Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Let's be quick. Okay, welcome back. We're gonna have a Ow, sorry. I just bit my cheek. Hate that really badly. I apologize everyone. We're back. We only talk about budget adjustment. We're going to start with VDH, Vermont Department of Health. This is all stuff we listened to the other day. They really only had two items in their budget adjustment. They're proverbial agency of digital services. Essentially, nothing we can do about that, so I'm going to recommend that we recommend that. And then there was a transfer from Investment GC to the general fund for the family planning service grant planned parent growth. So that was a wash, but not general fund wash. It is an increase of, for the record, denying all the joint fiscal office. So the investment GC is mixed state and federal. So it shows up

[Nolan (Joint Fiscal Office)]: as 300 general fund, but it's actually only an increase of maybe $170,000 in general fund.

[Alyssa Black (Chair)]: Yes. The money we appropriated didn't change, it's just that it was more general fund than the mix of general and

[Nolan (Joint Fiscal Office)]: But it's less general fund than 300, or less of an increase.

[Alyssa Black (Chair)]: Yes. And that was loss of federal funding due to HR1. Any concerns from anyone on either one of these? No. All right, let's move on to, let's go to DMH and Department of Mental Health. Sorry, talk in acronyms.

[Debra Powers (Member)]: This is too rustic.

[Alyssa Black (Chair)]: Go to the one that says

[Nolan (Joint Fiscal Office)]: think there are ups and downs, there's no numbers

[Alyssa Black (Chair)]: in

[Nolan (Joint Fiscal Office)]: their presentation.

[Alyssa Black (Chair)]: That's under FY 2025 budget for estimates?

[Nolan (Joint Fiscal Office)]: '26.

[Alyssa Black (Chair)]: Nolan, would you be able to refresh us really quickly on their four items it appears that there's a change to?

[Nolan (Joint Fiscal Office)]: I still don't have a Zoom invite. I still don't have it.

[Alyssa Black (Chair)]: I can start with

[Nolan (Joint Fiscal Office)]: I was going to pull it up on the screen.

[Alyssa Black (Chair)]: They had an increase in transportation costs for youth and adults, and those were to various facilities with acronyms that I can't Vermont Psychiatric. Yeah. And Riverside. Yep. Also, their forensic evaluations, they had increased cost in those because they had more, their utilization was up. Again, the ADS paying for IT support, Every department, I think, comes in with that. And then they had an increase in their PNMI caseload and utilization. That's sort of services that need to be provided. That's

[Nolan (Joint Fiscal Office)]: a

[Alyssa Black (Chair)]: Can't do anything about that. And the neutral federal revenue reconciliation, which I'm still unclear what that actually is, to be honest with you.

[Nolan (Joint Fiscal Office)]: Maybe. I'm not sure about that either, but it's neutral. That's probably tied to reductions in Medicaid from the federal level and then just supplanting federal funds with general fund. I don't remember specifically which policy that was.

[Alyssa Black (Chair)]: I don't recall that either.

[Nolan (Joint Fiscal Office)]: It's not in the narrative. I don't think it's-

[Alyssa Black (Chair)]: It's not in their narrative.

[Nolan (Joint Fiscal Office)]: Oh, you know what? It would be in this other one. Let me see here. Three, four, three, give me a second. Four zero nine. Just as grants, it doesn't say what for. I don't remember what they were for, but just offsetting the sense. GF.

[Alyssa Black (Chair)]: I'm going to say that none of us can recall what they were for, so unless anyone has some strong feelings, it clearly didn't rise to the level of scrutiny.

[Nolan (Joint Fiscal Office)]: 400.

[Alyssa Black (Chair)]: 400. But it's a wash, right? It's a wash, but it's a down in federal funds. It's federal funds they didn't receive that they thought they were going to receive and it's supplanted with general funds. So it was something we appropriated, we just thought we would have more federal funds for it, and we didn't.

[Nolan (Joint Fiscal Office)]: So they're making good on it? Yes. The federal, yeah.

[Alyssa Black (Chair)]: Okay, I'm okay with that. Let's move on to AHS. Debra. I'm sorry.

[Debra Powers (Member)]: Which one is which number?

[Alyssa Black (Chair)]: Did they not give us a narrative? Did. Think it was all narrative except for I'll

[Nolan (Joint Fiscal Office)]: tell you what, I will pull one up. And Tasha, if you go to Senate Appropriations today, can pull it in, because that one's more, The version that we had received had a typo. Yes.

[Alyssa Black (Chair)]: They fixed it. That's right. Forgot about that.

[Nolan (Joint Fiscal Office)]: I'll pull it up also from What

[Debra Powers (Member)]: page of plates are you on? I'm going

[Alyssa Black (Chair)]: to Appropriations.

[Nolan (Joint Fiscal Office)]: Don't worry yet.

[Alyssa Black (Chair)]: It's under Daisy Berbeco, that's that giant spreadsheet.

[Nolan (Joint Fiscal Office)]: No, you will. I'm gonna pull it up, and I'm gonna put it on the screen. Yeah,

[Alyssa Black (Chair)]: we're 're going to look at it through Nolan's. Here it is, you're buying it. Bless you.

[Nolan (Joint Fiscal Office)]: Alright. So this is so we'll start with the admin, extension of their contract for their CMO. I forgot what that stands for.

[Alyssa Black (Chair)]: Is that

[Debra Powers (Member)]: a go up? Sorry.

[Alyssa Black (Chair)]: No. Yes.

[Nolan (Joint Fiscal Office)]: Is it? Okay. And then some MLIS stuff, again, contract stuff. And then ADS, help contracts for things. So this is all contract adjustments that are typical mid year for Deva. In my opinion, there's nothing out of the ordinary on this. These

[Alyssa Black (Chair)]: come in frequently. So these are contracts that they have with contractors.

[Nolan (Joint Fiscal Office)]: To implement their program, some aspect of their program.

[Alyssa Black (Chair)]: Any concerns from anyone? Alright, let's go to the Yes, I'm sorry, go ahead. Do they fluctuate a

[Debra Powers (Member)]: lot year to year, or in how long are the contracts?

[Nolan (Joint Fiscal Office)]: There's always a contract for something. So they have to rely on outside contractors for all kinds of outside expertise, dealing with like, for instance, they're constantly gonna make changes to their eligibility system. Well, they can't do that. They have to constantly hire a contractor to do that. So it depends on how much it costs to do those things. So the amount fluctuates each year depending on what the need is, but the fact that there is an up in the contracting is not out of the ordinary. And sometimes they've come in and said, Oh, we found deficiencies and we realized we don't need this contract for something we thought we did and they'll ask for a down in it. So just kind of, but these numbers are always so big, cause everything with Diva is big, because much Medicaid and other departments flow through Diva. So they just have a very large budget. So it seems like big numbers, but relative to their gross, it's not.

[Alyssa Black (Chair)]: Typically, DEVA during budget adjustment comes in with the bulk of the budget adjustment or a large percentage of budget adjustment because all Medicaid funds flow through Diva. And that's a huge part of

[Nolan (Joint Fiscal Office)]: For the most part, nothing in this budget, and hopefully I don't eat my words, is new policy. It's like they would call it a clean budget adjustment where it's just implementing, further implementing things that need to be carried forward or some adjustments from policy or admin of say, They're not proposing, sometimes agencies and departments do propose new policy and some people can argue, is it a new policy or not new policy? But I don't see anything in here that is new policy directly, indirectly there is, indirectly, indirectly. Indirectly there is something you can articulate as new policy, but it's not their new policy.

[Alyssa Black (Chair)]: Right, on to BAA's admin budget. Can we skip over that slide? Let's skip over that.

[Nolan (Joint Fiscal Office)]: Okay, so this first one is the consensus update. So this is joint fiscal, me and Emily, getting together with Diva and NHS, and looking at what is the caseloads. When we do the budget, we do this consensus forecast. This is how many people we think are gonna be on the enrollment. This is what we think the costs are gonna be. And this is how much we think costs are gonna be. And the reason we have this consensus, and it's signed off by the emergency board, which is the governor and the four money chains. So the idea behind it is if we could all come to a bipartisan, multi agency, multi branch consensus on what the baseline costs are, we're not fighting over the baseline costs. In other states, each party puts out their estimates and they fight over the numbers as well as policy. And here we don't fight over the numbers because it's consensus. What this is, is this is us looking at it halfway through the year and going, okay, there were some ups here and some downs here. And what we're seeing here is quite a bit of up again and I can't tell you why. And when I do, I'm gonna be testifying at the e board on Friday for twenty seven budget to get the consensus for '27. And we're seeing continue to see some increase in case loads even though enrollments are still kind of going down. And don't have, there's no smoking gun. Some of the things I was talking to Stephanie Barrett earlier on, she said some of it is just continued rollout of redeterminations of just the higher, more expensive people that still haven't worked their way out of the system. Prescription drugs continues to always be a pressure. So those are some of the things, but there's no smoking gun. But this number, this 33.06, I will say is not a policy. This is JFO and administration coming together saying, yeah, there's more pressure than we thought there'd be. And these are programs, so

[Alyssa Black (Chair)]: if you've qualified for this, we must provide the services that are utilized. We don't get to say, oops, we spent what we anticipated and money's up, so we're not going to cover you. So we don't have that option.

[Nolan (Joint Fiscal Office)]: Some years, there's been significant reductions, and they've been able to reallocate that money for other things. So we tend

[Alyssa Black (Chair)]: to take a conservative approach Right. Or see them. So ultimately we can't do anything

[Nolan (Joint Fiscal Office)]: about this. Yeah, this Go ahead. So

[Debra Powers (Member)]: if they allocated a certain amount of money and they did not have enough, where do they get to cover anybody that was pre qualified for school.

[Nolan (Joint Fiscal Office)]: So this gets to the bigger question of what is budget adjustment? Budget adjustment across government is you make a budget based on projections across everything, not just health, but fish and wildlife and transportation. And now when you're six months in, the administration says, okay, saw some increases here, some decreases there, we had some new expenses that we weren't anticipating, and then we thought we were gonna do a program that we couldn't do. So we're asking to put that money back. That money sort of goes back into the bigger picture of the pool of, okay, they're asking for the money from here to be used this way, the money from this to be used this way. There's no new revenues. It's just reallocations of money already in the cauldron of water. You know we did that last year, though? Did we add

[Alyssa Black (Chair)]: new money? We do. Yes. We do budget adjustment every year.

[Nolan (Joint Fiscal Office)]: Was there any revenue source last year? Yeah. In budget adjustment? I don't believe so.

[Alyssa Black (Chair)]: I don't believe we had a budget adjustment last year.

[Nolan (Joint Fiscal Office)]: Mean, one year we didn't have one. It was last year. So they did it in the final bid. They did like an extra section in the bill.

[Alyssa Black (Chair)]: Yeah. Never voted on bid. Right. It got incorporated into the budget. But that was a thing. Okay, so then there's the reduction in the correct coding for the applied behavior analysis and we're going to take some testimony on this to let everyone know. So that's a down. There's the Medicare estimate, it's something inflation. There

[Nolan (Joint Fiscal Office)]: is something, I don't remember what MEC stands for, but basically this is how they pay the FQHCs, and this is an adjustment for the methodology, so how they pay the FQHCs. So this is not a new policy, this is just a readjustment of an existing policy.

[Alyssa Black (Chair)]: Then there's the family planning rate that was not implementable, and I do hope that the administration will come forward and provide us with suggestions on how they could actually implement this. Because this is something that has been a priority for its legislature for quite some time, which is why we put it in the budget. And frankly, we are not drawing down the federal dollars that we should be because it has not been implemented in many, many, many years. And we would like to implement that. So, it's a down. The other one is Planned Parenthood, who lost a year of funding under HR1 and has not been able to be paid for any services they provide whatsoever under Medicaid, and the state has stepped in and said we will pay that wage on the charge.

[Debra Powers (Member)]: So I don't want to pound this. Leaning off on my last question, is there any budget line or line budget item that has more wiggle room that you might take from? Are there any that you're like, okay, we don't have enough, so let's go see what they're doing here?

[Nolan (Joint Fiscal Office)]: No, I understand the question. I think I don't have a more granular answer than my previous one, which is there's gonna be ups and downs throughout the budget, and they use that to sort of fill the holes, and it's just more internal accounting. They're not necessarily budgeting. This is all about, I guess one way to look at it is don't look at this in terms of there's a pool of money somewhere coming from. This is about spending authority. This is about the authority to spend money, where that money comes from is somewhere in an account or something somewhere. And if it isn't, then they would be asking for revenue. But that gets into a It's a great question, by the way. But it gets into a weedier conversation for which I am not qualified to answer, other than the fact that this is all about spending authority and not account balances.

[Alyssa Black (Chair)]: If they can't spend until we've said you may spend it.

[Nolan (Joint Fiscal Office)]: Which is a good question though. I don't want to discount it. It's a good question, but I don't have a good answer other than the fact that this is about to be passed.

[Alyssa Black (Chair)]: On a budget we've already passed

[Debra Powers (Member)]: versus a new budget.

[Nolan (Joint Fiscal Office)]: That's correct. But I think the question she's getting at is, is there a pool of money somewhere this is drawing from when it goes above? And the answer is I don't have a good answer to that other than the fact that, yeah, but that gets into the weeds of the accounting piece, which I

[Alyssa Black (Chair)]: am not qualified to answer. Okay, let's get through these others real quickly.

[Nolan (Joint Fiscal Office)]: So then there's one time, there's this cloud migration, it's 2,800,000. This is not in the ups and downs, by the way, because it's in a different section of the budget, 700s. And then there's 8,000,000 for Brattleboro Retreat. This has to do with how they pay Brattleboro Retreat, they they have a contract with it and they had more bed days than they expected. That said, right now it's 8,000,000 or 7.9. Stephanie just testified in Senate appropriations an hour ago, less than an hour ago, thirty minutes ago, that they've been working on it internally and she can say the number is actually gonna go down. She doesn't know what the number will go down to, but it is gonna go down.

[Alyssa Black (Chair)]: But it's still a reconciliation based on a contract that they have with Bravo Retreat.

[Nolan (Joint Fiscal Office)]: And it costs more than they anticipated. Yes. But Bravo were provided the services, now we're just paying Not a new contract versus

[Alyssa Black (Chair)]: And these were just funding updates. They're not Yeah, just funding

[Nolan (Joint Fiscal Office)]: updates. So,

[Alyssa Black (Chair)]: let's go First of all, does anyone have any concerns around any of the items that have been requested that they would not feel as though we would recommend to our Appropriations Committee that we not fund.

[Nolan (Joint Fiscal Office)]: I see a

[Alyssa Black (Chair)]: finger. Oh, I'm sorry, go ahead.

[Debra Powers (Member)]: Your name, please. Because it

[Alyssa Black (Chair)]: was your committee asked. We're going to I'm jumping to them real quick. Let's talk about Bridges because we did receive a request from Bridges in budget adjustment because it is money that they need prior to the passage of fiscal year twenty seven's budget. I want to remind people that the legislature appropriated the money to fund bridges in H91 of last year, so it wasn't in the budget. And H91 was vetoed, which meant that the appropriation for bridges didn't happen and UVM Extension stepped in for funding to get them through. And this is now bridges coming to us saying, can you please help us get out UVM extension and into free and referral clinics? Is there anyone who has strong feelings that that is not something that we should support?

[Debra Powers (Member)]: I would just ask where that money would come from. Because I know we don't have a lot of money to play with, so where, if we did say yes for that appropriation, where would they be?

[Nolan (Joint Fiscal Office)]: So this is a good question and a different question. So there was what the administration, how they're moving things around, then the administration, they provide a budget. We work within that total number. So we have to find 167,000 within that construct. That's different. So the answer is the Appropriations Committee would have to find it someplace else in the budget.

[Alyssa Black (Chair)]: We're not figuring out where they're going to get it from. We're just making a recommendation to the Appropriations Committee if we think you should go looking for this and then it would be up to them to decide what ultimately to approve. We just get to weigh in as the policy committee on whether or not we think should these things happen.

[Nolan (Joint Fiscal Office)]: The difference between the two questions is the administration was saying, we have the funds, we're asking for the spending authority, assume we have the funds, and here's our total appropriation. But when they give it to us, that becomes our box. Okay, if we wanna spend more than what's in that box, we have to find it from somewhere else within that box. And so again, that would be a great question. And what this committee is really understanding is we want to increase the spending and we're asking you to find the money. And the appropriations committee will look at it and look at all the asks that are above the governor. They might say, well, we don't agree with the governor's cut here. We don't agree with the new program here, we're but not gonna do that, we're gonna do these three things. So that can build into their construct, and then you essentially vote on that as a bond. I encourage you to follow it

[Alyssa Black (Chair)]: as it moves through. Anyone not I'm going to ask, is there anyone not in support of recommending that two appropriations that we support? Is there anyone who doesn't support this?

[Debra Powers (Member)]: Okay. I appreciate the idea, and I feel like I'm a very compassionate person. I just feel everything is so good. And I have the huge amount of experience, It's hard for me to say this.

[Nolan (Joint Fiscal Office)]: Who knows

[Debra Powers (Member)]: if can hear it?

[Alyssa Black (Chair)]: My heart's

[Debra Powers (Member)]: coming. So I'm just on the fence. Just This is what I've been thinking about when I wake up. This It's hard. And I feel awful, but I'm struggling. Well,

[Alyssa Black (Chair)]: I will tell you, we're not gonna, we only take a straw poll on this, it's not anything official. It's a straw poll amongst the committee, And then we present a budget letter to appropriations. And I will just say, when I present this in appropriations, I will simply say, an honest draw poll of six, five, whatever, we vote to make these recommendations. So you can vote whichever way you wish. I have asked Jen to draft a letter and I've included this. I wanted to get the consensus of the committee if the majority felt we should include this in our letters. Yeah, I mean, not unofficial, but Circle. Are you talking about bridges now? Just putting it in our letter. Okay. So, we have the majority that would like it in the letter, so I've asked her to put it in the letter. We're going to vote on the letter tomorrow. We're going to straw poll the letter tomorrow. Last thing, and I know we have to get to the floor and I'm very, very sorry about this. Last thing is regarding back to Diva and essentially the budget adjustment rent. I think I just want to make a statement about this really quickly and then ask for whether or not I have the support of the committee in also including some language in the letter. First of all, have this is a contract that has already been executed for the return to the office. The space has been rented. They are just asking for funding authority to pay that, which is actually obligated at this point. So we don't have any concern over it, and I don't have any concern over it, and I personally don't feel it has anything to do with the return to office policy per se. I think the thing that I'm a little upset about is that the BAA is about an appropriation and spending authority, and it's not policy. And I feel as though the administration created policy abruptly, which is why it's being required in the BAA, and then came to the legislature for the spending authority for policy that the legislature wasn't able to vet. And I just feel as though this could have been vetted throughout the session and then we could have gone to the return to office standard in the fiscal year twenty seven budget rather than creating the policy and then just asking us for the spending authority. And I thought that if I had the consensus of the committee, and I'm just going ask for a real quick straw poll, that we just include a little language in our letter that says, we approve this. However, we don't feel as though it's appropriate to create policy in the BAA, and we feel like this should have been rather in FY '25 budget, '27. We have that argument with the GA housing problem. The what? GA housing, creating policy, GA I'm drinking too. I'm just saying, I get it, yes, I support you.

[Nolan (Joint Fiscal Office)]: Definitely.

[Alyssa Black (Chair)]: Okay, all right. +1, 23456, that's the So I'm going to include it in the letter.

[Nolan (Joint Fiscal Office)]: We can debate it further.

[Alyssa Black (Chair)]: We can debate it further when we get the letter. Right. I just wanted to have time to draft it. Thank you. We'll talk about this tomorrow. We'll find time on the skip roll. Thank Thank you. Everybody, let's keep you the floor. Sorry. Thank you, Nolan. No No star.

[Debra Powers (Member)]: Mommy's gone.