Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair)]: And we're live. Good morning. This is the House Appropriations Committee. It is Tuesday, 01/20/2026. It's just after 10:30 in the morning, and we are going to talk a little bit about the Budget Adjustment act and the department of health as it relates specifically to the recovery centers because we learned some things last week and we just want to understand what is going on so have you presented in our committee before times Well, so then why don't we introduce ourselves so you can meet us, and

[Rep. David Yacovone]: then we'll have to introduce yourself as well. Good morning and welcome. I'm David Yacovone. I represent the Lamoille, Washington District. Good morning. Welcome, John Kascenska. Represent the Essex Galleria Army District, 10.

[Rep. Michael Nigro]: Hi. Mike Nigro, represent Bennington and Mellon. Thomas Stevens from Waterbury representing Washington Chittenden District.

[Rep. Martha “Marty” Feltus (Vice Chair)]: Marty Feltus from London. London, Sutton, Sheffield, we lack of clarity.

[Rep. Eileen “Lynn” Dickinson]: Did you

[Rep. Robin Scheu (Chair)]: say all those before? I'm Robin Scheu,

[Rep. Eileen “Lynn” Dickinson]: who's in

[Rep. Martha “Marty” Feltus (Vice Chair)]: Middlebury. Tiffany Bluemle from the South End Of Burlington.

[Rep. David Yacovone]: Trevor Squirrell, Underhill, and Chattenden, Wayne Rush Huggin, Franklin, British Virgin and Berkshire.

[Rep. Michael Mrowicki]: I'm Mike Mrowicki from the Windham Forge District 55.

[Rep. Eileen “Lynn” Dickinson]: I'm Lynn Dickinson, I represent St. Albans Town.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Good morning, everyone. My name is Emily Truder. I am the Health Department's Division Director for Substance Use Programming. I have been with the division, I'll be this year thirty years, with the Health Department since 1994. And I'm a South Burlington resident, but formerly of the South End Of Burlington. Great.

[Rep. Robin Scheu (Chair)]: So we were presented some information both at our public hearing and by the Human Services Committee chair last week, and became aware that we need to understand the process by which you make your funding decisions, specifically for the recovery centers, because what they ask for, what they got are completely different and we'd sort of befuddled, but would love to get some clarification if we could.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Doctor. Tim, Thanks. So good morning. So I'm going to open with just a brief overview of the recovery centers themselves, to ground us on their wonderful work that they do. Vermont is home to 12 recovery centers across the state. We do have statewideness, which we're incredibly excited about. I did have the privilege of being here when the first flagship recovery center came into play at the Upper Valley Turning Point in White River Junction. So we've had significant growth over the last decade and a half. Recovery centers are open during the day for people seeking support in their recovery journey. They provide a wide array of services, everything from recovery coaching and support groups to referral to other services and other peer support. There are also large participants in community related initiatives. We just recently completed a round of community forums across the state. I think there's potentially some familiar faces in the room as part of that. And the recovery centers were clearly a well embedded component of their communities. We are in the process of certifying our recovery centers pursuant to the RSO certification role. We actively, I believe, have three recovery centers that are actively certified. We do have on the phone with us today Nicole Rao, who is our Recovery Services and Harm Reduction Director with us today. So if you have any specific questions about their program, we can certainly have Nicole participate in that. As far as the appropriation process, it is traditional for the health department at the end of any given legislative session to review the bills as they come through, whether it be the big bill or other bills that may have appropriations within them, and as necessary, also review for legislative intent. For the FY '26 bill, it did not specify how the funds were specifically to be used. So as part of that, what we do is traditionally the funding that has come through since over the past decade, we have allocated to the set of recovery centers that we have. We haven't always had 12, so it may have been ten, one year, 86, whatever that may be. We currently have a ranking of 12 and that has been our current practice. For the last several years in several appropriations, for example, in previous fiscal years, I've had this much money essentially divide by 12 and provide that as part of the methodology for the given year. For FY '26, in partnership with our needs assessment that was published in 2024 and our strategic plan that was published in April '25, looking at access to care, looking at some of the tenants of Medicaid, such as statewide ness, and looking at the size of our catchment areas, we utilized the following methodology, which is similar to what we did in FY 'fifteen. In FY 'fifteen, we used a geographic distribution and catchment area component as well. So the the color I just I apologize. My vision is terrible. Okay. We're on the same slide. So for f y twenty six, we use the following methodology. We, again, looking at all 12 centers, we gave each center $50,000. Of that, we took the remaining balance, and we used a population level allocation. And within that, we use the total population for each of the recovery center service areas and the percentage of the population enrolled in Medicaid. For that service area to calculate a total adult Medicaid population, which equated to just under 150,000 people. We then calculated a per person rate by dividing the remaining 200,000. So again, we gave 50,000 per centers that covered 600,000 of the appropriation. The remaining balance of 200,000 utilizing that methodology, it came down to a rate of approximately 1.34 per person. With that, we then calculated the total allocation for each recovery center, utilizing that $200,000 divided by the number of people, which gave us that rate, multiplied by the number of Medicaid members in their service area. So we do have an example at the bottom of the page. So, for example, number of people times that rate equals, for that particular example, 16,523 plus the 50,000 would have been the allocation for that given recovery zone. So that is that was the methodology that we used for this year. And, again, it dovetails nicely with our, strategic plan that seeks to look at access to services, making sure, for example, the population of Chittenden County is different than the the population of, say, a smaller county like Caledonia. And in that, you know, we we fund FTEs for individuals to provide services in many spaces. So you would traditionally need more recovery coaches, for example, potentially in Chittenden County, than you may need in a Caledonia space. So that was the methodology that we used for this fiscal year.

[Rep. Robin Scheu (Chair)]: So did you get input from the recovery centers themselves and ask them what they needed?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: We have regular communication with them. We have regular standing budget and budgets meetings with them. We didn't have a specific we had many conversations with RPV and the centers in presenting this approach. We did also have inquiries specifically because RPV supports wonderfully supports 11 of our centers, but does not support the RPV? RPV, Recovery Partners of Vermont.

[Rep. Robin Scheu (Chair)]: Oh, yes. Right.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: So they're supporting 11 of the centers, and there is an additional center in County that is not supported by them. So we had conversations extensively with RPV and with the members of the team, they were well aware of our approach and what we were using.

[Rep. Wayne Laroche]: I have a few questions. When you say 148,761, is that individuals? Yes. Could you just give me an idea of what tasks are performed at the recovery centers? What are you doing? Somebody comes in, walk me through what you do.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: I meant to look at the ceiling. Nicole, are you on there? Nicole is joining me She'll on the give a better explanation.

[Nicole Rao, Recovery Services and Harm Reduction Director (Vermont Department of Health)]: Not in the ceiling, Emily, but here. Absolutely. So recovery centers really work at a person level approach to support folks. So it could look very different depending on the individual who is walking through the door. But generally what would occur is folks would meet with a staff member from one of the recovery centers, talk about what their needs are, what are they looking to focus on, how they could be best supported in that recovery journey that can be for folks who are currently in recovery need additional support or who are actively using a substance and are looking to reduce that use or stop completely. From there, we have a variety of supports that grants like this one pay for for those staff time that can include one on one individual coaching that could look like evidence based groups to help support if a group setting makes most sense for that person. Sometimes it's as simple as I really need support in finding housing. And so they would look to make some referrals and warm handoffs to give someone that additional wraparound support that they need. So day to day, moment to moment could look different for that staff, but they are there to actively support folks as they are walking through the door, in addition to doing community outreach to ensure folks are aware of their resources and help ensure folks are getting appropriate referrals to them for that peer support.

[Rep. Wayne Laroche]: Essentially, you're consulting with people that come in, you're asking them what their needs are and whatever they have, and you're then directing them to the services that they're asking for where they can find them. Is that what you're doing? Essentially?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Yes, but

[Rep. Wayne Laroche]: you're not giving them money or you're not doing anything like that. So it's all consulting kind of stuff.

[Rep. Eileen “Lynn” Dickinson]: Exactly. It's all staffing.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: So the recovery coaching is an active service that they would provide there. So there are things they provide there, but they also help with connections in their community, whether it be to treatment if that's part of their path or if it's employment, all those sorts of Directing

[Rep. Wayne Laroche]: them to places that can also

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Yes, things in house as well as referrals. So let me understand.

[Rep. Wayne Laroche]: So you got 148,761 persons. I'm assuming that those are not evenly distributed across the 12 centers.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Correct, yes.

[Rep. Wayne Laroche]: But your method of calculating or allocating the cost assumes equal distribution across the centers?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: No, we have the 50,000 base per center, and then we take the balance and we use that 148 to calculate the value per person. I hate putting a dollar and 34¢ on any particular human being. But then from there, after we've calculated the overall state rate, so to speak, say Chittenden County has, I'm use round numbers, 100, but say another county has 10, it would be that value times that $1.0.3 and that would end up on top of their $50,000

[Rep. Wayne Laroche]: So you're parsing it out based upon the average Based on a calculated calculation based on the average?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Then the percentage of the population in a given service area.

[Nicole Rao, Recovery Services and Harm Reduction Director (Vermont Department of Health)]: Emily, I'm just noting I did move to the next slide, which shows those calculations for each center.

[Rep. Robin Scheu (Chair)]: Did you already give this to Autumn?

[Rep. Eileen “Lynn” Dickinson]: Can you help us? Yes. Yes.

[Rep. Robin Scheu (Chair)]: I believe so. I didn't see it the last time I looked. So Mike Nigro has pushed.

[Rep. Michael Nigro]: You you mentioned that during the process of of coming up with your distribution method, had conversations with with RPV. I guess I just I wanna be a little more explicit just to to ask, did you know that they had a different methodology they had hoped for and expected? And Yes. If you specifically knew that, why what was your thinking in not utilizing that?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Our thinking in not utilizing that is that when we received the the legislative intent that the you know, there was nowhere did it specify in the intent that we were not going to provide funding to all 12 centers, which has been the traditional practice of any appropriation that has come through for recovery support services. So without that being sometimes, for example, we'll get in the big bill or in other spaces, they'll say, give this very specific amount to this particular vendor or something like that. Or the other thing, give to the 12 recovery centers and distribute evenly amongst them have been pre appropriations in which we've received. For this particular one time appropriation, that was not specified in the bill or in the legislative intent that we received. So we went forth with a methodology that supported all 12 centers and still accommodated for the catchment area distribution.

[Rep. Robin Scheu (Chair)]: Even though some of them didn't need as much money as they got, that's what we're told.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: The feedback that we get on a regular basis from all of them is that we can, to be quite honest, is they're all seeking additional funds as part of the mix, that nobody will tell you that they had enough as part of the mix is the feedback we regularly receive.

[Rep. Martha “Marty” Feltus (Vice Chair)]: A tip in Angela. Yeah. There is this funny thing in budgeting where sometimes we will name organizations and amounts, but sometimes that's in a bill like the opioid settlement bill. And oftentimes we don't, assuming that the relationship among providers and the relevant agency or department will figure that out. I do know that some of us on human services and on this committee were aware that different centers needed different things. That some centers actually said that they did not need additional money, given the work they were doing, the number of people that were coming. So I can see where you can interpret legislative intent in that way, yet the very people that you're working with, this constellation of providers, was really clear when they came forward and there were, I think, emails that they showed to you from the centers that actually didn't want, didn't need additional money. And so I'm assuming that then the decision was made based on a departmental prioritization. I know that you've worked hard on the strategic plan. I guess I'm puzzled by the decision, given the fact that it would underfund a number of the centers. And they were really clear about that.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: We did have extensive conversations, for example, with Susie Walker, who is the current executive director for Recovery Partners of Vermont, walking through the strategy around the 11 centers supported by RPV versus the 12, walking through our methodology and the conversations that I personally had with her, there was an understanding of where the how we saw the legislative intent and looked where they're going to the future. So we did have those conversations, there was an understanding amongst those within them. I do respect that they did present a different budget here and what they were looking for. Utilizing the information that we had in those conversations I had with RPB and other centers, we did choose to go forward with this methodology.

[Rep. Martha “Marty” Feltus (Vice Chair)]: Can I just follow-up with So that what I heard is that this puts some of our centers at great risk financially? That not providing the funding in the way that the centers as a whole suggested puts some in real fiscal financial risk. That your understanding too?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: It's not my understanding. We currently right now, as part of the RSO certification, for example, do have an independent facilitator and contractor who's helping support the recovery centers in the evolution, especially to now that they have an opportunity to become certified recovery centers. So we have been working extensively with their budgets, with their expectations, looking at the different ways that their internal controls revolve in in their organization, and how they're using different ways to utilize their indirect rates versus other things. So we are providing a lot of technical assistance and coaching in the in the community. We do, up until about two months ago, we provided weekly vendor calls for our entire vendor pool. The recovery centers were the largest participants as part of that. So they got access to our entire operational side as well as our programmatic to help them maximize how they use their funds, and evolving some of that, because some of that strategy has improved the bottom line, I believe, in how they utilize to draw down their funds. But as far as funding for organizations themselves, I do respect that they are advocating for more. They're small nonprofits. I mean, that is part of the the mix in the world in which they live in. I do think that is a difficult space, in this world, especially with inflation and other things going on there. But, again, our goal was to ensure the sort of that statewide component because the and we had those conversations with RPB about that that was the methodology that we're going to use for FY twenty six. And they understood where the conversation I had, there was understanding there, though it may not have been exactly what they were looking for. Wayne Linn and Mike.

[Rep. Wayne Laroche]: So when I look at the table, I've asked you if you're basing this on the number of people using each of the recovery centers. But here, if you look at this chart, you're taking the county population you're looking at the percentage of that population that's on Medicaid and calculating the number of people and then you're using that to figure out how many people. 1.34. I don't see the connection between the number of people on Medicaid and the number of people that need to use a recovery center. So why don't you simply count up the number of people to go to each recovery center and so that you get a mean, maybe a Rutland's got 10 times more people going to a recovery center than one someplace else. One that's in a remote county. And you're parsing it out based on things that aren't necessarily the operating factors that are influencing the use of recovery centers. Could you explain why?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Part of the reason we use the Medicaid population and sometimes I agree we could look at utilization of the current centers, but that does not speak to sort of needing and not receiving services. So for example, when we're looking at treatment, we're looking at recovery services, there are individuals that we want to engage in the recovery centers that are not actively. So the percent of the population that is needing services and not receiving, whether that be because of access or because there may not be a level of readiness yet or something like that, that's why we use a bigger scale than just the number of current utilization within a given center. Because I actually think current utilization wouldn't give them the credit they deserve for the amount of services they could potentially provide.

[Rep. Wayne Laroche]: I still don't understand it. Is there a one to one relationship with the proportion of people that use recovery centers and the proportion of all people that are on Medicaid?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Medicaid is a proxy that we use oftentimes for our allocation methods. It's commonly used in treatment as well, as far as just as a percentage distribution. I would have to take that back specifically to some of our data people as to why that is. But that is a common approach for us when we're seeking to differentiate.

[Rep. Wayne Laroche]: Do you actually keep track

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: of how many visits you have to? Yes. They're required as part of grant reporting and as part of something called GPRA. It's a terrible acronym. It starts with government, and it's nothing about what it actually is. But it actually does, for recovery coaching specifically, it does very one on one transaction based data collection. But we do receive regular reporting from the recovery centers about the number of people they serve in different programs.

[Rep. Wayne Laroche]: I think it'd be really interesting to see those numbers.

[Rep. Robin Scheu (Chair)]: Lynn, and then Mike.

[Rep. Eileen “Lynn” Dickinson]: Yeah, thank you. I'd be interested in the Franklin County stuff, that's okay. Do you have data on the results of what happens with recovery centers to how many people become sober, how many people relapse? The basic, like what happens at the end when they're done? Are they ever done? And I'll give you an example. There was a movie made about St. Albans, and it's opiate addiction, among other things. It was a really well done movie, and I recognize a lot of people in that movie. Some of them recovered, but many of them didn't. They did, and then they relapsed. So what do

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: you have for statistics on any or all of these centers? It's hard to do something like that. So the recovery is a journey. It's a lifetime approach. It's chronic disease. So the maintenance of that requires a lifelong commitment. And once you get there, recovery services is a journey within the road. What I would say is recovery in many respects is born out of the AA model. So the second A and up as anonymous. So the historical tracking of individuals, oftentimes we get data that is in aggregate. So it's not necessarily person centered, but if it's person specific, it's de identified. So we can see a transaction, but it's not I can't tell you that it's Emily Trudger on a given day that particularly did that. We're able to track individuals in the Medicaid system sort of that way, but we aren't able in a recovery based space. As far as an evidence based practice or approach, recovery coaching, other things like that have been proven over time to be effective tools as part of the recovery journey. But I can't tell you specifically in St. Almonds that this many people went through this and they But shouldn't you? Wouldn't it be helpful to have that data for all

[Rep. Eileen “Lynn” Dickinson]: of them? Yes, agreed. Ten percent of them have relapsed. They've done several attempts, and some people did

[Rep. Martha “Marty” Feltus (Vice Chair)]: it once. Some people only did

[Rep. Eileen “Lynn” Dickinson]: it twice. I mean, it's common that this doesn't happen the first time out.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Absolutely. I think that's easier to do with treatment level data. I don't have a natural crosswalk from recovery services data to treatment. Oftentimes, of the, like the NISDAs or some of the national surveys and stuff can look at trends over time. I can take a look at some of the data we have and what maybe makes sense and provide back to you as part of that. But the relapse is certainly a common part of the practice. Again, if you're relapse and reengagement, you're still trying, that's a win as part of that. So I can take a look with our data and evaluation team as part of that. I would say one thing I would say, the one thing that there's never enough of as far as appropriations is evaluation. And evaluation, there's database evaluation, and there's qualitative, which is sort of the interview process and really following people over time. So there's certain areas where we can do some sort of high level data points, but there's other spaces where you're going to hear more anecdotal and you're going hear stories of people's lives and how they were impacted by recovery services. Thank you.

[Rep. Robin Scheu (Chair)]: If I grow it,

[Rep. David Yacovone]: then my clergy.

[Rep. Michael Nigro]: I don't want this question to sound like I'm questioning motivations, because I'm certain that VDH wants to support recovery centers in the best way. But the reason I'm gonna ask this question is because I think the this committee is thinking about, you know, how we're writing appropriations to make sure that our intent is followed as as we expect. So when you were referring to following legislative intent as written, I I guess I just it it would is the view of legislative intent simply what's written? Is there ever a time where, you know it it felt like there was an expectation that we understood, the methodology being created by by recovery partners was what was being supported. So I guess I'm just trying to is is the view of legislative intent only what's written, or is there a time where you're considering, but we understand this is it is what the committee is trying to support?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Yeah. I kind of think about again, that research and those pieces are done by different parts of our department. They're not conducted by me. I sit within the programmatic ranks of a division, so I would have to defer some of that back to the department. As part of that, I know that for me personally, in my experience, the recovery center approach has always been a full set approach as part of a mix. So the you know, without that specificity saying that there was something something that we were not gonna include in the mix, you know, the our goal is the statewide in providing that to all Vermonters, whatever those additional resources are. So that's where I was coming from as a division director. For your particular question, I'd have to take that back to the department. I I would I don't wanna make an assumption as part of that, but I would assume that we would consider that. But the but as as far as what's legal and what comes through and what we put out there, I would have to defer to our financial leadership.

[Rep. Michael Nigro]: And and again, I I think as a committee, we just view that as an important question. You know, I guess we don't wanna make assumptions. We're funding a certain methodology. Maybe we're not. Exactly.

[Rep. Robin Scheu (Chair)]: Every time we think we make the language clear enough, it just turns out there's yet another way to interpret it. Mike Muricki.

[Rep. Michael Mrowicki]: Thank you. Thank Thank you for your work. You for coming. I just wanted to share something that's been helpful to me, my thinking has evolved on this, people I know who have been in recovery, and I used to think of people getting in trouble, like perhaps they had a broken arm or a broken leg, and then they put a cast on it in six weeks, they're all better. And friend who's also diabetic shared that it's not the way it works. He said, Nobody questions my need for insulin for the rest of my life. And my recovery is similar. Person's using a medically MAT program, not exactly being clean and sober the way other people think of it, but they've been able to be a functional person staying out of jail. And I think that's one of the things where they cross the line when behaviors to support their addiction become illegal. I appreciate the ongoing work that the recovery centers do. I know they have a big task ahead of them. And the last thing I will say is that, you know, the reality from people who work with alcohol and drug abuse is the reminder that alcohol is still the most prevalent and destructive drug out there. And we're not talking about that as much as we should, primarily because it's legal, for the most part socially acceptable. But I think that's another reality at some point we may need to look at instead. Alcohol is still the most destructive and dangerous drug that's out there.

[Rep. Eileen “Lynn” Dickinson]: Yeah, tell me about the IAT programs. My experience is limited, but I know Turning Point does not do MAT. We have a center in St. Olaf's that does do MAT. Of course, lot of the hospitals in various places have directed people or worked with people. Is that a referral for you, or how does that work? Again, to keep the data, you would refer twenty percent of your population to an MAT environment where they could get that treatment?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: We, a division, directly fund the hubs of the hub and spoke system. So you have opioid treatment hubs. So for example, the Chittenden Clinic in Chittenden County through Howard Center, you will have Westridge and Rutland, but then you'll have BART, which is a national company who has several locations throughout the state, just recently opened one in Bennington, and HabitAlco, which has a couple of facilities throughout the state. So we directly fund that. The Spoke system, which is an outpatient primary care sort of based space and a prescription based space, they aren't providing the medications on-site. Those are spokes. Those are facilitated by the Blueprint for Health as part of the Agency of Human Services. There are the state of Vermont, to its credit as a whole, has done a lot of work in regards to access to MAT or medications for addiction treatment or MOUD medications for opioid use disorder or MAUD medication for alcohol use disorder. So whether it be your emergency departments working with MS and other initiatives, Vermont is very strong in respects and regards to access. So there is multiple data sources that you can take a look at to talk about that specifically. So if you had any specific requests, I could take that back to our data team and provide that as a follow-up. But there's a lot of data out there in that particular space.

[Rep. Eileen “Lynn” Dickinson]: I guess the question is, what kind of data do you have for the recovery centers that shows that they're transferred or referred to their lives? I

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: have to go back and take a look. I mean, they're one of our strongest advocates in our communities. I am a huge fan and champion of our recovery centers. They also, in a world of workforce issues, they are filling spaces that we greatly appreciate as part of that. Sort of back to the alcohol space, alcohol is a bigger issue than all the other substances combined. In the state of Vermont, with retail cannabis coming into play, if you look at perception of risk, I would highly encourage, especially among youth, that you continue to watch the cannabis space. But we can look at I will go back and take a look at our data set in regards to what we have for recovery centers, but they are everywhere in many respects all the time. And it's different in each community. Each community has its own culture, its own space, And they have found their ways into those lanes. So I'd say, let me take a look at that, and I can bring some information back for you. But I think that the bigger space is the recovery center data. It's a little bit more of an aggregate space than it is in person, which really ties in the land of Medicaid. We're talking about a one time funding that we put in last year's budget of $600,000 apparently. 800,000 Yes, I

[Rep. Eileen “Lynn” Dickinson]: was trying to figure out that.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Have we always done extra one time funding for this group of organizations or is this just something that came up last?

[Rep. Martha “Marty” Feltus (Vice Chair)]: It's an it's a it's been a little

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: different every year. I have to miss the one budget I I watch the most. It's the one that's sort of had the most growth over time. I was actually looking at their grants before I came in this morning, and there were grants in f y eleven for $50,000, and that was for the entire center. And if you look at their growth over time, they've they've been wonderful advocates, and they've you know, the growth has has you know, obviously, see that type of growth in that period of time is is pretty significant, though I can't imagine operating anything on $50,000. Even looking back at it, was surprised by it. So there have been several one time appropriations. There's been several base appropriations along the way. Fiscal year sort of has been a little different. So was there a base appropriation in last year's? Yes, we have a base appropriation as well. Yes. We have a base appropriation, last year there was a need to ask for this additional eight that was included in the budget. Okay. So, and you used the allocation and the allocation that you used, is that the same formula that you had used in previous years when there was an extra allocation? We used it in FY15 was the last time we used one specifically in this and where there was an appropriation and looking at catchment area indeed. So FY15 was the last time we specifically did it this way. But with the base of our using our needs assessment and our strategic plan, that's why we chose to use a service area size sort of modifier with a portion of the funds for just redistribution of the population. But more recently, since 2015, has there been an additional one time funding and you used a different allocation? The appropriation usually has been pretty specific for a while where it says literally said divide by the number of and divide equally by the number of recovery centers. So for example, last year essentially was the divide by 12 and that was the direction from the legislation.

[Rep. Wayne Laroche]: Marty's questions were touching on where I was going. The allocation to the base, are you using the same kind of method?

[Rep. Michael Mrowicki]: The base

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: is based on what the legislature has done previously. So whatever you did in a given year, it sort of built over time. Again, the appropriation was very small when it started, it's grown. So whatever was decided each year, we didn't change the base as it goes. We give outcomes new each year. Does that make sense?

[Rep. Wayne Laroche]: Did legislature state that each one of these recovery centers gets exactly the same amount of money?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: They did last year. Not this year. Not for that $800,000 It's in the big bill?

[Rep. Eileen “Lynn” Dickinson]: Yes. And

[Rep. Wayne Laroche]: you, as a health department, do you try to assess? You see where I'm coming from. I'm coming from are the right amount, is the right amount of allocation going to places where it needs it the most? Are you looking at the range of use across the centers? Do some require more and less? And does this, everybody gets the same kind of thing. Give a surplus to some that don't need it and shortchange others that do.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: I guess I would say it's not in any space in any of our programming. We you know, because the different type of expenditures that we pay for, we pay for salary and FTE is the primary thing that we pay for. But you still pay for rent, you still pay for utilities, still pay for food depending on the service. And we all know in Vermont that there are different things cost different in different counties and other spaces. So do I think that there's any automatic budget? And for even staffing planning, so for example, in the Chittenden and Turning Point, how many recovery coaches do they need to serve a population versus how many coaches are needed in another space to serve the population is different. So I personally struggle with a divide by 12 necessarily approach as part of that. Do so I think everybody has a foundational base. Like, does everybody need a business manager? Does everybody need an executive director and things like that? Yes. So you have your core foundation that any center would need to operate. But after that, it's about the services and the number of people that need to suit.

[Rep. Martha “Marty” Feltus (Vice Chair)]: Yeah, well this is my budget area, of course. And I guess there are a couple of things that I, based on our conversation here that I want to say. And I may have access to information that not everybody here has seen. There are one, two, three, four, five, six different recovery centers that are asking for this funding. They're Springfield, Chittenden County, Addison County, Bennington, Windham County. Journey to Recovery is located where? Newport. In Newport. What I understand is that in order to preserve current services in those areas, this additional money is needed. Second, that there were recovery centers who asked for less money. They did not need that, In part because these centers are also funded in part through DOC funding. That leads me to my third point, is the state has invested in these recovery centers as a key part of its strategy to provide continual support for folks exiting prison or exiting something like Valley Vista so that they don't fall through the cracks. And so I think you can talk with Representative McGuire from Human Services, because this is definitely his area. He feels very strongly about the effectiveness of the organizations. I don't have at my fingertips data, but I can certainly provide some. I've shared with you some of my thoughts. I do wonder whether it occurred to the department to reach out to Human Services Committee or the Senate Committee to say, what was the legislative intent? If you had heard this from the RPBs, is there because those kinds of my impression is that those kinds of conversations don't help often. So assumptions are made about legislative intent. Well, there is representative Gublai. I just mentioned didn't know about you.

[Rep. Robin Scheu (Chair)]: But anyway,

[Rep. Eileen “Lynn” Dickinson]: I really

[Rep. Martha “Marty” Feltus (Vice Chair)]: I would love so much for this branch and the executive branch to work closely together discern things like legislative intent or problem solve, and to have those conversations before the decision is made. I don't know how we're going to effectively address the kinds of problems that we face right now, we're all working together. And we may have differences of opinion, but I, at any rate, that is my fondest hope that I shared with you today. And now I will rest.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: And I appreciate that, thank you. I appreciate that, nurse, thank you.

[Rep. David Yacovone]: Yeah, I just have a, it may sound like a pot of questions, I don't need to just so you follow through with this here, but I kind of heard committee here that there may be one of the centers or a few that received more runoff actually would need perhaps not to hold money back, and that's not what I'm suggesting here, but it happens. I don't know what the magnitude of that is. You may not even know a number you could say, and that's okay. But it's just something to kind of think about. I know you've been trying to be fair with all the 12 centers here. This is a baseline, you want to kind of provide 800,000 plus whatever's left and to figure out some way to best provide more funding for centers that are much larger areas in the state. Here it is here today, and maybe it's food for thought for like the next time around here, but just, it's one of those things that kind of be thinking about here, because I'm sure they've all had some level of requests. Here's what we would need, you know, out of this amount here, perhaps, for and some, perhaps under what they requested for others, perhaps more. Were there other calculation, all kinds of things you were considering other than 50,000 across the board plus extra here than this one here. And I'm not trying to put you on the spot.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: No. Mean, we looked at us

[Rep. David Yacovone]: I understand the intent of what you're trying to do here. For sure. I want to acknowledge that.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Thank you. I appreciate that. I would say is we did get a slightly smaller base at one point in time, but the goal like, if you look at the value of an FTE, so to speak, know, if you lose 20,000 as a base, nobody gets an f you know, a full time equivalent position. So trying to trying to balance what the space looks like out there so that it's at least like an FTE appropriation as part of that. And then from there, you know, the balance. And appropriate, you know, across the base of the population size and potential to be served.

[Rep. Wayne Laroche]: It's a little bit of

[Rep. David Yacovone]: a follow-up. If everything's like 50,000, someone gets an extra looking at the chart here, an extra eight or 10 or whatever, but it's okay. Yeah. For 17, know, more than four will that find. Could nine. And I don't know the answer to that.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: It could straight up be hours of services. Maybe working part time, they could be buying resources in different tools and activities, supplies for some of the activities they do. It'd be very different by center and sort of what their catalog of services. They're all very creative in what they do. They're a core foundation, but they also have things that really dovetail to their communities as part of that. So we would, in many respects, defer to the centers. Centers do provide us with their annual budgets as part of their work. I think it's also, just to clarify, so that we receive a base appropriation. Sometimes we receive a one time. Some of them are receiving funding from DOC, for example, as other appropriations. Just important to note, we have about $2,200,000 in federal funds from the state response grant that is also distributed to the centers for recovery coaching and emergency departments and a parenting program for recovery support. Just note that there is a third appropriation in our space.

[Rep. Wayne Laroche]: So each one of those recovery centers, assume they have to have a Are they operating 20 fourseven? No, they do not.

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: The recovery coaches in the emergency department are on call as part of the mix, but the actual center itself is not 20 fourseven.

[Rep. Wayne Laroche]: The job is, do you have a minimum number of staff required by each one?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Don't have Nicole, I'm going

[Rep. Eileen “Lynn” Dickinson]: to defer to you. Nicole, are you there?

[Emily Truder, Division Director for Substance Use Programming (Vermont Department of Health)]: Still talking to ceiling, I'm sorry.

[Rep. Robin Scheu (Chair)]: I don't understand, it's up high there.

[Rep. Eileen “Lynn” Dickinson]: Did you hear the

[Nicole Rao, Recovery Services and Harm Reduction Director (Vermont Department of Health)]: question? I did. So we require through the RSO certification standards, which the centers had an opportunity to weigh in on, that they must be open a minimum of thirty hours. We really push for centers not to only have one individual working at a time for safety and just being able to meet the needs of multiples. We do not have a threshold in which we say you must have x number of staff present at any given time.

[Rep. Wayne Laroche]: Thank you.

[Rep. Robin Scheu (Chair)]: Anybody else have any more questions? One thing I am hearing is, well, you don't interpret legislative intent, somebody else does. Do we ever see those people who interpret legislative intent?

[Rep. Martha “Marty” Feltus (Vice Chair)]: I don't

[Rep. Robin Scheu (Chair)]: know. And so we want to be sure that we're as crystal clear as we can be when we're doing this, which we think we are and then we're not. So maybe we should chop it around, Anson.

[Rep. Michael Nigro]: Just to add,

[Rep. Trevor Squirrell (Clerk)]: I appreciate that you may not know who's in charge of legislative intent, but these are all recorded hearings. So our intent probably made clear at some point during the testimony, maybe we can send that memo up to people who are questioning legislative intent, especially after decisions get made, it's kind of hard to hear. As the Madam Chair said, we work really hard and being really clear in what we're doing, so if we can find a way to communicate that when it's already, you know, let's maybe remind people, but maybe footnote our bill and say what dates the hearings were held because the legislative intent I think is very clear.

[Rep. Robin Scheu (Chair)]: Well, is really helpful for us to understand how it all works. I appreciate you coming in on pretty short notice to give us this information. So thank you very much, both of you, coming, and we may see you again, or we'll see your other folks Thank in you again. Very much. Okay, thank you. Take care. So committee, we are done for the morning. If conferences are still going, I'm not sure they are, you're welcome to do that. I have a meeting type gfo we have the budget at one and