Comité Health de la Cámara de Representantes, 25 de febrero de 2026

Transcripción

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

1. 0:04:31

   There's a sign-up sheet on the podium if you'd like to sign up.

2. 0:06:52

   I got you.

3. 0:06:53

   Who gave you that one that has amendment on it?

4. 0:06:56

   Huh?

5. 0:06:56

   Who gave you the one that says amendment?

6. 0:06:58

   Billy Mitchell.

7. 0:06:59

   Okay. That's, we're not using. That's not-

8. 0:07:17

   Uh, good afternoon, everyone. It is 4:36, and we're gonna go ahead and start. And we're gonna begin with HB 1346. Representative Anissa Jones.

9. 0:07:32

   You're too fast, Mr. Chairman.

10. 0:07:44

    There you go.

11. 0:07:45

    Very nice.

12. 0:07:45

    Good afternoon, Mr. Chairman and members of the committee.

13. 0:07:48

    I believe-

14. 0:07:48

    Thank you for the opportunity to present HB 1346 as using LC620442S. And this is known as the Georgia Maternal Mental Health Improvement Act for your consideration today. Again, that's HB 1346 using LC620442S.

15. 0:08:20

    Before I speak as a legislator, I want to speak to you as a mother. I remember what it felt like to hold my baby for the first time, the joy, the exhaustion, the overwhelming sense of responsibility. And like so many women, I also remember the moments of anxiety that I did not expect. Moments where I questioned whether I had done enough or whether I was enough. Now imagine experiencing that not as a passing moment, but as something deeper, something persistent, something debilitating, and imagine not being prepared, not being asked, and not being helped.

16. 0:09:08

    For far too many women in Georgia, that is not hypothetical, it is reality. In Georgia, the data s- the data is sobering. Georgia has the second-highest maternal mortality rate in the nation, 66.3 deaths per 100,000 live births. That is more than double the national rate. For the period between 2018 and 2020, mental health conditions, excluding substance a- abuse disorders, at least probably contributed to 18% of pregnancy-related deaths in our state.

17. 0:09:47

    When substance use is included, the impact is even greater. The Georgia Maternal Mortality Review Committee has found that more than 60% of pregnancy-related deaths are preventable. A 2017 survey showed that more than half of new mothers in Georgia report- reported feeling, quote, unquote, "down, depressed, or hopeless." The bill responds to those facts with structure, accountability, and common sense.

18. 0:10:25

    That's why I introduced House Bill 1346. This is not a new program built from scratch. This is not a mandate. It is a structured, evidence-based system to ensure mothers are screened, referred, and treated early, before depression becomes crisis, before anxiety becomes hospitalization, and before children suffer lifelong developmental harm. That is responsible governance.

19. 0:10:56

    Now let's talk about fiscal impact. Early intervention reduces crisis care. Prevention reduces high-cost emergency services, and that's smart policy. This legis- this legislation does not create partisan division. It creates opportunity for consensus. Maternal mental health affects Republican families, Democratic families, and independent, independent families a lot.

20. 0:11:27

    It affects rural counties, suburban, and urban centers. It affects every community in Georgia. This bill is about protecting life, not just at birth, but after birth. It is about acknowledging that mental health is health. It is about ensuring that no mother in Georgia suffers in silence when early, low-cost screening and treatment could change the trajectory of her life and her child's life.

21. 0:12:01

    I respectfully ask for your favorable consideration of House Bill 1346, and thank you, Chairman and committee.

22. 0:12:10

    That was a very fine presentation.

23. 0:12:12

    Thank you.

24. 0:12:13

    How long have you been in the House?

25. 0:12:15

    I just got here last year.

26. 0:12:16

    I know. That's very good. Congratulations.

27. 0:12:19

    Thank you.

28. 0:12:19

    Okay, I got a, a couple lights here. Uh, who's six? I don't- Okay.

29. 0:12:25

    Thank you, Mr. Chairman. Thank-

30. 0:12:26

    Representative Schofield. Go ahead.

31. 0:12:27

    Thank you, Mr. Chairman. Thank you, um, Representative Jones. This is a great bill, much needed and timely.

32. 0:12:33

    Thank you.

33. 0:12:33

    I just have one quick question. Is there a fiscal note?

34. 0:12:36

    There is no fiscal note.

35. 0:12:39

    Okay. Uh, because on y- uh, line 157 it says it's, uh, subject to appropriations by the general assembly.

36. 0:12:46

    Right. The, the reason why there is no fiscal impact is because it is subject to appropriations. We're trying to do a, a pilot, a three-year pilot, pilot program for only high, um-

37. 0:12:58

    Risk

38. 0:12:58

    ... risk places as well as rural communities if it is appropriated. So that means that we don't have a risk to our fiscal budget if this is something that is not adopted in our annual budget review.

39. 0:13:13

    Follow-up. How much are you asking for?

40. 0:13:15

    Well, at this particular time, um, when we were looking at the numbers, we were actually looking at it being a very low cost because a screening of this magnitude could, um, at, when we did our research, it looked like it was gonna be may- maybe about 85 to $100 for the screening. Um, however, what our goal is is with this is for it to open it up for Medicaid recipients and that the Department of Community Health would implement those screening pro- protocols and those referral pathways as well as, um, get the Medicaid, um, uh, in, open it up in the Medicaid as it relates to the Department of H- Health and Human Services on the federal level.

41. 0:13:55

    That is our main goal, is make sure that when, uh, those, uh, women that are impacted by this as it relates to physicians determining that it is medically necessary, that they are able to get r- remunerated for the service that they have provided.

42. 0:14:12

    Thank you.

43. 0:14:12

    Right. Mm-hmm.

44. 0:14:18

    Representative Mitchell.

45. 0:14:20

    Uh, Chairman Mitchell.

46. 0:14:21

    Oh, oh. Hey, hey, hey, hey.

47. 0:14:25

    At the appropriate time, Mr. Chair, I wanted to make a motion.

48. 0:14:27

    Well, we've got a couple more questions ahead of you, so but hang on to that idea. Chairman Newton.

49. 0:14:35

    Thank you, Mr. Chairman, and-

50. 0:14:38

    Oh, okay.

51. 0:14:39

    Thank you. Thank you. And thank you so much for the, for the bill. Certainly maternal m- mortality i- is one area that we've been working on for several years and trying to make progress in Georgia, um, also, but short of m- mortality, there's a lot of morbidity-

52. 0:14:54

    Okay

53. 0:14:54

    ... which is just illness associated. And I really appreciate the fact that this is pointing a spotlight on something that often gets m- missed with postpartum depression, um, the, the challenges that come with maybe having one young child and now a newborn as well or, or even more than that, trying to manage, I think, remote a- availability-

54. 0:15:12

    Mm

55. 0:15:12

    ... of, of doing the mental health screening is a, is a key part and I certainly will strongly support this from the funding side as it gets to that effort as well, but pointing a spotlight at, at that, and plus the fact that this body has expanded the, the Medicaid and made it available to women for a full 12 months after. We got that waiver over several years working hard. We got to six months and then we got to 12 months, and that's really the amount of time that's needed to get on the, whether it's monthly medications or three-month medications, shots, whatever a- alternatives there are.

56. 0:15:43

    Just really appreciate the bill, and thank you for bringing it.

57. 0:15:45

    Thank you so much.

58. 0:15:48

    All right. Uh, I don't see any other questions. Oh, you've got one? Okay. Chairman Petrie.

59. 0:15:56

    Thank you, Chairman, and, and, uh, I agree with what, uh, Dr. Newton, uh, obviously there's nothing more important than making sure we protect, uh, uh, children, and we can't protect children without making sure they have healthy mothers. So, but, uh, so my question is this as I read through here, um, and, and, and I only have the experiences in my life with my wife and now my daughter. I have four grandchildren. So, um, th- most of what I see in here, one would expect that a physician that is, uh, uh, an obstetrician who's working with a woman through birth and so forth and following up with them, uh, whoever their physic- th- they would already be doing these things.

60. 0:16:36

    They would, they would already be getting this ti- they would be l- they would be looking for these, uh, they would be assessing always for most of what is in here. Is that, is that not the case typically? Because I know in, in my family's experiences, there's a relationship there that, you know, you develop with, with your physician and, you know, uh, w- physicians generally r- care about their patients and they want them to thrive.

61. 0:17:07

    And so, um, why is it that we aren't getting this? 'Cause what you're, what you're ensuring is that those physicians-

62. 0:17:14

    Mm-hmm

63. 0:17:14

    ... are doing these things, touching these bases. Are they not doing that? Obviously not. And w- and why is that? I d-

64. 0:17:21

    Well

65. 0:17:21

    ... I don't quite understand that part.

66. 0:17:22

    All right. I think, thank you for the question. I believe that this was really more about standardizing screening intervals and requiring, um, measurable accountability and not making it a mandate on physicians whether or not, um, it's something that, um, had to be done every single time with a patient. It was really about what was going to be done if they deemed it m- medically necessi- ne- necessity to be able to move forward, um, with doing it long-term.

67. 0:17:52

    Um, sometimes you have, um, women that do not start getting treatment or for care as a pregnant person until long after they're in, uh, f- middle term of pregnancy. Sometimes you don't get that touch point early, and those that are able to do that, I commend them on being healthy mo- mothers from the start of pregnancy. But sometimes it doesn't happen like that. Sometimes, uh, there are, there are women that are getting care from the, the, um, the free clinic.

68. 0:18:30

    Sometimes they're getting healthcare from, um, from the health department. So you have so many different avenues of care that may not look like the image of care that we may receive in our own homes. So we wanted to make sure that, number one, we we're, we weren't m- uh, mandating the physicians, um, that are, um, that do have the scope of practice to be able to do this. And then also we wanted to make sure that- they had the autonomy to be able to refer to another healthcare provider that was trained to do this.

69. 0:19:06

    Because if they're doing other work in their office, they can now refer this to a mental health counselor or a social worker, someone else that may have those skills to be able to still identify through these screenings and get moms the help that they need sooner than later. This is really a twofold thing that we're doing. Because I really believe that when we have a strong mother, we have a strong family. When we have a strong family, we now have children that are able to be productive citizens here in our state and be able to provide back to our tax roll.

70. 0:19:45

    That is where I am, um, with this. Just making sure that we're giving everybody the developmental tools that they need to be able to be productive and create productive citizens for our state so that we're able to now not have to worry about, um, having them, uh, on a, uh, on a, on a, on the, uh... What I'm trying to say, we don't have to pay for them to be able to live because now they will have the tools to be able to do that for themselves.

71. 0:20:14

    All right, thank you.

72. 0:20:15

    Thank you.

73. 0:20:16

    Uh, Representative Mitchell, you're up.

74. 0:20:18

    Mr. Chairman. Mr. Chairman, I, I didn't get a chance to sign up, but just real briefly.

75. 0:20:24

    Yeah. Okay.

76. 0:20:25

    Stan Gunter on behalf of Georgia OBGYN Society. We worked very closely with the representative to perfect this legislation. She has been great to work with. We think this is a very positive step for Georgia, and we support the bill.

77. 0:20:36

    Thank you. All right. All right. Representative Mitchell, you're up.

78. 0:20:42

    Thank you, Mr. Chairman. I, I move, uh, do pass.

79. 0:20:46

    All those in favor say, "I."

80. 0:20:48

    I.

81. 0:20:48

    All those against say, "Nay." Congratulations, Representative. You have your first bill. Way to go. All right. Okay. Up next, uh, Chairman Newton with 1275.

82. 0:21:07

    This bill has been remitted back to committee.

83. 0:21:09

    Yes, yes.

84. 0:21:09

    We heard this bill-

85. 0:21:10

    Right, I did a request for this to go back

86. 0:21:12

    ... earlier this week and-

87. 0:21:12

    Rules Committee did notice a, an, an inadvertent, uh-

88. 0:21:16

    Right

89. 0:21:16

    ... uh, uh, correction that needed to be made. If I can look to you. House Bill 1275 does deal with, uh, uh, regenerative medicine, which is like stem cell therapy, uh, uh, conducted with ethical parameters around it. But we did have, we did notice a, a, an incorrect error. If you look at line 66 and 67, um, that line used to end at, "Located in Georgia." We really meant w- that we were regulating the ones in Georgia, but, um, we did, we inadvertently sounded like we might be excluding other states, which of course we don't wanna do.

90. 0:21:49

    So we just added another state in the United States or another country, and then we added the same language to the similar line on line 68 and 69. We just added, we just corrected that, um, while we'll be regulating the ones in Georgia and require that they be parts of this, th- there's no prohibition on a, a material derived from another state or even frankly an- another country.

91. 0:22:14

    As long as they, uh, work within the structure-

92. 0:22:18

    They do

93. 0:22:18

    ... of this bill.

94. 0:22:18

    Right, we do.

95. 0:22:19

    Where they, where they derive the, uh, cells, correct?

96. 0:22:22

    Correct. Correct.

97. 0:22:23

    Correct.

98. 0:22:23

    And reg- either register with the FDA or one of the other accrediting organizations in this, uh, research space.

99. 0:22:29

    Okay. Thank you. That's helpful.

100. 0:22:30

     So I, I, I bring that to you. It's, it's LC 46-1482S, and I would appreciate the committee's consideration.

101. 0:22:38

     Right.

102. 0:22:41

     Uh, oh, we do have some questions. Um, I can... Who is it?

103. 0:22:48

     Representative Mathiak, is that you?

104. 0:22:50

     I, I didn't have a question.

105. 0:22:51

     Okay.

106. 0:22:51

     I just wanted to do pass at the appropriate time.

107. 0:22:58

     I'm sorry, I couldn't hear you over... Representative Douglas.

108. 0:23:01

     Thank you. We did make distinction between human and animal. Correct?

109. 0:23:05

     We did that. Um, this is in, that is already in the bill. For the, you're right. The amendment that was offered in committee, uh, for the first time, we, we already did get that corrected with ledge council. So we have corrected a- any question that there was about that. That was one correction. We missed this other one. Now we got a, an opportunity this morning to get it right. So thank y'all for allowing me to present it.

110. 0:23:26

     Good.

111. 0:23:26

     Chairman.

112. 0:23:27

     Okay. 17. Representative Gisler.

113. 0:23:33

     Uh, thank you, Mr. Chairman. Um, I, I did vote against this when it came through the committee before, and this is the exact reason. So I wanted to thank you, Chair Newton, for having that addressed. Thank you.

114. 0:23:43

     Very good.

115. 0:23:43

     Appreciate it.

116. 0:23:46

     Okay.

117. 0:23:47

     Feel free to add on a motion if you want to.

118. 0:23:49

     Right. Well, we got one more. Representative Mitchell.

119. 0:23:53

     Yeah. Thank you, Mr. Chairman. Um, I must say that, uh, this is a, I know this is a reconsideration by this committee of this bill, and I, and I appreciate the, the author, uh, here. But this would be a great opportunity for us to amend the bill to provide for Medicaid expansion. I understand the chair, uh, would like the, uh, author of the bill to be more updated on what the bill does.

120. 0:24:24

     And I certainly would appreciate the chair entertaining, uh, the discussion on this amendment.

121. 0:24:31

     I'd be glad to talk offline about that if you'd like.

122. 0:24:35

     Uh, your time of fame's up. No, we will not accept that amendment. But, uh, it's a good try again. And I, I appreciate your efforts and your, and your heart in this. Okay, do I hear a motion?

123. 0:24:49

     Move to pass.

124. 0:24:50

     Do I hear a second?

125. 0:24:52

     Second.

126. 0:24:52

     All those in favor say, "I."

127. 0:24:54

     I.

128. 0:24:54

     All those against say, "Nay." Well, congratulations, you got it.

129. 0:24:58

     Thank you, sir.

130. 0:25:00

     Full house. Okay. Up next, House Bill 1276.

131. 0:25:07

     Thank you, Mr. Chairman and committee. This, uh, this is an evolving, uh, bill that we've made several changes on. Um, w- what we're faced with is there have been several changes in, um, , um, the, the Medicaid program, which is of course a, a joint federal and, uh, state provided program. Financing comes from both the feds and the states. Regulations come from the feds as well as ones along with the state. I'm gonna talk real quick about what the bill does. This is HB1276. I'll go with the LC number fir- LC521051S.

132. 0:25:39

     Um, so what the bill does, how it does it, and why it's needed. Uh, just real briefly, it improves the way, how the state verifies eligibility for Medicaid benefits, brings us into compliance with recent changes in federal law. Uh, how does it do it? It, it ensures the state continues to verify all... And a lot of this is being done already. This bill will just codify it and make sure that we're, uh, completely aligning up, that our, our administrative departments are lining up with federal law. Ensures that the state continues to verify all key eligibility th- factors like income, identity, residency, household size, citizenship or immigration status, and to do those things before enrollment.

133. 0:26:16

     DCH tells us they do a lot of those things already, but we wanna make sure that there's a, a, not, they're not using anything that may have been granted in a waiver in the past but is no longer allowed. So we wanna make sure it's codified that, um, w- um, we assure that the, the case remains that we don't do self-reporting or self-attestation if that's in, in conflict with federal law. We don't want that used even if we had a previous waiver to allow it, because that in turn, turn could affect our error rate. So it improves verification of eligibility after enrollment by doing regular cross-checks of state and federal data sources.

134. 0:26:52

     That just sh- helps us correct. We, we're recertifying people or reverifying every 12 months. This would help us ch- notify any changes in eligibility between the application and renewal, which might be 12 months later. It does ensure that the state is only granting retroactive benefits for a period of 12, two months rather, um, previously it was three months, so now the two month will be the, the maximum required by federal law. You will notice there's a lot of times in the law, in the, I'm sorry, in the proposed bill where we, um, use the phrase, um, uh, except as required under federal law.

135. 0:27:26

     We do recognize that there's some, there's some flux in federal law. There are some changes as, as the department, the different CMS and other departments come out with regulation. We did wanna make sure that this bill recognized that, that federal law does preempt state laws. Um, and so we wanted to make sure those were allowed in this. So that, that's the final thing of, of how it does, the, the effort we're trying to do to make sure our error rates in Medicaid d- aren't excet- aren't, aren't exceeding a threshold that could have the program be penalized. Recent changes in federal law will start making patient, states pay for high payment error rates in their Medicaid programs.

136. 0:28:01

     So they'll start fining and penalizing the per- the states. That will take money away from what we would like it to go to, which is taking care of, uh, Georgia citizens. So if our state has an error rate above the 3% beginning in October of 2029, remember, there's a look-back period, so even though our next audit might not be until 2029, they'll be looking back sometimes two years to look at our error rate. If we were to be above the 3%, it's estimated that every 1% above that would cost the state about $100 million in penalties that would be basically taken or removed from the program and from the federal government's matching.

137. 0:28:38

     So basically, the federal government's gonna start scrutinizing how well states verify eligibility. The best way to clean up eligibility errors or potential errors is to improve the verification processes and do it by ones that are in compliance with the federal law. Our last reported error rate was very low, but some of that was due to the fact that a lot of waivers were granted in the past four years. I did hear there was a, a, a, a permission to do a county waiver in Georgia, you know, if certain counties had issues or disasters or things like that.

138. 0:29:09

     But it turned out s- we had requested a waiver in all 159 counties had been granted. So w- what the problem is, is as those go away, as those waivers are no longer accepted, we could find ourselves not with an error rate of zero, but 4%, 5%, 6%, and have several hundred million dollars that's taken out of our program. Um, I believe we need to be proactive and, and deal with this now, make sure we have the right guardrails for the department to, to take care of this now. And so that's what the bill attempts to do.

139. 0:29:40

     I'm glad to go through the bill-

140. 0:29:41

     Uh-

141. 0:29:42

     ... somewhat section by section, Mr. Chairman.

142. 0:29:44

     I think you did a great job of what you were doing. And, uh, I think we all know we don't, we don't have enough mo- money for Medicaid as it is.

143. 0:29:51

     We certainly don't, Mr. Chairman.

144. 0:29:52

     And we sure cannot afford to lose any more Medicaid money. We've got too many kids out there and age blind, disabled that, uh, their lives depend on that. So first up is Representative Gisler.

145. 0:30:05

     Thank you. Oh, I think I

146. 0:30:07

     No, hold on. Okay.

147. 0:30:08

     Uh, thank you, Mr. Chairman. Um, so, uh, just one thing on Medicaid. Um, I, I get that the bill's kind of targeted at, at combating fraud and waste in the system. It, uh, well, uh, whether there's intent or not, uh, it, I guess fraud implies intent, but-

148. 0:30:24

     Sure

149. 0:30:25

     ... but just errors.

150. 0:30:26

     Errors, sure. Um, so it, it, it occurs to me that there's an awful lot of, you know, new data sources here, more frequent, you know, obtaining that data, running checks on it, and taking action. It seems like it adds a, a very large administrative burden, which could increase costs, so I'm curious about a fiscal note. But also, with that much extra overhead on the administrative side of things, it seems like it opens the door for actually more mistakes, more errors at a higher error rate.

151. 0:30:57

     Uh, well, obviously, yes. The, first off, the department, and this, this would apply to both, uh, uh, Department of Human Services and the Department of Community Health. They're, they're both- ... generally guided by these already. This is largely what they're already doing. We're putting it into code for the first time just to make sure as there are transition changes in an executive branch or in a, um, or in the legislative branch, that, that it's clear that we have given them both, and, and in my opinion, be- on appropriations as well, that we give them both the funding they need to do these things, but we have clearly spelled out what we expect the executive branch or the commissioners to do.

152. 0:31:34

     And so w- w- we have these very clear specifications. They're compliant with federal law. Um, we are gonna appropriate the necessary resources, um, through our appropriations process to make sure the departments have that. But once again, they're doing a lot of this already. There are some, uh, I will tell you, sometimes it's in a couple of different departments, and we need to get a little better handle on how to make sure that, um, if one part's being done in one department and one part's being done in another department, that, uh, that the two know that it's, it's clear that they, that it has to be worked together and comply with this law.

153. 0:32:11

     Okay. Uh, a, a follow-up question?

154. 0:32:13

     Sure.

155. 0:32:14

     Um, if, uh, are, are the sources of the data changing at all? Or, uh, you say a lot of this is already in place or-

156. 0:32:20

     These are, uh, my understanding from the department, and they're welcome to, uh, uh, either department is welcome to, um, um... But these are a lot of the sources that they're already using.

157. 0:32:32

     Okay. And has the frequency changed at all, or is that under what they're doing already?

158. 0:32:35

     There, there was an earlier version of this that we did get some, that, that mentioned a every six-month review.

159. 0:32:41

     Okay.

160. 0:32:41

     And we did change that in the current committee sub, so that was a, a legitimate claim that, that, that did, was brought. But there are routine cha- uh, pr- uh, checks going on already-

161. 0:32:52

     Mm-hmm

162. 0:32:52

     ... to make sure that eligibility remains. Obviously, if someone dies or if someone-

163. 0:32:57

     Sure

164. 0:32:57

     ... uh, moves out of state or whatever, I think there's a... They're already doing a lot of this. This is really just a codification to, to make sure that there's no uncertainty, and we don't find ourselves with a multi-hundred million dollar fine or penalty in the program. And, um, and we had not, we in the legislature had not been clear in our instructions to the departments.

165. 0:33:20

     Okay. Thank you.

166. 0:33:21

     Representative Glenn.

167. 0:33:24

     Thank you, Mr. Chair. I have a couple questions. First, I wanna preface by saying I understand we have to respond to H.R.1, and I also understand we can always try to do better. So my two questions are on the self-attestation. To, to your point, to my understanding for at least 10 years, with respect to income, um, income ho- household c- composition and citizenship or immigration status, this is not changing practice. What it is doing is changing practice around residency and household composition, and my concern there is, uh, there was, there have been a couple programs in my own district where they were doing self-attestation for these.

168. 0:34:03

     And we have dealt a lot with housing in our, in our state, and those who might be most income qualified are those that might not even be on leases, might not have the utility bills because they have a bad landlord, et cetera. So my question is, with respect to the changes with residency and household composition, what type of document will be accepted in lieu of self-attestation?

169. 0:34:27

     Um, I might have to defer to the department on what they accept now and, and what they, um, what, what, um, uh, outside data they would use. Um, I'm not sure if there's someone who could speak to that.

170. 0:34:42

     Yeah, Emily Elna?

171. 0:34:44

     Yeah. Good afternoon, committee. Thank you, Mr. Chairman and members of the committee. My name's Emily, and I'm Chief of Staff here at the Department of Community Health. I also have Stuart Portman, who is actually our, uh, Medicaid director, to answer any technical questions that I cannot answer, just to be very honest. So on the attestation, it is a policy for the state that we don't allow attestation in most of our programs. Um, there may be that initial request, at least in Medicaid, I should say. In Medicaid, we may initially request information like, "Are you a caregiver? Are you a parent or legal guardian of a child up to six in our Pathways program?" But then we do verify on the back end.

172. 0:35:19

     So.

173. 0:35:19

     Yeah. And then I just had a second question.

174. 0:35:23

     Sure.

175. 0:35:23

     So, um, uh, th- thank you. Um, the second question, and it goes back to... Uh, again, I appreciate that we have to respond, and we did in our fiscal year '27 budget because w- w- there's been a lot of conversations around SNAP error rates. We put $12 million, or at least the governor's recommendation as it stands is $12 million. Do you have any estimate as to what implementing this would cost to reduce the Medicaid error rates?

176. 0:35:50

     Um, once again, uh, my, my understanding is a lot of this is already being done by the department, and they're, this is, I w- I wan- I wanna say belt and suspenders kinda thing. But it's, it's really more just a clarification that we all get a, make sure we're all on the same sheet of music. I, I believe we're already doing a lot of this. Um, will there be a lot of new expenses?

177. 0:36:12

     I, y- yeah, this is where, you know, there's a division in labor, just to be honest, with the Department of Community Health and Department of Human Services. Um, a lot of the operations is done by DHS, and I'm not sure. I think Em- Emma, the government affairs liaison, is there. I don't know if they've priced that out. From our perspective on the policy, there wouldn't be, but I do believe there may be some overhead for DHS, and so I'll let them speak as well.

178. 0:36:35

     Would you identify yourself?

179. 0:36:37

     Yes, of course. Hi, com- uh, committee members. My name is Emma Lowe, and I serve as the governmental affairs director for DHS. I wish I had a harder number for you guys. We're still kind of running what that would look like, um, on our side, but happy to provide that to the committee at a later time.

180. 0:36:51

     Okay. Thank you. Okay. Uh, let me see, who do we have next? Representative Davis.

181. 0:36:59

     Thank you, Chairman.

182. 0:37:03

     I guess I'm having a hard time of who to really ask this because, um, I've met with a number of organizations That had to deal with the crisis. And that crisis was when it came to renewal, and we had over, I mean, over at least 10,000 people who had errors when they was trying to renew their-

183. 0:37:35

     Re-verifi- reverification

184. 0:37:36

     ... uh, as, as far as reverifi- it's, what, you know, trying to sign up. Like recertification, trying to sign up for their yearly recertification. And I remember specifically at that time, you had, um, they had people trying to sign up for Medicaid, then they had people trying to sign up for SNAP, along with other, uh, items, but the number of workers that you had was so low that some of the people did not have...

185. 0:38:10

     I mean, because, I mean, they don't have computers, they would use their phone, and that phone would constantly have a number of errors because they could not answer some of the questions or fax in some of the information that you were requesting. A lot of it was technical administrative errors that when you're dealing with people who are underserved and under-resourced, they don't have computers, so the best they can do is their phone.

186. 0:38:44

     And then we didn't have anywhere for them to go and get assistance, and it was so bad that when they called me and told me to go to the, uh, the department, the line was around the corner. So I'm asking, did you correct that problem? Because you're getting ready to codify this, and if you didn't correct the root cause of what that crisis was, then we're looking at this problem probably getting worse.

187. 0:39:20

     I do think a lot of that was the redetermination that was done, that was required, that had been... We di- we're not doing the every year reverification, redeterminations, and then a whole lot of them came up at once at the end of COVID. But go ahead. You can speak to that.

188. 0:39:34

     No, that's a great question, and reiterate that point. I will also say that we've, um, been really lucky these past couple years from the investments from this body and the governor's office. We've had investments specifically for our OFI staff to, to handle some of that labor. Um, and we've also, um, I know I've spoken with some of this committee on this, we've also installed kiosks in public libraries to, um, help with access and in our lobbies as well to, um, kind of aid in the problem that you were talking about of, of signing up on your phone.

189. 0:40:09

     My understanding is nothing in this will r- re- reignite that challenge we had at the end of COVID to re- uh, redetermine everyone.

190. 0:40:20

     Um, follow up real quick.

191. 0:40:22

     Okay.

192. 0:40:23

     Um, truthfully, the, uh, I'm, I'm talking about, like, in the last y- year, year or two. So I'm, I'm, I would like to offline speak with someone to verify a couple of things because, um, I deal with, with this situation quite often, so, uh, I just wanna verify. Okay?

193. 0:40:51

     Thank you. Representative Clark.

194. 0:40:55

     Thank you, Mr. Chair. Um, I, my question that I had, and actually was kind of answered by the Department of Community Health, was on cost, and they did say that there is some cost, but they are not quite sure what those costs are. I feel, uh, very strongly that, um, we have to be very careful about changing Medicaid in any way or, um, without knowing, one, the impact on the department, especially as we talk about tax cuts and things like that, where there might be less revenue coming into the state, and what does this actually mean?

195. 0:41:29

     And so I, I do have some concerns about that. Uh, can you speak to that briefly?

196. 0:41:34

     Well, um, I, I certainly agree. I think we, we certainly work closely with the departments to try to streamline as much as we can. I think the biggest threat might be that either one of those programs, I know we've talked about SNAP in other d- other committees, but, um, error rates in either one of these programs I'm afraid could be the biggest threat, and I, I think w- we would be very wise to make sure w- as we go to the appropriations side, this is not really the appropriate bill to put an appropriation in, but it is clear we're expecting, uh, best practices, which we're codifying in this, in, that, that keep us in compliance with federal law and keep us from, you know, help prevent us from having the significant fines that could far way outweigh some of the, uh, whatever, uh, hardware, software, computer costs, or kiosk or whatever.

197. 0:42:23

     Uh, I, I agree with you.

198. 0:42:26

     Thank you.

199. 0:42:29

     Representative Jones.

200. 0:42:32

     Thank you, Mr. Chairman. I got a c- one confirmation question for the sponsor and then I believe a question for one of the departments. Um, I know that you know the appropriations and the budget very, very well. Is it fair to say the second-largest appropriation that we make is, for lack of a better phrase, the social tapestry? So after K-12, it's Medicaid, it's b- basically PeachCare, it's effectively everything that we do in a sense to have a safety net. Is that a fair statement, sir?

201. 0:42:59

     That is. Higher education's very important, too.

202. 0:43:01

     Yes.

203. 0:43:01

     But, but yes.

204. 0:43:02

     Yes, it is.

205. 0:43:03

     Uh, but, but it's not number two.

206. 0:43:05

     It is not number two. It is, uh-

207. 0:43:06

     Yeah

208. 0:43:06

     ... yes, the, the s-

209. 0:43:07

     One more question for the sponsor before we get to the departments. Is it fair to say that number two is our fastest growing budget line item in front of higher ed, K-12, DOC, transportation, et cetera?

210. 0:43:19

     It is. Yes, it is. Yeah, by leaps and bounds. Yes. Uh, a question for the department if that's okay, mis- Mr. Chairman? Yeah. And I promise it's a friendly question, but anecdotally, what I'm getting from my employers is that we do unfortunately have residents of our state who are, for lack of a better phrase, working under the table to put themselves in a position to gather cash, stay below certain income thresholds so that they become eligible for certain programs, including but not limited to Medicaid.

211. 0:43:54

     And we can take this offline, but I'd love to understand, again, I know this is a difficult thing for the departments, but what we're doing to audit and just random audits, I'm sure it's not every person. We don't have the time or the resource to audit everyone, but my hunch is there's some type of intermittent audit that we do to make sure that we are, I'll say, capturing the bad actors because to my colleagues in the front, I completely concur those that are truly in need, we need to have number two in the budget in terms of social tapestry, but those who are, I'll say, working the system, they are taking valuable resources for those who are truly in need.

212. 0:44:28

     So if you'd like to answer now, great. If not, I'd like to catch you offline. Well, I'll just say, um, for the Department of Community Health, and that's after someone's on Medicaid, you know, so that's when it switches over to us, but we do have an Office of Inspector General, and we're doing a lot in this space to that. I mean, you know, there's bad actors in everything, and we can try to keep up with them. We know there's always bad actors, but we as a department have done a lot in the last couple years to make sure that we're detecting this, and we'd love at some point to come kind of e- present that to you guys when everything is not, you know, closing on on Crossover Day or whenever y'all would like, but we can also talk about that.

213. 0:45:02

     But I just wanna say a lot of improvements have been made. I think there's been a lot of, um, federal, you know, um, spotlights to, you know, things that were going on on a federal level in other states, and so we've been really diligent to make sure that we're catching that as much as we can. I think I could speak for the whole committee. We'd be super interested in that IG report and any, I'll say, executive findings in terms of what we've learned, maybe what other states have learned, what best practices are, because again, we wanna make sure there's enough resources for those who actually need it. So thank you. Absolutely. I'll give you one stat if that's okay.

214. 0:45:33

     Um, one thing we've implemented is a new, um, system called Fraud Scope and just kind of give you some context, and it took a while to implement. But, um, on average, we sent about 13 cases over to MFUCU or, and I apologize, like we're calling them something different now, so but over in the AG's office, which oversees Medicaid fraud. Um, in the last year we sent 55. So we'll get you more information on that, but I just wanted to share that stat 'cause it does show what we're doing is working, so. Thank you. Thank you. Uh, Chairman Petrie.

215. 0:46:04

     Thank you, Mr. Chairman, and, and to the, uh, chief of staff's just co- uh, comment. I recently met with Director Portman, and I think you were telling me about this software, AI largely fueled, right? I guess the expert on AI over here. So, um, and that is, uh, discovering more potential fraud. Um, my question, so, um, first of all, to make sure I, uh, frame this right, we're dealing with individuals we have to determine Medicaid.

216. 0:46:35

     So this is not including SSI individuals anyway, correct? And to the... I may need, I'm gonna need DCH up here, too. Mr. Director, I mean, so- I'm the director- ... SSI recipients are automatically enrolled, correct? Sir, yes. This, this review does not include SSI- All right. So just those where we're g- using, uh, our defect side to do determinations. And, um, we did have a huge, uh, scenario post-pandemic because we had an, an, an enormous number of people who were on Medicaid post-pandemic who had long, uh, uh, not, no longer qualified for Medicaid.

217. 0:47:13

     That is correct. And so my, my concern is, um, because I've seen a lot of examples on both sides of this. I've seen individuals that don't have good family support in my career who, um, from no fault of their own because they have disabilities, uh, who don't know how to fill out the paperwork and may not provide the paperwork timely, and they must, we must care for those people. On the other side, I personally have dealt with the scenarios where families are hiding assets and obfuscating intentionally.

218. 0:47:52

     So I've seen it all on both sides, so I understand well what we're trying to do. What, uh, what I would, would like to know from the department is this looks like what we've long required, but is there anything in here that is, uh, that is additive of what we've, we've long required? A- and I understand we've got the, we're, we're carving out the self, the s- the self affidavits. I understand that and understand why, but I'd like the department to speak to that u- understanding that we, I know that y'all are working hard to find fraud, waste, and abuse, and we need to make sure, by the way, that they have the resources to do this, okay?

219. 0:48:35

     That's my opinion. If we're gonna ask them to do more, we have to make sure we give them resources, and we're working on that, um, in our appropriations committee 'cause I think it's important. And so, um, by the same token, we don't wanna see people who, uh, are unable to care for themselves and may not have adequate support to fall through the cracks. So having said all that, my question is really what is new in here? What is different for this body, so we all know concretely from you what is different that now is codified in statute that may not be in current practice?

220. 0:49:15

     I'm gonna let Stuart answer that question, but I just wanted to start with, I think one of the things for us is that's important to note, and I think there's some awareness to this and some not. So with H.R.1, there was, you know, the, the, the big beautiful bill, H.R.1, that was passed last year. But what our department right now is waiting on, um, a final rule from CMS that will outline a lot of the requirements that were le- that were hinted towards in H.R.1 but weren't clarified. And so a lot of this eligibility, ability we expect to fall in that final rule, which is expected around May, um, May or June.

221. 0:49:49

     Um, and so just kinda wanna preface with that. We can talk about the differences, and these are the things we, you know, think we might see. Um, but that, wanted to provide that clarification. The other thing I just wanna note, too, is, you know, we've, we've gotten the sub, but we're still... I mean, wanted to thank the sponsor 'cause he's been more than willing to work with us on this, and so we're of- offering up changes. So too that. But go ahead, Stuart, on the things you see.

222. 0:50:11

     Mm. No, I was just gonna say from the Department of Comm- Community Health perspective, the components in here that are related to us are codifications of requirements within H.R.1 that we would have to comply with either way. As it relates to system connection points, I would let the Department of Human Services speak to what they do and do not currently connect with in terms of some of the specific state and federal departments.

223. 0:50:32

     You make good points, but, you know, really, this is about taking care of folks, too, and we can't be pa- paralyzed by fear of someone doing something that they shouldn't and disregard the people that need our help.

224. 0:50:46

     Yes.

225. 0:50:46

     And I appreciate your comments.

226. 0:50:47

     Yes.

227. 0:50:47

     You make good comments.

228. 0:50:48

     Thank you, Chair.

229. 0:50:48

     But I think we need to keep our eye on the ball-

230. 0:50:50

     That's my concern

231. 0:50:50

     ... and these folks that need this. Representative Gisler.

232. 0:50:54

     Uh, thank you, Mr. Chairman. Um, my question is also for DCH, sorry. Um, w- when it comes to looking at fraud in the Medicaid program, is it not true that most of the fraud is on the provider side-

233. 0:51:06

     Correct

234. 0:51:06

     ... and not on the recipient side?

235. 0:51:11

     I think that's what we see. I'd have to take back on the actual, you know, the numbers. I mean, we, we definitely see it on both sides, I would say. Um, so I can't really speak to which more, and I, and I apologize, unless Stuart can to more than one or the other.

236. 0:51:24

     Um, I think, I think it goes to the, the difference between, um, the measure... The measurement that was, that the sponsor is speaking to, being the per audit, is more related to eligibility errors and documentation errors-

237. 0:51:34

     Mm-hmm

238. 0:51:34

     ... and is less about fraud.

239. 0:51:35

     Okay.

240. 0:51:35

     So the fraud question, i- is, is, is slightly separate, but if that is the question of where do we see the fraud-

241. 0:51:41

     We'd have to

242. 0:51:41

     ... we'd have to, we'd have to confirm that. There's definitely, there's been occurrences for both.

243. 0:51:45

     For both.

244. 0:51:45

     Mm-hmm.

245. 0:51:45

     And we have an office, like I mentioned, Office of Inspector General, that actually sits on purpose outside of the Medicaid Department, outside of Stuart's department within, and so we can get those stats for you if you'd like.

246. 0:51:55

     That, that'd be interesting, yes. And a, a quick follow-up. Um, w- when a Medicaid enrollee does commit fraud, they're not getting a check, right? They're not getting... They're going to the doctor and having a bill paid. That, that's what happens, right?

247. 0:52:09

     Yeah. I mean, there's... I mean, one example would be they've moved to a different state. And so it's, yes, to your point, it's wor- But the state is still spending taxpayer dollars-

248. 0:52:17

     Sure

249. 0:52:17

     ... that are... Yes. But there are not people walking away with cash in Medicaid.

250. 0:52:21

     Okay. Thank you.

251. 0:52:22

     So.

252. 0:52:23

     Representative Lim.

253. 0:52:26

     W- what I'm hearing is we don't yet know what the final regulations are, and we don't yet have a complete understanding of the fiscal note. For those reasons, I would at least like to, for this committee to entertain a motion to table until we have those numbers.

254. 0:52:40

     If I might add, one of the reasons on line 20, it says, "Except as required under federal law," line 28, line 105, several others, r- are in recognition of the fact that there are some CMS rules that may come out even after we, uh, are, are, are out of session in May or June. Um, we know this can change, so we've tried to make this bill as, as, um, respectful of the federal preemption. And since they've, certainly since they pay two-thirds of the, of the funding for this program, we're certainly gonna follow the, uh, the federal law.

255. 0:53:12

     Um, as far as the... W- we really in, uh, don't do a, typically do a fiscal note on, on this. This, the department is funded, um, but this would not be a place we would decide and, uh, deliver funding, would be typically through the health committee. That's gonna come through an appropriation, to my understanding.

256. 0:53:33

     I think you make some good points. But this legislation's also moving on the Senate side, and somewhere we'll be coming to the middle. And, um, this, this is gonna be a work in progress. Believe me, this, but this is unfortunately something we have to address, and maybe some, sometimes-

257. 0:53:52

     Again, I-

258. 0:53:53

     ... we're in a little bit of murky water, and I-

259. 0:53:55

     Well, but-

260. 0:53:55

     ... agree with your, your comment.

261. 0:53:57

     Yeah. I, I, well-

262. 0:53:57

     But I think-

263. 0:53:58

     I, so I'll, I'll be... I've asked for... And this is nothing against DCH or DH. I've appreciated working with them. I've asked for an audit because like, as I said earlier, we can, we can always do better, even if we were doing great, right?

264. 0:54:10

     Right.

265. 0:54:11

     We can do it to, to, to Chairman Petrie's point, they're, meet those people who actually need it.

266. 0:54:18

     Right.

267. 0:54:18

     And I think we all recognize, what I'm hearing is we need to really look at this to make sure that... Well, I think, let me just put it this way. What we don't wanna do is add additional requirements that will disqualify the people that most need it while still allowing fraud, abuse, et cetera, to go on, and that's why it's important to really understand the structure and what it will cost.

268. 0:54:37

     I agree. No, I agree. But I will tell you, the fiscal note and the ability to determine the cost of this may be well into the future. I'm, I'm still waiting on fiscal notes from weeks ago. And this is a real tough one to figure out what the fiscal note's gonna be. But nevertheless, this is something that the, the federal government's requiring of us. So sometimes we just gotta get up and tackle the person in front of us, right, Representative Douglas? That's what we have to do sometimes. Representative Schofield.

269. 0:55:07

     Just a quick question. Thank you, Mr. Chair. When you're, um, doing your data that, that, uh, Representative Gisler, can you sort this by zip code? I'd like some information by zip code.

270. 0:55:18

     I'll find that information. I'm pretty sure we can, and we'll get that back to you.

271. 0:55:20

     Okay.

272. 0:55:20

     Yep. Thank you.

273. 0:55:23

     Okay. Uh-

274. 0:55:23

     And I would like to thank the department, uh, Stuart and Emily f- and, uh, and, uh, DHS as well, uh, Commissioner Brose, for, for helping us to understand this, to help us so we could write this in a way that would comply with federal law, to not add unnecessary restrictions, but really to codify the work that, number one, is already being done, and as the rules change, to allow you to keep doing it. And we have a, an incredibly professional team doing that. Um, and I, and I just appreciate both, both departments.

275. 0:55:52

     This meeting is being recorded.

276. 0:55:54

     No, no.

277. 0:55:57

     Yeah, they usually are.

278. 0:56:01

     They are.

279. 0:56:01

     Yeah, if you can't sleep at night, you can watch this. Representative Jones. Chairman Jones.

280. 0:56:07

     I'd like to make a motion do pass on HB1276.

281. 0:56:11

     Second.

282. 0:56:12

     Do I hear... Okay. All those in favor say aye.

283. 0:56:15

     Aye.

284. 0:56:16

     All those opposed.

285. 0:56:18

     Thank you.

286. 0:56:18

     Congratulations. You have your bill.

287. 0:56:20

     Thank you, committee, and thank you, departments.

288. 0:56:22

     Mr.

289. 0:56:25

     Chair.

290. 0:56:25

     Meeting adjourned.

291. 0:56:35

     Hey, guys. Hey, thank you. Thank you.