Vermont Legislature SmartTranscripts:

[Speaker 0]: Let me

[Representative Matt Walker (Chair)]: We are live. Good morning. House Transportation on Thursday, 01/15/2026. Pretty much all day today is going to have a theme of public transit related topics. And when it comes to public transit, at least where we start as a committee, is always with Ross McDonald and the Agency of Transportation. So without a big speech this morning, I'm gonna hand it off and say welcome back to committee in 2026, and happy New Year, and

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: let us learn what's been going on. Thank you, Mr. Chair. It's nice to see everyone again. And Ross McDonald, I'm a public transit program manager, been at the agency in nineteen years, entering my seventh year as the program manager. And I do have some slides to share, if that's Okay. I'm sending the request to Gabby. Appreciate the opportunity to dive a little deeper into the older adults and persons with disability program. No question, it is the most unpredictable transit program that we operate, and it's the one with the most flexibility for our regions. But how do we get here? And I just want to start with a little bit of a flowchart. That extra share button that doesn't require. So the L and B funds are applied through the B TRAIN's annual grant process. So along with their fixed routes, their capital, their admins, Those funds are awarded to transit providers. And we are including those funds into their annual agreements covering all of these awards for all of their activities from their grants. And then the transit providers and their regional planning commission establish these O and D, or what we call mobility committee meetings, the agendas, the initial data, looking always in the rearview mirror thirty, sixty days of how the activities are scoring up against the budget. And as I mentioned, it's unpredictable. A few dialysis patients coming online has a real impact on these types of services. And so we always withhold a few $100,000 every year to wait for those six months to see who's doing what, who's up and who's down, so that we can kind of have this ability to respond to those evolving demands. But then the mobility committees work together and contribute to the budget information, discuss the program options, the local match, whether to use local funds or in kind dollars or in kind activities to make a match via non federal share. And then the transit provider shares regular budget reports. And that's the way it goes throughout the state, but it's never exactly the same everywhere throughout the state. But when we look at those awards, public transit initial awards and this is what we call the core budget operations, admin, preventive maintenance, CMAC and O and D, those types of things. And this year's budget only had about $4,500,000 in that line item. And we received requests for $6,100,000 You can imagine that was higher than previous years. But using older unspent funds from capital dollars that were from FHWA that we could use for the administration of the SONG program. Probably Peter to pay Paul, we were able to get to about $5,900,000 currently through that mid year adjustment that I talked about, adding those dollars to where they were needed most. So we thought we were doing pretty well, but these are constraints and we don't hit the mark and provide everybody with what they need entirely at any year. So the trips, and it's almost a waterfall flow of priorities. It's got to be critical care first, that kidney dialysis, cancer treatments, the non medicated medical needs. We've to get folks to their medical appointments. The senior meals program, that is part of Meals on Wheels or getting folks to the lunches in their region. Adult based services is also largely unconstrained and we know the importance of getting people to those services. The wellness is almost part of the medical, non Medicaid medical needs, but we wanted to ensure that those wellness programs, the balance, sash activities, those are accommodated. Know how important those are as well. Then essential shopping, the grocery store, the pharmacy, the food shelves. But then in the last ten, fifteen years, we've opened it up a little bit because we're getting those calls from people saying, we had the budget, we had this need, but you didn't allow us to get this person to and from work. Or they just had to get to this job interview, then they were going to get the job and get a carpool or fix their car whatever. So we started talking about that and working with Dale, Division of Aging Independent Living, and they have the data that show that social and personal trips have the same health determinant as getting to the doctors really. And so several years ago, we opened that up to the extent that the budget could accommodate those social personal trips. So that's where we are with the overall program before we get to the data and the details. Representative Pouech?

[Representative Phil Pouech (Ranking Member)]: Yeah, thanks, Ross, for coming. So based on the title here, all of these meet the federal sort of guidelines? Yes. And what you're saying is, hey, over time we've sort of expanded or adjusted some of the criteria, but they all meet the federal standards. Correct. And it sounded like you coordinating with the Sash group, which I guess, anecdotally or just from my experience here at the State House, seems to be a highly successful program to get folks to services that they might need, including transportation.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Absolutely, and we would generally hear from that from the call centers and the dispatchers. Hey, are Sash type of activities eligible? We wanted to make sure that that was carved out. And when I talk about this program, this is where the Rural Transit Program started. It wasn't with a bunch of routes. It really was essential services so people could age in place. And so people would have what they needed, but it was never intended to be all the trips you need whenever you need them. So it did start as critical care, adult day, shopping, and your medical appointments. But we have the schedule, we have that graded service with Medicaid trips, is far larger than this program. And so it's hard not to see what else can we do. And a good example would be the recovery job access program. It's not part of the O and D program, but it is part of the demand response programs. It starts with Medicaid. That's the entitlement. There are no denials allowed. O and D and then recovery jobs. If you are in recovery or if you're not in recovery but seeking job access opportunities, we worked with Department of Health and we split the local non federal match on those trips because there's such a overlap on that Venn diagram of our shared clients. And so that's another layer of demand response that resulted from the Opioid Coordination Council that I sat on with Department of Labor and people at AHS. That's a smaller program, but again, it's trying to figure out what more can we do with our demand response services. Statewide, when we look at the mode, volunteer drivers is down to 44%. It was well over 50% in years past. We know that, we'll talk a little bit about that. We also see that those social, personal, and vocational statewide make up 11% of the program. That's a pretty comfortable level for us because we can see that the priorities are the non Medicaid medical, the critical care adult day, those trip purposes. But when we take another layer of detail down, we see that there's quite a disparate use of those trip purposes. Whereas RCT provides two fifty six trips for vocational in 2025, GMT Urban and SSTA provided fifteen fifty three. That tells me a few things. One, that the overall trip demand in the urban SSTA because of whether it's car ownership, access to transit, or just overall need of their residents has allowed for more social, personal, and vocational trips. There's nothing wrong with that. But as budgets get tight and as we look at prioritizing those priorities we discussed on the trip purposes, that's why I've highlighted those. Just to show that we really do allow for that level of flexibility throughout all the regions because things change. Brattleboro or Bennington, small area served by transit. And so they have different constraints than others. So why are we talking about O and D? It's where the money is, I'm afraid. This was about $24 a trip pre COVID. We have more than doubled the per trip cost. And this is why last year the legislature provided one time $600,000 funds for us to really try to develop more efficient ways, more volunteers to try to address those costs to go to the lowest cost option to provide the scripts. And next week during the budget presentation, I can bring you through more details for each one of these categories. And then once again, because we have demand response at 50 three-fifty seven, it is pretty wide span when we look at the individual providers. When we look at GMT Urban is the paratransit ADA services. They don't use volunteers. And most of those people do require wheelchair lift equipment. But if you see the costs and those gray dots of the percentage of volunteers used, there's generally a connection there. Starting two weeks ago, GMT rural Franklin County has unique to RCT. You can imagine from the program management perspective, hey, let's move trips from here over to RCT with healthy levels of volunteers. Let's do that. Same even when we look at TVT, one of the higher cost per trips, but still significantly lower than the GMT rural costs right now. This is, as we say, we don't fund organizations, we fund services and routes. If there's a different approach and a lower cost option, we have to consider that. So the volunteer data, I just wanted to talk about in July when we received these funds, we had 5.5 volunteer coordinators, about 170 volunteer drivers. Just a few weeks ago, we asked for an update. We now have eight volunteer coordinators and 192 part time drivers. So these budget constraints and these issues with costs and demand are not new to us. We're trying to work through some of these issues, but we've talked about the cost increases, the volunteer driver decrease, significant demand increases. We know we're aging rapidly and the highest of our aging population that's growing is those 80 and over. Those are the folks who aging out of driving who need these services more. So we're expecting that not to change. We did add some of these trip purposes. And again, when we saw the 6.1, we said, let's get through this year, invest these dollars, bend the cost curve down. Maybe we can thread the, uh-oh, it's not really happening the way that we were hoping. And so a lot of our regions are looking at their trip purposes and frequency and adjusting to the budget after the midyear amendments. But we do have opportunities and work to do. Community driver program continues to incorporate sedans at lower hourly costs. Session 24 investments have been awarded and those are two year projects to get more volunteer coordinators, more outreach, more partnership. The time for mobility management is now. If we spend this year on setting up more robust volunteer programs we need to use this year and next to really hone in on mobility management, working with Tire Ability, working with our providers, working with the people who use the services a lot to try to combine trips. And we have the Section 28 presentation after this one where we'll talk about efforts to work with those health care providers so the transit providers and them can work together to find some efficiencies. That's part of mobility management as well. If we have underperforming fixed routes and we can sustain the successful routes, we're hoping that there's some money left over to redirect to cover these O and D demands. Increased local contributions, that is really where we use in kind. We bump up the trip cost by 20%, show in kind use, our volunteer hours in line, draw that down, and then bill the federal portion for about 100% of that trip cost. If we were getting only dollars like Colchester provides, we would have more trips and more money for more purposes. And then certainly, the clarion call is review and update the program guidance. We have a OND summit in person in June, and we'll be talking about these issues that you'll be hearing about today. But that's my presentation and I wanted to make sure I could just get started with the data and turn it over to the folks who are running this program.

[Representative Matt Walker (Chair)]: Representative. Does the actual rider pay anything?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: They do not. They don't. Not for the Medicaid program or the O and D program. Any of them.

[Representative Matt Walker (Chair)]: Does any them pay?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: The 20% non federal match is paid for by towns, and so they're taking on that match in many instances. And so they do that through town meeting day. We have a budget to match these services to get our older folks and people with disability out there so they can continue to live where they did.

[Representative Matt Walker (Chair)]: Representative White?

[Representative Candice White (Member)]: Thanks for this, Ross. I appreciate it. I just want to make sure, I wanted to return to the funding slide to just make sure I'm understanding the funding. So the O and D, so is that $4,500,000 that was budgeted in 2026, is that the total cost of the program or is that the state contribution?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: That is the state contribution.

[Representative Candice White (Member)]: Okay, so the total budget is 30,700,000.0?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: For those core activities, correct. Okay.

[Representative Candice White (Member)]: So it's, for example, 4,500,000.0 state match, and then that other 24,000,000 is federal?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It is federal as well.

[Speaker 0]: Okay, you. Sure. And I guess

[Representative Candice White (Member)]: I have one other question, which is Vermonters who use these programs, are they allotted, for example, two trips per month? You can use one for wellness, one for your haircut. Do they get a certain allowance or is this program just response driven? They get a request, they try to accommodate it.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It starts with two things. One, eligibility. Are you eligible for Medicaid first? And then we go to OMB, Recovery Child Access. And then once that's established, what are those constraints in that region? And so we start with unlimited critical care or at least two out of three die out, seven out of ten critical care. Your medical appointments are generally covered. Some people have those caps of six round trips per month for, as you mentioned, shopping or medical, and hoping that's enough. Those are general guidelines, and that's what they need the O and D committees discuss on their regular meetings, which is, hey. We're a little bit over here. We have a little bit left over here. Let's broaden the trip types or frequency or we're running hot, we need to reduce a little bit. But what you don't want to do is just cab off trips if you can at all avoid it.

[Representative Candice White (Member)]: Right, okay. So when we're looking at something like the requests are significantly over the budget, is the O and D board looking at limiting Vermonters' number of trips they can request to try to get closer to that budgeted number?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Yes, and so when we saw that 6.1 request come in, the budget's the plan, and then you get hit with the applications and the reality is very quickly upon us. And so what did we have for obligated unspent on capital through these federal funds? Can we move some of that to the O and P administration? Those types of trade offs are being done through April, May, June as we go back and forth with the providers to say, hey, what if we had this much money in ops and covered this much money in O and D? Could that work for your budget? Because 20% of the budget that we don't capture is coming from the local providers and their own funds. And so there's that latitude and is that approach that has allowed us to get to this point with our level of services, which again is about as high, if not the highest of all rural areas in the country. Our level of service is the highest. It's the most well funded transit program in rural America, but of course it's not enough and you talk about the gaps always. Services are one of them, but who's not getting those trips? That's the mobility management and the reality that we're facing.

[Representative Matt Walker (Chair)]: Representative Lalley? Just wanna make sure we get a view.

[Speaker 0]: I've got a basic question, but I just wanna be a 100% clear. These are you can only use unobligated capital funds too. You can use operational funds too. Okay, I know there's this big, really important distinction. Would you mind just kind of going into the weeds? Because I know there's constraints. One bucket versus the other.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: You got it. And so that's why I was talking like, okay, so we have obligated unspent funds. Are those capital funds? Or did we use our flex funds for that line item? And can we take that $2,000 remaining on that capital? Yes, we can for certain funds, but we can't with others. And so we have obligated unspent funds every year, but we also have programs where they've gone over so much that we need to adjust there as we go forward and understand that as we reconcile, wow, this agency spending a little more than we had planned on admin. How do we address that? And did somebody else spend less money in admin last year that we could then start shifting? And so it's this constant shift of trying to meet actual and still stay within the overall budget number, which is the key.

[Representative Matt Walker (Chair)]: Representative Keyser?

[Representative Chris Keyser (Member)]: Yeah, thanks, Russ. The rough idea of the percentage that this contributes to everybody's budget?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It changes quite a bit. RCT, it's over 50% of their program. And when we talk about SCBT down in the Bridalboro area, it's probably more like 30%. And so different areas with different densities, different communities served, like in Burlington, with a fairly robust transit service and their ADA, we don't have the demand response because we have the services in place.

[Representative Chris Keyser (Member)]: So this amount of money is a line item in, for example, the buses budget.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Yes, and full cost amortization using their cost allocation plan will assign overheads attached to that mode. And that is where we do have those high costs at the call center, the dispatchers, the schedulers. Fixed routes a little different where it's making sure the schedule is met. That's pretty predictable. It's the daily intake and coordination and trying to get those volunteers to provide as many trips as possible. And they're just one day away like this to say, I'm not gonna drive today. And so every day is kind of a starts off with a triage of who's in, who's out. And then those calls are saying, Hey, now I know you need forty eight hours, I was just given an appointment today that I really need to get to. Our providers are trying to also scramble to make those happen.

[Representative Chris Keyser (Member)]: So what you're saying is that if this money was not available, these services would not be provided?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Those constraints would grow. And so we're not going to do unlimited critical care. It's gonna be two out of three dialysis. We're gonna work with people that need to get a family member to take you there in the weekends, those types of things. And so we would have fewer trips for fewer people unless we get more money or we build some capacity. And that's what we're trying to do with some of these investments.

[Speaker 0]: Thank

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: you. Okay. I guess just clarification. So how much in advance do these people that are trying to get me services that are restrained, you're not gonna be able to do this? How do they know? They just call up and they tell them or is there sort of like an advanced notice? Those O and D, great question, because we start with those O and D committees and when it works well, they are meeting in July to roll up how they finished the last fiscal year, those costs, and then those plans will adjust. And so when people call in and say, Hey, the new parameters that start next month are going to be this or start in two weeks are gonna be this. But the goal is to make those trips and with no surprises.

[Representative Matt Walker (Chair)]: Thank you, Ross. Thank you. Who's gonna go up next? He's the

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: next floor. I know that

[Representative Matt Walker (Chair)]: we have some people that we don't always get to hear from. I'm not sure where you wanna go in the order, but I also know you wanted to make a comment. Think you still wanted to You can do it for me. Oh, okay. So does that mean Elaine is next? And for the committee members, can pretty well cross off that break at 10:30. That's not going to happen.

[Erin Frank (Town Manager, Colchester)]: We're going to be gone.

[Representative Candice White (Member)]: Fair work.

[Representative Matt Walker (Chair)]: Does that mean that Elaine, you're up next?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: I'm happy to. Hi.

[Representative Matt Walker (Chair)]: Welcome. Thank you for joining us.

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Thank you for having us, Chairman Walker. I'm happy to answer any questions you guys may have. I think that would probably be most beneficial to you if you'd like to speak about Medicaid or anything specific you'd like me to address them. I'm here for you.

[Representative Matt Walker (Chair)]: Well, that's pretty wide open. Not sure where that exactly drives anybody's on their piece.

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: So let me explain. My name is Elaine Heiko. I'm the executive director of Vermont Public Transportation Association, and I work with all the public transit providers and provide the brokerage for the Medicaid contract out of our office. So we do all the customer support reporting and oversight here, and we work directly with Medicaid very heavily. We work with VTrans as well. And we are here, of course, to answer any questions you might have on the Medicaid program or any of the T bill information that you might be interested in about community driver program. But it sounds like Ross covered that, and all the extra work we're doing on section 28, which is very exciting on the coordination of rides or any of those things you might wanna talk about today.

[Representative Phil Pouech (Ranking Member)]: Representative Pouech? Yes, hi, thanks for being here. Couple of questions. The additional funds provided to help for volunteers to, you know, get make the volunteer program, make it more robust, more Are you seeing some success there? Is, you know, either reducing the loss of volunteers or creating more volunteers? And is there anything else that would improve the volunteer program? I know that volunteers get gas money, mileage, which they can do even if they don't have to put that on their income tax. Is there something else the state could do to incentivize volunteers?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: It's a great question. We have seen success as Ross's numbers indicated. I think we've gained about 20 volunteers already. We're in the process and have hired, I believe, five volunteer coordinators. They have materials. It's about getting the word out. We do have an older base of volunteers, so we do lose a few. Some people are snowbirds. Some people drive very limitedly. We're very wide open to accepting volunteers to work when they want as they are volunteers. So we are unfortunately, folks as they get older are more apt to not want to drive in the bad weather. Some of them are snowbirds, lots of different things. Movement around in the wintertime is pretty common for us that we have to accommodate that, as Ross mentioned. But yes, we are seeing some success, and I think we will continue to see success. Are heavily working together as a group, trying to come up with success stories on what's working in what region to kind of share that information. The IRS generously just raised the volunteer rate from 70¢ to 72 and a half cents. That helps incentivize a little bit more. So that's in place. Each regional transportation provider has that coordinator in place, they do work for in different ways. And again, we're working on coordination on providing incentives for volunteers. We do not only the recruitment, but the retention piece around that, making sure they feel appreciated, and giving any IRS allowable gifts, luncheons, breakfasts, or any kind of incentives. Most of them buy in very heavily to becoming part of the team at the public transit provider, and often we'll have t shirts or mugs or things like that given to them to show our appreciation. So that's another piece that we need to continue to work on. But again, just sort of getting the information out there is the most important thing. And I think we've seen some success through the support of Etrans. So we're very appreciative for that.

[Representative Phil Pouech (Ranking Member)]: Well, certainly I see it as a critical piece of this transportation lead for Vermonters. And I encourage you to work with VTrans and the legislature know, here's something that would help. Here's an additional piece that would help increase this service or help keep up with the service. Because like you say, one, it's a critical need. I can say that for folks in my town and it's a growing need, so that's good. And then my, I forget what my second question was. That's it, thanks.

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Of course. Caleb Grant is in the room. He's a public transit provider at R. T. Caleb, did you happen to have any idea about what we could ask for in addition, since you're the largest volunteer holder, I think, across the state, and you guys are incredibly successful at recruiting volunteers, is there anything you might want to add?

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: I mean, it's a challenging program. You're trusting to put a complete stranger in the back of your car who may be going through some very challenging times in their lives, and so any type of incentive we can provide. I think tying into the veteran population is critical. Nationwide largest demographic group of volunteer transportation drivers are 60 to 80 year old veterans. Utilizing state connect teams to our veteran communities could be extremely helpful, but any type of protections you can give for either professional or volunteer drivers for mental health crisis operations is helpful, but the funds that were invested last year being fruitful. But it's really getting the word out and making sure we keep our drivers safe and I'm appreciated.

[Representative Matt Walker (Chair)]: Thank you.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: I'm just gonna add if I may. We've been struggling to get volunteers and when working with the healthcare providers they're also seeing a paucity in a reduction of volunteers and so we saw that statewide dynamic we thought let's change the volunteer program to the community driver program and add other options, other lower cost options than full boat retail of the CDL driver with the wheelchair accessible vehicle. We bought some sedans and hired people hourly for a lower cost. That might be a way to address that middle area between that 70¢ mileage reimbursement and that full transit cost. But that's just our other effort to try to see what we can do and not rely solely on the kindness of our citizens here. So

[Speaker 0]: just to clarify, Elaine, you said the 72¢, the mileage reimbursement?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Yep, 72 and a half cents per mile now.

[Speaker 0]: But that particular population is volunteered.

[Representative Candice White (Member)]: They don't get any

[Speaker 0]: other per hour pay?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: No, we don't. That remains tax deductible and they don't have to claim that on their taxes. So that is an incentive to not pay anything outside of the volunteer mileage reimbursement rate.

[Speaker 0]: And then, I also think you said that using another form of transportation is cheaper?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Well it can be, and so that's the thing if we had just cutaways with a CDL driver, what if we had more sedans with lower cost hourly drivers, kind of like maybe they would like to become a CDL driver once they get into the program, those types of things, But we're just trying to search for something in the middle between that big gap of 72¢ a mile and $110 an hour. So that was one of the reasons we rebranded the Volunteer Program to a Community Driver Program, so we could just provide more options for more people at lower costs. Thank you. I'm sorry, also Representative White.

[Representative Candice White (Member)]: Yeah, hi Elaine. So you mentioned that you work on coordinating the Medicaid Rise for Vermonters, and Ross was talking about when he was going over the Older Adults and Persons with Disabilities program, there were several parts of that. There were critical care, medical. Non Can you just remind me of what types of programs are serving Medicaid specific customers? And is Medicare also a part of that or no, is that separate?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Sure. So Medicaid covers all medical services that are through eligible providers, which gets vetted at intake. And then if a member could be dual eligible, they could be eligible for Medicaid, and they could also be eligible for OND because they might be over 60. So OND would cover things like shopping trips for them that are non Medicaid covered. And social personal trips, if that regional committee allows for that in their OND trips. So we have many riders who call in who are dual eligible and they get their care under Medicaid to a Medicaid approved provider. And then they might also receive trips to the grocery store for O and D so that they can do their shopping and some personal trips, So things like there's a lot of steps at intake to make sure that we're using the funding source of Medicaid first at all the providers. And then we look for additional funding sources that they're eligible for to cover the expense of other trips.

[Representative Matt Walker (Chair)]: Thank you. Thanks.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: In Chittenden County, we saw the news that SSTA was going

[Unidentified speaker]: to start being limited to six round trip rides per month for non emergency medical trips and that social and personal trips would be cut as well. Is that accurate? And is that happening in programs in other areas of the state or is that just GMT? Is that a new policy?

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Again, those decisions are made at the regional committees based on what they have for resources. And I see Clayton Clark has jumped on and I should punt to Clayton to let him answer questions in his own region. But yes, that can happen when demand goes higher and funding is restricted. That certainly can happen. So Clayton, I'm gonna punt to you to answer.

[Clayton Clark (General Manager, Green Mountain Transit)]: So for the record, my name is Clayton Clark. I'm the general manager for Green Mountain Transit. And sorry for the delay in my arrival this morning, and I apologize if anything I say was previously covered. So in Chittenden County, let me start with Washington and Franklin County. The trip restrictions that has been suggested for Chittenden County have already been in place for Washington And Franklin County since December 15. On Monday, Green Mountain Transit notified the Chittenden County OND partners that trip restrictions in Chittenden County, we would make them voluntary instead mandatory. And we, on the following day, indicated that the implementation date for voluntary trip restrictions would be February 23. So the statement that trip restrictions are mandatory and going into effect on February 1 is erroneous. And it's regretful that the individuals that spoke on Tuesday night at Colchester Select Board had not received that information and we're still under the impression that their rides were going to be eliminated on February 1.

[Elaine Heiko (Executive Director, Vermont Public Transportation Association)]: Thanks for clarifying that.

[Representative Matt Walker (Chair)]: I think we're at a spot where we're going to switch to the next. We appreciate, please, Erin Frank, town manager Colchester. We don't get to hear a lot very often directly from our town managers. I know that Colchester is a pretty spread out geographically town, so I imagine your needs vary quite a bit from one part of town to one I'm interested to hear what you really have to say. I appreciate

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: you traveling all the way down

[Representative Matt Walker (Chair)]: here today. So Welcome. Chairman Walker and, House Committee on Transportation.

[Erin Frank (Town Manager, Colchester)]: Thank you so much for having us, and it's wonderful to see from the state agency transportation, transportation providers, and and and end user. So happy to have this all together. I'm Erin Frank, the Colchester town manager. Actually, before I went into a Colchester to town management, worked twenty years in the transportation business in three different states, hold, operations management and consulting roles and efficiencies and operations. In fact, worked with Steve and Ross back when I did that. So I have a little bit of perspective. Honestly, if I could do anything, I would yield all of my time to the hearings that Senator Brennan heard with the Colchester Select Board Tuesday night about the extreme negative impact that these changes are going to place on the riders of OND program in Colchester. So that's just something. Maybe I could send the chair a link to a little video on that. And if you all would like to watch and hear from the real folks that are involved in this, we would appreciate it. So first, Ross knows more than could possibly be expected knowing that there's seven great transit providers in the state of Vermont that have a rider donation program for the O and D. So they might contribute a dollar, a couple, dollars 3. It's not mandatory, but it is an option there. So I do have some slides, and if Gabriel is able to

[Representative Matt Walker (Chair)]: All right.

[Erin Frank (Town Manager, Colchester)]: So some of this overlap with what Ross did, so I'll just go quickly through it. But the Vermont OND program plays an important role in critical gaps in existing transportation for seniors and persons with disabilities. The agency provides 80% federal funding, which is really amazing. And in most states, this is capital only. So it is truly something that other states look to Vermont and kind of think about how we can do. The way the program works is the state gives money to the seven regional transportation providers. And in Chittenden County, the transportation provider has a subcontractor, so it's a little bit different. That's why SSTA is involved in addition to Green Mountain Transit. So in order to fund the OND program, several funding sources are used. Some of the funds come from the Federal Transit Administration. That's helpful, but it's not sufficient. So they also pour in a lot of flexible funds as you all have heard from Ross, from other USDAOT sources. And then the human service agencies and municipalities pay up 20% match. So here's another slide that just shows that US DOT, which is usually federal highway money, get flexed over to federal transit. State dollars get put in, at least in the Chittenden County program. I think there's about 83,000 in state money in the OOD program there. That money goes to Green Mountain Transit. The local agencies, there's about 10 in Chittenden County, provide the local match, and then SSTA provides the services. So here's a map about Colchester. And really we have the third highest population of any city, town, or village in the state of Vermont, but we're the thirteenth largest by landmass. So we have a lot of people, but they're spread out and they're separated by a lake. And it makes it challenging to provide everything from police fire rescue, library, recreation services. We got to get around the bay to get things. Provide some it's almost the same as having them out. You've gotta get around it. So, little differences. Next, Colchester is predominantly not an urban area as classified by the US Census who really drives all the federal programs and the funding. This darker color in the middle shows the urbanized area with populations of 10,000 or more in 20 I think the twenty twenty census was still like this. And then Colchester with a population density about 500 per square mile, but understanding that most folks are concentrated in a few areas. We might be more like Vermont as a whole than Burlington, South Burlington, Winooski, and Essex who have population densities of 1,200 to 5,300. So we're thought of as Chittenden County urban, but we're only very partly so. Here's another perspective you heard about fixed route public transit and how it's an option in Chittenden County. But thinking about how much of Colchester is rural on different sides of the bay that's hard to get around. Here's how the value of Green Mountain Transit service, and this is combined fixed route and ADA paratransit are spread out. You can see Milton, which is pretty rural, doesn't receive a lot. Essex Town, and that's a town outside the the city now, doesn't receive a lot. And Colchester, and which is double the, size of Essex Town, is the third lowest and 40% 3% below average. It doesn't really have anything to do with how much we contribute. When I worked in the transit business developing grants and programs, if we had a root for Colchester, it wouldn't meet the thresholds for performance because we're too low density. So why do I give you all this background? OND is a really critical program for Colchester and other communities like it in Vermont. So here's another perspective of the communities that receive urban fixed route transit service. You can see both population and in blue and bus hours, which is kind of a measure of service.

[Representative Candice White (Member)]: Just to clarify on your previous slide, I'm just trying to understand the value of GMT service per resident fixed route and ADA. So example, in Colchester, can you just talk me through that? $45 means

[Erin Frank (Town Manager, Colchester)]: So is the total cost of the service provided? That's with

[Representative Candice White (Member)]: 45,000,000, like 45.

[Erin Frank (Town Manager, Colchester)]: So it's the total cost of the service

[Speaker 0]: Per person?

[Erin Frank (Town Manager, Colchester)]: Per divided by population. So it's based on hours of service within every community, and then that's multiplied by a cost per hour. And you just heard it might be 110 an hour or something like that. So there's so many hours of service in Colchester. You multiply by the hours of service, and then you divide by population. And so it's kind of a measure of how much service per individual person in the community.

[Representative Candice White (Member)]: So we're looking at, in Colchester, a trip costs $45

[Representative Matt Walker (Chair)]: No. Is. Okay. Person.

[Erin Frank (Town Manager, Colchester)]: Per year, per person total funding of the Green Mountain Transit services that are provided at Colchester, not by trip, but per person. It's basically how much is allocated for your population that have not per trip.

[Representative Candice White (Member)]: And it's not the population using the service, it's the entire population?

[Representative Matt Walker (Chair)]: Yes. Okay, thank you. Representative Paul?

[Speaker 0]: So is this what the town of Colchester contributing to? Or this entire amount, federal, state, and Colchester's share?

[Erin Frank (Town Manager, Colchester)]: Exactly, plus rider chair. So it's all four of those. So it's the total value of the service.

[Representative Matt Walker (Chair)]: Great question. Thank you. Hold on just one second, mister Frank. Your hand up there, Clayton, as you're looking for a chance to ask a question or a comment here.

[Clayton Clark (General Manager, Green Mountain Transit)]: I just wanted to clarify because, I wanna make sure everybody heard what I said earlier because it seems to conflict with how Aaron started this. It's very clear as of Monday that Colchester is not required to implement trip restrictions. They will be able to manage their own appropriation. So there is no threat right now that Colchester will not be able to do exactly what they want to do with the program. Frankly, I'm very concerned that people on Tuesday night were presenting information out of fear that they would lose their rides come February 1. A fear that was totally not founded in the reality that Colchester will control how this program is used. It feels to me like these people were put on display. I just think that for the record, I'm very offended by that.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Well,

[Representative Matt Walker (Chair)]: I guess I would say that today's Thursday. I wasn't there on Monday or Tuesday or Wednesday. I appreciate your comments, Clayton. I know you're a regular participant here in the committee. And I would say that we'll continue to move on, and we'll have to see where we end up on this piece. But thank you, chairman. You're welcome.

[Erin Frank (Town Manager, Colchester)]: Alright. So, again, of the nine areas, communities in Chittenden County that receive GMTA urban fixed route service, Pulchester is the third highest population, but we have the third lowest number of bus hours. And again, it doesn't really have a lot to do with we do contribute to Green Map Transit. We pay for the fixed route service. We pay for the ADA service on exactly the same basis of a member. It's just contractual. We don't send a board member. We just have a contract agreeing to do that. But it's important that we're a high number in population, but a low number of service. Again, it points back to how important this OND program, is. So next, we have the trip parameters. This is exactly what Ross, presented, so I won't go over it again, but it is important to the town, its riders, and perhaps even its representatives. So next, the o and d committee. There's an o and d committee in, each of the service areas of the transit providers, and the o and d committee in Chittenden County has 10 members. Colchester has about 115 riders based on ridership of the last, five months as of December. And the committee is facilitated by Chittenden County Regional Planning, and the partners are supposed to approve either by consensus or by vote two things. The split of, money every year that VTrans allocates, gives to the transit providers, and then the agencies are supposed to sort out who has the different needs in in the community, who should get how much, and then the trip purposes. So next, the Chittenden County o and d, committees, last approved trip purposes. You don't have to read this, but they are put in writing. It's mostly so they can be provided to SSTA, the service provider, so they'll know what the expectations are and so they're clear. Next, these are the o and d trip purposes for Colchester that will remain in place until February 23. And, you can see we have our own parameters on top of the overall parameters, maximum three round trips per week in any category other than medical. No restrictions for medical. Social personal up to three round trips per week or visiting spouse, cared outside the home, visiting trips or church, friends or church, and social personal for other needs are not permitted at the time. So we do have some restrictions. Here's a chart just on the annual budget for Chittenden County. You can see of all the agencies, Colchester is pretty much tied with Champlain Agency on Aging, now known as AgeWell. It is a substantial part of our transit program in in Colchester. So next, recent events and how we got here to me is important. So in FY '26, going into the FY '26, the regional transit provider received an additional 950,000 in state provided federal funds. This I'll acknowledge was in the governor's budget, but having been in that business in the past, I know how you get things in the governor's budget. You ask early, you ask often, and you make compelling arguments. And that's how things get in the governor's budget. At the same time, there was increasing needs in O and D program. In Chittenden County, we were over budget by 01/8000 last year, but there was no request of the transit provider for additional O and D funds. O and D funding was reduced by 300,000 statewide from f y twenty, six to 25, and the O and D partners were indeed aware that there would be a budget problem likely in July 2025 based on the, FY '25 spending. But OND funds is, OND program can be variable, very variable because of dialysis trips and other cancer treatment, other medical trips as Rob stated. So things do often go back and forth within partners in a area, but also across the partner lines across the state. And this is a very complex thing that B TRANS does and facilitates. It's very helpful, but you don't always know if you're going to have a year that looks like the last year. So people typically kind of wait and see, see what happens. And that's kind of what happened to us. So in December 2025, GMT identified that trends were so bad we couldn't run out of money in January halfway through. And so in response to that, VTrans offered 161,000. I think that's 100% funds including the match, and that was greatly appreciated. But when you're running double over, it probably was a 30%, 40% help to the challenge. So again, back to, recent events in December 10, Green Mountain Transit announced to the Lincoln County O and D partners that they were restricting trip types and number of trips. They mailed letters to the riders on December 17. Some riders did not receive the letter due to mail delays in the holidays. Some riders contacted the Colchester town offices on Friday the second, telling us they had trips that were scheduled for next Monday being canceled. And I assertively advocated to have this changed. Ultimately, Green Mountain Transit, Colton, Clayton granted this, for which I'm thankful. Again, next week, we heard how disruptive this was that, hey, a week's delay isn't enough. And so then I staunchly advocated again for another three weeks of delay. And when cities and towns make changes, planning and zoning, we do public hearings, and there's a notice of public hearings. It's hard to do things quick in government, and we wanted the same expectation of word to the riders who rely on these these trips for life sustaining needs. So indeed, the three weeks was, granted, and now, our current concern is that we want for the O and D committee to follow the state guidance, which is if a regional O and D committee foresees a budget for shortfall, it will institute measures to the greatest need for the remaining funds and will reallocate funds as necessary to have the smallest possible negative impact on the O and D transportation services. So here is a comparison of the now suggested, changes to the Colchester's past trips. So all riders now, have a six trip maximum per month. And as you saw before, it was used to be three a week. And if riders now take six trips per month for adult day dialysis or cancer treatment, they're not eligible for other trip types. And so critical care non Medicaid remains unlimited. Non medical Medicaid now is a six trip a month maximum. Senior meals, six trips a month maximum. Adult day remains unlimited. There's no more wellness. So we had a senior that has group exercise, and it's part of her doctor's regimen, and she's not really able to exercise alone. It's much safer for her to do that as a group, and it's, facilitated, but can't go to that anymore. Shopping now is limited to, six trips a month. No more vacational vocational, which is jobs trips, and no more social person. These are, again, suggested. So, the town doesn't feel the action taken on December was taken by the committee. It was announced at the meeting and then there was a letter to all the committee members ten minutes after the meeting over. It was not a discussion. It was an announcement. Colchester wants to engage in mobility management which Ross is suggesting, try to create more volunteer riders really quickly if we possibly can, and shift trips to family, friends, and other services. And Green Mountain Transit granted this request, but in such a manner that you have to wholeheartedly adopt their approach. And if we don't, then we're kind of on our own for cost of overages. So the folks that go along with the, now suggested mandate are gonna be held harmless for cost overage. But if Colchester does something more generous for its riders, like maintaining those work trips that we heard so much about on Tuesday night, we are entirely on the hook financially. So by doing the right thing, we're gonna be more financially at risk, for doing that. And we have nine riders that are going to work regularly on this program. And yes, Colchester has been generous. When I got in the transportation business thirty years ago, the select board was generous and provided more trips. I think it has to do with the community's mentality, but also understanding our geography doesn't put us in a place where fixed route transit works. So this kind of transit is a transit that works for Colchester. So here's a slide about so we've got nine people with disabilities working. And we're starving for workers in the state of Vermont. They have jobs they like that they want to continue at. We need to figure out how they can continue. And one person said that it'd be $500 a week for them to take an Uber, which was the only choice they had. And that's not sustainable for an individual. And even though it might be $50 a trip, it's a lot cheaper than taking an Uber. So there's societal reasons. There's individual reasons for this. So of the 115 riders that have used the Colchester OND program in the last five months, nine eighty nine were going to be affected by these changes. And, of those trips, nine were for work trips, two were vaccinations, 57 personal reasons, 25 social personal reasons, two for medical trips, two social trips, and one for substance use disorder treatment. So call Chester staff and we're asked by the select board to do this, engage in mobility management, carpools, friends, family covering trips, reach out to the community to find some volunteer drivers, consider restriction of grocery to in town only, and consider a town wide weekly grocery shopping trip instead of individual trips to help reduce our liabilities. But unfortunately, doing so under the offered now voluntary, it will place the town, at financial risk. So what can we do about this? Well, Colchester also pays a good portion of of two bus routes in Colchester. So the blue route is the route from Burlington to Winooski to Colchester to Essex Town to Essex Junction. Last time I knew was the second highest productive route in the state. Colchester has a very high density corridor, multi story buildings. Unfortunately, that area, we don't get any tax revenue, hardly, because it's not for profits and state and federal agencies and the college. So it's wonderful for employment and other things, but it doesn't really pick up the town a lot of taxes. But that route's very productive at $5 a month. You'd be pleased to know. Another route that we fund is the Franklin County Commuter. Local match is paid by Colchester, Milton, to my understanding not Burlington, Winooski, or St. Albans, and it's roughly $32 a one way trip. Uber, my check was 51, so less than that. But if you look at other options, Prius lease is $2.99 a month for with a 3,000 down, which turns out to $6.80 a day. And so why do I say this? We're having to make difficult choices locally, regionally, and statewide. And when we have a transportation purpose that people who cannot physically drive and there's other services for people who might be able to, my kids took to Green Mountain Transit and it saved them some money. It was good for the environment, but they were able to drive. So it was a choice. It's not a choice for all the riders, but it's just kind of a point to make in this committee's deliberations for next year. So you've seen these before from Ross, no doubt, but here's the chart about it's $40 a trip for the commuter routes on average. But there's some commuter routes in the $70 range, in the $60 range, these are a couple of years old. So if you're thinking about scarce resources, I would say please think

[Representative Matt Walker (Chair)]: of

[Erin Frank (Town Manager, Colchester)]: the folks that have no other choice first in your deliberations for next year's budget. Some of these commuter routes are rather costly in in a time of scarce resources.

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: That's what I have,

[Representative Matt Walker (Chair)]: mister chairman. Thank you very much. Representative White?

[Representative Candice White (Member)]: Thank you for this. So just wanna clarify that I understand correctly. So in December, Green Mountain Transit notified Colchester that there would be limitations on the O and D. Correct. And then in January, Green Mountain Transit backed down and said, are not mandatory cuts. These are voluntary cuts. Am I understanding that clearly?

[Erin Frank (Town Manager, Colchester)]: They're but they're financially incentive. If you agree to them, you're held harmless financially at the budget of over. If you don't agree to them, you're on the hook for any overages. They're The

[Representative Candice White (Member)]: mandatory cuts or the voluntary cuts?

[Erin Frank (Town Manager, Colchester)]: For the voluntary cuts. So they're voluntary with an incredibly strong incentive.

[Representative Candice White (Member)]: Okay, I understand. And some of these residents that you spoke of who are using the service to get to work, and you also talked about some of the bus routes you have, Are any of the residents who are using these offerings to get to work, are they are they paying anything on any of these services?

[Erin Frank (Town Manager, Colchester)]: So there's in Chittenden County, there is an optional you can pay if you want to. It's not required, and I'm not sure if it's legally allowed. Ross might be

[Representative Matt Walker (Chair)]: able to answer that question. Sorry about that. The next

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: session, what was the question? Is it allowed to charge people on O

[Erin Frank (Town Manager, Colchester)]: and D? We have a voluntary payment.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: We could take donations if they're going to pay fares, then it would be applied to the services 50% from local drawdown and 50% from the federal drawdown. That's the federal requirement for any fares that are received through those services. So it could happen, but of course you're talking about our most vulnerable adults.

[Representative Candice White (Member)]: Right, I understand. I'm just looking at, obviously you're having to prioritize what is most important, like typically dialysis, that's critical. People getting to work, that's also critical, but they're also getting some wage. So can they contribute something to continue to have this service lower than the cost of an Uber, lower than the cost of owning a car? But just thinking out loud in terms of trying to keep your service and defray your costs a little bit.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It's big numbers, right? So that percentage is 1% or 2% of the total cost,

[Representative Matt Walker (Chair)]: and it could help, but it

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: probably won't appreciate change the challenges, it's capacity or cost, to the extent that we would need to see. So far, the communities have been able to pay that local share on behalf of their residents in many instances.

[Representative Candice White (Member)]: I think, yeah, just wanted to add. So sounds like I have a better understanding of how the notification happened, that did sound pretty disruptive to the Colchester community, and maybe there was a better way to handle that.

[Erin Frank (Town Manager, Colchester)]: Yes, Clayton has acknowledged that. Appreciate it. Now we're really stuck with the difficult option as if we do something more generous than the suggested, not mandated new rules. We're completely on our own financial. The industry has its own fiscal challenges, as all the communities.

[Representative Matt Walker (Chair)]: Is there a committee group or somebody that oversees the O and D that meets on a regular basis that makes these decisions, or was it entirely a decision with GMT? In other words, does Colchester have a representation in this decision making process of when these recommendations come out?

[Erin Frank (Town Manager, Colchester)]: So we attended that meeting recently. It's it's been more of like, hey. Here's what we're doing. And so we've just read the minute. So to be honest Is this

[Representative Matt Walker (Chair)]: series of meetings, like, regularly occurring, or

[Erin Frank (Town Manager, Colchester)]: are they saying it's just it's as needed basis? So the regional planning generally tries to hold board meetings a year. And so they're kind of at critical times when a new grant comes out or if there is a need to reallocate money or let's check-in at mid year. But it's generally worked out in a manner that hasn't required a lot of involvement. Like last year, there was an overage, but it was something that the agency of transportation was able to help from. So there's lots of meetings to go to, but there hasn't been a lot of ability for the committee to participate, to be honest. The committee is intermingled with other folks. And you all are here at the House Committee on Transportation, but folks that aren't on this committee or supporting it mix in. So I don't know that the committee has felt empowered to make these decisions. And I've actually talked with Clayton, and he's shared the idea that the committee should be empowered. So empowerment comes with responsibility. So I'm I'm hopeful that we can move in that direction and have some conversations with Ross about that too. Representative.

[Speaker 0]: Are there any other accounts in the Dittenden County that are affected by this?

[Erin Frank (Town Manager, Colchester)]: Yes, they are. Williston has a similar demographic to Colchester, that part of it is very built up with lots of shopping. And they do have a couple of fixed route there. But the older part, the village and other parts of Williston, are much more rural. And so there are other communities. Hinesburg might have similar concerns. And so it's a community that's on the edge of the urban core that utilizes program more. And you'll look at the membership. It affects Colchester particularly badly because we have such a large population and because we don't have fixed route service that runs all day long on most of our community because it doesn't make financial sense to.

[Speaker 0]: And so this is all coming to a head because more and more people are using the service. Is that correct?

[Erin Frank (Town Manager, Colchester)]: So service costs have increased, and there is an increase in use. And there's also been a service cost increase. I think it was about a year and a half the last time that SSTA raised the cost. But the cost of paying drivers, buying vans, and all this stuff has increased. But I would say very roughly, it's probably half and half increased use. And increased use could be longer trips, and it could be more trips.

[Speaker 0]: And do you have any taxi service in Polkowski?

[Erin Frank (Town Manager, Colchester)]: Mostly, it's just Uber. And the folks that came to the meeting talked about how expensive that would be. And unfortunately, that's how it's evolved or devolved, that there isn't a lot of taxis.

[Speaker 0]: No other private taxi service.

[Representative Matt Walker (Chair)]: May be

[Speaker 0]: Traditional taxi.

[Erin Frank (Town Manager, Colchester)]: It's mostly gone to Ubers. Think maybe VPTA might be able to speak to whether there's any taxis in Chittenden County because it has to do with Medicaid, but I'm not familiar with it being as robust as before.

[Speaker 0]: Thank you.

[Representative Phil Pouech (Ranking Member)]: Yeah, thanks for this. I'd like to get a better understanding of how municipalities are charged the we'll call it overage or above what the committees determine are the standards. And I don't know, Ross, if you could sort of provide that, does every community get those charges? Because you know, it's something I don't really understand. And it would be interesting to see if in fact it does or a number of them do, how much people, how are they charged? I mean, let's see it on a chart.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Generally, transit providers enter into agreements with their partner organizations and that could be an agency aging, the towns, the hospitals, those types of things. And so every year, are negotiated and brought forth mostly through town meeting day to talk about those appropriations to cover their share to maintain those mobility services. Some areas do not provide, some towns don't provide, provide donations to support the services, but the local match is taken care of or the non federal match is taken care of through in kind activity. And so we have so much volunteer hours, we can then cover that 20% and draw down that federal dollars, but it draws the federal dollars down 20% faster. And some areas have that mix where we use a little bit of in kind, we use a little bit of the local dollars we receive from the towns and then of course those contracts that Aaron has with GMT allow for those types of variability and contributions.

[Representative Phil Pouech (Ranking Member)]: Just a quick Google follow-up. And the sweatboard for years in Gainsburg, I never remember a line item for this service. Was it because we had Heinzburg rides like in time services being provided and somebody figured that out? I'm a little confused.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: I don't know. I'd have to take a look at the specifics with Heinzburg but certainly can get back to you. Yeah, sorry.

[Representative Matt Walker (Chair)]: I could explain how it works in

[Erin Frank (Town Manager, Colchester)]: Colchester. So we have a contract with Green Transit and it says we are receiving $160,000 in transportation services. The local match is 20% of that, which is, I think, 40,000. We budgeted 35,000 this year. And my back of the envelope right now is that if we go the way we want to, which is to continue things as they were before. I'm not sure we can afford to do that. We're getting an additional roughly 60,000 from VTrans. Then this $35,000 budget at iDynamic goes up by an extra 100. So two and a half times, it's pretty significant. In other communities, might not be a big enough number that's the line item in the budget, might be a line item of something else.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Quick, thanks for enough. I have Steve right next to

[Dr. Natasha Withers (AVP Medical Director, High Value Care, UVM Health; Family Physician at Porter)]: me.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: The neuroend programs are covered through AgeWell. So age well is a partner that has the same type of contract with them. That's why that makes sense. Thank you.

[Representative Matt Walker (Chair)]: I have to jump in and I apologize Clayton, but I want to say a couple things as we kind of need to move to the next topic piece. And some of you will still be here, but to all the committee members. There's a lot of committee members who spend a lot of time and energy in public transportation. I also want to start out with the part that the agency, the state, has testified and is undisputed that we are, if not the top, one of the top funders of public transportation for a rural state. We do have, within this rural state, a very different need of rural areas and in the urban. And Colchester was demonstrating their issue of their urban and rural in the same vein. We also put huge financial pressures on Green Mountain Transit over the last x number of years and what level we just can and can't support that. We also started as our number one committee issue that we all know is transportation funding is flat and expenses are incredibly high. So the pressure in this area, having a local situation that is clearly an issue in Chittenden County with those bigger picture items is particularly valuable for the committee in terms of when these decisions are made, they have real impact on a certain percentage of Vermonters. We're not going to solve the piece here, and we have and will continue to take more testimony in public transportation, which is why we need to get to the witnesses that are here. But I really would want to frame that we really delved into a real significant issue on the impact to Vermonters, but also really need to understand it where it came from. We have a flat line of transportation revenue and incredibly limited in Vermont right now to do something about this from a state level. And we put huge financial pressures on our providers like Remountain Transit and like some of the others that are in the room. And that forces real issues within a town. So somewhere in this long term and continued effort, is there a different need for a solution in Chittenden County that is different from the solutions that are being provided by rural transit providers across the state. And that's something that we should really be looked at, is the funding and the needs of what happens in Chittenden County enough different than what happens out in the rural portions, which from every testimony we've seen has pretty significant success. But urban has a whole different pressure on it. And that's where I want to leave it at this point. I very much appreciate you coming in. I appreciate that you have a lot of work to do and solve on the area. I think the committee is interested that there should be perhaps a more depth in the regional solution. And we all need to be aware that you're gonna hear it on the news regularly. There's no new money coming in transportation unless this body can come up with a solution throughout the course of this session. So thank you very much, and thanks for coming down on a snowy day. Thank you, Chairman and Buck, it very much. So I think we're gonna bring Ross back up

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: to Thank you. I'm sorry.

[Representative Matt Walker (Chair)]: He's good. Let me bring Ross back up to the next section in terms of updates on health care and transportation partnerships. Real quick. I just

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: wanted to housekeeping. Gabby, do you have this presentation that you could help navigate with, Steve? Section 28? So while she's setting that up, I can just

[Representative Matt Walker (Chair)]: One second.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Section 28 was sent to you yesterday morning.

[Representative Matt Walker (Chair)]: You get that?

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Yeah, I'm

[Representative Matt Walker (Chair)]: sorry. You're all set, I'm sorry. Oh, okay, we're all right. Everybody's patience today. We don't usually have this many people in committee.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It's leading to the joint committee, right? Because we have all these interests trying to work together. But again, I'm Ross, public transit program manager at E Trains. And I'm just gonna very quickly kick this off to Steve Fobble, our primary consultant who wrote this report. And this is just in response to section 28. And are there opportunities to work with transit providers and healthcare providers on mobility management, on efficiencies, on scheduling, on advocacy at our different facilities and services. So we brought the working group together in August and have met five times. And just really thankful for all the good efforts and good faith partnership we've had to date. And I'll just turn it over to Steve and have him bring us through the PowerPoint, and then we'll get right to your questions. Thank you.

[Steven Falbel (Principal, Steadman Hill Consulting)]: Good morning. I'm Steven Falbold from Steadman Hill Consulting. I've seen most of you before, I've been doing this a long time. Before I jump into the presentation, one of our key partners in this is Karen Vastien from UVM Health. And last I knew she had a commitment 11:15. So I wanted to make sure to give her a chance to speak before, because this probably will take ten to fifteen minutes to get through the presentation. So Karen, if you're online, you can jump right in.

[Karen Vastine (Senior Community Relations Officer, UVM Health)]: I'm here and I thank you so much, Steven. And I'm joined here by my colleague, Natasha Withers. I actually now have been informed that the other piece is actually running a little bit late. And so if the committee would be okay with Doctor. Withers and me weighing in immediately after Steven walks through the presentation, I think the timing all work.

[Representative Matt Walker (Chair)]: Okay, great.

[Speaker 0]: Thank you.

[Steven Falbel (Principal, Steadman Hill Consulting)]: We can jump to the first slide. A lot of text on this slide, but it's text that you helped write. So I'm not gonna go through it in detail. This is section 28 from last year's transportation bill. I highlighted a few key phrases here, which was the main charge from the legislature last year

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: to convene

[Steven Falbel (Principal, Steadman Hill Consulting)]: a working group to improve coordination of healthcare and transportation services. And then to look at opportunities to coordinate scheduling of healthcare appointments and treatments to maximize the use of shared rides and to improve communication between the public transit agencies and healthcare providers. So those were really the two things we focused on. And it's relevant to the discussion we just had because to the extent we can coordinate rides, that saves money, that stretches the available limited dollars. Thank you, Rex. Stretches the limited available dollars much further and allows for more rides in general. Next slide please. The working group was convened under the leadership VTrans and AHS in October. You can see here the members of the committee, several members from the state agencies plus VPPA, plus the Vermont Association of Hospitals and Health Systems. And Devin Green is here representing them, University of Vermont Health. You just heard from Karen and the Bi State Primary Care Association. So these group members met several times over the subsequent months starting in October. Total of five meetings from October 2025 through December 2025. I also wanna highlight a couple of other efforts to date that have happened since the passage of Act 43 in the last session. So UVM Health instituted an expanded and enhanced care management process. And this actually started in January 2025. They had health related social needs screen for all primary care practices. So basically when any new patient came into a primary care practice, they were given a questionnaire and they screened for certain social needs related to health. And anything that was a positive result, if somebody said, yeah, I have that need, that person was referred to a care management team. And transportation challenges were one of the most common reasons for referral. And so that screening process is important. You'll hear about it again at the end. It's something that needs to be done more widely, but it helps to identify individuals who need some transportation assistance to get to their medical treatment. The other significant effort today, sorry, go back to the That's okay. In July, after the bill was signed into law, Tri Valley Transit in Addison County started working with Porter Medical Center and UVM Medical Center looking specifically at dialysis trips and ways to increase shared rides. So it's important to note that transit riders look for ways to share rides all the time at standard practice to try to group trips together in order to save funds. They have, Addison County does not have a dialysis treatment clinic. They either go to South Burlington or they go to Rutland. So there's long trips involved for anyone needing dialysis in Addison County. There were already some group trips, but through this partnership between Porter Medical Center and TBT and UVA Medical Center, they identified four additional individuals who could change their schedules slightly, change the appointment schedules so that they could share rides together rather than having individual trips. And just those four shared rides saved about $1,300 a month at least. And it freed up volunteer drivers. And volunteer drivers as you've been hearing is one of the most valuable resources that transit providers have because it's the lowest cost option to transport people. So instead of four individual volunteers carrying these four patients, they paired up, Two of those volunteers are now free to do other trips and they save money in the process. So that was one example, an early example of the transit providers and the medical centers working together to coordinate these rides and it's an immediate positive result. Now next slide, thank you. The working group, one of the things they did is begin outreach to medical facilities to try to start to discuss this issue and establish communication channels between public transit and between the working group and these medical centers. So you can see four systems, regional health systems have engaged thus far UBM Health. And you can see there's several facilities listed there. They're one of the leaders in this process, Northeastern Vermont Regional Hospital in St. Johnsbury, Springfield Hospital and Rutland Regional Medical Center. So all of those health centers have already engaged in this process and that's just beginning of it. Another effort that has begun is volunteer sharing. You heard Ross mentioning that before. And the idea here is that transit providers have a crew of volunteer drivers who, as you heard, get mileage reimbursement and carry people for all sorts of purposes. Hospitals also have pools of volunteers. They would come in and spend time with patients. The healthcare side can tell you better what they got, but you're familiar with that. It's been a long standing tradition. And the idea is to try to share these pools to see if some of the hospital volunteers, at least part of the time can provide transportation beyond what they're already doing with the hospitals. And the advantage of working with transit providers is that the transit providers have this ready made infrastructure to get background checks, insurance, reimbursement, all sorts of things ready to go. So if a hospital volunteer says, I have a few extra hours a week, I'd like to do it. They could slide right in, augment the access to medical centers and relieve some of the pressure on the existing volunteer pool with the transit providers. So that sort of cooperation is another important initiative here. And then travel coordination, the same thing that I mentioned before, to connect medical facilities with regional transit providers and to pursue opportunities for share rides. So when we looked at ways to attack this problem, we developed this sort of four quadrant approach to say, well, there's lots of trips happening all over the state, what are we gonna focus on? And you can see in this matrix here, on the left side, we divide into long trips and short trips. There's not specific definition of that, but could think maybe under fifteen minutes, more than fifteen minutes, something like that. And then across the top is frequency of trips. Do they travel frequently a couple of times a week or low frequency? Did they go once a quarter, a couple of times a year or something like that? And among these different quadrants, the primary target we identify are long trips with high frequency. And the best example of that are dialysis trips because these patients have to go three times a week, every week. And the example in Addison County, they have to go 40 miles or something each time. There's a long trips that have to happen three times a week. So that's been the primary target. You can see the two boxes in green are medium priority, something to attack once we've gotten all that proverbial low hanging fruit of the long frequent trips. So shorter trips that are high frequency, maybe dialysis trips in the Rutland area where they have a shorter trip to the dialysis facility there or in Chittenden County or their dialysis facilities all over the state to try to address those. And then another medium priority are low frequency long trips. And the report talks about cases where people living in the Bennington area may have to go to Dartmouth a couple of times a year. And yeah, that's only a couple of times a year, but in Bennington, they're sending a band to Dartmouth just about every day. And if there's a way to coordinate those trips a little more so that they went two or three times a week instead of every single day, that would save a lot of costs. So trying to coordinate those low frequency, each individual patient only goes once in a while, but collectively from the whole region, somebody is going pretty much every day to a distant medical center, either Burlington, Dartmouth, Albany, Boston, places like that. Albany, Boston, not quite as frequent as Dartmouth and UVM. And finally, low priority are the short low frequency trips. That's something that, yeah, in the future we'd like to address, coordinate as much as possible, but not the priority right now. So we tried to set some near term targets because the legislature asked us to look at this and we did some analysis. BPTA collected information from all of the transit providers looking first at dialysis trips. And in October 2025, when this survey was done, there were about 188 riders statewide who took those three times a week trips for dialysis. And then we looked how many of them are already in shared rides and the number was about 57. Not every single ride was shared. Some of them were shared occasionally, some of them others, but roughly a little under a third were shared rides. And then we looked at the information provided from those transit providers, like what days of the week are they going? Which facility are they going to? And what is the current time of their appointment? And then we'd start to say, well, here are some cases where it's only half an hour apart. Maybe those two riders could share and they live in the same town. We could make some adjustments there. That was about 30 riders statewide. We thought with some minor adjustments, we could try to get them into shared rides. And then another 52 riders, we said, well, if there were more significant changes, if they went Monday, Wednesday, Friday, instead of Tuesday, Thursday, Saturday, or if they changed around two in the afternoon to eight in the morning, something like that, that could allow for more shared rides. Obviously, we can't assume that that can happen with the snap of the fingers. There are lots considerations here. Some limits on potential sharing are the capacity at dialysis clinics. They're very busy. They slot everyone in as efficiently as they can and they can't very easily change schedules, but it's worth asking the question and working with them. Another limit on potential sharing is that dialysis is a difficult treatment for people. It's not like you have dialysis and then, well, we're gonna have you sit here for half an hour and wait for the next patient. And then your trip home instead of being forty minutes, it's gonna be an hour and twenty minutes because we have to take this other person home. That's actually asking quite a bit of that dialysis patient because after they're done with the treatment, they may be feeling significant discomfort. So they may be willing to do that, but we can't force them to do that. And we need to be cognizant that it is asking a significant burden on them to rearrange their schedules and perhaps have some additional waiting time when they'd rather just get home and lie down and take care of themselves. Thus far, we've talking a lot about dialysis. Substance use disorder is another significant trip generator in the state. It's about forty percent of all Medicaid trips are for substance use disorder. But the state has already been very successful at grouping these trips. More than ninety percent of these trips already happened in shared rides. There are relatively few that are just one person per vehicle. And in some cases that's because of behavioral issues, in some cases because where that person lives just is nowhere near anybody else getting the trip. So the transit providers are constantly looking to get these rides shared and that's mostly been accomplished. And then the third near term target is the trips to major regional facilities, which I was mentioning before. Looking at trips to Dartmouth, looking at trips to UVM, also Brattleboro Retreat. There are people from all over the state that go to Brattleboro, but a lot of the state is very far from Brattleboro. So looking to coordinate trips like that when possible. And the assumption is that we will try to change those schedules assuming no significant impact on medical care. Obviously, if there's a reason a person has to go a specific day of week and can't change for medical reasons, of course, we're not gonna say, no, you can't go that day. You have to wait till the next day. But if it doesn't make a huge medical impact, then we look for opportunities to reschedule things to allow for coordination. In terms of longer term goals, a lot of this is process oriented. In terms of this patient scheduling process, I mentioned at the beginning that UVM Health has instituted this screen and we'd like that screen to be implemented everywhere that whenever there's a new patient, ask them proactively about transportation challenges. Don't just assume that everyone drives and everything. So just note right away. And then immediately if someone has a transportation challenge, connect them with their regional transit provider. And then as that connection is made, work with the transit provider to coordinate trips from people living in the same general area. To allow that to happen, we have to establish communication channels between all medical facilities and the regional transit provider. In some cases it exists already, but in other cases, there may be somebody who's a frontline staff at a clinic who doesn't know who the regional transit provider is and has not made contact. So over the course, as said, these are longer term goals, over the course of this year, next year thereafter, to establish communication between every medical clinic facility, not just hospitals, but even dentist offices, places people have to go and the regional transit provider. So if somebody says, Oh, well, yeah, I do have a challenge. That person knows immediately, Okay, here's a number to call. They've already met that person, a dispatcher at the transit provider. So they're comfortable even making the call for them or something. But that communication is critical to make this work. And then the third longer term goal has to do with scheduling software. The state is in the process of having enhanced paratransit scheduling software rolled out statewide. This software is all cloud based. You could in theory have a portal available at a medical office so that the frontline staff, instead of having to call a transit provider to say, well, do you happen to have a ride going next Thursday at 11:00? Just have it on a screen there and to see what the rides are. Just a way to reduce the friction in the process and to save time. That's something that would have to be investigated with the technology. So just to wrap it up here, the recommended next steps are to make this working group permanent. It's had born fruit already. The partners are working very well together. The suggestion here is that the working group meets quarterly in those months and that they then work together to report to PTAC, the Public Transit Advisor Committee, which also meets in those months. The working group would set a target for each transit provider to achieve three new shared rides per quarter. Start with dialysis, but a goal is basically one new shared ride a month. Not a mandatory goal, but a target for them to work to. They would report to PTAC, they'd report annually to the legislature each January to say what progress has been made, what barriers have been encountered so that the legislature can help address those. And the other thing the working group is to do is continue its outreach to medical centers and Dartmouth Health is probably the first priority, big important medical center with a lot of facilities in Vermont as well. In terms of next steps for the legislature, monitor the progress of this, including the participation of for profit dialysis clinics. And this is something that we'll be talking a lot about in the report, but some dialysis clinics are not associated with hospitals. They are for profit agencies. They may not play ball because their main goal is to generate a profit. And so to the extent that the transit projects try to do outreach and try to do coordination and are rebuffed, that may be a place for the legislature to step in to try to increase the amount of coordination there. There's a recommendation to hold another joint session of the transportation healthcare committees as was done last year. Another long term suggestion is to consider holistic accounting of the costs of healthcare and transportation. And this came up significantly after the famous October 2024 report for the Green Mountain Board suggesting consolidation in centers of excellence. And the transit providers all went and said, Uh-oh, that means a lot longer trips. It means we can't go to our regional facility anymore. We're gonna have to take someone halfway across the state. And that's not to say it shouldn't be done, but the transportation impact of that have to be accounted for in a clear way. Because if that's really gonna raise the cost of transportation that has to be counted against any potential cost savings on the healthcare side. And then finally, the legislature last year invested in volunteer coordinators. And another role at transit providers are mobility managers. And that's sort of the analog to that care management team that I mentioned at the beginning of UVM Health. People who are dedicated to working with particular riders to help them adjust their schedules if necessary, to help figure out ways that they can get rides at places beyond just the public transit provider, family friend network, all sorts of churches, other things. A mobility manager would be tasked with that to help manage the demand level. As we've heard, the demand level keeps rising with an aging population. We expect it to keep rising. Mobility managers can help relieve some of

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: that pressure. And with that, I

[Steven Falbel (Principal, Steadman Hill Consulting)]: will turn it over to other witnesses or answer any questions you may have.

[Representative Phil Pouech (Ranking Member)]: In this process of looking at this, did you look at other states or other areas and are they sort of doing the same thing, struggling the same way?

[Steven Falbel (Principal, Steadman Hill Consulting)]: They are certainly struggling in a number of ways. Did a national search for examples of this and trip coordination is something that everyone tries to do to get shared ground. I look specifically the cases where transit providers or other state agencies were working directly with the healthcare sector to try to have this partnership in adjusting medical appointment schedules to allow for it. And I did not find any examples of that. Vermont is again, a leader in this sort of there is a thing called HealthTran in Missouri. I tried to contact them many times. They were very busy, I guess, and never returned my calls to find out what they were doing. But there are cases of transit and healthcare working together, but I did not find any examples of this specific partnership where they're saying, yeah, well, let's actually change how we're scheduling patients, try to increase the number of opportunities for shared rides.

[Representative Phil Pouech (Ranking Member)]: And Jeff, this might be for Ross. I assume in the volunteer drivers when you're in the program, there's always an attempt to sort of combine rides in those. And I imagine some volunteers are willing to do that, some might not, so that could be challenging. In our neighborhood, we have a elderly person who doesn't have a car. So neighbors sometimes help and family members help, which is good, but is there a way to sort of combine the programs that we don't wanna add more volunteer drivers who are gonna do it anyways, I guess, but at the same time, I don't know if there's

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: You can grow that network and one of the interesting points is talking about these types of efforts, the rural planning commission person says, the person who lives across the hall from me in my apartment building, I take them shopping with me every week. Oh yeah, well I just brought somebody to do cataract surgery because my wife is going on that way. We have our own neighborhood in Little Peacham right where we are helping folks. That's happening organically that's why this isn't a $60,000,000 program it's a 6,000,000 program because of family and friends and communities like you. Was wondering like how do we tap into that how do we further incentivize those type of assistance? And so I think that that's something to do but this ongoing conversation with the partners that we've met is definitely the next step and using that data my hope is that each provider will have their own plan of action to follow through on this nation's work that's been started.

[Representative Candice White (Member)]: Yeah, just want to say thank you for this very clear presentation and it's great to see this type of work happening. I think there's a lot of promise in that. And the mention of the mobility management, when you're talking about the friends and neighbors, I mean, you had a system where you could say, Patient A has a neighbor and a friend. So maybe the neighbor and friend is not available to other people, but goes into the mobility management of this particular person. That sounds like a good idea. There won't be a cost involved. But anyway, just great results, thank you.

[Representative Matt Walker (Chair)]: Do you want to help? I

[Speaker 0]: was just like, yeah, is great, really, very pragmatic and scuba. Are there any issues with HIPAA? Privacy, violence, I just wondered, just seem like every time you turn around, there's something that's because of HIPAA.

[Steven Falbel (Principal, Steadman Hill Consulting)]: I'll probably let the healthcare sector talk about the HIPAA. The analysis that we do was very cognizant of HIPAA issues. And so the report doesn't have any identifying information of anybody in it. But the transit providers deal with HIPAA all the time because of so many medical trips and Medicaid regulations. So that definitely accounts for it. I'll let my healthcare friends

[Representative Matt Walker (Chair)]: Who's speak to that up next? Should we

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: go to Karen and then Kevin? Great, I'll let him sit here for Karen.

[Karen Vastine (Senior Community Relations Officer, UVM Health)]: Hey, good morning and thank you for having us here today. I am actually joined by my colleague, Doctor. Natasha Withers. And if it's okay, we figured we could testify jointly and that way you can ask us both questions if that's all right with the chair.

[Representative Matt Walker (Chair)]: Excellent.

[Karen Vastine (Senior Community Relations Officer, UVM Health)]: Okay, so for the record, my name is Karen Bastien and I'm the Senior Community Relations Officer for UVM Health.

[Dr. Natasha Withers (AVP Medical Director, High Value Care, UVM Health; Family Physician at Porter)]: Natasha, do you to? I'm Doctor. Natasha Withers. I am a family doc at Porter and I'm also AVP Medical Director of our High Value Care team at UVM Health.

[Karen Vastine (Senior Community Relations Officer, UVM Health)]: So as you all heard, this has been just such an incredibly positive experience in deepening our collaboration with the transportation providers. So we just wanted to share with the committee on behalf of UVM Health that we are in support of the recommendations that Steven just walked you through. And I think all of us have just appreciated having the opportunity to do this real time problem solving that Steven referenced in report. And I was hearing the questions in the conversation about the community driver program and that conversation that you all were having about, oh, there's a lot of us doing this anyway. Those are the kinds of things that we've been thinking about with our volunteers at the hospital. So as part of this initiative, we're actually working with our volunteer coordinators at our three hospitals, which is Porter, Central Vermont Medical Center and UVM Medical Center, to see if there's a way to also encourage folks who are already coming to the hospital to volunteer their time if they would also be interested in taking on a couple of driving opportunities a week too. So we're excited to help VTrans and our local transportation providers get the word out and increase interest in this program. And so just in short, we're just looking forward to the continued partnership that Stephen laid out in the report.

[Representative Matt Walker (Chair)]: Thank you. Natasha? Natasha, anything to add?

[Dr. Natasha Withers (AVP Medical Director, High Value Care, UVM Health; Family Physician at Porter)]: Yes, I'd love to. So thanks so much for the opportunity. And I just wanted to kind of highlight the collaboration that happened between our dialysis units and the transit provider. This has been a really positive experience on both sides. The dialysis units for years have looked for ways to put patients together that have shared rides, but did not have the unique connection to the transit provider. So being able to put those two parties together and see how quickly they were able to problem solve and have such an impact in short order, was really a powerful example. And we are really looking forward to other opportunities. They continue those collaborations and discussions on a regular basis. So I imagine next time we report out that we will have even more successes to tell you about. And we're also looking for other opportunities where shared rides make sense. So we are fully on board with this. And as Steven mentioned, we also are identifying patients in our primary care practices that may have needs that have not previously been identified. So really looking forward to those ongoing discussions and how we might use our care management team and the screenings that we're doing to match resources appropriately in the community. So thanks so much for the opportunity. I appreciate it.

[Representative Phil Pouech (Ranking Member)]: Thank you. Representative Pouech. Yeah, thanks. And it's good to hear that the medical providers see this need too and are willing to join in. We talked about the initial screening for new patients. How do you identify a patient who may be all of a sudden has new medical needs that require transportation or their situation changes, now they might need transportation and might not know to tell the doctor or whoever, I'm not sure I can get to this appointment or yeah. I assume those are picked up. How is that typically done?

[Dr. Natasha Withers (AVP Medical Director, High Value Care, UVM Health; Family Physician at Porter)]: So we try to screen patients once a year. So if they're a new patient to us, we screen them. But if they're coming in for a wellness exam, we're also screening them. I think as a result of this screening and just general awareness around this issue, providers are also starting to ask these questions sort of ad hoc. So if they're saying you need to get to a specialist, they're starting to ask questions, can you get there? Do you have transportation? And because we have resources, it's really easy to ask those questions and be able to then take the next step. I think historically, not having that next step has been a barrier to asking the questions. But since we have that full system in place now, it's really working quite smoothly.

[Representative Phil Pouech (Ranking Member)]: Thank you. That makes total sense.

[Representative Matt Walker (Chair)]: Anybody else have anything? Okay. And we're gonna go to both. Thank you very much for joining us. There's a lot of enthusiasm. It's nice to have

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: a positive piece. We do have Kevin and I crazy time.

[Representative Matt Walker (Chair)]: Oh, that puts a lot of pressure on me.

[Karen Vastine (Senior Community Relations Officer, UVM Health)]: Thank you for having us.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Good morning. My name is Devin Green. I'm with the Vermont Association of Hospitals and Health Systems. We represent all of Vermont's hospitals. So actually 16 hospitals in total, 14 community hospitals, one VA and the Brattleboro Retreat. And all of our hospitals are nonprofit. Thank you for having me in here today. I don't often get to come into this committee, so I appreciate it. And I see it as a real sign of the times. Like Karen and Doctor. Withers, I'm very appreciative of this work and working with this group. As you all know, Vermont is, according to the US census, the most rural state in the nation, and that provides us with a lot of transportation challenges and a lot of health care challenges. And so it's very timely to have us coordinating together. And as was mentioned, I think a lot of good has come out of this. When I reached out to hospitals about sharing their volunteers, a bunch of hospitals, six hospitals jumped on it immediately because they didn't realize that there was an opportunity for their volunteers to have the liability protection and insurance that comes with this organization. And so that was really helpful making that connection. And I think we can reach into other hospitals to sort of tap into that resource. Unfortunately, our volunteer population has been hit pretty hard with COVID. They tend to be a little more elderly. So there only may be so much that we can do there, but it's still a great way to coordinate and sort of make our resources stretch as much as possible. So really appreciate that effort. I am looking forward to the opportunities around the scheduling software that is happening, and we are looking at our own software and seeing if there's a way that they can communicate to further increase functionality. So I think there's a lot of opportunity there. We've also, this is late breaking news, but I did reach out to Dartmouth Health. They are interested in pursuing coordination opportunities as well. So in all, I really think that there's a lot of work that can be done here, and I appreciate starting off at this level. And I do want to stress that our hospitals have transportation really high on their priority list. We are looking to go through a transformation process where services may be put in different places, And we understand that transportation is going to be a core function if that happens. And so we are really grateful for the opportunity to start with this collaboration and continue going forward to meet those needs. So thank you.

[Speaker 0]: Representative White? Just a quick question.

[Representative Candice White (Member)]: I believe that UBM contributes to public transit in their area. Do all of your hospitals that you represent contribute to public transit costs in their don't state areas? Actually know.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: I can get back to you with an answer to that.

[Representative Phil Pouech (Ranking Member)]: Yeah, thanks. I can see where in your systems between the volunteer, the new scheduling system where somebody has an appointment, they're there and now, or they're calling and they have an appointment and they go to schedule that appointment, if there was an indication that, hey, they need transit too, that might help to sort of bridge the two pieces together at the same time seamlessly, I guess, rather than just, oh, next Wednesday, I got an opening. Next Wednesday, gotta find a ride to get there.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Right. And the goal is seamless. I'm just going to manage expectations with electronic health records and with our systems. And I'm sure you all have the same issue with software. A lot of work can go into it, and it doesn't necessarily always end up seamless. But I think there's real opportunity given the new work that's happening here and then what the hospitals are doing as well.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: Potentially a pilot where we can have an application on screen where that scheduler, the healthcare provider has access and can actually book the trip, understanding that process, that's a worthwhile pilot in the next twelve months and they will be seeking that. And when we talk about volunteers, when I think about those facilities to have those posters of welcoming people to become a community driver, becoming a volunteer, we might be hitting folks right at the right time. And so even those types of advocacy steps could be meaningful to our outreach.

[Speaker 0]: Was going to ask you if you are just doing that as practice. If somebody says, hey, do you have a ride? Do you have a way to get here? If that's just something that's being gathered.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Yeah, I think in general, as was mentioned, and as you all have probably experienced, when you go for your annual visit, there's usually a survey that you have to fill out, and it asks about your food needs, your housing needs, and your transportation needs. So we think a lot of our hospitals are doing that already. There may be an opportunity to standardize that more, and we just want to make sure that we were meeting the that questionnaire is usually a part of a broader quality measures piece. And so we just wanna make sure that we're meeting that.

[Representative Candice White (Member)]: I I was I guess I

[Speaker 0]: was wondering at the moment of scheduling

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Oh, right, when you're doing the phone call.

[Speaker 0]: By practitioner assisting somebody perhaps who needs that or by somebody just calling up. I get an annual mammogram, somebody could say, hey, are you all set for getting here? It would be just one thing.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: I think that could go well in conjunction with the software piece, because I think the main, as Karen alluded to, the main issue is our providers do not like to ask a question more than they can't help the person. If they're asking if you have transportation and then we don't have the transportation to offer them, then that is an issue. But if we have a good system in place where we can seamlessly schedule them right then, I think that is more likely to happen.

[Representative Matt Walker (Chair)]: Anybody else? I think Grace is on our list next for testimony. Clayton, you had something you wanted to ask in between or

[Clayton Clark (General Manager, Green Mountain Transit)]: I just wanted to point out something that the University of Vermont Medical Center did that was amazing to help Green Mountain Transit is that they, this past year, did an unlimited access agreement with their employees, which gives us $60,000 worth of extra local match. And I'm really happy to report that we've seen ridership from hospital employees grow since that was put in place. And so I wanna make sure folks know of View of any medical centers could work in that.

[Representative Matt Walker (Chair)]: Thank you very much. I guess we'll go to you now, Grace.

[Grace Johnson (Medicaid Policy Unit, Agency of Human Services)]: Thank you. For the record, my name is Grace Johnson. I'm the Medicaid Policy Unit at the Agency of Human Services. I just want to thank you for the opportunity to be here in committee today, and thank you, Steven, for the presentation. I think we would just like to echo everything that has been said so far. And on behalf of the departments and the Agency of Human Services, I would just like to note that we appreciated the opportunity to be a part of this collaborative effort, and we look forward to working with this group moving forward to ensure that we're providing the best service possible to Vermonters.

[Erin Frank (Town Manager, Colchester)]: Wow,

[Representative Matt Walker (Chair)]: something seems up and down today. Ross, do have anything else that we want to add? Grace, thank you very much.

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: It's time to provide regular updates and final requests. Yeah.

[Representative Matt Walker (Chair)]: Anybody else in the queue? Okay. I know that we're all set for this piece. I think we covered everybody that was here for this morning. Caleb, you got skipped earlier. Don't know

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: if you wanted to jump back in.

[Representative Matt Walker (Chair)]: Anything you wanted to update us on?

[Steven Falbel (Principal, Steadman Hill Consulting)]: I'd hate to hold

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: it from lunch, but happy to discuss both the Medicaid program and the O and D program, which were,

[Erin Frank (Town Manager, Colchester)]: I believe, the agenda items of my testimony.

[Representative Matt Walker (Chair)]: If you You said you have something to say? Yeah, we got 10. Okay, we

[Ross MacDonald (Public Transit Program Manager, Vermont Agency of Transportation)]: have two.

[Representative Matt Walker (Chair)]: Excellent. Thank you.

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: For the record, Caleb Grant, the chief executive officer of rural community transportation provider of Essex, Lemoyle, Orleans. There's a lot Essex, Orleans, Caledonia, Lemoyle, Grand Isle, and Franklin Counties, as well as the chair of the Vermont Public Transportation Association. So I'd like to begin by thanking the O and D committees. It is work that all of you are familiar with. It's painful and it's strategic rationing. We begin each year with looking at both our request and what is awarded for the O and D budget. And then it's the process of extremely difficult conversations. I think what you saw this morning was the outcome of those incredibly difficult conversations. I realize it sounded very complex and a bit heated at times, but at the end of the day, you're making hard decisions. You're choosing which finger you want to cut off. Guess what I would like to share is a little bit of perspective as we go across regions and some statewide context. There's regions where the OND conversation really begins with looking at population dynamics. How many individuals do we have who fall in the older adults and persons with disabilities? Context, how much kidney disease do we have in the area? How much cancer do we have in the area? In the Northeast Kingdom, we've done those forecasts and found for the past two years, maybe longer, that two nutritional access trips. I say that because sometimes it's grocery store, sometimes it's the food shelf, and four medical trips was as much as we could do. I understand there's been some really painful select board meetings. I'm sure all of you have received testimonies or emails from constituents saying, this is something I'm losing. You want to hear real pain, sit in our call center. Our call center receives about 1,300 calls a day. A thousand requests for trips, for rides, and we can typically provide anywhere from six to 800, depending on how many volunteers we have that day, how much carpooling we can do. And that leaves an enormous amount of really unpleasant answers. I know you don't have groceries, but we can't get you to the grocery store today. I know that you need to go do this thing, but it is a challenge. So I just want to acknowledge the work of the O and D committees and a huge amount of appreciation for VTrans, who continues to be exceptional stewards of what is a limited budget for an exponentially growing need. As our population ages, as mobility decreases, this is only become a more complex problem. I was heartened by your closure to the last testimony. I think there's only gonna be more hard decisions. Costs continue to go up in this past year by no action of our providers across the system, our insurance costs went up by a million dollars. That is vehicle coverage, is umbrella coverage, there's any number of things. And nothing that we did impacted that. That's just how the industry would go. So we will continue to have these conversations and update all of you, but I just wanted to acknowledge that challenging and difficult work that our O and D communities do. The other thing that I wanted to mention, another big aspect of our program is the Medicaid transportation program. We eagerly are awaiting the award of most recent RFP. I'm proud to say that VPTA submitted what we felt was a very competitive application. And I'm excited to see what the outcome of that will be. And hopefully your regional providers will continue to provide that service. But unfortunately, we also need to face the current contract. We are in the second extension, taking us into year five of a three year contract. All of you are familiar with the dynamics of contracts. That fifth year, those negotiated rates from five years ago, if anybody can remember what the world looked like five years ago. Two years ago, the legislature took action in the Budget Adjustment Act to address shortcomings in the budgeted amount. And we are seeking that in this year's Budget Adjustment Act as well to cover losses from last year's fiscal outcome as well as projected shortfalls in this outcome. So it is one of those critical areas where transportation and health care collide. I would ask that you reach out to your colleagues in the healthcare committee and encourage them to address transportation deficits in the Budget and Act, as well as any colleagues in the Budget and Appropriations Committees to address that in this year's Budget Adjustment Act. Because as providers sustaining the losses, RCT experienced pretty significant losses in O and D, because we didn't feel we could go below four medical trips and two nutritional access trips. And that leaves us in a situation addressing deficits, but the losses in Medicaid were dramatic. So I would just encourage you to have those conversations with your colleagues because those conversations are what gonna keep your regional providers viable. So with that, I'm happy to answer any of the questions, but those are the critical points I wanted to address as addressed in the agenda.

[Representative Phil Pouech (Ranking Member)]: Yeah, thanks for sort of bringing it together here and pointing out a couple of things. One, the contract for Medicaid, am awaiting that too, because that's a critical piece. And it's important that the legislature that we know that soon we will continue that process because if it changes, that's gonna upset the apple cart in a big, big way. The other piece is maybe Ross or somebody could just provide us just a one page, half page thing about the budget adjustment and where we are in the fifth year of this three year contract as far as how deep in the hole are we and what is the ask, I guess?

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: I will provide that to you as soon as we leave Israel. And I appreciate that acknowledgement. I think we've seen it play out in other states and we'll address decisions as they come. But confident that the submission that we put up for consideration is competitive and considerate and obviously addresses. So come January, February next year, I'm not sitting here saying the budget fell short. The new contract addresses those things and had a possibility of a start date in January, which obviously without a decision is not a possibility. But it is the nature of a two year extension on a three year contract. The numbers just don't match anymore. Yes.

[Representative Matt Walker (Chair)]: Yeah. Yeah. Rick Steinberg?

[Representative Candice White (Member)]: Yeah. Following up on that,

[Speaker 0]: is have we made any request or is us making any requests or is B TRANS making any requests or your shortfall?

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: So we did make a request of DIVA that did not make it into their Budget Adjustment Act. We provided testimony in the open call in the budget committee yesterday. We have not had the opportunity to testify in front of the health care committee, but they have been aware of the memo that we've provided that outlined all the shortcomings in relation to the budget and the actual costs.

[Speaker 0]: So if we were to talk to our colleagues on the Appropriations Committee, we would reference your presentation

[Representative Matt Walker (Chair)]: then?

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: We were not given the opportunity for presentation within the healthcare committee, but they have been should provided with a memo. Be able to reference Jim Malton's testimony yesterday, which addressed the high points. But again, I'm happy to provide that memo to anybody who's interested in joining us in advocacy.

[Representative Matt Walker (Chair)]: Anybody else? And

[Representative Candice White (Member)]: I may have missed this, but where are the contract negotiations right now?

[Caleb Grant (CEO, Rural Community Transportation; Chair, VPTA)]: So there was no timeline in the RFP request. So we have responded clarifying questions and are awaiting a decision.

[Representative Matt Walker (Chair)]: I very much appreciate your flexibility and patience this morning, and I'm glad to get you into the seat and to hear your piece. And thank you for all that you're

[Erin Frank (Town Manager, Colchester)]: doing.

[Representative Matt Walker (Chair)]: With