Transcript Highlights:

• These reductions will add immense pressure on food banks that historically provide one meal for every
• nine meals that SNAP provides.
• Uber and Lyft have offered free rides, meals, and freight services to support wildfire response in the
• Donated food and drinks for survivors and hosted a very large community Thanksgiving meal.
• budgets thin. and of goods, services, and program delivery, stretching our budgets thin.

Summary: The joint Senate and Assembly select committee hearing focused on the challenges facing California nonprofits in 2025 and possible state responses. Opening remarks emphasized the sector’s size and importance, the impact of federal funding disruptions and tax policy changes, and the need for stronger public-private partnerships, especially in disaster response and recovery. Witnesses from community foundations, food banks, Cal OES, long-term recovery groups, CalNonprofits, and nonprofit finance organizations described funding uncertainty, delayed reimbursements, reduced indirect cost coverage, staffing strain, and the effects of climate disasters and immigration-related fear on service delivery. Testimony highlighted several policy ideas, including advance payments for state grants and contracts, prompt payment standards, sustainable indirect cost rates, contract flexibility in emergencies, streamlined registration and reporting, and a possible new Office of Nonprofit Empowerment to serve as a central point of contact and coordination within state government. Speakers also described how nonprofits and VOAD networks support wildfire response and long-term recovery, but noted that recovery groups often lack stable operating funding even when they are recognized as best practice. A food bank leader described federal food aid cuts and disruptions to deliveries, while other witnesses stressed that nonprofits are increasingly forced to use reserves, loans, or service reductions to manage cash flow gaps. Committee members generally expressed support for the sector and asked how the state could better partner with nonprofits during both disasters and budget crises. Several members raised the possibility of incremental steps if full legislative changes are not immediately feasible, and witnesses suggested pilots, better sharing of best practices, and stronger state leadership on payment timelines. Public commenters echoed the need for better contracting practices, support for community-based organizations, and attention to nonprofit worker compensation and protections. No formal votes or committee actions were taken in the hearing, which concluded with adjournment.

Transcript Highlights:

• — But you covered it because I was struggling to find labor and delivery.
• I was like, why aren't we talking about labor and delivery?
• Where does that fall under that could do the labor and delivery infrastructure?
• Since 2012, 56 hospitals in our state have shuttered their labor and delivery wards.
• Homestyle Direct provides medically tailored meals within the CalAIM program.

Summary: The hearing began with testimony from Let California Kids Hear and supporters urging action on pediatric hearing aid coverage. Advocates said California has repeatedly failed to enact a workable solution over the past eight years and argued that children need early access to sound to support development. The proposal discussed would limit the coverage mandate to the large-group market, which advocates said would cover roughly 70% to 80% of affected children and avoid the exchange-related cost issue that contributed to prior vetoes. Supporters, including parents, audiologists, and children’s health groups, backed the proposal, and the chair expressed sympathy and support while noting hope for a federal solution for exchange plans. The Department of Finance then gave opening remarks about the state’s structural deficit and the need to balance new investments against projected out-year shortfalls. HCAI followed with a broad overview of its programs, including CalRx insulin and naloxone initiatives, reproductive health grants, the Office of Health Care Affordability, hospital seismic compliance, workforce programs, and the diaper access initiative. Members asked about geographic targeting of workforce funds, the behavioral health workforce pipeline, and the status of the 21st Century Nursing Initiative, which HCAI said had reverted funds. The committee also discussed a proposed transfer of the Data Exchange Framework and Office of the Patient Advocate to HCAI, new reporting on long-term care staffing and health coverage waiting periods, and a Behavioral Health Services Act workforce proposal that would use BHSA funds to support training, stipends, and technical assistance while offsetting $100 million in General Fund spending; members and LAO questioned the offset and asked for more detail, and the item was held open. HCAI also presented the Rural Health Transformation Program, explaining that California received $233.6 million in federal funds for the first year and had to revise its proposal so that $35 million in provider payments would be tied to specific transformative activities rather than general financial relief. The program will fund rural care model redesign, workforce development, and technology/infrastructure improvements, with grants to be rolled out on a tight timeline and subject to CMS approval. Members asked about the size of California’s award, the use of funds for maternity care, labor and delivery access, dialysis, tribal set-asides, and the role of a technical assistance contractor. The department said the program will use supply-and-demand workforce modeling to target funding and that all funds must be obligated by October 30. Finally, the Department of Managed Health Care outlined its budget and two major bill-related proposals: SB 41 on PBM reform and SB 306 on prior authorization transparency. DMHC said SB 41 would require PBM licensure, ban spread pricing, require rebate pass-through, and regulate pharmacy network practices, while SB 306 would require reporting on prior authorization and create a list of services exempt from prior authorization. DMHC requested additional positions and funding to implement both measures.

Transcript Highlights:

• that has been the delivery system through what we call an epinephrine delivery system.
• Now there are nasal delivery systems and other alternative delivery systems.
• No. delivery system through what we call an delivery system through what we call an epien<00:24:34.000
• there are nasal delivery systems and other<00:24:38.880><c> alternative</c><00:24:39.360><c> delivery
• This other alternative delivery systems.

Transcript Highlights:

• I worked, I went on vacation, exercised, and prepared my own meals.
• Care at home represents the future of health care delivery, and mobile integrated health is the heart
• As a practicing pharmacist, I have witnessed firsthand the essential role we play in the delivery of
• Ultimately, I was invited into the OR just before the delivery.
• By giving patients the right to have their doulas present in the labor and delivery room.

Committee: Joint Joint Committee on Financial Services

Summary: The Joint Committee on Financial Services held a lengthy public hearing with testimony on a wide range of health insurance and access-to-care bills. Early testimony focused on prescription drug pricing and pharmacy reimbursement, with supporters of H. 1326 arguing that pharmacy benefit managers and MassHealth managed care arrangements reimburse independent pharmacies too little, contributing to pharmacy closures and “pharmacy deserts.” The committee also heard repeated support for H. 1151/S. 742 on cognitive rehabilitation for acquired brain injury, H. 1288/S. 716 on telehealth parity for nutrition counseling, H. 1309/S. 761 on full-spectrum pregnancy care without cost-sharing, H. 1312 on insurance coverage for doula services, H. 309 on prompt access to health care by removing deductibles for certain services, H. 809/H. 1227 on biomarker testing, H. 1162/S. 810 on reducing inequities in access to medical procedures by limiting insurer cuts tied to Modifier 25, and S. 726 on insurance coverage for mobile integrated health. Testifiers included legislators, physicians, pharmacists, dietitians, emergency and rehabilitation clinicians, and patients and family members. Supporters of the brain injury bill said cognitive rehabilitation is medically necessary, improves long-term outcomes, and can reduce institutional care and public costs; they noted the bill has been heard repeatedly and has support from the Brain Injury Commission and prior favorable committee action. Supporters of the pregnancy care and doula bills described out-of-pocket costs as a barrier to maternal health and shared personal stories of high bills and unmet support needs. Biomarker testing advocates and cancer patients said coverage gaps deny patients access to precision treatment, can lead to avoidable suffering, and should be standardized across insurers; several speakers said insurers often deny claims despite clinical benefit. Dermatology witnesses said insurers’ use of Modifier 25 cuts reimbursement for same-day evaluation and procedure visits, forcing separate appointments and increasing patient burden. Mobile integrated health supporters described home-based care as a way to reduce emergency department use and hospital readmissions, especially for patients with transportation or mobility barriers. No votes or formal committee actions were taken during the hearing itself.

Transcript Highlights:

• They would receive free meals.
• But I was also a child that relied on school meals.
• These meals are balanced.
• what healthy meals are.
• I'm certainly supportive of nutritional meals for kids.

Committee: House House Education Committee of Reference

Summary: The committee heard testimony on House Bill 2076, which would create a program and fund within ADE, in consultation with AZPOST, to reimburse eligible schools and employees for approved training, certification, and school safety equipment, and would allow schools to adopt policies permitting certain employees to carry concealed firearms on campus if they meet training, notification, and confidentiality requirements. The sponsor, Rep. Bliss, framed the bill as an optional, fiscally responsible medical-response measure focused on bleeding control and emergency preparedness, not a mandate to arm schools. Supporters said the bill adds guardrails, expands access to training, and could help staff respond in emergencies. Opponents, including Giffords, Arizona for Gun Safety, and the Arizona Education Association, argued it would normalize firearms in classrooms, create confidentiality and law-enforcement concerns, expose students and staff to new risks, and divert attention from prevention, mental health, and other school safety investments. After debate, the committee voted 6-5-1 to give HB 2076 a do-pass recommendation. The committee then took up House Bill 2830, which directs the State Board of Education to adopt science standards requiring instruction on fetal and prenatal development and specifies that the content is not sex education. Supporters, including the sponsor, a school board president, and a biology teacher, said the bill is about age-appropriate, medically accurate science, parental rights, and clear statewide guidance. Opponents, including the AEA and Reproductive Freedom for All, said it fragments science instruction, politicizes the curriculum, and omits the broader reproductive and public health context students need. Members debated whether fetal development can be taught without discussing reproduction, and whether the bill is an education measure or an anti-abortion effort. The committee approved HB 2830 on an 8-4 vote. The transcript also included discussion of House Bill 2093, which would repeal required mental health instruction and social-emotional learning in schools; supporters argued it restores parental control and refocuses schools on academics, while opponents said school-based mental health education saves lives and helps students who may not have support at home.

Transcript Highlights:

• </c> has to be from the restaurant delivery has to be from the restaurant delivery lency<03:24:52.880
• I— for merely for the restaurant delivery license portion.
• Well, and the people taking the liquor out with their meals.
• I— for merely for the restaurant delivery license portion.
• I— for merely for the restaurant delivery license portion.

Summary: The committee first took up an insurance-related chronic pain bill and an amendment modeled on language from Massachusetts and Maine. The sponsor explained the amendment was developed after stakeholder meetings because the original bill would have created an unaffordable insurance mandate in New Hampshire. The amendment was intended to improve access to non-opioid therapies by limiting prior authorization and step-therapy barriers so they are not more restrictive than for other treatments, including opioid therapies. After questions, the committee took a straw vote and advanced the amendment. The next item was a department-sponsored bill involving the state’s all-payer claims database. Insurance Department officials explained that the bill would encourage self-funded employer plans to opt in voluntarily by giving them aggregated, deidentified claims information in return. They said self-funded plans cannot be required to report data because of federal law, but the bill would provide an incentive while protecting employee privacy. Members asked detailed questions about who would see the data, whether individual employees could be identified, and how privacy would be enforced; the department said access would be aggregated and deidentified, and employer privacy issues would be governed by ERISA and the U.S. Department of Labor. The committee also discussed a glucose-monitoring bill. Members debated whether the bill was aimed at type 1 diabetes coverage or broader access to continuous glucose monitors, and whether it would amount to an unnecessary insurance mandate that could raise premiums. Department testimony estimated the equipment cost and said the annual impact per member would be modest, but also noted that non-insulin therapies have not consistently shown clinically significant A1C reductions. The chair and some members emphasized that the bill should be considered on its own terms as a CGM coverage issue, not as a general diabetes mandate. The committee discussed the bill’s cost implications and asked the department for any prior cost analysis.

Transcript Highlights:

• 6 million meals.
• They rely on food bank programs to bridge their meal gap.
• We estimate that due to these combined changes, the monthly meal gap will increase by 2.7 million meals
• To put this into context, to meet an increased monthly meal gap of 2.7 million meals, the food bank would
• And an earlier speaker had touched on who doesn't eat a meal. had touched on who doesn't eat a meal and

Transcript Highlights:

• They are paid by ICE to private contractors or local jails to cover housing, meals, and security.
• They are paid by ICE to private contractors or local jails to cover housing, meals, and security.
• getting food that had worms in it, only getting bread and water mostly or a frozen burrito for their meal
• We've been doing food deliveries for families that are frightened to leave their houses, and we have
• </c><00:29:30.360><c> for</c> We've been doing food deliveries for We've been doing food deliveries for

Summary: The meeting focused on the detention of Andrea Pedro Francisco, a 23-year-old Burnsville resident and Minnesota constituent who was detained by ICE and transferred from Camp East Montana in El Paso to the El Paso Processing and Detention Center while awaiting surgery for a large ovarian cyst. Senator Lindsey Port, Congresswoman Angie Craig, and Senator Alese Matson argued that she has been denied adequate medical care, receiving only Tylenol and constipation medication despite an emergency room confirming she needs surgery. They said the delay could lead to severe pain, bleeding, loss of fertility, infection, or death, and repeatedly called for her immediate release on humanitarian parole. Pastor Ellery Deikman described visiting Andrea in detention with other clergy and her lawyer, saying she appeared thin, in pain, and deeply distressed, though she brightened when told people in Minnesota were praying for her. He and others framed her situation as a humanitarian and human rights issue, criticizing the detention system as punitive and for-profit. Senator Matson, who is also a physician, explained that the standard treatment for a cyst of this size would be surgery and that waiting is medically dangerous. Participants also said Andrea had been in detention for close to 80 days, had limited access to legal and medical records, and had been separated from family and faith community. The speakers tied Andrea’s case to broader concerns about immigration enforcement under the current administration, saying detentions and arrests have increased sharply and that many detainees have no criminal record. Vicki Schmidt of Abriendo Fronteras said detention numbers and costs have risen, conditions are often inhumane, and many people are being held in for-profit facilities. She and others urged support for HR 7335, the Humanitarian Standards for Individuals in ICE and CBP Custody Act, and called on DHS to grant Andrea parole immediately. In the question-and-answer portion, the physician-senator reiterated that surgery is the only treatment, that the condition could worsen at any time, and that prior practice generally allowed asylum seekers to remain in the community while their cases proceeded if they were not a danger.

Transcript Highlights:

• and consolidate into a single, more efficient organizational culture and more efficient service delivery
• Even if to get a McDonald's meal, you had to go through one physical location to get your hamburger,
• Number two is the integrated service delivery, which is what I talked about.
• They spend all their time trying to negotiate cost arrangements and service delivery arrangements in
• The question is, do you have an integrated service delivery structure where...

Committee: All ALC-HOSPITAL, MEDICAID, & DEVELOPMENTAL DISABILITIES STUDY SUBCOMMITTEE

Transcript Highlights:

• All this bill does is this is just for meals. It doesn't include...
• All this bill does is this is just for meals. It doesn't include I don't know. Mainland.
• All this bill does is just for meals. It doesn't include lodging or gas.
• So the first thing, the cornerstone of what we're trying to do is project delivery.
• So that consistent project delivery year in, year out program delivery is the true cornerstone.

Summary: The Senate and Governmental Affairs Committee met on May 20, 2026, with a quorum present and no minutes available for approval. The committee first heard HB 181, which would let the legislative auditor review income tax data to verify eligibility for Medicaid and, at LDH’s request, SNAP. The auditor said the work would be limited to internal data testing under sharing agreements and not disclosed to third parties. After questions about privacy and duplication, the bill was reported favorably to the floor without objection. The committee then took up HB 906 on presidential preference primaries and party nominating petitions. The Secretary of State and bill author said the measure would let major parties decide whether unaffiliated voters may participate in their primaries, with 180 days’ notice to the state, and would keep party rules consistent within presidential years so elections can be programmed properly. Several senators raised concerns that the bill would disenfranchise no-party voters and give parties too much control, but supporters said both major parties had approved the approach. The committee voted 4-3 to report the bill favorably. Members also advanced HB 398, which would require the judiciary to use the federal GSA meal per diem rate instead of the current higher state judicial rate; HB 1052, which strengthens confidentiality protections for child abuse investigations handled by child advocacy centers and multidisciplinary teams; HB 1245, which protects witness criminal history records from unintended public release in clerk of court records; HB 202, which requires state civil service or hiring agencies to notify applicants when a vacancy is filled or they are rejected; HB 540, which requires disclosure of paid digital election advertising; HB 9, designating stuffed shrimp as a Louisiana specialty; HB 1057, extending the validity of absentee-by-mail applications for military voters from one year to two; HB 225, proposing a constitutional amendment to limit governors to two lifetime terms; HB 177, allowing retired court reporters to contract with former public employers; and HB 459, requiring disclosure when campaign materials use AI, with amendments adopted after discussion of First Amendment and campaign finance concerns. The committee also rejected an amendment to HB 1057 that would have expanded Sunday early voting in certain parishes. After the bills, the committee held confirmation hearings for James Kelly and Charles Wilkinson to the Board of Supervisors of the Louisiana Community and Technical College System, both of whom described education and workforce development backgrounds and were favorably received.

Bills: HB1979 , HB1225 , HB3931 , HB4454 , HB3849 , HB1746 , HB3720 , HB4275 , HB4300 , HB3586 , HB2268 , HB3755 , HB4117 , HB4294 , HB3650 , HB4298

Committee: Senate Health and Human Services

Keywords: early childhood education, task force, governance structure, healthcare access, stakeholder engagement, quality services, vital records, birth certificate, birth registration, biological sex, sex designation, male, female, nonbinary, gender identity, X marker, transgender, vital statistics, State Department of Health, State Commissioner of Health

Bills: SJR47 , SB1491 , SB1579 , SB1806 , SB1552 , SB483 , SB63 , SB137 , SB346 , SB514 , SB1344 , SB1360 , SB1380 , SB1437 , SB1189 , SB1217 , SB1221 , SB1262 , SB1272 , SB1325 , SB1339 , SB201

Keywords: voter ID, elections, constitutional amendment, Oklahoma, proof of identity, presidential electors, vacancies, oath of office, political party, property tax, valuation increase, taxpayer rights, homestead, protest process, foster care, adoption assistance, transitioning youth, Department of Human Services, voluntary services, county home rule charter

Transcript Highlights:

• The measure also requires service Oklahoma to offer an optional expedited delivery service for those
• It's expected that the proceeds from the expedited delivery would actually result in a near revenue neutral

Bills: SJR47 , SB1491 , SB1579 , SB1806 , SB1552 , SB483 , SB63 , SB137 , SB346 , SB514 , SB1344 , SB1360 , SB1380 , SB1437 , SB1189 , SB1217 , SB1221 , SB1262 , SB1272 , SB1325 , SB1339 , SB201

Keywords: voter ID, elections, constitutional amendment, Oklahoma, proof of identity, presidential electors, vacancies, oath of office, political party, property tax, valuation increase, taxpayer rights, homestead, protest process, foster care, adoption assistance, transitioning youth, Department of Human Services, voluntary services, county home rule charter

Transcript Highlights:

• provides school meals to every student free of charge, and SNAP.
• I don't really know what it looks like, like in an office ordering DoorDash for every meal.
• And isolate themselves from community and get DoorDash three meals a day.
• Our delivery to New Mexicans is really good.
• Is this the rural health care delivery fund? Yes. Go ahead, Secretary. Mr.

Transcript Highlights:

• Willie Gloria, Executive Director, Meals on Wheels California.
• Without it, we estimate the loss of 5.7 million meals annually, meals that keep seniors healthy, independent
• Without it, we estimate the loss of 5.7 million meals annually, meals that keep seniors healthy, independent
• Without it, we estimate the loss of 5.7 million meals annually, meals that keep seniors healthy, independent
• And in a time of budget cuts, serving a senior for one meal for one year on Meals on Wheels is significantly

Transcript Highlights:

• You all saw the alternative delivery last month.
• Item C, you have one alternative delivery method project for your review this month.
• This is the alternative delivery project. Members, do you have any questions on C1?
• This is for prepared meals at the Phillips County location.
• This is a new contract for meals for the Kids First child care location in Magnolia, Arkansas.

Committee: All ALC-REVIEW

Transcript Highlights:

• pantries, and Meals on Wheels for their health and independence so that they can age with purpose and
• When we requested higher volume deliveries, we were able to get them.
• We connect those farms with nationally recognized chefs, home delivery, schools through OSPI, as well
• as we connect those farms with nationally recognized chefs, Nationally recognized chefs, home delivery
• , schools through OSPI, as well as over 50 different food banks and food meal programs, principally in

Bills: HB2279 , HB2463 , HB1941 , HB2238

Committee: House Agriculture & Natural Resources

Keywords: PFAS chemicals, agriculture, environmental impact, regulation, food safety, farmers, food security, Washington, support for farmers, cannabis, cooperatives, marijuana industry, HB 2238, HB2238, statewide food security, food security strategy, hunger, food insecurity, food access, food assistance

Transcript Highlights:

• delivery.
• </c> chore help caregiver support and meal chore help caregiver support and meal delivery<00:35:33.839
• um and then I'll also touch on delivery um and then I'll also touch on the<00:35:36.160><c> office</
• </c><00:42:32.640><c> of</c><00:42:32.800><c> mental</c><00:42:33.079><c> health</c> actual delivery
• of mental health actual delivery of mental health services<00:42:34.280><c> and</c><00:42:34.400><c>

Committee: House Human Services Finance and Policy

Transcript Highlights:

• These are some of the most substantial structural changes in the behavioral health delivery system.
• Focusing on modifying or adjusting the delivery model so that we can get as much effective use out of
• And we provide over 10 million meals to improve poor nutrition for older adults and to bring food to
• They're looking to close labor and delivery at some point. Yeah. Thank you, Representative.
• And sorting through the mechanics of the drug, the delivery system, who is benefiting?

Committee: Joint Joint Committee on Ways and Means

Summary: The committee heard budget testimony from Department of Mental Health Commissioner Brooke Doyle, who said DMH serves about 29,000 people and is facing rising demand, higher operating costs, and uncertainty about federal funding. She explained that the FY26 budget prioritizes fully funding the state-operated inpatient system, which is at 100% occupancy and often serves people transferred from Bridgewater State Hospital, while making reductions in other areas to balance the budget. Those reductions include a 50% cut to case managers, a pause on closing the Pocasset unit pending a working group on Cape access, and changes to youth and contracted services such as right-sizing IRTP and CIRT, reducing Youth PACT from seven teams to three, scaling back flex and jail diversion grants as ARPA funds wind down, and preserving the behavioral health helpline and community-based crisis services. Members from Western Massachusetts and the Cape raised concerns about access, staffing, and the impact of cuts, and Doyle said the department would continue operating IRTP services, improve the referral process, and work with stakeholders on the Pocasset review and other access issues. The committee also discussed school-based mental health, 988, loan forgiveness for workforce recruitment, and the role of co-response programs for law enforcement. Secretary Robin Lipson then testified for the Executive Office of Aging and Independence, describing a proposed FY26 budget increase of about 21% to support councils on aging, home care, elder abuse investigations, caregiver support, care transitions, and nutrition programs. She said the agency is managing rising demand, especially from the growing 80-plus population, and noted uncertainty around federal Older Americans Act funding after the federal disbursement agency was disbanded. To control costs, the office will manage intake and caseload growth in a fully state-funded home care program, but current clients will not lose services. Lipson also highlighted a new $1 million line item for local mini-grants to support age-friendly initiatives. In questions, members focused on elder scams, and Lipson said scams are increasing and the agency is working with banks, district attorneys, and public awareness campaigns. The Health Policy Commission’s Executive Director David Seltz presented the agency’s FY26 request and said the biggest challenge is health care affordability, with family premiums near $29,000 annually and many residents delaying care because of cost. He emphasized that recent legislation significantly expands HPC’s role through a new Office of Pharmaceutical Policy and Analysis, which will examine the drug supply chain and pricing, and a new Office of Health Resource Planning, which will support statewide planning around closures and access gaps. The new law also creates task forces on maternal health access and primary care, and adds transparency and oversight for private equity in health care. Members asked about pharmaceutical costs, GLP-1 weight-loss drugs, 340B, and maternal health closures; Seltz said the data show rapid growth in GLP-1 spending and that the new offices will help the state better understand cost drivers and access problems. The Center for Health Information and Analysis then began its testimony, describing its role as the state’s data hub for health care spending, utilization, quality, and affordability analysis.

Transcript Highlights:

• </c> nutritious meal nutritious meal that<00:37:38.040><c> they</c><00:37:38.280><c> that</c><00:37:38.440
• And most services, as well as meals.
• Um, they go once a week to cook meals for the families staying there.
• Um, they go once a week to cook meals for the families staying there.
• Um, they go once a week to cook meals for the families staying there.

Summary: The Budget Review Subcommittee on Health and Family Services met in person, approved the July 15 minutes, and heard a presentation from Dr. Matthew Holder and Dr. Henry Hood of the Lee Specialty Clinic in Louisville. The clinic serves people with complex intellectual and developmental disabilities through a transdisciplinary model that combines medical, dental, behavioral, psychiatric, therapy, and other services under one roof. The presenters argued that this population is large-cost but small in number, often receives little provider training, and is vulnerable to diagnostic overshadowing, overmedication, and missed medical or dental problems. The clinic reported that in Tennessee, payer data showed average costs of about $5,200 per member per month before clinic involvement, with a 44% reduction in overall health care spending after patients were seen, including lower emergency room use, inpatient admissions, and prescription use. They said those savings were measured by the payer, not the clinic, and that the savings accrued to Medicaid or managed care payers rather than the clinic itself. They also shared a case example of a patient who had been placed on hospice but improved after diagnosis and treatment at the clinic. Patient and parent satisfaction were described as very high, generally above 95%. The clinic asked for roughly $5 million to expand into Northern Kentucky, estimating 500 to 700 patients would use the new site and projecting annual savings of about $13 million to $19 million once mature. Members asked about the budget, startup and operating costs, where the savings go, and whether the clinic had considered taking full risk or another value-based model. Senator Meredith and others encouraged the clinic to explore an accountable care or risk-based arrangement, while the presenters said they were open to that discussion but had not pursued it yet. The exchange ended with follow-up questions about the clinic’s overall budget structure and public-private funding mix.