Vermont Legislature SmartTranscripts:

[Theresa Wood (Chair)]: Okay. Welcome back, folks. Continuing our discussion on the FY twenty seven budget recommendations. And we are now moving to Dale, Department of Disability Aging and Independent Living.

[Daniel Noyes (Clerk)]: Right on. And Dan

[Theresa Wood (Chair)]: and Todd. This is Dan in Todd's area.

[Daniel Noyes (Clerk)]: Turn right over to Todd. Okay. So thank you so much. As you've heard, you know, a lot of the work that we've been thinking about around how we do our budget is directly tied to a strong Vermont and kind of our long term plans on how we make Vermont the best place to roll. So looking at the budget, a couple of things have come up that, one

[Anne B. Donahue (Ranking Member)]: of

[Daniel Noyes (Clerk)]: the things is the elder care clinicians looking at mental health services for older Vermonters. There was a $349,763 cut in the budget, which zeroes that out. So trying to figure out how we can continue that program, because as we see this population needing more of these preventative services, we just felt that that's something we would propose to the committee as a potential, something that we would fund. You heard in the presentation yesterday, the services are needed, they are basically piggybacked into other designated agencies that are already providing mental health services. So these are kind of like giving them the funds they need to provide services to older Vermonters, kind of over and above what they're doing with the rest of the population. And these elder care clinicians are working with case management, and the idea is that they're kind of around the state. So these don't pay for direct positions, they pay for existing positions at our DAs to just help offset those costs of providing mental health services to older Vermonters. You wanna have any questions on

[Theresa Wood (Chair)]: How many people are served?

[Daniel Noyes (Clerk)]: I'll have to pull that up, but I don't know if I have that. I have a bunch of tabs open, I might have that one open. How many people were

[Theresa Wood (Chair)]: served? I'm presuming that when Dale was asked why this

[Daniel Noyes (Clerk)]: Under is being utilization.

[Theresa Wood (Chair)]: That it was under utilization. And

[Daniel Noyes (Clerk)]: so, always an interest on how reporting is done, because these are not individuals that are directly employed, the funding comes through the agencies providing that information to Dale, information to Dale through the designated agencies that they provided these services.

[Theresa Wood (Chair)]: So I'm presuming that they record it in the MMIS, not the HMIS, but the MMIS, Medicaid Management Information System, that the agencies are reporting the units of services under this program? I would have to get clarification on that because I do not know. MMIS. Yeah. We'll find out. Just yeah. If we can find out how many people, how many units of service were provided So we can make an informed decision about if we agree with the cut, we know what's happening, what the impact is gonna be. And if we elect to restore it, that we know what the capacity is. Sure.

[Daniel Noyes (Clerk)]: So next, we've talked about bringing to the committee home share. This is, as we heard yesterday, really looking at keeping people in their homes, again, a preventable way to keep people out of assisted living, long term care, whether it's home and community based or nursing home care by just keeping them in their homes to have someone in there who can provide support, companionship, help around the house to be able to continue. In the past, they've gotten one time funding. So this would be a $235,000 reinstatement of the one time funding that they received that is not in the FY '27 budget. And so this is Northeast Kingdom work that they've been doing. And so that will be one of the things that we'll be proposing.

[Theresa Wood (Chair)]: Yeah, that's good. Sorry. Yeah.

[Daniel Noyes (Clerk)]: No worries. Again, home share housing is a big initiative for age growing.

[Theresa Wood (Chair)]: So do you have sources of funding?

[Daniel Noyes (Clerk)]: Not yet. Okay.

[Todd Nielsen (Member)]: I'm hoping.

[Daniel Noyes (Clerk)]: Prevention funds. The problem

[Theresa Wood (Chair)]: Oh, we have tapped the prevention funds.

[Daniel Noyes (Clerk)]: You know, five months allowed.

[Theresa Wood (Chair)]: Prevention funds have been tapped out and no one doesn't even know what else we spent from there today.

[Daniel Noyes (Clerk)]: As you know, the way the budgets are rolled up, there's a lot of line items that some show some pretty substantial increases that are just listed as grants. Looking for a breakdown on what those grants are so we can kinda weigh the where the money is being allocated versus where this committee may decide to allocate the funds. Hopefully I can get that information because I can just see grants and a number.

[Theresa Wood (Chair)]: Well, I think we know how much is appropriated for choices for care. I would see home share as a direct correlation to essentially another alternative to housing there. And so it's a pretty small number. It's something that I think that we could deduct from choices for care. Call it a day and say that's where we're at. Fantastic.

[Daniel Noyes (Clerk)]: Okay. Put that on my list. Thank you. The other thing that we've talked about, Todd and I met with Renee, a deaf blind man who came to the State House and we had a great discussion with him talking about how these interpretive services, his ability to communicate was cut and about 150,000. So we looked at the reimbursement rate that these individuals are given to provide this service. That's pretty technical. It's actually from someone who is lucky enough to have my sight and my hearing, interesting to communicate with someone who goes through these interpretive sign language in their hands, So, which is yeah, so again, quite a small amount to be able to provide services to this population.

[Todd Nielsen (Member)]: Todd? In our meeting with the individual, people who do help math only pay $21 an hour, it's part time, they gotta be trained, and they get no gas reimbursement. He likes to go, he might I think he might he's in Waterbury, right?

[Theresa Wood (Chair)]: Yeah. Yes, he does.

[Daniel Noyes (Clerk)]: And he

[Todd Nielsen (Member)]: the best. He loves to go into many things. That's like a six hour thing, going to the event and everything else. And $21 an hour to find somebody trained is kinda hard in my world.

[Daniel Noyes (Clerk)]: And so one of the things also that I thought was interesting is we do have transportation services for individuals through our E and B, drawing a blank on the new name, changed the name. But basically through Etrans, we do have access to transportation for these individuals, but kinda need someone to talk to the driver, kinda need someone to like, when you get out of the car, to be able to communicate when you go into the store to tell you, this is one of the things he said, I need someone to tell me what's on the shelf, what I'm looking for as I go through the store. So, this is one of the things that we all take for granted that sure, we can get someone to come to their house, give them a ride to the store, but once they're at the store or at an appointment or whatever they got going on, they need someone to communicate on their behalf through this process.

[Theresa Wood (Chair)]: And we have a bill. We heard testimony on this bill last year, at the end of last year. And I would still like to get it out of here if possible, I think it's 143. But this would support what that bill does, which is to essentially establish this program that it wouldn't be cut unless it was cut by an act of the legislation.

[Daniel Noyes (Clerk)]: So the next thing that we talked about is looking at, sorry, I'm just trying to find something real quick. So long term care ombudsman, she sent me some information last night that I forwarded over to you, and now I'm trouble I just wanna read it so I don't miscommunicate what what she sent me. And bear with me one second. I'm almost there. Okay. Here it is right here. So looking at this long term care ombudsman, make sure that people who are living in nursing homes, res care, receiving in home care through our choices for care, that they're being cared for with the money that we're spending for their care. And I asked about private equity, which has come up. These are nursing homes that are owned by investors. Nothing wrong with that. We need to have different levels of care in Vermont and how they're funded. But what comes, I asked her, what percentage of private equity corporations, so these are nursing homes, that are you seeing that you need to, you're having to provide your long term care to go in there. And it's 40% of the complaints in FY25 came from seven facilities in Vermont that are all owned by private equity. So 40% of all of her claims are from seven facilities.

[Theresa Wood (Chair)]: What is the percent of, what does that seven facilities, what percentage of all the facilities is that?

[Daniel Noyes (Clerk)]: Oh, well, I mean, there are hundreds. Right?

[Theresa Wood (Chair)]: Yeah. So it's It's

[Daniel Noyes (Clerk)]: a very small amount. These are big. These are not like small nursing homes, right? And I can dig down a little deeper into that.

[Anne B. Donahue (Ranking Member)]: Was she given figures just for nursing homes, which should be much Correct.

[Daniel Noyes (Clerk)]: Or 7% of their actions

[Anne B. Donahue (Ranking Member)]: are 40% of their actions.

[Daniel Noyes (Clerk)]: Are at seven locations.

[Anne B. Donahue (Ranking Member)]: Of just the nursing homes or all in the because nursing homes is like what, 30 something? 30 something units, yeah. Yeah. So it's probably twice the number of complaints for their

[Daniel Noyes (Clerk)]: Correct, because they are complaint driven. And so for her to be able to provide these services, she's looking for two thirty I'm sorry, got the wrong line item there. 275 was what we talked about. In terms of funding, we should look to the places where the complaints are coming from to help fund the positions she needs to be able to address these complaints and help these individuals. Because ultimately our goal is to make sure people receive the care that they need to be able to live in our state.

[Theresa Wood (Chair)]: On our list. So how much is that?

[Daniel Noyes (Clerk)]: How much are you recommending? $2.75. And

[Theresa Wood (Chair)]: that seemed to be more akin to a cola.

[Daniel Noyes (Clerk)]: That could be true. Okay.

[Todd Nielsen (Member)]: You confirm or deny? Nope.

[Daniel Noyes (Clerk)]: Preliminary information I'm providing right now. So I will be able to

[Theresa Wood (Chair)]: How much would it take for them to, I remember her saying they were losing a staff person. Correct. How much would it take to maintain the staff person?

[Daniel Noyes (Clerk)]: So looking at when you think about our funding ask, and if it's being a COLA, these agencies will have to pay their employees in order to keep them anyways. So we don't give them the money, it's gotta come from somewhere, they don't grant money. So will they reduce staff? In this case, sounds like they'll reduce staff. But this isn't the only one that could possibly reduce staffing based on the amount of funds that they have and to be able to retain the staff that they have to be able to do the work. So just throwing that out there, I will find out what it costs for one employee.

[Theresa Wood (Chair)]: Not what it costs for one employee, but what it cost? What is it gonna take in order for them to retain that one employee itself? It's not gonna be the total cost of that employee. I don't think we want to see this resource reduced, but I'm also committed to be treating everybody equitably, which in this Okay, case this year means

[Daniel Noyes (Clerk)]: not a problem. My job is to look at the overall picture at the Dale budget and come back with the recommendations.

[Theresa Wood (Chair)]: No. I appreciate that. I just I'm just To the committee. Trying to be No.

[Daniel Noyes (Clerk)]: I hear you. I hear you.

[Theresa Wood (Chair)]: Clear. I know. You don't like it. Get I'm slap. A fake smile, you know, long enough.

[Daniel Noyes (Clerk)]: Okay. So the next one I have is Meals on Wheels, and we heard that they are being even if you just look at the rate study from FY twenty four and look at the inflationary pressures that they're seeing in order to deliver Meals on Wheels at the million dollars, that's over 1,400,000.0. They were looking for 1,000,000 just to try to make ends meet, reduce some of the cost drivers that they're seeing in order to be able to provide this service. Currently, it's about $7,000,000 based on the rate study that they are having to fundraise. And so we had talked about including 1,000,000, which is $1 a meal, to provide them with more finances to be able to make sure that reduce their waiting lists if they develop and to deal with the increased number of people coming through the door. Is that 1,000,000 gross or net? Well, so that's a good question. We could do either one. And I'll tell you why the concern is the investment money. So there's always some concern that if we were to put more into investment and down the road, if that changes, we're gonna have to figure out where it's gonna come from, or we're gonna have even more deductions. So, I guess I would leave that up to some, depends on how much money I can find otherwise to be able to fill it. If we have to go with the investment, then yeah, that's considerable less money to be able to. If we can use general fund, that's a lot a lot more stable in the long run.

[Theresa Wood (Chair)]: One of the things that I have asked for additional information on is the allocation of the million and then it's a little 2, almost 2 and a half million now. Mhmm. You know, with the global commitment. How much of that money has gotten out to the meal sites directly.

[Daniel Noyes (Clerk)]: We asked yesterday.

[Theresa Wood (Chair)]: Right. So I think that they are working on I think they are. Because really, I think it's important to understand that things like the nutritionist and dietitian and all that, those are all things that have been previously covered under Older Americans Act. And so I'm trying to make sure that absent something relatively small, that money has gotten out to food providers, to meal sites. Between, hopefully, So between Dale and whatever the new name of AAAs is, that we can get that information by Tuesday. Yeah, like

[Daniel Noyes (Clerk)]: I said, I'm meeting with the commissioner on Monday, Todd and I are. So we can have some information to bring back to the committee. Do

[Unidentified Committee Member]: we think that additional but brief language very much setting very clearly our intent with this money should be laid out?

[Theresa Wood (Chair)]: I feel like it needs language in the language section.

[Unidentified Committee Member]: Yeah, definitely. It must directly be provided to the meal providers rather than

[Theresa Wood (Chair)]: Unless we can see some sort of, I guess, what I would call reasonable overhead that it I can't imagine that. I'm just trying to figure it out myself, to be honest, because it's all the same hundreds of meal providers out there, however many there are. There's quite a chunk of them out there. The money was all going out to the same people that AAA has already put the money out to under old Americans act. And so it didn't seem like it needed to be like some separate thing unless Dale was imposing some separate requirements, which I don't know, maybe they did. So yeah, it'd just be helpful before we decide whether we're gonna allocate more money to make sure that the money that we put out there already is getting to the intended recipients.

[Daniel Noyes (Clerk)]: Fair enough. We can work on that. All right, the last one that we have is looking at, back to my prevention, making sure that the home and community based providers through ACCS and ERC are supported. And so that goes right into your list of COLA. 1%, 84,000 for ACCS and 85,000 for each 1% in the ERC. So you're saying you're not recommending any colo for any of the other providers on the Love to, but You're highlighting those as extraordinary need? I'm just seeing, I think you're asking us to make choices and these are the lowest cost care for individuals in need of these services before they end up in the most expensive care. By the way, I got an amount yesterday from the cost of Medicaid nursing home, just to put that out there, couldn't find it because so many emails and texts flying around, I'm trying to capture all this information. But it was like 300, so it's over $300 a day for a Medicaid nursing home.

[Theresa Wood (Chair)]: Oh yeah, it's in Bennington, it is

[Daniel Noyes (Clerk)]: 600. Right, any way that we can provide the supports for our enhanced residential care and residential care. Here it is right here. Daily nursing home Medicaid cost is 3 and $89.98 as of January 1. So any way we can support these home and community based res care, we're gonna be better off.

[Theresa Wood (Chair)]: I'm just wondering, I know that there's been sort of some new ones come on, some ones had closed, and I'm just wondering if there's any thought being given to supporting some development funds to increase the number of residential care. I

[Daniel Noyes (Clerk)]: wonder if that's something that will come up through our health transformation. Know that they're really working on providing training and recruitment tech for staff. And so Is there a possibility that we could start seeing some work investments go into opening some more? But just to put this in perspective, if a nursing home is $389 it's four thirty days worth of one individual in a nursing home to give a 1% increase to ACCS and ERC. So four thirty six days in a nursing home for one individual will cover all the individuals, all of the providers. For 1%. For 1%. Each 1%. Each 1%. If we could keep one person out of a nursing home for a year and a half by giving them 1%, we win.

[Todd Nielsen (Member)]: Can you

[Anne B. Donahue (Ranking Member)]: explain what the numbers in the budget description slash other columns for referring to the services grants? Are you are you looking at the rate study

[Daniel Noyes (Clerk)]: that came out? Is it the

[Anne B. Donahue (Ranking Member)]: one I sent? I'm looking at the budget sheet.

[Daniel Noyes (Clerk)]: Budget sheet. Oh, the one that's in there? Yeah. Yeah. I am just starting working on that. I haven't put much in there. Don't read those. Consider it not risk. You. Actually, some of that is last year. So I'm just trying to get some template in there that I can go back and work on the numbers. So yeah, that in that document is not really ready for prime time for us.

[Theresa Wood (Chair)]: And I will remind folks over on the left hand side, and I included it with your email, a link to the document that we sent last year so you get a sense of what we're looking for. What else do you have, Dan?

[Daniel Noyes (Clerk)]: That's it.

[Theresa Wood (Chair)]: And so are you in agreement with the caseload increases in Dale, developmental services, in choices for care? Is there any nursing home rate increases in here?

[Daniel Noyes (Clerk)]: I don't have an answer for you right now. Could you repeat what you just said?

[Theresa Wood (Chair)]: You

[Daniel Noyes (Clerk)]: was trying to be helpful.

[Theresa Wood (Chair)]: Are you in agreement? Because you kind of lost over a little bit the two big increases budget, which is caseload increases in choices for care and caseload increases in developmental services. Okay. And so are you generally in agreement with those things?

[Daniel Noyes (Clerk)]: Yeah, I mean, they're looking at how many more people are coming into needing these different levels of care. I could ask them how many individuals that is, if that would be helpful, but-

[Theresa Wood (Chair)]: I think that would be helpful. I think it should be in their data there. Not The other thing only the number of I'm pretty sure I saw that in their description of their caseload increase. Is there a budgeted increase for rate increases for nursing facilities? I don't think it's a rebasing year, but I don't know that. Just am wanting to know that. You got it. Okay. So to summarize, what I heard you say is that priorities for the team are the deaf blind supports, the elder care clinicians, the Meals on Wheels, a inflationary increase of 1% or more for ERC and ACCS, an increase for the long term care ombudsman. Yes. Did I miss anything? Nope, deaf blind.

[Todd Nielsen (Member)]: Pardon?

[Daniel Noyes (Clerk)]: Deaf blind.

[Theresa Wood (Chair)]: I said that first.

[Daniel Noyes (Clerk)]: Okay, sorry. Yeah.

[Theresa Wood (Chair)]: Yeah, I

[Daniel Noyes (Clerk)]: just saw that on my list. Yep, that's it.

[Theresa Wood (Chair)]: Okay. And so far you've not identified any sources of funds for any of these?

[Daniel Noyes (Clerk)]: There is a grant that I found that I'm trying to get some more information on, it wasn't as much as I expected it would be. So I think you just have to look at the caseload increases and how those accurately reflect actual increases. At the end of the year, they're either gonna have estimated high or low, and there will either be money there or they will be here in the BAA.

[Theresa Wood (Chair)]: And typically, I have to say other than EFR, I haven't really been here for caseload increase, either on the DS side or on the Justice for Care side. Okay, this seems like a good place to start. Need to stop. We will pick up with additional discussion tomorrow after floor. And like I mentioned earlier, they're expecting our recommendations early next week. So we need to finalize these finalize these by Tuesday, just hoping. That means the language part two. And yeah. Has everybody read the language pieces for their pieces of the budget? Nothing. Nothing that you saw? Okay. Everybody's checked. Okay. Alright. So we'll see you back here after floor