WEBVTT 00:00:06.000 --> 00:00:10.000 that, we'll start the presentation by handing it off to Jeff Hughes 00:00:10.000 --> 00:00:14.000 . >> JEFF HUGHES: Hello 00:00:14.000 --> 00:00:17.000 , everybody. Thank you, 00:00:17.000 --> 00:00:20.000 appreciate the opportunity to visit with everyone 00:00:20.000 --> 00:00:24.000 . Today we are going 00:00:24.000 --> 00:00:27.000 to discuss opportunities that may be 00:00:27.000 --> 00:00:30.000 there within your state through Medicaid 00:00:30.000 --> 00:00:34.000 Managed consider 00:00:34.000 --> 00:00:37.000 d Care. The reason we wanted to do this 00:00:37.000 --> 00:00:40.000 today came about from a discussion Mary and I had 00:00:40.000 --> 00:00:44.000 several months ago with a few other people around 00:00:44.000 --> 00:00:48.000 Medicaid Managed Care and opportunities there are 00:00:48.000 --> 00:00:51.000 there for providing the 00:00:51.000 --> 00:00:54.000 necessary services to people with disabilities, especial 00:00:54.000 --> 00:00:57.000 ly around this time of COVID. So we thought that 00:00:57.000 --> 00:01:00.000 we would give kind of 00:01:00.000 --> 00:01:03.000 an overview of one entity 00:01:03.000 --> 00:01:06.000 that's prepared quite a bit of 00:01:06.000 --> 00:01:10.000 information about what they would like to see 00:01:10.000 --> 00:01:13.000 and what they suggest 00:01:13.000 --> 00:01:17.000 for Centers tr 00:01:17.000 --> 00:01:21.000 for Independent Living and working with 00:01:21.000 --> 00:01:24.000 specific MCOs, managed care, 00:01:24.000 --> 00:01:27.000 organizations. And this came from, the 00:01:27.000 --> 00:01:30.000 stuff I'm going to go over is kind of specific to Anthem, but 00:01:30.000 --> 00:01:33.000 it can be applied across the board to any MC 00:01:33.000 --> 00:01:37.000 O. It's good strategies to look for and 00:01:37.000 --> 00:01:40.000 how you can become a little bit better organized 00:01:40.000 --> 00:01:44.000 as or if managed care is 00:01:44.000 --> 00:01:47.000 moving forward within your state. 00:01:47.000 --> 00:01:51.000 So if 00:01:51.000 --> 00:01:55.000 -- I think that 00:01:55.000 --> 00:01:59.000 they're in some session there's 00:01:59.000 --> 00:02:02.000 around 39 states to where 00:02:02.000 --> 00:02:05.000 Managed Care Organizations are operating at this point, 00:02:05.000 --> 00:02:09.000 maybe a little bit higher than that now, but I think the 00:02:09.000 --> 00:02:12.000 last time I looked it was around 39 or so 00:02:12.000 --> 00:02:15.000 . And as we go through this, 00:02:15.000 --> 00:02:19.000 this is intended to be an interactive discussion around 00:02:19.000 --> 00:02:22.000 what is going on with in your 00:02:22.000 --> 00:02:27.000 state that you might want to discuss 00:02:27.000 --> 00:02:30.000 , opportunities that you have capitalized on, things that 00:02:30.000 --> 00:02:33.000 you missed out on. And if there's 00:02:33.000 --> 00:02:37.000 a way that we can help provide additional 00:02:37.000 --> 00:02:40.000 information or technical assistance around this 00:02:40.000 --> 00:02:43.000 whole big huge beast of Medicaid 00:02:43.000 --> 00:02:47.000 managed care, then we're very happy to do so 00:02:47.000 --> 00:02:50.000 . So I'm the Center Director 00:02:50.000 --> 00:02:53.000 in norman, Oklahoma 00:02:53.000 --> 00:02:57.000 . Progressive independence. I've been around for -- this is my 2 00:02:57.000 --> 00:03:00.000 1st year at P 00:03:00.000 --> 00:03:03.000 I. And we serve the 00:03:03.000 --> 00:03:06.000 Oklahoma City metropolitan area, but also we are 00:03:06.000 --> 00:03:09.000 planning on picking up 00:03:09.000 --> 00:03:13.000 areas within very 00:03:13.000 --> 00:03:17.000 southern part of Oklahoma and the 00:03:17.000 --> 00:03:20.000 southwestern portion of Oklahoma because 00:03:20.000 --> 00:03:24.000 of our partnerships with a couple of the Medicaid 00:03:24.000 --> 00:03:28.000 managed care organizations. So real excited about the opportunities 00:03:28.000 --> 00:03:33.000 that this has brought 00:03:33.000 --> 00:03:36.000 . Because now with this, we're able to reach out into 00:03:36.000 --> 00:03:39.000 those areas that have been 00:03:39.000 --> 00:03:42.000 unserved and underserved within Oklahoma for such a 00:03:42.000 --> 00:03:46.000 long time 00:03:46.000 --> 00:03:49.000 so let's go ahead and 00:03:49.000 --> 00:03:52.000 jump in and get started. Let me see if I can 00:03:52.000 --> 00:04:10.000 figure out how to share my screen here. 00:04:10.000 --> 00:04:13.000 So you may hear a little background noise, and I apologize 00:04:13.000 --> 00:04:17.000 for that. I'm having a little music studio 00:04:17.000 --> 00:04:20.000 built in our backyard as we speak. I didn't 00:04:20.000 --> 00:04:24.000 know it was going to be today, but they are working on that. So a couple 00:04:24.000 --> 00:04:27.000 of things with Anthem that we were 00:04:27.000 --> 00:04:30.000 -- we've developed and worked on is 00:04:30.000 --> 00:04:34.000 six principles necessary to modernize a healthcare 00:04:34.000 --> 00:04:38.000 infrastructure. Enhance 00:04:38.000 --> 00:04:41.000 ing self-care through improved coordination, encourage 00:04:41.000 --> 00:04:45.000 ing community integration and involvement, expanding 00:04:45.000 --> 00:04:48.000 accessibility of services and supports, uphold 00:04:48.000 --> 00:04:51.000 ing personal preference, empower people to participate in economic main 00:04:51.000 --> 00:04:55.000 stream and invest and improve technology. 00:04:55.000 --> 00:04:58.000 Here in Oklahoma we've had some pretty substantial challenges 00:04:58.000 --> 00:05:01.000 through our Medicaid system, including our 00:05:01.000 --> 00:05:04.000 1915 00:05:04.000 --> 00:05:07.000 C waivers well as as our 00:05:07.000 --> 00:05:11.000 Sunacare which is our 00:05:11.000 --> 00:05:14.000 state plan services. We were one of the first 00:05:14.000 --> 00:05:17.000 ones back in the nineties to first try Medicaid 00:05:17.000 --> 00:05:20.000 managed care, and the companies that came in at that 00:05:20.000 --> 00:05:24.000 time didn't do so well. So we've had to work 00:05:24.000 --> 00:05:27.000 through some of those struggles as well, because there are some people that are 00:05:27.000 --> 00:05:30.000 still around that remember the struggles that we had 00:05:30.000 --> 00:05:33.000 . It didn't really go well because 00:05:33.000 --> 00:05:37.000 various issues, but over 00:05:37.000 --> 00:05:41.000 time some of the Medicaid 00:05:41.000 --> 00:05:45.000 Managed Care companies have really learned from 00:05:45.000 --> 00:05:49.000 specific people like Bob 00:05:49.000 --> 00:05:54.000 Bob and 00:05:54.000 --> 00:05:57.000 Mike Oxford and many, many others 00:05:57.000 --> 00:06:01.000 on how to improve services as 00:06:01.000 --> 00:06:04.000 a state moves towards this direction. So as you can see here, 00:06:04.000 --> 00:06:08.000 this is one of the -- this is Anthem 00:06:08.000 --> 00:06:11.000 , who I'm on the Board of the Nags until 00:06:11.000 --> 00:06:18.000 tional Advisory Board within p 00:06:18.000 --> 00:06:21.000 Anthem and I'm really excited about the principles they've 00:06:21.000 --> 00:06:24.000 put forth. So enhance as an MCO is 00:06:24.000 --> 00:06:27.000 working within your state to 00:06:27.000 --> 00:06:30.000 address the needs and the gaps and 00:06:30.000 --> 00:06:34.000 the barriers that people with disabilities have 00:06:34.000 --> 00:06:38.000 . You'll want to make sure that these six principles are being 00:06:38.000 --> 00:06:43.000 adhered to, that there is within the 00:06:43.000 --> 00:06:46.000 plan as you're coordinating with an MCO, 00:06:46.000 --> 00:06:49.000 that you're meeting with them all the 00:06:49.000 --> 00:06:52.000 time, as much as you possibly can. 00:06:52.000 --> 00:06:56.000 We want to put forth a -- 00:06:56.000 --> 00:06:59.000 as a center network, you want to put forth a 00:06:59.000 --> 00:07:02.000 really good, organized approach 00:07:02.000 --> 00:07:05.000 to working with the MCOs so 00:07:05.000 --> 00:07:08.000 that they can provide services statewide, that you're 00:07:08.000 --> 00:07:11.000 ensuring that people with disabilities are at the table, 00:07:11.000 --> 00:07:15.000 that within their plans that they are addressing 00:07:15.000 --> 00:07:19.000 how self-care through their 00:07:19.000 --> 00:07:22.000 coordinated services are being addressed 00:07:22.000 --> 00:07:25.000 . Here 00:07:25.000 --> 00:07:30.000 we've had so many problems with 00:07:30.000 --> 00:07:34.000 our state agencies that 00:07:34.000 --> 00:07:37.000 -- you know, we were one of the first ones to receive 00:07:37.000 --> 00:07:40.000 one of the 00:07:40.000 --> 00:07:43.000 real choice systems 00:07:43.000 --> 00:07:46.000 change grants back in 2002, 2003 00:07:46.000 --> 00:07:50.000 . We were working with the State to 00:07:50.000 --> 00:07:54.000 offer consumer directed services 00:07:54.000 --> 00:07:57.000 , and we were going to -- the intent was the 00:07:57.000 --> 00:08:01.000 centers were going to pick up that 00:08:01.000 --> 00:08:04.000 piece of being the fiscal immediate yar 00:08:04.000 --> 00:08:08.000 intermediary. And unfortunately the State and 00:08:08.000 --> 00:08:12.000 home health agencies got together and pretty much 00:08:12.000 --> 00:08:15.000 just took it away, and now the 00:08:15.000 --> 00:08:19.000 fiscal intermediary comes from one entity 00:08:19.000 --> 00:08:23.000 , one national entity, that you probably have heard about 00:08:23.000 --> 00:08:26.000 . They've gone through several of them over the 00:08:26.000 --> 00:08:30.000 last several years. Because they're 00:08:30.000 --> 00:08:33.000 just not really good support and services that are being provided 00:08:33.000 --> 00:08:36.000 day-to-day. And that's something that should be provided by the 00:08:36.000 --> 00:08:39.000 centers, whether you're going to do the fiscal 00:08:39.000 --> 00:08:44.000 intermediary part or if you're going to do just the employment 00:08:44.000 --> 00:08:48.000 support alone. Then you guys 00:08:48.000 --> 00:08:51.000 , we centers for independent 00:08:51.000 --> 00:08:54.000 living, you've got to be engaged with whatever MC 00:08:54.000 --> 00:08:58.000 O is going to be working within your state. 00:08:58.000 --> 00:09:01.000 So right now we've got agreements -- 00:09:01.000 --> 00:09:05.000 Progressive Independence has agreements with four of the 00:09:05.000 --> 00:09:09.000 four EMCOs that have a 00:09:09.000 --> 00:09:12.000 pplied. We're going through another round of applications probably this 00:09:12.000 --> 00:09:16.000 fall, and I pretty much anticipate that it's going 00:09:16.000 --> 00:09:19.000 to be probably the same 00:09:19.000 --> 00:09:23.000 four -- there might be one more jump in. I hope there will be 00:09:23.000 --> 00:09:26.000 . And so we're engaging each one of them to make sure 00:09:26.000 --> 00:09:30.000 that we've got all of these issues addressed, and 00:09:30.000 --> 00:09:34.000 that we can 00:09:34.000 --> 00:09:38.000 create different services and programs that is 00:09:38.000 --> 00:09:41.000 at our core our core values, 00:09:41.000 --> 00:09:44.000 our core services of transition 00:09:44.000 --> 00:09:47.000 ing, helping people move from 00:09:47.000 --> 00:09:50.000 institutional settings in the community, or from high school on 00:09:50.000 --> 00:09:53.000 . That's one of the core components obviously 00:09:53.000 --> 00:09:57.000 that we must provide services around, and these 00:09:57.000 --> 00:10:01.000 EMCOs have been great to work with at this 00:10:01.000 --> 00:10:06.000 point in time. One of the services that we are 00:10:06.000 --> 00:10:10.000 -- that we've developed because of all this is 00:10:10.000 --> 00:10:13.000 personal care training for -- and registry 00:10:13.000 --> 00:10:16.000 for people with disabilities. This is 00:10:16.000 --> 00:10:21.000 not ever been done that I'm aware of in Oklahoma 00:10:21.000 --> 00:10:24.000 , and so with this, we'll be able to offer train 00:10:24.000 --> 00:10:30.000 ing on how to be 00:10:30.000 --> 00:10:33.000 editing how to direct your own services and 00:10:33.000 --> 00:10:36.000 we are putting people with disabilities alongside individuals 00:10:36.000 --> 00:10:40.000 who may be interested in providing that personal care 00:10:40.000 --> 00:10:43.000 side-by-side through training that's about 00:10:43.000 --> 00:10:47.000 8 weeks long. And that part is 00:10:47.000 --> 00:10:56.000 done really, really well. 00:10:56.000 --> 00:10:59.000 Well question is, will you go back and 00:10:59.000 --> 00:11:05.000 please explain what Anthem is and what agency 00:11:05.000 --> 00:11:08.000 Mr. Hughes is speaking from 00:11:08.000 --> 00:11:11.000 ? Anthem is a managed care organization, and they are in various 00:11:11.000 --> 00:11:14.000 -- I'm not exactly sure how many states at this point. They are 00:11:14.000 --> 00:11:18.000 in several states providing services to people with disabilities 00:11:18.000 --> 00:11:21.000 and people who are ageing 00:11:21.000 --> 00:11:24.000 through Medicaid services. And 00:11:24.000 --> 00:11:28.000 I work for a Center for 00:11:28.000 --> 00:11:31.000 Independent Living here in Oklahoma called 00:11:31.000 --> 00:11:42.000 Progressive Independence. 00:11:42.000 --> 00:11:46.000 We'll scroll on down to 00:11:46.000 --> 00:11:50.000 the next slide, which is encourage 00:11:50.000 --> 00:11:54.000 ing community 00:11:54.000 --> 00:11:57.000 integration and involvement. So obviously 00:11:57.000 --> 00:12:00.000 as a center for in 00:12:00.000 --> 00:12:03.000 dependent living, we are concern 00:12:03.000 --> 00:12:07.000 ed about the degree to which people with disabilities are involve 00:12:07.000 --> 00:12:10.000 d in issues such as transportation 00:12:10.000 --> 00:12:13.000 and housing 00:12:13.000 --> 00:12:16.000 . Recreational opportunities as 00:12:16.000 --> 00:12:20.000 well. One of the biggest barriers 00:12:20.000 --> 00:12:23.000 that we have is, as people with 00:12:23.000 --> 00:12:26.000 disabilities move into the community, or are already 00:12:26.000 --> 00:12:30.000 in the community and looking for a place to live is housing. We know 00:12:30.000 --> 00:12:33.000 that safe, affordable, accessible housing, 00:12:33.000 --> 00:12:36.000 there's such a shortage with regard to that. So how 00:12:36.000 --> 00:12:39.000 does that really fit into this 00:12:39.000 --> 00:12:43.000 whole framework of healthcare, Medicaid manage 00:12:43.000 --> 00:12:46.000 d care? Is this something that is 00:12:46.000 --> 00:12:49.000 compensable through Medicaid? And those were some of the questions 00:12:49.000 --> 00:12:52.000 that we had when we first started working with the 00:12:52.000 --> 00:12:56.000 some of the MCOs, and 00:12:56.000 --> 00:13:00.000 the beauty around doing so is 00:13:00.000 --> 00:13:04.000 that they can 00:13:04.000 --> 00:13:07.000 -- through their money that they already 00:13:07.000 --> 00:13:10.000 have, they can do -- they can 00:13:10.000 --> 00:13:13.000 create strategies to increase accessible house 00:13:13.000 --> 00:13:16.000 ing. They can work with centers 00:13:16.000 --> 00:13:20.000 to go in and do accessibility surveys of what already 00:13:20.000 --> 00:13:23.000 exists, have a good inventory of 00:13:23.000 --> 00:13:26.000 accessible units. One of the projects that we're 00:13:26.000 --> 00:13:29.000 working on right now is to have an 00:13:29.000 --> 00:13:33.000 inventory of statewide of the number of accessible 00:13:33.000 --> 00:13:37.000 units that are there. And that's quite 00:13:37.000 --> 00:13:40.000 an undertaking, but with the support that you can 00:13:40.000 --> 00:13:43.000 get through a Medicaid managed care organization, 00:13:43.000 --> 00:13:48.000 then it's -- you can have 00:13:48.000 --> 00:13:51.000 the resources available to you if 00:13:51.000 --> 00:13:55.000 you work with them in identify 00:13:55.000 --> 00:13:58.000 ing the number of accessible units ( 00:13:58.000 --> 00:14:02.000 train horn in background). 00:14:02.000 --> 00:14:08.000 Social obviously is the impact of having social opportunities 00:14:08.000 --> 00:14:11.000 through Medicaid Managed 00:14:11.000 --> 00:14:14.000 Care is incredibly important, 00:14:14.000 --> 00:14:17.000 and something the State hasn't really felt like it's been all 00:14:17.000 --> 00:14:21.000 that important. 00:14:21.000 --> 00:14:24.000 These organizations do 00:14:24.000 --> 00:14:27.000 realize that as part of living day-to-day, 00:14:27.000 --> 00:14:31.000 you have to have that opportunity to social 00:14:31.000 --> 00:14:34.000 ize. So resources can be set asize 00:14:34.000 --> 00:14:37.000 side to do 00:14:37.000 --> 00:14:40.000 various support services through social and 00:14:40.000 --> 00:14:49.000 recreational opportunities as well. 00:14:49.000 --> 00:14:53.000 Expanding the degree of accessibility 00:14:53.000 --> 00:14:56.000 of services and supports is always something that we're always 00:14:56.000 --> 00:14:59.000 concerned about. Again, 00:14:59.000 --> 00:15:04.000 as I mentioned here in Oklahoma, we have struggled over the 00:15:04.000 --> 00:15:07.000 last many years -- 10 years probably 00:15:07.000 --> 00:15:11.000 . Probably started around 2010, 20 00:15:11.000 --> 00:15:15.000 11 where Medicaid 00:15:15.000 --> 00:15:19.000 services were 00:15:19.000 --> 00:15:25.000 -- took a downturn. And 00:15:25.000 --> 00:15:28.000 it was really difficult, one, to find 00:15:28.000 --> 00:15:31.000 doctors within 00:15:31.000 --> 00:15:34.000 specific geographical areas. I'm located here in stral 00:15:34.000 --> 00:15:38.000 central Oklahoma, and it's really, 00:15:38.000 --> 00:15:42.000 really hard for us to find good physicians 00:15:42.000 --> 00:15:45.000 and special 00:15:45.000 --> 00:15:48.000 ty services that accept Medicaid. 00:15:48.000 --> 00:15:52.000 So and plus 00:15:52.000 --> 00:15:55.000 with them being -- 00:15:55.000 --> 00:15:58.000 finding ones that are accessible is incredibly challenge 00:15:58.000 --> 00:16:03.000 ing too. So 00:16:03.000 --> 00:16:06.000 I have one company in particular, 00:16:06.000 --> 00:16:09.000 Santine, 00:16:09.000 --> 00:16:13.000 donated several thousands of dollars 00:16:13.000 --> 00:16:16.000 to national council of independent 00:16:16.000 --> 00:16:20.000 living to address this issue within healthcare providers and 00:16:20.000 --> 00:16:23.000 accessibility therein. And we're very thankful for companies 00:16:23.000 --> 00:16:26.000 like Santine, 00:16:26.000 --> 00:16:30.000 and Anthem and some of the others that do recognize the 00:16:30.000 --> 00:16:34.000 importance of independent living. And 00:16:34.000 --> 00:16:37.000 Amanda Montgomery asked, what about surveys 00:16:37.000 --> 00:16:40.000 on housing units that could be made accessible? 00:16:40.000 --> 00:16:44.000 Yes, that's part of the inventory that we are trying 00:16:44.000 --> 00:16:49.000 to come up with 00:16:49.000 --> 00:16:52.000 . And if there are 00:16:52.000 --> 00:16:56.000 -- let's say if there's a housing complex 00:16:56.000 --> 00:16:59.000 of six units, it is covered under 00:16:59.000 --> 00:17:02.000 Fair Housing, so there's got to be a minimum number of 00:17:02.000 --> 00:17:05.000 accessible units that'll be made. So there could be 00:17:05.000 --> 00:17:08.000 opportunities to renovate, to make 00:17:08.000 --> 00:17:12.000 accessible some of those units. And 00:17:12.000 --> 00:17:16.000 again, it's a matter of engaging with whatever 00:17:16.000 --> 00:17:20.000 MCO is there. 00:17:20.000 --> 00:17:25.000 Within your state. And last I looked, I think there's a 00:17:25.000 --> 00:17:29.000 minimum of 00:17:29.000 --> 00:17:33.000 three, maybe four 00:17:33.000 --> 00:17:36.000 MCOs that are required to be within 00:17:36.000 --> 00:17:40.000 a specific state, and that is 00:17:40.000 --> 00:17:43.000 set forth by centers for 00:17:43.000 --> 00:17:48.000 medicare and Medicaid. 00:17:48.000 --> 00:17:51.000 Upholding personal preference. So an 00:17:51.000 --> 00:17:54.000 individual with a disability -- this is one that 00:17:54.000 --> 00:17:57.000 I feel really strongly about here 00:17:57.000 --> 00:18:01.000 in Oklahoma. 00:18:01.000 --> 00:18:04.000 Personal preference, choice of providers 00:18:04.000 --> 00:18:08.000 , having an opportunity to really have a 00:18:08.000 --> 00:18:11.000 choice is something that has not been offered within 00:18:11.000 --> 00:18:14.000 this state. What the State 00:18:14.000 --> 00:18:18.000 will tell a person is that, well, 00:18:18.000 --> 00:18:21.000 you can choose a different provider 00:18:21.000 --> 00:18:25.000 or a case management provider or whatever 00:18:25.000 --> 00:18:28.000 but you're still offered the same sets of services, the 00:18:28.000 --> 00:18:31.000 same thing over and over 00:18:31.000 --> 00:18:35.000 . So there's nothing that offers 00:18:35.000 --> 00:18:39.000 anything any better. This is it. This is all you get. 00:18:39.000 --> 00:18:42.000 It's administered by the state. There's nothing more. As we're 00:18:42.000 --> 00:18:45.000 moving through -- moving into this approach, 00:18:45.000 --> 00:18:48.000 now we will be able to offer 00:18:48.000 --> 00:18:52.000 a array of services that a person could truly 00:18:52.000 --> 00:18:55.000 choose from. So 00:18:55.000 --> 00:18:58.000 in other words, we have this 00:18:58.000 --> 00:19:03.000 last round of applications that we have 00:19:03.000 --> 00:19:06.000 . There were four organizations -- four MCOs that 00:19:06.000 --> 00:19:09.000 applied. And there was Blue Cross 00:19:09.000 --> 00:19:13.000 Blue Shield, 00:19:13.000 --> 00:19:16.000 Huhmana, 00:19:16.000 --> 00:19:20.000 sintine, and United. Each 00:19:20.000 --> 00:19:23.000 one of those will have an array of services that they're going 00:19:23.000 --> 00:19:26.000 to provide that are going to offer -- they will offer 00:19:26.000 --> 00:19:30.000 to individuals with disabilities and also people who are age 00:19:30.000 --> 00:19:33.000 ing that could include 00:19:33.000 --> 00:19:36.000 consumer directed services. It could include 00:19:36.000 --> 00:19:39.000 home mods, it could include equipment. They're 00:19:39.000 --> 00:19:42.000 going to have to provide the mandatory 00:19:42.000 --> 00:19:45.000 services, but there may be some optional services they 00:19:45.000 --> 00:19:49.000 will also want to include. I know Human 00:19:49.000 --> 00:19:52.000 a giving $150 each month 00:19:52.000 --> 00:19:58.000 through its medicare program 00:19:58.000 --> 00:20:02.000 to individuals who are enrolled with theirs 00:20:02.000 --> 00:20:05.000 to cover any ancillary services that they may not 00:20:05.000 --> 00:20:09.000 be covering. And there's going to be different ones 00:20:09.000 --> 00:20:12.000 that are going to be offering transportation services 00:20:12.000 --> 00:20:16.000 on a much higher degree, or personal care, 00:20:16.000 --> 00:20:19.000 or whatever it is there's going to be a true choice that hasn't been 00:20:19.000 --> 00:20:23.000 available prior to this 00:20:23.000 --> 00:20:26.000 . 00:20:26.000 --> 00:20:29.000 There is a question on how can we find out if there is 00:20:29.000 --> 00:20:34.000 managed care in our state? 00:20:34.000 --> 00:20:38.000 You can -- well, you can ask your state 00:20:38.000 --> 00:20:41.000 how your state Medicaid agency, how are 00:20:41.000 --> 00:20:45.000 services being delivered, who's doing 00:20:45.000 --> 00:20:48.000 it? Is it administered by the State, is 00:20:48.000 --> 00:20:51.000 it a third party like Medicaid Managed 00:20:51.000 --> 00:20:54.000 Care? That would be the first thing. And you can also go to C 00:20:54.000 --> 00:20:58.000 MS's website and look up Medicaid 00:20:58.000 --> 00:21:01.000 Managed Care. Just Google that, and your state, 00:21:01.000 --> 00:21:04.000 and it'll come up with a list of 00:21:04.000 --> 00:21:07.000 organizations that are providing services there 00:21:07.000 --> 00:21:12.000 . 00:21:12.000 --> 00:21:17.000 Employment. 00:21:17.000 --> 00:21:20.000 This is one where here 00:21:20.000 --> 00:21:24.000 in Oklahoma unfortunately we don't have 00:21:24.000 --> 00:21:28.000 a Medicaid buy-in. We passed legislation 00:21:28.000 --> 00:21:31.000 back in 2001 00:21:31.000 --> 00:21:34.000 to require our Medicaid agency 00:21:34.000 --> 00:21:38.000 to do 00:21:38.000 --> 00:21:41.000 it. But no one has held 00:21:41.000 --> 00:21:45.000 them accountable. The legislature in particular 00:21:45.000 --> 00:21:49.000 . There was one side that didn't want 00:21:49.000 --> 00:21:52.000 , you know, Medicaid to expand any further 00:21:52.000 --> 00:21:55.000 than what it has. And that's 00:21:55.000 --> 00:21:59.000 really been the challenge that we've had 00:21:59.000 --> 00:22:02.000 with trying to get a 00:22:02.000 --> 00:22:05.000 Medicaid buy-in up and running. And obviously in having 00:22:05.000 --> 00:22:09.000 that, that's going to allow people with 00:22:09.000 --> 00:22:13.000 disabilities to go to work without being penalize 00:22:13.000 --> 00:22:16.000 d. The people can go to work under our 00:22:16.000 --> 00:22:19.000 existing framework and 00:22:19.000 --> 00:22:22.000 Medicaid 1619-B will be available 00:22:22.000 --> 00:22:26.000 . So a person could earn potentially around $30 00:22:26.000 --> 00:22:29.000 ,000 a year but that's 00:22:29.000 --> 00:22:32.000 it. And 00:22:32.000 --> 00:22:35.000 so obviously this is something that 00:22:35.000 --> 00:22:39.000 we have to get 00:22:39.000 --> 00:22:42.000 moving so that people aren't limited with 00:22:42.000 --> 00:22:45.000 their income. We do have 00:22:45.000 --> 00:22:49.000 agreements with a couple of the 00:22:49.000 --> 00:22:52.000 Medicaid Managed Care organizations that we 00:22:52.000 --> 00:22:55.000 will be able to offer 00:22:55.000 --> 00:22:58.000 that component, so again, if we go back to personal preference 00:22:58.000 --> 00:23:02.000 and choice, then this will be 00:23:02.000 --> 00:23:05.000 a opportunity for people to participate in this 00:23:05.000 --> 00:23:08.000 . I'm hoping that this session 00:23:08.000 --> 00:23:13.000 will -- that that's going to pass without 00:23:13.000 --> 00:23:16.000 -- and it'll be available statewide to everybody 00:23:16.000 --> 00:23:20.000 . There is a big fight going on within our 00:23:20.000 --> 00:23:23.000 legislature over this 00:23:23.000 --> 00:23:27.000 . And I think it's going to be 00:23:27.000 --> 00:23:30.000 resolved, and I think we'll be okay 00:23:30.000 --> 00:23:34.000 in moving forward with the Medicaid 00:23:34.000 --> 00:23:37.000 Managed Care approach. 00:23:37.000 --> 00:23:41.000 Technology. One of the -- in one of the debates 00:23:41.000 --> 00:23:44.000 that the Senate had 00:23:44.000 --> 00:23:48.000 last year -- Oklahoma State Senate, 00:23:48.000 --> 00:23:52.000 our President Pro 00:23:52.000 --> 00:23:55.000 Tem making comments about trying to control the 00:23:55.000 --> 00:23:58.000 costs around durable medical equipment and 00:23:58.000 --> 00:24:02.000 wheelchairs and 00:24:02.000 --> 00:24:05.000 that sort of thing. So there is some 00:24:05.000 --> 00:24:08.000 concern from our 00:24:08.000 --> 00:24:12.000 community about what does that mean? How are they going to control this 00:24:12.000 --> 00:24:15.000 ? What does that mean for people with disabilities 00:24:15.000 --> 00:24:18.000 ? Who are already having a really difficult time in accessing the 00:24:18.000 --> 00:24:22.000 equipment that we need and 00:24:22.000 --> 00:24:25.000 supplies. Any type of assistive 00:24:25.000 --> 00:24:29.000 technology. It's not something 00:24:29.000 --> 00:24:32.000 that many case managers or 00:24:32.000 --> 00:24:35.000 existing case managers are really educated on. There's 00:24:35.000 --> 00:24:39.000 very little training, and 00:24:39.000 --> 00:24:43.000 under one of our waivers. And people with disabilities 00:24:43.000 --> 00:24:46.000 aren't even part of that training. They don't 00:24:46.000 --> 00:24:49.000 coordinate with the centers to offer any 00:24:49.000 --> 00:24:52.000 training around disability issues or anything. 00:24:52.000 --> 00:24:55.000 So again, this is another one of those reasons 00:24:55.000 --> 00:24:58.000 why we're very supportive of moving to 00:24:58.000 --> 00:25:01.000 a managed care -- Medicaid Managed 00:25:01.000 --> 00:25:05.000 Care approach. Because I know that companies like Anthem 00:25:05.000 --> 00:25:08.000 or Sintene 00:25:08.000 --> 00:25:11.000 or United are going to reach out to centers and 00:25:11.000 --> 00:25:15.000 say, well, let's talk about what type of technologies are available 00:25:15.000 --> 00:25:18.000 so this person can live more independently. And 00:25:18.000 --> 00:25:23.000 not have to 00:25:23.000 --> 00:25:26.000 wait on a personal care attendant to come in and help 00:25:26.000 --> 00:25:30.000 them get dressed or help them get into the 00:25:30.000 --> 00:25:33.000 bathroom or something like that. We are going to look at 00:25:33.000 --> 00:25:37.000 different types of approaches. And this is 00:25:37.000 --> 00:25:40.000 one of the things that the State's 00:25:40.000 --> 00:25:43.000 really been needing to do for many, many years, but 00:25:43.000 --> 00:25:46.000 unfortunately they don't see it that way. So there are some big chak 00:25:46.000 --> 00:25:51.000 changes that are going to be made around 00:25:51.000 --> 00:25:54.000 around the access to assistive technology 00:25:54.000 --> 00:25:57.000 . One of the 00:25:57.000 --> 00:26:00.000 approaches that 00:26:00.000 --> 00:26:05.000 we were trying to address last year prior to the 00:26:05.000 --> 00:26:09.000 RFP closing was how can we reach out 00:26:09.000 --> 00:26:12.000 to different 00:26:12.000 --> 00:26:16.000 minority groups, people of 00:26:16.000 --> 00:26:19.000 color, and so 00:26:19.000 --> 00:26:23.000 I used a lot of the relationships that I had growing 00:26:23.000 --> 00:26:27.000 up. I grew up in 00:26:27.000 --> 00:26:36.000 -- close to a town by a historically 00:26:36.000 --> 00:26:39.000 black college, Lang 00:26:39.000 --> 00:26:43.000 ston University and I'm very proud 00:26:43.000 --> 00:26:46.000 of that and took classes there 00:26:46.000 --> 00:26:49.000 . And we started that framework, how can we improve 00:26:49.000 --> 00:26:52.000 healthcare to address the healthcare disparities 00:26:52.000 --> 00:26:56.000 in underserved groups? I was 00:26:56.000 --> 00:26:59.000 really excited about the approaches 00:26:59.000 --> 00:27:02.000 that we are going to take, specifically 00:27:02.000 --> 00:27:06.000 around 00:27:06.000 --> 00:27:09.000 people of color and involving people with 00:27:09.000 --> 00:27:13.000 disabilities around policymaking, 00:27:13.000 --> 00:27:16.000 developing policies and procedures. You'll have an opportunity 00:27:16.000 --> 00:27:19.000 to get involved with an 00:27:19.000 --> 00:27:28.000 advisory committee or a board 00:27:28.000 --> 00:27:32.000 as things move forward. And again if you're 00:27:32.000 --> 00:27:35.000 not familiar too much with Medicaid 00:27:35.000 --> 00:27:38.000 Managed Care and want additional 00:27:38.000 --> 00:27:41.000 information, reach out to Mary or 00:27:41.000 --> 00:27:45.000 myself. Happy to provide any additional 00:27:45.000 --> 00:27:48.000 information that you might 00:27:48.000 --> 00:27:51.000 need as 00:27:51.000 --> 00:27:54.000 an MCO might be working within your state 00:27:54.000 --> 00:27:58.000 . You can also 00:27:58.000 --> 00:28:06.000 use -- if you get involved with an MCO and 00:28:06.000 --> 00:28:09.000 you can use that opportunity to -- as I mention 00:28:09.000 --> 00:28:12.000 ed on the previous slide -- reach out to various 00:28:12.000 --> 00:28:15.000 groups that haven't been provided 00:28:15.000 --> 00:28:18.000 services at this point. Unserved and underserve 00:28:18.000 --> 00:28:21.000 d populations, which could include people with autism 00:28:21.000 --> 00:28:25.000 , brain injuries or head injuries, 00:28:25.000 --> 00:28:28.000 developmental disabilities, mental ill 00:28:28.000 --> 00:28:31.000 ness. And you can reduce healthcare 00:28:31.000 --> 00:28:35.000 costs by making sure that wellness and 00:28:35.000 --> 00:28:38.000 prevention services are being provided 00:28:38.000 --> 00:28:42.000 . That is 00:28:42.000 --> 00:28:45.000 -- here in Oklahoma that's not been something that's been 00:28:45.000 --> 00:28:48.000 utilized very much at all. We do 00:28:48.000 --> 00:28:51.000 not have very good robust systems to 00:28:51.000 --> 00:28:55.000 provide services to people with head injuries 00:28:55.000 --> 00:28:58.000 . I'm pretty embarrassed about that 00:28:58.000 --> 00:29:01.000 . We had worked with the 00:29:01.000 --> 00:29:05.000 state -- our state Medicaid agency back 00:29:05.000 --> 00:29:08.000 in 2006, 2007 00:29:08.000 --> 00:29:12.000 to, 00:29:12.000 --> 00:29:15.000 one, to apply for the money follows 00:29:15.000 --> 00:29:18.000 the person grant. And within that 00:29:18.000 --> 00:29:22.000 grant we had written in 00:29:22.000 --> 00:29:26.000 there all five centers in our 00:29:26.000 --> 00:29:29.000 state was heavily involved in that application 00:29:29.000 --> 00:29:33.000 . And within that application we said that we want 00:29:33.000 --> 00:29:36.000 ed nursing home beds to be 00:29:36.000 --> 00:29:39.000 closed after a person moves out. And then 00:29:39.000 --> 00:29:42.000 that full amount of money would follow that person into the community, 00:29:42.000 --> 00:29:45.000 so that we would have additional resources to 00:29:45.000 --> 00:29:49.000 provide to that person and/or serve areas 00:29:49.000 --> 00:29:52.000 that we have not been real efficient in serving, 00:29:52.000 --> 00:29:56.000 such as people with head injuries 00:29:56.000 --> 00:30:02.000 . And it is 00:30:02.000 --> 00:30:05.000 -- I hate that we have not been able to do 00:30:05.000 --> 00:30:08.000 that as of yet. But that is something 00:30:08.000 --> 00:30:12.000 that we will get addressed as 00:30:12.000 --> 00:30:14.000 we move forward with Medicaid Managed 00:30:14.000 --> 00:30:18.000 Care. People with autism, very same thing. People with 00:30:18.000 --> 00:30:21.000 spinal cord injuries. We don't have a good, robust 00:30:21.000 --> 00:30:25.000 system at all. And frankly with 00:30:25.000 --> 00:30:28.000 my personal opinion is I don't feel like any of the systems that 00:30:28.000 --> 00:30:31.000 we currently have are very good at all 00:30:31.000 --> 00:30:35.000 . There will be people that'll disagree with that, 00:30:35.000 --> 00:30:38.000 but that's just my personal opinion 00:30:38.000 --> 00:30:41.000 . 00:30:41.000 --> 00:30:47.000 And finally, 00:30:47.000 --> 00:30:51.000 you'll have an opportunity to increase fund 00:30:51.000 --> 00:30:54.000 ing. Being flexible to serve community 00:30:54.000 --> 00:30:58.000 ies as you 00:30:58.000 --> 00:31:02.000 know that people need -- that people 00:31:02.000 --> 00:31:05.000 will be needing. You will be 00:31:05.000 --> 00:31:08.000 able to im 00:31:08.000 --> 00:31:12.000 prove education services. You'll be 00:31:12.000 --> 00:31:16.000 providing incentives through this whole Medicaid 00:31:16.000 --> 00:31:19.000 Managed Care. So there's a lot of opportunities and a lot of support that 00:31:19.000 --> 00:31:23.000 you can get, but the key piece of this is to be 00:31:23.000 --> 00:31:26.000 sure that you are engage ing 00:31:26.000 --> 00:31:29.000 ing your MCOs as they 00:31:29.000 --> 00:31:34.000 come into your state. And how do you do that? Well, it's 00:31:34.000 --> 00:31:38.000 you know, I spent 00:31:38.000 --> 00:31:42.000 a whole lot of time just getting on the phone and tracking people 00:31:42.000 --> 00:31:46.000 down. I 00:31:46.000 --> 00:31:51.000 am pretty persistent with 00:31:51.000 --> 00:31:55.000 any of them, but I'm not going to just sit 00:31:55.000 --> 00:31:58.000 by and let an organization say that they're going 00:31:58.000 --> 00:32:02.000 to come in and provide services without at least 00:32:02.000 --> 00:32:05.000 meeting with us, meeting with our consumers 00:32:05.000 --> 00:32:09.000 . We set up -- when the first time that 00:32:09.000 --> 00:32:12.000 we started meeting with MCOs 00:32:12.000 --> 00:32:15.000 , we set up a series of meet 00:32:15.000 --> 00:32:19.000 ings so that Edna would come 00:32:19.000 --> 00:32:22.000 in and meet with our consumers to answer their questions and 00:32:22.000 --> 00:32:26.000 concerns. San 00:32:26.000 --> 00:32:29.000 tine did that, 00:32:29.000 --> 00:32:32.000 malina did that. Hu 00:32:32.000 --> 00:32:36.000 mana did that. Blue 00:32:36.000 --> 00:32:39.000 Cross Blue Shield has not done that, but we will make sure they 00:32:39.000 --> 00:32:44.000 do on this next round. United, same thing. We always want 00:32:44.000 --> 00:32:48.000 these MCOs to answer the questions 00:32:48.000 --> 00:32:51.000 of our consumers has to how this is goipg 00:32:51.000 --> 00:32:55.000 going to work and how their needs are going to be met. It's 00:32:55.000 --> 00:32:58.000 not about my agency per se, it's 00:32:58.000 --> 00:33:01.000 specifically about addressing the needs of our community 00:33:01.000 --> 00:33:04.000 . And our community is done -- we provided 00:33:04.000 --> 00:33:08.000 a lot of training and a lot of support, a lot of educational 00:33:08.000 --> 00:33:11.000 opportunities for people to learn more about Medicaid 00:33:11.000 --> 00:33:15.000 Managed Care and how the systems could be structured so 00:33:15.000 --> 00:33:18.000 that increased services and supports could be 00:33:18.000 --> 00:33:21.000 available. So when we go into these meetings, they're very 00:33:21.000 --> 00:33:24.000 well versed, and they understand exactly how things are 00:33:24.000 --> 00:33:28.000 going to work. And so when an MC 00:33:28.000 --> 00:33:31.000 O comes in wanting -- saying whatever they're 00:33:31.000 --> 00:33:34.000 saying, bha, blah, blah. 00:33:34.000 --> 00:33:37.000 People are drilling them with questions about, well, how is thing 00:33:37.000 --> 00:33:41.000 this going to work? How am I going to receive supplies 00:33:41.000 --> 00:33:44.000 ? Like catheters or 00:33:44.000 --> 00:33:47.000 blue pads or how is wound care going to work 00:33:47.000 --> 00:33:50.000 ? And they really push on them and hold 00:33:50.000 --> 00:33:54.000 them accountable. And so the ones that we work with 00:33:54.000 --> 00:33:58.000 and that we want 00:33:58.000 --> 00:34:01.000 to have part of our infrastructure within the 00:34:01.000 --> 00:34:04.000 state, they are the ones that our consumers will say that these are the 00:34:04.000 --> 00:34:07.000 ones we want to work with. And if 00:34:07.000 --> 00:34:11.000 they don't want to work with them, then we don't do it. And we're 00:34:11.000 --> 00:34:15.000 very open about who should and shouldn't 00:34:15.000 --> 00:34:19.000 be part of this framework. And 00:34:19.000 --> 00:34:22.000 that has worked really, really well 00:34:22.000 --> 00:34:26.000 . So I encourage you, if you haven't 00:34:26.000 --> 00:34:29.000 done that, to make sure that 00:34:29.000 --> 00:34:32.000 you're involving your community with what this could 00:34:32.000 --> 00:34:36.000 look like, the opportunities that could be there, and 00:34:36.000 --> 00:34:39.000 help people become more educated around this issue, 00:34:39.000 --> 00:34:42.000 and then that'll make your job a lot easier 00:34:42.000 --> 00:34:46.000 as you're providing services. As you're coordinating 00:34:46.000 --> 00:34:49.000 services, as you're providing information 00:34:49.000 --> 00:34:52.000 to people about this whole Medicaid 00:34:52.000 --> 00:34:55.000 Managed Care framework 00:34:55.000 --> 00:34:59.000 . And we have a 00:34:59.000 --> 00:35:02.000 question. 00:35:02.000 --> 00:35:05.000 She would like to know if you guys 00:35:05.000 --> 00:35:09.000 have independent living in assist 00:35:09.000 --> 00:35:12.000 ed living facilities for a lot of youth, like myself 00:35:12.000 --> 00:35:15.000 that already have Medicaid in our area of 00:35:15.000 --> 00:35:19.000 Atlanta and just to let you know I already 00:35:19.000 --> 00:35:22.000 have Medicaid insurance and personal Social Security 00:35:22.000 --> 00:35:25.000 income letter for me 00:35:25.000 --> 00:35:28.000 as well as one of my Social Security (read 00:35:28.000 --> 00:35:31.000 ing chat). Yeah, one of the things 00:35:31.000 --> 00:35:35.000 that I know that Santine is 00:35:35.000 --> 00:35:39.000 really supportive and Santine and 00:35:39.000 --> 00:35:42.000 Anthem really want to address is around the 00:35:42.000 --> 00:35:46.000 whole issue of providing services to youth, younger people 00:35:46.000 --> 00:35:50.000 . And Cent 00:35:50.000 --> 00:35:53.000 ine would be one of the first people 00:35:53.000 --> 00:35:56.000 to say APRIL has done a really good job in 00:35:56.000 --> 00:35:59.000 reaching out to younger people with disabilities 00:35:59.000 --> 00:36:02.000 . And I know Sentin 00:36:02.000 --> 00:36:06.000 e will want to continue to support any efforts that are 00:36:06.000 --> 00:36:09.000 around youth-driven support. 00:36:09.000 --> 00:36:13.000 So there are a couple 00:36:13.000 --> 00:36:17.000 MCOs that do want to see increase 00:36:17.000 --> 00:36:21.000 d supports around those issues. So 00:36:21.000 --> 00:36:24.000 if they're not in your 00:36:24.000 --> 00:36:28.000 state, then find out who is 00:36:28.000 --> 00:36:31.000 and let's talk about ways that you can 00:36:31.000 --> 00:36:35.000 get some of these other MCOs in. There are 00:36:35.000 --> 00:36:38.000 some horror stories. I'm not going to sit here and 00:36:38.000 --> 00:36:42.000 pretend that it's all just roses 00:36:42.000 --> 00:36:45.000 when you have Medicaid 00:36:45.000 --> 00:36:48.000 Managed Care organization come into your state. There are all kinds 00:36:48.000 --> 00:36:51.000 of horror stories that we all hear in different 00:36:51.000 --> 00:36:55.000 states. But I will tell you that in Oklahoma 00:36:55.000 --> 00:36:58.000 that we have not had Medicaid Manage 00:36:58.000 --> 00:37:01.000 d Care for many 00:37:01.000 --> 00:37:05.000 , many years. And when we did it was just a 00:37:05.000 --> 00:37:09.000 half-ass approach from the very beginning. So if this 00:37:09.000 --> 00:37:13.000 does go ahead and move forward, which it will, 00:37:13.000 --> 00:37:16.000 it is going to be drastically different in 00:37:16.000 --> 00:37:20.000 providing the supports necessary for people 00:37:20.000 --> 00:37:23.000 here. The State of Oklahoma has done an awful 00:37:23.000 --> 00:37:28.000 job in providing the services to our community 00:37:28.000 --> 00:37:31.000 . I've been very vocal about it with our 00:37:31.000 --> 00:37:34.000 healthcare authority, with our legislature and with 00:37:34.000 --> 00:37:37.000 the Department of Human Services. And it 00:37:37.000 --> 00:37:41.000 amazes me they still receive funding to the 00:37:41.000 --> 00:37:44.000 degree that they do, and yet not 00:37:44.000 --> 00:37:47.000 really providing much services at all. To give you 00:37:47.000 --> 00:37:50.000 a good example of when 00:37:50.000 --> 00:37:54.000 what has gone on here, 00:37:54.000 --> 00:37:57.000 in 2016 in 00:37:57.000 --> 00:38:00.000 Oklahoma healthcare 00:38:00.000 --> 00:38:04.000 authorities annual report which covers all 00:38:04.000 --> 00:38:07.000 Medicaid services including waivers there was 00:38:07.000 --> 00:38:10.000 only 168 home modifications 00:38:10.000 --> 00:38:13.000 done state 00:38:13.000 --> 00:38:17.000 wide. So only 168. Of all the people that are 00:38:17.000 --> 00:38:20.000 on Medicaid. And we run 00:38:20.000 --> 00:38:23.000 into people dying, literally, to get that service 00:38:23.000 --> 00:38:27.000 addressed every single day. 00:38:27.000 --> 00:38:30.000 So we do have substantial problems 00:38:30.000 --> 00:38:33.000 within our state and are very excited 00:38:33.000 --> 00:38:36.000 to have an opportunity to improve 00:38:36.000 --> 00:38:40.000 the services and supports around our community 00:38:40.000 --> 00:38:43.000 . So with that, 00:38:43.000 --> 00:38:47.000 we'll open it up to additional questions. That 00:38:47.000 --> 00:38:50.000 covers the six principles that 00:38:50.000 --> 00:38:54.000 we want to see as Anthem address 00:38:54.000 --> 00:38:57.000 ed through any type of a Medicaid 00:38:57.000 --> 00:39:01.000 Managed Care approach. These should be described within 00:39:01.000 --> 00:39:04.000 any application that is put forth. The State will 00:39:04.000 --> 00:39:08.000 put forth an RFP and have a bidding process 00:39:08.000 --> 00:39:11.000 , and 00:39:11.000 --> 00:39:14.000 then they described what services are gieng to be 00:39:14.000 --> 00:39:17.000 provided. One question is, can you give 00:39:17.000 --> 00:39:21.000 me a concrete example of how an MCO 00:39:21.000 --> 00:39:24.000 would help my NCIL? And 00:39:24.000 --> 00:39:27.000 I absolutely can. As I mentioned 00:39:27.000 --> 00:39:34.000 earlier, one of the things that we are doing is 00:39:34.000 --> 00:39:39.000 personal care training and registry 00:39:39.000 --> 00:39:43.000 . So we are putting -- we are 00:39:43.000 --> 00:39:46.000 -- we have developed this training that is 00:39:46.000 --> 00:39:49.000 based upon a consumer-directed 00:39:49.000 --> 00:39:52.000 approach. And we cover everything within 00:39:52.000 --> 00:39:56.000 that training from how to 00:39:56.000 --> 00:39:59.000 hire, how to advertise, how to 00:39:59.000 --> 00:40:03.000 provide additional training to your personal care 00:40:03.000 --> 00:40:06.000 attendant, to also providing 00:40:06.000 --> 00:40:09.000 training to a potential 00:40:09.000 --> 00:40:13.000 personal care attendant. And 00:40:13.000 --> 00:40:16.000 that program is going to be funded 00:40:16.000 --> 00:40:20.000 through one or more Medicaid 00:40:20.000 --> 00:40:24.000 Managed Care programs. So that's one specific example 00:40:24.000 --> 00:40:28.000 . Another one 00:40:28.000 --> 00:40:31.000 is that we are -- I just took 00:40:31.000 --> 00:40:35.000 over an additional space 00:40:35.000 --> 00:40:38.000 -- office space, where we are provide 00:40:38.000 --> 00:40:41.000 ing -- we will be providing healthy 00:40:41.000 --> 00:40:45.000 cooking classes on a fully accessible 00:40:45.000 --> 00:40:50.000 kitchen that will be 00:40:50.000 --> 00:40:53.000 -- will have the fully accessible stove 00:40:53.000 --> 00:40:57.000 and all the accessible features that you would 00:40:57.000 --> 00:41:00.000 want within your kitchen. So that 00:41:00.000 --> 00:41:04.000 we can demonstrate that, but also 00:41:04.000 --> 00:41:08.000 on cooking healthy 00:41:08.000 --> 00:41:13.000 . And eating healthier. 00:41:13.000 --> 00:41:16.000 By using things 00:41:16.000 --> 00:41:20.000 like Hello Fresh or something as 00:41:20.000 --> 00:41:23.000 simple as that. It maybe 00:41:23.000 --> 00:41:26.000 a dollar more than what a person can 00:41:26.000 --> 00:41:29.000 get from, quote, Meals 00:41:29.000 --> 00:41:33.000 on Wheels, but it's so much fresher and 00:41:33.000 --> 00:41:36.000 better for you. So that'll be funded through an MCO. So house 00:41:36.000 --> 00:41:39.000 ing opportunities and, you know, doing out and going 00:41:39.000 --> 00:41:42.000 out and surveying a -- your house 00:41:42.000 --> 00:41:46.000 ing inventory, accessible housing and provide 00:41:46.000 --> 00:41:49.000 ing the resources to make a 00:41:49.000 --> 00:41:52.000 place accessible. That's another project that could be 00:41:52.000 --> 00:41:56.000 utilized. So it's all 00:41:56.000 --> 00:42:00.000 there, but think 00:42:00.000 --> 00:42:03.000 creatively on how you can 00:42:03.000 --> 00:42:06.000 provide services through your 00:42:06.000 --> 00:42:09.000 Center. What about nursing home transition? We also have 00:42:09.000 --> 00:42:13.000 an open doors fund where we will assist people with 00:42:13.000 --> 00:42:16.000 disabilities who are moving from an institution to the community 00:42:16.000 --> 00:42:19.000 for covering 00:42:19.000 --> 00:42:22.000 first month's rent, utilities, and a 00:42:22.000 --> 00:42:26.000 little bit of clothing, 00:42:26.000 --> 00:42:29.000 food allowances, stuff like that. 00:42:29.000 --> 00:42:32.000 That is funded through Medicaid Managed 00:42:32.000 --> 00:42:35.000 Care. During this time of COVID, it is 00:42:35.000 --> 00:42:39.000 so vitally important that we are 00:42:39.000 --> 00:42:43.000 engaging with our community around 00:42:43.000 --> 00:42:47.000 vaccines. So 00:42:47.000 --> 00:42:50.000 we -- 00:42:50.000 --> 00:42:55.000 earlier this year and all of last year we were 00:42:55.000 --> 00:42:58.000 giving out iPads so that people with 00:42:58.000 --> 00:43:01.000 disabilities would have that social interaction, 00:43:01.000 --> 00:43:04.000 would be able to keep up with 00:43:04.000 --> 00:43:10.000 vaccine related information in rural areas 00:43:10.000 --> 00:43:13.000 . I don't remember the number that we ended up giving a 00:43:13.000 --> 00:43:17.000 way, but it was a bunch of iPads so that people could have 00:43:17.000 --> 00:43:20.000 contact day-to-day with whoever 00:43:20.000 --> 00:43:23.000 that they needed. And 00:43:23.000 --> 00:43:26.000 also so that we can provide vital 00:43:26.000 --> 00:43:30.000 information around what people needed to be doing 00:43:30.000 --> 00:43:33.000 to get on the list, quote, 00:43:33.000 --> 00:43:36.000 list for your vaccination 00:43:36.000 --> 00:43:40.000 . And MCOs were 00:43:40.000 --> 00:43:43.000 funding that initiative as well 00:43:43.000 --> 00:43:47.000 . And as I mentioned with the COVID 00:43:47.000 --> 00:43:51.000 vaccinations, you know, this is something that I feel 00:43:51.000 --> 00:43:54.000 very strongly about that 00:43:54.000 --> 00:43:57.000 Centers need to be involved in 00:43:57.000 --> 00:44:01.000 developing the strategies around assisting people with disabilities 00:44:01.000 --> 00:44:04.000 , providing that opportunity, and 00:44:04.000 --> 00:44:09.000 maybe even getting people 00:44:09.000 --> 00:44:11.000 to and from a site to be vaccinate 00:44:11.000 --> 00:44:15.000 d. Or maybe you want to host it yourself. 00:44:15.000 --> 00:44:19.000 You can also engage Centers -- 00:44:19.000 --> 00:44:22.000 you can also engage MCOs around that 00:44:22.000 --> 00:44:25.000 initiative as well. I know Anthem 00:44:25.000 --> 00:44:28.000 has been very, very, very active around trying to get out 00:44:28.000 --> 00:44:33.000 good information around the vaccinations and 00:44:33.000 --> 00:44:37.000 I'm excited to be a part of that. That's been 00:44:37.000 --> 00:44:40.000 a really good benefit in being involved in this 00:44:40.000 --> 00:44:44.000 . So I first got involved with 00:44:44.000 --> 00:44:47.000 Aetna and its 00:44:47.000 --> 00:44:50.000 advisory committee. And A 00:44:50.000 --> 00:44:53.000 etna's gone through 00:44:53.000 --> 00:44:57.000 some struggles and some people have left. So I'm no longer 00:44:57.000 --> 00:45:00.000 on that committee, but then I moved over to Anthem, which I'm 00:45:00.000 --> 00:45:04.000 very excited about being part of. It's a 00:45:04.000 --> 00:45:07.000 great group, great information being shared. It is a leader 00:45:07.000 --> 00:45:11.000 among healthcare. So if you have 00:45:11.000 --> 00:45:14.000 that opportunity to get involved with one of them I highly encourage you to do 00:45:14.000 --> 00:45:17.000 so because you will learn a great 00:45:17.000 --> 00:45:21.000 deal of information. Question is: 00:45:21.000 --> 00:45:24.000 How do I find out if I have an MCO 00:45:24.000 --> 00:45:27.000 in my state, how do I send them ideas 00:45:27.000 --> 00:45:31.000 on first steps, getting them to pay for things 00:45:31.000 --> 00:45:35.000 like Hello Fresh program? So as I mentioned yerl 00:45:35.000 --> 00:45:38.000 ed earlier, reach out to your 00:45:38.000 --> 00:45:41.000 State Medicaid Agency and find 00:45:41.000 --> 00:45:44.000 out if you're already -- if Medicaid Manage 00:45:44.000 --> 00:45:47.000 d Care is already an option within your state 00:45:47.000 --> 00:45:50.000 . And as I mentioned, you can 00:45:50.000 --> 00:45:54.000 also go to CMS's website and Mary 00:45:54.000 --> 00:45:57.000 can probably get you the link to 00:45:57.000 --> 00:46:00.000 that. It'll tell you as well 00:46:00.000 --> 00:46:04.000 what MCOs are operating within your state. And 00:46:04.000 --> 00:46:08.000 put forth a proposal. Think about just like a grant or something 00:46:08.000 --> 00:46:11.000 . Come up with an idea of what you're want 00:46:11.000 --> 00:46:14.000 ing to address and why. And then 00:46:14.000 --> 00:46:17.000 go meet with the 00:46:17.000 --> 00:46:21.000 CEO. Each state will have 00:46:21.000 --> 00:46:24.000 a CEO over that 00:46:24.000 --> 00:46:28.000 plan, and so the 00:46:28.000 --> 00:46:31.000 United has a CEO here in Oklahoma 00:46:31.000 --> 00:46:34.000 and Humana has a 00:46:34.000 --> 00:46:37.000 CEO. Sent 00:46:37.000 --> 00:46:41.000 ine has a CEO. Each 00:46:41.000 --> 00:46:44.000 one will be over that plan and go meet with them. Take them to dinner, 00:46:44.000 --> 00:46:47.000 just like you would any other funding source 00:46:47.000 --> 00:46:53.000 . This is what we want to do, and how can we get support from 00:46:53.000 --> 00:46:56.000 hello Mr. Or Mrs. 00:46:56.000 --> 00:46:59.000 MCO on getting some funding to our 00:46:59.000 --> 00:47:04.000 community? And utilizing the centers 00:47:04.000 --> 00:47:07.000 . The more of you that 00:47:07.000 --> 00:47:10.000 do it, the better engage 00:47:10.000 --> 00:47:15.000 d that you will be 00:47:15.000 --> 00:47:18.000 long-term. And so right now I think that 00:47:18.000 --> 00:47:22.000 my agency's about the only one that's really 00:47:22.000 --> 00:47:25.000 been supportive of this Medicaid 00:47:25.000 --> 00:47:29.000 Managed Care concept. And I think probably because it's 00:47:29.000 --> 00:47:32.000 -- the other centers just don't 00:47:32.000 --> 00:47:36.000 see exactly how it's going to benefit 00:47:36.000 --> 00:47:39.000 them and their consumers. So we've got a little bit of 00:47:39.000 --> 00:47:43.000 work to do to bring some more centers on board 00:47:43.000 --> 00:47:46.000 . And so we're going to be doing 00:47:46.000 --> 00:47:51.000 more work with that. 00:47:51.000 --> 00:47:55.000 Hey Maw 00:47:55.000 --> 00:47:59.000 Maureen suggested that 00:47:59.000 --> 00:48:02.000 any state with MCO has an ombuds 00:48:02.000 --> 00:48:06.000 man to address issues that come up. And that's very much 00:48:06.000 --> 00:48:09.000 true. There are going to be issues that come up, and you will want 00:48:09.000 --> 00:48:13.000 to have a third party entity that will be working with 00:48:13.000 --> 00:48:16.000 you. You'll want -- unfortunately what we've 00:48:16.000 --> 00:48:19.000 had over the years is one entity doing it well, and that's been 00:48:19.000 --> 00:48:22.000 the Department of Human Services. 00:48:22.000 --> 00:48:25.000 So we -- they've really bury 00:48:25.000 --> 00:48:29.000 ied our community-based programs 00:48:29.000 --> 00:48:32.000 because they've always -- if there's 00:48:32.000 --> 00:48:35.000 an issue they don't want to get it out. And it's 00:48:35.000 --> 00:48:39.000 never even addressed. So very much 00:48:39.000 --> 00:48:42.000 make sure that you do have an independent 00:48:42.000 --> 00:48:45.000 third party ombuds 00:48:45.000 --> 00:48:48.000 man. That's absolutely correct. Where can we find out 00:48:48.000 --> 00:48:52.000 more about Medicaid buy-in 00:48:52.000 --> 00:48:55.000 ? You can go to -- 00:48:55.000 --> 00:48:59.000 you can just Google it, frankly, jut do a Medicaid 00:48:59.000 --> 00:49:02.000 buy-in. Just Google that, and it'll bring 00:49:02.000 --> 00:49:06.000 up administrational community living has put foth 00:49:06.000 --> 00:49:09.000 forth a little information on Medicaid 00:49:09.000 --> 00:49:13.000 buy-in. I think some information is available on C 00:49:13.000 --> 00:49:16.000 MS's website as well. Absolutely do that, and 00:49:16.000 --> 00:49:19.000 then if you have additional questions after you do 00:49:19.000 --> 00:49:22.000 that, reach out to Mary or myself or Mau 00:49:22.000 --> 00:49:25.000 reen. I'm 00:49:25.000 --> 00:49:29.000 glad Maureen was on this call. And great resources 00:49:29.000 --> 00:49:32.000 that are available to anyone interested going down this 00:49:32.000 --> 00:49:35.000 road. Mareen is from 00:49:35.000 --> 00:49:38.000 Wisconsin, and one of the people I learned a great deal about Medicaid 00:49:38.000 --> 00:49:42.000 Managed Care from was 00:49:42.000 --> 00:49:47.000 lee shults who was from 00:49:47.000 --> 00:49:50.000 Milwaukee. He and 00:49:50.000 --> 00:49:53.000 Phil Gratso from phoenix are 00:49:53.000 --> 00:49:57.000 a couple of my best friends. And I also learned a great deal from 00:49:57.000 --> 00:50:00.000 both of them about how to utilize the MCOs, and 00:50:00.000 --> 00:50:03.000 how to put together a good framework for services 00:50:03.000 --> 00:50:06.000 and supports. And the idea of putting together a 00:50:06.000 --> 00:50:09.000 personal care training and renl 00:50:09.000 --> 00:50:12.000 registry program came from Phil 00:50:12.000 --> 00:50:16.000 . He had -- Phil's retired 00:50:16.000 --> 00:50:20.000 now. If you know Phil. But he put together 00:50:20.000 --> 00:50:23.000 a huge program there in Fee in addition 00:50:23.000 --> 00:50:27.000 Phoenix that was supported 00:50:27.000 --> 00:50:30.000 by Medicaid Managed 00:50:30.000 --> 00:50:36.000 Care companies. 00:50:36.000 --> 00:50:40.000 Okay. Do we have any other questions 00:50:40.000 --> 00:50:52.000 ? 00:50:52.000 --> 00:50:56.000 I'm not see ing 00:50:56.000 --> 00:51:01.000 ing -- there we go. 00:51:01.000 --> 00:51:04.000 >> Mary: It looks like there's one more comment here 00:51:04.000 --> 00:51:08.000 . This is a comment 00:51:08.000 --> 00:51:11.000 . Super interesting presentation, Jeff. People 00:51:11.000 --> 00:51:15.000 can also look and see if your state offers 00:51:15.000 --> 00:51:18.000 United Healthcare. They will pay for gym memberships 00:51:18.000 --> 00:51:22.000 , they have transportation services, they will also send 00:51:22.000 --> 00:51:25.000 you a card in the mail that will help buy 00:51:25.000 --> 00:51:29.000 healthy food and more, for example, years ago 00:51:29.000 --> 00:51:32.000 my insurance would not cover weight loss surgery and 00:51:32.000 --> 00:51:35.000 I got United Healthcare and they paid for 00:51:35.000 --> 00:51:41.000 it. I live in North Carolina. 00:51:41.000 --> 00:51:44.000 >> JEFF HUGHES: Yeah, and again each MCO is 00:51:44.000 --> 00:51:49.000 going to offer different stuff. So make sure 00:51:49.000 --> 00:51:52.000 United does one thing and Krentin 00:51:52.000 --> 00:51:56.000 Centin 00:51:56.000 --> 00:51:59.000 e will do one thing and Huhman 00:51:59.000 --> 00:52:03.000 Humana will do something 00:52:03.000 --> 00:52:06.000 else. There's core services provides, but ancillary services 00:52:06.000 --> 00:52:10.000 will also be provided. So reach out, this is an opportunity for 00:52:10.000 --> 00:52:13.000 a center to receive funding 00:52:13.000 --> 00:52:17.000 on things that they may not have received funding before 00:52:17.000 --> 00:52:20.000 . One of the things that I get so frustrated with our state is 00:52:20.000 --> 00:52:23.000 that they want us to do everything for nothing 00:52:23.000 --> 00:52:26.000 . Which we have. We didn't have a choice. 00:52:26.000 --> 00:52:29.000 And so we were 00:52:29.000 --> 00:52:33.000 piecemealing everything we could possibly 00:52:33.000 --> 00:52:36.000 think of just to provide a level of 00:52:36.000 --> 00:52:39.000 support. And now as we 00:52:39.000 --> 00:52:42.000 move into this direction 00:52:42.000 --> 00:52:45.000 , there's going to be resources available to help us do 00:52:45.000 --> 00:52:49.000 it, so that's real exciting. Something 00:52:49.000 --> 00:52:53.000 that hasn't really ever been there before. 00:52:53.000 --> 00:52:56.000 So absolutely reach out. Reach out to your 00:52:56.000 --> 00:53:00.000 MCOs, get together with your other centers 00:53:00.000 --> 00:53:04.000 or just do it yourself. This is an opportunity for 00:53:04.000 --> 00:53:08.000 , like I mentioned, 00:53:08.000 --> 00:53:11.000 to receive some support for the things that we've 00:53:11.000 --> 00:53:14.000 all been trying to address for many, many years, but have 00:53:14.000 --> 00:53:17.000 not had the resources to do so. And also, the beauty about this 00:53:17.000 --> 00:53:21.000 is that these are private organizations 00:53:21.000 --> 00:53:25.000 . You don't have to go to the legislature and 00:53:25.000 --> 00:53:28.000 pass legislation just to get something 00:53:28.000 --> 00:53:31.000 done anymore. If it's a good idea and they want 00:53:31.000 --> 00:53:35.000 to get behind you, then they're going to do 00:53:35.000 --> 00:53:39.000 it. And that is a hell of a lot easier 00:53:39.000 --> 00:53:42.000 than trying to force the state into 00:53:42.000 --> 00:53:47.000 moving forward an inch and then 00:53:47.000 --> 00:53:50.000 just to be cut out of something in the backroom meet 00:53:50.000 --> 00:53:54.000 ing. We also here in Oklahoma, we had 00:53:54.000 --> 00:53:57.000 -- we had an home 00:53:57.000 --> 00:54:01.000 stead plan back in 2006 where 00:54:01.000 --> 00:54:04.000 we all -- all of our state agencies got together. 00:54:04.000 --> 00:54:07.000 We all adopted -- state agencies, people 00:54:07.000 --> 00:54:10.000 with disabilities, centers for independent 00:54:10.000 --> 00:54:14.000 living, SILCs, DD councils 00:54:14.000 --> 00:54:17.000 . Everyone got together add nauz 00:54:17.000 --> 00:54:21.000 nauseam to come up with an om 00:54:21.000 --> 00:54:24.000 stead plan. It was pretty good. It wasn't great 00:54:24.000 --> 00:54:27.000 . It wasn't the best, but we got quite a bit of stuff in there 00:54:27.000 --> 00:54:30.000 . And of course that just went on the shelf 00:54:30.000 --> 00:54:34.000 like so many other places and died. But 00:54:34.000 --> 00:54:37.000 one of the things that 00:54:37.000 --> 00:54:40.000 some of the MCOs has been asking about is, 00:54:40.000 --> 00:54:44.000 do you have an ohm 00:54:44.000 --> 00:54:47.000 stead plan? What about your 00:54:47.000 --> 00:54:51.000 MFP? Unfortunate 00:54:51.000 --> 00:54:54.000 ly our MFP program is pretty bad 00:54:54.000 --> 00:54:57.000 . It's operated by the State, and they doept 00:54:57.000 --> 00:55:01.000 don't really serve many people at all. So all 00:55:01.000 --> 00:55:04.000 of that can change and this is your opportunity to do 00:55:04.000 --> 00:55:07.000 so. >> Mary: Hi Jeff, we have 00:55:07.000 --> 00:55:11.000 one hand raised from 00:55:11.000 --> 00:55:14.000 Kyla, we have time for 00:55:14.000 --> 00:55:17.000 a short question. >> That was 00:55:17.000 --> 00:55:21.000 my fault. My cat jumped on the keyboard. >> Mary ( 00:55:21.000 --> 00:55:24.000 laughing). Okay never mind. Thank you 00:55:24.000 --> 00:55:27.000 . I do want to say there were a couple of things going on 00:55:27.000 --> 00:55:30.000 in the chat. Let's see 00:55:30.000 --> 00:55:34.000 if I can follow it here. 00:55:34.000 --> 00:55:37.000 Jacqueline says if you can dream it, a program or consumer 00:55:37.000 --> 00:55:40.000 service, then partnering with an MCO for funding and train 00:55:40.000 --> 00:55:44.000 ing support may be a way to achieve it. 00:55:44.000 --> 00:55:47.000 And Amanda says 00:55:47.000 --> 00:55:51.000 their MCOs are going to provide different services if you have 00:55:51.000 --> 00:55:55.000 dual coverage, meaning Medicaid and Medicare 00:55:55.000 --> 00:55:58.000 . And 00:55:58.000 --> 00:56:01.000 then curt says, would that 00:56:01.000 --> 00:56:04.000 be provided under United only if you are Medicaid 00:56:04.000 --> 00:56:08.000 ? What if you supplement under United and 00:56:08.000 --> 00:56:11.000 Medicare? I think that was maybe an answer. (Laughing) 00:56:11.000 --> 00:56:14.000 . Sorry. That you're going to get different 00:56:14.000 --> 00:56:18.000 services depending on if you have dual coverage, meaning 00:56:18.000 --> 00:56:20.000 medicare and Medicaid. 00:56:20.000 --> 00:56:23.000 >> JEFF HUGHES: Yeah, Oklahoma does dual. 00:56:23.000 --> 00:56:26.000 And it is -- you will get different thing 00:56:26.000 --> 00:56:30.000 s. Medicare's going to be paid for first, usually 00:56:30.000 --> 00:56:33.000 . And if it's deny 00:56:33.000 --> 00:56:37.000 ied through medicare then it'll fall to Medicaid. 00:56:37.000 --> 00:56:40.000 Little l bit of paper work there, but there are going to be 00:56:40.000 --> 00:56:44.000 quite a bit of services. Like here in the 00:56:44.000 --> 00:56:47.000 state, in Oklahoma, medicare services are being provided 00:56:47.000 --> 00:56:50.000 through Humana and United. And some of 00:56:50.000 --> 00:56:54.000 them that do provide medicare, but I don't think like Cent 00:56:54.000 --> 00:56:57.000 ine I don't think they provide medicare services, 00:56:57.000 --> 00:57:03.000 they're strictly medicare. >> Mary: 00:57:03.000 --> 00:57:06.000 It sounds like it depends on who your managed care organization 00:57:06.000 --> 00:57:09.000 is; is that right Jeff? Huh 00:57:09.000 --> 00:57:12.000 >> JEFF HUGHES: Uh-huh. It absolutely does 00:57:12.000 --> 00:57:16.000 . So again, you've got to become educate 00:57:16.000 --> 00:57:19.000 d on what your state is doing, where it's going with 00:57:19.000 --> 00:57:22.000 stuff. And who is at the 00:57:22.000 --> 00:57:25.000 table. Because it's never more important 00:57:25.000 --> 00:57:29.000 to be at the table than it is now. Obviously we have 00:57:29.000 --> 00:57:33.000 seen over the last several years how our community is 00:57:33.000 --> 00:57:36.000 just kicked aside and in a lot 00:57:36.000 --> 00:57:39.000 of ways I still feel like it's 00:57:39.000 --> 00:57:43.000 being buried. There are so many things that are going 00:57:43.000 --> 00:57:46.000 on right now that really affect our community more than 00:57:46.000 --> 00:57:49.000 ever. And now is the 00:57:49.000 --> 00:57:53.000 time to get involved with your state. Find 00:57:53.000 --> 00:57:56.000 out what's going on with related -- 00:57:56.000 --> 00:58:00.000 related to Medicaid. Get with your P and A. Get with 00:58:00.000 --> 00:58:03.000 -- your P and A usually can give you a 00:58:03.000 --> 00:58:06.000 little bit of information anyway. 00:58:06.000 --> 00:58:09.000 Form those relationships with your other centers 00:58:09.000 --> 00:58:14.000 and put together a good platform of, you know, 00:58:14.000 --> 00:58:17.000 a position paper on what you're wanting to 00:58:17.000 --> 00:58:21.000 see from a Medicaid managed 00:58:21.000 --> 00:58:24.000 care system like Maureen mentioned 00:58:24.000 --> 00:58:27.000 . You have to have that independent third- 00:58:27.000 --> 00:58:30.000 party ombudsman. You have to have an advisory committee 00:58:30.000 --> 00:58:34.000 that's made up of people primarily can disabilities 00:58:34.000 --> 00:58:37.000 . Home and community based services have got to be 00:58:37.000 --> 00:58:41.000 provided. Housing first, you may want to use 00:58:41.000 --> 00:58:45.000 that type of strategy in combination with 00:58:45.000 --> 00:58:48.000 Money Follows the Person >> Scott: And 00:58:48.000 --> 00:58:52.000 Jeff we're at the top of the hour, so that's a nice way to summarize everything 00:58:52.000 --> 00:58:55.000 we need to do. So thank you everybody for your 00:58:55.000 --> 00:58:58.000 questions today. And thanks to Jeff for the presentation 00:58:58.000 --> 00:59:01.000 . And as always make sure you fill out your 00:59:01.000 --> 00:59:05.000 review or your survey of this. And I'm 00:59:05.000 --> 00:59:08.000 sure like Jeff said that if you need to 00:59:08.000 --> 00:59:11.000 get a hold of him he'd be glad to answer