Vermont Legislature SmartTranscripts:

[Speaker 0]: Welcome,

[Rep. Alice M. Emmons, Chair]: folks. This is House Corrections and Institutions Committee. It is Wednesday, January 21. And we're going to start our afternoon with discussing the Vermont Medicaid eleven fifteen waiver and being able to provide Medicaid for inmates who are eligible, sentenced folks who are eligible for Medicaid to get them signed up with Medicaid prior to their release, a few months prior. So I'm not sure, should we start with DOC? Should we start, do we both want to go up there? What's the best way? Okay. Grab a chair. Move over, Brian.

[Rep. Brian Minier, Member]: Move over.

[Committee Member (unidentified)]: My fountain ball. And I'll see

[Rep. Brian Minier, Member]: the shops.

[Committee Member (unidentified)]: They don't tell you once you get your committee assignment, run to the room.

[Rep. Brian Minier, Member]: Ask everybody as

[Committee Member (unidentified)]: fast as you can. I did not know that.

[Rep. Alice M. Emmons, Chair]: You were a newbie.

[Committee Member (unidentified)]: I had to switch with Harrison, I think, because he couldn't

[Haley Summer, Director of Communications, VT DOC]: hear he couldn't hear that. He was

[Rep. Alice M. Emmons, Chair]: down there.

[Committee Member (unidentified)]: He was.

[Rep. Alice M. Emmons, Chair]: And then Donald's up here, and he comes here, and then we had to switch. Oh, good guy. And then the returning members go back to their old seats.

[Committee Member (unidentified)]: So

[Rep. Alice M. Emmons, Chair]: it's just kind of committees some committees, the chair appoints, tells people where they're gonna sit.

[Rep. Brian Minier, Member]: But you're more of magnanimous than that, Alice.

[Committee Member (unidentified)]: I moved in my last committee because Dan moved, and he had, like, food in his drawer. And my entire drawer was full of mouse stuff.

[Rep. Alice M. Emmons, Chair]: Oh, yeah. Wait. What was the rest?

[Committee Member (unidentified)]: Yeah. What did you say?

[Speaker 6]: Two years ago. The full mouse stuff.

[Committee Member (unidentified)]: The the mouse got anything to fit

[Rep. Alice M. Emmons, Chair]: on this. Anyway, that's No. But subcommittees, the chair tells where the members are gonna.

[Committee Member (unidentified)]: Mhmm.

[Rep. Brian Minier, Member]: So you got Troy and Kevin together. Right? The dream team?

[Speaker 0]: That's right. This is each other.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: We're a employee sits here. The vice

[Rep. Alice M. Emmons, Chair]: chair sits there. Those two seats were open. This side was all filled up.

[Committee Member (unidentified)]: Mhmm. What are you gonna do?

[Rep. Alice M. Emmons, Chair]: What are you gonna do?

[Committee Member (unidentified)]: What are you gonna do?

[Rep. Alice M. Emmons, Chair]: Last person in gets the last chair.

[Rep. Brian Minier, Member]: Well, no. Chittenden works to be out on the fire escape.

[Committee Member (unidentified)]: I'm inside. Sorry

[Rep. Alice M. Emmons, Chair]: to all you folks on YouTube. We're just getting settled in.

[Speaker 0]: Yeah, all right.

[Rep. Alice M. Emmons, Chair]: I'll turn it over to you, both of you folks, and if you could just identify yourself for the record before you start. And I know we have a handout on our website. And I would assume you would take questions as we go. For the

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: record, Aviva Teva, Executive Director of Health, Wellness and Engagement with Vermont DOC.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Thank you, Madam Chairman and the community members for inviting me. I'm Renee Weeks. I'm the Director of Complex Care and Field Services for the Agency of Human Services.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Thanks for accommodating both of our chairs up here, knowing they're in such hot commodities. So I was going to start with an overview of some of this. You heard the beginnings of last week in the context of DOC Health Services, but just some kind of high level summary of the Medicaid work that DOC has been involved in and then really turn it over to Renee to address BCCI and their role in it. So as mentioned last week, there's really three components of the state's Medicaid work as it relates to DOC and reentry, all of which has been being worked on for years and was implemented as of January 1, though it is still being stood up. Those three things are first, that people who become incarcerated while they are actively enrolled in Medicaid have that coverage suspended instead of terminated. Because it's suspended instead of terminated, it's able to be reactivated much more quickly when they're released. The second big change is that we're able to complete. So

[Rep. Alice M. Emmons, Chair]: how does this work, the suspension versus the termination? How does the suspension Is that true for everyone who's coming through the system who's on Medicaid, detainees as well as those become sentenced, that it now gets suspended?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes and no. So yes, in that it doesn't matter someone's legal status, but someone's eligibility is not suspended until twenty eight days of incarceration.

[Rep. Alice M. Emmons, Chair]: So they have to be there almost a month. And then it's regardless if they're sentenced or detained.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Correct. And that's all automated in the IT systems. And so there's data being sent and received, and all of that is set up to happen on an ongoing basis. So for those twenty eight days that they're there, do they lose Medicaid at all? They don't.

[Rep. Alice M. Emmons, Chair]: So it just hasn't Is that pre eleven fifteen waiver? Was that also the case that they could be there for like twenty eight days before they were discharged from Medicaid?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So I would wanna confirm with Diva or other folks, but my understanding is previously people were terminated when it became clear that they were incarcerated, but that there was no systematic way that that was necessarily occurring. But for example, if someone was coming up on a renewal and they were sent paperwork to their house to send something in so that they would have a redetermination of eligibility and they were incarcerated, so they didn't get the paperwork and they didn't submit it, their coverage would lapse. Now it won't because they will be in the system as incarcerated and they and or DOC will know that their coverage is going to end so that we're in a position to help them renew it before it ends.

[Rep. Alice M. Emmons, Chair]: That's a twenty eight day window. But previous to the 11:15, was there a twenty eight day window at all? It was immediate?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Well, there was no systematic way. So when it got terminated What's the renewal time? My guess is that was the most consistent way that it occurred, but it could have occurred any way that Deepa understood that someone was a carcerated. Because you weren't able to be enrolled. There was no suspension. You were terminated. Right. So if known that you were incarcerated, you could not also be enrolled. Now, because there is the ability to be suspended, it's possible to kind of be in that status instead.

[Rep. Alice M. Emmons, Chair]: And that's true for sentenced and detained. So if a person who was detained and they're there for four months and they came in on Medicaid, for the eleven fifteen waiver, they would have been suspended for Medicaid on the twenty ninth day of police.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes, and then twenty four to forty eight hours after release, the provider portal should show them as active again, as long as their coverage didn't lapse while they were incarcerated for a reason that we were unable to intervene and continue their coverage, if that makes sense. How could their coverage have lacked? So if they were coming up on a twelve month redetermination where they would need to submit additional paperwork to determine that they were still eligible, And if we weren't aware of it or they weren't aware of it and didn't respond with the appropriate paperwork, then they would be.

[Rep. Alice M. Emmons, Chair]: They're not gonna be aware.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Well, they will now going forward receive notifications to their facility address. They will be notified, I think, by Diva as well.

[Rep. Alice M. Emmons, Chair]: All folks who are incarcerated or sentenced. This also for detainees as well or just sentenced?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes. So these first two items are not related to legal status at all. Both the suspension and the enrollment while incarcerated are applied the same way to sentenced and detained people. It's just detained people likely being with us for less time and how it plays out when they're behind the walls for a shorter period.

[Rep. Alice M. Emmons, Chair]: So there's gonna be a shift in Medicaid in terms of the renewal time, where it used to be once a year. There's that kind of shift to once every six months.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I don't know the timeline for that, but I think that is eventually going to happen. Then I believe the systems that we've set up would still work the same way, and those notices would go to people's facility addresses, and they'll just have to go through the process more often.

[Rep. Alice M. Emmons, Chair]: So that's gonna put more pressure on corrections. Dominated this conversation.

[Speaker 6]: Doing a great job. No.

[Committee Member (unidentified)]: No, no, no. I'm good.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: The second big new thing, January 2026, relates to Medicaid and DOC, is that we can now enroll people or complete the application for Medicaid while they're incarcerated. We can do that in the online portal. We weren't able to do that before, and we are now. So we've set up a system whereby when someone comes in, we collect all the information that we need from them. First, we say, can we assist you with your Medicaid application? If they say yes, then we collect information from them to be able to submit that. Once it's submitted, we'll follow it from there. Hopefully, a lot of those are immediate approvals and result in immediate enrollment status or eligibility. But if not, we have a plan in place to work people through that, to hopefully enroll as many people as possible. And that's completely new because previously, again, there was no The systems didn't allow it, basically. You couldn't go and submit an application for someone who's incarcerated online if you acknowledged they were incarcerated.

[Rep. Alice M. Emmons, Chair]: So how many folks that come in are on Medicaid? Do you know? Ballpark 50? Half three quarters, a third?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I can't answer that question directly, but I can answer a different one that is maybe would shed light on it. So, I don't have the numbers for people coming in since January in part, because we're still standing up all the systems for systemically However, in mid December, we looked at all the people in custody on a given day and half of them roughly were already enrolled in Medicaid with full benefits.

[Rep. Alice M. Emmons, Chair]: And they came in?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: On that day. So yes, that would have been when they came in because our process of enrolling people was really only related to inpatient hospital coverage until now.

[Committee Member (unidentified)]: So by come in, do you mean like their process into the facility or do you mean like coming into an You say mhmm.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes, sorry.

[Committee Member (unidentified)]: So I didn't have to finish the rest of my sentence because I was saying, or did you mean coming into a meeting? But okay, I got you.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Admission into the correctional facility. Sorry

[Committee Member (unidentified)]: to cut you off. In my head, was like, well, do you mean the coming to an appointment specifically for this or during processing? But now I understand. Okay. Just making sure that I've that correct. Thank you.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: And then the third part, which I think we'll really focus on today, is specifically for sentenced people. It's specifically in the three months pre release, which is the Vermont Medicaid Reentry Program, which is enhanced case management that people will be offered if they're enrolled in Medicaid and sentenced and within three months of a release date. And that's where the sentenced status matters because someone won't be eligible for those services if they're detained.

[Rep. Alice M. Emmons, Chair]: Why is everybody looking at me? I

[Speaker 6]: do have a quick question.

[Committee Member (unidentified)]: So just for clarity, you're able to get them signed up for the Medicaid, but they're not covered while they're in the facility. So when they walk out the door, when they're done with their

[Rep. Alice M. Emmons, Chair]: They're covered within that three months

[Committee Member (unidentified)]: Right. Okay. Entry.

[Rep. Alice M. Emmons, Chair]: What happens previous to the eleven fifteen waiver, whenever anyone entered into the correctional facility, they would lose their medical coverage. Could be private insurance, could be Medicaid. Medicare, I'm not sure about, but Medicare. So it was all on the state's nickel. Pretty much, except for hospital care or something like that. What the eleven fifteen waiver allows is instead of the termination of Medicaid when they go through booking and are there, it allows Medicaid to be suspended until they reenter the community. It also allows Medicaid coverage where DOC gets money from Medicaid for that sentenced person beginning three months prior to their release. So there's some financial implications for DOC. So Medicaid, three months prior to someone who's been sentenced for their release, DOC will receive, correct me if I'm wrong, Medicaid payments for some of

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: the medical and mental healthcare that's provided in the facility. Yes, and the benefits that are included in that ninety days of pre release eligibility are very specific. It's a set of services. So some other Medicaid program or service that someone might have access to the community, they wouldn't necessarily be eligible for pre release because it's defined very specifically what services DOC is going to be achieving. They're eligible for that subset of services, which are services that we already provide. So this initiative is not affecting what clinical health services people have access to in facilities through WellPath. Those aren't changing, it's just that some of them are now part of a pre release benefit and thus eligible to be submitted to Medicaid for some funding to come back to Tennessee.

[Speaker 6]: We already talk about, I we probably did, I just

[Committee Member (unidentified)]: don't feel well today, so I forgot, I'm predictable. How long, so say somebody gets sentenced to five years, is the suspension good for five years? Is there a limit, or is it just, you know what I mean? Yes.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I can't speak to exactly how it works, but it should be good the whole time. It's not intended to lapse based on how long someone's been. But exactly how we made that work, I cannot. It's

[Committee Member (unidentified)]: a good question.

[Rep. Alice M. Emmons, Chair]: Is that on DIVASIM?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I would say it's all of the agencies involved because it involves DOC data of incarceration status. It involves DIVAS and NYS, they well managed system.

[Committee Member (unidentified)]: So it's complicated.

[Rep. Alice M. Emmons, Chair]: A little. Has it been rolling out pretty smoothly, or has there been a lot of big hiccups?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: There's a lot to figure out how to make work on the ground, but nothing feels like we can't figure it out, if that makes sense. But there's still a lot to work through, troubleshoot, bring the right people into the room and make sure that the systems are operating the way that we thought they would, that the right people have access to the right information when things work differently, they know why it's happening that way. And we're still very much in that process of working through all that.

[Rep. Alice M. Emmons, Chair]: And how did you roll this out in six facilities? Are you finding some facilities are more tuned into it than others? Or is it about people, There are some glitches in some

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: of the facilities. So in terms of the suspension and the enrollment, we're working across the system at one time pulling in people who have a role to play at whatever facility. And I would not say there's been clear differences yet. We're still standing up the programmatic element that Renee can speak to more in terms of what BCCI really does. And I think we'll see over time with that. But I think it will take months to really have a good answer to that question. And it might be about resources in the community near a particular site. It could be for any number of reasons. All right. Did you want to bring on to me? Great. The Vermont Medicaid Reentrance Program, which is this additional enhanced case management that eligible people will be able to opt into and will be offered is meant to be short term, intensive, whole person coordination. Again, to be eligible for that extra set of services through BCCI, people have to be enrolled in Medicaid, though it might be suspended, but they'll still be functionally enrolled, and be sentenced. And they also have to be within ninety days of a projected release date. It's a voluntary program. People do not have to participate. That will be explained when people are made aware of the program as an option. And it's really meant to serve as a bridge to the community to help people get connected and establish to services beyond the services that are already in place and the staff that already are playing those roles. And finally, the expectation is really that it improves continuity of care from the facility to the community because of having additional resources and staff and coordinated collaboration across all the entities involved. So some of those dedicated staff are in each of the main entities involved. So I think we could go to the next.

[Rep. Alice M. Emmons, Chair]: Thank you.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: For the medical contractor, that looks like nurse discharge planners. At DOC, it's primarily reentry caseworkers who will be involved. For probation and parole, there are reentry POs, and then six staff at BCCI. And so all of those people and others, but those are the primary, will be working together to provide reentry services and release planning to people in the three months prior to release.

[Rep. Alice M. Emmons, Chair]: So those six WellPath nurse discharge planner, one per facility? Is that how it breaks down? Yes. And then the same for the reentry caseworkers?

[Arlene Petty, Executive Director of Finance, VT DOC]: Yes.

[Rep. Alice M. Emmons, Chair]: And is that true for the CCI? Yes. One per facility?

[Committee Member (unidentified)]: CCI, CCI. Care initiative. Got

[Speaker 6]: you. You.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I'll turn it over to Renee.

[Rep. Alice M. Emmons, Chair]: So I'm

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: just going to give a brief overview of our Vermont Chronic Care Initiative program in general

[Renee Weeks, Director of Complex Care & Field Services, AHS]: and why we thought that it was a good fit for this reentry work. The Vermont Chronic Care Initiative has been around in Vermont for twenty years now, and we sit within the Agency of Human Services central office within the healthcare reform team. We're comprised of 16 nurses in the community right now who provide care coordination services to, vulnerable Vermonters. Our philosophy is really to provide a holistic team based care approach to people with chronic health and social needs that are complex. So that's the population that we serve. Right now, all of the people that we serve need to have Medicaid, and they're typically disengaged or not reserving services elsewhere. So they may have be experiencing homelessness and have diabetes and aren't connected to health care services. So our team comes in and we help them get connected to their health care provider, a medical home, to a housing provider. If there are justice involved in the community, because VCCI and Department of Corrections have worked together for years now, We involve their probation officer in that care team as well. Many of the people that we work with have really poor health outcomes without intervention. So our goal is to provide short term intensive case management services to get people connected to the providers and benefit programs that they need to be successful in the community. And the way that we do that

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: is on the next slide. Some of our four functions are and this will apply for the Vermont Medicaid reentry program work as

[Renee Weeks, Director of Complex Care & Field Services, AHS]: well. We will screen and assess people to see what their health and social health needs are, so assessing the social determinants of health, such as housing, transportation, safety, social isolation in the community, we can get an assessment of what needs they have in the community. One of our primary core functions is to connect people to medical homes, even if they don't have an acute health condition now, so that they can get tied in for preventative care. We help members and the people we serve navigate our complex systems in healthcare and mental health and substance use. It's really hard for people, especially those reentering the community, to navigate all of that, especially if they've been in for a while or aren't returning to providers that they were connected to previously. And then we also just do an ongoing assessment of needs because we know those change over time, and we update an ongoing plan of care. The model that we use is a two based care model, and we've been promoting that throughout the state for several years now. We had a learning collaborative with all disciplines of care in the communities over the past year and a half. We meet with members in their homes and in the community. We really leave it up to them where their preference to be served is and where they're most comfortable. And then the care coordination tools we use as part of our process are kind of getting an eco map of what relationships people have to see who needs to be part of a care team. And we facilitate a care conference and develop a shared care plan with all providers involved in that person's care. So that there's transparency around roles and responsibilities and meeting the goals in the care plan, and the providers know what other providers are doing with regard to that person's care and goals. So we're using that same model in this program as well.

[Rep. Alice M. Emmons, Chair]: So, for all of this that you've got, core functions in the care model, is six people in your world going to be able to take on everything that someone who's reentering faces?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Not alone, but with the team of providers, I think that it will work. They're convening the team of providers in the community and making sure those connections will happen and that people get established and engaged in those services before we would then discontinue our services. We have up to six months in the community to work with people to help make those connections.

[Rep. Alice M. Emmons, Chair]: To get it all started.

[Arlene Petty, Executive Director of Finance, VT DOC]: Yes. Shawn and then Troy.

[Committee Member (unidentified)]: Yeah, it kind of rolls from that number. So you have six of you. It's kind of covering about 150

[Speaker 6]: ish people, right, if everyone can't handle 25. Does that meet the need?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: That's a question that we don't know yet.

[Speaker 6]: Oh, I see.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: We had to base that number on some projections that we worked with DOC on people that would be eligible coming out.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: What else did we look at? Of eligible people, how long people would be in the facility pre release while being eligible, because that'll affect how long they're on a caseload. And then on the other side, there are also assumptions around how quickly someone comes off a caseload. So some people will be able to be connected and a warm handoff will occur to another program that's providing longer term support. And then some people may be with BCCI up until that six months. So there's a lot of projections involved in those numbers that we'll see as it plays out which ones we were made accurate projections.

[Rep. Brian Minier, Member]: So this just got going?

[Rep. Alice M. Emmons, Chair]: It's an eleven fifteen waiver.

[Committee Member (unidentified)]: Okay, so this is a So are you seeing people at this point?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: We just received our first

[Arlene Petty, Executive Director of Finance, VT DOC]: referrals from

[Rep. Alice M. Emmons, Chair]: the Department of Defense. This is just

[Renee Weeks, Director of Complex Care & Field Services, AHS]: have their Medicaid, and they're ready to go. And I think we've been in the facility this week meeting with people to do that first step, which is the assessment phase, to see what services we're going to need to connect them with in the community. And then we're scheduled to meet with more people next week. So it's just barely starting.

[Speaker 6]: Let me out of

[Speaker 0]: your coochie. Yeah. Sure. Couple questions. So G6 are exclusive to other reentry programs. Is that accurate?

[Rep. Alice M. Emmons, Chair]: Yes.

[Speaker 0]: Can you talk a little bit about what standing that up was like, recruitment, how easy was it to build? You're full. You're 100 full of staffing.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: We will be as of Monday, yes, or minus. We're still recruiting for a hair corn feeder in the Rutland region. But otherwise, we will be full minus the Rutland position.

[Speaker 0]: So how easy or hard was that to get this going?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Surprisingly, we had many candidates for each position. So it was a competitive process. And I was thrilled that the people applying really were committed to working in this program with this population of individuals. Some were internal candidates from the state, some were external, but all very passionate about this program in particular.

[Speaker 0]: And they're all state employees?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: They will be. Some were not state employees, to be convinced somewhere.

[Rep. Alice M. Emmons, Chair]: Nope? Two

[Speaker 6]: questions. So the first one you said was that you filled out six positions except for the

[Arlene Petty, Executive Director of Finance, VT DOC]: one in the Southwestern Region.

[Speaker 6]: Is that my understanding? Okay. And then for the 25 people per coordinator, is that about standard with general health care?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: With Vermont County Care Institute, yes,

[Rep. Alice M. Emmons, Chair]: for this type of work. Did any of the care coordinators, the six, the eight-five, any of them come from WellPath? Did any of them work at WellPath? No. Any of them work within DOC at all? Yeah. I'm just curious.

[Arlene Petty, Executive Director of Finance, VT DOC]: You're picking up what putting It's I dangerous. You want to

[Committee Member (unidentified)]: stay polite.

[Rep. Alice M. Emmons, Chair]: That's dangerous, Mary. So the places that you have listed here, is that the agencies or where are they meeting with people in those communities?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: So they would be meeting with people in the correctional facilities, community with which they're placed. Okay, so like Southwest Vermont, where I'm trying, it would be in parole, Would it be parole? When post release, they'll be meeting at the state district offices or meeting with people at Marble Valley in Rutland. Yes.

[Committee Member (unidentified)]: Post release?

[Rep. Alice M. Emmons, Chair]: They meet pre release and also do a warm and post release until they can get established in

[Renee Weeks, Director of Complex Care & Field Services, AHS]: the community. Our goal is because people everything is relationship based in this work, and our goal, we don't know how it will wash out, but is to have if I'm in the Newport facility and I'm being released to Rutland, I'm gonna start my services with the care coordinator in Rutland. And we're hoping for DOC, the goal is to get them in that pre release window at some point down to the Rutland facility so that case manager in Rutland can begin the assessment phase and begin working with them in that pre release time. And then they would be doing the post release care coordination as well. So a justice involved individual would get the same case manager in the prerelease window and the post release window. We might not be able to make that every single time, but that's the goal. So that's something we'll be tracking.

[Rep. Alice M. Emmons, Chair]: One thing that's coming through my mind is, and I'm looking at language, we updated the statute a couple of years ago in terms of the medical handoff for prescriptions. Because that was the biggie, be it your normal prescriptions that most people have for whatever, blood pressure, heart disease, cholesterol. How do you see this, the seamless transition from the incarcerated setting to hooking them up with a pharmacy in their local community that they're going to reenter to? How do you see the eleven fifteen waiver working in that particular arena? And also with the MAT or MOUD, where they're only given enough of the medication to carry them until they can hook in with a hub or spoke. So how do you see the eleven fifteen waiver working on that when they transition to the community? Because a lot of these folks may not even have come into the facility with a primary care provider or a listed pharmacist that they've been working with, or they've been incarcerated so long that the provider is long gone, so they don't have a provider and they don't even have record of any pharmacy. So how does the eleven fifteen waiver work for this?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: So I think the way we envisioned it was that once that assessment happens, the care coordinator will know what needs

[Committee Member (unidentified)]: they have.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: If they need a primary care appointment, we can make that appointment then so that rather than waiting until they're released to make that appointment, so it gives us that three month buffer. So maybe the wait time to get a provider isn't as long as it would be if the planning was just starting after they were released.

[Rep. Alice M. Emmons, Chair]: But what plays into that three months I'm just going to be a difficult advocate They need approved housing. So the person may think that they're gonna go to one place, one community. DOC knows differently because they've heard different information from supposedly where the inmate thinks they're going to go. DOC may have heard different information from that person. And they may not verify someone's housing until maybe two or three weeks prior to their release. So how does that work in terms of figuring out those connections with the providers on the outside? It leaves you a short window.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Barrier. Yeah. For me, we'd have to switch plans at that point if they were going to a different community than originally planned. And that could delay things, realistically.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: But hopefully, the team based care model in this context where the DOC caseworker is very involved and to the prescription question, the WellPath staff is involved, it will facilitate information sharing. So as soon as that plan changes, the VCCI person would be able to have access to that information and figure out what adjustments need to be made. So to use, again, the prescription example, we want to provide a certain as high as possible level of release planning, whether or not someone's in this program. So a lot of that care coordination, appointment setting, continuity of care is still WellPath's responsibility, whether or not someone's in this program. But if they are, then that information will be shared with BCCI so that they can have more eyes on it, fill in gaps, and then also be there if something changes, like someone being released somewhere other than what they expected to do that kind of last minute. What do we need to shift to support some of best possible when they do come out?

[Rep. Alice M. Emmons, Chair]: And one other question, I hate to dominate this. What if the person's having trouble getting an ID?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: That's something that we can help them with.

[Rep. Alice M. Emmons, Chair]: We hope. Can you identify yourself for the record?

[Speaker 6]: Sure, so Brenda, was the policy director

[Committee Member (unidentified)]: for the Institute of Human Services, And when

[Speaker 6]: I was at the Department of Health as the policy director, we implemented a process that allows folks

[Committee Member (unidentified)]: easier access to getting identification, which is an option

[Speaker 6]: as well to go with

[Committee Member (unidentified)]: the data. So it should be I'll shut up.

[Rep. Alice M. Emmons, Chair]: And then your document. Did you have more, Haley?

[Haley Summer, Director of Communications, VT DOC]: We have some essentially visuals about what the process is going to be put that we can run through if the committee would like.

[Rep. Alice M. Emmons, Chair]: I think it would be helpful.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So this is going sort of zooming back out from the BCCI component of the this is a bigger picture of what happens related to the Medicaid pieces, those three, the suspension, enrollment, and referral. So, perfect. So when someone becomes incarcerated, WellPath will confirm if they're already enrolled in full Medicaid benefits. If they're enrolled, then that suspension will happen automatically after twenty eight days. If they're not enrolled, then DOC will collect the information from them if they opt into assistance with their application and put that information in our system. At that point, WellPath will submit the application. And from there, the application will be processed just like anybody's submitted Medicaid application. Then if someone meets the eligibility for the Vermont Medicaid Reentry Program, the services component through BCCI, which means that they're enrolled, but they're also within ninety days of a projected release date, which may or may not mean that housing has been established. You raised the question of if someone's housing isn't confirmed, it will delay their projected release date and would delay their eligibility for the program. But if they have a projected release date and they're ninety days from it, then the caseworker will share information about the program, which they will have already done likely, but they'll revisit it and say, either you said you were interested before or you didn't, but you have this opportunity again, you're eligible. They'll share a flyer about the MRP and BCCI. And if someone opts in, we can go on to, I think, two from here. I might have gone quickly.

[Speaker 6]: Just a quick question.

[Speaker 0]: Do you have any thoughts or data on the likelihood that someone's

[Speaker 6]: going to opt in when

[Committee Member (unidentified)]: they were not in?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: To the Medicaid application assistance? No. And we, in the past few weeks, have seen more people turn down that assistance than we expected. So we're strategizing about providing more information upfront about the benefits of

[Arlene Petty, Executive Director of Finance, VT DOC]: Do know why we're turning it down?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Not yet. Okay. My hope would be that we solve that and that most people opt in because it shouldn't take that long to provide the information and we want them

[Rep. Alice M. Emmons, Chair]: to be

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: hold, but we'll have to figure it out.

[Rep. Alice M. Emmons, Chair]: So they're not

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: even willing to opt in to getting those services three months prior? Well, so what we were what I was just referring to is the application assistance, not necessarily the programmatic services through DCCI.

[Speaker 6]: This is a bumming, Troy.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So they have to opt into both. When they come in the door, they have to say, Yes, DOC, you can submit an application on my behalf. Or Medicaid. Or Medicaid, if they're not already enrolled. And then when they're within ninety days from a projected release date, if they were already enrolled, because they could have come in enrolled, then they'll be offered, do you wanna opt into this program with BCCI? Or if they did not come in enrolled and did not accept the assistance, they wouldn't be offered the service because they won't be eligible.

[Rep. Alice M. Emmons, Chair]: Is it because they don't trust DOC? It could be. I don't know.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I think our processes are so new. I could be wrong, but my read is that we'll be able to figure it out so that most people opt in and it's just tweaking something. I'll be very concerned if that's still true little bit down the road from right now. But right now we're standing it all up, and so it could the issues could be in a million tiny places. So the word-of-mouth between offenders needs to get out there too.

[Rep. Alice M. Emmons, Chair]: It could be a lack of trust or just a real lack of understanding that there is health care out there for them.

[Committee Member (unidentified)]: Yeah, I mean, was gonna because people sometimes have a tendency, if they're coming in and they're just being admitted, it's a lot. And they may be like, no, I don't want that because I don't want anything right now. But is there another follow-up or is that their last chance or

[Renee Weeks, Director of Complex Care & Field Services, AHS]: No, it won't be.

[Committee Member (unidentified)]: Okay, good. That's what I was gonna say. Like, even like a week later, hey, I know it was a little rough there that night, but we also wanna just as long as there's like, we want them to get this. You know? You want you want everyone you you know, it's it's too bad it's not automatic enrollment. But anyway. Alright.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: We were talking today, actually, in our Huddl meeting that we have about people they might not opt in in that prerelease, but once they're in the post release, they might say, hey, yeah, I do want that service, and being able to opt in with that.

[Speaker 6]: Unless you're well aware of it. Yeah. Obviously, you are. So thanks.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: We're trying to make as many points as possible to bring people in, even if they previously, either we missed them or they opted out. If someone does, they are enrolled, they're eligible, they're within 90, they get the information about the program and they say, Yes, I would like to participate. They sign a release of information, and then that referral is sent to BCCI. And so there's a couple parts of that. DOC sends some of their information, enough information to make up that referral for BCCI. And in addition, WellPath will send health information, a summary of their health information so that the BCCI team receiving that referral will have a pretty good preliminary snapshot of somebody's, the level of intensity of their medical needs at that time and other details, at that time where it looks like they'll be released to.

[Rep. Alice M. Emmons, Chair]: I know enough that it's dangerous. And then I don't know enough. So when someone's incarcerated, they have all sorts of release of information forms to sign. And I would assume one of them is for their health care in terms of what information can be released. What if they refuse to sign a release of information of their health care? Does

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: that impact them with this program at all? So we decided that the programs wouldn't work if someone wasn't comfortable with their information being shared. And the release of information covers both DOC and medical information maintained by WellPath. Opting into that information being shared is a prerequisite for participating in the program.

[Rep. Alice M. Emmons, Chair]: And how many folks do not sign that release of information in general? And that may be a question more for DOC because I've run into this at times with constituent issues where it's pretty clear the offender did not sign a release of information.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yeah. So for this program, we just need time to see how often people are not opting in and get a sense that if that is related to the release of information. But for releases of information in general, separate from this program entirely, we're working on streamlining that process. Some of what happens sometimes is there's a disconnect between releases of information for WellPath and for DOC, and they're saved in separate systems. And so constituent services, this again, just exempt, they can't access the WellPath release information. So for that, what we're working on actually currently is a process that for certain types of releases, it will cover both. And so there won't be so much so many opportunities for something to get lost basically in between the multiple systems where information is stored. So hopefully you hear fewer issues going forward, but that's a bit separate from the ROI for this program.

[Rep. Alice M. Emmons, Chair]: And would there be any hesitancy on the offender's part of family members knowing about this three month reentry help? Do you think?

[Committee Member (unidentified)]: I'm not sure.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So sometimes my release of information is not that they don't sign off on it because they don't want family members to have access. So to participate in the program, the release that they'll sign won't include family members. Later down the road, if someone says, I want my family member to be part of my care team, it could, but at the onset, it wouldn't necessarily be there unless they specifically note that they would like them to be included.

[Rep. Alice M. Emmons, Chair]: Who's going to get all of this information out to the person in the facility? Is it one of those let's go back to the chart one of those

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I mean, there's people who are eligible for the BCCI support. I mean, for a little nuance, it's hard even to sign up for it.

[Rep. Alice M. Emmons, Chair]: Is it gonna be the well path nurses? Is it gonna be the reentry case workers? I mean, folks are gonna have to be walked through this, the sentence folks.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yeah, so the formal referral is made by the caseworker. They're the one that puts in the system. They collect the opting in and the release information. But those other staff that you mentioned, we're also expecting to be kind of ambassadors to the program and to tell people about it and to be able to speak to what the benefits would be and to encourage people, Hey, I see that you might be eligible. Talk to your caseworker about this. We also are planning to further identify ambassadors within the facility. So for example, the open ears coaches so that there's that as wide an awareness of the possible benefits as possible so that people can, through word-of-mouth, learn about it if they had missed the other information channels.

[Rep. Alice M. Emmons, Chair]: I think your word-of-mouth is how people are going to find out about your word-of-mouth.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: And BTCI will be in the facility. I think that'll help. New staff and in person meetings should.

[Committee Member (unidentified)]: If you don't mind, how'd you

[Speaker 6]: get involved with all this?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Well, I've been working in Vermont for twenty seven years. I did the math before I came here. Was like, hello. But my background is psychology. I'm a licensed mental health counselor and a licensed alcohol drug counselor. I worked at Clara Martin Center for years as a clinician and became a program manager. I worked with Department of Corrections for many years, facilitating violent offender and sex offender programs, and then worked at the Upper Valley Haven for eleven years in the housing world, managing their shelter and case management programs before coming to the stage four years ago to do this, to try to have a broader systems level impact in improving our health and social service systems. So this was a great fit into our work at the Vermont Primate Care Initiative. We've been partnering with DOC for three years.

[Rep. Alice M. Emmons, Chair]: I have a lot of hopes for this program. I hope it really works because it will make a difference, and I think it will really help some of the statutes that we've updated in terms of helping folks reenter the community and make those connections because health insurance has just been such an issue for folks, and that has prevented folks from accessing care that they've needed. It's hard enough to navigate the whole system when you know what's going You just have the tools to work with and to think that folks just don't have the tools, and then we expect them to be successful. Anything else? Sorry, I dominated the conversation. Though I read Troy's mind.

[Speaker 6]: Anything

[Rep. Alice M. Emmons, Chair]: else?

[Committee Member (unidentified)]: You're right.

[Committee Member (unidentified)]: I really see you.

[Arlene Petty, Executive Director of Finance, VT DOC]: We'll connect

[Rep. Alice M. Emmons, Chair]: once you send me that email.

[Rep. Brian Minier, Member]: Yeah, toss it as you will. Let that be a warning to

[Committee Member (unidentified)]: you of what will happen. There you go.

[Speaker 6]: I don't know. I

[Speaker 0]: have one guess.

[Committee Member (unidentified)]: You're small for me.

[Committee Member (unidentified)]: But I'll tell you, Brian. Budget, budget, budget.

[Speaker 6]: I'm sorry. Do

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: you have copies of language there?

[Rep. Alice M. Emmons, Chair]: Sorry, tape, so people know what we're dealing with.

[Committee Member (unidentified)]: This was the screenshot.

[Rep. Alice M. Emmons, Chair]: Did you post that? Yeah. Well, we go, the ups and downs. Yeah, that goes down to Mary, and this goes down to the camera and go, Start to give up sometimes.

[Speaker 6]: Mary A.

[Rep. Alice M. Emmons, Chair]: This is for Mary.

[Speaker 0]: And gets one of those too.

[Committee Member (unidentified)]: Yeah. Thank you. But this

[Rep. Alice M. Emmons, Chair]: just says what's the differences.

[Arlene Petty, Executive Director of Finance, VT DOC]: Okay, that's for Mary.

[Rep. Alice M. Emmons, Chair]: That's for you.

[Speaker 6]: Well, I got one

[Rep. Alice M. Emmons, Chair]: of I'll

[Speaker 6]: give that to Will.

[Committee Member (unidentified)]: Here we go.

[Rep. Alice M. Emmons, Chair]: Oh, then we got more here. Hang on.

[Speaker 6]: I have one of those too.

[Rep. Alice M. Emmons, Chair]: Okay. We got a lot of documents here. And we have Representative Squirrel from Appropriations here that's going to give us some help and backup. What's your time frame, Trevor? Short?

[Speaker 6]: About two minutes.

[Rep. Brian Minier, Member]: No. It's hopefully.

[Rep. Alice M. Emmons, Chair]: I'm thinking maybe, should we start with that? I can start with DOC. Does that work? Or is it better for you to start We with

[Speaker 6]: wanted to hear from them. So if there's any questions around the money or dollars and the BAA items. Okay.

[Rep. Alice M. Emmons, Chair]: So for the committee, this is the first thing you need to look at. And it's also on our webpage. Okay. So what you'll see, and this is in the governor's BAA for the general fund. And the chair of appropriations showed this to me, and Shawn happened to be walking by. And Shawn and Kevin are our liaison to appropriations, so I hold Shawn in. So where do you see the asterisk? 3,100,000.0 is for FY 'twenty five Wealth HAP staffing invoices that are being paid for out of the fiscal year '26. You got a problem? We're okay? So it's fiscal year '25 that finished up June. So it's invoices from July '24 to June '25 that we're being asked to pay for six months into the current fiscal year 'twenty six. So the question is, why? There's three Maybe

[Speaker 6]: I should come up.

[Committee Member (unidentified)]: That's something we need you there.

[Rep. Alice M. Emmons, Chair]: So that's 3.16 the 3,100,000.0 plus. You can sit in the red chair.

[Speaker 6]: That one. And

[Rep. Alice M. Emmons, Chair]: then the other piece is 4,500,000.0 plus for wealth pass staffing contract amendment due to the increase in average daily population. And the big question that the chair of appropriations had is what's in their contract that allows this, and why is this happening? So between the two, we have more than 4.6 mil 8,600,000.

[Speaker 6]: Yeah.

[Rep. Alice M. Emmons, Chair]: Between the two. 7.6, almost 8,000,000 between the two. So that's a big number for BAA. So that's why your chair reached out. So Trevor, welcome.

[Speaker 6]: Welcome. Representing Trevor Squirrel, House Appropriations. Let's take the 3.19, which is the triennial rent in place from '25. Next. As most departments and agencies have problems with the vendor payment system, for some reason, it's slow, okay?

[Rep. Trevor Squirrell, House Appropriations Committee]: At least that's what I was told. So it ends up getting paid that by twenty sixth. I asked the question because we get a report on carry forward reversions from all the line items in state government. And when I looked at the correctional services line for carry forward and reversions, it was already short of about 900,000. So if everything was equal, then I should see at least $3,100,000 being carried forward in 2016, which I didn't see. So I've had a conversation with the deputy commissioner and this card is half an hour ago, I've asked Amy to get back in touch with her because she was supposed to get some information to me, which I haven't seen yet. It was explained to me that what happened is, for budgetary reasons, they had that money available at the end of the year because they weren't paying that invoice because it was being carried over, and they used it, in part of these, to pay more to the pay act. In other words, pay act, they had so much for pay act, and because of overtime and other workforce issues, they had to pay more. I don't know what those numbers are right now, And I believe there might be some other invoicing that's in that number. So that's all I can tell you right now. That's the explanation of what's happened. I just don't have the specific numbers. When I do, I can present them to the committee.

[Rep. Alice M. Emmons, Chair]: So some of this is kind of the, I don't want to say backfill. I mean, part of it was with the vendor system because that got changed. So invoicing got delayed.

[Rep. Trevor Squirrell, House Appropriations Committee]: Yeah, they're not the only ones who were

[Rep. Alice M. Emmons, Chair]: supposed to. Right, that was across the system. But also they used some of the money that they had that didn't go because the invoices weren't coming in. So they used some of that money to pay for staffing.

[Rep. Trevor Squirrell, House Appropriations Committee]: I won't say, part of it was pay act. I think this is a conversation that DOC had with that central office and their finance person. That's my understanding. And is that correct?

[Arlene Petty, Executive Director of Finance, VT DOC]: Yes, the carry forward for 3.1, that was for, we paid 13 invoices, we had 13 invoices to pay for 2025 instead of just 12. So, that 3.1 was carried forward that AHS was turning over to us to pay for that extra invoice. And so that's what that was for. And my understanding is that's net neutral, it's not new money. It's actually carry for that we're using to pay that. That's just one month, it's not several months.

[Rep. Alice M. Emmons, Chair]: So we're in a different world money wise than appropriations. So can someone explain what carry forward means? And maybe you could identify yourself for the I'm sorry. That's fine. Farley Bettenden, Executive Director of Finance for the Department of Corrections.

[Rep. Trevor Squirrell, House Appropriations Committee]: Carry forward is a reconciliation that's shown true up at the end of the year for every department and agency. They have a budget, let's say they have a budget of a million dollars, you normally spend 900, you have a $100,000 left on the bottom line. Finance and management comes in and knows that the $100,000 is on the bottom line. And the LIBOR letter, you carry over because maybe you didn't expend it on programming and it's to be completed. So you would hold it within your budget going into the following year. Or finance and management will say, Well, we're going to revert all of that back into the Jones. And there's one other element of that. When there is carry forward, there can be a decision made between the department agency and finance management to use that carry forward for pay act.

[Rep. Alice M. Emmons, Chair]: That's what happened in this So particular

[Arlene Petty, Executive Director of Finance, VT DOC]: it is not new money, this existing FY 'twenty five money?

[Rep. Trevor Squirrell, House Appropriations Committee]: Well, yes and no. Because that money carries over to FY '20 We're backfilling it, because if it just carried forward, we wouldn't be putting it in the So you're backfilling?

[Rep. Alice M. Emmons, Chair]: That's Yeah. The money we choose for the pair.

[Rep. Trevor Squirrell, House Appropriations Committee]: Or the invoices I should suggest.

[Arlene Petty, Executive Director of Finance, VT DOC]: Right. Right. This was for an additional invoice, 13 invoices instead of 12 for one year. And the next year, this year, we're gonna be paying 12. So that was for that one extra invoice.

[Rep. Alice M. Emmons, Chair]: And the invoice was for what in particular? Was it staffing or was it?

[Arlene Petty, Executive Director of Finance, VT DOC]: It wasn't for It was for WellPath. Was one month's payment. For staffing? Yes.

[Rep. Trevor Squirrell, House Appropriations Committee]: Talking about the 3,100,000.0 Right. I'm talking about the money that was left in the FY '25 carry forward example is to pay all the payments. And that's the information I'm getting from the president.

[Rep. Alice M. Emmons, Chair]: If anybody can follow this, good luck. Other committee members,

[Renee Weeks, Director of Complex Care & Field Services, AHS]: can you follow this? No. I

[Committee Member (unidentified)]: kinda can.

[Rep. Brian Minier, Member]: Yeah. Mean I just

[Committee Member (unidentified)]: I guess my question is, so that thirteenth payment, right, did we did was that like a surprise?

[Arlene Petty, Executive Director of Finance, VT DOC]: No, was, I think they had, it was probably towards the beginning of the contract and they were making the payments the same time. Now we receive them, we pay them in the next month within a couple of days of the next month. So that was really what happened, it was thirteen and one, and then the And that was the AHS had held that so that we could utilize it, as he said, '25 to '26. And these are things that are decided upon at the end of twenty five.

[Committee Member (unidentified)]: Okay. Well,

[Rep. Alice M. Emmons, Chair]: think we need I think appropriations committee needs to work with you a little bit more to really understand what's going on because I think there's

[Rep. Trevor Squirrell, House Appropriations Committee]: I understand what's going on. I just need to get the information. When I do, I'll come back to this committee. Yeah. Okay. I get it.

[Rep. Brian Minier, Member]: I might try to summarize near where I'm wrong. There was some amount of money left from FY '25, and that's a portion of the 3,100,000.0 that we're talking about that was used to pay this thirteenth invoice from And carry

[Rep. Trevor Squirrell, House Appropriations Committee]: forward doesn't become part of your BAA request. Okay.

[Rep. Alice M. Emmons, Chair]: And this is the 3.1, it's part of the BAA request. Yeah. So your carry forward doesn't become part of it.

[Rep. Trevor Squirrell, House Appropriations Committee]: There wasn't that much carry forward, was only 900,000.

[Rep. Alice M. Emmons, Chair]: But,

[Committee Member (unidentified)]: so my question is, so if you knew that there's 13 payments, then you budget for 13 payments, and it would already been in there, you wouldn't have to be moving money around to pay for the thirteenth payment. So how did that happen?

[Arlene Petty, Executive Director of Finance, VT DOC]: The budgeting was done for 12 payments with that. It was

[Committee Member (unidentified)]: a little, a full bah, a little boo boo, a little oversight.

[Rep. Alice M. Emmons, Chair]: And where does the budgeting for that? Is that within DOC or Agency of Human Services?

[Arlene Petty, Executive Director of Finance, VT DOC]: Budgeting for WellPath, it's in DOC. But at AHS, it goes through AHS. And then if we do the budget, it has to go through the agents.

[Rep. Alice M. Emmons, Chair]: I was 12 and not 13 if something doesn't seem something was amiss. Troy?

[Speaker 0]: The best guest representative minus that carried forward that 900,000, we should anticipate a 2.2 Mhmm. Adjustment

[Rep. Trevor Squirrell, House Appropriations Committee]: on this line? What I'm saying is that when I saw the request for 3,100,000.0, I would assume that you're paying 26 to add money on the bottom line. That's where I would look for that. Then the report shows 900,000 instead of 1.2 or 3.1 or whatever. So that's when I started asking questions, why that happened that way? And I was given the information that part of it was an increase around pay out and some other injuries, which is, you referenced other injuries. I just don't have that information.

[Speaker 0]: So

[Rep. Trevor Squirrell, House Appropriations Committee]: maybe all of us can sit down at some That point and sort this

[Rep. Alice M. Emmons, Chair]: would be helpful, and then get back to us. Yeah, I'll get back.

[Rep. Trevor Squirrell, House Appropriations Committee]: And actually, 4.5, that's a combination of the increase in the wealth management contract because of the census change. And I think also the substance use disorder expansion. So I think that's understandable. This committee knows about what's happening to the census and in corrections, and obviously has a direct impact on the health services. It's a big number, but it is what it is.

[Rep. Alice M. Emmons, Chair]: And there's no carry forward, right?

[Committee Member (unidentified)]: I mean, that one seems pretty straightforward, but the first one, three point one,

[Rep. Trevor Squirrell, House Appropriations Committee]: that one definitely needs. Yeah, I think it's more about understanding what exactly happened. Exactly.

[Committee Member (unidentified)]: It probably all make perfect sense.

[Rep. Alice M. Emmons, Chair]: So Trevor, when you had those conversations with the three point one million for staffing. The invoices just circle back to us. And then the 45.

[Rep. Trevor Squirrell, House Appropriations Committee]: I'll let them speak.

[Committee Member (unidentified)]: Yeah. Yeah. We'll take you off the hot seat. I never feel like I'm on the hot seat. That's good. But some people do.

[Rep. Brian Minier, Member]: The hot seat's here. You chose well.

[Rep. Trevor Squirrell, House Appropriations Committee]: May I

[Committee Member (unidentified)]: be excused? Yes.

[Committee Member (unidentified)]: Thank you, Trevor.

[Rep. Alice M. Emmons, Chair]: Thank you so much. Thank Trevor.

[Committee Member (unidentified)]: It was a big help. It was a

[Committee Member (unidentified)]: big help.

[Rep. Alice M. Emmons, Chair]: Thank you. Okay. Now we got two chairs. We got a red one and a black one. And you

[Rep. Brian Minier, Member]: can I've got breathing. I love Joe. He's gone.

[Rep. Alice M. Emmons, Chair]: Is he gone gone?

[Committee Member (unidentified)]: Yeah. Is. Gone.

[Arlene Petty, Executive Director of Finance, VT DOC]: I'm never in and take dads.

[Committee Member (unidentified)]: Okay.

[Rep. Alice M. Emmons, Chair]: Oh, there goes through this. I'm curious on this one. That's just a lot of curious answer. Okay. Again, if you both could just identify yourself for the record, please.

[Arlene Petty, Executive Director of Finance, VT DOC]: Arlene Petty, executive director of finance for Department of Corrections. Welcome. I don't

[Rep. Alice M. Emmons, Chair]: think you've been before this committee before, have you?

[Arlene Petty, Executive Director of Finance, VT DOC]: No, think. I started in June.

[Rep. Alice M. Emmons, Chair]: Oh, you poor thing.

[Committee Member (unidentified)]: Oh,

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Condolences, yeah. Aviv Viteva, Executive Director of Health, Wellness and Engagement for DOC. All right, shall we jump into this topic? Nice to see you all again. Alright. So for this 4,550,000.00, it's coming from two places, two drivers of changes to the well path contract. The biggest portion of it is due to a change in average daily population. So we'll come back to that in more detail. And then a portion of it is for the Burlington Response Recovery Project for enhanced SUP services at DOC.

[Rep. Alice M. Emmons, Chair]: Now, is that

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: in response at all to the accountability corp? Yes. So I believe they're the same thing. It's different names for initiative. But it was a million dollar increase because of the accountability for it? Yes, for WellPat Staffing to provide the extra services. Services we weren't previously providing.

[Committee Member (unidentified)]: And

[Rep. Alice M. Emmons, Chair]: what service Okay. Again, I know too much.

[Rep. Brian Minier, Member]: So you know too much?

[Rep. Alice M. Emmons, Chair]: I know too much. So this $1,000,000 go back. The $1,080,000 is for increase in services from WellPath to the folks who came through the accountability court. Is that in the Chittenden facility as well

[Committee Member (unidentified)]: as St. Albans? Yes.

[Rep. Alice M. Emmons, Chair]: Did WellPath know that the folks coming in went through the accountability court?

[Committee Member (unidentified)]: I'm going

[Haley Summer, Director of Communications, VT DOC]: speak to that. The record, Haley Summer, Director of Communications for DOC. So I think Doctor. Miller talked about this a few weeks ago, which was that there's no direct pathway right now for that notification and staffing for that program hadn't quite The person hadn't started yet, but now has started. And so the intent is to be able to provide those services to more individuals aside from just those that are coming in from the accountability court.

[Rep. Alice M. Emmons, Chair]: It's only 10 or 12 people that came in from the accountability. So WellPath does not know. The testimony that WellPath is given to joint justice oversight, as well as to hear, when someone is accessing health services at WellPath, they do not know if the person came through the accountability for or anything. They don't know anything about the person, the charges, the conviction. They just know that they need to deliver healthcare to this individual. So

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: this is just the beefing up of the substance use programming within WellPath at the Chittenden facility in St. Albans. And it's for the whole population, not just the folks coming through the accountability court. So the expectation is that we can bring more people into the program to take advantage of the enhanced services or find more people who would benefit. But it was set up specifically for people coming through the Chittenden Accountability Court. And you're absolutely correct. Regular health services are provided exactly the same. However, WellPath could receive a Invitation is the wrong word. A request to assess someone for the enhanced services. It's an enhanced, more robust assessment. And then provide the services from there. And part of the rationale for staffing WellPath to do this is they are already providing care to that person if they're in our custody. So to have more of an integrated program where we're building on the services they're already getting, they may have a MAT case manager, they're on MAT, they're seeing a doctor for whatever, that those services for that person can be all provided in an integrated manner, if that makes sense, compared to bringing in a new program to provide some services that wouldn't be integrated with the services someone may already be receiving just by nature of being in our custody. So what other new services would they be receiving that will be integrated? And this would be for the whole population that's going through WorldPath, correct? Not just those 10 or 12 people from the accountability court. So currently, the services are being offered to people coming through the court. The service A small number.

[Rep. Brian Minier, Member]: A million dollars, please.

[Rep. Alice M. Emmons, Chair]: Is it that's a question. Is it a million dollars worth for those small number of people? It's a handful of people that we heard. It's like 12 people.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: The grand piece? Yeah. The the million dollars corresponds to a staffing number that is for a

[Rep. Alice M. Emmons, Chair]: larger group of people

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Than the volume of people coming through the court. Yes.

[Committee Member (unidentified)]: Is it a timing thing or is it due to these 12 people? I could hear that you're just now catching up with staffing you need, and it's in the same timeframe as the twelfth, but maybe not. The problem, The is why did it

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: ADP driven cost increase is a bit of a catch up. I can speak to that. But the 1,000,000 associated with the staffing for the enhanced SUD services was specifically added for that initiative. Now we've also recognized that there are more staff that have, that will bring online with that money than the current volume of people coming through the court. And so we wanna identify people who have the need for the enhanced services, which is an enhanced level of SUD treatment than we otherwise offer to provide it to them. But for now, we're really focused on the people coming through the court.

[Committee Member (unidentified)]: So that's the question. What are those enhanced services? Is it language? Is it new equipment? What are the

[Rep. Alice M. Emmons, Chair]: enhanced So

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I believe Doctor. Used an analogy a week or two ago around dosage and kind of the level of intensity of a service. And so in oversimplified terms, the amount of therapy and counseling and groups will be much greater than if we didn't have this enhanced service, then someone might be able to access if they were incarcerated in our facility. So they're on the MOUD program. Exactly. So they would be on MAT already. And without this program, they could still participate in groups depending on the facility they're in, those groups would be different. They will still receive counseling. They may see a mental health clinician. All of that is still true, but there will be more groups and more therapy available to them to more mirror an intensive outpatient level of care, which currently the amount of services available in those categories don't meet that level of treatment.

[Committee Member (unidentified)]: No, I'm not good.

[Speaker 0]: The

[Committee Member (unidentified)]: reason I'm not good is because I don't know who decided that that higher level of support is necessary. It wasn't authorized as far as I know.

[Rep. Alice M. Emmons, Chair]: 5th Floor. 5th Floor would be accountability for it.

[Speaker 0]: Is this million plus anticipated that the volume of care is going to be needed going forward? Or is this because there's not a determined future for the accountability courts right now. In fact, everything that we've heard is that it's winding down.

[Rep. Alice M. Emmons, Chair]: The governor did say it was the pretrial supervision is going to be expanded.

[Speaker 0]: But is that going to result in more of this higher level care? So is that million dollars anticipatory? I guess that's my question.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So the staffing proposal was based on joint collaborative program design for what enhanced services would look like in association with the Chittenden Accountability Court, DOC, WellPath, AHS. I don't actually know exactly who was involved, so I don't wanna misrepresent by not naming other entities. But it was the discussions of what enhanced services would look like, what we would provide to meet the criteria of an IOP inside And the then the staffing was laid out for two facilities. So the idea was we would pilot this enhanced level of care at two sites, and that's what the staffing is based So off

[Speaker 0]: can we anticipate if you go to contract for another two years that it's going to need at least that much more going forward?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I think there are people in our custody, whether or not they're part of the program who would want and or benefit But from more otherwise I can't really weigh in on whether or not it would be prioritized as an initiative. I just don't know.

[Rep. Alice M. Emmons, Chair]: Brian?

[Rep. Brian Minier, Member]: I feel like I'm in danger of going over the same ground. Just want to make sure that I understand.

[Committee Member (unidentified)]: So the 3.5 is because of the increased population. The one is because

[Rep. Brian Minier, Member]: of the increased offerings of services. These two numbers are meant to cover all of the current fiscal year, '26 to June 30. These increased services, even though they came along with the accountability court, nonetheless, they're being offered to everyone possible in the two facilities. Currently,

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: we're focused on people coming through the court. But I guess if we get a green light to broaden, then we will identify people who would benefit from that level of care and identify more people to start a more robust assessment for, and then determine if they need more therapy groups.

[Rep. Brian Minier, Member]: So then for at least right now, then this million is for the year through June 30, and is for only the people coming through the court, those whatever the number is.

[Rep. Alice M. Emmons, Chair]: How does WellPath know that it's only those people coming through the court?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Because they're doing a more robust assessment for someone coming through the court if Coming through the accountability court? Yes. Sorry.

[Rep. Alice M. Emmons, Chair]: That kinda contradicts the testimony that WellPath has given. That's what I'm trying to connect here.

[Haley Summer, Director of Communications, VT DOC]: Related specifically to the accountability for folks, there is someone at DOC who, you know, continuously checks the docket to see who is moved into DOC testimony. And so I believe that's kind of the mechanism for providing that referral to WellPath that this person should have an enhanced assessment. I

[Rep. Alice M. Emmons, Chair]: think you're setting yourself up for a lawsuit because there are other people who are part of MOUD that might not have access to these increased enhanced services. And they're serving the same sentence.

[Committee Member (unidentified)]: Yep.

[Rep. Alice M. Emmons, Chair]: And the testimony we received from WellPath and Joint Justice Oversight as well is right here, they don't differentiate between the accountability court or any other path into the correctional facility to provide these other services. And they're rolling this out across the system for folks who are in MOUD to also provide these other supportive services. And I've asked Haley this morning, now that the budget's been proposed, that DOC has a structure for this. And I want to get that information so we can track with our legal counsel, our legislative counsel, to make sure we don't have to update the statute. Because I think we will in some places. And this is connected to the MOUD program. And we have 50% of our population on MOUD. So I'm just trying to connect the dots here, because I'm feeling like we're getting conflicting information.

[Committee Member (unidentified)]: If I may have, if this wasn't labeled as being part of the accountability court, could probably live with the number and still have questions. Think everybody in the room has the same questions about the legality and statutes, but 1,080,000 for basically it's 12 people. I don't know if it's 12, could be 13, could be 11. I don't, people keep saying eleven, twelve. So I'll say 12. That's 12 in a month.

[Speaker 6]: And so

[Committee Member (unidentified)]: I don't know, just like where did that number come from? It's a very precise number. I mean, doesn't have sense, but it's a pretty precise number. Where did that number come from? It certainly isn't divided by 12 in any logistically reasonable way. Are you gonna answer, but John? No. I'm okay. No. But I have

[Speaker 6]: something kind of to spin off that. But they saw correct me

[Committee Member (unidentified)]: if I'm wrong. They saw 45 or 50 people Right. The accountability court.

[Rep. Alice M. Emmons, Chair]: Yeah. But they didn't end up incarcerated.

[Speaker 6]: So do

[Committee Member (unidentified)]: they only see these these guys only see incarcerated people?

[Rep. Alice M. Emmons, Chair]: Right. Right.

[Speaker 6]: I just wanted to clarify.

[Rep. Alice M. Emmons, Chair]: Supposedly are all sentenced. They've been sentenced through the accountability court, but it's a small it's like 12. Yeah. So it's a small number.

[Committee Member (unidentified)]: Well, I think it's a little more by now, but it

[Speaker 6]: yeah. Not

[Rep. Alice M. Emmons, Chair]: by now. This was presented in December. Right.

[Committee Member (unidentified)]: Right.

[Rep. Alice M. Emmons, Chair]: This was presented to the appropriations committee about the twentieth, eighteenth, nineteenth, and December 20.

[Committee Member (unidentified)]: Got you. Somebody have a great answer for me?

[Haley Summer, Director of Communications, VT DOC]: Great. That a

[Committee Member (unidentified)]: Is that a standard too high?

[Renee Weeks, Director of Complex Care & Field Services, AHS]: Poor Gail.

[Haley Summer, Director of Communications, VT DOC]: I don't want to speak for Doctor. But I think he did testify to this last week, which is that if the capacity exists to serve more people than just those that are coming through the accountability court, they would absolutely like to serve those individuals. So I would be hesitant to say that that 1,000,000 is as simple as dividing by 12 or however many individuals have come through the accountability court. But that's how much it is to stand up that program that will maybe hopefully serve more individuals.

[Committee Member (unidentified)]: Back to the chair's point, the statutes has certain things that you can and can't do. I like to go 130 miles an hour on interstate, but the law says I can't. So you may want to serve or he may want to serve more because the statute doesn't allow for

[Rep. Alice M. Emmons, Chair]: That's what we're going to check for. We just want because there is a whole program that the 5th Floor and DOC has developed to increase SUD services within our correctional facility. The commissioner could not share any of that prior to the budget being The budget has now been presented. I wanna get that information so we can sit down with Katie McLint

[Committee Member (unidentified)]: Mhmm.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: And go through our

[Rep. Alice M. Emmons, Chair]: MOUD statute and see what tracks, what needs to be updated. Because we may not need to do anything, we may have to do something because you're offering a different SUD services.

[Committee Member (unidentified)]: And that's across the board from what I've heard. And maybe one way for me to understand is the cost per ADP is made up of counseling, medication, No, no,

[Rep. Alice M. Emmons, Chair]: that's separate.

[Committee Member (unidentified)]: That's separate. I know it's separate, but to get to the number that has had to increase because the ADP has increased, I wanna know what's making up the cost per person.

[Committee Member (unidentified)]: Are you talking about the 3,500,000.0?

[Committee Member (unidentified)]: I'm talking about the average cost per person being served. What makes that up? Seeing two nurses, one doctor, surgery, MODOD, psychiatric care. I wanna see what makes that per patient number up. Because when the numbers of patients goes up, obviously the cost goes up. The reason that's important is because now we're talking about taking whatever that lineup of services was and adding to it. Now we can understand why a 0.08 or how many of those people?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: The ADP driven costs or what we pay WellPath is all inclusive. I know. It's everything that they provide. That's not what you were asking.

[Committee Member (unidentified)]: Yes, I wanna know what's included

[Committee Member (unidentified)]: in it.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So you named many of them. It's pharmacy, it's off-site specialty appointments, it's in facility care, It's the staffing to provide that care, the administrative overhead, which is one of the smaller parts, staffing at both the regional office and the site level.

[Committee Member (unidentified)]: Trying to think No, no. I just don't misunderstand me. I can imagine what the list looks I wanna know how much you assumed for each person because it's obviously an average. So that we see that every person that's being counted is on average going to see $250 worth of opiate.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I see. And you're interested in that at the level of the individual? No. Okay. So we would have to follow-up. I have the total per member per month. That includes it all, but not this is pharmacy, this is staff. And I will just give a heads up that one of those categories is correctional health services, which is going to include multiple other things. So, that would include staffing. It's probably broken down into five buckets.

[Rep. Alice M. Emmons, Chair]: Okay, out of sense.

[Committee Member (unidentified)]: But the reason it's gonna highlight things is because now we've got an additional million dollars on top of the 33.4. So it's either additional categories or more of what's already included. That's what will help us understand.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: The 1,000,000, and we could actually, if we wanted, we could go to the end slide. But we also, do we wanna stay on this, move into ADP? The 1.08 is staffing, and it is included in the staffing total that the per member per month is based off of. Because all of the costs are put in that then come back out with the per member.

[Rep. Alice M. Emmons, Chair]: Branch.

[Rep. Brian Minier, Member]: Sorry. With the 1,000,000 whatever it 1.08, I'm understanding that it's covering whoever has been identified from the accountability court, which is nowhere near the capability of this group, is wasted up. And so we're not enjoying efficiencies and scale or whatever.

[Committee Member (unidentified)]: I assume it would be

[Rep. Brian Minier, Member]: somebody like Doctor. Who could speak to what that team could do in terms of population that they're serving with those enhanced services?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: I think Doctor. Ulliger and Shannon, who's the director of recovery and reentry services for WellPath, could speak to it. I also think the original, back to where the number came from, had projections for people served in it that those numbers were based off of. The number of people coming through the accountability court hasn't reached that, but whatever those initial assumptions were, if we can relocate them, would speak to what the staffing was based off of. We're trying to serve X people.

[Rep. Brian Minier, Member]: And then 1.08 will cover that x amount of people until June 30, and it could get somewhat larger. But then beyond that, you would need to add people around the second team or elsewhere.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Correct. If we were to offer that enhanced level of services at other facilities and fully used the resources at the two. In theory, maybe we wouldn't need as much because not as many people need that level of care. Don't know if we were to do that more robust assessment, how often people would have a finding from the assessment of needing that level of care. But maybe that is enough to cover other facilities. I just don't know yet because we haven't fully pushed the limits of what we can offer and to whom.

[Rep. Brian Minier, Member]: But then also it's not possible to line up that amount of money with the purported end of the accountability port because we're talking about this service going through the end of fiscal year, not through the end of this month.

[Rep. Alice M. Emmons, Chair]: Going through what?

[Rep. Brian Minier, Member]: The end of the fiscal year, through June 30, in regards to

[Rep. Alice M. Emmons, Chair]: That leads to my question. What's in the governor's proposed FY twenty seven budget the DRC, for this particular

[Arlene Petty, Executive Director of Finance, VT DOC]: program? For the SUV, would be the 1,200,000.0, if it's not prorated. 1,200,000.0 because it would be for twelve months not prorated. This $10.80 is a prorated amount, because it didn't get stood up for twelve months. It was just in the last ten,

[Rep. Alice M. Emmons, Chair]: six months, eight months, not even that.

[Committee Member (unidentified)]: It can't be 10.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: It's either 10.1 or 11.1 that it was based off of.

[Speaker 0]: Yeah. FY twenty seven, governors recommend for this enhanced SED is 1.2.

[Rep. Alice M. Emmons, Chair]: 1.2. That's fair. And is that just for the Chittenden facility in Southwest?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: That is for the same two that are currently in the mix, which is Northwest and Chittenden.

[Rep. Brian Minier, Member]: That 1.2 would notionally cover whatever number of people that team can serve for the full coming fiscal year?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yeah. The 1.2 is the staffing for a year.

[Rep. Brian Minier, Member]: Yeah. Is that a good serve? Yeah.

[Committee Member (unidentified)]: Is the capital bill doing that one point away?

[Speaker 6]: Or is

[Speaker 0]: it the big bill? It's

[Rep. Alice M. Emmons, Chair]: a big bill. Don't get it confused with our world.

[Speaker 0]: I was just

[Rep. Alice M. Emmons, Chair]: This is the general fund, BAA, that House Appropriations Committee started working on about the eighteenth, nineteenth, December 20 Okay. Before Christmas. They hope to get the bill out next week.

[Committee Member (unidentified)]: So you had mentioned in your answer to Brian, you mentioned that somewhere there's an estimate that was used to make this number. Can you guys get that number and your rationale, like how you came up with the confirm? Pretty please. Also, sorry that we're being sorry about you, but are

[Speaker 0]: we providing a recommendation to approve?

[Committee Member (unidentified)]: Are we providing a recommendation?

[Rep. Alice M. Emmons, Chair]: Between the two, you've got almost $8 to $10 That's a big budget adjustment. Yeah, it is.

[Rep. Brian Minier, Member]: So if this were not filled to the team's capacity from whoever comes out of the accountability port, It seems like given time, that's not going to happen. Then expand through the rest of the population as you've described up into whatever that limit is as soon as we can identify them. We'll need these services. Basically, give the team up to capacity when you can once the court is over.

[Rep. Alice M. Emmons, Chair]: Yes.

[Speaker 6]: Okay.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: And we would do it at the speed that we could fill the seats, So so to WellPath isn't going to hire people that there's no one in front of them to provide the service to, which based on where we're at right now, I don't know if I'm gonna get in trouble for saying this, but would mean we wouldn't fully spend the one point o eight because that is based on a period of time and a full staffing that we haven't reached.

[Rep. Brian Minier, Member]: I thought that was the minimum staffing, which is already in place. Misunderstood.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: That's the minimum staffing for the original program design for two sites, but WellPath had not hired all those staff. They're hiring very slowly, in fact, because the volume from the port is much lower than projected.

[Rep. Brian Minier, Member]: Got it.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Or I should say, those initial designs, we were working with the information that we had. And so the pace and the volume of people coming in through that particular program is slower and smaller than the numbers we're based off of.

[Rep. Alice M. Emmons, Chair]: Yep. You know what really frustrates me is when there's new initiatives done on the front end of a process in our criminal justice system, this is no complaint to you folks. But when there's new initiatives that are done on the front end of a process in the criminal justice system, there is going to be issues in DOC. There's gonna be pressures put on our facilities, and nobody talks about it, and nobody explains it to the public. And this is a good exam. Oh, let's work them through the court system really fast because the judges, state's attorneys, defense they wanna get these cases off their books, but then that's gonna put pressure on DOC, and nobody's talking about it. Mhmm. It never really bothers me. Mhmm. And then we're caught with something like this. It's no fault of anybody, but it's being touted out there that, oh, people volunteered. We had a specific person targeted to work in the state's attorney's office, and and a judge came out of retirement, but, bam, DOC's budget's gonna go up because of it. Nobody talks about that. Just a comment.

[Rep. Brian Minier, Member]: My understanding at least have

[Committee Member (unidentified)]: been nice for us to have a briefing and understanding. So if people ask us questions, which they do, we can actually have an intelligent answer instead of no.

[Rep. Alice M. Emmons, Chair]: Kevin?

[Committee Member (unidentified)]: My understanding is the ADP is actually for a range of individuals. Can you tell us what the range was I and what you're working with

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: made what I think is a very pretty chart to show you exactly Can I quickly go through the other slides just to get to that? Okay. So moving on to the bigger portion of the increase, which is ADP based, which is the 3.5 if we're rounding. So the original contract with WellPath was based on an average daily population of up to 1,300 people. To your point, representative, it is a 100 person range and the calculations are based off of the middle and we'll have a chart of that. Due to the increased population, DOC amended the contract in October to reflect an ADP of up to fifteen fifty. So, a range of fourteen fifty to fifteen fifty calculations based on 1,500. In doing that, we added between nine and ten full time positions to the contract to provide that level of services to more people. So this chart shows, starting

[Rep. Alice M. Emmons, Chair]: with the beginning

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: of the Well Path contract in July '3, 'twenty four. Could have said that wrong. FY 'twenty four, because we're in

[Rep. Alice M. Emmons, Chair]: 'twenty six now. Excuse me.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: The number of people and I just wanna note, the bottom vertical axis is 1,100 people. So when you look at this with the axis of zero to 1,500, it is much less dramatic, but I want you to be able to see what's happening. So this is the average daily population, which is per month. The red is what the ADP calculation is in the contract. So it was $12.50 until we changed it. So what you can see is that really starting a long time ago, the average daily population was higher than what the contract was calculated based off of. And I think we've shared our contract has a clause that if that's the case, they have the right to negotiate. So now what we're doing is catching up to our ADP having been higher than the range that they're getting paid for for many months now. So we went from $12.50 to 1,500 and that range. And so now what the contract states is that the ADP is in between $14.50 and $15.50. And their right now to negotiate is if it goes above $15.50. So some of what we were doing was anticipating continued increases in ADP and not wanting to have to immediately go back and up it because we'd already exceeded what we put in the contract. So that's the catching up and why there's such a significant jump of an increase in ADP. Because we didn't do it for a period of time that the theoretical well path could have asked us to do it earlier.

[Rep. Alice M. Emmons, Chair]: But if you're looking from a year and a half ago, our population has been increasing. And the bulk of that increase are detainees. Correct? Yes. So keep this in mind. The public wants us to lock up more people and take them off the streets. And your detainee population is gonna increase, which increases the cost of health care and increases the cost of staffing and increases the cost in the DOC budget. So I just want folks to keep that in mind. And that's what we're starting to see as a trend. It's not so much sentence folks necessarily. Our detainee population used to be about 300. We're now over 500. We have about, I want to say almost 1,600 beds, not quite We have about 1,500 beds at most in our system. But of those 1,500 beds, about 900 of those beds are only general population.

[Committee Member (unidentified)]: Say that

[Rep. Alice M. Emmons, Chair]: again. 900 are general population. The others are specific. Could be booking, could be infirmary beds, could be close custody beds, could be geriatric beds, could be mental health beds. So you're not gonna put a person who needs to be in a general population in those specific beds. That's the pressure we're feeling in our correctional facilities. That's the pressure that our staff are feeling. Yep. So the more people you wanna incarcerate, the more it's gonna cost us. So just keep that balance. Unless we don't provide any services to them and we just warehouse, then that's a whole different story.

[Committee Member (unidentified)]: Editorial comment is the reason we do that is because we believe that that cost is less than if the people who are hurting other people are out hurting people. Right? We do this. We spend more money in corrections because we believe that's a lower total cost to the civilization than the cost to those who are being offended. Vermont crime research

[Rep. Alice M. Emmons, Chair]: tells you the opposite.

[Committee Member (unidentified)]: That's why we do it. Crime

[Rep. Alice M. Emmons, Chair]: research, which we can have them in, will show it's different.

[Committee Member (unidentified)]: They want rehabilitation, so do I. But the question of money is one way or

[Rep. Brian Minier, Member]: the other. I don't think we're

[Speaker 0]: making decisions about incarcerated people because it's cheap. Or because they're doing a better return on investment. I don't think that's happening.

[Rep. Alice M. Emmons, Chair]: We can get the Vermont Primary Search in and talk about that, because they have done a comparison in terms of the cost of public safety in the community and the cost of corrections. They have done that comparison, and we can get them in for that. About prime research, we can get them in, bring that out. So it will be surprising, I think, for many people

[Committee Member (unidentified)]: to see the results. Kevin's point, it's probably, I

[Speaker 6]: could be wrong,

[Committee Member (unidentified)]: that the general population who may not be privy to this data would, generally speaking, think doesn't mean it right. People on the outside just think you have the price that it costs society for somebody to be out breaking the law versus locking them up, and they make those We hear it all the time. We always hear like, why why is somebody back on the street, for example, about bail? Because they don't understand bail law. Right? I mean, you know, so it's not whether it's true or not. It's people's interpretation. I don't think we're making that this is not a horror movie.

[Speaker 0]: No. I don't think society is making that decision. I think society is very much returning to a lock them up mentality in a general sort of sense. I don't wanna see the problems that I'm seeing, so they should be in jail. That's what I think has happened.

[Rep. Alice M. Emmons, Chair]: And that's why our detainee population is going up, which then that's why our average daily population calculation is going up. So let's get back to this, because we've only got a few more minutes

[Speaker 6]: to go here. We need get

[Committee Member (unidentified)]: out on the floor.

[Speaker 6]: Ten minutes.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So we can go to the next slide. I just wanted to provide some high level summary of what's happening with the changes in the contract and the calculations that were made that resulted in that final 3.5 number. So it was adjusted based on spending in years one and two. So we had years one and two based on a budget of what we would spend in each category, staffing, pharmacy, etcetera. And then when they provide the budget for this ADP, they adjusted it based on what we actually spent more on. So for example, pharmacy and off-site services were increased disproportionately because we had under budgeted for them and other things were increased the opposite. They didn't go up proportionately. Overall, the ADP increased 20% and the annual contract amount increased 11.5. So I think to your point last week, that's an economy of scale question. And also through analysis of what actually are the per person costs versus the ones that are system wide. And I think I had in a previous slide that just in terms of the staffing costs, which is one of many inputs, that's about 10 additional positions added to the contract to serve more people.

[Speaker 6]: Perfect.

[Rep. Alice M. Emmons, Chair]: Yeah. So

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: for this particular piece, what would be our recommend? You'd still get another sheet. Go ahead. This one. That's SED, which I think we covered in detail.

[Rep. Alice M. Emmons, Chair]: Requires seven new positions. So

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: in either the next slide or the one after it is the detail of the staffing changes. So on the left, these are the ADP changes alone, and on the right is the enhanced SUV services alone. And these positions are not all filled, again, because we don't have the volume of people coming through the port yet or at this time to need all those staff. And WellPath is not hiring them to have them sit in the facility and not provide the service. Okay. But the contract includes them. So when we, one way or the other, are ready to provide that enhanced care to whomever, through the court or otherwise, they have the ability to fill those positions through the contract.

[Committee Member (unidentified)]: And I think it's semantics, but this end of your chart, you had the same amount of personnel to serve many more people. So they obviously couldn't spend as much time with each individual. I'm I'm not sure.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Not completely telling you, but I'd like to.

[Committee Member (unidentified)]: This chart here. Yes. Your personnel jumped up. For this period here, there was opportunity to serve the people, but you didn't have the people to do it. Instead of having services, you were just able to provide the services that you wanted to within this red range. And you can't because you can have the people to do it.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes. I mean, were provided to the people in custody with the existing staff. It's hard to say how much more we would have been able to provide had we adjusted it earlier. But yes.

[Committee Member (unidentified)]: One last question. So on your ISO paper here, so it shows the point in questions we've been asking. But what if those aren't hired? Do we still have to pay WellPath Carried

[Rep. Alice M. Emmons, Chair]: out for you

[Committee Member (unidentified)]: or do we forward.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: So the way the contract is structured, if WellPath doesn't spend the money for most of the categories that make up the budget, the state gets the money back.

[Rep. Alice M. Emmons, Chair]: So it's carried forward in that budget.

[Speaker 6]: Does that ever happen?

[Committee Member (unidentified)]: Yes. Oh, cool. Hey.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Sweet. And that's that's true up until if they get right up at the top of the budget, And then there's negotiation that happens depending on how much over budget they go. But that hasn't happened.

[Committee Member (unidentified)]: I just wanted you to add on the positive.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Yes, it's in there. But if they don't hire people, we don't spend money. Sorry, Troy, need to cut you

[Speaker 6]: off.

[Rep. Alice M. Emmons, Chair]: So what is the committee's wishes in terms of our recommend to approach? Want more discussion about this?

[Committee Member (unidentified)]: Should we think about it for a minute? Sure.

[Rep. Alice M. Emmons, Chair]: Sure. Because we also have to hear back from Trevor.

[Committee Member (unidentified)]: Right. Think we

[Speaker 6]: have to wait till Trevor.

[Committee Member (unidentified)]: I agree with that. Right.

[Rep. Alice M. Emmons, Chair]: That's for the first part, the 3.1. This is his

[Speaker 0]: I can say that philosophically, I'm absolutely in favor of enhanced STD services. I think we're doing the bare minimum right. That's what I caveat that I wish we weren't doing it to privatize medical services, but we are. But that's just a philosophical thing.

[Committee Member (unidentified)]: My thing is this paper would have been This page, I would have started with this page because we'd be judged for half an hour about what this page answers. But mine is more a philosophical thing of whether, that's not even philosophical, just legal, whether or not it's legal to provide to detainees. We gotta update the law. Right. I mean, is on us. Don't get me wrong, but I want to make sure that we're complying. And there is no, as the chair mentioned earlier, opportunities for lawsuits for obvious reasons that we can take care of in advance. That's my biggest concern about issues.

[Rep. Alice M. Emmons, Chair]: It's up and down.

[Arlene Petty, Executive Director of Finance, VT DOC]: So I'm not remembering what

[Rep. Brian Minier, Member]: was officially any other so called 14 plan or whatever it was. Was this 14 bullets or whatever? Yes.

[Rep. Alice M. Emmons, Chair]: Say that again?

[Rep. Brian Minier, Member]: I was just wondering if this enhanced FPD treatment for those coming out of the court was part of the 14 plan. It sounds like it was. So that was the first question. And the second is, we heard a speech, but I want to know who's going to own the ongoing expense, who's going to admit to what this is.

[Haley Summer, Director of Communications, VT DOC]: Do understand

[Rep. Alice M. Emmons, Chair]: pre trial supervision? Yeah. Because it's DOC staffing that supervising the folks

[Rep. Brian Minier, Member]: in the community. Sorry, I meant to own in the sense of take responsibility for and not have to deal with. Who politically is going to own, who realistically is going to say, right? Because the accountability court is coming to an end. Notionally, according to the speech the other day, it didn't cost us much of anything at all. So if we're going to talk about what we're going to say to appropriations, I sure would like somebody to say, yes, we're absolutely in favor of this, this is what we're going to pay for it.

[Rep. Alice M. Emmons, Chair]: Yeah, it's ongoing cost. But what I'm hearing from the administration is this enhanced SUD is something they really believe in. It's coming from the 5th Floor. They really believe in it, and they'd like to do it across the whole system.

[Rep. Brian Minier, Member]: Yeah, let's hear it full throated, totally.

[Rep. Alice M. Emmons, Chair]: And if we support that, there's gonna be a cost to that. And we'll have to update our law on MOUD.

[Committee Member (unidentified)]: Right.

[Rep. Alice M. Emmons, Chair]: Which is age 32.

[Committee Member (unidentified)]: Yep.

[Rep. Alice M. Emmons, Chair]: That's where we're at.

[Committee Member (unidentified)]: Mhmm.

[Rep. Alice M. Emmons, Chair]: Well, let's go to the floor, and then we'll be back here after the floor.

[Speaker 6]: To wrap it up.

[Rep. Alice M. Emmons, Chair]: And let's hope. At least on this piece, and we'll hear the other piece from Trevor, the 3.1, because he's still got some moving pieces for that. So we've left you off. Thank you.

[Committee Member (unidentified)]: This wonderful chart talks about personnel, but I don't see any material costs, equipment costs, office costs. Is that out here someplace?

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: It is not in this deck. No.

[Committee Member (unidentified)]: So I'd be interested in knowing the other costs that makes up the total.

[Aviv Viteva, Executive Director of Health, Wellness & Engagement, VT DOC]: Absolutely. We have all that information.

[Committee Member (unidentified)]: Thank you. It might be fun.

[Rep. Alice M. Emmons, Chair]: Thank you. Oh, I'm sure it's fungible. Thank you.

[Committee Member (unidentified)]: Thank you so much.

[Rep. Alice M. Emmons, Chair]: Wasn't too bad for the newbies.

[Committee Member (unidentified)]: We're we're honestly Save it up.

[Rep. Brian Minier, Member]: I guess you have to the floor. What's that? Aren't you up after the floor?

[Committee Member (unidentified)]: It's not me. It's the governor's bill.

[Rep. Alice M. Emmons, Chair]: That's not governor's bill.

[Rep. Brian Minier, Member]: I stand corrected. Alright.

[Committee Member (unidentified)]: We're still on the high end.

[Renee Weeks, Director of Complex Care & Field Services, AHS]: That she needs to

[Committee Member (unidentified)]: Well, I'll say

[Speaker 6]: it on the