Public Health Welfare and Labor Committee - Senate and House
Video
Transcript
10 documents
Machine transcript
May contain errors. Verify important quotations against the official video.
About transcript accuracy
- Source
- Whisper
- Model
- ggml-large-v3-turbo.bin
- Processing date
- October 2, 2026
Representative Jeff Wardlaw
Unverified
0:00
by grabbing your seat. We'll get started here in just a second. We've got about one minute. If you would, please stand.
Representative Fred Allen is going to lead us in prayer. amen thank you representative allen
so with that i need a motion to adopt the minutes from september 1st i got a motion i got a second all those in favor say aye all opposed eyes have it with that members um item c was added to the agenda uh later this week or earlier this week uh if we
would we'll go ahead and recognize uh andy davis brian jones and brandon robertson to talk about the uams hospital agreements they've been forming around the state and while they're getting
their way to the table and take care of
some housekeeping without objection i'm gonna move item e on the agenda to the end i feel like these rules are going to be pretty much non-controversial and there's no reason for those agency guys to have to sit around through all the testimony so if you guys are okay with that i'm gonna move e to the very end of the agenda so without objection that is uh
Chair (Representative Jeff Wardlaw)
Unverified
2:12
done so you guys are introduce yourself and you're recognized to present all
Senator Matt McKee
Unverified
2:16
right thank you Mr. Chairman, thank you committee. I'm Andy Davis with UAMS, Vice Chancellor of External Affairs.
Speaker 17
2:23
Thank you, Mr. Chairman. I am Brandon Robinson, Chief Legal Counsel at UAMS. Thank you, Mr. Chairman.
Speaker 18
2:29
I'm Dr. Brian Jones. I'm Vice Chancellor for Regional Campuses and Assistant Professor of Health Policy and Management
Senator Matt McKee
Unverified
2:37
at UAMS. Mr. Chairman, committee, we were asked to come and talk about some of the hospital agreements that UAMS has announced recently, specifically the agreements that are called we call them co-management agreements and we've entered into these agreements with three rural hospitals now one in mina one in helena and now
one in warren at the bradley county medical center there and these co-management agreements are really pretty simple contracts they essentially just formalize a relationship between uams and these these other hospitals, and provide a mechanism for us to be of a service to them in consulting and advising on things from finance to compliance to revenue cycle, clinical operations as well. But they're non-binding to either party. We are not purchasing anything. The employees and assets
of the local hospitals stay with the local entities. They're really just a formal arrangement to kind of formalize a way for us to work together. And I also want to clarify, because we have a couple other announcements recently you may have heard about, these three are different from the arrangement we have with Jefferson Regional Medical Center in Pine Bluff and the hospital we opened yesterday in Bryant. Those are very different arrangements than the co-management agreements
Speaker 15
3:59
we talked about with Helena, Mina, and Warren. Mr. Chairman, we'd be happy to answer any questions.
Representative Jeff Wardlaw
Unverified
4:05
I think the first question I've got is walk us through the difference between Jefferson and Bryant and the
Chair (Representative Jeff Wardlaw)
Unverified
4:11
other three agreements and what it looks like for
Speaker 17
4:17
Jefferson on a long-term basis. Yeah, you want to explain that? Mr. Chairman, yes, the agreement with Jefferson is set up differently, completely, while UAMS has an ownership interest now and actually wholly owns the entities in JRMC and we just opened up the new hospital in Bryant. Those are part of UAMS now through various legal ways.
These management agreements are just, as Andy said, these are just advisory agreements providing consulting services. Chancellor Barnes, it's important to him to try to help out our rural hospitals, and so these are simply an avenue for us to further our mission and provide help and services to these rural hospitals. So, you must be a lawyer akin to
Representative Jeff Wardlaw
Unverified
5:00
one because you did a really good job of a lawyer in the hell out of that.
Walk me through the Jefferson Agreement. What does it mean now that you say legally or part legally we own part of that or we're running part of that? What does that mean long term for Jefferson Hospital? Are you taking on some of the debt? Are you filling in the cash gaps? We all know Jefferson's been losing millions of dollars on an annual basis. How does this work? Is EPIC being entered in there off of y'all's system? Walk us through completely what it means for Jefferson.
Please don't go back through the legal mumbo-jumbo. Tell me straight
Speaker 17
5:43
up what's the difference. I'm happy to do that, Mr. Chairman. The UAMS is now the sole member of the Jefferson Hospital Association, which is the entity that owns that. So we are committed to, just like our main campus, we will be looking at all avenues to improve that since we now own it. The goal is to get them on EPIC. That has no commitment. It's been made just yet financially. We're working through that.
Representative Jeff Wardlaw
Unverified
6:10
Okay. Any other questions from committee? Representative Ladyman. Thank
Representative Jack Ladyman
Unverified
6:15
you, Mr. Chairman. I think this would be for Dr. Jones. So you seem to be
the regional person sitting out there. So how will this agreement with these three rural hospitals, I know the goal is to help them and hopefully help them stay open and provide better service to the region, but how will this do that? I mean, I know you've got resources that they don't have,
but can you kind of flesh in, how will
Speaker 32
6:46
this do that? Yeah, that's a great question. I've been involved pretty heavily with the Helena Hospital situation, and so there are a lot of things that these hospitals need subject matter experts on in regards to maybe their facilities, in regards to compliance, in regards to budget prioritization, all those kinds of things. And so instead of paying a consultant to come in, which they don't have, to do those kinds of things, part of their agreement with UAMS is we provide that support.
Let me give you a real concrete example. So the Helena Hospital Finance Committee met on Tuesday, and so I was involved with that. We have a subject matter expert from UAMS who sits in on those finance committee meetings and is helping them with working through some of their budget and helping them prioritize some of their goals. We've vetted some vendors for them, helped vet some vendors for them, and then they came to the finance committee. for the finance committee of the hospital to approve whatever direction they decide to go in.
So it's been a very synergistic relationship with the hospital and with UAMS. I think
Representative Jack Ladyman
Unverified
7:57
that's a really good point. So you're not just providing medical skills, you're providing other sources. I think that needs to be really made public so that people can relate to that as to how that's going to help them stay open well and I will say too you know
Speaker 32
8:15
we have a teaching mission and so one of the things we've done too for instance in Helena we're working on having PA
students rotate through their emergency room so this is creating a whole new kind of environment for these rural hospitals and it's also exposing health care professionals to rural sites to be trained and once these professionals train in these sites they very well may decide once they complete their program, they want to return to Helena or Mina or Warren
Speaker 18
8:44
or one of these other outlying areas. Sounds like a really good program.
Representative Kenneth B. Ferguson
Unverified
8:56
Representative Ferguson. Thank you, Mr. Chair. I've got two questions and Mr. Chair, I can't go back in the queue for my third question. I heard you mention you said something about we owned it. I'm going back to JRMC's situation. What do you mean when you
Speaker 22
9:17
say we own it? So legally it is still a separate private entity, but we are the board. The board,
Speaker 44
9:23
it's called a member substitution. It's a common legal, I won't go too much into the legalese.
Speaker 17
9:29
It's a common legal contracting process in health care where an entity becomes the sole owner of a nonprofit. so that's the university of arkansas now is the
Representative Kenneth B. Ferguson
Unverified
9:43
owner of that non-profit so you am at uams now i was at the formal announcement in pine bluff and correct me if i'm wrong i understood the structure was going to be a seven member board four members coming from the current
uh board and three from uams was i incorrect in that assumption no sir that's correct so now are you saying uams will now control that seven member board is that what you're saying the the board
Speaker 44
10:30
is now controlled by the university of arkansas yes sir The UA system. It's a
Representative Kenneth B. Ferguson
Unverified
10:38
part of the University of Arkansas system. So JRMC,
through a contractual arrangement with UAMS, is now controlled by the UAMS system?
Yes, sir. Hmm. Okay. Third and final question. Now, does that mean that some of the UAMS doctors are going to be practicing medicine in a more comprehensive fashion at JRMC?
how does that work this just became effective yesterday but we are looking at
Speaker 44
11:09
all those options and yes sir eventually there will be a more UAMS physicians at JRMC okay thank you mr. chair
Representative Fred Allen
Unverified
11:21
representative Allen thank you mr. chair thank you all for being here you mentioned that you all had a ribbon cutting
Representative Fred Allen
Unverified
11:38
that was the hospital in bryant okay so the heart hospital will not be specialized in the cardiology care anymore uh it's just going to be under the umbrella of ums no sir let me
Senator Matt McKee
Unverified
11:48
try to explain that one because it's different from all the others that we've
talked about what happened what occurred in bryant is strictly a real estate transaction we have not purchased anything from heart hospital or heart hospital has not stopped providing any of the services they provide they quite literally left that building moved their resources to other clinics and to their hospital in little rock and uams moved into the building so it's that was really just a real estate transaction where we now lease that building we did not purchase anything
from the heart hospital okay and all the services they previously provided they still provide just
Representative Fred Allen
Unverified
12:32
in their other facility okay so explain to me how a real estate transaction is going to help better serve
Senator Matt McKee
Unverified
12:44
that community the heart hospital ran that facility specialized in what i would say hearts and bariatric surgery UAMS is going to operate that facility like a community hospital. You can think of it as like a full-service ER.
The other benefit to the community is UAMS will be staffing those beds for patients of all types and different things that they may need to be admitted for. Does that make sense? So probably a broader range of services in the building now than there were previously. So what
Representative Fred Allen
Unverified
13:17
you're saying today is that it's deeper than a real estate transaction because just a second ago you said it was just a real estate transaction. Now it looks like it's an operational transaction.
Senator Matt McKee
Unverified
13:30
Well, what I mean is we didn't take over any heart hospital operations. As of midnight, what, last night, night before last on October 1st, all the operations in the building became
Speaker 22
13:49
transaction, a real estate transaction. How would you explain that? It's
Speaker 44
13:53
UAMS operations. UAMS purchased the property and leased the building, and we are putting a UAMS-operated hospital there.
Representative Fred Allen
Unverified
14:01
Okay, so UAMS owns the hospital now. Yes. So it's not a real estate transaction. It's about ownership now. You own it, right?
Speaker 44
14:08
Yes, sir. In the sense that we have the license for the real estate, leasing the building but we own the license we are operating the hospital so let me
Speaker 15
14:18
let me explain it this way i think this might be more clear what you make what we're kind of
Senator Matt McKee
Unverified
14:24
used to seeing is an entity moves out of the building there's some period of time goes by and then another entity moves in their operations into that building obviously not wanting the hospital to not
be functioning and operating we worked with heart hospital to manage this transition where the hospital was always open to the public so there was no period of time where they left the building and we moved in we just transitioned at a point in time midnight on the 29th does that make sense uh kind of so we we own the hospital operations but we moved uams operations into the building we didn't take over heart hospital operations okay
Representative Glenn Barnes
Unverified
15:17
representative Barnes you're recognized Thank You chair like state representative Ferguson I was at that initial meeting also and I'm wondering when did the language change the language at the meeting was that it was a partnership between Jefferson County and UAMS. Now I'm hearing ownership. When did that
language change? Representative Barnes, I wouldn't say it changed. The partnership, currently there's
Speaker 44
15:49
four community members on the board and three UAMS board members appointed. The way that it is set up is to maintain that community involvement in that hospital. So while the university of The Arkansas system is the sole corporate member of that nonprofit. The way the board
Speaker 71
16:07
is structured is to be a partnership and have local representation and local
Representative Glenn Barnes
Unverified
16:15
control. Okay, local partnership, local control.
But you stated that you all would make the decisions. Is that
Speaker 46
16:25
correct? The board will be making the decisions, but certain certain powers are reserved for the sole member under this corporate structure
Representative Dolly Henley
Unverified
16:43
you mr chair i am so excited about what ums is doing across the state
for rural hospitals uh thank you very much what i'm most excited about is sharing that expertise in finance, physician recruitment, and also in telemedicine. I think that's just such a positive for us in rural Arkansas. I think you've talked about five total communities. Is that right? Is it three management and two? Okay. So in those five hospitals, that's wonderful for those communities. But how many other locations or what's the goal for other hospitals
throughout the state to be able to become a part or attach to UAMS? Thank
Senator Matt McKee
Unverified
17:32
I could put a number to it. You know, the other parties have to be interested and they have to kind of want to partner with UAMS to do this sort of thing. UAMS, under Dr. Barnes' leadership, is definitely trying to explore and grow to this hub-and-spoke system around the state. I don't think we could put a number to it.
Dr. Barnes has said that we're open and willing to talk to other hospitals. Of course, when we do that, we have to enter into NDAs and can't disclose a lot of things. But definitely, I think you will see us continue to try to expand that hub-and-spoke network around the state. Thank you
Representative Howard M. Beaty, Jr.
Unverified
18:17
for what you're doing. Appreciate that. Thank you. Representative Beatty. Thank you, Mr. Chair. I just want to kind of echo what Representative Henley had said. With Dr. Barnes' leadership at UAMS, we see the progress that we're making in the state, the outreach.
And the main thing is taking care of our citizens in rural communities where services are somewhat limited and having that lifeline, so to speak. So I guess my question is, regardless of who owns it and who's running it, in your opinion, Are the citizens getting a better, broader range of services provided at the hospital in Jefferson County than what they were getting at the facility they had before? Well, that's the goal. You
Senator Matt McKee
Unverified
18:54
know, it'll take some time to make changes, but someone asked earlier about UMS doctors going there,
and it takes some time to work those things out. But that's part of the goal is to try to make access to specialists more local, and JRMC in particular in other places. Yes, sir. Well, we appreciate that.
Representative Howard M. Beaty, Jr.
Unverified
19:10
Keep up the good work. Thank you, sir. Thank you. see enough other questions
Representative Jeff Wardlaw
Unverified
19:16
thank you guys for your testimony and thank you for bringing us up to date on what's going on thank you mr chairman thank you committee uh represent ferguson you do have one
Representative Kenneth B. Ferguson
Unverified
19:28
more question you're recognized thank you one final quick question it
i don't know whether this has anything to jrmc but maybe uams and i'm a patient at uams and have had very good experience with UAMS doctors. But I'm concerned about every two years it appears at UAMS, and this may not be an issue for this period of time, but it's something that I'd like you guys to take a look at and I want to have some further discussion on. The loss of some of you are physicians.
You guys have lost over the past two or three years. I know I lost a cardiologist and had to go to another cardiologist, which has been great. That cardiologist that I now have has really helped me. But I've noticed a loss in some of your doctors, and I think it may be something that we may need to have further discussion. I don't know if we as a legislator could help out on that, but you guys have lost a lot of good doctors.
I don't know if you can address it, But I just want to put that out there as to what's happening at UAMS from that particular standpoint. My wife, who also is a patient there, had a very good physician, and they were there for two years, and they went to the VA, and then one left. But anyway, I just want
to put that out. That's been bothering me for some time. I understand, Representative Ferguson.
Senator Matt McKee
Unverified
21:05
You all could probably call another meeting and we could spend a significant amount of time talking about physician recruitment and retainment and the challenges of doing that. In Arkansas, I'm confident in saying it's not just a UAMS issue. It's all hospitals in Arkansas. I think sometimes we take it for granted that we're going to have these specialists at UAMS all the time, but it is a daily fight to recruit. We're recruiting against surrounding states. It's really a nationwide issue when you're talking about recruiting a lot of these specialists.
So, unfortunately, it happens. Turnover happens. We fight every day to keep good providers in-state and try to train more so that there's a bigger pool to hang on to. But, yeah, it's a big issue we could talk
Speaker 15
21:56
about. And we'll probably bring you some things in session that we hope you'll support that
Representative Kenneth B. Ferguson
Unverified
22:04
may help with that. Yeah, and and I appreciate appreciate the answers the reason why I say that is I know that
You've lost a couple of good cardiologist Good liver doctor Kidney doctors and That really really concerns me But anyway, I thank you for you. Yeah, so thank you mr. Chair Representative Allen. All right. Thank you. One
Representative Fred Allen
Unverified
22:31
final comment. First of all, I want you all to know that I think the world of UMS, you had one of the best cancer doctors in the world,
and he left and went to New York City. And when you all purchased the Hart Hospital and JRMC, now it's the Hart Hospital. I just want you to say yes or no. Is the Heart Hospital now UMS, is
Senator Matt McKee
Unverified
23:04
JRMC now UMS? The building in Bryan, Arkansas, is UAMS. It is UAMS Health. Operations in that building are now UAMS Health. Okay.
I would characterize JRMC as JRMC with UAMS. The local leadership at J.R.M.C. is not going anywhere. They're still there. They're still running that hospital. But the heart hospital is not still running the
Representative Fred Allen
Unverified
23:33
heart hospital, is that correct? Not the one in Bryant. They are
Senator Matt McKee
Unverified
23:38
still running the hospital in Little Rock, yes, and they have clinics. They have clinics even in Saline County.
Representative Fred Allen
Unverified
23:46
They still have all that. So the heart hospital in Bryant is not in UMS. If they're not running it, do you all own the real estate? You're running the hospital, so
Senator Matt McKee
Unverified
23:59
you all own the hospital now? We lease the building. We own the operations is the distinction. Okay. Yeah, I get confused, too, in a lot of these meetings. They talk about who owns what and whatnot. The real estate is leased. The operations are UAMS-owned operations.
Senator Missy Irvin
Unverified
24:21
I guess I have to accept the
answer. Thank you. Thank you, Representative Allen. I was just going to say the reason why we cannot recruit specialists into the state of Arkansas is because a reimbursement is so low, period. Okay, and that's across the board. Whether you're talking about Medicaid rate, Medicare rate, or average commercial rate, that is the reason why specialists do not come to the state of Arkansas, don't practice here. And if they do and they get the runaround and their claims aren't being paid for over a year, then that's a problem.
And so that prevents our citizens in the state of Arkansas from getting care from highly specialized physicians because they can't make a living here. I think that needs to be stated very, very clearly and succinctly. It's about the reimbursement. It's about how much they can make or not make. And they have to weigh that in their decisions against Arkansas and other states where they have a higher reimbursement across the board, where there perhaps is not an income tax.
We lose a lot of physicians to Texas and Tennessee because of that one factor. But I think it's more about us not being able to be competitive with the other states, and there's a lot of reasons why. But you've heard time and time again the Medicare rate that elderly people are on, it's a federal program. We are the lowest reimbursed in the entire United States of America below Puerto Rico. Texas is the highest in Medicare reimbursement.
We are the lowest, and we cannot change that. and so the federal delegation could try to change it but you'd have to get everybody to vote against their own state interest to get it changed it's very very difficult so i just i appreciate the conversation and i just i just want to make sure we're providing really really clear information that everybody and legislators can understand and i don't have a problem saying it because it's just the facts and it's just the reality so i just i know that that's what you you know i appreciate
what you're doing i appreciate how you're trying to make it work you know giving limited resources and and so really appreciate the cut the uh partnerships because i think stabilizing our current health care infrastructure is the goal that we should all have thank you
and seeing no further questions you are excused this time no matter
Speaker 105
27:02
what all right thank you chairman thank you committee so with
Representative Jeff Wardlaw
Unverified
27:09
that guys we'll move on to item F you notice item D has been struck from the agenda so with that we'll move on to DHS
miss Pittman I believe you have a rule for us to review if you would introduce yourself in here you
Speaker 110
27:34
Division of Medical Services. I'm here today with a rule regarding reimbursement for physicians assistance as primary care providers in Arkansas Medicaid. This rule implements two pieces of legislation. The first one was actually passed in 2023. When we took it through with CMS in 2024,
CMS had some language on the same page. It was not language related to the physician's assistance, but it held the rule up. Then a new piece of legislation was passed in 2025, and so we combined the 2023 legislation with the 2025 to create this rule that you see in front of you today it is in final approval stages with cms it has gone through public comment we received one public comment through from the medical society and made some non-significant changes to clarify some things in
Speaker 111
28:19
the rule to address their comments and we're happy to take any questions
Representative Aaron Pilkington
Unverified
28:28
Representative Pilkington, you're recognized. Thank you, Chairman. Wardlaw, over here, Ms. Pittman. Thank you. Very supportive of this rule. Just was curious, do we have any inclination from CMS that they're going to approve this rule? I imagine they will, but I just don't know if there's been any conversation beforehand. Yes, sir. We've
Speaker 110
28:44
actually had quite a few conversations with CMS. This rule is very large. It touches on every aspect of physician services and primary care services that we have. So we've had a lot of conversations with CMS about it. We've gone back and forth. That's one of the reasons this took so long to get through. Gotcha.
It's in what they call clearance, which is their final approval stage. So we have been told there are no further questions from any review groups, and it is just getting the final clearance. It's fantastic. Thank you so much. Thank you. Seeing no further questions,
Representative Jeff Wardlaw
Unverified
29:11
your rule stands reviewed without objection. Thank you. So, members, we've got four
rules here that require the same people, so I'm going to call them to the table, let them explain all four rules. If you guys would, keep notes. you have questions at the end we'll go back to each rule that you have a
question about so with that I'll bring Paula Day Craig Smith and Charles Thompson to the table and you guys be recognized to present rule H I J and L so we'll take L out of order so if you would introduce yourself for the record and you are recognized to present H I J and L on the agenda thank you
Speaker 121
29:58
members charles thompson attorney arkansas department of health
Speaker 124
30:07
smith attorney for department of health and chairman l is a separate rule that does
Speaker 125
30:12
not involve miss day if you would like if you would allow us to swatch our we can but g i
Representative Jeff Wardlaw
Unverified
30:20
left g off so it should be g-h-i-j and we'll leave l off for separate okay and
Speaker 124
30:27
j is also a separate subject matter expert as well mr ages has three okay that's fine thank you sir the first rule is the
rules for conducting criminal history record checks in home health hospice and private care agencies in arkansas these proposed amendments are to add provisions allowing third-party evaluation services to conduct criminal history background checks and revise applicable language throughout the rules regarding that process as well as remove dhs's dip squad certification for private care agencies those are following act 674 and act 853 public comment was open on july 5th closed on august 4th and no comments were received the second rule is the rules for freestanding birthing
centers in arkansas these amendments are to allow electronic medical records allow private professional providers to complete building project review and approval and allow facilities to ban emotional support animals all under acts 141 591 and 819 those were opened up for public comment at the same time and no comments were received and the third one are the rules for in vitro fertilization in arkansas these amendments are to implement the changes pursuant to act 859
the restore act as well as to align provisions with current practices and utilization of electronic medical records and also had the same public comment period and no comments were received and with that open any questions let's go the next one
And, Chairman, for efficiency, if you would like, we can go through all the rules without bringing each subject matter expert up, and just
Representative Jeff Wardlaw
Unverified
32:34
if you have questions, they are available. I think that's what I tried to sell you in the first place, but if you'll do that,
Speaker 124
32:42
and then if we need the subject matter experts, we'll grab them as needed. Understood, sir. The fourth rule are the rules for Arkansas Kidney Disease Program. In 2025, Act 852 changed the pre-existing State Kidney Disease Commission into the State Kidney Disease Advisory Council,
where members are appointed under the Board of Health, and certain programmatic aspects were pulled within the department to make this process a little bit easier and to help our citizens a little bit faster. With respect to that, public comment opened on July 3rd and on August 6th, and no public comments were received. thank you the fifth thank you go ahead are
Senator Missy Irvin
Unverified
33:23
there any questions on that rule all right see no please go ahead thank you
Speaker 124
33:31
thank you the fifth rule is the rules for public access to epinephrine these are
these changes are to implement act 245 of 2025 that expanded types of epinephrine that is available in our schools public comment opened on july 3rd closed on august 2nd and no comments were received. Thank
Speaker 124
33:54
proceed. The sixth one are the rules for breath alcohol ignition interlock devices. These proposed amendments are to implement changes pursuant to 841 of 2025 regarding requirements for approval of devices and to update to industry
standards. Public comment was open on July 12th, ended on August 14th. There were a couple comments were received however most of the comments were either requesting changes regarding language that were copied directly from law or were changes that weren't tied to current proposed amendments and the latter ones we will take under consideration in future promulgations but were not relevant to these proposed changes and the last one rules pertaining to general sanitation these amendments are to implement act
314 and to clarify a certain plan review language public comment was open on july 3rd ended on august 3rd and no comments were received there so let's go back to the previous rule and you
Representative Jeff Wardlaw
Unverified
34:53
you made a comment that you you had some public comment but you were not taking those into effect but would for
later promulgation can you walk me through did those comments have anything practical that would have changed that rule or what was the reasoning or thought process from
Speaker 124
35:16
of those changes again were for existing language they were not to current proposed amendments and so it is more efficient for us to proceed with the amendments we are proposing now and then to take those into those comments into consideration for the next round of changes if there are any changes out of the next session that will allow is to review those and basically those comments were
Representative Jeff Wardlaw
Unverified
35:38
not in line with the current statute correct perfect
let's let's stay in english terms please yes sir all right any further questions
from the committee see it none without objection rule g h
i j k l m are all reviewed without objection thank you so if that members will move on to item e which we had
moved to the end of the agenda before we proceed members of the public here's how
this is going to work we've got a
number of you guys signed up to speak there was a lot of rude emails sent to staff i can tell you from being the chair of this committee we do not put up with that i actually called several cell numbers last night on those emails to have conversations personally with y'all not one person answered those cell phone numbers last night here's how we're going to proceed i'm going to recognize david watson first blake landers in the order they're signed up on this sheet
at the minute somebody says something the others have already said we will stop and we will take questions from committee and
that will be the end of the testimony we will not double hear remarks on the waiting list we will hear it for what it is these emails were
very rude and our staff does not deserve that kind of rude behavior from the public let's keep it very civil very much to the point and then we will go from there so with that i'm gonna recognize the agency for overview
Chair (Representative Jeff Wardlaw)
Unverified
37:26
miss stone would you guys introduce yourself for the record and
Senator Missy Irvin
Unverified
37:34
stone i i just wanted to re-emphasize my co-chair's comments and i appreciate his comments thank you representative wardlaw um our staff at the bureau of legislative research they work incredibly hard Uh, and they're amazing at what they do. Um, the emails that I saw were really, really, really rude and they were very, very inappropriate. Um, we are elected officials. We're very public.
Uh, we run for office and therefore we're public officials. So, uh, even though it's not good form to yell at us or it's not, you don't get your way if you yell at us or call us names or are rude or are demanding that generally is not welcomed or you won't really be heard by a member of the legislature if you do that to one of my colleagues. So I just recommend you not do it. You gain a lot more bees with honey than you do with vinegar, something my mom always told me. So I just, as we
move forward through issues, I think it's just an appropriate thing to say, please, if you have things. Thank you for the emails that you did send. There were several that were very excellent and great. Um, I will just give you my two cents worth. I would prefer not cut and paste. Uh, if you have something you want to say, I'd rather you say it to me personally and about your story and personal information. Um, your personal perspective versus a cut and paste email
those tend to not be looked at very well or or read just giving you some advice also the rules of this committee are governing who speaks and when that people speak so that is determined by the chair of the committee members can make motions that are either that are recognized some of those motions are debatable some are not so when we give you an answer as to well it depends there's not a guarantee that you're going to be able to speak or not when you sign up
there's a lot of factors that play into that which are really just the rules of the way this committee is guided by the chairs and the members of the committee so we're just trying to give information so again i just i want to defend our our staff i think they're amazing at what they do so please you know you can't you could put my name out there that's fine my phone number i'll give it to you but when it comes to them you know they they work for this legislative branch of the
government and they do an amazing job but they're not public and they're not elected officials and they're not public uh public people so i would just appreciate moving forward that we recognize that thank you mr chair so you guys
Representative Jeff Wardlaw
Unverified
40:28
are recognized to introduce yourself and give us an overview of where we're at. Thank
Speaker 151
40:36
you, Mr. Chair. I'm Jennifer Brise. I'm the current director of the Division of Developmental Disability Services with DHS. Good morning.
Speaker 144
40:45
Paula Stone. I'm the director of the
Office of Substance Abuse and Mental Health
Speaker 151
40:52
at DHS. We appreciate being given the opportunity today to speak a little bit about the recent news. And so we're here to update families, providers and partners on some of our near-term improvements to the community and employment supports waiver and our longer-term path to sustainability. We're grateful for the support of Governor Sanders as we work to make supported living services available to families on the CES waiver wait list, which is a really practical step that can help more Arkansans receive home
and community-based services sooner. We recognize the powerful impact that waiver services have on families and their stories have moved us and our goal has always been to connect eligible families to services that benefit them as quickly as possible. A brief history about Medicaid waivers. So in every state we're running a Medicaid plan under a federally CMS approved state plan that must mandatorily cover certain benefits like inpatient hospital, physician lab, etc. States
participating in a waiver gives states that just additional ability to tailor coverage for specific populations beyond the state plan coverage that Medicaid requires. 1915C waivers specifically cover home and community-based services for people who would otherwise meet an institutional level of care. In Arkansas, we launched a pilot in 1988 that was approved by CMS to provide alternatives to institutional care, serving about 75 individuals in 11 counties
with case management, supported living, and adaptive equipment. Then in 1990, Arkansas implemented its first 1915C version of the current Community and Employment Supports HCBS waiver statewide with CMS approval, and we served around 457 individuals. Through collaboration with the Department of Human Services, Arkansas legislators, and CMS, the number of funded and approved waiver slots grew to over just 5,200 by 2020.
Then in 2022, DDS, DHS received funding and approval from CMS, the Centers for Medicaid and Medicare Services, to cover 8,233 individuals on our 1915C waiver. Today, our CES waiver currently assists approximately 8,000 individuals with a single point in time maximum of 8,233 slots, as previously stated, which was approved in 2022. These individuals have to have a qualifying diagnosis of cerebral palsy, epilepsy, spina bifida,
Down syndrome, autism, intellectual disability, or another condition that causes similar impairment in general intellectual functioning or disability. These conditions to qualify for the waiver must also occur before the age of 22, be expected to continue indefinitely, and can create substantial functional limitations in three of six major life areas. Individuals are added to the wait list in order of application once eligibility for waiver is established.
We follow this process to ensure fairness. As of September 8, 2026, there were 2,464 individuals on the wait list. The current movement from wait list to funded waiver slot is about three years and one month, and about two-thirds of the current wait list are children. why supported living matters children on the wait list today have currently excellent access under Medicaid to 25 out of the 29 core services that are available to individuals also on the CES
waiver we are now working to add supported living for individuals on the wait list supported living helps individuals with disabilities live at home by providing active treatment that assist individuals in building and maintaining skills needed for daily living activities and helps individuals participate in the community. The most requested service for these individuals under the 1915C waiver is supported living. Today we spend around $460.6 million in total on supported living
services in the calendar year 2025 and are projecting to spend $745.7 million on these services in calendar year 2027. This reflects a recent rate increase and the additional availability for individuals on the wait list to receive this service. It's also important to note in many cases under the 1915C waiver, family caregivers are able to become employees of CES waiver providers and are able to be paid for the services they provide, like supported living, to their eligible loved ones.
Today, and we've been tracking this for several months, we estimate to end the current wait list of around $2,500, it would take an additional $50 million, that's $5-0 million, in additional state general revenue to eliminate the wait list. but calling out that would only then move the current wait list into the CES waiver slots. People are still continuing to become born and still becoming eligible every day. We're continuing to review applications on a daily basis.
We are looking forward to robust conversations with legislators, providers, and families and partners as we consider longer-term reforms to the CES waiver. Expanding supported living is a meaningful, near-term step, and we are committed to sustainable progress that keeps Arkansans supported at home and in their communities. We are working with our team on the waiver renewal that is due in 2027, and we are looking forward to making that even better.
Expanding supported living adds services families can access sooner, even while we work on these long-term improvements with the renewal of the CES waiver. It's also important to note that we've been running data on those folks on the wait list today, and currently we spend around $95 million on those individuals through those Medicaid state plan services. We are currently projecting to spend around $225 million with this added population to the supported living services and other things.
And now I'm going to turn it over to Paula, and she's going to share some additional information. Everyone on the CES waiver is put into a pass, and that's our managed care entities that assist this population.
Speaker 153
47:49
So I just want to make sure that everyone understands how this is going to work because we can pass policies, we can put money towards things, and then it has to be implemented. And so how this is going to be implemented is all of these individuals, as Jennifer said, are in a pass or will be in a pass
that are on the waiver wait list and they already have that past service of care coordination and the care coordinator is assigned it's a local care coordinator as close to them if they can have and that care coordinator meets with them on a regular basis they meet with them initially to develop a person-centered service plan and that identifies with the family and the member what services are needed and so this is an ongoing step this happens with the past members
and those person-centered service plans can be updated in any given time so not only at the regular meetings with them but anytime they meet with them or if there's a change and this is a big change right so they they have new services that are now going to be available to them so this is a change those person-centered service plans are individualized they're member driven so at any point in time if there's a change that happens with that individual or just in a regular
course of of their lives they can identify things and update their person-centered service plan so that's what's going to happen now is that the passes have already started working with their care coordinators and the care coordinators at their ongoing planning sessions with the families and with the members, they'll start adding these services or determining if these services are needed or actually will meet needs of people that are members of the PASS. Once those needs are identified,
then the PASS care coordinators will work with those wait list members to identify a service provider. So the PASS doesn't provide the services, the PASS pays for those services. So they'll look and make sure that those members that have identified supported living as a need get connected to an appropriate provider in their area. All those providers are Medicaid-enrolled providers. And they would then make sure that they determine with that family what services they needed, the level of services, when they need those services,
and then that provider would be asking to pass for an authorization for those services. that's all how that will work there's all those plans are available and if a family needs something quicker than the typical time frame for meeting with their care coordinator they can call so in this case the families can call if they want to get that going now the only other thing I had to cover is the rate setting methodology so Jennifer mentioned that the rates have changed
There was a rate that was developed. We did a big work group in October, and several of the home and community-based services rates were amended and changed. And we did that. There's a number of different rate-setting methodologies that you can use that CMS allows. And so we did this with a rate build-up model. And the rate build-up model is you determine all the costs associated with providing that service.
And we had a technical group of providers and others that came together, stakeholders, and gave information about the cost and what the components were. And then other information was used, technical work group, and then a provider survey was given to any provider who wanted to answer that survey, existing Medicaid and rural provider. And then that rate was done by building up those component parts. we can I see a
Chair (Senator Missy Irvin)
Unverified
51:46
lot of questions yeah we'll take some questions so what's the
Senator Missy Irvin
Unverified
51:51
right now did you say what that rate was I
Speaker 153
51:55
did not say the rate what is it 644 for a 15-minute increment six hundred and forty-four dollars six dollars and forty-four cents for a 15-minute okay
Senator Missy Irvin
Unverified
52:08
okay and how many units did I get of those per day
Speaker 170
52:12
so it depends um back to that individualized plan you know it really depends what's
Speaker 153
52:18
the maximum um the maximum could be up to 24 hours a day uh if somebody doesn't have
another service if they have that extreme need for the service and meets the description the needs for the description of that service so
Senator Missy Irvin
Unverified
52:32
okay and how does it work if a family member is the provider
Allison Guthrie
Unverified
52:41
for supportive living do you want to take that one so it works very similar to how
Speaker 151
52:46
it works if you don't have a family member it makes it a little bit easier if in finding staffing so the staff like the family member becomes a paid employee of the waiver provider
They go through the same trainings, requirements,
Senator Missy Irvin
Unverified
53:02
and all of that. Okay, okay. I just wanted to make sure. And then when you're talking about the $50 million in additional state GR, that's just the state portion, right? Correct. Okay, and then also when you're talking about we currently spend $95 million on them, and then that's projected to be $225 million for 2027. Is that the state GR portion as well? Just so I know what we're – I'll have to
Speaker 151
53:28
follow up on that, but I believe it's the entire bucket of state and federal, but let me make sure and confirm that.
Senator Missy Irvin
Unverified
53:35
Yeah, because I think, because you said in 2025 it was $460 million, so I'm assuming the $460 million and the $745.7 million in 2027, is that all state general revenue or is that the state-federal mix? So the $460.6 million that
Speaker 151
53:54
we spent on supported living alone for 2025, that's the whole mix. So that is the state and federal spend. That's state and. It is. Okay. Okay.
Senator Missy Irvin
Unverified
54:07
Okay. And this is at the 70-30 roughly, correct? That's correct. Okay. I just wanted to make sure we're consistent because if we're just talking state general revenue, understanding there's a federal component to that that's 70 70 percent federal and okay so I just want to make sure we're clear about the math so yeah let me know about those other if you don't mind so in 1988 is when we started it with a pilot of 75 people and now we are at 8,233 that's
correct um and and it's 2022 you said in 2022 when we asked cms uh we received money and where did we receive money from the federal government or from us state general revenue i would definitely like my
Speaker 151
54:55
my boss and supervisor melissa weatherton to come up and answer that as she was here when when that yes good stuff happened if if
Senator Missy Irvin
Unverified
55:07
you don't mind thank you and that was 2020 2020 and then 2022 is when we increased it the additional 3 000 that's right
Speaker 151
55:17
when we got the cms approval on the amendment that we did to the 1915c waiver that increased the number of
Senator Missy Irvin
Unverified
55:28
slots to 8,233. Okay, so how financially, how did we do that? Does that make
Speaker 185
55:35
sense? Can you just remind me? Thank you. Melissa Weatherton,
Speaker 186
55:38
Medicaid Specialty Populations. On the first question, Sandra Irvin, the numbers that she gave you, the 95 million currently for wait list members is total computable. Total? Total. Okay, that's fed
and same as the 225 million that were projected to spend in calendar year 27 that's total computable okay all righty you will remember
Senator Missy Irvin
Unverified
56:05
conference yeah i was i just think it's good information as part of the discussion which is why we wanted this to be on the agenda for everybody because i think it's it's a complicated policy knowing that you're never ever going to get rid of a wait list and so i think it's important for everybody to
understand the steps that this legislature took and it was the legislature that drove this initiative back in 2022 and it's a very in-depth policy it's obviously very expensive but
i think we just needed to have a refresher about
Speaker 186
56:43
the funding part absolutely so um back starting um in 21 um it was announced at a press conference that uh it was like we picked a point in time
if you remember i think it was as of december the first who is on the wait list today um we're going to make sure that it's cleared within three years so legislation was passed mandating the clearance within a time frame and then that same um during that same session um this body passed um the appropriation and the funding to add to the dms appropriation lawn um so that we could pull the sur portion to pull the federal match so it ended up we eliminated about 3 000 we added
3 000 additional slots to cover those individuals that were on the wait list the day it was announced and how did we fund it you passed legislation you passed a
Chair (Senator Missy Irvin)
Unverified
57:44
bill um and i do not remember the dollar amount
Senator Missy Irvin
Unverified
57:47
um what it was how we it but it was state general revenue yes we attributed i think it was part of premium taxes correct
Speaker 186
57:55
we use some premium tax at one point we have um we have moved tobacco funds at one point in the future y'all remember that we're funding 500 slots through tobacco
funding we're using past premium tax um to because the law states that half of the past premium tax must go um to supporting people on the ces waiver so we use that funding source to pay the per member per month premiums okay and then y'all actually added a pretty significant amount of of sgr in 2021 um before we amended the waiver to add the slots and receive cms approval in august of 22 okay thank you and
Senator Missy Irvin
Unverified
58:34
then the last thing i would say is i i think my understanding is
we're the we're and it's 17 million i think is what the governor announced that would come out of restricted reserve correct and then do we have a projection of
how much it would cost ongoing yes or is that the 95 225 number no yes it's all
Speaker 186
59:01
of that so um the 17 million of state general revenue was requested to get us through the end of this fiscal year so january through june
30th so 12 months of supportive living for the waitlist population is going to cost us 34 million dollars projected um in sgr so that 17 million gets us three at the end of this six months
Senator Missy Irvin
Unverified
59:27
okay and so okay so it's 34 million
so it's another 17 million for the remainder and this is to provide the service that's most requested yes and and for is it across the board or it's just those that are
on the wait list correct because those who are have a waiver slot are receiving it yes so it's And only if they meet a medical necessity as determined by their person-centered medical plan, correct? Okay. All right. So instead of a waiver slot with everything, which they're getting 25 out of 29 services now. So it's four services that they're not getting if they're on the wait list, correct?
Speaker 186
1:00:13
Yes. There's some specialized services like environmental modifications. that's a service on the waiver where we could come out and do some modifications to your home i got you things like that um supportive living is one of those services for the waiver clients that's the number one requested service so what we've asked our actuaries to do and we actually just submitted these rates um paula did her team yesterday so you have to submit rates 90 days in advance to cms for um actual soundness for managed care so they went yesterday um and they'll have up
to january 1st to approve them and that's when they'll go live so the numbers that we're talking about today um and the calculations that we have done to add money to allow this service to take place for wait lists are in the rates that cms now has i got you
Senator Missy Irvin
Unverified
1:01:06
okay well i just think it's important to to kind of decipher between the approach and I think it's and I would love
to run the numbers to see like if we you know providing services outside of a waiver slot
versus providing them just straightforward I'm I'm curious
as to what that would look like because that's kind of the different approach that we're taking and I think it's a good policy debate to look at so i just thank you for the information um turn it
Representative Jeff Wardlaw
Unverified
1:01:37
back to you thank you budget hearings start next week correct so with
the budget hearing starting next week it's an answer i already know the answer to question i already know this is that 34 million being added in to the biennium budget
for medicaid or dhs when we go into the
Speaker 186
1:01:57
budget hearings in the next few weeks honestly i have that would be a secretary man question i've not been involved in those conversations we've been focused on the 17 million from restricted reserve um that we
Speaker 202
1:02:08
need to bring before you guys clearly but that before january that
Representative Jeff Wardlaw
Unverified
1:02:12
only gets us june 30th correct yes so you can't yank the service out from under all these folks on july 1st
correct correct so we need to know how we're
going to pay for it on July 1st so we need an answer I'll
Representative Jack Ladyman
Unverified
1:02:41
get you one thank you you're welcome representative lady man thank you mr. chairman well you know the the waiver list when we eliminated that at 3,000
you know we thought that was the end but it's not three thousand more got on the list and that's going to continue as ms stone
talked about um but let me just say a couple things before i ask my question okay i have used all elements of i like to call it continuum of service because my son has been involved in this program since he was five years old so he's been on it 46 years through all elements of the waiver and the hdc so all of these are needed uh so we need to fund all of those i agree with that
how we found the money is the question but you know we need a seamless continuum of service And I wish somebody would quote me on that. Because every element of this service needs to work together. It's not one element needs more money than the other. Because I can say by experience, as you go through life from five years old to 54 years old, your needs change. So we need to be able to help that 54- or 67-year-old person that's in the Human Development Center
as much as we do that 5-year-old person that maybe just needs a few of these services. So I say that because what really bothers me is when we have a waiting list, and Jennifer, you said this, that we take them as they sign up, and I understand that. But is there any way to consider the seriousness of their limitations? You know, you may have a four-year-old that may not be able to make it two or three years
to get the service they need to survive. So I think somehow we need to be able to move serious cases up. I know that's not possible now, but could
Speaker 186
1:04:55
would allow me to clarify something. services on this in all of our 1915c waivers these are not medical services these people that are on this waiver receive all their services through the state plan they go to
specialists they go to doctors they have surgeries they get therapies they get all medical care outside of this waiver this waiver is a the supportive living service is a high school diploma ged usually trained person that comes into your home that helps you learn independent living skills um and and monitors and you know this you've we know this right um but these are
not life-saving services inside this waiver. So I think there's some confusion on that, and that needs to be clarified, so I'm glad this came
Representative Jack Ladyman
Unverified
1:05:54
up. Well, I appreciate that clarification, but just life needs, you know, if you have a three or four-year-old in a wheelchair or a walker, if they're not monitored most of the time, that can be life-threatening. It's not a medical thing, but it's a livable thing where you need monitoring much more than a normal child would need.
And that can be a life or death situation as well. So that's really what I'm talking about. The seriousness of their limitations, can regular life activities be fatal to them? And if it is, is there any way we can try to give that support? Do you understand my question? I do, I do.
Speaker 185
1:06:41
But the other side of that coin, so we've been talking about this
Speaker 186
1:06:45
a lot because this is a choice we can make when we renew the waiver, just to be honest.
And so if we eliminate the list and say we're going to do it different, like it's gone, right? We've cleared it. We're going to do priority different in the next waiver. we could do that. Here's what we keep talking about internally. Every single person that qualifies has gone through our psychology and medical team because you have one of those five qualifying diagnoses. You have already been deemed that your needs are so severe, you're at risk of going into an institution. What doctor on our team is going to say, no, you're more sick,
Your autism is worse, right? Your family is not as dependable. It gets into choices that I do not think we
Representative Jack Ladyman
Unverified
1:07:40
that decision would be challenging, very challenging. Well, thank you for that. One more question, Mr. Chairman, I'll try to be quick. Senator Irvin talked about, and you said $50 million would clear the waiting list for these additional services. Is
Representative Jack Ladyman
Unverified
1:07:59
Okay, let's just assume it's $50 million. So how much would the federal match be, and would that federal match be automatic? So if we put $50 million into this, how much more money would we get coming into the state to provide services for our people? So
Speaker 186
1:08:13
it's generally we get 70% pull-down because it's direct care service, so 70%. That's automatic? Yes. We don't need their
Speaker 33
1:08:25
What I mean is we don't have to have federal approval. We put the money in there.
We do have to have federal approval.
Speaker 186
1:08:32
The match will come. No, we have to have federal approval. So in the 1915C waiver, they run for five years, and it's a form. It's a template. And you go into it, and they ask you, how many slots are you going to find year one of the new waiver, year two? And then you show what your rates are, and you show the money that it's going to cost, that it's going to cost the state, and that it's going to cost them. That whole waiver goes through federal approval, so multiple levels of federal approval.
Okay. It usually takes, they want a minimum of 90 days, 90 to 120 days to
Representative Jack Ladyman
Unverified
1:09:07
look at it. I understand that's implementation, but my math says that we would get $150 million from the federal government if we spent $50
Speaker 186
1:09:19
million. Yeah, 70%. But you have to understand, yes, these are very expensive programs, so the numbers we've been throwing out. But what I'm
Representative Jack Ladyman
Unverified
1:09:26
saying is we could use federal funds, $150 million. So we need to think about that.
That's bringing money into our state to serve our people, and we're only putting in a fourth of that. So I think that's something that we, as this legislature, need to consider, the impact of that. Am I correct about that? That roughly? Yes. Yes, sir. Okay. Thank you. Representative Bentley. Thank you, Chairman. Thank
Representative Mary Bentley
Unverified
1:10:00
you again for having this meeting and to kind of clarify some things.
So just for clarification, individuals out there that are on the pass and have been deemed to be on the waiver list are receiving a lot of care. Can we go into that a little bit more, some of the care that they're receiving? So are they getting equipment if they need it for a wheelchair, if a child needs a wheelchair, if an infant needs some different things. Can we go over some of the things that those
Speaker 186
1:10:26
people are able to get at this point without getting the waiver? Yes, ma'am. And let me distinguish this. Let's talk about children. So if you're a child on Medicaid, we cannot have any kind of hard limitations.
That's a federal requirement. So unlike what we have on some of the adult services where we can have a limit, an annual limit or a monthly limit, We are not allowed by the federal government to put hard limits on any child service in Medicaid. That's under EPSDT. So children on Medicaid, not just children in the past, right, but any child on Medicaid has the availability to get any service under the Medicaid state plan. So, yes, wheelchairs, equipment, formulas, doctor's visits, OTPT speech, early intervention, day treatment, applied behavioral analysis, therapy for autism, orthotics, anything that we provide under the state plan they have available.
So that's why you hear us using the talking point of they currently get 25 of the 29 services that a child on the CES waiver can get, because they can, under the Medicaid state plan. Okay, great. So we're going to give supportive
Representative Mary Bentley
Unverified
1:11:40
living services now to those that are on the
waiver list. So tell me the other three or the other four that are not given. So what are those
Speaker 186
1:11:49
other four? Specialized medical supplies. So it's an extender. It's a state plan extender.
So there are certain things that are requested for waiver recipients under specialized
Speaker 232
1:11:59
medical supplies that they cannot get under the state plan. And Director Brzee can give
Speaker 149
1:12:09
you an example. I'm drawing a blank. This allows families the opportunity when something specifically, maybe a brand, is not available for, like, gloves or incontinence supplies, it allows them to get more specialized with that especially if someone has a skin sensitivity or an
Speaker 151
1:12:27
allergy so it's it's dme but it's like melissa said extended dme so that's one another
Speaker 186
1:12:33
one is environmental modifications um and then the other one is um supplemental supports supplemental supports which is not a highly utilized service on our waiver in fact the most we utilize it the most during covid um and then um it's died back down but um that was something that we ramped up then but it's it's not a highly requested service yeah thank you and that's very helpful so
Representative Mary Bentley
Unverified
1:13:02
just real fast what is the current rate per minute you
said we're gonna we've asked to go to 644 per minute so what is our current because it's gonna be helpful during budgeting if we know what
Speaker 186
1:13:13
the current rate is that would be helpful um i've just been asked about the new rate so many times that's the only one that's coming to my mind but let me get it for
Chair (Senator Missy Irvin)
Unverified
1:13:22
you okay all right this is helpful thank you very much thank you chairman okay representative
Representative Denise Jones Ennett
Unverified
1:13:27
Anna recognize question thank you sure woman I have a couple of questions and forgive me if if it's gonna be redundant you might have already addressed this but I'm ask
anyway act 1023 requires DHS to conduct full rate review according to a published schedule what is that schedule that rate review that's what miss stone was
Speaker 186
1:13:49
talking about in her opening um that was a piece of legislation that passed last session that mandated that we review pass specific rates so all the rates in the 1915 c the ces waiver and then all of the behavioral
health services that are in another federal program under the pass that's already been done We worked, like Ms. Stone said, these ladies, and I was there as well, we worked with providers and our actuaries. The rate report has been published since October of last year. It's on our website, and the new rates go live January 1st. They are included in the rates that were sent to CMS yesterday. So follow-up.
Representative Denise Jones Ennett
Unverified
1:14:38
So is it yearly, the schedule? No, ma'am. All of
Speaker 185
1:14:42
the rates were looked at and adjusted. Some went down, some went up.
Speaker 186
1:14:47
Supportive living went up pretty substantially, and that rate is set, and it'll stay that way until we review it again. That bill did not mandate a rate review schedule. Okay, okay, how often
Representative Denise Jones Ennett
Unverified
1:15:03
will CES waiver and supportive living rates be reviewed, and where, okay, you already said where it's published, okay, never mind.
I have a follow-up, Chairwoman, if you. Okay, go ahead. Let's see, the last study showed rates have fallen 23% behind actual costs because they went unreviewed for years. would DHS support putting a set review cycle in statute? No, ma'am. Okay. And why is that? Then we would need to do that for every single one of
Speaker 232
1:15:35
our Medicaid providers. Okay. I mean, if you want to pass
Senator Missy Irvin
Unverified
1:15:40
a bill that does that for every single Medicaid rate provider,
I mean, you have hospitals that
haven't had a rate increase in, what, 19 years? Okay. I mean,
Speaker 250
1:15:53
we want to start talking about that. We can talk about that. Okay.
Representative Denise Jones Ennett
Unverified
1:15:59
One more question, please. Let's see. Arkansas has previously used past provider tax revenue to open additional waiver slots. What share of current CES funding comes from general revenue, the Medicaid trust fund, provider tax revenue in federal match?
And I think you already touched on that, but I didn't hear anything about
Speaker 186
1:16:23
the Medicaid trust fund. So I can go back down and get a breakdown. So the Medicaid trust fund is not designated. It supports Medicaid programs across the whole, right? I mean, on all of our programs. So I'd have to go back and tell you where we're pulling the funds to pay the PMPMs, the per month payments to the four managed care companies each month. But, yes, I'm assuming some of it does come out of the trust fund.
This is a $1.2 billion program, the PACS is. And one more question. I was just
Speaker 247
1:16:56
going to say, you know, as a member of the General Assembly, you
Senator Missy Irvin
Unverified
1:17:01
can ask your fiscal division of the BLR to pull that information for you at any time. Go ahead. Okay.
Representative Denise Jones Ennett
Unverified
1:17:09
Is any of the revenue at risk under the federal changes to provider tax in the one big, beautiful bill act? and if so, how many slots depend on it?
Speaker 186
1:17:22
The provider taxes that are discussed in the Big Beautiful Bill do not pertain or affect the PASS program whatsoever. Thank
Chair (Senator Missy Irvin)
Unverified
1:17:33
you. Thank you. Representative Rose? Oh, sorry, go ahead. Representative Rose, you're recognized. Thank you. Thank you
Representative Ryan A. Rose
Unverified
1:17:44
for joining our committee today, and walking
us through a lot of these details. First thing I wanted to say is I certainly wanted to echo Chairman Wardlaw's request
on the budgetary information of what's this look like for the budget hearings that begin early next week. I would really like to be able to get that information. I don't know if that's even possible for somebody on your team to send a text to somebody on your team to see if before we walk out of here today if you guys can specifically address if we're going to see this reflected in your budget proposals for the future year that we're going to be, you know, making these budget decisions on.
I also had a couple questions pertaining specifically to some processes on the
current wait list. So I know that there is a pretty intensive
process, application. You guys have to, I'm certain, weed through applications, information, things that aren't completed, things that get lost. I've heard numerous stories of how difficult that is from a family's perspective.
close to a family that went through this uh took you know a substantial amount of time as we're looking at the number i think it's you know 80 8233 or so that are currently on the waiver 2464 who are on the wait list with all of those families i'm i'm certain that there are others who are currently in application to get on can you talk about the ability that we may have
to improve this process oh yeah i'm
Speaker 186
1:19:36
gonna i'm gonna ask jennifer because she has been working with the dds team on multiple fronts because there's definitely room for improvement on the application process and we do admit that things are often lost we get that complaint a lot so we're doing a lot of efforts at dds to try to uh do more electronic systems to track this so i'm gonna let her talk about that
Speaker 262
1:20:02
yeah i appreciate the question and we're multiple fronts so we're
Speaker 151
1:20:05
looking for opportunities in the waiver renewal to make that process better for families and less cumbersome as well as implementing several i.t solutions like miss weatherton was talking about That'll make it more electronic and having a portal so that documentation isn't perhaps lost in email or snail mail. So that we have a repository, a database where all of that information is going to in one place. And we're also working on several communications.
So making communication better up front with families that have applied for the wait list and when they achieve getting eligibility. more member-friendly and just better information to help families navigate what can be a very complex system. And I'll say across the board,
Speaker 252
1:20:54
something that I think is going to really improve our customer service at
Speaker 186
1:20:59
the department is it'll be coming before you guys in October, ALC. We are putting out a customer service center contract. That contract will be before you. Not only is this
going to improve DDS. But the goal of this contract is for eventually the Medicaid beneficiaries to have a one-stop shop, one phone number, one way they can chat, have an app on their phone, try to move into more technology where they will receive accurate information. Part of what we ask this contractor to do is kind of infiltrate our office, start doing script building, start learning our policy start learning what we're telling people so you're so people can stop being bounced across
our department because we know that is happening and so that contract's a huge contract they're also going to do outbound verification for our community engagement and work requirements that are going to start in january it's a huge contract it'll be coming to you guys um that week next week actually so on that no offense at all when i asked
Representative Jeff Wardlaw
Unverified
1:22:02
this but 10 years ago or so maybe
eight we started a division over there called dipsqua yes wasn't it supposed to do all that no sir well
Speaker 232
1:22:19
other because i've been asking for that for 10 years so if their provider so dips was provider it's in the name provider relations so what i'm What are we doing with the customer service center's beneficiary relations? Were you in
Speaker 269
1:22:30
here when I talked to the UAMS people earlier? I was. I guess
Representative Jeff Wardlaw
Unverified
1:22:34
so. Yeah, and you are a lawyer. We all know that about you. So don't try to outlaw
Speaker 272
1:22:41
us, please. Okay, I know. Representative Long. Oh, I wasn't finished if I can be permitted to continue.
Representative Ryan A. Rose
Unverified
1:22:46
Yeah, go ahead, finish, and then I'm going to work. Thank you. I appreciate your questions, though. So I'm kind of on a path here because I was shocked when hearing from,
talking with, and listening to families. I was shocked the amount of, like, handwritten paperwork that had to be submitted. And, you know, in business, I've had to submit paperwork, and you send this certified mail. You want to make sure it's not lost. And so this is shocking to me that we don't have a portal at this time, and it's not towards any individual at this time.
that was just shocking to me, something of this magnitude was just being handled in terms of paperwork sitting on somebody's desk. Do you know how many pages are required for a family to apply to get on the wait list? I know
Allison Guthrie
Unverified
1:23:36
it's a lot. And part of that is, you know, this is a very, well, very needed service to be on the waiver. It's very critical, too, that we have the best information possible to make sure we're only approving those who truly are of the highest need of, and like
we said earlier, potential need for an institutional level of care. And so it's very important, and I know
Speaker 151
1:24:00
it's cumbersome, that we have accurate records and documentation and assessments and really fully understand the picture of what an individual is going through to make that determination. once you're
Allison Guthrie
Unverified
1:24:12
determined eligible this it's very rare that we say someone is no longer eligible for this service sure and
Representative Ryan A. Rose
Unverified
1:24:20
I appreciate that and and I'm not necessarily advocating for a less
rigorous process I had some this is for the benefit of all of us on this committee I had some understanding through some family friends who went through the process of applying but it's really been in the last six months that I've become a little more educated on this process When you say it's a lot of paperwork, do you
Allison Guthrie
Unverified
1:24:47
mean 10 pages? I think it varies. We have forms that you report on called area of
Speaker 151
1:24:52
needs, which is several pages long, where you're documenting really your functional impairments
and how your disability is affecting your everyday life. But then we also request testing. Testing alone can be many, many pages depending on the level of IQ, adaptive functioning. I mean all the things we're also looking at if you're school age your school records so your IEP that documentation documentation from your perhaps physician there
Speaker 149
1:25:19
are a lot of things that we're asking so so significantly more I
Representative Ryan A. Rose
Unverified
1:25:24
mean we could be getting into the realm of 100 pages
or more for an application for a family
potentially yes so you mentioned that you're working towards a portal, how soon would that portal be active? We're hoping to
Speaker 262
1:25:39
bring on the most, the biggest piece of it in December and then adding enhancements to it throughout 2027.
Representative Ryan A. Rose
Unverified
1:25:46
All right, I'll begin wrapping up. Are there currently, and I understand, and for those who may not, and you could correct me if I'm wrong, I understand vacancies on the waiver only occur if an individual who's on the waiver
either leaves the state or is deceased. Is
Speaker 262
1:26:04
that correct? Or goes to skilled nursing facility or an ICF. So a lot of those individuals,
Representative Ryan A. Rose
Unverified
1:26:11
especially as they go older. A transition of what services they're receiving. Do we have any current
Allison Guthrie
Unverified
1:26:21
Representative Rose. Like that changes on a day-to-day basis. Just tracking alone, we're averaging around 150 individuals a year that leave for one of those reasons.
Representative Ryan A. Rose
Unverified
1:26:31
Are there also slots that are held vacant? Is this for children that may be in foster
Allison Guthrie
Unverified
1:26:38
care? That is also accurate. We hold a number of slots for what
Speaker 151
1:26:42
we currently have approved in our CMS waiver for a priority, which is children in DCFS custody, adults in
Allison Guthrie
Unverified
1:26:50
APS custody, and individuals wishing to transition out of an institution like an intermediate care facility. And I'll be true
Representative Ryan A. Rose
Unverified
1:26:57
to my point that I was wrapping up my questions.
do you know offhand the actively on the wait list the longest that somebody has currently been in waiting? Three years and one month. Okay so 37 months that they've been in waiting and if I understand it correctly is this first come first serve or is there some type of triage based on high acuity low acuity? It is
Allison Guthrie
Unverified
1:27:22
based on order of application and the date you're found eligible for the services okay all right i'll hop
Representative Ryan A. Rose
Unverified
1:27:28
out for now thank you for the latitude representative long
Speaker 287
1:27:34
thank you mr chairman um i'm in my first term on this committee so i'm
Representative Wayne Long
Unverified
1:27:38
trying to catch up here what what were the four thing or four categories you mentioned uh that the waiver uh is for because like you said everything else is provided so the excuse me not the waiver the waiting list what what was those four categories again and if for us new people if you wouldn't mind give us two or three examples of what each of those categories would provide so supportive living
Allison Guthrie
Unverified
1:28:05
is definitely the most requested and number one service that is utilized under the waiver and that is to have staff provider agencies provide staff to your loved one in their home and community it It helps with the activities of daily living, helps them learn how to budget, cook. Its goal is really to help create greater independence, but also there's a safety component, too. So you're having someone making sure you don't leave the stove on and perhaps start a fire or you may need assistance with toileting.
Speaker 151
1:28:43
So there are a wide variety of things that supported living can really help support someone with. The other services provide additional supports, so like home modifications. Say you need, because of your disability,
Allison Guthrie
Unverified
1:28:59
a shower bar or a specific toileting equipment, or you need the doorway widened even to get your wheelchair through the door. And so it's a very specific service that allows these families and providers
to work together to do three bids. they come back with, and there's a lot of rules and processes in place around that, but it allows families to then
Speaker 151
1:29:24
get those home modifications that are needed to help them live more independent and in their homes and communities. And then one of the other ones that's really utilized is the specialized medical equipment. And again, that was what I was saying about the DME extender, so the durable medical equipment that would not be exactly available
Allison Guthrie
Unverified
1:29:45
under the current state plan. It allows them to get specialized wipes or some over-the-counter medications in some instances, incontinence supplies, gloves, things, again, related specifically to that person's very person-centered specific disability. I was trying to keep
Representative Wayne Long
Unverified
1:30:03
up with her. Is that three that you just named off?
Speaker 151
1:30:08
Another service is supplemental supports, like Ms. Weatherton was saying, and that's as an ad-needed basis.
For adults, there is a transition service,
Allison Guthrie
Unverified
1:30:19
so when you're transitioning to your own apartment or house, we're able to provide you with some, like, say you need a washing machine or you need to pay your security deposit. It's not for room and board, and it's not a reoccurring expense, but we are able to support adults moving into their own homes in some one-time payment situations. And on average,
Representative Wayne Long
Unverified
1:30:42
what would be the savings to the state by doing this program and keeping people in their home versus if they had to be institutionalized?
Speaker 151
1:30:51
So that is part of the CMS waiver and approval process. We have to show cost neutrality that providing home and community-based services is a cost savings to institutionalizing individuals. So as long as it's neutral,
Representative Wayne Long
Unverified
1:31:03
you're okay? That's right. Okay. Thank you very much. Appreciate it. You're most welcome. Representative
Speaker 294
1:31:10
Grammich. Thank you very much Mr. Chairman. Very convoluted. There's a lot of
Speaker 296
1:31:16
stuff going on but like you know I met with some of the some providers and it's kind of with Representative Long's thing but it seems to me that if we can get these children's services and this won't happen for every child but you can get these children's services you can take them from going to be institutionalized and having one-to-one care and like really really expensive to giving them the supports and the stuff that they need.
so that you can start doing the supportive living. And so instead of one person watching one person, you have one person helping out four people. And so we're able to help more people at the same price. And so I think that's the way to go with this. And if we don't get these people on waivers and start getting them services that we need to, then it's just costing more to the state and to the taxpayer. And then, too, I get worried, too. like if we don't what happens to these people are these people who have just severe levels of autism
this end up on the streets or I mean there's some of that stuff and I see a big homeless population issue in my area right now and so and I just see this as a big piece to some of the larger problems we have and we got to move in this not just for families but for our communities so I'm supportive of finding the way to end this and finding the money but also like there's a provider issue we don't have enough providers even if we emptied it now like we don't have the providers to do all this work yet do we so how is there plans for that
Speaker 252
1:32:44
or so i think it's a distinction um we have
a very good provider network in this space it's the
Speaker 186
1:32:50
it's the direct care worker that works for the provider so i like to make that distinction because the providers like me to make that distinction um they do a good job that's it's that it's that front level worker and um again You know that rate increase will go into effect January 1 for this service So we do feel like that will be helpful. Okay, thank you very much
Representative R. Scott Richardson
Unverified
1:33:17
Representative Richardson Richardson Thank you, mr. Chair. Thank you guys for being here and
Trying to walk my way through all of this, but I got some quite my questions for you I think are rather simple. So past system has been in existence since 17, right? We're about 10 years into this, and what I'm hearing you say just a minute ago is that you guys are working on some IT systems, some marketing material, or making communication better, some cumbersome paperwork. Has this been from day one?
Have we had these same challenges since day one, since starting this in
Speaker 186
1:33:54
2017, 2018? So the past, we went full managed care in 2019. This really is not tied to the past. this is tied to the division and how we're doing the wait list you have to one of the things that I keep reminding myself was we didn't have a wait list so what's happened is is that we missed a window to putting critical IT infrastructure in place when we cleared it because we were only
getting about 450 people signing up a year and that was manageable that was manageable to keep up with. 2,400 people on a wait list that's not being captured in a pretty sophisticated system and tracking applications and paperwork is not manageable. So I think it just got away from us. Okay, it got away from you. Okay, I'll
Representative R. Scott Richardson
Unverified
1:34:45
leave it at that. Thank you. What caused
Representative Jeff Wardlaw
Unverified
1:34:51
that influx of people to sign up on the waiting list where it went from 400 people a
year to where you are now walk us through how that took place and where that came
Speaker 185
1:35:03
from so that's our average um we get about four or five hundred applications
Representative Jeff Wardlaw
Unverified
1:35:08
a year and since 2022 we've piled up to where we are now yes sir okay well that makes sense uh representative
Representative Denise Jones Ennett
Unverified
1:35:17
in it thank you mr chairman i have another question i don't know if you can answer this um somebody just mentioned about the rate increase in January um when that takes effect how much
Speaker 186
1:35:31
wages so when when we set Medicaid rates we set we set a rate for a service so we are setting a rate um increase for the service of supportive living so there's no correlation we have no control over the correlation between what an employee an employer pays their employee they bill us for the service that being said these providers are very
aware that they need to be able to pay people more to recruit and I cannot imagine one single DD provider that we work with that is not going to put this spending towards their workforce. Thank you. Representative Rose you're recognized. Thanks chairman. I want
Representative Ryan A. Rose
Unverified
1:36:26
to make sure I remember hearing you correctly. Somebody mentioned the number I think a couple
of times 150 is that about how many am I remembering that correctly that's how many rotate in or out roughly on
Speaker 262
1:36:47
the waiver annually that's correct sir on the people that fall into one of those move out
Representative Ryan A. Rose
Unverified
1:36:53
of state nursing home roughly 150 slots will open and roughly be filled each year yes sir that's the waiver itself now i imagine on some level the wait list itself also may have some people transition off for similar reasons.
Is that correct? It could. Yes, sir. So I was just thinking, you earlier told me that I think it was 37 months that an individual was the longest active on the wait list. If we've got, was it 2,446 or so that are on the wait list, And if we're transitioning 150 in, if you just get on the wait list today, you're looking at over 16 years waiting to go from the wait list to the waiver.
Is that correct? Based on the numbers we just
Speaker 151
1:37:50
yes. Assuming my math is correct. Right. And so we're tracking not yet the average wait time, but who's at the top of the wait list. And so today, at the top of the wait list, it is three years
Representative Ryan A. Rose
Unverified
1:38:04
and one month since they became eligible. I understand not wanting to track the wait time at present. And I get you didn't have a wait list, and now you do. But, I mean, if you're saying with pretty strong confidence you're rotating in about 150 a year with the current cap on the waiver,
To get the last person who was just added to the wait list at 150 new people on every year, that's about a 16-and-a-half-year wait. And so I just think we need
Senator Missy Irvin
Unverified
1:38:36
Thank you. I just want to make sure that we're clear just in response to your questions. No, there was a wait list. I mean, and so we took action in 2022. we were able to find the funding to do that and so we did at that time but you never do clear it
like at that time we we were able to take care of those those folks but it was not an immediate it was a three-year plan because the funding because of you know the funding to be frank with you um so it took three years to get those folks but um yeah so even if even though we passed the legislation to do that it still took a three-year time frame for those people so i'm not sure if they have been how long they have been waiting because the last time you know it went from i guess just
according to the testimony 75 people in 1988 1990 it was 457 and then 2020 we were already at 5200 and then that we just continued to add, but then added another 3,000 in 2022, but it took a three-year plan to do that. So I just want to make sure we're clear about that. Thank you.
Representative Jeremy Wooldridge
Unverified
1:39:58
Representative Woolridge. Thank you, Mr. Chair. And I think my questions may be a follow-up to what Senator Irvin was discussing. So, you've identified what the biggest expenditures are, and we've talked about what it would cost to get to a zero wait list. And I know you had mentioned earlier you have projections of what that would look like to continue just to keep a cleared list. So, are those projections based on a growth per year? What would that projection be? Is that something you can share with us of what you think it would be or what the commitment of this body would be to keep that as a cleared waiting list?
Speaker 186
1:40:34
These are rough projections. The only thing we have to go off of is because when we did clear the list in 22, and we did, we added those slots and watched, on average, how long it has taken to get back up to this spot, right? So about, well, we stopped in 21. It's been five years. This December will have been five years since those people were kind of frozen on the list, and we said, okay, this is the list that gets cleared.
in 22 so if you just think about we have about 2500 people that have built up over the last five years and those are the projections um that we're going off of um to try to figure out how much we would need in addition if we were able to clear the list today what we would need um on an annual basis the increase um for people that would come on and apply right and 150 people a year that leave
and how that would be offset so so
Representative Jeremy Wooldridge
Unverified
1:41:43
what is that number i will get you that number okay because i guess what i'm trying to wrap my head around in in defense of you all you can only do what we allot you to do financially so if we choose to wait and clear the list every three years or five years You know, whether that's a good practice or not, it's debatable amongst the body, but you have to work within the confines of the expenditure that you're given. So I guess I'm wanting to know what would be an annual growth projection that we would need to look at every year to say that we don't want there to be a waiting list moving forward.
So not only will we try to clear this waiting list, but we want to be forward thinking and plan to make sure that the wait list doesn't backstack again. So thank you for
Representative Jack Ladyman
Unverified
1:42:29
that. Thank you, Mr. Chair. representative lederman thank you mr.
chairman well folks we're asking them questions they can't answer you don't know how many people are going to be getting on that list nobody knows that but I know one of the reasons for that is that when you look at the people on this list and the people in this program
that's a very small percentage of our population there are people out there who need to be on that list that aren't on there for a number of reasons. Number one, they may not know about the program. There are people that don't know about this program that need this program. You know, I've taken my son to places, and people have asked me about it, and then I find out they have a daughter that needs this service. They have no clue. So the more publicity out there, the more you're – folks, let's don't fool ourselves.
This list is never going to be zero. it is going to grow uh now hopefully we can slow it down but we get more population we get more babies born you know these ailments are going to be with us forever so you you can't unless you've got a crystal ball somewhere ahead you you can't talk about how much that list is going to grow you have no idea because there's too many uh parameters that we don't know about uh so it's
it's going to grow. But when we cleared that list of those 3,000 people, I talked to people that have been on that list for 10 years. And that's one reason we took the action that we did because the people further down the list were 10, 12 years. They'd been on there. Some of them passed away. They did. So Representative Woodridge makes a good point there is we've got to figure out how we take care of the growth but we don't know what that is maybe we'll be able
to see that better when the list clears that wasn't really a question do you agree yes sir i think
Chair (Representative Jeff Wardlaw)
Unverified
1:44:37
they find it hard to agree or disagree so we all understand the positions
Representative Jeff Wardlaw
Unverified
1:44:44
so with that members seeing no further questions for the agency I want to thank you guys that's not been an easy place to set today appreciate it and we'll move on to testimony from the public yes Senator Irvin
will say something as y'all leave and I just
Senator Missy Irvin
Unverified
1:44:59
again want to echo thank you to our our agency folks really really appreciate the very thorough discussion because this is the appropriate place to have it in public health committee meeting because budget hearings are starting and so really really good thank y'all so much good clear information and we look forward to the follow-up from members questions on the financial parameters thanks with that we'll move on to David Watson
Representative Jeff Wardlaw
Unverified
1:45:31
everybody understands the rules no reason to repeat them right good I like it if you would mr watson uh please state your name uh who you represent and then you are recognized to give your testimony you have to hit that button turn it green perfect thanks
David Watson
Unverified
1:46:04
never done this before so uh i'm a newbie at this um yes thank you for allowing me to speak my name is david watson i'm a retired business owner but i'm not here uh because i owned a business i'm a citizen who uh my wife and i over the years have um had over 40 children in our home as foster parents we adopted two children out of foster care one of our
daughters Mariah has an intellectual disability she is doing
David Watson
Unverified
1:46:55
finished the two-year program at Arkansas State how program for young adults with intellectual disability about two weeks ago she was able to start employment as a teacher assistant at access school and
like many young adults in her situation she wants meaningful work which he just now has, friends, greater independence, and eventually a place to live outside her parents' home. She's currently in the process of becoming, or in the application process for Easter Seals roommate housing. However, Mariah is on the CES waiver wait list. She entered that list
uh on uh february 5th 2004 that's two years and eight months that she's been on the list they're over has already been uh recognized or stated uh by uh several people here today and i want to thank jennifer and melissa they've been very helpful as i've done some extensive research and uh their numbers concur with with what uh i have been able to gather as well uh so
i don't want to repeat a lot of the testimony that's already been uh presented uh very well but mariah is one of those 2 464 people who are on the wait list but she's
Speaker 322
1:48:49
daughter um didn't know where that came from but anyway um I use
David Watson
Unverified
1:48:57
her as an example of a child a
young adult who needs the services that she can't get unless she's off the wait list and has ces waiver services provided one thing i do want to change from the test the written testimony and documentation that i sent in i was estimating about 10 people a month leaving 120 people leaving the wait list and going on to service per year however that was clarified that it's
about 150 a year are 12.5 so i had a number of 20 years um not uh 16.4 years that if the person who's last on the list will take
David Watson
Unverified
1:50:02
uh presented uh there are uh there was a significant bump in a number of the number of slots available from about 5,000 or 4,763 slots in 2019 to 8,233
slots today and yet we have a wait list that has increased and the math that I put on the wrote down as there the testimony before me stated about 150 people leave a year and get on onto the ces uh services and about 500 are added so we're we're have a net increase per year of an average of 350 people so that unless we make changes
Speaker 329
1:50:49
and how we go about things we will have a perpetual growing wait list uh
David Watson
Unverified
1:50:57
and and people will wait even longer than 16.4 years so the question is not how many slots has Arkansas added it's how do we build a system in which eligible disabled Arkansans can actually receive services how do we prevent another large wait list from rebuilding our research my research
has pointed to three things that have already been addressed, but I'll just recap them without going through all the numbers. You can review my numbers in the packet that I sent to several of you on the committee. First of all, we need to expand, address the existing eligible waiting population with a measurable plan for adding the capacity needed to serve them. My research concurs with what was already presented, $173 million is needed to eliminate the wait list of which the federal government would provide approximately 30% or 70% and the state would be responsible for 30%, which is my number, so 53 million.
So we're very close in the number that was already presented of 50 million. Secondly, we need to build the provider and direct support workforce necessary to turn the authorized capacity into actual services. In my dialogue with several of the agencies or service providers, they're competing against the
Speaker 329
1:52:42
McDonald's, the Walmarts of the world
that are paying $2 to $3, $4 more per hour for direct cert for this type of workers that we would need. So, sir, it's a very sensitive matter, and I hate to
Representative Jeff Wardlaw
Unverified
1:52:57
stop you, but I'm going to stop you for a second. Okay. The service you mentioned your daughter needed, if I was listening correctly, and Melissa, I'm going to need you to pay attention here. The service you were asking for your daughter that she needs and she's on this waiting list is going
to be corrected in January with them allowing the supportive living service to be on the waiting list.
This testimony we're hearing today, if you read the agenda, is based on
the service that the governor has now initiated through people that are on the waiting list. It's not necessarily about the slots on the waiting list. Now, we let the members ask questions to the agency so they can understand the budgeting process on the slots, but
today's meeting is basically about where the new service is and how that new service is applied to the people on
David Watson
Unverified
1:53:53
the waiting list. Does that make sense? Yes, and let me just kind of respond to your statement or question.
I'm aware of the $17 million announcement. What I haven't been able to discern or figure out is, was that $17 million only Arkansas's portion, or was that? It is. Okay. That's easy. It is. Okay. Thanks for the clarification, because
Speaker 325
1:54:18
I didn't know that. Roughly $58 million total. Okay. Because I've
David Watson
Unverified
1:54:24
tried to get the information. I've asked, well, how does that practically work for our daughter specifically?
Representative Jeff Wardlaw
Unverified
1:54:36
helps by she's now eligible for the Easter Seals living at January. This is where Melissa needs to pay attention because I
Speaker 325
1:54:45
need a head nod. Yeah, I talked to several people. Senator Dotson
Chair (Representative Jeff Wardlaw)
Unverified
1:54:49
is causing us problems at the
David Watson
Unverified
1:54:52
moment, but go ahead. Okay, well, I talked directly to Easter Seals roommate housing within the last two weeks since the announcement thinking oh great my daughter will be eligible and they said nothing
is filtered to us exactly how that money would be implemented and until we get official notice your daughter has to be on the ces waiver for us to give for her to be able to be part of and that is 100 true to
David Watson
Unverified
1:55:22
good news i'm so thankful that she will be eligible January 1 but I want to make that clear on
Representative Jeff Wardlaw
Unverified
1:55:29
the testimony today from the public that's what we're here to talk about today okay the new service that is eligible to the folks on the
waiting list we're not talking about the slots at this point that conversation
will happen but today it's about the service that's being applied
David Watson
Unverified
1:55:54
being applied will be very beneficial to my daughter and others like her that needs supporting supportive living services so I I'm I applaud Governor Sanders announcement and efforts to make that happen I've acknowledged that to her both in in various forms and so I'm I'm I'm thankful
that there's been a very positive step forward and in no way want to imply that she's not making good effort to help alleviate the issue at hand. I think the other question or other thing that's already been addressed is how do we maintain a system in which we don't have a perpetual growing problem but that we address these things so families aren't waiting for for months or
years or decades and so that I think is the other issue so while my daughter Mariah will be a direct beneficiary of the new 17 million dollar or 58 million dollar announcement come January 1 there There are at least 2,463 other people that may or may not be beneficiaries of that funding that's now been made available.
So I'm not here just for my daughter. I represent a whole host of people who have waited a
David Watson
Unverified
1:57:35
really my testimony. I wanted to bring, it's easy to talk about numbers and money in a real theoretical
Speaker 325
1:57:45
way, but I'm here as a dad that has a daughter that has needs.
David Watson
Unverified
1:57:57
And I think we, as fellow human beings and citizens, need to do everything we can to help provide for the most vulnerable of those who live among us, including my daughter, Mariah. And I thank you for allowing me to speak. I've never done this before, so I'm new at it. so if i hopefully didn't step out of the out of the lane too much but i appreciate you guys
allowing me to be here today and and and provide testimony and i've got lots of documentation you've got questions but i think most of the answers have already been uh been answered by melissa and jennifer uh and and so um anyway thank you i just want to tell you you made it look easy
Representative Jeff Wardlaw
Unverified
1:58:57
testify at this committee and totally lock up and it is a very intimidating process and a very intimidating
place to sit and you made it look easy so for the first time mariah can be very proud of her dad he did
a good job so with that uh seeing no questions i thank you and as you and your other members of the public have handouts you can catch members when committee's over and hand that to committee members as you see fit but thank you for your testimony your thank you so blake landers again mr landers
don't want to repeat the rules but let's try not to repeat anything that's been
said um keep it on the service not on the waiver slots and you are recognized to introduce yourself to the committee and
Speaker 337
1:59:54
i want to thank um the chair uh and and and miss urban thank you very much and the senate for listening to us um you know i know you guys are very busy um and and we don't want to i personally don't want to take up too much of your time today um because there's there's um there's so many things
that you know we could talk about with the ces waiver and and thank you guys so much for asking some of the questions as some of the same questions i had uh coming in today um and thank you to jennifer and thank you to melissa for um your diligence here and also answering the questions in a uh a very uh easy way to understand because i know that that was probably uh some of the um some some of the issues i think that me and some of the other parents are having um but my daughter charlie landers she's uh four years old we had her in um october of 2022
she has a severe developmental disorder a rare genetic condition called ctnnb1 we've been navigating the unknown for about two years and um you know it hadn't been the easiest uh however um you know we just kind of put our faith in in in the lord and and we pray every day and and you know we work as hard as we can so um i just want to thank you guys for listening to us
today but some of the questions that um i had and uh i think some of the parents had were you know know when we're we're discussing this 17 million being allocated we're nothing but grateful and appreciative of that because there's been so many parents that haven't had that but some of the questions you know that that presents to me is you know I sell cars that's what I do you guys are you guys are really good at what y'all do and I know y'all are very intelligent and I know y'all you guys are always coming with a good game plan and when I sell cars a lot of people come in that
are on fixed income fixed income usually averages around two thousand dollars of people that can't typically get an auto loan their credit scores are below 500 below 550 they're they're in a position that they need help and and and you know it's so many times I have to tell them no and walk them to the door and that that's hard for me um but it happens and I think that when we talk about the
17 million being um allocated towards uh supportive living I don't know if we touch base on this and maybe I missed it uh but was it 17 million for those families that are um that are currently waiting is that close to what 550 575 per family per month I don't know if we touched on that or not Senator Warren well well you
Representative Jeff Wardlaw
Unverified
2:02:54
can't typically we don't allow public to ask questions but I'm giving a lot of lead way today sorry but you can't
really take that 17 million and divide it that way
because you've got 70 percent match from the federal government so you're looking at roughly 58 million dollars this will be allocated to the new service not 17 million does that make sense So that messes your math completely up, but that's the way you have to look at this. You have to put the federal match in
Senator Missy Irvin
Unverified
2:03:27
those dollar figures. That makes completely sense. And, and it also depends on the person, person centered, uh, review. So, you know, it, it's not an across the board.
Some, some people may need more, some people may need less, and that's determined based on that assessment that's done. So I would just say it's hard to do it that way. Yes, ma'am. But this is a good discussion, and I
think it's important to have good information out there. Yes, sir. Okay. Well, that does
Speaker 337
2:03:59
absolutely mess my math completely up. However, when we put that in, I mean, I guess what does it look like to families? Because I know that right now I'm spending about $30,000 to $35,000 a year out of my pocket for health care for my daughter.
because um her her daycare had to kick her out and and not it's not because they wanted to they were really good with her it's just they didn't have the staff to be able to provide for you know the ratio that they had i think it was one to ten um whatever the ratio is mandated in arkansas i mean they followed it they're they're a christian-based daycare they're great but i mean 30 to 35 000 a year that's i mean breaking broken up all over the waiters i just i feel like we're We're going to come up a little bit short of what some of those people need
to be able to provide for their children. However, I just want us to, you know, with the CES waiver, please all look into this when we come to General Assembly possibly. And, you know, all of us come together to maybe get a good plan revised for the waiters because there's not a lot of families that can afford that in Arkansas, the $30,000 to $35,000. And I know I've had thousands of families reach out to me over Facebook. I've had a few posts go viral just kind of asking why a lot of the questions
that I think we all have. And, yeah, I just wanted to say thank you to you guys. And I appreciate each and every one of you all for looking into this. My daughter, I know the families and the children across the state of Arkansas really appreciate each and every one of you guys. And, again, with, you know, Jennifer, I think if you look at the grand scheme of things, she hasn't been here in her position for a long time. She kind of adopted this as she came into her position. But I think she's done a remarkable job.
She's always answered every question I've ever had with DHS, DDS. And, you know, I can't thank them enough for continually putting forth the effort. I do want us to really focus on this coming up fiscal session if possible. And, again, I just want to say thank you guys, and
Representative Jeff Wardlaw
Unverified
2:06:09
God bless you. Thank you. And I would say that's one reason I've allowed your questions from the chairs, because this is
a very important discussion. These are some of the most vulnerable. And thank you for your testimony. Thank you.
Senator Missy Irvin
Unverified
2:06:23
Yeah, hold on one second, Mr. Landry. And you brought up an issue that is like a crisis in the state of Arkansas for every family, which is child care. Child care is really a crisis. And we are looking and trying to focus on child care policy across the board for all families because that is a
huge, huge issue. So that is policy that is being really, really strongly considered, just FYI. That's wonderful.
Representative Jeff Wardlaw
Unverified
2:06:53
Thank you very much. Thank you. Ms. Page McCommon.
And, guys, I'll tell you right off, I'm not running again, so I'm more apt to say things that I
normally wouldn't say. But never try to take a government equation and do 2 plus 2 and think it equals 4 because I've been here 16 years, and I've never been able to make that equal 4 in my life. But, Ms. McCommon, if you would introduce yourself for the record
Speaker 345
2:07:25
and you're recognized, give your testimony. My name is Paige McCammon. First and foremost, I'm Turner and Cord's mom. That's my most prized role. I
Speaker 346
2:07:37
was a public school teacher for six years. I taught fifth grade math and science. My favorite part about it, I ended up getting to be the inclusion teacher. I got to see what that was like to have our special ed kids come into our classroom, our gen ed. And that was my first run around with disability. I think that God was setting me up there before I even knew it that I was going to have a disabled child myself.
Um, I am here today, not only to just speak of my story, um, I have been online more than I would like to admit, letting everybody know the truth behind what it's like to have a disabled child here in Arkansas. Um, not even specifically the trauma that you have as a parent, um, medical trauma as a parent is something that I can't even truly put into words. When you look at the rating scale, I'm a school counselor, forgot to say that, school counselor, so mental health is huge for me.
When you look at a rating scale of war veterans and you look at parents of kids with complex medical needs, they are extremely close on the amount of stress because you are always, always alert and ready to meet your child's need, and that child's need is not an if, it's a when. So these aren't hypothetical things that can happen to your kid. These are things that are going to happen. You've seen it before. So having all these issues, I started collecting stories from Arkansas families
and reviewed 36 independent submitted cases involving the CES waiver, Medicaid Disability Services Pass, and Care Coordination. And I found that the same problems I was having kept showing up across families who do not know each other. So I went bigger and conducted a statewide survey. The survey had 258 participants from across Arkansas with more than 200 people answering every major question. I know that it's not every family in Arkansas, and I don't pretend that it is. That's actually a very small amount compared to the amount that we have here that are disabled.
But when hundreds of people with different disabilities, circumstances, and experiences in the system start telling you the same things, I think we're past the point of pretending there are just a few families who have had bad experiences. So from that, my family is living a lot what showed up in those reports, and I've got a few examples from today. So Turner is 2 years old. He has level 3 autism, Parkinsonism, regression similar to childhood dementia, and severe medication-resistant epilepsy that is caused by a rare neurodegenerative and progressive disease called DHDDS.
Most days, I can physically count my son having about 50 seizures. That is what I can only see. His last EEG showed he's having more than that. My brain never really shuts off because I'm constantly watching him and trying to figure out what I'm seeing. I decide whether something is another seizure or the beginning of a cluster, whether he needs rescue medicine, whether I need to call neurology, or whether this time we just need to drive to the hospital or call 911.
If he gets really quiet, I have to figure out whether he is just tired, had too many seizures in post-ectal phase, his blood sugar might be dropping, or if he's hungry, thirsty, anything. It's constant. Then we practically live at Arkansas Children's between appointments, testing, hospitalizations, medication changes, and specialists. His condition is actually so rare that most of his care does not even exist here in Arkansas. We travel across the country for it.
Actually, this past Sunday, I just got back from Mount Sinai in New York City, which is fully funded from my own pocket. Clinical trials is not what people believe. It's another damper on my finances. And then, somewhere in the middle of all that, I'm also trying to maintain a full-time job as an elementary school counselor and be a mom to my other little boy, Cord, who's three, an older brother, who is just as impacted by this as we are. And then I get to spend what time I have left, which is pretty much none, fighting the system that is supposed to be helping us.
We keep hearing that people on the CES waiver wait list still have access to services through pass. I have a problem with calling something accessible because it technically says it's covered on paper. If a family has to get denied over and over, appeal those denials, and eventually go to a state fair trial hearing just to try to get a service, I don't know how we can seriously call that access. A child can spend months going without something they need while their parents do everything they were told to do, and at the end of the day, they can still lose it. And the numbers from my survey back that up.
In the 36 family cases I reviewed, a quarter involved problems with medically necessary services or equipment, including denials of things prescribed by doctors and delays in medically necessary care. 44% involved serious delays in getting decisions or services made. Then I asked hundreds more Arkansas families what these problems had actually done to them. Then almost 62% reported delayed therapy or medical care. Almost 40% had lost access completely to their services. And then almost 40% had experienced delayed equipment or supplies.
Speaker 346
2:13:02
amazing gap filler for people sitting on the CES waiver waitlist. We have also been told that people on this wait list are already receiving the life-saving care they need and that CES is not a life-saving service and that the children on the wait list can still receive things like DME equipment through PASS or through EPSDT. I understand that Turner has doctors, seizure medication, hospital care, and emergency medical care, but I genuinely do not understand how DHS can take that back and use it to say that the services he is waiting for are somehow less necessary
because they are not the thing physically keeping him alive in an emergency. I have seven pieces of medical and therapy documentation supporting what my child needs. His neurologist specifically documented that delays in obtaining his in-home support place him at significant and avoidable risk of traumatic brain injury, aspiration, prolonged seizures requiring emergency intervention, and a more severe developmental regression. So if the doctors and professionals actually treating my child are documenting significant and avoidable medical risk from not having these supports,
I have a hard time being told that he is already receiving the life-saving care he needs as if those answer the question. There is a whole lot that can happen to a profoundly disabled child between being perfectly fine and being dead. I should not have to wait until Turner is injured, aspirates, or ends up in an emergency room to finally react and I keep hearing that children on this waitlist can receive things like DME and other services through the pass. Then where are they? My
child's out there not in a medical grade stroller because we can't get it. Turner does not have the equipment we have been fighting for. My child cannot access ABA therapy while he sits on the waiver waitlist. I'm not spending my time fighting for equipment in-home support and therapy because I think these things would be nice to have or that this is a fun meeting to attend. I don't have time to fight over things Turner needs. I'm doing this because I'm scared and because the professionals treating my child are telling me what he needs while the system keeps telling me about everything he's
supposed to be able to already receive, but he does not have it. Supposed to receive DME is not the same thing as having equipment in my house. Supposed to have access to a service is not the same thing as my child actually receiving it. Telling me PASS can fill the gap does not put a worker in my home, put equipment around my child, or get Turner into therapy he needs. If PASS is going to be used as the state's answer for why people can safely remain on the wait list, then where is the accountability when those services do not actually reach my child?
You cannot count a service as evidence that this wait list is okay and federally fine simply because that service exists on paper. You have to look at whether the person actually received it and what's funny is arkansas legislative audit has documented past related compliance problems more than once actually to 2023 past related finding was classified as non-compliance and a material weakness and it was itself a repeated finding then again in 2025 audit again reported a past managed care finding classified as non-compliance and a significant
deficiency but nothing's been done so then you have families like mine we're telling you there are problems and you just heard the numbers from my statewide some from my statewide survey about delayed medical care lost access to services and delayed equipment and supplies so when families are telling you the services are not reaching them the state's own audit has documented compliance problems and then parents are still having to fight denials and appeals to get services that supposedly already exist for their children, I don't understand how we can call
PASS in any shape or form a gap filler. I can show you exactly what that gap has looked like for my family and some transparency issues. On August 12, Turner was denied of supportive living. I know that we have already discussed that, but this is just an example of denial. The denial came from Empower, which is our past provider. It stated he was denied based on his age, development, and current needs. I questioned that denial, appealed it, and then I received Empower's
actual supportive living policy. That policy gave me a better barrier, or a different barrier, excuse me. It said supporting lived was only covered benefit for the CES waiver slot, and since my child did not have a CES waiver slot, he would not receive it. Again, I know that's coming up in January, but that's besides the point of what I'm discussing. I got a denial about one thing. I fought it. I received, I got seven different documentation, turned it in to then be told, just kidding, he does really qualify for that, but we're not giving it to because he's on a
wait list. That's changing the goalpost. If that was the problem in the beginning, why did I have to fight for you to just tell me in the end that I wasn't going to get it? So then on August 14th, I emailed DDS director Jennifer Brzee because I had read Appendix B3 of Arkansas CES waiver. The language I was reading specifically included people for whom waiver services were required, here it is, as an emergency to prevent immediate placement in an institution.
I wasn't asking DDS to create a special exemption for my child. I was asking them to apply language that was literally written in Arkansas's own waiver. I then sent another seven pieces of medical and therapy documentation supporting that request, including Turner's neurologist, specifically stating the unavoidable risks that I've told you about and supported expedited access to the CES waiver to receive that supportive living. On August 20th, Jennifer responded in writing that DDS recognizes only three limited exceptions,
even though it states four, in the normal wait list order. They said it would have to be an administrative or clerical error, someone already admitted to an institution who is being discharged back into the community, or someone in APS or CPS custody. Then her response said, DDS limits exceptions to those situations because they are objective rather than making what DDS called subjective determinations based on someone's level of need, severity, or acuity. But I wasn't asking DDS to decide that Turner deserved to skip the line because I think his needs are worse than somebody else's.
I was asking DDS to apply language already in the CES waiver about services required as an emergency to prevent immediate institutional placement. In that same response, Jennifer acknowledged that the waiver language had relied on was, in quotes, confusing, and said DDS plans to revise that language when the waiver is renewed in 2027. This is what families mean when we say the goalpost keeps moving. This is one in millions of examples.
So Turner was denied supportive living based on his age, development, and needs. When I questioned that, I was given a policy saying, nope, it wasn't because of that, it's because he was on a wait list. Then I went to the CES waiver itself, followed the language written there, and provided seven pieces of professional documentation supporting his need, and the answer was that DDS recognizes three different exceptions and plans to change that language I relied on next year. Meanwhile, I keep hearing about what Turner is supposed to have access to. I'm his mother, I live in the house with him, and I know what we actually have.
So if PASS is an amazing gap filler, then somebody needs to start holding it accountable for whether that gap is actually being filled. because eligibility is not access, coverage is not care, and telling me my child is supposed to receive something does absolutely nothing for him if the service, therapy, or equipment never actually reaches him. And while all this gets discussed in terms of programs, funding, and wait lists, there are actually children getting older and sicker while they wait. In my survey, 38.5% of families reported increased safety concerns,
and 16.7% reported hospitalizations or worsening conditioning while waiting. I personally know a family whose child has a terminal illness who had to turn to hospice care to get what he needed to be comfortable at home because they could not get the care he needed while he sat on the wait list. His family knows their child is dying. They're not asking the state of Arkansas to save a life. They're trying to make the time he has left on this earth safe and comfortable at home with the people who love him. The least our state can give that child is the dignity of living safely at home with his family while he literally wants to die.
In the first 36 families I reviewed, there were already families describing projected waits that could exceed medically meaningful timelines or even life expectancy. I forgot it over there, but I brought a picture of Ava, who has passed. Her family is pretty upset that this is still a problem. I know ending this wait less costs money. I know there is a state budget. I also know that every dollar you are looking at saving has an actual human being sitting on the other side of it. My child is not a budget line item, and I'm done accepting that his quality of life can depend on whether Arkansas decided there was enough room for him in this year's budget.
The people making decisions about this wait list have the luxury of leaving this meeting. Some do, excuse me, I will say excuse me, some have the luxury of leaving the room and not having that decision follow you on the way out. I don't. I go home. I count seizures. I wait to call 911, and I wait for another crisis to happen, because it always does. We live with the consequences of these decisions long after everybody leaves this room. On top of that, my husband has leukemia, and I have another little boy, a three-year-old,
that I'm trying to have a normal life, which is nowhere near. My son, Turner, requires essentially constant supervision, 24-7, and his medical needs and the lack of support have already cost me almost my job and a large majority of my income. There have been times, sitting right now, I can tell you we are financially and emotionally drowning. At one point, actually, I'll tell you three times, I have reached out to the state in writing
and let them know how bad it has gotten, including that I have a history of depression and that the amount of stress we were under was putting me at risk for my suicidal thoughts returning. I actually wrote that I was not including it to be dramatic whatsoever. You should talk to my counselor, talked about the medication that I would need to receive for stress and how my heart actually started having palpitations. Physically, I am going down. I am safe now, but I am not going to make that story prettier
because it is uncomfortable to hear. I knew I wasn't okay, and I asked for help multiple times. I never received a single thing of help other than I was told that I would have to keep my child on the waiver wait list. Nothing was ever offered to me or my child. Not a single thing. I knew I wasn't okay, and I asked for help. But in my survey, 85.4% of families reported emotional stress or burnout. 61% reported financial hardship, and almost half had stopped working or reduced their work.
We are not martyrs. Neither me nor my child, Turner, was put on this earth to inspire anybody about how much we can endure. God did not make me need less sleep. He did not allow my heart to beat faster. Just because Turner's disabled, and he did not give our family an endless supply of money or time or the ability to absorb an unbelievable amount of stress. I am just his mother.
I love him more than anything in this world and on this planet, but I am a human being just like you. At some point, families will figure it out stops being a plan. Parents figuring out is exactly what has allowed a broken system to keep functioning just like this. We keep finding some way to make it through another day because our children leave us with no other choice, but that should never be mistaken for proof that we don't need help because I'm telling you now we do. My survey asked 254 people whether they had ever been told directly or indirectly that
institutional placement, foster care, hospitalization, or a crisis situation could help speed up access to services, and 80 people said yes. That is almost one-third. If the system becomes easier to access after a family reaches crisis, then we have waited far too long to help them. That's not a resource. I started collecting these stories because I needed to know whether that was happening to my family was happening to other people. 36 families told me it was.
Then I asked hundreds more Arkansans, and they told me the same thing. I don't know what else families are supposed to do. Keep coming up here to prove this point. We have told you what this is happening. We have shown you the medical consequences, the financial consequences, and what this is doing to caregivers. Some families have been waiting so long the weight is competing with the amount of time they have left to spend with their child who is dying. I can keep fighting for Turner, and I will, but what I cannot do as his mother is fix a state system that has decided he has to wait for the care he needs.
That is not my responsibility. apparently we have taken it upon ourselves to try to convince you that it is yours. So I'm asking you to stop asking families to survive this wait list while Arkansas figure out how much it is willing to spend on us. Fund the CES waiver at the level it takes to consistently keep the wait list moving, at least. Not just reduce it enough to make the number pretty one time. Because I should be able to go home today and be Turner's mom. Instead, I'm having to keep coming back here.
This is my fourth time in a meeting just like this to convince the state of Arkansas that his life and his quality of life are
Speaker 345
2:27:24
worth funding. Please prioritize my son in the disability community of Arkansas. Thank you. No clapping. No clapping
Chair (Representative Jeff Wardlaw)
Unverified
2:27:32
or I'll have to clear the room. Representative Pilketon, you're recognized for a question. Thank you. I'm
Representative Aaron Pilkington
Unverified
2:27:36
over here, ma'am. Oh, sorry. No, you're all good. I appreciate
your testimony today. I know how difficult this is for you. I tell people all the time, if you think your life's hard,
go sit an hour in the waiting room or the lobby of Children's Hospital, and you will be thankful for all the hardships you have because they're nothing compared to what those parents are going through. Thank you. I have some really small technical questions. So not even that, but I'm just curious. You said you were paying for clinical trials. How much have you paid for clinical trials so far,
Speaker 352
2:28:11
and do you have the name of those companies? Yes, it's through Mount Sinai. Okay. Research Hospital, our doctor is Dr. Eva Marava. She's a geneticist.
At this point, I know we have running, I haven't paid for it all because it's still in money. Just tell me how much it costs.
Representative Aaron Pilkington
Unverified
2:28:32
About $6,000 total so far. Okay. And
Speaker 352
2:28:35
is that one year's, one trial? No, sir. I mean, you're adding in flights to New York City and
Speaker 346
2:28:42
things. That's separate. I didn't even add that. It's all the way through just to have an appointment there is money just in general. But the clinical trials itself, we
Speaker 352
2:28:51
pay out of pocket for those as well.
Monthly, it's about $100 a month for the supplement that he's taking that's the trial. Okay. Thank you. And then
Representative Aaron Pilkington
Unverified
2:29:02
the other one, and some of your questions I've written down, you answered in your testimony later on. On the state fair trials, what would you say the percentage of those you and your other families have won
when you go to those? Oh, I don't want to tell you that because that would be a
Representative Aaron Pilkington
Unverified
2:29:24
data on that, so I don't want to lie to you on that.
That's fine. Yes, sir. That's fine. I don't have that data either. That's why I'm asking you. Yeah, yeah. I can probably try to get it from the passes or DHS. Um, and then my third is, you know, you've surveyed all these families and I'm curious, I'm sure a lot of them used to live in other States, live here now. So I'm sure some have been lifelong Arkansans, so I've never experienced any other States, but I'm, I'm curious how, how does this system compare to some of those other States? Um, you know, that's, I think that's always good for us when we look for solutions to kind of see what maybe some of the surrounding
States are doing. And so I don't know if you've got any testimony from any of those families of some of the programs they've seen
Speaker 352
2:30:08
in other states could you elaborate on that yes and there are several other states that have um
Speaker 346
2:30:14
recently looked at the wait list and have abolished it um i know one state used their i know this doesn't apply to us but they use their medical marijuana fund to completely that is what they have dedicated now they've dedicated yearly that is how they are paying for the waiver um there are states um like pennsylvania i believe is one of them that
has a great program sadly majority of the people that have come here to arkansas have lost their waiver once they have gotten here um so they have had these supports the whole life moved here to the state of arkansas and then have to start from ground one so
Speaker 345
2:30:48
then put on the waiver wait list and like we said before there is no priority so even if this is the worst of the worst case and you move from one state that has a waiver automatically to here you're losing everything And that's where some of that data comes from as well, of complete loss of services.
Representative Aaron Pilkington
Unverified
2:31:04
Okay. Those are the questions I had. Thank you. I appreciate it, man. Thank
Senator Missy Irvin
Unverified
2:31:08
you for your testimony. Thank you. Just to follow up, a complete loss of services of the waiver services. Yes, ma'am. Not Medicaid.
Paige Mccammon
Unverified
2:31:15
Yes, ma'am. Yes. Yes, ma'am. There is some, like when we talked about like therapies, you know what I'm saying? They said therapies are- Maybe a little different. Not,
Speaker 346
2:31:23
yes. And so that is some they will lose as well. basic therapies are covered but like aba therapy is not covered for my child that's two different waivers and i would actually have to take my child off of the waiting list now to even get
Senator Missy Irvin
Unverified
2:31:40
a lot of barriers yeah yeah variations yes okay um representative rose you're recognized thank
Representative Ryan A. Rose
Unverified
2:31:46
you madam chair uh thank you for sharing your story uh, in detail with us today. Uh, I
think it was June 1st or June 2nd. I watched a video that you did in totality, um, at more than once in fact. And so thank you for continuing to fight for your family and, and several other families that I imagine you continue to connect with every single
day. Um, just, just for, uh, the sake of, of understanding, uh, for some who maybe haven't heard your story or aren't as familiar with this waiver, uh, did you and your
application to get on the wait list? Was it a smooth process? No, sir. Um, I would
Speaker 352
2:32:31
say that was actually one of the layers that led to me to suicidal ideation was how many times I had to turn in my CES waiver application and thank you for for bringing that up
Speaker 346
2:32:46
the depending on the size of the font it can
be different pages but mine was exactly 108 pages that I had to fill out and you basically if you go and read the questions I mean they're very detailed asking how long like basically how long can your child survive in a room I mean that's what you're going through and and answering how long would it take them to put their finger in this plug I mean they're thoughtful questions and I made the mistake in the very beginning of thinking that I could trust that this paperwork
Speaker 352
2:33:15
be mailed and I did not make a copy and that is my my boo-boo but I will not make again I mailed it off kept following
Speaker 346
2:33:26
up following up um somebody told me yeah I got I'm pretty sure I've seen it nothing nothing I finally get to talk to somebody and they're like no it never got to us
Speaker 352
2:33:39
so I refailed out again um i went to the post office to actually get it certified mail so i could track it and um so refilled out
Speaker 346
2:33:50
all those things again and sent it uh through the mail i received a notification that it was dropped off at the dhs office and it sat there i called like every other
day hey does somebody have it because my child's number is not going to be placed on that waiver waitlist until they run it it doesn't it's not when i send it in it's when they put it in i mean it took months i mean i had to keep calling keep calling finally they answer or no i don't remember the names i don't have it here but somebody at dhs was like oh my goodness here it is we found it it got lost in another office and it's been sitting on this person's desk forever so just
Senator Missy Irvin
Unverified
2:34:29
sorry i mean i think we've got some moving pieces here because um it is
confusing. Sorry. The ABA, you're confusing that with the autism waiver. So there's different things here. And then, um, I think your medical appropriate appropriateness, uh, that's determined for kids and a different through the EPSDT. So there's some moving parts here, but I just want to make sure. And then last thing I would say is I respectfully, I, I just want to respect the other people that have signed up and just to let members know we have a meeting in this room at one o'clock
um so and i have one two three four more people signed up to testify so i would love for those folks to be able to say what they came here to say but all that depends on the length of your answers and the length of your questions i'm sorry i really didn't well that's okay i'm just i was just answering this is one of those factors when i tried to email the person that was uh under not understanding this is one of those factors that are kind of outside of my control i mean i could cut you off but i don't want to do that but i just i just i'm asking people just to
respect each other's times that's all senator ervin i appreciate
Representative Ryan A. Rose
Unverified
2:35:44
that and thank you for for directing us on this and i'll just say and and
i'll allow you to to finish however you need at the at the chair's direction but i'll just say uh i don't think we can fully comprehend what you and your family have been through and the challenges and i'm not assessing blame to any one person in this room but i will say that families like yours and others have been let down by your state and i don't know if anybody said it but as a representative of your government
Thank you. We apologize for where we have failed and let you down and hope that progress will continue to be made to support families like yours in our state. Thank you very much. Yeah,
Speaker 346
2:36:31
thank you for saying that. That's the first time other than from Representative in it that we have been apologized to for things that have been documented. and data-wise shows that that is not happening. But thank you all for your time.
Senator Missy Irvin
Unverified
2:36:48
Thank you. Thank you. Thank you for your testimony. Okay, the next person I have is Lauren Newberry. And if you'll just come forward and state your name for the record, then you're recognized to give your testimony.
Speaker 388
2:37:14
Thank you. Good morning. Thank you, Chair, and thank you, committee, for hearing us and the parents this morning.
Lauren Newberry
Unverified
2:37:20
First, I just want to preface this with this is my first time testifying in front of a committee, so I apologize if I trip up my words a little bit. My name is Lauren Newberry, and I am the mother of twin boys who are both on the autism spectrum. I also want to clarify that I was a special education teacher in person in the state of Arkansas, but due to my son's disabilities, I've had to move to remote teaching and had to become certified in the state of Missouri for my current position just because of limited job availability with Arkansas Virtual Academy and things like that.
So I've had to change the way that I do my job, first and foremost, for my children. I'm submitting my testimony today to share our family's experience navigating Arkansas's waiver and Medicaid system and to advocate for the many families who are waiting for access to services that could make a meaningful difference in their lives. I do not have data in my testimony. Paige and Blake have done the major resource for our parent group and the major research,
and so my testimony today is just coming to you as a mother. My sons are twins, but their needs are very different. One of my sons, Levi, he has level three autism and requires substantial support with communication, sensory regulation, and daily safety. He's a sensory seeker and has a tendency to elope, meaning he may wander or run away without recognizing the danger. Keeping him safe requires constant supervision and vigilance. Something as simple as going into the next room in my own house can require additional planning and preparation.
And let me clarify this. We have an entire home security system that we've purchased out of pocket. We have indoor and outdoor video cameras with sound. we have window alarms door alarms we have extra door locks because my son knows how to unlock the door and whenever I leave a room and I go into the next room specifically our laundry room which is located in our garage I have to take my cell phone with me and I have to monitor my son or I
have to take him with me myself because of the amount of supervision that he needs my other son Liam he has level 2 autism and a speech delay he is more cognitively aware but he struggles with communication social skills and transitions these challenges affect his ability to navigate everyday situations and communicate his needs effectively although the boys share an autism diagnosis what works for one does not necessarily work for the other. Each of them needs individualized support
that recognizes their unique strengths and challenges. As their mother, I'm constantly balancing their different needs while trying to give both the boys the opportunity to learn, grow, and become as independent as possible. I want them to be safe, to communicate their needs, to participate in their community, and to have an opportunity to reach their individual potential. Achieving those goals requires more than love and determination. It requires access to appropriate services, equipment, and support. Both of my sons have been on the CES waiver wait list for a little under a year,
so we are at the bottom of the list. During that time, we have continued to navigate their needs while waiting for additional assistance. And I believe it was this representative over here. I can't see your name from over here, but you had a specific question about the page numbers. Just for our application, that is without submitting any documentation that I have on my son's, our application was 43 pages long. Thank you. I
Senator Missy Irvin
Unverified
2:41:20
want to go back to what we talked about at the beginning, and I apologize.
I'm trying to let everybody say what they've talked about, but with Mr. Watson and Mr. Landers, we had tried to say, please talk about the service that's on the agenda, the supportive living service, and not the waiver slots. Yeah, we don't have supportive living services. Okay, so, I mean, we gave latitude to Paige because she had the survey and things like that. So if we could just try to not repeat testimony because they have moved to other meeting,
but I know I only have one member of the Senate here, and I just want to make sure everybody gets heard. I'm almost finished. Okay, that's fine. But if you can talk about the supportive living services and how that will impact you or your children, I think that would be a really helpful testimony. I'm
Lauren Newberry
Unverified
2:42:16
getting there. Thank you. One of my sons currently receives ABA services through the autism waiver, and I am genuinely grateful that he has access to that support. However, the autism waiver is a three-year program, and the allocated funding must last for that entire period.
Families have to consider how those resources will stretch across the three years while their children's needs continue to evolve. And access to ABA services is valuable, but it does not eliminate the need for other supports. So unlike Paige and her family, my family chose for my son to receive ABA services through the autism waiver rather than be on the CES wait list because of the wait. So while he is on the autism waiver wait list, he is not on the CES waiver wait list.
Additionally, Arkansas does not allow an individual to participate in more than one waiver program at a time. This means that my son cannot access CES waiver services or a PASS provider while enrolled in the autism waiver. We are grateful for the services he receives, but those services do not meet every need our family has. We are left trying to fill the gaps ourselves while waiting for access to additional support. The CES waiver could help our family access respite care, sensory equipment, a tracking device to improve my son's safety due to his elopement risk, alternative communication devices, alternative therapies, and specialized nutritional equipment due to his dairy allergy.
These are not luxuries or conveniences. They are practical supports that could help us address our children's individual needs, improve their safety and quality of life. I recognize that the state-funded programs operate within budgetary constraints and eligibility requirements. However, I'm asking this committee to consider the real consequences of lengthy wait lists and gaps in services for families like mine. So I respectfully ask today that you consider the following. Review restrictions on participation in multiple waiver programs to determine whether individuals can access complementary services when one program does not meet all their needs.
improve the application and appeals process so that families can spend less time navigating administrative barriers and more time caring for their children, and expand access to practical supports including respite care, caregiver assistance, safety equipment, sensory resources, and specialized equipment that supports daily living. Thank you for taking the time to hear my family's experience and for considering the needs of Arkansas families navigating the waiver system i hope you will remember that behind every waitlist number is a child and a need that cannot
Senator Missy Irvin
Unverified
2:44:53
simply wait thank you for your testimony and just to clarify you're not your child is not on
Lauren Newberry
Unverified
2:45:01
the ces waitlist one of my children is because he's waiting on a spot for the autism waiver i see okay okay what i'm to clarify in arkansas you have to choose which waiver program you're going to be a part of So both of my children were a part of DDS. Okay. Okay. And then when Levi came up on the autism waiver, he dropped off of the DDS and the CES waiver wait list.
I got you. So he is only receiving services from autism waiver, and he's only able to receive services from autism waiver. Okay. And they both have autism? Yes. Okay. Liam is currently still with DDS because he's still waiting on a spot on the autism waiver. I got you. But when his spot comes up, then he'll drop off of both of those wait lists. And then when that three-year program is finished with the state, then they will come back up on the CES waiver wait
Senator Missy Irvin
Unverified
2:45:53
list. I see. And they're both on Medicaid?
Yes. And they're assigned to a pass?
Lauren Newberry
Unverified
2:45:59
No, you cannot be assigned to a pass while you're on another waiver program. So Levi is not assigned to a pass, but
Speaker 393
2:46:09
Liam is currently receiving services with DDS because they're under three. So you're receiving Medicaid health
Senator Missy Irvin
Unverified
2:46:16
care. But I have not personally spoken to anybody
Lauren Newberry
Unverified
2:46:19
that is with a pass provider or pass program. And when I have spoken to someone trying to get them on a pass, I was told that you could not be on more than one waiver program with the state.
Senator Missy Irvin
Unverified
2:46:36
okay thank you for your testimony okay jerry hill no you're fine
Jerry Hill
Unverified
2:46:48
i'm really super nervous i've only used to come here on field trips so um my name is jerry hill perfect do i am i doing
it right no you did perfect i was about to say your name for the record but you're ready for me good i apologize for interrupting each other but my name is jerry hill i'm a mother a gg and a retired home health aide i'm actually in all to
be here because i grew up coming here i'm on field trips bringing my kids here and actually be sitting here is actually pretty cool but with that being said if we have enough money for bombs then we have enough money to take care of all of our children and grandchildren thank you again for allowing me the opportunity to speak especially to the ones who stayed and paid attention to actually care what we people have to say thank you do you have a you're just a home giver oh no I'm more than that but that's just I didn't want to take up any more valuable time no but do you
Speaker 173
2:47:42
have a child on the waiver or receive that would receive the I have a grandson who's on the way on
Jerry Hill
Unverified
2:47:47
the list okay okay I was also declined uh to renew my when I wanted to renew my certification this year that I've had since I was 18 years old because I've volunteered for the last two years
Senator Missy Irvin
Unverified
2:48:01
the state of Arkansas refuses to recertify me okay all right thank you thank you
thank you for your testimony and being here okay I may not say this correctly I apologize Tamara okay did I say that correctly Tamara Cooper and then you could state your name for the record and you may proceed
Speaker 405
2:48:19
Okay. I'm not going to take a lot of time. My testimony is in the room, Maceo. So he has SMA type 2. It's a neurodegenerative disease. Additional diagnosis comes with it. He has lower, like his muscle tone is weak. He started standing. He never walked. Besides all that, I wanted to know when Governor Sanders had mentioned that there were 25 out of 29 services that we had access to on the wait list.
Like, if she's going to add supportive living, what are we still fighting for? You know, so I asked around, I asked DHS, what are the other four services that we were missing? I asked past workers. I never got a clear answer. Nobody knew. I ask waiver workers, but I know, I think it's Melissa, DHS, they testified that we have 25 services that are waiver-related. But according to their website, and also, I never read a code before, but it's Arkansas Code 20CAR.
It has those little squiggly lines, and then 535-102. And according to their website, there are actually only nine CES waiver services, and I'll let you guys know what those are. And none of us have access to them. And a lot of us are in desperate need for them. I know it's not easy to provide these services, but I don't have an extra set of hands at home or anything like that. So I'm lifting my son.
He's over 100 pounds, like a sack of potatoes. On Medicaid, I've been denied. a Hoyer lift ramp, another wheelchair. Arkansas didn't pay for my son's wheelchair. It came from Michigan. He's outgrown it. It's like completely stretched. But anyways, let me tell you what those services are. They're respite care, supported employment, supportive living, specialized medical supplies, adaptive equipment, community transition services, consultation, environmental modifications,
and supplemental support all the other services matter of fact all the 25 services that have been mentioned by the governor and also DHS today according to their website and state code those 25 services are past services they are not related to the CES waiver like my son I have another son that special needs but he's more on the behavioral and mental health side he also has access to all 25 of those services and he is not on the ces waiver wait list and that's my testimony
Senator Missy Irvin
Unverified
2:51:09
all right thank you so much i appreciate your testimony thank you for being here he likes to glad
we're growing that's awesome um hopefully if i will just remind people too uh these committee meetings are live streamed but they're also recorded so some of the information that was given in testimony uh you could go back and look at uh and maybe give you some clarification i mean anybody yeah yeah of the testimony we had previously thank you so much for being here
um and with that we have heard from everybody thank you again for coming and being a great discussion great dialogue um and i just appreciate everybody coming here and participating today As we go forward, I think we'll have different topics and issues as they come up, you know, as it may be relating to the slots themselves or the pass and medical necessity and determination.
Those are all different subject matters, and so I appreciate the latitude there. With that, is there any other business to come before the committee? All right, a representative in it for what purpose? Did she up sorry? Yes,
Representative Denise Jones Ennett
Unverified
2:52:40
thank you Chairwoman, I just had it just a quick comment. I want to thank the parents
I'm a part of this able me disability community because my son Who is a twin? He has autism. So I've been through all these things that the parents are talking about, and I just want to just say that I'm proud of you all for coming out, and I hope that we as a body can help alleviate some of the barriers so our most vulnerable can get the services that they need. Thank
Senator Missy Irvin
Unverified
2:53:14
you. Thank you. I appreciate that, and let
me just say too i'm i really i'm i'm so glad we're able to uh to extend this one this service um and i just don't want that to get lost in the conversation because the folks on the wait list this is supportive living services is really really going to be a big deal and a big help for everybody and so i look forward to getting that um feedback as that kind of rolls out clearly we have budget questions and budget issues um as we look forward through that but it's a unique
way of approaching the problem and i i do appreciate that i think it's it furthers the policy debate um about how we can
just really get services to people and within what systems we have and the flexibilities perhaps and then figuring out the best path forward for that so thank you all for the discussion thank you
representative in it for those comments are there any other business to come before the committee seeing none we are adjourned
Agenda
A. Call to Order
B. Consideration to Approve the September 1, 2026, Meeting Minutes [Exhibit B]
C. Overview of University of Arkansas Medical Sciences (UAMS) Co-Management Agreements
D. Presentation on Pediatric Complex Care of Arkansas
E. Discussion of Community and Employment Support (CES) Waiver Waitlist
F. Department of Human Services (DHS), Division of Medical Services, Review of Rule, Physician Assistants and Clinical Nurse Specialists as Primary Care Providers [Exhibit F] ̶ Elizabeth Pitman, Director, Division of Medical Services, DHS
G. Arkansas Department of Health (ADH), Division of Health Protection, Health Facility Services Section, Review of Rule, Rules for Conducting Criminal History Record Checks for Home Health, Hospice, and Private Care Agencies in Arkansas [Exhibit G]
H. ADH, Division of Health Protection, Health Facility Services Section, Review of Rule, Rules for Freestanding Birthing Centers in Arkansas [Exhibit H]
I. ADH, Division of Health Protection, Health Systems Licensing and Regulation Section, Review of Rule, Rules for In Vitro Fertilization in Arkansas [Exhibit I]
J. ADH, Division of Health Protection, Personal Care Services Branch, Review of Rule, Rules for the Arkansas Kidney Disease Program [Exhibit J]
K. ADH, Division of Health Protection, Pharmacy Services Section, Review of Rule, Rules for Public Access to Epinephrine [Exhibit K]
L. ADH, Office of Alcohol Testing, Review of Rule, Rules for Breath Alcohol Ignition Interlock Devices [Exhibit L]
M. ADH, Division of Public Health Practice, Environmental Health Branch, Review of Rule, Rules Pertaining to General Sanitation [Exhibit M]
N. Other Business
O. Adjournment
Documents
Speakers
Representative Jeff Wardlaw
Unverified
Chair (Representative Jeff Wardlaw)
Unverified
Senator Matt McKee
Unverified
Speaker 17
Speaker 18
Senator Matt McKee
Unverified
Speaker 15
Representative Jeff Wardlaw
Unverified
Chair (Representative Jeff Wardlaw)
Unverified
Speaker 17
Representative Jeff Wardlaw
Unverified
Speaker 17
Representative Jeff Wardlaw
Unverified
Representative Jack Ladyman
Unverified
Speaker 32
Representative Jack Ladyman
Unverified
Speaker 32
Speaker 18
Representative Kenneth B. Ferguson
Unverified
Speaker 22
Speaker 44
Speaker 17
Representative Kenneth B. Ferguson
Unverified
Speaker 44
Representative Kenneth B. Ferguson
Unverified
Speaker 44
Representative Fred Allen
Unverified
Speaker 55
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Representative Fred Allen
Unverified
Speaker 22
Speaker 44
Representative Fred Allen
Unverified
Speaker 44
Speaker 15
Senator Matt McKee
Unverified
Representative Glenn Barnes
Unverified
Speaker 44
Speaker 71
Representative Glenn Barnes
Unverified
Speaker 46
Speaker 74
Representative Dolly Henley
Unverified
Speaker 15
Senator Matt McKee
Unverified
Representative Howard M. Beaty, Jr.
Unverified
Senator Matt McKee
Unverified
Representative Howard M. Beaty, Jr.
Unverified
Representative Jeff Wardlaw
Unverified
Representative Kenneth B. Ferguson
Unverified
Senator Matt McKee
Unverified
Speaker 15
Representative Kenneth B. Ferguson
Unverified
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Representative Fred Allen
Unverified
Senator Matt McKee
Unverified
Senator Missy Irvin
Unverified
Speaker 105
Representative Jeff Wardlaw
Unverified
Speaker 109
Speaker 110
Speaker 111
Representative Aaron Pilkington
Unverified
Speaker 110
Representative Jeff Wardlaw
Unverified
Speaker 121
Speaker 123
Speaker 124
Speaker 125
Representative Jeff Wardlaw
Unverified
Speaker 124
Representative Jeff Wardlaw
Unverified
Speaker 124
Senator Missy Irvin
Unverified
Speaker 124
Senator Missy Irvin
Unverified
Speaker 124
Representative Jeff Wardlaw
Unverified
Speaker 135
Speaker 124
Representative Jeff Wardlaw
Unverified
Chair (Representative Jeff Wardlaw)
Unverified
Speaker 144
Senator Missy Irvin
Unverified
Representative Jeff Wardlaw
Unverified
Speaker 151
Speaker 144
Speaker 151
Speaker 153
Chair (Senator Missy Irvin)
Unverified
Senator Missy Irvin
Unverified
Speaker 153
Senator Missy Irvin
Unverified
Speaker 170
Speaker 153
Senator Missy Irvin
Unverified
Allison Guthrie
Unverified
Speaker 151
Senator Missy Irvin
Unverified
Speaker 151
Senator Missy Irvin
Unverified
Speaker 151
Senator Missy Irvin
Unverified
Speaker 151
Senator Missy Irvin
Unverified
Speaker 151
Senator Missy Irvin
Unverified
Speaker 185
Speaker 186
Speaker 191
Senator Missy Irvin
Unverified
Speaker 186
Chair (Senator Missy Irvin)
Unverified
Senator Missy Irvin
Unverified
Speaker 186
Senator Missy Irvin
Unverified
Speaker 186
Senator Missy Irvin
Unverified
Speaker 186
Senator Missy Irvin
Unverified
Representative Jeff Wardlaw
Unverified
Speaker 186
Speaker 202
Representative Jeff Wardlaw
Unverified
Representative Jack Ladyman
Unverified
Speaker 185
Speaker 186
Representative Jack Ladyman
Unverified
Speaker 185
Speaker 186
Speaker 215
Representative Jack Ladyman
Unverified
Speaker 217
Representative Jack Ladyman
Unverified
Speaker 186
Speaker 194
Speaker 33
Speaker 186
Representative Jack Ladyman
Unverified
Speaker 186
Representative Jack Ladyman
Unverified
Representative Mary Bentley
Unverified
Speaker 186
Representative Mary Bentley
Unverified
Speaker 186
Speaker 232
Speaker 149
Speaker 151
Speaker 186
Representative Mary Bentley
Unverified
Speaker 186
Chair (Senator Missy Irvin)
Unverified
Representative Denise Jones Ennett
Unverified
Speaker 186
Representative Denise Jones Ennett
Unverified
Speaker 185
Speaker 186
Representative Denise Jones Ennett
Unverified
Speaker 232
Senator Missy Irvin
Unverified
Speaker 250
Representative Denise Jones Ennett
Unverified
Speaker 186
Speaker 247
Senator Missy Irvin
Unverified
Representative Denise Jones Ennett
Unverified
Speaker 186
Chair (Senator Missy Irvin)
Unverified
Representative Ryan A. Rose
Unverified
Speaker 186
Speaker 262
Speaker 151
Speaker 252
Speaker 186
Representative Jeff Wardlaw
Unverified
Speaker 131
Speaker 232
Speaker 269
Representative Jeff Wardlaw
Unverified
Speaker 272
Representative Ryan A. Rose
Unverified
Allison Guthrie
Unverified
Speaker 151
Allison Guthrie
Unverified
Representative Ryan A. Rose
Unverified
Allison Guthrie
Unverified
Speaker 151
Speaker 149
Representative Ryan A. Rose
Unverified
Speaker 262
Representative Ryan A. Rose
Unverified
Speaker 262
Representative Ryan A. Rose
Unverified
Speaker 262
Allison Guthrie
Unverified
Representative Ryan A. Rose
Unverified
Allison Guthrie
Unverified
Speaker 151
Allison Guthrie
Unverified
Representative Ryan A. Rose
Unverified
Allison Guthrie
Unverified
Representative Ryan A. Rose
Unverified
Speaker 287
Representative Wayne Long
Unverified
Allison Guthrie
Unverified
Speaker 151
Allison Guthrie
Unverified
Speaker 151
Allison Guthrie
Unverified
Representative Wayne Long
Unverified
Speaker 151
Allison Guthrie
Unverified
Representative Wayne Long
Unverified
Speaker 151
Representative Wayne Long
Unverified
Speaker 294
Speaker 296
Speaker 252
Speaker 186
Representative R. Scott Richardson
Unverified
Speaker 186
Representative R. Scott Richardson
Unverified
Representative Jeff Wardlaw
Unverified
Speaker 185
Representative Jeff Wardlaw
Unverified
Representative Denise Jones Ennett
Unverified
Speaker 250
Speaker 186
Representative Ryan A. Rose
Unverified
Speaker 262
Representative Ryan A. Rose
Unverified
Speaker 305
Speaker 151
Representative Ryan A. Rose
Unverified
Speaker 282
Senator Missy Irvin
Unverified
Representative Jeremy Wooldridge
Unverified
Speaker 186
Representative Jeremy Wooldridge
Unverified
Representative Jack Ladyman
Unverified
Chair (Representative Jeff Wardlaw)
Unverified
Representative Jeff Wardlaw
Unverified
Senator Missy Irvin
Unverified
Representative Jeff Wardlaw
Unverified
David Watson
Unverified
Speaker 324
David Watson
Unverified
Speaker 328
Speaker 322
David Watson
Unverified
Speaker 329
David Watson
Unverified
Speaker 329
David Watson
Unverified
Speaker 329
Representative Jeff Wardlaw
Unverified
David Watson
Unverified
Speaker 325
David Watson
Unverified
Speaker 325
Representative Jeff Wardlaw
Unverified
Speaker 325
Chair (Representative Jeff Wardlaw)
Unverified
David Watson
Unverified
Speaker 300
David Watson
Unverified
Representative Jeff Wardlaw
Unverified
Speaker 325
David Watson
Unverified
Speaker 325
David Watson
Unverified
Speaker 325
David Watson
Unverified
Speaker 20
Representative Jeff Wardlaw
Unverified
Speaker 336
Speaker 337
Representative Jeff Wardlaw
Unverified
Speaker 269
Senator Missy Irvin
Unverified
Speaker 337
Representative Jeff Wardlaw
Unverified
Senator Missy Irvin
Unverified
Representative Jeff Wardlaw
Unverified
Speaker 345
Speaker 346
Speaker 345
Speaker 346
Speaker 345
Chair (Representative Jeff Wardlaw)
Unverified
Representative Aaron Pilkington
Unverified
Speaker 352
Representative Aaron Pilkington
Unverified
Speaker 352
Speaker 346
Speaker 352
Representative Aaron Pilkington
Unverified
Speaker 347
Representative Aaron Pilkington
Unverified
Speaker 352
Speaker 346
Speaker 345
Representative Aaron Pilkington
Unverified
Senator Missy Irvin
Unverified
Paige Mccammon
Unverified
Speaker 346
Speaker 345
Senator Missy Irvin
Unverified
Representative Ryan A. Rose
Unverified
Speaker 352
Speaker 346
Speaker 352
Speaker 346
Speaker 352
Speaker 346
Senator Missy Irvin
Unverified
Representative Ryan A. Rose
Unverified
Speaker 352
Speaker 346
Senator Missy Irvin
Unverified
Speaker 388
Lauren Newberry
Unverified
Senator Missy Irvin
Unverified
Lauren Newberry
Unverified
Senator Missy Irvin
Unverified
Lauren Newberry
Unverified
Senator Missy Irvin
Unverified
Lauren Newberry
Unverified
Speaker 393
Senator Missy Irvin
Unverified
Lauren Newberry
Unverified
Senator Missy Irvin
Unverified
Jerry Hill
Unverified
Speaker 173
Jerry Hill
Unverified
Senator Missy Irvin
Unverified
Speaker 405
Senator Missy Irvin
Unverified
Representative Denise Jones Ennett
Unverified
Senator Missy Irvin
Unverified