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The Future of Medicaid: Challenges, Costs & Care · Real State

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AI and telemedicine. You all see the big impact coming from either one of those.
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It's going to be the biggest impact in healthcare over the next two to five years.
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This is Real State, a podcast from CSG South. Join us as we talk with policy makers and public leaders
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shaping state-level decisions across the South and explore how ideas move from policy to real impact.
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Welcome to Real State. I'm your host, Lindsey Gray. For this special episode, we're taking you
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inside this year's Southern Legislative Conference in Lexington, Kentucky. State leaders from across
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the South gathered to tackle one of the most pressing issues facing every legislature
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Medicaid. Healthcare is one of the largest investments in every state budget and today's policy
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decisions will have lasting impacts on the access of care, rural communities, workforce development,
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and state finances. During this plenary luncheon, Kentucky Senate President Robert Stivers
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moderates a thoughtful discussion with legislators and healthcare leaders about the evolving
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Medicaid landscape, including federal policy changes, workforce shortages, rural healthcare,
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artificial intelligence, telehealth, and strategies for building a more sustainable healthcare system.
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Whether you're a legislator, legislative staff member, or simply interested in how states are
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navigating these complex challenges, stay tuned. This conversation offers valuable insights
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from leaders working on these issues every day. Here's the plenary luncheon recorded live
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at the 2026 Southern Legislative Conference in Lexington, Kentucky. Ladies and gentlemen, good afternoon.
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Welcome to this policy session during our plenary luncheon. We're glad everyone has shown up,
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caught the crown. This session will bring several leaders from across the Southern states
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to talk about the policies, workforce participation strategies, program sustainability,
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and the fiscal aspects of access to care. We're fortunate to have several people with us today,
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but I'm going to introduce our guest here today. First panelist who, the far right,
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is Senator Jim Burgin of North Carolina. Senator Burgin is a fourth term state senator
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from District 12. He chairs the Senate Health Care Committee, the Appropriations Committee on Health
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and Human Services, co-chairs, the Joint Legislative Oversight Committee on Health and Human Services.
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He also serves on the Agriculture, Energy, and Environment, Finance, State and Local Government,
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and Pinch and Retirement and Aging Committees. He is also one of our vice chairs for the CSG
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South Human Services Public Safety Policy Committee. Our next panelist is Senator Kay Kirkpatrick
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of Georgia. She is closest to me. She represents District 32. She is a doctor, has served in the
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Georgia Senate and legislature for nine years. She currently serves the chair as the Senate
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Children's and Families Committee, Vice Chair of the Health and Human Services Committee,
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and serves on the Insurance Labor Appropriations, Government Oversight and Military and Veterans
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Committees. She also serves on Georgia's Joint, Defense Commission, and Behavioral Health
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Coordinating Council. Our next panelist who is second from my left is Representative Ashley Hudson
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of Arkansas. Representative Hudson represents the 75th District in West Little Rock, and she has
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done so since 2020. She serves on the Judiciary Committee, the City County and Local Affairs Committee,
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the Joint Budget Committee, and is Vice Chair of the Courts and Civil Law Committee.
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She has been selected multiple times by both the Arkansas Judicial Council and the Plaski
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County Bar as their legislator of the year. And our final panelist in the middle of the group
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is Jeb Duke of Humanity Inc. Jeb is the Senior Vice President of Medicaid Markets at Humanity,
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leading the healthcare company, and in his role he is responsible for Humanity's Medicaid
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Health Plans for Market Operations, Strategy, Clinical Programs, External Relationships and Plan
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Performance. Jeb has 18 years of experience in the healthcare industry and has served as the
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chairman of Kentucky's Association of Healthcare Plans and is a board member of the Kentucky State
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Chamber of Commerce. I'm going to go back and just reiterate one thing real quick. I think all of us know
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that in our budgets and I know in the state of Kentucky our populations are changing for that which we
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deal with in Medicaid. It becomes really quite complex since a lot of the things we are reactionary to,
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not based on policies we adopt but that which comes down from the federal level. And it tends to change
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with administrations, which sometimes make it difficult when you want to do some long term planning.
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And the 30 years I have been in the legislative process, I don't think there is anything any more complex
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or anything that takes more thought in our budgetary process in dealing with Medicaid in our
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contribution rates as well as what we will define as the population for which we serve.
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So I'm going to start off with a lot of questions and hopefully at the end we'll be able possibly
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to answer some questions or take some questions from the audience. And the first one, I'm going to go
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and send it to you, Jim, you get it. Give us your overview of the current Medicaid landscape
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as it relates to federal policies, the developments in the states, what we should be watching for
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and what things are influencing the state Medicaid planning and decision making as you see them.
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I wanted to start by just thanking Senator Stiver's property to speak today. If you haven't met
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Senator Stiver's, he's an asset for our community. He's just as welcome in our rural communities as well
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as our Metro communities. I don't know if you're going to talk about gas policy and prices but if we
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can bring down gas prices, Senator Stiver's probably be the biggest winner from an economic return.
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I also want to welcome everyone to Kentucky. I'm a Kentuckyian. I've lived my parents for born here.
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I plan to live my life here. You're going to spend a lot of time and we're going to talk about horses.
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You're going to talk about bourbon but also want you to recognize Kentucky is a place of business,
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especially as we talk about health care. Our nation's largest hospitals, our nation's largest
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nursing home facilities, our nation's largest home health companies where our nurses are trained
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at the largest level in America. Also our Medicare Advantage and our fastest growing Medicaid company
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is all all happened in Kentucky by Kentuckyians and it really speaks to what the South can do
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and what people can do in this community. So please as you're exploring Kentucky also explore our
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businesses. If we talk about the landscape of Medicaid one in two bursts in America are born with
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Medicaid reimbursement in Kentucky one in three Kentuckyians are on Medicaid. We are really living
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in a time where things are changing and I like to think about three different things. I think you
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all might have talked a little bit about it this morning but one is just the cost. We are going to
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have physical constraints as we think about state budgets and Medicaid and how we handle that
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at the state level with our provider partners within Medicaid. COVID in the PhD,
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those are in our rear view mirror. We have to deal with lower reimbursement also maintaining access
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and ensuring that health care is delivered at the same high level that Americans expect.
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I think second I like to think about what are the impacts of HR1? What is the big beautiful bill
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and what are the impacts? How are we going over the next several years role of this program out
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and make sure it's successful? That means in some states where we haven't had cost share in Medicaid,
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it means in some states where we've done annual re-verification and Medicaid eligibility doing
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it by annually what that creates in the churn in the reimbursement for providers.
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And frankly it means work requirements, right? How are we going to work together to ensure that
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we're educated patients, we've educated members and people who deserve and have the right to have
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health care are getting that right information and completing those requirements and how are we
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meeting the intent of the policies so that we can ensure the results are yielded from it?
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I think the third thing we I think this was discussed this morning but
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rule health is absolutely something we should be sitting and thinking about in every state.
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What are the workforce challenges that these communities face? How do we support them in those
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challenges? And as we're thinking about HR1 and we're thinking about the potential impact of our
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real hospitals and those providers, how do we support them through this time to ensure that that access
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is not lost in those communities don't feel that harsh economic impact? So the three things I'm
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thinking about really is we think about national policy at the state level. Okay then let me open this
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up to our three policy makers. You have to live with the policy we adopt or that that comes from
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the federal government. I'm going to open it up we'll let either one of you all start but what are
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the most difficult or pressing policy issues as it relates to implementing or budgetary impacts
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that either in North Carolina, Arkansas or Georgia that you all are dealing with who wants to start?
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I'll go. Go ahead, Doc. Okay and I'm from Kentucky by the way so I'm so happy to be home.
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I wanted to say that Georgia's in a little bit different situation than a lot of other states
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because we already have work requirements and so the implementation of HR1 is going to actually
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add people to our roles whereas in another state people are going to peel off of the roles
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and that's because we already had covers for caregivers up to age six the bill takes it up to age 14
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and then the other thing is the it adds the medically fragile population and the definitions of
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that are not clear in the federal law so we're going to have to figure that out at the state level
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and that's going to come down to which ICD-9 codes or 10 codes are covered I'm showing my age ICD-9
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but which codes are covered and which things need to be cased by case and which things are going to be automatic based on the diagnosis.
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The other thing and this is a budgetary thing that is not really related to HR1 but I just want to mention it
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so it gets on the radar is pharmacy costs and the increase in GLP-1s in particular.
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I read this week that 15% of the population is on GLP-1s and what to cover and what not to cover in Medicaid is
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we're already dealing with that as a challenge in our state.
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Senator Bergen?
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Well we just passed our budget last week we were the last state in the country to do that and so we
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did that and we had to budget about 1.1 billion dollars for our Medicaid rebase.
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So it's very concerning and when we started looking at cost factors the ABA services, the services for
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autistic children is through the roof. We have 250% increase in the number of people getting services
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but then when we look at individual providers we've had as much on the last three years as a 900% increase.
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We have people that are telling folks to take their children out of school and put them in 40 hours of
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services and we said we just in the last week when we passed the budget we put a cap on the number
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of providers that can come into the state. I think we need to put some other caps in force.
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We have right now through Medicaid expansion which we did two years ago we had about 780,000
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added to Medicaid and at 90% we covered the 10% that the state was supposed to pay through
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tax on the hospitals and then we also put in the bill that if any of that changed, if the 10% changed
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or if there was work requirements required and we didn't meet that that we would suspend
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the expansion population but as the federal government is working on all these things you know we
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still don't have all the rules and I'm a rules guy so I like to know what the rules are going to be
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so we know how to handle all of these things and we've got costs coming down. We're one of the
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few states that still all of the determinations are made in the county level so we have 100 counties
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in North Carolina and you can imagine 100 different counties doing things, your error rates are all
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over the board and then the administrative cost, the administrative cost to our counties is going
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to be $69 million and that goes into effect this October so you can imagine they're all calling
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saying are you going to make us hold or not right now we have not done that so there's just a wealth
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of different opportunities for us to deal with Medicaid but folks it's not getting better and
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we went to manage care, we actually went to manage care the first year I was in office and that was
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supposed to level out everything and keep the costs down and then like I said this last year the
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biggest rebase we've ever had in our state happened under managed care, everything in Hudson thoughts
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from Arkansas? Yeah you know I think that what I'm hearing from all of the other senators and representatives
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up here is that all of our states really benefit from systems that have predictability which we don't
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really have right now I think over the past few years we've seen a lot of unpredictable ups and
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downs within the Medicaid system and that's something that really to some extent we can't control
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because a lot of our marching orders about how to administer these programs come from the federal level
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and so we're left as my colleagues up here to discuss to try to figure out what rules might
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be needed in order to implement new programs in our states and how to interpret legislation that
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may not necessarily make sense with what our existing state level legislation tells us we're supposed
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to be doing so our administrators of our Medicaid programs are dealing with some really unprecedented
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challenges from that respect. The other problem that we're running into in Arkansas is this idea and
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I know we're going to talk about it more later of not only recruiting but also maintaining
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healthcare workforce and we have been working on different programs and measures over the past few
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years to try to improve our workforce but the reality is as we try to come up with different
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and creative approaches we're all working with a finite number of dollars we're all working with
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a finite number of people who can come in and provide these services and we're especially dealing
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with challenges in our rural areas because of other issues that we may have with infrastructure
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with education that make it hard to attract providers to come into those areas especially in
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situations like we have in Arkansas where a number of our rural hospitals have been closing so
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from the Arkansas perspective we do look at this this large Medicaid population that we're trying to
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provide care for shrinking workforce in some of these areas of healthcare that are needed
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and the added challenge of having these hospital closures in rural areas and so
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you know we'll just to kind of set the table I think that those are challenges that everyone in
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this room can identify with in their states a lot of southern states are dealing with these same
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issues and our challenge as state legislators is to try to distill these mandates that come from
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the feds and put them into some sort of policy so that we can tackle those and that's sort of I
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think where we're all sitting at this point. You talk about this and this is I think for all of us
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significant healthcare changes that we see coming down the line or have already come down the line
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but do you have any thoughts about what legislators at the state level should look for something you
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would say hey we looked at this and we could do it better or maybe we don't even need to do it at all
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lessons learned from what you all done. We've all got to be better about forcing folks to give us
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good data I'm a data-driven guy our treasurer I got this from him but he got it from somebody else
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in God we trust everybody else send me data and so I think that's what we ought to do we ought to tell
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folks we need your data and we need to see we need to be comparing costs we were talking a group of
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us were talking this morning about scope of practice and we were talking about dance practice nurses
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but then there was a study done that shows I think somebody's going to maybe talk about it study
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done that shows that the dance practice nurses sometimes they even order more tests and so the cost
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of going to maybe an advanced practice versus versus going to primary care doc could be higher
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we need to know that and it's just like I told folks about the ABA services that happened
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over a three-year period and so we didn't catch it though until the second year and didn't act
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on it till the third year so it's cost you know close to two billion dollars that we should have had
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some kind of governor owned so that we you know kind of held that down so I'm talking to the HHS
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now about a report where anytime a level of service moves more than a certain percent
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that it sets off on the alarm so we start looking at it early then I'm going to go to use
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Senator Kirkpatrick your doctor UK U of L appreciate that house divided some of us on this podium
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are the same way me but we've heard two billion dollars so in Georgia what do you all look at to
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determine whether it be one dollar or two billion that you're getting your ROI you're getting your
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money's worth for your investment well to start with and this is true in every state
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Medicaid's our second biggest budget item in our whole thing K-12 education being number one
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it's a massive amount of money so between the two of those things is 77% of our budget and I'm sure
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it's very similar in other states a lot of that is programmatic it is already fixed based on the F-MAP
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with the federal government and so when enrollment goes up or down there are these wild swings in our budget
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that can be hundreds of millions of dollars and you really that's the very hard to predict so that's
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problematic the other thing is we do have a managed care model in Georgia and I won't get too far
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into that except to say that in the legislature we like to increase provider rates particularly for
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providers that haven't had an increase in a long time and we know that only 60% of our physicians
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participate fully in Medicaid and in order to get more people participating in the program
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we need to raise those rates unfortunately some of our managed care companies not all of them
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have then decreased rates on their own and the accountability for that is not quite where it needs
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to be so we're working on that but the from the ROI standpoint the data a lot of our programs are
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outsourced the management is outsourced and getting the data back from the vendors we can get it
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but it may not sync with our budget cycle and so the data is a huge challenge but I agree that's
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what we've got to operate on okay then let me throw this out we all think we have really good ideas
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when we pass legislation certain sense of pride and authorship but then once you actually pass it
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it's kind of like uh oh maybe we shouldn't have done that or wait a minute this that we did
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actually performed better than we thought so representative Hudson what do you got the good
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things the bad things the things you wish you did do or the things you wish you did more of you know
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and I think in Jeb could probably speak to the something because you know his company has to live
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with some of the things that we do right but we always have to try to keep an eye on is the the purpose
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and the reason that we pass legislation and what we forget often as legislators is all of the
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rulemaking and all of the effort that has to happen after we pass legislation and leaves the providers
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the insurers and the beneficiaries to try to figure out exactly what it means what these changes to
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to the law mean and how they affect them um especially when you're talking about providers how
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that affects them in their practice whether they can continue to practice for example or whether they
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need to um change how they're coding for billing purposes whether they need to get new providers in
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in different specialties in order to continue to provide a service and so you know I think that
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most recently we've had sort of a micro and a macro example of this on a micro scale I passed
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a ran legislation and passed legislation last year to have Medicaid coverage for lactation
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consultants which are consulted and have um and in in theory this is a good thing it is a good thing
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I don't think that it's even in theory I think practically it is however there's a lot that goes
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on behind the scenes after we say now we're going to cover lactation consultants um there are different
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types of lactation consultants there are different certifications for lactation consultants there are
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different um billing levels for the types of services that you're providing and once we pass
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this legislation we pass it off to our Medicaid administrators and we say good luck y'all figure it out
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right um and that's just one service line that we passed in one session and so that rule-making is
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continuing now and that doesn't even take into consideration some of the pushback that we often get
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from um in in a Medicaid expansion state for example from some of the insurers that provide um
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the Medicaid expansion coverage and whether they want to add this into their service line or whether
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they you know depress the rates in such a way that makes that coverage a luxury um on a my on a macro
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scale we can look at the Healthy Moms and Healthy Babies Act which we passed um in the 2025 session
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which is a larger all-encompassing maternal health bill that covers a lot of different types of
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service lines and tries to tackle our maternal health crisis through a bunch of different programs
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care coordination um investment in telehealth and in rural health and our providers in in order to
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take a multi-pronged approach to a very big problem so take what I just said about the lactation
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consultants and take that time is about a million and that's what our Medicaid administrators is
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trying to deal with now trying to figure out how we implement this big incredible amazing project
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in a way that actually delivers services in a way that improves women and infants lives and when
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you're talking about transformative legislation like that to us like we pass it we all have five there's
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a photo opportunity and then we go home um but the work continues for the providers and the beneficiaries
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and the care coordinators and the insurers that we've now given this mandate to and I think we
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often lose track of that that when we pass this legislation there is a real tangible practical effect
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on the people who live and breathe and work in this industry every day and we need to remember that
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as we're putting together and crafting pieces of legislation whether it's going to be um transformative
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and and help our constituents or not but really what that that day to day is going to look like
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and and never forget that every time we we write a piece of legislation and submit it for a passage
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that there are real life implications to what we've done so i want to throw it open to the two senate
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members uh that oops moment or that aha moment that hey we did something really good or we didn't do
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what we thought we did or we should have done more of it Medicaid expansion i think we were the
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last state to do it and and there was a lot of controversy over the years and a lot of folks were
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very concerned politically about it and and and it turned out that it was it was not that at all
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one of i was always against expansion because i thought it was just going to run cost up and
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but when we actually made the arrangement with the government we got 1.7 billion dollars of new money
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plus we got four billion dollars for our hospitals and then the hash money that follows and so i
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mean it ended up being seven billion dollars of new money coming into the state and i felt like
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we had a fiduciary responsibility to do it i'm a big proponent of mental health i think that we
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don't concentrate enough of mental health and and the secretary the prior secretary and i traveled
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to state doing town halls about mental health right after i came into office um and and what we'd
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be able to do we took 835 million dollars of that bonus and designated toward mental health
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to build new mental health hospitals and new facilities and put practices out in rural north
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carolina and and i don't know if we're going to get in talking about the rural transformation money
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but we're getting an additional 213 million dollars starting this year and if well next year
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and for five years i all every state in here is getting money and we need to be real careful about
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how we spend that money and that make sure that we really do invest it in in in rural health
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i was actually in Las Vegas the week it was announced that the consumer electronics show
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talking about artificial intelligence and health care and looking at health care and the innovation
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and while i was out there i had a request and i it was announced while i was out there before i left
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there to come back i'd had requests for a hundred and fifty million dollars of funding i told folks
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i was asked to fund things i didn't even know i had a problem with so um you know there are uh
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there's a lot of money and i described it as we have newly stocked ponds and everybody wants to
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fish in them so if you're from the country you know what i'm talking about now there's going to be a lot
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of people with a lot of solutions for problems for all of this money that we're going to be getting
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into carolina. Yeah so we took a little bit different approach in georgia we've kind of
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chipped away at medicaid and so pretty much everybody's covered except for the ablebodied 18 to 64
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year old population and so we passed a bill called the patience force first act which was a few years ago
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and the idea was to have in sync programs one is for the population i'm talking about that had the
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work requirements which also included um educational volunteer caregiving opportunities and things
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like that and then another program that was called pathways then another one called access which had
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to do with a state-based exchange which the idea would be to get people onto insurance that actually
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would be accepted in the doctor's office because a medicaid car doesn't necessarily get you seen
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in a doctor's office and so that was a good idea and what we found out in the implementation was
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that the access program the exchange based program was very successful 1.5 million people signed up
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for that the other program the pathways program got off to a very slow start and you can't just put
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something on a website and expect people to figure it out in the rural areas and so what we learned
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is that we needed right out of the gate to be reaching out in communities and telling people what
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they needed to know to participate in this program i did do not think we did a good job with the
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rollout and we now are backbill some of that and the participation is increased but we do that a lot
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in state government we have great programs that we pass into law and we fund them and then we don't
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tell anybody so i think the disconnect between us and the public sometimes is large okay jib i want
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to deviate from my notes a little bit all right it says i'm not to ask you who the winners and losers
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are in here but what i am going to ask you are not the losers but identify states and they may not
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be southern states that have from your perspective there's always give and take between the
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Medicaid managed care groups and the legislative and the providers and everything else but tell us
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some of the states that have done this well in europe and and why have they done it well before
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this we were talking about working in the ecosystem everything we decide from a policy has a different
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impact on a provider or a product we were talking about exchanges our exchange policy absolutely
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impacts Medicaid and are Medicaid policies impact the providers and the provider impacts and impact
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the community i think we need to take that same observation and think about how we develop policy
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we need to understand that our policy is working in a framework of cms under a federally man
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data program and when we're thinking about it we have to understand where are the waiver implications
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what are the approval process especially as cms is stepping back and saying how do we create more
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consistency in Medicaid over time so what i encourage and what i've observed are states that think
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about a process understanding community engagement stakeholder engagement understanding impacts developing
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policy and after the policy is created is having the runway for a good execution so they're going out
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and they're doing the planning they're creating the time to the their effective upon launch i'm going to
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pick a state from the south absolutely uh i think florida did a good job so if we look back to 2011
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that's when they decided they're going to go statewide manage care but they look forward to 2013 and
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2014 for a rollout so they did the policy development then they ran the procurement and then they
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went out and made sure they understood the impact before the planning and then they executed on a rollout
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basis over time so that there wasn't significant change that wasn't aware within the community and
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all the impact in that ecosystem and it was it was relatively effective and ensuring that they did
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that transition to fee for service to manage care we've already touched on this and you all know
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we're going to come back to it in Kentucky we had quite the large debate this year about unserved
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or underserved area which gets into workforce um it's been mentioned to be more rural but in our
32:46
largest city Louisville Kentucky um the metropolitan area of over a million people we have
32:53
unserved or underserved areas in my home area eastern Kentucky there are areas that are
33:01
unserved or underserved areas what is the solution to that um university of Kentucky we have data
33:11
trying to verify this that 60% of the doctors that graduate from the university of Kentucky leave
33:18
the state the lack of nurses the lack of telecommunications and telenetworks so I'm going to we're
33:29
going to start far in and work our way around talk about workforce shortages delivery of health care
33:35
syndrome burden thank you um north Carolina is a second most rural state behind uh uh
33:40
uh Texas I know they sounds interesting but it is and what we discovered 77% of all the doctors
33:48
now work for institutions and we've already predicted we're going to have a 22,000 nurse shortage
33:55
by 2030 so we've been working we have 58 community colleges one of the most robust community college
34:00
systems in this in the country and so we're working with our community colleges with UNC and other
34:06
organizations to double the number of nurses that we're turning out we're also open some new medical
34:12
schools and other ones coming online this year and then there's another one planned um we but
34:16
we've got to not only produce the doctors we've got to entice them to go to rural north Carolina
34:21
so a couple of years ago I introduced a bill to pay their debt a hundred thousand dollars toward
34:27
their debt if they go to one of our rural counties I wanted it to go to 200,000 this year it's
34:32
going to 150,000 this year most of the folks that are coming out of medical school right now are
34:37
coming out with debt up to 400,000 dollars and and they just can't you know I've spoken to a
34:42
lady here earlier today and I don't know where she's at but her husband she said this publicly so
34:47
I can repeat it you know they've been in practice a long time her husband's a doc and they just paid off
34:51
his student loan you know for years and years and years of award that shouldn't be the case we
34:57
need to make sure that we get people engaged in medicine we're trying to identify kids as young as
35:03
in high school that want to become doctors and then try to help them follow that path get them through
35:08
school get them into rural north Carolina if they want to go and then the other thing I'm pushing
35:13
and we haven't gotten it done yet is to raise the rates for our rural doctors our rural primary care
35:19
doctors I want to pay them 110% of Medicare not Medicaid to entice them to stay independent and to
35:26
stay in rural areas and then I said this earlier I jokingly also say I'm going to introduce legislation
35:32
to set up a matchmaking company to get them married to a local person in rural north Carolina so
35:36
they'll stay there there are people in Kentucky who've thought about that arranged marriages
35:41
medical marriage yeah arranged marriages once you get them rooted there it's hard for them to leave
35:48
syndicate or Patrick your doctor you may have a totally different perspective actually I think the
35:57
thing that we have realized is that we're competing with all of y'all and we're competing with the
36:03
whole country and so what we've got to do is grow our own because there aren't enough people in the
36:10
whole country for health care and so we've got to start earlier which I don't think we have really
36:17
done as much with that as you have in North Carolina but we're focusing more not just on medical school
36:24
but on graduate medical education meaning residences because we know that that greatly increases
36:31
the percentage of people that will stay in an area where they train we haven't even gotten a
36:36
fellowships yet but we're trying to get our state government to understand that we can leverage
36:45
federal money Medicaid money for GME and some states are doing a better job with that and we need to
36:51
take full advantage of that the other thing is we need to convince continue to work with our hospital
36:57
partners to understand that residents and I was one a long time ago are basically free labor
37:04
and they're a lot less expensive than paying nurses overtime to run things to the lab or start a
37:10
non-veer or whatever so we're trying to work in partnership with our hospitals to create more residency
37:16
opportunities and we've done a good job with it the problem is just like all of your states we're growing
37:22
southern states are growing that's not true around the country but even though we've added a lot of
37:28
providers a lot of physicians a lot of nurses a lot of programs we can't keep up and that growth is not
37:34
going to stop I predict we're going to see more of that and so we've got to start earlier and create
37:41
more programs so that we can train people in our states and keep them there. The president of Hudson
37:46
think you were the first to bring up rural health care thoughts in Arkansas? There are two issues here
37:52
right we need to we need to not only attract new providers but we need to retain the ones that we
37:59
have in Arkansas we have taken steps over the past several years to try to loosen up some of the
38:06
regulatory hurdles to independent practice for APRNs and we've tried to provide grants and reimbursement
38:14
for student loans for providers who will stay in the state or who will work in rural areas for a period
38:21
of time and commit to doing that work in our rural communities but those are all great things to help
38:27
us to attract new providers but I'll tell you something I was looking at the match day post that UAMS
38:34
are our largest teaching hospital in the state did recently and what I noticed was that most
38:40
of the medical students who were graduating from the University of Arkansas and practicing in areas
38:46
like primary care, pediatrics some of those bread and butter areas that we desperately need more
38:51
professionals for they were all matching out of state they were they were leaving the state of
38:56
Arkansas and and we were really not retaining very many of our own health care professionals
39:03
and I think that we have to take a hard look as southern states as to the why behind that and I
39:08
think that there are several I mean obviously there are several different factors if any of us had
39:13
figured out all the factors we'd be in a much better position. One of them of course is the the
39:19
flip side of this which is with the the closures of rural hospitals that we continuously see in
39:24
Arkansas and we have seen several more make announcements over the past year that they're closing either
39:30
the entire hospital or various departments that doesn't give a lot of that predictability I mentioned
39:35
in my in my first response to graduating medical students and nursing students if they don't trust
39:42
that they're going to have a job in their local community when they get out of school and we have
39:47
to do more to stabilize our rural hospitals and when we talk about Medicaid cuts coming from the
39:53
federal level or adding workforce requirements without thinking through exactly how that's going
39:59
to affect our rural hospitals. We're also taking a we're taking a bite out of our potential workforce
40:06
right. If rural hospitals are dealing more with uncompensated care if they're dealing with more
40:13
ER visits and those razor thin margins are are dropped even lower and they get into the red
40:19
then we have an issue with maintaining our workforce in those rural areas so whenever we enact these
40:25
policies we have to be thinking ahead as Jeb was talking about in the case of Florida you know five to
40:31
and 15 years ahead as to how these policies are going to affect our systems and that's the other
40:36
big thing that that I think that that all of us need to remember when we're talking about health care
40:40
policy generally is that when we talk about a health care policy and we talk about attracting providers
40:46
we talk about retaining providers we talk about our rural hospitals and having access to care
40:51
that's not just a health care question this is a systemic question right a provider wants to move
40:56
into a community where their kids can go to good schools where there's infrastructure in place where
41:01
their spouse can get a job if they want to they want to know that they're in a safe community they
41:06
want to know that there are activities for their kids to do on weekends they want to know that
41:12
there are cultural opportunities and all of these different things in their community and if we
41:17
are trying to attract them to go into areas where we haven't made that investment into these other
41:22
areas of of of community in our state then we're going to continuously be asking the question of how
41:28
do we attract new providers because we're not going to retain the ones that we have they're going
41:33
to continuously be going into these communities staying just long enough to get the benefits of these
41:39
programs that we've offered them and then getting out as quickly as we they can and so when we're
41:44
talking about health care policy we really need to be taking a broader look at how the other policies
41:49
in our states are affecting the ability to retain our health care providers and to encourage them to
41:57
be parts of those communities that we desperately need them working in. Jim you've heard this and I'm
42:02
going to come back to this in the essence from your perspective lack of a developed workforce
42:08
lack of health care most recently there was an area that we may be simplistic is losing the OBGYN
42:16
and you're two hours away from an OBGYN so what do you get there does it cost you much is that a cost
42:23
driver now that's a more common day-to-day type of situation versus having specialties,
42:31
subspecialties within a day's drive an hours drive how do you see that in the way it impacts you as a
42:40
cost driver to the system. That's a great question that Senator Stiders so let me approach in a
42:46
couple different ways first I would just say when we think about workforce we translate that the
42:50
network adequacy and we need to meet the regulatory demands of our contracts so it's absolutely
42:55
something we think about 150 million Americans defined by the federal government don't have access
43:00
to primary care in a consistent basis it's even worse as we think about substance abuse and behavioral
43:06
health the cost is always another conversation we had as a sidebar is is we have to understand how
43:14
policy both the federal state policy impacts provider reimbursement when we think about a birthing
43:19
center or we think about an outpatient we're inpatient states it's what are the mechanisms for
43:26
reimbursement and how do we educate on those you know what has a perspective payment system what
43:31
has a federal match in a drawdown how does an independent force of a facilit provider who's related
43:37
to a system how are they reimbursed I do think we need to recognize two things one is that you absolutely
43:44
have to have centers of excellence when you think about specialty care the economics truly do demand
43:50
that you have the ability to have those types of services within a lot of our metropolitan
43:56
geographies what our what our job is to figure out how we fill those gaps and how do we make sure
44:01
that access still remains from a managed care perspective we do several things and no not all
44:07
them are the answers we're still searching for the answers some of that's benefit design you know
44:12
and a lot of our Medicaid programs and Medicare programs we ensure the transportation is provided
44:18
where it doesn't get reimbursed from a fee for service basis we have access from a care
44:22
coordination perspective where if a member can't get into a dentist or they can't find an OBGYN
44:28
they can call Humana and it's our job to ensure that we find that but I think we we still need to
44:34
continue to have the conversation and it is a valid point that from a state perspective we do
44:40
have to talk about reimbursement you know one thing is is is we do have to consider the reimbursement
44:46
for our communities but we have to consider consider it in the context of how rate setting works
44:51
and how our broader program works we can't take a dollar from a metro provider and give it to
44:56
an urban provider without breaking something else so we either have to find savings and how we coordinate
45:01
care or we have to find a different model in order to reimburse that then I'm going to fill this
45:05
in of the mix anybody can jump in AI and telemedicine you know see the big impact coming from either one
45:12
of those it's going to be the biggest impact in health care over the next two to five years and I
45:17
serve on a national AI and health care committee and we've been on it for I think two and a half years
45:22
now we travel all over the country and we're in Canada in Toronto and then my wife and I just got
45:28
back from China last week and it's over there looking and talking to them about AI and just a lot of
45:33
subjects in health care and you're you're going to see probably in the next two years that the first
45:40
visit for both Medicare and Medicaid is going to be with the AI bot there's one out right this down
45:46
Tom MD and go look at it it's a primary care bot that is being pushed out a Google is behind it the
45:54
folks that did web MD or involved in it and and it works I mean I still say there's got to be humans
46:01
involved but I do a whole little talk about AI I say AI has no conscience it has those morals
46:07
and it has no ethics and if there's not a human component and I as a Christian and especially
46:13
concerned about artificial intelligence and where we're going with it but the people that are
46:17
building the most data centers right now and doing the most work on AI or in China and they are
46:23
getting ahead of us quickly so I'm very concerned about AI and health care. Let me just add a note on
46:28
on telehealth because that was one area that we really looked at in the Healthy Moms and Healthy
46:32
Babies legislation and about half the counties in Arkansas a pregnant woman does not have access
46:37
to a provider within her own county she has to travel outside of her county to seek health care
46:42
for her pregnancy and so the Healthy Moms Healthy Babies Act included language in it that would
46:48
improve access to telehealth because what studies have shown is that the compliance rate for women to
46:54
seek prenatal care increases in situations in which things like transportation and distance
47:02
are not burdens to them. If you think especially in terms of a rural Medicaid population you will
47:08
run into people who may not necessarily have a vehicle available to them a reliable vehicle
47:12
who may not be able to take time off work in order to go to a provider during the week
47:17
that's that's an hour or two hours away from them and so having access to more telehealth
47:24
options does allow them to be able to communicate with their obstetrician to have questions answered
47:31
and to get that day to day care. Now that doesn't necessarily solve the problem of course of
47:36
urgent care needs or of labor and delivery you know you're not going to have a provider talk you
47:42
through how to deliver a baby in your living room and with all respect to Tom and MD I've gone on
47:47
Web MD my whole life and they'd always tell us about to die so you know we've got a little work to do
47:54
right but you know in terms of ensuring that we have access to or give access to
48:01
a provider in order to get those questions answered on a day to day and to ensure compliance
48:08
with those vital prenatal appointments I think that we can see a lot of really good things to do
48:15
with telehealth and that also folds into what we're seeing with our behavioral health providers
48:20
same issues with people in rural areas who need who need to speak to a therapist or who need to
48:26
communicate with the psychiatrist about medications being able to do that from home
48:31
improves their outcomes as well it improves compliance with their treatment plans
48:37
and being able to access their medications of course ensures that especially the seriously
48:43
mentally ill are more able to to maintain their medication protocols stay on the treatment
48:49
plans which keeps them from going into that pipeline into prison because they're committing
48:54
crimes in cases where you've got the severely mentally ill if they're able to receive treatment
48:58
within their communities then we see those outcomes start to improve as well so there are a lot of
49:03
real benefits I think to telehealth in our states and and I'm a big proponent of trying to make it
49:10
easier for beneficiaries to access telehealth especially in areas where seeking medical help
49:17
from a from a human being one-on-one maybe more challenging. Senator doctor which one
49:22
can I call you? Yeah, either one. Any speakers or doctors? I would say that before COVID we really
49:28
were not using telemedicine very much and during COVID we had to and what we've learned is that
49:34
some things are more amenable to telehealth than others and I think those boundaries are being
49:39
better defined now and the technology will help us however I go back to what Mr. Bergen said
49:46
and I did a bill this year about the use of AI in prior authorization for insurance and it's all
49:54
it's all good to use AI and it's a great tool for providers as well to automate and streamline
50:00
the process however if you're going to deny somebody's medical care a human has to review it
50:06
a clinical peer has to review it so I think that the parameters are going to become more clear
50:12
but it's going to be a hot topic per week. Well we've we've opened up the can of worms here
50:16
because I know you can put in five or six symptoms and get 756 diagnosis of what's wrong with you
50:23
and so Jim. And you're always going to die. Yeah. Yeah. And I'll go back to and this is effect in the
50:30
we have two hospitals in our county 147,000 people we've not had labor and delivery in the last two
50:36
years because we had we had two OBGYNs one of them retired out couldn't get another one to come
50:44
and so women have to drive you know 35 40 minutes to another county to get services now the hospitals
50:51
were working with them and they say they're going to bring it back but I see that happen everywhere
50:55
and and consolidation and health care is a big concern you know I'm afraid in North Carolina we're
51:00
going to deal with three or four systems and then everybody else is just going to have to to
51:05
drive and get there and I think it's happened I talked to I met a lot of you over the years being in
51:10
the legislature and coming to all these meetings and and the other meetings we all go to we're all
51:15
facing the same things and it's it's harder and harder for rural hospitals to compete and and I
51:22
think it's just going to that's going to continue but but there's so much money being spent right now
51:27
and I don't know if we're going to have a chance to talk about involuntary commitment but that's
51:30
another thing that's blowing our system up to quick thoughts on just on AI is is what do we know and
51:36
what we don't know and how do we have a commitment to work together to do it transparently to do it
51:41
humanely and to do it competently working in corporate America you know that AI is absolutely
51:46
going to change the game for everyone it means cost will come down as if we think about administrative
51:51
costs if they think our encounters will improve our ability to communicate importing will improve
51:56
if we think about a provider who doesn't have access to AI and the resources they will look like the
52:02
quality of their systems or poorer in their outcomes or poor if if from a cost structure if we
52:08
have a provider who's not using AI and you've a provider who is if if we can't help them and support
52:14
them in that journey then they may not survive and you're going to see more and more consolidation
52:19
so how do we as a community as states ensure that our lessons learned from AR Sprite Broadly and
52:25
that we're able to understand those impacts and also say it's going to advance as we think about cost
52:30
yep we think about the cost and Medicaid the vast majority of that cost is pharmacy cost if we're
52:36
applying AI technology to advance care we're going to see increasing cost structures around our
52:42
specialty care and our pharmacy costs and we need to make sure that those dollars are being distributed
52:47
in a way that support the outcomes of our of our members and patients and that they support the
52:52
programs that exist within Medicaid okay I'm gonna I'm gonna go back to one last thing because
52:57
I got the one minute notice and then we're going to open it up the audience for questions
53:01
Senator Bergen you you talked about you know education and recruitment and how you don't have
53:07
certain people how much do we have to place responsibility on our educators the people who are
53:18
producing the radiology technicians denerses the doctors be it an MD or an OD to get into these rural
53:29
areas or underserved areas to recruit or start programs because one of my universities just brought
53:36
to me let's do a dual credited program for high school students that they would actually have an
53:43
associates in nursing when they graduate from high school at age 18 or 19 how much do we need to be
53:50
pushing those educational institutions thought it opened anybody we've got to do that we do that
53:56
through our community colleges we I'm almost all the counties now started early college program
54:01
and a dual program where you can actually be in high school take community college credit a lot of
54:06
kids are going into four year now as they already have their first two years but other countries
54:11
are doing it completely different you know if you're become a doctor in China or India or any of those
54:17
the system is completely different the cost are different and and I think education cost a lot
54:23
of us have talked about this have just gotten completely out of hand and and I've proposed an idea
54:29
where we actually do the first year first two years of of college that we do at the community college
54:35
level and encourages say parents tons of money and then we could turn our our our colleges into the
54:42
last two years and the graduate programs I've also proposed an idea I think we need to be
54:47
looking at statewide year round schools we spend billions of dollars on new school construction
54:52
and it's proven fact kids lose a lot of knowledge over the summers there's a lot of things we need to
54:57
do in education to get us ready and and some of the training and stuff I think could be truncated
55:03
and overlapped the other panelists about pushing our educational institutions to come up with ideas
55:09
on how we feel those unserved underserved areas you've got a great program in Kentucky at the NCSL
55:17
meeting a couple years ago there was a whole session on mobile unit that travels around and it's
55:26
got different age appropriate activities for kids starting with elementary school and going up
55:32
to high school where they can learn about being health care professional and stimulating interest
55:38
and being a medical professional I think that's we should replicate that in other states and in our
55:44
excited I've been touched on this earlier Arkansas does have a program in which if if a provider will
55:49
agree to locate their clinic in a rural area that's identified as a specific area of need
55:54
that will reimburse them I think about $80,000 of their costs in order to get started up and
56:00
establish their their practice there so we do have programs like that one thing you know kind of going
56:06
back this idea of all of these being you know systemic issues is that even if we are able to
56:13
you know increase our output and retention of physicians we we do still have a workforce problem
56:20
not only with nurses but also with the CRNAs with the assistance and with the QBHPs in the
56:26
mental health area and all of these other health care adjacent or health care supporting
56:32
areas and part of the real struggle with that I'm a I'm a health care attorney it's my other job
56:39
I guess this is my hobby I don't know but one of the problems that my clients run into often is the
56:45
fact that these physicians are their hourly positions their hard work and they may be able to pay
56:53
them 20 or 25 dollars an hour which is which is fine except for that same person can go down the street
57:00
to the new buckies that's opening and get paid that same amount and not have to work as hard as they do
57:06
in health care and often when they're competing with some of these corporate employers those larger
57:12
corporate employers can provide better benefits better options for for promotion and things that these
57:19
health care providers just can't and so this kind of goes back to this idea of how we reimburse providers
57:25
for the services that were they're providing and how we look at their workforce and how we try to
57:31
recruit and retain workforce beyond just the physicians and the nurses because there are a lot of
57:37
other health care providers that we need in order to make these systems work and we really need to be
57:43
you know from the middle school and high school levels encouraging kids to look not just it I want
57:49
to go to med school but maybe there's a kid who really loves working with the elderly and wants to work
57:54
as home care or in a nursing facility or assisted living facility maybe there are kids that really
58:00
have a heart for working with with kids with intellectual disabilities in a school setting but they
58:06
don't necessarily want to be a teacher or provider they won't maybe want to be an assistant so we
58:10
really need to look at how we can capture those interests early on and support those students as well
58:15
in seeking the education and training that they need to be successful in those fields.
58:19
We're out of time for what we're going to do here on the panel. We're going to open it up to the
58:26
audience I believe we have several microphones located throughout the room and I already see one
58:36
I'm going to ask that you identify yourself your state your position and who you're directing the
58:44
question to so Shelley I'm going to start with you. Yes thank you my name is Senator Shelley
58:51
funky pro-meyer I'm from Kentucky and I'd like to open this up to anyone who has an interest in
58:58
answering but you mentioned you have the business of health care what is the potential of that
59:05
intersection of lifestyle medicine so that we really start to see the wellness outcomes that we
59:12
need Kentucky though we have some innovation around Medicaid persistence and the use of Medicaid
59:19
we're not seeing it result in great health and wellness so is there a potential business case for
59:26
lifestyle medicine naturopathic at these rural hospitals that really collaborate maybe even nutrition
59:33
maybe even more that can happen in those rural hospitals that are
59:39
resulting in healthy independent thriving communities not so dependent on Medicaid. Great question
59:47
thank you so much for the question a couple things first I think there's a there's a perception
59:54
that outcomes aren't getting better in Kentucky what I would say is that is as a nation outcomes
59:59
are getting better and the way we're judged is on the outcomes and part of what is happening
1:00:04
Kentucky is economic and social it is the existence of persistent poverty within that state if we
1:00:11
can't solve that we're not going to independently solve the health care and the outcomes of Kentucky.
1:00:16
Partners with rural hospitals with rural providers absolutely I think there's opportunities
1:00:22
again we have to figure out how the fits in the model you know how we provide rewards either to
1:00:29
provider or some member who's engaged in those activities what I would say is that we've just being
1:00:34
transparent we have designed a lot of great programs that reward people for doing healthy activities
1:00:40
but the reality is the people who engage in those programs are likely the people who are
1:00:44
already going to be engaged with seeing their primary care physician with seeing their special
1:00:49
spouse being met being adherent to their medications we have to find ways in engaging those people
1:00:55
who are who would not typically go and see that provider and that is ultimately you know if we
1:01:01
can solve that I think we will see better outcomes so I'm delegate Jessica Anderson from Virginia
1:01:07
and my question that had a lot of conversations I'm a former Medicaid recipient so I was really
1:01:11
excited to come to this platform on this part of kind of what I ran on but my question to you all is
1:01:17
obviously we don't understand what the role else look out looked like for the federal cuts that
1:01:21
are coming for Medicaid specifically in January but we do know that it's going to implement some
1:01:27
impacts on individual states especially in the south and one of my concerns is we already have a
1:01:33
pretty significant gap with health care coverage which I think some of you've talked about a little
1:01:37
bit today and a lot of states don't have the opportunity to supplement their Medicaid coverage to
1:01:44
effectively make the difference between the poverty federal level which I think many of us think
1:01:48
is very in my opinion very outdated and is not meeting the actual marker where we are society wise
1:01:54
versus Alice which is a more you know realistic perception meaning that the poverty rates were seen
1:01:59
or even worse than what they really are on paper what conversations are you having in the legislative
1:02:06
body to address that existing gap on top of the fact of federal cuts coming I know in Virginia
1:02:12
we have an automated program which I was a part of every year your taxes were immediately pooled
1:02:17
to see if you still qualify for Medicaid and ebt snap if you did you are automatically re enrolled
1:02:24
you were sent a paperwork there was nothing you had to do as an individual now we have policy that
1:02:27
we know without a fat without a doubt is going to be every six months you have to prove employment or
1:02:32
some type of income verification that is a pretty significant shift for states like mine and probably
1:02:36
other states in the south there's a very uninformed populace that is still going to qualify and not
1:02:41
knowing the changes and they're going to go swipe their or get their Medicaid card and go oh you
1:02:44
don't have health insurance anymore so what conversations are you having about one informing the populace
1:02:49
but to closing the gap on what we're about to experience on top of what already exists we're having
1:02:54
the conversations because each county has to do that so all of them are reaching out to their
1:03:00
elected officials saying are you gonna like my county they said we need six more people Jim if
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we're going to do this every six months we're going to need more people we need this much more money
1:03:08
and so that's what we're all faced with but we've got to rethink Medicaid I don't I think we said
1:03:14
it uproamed to begin with we we don't have a plan to get people off I've been talking to the folks in
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White House in Washington about letting me use Medicaid dollars to pay for people to go to community
1:03:26
college pay for child care while they're there and then get them in a job we need to have programs to
1:03:31
get people off of government programs instead of just adding more and more people to those and I
1:03:37
have a saying that thank you I have a saying we don't need safety nets we need trampolines for people
1:03:44
we need people to be able to take care of their sales I think again I'll go back to as a Christian I
1:03:49
I believe that that people are happy if they're working taking care of themselves and taking care
1:03:54
of their families and I think we're depriving people of some wonderful opportunities for employment
1:03:59
and I don't mean having jobs that they are still qualified for medical I mean for for government
1:04:05
programs I mean a fulfilling well-paying job that they can take care of themselves and the families
1:04:11
just I'm sorry I was just going to add one thing I think we've got to streamline the eligibility
1:04:17
process and we've got a use technology to do it because the paperwork for reporting the 20 hours
1:04:23
a week right now is not user-friendly in our state and and you know we meet for three months
1:04:29
every year and the our committees don't really meet in the interim unless it's a study committee
1:04:34
and so those of us who are highly involved with health care are working with the agencies the department
1:04:40
of community health and people like that to be sure that they're addressing that and they'll be ready
1:04:46
when these things change and I appreciate the question I was reading in article in our local paper
1:04:52
this morning that estimates that Arkansas is going to lose about $250 million from the cuts coming
1:04:57
in January and I think that there are two our Medicaid programs specifically so I think that there
1:05:02
are a few things that we need to kind of keep in mind and balance on that I mean one it was touched
1:05:07
on earlier we are going to get this rural health care transformation money which is going to be
1:05:11
one time money for five years two hundred million dollars for the next five years but then after
1:05:15
that it stops the cuts will be permanent so we need to be really strategic and smart about how we
1:05:20
invest those funds from this rural transformation we're talking about um shoring up our rural hospitals
1:05:27
making sure that our workforce is ready but also making sure that people are aware of the benefits
1:05:34
in the care that are available to them and there's been a little bit of talk about the administrative
1:05:39
burdens and costs not only on the system but on the beneficiaries and I think that your story bears
1:05:47
that out in terms of how you know people were automatically renewed from their taxes and
1:05:52
we see that Arkansas didn't expand the postpartum coverage for 12 months postpartum for
1:05:57
women who just had a baby and so that requires a new mom at 60 days to go and have to provide
1:06:04
documentation and paperwork in order to try to patchwork together coverage to get her through that 12
1:06:08
months well you know it's 60 days postpartum with I've got four kids I mean after my fourth one I
1:06:14
thought I could maybe be a Dallas Cowboy cheerleader because I've been watching that TV while trying to
1:06:18
breastfeed for weeks and I wasn't sleeping I could have never filled out paperwork to try to figure out
1:06:23
how to continue my health care so we need to look at the cost benefit analysis on whether or not
1:06:30
forcing people to continue to do paperwork on sort of an ad hoc basis at random times and the cost
1:06:37
associated with it even from a processing perspective you've got to have people to review the paperwork
1:06:42
and file the paperwork and make decisions about it whether that cost is is makes sense
1:06:48
because there are real dollars being spent on engaging in that process versus the effect that it has
1:06:55
on the beneficiaries and and the people that we are losing who are eligible for an title to
1:07:01
Medicaid benefits because they don't have access to internet they didn't know that they were
1:07:06
required there was a new requirement to do this reporting or this application and so on and so forth
1:07:12
and you know in Arkansas we did work requirements in 2018 and so we have some data that kind of bears
1:07:17
out the effect on the system in 2018 we rolled out work requirements and the stated golden as
1:07:25
it is now was to try to encourage more people to come into the workforce what we saw was that
1:07:32
several or I think about 18 to 20,000 Medicaid beneficiaries were dropped off the rolls
1:07:37
the majority of the people dropped off interestingly enough didn't have access to internet
1:07:42
and that was a big barrier when they were supposed to be doing their reporting on whether
1:07:47
they had a job or whether they qualified for an exception and they had to do it through a portal
1:07:53
so we dropped them off the rolls and then we look at what the data shows us about workforce
1:08:00
participation didn't change no change so again I mean we need to look at you know what our
1:08:08
stated goals are if if the stated goal is to go through and check eligibility for people that's
1:08:13
one thing if the stated goal is just to create a burden and an administrative burden to keep people
1:08:18
off the rolls that's another thing but there is a cost to that especially when we know that every
1:08:22
Medicaid dollar that we spend has an ROI of about eight to nine dollars back into the state
1:08:26
because of the fact we're not doing uncompensated care and we don't have a bunch of people showing up
1:08:31
in our ERs and putting strain on our rural hospitals. I hate to do this but we are at our time
1:08:38
and what I am going to say is I have like six more questions I could ask. I hate to stop this but we
1:08:45
are at the one thirty-time marker so for two people I'm going to hope some of our panels stick around
1:08:52
we appreciate this opportunity there are so many questions circulating around Medicaid and not
1:08:59
just Medicaid healthcare and everything that influences healthcare but I want to say thank you
1:09:04
all to the panel appreciate the opportunities that we've had to discuss Medicaid and healthcare
1:09:11
today to the audience thank you for the participation we could go on don't know if you're all going to
1:09:18
stick around but I'm sure throughout the week you all be available for further conversations
1:09:23
and to the group welcome to Kentucky thank you for being here and let's give our panelists
1:09:30
a good round of applause. Our thanks to Kentucky Senate president Robert Stivers from moderating this
1:09:40
Medicaid discussion and to Senator Jim bargain of North Carolina Senator K. Kirkpatrick of Georgia
1:09:48
representative Ashley Hudson of Arkansas and Jeb Duke of Humana for sharing their perspectives
1:09:55
as you've heard there is no simple answer when it comes to Medicaid states across the south are
1:10:01
balancing fiscal responsibilities with the need to expand access to care. Straighten the health
1:10:08
care workforce support rural communities and prepare for the rapid changes in technology
1:10:14
and federal policy while each states approach may differ the challenges and the opportunities are
1:10:20
remarkably similar that's exactly why conversations like this matter the Southern Legislative Conference
1:10:28
exists to bring policymakers together to learn from one another and exchange ideas that can improve
1:10:34
the lives of the people they serve. Thanks for listening to Real State subscribe wherever you get your
1:10:40
podcasts and visit CSG Southorg for more resources like these until next time I'm Lindsey Gray let's
1:10:47
keep it real thank you for joining us today on real states where we keep it real about what really matters