-- c-span or on the c-span radio app. >> c-span is your unfiltered view of democracy. along with these other television providers, giving you a front row seat to democracy. >> improving medicare and

medicaid for people who are eligible for both programs. >> good morning. at the hearing will come to order. today's focus will be on sending -- seniors who depend on americare and medicaid. over 12 million americans are eligible for medicare and medicaid. including almost half a million in pennsylvania. these americans are expected to know which service is medicare

services, which services medicaid covers and which programs are not covered at all. one for their primary doctor, one for their behavioral health and one for prescription drugs in the list goes on and on. they might have a doctor who takes their medicare insurance but not their medicaid insurance. not only is this confusing and frustrating, it creates unnecessary hurdles for people trying to catfished care they need. we will hear today in the northeastern corner of our state. jane will share her harrowing story of navigating the complexity of these benefits, not only for herself but also as

a caregiver for her mother. she will also describe how she listened inferior to her doctors home she trusted to keep her healthy will no longer take her coverage. we will also hear from dennis about his coverage that provides medicare and medicaid. it was quite a road to get here to get independence. certainly they worked to be done. this bill will eliminate preventative measures. in pennsylvania we called them

light programs. with that name pace. these programs enable people with a and medicaid to receive all the benefits through a single organization, providing primary care, long-term care and more in one place. the case also in -- enables people with a high level of needed to stay in this community rather than receiving care in nursing home if that is a preference. this is a preference for the majority of older adults, as well as people with disabilities. for these services, states are using these resources to help more seniors and people with

disability access care and to pay heroic home care workers the bonuses they deserve. this investment in the rescue plan of 12.7 billion dollars will be good for a step. but we need to do more and ensure more so disabilities and seniors can receive more care in their home. this bill would make a permanent investment in home and community-based facilities. people with disabilities and their families would ensure a strong and secure workforce to provide a better workforce to better care.

this would navigate better care -- medicare and medicaid. we will highlight to continue to improve care. >> thank you, mr. chairman for working together on this act. it is beautiful for the country to see. on behalf of the country and behalf of the democrats and republicans. one of the things i enjoy about this community -- this committee. that should be a mission for our nation for the examples you are leading by. i appreciate your work for that one stop shopping concept. it is something really important when you have so many layered in your life as you age.

if we could eliminate any of it, it helps all of it become more adjustable. thank you very much for your hard work on that issue. another reason this is so important, we have 12 million americans who are dual eligible. having multiple caregivers, multiple places they go. when you think about medicare and the actual program running from government, the state government. getting those whose work together is not as easy as it should be. anything we can do in the direction of making that happen is going to be in the best interest of seniors across this nation and certainly the seniors in south carolina that i know and love so much.

the biden administration needs to be continuously working to make sure it is open. president biden asking for releasing the telework's for agencies. it is really important to have an opportunity to have our seniors have the place to go either virtually or in person. when the pandemic six -- subsides. from the agent -- the agency they eventually want it.

i thought i would use examples who have benefited from having caregivers who understand the complexity of the administration. we are seeing improvements throughout the state. one member of our program was living in his car, homeless. his care manager his plan

manager assisted him and found a place to stay. another member, having gradually declining over the past several months, his daughter, and his caregiver noticed he was having more and more difficulty, even with his walker and needed more support. his care coordinator worked with his doctor and the general doctor on the needs and soon thereafter, covered and delivered. the members from the doctor reported they were about to leave but because of the support being provided, further state legislations to provide grants.

i look forward to hearing from our witnesses about what else we can do as congress members, senators to improve the lives of our rule. >> former senator collins, the chair of this committee, for moving in and out because of hearing engagements.

let me start with our first witness. dr. figure own is a professor at harvard university school of public health. dr. -- research understands the drivers in health care spending -- hospital in boston where he provides medicare and medicaid. i want to thank dr. figeraux

for being here and sharing his expertise. >> please welcome eunice. the director of programs for the south, human services. the agency responsible for running our medicaid programs and providing health care coverage to more than one million south carolinians. mr. medina is testimony today comes from more than 18 experience working on this issue in the south carolina and florida where she recently lived. she has dedicated her career to working on behalf of older americans and americans with disabilities. those who are most winnable and need the assistance the most.

they work every single day to make the lives of south carolinians better. welcome to the hearing and welcome to south carolina. >> next, i will introduce dennis he pp dennis is a -- of the disability policy. dennis is also a commissioner --. they also happen to have medicare and medicaid. thank you for being with us

today, sharing your expertise with the committee. our fourth and final witness is miss jane derose. of bard and phil come pennsylvania. as i mentioned in my opening statement. jane has two children and three grandchildren. while they don't live close by, she is able to connect with them through daily phone calls. jane describes herself as quote -- as "an artist." she also helps care for her mother who has medicare and medicaid as well. thank you, jayna for being with us today and sharing your personal story with the committee. we will turn, next, to our witness statements and we will start with dr. figure own needs. dr., you may begin. >> thank you chairman scott and

all the members of the community. my name is --. and i am a does -- an assistant director -- the hospital. for my research, i focus on how to deliver a quality of care to my patients. those who qualify for both medicare and medicaid programs. i can attest to the fact that navigating our -- was frailty, multiple chronic conditions and because of these vulnerabilities, dual eligible people are much more likely to

require hospital care, nursing home care, long-term care, home-based behavioral health. unfortunately, an increased risk . a great failure of our health care system is so much of dual eligible patients time is lost navigating the complex and confusing rules and regulations of two programs. which they must do in order to ensure they get the care they need. this is valuable time they could spending at home with their families, with their friends. one of the most -- as a physician, one of the most frustrating realities is that we correct this process. countless hours are spent by clinicians, social workers trying to determine what should be the safest discharge plan for our patients while at the same time trying to coordinate the best care possible for the

providers. this often results in long hospital stay of our patients while they wait. one important way of doing so is -- through integration of medicare and medicaid programs, financially and clinically. integrated programs have the potential to improve the quality of care as well is patients. today there are three major types of fully integrated care models. they include, i mention the program of care for the elderly. medicare advantage, dual eligible and state medicare and medicaid plans.

there are some reassuringly positive -- administered to the individual patient. only one in 10 are enrolled in care model. 50% don't even have access to one. in my written testimony, did not have integrated

meaningfully better value than the status quo that should service -- cover all service to long-term care and behavioral health services. the enrollment process should be easy. finally, we need better transparency on performance, data and we need to develop better quality measures to capture what truly matters to patients. if and when we do this we can ensure high-quality care across our country. thank you for your time. >> dr., thank you very much. next we will turn to ms. medina. >> thank you for the opportunity

to participate in today's discussion. i spent -- community-based labor programs. traditionally medicare beneficiaries into now what is a state program.

in june 20 21, i joined south carolina's medical agency. how does that help the state by evaluating medical programs and developing a plan to improve quality competency. according to summer 2021 data, -- 15 state program. over the age of 18 or the elderly. in 2015, better integrated

services for seniors. this program was focused on --. this marks our anniversary since implementing this program. we have found in page -- in cases where beneficiaries -- medicare only covers a limited amount of -- we have a big

exploring is the fact medicaid programs are -- looking to integrate care. consider the capacity to manage the program already submitted to. use the nursing facility level care. this is the approach that florida took. florida consolidated. if someone enrolled in one of these plans, they can receive medical and learn less long-term .

local programs and funding on an integrated program can focus on beneficiaries and providers. chief among them being integrated data. in conclusion, i truly believe -- our state will be looking for the ability and to design our community after the data. it is time to responsibly shift to a model that allows to shift to the changes that allows. on a topic i truly am passionate about. >> miss bonita, thank you for

your opening statement. we are going -- we are going to now hear from --. go ahead. mr. -- i think you might be muted. >> apologies. >> thank you. >> chairman, kc, ranking member scott, secretary committee, thank you for the opportunity. my experience as a fully eligible start to want to give a special thanks.

i am here to speak to you from the perspective of one share integrated model of massachusetts. what was established for the health and wellness with medicaid and medicare. one care was designed to plays increased -- and the health services and emphasizing independent living and recovery. i became a member of one care in 2013. i had fear of losing my independence and algorithm driven to a medically focused service plan.

complied to many stakeholders, consumers and our family members. working in parts of the state to meet these he's national meet these needs. recovery and other needs. helping the person. in my case, it means ensuring having a home-based community services i need, durable medical equipment, equipped wheelchairs, technology, medical supplies. a care plan i created with my care team and direct communication with my nurse practitioner. all of this to respond directly to my needs without having to be

in an emergency department or without--. my personal care attendant who helps -- to do wound care, catheter change and more. many hospitalizations and over a year of recovery. rather than going into a nursing facility, -- they increase the number of hours. even as a network provider was

consulted, i received -- from my bed to my wheelchair. most health plans do not provide people like me these types of service. thankfully i usually don't need those type of services. what i need most are home-based services. with people i know and trust. frustratingly, even designed to be fully integrated, the whole place set up. i went to the the emergency department for the first time in years. instead i could only get to the after hours answering service.

not knowing what to do, i drove my wheel to the hospital. if i have been able to reach someone with medical knowledge, i would not have gone to the emergency department. including lack of a care plan. the one care plan themselves to adjust what appears to be -- because of the state, we will be heard and we will make change. every state needs consumer boys to succeed and integrating health care system.

thank you for the opportunity to speak with you today and i look forward to your questions. >> thank you for your opening statement and we will turn next to miss doyle. >> good morning, chairman kc. my name is jane doyle. i have lived in pennsylvania for the past 32 years. i have two children and three grandchildren living in the suburbs of boston. i am honored to have this opportunity to help make change prevent -- better health care for everyone. i have experience for myself and my family several costs of dual eligibility.

i have access medicaid through a special program. it allows people to work and still earn higher incomes. otherwise qualified by medicaid to pay premiums through benefits. it was a relief to have affordable insurance that covers out-of-pocket cost and i found it quite purposeful to continue to work. since 2017, due to medical circumstances, i have been unable to work. i applied for regular medicaid in 2020. pennsylvania required medicaid through health care. from the eight doctors i see, i don't believe any of them are enrolled in the new system. so far i have been fairly lucky.

most of my doctors have continued to see me but they must write along the balances of medicare. i recently received balance bills for my new doctor who may not have even been aware they were not permitted to balance because medicaid. my doctors say the new system is complicated and the rules are different across three different networks. i also worried that since many doctors don't take the managed care, these programs try to cut off the quality of care i receive. during the pandemic i had three alterations. one was a result of your reversible nerve damage. this resulted from needy neurosurgery and i had to travel 100 miles to philadelphia to get that care. my mother is also duly eligible. she is enrolled in medicare and needs more help. she needs the kind of long-term

care medicare does not cover. sometimes for home care, paying out-of-pocket sometimes $1700 a month. but as a widow, her money was running out at 87 years of age. thankfully in pennsylvania, there -- medicare has a special wage. our family views this is a great alternative. to qualify, someone must first apply for medicaid and apply -- must qualify for medicaid and apply. the recommendation for medicaid and doctors, choosing a program to oversee your taste and another medication -- the

pennsylvania health law project. they helped expedite my mother's case. as you can imagine, not knowing how we were going to care from -- care for our mother. i talked about the mother -- the problems my mother faced, the challenges i experienced as a duly eligible person. i would like to tell you what would happen if i stop becoming duly eligible. if i lose medicaid, i would not be able to buy medigap insurance to cover out-of-pocket costs because i have a pre-existing condition. for those with a medicare -- a pre-existing condition, when you sign on, as a result, i am stuck. i cannot increase my income or savings because i will no longer

have medicare since i can't buy medicine. i would no longer have medicaid and i won't be able to buy medigap. i was he much higher cost without having insurance. this is the cost for one person wanting to navigate. the pennsylvania health law project and the medicare rights center national helpline, which i have reached out to. i asked you today to do whatever you can to ease the burden of people like me and my mother who would have many challenges. while these programs are important, they are not easy to use. to make these programs actually work, it makes easier for my mother and me to find care. thank you for the opportunity to

stay with you today. i look forward to answering your questions. >> thank you very much. we appreciate your testimony. i will start with jane doyle for the first question. i want to thank you again for your testimony. these stories that are shared by you and other witnesses help all of us when we are trying to formulate policies. especially top issues like health care. and the challenges that dual eligible americans face with regard to medicare and medicaid. in your testimony, you talk about your mother receiving long-term care at home. you said you viewed this as a great alternative to a nursing home for your mother, as it would allow her to stay independent and involved with us. to be able to receive the care

they deserve, everyone should have the option to stay close with their families. can you tell us more about why home and committee services are so important to you and your mother and your family. ? >> in our particular situation it was my mother's choice and we wanted to honor that. although my mom was college educated, my mom was a homemaker. she was not accustomed to a lot of outside socializing. the second piece to that question -- nursing homes that

provide reinstate -- rehabilitation were grossly understaffed. from a recent hospital visit, that understaffed edge is even worse. it is hard to leave your loved ones and go home and not know if they are going to answer your loved ones call or simply place an order within their reach. my second question is to doctor --. your experience not just as a researcher but as a provider to patients that have both medicare and medicaid. your testimony spoke to having options for people in integrated care models. one of the models you mentioned was a base program or the life

program in pennsylvania. we have 7000 pennsylvanians who rely on this for their care. many who would otherwise receive care at a nursing home. hundreds and thousands of others was medicare and medicaid in pennsylvania, there are. they may not live near the program or know it is an option available to them. to reduce barriers in the program. could you show -- could you share with the committee how expanding a program like this might be better able to support individuals with both medicare and medicaid? >> thank you, chairman casey. the pace program you mentioned

provides all health care services to older adults who would otherwise be in a nursing home. the primary objective of the pace program is to keep them home and safe as possible for as long as possible. one is that they are fully integrated financially, two, a one-stop shop of nurses, social workers, caseworkers, all with one common goal that they are fully accountable for their patient across the entire package. and number three is that they maximize keeping the patient at home in their communities with their love ones.

they do a full review of their medical needs and they try to ascertain what matters to the patient. what values do they really appreciate and do they want to preserve? they look at each individual patient. it is a good option in areas where there are no integrated care models.

as you might have mentioned, there is knowledge for the health care work system. an important challenge that needs to be overcome. when we think about changing the scope of the program, expanding to other patients who do not necessarily qualify. a model would be beneficial for younger people with disabilities. or mental disabilities. >> ok, dr., thank you very much. >> your chairman on your right and your former chairman on your left, --.

>> first of all, thank you senator scott. you are always so great and i very much appreciate you both for holding this very important hearing. dr. -- i want to start with you. as we have learned today listening to the testimony and we know from our own experience doing casework in our state, the dual eligible population is extremely diverse. many people think the common words has called -- the common words has --. an 80-year-old woman who

requires assisted living services and has spent her remaining income on medical expenses. it could be a mental -- a middle-aged woman with diabetes or pulmonary disease who requires a variety of specialists. it might be a young person with disabilities who lives at home and requires assistance with the activities of daily living. moreover, some dual eligible people are not actually costly but the minorities makes the dual overall one of the most expensive groups for both medicare and medicaid. my point is, what is driving the cause is different for each sub population. as we see reforms to improve the care and lower cost where costs

flow -- knowing there is not one-way. could you give us some guidance on that? >> thank you, senator collins. we should not expect, given the diversity. we should not expect one strategy will work. what we need is, we need better data to understand what works with the population. in order to get to that level of understanding, we must do a better job at how we care the different programs that care for dual eligible patients.

we need to understand how well we perform with these populations. we need to understand what population experience is like. we have more -- of haitians whose care is significantly different under these programs. and we have data -- improve health care tomorrow. the evaluations are from 2012, 20 132014. -- 2013, 2014. that is very challenging for us. we look at what policy is implemented at the state level. make state data better and more transparent and also be able to -- what program is better.

i think we can adopt and expand the model. >> thank you, doctor. the second issue i want to talk on with you briefly is the challenge posed by the workforce issues. there was a recent survey of long-term care facilities in maine that found 90 for -- 94% of main care facilities or experiencing staffing shortages. their situation was at a crisis level. at the same time we know the interdisciplinary teams are an important component of the integrating care for dual eligible. could you comment on how the

workforce challenges affect our ability to adopt and scale integrated care models for dual eligible. is this an area that should be more of a focus for congress? >> thank you, senator. i agree it should be an area of focus for congress. we have taken a look and staffing agencies over the country. the covid pandemic really exposed that vulnerability in our health care system. for example, we think of nursing homes. nursing staff shortages and the nursing homes with those shortages -- by covid-19. in terms of creating workforce,

we need to compensate the workforce in certain areas, better. we need to provide decent wages so we have less turnover and we have more people, good people wanting to work in the health care sector. when we think about this, we think about training and diverse cores in all areas of the country, caring for majority of patients. in some areas we need collaboration with doctors. for example, we think about expanding community. as well as low income american --. when policies can we do to promote? we should think about approach

and not just providing services -- in their community. those are the things that states can consider. >> thank you again. senator scott. >> i want to knowledge again senator coming in throughout the hearing. senator braun was with us and will be joined with other sinners very soon. i want to turn to senator scott for this question. >> thank you, mr. chairman. miss medina, the first major effort targeted towards dual eligible individuals, miss medina can you talk about what level of concern during this and how do you envision this future moving forward? >> thank you, senator scott.

it has been great in south carolina with our dual -- having said that, we are at a point in the administration that we have been working with our partners at the centers for medicare to figure out what our next steps are. there are differently opportunities to figure out what really works best in the state. what we can take from the experience into whatever designs we find for the future. >> let me ask you a question, i have introduced legislation to provide resources for duly eligible individuals. as for state medicaid offices to

expand their understanding of the medicaid program. is this something you think states would benefit from? what others like to weigh in >>? >> for sure, i think when it comes to medicaid, the focus is -- the dual integration has become such a hot topic. understand the medicaid role and how it essentially -- the program. or manager during -- or managing their dual. increase our institutional roles with medicare. >> thank you.

any other panelist would like to weigh in on the question? help bridge the gap of understanding the complexities of the two programs? i will continue with miss medina. >> increasing capacity for -- medicaid and medicare information. it works to understand. it is better. >> thank you, sir, for your comments.

there is always the natural tension between the state, federal government about the amount of federal involvement in administering large programs like medicare. are the states their own laboratories were administering their own regulations. do you believe you have the appropriate supplements for improving dual individuals? >> i think the agency, we have to navigate the complex authorities when we want to design programs. there are often delayed issues in new processes. working to figure out what are the best pathways we should take, especially when it comes to this area.

>> another question we may not have time to answer, i would like you to point out having excellence and people who are dealing with the dual challenges of this complex system. thinking about this comment as it relates to having to take his wheelchair a mild to a hospital to get care. or taking him out --. there is something about hearing from experts to help eliminate the direction but it is also incredibly informative and important to hear from witnesses who understand the real-life pain and challenges that come with the system.

the balance has been helpful for me today. >> very well said by the ranking member. very, located issue, very personal. we turn next to senator warnock for your -- senator warnock. he is joining is virtually. sen. warnock: medicaid was created to expand medical access to children of low income families and families with disabilities. the affordable care act allows to expand medicaid, there are more than 10 million americans that qualify due to --. many of these also have medicare.

300 thousand georgians eligible for medicaid and disability. however, that number would be higher if all of the state of georgians would expand medicaid. individuals who live in the comfort gap. in the medicaid coverage cap. 500,000, on -- uninsured georgians. -- who would qualify. mr. healy, and your testimony you highlighted not every state

has access to health care services. like yours has. can you talk about the implications of living in a state -- and >> i wouldn't be testifying. it is very challenging with anyone with a disability to live , even with medicaid. it is more understanding. what needs to be considered, too, work environment.

someone like me, i love working. it is important to me. a work environment scares me. these folks who may not have the able to demonstrate the level of disability required to be eligible for medicaid --. access to medicaid is access to facilities, really a human

rights issue and a civil rights issue. i would not be able to live in another state. because of the health care system here. often times, other states have not been able to take those challenges because of a lack of -- provided. the increase the amount of money i make and the ability to maintain medical requirements. i think what is important to get medicaid and work at the same time. >> the answer to my question and your point.

from 18,000 to those. after just 10 hours? expanding and i would like to hear from you. you might reside in the wrong state, or the wrong health care system. as a human rights in all 50 states, where we have affordable health care laws. >> thank you senator warnock. i will continue with my questions and turned to the ranking member after that. -- i want to turn back to jane doyle.

you highlighted how difficult it was to help your mother and role the care that she needs and your testimony you talked about several applications and having to attach hundreds of documents -- hundreds. you also describe your own it experience applying for medicaid while you had medicare, while you are working and when you could do longer work. at various points you turn to nonprofit organizations like the pennsylvania health law project and -- i imagine there are so many people listening at home who can relate to your story. as ranking member scott made reference to, it is important to hear from people living through these challenges. are there things, jane, that could have made the application

and enrollment process easier for you and easier for your mother to navigate? >> thank you, senator. well, it was a little more clear for basic medicaid for myself but for my mom it was not. in short, i think the answer would be make the whole process quicker. that might not be exactly realistic. a certain degree of prudence needs to be -- needs to ensure compliance for the programs. for what we call in pennsylvania as nursing home level care medicaid, the issue i had was the $7,000 -- with the $7,000

asset marked for a person with very high needs, that money is spent very quickly. as i mentioned in my testimony, you have to qualify for medicaid and not everyone is already qualified for medicaid and then you go onto the next application of waiver. these dual applications can take to-three months. as you can imagine $7,000 -- that is not going to last the duration. possibly that limits may be able to increased to allow people the time needed to get through the process, maybe -- the other way, maybe integrating. we talked a lot about that but possibly integrating that

process of applying for medicaid and waiver together. that may make that more efficient. also, in my case, this may be local but it would be really great if they update government and local government update their websites to make sure they have the correct forms online so that people can access those and that you can upload those documents that you mentioned earlier. that would be far more easier than having to photocopy a book -- with your process. the other thing i will talk about, there is a lot of programs for help to reach out, to reach out to. i found myself making numerous

phone calls before he found the right source. i cannot imagine that elderly people with may be fewer skills or a bit of confusion, i cannot imagine how they would get through the process. i would suggest more awareness and designate maybe one agency that fields people to the right resource. that might be helpful. my first resource, which was unfortunately not all that helpful was a local office for aging. i did not find them particularly resource knowledgeable. i think elderly might tend to go there. that might be a good start. that might be a good place to start for people to find out where they need to be guided for specific issues for this massive

system. >> jane, thank you very much. thank you for your perspective from a practical perspective which you have. i will turn to ranking member -- >> i will also note that some of the comments during the hearing are about the importance of understanding -- some of the challenges that face folks who have been in the situation. there is always going to be a carveout or second look at -- i believe that bill clinton's approach in the 1992 campaign was able to pass through an overall for the country, it was good for the country. it was something i support. we should take into consideration special exceptions when necessary. the path forward is a good one overall.

-- about the challenges you find dually eligibility beneficiaries face. i think the chairman did a good job of simplifying this web of challenges of paperwork and the streams of challenges that go along with those binders that you are of to find your way through when you are looking for help in all of the wrong places because the jigsaw puzzle seems to be missing pieces. can you talk about some of the other challenges of juliet jubal beneficiaries? dually eligible beneficiaries? >> the administrative web of complexity is a wall -- it is a wall that people have to climb over to access health care and as we mentioned, these are vulnerable people living in

poverty. some of these people have limited health literacy, limited computer proficiency, it is insurmountable for some. these are the people that need care the most. these are the people that want to be at home living with family and their friends. these are the people who are unfortunately stuck behind this wall. this wall prevents them from, for example, if they need medical equipment to be at home and they have to comb different insurance programs, they have to sometimes wait to be denied i medicare programs. can you cover this medicare equipment that therapists and doctors say i need? so i do not -- so i can get around my home safely? the two different programs sometimes as well and getting

payments for their hospital care and trying to figure out sharing between the two different programs, also in terms of how long can they be in a nursing home and how many days are covered by the medicare program? it is all a wall that complicates the life's -- the lives of patients and health care providers and us. instead of us pending -- instead of us spending time improving their health, we are spending time on the phone trying to figure out how to get the care they need. that is a problem in our country that we need to fix. the way to do it is to integrate everything. to have one pile of money where the people and the health care providers who are responsible for the patient can use to

achieve and cover everything a person needs. >> thank you very much. miss benita, -- miss medina, how can states several more people in plants that work for them? >> in south carolina, i hope to approach this in two ways. first, by streamlining our programs as i mentioned earlier. when you have so many options, it is hard for beneficiaries to really understand which direction to go. we offer them one really good program or just a couple and think that makes things easier for them. i also hope that here in south carolina we bolster our service approach. i think that the state medicaid agencies -- for beneficiaries --

we have a responsibility to be available to them when they encounter roadblocks. >> thank you very much. chairman? >> thank you very much. i want to move to a question for mr. -- regarding home and community-based services. i mentioned that we have legislation to provide more of those opportunities. you had mentioned in your testimony the importance of those services in keeping you independent and giving you a high quality of life. on page three of your written testimony you said that what you did boast our home and community-based services and support. you later noted that your personal care attendant often participates in conversations with you and members of your care team. your testimony spoke to the importance of making sure the services are available to all who are available -- or

eligible. the quality and availability of the services across states. that is why we have introduced the better care, better jobs act. from your perspective, how would a robust investment in these services impact the lives of medicare and medicaid across the country? >> so many things come to mind but first is to recognize -- as a means of offsetting -- who have medicaid and -- myself, i am someone who has -- who is nursing home eligible. for me, i would be in a nursing home if i did not have the ac bs services that i received.

i think it is important that when other people -- people in the family rather than be isolated and in an institution and away from folks who some ply the support. states maintain a commitment to allowing people to remain -- evidence shows that increased choice -- associated with home settings -- people with disabilities in small settings are also more likely to achieve positive outcomes and improved quality of life. then those living in larger settings.

probably, the most important aspect to consider is it is important to look at the lifespan approach. recognize the needs of children and families are different than adults or older folks. -- it does not take into consideration the developmental milestones of kids with disabilities. those of us who learned how to drive, have a driver's license till how important -- to do things for ourselves. for people at disabilities it is important to have a wheelchair that meets their needs and meeting a milestone. an expansion of understanding of what determination of need is. it is important that -- whether

it be at adults with developmental disabilities -- the promise of integrated care is to provide tailored hbs services that meet the person's needs. i have experience that here myself as a dual eligible. if i were not able to use the services, it would be a different situation. it is important -- they are so woefully underpaid and underappreciated. they are in homes doing things that nobody else wants to do. a lot of folks cannot do the work and yet the amount of money that they make is not there.

-- engage in what would be nursing level activities, that includes changing my catheter and as the city with my -- they are doing all of this work and not receiving the money that they need. an example would be in massachusetts which is really generous at $17 an hour. the minimum wage in boston is over $19 an hour. -- as a cbs is being determined, the wages of folks doing this direct community work needs to be considered. the last thing i would say would be it is really important that the consumer driven model be central because i am a consumer

employer. i have been able to direct my care to them. i have been able to define my schedule. i am able to travel to work and do things in my community that i would not be able to do in an agency. there is a place for the agency model but for folks like myself who really need that flexibility to engage in the community we need the opportunity to live in the community -- with covid not for my personal care at home -- i would have been devastated. the relationship that i have -- during covid despite putting themselves at risk.

i cannot say more about making sure that these folks get reimbursed. >> thank you for your personal testimony based on your own experience and being a voice for those workers who are among the folks that we hope to be helping with some investments in home and community-based systems. >> can i say something more? it would be really helpful to institute like the national -- also cap -- this would give us a better sense of equality and access and the outcomes. having that -- how they are performing is critical. >> we are waiting for some other

senators who had to juggle things. we hope they arrive but in the interim, ranking member scott? -- right on the money. >> a quick question for the panel. have you been thinking about integrating -- do you have any examples where this is already being done specifically when it comes to navigating --? >> i can go ahead and start. i think -- health-care workers play an important role as a liaison between the health care system, social services and the patient's and community.

it is a potential workforce that we should tap into. it is a limited workforce. -- the key for successful community health care worker relationships is they must be integrated with the care team. if they are only in the community and not necessarily integrated with the care team it is not going to be a successful relationship rate trying to promote integration is key. i do know of one example in massachusetts under the 1115 demonstration, massachusetts made all of their medicare patients participate. there were a lot of funds for -- for example, western massachusetts where there are not as much providers as easter

massachusetts. -- in the survey we showed that providers think that community health workers are operating in -- >> thank you, mr. chairman. thank you senator. we are going to move to our closing statements at this time. i want to thank ranking member scott for hosting this meeting with me. -- and the work he is done on the legislation we have introduced. i want to thank him for that work. i want to thank our witnesses for their invaluable input as we noted earlier, their personal experiences. as we heard today, people with medicare and medicaid face many challenges in navigating health

care system generally but in particular, these challenges that our witnesses outline today , this challenge will impact their overall health and their way of life. we have work to do. the people that testified today whether it was jane or dennis or others who share their stories, these stories help us in congress to formulate policy and proposed legislation to make these programs work better. the health care system should provide support for them rather than adding another headache and so much confusion. jane, for example, should not have to worry about getting a surprise bill in the mail after a doctor visit.

dennis should not have to go to the emergency room because he cannot get a hold of his plans care team who were supposed to be there to help in. we need to make sure that the care delivery model available to people with medicare and medicaid meet their needs and meet their preferences. we must pass the pace expanded act to increase the availability of programs. it is why we should make a permanent investigation -- investment in home-based services to help people remain with their families in their communities. we are grateful for the testimony of our witnesses and now i return to ranking member scott for his closing statement. >> thank you, mr. chairman, for holding an important heating --

for holding an important meeting. for more americans looking for more information as they deal with declining health and challenges that all too often come with aging. today, we learned about the challenges of caring for dual eligibles. there are numerous gaps in policy that contribute to these challenges. as a son of a caregiver, -- a nurse's assistant for her entire career, last week i was visiting her at the hospital. this week is our 49th year at the hospital. she loves her patients and loves what she does because she loves making a difference. in today's world we need more people dedicated to that mission , whatever that mission is to you. we should be thankful that people have the mission to provide care for those who cannot provide care for

themselves. supporting care for dual eligible individuals will help fill some of those gaps. the legislation will help states provide care for populations who are desperately in need. the testimony today reinforces and amplifies the importance of that truth. two other points i think are really important. dennis, and so many others made a good job of helping us understand the importance of home health care and how you can sometimes get in a senior facility, so many people -- there care to be given in the environment that is best for then. that environment is so often at home. i think all that we can do to help people receive the care they need and they place of their preference is an important

part of health because peace of mind and health are so often synonymous. not only is there a mental health aspect but -- it cannot be overstated. i think very often, providing home health care is actually better overall in a system that has limited resources. it does not seem that we do but when we are spending money for medicare and medicaid and money for veterans benefits as well be read into the challenge of limited resources. i think we can take our resources further by focusing on a delivery system that is so often at home. the final comment i would make is that if we think through the unbelievable challenges of the

pandemic, one of the more important points is the delivery system of virtual health care. you have patients being able to see their doctors from their homes when possible, really helpful. i hope we continue as a nation to move in the direction of providing virtual health care is a priority and as a priority delivery system. i believe that it can take care of our patients and help us spend limited resources in the most effective way possible providing amazing assisted care to those who desperately needed. thank you again, mr. chair. i look forward to the next meeting. >> thank you very much. i want to thank you again. i want to thank all of the witnesses for their expertise and their time today. if any senators have additional questions, or statements to be

added, the record will be open for seven days until next thursday, february 17. thank you for participating. we are adjourned. [captions copyright national cable satellite corp. 2022] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> see the one focuses on lyndon johnson. -- the march on selma, and the war in vietnam. not everyone knew they were recorded. >> johnson secretaries new because they were tasked with transcribing many of those conversations into -- in fact, they were the ones that make sure the conversations were taped as johnson would go to them through an open door between his office and theirs. >> you will hear some blunt talk. >> i want to report the number of people -- >> presidential recordings.

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