June 17, 2026 · AGING AND OLDER ADULT SERVICES · 12,176 words · 18 speakers · 132 segments
Thank you. Thank you.
Chairman Dan Williams and Doyle Hefley, thank you for being here. Please be aware that this meeting is being recorded and that we'd like you to silence all of your electronic devices. And also, if you see members coming in and out of this meeting, they do have other meetings and other hearings to attend, so people will be coming and going. For today's attendance, let's ask committee members to state their names and where they're from.
Steve Menser, represent part of Lancaster County.
Representative Madden, I represent the 115th Legislative District in Monroe County.
Good morning, everyone. Dan Williams, I represent the 74th District in Chester County.
Good morning, Representative Doyle Hefley, 122nd District, Carbon County. Representative Malou McKenzie from the 131st District,
which is part of Northampton County, part of Free High County, and part of Montgomery County. Good morning, Barb Gleim from the 199th. It's northwest portions of Cumberland County. Good morning, George Margettis, the 196th.
It's the western part of York County, and Mark's here to the north of me here.
Hi, Mark Anderson, 92nd District, northern York County.
Hello, Eric Nelson, 57th District, Westmoreland County.
Good morning, Jessica Benham, 36th District, out in Allegheny County.
Good morning, Representative Keith Harris, 195th District in Philadelphia.
Good morning, Nikki Rivera, 96th District in Lancaster City.
Good morning, Lisa Borowski, the 168th in Delaware County.
Thank you, and we have been joined by Representative Bridget Kozaroski, representing Lackawanna County. Did I get that right? And can we please have the folks online introduce themselves, the members?
So, Representative Arvin Venka, 30th Legislative District, Allegheny County.
Taracon, 194th District, Philadelphia County.
Rep. Jones?
Sorry, Mike Jones, York County, 93rd District.
Shelby Labs, 143rd District, Bucks County.
Kristen Marcel 178th and Bucks County Thank you all
The purpose of today's hearing is to provide members with an update on the implementation of the Inluon Services, or ILOs, initiative within Pennsylvania's Community Health Choices Program. As policymakers, it is critical that we understand not only how the program is being rolled out, but also the changes, opportunities, and lessons learned through the implementation process. Just as importantly, today gives us an opportunity to hear about the impact of ILOs is already beginning to have on the lives of Pennsylvanians. the program was designed to give managed care organizations greater flexibility to address unmet needs through innovative person-centered services that help individuals remain healthy, independent, and safely supported in their communities. While implementation remains in its early stages, there are encouraging developments that warrant our attention. As Pennsylvania's population continues to age and the demand for long-term services and supports grow, innovative approaches such as ILOS may help improve quality of life, expand consumer choice, and reduce unnecessary institutionalization. The success of these efforts will depend on thoughtful implementation, strong oversight, and continued collaboration among the department managed care organizations, providers, advocates, and participants themselves. Before we get started, I'd like to ask the Chairs, Menser, Williams, and Hefley if they have any opening remarks.
I'd just like to thank Chairs Madden and Williams for putting this informational meeting together. And I think we're all very anxious to see the progress that's being made in the interlude of services area.
I'd like to echo that sentiment again and say good morning to all of our committee members as well as the appropriate chairs. And thank Chair Madden for making this opportunity to talk more comprehensively about something that I think impacts all of Pennsylvania.
I'll simply say that today's discussion is an opportunity to examine the progress of assisted living in lieu of services program. And better understand how policy makers can strengthen and then expand access to these options for older adults and individuals with disabilities. I look forward to the discussion. Thank you.
Thank you to all the chairs that are here and all the committee members that are here today for this really important meeting as we look here at the opportunity to hear about funding long-term care services through medical assistance. As a Republican chair of the Human Service Committee, I understand the importance of ensuring that older adults can access these services in a way that meets their individual needs. And I want to thank the testifiers for being here today.
Thank you, Chairman. And again, I would like to thank all the participants and the testifiers that are here today. We appreciate your partnership and your willingness to come and let us know how the program is going. And we will start with a good friend of both of our committees, Deputy Secretary Juliet Marsalis.
Thank you in the Department of Human Services Committee As you know I Juliette Marcella and I serve as the Deputy Secretary for the Office of Long Living in the Department of Human Services And I am really grateful for the opportunity to testify today regarding the In Lue of Services, or ILOS, and specifically the Department's Assisted Living In Lue of Services option that is available under the Community Health Choices Managed Long-Term Services and Supports Program. And this is the program that is overseen by the Office of Long-Term Living. So I'm really pleased to have the opportunity to talk about this innovative option in the CHC program aimed at providing another high-quality service option to eligible participants in the program. So for a little bit of background, assisted living is not regulated by the federal government. So as such, there is no single definition for assisted living in the United States. Assisted living is a term that's often applied to community-based residential settings that provide housing and meals, the sort of room and board, as well as various activities of daily living or long-term services and supports to assist a resident being served. So across the nation, there are a wide variety of settings that may be referred to as assisted living with a myriad of service requirement levels. And so it's critical to keep this in mind when speaking about assisted living, and especially when comparisons are being provided using other state definitions of assisted living. For the purposes of today's testimony, I'll be speaking about assisted living and assisted living residences as those concepts are regulated under Title 55, Chapter 2800 of our Pennsylvania Code. I've shared a one-page, or Ann Marie has graciously shared a one-pager handout that highlights the key differences in Pennsylvania between personal care homes, assisted living residences, and skilled nursing facility settings, for your reference. So the differences in requirements, particularly in licensed staff and staffing, address the different levels of care needs of each resident served in each setting. As you know, in 2016, the Centers for Medicare and Medicaid Services finalized regulations that formally recognize states and managed care plans' abilities to provide services or settings that are substitutes for services or settings covered under the state plan. And that is why we term this in lieu of services. Prior to this, our managed care partners could cover alternative services or services in alternative settings under risk-based contracts. So it's a slight change to that. So the Community Health Choices Managed Care Organizations can now identify and pursue in lieu of services for health-related social needs or alternatives to current state plan-covered services. And by promulgating regulations, CMS's goal was to bring consistency to the plan's use of these alternatives, as well as ensuring adequate enrollee protections. So under federal regulations, the following requirements must be met. The ILS must be cost effective. It must be medically necessary or a setting that is offered to a participant as that substitute for a state plan covered service or setting like a nursing facility. Participants cannot be required to use an in lieu of service. In lieu of services must be provided at the option of the managed care organization. So what this means is that the Office of Long-Term Living does not direct their in lieu of services. This is something they create within their programs that makes sense to sort of their model of operations and their models of care In lieu of services cannot violate any applicable federal requirements and there are general prohibitions on payments for room and board costs under the Social Security Act that applies. So in CHC, we do have that assisted living in lieu of services, And I'm excited to talk about it because as of June 1, 2026, we have 64 assisted living residences or ALRs across the Commonwealth, which represents about 5,300 or 5,384 license spots. And approximately 69% or 3,700 of those spots are currently filled in our assisted living residences. So these are filled with Pennsylvanians who privately pay for room and board and personal care tasks. And assisted living residents offers all the care provided in a personal care home level of care, but may also be able to serve individuals with higher care needs as they have different staffing levels, training, and building requirements. So assisted living residents provide opportunities for residents to age in place. It's different than personal care homes. And they're licensed by us in the Pennsylvania Department of Human Services, and they must adhere to the Title 55, Chapter 2800 of the Pennsylvania Code. An assisted living in lieu of service option in the CHC programs allows Medicaid to assist with covering the costs for the personal care tasks, not the room and board. As I mentioned earlier, covering the cost of room and board is not permissible because an in lieu of service cannot violate any current rules that govern the Medicaid program. An assisted living option was pursued by all three of the CHC MCOs as an alternative for nursing home placement. Nursing facility services are a covered state plan, so this is the service it's replacing. And it's replacing it because assisted living is anticipated to provide a less restrictive and a less costly option. So the target group for the assisted living in lieu of services are nursing facility clinically eligible individuals enrolled in the Community Health Choices Program who are in a nursing facility but are interested in transitioning to a less restrictive setting or individuals at risk of a nursing, imminent risk of nursing facility placement who are interested in diversion from placement in a nursing facility into assisted living. So individuals residing in a long-term care facility or receiving home and community-based services can transition into an assisted living in lieu of service and receive that in lieu of service in place of their facility. If all the other eligibility criteria are met for enrollment in the Community Health Choices Program. Individuals not enrolled in the Community Health Choices Program do not have the option of this service. So OLTL is supporting the In Lue of Service effort by enrolling assisted living residences as Medicaid providers for the specific purpose of helping to track the In Lue of Services progress. And as of May 1, 2026, we have supported and enrolled 18 assisted living residences so that they can continue the contracting process with each of the respective CHC MCOs. and so these 18 assisted living residences represent over 28 percent of all the licensed assisted living residences and we continue to encourage more providers to join and to educate current personal care home operators that they also may be able to convert their license to assisted living to become part of this in lieu of service if they meet the sort of regulatory requirements, and many of them do. And so we really are focused on strengthening the network across the Commonwealth. So the Office of Long-Term Living has developed policies to outline the requirements for the CHC MCOs to provide the assisted living in lieu of service. In addition, we've developed guidelines documenting, outlining the enrollment process for all the providers interested in offering this in lieu of service option. We have developed an operations report to track the utilization of assisted living in lieu of services and outcomes for participants. In the calendar year 2025, 15 individuals selected this option and in the first quarter of 2026 we had 13 additional individuals select this option so it's almost doubling the total number of participants from last year and in the very beginning of this year so that's exciting so out of the 28 participants currently participating in the assisted living in lieu of services 12 individuals transitioned directly from a nursing facility, and 16 individuals were diverted from going into a nursing facility. So we continue to monitor the utilization and the outcomes of the in lieu of service option under the CHC program. We have engaged the University of Pittsburgh Medical Research Center to assist in completing an independent satisfaction survey of all the AL, assisted living in lieu of services participants and providers. We continue to collaborate with our managed care organization partners and our assisted living resident providers to ensure this remains an innovative option for CHC participants. In lieu of services eligibility, we implemented a new eligibility procedure to ensure our county assistance offices were correctly reviewing and processing eligibility for those seeking to reside in an assisted living in lieu of services. So individuals residing in this setting who are nursing facility clinically eligible, they're reviewed for medical assistance eligibility using the same rules used to determine eligibility for people eligible for medical assistance due to their need for care in a long-term care facility. So like long-term care medical assistance, recipients may be responsible for making a monthly payment for their care to the assisted living residents. It's a sort of patient pay portion that is also utilized in long-term care. And that's part of the eligibility process. The county assistance office determines what that sort of patient pay amount would be. And that sort of goes to that room and board piece that I was referencing earlier. So as we continue to see growth in this use of assisted living in lieu of service, we are going to be able to increase our ability to evaluate the impact of the in lieu of services option and that option's inclusion in the CHC program. We will continue to evaluate the success of the program's compliance with the required parameters previously mentioned that are put forth by CMS. and most importantly, we're going to be assessing the impact for Pennsylvanians receiving care. The implementation of Enloeith services has been a very beneficial option We are eager for more providers to enroll If you know providers encourage them to enroll And we really do want them to enroll with the CHC MCOs because building that strong and robust network across the Commonwealth is going to be critical for any additional expansion or adoption of assisted living residences as a permanent service. So this is that beginning of that journey to what we hope is a permanent service. Including the assisted living in lieu of services as an option in the CHC program has provided a measured approach to understanding how it can meet the needs of eligible Pennsylvanians. And from this implementation approach, we're able to carefully evaluate the needed capacity, the provider education, policy and operational workflow development. And we are excited about the progress that we've made with the implementation. And we look forward to the continuing growth and success for years to come. And I'm happy to answer any questions because I'm excited about this. Thank you so much.
I'd like to mention that we've been joined by Representative Hogan. Representative Serrato. Does anyone have any questions?
Chairman, sir? Thank you, Chairman. Just a clarification. So the room and board piece, if we have a participant A who might have a $2,500 a month Social Security check and qualifies, and then we have another patient who has a $1,200 Social Security check but qualifies, that is how the counties determine who's eligible and who's not eligible based on some formula?
No. The county assistance office will determine the eligibility for the CHC program first, as they do any participant of the Community Health Choices program. Then what they do is they determine a patient pay portion that goes towards the room and board. So that's a sort of another additional calculation. calculation. So if someone's receiving $2,500 or $1,200, there's a certain amount that a person can keep for themselves for their buying things that they need, snacks at the snack bar, pair of bed slippers. And then there's the portion that would go to the provider facility towards the room and board. So the county assistance office does both of those calculations. Thank you.
Chairman Williams.
Thank you, Madam Chair, and thank you for your testimony. Just a quick question. I heard you talk a little bit about implementation and expansion. How is the department informing current nursing facility residents that they might be eligible for participation in the program?
Yeah, that's a great question. For every member that is in the Community Health Choices Program, and the majority of nursing facility residents who are Medicaid eligible are in a Community Health Choices Program with a managed care organization, they each have a service coordinator that meets with them in the nursing homes and orients them to all of their services and talks with them about the potential to transition and checks in with them to see if they wish to transition back to the community Anyone who raises their hand and says I like to go home the CHC MCOs will support them in developing a plan and that plan could include assisted living as their option, and they'll provide that as an option as they do every HCBS service.
Good. Quickly, among the individuals who are eligible for assisted living, what are the most common reasons they ultimately choose not to pursue that option?
Well, I honestly don't know. I think the CHC MCOs may be able to speak better to that experience as they're in that day-to-day. I haven't heard from individuals who have refused that option, but it could be paying for the room and board. It could be that the assisted living residence isn't close to their family because we only have 18 enrolled today. So there might be a wide variety of reasons why someone may choose not to pursue assisted living. They may want their own apartment. They may want to be back with their family.
I appreciate that. Thank you.
I would also like to mention that we have been joined by Representative Borowski and Rep. Razzle. Did I miss anybody? We're all here now? Okay, great. And Representative Marcel, oh, Representative Halfley, you have a question? Chair Halfley?
Yeah, I'm sorry. I didn't know.
You're good.
I just obviously seems to be something we want to pursue. How do we get more assisted living residences to enroll in these Medicaid providers so that they can participate in this program? Are we hearing from that there's any impediments to them getting into the programs?
So I think part of it is sometimes it's still fairly new, and some folks may want to wait and see what it's like. There is a considerable vetting process for being enrolled as a Medicaid enrollment provider. So there is paperwork and an application process and the requirement to have specific background checks and ownership information. So there is a body of work that needs to be done. I am very grateful for the 18 first adopters because they're our trailblazers. And I think as we are able to celebrate what they've accomplished, we are going to all the local conferences. We are providing additional education. um you know i know some of the associations are here we've had joint presentations with assisted living residence providers that have gone through the process um the the sort of first couple were a little bumpy because we had to figure out the new provider type and all the different pieces um but i think right now we have that process set and a lot of support available so we haven't had any feedback from those 18 or any other states that i've implemented anything like this as to what, if there's anything in our process that could be a hurdle. Sometimes, I mean, obviously every time we, there's always a lot of regulations that oversight, and necessarily there should be, but I don't know if as we move forward with this, because this seems like something we really want to do to, you know, get more people into environments so they maybe feel more comfortable and get them the services they need there. So as we move forward, if those things are identified, anything that the legislative branch can do to assist, and that would be something I would be willing to focus on. Yeah, I don't think there's sort of barriers to enrollment. I think one of the sort of biggest pieces of work is when providers enroll in Medicaid they have to evaluate all their policies and procedures and operations And there's a learning curve with matching that with what's required to be part of a Medicaid program that perhaps an assisted living residence didn't have to do before. So it is sort of a big operational shift for some of those things in terms of changing their policies and procedures to meet the Medicaid requirements.
All right. We'd like to dive into that. So we're going to have some discussions moving forward. But I think it's how do we make that process a little bit easier? How do we educate those folks? But we can talk about that a little bit more in depth maybe.
Yeah, happy to. I have a whole team available to support any provider interested.
Yeah. Thank you. We have questions from Representative Marcel online, and then we'll go to Representative Gleim and Representative Rivera, and we have been joined by Representative Marla Brown. Good morning. Rep. Marcel?
Thank you so much, Madam Chair. I had a quick question relating to the – at the end of your commentary about the in lieu of service kind of pilot program or whatever we were calling it. Is there data that would support making that program more permanent from your perspective?
Yeah, I think we're at the very early stages of that. Right now, we've only had a year and a couple quarters of activity in the service area. And we only have 26 residents currently utilizing the service. so I hope to build on that as we get more data in as we get more time in to see the outcomes be able to compare outcomes with participants currently in the program and really learn more about individual satisfaction with their experiences and their journey and transitions we'd be able to to tell more in addition we will be doing as part of our independent evaluation with our university partner to evaluate both their experience, but we're also needing to evaluate the cost to ensure that it costs less than any of the services it is replacing. And I think as we find out more about the financials and we find out more about their experience, we would have a much better sense of where we may be with the journey towards a permanent service. In addition, we would have to see a larger increase in the provider network across the Commonwealth. That is a key piece of this strategy. We need to see that additional interest from providers, new existing or personal care home providers converting.
Thank you. Thank you so much.
Thank you, Chair Madden.
I am curious. Hi there. Thank you for all the information. You piqued my interest with definitions and vocabulary all across the nation, and federally there are varying definitions. Are there other states in the U.S. that are doing this well that we're modeling ours after? Is there somebody that we've based our approach on for this?
So there are several hundred different definitions of assisted living, group settings, residential settings. Pennsylvania is not new to having different types of residential settings in our various waiver programs. So we haven't modeled this after a specific state. You know, we have sort of made this Pennsylvania because Pennsylvania has a very distinct separation between nursing facility, assisted living, personal care home, and other group settings licensed by other bodies. So we've really kind of had a Pennsylvania-first approach.
Wonderful. Thank you.
Representative Glein.
Yes, ma'am. Thank you. I would like to know who is the university partner you're using, and should we also be looking at the direct care worker staff, and do you have enough staff? Do we need to upscale staff first before we have the providers come into this program?
Yeah, very good questions. So a lot of our work that we do to evaluate the Community Health Choices Program is with the University of Pittsburgh Medical Research Center. And so they're really well-versed in all of our CHC programs and do a lot of our independent evaluation. So they are doing the independent evaluation of the member experience in the in lieu of service. With regards to looking at the direct care workers within assisted living residences, that was part of our evaluation process of approving the in lieu of service. The 2,800 regulations in the Pennsylvania Code, it was designed intentionally to be able to allow individuals to age in place. So it has that additional nursing and direct care worker staffing ratio requirements to give us confidence that these are settings that could serve individuals who have skilled needs. to answer their question with regards to direct care workers across the board. We all know there's a direct care workforce shortage. Our assisted living residences are not immune to having that challenge be something they need to face. And you'll likely hear more about those challenges from the associations who are providing information. And, you know, one of those challenges for, like, personal care homes and assisted living residences across the board, again, is always how do we create a living wage for direct care workers? And certainly, as you know, with this administration, we are pushing for that $15 an hour increase. That certainly would help.
Thank you.
Rep. Borowski?
Yes, thank you, Deputy Secretary. I appreciate your testimony and very interested to learn about this program. I guess what I am trying to glean from what you've talked about, what are the benefits to the groups participating in this program? So what are the clear benefits to them?
So as we work to try to get more people enrolled or more providers enrolled, What would be the clear benefits to this? For providers?
Mm-hmm.
Okay. I think there are several. One is that for individuals currently residing in assisted living residences, as their resources are spent down, they won't be forced out of their homes. The providers who have built long relationships with them may continue to serve them if they become eligible for the CHC program So that a benefit both to the provider and more importantly to the Pennsylvanian As you noted prior in my testimony right now there some capacity in assisted living residences. They're about 60% filled. This provides an opportunity to serve a population with funding that they wouldn't have had before because that personal care portion or the additional needs above the basic personal care portion can be paid and covered by Medicaid. That provides, I think, another revenue source for assisted living providers that they did not have before.
Rep Hogan.
Thank you, Madam Chair, and thank you, Secretary, for being here today. So you just said something that I thought was a little interesting, but I want to start with a different question because this is a pilot program and Medicaid is the largest part of our budget. What is the current budget for this pilot program and where in the Medicaid line item is it specifically located?
It falls under the CHCMCO capitation line, so there's no new funding. It's a service that's added by the CHCMCOs. So the CHCMCOs get their capitation payment, And what this option allows them to do is sort of have cost savings within their program because nursing facilities cost more. Assisted living residents should cost a little less. That it doesn't create new funding.
So you just said, though, that as individuals draw down their resources, couldn't that potentially put more seniors in the Medicaid that were not previously on Medicaid and cost the state more money?
Well, those seniors are not on Medicaid or residing in assisted living residences today. They would become eligible if their skills went up and their resources went down anyways. So it's not creating any new population that would not ordinarily be served in CHC. What it actually does is those seniors today, more often than not, if they are at assisted living, they spend down and they cannot afford the entirety of the private pay portion of assisted living, they wind up in our nursing facilities on Medicaid anyways.
Okay. And just one last question. Which costs more. So thank you for that. And then finally, because this to me, you know, and I came in late, but I was reading the testimony, kind of seems like it operates outside of traditional Medicaid parameters. Has the department been working on or looking at models to combat any type of waste, fraud, and abuse that we've been seeing nationwide in Medicaid programs? Specific to in lieu of service or the program integrity overall?
In lieu of service. Yeah, so that's part of the requirements of being enrolled as a provider, right? You have to go through a thorough vetting process. You have to have policy procedures, operations that are acceptable for the Medicaid program. The ownership is vetted to make sure that they are eligible for the Medicaid program. They're not on any exclusion list or anything of that nature. Coming in as a provider, the Medicaid program also subjects you to our program integrity monitoring. So we have our CHC MCOs and their special investigative units are involved routinely, as they are throughout the program. We have our QMET teams that are involved. We look at the claims data that's coming in, similar like we do in nursing facilities. We make sure the person's actually there, actually getting services. And they still licensed and regulated by our Bureau of Human Services licensing to make sure they meet all of our regulations on to have an active license which they must maintain to remain in the Medicaid
program. Okay, thank you. Thank you. And our last questioner is Rep. Nelson.
Thank you, Chair. Always great to hear your testimony. And I was trying to, very interesting numbers. You know, as we were looking at the 69% utilized beds in skilled nursing, and I was texting with some facilities just to see, at least, you know, this is a pilot and we're learning, but my understanding is it's not possible for a facility would need to decertify as a skilled nursing to then become assisted living, or could they do both, you know, because these, at least some of the impression is that they would almost have to be like they were closing. Their skilled nursing residents would have to go because it's a different set of regulations. Even though there wouldn't need to be a lot of physical changes at the facility, their current clients, would they need to be relocated? Would a facility be able to easily achieve a dual certification to utilize these slots that you had referenced?
Yeah, so the assisted living residences are in lieu of a nursing facility placement, right? We're not talking about skilled nursing facilities becoming assisted living residences. So they certainly could consider changing their license to become an assisted living residence. The nursing facility is considered an institution. Assisted living folks are in their individual space apartment setting, right? They're sort of very different. Could a nursing facility change their floor plan and become assisted living? They certainly could contemplate that. but we are not looking at co-locations because there are some very clear rules in home and community-based services and Medicaid and Medicare CMS that specify what could be considered a community setting versus an institution and one of those is you could not co-locate on the same grounds as a nursing facility so there would not be a dual license of a nursing facility and assisted living in one building. There would be some challenges and hurdles to that.
Okay, thank you. Thank you for that clarification.
Thank you, Deputy Secretary. Thank you for being here. Thank you for sharing all that wonderful information. Our next panel is Heather Holman, who serves as Vice President of Managed Long-Term Services and Supports for UPMC Health Plan, and Joseph Elliott, who serves as the Director of Care Management for long-term services and supports at PA Health and Wellness. Welcome.
Good morning. Good morning. Thank you for having us here. It's an honor. I will say this is a little surreal for me. I started my career as a district office staffer in York many, many years ago, and now I'm sitting here, so it's kind of exciting. So thank you for having us here. So I'm Heather Hallman. I am the Vice President for Managed Long-Term Services and Supports at UPMC Health Plan. And I'm really excited to get this opportunity to talk about In-Lew-Ov Services with assisted living. We worked many many years in partnership with the Office of Long Living to make this happen And they were great partners with us to make sure that we could find a way to offer assisted living without exactly what Representative Hogan talked about without woodwork effect How can we make sure that this is a less costly alternative and make sure that we're not unintentionally growing the Medicaid program? So I'm here to tell you a little bit about what we have done. And so, and we have a PowerPoint because I'm not good at reading things. So can we flip to the next slide? All right. So assisted living, I don't want this to be duplicative of what you've already heard. So we're going to talk a little bit about what really is assisted living. Assisted living is a residence, but we actually are only paying for the services that are received within that residence. We cannot pay for room and board per federal law. And so what is offered through this, and you'll see the list there, personal care, emergency alert response systems. We're talking about non-medical transportation so they can get out into the community and still be part of the community with their friends and families. Basic cognitive support, those chore services that keep people, their homes clean, and 24-hour response if something happens. So this is really what we're talking about. we are paying for those services that we would have also paid for if that individual was in a nursing facility or remained in their home with home and community-based services. So that's how we look at this, is those are the services that we are paying for. Next slide. All right. So we utilize, so as Deputy Secretary Marcela said, each MCO is implementing in Louisville services a little bit differently. I would be willing to bet pretty much the same, but you know, we all, I'm sure, have a different spin on it. So we look at this as an alternative placement to a nursing facility. So we have individuals who are in a nursing facility and are ready to step down to a little bit lower level of care, but they still meet that clinical eligibility for nursing facility level of care. They're not ready though yet to move back into the community. They might not have the housing. They might need additional supports that we really can't offer as easily in the community. So this we look at as a step down from a nursing facility to a less restrictive setting for them. We also are looking at individuals who are currently in their homes, they're getting home and community-based services, but are at risk of losing their housing. We all know that there is housing for seniors and for people with disabilities is not inexpensive, so it's important for us to offer this as an option rather than them automatically having to go into the nursing facility when that's not the level that true level of care that they actually need so this is how we look at it we're looking for individuals who are at risk of losing their housing or ready to step down from that nursing facility and we look at you know barriers for securing the housing to do their activities of daily living lack of those informal supports in their homes because while we can offer 24-7 services in a home, things break down. There are times where people need additional services or they need their informal support. So it's really critical that they have those backup plans. And if we're not ready, if they're not ready and able to do that yet, sometimes the assisted living residence is the right place for them at that time. All right. So what is important here is that the managed care organizations and our service coordinators, we have service coordinators who work with Every single member that is in community health choices, and they are the ones who really work with the individual and identify what's the right need for them. We want to make sure that an assisted living residence is the right placement for that individual. We don't want to unintentionally take people out of their homes and put them into facilities when that's not necessary, and we're able to keep them safely at home. And so this is really important that it is us who work closely with those participants and their family members and all of their supports to make sure that this is the right option for them. All right. So, again, it's important to know that we are the lead and that we work very closely with the power of attorney, their legal guardians, their supports. We work with those residences to make sure that it is the right facility for those individuals. And then also, if you guys have anybody who you say, hey, I think this might be the right option for them, please reach out to us and we'll work closely with them to make sure that we get a good option for them. All right. All right. This is how we work. We work very closely with those residences and the participants. We work with them to anticipate what they're going to need. As Deputy Secretary Marcello said, the county assistance office is who determines that patient pay portion and then their personal needs allowance for those individuals. Because, again, we are only paying for the services. We can't pay for their room and board. And then if somebody says that they're interested in pursuing an assisted living residence, we work with those assisted living residences to find the right placement for those individuals. We are currently contracted with 15 of the facilities that have enrolled in the Medicaid program. We have two that are pending, and we have reached out to all of them to make sure, let them know that we'd be willing to work with any one of the assisted living residences that wants to go into the Medicaid program. So we want to have options for our participants. We think this is an exciting opportunity for them. All right. So when they move in, when participants move into an assisted living residence, especially if they're coming from a nursing facility, they may need some supplies to make there to get them into the place. So here's just a list of some of the things that we are able to provide for that move-in assistance to make sure that the participant is set up for success in their homes. So kitchen essentials, towels, curtains, these are all things that if they were in a nursing facility they didn't have to have on their own. So we want to make sure that they have that and that they're set up for success when they go in. All right, here's my exciting. So we were the first MCO to have a participant who was placed in an assisted living residence. And so then Ms. ST, she was very excited. We were able to get her in in August of 2025. She was in a nursing facility for a year and a half and we successfully transitioned her. We had a whole community engagement team out there to like get to be there with her. She is so excited about what is about her residents now her abilities to be more in the community to feel like she is part of another community and the supports that she gets at the facility So it is very exciting I get excited every time I see her And then a little bit later I was given a preview that you actually see a video of her when Pala presents But we were very excited to be able to be the first ones to do this for our participants. And then please next. And so here's just a little bit more. This slide's outdated because we now have 23 participants who are in assisted living residences. We have 15 that are still in the queue. So we are working closely with them to get this to happen for them. And so we are really excited about this. We have had two participants, one participant that went into a nursing facility because their level of care increased.
And then we had two that did go home with hospice. But we are very excited about those that we've been able to provide these services for. And as Deputy Secretary Marcella said earlier, too, if a participant goes into an assisted living residence, they're like, this is not for me. We will work closely with them to get them to the right placement for them. So that is it for me. Thank you very much.
Go ahead. We'll hold off on questions until our last discussion.
Good morning. Excuse me. Good morning, Chairs Madden, Menser, Williams, and Hefley, as well as members of the House Aging and Older Adult Services and Human Services Committees. My name is Joe Elliott. I'm the Director of Care Management for PA Health and Wellness. Thank you for the opportunity to speak today about the critical role that assisted living facilities play in supporting older adults and individuals with disabilities in our communities. At the core of Pennsylvania's long-term services and support system is a simple but powerful principle that individuals should have the opportunity to receive care in the least restrictive setting, most appropriate setting, consistent with their needs and preferences. Assisted living is a key component for us achieving that goal. Assisted living provides a person-centered, community-based alternative to institutional care. For many individuals who meet a nursing facility level of care but do not require 24-hour skilled medical oversight, assisted living offers a balanced model of support, combining personal care, medication management, supervision, and access to services, all within a more home-like environment. This model is particularly important because it expands meaningful choice. Participants can transition out of nursing facilities, avoid institutional placement altogether, or select assisted living as their long-term residents based on their needs and preferences. In practice, assisted living supports several key populations that we've previously discussed, individuals stepping down from nursing facilities who are ready for a less restrictive setting, individuals in the community whose needs exceed what can be safely provided at home, and individuals with cognitive conditions such as dementia who benefit from specialized environments. These use cases demonstrate how assisted living can meet individuals across the continuum of care. The outcomes are clear and compelling. Assisted living supports increased socialization and community integration amongst our older Pennsylvanians, improved participant satisfaction, and enhanced quality of life, all through the delivery of care that is most closely aligned with the individual's preferences and goals. These are meaningful impacts helping individuals maintain independence remain connected to their communities and live in environments that promote dignity and autonomy Assisted living also plays an important role within the broader care delivery system It integrates with existing services such as physician care, therapy, and behavioral health supports, while service coordination ensures ongoing monitoring of participant needs, satisfaction, and quality. At the same time, it's important to acknowledge a key implementation challenge that we've experienced. assisted living providers have been relatively slow to enroll in the Medicaid payment models, including the in-lieu-of-services options. This slow uptake limits access for eligible participants who could benefit from this setting and creates variation in availability across regions. While a model is well aligned with participant needs and system goals, broader provider participation will be necessary to fully realize its potential as a community-based option. Within PA Health and Wellness, progress is being made to expand access. PHW has attempted to contract with all 18 assisted living residences, successfully contracting with 15, and has supported 22 participants currently residing in assisted living facilities. One notable example was that of a 57-year-old participant with a history of bipolar disorder and multiple unsuccessful living arrangements. She faced increasing challenges maintaining independence, ultimately requiring nursing facility care. During her time in the nursing home, particularly throughout the COVID-19 pandemic, she experienced significant isolation and felt the setting did not meet her needs. Despite financial barriers and prior traumatic transitions, she expressed interest in assisted living and actively advocated for herself. Our service coordinators partnered with the Assisted Living Admissions and coordinated with her peer specialists to ensure continuity of behavioral health supports and appropriate service alignment. Following her transition to assisted living in May of 2026, she reports improved well-being, greater stability, renewed independence, and sustained community living without the need for readmission to a higher level of care. Ultimately, assisted living is not a replacement for nursing facility care, but it is a critical option within the continuum. It allows us to better match individuals to the right level of care at the right time in the right setting based on their critical or their clinical needs and personal preferences. In closing, assisted living facilities represent a proven, person-centered approach to care that strengthens the alignment between someone's care needs and care settings. It promotes their independence and dignity. It expands their access to community-based options. And most importantly, it contributes to and can improve their overall quality of life. Thank you for your time and your commitment to supporting individuals who rely on long-term services and supports.
Thank you for your testimonies. We'll go right to questions. Chair Williams, you have a question?
Thank you, Madam Chair. Mr. Elliott and Ms. Holman, thank you for your testimony. Just a quick question. I heard you talk about broader participation. I'm wondering are there specific programmatic or policy changes that might be more effective in increasing provider participation?
To be honest with you, I think we just need a little time. They need to see how this actually works and let those 18 that have become Medicaid enrolled providers really see how it shakes out at the end of the day. I really think that's part of it. It would be interesting to see I think that there because of the home and community settings rule which is a federal rule there are certain criteria that they must meet in order to be considered a community setting And I honestly would have no idea how many might not qualify because of that federal rule. It's stuff like being attached to a nursing facility and those kinds of things. So that could be a barrier, but that also is at the federal level and something that, I mean, would need changes there for that to happen. But I don't have an answer other than give a little time and let's see the success of it.
Appreciate that. Thank you.
Chair Mencer?
Thank you, Chair Madden. This is more of a comment than a question, and it goes to Ms. Hallman's comment in her opening statement. We have been working on this, the Aging Committee has been working on this for a very, very long time. I mean, and I thought if I would have to go through one more session talking about how we can take advantage of this and make it more efficient to use assisted living rather than personal care, you know, I was just going to block it all out. So I'd just like to thank you for doing this pilot program, both of you, and the Deputy Secretary Marsalis for cooperating, because this could really wind up saving the state a lot of money and helping a lot of people. So thank you.
Chair Hefley?
Thank you. So I agree with the Chairman's statement there about wanting to, you know, definitely look to see how we can expand it. This could be a cost savings. And how, like if a constituent came in and was interested in getting into a program like this, how would we kind of refer them over? And the local area agencies, how could we help them to get these programs out? I mean, the area agencies do a wonderful job, the AAAs, in getting this type of information out. So how can we utilize those things that we already have in place to spread the word about these programs?
That's a great question. So each one of our participants that's enrolled in the Community Health Choices Program and is nursing facility clinically eligible would have a service coordinator that works directly with them to make sure that they're receiving the services that they need to remain healthy in the community. So the first step for, for example, a AAA were to encounter a participant who was interested in assisted living would be to instruct the participant to connect directly with their service coordinator and express that desire with them. And then they would go through that process of determining, you know, if there are facilities in their geographic area where they would want to live and then go through that process of admissions. I'll just add, if it's someone who's not currently in the Community Health Choices program, they would go through the independent enrollment broker, Maximus, just like they would if they wanted to do home and community-based services, and then they'd be able to get into Community Health Choices because they have to meet all of those eligibility criteria. And through that, then, they'd get the service coordinator and be able to work with them on the placement.
Thank you.
Rep Hogan?
Thank you, Madam Chair. Thank you both for your testimony. This question is not so much targeted at this program as more about, you know, just all of the programs in the Department of Human Services, especially pilot programs now because as I take meetings sitting in human services, I'm constantly being told about mandates. I'm being asked for more money in the budget, and, you know, I've started asking groups, what are we doing? What is government forcing you to do that's not really effective anymore in the community? Or what's, you know, we're struggling. We keep talking, how do we get more people in here? I hear the same issues about the LIFE program through, I think, Medicare. But if this program is not working out, are the MCOs actually going to recommend to the department saying, hey, this isn't as effective as we had hoped? but it's not really achieving the goals that we had set out for? And if so, what does that process kind of look like with the department?
So I will say that if we go down this path of in lieu of service and it's not being effective first, the department has requirements with the Centers of Medicare and Medicaid Services to show that it is a less costly alternative. So we'll start to see that. we have to keep a lot of data to show what the cost would have been for those participants if they would have been in a nursing facility and what they are with them being in an assisted living residence. Is that a cost-effective thing, all that regulatory requirements as a provider? We have a lot of data that we collect and a lot of requirements when it comes to what we report on. I don't know that this is so onerous. I mean, there's reasons why we do that is to make sure that it is a cost-effective pilot. I am – my history, I was in the budget office, and I care a lot about making sure that what we are doing is cost-effective for our participants and for the taxpayers and good stewards of the taxpayer dollars. So I think that it's important for us to really look at it and make sure that it is a cost-effective thing. And if it's not, why isn't it, and what can we do to make it cost-effective?
Yeah, well, thank you for that. I appreciate hearing it. I guess the last question then is if a provider decides that they just don't want to do this program anymore, can they unilaterally do it, or does the department have to authorize them to more or less walk away?
I think my understanding is that a provider could terminate their contract with any one of the MCOs. At that point, we would work with our participants to make sure that we identified alternative living arrangements unless that participant wanted to remain there.
So it doesn't require the department sign off?
I'm actually not 100% certain on that.
All right. Thank you.
Thank you. Rep Harris?
Yes, yes. Pardon my voice. I want to thank Chair Madden and Williams for entertaining us and the speakers. I'm coming from a deputy registered will perspective as well as before I was elected state representative. it seems like the in lieu of services does that seems like it's a good pilot does that diminish the liquidation of assets as far as itemization of costs and also I'm witnessing as people enter assisted living and long term care the houses just sit you know and what's the process of if the assets are liquidated to sell the asset because the facilities actually acquire it. And also the question also is, how does it diminish the cost of the homeowner assets? Like if they don totally liquidate all the assets is it a help to the client If you understand what I saying So I say that I don have a specific answer for you other than they would go through the
same eligibility process that they would for community health choices, whether or not they were going into the assisted living residence. So it would follow that. And then the Department of Human Services has certain rules and regulations when it comes to those kinds of assets and how they can remain. And then my understanding is after someone passes, if those assets were to be liquidated, they would go through a process with the department to determine if there was any dollars owed to the department for the coverage of those services because of the sale of those assets.
It seems it takes a very long time, and the houses just sit there, and it causes a blight in the community. So thank you.
Thank you.
Rep Glein? I'm sorry, Madam Chair. I'm going to go back to the workforce again because I want the program to work out, but I'm really worried that as a provider you're not going to be able to get the direct skill people that you might need. I know that there is an issue, and I'm not so convinced that it's just the minimum wage that is the issue. How are the employees working in the assisted living actually – what is the requirement for you to expand the training and the hiring of the direct skill worker? And do you need more under this program?
Regarding the volume of direct care workers in the assisted living facilities, I'm not – familiar with the need for more, but the training and skills that are required are covered under the policies for licensing for those facilities. So that would define what training and skills that the direct care workers in those facilities would require. Okay. So I would think that
expanding those opportunities or expanding, you know, the actual ability to get workforce would also help this pilot program, just in my opinion. So thank you.
Thank you all for your testimony. I just, before we bring up our last testifier, I just want to say aging our way, right, the 10-year plan and people aging in place is the most important thing, correct? Within, by the year 2030, 60-year-olds are going to outnumber 20-year-olds. And so not only is it cost-effective, but can you talk a little bit about what does it mean for the emotional and the physical well-being for someone to come out of a nursing home and be able to walk and be able to be in their community? You mentioned there was a video that we didn't get to see, but could you all just, because this is our goal, right, is to keep people in their communities, in their homes as long as possible. And if they're in assisted living and then all of a sudden they can't dress themselves in like a, you know, a home, like we, we had a tragic story in my community where a woman was in an, in a, um, in an assisted living, um and she was having trouble dressing and she was having trouble doing things And they told her well if you can do these things you going to have to go to a skilled facility So she went and had a surgery to repair her shoulders so she could get better And she ended up falling into a coma and dying after the surgery. And this is a very extreme circumstance, but this is what's going through my head as you're speaking, that someone who could get assistance with dressing and the daily needs could have stayed there where she had a community. She had met a male partner there. She was living her best life, right? And so just tell me a little bit about the experiences with the woman you shared with us and about some other folks who are now living their best lives because they're back in their communities. They feel like they have charge of their life. They're not sitting in a wheelchair waiting for someone to give them medication. Talk about that a little bit.
I'm so happy to do that. And you will get to see the video when Paola presents, so you'll get to see it. But no, I always say community health choices is our family members. They are our grandparents, our parents, our loved ones. And so it's so important for us to put a face on that and not just look at the numbers. I recently attended our participant advisory committee, and we had a participant there who had been in a nursing facility. And our service coordinator worked with him on nursing home transition. And he is now back in the community and so excited to be out and come to our office to have a meeting and share his experiences and be part of going to different kinds of – going to his places of worship, going to the, you know, picnics and all this other kind of stuff. It truly is what would we want for ourselves. And that's how I always go about this. Like, what would I do for my family members? What would I want for them? And we all know that the majority of people want to remain in their community with their loved ones. And sometimes that's not always the option. Sometimes for reasons they need to go into some kind of higher level of care. But having an option for assisted living just gives them that opportunity to be more community-like. It's not nearly as onerous as a shift to a nursing facility where they really need those high, high levels of care. This is just, to me, a really exciting option for our family members to be able to continue through their golden years to live in a better situation. And I get very excited talking about it because at the end of the day, there is a face behind every case that we have, and we need to know about those participants.
Representative Madden, I think you touched on it, is that folks aren't just sitting around waiting to be delivered, having their medication delivered to them. These are apartment-like settings where folks have their own unit. They have a living area where it's not just a bed and a television, where they can experience that community-like setting and interacting with the other residents of the assisted living through whatever activities are provided there. So I think you kind of answered the question whenever you talked about how these folks that are moving into the assisted living communities have that sense of community. Thank you so much. And thank you for all the work that you do for our seniors. You know, we want to make sure that the golden years really are that, right, that they're not filled with worry. We know so many folks have you know when my mother was diagnosed with vascular dementia I was the last family member she had left so it was on me right And we didn have this wonderful program and so at a certain point she did have to go into a skilled facility where she was taken very good care of, but right to have someone come in and help would have been tremendous. So thank you all. I would be remiss if I didn't say about the great partnership that we've had with your committees and your staff and the chairs, and I remember meeting with a couple of few years ago saying we're going to get this done i promise and so i'm so excited to be here for that and your teams have been absolutely amazing so thank you thank you for that and we are going to get this done okay so our last testifier is susan saxinger who serves as executive director of pennsylvania assisted living association and before susan begins i have to mention we have a new member who joined us who is a new member to the house of representatives so and this committee so I'm not even going to try to pronounce your last name. Representative Andrea Verobish. See, I would have gotten that wrong. Welcome. Thank you. Good morning, Susan. Thank you. Welcome. Thank you.
Well, my chair is a bit far away from the table. Again, good morning, Chairwoman Madden, Chair Menser, Chair Williams and Chair Hefley, and members of the Aging and Older Adult Services Committee and Human Services Committee, thank you so much for the opportunity to testify this morning. My name is Susan Saxinger. I serve as the Executive Director for the Pennsylvania Assisted Living Association. I am especially excited to testify this morning and talk about In Lieu of Services because I've spent 20 years working in this space. Prior to coming into my role as executive director for PALA, I was a personal care home and assisted living administrator. And I've seen countless individuals be forced through the continuum and end up in skilled nursing facilities because we lacked a program like this. So I'll lead with saying, pardon me if I get a bit emotional, but this is real. It's very real. And what I hope to bring to you today is the human impact of InLU of services.
And we won't keep the anticipation going. We will share Sylvia's testimony here shortly.
Pala represents Pennsylvania's licensed assisted living residences and personal care homes. And together, those settings serve over 40,000 older adults and individuals with disabilities across the Commonwealth. Our mission is to promote access to affordable, community-based, person-centered care that allows individuals to maintain their dignity, independence, and quality of life. I would like to begin by thanking the Pennsylvania Department of Human Services, the Deputy Secretary, the Managed Care Organizations, the Legislature, and all of you in leadership for exploring In-Lieu of Services and seeing through and supporting its implementation. This program represents an important step forward. It expands access to care. It increases choice and it provides new opportunities for older adults to receive services in settings that align with their needs and their preferences. The results are encouraging, as you heard from others. Participation started modestly. We've been talking about this program for quite some time now. However, we are seeing incredible growth. of organizations is currently serving 17 individuals through in lieu of services. And we're seeing the number of participants either being diverted from skilled nursing facilities or moving from a skilled nursing facility into an assisted living community increase. The outcomes demonstrate that in lieu of services is working and that there is a demand for additional care options within Pennsylvania's long-term care system. So to illustrate the impact of In Lue of Service, I would like to share the story of Sylvia. She is the first participant and a resident of Tapestry Senior Living in Moon Township. Her life was positively changed by the opportunity to transition from a skilled nursing facility to an assisted living community. so Sylvia you were living in a nursing home prior to moving into tapestry uh how long were you there
a year and a half year and a half how did you like it there I liked it fine um everyone was very good to me but it was time for for me to move on I was becoming more or more independent so as they could wait for someone else. Okay.
How did you find out moving to assisted living under the community health choices was an option for you?
My social worker called me into her office and told me that this might be something I would be interested in and should she go along with it, that's just sure.
So how do you like having your grandma here?
I absolutely love it. It's just wonderful. It's a blessing. I mean, I have my own bedroom. I don't have to worry about how loud my TV is. I have my own bathroom. It's wonderful.
Great. So far, I know you haven't been at Tapestry too, too long, but so far, what's your favorite thing about Tapestry?
The people here. Not only the people who work here, but the tenants here as well. They're very friendly. Everyone introduced themselves to me It a very nice environment Do you do a lot of the activities I try to do all the activities I play bingo. I play pokino. I take walks, which is nice. I'm not able to walk too far, but I'm walking further than I have been at the other place, and I'm just enjoying myself.
And how's the food?
Let me get on the scale next month, I'll let you know. The food is absolutely delicious. I haven't had a bad meal yet. And I don't miss a meal. I miss all three meals.
All right, my last question for you. What would you say to someone else that would be considering moving from a nursing home to tapestry?
I would tell them to take advantage of it, to definitely move on. If they feel that they could be independent enough to have their own room and their own facility to go for it. This has been a wonderful change in my life.
That's great to hear. Any final thoughts you have?
No, I just want to continue on the way I am. I'm very happy. Happier than I've been in a long time. All of my needs are being met. My medical needs, my personal needs. I don't have a problem. But if I do, I know who to come see.
Absolutely. All right. That's all I have for you, Sylvia.
Thank you. You're welcome.
Menopause kills your metabolism. Different subject, different hearing. I think that's a health hearing.
You heard the story straight from the source, and Sylvia's story is why we are here today. For legislators and people that do your great work, in lieu of services might be a policy discussion, but for Sylvia, it was life-changing. You heard her touch on how happy she is how this experience has been a blessing and that she would recommend it to others in the same position that she was in It was an opportunity for her to leave a nursing home, move into assisted living, receive the care that she needs in a setting that is more home-like and better matched her needs, her preferences, and her capabilities. And Sylvia is not alone. As I mentioned, we did see a slow start to In Lue of Service, but it does continue to grow, and more older adults are successfully transitioning from skilled nursing homes into assisted living communities. The outcomes matter because they represent something larger than a policy discussion. They represent change. They represent choice. They represent dignity. and they represent the ability for older Pennsylvanians to receive the care they need in a place that they are proud to call their home. The success of In-Lew of Services demonstrates what is possible when we expand care options and as Pennsylvania's population continues to age and the demand for long-term services and supports grows, we believe there is an opportunity to build on that success. Today, In Lue of Service serves as the primary pathway for Medicaid-eligible individuals like Sylvia to access assisted living services. As we heard earlier, Pennsylvania does not currently have assisted living identified as a permanent service under the Community Health Choices waiver. The success of In Lue of Service and stories like Sylvia's demonstrate both the value of this option and the opportunity to continue to evaluate how assisted living can support Pennsylvania's long-term care goals. PALA supports the continued development and evaluation of in lieu of services and encourages policymakers to consider ways to make assisted living services more broadly available to eligible Medicaid beneficiaries in the future. We are committed to working with the Department of Human Services and the managed care organizations to see through its success. Our goal is simple. Let's make more stories like Sylvia's. Thank you again for the opportunity to testify, and I'd be pleased to take any questions.
Thank you so much, Susan. Do we have questions? Yes.
Thank you all to all of our chairs and thank you for coming and testifying today I just wanted to see do you have any suggestions on how we can increase the number of people who are participating in assisted living Thank you for the question.
And to clarify, do you mean increase the number of providers that are participating?
I guess both providers and residents. Sure.
I think it's twofold. If we see the number of providers increase, then we'll see the number of participants increase because we will strengthen the network adequacy. The association is working to partner with the Department of Human Services, OLTL, and the MCOs to educate the industry on this valuable service. We are developing touch points so that personal care home providers that might have interest in learning more about in lieu of service and how it supports lower-income individuals, how it can be so beneficial, and if they're considering changing their licensure to assisted living, what that might look like for them. So we provide a wide variety of education to the industry so that we can hopefully support ongoing growth.
Thank you so much for your testimony. Thank you to all our testifiers. And we look forward to, you know, helping in any way we can to get this out and to make sure that more seniors can take advantage of it. And, wow, we finished this hearing in under an hour and a half. Thank you all. Thank you. Thank you.