Alzheimer's Disease and Dementia Advisory Council
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Representative Julie Mayberry
Unverified
0:30
chair sees a quorum of this committee um we appreciate y'all being here today had to move up the time just a little bit to 12 30 so we might have some members that did not
get that information to know that we're starting a few minutes early and maybe they'll follow in in just a little bit. Introducing myself again, State Rep. Julie Mayberry, and our new co-chair.
Say your name. Clint Penzo. Do you care to say anything else? I'm good. Okay. Happy Halloween to everybody. I know that DHS has a big event taking place later today, about 2 o'clock,
2.30, something like that, and that's why we moved the time up to 12.30 to allow some folks who needed to go to that event so i appreciate you coming in and interrupting your lunch hour a little bit first thing on the agenda that we need to do is approve the minutes do i
have someone who will motion to approve the minutes david cook thank you a second and stephanie cook thank you no relation um all in favor say aye anyone opposed okay now we can move on to the business of today. And I'll tell you how this subject kind of has come up. Over my years of being in the legislature, I've had quite a few people who have brought to my attention the personal needs allowance in nursing homes and the need for that amount of money that nursing home
residents receive to take care of personal needs needs to be increased. I've received numerous phone calls, and then there was a story on Channel 11 back in June on it, and I promised the reporter then that I'll make sure that we have that discussion, and that's what this is. This is just discussion of what is a personal needs allowance, how long has it been, the amount that it's been, what can it be used for, etc. So the first thing I'm going to show you is Exhibit C.
All of you should have that copy and I'm just going to read out loud the first two paragraphs if that's okay and then we're going to have some guests come up and we have DHS here to answer some questions as well. So personal needs allowance is the amount of monthly income a Medicaid-funded nursing home resident can keep of their personal income. Since room, board, and medical care are covered by Medicaid, the majority of one's income must go towards the cost of nursing home care. The P&A is intended to cover the nursing home resident's personal expenses, which are not covered by Medicaid.
This may include, but is not limited to, haircuts, vitamins, clothing, magazines, and vending machine snacks. Federal law requires that a Medicaid-funded nursing home resident receive a personal needs allowance, authorized by the Supplemental Security Act amendments of 1972 and enacted in 1974, the federally mandated P&A was set at $25 a month. The 1987 Omnibus Budget Reconciliation Act,
effective in 1988, increased it to $30 a month, where it still remains. Each state, however, can allow for a higher personal needs allowance up to a maximum of $200 a month. While the P&A amounts vary by state, it ranges from $30 a month to $200 a month. You also have a sheet of paper that I put together. It is not fancy at all, but in Exhibit C, it outlines what every state, as of when this was written, what every state currently allows for their personal needs
allowance, but it was kind of hard to read it that way and see where Arkansas ranked, so I put it in a little table for you, and you can see that Arkansas is not on the lowest end. I'll give you an example. Alabama is at $30, and Alaska is at $200, so there's a wide range, but under $40, there's one, two, three, four, five, six, seven states, and at $40, there's one, two, three, four, five states and everything else is above that so we're we're on the the bottom tier and so the
question is what is this personal needs allowance how is it used and we asked if some nursing home advocates come and share with us their story so first up we have um martha deaver she's the director of arkansas advocates for nursing home residents if you can come to the front there and with her is Veronica Tess Myers and if you all will mind sharing your story what is this personal needs allowance how is it used what are your thoughts welcome you can hit that microphone
Martha Deaver
Unverified
5:36
there you go green button on kind of turn it would you like me to tell you a little bit about our organization and my work a little bit first Okay. Can you hear me? Okay. My name is Martha Deaver. I'm the director of the Arkansas Advocates for Nursing Home Residents. I want to thank Representative Julie Mayberry for asking me to be here today. My organization is an all volunteer advocate group that has been in place for 30
years. We are here solely to protect the rights of all long-term care residents and to educate the public. I work one-on-one with residents and their families and have for decades and continue to daily. During the past 30 years, I have worked with the Office of Inspector General, the Government Accountability Office, the Arkansas Attorney General's Medicare, Medicaid, Abuse and Fraud Department, the Federal Bureau of Investigations, the Centers for Public
Integrity, Ladies Home Journal, the Kaiser Foundation, Consumer Reports, and national and state media outlets. In 2010, I was humbled to receive the Arkansas FBI Director's Award. Later that year, I was honored to receive a second award from the United States FBI Director in Washington, D.C. I have served under two Veterans Affairs Directors. I've been honored
to serve on numerous committees with the Alzheimer's Arkansas Association. Our organization is a stakeholder with Alzheimer's Arkansas. Their director speaks at our meetings annually, and we distribute information about Alzheimer's Arkansas to help educate the public. Our organization worked with Coach Frank Broyles over 20 years ago to pass legislation to increase Alzheimer's training for direct care workers.
We were successful in getting 15 hours of Alzheimer's and dementia training added to our state's training requirements. CMS has documented over 3 million United States nursing home residents diagnosed with dementia and Alzheimer's from 2007 to date. I am here today to speak to you about the importance of the personal needs allowance that is given to our Arkansas nursing home residents on a monthly basis
and how this money can greatly enhance their lives. The personal needs allowance was enacted by the federal government in 1974, and it was revised in 1987. It requires states to allocate a monthly allowance for each Medicaid nursing home resident. This allocation is between a minimum of $30 to a maximum of $200 a month. The residence allocation is determined by each state.
I have also brought some copies of an explanation of the personal need allowance and a list of the amounts of the allowances for each state. The personal need allowance is given to all Medicaid recipients, which is well over 50% of our state's nursing home residents. In Arkansas, over half of these recipients have a diagnosis of Alzheimer's or dementia. I was the caregiver for my mother and grandmother, who both had Alzheimer's.
I'm here today to speak to you about how important it is to raise the personal need allowance, which has not been increased in about 30 years. Arkansas nursing homes residents receive only $40 per month for their personal needs allowance. They must stretch this $40 in order to purchase items not furnished by the nursing home. These are some, but not all, of the items.
Clothing, shoes, pajamas, socks, underclothing, books, magazines, cosmetics, vending machine items, toiletries, haircut, permanents, yarn, tobacco products, greeting cards, postage, cell phones, cell phone bills, and cell phone chargers, and much more. Arkansas is one out of ten states that receives the lowest personal needs allowance in the nation. Increasing the monthly $40 allowance would greatly enhance our Kansans' lives.
I want to thank Representative Julie Mayberry and the committee for your consideration on raising the personal needs allowance for Arkansas nursing home residents, and I thank the committee for the opportunity of speaking here today. Okay, and you brought with you
Speaker 22
11:00
don't know if I can imagine that. Hello.
Veronica Tess
Unverified
11:04
My name is Veronica Tess Myers.
Those of you that know me in an era of autism advocacy and disability rights resource, thank you for inviting me here with Ms. Deaver today. Just to add to how much this would be a much-needed convenience for the patients at nursing homes, As an advocate myself, I just recently acquired full legal guardianship rights to my father, who's at Blossoms at Woodland Hills. And that was back in 2020.
He suffered a stroke after being assaulted at one of the local high-rises, which warranted him being at the nursing home for rehabilitation. As I am present to make visits and bring forth personal items for him, I do have other patients that also ask me to supply them as well. And, of course, that dips into my own budget for my child that's at home with me with a pervasive level of autism. So I'm on both ends of the spectrum when it comes to being a caregiver of someone that's the most vulnerable of our society.
So there is a definite need to increase the personal needs allowance.
Representative Julie Mayberry
Unverified
12:21
can you give us an example of what some of those residents are asking you for sometimes
Representative Robin Lundstrum
Unverified
12:26
it can be something as simple as peanut butter crackers that they see me bring my dad or
Veronica Tess
Unverified
12:32
it can be something as major as a t-shirt that I've gotten his name printed on and they want a t-shirt that matches his t-shirt and that I'm one of their caregivers I do frequent the nursing home quite a bit just to kind of build a rapport with not only the staff
there but administration and the patients as well just so they can know they do have someone other than themselves and their own thoughts and thinking about why they're there and there are no other family involvement um and giving them what they need to feel like they are part of society but it can be something that's minor it's like i said cheese and crackers or peanut butter and crackers or when they see me bring just socks colorful socks and they want those socks or they'll ask me if they see the bag and I'm coming down the hall with my son and we're making a delivery to my dad, they'll ask, did I bring them anything?
So that's sometimes, at first I used to get saddened by that, but now I do a little bit more and try to bring more kind of care packages for some of the ones that actually call me by
Representative Julie Mayberry
Unverified
13:37
name or speak to Alexander when we come in to visit. Okay. Before we go
to DHS, does anybody have a question? Okay. Senator Love, did you have a question? Okay. David Cook?
David Cook
Unverified
13:54
I just wonder if you could speak to, you know, with the economy changing, prices have gone up. So how far are
Representative Robin Lundstrum
Unverified
14:04
you able to stretch the $40 that you currently are getting for the P&A? The $200 would be
Veronica Tess
Unverified
14:09
a much better need. It's very difficult to stretch $40 when you're trying to get socks and, you know, So just stenography materials, if he wanted to draw, comic books, things of that nature. I mean, $40 is not going to go very far, even for myself with my son that's at home with me,
let alone a person in a nursing home
David Cook
Unverified
14:31
that is incapacitated. Thank you both for
Representative Julie Mayberry
Unverified
14:35
presenting. I appreciate that. Absolutely. Thank you. Okay. I believe that Jay Hill
is prepared to just share with us some thoughts on the personal needs allowance from DHS perspective and how we go about
asking DHS to consider raising this amount. So, thank you, Representative Mayberry.
Speaker 43
15:00
like you, I kind of worked through our list of states to see where we were. So I'll present facts, not opinions per se, but facts. So Arkansas, we are at $40. And, Ms. Deaver, you're correct. I believe our rate has been in place since 1997. There are seven states below Arkansas. Four states equal, 16 within $10 of us.
So our state falls, we're in that 55% of the 51 entities represented, the 50 states in the District of Columbia. So we're somewhere in the middle as far as the number of states and the amount that our state allows for personal needs allowance. It does range much higher when you look at states like Alaska,
Speaker 44
15:54
Florida, District of Columbia that are at
Speaker 43
15:59
$100 up to Alaska the highest at $200. There are approximately 11,500 Medicaid beneficiaries in Arkansas nursing homes.
That number does fluctuate. What we did, we looked at this from a perspective of a fiscal impact to the state, to the agency, to the budgets that we currently have. Of course, keeping in mind, we are presently in the final stages, we believe, of a Medicaid review. So there is a system of, an entire system of care review going on Medicaid or undertaken for Medicaid presently. I believe our Medicaid director anticipates that that report would be ready sometime after the first of the year.
And it is looking at all of our programs, top to bottom, where our spend is, what the trajectories look like. So for every, just again, this is for the benefit of the committee. For each $10 increase in the allowance, the offset to the Medicaid payouts for those skilled nursing facilities would amount to between, given the population that we have today, would range between $1.3 and $1.4 million for each $10 that we adjust up for the personal needs allowance.
To echo your sentiment, too, as having run a nursing home, I've ran the Arkansas Health Center, our state's nursing home, for several years. That personal needs allowance is certainly very, very important to all the people that live there. Primarily, my residents used it for tobacco or preferences, Pepsi over Coke, Colgate over what version of toothpaste we may have, as well as those things seasonally, maybe socks, you mentioned socks, personal needs.
We did, we found that it was really either a feast or famine. We either, our residents either needed more in their personal needs allowance to buy things that they wished to buy, or many of our residents rarely accessed their personal needs allowance. They found that what the facility offered was what they needed, and we occasionally, we run into those issues where that $2,000 Medicaid threshold was being closed in on, and then we would go on a spin down for our beneficiaries. It may be that they
would needed a television or they needed something for their room, something that was a sizable enough purchase that would get them down far enough under the $2,000 range so that they would not be in danger of losing their Medicaid. Again, that's just kind of the facts of where we are. It will result in an increase in Medicaid. Medicaid is being reviewed right now. That review
Speaker 48
18:46
is not yet complete, but is imminent in
Representative Julie Mayberry
Unverified
18:51
the very near future. I guess my question is, is this particular issue being addressed in that review?
Speaker 48
18:57
The personal needs allowance is not a Medicaid spend. So, no, it's not being directly looked
Speaker 43
19:04
at in the system review. Medicaid payouts to nursing homes are. So that is part of that review. Our long-term care facilities are a very substantial portion of the Medicaid spend in our state. So to change that, that review will look at what are those impacts to the statewide system if there are fluctuations in any payments made to long-term care facilities.
Because, again, as I said, that industry is a sizable percentage
Senator Fredrick J. Love
Unverified
19:39
Arkansas. Okay. Senator Love, you had a question?
Thank you, Madam Chair. And I think Mr. Hill did address pretty much what I wanted. Let me ask you this, though. And so these funds are taken out. Once you complete that rate study and decide how much the spend is going to be with the nursing homes per individual,
So these funds also come out of that bulk amount. So these funds would come
Speaker 43
20:10
from an offset, for instance, their Social Security check that is payable to the facility to offset the cost of their daily rate. An increase in personal needs allowance would mean a decrease in that check's impact to the daily rate, which would result in an increase in the Medicaid reimbursement from the agency to make them hold for that daily rate.
Senator Fredrick J. Love
Unverified
20:34
This is not a Medicaid, these are not Medicaid funds. Okay, I got you. So the Social Security side, the federal funding that's coming to the
Speaker 43
20:53
facilities, explain it one more time so I can better understand. Using round numbers, $100 daily rate, if the needs allowance is increased by $10, then that would result in Medicaid offsetting that $10 towards that beneficiary for that reimbursement rate.
It's pennies on the dollar for a day multiplied by 11,000 today, approximately 11,500 beneficiaries. And so the increase to Medicaid to meet that daily rate threshold when the Social Security check is decreased by $10, $20, whatever that amount may be for a personal needs allowance, if there is a shift, results in that Medicaid increase. Gotcha. Okay. That was a simplified version, but... No, no,
Speaker 66
21:40
You got it. Okay. Thank you. Yes, sir. Phyllis Bell. I guess this is a question that's maybe better offline, But, Jay, do we have any idea of how many people may not know about their personal care, personal needs allowance? Do we have any concerns of people not
Speaker 48
22:08
having access to that? Everyone has access to the degree with which a patient may not know.
I think that would be case by case. So, again, my examples go back to my experiences at the health center. I do have residents who have dementia, advanced dementia, for instance, and
Speaker 43
22:27
they may not be aware of what is there for them. Now, what we do at our facility, and I suspect most of these facilities do, I have a shopper. I have a staff member who shops 40 hours a week for the, you know, 180
Speaker 48
22:44
to 200 residents that we have as our census ebbs and flows.
Speaker 43
22:49
And what that individual does is, for all of our patients that need, what you said was a great point, socks. We buy a lot of socks. We go through pajamas. We go through undergarments. We go through preferences. But that's what we will do. We will work on those residents' behalves with their guardians, with their designated guardian, to make purchases for them for things that the state cannot buy or that they simply need. So to
Speaker 48
23:15
the degree that people don't know, I don't know that I have a number for you, Phyllis, to answer that.
But I do know in the cases at our facility, for those
Speaker 42
23:28
that personal needs allowance, we work with their guardians to make use of those funds
Speaker 66
23:35
for their needs. So as a follow-up, so if someone doesn't have a guardian, do they, And if they've requested of their facility leadership, who's the best person to talk to if they've not received that follow-up, if they've requested it, their ombudsman? They
Speaker 48
23:50
could absolutely reach out to their ombudsman.
I would believe they could request to sit down and simply speak with their facility administrator to discuss that. Because I have heard
Speaker 66
24:00
concerns about that from people that I know. Absolutely.
Speaker 43
24:03
There are a lot of avenues to go. The ombudsman is a great place to start, and that is a resource for the residents to tap
Representative Julie Mayberry
Unverified
24:16
into for that purpose. Any other additional questions from members or statements or
Representative Robin Lundstrum
Unverified
24:21
thoughts? Yes. I do have a question when you talk about what you did in your nursing facility.
Veronica Tess
Unverified
24:26
A lot of times, just from my perspective as an advocate, I did not know anything about the patient liability versus the needs allowance. I had to learn that I didn't give all access to my dad's finances to the nursing facility. I maintained that responsibility, and that's how I learned about the personal needs allowance versus the patient liability. So I'm not understanding the differential between when we talk about the patient liability
and we're trying to get an increase in that personal needs allowance and how that plays into the patient liability that we're responsible for outside of what you're already receiving at the nursing home as the cost of what it means for a patient to be in your nursing
Speaker 57
25:14
home. So that patient liability, if that needs assessment is increased out of the patient liability, I think
Speaker 43
25:19
Medicaid will make up the difference for that
Speaker 48
25:22
daily rate that the nursing home is entitled to have. And I'm sorry if I'm not answering that question
Veronica Tess
Unverified
25:27
clearly. What I'm wondering is, why is the second-guessing an issue if we're part of the lowest on the totem pole
of meeting the needs of patients increasing the allowance, whether there's a dementia patient or a patient that has a guardian that would need to know that this is justified to have it happen? And you're asking about this. It sounds like we're not
Speaker 48
25:51
wanting it to happen. No, no, I'm not presenting it necessarily. Again, I want to make clear
Speaker 43
25:56
I'm presenting the facts of where we are, that there are fiscal impacts to the state Medicaid budget to make those changes.
We are in a process right now. We're not augmenting any rates presently until the review is through, in fairness to understand what the sum total of Medicaid spent in the state looks like, what those allocations should be, where those funds are going presently. Also, when I tell you, too, that that review is pending completion very soon, so we will have a better idea of what that long-term care Medicaid spend is, should be.
And at those points, I think these are discussions we can certainly have. And we're having these now. Representative Mayberry sent this over. And so I'll tell you, we've been in discussions with our Medicaid director, with my division, with Medicaid, our division of medical services on these P&As. I'm sorry. But
Veronica Tess
Unverified
26:49
we do understand that it's more than just about SOCs, right? Yes. Again, I
Speaker 48
26:54
wasn't trying to oversimplify my examples. It was really just to say that I understand exactly what you're
Speaker 43
26:59
talking about with the needs for these personal needs allowances and how they're used by our residents for a myriad of things.
Representative Julie Mayberry
Unverified
27:07
I had asked BLR many months ago to help me understand $40 in 1997, what that $40 would be today, and they used a CPI inflation calculator that's used by the U.S. Bureau of Labor and Statistics website, and it came up with $75.22. I mean, that's just what it is. So I guess my question is, at some point in 1997, 1996, whenever this started coming up,
they factored in what that amount should be, and it was set at $40. So they must have used some type of assessment, what is needed. So my question moving forward is, how do we find out what that assessment was then, and how do we do that now? Because we are talking about Medicaid and all that, And before that's too set in stone, can this be factored in? Can we see? And it may not be
$75.22. That's just what your $40 can be.
Speaker 48
28:12
Consumer price index, correct? Correct. Yes. And I don't know, Representative, what formula was used. And not being facetious, I wasn't at DHS for those discussions. Many of us weren't. but that's not to say that we can't look at that and really understand what is that impact to our residents today with the personal needs assessment being where
Representative Julie Mayberry
Unverified
28:40
it is. To me, it's been 26 years, and so
is it time to look at this?
It may still need to be $40 because maybe
some other things are covered. I don't know. I don't know what that amount should be, But it does seem to me, and this is my opinion, that after 26 years, we need to look at this. And while we're looking at Medicaid as a big hole and making some adjustments, that we need to factor this in. And that's what, so what are those steps? How do we formally request that DHS look into this? How do we go about doing that?
Speaker 42
29:19
I think we would consider your request today to be that. Okay. Okay. Well,
Representative Julie Mayberry
Unverified
29:23
and would you agree with that, Senator? That's fine.
You can disagree with me, too. I mean, it's
Senator Clint Penzo
Unverified
29:34
something that could be looked at. I mean, if we're going to be increasing Medicaid spend, I mean, there's a lot of factors we need to look at. So I'd need more information before I have an opinion on it. And, you know, there's probably some places where we could do some cutting if this is important.
So I'd be interested in looking at some numbers. And I think that's
Representative Julie Mayberry
Unverified
29:59
what my request is, is just, you know, can you evaluate what is that? You know, what do we think that
the people need nowadays compared to whatever was used to come up with $40 way back when? And just let us have
Speaker 48
30:18
that information. I think what to your point, Senator, what I'm giving you today are estimations on census data, fiscal impacts,
but a more formal study would be undertaken by the agency to really look at what's that impact to Medicaid as a whole to do. And I believe we can work on it. We
Representative Julie Mayberry
Unverified
30:39
can put that together for you. Thank you. Thank you. Ms. Deamer, you had another question.
Martha Deaver
Unverified
30:46
Yeah, I just wanted to mention that there's probably not anyone in the state that has spoken to more family members and residents than I have throughout my years of my advocacy work. So many times, these residents, just the basic things that I have mentioned, which I haven't mentioned them all,
But I know back in the 90s, residents didn't have access to cell phones and things along those lines, which so many times is their main communication with the outside world. And, you know, the clothing, the shoes, the self-respect they get from so many of these items. And, yes, tobacco products. And because my husband of 52 years is a smoker, I think we all know that these tobacco products can really make a huge difference in residents' lives.
And so many of these residents are dementia residents, and a lot of them don't even know to ask for something. And so many times, you know, until I tell families or until I tell residents that this money is there for them to purchase certain items, they don't even know. And so few of these residents, the statistics on how many residents really even have visitors or families is very sad sometimes.
And so, you know, the outside world, by having so many of these items, it just brings back so much of the past to them. Just a simple action of being able to buy a Coke or to be able to purchase chips or even have somebody go purchase them a hamburger. And another thing that I've dealt with for decades is our young people in these facilities. There are a lot of young people.
And the cost of living certainly has not even begun to catch up with the resident's personal need allowance. So I guess that's mainly what I wanted
Speaker 94
32:59
to mention from my views as an advocate. Thank you. Representative Johnny Rye,
Representative Julie Mayberry
Unverified
33:06
I think, had a question. Yes, ma'am. Thank
Representative Johnny Rye
Unverified
33:12
you, Representative Mayberry. Jay, I heard you mention a $1.3 million.
Is that what it costs us
Speaker 98
33:22
now for this, or is it $1.3 for every $10? It was $1.3
Speaker 80
33:28
to $1.4, but somewhere in that range for every $10 that we would increase based on the estimation of today's
Representative Johnny Rye
Unverified
33:35
Medicaid census in nursing homes. Okay. Okay, so if we move that to $100, would that be about $13 million total? And then once you figure the federal part of that,
Speaker 98
33:49
it's probably around 70%, do you think?
You're putting me on the spot
Speaker 48
33:55
with math without a calculator. I would, it would be somewhere in the range of $10 million. $10 million? Yes, sir. Okay. And out of
Representative Johnny Rye
Unverified
34:05
that $10 million, though, Jay, what percentage of that is federal? Would it be 70%? Three to one match, generally. 75%.
Speaker 11
34:24
Actually, if we did this with federal. Through every $1, there's $3 matched
Speaker 107
34:31
by the federal government. Right. You know what? Do you hear the question he's
Speaker 59
34:35
asking? He's asking what the... Is it matched? Yes.
Speaker 80
34:37
Is this funding matched? Whereas Medicaid is matched. This
Speaker 109
34:39
funding, I don't. I don't know that. For anyone matching, isn't that right? Yeah, we
Elizabeth Pittman
Unverified
34:47
got it. So all Medicaid funding is matched. It depends on what service category and our standard... I'm sorry, by the way, my name is Elizabeth Pittman. I'm with Division of Medical Services, and I just answer questions.
Sorry about that. So all Medicaid services are matched. So this is matched. We do receive a federal match. Now, we tax nursing homes to pay portions of the state share. So I can't tell you sitting right here exactly what that would cost the state versus what that would cost a nursing home to increase that Medicaid rate. Jay, do you know more about that? Unfortunately, the people that I ask that information are not here today. But portions of the state share of the Medicaid rate are paid for by a tax to the nursing homes. So I can't tell you today exactly what the budgetary impact would be versus the tax impact.
Representative Johnny Rye
Unverified
35:32
Follow-up, please. Ms. Pittman, would that be if it was $10 million and the Fed paid 75 percent, would it be about $2.5 million
Speaker 116
35:38
that the taxpayers of Arkansas would actually have to pay? If that were correct, yes,
Elizabeth Pittman
Unverified
35:43
sir, but I can't tell you today that that is correct because, like I said, we do an assessment to nursing homes to get portions of that rate paid. So the state budget share is not the standard state
Representative Julie Mayberry
Unverified
35:56
share. Rachel Bunch had a comment from the Arkansas Healthcare Association. I
Senator Missy Irvin
Unverified
36:00
was just going to add on the matching amounts.
Typically, speaking in broad perspective, for the nursing home program, 13 cents of every dollar is from the state general revenue. The rest of it is a combination of the patient's liability, their Social Security check that goes to their cost of care, the federal match, and then
Representative Julie Mayberry
Unverified
36:25
the provider tax. Thanks for clarifying.
So in other words, for every $10, it's not going to hit our budget $1.3 to $1.4 million.
But we don't know exactly what that
Elizabeth Pittman
Unverified
36:39
amount is. Right. That's the impact on the state share portion, and we should have specified that, sorry. So that state, I mean, the total impact, I'm sorry, the total Medicaid budgetary impact. I can't use words today, guys. I'm sorry. I'm envisioning having to dress as the Wicked Witch later and paint my face green. But anyway, no, that's the state total Medicaid impact. So counting the federal share, counting the state share, counting the tax, all of it.
So the total appropriation increase would be 1.3 to 1.4. Sorry, Jay, I should have specified that
Representative Julie Mayberry
Unverified
37:16
on that sheet of paper, isn't it? I think I'm more confused now. I'm sorry. Okay. Representative Love, I mean, Senator Love, I'm sorry.
Speaker 59
37:30
the house. So, all right, let's get back to that share. Because, I mean, that
Senator Fredrick J. Love
Unverified
37:37
was the question that I had.
So, it is a three-to-one match. We have a three-to-one
Elizabeth Pittman
Unverified
37:44
service match, correct? Yes, but I'm saying, but
Senator Fredrick J. Love
Unverified
37:46
this amount, this funding right here is going to meet that criteria, the 3-to-1 match. No, sir. So that's where this gets really complicated, right?
Elizabeth Pittman
Unverified
37:56
So we establish a rate, and I think Jay may explain this better than me. So let's say the nursing home rate is $100 a day. That's very clearly made up, but pretending for even round nervous purposes. And they get a Social Security check of $50, and 10 of that is the personal needs allowance.
40 of that's going to go to that $100 rate. Medicaid's going to pay 60. And that 60 is where we get
Elizabeth Pittman
Unverified
38:25
sense? 60-40? Yeah. Is that correct? Our match rate is 70-30. 70-30 on average. 70% federal, 30% state. 70-30. Yes, sir. So what's the 60-40? The 60-40 is just an example.
So if you get $40 of personal needs allowance, that's $40 that we're not going to apply to that facility's rate. So Medicaid is going to make up that difference. So for every time you increase the personal needs allowance, Medicaid dollars, state and federal, are going to come in and match that rate. Does that make sense? We're going to make up that difference. I
Speaker 59
39:17
Yeah, that would be better, because I'm an official person, too. Me, too. It's like you're at co-pay. So when you
Elizabeth Pittman
Unverified
39:23
go to the doctor, you pay $25 co-pay. That goes towards that doctor's visit insurance, pays the rest. Well, you're reducing your co-pay when you increase your personal needs allowance. Does that make sense? So you're reducing the amount that a nursing home resident pays towards that daily rate. which means that we as the insurance come in and make up the difference.
Representative Julie Mayberry
Unverified
39:50
Okay. Is our state match right? Yes, sir.
Speaker 123
40:00
Okay. Any other questions on this topic? Don't let lawyers speak
Representative Julie Mayberry
Unverified
40:05
about finance in the future, by the way. Okay. Well, we appreciate y'all coming in and sharing and allowing us to have the conversation. I always think that it's good to at least have conversation to know what's out there and what the concerns are, especially when you're looking at a big picture. And I hope that, you
know, you all can consider this and let us know what that $40 is based on
and if it's time to look at that in
the big picture of everything. So appreciate you. Thank you. And thank you both for coming in and sharing today. It's our pleasure. Thank you very much for inviting us. We appreciate the feedback. Like I said, I've had numerous people who've asked me to look into it, and that's what we've done today. We've started some discussion, and discussion is always good, hearing lots of people with different views and what can we come to terms with. So thank you.
Okay. Moving on to our next. This is just a very quick follow-up to our meeting last month where we talked about Alzheimer's medication coverage, and Jack Hopkins is joining us now. He's with Government Relations for Centene, and he sent us a letter. He could not be with us last month, and so he sent us a letter, and he had said he'd love to come and just address the committee,
and so I'm just opening the door to allow them to just address the committee and you all can ask questions and we appreciate you being here Jack. Thank you. Yeah
Speaker 137
41:39
absolutely. Good afternoon Council. I just wanted to make sure that I followed
Speaker 138
41:42
up from having to miss last month due to a funeral so I wanted to present myself. I know I wrote a letter and said that our plans here in Arkansas do in fact cover the Quimby so I wanted to present myself for any questions or follow up that I can be a service to the committee on.
Representative Julie Mayberry
Unverified
42:04
And you are definitely still covering? There's been no change? That is
Speaker 138
42:11
correct. To covering the LaQuimby? That's correct. It is a medical benefit for us, and it is covered by our Medicare plans and our marketplace plans here in Arkansas. So that's all I've got, but I'm happy
Representative Julie Mayberry
Unverified
42:23
to answer any questions. Did anybody else have any other questions? That is, oh, wait,
Speaker 141
42:33
hold on, Dr. Azar. Will it also cover the cost of MRIs associated with Lequimbi monitoring?
Speaker 138
42:40
It wouldn't be covered underneath the benefit of Lequimbi. It would be covered underneath the medical services of the patient. But I cannot. Let me follow up on that, and I'll get back to you with some specifics. Thank you.
Representative Julie Mayberry
Unverified
42:56
any other questions okay i will say there was a a story in the today's democrat gazette
on the front page um following up on our conversation that we had last month so i appreciate all of you um being a part of that and at least making some awareness of the new medications and the
promises that we have for the future so um appreciate the
the coverage and and the conversation again. We hope that there'll be another medication approved in the next few months, and we'll follow up with conversations again to see who's covering it and who's not. David Cook, you have a question?
David Cook
Unverified
43:33
This is in addition to what Dr. Zargar mentioned, but do you cover diagnostics as well, especially if the amyloid PET scan, we
don't have that available in Arkansas,
so if someone had to travel out of state, do you guys cover those expenses as well for
Speaker 138
43:49
diagnostics. It would depend on whether that provider in the other state were one of our contracted provider, what the plan was specific or our coverage plan was to the specific member, whether they're in network or out of network, that type of thing. But if there's a specific provider that you have in question, I can look into that. Thank you.
Representative Julie Mayberry
Unverified
44:10
Seeing no other questions, thank you for being here today and appreciate you wanting to be here in person
to share your thoughts. Thank you. Okay. And then
the last thing, our schedule is a little bit shorter today, so you have a little bit more time. Stephanie Cook, the executive director
of Alzheimer's Arkansas, is going to join us with perhaps a little bit of a fun activity. I like to end meetings on a happy note with good things that are going on and ways that we can learn more. And she approached me last
month and said hey i'd like to share
this really cool thing i said okay
Speaker 148
44:53
let's do it thank you so much for the opportunity to uh present some uh additional
Speaker 149
44:58
fun information i hope you know we had an opportunity especially the last couple of months to talk um more about the the uh treatment of uh dementias but we continue at all simmers arkansas getting comments and questions about what can we do to prevent it and we're being asked to do more and more presentations and
having conversations with family members about what they can do and so I was sharing with representative Mayberry that there are a lot of programs in place here in Arkansas some of which you may know about and others you may not have heard it just depends on where you live in our state and if you have access to to maybe an active area agency on aging or work with UAMS or have senior centers and things like that that offer these, but I thought it might be helpful to at least to present some things that can be done for prevention. I am not a, I don't have a
medical background, so I just want to state that, but these are things that we
Speaker 148
46:04
suggest folks look into, to participate in for physical and mental health. So current research suggests that we've
Speaker 149
46:14
got a lot of control over our own brain health, and we may not be able to control the fact that we are aging or our genetics, but we can do things to reduce our own risk of developing dementia today. Some of the programs even help in the development of new neurons in the brain, and so
that's pretty exciting and I would like us to consider what we might do even today to improve our own vitality of life as well as a quality of our own lives. We know today that just activities of daily living affect our not only our physical health but our brain and and they can be positive or negative you know effects but these are some of the things that current research is showing
have a positive effect on the brain things like just general reduction of stress simple exercising and this is not to go and run a marathon but basically just movement general move vacuuming mopping push mowing your grass versus a riding lawnmower walking around the block. Receiving a good quality of rest. Eating well. Keeping our brains active. Keeping social networks intact. Staying positive. A positive mental attitude. Laughing. There is laughter yoga.
Has anyone heard of laughter yoga? Those are actual classes that you can participate in. showing gratitude, meditation and prayer, and then, of course, I know our friends from UMS have talked to us even in this group about managing chronic illnesses and getting control over things like our blood pressure and other chronic conditions. The National Institute on Aging recommends health screenings,
Speaker 148
48:14
managing chronic health problems, reviewing medications, and as
we've done with my mother, we do that quarterly. It's not something you just do at an annual visit but speak to your physicians more frequently and check
Speaker 149
48:28
your medications. Reducing risk for falls and other accidents, limiting the use of alcohol, limiting or quitting smoking and getting enough again quality rest. That's the key. So there are some different activities that I know we have available here in the state of Arkansas at various locations and with collaborative partners.
I just brought a short list of those. One is a brain fitness program called Super Noggin, and I've had the wonderful opportunity to collaborate with our Central Arkansas Area agency on aging care link to become a certified super noggin instructor and this particular program is suitable for any adult not diagnosed with cognitive decline so this is this is prevention
of cognitive decline it's evidence-based very comprehensive holistic and community-based and i'm going to tell you a little bit more about that in just a moment and then there's another program called Ageless Grace. That is another evidence-based seated exercise program that's done to music that stimulates the neuroplasticity in the brain along with laughter and exercise. And I don't know if you can actually see this on the slides, but Super Noggin, this is just a little
bit more detail about the particular class. It's a year-long commitment with weekly meetings, and those weekly meetings range from 13 to 18 weeks and then you attend a monthly meeting until that year is up. Classes are being formed or offered across the state now. I know I'm actually in my 11th week but there are new classes forming around the state right now and most of these are being offered through area agencies on aging, those partners. And so you might check
with people that work at your local area agency on aging. Some of these are at senior centers or senior wellness centers today. And even some health care providers will talk to you about Super Noggin. And what's fun about this, I told Representative Mayberry, we may want to do this as a group to kind of close out my session time today, but I have a
Speaker 148
50:59
group of 13 individuals that are over the age of 60 in my weekly class, and they're reminded
Speaker 149
51:05
on a daily basis to jot down
something that they're grateful for. They show gratitude on a daily basis, and you can't list the same thing twice. So for 365 days, they have to list something unique that they're grateful for. Eating well, they get points for eating so many fruits and veggies a day. They have exercises, brain exercises, things that they can, actually creating stories, writing stories,
reminiscing about their past and being very specific in those stories. So those are the things that they actually do on a daily or a monthly basis and come and share with a group about, but there's some laughter exercises and some real fun movements that you do. You get up and move around, and you think it's pretty corny, but there's not a single one of them that doesn't come in chuckling and smiling at the beginning of class, and at the end, if I forget to do one of our little laughter exercises, they're on me because it's something they look forward to.
And when, as the doctors know that are here in the room, when we're doing things like that that make us happy and that are uplifting and positive, we have hormonal changes in the body and in the brain that affect us in a very positive way. So it's pretty fun. And then Ageless Grace, again, are classes that are led by instructors that are certified, and again, in senior centers or wellness programs. And it's really, really fun. You can, there's specific movements to wonderful music and the last time I tried to do this in a
group of about 60 people, most of which were 70 and above, I was the one in the room winded. They worked me out pretty hard. If anyone's familiar with Drums Alive, this is something else that's a lot of fun. It's a program that fosters a healthy balance physically, mentally, emotionally and socially using rhythm to inspire physical movement uh with the brain effects of music so drums alive and typically you're on a large like yoga ball with drumsticks and you're
pounding on those to the beat or the rhythm of certain music uh which again is it's a physical emotional psychological uh balancing there and something that's very uplifting there's also a four-week program called a matter of balance that meets twice a week for a couple of hours and again this is an evidence-based program in regards to helping with fall prevention and reducing someone's fear of falling. And then silver sneakers is also pretty popular in some areas.
Interactive and fun classes are designed for seniors and led by support of instructors. They can be offered online or in fitness centers around the state and can be for beginners or those more experienced. And there's also something, I would be very curious to know how many of you all have heard of Dementia Friends, Dementia Friends Arkansas. This is some social interaction and communication techniques
that for those living with dementia, we learn more about. how to look for, watch for cues. This is a training that lasts about 45 minutes for individuals, and it's basically making us or giving us an opportunity to be more empathetic for those living with a form of dementia. And then it's also a great reminder, the class is, that folks that live with dementia are still people too.
They are inside that body just struggling with a disease like any other chronic illness. And we are reminded of what a normal part of aging is and is not, and what we might do to support, be more supportive of those folks living with dementia and their caregivers
Speaker 148
55:20
and their loved ones. And at the end of the program, participants may be given a certificate to illustrate that they are committed to being more dementia-friendly in Arkansas.
Our friends at UAMS, the Geriatric Education Collaborative, has the license for that program here, and Alzheimer's Arkansas is a collaborative partner, and so we are able to go out like our friends at UAMS and offer this class to individuals, groups, community groups, even businesses that serve the dementia population so these are some examples of where you can
learn more about the programs that i've listed and brought to your attention if you were unaware of their existence here in in the state but again you can go to the area agency on aging senior centers wellness centers uams centers on aging life quest check with the arkansas geriatric Education Collaborative, and then there are
Speaker 149
56:25
a lot of independently trained and certified instructors in each one of these. So I just
Speaker 148
56:31
wanted to just bring it to your attention that there were programs in place today that you and your loved ones can participate in to help improve
brain health. So I would like for you to join me in a fun little clapping exercise. This is how we end our weekly classes and it's simply uh standing up if if we can stand up that's part of the that's part of the fun of this and uh just clap your hands and it's very good very good yay but the key here is when you very good very you keep your hands flat so we have pressure points in our hands that stimulate all parts of our bodies if you're into acupuncture acupressure reflexology so it's
very important you keep your your hands flat and it's very good very good and then when you say yay you say yay with enthusiasm and we do this a couple of three
Speaker 155
57:24
times so join me very good very good yay and one more time very good very good yay and then I encourage you to look
Speaker 147
57:33
at your neighbor and laugh just look at the person beside you and laugh laugh thank you for the opportunity to be here you
Representative Julie Mayberry
Unverified
57:46
have to know my background is dance so anytime
i can add movement into something i'm happy it makes me happy so um thank you for sharing that information uh next on our agenda really is to um discuss when our
next meeting is and we've been doing this on the last week of the month on the monday or the tuesday um according to all of us up here uh november 27th or 28th at one o'clock that's the monday or the tuesday is there any uh
pressing issue that any of you have on those days that neither one would work or
Representative Julie Mayberry
Unverified
58:25
don't know about okay is that good with everybody okay um we're gonna
go for the 27th at one o'clock then um sounds great and i think at that time we are going to talk about some in-home care, caring for dementia patients in the home and some issues that are there, really struggling to find people to offer those services as well.
Agenda
A. Call to Order
B. Consideration to Approve the Minutes from the September 26, 2023 Meeting [Exhibit B]
C. Medicaid Personal Needs Allowance [Exhibit C] 1. Martha Deaver, Director, Arkansas Advocates for Nursing Home Residents 2. Veronica Tess Myers
D. Follow-Up to Alzheimer’s Medical Insurance Coverage - Jack Hopkins, Director, Government Relations, Centene Corporation
E. Overview of Super Noggin Program [Exhibit E] - Stephenie A. Cooke, Executive Director, Alzheimer’s Arkansas
F. Other Business
G. Adjournment
Documents
Speakers
Representative Julie Mayberry
Unverified
Martha Deaver
Unverified
Speaker 21
Speaker 22
Veronica Tess
Unverified
Representative Robin Lundstrum
Unverified
David Cook
Unverified
Speaker 42
Speaker 43
Speaker 44
Speaker 48
Senator Fredrick J. Love
Unverified
Speaker 62
Speaker 66
Speaker 57
Senator Clint Penzo
Unverified
Speaker 94
Representative Johnny Rye
Unverified
Speaker 98
Speaker 80
Speaker 11
Speaker 105
Speaker 107
Speaker 59
Speaker 109
Elizabeth Pittman
Unverified
Speaker 116
Senator Missy Irvin
Unverified
Speaker 126
Speaker 129
Speaker 133
Speaker 123
Speaker 137
Speaker 138
Speaker 141
Speaker 148
Speaker 149
Speaker 155
Speaker 147
Speaker 157