Public Health, Welfare and Labor Committee- House and Senate

And our kids be but I would like to point out some additional new information that we have gotten today. Am a lot of people interested parties have questioned. Are we closing kids wrong are we taking too many children off the roles so we've started our analysis on charn which is if we've disenrolled them for procedural reasons or any reason are they coming back to medicaid and so we have that initial analysis for jean jilon august and we will continue on as we go through this process and go back into regular operations. But so far we've had a total of fifty two hundred and six children come back to the roles. And that is a approximately three point nine one percent of all the children that have been disenrolled so we are trying to track that very carefully so them coming back they they've actually gotten their coverage reinstated or reinrolled. The. And when when the coverage is reinstated or reinrolled isn't is there a in their right time like a retroactive of coverage can you just speak to that we do have ninety day retroactive coverage for children and so if applicable or needed we will make that retro active for their eligibility okay I think that's important to know and then the next couple of pages talks about closures by age enclosures by gender. And then some um demographics on the next line and then a breakdown by county and I know i've kind of gone fairly quickly but i'll take questions. Okay and I think it's just important to know that we did have this and statute is that correct that you give us a report and update on the medicatory determination process we're complying with state statute by giving this report number one material I think it's also important to. Just a. Emphasis what the federal laws have never changed. As it relates to redetermination of maticate so if you'll just speak to that we have to follow in medicaid we have to follow cms rules so that is correct so when we make the statement that we're returning to back to the normal course of business so annual determinations are done annually for everyone in medicaid and during the time period of march of twenty till april first of twenty twenty three we were still working every month to do our and your case are work our case work and if they were likely to be disenrolled but we could not disenroll them due to the public health emergency we put them in an extended category and continue their service so as we began april first we could continue our work load but then we could actually at the end of the month or when it's appropriate when they've received their ten day notice they could be disenrolled from medicaid now so for the past five months in september is the six month in accordance with the statute that you all passed in twenty twenty one we have been working through are extended redeterminations plus our regular renewal determinations that happen every month so where we anticipate is made october november work load will be back to the normal course of business and we will be reporting on our normal business with redeterminations we will have worked through the extended categories and they will have either been disenrolled and their information sent to the marketplace for future coverage or they will have been enrolled in a different category of eligibility with medicaid and so is it fair to say that some of these people that were placed on that extended you know because extended category that we had actually looked at their redetermination at least once maybe even twice or three times we had determined that they no longer met the requirements for medicaid however due to the public health emergency we had to freeze and could not remove them. From the roles but we had done our due diligence we had complied with federal law or federal rules according to cms and we did are due diligence by continuing to do that as it did i'm sure every other state however if they may be night I have been proceeded but that then we did not remove them but we knew at that point they were not qualified to remain on medicaid that is correct so we during the pandemic we most of our staff didn't miss many days of work they continued working in the county officers and in the central office and working on their their cases and as cases were determined they would not have been eligible during the normal course of business but due to this requirement to keep them on the roles they removed to the extended category and we monitored them so potentially someone could have gone through read three redeterminations without being disenrolled until april first of twenty twenty three right. But yet we didn't just immediately we went back through them again we did and so so so they were a bit lengthy process we start ninety days out for most of our categories of eligibility sending notices in for a long term care we actually add thirty days and send notices to them at a hundred and twenty days to work through the requirements and to try to give ample time to either call or email or come or come to the office to complete that application right and so I just I am getting so very tired of reading things or hearing from people that it do not understand the facts of what we are too in so I think it's just really important to continue that representative ladyman. Uh okay you're recognized for question thank you madame chair. Well i'm getting very tired of that too chairman because I think people don't understand the what why were removing people and you see every week for every couple weeks at a removed thousands of people why are you doing this. But II do believe that we did a better job in arkansas most states I think we. Probably were ahead of all states to begin with because of the work that yawded. And in this committee monitor what you were doing six months before you actually could start looking at these removing folks that were not eligible so I think you are there to great job on that. But when we budgeted it last session we did not know the how many we're going to be removed where it was a gas I think was a pretty good yes but that's really my question because the budget was set up we were going to we made it withdraw money from the reserve we didn't know there were a lot of question marks so my question is are we hitting the numbers that we. Projected how does that compare to what we thought we would were we thought we would be yes or so first i'd like to say the team did a great job but with and mary franklin as the director of county operations a tremendous job getting us ready and exercising and going through this process of redetermination in addition to finance and on our budget we have been very cautious about making a public statement about what we predict what happened to the budget because we didn't know the national averages were anywhere from fifteen to thirty percent of our roles would change and so we have begun the detailed work of what did we put into a op in the budget next year versus what is truly happening and that's why this data that we got today on the beginning of the charn is so important because I do think while we are below prepain damage numbers for the first time we we could see some children and others come back in the fall in we think that we will see a solid baseline by december so we are working on those budget details i'm i'm cautious to give numbers because once I put them out there then if they if they do change naturally it's always you know what happened what occurred into finance is working on that i'm diligently because I asked a lot of questions this morning so by the end of october we should have some better numbers we should have some solid eligibility numbers the end of october into november and we've already started taking the new enrollment numbers and applying some some details to those for the budget so it we're not waiting for final eligibility numbers to work on the budget we're working on it now that we're we're fine tuning it every time the numbers get updated thank you. Yeah. Representative of poking. Thank you over here thank you i'm over on the side he insurance so it's a double way for yeah I noticed that they're fifty one thousand more women than man who are the percentage of closure not percentage but total of closures can you can't talk to a little bit why are we seeing a higher number with females as poster mails. We will have to ask the staff at at I mean we put the numbers together and we're still diving into what's making all of them up but I don't have an answer for you to david you help me do that okay it seems like the ages are pretty normal for a normal distribution and I just I was curious it just seems like there's a little uptick there so just I would be curious to see if we have any thoughts of theories about that so age and gender. Okay senator boy to recognize. They came out of chair on this man i've got that kind of a statement than a question so then my role is state senator like is the state representative the past a lot of times with every determinations or other hiccups with the system and paper constituents would reach out and say hey I got kicked off can I get can you help me get back on i've read a lot in the news about this issue this redetermination about how many people are being removed and in my office as a senator act have not had a single constituent reach out to me so here in a minute i'll ask have you had other representatives or senators who have had an issue because I don't know if i'm just in a unique area then secondly as you matter might not know in my other job as a pharmacist as a health care provider every patient that i've seen that was a potential person affected by their seemed a no I have yet to have one who seemed to be surprised so the second question would be do you have other health care providers who are reaching out to you that maybe seem to have a different experience like people don't seem to know so if you could answer that i'd appreciate it certainly so i'll start with the first one we have not done this without making mistakes II would I would be remissing saying that we did it perfectly as we have those have been brought to our attention through the legislature or through constituent calls or through providers we have worked with each one of those to find you know what did we do wrong how can we correct it is you know hopefully it's not a systemic issue and so we have worked those case by case and so we have gotten phone calls from other legislators and other concerned i'm citizens that have asked you know what happened to my coverage so we've worked through those and at one say constituent office has kept track of those to make sure that we have addressed all of those and not left. Let those linger and then the second question whether or not other providers have reached out and i'm I am glad to hear that you're beneficiaries of your clients are aware of that when they came to get their prescriptions we spent over a year planning and doing outreach and trying to work with any in every in you know provider group beneficiary advocacy group has been in the beginning of the unwind was having weekly calls that were open to all providers that could call in and talk about if they were seeing anything or had questioned I think we moved that down to every other week in july and so and I think people have still been zooming in we've do that meeting mazim so that people can participate and so we are continuing to do that uhm. We did have one or two provider groups call and ask his questions we went met with them again and provided information and we've answered questions about outreach so we've tried to be as forthcoming but is getting the information out there as quickly as possible to said so we we have had providers who have come to us whether issues and we've been working through those as we get them assessing whether it's a systemic issue or whether it's just human air and we we have been working through there was but providers have been really helpful and getting as information we needed to figure that out. What of course I mean if you've been on medicaid you know that you have to be redetermined every year so it should be a surprise to nobody that's been on medicaid because they know they have to go through redetermination every year because circumstances in their lives change and medicators based on very specific criteria including encounter providers hospitals anybody in health care who has patience and medicators their payout then they are going to assist them in making sure they turn in their paperwork to get redetermined so they can get paid for the services that they're rendering to the patient this does not rocket science and really really tired of them of the literally just fabrication. Of lies that are being out in the public and repeated time and time and time again. There are opportunities where we do not do a good job I fully admit I don't I do that as well the yob done and outstanding job and i'm really really just. Saying this very emphatically am tired of it because this is not you know something new this is something that we've always done and so I just applied to you and your team take that message back at least from me as you know the questions I do think it's important to track the turn because that again is I think it's a fabrication of just trying to throw a just trying to throw some mad at the wall and see if it's sticking. That's exactly what's going on so appreciate the work on that and we'll just continue to march on the path and thank you for giving us those numbers thank you thank you as we are going to move to the next item on the agenda. And I know we have a lot of folks on this I will say that I made a motion in legislative council peer subcommittee to hear this issue before us. Um. For the purpose of input from members who were asking lots of different questions about the financial finances that is at regards to senior citizens centers and so. Also alc peer subcommittee will be wanting a recommendation from us before moving forward with any federal funding as a relates to this next item so members as you are can we through this listening to the testimony please be engaged and understand that at the end of this we will have a recommendation to submit to alc peer for the next meeting which could or could not be at the end of this week okay if you are all. Yeah I want to come up to the table. If there's not enough chairs that's fine not everybody has to come. But I do think it's important that we have. Okay and members they do have a hand out that I have approved has been sent to you. I feel just state your names for the record and then we can proceed the afternoon jay here with division of edging and not behavior health with human services jason classie daba. Brad daily executive director area on aging and president of the association agencies on eighteenth present time. Are if you can give me an update as to where we are and based on your request and then i'll turn it over to members for questions thank you madame chair so the arpa request that was before you for expansion of work for services that was core a little over six hundred thousand dollars total up it varies between accc it was despised based on the interstate funding formula that we use for the older americans act the awards between the triple a's range from one hundred and thirty one thousand down to fifty six thousand dollars and in working with the agency's mister bailey can elaborate on this little further and he also has a power point to cannot. Just talk a little bit about what the area agencies do and to help everyone with them just understanding as how they utilize their dollars the agencies are requesting we have confirmed this there AC l three administration for community living to utilize the fines to both bring on new contractors or expand the hours of existing staff to deliver additional home delivered meals so it will go for nutritional services. And there was a letter provided to to be alarmably that maybe dispersed to you all from the agencies to. Give you their. Their confirmation that that is how they intend to utilize these dollars. Okay thank you. Mr bailey. You want to go ahead and percent. This is e two members accepted to all right thank you for the opportunity to present today i'm hoping that I can clear up some. Make everybody aware of what aa's actually do the last were originally established in arkansas particular was in nineteen seventy nine the older americans act that authorized. Area agencies on agent goes all the way back to nineteen sixty five so part a lot of our efforts are to assess commuting needs and develop programs to respond to those needs. Educate we help people with medicare part day all the time medicaid of just helping the elderly access services they that they need. Reporters to carry assessments will be referred and other care providers would it be personal care if my needs referred to an independent living assisted living nursing homes were involved in all that and referred and help our clients get eligible for that we tried to maximize use of public and private phones to serve as many consumers as possible I a lot of these federal dollars have matched requirements on there in my area i'm not going to speak for everybody but my area I can't speak to everybody is required to match at least fifteen percent of those federal dollars with local dollars. Now a lot of times that's when you're hearing fish fries dances on friday nights those kind of things that's part of it but then we're also approaching county governments approaching united ways cities we get help with cities. And I will tell you that that is more difficult and rural counties so but we do try to bring more money into the program and spend it on those meals and we also develop and phone and coordinate a wide range of services. Our core services then this is why each way you can be confident that each is doing these core services. And those services are nutrition which is the congregate male setting which is taken a bit you know through the pandemic trying to get her numbers back up on that but during the pandemic we had. The we were given the leeway to do kerbsi pickups to where we just handed a meal through the window of those folks and they were able to go on and we less than their chance for exposure so that did get more people used to that and people got more use to the condolence male sell the home delivered meal program has grown through this pandemic so support services from dedicated information the system phone lines care coordination I kind of hit on that a while ago that is where we have staff that go out and help people apply for apply for a medicaid applier for food sam supply out for farmers market coupons different programs I will say that you know some of our rule counties have a hard time serving all the people that want home delivered males but we do try to find other ways who food banks. Referring for food samps and you know my agency we have fine set aside that they can apply for to help them in emergency situations if a burnout or something like that you know we're just can't afford food we have a program through our foundation where we raise money to help health and wellness that is exercised classes and side chat to the senior centers of course that you know that declined a lot of people got out of the habit of exercise and during the pandemic because you couldn't go can be around people so that hurt our programs there elder writes that's the ombudsman program and that's a lot I never had heard the word ombudsman until I started working at the area agency and agent with that is an independent advocate that goes in to the nursing hound and they're independent and I hear about sides and try to work through those problems with residents so that is that. And if you all have questions that i'm going through here feel free to start me like. The snack slide we're gonna let you go ahead and present and then we'll reserve our questions for at the end yes. Additional services this is where you're going to get into an area we're not every trip a is a saying. Older workers that's a state program we provide people that are income eligible fifty five older job experience to help get him back into the work force for whatever reason they've been out of the work force. We do in home care which is our personal care program. The tendent care a lot of the triple aids or medicaid providers. Transportation through the years of the non emergency medical transportation program we've had triple aids that have been involved in that in some still have contracts to provide transportations to different hospitals and touch. Case management that's the program to help people with the different benefit programs. Senior companion. That's more available support that's not a program that i'm just real familiar with senior companion some of our agencies do that personal emergency response systems. Let's say we do that private pay and for medicaid but those it is not the company that we use but everybody seen the button that they pursue help me a falling I can't get up it's that which that kind of computer technology that we're using for that. Hospitals we have some hospital providers we have assisted livings in the state that are operated by agencies on aging and senior housing and most of those are heard senior housing programs it's independent but it's it's based on income so we've got several of those throughout the state. Okay this slide here kind of tells you how the funding comes and. Or where are funding what's the big categories of our funding are so as you say are in home care program and this is throughout the whole stay but about seventy two percent of the income coming in to triple aa's is from different in home programs. The senior center services program is about ten point one percent older workers three point four. Are support staff four point seven senior housing insisted living three point six. Care coordination three point nine. So a lot of work what we're tasks to do under the old americans act is to reach out and expand services so that's why you see into all these other other programs. And a lot of times are. Senior service program actually benefits from arian home program. Through the years in northwest arkansas we've actually taken out loans to build senior centers. And so and we search out grants to be able to build senior centers. When we can. The. So and. Under the older americans act were charged with over seeing there so when we have subcontractors it's the early agencies on aging responsibility to monitor them we issue the finding based on their expenditures the mails that they're providing they provide an audit provider in audit and then mr hills group looks at our area plans each year and I approve how we're going to be spending the money as well. These are funding sources the older americans act. Other federal grants and believe that social services block grant falls under that other state funding contracts and fee for service. Most of us that are doing the medicaid program have also contracted with the past organizations that have been. Formed in the state of arkansas we also contract with the veterans administration to provide in home care to seniors. We are five oh one c three so we've often times. We solicit fines and you know provide two or downers the the necessary documentation that they need to be able to do that for. For their income taxes or or whatever. And private pay services we have individuals that don't have an outside payment source that they need somebody to come in and care for their parents or. Nelson light assistance to help them or they need a respect you know it it's it's tough business being a caregiver it wears people down a lot of pounds they need that break so are we do have people that private pay for that as well. This is just kind of showing you how our funding is going. A lot of times are. Are subcontractors I mean they know that they're not getting as much money some years as others. Some of that is completely out of the state's control for years in years we've been the beneficiary of cigarette taxes. And. I think with cigarette tax was implemented to discourage folks from smoking and it's working so that that is a declining revenue stream force. So as you're looking. Physical year twenty twenty thirty three million two hundred and eighty five thousand for their about compared to physical year twenty twenty four projected. Thirty one million one hundred and sixty three thousand fifty four dollars. During that time we've had increases in labor costs we've had increases in food cast without increases in fuel and much like public schools. Right now it's hard to get insurance on some of the size roofs that we have out there in these communities. Just all the different wand and hail claims and all that stuff. That affects us as well so are costs are going out. All right one time finding which is. Kind of what we're talking about today you can see in physical year twenty the federal funds started coming in that year two million two hundred and eight thousand. Physical year twenty twenty one million three hundred and eighty thousand seventy dollars the cares act the eighty five htc five act expanding covered vaccines we were fortunate to get some finding from the state that you're the cold and steering find. So and as you as you look at that that is a lot of money coming in one year but the federal funding unlike state funding is we have a longer period and that sunshine period on that funding being. Being eligible to spend it is approaching in september of twenty twenty four. The american in physical year twenty twenty two the physical american rescue plan gore bag on acronyms where I work our pa is what we call that and that's to benefit. Are caregivers particular personal carraids nurses and folks like that so it's retention and recruitment money for that and that money was spread out not only among also to all in home providers in state. The. Yeah. Just kind of give me an idea. A lot. We've got a senior center side of our business and then also under the older americans act. There's required support of services under that as well that comes through the. Through the federal government and also through the state government. So are. We are allowed to charge administrative cost on that up to ten percent. And based on our on the analysis of the funding that mister hill provided to us were right around nine point one percent on both the senior center of able phones and also in the required support of service. So the senior center finds i've got to hit on it already nutrition transportation socialize. Socialization. Fitness and wireless. And the other services that a lot of times is going out directly into people's homes. This care coordination. Family caregiver support providing people information and assistance evidence based health promotion ombudsman legal services and client representation. Okay the older american act has strict guidelines regarding the use of the fines the match requirements. Fifteen percent. On the federal phones and often times that's not enough to operate some of those programs so you have to go outside and fund there is limited transfer authorities under those funding so the majority of older americans act funds cannot be transferred from the original purpose of funding even if other services are in need of those funds so. A specific find distribution. The state distributes older americans act fines based on a funding formula. And the ombudsman program ill american requires the old americans act requires maintenance of effort based on expenditures by benchmarked. In a federal physical year. So that. So on that they might just be looking at my twenty fifteen they look at what we spend on the ombudsman program and that that you can't go down below there. All right this is the current funding formula that we are operating under this finding formula changed in physical federal physical year or state physical year of twenty eighteen twenty ninth so the way the fine to go out right now to the triple eyes in the state of arkansas is right off the top one percent is taken off. I work at the area agency on aging for twenty four years and the reason that this is done is this one percent is taken off and then distributed out to each a and it's designed to take a little bit. Off of the urban bars's rule it helps sells rule counties get a larger portion of the money. And then after that eight percent is taken off the ninety two percent is based. I'm. Sixty twenty five percent goes out on sixty plus low income thirty five percent goes out on sixty plus district people over sixty five percent goes out on seventy five plus fifteen percent goes out on the on the rule and sixty. Twenty percent goes out on sixty plus low income minority. When this was changed to put more emphasis on on the rule and a low income a prior to this the finding went out fifty percent on sixty plus. Forty percent on low income and ten percent on low income minority so you could see that there was some emphasis put on the rule counties when this change was made. So you know how many senior centers you're dealing with throughout the state and these are senior centers that are read savings state and federal fines and they're under our aspects and they're agreeing to adhere to the one third are meet those match requirements meet the spending requirements on those federal funds so there's are a hundred and forty five. Different senior centers in the state of arkansas. That are receiving over americans act funds. Thirty two different contract providers. It is something that I have noticed through the time that i've been here that there are less and less contractors willing to take on take on this program so when that happens the the as a lot of times do direct services and even though we're doing direct services were still following the guidelines of the program. The. Senior center support we help them. With. Throughout the state most I think everybody is using an electronic basis. Well sky is what we use and people swap the card when they're coming because we have to keep up with every single one of those meals when they're sorry keep up with that person's income keep up with their how they identify keep up with her income sex all the hole at so it's not like operating a restaurant there's a lot of data that you have to collect and report that to dhs and the dhess and turn reports to the federal government so there's a lot of oversight on how these funds are spent. Each year each submits an area plan. Two the division of aging an adult behavioral services which outlines how we're going to contract. Ah the administrative fees it'll come off of each of those funding sources. And just the senior centers that are provided in all the different services that we are going to do and das signs off on that before dispersing any money to us. This. So challenges that were facing. As agencies on aging and people trying to feed seniors in arkansas over twelve thousand people a day. Current sixty five in the us we've got declining revenue streams I kind of hit on that a while ago pay our choices meal reimbursement rights or the same as what they've been for a long time the governor staff right now is looking into they're looking at all stuff medicaid right now so hopefully that will get some light signed on it of costly labor market insurance expert says food inflation for your cars about everything that any business in the state of arkansas experience who right now except for medicator reimbursement so. Um. The. So it's challenge. To keep matching to keep up with the increase in costs. And we just want to you may not be able to partner with us or whatever but I just want I just want everybody every elected official if they have trouble with the constitutional please reach out to us so that we can help that person. You know we may not be able to get an eligible from medicaid but we may be we will find another program that will help him with their immediate need so we want to be an asset. To our elected officials. To the department and just be a good team player on trying to help seniors in arkansas. Thank you I appreciate that I have a couple of questions. Uh we have represent of allen. Recognized for question thank you madame chair I want to sincerely let you all know that I appreciate what you all are doing I have called on you although it's occasional some market status in my district that need it your services and you all they had a very good job of responding so I appreciate that what I have a question to hamp on a annual basis how many meals do you all serve a year approximately. We're projecting this year between the home delivered meal program. And and the congregate meal setting three million two hundred ninety six thousand seventy four million. Yes I know around the same way I can sell and some points about state especially in rural areas we have what you call food deserts so in areas where they are food basis do you all have a big process there. There are senior centers and every county in the state of arkansas have a presence in every county as well. Sometimes it's tough. You know it is when some I live sixty miles away from a grocery store sometimes it's hard to be able to transport them as often as they want to go but we try to work through the situations and get him to where they can get their food. Again thank you all for what you do. Thank you represent a fight you're recognized thank you madam chair i'm right here. First i'd like to talk about the letter for just a second the money as this was one of the questions that we had there and alc this is one time money and we're hiring people with this money are paying them with this money what happens when this money is going how are we going to pay these people that we've. I had taken on you know hard is a be support or help or whatever they might be doing where will the money come from. They're six hundred and twenty eight thousand dollars that does that make sense what i'm trying to ask you our plan has been we know what's one time money. And so when you see increasing hours. Much like the arpa money were able to pay in home more right now it'll be the same with this program will we can increase their hours to help you out or meals okay but do these people that were hiring no this is one time money and. If we're going to keep them on staff where all the money come from them. I can honestly say we've not notified them yet because we don't know if we're gonna get the money and if it's going to be eligible for the planet that we're proposing. The. Can I have a follow up my am yes thank you. And I want to go to your power point it looks like it's a page for it tales about the federal funds the state finds it says a and state senior services at the top. One of the questions that i've had for. Several several years is how much money we're spending on administration so how much this money that we get every year goes to admin. Do you know nine point two percent nine point two percent. Some of those fines and that's what that's across all those fines the nutritional services incentive program. You can't politely admit off that you can't pull out moving off health and well this morning so when you were allowed we say it generally we can charge up to ten percent on federal fines but with all these others thrown in there that you cannot pull admin fees on it pulls it down and nine point two percent I can get back in the queue if there's other questions ma'am and okay the nine point two percent is that is that based on this bottom number that i'm seeing the thirty three reference thirty four million so nine point two percent of the thirty four million over eight days. That right is add the math i'm looking at yes and I will say has an independent audit on what they're looking at and legislative audit comes in from time to time to look to see if we're charging appropriate administrative fees and then the division signs off on our area plan each year on what we plan to charge as administrative fees okay and then I think you know one of the concerns I think that was brought up during the peer subcommittee meeting was you know where we hear a lot of times whether cutting the meals back to cut the mills back you know we hear from senior center citizens from our areas that uh will yall or cutting or funding meaning me this legislative branch of government. And so I think that's the level of frustration that me and my colleagues find herself in when we get phone calls from seeing your citizens or people that attend the senior centers senior centers. You know and they come away with some information somehow some way though you know the legislature's cutting their funding could you respond to that we try to provide information to home and it was like what I was trying to explain earlier through no fault of your own the cigarette tax revenue has gone down through the years there's no way. The legislature can control that but we tell our subcontractors. Why things are happening where the funds have been cut hopefully they tell their senior senator directors but and then when i. Sometimes. It's hard to explain all these different funding sources. And why it might be less. But. My is not putting out their hell sometimes the finding goes down and want to get its down to the participant level. They voice their concerns we try to explain it's not your legislator's fault and if you want to refer those folks to me I will try to explain why there is less funding available do you do you buy a chance to have any kind of like. Annual or a semi annual meeting with your senior center directors to explain funding and those kinds of things I mean seen people check their heads on the bags but. Do you have do you have those kinds of meetings where you can you can have those meet update them to say this is actually what's happening. And describe I mean II appreciate that you've delineated the one time funding out in your power point and because that was a bit concerned we sold as money flowing here from the the cares actor from arpa and the big fear was if you become so dependent on that then it's gonna wrap it up the pressure per state general revenue to fill that gap when that gap when when that gap is created because the loss of others federal funds that's the biggest concern that we have is is that number one but also. You know making sure that the funds get to the people that that need need the assistance the most I mean that's that's what I hear repeatedly from my colleagues and legislature I think it is important to highlight the fact that the senior centers that that that fundraising mechanism is part of the requirement of the federal find and and so I mean again and I think. Needs to be stress you are fun raising because it is a requirement free to fundraise not because the state legislature has cut your funding so because you know how I mean I have personally heard that before. So I mean what happened to us is we basically had to shut her the doors at all a senior center so there there not was no fundraising for two and a half years and there's a lot of there is a lot of turnover in those senior center direct yeah I know because there's some that have never been exposed to the need the fundraisers as much as what they want to understand that but if you receive into nine point two percent admin administration fee then I think as part of your administration of the senior centers I think it's very imperative for you despite of turnover we have to deal with turnover all the time and state government or in our personal businesses it's important to that be effective and communicating that with your senior centers and your directors even turn over understand that but that needs to be part of your administrative plan I think an important for that speed clearly communicated and nf and if we are if we are reducing state general revenue that absolutely that's that's on this body because that's a decision that we have made but as you have stated we have no control over a tat at funding that is that it's tied to attacks with we you know we can't we can't go out there and make people buy cigarettes not not what we want to do right so we don't want to do that but but every I think it's it's very important for you to have those discussions because I just being candid with you that that is what I hear the frustration from my colleagues is repeatedly uhm with that I have reps of ladyman you recognized thank you madame chairman I had a question on the senior housing you talked about your provide some senior housing or do you operate scene. Have my agency their heart their hard properties and we apply for a to build and so each one of them is a five or one two three this audited on its own but it's a. Most cover sixty plus and is based on their income so it is independent living okay so you show growth here in sixty five plus one one chart in so if there's a shortage of senior housing. How do you or who identifies or do you all do it how do you identify where these out this extra housing is needed where there's a shortage do you provide that or do you provide contacts. You know in some areas like northwest northeast arkansas a lot of growth in population so when a population rose the senior population rose. So with the senior housing availability doesn't grow then we got a shortage. Yeah we can we've not built any new ones in a long time it sub basically like the maps they showed on the medicaid eligibility people people be in this enrolled that's where there's a shortage between white and so I asked him john's borrow glasgy those higher metropolitan areas it's it's a problem there are other programs were not. We used to manage a tax credit property and that's a program through the federal government that investors can actually invest in these housing programs and receive a tax credit from that so okay for an area agency on ageing that work in contact example so that's not a not something that we could advise people on how to contact the right people to go about the plastic. Okay thank you. This month yeah i'm not sorry yeah I had a couple of questions myself and and some of these questions i'm happy to get. Set to me as they don't you don't necessarily have to answer them today a couple of months. Are probably pretty easy to answer just things that I don't understand and i'll try to get through them just bad the pages the pothood unemploying are kansas this is twenty three sixty our kansas that partard is that's the distribution of how the people are employed is that i'm just make sure I understand that graph correctly so you employee seventy one percent of the twenty three sixty or employed in in health care services yeah those the two thousand three hundred and sixty hours supposed to hit on that and I missed it but two thousand three hundred and sixty people are employed by area agencies on aging. In the state of arkansas. And of those two thousand three hundred and sixty these are the percent percentages of where the so that is anything to do with revenue or services provider that's employees I mean this understood that when you were going through there's every chance in the world that i'm sure you did find it was a long presentation on the next page so this this looks to me this graph where it says area agency on aging funding sources. Yeah that's the one so I get okay. You get the older americans act finding which if you flip to the next page that's the federal finds correct yeah and then you get other state finding i'm assuming that's the state there's there's no other state funding it's just the state finds correct correct so there's some voluntary donations that people can income tax check off okay and the license plates yeah that's that's part of it so so from it would be interesting to me to see from our standpoint of funding. You're there there are these other funding revenue sources it looks like contract fees for service fundraising private pay services other federal grants. I'd be curious you know what percent of your finding is i'm assuming the the bass majority the president of finding its federal and state fines not. Contract fees for i'm getting a lot of headshakes in the back so I it is interesting me like what would be interesting me to know is how self sufficient through contract services are some of these nonprofit. Areas it may be even broken out our region so if it I guess we're masking is or some of the areas more depending on state funding and then others yes okay and so like that would be an interesting information to have so if I could I don't know if you may ask the communities interest and that I certainly interested in having sort of a breakdown bar region you know hamp is region four yet what percentage of their revenue is from state and federal phone combined versus. Fundraising or fees from contractual services are because if there's if there are some. Regions. There are more self sufficient that maybe because or that are less reliant on federal statements that maybe because of just the population the demographic of that or it may be that they are doing something different or better or have a different plan than the other areas or region so anyway to me that would be good information to have as far as looking at opportunities for a premium would be breaking down what are the revenue sources and then breaking it down by region is that something that jacket provide the committee or provide me okay I can't try to go just listen and i'll just look behind you when they're not in i'll tell you it's okay s l t it's a problem the other thing i'm sorry interrupting but I counted our funding sources a while ago on my audit and my agency has twenty two different funding sources. Whether it be housing private pay ssbg so when it tax title see warranty two three b there's there's a lot of different funding source it looks like that can be represented in just a part right apart art here's their part here's where the procedure of our funding is and I would i'm like a my expectation would be that most regions would be pretty similar in their patch or distribution if they're not i'd have questions as to why that is the other to ask another couple questions one second and my my staff is telling me that state agencies and the senate has adjourned in the senate will be back in session within fifteen minutes upon a german. So we need a wrapped us app and some going back to you I can get with other people at the curious to about state funds on the next page if dear face here I don't need you to come to the table but I would be interested in a breakdown of you know you keep we keep mention the cigarette tax is that the only source of revenue from state finds or do you get state funds from other. No no representative so I would be curious like if the state of the if the if the cigarette taxes declining where the other revenue sources from the state is a general revenue is alcohol from general revenue or do you know there there's a bland of revenue represent johnson if you look at exhibit eight three of your packet it's got a breakdown of the federal phones the state phones and then the other state revenues which is where is this the english interest we trust finding we can at the division to assist we can break down the funding levels by the eight regions. And export that to you I would I would like to see that I would I think that would be helpful. Just as a side note we could always raise the cigarette taxi. They could change finding those right so it's always always a common thing for me to play for whenever I did the chance i'm gonna reserve any other questions I have i'm happy to circle back around to you or the people with the area to see on aging III think it's a I mean I i'm curious about the regions how they're divided up how long have there been these eight regions this way is that something that's under our control is their up to look at changing the regions this formula that you talked about this interstate formula I don't understand that right now and I don't know if that's something that should be flesh out better but i'll get with some people offline individually lucky free all the since it's about to and we can just talk later this part. All right are there any other questions from the members of the committee okay seen nine do I have a recommendation. From this committee to allow. To allow the department of a finance to me forward with the arpa request. So moved and is there a second second those and they were say I and opposed I have it thank you for all being here now we didn't hear from all of you today but you were you were helpful of course to represent johnson when you are shaking your hands one way or the other now III do just want to say it it is a serious issue we all deeply care about our senior citizens that's why we're here today that's why we had this very thoughtful discussion and dial up I thought it was very worthwhile we are concerned about one time phones we do want this this federal funding to proceed however we just want more clear communication I think with the senior directors as so where they're funding how that are that occurs thank you so much for being here all right members moving on we're going to quickly get to the last items of our agenda. And i'm going to turn the tear probably over to represent the answer. It looks like we have a few rules to review the next step is adam f d h DHS was pitment here. Yeah if you come to the table identify yourself I just explain the rules that we're going to review today and if there's any questions we'll let you know good afternoon i'll be brief and elsewhere with pitment with direct the division of medical services metros chief staff in the house thank you we have a rule today for review and it's a mandate from the centers for medical services our federal partner to cover a services incident to clinical trials so when a client or a medicaid beneficiary receives clinical trials as part of a pharmacy clinical trial we cover their services internet to that under this and that's what this will does and it is a clarification of current policy. Happy to take any questions members are there any questions seeing now and we mark this as reviewed thank you so much for your time without objection. Next step was seasonal from department's health yes machine. She can do the table and understand yourself and you'll be recognized which I did for yourself to present. You're all. Thank you mr chair members of the committee i'm larassu and i'm general council for the department of health. Crick smith attorney for the department of health. Our rule to present today is our rules for declaratory orders this is a new role that it is mandated by arkansas code twenty fifteen two oh six two outline a process for allowing members of the public to ask questions and resolve customs or doubts about how a statute of role may apply to their particular situation uh not for general policy comments and without have to answer any questions. Many questions from canada members. Without objects who mark this rules read thank you thank you members I see no other business is anyone have any other business to bring for the committee before we adjourn. Seeing no meeting adjourned.