Vermont Legislature SmartTranscripts:

[Robin Scheu (Chair)]: Good morning. This is the House Appropriations Committee. It is Friday, 01/30/2026. It's 11AM, and we are back to focusing on the FY 'twenty seven budget. And we have with us the Commissioner of the Department of Health and the Financial Director for the Department of Health.

[Eileen Dickinson (Member)]: So welcome to both of you.

[Robin Scheu (Chair)]: And I'm trying to remember, were you here in December? Yes. So you actually had met everybody. Yes. So you can introduce yourselves for the record, and then we have your information here. And if you wanna share some of that, we could do that or not. It's up to you.

[Rick Hildebrand, Commissioner of Health]: For the record, Rick Hildebrand, commissioner for the Department of Health.

[Megan Polk, Financial Director, Department of Health]: And for the record, Megan Polk, financial director of Vermont.

[Robin Scheu (Chair)]: Thank you for having us.

[Rick Hildebrand, Commissioner of Health]: I'm gonna give a high level overview of handful of things, and I will defer to Megan for a lot of the questions you likely will have about specific numbers. And we have a blank

[Megan Polk, Financial Director, Department of Health]: Maybe I won't share my presentation. It was loaded just a second ago. Hold on. You can get started. I'll catch up

[Eileen Dickinson (Member)]: and see

[Rick Hildebrand, Commissioner of Health]: if first slide is our mission and our vision and our values. And again, I put this up often just to remind us all and to reconfirm our commitment to the Monsters that we stand by them in these challenging times, in this challenging landscape, and something that we feel very strongly. The second slide is our organizational structure, which, again, you've seen before. The health department consists of six sixteen physicians in our central office, our 12 district offices, the Office of the Chief Medical Examiner, our warehouse, and our lab. It's a reminder to me and something I often refer to, the breadth of what the department does. We cover a lot of ground, and public health touches so many parts of our lives. And the health department does many things, including very clinically relevant things like in the office of the chief medical examiner. We do home visits for new families. We do laboratory testing, but we also do community based work and very public health based work, including ensuring the health and safety of our water and our air, food safety, things of that. And the other piece that I find helpful is just to remind myself and to remind us all that I've got people in all of these areas. We have people in all these areas that are experts in the fields. I am not the expert in all these fields, but we have incredibly intelligent people who have been studying these topics for decades, and we can always rely on and can come into committee if needed. The other piece, just to say, is we love data, and we provide a lot of data and reports other than the programmatic stuff to the legislature and to the state, including the state health improvement plan, the state health assessment, Healthy Monitors 2030 dashboard, and many, many others. And these are resources if you care to review. You can see these reports and many others. Geez, was that this week? Earlier this week, AHS came in, and I can't believe that was this week, gave a high level overview of the FEDFIC process that we had this year. It was very, very different. It was my first time. But from what I understand, it was very different than in years past. It was not looking at just the health department budget. It was looking at the entire agency as a whole, which was, A, very helpful to see what we're looking at, but, B, also made it challenging because we had to stack initiatives and things that we do

[Robin Scheu (Chair)]: in the health department against things that are being done in Diva, things that are being done at Dale that touch patients' lives in a very, very dramatic way. And when looking at where we're gonna

[Rick Hildebrand, Commissioner of Health]: invest our money and where we're gonna make cuts, that was very much taken into consideration. And I want you to realize that when I walk through a couple of these things, which we wanna keep everything. The health departments feels strongly about all our programs, But when you put it in the context of the other programs we're looking at, that's where some of these decisions came from. This is our pie chart that describes where our budgetary funds come from. And in the 2027 budget, we have a budget of just over $221,000,000. That's a 1.2% overall decrease from fiscal year twenty six. Federal funding remains the single largest source of funding for our department program. General funds account for 11 of the total budget. The general fund share of the budget plus the state share of global commitment is 22% the department's budget. Compared to That's a decrease. Correct. Compared to '26, our global commitment budget requests us $5,000,000 lower, and the federal receipts are $1,100,000 lower.

[Robin Scheu (Chair)]: So I have this all got this spreadsheet for all the areas, so I can look through it. But is that a decrease in general fund also? Okay.

[Megan Polk, Financial Director, Department of Health]: And the health department starts on page 10 of the AHS. Yes. Yes. Thank you. Wayne?

[Wayne Laroche (Member)]: What was the cause of the things that weren't able to be billed?

[Rick Hildebrand, Commissioner of Health]: You're saying the federal receipts being lower?

[Megan Polk, Financial Director, Department of Health]: I think it was just it's a loss of some COVID era grants that ended in 2026 that were not expected. Yes. Of them are COVID.

[Rick Hildebrand, Commissioner of Health]: All right, so some of the most painful things that we often talk about are programmatic eliminations, and we are proposing three. Two of them are in workforce development, and one of them is the effort to implement the Non Use Drug Depository Program. I do have slides on each of these. The Health Professionals Educational Assistance Program at a high level is a tuition reimbursement program. And the AHEC program is to promote health professions in high school and college students. And both of those eliminations so the first one is $4,100,000 and the APEC is $550,000 And then we have not been able to implement the efforts to use the unused drugs. We have tried for a number of years, had not been able to start that up. So given that we were never able to start the program, we propose eliminating that. We don't think the funding is sufficient, really, to get that started. And when making looking at cuts, not starting something you never started is one place we often That's a visa. Decision.

[Robin Scheu (Chair)]: So

[Rick Hildebrand, Commissioner of Health]: again, the first one, which is the largest line item, is the health care professional educational assistance programs operated by the University of Vermont's Statewide Area Health Education Center or VSAC, which is the Vermont State Assistance Corporation. Together, they provide forgivable loans for students and loan forgiveness for participating professionals in exchange for commitment to practice Vermont. The current funding level for the UVM program is $667,000 and $3,500,000 for the program operated by SAC.

[Robin Scheu (Chair)]: 600,000 UPS?

[Rick Hildebrand, Commissioner of Health]: Yep. 667,000 were vSAIC. Of those 4,200,000.0, 3.4 is in nursing, about

[Unidentified Member (House Appropriations)]: 420,000

[Rick Hildebrand, Commissioner of Health]: is primary care physicians and APPs, 190,000 in dentists, and 100,000 in identified jets. That's how the breakdown of that $4,200,000 is spent in tuition reimbursement and scholarship programs.

[Robin Scheu (Chair)]: And tell us more about the thinking behind eliminating these particular programs when we have a workforce issue.

[Rick Hildebrand, Commissioner of Health]: And again, I do want to impress that this has been a challenging year. We looked at a lot of different things and went stacking it against programmatic cuts, services to individuals, this sort of felt lower on the list. It wasn't that we don't care about it. I will say there's also been part of this last six month period of time has been an application for rural health transformation program. And we do know that we had planned on and helped on making some investments in workforce development in that space. But really, the primary driver was we've got a hard budget year when we're stacking against programs that are providing services to people versus these programs. We felt that these were of less importance. Not that they aren't important, and we wish we could continue to monitor

[Robin Scheu (Chair)]: You had to prioritize. We weren't at the top. And I believe the Rural Health Transformation Grant limits what you can do for workforce.

[Rick Hildebrand, Commissioner of Health]: It does. It has, as many grants do, it has particular clauses in it that limits what we can do. We very clearly would not be able to replace any program that we're currently doing with that. It does, however, provide funds that we could use in a different way. One thing that we look at with all our programs is how the programs are performing. And that's something we want to look very critically at. In the past, we have. It's not that these programs have performed poorly. We believe there's an opportunity to do better. And the outcomes we've primarily looked at is how long people have been here for a period of time after they've graduated. So again, I think we have an opportunity to look at this. But again, the primary driver, just to be clear, it's been a tough year, and it's less than fair.

[Unidentified Member (House Appropriations)]: David, just so that I can understand, if someone could give us a spreadsheet that says, here's what we're reducing. It served this many people on average. Here's what we're coming in with the 195,000,000 a share for scholarships that we believe will serve x number of people. So we can see, are we gaining in total for workforce development, or are we losing? Do want to be Somebody have that?

[Rick Hildebrand, Commissioner of Health]: We can get that. I do want to be very clear. We are not replacing this program. This isn't a replacement of one for the other. It is a different way in which we fund workforce. The total amount of dollars we can absolutely get for you. Much

[Unidentified Member (House Appropriations)]: you're Can explain gonna say to us the different way?

[Rick Hildebrand, Commissioner of Health]: The pieces that I can say is we cannot give tuition reimbursement. That's not an option with the federal funds. We can give tuition scholarships programs. The program would be a different type of program. By the nature of the grant, we can't But scholarship is pretty powerful. It is very powerful.

[Robin Scheu (Chair)]: And we can do

[Rick Hildebrand, Commissioner of Health]: a lot with these funds, and we want to do a lot with these funds.

[Unidentified Member (House Appropriations)]: I recall last year seeing that Vermont had a shortage of maybe 5,600 nurses and over 300 physicians. And that seems pretty weighty to me if we stop Agreed. Any of And

[Rick Hildebrand, Commissioner of Health]: what I'm particularly interested in is looking at ways in which we can ensure that we hire and train nurses and doctors that work in primary care and want to stay in Vermont, who weren't necessarily thinking of staying in Vermont before getting these funds, okay? That's the kind of thing I would like to really hone in on. And when we're looking at what we might have from RHDP, build a program around that.

[Tiffany Bluemle (Ranking Member)]: Eileen, go ahead, Nini.

[Robin Scheu (Chair)]: I would like to hear

[Eileen Dickinson (Member)]: Okay, I have this as my portfolio, your budget.

[Rick Hildebrand, Commissioner of Health]: Yes.

[Eileen Dickinson (Member)]: I would like to hear you discuss AHEC now.

[Rick Hildebrand, Commissioner of Health]: Yes.

[Eileen Dickinson (Member)]: And then when you're done, I want to ask just a couple of questions. And I can go on to this later with you when I sit down with you to go through the budget. I'd like you to do anything first. And ask your questions.

[Rick Hildebrand, Commissioner of Health]: So the recommended budget would end the Global Commitment funded grant, which is $500,000 that provides support for the statewide area health education centers. And the focus of that is to promote health care careers among college, high school and middle school students. It also would end a $50,000 grant to UVM AHEC program to recruit UVM medical students and medical residents to work in Vermont. So those are the specific programmatic cuts that we are proposing. These are not easy choices and will have impacts, will have impacts on AHEC for sure.

[Eileen Dickinson (Member)]: Okay, so the question I have is when we had a whole group of you

[Rick Hildebrand, Commissioner of Health]: here, you

[Eileen Dickinson (Member)]: probably were here, One of the things that was said by the secretary or someone was that they were going to take these two programs, find a way to combine them and make them probably more efficient. And I have more than passing interest in this because I worked on the legislative trustee on the Massey College system, which means we do all our nursing, radiology tests, all that. Those were critical occupations that got ARPA money. I think that those were done really with the space act that got it. They were the forgivable loans with the requirement that you work so many years, each year you got a forgivable towards your loan. And if you didn't work here, they would transfer to us, a loan and you have forgiven. So is that what you're talking about here in the VSAC, that this is a different program?

[Rick Hildebrand, Commissioner of Health]: This is not for loan forgiveness at all. This is for running the program to encourage students to enter health care fields. The other money, that's the loan repayment and forgiveness.

[Eileen Dickinson (Member)]: The AHAC?

[Rick Hildebrand, Commissioner of Health]: No, AHAC is not. VSAC is.

[Eileen Dickinson (Member)]: VSAC is, yes. Okay. You give a bunch of different categories for that. Correct. That's different from they are from money that was given Correct. Okay. Now the AHAC, I was unaware that AHAC was involved with high school and college students. I'm not sure about the medical students or residents, probably the residents I've been aware of, but my understanding of AHEC, it was a forgiveness up to $20,000 depending on how many Medicaid patients were being served, increased number of Medicaids. And that was direct forgiveness to a practicing primary care doctor, dentist, physician. And you got it whether you stayed here or not.

[Rick Hildebrand, Commissioner of Health]: Yeah. So to be clear, we're not the only funders of ACAC. Right. And my understanding is our piece is not that. It is more programmatic and staff to run the program, which, again, encourages the middle school, high school and college students to enter into these fields. It's not around loan payment or loan forgiveness. That's my understanding.

[Eileen Dickinson (Member)]: Okay. All right. That's good. I can get into it later with you. But the concern I have is that I need data to see how this worked out for your high school and college students, even for your well, your medical students are probably gonna graduate along to a career anyway. But everybody and their brother sometimes, wiles, wanted to become a doctor, and they all got into pre med until they got into orthopedic chemistry.

[Rick Hildebrand, Commissioner of Health]: Oh, yeah, I know. I remember many of my friends dropping like flies. Yeah. Again, I agree with you. Outcomes are important. What I would argue is we're not doing a good enough job, because there is still a massive shortage, and it doesn't seem to be getting better, okay? So I look at this as this is a challenging year. It's really hard to talk about cutting this program. We have an opportunity with this RHDP to relook at this entire system, rebuild or reimagine what we're doing, because I would argue we can do better. We're just not getting enough nurses in Vermont. We're not having enough primary care physicians in Vermont. We don't have enough dental hygienists. I know that, for sure. And there's so many other fields that we need to work on, and I think we can do better. Okay, thank you.

[Tiffany Bluemle (Ranking Member)]: I just want to step back. Sure. Well,

[Robin Scheu (Chair)]: thanks for being here.

[Tiffany Bluemle (Ranking Member)]: And I appreciate the cuts are hard to make. I'm concerned because there are I've been watching this department's budgets over the last several years, and maybe the increase is 1% each year, whereas many other departments are getting it 3%, And you're going down by 1.2% when we know health care costs for employees are higher. And I think I'm expressing some concern that the Department of Health may be underfunded. And I don't know what was asked of you, but that is a I've just seen this as a trend, and then to go down near the first budget, I think, that we've seen that's going down at a time when I think that you are playing a pretty critical role in community health and in setting statewide standards, etcetera. So maybe I'm missing something, but I'm concerned.

[Rick Hildebrand, Commissioner of Health]: I appreciate your comments. And I also appreciate the implicit thing you're saying about the value of the health department to the people of Vermont. I completely agree with you. And to be fair, I did enter this process part of the way through. The pieces that I've tried to focus on are the program level things. And there was, again, a very robust discussion about here's the programs that we've looked at across the agency and which ones do we think are really, really important must continue, like the immigrant health program and providing occupational therapy services to people with disabilities and many other things that were sort of on this list that we have looked at. And while this is incredibly hard to look at these programs when stacked against others, it did make sense to say, hey, we think these programs are more important globally. And as you're saying, the sort of 20,000 foot view, I don't have the perspective for because I've just been here such a short period of time. I feel very strongly about the work that we do. And I also want to be fiscally responsible to be completely fair. It's important that we invest dollars in the right way and we get the outcomes that we want. And I'm definitely committed to doing that both now and in the

[Megan Polk, Financial Director, Department of Health]: future. And just to kind of touch on your other point, yes, the overall health department budget is a down, but it's largely, it's because of these three program eliminations, other public health funding has remained stable in our budgets.

[Rick Hildebrand, Commissioner of Health]: All right, the last slide I have is on for me, and then I'll switch to Megan, is again the elimination of the proposal for the state prescription drug depository program. This is a program that was designed to collect unused prescriptions, resort, repackage and provide them to Vermonters. It's a program that has been done in other states, and it's been done successfully. We had tried to find a partner to implement this program, and we have been unable to do so for a couple of years. And given that, and again, my assessment here is that the funding level is just not high enough to actually implement the work. Not that it isn't a great idea. We propose to look at that.

[Robin Scheu (Chair)]: Makes sense to me that's an easier one, right, than the other ones. Given the budget situation and the federal situation, we all have to expect and remind ourselves, I just have to remind myself, programs are going to be cut. We can't keep everything, and it's going

[Eileen Dickinson (Member)]: to be

[Robin Scheu (Chair)]: hard and be unhappy with decisions. Or somebody will be with every decision, right? Maybe not the drug first.

[Rick Hildebrand, Commissioner of Health]: And I put this slide up for initial questions, but I'm glad that you guys have been asking me questions right along, because that's my preference.

[Robin Scheu (Chair)]: Well, let's continue that way. Okay, now

[Megan Polk, Financial Director, Department of Health]: you're with me in the numbers. Again, I believe the BDH budget starts on page 10 of the AHS ups and downs, you're looking for a more holistic view of this. The health department budget, just as a reminder, is broken into three separate appropriations. Our admin and support division, which includes the commissioner's office, business office, our office of health equity, our public health appropriation, which is the largest and includes most of our divisions. And then finally, our substance use programs appropriation. This first section of the ups and downs that you'll see here is the overall changes in salary fringe from 2026 budget to this current 2027 budget that we are proposing.

[Robin Scheu (Chair)]: We see 2020 Okay.

[Megan Polk, Financial Director, Department of Health]: Are This is the difference between what was in 2026 as past and what we

[Robin Scheu (Chair)]: are proposing. So, you don't have totals for 2027, you just have?

[Megan Polk, Financial Director, Department of Health]: This is, yeah, this is the net change. So, this is that ups and downs spreadsheet that really only doesn't show the total funding, but shows the change between for each line, the change from one year to the next. You'll see we have we do have some downs in here, and that is because there are 59 positions in our admin and support administration, compared to 62 that were in the 2026 budget. Part of that is two positions have moved just within the health department. So, out of our admin appropriation and into public health. And then, we did have one position that was riffed due to the cancellation of the federal health disparities grant. So, a net, in this appropriation, a net reduction of three positions, but only one has actually left the health department entirely.

[Robin Scheu (Chair)]: So that was due to the cancellation of the grant? Yes.

[Megan Polk, Financial Director, Department of Health]: Two other positions have moved to our public health group reach.

[Robin Scheu (Chair)]: And the grant that was canceled, you don't need to go into great detail, what's the headline about what it did?

[Megan Polk, Financial Director, Department of Health]: Yep, the health disparities program was largely an attempt as a result of COVID, you know, COVID came about from the COVID era response funds, and it was intended to help support addressing health inequities and health disparities across the state. So we gave a lot of money to community partners.

[Robin Scheu (Chair)]: You didn't have to. Was it just sort of canceled midstream and you didn't have to claw back what you'd already spent?

[Megan Polk, Financial Director, Department of Health]: No, they did not claw back what we already spent was I forget the exact time frame, but it was canceled at least a few months ahead of when you're expecting So

[Robin Scheu (Chair)]: if you had spent it all, wouldn't that would have been that. But you had some left and they did.

[Megan Polk, Financial Director, Department of Health]: Yes, we did. Yeah, we did have to leave some give us. Didn't We give any money back. Okay, thanks. This next section shows one last change to the workers' comp insurance for our admin salaries. And then after that, we have the change in our operating expenses. So, those internal service charges, fee for space at our, excuse me, central office.

[Robin Scheu (Chair)]: Don't worry about any of those things. Just skip right over those.

[Eileen Dickinson (Member)]: We'll go right along there. This

[Megan Polk, Financial Director, Department of Health]: grant section is where you'll see, again, we had some internal moves within the health department. These first three lines that say net neutral to section B312. Those are again, those programs that we moved out of the administration and support and within to health appropriation. So, you'll see corresponding ups there. I will note that we have those two programs that Doctor. Hildebrandt mentioned, the area health education centers and the education loan repayment that are those are the two proposed program reductions. However, education loan repayment does have a federal grant that will be continuing and will be operated within the public health appropriation. So you won't see this $4,000,000 of GC, but you will see this $250,000 of federal funds continuing in our public health.

[Robin Scheu (Chair)]: So, you've got a down of the $2.50 in federal funds because it's

[Megan Polk, Financial Director, Department of Health]: But it's yes, it'll be an up in our public. And then similar thing with this last line, the quality improvement prescribing, it's just moving to our public. Is the last slide for our admin and support appropriation. This next slide is public health, and I believe that should be on page 11 of your ups and downs. Very briefly, net changes for positions between twenty six and twenty seven. Again, we do have some reductions here. We have five ten positions in this appropriation compared to five thirteen last year. And I can get into the details of those changes if you'd like, or we can just keep

[Robin Scheu (Chair)]: Okay.

[Megan Polk, Financial Director, Department of Health]: Then the last item in personal services is, as Doctor. Moldavrant mentioned, that unused prescription drug repository contract. That's our third proposed program elimination. And then similarly, we have deeper space in our district offices and our public health lab. And then the medical and lab supply line, that is the NARCAN program. It is moving, it was previously operated in public health. We are moving that to our division of substance use. So, will show as an up in our substance use.

[Robin Scheu (Chair)]: And that's a special fund?

[Megan Polk, Financial Director, Department of Health]: Yes, that is the evidence based education special fund.

[Robin Scheu (Chair)]: And so, you're moving?

[Megan Polk, Financial Director, Department of Health]: We're just transferring the spending authority from one corporation to the other.

[Wayne Laroche (Member)]: Okay.

[Megan Polk, Financial Director, Department of Health]: We have There's two separate slides on our grant section in public health, just because we had so many changes this year. These first three lines are exactly the same as what you saw in admin. These are just corresponding ups for those kind of program shuffles between appropriations. And then, again, very similarly, that education loan repayment here is where that federal grant is still within our budget. Final slide on public health, I believe, is the last few changes in our grants appropriation. For our immunization program, we are requesting increased spending authority in the special fund that help funds our Vermont vaccine purchasing program. This program allows the state to ensure universal access to vaccines for all people in Vermont at no charge to the individual. The program reduces total cost of vaccine by using volume purchasing contracts that we usually get through the CDC. And the program costs are funded by assessments to health insurers, which are then deposited in the special fund and used to pay for the program.

[Robin Scheu (Chair)]: So our health insurers that operate in Vermont are paying something to help us with this? Yes. There may have been some hint of this when you talked to us in December, but this is as a result of the federal government canceling all

[Megan Polk, Financial Director, Department of Health]: of their immunizations? This is not as a result of that. This is just our anticipated increase of meetings, more spending authority to account for the revenue that we are receiving for those health insurer assessments.

[Eileen Dickinson (Member)]: Lynn, go ahead. Yeah. Maybe this is what you're trying to talk about from December. It seemed to me there was money that we transferred from the 30,000,050 million dollars whatever it was. We did SNAP. Did we do this as well? Only thing we have

[Robin Scheu (Chair)]: done is SNAP. How we've put in the budget adjustment, the $5,000,000 for Section eight housing. There's been nothing that we do.

[Eileen Dickinson (Member)]: So just want to double check. Unless you did on your own.

[Robin Scheu (Chair)]: It's their own special fund.

[Rick Hildebrand, Commissioner of Health]: Insurers that are paying into the special fund, we just need more money to cover the increased cost of passengers. Thank you.

[Megan Polk, Financial Director, Department of Health]: The next line

[Eileen Dickinson (Member)]: Oh,

[Robin Scheu (Chair)]: I'm sorry. Go ahead, John.

[Rick Hildebrand, Commissioner of Health]: Why don't we just skip ahead here?

[Eileen Dickinson (Member)]: Oh, sure.

[Rick Hildebrand, Commissioner of Health]: So you just go into the next line? Yes. You sure? Okay. Sorry.

[Megan Polk, Financial Director, Department of Health]: No, the HIVAIDS service line item, the 695000 of general fund, that is again, another budget neutral change. We're taking our syringe service program and again, moving it out of our public health appropriation and putting it into our substance use appropriation. So, there will be a corresponding up later on. Next two lines for maternal and child health program grants reflects the first is a change in just the way the preschool development grant is being managed within the agency of Human Services. The Department of Children and Families is the direct recipient of that grant. They manage it the past few years. The health department has done a significant amount of work in coordination with DCF to implement those programs in the coming year. The health department anticipates just doing less for that grant, and DCF is taking over some of what VDH had previously been doing. So that's why there's a reduction in our interdepartmental transfers there.

[Robin Scheu (Chair)]: And so, but you don't have a note that says it's going to DCF, but that would be the note we could make? Well, it's so

[Megan Polk, Financial Director, Department of Health]: because it's interdepartmental transfer, you won't see that straight in out deal for DCF because they receive it and it's federal funds in their budget. So that, you know, we don't

[Robin Scheu (Chair)]: Oh, okay.

[Megan Polk, Financial Director, Department of Health]: I didn't want to call that one net neutral because you won't see a direct one to one relationship. Okay. The next line, and this one you will see, you do see this is a direct move from the health department to DIVA. This is the school Medicaid assistance claiming process, and that is going to be managed by DIVA.

[Robin Scheu (Chair)]: That's the agency of education is involved with Yes. This one Yeah, so I think there's still discussions on like implementing this. Yes. Okay.

[Megan Polk, Financial Director, Department of Health]: Then our tobacco control program. This line represents a change in funding for grant costs in our tobacco control program. Overall, the program has three different sources of funding, a federal grant from the CDC, an appropriation of tobacco litigation settlement fund and global commitment investment. And really, this change is just to better reflect how we are actually spending those three pots of money. There's no change in the overall funding of the base funding of the program, the overall spending. We're just trying to align the budget better with how we actually spend those three different sources. And then lastly, the emergency medical services line. This is kind of a housekeeping item. In 2024, there was act 143 increase the amount of the annual transfer into this fund to 450,000. It was previously 150,000. So this is us asking for that extra spending authority to accept that transfer.

[Rick Hildebrand, Commissioner of Health]: So what's that funding used for? Is it training? Is it

[Robin Scheu (Chair)]: Yes.

[Rick Hildebrand, Commissioner of Health]: Overall administration?

[Megan Polk, Financial Director, Department of Health]: Yep, it's administered to various EMS services throughout the state.

[Rick Hildebrand, Commissioner of Health]: How many, what do they call? That vary across the spectrum?

[Megan Polk, Financial Director, Department of Health]: Oh, that I do not know the answer to.

[Robin Scheu (Chair)]: We could get back to you. Yeah.

[Rick Hildebrand, Commissioner of Health]: Yes, yeah.

[Megan Polk, Financial Director, Department of Health]: Any last questions in our public health report? Seems

[Robin Scheu (Chair)]: like we're good there.

[Megan Polk, Financial Director, Department of Health]: And finally, have our substance use appropriation. This is page 12 of the ups and downs. Broken record, but this is our net changes in salary fringe for the appropriation. And this appropriation, had, there were 47 positions this year compared to 57 last year. And largely that change is due to 11 positions were moved from the substance use appropriation to the public health appropriation. So, were ups in that appropriation. And those are our prevention consultants that work out of our district offices. Their work is not changing. We were just moving them to public health to kind of better align with the work they are doing and where they are housed in our offices of local health. Keep going, this medical and lab supplies line, this is that NARCAN program that I mentioned that's coming from public health. And then finally, the Substance Use Appropriation Grant section for substance use prevention. You see that the annual, this special fund increase is the increase of the substance misuse prevention funds. This is the 30,000,000. Yeah, that's the 2,000,000. The administration anticipates the amount of revenue available in 'twenty seven to be a total of 9,500,000.0 overall. So in 'twenty six, our appropriation was just shy of 7,000,000, and the two gets us, makes up the difference for us to meet that estimated revenue.

[Robin Scheu (Chair)]: And why are federal funds going down there?

[Megan Polk, Financial Director, Department of Health]: Is that something they're not funding anymore? It's, the overall spending in that program code is increasing. Again, it's scenario where we're trying to better align our budget with how the funds are actually spent. So we have there wasn't a reduction in any federal grant. It's just we found that we're spending a little less federal grant money on prevention and more in that substance misuse special fund. So, it's that aligning of funding sources for the overall prevention. Are we leaving money on the table? No. That federal funding is still being

[Robin Scheu (Chair)]: Our

[Megan Polk, Financial Director, Department of Health]: substance use intervention line, this is what was listed as the syringe service program in the public health appropriation. It just now has a different name in the public health grant account code or in the substance use appropriation grants. So this is the Syringe Service Program. Substance use treatment. This is an area where, again, we're trying to better align our spending, we fund our spend, how better align our budget with how we fund our spending. So we have an increase in federal funds. We've been spending a lot of substance block grant on treatment, and we're able, by doing that, we've been able to reduce our investment dollars spent on treatment. But again, the overall program is not being reduced. We're just kind of shuffling, shifting the funding. Wayne.

[Wayne Laroche (Member)]: So you got a syringe program here. Is this the only one? I keep hearing syringe programs. Are there multiple ones? What's the difference between one?

[Megan Polk, Financial Director, Department of Health]: There's multiple providers that help us operate that program or community partners who help.

[Wayne Laroche (Member)]: Are there funds coming out of multiple budgets, in my curiosity?

[Megan Polk, Financial Director, Department of Health]: It is, I believe, it's just this one.

[Robin Scheu (Chair)]: But you hear on the news about different things, but they're it's individual information. Heard them in the testimony,

[Wayne Laroche (Member)]: or maybe it's it's I'm confusing BAA stuff with this.

[Megan Polk, Financial Director, Department of Health]: Yes there was some there was some talk in BAA about increasing the amounts to these providers.

[Robin Scheu (Chair)]: Okay thank you. Yeah it's the same yeah. Is that

[Tiffany Bluemle (Ranking Member)]: the same? I actually, I have a question. You've written a whole report about the opioid settlement money. And can you just briefly summarize your approach to that money and kind of what guided your recommendations since that, is any of that money supplementing general fund that we would normally commit to various programs? Is it funding state positions? I mean, you moving things in house? Or is it how much of it is going to the community? A general, because I will dig in and probably have a lot of questions for you, but this committee won't really hear about that until we get the bill.

[Rick Hildebrand, Commissioner of Health]: That's a great question. I'm not fully prepared to give you everything on OSAC. I can certainly do that. I will say that the committee gives recommendations around what to fund. It is not intended to supplant general funds or other funded programs. And in fact, this year, we are the health department feels strongly about a program that was funded in the past by OSAC and was not being recommended to be funded by OSAC in the former year. So we're actually moving that to the general fund because we feel so strongly about it. But we are very critical of the program to make sure that it continues to fund what we believe is important. It's been it has an opportunity to improve, that's what I will say, because it hasn't been very clear, is this intended to say, here are the important programs we're gonna fund them ongoing? Or are we gonna every year look at, here's a new thing we wanna try and start? And that's something that I intend to get a little bit of a better handle on this coming session, because that's been unclear to me. And that was probably part of the reason you have some confusion.

[Megan Polk, Financial Director, Department of Health]: I will say, at least at the health department, there are no positions funded by the

[Wayne Laroche (Member)]: Go pass through.

[Megan Polk, Financial Director, Department of Health]: Our last line, I believe I touched on treatment, another transfer to the Department of Mental Health for certified community based integrated health centers. Those there are a number of providers that previously were in the health department's budget as fee for service Medicaid, but they are transferring to that community based integrated health center model and will be paid out of the Department of Mental Health. So transfer of GC. Yes,

[Unidentified Member (House Appropriations)]: Dave. Apologize, you may have covered this. I just wanted to be clear though. Is our recovery network level funded at least in FY twenty seven? Yes. They're not going backwards.

[Megan Polk, Financial Director, Department of Health]: Correct. You'll see recovery center recoveries is our recovery grant account code is not listed on here because it's level funded this year. There was no change the funding recommendations from last year.

[Unidentified Member (House Appropriations)]: That's not being folded into this mental health community effort that you just spoke of.

[Rick Hildebrand, Commissioner of Health]: The CCBHC? No, no, no, that's

[Unidentified Member (House Appropriations)]: standalone, so to speak. Thank you.

[Robin Scheu (Chair)]: Why don't do you have a

[Wayne Laroche (Member)]: question before we move on? There's more. There's more. There's more. But if they're At the end. At the end.

[Robin Scheu (Chair)]: You'll wait till the end. Okay. So maybe we go and talk about persistent changes and vacancy savings. I'm following along in your booklet,

[Eileen Dickinson (Member)]: so I kind of skipped a couple of cases.

[Megan Polk, Financial Director, Department of Health]: Here we go. Yeah, so

[Robin Scheu (Chair)]: I was less worried about Oh, you had no notice of federal funds, this kind of report, no notice of funds. Yes. But that's good. But we'll hear if there is. Yeah. Okay.

[Megan Polk, Financial Director, Department of Health]: There's been some turmoil lately, but everything's been walked back.

[Robin Scheu (Chair)]: I know. Just wait a minute. It's sort of like the New England weather. If you don't like the New England weather, wait a minute.

[Rick Hildebrand, Commissioner of Health]: I'm trying to play defense.

[Robin Scheu (Chair)]: Okay, so you do have some position things.

[Megan Polk, Financial Director, Department of Health]: Yes, and this is some of what I alluded to earlier. Our reduction our total reduction in or change in positions is a reduction of 16 compared to twenty twenty six. 18 limited service positions ended, as I said previously, because of those federal COVID era federal grants. 13 of those were, again, very specific immunization, epi lab capacity, public health emergency response grants that we knew were one time limited funding. Three positions were in that health disparities grant that was canceled. And then two positions were eliminated because of a lack of work or just the work was reassigned to other positions within that department. And then we had an addition of two positions that were not in the 2026 budget, so net of 16. 16.

[Robin Scheu (Chair)]: Okay. So Yes, sorry, net 16 down. Right. The two positions eliminated due to lack of work. They were reassigned, but not to The

[Megan Polk, Financial Director, Department of Health]: work was just the amount of work, but if they were reassigned The work was reassigned to other positions.

[Robin Scheu (Chair)]: So those were all the Yeah.

[Eileen Dickinson (Member)]: Okay.

[Megan Polk, Financial Director, Department of Health]: And then for vacancy savings, we didn't have a line item on our ups and downs because our rate did not change compared to 26. We kept it at 3%. The health department is seeing an actual vacancy rate of about 8% right now. But for budget purposes, it was remained it.

[Robin Scheu (Chair)]: Are you having trouble hiring or are you guys having reasonable, you haven't needed to hire people? I think

[Rick Hildebrand, Commissioner of Health]: we have the lowest vacancy rate outside of central office within AHS. So we do a reasonably good job. I will say, writ large, public health is a concern of mine, recruiting going forward. I'm very worried about college kids going into public health today.

[Robin Scheu (Chair)]: Or not going into it?

[Rick Hildebrand, Commissioner of Health]: Correct. Mean, still, what's going on nationally, I mean, you're seeing massive cuts on the federal scale and the number of jobs globally going down. That's usually not an enticement for people to go into this work. I'm very worried about that right now.

[Robin Scheu (Chair)]: Yeah. But that's a long term process. And if people are feeling that way now, we may not feel the effects of it for four more years or after that.

[Rick Hildebrand, Commissioner of Health]: I've already reached out to UVM's public health education program just to do anything that we can to continue to encourage that. And one thing we are working on is internship programs, which has been a little bit more haphazard in the past, and we want to make that more formal so we have a pipeline for people to go on public health.

[Robin Scheu (Chair)]: All right, let's what else do we have here?

[Megan Polk, Financial Director, Department of Health]: This is the next page of Yeah.

[Eileen Dickinson (Member)]: UVM has an Miles per hour. Does anyone in the state have an Miles hour?

[Rick Hildebrand, Commissioner of Health]: Yes. UVM

[Wayne Laroche (Member)]: has. Yeah. Thank you.

[Megan Polk, Financial Director, Department of Health]: The next item is just a general description of our subgrants issued by the health department. We have a very large portfolio of subrecipient grants that we help administer last year or the yeah, the current year we have about four fifty. So you'll see in our detailed budget

[Robin Scheu (Chair)]: what it's

[Megan Polk, Financial Director, Department of Health]: Switch quickly. This document that was also sent along with you, there's we tried to for the grants where we knew who was getting the money, the kind of recurring not appropriations, but the recurring grant opportunities, we tried to list those We specific tried to list those specific

[Robin Scheu (Chair)]: Whoops. And before you would change to that, I had turned the page and I see the sub grants that you're not renewing, which is what we had talked about at the beginning, but this has the dollars broken out as I was madly taking notes and doing it badly. Okay.

[Megan Polk, Financial Director, Department of Health]: Yes, this next slide is the breakout of those three program eliminations to VSAC and A.

[Robin Scheu (Chair)]: Okay. Okay, that's helpful to see that page.

[Megan Polk, Financial Director, Department of Health]: Next slide is just a descriptive blurb, really, about the fact that we did not have to carry forward funds, or there was no carry forward at the end of the Are there reversions? I don't believe so, but I will have to get back

[Robin Scheu (Chair)]: to you on that. The

[Megan Polk, Financial Director, Department of Health]: single audit findings the health department had, the most recent audit was 2024, the 2025 is still being finalized, but there were two programs to have with findings in the health department 2024 and corrective action plans have been implemented.

[Wayne Laroche (Member)]: What the nature of the findings?

[Megan Polk, Financial Director, Department of Health]: One was a, excuse me, a FFATA, Federal Financial Accountability and Transparency Act compliance finding. And the other was a case of program documentation being submitted to the federal government that we just couldn't find the backup for that. So neither were a material weakness. Both have been corrected.

[Robin Scheu (Chair)]: It said two programs were found to have material weaknesses.

[Megan Polk, Financial Director, Department of Health]: I believe that was a misstatement. I believe they were the same program.

[Robin Scheu (Chair)]: But the we just

[Megan Polk, Financial Director, Department of Health]: there were two there were two weaknesses in one program. I'll double check. If that's the case, admittedly, I've the 2025 audit is still very fresh in my brain. I'm thinking that's

[Robin Scheu (Chair)]: where you're focusing on.

[Megan Polk, Financial Director, Department of Health]: This next suite of slides is really

[Eileen Dickinson (Member)]: just

[Megan Polk, Financial Director, Department of Health]: to try and help present all of the accreditation work, results based accountability, performance metrics that the health department goes through on an annual basis to review and analyze our various programs. So we are an accredited health department since 2014. Part of that is we need to ensure that we use that results based accountability method or method isn't the right word. Use results based accountability to review our programs. We do have a There's a scorecard if you're interested as part of that national accreditation. So we have many,

[Rick Hildebrand, Commissioner of Health]: it's

[Megan Polk, Financial Director, Department of Health]: a large set of sort of scorecards where we

[Robin Scheu (Chair)]: review Yes, our Drew was at, I was on the old Government Accountability Committee, and she would come in and she really was such a champion that it really, the whole agency really went to work on that which was great.

[Wayne Laroche (Member)]: So you obviously, you were here before, you heard me ask questions about being able to track everything again, it's taking the possibility at least of this million dollar rule transformation not coming in. Do you feel fairly confident that you're going to have in place the systems necessary to track the fund that goes out to those who may not be amenable to audit?

[Megan Polk, Financial Director, Department of Health]: The health department and the agency of human services has very strong internal controls on our financials. And I don't want to misspeak, but for me as a financial director, one of my priorities for the money that's coming to the health department is to make sure that we can track it and be responsive to any and all federal and state reporting requirements.

[Wayne Laroche (Member)]: You're not going to know about that until the federal budget passes.

[Megan Polk, Financial Director, Department of Health]: It's the Rural Health Transformation Program isn't set in stone yet.

[Robin Scheu (Chair)]: And in fact, just to let everybody know, since it's come up, the Joint Fiscal Committee has to accept the grant. And we are meeting publicly next Friday from 12:15 to we hope it won't for two hours but 02:15 to review the grant publicly and talk about it and then accept it so so we have an opportunity to accept it We can't make changes to it. And the legislature has no authority to direct or reappropriate the money or tuition. The only thing we can do is as a joint fiscal committee is to accept the grant. We could choose to not accept the grant, and then we wouldn't get $195,000,000 a year for five years. But we want to sort of publicly accept it so that everybody can understand. There'll be a reporting of how it's all supposed to work. The rest.

[Rick Hildebrand, Commissioner of Health]: Just to your specific question, there was a discussion of, do we have enough resources in our finance departments to appropriately administer this law? And we looked at physician level, hey, do we need to add physicians and where to make sure we're effectively administrating this loan? So that was part of the discussion.

[Wayne Laroche (Member)]: If we have the policies at risk, then we can ask a specific Right.

[Rick Hildebrand, Commissioner of Health]: I think that's on everyone's radar. It's how do we prevent that from happening.

[Eileen Dickinson (Member)]: Did you have a question? Yeah, I just want to say, federal audits for federal money occur every year. So you should be able to, as it's been granted, you are going to have a requirement. Maybe it isn't going to be you guys so much as it will be the central office or a little bit of But there will be, I mean, every federal grant, student financial aid for someone who drops out two weeks into school and doesn't get notified until two weeks

[Robin Scheu (Chair)]: later, that's

[Eileen Dickinson (Member)]: an issue. That's a warning issue on an audit. It's picked up all the time. So the question I have is, this is not going to supplement programs. It's not a program grant. It's a transformation grant. And it's going to look at how you organize things and how you hopefully can be more efficient and provide the services better to a broader variety of people among all these different areas that you have in health care. Is that correct? I mean, it's not going to be a program that we go and we step the money into.

[Rick Hildebrand, Commissioner of Health]: So it's somewhere in between, I would say. There are some programs that we are going to be reimagining or rebuilding. I'll be very specific to the Department of Health, because that's what I know. There's money that's looking at community paramedicine and more integrated health. The way we deliver emergency medical services in the state, we need to look at and perhaps change so that we can, in my opinion, infuse some more money into our EMS system so that they can be viable and provide different services that don't require people to go to the ER every time, make sure that they can get paid for that. So it's a program in that we're looking at the way in which we do this. We want to structurally change some things and put some things in place so that going forward, it's not going to require ongoing funding, but it's set up in a different way. So it's not a program in the traditional sense, but it will be a piece of work that requires a program manager to implement and rechange that system. And there's a variety of different ways in which that'll pan out in this thing, some of which are certainly within the health department and across HHS. So

[Robin Scheu (Chair)]: I'm looking at our time, and we have five minutes. Is there anything else you want to be sure that we know about?

[Megan Polk, Financial Director, Department of Health]: I don't think there's anything on my end. Just, you know, we've tried to be responsive to your memo with these slides. Yeah. Yep, and our budget detail book. So please feel free to let us know if there are any other questions or

[Robin Scheu (Chair)]: I think we have, this is a combination. Your eight is Tiff and Lynn both have parts of this. They're our liaisons. Yeah, she's

[Tiffany Bluemle (Ranking Member)]: got public health and admin and I've got, A313. Right. So,

[Robin Scheu (Chair)]: hope Doctor. Gilbert, you have not been through this before. So I don't know. I don't have anything to compare it to. You've been through it before, but it sounds like you all found that sort of joint process as an agency helpful in getting And those teams to

[Rick Hildebrand, Commissioner of Health]: the feedback I've gotten from my fellow commissioners who have been through it before,

[Wayne Laroche (Member)]: it's

[Rick Hildebrand, Commissioner of Health]: very, very helpful. I can say that it was helpful for me, for sure. I don't know what it was like before. But again, to see the landscape of all of AHS was a health.

[Robin Scheu (Chair)]: I could imagine that would be good stuff. Appreciate the work that you all have done and the whole agency has done to work on this collaborative. Not always easy, some tough decisions. We'll be learning more. And thank you so much for your time. Thank you, appreciate it. Committee, we are going to be back at 01:00. We have three items this afternoon. We have the Department of Human Resources.