Vermont Legislature SmartTranscripts:

[Sen. Brian Collamore (Chair)]: So a former secretary of the agency of human services. So he comes with tremendous credentials and I wanted to give him an opportunity to come before the committee and talk to us about potential tweaks, improvements, whatever, in the operation of the AHS. We don't have a bill that's active right now, but anyway, welcome in, Doug, and let's go around in case you it seems like

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: you know everybody, though. Here. Yes. I I probably know most senator Vyhovsky very well. I think we just met once

[Sen. Tanya Vyhovsky (Vice Chair)]: I think so.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: At 5 Corners in Essex waiting waiting at the cars during the campaign. Wow.

[Sen. Brian Collamore (Chair)]: You drive the side lanes too, Yes. We do.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Yes. We do. Okay. Senator Morley and I honor each other, but we think we've all each other very well. Person I know best is probably senator Clarkson. So

[Sen. Alison Clarkson (Member)]: Which is great. Always wonderful. Seen at

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: the doctor we saw Doug in

[Sen. Alison Clarkson (Member)]: most recently, I guess, in September.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Yeah. But what was that? Thank thank you, senator Collamore.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I really appreciate this opportunity and and your interest. We've been looking forward to the community meeting about some of my concerns that I wanna express here today. Yeah. But I appreciate that the committee's gonna take some time to hear them and perhaps help the agency of human services with an ongoing project. My back gave gave my introduction of what I've done, probably leaving the work with me as secretary of the agency of human services is most relevant right now. I also, during that time, I worked a lot with my national organization, my peers, the American Public Human Services Association. So a lot of what I learned about human services management delivery, I learned by listening to my peers who have been doing it a lot longer than I have. And after I left the agency, I continued working with them and helping them with conferences and presenting, mostly around what I want to talk to you about today, is the integration of services, breaking down silos within the agency, and how IT properly used, properly developed, can facilitate that. There is a major modernization program going on with IT in the state of law. We're spending tens of millions, if not more than that, on it. And it's long overdue. I mean, it's, when I was there at the agency, most of the IT was 30 years old. Well, it's been twelve years since I left, and a lot of it is is still there. Big Space Invaders, you know, and the Pong or whatever the games were the first video games that came out in in modern. So it's really old, old technology. And the project underway is a bit about that. I think they're they're doing very well for everything I've seen and heard. And I talked to consultant who worked with worked in the state back when I was secretary, who worked on these issues about IT and delivery services in at the agency. And that's what he does. He's a consultant. He works in states that are trying to pay optimum use of their IT technology. He's very impressed with what the state's doing, but there was one missing element from his point of view. In all the public documents that he read and that I've seen, there's it's really not clear that there is synchronization between the agency of human services and the agency of digital services. And that's what wanna talk to you about today. The state agency of human services works in silos, so does state government, and so does the legislature because, you know, these sorts of issues can get discussed in a variety of committees. And I'm here to do it today is try to get you to focus on on the intersection, which really seems perfect for government operations, because it's really about the operations as a government. The opportunities, are, say, possible savings. We spent a lot of time on on bureaucracy, money that could better be spent and time better could be spent serving the clients of that agency. Certainly better outcomes for the people who are receiving services because there's often a lack of connection between different programs and the services that people are providing, but this problem is silos. Also allows for greater accountability because you can get better information out of an upgraded system. There's an article from seven days recently about that very issue that children might be in danger because DCF's system broke down and they really couldn't Yeah. They really couldn't communicate. So in terms of helping the the stories have been about the legislation not getting information it needs. I think one story focused on the education of the agency. Well, it's across state government. And better technology produces better accountability, better information, and allows the legislature to have all the information they need to make good decisions. I also wanna mention that I did I understand secretary is not gonna be here today, but I talked to one of her staff. Told me I think they're listening in today. They suggested they will be using what I have to say, And and we had a very positive conversation with Ed Fisher, who was the principal Yep. Principal assistant to the secretary. I was greatly encouraged by by what's going on. I started off asking questions, then I go, is it really is it really as good as it looks? Or I think it is. But there's Oh, yeah. Senator Vyhovsky, do have a question?

[Sen. Alison Clarkson (Member)]: Yeah. Have a question.

[Sen. Tanya Vyhovsky (Vice Chair)]: It may not be for you, Doug. It may not even be answerable in the room, but I know that the state is on a bit of a technology update plan sort of generally, and I'm just wondering if anybody in the room has a sense of where we're at in that process. Because I agree with you. The technology is deeply in need, and we would do a lot better if it was properly uploaded. But I just don't know if anyone in the room knows, like, where we're

[Sen. Alison Clarkson (Member)]: at in that process. Well, AHS and the Department of Labor have been on sort of the same time track. I mean, both very antique systems. DOLs is going live to change this spread. So DOLs So it's not already finally no. DOLs finally gonna be modernized with its and it's gonna be all today. And I thought AHS was on the same time frame, but we should obviously get them. And we should get ADS in here. We to to testify Yeah. All the different departments and agencies are.

[Sen. Tanya Vyhovsky (Vice Chair)]: I would just with the AHS being such a massive part of state government and such a we spend a lot of, rightly spend a lot of money on those services, I would think that we would want to kind of prioritize their update. Labor reports, mean, they're all important.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: They really are all important. It was being discovered during during the pandemic and number of people filing the appointment to what happened, the whole breakdown of that. Yeah. Which was just symptomatic of of outdated IT. I mean, you you don't expect something as big as pandemic and the impacts of the pandemic, but we were woefully prepared for it. There was also problem with in the Department of Children and Families distributing childcare money. There was additional money for that, but became a lot of regulations and it's okay. But a lot of a lot of overtime was needed in workers in that across that department to make contact with the day care providers. It was a paper process. They were calling them and saying, how many children do you have? What are their names? Are they? Do they qualify? They put it into the water guard or whatever they put it into the system. And then two days later, the system didn't they needed a new spreadsheet, so they did the whole process all over again. So 100 probably hundreds of thousands of dollars of overtime money Oh, my gosh. Because we didn't have IT systems that could handle the extra work that was required to get these distribute this money for childcare. Point was it should have gone to childcare and and because of the technology problem. So it's it's obvious, I think, to everybody that we really need to to upgrade. What I'm hoping to do today is to encourage this community and the legislature in general to provide oversight of these just to make sure it's being done in a coordinated way, and to provide support to the folks, particularly right now at AHS, who are somewhat dependent on the work that the agency of digital services, the DDS, is doing. And I just I don't know the answer. Okay? It could be everything's fine, but I don't know, and I don't think anybody else will be. So why why did I come to this committee? First of all, Sandra, you've been you've listened to me in the past about issues in the within the agency of human services, and and I and I appreciate that. To me, this this committee, over the years that I've been in this building, and your counterpart in the house have really been undervalued because these are important issues. And legislature can pass good policies, policy committees. They can be funded in the appropriations committee. The taxes can be raised across the hall. But policy needs to be translated into good practices. And that's not always the case. And given the nature of our legislature, being a citizen legislature, part time, understaffed, it's very hard to do oversight whether the executive branch is actually accomplishing the purposes stated in the legislation passed in this building, and they're all busy. You know, we talked about AHS. Well, certainly, there's the committee down the hall, but they've got their bills on the wall too, and there are crises that have to be dealt with, and coming around saying, well, we passed x y z legislation three years ago. How's it going? We don't ask those questions. At least when I was here, didn't ask those questions As often as as in my in my experience, Senator Wabiri, we didn't ask those questions, and I was chairing the committees. Mhmm. Would advise them to that. Yeah. So anything else?

[Sen. Tanya Vyhovsky (Vice Chair)]: I will hear, and I know you're specifically talking about being a chess, but this brings up another tweet that's really to to me, and that is government accountability. And the legislature is supposed to be a separate but equal branch of government. And so I wonder if you have any thoughts on ways I think we have done some work to try and build some of those questions And being yet, we have rules that aren't being promulgated. We have reports that aren't being done. And so I wonder if you have any thoughts about how we could increase that accountability, given the construct of the current state of affairs.

[Sen. Brian Collamore (Chair)]: Think to the pre- Back on to that, guess one of

[Sen. Alison Clarkson (Member)]: the questions government accountability asked every committee to be asking is how are you measuring, how are you reviewing that data? All of those measurables, which we've really focused on, I think, as legislator in the last ten years is really

[Sen. Tanya Vyhovsky (Vice Chair)]: But as you may recall, we did put forward a bill from our summer government accountability group Right. Group that didn't pass. And so I'm really I welcome your knowledge and and expertise in this arena, and I really would love to, you know and if you can't answer, don't know why I totally understand, but I I do wanna build that accountability.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: From what I saw on the website, there's no more government accountability to try to government accountability committee. I think to answer your question, that's a possibility. But those joint committees have a real hard time eating. That's the that becomes becomes the issue. And even when committee focuses on it, I think that the No. Agency of human services, which I'll speak to, is somewhat hamstrung because it's hard to produce the information Mhmm. That the legislature wants. And I became secretary of that agency, and the senator was asking me to show results of every to identify every single program in the agency, who's on it, who's receiving services, how much money is being spent, are we making lives any better? Folks Couldn't produce it. It just it just you couldn't get it out of the systems that we had. So while the effort was there, I think that it was limited in its effectiveness because of the lack of information, so we just sort of kind of keep on going. I would like more oversight when I was secretary of the agency of human services, because then it would me an opportunity to talk about things that we weren't doing and effectively, but why. And the why always came down to technology, staffing levels, and just the resources we needed to to develop good business practice so we can actually do what the legislature has to do. I didn't get asked that very often. I'd go in I'd go into an appropriations committee and say, well, I got we requested three IT positions. Well, why do you need those? There wasn't a whole lot of connection between the two branches, and I think, you know, the two branches, sort of getting into political theory here a little bit, but the two branches need to work better together, in my view. I often said when the founders put our constitution together, there were checks and balances in there. There were no political parties. It wasn't between two parties or three parties. It was between branches of government. And I certainly felt that when I went to the agency of human services and would go into committees, there was more of an interrogation than it was a partnership. And that's what I'm hoping maybe what I'm proposing is more of a partnership on this particular project with IT.

[Sen. Brian Collamore (Chair)]: May I just have a request?

[Sen. Alison Clarkson (Member)]: So government accountability has a good DNA. It doesn't exist in exist

[Sen. Tanya Vyhovsky (Vice Chair)]: in the Yeah. Just for my objection. No. I recall. Three years ago. Of government oversight committee. No. We should not. No. The government does

[Sen. Alison Clarkson (Member)]: well. No.

[Sen. Tanya Vyhovsky (Vice Chair)]: Why? We not We could. We sunsetted it three years ago, again, to my objection. Think The accountability, not

[Sen. Alison Clarkson (Member)]: the oversight.

[Sen. Tanya Vyhovsky (Vice Chair)]: The gov yeah. The government accountability committee was sunset three years ago.

[Sen. Alison Clarkson (Member)]: Remember when that was Instead, Jack and so keen

[Sen. Tanya Vyhovsky (Vice Chair)]: what we did to somehow make me feel better was we did the summer government accountability study, and then we promptly ignored all of suggestions. Oh, no. And

[Sen. Alison Clarkson (Member)]: was one of them to establish a government

[Sen. Tanya Vyhovsky (Vice Chair)]: It was with much more parameters and a bit of a shift in I think I'll find the

[Sen. Alison Clarkson (Member)]: bill actually, think

[Sen. Tanya Vyhovsky (Vice Chair)]: the bill came from the house was garbage, but I think they'll find the report that came from that committee, and we can circle back to it. Because I think

[Sen. Alison Clarkson (Member)]: it's important. Because just saying, if we wanted to think about reestablishing that and as a committee bill, just censure on our deadline for, committee bill introductions next Thursday.

[Sen. Tanya Vyhovsky (Vice Chair)]: And any member of the committee

[Sen. Alison Clarkson (Member)]: excuse me.

[Sen. Tanya Vyhovsky (Vice Chair)]: For committee bill introduction on the floor or the committee? It has

[Sen. Alison Clarkson (Member)]: to be introduced it has to be introduced and sent to the it has to be passed out of committee on Thursday. It can go to the floor. No. But and then it can get then it will be sent back to committee for work. All they're doing is identifying Doing them. Getting the committee bills established in drafted principle, and then they are sent back to committees to work on the

[Sen. Tanya Vyhovsky (Vice Chair)]: because I'd be more than happy to introduce Right. Language and do that process if that's something the committee wants to look on. It's also helpful information for something I wanna do in judiciary.

[Sen. Brian Collamore (Chair)]: I'll just add as a sort of historical note. I was chair of the GAT committee at one point, native Townsend. Yeah. Once upon a time.

[Sen. Alison Clarkson (Member)]: I remember that.

[Sen. Brian Collamore (Chair)]: And the composition of that committee changed here because people that were on it, with all due respect, my impression was it was their least favorite thing to do.

[Sen. Tanya Vyhovsky (Vice Chair)]: Oh,

[Sen. Brian Collamore (Chair)]: really? They didn't really wanna be on it. They didn't really wanna meet. We had Sue

[Sen. Tanya Vyhovsky (Vice Chair)]: Who is her?

[Sen. Brian Collamore (Chair)]: Pat Mc Pat McDonald's sister.

[Sen. Alison Clarkson (Member)]: Pat McDonald's sisters in Kim.

[Sen. Brian Collamore (Chair)]: She was in the administration anyway. She was part of the And if I'm mischaracterizing anybody's feelings, I apologize. But that's what I remember. I think that's fair. We had Anthony Polina on it for a while. We had Technopharmac on it for Janette was on it for a while. And we had- I understand. Uh-huh. Indicators that we used to have this big huge dashboard we'd be able to look and see how much we're spending, Will people any better off because we were spending that money? All that sort of stuff. And it just it seemed to be a committee that just kept commit meeting, but never really did anything sort of. But we changed the indicators every now and then. Anyway and if if you're wanting to do that, I'm I'm fine, I guess, with the with that. I I don't think you'll have a waiting line of people that wanna be on it, but I

[Sen. Alison Clarkson (Member)]: could be wrong. You mean on the government's oversight committee? It's called accountability, not oversight. No, no. But I think it actually could be renamed as a government oversight committee. Well, we've

[Sen. Brian Collamore (Chair)]: got different charges, I understand.

[Sen. Tanya Vyhovsky (Vice Chair)]: So the summer working group that probably started meeting in December, as we do, they put forward some specific recommendations for how to reconstitute that committee with a slightly different charge and some parameters that I would probably just grab that and

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: start with

[Sen. Brian Collamore (Chair)]: that. We can certainly take a look at it. Just had questions just kind of on a personal note. Jane Kitchell was also a secretary at one point. Did you succeed her or were you there before? How many people were also employed by because the Agency of Human Services is the biggest agency in state government right now, and I don't know how many employees are there, but it seems like there's a lot. And I don't know whether it's a function of the legislative process getting better and reacting to people's needs more nicely, or whether it's like a lot of other things, it just keeps getting bigger, but it really doesn't

[Sen. Alison Clarkson (Member)]: change anything sort of.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I was there, it was about 4,000 employees. Over a thousand of them were in the corrections department, so that tends to

[Sen. Brian Collamore (Chair)]: Oh. That's right. It is part of

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: the Yeah. Yeah. It's it's an unusual arrangement. I think it's a great arrangement.

[Sen. Brian Collamore (Chair)]: You do?

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Absolutely. Okay. And I'll get to that a little bit. Alright. But but yeah, I'll I'll I'll address corrections in a moment. But after senator senator Kitchell was the last secretary under governor Dean, and then governor Douglas was there for eight years, there were four secretaries. And then

[Sen. Alison Clarkson (Member)]: Which tells you a lot in and

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: of itself. It's the lack of continuity.

[Sen. Alison Clarkson (Member)]: Yeah. Back of

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I mean, it's going back to the government accountability committee, that's when I think the speaker and the pro tem both were really focused on results based accountability.

[Sen. Brian Collamore (Chair)]: Yeah. I remember that phrase.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: And OV was passionate. And but when the leadership changes, it's not the same priority anymore. It is. And that and and the same thing goes on in the executive branch. Yep. And the lack of continuity is a problem because secretaries come in with different charges. Sometimes the governor can set the agenda no matter who the the secretary is, but realistically speaking, the governor doesn't pay that close attention to the functioning of every part of service they cover, which is by virtue of the job. I think it's unfortunate that there is no accountability committee anymore. When I started in an agency that we had come through the previous administration, the challenges for change operation, which was agreed to by a legislature. And basically, was cut for the agency of human services, it cut $25,000,000 out plus the natural federal Mhmm. Any change in processing processes or anything like that. And the challenge was to do some better job with it. But coming with that were a whole lot of accountability measures. And there was a requirement that that my agency submit a quarterly report to legislature on progress made and outcomes and all of that. I had one full time staff person who did nothing but that. I was trying to get the information because of the IP, and I don't follow any legislative behavior looking at those reports because the leadership had changed and so on and on. You know, that's just it's it's just the way government works. And the challenge is to try to figure out how to work, make it work a whole lot a whole lot better than it does. There's no one person involved. It's not a partisan. It's not political. It's just functioning. It's functioning from it's a big organization. Yeah. And but it can be made better, and that's something that I firmly believe. Governor gave me the charge of breaking down silos, and that's what we're working on. We got interrupted by Irene, which which closed down which all of a sudden shifts to 2,000 people, happened into temporary offices. My office was in the back storage room in Williston for for three years. After I read? After I read. I miss going into the new building by an out of a month. It's going crazy. But I've been so involved with with the design of that building and the size of that building. And, you know, I said I'm a bit like Moses. I was trying to lead us to the promised land, but I didn't get to see it. So Weird. Anyway, you know, it was

[Sen. Alison Clarkson (Member)]: Well, hopefully, just didn't get to work to work.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Get to work in this. I was Anyway, the point of IT for me is it's a tool. It's not a policy. It's not a program. It's a tool. And my dad always used to tell me there's no job you can't do if you've the right tools, and the agency has not had the right tools. And I think what's going on right now gives the agency a lot of the right tools, but not all, and what I hope they're doing that I haven't seen that I'm talking to folks about today is developing this IT in a way that allows that integration to occur. The agency, is still focused on it. Then, mister Fisher, I talked to yesterday, assured me, you they've got, there's a there's a report, which I'm gonna get to, which has come to this committee along with health and welfare and and your house counterparts. But it talks about integration. Integration is all the way through. The the fact is we need to build our programs around families and they come in silos. And I had a nice illustration when I got there when we were starting to talk about integrated IT is the the silos are there. There's children and families, and then there are different programs. They all have their own IT systems. Then there's nail, and then there's corrections, and then there's mental health, and there's nothing tying them together. And the challenge is to build the ITs, so I'll tell you how little I know about IT, but in theory, build a platform underneath it that supports them all. And underneath it, is all the communication, all the data, all the data that people know when they apply for one program. It sits there. If they apply for another program, the information's already there. It's something mean, like you to

[Sen. Alison Clarkson (Member)]: be creative. You don't have

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: to recreate it. It's there is potential there. It's being done elsewhere in the country by other states. Vermont, I think we're on that track, and I guess that they've continued on it. But I think it's it's really it's gotten a lot of energy because with the potential of this IT project. So the the underlying question is, are they working on on together? I don't know if I can convince you about the value of integration, but I came across this document. 10 reasons why you and your governor, that this was addressed to people like me when I'm serving in that role. Why states should be integrating their health and human services business processes, because that's what I'm being about. And it says it on. I mean, I could

[Sen. Tanya Vyhovsky (Vice Chair)]: Oh, okay.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I could read through it. But This

[Sen. Tanya Vyhovsky (Vice Chair)]: is it on the

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I no. I didn't get that. I

[Sen. Tanya Vyhovsky (Vice Chair)]: But I didn't get this.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: No. I didn't. No. I I I did not. I came across this. I was going through all my oh, yes. Sorry. It's That's okay. Somebody's hiding me.

[Sen. Brian Collamore (Chair)]: Let me

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: get this back. Some. I have another one. Okay. You would like But, anyway, it's, you know It's fair. And the the first thing is the opportunity. We got $90.10 federal money to do this because the federal government is fully involved with trying to integrate health and human services, recognizing the social determinants of health and all those other things. Meaning work. Yeah. Are they They still are. They aren't full of money. So they are urging states to develop the IT to allow integration of health, Medicaid, and all the other, the various human services programs. As far as we know, it's still going on amidst all the craziness in Washington and all the cuts, and it seems like these efforts are continuing. Certainly, when I talked to Mr. Petrus, who was a consultant for the Muse, he says the money is still there and the encouragement is still there from the Centers for Medicaid and Medicare Services. So it's it's being it's being developed in heat. And then I don't know if you received the other piece that I sent. We have two Two docs. That's okay. You got both of them. Yes. The other one is

[Sen. Alison Clarkson (Member)]: Oh, did we have another

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: gets into the weeds, but it's the Integrated Health and Human Services National Trends. First pages are interesting. After that We're pages long. Wow. Yeah. You can get into if we get into the weeds. It makes the case for full integration and developing the IT systems needed to make that happen.

[Sen. Brian Collamore (Chair)]: Senator Morley? Don. So I'm on the health care

[Sen. John Morley III (Clerk)]: committee too, I know that a lot of the rural grant coming in is to help a lot of it is to streamline, right? And it's on IT. It's the the EMR systems and all that stuff. You're not this is this is a separate bucket bucket of money coming in? I think they're I don't know. I I don't know if they're blended or they're separate programs. I don't I get ADS people then because that's where the the funding being spent. So I don't know the answer. That would be great. There was two different funds coming in. The rural dollars, which has about 295,000,000 for five years, one time dollars. Mhmm. And then the $90.10 of of this would be wonderful. I guess, AHS, I agree with you, needs to keep up, along with the hospitals and everyone else, so that they can all get lived together. It's not an easy problem to solve to keep things together.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: The hospital's been working on this for a long, long time. It's very difficult. You run into HIPAA, little issues, which can be overcome, but this is not it's not easy. I'm not here to be critical of anybody this one. This I think it's just, there's an opportunity out there that hope And is not I will say from my perspective, integration works. I go to the meetings by national with my national groups, and they were talking about all these best practices and integration. They've got something called a value curve, how agencies can modernize one step at a time and all of that. And I walk out of check, gotta go back home and transfer transform that agency. And go back in a survey desk and all these other problems were coming in because mostly what you deal with in government, you do it in the legislature, we did it when I was in the executive, is crisis management. And thinking ahead and trying to develop better ways of dealing with new problems and developing problems. Opioids were not the same issue fifteen years ago that they are today. But all all those issues land right in the agency of human services, and they're using the same IT and the same processes there. So when I came back, I realized, can't transform the whole place. The last administration that really tried to do major reorganization was the Kennedy administration, and it was took five years for the agency to recover because they reorganized all the boxes and changed the stationery, because we had the print stationery then. It was just so I couldn't go back and say, we're going to transform this agency. I did an internal document, so I never said it out loud. Tried doing one issue at a time, and the opioids came up, and Senator or Governor Shumlin pointed at that one here and deeply recalled what was his whole state of the state address on that. Out of all that came hub and spoke. Hub and spoke system, which I has been very don't know how if it's still successful or not.

[Sen. Alison Clarkson (Member)]: I understand still is. It still is. It your work.

[Sen. Tanya Vyhovsky (Vice Chair)]: The hubbles folks system is still in place. I I think and they do great work, but I I don't know that it's a holistic picture of, you know, all that is needed.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Think It's it's it's far as needed. But it's it's all that's needed. Depends on resources too and and and policies and regulations and plan. But the what what was going on at the time was a health department ran the methadone clinics, and Diva, through Medicaid, was funding buprenorphine in doctor's office, and they're dealing with the same clients. And there was no connection between the two. If you remember Barbara Somaglio, who was the I do. Deputy, she came into my office early on and said, we have an opportunity to put those two together and develop a new program that integrates Health Department and Diva and other parts of the agency around the opioid problems. People were going into we weren't getting at the root causes. And to get at the root causes, you gotta do an assessment. And nobody was responsible for doing the assessment. What do people need? Do they need housing? Do they need a job? Do they need mental health services? What kind of services? So the whole idea was to use the Accountable Care Act money, otherwise known as Obamacare, to blend those two programs and develop the hub. Then these folks would go out to housing or job training, a primary care provider, and all of that. That's a good example of what integration can do. It was difficult to do it. Funding was difficult, but we did have a grant from the federal government that enabled it, and we built it, and it's worked. Part of I mentioned I was going to do going to conferences. I went to some for sponsored by the National Governors Association, their best practices unit. Never saw a governor there, but that was for staff. And they we've made presentations there several times because it was considered a model. Kentucky had a model and we had a model. But it shows the value, to me it shows the value of integration. Another integration effort we made was around home visiting. We had health department nurses visiting homes, and we had children and families through, mostly through our parent child centers and other community partners. They were visiting homes, but they were going separately, and they were looking at different things. And oftentimes, would make recommendations to the family that would find pictures, you know, and contradict each other. And that's, you know, and so we integrated those. That was a that was a tough integration that happened, but it's more difficult if they can't share the information. And that's why what I've been talking about. So I think the opportunity is there. The federal money is there. The federal departments are aligned with with, what we're trying to do. And I think there's a real urgency to doing this too, I would urge you to, take on that sense of urgency. We're we're about to lose as everybody knows, pull a lot of federal money in this in this arena. And based on only what I heard from the governor yesterday, it sounds like the impacts can be ameliorated in this coming year. What happens after that is a big is a big question mark. And I think it's gonna call on some call for some major changes in how the government operates. And it could involve tax policy. It could involve, you know, obviously, the budgets, but it it should involve management because to adapt to it, we need more efficient government. You know, people want I think citizens want government to work. You know, people have people have different political views, but the bottom line is everybody wants to see progress, wants to things things work better. There's more and more regulate regulations on, like, staff, three squares benefits, qualifications for Medicaid. All that's gonna require a whole lot bureau bureaucratic work. I use bureaucratic in neutral way because it's a bureaucracy. But it's gonna require a lot more staff time given our current our current IT setup. So chances of or the opportunity to build IT will help us get through and adapt to some of these changes that are coming from the federal government. You know, people say, well, maybe it'll only be blessed for a few years, but in meantime, those few years could have you could have serious impact upon upon families that that we were serving. Now just one last thing. I think this is probably most important is the report I sent to you, which was also sent to your committee, so I don't know if you've already had already seen it, reenvisioning the agency of human services. This was reading this, I say the agency is really ready to redo how it works and to fully integrate services, but they need the right tools.

[Sen. Alison Clarkson (Member)]: Is this the proposal that Jenny and Jane had about dividing the agency?

[Sen. Tanya Vyhovsky (Vice Chair)]: No, it's a different one.

[Sen. Brian Collamore (Chair)]: This is a report out

[Sen. Alison Clarkson (Member)]: of Act 119.

[Sen. Brian Collamore (Chair)]: Oh, right, Which Secretary Samuelson wrote, and there are structural options, agency operations, all kinds of things, including, as Doug has mentioned more than once, the integration

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: of The integration. A bunch of It's all about integration. It is a fabulous report. I've been looking for this since I left the agency when I found any opportunity, so I didn't really know what was going on. And when I read this, I was I was I was thrilled. The policy wonk in me says, this is a good report. It's serious. They talk to a lot of people. They write there in the front the staff hours, seventeen thirty six staff hours to put this together. This was not a slab bash. This was a very thorough report on some of the changes that are needed, and IT was underlining the ability to actually implement this vision. To me, it is the right vision. They need support, and they may need legislation. Senator, it sounds like you've been through it, but there are proposals for Yeah. I did agree. A couple of some some physicians, a couple of deputy positions that has to come from the legislature. I mean, the government can can propose, but it's up to the legislature to fund those positions and other major changes. Most of it's internal management, but they keep talking about integration and the need for information technology. So this is a great piece of work. I hadn't talked to them, but they've invited me to come and talk to the staff Oh, great. About this later on this week, just to talk about the process because we the process of making changes is really very, very difficult and very political. Every time you go and make a change, if you're moving dollars around, somebody is losing something. Yeah. Okay? And it's really that's really hard to do. And when I was doing it, sometimes the legislature would be supportive and sometimes it wouldn't be based on, like, lost losing positions or constituents who are running a program saying, geez, it's not you know, we're not gonna get the same amount of money because they're shifting priorities. But that's where we the two branches need to work in partnership. And one of the values of having a community looking at this is understanding the management issues that have to be faced to make to make changes, to make changes for the better. I got a few recommendations for your committee just for what it's worth. The first is to get secretary Samuelson in here, and I she was planning to she'll be here next week. Yeah.

[Sen. Tanya Vyhovsky (Vice Chair)]: Yeah.

[Sen. Brian Collamore (Chair)]: We'll we'll have her head, and we'll have ADOs in the book.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: About the their role in this Yep. Because it's not clear that they design too. With the vision that secretary Samuelson and her staff have for the agency. And if they design it, it does a really good job on a, b, and c programs. It may not do the x, y, and z that's needed for integration. And that's an issue too. And that's with the vendors who develop these systems and bring them to the states usually want to sell you off the shelf things. We do. Okay, they want them to. So the big one

[Sen. Brian Collamore (Chair)]: is

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: integrated eligibility. That's a huge one. It needs to be done. One form, one form. One form. They're talking about it for DCF. Does it Is it one form for Medicaid? Is it the same form to the family eligible for mental health services? I don't know, but it could be.

[Sen. Alison Clarkson (Member)]: A lot of the basics could be.

[Sen. Tanya Vyhovsky (Vice Chair)]: I wonder, and this may not be a question that is answerable, but I would be really curious, you know, how much administrative time we are spending actually going through those forms. When the state of Vermont actually knows how much money everyone makes, they can just give the benefits to everyone eligible for them with no forms.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: If the tax department could communicate with the economic services division of DCF, they could.

[Sen. Tanya Vyhovsky (Vice Chair)]: Yeah. Because I feel like that would cut out a lot of administrative bureaucracy.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: It's like Office of Child Support. You know, they have information too. Yep. And is that getting to the DCF reach up case managers who are working with the individuals who should be receiving child support and maybe are not? We don't know. I mean, are issues where somebody gets released from one of our correctional facilities. They go back where they came from in their home. Does the family know that this person has been released? Probably. I think Corrections does a pretty good job of informing the victims. Yeah. But does the reach out case manager who's working with that family know? And are they surprised when they go and do a home visit that there's somebody else living in the house now? And how does that affect the program the person's on? Has it had an impact on them? Are they still able to be getting an education? It just raises a whole lot of issues because we don't know from one program to another. So I would ask the secretary how their vision is being baked into the system. So the system actually enables them to do what we're talking about here today. I would ask, I would also suggest, secretary of the agency of administration, who I guess is coming in tomorrow. Please. Yeah. Well, I think the world of. I, she was, when I was at the agency, she was the Chief Fiscal Officer for the Department of Corrections, and then Jim Reardon, who was the Finance Commissioner, stole her away to be his deputy. And I was in the process of stealing her back because I had one good C and the CFO of my agency, there was a retirement there. And just to to the story, a little personal anecdote, we met for lunch next door or whatever it was, and I offered her the job. We had been talking, and and I offered her the job, and she accepted it. And I did that at noon. At 02:00, I came over to 5th Floor, and got fired. So I never got to work I never got to work on Sarah, but I think I think very happy with her. So but I could ask her because that's where ADS and AHS or any of the other departments come together. Yep. And are they being coordinated? And if the secretary is is agency administration is demanding it, they will have it because that's the the greater of all the evil secretaries and and commissioners. Essentially, one of the many bosses that I had when I was secretary. The other thing, there are recommendations in there for positions. I don't know what their position would be on asking for positions because that's something that has to go up through all the folks on the 5th Floor before they can request them. But you can certainly ask them about that whether they're needed, when they're when they're needed, and ask whatever what what can the legislature do to make this happen? Do you partner with the executive branch? Oversight is important. I'd ask that you provide on it. They've got a plan, and we're developing a plan, an implementation plan with this. Ask for occasional remarks from them just on the progress they're making,

[Sen. Brian Collamore (Chair)]: what they're encountering. So I don't if I could

[Sen. Tanya Vyhovsky (Vice Chair)]: check on So

[Sen. Alison Clarkson (Member)]: you have been here. We do have a joint oversight committee on IT. Right. JITalk. Right? Anyway. Okay. That also then follow-up and be do follow-up work. Yeah. They Or say

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: They haven't met they haven't met a whole lot. They met quite a bit this summer. It's last summer, I think. But, again, it's one of those committees that it's hard to meet during during the session, and these these projects are going on. I think it's it's important that they're there. But what's their charge? Is their charge to look at whether it's gonna be functional for the agency of human services to accomplish its mission, or is it mostly focused on the budgets and timelines, which is what they really should be looking at. But where is where is it coming all coming together? Where are these coming together? And that's why I think this committee is uniquely uniquely qualified. So I'll end there. I I've been repeating myself a lot here.

[Sen. Brian Collamore (Chair)]: But okay.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: I apologize for that. But there's an opportunity here to really improve state government, improve the outcomes for the clients of the agency of human services, modernize our management, modernize our programs. We aren't the only ones going through this. This is every state, but we are one of only a handful of states that has an agency of human services like we do. My counterparts and when I go to these national meetings, my counterparts were mostly the equivalent of the commissioner of the Department for Children and Families focused on children's issues and economic services and program and all and all of those. One of my counterparts, was in an administration. There were eight separate agencies all reporting to the governor and said, how do you coordinate? How do you integrate? Well, we have quarterly meetings with the the eight of us. You know? That doesn't that doesn't work. Or they have a children's cabinet where they can talk with each other. But we're talking here about day to day operations and not just overarching plans.

[Sen. Brian Collamore (Chair)]: Well, knew you could tell forty five minutes, Doug, and you did.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Happy to. In front of me, so

[Sen. Brian Collamore (Chair)]: I have no idea where we're going.

[Sen. Alison Clarkson (Member)]: Oh, I'm so I'm so glad you've stayed engaged with this.

[Sen. Tanya Vyhovsky (Vice Chair)]: I just have a quick question, and you may have said it, I just missed it. But where did the where

[Sen. Alison Clarkson (Member)]: did the stop the call come from? Who put it?

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: You know, I wish I knew. Okay. I kept looking for it myself. I think it probably I filed my claims. I filed my And I have I have a lot of files on the agency of human services. I just dating age. Like, I guess, I did consulting for APHSA afterwards. I was down in Mississippi. You think we got problems here. That's right. Try going down to see what's going on in Mississippi. Yeah. But I I did I was involved in leadership meetings with the CEO, all ourselves CEOs of these these departments. I was involved with continue to be involved in it, but I kept picking things up as I go to these meetings. And this one was in the pile, but I probably lost the cover page, Sandra. And then it's done. It's in it's in there somewhere, but I have no idea, but it's about ten years old. I didn't

[Sen. Alison Clarkson (Member)]: I was gonna say the one thing we're missing here is also a date.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: So Yeah. It's but the the 10 reasons are are still valid.

[Sen. Alison Clarkson (Member)]: They're still strong.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: Yeah. I think they're still strong. It's a way of making, you know, making making points. So I urge you to to stay involved. I think you could do a lot of good things by asking the right questions. Okay. Well, thank you for coming in today. You, Rutland. Thank you for listening. I appreciate it. I

[Sen. Alison Clarkson (Member)]: Well, thank you for staying engaged.

[Doug Racine (Former Secretary, Vermont Agency of Human Services)]: It's I you know, it's it's important to me. I mean, you know what I've been working on for my my time in politics. It's around kids. Oh. And so families, and we need to support families. We had the the child poverty council many years ago. We could have called it family poverty council because children do not exist then. But terms of the politics of talking about poverty, he's better focused on children than his. It's about PR too a little bit. But, you know, it's but I've I my interest is has continued. And I when I was head of that agency, I thought there's a whole lot we can do better. Yeah. And I would say I'd go to the committees, and I'd say, you've given me a box of money. This is how much I have. Don't tell me to raise taxes. I don't have the authority to raise taxes. Yeah. We'll talk to the governor about that. But this is the money you give me.