Vermont Legislature SmartTranscripts:

[Theresa Wood (Chair)]: Welcome back, folks. We now have Meg Burmeister, who's the executive director of the Northeast Kingdom Council on Aging. And she's going to talk to us about a couple of different things. But Meg, welcome. Welcome to the House Human Services Committee, and the floor is yours. And we do have your testimony on our webpage, members, if you want to follow along. Thank you.

[Meg Burmeister]: Thank you. So, my name is Meg Burmeister. I'm the Executive Director here at the Northeast Kingdom Council on Aging. I'm here testifying on behalf of the five Area Agencies on Aging. And I'd like to take a moment to let you know that previously, the AAAs were part of the Vermont Association of Area Agencies on Aging, which was V4A. You may be familiar with that. This year, we have transformed our organizational structure and are now part of the Vermont Aging Network Consortium. We provide the same services, just under a different umbrella.

[Theresa Wood (Chair)]: That was very helpful. I mean, had heard this back, I don't know, this summer sometime, and I felt like, why do they need bank and B4A? So I was actually glad to see that you're just I don't have a value statement about either one, but then just that we didn't need It seemed both seemed very confusing. We agree. Yeah, thank you.

[Meg Burmeister]: So, throughout last session, the legislature appropriated funding for a 2% Medicaid rate increase for the case management service we provide. Representative Yacavone spearheaded this effort with the House Appropriations Committee and his intent, and we believe the subcommittee or the committee's understanding, was that the AAA case management would be included. However, Dale had not budgeted for AAA case management, so it was excluded from the 2% increase. We are requesting that funding be added to the BAA to cover this 2% increase. The increase is necessary to provide and maintain quality of services that the HCBS system relies on. Throughout the last two years, the role of case management has undergone a significant change in response to a federal rule that imparts conflict free case management. For the five area agencies on aging, this meant a significant effort to scale up to a dramatic shift in the volume of work, which in many cases doubled, and staffing needed to accomplish that, all while supporting frail elders in the community who choose to remain in their homes for their long term care needs. This shift results in financial stressors for the AAA network. As workforce stability is crucial in this work, we are continually seeking, seeing a lack of funding to meet the workforce demands that we are confronted with, and the funding has not kept up with the increased cost of doing business and doing it well. The demands of these changes present us with more complex clients who are presenting with greater frailty, multiple health conditions, and increased need for coordination and advocacy. In our system where healthcare costs are exceptionally high, the work of the HCBS or Home and Community Based Services, case management by the AAA network plays an important preventative role. By supporting older people to navigate care systems and remain safely at home, these services help delay entry into residential care and reduce avoidable hospital admissions. This represents a cost effective investment compared to a higher cost downstream service. Because the legislative intent was to include the AAA case management in the 2% increase, we are asking the legislature to support this BAA request. We do have several other priorities. We would continue to request an additional $2,000,000 in base general funds for the home delivered meals for older Vermonters, including the option to draw down additional matching funds through the global commitment investment. Support for reforms to make healthcare more affordable, including strengthening home and community based services, such as choices for care, case management, home health, Meals on Wheels, skilled nursing, and enhanced residential care services. Support for upcoming bill to appropriate $500,000 to the Dementia Respite Grant Program administered by the Area Agencies on Aging to serve more unpaid caregivers of loved ones with dementia. Support for consumer privacy protections consistent with the state Senate passed in S-seventy one. Support for hunger free Vermont advocacy for improving access to SNAP outreach services for Vermonters, including 60 plus, disabled, and homeless Vermonters, and improving benefits navigational services for eligible Vermonters in light of federal actions. Support for reforms to reduce the cost of health insurance premiums for employers and employees. Support the full implementation of long term care pay rate studies, and support for the Home Share Network as a source of relief for elders wanting to remain in their homes. Thank you.

[Theresa Wood (Chair)]: Meg, thank you for your testimony. So I would I just wanna make sure that I'm understanding. Are you looking and the things that you have identified as other legislative priorities, Are you requesting that in f for f y twenty six BAA or is that for f y twenty seven?

[Meg Burmeister]: For f y twenty seven. I believe some of those things might be on the current listing, but they're not it would come for next year.

[Theresa Wood (Chair)]: So what we're really looking at for

[Meg Burmeister]: the

[Theresa Wood (Chair)]: purposes of today is the 2% Medicaid rate increase. Is that right?

[Meg Burmeister]: Correct.

[Theresa Wood (Chair)]: Okay. And we had a document earlier from the long term care crisis coalition that documented that that amount would be approximately 140,904. Is that what your estimates say as well? Is that what you're believe

[Meg Burmeister]: that Yes, it is.

[Theresa Wood (Chair)]: Okay. Since this is choices for care, and it was the same thing with ERC, this is Medicaid. Just want to make sure that people understand that this is Medicaid. And that's the total dollar amount, not just the state share. Is that correct?

[Meg Burmeister]: I believe so.

[Theresa Wood (Chair)]: Okay. And folks, just so you know, in terms of state funds, it'll be about 45% of that dollar amount roughly. So the same thing with million dollars that we heard about a little while ago, because these are both Medicaid services, so they will be eligible for a federal chair. Okay, questions from folks. So, do you have any I guess I'm trying to figure out because when we worked with the Appropriations Committee in identifying a 2% cost of living increase, We've always provided it to all choices for care services. It's home and community based side. The nursing facility side is different. But we're just trying to figure out what happened.

[Meg Burmeister]: We were equally as surprised as you are.

[Theresa Wood (Chair)]: We thought that it was included

[Meg Burmeister]: in it, and we were very surprised when it wasn't. And this has certainly been a challenging year as we fully implemented the conflict free case management. We saw almost a doubling of the clients that we were servicing and working with, which really put a great financial strain on all of the agencies to be able to staff up both in case management and then all of the support that needs to occur to make that function well.

[Theresa Wood (Chair)]: We have a question. Representative Noyes.

[Daniel Noyes (Clerk)]: Thank you so much for being here today and the work that you're doing. I just had a question. When you went to the conflict free case management, did that include increase in the Medicaid rates, not the Medicaid rates, the total Medicaid dollars that came to the AAAs to be able Because to deal with

[Meg Burmeister]: we were billing more and providing more services to more people.

[Daniel Noyes (Clerk)]: Gotcha. So, did increase when you took on that conflict free case management.

[Meg Burmeister]: But we also had to do an assessment of staff pay and salaries in that work, and that was all part of the transition plan that we worked with Dale on. So, for many agencies, we increased the pay rate to be more marketable and competitive, and that has, of course, created more costs for the agency in terms of bringing on additional staff. For the Northeast Kingdom alone, we ended up needing to double the case management staff that we had.

[Theresa Wood (Chair)]: Can you since we have you online, we we were talking with Dale about this yesterday a little bit. Can you describe and we have we have a few minutes here. Can you describe I guess I would be interested in, from your perspective, this change has happened over the last several months, and the, I guess I would say, varying degrees of disability and health issues for people on choices for care who live in the community. How has that been for your agency in terms of implementing this change? Would imagine that you have folks who have higher needs than maybe perhaps that you had on your caseloads before. And I'm just wondering how you're responding in terms of staff training and being present in the community, in people's homes and things like that. Yeah,

[Meg Burmeister]: we certainly are seeing a wide array of different cases with significant mental health issues, significant physical disabilities, and those require different kinds of case management support. And so, we've been doing a great deal of training and offering the opportunity for helping people to be successful to remain in their home. And of course, that was a very large transition for the individual consumer. They had to face, in some respects, letting go of a system they had been very comfortable in and moving into a new agency working with them. So, there were a lot of pieces to that complexity that created difficulties for the consumers of the home and community based services. And I think one of the other things that we see kind of as we move forward is the role for us in the healthcare transformation. We certainly know that if we can support people better in their homes and help them to remain there, that is significantly less costly than some of the other options for institutional placement, perhaps.

[Theresa Wood (Chair)]: And what's the average caseload for people on your or the range, you know, for people on your choices for care caseload?

[Meg Burmeister]: They're running at about anywhere from 50 to 60 cases.

[Theresa Wood (Chair)]: Wow.

[Meg Burmeister]: And we also are just I think it's a good thing. We're working towards the NCQA certification for case management. So, that's a national standard of a very high quality, and we'll be undergoing that evaluation by NCQA this coming February.

[Theresa Wood (Chair)]: Is that for all of the AAAs or just yours?

[Meg Burmeister]: Yes. No, all AAAs.

[Theresa Wood (Chair)]: All of them? Okay.

[Meg Burmeister]: Part of the initiative under VANC is us coming together to do things consistently across the state, and to be able to reduce costs where we can. So that is part of the initiative for us is that we see a need for quality services, but those to be consistent from one end of the state to the other.

[Theresa Wood (Chair)]: Great. Thank you. We have a couple of questions. Representative Noyes and Garofano.

[Daniel Noyes (Clerk)]: Thanks again. So in the GA housing program, there's roughly 10% give or take are over the age of 65. And I just wonder if you could talk about your work with that population and case management services for people who are in the GA housing.

[Meg Burmeister]: We work with those all the time. We are in every corner of our counties and regions. They present some different issues to support people. We, the home and community based services for both the Choices for Care program and then the moderate needs component of the Choices for Care program, are in many housing communities to help people be able to remain there and get the support that they need to do so.

[Golrang "Rey" Garofano (Vice Chair)]: Thank you. Thank you for the information and your testimony. When you were talking about the caseloads for the case managers, I'm wondering, is there a recommended number, like a best practice?

[Meg Burmeister]: What we have worked with Dale on is looking at around 50 cases. And so we've all been working to scale to that. Thank you.

[Theresa Wood (Chair)]: Because you were choices for care case management providers before, but you weren't the only providers, and now you are. And so was that roughly the caseloads before the transition last year?

[Meg Burmeister]: Think ours ran a bit higher prior But to really, with the volume of work and the demand for documentation and compliance, those numbers have needed to be adjusted so that the staff member could accommodate all that needs to happen for a client.

[Theresa Wood (Chair)]: Gotcha. Well, certainly, I I think that we recognize that it's a a challenge and sort of changing expectations and changing needs of Vermonters out there and, of course, their desire to remain in their homes and communities for as long as they're able to. So thank you for your work in doing that.

[Meg Burmeister]: You're very welcome. It's a unique feature in Vermont that we can provide the level of service that we are able to do in homes. And over and over, we hear from those consumers how grateful they are to be able to remain in the community in the places that look, feel, and smell right because it's their homes.

[Theresa Wood (Chair)]: Yeah. Thank you so much. Okay. Thank you, Meg. We appreciate you being here this morning and appreciate giving us an advanced look at what you're looking for for '27. Thank

[Meg Burmeister]: you very much.

[Theresa Wood (Chair)]: Okay. All right, folks. We'll take a fifteen minute break.