Comité Health and Human Services del Senado, 18 de febrero de 2026

Transcripción

292 turnos. Seleccione un tiempo para reproducir ese momento del video.

1. 0:16:25

   For the Senate Health and Human Services, uh, Committee. And, uh, Senator Goodman, do you mind, Chairman, um, bringing us to prayer?

2. 0:16:35

   Absolutely.

3. 0:16:36

   Yes, sir. Thank you, Mr. Chairman. If y'all will, uh, pray with me. Dear heavenly Father, we just thank you for today, Lord. We thank you for loving us. We thank you for the gift of salvation, and we thank you for the awesome opportunity for us to come together as this committee and, and do the work of the people. And, uh, Lord, as we go about that, we just ask that you please grant us wisdom and discernment so we can make the best decisions possible, Lord, possible, Lord, on behalf of the people that we represent. Thank you again, Lord, for loving us and all your blessings. In Jesus' name we pray, amen.

4. 0:17:06

   Amen.

5. 0:17:08

   Thank you, Chairman. Uh, can somebody get that door, please, uh, so we don't hear that echo?

6. 0:17:13

   Did anybody sign up?

7. 0:17:14

   Mm-mm.

8. 0:17:15

   I can go get it.

9. 0:17:16

   Go get it.

10. 0:17:17

    Uh, so we just have, uh, one bill today, Senate Bill 428. Uh, the vice chair and chair of-

11. 0:17:29

    Childrens

12. 0:17:30

    ... uh, Children's and Family. And, uh, so, um, yeah, why don't you do that so that both of you will be up here. Um, and just,

13. 0:17:46

    this should not take long, but, uh, we're here for the hearing and a vote. And while you're doing that, everybody look in their folder, and Health and Human Services committee dinner on March 9th, so just everybody put that in their calendar. And, uh-

14. 0:18:07

    Well, it just happens to be in my district

15. 0:18:09

    ... this is your district. A lot of things are in your district, no doubt about that. So Senator Kirkpatrick, the floor is yours, and we got all three microphones, uh, on. Thank you.

16. 0:18:23

    Thank you so much, Mr. Chair. And, uh, if it's okay with you, I brought my friends from DCH, and I'll let them introduce themselves when we get to questions. Um, this bill is an agency bill and is to deal with the most complex homeless individuals who are also seriously mentally ill. This problem impacts cities, counties, businesses, and public safety all over our state. The bill enables DCH to apply for a new federal waiver program.

17. 0:18:56

    It's called a 1915C waiver, which I'm sure no one here has heard about yet. And this, uh, would provide for basically case management services with a goal of providing community resources while keeping these individuals out of our ERs and our jails. So that's the short version. It's, um, there are services that are provided that are intensive case management, housing support, clinical and behavioral services if needed, employment assistance, transportation, and, uh, respite and skilled nursing if needed.

18. 0:19:38

    These are members that are not currently Medicaid eligible. But with this newly approved waiver, um, these individuals would be adults 21 and older with severe and persistent mental health and/or substance use disorders who experience repeated crisis treated through emergency rooms, incarceration, and/or homelessness. And, uh, I think I'll stop there and see if the committee has any questions. And also, uh, I'd like for my helpers here to introduce themselves.

19. 0:20:12

    That'd be great. And if you can explain what 1915C means. I presume that's some section of federal bill. Thank you.

20. 0:20:19

    Good afternoon. I'm Brandi Sylvan, director of government relations with the Department of Community Health.

21. 0:20:24

    Good afternoon. I'm Stuart Portman. I'm the executive director of the Medical Assistance Plans Division at DCH, so I'm the Medicaid director. Uh, and, uh, 1915C i- refers to Social Security Act Section 1915C. It is a, uh, a waiver authority in order to cover certain populations in a cost neutral way, um, that allows you to, um, have a level of service that i- for individuals that have institutional level of care but to treat them in the home or community. Um, and that is the, the basis of 1915C.

22. 0:20:56

    And the specific authority that's being requested is built upon some modifications of the 1915C that has existed, um, in statute for, for decades, but modifications made in H.R.1 that open up opportunities to, uh, utilize that authority in new ways.

23. 0:21:13

    So it has to be budget neutral?

24. 0:21:15

    It, uh, uh, it- on an individual basis, it is required to be cost neutral.

25. 0:21:19

    Gotcha. Okay, thank you. Uh, appreciate that. Uh, well, Stu- I didn't mean to monopolize that, uh, question. Uh, any other questions from the committee? Senator Lucas is on. We're gonna call-

26. 0:21:31

    Can, can, can you tell me, uh, once these, the places are open up or what- whatever, who's gonna inspect the places and, and determine whether or not those who are supposed to be pro- providing the service to the clients?

27. 0:21:50

    Uh, uh, DCH would be accountable for that. And, um, they would be working with different professionals, nurses, and, um, licensed professionals to be sure that the, um, all the services that are needed are, um, provided in an appropriate way. But DCH would be, um, in charge of the process.

28. 0:22:21

    Anything else we have? Page nine. Chairman Hufstetler and then Hodges. Um, is there a, is there a dollar amount or a cap or something on the federal program, and if so, what is it?

29. 0:22:35

    Uh, so again, by definition, these waivers must be cost neutral.

30. 0:22:39

    Mm-hmm.

31. 0:22:39

    Uh, so there would just be a one-time expense, uh, for us to develop the waiver application of $500,000, but there would be no ongoing budgetary requirements from the state on this.

32. 0:22:51

    So I'm, I'm trying to figure this out then. So what dollars are being put in there now that we would be neutral to?

33. 0:22:57

    So these are high utilizers of, say, emergency room settings or, you know, they might be-

34. 0:23:03

    Jails

35. 0:23:03

    ... go into the correctional system. Uh, so those are, from the Medicaid perspective-

36. 0:23:09

    Mm-hmm

37. 0:23:09

    ... we would be spending more in the ER setting than we would by offering these supportive services in the home and community.

38. 0:23:17

    Okay. I'm, I'm still a little vague, but is that neutral per person or on a overall amount?

39. 0:23:23

    It, it is, it is both. It's not just that the program has to be budget neutral. It's that the actual cost for the individual to receive services under the waiver must be less than if they were continuing to receive services in an institutional level of care, like a hospital.

40. 0:23:36

    Okay.

41. 0:23:37

    So that requirement is there, and this is modeled off of a, a waiver that exists in Texas that has shown cost savings, um, for the, for the state.

42. 0:23:44

    They don't, they don't share the savings in that? I mean, if you save the federal government money, I mean, seems like we'd split it 50/50 or something, right? I m- I mean, that's what accountable care organization is. They don't go for that. I got you. All right. Just, just a quick question. This is for individuals age 21 and older. What, what about folks 20 and under? Why not?

43. 0:24:12

    So, so the services that they would receive today are covered under, um... It's a population already covered by Medicaid and governed-

44. 0:24:19

    Okay

45. 0:24:19

    ... by a number of, um, policies like the early and periodic screening diagnosis and treatment, um, EPSDT, that'll- covers a, a wide swath of services for what they may need. Um, as it relates to this population, um, they are currently not, as is mentioned, they're not currently Medicaid eligible-

46. 0:24:37

    Okay

47. 0:24:37

    ... so they would not be able to receive any of these services.

48. 0:24:39

    Okay.

49. 0:24:40

    And someone did ask the question when I took the bill around for signatures about why do we need to do legislation for a waiver? And the answer is that that's kind of, DCH has always gotten legislative approval to apply for a waiver.

50. 0:24:58

    That's right.

51. 0:24:58

    There have been previous bills that, you know, there was some contemplation that a budget item would have been sufficient, and it, we did encounter issues down the road. So just to kind of be-

52. 0:25:10

    Yeah, I'm, I'm-

53. 0:25:10

    ... err on the side of caution

54. 0:25:11

    ... I'm not aware that a, a, every waiver requires legislation, I mean, approval. That's my understanding, but maybe I'm wrong. Um, am I wrong on that?

55. 0:25:20

    So there is a, a, s- a... And I- I'm happy to get the exact citation and provide it to you, but there is something in state code that says if you're, uh, expanding the population of who is eligible, uh, then you do have to get legislative authority for that.

56. 0:25:35

    Okay. And, um, all right, I've, I've looked to my right, and I'm looking to my left. All right. Let me go with the s- the senior senator, senator, uh, whose district we're in.

57. 0:25:46

    Uh, thank you, Mr. Chair. Um, the, the, the question I had, it, it sounded like you were saying that each individual history of utilization of any of these things, being hospitalized, emergency department visits, incarceration, et cetera, th- that, that individual, cost that that individual had incurred to the system would, would be, um, uh, it, it, that it's, it's on an individual basis.

58. 0:26:20

    I mean, who, how, what, in what nightmare scenario can someone, uh, t- take an individual that's in all of these states of, uh, you know, uh, psychiatric crises that take just a myriad of, of, uh, settings, how on earth would you even begin to, you know, crunch the numbers to say, "Well, that individual has expended, has been, has cost us this much, uh, in the current thing, and so the waiver would cost us less"? How would the wor- where would you start on that?

59. 0:26:52

    I can't, I mean, I'm just, I'm ba- I'm kind of baffled at the cost.

60. 0:26:55

    So everybo- every, I mean, it's, it's, it is always done. They kn- if you have a Medicaid card or if you have a Medicare, if you're Medicare through disabled-

61. 0:27:03

    No, no, no, no, no. They don't have, they, they don't have a Medicaid ca- they're not, they're not qualified for these community and ho- home and community services now. They, they aged out, uh, and they're in, they're in a post-

62. 0:27:15

    All right. Well, help us out here.

63. 0:27:17

    Yeah. This would be, uh, this, given the high acuity, uh, of the population, uh, they are, and the homeless component to the, um, to the population, they are likely uninsured, and those costs can be picked up through all of our broader, uh, relationships that we have with all of the institutional levels of care. We know how much it would cost if someone is receiving healthcare in a jail setting, in a prison, if they're receiving emergency services only. And so-

64. 0:27:42

    Right

65. 0:27:42

    ... part of the, part of the cost specifically of this bill, which is to do the model to develop the waiver, the model development is what would be the gathering of that data and compiling it in order to make the, um, correct, um, assertions.

66. 0:27:54

    But, but, but, but if I, if I could further question. So, so then that indivi- but d- as I understood you to say, that particular individual is gonna have a, a, a, a, a dollar mark that you've calculated that they've already utilized systems, you know, by virtue of this, uh, of their mental, uh, mental health condition, uh, and you're gonna tie it to that individual? You're gonna go back, you're, you're charged with... It, I mean, I know you're trying to com- you're complying with federal requirements, uh, to do this.

67. 0:28:24

    I'm just trying to understand, uh, how or, or what, uh- Incredible process. How do you do it? How-

68. 0:28:31

    And I, I guess I just want to clarify that that is-

69. 0:28:33

    Okay. Maybe I'm misunderstanding

70. 0:28:34

    ... that is just something we need to demonstrate at the time of application, that this would be a cost neutral waiver program. The, the feds just want to see that they're not going to be paying out more-

71. 0:28:46

    Uh-huh

72. 0:28:46

    ... uh, to Georgia than they would've previously if we had not adopted this. But there isn't going to be like an ongoing monitoring of individuals enrolled in this program, correct?

73. 0:28:58

    We, for, we will monitor the cost of the program to make sure that we re- remain compliant. Um, but it is different from an individual-

74. 0:29:04

    Oh, okay

75. 0:29:05

    ... the individual component is based on the development of the waiver itself-

76. 0:29:07

    I see

77. 0:29:08

    ... in order to comply with those federal requirements. And then the ongoing monitoring is to con- continue to confirm that we have not exceeded the estimate, estimate that we've, uh, made as a state.

78. 0:29:17

    Well, it's a good, it's a good day. It, it's mental health day here at the Capitol. This is a good day to bring this bill.

79. 0:29:22

    Um.

80. 0:29:25

    Senator Hatchett.

81. 0:29:27

    I'll, I'll close with that comment, Mr. Chair. Thank you.

82. 0:29:29

    Six, uh, four.

83. 0:29:31

    So-

84. 0:29:31

    Yeah. W- I'm doing the left and then we'll do the right.

85. 0:29:34

    Um, a couple questions.

86. 0:29:36

    Sure.

87. 0:29:37

    Are these individuals who are eligible, just for clarity, are they already on Medicaid?

88. 0:29:43

    They-

89. 0:29:43

    Are they, yeah

90. 0:29:44

    ... they are not.

91. 0:29:45

    They are not.

92. 0:29:45

    They are not.

93. 0:29:46

    Okay. And then on the factors here, it lists a history of hospitalization, say, psychiatric crisis, emergency department visit, prior incarceration, and homelessness. So is the homelessness a requirement?

94. 0:30:00

    Could it be or homeless?

95. 0:30:01

    Well, that, it, that's what I meant. That's what I'm asking.

96. 0:30:03

    So, so the way that this is... And part of the, part of the timeline here is to develop what makes the most sense for the state and put together an implementation plan. Um, as developed in, as developed in Texas, they had a requirement that said that you had somewhere in the range of 12 to 15 ED visits, emergency department visits, within a two-year span, um, or you were homeless, or you had three, uh, uh, incarcerations within a year, sort of a standard, a breakdown across those populations.

97. 0:30:30

    It, it-

98. 0:30:31

    And-

99. 0:30:31

    And, and the language says, "Including but not limited to," so I think that addresses it.

100. 0:30:36

     Well, I, I guess my question is-

101. 0:30:39

     But I'm-

102. 0:30:39

     ... is the and a catchall for the entire list, meaning you have to have all of those things, or is it you have to have one of those things and homelessness, or just, I know it's including but not limited to. I'm just worried about the-

103. 0:30:53

     I, uh-

104. 0:30:53

     ... the qualification of and. Uh, is the intention to be you have to be homeless and have a, another factor in order to qualify? Is... I'm just, I'm looking at the, just the verbiage itself to make sure we're capturing what the intent of the bill is.

105. 0:31:11

     And I, I'll definitely like you to add into-

106. 0:31:14

     Yeah

107. 0:31:14

     ... my response, but I, I do. So the language in the bill is really intending to authorize us to develop the waiver, and the waiver is where we're gonna really define all of those specific parameters of eligibility. And, um, but I'll, you know, I'll let you speak to intent.

108. 0:31:33

     So, so the other... And this, this, um, in answering your question, I'll also note one point that is b- one of the, one of the components of a 1915 C waiver is that it can be capped, right? So the, so the state can determine what is the appropriate number of people to get some real world experience. It can grow the cap over time, but you, it is not entirely open-ended, um, a- as can exist in other components of the program. So the, the intent, the intent is that this is, um, that there is a component related to homelessness in, in, that is captured here, but is it a requirement?

109. 0:32:07

     I don't know that there was a final determination that you must be homeless, but if you're a high utilizer and have high acuity or have frequent incarcerations and are also a high utilizer of services, there's still a net benefit of making sure that there would be, um, a, a, a improvement in their economic situation as given through the list because the underlying, um, goal here, right, the, there's the limited benefit package of medical services, there's the supportive housing for stabilization, and also supportive employment, which we don't believe, um, exists elsewhere, um, as a way to get these individuals back up and on their feet and get them back to work.

110. 0:32:40

     And Mr. Chairman, if I can-

111. 0:32:42

     Sure.

112. 0:32:42

     Okay. So just hearing what you said, homelessness isn't, the goal of this bill isn't to only capture people who are homeless. So my suggestion, I may ask Chairman Cowsert as well if he would chime in and see if you, you agree with me on this, but I think because there's the and-

113. 0:33:00

     Uh-huh

114. 0:33:00

     ... I believe that's, that, that's a qualifier which would be-

115. 0:33:04

     Yeah.

116. 0:33:04

     I, I think that should be an or.

117. 0:33:05

     Consideration.

118. 0:33:06

     Yes.

119. 0:33:07

     I strongly agree.

120. 0:33:08

     I think I agree.

121. 0:33:08

     The non-lawyer agrees with you.

122. 0:33:10

     I think that-

123. 0:33:10

     You know, actually-

124. 0:33:12

     Yeah

125. 0:33:12

     ... actually in the-

126. 0:33:13

     Yeah

127. 0:33:13

     ... if you look at the, uh, summary and analysis, uh, it is an or. But in the bill-

128. 0:33:19

     Oh, it's an-

129. 0:33:20

     ... it's an and.

130. 0:33:20

     All right.

131. 0:33:21

     Well, uh-

132. 0:33:22

     Thank you

133. 0:33:22

     ... I think that we could certainly entertain-

134. 0:33:25

     Yeah

135. 0:33:25

     ... changing the and to an or if somebody wanted to make that amendment.

136. 0:33:29

     Do we need to bring that up?

137. 0:33:31

     Is, uh-

138. 0:33:32

     Vote and then-

139. 0:33:33

     Do we have legislative counsel? Who's representing legislative counsel? You are?

140. 0:33:38

     I'm deputizing for Sarah today. Um, in this case, it's, it's really, it's not making it a requirement as I read it. Um-

141. 0:33:46

     Because it's a consideration

142. 0:33:47

     ... it's just saying that it's one of the factors that need to be considered. It's not saying that it needs to be met, that they are homeless.

143. 0:33:53

     Okay.

144. 0:33:53

     I agree.

145. 0:33:54

     But if it makes anybody feel better to make it an or, I don't think it will hurt the bill.

146. 0:33:59

     That is fine.

147. 0:33:59

     It'll, it'll-

148. 0:34:00

     So, so legislative counsel says if, if the preference is or, sh- she's good with it.

149. 0:34:05

     Yeah.

150. 0:34:06

     And if, if your preference is a or, is the l- the lawyers on the committee, um-

151. 0:34:11

     To be safe, I would-

152. 0:34:12

     And then-

153. 0:34:13

     Yeah. I got it. Okay. All right. So, uh- Any other questions? Senator Merritt?

154. 0:34:20

     These judiciary members.

155. 0:34:21

     Yeah.

156. 0:34:22

     Watch us.

157. 0:34:23

     So, okay. All right. All right. Uh, Senator Mangham.

158. 0:34:29

     Thank you for bringing this bill. Um-

159. 0:34:34

     The or does make it optional in my estimation-

160. 0:34:39

     All right, so we'll, we'll get that. I think we've covered that-

161. 0:34:40

     However-

162. 0:34:41

     ... the or. But go on

163. 0:34:42

     ... I, I really didn't get a clear answer to that intent. Is the intent of this is to deal with the homelessness issue? Um, because-

164. 0:34:53

     This part

165. 0:34:53

     ... you can be incarcerated. I can be, have a history of hospitalizations say, and I'm a billionaire.

166. 0:35:00

     All right, so the question is the intent.

167. 0:35:02

     So what is the intent of the legislation?

168. 0:35:04

     Thank you.

169. 0:35:05

     And-

170. 0:35:05

     And what difference will it make to anything if you do this? Because we have a lot of people in jails-

171. 0:35:14

     Um-

172. 0:35:14

     ... because they're mentally needing ... And it's getting worse.

173. 0:35:18

     Gotcha.

174. 0:35:18

     Worse.

175. 0:35:19

     All right.

176. 0:35:19

     What, what-

177. 0:35:20

     I turned your mic off for a reason. She's gonna answer the intent. Thank you.

178. 0:35:23

     Thank you, Mr. Chairman.

179. 0:35:25

     Thank you.

180. 0:35:25

     Yes, sir. And those are, are the types of details we are gonna flesh out in the actual language of the, the waiver application. But we're looking at specifically defining, kind of like Stuart was saying, about a specific ... To qualify, you might need some combination of a specific number of emergency room d- visits, uh, or a certain number of, uh, times of being incarcerated, um, or homelessness-

181. 0:35:53

     So, so these are high u-

182. 0:35:54

     ... or a certain combination-

183. 0:35:54

     ... high utilizers.

184. 0:35:55

     Right.

185. 0:35:55

     Exactly.

186. 0:35:56

     High u-

187. 0:35:56

     Spending a lot of money.

188. 0:35:57

     That's right.

189. 0:35:57

     Right.

190. 0:35:57

     A lot of resources on a small number of individuals.

191. 0:36:00

     And we've-

192. 0:36:01

     And that's what you're going after

193. 0:36:01

     ... we would be-

194. 0:36:02

     That's the intent.

195. 0:36:02

     Yes.

196. 0:36:03

     And you had a follow-up question or not on that question?

197. 0:36:07

     I did. Uh-

198. 0:36:07

     I gotcha. All right. Senator Robertson.

199. 0:36:10

     To the author of the bill, I heard you say something during the cross-conversation a while ago about people in jails. Uh, if we're housing someone in jail that meets these qualifications, could they apply for the waiver?

200. 0:36:25

     So jail-based restoration and-

201. 0:36:27

     Yeah

202. 0:36:27

     ... psychiatric treatment in jails, is this a piece of the puzzle?

203. 0:36:30

     I mean, there, there are some programs, as you know, already existing for jail-based restoration, but they're very localized.

204. 0:36:38

     Right.

205. 0:36:39

     And this is a broader approach by trying to identify those people, but also that are not currently being served with wraparound services, but also the population of people that are on the street, and the population of people that are in the hospital and really don't need-

206. 0:36:57

     But does, does this expand in, into some- something Senator Mangham I wanted to, to agree with him on, is that our jails are overpopulated, which is why I'm so excited about us building the first new mental health hospital since the 1960s, uh, with the current budget coming out of the Senate. But, um, would this expand that and give some of these communities opportunities that don't have these in our, in their jails to apply for this waiver to, to offset some of that expense?

207. 0:37:23

     So-

208. 0:37:23

     Probably not. Probably not.

209. 0:37:25

     Yeah. Sure, Stuart.

210. 0:37:26

     Okay.

211. 0:37:27

     It would, it would still, it would still need to be in a home or community setting, um, in this case a community setting because of the supportive housing component, um, in order ... So, so a jail would not qua- qualify.

212. 0:37:37

     A jail does not qualify as supportive housing?

213. 0:37:39

     But, but it would, it would be a connection. We would ... The, the departments would connect in that regard, um, to make sure that there can be an easy, warm handoff so that as someone leaves the jail, they have a place to go. And if there's a ... And that's how we've seen some of these programs exist. I don't mean to ... We're Georgia, we don't have to always-

214. 0:37:56

     Yeah

215. 0:37:56

     ... harp on other states. I just highlight the data from the, the state that has this, which they've seen, um, specifically as it relates to jails, um, about a quar- 20 to 25% reduction in-

216. 0:38:07

     In recidivism

217. 0:38:08

     ... correction, in recidivism.

218. 0:38:09

     Fantastic.

219. 0:38:09

     All right, that's great. All right, other questions? All right, uh, Ag Chairman.

220. 0:38:16

     Thank you, Mr. Chairman. I'm gonna ask this, ask this question the way the senator from the 26th would. So to boil all this down-

221. 0:38:24

     Uh-huh

222. 0:38:24

     ... is this not gonna help us get better outcomes for mental health patients, and it's not gonna cost the state or the federal government any more money? Is that basically what we've got?

223. 0:38:36

     I like that.

224. 0:38:37

     I'm all for it.

225. 0:38:37

     Yeah.

226. 0:38:37

     All right.

227. 0:38:38

     All right.

228. 0:38:38

     So that's pretty good. And, and as you know, we've, we've thrown a lot of money at the issue of homelessness over the years, but we still are having a lot of trouble with solving the problem. And so, uh, when I, when they first brought me this bill, the key in my mind is the case management services, and making sure that everyone is communicating about how to provide whatever any individual needs to keep them out of jail or out of the hospital.

229. 0:39:11

     So that's how I saw it when I first looked at it. And, uh, so is it gonna help us? We'll find out, but we've done a lot of other things that haven't worked.

230. 0:39:21

     Yeah. Well, well, I mean, we do have a model. I mean, Texas is ... I mean, you already quoted the 25% reduction in recidivism, and that, that saves everybody money and jail time and so forth. So, uh ... All right, if we haven't exhausted those question. Got one question. All right.

231. 0:39:37

     Just real quick. So there have been some federal cuts to Medicaid. Is, would this be affected at all by any of those cuts that we know of? No. In fact, um, part of the new provisions of H.R.1 are what is allowing us to pursue this waiver, 'cause they made some changes to provisions that have to be met in the application for a 1915 C waiver that we would not have been able to seek this type of waiver prior to that. But no, none, none of the eligibility type of conversations- Great ...

232. 0:40:08

     would impact this. Thank you.

233. 0:40:12

     All right. Yes, sir. Senator Mangham.

234. 0:40:16

     Not, not to belabor it, but I, I do think, uh, for I can think of a sheriff right now in my mind that brought a issue about these mental patients. Would there be, would it be appropriate to at least talk with the Sheriff's Association or something to see how this would play out, uh, how- Or is that the implementation? You just, this is-

235. 0:40:40

     That's-

236. 0:40:40

     ... enabling-

237. 0:40:41

     Okay. That's exactly-

238. 0:40:41

     ... and then you work that out later?

239. 0:40:42

     I see him nodding.

240. 0:40:43

     Is that what you're doing?

241. 0:40:43

     You answered your own question.

242. 0:40:45

     Okay.

243. 0:40:45

     Yeah, you got it. Thank you.

244. 0:40:47

     Thank you.

245. 0:40:47

     I'll be happy to entertain a motion. So moved and seconded by the chair of agriculture, Senator Robertson. Uh, so-

246. 0:40:57

     Got it.

247. 0:40:57

     We're gonna pass this, and then we need to do the amendment. So, uh-

248. 0:41:01

     The Senate Finance Committee

249. 0:41:03

     That's okay.

250. 0:41:04

     Start counting.

251. 0:41:05

     I would like, at this time, like to offer an amendment.

252. 0:41:09

     All right. Number four.

253. 0:41:11

     On line 18, I would

254. 0:41:20

     strike the word "and", and then after the word "homelessness", add, "or any combination thereof."

255. 0:41:32

     I'll second that.

256. 0:41:39

     All right. So let's make sure we're all clear. So line 18, striking the word "and", and keeping the word "homelessness." Remove the, the period, and say, "or combination thereof."

257. 0:41:55

     Or, or any combination thereof.

258. 0:41:56

     Or any combination thereof. Yeah.

259. 0:42:00

     Unreadiness.

260. 0:42:02

     Okay. We got that?

261. 0:42:04

     Unreadiness?

262. 0:42:05

     Yes. For clarity. If I asked the question, if I'm a billionaire and I have a history of hospitalization, how would that impact this legislation?

263. 0:42:17

     I think if you're a billionaire, you wouldn't qualify for a Medicaid waiver to begin with because of your income and assets.

264. 0:42:24

     Not necessarily.

265. 0:42:26

     Okay.

266. 0:42:26

     She will.

267. 0:42:27

     Yeah, you can't qualify for Medicaid if you have a certain-

268. 0:42:29

     Yes sir, there are income and asset limits, uh, tied to Medicaid eligibility.

269. 0:42:34

     So you won't-

270. 0:42:34

     Other than the Katie Beckett program. That's the only exception.

271. 0:42:38

     You won't be able to qualify.

272. 0:42:41

     All right. Uh, so that was an amendment, and seconded, s- seconded by Senator Robertson. All those in favor of the amendment, raise your hand. Uh, can you wake up Senator Lucas? All those in favor of the amendment, raise your hand. He's raising his hand. We got it. All right. So passes unanimously. And then the- we're back to the original underlying bill.

273. 0:43:15

     And we're all clear? Okay. And so all those in favor of the bill as amended, uh, raise your hand. I don't, I don't vote, so we're good. All right. Unanimous also. All right. So all right. So that bill passes, moves on to rules. And, uh, all right, trivia question. What is the 1115 waiver?

274. 0:43:39

     Ooh.

275. 0:43:40

     1915.

276. 0:43:42

     The most important waiver that this committee has ever done. Stuart.

277. 0:43:49

     Yes. The, uh, so section 1115 of the Social Security Act is the waiver that allows for states to do demonstrations and waive components of their eligibility and their finances.

278. 0:43:59

     Okay. And we did it for-

279. 0:44:01

     And that's where your billionaire would come in.

280. 0:44:03

     The exchange.

281. 0:44:04

     The, yes.

282. 0:44:05

     ACA exchange. And then-

283. 0:44:06

     And Georgia Pathways

284. 0:44:07

     ... what was it, 1332?

285. 0:44:08

     1332 was for the exchange.

286. 0:44:09

     1332 was the other waiver that we do for federal poverty level 100% on down.

287. 0:44:14

     That's right.

288. 0:44:14

     And that's called Pathways. Pathways out of poverty. Trivia for tonight. All right.

289. 0:44:21

     And who pushed that legislation?

290. 0:44:23

     Uh, Senator Tillery. Chairman Tillery did. It was the first bill that was done under- I was, I was chair. So, um-

291. 0:44:32

     Wow.

292. 0:44:34

     And no further business. Y'all please notice your, put that on, mark your calendars, Health and Human Services, uh, Committee dinner, uh, March 9th. And meeting adjourned. Thank you.