Vermont Legislature SmartTranscripts:

[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 Harvey from Legislative Council here and we will get copies of the bill momentarily. But in the meantime, don't if you want to share the screen. Jackie, introduce yourself and tell us what we're looking at, please. Great.

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: For the record, Jen Carvey from the Office of Legislative Council. 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 drug 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 Dita 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. So they want the first five pages, I think, so does six pages. Yes. 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, this 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 generated. 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 recall DITA's rationale for that.

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

[Jennifer (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.

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

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

[Robin Scheu (Chair)]: That's where I can see the reason it would come to us because I

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: don't think this is the one I get to 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 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. 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 new 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 employers 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 of the Department of Remote 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 some 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 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 B farm 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 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 not 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, 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.

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

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: Set aside, yep. I think it's the language that they use in their rules.

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

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

[Trevor Squirrell (Clerk)]: Obviously if they're applicants.

[Jennifer (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

[Trevor Squirrell (Clerk)]: they could reserve a certain amount of money in their Medicaid benefit. Is this money that will be paid and that they will reserve in there or is this a paper thing where they fill out a form and they're reserving so much of their benefit for this purpose?

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: 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.

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

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

[Trevor Squirrell (Clerk)]: Okay, so this has nothing to do with Medicaid, has nothing to do with the appropriations?

[Jennifer (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 in this certain type of account while for arrangement while still being eligible for Medicaid because they're otherwise eligible for Medicaid.

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

[Trevor Squirrell (Clerk)]: Right, I understand. So the $10,000 or the $15,000 limit, that's money that they pay to the funeral. Right, that's their money. So yeah, that's nothing that we have

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: to It's not coming out of what you're appropriating, but it is putting Medicaid, specifying and requiring that the written contracts for these arrangements put Medicaid, the state recovery where 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 saying basically you can't like 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, really, this is the only time money will change hands other than them giving money to their own money to it. It's when after they're deceased and the state tries to recover some of the Medicaid money. Right. That's left in account, in that account for the wasn't spent on the funeral. Dave?

[David Yacovone (Member)]: I think you're right, 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.

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

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

[David Yacovone (Member)]: That's why I'm not sure yet.

[Trevor Squirrell (Clerk)]: I think

[David Yacovone (Member)]: she's right to go back to me. Today, 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 the 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 starts paying immediately. So my way of thinking is it used to be 10, now it's 15. So isn't the liability to Medicaid is 5,000 more than it used to be for X number of people.

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: Don't know, that's a lie. 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.

[Robin Scheu (Chair)]: They don't put any Medicaid money in. It's 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. But it just doesn't count when they count assets for it. And if you don't get it back, it costs less than the $15,000 it doesn't come back to you or to Medicaid. So Medicaid, it's only used for accounting purposes.

[Jennifer (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.

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

[Jennifer (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 estate recovery anyway? So if the person was, you know, was on choices for care and was living in their home and the home gets sold, there's, you know, certain amounts are excludable and Medicaid does a state recovery So what

[Trevor Squirrell (Clerk)]: 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.

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: I I mean, 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.

[Trevor Squirrell (Clerk)]: But that's the only thing that I could see is that they, 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 this money is still left in there, Medicaid is being able to recapture. Or for recaptures. So whether or not that's going be a net up or down for anybody, who knows? So that's why I think it's safe to say,

[David Yacovone (Member)]: Madam Speaker, you remember the appropriations committee looked at the bill, we determined there's no fiscal impact on the state of Vermont's budget.

[Robin Scheu (Chair)]: That's right.

[David Yacovone (Member)]: And silently, somebody, it's de minimis, know, it's just

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: bugged Well, let's finish going through it so that you can feel confident in that statement, but but I think if anything it may be it's a 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 to 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 both those dates to 2027. So if we were going to get a state plan amendment that would have affected the FY '27 budget. No '26 budget. No, '27 budget. I'm getting myself confused. It

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

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: So if we were 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 for 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 you know 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 bill of services.

[David Yacovone (Member)]: But if it did, when we reported the doula bill last year, would have been the conversation in time to discuss Medicaid impact, wouldn't it? We already crossed that

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

[David Yacovone (Member)]: Mike, last year, did you do little bit?

[Robin Scheu (Chair)]: Of ours?

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

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

[Robin Scheu (Chair)]: Yeah, but it would have come here too.

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: Yeah. It

[Robin Scheu (Chair)]: might have been this month.

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: That's it for the But forgive me, may

[Trevor Squirrell (Clerk)]: not have been mine.

[Robin Scheu (Chair)]: Secretary of State Was OTR, yeah. Would have been Mike. Mike Mrowicki. I

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

[Trevor Squirrell (Clerk)]: Sorry not

[David Yacovone (Member)]: to deliver.

[Trevor Squirrell (Clerk)]: The news about the delivery. So,

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

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: So, I'd

[Trevor Squirrell (Clerk)]: go through all the

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

[Robin Scheu (Chair)]: Yeah. 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 if we took a vote on this now and moved it along, speaking of moving it along?

[David Yacovone (Member)]: Actually, you mean?

[Robin Scheu (Chair)]: I'm asking the whole.

[David Yacovone (Member)]: I am, I'm just sure. Okay.

[Robin Scheu (Chair)]: Well, yeah, I am too. I just want to be sure.

[David Yacovone (Member)]: I

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

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

[Robin Scheu (Chair)]: Yeah, as amended? But you're

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

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

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

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

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

[Trevor Squirrell (Clerk)]: come to the vote. Representative Bluemle?

[Jennifer (Jen) Carvey, Office of Legislative Counsel]: Yes.

[Trevor Squirrell (Clerk)]: Absent Representative Feltus? Yes. Representative Rosh? Yes. Representative Wicki? Yes. Michael Nigro? Yes. Squirrell, yes. Mr. Yacovone? Yes.

[Robin Scheu (Chair)]: Doctor. Robin Scheu? Yes.

[David Yacovone (Member)]: 83.

[Robin Scheu (Chair)]: 803, that's good. Was this unanimous out of healthcare? It was. Okay. Was a little off. 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 on notice today, tonight, tomorrow, right? On the floor Thursday. Yes,

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

[Robin Scheu (Chair)]: Right, so it'll be on the floor Thursday, Friday. Okay. All right, Jen, thank you for coming. Sure, thank you. Thank for telling us all about this bill.

[David Yacovone (Member)]: Boisey time.

[Robin Scheu (Chair)]: I just 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 they're quick, and then Deeba'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, you could meet people or ask questions or post it in somewhere else or whatever. And then in the afternoon, of Education is coming, including the secretary who's going to come to our committee for the first time. And then the adjutant general is coming in at 02:15 and party's coming back. What's he coming back for?

[Trevor Squirrell (Clerk)]: For the governor's office. Okay,

[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.