Video & Transcript : 'regulatory efficiency' :
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MN
Minnesota 2025-2026 Regular Session
House Public Safety Finance and Policy Committee 4/15/26
Public Safety Finance and Policy
Transcript Highlights:
- faster center, which allows for faster coordination,<00:15:28.960><c> more</c><00:15:29.200><c> efficiency
- </c><00:15:29.840><c> use</c><00:15:30.080><c> of</c> coordination, more efficiency use of coordination
- , more efficiency use of resources,<00:15:30.880><c> and</c><00:15:31.000><c> allows</c><00:15:31.720
- no repeated questions to multiple dispatch centers or callers, no manual relay, faster and more efficient
- </c> manual relay, faster and more efficient manual relay, faster and more efficient dispatching<00:20
Committee:
House Public Safety Finance and Policy
Keywords:
public safety, radio communications, infrastructure funding, county funding, interoperability, ARMER network, local jurisdictions, HF4597, Minnesota public safety, 911, emergency dispatch, emergency communications, public safety appropriation, Metropolitan Emergency Services Board, PSAP, dispatch interoperability, real-time coordination, emergency response coordination, cross-jurisdictional response, 911 center awareness platform
MN
Minnesota 2025-2026 Regular Session
House State Government Finance and Policy Committee 4/7/26
State Government Finance and Policy
Transcript Highlights:
- 00:24:27.840><c> faster</c><00:24:28.200><c> and</c><00:24:28.320><c> more</c><00:24:28.440><c> efficiently
- </c><00:24:29.400><c> So,</c><00:24:29.840><c> it</c> much faster and more efficiently.
- So, it much faster and more efficiently.
- ><c> in</c><00:40:23.760><c> both</c><00:40:24.640><c> the</c><00:40:24.760><c> overall</c> more efficient
- um in both the overall more efficient um in both the overall council<00:40:25.560><c> but</c><00:40:
Committee:
House State Government Finance and Policy
MN
Minnesota 2025-2026 Regular Session
High Subsidy Transit Routes report 2/18/26
Minnesota House Floor Meeting
Transcript Highlights:
- my perspective, again, we're trying to create, make sure that our taxpayer dollars are used as efficiently
- my perspective, again, we're trying to create, make sure that our taxpayer dollars are used as efficiently
- Taxpayer dollars are used as efficiently as possible, and all modes of transportation, and recognizing
- Quite the contrary, it's about making sure that we have cost-effective and efficient and productive transit
- So removing overhead cost, efficient scheduling, or other efficiencies that a provider may find can help
NH
New Hampshire 2026 Regular Session
Senate Executive Departments and Administration (01/28/2026)
Executive Departments and Administration
Transcript Highlights:
- make our process a little bit more streamlined in a time when I think everybody's looking for efficiencies
- when I think everybody's<00:06:52.800><c> looking</c><00:06:52.960><c> for</c><00:06:53.199><c> efficiencies
- </c> everybody's looking for efficiencies. everybody's looking for efficiencies.
- That is a pretty large burden at a time when we're trying to find efficiencies within our process.
- I mean, we're doing it now, but it's a pretty large burden at a time when we're trying to find efficiencies
MN
Transcript Highlights:
- Um, reallocating the efficiencies from MnDOT, the 15% towards quarters of commerce I think is a huge
- Um reallocating the<00:02:40.480><c> efficiencies</c><00:02:41.200><c> uh</c><00:02:41.360><c> from</
- c><00:02:42.000><c> Mindot</c><00:02:42.560><c> the</c><00:02:42.720><c> 15%</c> the efficiencies uh
- from Mindot the 15% the efficiencies uh from Mindot the 15% towards<00:02:43.599><c> quarters</c><00:
- So it's just an efficiency and technically a technical fix.
Committee:
Senate Transportation
HI
Hawaii 2025 Regular Session
TCA-HRE, HRE Public Hearings 03-20-2025
Transcript Highlights:
- yes, based on the duties and so forth, what I've taken away from the resolution when it comes to efficient
- yes, based on the duties and so forth, what I've taken away from the resolution when it comes to efficient
- continually raise more money, you know, it's we're following the money and doing it in the most efficient
- are in place, and if— the the and and doing it in the most the the and and doing it in the most efficient
- manner yes I I think the at efficient manner yes I I think the at least<00:47:54.240><c> what</c><00
Summary:
The meeting covered several Senate resolutions related to the University of Hawaiʻi system, the East-West Center, and related education and workforce issues. On SCR 178 and SR 48, testifiers strongly supported the East-West Center, describing it as an important Hawaii asset that promotes cultural exchange, global citizenship, diplomacy, and ties to the University of Hawaiʻi. Speakers said the Center has helped train leaders and bring international connections and investment to Hawaii, and they urged continued funding despite federal cuts. The chairs then recommended passage with technical amendments, and both resolutions were adopted by the committees.
The committee also heard testimony on resolutions calling for audits of University of Hawaiʻi operations. On SR 32 and SCR 50, the University of Hawaiʻi said it supported the resolution and had already begun work on establishing a Bachelor of Science in nursing at the UH Maui campus, with additional staff available on Zoom to answer questions. On SR 160 and SCR 142, which sought a financial and performance audit of UH Mānoa facilities, UH Athletics said it already undergoes annual financial audits required by NCAA bylaws but not performance audits, and discussed its internal evaluations, contingency planning, and efforts to address concerns raised by student athletes and staff.
The committee then took up SCR 138 and SR 55, requesting a management and performance audit of the UH Office of the Vice President for Academic Strategy. Vice President Deborah Halbert and P20 Director Steve Shotz said they did not oppose the audit and believed it could provide clarity, while explaining that the office is relatively new and works collaboratively across campuses on articulation, transfer, grants, and workforce alignment. They described grant programs including Perkins, GEAR UP, preschool development, and data-sharing efforts, and said they are focusing more resources on teaching, health care, and skilled trades. The discussion also touched on SR 54, a proposed performance audit of the UH Foundation, where foundation representatives said they already undergo annual financial audits, acknowledged some donor communication issues, but emphasized improved stewardship and growth in fundraising over recent years.
TX
Transcript Highlights:
- Because our small and mid-sized schools don't have the same efficiencies and economies of scale that
- The third thing is, is our I wrap up my minute and a half is trying to find efficiencies.
- We've done that through trying to find some efficiencies within an administration or maybe.
- Well, now you have two 1,500-student high schools. inefficiency gap as we grow to efficiency in those
- that that fast growth a lot Helps us to kind of fulfill that gap as we grow our students into an efficient
Committee:
House Public Education
Keywords:
public education, teacher compensation, certification, funding, school finance, educator rights, education funding, charter schools, staff compensation, state aid, retention allotment, disaster preparedness, emergency management, flooding, mass fatality, mass casualty, fatality tracking, body recovery, autopsy, justice of the peace
OK
Oklahoma 2026 Regular Session
House of Representatives Second Regular Session of the 60th Legislature Day 53 Afternoon Session May 6th, 2026 at 01:00 pm
Oklahoma House Floor Meeting
Transcript Highlights:
- Members, Senate Bill 1916 is another government modernization and efficiency bill.
- two modest but meaningful reforms to give some financial relief to childcare providers and reduce regulatory
Bills:
SB1687 , HB1687 , HB4431 , HB2894 , HB2979 , HB3262 , HB3298 , HB3369 , HB3431 , HB3462 , SB1226 , SB1876 , SB1916 , SB1920 , HB3467 , HB3498 , HB3500 , HB3521 , HB3581 , HB3650 , HB3673 , HB3764 , HB3767 , HB3781 , HB3800 , HB3831 , HB3834 , HB3941 , HB2749 , HB3970 , HB3972 , HB3979 , HB3980 , HB3981 , HB3996 , HB4095 , HB4104 , HB4191 , HB4248 , HB4298 , HB4338 , HB4427 , HB4428 , HJR1023 , HB3660 , HB3718 , HB4326 , HB3443 , HB3880 , HB3649 , HB3000 , SB1651 , SB504 , SB372 , SB1326 , SB1633 , SB248 , SB1242 , SB1238 , SB423 , SB1989 , SB1286 , SB904 , SB1213 , SB1216 , SB1827 , SB65 , SB1390 , SB259 , SB1944 , SB540 , SB2139 , SB346 , SB1595 , SB1400 , SB1555 , SB1209 , SB2110 , SB1670 , SB1061 , SB2104 , HR1057 , SB1946 , SB1734 , SB1316 , SB1360 , SB1557 , SB1684 , SB2049 , SB1410 , SB2011 , SB1437 , SB1204 , SB1732 , SB1775 , SB2084 , SB1380 , SB1572 , SB1772 , SB1224 , SB710 , SB1338 , SB1266 , SB1303 , SB1307 , SB1562 , SB1794 , SB1191 , SB1983 , SB1832 , SB1448 , SB1534 , SB1593 , SB1597 , SB1630 , SB1489 , SB1726 , SB1796 , SB1806 , SB1877 , SB1451 , SB1553 , SB1632 , SB1423 , SB1425 , SB1502 , SB2180 , SB1725 , SB2182 , HB3003 , HB3004 , HB4434 , HB4324 , HB4342 , HB2137 , HB4432 , SJR50 , SJR52 , SJR53
Keywords:
driver licenses, exam proctor, Service Oklahoma, commercial training, background checks, advance directive, advance health care directive, health care proxy, medical power of attorney, durable power of attorney for health care, living will, surrogate decision-maker, default surrogate, health care agent, capacity determination, supported decision making, mental health directive, psychiatric advance directive, end-of-life care, life-sustaining treatment
NH
New Hampshire 2026 Regular Session
House Health, Human Services and Elderly Affairs (04/15/2026)
Health, Human Services and Elderly Affairs
Transcript Highlights:
- So, there's a really wide, urgent, and efficient, and demanding collection of information to make sure
- So, there's a really wide, urgent, and efficient, and demanding collection of information to make sure
- So, in other factors that affect efficiency of those dollars matters to all of us.
- So, in other factors that affect efficiency of those dollars matters to all of us.
- efficiency efficiency uh<01:18:40.960><c> of</c><01:18:41.320><c> of</c><01:18:41.480><c> those</c><
KY
Kentucky 2025 Regular Session
Interim Joint Committee on Transportation (6-3-25)
Transcript Highlights:
- Knowing our crews and how efficient they are and how quickly they respond, that didn't happen.
- Knowing our crews and how efficient they are and how quickly they respond, that didn't happen.
- Knowing our crews and how efficient they are and how quickly they respond, that didn't happen.
- they are and how quickly they efficient they are and how quickly they respond,<00:15:49.680><c> that
- Uh we've also efficiently as possible.
Keywords:
00:00:39 Roll Call
00:02:57 Severe Weather Damage
00:39:00 Work Zone Safety
00:47:12 Local Assistance Road Program
01:10:18 Admin. Regs
01:15:37 Aviation Impact Study, 958, all
Summary:
The committee’s first interim meeting opened with roll call, a quorum, and a briefing from Transportation Cabinet officials on the Cabinet’s response to severe weather and tornadoes in Kentucky, especially the May 16–17 storms that caused deaths and widespread damage in Pulaski and Laurel counties, with an additional tornado noted in Washington County. Secretary Jim Gray, State Highway Engineer James Ballinger, and District 11 engineer Chris Jones described how crews in all 120 counties were placed on alert, how roads were cleared of debris, and how KYTC coordinated with emergency management, law enforcement, local governments, and utilities to restore access and power. They reported major impacts on roads, signals, and other infrastructure, including the EF4 tornado path through Pulaski and Laurel counties, and said KYTC also helped with debris hauling, airport cleanup, and delivery of water and meals.
The officials gave specific recovery figures for Laurel County, including 1,800 loads of construction and demolition debris hauled, about 11,000 tons and 22,000 cubic yards removed, with roughly 50% of vegetative debris cleared at that point. They said all state roadways in Laurel County were reopened, the London-Corbin Airport was returned to flight operations by Sunday, and a transition plan was underway for Laurel County Fiscal Court’s contractor to take over debris operations. Gray also noted that KYTC had helped issue replacement IDs, licenses, registrations, and titles at no cost in disaster areas, and said the Team Kentucky Storm Relief Fund had raised nearly $1.5 million from more than 6,000 donors.
Members praised KYTC staff as first responders and thanked them for their quick response and coordination. Several legislators recounted local impacts in Washington, Pulaski, and Laurel counties, including blocked roads, rescue challenges, looting concerns, and the scale of property damage. One member asked how KYTC inspects bridges and infrastructure after disasters to check for hidden damage, and officials said the process depends on the event and can include bridge inspections and checks of tall infrastructure such as light poles. No votes or formal committee actions were taken during the discussion.
MA
Massachusetts 2025-2026 Regular Session
Formal House Session 33 Jun 21st, 2026 at 11:00 am
Massachusetts House Floor Meeting
Transcript Highlights:
- tasked the Inspector General to investigate and report on how to best contain costs and institute efficiencies
- tasked the Inspector General to investigate and report on how to best contain costs and institute efficiencies
Summary:
The House opened with the Pledge of Allegiance and adopted two ceremonial resolutions: one commemorating the dedication of the Woburn Battle Road Memorial as part of the Massachusetts 250th celebration, and another recognizing May 1-7 as Elks National Youth Week. The chamber then took up House Bill 4005, a fiscal year 2025 supplemental appropriations bill using FY24 Fair Share surtax surplus funds, and ordered it to a third reading before later considering it for passage to be engrossed.
During debate on the bill, the House heard a lengthy presentation in support of the proposal, which would direct about $828 million to transportation and $353 million to education. The transportation spending was described as primarily supporting the MBTA, including workforce and safety funding, reserve replenishment, station and infrastructure improvements, reduced fares, and reimbursement for tunnel closure costs, along with smaller amounts for regional transit authorities and unpaved roads. The education side included additional special education circuit breaker funding, vocational school capital, early education workforce supports, early literacy, universal school meals, higher education endowment matches, Green School Works, and ESOL waitlist reduction, with the Inspector General directed to review circuit breaker cost controls.
Members then debated several amendments. One amendment related to a school athletics policy was modified by a further amendment calling for DESE analysis before implementation; both the further amendment and the underlying amendment as amended were adopted. A transportation amendment to shift $50 million from MBTA funding to Chapter 90 municipal roads was supported by members emphasizing rural road needs but was rejected on a roll call, 25-120. Another transportation amendment adding at least $300,000 for Route 93 mitigation costs in Medford was adopted, 133-20. The bill itself then passed to be engrossed on a roll call, 140-14. The House also observed moments of silence for former First Lady Kitty Dukakis and for victims of the Santo Domingo nightclub collapse, and later adopted an order to meet the next day at 11 a.m. before adjourning in memory of former Representative Philip W. Johnston.
CA
California 2025-2026 Regular Session
Assembly Appropriations Committee Apr 22nd, 2026
Transcript Highlights:
- ensure the High-Speed Rail construction project is a success and that the project is delivered as efficiently
- ... ...project is a success and that the project is delivered as efficiently and effectively as possible
Summary:
The Assembly Appropriations Committee met on April 22, 2026, with a quorum present and first took up a large consent calendar. It moved a set of bills to the Assembly Floor consent calendar by unanimous vote, including AB 1773, 1785, 1828, 1873, 1918, 2001, 2085, 2173, 2412, 2536, 2644, and 2781, and separately approved another group of unanimous bills not eligible for floor consent, including AB 1544, 1555, 1614, 1621, 1637, 1704, 1816, 1933, 2529, 2559, 2663, and 2731. The committee then heard several individual bills, with each author describing the measure and witnesses generally testifying in support; no organized opposition was recorded on the bills discussed.
Among the measures heard, AB 2393 would create fixed statutory damages for certain false imprisonment and arrest claims, while exempting peace officers, custodial officers, and public entities. AB 1697 would delay implementation of a recently enacted prohibition on employment contracts that require workers to repay employer debts if they leave a job, and AB 2534 would extend Domestic Violence Prevention Act restraining order protections to attempted forced marriages and survivors of forced marriages. AB 1608 would strengthen the High-Speed Rail Inspector General’s office by adding staffing and contracting authority, requiring public reports, and allowing limited temporary confidentiality for sensitive information; the bill drew questions from members about transparency and whether information could be withheld, but the author and Inspector General said the measure would increase accountability and only allow narrow, time-limited confidentiality.
The committee also approved AB 1916, which would allow American Sign Language interpreters to participate in the same collective bargaining process as other certified court interpreters, and AB 1803, which would require anti-hate speech training as part of workplace harassment prevention training for employers with five or more employees. AB 1821 would change Public Records Act response timelines from calendar days to business days, with local government sponsors arguing it would better reflect actual processing time for broad and complex requests without reducing access. AB 1919 would establish election procedures to let voters decide the future of Santa Cruz Metro service funding after a one-time grant expires. Each of these bills was moved forward on due pass votes, with some members not voting on certain measures. The committee then approved a long suspense file, and the remaining suspense bills were deemed approved without further discussion.
CA
California 2025-2026 Regular Session
Assembly Appropriations Committee Apr 22nd, 2026
Appropriations
Transcript Highlights:
- ensure the High-Speed Rail construction project is a success and that the project is delivered as efficiently
- ... ...project is a success and that the project is delivered as efficiently and effectively as possible
Committee:
House Appropriations
ID
Idaho 2026 Regular Session
Agenda Mar 10th, 2026
Transcript Highlights:
- better to add just a little more money in there to make sure that the audit gets done timely and efficiently
- Gets done timely and efficiently. And a follow-up question. Thank you, Madam Chair, and Mr.
Summary:
The House Health and Welfare Committee approved the minutes from February 26 and March 2, then considered RS 33677, a revised version of a prior bill dealing with Medicaid/provider rate-setting and cost surveys. Representative John Vanderrata said the new draft clarified the intended spending reduction, identified the affected line items and state match, narrowed the services to be cost-surveyed, pushed the implementation date to December of the following year, and added language stating rates are subject to legislative appropriation. Department of Health and Welfare Medicaid administrator Sasha O’Connell explained the department would conduct annual cost surveys similar to current practice, audit a random 15% of responses, and likely continue using its existing auditor, Myers and Stauffer. The committee voted to introduce RS 33677 and send it to the second reading calendar.
The committee then introduced RS 33626, which would create a legislative oversight committee for Idaho’s rural health transformation funds, awarded through a federal rural health program. Representative Jordan Redmond said the bill was intended to provide legislative oversight of the nearly $1 billion in funds over five years. Members asked about minority-party representation and rural membership on the committee, and Redmond said leadership had discussed those issues and he expected minority-party participation, while noting the House and Senate versions differed on committee size and rurality requirements. The motion to introduce RS 33626 passed.
Finally, the committee heard House Bill 758, a cleanup bill for child care licensing rules. Representative Barbara Ehardt said the bill clarified that providers may use monitors rather than remain physically in the nap room so long as they are within reasonable hearing distance, and it also clarified how providers’ own school-age children are counted in group size. A member of the public, Elizabeth Nune, testified in opposition, arguing the changes would weaken supervision and professionalism in child care. Ehardt responded that without the clarifications, many home daycare providers could be forced out of business. The committee voted to send HB 758 to the floor with a due pass recommendation, and then adjourned.
OK
Oklahoma 2026 Regular Session
Judiciary and Public Safety Oversight Mar 5th, 2026 at 10:30 am
Judiciary and Public Safety Oversight
Transcript Highlights:
- Members, 3430 aims to make the collection process more efficient for the court costs and fines and fees
- on VIN inspections and the Goal is to modernize the statute, ensuring inspections are conducted efficiently
Bills:
HB2650 , HB3277 , HB3386 , HB3419 , HB3430 , HB3742 , HB3791 , HB3835 , HB3905 , HB3968 , HB4119 , HB4153 , HB4408
Committee:
House Judiciary and Public Safety Oversight
Keywords:
probate, estate administration, summary administration, decedent, inheritance, vehicle inspection, title registration, salvage vehicles, ownership, Oklahoma Statutes, evictions, forcible entry, mediation, residency proof, children, housing law, corruption, nonpublic information, government accountability, criminal law
MO
Transcript Highlights:
- It maximizes the effectiveness of targeted removal as efficiently as possible.
- It must be conducted as efficiently as possible. We do.
Committee:
House Agriculture
ID
Transcript Highlights:
- collaborative practice, design models with a focus on primary care, specialty medicine, surgical practice efficiencies
- presentation, he stated that his goal was to ensure that the health insurance exchange operates as efficiently
Summary:
The Senate convened with 34 members present and approved the previous day’s journal. After prayer and the Pledge of Allegiance, the body received committee reports on several measures, including Senate Joint Memorial 109, Senate Resolution 115, and multiple Senate bills that were referred to the appropriate committees or advanced to second reading. The Senate also received House Bills 540 and 541, both sent to the Judiciary and Rules Committee, and moved House Bill 514, House Bill 515, Senate Bill 1244, and Senate Bill 1232 to third reading.
The chamber then paused for its Lincoln Day Service, featuring remarks on Abraham Lincoln and the American experiment by Secretary of State Phil McGrane. Following the service, the Senate took up several gubernatorial appointments to the Idaho Health Insurance Exchange Board. The Senate adopted committee reports confirming Dr. Karen Cabell, Robert Cuyo, and Kevin Settles, with members speaking in support of each nominee’s health care, business, and public service experience.
The Senate also adopted the committee report confirming Senator Todd Lakey to the State Insurance Fund Board. In miscellaneous business, senators made introductions and announcements, including notice of a noon Capital Clarity session on weather modification and mosquito abatement and comments about a recent go-kart event. The Senate adjourned until 11 a.m. the following day.
ID
Transcript Highlights:
- We are supporting in this resolution continued efficiency and modernization.
- Because as we make these investments in recharge, in efficiencies, and making sure that the dam systems
Summary:
The Senate convened with 34 members present, approved the previous day’s journal, and heard an opening prayer and Pledge of Allegiance. The chaplain’s prayer focused on drought, low snowpack, and asking for rain and conservation, and the Senate also noted Senator Woodward’s absence due to his son’s injury. Senator Den Hartog outlined the day’s plan, including gubernatorial appointments and several water-related concurrent resolutions.
The Senate confirmed David Dean to the Idaho Endowment Fund Investment Board and Amy Anderson to the Commission of Pardons and Parole after committee reports and brief debate highlighting Dean’s financial and business background and Anderson’s 30 years with the Department of Corrections. The chamber also received House Bill 559 and introduced several Senate bills, including measures on state budget limits, rural health transformation, chiropractic prescribing, mental health detention, blindness reporting, and child protection.
The main policy action centered on water resolutions. SCR 117, supporting Water District 4 projects such as managed aquifer recharge, cloud seeding, infrastructure modernization, and the Upper Snake River Study, passed after debate. SCR 118, supporting Water District 3 projects in the Magic Valley, including Milner Dam work, the Little Wood River Channel project, and canal improvements, also passed by roll call despite several senators voting no over cloud seeding language. SCR 119, supporting Water District 2 projects including Treasure Valley recharge, the Mountain Home Air Force Base water conveyance project, and Anderson Ranch Dam work, was adopted by voice vote. The Senate then moved through second-reading business, referred SB 1232 to the 14th order for possible amendment, and adjourned until 11:00 a.m. the next day.
AZ
Transcript Highlights:
- Matt Nielsen, just efficient. I apologize. We appreciate efficiency.
Summary:
The Senate Education Committee first approved the January 21, 2026 minutes without objection and then held an executive nomination hearing for James McCain to the Arizona Board of Regents. McCain described his military background, education at Arizona State University, and interest in serving rural, tribal, and veteran communities. Senators from both parties praised his service and bipartisan support, and the committee voted 7-0 to recommend his confirmation to the full Senate.
The committee then considered SB 1026, which limits how often alternative education programs and schools in good standing must recertify and allows ADE or the State Board of Education to require certain student-population and compliance showings. After adopting a committee amendment, the bill received a 4-3 do-pass recommendation, with some members objecting that the bill reduced accountability and did not clearly define good standing. SB 1126, which requires schools to provide information to DCS caseworkers during abuse or neglect investigations and bars schools from preventing employees from speaking with DCS, passed 7-0. SB 1143, requiring schools and LEAs to submit CRDC information and directing ADE to publish an annual school safety report, also passed 4-3 after testimony that the bill was redundant and burdensome.
Finally, the committee heard SB 1166, which expands high school equivalency preparation instruction through accommodation schools from only 12th grade to grades 10 through 12 for students at least 16 years old. The sponsor said the bill simply broadens access to the program, while some members questioned whether it could encourage students to pursue a GED earlier than intended. The bill received a 5-2 do-pass recommendation, and the committee adjourned after completing its agenda.
NM
Transcript Highlights:
- It's just a more efficient way to get things done.
- providers and teams to help us provide the best care, the most humane care, and the most effective and efficient
Committee:
Senate Senate Rules
Keywords:
school elections, partisan elections, voting rights, constitutional amendment, New Mexico, elector registration, pediatric palliative care, pediatric hospice, Medicaid, state plan amendment, Health Care Authority, children with serious illness, life-limiting conditions, complex medical conditions, curative care, concurrent care, family-centered care, hospice services, managed care, pain management