Vermont Legislature SmartTranscripts:

[Rep. Theresa Wood (Chair)]: Okay. Committee members and others to House Human Services on Friday. We are going to start off the morning with continuing our work on H-six 60, And then we are going to move H-six 60, which is about the opioid special fund. And then we are going to move to additional testimony on H549. Five ninety four. Five ninety ninety four. Bill has many numbers. I don't know. But we call it by many names. That's why I never use numbers. I know. The preview next week, it'll have an even different name and number. So wow. Okay. Welcome, Sheila, to House Human Services. Welcome back. We've we've we've seen you.

[Sheila Livingston (Advisor, Vermont Department of Health)]: It's always nice to see you. Yeah. Always nice to be here.

[Rep. Theresa Wood (Chair)]: So we are interested in the department's recommendations for funding. I am going to let you know, in case you haven't taken a look at our website, the Joint Fiscal Office and the person of Nolan has put together a spreadsheet that summarizes everything in one really nice spot. Members, you can take a look at that. And we did have some background from Jess Kirby yesterday about the sort of different approaches and understanding and evolution a little bit about how the OSAC has been operating this year, but also interested in the department. Oh, you pulled it right up there. How's the department's perspective on that? And we have the department's recommendations here as well. So floor is all yours.

[Sheila Livingston (Advisor, Vermont Department of Health)]: So much. I'm Sheila Livingston. I'm an advisor in the commissioner's office at the Health. Thank you for having me. So I can do a number of things. I thought I would start with a pretty high level overview of the health department's report, which we sent you on the fifteenth, is on your website. And then I'm happy to dive into details about other pieces of that. And I have brought some friends with me for the parts that are not the health department so that we can answer any questions. And then I also a big bulk of the recommendations are the same between the the OSAC committee and the health department. That bulk of money, at least sort of the newer or novel stuff, is on recovery housing. And I know that you've had some testimony on that, but we have a couple of reports on that. And I'm happy to dive into that a little bit, but would love to come back and do a deeper dive on that so that you can see how we've been thinking about that as a department. Just really want to emphasize that in the recovery housing space, generally, we have a needs assessment, a report, a gaps analysis, and we have used that information to inform what we are presenting to you here. And again, that might take longer than today alone. Yeah.

[Rep. Theresa Wood (Chair)]: And we'll figure out, I guess, how that all plays. One of the things that because I don't have it up right now, but you probably know the answer to this is, is there anything I'm trying to remember from the commissioner's testimony on the VDH budget, separate from the opioid special fund, whether there is anything, any investments in substance use or any decreases in the budgets in the DSU. Okay. So pretty much Guess who's level in the budget? Okay.

[Rep. Doug Bishop]: All

[Rep. Theresa Wood (Chair)]: right. Thank you. So, and we, the Senate is taking up a recovery housing bill. Yes. Steals with zoning primarily and some other stuff. So we'll definitely take a deeper dive on that probably after crossover.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Yeah, and that's what I figured. So I'm

[Rep. Theresa Wood (Chair)]: not going to dwell there. Thank

[Sheila Livingston (Advisor, Vermont Department of Health)]: you. But please know that there is more than just three lines in this report behind that recommendation. Let's do the boring stuff first. We do need a couple of technical changes in June leads. Two of them are reversions, so more money coming back in. Some of that is because the legislature provided base funding for reengagement beds. I can go into details of what those are, but the takeaway for this bill is we don't need that money anymore. We want that money to go back into the OSAC one so it can be reused. And another piece is The next two pieces are around medication dosing units. And these units, one of them was meant for corrections, and corrections has found a different way to do that and does not need the majority of that funding. So that's that 444,000 that you see right there. We would like to revert that back. And then there's a correction that we need to language where one of the medication dosing units in Chittenden County in statute that says the Howard Center. Howard Center is not interested in providing that service. We do have another provider, and so it's just a tech change. We got to just strike Howard Center and just say Chittenden County. That was money that you appropriated.

[Rep. Theresa Wood (Chair)]: We didn't do that last year? I remember this conversation from the budget last year and the length of But

[Sheila Livingston (Advisor, Vermont Department of Health)]: we have a have a group. We're close to that. Okay. We just need the official you guys. So that's that's the boring

[Rep. Theresa Wood (Chair)]: Okay. Slash good news. Have you been in contact with Katie around reversion language at all? Just I

[Sheila Livingston (Advisor, Vermont Department of Health)]: think so. But we will absolutely Okay. Get her exactly what we need. Yeah. Okay. The Okay. Other thing that I just want to draw this committee's attention to, I guess the big picture thing that I want to draw the committee's attention to and that we've talked a lot with the OSAC about, is the long term viability of this money. And so we really looked at what we think is coming in, and I want to be clear, it's not super solid how much money comes in every year, because companies can pay in advance, which means they pay less overall, and there's a bunch of different things that can change. There's also pending litigation where we might get more funds. So the balance in the budget is something that we all want to know and have this really clear, hard number and know what it is every year. And that's not, unfortunately, the way it works. So in this report, there is a hypothetical long term outlook. And I think the really important thing to think about is how we're going to use these funds over time and whether the things we're funding get ongoing funding year over year. Our recommendations are that we really focus the funding on those long term projects. Many of them have taken time to start up, And they are really meaningful, and they will have really great impact. And so that's just as we go through, I just want to let the committee know that that is definitely a principle that we worked off of. The other thing that came up yesterday in testimony and I wanted to address was the list of places and focus points for this funding. I'm not going go through the whole thing. But when we, the department, are looking at this money and thinking about the recommendations that we put forward and how they might be a little bit different, we have the benefit that the opioid settlement committee doesn't have of knowing what the whole budget looks like and knowing where the gaps are and where the threats are and where the holes are and where we've got money. So something like NARCAN, we don't need to fund right now out of this funding. We have other funding for that, but we know that that's there and it's in place, that that is funded something like programming for pregnant and parenting women. We have another funding pot for that. And so that's something that's specifically called out here in the statute. And so I just want to say that while not every bucket of focus areas that are in this statute are in our recommendations, I want to really acknowledge the importance of these buckets and that we are paying attention to that, and that many of them

[Rep. Theresa Wood (Chair)]: are in other places in the budget. So I guess a couple of questions that raises for me, Sheila, is I get that BDH has a potentially broader view of the things that are available. The part that I didn't really get is when you said the the OSAC doesn't have access to that information. I guess I would presume that the Department of Health representative, paren s, would be sharing that to try to let people know that, okay, we have plenty of funding for Narcan, and so you don't need to fund anything related to Narcan. So do those conversations happen? Absolutely. Sorry.

[Sheila Livingston (Advisor, Vermont Department of Health)]: So yes. So we had a presentation. So remember, committee is volunteer humans. They are there. They get 12 meetings a year. We did a full presentation to them on the department's programming in DSU and what's funded and what the budget is. You all know what it feels like to get that rapid fire. You get one hour and in and out, and that's what you get. So yes, we did do that. But I really appreciate this committee and the amount of work that they have to do and the amount of stuff they're supposed to internalize and absorb and analyze. And so I just want to be really clear. I don't think there's a lot of conflict between what we put forward and what the committee put forward. And I do think that the differences stem from just the different staff and knowledge and understanding. That's not a bad thing. It just is. But yes, absolutely, Chair. Abided that. But I don't want to presume that that then means they They understand. Know everything. It's not there.

[Rep. Theresa Wood (Chair)]: Yeah. So I guess another question arose yesterday when the vice chair of the OSAC gave testimony, and she indicated that they didn't know that the department actually had different recommendations. So was the department's recommendation shared with the OSAC?

[Sheila Livingston (Advisor, Vermont Department of Health)]: Great question. And I want to be clear. We have other colleagues in the room. It's not just the department. We did two things this year. These are the governor's recommendations, so we really worked hard to make sure that the department incorporated all administrative recommendations for OSAC funding in one space and in one place. We offered to provide, and we're actually about to provide that presentation to the OSAC, and they decided that they didn't want to see that because they didn't want it to weigh their decision making and what they were gonna recommend, which we respected, and so we backed off. So we did offer that. They chose not to see the administration's recommendations so that it didn't bias their decision making. And then they made the recommendations, and we did. And the timing was like this at the end. So that's where it landed. And it's a public letter. It's not

[Rep. Theresa Wood (Chair)]: No, I understand it's not a secret. But I guess I I would have expected a I would have expected the department to at least provided a, you know, a copy, not a meeting or presentation even, but after you'd issued your recommendations and if they wanted to see them or not. It just seems like all I can say is a polite thing to do since this is something that and we set up set up the legislature set up the ability for there to be separate recommendations so that it it is if they do differ that we get to acknowledge that and understand the reasons why. I just thought it was odd yesterday when the vice chair said, well, we didn't know that. And so, again, it's kind of all about communication. And I realized there was a lot of communication during the course of the meetings with this committee over the course of the year. So just encouraging. We

[Rep. Esme Cole]: were very

[Sheila Livingston (Advisor, Vermont Department of Health)]: clear that we were doing a separate letter. Yeah, Did not want to hide it from anyone.

[Rep. Theresa Wood (Chair)]: No. I guess I would appreciate if you could issue that letter to the OSAC. Absolutely. Okay. Go ahead, Representative Bishop.

[Rep. Doug Bishop]: A question to try to help share a clear picture of this process. You referenced that OSAC not wanting to be influenced by the making. Does this run I guess I had thought, maybe mistakenly, that OSAC makes recommendations based upon that, the administration then refines, agrees, alters, or are there two separate tracks going on at the same time? OSAC is working on recommendations, and the administration is working admissions?

[Sheila Livingston (Advisor, Vermont Department of Health)]: Okay, that's a great question. So the administration builds our budget before OSEC comes to a final decision. So it's not that we're not taking into consideration, but we have to have a scaffold before they are done with theirs. So we started out with, like I said, I think it was September when we offered to show what they were thinking. And they were not done yet, even close, which is fine. Again, that's their timing. And then, yes, we reviewed the recommendations that they were putting together, but they didn't finalize that until the January when

[Tom Simmons (Executive Director, Neighborhood Connections)]: I think

[Rep. Doug Bishop]: Great. If I may, backing

[Tom Simmons (Executive Director, Neighborhood Connections)]: up a

[Rep. Doug Bishop]: little bit, you talked about the challenges of trying to determine the out years, how much funding we're going to receive. And then I think if I understood correctly, you said it's difficult. So we recommend the recommendation or viewpoint of the department is to fund long term projects. I guess I would think if there's uncertainty about funding in out years, wouldn't we want to look to fund long term projects with base funding rather than uncertain one time funds?

[Sheila Livingston (Advisor, Vermont Department of Health)]: Let me rephrase that. That was a great point. Okay. So wanna make sure that the long term funding objectives from from these monies, that there's enough to fund that. And when we continually add new short term or one off or novel pieces, that jeopardizes potentially how long we can use this money for those longer term investments. Is that better?

[Rep. Theresa Wood (Chair)]: Got it. And I do want to refresh the committee's memory about what our witness said yesterday, that number of applicants who had received funding in f y twenty five were surprised to learn that they weren't going to be receiving funding or f y twenty six. Were surprised to understand that they weren't gonna be getting a recommendation for funding in f y 27. And they said, this isn't just a one time project. So I think that's what the department is also trying to highlight.

[Sheila Livingston (Advisor, Vermont Department of Health)]: And we're very aligned, I think, with that. Yeah. Meeting that shift at this point.

[Rep. Theresa Wood (Chair)]: Okay, thank you. I just wanted to cover process a little bit. Thank you.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Okay. I'm going to scroll. Sorry for the screen here. So let's hit the things that are the same or very similar. Outreach and engagement staff, we've talked a little bit about this the other day with you all on a different testimony. So we are recommending to continue to fund those. We need a little bit less this year because of carryforward, but just really noting that these staff are important. They are hired human beings, and they will eventually cost about $1,900,000 a year. Recovery residences ongoing operational funding, dollars 1,400,000.0 in here. It's a little bit different than what the committee recommends and what the recovery advocacy groups ask the committee for. I don't have a final budget yet for the Rural Health Transformation funding, but we will have funding in there for recovery residences. Right? I wanted to make two statements. One is ongoing funding for operations is important. We recognize that. We need to make sure that that is in a bucket. I would ask the committee for a little

[Rep. Esme Cole]: bit of flexibility to be able

[Sheila Livingston (Advisor, Vermont Department of Health)]: to come back once we have a final budget from Rural Health Transformation and see if we can use this money in a way that we cannot use RHT for recovery residences. So we don't have all that totally figured out quite yet. Sure. So we don't have exactly figured out with Rural Health Transformation what we can use those funds for specifically for recovery residences. Once we know that, we might come back and say, We would like to fund ongoing operations right now with this other money. Can we modify what the purpose of the OSAC money is for recovery residences? I'm gonna give you a hypothetical example. We cannot use RHT money for capital investments at all. And so let's say that maybe we did need some capital investments in this space. We do have that flexibility here. I don't have those details for you today. But I don't want that to be a surprise that we're appreciative about this other money. We might come back and say, we will cover this somewhere else, and

[Rep. Theresa Wood (Chair)]: we get a little more flexibility here. What seems unclear because it feels like we've gotten a little bit of different information. Granted, I know it's sort of evolving still, the Rural Health Transformation Grant. My recollection from when we talked about that at this health reform well, my tongue got bigger all of

[Rep. Esme Cole]: a sudden.

[Rep. Theresa Wood (Chair)]: Health Reform Oversight Committee was that paying for direct services was not allowable in the transformation grant. If they are covered by insurance, which these not.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Or worse are not. I have a lot of questions in that space, but I think more questions than answers, but I

[Rep. Theresa Wood (Chair)]: could answer that one. Yeah. It's a little bit of a moving target, I think. Okay, so what I'm hearing you say, just to summarize, I'm hearing you say, yes, we recognize it's different than what OSAC recommended and what the providers are saying they need. And we may be able to shift some stuff around. So keep an open mind, Please. Sorry. Recognizing we're going to have to pass a bill before crossover. Definitely.

[Sheila Livingston (Advisor, Vermont Department of Health)]: And I should have it far before that. Okay. I just don't have it today. Peer Recovery Services, this is Department of Corrections. This is an existing program embedding recovery coaches and DOC. This is the same or similar as the committee. The numbers are slightly different. We can live with different numbers. Emergency shelter service supports. So this is not in the committee's recommendation. This was an $800,000 appropriation that

[Rep. Theresa Wood (Chair)]: I'm I'm gonna stop you for a minute. Did you kinda skipped over a couple. Syringe services and the Overdose Prevention Center. Sorry.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Yeah, those are not in our recommendations right now. But I can explain that. Syringe services and the Overdose prevention center have carry forward dollars. Do not need any funding this year. So they are not in our recommendations for funding this year, not because they're not important. They don't need it right now. Apologize. And they are also not in the committee's recommendations for this year. So that's also the same.

[Rep. Theresa Wood (Chair)]: Any questions on DOC? Because I also went fast through that. My only thing on and it pervades everything, everything, and it's not just with opioid settlement funds, but it's with kind of like everything we see coming out of not just the issue, but the health department in general, but the issue particularly, is severe delays in grants going out to providers. And I know that the commissioner is on this. He told us so. But we're just going to continue to raise the issue because it's been a perennial issue for several years now. We're saying this for, because I know you know this already, but saying this for the providers and the people listening to let them know that we are gonna be continuing to monitor that and be asking for progress reports about what systems are you going to change in order to have that not continue to occur. So I'm not expecting this one. Unless you got a question. One, actually.

[Sheila Livingston (Advisor, Vermont Department of Health)]: That's an issue. It's an issue that we want to fix, that the commissioner does really want to fix. The Division of Substance Use is going to issue I'm not going to get the term right, so I apologize for that. The guidance and the information needed for grantees in March, so in the spring, we will notify you all when we issue that so that you know when that has happened by. And then the grantees need to provide the information that we need in order to issue the grants before July 1. But we are committed to that, and I want to be really clear about this, for those ongoing services. So if there are new grants that happen and are appropriated newly and that bill doesn't pass until June, I really want to be clear that the expectation that there would be a July 1 start date for those grants is not realistic. The majority of them are not that. The majority of them can be executed on time, and we are going to push for that. That team is committed to it. And we will provide you the updates of when we're ready for the grantees to submit and how it's going through the spring, because we know that's a focus for you all. It's a focus for the commission.

[Rep. Theresa Wood (Chair)]: Oh, go ahead.

[Rep. Eric Maguire]: We don't have, like, a a grant cycle established with OSAC. Do we and what I mean you know what I mean by Would it be appropriate to establish that grant cycle saying, okay. The bill passes in July, so we will set the time to execute that grant October 1. So it goes October 1 to what's September? I don't know. What what's monthly for it?

[Sheila Livingston (Advisor, Vermont Department of Health)]: Yeah. I hear you. '38. I hear you.

[Rep. Theresa Wood (Chair)]: It's not September.

[Sheila Livingston (Advisor, Vermont Department of Health)]: So I think it depends. And that's the tricky part. Because, like, something like the outreach and engagement workers Mhmm. That's ongoing money. It's we've all agreed on it. We've got grants and you know, it's not nobody's writing anything that or reissuing. We can anticipate, unless you don't tell me differently right now, that that's most likely going to be something you've indicated in the past. You wanna fund that ongoing. We've indicated we want to. The committee has. There should not be an issue there. With something. If it's a new grant, it's a new grantee, the new topic, we've never written it before. Yeah, I wanna change the expectation that it cannot be July 1.

[Rep. Theresa Wood (Chair)]: Well, was just gonna say that's important for us to know because then also we wouldn't appropriate a full year's work necessarily out of in a year one project, maybe. That's the

[Rep. Golrang “Rey” Garofano (Vice Chair)]: way to deal with it. Could we consider doing like their next grant as a fifteen month grant so then they can be on a federal fiscal year October to for future years. So then we have three months grace period. Representative

[Rep. Theresa Wood (Chair)]: Steady, Could you mute yourself, please? Of course.

[Sheila Livingston (Advisor, Vermont Department of Health)]: I don't want to answer that because I am not an expert in that space. We can come back with a proposal. I hear what you're saying, and

[Rep. Golrang “Rey” Garofano (Vice Chair)]: we can come back with a proposal. Just so to kind of make the timing more Logical. Yep. Logical and make more sense. And another question, if I may, I had. Just as far as I love that there's a system and thinking about funding ongoing longer term projects. I would love the department and OSAC to kind of and we mentioned this to Jess yesterday as well to kind of come together and develop some measures so over time, metrics, we can see for each of these buckets where are we making improvements and what the impacts have been. Obviously, it's a new program, so we've only had a couple of years of data. But now, as we're making a foundation and a commitment to funding some of these bigger projects that are long term, then I think we can really think about that and collect some data.

[Rep. Theresa Wood (Chair)]: Well, I was just going say the amendments we made to the bill last year requires that to be in the grant agreements with the department.

[Sheila Livingston (Advisor, Vermont Department of Health)]: And we and we have started that process, and we but we need to the the steps that need to happen now is the committee needs to see that. I mean, I'm like I mean, you know this, but, like, all of these things that, you know, they start up, and then, you know, they hire people, and we gotta give the time for all of it to happen. But we the the OSAC committee was very clear, and we definitely agree that we need to focus on looking at what we've already funded and whether it's working as the beginning of this next cycle.

[Tom Simmons (Executive Director, Neighborhood Connections)]: For sure.

[Sheila Livingston (Advisor, Vermont Department of Health)]: You. Yes. DOC?

[Rep. Esme Cole]: We're good?

[Sheila Livingston (Advisor, Vermont Department of Health)]: Right. Dale, you can go. Thank you. Emergency shelter substance use support. So this is the next bucket. This is one that's different from what the council the council did not recommend this. The legislature appropriated $800,000 last year for this work. The Department for Children and Families is asking for $250,000 this year for this work. This committee knows a lot about what's going on right now in the shelter space, but I have Lily Sojourner here in case anybody has specific questions about this because it's different than public council. Representative

[Rep. Theresa Wood (Chair)]: Bishop does.

[Rep. Doug Bishop]: So the $800,000 you're saying that we Slater appropriated last year was not part of the opioid special fund. It was a separate appropriation.

[Sheila Livingston (Advisor, Vermont Department of Health)]: It was part of It came out of the opioid special fund last Okay.

[Rep. Doug Bishop]: To harken back to my question earlier about the approach that the administration would like to take of putting funding towards some of these longer term goals, and make those four principles established longer term goals. And I guess this doesn't seem to neatly fit in one of those four. There are other funding requests being made by AHS related to sheltering and specifically substance use recovery shelters. So why would we not include the funds in the budget for the year, the upcoming fiscal year, rather than using these special funds?

[Sheila Livingston (Advisor, Vermont Department of Health)]: So I can answer that in part, then I will ask if it's Okay if Lily comes and help me. So we had that $800,000 appropriation. We have been using that to really figure out where the gaps are and the holes are and how we can support shelters. We're also trying to work really hard to find ways that existing systems can fill the needs and the gaps that these shelters are experiencing in this space, which is why you see some of the reduction in the request. I don't know that we'll get to zero, but the health department is committed to working with DCF to try to see how our existing systems can come in and support shelters. And you heard a little bit of that in last week, or last week, whatever, the testimony before around making sure that there's recovery coaches there, making sure that there's treatment providers there, making sure that we have transportation. This is helping sustain some of those needed services as we figure out, not OSAC money, other funding and other systems to come in and support.

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: Yeah, Michelle. So I would say

[Rep. Esme Cole]: I'm sure

[Rep. Theresa Wood (Chair)]: I didn't. That's right. Thank you.

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: For the record, Melissa is the director of the Office of Economic Activity. Yeah, thank you for the question. I think some of these are funding things that are not traditionally eligible activities through our other funding sources for shelters. So I think Sheila mentioned a good example of recovery or non Medicaid reimbursement, like peer support groups or other things that may not be covered for Medicaid that you need to get transportation to, and that has been a barrier. Surveyed our shelters and identified some of these key barriers to helping people access the services and support that they need. And then that's where we targeted. So that's one example where that's not something that we would cover normally through our housing opportunity grant fund, is paying for transportation to having getting people to peer run support groups or vice versa. What some shelters are doing are then creating MOUs and addressing barriers so those support groups can happen on-site at shelters. And I think that's one reason, as again, Sheila said, we've seen the reduction in our ask is because we have this year been able to really target where are the gaps, whether that's regional or specific aspects of our system, but we still feel

[Rep. Theresa Wood (Chair)]: like we need some of

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: this bridge support next year to help while, again, those other systems not out of OEO or DCM traditionally, and work to address some of those barriers.

[Rep. Doug Bishop]: I agree with the merits. I'm not at all questioning the merits of the work. Guess I was just trying to identify really whether we've got the right funding stream. And if I'm hearing you correctly, this is something that can't be or at least not traditionally is funded through HOP?

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: Right. Again, that type of transportation or other support for those folks' time would not be something that comes through or would just create an additional significant pressure on that budget that we had not otherwise accounted for in the governor's recommended budget.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Thank you.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Any other questions for Lily? Not

[Rep. Theresa Wood (Chair)]: a question, but I guess I feel compelled to comment that the HOT program is state funds primarily, and we make rules about what we use those funds for. And so I appreciate the question. Had the same question. I

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: think then it just would create a different budget pressure. Does that sound right?

[Rep. Theresa Wood (Chair)]: Yeah, no, I appreciate the identification of other resources. The ask is down from last year. And the administration's proposal, we see a lot of money in the OEO budget that is really gonna be used by other departments. So I'm not really sure why this didn't qualify under that either. So I I I understand the question and the answer. Thank you. Alright.

[Sheila Livingston (Advisor, Vermont Department of Health)]: The next two are just reminders. We have two things that are running right now. Contingency management, so this is a treatment format that is particularly very successful with stimulants. We are seeing an increase in stimulant use in Vermont, there's not buprenorphine. There's not methadone. There's not a medication for stimulant use the way there is for opioids. This is an evidence based practice that can really support people who are experiencing this. It's taken a while to get it off the ground, so it has carry forward money right now. But it has been funded through OSAC. And should we continue to run this program, it will need future funding. Again, doesn't need it today. Same with syringe service programs, obviously incredibly critical service. We'll continue to need funding in the future. Doesn't need it in this year. But those are just

[Rep. Theresa Wood (Chair)]: reminders. And some of these things, guess I'm interested to know, and it doesn't have to be right now, though. We will, at some point in the future, run out of opioid settlement. Settlements only last for so long. Correct. And some of these things we've identified, particularly the things that have been identified for continuation funding each year, those sort of forming projects right now, and then some of this other. What kind of planning is the department doing to incorporate those things in its base budget in the out years? And maybe we should be starting to transition maybe one a year or something like that as we look forward. We just did.

[Rep. Esme Cole]: Great point, Cherilyn. So we moved

[Sheila Livingston (Advisor, Vermont Department of Health)]: the Dale. You'll see there's not the Dale program that supports employment support for people experiencing a opioid use disorder. It is not in the ongoing funding from OSAC recommendation end of this year. It is in the Dale budget. So yes, we need to do that, and we need to figure out how to do that slowly and thoughtfully. The DCF ask, you will see, I hear you. Why isn't it somewhere else? Well, this is where we could fit it. It's getting smaller. We're trying to figure out how to systematize it so that it's not in here, we're not relying on it. And we will have to do that together over the next, depending on how much we spend at once, ten to fifteen years.

[Rep. Golrang “Rey” Garofano (Vice Chair)]: Thank you. Agree.

[Rep. Theresa Wood (Chair)]: Okay. Let's move forward to those kind of recommendations for future direction. Oh, okay. Can I just do these three? Yeah. I can

[Sheila Livingston (Advisor, Vermont Department of Health)]: do those. I'm gonna build very fast on the recovery beds. We want to expand recovery residences in Vermont. No shocking surprise to anyone. We agree with OSAC, the committee, that needs money. We also agree on this pre hospital EMS program. So this is where EMTs and paramedics are able to dispense buprenorphine off in the back of a truck after an overdose to bridge services. It's really cool. It's really new. We're working on training. So hopefully, would again, that's a point of agreement. Public Safety Enhancement Team community convenings. This did not make it into the recommendations from the OSAC committee. This is run out of DPS, and I know very little about this one, but I brought a friend. Same. Dan Batesy from DPS. He does talk very briefly to you all about it, because I know you didn't hear about this from They are not here

[Rep. Theresa Wood (Chair)]: to buy that. So go ahead. Thank you. Welcome to House Human Services.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Good morning. You. For the record, I'm Dan B. I'm the deputy commissioner of public safety. I'll give you the very brief wave tops of the Public Safety Enhancement Team. Born out of the governor's 14 anti violence plan had its roots in the COVID response. We were very successful by breaking down barriers between the different state agencies and departments to say we have a singular focus. Let's stop thinking about how we're different and start thinking about how we can work together. What the PSET team does, what PSET does is to collaborate with local actors. So there are seven communities right now who have formed together stakeholder groups to address what we loosely refer to as chaos in their communities. And the chaos is the greatest hits that I'm sure you hear every day, housing, substance use, mental health, all of the things that are most common. But the key is that those local stakeholder stakeholders are are working together to see if they can address some of the indecision causes. How can they and the communities work together to work on some of these issues? And that might mean working with the chamber of commerce and landlords and local developers to refurbish Bennington High School. These are things that we've worked on with PSET. The broader piece of it, though, is a number of state actors, the muckety mucks of of the state enterprise, if you will, coming together to say, we have your back. Going to Bennington, going to Springfield, going to Brattleboro and saying, we we appreciate what you're trying to do. We're gonna help you frame some strategic measurable goals out of this, and we're gonna leverage all of the influence we have and all of the best practices that we've seen in other places, including out of state, and say, here's how we can help you with these things. It's not taking over anything in the communities. It's just saying, here's some best practices, and here's how we can help you out. And that that has really ranged across the spectrum of things, like simply answering questions saying, you we've always assumed that we couldn't share this data between mental health and the fire department. Well, when the mental health director is there, we can say, yes, you can. And all of a sudden, it's happening, and now they're communicating and working together. Sometimes it's bigger stuff like arranging data of manipulation at the police departments, things like that. But it's it's broadly a collaborative effort that we're trying to get to. So what this money will allow us to do is expand that project. Right now, there are seven communities. We think there's room for more. It also enables us to do a lot of the logistics behind how we make sure that good ideas are transmitted across the spectrum. We have four quarterly collaborations consortiums rather, where we bring in guest speakers and then we report out from each of the different communities so that people can hear what's happening in Bennington as it applies to Springfield, as it applies to Brattleboro. We also work with crime, CRG, crime resource research group. Sorry. Forgive me. They are the data experts who know how to take the data in a really statistically significant way and work their way through it so that we can actually measure success. So it's not just us saying, hey. We think we're doing a good idea, but we're actually doing a good idea. And that allows us to take these concepts and move them to a strategic level. So if, for example, Taylor mentioned the EMS buprenorphine project, that started in Bennington. And we said that it's a shame that people have to go from Bennington to North Adams, Massachusetts to get medication assisted treatment. That doesn't make any sense. If you have to take a cab and travel ninety minutes to get your medicine three times a day, you can't hold the job. So how about we create some different options for that? And that we work with Bennington Rescue to establish a capability they have to to administer buprenorphine. It's not the the only piece of it because what we've also done is paired them up with recovery coaches in town and also with the substance abuse treatment centers in town to to sort of connect people into the nexus. Small numbers so far, but what we're seeing is good connections going on in the long term, which is, you know, really what we wanna do.

[Tom Simmons (Executive Director, Neighborhood Connections)]: So that's the broad strokes of what's happening here.

[Rep. Theresa Wood (Chair)]: So you said seven and this says four.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Yeah. So this predates this information is predates when we first started it, there were four. Now there are seven.

[Rep. Theresa Wood (Chair)]: There are seven. And how many more do you want to expand to with these resources?

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Yeah, I think there's not gonna be that many more only because sooner or later, we're gonna reach the critical mass of the largest communities and the biggest problems. I think what's yet to be determined though, is how we can take some of the smaller communities and and and put them together. For instance, we just started one in Hartford, which is really a collaboration between Woodstock and White River Junction and all of the small communities that exist there. Any one of those communities alone is probably not big enough to dedicate a big giant resource to, but together, they make a lot of sense. So would something similar apply to Essex Junction and Williston and, you know, places like that? Think that's still the question that we have, and and I I can't necessarily answer that right now.

[Rep. Theresa Wood (Chair)]: And so you you did the existing ones that you have, the seven that you did within public safety's existing funding.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: They could see savings and a variety of other

[Rep. Theresa Wood (Chair)]: A variety of different things.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: None of the couch cushions.

[Rep. Theresa Wood (Chair)]: I I we we know that well. And so what would be your plan for continuing this on an ongoing basis since this is not likely to get ongoing funding?

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Yeah. Well, so so this project is not dependent solely upon this funding. We are gonna continue the work that's going on from a variety of different methods. And and the reality is this is not the idea is that we will fund we will get momentum moving, and largely, it's dependent upon the local communities themselves and the work they're doing. So we're kind of just momentum building and nudging people along. I think with some of this funding, we can do more. We can connect more communities to CRG. We can use data better. We can create more opportunities for collaboration. But without it, we just strip it down and say, okay. Let's keep going and figure out a different plan. So this is not we're not to hold into this funding in the long term.

[Rep. Theresa Wood (Chair)]: Representative Maguire.

[Rep. Eric Maguire]: Yeah. I was gonna say just quickly because it's written on up there and so forth. It would it sounds like what's going on is you're providing some good backbone support to the situation tables. Well, situation going

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: on option that he said. Yeah. If you're familiar with the situation table, it's a a a product. So that came about because of p set. That was an idea that we found out of state. We brought it here and said, hey. This makes a lot of sense. Let's put it into effect. It's now in more than seven communities, nine communities at this point. And and by the

[Rep. Eric Maguire]: way, yielding tremendous success. Absolutely. Rutland is and I know Burlington and many other things and and involved with the Rutland the Rutland Situation Table, it is really help collaborate and bring things together and identify the best appropriate resource for the individual being served. Very, very effective. It's great to hear.

[Rep. Theresa Wood (Chair)]: Thank you.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: In a lot of ways I'm sorry to interrupt you. In a lot of ways, situation table is the microcosm of greater PSAT. Situation table deals with individuals, individual situations, and brings those resources in collaboration to address those. PSAT looks at the broader stuff, right, the bigger trends.

[Rep. Theresa Wood (Chair)]: I'm gonna take advantage of having you in the witness seat and you being being from public safety and Of which emergency management is a unit within public safety. In the governor's housing plan in the Department for Children and Families budget, there's $292,000 for natural disaster sheltering options. I'm just wondering if you could if you can't, then you can have your emergency management director come speak to us, and we can do that.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Think I'd prefer to do that. I don't know exactly what you're talking about. And then rather than extemporaneously try to make something I'm

[Rep. Theresa Wood (Chair)]: just trying to be efficient if you don't

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Every time that I get in

[Tom Simmons (Executive Director, Neighborhood Connections)]: trouble when

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: I do that.

[Rep. Theresa Wood (Chair)]: It's all good. That's it. We all need to know when we get out over a space.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: I'm glad to have some follow-up

[Rep. Theresa Wood (Chair)]: with you. No, I appreciate that. Thank you so much. Thank you for being here and providing that clarification.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: Thank you.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Okay, that concludes the request. If that was too much, there's a table at the end of the presentation. Much simpler. And then the direction for ongoing funding is exactly what we've already discussed, really looking at outcomes, really looking at focusing on the ongoing funding first. And this is not something necessarily I mean, I think it would be really important to get a sense of where this committee is and if you agree with that direction. But it's really something that we, the department, are going to work with the Opioid Settlement Advisory Committee on going forward and wanted to write it down here so that you could see that and weigh in if that's not the way that you see it going.

[Rep. Theresa Wood (Chair)]: Okay. So we'll have to think about that a little bit more. So I haven't had a chance to read this proposal part down here yet in terms of thinking about that.

[Sheila Livingston (Advisor, Vermont Department of Health)]: And I can I can explain it too? I don't wanna just don't wanna Yeah.

[Rep. Theresa Wood (Chair)]: Mean, essentially, you're you're looking to Are you looking for funding to do this?

[Sheila Livingston (Advisor, Vermont Department of Health)]: No. No, this recommendation is how to use this funding going forward. In the future. And the idea is to look at the results, is to look at how we do sustainable ongoing projects. It's to maybe take a pause on accepting new proposals and projects until we really make sure that we have a solid plan for the future. And then if we continue to take new proposals, one option is to not have the committee take individual proposals from the community And instead to say to whichever department it is that they are directing to, we want more funding, this much funding, focused on whatever the thing is, Narcan or overdose response. Because it is a lot. We have a member of OTHEC sitting here. They got 67 proposals from the community. It is a lot of work to try to sort through that and make sure what your recommendation is and come to that as a group in that manner.

[Rep. Esme Cole]: It's a lot of work

[Rep. Theresa Wood (Chair)]: for the community, too. Same thing for the summit. So thinking about whether a pause in allowing us to sort of like evaluate what we put out there already and what the it's worthy of consideration. Last question from representative Garofano.

[Rep. Golrang “Rey” Garofano (Vice Chair)]: And we can follow-up after. But I'm just curious if you know if there's collaboration between the communities and the providers that are asking OSAC for money and their municipal government, because municipalities are also getting us money directly. And it's kind of there's not great data on where that money is going and how it's being used. So I'm just curious, are they leveraging all the resources available for the various projects that are out there? And we can connect on that after, because I don't know.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Okay, let's have a bigger conversation for that.

[Rep. Theresa Wood (Chair)]: Yeah, I mean, I think it would be helpful to know what communities are utilizing I this on

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: haven't been there.

[Rep. Theresa Wood (Chair)]: Don't know. Okay. Thank you. Thank you, Sheila. I appreciate you being here today. Thanks, everybody.

[Sheila Livingston (Advisor, Vermont Department of Health)]: Just

[Rep. Golrang “Rey” Garofano (Vice Chair)]: brief comment on that. I think, forwarded us a, figure or voice article on that, and it was interesting to see a lot of communities that hadn't used it yet. We're still trying to figure out what to do with it, and maybe some of you need to suggest that requires community site. Okay,

[Rep. Theresa Wood (Chair)]: we're going to now hear from the southern part of the state. You Tom? I'm Tom. Okay, welcome to the table, Tom.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Thank you.

[Rep. Theresa Wood (Chair)]: Appreciate you being here. We'll do a brief round of introductions because this is your first time in in our House Human Services Committee.

[Tom Simmons (Executive Director, Neighborhood Connections)]: It's a very cloaking committee. I had no idea. Nice to meet you.

[Rep. Theresa Wood (Chair)]: We try not to make it too intimidating. We're just, you know, trying to hear from people all over the state and really appreciate the fact that I know there's been stuff going on in Londonderry. I've been aware of that over the course of the summer and fall and appreciate the work that the community is doing to try and do the best they can to help people who are homeless. So thank you for being here today. Really appreciate it. Thank you

[Tom Simmons (Executive Director, Neighborhood Connections)]: for having me. I wanted to actually speak to you for a long time. So I'm, like, really excited that I'm here.

[Rep. Theresa Wood (Chair)]: We'll a round of introductions. Okay? I'm Theresa Wood, and I am from Waterbury, and I also serve Bolton, Gulescore and Huntington.

[Rep. Anne B. Donahue (Ranking Member)]: Hi. I'm Anne B. Donahue. I'm from Northfield and also represent Berlin.

[Rep. Daniel Noyes (Clerk)]: Glad you're finally here, Tom. Hi, Greg. I'm Danan. I represent Wolcott, Hyde Park, Johnson, and Belvedere.

[Rep. Eric Maguire]: Hi. Good morning. Eric Maguire. I represent Rockwood City.

[Rep. Doug Bishop]: Morning. Doug Bishop, I'm from Colchester.

[Rep. Zon Eastes]: Hey. Morning. I'm Zon Eastes. I live in Guildford, and I also serve Vernon.

[Rep. Esme Cole]: Hi. Welcome, Esme Cole.

[Tom Simmons (Executive Director, Neighborhood Connections)]: You're from my neighborhood. Yes. Yeah. Yeah.

[Rep. Esme Cole]: Hi. Esme of Hartford.

[Rep. Jubilee McGill]: Hi, I'm Jubilee McGill, and I represent Bridgeport, Middlebury, New Haven, and Waybridge.

[Rep. Golrang “Rey” Garofano (Vice Chair)]: Hi, I'm Rey Garofano. I live in Essex, and I also represent part of Essex. Okay. Representative Steady?

[Rep. Theresa Wood (Chair)]: No. You're you're you're muted.

[Rep. Jubilee McGill]: Representative Steady, Westford,

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: East Milton.

[Rep. Theresa Wood (Chair)]: And then we are going to go straight around the room, starting with our magician. Written by the and Wizard.

[Dan Batsie (Deputy Commissioner, Vermont Department of Public Safety)]: My name is Isaac Oxford. I'm sitting in the legislative process. Great, welcome. Yep.

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: My folks, Action circles. Brenda Siegel and the homelessness Vermont.

[Rep. Theresa Wood (Chair)]: Good.

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: And Hinchel, just community stakeholders. Wonderful. Monica Menieres from Franklin Health and Shepherd Oasis. That's Susie Walker from Recovery Partners, Silk Road Homes. Hi, I definitely don't get up with the Lamoille show. I'm gonna advocate to your minds.

[Rep. Theresa Wood (Chair)]: Wonderful, thank you all for being here and supporting Tom So in his first Tom, the floor is yours. If you just introduce yourself and tell us a little bit about yourself. And I will say that the former representative Kelly Paolo served on this committee and president and former town clerk of Londonderry. So sitting right there where representative Bishop sits. So I felt like I needed to bring up her name because she is a person who represented your community very well here. So welcome.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Okay, thank you. My name is Tom Simmons. I'm the executive director of Neighborhood Connections. I have been so since early twenty twenty four. We're in Londonderry. And prior to that, I was the nutritional wellness director of Senior Solutions in Springfield. What I'd like to do today is give you a brief overview of my agency, who we are, and then talk about our experience with Magic View Motel, which is part of the motel program in the past, And then make some comments very specific to H594. I think I got the numbers right. Because I think there are some very positive trends there, and there are some very concerning issues as well. And so I'm speaking from my perspective of having worked with home the homeless population over the course of the last year in a hotel. Neighborhood Connections has been in existence for seventeen years. It's been around a long time. It serves 12 towns in three different counties, Western Wyndham, Southwestern Windsor, and Northeastern Bennington. We are kind of on the on the fringes of the three counties. It also means we're on the fringes of most of the regional agencies that generally provide services. And one of the problems has always been being on the fringe. It's out of sight, out of mind. So we, we operate in four different areas. First, is nutrition. We deliver 20,000 Meals on Wheels to people in the mountain towns as well as sponsored community meals. We have our own transportation system. We have a bus, an accessible 12 passenger bus, and three other vehicles that we use. We provide 6,100 trips per year at no charge, mostly to seniors and the majority to medical appointments. We also engage in a series of wellness programs and disease self management programs, people in the area. And probably the most important part of what we do is social work. Out of six full time employees, three of them deal specifically with social work and case management. We and that includes application assistance for benefits like SNAP and LIHEAP, Medicaid, Medicare savings programs, Social Security issues. We also have provided in the last year over a $100,000 in direct financial benefits to people finding themselves with broken pipes and heating systems that have fallen apart or, you know, leaking chimneys and things like that. And then just general counseling one on one with people to help get them back on their feet. In fact, this year, we became designated as one of only two benefit enrollment centers by the National Council of Aging in the state of Vermont for the work that we're doing. So a lot of the work that we do is with seniors, the disabled, and low income people in our area. And as I said, a lot of the the community action agencies, the housing agencies, the triple a, for we're on the fringe geographically for them. It's not easy for them to get to our area. And so we have taken on the role of much of what these other agencies do.

[Rep. Theresa Wood (Chair)]: It sounded very familiar to what AAAs are charged with and funded to do.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Yes. And that's another issue. The two always with no funding whatsoever.

[Rep. Theresa Wood (Chair)]: I was gonna ask you if you get any funding, you know, either through a subgrant from AAA or or not or from the Department of Disability, Aging, and Independent Living at all.

[Tom Simmons (Executive Director, Neighborhood Connections)]: We have a $1,100,000 budget. 75% of that is through private local donations. We do get pass through over American acts funding for our meals, which covers about 60% of our meals costs. Also, VCIL does the same. And we do, for the first time this year, have a $41,000 grant from ESD for SNAP enrollment. Usually, that just goes to the CAAs and the AAAs. We were added for the first time this year as an additional designee for that. But that's pretty much it. So let me talk about Magic View Motel. Magic View Motel was part of the state's motel program, and it is located on Route 11 in Londonderry. It is located on a highway, two lane highway, that has no shoulders. There are no cooking facilities, no laundry facilities. The rooms are inaccessible, including the bathrooms, and there is no on-site full time staffing. The closest market, if you walked in the roadway, is two miles away. So we worked in, and I'm talking about the twenty fourth through twenty five winter season, winter emergency season. We worked with 53 different individuals at the hotel directly. The majority of people who were placed there by the state were seniors. The majority who were placed there had a disability, either physical, cognitive, or emotional. And most of them had or fell into both of those categories at once. Most of them had no automobiles, no phones, and there is no phone system in the hotel either, and no source of income. They were placed in the motel program, and no one was really told about that. Mean, the state didn't notify us. They didn't notify the AAA. The housing agency that covers the area, Springfield supported how supported housing. First, I I'm not speaking negatively about them at all. We've worked very closely with them. They didn't have the resources to do much at Magic Butte. So we were the on the ground agency. In fact, we were there every single day, Saturday and Sunday and nights with our staff. Because when you drop someone at a hotel and they have no money and no phone and no food and no cooking facilities and don't even know where they are sometimes, sometimes they will place them as far as Williston, someone needs to help them. There there's there's an immediate need, for basic things like food. So, basically, to give you a sense of the of the needs of these people, We dealt with a senior who had the cognitive abilities of a five year old who's in diapers that needed to be changed every day. I've been getting really emotional about this, so please forgive me.

[Rep. Theresa Wood (Chair)]: It's okay.

[Tom Simmons (Executive Director, Neighborhood Connections)]: We had a senior with a broken hip. We had two double amputees, one of whom ended up being taken to a hospital by our rescue department because she fell on the floor trying to use the bathroom. Many with dementia. And some who would just get angry over the fact that they had dementia. And you'd ask them, What month is it? And they'd mean to say September, and they'd say purple because they had suffered a stroke and had had some serious issues. One gentleman with a colostomy bag, one in kidney failure, one with colon cancer, several with large open weeping wounds on their legs. And these were the folk who were placed at Magic New Motel. The state was very clear that they do not provide case management services. You're not placed there with a promise of case management. Well, who's gonna do it? So being there, being in London Dairy, we became the triage agency. So for each of these persons, we initially needed to get medical care. And that meant a brand new appointment. Usually Mountain Valley Health Center, which is part of North Star now, was the was the go to. Sometimes it was Grace Hospital. Sometimes it was Springfield Hospital. Most of them needed initial workups. They may have had a doctor when they passed somewhere. They may have even had medication and been on medication, but when they will move from one part of the state to another, they no longer had access to that medication. We the most important after we got medical stability for many of these people, one of the most important things that is often overlooked in the whole case management approach is we had to reestablish personally. They didn't have social security cards. They didn't know the numbers. They didn't have birth certificates. You don't live in a tent for three years and have a birth certificate nicely, you know, packed in a packed in your pocket. Social Security or or, disability benefits, if they had them, probably stopped because they were getting checks and they moved so many times, the checks got returned, and so they were cut off. Any application for any services that could help them from Medicaid through SNAP all require some degree of, well, who are you and where do you live? These people live all of that. And these are the most needy people that we were working with. And the very first steps were not possible until we could get some of these documents. So there was a lot of time spent on document retrieval and recreating personhood for people who didn't exist in in the eyes of of the state. And there was one gentleman, he was a Vermonter for most of his life, but he was born in Chicago. And the procedure for getting a birth certificate for him was fairly straightforward, but the city of Chicago was behind two months. So nothing nothing progresses for two months. We provided in addition to to all of this work, we provided 873 trips in our transportation system for the folks at Magic New Motel, to doctors, to court appointments, to pick up their pharmaceuticals, to get food. We established a shuttle bus to the local food pantry to make sure we get people to get, you know, food at the pantry. We provided 1,200 meals to them. And, again, they had no cooking facilities, so we had to bring things that could be microwaved. Several of several of the residents there could not work a microwave. One of them it's it's a it's a laugh, cry situation. Used to call 911 because he didn't know how to push the odd button on his microwave. We spent a minimum, and this is very conservative, of forty hours a week of direct contact and direct social work every week for six months in order to to to help these people. Plus, because their stay at the motel had a time limit, which they could renew. Of course, renewing when you have dementia, when you don't have a phone, maybe it's very and then you're reading online at ESD was very difficult. Many of them had gap nights, meaning you're out tonight. So there was a two or three gap night. We would pay for their stay to make sure that they they stayed there.

[Rep. Theresa Wood (Chair)]: Can I ask you a question? So, Juan, thank you for what you did for those people. That's the first thing. And do you know what has happened to them? Because you I I understand that cell is not being used, and I'm just I'm curious of that, you know, through your work or connection with other community providers, you know, do you know if any of these folks have been placed into, like, residential care home or any

[Tom Simmons (Executive Director, Neighborhood Connections)]: I have those figures.

[Rep. Esme Cole]: You do. That's right. I'm gonna get to

[Tom Simmons (Executive Director, Neighborhood Connections)]: that in

[Rep. Doug Bishop]: two seconds.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Oh, okay. Break If my creative thought, I'm never gonna get through this. I apologize. No. It's okay. I just

[Rep. Theresa Wood (Chair)]: wanted to make sure that we get to hear everything And that you have to I'm deeply impressed with the amount of local coming together that you did in the face of having these people just of walked into And your I've been to Londonderry. It's not exactly a place that's easy to get to.

[Tom Simmons (Executive Director, Neighborhood Connections)]: No, it's not. It's not. So we performed we performed. We we completed 53 coordinated entry applications for all of these people. Normally, Springfield supported housing would do that. They were unable to they were simply unable to do that. In fact, I can tell you they were at that motel three times between November 1 and January 15. Again, not a criticism, an objective reality. They don't have the resources to get there and do this. So we did all of the coordinated entry applications for these folks, for which we received, again, no state assistance, no Springfield supported housing funds. We applied for HOP. We're not awarded. And our local our local rescue, which is completely volunteer, respond to 35 calls in six months, in 2025. Now, as for those 53 coordinated entry applications that we completed, 20 folks, I mean, well, 23 folks either died or moved, or, were were somehow received housing on their own. We don't we don't know what happened to them. 20 of them, we found housing for. But I have to say, all 20 were outside of the coordinated entry system, mostly because the people who were placed there do not are not considered priorities for that system. They don't have income, they have disabilities. There are people that landlords-

[Rep. Theresa Wood (Chair)]: I don't need to, I don't I need have to a slice. Get it. Am

[Rep. Jubilee McGill]: angry. And

[Rep. Theresa Wood (Chair)]: you're being so gracious. And with the failings of this, what I loosely call a system. And just I'm I'm sorry. I have this it was inappropriate of me to to sort of, like, have that gasp, but I I'm

[Tom Simmons (Executive Director, Neighborhood Connections)]: I get it. We could not work through the coordinated entry system for these people that we work with. So 20 of them, we found rehousing, permanent stable rehousing on our own outside of the state system. Of those twenty, ten went into assisted living. They qualified both medically and clinically for assisted living placement. It took a lot of work. It took a lot of work, again, establishing personhood, getting the clinical review, getting the financial review, getting approval, and then finding a bed somewhere, which we did for those 10 peoples. And, again, no compensation to us. We spent and this is very conservative. We spent a $120,000 working with Magic View Motel during 2025. I want to also say that even though we did the coordinated entry applications in the statistics that are provided to the state for the number of applications provided, it doesn't say it came from neighborhood connections. It says it came from Springfield supported housing. It came from us. In the ERAP figures that SEVCA provided the state, three quarters of the rehousings came from us. But we don't report directly to the state. We report to SEVCA who then aggregates the numbers and reports them to the state. So let me I I'd like to talk about five ninety four very specifically. And there's a few things. First of all, I'm gonna really, when I first read it and I read it through a 100 times, there's a few things I really applaud. First is is the idea that, you know what? Motels aren't the best place to drop people. And they are, especially when they have no facilities, going on there. And I spoke directly with Miranda Gray and with commissioner Hoffman about Magic View, as did several other people from our town. And we said, look. This this can't go on. What you're doing is is inhuman. It's making the situation worse. And they agreed at the end of last in the summer that they would no longer place people there unless we or Springfield supported housing agreed to a case management arrangement. Now since that time, they have failed water tests again, and the motel has been closed out. So we're not dealing with that motel this winter. There are no placements there. So I applaud that. The notion of tears, that there are different levels of need and different requirements, is appropriate because not everyone is the same. When you're dealing with someone who's young and in their thirties and has a car and a phone and a disability income, you may be dealing with someone a lot different than someone who's 75 and has dementia. And I do applaud the fact that this bill mentions the requirement of the need of case management. This is absolutely critical if we're going to change someone's life so that they're not a chronic homeless statistic in the state of Vermont. Having said that, here are some of the concerns that I have. And this may be optics, and I may be misreading the bill, or there's language that's got that that's got, you know, buzzword behind it that I don't get. Mhmm. But there's a prioritization scheme, and the priority appears to be those who are the most capable and the most able to help themselves and the most capable of of working with an agency to fill out a form and and do things like that. And part of me says,

[Rep. Theresa Wood (Chair)]: why?

[Tom Simmons (Executive Director, Neighborhood Connections)]: It's the people who are who are seniors and disabled, have dementia, have physical needs. These are the people who are in most need of support, and they appear to be the lowest priority in the bill. That was my my first concern. Related to that is the state's is the perspective on case management. Case management is critical, but I can't say strongly enough that case management does not mean collecting data.

[Rep. Theresa Wood (Chair)]: Thank you. Section 15 I know. I'd be reading it right now.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Section 15 has 14 subsections of data to be collected. Now I understand the importance of data. I'm an economist by trade. That's actually my background. I get the importance of data. Currently, the coordinated entry app application, which is required of anyone going through the system, is 25 pages long. So question one, are you not getting the data you need from this 25 page questionnaire? And if you're not, if you're gonna add another 25 page questionnaire on top of the seven pages of releases of information, on top of the 10 page Meals on Wheels application, What you've got is a situation where you're doing a lot of paperwork and collecting a lot of data, and that's where all the time is gonna be spent by these agencies working with these people. I've just described what we went through to help these people to get them into housing, and paperwork is not what helped them. Most of the I mean, there's a sense in the bill, and, again, it's it's how I'm reading it, that kind of says, if you want help and you want emergency housing, then you better do case management with us. That's kind of a finger wagging sense I got. Most of the people I work with don't have an objection to doing case management if it's actually gonna lead to a change. But what's their experiences have been is that they answer hundreds of questions all the time, the same questions, and nothing changes. It's the same thing over and over. I was reading section five where there's a requirement that for the the high barrier shelters, the most capable people, that the case management to to client ratio had to be no greater than 25 to one. And for the low barrier, which was the the those with lower capabilities, the case manager ratio was 35 to one. First, that's entirely reversed. Those with greater needs need greater case management. Those who are fairly capable can operate a phone, can operate a computer, they need less handholding. It's the folks who absolutely need the handholding, who need their diaper changed, who need someone to walk them through a situation that they don't understand, who can't work a microwave. They need the case management. Why is the ratio reversed? And quite frankly, either ratio is completely unrealistic. It's absolutely completely unrealistic. There's no way 35 case managers are gonna work with or or one case manager is going to work with 35 people who have this level of need. We dealt with 20 at a time, and the entire office was full time, triaged, on deck, seven days a week, because there was no other way to do it. And that's why part of me says, is the thought process that case management is simply gonna be fill out a a bunch of forms, and then you're done with that person to to collect data. I noticed in section 17, the appropriations section, there's $10,000,000 for the program. That program seems to include data collection, data input, and maybe case management. There's really nothing specific designated for case management. So let end, and I'm more than happy to take questions, by saying what I'm responding to is my experience actually working with these folks on the ground. My experience is that the regional agencies that almost always get funded by the state, whether it's a CAA, a AAA, a housing agency, for whatever reasons, and it's not a criticism, they don't have the capacity or the ability or the directive to provide real case management, especially in the more rural areas where it's not happening. If they're supposed to, it's not happening. HCRS, another agency, again, I respect them greatly. They wouldn't go to Magic View without a police escort and two staff able to do so. They did so once last year. And a lot of these people had mental health issues as well. And they and that was because of their fear for the for the the crime. One of the things I noticed in the bill is that, I think it's tier 2A, it combines those who have disabilities with those who have long term recovery problems as a single tier. I don't know if that means the housing facility for both of those populations would be the same, but if it is, I cannot imagine a worse combination than to lump those two together. Three of our disabled seniors at Magic New in one season have their rooms broken into, were beat up, one had a shoulder dislocated because there was and it's usually a very small number of people, but they're there. There were, violent people placed in the motel who had substance abuse issues who needed to rob in order to support their habit. The easiest person to rob is an elderly disabled person who you think or you hope has Social Security, on a or a debit card that can work or something like that. Three of them were beat up. One of them was bloody, didn't have a phone, couldn't call 911, so they ran out into Room 11 waving cars down to get a trip to the hospital. So I will end there. I'm more than happy to take questions. But these are real people to me. I know who had a, you know, when a daughter who committed suicide and caused a downward depression spiral, which caused that person to be homeless, and they were chronically homeless. I know who was a victim of domestic abuse but didn't go through the domestic violence program but instead lived in a tent for two years. And they can be helped, but they need the case management to do it. And data collection is not case management. I'll stop there.

[Rep. Theresa Wood (Chair)]: Yeah. My colleague here just said this very powerful testimony and the experiences of hearing, one, you're on the ground. All I can say is thank you, really, on behalf of those people who hopefully thanked you, but even if they weren't able to thank you, they appreciated what you and all of the volunteers and the folks that you had built in your community to help serve them. I know that they appreciate it and we certainly here appreciate it. And you provided some really constructive information for us and really also helped us to see the vulnerabilities of people. One of the things that we hear some of, but we don't hear often enough from are the folks like yourself, sort of, you're a formal organization, kudos to all the people who donate to you. They're getting their money's worth. But you're also doing the work that the state charges other people to do. And frankly, pays

[Lily Sojourner (Department for Children and Families, Emergency Housing/GA)]: for them

[Rep. Theresa Wood (Chair)]: to do. Mhmm. It just it highlights a real weakness. And I will say, just so you know, don't be surprised. I sent an email while you were talking to the commissioners and deputy commissioners who are responsible for all of the services that you were talking about. And I said, you really need to watch this testimony. So you may be hearing from those people. I don't know. And I have honestly never done that before. And so, said you were nervous, but you had nothing to be nervous about. Delivered very compelling testimony that was very helpful for us to hear. So let me just open it up to see if there are any questions. My questions aren't for you, frankly. My questions are about the systems that failed these people and failed you and your organization in trying to help them. Go ahead, representative.

[Rep. Jubilee McGill]: Yeah, so I understand Mountain View is not being used this winter, but I am in the capacity that you're still working with these folks. We hear a lot from the departments or the various departments involved that they have people out. They're doing services. And you're not the first person to counter that. And so this really isn't a question for you. But I guess, are you seeing that? And then I think I just had an moment from your testimony, your words that this case management and services that we hear about, that were asked for more funding for physicians for, I'm guessing it's probably data collection rather than case management. And it brings me back to conversations we've had in the past about the renewals and the bars. So are we creating more positions, spending more money on data collection that we're creating ourselves in our yes, for VOE as a state versus actually spending it on people doing the services, direct services with clients. So question for all of us, but just what are you seeing in terms of department support and services on I the

[Tom Simmons (Executive Director, Neighborhood Connections)]: will say this. And again, I'm not complaining about what Springfield supported housing and have been incredibly supportive of us to the extent that they are able. In fact, both of them went to was, commissioner Gray or associate commissioner Gray at the time, and they complained with us that money should be flowing to us. There was there was $27,000 in ERAP funds left that Sevka had, they subcontracted with us to do the work. But if you're in Springfield and you're dealing with an overwhelming problem in Springfield, you're not sending a case manager forty five minutes out to Londonderry to start their day to work with a handful of people. If it I mean, there's an opportunity cost for them. So the bottom line is the whole reason neighborhood connections began seventeen years ago is because the mountain what we call the mountain towns couldn't get the services. It just it I we had one case manager from Senior Solutions who came out to work with us during this period of time. He was the only person from Senior Solutions who stepped foot, you know, into into Londonderry in that area. She came because I had worked there before, and I begged her to come. And, you know, she would come and help us with five clients at a time in our offices. I actually tried to beg her to move her office to embed her in our air in our office, which it it is a total other subject, but but is ripe for discussion. HCRS couldn't come out. SEVCA never came out. And it's just a it's just a jurisdictional black hole where we are.

[Rep. Jubilee McGill]: Yeah. Lots of those.

[Rep. Doug Bishop]: Yeah.

[Rep. Theresa Wood (Chair)]: Thank you. Other questions? Go ahead, Paul. And I'm sorry. Dan is in front of you. Go ahead, Thank

[Rep. Daniel Noyes (Clerk)]: you so much for your testimony. And I can only agree with our chair that I also would have told the commissioners they should probably watch your testimony, but she beat me to it. I really appreciate your framing of having to first establish personhood where someone has been living outside and now the first step really is to figure out like their IDs, how

[Rep. Golrang “Rey” Garofano (Vice Chair)]: do we

[Rep. Daniel Noyes (Clerk)]: establish that level of just, like, you can't go anywhere until you have all of this. And I really appreciate you kind of bringing that up and really talking about that.

[Tom Simmons (Executive Director, Neighborhood Connections)]: You can't do a snap application without some form of ID. So every application that you can imagine that would help someone. It's like, just fill out these forms, call this office. You can't even start until you've done the personhood.

[Rep. Daniel Noyes (Clerk)]: And so I guess my question is we often hear that in order for someone to move into residential care, When they're coming from homelessness, there needs to be some support for them before they get to being successful, even just living in a res care or a nursing home or whatever. And I was wondering if you could talk about any work you did, like preparing people who are coming out of not having, or if you even saw it a problem of not having to Is there any I'm just trying to, sorry. Why don't we reset? Did you have to provide support to individuals coming from a hotel into assisted living or nursing homes or anything. What what when what does that look like?

[Tom Simmons (Executive Director, Neighborhood Connections)]: That is extremely labor intensive, extremely labor intensive. Because first, you establish a financial eligibility, and some were eligible under choices for care, some were not, some went through community Medicaid, where 85% or something of their of their income has to go to pay the facility. So there was a lot of financial work and application work that way. Then there was the clinical aspect of that. You have to be shown to be clinically eligible for Medicaid. One of the issues there is that is at least in Vermont, at least with the personnel we were dealing with, Mental health was not considered a clinical eligibility issue. It had to be physical. And because the person who did the clinical review met this one person before and thought that they were just not taking care of themselves, they rejected her three or four times. We still got her out of it through community meditate. They also got to move. Someone's got to pack them up. Someone's got to put them in a van. Someone's got to take them to the to the location. That's not something that, you know, an ambulance company or a rescue company or an assisted living home does. We had to do we had to do that labor. And we did, and we did it gladly.

[Rep. Theresa Wood (Chair)]: Okay. I I just wanna interrupt just

[Rep. Esme Cole]: for a minute

[Rep. Theresa Wood (Chair)]: because we're we're getting short on time. Sorry. No. No. That I wanna follow-up on your question. I I think representative Noyes is really specifically referring to we hear from the Department of Disabilities Aging and Independent Living that the folks who are homeless, who come into these facilities, need a whole bunch of extra support the facility. So if one of the people, let's just say one of the people that you moved and found a place for in res care, were you ever then contacted back by the facility saying, you know, we need we need extra support here, extra staff in order to be able

[Tom Simmons (Executive Director, Neighborhood Connections)]: to support It did happen to one of our other 10 clients that we placed. And we knew he was prone to to yelling outbursts.

[Rep. Jubilee McGill]: Uh-huh.

[Tom Simmons (Executive Director, Neighborhood Connections)]: He was not violent in any respect, but he presented as violent and scared those in the

[Rep. Esme Cole]: Scared other people,

[Tom Simmons (Executive Director, Neighborhood Connections)]: yeah. And they ended up moving him to a psychiatric facility, and he's still there right now. Okay. I

[Rep. Theresa Wood (Chair)]: But by and large

[Tom Simmons (Executive Director, Neighborhood Connections)]: By and large, the others are are still where we place them. Yeah.

[Rep. Theresa Wood (Chair)]: Yeah. Thank you. No. That that that's what we would you know, we're trying to sort through the wheat and the chaff and trying to get to what's real. So thank you. Representative Cole, and representative Cole will

[Rep. Esme Cole]: be the last question. Thank you. You. Thank you. I yeah, just echoing, as our other representatives said, this is the missing piece I think that we have been waiting for for a while in many respects. Clearly the headliner to this discussion has been integration of real case management is the missing piece to long term sustainable solutions. And I think, you RevPar2, you recognize that and respond to the bill. In terms of, so next week we start markup of the language precisely. So in terms of what is going to be required in the language in order to best carry out that mission there. And we have a couple options, of course. We can really tighten up the language about, like it is a mandate for these specific agencies to be in the community physically interacting with the folks affected. But then there's also the financial piece. And obviously, you can act only to the extent of how you're financed to act. Even though some people clearly do a lot more with money than others. I don't, not to be rude or anything, but like you said, you have pinched every penny and it takes a lot of heart and character. But I think the point of my question is, are well suited to do this work, maybe not from a financial standpoint, because of who you are, because of the way your organization works, because of the proximity, locality to the people, right? Like physically too. We know there's a transaction cost associated with travel to Springfield and elsewhere too. So in terms of money and shuffling things, like who are we to mandate does this very, even if we have suggested it before, like the AAAs, you should be there with people who need your services. In our real language, who do you think we should be? Should it be you? Should we be trying to funnel more resources directly into you?

[Rep. Doug Bishop]: Should it

[Rep. Esme Cole]: be these state agencies, So you know, right

[Tom Simmons (Executive Director, Neighborhood Connections)]: I know.

[Rep. Esme Cole]: I mean, in an instant, if that was quite impactful.

[Tom Simmons (Executive Director, Neighborhood Connections)]: I think the reality is there are a lot of small organizations in Vermont that are local, that are doing incredible on the ground work, and they are usually shut out of the system because the Vermont approach is Yeah. If you've got an issue, you know, if you wanna fund something for older folk, give it to the triple a. Yep. If you wanna fund something for, you know, social and low income people, Send it to the CAAs. Yep. You I mean, this is just the standard approach. And there are a lot of senior centers, community centers, organizations like CIDR in the Champlain Islands. See, I even know things in the that are doing this kind of work, but we're we're outside the system.

[Rep. Theresa Wood (Chair)]: Okay. Thank you. Thank you very much for that.

[Tom Simmons (Executive Director, Neighborhood Connections)]: Thank you very much. I really appreciate it.

[Rep. Theresa Wood (Chair)]: Very insightful testimony and making your way up to it really was, I know it takes a lot of effort to get here in the building, but I can tell you it makes a big difference. So I appreciate you taking the time to travel to Waterbury to be here. Mean, to help the volunteer.

[Rep. Daniel Noyes (Clerk)]: Thank you very much.

[Rep. Theresa Wood (Chair)]: Thank you. Okay. Alright, committee members. We have witnesses coming back at one. So, sorry for the