Transcript Highlights:

• credit allocations, and whereas through collaboration among organizations, finance professionals, service
• professional known for her integrity, steady leadership, and commitment to excellence and resident care
• She further expanded her expertise by obtaining a wound care certification, enhancing her ability to
• daily actions, her leadership, and her unwavering focus on delivering compassionate, high-quality care
• Washington High School Hornets, and service veteran with the 82nd Airborne. airborne.

Bills: HR1041 , SB137 , SB1255 , SB1226 , SB1238 , SB1258 , SB1325 , SB1460 , SB1543 , SB1730 , SB1921 , SB1733 , SB1216 , SB1256 , SB1061 , SB1534 , SB1873 , SB1653 , SB540 , SB1948

Keywords: Oklahoma, House Resolution, HR1041, Nuclear Lifecycle Innovation Campus, Department of Energy, DOE, advanced nuclear, nuclear energy, small modular reactors, SMRs, microreactors, energy innovation, advanced energy, energy security, economic development, job creation, workforce training, research and development, nuclear supply chain, clean energy

Transcript Highlights:

• May they be reminded and inspired by your plans and loving care for them.
• professional known for her integrity, steady leadership, and commitment to excellence in resident care
• She began her health care journey as a certified nurse's aide and, through dedication and continuous
• She further expanded her expertise by obtaining a wound care certification, enhancing her ability to
• Washington High School, Go Hornets, and a service veteran with the 82nd Airborne.

Bills: HR1041 , SB137 , SB1255 , SB1226 , SB1238 , SB1258 , SB1325 , SB1460 , SB1543 , SB1730 , SB1921 , SB1733 , SB1216 , SB1256 , SB1061 , SB1534 , SB1873 , SB1653 , SB540 , SB1948

Keywords: Oklahoma, House Resolution, HR1041, Nuclear Lifecycle Innovation Campus, Department of Energy, DOE, advanced nuclear, nuclear energy, small modular reactors, SMRs, microreactors, energy innovation, advanced energy, energy security, economic development, job creation, workforce training, research and development, nuclear supply chain, clean energy

Summary: The House convened, completed the roll call, prayer, and Pledge of Allegiance, and then moved through routine business including second-reading referrals and committee reassignments. Senate Bill 1627 and Senate Bill 625 were withdrawn from their prior committees and assigned to Rules. The chamber also recognized Dr. James David Campbell as Doctor of the Day and Courtney Copen as Nurse of the Day. Members held several floor presentations honoring the Choctaw High School drama team for winning the 2025 OSSAA 6A-1 one-act play state championship and related speech and debate honors, and the Arapaho-Butler Lady Indians for winning the 2025 Class A fast-pitch softball state championship. A proclamation was read designating March 31, 2026, as Affordable Housing Day, highlighting Oklahoma’s housing shortage and the economic impact of the state’s affordable housing tax credit program. The House adopted House Resolution 1041, which supports designation of a nuclear lifecycle innovation campus in Oklahoma, after Representative Archer explained the measure and requested unanimous consent. During announcements, members noted Transgender Day of Visibility, committee meeting changes, a rural caucus meeting, a public health meeting, and a Capitol devotion. The House then adjourned without objection until Wednesday, April 1, 2026, at 1:30 p.m.

Transcript Highlights:

• He's retired from the US Air Force with more than 26 years of... ...service to our nation, beginning
• After military service, Chief Kulla continued to serve others.
• Chief, we'd like to thank you for your service and your continued commitment to the people of Oklahoma
• And whereas Chiefulla's many awards and honors include the Meritorious Service Medal with five devices
• And whereas following his retirement, Chief Kula continued his service to his community and country as

Bills: HR1041 , SB137 , SB1255 , SB1226 , SB1238 , SB1258 , SB1325 , SB1460 , SB1543 , SB1730 , SB1921 , SB1733 , SB1216 , SB1256 , SB1061 , SB1534 , SB1873 , SB1653 , SB540 , SB1948

Keywords: Oklahoma, House Resolution, HR1041, Nuclear Lifecycle Innovation Campus, Department of Energy, DOE, advanced nuclear, nuclear energy, small modular reactors, SMRs, microreactors, energy innovation, advanced energy, energy security, economic development, job creation, workforce training, research and development, nuclear supply chain, clean energy

Transcript Highlights:

• , please join me in recognizing and thanking Miss Cynthia Cochra with her many years of dedicated service
• He's a licensed clinical psychologist based in Oklahoma City and the owner of Elevate Psychology Services
• If the clerk would please read, clerk will read Mariane Nellie Castaneda began her state service as an
• and has consistently demonstrated a profound commitment to the mission of public service and improving
• I proudly represent the Hayworth FFA chapter as a national champion in the Environmental Services and

Bills: HB4440 , HJR1067 , HJR1087 , HB4426 , HB3704 , HB4311 , HB3044 , HB4191 , HB3465 , HB3972 , HB3759 , HB3625 , HB1411 , HB2980 , HB3015 , HB3147 , HB3277 , HB3323 , HB3443 , HB3882 , HB3406 , HB2975 , HB3977 , HB3263 , HB2988 , HB3404 , HB1770

Keywords: Medicaid, low-income adults, healthcare, eligibility restrictions, constitutional amendment, Medicaid expansion, SoonerCare, health coverage, federal matching funds, FMAP, Article XXV-A, state question, special election, Title 63, public assistance, healthcare funding, federal-state match, Medicaid eligibility, Oklahoma Constitution, ad valorem

Transcript Highlights:

• Cochran brings to this recognition 40 years of distinguished service in the nursing profession.
• He's a licensed clinical psychologist based in Oklahoma City and the owner of Elevate Psychology Services
• Marianella 'Nellie' Castaneda began her state service as an executive assistant to Senator Michael Brooks
• a profound commitment to the mission of public service and improving the welfare of all people who reach
• I proudly represent the Hayworth FFA chapter as a national champion in the Environmental Services and

Bills: HB4440 , HJR1067 , HJR1087 , HB4426 , HB3704 , HB4311 , HB3044 , HB4191 , HB3465 , HB3972 , HB3759 , HB3625 , HB1411 , HB2980 , HB3015 , HB3147 , HB3277 , HB3323 , HB3443 , HB3882 , HB3406 , HB2975 , HB3977 , HB3263 , HB2988 , HB3404 , HB1770

Keywords: Medicaid, low-income adults, healthcare, eligibility restrictions, constitutional amendment, Medicaid expansion, SoonerCare, health coverage, federal matching funds, FMAP, Article XXV-A, state question, special election, Title 63, public assistance, healthcare funding, federal-state match, Medicaid eligibility, Oklahoma Constitution, ad valorem

Summary: The Senate convened, established a quorum, and opened with prayer and the Pledge of Allegiance. The chamber then recognized several guests and honorees, including the doctor of the day, Dr. Mukesh Perek; nurse of the day, Cynthia Cochran; psychologist of the day, Dr. Colby Kipp; and a guest introduced by Senator Brooks, Marianella “Nellie” Castaneda, who was honored for her quick action in responding to a distress call that helped prompt a law enforcement response in a domestic violence situation. Senator Brooks and Castaneda both spoke about the incident and the importance of staff responsiveness and public service. The Senate also honored Jalen Lundry of Hayworth, named a national champion in the FFA Agriscience Fair for research on red wiggler worms and soil health. Lundry spoke briefly about her project and thanked Senator George Burns. The Pro Tem recognized April 6, 2026, as National Rifle Association and Oklahoma Rifle Association Day, with representatives from both organizations present in the gallery. The chamber also introduced the week’s pages, who each identified their schools, senators they were paging for, and future plans. No legislation was debated or voted on during the session. Instead, members made committee and floor announcements, including upcoming meetings of Revenue and Taxation, Appropriations, Public Safety, and the Senate Rural Caucus. The Senate then adopted a motion to adjourn and stood adjourned until Tuesday, April 7, 2026, at 1:30 p.m.

Transcript Highlights:

• in the managed care realm, which is called a state-directed payment.
• We also were directed to discontinue the Healthy Connections Value Care and Primary Care Case Management
• And then we had the fee for service We had primary care case management, and then we had the fee-for-service
• organization to another managed care organization, from fee-for-service to managed care.
• organization to another managed care organization, from Thief for service to managed care.

Committee: Senate Health and Welfare

Keywords: 989, all

Transcript Highlights:

• direct care workers... ...and care managers and others play in making sure that direct care workers'
• and things that support direct care workers.
• We have waitlists to begin services. There's gaps in care.
• care component some certain percentage has to be spent on direct care workforce.
• care claims for dental services.

Summary: The committee began with an extended work session on the long-term care workforce. DSHS Assistant Secretary B. Rector described the new Home and Community Living Administration and outlined major workforce pressures: Washington had about 126,000 long-term care workers in 2022, with demand expected to outpace supply as the 85-plus population and dementia prevalence rise sharply. She emphasized that direct care workers are largely women, people of color, and immigrants, and that family caregivers are also a major part of the system. She highlighted recruitment and retention efforts funded through federal Money Follows the Person dollars, including high school training partnerships, a retention toolkit, transportation support, caregiver newsletters, tribal workforce navigators, and a remote caregiving pilot. Committee members asked about career pathways, technology use, and turnover drivers; Rector said wages, benefits, unstable hours, and workplace support are key issues and promised follow-up data. Aidan Swain of the Washington Health Care Association said skilled nursing and assisted living facilities face acute RN vacancies, wage pressures, and Medicaid reimbursement that does not cover costs, and urged modernization of training, better reimbursement, and continued support for facility-based care. Maddie Fouch of SEIU 775, representing about 55,000 caregivers, said low wages, weak benefits, lack of voice, and certification delays are driving turnover and shortages, and argued for higher compensation, better worker protections, and more transparent reimbursement. Catherine Smith of Behavioral Health Solutions described growing behavioral health needs in nursing homes, the role of expanded behavioral supports programs, and credentialing delays that slow hiring. No votes were taken; the panel was informational only. The second agenda item was an overview of the palliative care benefit work group report required by 2024 legislation. Nico Jansen of the Office of the Insurance Commissioner explained that the work group, convened with the Health Care Authority, studied a potential palliative care benefit for fully insured commercial plans and also Medicaid, PEBB, and SEBB. He said palliative care is a philosophy of care focused on symptom management, coordination, and support for serious illness, and is distinct from hospice because it can be provided alongside curative treatment. The actuarial analysis concluded that creating a new benefit would likely increase costs, estimating about a 28-cent per member per month increase overall and roughly $2.6 million to $4.5 million in annual state Medicaid costs if implemented in 2027. Jansen said the consultants did not find sufficient evidence to assume savings from avoided hospitalizations or long-term care, though several work group members disagreed and submitted response letters. Senators asked about other states, Medicare, health homes, and whether more research could clarify cost savings; OIC said some states, including Hawaii, are moving ahead with Medicaid palliative care benefits, Medicare covers some related services but not in the same way, and further evidence may emerge over time. OIC did not take a position on whether the Legislature should create the benefit. The final presentation covered health care price transparency tools in Washington and federally. Evan Klein and HCA Chief Data Officer Vishal Chaudry reviewed federal hospital and health plan transparency rules, the state all-payer claims database, prescription drug price transparency, the Health Care Cost Transparency Board, the Prescription Drug Affordability Board, and other reporting systems. They explained that the APCD contains claims from fully insured commercial plans, Medicaid, and public employee programs, but not self-insured employer data except for limited voluntary submissions. They also described how machine-readable files, consumer price tools, and aggregated dashboards are used, and noted that data limitations, delays, and complexity remain significant. Senators asked about voluntary self-insured participation, the role of AI in making data more usable, and whether transparency can really help consumers given access barriers and medical debt. HCA said AI is increasingly used by private entities to mine large transparency datasets, but state agencies still face limits in data access and analytic capacity. The committee did not take action; the session was informational and ended with a discussion of how transparency data might better inform policy and purchasing decisions in the future.

Transcript Highlights:

• in the managed care realm, which is called a state-directed payment.
• We also were directed to discontinue the Healthy Connections Value Care and Primary Care Case Management
• We had primary care case management. And then we had the fee-for-service model.
• So all services will be managed by one managed care organization for participants.
• organization to another managed care organization, from fee-for-service to managed care.

Summary: The Senate Health and Welfare Committee received an update from the Department of Health and Welfare on House Bill 345 and Idaho’s transition to comprehensive Medicaid managed care. Medicaid administrator Sasha O’Connell reviewed the bill’s directives, including rural hospital designation, work reporting and community engagement requirements, eligibility redeterminations for expansion adults every six months, changes to renewal processes, the choice waiver, state-directed payments, discontinuation of Healthy Connections Value Care and primary care case management, site-neutral payments, practice authority protections, and expanded cost-sharing. She also explained that the department is awaiting some CMS guidance and is pursuing federal approvals and public comment on several state plan amendments and waivers. A major focus was the planned move to comprehensive managed care, under which one managed care organization would coordinate most services for each enrollee, with Idaho planning three statewide plans rather than regional contracts. O’Connell said the department has held listening sessions, tribal consultation, and a request-for-information process, and that feedback has centered on continuity of care, timely provider payment, network adequacy, behavioral health and developmental disability services, and the need for clear, consistent contract standards. She said the department is using other states’ contracts and a set of program design pillars to shape the upcoming request for proposals, with a phased rollout planned for January 2029 for most services and January 2031 for developmental disability services. Senator Wintrow asked about EPSDT after a related statutory repeal in House Bill 345, expressing concern that families might think the protection had been removed. O’Connell responded that EPSDT remains a federal requirement for children and youth and that the department has not changed that obligation. The committee took no vote or formal action and adjourned after the update and questions.

Transcript Highlights:

• people who rely upon the direct care service, and college students to complete the educational program
• </c><00:02:05.320><c> care</c><00:02:05.560><c> services</c> across Minnesota's direct care services
• across Minnesota's direct care services for<00:02:06.200><c> individuals</c><00:02:06.680><c> with</c
• support professional for the direct care, for all of the direct care lines of service here to help testify
• </c><00:04:30.800><c> here</c> of the direct care lines of service here of the direct care lines of service

Committee: Senate Human Services

Keywords: 1187, senate, all

Transcript Highlights:

• Finally, moving to the direct care and treatment chapters, we have Chapter 246, State Operated Services
• officer, and governs the duties and authority of those entities and of Direct Care and Treatment services
• Finally, moving to the direct care and treatment chapters, we have Chapter 246, State Operated Services
• Finally, moving to the direct care and treatment chapters, we have Chapter 246, State Operated Services
• You know, we really want to care for them well. um Direct Care and treatment services um Direct Care

Committee: House Human Services Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• and personal care services.
• The direct care workforce, particularly those who served in the Medicaid home and community-based services
• crisis, specifically the shortage of direct care workers.
• the largest share of the direct care workforce.
• It has the largest share of the direct care workforce.

Committee: House Legislative Health & Human Services Committee

Transcript Highlights:

• Direct care and treatment has 5,000 employees.
• Direct care and treatment sits within the Senate Human Services Committee for its funding and primary
• ,</c><00:23:06.320><c> uh,</c> Services, direct care and treatment, uh, Services, direct care and treatment
• Direct medical care to constituents, not just paying for it, but they are in our care.
• Direct medical care to constituents, not just paying for it, but they are in our care.

Committee: Senate State and Local Government

Keywords: 1187, senate, all

Transcript Highlights:

• </c> Direct Care and treatment vulnerable Direct Care and treatment vulnerable adult<00:03:53.959><c>
• Then there are direct care and treatment facilities. services for adults with mental illness services
• Moving now to direct care and treatment: these are state-operated health care services for individuals
• This slide covers, in a great deal of detail, the services provided by Direct Care and Treatment.
• c> Care</c> are the services provided by Direct Care are the services provided by Direct Care and<00:

Committee: House Human Services Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• only reimbursed for services rendered. for the direct services we provide: life-affirming counseling
• One in regards to community care services and attendance, again only focusing on the direct attendant
• you that 107% was spent on direct care staff.
• care services for our most fragile citizens.
• Direct care workers deserve better.

Bills: SB1 , SB 1

Committee: Senate Finance

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• managed care will provide an option to states to direct payments to providers through managed care.
• give states the ability to to direct payments to certain provides to managed care plans.
• The goal of state direct payments are intended to promote quality and access to managed care.
• Has an comp isn't competent care, charity care which is a different funding streams and the direct payment
• care is not my the department's direct care staff.

Transcript Highlights:

• Direct primary care offers really high-quality care at a dramatically lower cost.
• Direct primary care offers really high-quality care at a dramatically lower cost.
• My first experience with direct primary care came when I was a home care nurse caring for a young ALS
• that direct primary care doctors provide.
• that direct primary care doctors provide.

Committee: Joint Joint Committee on Financial Services

Keywords: 995, all

Summary: The committee held a public hearing with testimony on several health care bills, with most of the discussion focused on primary care access, community health center reimbursement, midwifery and birth centers, telehealth, hospital-at-home, direct primary care, and trans-inclusive health care access. Chair Feeney and Chair Murphy opened by noting the large number of signups and asking testifiers to keep remarks brief because of time constraints. Legislators and witnesses repeatedly emphasized that Massachusetts’ primary care system is under strain and that federal policy changes and reimbursement gaps are worsening financial pressure on providers. On community health centers, Representative Blay, Senator Lovely, Michael Curry, Bethany Keeley, Jag Deep Trevetti, Sean Cahill, and Christina Severin all supported H. 1096/S. 711, which would require commercial insurers to pay federally qualified health centers at least the MassHealth prospective payment system rate. They argued that commercial plans currently reimburse health centers below Medicaid rates, threatening sustainability, staffing, and access, especially as federal cuts and coverage losses could increase uncompensated care. Testifiers said the bill would stabilize health centers, protect primary care access, and not cost the state money. A second major topic was H. 1117/S. 784 on sustaining birth centers and the midwifery workforce. Senator Lovely, Senator Miranda, Emily Anesta, Rebecca Orden, Catherine Rushworth, Nishira Burrill, Joel Sutherland, Rachel Blessington, Joelle Ward, and others described the 2024 maternal health omnibus as an important first step, but said birth centers and midwives still face low reimbursement, workforce shortages, and financial instability. They urged reimbursement parity, a workforce development fund, and support for freestanding birth centers, citing improved outcomes, lower C-section rates, better patient experience, and racial equity in maternal health. Several speakers shared personal birth stories and said the bill would help preserve and expand birth options in communities like Roxbury, Worcester, and the North Shore. The committee also heard support for H. 1343 on direct primary care from Dr. Garofalo, Dr. Altman, Dr. Nair, Stephanie Cameron, Dr. Haley Moke-Blessed, and others, who said current insurance rules force patients to use a separate in-network primary care doctor for referrals and sometimes prevent physicians from dispensing medications. They argued the bill would reduce delays, administrative burden, and costs while improving continuity of care. In addition, Dr. Miklides and Sue Stempeck supported H. 1141 on hospital-at-home parity, saying the model has strong outcomes and should be reimbursed at the same rate as brick-and-mortar hospital care. Heather Myers and Katrina Cook testified on telehealth and digital health equity, urging broader coverage for asynchronous care, remote monitoring, interpreter services, and digital literacy supports. SEIU Local 509 supported H. 1188/S. 681 on trans-inclusive health care access, saying it would remove arbitrary insurance barriers to gender-affirming care. No votes or committee actions were taken during the hearing.

Transcript Highlights:

• </c><00:00:50.039><c> care</c> hour and 45 minutes for the direct care hour and 45 minutes for the direct
• </c><00:01:19.400><c> care</c> director for direct care director for direct care treatment<00:01:22.119
• </c> experienced Direct Care staff to deliver experienced Direct Care staff to deliver those<00:03:26.760
• Direct Care and treatment pressures that Direct Care and treatment is<00:04:42.800><c> facing</c><00
• Direct Care and treatment challenged at Direct Care and treatment that<00:39:38.359><c> we</c><00:39:

Committee: House Human Services Finance and Policy

Keywords: 1183, house

Transcript Highlights:

• Texas Medicaid is transitioning from fee-for-service to value-based care.
• Direct care attendants provide specialized, compassionate care and become lifelines to our family.
• Texas Medicaid is transitioning from fee-for-service to value-based care.
• Direct care attendants provide specialized, compassionate care and become lifelines to our families.
• But I also have host home companion care providers and other services.

Bills: SB1 , SB 1

Committee: Senate Finance

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• And direct services alone do not feel.
• Proposing on the personal care and homemaker services, Proposing on the personal care and homemaker services
• care coordination services would still be a part of the fee-for-service model?
• care coordination services would still be a part of the fee-for-service model?
• coordinated care services.

Summary: The Assembly Budget Subcommittee on Health held a May Revision hearing covering several health-related budget proposals and broader concerns about the state’s budget structure. The Chair opened by praising some May Revision changes, such as added health IT funding, county administration support tied to Medi-Cal changes, a delay in Medi-Cal cuts for some lawfully present immigrants, and additional support for Covered California subsidies, while criticizing proposed increases in Medi-Cal premiums, changes to senior eligibility, the lack of a Medi-Cal dental solution, and other reductions affecting counties, mobile crisis units, workforce incentives, and physician shortages. The Legislative Analyst’s Office said the state’s budget condition remains weak despite progress on the structural deficit, and the Department of Finance said the May Revision uses a mix of reductions, reforms, revenue proposals, and fund shifts to cut out-year deficits. The committee first heard Department of State Hospitals proposals, including adjustments to county bed billing authority, contract exemption language for online clinical/pharmacy subscriptions, reversion of unspent funds, a revised Metro Central Utility Plant replacement project, electronic health record implementation, and workforce development funded partly through Behavioral Health Services Act resources. DSH also described savings and realignments in incompetent-to-stand-trial and conditional release programs, including extending the independent placement panel program and shifting funds to support additional bed capacity and a mental health rehab center. Members asked about the use of BHSA funds for workforce programs, and the department said the proposal would replace General Fund support with BHSA reimbursements. The Emergency Medical Services Authority proposed funding for statewide behavioral health crisis response guidance and for enterprise system development, and the Department of Managed Health Care proposed modernization of its complaint system and claims-settlement data system to improve oversight and comply with AB 3275. The largest discussion centered on the administration’s BHSA spending plan under Proposition 1, including state-directed prevention, workforce, and other uses, plus General Fund offsets for existing programs. The LAO questioned whether some proposed offsets fit Proposition 1’s non-supplant and eligible-use requirements, while the administration argued the uses were consistent with the measure and that the state-directed share can be adjusted annually. The Commission for Behavioral Health’s proposals drew the most public and member concern. The administration proposed cutting the commission’s Innovation Partnership Fund from $20 million to $10 million and reducing the Community Advocacy Program by $6.7 million, while redirecting BHSA dollars to other state purposes and direct services. Commissioners, advocates, and several members argued the cuts would weaken community voice, reduce support for underserved populations, and disrupt grants already in process; they also objected to using BHSA funds to backfill General Fund commitments. Public commenters, including youth, disability, behavioral health, LGBTQ, tribal, veteran, immigrant, and community-based organization representatives, overwhelmingly opposed the cuts and urged preservation of prevention, advocacy, mobile crisis, and innovation funding. No votes or final actions were taken during the hearing.

Transcript Highlights:

• Uh, the 6.7% that I mentioned earlier on the managed care side, uh, that is due to directed payments,
• of what we pay to the managed care organizations is actually paid out through a directed payment.
• Uh, the 6.7% that I mentioned earlier on the managed care side, uh, that is due to directed payments,
• Earlier on the managed care side, uh, that is due to directed payments, the growth in state-directed
• of what we pay to the managed care organizations is actually paid out through a directed payment.

Keywords: 958, all

Summary: The Budget Review Subcommittee on Health and Family Services heard a presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults with serious mental illness who do not qualify for nursing home care but need structured support, medication assistance, meals, housekeeping, transportation, and supervision. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and rely on a state supplementation rate of about $50.70 per day, which they argued no longer covers operating costs because of rising food, labor, insurance, and maintenance expenses. The presenters said the sector has shrunk significantly over time, citing a drop from 64 homes in 2002 to 34 today among the homes serving this population, with 30 closures over 23 years and two more closures since August. They argued that the closures have contributed to homelessness, hospital overcrowding, and longer stays in psychiatric hospitals, and they gave examples of residents who had spent many months in hospitals before stabilizing in a personal care home. One provider also described spending more than $800,000 on capital improvements after acquiring Kentucky facilities and said reimbursement is too low to sustain safe operations. They asked for an incremental reimbursement increase over two years and said they have also proposed an assisted-living model for people with mental illness. Members asked about staffing, reimbursement, and the number of people still needing placement. The presenters said there is no requirement for licensed or certified staff in these facilities, though some homes use medication technicians and occasional LPNs. They estimated they are currently serving about 2,000 residents and said they receive roughly 30 referrals for every one person admitted, with many referrals involving people whose needs exceed the personal care home level. Senator Meredith and Representative Fleming said any funding request would need documentation of savings and corresponding budget offsets, while Representative Duval expressed support and asked about possible staffing and program improvements. The witnesses also compared Kentucky’s flat-rate reimbursement to a more individualized reimbursement model in Minnesota, saying a needs-based system would better match staffing and reduce hospitalizations.