Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair)]: This is the House Appropriations Committee. It is Tuesday, 02/03/2026. It is 03:40PM, and we're going to change tack a little bit and talk about a bill, H611, and we have Jen Carvey from Legislative Council here and we will get copies of the bill momentarily, but in the meantime, I don't know if you want to share the screen. Jen, introduce yourself and tell us what we're looking at, please.

[Jen Carvey (Office of Legislative Counsel)]: Great. For the record, Jen Carvey from the Office of Legislative Counsel. This is H611 as recommended by the House Health Care Committee. It's a strike all amendment, although it doesn't change too much from the bill as introduced. It has a number of different sections. It's an act relating to miscellaneous provisions affecting the Department of Vermont Health Access. So for the most part, this is sort of what we were referring to as the DBA Housekeeping Bill. The first section is a very long section, but what it does is take DIVA and take Medicaid out of the scope of an existing statute on prescription drugs, cost transparency that has health insurers and with a certain number of covered lives in the state for major medical health insurance and Medicaid report annually to the Attorney General's Office on 10 prescription drugs for which the cost has increased significantly over a fairly short period of time. And then the idea behind this language when it was passed was the Attorney General's Office would then approach each of the manufacturers, ask them for a lot of information. In practice, it's been very difficult to get that information. And you can see there's an annual report that gets posted on the legislative website from the Attorney General's office basically saying yeah there's a lot of stuff that goes into drug pricing and we try to get information but we can't really. So apparently my understanding is that having the Medicaid information has not been particularly helpful because there's a different way that drugs get priced in Medicaid anyway. And so having Diva spend a lot of time tracking down this particular information and reporting to the Attorney General's office was not seen as having a particular positive impact. So it would just strike all the language having to do with Deeva.

[Rep. Robin Scheu (Chair)]: Okay.

[Jen Carvey (Office of Legislative Counsel)]: Really what the first five pages, I think, or so does. Six pages.

[Rep. Robin Scheu (Chair)]: Yes.

[Jen Carvey (Office of Legislative Counsel)]: Just that section. Section two would delete a section from legislation that was passed last year around 340B prescription drug pricing and 340B covered entities and the pharmacies that they contract with. And it prevents or prohibits certain discrimination against 340B drug entities by drug manufacturers. One of the provisions of our law passed last year that says a manufacturer is a drug manufacturer or its agent has to make the 340B drug pricing available to a 340B covered entity or its contract pharmacy in the form of a discount at the time of purchase and not a rebate to be collected later. There have been a number of challenges. We are currently in litigation on our 340B provisions passed last year. As a number of other states have as well, most of the provisions that we have in ours have been the majority of the courts have upheld those. But this piece, there's only two cases that have been completed on this, and it has not gone well for those states. So there's a suggestion to just take this language out of our statute. We're actually currently under preliminary injunction anyway on this piece where we're not allowed to enforce it. So the suggestion is just take this out of the law and avoid having that problem. So that's Section two. Section three makes some changes to the Medicaid and Exchange Advisory Committee based on some new federal requirements. So we do have this combined Medicaid and Exchange Advisory Committee that is required by federal law. There's a fairly new requirement that this committee, at least our Medicaid Advisory Committee, include individuals who are also members of the new Beneficiary Advisory Committee required by federal law. So this is making sure that those folks are in there and eliminating language about the commissioner reappointing members to serve more than one term. Specifically, call Diva's rationale for that.

[Rep. Robin Scheu (Chair)]: Representatives of those eligible for or enrolled in both health plans. So it could be individuals.

[Jen Carvey (Office of Legislative Counsel)]: Yeah, actually, and then in 2B2, there is really just making the language clearer. So under existing law, the remaining members, a quarter of them have to be from certain constituencies. And one says individuals, self employed individuals, health insurance brokers and agents, and representatives of business eligible for or enrolled in the exchange. This would change that to representatives of the first three groups and then representatives of small business owners and employees.

[Rep. Robin Scheu (Chair)]: So are there per diems involved?

[Jen Carvey (Office of Legislative Counsel)]: Believe there are for people who are not otherwise compensated for their participation. But this isn't changing the number of those people. It's just clarifying the language about who's a representative of whom.

[Rep. Robin Scheu (Chair)]: That's where I can see the reason it would come to us. Don't think this is

[Jen Carvey (Office of Legislative Counsel)]: the one I get to the part. I'll maybe check-in with the clerk's office, and I understand it is the dollar figure that is in here, but it is not really a dollar figure that affects the state budget. There are a few arguably, so that there is a couple of sections, you'll see that there's the potential to expand the size of the Clinical Utilization Review Board that could have a per diem's impact. There's also a provision later in the bill that extends by a year of the date for when the DIVA has to seek a state plan amendment to start covering doula services in the Medicaid plan. The delay of that could arguably have a fiscal impact. But I think the real reason it's here is just based on a misunderstanding. But there's some tangential things, so we'll make sure you understand it. Section four is really just a sort of a housekeeping, a real housekeeping change. Last year when U of the legislature permanently unmerged the individual and small group health insurance markets, we should have made a similar change to the language on the reflective health benefit plans because these people don't need the reflective benefit plans because they're not getting subsidies. So this is just striking out employees of small employers as people who would be offered these plans. Section five is the Clinical Utilization Review Board. This is a group in the Department or the Department of Vermont Health Access on services and evidence base evidence basis for coverage and whether they want to make some recommends making changes on coverage, place of service, medical necessity, etc. The first change here is to make the existing 10 members a minimum, not a hard cap, although it sounds like Diva doesn't have any plans to expand that but wanted some more flexibility. There's just some terminology updates and cleanup language for the fact that this board was set up in 2010 and doesn't need some of its implementation language in it anymore and still allowing the board terms to be staggered. Section six was a request from the Office of the Healthcare Advocate and this has to do with the way household income is calculated for B Farm, which is one of the prescription drug assistance programs for older Vermonters under the Medicaid program. And it's my understanding that this again is sort of a cleanup change that the language in the statute talks about somebody having household income calculated using modified adjusted gross income, but that is in fact never the way income has been calculated for VFARM purposes. So this would strike that reference to using modified adjusted gross income. Section seven, this is the one I think is why the bill is here. But again, I don't think it is a I don't think it's a cost to the state of FISC. So this is allowing subject to approval from the Centers for Medicare and Medicaid Services. It is directing the agency of human services to amend its rules and procedures. Currently, certain Medicaid applicants and recipients are able to preserve monies for funeral and burial expenses. And by putting away thousand dollars more than $10,000 this would allow them to put away not more than $15,000 in an irrevocable prepaid funeral arrangement, which is something we have in statute with certain requirements around Medicaid estate recovery. So requiring that the written contract for the Prepaid Funeral Arrangement include a provision saying that Vermont Medicaid gets anything remaining after payment of the deceased individual's expenses up to an amount equal to the total Medicaid amount paid on behalf of the deceased individual. And I think some of this is already the way they operationalize it, but this is putting Medicaid estate recovery sort of front and center. In the event that the person responsible for making the funeral arrangements for the deceased individual fails to have funeral services provided, then the funeral director gets to keep a certain amount that's set forth in the specific statute. And then Vermont Medicaid would get the balance, again, up to an amount equal to the total Medicaid amount paid on behalf of the deceased individual. And assuming we get CMS approval, these rules amended rules and procedures would apply to prepaid funeral arrangements entered on or after 07/01/2027. So I've closed through some of the estate recovery and with the increased set aside, it's possible that there could be some modest benefit

[Rep. Trevor Squirrell (Clerk)]: to it. So Wayne is the question. Yeah, well, first I look at the word preserve monies. Preserve. Is new formalin or what?

[Rep. Wayne Laroche (Member)]: Obviously

[Jen Carvey (Office of Legislative Counsel)]: Just set aside. Yep. I think it's the language that they use in their rules.

[Rep. Wayne Laroche (Member)]: So anyway, so you've got Medicaid applicants and recipients. It means they haven't received the money yet, right? Nobody's been transferred hands.

[Jen Carvey (Office of Legislative Counsel)]: So you're talking about if they're an applicant?

[Rep. Wayne Laroche (Member)]: Yeah, they're applicants.

[Jen Carvey (Office of Legislative Counsel)]: It's just what they can It doesn't disqualify them from eligibility for Medicaid if they put this much money away as far as looking at the resources available to them. So what I'm getting at is they could reserve a certain amount of money in their Medicaid. Is this money that will be paid and that they will reserve in there? Is this a paper thing where they fill out a form and they're reserving so much of their benefit for this purpose? I believe the way the prepaid burial arrangements work is you give your money to the funeral home or whatever it is and they it's sort of you're prepaying your funeral expenses.

[Rep. Robin Scheu (Chair)]: Are you asking if they use Medicaid money for it?

[Jen Carvey (Office of Legislative Counsel)]: They're not using Medicaid money for it. This is their own money, their own assets.

[Rep. Wayne Laroche (Member)]: Okay, so this has nothing to do with Medicaid, has nothing to do with the appropriations?

[Jen Carvey (Office of Legislative Counsel)]: It does have to do with Medicaid in the sense that it's allowing somebody to keep more money and still keep more money in this certain type of account while for arrangement while still being eligible for Medicaid because they're otherwise eligible for Medicaid.

[Rep. Robin Scheu (Chair)]: It doesn't count against them when you look at the assets.

[Rep. Wayne Laroche (Member)]: Right, I understand. So the 10,000 or the 15,000 limit that's money that they pay to the funeral. Correct. That's their money. So yeah, that's nothing that we have

[Rep. Robin Scheu (Chair)]: to It's not coming out

[Jen Carvey (Office of Legislative Counsel)]: of what you're appropriating, but it is putting Medicaid, specifying and requiring that the written contracts for these arrangements put Medicaid estate recovery or Medicaid comes back in and gets some of the money that they back when somebody passes away if they still have the person still has money. Medicaid recovers some of what they've spent on behalf of that person on the Medicaid program from their estate. And so it's basically, you can't avoid Medicaid estate recovery by putting money in your prepaid burial account. If there's money left, Medicaid still gets its spot in line. So again, so really, this is the only time money will change hands other than them giving money to their own money to it is when after they're deceased and the state tries to recover some of the Medicaid money. Right. That's left in that account, for the wasn't spent on the funeral. Dave.

[Rep. David Yacovone (Member)]: I think you're right, and I apologize. Earlier I said, I think you're right, but I just want to walk through this, because I get confused as I think about it.

[Rep. Robin Scheu (Chair)]: Is this your bill too, Dave? Unfortunately.

[Jen Carvey (Office of Legislative Counsel)]: There's nobody from here, there's anybody.

[Rep. Robin Scheu (Chair)]: That's why I'm not sure yet.

[Rep. David Yacovone (Member)]: I think she's right, no effect. So, today, if I go in and apply for Medicaid, and I have $15,000 to my name, I'm not eligible until I have to spend it down, I think, to 2,500, a certain amount. 2,500. And then Medicaid starts paying my bill. So tomorrow, I've got 15,000 to my name. I put it all into the prepaid burial. Medicaid started paying immediately. So my way of thinking is, it used to be 10. Right. Now it's 15. Right. So isn't a liability, let's try to work, to Medicaid is 5,000 more than it used to be for X number of people.

[Jen Carvey (Office of Legislative Counsel)]: I don't know, that's a lie. Just, it allows somebody to qualify incrementally faster for Medicaid if they had this kind of arrangement because they put an additional 5,000 of their countable assets into a prepaid funeral.

[Rep. Robin Scheu (Chair)]: They don't put any Medicaid money in. Not Medicaid money. Frankly, you could have a relative, I'm guessing, put the $15,000 in for you. It's in your name, maybe. I don't know if that's right. It just doesn't count when they count assets for And if you don't get it back, costs less than the 15,000, it doesn't come back to you And or to Medicaid. So Medicaid, it's only used for accounting purposes.

[Jen Carvey (Office of Legislative Counsel)]: Right, it does. If you don't use all of it, then Medicaid can come after it as part of a state recovery.

[Rep. Robin Scheu (Chair)]: But they never had it in the first place. It's just a gain for Medicaid.

[Jen Carvey (Office of Legislative Counsel)]: Right. But they can, I mean, they come after somebody's estate for people Yes, who are on long term care they can do a state recovery anyway? So if the person was on choices for care and was living in their home and the home gets sold, only certain amounts are excludable, and Medicaid does a state recovery Exactly pay into this.

[Rep. Wayne Laroche (Member)]: Right. So what Dave's saying, so what this does is essentially allows them to start drawing Medicaid earlier than they would if they had to spend down their own money.

[Jen Carvey (Office of Legislative Counsel)]: I mean, I don't know the extent to which people are if anybody's putting anything in a prepaid funeral account. I mean, it is an option.

[Rep. Wayne Laroche (Member)]: That's the only thing that I could see, is that if they were able to draw money when they wouldn't have been able to draw money, they would take more out. But on the flip side, if they die and there's money still left in there, Medicaid's being able to recapture. Or to recapture. So whether or not that's going to be a net up or a down for anybody, who knows? So that's why I think it's safe to say,

[Rep. David Yacovone (Member)]: Madam Speaker, you remember your appropriations committee looked at the bill, we determined there's no fiscal impact on the state of Vermont's budget. That's right. And silently, somebody, it's de minimis, it's just bug

[Jen Carvey (Office of Legislative Counsel)]: Well, let's finish going through it so that you can feel confident in that statement, but- But I think if anything, maybe it's at least short term positive. So Sections eight and nine are, this is the piece I was talking about with the doula coverage. Under a bill passed last year, DIVA was directed not later than July 1 seek a state plan amendment from the Centers for Medicare and Medicaid Services to allow Medicaid to provide coverage for doula services. And then the doula coverage would take effect on the later of 07/01/2026 for approval of the state plan amendment. This is moving that the both those dates to 2027. So if we were going to get a State Plan Amendment that would have affected the '20 the FY '27 budget, Right? No, '26 budget. Where are we? No, '27 budget. I'm getting myself off the news.

[Rep. Robin Scheu (Chair)]: 07/01/2026. Right.

[Jen Carvey (Office of Legislative Counsel)]: So if we were going to have gotten a state plan amendment to allow Medicaid coverage to begin before 07/01/2027, then this would delay that. But it wasn't clear when we would get the state plan amendment in order for that coverage to begin. So it's the later of the date or approval of the State Plan Amendment. So it's entirely possible they could have applied for the State Plan Amendment by 07/01/2026 and gotten a no or gotten a come back later in which case. So it's hard to quantify whether this actually has a fiscal impact, but it delays the start date for Medicaid coverage and doula services. But if it did, when we reported the doula bill last year, would have

[Rep. David Yacovone (Member)]: been the conversation in time to discuss Medicaid impact, wouldn't it?

[Rep. Trevor Squirrell (Clerk)]: We already crossed that bridge.

[Jen Carvey (Office of Legislative Counsel)]: Yes, I mean, to the extent there was thought about it affecting the '27 budget, would now affect the '28 budget.

[Rep. Trevor Squirrell (Clerk)]: Mike, last year, did you do deal with that?

[Rep. Robin Scheu (Chair)]: Of ours?

[Rep. Trevor Squirrell (Clerk)]: No, I thought it was the

[Jen Carvey (Office of Legislative Counsel)]: No, it was from healthcare, it was a healthcare bill.

[Rep. Robin Scheu (Chair)]: But it would have come here too. Yeah. It

[Rep. David Yacovone (Member)]: might have been this morning.

[Jen Carvey (Office of Legislative Counsel)]: Okay, that's it for the

[Rep. David Yacovone (Member)]: Oh, forgive me. That's mine.

[Rep. Robin Scheu (Chair)]: Secretary of State.

[Rep. Trevor Squirrell (Clerk)]: Such a good job.

[Rep. Robin Scheu (Chair)]: Was OPR, yeah. It would have

[Rep. David Yacovone (Member)]: been Mike. Mike Mrowicki. I

[Jen Carvey (Office of Legislative Counsel)]: can tell.

[Rep. Trevor Squirrell (Clerk)]: Sorry. Not to deliver. The dude's about to do.

[Rep. Robin Scheu (Chair)]: So this is sort of a nothing to see here let's move along kind of thing. Right, think so. It's still your bill though, Dave.

[Rep. Trevor Squirrell (Clerk)]: So I'd

[Rep. David Yacovone (Member)]: go through all the motions and end up on the calendar.

[Rep. Robin Scheu (Chair)]: Yeah, so I don't feel like this is one where we need a full complement of our committee here to make a vote. And Dave is the one who needs to do it. So, are people comfortable that we took a vote on this now and moved it along, speaking of moving it along?

[Rep. David Yacovone (Member)]: You mean?

[Rep. Robin Scheu (Chair)]: I'm asking the whole. I am, I'm sure. Okay, well, yeah, I am too. I just want to be sure.

[Rep. David Yacovone (Member)]: I

[Rep. Robin Scheu (Chair)]: think that's good. So we'll get Jen to help us say the right thing. I entertain a motion to

[Jen Carvey (Office of Legislative Counsel)]: approve the bill. The bill as recommended by the committee on health care.

[Rep. Robin Scheu (Chair)]: Yeah, as amended? Well, but

[Jen Carvey (Office of Legislative Counsel)]: you're not amending it. So you want it as recommended by them. They're recommending them. Okay.

[Rep. Robin Scheu (Chair)]: Is there a motion to approve age six eleven as recommended by the Committee on Health Care? Dave? So moved. Is there a second? Wayne?

[Rep. David Yacovone (Member)]: Sorry, who read the motion? Dave.

[Rep. Trevor Squirrell (Clerk)]: I can fill this

[Rep. David Yacovone (Member)]: all out.

[Rep. Robin Scheu (Chair)]: Okay, is there any further discussion? Seeing none, the clerk may Oh,

[Rep. Trevor Squirrell (Clerk)]: Representative Bluemle?

[Rep. Robin Scheu (Chair)]: Yes.

[Rep. Trevor Squirrell (Clerk)]: Absent, Representative Feltus?

[Rep. Martha Feltus (Vice Chair)]: Yes.

[Rep. Trevor Squirrell (Clerk)]: Representative Rosh? Yes. Representative Wicki? Yes. Michael Nigro?

[Rep. Michael Nigro (Member)]: Yes. Squirrell, he does.

[Rep. Robin Scheu (Chair)]: Speedy. Out.

[Rep. Trevor Squirrell (Clerk)]: Representative Yacovone? Yes.

[Rep. David Yacovone (Member)]: Barbara Kelly Scheu?

[Rep. Robin Scheu (Chair)]: Yes.

[Rep. Trevor Squirrell (Clerk)]: 03.

[Rep. Robin Scheu (Chair)]: 803, that's good. Was this unanimous out of healthcare? It was. Okay. That's always good to know. Yes. And so Dave will be the reporter of the bill and you guys can organize emails to Nigel, whatever that has to be done. Probably go unnoticed today, tonight, tomorrow, right? On the floor Thursday. Yes,

[Jen Carvey (Office of Legislative Counsel)]: if you report it to them tonight, it'll go on notice calendar for tomorrow.

[Rep. Robin Scheu (Chair)]: Right, so it'll be on the floor Thursday, Friday. Okay. All right, Jen, thank you for coming. Sure, thank you. For telling us all about this bill. I still have a couple that we're easing our way into without too much comment. Our turn will come. Okay, so committee, that is the last item for today. Tomorrow morning at 9AM, University of Vermont will be here. We'll get to meet the new president. And then they're quick, and then Deeva's coming in at 09:30. And that's all we have for the morning tomorrow, which means there will be time for everybody to work on their budget stuff. We're trying to leave in little breaks here and there, so you can meet people or ask questions or go sit in somewhere else or whatever. And then in the afternoon, Agency of Education is coming, including the secretary who's going to come to our committee for the first time. So, and then the adjutant general is coming in at 02:15, and party's coming back. What's he coming back for?

[Rep. Trevor Squirrell (Clerk)]: For the Governor's Office. Okay.

[Rep. Robin Scheu (Chair)]: Governor's Office and then the commission on a minute. So we have a few things, but we have a little break in between and the big one will be the human services one.