Vermont Legislature SmartTranscripts:

[Chair Robin Scheu]: Good morning, this is the House Appropriations Committee. It is Thursday, 01/29/2026. It's just after nine a. M. We're continuing our focus on the FY27 budget. This morning we're delighted to have the Department of Disabilities, Aging and Independent Living, AKA DAIL, with us and have a few folks here including the Commissioner and Friends. So if you would all introduce yourselves and take your time, please.

[Commissioner Angela Jill Rowan (DAIL)]: Thank you. Hi, I'm Angela Jill Rowan. I'm commissioner of the Department of Disabilities, Aging and Independent Living, Dale. And to my left.

[Deputy Commissioner Angela Smith (DAIL)]: Deputy Commissioner Angela Smith J.

[Bill Kelly, Finance Director (DAIL)]: And to the Finance Director, Bill Kelly.

[Commissioner Angela Jill Rowan (DAIL)]: And also we have with us. Welcome all of you. Thank you. And Rebecca's going to share our documents so that we can walk through together.

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: And we have an hour or so

[Chair Robin Scheu]: to go through.

[Commissioner Angela Jill Rowan (DAIL)]: So, we're going to start with just a basic background and then highlight some of the departmental programs that we want to highlight for you, show you a couple of data graphs, and then get to the numbers. So we're up here. Let's go to page four. Page four. Just as a reminder that Dale has five divisions. It's the adult services division, which is inclusive of older Vermont or focused, division for the blind and visually impaired, developmental disability services division, which includes the office of the public guardian, Division of Licensing and Protection, which includes Serving and Certification and Adult Protective Services and the Division for Vocational Rehabilitation, Doing Business as Hire Ability, which is inclusive of the EAP employee assistance program. Highlights for this year is the H. R. Vermont plan. I don't want to make the assumption that everybody's familiar with the Age Strong Vermont plan, but I would like to invite you to review it if you haven't. It is one of the few states that has embarked on a multi year, multi sector plan to prepare for an aging demographic. And we are the second fastest growing state in the country. We have about a third of our folks 60. We're very cognizant that there is a big difference between what we need to plan for, for those between 60 and 69, 70, 79, 80 and 89. It's not a monolith. We are in year two, and year two report will be released next month. So we encourage you to take a look at that. Conflict free case management, developmental disabilities, inclusive of developmental disabilities payment reform, went live on 10/01/2025. And we are in early implementation phase. That put us in compliance with CMS's requirements as our corrective action plan, as well as the state auditor's findings. Developmental disabilities supported housing. So Dale supported several housing initiatives, progress on the act 186 initiatives, some new programs that stood up. Upper valley services opened a housing project in Randolph. There's Marsh House opening in Waterbury. There's Champlain House and Trust work in collaboration with Howard Center in Burlington. Able House opened, Able House is Northwest Counseling and Support Services. That is particularly interesting because it's built for people with developmental disabilities who are also aging. And so that is kind of their forever home because it's built with the ability. So that was good, innovative planning and KHS Open Mountain View home. So, the Act 69 work group, resulted in several a report wrote the Roadmap for Housing. What Act 69? That was the Developmental Disabilities Housing Committee that came out of legislation last year. It was a very active, multi stakeholder involvement, including families and several recommendations came out of that report that we are also supporting, following up on. This is really to address options in the developmental disability space for housing, the decrease in the number of shared living provider interests and the number of options, looking at other practices, different types of group programs. Right now, there's a recommendation that came out to look at what regulations and licensing issues may be challenging, and that has been created as a subcommittee of the DS standing committee.

[Chair Robin Scheu]: So you mentioned that there are fewer shared living or opportunities that somebody, a family or a person or whoever takes in somebody in house. Do you have a sense as to why is it, again, our aging population? Are there a few people doing that?

[Commissioner Angela Jill Rowan (DAIL)]: A couple of things. So the SLP, or the shared living provider approach, was most close to all of what the residential sector for developmental disabilities was. It grew out of the closing of the residence hall, and it was really folks who were working there to a degree who brought people in at its closing. So that grew then, and there was a goodly amount of folks who were interested in doing that. So there's a couple of reasons. One is, to your point, some of those folks themselves are retiring. There's less interest in younger folks right now, and some of them don't have the wherewithal. They don't necessarily own their own homes or have space to do it. So the number of people who are leaving that space exceeds the number of people who are entering that space. There's also interest in a sector of families and individuals served who are looking for some alternative options that might be better fits for some.

[Chair Robin Scheu]: Right, I know personally of several people who have children who have developmental disabilities, and they're worried as they age who's going to take care of their children? That's a common theme.

[Commissioner Angela Jill Rowan (DAIL)]: Yes, DDHI, for example, very present in the Act six and nine committee, and very active in terms of bringing that to light. And also just the different approaches that are available. That was what the original planning grants that were given a couple of years ago were about, develop different models and make society. And so those are mostly all operational now, or soon to be.

[Chair Robin Scheu]: Can I just ask, is the shared living housing, is that what we used to call group homes?

[Commissioner Angela Jill Rowan (DAIL)]: So the shared living provider is actually somebody's home, like a family home. So it's not considered a group home in the same way. A group home has more people that they're serving. So an SLP could have more than one person. Could have two people. Can it go up to three? No, the maximum is two. Yeah, but a group home can have three or four. Once you get over three, you're really looking at a different kind of

[Deputy Commissioner Angela Smith (DAIL)]: So more than three people in a home require a license. We have group homes that support up to six people in our system. More than six people require from the department. We don't currently have personal homes that support more than six people, although as we've been talking, there's interest in some of these more peer based models that would be slightly larger, but also might just have sort of mixed housing, so the more general population and service supported housing as they get larger in size.

[Commissioner Angela Jill Rowan (DAIL)]: And we're working pretty closely with the ones that are actually in existence through the payment reform and Comfort Free, we're able to look at things in a different way related to some of what their challenges have been. So we're actively working on that with them right now.

[Rep. David Yacovone]: And Tom has a question.

[Rep. Thomas Stevens]: Yeah, I appreciate the fact that you put the link in, and I'll be reading the report when I can. But can you just give me a quick summary? The report that was issued before that spurred on the pilot programs called for based on the folks who were the advocates and everybody involved in that particular study identified the number of needed units to be 600. And, you know, I always got to chuckle with the advocates because after we did the pilots, was like, all right, 14 down, five eighty six to go. So what was what came out of Act 69? If you could just give me a quick thumbnail because I will read the report of

[Commissioner Angela Jill Rowan (DAIL)]: Yeah, we're still How do we

[Rep. Thomas Stevens]: get to 600? Where we put the I'm sorry I'm asking questions that could take an hour, but just give me a quick summary and then I'll reread the report.

[Deputy Commissioner Angela Smith (DAIL)]: Yeah, perfect. Really the recommendations from Act 69 report are really about how to sort of get to that 600 or a little more than 600 as our population grows over the next ten years. So it's through a variety of approaches, voucher based systems, applicable capital, infrastructure bills, a lot of services for data housing, lot bill, together in a dream apartment, the but then because the services that come in match our needs, it's not about building a specific group home that's sort of blend people based on community based supports and try to match at that same level so that we're really all that allow people to live where they want and the community disintegrated, again through a blend of things but largely thousands systems and stumps develop

[Chair Robin Scheu]: it.

[Rep. Thomas Stevens]: No, I appreciate the commitment to this population that they've been relatively they feel they've been relatively ignored for the last thirty plus years and so, and knowing full well how difficult it is for the parents, especially aging parents. And this population is probably even more fluid than anybody else that we want to work with. And I hope that you're laying in I hope that this work is going to represent long term commitments to this population. It's small. It can be ignored. But it's much appreciated that they've been front burner for the last several years and solutions are being contemplated.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah. Thank you for that. If we imagine this vision actualizing ten years from now, there would also be a lot more choice for people, because one size just doesn't fit all.

[Chair Robin Scheu]: Well, one more question on this, and then we're gonna move on. Thanks.

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: Yeah. I just wanna is there money in the budget that is appropriated to advance this particular goal? Not at this time, right?

[Commissioner Angela Jill Rowan (DAIL)]: It's very early planning. We're very early in our toes in the water for the if you read the report, there's some recommendations.

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: Right. No, I actually read the report and I, okay, that's all I needed to know. Was looking through your, budget document and I wasn't sure that

[Chair Robin Scheu]: I could see it, so

[Commissioner Angela Jill Rowan (DAIL)]: I But just wanted to I just wanted to highlight the programs that we are already supporting, some of which are going to be coming online in 'twenty six, some of which came online in 'twenty five. So it's not that we stop. And I really want to give kudos and a shout out to the partnerships that have ensued to create these. It's quite a few that have come up and grown, and that was really public private partnerships. There were private donors, there were land trusts, and the families. And they really took these planning grants, and that was the expectation of what's the process that can ensue that can result in actual bills. And it happened. So we do know that there is a way to do this and are still supporting that. Right now, we're pretty focused on some of the things that have to happen upfront, such as are there regulatory barriers to accomplishing what they're looking to accomplish through this roadmap? So some of the folks who are currently Riverflow and Hartwell, Yellow House, who are already looking to what a sustainable model for them is. And that's, we're working on that. That kind of has to be solved and resolved before you start building, and then having our licensing folks work with this group through our standing committee to figure out what else might be needed, or is there a different type of regulation that's needed, or is what we have as our option doable for what they're proposing? So that has to happen first.

[Chair Robin Scheu]: Okay, let's continue.

[Commissioner Angela Jill Rowan (DAIL)]: All right, so then let's go to I just want to very quickly say on page six, the direct care workforce work, incredibly important. We don't have enough direct care workers, and we are very actively working to encourage people to be coming into this work. We were chosen to participate in the National Direct Care Workforce Strategy Center that was last year, and again, this year in the state advancement lab. This is really important because this is across the country for those who have been selected to really come up with best models. And we put some of those into place, including our Careers and Caring campaign, which had 120,000 visits to the Careers and Campaign website, nearly 200 web outreach inquiries. And we, through some of the best practices that we learned, we released an RFP for a direct care worker registry, which helps connect independent direct care workers with people seeking, like families and others seeking direct care workers. And then we have been able to work on the LNAs through the monies that were appropriated from the legislature in the last two years to help with recruitment and training, and we're looking to continue that this year through some funding through the Rural Health Transformation Program. So I'm going to jump to page seven, where the high ability opioid recovery employment. That pilot was just really successful. What this does is have people who are in recovery from opioid use disorder be connected with employment. Being in recovery helps people succeed in employment. Being employed helps people succeed in their recovery. So you'll see that in our budget, because that is being based on

[Rep. Thomas Stevens]: There's

[Commissioner Angela Jill Rowan (DAIL)]: all kinds of things you could do.

[Chair Robin Scheu]: I'm sure it

[Commissioner Angela Jill Rowan (DAIL)]: is, but it's also Mental Health Advocacy Day. I don't know if I Okay, can go in the so number eight. So on page eight, admission care at Bennington, just wanted to highlight that. Since they opened at the 2024, so last year, they brought in 60 new residents, and they're at 89% capacity. 29 of those people came from hospitals who were boarding in hospitals, 11 from out of state nursing homes that were coming back home, right, because they had to be placed out as we didn't participate.

[Chair Robin Scheu]: In out of states, yeah.

[Commissioner Angela Jill Rowan (DAIL)]: Nine from community settings, five from correctional settings, five from motel homeless GA, and one from a different in state nursing home due to complexities. So that is like working. And then on page nine, the nursing facility, stabilization and sustainability, which we're happy to talk about some more. It's the beginning process of what looks like will be a ten year plan to address the instability and the need for sustainability in the nursing home system, the long term care in general system, which is more than just nursing home. We're beginning that process, and started our stakeholder engagement, and we will be doing that throughout, the next several months to bring their ideas and focus and attention. There will be a finalized plan, by the end of the year. We're looking at five major areas: capacity and infrastructure, workforce, financial stability, quality of care, and complex care.

[Chair Robin Scheu]: Great, yes. And I know that you've given a lot of money to this on the EFRs for financial relief over the last few years. It's coming down a little bit.

[Commissioner Angela Jill Rowan (DAIL)]: It did. It's still a lot of money. Yeah, and it's still absolutely an essential part of it. But if there is an EFR report, which hopefully, I don't know if you had a chance to read that because you have so much free time. Diva did, and we had input into it, produce a report on extraordinary financial relief with several proposals embedded in there that could have an impact in stabilizing itself.

[Chair Robin Scheu]: So we'll get a copy of that?

[Commissioner Angela Jill Rowan (DAIL)]: Yeah, well, that's available. We've also linked it here just for a relief.

[Chair Robin Scheu]: Report under There you go. David, you're all over it. Yeah, yeah, I'm trying.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah. That has some interesting suggestions in terms of how to do rates maybe differently. One of the things that helped bring it down this past year was that the rate we base this time, which is for nursing on a two year cycle, for other things on a four year cycle, was closer to reality than it was before. So about two thirds, benefited from that. Two thirds of nursing homes benefited from that. So it did come down some, but nowhere near. It's still the workforce as a significant driver. But there are some suggestions in there, such as aligning all of the rebases and maybe on a shorter time frame. That could bring closer to reality funding, which would have a stabilizing. Anyway, I encourage you to read that. Okay, next is, I'm going to go quickly now, the APS statute on page 10, just to let you know, because that is in this year's, don't know what APS is. That's the Adult Protective Services. There was a federal regulation which required us to come into compliance. That was a few years ago with, some new statutory requirements and new federal requirements. The federal regulation, as I said, we were kind of ahead of the curve here, so it wasn't that hard for us to meet the federal regulations, except in one area, and that was the caregiver neglect piece of it. And there were concerns in the provider and in other stakeholder network, really. And so we came together this year at 14 different meetings, really working through what the challenges are, Because understanding that certainly Dale, as

[Rep. David Yacovone]: a

[Commissioner Angela Jill Rowan (DAIL)]: state entity, care about all of the people, and we're not comfortable with the workforce feeling impacted by that, just as much as we're not okay with individuals being at risk. So we did come together and get to some good compromises and come up with a proposal that keeps us compliant with the regulations, but gives some really Vermont flavor to it for us to do this in a way that meets our needs. Okay, so I'm now going to go ahead and jump to page 17 so I could show you some results. What's going to come up here is the adult services division. So there are nearly 7,000 people who receive choices for care services across all settings, which is a 4% increase. Nine seventy three of those were moderate needs group and over six thousand were in the high highest needs group. And then of the total in the high highest needs group, four thousand six hundred were in a home based setting. That's the majority. I think that's important, because as we talk so much about those who need nursing homes and we need to have capacity for them, we still have more than or somewhere, it's not twice as many, but it's a significant many more that are being served in a home based setting. Seven sixty were in a residential care home or assisted living facility, and nearly 3,000 were in a skilled nursing facility. And then we have a graph that just kind of highlights that so you can see the growth. The blue is 2025, and the green is 2024, so you can see where there was growth.

[Chair Robin Scheu]: I would imagine, given the choice, most people would rather be at home.

[Commissioner Angela Jill Rowan (DAIL)]: You know, it actually depends, right? It depends. So the average age in nursing home, as we had talked about in BAA, is somewhere around 84. So it might, depending on where you are, what your complexities are, who is helping you, what's available. Because you might think that, but there are folks who are like, they need something else, they want something else, and they have to have that available. Oh, absolutely. Or they just reach a certain level where the home care- There's too much to do with the home. Yeah. So, right. And I mean, this is where things like respite care and caregiver support, Money follows the person, which is incredibly important for bringing funds like that into that kind of option. The residential care homes, the assisted living facilities, especially the ERCs where they can provide the kind of care that you can get in a nursing home, but it's in a different setting. At less cost too. Yeah, right. But choice is also an important part here. So I think we make the assumption that people are not choosing nursing homes, but sometimes they

[Chair Robin Scheu]: absolutely I would guess that some people are, but by and large, I would guess that most people want to be at home if they could. Dave, did you want to say something?

[Rep. David Yacovone]: Yes, I think this work is extraordinary. Really do. We've made great things that are happening. When I think about choices for care, before it started, 90% of all of these state spending went towards institutional care and 10% was home care. That was many years ago, And the none of that's changed. So the majority of the people are being supported in home as opposed to nursing homes. But the dollars are not fiftyfifty. And the cost won't in the nursing home. The concern I have, and this is probably just financial capacity, lack of it. I don't think when I'm in the home and I can't get a caregiver, none of those home budgets would support a traveling nurse. They do if they manage it that way. But whereas in the nursing home, many, many traveling nurses keep it propped up. I don't think when I'm struggling in the home care system, I can request extraordinary financial relief to prop things up and keep it going. And I wonder how many of the folks in the homecare part of the choices for care, it might be appropriated, whatever 50,000 a year, but they're only able to spend 35,000 because they can't get those direct support workers. And I don't know how to solve that. The pool may be, they just aren't there to get, or we favor that may be the wrong word. We don't favor that side of the system of care, way we do the nursing homes, which have licensure requirements and other things. And that just weighs heavily on me. And I think with the ERC or the residential care, we do not have EFR for residential care. I don't even think we have anything near, they don't even submit cost reports. I could be wrong on that now, they didn't used to. And they may lack the financial capacity even to do that. But I worry about whether we're supporting residential care homes sufficiently so that people don't have to go into the nursing home. And finally, just one other point. We used to believe that if a nursing home is closing because consumers aren't going there, that's okay. That's the market speaking and that's choice of people to go elsewhere. But if they're closing because they can't staff sufficiently, that's different and we need to step in. Right. Is what I think we're doing with the EFR. Yeah. But I don't know how many of the EFRs are because people aren't going there or because it just, they can't support Yeah, traveling, traveling

[Commissioner Angela Jill Rowan (DAIL)]: so the five areas that we talked about, the complexities and the workforce are like, but we have some things we wanna say in response to that. Do you want to take that, Uzi? Well, I just want to say that for extraordinary funding relief, there is provider stabilization grants. Four of the residential care homes did apply and receive.

[Rep. David Yacovone]: Four of them did?

[Commissioner Angela Jill Rowan (DAIL)]: Yes. And just so that that's Thank you.

[Deputy Commissioner Angela Smith (DAIL)]: Yeah, think we do a lot of individualized rates for individuals who live in the community, so we do take into consideration that if somebody has to pay a higher rate, work with individuals so that they have a choice between a different agency can provide, they can go through self direction, and so we do authorize above the base authorization for those circumstances. We have special rates at our ERCs, so we do a lot of individualized looking at those care plans so people can get their needs done.

[Commissioner Angela Jill Rowan (DAIL)]: One other thing this year, so there is instability in, I mean, I know we've talked about this, but there's instability in the nursing home system, and in the long term care system, We had some residential care homes closed this past year and some new ones open. We actually netted 25 beds. Yeah, we netted. But this flux is that's some part of the instability. So we're constantly trying to get ahead of it. Nursing homes also. We currently have a nursing home that's closing, the Great Green Mountain. And we will net a loss in the system. And it's not as big a loss as it would have been if we hadn't expanded some beds in some places, but it is a loss. When we're talking about a stabilization and sustainability plan, we have to go forward. And we have to make sure, given that the complexities may not be something that's easy to manage at home, in the Rural Health Transformation Plan program, We are looking at increasing our ability to have ventilation in nursing homes and also more dialysis in nursing homes. Those two pop to the top of the complexities and the needs that the providers requested. But there are a whole slew of complexities that come together. People are living longer. They have multiple physical health problems, mental health challenges. There's just a whole slew of things that we refer to as complexities. There are special rates, but we need to have capacity for the whole thing. To me, it's not eitheror. I look at what's on the screen, and I'm pleased, just like David, that there's so many that are being served at home. But I also think about how many of those will, at some point, either choose or need to be in a nursing home, and we must be prepared. And they have to be welcoming places. I've been to almost all the nursing homes in the state. Some of them feel like a home. They feel they're lovely, and people are happy there, and the families are happy there. Others look like they're old, and that means that they feel a little bit less warm. Rarely do I find someone who says, I'm miserable here, but they're talking to me. I do peel off from people there, but I do get a sense that for many of them, feels like this is their community. Just so I think- It's across the gamut, I totally understand. Yeah, we can go to the next-

[Chair Robin Scheu]: May I just quickly just sort of,

[Rep. David Yacovone]: when a nursing home closes, do the dollars disappear or do they go elsewhere in the choices for care? Do you have the latitude to move them around in the choices for care budget?

[Commissioner Angela Jill Rowan (DAIL)]: So do you have an answer to that? Because, I mean, they get paid based on services, right?

[Bill Kelly, Finance Director (DAIL)]: Right, well, speaking of the dollar, someone else can speak to them. The dollars don't go away, go back into the system. We still have to care for the choices for care eligible individuals and some outskirts. Yeah, well,

[Commissioner Angela Jill Rowan (DAIL)]: the individuals, like what's happening at Green Mountain right now, are being Absorbed. Yes, assessed and absorbed elsewhere in the system. Did you want to say something about that?

[Deputy Commissioner Angela Smith (DAIL)]: No, I think that that's it, that funding sort of goes with the person, that we hear for them either in another facility or in the community.

[Commissioner Angela Jill Rowan (DAIL)]: Okay, thank you. Okay, so the next slide will be page 18. And this just goes back to wanting to highlight what you were saying. The blue is home and community based services, and the orange is nursing home. So we can see that the home and community based services are still outpacing nursing homes. So it's not an eitheror, it's definitely a both. Absolutely. Let's go ahead and get to page 26. There's lots of good stuff in here, but I highlight it.

[Chair Robin Scheu]: Yep, that's great. Yep.

[Commissioner Angela Jill Rowan (DAIL)]: We have page nine, okay. So this is looking at home community based over time. This is longitudinal data, just looking at what happened from 2021 to 2024. And you can see that there was a drop in '22, which may have been coming back out of the pandemic, and people who were not going to nursing homes then did, but it grew right back and exceeded where we were in 'twenty one. So just so that we can see how the home community based services population is growing over time. Again, there were almost 3,400 people who were served in home community based services in 'twenty four, And it's a whole range of different types of services from flexible family funding, family managed respite, the bridge program, guardianship services and rep payee services, in addition to your more traditional home and community based services.

[Chair Robin Scheu]: I have a question, Jill. Yes.

[Rep. Thomas Stevens]: Actually, just looking at the graphs, it's only about a 1% difference between the top and the bottom, so it looks pretty stable. The graphs, The way it's graph exaggerates the difference. So it doesn't look like that much, about 35 people different.

[Commissioner Angela Jill Rowan (DAIL)]: Just seeing that it's on the upswing was a trend that we were happy about, because people leave and people come in, which means that we have a pretty good flow of people coming in, but people are leaving at the same time. So that's why it stabilizes out a bit. I'm on page 34, and just want to quickly show you the effectiveness of our employment efforts for blind and visually impaired. Just really want to highlight there that we are doing better than the nation as a whole. And you can see that thirty five blind or visually impaired individuals closed their cases because they attained successful employment. Eighty two percent had a wage above 125% of the minimum wage, 58.5% employment rate for four quarters post exit. So what that means is that they're keeping the job for these federal guidelines in terms of how many quarters.

[Chair Robin Scheu]: Is that the federal minimum wage, or is that the state minimum wage? When you said 125% of

[Commissioner Angela Jill Rowan (DAIL)]: the Of state. That's compared to our Oh, great. Yeah. Is a little Yeah. No, I'm talking about the measures that are like, they hold the employment rate or quarters post exit, you know, that kind thing. Yeah. And then you can see the bottom really is the measurable skill gains, that MSG rate. And if you go over to, say fiscal year twenty five, you see the 57.6, which basically is a measure of the skill gains compared to 52.2 for the nation. If we go to page 46, you're going to see, through higher ability, similar comparison to the nation where we are exceeding earnings and measurable skill gains compared to

[Chair Robin Scheu]: People go through I'm just seeing it now. Five sixty three individuals closed their cases in fiscal year 'twenty five, how long is a case? So, I mean, of those, it's been two or three years and the cases are closed, does it span fiscal years or is it within one fiscal Well,

[Commissioner Angela Jill Rowan (DAIL)]: I think it's variable. It might span fiscal years. And everybody needs something different, sometimes there are hits and starts. But it can be also brief. I mean, the idea is that you're working on an end goal and they reach their end goal and they're successful in that employment.

[Chair Robin Scheu]: I have met one person who went through this program, and I'm not from Chittenden County, but maybe that's where they got their cream, because you said it's only in two counties right now. Or is it more now?

[Commissioner Angela Jill Rowan (DAIL)]: Is Viability? Viability is, of course.

[Chair Robin Scheu]: I guess there was something I saw.

[Commissioner Angela Jill Rowan (DAIL)]: Even thinking of the opioid response, is now broader, and I'm going to talk to you about that.

[Chair Robin Scheu]: All right. Well, I think we've maybe gone through that anyway. Thrilled with the program. Absolutely thrilled with the program and is so happy to be working and has a great job. It was just really nice to meet somebody who'd been through it.

[Commissioner Angela Jill Rowan (DAIL)]: Well, you know who else is thrilled with the program? The business community. Oh, excellent. We get such great feedback from the business community saying this has really worked for them. Hire really, really works with the Department of Labor very closely, and they look at where there are holes, what are the needs of our business community? And we train folks so that they can even sometimes get credentials and then be able to meet that need? We just have had such really positive feedback from the business community. So it's a win win.

[Chair Robin Scheu]: That is a win win. Great.

[Commissioner Angela Jill Rowan (DAIL)]: So the reason the opioid recovery, which just happens to be on the next page, the opioid recovery pilot has expanded now to more than just the two. I think we're at five different locations. And again, we did mention that before, but it is a real also a win win. And now we can go to page 48 where we can give you a summary of our budget. So for

[Chair Robin Scheu]: For all these pretty standard, you know, the increases for salary, etc. At all? Any new initiatives in here? Are there just somewhere else you've got?

[Commissioner Angela Jill Rowan (DAIL)]: The additional opioid response baseline is new, and that's the only initiative, right?

[Bill Kelly, Finance Director (DAIL)]: Yeah, no, it's standard. Okay.

[Commissioner Angela Jill Rowan (DAIL)]: So, and also the breakdown is not like the percentage that for by division is not significantly different.

[Chair Robin Scheu]: Were there any programs as you went through deciding, know, was great to hear from the secretary about how you all worked together. As a result of those conversations, there any programs that you're either changing or not continuing going forward? There are

[Commissioner Angela Jill Rowan (DAIL)]: some, not really changes to a program, but there were some efficiencies that we found that really don't have an impact on individuals served, or the providers. We can go through that in the next, because you can see, let's just go to the next page, because some of the questions you're asking.

[Rep. David Yacovone]: We're on 49 now or 50? Yeah. Thank you. Thank you. Yeah.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah. It's 49 where we have the like Oh,

[Chair Robin Scheu]: this is the '29 first.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah. This This is the changes from last year to this year. So the, right, which is a little over $31,000,000. So these are the changes. Yeah. I don't know.

[Chair Robin Scheu]: So for example, I see that you're taking a million out of the adult day rehab services? The

[Commissioner Angela Jill Rowan (DAIL)]: adult day services, they help in rehab, that's what it's called. Again, no impact on providers or consumers. Fewer people are utilizing this service, and that's now been a pattern for a bit of time. We are working to encourage more people to use that service. It is a really important part of the continuum, and it is active, and it is serving well. Just not as many as we're both hopeful. Not as many as pre pandemic. Some people just didn't want to come back. Yeah. Okay. Good.

[Deputy Commissioner Angela Smith (DAIL)]: And the day health rehab services, adult day health rehab is a state Medicaid benefit. It's not choices for care. In choices for care, we're seeing a slow increase in use of adult day. But in the day health rehab setting, we're not.

[Rep. David Yacovone]: Dave? I don't disagree that if people aren't using the service, they shouldn't fund it, And that's what I think is happening here.

[Commissioner Angela Jill Rowan (DAIL)]: We're just pulling back money that wasn't being utilized. Wasn't being used.

[Chair Robin Scheu]: Right. The program's not going away,

[Commissioner Angela Jill Rowan (DAIL)]: it's just smaller. And if the utilization changes, then we would adjust that.

[Rep. David Yacovone]: Okay. What trying to discern, I don't know the order of magnitude is, or they're not, but you know, is this a 5% overall reduction to their budget? Is it a 20%? Cause if I'm an adult day and I'm serving 20 people, I guess I wasn't getting the money anyways, if they weren't coming in. So financially, I don't think there'll be an adverse impact, but if I was getting the money and now it's gone, will I be able to keep the lights on for the remaining 16?

[Chair Robin Scheu]: You know what I'm

[Rep. David Yacovone]: trying to articulate? Yeah, so

[Bill Kelly, Finance Director (DAIL)]: I could give some context. Thank you. There's approximately 3,300,000.0 appropriated for this program. In 'twenty $31,000,000 was spent. In 'twenty four, 1,500,000.0. In '25 1,800,000.0. So the increase is slowly increasing but not near what's appropriated. This million dollar reduction still allows for additional increase in utilization. It wasn't money that the adult days were getting anyway because it wasn't being utilized.

[Rep. David Yacovone]: Thank you. Thank you. That helps. Okay.

[Commissioner Angela Jill Rowan (DAIL)]: So some of these other ones that you're seeing here in red are sort of technical, maybe interdepartmental transfers or move from one fund to another. If you go to the next page, the ARRIS payroll, which did come up, I think, yesterday. Oh, yes.

[Chair Robin Scheu]: Trying to figure out what that was.

[Commissioner Angela Jill Rowan (DAIL)]: It's basically, payroll benefit withholds at ARRIS, which was more than what they needed over time. So we're pulling some portion of that.

[Bill Kelly, Finance Director (DAIL)]: Then,

[Commissioner Angela Jill Rowan (DAIL)]: again, just the budget to actuals adjustment on the federal funds. So those are technical issues. You're going to see errors come up in a couple of different places just because it's the

[Chair Robin Scheu]: same issue. They just serve a different line. So are you worried about other federal funds impacts, losses at this point?

[Bill Kelly, Finance Director (DAIL)]: I want to make a point that anywhere you see an adjustment to federal fund, it's not because at the federal source the award went down. It's I'm adjusting the spending authority according to utilization that we know. That's all that is.

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: Yes. So I appreciate that,

[Chair Robin Scheu]: and I'm asking a different question.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah, I got that question. So we do have some concern, which is really just new information, that it might a reduction to how money follows the person, which is federal funds gets funded. But it's not clear yet exactly what that would be or what that impact would be. We're working with CMS on it. But for the most part, in our programs, we haven't had a significant negative impact. You'll see that in other departments.

[Bill Kelly, Finance Director (DAIL)]: We haven't any.

[Commissioner Angela Jill Rowan (DAIL)]: This is the first thing where we're like, wait a minute, and it's not like the program's going away. It's just the way in which they're talking about sort of reorganizing it might have an impact on us. It's not clear yet. But that was the first time we really had any it's been really for us.

[Rep. David Yacovone]: Okay. Great.

[Commissioner Angela Jill Rowan (DAIL)]: But we were eyes wide open.

[Chair Robin Scheu]: I'm sure. I'm sure you're thinking of it.

[Commissioner Angela Jill Rowan (DAIL)]: Paying attention.

[Rep. Thomas Stevens]: I'm just trying to get the budget a little bit down this year total. What's the total? We don't have an ups and downs so it's kind of there might be

[Bill Kelly, Finance Director (DAIL)]: some point here right at the top of this section there's a change from six to seven

[Chair Robin Scheu]: what page are you on

[Commissioner Angela Jill Rowan (DAIL)]: 49

[Bill Kelly, Finance Director (DAIL)]: And so the budget's increasing over $31,000,000 gross.

[Commissioner Angela Jill Rowan (DAIL)]: Yeah, that's the increase. The budget itself is $8.29. $829,000,007 and 46. That's the page before. If you go to 40

[Deputy Commissioner Angela Smith (DAIL)]: Oh, yes. So we can see it for each of the Well,

[Commissioner Angela Jill Rowan (DAIL)]: up at the top of the previous page. Go to the previous page. Up at the top.

[Chair Robin Scheu]: On page 48 there.

[Commissioner Angela Jill Rowan (DAIL)]: On page 48. I don't know. That's keep going there. It stops. That's the budget for fiscal year twenty seven. It is higher.

[Rep. Thomas Stevens]: Well, I was looking at last year's budget, I didn't see where the I never saw that big number, $829,000,000. And then I saw other parts. Was looking at $3.46 to $8.58, which matches up. So I see a lot of them stay about the same.

[Commissioner Angela Jill Rowan (DAIL)]: Right. Well, we have a $31,000,000 we have caseload and utilization pressures. Have nursing homes.

[Chair Robin Scheu]: Everybody's major driver is the caseload and utilization.

[Commissioner Angela Jill Rowan (DAIL)]: And nursing home pressures are part of that. Inflation, statutory required

[Chair Robin Scheu]: Of the eight '29 or eight thirty, how much of that is federal?

[Commissioner Angela Jill Rowan (DAIL)]: Okay, so the fund split, federal on that same page, 48, you can see the breakdown by division.

[Rep. Thomas Stevens]: Do you have a So I'll give you

[Chair Robin Scheu]: The percent. The 5%. Okay.

[Bill Kelly, Finance Director (DAIL)]: So from here federal, not including Medicaid, of the $829.54.200000.0 is federal funds.

[Commissioner Angela Jill Rowan (DAIL)]: But then this global commitment, which we have a map.

[Chair Robin Scheu]: That's a gross number, right? So I'm looking what is the Medicaid or the side of that. I'm trying to figure out how much of this is actually general fund of the eight So point the general funds, okay.

[Bill Kelly, Finance Director (DAIL)]: Pure general fund outside of global commitment, it's 39,100,000.0.

[Commissioner Angela Jill Rowan (DAIL)]: Which is 4.7%.

[Bill Kelly, Finance Director (DAIL)]: Then there's approximately I don't know the match rate right up. Approximately 43% of of $730,000,000 global commitment funds is general fund.

[Chair Robin Scheu]: Okay, in addition to, yeah.

[Rep. Thomas Stevens]: So total general fund would be worth $769,000,000

[Chair Robin Scheu]: Actually, the spreadsheet that whether it was Tracy that handed out or Secretary Sanderson has the gross and go buy requirement. It's a great new spreadsheet. It's handed out.

[Commissioner Angela Jill Rowan (DAIL)]: Yep, we're in there.

[Chair Robin Scheu]: So that's how I get

[Deputy Commissioner Angela Smith (DAIL)]: my answer.

[Chair Robin Scheu]: Yep, remember this that you got yesterday.

[Commissioner Angela Jill Rowan (DAIL)]: Yes, that includes everything. Right. Now you need

[Chair Robin Scheu]: a nice summary. You need an

[Commissioner Angela Jill Rowan (DAIL)]: eye or so.

[Chair Robin Scheu]: Well actually somebody gave me a bigger spreadsheet so I have get a little bit better.

[Commissioner Angela Jill Rowan (DAIL)]: Listen, my spreadsheets are I fell in love with 11 by 17.

[Deputy Commissioner Angela Smith (DAIL)]: Yes, they're wonderful things. I

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: can't remember how your budget looked last year but the EFR line item does that only appear in the budget adjustment and

[Chair Robin Scheu]: do you have any sense of what that looks like being submitted? This year? In FY twenty twenty

[Commissioner Angela Jill Rowan (DAIL)]: Yeah, so it's been in the BAA because it's hard to know exactly what it's going to be, right? And it did go our ASC if BAA went down from 21, I think, last year to 14 in this BAA. So yes, making some progress. But we will, again, be faced with EFRs this year. Yeah,

[Bill Kelly, Finance Director (DAIL)]: you've done, say, even since global COVID, In five years, we've gone from two or three million to a height in twenty three of eighteen million. You know, it's such a wide ranging number that with the report, with the EFRs going forward, that we also hope would go back to, you know, just a couple million dollars.

[Commissioner Angela Jill Rowan (DAIL)]: This year. Wouldn't happen if you're about 27. Yeah. Right.

[Bill Kelly, Finance Director (DAIL)]: You know it'll take a while for that to go down, but we don't know in advance.

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: I understand that. Think that there are lots of unknowns and lots of budgets and that line item, I mean we just keep coming back to it, it's standard part now of every budget adjustment. And I just, I'm trying to work out in my own mind, is it better budgeting to have a line item there for that? I know it's hard to make the numbers work, but then we're faced with the challenge of trying to find that money in the following, mid year and the following year, which might be a much even tighter year. So I'm raising it as a question just as our committee.

[Bill Kelly, Finance Director (DAIL)]: Yeah, well, would answer it from a language point of view. Just remember that Choice for Care has a reinvestment language to it. So with an item that this big that fluctuates from year to year, and we hope will continue to decrease, there's language in there that anything unused ends up being part of a calculation for reinvestment. And we wouldn't want this large of an unobligated potentially number being calculated into a reinvestment dollar and not for the intended purpose of an EFR. So it gets complicated with the associated language governing choices for care.

[Commissioner Angela Jill Rowan (DAIL)]: That has been raised before and after lots of conversation. It keeps going in.

[Rep. David Yacovone]: Dave? It's probably here, I just can't see it though, but developmental services, can you tell me how much that's increasing? I see it's $367,000,000 is the proposed, right? Page down. Page down? Yeah. Go to that one. Go down. Keep

[Commissioner Angela Jill Rowan (DAIL)]: going down. Keep

[Rep. Thomas Stevens]: Right going here.

[Commissioner Angela Jill Rowan (DAIL)]: You can find it on page 50. Okay. 8.1. 8.2, almost 8.2. That on Kascen?

[Chair Robin Scheu]: Three fifty to $3.58. That's right. So it's about an $8,000,000 increase.

[Commissioner Angela Jill Rowan (DAIL)]: And you'll see there where it says total changes, mid page of 50, that's for the developmental services section, B333.

[Rep. David Yacovone]: And is that just caseload?

[Commissioner Angela Jill Rowan (DAIL)]: It's If you go look here, number one is caseload. Yep. So the first two line items, one and two, DS caseload, and then the public safety specific caseload.

[Rep. David Yacovone]: Okay. So there's no, Chris, we all know the answer, but there's no wage increase for the caregivers. They're level funded, no COLA. You're talking

[Commissioner Angela Jill Rowan (DAIL)]: about the providers, the caregivers? You talking about the caregivers, okay.

[Rep. David Yacovone]: Well, yes, the people who do provide the care in the field, some are direct service by the families, and some are in the providers. Is there any increase for them? No. None, okay. Not for choices for care or developmental, okay. Thank you.

[Chair Robin Scheu]: That's the statutory nursing home inflationary increase. Great. And is that our statute or federal statute? Vermont.

[Rep. Thomas Stevens]: Wayne? So where will we find the bulk of the $31,000,000 that's up?

[Commissioner Angela Jill Rowan (DAIL)]: Say that again.

[Rep. Thomas Stevens]: $31,000,000 up, that's above last year's budget. What categories would the bulk of that be in? Is there any one single one that has the bulk?

[Commissioner Angela Jill Rowan (DAIL)]: I think you would find I'm sorry, adult services and DS. Adult services. And developmental service.

[Bill Kelly, Finance Director (DAIL)]: Yeah, a very lighter.

[Chair Robin Scheu]: The caseload and utilization those courses.

[Deputy Commissioner Angela Smith (DAIL)]: So at the top

[Chair Robin Scheu]: of page 50, for example, the caseload for GDS

[Commissioner Angela Jill Rowan (DAIL)]: The choices of care is half of it.

[Chair Robin Scheu]: Is $10,000,000. If you go to

[Commissioner Angela Jill Rowan (DAIL)]: the bottom of page 58 for Choices for Care, you're gonna see about half of it there.

[Bill Kelly, Finance Director (DAIL)]: Yeah. The Choices for Care program and the Developmental Services program together is 8590% of our budget. So between choice for care and developmental services, there's 22,000,023 million dollars of the 31

[Commissioner Angela Jill Rowan (DAIL)]: Other

[Chair Robin Scheu]: questions? Is there more that

[Commissioner Angela Jill Rowan (DAIL)]: you want to? Share? Well, I do want to bring you to the back, if we can, to the performance measures. There were several things that were asked for here, but we did this even before we were asked, but we were really glad to, be able We to do have this, item by item. We have it lined up. So it would be something great if you have, again, I think you're going have to wait for the summer when you're laying on the beach, because this is such good reading. But we have program summary that gives you who we're serving, then the description of the program, the division, the performance measure, and then this year's proposed budget specific to each program. And

[Chair Robin Scheu]: it's good to know the volumes, but it's also good to know about satisfaction or that they feel like they've had a positive impact on their lives. And these are sometimes hard to measure. Yeah, in the document is also, We didn't go through every page of the document,

[Commissioner Angela Jill Rowan (DAIL)]: but there are things that says, Are we doing better? How are we doing? There's a section, and that helps to show you that. But everything in is these, this appendix that really goes through the program.

[Deputy Commissioner Angela Smith (DAIL)]: So where we have that available, we've included it in the summary, for example, SACH outcomes, home share outcomes, those types of things are all included in the report.

[Chair Robin Scheu]: That's good, and some of these, I think, when you have numbers, it's good to know how many are served, but how are you defining success? And do you have a way to define success for some of these areas?

[Commissioner Angela Jill Rowan (DAIL)]: It's different between the output and the outcome, and we recognize that. Wherever we have outcomes, we are reporting it, and if we don't, then we are trying to develop it. And some of that will come through some of the new initiatives from last year, Complex Free, quality the of data analysts, they were five of them, and we're just about there with hiring those. I got nuts over there, yes. But that's going to help those sorts of approaches. Some of it we do have outcomes for, like when we look at the work that we do in the GA program with homeless, we're looking very closely at outcomes like where do the people that are served through our programs that were experiencing homelessness, where did they go after we intervened? We do know how many went to another apartment, how many went to a nursing home, how many went to a residential care, wherever they went, we are tracking that. So we are very interested in outcomes. Great.

[Rep. David Yacovone]: John, you have a question?

[Rep. Thomas Stevens]: Just real quick, after seeing all the data tied in that performance here, anything, any surprises for you?

[Commissioner Angela Jill Rowan (DAIL)]: I mean, nothing that's, like, blowing us away. No. Because I mean And

[Rep. Thomas Stevens]: you kinda set what you're which where

[Bill Kelly, Finance Director (DAIL)]: you wanna go here for

[Commissioner Angela Jill Rowan (DAIL)]: Well, yeah. I mean, where we set targets. But So there's a lot of work still to be done to set, like, their targets across the board. But I don't think there's any major surprises. We're very close to the ground, dear folks. And so it's not really a surprise because we certainly know where the sticking points are. So if we're seeing a problem, we're usually not surprised that that's there or that there's a gap somewhere. Which kind

[Rep. Thomas Stevens]: of where we are?

[Commissioner Angela Jill Rowan (DAIL)]: Well, we have a strategic planning process that we do. So we look at this data very closely. In fact, we have a developmental disabilities annual report to the legislature that is due in February. That's going have more data in it, probably than we've had before, because we're really trying to look at what is happening in that space. But I wouldn't say that we're being blown away by the data that is showing us something really very significantly different than what we're seeing, at least not yet. So

[Chair Robin Scheu]: we know that the one new initiative is expanding the opioid program. You're reducing utilization dollars for the adult day rehab, but that's available to come back if needed. Is

[Deputy Commissioner Angela Smith (DAIL)]: there any one time money

[Chair Robin Scheu]: that is in the budget, or

[Commissioner Angela Jill Rowan (DAIL)]: is this just all your base budget? Yeah, and this is the other sort of new, it's the ADS statute that has to be finalized. The adult protective surgeons and caregivers? Yes,

[Chair Robin Scheu]: And then you're continuing to work on, I guess another initiative, working on the payment reform and the continued smooth rollout of the conflict free business.

[Commissioner Angela Jill Rowan (DAIL)]: Yes, this is implementation. This is implementation, right? It's a new initiative this year. Right, but it's a big deal. Yes, implementation is a big deal.

[Deputy Commissioner Angela Smith (DAIL)]: I'd say rural health transformation, Dale will also play a role in that and be supporting some of the initiatives around long term care.

[Commissioner Angela Jill Rowan (DAIL)]: Yes, there are some things that are embedded. We also will be working with the GA system. So there will be some that come under us that may go through DCF and then come to us, but it's around the old medically vulnerable, many of whom are older providers, and our approach is there to standing up medically vulnerable shelters specific to the needs of that population. There's that, although it's not coming directly into our budget. And then the rural health transformation, there are two programs there that we will be supporting, searing. One is around dialysis events that I had spoken about, and the other is about training, especially around LMATE.

[Chair Robin Scheu]: And you're feeling comfortable that you can handle all that within your current budget or your current staff or whatever you're going to get from this? Because I know that we're going have to spend all that $195,000,000 by September 2027, so it's not a very long time to get all the money

[Commissioner Angela Jill Rowan (DAIL)]: out It's of an intensive effort, but worth it.

[Bill Kelly, Finance Director (DAIL)]: I just have one slight correction here. The opioid, as you know, we've had funding for that previous years. So what's it's not really a new initiative. It's a continue

[Rep. David Yacovone]: Okay.

[Bill Kelly, Finance Director (DAIL)]: And what's new is it's now being base budgeted. Was opioid a slight correction.

[Commissioner Angela Jill Rowan (DAIL)]: It was opioid settlement dollars, and now it's coming into Base. Yeah. It's all

[Bill Kelly, Finance Director (DAIL)]: this is the '27 budget, so we're continuing that five it's already at that level.

[Commissioner Angela Jill Rowan (DAIL)]: Okay. Right so we're good with that.

[Chair Robin Scheu]: Other questions for anybody?

[Rep. Thomas Stevens]: After an hour I figured things out I'm used to looking at ups and downs

[Chair Robin Scheu]: I know we're all getting used to having

[Rep. Thomas Stevens]: different Figured out how it works on this way

[Chair Robin Scheu]: Okay I'm

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: wondering, so there's a built in annual adjustment for nursing homes. And David asked about caregivers. And I'm just wondering, are there any Do you give annual adjustments to any of the contracts? I'm just looking right now at the screen, legal aid, at that 700 ks. My sense is that is the same, it's level funded. That contract with the ombudsman is level funded. I guess I'm wondering, are there any other providers that are either just in the system or under contract that have gotten an increase to reflect inflation and etc. We're in

[Commissioner Angela Jill Rowan (DAIL)]: negotiation right now. The CBA. Yeah, it's the CBA, we're in negotiation with them right now. CBA, which is the they're independent

[Chair Robin Scheu]: Independent direct support workers. Yeah, so

[Commissioner Angela Jill Rowan (DAIL)]: manage sort of that contract with the independent support workers, and so we are in negotiations.

[Chair Robin Scheu]: Their In general, their budgets have not included rate increases for home and community based services, caregivers. Some of these others, we just

[Unidentified Committee Member (possibly Rep. Tiffany Bluemle or Vice Chair Martha Feltus)]: have not picked up. Which makes employment in those fields really difficult. It runs counter to the goals that you've stated early on for workforce development.

[Commissioner Angela Jill Rowan (DAIL)]: I mean, rates get adjusted as appropriate, and now we have standardized rates in some of our programs. So there are administrative pieces of that. But to your answer, no, it's not built in like with the nursing home, which is by statute. Yeah, that's by statute.

[Rep. David Yacovone]: Else by anybody? I just wanted to on the org chart, I'm not supposed to mention names probably, but a remarkable person heads up the division of vocational rehabilitation. And I think she's been there a while. Diane? Yes,

[Commissioner Angela Jill Rowan (DAIL)]: Diane is amazing. Fifty years? Fifty plus years.

[Rep. David Yacovone]: Fifty years. She's awesome. She's still And she's only 62, and she's

[Chair Robin Scheu]: I did a science program.

[Rep. David Yacovone]: She's an extraordinary state employee. A

[Commissioner Angela Jill Rowan (DAIL)]: shout out. I mean, hireability is more than I think people really understand that it is. That's why I like to talk, like, opioid employment program, the employee assistance program. I mean, it's really quite an entity that has such an impact. The work that they do includes transition for students coming out of school with a whole range of disabilities. They focus not just on job opportunities, but career opportunities for folks with disabilities. They are world class, absolutely, and recognize this. Yeah. And she is an extraordinary leader.

[Chair Robin Scheu]: You tell her I said hello. I sure will. She's

[Commissioner Angela Jill Rowan (DAIL)]: now got this, hey, I think we're all now. Yeah. Some people say, oh, when I grow up, I want to be Diane. Don't know. But I'll be there for the Yeah, next year to she's still enjoying herself. She loves the work and

[Chair Robin Scheu]: she's That's great. That's great. Well, thank you all for coming in. Thank you all for supporting programs and for all the good work you do for the doctors. So we appreciate it.

[Rep. David Yacovone]: And

[Chair Robin Scheu]: Dave is your contact. If there are questions, you may hear from him and we'll funnel our questions to Dave. So committee, this is an opportunity. We're going to be back here at 01:00 with ADS, but we want to, this is also some time to work on your budgets, sort of get familiar now that we're through budget adjustment, figure out what your budgets are, who you need to talk to, check the agendas of the committees, whose portfolio we have, and if if they take somebody in, if you want to hear, let me know and go off and go do that because you're there to ask people to do So

[Rep. Thomas Stevens]: I do I did get a request from a shared jerky to about the budget we agreed with. Great.

[Chair Robin Scheu]: She will. So please go ahead and do that. Think a lot of us are being asked to go to the city staff.