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Senate | February 12, 2013 | Committee Room | Appropriations on Health

Full MP3 Audio File

Like to welcome everyone to the first joint sub-committee meeting of health and human services appropriations. We're glad to have all of you here with us this morning. Today we're just going to go through a few housekeeping rules and establishing what we're going to do as we go through this winter and spring and hopefully out of here before summer arises. but our job of course is to put together the health and human services budget for the legislature for the upcoming two year period. I'd like to welcome all of you here today as we embark on this every two year cruise and we;'re going to work very diligently this sub-committee will on both, from the senate and the house as we prepare the budget for our state for the coming two years. I'd like to introduce our sargent at arms from the house, Fred Hines, and Charles Godwin. From the Senate, Leslie Wright and Steve Wilson. And we're delighted to have these folks with us, they help us move along in an orderly fashion and we appreciate their service. Also we have some pages with us today. I'd like to introduce our house pages first and when I call your name if you will raise your hand to let us know where you are we'd appreciate that very much. Alec Johnson, sponsored by Representative Queen from Haywood county. Alec? Over to the left at the rear, thank you very much for your service and I hope you'll enjoy your stay in Raleigh this week. Erin Kayho [SP] from Cumberland county, sponsored by representative Glazier, she's at the back of the room, thank you very much Erin. Reyas [SP] Lane from Shewon [SP] county, sponsored by Representative Stein, over to my right at the rear door, side door. And Claire Ledford from Yancy county, Representative Presnell [SP] is your sponsor and we're glad to have you here as well. From the senate Jessica White from Mocksville, represented by Senator Brock. Is Jessica here with us? At the very back, thank you Jessica for your being here this week as well. I'd like to introduce the other co-chairs from the senate and the house and let them make any remarks that they would care to at this time. Senator Hise. Senator Hise is going to reserve his comments for later. Representative Avila. Representative Brisson [SP], Representative Hollow, well these folks are going to be very quiet but they'll speak softly and carry a big stick I'm sure. I'd like to introduce our staff from fiscal research, Susan Jacobs. And you folks if you have any comments to make please do so, if not well just raise your hand and let us see who you are. Susan Jacobs, Denise Thomas, Donnie Charleston, Jennifer Hillman, Joyce Jones. Joyce is from bill drafting staff. I guess I should have gone back and let you know the first three. Susan, Denise and Donnie are from fiscal research, Jennifer is from research, and bill drafting is Joyce Jones. Lisa Wilkes and Ryan Blackledge, and, OK, thank you very much. You know the staff is very dedicated, they're the unsung heroes who do all the pushing and lifting and get this thing going and see to it that we get through in a timely fashion so we really appreciate our staff. Now I'd like to ask all of the members who are here to please introduce themselves and give us a statement as to what you think you would like to see come out of this sub-committee as you are entering into...

of you are freshmen and some have been here for a term or two, and so we welcome all of you to the subcommittee on appropriations for the health and human services. I'm going to start off on my left, Sen. Beringer. It has to be held down while you speak. Maybe you can borrow Sen. McKissicks's. [SPEAKER CHANGES] Hello? Good. I am Sen. Tamara Beringer, I represent district 17, I'm a freshman, I'm very excited about this appointment, and I reserve further comments for later. [SPEAKER CHANGES] Sen. McKissick? [SPEAKER CHANGES] Sen. Floyd McKissick, representing Senate district 20, involving Durham and Granvill counties, look forward to working with the group as we face some very challenging times. [SPEAKER CHANGES] Sen. Robinson. [SPEAKER CHANGES] Thank you Mr. Chair, I'm Sen. Gladys Robinson, district 28, Guilford county, and I'm looking forward to what the group proposes, and then I'll certainly reserve my comments until then. [SPEAKER CHANGES] Rep. Farmer-Butterfield. [SPEAKER CHANGES] Thank you Mr. Chair. I'm from district 24, I represent portions of Pitt and Wilson counties, and I'm hoping I will be able to actively ensure that people with health and human service needs across the state are being addressed in a qualitative manner. [SPEAKER CHANGES] Rep. Ford. [SPEAKER CHANGES] Yes sir, Carl Ford, district 76, portion of Caberras and Rowan counties, and look forward to serving the people of that district and the people of North Carolina. [SPEAKER CHANGES] Rep. Fulgum. [SPEAKER CHANGES] Jim Fulgum, Wake county, district 49. I have a lot to learn and listen and say something when I know a little bit more. Thank you. [SPEAKER CHANGES] Rep. Martin. [SPEAKER CHANGES] Rep. Susan Martin, district 8, portions of Wilson and Pitt county, also a freshman and looking forward to digging into this and hoping we can make some sense of this big mess. [SPEAKER CHANGES] Rep. Lambeth. [SPEAKER CHANGES] Donny Lambeth, Forsyth county, I'm also a freshman, I think this is certainly a critical time for health systems and coverage in our state, so I'm lookin gforward to participating in some fairly nice discussions about where we are in health care. I'm certainly interested in raising the quality of care in North Carolina, I think we ought to be the premier state in the nation in terms of quality care for our citizens. [SPEAKER CHANGES] Rep. Murry. [SPEAKER CHANGES] Just glad to be here. Glad to have you. [SPEAKER CHANGES] Thank you members for being here today, and I promise that the lifting will get a little bit heavier as we go along. We have several, I see a couple of representatives from the department of health and human services, I'm going to ask Mr. Steve Owen, if you will introduce yourself and any other members from the department who might be with you Mr. Owen. I'm sorry, you're signing in at the same time, but if you'd approach the microphone and invite any other members of the department to come forward and make remarks after yours. [SPEAKER CHANGES] My name is Steve Owen, I'm the chief business operating officer for the division of medical assistance. [SPEAKER CHANGES] My name is Jim Slate, and I'm the director of the departments division of budget analysis. [SPEAKER CHANGES] Good morning, I'm Adam Scholler, I'm the new legislative liaison for health and human services. [SPEAKER CHANGES] We're glad to have you gentlemen with us. I understand perhaps some other members from the department may be coming in as we go forward. Thank you very much for your attendance today. [SPEAKER CHANGES] Going to ask Denise Thomas if she will come forward and speak on the area of team assignments. [SPEAKER CHANGES] Good morning Mr. Chair and committee members. I'm just going to very quickly go over a handout that should be in your notebooks in front of you. It's the health and human services team assignment. This session we are- we're formulated a little different in that the health and human services team is now made up of the members of the fiscal research division, research division and the bill draft

?? we’re trying to operate as one seamless team. As you heard before that we introduced Susan Jacobs, Donny Charleston and myself are the members from fiscal research. We also have a research assistant who will be working with us for the session. She’s not here today. ?? Thomas from the legislative tracking division is Joyce Jones, Brian Blacklitch and Lisa Wilkes and the research attorney is Jennifer Hillman and later on in another presentation you’ll hear about ?? specific roles but we just want you to have this team assignment. It’s pretty self explanatory as far as it shows all of the divisions in the department. It’s a very large department as you can see. On the division of central management and support, Susan, Donny, Joyce and Lisa will handle all of the issues related to that and that division includes the office of the secretary and it also includes their division of information resources management, their IT area. The division of medical assistance is primarily responsible for the Medicaid program and all things Medicaid related and Susan and myself will handle that for fiscal. Ryan is the bill drafting attorney assigned to it and Jennifer Hillman the research attorney. The division of Mental Health Disabilities and Substance Abuse under that area is also the Medicaid portion of Mental Health ?? 1915bc waivers primarily. I am the primary lead on that with Susan and also working on from fiscal and Joyce, Ryan and Jennifer will also staff that. The division of state operated facilities, that is division with all of the psych hospitals in the state, psychiatric facilities and other facilities, I also handle that along with Donny. Joyce is the drafting attorney. The division of health services regulation is Donny also and myself. The division of public health because we are a little short staffed in fiscal Susan and I will be trying to handle that together this session or at least until we can get another staffer on board and Joyce will be the bill drafting attorney. For Social Services it will be Donny Susan and Lisa. The division of aging and adult services, I will handle that, along with Susan and Joyce. Vocational rehabilitation I will also handle with Donny and Lisa. The services for the blind and deaf, and also the division of services for the deaf and hard of hearing I will also handle with Donny and Lisa and finally the division of child development and early education will be Donny 's area. Susan will back him up on it and Lisa Wilkes is the drafting attorney and Mister Chair that concludes my presentation [SPEAKER CHANGES] Thank you are there any questions from members about the team assignments? Being none thank you very much Denise. Next the appropriations process will be covered by Donny Charleston from our staff. [SPEAKER CHANGES] Thank you Mister Chair and good morning members and members of the audience. The document I’ll be referring to is the document you have in your packets entitled appropriations subcommittee process and role of central staff. Today my presentation will be a basic review for new members, what you may have already heard in orientation and for others this will be a review of the process you’ve undergone during your tenure here. The first item listed on the document is a continuation expansion budget. It refers to the two basic components of the budget. The continuation budget is a recommended level of funding needed to carry on government operations at its current level. The continuation budget typically contains inflationary increases for certain operating costs, annual ?? for programs that may have been funded for only a partial year, for example, pilot programs and may include operating funds for newly completed facilities. That is the typical information, including the continuation budget. We don't as yet know what information will be given by the Governor’s office to departments regarding what to include in the continuation budget. So we’ll have to wait and see what that budget will contain. The second component of the budget expansion budget and it includes any budget expenditures. Expenditure items beside and apart from the inflationary costs in the continuation budget. For example new programs, program expansion, moving items from one time to recurring funding. For example, pilot programs. The actual documents that work with in terms of and inform the appropriation process

are the Governor's recommended continuation budget. With it contains the base budget and any increases allowed in a continuation budget and the Governor’s recommended budget adjustments, which that document summarizes the reductions and expansion items that the Governor recommends. Now, as regarding the overall schedule, typically the process takes about six weeks, which includes the joint meetings and deliberation before chambers split to develop their respective budgets. For 2013, this Senate is slated to develope their budget first as the 2012, the House was the first chamber to develop their budget. As part of the budget process, committees will receive a budget target, which is essentially a dollar figure which is the total appropriations for the entire department, as determined by the full Appropriations chairs. The overall goal of the subcommittee is to produce a package which will contain the subcommittee report and any special provisions to be presented to the full Appropriations. Essentially, it is a recommended budget for DHHS, taken into consideration the Governor’s and the General Assembly priorities. Throughout this process, fiscal staff, as well as bill drafting and research take on a variety of roles. In analyzing the budget, fiscal research will look at the historical departmental spending and obtain detailed spending on programs from the department. This information will be used to assist the committee in deliberating about reductions, expansions, meter changes and any other options that the General Assembly wishes to take into consideration. Fiscal also handle requests by members to agencies for information to inform committee deliberations. We take these requests from you as members and we submit them to the department, basically confidentially, so we don’t refer to your requests using your information. Basically send it to the department as a request from a member, and we provide the information back to you when we receive it from the department. Earlier I mentioned special provisions. These are essentially individual sections in the budget that direct policy action or specify how monies are to be used, bill drafting takes the lead on crafting those special provisions for the budget. Fiscal staff also coordinates the activities of these proceedings by taking direction from the subcommittee chairs regarding the agendas, scheduling and report preparations. Additionally, fiscal will prepare fiscal notes, which are formal detail estimates of a bill’s impact on the department of health and human services. Earlier I also mentioned bill drafting and research. Joyce Jones, Lisa Wilkes, and Ryan Blackledge, will form the team along with fiscal research to health and human services team as it deliberate throughout the process. The research division in addition to bill drafting, is another central subcommittee process that will provide assistance as needed in analyzing legislation for constitutional problems. Analyzing the legislative impact on existing statutes and looking at the impact on regulations and procedures, policies and pointing out any ambiguities in potential legislation. Today we have representatives from the department of health and human services, they’re usually permanent fixtures at these meetings, and they serve as expert resource for member questions and will make presentations on different budget issues. The office of state budget and management will also participate in these proceedings and their roles to assist members and their staff with information on departmental budgets. That would essentially be a global overview of the appropriations process, and Mr. Chair, that concludes my remarks. [SPEAKER CHANGES] Are there any questions from members for Mr. Charleston. Senator McKissick? [SPEAKER CHANGES] Sure. This is just an inquiry so I know how we might be proceeding as a committee. Were there any items that were identified for continuation review going into this budget cycle where there’ll be reports coming back relating to its finishers that might have been made over the last budget cycle that were going to be reviewed by the subcommittee moving into this cycle, and if so, what was identified for continuation review and when will we be reviewing it. [SPEAKER CHANGES] We’re in the process of working with the committee chairs in compiling information and my assumption is that the committee chairs will disseminate that information to the remaining committee members. [SPEAKER CHANGES] Thank you. [SPEAKER CHANGES] Any further questions from members? Hearing none, Mr. Charleston thank you for your presentation. Next on the agenda is the Appropriations calendar by Susan Jacobs. [SPEAKER CHANGES] Mr. Chair, members of the committee, good morning. I’m having issues with the microphone. You should have a calendar in your notebook, and I will pick up where Donny left off talking about your appropriations process.

and every year the full chairs of appropriations come to an agreement for on a schedule for the upcoming session and that's what this calendar represents. So you will see in February that joint subcommittee meetings, of course, begin this week. Last week you were in this room hearing budget briefings from other colleagues in fiscal research on the fifth and sixth for the overall budget. This week you start your joint committee meetings. Today's meeting, of course, is an organizational meeting. Secretary Wos is scheduled to be here tomorrow to talk about her priorities for the agency for the upcoming biennium. The state auditor will be here on Thursday morning to talk about the Medicaid state audit that was released a couple of weeks ago. The following week will include non-profit reports that are required in the last session's budget bill. The week of February 18th will be dedicated to hearing those reports. If you turn to March, you will see that the joint work continues through March. You also have on your calendar, for your reference, several bill drafting and bill filing deadlines for your information. Corey and bill drafting sent this information out, I think last week, and it should correspond with what we have in the calendar here. We anticipate, or have been told, by a budget development team that hopefully we will have the Governor's recommended budget by the week of March the 18th and at that point, of course, we will include in your schedule some time for you to hear a presentation on the Governor's recommended budget. Beginning the week of April, I meant the month of April, joint subcommittees continue to meet until April 15th when the Senate plans to begin on working on its budget. That Senate budget process will last through the end of April with the Senate anticipating the third reading of its budget on May the 9th. The House will work on a response to that budget during the week of May 13th and May 20th with anticipating passing a House budget on third reading on May 30th. The final page, of course, is June with a conference report anticipated being passed on June 13th. And, Mr. Chair, if there are no questions on the calendar I will move into the next presentation. [SPEAKER CHANGES] There are any questions from members for Ms. Jacobs? Before we go forward, please, Representative Earle came in after the committee members introduced themselves. Would you like to introduce yourself to members, please, ma'am? [SPEAKER CHANGES] Thank you. I apologize for being late. Beverly Earle, Mecklenburg County, District 101. [SPEAKER CHANGES] Go ahead. [SPEAKER CHANGES] You should have, outside of your notebook actually, was a hard copy of this presentation that I'll be doing this morning and it is basically a very high level overview for the budget for the Department of Health and Human Services. Tomorrow, as I stated earlier, you will have the secretary's office in here. She will go into greater detail into some of this information when she has her staff. You will also receive more detailed information as we go through our briefings on each agency throughout the joint process. I think the first agency we will actually get into more details on will be the week after the non-profits, the following week Denis Thomas will begin with the division of mental health. So as we look at our agencies and evaluate core missions and functions we like to begin by looking at what's actually in state law and how those duties are defined. On slide two you see that the authority for HHS is down in GS-143b 127.1. The last time this was changed appears to be in 1997. Interestingly enough, I would point out from this authority that there is a lot of focus on, if you look throughout these bullets, on, the first bullet of course references public health and mental health but there is a heavy for preventive measure, if you look at the least couple of bullets. So when we look at our, when we look at agencies that we're covering and we look at the functions they are currently performing we like to go back and look at what the General Assembly had in mind for that agency when the agency was established. So you spend a lot of time, members and staff as well, looking at Medicaid and Medicaid expenditures, which, as you know, pays for health services. But, as I said earlier, the authority does reference prevention as a really high priority for this agency. You have the Office of the Secretary's work chart in your book and there are about 24 divisions and offices in the Division of Health and Human Services. A little over 18,000 positions

16,000 actual employees. So, we'll start by looking at the budget as a whole for general funding appropriations. So, 12-13, the Health and Human Services Budget, out of the 20.2 billions that was appropriated, and that's what your money report, your conference report actually shows when you start deliberating and voting on your budget in here, we'll talk about the funds that come in from tax proceeds. So, the total budget is about 52 billion dollars from all sources. But the amount that's in your committee report and in your budget is about 20.2 billion. Education, of course, has the lion's share of that 20 billion dollars, at 54.86 percent. Health and Human Services, as far as the size of its budget, is second, at 4.7 billion dollars, or 23%. The total of these two agencies, of these two subcommittees alone add up to about 78% of total funds of the 20 billion dollars. Now the reason this is important is because, at some point when you have both House and Senate targets, and begin putting your budgets together, in years where there have been a shortfall, and the full chairs and sub-chairs have to identify cost savings, if it is a significant shortfall, then of course the agencies with the higher percentage of general fund dollars receive the higher reduction targets. So, if you look at the 23% on the print from the previous slide and look at it more by function you see that Medicaid of the 20.2 billion dollars is about 3.1 billion, or 15%, the second largest would be mental health at 696 million, or 4%. All the other H.H.S. agencies, at 887 million dollars. Of course if you look at the education component,the 55% that I talked about a minute ago, public schools are 37% or 7.5 billion dollars, and higher education which includes universities and community colleges, 3.6 billion or approximately 18%. So I apologize for all the acronyms on this page, it's hard to put the full titles of these agencies on the slide, and so I'll talk briefly about this, you'll see on the next slide I actually have the names of these agencies. So we've started out at the subcommittee level and talked about the percentage of subcommittees' funds as it applies to the total state budget. And then we talked about program area Mental Health and how that applies to the total state budget. And then when you look within the subcommittee at the divisions within the Department of Health and Human Services, and how much money they have as a percentage of their total 4.7 billion dollar appropriation, you see that DMA, of course, has roughly 66% of the total funds, followed by mental health at 15%. I think this slide is probably more helpful for you, in looking at where the majority of funds actually are within Health and Human Services. And, again, this becomes important when you start your deliberations and begin putting your package together for a budget. So if you rank these divisions, in order of magnitude, beginning with the smallest and moving to the largest, you then see that Medicaid of course is at 66%, 15% mental health. So a 1% reduction, I don't know what you're target would be if there is a target. In the past, if you had a 2% reduction, you could...a 2% reduction would be almost 90 million dollars. So you could easily see that in magnitude...you could almost eliminate all the first five agencies before you actually reached your target. Now I say that because, when you then see a money report and options from your Chairs or you start deliberating jointly on options that you'd be willing to consider, when you have large targets, just like the full Chairs when they assign targets to subcommittees, you see big reductions in the divisions that have a lot of state money. So, as we do our highlights for you, and talk about legislative highlights and talk about where changes have been made, it's important to keep that in perspective. When you see smaller changes in some agencies, it's typically because they have a smaller state funded appropriation. This is a busy chart, and it is an attempt at highlighting for you, for the budget, what has happened in the past two years. So this first chart is fiscal year 11-12, as Donny told you just a few minutes ago you begin with the Governor's continuation budget, which we refer to sometimes as the base budget, it does have some inflationary increases and adjustments, the past couple of years it has not included the rebase amount for Medicaid. So for legislative changes, you see that compared to the Governor's continuation budget for 11-12, the net changes were 433 million dollars; now, the net change is an important distinction here because...

this is a chart that’s in the front of you money report that talks about a summary of changes across all agencies. There’s a lot of activity going on within these budgets that you don’t see in this chart or that you would not necessarily see in the front of that document. So just as we will go through the details of what has actually happened in these agencies as we do our briefings for you. Some that actually need to be pointed out in this chart would be, the first one is the one in child development where the Pre-K funds were transferred from DPI into the Department of Health and Human Services. So while it makes it look like there’s a positive change to that agency, in fact there were several reductions in that agency is a positive change simply because of that transfer. There are of course several things that were going on Medicaid and we’ll talk more in depth about that when I cover the Medicaid budget for you. In 10-11 there was an f-map or that’s the amount of money, or the rate that the federal government matches our Medicaid funds. There is a short fall, there was a contingency plan to take care of that in the technical corrections bill so that impacts that budget but is not represented by these figures. Moving to 12-13. [SPEAKER CHANGES] Susan excuse me for interrupting you, some members and people in the group may not understand Medicaid rebates. Would you mind going back to that and briefly explain it please? [SPEAKER CHANGES] Yes sir Mister Chairman and members of the committee when I refer to Medicaid rebates it refers to the amount of money you would need for the Medicaid program. Medicaid is an entitlement program, which means that states don’t have to participate in Medicaid but if you do participate in Medicaid and all states currently do, there are certain guidelines the state has to follow. You have a lot of flexibility about the kinds of services and things that you provide and the rate that you pay for those services but once a person is determined to be eligible for Medicaid they are then entitled to receive Medicaid services. So the rebates refers to the amount of money necessary to fund the Medicaid program in the upcoming?? or the next fiscal year, so how much money does it take to fund that program. Once you have that rebates number and it’s the same as the ADM number or the daily membership number you have to use in DPI for public schools. So basically since you have public schools the number of children grow, other things change and you have to apply and appropriate additional funds for that. The same thing holds true for Medicaid the rebates refers to the amount of money you would have to fund the growth in the Medicaid program. [SPEAKER CHANGES] So moving to 12-13, you have the Governor’s continuation budget again, you will see that for 12-13 it was only a million dollars more for the second year the biennium than it was in the first year in 11-12 so not much of an increase in the Governor’s recommended continuation budget for that year. Net changes were two hundred and forty four million dollars and you see the revised appropriation of 4.96 percent. I will tell you that if you break it out and look at it by the magnitude of reductions that year they were over 800 million dollars. The offsetting positive items that year would have been over five hundred million dollars and that’s why you have a net reduction of two hundred forty four million dollars, which is why I caution you, looking at these summary charts that we actually publish and try to figure out the level of activity, you have to look deeper than that into actual subcommittee report to see the level of activity. This I will point out on this chart will be of course; this is the second year of a Medicaid shortfall early on that session the General Assembly had to pass legislation to appropriate funds to help with that Medicaid shortfall. Two pieces of legislation were passed that year to help with that shortfall. There was also a technical adjustment. If you look at the division of Public health, where I had the two asterisks you see a positive number there where almost 7 million dollars, there were reductions in that agency that year. There’s a positive number here because of the program because environment health was actually transferred. So we talked earlier about on the four billion dollars and how it how it relates to your twenty billion dollars general fund budget. The total budget for Department of Health and Human Services is over eighteen billion dollars so the deliberations that you have the conversations that happen about changes to the budget is focused on approximately twenty seven percent of their total budget, State fund appropriation only makes up less than a third of the Department of Health and Human Services budget. [SPEAKER CHANGES] This last chart that I’ll cover with you deals with historical expenditures and up until this point, we've been talking about budget. Budgeted amounts and how the budget compares to the Governor’s recommended budget. We

[0:00:00.0] I will say that when we are looking at historical expenditures here because number one the state appropriation for the department is not even half of what the total budget is. And two, because of this significant change that had been occurring with reseat in this agency. In order to look at a real historical trend you need to look at total funds. So, that top numbers they have the 16 billion beginning in 2008 is actually the total expenditures for that year. You see that the blue shading will represent 12.2 billion dollars and that is the amount reseats for the department, the 4.6 billion dollars as the general fund appropriation. So, if you look across the years from 2008 to 2012 you see that it looks like the general fund appropriation has remain relatively flat that’s because primarily begin in 2008, 2009 the ARRA money starting to coming stimulus money of the American Recovery and Reinvestment Act begin paying for a higher percentage for medicate than they have previously, the Federal Government have paid previously. So, in other words if you are looking at the general fund appropriation and comparing that to how much you have actually had to put into that agency that’s a good number. If you are looking and trying to figure out whether the cost saving measures have been effective we are looking at any individual program as to if they have been successful and controlling cost and I don’t recommend you that you would need to look at total funds rather than just general fund appropriation. So, in the presentations that we will do for you would include both, we will talk about general fund appropriation because that’s why you will have to make decisions on whether it will make changes if there are any and off course total funds when we are looking at activities and trying to determine if a program has been successful and controlling cost in the any individual agency. So, Mr. Chairman that concludes my presentation on the overview of the program, we look off course how this same information in greater detail for all of our divisions in upcoming weeks. [SPEAKER CHANGES] Thank you Susan, are there any members who have questions? Senator Robinson. [SPEAKER CHANGES] Thank you Mr. Chairman and thank you Susan for your comprehensive report, just a question, you explained on page 11 that are all of those in the upper tier ARRA funds or is it other Federal money that we draw down and when does ARRA expire? [SPEAKER CHANGES] Mr. Chairman and Senator Robinson, the top number is actually total funds from all sources including ARRA, including that number would be the medicate Federal funds, other Federal grants or any kind of any other reseat fees or anything else that will be included in that top line, if you are going to see the reseats only where the ARRA money shows up is in that blue chart. So, in 2008, 2009 the ARRA funds were approximately I think 800 million dollars. In 2010, they were 1.4 billion dollars and this is just health and human services and then in 2011 the amounts of funds were close to a billion dollars for ARRA. [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] Yes, follow up please. Is there an expiration what is the expiration for ARRA funding? Was that permissive? [SPEAKER CHANGES] Mr. Chairman and Senator Robinson, the last year the ARRA funds actually expired. The 2011 was the last year. So, the most recent budget in 2012 you did not have any budget ARRA money there could have been some care for funds for agencies did not spend all, they can ___[03:48] into the next year but I think that all the budgeted funds, all the funds we have received have been budgeted. [SPEAKER CHANGES] Further questions from members of the committee? Representative Farmer-Butterfield? [SPEAKER CHANGES] Thank you Mr. Chairman I got an easy one for Susan and looking at your chart on page 7 you use a lot of acronyms, is it fair to say that the acronyms can be defined and looking at page 7? On your chart on page 6, I think it will be 7. [SPEAKER CHANGES] Mr. Chairman and Representative Farmer-Butterfield absolutely so that’s why I said you probably won’t like that chart. On the slide 6 which is why it’s the same information on slide 7, the response of those individual acronyms on the previous page, I think this is a better chart if you wanna look at individual divisions and what they are actually called I’m trying to relate in the actual services. So, yes this is a better chart. [SPEAKER CHANGES] There are a lot of acronyms associated with health and human services and we will be conducting pop-quizzes as we go along to see how proficient you are. [0:04:59.9] [End of file…]

Any other questions from members of the committee on this also represent a land of the same question that the carols, said Gary one of these number somewhere at (SPEAKER CHANGES) Mrs. Share represents about half the frustration you can watch on actually an additional system that's down from its new supply at 311 billion dollars (SPEAKER CHANGES) from members of the committee of burgeoning market and engines can see things in a(SPEAKER CHANGES) separate question on a web site in north county health release was defined in the state chair in representing buying hole twice by promising officer respect and pride and four children in North Carolina that a program commerce children, AC Martin sent eight IP H6 but health was prior camera picks up where that would make a stock's Commerce people up to 200% fell on the level set is actually managed by the National Systems in research department for children and, like Medicaid is not an entitlement program is a grant from the private and Federal government, we have constant five volunteer next rate is higher than bringing a 75 students range elsewhere Spartans to gauge on average about 66% (SPEAKER CHANGES ) any other questions from members of the committee on thank you very much in the season for the sun with this report on form a union to the next item on the agenda which is a subcommittee got its on the on the house and senate corporation shares have one issue go their goals for the work of the subcommittee a short subcommittee and are on board at which you missed the as four is a joint budget strategy is concerned we're going to focus on core functions of government and whether or not they are adequately funded realizing that health and human services is one piece of the total state budget will continue to look four fish and cities across lake government including looking at complexity of programs we will evaluate the appropriate funding levels four non-core services including nonprofits and other nonessential services we will consider ways to strengthen the general fund and evaluate special funds on getting down to the nitty gritty of our subcommittees work we will conduct one joint meetings with both house and senate members of their appropriations on subcommittee on health and human services we will maintain transparency as we go through this process of having open meetings and certain members of the public are invited to attend the meeting we may help and we will have to the maximum use impossible use our website to inform the public than the way you're going to help the schedule being so that will be a main avenue of getting the word out to the public that we have of one of the subcommittee staff for the time. Coming up we will be every Tuesday and Wednesday and Thursday at 8:30 until 9:45 and that will be the main deliberations of the town 4 hour as we hammered out a budget we are starting as you noted today was to one edge official meetings with fiscal research service provider will above to background to which you past legislative budget policy actions we will review the Enron Committee reports will review Federal changes that impacts the various states and how it affects our state and we we hear the governor's budget when that becomes the appropriate for us when of the governor's budget description they'll be certain items that we cannot answer in the subcommittee and we will have to go to the appropriation chairs from the house and senate four answers such as celery related items that service or other statewide issues also…..

Increases or decreases, and any unresolved items that we as a sub-committee, joint sub-committee are unable to reach. And we will consult with other sub-committee as necessary, for instance our program evaluation and other committees as we go along, other sub-committees who may have some like interests with our sub-committees. we will receive guidance form the appropriations chairs on the house and the senate on spending targets when they are resolved, sub-committee deliberations in voting. As you know we're members of the senate and others are members of the house and when we come to a vote that will be worked out, we're not going to vote together we will vote separately and all that remains to come out of the deliberations between the four chairs. And special provisions, that will - we'll get guidance on that from the chairs. Now having heard all of this, is anyone on either the house or senate sub-committee who wishes to withdraw from this sub-committee? Well you're not going to be able to, you're here, you're sentenced for the next several months to be on this committee and it's very important work that we do here because let's face it, we are looking out after some of our most vulnerable citizens in this state and we must do it with care, efficiency and compassion. Now Susan are you supposed to get back up here and give us something else now? You're finished? Are there any closing remarks form any of the chairs? You're still holding your silence, something tells me this is not right. Members of the committee are there any closing remarks? Oh, I'm sorry, senator Robinson forgive me please. [SPEAKER CHANGES] Okay, thank you Mr. Chair and thank you for leading this committee. We appreciate our experience in this area and I wanted to commend the staff when she went through the teams, everybody has a whole lot to do. and that takes competency, that takes efficiency, that takes long hours and I'm not sure they get commended for all they do. I know they're small and they've been cut and that kind of thing but we can see the dedication, they do a fantastic job so I just want to extend my personal thanks to them. [SPEAKER CHANGES] Thank you for that and in keeping with that I think it's very important that we be cognizant of the time, the limited time that the staff has to give any of us. They do a great amount of work in a very short time meeting short deadlines and we have to recognize them and for their endeavors. Is there anyone from the department who has anything to add to today's meeting? Mr. Slate? Mr. Owen? Any? I understand the secretary will be joining us tomorrow and we look forward to hearing from her and some who have not had a chance to meet her to actually see her and have an exchange with her and members of your staff. Is there anything else to come before this sub-committee today? If not thank you very much for your attendance, we are adjourned.