION.

AND THEY DO.

IF I HAVE A NEW CHILD I'M NOT IMMEDIATELY REQUIRED TO MAKE THOSE REPORTING.

SO ADDING ANOTHER REDETERMINATION PROCESS, WHICH IS A INVOLVED PROCESS, YOU CAN ASK ONE OF 1.5 MILLION KENTUCKIANS WHAT THAT INVOLVES, AGAIN, ADDS ANOTHER HURDLE TO BEING ABLE TO STAY COVERED OVER TIME.

WHAT I THINK IT'S GOING TO DO IS NOT NECESSARILY KICK PEOPLE OFF PERMANENTLY IT WILL INCREASE CHURN WHERE HAVING AN UNDER RESOURCED CABINET COMES INTO PLAY.

BECAUSE THOSE FOLKS WILL FALL OFF OF COVERAGE AND HAVE TO TRY AND REAPPLY.

WHICH IS A MORE ONEROUS PROCESS.

SO I THINK THERE IS A REAL CONCERN THAT STATES ARE NOT GOING TO BE ABLE TO KEEP UP WITH IT.

THERE IS EXTRA MONEY IN THE BILL TO MAKEUP FOR THAT BUT IT IS A LITTLE AMOUNT OF MONEY NOT MUCH.

>> Renee: Mr. SECRETARY?

THAT TITLE FOR THIS PART OF THE DISCUSSION.

>> I HAVEN'T HEARD THAT TERM FOR QUITE A WHILE.

I COME AT THIS FROM A DIFFERENT PERSPECTIVE.

I THINK WE HAVE TO FOCUS ON WHICH POPULATION THE SIX MONTH REDETERMINATION APPLIES TO.

THIS IS THE ABLE-BODIED MEDICAID EXPANSION POPULATION THAT WAS BROUGHT IN UNDER THE AFFORDABLE CARE ACT.

THESE ARE THE PEOPLE THAT ARE MARGINALLY EMPLOYED THAT HAVE A VERY FLUCTUATING LIFESTYLE.

SOME MONTHS THEY HAVE MONEY, SOME OTHER MONTHS THEY DON'T HAVE MONEY.

SO I'M NOT CONCERNED ABOUT THE SIX MONTH.

I THINK THIS IS AN OPPORTUNITY FOR A LITTLE BIT OF VALIDATION, I WILL SAY TO THE SENATOR, SPEAKING FOR MY COLLEAGUES, MY FORMER COLLEAGUES AT THE CABINET, THEY WILL NEED ADDITIONAL RESOURCES OR BE DIRECTED.

BECAUSE I THINK THERE WILL BE ADDITIONAL BURDEN TO THE CABINET FOR THIS -- THESE ACTIVITIES.

BUT JUST LISTENING TO THIS CONVERSATION, IF THERE'S ANY BENEFIT THAT HAS COME OUT OF THESE CONVERSATIONS THAT WE'VE ALL BEEN HAVING FOR THE LAST SIX OR EIGHT MONTHS, MEDICAID IS NOW AT THE BIG TABLE.

IT IS NOW A HIGH PROFILE ISSUE.

YOU'VE NEVER HAD A SHOW THAT WAS JUST MEDICAID.

THIS IS MY FIRST TIME HERE.

AND JUST THE FACT THAT WE'RE ALL TALKING WE HAVE THE MEDICAID OVERSIGHT AND ADVISORY BOARD, THAT WILL GIVE ANOTHER TRANSPARENCY CONVERSATION.

SO I THINK THIS IS WE'RE MAKING PROGRESS.

MOST PEOPLE MEDICAID WAS THIS BIG SECRET NOBODY REALLY KNEW EXACTLY HOW MEDICAID WORKED.

AND MEDICAID PEOPLE I AM A RECOVERING ONE, REALLY DIDN'T WANT OTHER PEOPLE TO UNDERSTAND IT.

BUT IT'S OUT NOW.

THIS IS IN THE MAINSTREAM.

AND I THINK WITH SOCIAL MEDIA AND EVERYTHING THAT IS GOING ON, THIS RECONCILIATION BILL IS DIFFERENT THAN THE MULTIPLE ONES WE DID IN THE 1980s.

BUT WE'RE ALL TALKING ABOUT IT.

AND THANK YOU FOR PUTTING THIS ON, BECAUSE I THINK THE MORE WE DO THIS, THE MORE WE'RE GOING TO SURFACE ISSUES, PREPARE THE LEGISLATURE, PREPARE THE HOSPITALS, PREPARE THE COMMUNITY OF WHAT IS COMING.

>> Renee: GOOD POINT.

THIS WE'RE GETTING LOTS OF QUESTIONS RIGHT NOW.

THIS FROM AN UNNAMED VIEWER THEY SAY QUOTE I HAVE LUPUS AND I WORK TWO JOBS AND ON MEDICAID IF I DIDN'T HAVE COVERAGE I COULDN'T WORK.

I KNOW I AM NOT THE ONLY ONE IN THIS SITUATION.

HOW MUCH OF US ARE LEGISLATORS TALKING TO?

>> I TALK TO PEOPLE ON MEDICAID ALL THE TIME.

AND I DON'T KNOW THE SPECIFIC CIRCUMSTANCES OF THAT PERSON'S SITUATION.

BUT IF THEY ARE ON MEDICAID NOW AND, I DON'T SEE THAT THERE WOULD BE.

>> Renee: AND WORK TWO JOBS.

>> I DON'T SEE A DISRUPTION.

>> THEY MEET THE 80 HOURS A MONTH.

>> Renee: AND WHAT THE WORK REQUIREMENTS ARE.

COMMUNITY REQUIREMENTS.

>> THE WORK REQUIREMENTS IN THE NEW BILL ARE BASICALLY, TO BE INVOLVED IN A COMMUNITY, BE VOLUNTEERING DOING EDUCATION, GETTING A CLASS AND'S GED, COMMUNITY COLLEGE FOR SUM TOTAL OF 80 HOURS A MONTH.

>> A MONTH.

>> SO THAT'S PART-TIME EMPLOYMENT.

SO IT SOUNDS LIKE THERE'S NOTHING THAT WILL CHANGE FOR THIS PERSON.

>> I THINK SHE WILL NEED TO CERTAINLY ESTABLISH THAT SHE HAS LUPUS WHICH IS SHOULD, I THINK QUALIFIES IN DISABILITY.

AND THERE IN LIES PART OF THE ISSUE WHICH IS THAT I THINK THIS IS LESS A WORK REQUIREMENT OR A COMMUNITY ENGAGEMENT REQUIREMENT AND MORE ABOUT REPORTING IT.

IDEALLY THERE'S GOING TO BE SYSTEMS THAT MAKE THAT EASY FOR FOLKS TO DO OR DO ON A AMOUNT PARTICULAR BASIS AND PLACES LIKE GEORGIA THAT IS NOT ALWAYS THE CASE.

THERE IS AN ESTIMATED 240,000 GEORGIANS ELIGIBLE FOR MEDICAID EXPANSION THERE AND SO FAR THEY HAVE 7,000.

>> Renee: WHY?

>> WELL, THERE IS A LOT OF REASONS.

PART OF THE REASON IS THAT WHEN FOLKS APPLY TO THEY CALL IT GEORGIA PATHWAYS, THEY HAVE TO HAVE ALREADY A MONTH OF WORK UNDER THEIR BELT OR HAVE TO HAVE PROOF THAT THEY HAVE A SUBSTANCE USE DISORDER OR DISABILITY, AND A LOT OF FOLKS CAN'T PROVE THAT.

THEY WORK ON AND OFF.

THEY CAN'T SHOW THEY HAVE HAD A STEADY 80-HOUR MONTH BEFORE THEY APPLY.

IN ORDER TO PROVE THEY HAVE A DISABILITY THEY HAVE TO GO TO A DOCTOR TO HAVE THAT PROVEN BUT YOU CAN'T GO TO A DOCTOR UNLESS YOU HAVE COVERAGE.

IT IS A BIG HURDLE FOR A LOT OF FOLKS.

I DON'T KNOW ABOUT THIS VIEWER EVERYBODY'S CIRCUMSTANCE IS DIFFERENT BUT I THINK IT'S THE REPORTING THAT CREATES THE HURDLE AT LEAST IN GEORGIA IT'S BEEN DIFFICULT TO OVERCOME.

>> Renee: SO THIS QUESTION FROM LISA OF NEW CONCORD I HAVE AN EIGHT-YEAR-OLD GRANDDAUGHTER ON DISABILITY.

I SEE THAT ONE OF THE REQUIREMENTS WITH THE NEW BILL IS TO BE WORKING HOW WILL THAT AFFECT ME AS A CAREGIVER?

>> NOT AT ALL.

>> IT SHOULD NOT.

>> Renee: MS. LISA IT SHOULDN'T YOU HEARD IT HERE FIRST AND HOPEFULLY RIGHT.

SO THIS QUESTION FOR SENATOR ADAMS SPECIFICALLY, YOU'RE A FAN JULIE, HOW CAN YOU SPEAK OF JOB GROWTH IN EASTERN KENTUCKY WHEN JOBS ARE LEAVING THAT AREA PUBLIC SCHOOLS AND RURAL HOSPITALS ARE THE LARGEST EMPLOYERS IN THOSE AREAS AND ALSO IF THERE IS A WORK REQUIREMENT FOR THE ABLE-BODIED CITIZENS WILL THE LEGISLATURE LOOK AT UNIVERSAL PRESCHOOL KINDERGARTEN AND ADDITIONAL FUNDING TO HELP WITH DAYCARES TO HELP THOSE FOLKS IN FINDING A JOB.

>> THERE IS A LOT THERE.

I THINK THAT ONE OF THE THINGS THAT HAS BEEN BROUGHT UP PRELIMINARYLY WITHIN THE MOAB CONVERSATIONS HAS BEEN HOW DO WE LOOK AT SHORING UP THE WORKFORCE THAT HEALTHCARE WORKFORCE IN SOME OF THESE RURAL PARTS OF KENTUCKY.

AND YOU KNOW, AS NANCY TALKED ABOUT, STAFFING IS SUCH A HUGE BUDGETARY COMPONENT FOR A LOT OF THESE RURAL HOSPITALS.

CAN THE STATE LOOK AT ANY CREATIVE WAYS TO HELP WITH THAT WORKFORCE COMMON?

SO THAT IS ONE OF THE THINGS THAT WE'VE BEEN TALKING B UNIVERSAL PRE-K THAT IS A NONSTARTER IN THE GENERAL ASSEMBLY.

BUT THAT'S NOT TO SAY THAT CHILDCARE IS STILL ON THE TABLE.

ABSOLUTELY.

BECAUSE YOU CAN'T HAVE A VIBRANT WORKFORCE IF YOU DON'T HAVE A VIBRANT CHILDCARE SYSTEM.

AND SO MY COLLEAGUE REPRESENTATIVE SAM MARCOSSON HAS BEEN THE LEADER IN THE GENERAL ASSEMBLY ON FIGURING OUT WHAT IS THE BEST WAY TO HELP THOSE PEOPLE WHO WANT TO GET INTO THE WORKFORCE THAT WANT TO GET ENGAGED, WITH THAT CHILDCARE COMPONENT BECAUSE YOU CAN'T HAVE ECONOMIC DEVELOPMENT IF YOU DON'T HAVE CHILDCARE.

THAT IS A REAL CONCERN.

SHE IS RIGHT IN THAT.

AND SO THAT'S ANOTHER WAY THAT THE GENERAL ASSEMBLY HOPEFULLY CAN HELP AID IN SOME OF THESE CONVERSATIONS AS WE GO THROUGH THIS NEW PARADIGM.

>> Renee: BACK TO NANCY GALVAGNI AND ASK WHAT ARE SOME OF THE SOLUTIONS?

THEY WANT TO KNOW HOW TO SHORE-UP THE HEALTHCARE WORKFORCE ANY IDEAS YOU CAN LEND TO THEM?

>> AT THE END OF THE DAY WE HAVE TO HAVE OUR COSTS COVERED ANY BUSINESS CANNOT STAY IN BUSINESS UNLESS THEIR COSTS ARE COVERED.

70-80% PATIENTS ARE COVERED WITH THE GOVERNMENT PROGRAMS AND THE FEDERAL GOVERNMENT IS SETTING THE RATES AND WE WILL BE WORKING WITH OUR PARTNERS IN THE GENERAL ASSEMBLY AND WE KNOW THEY SUPPORT OUR HOSPITALS.

SOME OF THIS IS GOING TO HAVE TO BE FIXED AT THE FEDERAL LEVEL.

THANKFUL FOR A COUPLE YEARS TRY TO GO BACK AND WE WILL NEED THE SUPPORT OF OUR STATE LEGISLATURE TO HELP ENCOURAGE OUR FEDERAL DELEGATION TO MAKE SOME OF THE FIXES FOR KENTUCKY.

AT THE END OF THE DAY WE HAVE TO HAVE OUR COSTS COVERED.

AND CERTAINLY IT'S VERY FRESH THE BILL IS VERY FRESH.

BUT WE WILL BE INTERESTED IN THINKING OUTSIDE THE BOX, CREATIVELY HOW THE STATE CAN HELP US.

PART OF THIS IS GOING TO HAVE TO BE FIXED AT THE FEDERAL LEVEL.

>> Renee: AND J.D.

VANCE SAYS THERE COULD BE FIXES THAT COME ALONG THE WAY.

THIS DOESN'T HAVE TO WAIT UNTIL IMPLEMENTATION HAVE TWEAKS.

THAT IS WHAT YOU ARE HOPING FOR.

ANY OTHER COMMENT HERE?

>> SURE, THINKING ABOUT TIME AND TWEAKS, RECOMMENDATIONS ARE DUE FROM THE DEPARTMENT FOR HEALTH AND HUMAN SERVICES HHS BY THE END OF THIS YEAR FOR GUIDANCE ON IMPLEMENTATION.

SO I THINK NOW IS A PIVOTAL TIME FOR THAT GUIDANCE TO BE DEVELOPED.

AND I KNOW FOLKS AROUND THIS TABLE WILL BE INVOLVED IN THOSE DISCUSSIONS.

I ALSO THINK CREATIVE EYES SHOULD BE PUT ON THE STAFFING OF ENROLLMENT COMPANIES AND COMPANIES THAT ARE DESIGNED TO HELP PEOPLE WITH THE ADMINISTRATIVE BURDEN.

THAT IS PART OF THE WORK AND COMMUNITY ENGAGEMENT REQUIREMENT REPORTING.

SO THAT ALREADY EXISTS FOR ANYONE WHO WORKS IN MEDICARE AND MEDICAID.

THEY ARE ACCUSTOMED TO INDIVIDUALS AND ENTITIES WHO GO OUT AND HELP PEOPLE WITH THAT PAPERWORK AND THAT IS SOMETHING -- >> Renee: HOW DO YOU FIND THEM?

>> YOU HAVE TO FIND THE STAFFERS AND TRAIN THEM BUT FUNDING MIGHT BE IMPORTANT ON THAT AND WOULD BE CERTAINLY MUCH OTHER COST-EFFECTIVE WAY TO DEAL WITH THE REPORTING REQUIREMENT DEFICIT THAT MAY COME FROM LEAVING BENEFICIARIES ON THEIR OWN.

>> Renee: AND FOR MEDICAID BENEFICIARY HOW DO THEY KNOW HOW TO DO ANY OF THIS?

>> THE MANAGED CARE ORGANIZATIONS WHICH MANY ARE ENROLLED HAVE DATA WHO THE BENEFICIARIES ARE.

AND TO THE POINT THAT IS A MOVING POPULATION AND THEY ARE NOT ALWAYS IN THE SAME PLACE.

BUT THERE IS FAIRLY ACCURATE DATA HELD BY THE MANAGED CARE ORGANIZATIONS.

CERTAINLY COORDINATION OF THOSE EFFORTS COULD BE STARTING THERE.

>> Renee: ANY OTHER COMMENT ON THAT?

>> IN HOSPITALS STAND READY TO CHANNEL PEOPLE, GET THEM TO THE RESOURCES THEY NEED TO GO TO.

I KNOW AT THE UNIVERSITY OF KENTUCKY WE IDENTIFY POTENTIAL CANDIDATES AND HELP THEM NAVIGATE THE SYSTEM.

SO THERE IS A TERM THAT HAS COME OUT AS PATIENT CARE NAVIGATORS.

WHICH, I THINK, IS PROBABLY ONE OF THE MOST IMPORTANT BENEFITS THAT CAME FROM THE ACTION THE AFFORDABLE CARE ACT THAT ALLOWS INDIVIDUALS THE OPPORTUNITY TO FIGURE OUT THE ACRONYMS AND WHERE DO THEY GO FOR WHAT?

MEDICAID HAS ITS OWN LANGUAGE.

>> Renee: AS WE'VE HEARD TONIGHT.

>> YES.

>> Renee: WELL, THERE HAS BEEN A QUESTION ABOUT OPTIONAL BENEFITS YOU MENTIONED MATERNITY CARE WHAT ABOUT COMMUNITY AND HOME-BASED SERVICES?

WHAT DANGER COULD THEY BE IN?

>> FROM A HOSPITAL'S PERSPECTIVE HOSPITALS PROVIDE OUTREACH, FREE CLINICS THEY WILL BE LOOKING AT EVERYTHING.

BECAUSE I'M HERE TO TALK ABOUT THE CUTS TO HOSPITALS BUT WHEN YOU TAKE BILLIONS OF DOLLARS OUT OF THE SYSTEM, THERE'S GOING TO BE CONSEQUENCES BUT IT'S TOO EARLY TO TELL.

>> Renee: YOUR THOUGHTS DUSTIN?

>> ONE SPECIFIC WAY IS MORE RISK AT OTHERS AND THAT IS THE SUPPORTS FOR COMMUNITY LIVING WAIVER.

THIS IS SERVICES FOR FOLKS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES AND SPECIFICALLY THEY ARE AT RISK ONE OF THE WAYS THIS BILL CUTS MEDICAID IS BE REDUCING PROVIDER TAXES.

WE HAVE SEVERAL DIFFERENT TYPES OF PROVIDER TAXES HOSPITALS ARE ONE OF THOSE.

SCL THIS WAIVER IS ONE OF THE FEW THAT IS ABOVE THE LIMIT THEY ARE DIAGNOSE TO REQUIRE STATES TO DROP AND THAT IS GOING TO BE ABOUT $60 MILLION LESS THAN WHAT THEY HAD BEFORE.

SO THAT PROVIDER TAX IS USED PRIMARILY TO SUPPLEMENT RATES FOR PROVIDERS TO MAKE SURE THAT THEY CAN ACTUALLY HIRE PEOPLE TO OFFER THE SERVICES.

AND SO THAT IS ONE PARTICULAR WAIVER I AM CONCERNED ABOUT.

>> Renee: THIS QUESTION FROM FAYETTE COUNTY, PROBABLY THE LAST FOR THE NIGHT COULD MEDICAID USE ACCESS TO UNEMPLOYMENT INSURANCE PAYMENTS BY CORPORATIONS TO VALIDATE EMPLOYMENT?

>> I DON'T KNOW.

>> I THINK THAT IS ONE OF THE CREATIVE SOLUTIONS.

THAT IS ONE OF THOSE SOLUTIONS THAT WOULD HAVE TO BE LOOKED AT ACROSS GOVERNMENT TO DETERMINE WHAT COULD BE SHARED IN WHAT WAYS AND WHETHER THAT WOULD PASS LEGAL MUSTER AND WHETHER THAT DATA IS USEFUL FOR THAT PURPOSE.

>> Renee: SOMETHING MOAB TAKES UP?

>> I'M OPEN TO ALL ANY AND ALL SUGGESTIONS, RENEE.

>> Renee: I WANT TO GO BACK QUICKLY IN TWO MINUTES ABOUT IF THERE ARE CLOSURES IN RURAL HOSPITALS AND THEY HAVE TO FLOOD TO U.K. HEALTHCARE.

WHAT KIND OF IMPACT COULD THAT HAVE?

WOULD YOU BE ABLE TO HANDLE THAT LOAD?

>> WELL, ONE OF THE THINGS WE'RE FOCUSED ON IS BUILDING A NEW PATIENT TOWER.

ANYBODY THAT HAS VISITED OR TRIED TO ADMIT A PATIENT TO U.K., IN RECENT MONTHS, THAT IS A CHALLENGE.

WE'RE FILLED TO CAPACITY.

AND WE KNOW ONE OF OUR PRIORITIES IS TO BUILD A NEW PATIENT TOWER TO REPLACE THE OLD CHANDLER CHASSIS AND POTENTIALLY PULL IN GOOD SAMARITAN.

THAT INFRASTRUCTURE IS ANCIENT.

SO WE NEED TO UPGRADE THAT.

AND ADD A FEW OTHER BEDS.

BUT, I THINK, WE WANT TO WORK IN PARTNERSHIPS.

WE HAVE CLINICAL NETWORKS THAT WE HAVE THROUGHOUT THE COMMONWEALTH.

WHERE WE CAN SEND PHYSICIANS TO REMOTE LOCATIONS SO THAT PEOPLE CAN GET CARE CLOSE TO HOME.

PEOPLE DO BETTER.

THEIR HEALTH OUTCOMES ARE BETTER.

SO WE'RE LOOKING AT CREATIVE OUTSIDE THE BOX SOLUTIONS TO BOLSTER UP THE COMMUNITY HOSPITAL SYSTEM SO THAT PEOPLE CAN GET THE RIGHT CARE AT THE RIGHT TIME AT THE RIGHT PLACE.

SO THAT IF THEY NEED TO COME TO U.K., WE HAVE A BED AVAILABLE FOR THEM.

>> Renee: WELL, IT'S BEEN A GOOD DISCUSSION I'VE LEARNED A LOT I HAVE TO REWATCH IT.

I APPRECIATE YOU ALL'S ATTENTION AND EXPERTISE THIS EVENING.

WE HOPE YOU WILL JOIN US NEXT MONDAY NIGHT FOR "KENTUCKY TONIGHT" LOOKING AT SOMERSET AND PULASKI COUNTY AS WE GO ON THE ROAD I WILL BE REPORTING FROM THERE TOMORROW.

WATCH "KENTUCKY EDITION" EACH WEEKNIGHT AT 6:30 EASTERN 5:30 CENTRAL HERE ON KET AND JOIN BILL BRYANT AND A TEAM OF JOURNALISTS TO DISCUSS THE NEWS OF THE WEEK ON "COMMENT ON KENTUCKY" FRY DAT AT 8 EASTERN 7 CENTRAL.

THANK YOU FOR WATCHING.

I'M RENEE SHAW.

THAT'S MY NAME AND I WILL SEE YOU TOMORROW NIGHT.

TAKE GOOD CARE.

[♪♪]