Vermont Legislature SmartTranscripts:

[Robin Scheu (Chair)]: Good morning. This is the House of Corporations Committee. It is Wednesday, January 28, not June, 2026, December 1030, and we have a whole lot of the Agency of Human Services Committee with us, which is very exciting. Welcome to all of you. And we're glad to have you here. And I think this is our overview. And then we'll be taking on the department budgets as we go along, but we're starting with the top of it, even the big picture for your agency. So welcome, introduce yourselves, take it away.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Thank you. Good morning, Chair and committee members. For the record, I'm Jenny Samuelson. I'm the Secretary for the Agency of Human Services here in Vermont. And I'm joined by our executive leadership team, which includes myself, our deputy secretary, our Medicaid and health systems director who is absent today, and our six commissioners, and our chief financial officer. And I'll let you introduce Yeah, thank you. For the record, Tracy O'Connell, Chief Financial Officer for the Agency of Human Services. And Chair, how would you prefer we take questions ongoing or go through and take questions at the end?

[Robin Scheu (Chair)]: If you have sections, so I can just see if there are questions at the end of each section and try to

[Jenney Samuelson, Secretary of the Agency of Human Services]: push that way. Perfect. Sound right? So the Agency of Human Services, as I don't need to remind this committee, includes six departments: the Department for Vermont Health Access, the Department for Mental Health, Department for Children and Families, the Department for Disabilities, Aging, and Independent Living, and the Department for Corrections. It also has the Secretary's Office. And within the Secretary's Office, we'll go into more detail. But some key programs there include the Blueprint for Health, the Office of Health Care Reform, the Vermont Chronic Care Initiative, the refugee programs, and the field services division at the agency. Our overall budget is $3,750,000,000 and it is spread out across those departments. The Agency of Human Services is one of the largest agencies in state government with a little over 4,000 positions. On this slide, you can see the positions as they are described in the agency. Also on this slide is the current vacancy level for those positions across departments. So as we look at the budget this year, again, we're looking at a budget over $3,000,000,000 We are looking at an increase of $86,100,000 or a total of 6.1%. That increase includes $74,000,000 almost $75,000,000 in direct current services or base funding to keep the current programs that we have at the agency going. It also includes $11,200,000 or 0.8% of general fund to increase the direct the base for initiatives, we think, for this year. The reason we brought our executive leadership team with us today and the names of those members are here on this slide is because this budget process this year, we did significantly different than the way that the agency has done its budget process for as long as I've been with the agency. Many people know, if you've been around, the agency has often talked about being one agency in work this year to look at and evaluate our agency structure. One of the things that consistently comes up is that it's really valuable for the components of the agency to be together. But we need to do the work to make sure that they're better aligned. And so what you will see is the budget process this year is intended to do exactly that.

[Robin Scheu (Chair)]: Did you find that helpful to do it a little differently this time?

[Jenney Samuelson, Secretary of the Agency of Human Services]: We did. In the past, and I've been with the agency for twenty years, and in leadership for many of them. The way that the budget process has worked is that we get a target from executive branch, from the administration. We then take and hand that target down to each one of the departments. The departments in their own departments looks at their budget, decides how to meet that target, and then they propose it back up to the secretary's office. And then the secretary of the secretary's office is the one who makes the decisions about the way that the budget works. If we really want to lead across the agency, then we need to empower our executive leadership team, including those commissioners, to wear two hats, not just the hat of their department, but also what it looks like across the agency. And so we try to put our money literally where our mouth is in this budget process. So the way that we did it is the first thing that we did was look at what are our priorities. We looked at the governor's priorities. Everyone's heard them for years. They've been consistent, grow the economy, make Vermont more affordable, and protect the most vulnerable. There's a major component of the Agency of Human Services in those priorities. And so we asked ourselves, what are the things that we need to focus on as an agency over the next year, three years, five years? And that executive leadership team identified four things for us to really focus on. We need to keep the rest of our programs running, but the fourth thing to prioritize for really housing, with a particular focus on addressing homelessness in partnership with the other agencies in, say, government, substance use and mental health, and that's across prevention, treatment, recovery, and stability. And in this case, what we're really talking about is, how do we really integrate these systems? Because the majority of the people who receive services in the mental health and substitute system receive them in both systems. It's how we do health care affordability, sustainability, and quality as a major priority for the agency. And then looking back, one of the most valuable resources that we have as an agency that we don't talk about enough are the workforce that we have, the people who do the work on the ground every single day. So how do we make sure that we're building a strong and resilient workforce within the agency of human services and also within the human services agencies outside of the agency? So this year, we took and looked at the we did an evaluation of the programs across the agency. We looked at what data do we have, particularly starting with the Medicaid program. So as folks will remember, the Medicaid program isn't just DIVA, but it's actually run by there are elements of it in every single department across the agency, particularly in the Department of Mental Health, Disabilities Aging, and Independent Living, DIVA, and the Department of Health. And so we evaluated those programs on multiple different areas. And we evaluated our budget to make sure that it aligned with the priority areas. So what could we do to make sure that we were investing in things that really made a difference for Vermonters? And did our investments reflect what our priorities are going forward? And I'm representing this work for the entire executive leadership team who's here. The whole team will take questions. But we took an inventory we started by taking inventory of our current services cost. How much was it going to cost to implement the programs that we currently have implemented through the Agency of Human Services? That initial look showed a pressure of over $117,000,000 just to keep the base programs that we currently had going.

[Robin Scheu (Chair)]: As is, not changing any programs.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Not changing anything. Correct. Then we compared that against the 3% target, which we anticipated that we would receive and which many folks saw in the budget instructions. That 3% target gave us an increase of $42,000,000 which left us short by about 74 almost $75,000,000 So that's where the agency started process. We asked the departments to come forward with areas for potential savings to the executive leadership team, not to the secretary, but to the full team. And we did that by focusing on identifying things like revenue offsets, looking at administrative and program efficiencies. And this was a key area that I don't think the agency has done for many years, which is to look at whether the programs are achieving the outcomes. Are they equitably distributed across the state? We have many pilot programs that either started as a pilot or started in one area and have shrunk down so that they're not accessible to all Vermonters. We looked at how many Vermonters they served and which of those programs were required by the federal government in the programs that we administer. We looked for program reductions based on some of those efficiencies and effectiveness. I also want to say that we looked at how we administer our programs and where we could get cost savings within the agency. So we weren't just looking for program efficiencies. We were looking for administrative efficiencies where technology or where programs had changed and where we could gain those efficiencies inside of state government. And so based on those program decisions, we made sure that we aligned, again, from the previous slide, what was the most effective programs that we had and what were our priorities in order to achieve the overall goal. Anything that? Okay, that's great. Okay, delve into what we were seeing for current service pressures, which the Secretary alluded to, which when we whittled it down, it was about $115,000,000 in increases for current services. Two of the biggest areas being revenue loss, a backfill of lost revenue from federal grants or from special funds, which I'll get into more detail. And then also in the caseload and utilization space, which is what you also just witnessed in budget adjustments. So for the backfill of lost revenue, the biggest change we see is $13,000,000 needed to backfill the FMAP change. FMAP is the federal medical assistance percentage that CMS matches Medicaid with. Right now, for this budget, is 58.07%. And that is a 0.73% reduction from the previous fiscal year. So that means that we will receive $13,000,000 less from the federal government, and we have to backfill that with general fund, just all things being equal, current services and building the budget. And then this one, I want to note that this is a usual process. The FMAP is reconsidered every year. We often get the question, is this related to anything different happening at the federal government? This one is not. Our FMAP rate is actually historically high for what it has been and continues to be high. And so this is a normal annual adjustment. Some years, it goes up a little. Some years, it goes down a little. But because of the magnitude of the Medicaid program,

[Robin Scheu (Chair)]: it has significant impacts on the overall budget. Is this the one that they tied it to household median income or something? Yes, yes. Don't remember.

[Jenney Samuelson, Secretary of the Agency of Human Services]: They haven't changed the calculation at federal level. The next area is for SNAP admin with HR1 beginning in October '6. The federal matching percentage will be reduced from 50% to 25%. Therefore, the state has to kick in 75%. And so on a three quarter year basis, that equates to $4,500,000 in lost federal revenue that we general fund to backfill. And then the next biggest area is the child care special fund revenue downgrade from the economist forecasts. That's part of the yes. I think this program is still in its infancy and they're still trying to understand what the projections will be in the area of the 0.4% payroll tax. And so we're seeing the economists forecasted an $8,700,000 decrease.

[Robin Scheu (Chair)]: Would that only have an assessment on your budget if there were enough people applying for

[Jenney Samuelson, Secretary of the Agency of Human Services]: vouchers? That would be separate. This is just the payroll tax collection. We're just not seeing the receipts that were anticipated. But it's used for And we are not adjusting the program. Correct. The caseload and utilization for the CCBAP program is remaining steady. And so we need the same amount of spending authority to maintain that program. We just are missing some special fund to help support that. So is this a reduction in the payroll tax, meaning that fewer people are participating or it's growing slower than was expected? Or it's expected to grow more slowly than was originally forecast? I think that is the question for the tax department. The tax department is collecting the 0.44%. And again, I think it's only been a year. And so I think they're looking at what they are receiving, the cadence by which they're receiving the collections, looking into compliance of who's paying. So it's still pretty early, but this is what we're anticipating for receipts.

[Robin Scheu (Chair)]: Let's go with the review of paper copies. Did you have anything else, Helen, that was that copy. Okay, we'll know more as we go along. Mike, you want the questions on this? Are we going to wait for questions? Well, let's just quickly ask this one and we'll go on.

[John Kascenska (Member)]: Just to put it in the parking lot if you want, going back to vacancies. It's a 30% vacancy rate for mental health, and an overall vacancy rate of 11.5%. How does that compare to past year?

[Jenney Samuelson, Secretary of the Agency of Human Services]: That's a great question. So the vacancy rate and Commissioner Haas will continue adding here. But the vacancy rate at the Vermont Psychiatric Hospital is the vacancy rate that is driving that 30% in the Department of Mental Health. Post the pandemic, like many other health care facilities, Vermont Psychiatric Hospital saw significant use of traveling workforce. We had a vacancy rate coming out of the pandemic close to or at 60%. So what you're seeing here is slowly, we're beginning to fill those positions, and we've gone from a 60% vacancy rate down to about a 35% vacancy rate today. And so it's important to put a pin in that because we will be actually talking about one of the budget reductions later on applying the BPCH. So again, we've seen high vacancy rates coming out of the pandemic, and that's been reduced over time.

[Robin Scheu (Chair)]: Moving

[Jenney Samuelson, Secretary of the Agency of Human Services]: on to caseload and utilization, these are few of the same items that we saw in budget adjustment. The Medicaid consensus is $14,900,000 general fund or $35,000,000 gross clawback and buy in. And then we have adjustments for the developmental services caseload, which is $4,100,000 general fund or $10,000,000 gross. And then nursing home bed days and home and community based services utilization, 4,400,000.0 general fund for 10,600,000.0 gross. I'm pause here. Any questions on these pressures?

[Robin Scheu (Chair)]: Makes sense. Removed not happy to have made sense. Yep, thank you.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Salary and fringe benefits for the agency have placed about $21,300,000 general fund. And this includes a request for just shy of $05,000,000 general fund for 12 new Hay U staff that will be needed to support the Medicaid work requirements and the biannual redeterminations that go into effect at the beginning of calendar year '27. So we'll dive into that more with the

[Robin Scheu (Chair)]: appropriate department. With DEVA, correct.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: And then for operating, we have an increase of $6,500,000 general fund, the bulk of that which are the internal service funds, which I know you're familiar with, HR, insurance, ADS, so those bill backs. And then we have a increase in Nextiva Pilgrim Park lease, which you saw also in budget adjustment. This is for the full year, and then some operating expenditures for DOC related to vehicles, utilities, uniforms, and inflationary pressures.

[Robin Scheu (Chair)]: Linda? I'd like to clarify $1.1192000 for Hobart Park. Seems like that was in the BAA.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: That is correct. But that's for

[Robin Scheu (Chair)]: a whole year or is that just

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: for the half year? In budget adjustment, it was for half a year and so this was for

[Robin Scheu (Chair)]: the full year. Is on top of what we had last year.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: This is like the increase. This would reflect the because this is a new lease. This would be this 192,000 would be to pay for 07/01/1926 through 06/30/1927. Moving on to contracts, $17,000,000 general fund pressure, and most of this is what we saw in budget adjustment. There's a few at Diva related to Gainwell, the call center, and the Medicaid data warehouse. Transportation at DMH and DCF, DMH forensic evaluations and travel nurses, the Windham Youth Crisis Stabilization Program, Well Path to adjust the average daily population increase. And a new item that wasn't in budget adjustment is $247,000 to address transitional housing with the Burlington Housing Authority, they received a reduction in some of their federal EPUD funding. And so this seeks to maintain that level of that they were receiving. They can maintain the same number

[Robin Scheu (Chair)]: of beds. Okay. So there is what's the name of the place in Burlington? It's the traditional housing, do you remember?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Ms. Shimura.

[Robin Scheu (Chair)]: The Burlington Housing Authority? No, I know the housing authority, but the traditional housing, is it a specific house or is it just in a certain apartment building? I think it's units within the facilities that you have. Okay, thank you.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: A $10,600,000 general fund is going to support multi year programs. These are programs that we started in state fiscal year 'twenty six. But because they were only built into the budget for half a year or a quarter year, we needed to annualize them. So for example, with Diva, the Medicare Savings Plan, that turned on in January. And so only six months was built into the budget. And so this annualizes that amount.

[Robin Scheu (Chair)]: So we approved it was the benefits cliff kind of thing when people were turning six to five. That's correct. This is the first year it's actually happened?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Yes, it went live this month.

[Robin Scheu (Chair)]: So it

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: went live this fiscal year, and then this is annual izing it for the quarter. Correct. Okay. Cool. And DMH, Alternative to Emergency Departments, this is backfilling the Home and Community Based Services FMAP spending plan that is just about fully exhausted. And so this is annualizing a couple of the programs that were very successful under that effort in DMH. Commissioner Haas will speak to that later today. And then for shelter investments, dollars 7,500,000.0, 1,300,000.0 of that is for cold weather shelters and 6,200,000.0 is for hot shelter expansion. And these were previously funded by one time dollars that we are seeking to build into the base.

[Robin Scheu (Chair)]: So how much was it in FY twenty six? And maybe that's the question you're getting. Well, in the base. We had a 2,000,000 here and a 4,000,000 there for shelters, and I just don't remember what's the

[Jenney Samuelson, Secretary of the Agency of Human Services]: I think that we can definitely, if Sandy has it We'll

[David Yacovone (Member)]: have DCF talk.

[Jenney Samuelson, Secretary of the Agency of Human Services]: DCF. I think you'll see this year as you come in is a shift and a change in moving some of the things that were one time that we know are going to be important for ongoing operations. And this is one of those areas where you see that, where those shelter investments really make it from one time to the base budget, but continue the overall investment in housing.

[John Kascenska (Member)]: Shelter investments, well, does that involve purchasing property, improving property?

[Jenney Samuelson, Secretary of the Agency of Human Services]: It involves actual again, it's the cold weather shelters. Year, if the deputy secretary can answer this question as well, but this year, we've put in place statewide extreme cold weather shelters. That is a portion of it. It's $1,300,000 The second, and we will go ahead and put that into space. The second piece of

[Robin Scheu (Chair)]: this are shelters that actually are new shelters that came on. I don't believe these families. We'll get into the details about that when they try to keep this sort of the overview. I'm taking notes on what I want to talk to you about when they come up. Now you have fair warning of some of the questions I'm going to be asking.

[Jenney Samuelson, Secretary of the Agency of Human Services]: So we have a few areas to address provider rates. With the exception of the Northeastern Family Institute, the rest of them are either federally required or state ruled required to address inflation. With Northeastern Family Institute, this is a provider that's kind of been an outlier in years past. They haven't received those across those 8%, 5%, 3%, 2% rate increases that some of the other home and community based providers have received. And we're seeing a need for this provider to address stability to build into rates. Okay, so the in this case this is an

[John Kascenska (Member)]: Water over there.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Thank you. What you see here is the I'll just catch up to where we are. What you see here is an increase in the general fund for credit purposes. What we have is an increase in general fund revenue of 30%. We see savings in our program in caseload utilization of 13%, a small slight rate increase, programmatic efficiencies that we were able to gain from our departments, and administrative efficiencies, and then program and service reductions. So this is where we were able to address that gap that you saw between where we started and where we ended up

[Robin Scheu (Chair)]: in our budget. But just so I understand this correctly, the program and service elimination, so that's really you've saved 24%. You cut it 24. Don't something to do, right? Yes, exactly.

[Jenney Samuelson, Secretary of the Agency of Human Services]: So in this case, what we saw, I'll go back through it more slowly. Okay.

[Robin Scheu (Chair)]: And then, but you also have increased revenue?

[Jenney Samuelson, Secretary of the Agency of Human Services]: We do have increased revenue. So why don't we go through all the time. It

[Robin Scheu (Chair)]: stands out when you see increased revenues.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Let me go through where those are. Okay. So we're going to start with the revenue. What we saw is that in the Secretary's Office and the Global Commitment Budget for new adults, that new adult group has a higher SGMAP rate at 90%. And so with an increase in utilization by new adults, we saw an increase of $3,000,000 in our budget for our Medicaid program.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: The Secretary's office also receives a 70% match on our FMAP for our CCBHCs, or funding going to our designated agencies who have moved into the CCBHC model. That increased match rate gives us a savings of $6,600,000 in our Medicaid program. In our substance use treatment, we have federal grants in our block grants of $1,500,000 of increased revenue to help offset some of the costs in our substance use treatment programs. For the Department for Mental Health, we have an opportunity to increase billing to Medicaid for the services that are offered there. And based on our ability to draw down federal match for those Medicaid services, there's an increase in an anticipated increase in revenue of about a half $1,000,000. And then folks will remember that in HR1, that there was a requirement to have cost sharing, particularly in prescription drugs. In this increasing the co pays based on the requirements in HR1. The question we often get is, what does that actually mean in a dollar amount? It depends on the medication and the prescription, but it's a $1.02 or $3 copay. Diva can go into more detail about those co pays. Sarah, I think that that covers the revenue. Any questions there?

[Robin Scheu (Chair)]: So we're saving money, and somehow that becomes revenue?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Actually, in this case, are drawing down more federal funds in these cases, minus the last one, where the revenue actually comes from prescription. Right, so savings. Okay,

[Robin Scheu (Chair)]: great. It's nice to know these days we can draw down what that holds up.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Good? Yeah, I'm good. My apologies. Have a few areas Her case was out yesterday, we appreciate that she is inside. I just got a little tickle.

[Robin Scheu (Chair)]: Probably dragged up from what cost drops. That's good. It's That's awful.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Little tickle. Caseload and utilization, dollars 5,100,000.0 general fund savings. There's an area of underutilization for the level one beds at Rutland Regional that DMH pays for, about $718,000 general fund, and then some savings in DCF reach up and substitute care for those caseloads, and then also adult day health and rehab services, 419,000 general fund. So we can ask Dale about why that's decreasing with Dale? Yes, you can. In most of these cases, these are a true up to actuals. And so when we think about the adult day and rehab as an example, what we have seen is a lower utilization, even with Dale working directly with those adult day centers to take specific actions to try to make sure the services are provided. We just post pandemic have seen a reduction in the number of people who are actually seeking those services. For our administrative efficiencies, we've identified $7,300,000 general fund. Each department looked at their prior year spending in terms of operating, so travel, equipment, supplies, fleet, and contracts. And so we right sized budgets there to the tune about $811,000 general fund. And then DMH and DOC adjusted their vacancy savings more in line with what you saw in the first full slides to adjust those vacancy rates, 6,100,000.0. And then Dale did a technical adjustment in other personal services for that budget line item. Back to vacancy

[Robin Scheu (Chair)]: savings for a moment, just philosophically, are you intending to keep those spots open, or

[Jenney Samuelson, Secretary of the Agency of Human Services]: are you trying to fill them and just thinking that the timing is going to create the savings? We continue to try to fill the positions across the agency. But at this point, I think we are recognizing that, particularly for corrections, we've hit kind of a steady state, even though we continue to take significant efforts to increase recruitment and retention. We would, if for some reason that we do adjust back up and increase the number of employees that we have, we would adjust the vacancy savings appropriately. What you will see in a subsequent slide is that at the psychiatric hospital, based on caseload and utilization that we have across the state, the whole mental health system, And based on what's feasible and economically appropriate, we are looking to move from 25 beds to 21 beds. And in that case, we would not be permanently seeking to those. And John, you might have brought it

[John Kascenska (Member)]: to me just quick. And if it's coming along later, can wait here. But the drawdown of more federal funds, is that across what we just talked about here in terms of caseload utilization there or is it in other areas?

[Jenney Samuelson, Secretary of the Agency of Human Services]: The increase in federal funds that we've seen are in these areas where we're able to draw down more federal in these specific areas. Yeah. So in the childless new adult space, yes, that's an increase. The utilization is more than we had budgeted in the previous year. So yeah.

[John Kascenska (Member)]: Okay, thank you.

[Jenney Samuelson, Secretary of the Agency of Human Services]: So you see both increased decreased revenues in some areas and increased revenues in other areas.

[Robin Scheu (Chair)]: Yeah. Thank you.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Program efficiency is so $6,000,000 One area to highlight, I'm not sure if you've made aware, but we are seeking to move the school based services program that is administered at AOE to address Medicaid compliance and to just build some efficiencies. Currently, again, it's an AOE and BDH has a portion for school Medicaid administrative claiming. And so by putting it in Diva, we think we can achieve about $450,000 general fund savings there. Diva is going to implement utilization management for durable medical equipment. That should save about a $922,000 general fund. And then we also have the applied behavioral analysis coding compliance savings that we brought to you in budget adjustment that goes into effect this month. And then as the secretary just alluded to, we're suggesting that the VPCH beds be reduced to 21 beds from 25 beds based on historic utilization of that unit being closed. There's also $1,900,000 worth of general fund at Dale for the ARRIS payroll benefit percentage withholding. This is excess cash on hand at ARRIS, so there's no impact to consumers or providers by ARRIS.

[Robin Scheu (Chair)]: ARRIS is They're the payroll. Primarily payroll, but it's the benefit clause that was part of there. It's under due line so we can build that for their immune body. So, there benefits of the employees are now not going to

[Emily Hawes, Commissioner of the Department of Mental Health]: be No, no, no, no. Yeah, yeah, this is just No no E2B.

[Jenney Samuelson, Secretary of the Agency of Human Services]: This is funding that had accumulated at ERIS, which administers the payroll for many of our home and community based service providers. And over time, they have built up a cash balance. And so what we're saying is, rather than sitting on that cash balance, we're going to back and draw use it as savings for this year's budget as a one time. So it doesn't impact clients, and it doesn't impact individuals who are getting paid. Thank you. So the agency has identified about $9,900,000 worth of program and service reductions or eliminations. This is just a small subset of the list. We have about 38 programs that we're either proposing to reduce or eliminate. In the materials, the supplemental materials, have a whole one pager that kind of summarizes more of these in detail. And so you can refer to that after our testimony. But here's just a snippet of things that we thought we should highlight. For the secretary's office, there's a half million dollar reduction for the refugee transitional housing program. A couple years ago, $900,000 general fund was built into the base to address refugee transitional housing. However, due to the change at the federal level, we are receiving about 75% less refugees in Vermont. So where we used to receive between four hundred and six hundred a year, it's now covering at 100. So there's not as much of a need for transitional housing. There is still a need for wraparound services, legal services, case management services, employment services. So we are seeking to keep up 400,000 in the base to address that, which is complemented by the federal funds that we do receive for some of those programs. But unfortunately we're seeing a reduction here due to less refugees. DIVA is proposing to eliminate the Vermont Legal Aid Medicare Assistance Contract. This is actually codified in statute that if the contract is not producing revenue savings to the equal amount of the value of the contract, that it could be proposed for elimination. And so that is what PIVA is seeking to do here.

[John Kascenska (Member)]: I'm sure you'll hear from

[Robin Scheu (Chair)]: the delay about that as well.

[Jenney Samuelson, Secretary of the Agency of Human Services]: There's $2,100,000 savings for the ACO, the accountable care organization per member per month payment. As most folks know that program ended last month, the Accountable Care Organization and so that funding is no longer needed to support that program. Has a couple reductions in the area health education centers and the education loan repayment program that I know that Doctor. Hildebrandt will speak to in his testimony, but just to highlight that we see the RHDP grant award as an opportunity to redesign that program and leverage that federal fund.

[Robin Scheu (Chair)]: For the education loan repayment. So you're talking about the Rural Health Transformation, the $195,000,000

[Jenney Samuelson, Secretary of the Agency of Human Services]: a year ago.

[Emily Hawes, Commissioner of the Department of Mental Health]: Yes, the

[Jenney Samuelson, Secretary of the Agency of Human Services]: Rural Health Transformation Program, I just want to clarify, we're looking at reinforcing the workforce options. So things like paying for tuition while people are currently enrolled. There were some prohibitions. We could not pay for actual loan repayment using those funds, but there are significant funds invested in the rural health transformation that actually support what we've seen as evidence based programs to increase workforce in Vermont.

[Robin Scheu (Chair)]: But the loan repayment program is going to go away?

[Jenney Samuelson, Secretary of the Agency of Human Services]: There continues to be loan repayment in other programs through VSAC, but yes, the one through the Area Health Education Centers for its funding.

[Robin Scheu (Chair)]: Oh, this is the AAM?

[Jenney Samuelson, Secretary of the Agency of Human Services]: So again, have multiple places where we're doing loan repayment right now. The majority of it is out of VSAC. This consolidates that. Okay.

[Emily Hawes, Commissioner of the Department of Mental Health]: Yeah, Dave.

[David Yacovone (Member)]: You said it consolidates it. Are there actual savings or are they being transferred? It reduces them. So it is a reduction. If some, well, I'll ask that the department will just be curious what the total number is and what percent this might be, a reduction to that. Thank you.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Yes, thank you. I would recommend as you go through that with the Department of Health, that you also look at what the overall package is for our workforce, particularly the workforce training programs. A significant portion of the Rural Health Transformation funds are invested in that, including a program where we would have a rural health residency program for physicians in our federally qualified health centers. So there's a pretty robust package of workforce development programs, again, those that are promising in the In DMH, there's a proposal to eliminate the Chittenden County Community Outreach Program, 160,000 general fund and outpatient services for traumatic brain injury, elder care and reach out services and the care coordination that was actually only available at one family practice. And again, Commissioner Haas will be in later today to speak about these programs. DCF is proposing to reduce the amount of hours for the 02:11 call center since some of those calls cannot place individuals for housing after 11:00 since the hotels will not accept placements. And so we're seeking to build efficiencies there by reducing the hours of operations for that call center. The strengthening families program and reduction of just shy of half $1,000,000 general fund and some eliminations for reach up agreements in one position in the Reach First program. The one thing that I think is important to note, with all of it, it was very difficult decisions about what programs. The agency did something that we have not done in a long time. And we looked at the effectiveness and efficiency of each one of the programs, statewide reach, whether they're federally or non federally required. As we go through the programs, I think it's important to ask, what were some of the reasons behind eliminating some of the programs? Cannot, the Agency of Human Services, some of these were programs where there was duplication of efforts, for example, in some of the crisis services in mental health, where we brought on new programs that are more effective, like nine eighty eight, Mobile Crisis, and the Alternatives Emergency departments, it's incumbent on us as an agency to actually then go back and look through our portfolios and make sure that what we do is effective and efficient. And so I know for many people, these programs are programs that they design, they developed, they built. Some of them are programs I've designed, developed, and built, including the ones in A Tech. But I think it's important for us to ask ourselves, is this the best use of our the question that, as an agency team, with the executive leadership team, we ask ourselves, is this the best and most efficient use of the funds that we have available? Because we don't have unlimited funding.

[Robin Scheu (Chair)]: That's right. That's right. And this is what we ask you to do. So if your team was with absolutely no changes, that would not be a big thing either. So it's great that you're doing this exercise and I know it's not always easy to make these decisions, we need to do some things differently sometimes.

[Jenney Samuelson, Secretary of the Agency of Human Services]: And the programs have clear criteria, and they can share that with you, particularly for the Medicaid programs to make these decisions.

[Unidentified Committee Member]: Stop me if this is something that we'll talk about later, but on the two-one-one hour reduction, so what happens if I call at midnight? You said that if I'm not calling for housing.

[Jenney Samuelson, Secretary of the Agency of Human Services]: The calls that we're receiving in the night are typically around the housing program. And right now, if you call to get placed for an emergency voucher, which is why DCF is the one who is funding it versus another part of the agency, if you call in the middle of the night at midnight and you ask to get into a hotel room, they'll tell you to call back in the morning. And so for those folks who are asked to call who are calling in the middle of the night, there's really no opportunity to serve them. So this was a difficult decision. It was based on call volume. DCF can go into it in a lot more detail. But what we found is that there were very infrequent calls that were anything other than our housing program.

[Unidentified Committee Member]: So if I needed housing and the hotels or what, again, calling back in the morning. I'm just curious. I mean, we've been back and forth over the last fifteen years about how two

[Robin Scheu (Chair)]: zero is funding.

[Unidentified Committee Member]: So Noah will ask more questions later.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Think it's a really valuable question, and that's why they took it to get their call volumes and what types of calls they were getting. And again, if someone calls at midnight, hotels won't intake someone at midnight, and so they're just telling them to call back in the morning and to call ESD on their services.

[Unidentified Committee Member]: Thank you. That's enough for me to have.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Again, think everyone, I have copies. It should look like the committee has handed them out. This is the full list so that you have it in one consolidated plate. If you're the skinny, I'm also welcome to hand out the little bit bigger copies. But this is a consolidated list that reflects their work with the agency, did list the 39 programs and where they are, and it lines up with the presentation here today, revenue pressures, salary pressures. Thank you. So we know that one of the things that we also said, and it's hard to have that conversation about the efficiency and effectiveness of programs and making decisions to cut them at the same time that we look at aligning resources and gaps in our system. But the agency did look at where it made sense to align our resources with our priorities. And you saw investments of that overall. Well, you see investments in emergency housing, a $10,100,000 general fund investment in family specific housing units, domestic violence specific units, those who are medically vulnerable. These are all sheltering options so that we make sure that we enhance the shelters for our most vulnerable Vermonters. We also know that we need more recovery housing and recovery shelters, places that individuals who are currently in recovery have access to, to continue to maintain and support their recovery. There's case management enhancements, rental assistance, and overall staffing support. These are built in primarily to the DCF budget, but we knew that housing continues to be one of the things that we need to address as an agency. That's Bates' budget. There's also a one time of $21,100,000 for the regular general assistance housing program, the weather dependent program, and additional staffing. Dale, over the last few years, has implemented a program in collaboration with the Department for Health. This program specifically was funded by the Opioid Settlement Fund. It has proven to be very effective. What it does is for individuals who are currently experiencing substance use disorder, it provides job training and supports to help them move forward in their recovery. Again, this has been very successful. It is not, as far as we know, the letter being funded by OSAC this year, and so we want to maintain it. It does present both the benefit and risks of the OSAC funding. In this case, this is a program that was an initial pilot. And how we move pilots to programs both statewide and out of one time funding sources so that they can get the stability is question that we really should be asking around what we fund with our OSEP funding. In addition to that, pre child supervision is moving to statewide at a cost of $200,000

[Robin Scheu (Chair)]: That's been very successful. So

[Jenney Samuelson, Secretary of the Agency of Human Services]: the central office at the Secretary's office, and we'll walk through in more detail the ups and downs in this budget, But the secretary's office, as many of you are already aware, includes the general secretary's office and our staff. It includes health care reform, which has been responsible for planning, implementing, and coordinating health care reform initiative. For example, they are the ones who applied for and received the Rural Health Transformation funding. They're the ones who applied for AHEAD. They're the ones working with primary care and working with the hospitals to reevaluate what those systems look like and what investments are needed. Field services is charged with optimizing the functions of the agency on the ground in each one of the districts across the state. Our refugee programs support refugee resettlement in the state and provide funding and support for those programs. We have Serve Vermont, and then we have two committees in conjunction sync. So the entire central office budget or the secretary's office is 30,100,000.0 budget, 30,100,000.0, all funds. And you can see the fund breakdown below. And we have 78 positions, three of which are big in. Prior year accomplishments that central office team partook in, and so we just wanted to highlight some of those. So field cert just these give some examples of some of the units. Field services and the Vermont Chronic Care Initiative work very closely together. They're in the same unit. In the last year, they were instrumental in getting the family shelters up in both Waterbury and Burlington, and particularly in getting and coordinating the services in those family shelters. They also were instrumental in Burlington, at and coordinating the services in the Burlington Accountability Court, which has been an instrumental component of connecting people with services currently in our judicial system. So with regard to

[Robin Scheu (Chair)]: the family shelters, these two particular ones, if we want to get more detail about costs and numbers of people served, etcetera, is that your office, or is it one of your other departments? In

[Jenney Samuelson, Secretary of the Agency of Human Services]: this case, the Department for Children and Families can help provide and eliminate that cost. Where family services came in, it was really working with the community to figure out where to site that, working with the community to coordinate with service providers. And so I think the theme that you're going see across a lot of the initiatives that we did and across these is that we really are working across agency boundaries. And so it's difficult to attribute success to just one department when the agency is working together across. It's nice not to have silos.

[Robin Scheu (Chair)]: I just don't want to know at the moment where I can get the data about the shelters. Would that be from DCF? Yeah, I would request it from DCF. Okay, great. That's where you're

[Jenney Samuelson, Secretary of the Agency of Human Services]: gonna get robust. You. We also have been working in healthcare reform on hospital transformation plans and the Rural Health Transformation Program, where we got and sought funding. And if we are successful in the five years, could equal almost $1,000,000,000 over five years. And then this year, we really weren't able to support when we saw all those ups and downs in what the federal guidance was gonna be for the SNAP program. One of the folks that were carved out of that, or group of individuals carved out of that, were individuals who were refugees and asylum seekers. And so through the refugee program, we were able to make sure that there was at least some support in communities for families who were transitioning off of that program. This slide shows a snippet of the traditional ups and downs by line item, which I know we don't have to go into detail on a lot of them, but just shows the various changes. And so then the next slide, just a little bit more description on some of those changes. About $2,800,000 reduction in general fund for the ADS service level agreement, those costs have been shifted over to the ADS core enterprise service allocation as part of the internal service fund, which I'm sure you're seeing across. We probably see that. Is this a new thing this year? Yes, where they are reduced. So they've reduced some services in the service level agreement, such as Microsoft licenses, desktop support, a couple of other things tied to licenses and said, hey, this is part of core enterprise services. And so here's an annual allocation instead of just looking at the number of individuals each year. We'll be talking

[Robin Scheu (Chair)]: to ADS, I'm sure. Yeah,

[Unidentified Committee Member]: this just spins me around on our

[Robin Scheu (Chair)]: Yeah, I know.

[Unidentified Committee Member]: Saga of ADS service level agreements. Last I heard previously on ADS, we heard that maybe AHS or some other would get a chunk of money and then it was allocated, costs were then divided in between all the different divisions. This is implying that maybe what you're getting charged will be less because some of this will be moved over to a different silo, but you'll still be given an invoice that you then have to split up?

[Jenney Samuelson, Secretary of the Agency of Human Services]: It's a no. So you are correct that in budget adjustment, we had funding for the service level agreement in the secretary's office budget. And then we parsed it out to departments once we had a better handle on which department should get their slice of the application. In 'twenty seven, what ADS has said, Okay, now your whole service level agreement is being decreased. And however, some of it is now going into the ADS allocation. So they've that amount of They've already predetermined that amount what should be billed by department. And so you'll see increases to the ADS allocated charge. You will see increases based on those allocations that we receive via finance and management. ADS work with finance and management to assign these allocations.

[Unidentified Committee Member]: So never mind the built in obsolescence about any kind of software and whatnot, how many man hours do you have to budget for in order to manage just that line?

[Jenney Samuelson, Secretary of the Agency of Human Services]: Let me get back to you on that. Yeah, let me get back to you. It's an interesting question. I'm not sure we thought about it in

[John Kascenska (Member)]: that way. Well,

[Unidentified Committee Member]: I mean, it may be somebody that you wouldn't hire or maybe it's something that you just spent five minutes and you can probably do that 10 committees. There's an hour of just trying to explain it. There

[Jenney Samuelson, Secretary of the Agency of Human Services]: are a lot of components to it. It is true. And so this is where I think they are trying to align it with core enterprise services. And by no means am I an expert in that area. And so that would be an ADS question as to what are we getting for in that space?

[Unidentified Committee Member]: Again, core enterprise services is something that everybody has to have.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Think about your laptop and the other types of things that you need to do now in a modern business world with every single one of our employees' needs. And I think that what they're trying to do is acknowledge modernization and capture it in a different financial way to try to make it more efficient and more effective so there's not a spending an hour spent on accounting for it.

[Unidentified Committee Member]: I know that those are the words that we try to put to modernization, because it it still seems to cost. We didn't seek to charge off index cards.

[Emily Hawes, Commissioner of the Department of Mental Health]: Okay,

[Jenney Samuelson, Secretary of the Agency of Human Services]: in the secretary's office, we also reduced general operating expenditures by about $158,000 We took a look at what prior year actuals were for travel, equipment, fleet, and other. So we were just rightsizing the budget there. The refugee transition and housing, I already spoke about. We're seeing 75% less refugees. And then two other small reductions. One is for the field service coordination grant. There was only two districts that had grants for this extra support for the complex cases in those districts, and the field service directors believe that they can take on that work now in house. So we don't need to exercise those grants any longer. And then a $19,000 reduction for our foster grandparent program that ended at United Way. This particular portion of money was used as state match on one of their federal grants that they no longer applied for. So that program is no longer in play. And as the secretary said, we offer support to two other areas in central office, the Developmental Disabilities Council, which is 100% federally funded, has three physicians, and also the Human Services Board, which is a blend of general and federal funds, and five positions.

[Robin Scheu (Chair)]: So if we wanted to find out more about the Human Services Board, we'd ask you guys. Yes, yes.

[Jenney Samuelson, Secretary of the Agency of Human Services]: And there is a report that they do an annual report that I can share a link with. Oh, that would be great. And talks about the number of cases.

[Robin Scheu (Chair)]: Yeah, because I think there have been, anecdotally, I'm hearing that there were a lot of appeals around eligibility for the hotel motel program. And I hit this all along, but I think that's what I heard. There were a lot of appeals and the people who were appealing won in many, many cases. So I'd like to get some data around what's happening in the human service court, just so I understand that.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Specifically around that related issue, I think DCF can provide you some significant insight. I think part of that is an interpretation of the previous legislation that they can provide.

[Robin Scheu (Chair)]: Yes, but any data on what the board does in that, that would be a real problem.

[Jenney Samuelson, Secretary of the Agency of Human Services]: This next slide just shows the line item, the ups and downs across account float and fund area for those two divisions. And we'll get into global commitment. So global the HHS Secretary's Office Global Commitment Appropriation supports the global commitment spending that you see in all the other departments. B301. B301,

[Robin Scheu (Chair)]: yes.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Also known as the mixing bowl, it's both of the federal and state match associated with paying the global commitment fund. And again, match percentage, the state share of match is 41.93 with the federal match being 58.07. In 2026, we need to submit our eleven fifteen Global Commitment to Health Waiver Renewal application that's due by the end of the calendar year. And then we will embark upon a one year negotiation with the CMS to renew that for the end of calendar year 'twenty seven. And

[Robin Scheu (Chair)]: I imagine this is going be a little different than the last time you negotiated. It's a different administration. There's probably a

[Jenney Samuelson, Secretary of the Agency of Human Services]: lot of different people at CMS that were there before. I think that that's an appropriate assumption. We were asked by the Human Services Committee, what do we anticipate is different? So we enter into negotiations. I can't speak to that. What they have clearly said is that there are things that were authorized previously, particularly around health related social needs, like housing, which is a benefit that we have not exercised because they have been very clear that they are going to eliminate it in the next negotiations. Vermont's waiver is also significantly different. It has allowed us to be very successful in in the state at really getting to prevention and cost containment, some of those investments that we, at times, think are base Medicaid are actually both investment dollars or programs or operations that we've chosen to engage. Those things will all be, I think, a point of discussion with the federal government. Again, because Vermont's waiver is unique to Vermont. There is not another single state that enacts the Medicaid program the way that we do. I would say it's that helped us be very successful, but there will be a lot more questions on those investments as we go forward.

[Robin Scheu (Chair)]: That's what worries me, is what they decide at the end of the day, even if we've been very successful in the programs that have come under this threat.

[Jenney Samuelson, Secretary of the Agency of Human Services]: I think that the insight that folks have asked for is a better understanding now of what are required programs under Medicaid programs, what programs are programs that Vermont has implemented as programs under the Medicaid program, and those programs that are investments. I think some base background for folks as and before we get into the waiver, will help understand what risks that there are. We've done that analysis internally already, and I'm sure that we would be happy to have our Medicaid policy unit and department come in and share some of that. Can't, again, we don't want to precede our negotiations and disrupt, We don't want to make it harder for us to negotiate. But we can at least illuminate for you what programs are required federal programs. We looked at it actually for our budget for this year, which programs are not required programs and which programs are investments.

[Robin Scheu (Chair)]: That would be great. Once you get the budget out the door, we'll come back in April. Whenever is convenient. I just think it will be helpful as a face. Thank you. John?

[John Kascenska (Member)]: Just answered my question. I was gonna ask, with all that you're doing presented so far, I'll help you once you get to know negotiation in the next year. Yeah. Just help maybe perhaps hopefully streamline that so that she can.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Exactly. We have been preparing for these negotiations for some time. Now, it hadn't been before, but there is now a Medicaid executive team within the agency who is trying to ensure that there's alignment across the Medicaid program, across departments. And they really, that's led by our Medicaid policy director and our Medicaid director and our CFO, Tracy, they've done phenomenal work to understand these key pieces to help us with the negotiations. Again, we'd love to share it, but it also demonstrates the work that we're doing across the agency to break down the silos to make sure that our Medicaid program is administered consistently across the agency and not just piecemeal by department or by department.

[John Kascenska (Member)]: Thank you.

[Jenney Samuelson, Secretary of the Agency of Human Services]: Here is a snippet from the ups and downs for V301. And just as a reminder, anytime there's a change in the global commitment or the departments, the six AHS departments and the secretary's office, that flows through to this appropriation that both the state and federal share. And so just to highlight a couple other things, while we talked about the $13,000,000 backfill of federal loss dollars for the FMAP that's in that appropriation B301, as well as a special fund for the Success Beyond six program that the designated agencies supply the match for.

[Robin Scheu (Chair)]: Tell us what CCDHC is.

[Emily Hawes, Commissioner of the Department of Mental Health]: That's the as we've talked about in the past few years, those are some agencies shifting to a federal model.

[Jenney Samuelson, Secretary of the Agency of Human Services]: What does it

[Emily Hawes, Commissioner of the Department of Mental Health]: stand for? Yep, Certified Community Based Integrated Health Center. Very similar to an FQH.

[Jenney Samuelson, Secretary of the Agency of Human Services]: It's a federal program. You will hear the acronym called something different at the federal level. This is a federal program, and that's why we typically refer to it CCBHC, so folks can see how it matches up versus bias.

[Robin Scheu (Chair)]: That's correct. Okay, thank you. Yeah, and so

[Jenney Samuelson, Secretary of the Agency of Human Services]: the federal government offers an enhanced FMAP for using this program and this service. So we get to claim it at 70.65% instead of the traditional 58.07%. And correct me, Commissioner Haas, this program is an exciting program for Vermont, because it allows us to do more comprehensive services in one place. It sets a set of standards for our mostly designated agencies at this point. And like effectively qualified health centers, insures that an individual who is getting mental health, they can get both mental health and substitute treatment, But they also can get physical health services and other services. So it's a comprehensive care bottle that's being administered by our designated agencies. The last two bullets just reflect the match that changes with the changes in the global commitment appropriations in the departments. Why is the mixing bowl? Here's a slide that depicts our grants out that come out of the secretary's office for both the refugee resettlement program. We have some miscellaneous grants related to direct service staff, the field service grants that are related to direct service dollars and a few other miscellaneous grants. And then to the Developmental Disability Council, they issue some awards as well.

[Robin Scheu (Chair)]: So if we wanted to know why the miscellaneous grants went down to the 7,000, is there something on Vantage we can look at? Or can you just tell

[Jenney Samuelson, Secretary of the Agency of Human Services]: us what happened? Actually was back on That

[Robin Scheu (Chair)]: was pre

[Jenney Samuelson, Secretary of the Agency of Human Services]: Yep. So when we talked about reductions Yeah, last few bullets. So there's the field service coordination grants and foster grandparent. And

[Unidentified Committee Member]: on the foster grandparent program, you said that they weren't applying for it, but is that because the federal government froze the money? Is that I mean, they froze a lot of programs like that. Is this one of them?

[Jenney Samuelson, Secretary of the Agency of Human Services]: I don't believe so, because there's one other program still operating in Rutland, so that one is still in existence. My understanding is United Way stepped away from this program.

[Robin Scheu (Chair)]: Okay, thank you. Great, thank you. Yeah, I'd say

[David Yacovone (Member)]: the Developmental Disabilities Council, is that general

[Jenney Samuelson, Secretary of the Agency of Human Services]: fund? Federal.

[David Yacovone (Member)]: So, just curious, why would we give back money to the federal government for these kinds of services? What's the backstory?

[Jenney Samuelson, Secretary of the Agency of Human Services]: No, we're not proposing that. So actually,

[David Yacovone (Member)]: Did we're I misread it?

[Jenney Samuelson, Secretary of the Agency of Human Services]: Yeah, these are just grants out.

[Robin Scheu (Chair)]: Oh, I'm

[David Yacovone (Member)]: sorry, they have to take cuts.

[Jenney Samuelson, Secretary of the Agency of Human Services]: No, no, no, grants out. What you can see is in the first column, it's as the budget pass

[David Yacovone (Member)]: And you're just saying

[Jenney Samuelson, Secretary of the Agency of Human Services]: the governor's budget.

[David Yacovone (Member)]: France, how I misread Oh, thought it said cut. Sorry. Thank you.

[Jenney Samuelson, Secretary of the Agency of Human Services]: It's not a new three thirty display. So, and then there are a few supplemental documents to address some of the other things requested for the budget presentation. So we have our typical ups and downs workbook that encompasses the entire agency's budget, the summary budget that the Secretary identified, which is kind of an easier guide or summary. There's the list of state fiscal '25 carry forwards and reversions for the entire agency, a list of the state fiscal year twenty four audit findings and their status, and also the 1% community based provider rate calculation.

[Robin Scheu (Chair)]: I'm looking online at the supplemental documents. Thank you for organizing it this way. This is very helpful in having a separate document. I'm just wondering if there's anything you want to let us know about the single audit findings.

[Jenney Samuelson, Secretary of the Agency of Human Services]: I will say, actually, we've had a reduction in findings that we are anticipating. So in 2024, we had 14 findings. But in 'twenty five, these are all in draft. Or it's not final, we've reduced it to five. So we have made significant progress. I think one area to highlight is in the FFATA reporting audit finding. And I know this has been a statewide challenge, is where you have to enter in your sub awards into the federal portal to identify any grants or contracts that you fund with federal dollars. You have to do it in a certain amount of time after execution and paperwork. Some And so our internal audit group has been monitoring all of the AHS departments along the way and just we've made significant progress. And now we only had one agreement that was found in the sample that did not get entered timely. So that was significant improvement. I know at the state level, they're very pleased with that because it reduces the audit costs going forward to not have to repeat that. Great. Other questions from the board?

[Robin Scheu (Chair)]: Yes, Dave.

[David Yacovone (Member)]: Just back to the Human Services Board. Do you, as secretary, have the authority to reverse a decision made by the Human Services Board?

[Robin Scheu (Chair)]: We rarely do that. But you do

[David Yacovone (Member)]: have the authority. So if you feel it's just arbitrary or totally inaccurate, you can assert yourself.

[Jenney Samuelson, Secretary of the Agency of Human Services]: This is one where I would want our attorneys in the conversation. Sure, sure. But we take a very specific evaluation of those. The decisions that we look at for the Human Services Board, really are whether they're compliant with our Medicaid, and we rarely reverse them, this year I think it's one of the first times in history, and it had to do with it's compliant Medicaid with program, Katie Beckett specifically, in the one reversal this year. And so it's, yeah.

[David Yacovone (Member)]: I just wanted to make sure you had the authority. I didn't know if it had been taken away years ago. Thank you.

[John Kascenska (Member)]: I'd like to applaud your efficiency and effectiveness look through. And just as a question, given what you saw, how much more do you think how much farther can you go? Is this going be an ongoing thing that we can target targeted places to look?

[Jenney Samuelson, Secretary of the Agency of Human Services]: I think what we would say is, and I want to thank the teams, is that this year, the process that we went through to look for efficiency and effectiveness was a step forward for us as an agency. It's something that you all have asked us to do before, in terms of evaluating our programs. It's something we took very seriously this year. So yes, I believe it will continue. I also want to take a moment to thank the teams who did this work. The commissioners were flexible and did work in a way that they've never done it before, but it also permeates down to our policy team and our budget team and our program teams on the ground. It's the privilege to work with such an amazing group of dedicated staff who are willing to try something different in order to get a better outcome on behalf of the market.

[Robin Scheu (Chair)]: I have to say that I'm very impressed with what you all have done. You had the hardest budget by far of all the agencies and you've been saying progress not perfection but I'd say you've made a huge amount of progress over what we've seen in the past And you're certainly meeting and maybe exceeding my hopes of where I thought we would be. And I think it ends up being a richer conversation. Great to hear from you guys. I know that our conversations with your team are now going to be that much better because we have And I hope it was useful for you guys to do this as well. Incredibly. Think

[Jenney Samuelson, Secretary of the Agency of Human Services]: it's hard to describe how it fundamentally has changed the way that the agency is working together. And I think it comes from the seats. I also ask for your patience, because we are doing this as teams. It may be that we ask for more than one department to come in at the same time, like we see with our commissioners at the house. Really have to try and simplify that. But I would, again, thank our leadership team, and I think you're getting from the head nods, it really has made a fundamental difference. Yeah, but it's

[Robin Scheu (Chair)]: a big difference. It's great. Yeah, echo that. I think, you give us just one example of the way in which this process has facilitated a closer collaboration and maybe programmatic change and maybe administrative change across departments? I'm going to speak to the way

[Jenney Samuelson, Secretary of the Agency of Human Services]: it was before, but I'd like our commissioners to speak to that. I also, I apologize, I'm going to have a hard stop in about five minutes. The team can stay with you, but I'm going to have to In the past, when we've done our, what I've seen is what I've been asked to arbitrate between, and being in the deputy's position before that, and actually in the deputy commissioner's position before that, What I saw is departments would say, that's not my client, and that should be paid for by this other department. And so we're going to eliminate that program and knowing that it was just going to impact another department. So an elimination of a mental health program has a significant impact on the children and families that we serve in DCF. And I would see what I would describe as this, between departments, trying to get savings by shifting the problem to another department, like squeezing a balloon. I didn't see that this year. And what I actually saw is on the ground departments working together to work together to own a problem or to solve a challenge for a population of the people that we serve. And I guess I would ask the commissioners to give some examples of some of those areas. But we've stopped the shift things from one being or have just a single person decisions. That's not the way to lead an agency. We shouldn't have one charismatic leader. We should have a team of experts who can look broadly across the program and work from a consensus. Not that I don't make decisions, but I need an entire team to advise those decisions.

[Emily Hawes, Commissioner of the Department of Mental Health]: Mean, we're just Emily from DMH. We're not getting here on call, and we can highlight some of those conversations and collaborations. But one that stands out for me is a rate increase specific to an FI, which limits the NEBA budget, but it is overseen by the Department of Mental Health. And that has historically been really challenged to match the rate that that particular specific hospital diversion program does and how it impacts that pre commissioner that's sitting right here. And so, we met almost on a weekly basis over the summer and being able to have those conversations about what that particular program does in the full scope of all the things that Medicaid is funding that each commissioner is trying to make decisions on. And for me, that was a really good example of everyone looking at one thing as they're serving directly. I've gotten to be a part of many budget seasons, This one was the most helpful for me. I learned more about everybody else's budget, good or bad. That's great. It was conflict and that was okay. It's okay to

[Robin Scheu (Chair)]: have conflict. Is. Some day

[Emily Hawes, Commissioner of the Department of Mental Health]: you have good conversations and then it's an excellent product.

[Robin Scheu (Chair)]: Great. Think it just changed her identity from being

[David Yacovone (Member)]: Last year we appropriated $10,000,000 for the stabilization fund. This year, I think, thought I saw in Adam's presentation a $2,000,000 ask. Could someone, you may have already provided this, but if somebody could just give us a little spreadsheet that says, here's how much we've given out, here's how much is less left. And maybe thinking about some language, just in case provider A is in a real difficult situation and the 2 million's gone to give someone the authority to do something. So it doesn't go under when we're out of session or something like that. I Thank

[Jenney Samuelson, Secretary of the Agency of Human Services]: think Diva, who has mentioned the program this year, can definitely give you that. And that is actually another one of the It was one I was gonna highlight, is one of the places where we've seen a lot of collaborations. So just by the

[Robin Scheu (Chair)]: way. Great, great.

[Jenney Samuelson, Secretary of the Agency of Human Services]: I apologize. No, we don't have

[Robin Scheu (Chair)]: I think we're about done. And I also want to thank you and thank your whole team. This is really great. Really appreciate all the work, I'm glad it's also been useful to you as well. Think it's going to be better for Thank you. Thank you very much all of you. We'll see you again when it's your turn. You for having us. Okay, thank you.