2022-02-15 00:00:00 - Joint Committee on Ways and Means

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AMY KERSHAW - DEPARTMENT OF TRANSITIONAL ASSISTANCE - Okay, good morning. Vice Chair, Donato and Vice chair Friedman Distinguished members of the123 joint committee and my colleagues from HHS it's nice to be with you this morning. My name is Amy Kershaw. I'm the Commissioner of the Department of transitional Assistance. I appreciate the opportunity to join you to discuss the important work of our agency and how the Governor's house to Fiscal year 23 investments will support our continued efforts to increase and streamline access to150 services, promote economic mobility and support the department's efforts to modernize all of our operations as we move towards a post pandemic recovery. PFAS mission is to assist and empower low income individuals and families to meet their basic needs, improve their quality of life and achieve long term economic self sufficiency. Okay, as I look at the agency today, I'm proud to say that we have kept the mission at the heart of our work as we have navigated the public health crisis.184

Each day, the nearly 1600 staff who work across our agency bring their commitment to this work, serving the now one in seven residents194 of the commonwealth who utilize our programs. The department administers the Supplemental Nutrition Assistance Program or SNAP the Transitional Aid for Families With Dependent Children Program or TAFDC. Emergency Aid to theEelderly Disabled or EAEDC. The state's SSI State Supplemental Program, the Healthy Incentives Program or HIP. And we also provide important workforce219 development opportunities220 and supports for all of our clients. When I testified before this committee last year, I shared four key priorities as we looked ahead to FY22. Those priorities included expanding the ways in which people can do business with the department. Managing anticipated caseload fluctuations across are accounts, embedding equity driven thinking into our policies, procedures and practices and modernizing the agency's operation to be more flexible and responsive as we engage clients on their path towards long term economic mobility.

Over the course of the last year, we've made great progress in each of these areas. The Baker Polito administration’s FY23 proposal which funds to at 831 million represents a 5% increase over last year's budget, enabling our department to continue to advance our priorities and build on our recent successes this year's budget in particular positions. The department well to continue responding to the fluctuations in the290 state's SNAP the TAFDC and the EAEDC Caseloads while also promoting benefits stability during the pandemic. The department's caseloads have responded to shifting state and federal policies and pandemic related supports. As individuals and families sought economic support from the agency to best meet their basic needs. The state's SNAP Caseload is now 30% over what it was. Pre pandemic levels when we have been serving about 450,000 households.

As of December, the Caseload is at about 600 600,000 households. Or nearly one million individuals were also continuing to administer the federally authorized COVID-related supplemental SNAP payments at this time. DTA’s Economic Assistance Caseloads have also seen dramatic increases, particularly following the termination of the pandemic unemployment related benefits in September of 2021. In addition, these have been impacted by recent state level changes that expanded eligibility, including a 20% increase in the income thresholds and benefit levels and an elimination of the asset limits across both programs. As of december. Um the TAFDC Caseload was 33,000 households, which is a 12% increase over pre pandemic levels. Also in December, the EAEDC Caseload was about 25,000 households, which is a 31% increase over our pre pandemic caseload levels and an391 historic high for this program.

The administration's budget proposal395 funds these accounts in anticipation of continued caseload growth and we will be closely monitoring and communicating about the projected changes in these accounts during the course of the budget process. In my written testimony, I have provided um caseload trend charts for across our programs that show changes in the caseload along with key milestones associated with federal or state level policy changes that have affected caseloads throughout the pandemic for your reference. Okay to support clients and staff safety while responding to the increasing demand for our services. The department has focused on moving the agency away from a traditional bricks and mortar approach to create a much more modern and flexible way of delivering services. These investments have enabled Massachusetts residents to do business with us at times and locations that make the most sense for them.

Whether that's on the phone online, through the DTA. Mobile connect app at one of our many partner agency sites or through one of our local offices. Today, individuals and families can do all of their business, with DTA without having to visit one of our 20 local offices unless they choose to do that through modernizing our operations, pursuing all federal waivers and heavily investing in technology. DTA has significantly expanded access for the vast majority of families and individuals receiving services. Last year we sent nearly 13 million text messages and nearly 1.8 million emails for the first time to our clients. We also now have more than 219,000 new users on our DTA Connect Mobile App. We've been able to leverage the success of our remote communications507 and texting capacity to partner to provide key resources to our clients across systems.

We partnered with the Department of Public Health to provide information about vaccines, vaccine sites. We department we partnered with the Department of Housing and Community Development to share information about important pandemic related housing resources for our clients. And we also shared information with clients via text about the child tax credit and the earned income tax credit To support our clients who don't have access to technology or can't safely access are now vast array of remote services. We did reopen our local offices in June of 2021 under551 a new operating model that focuses on guided self service. A client visiting a. DTA office today is now greeted by a staff member trained in a new customer service model which allows them to do their urgent business of the day today while also learning about access to remote services which they may572 choose to take advantage of in the future.

DTA’s broad expansion of our options to conduct business with us remotely has drastically reduced wait times in the offices, I'm very pleased to say and our foot traffic is about 20% of the pre pandemic levels, visits to offices. We also launched significant changes to the DTA’s assistance line, which is our call center including simplified menu options, expanded language is the ability to accept telephonic signatures and direct connections to our domestic violence specialists, our workforce and education specialists and our disability client coordinators. Most of these services were only available in person prior to the pandemic. During this time, the department also focused on expanding access through strategic partnerships in the community so that we could reach clients where they were instead of having them have to come to us. This has involved close work with are more than 100 community partners and sister agencies including schools, resettlement agencies. The Mass office on refugee and immigrant assistance. So thank you. Director trunk for that work.

648 We also have more than 40 kiosks place at community locations across the Commonwealth. Today. Another important part of DTA 's community engagement work is with our employment providers. During the past year, DTA implemented a brand new redesigned employment program that is intended to provide human centred, goal oriented, individualized services to our clients to engage in meaningful career pathway opportunities connected to in demand industries. The administration's proposal includes more than 24 million to support the department's continued686 work in this area, including five million for our work with the Department of Housing and Community Development, unemployment for homeless families. 2.5 million in collaboration with the Department of Public Health for our new to generation economic mobility programming and a million for our pathways work with the mass higher career centers.

The governor's budget also includes investments across DTA and the Massachusetts rehabilitation commission to support continued growth for our empowering to employ program, which provides DTA Clients with disabilities with access to vocational services and job placement services through MRC. Bringing some of the best of what government can do with each of us, providing what we can do731 best for our shared clients as you well know for low income families with young Children. A common barrier and even more so today than ever before to meaningful participation in workforce is access to childcare. The governor's budget includes $9 million across DTA and the Department of Early Education and Care to create a more streamlined access for our clients to be able to access childcare two expediently enroll in either work or employment related activities and for the first time investments in this budget will also prioritize access for working SNAP families to enrol in employment related programming.

Finally, the administration remains committed to promoting food security across the Commonwealth and Bolstering a resilient and just local food system. To date, the administration has invested more than $100 million dollars to support food security efforts and build a more equitable food system. Following the recommendations of the COVID-19 Command Centers Food Security Task Force, a key area of focus and investment for the task force. Was the healthy incentives program this year we launched DTA Finder a mobile friendly and Multilingual website that connects clients with local HIP vendors. The administration's FY 23 budget includes five million for HIP In spending. With an additional eight million from FY 22. In total, the 13 million investment in the program will support the agency's work to ensure vendors are equipped to ride clients with a smooth and equitable experience and SNAP clients are aware of the multiple835 places where they can use their SNAP benefits to access HIP.

Moving forward, the administration is capitalizing on the strong partnerships that were facilitated by the Food Security task Force so that we are able to continue to address these critical851 food security planning efforts by bringing together the many agencies across state government that touched the food system and have responsibility for food access. Thank859 you for your continued partnership in helping us address food security, economic mobility and improving the customer service experience for our clients. We look forward. I'm grateful for the opportunity to provide this testimony and look forward to working with you in the months ahead. I'm happy to take any questions from the committee.

REP DONATO - Okay, thank you commissioner. I I do have just a couple of questions and the first one is what is the department's foresee relative to TAFDC and EAEDC Caseload in the coming year.894 And let me ask you what effects of the national economy, climate in trajectory and the pandemic likely to have on this.

KERSHAW - That's a great question. And um as we like to say that the department I would say the worry of the day. Um So um as I mentioned in my testimony our Economic Assistance accounts and also our our SNAP accounts have experienced incredible volatility during the course of the pandemic as federal policies waxed and waned. Um And as new state level policy changes came in. So um it is fairly early in the experience of the significant changes that were implemented last year and in particular those state legislative changes that lifted the asset limits um And and also raised benefit um and income threshold levels. Um We are fairly early in sort of tracking the data on that. As you can see from the charts we provided we've had a very significant um and fairly steep increase um And we are tracking those caseload trends very very carefully so that we have a sense of um what the impact will be going forward. I think we're a little earlier in the data collection effort but as I mentioned will continue to we are anticipating continued growth. I think it's the pace of growth that we're going to be monitoring closely so that we will be able to communicate that during the budget process.

DONATO - Well according to your chart you had about 140,000 new cases is that correct?

KERSHAW - In in the TAFDC or in SNAP?

DONATO - In SNAP.

KERSHAW - Well in SNAP. Yes, we we are up almost 150,000 new households and that represents a great deal more individuals and on the TAFDC and EAEDC side um really since september we've seen very steep increases in both of those caseload. So the TAFDCcaseload is about 21% of pre pandemic levels um and the EAEDC caseload is1015 about 25,000 households right now which is an historic high for that caseload. We've never seen it at that level before.

DONATO - So have you made any organizational technological progress in closing the SNAP gap this year?

KERSHAW - That is a great question. You know, we have been working really closely with Mass health I think are the relationship between the agencies to focus on the1040 SNAP gap which for as most of you are aware is folks who are members who are receiving mass health and appear to be eligible for SNAP but aren't. Um so the agencies working together have done a number of initiatives this year that have done direct outreach. We've worked on a pilot um with boston Medical Center to Cry and create a common application experience. Um and we've also done direct outreach are we've had mass health do direct outreach to their members who informed them. We made a change to the paper applications that would enable clients who are applying especially in the Sena application to be able to also indicate they were interested in SNAP and I'm sorry to be stealing the thunder from Amanda Castle Kraft.

Who will be hearing from um soon but the agencies are excited to announce that we will be making an upgrade to the mass health online application um beginning in july of next of this year um that will enable an applicant uh to be able to indicate that they would like the information um in their application for Mass health to be transmitted to DTA to be considered the start or initiation of of an application for SNAP. It's the administration has1114 been um committed to trying to figure out how to close SNAP gap and these efforts combined will continue to do that. I think important to note that our work has really focused on both trying to keep the gap from growing so that's where we reach people at the application point and also try and shrink um the existing gap by reaching people who may who may be in that. And part of our work has been with mass health but also our community partners because many of them so are working with clients who may be mass health members but not yet receiving SNAP but we will continue these efforts and keep you up to date.

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SEN FRIEDMAN - Yes, thank you and thank you commissioner. I just have a question to follow1161 up to um rep Donato. So I'm looking at these numbers, you're following them closely. You know that things like childcare are not going1170 to be solved in the next couple of months um and which is a huge factor for a lot of people And yet you've only increased the budget by 5%. So we talk about what the thinking is there because it doesn't quite fit with the 31% and the 30% numbers that we're seeing of growth. Can you talk1191 a little bit about that and how you1194 got to it and why the1196 5%.

KERSHAW - Sure. I mean, as as I mentioned, we have been experiencing sort of very um a lot of volatility and so being able to, we've been working really closely with the office administration and Finance and the ehh and the Executive Office of Health and Human Services to track what could be a low medium or high caseloads projections. And as I said, it's It was, it is difficult at this moment to predict exactly what FY23 is going to look like and I1228 think we'll have um a better um more um solid projection. Once we've had a couple more months of data um the changes came fairly quickly. We saw this1239 dramatic increase. We've been anticipating a leveling off, we're starting to see a deceleration um in in the applications which is a leading indicator for what caseload will look like. So We do anticipate having updated numbers for FY23 um in the next several months that will be based on sort of the data trends that were able to capture from the last several months.

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REP SCHMID - Thank you. Chair Donato and it's Commissioner Kershaw, it's great to see you. Ah we've done a great job and I remember working with you a bunch of years ago to decrease the effect of the the cliff effect and I really appreciate how you dug into that little issue and really made some progress. So hats off to you HIP, you've been a wonderful partner on that important program. And I note that your uh the governor's budget includes. I think you said 13 million For FY23. Someone told me that we're on track for spending about 16 million FY22. Uh Although maybe we haven't seen the up to date figures. Mhm. We do want to be able to maintain this program program on a 12 month year. Do you have any comments on the seeming budget shortfall For FY22? For FY2023.

KERSHAW - So in fY22 we are so thrilled to be able to offer this program year round, which as you know, representative Schmid was a priority of the food system Caucus and um something we've talked about over over several years and Um we're also hit a milestone earlier this year with $1 million dollars a month being spent in HIP transactions. And um it has been a really key um Strategy for us in terms of food security because it really reaches both our clients having access to1398 local healthy foods and also supports the local economy for the farmers and our focus. This year, we brought on 39 new vendors this year and our focus has been to try and get them fully on boarded and make sure clients know how to use those services. Um the latest projections I saw had us being able to maintain full time access to services for FY22 at our existing At our existing funding level and carrying that into FY23 to be able to1425 maintain access to the current level of services. And again, our priority going forward is to make sure we're bringing on those new vendors, making sure our clients know about them. We I'm happy to share if there's updated um projections that put us over this year's allocation, but that's not, that's not what we're seeing right now at the DTA. Level.

SCHMID - Thank you madam commissioner and I whenever I think about the HIP program, I think about chatting with somebody in the line in fall river and she said to me, you know, just because I'm poor shouldn't mean that I can't eat healthy, right? No, that kind of motivates my thinking on1467 the HIP program. And with that chair Donato I yield the rest of my time.

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CECILY REARDON - DEPARTMENT OF YOUTH SERVICES - Good morning. Vice chair. Friedman Vice chair. Donato and distinguished members of the Joint Ways and means Joint Committee on Ways and means. My name is Cecily Reardon and I am the acting Commissioner for the Department of Youth Services. It is a pleasure to appear before the committee today to speak about1531 our departments mission Priorities and the Fiscal Year 2023 House to Budget. As many of you know commissioner Peter Forbes retired at the end of December of 2021 after serving the department for 39 years. Commissioner Forbes was the longest serving commissioner in the department's history and I had the privilege of working alongside him and learning from him for the last eight years as1556 his general counsel. Well we I know I will certainly miss his dedication and his leadership.

I1563 am honored to step into this new role and to address the committee today with me. Today is Margaret1569 chow Menzer who is our Deputy Commissioner for administration and finance in case you have questions that are a little more in in the weeds or detailed than I can assist you with. So I'd like to just begin you know, noting that DYS’s number one priority is ensuring the health safety and security of our youth staff and our programs so that we can remain true to our mission which is to promote positive change in the life trajectory of the youth in our care and custody. Governor Baker's proposed fiscal year 2023 budget of $175.8 million dollars will allow DYS to continue to invest in the highly qualified staff so necessary to operate a service continuum that supports and engages youth families and communities and strategies that promote positive youth development.

Now more than ever it is critical that DYS continued to provide young people with quality education, career readiness and employment opportunities and medical and behavioral health care to help them successfully navigate the challenges of reentry reintegrating into the community. I'd like to begin by providing you with a snapshot of the DYS’s calendar year 2021 census. In Calendar Year 2021 We served 398 committed youth. We also had 564 detention admissions And we had 451 overnight arrest admissions. This is the 6th year the DYS’s average daily population has decreased. Now the decline was much, much deeper. In calendar year 2020, with the advent of the pandemic. However, in calendar year 2021, we have continued to see a decrease with a 16% decrease in the daily average number of detained youth And a 29% decrease1675 in the daily average number of committed youth.

Our average length of stay has continued to increase. It increased from 52 days. In calendar year 2020 to 65, days in calendar year 2021 as delays1688 in court proceedings have persisted Consistent with prior years. The average age of the detained youth was 16, while the average age of a committed youth was 17.8. Now DYS. Youth are served across the continuum. That is both evidence based as well as shaped by promising practices. Our state and contracted provider operated settings include 36 hardware and staff secure residential programs. Three reception centres which provide community based options to youth who have lower risk profiles. Seven independent living programs, those include pre independent living options and the good news is we were able to expand those in 2022 to make sure we had options for youth across all of our geographic regions.

We also have 21 district offices that provide community support and supervision to youth whom we have granted conditional liberty And we operate eight overnight arrest programs to assist cities and towns and local police departments with youth arrested after court hours awaiting their first court appearance. Now. At DYS, we know that are the key to our ability to maintain this continuum is a stable, well trained and well supported workforce During the last fiscal year, DYS. has prioritized the implementation of new recruitment and retention strategies to address hiring challenges we have faced created by the difficult labor market and the additional demands on staff. During the COVID-19 pandemic. DYS, has worked collaboratively with the executive office of Health and Human Services to implement exigency differential. Pay increases to attract candidates using new strategic job search strategies as well as job search platforms. And we've also worked on a recruitment campaign using social media.

Attracting and retaining a workforce committed to the mission of the DYS, remains a top priority for DYS in 2023 we know that a stable and well trained workforce is essential for programs safety. We also know the corollary is true. We know that we cannot recruit and retain staff without making safety a top priority for the agency. As many of you know, we have a longstanding safety committee that meets regularly to review data regarding our safety metrics which include the number of assaults in our programs. The use of room confinement and industrial accidents. And this committee meets regularly to develop new strategies and action plans for improving safety across our continues. I am pleased to say that in fiscal year 2021 the use of restraints in our programs declined by 26%. involuntary room confinement declined by 32 And we saw a decline in assaults of 15%.

Now we are continuing to monitor this data very closely. In particular. We're looking at the impact of pandemic stressors such as the delays in resolution of court matters and the attendant increase in the length of stay for our, we know this has a significant impact on youth and staff morale and our programs and we're watching it closely. We're also watching closely the impacts of quarantine and medical isolation on our youth and we're looking at the disruptions we've had to experience in residential pro mate programming to see how that impacts youth and staff. Now we also believe that our longstanding commitment to equity and fairness and the various initiatives that we have implemented to ensure equity and inclusion contribute to our recruitment and retention efforts.

DYS has long believed that a diverse workforce that is representative of the youth families and the communities we serve builds trust. We know that it is of critical importance that for young people to see themselves in our workforce and know that there are1910 options for them across job titles and roles. This is1913 just as important for our staff And in February of 2021 Commonwealth magazine highlighted the latest data on diversity and state government and I have to give kind of a brag alert I guess. Um DYS lead the agencies with the highest percentage of diversity in our1927 workforce at 51% With 33 persons of color in the top job here In fiscal year 2021, more than half of1935 all promotions within DYS, were staff of colour. Calendar Year 2021 also saw the DYS Training Academy pilot, a new training on race equity and inclusion, which is now included in basic training for all staff joining DYS.

This training is designed to provide staff with a shared baseline understanding of historic and current events and terminology. We wanted to ensure that staff were equipped to support each other in the hard conversations that are necessitated by current events and the lived experience of the population we serve And we are proposing a performance school that by the end of fiscal year 2023, that 90% of the DYS staff will have completed our race equity and inclusion training. We've also added additional training designed to foster team building and to provide professional development opportunities for our juvenile justice youth development specialists who are the backbone of our youth of our workforce. Many of you will recall that we recently retooled and rebranded and upgraded this role. We used to call them group workers, but we now recognize their their incredible contributions to our youth and our workforce and note that they are now juvenile justice youth development specialists.

2005 Now we focus in particular on engaging our front line staff in programming such as education because we know that education is a key protective factor for our youth that impacts recidivism and that our front line staff, many of whom come from the communities as our youth, the same communities as our youth can serve as credible messengers about the importance of education. And so while this new training initiative is part of our retention and recruitment strategies, it also highlights another one of our ongoing priorities, which is educational attainment for our youth. Youth involved in the juvenile justice system have incredibly complex educational needs as such. DYS provides individualized educational approaches to engage youth and learning. These individualised approaches have helped us youth achieve positive education and career outcomes.

In the last school year, DYS had 47 youths who earned their high school diploma. 23 youths who earned their GED or high set, That's a 83% pass rate. And we also had 58 youth who took and completed online college courses. The department also had 172 youth who participated in career readiness and received employment certifications. Now at DYS we want all of our youth to see themselves as college material and to believe that college is an option for them. But we also know that many of our youth have skills interests and talents that are much more aligned with vocational and technical education. And to that end we have now executed request for a response which we're calling our skill up our fr that will allow us to procure a diverse network of vocational service providers to work with DYS youth Governor baker's house to budget provides resources for DYS to compare this RRF Equipment purchases and the reconfiguration2114 of existing programs faces to support quality vocational education.

In addition to continuing to prioritize educational and vocational attainment. DYS is always is also continuing its full court Press on reentry supports since October of 2019, the us has received a federal Second Chance Act reentry Grant Which funds three employer outreach specialists through the same grant, DYS has also developed a strategic plan for housing stability and homelessness prevention for DYS‘s Youth. And in fiscal year 2023, the department plans to hire housing transition specialists to help you navigate housing issues during the reentry process. I'd also like to give you a brief update about our youth engaged in services program, which we can now officially claim as another protective factor against recidivism Since 2016. The youth engaged in services program or YES, program has been2170 offered to all youth discharging from YES custody. Through a YES agreement, voluntary agreement.

A youth continues to receive case management services and other transitional supports such as housing political services, continued education or job readiness training. And this is all during the that that highest risk period for recidivism, which is the first six months after discharge In calendar year 2020 121 youth representing 68% of those who discharged signed an agreement with the DYS for voluntary services. Just remember nobody ever wants to come to DYS but we have 68% of our young people asking to stay with us to provide them voluntary services to continue our engagement. We see that as an incredible uh positive choice on behalf of our2220 young people. In june of 2021, DYS contracted with the boston University Series Institute for Children and Youth to study the effects of the YES programme on2231 recidivism and I am happy to report that this study found that time spent in the YES programme was a protective factor against recidivism. In fact, the longer young people spent, the greater their their the risk was that or the lower their risk was of recidivism.

In addition to focusing on our on increasing our protective factors for young people were also devoting significant attention to our prevention mandate. Now in new and fiscal year 2022, DYS in partnership with the office of the child advocate established three sites for new diversion learning labs. These sites provide provide youth who have low risk profiles, supportive services such as housing substance use services for2271 mental health services and may2273 make it so we never see those youth in our residential programming. In conclusion, I2279 just like to reiterate that the fiscal year 2023 house two budget of $175.8 million submitted by governor Baker and secretary Sudders supports continued progress for the department of these services and allows the department to meet the needs of our current population. I look forward to working with this committee and the entire legislature in support of the DYS Core goals and objectives. And I thank you for the opportunity to testify before you today. I'm happy to take any questions that the members may have

FRIEDMAN - Mhm I have a question. Mr chair there, are you there?

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FRIEDMAN - Commissioner, I I'm a little confused. Ok, because you know, certainly we and you you mentioned it that workforce is a really serious problem and we've heard about it throughout the pandemic. We know it's still going on um you know, DYS The workforce is really strained given everything that's going on in the need and yet. I haven't heard anything about what, what the the department is going to do about increasing the pipeline or the workforce or um you know, all these programs are great but if you can't get the workforce? I don't see how we can continue to support people. So can you talk about what specifically you are doing or more importantly for us, what you need in order to address the issues of workforce.

REARDON - Thank you Senator Friedman. Yes, so senator Friedman it is a significant challenge and I will tell you we are spending tremendous amounts of energy and creativity just to really to partner with existing community resources to really try to get our name out there and to really in some ways make ourselves much more accessible to audiences that may not have considered working for us Now Right now, our turnover rate is about 18%. So we're hoping that with our strategies, you know, from the social media campaign that I mentioned as well as differential base pay increases we've been able to offer and really getting out to new um new partners for us to try to identify candidates that that will help bolster our efforts to recruit and retain staff.

I think one of the things we've learned is that word of mouth is actually one of our best sources for new new hires. And so we have2462 really been trying to also ensure that our existing workforce really feels that this is the place they want to be and really feels that they want to communicate that to their peer group, to their friends, to their neighbors, to the folks they go to the church with and all of the different, different kind of soft places that, you know, we haven't necessarily targeted in the past. So we're looking at social media, we're looking at different platforms. We know that Mass careers can be challenging for some folks to navigate. So we're really trying to get out2494 there into community message boards to other websites such as Indeed and and websites like that to really market information about ourselves.

And we're now also increasing our presence, you know, through Twitter through2505 Instagram to really try to showcase our programs, to showcase our initiatives, really try to attract a new generation of employees. But as I said, you know, we are looking at about 18% turnover right now. Uh this is actually lower than in calendar year 2020 and it is a little bit higher than the lows that we were experiencing in prior years. But you know, between the, between those strategies, as well as some incentives we've built in, like we've just shifted actually to a four day workweek. And this has been a very significant draw for some individuals in our programs. We piloted at first to see how that would work for individuals. So they have their guaranteed at least one weekend day off, which is not always true for our programs.2554 And there are many people who seem to feel that that working that 10 hours, 10 hour days, but only working for four days really fits their lifestyle and schedules better.

And it also allows us to have overlap between our shifts to ensure greater continuity and information transfer and support during those key times of the day when when we have transition periods for young people and you know, to make sure there's constantly something going on for them. We also are exploring bringing people back part time. We certainly have individuals who have left us over the years to explore other options, other career options, education. And we've actually made a campaign of reaching out to to them and also to see if they would be willing to come back to perform part time work. Because we know we've trained them,2600 we, you know, need to update their training, but that they know who we are and they know the work. And and then we also found some success there in reaching out to folks to return part time. I hope that answers your question.

FRIEDMAN - Thank you. And I I don't know how much you also are2616 looking at are advocating for increasing some of the the pay because I think that that has been historically2623 a problem for people who want to do this work, but just can't, you know, they can't live on on salaries. So, I hope that that's also part of your advocacy and your strategy.

REARDON - Absolutely. That is that is very much a work in progress right now. So, thank you.

FRIEDMAN - Thank you

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REP BLAIS - I do Mr Chair, Thank you so much. I appreciate that Commissioner, thank you for your testimony today. I was interested in your comment that the average stay has increased from 52 to 65 days and you noted twice that this increase was2674 due to delays in court proceedings or the resolution of court matters. I imagine that we share the desire to reduce the average day. So I'm wondering if you can talk a little bit more about the cause for these delays2688 and the specific actions that you've taken to identify solutions. Mhm.

REARDON - Thank you Rep Blais. So what I can say is that we've worked very closely in partnership with the juvenile court throughout the pandemic as well as with the juvenile criminal delinquency bar and the district attorney offices to really identify and get some traction on these issues. You know one of the things that happened early on is there was a need to switch to virtual hearings so that young people could continue to have court appearances and to continue to have their cases move forward. Unfortunately, substantive matters are not really suited for virtual hearings. So anything requiring testimony or evidence evidentiary hearings, those who have necessarily been delayed as have trials. And so I know that I note that trials resumed. I think it was yesterday in the courts.

And so I think that this is a really good indicator that things are beginning to move back into the normal course. However that delay in getting to resolution for young people has been a challenge. So on our end, what we've really tried to do is be facilitators so to make sure that we were facilitating virtual hearings, making sure youth were ready for those. The space was created for those confidentiality attended to. That was respected, that you've had multiple opportunities to meet with their attorneys. We never barred attorneys coming to our programs even in the height of the pandemic. We just took additional precautions to make sure it was as safe as possible and increasing the opportunities. Virtual communications with2778 attorneys so that you could continue to work on their defense strategies, all of that to try to2784 help feed that process.

And we remain in regular communication with our court partners to talk about young people who seem to have been staying longer. Uh you know, there's a whole host of very small but significant pieces of work we've done around ensuring young people can be bailed when they, when they are ready to be bailed, that we can get young people to court appearances when their presence isn't required in ways partnering with the Sheriff's and a number of different entities. So, you know, it is something that I think everybody is very mindful of and concerned about and working toward resolving, but I think it is going to still take a little bit of time and I don't know that we'll start to see decreases in length of stay to our more normal levels for at least another few months.

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DONATO - I do have one last question. And could you just outline the cost drivers for DYS and how the impact of the pandemic has impacted those services.

REARDON - So when you say cost drivers, you know, certainly a biggest percentage of our of our budget goes towards our residential programming and towards our contracts with our providers to provide both residential programming as well as uh support services within our programs such as clinical additional clinical services. And many of our support contracts provide our kitchen services are maintenance services. And so we've certainly continued to uh you know, work with our providers, we have a very tight relationship with them. Um and you know, so what we've done is continue to support them in their efforts to ensure that their workforce is supported. And you know, we also have been working uh significantly on our overtime numbers. That's over time is a very significant cost driver for us, you know, pre pandemic.

Uh it would we had made some really significant traction in reducing our over time. But what we found is, you know, as as there have been challenges with staffing that does lead our overtime numbers to creep up. So our recruitment and retention efforts are really designed to help us drive those numbers back down. We've also been in constant communication with our labor union partners working on, you know, ensuring that we have communication about our various changes in processes and uh and that's you know that's another piece of our of cost for us. They certainly have voted different increases that have, we've had to then meet through our budget. So that's another significant outlay for us and you know another driver for us is our IT. Modernization. That's been absolutely critical during the pandemic since we have had to shift to a lot of virtual modalities especially with the court.

And we've added that virtual option of additional visits for families through virtual options and also some virtual telehealth services. So we really had to that's been a really significant driver for us especially as you know parts of our workforce went remote making sure that they had the technology necessary to continue to be part of it and then you know another driver for us has has certainly been personal protective equipment, you know in our COVID response and ensuring that our staff have all of the pieces of equipment that they need to be safe in our programs, masking testing our vaccination strategies all of that. So those are are significant drivers. And I think what you what you see is that we've actually been able to really effectively manage many of those costs by right sizing our continuum, you know we have continued to experience declines in our census and so we've been very uh we've been very skilled and adept I would say at figuring out ways to re invest money that you know as we've gained from our decline incentive census to ensure that we have the coverage for those drivers.

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DAVID SELTZ - HEALTH POLICY COMMISSION - Good morning Representative. Good morning Representative Donato Senator Friedman members of the joint committee. Thank you so much for this opportunity to be able to testify this morning. I am David Selts, I am the executive director of the Health Policy Commission. Um I have prepared my testimony with a slide deck. Um so if you'll uh labor me for just one second while I pull that up um just to help guide our conversation today and we'll make sure that this presentation is available to all the members of the committee and of course the wonderful staff of ways and means that do so much in preparation for the budget. So hopefully you can see me and this background here.

Great. Um well3113 as I said really an honor to be able to testify this morning and I first just want to reflect,3118 I think as many state agencies that you'll hear from today how challenging the past two years has been. Um we at the HPC however have been very proud um to be a part of the state's response to3135 the COVID pandemic and to really pivot our work in ways that support the commonwealth response, support our health care systems response. Um and really to be able to have a3149 greater understanding of the impacts of the COVID-19 pandemic on our health care system, functioning healthcare access and healthcare outcomes and of course health care costs. Um we did this right away at the beginning in March 2020 by redeploying a number of HPC staff to help support Secretary Sutter's and the COVID-19 Command Center.

Um and that support continued in the last calendar year with daily support to the Department of Public Health on Data analysis of of hospitalizations and census within our hospitals with the goal of course of being able to3187 manage capacity across our system and ensure ongoing access to necessary health care. We've also pivoted and use the data and research and unique um skills that we have at the HPC to try to use the data to understand the opportunities and challenges of the pandemic in terms of health care delivery. And so we are continuing to prepare research reports that we release on a regular basis detailing some of those trends that we've seen and hopefully providing a greater understanding of where our health care system will go into the future.

And then finally, I'd say one key aspect of the3230 last few years and our work at the HPC has been a renewed commitment3237 and intentional action on health equity and really putting the health equity lens on all of the work of the HPC to ensure that our activities are really helping to reduce and ultimately eliminate disparities in health care access and healthcare outcomes. So I'll touch on those themes a little bit as we go through some of my slides. But first I just did want to provide an overview of the HPC and the health care cost growth benchmark, just as a reminder of who we are and what we do. So, as you probably remember, the Health Policy Commission was established almost 10 years ago in 2012 and the creation of the Health Policy Commission as part of landmark healthcare cost containment legislation reflected an ongoing challenge that we know in Massachusetts, which is the high and rising costs of health care, which creates incredible burdens on families, individuals and employers.

In our commonwealth. This slide is just showing trendlines for a number of different health care affordability metrics, employee premium contributions, total family premiums, employer premium contributions all at the top here. And you can see that those trends far exceed the pace of other trends here, shown on the bottom in terms of personal income and general price inflation. And the point here is that as health care costs increased at a much faster rate than our economic growth or income growth that just results in less and less resources available for our Massachusetts residents and creates a crowding out effect to help address this Unsustainable rise in health care costs and premiums. The landmark bill that was passed in 2012, established the Health Policy Commission as an independent state agency to help monitor the state's activities to really bend that health care cost curve and to meet what was established in law as a health care cost growth benchmark.

And this is a figure set in law that is intended to calculate the annual growth in health care expenditures. And the goal of the law was to to still have growth in health care, but to have that growth be something that could be more sustainable and affordable over time. As I mentioned, the HPC is an independent state agency. So how does that work for our governance standpoint? So I'm the executive director and I report to a board of appointed commissioners. The commissioners are appointed, the 11 commissioners are experts in their fields across a number of different dimensions and dynamics and health care and are appointed by the governor of the attorney general and the state auditor.3411 As you can see every one of the board members3414 has a particular area of expertise, as a primary care physician, as a consumer advocate, as a behavioral health expert, etcetera.

And so we meet regularly in public board meetings, um and the board steers and guides the work of the agency. Uh and as executive director along with Coleen L. Steinmeier, Deputy executive director, we run the operations and of the3438 day to day of the state agency. So I mentioned a little bit about the health care cost growth benchmark, importantly, this was a target that was initially set in law at 3.6% Uh and then was reduced um in more recent years to 3.1%. As I mentioned, it is a target, it is not a cap3459 and as I will show you the Commonwealth can exceed this target, but it was really intended as an organizing principle for both public and private action to work together to try to be able to meet this more sustainable growth rate. The HPC can hold individual health plans and providers systems accountable to the benchmark through a performance improvement plan process which will speak a little bit more about later,

Um notably with the benchmark, it there is some discretion given to the board about where that benchmark can be set, um and this coming year is the first year where the board actually has broader discretion to set the benchmark beyond just 3.1 or 3.6% and so that will be an upcoming activity for the HPC this year, I would note that are um implementation of this health care, cost growth benchmark has become a model for the country and there are now many other states that have adopted this first in the nation approach. Health care cost containment, as shown on this slide and are implementing or in the process of implementing their own health care cost growth targets or benchmarks inspired3537 by the work of Massachusetts. And finally, while cost containment is central to our work, we have a really stated commitment to making sure that health equity is embedded3551 in everything that we do. We will not be successful in our mission of advancing a more affordable and more transparent and more accountable healthcare system.

If it's only for some of our Massachusetts residents, it has to be for all. And so we have intentionally put a health equity focus on to all of our work so quickly. How does the HPC advance these different ah goals in terms of cost containment And and these are really are four rolls and I'll walk through these relatively quickly but did want to give the committee just a sense of the breadth and depth of the work that the commission does to help advance our shared goals of healthcare cost containment starting first3596 with research and reporting. Um so here, I would just note uh and and share our results over the last number of years. So this slide is just showing our state's performance against that health care cost growth benchmark as indicated in the orange dotted line. And as you can see over the course of the seven years that we have data available, There have been three years where we were below the benchmark. Uh and there have now been four years where we were above the benchmark.

So a little bit of a mixed bag in terms of our progress in meeting the benchmark and3634 I think most concerning Lee is the last two years where we do see an acceleration of health care spending prior to the pandemic, But overall, if you look across the seven years, the average growth rate was 3.5, Um and the initial stated goal in the law was 3.6% growth. When we compare ourselves and our performance on healthcare spending growth to the United States, we see that there has been progress. And so while we haven't necessarily met our own goals every3668 year, when compared to the United States, we can see that there has been some progress in being able to restrain the growth in health care spending here. I'm just showing two trend lines in commercial spending growth. So employer sponsored commercial spending growth. The orange line is Massachusetts and the blue line is the United States showing growth over about a 12 year period.

And as you can see throughout the two thousands Massachusetts was above the Blue line in terms of growth. But then you can see in 2012 around the passage of Chapter 224, that orange line now dips below the blue line and has been below the blue line ever since, resulting in billions of dollars in avoided spending here in Massachusetts. This is good news. However, there is still a lot of work to be done because the high, very high cost of health care continues to grow and create significant affordability challenges for our residents. This is just showing3736 you the cost of a family premium in Massachusetts Over a 20-year period of time in the orange bars and the average cost of a family premium one year. Family premium is now Over $21,000 in Massachusetts and exceeds the cost Of a normal a new brand new compact car. In 2019, Massachusetts had the fifth highest family premiums of any state in the United States. And again, this is essentially buying a new compact car every single year.

And this creates, as I said, affordability challenges that have impacts on health care access. This is a recent survey from last year Where Massachusetts adults reported, 46% said that they had gone foregone care, necessary healthcare due to3789 the cost of care. Um, and that three in four Massachusetts residents were worried about being able to afford health care in the future. Um, and we know from other data sets sets that when Massachusetts, adults and adults say that they differ necessary care due to the3807 cost of care, they are more likely to end up using an emergency department in a setting that maybe could have been avoided. And these affordability challenges are even more acute For our residents of colour in the Commonwealth. So taking again those same statistics which were averages on the previous slide and now breaking this down by race and ethnicity, you can see that 75% of Black residents in Massachusetts reported and3840 affordability burden 66% said that they had foregone two and three black Massachusetts3847 residents reporting having foregone care due to the cost of care.

That is why this is so critical that we continue our efforts to really reduce the underlying costs of care so that we can have more equitable affordability for all residents. Um, We have set forth in our annual report, a number of recommendations that we think can help continue and renew the state's effort to make sure that we are continuing to meet the benchmark for the next 10 years. Uh, and those are summarized in our report and happy to um speak with uh. committee members at any time about the recommendations included there. Um, moving on to3895 the watchdog role. So here we, here, I just wanted to note the role of the performance improvement plans. So, as I mentioned, the state target is an all in HPC target, but the HPC does have the ability to require individual providers or health plans to take action if warranted to reduce their own spending growth. This is a process that is quite an extensive review process.

I won't walk through all of the different steps in the side other than to say it is an extremely rigorous confidential annual process where the HPC reviews entities that have excessive healthcare spending to determine whether a performance improvement plan should be required and is warranted. I would note that this year and earlier this year the HPC required its first performance performance improvement plan of mass general Brigham. Um and that process is now ongoing. In addition to the performance of proven plans, we also track all other types of changes to our health care market, reflecting the fact that we know that healthcare market functioning and the organization of our health care system has direct impacts on access quality and cost is important and critical that we transparently track and review all of these changes and that is the role that the HPC does continuously.

Um In addition, we can also comment into the Department of Public Health uh and to their determination of need program on certain market changes that may not fall before us as a commission, but really the goals here are to promote transparency and accountability for these market changes and ensuring that they are really consistent with the health care cost containment goals of the state We have since we were established, we have reviewed over 135 market4024 changes. Um and I would note that that works out to be about one a month over the last 10 years. Um a little bit more than that, but we currently have six under review right now with a number that we know are about to be filed with us. So this is a very dynamic period of time for our health care4045 market with a lot of changes that may have significant future impacts on health care costs and functioning.

Um separate from that process, we also have a role in reviewing the value of drugs that are referred to us from the Mass health program. Um this is a program that was established by law a few years ago and we um administer this program and partnership with mass health where4073 they are able to negotiate greater rebates um with pharmaceutical manufacturers for the program. This program has been very successful to date and has generated a significant savings to the commonwealth even though there has not4088 yet been a drug referred to the HPC for a review of its value. Um this process of negotiation and transparency and accountability has been extremely effective and is one that we recommend should be expanded.

And then finally, we also note that we have a role in providing direct assistance to consumers in Massachusetts through our office of patient protection um where we directly work with consumers to help ensure that they are able to avail themselves of their rights to appeal denials of services and treatments by their health insurance companies. And4132 also just as a hotline that we run and and help steer and navigate patients who may be confused or Having difficulty navigating are very complicated health care system. And last year we received about 1300 phone calls to our, our daily hotline um in the role of partner. Um We work directly with provider organizations through a number of grant programs, many of which have been supported by the Legislature in recent years. Uh there's there's a lot4168 here in the history of our our work and doing innovative grant programs.

I'll just highlight the two most recent ones. Um the cost effective coordinated care for caregivers and substance exposed newborns or C4SEN. Unfortunately, the sad truth is that during the COVID-19 pandemic are opioid epidemic has not abated and continues to have a significant impact across the Commonwealth through this grant program, we're providing support to a number4199 of provider organizations who are working with newborns and their families to help provide support beyond the hospital stay and to really extend those supports into the postpartum period of time for those newborns who4217 have been exposed to substances while in utero. Um This was originally funded by the state legislature through the4226 state budget with a $300,000 earmark, we were able to redeploy uh some additional funding to make this an even greater program.

So thank you legislature and the committee for your support and providing that initial funding. Um The other one I'll mention here is our birth equity and support through the inclusion of dual expertise or beside program reflecting the4250 fact that maternal mortality um and poor maternal outcomes are much disproportionately greater for our black burning people of the commonwealth. This is a program that we are working with a number of provider organizations to help support the inclusion of doulas into the care and treatment of black burning people as a support to be able to reduce avoidable harm. Just to show you where these projects are located. This is the C4SEN awardees across the commonwealth working with a number of institutions. Um and then the beside program just to institutions based state and boston Medical Center. Again, this was a $500,000 earmark that was included in the state budget led by you the legislature. So thank you again for that support.

And we're continuing to administer these grant programs into FY23. Finally, our last role that we play to4312 try to advance this work is as a convener. As I mentioned, we conduct all of our meetings, board meetings in public uh and also have a number of events throughout the year to bring stakeholders together to discuss the challenges of health care, cost containment and to help chart a path forward. Most notably, we hold an annual healthcare cost trans hearings, which is our signature event now in the fall um and have used this as an opportunity to bring leaders of our health care community together to discuss the challenges of both a post COVID health care system as well as a healthcare system that is really focused on healthcare equity. So what is next for the Health Policy Commission?

Um We have a lot in our place this year. As I mentioned, we are very busy across a number of different dynamics. We will be overseeing our first performance improvement plan in the coming calendar year. We have a number of reports due to you the legislature on the impacts of COVID, Specifically on the use of telehealth as well as the impacts of COVID-19 on our health care workforce, a very important topic. Um We are continuing to monitor all of the healthcare mergers and consolidations um and will continue to make the investments in programs as mentioned on the previous slides. Ah just sharing here. We have a number of reports that have been recently filed with you. And are available on our web sites. Most recently wrote a report on Children with medical complexity which was just filed very recently and a number of other publications as shown4416 on the left side of this slide and on the right hand side of the slide.

You can see that we have a number of upcoming publications4424 due to you and the public as well. And then finally upcoming. Soon next month we are planning to hold a hearing on the health care cost growth benchmark and we conduct this hearing in partnership with the joint Committee on Health care financing. So I look forward to that important event on Wednesday March 16th. So with all of that as background, I did want to conclude my testimony today with our humble request for our budget for fiscal year 23. So one important thing about the HPCS budget is that it is set every year by the state legislature and signed by the governor in the GA. However, that amount is actually billed to our health care, acute care hospitals and our health plans um and and revenue was collected in that amount and deposited in the general fund to help support the cost of the HPC. So from a budgetary perspective from a state budget perspective, the HPC holds the state budget harmless and does not cost the general fund revenue.

Again, the numbers set and we assess acute care hospitals and health plans for that total amount. We are requesting humble increase of 3.5%,4508 really just an annualized increase um to be able to support all of the activities that I've, I've over viewed as well as some of the expanded enhanced activities that we know have already been uh required of us. Um specifically on, on4526 reporting on the COVID-19 impacts as well as our implementation of the first performance improvement plan. I would note that there is a lot of activity on healthcare reform legislation currently on Beacon Hill. This budget request does not reflect what could be and is likely to be additional resources necessary if any of those bills that are both currently pending before the House and Senate were to be passed into law. And so at that time I would um may seek to come back to this committee and back to ways and means with an additional request at such time as perhaps one of these bills is passed into law.

And I would just you know, we have really tried to be an efficient organisation and to execute at a very high level on all of these activities with a tremendous, Tremendously talented and dedicated staff. And as you can see, this is just showing RFD levels over the entire history of the HPC. And for the4594 last five years we have been very stable at around 60 employees who do incredible work and and just really a testament to the quality Of the staff that we've been able to hire and retain over these last 10 years. So I will conclude my remarks there. Thank you for indulging me with the power point. Um I will do my best to try to remove this screen um and return us all to this team's room and happy to answer questions or um take feedback on anything that I just presented

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DONATO - Thank you. Commissioner. Part of You point out that $21,000 is the escalated the cost of health care today4669 and part of that is pharmaceutical and drug drug costs. And you were given new authority to uh to4676 to work on that. And can you provide us what the HPC has a utilized their funding to do with this new authority?

SELTZ - Sure. So the new authority that we received a few years ago is really um tied to mass health negotiation of of supplemental rebates. And so the way that the process works is that Mass Health has engages in a negotiation with a pharmaceutical manufacturer. Um and there is a back and forth around um that manufacturers being able4711 to provide additional rebates or essentially revenue to the commonwealth to offset the cost of the drugs and the Mass Health program. If those negotiations are not successful, the Mass Health can then refer drug to the HPC for an independent objective review of the drugs pricing in relation to its value. Um as I mentioned before to date, we have not yet received a referral from mass Health, but that is not to say that this process has not been working. Um The Mass Health has been able to leverage this process and I will defer to them to give you exact numbers um but has leveraged this process to be able to garner significant um rebates for the commonwealth for the4759 state budget uh and the Mass Health program as a result of this process. So this is, we have been able to stand up4768 our role here.

We do have staff that have been working in preparation for when we would receive our first referred drug to us. We spent a lot of time developing regulations and setting up the framework for that. So we are ready to go should we receive a referred drug? Um In addition, there is legislation that's being proposed that would expand this authority of the Health Policy Commission so that we can more directly impact not just drug pricing in the Medicaid or mass health space, but really in the entire healthcare market. And thinking about the challenges that drug pricing has on uh families and individuals and employers in4811 the in the commercial and employer sponsored space. Those legislative efforts are underway. Um and uh and we do recommend in our policy recommendations that the legislature do expand our authorities so that we can more directly be able to influence the drug pricing trends. Representative that you noted are contributing to higher health care costs.

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FRIEDMAN - I don't know you are. I don't have any questions. I thank you for all you do and appreciate your willingness to have us push all the hard questions of health care to you to come back and tell us the answers. Um but we will be looking really closely at um what the legislature both in the House and Senate are proposing4869 because we do know that that will have an effect on your um budgets and um and so we are cognizant of that, but just thank you. It was a great presentation.

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DONATO - One last question. When you indicate that you monitor the pharmaceutical drug, drug prices through mass health, uh and Medicare, do we navigate uh those two agencies toward generic uh drug pricing versus the the pharmaceutical pricing?

SELTZ - Um I would say broadly that yes, that is certainly one of the strategies, um Massachusetts, and I can get you the exact sabot Massachusetts is one of the highest4930 states in terms of of generic the use of generic drugs. Um and that is um, you know, a key way to be able to ensure, you know, the effective medications are there um at a lower price point. Um and so generally, yes, one of our key strategies. Okay,

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4994 TONY WOLF - MASSACHUSETTS REHABILITATION COMMISSION - Good morning. I'm Tony wolf, as you said, the commissioner of the Massachusetts rehabilitation commission. It's delightful to see you. Uh and I want to acknowledge Vice Chair Donato and Senator Friedman, nice to see you senator uh and distinguished members of the joint committee on Ways and means so thank you for having me. Um, I'm honored again to appear to you to speak about our mission, Our5021 priorities and Governor Baker's house to fiscal year 2023 budget. Um as we all have5029 heard, uh we have all survived COVID-19 the pandemic and in this time MRC particularly has really been strategic and adapting our services to break down the barriers and empower individuals with disabilities to live life on their own terms together with stakeholders, partners and allies.

MRC has collaborated problem solved and innovative to bring about a better Massachusetts for everyone. 11 that is totally about uh equitable, inclusive and accessible and I want to, you're going to hear those three words often. Um but I think it's really something that MRC is totally embracing and With Governor Baker's proposed budget of 78 million. Um, it will allow MRC to continue to recruit, retain and train our dedicated workforce, fund effective services and programming, make strategic investments in service models and expand what's possible in the lives of people with disabilities. Our programs focus on training, employment, community living and disability termination for federal benefit programs, MRC’s vocational rehab division prepares individuals to take on the modern workplace together with public colleges and universities, professional training5120 programs and employers statewide. We have partnered with individuals to expand what is possible in people's lives and careers.

Our programs give individuals the opportunity to explore many industries and sectors so that we with them can find what's5138 best for them. We guide and support employers all right to really make sure that their environment is accessible and inclusive for all our community living Division addresses the diverse needs of adults and transition age youth by providing housing a set of technology, home care supports and Employment Day services if someone's ability to work due to their disability is limited. MRC’s, disability determination services funded by SSA Social Security Administration is here to make sure they get the benefits they need to build a more independent life governor Baker's proposed budget will enhance the needs of individuals with disabilities, including additional supports to independent living assistance.

Home care assistance for individuals with progressive and severe abilities, medical conditions, individuals with traumatic brain injuries through the statewide head Industry program and assisting individuals with physical disabilities, transitioning out of high school With the goal of living in the community as we call turning 22 program. In addition, this budget will also transfer funds from the Department of Mental Health Two MRC to allow us to5226 continue serving individuals with mental health conditions in achieving their employment outcomes. And just to give you some a little bit of data, so you have some scope MRC served 21,357 individuals through RVR services programs, assisted 13,000 individuals through community living services. And determined eligibility for 59,000 individuals through its disability determination services Despite a high disability unemployment rate across the Commonwealth. In FY21, 2727 individuals with disabilities were successfully placed in competitive employment.

Uh and we have actually totaled their salaries to give you some sense of impact together collectively total $67.6 million dollars in their5280 first year of employment. I think that's a true example of investment. Um, I also want to take a little bit of time to highlight some things for you in terms of what has been achieved this year. And for I just need to say, we see ourselves at MRC as a change agent and community builder for too long. People with disabilities have faced social and physical barriers in their path to independence and self determination.5309 Over the past year, we have partnered with several allies and organizations to innovate and transform our services for job seekers. I think we all know these days, we spend lots of time online. Uh we're all constantly pushing our mute button and5325 not a mute button. Uh and yet5327 we also wanted to make sure that our services are accessible to5332 everyone.

Therefore that's why we built an MRC very similar to what you heard5338 about with DTA, MRC connect. It's a virtual gateway that connects people with all our services and programs they need. And I just want to remind people that in the past, people used to have to go to different offices, different programs to be able to access services. Now there's one front door and that's MRC connect. It gives people the opportunity to complete a single online application connecting individuals to a broad range of services for training, employment and community living and a staff member is there with every5373 individual, every step of the process, whether that's by phone or whether that's online. Since its large lunch MRC connect has been able to support over 15,000 individuals and just this past month Through our call centre just5390 gives you an idea of that. We received 500 calls. So again, it's really an opportunity5396 for people to access services to find out what's going on at MRC and to really be able to look at the services that best suit their needs.

We've also partnered with Roxbury Community College and Holyoke Community College and Cisco to host what we're calling the MRC Technology Academy program. This program provides individuals receiving service from MRC. The opportunity to be trained in cybersecurity and earn a certificate from Cisco. Now, let me just say that has been a nine month program. Uh, so people have been incredibly committed and we've also been able to provide stipends along the way to make sure that people stay engaged in this academy and also successfully graduate. We're really pleased that the cybersecurity labor market offers the beginning salary of 60,000 a year. And the average salary our program participants have earned is 75,000 a year. So again, it's not just about jobs, it's about careers. Um, we also recognize the critical need for access to technology during the pandemic and and also to help what we're calling social isolation that people have experienced. So we were able to identify and deploy more than $13.6 million 3.7 million to purchase more than 12,000 pieces of technology.

So again, we were mindful of the digital divide and wanted to make sure our consumers had the equipment so that they continue to provide services and really be5499 able to excel in their life. Federal legislation including the rehabilitation act,5504 the americans with disabilities act and most recently the workforce investment and opportunity to act. Have all mandated employment for people with disabilities. Yet it's not enough. And so we are mindful that not everyone has employment opportunities and we want to make sure that that changes national data on disability employment races and raise, paint a grim picture, especially for young adults and those living with intellectual and5535 developmental disabilities. Just5537 to give you some idea of the comparison according to the5541 US Department of Labor.

The labor force participation rate for persons with disabilities is currently at 19.9 Compared to 66% for those that do not have a disability. This is particularly acute with our young adults 20-30 years old with a disability, only 44.2% have been employed, compared to 70%5567 of the same age group Among working age, 21-60 for individuals with intellectual disabilities, only 44% are in the labor market compared to 83% of those disabilities. This past november. Um I have, I'm really proud to say that MRC was awarded a very competitive grant nationally and it received 17 million innovation grant from the federal rehab Services administration in partnership with Massachusetts club Massachusetts Commission of the Blind and the Massachusetts Commission of the Death and hard of hearing.

Um The goal of this program is to really be able to focus on youth what we're calling next gen careers. It is a new innovative approach to assist youth with their careers. Young adults with a disability between the ages of 18-30 will5623 be eligible for this service. And again we're looking at underserved populations um as well as folks from that have developmental disabilities, autism spectrum disorders. Century disabilities. Uh and we're very mindful that5641 we need to serve black and latin X populations. So this grant, in addition to a new model design will be very aggressive in terms of community outreach and really provide a different type of community outreach to make sure that we reach diverse populations. Um again, we believe that we need to amplify our collective voice and to do that means that what we do first and foremost is really make sure that the person is at the heart of everything we do.

Our goal is not just to deliver services. It's to empower people to live life on their own terms. The goal of the department this year that we've been able to create is called the Office of Individual and Family Engagement. This is particularly mindful of making sure that individuals with disabilities are part of the co creating that we're doing here at MRC. We have hosted listening sessions, learning forums with the disability community resulting in connections over 600 individuals just this year alone. And the goal is continually helping people know about our services and connecting with them and hearing what's working and what's not working for them. In addition, we have also created a quarterly newsletter Distributing to over 15,000 individuals to inform them about our services. And lastly, as I5727 said again in our desire to5728 develop innovative services, we need to do that in5732 the co creation approach and therefore we have hired and have what we're calling disability inclusion leaders.

So that is individuals with5741 disabilities and family allies who are at the table who are engaging in spaces where decisions here and a mercy are being made to make sure that we embrace5752 their knowledge, their diversity and their expertise. I want to also say that very similar to DTA were very proud of our partnerships with our5761 state agencies and we have partnered with with DTA. Um with a program called Empower to employ uh and this is an opportunity to really be able to support DTA. And MRC shared consumers providing them employment supports. We see ourselves at MRC as experts in terms of serving people with disabilities and it's a great marriage with D.TA Lastly, as I mentioned with the FY23 budget, MRC will receive 4.6 million to support the Department of Mental Health adult Community Clinical services in employment partnership last year we were able to Continue this work and we've exceeded our goal by 34%. And assisted 1740 for individuals.

And this is during the pandemic. I do want to say that. So it's really important that with this incredible engagement of our services, we're seeing people staying connected to MRC and working in the community. We have specialized VR counselors specializing in mental health that partners with A CCS providers to really be able to together work with the individual to find out what type of employment they want and how best we can wrap around services to support them. Our community living division has played an intricate role in providing support for individuals pathway himself sufficient through our waiver program, 1000 79 individuals were moved out of a nursing home just this year and 177 individuals5862 received modifications um to be allowed them to transition from the institution to their home. Um And I want to again state that we know that this has been incredibly challenging for all for all our nursing homes and to be able to have again this opportunity to really move people out of the community out of the institutions into the community is essential.

Our waiver progress, staff supported nursing facility staff in completing 800 applications. All right. And again, we have also provided access to food, shelter, transportation, medical care are infamous. PP All right. Um5902 and we've been able to our with our independent living centers. They have successfully on top of what we have achieved transitioned 178 people from the nursing homes into the community. I also want5917 to recognize that in september the joint motion for dismissal in the Hutchinson versus Patrick was approved. The judge recognised that there's been enough and significant system change and that the efforts of the commonwealth have changed the world for individuals in nursing facilities with those that have acquired brain injury under the leadership of the OHS. And in collaboration with our sisters agencies? DDS. And Mass Health MRC was deeply invested to finalize the Hutchinson settlement.

So in closing it's been a while, two years and we all can say that, but MRC has truly navigated the pandemic, We've been resilient and I'm very proud of our staff. I can say that with a great deal of pride. In addition to promote promoting and providing remote and in person services, our workforce has led extensive efforts5973 for individuals residing in institutions and we know there's more to do and we are very committed to making sure that those individuals have community access. And lastly, I want5984 to say that we really see ourselves as agents of change in people's lives. We bolster and build better communities and put the people we serve at the heart of everything we do. So in closing, I really ask you to support uh the FY23 House two budget of 78 million. I want to thank the Governor and Secretary Studies has been incredibly supportive to MRC and I thank all of you in your equally in your support. I am incredibly grateful to everything. So I'm hoping open to any questions or thoughts you may have.

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DONATO - I have one question and that is, could you explain the funding increase for the vocational rehabilitation services and vocational rehabilitation rehabilitation specialists that MRC will be contracting with the DMH?

WOLF - Yes, that's the money that we mentioned that we're transferring over into. So the money was at DMH and now it's actually coming into our base at MRC. And that has provided 21 specialist counsellors that have a combined expertise of vocational rehab and mental health and supporting those individuals that live in the adult community programmes of DMH. So it's really a partnership we really share with DMH and MRC, a shared mission of making sure that individuals have access to employment services so they can thrive.

DONATO - So this is a service expansion. And should we see this expansion in the future as well?

WOLF - We hope that's our plan. That's why it's actually been put into our base. It was uh, an understanding with the DMH. That it was through an ISA. For the last two years where we together monitor outcomes, really pleased with our outcomes and our metrics and therefore it's in our base this year.

DONATO - Well, we thank you for all you do for MRC. It's really been a pleasure working with you and uh, I'm a member of the board of directors,6130 as you probably know of Triangle Link and they have been there and have been there for a number of years and we've navigated to instead of doing work in the facility? We have done exactly what you advocated and that is bringing our clients out into the workforce and it has been very successful. So we thank you for your advocacy.

WOLF - Thank you and thank you for all that. You do.

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OPEOLUWA SOTONWA - MASS COMMISSION FOR THE DEAF AND HARD OF HEARING - Vice chair Donato, Chair Friedman and honourable members of the Joint committee on Ways and means. My name is Dr. Opeoluwa Sotonwa and I am the Commissioner of6227 the Massachusetts Commission for the deaf and hard of hearing, otherwise known as MCDHH. It is an honor to be here with you today. Thank you so much for the opportunity to come before you and respond to questions about the Governor's FY23 budget. I want to thank Governor baker secretary centers and each of6249 you for your support of MCDHH. the new funding included in the Governor's budget represents an important investment in our community. MCDHH Is responsible for6263 providing communication access throughout the commonwealth.

MCDHH. Provides American Sign Language English Interpreting Services otherwise known as ASL and Computer Assisted Real Time Transcription referral services, otherwise known as CART. This also includes 24/7 standby referral for press conferences, referral for court and legal proceedings, quality assurance, communication, access training and technical assistance. Additionally, MCDHH Provides case management and independent living services. MCDHH. Partners with sister agencies and community entities to increase accessibility and improve the quality of existing and new services throughout the commonwealth. two individuals who are deaf and hard of hearing As you know MCDHH was established by Chapter 716 of the Act of 1985, Which amended the Massachusetts General Laws. Chapter six, Sections 191-197.

Last year we started the celebration of 35 years of service throughout the Commonwealth. Our hardworking staff provides the commonwealth with the resources it needs to serve deaf hard of hearing and late deafened individuals and insensitive range of human services, healthcare, safety, legal education and economic settings And to provide6361 accommodations that are required under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. I'd like to talk now about the fiscal year 2023 Outlook. The house two proposes $8.6 million dollars MCDHH operations Which is in line item 41250100. The House two budget recommendation is 1.4 million Or 19% above MCDHH’s FY22 General Appropriations Act. We are grateful for this increase because in addition to maintaining MCDHH programs and services At the FY22 level mhm FY23 Recommendation will continue to fund the implementation of our new Interpreter Referral Software and other6423 IT.means.

Included in this budget recommendation is a new chargeback account with a ceiling set at $6 million dollars per fiscal year. This will centralize billing for freelance American Sign Language interpreter services and for CART services across the EOHHS. Agencies. This will help facilitate timely payments for our valued independent contracted communication access providers to provide additional incentive to resolve the dwindling pool of available interpreters throughout the commonwealth and lead to increased service provision. The governor's recommendation will also provide funding for core human services in interpreter and current referral bilingual case management and Children's services, communication access technology and training services and special projects coordination.

In addition, and hard of hearing Independent Living Services otherwise known as HHILS Will be funded with $2.2 million. This figure is the result of the implementation of the Chapter 257 rate. Mhm. Now I'd like to address are critical priorities for FY23. For FY23. MCDHH6513 is focused on the following. We will be leveraging the celebration of the MCDHH’s 35th anniversary to take stock of where MCDHH has been, where it is now and where it needs to go to6535 meet the current needs of the diverse communities we serve through collaborations in strategic engagements. We will also be continuing our close work and our close working relationship with Konica Minolta Business Solutions. Otherwise, KMBS create a fully modernized interpreting referral system and to shepherd that project to a successful conclusion. Using the referral modernization project as a jumping off point to review and analyze the referral departments workflow, reorganizing that department as needed and6576 partnering with EHS and others to come up with innovative solutions to meet6583 the critical needs for after hours, emergency services and staffing for governors in the governor and mayors vital press conference requests.

We'd6600 also like to make inroads into our communication access services, divisions, workforce development programs to lay the groundwork for building6611 a pipeline of communication access providers with the goal of developing a stable communication access workforce and significantly increased in both sides and diversity. One that is reflective of the communities we serve. We're also seeking to continue providing critical communication access services for our constituents for their vaccination, appointments at clinics, vaccination sites are pharmacies and health care providers offices across the country will also continue to pursue collaborations and partnerships with sister agencies, some of which have already led to an increase in both hours of service provision for our deaf blind constituents as well as an increase in linguistically and culturally competent services. Our colleagues at MCB, now have signed fluent case managers who can communicate directly with deaf blind people via video phone, as well as ensuring that deaf blind constituents6684 have access to in person interpreting services.

We also seek to continue to address the need across the commonwealth via our Department of Case management for linguistically and culturally competent, directly provided mental health, social and educational services, as well as critical services that intersect with the court and the legal system. We'll also continue partnering with the Massachusetts rehabilitation commission and community Partners to increase visibility. Accessibility and opportunities for people who are deaf hard of hearing. Deaf blind and oral deaf people in vocational settings will also continue providing support to the deaf and hard of hearing. Independent living services. The deals programs From an allocation of $2.2 million Chapter 257 according to contracts signed with each provider is listed by region. Still services are provided in eight geographic regions to a total of 4,568 clients, including information referral advocacy, skills training, emergency intervention, peer mentoring and community based assistance.

We also provides services to Children and6773 adults through our social services and case management department, 70% of whom are on mass health. We also separately provide substance use disorder services via our partnership with the Department of Public Health and the Bureau of substance addiction Services. We will also look to expand our trainings provided to law enforcement offices, fire departments and emergency responders by our communication access training and technology services department, otherwise known as the Cats Department, which served over which serves over 5000 people annually. I would like to talk about our chargeback funds. MCDHH. Will continue to collect revenue from communication access services provided by our staff interpreters. These6842 funds are reinvested to protect and stabilize communication access in situations where there is no other responsible entity.

Our line item 41250122 Records chargeback revenue with a ceiling of $450,000 revenue6859 collected has been lower in the past two years. We attribute the decrease in revenue to a sustained pandemic caused change in the market dynamic for interpreter services, resulting in6873 a shift to remote services and an overall drop in requests for outreach and trainings by our communication access technology and training services department and advocacy services by our case management. Additional revenue charged as fees to other public and private entities for interpreter services are collected under our expendable trust 4125 0104. All revenue is generated and reinvested as follows, contracted interpreters to increase availability to meet interpreting demands from state agencies, courts and consumers, workforce development training to increase existing interpreters, skills for work in medical and legal settings, interpreter and card services to constituents in situations where there is no funding and or no other responsible entity and interpreter for inter agency meetings or collaborations where communication access is not otherwise funded.

In conclusion, the governor's FY23 budget ensures MCDHH. Will remain fully committed to our priorities which are accessible communication, education and advocacy to consumers and private and public entities so that programs services and opportunities for health care, independence and resilience are fully accessible to deaf and hard of hearing, adults and Children in Massachusetts We at MCDHH, look forward6976 to continued collaboration and partnerships with the legislature and our constituents. Thank you for your continued support and for this opportunity to testify on behalf of the Massachusetts Commission for the different heart of hearings. FY 23 budget. I'm happy to answer any questions at this time that you

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DONATO - I have one question. Could you outline for me? The main cost driver drivers for the MCDHH A year over year and how the pandemic has impacted those services you wanted to provide?

SOTONWA - Mhm. Thank you so much. Vice Chair Donato Obviously the pandemic has had a great impact on many of the services that the EHHS provides, including MCDHH. The communities that we serve are equally diverse. We have people in7049 our commonwealth who are considered culturally deaf people who are hard of hearing or late deafened people who are deaf blind or oral deaf and all each unique group has individual communication access needs, so with a diversity and needs, we need to have a diversity in service and as you can imagine for people who really depend on lip reading, wearing masks has been incredibly prohibitive and maintaining effective communication especially when in person.

So having things moved to an online platform offer some relief, but many people are not able to afford internet wifi services, there is the technological divide that impacts our community as well. However, MCDHH has been very creative, we found many different approaches and ways to connect with our communities. We have had some in person meetings and we've also worked very closely with are deaf and hard of hearing, independent living service providers who are out there working with grassroots communities. So we have been instrumental in helping finding additional funding and monies for our deal services to continue to outreach to the deaf and hard of hearing.

Late deafened oral deaf community and that includes helping to secure communication access as well. You know, many of our7145 staff interpreters have been providing in person interpreting services out into the community but with the pandemic, their ability to travel long distances and interpret in person was severely cut due to the pandemic. Therefore are chargeback account also suffered7161 a fiscal hit as well. I'm sure that we're not alone in our experience in managing the pantomime. I guess my sister agencies have already testified, but I do think that with the resilience and the creativity that MCDHH staff have brought to the table and their willingness to really dig deep and find ways to connect with the community. We've been able to maintain successful relationships with our community and I hope that answers your question.

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DAVID D'ARCANGELO - MASS COMMISSION FOR THE BLIND - Morning to all of you. I hope you're doing well. I hope you all staying safe and well. Many thanks to you. Mr Chairman, Senator Friedman the rest of the committee, All of my colleagues here today. It's David D'Arcangelo lo from the Massachusetts commission for the blind. I'm very pleased to testify today. I think you have gotten our memo so I won't be too redundant. But I do want to emphasis that we are very pleased with the Governor's budget7266 and Secretary Sudder's leadership. We've had a very challenging couple of years as everybody knows, but we've managed to get the job done. There certainly have been challenges and we've made our mistakes and are not perfect. But as we've talked about many times. Mr chairman, well I value and appreciate the work that you all have to do as a former legislative aide. I think you taught me well that the numbers only go so far.

We're dealing with people and families here and particularly people who come upon blindness. It can be very challenging and there can be real suffering there. And so I just want to start with thank you to my team, the workers at MCB. From our executive committee all the way through our entire staff. That really has done a great job and risen to the occasion during a very challenging times of COVID as you know, our service delivery model traditionally has been based in the community, mainly in Homes sitting at people's kitchen tables and when our counselors have been inhibited by doing that because we're trying to keep everybody safe as a result of the pandemic. That's been very challenging but again with creativity resiliency really perseverance on our consumers and our teams end, we have managed to continue the services flowing and gotten success from it.

So There are three main accounts are are social rehabilitation services, are vocational rehabilitation services And then are deaf blind extended support services are turning 22 accounts additionally, we have taken Extra effort this year to try to make good on the legislature's wishes and7383 the $850,000 earmark for assistive technology services dedicated to seniors. We're working our best to program that money and get it out the door this fiscal year. There's been a little bit of a challenge there because7399 I think as we've discussed previously Really, job one for us is getting our consumers accepting of the services and and having them adjust to blindness. Once we are7414 able to do that, we're then able to administer the services and many consumers that we say, well let's get you try to using some of this technology at first they're very resistant. T

hen, you know, if we can get them to use the iPhone we can't pry it away from their hands after that. So, but it's really getting in their building that relationship and trust, then getting the training and services flowing so that they can become as independent and self determination, as self determined as possible. So with our social rehabilitation services, I think we've been mostly successful and we have adequate funding there I think and the assistive technology has definitely helped. We've upgraded a lot of our older technology, our team over the years has done a great job of repurposing technology whether it be a hand held magnifier or a desktop magnifier, whatever7481 the case may be. We've done a good job of tagging those and when people are completed with using them, getting them back and then repurposing them. So now what we've been able to do is retire older machines, so I don't think there's any more black and white machines out there now they're all in colour.

That's a good thing. Many more handhelds are out there in the community. That's a good thing. So I think we've been successful the support groups. Now we've worked with our vendor community and our stakeholder community, whether it be, I'm Abbvie or local association or sight loss services, the Carol Center for the blank, all of the great organizations that we work with, but to get the services out there into the community, many of the support groups have been meeting virtually, which again, if you, if we had said that before the pandemic, hey, we're just gonna, we're gonna meet on a zoom meeting, I don't think you would have had much participation, but now we've actually had some really good participation, which is a good thing. So I think when we do get back to more we have been in person on some limited basis, but when we get to more widespread in person, I think many of the things that we've been able to learn from COVID will7569 benefit our community and will benefit our consumers.

7572 So there are some7574 silver linings. You know me, I like to look on the positive as much as possible. So that's a good thing transitioning over to vocational rehabilitation. We've had great success story there, many of the traditional barriers that have inhibited people with disabilities and particularly people with blindness such as transportation to certain employment opportunities. Well, many of those can be ameliorated now, just like we're doing here with zoom or teams or other electronic means. So again, a little bit of a silver lining there is we've seen some success there remote and virtual participation and employment that maybe didn't exist before so long term. I think that's a real opportunity for our community and we continue to work on that and refined that. So that's I think generally a good thing. Our numbers are very strong there.

We were one of a few states to really show gains and we showed significant gains last year and then this year were slightly down, but I think we're we're going to be on Goodpaster to gain most of that back because the larger uh employment situation is tending to benefit people with disabilities.7646 We we I tune in regular to to the national end tied call and people with disabilities. Both the labor participation rate and the employment to population ratio have improved and that is a good thing. So we continue to work there again with the success of our team and community. We're getting it done in some way somehow. And then finally in are deaf blind extended support unit. Uh, The numbers that we show support all the 257 increases.7673 And as you know, that program is very sensitive. It's a discrete program meaning though the universe of consumers is not very large. So when a consumer or to come in or out of the program that can really impact the budget flows in that program.

Unfortunately, somewhat recently we've lost some of our long term consumers out of that program. So we're now trying to reprogram dollars as best we can to get those out to the rest of the community. But I think you'll see by7713 my testimony that we submitted, we've had so many great events with our community, really trying to get out there and let people know that the services are there for them and that we as an agency are there for them. So ah there were two to earmarks. One I mentioned was the assistant technology. The other one was for the tech and affiliates we now call them the MAIN network, the Massachusetts Audio Information Network. And I'm very pleased that I know many of your colleagues here got to join us. We had a great volunteer appreciation for them for the great volunteerism that they provide for our consumers, the community and really the commonwealth.

So we were pleased to acknowledge them and you know, I'm sure that we might get some questions about that as well as I know they have lived from earmarked to earmark. I'm open to whatever solutions you all want to talk about if there is a long term uh prospect there. I really believe in the service, I believe in the volunteerism and the organizations for adjusting to the pandemic. I think they were very helpful with helping us get our message out during COVID when many things were closed, they were still open. They were still reading the news and reading the the periodic ALS and things and7799 helping us get our message out to the community. So I value them. I appreciate them for their service. So really here to answer any questions. Have a dialogue with you all and let me know how we can be of service. We're trying our best. I think we're getting it done. There's some challenges but there's been many opportunities to so7820 thank you.

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DONATO - Commissioner. I want to let you know that you'll be proud to know that Carl Richardson keeps the legislature and the staff informed about MCB. And uh, if there's any questions that the members have Collins they're ready to answer and bring the information back to you. So thank you once again for your testimony and have a wonderful afternoon.

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MARY7858 TRUONG - MASS OFFICE OF REFUGEES AND IMMIGRANTS - Good afternoon. Um, Vice chair Donato Vice chair Friedman and members of the joint Committee on Ways and means Committee. I would like to extend my heartfelt thank you to each and every one of you for the opportunity to address you today and to be able to answer any questions you have7879 for the office for refugees and immigrants. Uh, fiscal year 2023 budget. I also like to take this opportunity to thank governor Baker. Uh Lieutenant Governor Polledo and Secretary Sudders for the proposal of over $1 million in state funding in fiscal year 23 to continue to support for our citizenship for the new American program known as Sena Um, which will provide services to more than 2000 refugees and immigrants.7906

Uh, this appropriation We also support our financial literacy for newcomer program uh, to provide a much needed7911 financial training to 300 newcomers. And so with your help, we can continue to make an impact on people's lives. The data from last year in fiscal 21 Uh, fiscal year 217927 show how your support had helped many of our refugees and immigrant clients. Uh, synapse services provided to 3687 Massachusetts residents Through our eyes network of 18 providers across the state, including the Cape and the islands. In addition, We have conducted a total of 92 online financial literacy workshop uh, serving over 450 refugees and immigrants in Lynn in Dorchester High Park, West Springfield, Worcester at a borrow Lauren and new Bedford With the support of 10 financial literacy service providers And 16 subject matter experts. So thank you very7969 much for supporting those two programs.

ORI has been working diligently also to implement the $20 million earmark received as part of the fiscal year 22 American Rescue plan act spending bill This $12 million Afghan evacuees. The fund will be distributed shortly among the resettlement agencies that hold our refugee case management contracts. So the remaining eight million is earmarked to support the ORI immigrant and immigrant family services institute known as gypsy Which will assist eligible Haitians who arrived to the us8016 after July 29 of 2021 ORI is finalizing the contract with IPSY and funds will be available to them to you shortly as well. So in closing, I would like to say that it is an honor to continue to work on behalf of the state to integrate newcomers to the commonwealth. So with that if I may answer any questions that you have, Thank you so much.

DONATO - Thank you. Uh, the level of funding is that enough to continue to serve the Afghan and Haitian immigrants through fiscal 23.

TRUONG - Uh, yes. Vice chair Donato The resettlement agency8075 has been very appreciative of this funding to support them for the first time from the Governor's and the legislators.

DONATO - Are we anticipating any further immigrants from Afghan and Haitian and Haitian refugees in the commonwealth of Massachusetts?

TRUONG - Yes, we will continue to welcome these newcomers into the Commonwealth. So, as of last week,8097 according to the Department of State, we already welcome in Massachusetts about 1725. And we're projecting that the resentment agency, I will close the fiscal year serving 2000 of the Afghan evacuees alone.

DONATO - So we're prepared to help them settle in the commonwealth?

TRUONG - Yes, yes sir.

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CHERYL POPPE - MASS DEPARTMENT OF VETERANS - Good afternoon. Vice Chair Donato and Vice chair, Freeman and esteemed members of the Joint Committee on Ways and means my name is Cheryl Lussier Poppe. And I am honored to be serving as the Secretary of veteran services for the Massachusetts Department of Veterans Services. Today, I am joined here by8167 Superintendent Eric johnson. The Soldiers' Home in Chelsea, an interim Superintendent, Michael Lazo of Soldiers' Home in Holyoke. And I want to thank very much The members. Uh, the chairs and the members for the opportunity to address you today and answer any questions you may have about Governor Baker's fiscal year 23 house to budget proposal for the Department of Veterans services and the soldiers. Homes.

We are very grateful to governor baker,8207 lieutenant governor paul ito, the administration and secretary centers in the Legislature for providing critical support for the department to continue to serve The over 307,000 Massachusetts. Veterans, men and women who have served our nation with honor and dignity and thanks to your support, the work of our staff and the veterans Service8228 officers in every city and town. We continue to8232 be a national leader in providing veteran services and benefits and the leadership in the commonwealth allows us to offer a robust array of programs and our dedicated community partners who support this work. And it makes Massachusetts, a place where veterans and their families can live healthy and productive lives. So the governor's budget Allocates 93.5 million for fiscal year 23. And this supports ongoing program from the department.

This8263 includes our outreach programs and our benefit programs. This includes our Save Team, statewide advocacy for veterans empowerment, our veterans memorial cemeteries and financial programs and also to continue to expand the women. Veterans network outreach program. And it supports the expanded outreach efforts to engage with veterans in our communities and support continued collaboration8287 with community providers, service organizations and other state agencies that we work with to look for the best outcomes for our veterans and their families. So the FY23 recommendation includes $68 million dollars in benefits for veterans. This includes $35 million 7000 individuals who receive our safety net benefits, otherwise called Chapter 1:15. This provides economic assistance to qualified veterans in the dependence for necessities like food, shelter, clothing, fuel, medical care when necessary. And I do want to point out that while the total recommended budget does reflect a 4% in decrease, I do want to be clear that this is not a cut to benefits.

The amount reflects the full reimbursement to Mississippi realities and districts who administer these benefits And that reimbursement is made one year in Arrears. The budget also includes $32 million dollars for our annuity program. This is financial support for 16,000 individuals who are either 100% service connected or a gold star parents or surviving spouses of veterans whose death was related to their military service. And the governor's budget recommendation also includes support for, as I mentioned earlier, the statewide advocacy for veterans Empowerment that's appear support program whose primary purpose is suicide prevention, but it approaches that by breaking down the barriers that are either real or perceived to8396 veterans receiving services and that also collaborates with our partners in the Department of Public Health and the Department of Mental Health in the areas of court involved in justice involved veterans with the treatment courts as well as the Department of Mental health jail diversion program and also helps refer veterans to substance abuse services and mental health services.

Mhm. Just this last year in 2021 save received 535 referrals From the veterans community. And they are currently helping 224 veterans with active peer case management And currently with 21 veterans who were involved in the treatment courts.8440 The governor's budget also continues to fund the expansion of the women Veterans network. Women veterans are the fastest growing population of veterans. They are now almost 8% of veterans in the country and they are 20% of new recruits in the military. And so we are working to really reach out to this faster growing population. I did want to highlight a couple of the other initiatives that we have under way, as you may know, we are the only state in the nation that has a veteran service officer in every city in town which makes Massachusetts very special and supportive. So this budget provides training programs for over 200 municipal veterans service officers and their staff and they they provide that on the ground community support to veterans in their cities and towns with specialized training and benefits.

This also includes training on supportive services and a newly modernised benefit administration system that rolled out just last year for all department of veteran service staff and Veterans service officers. It's called the on based program And in 2021 we had over 60 in person 110 virtual training sessions to ensure a smooth transition. Um and we continue to implement enhancements and other8529 changes as this program needs in order to improve the system. We also, the commonwealth is home to two very beautiful veterans memorial Cemetery, state cemeteries both in Agawam and Winchendon. And together they hope, you know, they provided that last true measure and8549 honor to our veterans who have passed away with 1300 burials in the calendar year,8556 2021. That's the highest number in any calendar year since their opening. They have also been recognized by the National Cemetery Administration with higher scores for being beautiful and almost shrines to the Department of Veterans Affairs and they serve as models throughout the country as they are so well tendered.

The budget also includes veteran homelessness prevention and this supports our providers around the commonwealth who offer housing and supportive services to veterans who experience homeless or housing insecurity or could be at risk of homelessness. This this includes providers such as New England Center and Home for Veterans Soldier On Out in Western Massachusetts, Veterans incorporated in Worcester and some of the small, some of the other providers, such as bilingual veterans outreach center and all across the8615 department.8615 We have been engaged in a Substance Abuse And Mental Health Services Administration or SAMHSA and VH initiative called the Governor's8625 Challenge. And this is a policy academy to prevent suicide prevention among service members veterans and their families.

There's a three pronged approach to this initiative identifying service members, veterans and families. Or, more simply, what I say is asked the question, ask the question has, have you or a loved one ever served in the military so that we can identify veterans and their families and refer them to supportive services, Also improving peer support and access to care services. The third is reducing access to lethal means and improving safety planning as part of that. And because we're Massachusetts, there were three goals. We added 1/4 which is also expanding military cultural awareness training. So in november of last year, Together with our partners, we held a virtual training on military culture that was attended by over 170 professionals. Non VH affiliated clinicians and this also included information on how to become a VH provider to some of those clinicians who may not8701 have been VH providers Before. I do want to touch again on a women veterans network.

We've been engaging with women veterans in new ways. Uh, this last8714 summer we had our uh we were finally able to get outside after the pandemic and have our women veterans appreciation Day and Sharon that Sharon is actually the home of Deborah Sampson, the heroin that uh, you know, the woman veterans network aspires to. And then they also held a hybrid conference in the fall. So we were able to gather outdoors at done State Park in Gardner. And that was followed by four virtual events in the evening. And the combined activities involved about 180 participants. So it was a good initial hybrid outreach to our women veterans. We are also involved with a statewide survey trying to look at what the needs of8762 women veterans are uh, that we're doing within the department. And this will be looking at the, the services that women veterans are using currently as well as identifying some of the service gaps that might exist for women veterans and their families to help us redirect our efforts in the way that better helps to serve them and their families. And we're also pleased to share with you that we are completing the procurement process for the Electronic Medical Record or otherwise known as an EMR. For both of the Soldier’s Homes

This will manage the support of eligibility, determination, admissions, um, clinical care, compliance with regulatory requirements and also help with any reimbursements or billing. It supports our caregivers and it helps continued focus in better coordination of care for our veterans, improving their outcomes and promoting safety of our veteran residents to the So that just covers some of the topics of what the what the you do have the written testimony from us that we provided. But I am very, very grateful for the time that you've given us this morning and I urge you to support the governor's fiscal year 23 budget8845 request for the department veteran services so that we can continue to provide the high quality care to those who have supported our nation's commonwealth. I'm happy to answer any questions that you may have before. We invite our Superintendents to speak for the Homes.

DONATO - Well, because of the difficulty in the labor market,8872 do you feel that the H2 funding is adequate for both Homes to maintain the necessary staffs?

POPPE - Well, I I know that that will be a question that may come up to the the the Soldier’s Homes, but yes, we do. Um, we are obviously working at, you know, as, as the, as they will present, they have a good level of staffing. Now we do know that there are challenges right now in the health care field. And so both the homes,8902 along with the Assistant Secretary of Veterans Homes are going to be working strategies to look for uh, to have sources of, of growing growing the capacity in the future for the staffing at the Veterans Homes And obviously, as you will hear when Chelsea speaks, we do know that there was an increase to their budget because opening the new community living center uh, in fall of 2022 will, will require8930 a larger number of staff given the small home design.

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ERIC JOHNSON - CHELSEA SOLDIERS' HOME - Uh, so good afternoon sir. And distinguished members of the joint committee on Ways and Ways and means, my name is Eric Johnson and I am the Superintendent of Soldier’s Home in Chelsea. I would like to extend my gratitude for the opportunity to appear before And testify on the soldiers home. Uh, in Chelsea's mission priority and the governor's proposed this little year 2020. The government wants to budget. The Funds will hold his home and healthy at 49.3 million Fiscal Year 2023. Which is funny what happened to this. Funding will support staffing and operations and provide quality care for our veterans through the opening of our new community living Senate. Uh, the soldiers home in Chelsea is the second oldest veterans home in the nation's. We provide the finest care and support for generations of Massachusetts veterans.

We're proud to be able to continue that tradition and are excited9026 to soon be able to do9028 that in the new state of the art facility. We provide skilled long term care and don't distillery supportive services for those who have honorably served our country. The mission of the homes is to provide care with serve care services with dignity, honor and respect. We currently provide care for approximately 87 veterans in our long term care building And approximately 120 veterans in our hill9055 maxillary program. We welcome, we welcome new veterans admissions regularly and the veterans in our long term care building are provided skilled care from our nursing and medical teams are Domb Auxiliary veterans receive supportive services from care managers, social workers who respond to their unique needs. We actively collaborate with local partners such as community housing authorities, employment providers, community leaders, health care providers and educational institutions to assist and strengthening the residents uh, in their ability to return to the community.

Our long term care facility currently has a waiting list of approximately 30 for veterans. We operate on a first come first served basis. Once the center is open we will have a capacity of 154 which is all private rooms in a small home design. In addition to striving to provide excellence at the veteran residents every day. We also focus on the social and emotional well being of our veterans. We offer a robust calendar with daily opportunities of recreational activities as well. Currently the Soldiers Home in Chelsea has 287 employees. It's in the process of9137 hiring additional direct care staff. Our direct care staff are, I'm sorry, our veterans currently receive approximately 9.3 hours of care patient per day care, which is significantly above the CMS Five star requirement of 4.4 hours a day. Our Soldiers Home in Chelsea is in the9160 middle of significant growth, both among its staff. And it's just in FY23. The long awaited Community living center will open, But again, as I said earlier, it will have 150 for long term care beds, all private rooms.

This process started back in 2016 uh in Khan in in concert with the executive Office of Health and Human services, Department of Veterans Services and the division of Capital, asset management and Maintenance. The facility was originally built back in the early 50s as an acute care hospital Uh in September of 2018 broke ground on9208 199 million long term care community living center. The design of our new centre follows the most current be a standards and will provide community based services and supports a more home like setting. The new center will allow veterans to live in private rooms while receiving quality health care and enjoying the bribery and support of their fellow veterans and dedicated staff. As secretary. Poppe mentioned earlier, one key improvement of the new center is the ability to accommodate more women veterans, which is the fastest growing segment for veteran population as our community living living center comes, it also comes with an increase in staffing Uh to take care of our residents in that 154 bed facility.

That 154 bed facility is 80,000 square feet larger than the facility we are currently occupied. It comes with an increase in the space of private rooms. It also comes with an increase of direct care staff.9274 The budget, the budget reflects an increase of 104 full time employees from the FY22 ah Budget staffing model apologized to accommodate the expansion of the change. One of the examples of of the size of which we're going to increases, we go from 40 bathrooms to 175 bath. Our residents, seating areas go from two to 18 And our foods are kitchens and food stocking areas go from one to 11. Uh And there's a much anticipated outdoor meditation garden. We will be enhancing the services that offers but it offers a veterans with an opening of a new building with the goal of becoming a certified dementia care facility, adding a post acute care neighborhood with additional therapeutic services such as physical and respiratory therapy on the door. Maxillary side.

The second phase of development is taking place in collaboration with decamped And the Department of Veterans Services. Phase two will provide veterans in the region with new and affordable supported housing Forward. The assess management board approval decamped, issued a request for proposals in December of 2020 for redevelopment of the facilities and the long term service provision. In consultation with multi agency evaluations committee decamp selected Penrose In September of 20. We won as the Commonwealth Development Partner for a 99 year lease this year in coordination with DDSD, HHS and the Chelsea's, Soldiers home is expected to decamp and Penrose will execute a master Development agreement, advanced design of the9386 campus, complete the local zoning process and identify public financing for affordable housing and historic preservation.

The redevelopment is expected to break ground in 2023. The secretary, Poppe mentioned earlier, we have been working with our counterparts in polio on the procurement of an electronic medical record system. Uh this process has been a collaborative effort from both Homes DDS and EOHHS-IT. And has involved several other internal and external stakeholders, stakeholders. You are very much looking forward to the completion of the procurement process and starting the implementation phase of the process. Thank you for the opportunity to testify and I'm happy to answer9435 any questions.

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MICHAEL LAZO - HOLYOKE SOLDIERS' HOME - Thank you. Secretary, Good afternoon. Vice Chair Donato and distinguished members of the joint committee on ways and means my name9479 is Michael Lazo and I'm the interim Superintendent of the Soldiers home in Holyoke. I want to thank thank you for the opportunity to testify you on behalf, testify before you on behalf of the soldiers home in Holyoke. The governor's fiscal year 2023 budget, which proposes 29.7 million to support the mission and priorities of the soldiers home in Holyoke. The budget funds robust staffing levels to support quality care as we continue to make strong progress and clinical infection control protocols. 2022 is proving to be a significant year for the soldiers home in Holyoke. We have had the honour to care for and serve some of our nation's heroes every day and are planning in the future of the soldiers home in Holyoke.

As we have welcomed new residents in the home for the first time in over 18 months, the soldiers home remains committed to ensuring the safety of the veteran residents and treating them with honor, dignity and respect and continue to strengthen and support our staff. A 300 person strong staff take great pride in providing care to the 92 veterans who currently reside at the soldiers home in Holyoke In December 2021. We were pleased to resume admissions to the long-term care facility and have welcomed 11 new veteran residents since9563 none of the progress we have made or the planning for the future would be possible without our dedicated team. Over the course of the public health crisis, our staff has shown resilience, flexibility, dedication in caring for our veterans residents. They remain steadfast and vigilant in compliance to infection prevention and control measures and following the guidance for well being of our veterans and each other.

The soldiers home continues to engage in recruitment for qualified clinical and non clinical staff. The Soldiers home is focused on recruiting and hiring direct care staff such as CNAs LPS and RNS and has filled the key positions of chief medical officer, chief financial officer, volunteer services coordinator and to infection prevention nurses. The home also utilizes contracted agency staff to support strong patient care staffing patterns As a result of the increased staffing hours per patient. Day consistently remains above the CMS five star rating standard of 4.408 for skilled nursing facilities. With the January 2022 average HPPD of 10.7 we continue to build our team and remained focused on continuously recruiting qualified clinical staff. The soldiers’ home in Holyoke continues to maintain high clinical standards as evidenced by successful surveys conducted over this past year.

In March of 2021 US Department of Veteran Affairs conducted their annual survey of the homes long term care and Domb Salieri, Our home met 449 out of 472 standards. The few deficiencies were cited as no actual harm with potential9655 for more than minimal harm. A corrective action plan was submitted to the VH and was accepted. Holyoke was granted Provisional certification. Following this acceptance in June 2021, the Joint Commission, an independent not for profit accreditation organization surveys the home every three years. On July 15, 2021, the Soldiers home Holyoke received accreditation from the Joint Commission. The Soldiers Home conducts a satisfaction survey with the national survey firm. In 2021. The soldiers saw monthly satisfaction survey conducted by pinnacle insights resulted in an overall9694 satisfaction rate of 87 this past year, the soldiers home welcome back entertainers, volunteers sponsored celebrations9699 and special guests of note.

The home was honored to9704 have Congressional Medal of Honor recipient Michael Fitzmorris visit and spend time with our veterans in September As part of the National 21 Medal of Honor Convention that took place in Boston Mr Fitzmorris was flown to Holyoke in a Blackhawk helicopter that landed in our parking lot. He spent time talking about veteran residents 12 month. They were honored and thrilled to welcome him and see his ride up close the soldiers home in Holyoke in partnership with the executive office of Health and Human Services Department of veteran services, the division of capital, asset management and maintenance made significant capital investment to address both short term and long term needs of the home. This includes a short term refresh project and all of our nursing units and throughout the home. In the longer term rapid planning capital project to create a new soldiers home9761 in Holyoke, an additional ongoing construction effort will improve our isolation unit by making it a fully enclosed negative pressure space.

The Refresh project was completed in October of 2021 and9771 all of our veteran residents are now in their newly refreshed rooms As part of the project, the updated Canteen reopened in June of 2021 and our veteran residents were thrilled to return and enjoy congregate activities, including entertainment, bingo art projects, ice9785 cream, socials, exercise classes, pointing events, movies and celebrations. We also opened a new media room gift shop and hair salon. I would like to thank the governor and his administration and the Legislature for securing the capital authorization to construct9801 a new long term care facility for the soldiers home and Holyoke. With this authorization and the overwhelming support of the Baker Pollito administration and the Legislature. In july 2021 the soldiers, Holman Holyoke submitted a grant application to the US Department of Veteran Affairs, State Home Construction grant program, which if approved would reimburse the commonwealth up to 65% of the cost to design and build a new long term care facility.

Local veterans organizations and Bso is an integral to the mission of the soldiers home and Holyoke. Their volunteer power and support are part of the daily lives of our veteran residents and we deeply appreciate, appreciate their partnership with the home. In November of 2021 soldiers home held its first veteran community engagement meeting to keep them abreast of the work we do with our veterans and to gather their feedback. This quarterly meeting provides updates to local veterans organizations and veterans service officers. This meeting served to open lines of communication in order to better serve veterans in the community and the home along the same lines, the home launched a new a new community newsletter called the front lines to keep the community informed and updated. In conclusion, I would like to thank you all for the opportunity to testify. I am happy to answer any questions you may have about the home and our proposed FY23 budget.

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SEN GOBI - Just just9893 a common if I could, I just want to thank the secretary and um the Superintendent's obviously thing that um um all the hurt that that we witnessed unfortunately at the Holyoke soldiers. So I just want to say thank you, I know that from families that I deal with, that have loved ones there now that they are seeing the changes they are liking, what they are seeing and so that is definitely a positive and you know, as we move forward and and we look at other ways that we can serve veterans throughout the commonwealth. I know that will have opportunities to speak as well on that, but I did want to say a sincere thank you for that. Thank you.

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