Tuesday, February 28, 2012

Mythbusters: Telling the whole story

The Brownback Administration and proponents of including long-term services for Kansans with ID/DD have used various arguments throughout the last few months.  Their arguments have focused on claims that spending for these services is out of control and that the health care needs of Kansans with DD are poorly coordinated - in fact, a recent Wichita Eagle editorial, Lt. Gov. Jeff Colyer inferred that Kansans with DD are dying sooner because of this alleged lack of care coordination.

Unfortunately these claims and public statements lack in factual detail and fail to share the entire story.  Click on the links below to learn more about the top three Mythbusters regarding the Administration's arguments for including long-term care services for persons with DD.  


Mythbusting #1
Are costs really out of control for serving Kansans with developmental disabilities?


Mythbusting #2
Are Kansans with developmental disabilities really dying sooner because they aren't in managed care?




















Mythbusting #3
Are the health care needs of Kansans with DD really poorly coordinated by the current service system?













Despite what the Administration might have you believe, despite what some legislators may be saying, long-term services for Kansans with intellectual/developmental disabilities CAN and SHOULD be carved out of KanCare.  But only if YOU take action!

We urge you to share the above documents with the Governor, your legislators and your local news outlets.


Meet Your Managed Care Partners: Advocacy

Administration officials announced last week the five insurance companies (aka Managed Care Organizations or MCOs) who have submitted bids in response to the KanCare proposal to overhaul Medicaid services.  While some of these companies have subsidiaries in areas of Kansas, they are all nationally headquartered in other states – meaning massive profits will go to out-of-state companies at the expense of Kansans.  Of these five companies, three will be granted the contract to manage Medicaid programs for the elderly, the disabled, the mentally ill and persons with  intellectual/developmental disabilities.

While officials have expressed confidence in these potential MCOs, some research indicates cause for concern.  Below are some examples of what's being said of our potential partners across the country...


WHAT’S BEING SAID ABOUT COVENTRY HEALTH CARE & WELLCARE IN KENTUCKY?


“Why don’t you communicate with these people enough that they don’t call us when they don’t get paid?” – Kentucky Sen. Tom Buford said in a hearing regarding managed care in which providers expressed concerns over lack of payment from Coventry Health Care and Wellcare. (The Courier Journal)

“Please make it stop” – Kentucky Sen. Julie Denton said in response to email complaints regarding lack of payment from Coventry Health Care and Wellcare. (The Courier Journal)

“[Managed care is] causing drastic cash flow problems.  The payment issue has been very significant” – Kip Boman, Kentucky Home Care Assoc. said to legislators in a hearing regarding managed care. (The Courier Journal)



WHAT’S BEING SAID ABOUT CENTENE & WELLCARE BY STANDARD & POOR’S?

Standard & Poor’s gave Centene a rating of BB, placing it in a rating category entitled “Vulnerable: Marginal/Extremely Weak”. (Northwestern Mutual Life Insurance Company)

Standard & Poor’s gave Wellcare a rating of ≤B, placing it in a rating category entitled “Vulnerable: Marginal/Extremely Weak”. (Northwestern Mutual Life Insurance Company)



WHAT’S THE US DEPARTMENT OF JUSTICE SAYING ABOUT AMERIGROUP?


Amerigroup Settles Federal & State Medicaid Fraud Claims for $225 Million - headline from a 2008 news release by the US Department of Justice.



WHAT’S BEING SAID ABOUT UNITED HEALTH CARE?
United Health Care was one of three organizations recently dropped from managing Connecticut’s Medicaid services: “Connecticut has a 15-year history with managed-care organizations, and there has been a diminishing confidence in the value of what they are providing” Mark Schaffer, Connecticut Medicaid director. (USA Today)

From HutchNews: Bethell backs carving services out of KanCare

Full Article: Bethell backs carving services out of KanCare
By Mary Clarkin - The Hutchinson News

Article Extract:

"Rep. Bob Bethell, R-Alden, is a pastor/consultant representing the 113th District. He is chairman of the House Aging and Long-Term Care Committee and also sits on the Health and Human Services and Transportation and Public Safety/Budget committees. His office is in the Capitol; the email address is bob.bethell@house.ks.gov; the phone number is (785) 296-7616.


Advocates for people with disabilities don't want to be part of the Medicare changes. Should that group be carved out of KanCare? Persons with developmental disabilities receive services as well as health care, and they are "very different" from the medical model for an insurance company, Bethell said. "It is not at all inappropriate, in my mind, to carve those services out," he said, of the planned managed-care approach. "

Friday, February 24, 2012

Meet Your Managed Care Bidders

Announcements were made on Wednesday afternoon regarding the managed care organizations who have submitted a bid for the Administration's KanCare proposal to provide managed care Medicaid services:

The following list comes from the KHI news article listed below:


  • Centene, which is headquartered in suburban St. Louis, but its subsidiary has opened a Topeka office,
  • Wellcare of Kansas, which is based in Tampa, Fla.,
  • United Health Care of Minneapolis, Minn.,
  • Coventry Health Care of Kansas, which is headquartered locally in Wichita and nationally in Bethesda, Md.
  • Amerigroup, which is based in Virginia Beach, Va.



Please review the articles below for details:

From The Wichita Eagle:
Kansas attracts 5 bidders for 3 Medicaid contracts

From Kansas Health Institute
Centene and Coventry get Missouri managed care contracts: Companies also among those vying for Kansas Medicaid business



From CJOnline: Managed care for disabled debated


Photo: Eric Smith/The Capital Journal
The conversation of moving the state's long-term care services for the developmentally disabled to a managed care system contracted out by insurance companies was rekindled Thursday night during a town hall meeting.
The meeting was hosted by TARC, a provider of services for people affected by intellectual, developmental and related disabilities. More than 50 people, some of whom were guardians, family members and service providers of the disabled, heard both sides of the issue at the Topeka and Shawnee County Public Library.
The sentiment from most at the meeting was that Gov. Sam Brownback and his staff are moving "way too quickly" on the plan that calls for putting those with developmental and intellectual disabilities on a managed care organization by Jan. 1, 2013.
Shawn Sullivan, Kansas secretary on aging, presented the state's side, giving a brief overview of the governor's plan, which is called KanCare.
Tom Laing, executive director of InterHab, is opposed to Brownback's proposal, and he presented his case for the current long-term services in place.
In Brownback's proposal, the reform calls for coverage to all Medicaid-eligible children and pregnant women, low-income adults, people with disabilities, and others.
Sullivan said the managed care organizations must assure all medically necessary services currently available through the Medicaid state plan and home- and community-based services waiver will be included in their benefit plans. Additionally, the proposal calls for the managed care organizations to provide medical necessity standards for services and adopt guidelines to ensure services are available statewide in an amount, duration and scope no less than required through traditional Medicaid.
Laing said the move would be the "single biggest transaction in the state's history."
Brownback's proposal mandates that managed cared organizations must demonstrate...Read More

From KHI: Feds issue new rules on Medicaid waiver transparency

By Mike Shileds
KHI News Service
Feb. 23, 2012


TOPEKA — Federal officials have published new rules intended to make the Medicaid waiver process more open and responsive to public concerns.

The new rules, which become effective April 22, could have bearing on the waiver request the administration of Gov. Sam Brownback is preparing to submit to the U.S. Department of Health and Human Services as part of its effort to expand managed care within the state's Medicaid program.

Brownback officials on Jan. 26 submitted to federal officials a concept paper broadly outlining their upcoming waiver request. Officials have said they have "no timeline" for submitting the complete application, but they have announced they intend to launch their KanCare plan statewide beginning Jan. 1, 2013. Many of the plan's key provisions would need waiver approval.

In the concept paper, Kansas officials said they would seek an "1115" waiver, a type used for demonstration or pilot projects and which HHS has the broadest latitude to accept or reject. More than 35 states operate with some type of 1115 waiver, though they vary significantly in what they aim to accomplish or demonstrate.

The Kansas proposal, according to its outline in the concept paper and statements by administration officials, would be different than most 1115 waivers approved by the Obama or earlier administrations. Most proposals that have been approved included provisions that would expand Medicaid coverage to significant numbers of people otherwise not eligible. The Kansas plan, as outlined, would not do that.

Kansas officials also have said they want a far-reaching "global waiver" that would cap the amount of federal Medicaid dollars the state could receive in exchange for freedom from many or most federal Medicaid regulations. A global waiver, sometimes described as a block grant, has only been granted once in the history of the Medicaid program, and Obama officials have made it clear they do not support them.

The new federal rules were in response to changes in the waiver process included by Congress in the Affordable Care Act. Those changes in the law came after reports that HHS had done a poor job making the waiver process transparent and responsive to public input. Those concerns were heightened by a couple of relatively speedy waiver approvals during the administration of President George W. Bush, including a so-called global waiver for Rhode Island approved in the administration's final days and an earlier approval of a waiver request from Florida when the president's brother, Jeb Bush, was governor of that state.

Critics said those waivers were granted without proper public input.

"When Gov. Bush submitted the waiver to his brother's administration...Read more

Tuesday, February 21, 2012

Wichita Eagle Opinion: Point, Counterpoint

Last week,  Lt. Gov. Jeff Colyer published an opinion piece in The Wichita Eagle touting the benefits of KanCare particulary for the developmental disability community.

Below is a letter to the editor from Ron Pasmore, President/CEO Ketch, Inc. in Wichita.  This letter was published in The Wichita Eagle today:




No evidence
Lt. Gov. Jeff Colyer implied that lower life expectancy for individuals with developmental disabilities is somehow a result of poor access to and coordination of health care services (“Focus on the best results,” Feb. 12 Opinion). In fact, life expectancy for those with developmental disabilities is related to the effects of their disabilities.

Life expectancy has dramatically increased over time. For example, the average life expectancy for those with Down syndrome has doubled since 1983.

Colyer also stated that the greatest growth in Medicaid costs was for people with disabilities. But the University of Minnesota reported a decline in per-person spending for home- and community-based services in Kansas of 18 percent between 1993 and 2009.

Regardless of the medical needs cited, to my knowledge no one has questioned the administration’s desire to place medical services paid by Medicaid under managed care. What has families and advocates so upset is the inclusion of nonmedical residential and day supports provided through the home- and community-based services waiver.

I keep searching for evidence from around the country that managed care will be of positive benefit for the needs of people with developmental disabilities. I have yet to find any.

Read more here: http://www.kansas.com/2012/02/19/2220366/letters-to-the-editor-on-hotel.html#storylink=misearch#storylink=cpy#storylink=cpy

Monday, February 20, 2012

Upcoming Events: Community Forums on KanCare

Participants at community forum in Lawrence, KS
last week hosted by Cottonwwod, Inc.
Picture by Karrey Britt, Lawrence Journal World/WellCommons
Across the state InterHab members and fellow stakeholders have been and continue to host community forums to share information with individuals with DD, their family members, the professionals who support them and community members.  Check out the schedule below for upcoming events.  Please email eroberts@interhab.org if you have questions about these events or would like to share an event of your own!


Upcoming Community Forums on KanCare:

2/21     El Dorado
2/23     Topeka
2/27     Hutchinson
2/27     Pittsburg
2/28     Newton
2/29     Independence
2/29    Overland Park




Legislative Calendar: February 20th - 24th


HOUSE:
Monday:

Appropriations Committee
9:00 AM               RM 346-S
Budget recommendations for KNI, Parsons

Social Services Budget Committee
3:30 PM                DSOB 711
Continuation of Aging and SRS budget presentations



SENATE:

Monday:

Ways and Means Committee
10:30 AM             RM 548-S
HB 2453 – Commission on Disability Concerns; changes


Tuesday:

Public Health and Welfare Committee
SB 397 – Terminology change from MR to DD

Article Update: KanCare, Adult Protective Services, Reorganization

February 20, 2012
The Hutchinson News

February 20, 2012
Wichita Eagle Blog

February 18, 2012
Midwest Voices of Kansas City Star

February 18, 2012
The Newton Kansan

February 17, 2012
KHI News Service

February 15, 2012
The Wichita Eagle

February 15, 2012
The Emporia Gazette

Aging secretary responds on KanCare
February 11, 2012
Lawrence Journal World

Friday, February 17, 2012

Legislative Update: Seclusion & Restraint; Adult Protective Services


The Children and Families Committee advanced to the House floor HB 2444 to enact the State Department of Education’s (KSDE) current guidelines for the appropriate uses in schools of seclusions and restraints as law. This is the most meaningful legislative step yet taken in a ten year effort to assure a more enlightened and humane system for special education children, and all children.  DRC and Families Together led the way, and InterHab was active in support of this bill.

Past practices for behavior related classroom issues, usually affecting special needs children, were a statewide patchwork quilt, as varied in consistency as the differing philosophies of USDs, Special Ed Directors, and even building principals.  Family, children and DD advocates have argued for years that there must be a defensible and standardized set of standards in our State. KSDE finally responded a few years ago, but not with rules and regulations as many legislators had urged, but with “guidelines” .. not enforceable, not monitored, and not (in our view) effective or humane.  

Representative Mike Kiegerl took on this issue last year, and again this year, with a bill to make the KSDE guidelines the law. The committee took testimony last week, and Tuesday passed the bill with only two dissenting votes.  The next step will be the floor of the House, unless the bill is referred elsewhere for additional hearings. Thanks are owed to Rep. Kiegerl. This is a very positive step forward in assuring the rights of Kansas children to be educated in a safe and healthy atmosphere.

Also on Tuesday, the House committee on Aging and Long Term Services took testimony on HB 2656, to move the State’s APS programs to the Office of the Attorney General.  InterHab did not testify on this bill, having already opposed it in the past, and the 8 conferees already signed up were unanimous in opposition or were neutral on the bill. There continues to be legislative concern over the many reports of APS not working well, so we may see legislators make a major push in the near future. At the moment, the majority of the committee members were somewhat persuaded by new  designated-Secretary Phyllis Gilmore’s assurances that work plans already in place for APS in its current SRS venue, will produce positive outcomes.  

They may pass the bill out of committee, to “send a strong message of emphasis” of their concerns. Or, they may defer to the Chair’s wishes, and the Chair seemed satisfied that the reporting from SRS held some promise. However, almost certainly the next legislative session will see a renewal of aggressive advocacy among legislators if they continue to receive complaints of ineffectual APS activities.  


Thursday, February 9, 2012

The Newton Kansan Articles: Point, Counterpoint




Editorial responds to legislative support for KanCare in the Newton Kansan.


(Articles copied from the Newton Kansan, compiled by InterHab staff).




From LJWorld: Medicaid Push

Editorial from Lawrence Journal World
February 9, 2012


Medicaid Push: 
Kansas officials should listen to those voicing concerns about Medicaid changes and take the time to make the necessary revisions to their plan


Gov. Sam Brownback and his administration have come up with a plan they say will improve care and reduce costs for Medicaid recipients in the state. That’s a good goal, but questions being raised about the plan indicate that the state needs to iron out more of the details before rushing ahead with a plan that will affect about 380,000 vulnerable Kansans.
The governor’s office says there’s no need to delay the scheduled Jan. 1, 2013, implementation date for the new plan because the administration already has been working on the plan for more than a year. State officials also say they have been talking to people across the state about the plan, but it’s not clear to whom they were talking. Since the plan was released to the public about two months ago, various stakeholders have raised many questions and concerns, but state officials have shown no willingness to revise or slow their plan based on what they are hearing.
A major area of concern in the Medicaid plan is how it will affect Kansans with developmental disabilities. Although advocates say managed care may be a valid way to handle the health care needs of this population, they don’t see how it will work for the other services, such as in-home support, that help preserve clients’ independence.
Despite the concerns voiced by agencies and legislators on both sides of the aisle, the Medicaid effort led by Lt. Gov. Jeff Colyer is moving full speed ahead. Colyer said Tuesday that...

Wednesday, February 8, 2012

Winfield Courier: Brownback's order on social services is premature

Winfield Daily Courier
Published: Wednesday, February 8, 2012 12:08 AM CST


The Legislature should proceed with caution on Gov. Sam Brownback’s executive reorganization order for social service agencies.

Unless the administration can provide adequate answers to several questions, lawmakers should vote to overturn the order and work out the reorganization themselves.

The number one question is: Why are we doing this?

The Department of Social and Rehabilitation Services has been slimmed down since the administration of Republican Gov. Bill Graves.

Gov. Brownback wants to further reduce the size of that agency by transferring programs for the mentally ill and developmentally disabled from SRS to a newly constituted Department of Aging.

This may or may not be necessary.

The number two question is: Is the governor’s order going to make any difference?


From KHI: Compact to remove KS from federal Medicaid/Medicare


Compact would take Kansas out of federal Medicaid and Medicare programs

By Jim McLean
KHI News Service
Feb. 7, 2012

TOPEKA — Kansas legislators are being urged to join a multistate compact formed to challenge the federal government’s authority to set health policy.

Dan Tripp, national field director for the nonprofit Health Care Compact Alliance, testified Monday to the House Health and Human Services Committee in support of a bill that would authorize Kansas’ membership in the Health Care Compact. Similar bills have passed and been signed into law in four states: Georgia, Texas, Missouri and Oklahoma.

The measures – including the one being considered in Kansas, House Bill 2520 – are based on model legislation promoted by the American Legislative Exchange Council, a nonprofit, pro-business organization that includes state legislators – mostly conservative Republicans – and businesses as members.

Tuesday, February 7, 2012

"Raising Renee"

From disabilityscoop.com
By Michelle Diament


HBO To Air New Film Tackling Disability Caregiving

A new documentary chronicling one woman’s experience as she assumes care of her sister with an intellectual disability is set to premiere on HBO later this month.

The documentary "Raising Renee" is scheduled to premiere on HBO2 Feb. 22 at 8 p.m. ET. (Courtesy: West City Films, Inc.)

The film, “Raising Renee,” follows Beverly McIver and her older sister, Renee, over a six-year period. An acclaimed painter with a flourishing career in the art world, McIver casually promised her mother that she would take care of Renee, who functions at the level of a third-grader, when her mother could not.
When McIver’s mother died in 2004, she followed through on her promise, moving Renee from their mother’s home in North Carolina to live with her in Arizona. Soon realizing that she needed help caring for Renee, McIver ultimately returned to North Carolina — a place she’d vowed never to live after leaving the segregation-filled environment of her youth.

The documentary, which premieres Feb. 22 at 8 p.m. ET on HBO2, follows the two sisters as they adapt to their new reality and confront the opportunity for Renee to live independently for the first time ever at age 50.
“Raising Renee” is just the latest film focusing on disability issues to appear on HBO. In recent years, the cable channel aired Monica & David, a documentary about the marriage of two young adults with Down syndrome, and produced a biopic of autism self-advocate Temple Grandin.

Catholic Diocese of Wichita Shares Concerns about KanCare

A thoughtful post on the Catholic Diocese of Wichita Website by Tom Racunas, director of the diocesan Ministry with Persons with Disabilities.

This past November, the Executive Branch of our Kansas government announced plans to implement a new system for how Medicaid services are delivered and reimbursed, called KanKare. This decision follows the trend that most states have made in an attempt to improve care and reduce costs. Three billion dollars will soon be managed by three private, for-profit, out-of-state insurance companies.

Unlike most other states, however, the new KanKare system includes the provision that long-term care services for people with disabilities, including those with intellectual and developmental disabilities and the elderly, will also be managed by these insurance companies. Most states have excluded services for people with developmental disabilities from these managed-care systems. (Or have “carved them out” after managed care systems didn’t work). While insurance companies may do a fair job of managing medical services, insurance company representatives admit that they have little to no experience providing long-term care services for those with significant developmental disabilities. Examples: a young man with autism who has severe, challenging and life-threatening behaviors; a young adult woman who is severely multiply disabled, has progressive health related issues and is in need of residential services because her parents are ailing or an older adult with intellectual disabilities and mental illness. These are not random examples. These are three examples of Catholics and their families who live in the Diocese of Wichita.

At a community meeting held recently in Wichita, Shawn Sullivan, Secretary of the Department of Aging, spoke to people with developmental disabilities, their families, caregivers, and representatives from agencies which coordinate and provide services. With sincerity, he tried to alleviate some of the fears that have been expressed regarding the upheaval that this change may cause. Specifically, Secretary Sullivan, stated that people with developmental disabilities could keep their current case manager if they so choose, that services and reimbursement rates won’t be cut, and that service agencies will be able apply to be a provider with one of the managed-care companies. But many critical questions still need responses. To name a few:

  • How will cost savings be realized if many provisions of the current system are to remain the same?
  • How will managed care affect the recruitment, training, and retention of direct care staff and, more importantly, the overall quality of care?
  • How will the KanKare system impact the nearly 4,500 Kansans with developmental disabilities who are on a waiting list for services?
  • Most significantly, how will managed care impact choice in services and supports that persons served and families have come to value as a meaningful testament to their dignity as a person regardless of the nature or severity of their disability?


Continue reading Tom Raucus' thoughts...

Letter to Wichita Eagle: Remove DD from KanCare proposal

A letter to the Wichita Eagle Editorial Board:


Remove DD from KanCare proposal

We are still very concerned that long-term care services have not yet been removed from the Brownback administration’s KanCare managed-care proposal. Our daughter Julie is a 26-year-old young lady with severe intellectual disabilities, cerebral palsy and epilepsy.

We understand that there needs to be a way to control spending, but the companies that are bidding on the managed-care contract do not have experience providing services to this population. Further, the services that exist for people with developmental disabilities in our community have been built from the ground up as a response to the needs of our community. They have been fine-tuned over decades to fit the specific needs of those with intellectual and developmental disabilities.

This is something we should be proud of and protect, not something we should allow to be destroyed.
We are watching this issue closely. We expect DD long-term care services to be removed from KanCare. Lawmakers should take any and all action necessary to remove DD long-term care services from the current managed-care proposal.

CONNIE and STAN ZIENKEWICZ
Wichita




Wichita Eagle Blog: Insurance companies lack track record on DD care

By Phillip Brownlee
Wichita Ealge Editorial Department Blog

Insurance companies lack track record on DD care

The announcement last week that Blue Cross and Blue Shield of Kansas would not bid on the state’s managed-care contracts for Medicaid raised more concern about the wisdom of including long-term care for the developmentally disabled in the contract. “Because there were new populations in new settings that we can’t serve in our current business model, we decided to not submit a bid,” Blue Cross spokeswoman Mary Beth Chambers said. Wichita-area service providers complained to The Eagle that the insurance companies looking at bidding on the contract don’t have a track record of providing services to the developmentally disabled.

ReThe announcement last week that Blue Cross and Blue Shield of Kansas would not bid on the state’s managed-care contracts for Medicaid raised more concern about the wisdom of including long-term care for the developmentally disabled in the contract. “Because there were new populations in new settings that we can’t serve in our current business model, we decided to not submit a bid,” Blue Cross spokeswoman Mary Beth Chambers said. Wichita-area service providers complained to The Eagle that the insurance companies looking at bidding on the contract don’t have a track record of providing services to the developmentally disabled.

Gov. Brownback Issues ERO to restructure SRS and KDHE

The acronyms are abundant in this legislative update, but we'll attempt to clarify as much as possible!

What's in this ERO?
Yesterday, Governor Brownback issued Executive Reorganization Order (ERO) No. 41.  Remember this number because it pertains to a massive change for a number of social service agencies including Community Service Providers (CSPs) and Community Developmental Disability Organizations (CDDOs) who provide service to individuals with developmental disabilities.

The ERO proposes that CSPs and CDDOs who have been under the purview of The Department of Social and Rehabilitative Services (SRS) will be transferred to the new Department of Aging and Disability Services (a sub-department of KDHE: Kansas Department on Health and Environment).  In addition to DD services, the Department of Aging and Disability Services will assume responsibility for all Medicaid waivers including Physical Disability, Frail Elderly and Mental Health Waivers.  Secretary Sean Sullivan is the head of the Department on Aging an Disability Services.

SRS will be renamed the Department of Children and Families and will assume responsibility for foster care, adoptions, and child and welfare programs.  Last Friday Gov. Sam Brownback appointed former legislator Phyllis Gilmore to serve as Secretary of SRS.

What happens next?
The legislature has 60 days to act on the ERO - they can approve or disapprove it.  If neither chamber votes to reject the ERO it will go into effect July 1, 2012.

Legislative Calendar: Feb. 6th - 10th


HOUSE:


Tuesday:

Children and Families Committee
9:00 AM               RM 142-S
Hearing on exclusion of DD and HCBS from Proposed KanCare legislation

Health and Human Services
1:30 PM                DSOB 784
Overview and Discussion about Centers for Independent Living (CILs)

Wednesday:

Social Services Budget Committee
3:30 PM                DSOB 711
Parsons State Hospital and KNI Budget Presentation and Public Testimony

Thursday:

Social Services Budget Committee
3:30 PM                DSOB 711
Parsons State Hospital and KNI Budget - Deliberations




Friday, February 3, 2012

Phyllis Gilmore new SRS secretary

From KHI News Service

Phyllis Gilmore appointed new SRS secretary
Former legislator supports administration's recent change in food stamp policity

Photo by Phil Cauthon, KHI.org