Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Morning, this is the House Appropriations Committee. It is Thursday, 02/26/2026. Twotwenty sixtwenty six. Okay, it's 09:30 and we are starting to take testimony on letters from our policy committees. And our first one is this morning, and we're delighted to welcome Chair Black and Vice Chair. So welcome, we're looking forward to hearing about your letter and if you want to introduce yourself and tell us all that way.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Thank you, Madam Chair, for having us. I'm Representative Alyssa Black, Chair of House Healthcare and

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Ranking Member Rebecca. So

[Rep. Alyssa Black (Chair, House Health Care Committee)]: I thought I would just start with an overview of how House Health Care develops their budget recommendations. We first invite in all the various agencies, departments that House Healthcare has its purview over, which is essentially DIVA. We do hear VDH, although Human Services also hears from VDH, DMH, and the central office at AHS. We do not typically hear from Dale, so just wanted to put that out there. They essentially come in and they give us the same budget presentation that they have already given to you, in house appropriations. And at that point, once we've heard from all of them, if there are additional questions, we meet sort of offline with them to get answers, our budget liaisons. And this year, our budget liaisons were Representative Houghton and Representative Berbeco. We try to answer all the committee's questions on the governor's budget recommends. And at that point, we also start having in all the various agencies or organizations that are either subject to cuts or ups or downs within the governor's recommend, as well as additional organizations who may or may not have received any mention at all, and whatever their asks are. Then we go through a process within our committee where we spend essentially a day going over the whole entire spreadsheet, which you have, I believe, in front of you. We organize on a spreadsheet all the asks that we've received. We go through, we make sure that everybody in the committee understands all of them. And then we go through what I have described as a laborious process of each and every member within our committee ranks their top five recommendations in order of what their recommendations are. And then our JFO, Nolan, sits over at the table and calculates the total number of points that every single ask has gotten. And that is what you have in front of you, which is our priorities one through 10.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So the other spreadsheet you waved around, we do not have a copy of that. Don't know the key one, but if you'd like us to have one, that might be helpful. But I don't believe we got

[Rep. Alyssa Black (Chair, House Health Care Committee)]: I believe that was sent with our letter.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Did send that. Okay. We'll let you know. We need to

[Rep. Alyssa Black (Chair, House Health Care Committee)]: get it. I believe that our recommendations to appropriations were our letter, which included our top 10, but not the entire spreadsheet, as well as additional language that we are suggesting for the budget.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay. Yeah, and then post it. That'd be great. Okay. So, yeah, so we have your four page thing that includes language and your top 10. We will get the spreadsheet as well. I just want

[Rep. Alyssa Black (Chair, House Health Care Committee)]: to appreciate the very, very difficult job that you all have in this committee. And as I reminded our committee, we are a policy committee, and we made our recommendations based upon what we feel are the top priorities on policy. We did not take into account the money piece. And so I do I mean, I just want to make sure that put it out there that you have a very difficult job to do. But if you are going to take any of our recommendations, we want to ensure that you have what our top priorities are. And if it's able to be found in the budget, then we hope that that would be achievable. So coming in at number one, and I feel like every year, the VNAs come in every year at number one. And I want to make it very clear because in last year's budget, they also were our top priority. And the VNAs can be separated into two different categories. There is the home health portion, which is if you think about you're hospitalized, perhaps you you have a wound that needs dressing, or you need nursing care in your home, and a nurse comes out and provides clinical nursing care. That is the part of the budget of VNAs that we have, and we are recommending a 3.5% increase in their rate for this home health portion of it. VNAs also provide care in the home, and they provide care for, like, assistance with daily living type things. That is usually in the purview of the Human Services Committee. And last year, a rate increase was put in the budget for those types of services, but home health of B and A was left out. I wanted to make that point that this year, again, they are and they have also been receiving cuts from Medicare on a federal level.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: 1,800,000 or something?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Yes, yes. Every year, they've been receiving a lower, and their rates have been decreasing from Medicare. And I'm not sure if the PNAs are in here, but they've also some clawbacks. Yes. So when

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: you see VNAs, so we have an Addison County Home Health and Hospice. That considered a VNA? That's a VNA. The same.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: The VNAs are almost like in a little in a small way, they're almost like how our system of designated agencies Okay. Not leaving someone out of the Every single health service area is covered by a different VMA.

[Rep. John Kascenska (Member, House Appropriations Committee)]: And you'll look at that as wealthier.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Believed. Oh my goodness, what are the eight? The eight are dying? Not. DNAs? Is it eight? Yeah, thank you. I can't believe I recall that. So there's eight across the state? Yes. So it's helpful.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Yeah, okay.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: There's eight, then there's one private one. There's a private one also, I believe.

[Rep. John Kascenska (Member, House Appropriations Committee)]: We've heard a lot about we've heard the number 3.5% increase across the board. Some of them have heard the same things, but it's all about these services in different places. Does that represent an increase in overall funding or is it for salaries? I'm getting the feeling that salaries are being worsened. I don't know how it's phrased in real world where if a service provider is given $20 to show up, it's going to be $25 now or whatever the number is. Not that much, but

[Rep. Alyssa Black (Chair, House Health Care Committee)]: It would be the Medicaid rate for that particular service. So a VNA would bill And I think it's often a case rate on the number of weeks. But it's also individual services. Like, nurse went out to that house and was there for fifteen minutes. There would be a code that would be billed. Medicaid would pay their reimbursement that they have as their allowed amount. And this would be increasing that allowed amount 3.5%.

[Rep. John Kascenska (Member, House Appropriations Committee)]: Which matches inflation, I think. Robert. And so we think this the age old card in funding, which is, if you give me $100 last year and $100 this year, you're really giving me $96 and that's the spiral down. And so this has been what conservatives have been talking about for years.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Yes. And and I believe this rate was not has not been raised in a couple of years.

[Rep. John Kascenska (Member, House Appropriations Committee)]: So it's almost truing it back up to what it's

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Well, I'm not even sure it's truing it back. What they're trying to get is they're trying to get to the equivalent Medicare reimbursement. And they're trying to get to 70%. Right now, I think they're around 60 So on Medicare? Yeah, of Medicare. So I mean, you imagine Medicare already has a relatively low rate. Medicaid pays less than 70% of what Medicare would even pay for that service. This

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: would bring them up to 70%.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: This would bring them up to 70%.

[Unknown Member (House Appropriations Committee)]: Okay, so Marty. So you indicate that this is distinguished from what we also call home health services, assisting with either meals or anything or things like that. So do we need to be very specific? No,

[Rep. Alyssa Black (Chair, House Health Care Committee)]: this is just this is yes we have some

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: other issues about that I think so no one

[Unknown Member (House Appropriations Committee)]: we have a way of distinguishing what you're looking for from the other? Right. Okay.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: And then, so the Medicaid rate is set by the federal government. The Medicare rate?

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: The

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Medicaid rate is set by the state? The state. That was where I was getting to.

[Rep. John Kascenska (Member, House Appropriations Committee)]: Thank you.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Eva was said that way.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: So our second ask is Vermont free and referral clinics. Think that one of the things that I know I personally approached with budget recommendations, and I know many other committee members, is because we are in such a tight fiscal year, I sort of prioritize agencies or services that really have no other way of supporting themselves and how vital they are. Our free and referral clinics right now, and I want to remind everybody, these are clinics where the providers within these clinics are all volunteer. These are volunteer providers. Doctors and nurses. What they do need to pay for is they need to pay for the facilities that they're within. They need to pay for the staff who staffs them as far as the person who's sitting at the front desk when you come into the clinic. I mean, staff, any

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: kind

[Rep. Alyssa Black (Chair, House Health Care Committee)]: of upgrades to the facility, supplies. They are frankly overwhelmed and they're overwhelmed with the need as insurance becomes less affordable, people are going without or their out of pocket is so And they charge nothing. Free and referral clinics charge nothing for their services. Can go to them. And frankly, they're a little overwhelmed with the need. And many of them would like to increase the hours that they're open. I think we heard from the free and referral clinic that it Oh, look, there he is. It varies. You're open currently four days a week?

[Nolan Langweil (Joint Fiscal Office analyst)]: Three and a half.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Three and a half. And would like to expand two more days because the need is so great. So this is

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: one place that's taking the place of people who drop their health care because the premium tax credits run away and they can afford 2,000 or $3,000 a month. And instead of going to the emergency room, which is the most expensive place to go, and I assume some are still going there, they can come to the free and referral clinic. Yes. And do

[Rep. Alyssa Black (Chair, House Health Care Committee)]: we They provide know dental care as well, which is very, very important.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Yes, and do we know at this point how many people didn't re up for health insurance?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Oh, let's see. I'm sorry, we heard from 2,500. They're recalculating each month because each month people are dropping off as they realize that they cannot sustain the premium.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: One number we heard from the free and referral clinics is that their patient load increased by 40% last year. Yeah, significant. 2025. Calendar year? And the insurance. This year. Right. So even without the insurance trials, they're But we had double digit rates. That's right. The insurance rates for the previous year went up a whole lot, too. So they've probably lost a few then, and then we're losing more with the second round of health care cuts and costs.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: So a third recommend oh, I'm sorry, were there any other questions on

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: I think we're good on no, wait, wait, sorry.

[Unknown Member (House Appropriations Committee)]: You mentioned clawback. What's the magnitude and what was the cause of these clawbacks and how does that affect its operation?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: The clawbacks are coming from CMS, the federal clawbacks. And I have to be honest with you, I am not really well versed. There was some rule that came down many years ago, federally, claiming home health had been overpaid. I think it had something to do with budget neutrality. And so over the years, they've been, first of all, cutting the rate each year and threatening clawbacks of money that was paid many, many years ago.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: But not for a specific thing that was done.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Not for a specific thing. It's just- state, national. It's like ten years ago, we think we paid you too much because of budget neutrality, so therefore we're going to take it back. And it's been threatened, I know, for many years, and I believe that they might have indicated that the process might begin this next year.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: So is

[Rep. John Kascenska (Member, House Appropriations Committee)]: that going back in Poland, is it a portion of?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: It's a portion of some determined CMS calculation.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So there isn't anything we could do to prevent it? No. There's nothing that we

[Rep. Alyssa Black (Chair, House Health Care Committee)]: did And there's nothing we did wrong. Right.

[Unknown Member (House Appropriations Committee)]: But what's the magnitude of the whole that stuff put into?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: I'm sorry, I'm really not sure about that.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: At least 1,800,000 less than what they had. And that happened the previous year, too. On Yeah. To number three.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Number three, SASH. And can I make an assumption that everyone in this committee might remind us what SASH is? Sash is an organization that provides wraparound services to seniors living in senior communities. Like, Cathedral Square, it's funded through Cathedral Square, and they have sash services, I know, in Chittenden County and also they serve 5,000 low income seniors across the state. SASH is a nationally recognized team based program of care coordination shown to improve population health, and it saves on Medicare dollars and helps people stay healthy so that they can remain living at home rather than going into Yeah,

[Rep. John Kascenska (Member, House Appropriations Committee)]: they've been here. They've been growing for the last ten years. Started off with pilot programs, we've added it as part of our budgets. They work as pods. Each pod is about 100 people, and it's been the success rate is about keeping people in their homes healthy. It's always people checking on them. It's been a huge success in both Cathedral Squares and in what I know of in Washington County terms. I'm surprised that they weren't funded in spending or they've been cut, mechanism is here for the administration. But they've been incredibly successful.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: And it's less expensive to keep people at home and put them into a nursing home or into the hospital.

[Unknown Member (House Appropriations Committee)]: Works against some

[Rep. John Kascenska (Member, House Appropriations Committee)]: of the nursing home issues that we're dealing with, except that it's just much less expensive. It's less chaotic for people who are being served because leaving home to go to a nursing home or to a hospital is worse for your health, just leaving home. Yes. But it also integrates with wheels and integrate. I mean there's a whole bunch of services that are provided right there at home.

[Unknown Member (House Appropriations Committee)]: Okay. Well, these beneficiaries, are they only in organized groups like Cathedral Square or does do this sex provide services? I

[Rep. Alyssa Black (Chair, House Health Care Committee)]: believe in Brattleboro, they've actually extended it to families, but their current model and the pilot was essentially in senior living communal type settings. Like a retirement community? No, not necessarily. Well, and for instance, in Burlington, there's Decker Towers, which is It's a low income. It's low income. Yes.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Public capital authority? Yes. So

[Rep. Alyssa Black (Chair, House Health Care Committee)]: this funding is essentially bridge funding. They were funded previously through the all payer model. And this is bridge funding to get them through to the Ahead model.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: And that's what we had to

[Rep. Alyssa Black (Chair, House Health Care Committee)]: do last year. We thought the Ahead model was going

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: happen starting this year, and it didn't.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: And it didn't. This is another, did fund it last year for that reason.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So, had a question and then to

[Rep. John Kascenska (Member, House Appropriations Committee)]: No, I just wanted to share how there are different models around the state. Brattleboro, the Brattleboro Housing Authority, will actually, they have teams that will actually go to individual homes to see what people need for people, make the home safer, what service they need, so it's not just

[Unknown Member (House Appropriations Committee)]: Not just the environmental regulations.

[Rep. John Kascenska (Member, House Appropriations Committee)]: Trying to get to them. Yeah. Going out to the community, United Health Bravagogue is a pilot program for that, but I think around the state there are different manifestations about

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: However it works around

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Is it statewide? It is not statewide, but it is expanding into new communities, although this is not an expansion at all. This is to maintain where they are.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Chip? Yeah, I think we did an appropriate money amount last year

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: to expand it. You had them all

[Rep. Alyssa Black (Chair, House Health Care Committee)]: just in a nutshell, where are we with that? And is that truly gonna come to be, or is that really in I believe that they still think that it's going to come to be. It has Oh, well, AHS, Agency of Human Services. I think the model has changed a little bit on the federal level. So what we thought the model would be, I believe has changed a little bit, but we're still waiting for I believe we're still waiting for guidance from CMMI or CMS, the federal, that's on what is going to be in the model. And I think it's still being designed. So last I asked was probably two months ago, and they're still waiting for guidance.

[Unknown Member (House Appropriations Committee)]: So, SASH is part of the agency of health, human services or is independent? It's an independent,

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: it's a non profit. And it's called SASH?

[Rep. John Kascenska (Member, House Appropriations Committee)]: Dave, Yes. Did you have

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: a question about what?

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: I was trying to recall what seniors and supported housing something. Support and services at home. It may

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: be independent and maybe a nonprofit, but the money has to flow through somewhere. What does it flow through?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Well, was flowing through the all payer model.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: So that is what Department of Health?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: The all payer model is all insurers paying it. It's Because that's no longer around. That's no longer around. And this is the bridge funding that that used to come from. And I believe it was paid through the blueprint, but it was paid through the blueprint, but it was all payers, Medicare, Medicaid. And then I think that Sash was just Medicare and Medicaid. And this is for the Medicare portion because Medicare is no longer paying to that.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: So does that come through Diva?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: It will go through Diva? Yes. I think so.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: I think, was this the one where hospitals paid a little bit and the health insurers paid a little bit through the ACO and that's how it ended up getting funded? I'm not sure I

[Rep. Alyssa Black (Chair, House Health Care Committee)]: mean, yes, they paid into the all payer model, but I'm not sure that the funding for SASH in particular came from that. I think it might have just been Medicare and Medicaid in a big pot.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Long has the program been around?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Why do I not have Representative Houghton with me? She is the expert on sash. I think it's eight years?

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: More than that. It started out as a very small pilot, I believe, in 'ninety seven. Wow. Twenty years, long time. It's grown

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: since '11.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: 2011?

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Fourteen thousand participants since 2011. 200 plus housing sites, and it was funded federally, primarily federally, until the ACO went away. Yes. And we needed this bridge funding. Okay. So fifteen years more recently, so maybe pilot back in Dave's time, but fifteen years for the kind of the program that we're seeing.

[Rep. John Kascenska (Member, House Appropriations Committee)]: Okay. And it is, I would consider it a mature program. And it went through the process of being a pilot program. It went through all these different funding sources to get to the point to try to get into the budget. And with all the help that it's received, SAC for Families is an extension of that program. It's specifically because this worked so well with seniors that they brought it out and they're piloting it in certain counties where it's going. So children are receiving the services in ways that are in the same as seniors and it's just children or families with children. And it's just a remarkably successful program for the people serving.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Okay, so that was smart.

[Unknown Member (House Appropriations Committee)]: All of these first three, you indicate that there's a state amount and it appears that there's a federal amount because you have another gross amount so are you certain that there's federal funding available to match this state that imply we're getting the federal funds for the global benefit?

[Nolan Langweil (Joint Fiscal Office analyst)]: Yeah, you have Medicaid in the state and federal partnership, and Medicare is pure federal, we're losing our Medicare, so we're just increasing our Medicaid share to offset the loss of Medicare. Because of that we can continue to use our Global Predictive Match, so we can get federal match of that.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: I think I have Lynn and then John.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Yeah, thank you. Did you hear anything from Do Not Peer Board about any of these things that are on this list in terms of what they're expecting, in terms of how this all works together financially from their perspective when you're talking about who lost the ACO, the ACO may be re if the head moves ahead, it may, in fact, send the money to an ACO and send it to the state, which we would refer those to the state. Understand that talking to them.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Did you hear anything from them? We heard nothing from the Green Mountain Care Board on these budget items, particularly as it pertained to ahead. I think that they are waiting to see what happens with ahead just like the rest of us are.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: And did you hear anything from the Rural Health Transformational Group?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Well, yes. So there's a couple items on here, and SASH was one of them in particular. I am looking for it. So the rural health transformation, there were several cuts within the governor's recommend, or I should say, not even cuts, but more didn't get a mention, where we heard, we think we can use rural health transformation. And as there was more questioning, it became very, very confusing on whether or not any these things would actually be eligible. Sash was one of them. I think that there's still a little bit of confusion over whether money can be used in Chittenden County. I think we heard from AHS at the presentation that they did in front of the Joint Fiscal Committee, that the money has to So it's for rural and the rural designations within the Rural Health Transformation does not include Chittenden County and that the money actually has to flow, flows to where the person is when they're receiving the services. So there was a lot of confusion over Sash in whether or not the Rural Health Transformation money could be used for that because it's not primarily, but there's a large portion of it that's in Chittenden County. And if I see joint fiscal over here and probably going to correct me and everything We

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: also had the Washington delegation in to talk to us and

[Rep. Alyssa Black (Chair, House Health Care Committee)]: we brought this up. Yes.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So, but I'm to have Nolan and then

[Nolan Langweil (Joint Fiscal Office analyst)]: Yes, please. So AHS has submitted their budget to CMS, which has been approved, and there's nothing for SACH in that blue button. Nothing in the RHDP currently proposed or SACH or from relatives who bring without sex.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay, thank you for clarifying. And the RHDP funds cannot pay for direct services as well. There's a lot of So we're going to have Jill Mazza Olson in here on March 10, I think, when we get back. And we're going to go through that whole grant program and all I mean, the 38 projects. And we know it keeps changing. I would just can I add one thing about SASH? Because this has come up in our committee the last couple of years as a priority program. And I think it's because PrEP Dickinson, I think you're getting at this in terms of looking at larger health care reform strategies, really, making sure things are aligned and we're investing in a vision. SASH is something that really keeps folks at home and brings the services to them and connects people to the services. Rather than having folks leaving their homes, needing transportation, needing all of these other things, Sash actually connects them to the services that are already existing. So it's a really critical piece of any health care reform thing that we do, allowing people to age in place. And I think our committee sees great value in that. And

[Rep. Alyssa Black (Chair, House Health Care Committee)]: ensuring that people are receiving the right care at the right time in the right setting, as opposed to things becoming an emergency and ending up in our hospitals. That is also what keeps our costs low. It's programs like such.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: John, did you have a question too?

[Rep. John Kascenska (Member, House Appropriations Committee)]: Questions I had have been answered, when we had Jill Brits come in and talk about some the rural health transformation, program, of that is still held to, excuse me.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Not not in patients.

[Rep. John Kascenska (Member, House Appropriations Committee)]: I'm good. Word for Joseph. I just recall part of that program is to bring some services to people, but we don't know exactly what the specifics are to the right amount of time. So some of that might be happening if something could be funded. I

[Rep. Alyssa Black (Chair, House Health Care Committee)]: think it's sort of up in

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: the air.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: It's up

[Rep. John Kascenska (Member, House Appropriations Committee)]: in the air, yeah.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So if we if this doesn't get funded, what happens, Sash? It ends. It just ends. It ends.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: They Okay. Again, we sort of prioritize things where if it doesn't receive the funds, they have no other mechanism for receiving funds. And these programs just end.

[Rep. John Kascenska (Member, House Appropriations Committee)]: Yeah. Okay. Thank you.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Let's move on. We don't want to We've here all day, but we

[Rep. Alyssa Black (Chair, House Health Care Committee)]: don't Yes, which leads to Yeah, we have ten thirty testimony, which leads to number four, which was a tie. We have a tie, and we didn't I did not make everybody go through and do a tiebreaker. I'm sorry, I wasn't doing that. So we have a tie, and there's really two pieces here, and this also kind of weighs in on the RHDP funding. So in the governor's recommend, there were cuts to AHEC and there were cuts to VSAC. And this is all specifically around workforce development in healthcare. And because within the RHDP, there are proposals around workforce development for health professions, those are mainly covered by the VSAC cuts that were made. Nothing that AHAC does would be replaced. This would be gone. So, AHAC has no other or what we heard was that there is no other there's no ability to use the RHTP with AHEC, which is why it ranks so highly. These funds are used for physicians. They are loan repayments for dedicated service obligations for physicians and primary care specifically. They also have, think it was 50,000 of this, they use for a program which actually It's sort of a clearinghouse for open positions within Vermont, within primary care, and helping place primary care physicians in needed health centers around the entire state. And then there's also a piece where I have to be honest, I didn't really know this until this year, but I think it's fantastic. They have a program working with youth in Vermont and exposing them to health professions. And so we knew there was that part.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: When you and I chatted about this one point, can you break out how much is for the youth programs versus how much is for loan repayment for primary care?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: I am sorry, the spreadsheet that I have in front of me doesn't have that breakdown, but I know that we had that and we can get that for you.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: It would be helpful to understand that because tight things are and if we're making decisions and can partially fund things, I mean, you know, I'm not promising anything, but it'd be nice to know, get that detail, level of detail. Yes.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: And am I correct that they get a fiftyfifty match? Is that a fiftyfifty federal match, Nolan?

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay. It's fiftyfifty. Okay. Liz?

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Yeah, Okay. They get $550,000 for this. Dollars 50,000 goes to the position of recruitment, which I understand is third year medical students. Or third year residency? Those third year medical students. Recruit them to stay in Vermont for their residencies here in Vermont. Now, the question on that is, does anybody have any data on the success rate of any of this, whether it's residents or medical students? Now, two AHEC does have Yes. They have data, or UDM has data on that, that would be helpful. The whole goal of all of these programs, from what I understand, and at the Department of Health and with VSAC, is to go and recruit and maintain and give the money to people who will actually work and stay in Vermont. And that's the number one point. Even after they complete their application, absolutely. Yes. And so the second thing is that there is a thing for, I guess, high school students that is the outreach, and I don't know if that's the whole $500,000 But again, what exactly does that do? AHAC is generally used to go and help forgive loans for existing professions versus doctors, dentists, whatever. Again, with the idea of trying to keep them here, they work here, they get a certain amount of money, and then they hopefully they stay here.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: They have to. It's a one to one. It's a one year funding if you stay for one year.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Yeah. You get whatever the money is, thousand dollars $20 whatever it is, and then you work that year. Yes. And the problem is that sometimes they leave after that first year. I mean, that's one of the But I'd like more data on all of that. I don't know if it's from UVM or if it's from

[Rep. Alyssa Black (Chair, House Health Care Committee)]: We have that and we will absolutely get you that information.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Who would have AHEC in their budgets? Is that Dave, is that you or is that me? I thought it was Lynn.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: It's affirmative.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So it's you. It sounds like we want some more data on this. I'm going to move us along because we have people coming in at 10:30 and I know we're going to want

[Rep. Alyssa Black (Chair, House Health Care Committee)]: a break. If you have

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: a burning question, ask it.

[Unknown Member (House Appropriations Committee)]: One, check. Is this the same forgive the longs for nurses and such. Is this the same that we worked on with the economic development?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: That's actually number 10. So VSAC, through VSAC, they do more nursing and other health professions, radiology technicians, dental hygienists, allied health professionals. Really quickly moving on to Ty, I don't think that this really needs much explanation Vermont Care Partners which is all of our designated agencies and our SSAs.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Is that a 3.5% also?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Is a I believe it's 3.5% yes.

[Nolan Langweil (Joint Fiscal Office analyst)]: I've been able to verify the percent to pay us in a lot of quality and revenue.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay, right. We all

[Rep. Alyssa Black (Chair, House Health Care Committee)]: know the services that they provide and what the state of Vermont has tasked them with doing and this is essentially a cost of living increase. Don't think. So number six is a program through Howard Mental Health, and it is a community outreach where the proposal from DMH was that it could be supplanted with mobile crisis. And it's really important that this isn't crisis. I say this to them every single time, if you meet everything with crisis, it becomes a crisis. And this really isn't. This is people within our communities who are being identified as perhaps just needing some outreach, housing. In my community, our librarian, our librarian in Essex Junction uses this for people that come into the library and are in need or are having a mental health crisis, but not a crisis. Not desperate crisis. Or, I mean, Representative Houghton had a woman next to the flower shop who was sleeping out by the flower shop and was cold and needed some help. And she called and they come out and they meet people where they are. And it's an invaluable

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: It's been big. Representative Bishop was in here yesterday. And every single legislator in Chittenden County, party neutral. To keep this. I actually have heard from former legislators, recent former legislators, saying, Please, please do not. Received communication

[Rep. Alyssa Black (Chair, House Health Care Committee)]: from every single town in Chittenden County, all legislators. Yes, mayors. We've received

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: a lot of letters. And

[Rep. Alyssa Black (Chair, House Health Care Committee)]: a police department. I meet personally with the police chief of Essex every single year and the one thing he thanks me for is this program. It is invaluable.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Thank you. And

[Rep. Alyssa Black (Chair, House Health Care Committee)]: number seven, this is where I cry every year, but

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: This is in what we heard from the delegation. They put in for money for Bridges for Health. And I talked to Rep Houghton, who your house, know, talked about this. She's checking into whether the delegation is going be able to cover that.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: Okay. I had not heard that. Mhmm.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So think We learned it when they came to us on Monday, Tuesday. That means I'm not gonna cry.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: You you I'm sorry. I I love bridges to health.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: I think there is

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: This is still this is also Yes. Okay. Department of Health. My understanding from Department of Health, this is a pass through to UVM to the extension service. Think it's Handles it now. Yes. And from what I understand, now it says here it's going to transition to the Vermont Friend referral. Yes.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: They are leaving UVM. They have always been part of UVM Extension, and they have found a new home with the free and referral clinics. Although they are separate, they are completely separate programs, but they're Yeah, I'm familiar with the Yeah.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: There is a couple of carry forwards in that that go to December 26. Is this half money supposed to be just for the rest of 'twenty seven?

[Rep. Alyssa Black (Chair, House Health Care Committee)]: It's for the rest of 'twenty seven, yes. So it is not a full year. It is enough after their carry forward. Okay,

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: thank you.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: The Office of the Healthcare Advocate, this is not new physicians. This is just simply he's been level funded for I'd say he, I'm sorry, the office has been level funded for a few years. This is essentially increase for their employees. I'll put in little I'll put in a plug in there are many things that we have all worked on over many years. And those have come to us from the Office of the Healthcare Advocate. And the common theme that runs through all the proposals that have come forward. I mean, you can think about things like Medicare Savings Plan program. IHIP came from the Office of the Healthcare Advocate. They have increasing responsibilities that we statutorily put on them. They are a party to everything that the Green Mountain Care Board does and much of what AHS is doing. And the common theme, though, that I would say that runs through everything of the Office of the Healthcare Advocate is you can look and you can say, this is good for Vermonters. And this represents Vermonters and affordability and

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: That's what their office says. That's it. You have we do need a break. So if there's a lot we can talk about offline, that would be

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Team Two, do you want to talk about Team Two here real quick?

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Yes. You're much more well versed in it. Team Two is a trainee for first responders, law enforcement, such that has been around for about twelve years, was developed in partnership with some first responders and the Department of Mental Health. The Department of Mental Health now has identified that they can bring this service to first responders in house. So they have a crisis team in house that they're going to deliver this training to folks who request it.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: And then finally, number 10 was VSAC, which is the loan repayment for allied health professionals. And again, this is in here, there is talks around whether or not the RHTP. So I'm just going leave it at that. Okay. You have some language? We have some language. There is another line item in there around Vermont 211. So within the governor's recommend, it was a reduction to two eleven. And they also are doing a program that is a closed loop referral with UVM network, where essentially providers are now able to refer to two eleven who then can refer a person to services that comes back to the provider to ensure that it's a closed loop.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Somebody followed us, actually did use the referral.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: We are recommending funding of this and there is a app, the HIT fund, a special fund that does have a surplus in it and this absolutely would qualify as something that the HIT fund or we believe that the HIT fund would. It's an allowable use of Yes, the HIT allowable use. Yeah, I do. Is this a one time? This is a one time. Is this $3.32, that is for the two eleven services general. So we did not make recommendations around the cut of the base of two eleven, which is in the governor's recommend, but we did recommend their ask for developing this closed loop referral, and we're suggesting using the HIT fund for that. And that's a one time.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay, so would this be

[Rep. Alyssa Black (Chair, House Health Care Committee)]: in addition to how they're funded through GCF, or is this a way of preserving two zero one services? We are not recommending It preserves it. I believe that the response from And is it DCF? We actually don't have them in our committee. So there was a lot of, I think, human services. Made no recommendation to not concur with the governor's recommendations. But

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: this funds are separate. Specifics that are really necessary for communicating and care coordination of the providers. And you've got

[Rep. Alyssa Black (Chair, House Health Care Committee)]: the fund. The next one? There's an elimination of a sunset, and that is through AHEC because they have some carry forward and they have 11 students that they would like to award it to. So it's just language around removing a sunset. Does that keep AHIP? No, it keeps it allows them to spend the money they have left. Okay.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: So regardless of what we decide on the other page, this is separate. Yes. Okay.

[Rep. Eileen “Lynn” Dickinson (Member, House Appropriations Committee)]: Rhonda, do have a question?

[Rep. John Kascenska (Member, House Appropriations Committee)]: I'll just real quick. We can keep looking at it. Okay.

[Rep. Alyssa Black (Chair, House Health Care Committee)]: All right. Let's see. So again, we have language in here that our intent that Department of Vermont have Health Access figure out how to implement coding changes that enable a state ninetyten match on federal funds for family planning services. We did this last year in the budget. They came back in the BAA and said it wasn't implementable. This ninetyten match has been around for, I think, forty two years. We're recommending that they figure it out. So we're going to keep putting the language in there. This is a ninetyten match that we have been foregoing since the inception of this. AHS is not doing this. CHEBA is not Yes. Doing It's how claims are coded, how these claims would be identified, and we're asking them to please

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: report And back to To report back

[Rep. Alyssa Black (Chair, House Health Care Committee)]: and not report back that they couldn't do it, but report back on the steps they have taken to actually So do we're recommending that. And then there is a we had a bill, H-five 85, which allows AHS to seek a waiver for reinsert the 1332 waiver of reinsurance through CMS. And we have taken the language out of that five eighty five and put it here in the budget. And this just tells them that they can seek a waiver.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: Okay. And

[Rep. Alyssa Black (Chair, House Health Care Committee)]: that's about it. And thank you for Thank you for

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: all the work you've done. You've had to make a lot of hard decisions too, and you're one policy committee. Glad you guys are on this. This is very complex stuff, so it's really Thank you to

[Rep. Alyssa Black (Chair, House Health Care Committee)]: the committee. Glad you were the one looking at that column, not us.

[Rep. Robin Scheu (Chair, House Appropriations Committee)]: It's going be a tough year and you've acknowledged that. We appreciate that. Thank you so much. Have people will come back to you with questions. I think we have some more information we're going get from you next Thank you so much. Thank you. Appreciate it. Minnie, we are going to take a break. If everybody that's coming in for ten minutes.