Vermont Legislature SmartTranscripts:

[Nolan Langweil]: Good

[Alyssa Black]: morning everyone. It is I don't have my computer in front of me so I'm not even sure what day it is. It's Friday, January 9, we are starting a little earlier than we had anticipated with Nolan, and Nolan is going to give us a tutorial on how to read budget. Updies and downs, and what these numbers and columns all mean.

[Nolan Langweil]: For the record, Noel Langwell, the Joint Fiscal Office. So our office is going to be doing a tutorial for members on the budget, I think sometime next week. I think Representative Shai is organizing it. I always encourage people to go to these because the budget's complicated to read. And I think everyone, I think all legislators should really make the effort to try to understand how to read budget.

[Alyssa Black]: There's one at noon to forty.

[Nolan Langweil]: Oh, good. Yeah, go to all of them. And you know, because you're not gonna, so I'm gonna do a very high level about the budget, but I'm really just gonna focus on this document called the ups and debts. And the reason I'm focusing only on this today is because when you hear from different AHS agencies, they always refer to it as this is where the numbers are. But I want to explain to you, kind of help you understand what is this and how do you read it? And I joke around, there's the ups and the downs and the ups and the downs and trying to get too nauseous, okay? But first, real quick, the budget is organized into sections, A through E, right? So the A sections explain the bill, the B sections are the number sections, that's where the appropriations often are. C sections are current year adjustments, appropriations, and amendments. They're typically effective upon passage. D sections are transfers, reversions, reserve allocations, etcetera. These are very typical, sorry. And then E sections are like everything else. And that's usually where the language is. Now, the ups and downs focus on the numbers, section. But when you start looking at the language, you're gonna be looking at the E section. The numbers from the E section always correspond to the B section. So the words always correspond to numbers, but not every B number that's in B has an E. So there's not always an explanation of the number, but if there's an explanation, it's always tied to them. I know. Are you nauseous yet?

[Alyssa Black]: I know, but I forget because they're often divided into things like e 109.

[Nolan Langweil]: Yep, we'll get to that.

[Alyssa Black]: If there's language in e, is it like e 109?

[Nolan Langweil]: It'll always correspond. It always corresponds. It does. Yes, it should always correspond.

[Alyssa Black]: I'm glad I'm not the first one to think that would make things easier.

[Nolan Langweil]: Real quick, I just want to give you a visual. So here, here's the budget. So you can see A, there's the explanations. There's a title of the budget. It has a legislative intent. And then it just talks about what the bill is, what it does, got definitions. And then it also lays out, it talks about federal funds, and then positions, and then what it does, it lays out, this is how the ledger, this is how the bill is organized. So in addition to your A sections, you know, your A, B, C, D, you have a number and the numbers are always tied to a specific government function. So for instance, 100 to 199 is general government. So you'd find the numbers for that from B100 to B199. The words for that would be E100 to E199. 200 to two ninety nine is protection of personal, persons and property. 300 to three ninety nine which is where you pretty much live is human services, 400 is labor, etc, etc, etc. So this committee will focus primarily on the three hundred to three ninety nine, and specifically you will be like 300301, which is like AHS central office. Diva is 306310, and you know, there will be like 3101, 3102 if there are things that are like changes, ads, etc. DMA, Diva is 311 to, no, sorry, BDH is 311 to 313, DMH is 314315, and the Green Mountain Care Board is 345. Now I'm telling you all this because the ups and downs on here will have those numbers. So you'll see B304, DIVA, the section, and what the ups and downs are doing is they're corroborating to that section of the budget. So that's how you find, so when DMH comes in later and she's talking about the budget, Emily's talking about the budget, you can go, you guys will be looking at B342, so that would be on page 10 of the ups and downs. And that's where the DMH budget will be. Some of them have multiple, like Diva has four or five, DMH I think only has, they have two, they have three fourteen and three fifteen, so you'd be looking on ten and eleven. So when Emily comes in, it's talking about we're doing changes, it's like the hospital, it's $1,000,000 you'd be on page 11 and you can see it on the ups and downs. That's just a high level. Now, it gets even more complicated because we have a global commitment and I can do a thing specific for the new members or everybody if you want on global commitment because you're gonna, global commitment will show up twice. So the idea behind global commitment in short is that the way our waiver works, and I can get into what a waiver is another time, is that the federal matching dollars are usually matched at the AHS central office. So that's where you'd see the general fund and the federal funds. And then it moves to the department. So like Diva, for instance. So I'm gonna give you an example. If you look on page, where is it? We look at sections oh, I wrote my notes here. Okay. Look on page okay, let me find it. I was trying to prep and have all my page numbers beforehand, but I didn't. So look on page seven, then under B307. And the bottom of that one, you'll see the family planning rate. I'm talking about this because you guys were talking about the family planning rate yesterday. And if you look, you can see the total cost of that is $850,000 And that's just under this Medicaid GCF, and I'll get into the specifics of what those different meanings, right? Now, if you go to page four, which is AHS central office, we're probably doing this out of work, and in the middle here, you can see, in the middle you'll see family planning rate change not being implemented. If you look over, you can see 850,000 also on the far right, but you can see it shows up on the FF and GNA, and that's the general fund and the federal fund. So this is where it's matched under this, but then when you go to section three zero seven, it shows up on the Medicaid GCF line. I'm gonna explain what each of those headings are, and I should explain what those headings were before I did this example. But that's what I'm showing. So it shows up in those two places. So you'll see on the diva section, it'll just be like, it's a 150,000 appropriation, but it's smashed in the general, in the HS. Now, when they come in and DIVA comes in and does their budget, they will just tell you in their narrative, this is how much general fund it is, because they don't want you to have to keep looking back. They're just gonna give you that because you make changes. They want you to know what the general fund piece of that is. The other piece, now this is the other thing I should have done before I did that explanation. If you look at the top of each page, you'll see GF, SF, TOB, etcetera. So GF stands for general fund. Those are our state dollars. SF are special funds. So there might be special funds from like the opioid fund or some tobacco settlement funds. They're not in the general fund, they are in a special fund. Then you have

[Leslie Goldman]: It's a state fund, that's what I thought.

[Nolan Langweil]: They are state dollars, but it's not the general fund.

[Leslie Goldman]: Okay.

[Nolan Langweil]: Everything is a state fund except for the federal fund. And then it gets even more complicated in a second. So general fund, special funds, tobacco fund, which is a special fund, but this is an AHS up and down, and tobacco funds are used very specifically, so they have it separately. So that's from the tobacco settlement.

[Alyssa Black]: Where it says?

[Nolan Langweil]: TOB. TOB. Okay, GFSF, TOB. This

[Leslie Goldman]: is on page one.

[Nolan Langweil]: Just pick any page that's not page one.

[Leslie Goldman]: Well, the other ones don't have, are different.

[Nolan Langweil]: Just pick another color page that isn't page one, so doesn't matter which one, just not the first page. And you'll see GF, SF, TOB, so that's tobacco. Now, State Healthcare Resources Fund. Now, this is also a special fund, but it's called out on this document because AHS uses it specifically. It used to be that that was one of the major places where we used to draw a match. It changed several years ago, but tobacco dollars used to go in there, the provider tax, all this used to go into there. They changed that five, six, seven years ago and just made everything go to the general fund. And part of it is because the bonding agencies were like, you guys have no general fund. We're like, but we have all these state dollars. They're like, but it's all in these special funds. So we moved stuff over to general fund to help with our bond rating. And it didn't really matter anyway because it was coming out of just state healthcare resources, but we're still taking general fund dollars. So it just got confusing. So there are still things in the state healthcare resources fund, but it is a very much, much smaller fund now, but it is still called out on the ups and downs. IDTPT, that is interdepartmental transfer. That might be Green Mountain Care Board is going to transfer money to you know, that's where it'll show up. Federal funds, these are our federal, these are our pure state, pure federal funds. Now here's where it gets really fun. You have our Medicaid GCF and you have investment GCF. GCF stands for global commitment fund. So if you recall before, when we did this example for the 850,085, some of it came out of federal funds and some of it came out of state funds. When you looked at it before, on the AHS line, it was showing up as GFFFs, but when you went to the DIVAS section, it showed up on the GCF as the total amount. So that's what's happening is they're matching it in AHS, the state and the federal funds, but then it shows up in the other department as global because it's a match to our weight. So that's why you're seeing the double. But the reason it gets confusing is because it'll show up as $850,000 on the diva line, but there's federal dollars in there, but they're just not showing up on the federal line because it's already been captured on the federal line in a previous document. Does that make sense?

[Alyssa Black]: And

[Nolan Langweil]: same with investments. Investments are another portion of our global commitment that's a little bit different, but it's the same principle of how it gets matched. And then you have the total. And ultimately, the total should always match what's going on in the HS central office versus There's mud?

[Alyssa Black]: No, it is actually. It's very clear. However, interdepartmental transfers. So if we appropriated something in say the fiscal year twenty six budget, which we're in right now, that started in July, and one department transferred money to another department, does that show up in business budget?

[Nolan Langweil]: Or do

[Alyssa Black]: you know how

[Brian Cina]: to that?

[Nolan Langweil]: It would probably up in a BA. It depends on when they did it. I'm not an expert on how intercompartmental transfers work. I don't think they're that super common, but I'm not an expert on how they work, but they exist, and that's why there's a line.

[Alyssa Black]: They were super common last year.

[Nolan Langweil]: Oh, I don't know the answer to that, I'll be honest. Oh, you're right. There was $5,000,000 So I'm not an expert on how those work in the timing. That gets into the mechanics of the accounting piece.

[Alyssa Black]: And does that show up as like a red on department?

[Nolan Langweil]: It should match.

[Alyssa Black]: It'll be black on who they gave it to. Correct.

[Nolan Langweil]: And I think where it shows up, it shows up in BAA versus the budget. I think it depends on when it happens, right? If it's during the year, but they needed it, they would do it there. But if they're just like, no, no, we're going give you money to help offset your next budget, then it would show up in the budget. So I think it's timing issue when it shows up in which part. Again, it's just an accounting mechanism. Now, really important thing is the ups and downs are exactly that. They are how much did we increase or how much did we decrease from the base, Right, the base is how much are we spending total? And you're not gonna see the base on here. You'll see the base on the bottom lines, which I'll get to in a second. But all these numbers you're seeing, so again, if you see, if we go to page seven and we're looking at family planning, you're seeing a down of $850,000 So that's when Diva said, hey, we can't implement this, so we're taking, we're reducing the appropriation for this by $850,000 They're reducing it by $850,000 because they had an up, they had increased it by $850,000 in the budget to do it, and now they're taking it back. So it's a change from the base, and the base is what we passed. So the underlying budget is the base. So when you come in next year and you see, when they do the budget, and you're gonna have to see the ups and downs, the new base is what was passed in budget adjustment, right? Because that's the base of what they're doing is they're saying the budget, we're going up, we're increasing it by a million dollars over the previous fiscal year, and the previous fiscal year baseline is what we passed in the budget, and the budget adjustment becomes the new base because that becomes the budget. So this is ups and downs from the baseline. What you won't see is existing program. If they're not making any changes to existing program, you're not going to see it in the ups and downs. Now your next question, where can I find it? And I'll get to that at the end.

[Alyssa Black]: May I ask another question? So let's go back to the family planning one. So I understand that it's in AHS, that's where cauldron is, where they mix the funds and set out global commitment funds.

[Allen "Al" Demar]: Is this what page that was?

[Alyssa Black]: You get at the bottom of AHS, range of $59,000,000 $60,000,000 And it's shown as a down at AHS, but then you go to Diva, and it's shown also as a down at Diva with a total of 29,000,000. So is the 59,000,000 that we see not bothered by that either. I see 69.

[Nolan Langweil]: So we'll be in Diva.

[Alyssa Black]: I'm on I'm back and forth between page

[Nolan Langweil]: four. So I'll get to that. That's my last that's my final thing about the bottom line.

[Alyssa Black]: Doesn't it seem like it's double counting?

[Nolan Langweil]: No. No. I'll get to that. Okay. I'll get to that. I understand the question now, and I will get to that. That's one of the it's the last thing I have on my list of things.

[Brian Cina]: Okay.

[Alyssa Black]: Sorry, Leslie, go ahead. Can you

[Leslie Goldman]: just show me, like, like using the example that we're familiar with, with this Planned Parenthood money. So there's on page four, there's $8.50 as a red, or that's a down, because they didn't spend it. So it has to show up as a black somewhere in their budget because they didn't spend it. Is that true or not?

[Nolan Langweil]: No, this changed from the appropriation. Not how much

[Emily Hawes]: It's not getting back to their

[Nolan Langweil]: It's not how much is in your fund, It's what's appropriated.

[Leslie Goldman]: So they the $8.50 was appropriated but not used. Correct. So it's a down.

[Nolan Langweil]: In the appropriation fund.

[Emily Hawes]: In the appropriation.

[Nolan Langweil]: Yeah. This is only appropriation and not how much you have sitting in

[Emily Hawes]: the bank.

[Leslie Goldman]: So it doesn't show up anywhere else as adding $8.50 somewhere.

[Nolan Langweil]: The accountants, not the accountants, the AHS or not AHS, and management tracks how much they have in the bank, how much they have in their copper. So that has a whole other report, which we're not gonna get into.

[Leslie Goldman]: Okay, so I don't understand-

[Nolan Langweil]: We're just focusing on how much is appropriate, because that's your role. Your role is to appropriate.

[Leslie Goldman]: So we're not gonna see a Black eight fifty anywhere in No. Your ups and Okay. That's what was looking for.

[Nolan Langweil]: Unless they were specifically saying, well, we're not doing this, but we're gonna We captured it in our as a savings and we're using it for new programs. Okay. But you wouldn't know that because it just falls into the pond and then they're scooping fresh water out of the pond to pay for some.

[Alyssa Black]: But they have to ask us if they want to pay for something else.

[Nolan Langweil]: Absolutely. But they're not saying, okay, we're taking this eight fifty and we're What taking eight fifty often happens is, they have other pressures. So for instance, you know, they're coming in, they're saying, okay, we have $31,000,000 in new Medicaid pressures, but where are they getting that money? Right. Okay, so maybe it might come from more revenues than we expected, and other might come from what we have down in vacancy savings. It all goes into the ups and downs, right? It's like we're putting money in the pond and we're scooping money back out of the pond, right?

[Alyssa Black]: I just had a terminology question. When you say change from the base, do you mean change from appropriations?

[Nolan Langweil]: Yes. The appropriation is the base, right? So what you passed for the budget is the current base, and when you pass budget adjustment, that becomes the new base. Yep. Versus, now this is actually a good point because you have base and you have one time. So when you're doing the budget, you're gonna see some stuff where it's like in the base. So like for instance, if you do a rate increase, you're paying providers and we wanna give a 2% rate increase to home health, which is an example. Well, it's not one time, it goes into the base and it just becomes, so let's say we're giving them a million dollars and the new is $1,250,000 Well, next year, the base is that 1,250,000.00 versus if you're saying we're gonna give them a one time grant of $250,000 they're getting a million in rates, if we're getting a one time grant, $2.50 next year and the base would only be 1,000,000. And there's different sections of the budget for one time. One times actually are usually in the 1,100. So we talked about the, you know, 100 to, the 11 hundreds to $11.99 are usually the one times and other things. So when you're looking at the budget here, reduced here.

[Allen "Al" Demar]: What's the medium plan that's one time frame on this year?

[Nolan Langweil]: 1,100, so here I'm showing you an example. So here we go, this is the budget. Here you go, miscellaneous year, one time, and here's all the one times that we put in last year for all the different things, right? So that's my point. It's all in the B1100s generally, And it might be or 1,100 or higher. That's how we organize the budget. Now, before we run out of time, we got five minutes, I wanna get to represent the blacks last. So let's go back to page seven. And you see, you have the orange line, right? So what this is, is this is the BAA increase versus decrease, and then the new governors recommend. And what that is, is that's just for that section. So it's not gonna show up in the AHS, it's gonna show up differently in the AHS because they have other things. In the AHS on page five, you can see, sorry, not page five, on page four, you can see they have a lot of other things that are also being matched from other departments within AHS. So their bottom line is gonna be 59,000,000, whereas the Veeva three zero seven on well, this is why I've made hard copies, is only 29 because that's that specific session. Now, if you go to page 19. No, sorry. Go to the very back. Go to the very, very back. You're gonna have the total of everything on that white box on the bottom. So you can see the BAA, the reduction, the increases total there's $8,800,000 of increases. And then the new governor's recommend is $2.39. So this is where it all gets aggregated. It's broken out by fund.

[Alyssa Black]: But isn't this blue and white, isn't that basically the addition of all the oranges?

[Nolan Langweil]: Yes, it's all the oranges combined.

[Alyssa Black]: So that's what I'm saying is, isn't it counted twice because it's

[Nolan Langweil]: in No, don't. They're good about, it shouldn't be double counted on that line. They're generally really good about making sure they don't double count. So I haven't added up, but I'm pretty sure if Tracy O'Connell were here, I would say, can you confirm that for me? But she's not. And then, so the orange line is these are the increases and decreases and the new proposed total. And then the green will be what use it. Are you nauseous yet?

[Leslie Goldman]: Oh, we're just, let's just say it changes. Gotcha.

[Nolan Langweil]: Yep.

[Leslie Goldman]: Yeah, I'm nauseous. Sorry.

[Alyssa Black]: Is there a total by

[Emily Hawes]: section?

[Alyssa Black]: Yes. AHS, is there AHS total?

[Nolan Langweil]: It's section, yes. So each one, so if you start, if you look on page three,

[Allen "Al" Demar]: you

[Nolan Langweil]: have the secretary's office, and that's the total for the secretary, the orange. Yeah. That's the total for the secretary's Office for B 300. And then the section for B 301, the total would be 59.8. What they don't do is they don't say, okay, AHS Central Office, boom, DMH 314315 combined, boom. They don't do it that way. It's just by the B301, B302, B303, you see what I'm saying? They don't have it at the end. They won't be like,

[Leslie Goldman]: this is

[Alyssa Black]: B300 to 399?

[Nolan Langweil]: Well, maybe that's the first page, don't know. Oh yeah, the first page, you're right, does do that. Yeah, that's the first page, thank you, Daisy. Oh, okay. So, and I'm happy to help people. This is really meant to be a first of how this works. But now when Emily comes up here and it's saying, we're doing, we're making changes to the Vermont Psychiatric Hospital, you guys can look at B314 and B315 and be like, ah, there it is, I see it. Is this much in global commitment or is this much in this? And this will help you when you hear from Diva again or whatever, and when you're making your recommendations. And I suspect this won't be the first time we kind of go over this. I'm around, I'm here to help, and we will be doing more of this in the future. But with that

[Leslie Goldman]: Very helpful. Thank you.

[Nolan Langweil]: Thank you. I hope that was helpful.

[Emily Hawes]: Thank you, Donna. Thank you, Allen.

[Nolan Langweil]: Thanks. Oops, sorry, let me stop sharing.

[Alyssa Black]: Did all the computers get together for a party? And I did do it, obviously. Love her. The one with the highest level has to The lesser

[Emily Hawes]: Now that we are all experts on how

[Alyssa Black]: to read budget,

[Nolan Langweil]: so you know.

[Brian Cina]: I just reminded people we were live, just in case people got too comfortable unless I shared something personal.

[Emily Hawes]: Thank you. I did just share it. Now

[Samantha Sweet]: that they have that security question,

[Brian Cina]: like what's your birthday and what candid are you? What was your first pet's name? Forget it. My first pep is cum gel.

[Alyssa Black]: Thank you. I'm going to have our new members introduce themselves to you, because you will see this lovely group of people on many occasions. To include, we should introduce Claire and also our committee assistant. So Val, if you'd like to introduce yourself.

[Emily Hawes]: Thank you for being here.

[Alyssa Black]: Val Taylor, and then District eleven. Hi, I'm Karen Lueders at C4. Great, nice to meet you. I'm Sasha Black, we're the new committee assistant. We

[Emily Hawes]: can do DMH staff. You want me to start on record? Then intro? Great. Good morning. My name is Emily Hawes, and I'm the Commissioner for the Department of Mental Health. Thanks for having us today. With me today, we have Stephanie Taylor Marshall, who is our Policy Director Claire Neal, our senior policy advisor and Samantha Sweet, deputy commissioner. Who we don't have with us is a finance director, Chittenden Thompson. She has since retired, and so that position is currently vacant. So maybe I should have sat in with the ups and downs,

[Alyssa Black]: because paying

[Emily Hawes]: in spreadsheets, it's hard for all of us. Thank you for having us today. We thought we'd spend a little bit of time going over the system as a whole, what DMH does, although I know we'll be in future opportunities to go in more depth, that sometimes is helpful when we're going through our DAA. Does that sound okay for this morning?

[Samantha Sweet]: Sounds great.

[Emily Hawes]: So I'll start off with what we do at the Department of Mental Health. So we're responsible through statute for the mental health system of care for Vermonters. We're currently composed of three twenty six staff positions, including two forty five at the two facilities that the department oversees and 81 positions within our central office. Teacher positions, not positions. Yes. 81. 81 at central office, two forty five within the two facilities.

[Nolan Langweil]: That's just for mental health?

[Emily Hawes]: We have a budget of around $339,000,000 that supports the mental health services to over 25,000 Vermonters. We oversee 10 designated agencies and two specialized service agencies. Like I said, we oversee and run the Vermont Psychiatric Care Hospital, which is a 25 bed hospital for adults who are under the care and custody of the Commissioner. And then we also operate River Valley Therapeutic Residence, which is a 16 bed secure residential treatment facility for adults who are under the care and custody of the commissioner. We manage their Oh.

[Brian Cina]: Just because it's directly related to this, and it doesn't make sense to wait. The three twenty six staff, it says two forty five facilities staff, does that include every single program including the hospital and the residents? In other words, does that number include the staff of the hospital and the residents?

[Emily Hawes]: Yes. It does not include physicians. We have a separate contract for physicians to operate from that capacity.

[Brian Cina]: But all other allied mental health professionals are included in that?

[Emily Hawes]: Yes, absolutely. That is the physician count for the facility.

[Brian Cina]: That makes more sense why it's that number then if that's staffing two serious facilities.

[Emily Hawes]: Two facilities 20 fourseven and it takes about seven and a half FTEs for one shift at the facility and they're

[Alyssa Black]: on twelve hour shifts. Thank you. Sorry to go down this detail.

[Emily Hawes]: No, that's okay. We also manage multiple grants and contracts with peer organizations, forensic evaluations. Like I said, our psychiatry physicians at the hospital and at River Valley. Then our community roundtable contract for analysis of population level data related to mental health. And then we also partner with just about anyone you can think of local law enforcement, schools, community partners, hospitals, courts, and just about anyone who is interacting with all of us in our communities. I have to catch my file point up. I'm not on this. Whatever happens back here. Great. So I will move us into what we like to fondly refer to as the pyramid, which is a visual of our broad system. If you look at the bottom section of the pyramid, that is our community mental health system. And so that starts with our micro residential programs for youth, our youth group homes, or otherwise known as PNMI, which stands for private non medical institution. We have group residential homes for adults. We also have shelter plus care vouchers for adults, which provides shelter plus twenty hours, I believe, of case management services for folks. And then our array of your traditional outpatient services, therapy, individual therapy, case management, and such. The next level up, this committee has been engaged with over the last couple of years, is targeting our crisis supports and response. And so that includes our enhanced mobile crisis program, which is a two person, 20 fourseven response out into the community. That includes our integrated crisis feds, which is an opportunity for folks to access a crisis fed regardless if they are experiencing a substance use or mental health challenge. We also offer our youth crisis fed, youth hospital diversion, and all sorts of those crisis response targeting community members, hopefully to intervene before something that original

[Alyssa Black]: higher level.

[Emily Hawes]: Anything you want to add on that level? No, I think you covered it all. Okay. It's hard to see it on your screen. Let me make it bigger here.

[Anore Horton]: I just want to

[Alyssa Black]: point out, especially for the new folks, I really appreciate that this pyramid has the little symbols that correspond to who delivers

[Samantha Sweet]: care at those places.

[Alyssa Black]: I think that's important to note where the Department of Mental Health is lead at that facility. I don't know if you want to say anything about that in terms of who's at which levels of care. Sure.

[Emily Hawes]: When we get up to the secure residential and one of the hospitals, those are directly operated by the Department of Mental Health and the rest are contracted out that we work with other providers to deliver that care.

[Samantha Sweet]: The only thing I'll add to what Daisy said is you'll see the key right here and the orange is for youth and adolescents, and then the blue is for adults. Sorry, orange is for the whole system of care. So from birth to older Vermonters, and then the blue is for adults, and then green is for the youth adolescents. So we did color code it so you could see exactly which programs are serving which population. Symbolism

[Brian Cina]: to the color?

[Emily Hawes]: I believe that it follows the accessibility format.

[Brian Cina]: So there actually is a reason for these colors. Yeah. Okay. The other thing I would

[Emily Hawes]: be remiss to mention is the value of a 988 text and chat line for Vermonters. That is a 20 opportunity for individuals experiencing any type of crisis to reach out. We have two agencies that provide that service. Then I'm sure we'll hear more in-depth about that as the session goes on. But for the most part, those calls are answered by Vermonters, unless for some reason the call center is busy and then it gets rolled over to the national line. But it is answered by a human 100% of the time.

[Alyssa Black]: Maybe I just have never noticed it before, But can you talk a little bit more about the shelter and care vouchers? How is that different from what I thought?

[Emily Hawes]: They can be very similar. This opportunity is for individuals who have a serious mental illness. Okay.

[Samantha Sweet]: And so it's a voucher that an adult can use for their residents. And so it's similar to a Section eight voucher, but the plus care is that they need to continue with treatment. So we don't want to, they're distributed through DMH to the DAs to provide to their clients. And so it's a voucher and then the PlusCare is the treatment that they continue with. Got it. Yes.

[Emily Hawes]: We also have intensive residential treatment programs throughout the state. We have our youth residential, which is PNMI, And then we also have youth psychiatric residential treatment facility, which is not open yet, but is on tap to be open within the next year at the Brattleboro Retreat. And then we have intensive recovery residentials for adults throughout the state as well as peer run residential. The next level up is our River Valley Therapeutic Residence. Like I said, that's a 16 bed resident for those folks who still require a high level of mental health services in a locked residential setting. And then inpatient hospitalization, which is your highest level of care, which requires an individual to meet hospital level of care and have a medically necessary reason to be admitted onto those units. So currently we have children adolescent beds at the Brattleboro Retreat. We also have general unit beds at UVMMC, Windham Center, also at the Brattleboro Retreat, Rutland, the VA, and then we have level one inpatient. Level one was a term that the state of Vermont uses to define those units that serve adults who require additional resources in order to meet their mental health needs. So for example, folks who are admitted to a level one unit are typically involuntary, and may need to go through the court ordered medication process, and also may have, some history of violence or exhibiting current violent behaviors.

[Alyssa Black]: Are all the beds online at River Valley now?

[Emily Hawes]: They are not all online. I believe they can serve up to 12 in order to adequately manage the budget there. They still have a mixture of travel staff and permanent staff, although we're seeing that gap close for River Valley. But essentially, they aren't taking on new travelers as they hire on more permanent staff than they open more beds as more permanent staff are back.

[Alyssa Black]: Al, did you have a question? Yeah, it might be silly. So each line, I'm just wondering, I mean, there are more programs which would lead to more patients on the bottom. Is there any correlation between the population with the pyramid? It go ahead. Is it definitely set up? Yes. Okay.

[Samantha Sweet]: Yes, it's definitely set up. So very few would have served at the hospital level of care, right? So in the hundreds. And then at the bottom tier, it's like thousands of people are served.

[Alyssa Black]: Go ahead, Brian.

[Brian Cina]: I'm just curious, I know that we utilize traveling nurses because of the shortage in workforce. Is there a point with the comp Do they sign a contract that's a limited time and then at which point they're offered full time employment, or do they just get that renewed in perpetuity? How does that work? What safeguards are in place to transition staffing to full time from travelers when the travelers are long term?

[Emily Hawes]: Yeah, that's a great question. So I will say that travel contracts typically are our number one recruitment tool. So oftentimes, yes, they do sign thirteen or twenty six week contracts. Sometimes those are extended, sometimes they are not, but oftentimes we are able to get someone who has done a contract to come over as a permanent staff, And that can work really well. They already have a place to live. They're already trained and then they start accumulating longevity within the facility. Can I ask a follow-up question?

[Alyssa Black]: Yeah, of course. Are

[Brian Cina]: there incentives that are used, for example, bonuses, sign etcetera? Because I can imagine being a traveler and liking the job, them being like, I'm going to get paid less than I am as a traveler, but I don't really want to go home. But if the state was like, you get a sign on bonus if you stay a year more as a regular employee, the numbers may work out that that little bit of a boost to keep them pays off. Is there anything like that used? Any tools like that?

[Emily Hawes]: And if so, what might they be? Sure. We don't currently do a sign on bonus for either our nursing or mental health specialist positions, which are the two nursing department positions that we have travel contract staff in. But we do offer opportunities for hiring into range. As a reminder, DMH shares the same collective bargaining agreement pay scale as the rest of state government. And so when somebody is looking at transitioning from a travel staff to a permanent staff or a new employee, we have an opportunity to hire into range, which means that they don't necessarily need to start at pay grade whatever, step one. We can move them into like a step seven or something like that, depending on what their qualifications and experience is. Now that works really well for new staff coming in. Part of the collective bargaining agreement does not allow existing staff who are moving into other positions an opportunity to hire and to range, which can cause some retention challenges.

[Leslie Goldman]: And you have travelers with existing staff. No, am not saying But

[Brian Cina]: existing staff within state government between positions, this is determined by the contract. That's correct. So that the employees union has decided this with the administration. So it really is something you would work out with them and that we don't meddle in.

[Emily Hawes]: Well, it's the overall contract for the state of Vermont, but that is negotiated between the administration and bargaining unit. Thank you.

[Alyssa Black]: Bring the travelers on in the summer and mold them into things.

[Emily Hawes]: Mean, and the winter recreation. Oh,

[Alyssa Black]: I forget about those people.

[Emily Hawes]: No, don't those people either.

[Alyssa Black]: Just not mud season. Yeah. We don't train anybody on and Top

[Samantha Sweet]: rack on this

[Alyssa Black]: question.

[Leslie Goldman]: It's Leslie. Thank you. I've always loved this because it helps, but the visual I'm looking at is the designated specialized agencies airports, which are independent from DMA. And they bill for their services and we know their payer mix is skewed towards Medicaid, so they don't get great reimbursements. But we have supported them in the last couple of years of increasing. Can you just remind me, and I don't know if you know on the top, what we've done in the last couple of years to support that workforce?

[Emily Hawes]: Yes.

[Alyssa Black]: Not maybe now, but

[Emily Hawes]: We should come back and do a little bit more of an in-depth level setting around workforce development investments that the legislature has done because there has been rate increases, but there's also been a workforce development work group that has looked at other things. So we're happy to come in and talk a little bit more about where that is, how that's impacted vacancies across the system, which we are seeing come down into, I think, the high teens. Comparing though to an inpatient unit who is in the high 30s, 40s for a vacancy rate, there is quite a discrepancy between the outpatient setting and the inpatient setting. I hear a

[Leslie Goldman]: lot from our designated agencies of the difficulty. So just curious. Yeah.

[Emily Hawes]: If there's no more questions for the pyramid, I'll move us into our ups and downs sheet. Great. So I'm going to start, if folks have access to this, at B314.

[Alyssa Black]: We just went through this, so let's just go through all of this. The

[Samantha Sweet]: three fourteen happens to be Kai.

[Emily Hawes]: Kai. That's true. I mean, think our work here is done if we're talking about that type of advanced mathematics.

[Alyssa Black]: So I'm still struggling with the number chart, finding it on the paper.

[Emily Hawes]: Yeah, I believe it's page is it page 10?

[Alyssa Black]: It's on the left hand column where the numbers are.

[Brian Cina]: The left column is where you

[Alyssa Black]: can find sections and numbers.

[Leslie Goldman]: Ten and eleven.

[Alyssa Black]: Yeah, see it. It just takes a second to get oriented.

[Brian Cina]: B, it's like bingo. B3-one-four, B3-one-four.

[Emily Hawes]: Although not as fun to put together in the antidote. So I'll start with section B3-one-four, which is the central office section of our BAA. BAA is the subject of our testimony today. So for central office, there's a few items to call attention to. And if you don't mind, I have to grab my talking points from my retired finance director to make sure I say all the right things. So, first, I'm sure she

[Alyssa Black]: probably is. So,

[Emily Hawes]: so under personal services, transportation, increased cost for youth and adults. This is typically transportation from emergency departments to inpatient care. It also includes transportation to out of state facilities for youth who are accessing residential services out of state. We have seen an increase in the number of transports that we're doing. Also, cost of transports has increased. Families' ability to transport their loved ones has changed over time. We aren't seeing as many family members being able to transport. And so we work to get folks to the right level of care as quickly as possible.

[Alyssa Black]: Brian?

[Brian Cina]: Is this a separate cost than youth who are in DCF custody who go to out of state facilities or is there sometimes overlap like when the DCF goes to a mental health facility, it's a DMH when it's a mental health facility versus a You see what

[Alyssa Black]: I'm saying? I don't

[Brian Cina]: know if everyone understands the difference.

[Alyssa Black]: Yes, we do

[Emily Hawes]: have budget line items for transportation and so we both utilize It can be the same kids. It can also be distinct different children.

[Brian Cina]: And you just honestly decide on a case by case basis.

[Emily Hawes]: Depends on what they're doing.

[Alyssa Black]: Yeah. Okay, thank you.

[Emily Hawes]: Does that sound right to you?

[Samantha Sweet]: Yeah. Typically, if they're in DCF custody going out of state to an placement, it's under DCF line. You'll see it there. If it's not a DCF kit, it's DMH will pay for that.

[Brian Cina]: That's general practice. That's the general Yeah.

[Alyssa Black]: I have two questions here, but I just want to when we're talking about out of state, we're talking about PNMI.

[Emily Hawes]: And the PRTF, which is the psychiatric residential treatment facilities.

[Alyssa Black]: How many kids do we have right now that are out of state?

[Emily Hawes]: That's a great question that we'll have to come back to you with.

[Samantha Sweet]: What's PMI? Private non medical institutions.

[Leslie Goldman]: You said that louder, so

[Alyssa Black]: It is actually private non medical institution, right? Thank you. Daisy and then Topper? So on the transportation line, we haven't talked about this much before, but if there's a scenario where a person presents in the ER, they're in a mental health crisis, say they're not a person who's already in the care of a facility in Vermont and they need to be transferred to Connecticut where they live or something like that, is that transportation cost here, or is that on the hospital?

[Samantha Sweet]: That would not be here. That would not be there.

[Emily Hawes]: And I'm not sure if it would be with the hospital either. I'm not sure how that transport would occur. And similarly, if One guess is ambulance or something like that.

[Alyssa Black]: And if a Vermont resident is out of state and has a crisis and needs to get back to Vermont, does the Department of Mental Health cover those transportation costs?

[Emily Hawes]: It depends on that individual's situation. So if someone is in another state and they come under involuntary care in that other state and they're admitted to a facility there, we do have an interstate compact agreement with other states to work to bring folks back to Vermont. And we would collaborate with transportation costs around that. That transition from one state to another requires someone on the receiving state end to accept that individual upon discharge. So that's typically a family member or something like that. So it's not overnight, takes some time.

[Alyssa Black]: Ballpark, what alternative of those cases do you have per year?

[Emily Hawes]: Since I've been with the department, I can think of one. Can you think of another?

[Samantha Sweet]: Yeah, I think we will do it for youth when they're to coming the state of Vermont from a PNMI or PRTF. We'll coordinate transportation and pay for that on a voluntary basis. That's true for you. I was

[Emily Hawes]: thinking adults. We don't have a lot

[Samantha Sweet]: of adult coordination going out of state. Rarely does that happen, What like Emily

[Alyssa Black]: state predominantly do youth go to? Are we talking New Hampshire, Massachusetts, or are we talking Florida?

[Emily Hawes]: There are some youth in Florida. There's some youth in Arizona. We're very happy to have the child and adolescent team come in and talk about the work that is happening with youth out of state and where those placements are. I'll

[Alyssa Black]: do that another time, sorry.

[Allen "Al" Demar]: I wanna make sure I heard you correctly. Did you say you have more of a call for transportation?

[Emily Hawes]: More requests for transportation overall, yes.

[Allen "Al" Demar]: Yeah, that's what I thought.

[Emily Hawes]: Yes, I do.

[Allen "Al" Demar]: Okay, now, if that's the case, if I'm reading this thing right, I don't know if I'm even reading it, $3,320,000 from the general fund. But you're losing 150.

[Emily Hawes]: Oh, I could speak a little bit to that. For those individuals who are transporting that don't have, a serious mental illness, we need to use general fund for this. Okay.

[Samantha Sweet]: So what we used to call the CRT population, that is covered under Medicaid. So those that are not SMI, serious or mental what we used to call CRT, we have to pay general fund for them.

[Allen "Al" Demar]: So that's why that happened.

[Emily Hawes]: That's correct. Yeah, it's not a Medicaid reimbursable. Yeah.

[Alyssa Black]: All right.

[Emily Hawes]: I'll move us along to the next line item. So you'll see in the next line item is, forensic evaluations with an increased cost for the department. Forensic evaluations are ordered by the court for individuals whose competency is under question. So they've been cited or arrested for a crime and there's question of whether or not that individual is competent to stand trial. So we've seen an increase in requests for competency evaluations, as well as the cost of competency evaluations has increased.

[Alyssa Black]: I know at one time we had a shortage of evaluators. Can I assume that if we're spending more?

[Emily Hawes]: We do not have a shortage of evaluators. I would say we have expanded that access with the use of telepsych, which works pretty well. Folks can have that competency evaluation from a hospital setting. They can also have it from a community setting. Number of competency evaluations for Vermont hovers around 800 to a thousand a year, and so that's up from probably five to 600, not five years

[Alyssa Black]: I

[Brian Cina]: can't remember, so forgive me, but what's the current competency restoration effort like?

[Emily Hawes]: Vermont doesn't have a competency restoration program or a required competency restoration.

[Leslie Goldman]: We don't

[Brian Cina]: have a friend. We never move forward with any kind of forensic facility.

[Emily Hawes]: Do not have a forensic facility.

[Brian Cina]: Yeah, I remember us discussing this for nine years. So just checking on where it's at.

[Alyssa Black]: Are we utilizing River Valley as a forensic facility?

[Emily Hawes]: We are not using River Valley as a forensic facility. There are folks who require the level of mental health treatment that River Valley has who have been engaged in the criminal justice system and we do serve individuals there. No, that's okay. That's for me to phrase. But I mean, I know we did work

[Alyssa Black]: around changing things at River Valley

[Emily Hawes]: in order to accommodate things that we did. A court can order someone, to River Valley if there is a if it's an appropriate clinical need. So that is new. And River Valley also has the ability, should the need arise to do a seclusion, restraint or court ordered medications. If

[Brian Cina]: I want to send you and your staff a bill that addresses this, and just to talk offline, who should I send it to?

[Emily Hawes]: Stephanie Marshall and Claire.

[Brian Cina]: Okay, I will, thank you. Yes. Because I don't want to get into an out, I know I'm kind of close.

[Alyssa Black]: Oh, go ahead. Well, just wanted to understand, is this 645, is this an increase for six months or a year? What is, or new, I mean, I just wanted to get some context.

[Emily Hawes]: Sure. This $6.45 is what the increase was for FY '26.

[Alyssa Black]: And the anticipated for the remainder of '26. Great. Next.

[Emily Hawes]: The next line item is an AHS net neutral transfer. So I'll not talk much further about that if there's no questions. And then the next line item is related to the private non medical institutions increase. And so those increases relate to an increase in utilization as well as rates primarily for our out of state institution settings, which we don't control for

[Alyssa Black]: this space.

[Emily Hawes]: If there's no more questions on that, I will move on to section B. Can you give us an

[Alyssa Black]: idea? Sorry. Sure.

[Leslie Goldman]: Give us a,

[Alyssa Black]: like maybe a percentage increase in utilization of what was anticipated or

[Emily Hawes]: I cannot today, but we can come back and give you that information.

[Nolan Langweil]: All right,

[Alyssa Black]: now you can move

[Emily Hawes]: up. Great! Unless you have it off the top of your head.

[Alyssa Black]: I don't. I'd be really impressed.

[Emily Hawes]: You're already really impressed. Right. So section B315 is a combined budget of the two facilities that DMH oversees and runs, so the Vermont Psychiatric Care Hospital and River Valley Therapeutic Residence. So you'll see the first line under personal services. BPCH did not accumulate as many reimbursable dollars as we had originally anticipated. And so that is a loss at BPCH. So we have to swap out general fund dollars to make up for that. What that means is we weren't billing or we weren't able to bill Medicaid and Medicare for some of the services that we anticipated being able to bill for there.

[Alyssa Black]: Maybe I missed it on my Nolan tutorial, but the fact that it's in red in general fund, doesn't that mean that you didn't have Oh, maybe we did it the other way around.

[Emily Hawes]: Is that right, Nolan? Did we do it the other this just came up the other day, yesterday, didn't

[Nolan Langweil]: it? We

[Alyssa Black]: saved $1,000,000 out of the general fund and were able to use global commitment, which is my understanding.

[Emily Hawes]: Understand it as the other way around. And so what's we'll come back to that. I can check with Tracy O'Connell. Yeah, we weren't able to, so I'll follow-up. That's part

[Leslie Goldman]: of the question.

[Emily Hawes]: Okay, yeah, that's a question mark. And so Claire and Stephanie will need to just get clarification from Tracy. The next line item down is the vacancy turnover savings. So this year, we've separated out our vacancy savings line with how much we're spending on travelers. And so the line that says vacancy savings turnover is the $4.05, 49, eight, forty six. That is our vacancy savings. And then the current travel nurse contracts is how much we spent in the travel nurse contracts.

[Nolan Langweil]: Oh, very close.

[Alyssa Black]: Not necessarily people. What is close

[Emily Hawes]: only counts in horseshoes and

[Alyssa Black]: something pretty wild. How much more the travel nurses get.

[Leslie Goldman]: Well, do we know the numbers?

[Alyssa Black]: So it's not like it's a one to one swap.

[Brian Cina]: You're not getting the same value. You know

[Leslie Goldman]: what the numbers are like?

[Alyssa Black]: They can pretend and the other company

[Nolan Langweil]: might be.

[Emily Hawes]: I will say that we've seen the travel contracts come down significantly. The number of travelers and costs last year, we did not request an adjustment to our budget to fill the travel need. There are around 47 travelers at the EPCH right now. That's down from 51 from last year, but down significantly from prior years. Pre COVID we covered anywhere between 16 to twenty, fourteen to 20, somewhere around.

[Leslie Goldman]: Leslie, do you tell that?

[Emily Hawes]: Was wondering, Maybe

[Allen "Al" Demar]: I just missed it. The 14 to 20. Let me tell you what my question is. How many of those travelers, or did any of them become permanent employees?

[Emily Hawes]: Oh, a lot did. And I don't have it. That's my feeling because I sign off on this, but I can give you the exact amount. I can have the hospital pulled that as well in River Valley.

[Allen "Al" Demar]: And remove your income so they don't lose any money.

[Emily Hawes]: The next line item down is the River Valley Therapeutic Residence Room and Board Cost. So this is covering for room and board for the individuals who are receiving services and residential services at River Valley so that they don't have to pay for that room and board. Medicaid does not pay for room and board. Why

[Alyssa Black]: are they not paying for room and board?

[Emily Hawes]: Some are. It doesn't close the gap for how much it costs.

[Alyssa Black]: Can I make an assumption? And this is really just an assumption. Sure. So I could be totally wrong. Can I assume that most people, most residents at River Valley are on social security disability?

[Samantha Sweet]: I think that's a safe assumption.

[Alyssa Black]: So they are receiving

[Samantha Sweet]: social

[Emily Hawes]: security And they'll

[Samantha Sweet]: pay about 30% of their income toward rent, but there's a gap between how much they pay toward rent and how much room and floor costs.

[Alyssa Black]: Can I ask, absolutely, what would the rent be if How much would your rent be? Is Yeah. A

[Emily Hawes]: didn't feel prepared to talk about that today, but we can get that from our business office.

[Alyssa Black]: All right. Yeah.

[Emily Hawes]: You know, I tried to come out of testimony with no follow ups, but right now I have

[Leslie Goldman]: a whole lot honesty.

[Emily Hawes]: Know, those are great questions. Is it reasonable?

[Alyssa Black]: If you think about it, it's somebody's home. It's somebody's personal. It's like having a personal care attendant in a way. It would be your food, all your utilities. So I mean, would imagine that it's more than a studio apartment in Burlington.

[Emily Hawes]: I

[Alyssa Black]: would question that. Okay.

[Emily Hawes]: And that is all.

[Nolan Langweil]: Thank you. Just that.

[Alyssa Black]: Okay, any questions?

[Brian Cina]: Not about the budget.

[Alyssa Black]: Yeah.

[Brian Cina]: I look forward to talking more about the other policy issues later.

[Emily Hawes]: For sure.

[Alyssa Black]: And I know we are running out of time, but I do want to ask you really quickly, speaking of other issues, since we had Jill Olson in here to sort of give us a high level overview of the rural health transformation. And I'm wondering, there some opportunities in there and is there anything you're excited about?

[Emily Hawes]: Yes. I hope continues to come into fruition with that are a couple of things. Continuing our investments in alternatives to emergency departments or mental health urgent care, which we'll talk, I'm sure at some point about how the state of Vermont approaches those and also the pediatric consultation. So Vermont CPAP, which is an opportunity for primary care physicians to receive in the moment psychiatry consults for youth who are in their business. So we're excited about that opportunity to stabilize and expand.

[Alyssa Black]: I'm just wondering if you have a page of the acronyms. Oh man, we do.

[Emily Hawes]: Because we've talked letters. I'm so sorry.

[Alyssa Black]: Yes, I was trying to hang on.

[Emily Hawes]: Absolutely. Stephanie, our new policy director has been here for a week today and she's like, I need you. We consistently are needing to update that, so we're happy to do that.

[Alyssa Black]: That would be great. And then on the subject of needs and not being in the emergency room when it's not the best place, are those, there must be some housing interface with that and I don't know if there are housing resources for those kinds of sort of maybe small group internals. I don't know.

[Emily Hawes]: We're happy to come back and talk a little bit more about that. But typically, when somebody presents that we're interacting with, it's not necessarily because of their housing status. They're experiencing a need for a higher level of care. Of course, when somebody is discharging from a hospital, all options for a safe discharge to the roof are explored. Some people take advantage of those and some people do not.

[Alyssa Black]: Well, you.

[Emily Hawes]: Thanks for tuning in.

[Anore Horton]: Thank We

[Alyssa Black]: And will have you in are affirming to I'm sorry, I might mispronounce your first name. Is it Anor? Yes. From Hunger Free Vermont. While And we've been hearing from agencies, is a request in the BAA that's not in the governor's recommend. So I wanted to give us a chance to hear on it. Personal privilege, frankly, because it's one of my favorite organizations. Agree. For the record, I cried in appropriations last year when I went in to present about Well,

[Anore Horton]: Chair Black and members of the House Committee on Healthcare, I'm Anoa Horton. I'm the Executive Director of Hunger Free Vermont. And thank you so much for fitting me in this morning. And I'm here to express Hunger Free Vermont's strong support for including $167,700 in the FY 'twenty six Budget Adjustment Act in support of Bridges to Health. This funding is urgently needed to aid in transitioning the Bridges to Health program, and I'll talk a little more about what that is in a moment from their current home at the University of Vermont to fiscal sponsorship with Vermont's free and referral clinics. UVM has provided some bridge funding to Bridges to Health to sustain the work through the June. But as of July 1, Bridges to Health has to exit from their home at UVM. And Hunger Free Vermont has joined with NOFA Vermont and some other organizations who all have a vested interest in making sure that the really, really vulnerable population served by Bridges to Health does not lose these critical connective services. And so that is why I am here today to speak to you about this matter. So Bridges to Health is a health outreach and care coordination program for migrant and immigrant workers and families across Vermont who are not otherwise served by existing programs. So they ensure that essential immigrant workers and family members in agriculture, the building trades, and the service industries have timely access to needed health and health related supports. Eight regionally based community health workers meet needs identified by the communities they serve, engaging with well over 1,000 individuals a year. They work one on one with families and with households to navigate an increasingly complex health care system and also an increasingly pitfall laden system for accessing the things that ensure people have health and can access health care, like transportation and food, which is why Hunger Free Vermont is deeply, deeply concerned about this.

[Emily Hawes]: This is a

[Anore Horton]: population that research shows us and also we know from our community outreach through our eight food security networks around the state, is the most vulnerable population in our state to experiencing severe hunger. And so that is why we're deeply, deeply concerned about any interruption in services for Bridges to Health. These community health workers through Bridges to Health have trust and rapport with clients, employers, volunteer drivers, volunteer health providers, and community based organizations. They have developed deep relationships and connections that directly address the systemic and individual barriers to care. And so they are really able to ensure that as many people as possible can access needed health care services, even if they are understandably really afraid and inhibited from going to kind of standard ways to access these services. So without the trusted connections to healthcare, food, transportation and other critical basic needs that Bridges to Health's community health workers provide, the essential workers and their families who are served by Bridges to Health will have no way to access these basic needs, except through our already overstretched hospital emergency departments. And I don't need to tell you in this committee that this is the most costly and least effective approach that we as a state could take and will cause great harm to families, employers, and our already fragile health care system. So this BAA funding request would cover expenses related to the transition of Bridges to Health to their new home under the auspices of the free and referral clinics, as well as six weeks of core operations because their funding at UVM ends before the new budget year goes into effect. So this is just this kind of bridge period and Bridges to Help will also have a FY '27 budget request, but that's not what I'm here to speak to you about today. So this would cover transition expenses also like IT setup and security systems to preserve securely preserve people's health records and health information, computer software and programs, office space and related supplies, storage space for health outreach supplies, and the transfer of and updates to the program database on a new secure server, telecom services, and various business and program insurances. Vermont's reliance on immigrants and migrant workers to fill critical jobs on farms, in home construction and repair, in health care, in restaurants and hospitality has increased significantly in the past five years. These same essential workers and their family members are facing the cascading negative effects of federal decisions, actions and appropriations. Ensuring Bridges to Health's successful transition to their new fiscal sponsor is a necessary first step to maintaining the trust and provision of services to immigrant communities that are increasingly wary of accessing needed health services in a timely manner. And we at Hunger Free Vermont are particularly concerned about ensuring the continuation of Bridges to Health programs because it provides not only direct health care support, but also assistance connecting to food resources to over 1,000 farm workers on farms across all 14 counties in Vermont and supporting their families in accessing food and other basic needs. So Hunger Free Vermont is respectfully requesting, on behalf of the population served by Bridges to Health, that this committee support a state appropriation of $167,700 in the FY 'twenty six Budget Adjustment Act to ensure that Bridges to Health's critical work can continue without interruption. And thank you so much for your time this morning.

[Alyssa Black]: Thank you. And I'm not sure if you know this or maybe Amy knows this. Can you remind me what happened with their funding in last year's budget? Were they able to secure it through the budget ultimately or did it come through some grants? Amy Schallenberger for the record.

[Amy Shollenberger]: So there was an appropriation included in age 91, which got vetoed, yes. And the appropriation thus did not go through. So, they were at risk of closing in January, but as Anor explained, they were able to negotiate with UBM and UBM stepped up and is funding them through June. So there was an intent from the legislature to fund, but it didn't happen. That's right, I remember that.

[Alyssa Black]: I was trying to track all of it in the end and that was Did you want to

[Brian Cina]: Well, a question. You said that you are transitioning from the, I don't know what you would call it, like the physical home or the physical home of the hospital or the UBM health network or whatever they're called now to college, the medical

[Anore Horton]: school. It's actually UBM Extension.

[Brian Cina]: So it's the university, not the medical center. Yes,

[Emily Hawes]: that's accurate.

[Brian Cina]: You're moving from the university to the free health clinics. That's an interesting transition. And I'm curious if you're aware of any partnership happening with the federally qualified health centers, because they were talking about a food as medicine working group and food prescriptions, and it just seems in alignment with your work.

[Anore Horton]: Well, and to be clear, it's not my work. I mean, not Hungerford Yes, or my right. Yes, the collective work. Our work. Yes. And yes, so I know that Bridges to Health has worked with the federally qualified health centers to some degree in the past. However, in working to find what entity would be willing to take this program in, the free and referral clinics ended up being the entity that was willing to do that. And of course, given the population that Bridges to Health serves, the free and referral clinics work very, very closely with this program and always have. And so I think in the end, it felt like a home that could last and be a really good connection. But yes, there is a new food in medicine task force that is being stood up by state, the Association for the Federally Qualified Health Centers. Are Hunger Free Vermont is participating in that task force. And yes, so all of those questions. And of course, we are here because food is medicine. And when people don't have a way to get connected to health care that they can afford, the very first thing that's going to happen is that they're going to start experiencing hunger if they weren't already, because they will move funding from their basic needs food budget to cover their basic needs health care. And that, of course, is going to make them sicker and less able to heal and less able to have health. So for us, health care is a hunger issue. And that is why we've been involved in supporting Bridges to Health and why I'm here today speaking on behalf of ensuring that this really vulnerable population of critical workers and their families and their children doesn't have an interruption in these critical instances.

[Nolan Langweil]: Well, thank you.

[Alyssa Black]: I'm sorry if you already said this, so $167,700 Yes.

[Anore Horton]: $61,107,100 dollars is the request. And

[Alyssa Black]: is that number UVM extension? Is that where you got that number from?

[Anore Horton]: Or are these calculated through Bridges? Through Bridges to Health, yes. So this is what they need to be able to leave UDM and transition over to the free and referral clinics. So they're funded through June 30 by UDM, But as of July 1, they have to move under this new umbrella and all of the costs of transitioning. For example, at UBM, Bridges to Health had access to secure servers that were certified to store health records. But they now have to get their own new server, for example. So it's transition costs and covering six weeks of funding for the community health workers that because there's this gap, and this, of course, is assuming that funding from this body and they'll be able to fundraise on their own behalf when they're separated from UVM will be available in FY 'twenty seven. Thank you.

[Alyssa Black]: Leslie has a question here really quickly.

[Leslie Goldman]: A request. I thought that your presentation was really helpful to me. It really gave a broad outline of the program. So I'm hoping you could submit it so we can review it. We just did submit it

[Anore Horton]: about ten minutes before I sat down in this chair. So you should have it.

[Emily Hawes]: Okay, not quite yet,

[Alyssa Black]: but soon.

[Leslie Goldman]: Wendy's refresh. Just quickly, so there already is

[Alyssa Black]: a facility that's set up to go June 30 then, correct? Yes. Okay, so this is mostly just the logistics of moving?

[Anore Horton]: Yes, in order for them to be able do that shift, they need this funding. And the employees that work for Produce to help, are they? Funds that? Is it Well, UVM continue? No. No, that will be an FY '27 budget request. And we'll have to get

[Alyssa Black]: They used to be funded by a grant. The grant ended. And since that time, the legislature has they come to us with one time requests and we have done that several years or a couple of years, I think, moving forward. But last year, we did appropriate the money. It's just that the appropriation was in H91, which was vetoed. So they weren't able to receive the funding that the legislature had. So UBM Extension stepped in and provided them with the funding to get them through June. June. But these are unforeseen expenses that they would need before that, before the June, where hopefully the legislature would step in and provide them with funding for next fiscal year. Okay. Have we got it right? Do you know, have they requested has this request been made to appropriations at this point? The committee? So I had a conversation with her bringing this, and she said no guarantees, but it's okay to ask, and we do have a pupil schedule next week to testify at the public hearing.

[Anore Horton]: Okay. And I'll add that I have provided testimony earlier this morning to the House Committee on Agriculture, Food Resiliency, and Forestry on this same matter. And

[Alyssa Black]: I believe there might be some conversation pending. Yes, and I have spoken with the chair of that committee. And while it is ultimately the determination of the Appropriations Committee, it's often nice if other committees weigh in to maybe So I suspect that Representative Murphy and I will do a letter to the Appropriations Committee. Thank you. Thank you. I wanted to make sure everybody knew, remind you all of who Bridges is. Thank you for coming in and on their behalf, and thank you for stepping in and advocating. It's my pleasure.

[Anore Horton]: Thank you so much for your time. Thank you. I really appreciate it.

[Alyssa Black]: Alright, we're done for the morning. We will be back here at 01:00.

[Brian Cina]: For the gripping topic of insurance solvency,