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[Jessica (DAIL senior official/lead presenter)]: 48. 48. Right. Okay. Yeah. We had a page somewhere between my
[Theresa Wood (Chair)]: Okay. Welcome welcome back, folks. We just returned from a brief break, and we're now diving into the dollar figures that we're looking at for the Department of Disabilities Aging and Independent Living. So thank you for sticking with us, and thank you for, again, putting up
[Jessica (DAIL senior official/lead presenter)]: with all of our questions. Appreciate it. Thank you. So this is the Bowen Commissioner of Dale. So at the top of page 48, we'll see the total proposed budget of 829,747,105. The percentage breakdown by funding sources, 4.7% for general fund, 88.2% for global commitment, 6.5% federal funds, and less than 1% of the special and interdepartmental fund.
[Theresa Wood (Chair)]: I think that's a really important point. I just want to highlight for members of the committee, that, you know, when, we look at GF only, it's a very small percentage of the Dale budget. So when we concentrate on what's happening at the federal level, has big impacts, in particular, in this department. So whether that is through Medicaid, whether that's through the Older Americans Act, whether it's I'm losing the name of the federal thing for
[Jessica (DAIL senior official/lead presenter)]: hireability. It's VOE right now. VOE. We owe a, right?
[Theresa Wood (Chair)]: It's just highlighting for folks that when you lose a dollar of general fund in this program for in this department, you are often losing $3 because of it being matched with other federal funds. So and highlighting for us the importance of understanding at the federal level what's happening.
[Jessica (DAIL senior official/lead presenter)]: I appreciate you saying that, which is why I mentioned earlier that we are very grateful that we haven't been impacted directly in this department yet. There are certain aspects, like when the government shuts down survey and certification, can't do their federal, unless it's emergent, they can't do their federal surveys. They can do their state surveys.
[Theresa Wood (Chair)]: There are things like that,
[Jessica (DAIL senior official/lead presenter)]: or some money flow for hireability, for example, could be impacted. But as of now, we are not having a funding flow issue at this department. We did have some
[Theresa Wood (Chair)]: possible reduction to money follows the person, so we're looking at that. Can I ask about that just went out of my head? Money follow it wasn't money follow-up
[Jessica (DAIL senior official/lead presenter)]: person. Medicaid.
[Theresa Wood (Chair)]: Alright. It'll come back, and I'll I'll it'll probably be at the most inopportune time. Whenever we'll
[Jessica (DAIL senior official/lead presenter)]: pivot right to it. Sorry. So now what is below those total proposed budgets?
[Theresa Wood (Chair)]: Sorry. Representative Noyes had a question.
[Daniel Noyes (Clerk)]: Sorry. I just had a quick question. We were just talking about the potential waiver that we're reapplying to. So under global commitment, the 88% of the budget, what percentage of that would be considered under that waiver?
[Jessica (DAIL senior official/lead presenter)]: Right. So I'm going to request that you reach out to Medicaid policy on that and Diva and stuff. But I tell you that there are certain parts of the budget that are tied to more sort of mandated services that may have been subsumed under eleven fifteen but have other kinds of standing and others that are less. We have been looking as part of Medicaid leadership responsibilities at what could this look like. So there's some work already happening on that, even though the eleven fifteen is still you have to start planning a fair amount in advance, so it's still good through. I think it's two years, Dylan?
[Bill (DAIL finance/budget official)]: Our waiver goes to the 2027 at Dylan Fraser Agency of Gift Cards.
[Jessica (DAIL senior official/lead presenter)]: Right, so it's not till '28 that it would But we have to renegotiate. It's FY '28.
[Daniel Noyes (Clerk)]: Yeah. I appreciate that you're thinking about this because
[Jessica (DAIL senior official/lead presenter)]: So much. Me too. So much thinking about this. Right. Okay. So the breakdown then. For developmental disability services, the proposed budget is just under $368,000,000 It's 44% of Dale's total budget, and you can see the fund split there with, just to your point, really, Cherwood, it's 97% of the total is the global commitment money. The adult services division is 403,614,407, which is 49% of Dale's total budget. So you see what we've just done is captured most of Dale's budget between developmental disabilities and the adult services division. Similarly, in the adult services division, most of it is global commitment at 93%, but you see the slightly higher federal, which is from OAA. Vocational rehabilitation or hireability is, just under $36,000,000 and you can see that a good portion of that is federal. 76% of that comes, directly, and 24% is general fund. Similar breakdown for blind and visually impaired, a little under $6,000,000. And then licensing and protection is just under $8,000,000 and that's, more of a split between general fund and federal. The commissioner's office is 8 and a half million. In that case, it's mostly general fund, but it's approximately 1% of the budget. And so our total then comes back to the 829,747,105. Any questions on the breakdown? Okay, on the next page, what we're going to see here is the difference between last year's budget and this year's budget. So the total change between state fiscal year '26 and state fiscal year twenty seven's recommended budget is just over $31,000,000 So it's $31,346,555 difference. Total department. So if you break it down by the different sections, it's the administration and support. The fiscal year base appropriation was 55,517,792. The proposed changes are salary and fringe related at, 5,800,000.0. And you can see the splits underneath that, so you see how much of each type of funding source, attributes to that increase over last fiscal year, and that comes to 61,383,402 for the administration and support portion, an increase of 61,000,000 over last year's. And I mean, the total for '27 with the 31,000,000 increase.
[Theresa Wood (Chair)]: Different departments are doing this differently. All staff positions are in administration and support. Is that right? Yes. Okay.
[Jessica (DAIL senior official/lead presenter)]: So just so that I'm 100% clear, it's 55,500,000 more for administration and support over last year, which brings administration and support to over 61,000,000 for '27, and yes, on the physicians. It's not 55,000,000
[Theresa Wood (Chair)]: more. That was what you started with. That's what we started with. Yeah. Okay. It's 5.8.
[Jessica (DAIL senior official/lead presenter)]: It's 5.8. I'm sorry. It's 5,800,000.0 more.
[Theresa Wood (Chair)]: So are there any changes in positions? So are there any reductions in the number of positions? Are there any increases in the number of positions in this budget?
[Jessica (DAIL senior official/lead presenter)]: So the increase was from last year's increase for the conflict free case management. There were five new positions. Three were quality management positions, two were data analyst positions. There was one position that was absorbed for just efficiencies, and there were some limited funding positions. Funding. Ended. So
[Theresa Wood (Chair)]: it would be helpful to know how many positions what's the net change in positions? Four. Four. Okay. Thank you.
[Bill (DAIL finance/budget official)]: And down by four. Down by four.
[Theresa Wood (Chair)]: And were those in any particular, I mean I'm sure they were in particular places, but I mean were they an admin, were they in programs? So admin positions,
[Bill (DAIL finance/budget official)]: but mainly the larger reduction was limited service positions related to APS. This was
[Jessica (DAIL senior official/lead presenter)]: expected address and where it would be addressed and is not having an overarching impact on services provided.
[Bill (DAIL finance/budget official)]: I would say an increase of one in a classified position, period of OPT.
[Theresa Wood (Chair)]: So there is an increase So it's to what? Of Public Guardian. So there's a it's a net decrease of four? Correct. Okay. But there was one new position in OPG. Is that is that a direct service? A direct service A guardian.
[Jessica (DAIL senior official/lead presenter)]: A public guardian. Okay. These the new positions that were haven't actually come on board. Some of them have two of them have come up three of them of the five have come
[Theresa Wood (Chair)]: on board. Okay. Much from FY 26 appropriation. Right?
[Jessica (DAIL senior official/lead presenter)]: Okay. Did you have something more, Bill?
[Bill (DAIL finance/budget official)]: So related to limited service positions, there's a constant churn even after this budget is finalized, so I'm not sure which ones you're referring to. Right there, but
[Jessica (DAIL senior official/lead presenter)]: When we talk about the three, it's the five positions that were approved for the connection with conflict free kids' mind.
[Bill (DAIL finance/budget official)]: Okay.
[Jessica (DAIL senior official/lead presenter)]: That's the ones I was talking
[Theresa Wood (Chair)]: I'm talking about he's talking about the reductions, I think. I I understand the that we did last year. I was just looking to see so those are annualized in this budget as well as one new public guardian.
[Bill (DAIL finance/budget official)]: And those increases related to P2P grant limited in service physicians.
[Theresa Wood (Chair)]: P2P, partnership, waste ownership. That's the higher ability
[Jessica (DAIL senior official/lead presenter)]: and DBVI vocational work with transition aid. Okay, if we go on to the adult services division, we will see that for 2026, the base appropriation was just under $25,000,000 The proposed changes for this year is $1,000,000 due to the underutilization of Adult Day. We talked about that in BAA. Is a that
[Theresa Wood (Chair)]: buffer so that if things started to increase?
[Jessica (DAIL senior official/lead presenter)]: Federal revenue, that was a zero. That was what moved from one as a technical reconciliation. The budget to actuals adjustment was $3,350,000 The total changes for the Adult Services Division was $2,350,782 which brings our state fiscal year '27 recommend to 27,260,274 for
[Theresa Wood (Chair)]: the adult services division. We have a question from.
[Daniel Noyes (Clerk)]: Just quickly on the adult days. We had set some money aside to help stand up adult days in areas where they close. And I was wondering if that money is still there and we can talk about where it's going. I was just more on the money thing. It's there's still money available for someone to start in Rutland or
[Unidentified DAIL official]: That money was appropriated a couple of years ago, carried forward. It's being used via a grant to the organization that's working to stand up the Multigenerational Adult Day in the area.
[Daniel Noyes (Clerk)]: So that will close that out or is there Okay. So there would be no money for the other areas that closed. And there's no plan right now that's on the table or a proposal
[Jessica (DAIL senior official/lead presenter)]: for that. So it was
[Daniel Noyes (Clerk)]: for anybody either. Or are you?
[Jessica (DAIL senior official/lead presenter)]: What? Are we looking for somebody to open up another areas that are underserved?
[Unidentified DAIL official]: I would love for someone to open up another area. If if anyone came forward as interested, we would wanna work with them. Sure.
[Jessica (DAIL senior official/lead presenter)]: We do think it's an important part of the continuum. It was just the extra money here. So that
[Daniel Noyes (Clerk)]: because I originally thought it was for three originally.
[Unidentified DAIL official]: It was, but it it was, up to three, right, in those areas where they had closed, but we only
[Jessica (DAIL senior official/lead presenter)]: had one come forward. Bill?
[Bill (DAIL finance/budget official)]: So I have to apologize to the committee and correct testimony on the positions because I pulled up the wrong file, sorry. So from last year to this year, it's an increase of eight positions, all limited service. One in Money Follows the Person, four APS, one VR counselor, and I'm pretty sure that's related to, it's a limited service related to Manifest person, EAP counselor and a VR counselor. So it's an increase of eight limited service from 26 to 27. I apologize.
[Theresa Wood (Chair)]: Okay. So there's no net decrease of No. Okay. Cross that out. And there still is an OPG position? That wouldn't be limited service.
[Bill (DAIL finance/budget official)]: Addition last year.
[Theresa Wood (Chair)]: So That was last year.
[Bill (DAIL finance/budget official)]: Scratch that.
[Theresa Wood (Chair)]: Scratch that. Okay.
[Bill (DAIL finance/budget official)]: All
[Theresa Wood (Chair)]: right. Rewind. I'm just scratching it off of my list of asking Bill whoever. So they're always good service positions in various areas. Yes.
[Bill (DAIL finance/budget official)]: Increased rate.
[Theresa Wood (Chair)]: Okay. Got it. Thank you. Most limited service. Yeah. Okay. I have a question about what exactly does budget to actuals adjustment mean,
[Jessica (DAIL senior official/lead presenter)]: that 3,300,000.0? Wanna answer the budget to actuals?
[Bill (DAIL finance/budget official)]: Okay, Chuck, about those positions.
[Jessica (DAIL senior official/lead presenter)]: So we're in adult services number three.
[Bill (DAIL finance/budget official)]: So throughout the ups and downs, you'll see some various corrections by fund to spending authority. For example, federal fund, we have no decreases in federal funds from a federal grant point of view, but reconciling the spending authority needed in those funds is what that is. I
[Theresa Wood (Chair)]: guess what I'm trying to get at is it's not actually new
[Jessica (DAIL senior official/lead presenter)]: money.
[Bill (DAIL finance/budget official)]: No. Okay. Vice versa. If it's a down, it's not a
[Theresa Wood (Chair)]: It's not actually a decrease.
[Jessica (DAIL senior official/lead presenter)]: Yeah. Okay. Suggesting spending authority in the federal. Okay. Should we go
[Unidentified committee member (possibly Anne B. Donahue, Ranking Member)]: on Well, to I'm trying to follow-up understanding that now. So the increase in the base from 24.9 to 27.2 despite a million dollar cut is based on these technical changes, the budget to actual adjustment and reconciliations. No, there is no reconciliation.
[Bill (DAIL finance/budget official)]: So yeah, we're earning more federal than what the 7.3 base spending authority in that fund would allow. So I'm increasing the spending authority need in the federal fund to 10,500,000.0 because that's what we're earning in federal funds.
[Unidentified committee member (possibly Anne B. Donahue, Ranking Member)]: So the increase has to do with the balance between state and federal not an actual program money increase
[Jessica (DAIL senior official/lead presenter)]: of that amount.
[Bill (DAIL finance/budget official)]: Correct, in a given year we can adjust federal fund spending authority by doing an excess receipt request. So earlier it was asked if something was going to be in BA, I forget what the Another alternative to that is doing an excess federal receipt request. Rather than doing that paperwork, I'm increasing the base need here so we don't have to do that paperwork on the side and be more transparent of what we're actually earning in federal funds.
[Jessica (DAIL senior official/lead presenter)]: Thank you. Okay, so then we're going go to blind and visually impaired grants, and there's no proposed changes from last year's base appropriation of $3,400,000 Vocational Rehabilitation Division, which is higher ability, is next. The twenty sixth base appropriation was just over 10,000,000 There's an interdepartmental transfer, of a little over 1,000,000 budget to actual adjustment of a little over 1,000,000. And then this is the 875,000 for the opioid recovery employment program. So then the total change is $840,000,000, and that brings us up to 11,000,000 for state fiscal year '27. Any questions on the technical stuff? I'm sure Bill can answer
[Theresa Wood (Chair)]: them. Go ahead, representative Bishop.
[Doug Bishop (Member)]: I'm just trying to make sense of some numbers. On the previous page, there was broken out by division and Voc Rehab was in at about 36,000,000.
[Bill (DAIL finance/budget official)]: That includes the administrative portion of VR. So you're looking at the VR grants only in that section. Okay. Correct. Okay, thank you.
[Jessica (DAIL senior official/lead presenter)]: Okay, and again, we're looking at the changes in where, right, so the next page has developmental services grants appropriations, and last year that was just under $350,000,000 Now we're looking at DSK caseload pressures, which is $6,600,000 in DS case load pressure for this year, 3,300,000.0 in Public Safety Act two forty eight case load pressures, and then Internal Service Fund. This is a commercial policy workers' comp premium increase of $8,000 There's an Can I
[Theresa Wood (Chair)]: just back up for a second? What's the estimate on the number of people under DS case load and Act two forty eight public safety?
[Bill (DAIL finance/budget official)]: So So I looked at that based on your earlier question. So the three year average compared to last year to this year has gone down by about 20. That's a three year average. It's pretty flat. So to answer your question exactly, give me a second to make sure I hit it right. Three zero seven and nineteen for public safety.
[Theresa Wood (Chair)]: Okay, thank you.
[Jessica (DAIL senior official/lead presenter)]: Okay, the ARRIS payroll benefit withholding percent reduction is, again, no impact on consumers or on providers. This is just additional money for benefits that was held in Aris' account that was not used, so we pulled it
[Theresa Wood (Chair)]: back in. Does that mean that they had excess withholding? Did they withhold too much from people's pay? I'm a little confused. I don't really know what this is. Yes,
[Bill (DAIL finance/budget official)]: the rates were higher than what was needed.
[Theresa Wood (Chair)]: Than what was needed.
[Bill (DAIL finance/budget official)]: Over the years. So we're utilizing that funding to lower the impact.
[Daniel Noyes (Clerk)]: Okay.
[Theresa Wood (Chair)]: And is that all of what they've been holding out there or more out there?
[Bill (DAIL finance/budget official)]: There's more out there. It's not really like a base reduction, but enough there to make it a base for a while.
[Jessica (DAIL senior official/lead presenter)]: That's my question. Yeah. So we didn't zero it out or anything because they still might need it, but it was enough that we could bring some of it back in and avoid any other kind of cuts that we might do that could potentially have had an impact on. I appreciate that. Budget to actuals, adjustment of, almost 17,000. That's interdepartmental transfer funds, disability rights with DCF and DMH. Budget to actual adjustments federal fund, that's another technical at 203,573. The ARCH program ended, and funds were returned to Dale. That's in AHS net neutral with ZMH. Integrating family services ended, funds returned to Dale, again, AHS Net Neutral with DMH. Then Integrating Family Services ended, funds returned to DCF on deposit with Dale at 200,000. So the total changes is 8,184,001, which brings our 27 recommend to 358171468. Okay, we move on to the brain injury program. Our PACE appropriation in '26 was 7,500,000.0. There are no changes to the brain injury, So we're coming in '27 at 7,500,000.0.
[Theresa Wood (Chair)]: So is there no caseload increase there or the caseload decrease is being or any increase is being offset by people who leave the program or?
[Bill (DAIL finance/budget official)]: The current utilization is under appropriated, so if the program, which you can speak to, but even if there is increased utilization, there's enough room in the appropriation.
[Theresa Wood (Chair)]: So the current program is being underutilized?
[Bill (DAIL finance/budget official)]: Correct. Is that what you're From a expense point of view.
[Theresa Wood (Chair)]: Okay. And is that so is there a carry forward from FY twenty five and six
[Jessica (DAIL senior official/lead presenter)]: expected? No. Okay. But if it's being underutilized, it seems though there would be?
[Bill (DAIL finance/budget official)]: Well, not every corporation works like Choice for Care. Okay. So there could be.
[Theresa Wood (Chair)]: It'll be. There could be an underutilization at the end, but it is probably going to go to the AHS bottom line. That's what you're telling me.
[Bill (DAIL finance/budget official)]: Unless caseload starts increasing, see the need to carry forward for this purpose.
[Theresa Wood (Chair)]: Okay. Do you have anything else you want to add?
[Unidentified DAIL official]: I would say that there's a good chance of this year that we will see more utilization just with the case management organizations, Benchmark and Columbus coming on through profit and case management working to the hearing with those folks so we could see more utilizations there.
[Theresa Wood (Chair)]: Go ahead, Doctor. Septal. What is the current caseload?
[Bill (DAIL finance/budget official)]: I can give you a second, nineteen fifty. Okay,
[Unidentified DAIL official]: It's typically under 80.
[Daniel Noyes (Clerk)]: Okay, under 80?
[Unidentified DAIL official]: I thought that I saw 72 recently, but Bill will help us. Just
[Daniel Noyes (Clerk)]: along those lines, what would be the capacity at this funding level?
[Jessica (DAIL senior official/lead presenter)]: How high can you go?
[Theresa Wood (Chair)]: Come on. You can go. You can do it. You can do it.
[Bill (DAIL finance/budget official)]: If you give me a second, and you can get back.
[Jessica (DAIL senior official/lead presenter)]: So we'll let them think. I don't want to go forward with the numbers. Yeah, all right, we'll give him a second. I don't want to go forward with the numbers until I have Bill paying attention. Do you know what the program capacity is?
[Unidentified DAIL official]: I think that's a tricky question to answer without a calculator and a spreadsheet.
[Jessica (DAIL senior official/lead presenter)]: Yeah, my
[Bill (DAIL finance/budget official)]: guess is there's probably 15 more. Yeah,
[Jessica (DAIL senior official/lead presenter)]: That makes sense to you. Okay. We have consensus, money, program, money, program. Okay, great. So we're moving into choices for care now. So the twenty six's base appropriation was $346,000,000 or almost $347,000,000 Nursing homes, inflationary increase is, just under 5,500,000. The nursing home Medicaid day pressure is 9,600,000.0. The home and community based caseload pressure is a little over 1,000,000. And then another pullback on ARRIS in this, service line. And then the total changes is 14,100,000.0, which brings which 27 recommend to 360,963,717.
[Theresa Wood (Chair)]: I'm just looking at
[Bill (DAIL finance/budget official)]: the
[Theresa Wood (Chair)]: ARRIS benefit, which and the DS one, and you're saying that there's still quite a bit more money left out there. That that's a lot of money.
[Jessica (DAIL senior official/lead presenter)]: Yeah. I can build it slowly over time, and it was a And there's still more out there. That's the k. Well, what's out there now is more like what would you would want to have out there for the purposes that's intended. Uh-huh. We'll keep it I think we'll keep
[Bill (DAIL finance/budget official)]: a close eye on it.
[Daniel Noyes (Clerk)]: Go ahead, representative. Do you ever put EFR here to plan? I mean, are you foreseeing any need for EFR in 'twenty seven?
[Jessica (DAIL senior official/lead presenter)]: That comes up at every budget meeting and every sort of BAA, right? The same question. There's a rationale. There's rationale to having the BAA. You don't know how much it's going to be. Not baseline money.
[Bill (DAIL finance/budget official)]: When you think about that line item, ago we had 1,500,000.0 in the base when that was an annual EFR pressure. And if we didn't use it for that it would go to a community base or wherever in the appropriation. And in recent years as you know it's increased substantially, and we hope we know it's decreasing and we hope it decreases substantially again. So yes, it's a B. A. Again. And to answer some of your TBI questions, there's room for 92, there's 76, average cost of 70 some odd thousand per Thank you.
[Jessica (DAIL senior official/lead presenter)]: In these choices for care line items here, some of the questions were answered directly on the screen.
[Theresa Wood (Chair)]: Can I ask a question about ARRIS or not ARRIS in particular, guess, but where are we in terms of extensions of contracts or for the payroll service? And they at the end of a contract? Is that going out to bid? Is there
[Jessica (DAIL senior official/lead presenter)]: It went out to bid, and they were awarded. Okay. So they're at sort of the beginning of the next run period.
[Unidentified DAIL official]: Negotiations are going on now.
[Theresa Wood (Chair)]: Okay. And then I have a a question, and I don't want to I don't want to you know, I'm not tipping my toe into contract negotiations for the collective bargaining agreement with people paid via ARRIS. And then I'm trying to remember where I read this, but I read someplace. I can't remember who was quoting you, commissioners, or somebody in the department, that saying you were limited by what the legislature told you to do or something along that lines. In terms of the increase that would be available for people. I don't know exactly who quoted whom, but that was something that appeared in writing someplace last week. I just want to make, I guess, what I would say is a statement to the impact of those individuals on people's lives. And honestly, anything below 20 an hour is an insult to the people providing very direct services. So that's more of a value statement coming from me personally, not from the committee necessarily, but What is covered in that agreement, and those are people providing very direct services to people hands on, day in and day out. And what I read was a summary someplace in Digger or someplace. I don't remember exactly where it was. I'm just encouraging you to really understand through a monetary agreement the value of those people. Think you didn't ask
[Jessica (DAIL senior official/lead presenter)]: me any questions last week.
[Theresa Wood (Chair)]: No, it was something that was somebody might not have been you, maybe in house health care. Did this come up in house health care? I don't really. I read it someplace. I'm sorry. I can't pinpoint it. But is that under negotiation right now? It's my understanding that it is.
[Jessica (DAIL senior official/lead presenter)]: It is under negotiation, so I'm not sure
[Theresa Wood (Chair)]: what you- Yeah, I realize you can't say anything. I'm just conveying to you the work that people are doing and the ability to maintain and retain people is so important, and they're not benefited individuals. And so I would be remiss if I say something on their behalf, I guess is what
[Jessica (DAIL senior official/lead presenter)]: I'm saying. We appreciate that. When the negotiations are done and all that, maybe we can have more of a conversation.
[Theresa Wood (Chair)]: Yeah. Did you have a question, Representative Noyes?
[Daniel Noyes (Clerk)]: Yeah. Back on the choices for care. We're just wondering about any sorry. Are you planning for any increases in, like, ACCS or ResCare? That would be under this, correct? And as we're looking at our GA housing and just trying to provide a more stable housing for individuals who are homeless, That might be an option for some people, and we can see the number of individuals 65 that are in GA housing. Is there any planning for that to be increased, if that's a workable solution for those individuals?
[Jessica (DAIL senior official/lead presenter)]: First of all, wanted to say something that I think is important to say that, and I've talked about the instability in the long term care continuum and are concerned about that, but the residential care homes and the assisted living are an important part of this community home. And some of them have closed this past year, but new ones have also opened this past year. And we've netted increased residential care home beds. We are actually
[Theresa Wood (Chair)]: First time in a while.
[Jessica (DAIL senior official/lead presenter)]: That's why I wanted to highlight it.
[Theresa Wood (Chair)]: It might have something to do with rate increases that we provided, I'm just saying.
[Jessica (DAIL senior official/lead presenter)]: It could be. I think the plan for that might have proceeded, but it certainly doesn't hurt. There is Bill, you speak to the $1,000,000 home community based caseload pressure on line three in choices for care?
[Theresa Wood (Chair)]: 22 people, yeah. It's probably a net of 22, though. As people die and people leave.
[Jessica (DAIL senior official/lead presenter)]: People are going to Right, so some growth. Sure. Did you to say anything to clarify that?
[Bill (DAIL finance/budget official)]: Since the beginning of Choice for Care, really, think the goal was to increase home and community base caseload 30 to 50 individuals a year, as the goal of reaching fiftyfifty in every county in Vermont. So as I mentioned earlier, the current utilization for home and community based caseload is under this year. So to get to the threshold of need 22, we may be on a pace of around 40 from now until, so that gives you context of what's been expected over the years and what
[Jessica (DAIL senior official/lead presenter)]: this represents. So I think it's important to note that this year we have a funding line for that, and there's still some leftover from that pandemic, era money that was put in there. But then next year, think that will be completely spent out, right? So, yeah. At
[Bill (DAIL finance/budget official)]: the beginning of the year, as I mentioned in BAA, I really thought home community base this year was increased, but it hasn't proven to.
[Theresa Wood (Chair)]: So are there any sort of behind the scenes, hidden decreases in any rates? I feel like I
[Jessica (DAIL senior official/lead presenter)]: need to ask that question this year. There were no behind the scenes anything that happened last year. We
[Theresa Wood (Chair)]: Not expecting. Let's just put it that way. I have
[Jessica (DAIL senior official/lead presenter)]: to tell you the moment I saw it, I paused you. You did. Know. That's why you
[Theresa Wood (Chair)]: knew it wasn't legislative intent.
[Jessica (DAIL senior official/lead presenter)]: Well, there's such a more story behind it I learned.
[Theresa Wood (Chair)]: Is there anything
[Jessica (DAIL senior official/lead presenter)]: Not that I'm similar. Anybody producing? Okay. And
[Theresa Wood (Chair)]: likewise, because it hasn't passed the body yet. There would be adjustments necessary if it passes the body because we
[Jessica (DAIL senior official/lead presenter)]: We saw what you've Yeah, okay.
[Bill (DAIL finance/budget official)]: So I would just say, you mentioned the community based rates and that's negotiated as the legislative session goes on and you're alluding to behind the scenes decreases related to rate study, related to the increases that we do put in, and I'm speaking to the wrong committee buckets, it ends up being a last minute add and it is complex. I just, if folks would add that a little earlier because you know to fully understand what rates they are increasing so there is no surprises. That's just the general comment.
[Theresa Wood (Chair)]: Do you want to say something? Had something to say.
[Unidentified DAIL official]: I just, since we were talking about residential care homes and assisted living, last week you had asked me about the total number we had, or I had shared the number that accept Medicaid. Yeah. So we have 81 residential care homes and assisted living that accept Medicaid, 21 that do not, a total of 102.
[Theresa Wood (Chair)]: And accepting Medicaid doesn't mean that all of the beds are Medicaid, just means that some of them are probably Medicaid.
[Bill (DAIL finance/budget official)]: Those are
[Daniel Noyes (Clerk)]: not bed, Those are beds, or are those
[Unidentified DAIL official]: Those are
[Theresa Wood (Chair)]: facilities. Oh, okay. Yeah. Yeah. I'm sorry. Said beds, but facilities. Yeah. Yeah.
[Jessica (DAIL senior official/lead presenter)]: So it is it's not a small segment. It's just that there's some instability in there. See anything Anytime in the long term care continuum close, we have to go in the other. We know that. You're you're aware of us on that. Okay.
[Daniel Noyes (Clerk)]: So this could have been included in that last question that you asked, but I just wanna in the BAA, we increased ERC roughly one
[Jessica (DAIL senior official/lead presenter)]: We saw it.
[Daniel Noyes (Clerk)]: One okay. Is that No. We need to figure out if that's going forward.
[Theresa Wood (Chair)]: No, that's up to us because that change happened
[Daniel Noyes (Clerk)]: It after has already until it's passed inside. Okay. So, right. Just thinking about.
[Theresa Wood (Chair)]: Thinking about our recommendations to appropriations. Correct. Yes. That would need to be annualized because there's only one quarter's worth.
[Daniel Noyes (Clerk)]: And that's not it. Correct. Great. Thank you.
[Jessica (DAIL senior official/lead presenter)]: That concludes that, but I did want to just bring to your attention the back of the testimony, and if you can bring up just the top page that, Rebecca, which would be page 53. So what we have here is all of our programs with the data. It's broken down by who do we serve, what's the program description, and you can see which division they're referencing, the performance measures, and the state fiscal year twenty seven's proposed amount. And so it's a really great reference to go for any particular program question that you might have. How much money for that particular program? What are they, you know, who are they serving, how many people, and if we have some outcome measures, they would be there or satisfaction surveys. I really appreciate that folks put that together, and it's a great way to see everything all at once.
[Theresa Wood (Chair)]: Thank you.
[Jessica (DAIL senior official/lead presenter)]: Go ahead. Oh,
[Unidentified DAIL official]: was just saying, wish we had This is so helpful. This Yeah. Is a snapshot. Yeah.
[Jessica (DAIL senior official/lead presenter)]: Kudos to the Dale team.
[Theresa Wood (Chair)]: Yeah. It's wonderful.
[Daniel Noyes (Clerk)]: So since we're in this back section, if we go to page 56 and look at the Sash program. So this level funds SASH for administrative, but I understand that there was money for a head that was some bridge funding Give me a second. You're about GAP funding? Yes.
[Jessica (DAIL senior official/lead presenter)]: Okay, you're talking about Blueprint? Yes. Blueprint and Sash got GAP funding. Yes. Right? This year, it's not in the budget, the GAP funding. But we're working, or AHS as a whole, with CMS to see whether it's possible to use Rural Health Transformation program funding for that. We're working with Cathedral Square. Okay, what's the
[Theresa Wood (Chair)]: need if for some reason that doesn't
[Jessica (DAIL senior official/lead presenter)]: work out? I would have to get you back.
[Theresa Wood (Chair)]: Okay, So Dan and
[Jessica (DAIL senior official/lead presenter)]: Todd And will be on if,
[Daniel Noyes (Clerk)]: Doug was saying earlier, that there's a this is to be used not in Chittenden County, how will that affect any work that you're trying to do to use that?
[Jessica (DAIL senior official/lead presenter)]: Depends on the conversation with CMS. I won't be able to speak to that right now, but we can get that.
[Daniel Noyes (Clerk)]: As we're working forward, keep coming back to the GA housing and the individuals that are homeless, and I see SASH as one of the abilities to provide that support to these individuals, and we should make sure that the funding is there to support their workforce to be able to have that outreach and case management.
[Jessica (DAIL senior official/lead presenter)]: Yeah, looking forward to hearing. Appreciate that, thank you.
[Theresa Wood (Chair)]: Mean, we continually hear from housing providers the need for supportive services inside housing units, for lots of people, as we've been particularly highlighting, folks who have been unhoused, say transition into housing. Sometimes there are needs that crop up that certainly SASH is one of those providers that would assist with that.
[Jessica (DAIL senior official/lead presenter)]: Thank you for closing the blinds. Until you close them, I didn't realize how badly I needed them.
[Theresa Wood (Chair)]: Don't need sunlight. It's part of our strategy, Jessica.
[Jessica (DAIL senior official/lead presenter)]: I don't know the answer. Always like having a big
[Theresa Wood (Chair)]: light, yeah. The light from disaster. That's great. I'm sorry. Thank you for this background. We, of course, get a bevy of information in the annual report that DD Services Division puts together and have for a long time. So it's really helpful having this in addition to that. So thank you. Yep. Any other questions? Now that we've kept you past your allotted time. No,
[Daniel Noyes (Clerk)]: thank you.
[Theresa Wood (Chair)]: So our Dale team, as you know, is representative Noyes and representative Nielsen. And so they'll be in touch. And just I'm gonna say it again, say, well, for each department that we are I'm leaving it up to the the budget teams to recommend if there are any community partners that we hear direct testimony from. And so those recommendations will be made to the full committee by the budget team. So just so you know, we are likely to hear from some community partners. Anybody have any other final questions, or do the witnesses have any other final comments that they want to make? I am a little old school.
[Jessica (DAIL senior official/lead presenter)]: I mean, I do all my work electronically, but when it comes to, like, this level of conversation, it just comes back to paper for me.
[Theresa Wood (Chair)]: That sometimes is the easiest thing, you know, sometimes. So I like paper. Okay. Thank you all very much for being here this morning. And we look forward to continued discussion as we work through this process. And so we're aiming to have our recommendations done by the February to the House Committee on Appropriations.
[Jessica (DAIL senior official/lead presenter)]: Okay, thank you so much. Thank Thank you.
[Theresa Wood (Chair)]: Okay, committee members. So you will have about forty five minutes. I just want to update folks again. This is the ever changing homelessness situation. So one of the reasons that Eric wasn't here is that he and I and Katie met this morning to sort of like There's an evolution of ideas coming up as a result of all the testimony that we've received, including the testimony that came yesterday from the community partners and the advocates and providers, as well as the discussions that we've had with the agency human services. So I am hoping that we're not going to have something to look at this afternoon. So what we may in fact be doing this afternoon is having some discussion, committee discussion about an idea about where we're headed. And I think it's an interesting idea. Let's just put it that way. But Katie won't have language ready by that point in time. We'll have some discussion about that this afternoon, but then we will move to budget work time for committees to work on budget stuff. Okay? So and that's what you all have available to you right now. K. Thank very much, and we will be back online.