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Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
Hello, and welcome to a special Health Affairs podcast on aging and health as part of our Age Friendly Health series. The series and this podcast is supported by the John A. Hartford Foundation. I'm your host, Katherine Ornstein, professor at Johns Hopkins University and health affairs advisor for the Age Friendly Health Series. On today's episode, we are talking about the 2025 Budget Reconciliation Bill, commonly referred to as the One Big Beautiful Bill Act or OBA.
Katherine Ornstein:There's been a lot of discussion about its major impact on states, the Medicaid program, healthcare consumers and providers, and the overall healthcare system. Today, we're looking at it through the Age-Friendly Health lens to consider state health policies and programs affecting older adults. I am here today with Hemi Tewarson. She's the Executive Director for the National Academy for State Health Policy or NASHP, an organization working on the development of state health policy and programs. And as the leader of NASHP, Hemi is uniquely positioned to provide insight on what OPAP means for state health policies and programs affecting older adults.
Katherine Ornstein:Hemi, welcome to the program.
Hemi Tewarson:Thank you, Katherine. It is great to be here with you today and it's obviously a really good topic for us to talk about.
Katherine Ornstein:Wonderful. Well, we're going to go ahead and get started, because we have a lot of questions for you. And, know, OBA clearly will have a major impact on Medicaid. I mean, the main Medicaid provisions of OBA that, you know, we keep hearing about are the work requirements, new limits on provider taxes and state directed programs, and restriction of Medicaid eligibility to US citizens and lawful permanent residents. Which of these do you think will have the greatest impact on older Americans and their caregivers?
Hemi Tewarson:Yeah, it's such a great question, Catherine. And just maybe just taking a step back for a minute, we here at NASHP, for those who may not be familiar, we are a nonprofit and we work solely with state leaders across all 50 states in the District Of Columbia. So as you might imagine, this has been sort of front and center topic. It's clearly sort of top of the list. There are all these different provisions, very significant, will require a lot of work to implement and some are, you know, the deadlines are coming up really quickly.
Hemi Tewarson:So particularly with, the work requirements or community engagement requirements. So, you know, just reflecting on this question for a minute, I just wanted to share, it's been sort of a really interesting time to think about Medicaid. I've worked in Medicaid for, you know, my entire career or so, and I've seen it sort of in different variations. I've worked in private sector over the federal government, now with states. And, you know, there's times when Medicaid is really been expanded.
Hemi Tewarson:And I think over the past couple of years, we've really seen that coming out of the pandemic for older adults and their caregivers. There was money flowing, you know, post pandemic to stay. State budgets were very strong. You saw so many expansions in things like home and community based services, you know, really cutting down on the wait list and, you know, increasing in home care patients and their workers, increasing reimbursement. So it was really a time for, I would say, innovation in the Medicaid program and different types of services that were really being provided at a new level across the country, including investments in behavioral health.
Hemi Tewarson:So we're coming out of this period of like a lot of, I would say, growth in the program. I think the challenge now is that there is just more limited resources clearly at the federal level with changes in OBA, which will really reduce Medicaid, you know, resources from federal perspective, but also at the state level, even sort of outside of OPA, states have had just more constrained state budgets. And you've seen it in the legislative session this year. I think you'll see more next year and the following year, just with respect to states just having less revenue and having to think about how are we balancing our overall budget. So I just give that as background before sort of specifically answering your question, because I think it's really important to think about it holistically.
Hemi Tewarson:That's certainly how we're doing it at NASHP. And, you know, when you think about sort of Medicaid and older adults, you know, there's 22,000,000 people on Medicaid that are, you know, 50 years and older. They're, you know, almost a fourth of the population and they count for almost half of the spend. So when we're in a time thinking about, you know, changes to the policy in Medicaid or changes to the finances, it's a very critical program, obviously, for older adults. I think the other piece that I think we probably all know for listening to this podcast is, you know, the the age of 65 and older is the fastest growing segment in our population.
Hemi Tewarson:So, you know, when states are thinking about projecting, how do we implement these over requirements along with sort of changes in our own fiscal footprint? Clearly, you know, they're anticipating there's going to be continued increase in the needs for the, you know, those who are aging and on Medicaid. And so that's part of the conversation I think that's happening. You know, how do we really make sure that Medicaid is sustainable over the shorter and longer term given these big changes? So I guess just to come back to your question about these different provisions, community engagement obviously is front and center because it's the one that's happening first.
Hemi Tewarson:Are, all the states will have to comply with community engagement, which means that, you know, those who are not exempt from the requirements actually have to show that they're working or volunteering or, you know, seeking educational opportunities at least eighty hours a month.
Katherine Ornstein:Right. Unpack that a bit because everyone's talking about that. Everyone's concerned. What does that mean, especially for older adults?
Hemi Tewarson:Yeah, it's a really good question. And just in terms of those requirements, they're going to be required as of January 1, and there's a couple of states that are going to go before January 1 to implement. So what does that mean for older adults? I mean, the good news is for those who are over, you know, who are 65 and older, these requirements will not apply. So they will be exempt from the community engagement requirements.
Hemi Tewarson:So that's helpful. The other piece though is there are still folks that are between, you know, 50 and 64 who will be subject to the requirements if they're in a state that has expanded Medicaid, which, you know, at this point, there are many states, 40 states that have expanded Medicaid. And in addition, you asked about caregivers. There are a number of caregivers who are in that age range or younger who also are on Medicaid. So those folks are going to be impacted by this.
Hemi Tewarson:So what does that really mean? You know, where states are is they are implementing changes to their eligibility systems, which is very significant. This is going to be the first time since we've expanded Medicaid to those populations where folks are going to have to prove that they are either working, volunteering, or getting educated before they can qualify for the program. And it really is
Katherine Ornstein:this for new folks or people who are currently
Hemi Tewarson:receiving? People who are both. So those are new and people who are currently enrolled will have to establish this. So there's not a grandfathering. If you've already been eligible for Medicaid, you don't have to meet these requirements.
Hemi Tewarson:That's not the case. So everyone who is currently on the program will have to meet the requirements, and they'll have to meet them as of January 1. When you unpack that a little bit more, where states are is they are implementing these different requirements and having to really make significant changes to their eligibility systems. Obviously, work with the state, so that's our focus. But for the consumer, it's going to mean that they have to understand and navigate a new set of requirements to demonstrate eligibility.
Hemi Tewarson:States are really being encouraged by CMS to do as much automation as they can, which will help, you know, reduce the requirements of individuals having to produce more documentation and having more risk of not meeting that burden and then no longer being eligible, even if they would otherwise qualify. So that's certainly, I think a goal of this program and how states want to implement. But there's a lot of work to get that right. And there's a lot of things that states are doing now that they really are going to have to test once it actually goes live. A couple of things just specifically to sort of the older adults who are in that 50 64 age range and their caregivers, states are trying to think about, you know, what can we automate?
Hemi Tewarson:So for example, for caregivers, if they're getting paid by Medicaid, you know, can we automate like using claims data? Is there something that we can do that, you know, if we have a caregiver assessment, we'll know that their caregivers we can pull from that. When they apply for taxes, do they claim the care recipient as a dependent? So those are the types of, I think, data sources that states are looking at. But that's not going to capture everyone.
Hemi Tewarson:I think there are some states that are looking at, you know, can they self attest that they're caregivers? We don't have a final rule from CMS to know whether, you know, that's going to be 100% okay to do, But I think there are states that are really, you know, wanting to move in that direction, some states at least, to allow them to self attest. For those who are not caregivers and who are, you know, between the ages of 50 and 64, that's a sort of a whole different bucket of, you know, how do you establish, you know, do you have any sort of medical frailty? That's one of the exemptions in the requirements, which means like if you have a medical condition that, you know, requires you to be unable to work and you have other sort of challenges, you can demonstrate that and then you will not have to meet the work requirements or the volunteering requirements. What about the issue around citizenship and lawful permanent residency?
Hemi Tewarson:Any changes around that? Yeah, there have been changes and there was actually just a guidance that was just released by CMS to clarify that the definition of those who are permanent residents and qualified immigrants has changed in individuals. There will be some individuals that will no longer qualify for Medicaid that had qualified previously because of those changes. So if you're an older adult and you fall into that category, you will no longer be eligible for Medicaid. It is also true for, you know, we're not talking about Marketplaces today, but it's also true for those who got subsidies for the marketplace as well.
Hemi Tewarson:Yeah.
Katherine Ornstein:Interesting. Okay. I want to move on to another topic related, of course, to the bill. And it's really just thinking about the Rural Health Provider Relief Fund, which is part of it. And it is authorized to provide $50,000,000,000 in rural health transformation grants over five years to states to support rural healthcare providers.
Katherine Ornstein:Now, this point, I believe all states have applied for and have been awarded funds. Which of these state grant program designs are particularly innovative in their aims to impact health for older Americans?
Hemi Tewarson:Yeah, what a great question. So we're spending a lot of time here at NASHP thinking about the World Health Transformation Program and working actually with all 50 states on that through our various networks. And we have taken a look actually at the RHTPs, which I like to call it, just so I don't have to say the whole phrase, RHTP. We have been looking at those applications and we have really been interested to see how many states actually addressed aging in their applications. It's notable because there were a lot of areas that were mentioned in the request for applications that states did follow, you know, IT and other areas.
Hemi Tewarson:Aging wasn't listed, but states went ahead and actually included a lot of initiatives that addressed aging. Yeah. So and I think part of that is a reflection of almost 20% of rural populations are individuals over 65 years of age. And I think there's a recognition that we have to really think differently about the rural health care system for those who are aging. So anyway, so just wanted to share that sort of background.
Hemi Tewarson:When we looked through the applications, there were a lot of things around, you know, workforce and how do we change their long term care systems and improving coordination for those who are duly eligible. There were some technology initiatives. There were areas around how do we support family caregivers? And there was a couple of states and I will just call this one out, the program of all inclusive care for the elderly or the PACE program. That has been a, I think a program of interest, know, for many, many years now, but it's hard to scale for a number of different reasons.
Hemi Tewarson:And there were 10 states that actually mentioned proposed initiatives to create or expand PACE programs, which we thought was notable and interesting using the Rural Health Transformation Funds. There was a couple of states that really wanted to address how to provide services for those diagnosed with Alzheimer's and dementia. And there were some states that wanted to think about fall prevention. So I just mentioned that because And there was also some states that wanted to think about programs for palliative care. So lots of different ways to think about it.
Hemi Tewarson:In the technology area, that has been an area that's been, I think, promoted by CMS and really, you know, wanting to see states think about how to use technology in rural areas. So there was a couple of notable ideas for those in the aging population. I'll just call out North Dakota as one because we thought that was an interesting set of ideas here. So they would like to make investments in motion sensor technology to prevent and detect falls alongside of other AI and smart technology to keep sort of elders safe at home. They also are a state that wanted to build on their PACE program and dual needs special needs programs.
Hemi Tewarson:And they wanted to think about how to really build their statewide telehealth network to make sure that residents have sort of more choice and aren't restricted to small rural networks. So just a couple of things there to just to pull out the themes a little bit more. I will say, you know, and we didn't talk about this yet, so maybe we can go back and talk about this. OBA also has a number of, you know, fiscal changes in terms of how the Medicaid program is going to be financed in future years, and there's going to have disparate impacts on states. This money isn't going to make up for all of that.
Hemi Tewarson:You know, I do just want to be clear and say that. So there's a real opportunity, I think, to catalyze changes and innovations for older adults in rural areas. But we also have to understand that there's going to be sort of other challenges, particularly for the providers and others in rural areas that this money won't completely be able to relieve.
Katherine Ornstein:I think that's important to clarify. Thank you. And so it sounds like not all states are really thinking about focusing on older adults with this, what did you call it?
Hemi Tewarson:RHP. RHTP?
Katherine Ornstein:RHTP. Like, it's not particularly focused on older adults for everyone in all schools.
Hemi Tewarson:No. Yeah, but I guess what I was saying in the beginning though is that there was, we were surprised to see so many states including initiatives for aging adults. And if you're interested in Ashby had a blog where we tallied all of the different numbers of states that had these types of ideas in their proposals. And there was a lot of them. I feel like almost all of them touched on it in some way.
Katherine Ornstein:I'm going to move to an area that we're very interested in, which is thinking about OVA authorized a new kind of Medicaid waiver for home and community based services for people who don't need institutional level of care, with a total of $100,000,000 to states to support implementation. So to what extent are states taking up this option?
Hemi Tewarson:Yeah, it's such a great question. And it was, so this is an area that, you know, in my work with states, there has been sort of a longstanding interest in how do we think about getting home and community based services to folks who may not need institutional level of care? Is there a way to be able to do that? Would be great to have more flexibility to do that because it is a pretty high level. You have to be pretty sick, right, in order to then get home and community based services.
Hemi Tewarson:So I think sort of a for some states, you know, a welcome new idea that they have some interest in. A couple of things I would just say, we haven't seen like, you know, ten, twenty states like all of a sudden saying we're going to do this option. I think that's just because you have this is not going to actually come into effect until July 2028. So we have some time. Awesome.
Hemi Tewarson:Yeah. So you can only start implementing the waivers in July 2020. So it's a little early right now and there's so many things on the plate of states that have deadlines before that. That's just something
Katherine Ornstein:to share. No, that's important to know in thinking Yeah. About
Hemi Tewarson:And so it's been interesting. There was one state we actually saw that is, know, the legislature wants the state to pursue this waiver, but it's for behavioral health. So it's not for aging populations in Georgia. So that's a bill that's been passed both from the Georgia House and Senate. So that's one we're tracking closely because we're interested.
Hemi Tewarson:But I do anticipate there'll be some states interested in this. It's just the when, given all the other priorities they have on their plate. The other piece which we haven't talked about is financing. So if we want to spend a minute on that, I'd love to share just thoughts on sort of Medicaid financing right now.
Katherine Ornstein:Sure. If
Hemi Tewarson:that's okay with I
Katherine Ornstein:think that's very relevant.
Hemi Tewarson:Yeah. So, I talked a little bit in the beginning about, challenges with state budgets, even, you know, independent of what's happening with OBA. There's a number of states that have sort of had challenges and tighter budgets and have had to really think about, you know, how they can balance their budgets, which they have to do unlike the federal government. So OBA though sort of takes additional steps for certain states because they're changing the way states can finance their programs with respect to provider taxes. So that's been sort of a, not to get too wonky, a long standing way that a part of how states have financed, know, particularly provider payments and some of the other aspects of Medicaid has been through provider taxes and taxes on, you know, health plans.
Hemi Tewarson:Not all states have used this in the same way, so this doesn't, you know, it's not equally applicable across states. But under OBA, there's going to be over ten years sort of a ratcheting down of the level of provider taxes you can actually utilize in your program. Without getting too wonky, you know, it's like from a 6% to a 3%. It may not sound significant, but for some states it will be if they've maxed out their ability to actually utilize provider taxes. So that's going to change one area of financing for some states.
Hemi Tewarson:The other area is state directed payments. So states have used that mechanism, particularly under the last administration, it really expanded, particularly for hospitals as a provider, where they really built a lot of supplemental payments through these directed payments. And in some states that's resulted in hospitals getting close to commercial rates actually from Medicaid. There is now going to be sort of again a ratcheting down over ten years, so it's going to be gradual where for expansion states you're going to have to actually be at 100% of Medicare and for non expansion states it's like 110% of Medicare. So for some states that's going to be significant decrease in how they are able to reimburse providers through this state directed payments.
Hemi Tewarson:So I just share that because as states sort of do their projections for some states they're sort of looking down you know the next couple of years and they're realizing they're going to just have less less finding financing and funding for certain types of providers particularly, and then of course for the overall program. And you know some of the conversations to bring it back to older adults, some of the conversations that have been happening have been you know okay what what options do we have if we have to tighten up our budgets? And the areas that really come to mind is you reduce your payments to providers and you look at your optional benefits. And you just slow down on your, you know, growth of what you may be doing on the optional side. Home and community based services is an optional service.
Hemi Tewarson:Nursing home is not. Nursing home is required under Medicaid, home and community based services is optional. And I don't want to be sort of doom and gloom here. We haven't seen states ratcheting back their home and community based services as of now. But I do think behind closed doors, there's a couple of states that have been talking about our spend on home and community based services really invested a lot.
Hemi Tewarson:We wanted to move people out of the institutions. We want to serve people in their homes. So we've really rebalanced really effectively. We want to make sure we can sustain that in the years to come if we have less money for our Medicaid budget and how do we do that effectively? So I guess I just raise that as something to watch over the next, you know, couple of years.
Hemi Tewarson:I think there are some states that are trying to be creative. You know, there's there are states that have like increased their taxes, right, this legislative session to generate more revenue. And that could come, you know, in future years as well. So it's not all about cutting, but there are other states, and I just, you know, call out like a state like Colorado who really had a tight budget situation, and they put some changes to home and community based services out. They said we're going to have to slow down, you know, the way we pay the providers.
Hemi Tewarson:We're going to have to think about capping the number of hours that we're, you know, reimbursing family caregivers. There were some other things that they did. There was some pushback and some of those changes actually haven't been implemented. It's just to say that it's on the list if states are actually really in tight fiscal budget situations. So just wanted to be sure to point that out.
Katherine Ornstein:Yeah, thank you. Anything else that you think is particularly important for older adults that may be on that list?
Hemi Tewarson:So I definitely think, you know, we don't have enough home care workers, honestly. Yes. And so there has been, know, I think some work in the past couple of years to try to increase payments to the home care workers, think about how to recruit. Right. So I do, you know, I do wonder how that will fare if there are sort of more challenging budget situations.
Hemi Tewarson:Will states continue to be able to invest in the same way that they have been in the past? If we don't have the workers, we can't have the services, right? So there's that challenge. I will say the other piece, there is a lot of focus right now on program integrity and fraud really coming from the federal government as well as states who want their programs to be robust free of fraud and efficient and accountable. So part of what CMS is asking the states to do is look at where have you had sort of high levels of spend and can you make sure that those services are justified?
Hemi Tewarson:And one of those areas is home and community based services. So I just share that because there's an oversight element to this as That states are really, you know, having to look at, you know, how do we provide those services? You know, we want make sure that all the providers are appropriately enrolled and, know, payments are accurate and correct and beneficiaries are getting the services that they should. So that's just another element, Catherine, in addition to you know overall budget there's also sort of program integrity and accountability.
Katherine Ornstein:How are they enforcing the accountability? Like, how are they making sure that programs are really looking, you know, within the state and seeing?
Hemi Tewarson:Whether everything is A Okay.
Katherine Ornstein:Exactly. Or, you know, they have to report that?
Hemi Tewarson:Yeah, states have and this could be like a whole other you know podcast session states have very robust oversight mechanisms. They you know, they have Medicaid integrity fraud units, MUFCUs, they have audits, they report their expenditures to CMS, they have provider certification. I mean it's part of you know I think sometimes complaints on the about the bureaucracy of state government as well as federal government frankly in terms of all of those checks and balances. So there's certainly a lot that states do to make sure that you know things are working as they should but no system is perfect right so there is I think just an additional layer of oversight, frankly, from CMS, which has begun across not just for Medicaid, it's across all of sort of the public programs that's really requiring states to then respond and really, you know, look for documentation and try to, you know, explain all the different expenditures, which is I think going to be an ongoing initiative for the next many, many months.
Katherine Ornstein:So what do you think are the biggest priorities at this point for state policymakers who are just seeking effective ways to improve healthcare for older Americans?
Hemi Tewarson:Yeah. And I will just say, so I have been sort of working Medicaid and aging along with other areas in Medicaid for a number of years. And I really do feel like there's a lot of interest at the state level of really thinking about older adults and how to improve the program. So I'll just note there's these master plans on aging, which is not specific to Medicaid, but for those of you who are following, there's been so many states that have picked up master plans on aging, really thinking about across the continuum, how do we think about changing our systems for older adults, which is wonderful to see. Medicaid is included in that.
Hemi Tewarson:It's not a Medicaid driven initiative. So that's one that I just would want to note. I think there's always been interest, but I think a renewed interest in thinking about those who are eligible for Medicare and Medicaid. How do we simplify the systems? How do we think about more coordinated care between those programs?
Hemi Tewarson:So I definitely think that's on the list and has been for many years of where can we make more progress on it. Another area I think is really about, I talked about the Rural Health Transformation Fund. So I do think there'll be some interesting things to watch at the state level with respect to older adults and you know, Rural Health Funds and what states are going to do with those programs. And then the other area I would say beyond that is I think there's a real interest in thinking about how do we braid and blend funding for older adults, knowing that we may just have tighter Medicaid budgets. There's the Older Americans Act.
Hemi Tewarson:Some states do this very well, other states are really trying to think about how they can do more of it. And I know that sounds wonky and you know sort of inside state budget, but it really is important to think about how to braid and blend funds to create more sustainability for programs. I think there's some interest in public private partnerships at the state level of thinking about new innovations for for those who are who are older and that you know that touches on the technology realm and thinking about like wearables and smart homes and all of those things as the future of how do we really help people stay in their homes longer and really be able to to say stay as healthy as they can. And then the last thing I would say is I think there's a real interest at the state level to understand what's really working for older adults. Like, how do we how do we figure out, you know, where we can make the best investments and, you know, where we can really see, you know, really increase like improvement in outcomes as well as, you know, maybe hopefully reducing costs.
Hemi Tewarson:And so I think, you know, here at NASHP, there's a couple of areas where we've seen like, you know, are looking at like, what can we do differently with with nursing homes? How do we improve that experience? We know some older adults will have to go to nursing homes. Many don't want to be in nursing homes. You know, how do we think about, you know, that that site of care differently and improve the experience?
Hemi Tewarson:So that's definitely, I think, an area. I think another area is how do we think about what comes next for those who want to have a different set of options, you know, as they get older, like through things like palliative care and thinking about what kind of services when those who are seriously ill, who are older adults, but also others who are seriously ill, how do we help during that period of time and giving folks choices for that type of care in a different way? And we've been working on that here at NASHP for a number of years and I've seen a number of states interested in thinking about that.
Katherine Ornstein:I wanted to ask a question because we didn't talk about it. I know this is very relevant. It's just thinking about dementia care priorities and how relevant that is and what, you know, we do a lot of work in that and obviously we're seeing a huge need there impacting all of these things, the direct care workforce and caregiving and the home and community based services. So I just would love to hear if there's, you know, states that are working on this, any perhaps positive innovation you see happening in that area.
Hemi Tewarson:Yeah. I don't have like one state to call out on that topic, I will say it is, I think, increasingly becoming an area of priority for states to think about how do we better serve those with dementia because of the increasing numbers of folks, as you said. And I would say for our work, kind of cuts across the existing work that we're doing. You know, there's there's folks who are in nursing homes who have dementia, and it's like, do those nursing homes better serve those populations? How do you help nursing homes be more equipped to deal with those with dementia, especially if there are not other alternatives for lower income elder adults to go for that type of care?
Hemi Tewarson:We do, I didn't even mention this, we do a lot of work on caregiving. I mean, caregiving. We have, I think, 63,000,000. I think that's the number of family caregivers in this country. One in four adults, right?
Hemi Tewarson:Dementia is not the only piece of that puzzle, but certainly an increasing piece of that puzzle. And so thinking about how you support those caregivers with things like respite and training and understanding what they're able to do and when they're going to need sort of additional services when it's beyond, I think is another area that states are looking into. And then the last piece is about, you know, what are the other types of facilities? And so we didn't even get into this in this conversation yet, but you know, the assisted living facilities and how they're sort of upgrading to really have these additional capacity to help those with dementia. I think one of the ideas of states is like how do we help people sort of stay in their place longer before they have to spend down to Medicaid?
Hemi Tewarson:There are people that spend down to Medicaid because that is the primary payer of long term services and supports right now in this country. So if you need nursing home care or 20 fourseven home and community based services and you can't afford it, spend down to Medicaid, right? But there's a lot of people that don't want to do that, including people with dementia. So I think states are interested. I can't, you know, say that there's a state that solved this yet, but they're interested in ideas of how do we help folks, you know, remain more stable, frankly, in where they're being served through these different ways, caregivers and different sites of care, etc, before they have to then go to Medicaid.
Hemi Tewarson:The other piece I would just say too, that we're seeing is the increased need of behavioral health services. So you talked about dementia, but there's also, I think, sort of a new element of behavioral health needs that is coming up in our work with states, particularly in areas like nursing homes and family caregiving that I think also need some new ideas.
Katherine Ornstein:Before we wrap up, are there any resources that NASHP has put together that we can share with interested listeners?
Hemi Tewarson:Oh, what a great question. Yes, so, on our website we have all sorts of resources that really address older adults in different ways. There is work that we do on caregiving, there's work that we do on nursing home reform and palliative care, but I also wanted to just call out our Rural Health Transformation Program work, RHTP, where we have some focused resources on, you know, what are in state applications, including specifically on aging. So those, I think, are just a couple of resources. We also have sort of broader Medicaid resources for folks interested in how states are navigating their Medicaid programs with respect to OBA.
Hemi Tewarson:So we are and if you're if you really love that, we have a weekly newsletter that you can sign up for and you can sort of see in real time our new publications as they come out because we do a fair amount of publishing on older adults.
Katherine Ornstein:Wonderful. Well, thanks Hemi for joining us today on this special Age Friendly Health Podcast from Health Affairs Publishing. And I want to thank all the listeners for joining us. We hope you'll check out the other episodes in the series available on the Health Affairs website or wherever you get your podcasts.