mr. coleman, let me turn to you and follow up on what the senator mentioned, with focus, and i will turn to dr. feder, in rural parts of the country in colorado we hatch eave, the eas part of our state is rural. we produce fuel, fiber, we hatch eastern reaches that are rural. what have you found that are unique challenges in providing long term services into the parts of the state. and then, dr. feder, i would look you to follow with how medicare itself could work with the dynamic. >> again, minnesota has -- greater minnesota also. where the population density is, a challenge in providing services to -- to older people, old eer adults, and people with disabilities. what we found is we need flexibility. that -- again, relying upon the communities, and the community infrastructure, with which to base long term care services and supports, we need to acknowledge that drive time, the -- the differences that we need to accommodate in our policies to allow people to have some choice but they may not have as much choice. it is a challenge, but it can be done. we are also learning the value of te

mr. loren coleman is with the department of human services, with more than 25 years of experience with with long term care facilities, a host of programs for older adults, and is the leading force behind minnesota's transform 2010 program. which is designed to help the state prepare for retirement of the baby boomer generation. dr. aiken is president of the american action forum. he was chief economist with the council of economic advisers from 2001 to 2002. and he serbs as the director of the congressional budget office from 2003 to 2005. professor judy fader has had a long and established academic career, serving as dean of the policy in washington, d.c., from 1999 to 2008. today she's a professor at georgetown university, a fellow at the urban institute and an elected member of the institute of medicine. we also have dr. bruce chernoff with us today, the president and ceo of the scan foundation. an organization that's dedicated to research and dissemination knowledge that improves the health of older older adults. dr. chernof also served as director and chief medical officer for the los

mr. coleman, we all know that medicaid was never intended to be the primary provider of long- term care coverage, yet medicaid is the largest pair of long-term care services. with long-term care accounted for almost half of national long-term care spending, as a former governor, and of giving our states the flexibility and resources they need to innovate is a first and critical step toward controlling spending in the medicaid through -- program and an improving long-term care outcomes. we will never achieve equality in savings -- treated with a one-size-fits-all service. as you noted in the testimony, [unintelligible] to make sure the services go to the most in need, which i agree with. with that being said, what steps did congress take to improve and create it -- improve the flexibility states like west virginia and minnesota? >> thank you for the question. i, too, believe that states can manage programs effectively and i think minnesota is an example of if you have a vision, if you have a goal, and if you plan properly, you can achieve that. but it takes some prerequisites. it cannot have a ho