Vermont Legislature SmartTranscripts:

[Rep. David Durfee (Chair)]: Okay, good, we're all set.

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: You again for having us today. I'm just as excited as you are about this topic. My name is Tina Zuk, I'm with the American Heart Association, but I'm part of the Food is Medicine Task Force, which a lot of the people in this room are many organizations, hospitals, insurers, providers, patients, farmers. It's a great task force. And we're looking into ways to make Food is Medicine happen more across the state. We don't have an ask for you this year. We probably will next year, but we want to do our research to make sure we figure out what works best. And we will be, bless you, drafting those recommendations this summer for next session. But so for folks who might not be aware what food as medicine is, it's a covered medical benefit when a healthcare provider prescribes healthy food that helps patients treat, manage or prevent chronic conditions. And it's needed because 90% of the $4,300,000,000,000 in annual healthcare costs in The United States are spent on care for chronic diseases, and diet is a major risk factor for many of these diseases. Obviously, we care about cardiovascular disease and stroke, which these kinds of interventions can help with. In Vermont, there are six healthcare CSA agriculture share programs that cover eight of Vermont's counties. You'll see a version of a CSA in a couple of minutes. There's also one downstairs in our display in the card room. These are what patients get as part of Food as Medicine. And working with healthcare providers to prescribe healthy food, these programs and their efforts impact diet related diseases, but they also address food insecurity and farm viability in the state. Though providing promising results and unmet need analysis of the efforts in Vermont by Culinary Rehab in August '25 found that sustained funding was needed for long term success for these programs. The report pointed to Medicaid reimbursement and funding via the eleven fifteen waiver in Vermont as a priority, and currently 13 states have approved such waivers. Three other states now have pending applications. In terms of what can be realized by food as medicine programs, research has found that medically tailored nutrition interventions could save Vermont $53,000,000 in healthcare expenditures and translate to a net savings of $2,702 per patient in Vermont. Participation in the Massachusetts Food as Medicine pilot program was associated with a twenty three percent reduction in hospitalizations and a thirteen percent reduction in emergency department visits. In Vermont, three federally qualified health centers have seen decreases in blood pressure and cholesterol among their food as medicine enrolled patients who either had cardiovascular disease or were at risk of cardiovascular disease. In terms of benefits to Vermont farmers, food as medicine programs provide stable seasonal markets for local farms. They create reliable demand that help farmers plan and stay strong and stay in business. In 2024, Vermont produce prescription programs that we mentioned above purchased $405,000 in food from 39 Vermont farms. That's 162% increase from the year prior. And Rutland's pharmacy, spelled with an F, has invested approximately half $1,000,000 in Vermont farms since 2015. So it's really helping Vermont communities as well. So I'm just the opener. You have some wonderful people who are gonna talk about the great work being done, and I hope you ask them some awesome questions.

[Rep. David Durfee (Chair)]: Any questions for Do we know how many, you have data on how many Vermonters are enrolled or participating?

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: Not off the top of my head, I gave the committee a few fact sheets that we put together. There's one for each topic, health outcomes, farms, and just an overall. I think the health outcome one does talk about how many people I want us. I don't want to speak out the cuff because I don't remember. I'll probably say wrong number, but we do have this information downstairs in our display area as well.

[Rep. David Durfee (Chair)]: Great. If anybody has prepared remarks that you want to submit, we can post them on our webpage and send them to Patricia, the committee assistant.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: Okay, will do.

[Rep. David Durfee (Chair)]: Make sure that happens. I should just also say while we're transitioning to whoever's gonna be next, that we've got one committee member, maybe two joining us online. I'll just have us quickly introduce ourselves and let you know where we're from here. I'm David Durfee, chair. I live in Shaftsbury in Dankton County. I'm John Bartholomew from Portland. I also represent Windsor and West Windsor. Michelle

[Rep. Michelle Bos-Lun (Member)]: Bos-Lind, Northern Windham County. I represent Westminster, Rockingham, and Brooklyn.

[Rep. Brigham (first name unknown) (Member)]: I'm Jack Bergen, farmer from St. Albans County City.

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: Jed?

[Rep. Jed Lipsky (Clerk)]: Jed, let's get on one on one.

[Rep. Richard Nelson (Ranking Member)]: Yeah. And Richard Nelson, Orleans one derby, and, we are what we eat. And I used to be a potato chip, but I'm not anymore.

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: It's great.

[Rep. David Durfee (Chair)]: Good. All right. Who's next? Grace.

[Grace (Community Health Manager, Vermont Youth Conservation Corps)]: Good morning. My name is Grace, and I am here representing the Vermont Youth Conservation Corps. And we have our sample or CSA share from Riverside Farm that Danielle will speak to after me. BYCC operates a nine acre educational farm and coordinates the Healthcare Share, which is Vermont's largest and longest running food as medicine program. In 2025, we provided over 500 households with weekly bags of our farm grown veggies and eggs. We're in our fourteenth season and are now one of six programs in the state providing locally grown food to patients, patients who are experiencing diet related disease and food insecurity. This type of food is medicine initiative is called a produce prescription program. Healthcare providers prescribe a share of fresh fruits and vegetables, and patients receive the CSA style bags at no cost, along with recipes and cooking classes that help them learn how to prepare and use the food in the shares. While other food security programs provide essential access to produce, food as medicine programs go a step further by integrating food directly into patient care plans. This approach links healthcare dollars directly to locally grown food, creating a guaranteed market for farms while treating nutrition as a key part of health care. Having worked on other farms both in Vermont and across New England, I've seen firsthand how critical secure contracts and reliable markets are for farm viability. As we know all too well in Vermont, growing food is unpredictable. Weather, labor, market fluctuations can all affect a season's success. But food as medicine programs, like CSAs, provide steady demand that allow farmers to plan what to grow, when to grow, and how much to grow, all while minimizing risk. Reliable contracts don't just support individual farms, they strengthen local food systems and help ensure that fresh, healthy food reaches the people who need it most. This creates economic benefits that ripple through local jobs, food hubs, distributors, and regional food infrastructure. And as Tina said, in 2024 alone, Buddhist medicine programs in Vermont purchased more than $405,000 in food from farm, And that was across food from across 39 farms. Farmers are ready and eager to grow this food, and health care providers and patients are ready to receive it. What these programs need now is sustained investment. In other states, mechanisms exist through state funds, Medicaid, or insurer support to cover the cost of food as medicine programs. In Vermont, however, each program currently pieces together funding from a patchwork of sources, limiting growth and the long term stability of these initiatives. From BYCC's perspective, food as medicine is a proven model showing how agriculture, healthcare, and workforce development can work together to strengthen farms, improve health outcomes, and support a resilient rural economy. We urge the committee to explore ways in the future to invest in these programs, which create reliable markets for Vermont farmers, bolster rural communities, and expand access to fresh and local food. Thank you for this opportunity to share our experience and for your leadership in supporting Vermont agriculture.

[Rep. David Durfee (Chair)]: You're the manager of produce, prescription produce?

[Grace (Community Health Manager, Vermont Youth Conservation Corps)]: Yeah, so I'm the community health manager. So my role is really overseeing the whole healthcare share at BICC. And then we have a dedicated production team that's doing the growing.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Spread across a number of farms?

[Grace (Community Health Manager, Vermont Youth Conservation Corps)]: So our share is actually comprised of veggies solely grown on our farm. So we have a nine acre farm where we're growing a variety of different vegetables. The other produce prescription programs in the state are sourcing from neighboring farms, wet and cleaned and donated items.

[Rep. David Durfee (Chair)]: Where's your farm?

[Grace (Community Health Manager, Vermont Youth Conservation Corps)]: We're in Richmond. So Chittenden. Yeah, we're the big red barns.

[Rep. David Durfee (Chair)]: You can search. Yeah. All right, thank you very much.

[Grace (Community Health Manager, Vermont Youth Conservation Corps)]: And Danielle on Zoom is next.

[Danielle Allen (Root 5 Farm)]: Okay. Can everyone hear me okay?

[Rep. David Durfee (Chair)]: Can, yes, good morning.

[Danielle Allen (Root 5 Farm)]: Okay, great. Well, thank you so much. I'm very happy to be a part of this group and to be here today. I'm sorry I couldn't be there in person. We are busy in our greenhouses on this sunny day getting all of our seedlings going. So yes, my name is Danielle Allen. I'm from Route5 Farm in Fairleigh, Vermont. We are a 38 acre certified organic vegetable production farm. And we have been in business, my husband and I, together for twenty five years growing vegetables. And we are yeah. We're very much a production farm. We employ 12 people all from local folks.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: We

[Danielle Allen (Root 5 Farm)]: let's see, we grow a huge wide range of vegetables. We sell to our local co ops in Hannover and Lebanon and White River Junction. And then we pack over 400 CSA boxes each week to distribute all within our Little Upper Valley area. And I guess today, I'm bringing the perspective of, like a full time production farm that has partnered with the Little Rivers Health Center bring, you know, through this pharmacy or food as medicine program to bring food to folks who need it in our community. But I guess I'm bringing this perspective of, you know, we do about 15 boxes right now through the Little Rivers program. So it's not a huge part of what we do. But it's it is certainly part of our mission to be to be bringing produce to, you know, all members of our community. And they help us do this in this way that is very, like, it's integrated into things we're already doing. So it isn't this, you know, a whole list of extra tasks that we need to figure out or a different way to go about it, you know, it doesn't add more work to what we're already doing. So it's, it has been a really, we've been doing the program with them now for three years. And so it's been, yeah, it's been an incredible way for us to kind of just reach a more diverse set of members of our community without having to does that make sense? Just like, yeah, do a lot of extra things to make that happen. So Emily Perry, who I think is in the room today. Yeah, Emily. She'll come or or another representative from Little Rivers will come down to our farm, which is about five miles away. And once a week and with a pickup truck and we load up with 15 boxes of fresh veggies, but not just veggies, also eggs, milk, sauerkraut, fruit from we partner with a number of other farms in our area to bring we don't, so we grow all the veggies and we kind of bring in other local products to round out the shares. So they're getting everything except meat. So it's a pretty well rounded box. And yeah, so it's and we're already packing 200 boxes and we pack an extra 15 and Emily comes and picks them up and it's super smooth. Really, the logistics work so well. So it's been a delight to be a part of this program and I fully support it as a farmer and a community member. And, yeah, that's my story.

[Rep. David Durfee (Chair)]: And somebody dropped off a sample, a CSA box here, and it's at the other end of the table. I see a jar. Well, first of all, see very full box, noting that it's April 7 or whatever the date is Yes. This is a box that would be distributed to CSA members this week?

[Danielle Allen (Root 5 Farm)]: Not quite. It's a little early. We begin in two weeks. April 24 is our first distribution. But we were able to kind of pull together because much of what's in that box is crops that we've stored through the winter, potatoes, carrots, beets, and then eggs, of course, are in abundance this time of year. And then we do we have a few green things like fresh scallions coming out of our high tunnels and some microgreens from the greenhouse. So, yeah. I think probably you all know that Vermont farmers are a very, you know, yes, like ingenious bunch where we just we are always coming up with ways to stretch the season and season extension is really critical to vegetable production in Vermont since we have such a, you know, wild weather in the spring. So this is how we get creative. We also make lots of sauerkraut. So the jar is, yeah, our own sauerkraut from cabbage that we grow. So we have ways of preserving and kind of stretching the harvest so we can start really, really early in the spring when people are so eager to get veggies.

[Rep. David Durfee (Chair)]: We all sense that eagerness. We all feel that right now.

[Rep. Michelle Bos-Lun (Member)]: Yes. Yes. I'm just wondering, I love this program. This sounds amazing. And how who pays for the 15 boxes? Like, how do you get compensated for your work?

[Danielle Allen (Root 5 Farm)]: Yeah. For us, it's very straightforward. And maybe Emilie can follow-up on this too. But for us, Little Rivers Health Center cuts us a check beginning of the season. And so I'm not sure exactly how it works on their end. They may want to fill in on that. But I guess that maybe my testimony would be like, as a farmer, it's a very straightforward payment process. There's not some exception made or some, you know, it just kind of works right into our existing CSA system.

[Rep. David Durfee (Chair)]: Are you are you paid, what you're paid for any share?

[Danielle Allen (Root 5 Farm)]: Yep. It's full value for the shares. Exactly. Yep. Yeah.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: I can fill it for that. So my name is Ashley Buchanan.

[Rep. David Durfee (Chair)]: Ashley, why you climb up to the Thank table you.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: I'm the manager of grants and public relations at Little Rivers Healthcare. We partner with Danielle at Root five Farm. And the real overarching method of our grants is that we are not asking for donations from farms, we want to pay them in full, because ultimately, we are supporting them in bringing agriculture to our communities and creating this ecosystem where people have access and continued access. So we receive funding from various locations. We usually get a large bulk of that funding from the Vermont Food Bank, or we have partnered with Bi State and Vermont Department of Health. And we use that funding to be sure that they are receiving their full amount for each CSA.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: That's all.

[Rep. David Durfee (Chair)]: Thank you. Thank you. Wait a minute, before you go,

[Rep. Jed Lipsky (Clerk)]: President Lipsky. Ben, I apologize, was trying to get my internet thing, it's all blocked up, so I don't have all your access to the agenda. But my question, you may have answered this, the overarching theme is that fresh, nutritious, locally grown food makes healthier population. Exactly. Serving the body. Are there specific health challenges that you might tailor a given box if a client is struggling with one health issue? Or is that too specialized for this program?

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: No. For Little Rivers, and Emilie can speak more to this, she is our program developer and coordinator. But what we are doing is we offer a food pharmacy and that is a prescription program. And there we offer some shelf stable food items that are tailored to diet responsive health conditions, such as diabetes, hypertension, cardiovascular disease. So, those boxes that are for our patient's prescription, they are tailored in guideline with lifestyle medicine. So, sodium and sugar as minimally processed whole grain options. And we also have food shelves that are open to the public at all four of our sites that are tailored to this guideline. So, they are open to the public, but they are not food shelves with just anything available on them. When it comes to our CSAs, we do not tailor them, because we consider every item in that box already tailored to a healthy lifestyle for anyone with chronic health conditions. Right? Thank you. I

[Rep. David Durfee (Chair)]: think on the agenda, Maureen, who's joining us remotely today is listed next, but had a couple of references to Emilie. I wanna be sure that if Emilie wants to say anything, follow-up, you're welcome to.

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: I'm happy Maureen is going to be here representing us today. I'm happy to speak if we have time at the end also, and I did get the pleasure of speaking with you on behalf of the food bank. So I've told you a little bit about our Let's talk more about it

[Rep. Brigham (first name unknown) (Member)]: and love

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: to have Maureen represent us today.

[Rep. David Durfee (Chair)]: Thank you. Right, Maureen, we'll turn it over to you.

[Maureen Boardman (FNP; Director of Clinical Quality & Research, Little Rivers Health Care)]: Thank you. So I'm not sure how much I came in a little bit late because I was in the wrong meeting for a few minutes before I realized I was in the wrong meeting. But I'm Maureen Boardman. I'm a family nurse practitioner, and I'm director of clinical quality and research here at Little Rivers. So I started working on our food pharmacy back in 2020. And when we started, we started with just 200 to 300 pounds of fresh food from Willing Hands, which is a gleaning organization in the Upper Valley for those of you who don't know. Over the course of the last six years, we have grown exponentially, but still there's need. We now receive about 30,000 pounds of food a year from Willing Willing Hands and approximately 7,000 pounds of food from the Vermont Food Bank. And then as Ashleen alluded to, last year and the year before, we distributed 180 CSA shares from Route five Farm, which resulted in 15 families from Little Rivers receiving a CSA share for twelve consecutive weeks. And then on September 2025, we held a Stuff the Van food drive at the Bradford Hannafords after they donated a cargo van to Little River's food pharmacy program. So as Ashleen said, food as medicine affirms the premise that access to nutritional food is critical to health as well as well-being, especially by managing and preventing diet responsive conditions such as diabetes, high blood pressure, and coronary artery disease. Studies have shown that half of American adults have one or more preventable chronic diseases, and many of these are related to poor quality eating patterns. At Little Rivers, eight percent of our patients are food insecure, and seventy five percent of our patients have at least one chronic disease diagnosis. Currently, food pharmacy serves around 100 patients, but we would like to increase this number. So, anyone who's been to the grocery store recently can attest to the fact that eating healthy food is expensive and getting more expensive. Patients and families who are food insecure often rely on cheaper processed foods that have little or no nutritional value and can actually be detrimental to health. I compared a box of Kraft Macaroni and Cheese at $1.5 a box, which will feed four, to the average cost to make a basic homemade garden salad for four people is approximately 5 to $10 depending on the ingredient choices and seasonality. Our goal for Little Rivers Food Pharmacy has been to create a dignified, welcoming, and comfortable atmosphere where free, healthy food can be easily accessed by patients, to use food as medicine to manage, treat, and prevent diet responsive chronic diseases in our rural community. And it touches a really special place in my heart when patients talk to me about how their lives have benefited from the access to our food pharmacy.

[Rep. David Durfee (Chair)]: Thank you very much, Mollie. Any questions? Is Little River's FQHC? Yes. And it's located somewhere in the Bradford area, sounds like?

[Maureen Boardman (FNP; Director of Clinical Quality & Research, Little Rivers Health Care)]: So we have four offices, East Corinth, Bradford, Wells River, and Newberry.

[Rep. David Durfee (Chair)]: Alright. Well, thank you for the testimony. Great, Kate. It's listed next.

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: Do you mind if we go out of the chain?

[Rep. David Durfee (Chair)]: Out of order or slide, any order you want to slide, yeah. Okay, great.

[Rutland Farmacy Program Director (name not stated)]: You're welcome, Matt. Ryan and I are testifying together here from the Portland area.

[Rep. Jed Lipsky (Clerk)]: You can help me.

[Rutland Farmacy Program Director (name not stated)]: Yeah. I'm the program director at Rutland's Pharmacy Project, pharmacy with an F. We've been a food as medicine program since 2015, and we have impacted over 4,000 individuals based on household size of those that have been enrolled in the program. We have hundreds of stories and testimonies from almost twelve years of running this program. One that I loved last year was a woman who said she was actually really reconnecting with her teenage daughter because they were cooking together for the first time in many years, receiving the weekly share and recipes. We've had many patients get off diabetes medication or lower diabetes medications, lowered A1Cs, weight loss, and general health improvements over the last twelve years. But I also really want to focus on the farm impacts. And I asked Ryan to be here today to take time off the farm to come up and speak as a farmer who has been with us since day one of pharmacy. We are really proud in Rutland that we will reach a half million dollars that have gone directly to these farms since 2015. And we modeled our program after VYCC, but we partner with up to 13 to 20 local farms every year. Every year, though, we really are reliant on grants. We never know whether we're gonna hit our budget, maintain, our budget, or be able to expand shares. We have been able to, but every year looks really different, from those sources. But our farmers are relying on us. Now that we're in our twelfth year, they really depend on the pharmacy project. It's a mutually beneficial relationship with all of our small farms. And this year on our crop plan, we have 13 small farms who are starting seeds right now, planting in their greenhouses, getting ready for the season. So I'll give I'll give Ryan Yoder the chip.

[Ryan Yoder (Yoder Farm, Danby)]: Thanks, Yoder. Farm. Yeah. So we have Yoder Farm down in Danby, and we've been with the pharmacy program since it started. And when I'm putting it in that ratio perspective, it's some years up to about a tenth of our ag sales have gone to the pharmacy program, which feels pretty significant. To me, the whole food is medicine thing feels like it goes way beyond just healthcare shares, just vegetables. I would really advocate for some long term thinking and getting the folks with the health care committee having a coherent vision for Vermont's future as a really healthy place. This sort of program could change the paradigm of health care from treating symptoms to actually being preventative care. And it could simultaneously keep as much of the food money in Vermont as possible to recirculate and help to keep the entire economy on a square footing. On top of that, the things that are gonna make the most nutritious, least toxic food are the same things that are good for the environment on average. By rebuilding soil and healthy soils, nutritious soils, you're going to have healthier food. A couple of things that have to happen is there needs to be much more concerted effort to study how this works, not just the impacts and stuff, but what are the dietary and lifestyle modalities, functional medicine, holistic medicine, whatever they are, to actually have the biggest impact. Be great to see more doctors involved in studying this stuff really coherently. And is there an option for full dietary medical interventions that can intervene in a person's life for a month to get them back to a more homeostasis with their personal health. The impacts, I think we're just scratching the surface with what's happening with things like the pharmacy. That's my personal guess. And I think it would be hugely beneficial for those of us in agriculture if that whole paradigm was reworked. Big hurdle is just the economic distortion where you have really bad food, really cheap. And the best food, really expensive and hard to access. I don't think that's a natural state of affairs. I think it's due to not having a really truly free, fair market in America. I think it's agribusiness at a very big scale, subsidy structures, chemical companies, banks, they're all involved. So that can be changed. It's gonna I don't think it'll start honestly from legislative positions. I think the place it'll start is with individual people who have the knowledge and capacity making changes in their own lifestyle and behavior, and then that affecting decision making at more centralized levels. That's just my personal guess. They both gotta happen, though. So messaging, advertising, whatever.

[Rep. David Durfee (Chair)]: Great, that resonates. Hear that. Questions, Representative Brigham.

[Rep. Brigham (first name unknown) (Member)]: So do you have, when your boxes and stuff you send out, or the people you serve, do you have help for them to know how to prepare the stuff?

[Rutland Farmacy Program Director (name not stated)]: We send at least two recipes a week with every share, and then try to provide and partner with a bunch of other resources like My Healthy Vermont webinars. We give them as many resources as we possibly can with a limited budget. But yes, we do some in person cooking classes as well, if we can pull that off every year. And Ryan has actually been on our pig TV, Rutland pig TV, public access television, showing us how to create a delicious recipe with veggies grown on his farm before. So we do other education.

[Rep. Michelle Bos-Lun (Member)]: What did you demonstrate?

[Ryan Yoder (Yoder Farm, Danby)]: I cooked beans.

[Rutland Farmacy Program Director (name not stated)]: Dried beans.

[Ryan Yoder (Yoder Farm, Danby)]: Dried beans, start to finish.

[Rep. David Durfee (Chair)]: So what do you grow on your farm?

[Ryan Yoder (Yoder Farm, Danby)]: We grow vegetables, berries, popcorn, chickens, and we make vinegar. So we have leases on a number of areas that have a lot of apple trees that are mostly wild apple trees that are not in particularly orchard condition. And so it's kind of a foraging, I'd say, facilitated foraging process. And then we make vinegar out of that, cider vinegar and some other vinegar related products.

[Rep. David Durfee (Chair)]: You make switch off? We we

[Ryan Yoder (Yoder Farm, Danby)]: don't make switch off. We make tonics that can be used to switch off. So they got honey, they got fruit, they got vinegar, fire cider. We're gonna do a switchl with maple at some point.

[Rep. Jed Lipsky (Clerk)]: There was maybe in the 1950s, a Barry Vermont doctor Jarvis who wrote a famous book which was influential in my life called Folk Medicine, and he was a real believer in apple cider vinegar Yeah. Honey.

[Ryan Yoder (Yoder Farm, Danby)]: That's all of our best customers are the ones who actually go through more than a bottle in a month. And it's only with people who are taking it as like a health for health benefits that really go through vinegar that fast. It's a tough business model. It's not easy to sell lots of vinegar.

[Rutland Farmacy Program Director (name not stated)]: But it's really good vinegar. I highly recommend seeking it out.

[Unidentified committee member]: It's good vinegar.

[Rep. David Durfee (Chair)]: Put a little bit in one of the boxes.

[Ryan Yoder (Yoder Farm, Danby)]: It'll hopefully be more widely available at some point, we're not all over the state.

[Rep. David Durfee (Chair)]: Just thinking about the scale of what we spend collectively on health care and what dollar figures we've heard already this morning, and some of you were across hallway in the health care committee. I don't know what the number is, but it may be in the $2,000,000,000 range that comes out of economy going to health care.

[Ryan Yoder (Yoder Farm, Danby)]: There's opportunity. And a lot of that health care money probably leaves the state pretty quick.

[Rep. David Durfee (Chair)]: All right, thank you. Thank you.

[Rep. Michelle Bos-Lun (Member)]: Morning. My

[Susan Smiley (Board Member, ACORN Food Network)]: name is Susan Smiley. I'm on the board of Acorn Food Network, which is based in Middlebury and operates in Addison County for the most. Acorn has been hosting the Addison County Pharmacy Food is Medicine program every summer since 2019. We currently serve 100 families who are mainly referred by Porter Hospital UVM Medical Center, the Department of Health, a local food shelf, and a private practice in Middlebury. We are contracting with four local farms, providing a stable and flexible market for emerging farmers and experienced farmers. These four farms are Old Road Farm in Granville, Green and Gold CSA in Sudbury Last Resort Farm in Hinesburg and Jumprope Farm, a new farm in New Haven We pay farmers upfront This year, for the first time, raised enough money soon enough that we'll be able to pay the full value of the contract to the farmers at this time of the year. Usually we do half at the beginning and half at the midpoint. In 2024, we added a winter pharmacy program that serves 65 families monthly with monthly deliveries, with a mix of vegetables, dairy, meat and bread to help bolster markets in the slow months and provide more consistent food security. Over the course of the eight seasons we've been operating, 2019 to 2026, we will have paid farmers a combined total of $300,000 and we'd love to grow this as funding allows. ACORN is part of and helps curate the farm to plate healthcare CSA community of practice. And this includes all these other programs, some of which you've heard from today in that effort. And I'd like to close with a quote, too, from one of the farmers that we contract with. The pharmacy program has been a great fit for our farm as it allows us to work collaboratively with other farms in the area to get our produce out to a large group of people in the local community that would otherwise be difficult logistically for our business to reach without the support of Acorn. We tried a CSA with just our farm in the past, but pharmacy works so much better for us by allowing us to focus just on growing the crops we enjoy while relying on other farms to supply the range of produce needed for a full CSA. It feels really like a win win situation for both farmers and CSA members, and we are so appreciative of Acorn's work in administering the program. Thank you.

[Rep. David Durfee (Chair)]: Thank you. Representative Nelson had a question.

[Rep. Richard Nelson (Ranking Member)]: Yes. Thank you. Thank you, chair. Does anybody in these groups, pharmacy and I love the name pharmacy programs, do you work with NOFA and the Crop Cash or the Crop Cash Plus programs at all?

[Susan Smiley (Board Member, ACORN Food Network)]: No, we're very aware of them and we work with Dove in many ways, but we are not part of those programs. But we have a farmer's market in Middlebury every Saturday, and and the programs are available to vendors there.

[Rep. Richard Nelson (Ranking Member)]: Okay, thank you.

[Danielle Allen (Root 5 Farm)]: Richard, we, work with NOFA, but it is a separate program, the farm share program, where they raise funds and sponsor CSA members, then pay 50% of their share costs. And then the farm pays an additional 25%. So the CSA member is paying, like, a very reduced price for their share. So it's a sort of a collaborative effort to support additional CSA membership, but it's not it's totally separate. It's a different program than the one we're talking about the farm pharmacy.

[Rep. Richard Nelson (Ranking Member)]: Thank you. I'm a dairy farmer by trade and I know where a lot of the dairy farms in the state and I would love to have a map of like where all y'all's farms are. So when I'm traveling around the state in the summertime, know, just if I had time to bop in and say hello and see what you're doing because I growing food, you know, raising animals, all of this is just it is right in my bowl boilerplate and we all work hard together to feed the nation. So thank you for your efforts. Appreciate you.

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: I would say also that I think that my understanding of cow catch is that it is an added benefit to SNAP recipients so you can buy local produce. So everybody who comes to our program, we do connect them with these organizations and agencies that already exist, these resources. Our hope is that they are utilizing all of those programs first, and then we can supplement with the healthy food on top of it. So we can do the extra work, the education, and have more room to do that. But we are doing everything we can to connect them with those agencies first.

[Rep. David Durfee (Chair)]: All right, thank you.

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: So I have a question, but I

[Rep. Michelle Bos-Lun (Member)]: don't know who to ask. I guess I'm wondering just from these longstanding programs, if anybody could offer any more examples of sort of transformations you've seen with people who have participated. Mean, somebody mentioned a woman cooking with her daughter. I mean, that's nice. But I'm also wondering about like some of the healthcare kind of transformations or something like that. Because I certainly have heard of lots of examples. I know of some examples in my own life, but I'm wondering if you have any examples you can think of, anybody.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: I'll put you on the spot, Maureen.

[Maureen Boardman (FNP; Director of Clinical Quality & Research, Little Rivers Health Care)]: Well, I have some data. I don't have it right at my fingertips, but I can certainly get it to you about lowering blood pressures for people who are in the food pharmacy, as well as folks who have diabetes and prediabetes who are enrolled in the program with bringing their blood sugars in better control by having access to this healthier food alternatives. So yes, I can certainly get you some of the data that we've compiled.

[Ryan Yoder (Yoder Farm, Danby)]: My sense is it's hard to get to a lot of that information. I know with the pharmacy in Rutland, we get the anecdotal feedback from the patients, but to coordinate and compile data from the doctors who are given the prescription, more complicated. It would be really great to be able to do that.

[Rep. Michelle Bos-Lun (Member)]: Is the task force paying attention to that in terms of looking at?

[Unidentified committee member]: Yeah, we do have a group that stories from the field that are busy gathering.

[Rutland Farmacy Program Director (name not stated)]: Okay. We're working on that in Rutland. We're finally talking to our director of population health. He's engaging in a way where we are looking at a cohort now of participants that have been

[Rep. Michelle Bos-Lun (Member)]: in the program for five years. So it's actively happening right all right. Just if we're gonna have legislation next year, having some prime examples to come in and talk about what their experience was and those are really helpful for us.

[Rep. David Durfee (Chair)]: Gentleman in the yellow shirt, just say his name for the record. My name is Herbert Will. I'm with the Northeast Kingdom Council on Aging. Thank you.

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: If I could just add, we provided a couple of documents to the committee, one's on health outcomes, one's on farmer impact, and one's just a general overview. But the health outcome one, I believe, has some quotes from patients who've

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: been part of the program, which

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: are really kind of hurting

[Tina Zuk (American Heart Association; Food is Medicine Task Force)]: me than me, like weight loss and their A1C levels, so not hard statistics, but very good work being

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: done. Great.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: Can I add one comment?

[Rep. David Durfee (Chair)]: Please.

[Ashley Buchanan (Manager of Grants & Public Relations, Little Rivers Health Care)]: My name is actually with Little Rivers, and I know Mary Kate is here with Bi State, and Bi State we work very closely to collect this clinical data. They are able to pull Medicaid claims from our healthcare facility. So we get medical data and we have been able to show a statistical significant decrease in outcomes for blood pressure, systolic blood pressure decrease, cholesterol decrease, and also one that caught us off guard was an improvement in coming to their medical visits.

[Rep. David Durfee (Chair)]: Interesting. Representative Lipsky.

[Rep. Jed Lipsky (Clerk)]: Chairman, this actually may be a question for you, but for everyone here, we have it's been a high priority for our committee to request budget support for farms, you know, farm to school, bridges to health, Vermont Food Bank. Have you ever put in a request to the agriculture, food, so I'm seeing a forestry committee for specifics before?

[Rep. David Durfee (Chair)]: At the top of the hour, we had heard that there was no request this year, but there might be in the future. And I don't know if there's ever been one, but I think that this is an interesting good question, maybe that gets to the critical, the heart of the matter and the funding. So I don't know if we want to hear from Yeah, okay, good, come on up.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Good morning. Thank you for having us. My name is Mary Kate Mollman. I'm the director of Vermont Public Policy with Bi State Primary Care Association. The Primary Care Association supports Vermont's federally qualified health centers. We have 11 organizations, but come up to about 97 sites around the state in every county, primary care, dental, mental health, food based clinics or no, sorry, school based clinics. Talking about food in schools. We also support Vermont's free and referral clinics as well as Planned Parenthood, just to give you a sense of who we are. I spend most of my time across the hall in the health care committee, so this is the first time I've been here. But I have to say my father was a forester in his professional career and my uncle and now cousins run a farm up in Hardwick. So I feel like a little bit like I'm coming home here. On the health care side and with the task force, what you often hear about these groups is they are funded by grants. Grants are really great to start a program, study it, but the problem with grants is they end. And then you get something that starts to work. You get communities engaged. You get patients engaged. You start seeing results. Grants end, and all of this work, Connie, and then you're struggling to figure out how to fund it. So the primary goal of this task force is to understand and examine and explore different ways that we can have sustainable funding. And I call this out, I want to call out the food as medicine, and I want to call it out slightly separate from our food access programs. Like you have the three squares or veggie van go, that's really about food access, food security. Food as medicine is really looking at how do we get and use food and nutrition to treat chronic and diet related conditions. Now there's a big overlap in those two circles in that diagram. I'm not sure I'm speaking right, but I just want to call it, this is really looking at it from the medical perspective. And so can we look at our payers, who pays for our health care, and how can we involve them in these programs and supporting these programs? So I also want to lay out a timeline for what we're looking for going forward. And I'm going to hesitate because I may lean into some of the healthcare speak. So if you hear me say something and you're like, what is that? Please stop me. So our Medicaid program is really supported through an eleven fifteen waiver that allows, that is a waiver from the federal government that allows us to use Medicaid dollars in a more flexible way, something that may, you may spend something that wouldn't be initially approved under the traditional Medicaid program. And really, our whole Medicaid program is under this eleven fifteen waiver. That waiver is ending at the 2027. AHS, our Agency of Human Services and the Department for Vermont Health Access, are going to start looking at reapplying for another waiver starting this summer. And the idea is then they submit that waiver next summer and then go into negotiations with the Centers for Medicaid and Medicare Services for that new waiver to go into place in January 2028. So the idea is that at this point, taking all of the work that this task force is doing over the six months, which is looking at return on investment, looking at stories from the fields, looking at different payment methodologies and policies that we might need, working, taking all of that information that we're gathering and starting to work with the agencies of human services and also working with Blue Cross Blue Shield of Vermont or MVP, other commercial payers, to think about what policies, payment programs we could put in place over the next twelve months so that we can start supporting these programs in a more sustainable way. So that's kind of the timeline of what we're looking at and what the pieces and policies that we might need to bring to you all next session. So it might be an appropriations request. It might be just a new policy or Medicaid requirement, it may be rulemaking. So those are the things that we're exploring right now. So I'm going to pause there because I don't want to get too far.

[Rep. David Durfee (Chair)]: So historically, the eleven fifteen waiver has allowed the system to draw in federal money.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: So the waiver is really about flexibility in how we spend the money. What services can we cover? What populations we can cover that might be different from what that core Medicaid program was designed initially. We have had this waiver in place since 2006. So when it kind of initially came under Governor Douglass, and it's gone through many iterations. It's changed over time with each iteration and application and renewal. So now we're kind of coming up to that next iteration, that next renewal. I'm trying to think of

[Rep. David Durfee (Chair)]: I guess I'm just not quite clear on whether Food is Medicine program has been funded through Medicaid dollars.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Not in the state. Other states have looked at it. You could set it up potentially as a demonstration program where you could use I'm not sure exactly what category of Medicaid dollars it would fall under. I don't want to get too into the details of different Medicaid dollars, but you could use that as a demonstration that then could then be used to put it in part of our state plan for Medicaid as a covered benefit. You could potentially look at ways to cover it through what we might call a value based payment, which could be a capitated lump sum payment that a provider gets for caring for a patient. So those are the different ways that we explore. We, as a state, don't have managed Medicaid, which is another avenue that other states have used.

[Rep. David Durfee (Chair)]: What about other other insurance payers? So Blue Cross, for example, or Medicare.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: So I'm gonna talk about the commercial first. Blue Cross Blue Shield, we they have been part of the task force. They were actually going to be having a conversation with them this afternoon by state and Blue Cross. That could looking at it again, is it a covered benefit in their health care plans in terms of like, is it reimbursed what we call as a fee for service? Or are they looking at different primary care programs where they maybe give an enhanced payment that would cover some of these services provided by the doctor and also that would cover some of the food. So that would just be how they interact with the providers and the contracts they set up with the providers. Medicare is a different animal. We don't have control over that. We may be participating in a model in 2028 called the AHEAD model, which potentially has some avenues for bringing Medicare dollars in to cover something like this, but that is uncertain whether or not we participate in that program at this point.

[Rep. David Durfee (Chair)]: Right. When did the 11/15 waiver end?

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: This current round, agreement the that we are currently under ends December 2027.

[Unidentified committee member]: So is it statutorily sunsetted? I mean, could it be potentially the sunset moved?

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: No, this is an agreement with the federal government. And so the agreement for the eleven fifteen waiver ends at the 2027. So the state is going to be working over the next year to put together a renewal application that will then be submitted to the federal government next summer, I believe. And then that gives them six months of negotiations to come to those final terms so that the new waiver can start January 2028.

[Unidentified committee member]: Potentially, it may not happen?

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: That is always a possibility for the federal to not approve the waiver.

[Unidentified committee member]: You know how much you access from that?

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Like how much the

[Unidentified committee member]: If you were to replace those Medicaid dollars

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Well, it doesn't replace it would just pull back a lot of the flexibilities and a lot of the programs that we're currently funding through the flexibilities under the Medicaid program. It doesn't take away the Medicaid program. It just would revert it back to some of the more structured traditional Medicaid program without the flexibilities.

[Unidentified committee member]: How much it would divert, you know?

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: It's hard to tell. I mean, the Medicaid program is about 2,000,000,000.

[Rep. David Durfee (Chair)]: Medicaid itself? Yes.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yeah. The state and Yeah.

[Rep. David Durfee (Chair)]: Got a couple more minutes if there's anything else you wanted to cover. That's

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yeah. Those are the big pieces.

[Rep. David Durfee (Chair)]: Okay. Was there anything else that if we were talking, somebody thought, oh, I wanted to say this, or maybe had an answer to a question that somebody raised?

[Rep. Brigham (first name unknown) (Member)]: Representatives. So doctors, their healthcare providers are charging people to eat healthy. So they go to the inverts or whatever, buy the carrots and kale. As farmers, you know, we never have time to get the word out. So I would suspect that the farms in Vermont that are doing this, I mean, this stuff is gonna be way better because it's growing in healthy soil than what's coming from California and sprayed all up with pesticides. And that word needs that word. You're not gonna get cured by some of that stuff.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yeah, and I think that's one of the reasons why we're not just talking to the healthcare about how to fund food prescriptions. We're also talking to you all on the Senate Agriculture. So how do we link it in with our agricultural small farms businesses in this state and keep it local?

[Rep. Brigham (first name unknown) (Member)]: Dairy farms go out, and I go to dairy farms. In Franklin County, we're seeing a lot of small vegetable chickens popping up in that lane still being utilized.

[Rutland Farmacy Program Director (name not stated)]: Great.

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: It really helps our resiliency as a state. All experience COVID, we experience with your assistance,

[Rutland Farmacy Program Director (name not stated)]: you're keeping at Load Mollie, you really

[Emilie (Program Developer/Coordinator, Little Rivers Health Care)]: just build your resiliency and build the communities.

[Rep. David Durfee (Chair)]: Well, think that's a good point to end on and say thank you to you for organizing this, Dana, for everybody for coming in. We appreciate hearing the testimony.

[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Thank you for having us and hearing about this. All

[Rep. David Durfee (Chair)]: right. We'll take thank you, Zoomers. We'll take a short break.