Vermont Legislature SmartTranscripts:

[Speaker 0]: So we're live and we're coming back to Friday, January 9, Senate Health and Welfare, and we've asked folks to come in from the Agency of Human Services to share with us what's coming or what has come around federal issues in the healthcare world and human services world as a result of the bill that was passed in Washington on July 1, signed in July 1. Welcome, I'll turn it over to you.

[Jill Mazza Olson]: Great, thank you. Good morning, I'm Jill Mazza Olson. I am the Medicaid and Health Systems Director for the Agency of Human Services. Let's see, Ashley, you're running the slides. Is that right?

[Ashley Berliner]: Yes, I'm on the slides.

[Jill Mazza Olson]: Okay. I was just waiting for that first slide because I'm going to just give you a quick overview of the presentation. Going to actually Why don't I let Addy introduce herself and then Ashley after that, since she's doing the tech. Actually, Ashley, before you hit share, why don't we do the intro? Sorry, Addy.

[Addy Stromolo]: Good morning, everyone. Addy Stromolo, I'm the Deputy Commissioner at the Department of Vermont Health Access.

[Jill Mazza Olson]: You may ask me to repeat yourself because it's actually really quiet in the room. Can do it again?

[Speaker 0]: She's gonna turn to sound

[Jill Mazza Olson]: like she did. She did? Okay, good. Okay. Ashley, are you good to go? Sorry.

[Ashley Berliner]: I'm good. Yeah, Ashley Berliner. I'm the Director of Medicaid Policy for the Agency of Payment services.

[Jill Mazza Olson]: So these are two of the smartest people you ever going to meet. Knew that before I started this job. Right, so Ashley, I still don't see your slide. There they go, okay. So, I think I said just before we were on camera, I'm mostly here to really to share with you the overview and maybe to help us in translation. There's a lot here that is changing, and so to explain what's changing, it's gonna be hard to provide you maybe all the context you need about what it used to be like. So we'll do our best to sort of help make sense of it all. But we are talking about the, we call it HR1. It's also referred to as the one big beautiful bill, so just to orient people, that's what we're talking about. And we're talking about the major provisions that impact Medicaid or the health system. It's not everything in that bill, but these are the things that we've identified as things that we think Vermont policymakers really need to know about. So, we're going to start with Ashley, and she's going to talk about funding for Planned Parenthood, provider taxes, state directed payments, and cost sharing, and she'll explain a little bit more about all of those things in her presentation. And then Addy is going to talk about the many eligibility issues for Medicaid and issues with the exchange that are impacted by the bill. So, we're going to start with Ashley and then we'll flip to Addy for probably the lengthier part of the presentation.

[John Morley III (Member)]: Right. Can

[Jill Mazza Olson]: I ask for a question before we start? It seems like there was a bill passed last night, potentially the reinstate the ACA credits. Is that going to play into any of this or did Annie just say yes? Chittenden, was like, said, yeah. Mean, I will say this, it's still not a done deal. So I would say no for the purposes of today. Yeah. Yeah, that is a yes. It was certainly a notable thing, but it hasn't changed the world yet. I think which means. Thank you. If it does change or not. If it does change, you'll need us back, I think, if something does change.

[John Morley III (Member)]: Okay.

[Addy Stromolo]: Just to clarify, this presentation focuses on the impact of the Budget Reconciliation Act from last summer. Think she turned off.

[Speaker 0]: Needs to get closer. Addie, you need to get closer to the mic.

[Addy Stromolo]: Alright. Let me work on that while Ashley talks.

[Ashley Berliner]: I can hear you fine, Addy. So I don't know if there's something in the room.

[Addy Stromolo]: Okay.

[Ashley Berliner]: You're close.

[Jill Mazza Olson]: It was better when you moved closer. Okay. Let's let Ashley start.

[Ashley Berliner]: All right. So the first thing we're gonna talk about today is Planned Parenthood funding. This is a provision of the bill that went into effect on day one, 07/04/2025 when the bill was signed into law. And it is a federal prohibition on Medicaid reimbursement to Planned Parenthood and Planned Parenthood like entities for one year. It expires on 07/03/2026. In the state of Vermont, there's a fiscal impact here of about 600,000 in federal financial participation that is lost from the 1,100,000.0 in gross Medicaid claims that we anticipate paying in twenty twenty five, twenty twenty six. We have decided to backfill those costs with general fund dollars, that 600,000 in lost federal revenue. And so Planned Parenthood Medicaid claims are being paid today by 100% state general fund dollars. You might hear in the news, has been a lot of ongoing litigation around this provision in particular. There were injunctions, there were reversals of injunctions, there were more injunctions, there have been sorts of decisions that have kind of ping ponged back and forth on whether this prohibition can stand or not. We are sticking with 100 state funding until which time the courts have fully settled on a decision so that we don't have to keep changing our systems and have financial exposure if and when ultimately federal prohibition stands. So that's our practice right now is just regardless of what's happening in the lower courts, we are sticking with general fund and we're just waiting on that final court decision. We'll make sure that we're back billing for any federal dollars if it does ultimately fall. But just wanted to make sure you were aware of this because it has been in the news and it's kind of hard to follow. Our course isn't changing. The next provision I'm going to talk about relates to provider taxes. This bill prohibited the creation of any new provider taxes upon signature. It also requires effective November 2027 states to begin reducing hospital provider taxes by 0.5% per year for five years until that cap is lowered from 6% of hospital provider tax revenue to 3.5%. And that would be fully lowered to 3.5 by 2032. So it will take five years from 2027 to 2032 to reach that lower threshold. A 0.5 reduction in Vermont hospital provider taxes amounts to approximately $18,000,000 a year in general fund revenue lost. And over five years, that would equal $87,000,000 in today's dollars in lost general fund revenue. And that would be an

[Speaker 0]: unanswered loss. Ashley, we have a question. We're gonna probably interrupt you in between. Senator Cummings has a question. Yeah. It's it's not a question. I'm just thinking of the newbies. Oh. I was too. I was checking there. What do we do with provider tax? What are provider taxes?

[Nolan Langweil (Legislative Fiscal Analyst, JFO)]: So we can do I can do a provider. You don't wanna go into it today. Can come in and do thirty minutes.

[Speaker 0]: Yeah. We'll do that.

[Nolan Langweil (Legislative Fiscal Analyst, JFO)]: We'll do that. Let

[Jill Mazza Olson]: me say the important thing. What this means is less money

[John Morley III (Member)]: to Vermont.

[Jill Mazza Olson]: That's the important thing for me. The conversation. Yeah.

[Speaker 0]: It sounds like reducing costs to hospitals by $87,000,000 would be a good thing.

[Jill Mazza Olson]: But it also means lots of Right.

[John Morley III (Member)]: For for the state.

[Speaker 0]: Yeah.

[John Morley III (Member)]: Yeah.

[Speaker 0]: But that money gets recycled back.

[John Morley III (Member)]: But it's not just hospitals, it is a provider taxes for other areas as It

[Jill Mazza Olson]: actually doesn't affect the skilled nursing facilities. This change does not affect skilled nursing facilities. Their tax remains intact. It was not part of this bill, and in Vermont we no longer have a home health provider tax.

[Nolan Langweil (Legislative Fiscal Analyst, JFO)]: Yeah, and the annual tax is below the threshold, so it only affects hospital provider taxes in Vermont. Okay.

[Ashley Berliner]: Yeah, it is a nuanced provision. Think, yeah, it would be very helpful to have Nolan come in and talk in more detail about that. But this is, as Jill said, really just a reflection of lost general fund revenue to the state, which can be matched for federal funding in many instances. Okay. The next provision relates to a term of art called state directed payments. This is a mechanism where states require managed care plans to pay healthcare providers in specific ways to achieve their state policy goals. Effective upon enactment of HR1, state directed payments are not permitted to grow and any new state directed payments are capped at 100% of Medicare rates. Existing state directed payments that are above Medicare rates need to be reduced by 10% a year starting in 2028 until the state directed payment is at the 100% Medicare level or less.

[Jill Mazza Olson]: Ashley, I just want to say one, just to make sure one thing is clear, we're talking about Medicaid payments, payments made by Medicaid, not by other payers. This is related to Medicaid.

[Ashley Berliner]: Important point. In Vermont, we have sorry. Let me Vermont state directed payments are limited to those where the state contractually obligates Diva to pay certain provider rates or participate in multi payer initiatives. And that would come in the form of legislative mandates. Under this provision, Vermont currently has two recognized state directive payments, which means CMS knows of them and we have already kind of established that they're state directed payments. And those are the Blueprint for Health patient centered medical home payments and community health team payments, both of which are over the Medicare, 100% Medicare fee schedule threshold. We also have other payments that are not known to CMS such as the legislative requirement several years ago to increase primary care rates to one hundred and ten percent of Medicare payments. And so we're currently going through right now to really understand the full landscape of where we have these state directed payments that are above Medicare rates. Right now, as we read this by the letter of the law, Blueprint payments would be impacted starting in 2028, So not a this year budget problem. But we're also exploring options to make sure that we're in compliance with this provision while still ensuring flexibility and the ability for Diva to pay providers in a way that is aligned with our policy goals. So I want to just make sure that people understand that this to is amount to a change in how we think about setting rates for Medicaid, but we're hopeful that it won't impede our ability to set rates. It's just going to be a careful consideration of how DVA sets those rates. We need to make sure that the legislature is not putting in long specific direction to set rates in a very specific way, such as that primary care at 110% of Medicare costs. So this is really like a future year issue, but a flag that we're going to start having conversations about making sure policy is developed in a way that is consistent and compliant with this provision.

[Jill Mazza Olson]: So I would view this as something we want you to know about. It's something that might could come up this year in terms of if you were to consider an additional state direct payment that we would probably flag this, but it's not a this year budget issue because it doesn't go into effect yet. And we do think there's good work that we can do to preserve the policy goals that we share, but we may have to make some adjustments.

[John Morley III (Member)]: Wondering, these changes are coming from the Fed.

[Jill Mazza Olson]: Yes. You'll hear it say CMS a lot. The Yeah.

[John Morley III (Member)]: And so, I take it that these changes are trying to reduce the Fed dollars coming into the state and also reducing costs on the state side too. Am I right in saying that?

[Jill Mazza Olson]: Well, does. When Medicaid, yeah, you are right that, and I'll let Ashley stop me if I, she thinks I'm saying something wrong, but yes, because Medicaid is a shared program between the states and the federal government, how much we pay in Medicaid does impact whatever our rate is. It has an impact for both the general fund and for our federal match. So it impacts both, yes.

[John Morley III (Member)]: So is that why they've done this? Is to reduce health care?

[Jill Mazza Olson]: I don't like to necessarily speak to why other people did things.

[Speaker 0]: There's motivations. Yes. One, I mean, could go through the litany of motivations that come from Washington.

[John Morley III (Member)]: I apologize, but I'm sure.

[Jill Mazza Olson]: But there are a good question. But I I do think it raises one good point that I'm gonna let Ashley make, which is that some states have used state directed payments in a really different way than Vermont has. Ashley, do you wanna just touch on that issue around the the Sure. Yeah.

[Ashley Berliner]: Yeah, what we know is that many states have directed their managed care plans to pay well beyond Medicare rates, and it has significantly driven off a federal budget since these state directed payments have been permissible, which is only in the last seven or so years. And so they've been flagging at the federal budgetary level, both state directed payments are direct correlating to an increase in Medicare and Medicaid costs. And so this is an attempt to really rein that in. It's a very different situation in Vermont. Vermont doesn't have managed care the way other states have managed care, where California might be directing Kaiser or United to pay in a certain way. In Vermont, it's DIVA paying. It's a public managed care like entity. We are not really the problem that the federal government is trying to solve for, but we are kind of caught up in this provision. And I'll also say we were a lot more caught up in the provision and we worked really closely with CMS to kind of detangle a lot of our rates, which had previously been considered state directed payments. We got in writing that they're not considered state directed payments for the purpose of this provision. So we're in a much better place than many other states, but that's kind of, not to speak specifically to the motivation, but that's really, I think, where this was coming from was a real trend on the budget side from state directed payment

[Jill Mazza Olson]: and cost.

[Speaker 0]: I'm sorry, I couldn't hear you. Now say it.

[John Benson (Member)]: Oh, yeah, sorry. I was just saying, in the briefing John and I got the other day, remember there's a chart or something in here that shows for each dollar that we spend how many dollars of federal monies come in. I can see where

[Jill Mazza Olson]: what you're saying is short,

[John Benson (Member)]: is you could almost use it as a money laundering or way of gathering additional federal dollars coming in. Or you'd spend the more federal dollars come in.

[Jill Mazza Olson]: It's a shared program.

[John Morley III (Member)]: Yes.

[Jill Mazza Olson]: It's a shared program. It's shared responsibility. So, from the state, dollars from the federal Yes.

[Speaker 0]: Okay. But there are people at the other end of it.

[John Morley III (Member)]: Yes.

[Jill Mazza Olson]: Yes, always. Yeah. So

[Ashley Berliner]: the last provision I'm going to talk about before handing it over to Addy relates to cost sharing, and this is a provision that goes into effect on 10/01/2028, so down the road. And it requires that for the new adult population, the expansion population with incomes above 100% of the federal poverty level, it requires states to impose cost sharing in the form of co payments with the exception of certain services, certain preventative services, certain emergency services. But this would be a real change in how we administer co pays today. We have a very limited set of co pays on hospital stays, dental and pharmacy. This provision will require us to implement co pays for that new adult population on nearly everything with the exception of those limited carve outs. We are anxiously awaiting regulatory guidance on this provision. We have a lot of questions about how this would be administered and they have not provided any regulatory guidance to date. So we anticipate that coming out maybe later in 2026 or 2027, but just a formula for you that this is going to be coming. It will be a change to what people are paying out of pocket in the Medicaid program who are in that new adult group.

[Speaker 0]: So Ashley, is there any provision in the bill that would provide resources for the administrative changes needed for any of what we're talking about. Yeah, I'm gonna actually, that's a

[Ashley Berliner]: great segue to pass it over to Addy and she can answer that question and then get into all of the eligibility work as well.

[Speaker 0]: Okay.

[Addy Stromolo]: Can I start by checking my audio? Is it okay?

[Speaker 0]: It's great. Good.

[Addy Stromolo]: Okay. I switched to a external mic, so hopefully that'll last. Okay, thank you. So, again, I oversee eligibility and enrollment into our health care programs, both Medicaid and the Marketplace, and I know earlier there was a question about the enhanced federal subsidies on the Marketplace. This Budget Reconciliation Act that we're talking about here actually didn't do anything to do with those subsidies, so we weren't planning to talk about them today. I am aware of the bill that passed the House with a clean three year extension. We're being told that definitely won't pass the Senate. At best, there may be some kind of compromise measure in the Senate that would then have to go back to the House and have a long journey. So, of course, we're watching that closely, but don't have any, you know, helpful updates on that topic, at least as part of this presentation. So, in the eligibility and enrollment space, that's, you know, essentially the entry point for people to get and maintain health care coverage, and that process, that eligibility process, is really one of the major levers that was used in the Budget Reconciliation Act to meet the targets that were established in Congress. So, a lot of the near term work in implementing this bill is with us and our teams at DIVA. We began this work right when the bill passed, including some small pieces that actually had to happen for open enrollment this fall, And right now, we're focused on three major changes, major provisions requiring implementation during 2026 for either late twenty twenty six or early twenty twenty seven. And then there's a fourth provision effective 01/01/2028. And to answer your question, Madam Chair, there has been one grant. It's called a government efficiency grant made to Vermont to help with this implementation. It's about $2,000,000 We are working on how that impacts our overall budget for this implementation, but there is some money available as part of this bill.

[Speaker 0]: Thank you. Doesn't sound like sufficient, but we'll see where it goes.

[Addy Stromolo]: Right. It's a start.

[Jill Mazza Olson]: So, we can go to

[Addy Stromolo]: the next slide. The first provision, which we are working on currently for implementation, are changes to healthcare eligibility based on immigration status. So, for Medicaid purposes, these changes apply across the program. They're not specific to certain eligibility groups, and they're effective October 1. Then there's a parallel change for Marketplace premium assistance eligibility, which will take place for 01/01/2027. And effectively what this does is it blocks eligibility for those programs for asylees, refugees, and certain other non citizens that are currently eligible for Medicaid. Sorry,

[Ashley Berliner]: go ahead.

[Jill Mazza Olson]: Keep I

[Addy Stromolo]: was just gonna say this is While the impact is kind of across programs, it is expected to not be a huge number of enrollees that are impacted. We actually don't know that number. We're working hard to figure it out. We think it's in the 100s, but it's difficult to identify because right now we don't collect that level of detail as part of the application process because many people who are lawfully present but not citizens can be found eligible for the programs, So we will be working on that hard over the next few months.

[Speaker 0]: Thank you. I was going to ask that question actually and then the consequences of this, I mean even if it is a small number, it leads to greater emergency room access and it could also lead to a lot of free care that hospitals and others become responsible for.

[Addy Stromolo]: That's correct, yeah. And the remaining coverage program for a subset of this population is the Immigrant Health Insurance Program, IHIP, that you all enacted several years ago. That is for pregnant individuals and children, so obviously a subset of those who will lose coverage based on these changes.

[Nolan Langweil (Legislative Fiscal Analyst, JFO)]: Thank you.

[Jill Mazza Olson]: I think we can go

[Addy Stromolo]: to the next slide. The next major provision has to do with the renewal or redetermination process. These are those mandated rechecks of eligibility that take place under current state every year. And so what this change does is that it changes the cadence from that annual redetermination to a six month redetermination, but it is specific to the expansion population that Ashley described earlier. So the non disabled adults that are eligible for Medicaid based on income up to 138 percent of the FPL federal poverty limit. We refer to this population as the new adult population and currently have about 55,000 enrollees in this group. So this is a really significant change to our typical eligibility process. It effectively doubles the workload related to redeterminations over the course of the year. It goes into effect 01/01/2027.

[Speaker 0]: Do you have how much we're currently investing in redetermination? Mean, because obviously it's happening now, but so would we just be doubling that amount of money and people? Or will there be some leeway in changing the form so it's less complicated? What's the?

[Addy Stromolo]: Thank you for the question. I think we'll talk a lot more about that in the context of the budget recommendation, but we've looked hard at how we can make these changes efficiently, and even though this particular provision effectively doubles the processes, overall, we think these changes are about a 30% increase in workload, and so we've made a proposal for additional staffing and resources with that assumption in mind.

[Speaker 0]: Okay, thank you. We'll see it in the budget, you said.

[Jill Mazza Olson]: I think we can

[Addy Stromolo]: go to the next slide, which is the third big provision for 2026, these are the work requirements for Medicaid, also known as community engagement. So, this also applies to that expansion new adult population and is effective at the same time as the redetermination change 01/01/2027. And this newly requires members to demonstrate eighty hours per month of work, community service, or education as a condition of Medicaid eligibility. Built into the bill are a number of exceptions in accepted populations, like pregnant individuals, medically frail, those with children 14, and sort of taking those exceptions into account, we think that this change will impact about 30,000 members in terms of having to provide additional verification in order to maintain eligibility.

[Jill Mazza Olson]: Yeah, so just to clear, 30,000 members who may need to provide additional documentation, whether, it's the

[Speaker 0]: ones

[Jill Mazza Olson]: that we cannot yet today see would already meet the requirements. How many people are actually impacted in terms of enrollment is not clear.

[Speaker 0]: So, go ahead, go ahead.

[John Benson (Member)]: Just a quick clarification on the 30% increase in workload that you mentioned, does that also include the additional workload that would be associated with this provision?

[Addy Stromolo]: Yes, it does. So the way we calculated that was just adding up the additional eligibility transactions that we will have to make because of these changes, including the work requirement changes. Obviously we can't completely predict how that will play out, but that did all factor into that 30% projection.

[Speaker 0]: Thank you. Is there any leeway for the state to make decisions about who's exam two's excluded or gradation of criteria for folks?

[Addy Stromolo]: Great question. This is one of those areas where CMS is supposed to give some guidance. They aren't required to give the guidance until next June, which is obviously too late for our implementation purposes. They are showing some flexibility with respect to we're expected to do for the first implementation. So, the effective date, they refer to it as the minimum viable product, so having some flexibility to do what we can to meet that date. But, big picture, it's quite prescriptive. So, there isn't a tremendous amount of flexibility, although obviously we're looking to take it where we can, especially for the first year's implementation.

[John Morley III (Member)]: Go ahead. That's a great question. The eighty hours per month of work, who forces that? Who's going to monitor it? Seen that being disastrous.

[Speaker 0]: That's the administrative cost of this. Did you make an estimate of administrative costs for just looking at doing what Senator Morley has asked?

[Addy Stromolo]: We can break that down based on the IT that will go into this, but essentially, there are ways to What we will try to do is validate that someone meets that requirement using the proxy of income, and we have data sources that we can look at to validate that. If we can't validate it based on data sources, then we will require documentation from the member. We do have the flexibility to only ask them for documentation of one month of work during their coverage period, so rather than the full six months is what it will be for this population going forward, there's some flexibility there. But yeah, it's tremendous new requirement for members and a lot more work for us.

[Speaker 0]: Then, so defining community service, defining education, and then finding people who can work twenty hours a week while they also have a chronic illness or some frailty. This is very concerning, I think. I mean, the cost is one thing, but then looking at the other end, at the people who are being expected to comply with these requirements. I assume that if you come in and join the trash people, the pickup trash on the street. If you can walk in, somebody's right now, they just show up. They're volunteers. But if this goes in and you're a trash buddy, somebody's gonna have to document that you are actually out there. That means somebody who right now is a volunteer is going to have to be responsible for another buddy. Well, for reporting to the federal government, which gives you some personal liability. And a lot of people, given the present state of affairs, might not want to take that risk. Well, so as you're looking at this, and I'm looking at Jill and I'm looking at each one of you, we just went through, you did a humongous amount of work on the eligibility rules for Medicaid that were just have gone through LCAR and I think have they gone through LCAR. Now I checked off checked them off in the fall, but they this is a whole another boatload of changes. Can

[Jill Mazza Olson]: I ask can I ask a question of what are they correcting for just fluctuations in the job market as we're seeing I mean I just saw yesterday that unemployment is on the rise in Vermont? And as we lose small businesses to AI and because of tariffs, etcetera, and people can't find jobs, is there a correction for that? Is there a I mean, I'm so confused.

[John Morley III (Member)]: I think everyone is.

[Jill Mazza Olson]: Is that in front

[Addy Stromolo]: of No, I'm happy to attempt to respond to that and a few of the questions that have come up. I think the answer to that question is no, there isn't kind of like a correction built into this law. It's pretty black and white, at least as passed, so maybe there will be some evolution as it gets implemented and the challenges become more clear, but I think that's probably all I can say on that piece. I did also just want to comment that the main way that we can help people with this new standard is if there is a data source that our system can use to check that they need it rather than ask them for documentation. And of course, that doesn't exist for things like community service. It's even hard to do education and certainly people who have different areas where they're kind of combining to meet the standard. Whereas when we did redeterminations after the public health emergency, we did a great job of trying to increase the use of those automatic renewals using data sources, we don't have that possibility here. We're going to try as hard as we can to get more in, but we will not be able to cover everything that people may be using to try to meet this standard. Thank you. And Madam Chair, we will have a new set of revisions for the HPE, the Health Benefits Eligibility and Enrollment Rule, coming through over the course of 2026 with these changes in it.

[Speaker 0]: That's a huge workload that's being placed on you. And it is costly in terms of hours and not to mention just money, but costly in terms of the human condition.

[John Benson (Member)]: That's why it has a 30% Yes, exactly. Okay.

[Addy Stromolo]: Okay, we have one last slide. I don't need to spend a lot of time on this, but this is the fourth major eligibility provision. This one has a 01/01/1928 effective date, and it's specific to the health insurance marketplace, so the qualified health plan enrollees, and it effectively changes the way we do renewals for that population rather than doing a large kind of automatic renewal process where people default into their same plan and continue with their coverage if they don't do anything besides update their information. We will now be required to validate that they meet all of the eligibility standards before we renew them in order for them to receive subsidies. So, it's a sea change in the way that we would do renewals for the marketplace. I'm a little bit hopeful that some of this gets kind of softened in the implementing regulations that CMS will put out, which we haven't seen yet but do expect to see later this year. So, there'll be more to come on this, but it's fourth provision that's kind of looming over us after we finish all of the tremendous work that we have in front of us for 2026.

[Speaker 0]: Wow. I'm just saying. I don't want to be in your shoes with all this. It's still a lot of work. I don't know how you're doing your jobs in this environment. I

[Jill Mazza Olson]: so much respect for you all. Thank you.

[Addy Stromolo]: Thank you for saying that.

[Speaker 0]: Yeah, I think we're all feeling that, your pain right now, and have that same sense.

[Addy Stromolo]: We did have one last kind of closing slide just to say what we've said already, which is this is kind of our work for the next year. It's a lot of work, and it's not just the implementation, but trying to do the implementation in a way that mitigates coverage loss. That's our guiding principle, number one goal. We hope to leverage many of the lessons we learned during the unwinding process or the restart of renewals following the public health emergency. One flag I wanted to make is just that in that unwinding process, we had kind of a soft landing for people who were no longer eligible for Medicaid in that they could come into the marketplace with those significant subsidies available. People who don't meet the community engagement requirements under HR1 cannot do that. Loss of eligibility carries over to the marketplace, so subsidies are not available if they also don't meet the work standards for Medicaid. So that's just another challenge in our overall implementation efforts and then in our overall goal of retaining as much coverage as we can throughout this. It's a really big project, but it's well underway and we're happy to continue to provide updates as we progress and appreciate your support.

[Speaker 0]: We're going to need updates. I mean, it doesn't have to be a formal update like this, but somehow we don't understand,

[Jill Mazza Olson]: trying to understand. Yeah, it'd be great if we could find a way to keep you updated while also, you know, keeping in mind that Abby's actually leading this effort. So we'll have to find a good balance. We do have regular written reports that that Abby's putting together for other purposes. So I just wanna yes. So anything we can flag for you when we feel like there's enough of a change that maybe you might wanna really get a question and answer format update. But, yeah, lots of ways we can keep you posted.

[Speaker 0]: Senator Benson has a question.

[John Benson (Member)]: Just curious as part of all of your work planning that there's an outreach education process here for the recipients so that they don't get blindsided, that all of a sudden, tomorrow, they're not in

[Jill Mazza Olson]: it. Yes. Yes, absolutely. There's a significant outreach process. I don't know if you want to speak to that. And there's also an advisory committee that includes beneficiaries who we can sort of talk to about how to best communicate. Patty, I'm sorry.

[Speaker 0]: I don't want to steal your thunder on this one.

[Addy Stromolo]: No, that's great. Yeah, it's a huge part of our kind of readiness for these changes. I think that is one area that we improved upon during the unwinding in terms of being able to communicate with members through multiple modalities. Yeah, we'll have a large effort in that area, also connecting with community partners, assisters, everyone in the field, to make sure people are ready, and then to help them through the process as much as possible.

[John Morley III (Member)]: I I think, Jill, I understand what the federal government's driving at as far as the the the timeline. I I think I get it, but I'm not sure that that's I'm concerned that they're not gonna get the outcome they decide or what that we desire. And the reason I say that is I'm concerned that those individuals aren't going to do it. They're no longer going to be, providing Medicaid services. And then you've got an uninsured or underinsured individual that's gonna go to the hospital.

[Jill Mazza Olson]: And so Yes, that's always the risk of people not being insured. Absolutely. They'll seek care that's on an unreimbursed

[John Morley III (Member)]: And which is easier for them. And so, I just think we're gonna you have the potential of having more costs.

[Speaker 0]: You have a lot of potential of more costs with sicker people and more community services needed and EDs getting piled up and all of those concerns that actually, you know, I think the pandemic demonstrated what can happen, you know, that type of situation.

[John Morley III (Member)]: So I I I look Yeah. Certainly, thank you for everything, and and I'm learning, but it's it's a tough you you're in a tough business. So it's more cost to us, not the federal. Correct. Well, that's what I'm saying. This I think it's gonna exacerbate some housing in the state.

[Speaker 0]: The the yeah. That's the point, I think. The thinking is that, you know, states should be able to take care of themselves. Yeah. And that there's not a community based there isn't shared there aren't shared resources. But that's not the way we work in this world. It isn't sad. But I do have a couple questions actually, Ann. One is, let me go with the IT first. So there's a lot of IT potential in this, and the federal government is so excited about AI right now. Are they is there any funding in this for improving our IT that will help you with recording or data collection or infrastructure development?

[Addy Stromolo]: The the IT grant the grant I mentioned earlier is pretty broad in terms of what it can apply to. So I think I I'm pretty confident that we're gonna kind of blow through it implementation and then all of the kind of associated processes, 1,900,000.0. But then, you know, when it's about implementation and development, we do have the opportunity for an enhanced administrative match from the federal government through what's called an advanced planning document process. Once we run through the grant, we will shift to that and try to leverage federal funds as much as we can.

[Speaker 0]: Okay, thank you. And then another, the reporting piece where you'll have to have regular reporting on all of this so the federal government can make sure that we're not wasting money on sick people. That was a sarcastic I couldn't resist. I know, it's hard. I don't mean to put you in that position, but I couldn't resist. So you will have reporting requirements without having the resources to do that.

[Addy Stromolo]: Have a feeling they're going to try to leverage. We do a lot of federal reporting now and I think they're probably going to try to leverage that to get at how we're doing with all of this. But like I said earlier, there hasn't been a lot guidance from the federal government and I can't really predict what they may ask of us as we get further down this road.

[Speaker 0]: Okay, thank you. And then I have a question for Jill, and that is, right now we've been going through reports in this committee, it's separate from H1. We've got a lot of reports that we've asked for in our legislation and Jen and Katie have been really going through some of the reports that we have. Okay. But it would be helpful to know which of those are are somewhat problematic for you in particular going forward. We have a lot of quarterly reports. Oh,

[Jill Mazza Olson]: you mean things we could do less of? Yeah. Oh, I'll be happy to take a look

[Speaker 0]: at that. But for the team. Yeah. Sure.

[Jill Mazza Olson]: That's what I'm saying. I mean, all the Thank you, madam chair.

[Speaker 0]: It fits in with Yeah. The obligations that we're seeing here.

[Jill Mazza Olson]: Well, we, of course, want you to have information that's really important to us. And I think that that this is a two way street in terms of thinking about what information do you need to do the oversight that you do helps us to know also which ones do you actually read and which ones not. Right? That's a piece of the puzzle. And then we can certainly, you know, we do really try to keep track of the effort it takes to do a work. Well, and

[Speaker 0]: the data that we ask for sometimes can be available if we ask for it. Don't even get it all the time. So that's gonna be the fine balance. Some people want more and some want more.

[Jill Mazza Olson]: Right. The timing and the frequency

[John Morley III (Member)]: and all those things. Sure.

[Jill Mazza Olson]: Okay. Good to know.

[Speaker 0]: And then I think any other questions from committee members?

[John Morley III (Member)]: I

[Speaker 0]: can't tell you enough how helpful this is, but I think I want to echo Senator Gulick has said it accurately, you're doing an amazing amount of work and we greatly appreciate

[Jill Mazza Olson]: what you're doing. Thank you. It's an incredible team. Yeah, it

[Speaker 0]: is an incredible team. We are lucky. Thank you, Ashley and Addy. Thank you. Yeah, that was good. All right, well, that's it for this topic. I think we're gonna end in just about two seconds. Just a reminder to look at the reports, look at the bills, and bring in your suggestions for bills. We'll get to that on Tuesday if you have a priority set of interests. And what else? That's it. 11:30.