SmartTranscript of House Appropriations - 2025-04-22 - 2:00PM

[Eileen Dickinson]: Good afternoon. This is the House [Robin Scheu]: Appropriations Committee. It is April twenty second twenty twenty five, December two PM, and we are here to continue our conversation about federal funds. This is about substance misuse, and we have Paul Daley, who's the finance director for the the Vermont Department of Health with us to talk with us. So welcome. Thank you very much for coming. Thank you. And we appreciate your time. So we and for me, there's something on our committee page about this. So anything that you wanna introduce yourself, Paul, and take it away, please. [Paul Daley]: Thank you. I'm my name is Paul Daley. I'm the financial director for the health department, and I've been invited to testify to the committee on federal funds, used for substance misuse. And, provided a summary to the committee that's been posted on committee's web page, and I'll refer to that in my testimony. Our substance use programs appropriation is section B313 of the budget bill, and that's where our substance misuse prevention or substance misuse funding is contained. So that's the appropriation I'll review for you today. You can see from the material I provided, the overall appropriation that's recommended in your version of the budget as passed is sixty nine million and change. And of that, just under sixteen million is expected to come from earned federal receipts. And there's five sources of these expected federal receipts, and I've described each of them in the summary I've provided. The largest of the five is the substance abuse block grant, which has recently been named the substance use prevention treatment and recovery services block grant. So it now is referred to as SUBG. This grant comes from all of these the funds, all federal funds I'll be talking about come from the Health and Human Services Department. The SUBG comes from the Substance Abuse and Mental Health Services Administration. It is one of our oldest grants was originally authorized in nineteen ninety two and it's a non competitive formula grant. So the amount is authorized by Congress and there's published formula for each state gets. The each year we get an award and we have twenty four months to spend that award. So the state has some flexibility. And the current award period for that grant ends the end of September twenty twenty six. [Robin Scheu]: When so you don't need to apply. You just That's correct. Okay. [Paul Daley]: So We need to submit a budget and a work plan You do. But they're not competitive. [Robin Scheu]: Right. And so when do you typically so if this runs out in September, you know, a year from now, fifteen, sixteen months, when do you have to start putting together a [Paul Daley]: We will get a new award on or about July first or up for the grant that is funded in this federal fiscal year's budget and will extend until September twenty ninth twenty twenty seventh. Okay. So they actually have overlapping performance. [Robin Scheu]: So you you hope you'll hear something from the federal government this summer, basically? [Tiffany Bluemle]: Right. [Paul Daley]: Okay. Thank you. The next one is the, state opioid response grant. Again, the funder is, HHS SAMHSA. These this grant is available again as a non competitive formula grant awarded to all states first authorized in two thousand and eighteen as a response to the opioid use crisis. And it provides a broad range of allowable uses from the entire continuum of substance use prevention through treatment. This is a this award is has a five year project period, which will is runs through September twenty ninth twenty twenty seventh. If we receive annual grant awards, each of the with the exception of Medicaid administration, which I'll address, each of the grants I'm referring to, the appropriations that will fund the grants that we'll be earning in fiscal year state fiscal year twenty six are included in the current federal budget, the one that's run under the continuing resolution. That's one of the reasons why you'll often see grant awards of September twenty ninth because they're actually awarding the funds on the last day of the fiscal year. [Robin Scheu]: Okay. So you you get this as a five year grant, but you get to draw down once a year? [Paul Daley]: You'll get an award each year. And k. Usually, in in most cases, and and it's clearly the case in these, funds that are unexpended at the end of one budget year remain available through the end of project period. [Robin Scheu]: And And they remain available. They're being housed in the federal government, or do you draw them down and you can use them over the course? [Paul Daley]: In general, madam chair, the the the agency follows a federal requirement that says you have to minimize the amount of time between when funds leave the federal treasury and when they're put to use. Okay. In practice, what that means is we draw down funds weekly, monthly, or quarterly based on the expenditures that the state has already incurred. So for the most part, we're drawing down after we've spent the money. [Robin Scheu]: Okay. [Paul Daley]: The next one, we're budgeting is over one point five million in a grant titled Overdose to Action in States. This one this grant is from the Centers for Disease Control and Prevention. It's it was initially authorized in twenty nineteen with a current project period running through August of twenty eight. This focuses on surveillance and prevention grants, prevention efforts. And it's just one of the first large scale CDC grants that was really trying to under trying to understand what was going on with the opioid use crisis. So there's always been a the SAMHSA's focus while they try to understand the broader picture in the population, they're often focused on on on treatment simply because that's where the need is greatest. So these two state state opioid response and OD two a are are relatively recent, and they're a significant part of our ability to fund the our funding portfolio for substance use prevention, treatment, recovery. And and we do while we have a broader portfolio in in this appropriation than we have in some others, the federal these federal grants amount to just under a quarter of our overall budget. We have that when you take into account the global commitment funding and the special fund funding in the twenty six budget, you've got a significant new infusion of funding from the substance misuse prevention fund that provides for a more balanced portfolio than usual. And in addition, it's not included in our base budget, but the one time appropriations that have been made from the opioid abatement special fund are also part of that portfolio. The next one is slightly different than the other grants about just under one point five million for Medicaid administrative claiming. This is from the Centers for Medicaid and Medicare. Then The Medicaid program authorizes states to claim reimbursement for expenditures necessary for administering their Medicaid program. And we claim in this appropriation administrative costs for the the people who oversee the credentialing and monitoring of our substance, use treatment, providers. The federal participation rate is fifty percent. And it shows as federal funding in our budget because Medicaid administration is not included in the global commitment waiver. So the appropriation comes as federal rather than GC. That's an annual grant award, but it it's it's hard to think of it as as an annual program. These are this is an acknowledgment in the state federal partnership for Medicaid that these are this is what it takes to run the program. And the last one is the again, from SAMHSA. It's the strategic prevention framework partnership for success for states. Okay. The health department calls it PFS three because it's the third iteration we've had of the award. This is a SAMHSA grant that's focused exclusively on prevention, and it's it is part of our portfolio for the substance misuse prevention, primarily focusing on community prevention. This is a competitive grant program with a new project period starting in September. We have submitted our application for the new project period. And in in most years, we won't expect to see a final announcement until then. While it is a competitive grant, the the the funding agency awards these grants in tranches. So more than half of the states have them, and we're on staggered schedules. So there'll be, I believe, six maximum awardees, but that doesn't mean our chances are six and fifty. And this would be, the the third consecutive program period or project period that we've had if we received that award. [Robin Scheu]: Paul, let me ask you. Are you are your contacts in the federal government all still there at SAMHSA, at CMS, at, you know, the people that you normally work with? Are they still employed? [Paul Daley]: I can so in my office, our our we we have seen we've had trouble in this with folks where offices have essentially been laid off in CDC. Mhmm. Can't say with confidence that they've that that has occurred to the same extent as the same. [Robin Scheu]: Because I've heard that SAMHSA had some cuts or layoffs or something. I see here [Paul Daley]: Can't speak to that, madam chair. [Tiffany Bluemle]: Yeah. Jen? Can you enlighten us at all as to what you're hearing? I thought I saw something interesting about vaccine promotion that may have been used, and I don't know if that was actual. Did we get federal help for administering vaccines, or is that only during this pandemic? [Paul Daley]: Thank you, representative. I was I came prepared to talk about substance misuse. So what what I've department [Robin Scheu]: thought that would be sort of a separate I'm happy [Paul Daley]: I'm happy to try that because it's an area I'm familiar with. Okay. The the the federal obviously, HHS and and immunizations have been on our mind in public health for the last month. And the Health and Human Services provides significant assistance to states for vet immunizations. The HHS provides direct funding direct assistance to states for what's called the vaccine for children program where children on Medicaid and federal government provides vaccine to states at no charge. So you don't see it in our budget because it comes as basically an in kind contribution. These be like measles. All the recommended childhood vaccines. Yeah. All those recommended by the the committee on vaccine on immunization, which has not met since the new administration started the advisory committee. There is so [Tiffany Bluemle]: Any change in that statement? [Paul Daley]: I can, so there we've seen no, no evidence, no, nothing official or even implied about the vaccine for children program. The state receives an immunization grant that, to operate our overall program, including an immunization registry. That project period ends at the end of June, which submitted an application for a new round of funding that would start in July. You may have read that there was one grant that was recently it it was canceled sooner than expected, and it was an immunization supplement award that was initially awarded during about the second year of the COVID pandemic and had been extended successfully. That award was slated to end at the end of May of twenty of this year, twenty twenty five. There had prior to the change in administration, we had been told to expect a what what's what's called a no cost extension where they wouldn't give us a new award, but we would have more time to spend the remaining balance. The this administration chose to cancel that award among several other COVID era awards effective March twenty fourth. [Tiffany Bluemle]: Is that for the actual vaccine or is that for the function of the availability of the vaccine? Right. [Paul Daley]: When the award when when it came initially, it was still at a time when the federal government was funding all of the the COVID vaccine costs. So the the primary intent initially was to do outreach to to encourage folks and and and help facilitate the distribution of the vaccine. In more recent years, you we states could use it to purchase vaccine. And but that usually wasn't the main thing because you had a situation for where for most of the past two years, Medicaid has been funding COVID vaccines at a hundred percent federal participation rate. And in Vermont, the state's vaccine purchasing program recommended COVID and was purchasing it and distributing distributing it to providers at no charge to the providers. So the the funds in that award were primarily used for work to to increase or maintain immunization rates, particularly among children, which there was a fair amount of catch up to do after the pandemic because it was people many young children got off schedule because of the having a challenges getting into doctor's offices. And so that's where a lot of work's been gone. So we will be submitting our final aim for federal funds in that grant this week. [Tiffany Bluemle]: Thank you. You can take your own preference. [Paul Daley]: Could just I feel more confident when I know I'm prepared. And so [Tiffany Bluemle]: We all do, I guess. Stopping. Yeah. [Robin Scheu]: We have to cancel director. So, any other questions for Paul on this? Well, I yeah. Go ahead. I mean, I guess what I'm taking from your presentation is that, well, let me ask the question. [Eileen Dickinson]: Are you concerned about renewal of any of these grant programs? [Paul Daley]: Were these five Yeah. Representative Bloomly I'm not I'm not I'm not concerned primarily because these have been appropriated. All the funds that will be in these grants that we will draw down have been appropriated by Congress. And while there has been some question about compliance with the the impoundment act, the the administer we have we have across our portfolio of federal awards, and we have about a hundred and thirty active federal grants at any one time, we have there has been it's not anywhere close to normal, but we are we are seeing grant awards on on closer to a normal schedule. The the early attempts where we we were told these are frozen, we we're not hearing that anymore. So I expect that the funds that have that are in the budget, we would see those. There's not an ideological basis for this administration to want to try to change these, whereas you could this committee, some of the members probably were are were familiar with the in the first Trump administration. They there there was a the rule change that really made the state unable or unwilling to participate in the title ten family planning program, and the state had to fund that for two years. So we know those things are happening, but these grants aren't in the process. [Robin Scheu]: And who are the beneficiaries of these grants? [Paul Daley]: In each case, about between seventy and ninety percent of the funds go out as grants. The and the substance use prevention block grant is about thirty percent personal The overdose data to action has more staff in it because a lot of the surveillance work is done by our own staff, this surveillance and analysis. So that one's about that's the one that's about fifty fifty. [Eileen Dickinson]: But who who actually are [Robin Scheu]: the beneficiaries of this? Who are the Vermonters that benefit from having these programs? [Paul Daley]: Okay. And the each of these, each all but the the the PFS are available to fund the entire continuum of substance use services. And that could that it's it starts with prevention, whether it's in in school age populations and community based prevention. It continues through the support for outpatient services provided by our community providers, often providing support for their clients who are completely uninsured. These provide that gap filling, provides workforce development in some cases for some of those providers. In residential treatment setting, it often funds those things that would not be eligible under Medicaid. And it provides it's a it's a it's a substantial part. It's not the largest part, but it's a significant part of the funding for recovery services. [Eileen Dickinson]: Excellent. Yeah. We've just talked about, you know, to expand. I am trying to spend a moment with density treatment for people with mental health and substance abuse. Mhmm. What is we've had these for a while. [Paul Daley]: That's correct. [Eileen Dickinson]: What's the efficacy of this? I mean, when you talk about who are the beneficiaries, are we seeing less of it? Are we seeing an improvement in the people who have been suffering with substance abuse? Will be I mean, where what are we getting for the ballot? What's the bottom line for the ballot? [Paul Daley]: Representative Dickinson, that's outside my area of expertise. I can offer I know I know from having heard the the subject matter experts talk. And one of the things that's often brought up is particularly the substance use treatment prevention treatment block grant is is one of the few places where we can focus on alcohol use disorder. The more recent funding has been focused on opioid use disorder and alcohol use disorder is a much bigger problem in Vermont. With respect to how well they work, they we because we've been doing prevention work in some cases for two decades or longer, there has we have been able to accumulate significant evidence that, evidence based practices in communities will have a different will make a difference in the rate at which in the age at which, youth take up, the use of tobacco, alcohol, and other products. And that's an important that was an important precondition for, certainly for doctor Levine's willingness to to not necessarily support, but his objections to legalize cannabis were addressed in a key way by the creation of the by the commitment of thirty percent of excise tax revenue from cannabis to be used specifically to educate young people about the risks of cannabis to developing brains. So that that wasn't coming out of a vacuum. Doctor Levine was confident from the evidence we have in Vermont that communities that have been able to apply evidence based practices over time reduce substance, use, particularly among young people. And that that's that often that usually, particularly for illicit substances, will continue well into adulthood. [Eileen Dickinson]: What about things like vaping? I mean, tobacco seem to go to a it was a long time ago. It's a decline, and now it's going back up. Now we're getting vaping. Is that part of this? [Paul Daley]: I it's you make could you address a good point, Representative Dixon, because the appropriations do that are reviewing our office that it's in the public health appropriation that we do most of our tobacco control program work. And while vaping is one method of use of cannabis, particularly among young people, it's been primarily for use of nicotine. And that has that there's I can tell you that the vaping use among school age children has declined significantly from its peak. I think it's too I think the science has not been able to determine the reasons for that, but that it is clearly in decline. [Eileen Dickinson]: It's not what I do on the [Robin Scheu]: street, but that's nice to know. [Paul Daley]: Again, the this probably for for Vermont specific data, the, you know, the for the most reliable source is the youth risk behavior survey, which has been consistently validated for decades. And that that's what we use to track So [Robin Scheu]: that's particularly Yeah. Any other questions for Paul? Thank you very much for coming in. We appreciate it. [Paul Daley]: I hope it's helpful to you. [Robin Scheu]: It's very helpful. All of it's helpful. Very little piece of the Thank you. So Thank you. And. Committee, that is it for today. Tomorrow morning, we start at nine. The regional planning commissions are coming in, to talk about their life and their world. And then at ten thirty, of economic development and the department of tourism. Everybody's asked about the department of tourism there. I mean, tomorrow is ten thirty. And then we'll have a and r in the afternoon after the fourth. So that's where we are for now. We don't have any bills yet, but we'll probably be getting more bills. So So I'll let you know as I hear, but So I sent you a list. Services wants to be at ten o'clock. At ten o'clock? [Tiffany Bluemle]: They They [Robin Scheu]: haven't asked me yet, but it's on their agenda. So I'm ready. Great. Well, it's something. Hopefully, they won't need you for more than half an hour. They believe that. They're kind of stories of

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SmartTranscript of House Appropriations - 2025-04-22 - 2:00PM

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