Vermont Legislature SmartTranscripts:

[Senator Russ Ingalls (Chair)]: Good morning. Wednesday, January 28. We are gonna spend some time this morning, talking about food as medicine. We got a room full of folk. I'm gonna, just let you know that we're gonna have to cut you by about fifteen minutes, so we got forty five minutes if that would be okay. We gotta vote out a a rather large miscellaneous bill to to meet some deadlines and all that. So I'm gonna quit talking. Welcome, the floor is yours.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: Thank you. It's absolutely okay. My name is Tina Zook, I'm the Government Relations Director for the Vanity Heart Association in Vermont. We really appreciate you just making the time to hear about this. We don't have a big ask, we just wanted you to know about some of the great stuff that's happening in Vermont related to farm and medicine. So I will give just a super quick intro just on the issue in general. Grace is going to be a rock star to tell you a lot about everything from the path of the farmer to the patient with this issue. But just as quickly what it is: food is medicine as one of the physicians, or a healthcare provider prescribes healthy food to patients to either treat, manage, or prevent chronic conditions such as cardiovascular disease, which we obviously care about, and in a way that's integrated with E4 by the healthcare sector. This effort results in benefits not only to the patients, but also to communities and to the farm economies, including in Vermont. It's needed because an estimated 90% of the $4,300,000,000,000 annual cost of healthcare in The United States is spent on medical care to treat chronic diseases, and for many of these diseases, including cardiovascular disease, diet is a major risk factor. So, as medicine can also improve health outcomes, and we're seeing that here, and you'll hear from some of the folks behind me. Researchers from the Tufts Food as Medicine Institute have admitted that a potential impact to states of providing 10 medically tailored meals each week to patients for about eight months could result in case to a net savings of $2,702 for each patient, which is great. Research by Shubi Bennington and colleagues also found that scaling medically tailored nutrition interventions would save Vermont $53,000,000 in net savings and savings. You'll hear from our witnesses today, seeing positive health and health issues in Vermont, from lower blood pressure to cholesterol levels, from the programs that are happening currently here at Brown State, but that we also need to ensure that these programs are sustainable to continue this great progress. And as

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: I mentioned earlier, I'm going

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: to turn it over to Grace right now to give you a broad overview of exactly what these programs look like in Vermont, starting with pharmacy and then even with the patients. I'm gonna

[Senator Russ Ingalls (Chair)]: make sure we've got their health care. Thanks, Steven. Thanks. Morning. Morning. My

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: name is Grace Warrock, and I'm here representing the Vermont Youth Conservation Board. BYCC operates an educational farm and coordinates the Healthcare Share, which is Vermont's largest and longest running food as medicine program. We are in our fourteenth season and are now one of six programs in the state providing locally grown food to patients experiencing diet related disease and food insecurity. This particular food as medicine initiative is called a produce prescription program. Healthcare providers prescribe fresh fruits and vegetables and patients receive the CSA style shares at no cost, along with recipes and cooking classes that help them learn how to prepare and use the food in their shares. At EYCC, we serve participants in Washington, Orleans, Chittenden, Windsor, Caledonia, and Addison Counties. While other food security programs provide essential access to produce, food as medicine programs go further by integrating food directly into patient care plans. This approach links healthcare dollars directly to locally grown food, creating a guaranteed market for farms while treating nutrition as a key part of healthcare. Having worked on other farms, in Vermont and across New England, I've seen firsthand how critical secure contracts and reliable markets are for farm viability. As we know too well in Vermont, growing food is unpredictable. Weather, labor, and market fluctuations can all affect a season's success, but food as medicine programs, similar to CSAs, provide steady demand that allow farmers to plan what to grow and how much to grow, all while minimizing risk. Reliable contracts don't just support individual farms, they strengthen local food systems and help ensure fresh, healthy food reaches people who need it most. This creates economic benefits that ripple through local jobs, food hubs, distributors, and regional food infrastructure. In 2024 alone, Buddha's medicine programs in Vermont purchased more than $405,000 in food from 39 farms, a 162% increase from the previous year. Farmers are ready and eager to grow this food and healthcare providers and patients are ready to receive it. What these programs need now is sustained investment. In other states, mechanisms exist through state guns, Medicaid, or insurer support to cover the cost of food as medicine programs. In Vermont, however, each program currently pieces together funding from a patchwork of sources, limiting growth and the long term stability of these initiatives. From VYCC's perspective, Buddha's medicine is a proven model showing how agriculture, healthcare, and workforce development can work together to strengthen farms, improve health outcomes, and support a resilient rural economy. We urge the committee to explore ways to invest in these programs, which create reliable markets for Vermont farmers, bolster rural communities and expand access to fresh and local food. Thank you for the opportunity to share our experience and for your leadership in supporting Vermont. Sure. It's great to. Thanks.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: I go?

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: I think Danielle's next.

[Senator Russ Ingalls (Chair)]: She's running bug. Good to hear.

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: If I can, Danielle, are you ready

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: to go?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah. Absolutely. Yeah. My name is Danielle Allen, and I am a vegetable farmer in Fairleigh, Vermont. And I've been in the business of growing vegetables in Vermont for about twenty five years. And for the last three years, we've been partnering with Little River Healthcare with Emily Perry, who I think is in the room also today, for this incredible program for Food as Medicine. And so, our farm grows food for about four fifty families through our CSA program. And Little Rivers was able to plug in with this program, purchasing 10 shares, so 10 weekly boxes of vegetables. And it was just a very well integrated, really smooth logistically on our end in order to pack boxes. We were already doing this work. And so Little Rivers was Emily was able to come and pick up boxes right from the farm. So from our perspective, it was this incredible way that we could, you know, connect with folks in our community that are don't have the means to purchase a CSA box at full price, but get access to, you know, first quality, you know, really good quality produce from our farm on a weekly basis throughout the growing season. So yeah, I think from a farmer's perspective, this program really meets us where we're at so that we can, you know, get food to our community without adding lots of extra headache and logistics and sort of extra steps. It was just a very smooth integration for us. So I am in full support of this program, and thank you for the time and for hearing what we have to say.

[Senator Steven Heffernan (Clerk)]: Thank you, Kim. Quick question, grunt season, when's basically your first box go out say the last?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah, so we begin the April and we go until the November. We have a thirty two weeks distribution season.

[Senator Russ Ingalls (Chair)]: Great. Where's your product going? I know it's going everywhere, but how are you distributing your product?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah, thanks for asking. So we're a bit of a food hub, we grow all vegetables at our farm, we purchase yogurt and milk and eggs and dry beans and grains from other farmers in our region. And we're distributing throughout the Upper Valley. So down to White River Junction, up to Bradford Newberry, out to Versher. That's kind of our zone is like the Upper Valley, Vermont, New Hampshire.

[Senator Russ Ingalls (Chair)]: Is it your transportation that's doing it?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: It is, yeah. We do all our own distribution with a delivery van. Yeah, yep.

[Senator Russ Ingalls (Chair)]: Good. Any commercial or is it all

[Senator Steven Heffernan (Clerk)]: pretty much residential that you're delivering to?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: We deliver to community locations. So we deliver to healthcare centers, general stores. So we'll drop 20 boxes, you know, on the front porch of the Lime Country store or the River Valley Club is like a health center, those kinds of. So, we we are distributing to community centers for people to pick up their CSA boxes.

[Senator Russ Ingalls (Chair)]: Where is the farm as opposed to like Lake Moray?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: We are right adjacent to Lake Moray, very close. Oh, awesome. Right on Route 5. Yep.

[Senator Steven Heffernan (Clerk)]: I will make sure that I stop by.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Absolutely. We would welcome your visit. Yeah. We're called Route five Farm, and we're located right on Route 5.

[Senator Russ Ingalls (Chair)]: Oh, yeah. Okay. Are you spell it R R 0 T Or R 0 That's correct.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yes. We'll play on words there. You.

[Senator Russ Ingalls (Chair)]: Alright. Many varieties would you say you're growing?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: I can ask Adam. He's working on the crop plan right next to me here. We grow over a 100 different varieties of vegetables. So a huge, huge variety, all organic. Yep. And we grow on 38 acres.

[Senator Russ Ingalls (Chair)]: 38 acres. How how many years have you in business?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Twenty five.

[Senator Russ Ingalls (Chair)]: Twenty five years. Yeah. Yep. It

[Senator Steven Heffernan (Clerk)]: it it is a little disappointing being the executive director of the Upper Valley Aquatic Center that you're

[Senator Russ Ingalls (Chair)]: going to the Rift Rally Club instead of quieter.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Heard. Well, we'll have to we'll have

[Senator Russ Ingalls (Chair)]: to make a chat offline. Yeah. We can talk offline.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Okay. Sounds good.

[Senator Russ Ingalls (Chair)]: We're good. Everybody good? I was just. Thank you, Danielle.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah. Thanks very much.

[Senator Russ Ingalls (Chair)]: Yep.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: I don't believe she's on your witness list, but Emily Ferry is who Grace I'm sorry. That Danielle just mentioned. Oh, you're Emily. Yeah. Do you did you like to say a couple of words? Or That's alright. I I know never been done, but Maureen also is here.

[Senator Steven Heffernan (Clerk)]: I think I told you that it should make a talk about it. Okay.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: So then Stephanie. Hi. Hi.

[Senator Russ Ingalls (Chair)]: How are you? Good morning. Morning to you. So,

[Stephanie Pinaire (Community Resource Manager, People’s Health & Wellness Clinic – Barre)]: thank you for having us, thank you for hearing us. I'm Stephanie Pinaire, grew up in Montpelier, and I am a community resource manager and the coordinator for the healthcare share from People's Health and Wellness Clinic in Barrie. I'm not sure if everyone's heard of us, but we're a charity that we provide free essential medical, dental, and I provide the social services for all of Center Vermont, about 700 patients a year. Of our patients are uninsured, underinsured, and many are unhoused, and many of them suffer from food insecurity. So, my role at the clinic is I coordinate with Grace and her team to provide the boxes that are dropped off on a weekly basis. So, these participants get these fresh veggies and yogurt and eggs, occasionally meat at no charge. We are matched with those participants from local providers, Seminole Medical Center and around town, and also our providers. One of the things it does is it takes the focus of our providers off of finding food security for them and they can focus on the preventative medicine portion of that. A couple of things I want to touch base on is participant from background. I have a lot of quotes from them. One of our participants reports, I was not aware at all of the vegetables that there were. I didn't even know there were that many sources of veggies. And I'm a vegan and I feel like I should

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: know that, but I did not know that.

[Stephanie Pinaire (Community Resource Manager, People’s Health & Wellness Clinic – Barre)]: And she said that I did not have access to them as a child. Our demographics at the clinics have faced a lot of barriers. Transportation is one of them. One of our participants has said to me, I can walk to your clinic to pick up my farm share, but I can't walk as far as the food pantry. We're able to provide that for that participant. One of the participants has told me if they didn't have this, they just wouldn't be able to feed their families fresh veggies. Trade offs that our participants or our patients are making, many of our patients need to pay rent for their electricity bill. Some of them have substance use disorder, quite frankly, and their priorities are elsewhere. Those things often come first before buying fresh food, so again, we're able to provide that. And they just face challenges where they're worried about food running out and there wouldn't be enough. We do a survey at the end of the year and many people circled. I do worry there wasn't enough food for this week. I do worry that I wasn't able to stretch my dollars. What changed during that multifaceted weeks is, these are some of the quotes I've gotten, is I seldom can afford farmer's market prices. This gives me healthy food. Health Care Share introduced me to veggies I would not have been able to afford to buy for my family. I love kale now, flat out was the quote. I save money while having access for fresh food that I wouldn't have been able to afford with increased prices at the grocery store. I noticed an increase in confidence in cooking skills. One of the survey questions is, do you find that you're cooking more and using more vegetables? Across the board, everyone has said they're more confident in their ability to cook, they ate more veggies, and locally sourced food is important. So they share recipes with me. When they show up, I'm the person that gets their food bundles, talks to them every week, and we communicate back and forth about how much this food needs to them sharing recipes. Goes to bars, there's a 60 year old woman in Barrie that will make carbs vegetable themed and pass back and forth through me to all of the volunteers at the farm. I was lucky enough to spend a half day at the farm, which is an amazing farm, 11 acres, and got to see where the food is grown. I met the volunteers. I stayed for lunch. It's an amazing program. Supporting our local farm where the food is grown is obviously a huge part of living in Vermont, and it's a big part of the healthcare share. From what I see on a day to day basis during this season is the food is medicine, improving health and reducing stress, preventative medicine that food can be. And my last vote is by augmenting food sources, I've had less stress in my life

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: and therefore am more healthy. Next question.

[Senator Steven Heffernan (Clerk)]: Question for Grace. So, is it most of the volunteers' kids that come work for the summer? Yeah, so do Now, same question we asked Danielle, when do you start, when do you finish?

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: So we operate winter share that goes from December to March, and then our main season is June through Thanksgiving, so through November. Then, yeah, the folks at the farm that Stephanie's talked about, those are the core members that are there, so the youth and young adults, and then we have about six full time staff.

[Senator Steven Heffernan (Clerk)]: Is that around the Richmonds?

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: Yeah. There's a little farm stand right out front then, right? That you can go to, like you could just drop by and grab your pictures. Thank you.

[Senator Russ Ingalls (Chair)]: Thank you very much.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: More information is up next.

[Senator Russ Ingalls (Chair)]: Good morning, Maureen.

[Maureen Boardman (Family Nurse Practitioner and Director of Clinical Quality, Little Rivers Health Care)]: Good morning. Thank you for this opportunity. So I'm going to speak a little bit about the food pharmacy that Danielle already alluded to at Little Rivers Healthcare. So Little Rivers began our food pharmacy in 2020.

[Senator Russ Ingalls (Chair)]: I'm just going have you identify who you are just for the people that don't know, please.

[Maureen Boardman (Family Nurse Practitioner and Director of Clinical Quality, Little Rivers Health Care)]: Oh, okay. So I'm Maureen Boardman. I'm a family nurse practitioner here at Little Rivers, and I am Director of Clinical Quality for the organization as well. And I started the food pharmacy in 2020 after I went to an educational seminar that was put on by Bi State that brought somebody from Geisinger Health in Philadelphia, who they had built a food pharmacy or basically a grocery store onto one of their inner city clinics. And while I knew that wouldn't work in rural Vermont, I was intrigued by the idea because I've encountered so many of my rural patients who are food insecure. So it started with me receiving 200 to 300 pounds of fresh food from Willing Hands, which is a gleaning organization out of Norwich, Vermont that services the Upper Valley. I would teach at Dartmouth Med School in the morning and then drive over to Norwich, they would load up back of my RAV4, and I would drive it back to the clinic to be distributed to our patients. We now receive between 800 pounds to 1,200 pounds of food a week from Willing Hands. The difference is the winter months and the summer months. Little Rivers also receives approximately 7,000 pounds of food from the Vermont Food Bank to support our food pharmacy, as well as the past three years we have had the CSA shares that Danielle alluded to from Route five Farm. This year, we also had a Stuff the Van food drive at the Bradford Hannafords after they donated a cargo van to Little River's food pharmacy program. So, food as medicine affirms the premise that access to nutritious food is critical for health as well as well-being by managing and preventing diet responsive conditions such as diabetes, hypertension, and coronary artery disease. Studies have shown that half of all American adults have one or more preventable chronic diseases, and many of these are related to poor quality eating patterns. Eight percent of Little River's patients are food insecure, and seventy five percent have at least one chronic disease diagnosis. Currently, Little River's fresh food pharmacy serves 100 patients, and we have a three week rotation for food from the food pharmacy. Patients to be eligible have to be both food insecure and have at least one chronic disease diagnosis. So, food as medicine affirms the premise that access to nutritious food is critical to health and well-being by managing and prevention of these diet responsive conditions such as diabetes, hypertension, and coronary artery disease. I certainly want to say that anyone who's been to the grocery store recently can attest to the fact that eating healthy is expensive and getting more expensive. Patients and families who are food insecure often rely on cheaper processed foods that have little or no nutritional value than healthier fresh fruits and vegetables, dairy and lean proteins. So think about the difference between the cost of a box of Kraft Macaroni and Cheese, I Googled it this morning, averaging 1.5 in the state of Vermont that will feed four. And the average cost to make a basic homemade garden salad for four people is approximately $5 to $10 depending on ingredient choices and seasonality. So, my goal for Little Rivers Food Pharmacy has been to create a dignified, welcoming and comfortable atmosphere where healthy food can be easily accessible by patients, to use food as medicine to manage, treat, and prevent diet responsive chronic diseases in our rural community. It touches a special place in my heart when patients talk to me about their lives and their health, how their lives and their health have benefited from having access to our food pharmacy. And I also want to say that the largest geographic food desert is also located in Little River's food service area. So 25 West from Bradford to Barrie, there is nothing but convenience stores and the same thing three zero two from Wells River to Berry also know reliable sources of fresh fruits and vegetables.

[Senator Russ Ingalls (Chair)]: Well, thank you. Appreciate it very much. Questions from the committee? If

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: I could ask the committee, since we have some time, we do have a witness we didn't let you know about, I would love for her to be able to talk to you. It's Susan Smiley and she's from the pharmacy program at the ACAR Food Network, which is in Addison County. Absolutely. Do you wanna

[Senator Russ Ingalls (Chair)]: Say it, please?

[Senator Steven Heffernan (Clerk)]: Yeah. We have time for Addison Care.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: Hi, my name is Susan Smiley. I am on the board of the Eight Part two Network. We have been since its founding. Of the

[Senator Russ Ingalls (Chair)]: programs When was that?

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: That was 2002. One of the programs, we have various programs that we created over those years to support farms with markets mostly, and strengthening the connection between growers and buyers. But I'm here today to talk about our pharmacy program, in twenty which nineteen, inspired by the BYC's program and Rutland's program, but we've been hosting the Addison County Pharmacy Food as Medicine program since 2019, every summer. We currently serve 100 families who are mainly referred by Porter Hospital, which is our local hospital, and the Department of Health and a local food shelf and private health clinic. It started out as a hospital solely, but others have added their, some people that they see to our list of people we support. We contract with four local farms, providing a stable, flexible market for emerging growers and experienced growers. In 2024, we added a winter pharmacy program that serves 65 people monthly with a mix of vegetables, dairy, meat, bread, which is news. And fosters markets in the slow months for producers and provides a consistent supply of food to folks in the winter. Over the course of eight seasons, from 2019 to 2026, we paid farmers a combined total of $300,000 We contract for their production and status prices beginning early in the season. We would love to grow this fund as funding allows, and currently funding comes from Acorn. We raise money for this program in Addison County. And ACCOR is part of and helps curate the farm to plate healthcare CSA community of practice organizations. So our executive director is a regular participant in a group, same wide group, that needs to talk about how things are going, how we do things, and sharing that information. That's what we're doing at Addison County.

[Senator Russ Ingalls (Chair)]: Thank you.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: And we deliver from mid June now through March, but it started out mid June through October, but we'd rather make a shift.

[Senator Russ Ingalls (Chair)]: So you mentioned four farms. Where are they and where do they grow?

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: They're vegetable farms. One is over on the other side of the mountain in Hancock. The other three are in Moncton, in Salisbury, and I think it's in Huntington. Okay. And what are they called? They grow a wide range of vegetables, an amazing range of vegetables. Some of the growers are new, apparently new, and others have been doing it for a long time.

[Senator Russ Ingalls (Chair)]: Thank you. Thank you. Danielle, can I ask a question of your business?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Absolutely, go ahead.

[Senator Russ Ingalls (Chair)]: Do you have greenhouses?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: We do, yeah.

[Senator Russ Ingalls (Chair)]: Okay, so you're growing, you're starting, you're year round as far as prepping for the next season and everything?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Not quite. So we have one heated greenhouse for propagation early in the spring so we can kind of get a jump start on the season. And then we have four high tunnels. So they're unheated structures. We have some in ground heat, we can start tomatoes earlier. But we are not a farm that is producing year round. We do a lot with storage. So we will We have carrots and beets and winter squash in storage that we sell, you know, but we're And we do We make a lot of sauerkraut as well, but we're not producing vegetables year round.

[Senator Russ Ingalls (Chair)]: So you're storing most of your product on-site?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Correct, yeah, yep.

[Senator Russ Ingalls (Chair)]: So you must have a substantial sized building.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: We have two buildings, yeah, yep. We have, yeah, we have some storage base, but it's never enough. Oh, okay. We'd like to build more.

[Senator Russ Ingalls (Chair)]: I know you have more people, but are we finding that there's a market for everything that's being grown? That's question for me. Anybody that wants to answer, but you have In to be, you

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: my experience here in the Upper Valley, yes, there is a market for everything that's being grown. Yeah, absolutely.

[Senator Russ Ingalls (Chair)]: Do you have random calls from people from well outside of our area asking if you've got a little bit more?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: All the time. Yeah, we have people calling from the strangest places asking if we'll ship and we don't ship. Sell, you know, right in our own region. We don't sell outside of the Upper Valley.

[Senator Russ Ingalls (Chair)]: Okay. Nice.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: Yep. If we could squeeze in one more person. Christine Heffernan is online. Who works with Grace at VYCC and the Health Care Share Program.

[Senator Russ Ingalls (Chair)]: Christine, go ahead. You're on.

[Christine Hadacall (Director, Food & Farm Program, Vermont Youth Conservation Corps)]: Hi, Christina. I'm actually just here for any Q and A, So I don't have a statement. I sent a written statement and I'm here just to answer any questions that you all have. But I'll just emphasize that we currently across the state, collectively, of the food is medicine programs are working with 39 farms. And we've heard just that there's incredible demand for this program. In other states, food is medicine programs have grown significantly with the introduction of state funding. And so I know that there's just a lot of potential for growth to support small local farms that are looking to be able to infuse their food into local community clinics, hospitals, health centers, and I'm excited to be part of this really great work and just excited to tell you about it today. And I know Mary Kate is also there to speak.

[Senator Russ Ingalls (Chair)]: Sounds good. We got a question, but I just want to make sure because you're not on the list just to tell everybody who you are.

[Christine Hadacall (Director, Food & Farm Program, Vermont Youth Conservation Corps)]: Sure. Christine Hadacall, director of the Food and Farm Program at Vermont Youth Conservation Corps.

[Senator Russ Ingalls (Chair)]: Thank you. Go ahead, Steven. How much dairy from our local farms do you try

[Senator Steven Heffernan (Clerk)]: to incorporate in, like cheese, milk, is also tried to be integrated with this, being it's mainly vegetables you're dealing with?

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: I can speak for UICC at least. We are right now just, growing vegetables, and then we have some, laying hands for eggs. We, this year, were able to get, donated yogurt from Stonyfield Farms, but we, at this point, do not incorporate dairy regularly. Yeah, it's really just veggies and meat.

[Senator Russ Ingalls (Chair)]: Any beef?

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: Not on our end. I know that the Acorn Winter Pharmacy, at least, is incorporating regular protein sources in their winter share, so I'm assuming they've had beef in there.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: And one reason it's been easy, possible for us to do that is we also have an online food hub. So we have probably five or six meat producers who sell their meat by the cut and by the box online. So those producers are bringing their products to our warehouse to anyone, and it's been easy to add protein proteins to what we give out every day.

[Senator Russ Ingalls (Chair)]: Does anyone get requests for vegetables or fruits that are not grown here that somebody's looking for?

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: We get, well, so in our end of season surveys that Stephanie talked about, there's often a question saying, you know, was there anything in the share that or anything that was not in the share that you'd want? I've seen a lot of requests like for mushrooms, which we at BYCC don't grow. And then in the winter share oftentimes, there's requests for tomatoes and things that are not beets and carrots and potatoes and things everyone's sick of. But we don't typically give requests for anything. Yeah, every now and then, some of us say they want to see berries, or you know, winter items or fresh summer items, but,

[Senator Steven Heffernan (Clerk)]: That's a good question. Do you get a lot of apple resources, that from growers that want to maybe have extra apples that they give to the community shelves or?

[Grace Warrock (Vermont Youth Conservation Corps – Health Care Share)]: Yeah, prior to my time, I know that we've included apples just from donated orchards. I've only been here a year and given flooding and weather, it's been bad apple years. But I know in the past we've relied on gleaning and donated apples as well to include.

[Senator Russ Ingalls (Chair)]: Danielle, is it fair to say that your requests have outstripped your ability to grow? Do you have a lot more requests than what you can supply? Like, people saying, if grow this, we'll buy that. And where are you with that?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah. I'm not sure what you mean, are you, do you mean specifically in this program or just in general as a farm?

[Senator Russ Ingalls (Chair)]: You growing all that you can grow or you could have more labor, more land and all that? You could certainly scale bigger.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yeah, and I think for us, we have reached a scale that we're comfortable with, that works for our family and for the land that we own, that we have and our community. So we're, we've sort of reached a scale that's working and very efficient and, and we're able to sell everything we grow, you know, with ease. And so we're sort of, we've been at this place now for about six years, and we're kind of in the mode of like, holding steady that this this steadiness is sort of what is best for our business and our family at the moment. That's my personal story, you know, and all farms are in different places of growth or, you know, scale.

[Senator Russ Ingalls (Chair)]: Do own all the land that you're on? And I think you said you have 38 acres?

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Yep. Yes, we do. And That's correct.

[Senator Russ Ingalls (Chair)]: Okay. Job. Well, cool. What else? Spam.

[Danielle Allen (Co-owner, Route 5 Farm – Fairlee, VT)]: Does that mean?

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: Alright. I got to be the closer. Hello.

[Susan Smiley (Board Member, ACORN Network/ACORN Food Hub – Addison County)]: My

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: name is Mary Kate Mollman. I am the director for Vermont Public Policy at Via State Primary Care Association. We are an association that supports Vermont and New Hampshire, I'm gonna talk about Vermont, federally qualified health centers. We are present in every county in the state. We have 11 organizations in Vermont, over 100 sites. So, Gifford is one, Love Rivers is another, Rutland Community Health, Community Health Centers in Burlington, Mountain Community Health in Ownington County, Battenhill down in our Southwest region. Well, really what I, why our take home today was really to provide some education about how we, the arc between the farm, the provider, and the patient, and how that all flows together. We hope we've demonstrated that, make sure I'm covering my points here, and really calling out that this is a high value approach to supporting our farmers, to improving Vermont population health, and controlling our cost of healthcare in the state, which is a major factor in affordability for Vermonters. I mean, it's the fifth of our economy, which really can suck a lot of the resources away from others, really important things that this funding should go towards, that our general fund go towards. So, I think investing in primary care and preventive care can really help address that overall cost of care. So, that's the goal with this program, so we want to achieve. So, looking forward, what do we want to have happen next? We have formed a task force, a food dysmenorrhea task force. It involves policy experts, Vermont farmers, nutrition experts, a number of our Vermont federally qualified health centers, QI experts, quality improvement, and payers. So, haven't brought in Medicaid, but we are working also with commercial insurers. And the goal of this task force is really to establish sustainable reimbursement. All of these programs are often supported by grants. That should be great, you got have a great program running, you've showed some serious success, and the grant funding dries up, and the program now needs to go away. And you actually then have to then dismantle all of that infrastructure that he established. And then if you get another grant, have to rebuild that infrastructure of it, it's inefficient. So, we wanna get to a place where we are actually paying for this food, paying for these services, paying for this access through sustainable So, we are working with payers trying to identify the mechanism for payment. Is this a reimbursement, like a fee for service reimbursement? Do we, I don't know how familiar you are in the healthcare world, we often talk about value based payments, value based care, where we like to do a capitated payment that covers a whole range of services. Is this a service that might be folded into that type of payment account for Medicaid or the commercial payers? So, that's one of the things that this task force is exploring. We also want to explore the scope of what this benefit might be, like who does it cover, who's eligible for these payments, what is the scope of the benefit? What does it cover? And then, how much should that be reimbursed? Because again, you want to make sure that you're covering the cost of these programs. They have a high return on investment, but you're not gonna see that investment unless you cover the cost of actually providing it. So, that's what the task force is planning on, is working on, brought together a great coalition of individuals and organizations across the state. And while we don't have a specific task right now, we hope that in the future we can work with this committee, and I spent a lot of my time in the Senate Health and Welfare Committee, so maybe we saw Sherri Lyons in here just at the beginning, we could do some collaboration, figure out maybe what's the next steps to really incorporate sustainable funding for these really important ways of improving health and wellness of our learners.

[Senator Russ Ingalls (Chair)]: Good. Good. Good. With some of the volatility that's happening on the federal level

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Mhmm.

[Senator Russ Ingalls (Chair)]: How much is that affecting you before?

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: The big question.

[Senator Russ Ingalls (Chair)]: And a Reader's Digest version.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yes. So, I think the Reader's Digest version is the biggest concern would be around the compensated care at this point, and people Vermont has been really successful in maintaining too low uninsured rates, so that means that we do have payers that can start to pay for the cost of care. Federally qualified health centers have to be anyone regardless of their ability to pay. As we see potentially more Vermonters coming off of insurance or being under insured, meaning they don't have, like, what their out of pocket is of certain portion of their paycheck and income, that's the definition for under insured. As people become more in those categories, after you still have to see them, but it comes now out of a different bucket that had been used for providing free dental care or these Buddhist medicine programs. So, that is the biggest one, would say, with the enhanced premium tax credits going away, we're just seeing now the impacts of that. Early numbers out of Department for Vermont Health Access was Tucson that declined 2,000 individuals, but we're gonna have to see how that shakes out over the next few months. Next year, we have Medicaid with their regular, or an increased number of redeterminations, meaning are you going to be able, are you still eligible for Medicaid? I did a check that twice a year instead of once a year, and there's a real concern that people are gonna be coming off Medicaid, or eligible for Medicaid, but just because of paperwork or missing a deadline, they fall off, and then they fall into the uncompensated care bucket. The work requirements. We don't know how many people are gonna be, who might be eligible, who might be coming off because of the work requirements. So, there's a lot happening. And then there's a overall cost of care continues to grow. So, trying to manage those operational budgets. Right now, I'd say most, on average, across the board, we're seeing operational deficits.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: They may try to make those up in other creative ways, but that's a reality that a lot of our health centers are facing.

[Senator Russ Ingalls (Chair)]: Well, I, speak for myself, and I appreciate your work, and you did, you were a club or so. You did a tremendous, imitation of Mariano Rivera. Oh, thank you. I wanna ask, because it's a wide ranging, and we haven't really unpacked all of what it is, and it's kind of out of our bucket list, but the $195,000,000 that's going to come for the healthcare for five years, so a billion dollars Are is going to come into you folks going be benefactors of some of that dollars?

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: We've been certainly looks at my company. Yeah, so we actually were on a call this morning with AHS and they're still in the process of figuring out the line item budgeting. We have our top line number, we're still figuring out the line items for that, the budgets for that, and then, AHS is gonna be, like, lights out trying to figure out how to move this money out of the state and into provider and community providers and infrastructure. The way that I describe it, it's it's not gonna go towards reimbursement. It's not supposed to be used for any, like, base funding. It is really transformational investment. So, we have to think what are the pieces that we're putting in place that will get us from a high spend here to a lower spend here. That's the that's the idea. We'll have to see how well that works out. It's a lot of money that needs to move out really, really quickly.

[Senator Russ Ingalls (Chair)]: Yeah. Because there's another 195,000,000 right behind there. We hope. Well, think it's yeah. I don't think what we have to hold. I think the money is there. It's been appropriated and all of that. So yeah.

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: Yeah. We can see what we spend in this first year, and then the FAFSA will give us our budget for the subsequent years. But Well, cool.

[Senator Russ Ingalls (Chair)]: Anything else?

[Tina Zuk (Government Relations Director, American Heart Association – Vermont)]: No. Thank you for

[Senator Russ Ingalls (Chair)]: your time. Thank you guys for being here. Right on time. Okay. Good job with that, guys. We're gonna stay on the line, and we're gonna wait to as you know, we have a procedural vote to be made to vote this bill out. We'll actually ask you to recall and bring it back into our committee. I think everybody understands the mechanism of it. So the things we have to correct in, let's kind of come back here. Everything starts anew. There's nothing in this bill that has to pay. There's nothing in this bill that has to leave. It all is gonna be done through the process of committee work. Okay. And all we're doing is just fall into rules to get us out of here, we'll get back in, and we'll go to work. Yep. I will say that it's it's we have a lot to do. We all need to work together to get, you know, through with what we have. Things we need to remember are that there are people that have asked for a lot of this stuff, the farmers, to the people that we represent, and, you know, we'll be able do all that we can do to get it out of here and get it going. We got 14 subjects on this one bill here, I think there's two more that want to get attached to it. So we're looking at 16 things covering the large spectrum of farming. We have the new additions, as you get some language today about the hemp. Remember what we're really trying to do with the hemp, and we are trying, and we're not voting on that now. But the hemp is really how does it relate to agriculture? That's why we're not really talking about the marijuana part of it. We're talking about the hemp part of it. Specifically in the bill right here, it says that we are just looking at how it relates to agriculture. So that we have that, and we have some current use language that's gonna come in. Hefty, hefty, hefty stuff. You haven't seen the language on that, but I'll just bring you the 30,000 foot view of it. We have some farmers that keep on getting caught up in how current use is administered or as how it's applied. With the regulations of listters being kind of pulled away from towns, as Senator Collamore and his committee is understanding, it's looking like it wants to go to a state system. You don't have as many listters anymore going around and reminding these farmers, hey. They put that new barn up. You know, are you good with current use? You've done this. You've added this parcel over. Are you good with current use? And so I haven't seen the full language on that bill yet, but it's going to basically kinda help stream farmers. We have another guy that was in here the other day that I was made aware of that it was his family farm got put into an estate, and everybody just thought that it would just carry over. So we're going to see that language as it relates to current use and help farmers stay involved in it and maybe get away from the yearly requirements, that there's no changes. So that's going to come in as well. Very, very important work as well. What we have in front of us right now is what was reviewed yesterday. Does anybody have any problems fundamentally with anything you didn't think that it would be included in this bill, at least to start at least to at least have a further discussion on it. I'm not saying debate the merits of it or whether you like it, but does I anybody fundamentally believe that there's something in this what we're gonna vote out, that should not be in this, at least to have a discussion? I suppose I'll say that this is just a procedural vote for me. Put out some issues with things that we're gonna have to figure out. I understand. Other than this, I guess I just wanna make sure it's on the record, we're gonna vote yes to vote this out. No, again, someone may proceed for a vote so that we can dive into it, because having a 45 gauge bill for one day is not enough. Although, quite frankly, think a lot of the communities don't have this wrong enough in general, so but I'll I'll that's all I wanna say for this, but I'm I'm gonna vote last to vote on that. I like that. I agree with this statement. Okay. So if you guys are good with understanding what we're doing, which again is to reiterate what you've said, Senator Plunkett, is that we haven't had this build up only for about twenty four hours, and that we are following a procedural vote to vote the bill out so that we can get it back in and tear it apart from the studs to the roof to fully understanding that some of this or a lot of the language that we have in this bill is going to be different if it makes it to the edge at all. I would entertain a motion to procedurally vote this bill out. I'll move that we vote out an act relating to miscellaneous agricultural subjects, draft 20 six-five 53, paper and voting. I don't know that I'm the clerk, but right, Linda, hand it to me. Oh, did you want me do the paper? You've got the paper. That's alright. That's everything. Can we add onto it that we're gonna tear down the studs and rebuild and then have my house be the next step? Yeah. So

[Senator Steven Heffernan (Clerk)]: allow maybe we got some set. No.

[Senator Russ Ingalls (Chair)]: We got we so we have a we have a motion and we have a second. It sounds like we might have a seventeenth bill after, but So we have a motion and we have a second, and I would say, if you would, please call it. Senator Collamore votes yes. Senator Heffernan? Yes. Senator Major? Yes. Senator Plunkett? Yes. And Senator Ingalls? Yes. Okay. So five-zero-zero is the vote. We don't have to have a reporter yet, because we don't have a bill number yet, but it's a draft, and we'll get this stuff to go out of the bluebird and then get it on the calendar. Right? The one in the twelve minutes. I like it. Okay. I think I might have the Linda's gonna tell us what we have to do with that. You

[Linda (Committee Assistant)]: just need to sign it and make it to the sergeant.

[Senator Russ Ingalls (Chair)]: K. So I gotta do that.

[Linda (Committee Assistant)]: And they will ask them for it to the dog.

[Senator Russ Ingalls (Chair)]: Okay. Okay. So do I find you to accompany it?

[Linda (Committee Assistant)]: No. That's

[Senator Russ Ingalls (Chair)]: So I I find the last page?

[Linda (Committee Assistant)]: Yeah.

[Senator Russ Ingalls (Chair)]: What's the date today? 01/28. 01/1926. Okay. Thank you for all of that. I'm just gonna ask for, like, a