Vermont Legislature SmartTranscripts:

[Emilie Kornheiser (Chair)]: By the means, it is still Tuesday, February 24. We are continuing our education finance Tuesday afternoon testimony with a look at H-five 58, which came over from House health care. And I'm really excited for you to take us through the bill. Thanks, Jen.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: Great. Good afternoon, Jen Carvey from the Office of Legislative Counsel. I'll put the language up. We are looking at H-five 58, an act relating to Medicaid, the Medicaid School Based Services Program. And kind of on a broad level, the bill would transfer sole authority over the Medicaid School Based Services Program to the Agency of Human Services. Right now, there's some administration done by Agency of Human Services and some done by the Agency of Education. So this would create a new section in title 33 in the chapter on Medicaid, on the Medicaid school based services program. It starts by expressing legislative intent that the state maximize its receipt of federal reimbursement for medically related services provided to students who are eligible under Title 19, the Medicaid title of the Social Security Act, and expresses legislative intent that Vermont's school based medical assistance program shall comply with all federal Medicaid requirements and that as the state Medicaid agency, the Agency of Human Services will have the sole responsibility for determining and maintaining program compliance. Then it gives the duties of the Agency of Education as it relates to the program. So the Agency of Education will be responsible for coordinating the school based medical assistance program with statewide education policy and objectives and for communicating with supervisory unions. And that agency may specify the use of program funds that are received by state education agencies as spelled out in existing statute that then gets amended in the bill. Directs the Agency of Human Services to adopt rules to identify services that are available through the school based medical assistance program and set forth requirements for supervisory union participation. And the rules will include state and federal requirements for Medicaid reimbursement, Medicaid cost reports, provider enrollment and trainings, Service Documentation, Medicaid Eligibility, and anything else necessary to comply with the Medicaid program. And then it directs the Agency of Human Services to support supervisory unions by funding and providing the technical elements of the program necessary for federal compliance. Section two adds a new section just following that. It creates a special fund, but what it actually does is repurposes or gets rid of one special fund in the education world and creates it in the human services world. So you'll see in upcoming sections that it strikes the existing school based Medicaid reimbursement fund in Title 16. So this establishes the School Based Medicaid Reimbursement Fund as a special fund to receive federal reimbursements for medically related services delivered under the Medicaid School Based Services Program. And the monies received by this state will be transferred to the school based Medicaid this fund, will be administered by the Agency of Human Services and fund receipts will be allocated in accordance with this section. This directs the Department of Vermont Health Access to pay 55% of the federal reimbursement monies generated by these medically related services delivered in each supervisory union under this program to that supervisory union based on the Medicaid cost reports, service claims, and Medicaid administrative costs submitted by the supervisory union. And I think Ashley is going talk to you about the sort of existing programs, and there's a little bit of money change here. I think it's 50% under the current statute. It would be 55% in this one that would go back to the supervisory union. Up to 25% of the federal reimbursement monies generated by the services delivered under this program would be available for the administrative costs of the two agencies related to collecting, operating, and reporting the school based medical assistance programs and statewide programs. I think that is up from 20%, unless it's down from 30. Anyway, Ashley will talk to you about the money. We'll look at that as we go through the struck out stuff and look at struck out a little bit too. Directs the agencies to enter into a memorandum of understanding, setting forth the processes by which Medicaid reimbursement monies available for administrative costs and statewide programs are allocated to their respective agencies. But it also specifies that the Secretaries of Education and of Human Services will spend money from the Fund only as appropriated by the General Assembly and directs at the close of each fiscal year, the Commissioner of Finance and Management to transfer and deposit any balance remaining in the Special Fund into the Education Fund. Now you can see this is the existing statute that gets referenced in Section one. This is 16BSA 2959A. And the title of it changes, and it it changes some of the language to align with the new language added in section one, expressing legislative intent to maximize receipt of federal dollars for reimbursement under the Medicaid program that are eligible and in compliance. And then also sort of makes a few modifications to existing language expressing legislative intent that each supervisory union identify special education and other students who are eligible for Medicaid reimbursement and to the extent possible submit, and this changes the language a little bit, Medicaid compliant cost reports and service claims to more accurately track what is required. And keeps language saying that the two agencies work with local school districts to maximize reimbursements, including services to non IEP students. So you can see the struck language in the existing law on the Medicaid reimbursement special fund. So this is the special fund that kind of becomes the new special fund in Title 33. Here's that 50% that struck through that goes into the goes back to the supervisory union. That is now 55% in this bill. And then there are some particular amounts around what happens to be excesses that would be streamlined in the new legislation, the new version, and then just changing some of the references to refer to the new language. And then so this 30% is available for for administrative costs. Now that becomes 25%. And as under the current law as struck here, the remaining amounts, reimbursement amounts go into the Ed Fund. The bill also directs the agency of education to adopt rules and their responsibility for rules is to set forth the requirements that supervisory unions and school districts must meet regarding the use of Medicaid reimbursements from the school based Medicaid reimbursement fund and coordinating reimbursement related to state place students with the Medicaid School Based Services Program. And the rules will address the manner in which supervisory unions receive and reconcile funds in alignment with education cost reimbursements under that Section 2,950. Finally, the act would take effect on July 1. So big picture is it comes all of the kind of regulatory compliance work entirely to Agency of Human Services and then make some modifications in the amounts that go back to the supervisory union and that are available for administrative costs.

[Emilie Kornheiser (Chair)]: Questions for Jen. We'll hear from Ashley from the Agency of Human Services about some more context of all this.

[Charles "Charlie" Kimbell (Ranking Member)]: Yeah. Where do the balances balance remaining go now?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: It goes to the education button that whoops. That language is is in there. The existing law, but gets struck because it's moved. But you can see on the top of page eight Row seven. Row seven.

[Emilie Kornheiser (Chair)]: It's so tiny.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: Very But yes, under existing law, remaining reimbursed funds go into that fund.

[Rebecca Holcombe (Member)]: Did this bill go to the education committee? No, it's just going go I

[Emilie Kornheiser (Chair)]: think they're going to visit it, but it won't be formally referred.

[Rebecca Holcombe (Member)]: So can I just talk more about that in mind? Yes. When you say the bill transfers sole authority, one of the concerns I have is that districts have statutory liability for making sure that students receive the services required by an IEP in a timely way. And there have been significant challenges in some parts of the state when they've depended on the designated agencies in particular because they've been underfunded or have trouble with staffing. So the penalty or the liability goes back to the school districts. So I wonder how this works. Is this bill also transferring that liability to AHS so

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: that Can I you defer these questions to Ashley who may know more about this because she lives in the weeds of Medicaid housing?

[Emilie Kornheiser (Chair)]: We'll ask her when she

[Rebecca Holcombe (Member)]: comes up. Can I ask just a couple? When this bill was being drafted, were people thinking ahead to some of the transitions happening at the federal level, including some of the is this was was the impetus also to mirror what's happening at the federal level with the shutting down of the department and moving of services over to AHS?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: Don't believe so. But again, I will defer to AHS because I think that is where sort of the AHS I know h the agency Education Agency of Human Services has been working closely together on developing this proposal. So we'll defer to Ashley on what their thoughts were, but I think it it's focused more on ensuring the locus of responsibility for Medicaid

[Rebecca Holcombe (Member)]: compliance. I understand that. And on page two, in section B2, you refer to state education agencies in the plural. What are the other state education agencies other than the Agency of Education? My understanding that this is some terminology that is used in the statutes, but this is not my area. So if it is not the right terminology, I'm happy to make modifications.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I think this was language that was provided to me by the two agencies. So Can you run it? Relied upon it.

[Emilie Kornheiser (Chair)]: Will you run it by Beth? Sure.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I think I did. Oh, okay. By from the the bill before it

[Rebecca Holcombe (Member)]: was introduced by Beth. I'm wondering if it's a reference to Elliot's, which will think education agencies more so the same. Yeah. And I didn't know if that's what you were trying to get at there.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I think no. I think the point is education agencies in this state, not the state agency of education.

[Rebecca Holcombe (Member)]: In the health care committee, was there any discussion of unintended consequences or potential financial incentives that are created? And for example, in Section C, when sole responsibility is defined at AHS, one of the changes that happened recently is we moved from bundled rates to bundled services. And if a district is receiving a tremendous amount of increased tax capacity or potentially in the future, a larger foundation block to provide some of these services, If they feel they can't get the services through the DAs, and that's how this has been defined, are we potentially creating an incentive for districts to caution back to the Ed Fund for some of these services?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I don't think I know enough about the education money flow to answer that question, but there may be other witnesses who can do that.

[Emilie Kornheiser (Chair)]: I have a somewhat like, a very technical question, more about how statute works than even this particular Okay. That's in

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: my world,

[Emilie Kornheiser (Chair)]: yeah. So, and I really mean this purely technically, though I know it's sort of a controversial topic. But if in statute we essentially remove supervisory unions and only have school districts this year, will conforming changes move through all of statute? Because you have supervisory unions referenced here. Or will we need to?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: So I think it's a good question. That's all

[Emilie Kornheiser (Chair)]: we'll do all summer. It's just

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: Probably. I mean, I think it's going to be a matter of how you set it up in whatever legislation changes terminology. Often, it will direct my office to go through the statutes and make the changes during summer statutory revision. But if they're not clear, one to one, change this term to that term, then it can require an additional piece of legislation. But sometimes you could put language in saying, you know, for this transitional period, statutes that still say whatever term shall also be interpreted to mean this meaning for these purposes or list the statutes or something. I mean, we have ways to work around to achieve your legislative intent without letting some of the processes get in the way.

[Emilie Kornheiser (Chair)]: Okay, thanks. And I think SU is appropriate in the current law context.

[Rebecca Holcombe (Member)]: Well, actually, have a question about

[Emilie Kornheiser (Chair)]: that because I don't think it is. You don't? Okay.

[Rebecca Holcombe (Member)]: There are already districts that have Boards of Collaborative Education services, one of the whole ration, even SUs are not big enough for some of the kinds of services that are being provided. So will this language preclude how would work in the context of a board of collaborative education?

[Emilie Kornheiser (Chair)]: I meant that SU rather than SD was more appropriate, but your question makes sense. Yes. Yes.

[Rebecca Holcombe (Member)]: The whole other construct that isn't in there. Don't know. Okay.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: And I do do you have agency of education folks you're gonna hear from? Or

[Emilie Kornheiser (Chair)]: No. We're just gonna hear from Ashley right now. But this is not the last time we'll talk about it.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: Okay. Otherwise, you'll want somebody who speaks education to come in. Right.

[Rebecca Holcombe (Member)]: One more. Yeah. That's statutory language. Several times here, it sets forth that the purpose is to maximize the use of Medicaid reimbursements. Does that mean that if they have option of billing to Medicaid, the district is compelled to purchase the service in a way that makes them access Medicaid? I don't believe so. Think, I mean, it's largely, I think, in the context of intent, and

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I think it's really just sort of broad messaging that our purpose is to try to comply with the federal requirements to ensure that we are not inadvertently leaving money on the table that would otherwise be reimbursable. But I don't think it actively compels behavior that wouldn't otherwise be occurring.

[Rebecca Holcombe (Member)]: That would happen in rules, in my understanding? That would be up to the agency of human services to decide in the rulemaking process?

[Emilie Kornheiser (Chair)]: Is it in a section that would lead to rulemaking, or is it just in the section?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I mean, I think the language about maximizing receipt of federal reimbursement as appropriate is really in the intent language.

[Emilie Kornheiser (Chair)]: Which has like, in terms of what the intent language actually means in a bill is nothing?

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: I mean, it is But It is advisory. Okay. I would say I mean, you know, it it's not I wouldn't say intent language is generally not enforceable, but it can help a court interpret language or outside or federal agencies to interpret what is intended by language. But I don't think you can independently compel enforcement of intent. Thank you.

[Emilie Kornheiser (Chair)]: Anything else for that? Not right now. Okay. Thanks. Thanks, John. Ashley, do you want to join us? Welcome to Weight and Means. Thank you. I don't think you've been here with us before.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: In maybe a decade.

[Emilie Kornheiser (Chair)]: We are glad to have you. I'm never it's always a balancing act. If You're here to explain why we're doing this, and we've already looked at the language, and that's a little confusing. But you're welcome to start at whatever beginning you want to start at.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: Great. For the record, I'm Ashley Berliner. I'm the director of Medicaid policy for the Agency of Human Services. I'm going to share some slides.

[Emilie Kornheiser (Chair)]: So if folks have more questions about the legislative language after all of the conversation with Ashley.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: We're in business. Yes. So I am going to provide the backdrop that Jen just shared around all the statute. Why are we actually doing this? So first, I want to just start. Maybe you know this already because you are focused on education. But what are Medicaid school based services? And those are health related services provided to Medicaid eligible students in schools funded by Medicaid dollars. And they're really the services provided to Medicaid recipients that are medically necessary. And they're treated differently than the same service would be treated outside of the school, because the very nature of the fact that it's being delivered in schools means that a separate set of regulation and policy applies to those. So there are different requirements about provider qualifications and documentation and billing. The setting makes it a unique set of services in the Medicaid program. Okay. So for the past eighteen months, we have been working really closely with the Agency of Education to implement really significant school based services reforms, including an electronic health record and a random moment time study that we plan to implement in October 2026. We are planning to include substantial training and onboarding support to schools and school staff, beginning school year 'twenty six-'twenty seven to meet CMS grant requirements. And we are also aiming to solve numerous existing programmatic issues with the school based services program as it exists at AOE, encourage school participation through administrative efficiencies. So we do have a federal grant that is allowing us to move a lot of this work forward. It's a three year grant that started last year. So we're in year two. And the pillars of that grant are, as stated here, ensuring federal compliance, expanding access to care, reducing administrative burden for schools and the state, and maximizing federal Medicaid reimbursement. And representative, just to speak to your question specifically about are the schools compelled, Schools are not required to bill Medicaid. They are required to deliver the service. They are not required to bill Medicaid. So our goal is really to make it as easy and favorable to the schools as possible for them to participate in the Medicaid program. Right now, Vermont is really uniquely situated in the country where it has 100% of its schools engaged in the Medicaid program right now. That is not something we take for granted. Other states do not have that level of participation. Many schools do not bill Medicaid across the country. And so we really are focused on maintaining that, making sure that we're just making this even easier than it is today, a lot easier than it is Vanessa?

[Unidentified Committee Member]: Yes, Sandy. What do you attribute to our 100% participation?

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: I couldn't even begin to opine on that. Continuous effort? Am with the agency of human services, not the agency of education. So I think they would have to speak to that.

[Unidentified Committee Member]: Okay. But I appreciate that. Thanks. Yeah, sorry. That's all right.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: So before I get into what the statute says, I really think it's important to understand the broader framework of the work that we're trying to do around school based services. And it's really, simply put, a broken system as it exists today. We've identified numerous programmatic issues and have committed to CMS that will be transforming to a new payment methodology by 10/01/2026. We're thinking about this in a three pronged, three leg of the stool framework, where we have needed change in program administration. That's moving the program from AOE to AHS. Creating a new payment methodology, which is adopting the random moment time study, RMTS, and ensuring that we are capturing sufficient clinical encounter level data, which we're going to be doing through the implementation of electronic health record. So getting into the specific statute. What that statute is saying in plain language is that for AHS, it'll be establishing a special fund for the agency to receive and reimburse schools for the federal portion of a Medicaid payment for these school based services. It establishes AHS and Diva as the administrator of school based services, moving that away from AOE. It provides rulemaking authority for AHS to establish requirements related to school based services. And it requires that AHS support schools by funding and providing tools needed for program compliance. So AHS is committed to funding in its entirety the RMTS system and the electronic health system for all of the schools in Vermont, all of the public schools in Vermont. For AOE, it authorizes AOE to define how schools may use federal payments from AHS to the schools. AOE refers to these as reinvestment dollars. And I just want to stay there for a second to make sure that it's understood today how it works. Schools spend 100% of the cost of school based services out of their budget on the front end. They are paying 100% of the cost. Whole dollars is how we think about it, as opposed to a matched dollar. In the Medicaid world, typically, we would have a 55% roughly of every $1 spent on the Medicaid program is matched by the feds. So if the federal government is paying $0.55 of every dollar, it's probably significantly higher in the schools because of enhanced matches. But just for illustrative purposes, we'll keep it at 55%. Schools are paying 100% upfront. And then they're getting reimbursed a share of the federal percentage. So of that $0.55 some of that is being sent back to the schools, not all of it. And we'll get into the percentages on the next slide. And what is being sent from the federal portion to the schools are these reinvestment dollars. And so that is in this statute. And as it exists today, AOE is authorized to define how schools can use that federal payment into a school. Even though they've already used it for some time?

[Emilie Kornheiser (Chair)]: Yes. And then, so they're sending it to the schools, and then the other

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: portion is what we see as the Medicaid payment into the Ed Fund. Yeah. So we'll get into that in just one second. But absolutely, that's part of it. And the final thing in the statute is that the agency of education is granted rulemaking authority to set requirements for how schools are allowed to spend their investment. So they're defining how schools can use it, and then they're giving rulemaking authority to further define and establish that criteria and rule. Okay, here's the dollars. So actually, the percentages, because this doesn't include dollars. And before I get into the percentages, it doesn't include dollars because it is a little bit of a flux state right now. We have a transition happening in the school year 'twenty six, 'twenty seven that is going to bridge both old system and new system. And then we're doing several things that will impact future dollars. So we're trying to stay out of pegging specific dollar amounts to these percentages, but we are working closely with JFO to generate those separate from this testimony. JFO is here and they're on the agenda, but they are not gonna have more specifics than we have right now, but they will soon. They're just hanging

[Emilie Kornheiser (Chair)]: out because they're great. Yeah. So

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: in the current state, on that side, the left side of the screen there, 50% of that federal share is going back to the school today in the form of these reinvestment dollars. Up to 30% can be retained for administration of the program, so AOE, AHS staff. That's functionally general fund dollars. In

[Rebecca Holcombe (Member)]: terms

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: of what it can be used for. And then anything that's unspent from the state administration portion so if you only spend 20% of FFP instead of 30%, that will go to the Ed Fund, as well as an additional 20. So 20% always goes to the Ed Fund. Anything that remains of that 30% of state administration goes to the Ed Fund. And then in statute today, there is this very convoluted mechanism referred to as the incentive fund that sets up a structure for additional payments for schools if certain thresholds are met. It is not used to my knowledge, it has never been used. We've never met the threshold. And so we are proposing to just strike it, or asking you to just strike it. Below the top box, it gets into health access and outreach. So today, we have a school based program that's split across two agencies. Direct services are administered at the Agency of Education. And health access and outreach services are administered at the Vermont Department of Health. This is referred to as the Medicaid Administrative Claiming Program, for those that might be familiar with MAC. And that percentage allocation is 85% of FFP federal funding participation to schools and 15% retained for state administration. That's current state. Future state, which we expect to be largely budget neutral in year one, really simplifies all of this. It combines the Medicaid administrative claiming with the direct services. So it's one unified program, unified percent allocation. And it is increasing the distribution to the schools to 55%, up from 50. It is reducing the state administration from 30% down to 25. And the Ed Fund remains the same at 20% plus unspent admin.

[Emilie Kornheiser (Chair)]: Are you imagining that the pie is going to grow a little bit? We don't know yet. I'll wait. Sorry. We're waiting. I didn't ask the question. Yeah, percent of them.

[Rebecca Holcombe (Member)]: When you talk about schools, do you mean schools, individual schools, school districts?

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: We think of them as local education agencies in the Medicaid program. So LAH. Yeah.

[Rebecca Holcombe (Member)]: How will staffing there's currently a Medicaid division in AOE. How will staffing be

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: allocated for this work across agencies? So the statute, as written right now, asks that the agency of education and the agency of human services develop an MOU to distribute the state administrative funds. We have in our budget at AHS a proposal to have a new business office position to focus on administering this program. Currently, we have some grant funded positions that are not part of the proposed budget. And then I cannot speak to the AOE budget. I don't know the details there. But the way we are talking about it with AOE is that we would have this MOU that would split it.

[Emilie Kornheiser (Chair)]: And the Appropriations Committee is aware that this bill is coming as they talk to old agencies about their budgets.

[Rebecca Holcombe (Member)]: So I didn't get the question. I'm wondering, what's happening to the people who are currently in the Medicaid team at AOE? Where will they

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: be sitting? They will still be sitting at AOE. So there are six positions. There is one manager director level position at AOE that we work really closely with, A very collaborative partnership at AOE, who's super involved in this project. And then she has staff under her who, right now, are in the field. And they do a lot of paper administration, which is actually something I should have said at the beginning. One of the reasons we're moving to an electronic health record and a random moment time study is because today, absolutely everything related to Medicaid billing is done on paper. So AOE has a team of six individuals that actually go into schools, and they help go through the paper and turn it into Medicaid billing. That's a very simplified version of what's actually happening. But that is what's happening today. That will not happen in the future. So you'll have to talk to AOE about what their vision is for those positions. But they will not be involved in the AHS administration of the program.

[Rebecca Holcombe (Member)]: Said earlier that when you use the word schools, you're referring to LEAs. So when you said that you were providing a type of slide back of the system,

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: You were supporting schools by funding and providing tools needed for program compliance. I assume there you're talking about LEAs as well. Yes. We refer to LEAs. That's the Medicaid recognized nomenclature for supervisor unions, school districts. That's who we're referring to. We're gonna be working with the supervisor union, school districts level. And whatever iteration that looks like. We're really thinking about this agnostic to any of the changes happening with districts.

[Rebecca Holcombe (Member)]: Is that what's going on?

[Unidentified Committee Member]: Yeah. Dumb question at this point, but I didn't write down FFP when you went.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: It's the federal financial participation. So it's the share of the federal.

[Unidentified Committee Member]: Makes good sense. Now.

[Charles "Charlie" Kimbell (Ranking Member)]: So the incentive fund is not being used anymore already?

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: The incentive fund, to my understanding, has never been used. If you look at the statute, and Jen could probably speak more to it than I could, there is a very complicated list of things. Thresholds have to be met. There's an inflationary adjustment. And it is based on a certain amount of revenue coming into the system. And if a certain amount of revenue comes in, then additional money will be given out. And we've just never met that revenue threshold.

[Charles "Charlie" Kimbell (Ranking Member)]: The schools won't miss it if they're not getting it now.

[Rebecca Holcombe (Member)]: It's actually an issue because, mean, sat in that seat, we just did the math, and if it cost us more to access Medicaid, we wouldn't access Medicaid. So, you have to make it worth it for them to do all the paperwork or they won't bother to do the paperwork. The incentives are aligned. Can I ask another question? And this is actually not for you, it's for us just more broadly. And it goes to some of the larger conversations we've had about foundation plans moving forward. I know that when that initial cost factor study was done, it excluded federal funds and it excluded tuition students. Another thing I assume it excluded was Medicaid. I don't know. They don't remember. Because these funds are all, I don't know what will happen, and it might make sense to anticipate that and have a better understanding of how Medicaid interacts with the funding formula.

[Emilie Kornheiser (Chair)]: And you mean we don't know what will happen because of federal action? We don't

[Rebecca Holcombe (Member)]: know what happens at the federal level, but we also don't know. This reimbursement is coming in after the Ed Fund is spending, but it's a significant amount of money for some districts. It's also not equally distributed the state. And so when we talk about transitions and incentives, it would be helpful to have modeling that helps us know what we're doing.

[Emilie Kornheiser (Chair)]: And my understanding of what your goals are, Ashley, is to make, when the You're really lowering the friction for districts through this process in order to mean the incentives don't have to be as high to participate, because you're significantly lowering the friction.

[Ashley Berliner, Director of Medicaid Policy (Agency of Human Services)]: That is absolutely our goal, is to really focus on reducing that administrative so that we

[Emilie Kornheiser (Chair)]: can maximize federal policy and then we have it more equitable around the state. I want to make does anyone have anything else on this slide? Do you have another slide?

[Rebecca Holcombe (Member)]: I think so. Oh, great. Okay. Yeah, go ahead. I wonder, I don't know, but I wonder if it makes sense to get some testimony from some of the school districts that have the largest amount of Medicaid reimbursement, because I've heard some pretty different accounts, I don't know what's what, but maybe we had to hear from districts as well, particularly if this hasn't gone to education. Anyone

[Emilie Kornheiser (Chair)]: have anything else for Ashley? Do folks feel like they understand what the agency is proposing here? Okay. Thank you so much for your work on this. You.

[Rebecca Holcombe (Member)]: Julia and Nolan,

[Emilie Kornheiser (Chair)]: do you want to sit there and say anything? Okay, cool. Will you come back some other time? Great, thank you. Do either of want to say anything at this time, or do you want to also come back sometime and say something? Yep. Okay. Cool. Okay. With that then, I think we are done for today, and we are back here tomorrow at nine I didn't do my full agenda of the week review, which I usually do on Tuesday morning. So I'm going take a brief moment to do it, because I know that a couple of committee members actually don't look at the agenda for the week. So Cathy's agenda is actually useful for me. It's not woody.

[Rebecca Holcombe (Member)]: He has no printed right in front of me. I read it wrong.

[Emilie Kornheiser (Chair)]: It was not USABN either. I'm not pointing any fingers. I'm just saying that I always thought that I was an elimination.

[Jennifer "Jen" Carbee, Office of Legislative Counsel]: It's splurgeons, everything.

[Rebecca Holcombe (Member)]: I know it's splurgeons.

[Emilie Kornheiser (Chair)]: I just thought I was wasting my breath, then

[Rebecca Holcombe (Member)]: I found out I wasn't.

[Emilie Kornheiser (Chair)]: Okay. So tomorrow, we are taking the second half of testimony on age eight eighty six that we took the first We had a bill introduction from Bridget and Erin last Friday before the storm. And so we are hearing from national experts at nine We were returning to our link up federal conformity tax code stuff at 10:15 with some legislative language, etcetera, with Kirby and Pat. And then we are doing a walk through of H757, which has significant tax policy in it. We're hearing from the tax department. And then we'll probably need a couple versions of that and maybe some other witnesses before we move it out. It's probably not going to move until crossover week. And then further work on the school construction language and maybe a community conversation about that. Oh, that's your bill, Charlie.

[Charles "Charlie" Kimbell (Ranking Member)]: It is.

[Emilie Kornheiser (Chair)]: We're probably not going to vote on that, though. There should vote more. I'm sorry. Yes. Okay. And then Thursday, we're going to essentially run through a lot of the stuff that we've been working on all session. The regional assessment districts, the tax classifications, the miscellaneous tax bill in order to figure out what needs to happen over break so that we can vote the following week. And we have a bill coming from OPR that, rumor has it, has no fee changes in it. So that's exciting. And they got a bill from the House Education Committee that we're going to work on, and an extended producer responsibility program for beverage containers from the local research committee. And then on Friday, there's stuff there, but it'll probably change, so I'm not

[Rebecca Holcombe (Member)]: gonna talk about it as much.

[Emilie Kornheiser (Chair)]: Thanks. See you tomorrow.

[Charles "Charlie" Kimbell (Ranking Member)]: Thank you. Good work. Thank you.