Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons, Chair]: Dear, all right. So this is Senate Health and Welfare. We're back on Friday, April 3, and we're continuing a look at budget requests. So we went through the budget with joint federal and now there are folks in the room who have either been underfunded based on what's come over from the house or were not originally funded or not funded and we'd like to hear from you because we know that there are a lot of organizations and people in our jurisdiction and we have concerns. So we wanna hear and then we'll be able to set our priorities. We're not setting our priorities today, but we'll take your testimony. I'm asking each person to be about two minutes. That gives us time to listen. You give us the information. We will come back next week at different times for committee discussion, and at some point we'll be able to make our voices heard down the hall in the appropriations committee. So, Jenny Horton, there you are.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: There I am.

[Jenny Horton — Alzheimer's Association (Vermont State Government Relations)]: Morning. Good morning. Thank you so much, Madam Chair. Counseling to Committee for the Record of My Name is Jenny Horton. I do our state government relations work here in Vermont with the Alzheimer's Association. I'm here to address you all today to discuss caregivers for those living with Alzheimer's and dementia. I have some papers for you all. I know we've discussed in detail before the facts and figures and the impact of Alzheimer's and dementia on this date. That's all included in your packet. But to just highlight, are 20,000 unpaid caregivers caring for people with Alzheimer's and dementia in the state. That's equating to twenty nine million hours of care each year at a value of $770,000,000 These caregivers are not just helping occasionally, they are providing care 20 fourseven, often bathing, dressing, feeding, managing medication, finances, and constant supervision and transportation for people living with the disease. So it is a relentless job that these people do with very little support. So over thirty five percent of people who are caregivers for those with Alzheimer's and dementia experience depression. More than sixty one percent of them live with chronic health conditions and more than ten percent report for physical health. Often they are caring for years at a time and in many cases they're also caring for their children at home as well. So one of the most effective supports that the state offers is the Dementia Breastfeit Grant. This is a program that allows caregivers to access short term care through in home services and adult day programs. So, it gives the opportunity for caregivers to attend medical appointments, simply recover, do grocery shopping, and this is a vital life line to these caregivers as burnout is very high when caring for someone at this very, very high level. So what we're requesting is an increase in funding to the dementia respite grant programs. This fund has not been increased since 2003, And I think we can all agree that the cost for care and everything is significantly higher than it was over twenty years ago. So we're requesting an increase from 250,000, which is the base fund that's currently in the budget to 750,000. We would also request to raise the cap to 300,000 and look at doing 20% of that being required for home day respite. We're additionally requesting $100,000 for a pilot program for dementia people programming in Washington County. These counties were significantly impacted with the loss of adult day programs post COVID. And so we are looking at this as an opportunity to create more dementia people programming in those areas so that people who are looking for respite have something to access to do that. So respite is not only compassionate, it's physically responsible. Sports caregiver help, delays Medicaid entry and helps people with dementia remain safe living at home rather than entering a more costly and restrictive long term care facility. I do want to point out on the back of our letter, our COVID-nineteen letter, there are a number of caregiver stories that give you a very small glimpse of window into the cost and if the challenges of caring for someone with the disease. We hope that these stories really make through the challenges of care for communities of this lifeline. Happy to answer any questions.

[Sen. Virginia "Ginny" Lyons, Chair]: So, I do have a question. Yeah. There an increased number of individuals who require care and their Is there an increased number of folks with Alzheimer's who are requiring the dementia breastfeed care? We certainly see the numbers of Alzheimer's only growing and the need for caregiving only growing. Also seeing the strain on our long term care systems, it's really just a huge need. One adult day and COVID in Central Vermont, the deep stress on caregivers, which frequently, those who don't know, yeah, Director of Intercompendence, we would frequently pick up people when their caregiver ended up in the hospital, frequently from exhaustion. It was frequently men who were trying to do it all alone. Alzheimer's, if nothing else, frequently don't sleep at night. And exhaustion, I mean, just not being able to sleep, being afraid they're going to leave Absolutely. Out front door, and they do an adult day would take them during the day. We'd send them home tired if we couldn't, that would help. But without that, with a caregiver and I know there were caregivers who once a month would just go away for a day or a week at just so be away from. It's an essential service. Without it, these people end up in high cost nursing homes. Senator, you're right. And so what I'm gonna suggest is that this is an important comment to make when we get to committee discussion. Make sure you write down what we're going to hear. Because we're gonna come back to this. Because if we talk about each one as we go along, we'll be here the next week. But I agree with you. Understood. Understood. A quick comment or quick question is fine. Was really concise. I think I have my hand up, Bruce. You too, I'm sorry. I know. I feel like a bad tired of early days.

[Sen. Ann Cummings, Member]: We're coming. The fact that we have an aging population, we haven't updated since 2003, and it seems like we have cuts towards adult daycare is not a good scenario.

[Sen. Virginia "Ginny" Lyons, Chair]: So, thank you. Senator Cummings is always right. Always. The Secretary of the Senate says the chair has ultimate power. It does. I enjoy

[Unidentified Senator (member)]: The the additional 500,000 gentleman Mhmm. That's just in GM. Do you get any federal dollars at all?

[Sen. Virginia "Ginny" Lyons, Chair]: I don't believe so.

[Unidentified Senator (member)]: For this grant? No. So this is strictly a scam.

[Sen. Virginia "Ginny" Lyons, Chair]: You. Good question. Okay. Thank you. Thank you so much. Alright, so we're going to move on to Kelly. I stopped. You're trying say no.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: My name is Kylie Kuiper. No, I really blew it.

[Sen. Virginia "Ginny" Lyons, Chair]: I've heard it before and I didn't remember. Thank you for Thank being

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: you.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: I'm the State Long Term Care Ombudsman. The Long Term Care Ombudsman program was created in state statutes to represent the interests of older Vermonters and Vermonters with disabilities who receive long term care services. I have a staff of seven local ombudsmen and we cover over 6,000 licensed long term care beds and an additional 4,600 individuals who receive long term care in the community through the Choices for Care program. I gave you some handouts of our last annual report and some case examples that include how we help people access needed services, like the developmentally disabled man who helped, we helped him get cataract surgery so the kids are gaining sight. We help alleviate suffering, like to hospice patients, we help to get their prescribed pain medications, and we help keep people housed and receiving necessary services through our work assisting residents

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: who need help appealing a involuntary discharge.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: Our work helps avoid hospitalizations and homelessness, and we also help ensure that the large amounts of money the state is putting to long term care Medicaid actually goes to quality care and not just to own our profit. We added an additional position in 2024 to cover Bennington County because we found that we simply didn't have the staff to adequately cover that area of the state. In the year that that Ombudsman served, she tripled the number of complaints that she was able to work on compared to what we did the year before. And I think that really illustrates how important it is. It's absolutely vital that we have enough Ombudsman to cover the state in person. They need to be in facilities and talking to residents and monitoring conditions there. We haven't had a funding increase in three years. We're asking for an increase of $275,000 to cover the 19 position and significant inflation, especially health insurance increases. That amount qualifies for a federal match. I think it's almost fiftyfifty, and so every dollar that the state puts in will be able to pull down more federal funds. Without the funding increase, I'm going to have to lay off one to two ombudsman, and we simply can't fulfill our state mandate without adequate staffing to have boots on the ground in Vermont. We recently received a lovely thank you note from a client's daughter who said, the ombudsman prioritized her voice despite her vascular dementia and aphasia at a critical time when she felt she had no voice. Please keep up the good work on behalf of Vermont elders. So I'm asking you to support our funding increase so we can fulfill our mandate and reach for monitors across the state of Vermont.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you. You. And thank you for your work. Absolutely. And so you are you are designated through statute, and you are within Vermont Legal Aid. Right. And then the laws of independence. Yes. Yeah. Understood. Thank you very much. Thank you. So Olivia Olivia Cheryl is here. Thank you.

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: She was there yesterday. It's no problem. I live in Barrett's. Oh, it's not us. For the record, my name is Olivia Scherham. I'm the executive director of Vermont Screen Referral Clinics. I'm here to ask you to please support our FY twenty seven budget request at the level that was included in the house budget. The amount is $924,000 Half of which is from the general fund and half of the supplemental match of Medicaid. Vermont Screen Referral Clinics is a statewide association with eight member clinics. On July 1, we will become a fiscal sponsor for a community health worker program called Bridges to Health. Funding for Bridges to Health was also included in the housing budget, and I hope that you will support the request as is so that their incredible work can continue. Last year, our members cared for over 9,000 patients. Five members provide clinical services, all member clinics provide health system navigation support. They help patients access health insurance, free prescriptions, and other benefits and programs. As eligibility becomes increasingly complex, the role of the Benefit Assisters network is becoming ever more urgent. For this reason, although VFRC's funding is already in the House's budget, we respectfully urge this committee to consider funding rest of the benefits assistant proposal that you will hear about this morning.

[Sen. Virginia "Ginny" Lyons, Chair]: Services in our

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: networks are pre COVID and by providing an extremely low cost setting for patients to get the care that they need, who don't have insurance or a primary care provider, we divert patients from the emergency room. With non acute needs from the emergency room and save the system millions. We are on the frontlines in the midst of convergent crises that are impacting all of our homeowners and parties. Between the loss of intense subsidies, changes to eligibility, and rising costs everywhere else, we anticipate significantly increased demand for our services. Our request will allow us to operate for more hours and see more patients in the time we have. This will allow us to meet increased clinical demand and support more providers than ever with insurance, benefits, education. Now more than ever investing in affordable programs that reduce costs for Shelbyville.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you. And thank

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: you for your work. Thank you for having me, Chittenden. And we another member of our coalition is on Zoom, so I will hand it over to who is also the vice chair of the board of directors for. So

[Sen. Virginia "Ginny" Lyons, Chair]: Heidi is here and she's gonna present additional information or? Yes. That would be great. Heidi Schulick, why don't you just go right ahead?

[Heidi Sulis — Executive Director, Open Door Clinic (Middlebury)]: Good morning. Good morning. I'm the executive director of the Open Door Clinic in Middlebury, where we provide acute and chronic care, dental care, referrals to specialists when needed, help with health insurance, and a robust outreach program. Last year, migrant workers comprised 53% of our patient population, and we provided health care on 42 farms, orchards, and local businesses throughout Addison County. We do this through less than six full time staff and an amazing cadre of 143 volunteers who support our patients through medical care, interpretation, and administrative work. As safety net organizations, our ability to provide unencumbered grassroots care allows us to serve people who really have nowhere else to go. We are meeting people where they are and directly addressing their barriers to care, including, but not limited to, transportation, work schedules, language access, and navigating a highly nuanced health insurance marketplace. We are seeing far more chronic illness among our patients and more patients with complex multifaceted needs that require more of our resources, care coordination, and case management. And once again, we're picking up the pieces and they're getting bigger by the month. Over the past three months, due to eligibility changes at UVMMC's Health Assistance Program, our patients no longer have access to affordable meds. So an incredible burden has fallen to our nurses who've been spending one to one and a half hours per patient on a single pharmaceutical Medicist application. And given the recent destabilization of Bridges to Health, we've hired our own community health worker to address the resulting residual gaps in care. These are just two examples of burden and expense that rest disproportionately on the shoulders of our free clinics. An increase in funding would help reduce the significant burden and sustain our increasingly critical programs. We are a stable, safe, respectful and respected organization within our communities and an integral part of the healthcare delivery system in Vermont. Thank you for considering this.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you. Thanks for being here. Thank you. Any questions? No, thank you. We have Jessa Barnard from BMS, Vermont Medical Society.

[Jessa Barnard — Vermont Medical Society]: Good morning. Thank you for having me. Jessa Barnard with the Vermont Medical Society, and I actually am joined also on Zoom by Zoom by Katherine Schwartz, the executive director of the AHEC program, because a lot of our what we're gonna be talking about this morning is related to the AHEC program, that she is really the expert and can help answer questions if they come up. Or I would encourage you, when you're through this really busy budget process to have AHEC in to talk in more detail about their programs to you. So I'm here on behalf of the Vermont Medical Society, the American Academy of Pediatrics Vermont Chapter, and the Family of Physicians. Our first and these are actually both about restoring cuts that were proposed in the governor's budget. So and one was sort of half restored and one was not restored in the house. So our first request is to restore the Diva Alternative Payments to primary care. This is a $2,000,000 cut to primary care of general fund, a $5,000,000 gross cut. So, you know, you did all your work on S197. We're talking about trying to move primary care to alternative payments to stabilize our primary care program. And yet we're facing a $5,000,000 cut from this one loss on top of other cuts, I will say, if you're using primary care in FY27, a slight reduction in our Medicaid fee schedule, and also the end of alternative payments also through other streams of funding for One Care's primary programs. So this was DIVA's way. They were contributing to the One Care primary care programs. I know we have heard them say their concern is how to kind of operationalize getting this funding out the door. I will say it feels a little bit like Groundhog Day. I was looking back and reminding myself in 2019, faced, DIVA proposed having an alternative payment to primary care, and the budget had a cut to the ABAC program. So we're back with both of those issues this year, as Maria also are all talking about the need to strengthen primary care. There are mechanisms for distributing payments to primary care through either the Blueprint or through Diva in the past when proposed that pass cut actually was making monthly per member per month case management payments to primary care. So we do know the mechanisms exist. This is an effective and an immediate way to support primary care practices as we're trying to actually build and strengthen our system of primary care in the state. The other piece is restoring the cuts to AHEC's primary care workforce programs. AHEC is a statewide network of academic and community partners working to strengthen the pipeline of primary care and healthcare in our state. There were three, there are three sort of buckets that are implicated by this cut. It's a $1,270,000 rose cut, both to primary care loan repayment, early pipeline programming, and physician placement. The house did restore a significant portion of the primary care loan repayment. I never want to put words or thoughts in people's mouths. I believe there was some confusion about which amount of funding was needed to restore which So you'll see that amount of funding is actually closer to what would be needed for the sort of network early pipeline programming. So there was a lot of there were a lot of line items and concepts floating around, but we are grateful that they at least came close to restoring that bucket of funding, but then didn't put anything in the early pipeline programming, and then they did restore the MD placement program. So just to give you a little bit of snapshot, and again, there's more slides in here than I know I've got time for, so some of this is just background, but the need for loan repayment in primary care. We know MDs, APRNs, PAs are graduating with huge amounts of debt, up to $400,000 of debt for medical students, over 50 for graduate nursing students, over 100 for PAs. And we know primary care, we don't have enough primary care. We already know that. We're short. The shortage will only grow. And I will mention, importantly, obviously we're starting the conversation around RHTT, the Rural Health Transformation Program grants, that it is very explicit that that money cannot be used for longer payment, and it cannot be used actually, should have mentioned on the DIVA part, it can't be used for rates or supplanting budget funds. So we don't believe there's really a pathway to just saying, oh, let's just, you know, support these programs through RHDP funding. So there's no, as far as we know, no other pathway to fund this really important work. The loan repayments go to all primary care specialties, family medicine, pediatrics, OBGYN, psychiatry, the range of provider types, physicians, nurse practitioners, PAs, nurse midwives, dentists, RNs. It is effective. Over 60% of recipients continue practicing in Vermont, and a lot of these dollars are actually matched by the employer. So this funding comes in, but then the employers are generally asked to match at least a portion of that to keep that new person working in the practice. So these are just some, I'm gonna skip through this background. I just wanna

[Sen. Virginia "Ginny" Lyons, Chair]: mention- We're really over your I'm

[Jessa Barnard — Vermont Medical Society]: over my, I can stop there. I just wanna mention really quickly the early, I don't wanna forget the early pipeline programming working with middle school all the way up through medical students to get them into the health sectors. And then a little data I'll leave for you to review on the physician placement program that helps people get into the workforce and practices around the state.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you. Thank you. So senator Gulick is our timekeeper. Okay. I know this is the enforcer. I know. I know. So that's better that's better than the Witcher.

[Unidentified Senator (member)]: That's great.

[Sen. Virginia "Ginny" Lyons, Chair]: So, and Catherine Schwartz, we'll hold your testimony at this point, but should we have questions on AHEC we know exactly where to go and we appreciate your being here this morning with us.

[Jessa Barnard — Vermont Medical Society]: Thank you.

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: Okay.

[Sen. Virginia "Ginny" Lyons, Chair]: All right, so we're going to go to Susie Walker, the Executive Director of Recovery Partners.

[Susie Walker — Executive Director, Recovery Partners of Vermont]: Good morning, senators, and thank you for hearing my testimony today on behalf of Vermont's Peer Recovery Centers. My name is Susie Walker, and I live in Brattleboro. I'm a woman in long term recovery, and it's my privilege to serve as the Executive Director for the Recovery Partners of Vermont. Recovery Partners represents 14 peer recovery organizations across the state, including recovery centers and recovery residences. Our members provide top caliber recovery supports for people in or seeking recovery, and RPV is the umbrella organization, provides member services including medical benefits management, advocacy, workforce development, EAP services, policy and compliance support, and more. We work closely with our partners at the Department of Health and our provider community. Our membership shares a vision and a strategy for ensuring that Vermont's certified recovery organizations flourish and help community members gain health and purpose. We're tremendously grateful for the funding support the legislature has provided to ensure that our recovery service organizations can provide life saving services to our friends and neighbors. We're sensitive to how challenging this year's budget is and how difficult the choices are. We appreciate the thought and care our legislators bring to this complicated process. Knowing all of that, we're compelled to request that $800,000 be included in the budget to level fund the recovery centers. That's how important it is to the health of our recovery center system and the Vermonters we serve. This renewal would preserve current services at a time when recovery centers are facing increased demand. People in or seeking recovery benefit from recovery programs that provide access to services, and importantly, connect them with a community of people with lived experience to guide the way to healing and purpose. The loss of this $800,000 in funding would mean having to curtail services and downsize staff, threatening an already vulnerable situation. Recovery organizations have seen a significant increase in demand for our services, and we expect this trend to continue as federal actions make it harder for people who are struggling with substance use to access resources and services. Recovery organizations are also seeing an increase in the number of visitors who are accessing recovery spaces for more general support as other community partners and local agencies downsize or close. In particular, we have seen an increase in the number of people experiencing homelessness who access our space. We do everything we can to support any individual who comes through our doors. As the former director of the Turning Point of Wyndham County, I know the impact peer recovery support services can have on people and places. People become contributing members of their communities and families, and provide compassion and hope for others. One impact we see over and over in the recovery centers is that people who once access the centers for recovery support and resource connection become trained recovery peers themselves. They're lived

[Sen. Virginia "Ginny" Lyons, Chair]: Oh, Susie, we're way over two minutes.

[Susie Walker — Executive Director, Recovery Partners of Vermont]: Okay, thank you.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank We did hear your request.

[Jenna O’Farrell — Vermont Community Action Partnership (NEKCA)]: Okay, thank you.

[Sen. Virginia "Ginny" Lyons, Chair]: Level funding and we do have it here in writing. Thank you. We get it. Thank you. I appreciate it.

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: We're very

[Sen. Virginia "Ginny" Lyons, Chair]: much appreciated. We're going to move on to Rosemary Ross of the Turning Point Center from Central Vermont. Thank you for being here, Rosemary. Thank you for having me. Good morning. Thank you for the opportunity to hear my testimony. My name is Rosemary Rosa and I serve as the Executive Director of the Turning Point Center of Central Vermont, a peer led recovery center serving individuals and families impacted by substitutes across our region. I want to acknowledge the reality of this moment. We understand that this is a very challenging budget year with difficult decisions and competing priorities. We appreciate the care and thought that goes into every allocation you consider.

[Rosemary Rosa — Executive Director, Turning Point Center of Central Vermont]: At the same time, I'm here to respectfully urge you to include 800,000 from the prevention fund to level fund for Mott's Recovery Centers in the Senate budget, because this investment is not only compassionate, it is essential. It has been interesting listening to the discussion around the prevention fund, and we would be happy to come back when you dive in more deeply on that. What makes Recovery Centers uniquely effective is our staff. Our programs are led by people like me who are in recovery themselves, individuals who bring lived experience alongside professional training. This combination is powerful because it allows us to connect with people in ways that traditional systems often cannot. When someone walks through our doors feeling vulnerable, ashamed, uncertain, they are met by somebody who has been there, somebody who understands not just clinically, but personally. That connection can make the, be the difference between someone walking back out the door, staying long enough to take the first step toward recovery. Without the 300,000 in level funding, our work is at risk. Recovery centers operate on these budgets, yet deliver high impact community based support that reduces reliance on more costly systems such as emergency departments, law enforcement, and inpatient care. Investing in recovery centers is not only the right thing to do, it is also fiscally responsible. We heard the concerns about the lack of funding going to Chittenden County since Chittenden County can't access the Rural Health Transformation Grant. This 800,000 allocation includes funding for

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: the Washington County Recovery Center.

[Rosemary Rosa — Executive Director, Turning Point Center of Central Vermont]: So recovery centers statewide collaborate closely and we all support each other's work. This past year, the recovery centers went through the process of credentialing our staff through the Office of Professional Regulation and certifying our centers through the Department of Health. If we lose funding, lot of this progress could be set back and lost, and our impact would not be as great. If we lose staff, it takes at least six months of full time work before they are eligible for certification. It would take so long to rebuild. If we lose this funding, more lives would no doubt be lost without the support of the recovery centers. But we are not asking for expansion, we are asking for stability, but the ability to continue showing up every day for the people who are often at their most vulnerable. I urge you to include the 800,000 in the Senate budget to level fund recovery centers. We're not asking for an increase, we're just asking that we don't lose any ground in this life saving work. This is an investment that affirms that recovery is possible, that lived experience matters, and that every Vermonter deserves access to support, dignity, and hope. It ensures that our communities can be healthier places to live. Thank you for your time, your leadership and your commitment to the people of Vermont. Thank you. So your request is consistent with the other recovery residents' requests and what we're hearing is that this is fundamental across the state. Yes.

[Sen. Virginia "Ginny" Lyons, Chair]: Okay, thank you. Thank you. So we have Carol Lang

[Carol Lang-Godin — Executive Director, Lamoille Family Center; Chair, Vermont Parent Child Center Network]: Good morning, everyone. For the record, my name is Carol Lang Godin. I'm the executive director at Lemoyle Family Center in Mooresville, and I'm the chair of the Vermont Parent Child Center. So I'm here on behalf of the PCCs. We respectfully request an increase of $500,000 to the Vermont Parent Child Center Network's integrated grant appropriation for a total of just over $7,500,000 to support Vermont's 15 parent child centers. This request reflects the very real and rising cost of delivering our eight core services. We are concerned that this $500,000 request was not included originally in the House budget. PCCs are established in statute, and it's notable that other statutorily recognized providers have received cost of living adjustments in the House budget. If this request is not funded, it will mark the third consecutive year without a COLA for PCCs, an unsustainable situation for a statewide workforce of more than four seventy five employees. This funding increase would provide approximately $33,000 to each of the 15 parent child centers and would go a long way towards stabilizing our staffing. Our work is fundamentally relational, human to human support, and cannot be done effectively without a stable, well trained workforce. PCCs are often the trusted support system for caregivers who lack extended family or other supports. We serve as an early safety net, helping families build social connections and support networks. Our staff act as referral specialists, guiding young parents to quality child care and financial assistance. We are developmental educators supporting families as they navigate difficult news, such as a child's autism diagnosis. We are home visitors delivering diapers and food to families without transportation. We are early childhood experts leading playgroups that foster both child development and parent connections. We are case managers helping families navigate housing instability. Above all, PCCs are community hubs, meeting families where they are and providing immediate support, resources, and reassurance during times of crisis. None of this work is possible without our dedicated and highly trained staff across all of the 15 centers. At my own agency, we recently celebrated an employee's fortieth anniversary, an extraordinary example of commitment to Vermont's families. Yet without increases in state funding, offering competitive salaries and benefits remains an ongoing challenge and a growing risk for nonprofit organizations delivering state contracted services. PCCs cannot continue to operate with level funding for a third consecutive year. In FY '26, Lemoyle Family Center alone will spend nearly $325,000 to provide health insurance for 90% of our staff. This is an increase of $45,000 just from last year. Maintaining this level of support for our employees will not be sustainable without additional funding. We respectfully request a $500,000 increase to the PCC Networks integrated grant appropriation, bringing the total to just over $7,500,000 This investment will allow each center to strengthen staffing capacity, retain the qualified employees that we already have, and continue delivering the eight core services that Vermont families rely on. Most importantly, it will help ensure we do not have to reduce services due to staff vacancies at a time when families need us most. We also respectfully ask that you support the $180,000 that was allocated in the House budget for concrete supports, which is one of our eight core services. Thank you again for your time. I know how hard you work,

[Heidi Sulis — Executive Director, Open Door Clinic (Middlebury)]: and I know how You hard this session

[Sen. Virginia "Ginny" Lyons, Chair]: just wrapped on time. That was perfect timing.

[Carol Lang-Godin — Executive Director, Lamoille Family Center; Chair, Vermont Parent Child Center Network]: Great, thank you. PCCs are perfect.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you very much. So we're going to move right along to Jenna O'Farrell of the Northeast Kingdom Community Action Center.

[Jenna O’Farrell — Vermont Community Action Partnership (NEKCA)]: Thank you. Good morning. I'm Jenna O'Farrell. I'm here on behalf of Vermont Community Action Partnership to ask you to invest in proven cost effective tools that prevent homelessness, stabilize households, and strengthen our communities. Our first request is for $1,250,000 for statewide concrete support. This funding is not included in the House budget. Distributed across the five community action agencies, these flexible client directed dollars meet acute needs. They pay for emergencies, emergency rent, utilities, clothing, hygiene supplies, replace IDs, transportation, other small but essential items. All five community action agencies already use federal funds and local fundraising dollars for concrete supports, but the demand outstrips resources. These modest investments routinely stop a household slide into crisis and help people who are currently unhoused to get basic items they need to connect with services and regain stability. Preventing eviction and homelessness with small timely payments is far less costly than emergency shelter, hospitalizations, or court proceedings. Please fund our 1,250,000 so our agencies can quickly respond and equitably across the state. Our second request is for 1,500,000 for case management and housing navigation support for three full time employees at each community action agency. Case management is client centered, holistic approach. We assess needs. We create individual plans, advocate, coordinate services so people can secure and sustain housing. Housing navigators work directly on long term housing goals, removing barriers, securing placements, and intervening when housing is at risk. H938 includes some case management funding, but distribution, eligibility, and sufficiency are unclear. A dedicated statewide increase of three full time employees to community action agencies per community action agency ensures consistent locally grounded capacity to implement H-nine 38 mandates to meet the day to day needs of our communities. Investing in these positions reduces recidivism into homelessness and connects people to benefits, health care, employment supports, and stabilization services. The third request is for $200,000 to restore the Fair Housing Programme through DHCD. This work was previously supported by federal grant that can no longer be performed under acceptable to our community action agencies. State funding would maintain critical fair housing capacity, reduce homelessness and evictions, investigate and restore, resolve discrimination complaints, educate landlords and tenants, correct systemic barriers, and expand access to the existing housing inventory. This is a prevention and protection that supports long term housing stability. I urge you to please include these amounts in the final budget. Thank you for your time and consideration.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you very much. Well done. So this very much relates to H938 that we'll be looking at, and I know there's money in the budget, but we'll have to sort out what it is and where it is and how it works. Well, thank you.

[Jenna O’Farrell — Vermont Community Action Partnership (NEKCA)]: Thank you.

[Sen. Virginia "Ginny" Lyons, Chair]: All right, and Charlie Gulickerman is here from the Vermont Network Against Domestic and Sexual Violence. Thank you. Thank you, good morning. My name is Charlie Gulickerman, I'm the Policy Director of the Vermont Network Against Domestic and Sexual Violence, and appreciate the opportunity to speak with the committee about supervised services. The House budget appropriates a one time increase of $130,000 in general funds for supervised visitation.

[Charlie Gulickerman — Policy Director, Vermont Network Against Domestic and Sexual Violence]: Or requesting at least a $250,000 general fund appropriation to prevent closures of existing programs and expand access in underserved areas. Supervised visitation provides a safe, structured setting where a parent can have monitored time with their child. Courts and DCF order supervised visitation in situations where safety concerns exist either for a child or a non abusive parent, and this includes many cases of domestic violence. Trained staff ensure visits occur in a safe, supportive, and trauma informed environment. Many programs also offer supervised custodial exchange, allowing children to move safely between parents without exposing the non abusive parent to risk. At their core, supervised visitation services are designed to serve children and help foster safe relationships between them and their parents. These services also play a critical role in protecting the safety of a non abusive parent. Abuse often escalates after separation, and custody and visitation arrangements often necessitate ongoing contact with an abusive partner, which creates safety risks and disrupts the survivor's healing. Supervised visitation programs have been chronically underfunded for more than fifteen years, which has led to multiple program closures and significant gaps in services. Currently, each program received small grant from DCF and some received supplemental funds from the Vermont Center for Crime Victim Services. Together, these funds range for approximately $16,000 to $40,000 per program annually, which is far below what is needed to sustain services. Last year, we provided testimony to this committee about supervised visitation with similar urgency. When additional funds were not appropriated, one of the state's few programs was forced to close and other programs are similarly at risk now. So can you give us the bottom line? We're making that. Perfect. Well, I would say that DCF and the judiciary created a report at the request of the legislature last year detailing the challenges facing programs, and that we would request the committee continue this conversation by having a bearing on the report and appropriating $250,000 in additional general funds to support the programs. Thank you. Thank you very much. I know this is one of those areas that does overlap in judiciary.

[Sen. Virginia "Ginny" Lyons, Chair]: We'll continue to work with them as well. Perfect. Thank you very much. Thank you. Amy Schollenberg here.

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: Thanks for reminding me.

[Amy Schollenberg — Benefit Assisters Coalition]: I'm here to my name's Amy Schollenberg, and I'm here to ask you to support the request that's been put forth by the Benefit Assisters Coalition. There's a handout and a letter of support under my name and documents. This request is for the senate to include an additional 3,496,000 over the House budget to support this proposal. I wanna note that the free clinics are also in this coalition that their funding is included in the House budget. And the asset that is also still in the agency. So this proposal came as a direct result of the changes in HR1, the youthful bill, to SNAP and Medicaid, which would increase requirements on people receiving these benefits to submit more paperwork to enroll in Medicaid. They'll have to enroll every six months as opposed to every twelve months. And in the Governor's proposed budget, they have included additional capacity to process that paperwork. This proposal is to help people actually do that, to understand what's required of them, to make sure they are getting their paperwork in, to make sure they're providing accurate information to the state, which will help to keep our SNAP error rate low which we are all absolutely committed to in the state. So this is to help people for both SNAP which we call Free Squares Vermont and Medifree. There are two training programs for benefit assistance to get certified. The Medicaid one is run through

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: GIVA. Hunger Free Vermont runs the SNAP one. And

[Amy Schollenberg — Benefit Assisters Coalition]: all of these providers have agreed, if the funding is available to train staff to get them certified to make sure there are assisters available as is trusted community service provider organization. The whole point of this is to make sure that we are utilizing our community service network community effectively. We're providing support to the people who need it at places they are already going to get other services and by talking to people they already trust at those organizations. And we want to make sure that they're getting their federal food and health care benefits that they're eligible for because this money actually supports our state. This is federal funding that flows directly to our grocers and to our healthcare providers through the people who receive these benefits. And it will be a relatively small investment to make sure that federal funding keeps coming. We're good.

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: Great.

[Amy Schollenberg — Benefit Assisters Coalition]: So when we have your written testimony, I'm sorry to keep doing this, but we have to get everyone in. Okay. Thank you for coming in, we understand you represent a broader coalition. Yep. You have the documents. Yep, we got it. Thank you. So we're gonna move on to Melissa Appleton of the Lunch Center. Thank you for being here. And so we're in a very, we're in crunch.

[Sen. Virginia "Ginny" Lyons, Chair]: Yeah. What we're looking to is what your bottom line request is. Sure. That is or not fully funded in the budget. Okay.

[Melissa Appleton — Lund (Post Permanency Program)]: My name's Melissa Appleton. I oversee the Post Permanency Program at Lund. I'm here to provide testimony. Thank you so much. We wanted to thank you for this time. We wanted to express concern about the post COVID discrimination services that's currently in the budget, the FY '27. This remains to cite the House Human Services Committee, recognizing it as a high priority. We're very concerned about the impact for adoptive and guardianship families. We hope your community can support this and make our levels pull to fiscal year 2026. We'll

[Unidentified Senator (member)]: end

[Melissa Appleton — Lund (Post Permanency Program)]: the line with Easter Seals and NSI Vermont provide post permanent fee services in Vermont. It's a very important service to adopted and guardianship families. We are working with families with trauma related behaviors, identity and attachment issues, parenting challenges, issues accessing services. We provided some testimonies from families that gives you a fuller picture of what they're managing and what they need. We exist to support family stability, resiliency, and ultimately preserve that placement. We do not want kids reentering care, to seek care. We do not want kids needing to access residential care. We do that through parent coaching and support, advocacy, informational referral. Again, you'll have some materials on that. The proposed cut would mean a 25.5% cut to LEMS funding. That's very big for our families and for our program. We would have to reduce caseloads and limit number of families served. The state is estimating 60 families across the state would not be receiving services through the three agencies. For families, this would be longer wait lists, less access to support, and short duration of support. I also want to know, right now the guidance is saying that DCF facilitated adoption would be prioritized, so that's really leaving out guardianship families, so more often kin, Aunts and uncles, grandparents who are stepping up to take care of their kin would not be prioritized for our services. So we're very concerned about that population. We are concerned about this with increased care burnout, placement instability, and heavier reliance on an already taxed mental health system. We're preventative, we're responsive. We're really hoping that you all can support us and going back to those fiscal year twenty seven level funding. Thank you. You. You.

[Sen. Virginia "Ginny" Lyons, Chair]: Chad Simmons from the Homeless Alliance. Thank you for coming back today.

[Chad Simmons — Housing & Homelessness Alliance of Vermont]: Good morning. Name is Chad Simmons. I'm with the Housing and Homelessness Alliance of Vermont. My partner is very brief. We are we represent more than 50 organizations and many individuals who are supporting the housing and homelessness continuum across the state. We are I'm specifically here today to talk about provisions and investments made in H938. We appreciate the work that the House did on the budget, but are concerned that the amount appropriated in the budget and expended through the bill may not be enough to meet the needs Vermonters experiencing homelessness, and concerned that we won't have enough resources to put forth. So we hope in the coming weeks that that conversation will allow us to look at specific areas. In particular, we'd like to see additional resources, at least $3,000,000 added to the case management line item that's currently proposed in the bill, and that will provide statewide resources to provide navigation and case management for folks experiencing homelessness. This is in particular response because we've heard from our members that that is one of the greatest needs for folks experiencing homelessness. Another concrete thing that was named in the bill, but has was not funded in its current construct is a proposed merger of the two continuums of care across the state. We are open to exploring what that would look like. The state cannot mandate the merger, but we would ask for resources including up to $50,000 to help with the conversations, reporting necessary, especially working with our federal partners in HUD and trying to maximize how much federal dollars that the state can bring in, not just in the first year, but over multiple years. And finally, we support the SASH program, and it is not currently considered in the FY twenty seven budget because it's exploring other funding opportunities, but asking that this committee include a letter of support encouraging AHS leadership to find the additional funding outside of the FY '27 budget that will provide a $5,100,000 gap in calendar year 2018. Thank you so much.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you. And you know, we'll be taking up H938 separately, we'll probably hear you again.

[Chad Simmons — Housing & Homelessness Alliance of Vermont]: Yes, I hope so.

[Sen. Virginia "Ginny" Lyons, Chair]: Okay. Christina McLaughlin from Health First. Thanks for being here. Hello, good morning. Thank you for having me.

[Christina McLaughlin — Health First]: So my name is Christina McLaughlin. I'm here on behalf of Vermont Health First, which is an independent physician association, representing healthcare practitioners, working at clinician owned practices throughout the state of Vermont. Currently have about 66 primary specialty care practices across 11 counties in Vermont. This includes 127 primary care clinicians caring for about 90,000 patients in Vermont. We have 108 specialists offering over 25 specialty care services. So you heard from BMS earlier today about the numerous cuts or lack of funding to primary care in the FY '27 budget, so I won't get into all of those. But I'm here to specifically ask that your committee consider reallocating the $2,000,000 appropriated in the House passed budget for the Provider Civilization Fund to instead use that $2,000,000 to restore the $2,000,000 cut that Department of Vermont Health Access cut in base funding, which would draw down $5,000,000 in gross. This cut eliminates a $4.75 PMPM payment to primary care practices, which has been very critical to our practicing table, Robin. As I mentioned, there have been numerous cuts to primary care. And so we're trying to come to you with a proposal to say this may be a nice way to truly provide stabilization to providers, particularly primary care, draw down more funds while acknowledging there are further cuts happening. This would really, really go a long way

[Olivia Scherham — Executive Director, Vermont Free & Referral Clinics]: to give those further cuts. So

[Christina McLaughlin — Health First]: we really support this proposal. We hope that you're truly considerate, and we appreciate you caring from us and you for your consideration. Thank you. And? We don't have it

[Sen. Virginia "Ginny" Lyons, Chair]: in writing. I think there are a number of folks who didn't send

[Christina McLaughlin — Health First]: it in. I will send it.

[Sen. Virginia "Ginny" Lyons, Chair]: We'll get that. Yes, I hear that. Okay, that's great. Thank you. So we'll move right along with Carrie Stallard. We have two more folks. We have Carrie Stallard and Christina Kennedy. So we wanna hear both both. So Carrie, go right ahead.

[Carrie Saylor — Government Affairs Officer, Vermont Foodbank]: Great. Thank you so much, Chair Lyons. Thank you committee for your time today. My name is Carrie Saylor. I'm the government affairs officer for Vermont Food Bank. And when the state of Vermont steps into leadership for food security, all of our collective action will be successful. Vermont Food Bank is seeking a total of $5,000,000 in state FY '27 to support the roughly 70,000 people our network feeds each month. This is detailed in three different areas. I'm gonna give you the tree tops. You should have our full written proposal. I'm also gonna let you know what happened in FY '26 and what is currently in the house version of the budget. The first portion of our request is $2,000,000 to fully fund the Vermonters Feeding Vermonters grant program through the agency of Ag Food and Markets. This program grants funds to purchase Vermont grown and raised food that Vermont Food Bank distributes through food shelves, meal sites, and direct distribution programs that serve people in all 14 counties. In FY '26, $885,000 was appropriated to this program. In the FY '27 house budget, there is $400,000 for this work. We ask that you retain the $400,000 in the house version of the budget in your senate budget. Part two is $2,000,000 to fund food shelf and, meal site network partner services. This supports our local partners, about 220 of them across the state. This helps to keep shelves fully stocked and make sure there is enough food for the neighbors visiting those sites each week. In FY '26, this was funded at $1,000,000, and that funding came through DCF. It is currently funded at $0 in the FY '27 house budget. We ask if any additional one time money becomes available that some is allocated to this portion of our request. The third section is $1,000,000 to fund a ready response program to ensure that food and water water is available in disasters and other emergencies. Through this program, we're seeking to formalize a relationship with Vermont Emergency Management to assure that Vermont Food Bank and our network are prepared and resourced to address acute short term needs for food and water in emergencies or disasters. The language creating this grant program is traveling with bill h nine thirty five, which allocates $500,000 in one time funding to this program. We would simply ask that this committee supports retaining that level of funding in the senate version of the budget. We also would like to ask that you support the benefit assisters request that you have heard about earlier. We view this as critical strategy to relieve pressure on the charitable food system by helping more people access federal benefit programs, including SNAP, which provides money to buy groceries. Funding at the requested level of $3,496,000 will directly help meet people's basic needs and hopefully alleviate some need for people to use food shelves and direct distribution events. Thank you for your consideration at this time, and I'm happy to answer any questions.

[Sen. Virginia "Ginny" Lyons, Chair]: Thank you, Carrie. Scott. And I'll make sure we have everything on our web page.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: Great.

[Sen. Virginia "Ginny" Lyons, Chair]: And Christina Kennedy, you're here. Good morning. My name is Christina Kennedy, an intern at DAS and Run through, and I'm here to present the testimony of the Vermont EJ Network Consortium. VANC is a formal affiliation of the five designated area agencies of aging. We request the following budget items.

[Christina Kennedy — Vermont AAA Network Consortium (intern presenter)]: So VANC requests a total appropriation of $2,000,000 inmates' funds for home delivered meals for older Vermonters. The House only appropriated $500,000 in general funds. And we have requested in the House a 3.5% inflationary increase in Medicaid reimbursement rate, which includes AAA case management services. The House only appropriated what amounts to approximately a 1% increase. We joined with the Alzheimer's Association and the Vermont Association of Adult Day Services, who requested support for the ASPS in S-two forty two. An increase in the dementia respite grant program by $500,000 as well, as a $100,000 request to support services in underserved areas. This grant is administered by the Area Agency on Aging to serve unpaid caregivers of loved ones with dementia. Thank you very much. That was quick. That's a short time.

[Kylie (Kiley) Kuiper — State Long Term Care Ombudsman]: Short time, know you're out of time.

[Sen. Virginia "Ginny" Lyons, Chair]: But I am hearing that you have some consistent recommendations consistent with what the Alzheimer's folks have. Yes. Okay. Thank you. Okay. That good. We did it within our time allotted. We're creeping I appreciate you. She's on the list. Oh, that was written. We're good. I think we're ready. Committee, my suggestion is think about the budget presentation that you had today from Nolan and Amy. Look at the information we had on the substance misuse and recovery data and think about these requests and how they fit with our priorities, your priorities, we will come back to these for discussion because I know there's a lot to be said about each one of these. So we are calling it a wrap for the week.