Vermont Legislature SmartTranscripts:

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: He's told me not to spend any money, fine.

[Andrew Perchlik (Chair)]: Federal High Senate Appropriations, February 11. We're I'm going to fiscal year is '47. But if Sorry for you, dear. Requested, ma'am. Legal aid. Afternoon. Hi,

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: my name is Trustee Weiss. I am Interim Executive Director for Lamont Legal Aid. Thank you very much for having me this afternoon. We really appreciate the opportunity. Vermont Legal Aid as a whole, with its sister organization, Legal Services Vermont, provides the core of this state's free civil legal assistance efforts and has served in that role for almost sixty years. I'm here today to speak to our budget request for state fiscal year twenty seventh and to highlight that the Governor's proposed budget does not maintain level funding for monthly leave. Specifically, it proposes eliminating the appropriation that funds Medicare Advocacy Project known as MAP. This program has been part of Vermont Legal Aid since it was established in statute in 1989 and VLA has since held long term contracts with DIVA to operate it. My testimony today will begin by focusing on the Medicare Advocacy Project and the critical importance of restoring the funding for this program in the budget. I will then address our broader budget request emphasizing the essential role Vermont Legal Aid plays in meeting a wide range of legal needs at a crucial time for Vermonters. The purpose of MAP is to ensure that dual eligible individuals, those eligible for both Medicare and Medicaid, receive the Medicare coverage to which they are entitled. When MAP finds a provider who is billing Medicaid for a service and instead it should be billed to Medicare, Matt works to recover those healthcare costs to the state. With the massive federal cuts to Medicaid with an H. R. One, known as the big beautiful bill, securing federal Medicare dollars for Vermont's critical healthcare is now more important than ever. I would like to tell you about some of Matt's accomplishments. Since 2000, recovery for the state has exceeded what Vermont Legal Aid has received by roughly $3,400,000 Some significant accomplishments for MAP was the success of a class action lawsuit MAP helped to win with the Center for Medicare Advocacy in Connecticut. The named plaintiff Glenda Ginny was a resident of Lincoln, Vermont. In a 2013 settlement, Medicare agreed that it would cover maintenance, nursing, and therapies for people with conditions that would not improve, people with ALS or Parkinson's disease or paraplegia, thus expanding Medicaid coverage for millions of people across the country. Prior to that case, Medicare covered services only if there was, but it had an improvement standard for covering services. MAP appeals have been critical in getting Vermonters access to better healthcare in facilities and critical home healthcare paid for by Medicare. Over the years, the BLA has done this work. There has been a large shift to Medicare billing for home healthcare, resulting in a reduction of Medicaid billing from home health of $2,000,000 from ten years ago. Home healthcare avoids suspense of longer stays or readmission to skilled nursing facilities. Therefore, we were shocked to learn two weeks ago by listening to testimony in the House Preparations Committee that the Governor's budget proposes to eliminate that. This comes despite BLA being awarded a new five year contract in November after a competitive bid, and without any communication or warning from Diva about canceling the contract.

[Andrew Perchlik (Chair)]: Who is that contract with? With Diva?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Yes, with the Department of Omaha, that's yes. While it is true that the contract price has exceeded recovery in recent years, there are multiple reasons for this. At the onset of COVID, we were directed by Diva to cease recovery efforts for several months. Recovery from skilled nursing facilities remained difficult with the ongoing disruption of COVID in the years following the pandemic. The Genesis bankruptcy of July 2025 affected nine skilled nursing facilities, resulting in mass freezing of over $200,000 in potential fines. Medicare Part C plans added a whole additional layer to billing appeals. There would be the appeal to the Part C plan that had multiple layers and then there'd be the appeal to Medicare that also had multiple layers and that made it much more difficult to successfully appeal nonglucine claims. And as we all know, Medicare Part C plans now left the Vermont landscape. Which brings me to what MAP is working on right now with Eva to improve recovery. In our bid last fall, we acknowledged the challenging landscape of declining Medicare reimbursements and we proposed solutions. These strategies are currently being implemented such as meeting with Eva staff to discuss ways to improve data collection and provider education. Holding a training just last month for DIVA's Provider Relations staff to train on Medicare coverage standards. We have plans for multiple training sessions with healthcare providers on the importance of proper Medicare documentation requirements for successful appeals. We have plans for quarterly meetings with Veeva to review data quality and progress. Right now, between open cases in 2025 and last month, MAP is currently pursuing over 1,100,000.0 in Medicaid recruitment. Finally, we don't believe the state has complied with the statutory criteria for ending MAP. The statute requires two criteria of VBAP before the Commissioner of DEVA is permitted to end the contract of this work. Those criteria are: the amount of the state share of recoveries during the preceding year did not exceed payments, and the Commissioner determines based upon information from the contractor, providers, areas of agencies on aging, the AAAs, and others affected by the program, that it is not accomplishing its goal of protecting dual eligible individuals from improper denials of Medicare coverage. That authority is at 33 Vermont Statutes Annotated Section 6,703. In addition, it seems unlikely that plans currently exist to bring this work in house to be back. Given the newly awarded contract, the lack of the commissioner's determination, and the level of expertise that is needed to do the work, The team of attorneys and paralegals assigned to MAP at BLA are experts in Medicare and Medicaid law. By losing MAP, Vermont would lose its Philly watchdog. It is easier to bill Medicaid, and there is every reason to believe providers will then increasingly do so. If MAP funding is not restored, Vermont Legal Aid would lose over 5 and $25,000 in state fiscal year, October 26. Such a hole in our budget would have ripple effects beyond the loss of MAP. It would require further staff layoffs, and it is important for the committee to be aware that the attorneys for MAP also do vital work in other areas such as the Elder Law Project. Project. We can't overstate how critical it is that the legislature restore MAP funding in the budget. We would be happy to report back to the committee next January on our progress. Unless there are questions right now, I can move on to the rest of our budget request.

[Andrew Perchlik (Chair)]: Just wondering, was the rationale that we're getting for reduction?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: For the elimination of, we were not given a rationale. There's been no communication from Diva about this at all, although I do, we found out in some ways by happenstance, by having listened to some testimony. Okay.

[Andrew Perchlik (Chair)]: It means to be going with the agency of administration, whether you're not anywhere else by yourself. You're just contracted, you're not We're contracted, correct. All your non profit? We're

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: non profit,

[Patrick "Pat" Brennan (Clerk)]: That's big The question is, I think his question is the payment that goes out for the contract, who does it come from? Which department does it come from?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: We have.

[Andrew Perchlik (Chair)]: It's all due, you don't have other contracts through other parts of state government?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: We have, our other major contract is with the agency itself, the agency of human services. That's the contract that I'll be talking more about in just a moment. It's the contract that provides funding for both mandatory legal services and general legal services. When I talk about mandatory, it means involuntary mental health treatment, guardianships for people who are developmentally disabled, and as we have not received any inflationary increase over the past few years, the part of the contract with AHS that covers those mandatory services has grown, has taken up a bigger proportion, the proportion going to the more general legal services is of course training. I'll move on now to the rest of my testimony. As I stated, BLA, with Legal Services Vermont, the only providers of a range of core legal services throughout the state. We offer free legal advice and representation to low income Vermonters from four offices located across the state. We operate a statewide legal helpline providing quick legal advice information and referral. We maintain a website that guides Vermonters on how to solve their legal problems on their own that gets over 600,000 hits per year. We field around 26,000 requests for legal assistance every year, and last year we directly assisted 18,000 promoters. We provide full representation in approximately 2,600 to 3,000 cases every year. Despite the overwhelming need and increasing demand for legal services, this will be our third straight year that we have not received an increase in our appropriation from the Agency of Human Services, Level funding is hitting us especially hard because of significant federal funding cuts and annual increases to our costs, especially in healthcare insurance premiums.

[Andrew Perchlik (Chair)]: Is it an appropriation or is it a budget?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: It is a contract, but we do have a line. It's an E300 in the budget, and we have lines in the budget in different spaces, in different places, but one of its places is an E300 where most of the AHS funding that goes into that contract is located there.

[Andrew Perchlik (Chair)]: In that one. And then

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: there's more in BMH's, the Department of Mental Health budget.

[Andrew Perchlik (Chair)]: What did you say it was? E what? 300. E 300. An

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: increase in our state fiscal year '27 appropriation would compensate us for inflation, restore two staff attorney positions in our poverty law project, better access chronically to underfunded helpline, as well as fund a vital new project that helps immigrant families stay together. The poverty law project provides general legal services, and as I was saying, is being squeezed as a greater percentage of our appropriation goes to mandatory legal services such as involuntary mental health treatment cases, protective services, guardianship cases, and Act two forty eight cases. The vast majority of Vermonters cannot afford legal counsel. They need attorneys and access to legal help, especially at a time when the state is investing heavily in housing stability and healthcare. Vermonters need advocates and lawyers to help them navigate these complex systems. Vermont Legal Aid provides that guidance as representation, helping people stay housed and provide access to healthcare and benefit they have earned and are entitled to. Moving on to our helpline. Our statewide helpline fields 26,000 calls every year. It provides remote legal aid with many of our case referrals and provides some level of direct assistance to approximately 18,000 promoters, but it is significantly underfunded. The health line receives just $100,000 through the AHS appropriation. The total operating cost is over $900,000 Due to the reduction in staff, we have already needed to restrict the types of calls that receive a callback and callback time for non urgent calls has increased to almost two weeks. Moreover, there's been a surge in demand by more than 100% since 2022. Without additional funds, helpline services will likely be further eroded. Increasing funding for the poverty law project in the legal helpline is a good investment for the state in two ways. The first is that for every dollar spent on general legal services, access to public benefits, food, energy assistance, social security disability benefits, and housing, the Agency of Human Services gets 50¢ back in federal matching funds. The second is that a 2019 study commissioned by the Mont Baruth Foundation found that legal assistance programs generate $11 in economic activity for each dollar invested in Vermont Legal Aid and other legal assistance providers. That makes sense if you think about it for a minute because by keeping people housed and receiving the benefits to which they are entitled, they can continue to be productive, and they can help the economy. And our last request is around a new program, the Immigrant Line of Guardianship Program. In February, Vermont Legal Aid responded to the needs of the immigrant community by establishing a program to help families make a plan in case of family separation. BLA staff and trained and trained volunteers meet with immigrant families who have a trusted relative or friend fill out guardianship petitions that would take effect should the parents be detained or deported. Since this work began, plans have been established for over 75 families and over 130 children. Without a plan and a guardian, children would likely end up in BCM custody and would unlikely be reunited with their parents in a foreign country since DCF cannot do any home visits or work with foreign governments. This work is not eligible for funds through the Immigrant Legal Defense Fund since that fund is reserved for providing legal representation in deportation cases. Therefore, the work is largely unfunded and costs legal aid approximately $150,000 according to our budget analysis. As I said, we already lost staff last year. Even without the loss of MAP funding, we are looking at another deficit budget. A loss of over 500,000.0 and that combined with no additional funds would be devastating. We would lose more talented and dedicated staff and our ability to continue to serve as the core provider of free civil legal services would take a substantial hit. And the outlook for federal funding is bleak. Congress will cut funding to the primary funder of legal services, Vermont or sister organization, by 3.8% for their current funding year. And there have been threats to the federal funds that support the disability law project. And despite having been awarded a fair housing grant through HUD after having them eliminate that grant after nineteen years of funding us for Fair Housing work. We were once again awarded the grant in September, but we've yet to receive the funding. And it's very difficult now to reach any people in to move that grid forward. We understand that you are facing unprecedented challenges this session, and we appreciate the funding you received through the state and with your help. Thanks again for the opportunity to speak with all of you this afternoon.

[Andrew Perchlik (Chair)]: Thank you. That's important. Was the 2,600,000.0 total between the different contracts that you received? Where is that number?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: The 2,600,000.0 is the total between the AHS funding for the mandatory and the general legal services and then Department of Mental Health funding that came at a time when the work to our mental health law project increased because they took on representing people who were judged incompetent to stand trial. Me see, Is there anything in addition to that? I think that covers it.

[Andrew Perchlik (Chair)]: Okay, that'd be great. And how many total staff do you have?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: We have about, It's been fluctuating right now. We have about 80.

[Andrew Perchlik (Chair)]: Where are your offices now? Remember they used to be just down here.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: There's one in Montpelier. It used to be really close by. It's now near Vermont Fine Art, the college up on Greenway.

[Andrew Perchlik (Chair)]: I'm not

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: College of Fine Arts, but now Greenway. Yes, yes. So, it's right up there. Have an office, Rutland, have an office in Springfield, Burlington, and to save some money we closed our St. Johnsbury offices, but we're doing local clinics there and have a space we can use at the AAAs.

[Andrew Perchlik (Chair)]: Okay. Councilor Washington?

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Thank you. So, the contract that you have with DIVA for this, that contract is just for the MAP funding, or is it for all well, it would be. I guess my my question is is are are any of these items broken out in that contract? So, contract is for that precise amount. It's just And that's the Diva map contract. And that's just that line. That's correct.

[Andrew Perchlik (Chair)]: And that's the one that they cut? Yes. Okay.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Yes. After having just awarded it to us in November after a competitive bid.

[Andrew Perchlik (Chair)]: And without explanation.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Without explanation.

[Andrew Perchlik (Chair)]: And these have to ask me.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: And then where do these are are the the other items here, your either where do those live in? Sure, thank you. The inflationary increase in the two FTE staff attorney restoration that we're requesting, that would be then added to the age at the E300 line item. That's the area that has been level funded for three straight years. Therefore, that's why the poverty law project has been squeezed. And the helpline funding was, where that is, there's $100,000 that was given, that was provided for the helpline several years back. And I'm not exactly sure where it is. But it is very and we hold the organizations, try to make it work with the little bit of discretionary funding that we get.

[Andrew Perchlik (Chair)]: And the other organization being poverty loan.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: The other organization is our sister organization, Legal Services Vermont. That's the LSD organization, Legal Services Corporation funded organization in Vermont. One other question, so the immigrant minor guardianship project, where is that funding coming from now? The only funding we have for that right now is about little less than $30,000 in donations. And the services are, the requests for those services have picked up significantly in the last few weeks. Yeah. So, the 150 is what it's costing your It's the staff time, training time. But that is also a part of your ask from the state. It is. We at least want to make people aware of the work and that it is unfunded and not sustainable. We have an MOU with DCF to do the work, cooperative relationship and communication lines between us because DCF very much wants us to do this work for probably reasons that are clear to you, that avoids kids ending up in custody. I don't know if there's any chance that there's any funding for ETCF that would help fund this work. Well, I just want to appreciate all the work that you do, especially in the times that we're in right now that work particularly. Thank you. Thank you.

[Andrew Perchlik (Chair)]: Any other questions? Yeah. Thanks for your support for. You you also sent that to Elle, that. Yeah. Okay.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Thank you very much for having me.

[Andrew Perchlik (Chair)]: Thank you.

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: Sure.

[Andrew Perchlik (Chair)]: Well, the announcement is VA was on notice today, so we normally take it tomorrow, but we have our public hearing at 01:45. That just gives us, like, twenty five minutes or whatever, half an hour to do the presentation. Approach I thought would be better for you. No. We do have a well, you already got it? You got it. So we're gonna do it Friday, then Tuesday for the third reading. This is exciting. Hope so. Did y'all be getting this? I know. I

[Trustee Weiss, Interim Executive Director, Vermont Legal Aid]: got