mr. colman? >> thank you, mr. chair and members of the committee. on behalf of commissioner jesseun, i thank you for the opportunity to share with the efforts that minnesota is making to provide the best possible long-term care system for older adults and persons with disabilities. minnesota has a strong infrastructure built over many years of long-term care services and supports for older adults and people with disabilities. last fall we were very proud and gratified to see the quality of minnesota's long-term system recognized by the aarp and the scan foundation. minnesota ranked number one among all states in the first ever aarp scoreboard on long-term care services and supports for older adults, people with disabilities, and family caregivers. the report validates the direction that minnesota has been moving for the past 25 years. to reduce reliance on institutional care and encourage access to services in home and community-based settings. it acknowledges minnesota's efforts in providing comprehensive phone and web-based information and referra

mr. colman? >> i think initially we have to look at what is the consumer want and what does the consumer have the ability to have as choice. and the number one thing we hear from older people in minnesota is they want to remain in their homes. and if we can provide low-cost interventions, we can delay the need for more expensive services for some period of time. and that's what we're really focusing on is delaying the need for more expensive services. we have a -- we have a tracking in minnesota. 92% of long-term care in minnesota is provided by families right now. and they want to continue to do so. and the more we can support families to continue to help their older family member, again, it will conserve dollars for those that truly have higher needs. >> is that 92% lead the nation? >> mr. chairman, i don't know. i don't know what other states are tracking. >> are you imagining? because you've been in this field a long time. that that's among the very highest in terms of percentage? >> i think

mr. colman, right there, 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 accounting for almost half of national long-term spending, as a former governor, i know that giving our states the plexability and resources they need to innovate is a first and critical step toward controlling spending in the medicaid program and improving long-term care outcomes. we will never achieve quality and savings with a one size fits all approach that ignores the differences and medicaid population from state to state. as you noted in your testimony, minnesota is applying waivers under medicaid to improve the way to deliver and pay for services and to make sure that services go to the most in need, which i agree with. with that being said, sir, what steps could congress take to improve and increase the flexibility to states like west virginia and minnesota to maximize the value in long-term care in their medicaid programs? >> thank you for the question. i too believe that states c

mr. colman? >> thank you for the opportunity to share the efforts minnesota is making to provide the best possible long-term care system for older adults and persons with disabilities. the structure was built over many years of long-term services and support for older adults and people with disabilities. last fall, we were proud and gratified to see the quality of minnesota's long-term care system recognized by the aarp. we write number one on the first ever aarp scoreboard. the best we ranked number 1 on the first ever aarp scoreboard. -- we ranked number 1 on the first ever aarp scoreboard. this enologist minnesota's effort in providing comprehensive -- this acknowledges minnesota's effort in providing comprehensive service. it provides evidence base support for family caregivers. not that long ago, most people were served by medicaid in minnesota received long-term care services in institutions. we have developed the support needed to survey the best serve people in their homes and communities

mr. colman. >> thank you mr. chair and members of the committee. behalf of commissioner jess and thank you for the opportunity to share with the committee the efforts that minnesota is making to provide the best possible long-term care system for older adults and persons with disabilities. minnesota has a strong infrastructure built over many years of long-term care services and supports for older adults and people with disabilities. last fall we were very proud and gratified to see the quality of minnesota's long-term care system recognized by the aarp and the scan foundation. minnesota ranked number one among all states in the first-ever aarp score bard -- scoreboard with people with disabilities and family caregivers. the report validates the direction minnesota has been moving for the past 25 years. to reduce reliance on institutional care and encourage access to services in home and community-based settings. technologist minnesota's effort in providing comprehensive phone and web aced information and referral sources for seniors and their fami

mr. colman, and the follow-up on what senator manchin pursued and what particular focus and the will turn to dr. feder as well in rural parts of the county. in colorado with every eastern region of the state is very rural. we create a lot of fruit and fiber and fuel for the country. we have western regions in colorado that are very rural. what have you found a unique challenges in long-term services in those parts of your state? dr. feder, how medicare itself could work with that dynamic? >> minnesota has greater minnesota also. population density is a challenge in providing services to older adults and people with disabilities. what we found is we need flexibility. relying upon the communities and the community infrastructure with which to based long-term care service and support. we need to acknowledge the drive time, differences that we need to accommodate in our policies to allow poor people to have some choice but maybe not as much choice. it is a challenge to divide policies that accommodate those distinctions and differences but it can be done. we are also learning the value of tec