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Medicaid Industry Who’s Who Series: Warren Hebert

Warren Hebert is a featured panelist for the upcoming Medicaid and Long Term Care Webinar on May 2nd.

RESERVE your seat today at


Medicaid Who’s Who: Warren Hebert – CEO of HomeCare Association of Louisiana

1. What segment of the industry are you currently involved?

A: I am involved with skilled home health care, primarily Medicare patients, as the executive for the state association. In that role I find myself engaged in conversations about long term care for seniors and those with physical and cognitive challenges. We are also Medicaid consumers, as our 25 year old daughter has Down Syndrome and has a waiver that provides her with assistance. She has direct service workers who have been godsends in keeping her engaged in the community and allowing my wife and I to continue to work.

2. What is your current position and with what organization?

A: I have served as CEO of the HomeCare Association of Louisiana for 18 years, handling advocacy in the regulatory, legislative, and reimbursement arenas. Our organization also hosts workshops and educational conferences here in Louisiana and across eight states. This role has included Congressional advocacy, engagement with an IOM study on the future of home health, as a grant reviewer for the Centers for Medicare and Medicaid Innovation, and on a CMS technical expert panel.

3. How many years have you been in the Medicaid industry?

A: I have provided care as a home health nurse to all patients, including Medicaid, as far back as 1974 when I was a student X-Ray Tech, and later a nurse at Charity Hospital in New Orleans. My home health career involved work in rural impoverished areas, where Medicaid was the primary payer. And now the association executive role involves advocating for fair reimbursement for Medicaid beneficiaries. One might argue that we have access to care issues in many states due to poor reimbursement for services provided to Medicaid beneficiaries.

4. What is your focus/passion? (Industry related or not)

A: My focus is family caregivers. There are over 45 million family caregivers across the country. My wife and I are caregivers to our daughter. Though very high functioning and fiercely independent (she is a university student and in a college sorority), we are still her primary caregivers. My family cared for my father over his seven year challenge with Alzheimer’s and Parkinsonism. He was not hospitalized once over those years, even when he was bed & chair bound in his last 12 months. Family caregivers provide over 80% of all long term care, at no cost to taxpayers, insurance companies, or government. The Rand Corporation estimates that has an economic impact of $522 Billion a year. One study showed that heart failure patients, going home from the hospital to a family caregiver, is less than half as likely to be readmitted to a hospital than a person going home alone.

I have hosted a weekly radio program, Family Caregiving, for seven years on a station that broadcasts on the web, and across seven states. Three of those stations reach into Houston, Chicago, and New York City. I focused my Doctoral project on family caregivers. They deserve our support.

5. What is the top item on your “bucket list?”

A: I would like to see as many of our National Parks as I can. I’ve been to Rocky Mountain, Glacier, Hot Springs, Hawaii Volcanoes, Mammoth Care, and Jean Lafitte here in Louisiana. I would like to visit Acadia in Maine, Bryce, Zion, and Arches in Utah, Grand Canyon & Petrified Forest in Arizona, and Yellowstone.

6. What do you enjoy doing most with your personal time?

A: Our ten grandchildren are the greatest enjoyment for my wife and me. The oldest is 8 and the youngest is due to arrive in June, but we’re counting him already. Eight live within ten minutes and the other two are just 90 minutes away. This past weekend we rode bikes, planted Marigold and Sunflower seeds, and had an early morning around our backyard fire pit. We have taken Saturday morning hikes and visited local cultural sites here in Cajun country over the past few months. We also love spending weekends at our local state park cabins.

7. Who is your favorite historical figure and why?

A: I’d like to name two, Mahatma Gandhi, because of what he accomplished via nonviolence in leading India to independence.

The second is our most recent historical figure, Pope Francis, born Jorge Mario Bergolio. He is the first Pope from the Americas, and the first Jesuit Pope. He selected the name of Francis of Assisi, who loved the poor. The Pope’s compassionate approach to leadership is shaking things up in the name of love and concern for those on the fringes and margins of life. He seems to have a strong bias for the marginalized in society.

8. What is your favorite junk food?

A: Do I have to have just one?? OK, an ice cream made in Brenham, Texas, sold in many southern states, Blue Bell, and Homemade Vanilla is my favorite flavor. 

9. Of what accomplishment are you most proud?

A: Our children. Two daughters followed Dad into nursing, one is a Neonatal ICU nurse, the other a Family Nurse Practitioner with an oncology group. Our eldest son is a Chiropractor, and our younger son an Assistant District Attorney. And our Daughter with Down Syndrome indicates she wants to “work in a hospital helping little children so they don’t cry.” They are all compassionate people, who married compassionate people. So our grandchildren should all turn out to be very loving human beings.

10. For what one thing do you wish you could get a mulligan?

A: Sorry, no mulligans!! One of my favorite books is entitled Everything Belongs. It was written by a Franciscan priest, and the premise is that everything that has happened in our lives belonged there. Our mistakes, failures, omissions, faux pas, etc., have all impact the person we become. So I’m good not taking a mulligan, thanks for offering. (On the golf course I would definitely take that offer though!!)

11. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

  1. Recognize the family caregiver’srole and be creative in supporting them. Whether it’s tax breaks, pay for those who need it, extra time away from work to give care, training, counseling, or more, we should support family caregivers to a far greater extent than we do now.
  2. Remove constraints to practice from Advanced Practice Nurses. As a nurse myself I have a bias. Nurse Practitioners are educated and trained to provide primary patient care. Research has quantified NP’s effectiveness as at least equal to the outcomes of physicians. Nurse Practitioners have had a positive impact on access to care, especially in impoverished urban areas and rural areas that cannot recruit physicians.
  3. Advance health policy that promotes equityin care for those on Medicaid. The poor, among them those on Medicaid, have a right to fair, just treatment. If all things were equal, then we would be OK with equal treatment of all. But all things are not equal. We often have different starting points, different resources. That’s why we need health policy that promotes equity.    Equity goes beyond equality. It  involves trying to understand each individual’s situation, and giving people what they need to enjoy full, healthy lives.


A quote that best illustrates equity is one from former Vice President Hubert H. Humphrey. “It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.” 


To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter and join the discussion on LinkedIn.

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Clay’s Weekly Medicaid RoundUp: Week of April 11th, 2016

GOLDEN STATE WANTS ITS MONEY BACK- By now I don’t even have to tell you the details. If “MMIS” is in the sentence, you can tell me the rest: overbudget, late and ugly. CA just signed the divorce papers with Xerox (old ACS for anyone returning to the space, or those – who like me- never could make the mental switch from ACS to that company that makes copiers). The implementation is far from finished, but the state has decided its better to just start over. I’m sure CMS is happy, since they paid 90% of whatever has been paid so far. Xerox has agreed to pay the state $120M, and continue operations until 2019. Ouch.

BEEHIVE STATE EXPANSION COULD BEGIN NEXT YEAR- If CMS approves it. The main hitch is that the UT plan will cover about 16,000 new members. If UT has just been a good little soldier and taken the expansion exactly as offered, about 100,000 would have been covered. The expansion will cost UT $30M each year, and hospitals have volunteered to be “taxed” to cover about half of that.

PINE TREE STATE POLITICIANS PASS SYMBOLIC EXPANSION VOTE- Dems in the Maine Senate and house passed a largely meaningless bill this week- but everyone still expects the big bad wolf, er, I mean the Good Guvn’r LePage to veto it. Don’t count it out just yet – the GOP governors have fallen one by one on expansion the last few years. LePage just needs to figure out how to make it not look like “ObamaCare” in the press release.

LONE STAR STATE CUTS GO THROUGH – TX Medicaid agency have to follow the budget as passed by the legislature (egads!), which includes $350M in cuts. Although our hero, District Judge Tim-Screw-Checks-and-Balances Sulak blocked the cuts made in accordance with the law of the land last September, the TX Health and Human Services Commission testified this week that it has to follow the legislature’s instructions and make the cuts.

UPDATE ON OUR SUPPORT VETS FUNDRAISER- Last week I asked for suggestions on a charity we (the Mostly Medicaid Motley Crew) could all donate to between now and 4th of July. All you Readers who wrote in – thank you! I got several great suggestions, and will start running links to them in the newsletter each week until 4th of July. I don’t know a really good way to calculate how much we all give combined (and that’s not the point anyway). If you do give to one of those listed, please post a note in the Mostly Medicaid LinkedIn group, or comment on one of my posts related to this. $ amount doesn’t matter – let’s just encourage and challenge our healthcare industry colleagues to show support with a focused effort the next few months.


FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Shifo Healthcare Services (a home health company) of Ohio is under investigation for $2M in overpayments as of this week. OH Auditor Dave Yoast is digging but not finding documentation supporting the claims. Yury Baumblit of NY runs a flophouse (had to look that up), and got charged this week with $2M in Medicaid kickbacks related to addicts living in the flophouse. Seems Yury forced tenants to attend Medicaid group therapy sessions for substance abuse, and providers paid Yury and his wife (Rimma) kickback fees. Step by Step Senior Care (another home health company) of Little Rock, AR agreed to pay back $472k this week for charges related to billing for imaginary patients. Miami fraudsters David and Cecilia Krochmal were arrested this week for $100k in Mcd payments related to services not delivered for I/DD members. Mr and Mrs Baumblit – you win! And wow. That’s some really terrible stuff.

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (spring planting almost done!) and keep running the race (you know who you are).


FULL, FREE newsletter:

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

‘arsal al’ab w alaibn li’iinqadh alealam

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Clay’s Weekly Medicaid RoundUp: Week of April 4th, 2016


OH MY DEAR TARHEEL STATE, WHY CAN’T YOU GET IT TOGETHER? I love NC. Heck I lived there for 2 years. But its time for an intervention. News of $835M in misspent 2015 Mcd funds came out this week. Agency officials acknowledge the problem of improper payments, but challenge the number (but don’t provide an alternative number). Beth Wood (the state auditor) is sticking by her $835M number, which is based on a sample of 396 claims. For those of you with an NC connection (which is a lot of us in the Mcd world), you know this is just the latest bump in the road.

MO PUTS FOOT DOWN ON MCD BUDGET; IN OTHER NEWS HELL HATH FROZEN OVER- The Mcd agency was asking for an increase that would have consumed all new state revenues for the fiscal year. Instead, the Senate came back with a $55M cut for Mcd in the Show Me State. News of this unprecedented event (an actual cut to a Mcd budget, not a “we would have spent even more, so give us 10% more than last year and call it a cut”, cut) was immediately followed by swarms of locusts, great cracks in the ground swallowing cars and the Mississippi River turning to blood.

TEMPEST IN A TEAPOT: IOWA MCO TRANSITION GOING JUST FINE- The move to managed care can be painful. You’re taking what has been run by the government for decades, spawning hundreds of mini, protected, subsidized fiefdoms – and converting it into something that has to be run efficiently enough to turn a profit. There’s some growing pains. Iowa became the 39th state to make the switch to managed care this week, but only after months of “the sky is falling” and ripping of sackloth from the legacy stakeholders. As long as the Good Guvn’r Brandstad is right, there wasn’t much to fuss about. The transition is going smoothly. We can all hope for a 6-month honeymoon, at least until the MCOs begin the obligatory “our rates are too low, so this is why the sky is falling now” wailing. See- the sky is always falling in Medicaid. It’s only a question of who’s playing Chicken Little.

MCD EXPANSION = BOON TIMES FOR LOBBYISTS- If KY is any indication, anyway. Looks like health related lobbying has ramped up 30% this year compared with last. I think they measure that based on reported payments to lobbyists, but not exactly sure. Would love to hear what you are seeing in your statehouse if your state is one of the expansion holdouts.

ANYBODY KNOW A GOOD CHARITY FOR VETS? For the last several years I have wanted to do a fundraising campaign for vets to be timed with Memorial Day / 4th of July. Both always sneak up on me … If you have a good one you recommend, please email it in.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Start the ticker and let’s see who wins this week’s award. Elva Santos and Manuel Gomez of TX got pinched for two very similar (but not related) scams this week. Santos pilfered $581K of Mcd dollars with her DME company; Gomez did the same with his, but added a patient data buying scheme to the charges. Gomez’s tab rings up at around $2M.  Christina Benson of Tallahassee plead guilty Mcd fraud- she got $170k by paying homeless men and women to pretend to be Mcd patients and then bill for home care solutions they did not need. Mr. Gomez – you win!


That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (its almost time to plant!) and keep running the race (you know who you are).


FULL, FREE newsletter:

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

ābi le‘alemi hone kewelidi bek’eri welidimi

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Medicaid State Spotlight: Tennessee

We spoke with Brooks Daverman (TN Division of Healthcare Financing and Administration) and and Patti Killngsworth (Bureau of TennCare). They covered lots of topics with the group, including the Tennessee Health Care Innovation Initiative, the Primary Care Transformation Strategy, use of Episodes of Care for Bundled Payments, and the TN Long Term Services and Supports (LTSS) strategy.

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Clay’s Weekly Medicaid RoundUp: Week of March 28th, 2016


OK NOT OK – A 25% provider rate cut is on the table to address budget holes. Hospitals are wailing, with individual facilities beginning to report impact. (Hit to Duncan Regional – $2M). The cut comes right on the tails of a proposal (blocked this week) to remove 111,000 from the rolls via a waiver excluding non-pregnant, able-bodied adults under 65.

NM PASSES THE HAT TO PAY THE PIPER- NM is looking at the increasing expansion costs over the next few years (it ain’t free forever, people), and is starting to socialize the idea of getting counties to chip in more revenues to cover the bill.

OH ASKS BENNIES TO SPLIT THE TAB- Or at least pay for the appetizers. Kasich is pushing forward a plan to require Medicaid members to pay into an HSA to help cover the costs of their own medical care. Bennies would lose their card if they don’t pay 2% of their income (or $99- which is roughly what 1 carton of Marlboro Reds – what I used to smoke back when I did – now costs in Toledo, OH. Or 3 weeks of a daily Starbucks for those of us who grew up into fancy hipsters. Or 1 prescription for those of us with insurance we pay for under the “new normal” prices for everyone not on Medicaid).

ARE YOU WANTING TO CONTINUE YOUR MEDICAID HOSPITAL FEDERAL FUNDING, BUT DON’T WANT TO EXPAND? NOW YOU CAN (HERE’S HOW)- A little birdy brought a CMS letter to MS Mcd to my attention this week. In the letter (dated Mar 22), CMS tells MS Mcd that their plan to incorporate $533M of hospital UPL payments into its MCO rates as a pass through violates 42 CFR 438.60. But – since MS went ahead and did it, it would be hard to undo so CMS will look the other way for now. I uploaded the letter to the site here ( for those who want to spend a little more time with it and tell me all about how I’m wrong to think this is questionable.

TN MCD DIRECTOR STEPPING DOWN- Darin Gordon has “sat in the chair” since 2006, and is now leaving TennCare. Gordon is widely respected on both sides of the political aisle, remaining in his spot for 10 years and through gubernatorial transitions. Congrats on a great tenure at TennCare, Darin! If you’re reading, I would love to interview you for the book I am working on about Medicaid directors. Working title – “A Day in the Life: The Medicaid Director’s Job Really is Rocket Science.”

ACA TURNS 6- Hard to believe that shining example of bipartisan politics, that grand-ole bill that passed with broad support from both parties elected to represent roughly 50% each of the American people, that policy that passed definitely not by procedural tricks and legislative bullying and good ole’ ram-it-through-no-matter-what-they-think elbow grease – [insert sound of vinyl record scratching to a halt here]. ACA turned 6 this month and a new round of analysis of impact is out. Punchline – for all its bluster about reducing the uninsured with exchanges and reforming commercial insurance, ACA is one big, fat Medicaid expansion. Which is great for us who live and breathe Medicaid. Not so great for the 50% of Americans (those evil Republicans) who are becoming more aware that Medicaid is another tax. Medicaid rolls have grown 25% since 2013 (when exchanges opened, and ACA really began in full force); Commercial coverage has dropped by 9M using CBO numbers (check the twitter feed for links to these #s).

FARRIS’S FANTASTIC FRAUD FOLLIES– I put lots of goodies in the twitter feed for all your fraudies that need your fix this week.

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (its almost time to plant!) and keep running the race (you know who you are).


FULL, FREE newsletter:

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

Die Vader het die Seun aan die wêreld te red

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Medicaid Industry Who’s Who Series: Linda Rosenberg

Linda Rosenberg is the featured panelist for the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!


Medicaid Who’s Who: Linda Rosenberg – President and CEO, National Council on Behavioral Health

  1. Which segment of the Industry are you currently involved?

A: Mental health and addictions – behavioral health: advocacy and education

  1. What is your current position and with what organization?

A: President and CEO, National Council for Behavioral Health

  1. How many years have you been in the Medicaid industry?

A: More than I care to count – 25 years

  1. What is your focus/passion? (Industry related or not)

A: Mental Health First Aid; Expansion of the Excellence in Mental Health Act – creating Certified Community Behavioral Health Centers to expand access to services and support services of the highest quality

  1. What do you enjoy doing most with your personal time?

A: Being with my grandchildren

  1. Who is your favorite historical figure and why?

A: Dorothea Dix – her effective advocacy on behalf of people with mental illness

  1. What is your favorite junk food?

A: Frozen devil dogs

  1. Of what accomplishment are you most proud?

A: Personally – raising two wonderful sons; professionally – bringing Mental Health First Aid to the US.

  1. For what one thing do you wish you could get a mulligan?

A:  Not a thing – it is not my style to look back

  1. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A: Establishment of Certified Community Behavioral Health Clinics; development of a continuum of community based services that reflect addictions as chronic medical conditions; pressure on candidates for President/party platforms to detail how they would increase mental health and addictions service capacity and quality

Don’t miss hearing Linda Rosenberg during the upcoming webinar on Certified Community Behavioral Health Clinics on April 4th. RESERVE your seat today!

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Medicaid Industry Who’s Who Series: Jay Ludlam

Jay Ludlam is the featured panelist for the upcoming State Spotlight Series Show: Missouri Medicaid on March 18th. RESERVE your seat today!


Medicaid Who’s Who: Jay LudlamDeputy Division Director of Administrative and Fiscal Services, MO HealthNet (Missouri Medicaid)

1. What is your current position and with what organization?

 A: Deputy Division Director of Administrative and Fiscal Services for MO HealthNet (Missouri Medicaid)

2. How many years have you been in the Medicaid industry?

A: 9 years

3. What is your focus/passion? (Industry related or not)

A: Demonstrate that a state-run Medicaid program can provide participants with all the services to which they are entitled and also be run efficiently and effectively, like a commercial business.

4. What is the top item on your “bucket list?”

A: Fly in space

5. What do you enjoy doing most with your personal time?

A: Traveling.  If I am not traveling, I spend as much time as possible with my family.

6. Who is your favorite historical figure and why?

A: Charles Darwin because he observed the world around him and gave voice to ideas which challenged the beliefs of his time.

7. What is your favorite junk food?

A: French fries, chocolate chip mint ice cream and blueberry muffins

8. Of what accomplishment are you most proud?

A: My case State of Missouri v. Spilton which establishes Missouri case law that statutorily defined civil penalties are permissible when prosecuting civil Medicaid fraud.

9. For what one thing do you wish you could get a mulligan?

A: I wish I had bought stock in our competitor, America Online, back in 1994.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A: New Access regulations, new Pharmacy regulations and MMIS modularity


To ensure that you’re in the loop on all things Mostly Medicaid, be sure to sign up to receive our free newsletter, join the discussion on LinkedIn and check out tons of great content at


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Clay’s Weekly Medicaid Roundup: Week of February 29th (Leap year!), 2016

MI COVERING HEP C DRUGS IN MCD- We covered the lawsuit in WA to cover these on the last monthly news show. Looks like MI is pre-empting a suit and has decided to cover the insanely pricey drugs in Mcd. State reps approved a budget for it (I don’t know how much yet) this week.

ITS A MANDATE! The Good Guvn’r Hutchison of AR is looking at pro-expansion Republicans winning in primaries this week as a mandate for his expansion plan. Not so fast so wonks in the state. Voters think about other things besides expansion (and usually they don’t care near as much about Medicaid as those of us who make our living off Medicaid wish they would).

DETAILS EMERGING ON TARHEEL STATE TRANSFORMATION PLAN- Based on presentations in the NC General Assembly this week, it looks like Mcd bennies will be able to choose from 1 of 4 MCOs – in about 3 years. CMS is expected to get the official proposal by June 1.

PLAN PROTESTS IN THE PEACH STATE POOH-POOHED- Its a rainy night in GA for AmeriChoice (UHC), Humana and AmeriHealth Caritas. GA Dpt of Administrative Services just threw out their protest over losing bids for the ginormous MCO business awarded recently. New contracts for Amerigroup, Peach State, WellCare and CareSource were set to start July 1, but the latest I have heard is that the implementation date is now Jan 1, 2017. Anyone who knows why, please write in and let me know.

AK JUDGE DISMISSES ANTI-EXPANSIONERS SUIT- The plaintiffs (legislators) sued, saying that the expansion population was optional, and any optional Mcd spending had to be approved by them. The Judge looked at the decision by the SCOTUS that said states could not be penalized for not exercising the option to expand – and then he concluded that Mcd expansion in AK somehow was mandatory and could be done with only the Good Guvn’rs approval. I think this quote from a local newspaper explains the Judge’s misunderstanding best: “Because the Social Security Act requires expansion, state law makes the expansion group eligible for Medicaid services. Because existing law required the governor to provide Medicaid to the expansion group, the governor did not violate the Alaska Constitution by doing so.” Judge Piffner – if you are Roundup reader please call / write in so we can discuss.

SD REPS REMOVE GUVN’RS ABILITY TO STOP EXPANSION- A move to require legislative approval for expansion was killed in committee this week. Make sure you read this slowly- a state legislature (that’s the “legislative branch” for those who have never had a “civics” class) just voluntarily decided to limit their own power and defer to the Guvn’r (the “executive branch”). Maybe I misunderstand my own education about checks and balances. Is it that the legislature is really good at writing checks, and the executive branch’s main job is to make sure the balance of power swings their way?

NE TRYING TO FIGURE OUT HOW TO PAY FOR EXPANSION. HAS ANYONE CALLED BERNIE? Looks like NE needs to come up with $112M in state dollars to pay for 5 years of expanded Mcd. Fun comparison – that’s about $22M/ yr. Average teacher salary in NE is $50k. So NE could hire 440 new teachers, or expand Mcd. Easy choice. Everybody knows Mcd beats out all other priorities, every single time.

MI GETS APPROVAL FOR MOST SPECIFIC MCD EXPANSION EVER- CMS approved expanding Mcd to kids in Flint, MI in households up to 400% FPL this week. An estimated 15,000 new members will be eligible. All this is to help address the water crisis and related health impact in the area, so the expansion is not only narrow in scope but also (likely) time limited.

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (its almost time to plant!) and keep running the race (you know who you are).


FULL, FREE newsletter:

News that didn’t make it and sources for those that did: twitter @mostlymedicaid
el Pare ha enviat el Fill per salvar el món