2023-03-21 00:00:00 - Joint Committee on Ways and Means
2023-03-21 00:00:00 - Joint Committee on Ways and Means
SHOW NON-ESSENTIAL DIALOGUE
Mike Kushner for small screen remarks.
Thank you, sir. Minutive. Good morning, everyone. Welcome to Pittsburgh. This is this is a really a momentous occasion for us. We couldn't be prouder of hosting, a ways and means commitment to join community here today.
You guys really handle some important issues. I especially nearly 10 years in the legislature as well. So I know I know something of what you go through. But again, we're very, very proud and happy to hear that we are able to host a joint committee's meeting here today. And again, thank you for the great work that you do for the and wealth, and for the people of the city of Pittsburgh included in
that as
well. Thank you, and welcome again to Pittsburgh. Thank
you,
man.
Everyone.
Thank you. And welcome to the third Worcester District. I'm appreciative of today's shares. Senator John Cronin and rep Cabbie La Nadra, and thank you both for allowing us this opportunity to know only address you, but address my former colleagues. Each of you, thank you, Laura, for making the trip to Pittsburgh. Truly believe that Pittsburgh is a microcosm of the entire commonwealth within half a mile of where you are right now. You can be in a farm, a college campus, a dense urban environment94 in a in a manufacturing plant of Brewery. You name it Pittsburgh has it and with it represents all of the challenges of the Commonwealth, but also all of the opportunities of the Commonwealth. And so I am I grilled that you are111 here today and thankful for the work and the crucial work that you're doing today and in the weeks ahead as we move118 forward, say, up 01:24 budget for the state. So thank you. Again, welcome to Pittsburgh, the third with the districts and look forward to having more conversations with each one of you.
Thank you, representative. Thank you, Mayor I’ll welcome everybody to the second regional hearing of joint committee on ways means. Again, we're grateful to the city of Fitchburg. Every everybody on the joint committee are staffs that clerks, court officers, and everyone whose work worked really hard to allow us to come together today to confront these issues. I'm really pleased to be chairing this committee with my colleague, Representative LaNatra today,
And grateful to chairs Michlewitz and Rodrigues for the opportunity to have this discussion here in a gateway city in Pittsburgh, North Central Massachusetts. The agencies here today are part of a critical safety net for Commonwealth. There are communities, our community responders for the commonwealth's most pressing concerns. o thank you to everybody who is testifying today. I'm pleased to be joined by my senate colleague, senator Liz Miranda, and from Boston. And I will now turn it over to representative, Patrick, to welcome members of the house.
Thank Senator Cronin. Good morning, everyone. Welcome to the second hearing of the Joint Ways Committee. I'm happy to join all of you today, and I'm very not hosting with senator Cronin. I would want to thank everybody in the town of Bitchburg especially for graciously hosting today I'd like to offer my gratitude to the clerks, the211 legislative information services, and the court officers that make this possible to215 have of the meetings that we are able to have today remotely. I would like to extend my thanks for all those testifying today, whether you're joining us teams or you're here in person, and I bring greetings from the house.
And I would like to introduce the long list of esteemed colleagues in the house serving on ways means. Some are here today with us some we have on Teams. But first, I would like to thank the work and leadership of our Chair, Aaron Michael Woods, Vice Chair in Margaret Ferrante, as assistant vice chair Patricia Haddad, breaking minority member, Todd Smollett Russell Holmes, Natalie Higgins. I should say rep, rep, somebody at the Montagno, Rino, rep Allan Sylvia, rep Bana Howard, rep Charles Jordi, rep Patricia Duffy, rep Sally Curbs, rep Natalie Blay, rep Dave to Bill, rep Andy Vargas, rep Dylan Verandes, rep Megil coin, rep Rolando Ramos, rep half are Kurni, Rhett, Kate Clifford Garrabedian, Rhett and China Tyler, Rhett, Brian Murray, Rhett and Tuck Stephristine Barber, rep Angelo D'Amelio, rep Natt Muratore, rep Donald Berthiaume, Jr. Rep Joseph Mckenna, rep Kelly Ps, rep Allison Sullivan and Almedia, and not last but not least, rep Steven Exxaro. So we do have a long list of house members on this. Thank you for all of your hard work to this committee, and I look forward to hearing from all of you. Thank you. Thank
you, representative. I also want to extend a welcome and recognize my colleague who's joining us on team, Senator Comerford. Senator, thank you for being with us today. I'd now like to invite Secretary John Santiago, the executive office of veteran services and soldiers homes to testify.
I'll be joined by attendant, Mike Lazzo, a second director, Robert
Engle.
JON SANTIAGO - EXECUTIVE OFFICE OF VETERANS' SERVICES - Good morning. Chairperson, chair Cronin, Chair LaNatra, and distinguished members of the Joint Committee on ways and means. My name is John Santiago, and345 I'm honored to serve as the first secretary of the newly established349 Massachusetts Executive Office351 of Veterans Services, which was made possible with your leadership in reforming a broken system in passing chapter 144 of the acts of 2022. As a former legislator, I have tremendous respect for your leadership and extend my deep heartfelt thanks for your continued support for veterans all across the Commonwealth.
Thank you to the chairs and members for the opportunity to address you today and answer your questions about Governor Healey’s FY 2024 House one budget, proposal for the executive office of veteran services and two veteran homes. I'm joined here today by superintendent Michael Lazo from Holyoke and Robert Engell director of Veterans Services oh, excuse me, in Homes and Housing, who currently serves as the acting superintendent of the Veterans Homes in Chelsea, you will hear from them later. But first, I want to start by recognizing and thanking Cheryl Poppe for her long standing service to our veterans as a former secretary Department of Veterans Services.
She has led the Commonwealth veteran services work with a steady hand through some incredibly troubling times. We are grateful for her service. As you are aware, the passing of chapter 144 created a multi of statutory and governance changes greatly impacting executive officer's role in providing services or veterans, and those changes include elevating the Department of Veterans Services, which was under the executive office of Health and Human Services, to its own cabinet level secretary you. The state operated Veterans Homes in Chelsea, and Holyoke now reports to the Secretary of EOVS, including both lieutenants. The homes must apply for and maintain certain DPH licenser in CMS certification and can be inspected twice annually by DPH.
The establishment of an independent office of the Veterans Advocate was to be jointly appointed by governor, the attorney general, and the state auditor. This office is now within or subject to the control of any other agents Additionally, thanks to your support and the work of our dedicated staff, I am able to share that Massachusetts continues to be recognized as a national leader in providing veteran services and benefits. Including monetary and nonmonetary efforts, affordable housing opportunities, resources for women veterans, peer to peer outreach to help prevent suicide, and support in the operation of two different cemeteries and aguaam, which is not including the approximately $79 million allocated to operate both veteran homes.
The governor's house one budget allocates a 106.5 million for FY 2024 to support ongoing programming in the executive office of veteran services. Key initiatives include the following: 68.2 million to support more than 7000 individuals receiving Chapter 115, safety net benefits. Chapter 115 provides economic assistance to qualified veterans and with dependents to purchase and assess things like food, shelter, clothing, fuel, and medical care. $32 million for the annuity which provides financial support by a way of two $1000 checks annually from nearly 17000 individuals. Veterans must be a 100% service connected to qualify for this annuity.
Gold Star parents surviving spouses of veterans whose debt was related to their military service567 are also eligible. This budget includes $9.5 million to571 fund veteran homelessness prevention efforts by way of contracting with direct service providers. Funding for emergency shelter providers such as newness and apart from homelessness,581 veterans and soldier on offer approximately 150 temporary beds each day. This past year, we announced nearly $4 million in new funding as part of Department of Veterans Services. Outreach propagation for increased services. This additional funding was able to reach our most underserved veterans in the provided for food and clothing, employment services, transportation to and from medical appointments.
Career deposits for or veteran specific housing, low or no cost housing upgrades, and counseling for female veterans struggling with PSD. The budget also includes $4.2 million to bolster information technology for the two veteran homes and improve service delivery a new IT office responsible for IT strategy and delivery. $2.2 million to cover the additional cost of the elevation to criteria. This will offer the creation of a new human resources and labor relations office, expand our existing legal, finance, legislative, and communications functions that one staff will help increase EOVS capacity as a liver effective, which responsive and timely services. Funding654 will654 also support our two veteran homes to maintain critical staffing and infrastructure improvements
Including preparing for the opening of a new Veterans Home facilities. You'll hear more about that from our two superintendents. The Governor's budget also includes $1.5 million to support vital peer to peer outreach services to Statewide Advocacy for Veterans' Empowerment otherwise known as SAVE. SAVE is a peer support program focusing680 on suicide prevention, gel diversion, and substance use mental684 health treatment. The women's veteran outreach program budget recommendation is for $629,000. Women's veterans comprise the fastest growing segment of our veteran community, now represents earning almost 25000 individuals to become more.
This past year, the WBM conducted its first statewide survey of women veterans and decades to better understand the services that women veterans and the commonwealth currently use. In conclusion, the Governor Healey’s House one budget proposal is committed to meeting a moment and supporting our veteran community. My priority as the first secretary of Veterans Service to build that a robust secretariat. In order to further scale up our veteran support programs and provide that needed by financial assistance. Given our shared vision and desire to see the veteran community excel, I urge your support for the governor's budget request and for our737 office. I'm now happy to answer any739 questions you may have before writing, sir Prince, to speak. Thank you,
SHOW NON-ESSENTIAL DIALOGUE
Thank
you, mister Secretary. I'd like to open up to the committee for my questions.
REP LANATRA - I just have a question. Hello, Mr. Secretary. So good to see you. So being the new Secretary, what are the goals for establishing the executive office in FY 24?
SANTIAGO - Really the goals come down to one thing. It's how do we rebuild trust in the metro community? This is effect probably a startup inter turnarounds in some respects. The governor has invested a significant amount of financial human resources to do just that. Now I'm here with our superintendent from Holyoke and her superintendent in Chelsea, who are committed to painting the culture, rebranding the institution.
The best of our veterans. As I've stated before, she investment millions to do just that. We have a whole host of issues that need to be addressed. But I think in their testimony, you'll hear more about what going on to respect the problems. They've changed operations. They've changed infection control procedures that make the situation significantly better for the veterans, their staff and their families.
LANATRA - And do you expect the funding in H1 to exceed those goals? Do you think that's going to be enough for those goals?
SANTIAGO - I think so. I think we're we're pretty excited about the plenty of their city. Additionally, the governor has invested about 11% increase in our operations. And it's quite a task. This was a department in HHS. I think it was 1 of 16 there. Now the transition from a department to secretariat comes with a certain level of expectations and professionalism. The fundings that allows us to do just that. When the midst of hiring, a whole host of people who lead those efforts from the director of HR who just started yesterday, a legislative director, chief information officer who all started on April third, Deputy Combs director, you name excited about it. It's a big task at hand, but the team's committed to do the job.
LANATRA - Great. Thank you.
SEN MIRANDA - Hi. Great to Secretary to my colleague. Fellow Bostonian. I'm the chair of the racial equity civil rights and inclusion committee. And you obviously are a Latino man, an act of duty and also a doctor. And I had the honor serving on the veterans. Can in the house for four years. I have a specific question around how we're serving. I'm glad to hear about the women, but and brown veterans.
We have approximately 380000 veterans in the Commonwealth of Massachusetts. It's a great state, not only for the veterans that are from our state, but many veterans flock to our state for job opportunities each year. Do you have any specific goals related to that population because 1 of the things that really struck me during COVID-19 was not only the absence abuse disorder, but the homelessness and the mental health challenges of our veteran populations, which factored?
SANTIAGO - Well, thank you, senator Miranda, for the question. I share your concern. I share your empathy and your desire to treat veterans and take a better mix of color as a personal color myself. So who served deployed twice. I show those concerns deeply, and I'm committed to making sure that the office, as its represented, also reflects that in our hiring and what we do. In fact, as we create this organizational chart, which we hope948 to fill as soon as possible, there are elements of it which will address diversity equity inclusion.
So hiring people that represent the community make it sure that they're playing an important role throughout the entire secretary oversee what’s community is doing. But first and foremost, first and foremost, making sure that we're out there engaging with these that is committed to do it committed to doing it in a culturally sensitive and and linguistically appropriate way. And, you know, as a Bostonian, as as someone who spoke to these977 communities. I don't care very much about it. That's something I talked to the owner980 about, and she's committed to it as well. SHOW NON-ESSENTIAL DIALOGUE
Representative piece. Yeah.
REP PEASE - So I good morning, and thank you so much. Now, I'm not sure if this question is maybe more for the superintendent, but I know that the Poll York soldiers home used to have an patient clinic there that got shut down, and I'm not sure if it just got shut down because of COVID. I mean, we're fortunate also to have a VA out there, but a lot of the my because that you had said really might go into that outpatient. I was wondering if there's any plans to1007 put that back in place.
MICHAEL LAZO - SOLDIERS HOME IN HOLYOKE - Thank you for that question. At this point, there are no plans to reopen. In fact, that outpatient services has been quote prominently. It will be replaced by the adult health in new building.
REP KERANS - Thank you. Good morning to my former colleague. As the senator said, so accomplished. I always feel like a bit of a Slacker when time. Just a quick question about the North Shore Veterans Counseling Center. It's in Beverly, not my district, but my daughter happens to live two doors away. Where in your budget do you think that and similar services for veterans. I I don't ever seem to see women going in and out. So is an expansion of counseling services for women and for all veterans, is that part of the 106.5 million?
SANTIAGO - Well, let me just state very clearly that similar to that, senator Brandon's question, we remain committed to supporting our women veterans. There's about 25000 across commonwealth fastest growing community with respect to the veteran community. And as you know, there was not a done by the previous auditor that said, look, things aren't going as well as I could be going. Right? There's a lack of strategy. There's a lack of investment. And what our office did before I was there last year in 09/19/2022, the underwent a survey.
And they had to consultants bring in and to come in and say, listen, what do we need to do to best serve our living veterans? And in that study, which is public, they provide a whole host that strategies and plans to do just that. Now I'm in my third week in the office. I've read the study, but let me just tell you that we're committed to implementing that As I said, it's the fastest growing community in terms of the veterans, and we'll make sure that they have the support that they need, that they deserve. They serve their country. We're committed to to support them. You know, what's unique about this particular position?
That's not you know, the position, as was mentioned, served, been in jobs that are pretty inspiring. But already in the week two, week three, whatever we're in, everywhere I go, it's a pretty inspiring job hearing the stories and I don't care what your ethnicity may be, what your gender may be. Everyone is always rooting for and we take that with us in the work that we do day in, day out. It's very palpable on the streets and the veteran homes and we're committed to making sure that veterans across the Commonwealth know that we have their back.
KERANS - Thank you.
SEN CRONIN - Thank you, Mr. secretary. I I have a question. I'm wondering if you could speak to how the change and expansion of DVS to a secretariat level department is impacting the operations of our soldier's homes. And to to dovetail that a little bit. I think one of the things that we hear from our healthcare system all across the state is incredible workforce shortages. And I'm wondering if you could speak to some of those challenges that are show are soldiers homes and in ways that we can help.
SANTIAGO - Yeah. So let me take the first part. I don't know if okay with you, Mr. Chair?
CRONIN - Please.
SANTIAGO - They have some testimony that they might be able to align you all with some of the issues and challenges that are that are probably facing? Well, let me get that first1222 part of the question. As I said, the governor has1225 invested significant financial resources building the secretariat. But much of that is internally. Prior to this, we have been dependent on EHS for a whole host of different services, whether that was HR, whether that was the general counsel, whether that was our communications department. So now we are building out out this whole program and this whole operation. And it's challenging, you know, every specific office I feel like every day, I'm interviewing three or four people from variety positions.
And we've had some luck in putting in at least, you know, 10, 11 folks already in senior positions. Gonna take a lot of work, a lot of reviews, new applications, and everyone can get this done. But I I view that as somewhat separate what's going on with homes. Now they provide capacity at the secretary level. They will provide support for what's happening there. You need home has their own HR team, their own condensate, but we wanna support them to the best of our abilities, make sure that they're, you know, adequately resource and able to do the job. And I think in their testimony, it will provide you some insight as to what's going on right now at Holyoke in that Chelsea. Right.
CRONIN - If you wanna provide that testimony. Please, sir. Thank you very much.
LAZO - Good morning, Chair Cronin, Chair LaNatra , and members of the Joint Commission on ways it means. My name is Michael Lazo I'm the superintendent at veterans home and Holyoke. Thank you for the opportunity to testify on behalf of the Veterans Home and Holyoke Governor Healey’s fiscal year 2024 deposits $30 million to support the mission and priorities of the Veterans Home and Holyoke. The budget funds robust staffing levels to support quality care and continues to make some natural progress in clinical and infection control protocols.
As we transition to the new reporting structure on the executive ops veteran services. 2023 will be a turning point for the Veterans Department of Holyoke. As of March first, under EOVS our name is changed to the and Solomon Holyoke. Still our mission remains the same, providing care with honor, dignity, and respect to Massachusetts' veteran. Planning for the future of the new Veterans Home in Holyoke will also become a reality this year as a domiciliary building was permanently closed with preparation for the groundbreaking of the new facility and the adult day health program.
Currently staffing levels, we are currently on 315. The staff takes great pride in providing care to the 108 veterans currently residing at the Veterans Home Holyoke. Plans are underway to expand our workforce in reparation from the new veterans home in Holyoke, which will house 234 long term care veterans and care for up to 50 in the Adult Day health Program. All the progress we have made in the planning1386 for the future are only possible with that dedicated team. Throughout the public health crisis and the period following staff has shown resiliency, flexibility, dedication, and caring1395 for our veteran residents.1396
They remain steadfast and vigilant compliance with infection prevention and control measures and are following guidelines for the well-being of our veterans and each other. Then Veterans Home continues to engage1409 in recruitment of qualified clinical and1411 non-clinical staff. The Veterans Home has focused on recruiting and hiring direct care staff such as CNA's, LPN's, and RNA's. We have filled critical positions such as the recreation director and the budget director. The home also utilizes contracted agency staff to support strong patient care staffing patterns.
As a result of increased staffing, our hours per patient consistently remains above the CMS 5-star rating standard of 4.408 hours for skilled nursing facility. Our January 2023 average hours per patient day was 7.59. We look to build our team and remain focused on continuously recruiting call by clinical staff. The homework with a consultant to conduct a staffing assessment to begin laying the groundwork for staffing needs for the new veteran's home in Holyoke. The modern design of this new facility will require additional clinical and non-clinical staff to maintain the 234 bed facility at opioid levels. The Veterans Home and Holyoke provides quality care and maintains high standard as evidenced by successful survey since past year.
In January 2023, the US Department of Veterans Affairs surveyed the home, long term care facility. The final report showed that out of 472 standards, a home at 466 or 98.7%. Only one of the findings was of a clinical nature. The corrective action plan has been written reviewed by EOVS and submit it to the VA on March fifteenth. The VA will review and will return an accreditation decision over the coming weeks. I'm very confident the home will receive accreditation. The Joint Commission, which is an independent not for profit accreditation organization, surveys the home every three years, and they visited the home in June of 2022.
On 09/09/2022, the veteran home and Holyoke received accreditation from the Joint Commission. The home conducts customer satisfaction surveys with a national survey. In calendar year, 2022 veteran home monthly satisfaction survey conducted by Pinnacle Insights resulted in an overall satisfaction rate of 96.3, which is a 9.3% increase over 2021. Clinical quality insights conduct surveys with low London residents to provide feedback and measuring tools to help us improve overall satisfaction. The surveys are essential because they provide with actionable data that can help improve customer experience.
The soldiers home in Holyoke's grown the top 15% of homes across the nation over 12 month area. As a result, the home earned clinical customer experience awards in the following area. Overall satisfaction nursing1565 care, food quality, cleanliness and individual needs, communication from the facility, response to problem, dignity and respect, recommend to others activities and overall customer experience. Recreational activities with volunteer support continue at the home. Recreation department maintains a complete activities calendar emphasizing activities that meet the five domains of therapeutic recreation.
The domains are cognitive live, physical, emotional, social, and spiritual. The Veterans Home in Holyoke is planning for the future and partnership with the Executive Office of Health and Human Services, Executive Office of Veterans Services, a division of capital asset management and maintenance continues to make significant investments to address the short, long term needs of the home. I again want to thank the legislature for securing the capital authorization to construct a new long term care building for the Veterans Home in Holyoke. The application to the US Department of Veterans Affairs State home construction grant program is coming to fruition.
The home has received a conditional award of approximately $160 million to begin construction of the new Veterans Home in Holyoke. Thank you to DCAMM for their hard work and prepare the necessary documentation to complete the grant process to secure this conditional grant. We look forward to a groundbreaking ceremony with of the Healey’ fiscal administration. Ongoing construction efforts continue in the current facility to improve our isolation unit by making it a fully enclosed negative for space. This project will close in the coming weeks.
Additional projects regarding emergency power generation and facade improvements in the planning phase. The home is working towards becoming certified by the Centers of Medicare and Medicaid Services and licensed by the Department of Public Health as a Nursing Home. The home has engaged an external consultant, and our staff has been working to incorporate changes in recommendation, as recommendations by this expert. The home we'll be submitting applications as soon as possible. Another important initiative that we have underway is implementation of electronic technical record.
In collaborations with the Veterans Home in Chelsea, we have contracted with an EMR vendor who will be moving forward with simple mutation following the final decision in contracting for the implementation vendor. The Holyoke team is looking forward to progressing in this important initiative. The home in Holyoke continues to engage with community partners. This past year, I was invited to the Chicopee senior center provide information on the new Veterans Home in Holyoke We had a great discussion and I appreciate the opportunity to meet with this community.
Also invited to represent the Veterans Home at Holyoke Listeria Hurst Museum, translating uniforms and understanding survey exhibit. Our veterans are also returning to the community for the second year in a row. The veterans and staff of the home in Holyoke have joined the of Holyoke in the Saint Patrick's State Parade. It was a great event truly enjoyed by our veterans, and it has been a pleasure of reintroducing the home to the local community. Local veterans are organizations and VSOs are integral to the missions of1746 the Veterans Home in Holyoke. The volunteer power and support are part of the daily life of our a veteran of our veteran residents, and we sincerely appreciate their partnership with the home.
We hold our quarterly veteran community engagement meetings to keep them abreast of our work without veterans and to gather their feedback. Most recent meeting was held on February thirteenth, providing updates to local veterans organizations, and veteran service officers. This meeting keeps an open line of communication to better1772 serve veterans in the community and after home.1774 Along those those same lines, the home continues its community new community newsletter called the front lines to keep the community informed and updated. And conclusion, I thank you for the opportunity to testify, and I'm happy to answer any questions you may have.
CRONIN - Thank you, Mr. Lazo. I do have one question. I I think a major area of focus with the legislature over the past two or years since the beginning of the pandemic has been making sure that no matter where a veteran is from in Massachusetts, they have access to to use our our soldier's homes and and to get fed there. Can you talk about some of the reforms under your leadership for those intake procedures to make sure that, you know, it's just not that the greater Holyoke or greater Chelsea area that that that's veterans are are able to utilize the the homes?
LAZO - Yes. Thank you for that questions. So monitor. We've taken a good hard look at our admissions process and we've standardized the process so that veterans of of any area, any1836 community in in Massachusetts are eligible. As long as they meet the eligibility as as based on the law, we will review and accept any any better from the many part of Massachusetts.
CRONIN - Are you seeing applications from across the state? Or is it kind of internal centric?1852
1853 LAZO1853 -1853 Most1853 of the regional, mostly, you know, Worcester West.. Nothing1856 nothing really used to Worcester at this time.
CRONIN - Excellent. Thank
SANTIAGO - And you said, as a part of chapter 144, which many of you guys played a role in, the governance had changed So part of what you were suggesting though is that there was a sort of level of patronage of proconsulism that existed in these respective homes. They had been previously used pertaining have been appointed by a certain Board of Trustees. I think every time it was about seven people. Now given chapter 144, that process is complete and change
Now, executive director of homes and housing will be running that statewide cohort statewide council that will be effectively in charge of selected support that's that's consisting of five members from Chelsea, the Board of Trustees, five members from Holyoke, four selected by the governor, three by the HHS secretary. And I think you're going on those what? So that's gonna add I mean, a certain level professional or someone else will just a widespread of fibrosis opinion and got throughout the commonwealth
CRONIN - Thank you, Mr. Secretary.
ROBERT ENGELL - CHELSEA SOLDIERS' HOME - The other thing I would. Excuse me, the other thing I would is part of the chapter 144, and thank you very much for the leadership and adding this. There's a provision1927 for addressing specifically geographic accessibility and equity to quality care. So that is one of the things that we'll be looking at. To develop mechanisms to better understand that, and we're1939 looking for both of our homes and their local boards of trustees to help their MSRs as1945 it were to all of the VSOs into the geographic areas that each of them is representing. So we're hoping to do that and to continue to increase and under a better understanding of the need for access1957 for services and how best to provide1959 those services to our veteran populations wherever they live in the Commonwealth.
CRONIN - Thank you, SHOW NON-ESSENTIAL DIALOGUE
No. Rep Moore's Law? Yeah.
REP MURATORE - Thank you very much. Appreciate that. First of all, congratulations sir. Mr. secretary's for your new position. I'd love to see you in that. As a as a nursing administrator license in Massachusetts. I've got a comment on a question. Question is, are the folks running these two homes now licensed in the commonwealth office nursing administrators? Is that going to happen?
SANTIAGO - We have both license with this.
MURATORE - Excellent. Excellent. And I applaud you for your staffing levels. Sure how you're doing it, but that's unheard of to see here staffing levels like that. But I'll tell you that equates to good care, so I'm sure. You know, that's that's going on. A bunch of everything you're doing unfortunate that media doesn't pick up on the good things that happen in the soldiers home. But I I apologize for your delay. You should be, you know, extremely courage staff from what they're doing. So thank you very much for your time.
SANTIAGO - To your point, Reb, as many of you know, with channel 144, that was part of that story changed it. Both superintendents had to be nursing home administrators. And so that's currently ongoing. And we're in the process in DPH and CMS purification as well. So we're beefing up our professionalism and I hope to help translate to better care confident in the world. SHOW NON-ESSENTIAL DIALOGUE
In repeat, we should just add
DPPH and CMS, like license through CMS. So
Hey, Mr. Rangel. I'd wanna invite you to provide here as I spoke to. Okay.
ENGELL - Thank you. Good morning, Chair, Cronin, Cahir LaNatra, and all members of the join committee on ways and needs. My name is Robert Engell and I'm honored to be here as early acting superintendent of the Veterans Home in Chelsea as executive director of Veterans Homes and Housing. Thank you for the opportunity to appear before this committee and testify on behalf of the Veterans Home in Chelsea. Governor Healey’s fiscal 24 budget proposal of $49 millio will fund the staffing and operation of our newly built Community Living Center and our domiciliary Residential Program. We are actively planning our move into the Community Living Center or CLC for as the end of spring.
Our entire team is working together as we embrace the veteran administration's small home design concept of supporting care and services in a truly home like environment. The Veterans home in Chelsea opened in 1882 as the second veteran home in the nation. Since our founding, the Veterans Home has continued to provide care and services for generations of Massachusetts veterans. We are proud that tradition honored to be part of the new Executive Office of Veterans Services and committed to our mission of providing care and service services with dignity, honor and respect for our veteran residents and our team members. Veterans residents in the long term facility provides skilled care from our nursing, ancillary clinical and medical.
In our domiciliary, veteran residents received support from residential service a staff, clinical and supportive services from nursing, social work, and the medical team who work with the response, who work with and on to each veteran's unique needs. Our goal in domiciliary is to support residents and facilitate their they've transitioned back to the community whenever possible. We actively collaborate with local partners such as community housing authorities, employment providers, community leaders, healthcare providers and educational institutions will assist us2174 in strengthening our residents' ability to return to the community. The Veterans Home in2179 Chelsea is focused on our residents.
Our 325 team members care for 200 veterans in our long term care and domiciliary programs. Our team members believe in their service and are honored to provide excellence in all that we do with the veterans we are privileged, sir. Diversity, equity, and inclusion are important to us. And we are pleased to say that our team is representative of our2205 greater community with 31% of our workforce identifying as black, 16% as Hispanic, 2% Asian and 61% is women. We are also proud of our partnership and collaboration with labor in the 8E continues to represent our team. 68% of2222 our staff have been with the veteran's home for five or more years, which is a testament to2227 the commitment and dedication of our staff.
We are appreciative of the tremendous support we receive from the Commonwealth. This support allows our veterans home to establish standard of care with an average of 10.2 hours of direct care for patient day in our long term care setting in the most recent model. Our staff have remained committed in dedicated to our residents throughout these challenging times with the public health emergency. They have exhibited an exhaustible work ethic and with true commitment those observed while maintaining the utmost concern in vigilance for infection prevention and control.
Our infection control team is led by our medical director and support from2266 our infection preventionists and occupational health nurse along with our entire2270 team. Our team members2272 are continuously learning and improving through both training and education programs and the consistent oversight in and consultation with the Department of Public Health, Infection Control, and Prevention nurse advisors. Our new community living center is located on the campus atop iconic Powder Horn Hill. It will serve the Commonwealth's veterans as a state the art long term care facility. The thoughtful building design will provide an uplifting and pleasant environment for our residents.
It is designed to capture for daylight and provides an array of2302 views of downtown Boston and the harbor. Not only a model for dignify long term care veteran care. Our new veteran's home will be a state of the art resilient and sustainable building that meets current and future needs for our veterans in Massachusetts. The existing quickly hospital building will be taken down when a new home becomes operational, facilitating the final development of a full seven-acre site into an accessible landscape while restoring the enhanced and enhancing Power Horn Hill as a public many. At its2334 core, the community2335 living center is designed. Design is about creating a home for our veterans. It is based on the guiding principles of autonomy and dignity in a home like environment.
With enrichment activities, socialization as a goal with2351 space for family and friends to visit,2353 including kitchen for meals and a den for spending time together. There will be 214 resident2360 homes on each floor called neighborhoods. With 11 homes, we'll have a total of 154 total2368 rooms for our veterans. We'll also be developing new focus programming for our Alzheimer's and related dementia. Right? Evidence. We thank the legislature and our colleagues in the executive branch for their vision and support of this truly amazing facility, which will facilitate nothing short of transformational care and services for our veterans. DCAMM has been with us every step and we are indebted to their resite and management of the project.
Our entire team at Chelsea, with the support of the Executive Office of Veterans Services, is excited and focused on enhancing systems and processes. We are currently pursuing full CMS certification and DPH licensure for the 150 bed TLC. We will also continue to grow our human resources through aggressive hiring efforts. We're presented2419 most recently with our hiring event that drew over 100 job seekers. And year to date have hired over 30 employees and are on track as we strive to grow our team to 400. We are very proud of our team at Chelsea and excellence in care and service that2437 we provide. There are several external regulatory agencies and accreditation organizations that come on-site perform rigorous standard days inspections of our home.
The Veterans Administration completed their annual survey in2450 January, and while the results do include your is that we can improve, there was no harm noted at any of the citation. In addition to the VA, we have had mass choose its DPH on-site at the home conducting infection control and prevention, consultative visits. Each visit includes touring of the facility. Since December 2022, we have had over 20 visits, each with positive results and helpful recommendations and observations to further enhance our programs. An under indicator of quality can be measured in demand for our services. At present, we have a waiting list of both domiciliary and our long term care facilities.
We are working with 15 families2491 for the domiciliary and 902493 in long term care. We also have continuous program conducting satisfaction surveys monthly. Surveys are conducted on our behalf by clinical and independent third party agency. We are2505 pleased to share that Chelsea is a recipient of the annual customer experience reward with recognition in 10 areas noted for overall status action and customer experience, dignity and respect, nursing care, quality of food, cleanliness and individual needs, responsiveness to program to problems, activities, and communication. One of the benchmark awards from Pinnacle is2529 that we are recognized the category recommend to others. This is truly an indication that those who know our veterans home in Chelsea, but else.
Residents and their loved ones will recommend us to others and is an overall indication of their trust and their status faction in us. In addition to striving to provide excellence in care, we are also focused on social and emotional well-being of our veterans. We are road very robust calendar recreational programs with daily opportunities for our veterans to be engaged and purposeful activities. The veterans home in Chelsea is fortunate have community partners from all over the state, our leadership of attended dinners, awards, ceremonies, women's, veterans, network events, stand downs and several other events throughout the year, allowing us to engage and educate on Veterans benefits and the role of the Veterans' home.
And we are very pleased to start opening back up again and are thrilled that several of our community partners were on-site again over the holidays and for weekly bingo and other much appreciated events, including off-site trips to old iron sides and deep sea fishing trips. We are very positive about the future of the veterans home in Chelsea. The home is working towards becoming certified by the Centers for Medicare and Medicaid Services, CMS, and licensed by the Department of health as a nursing home. We've been working diligently with our own staff supported by an outside expert consultant and will be submitting our application as soon as possible. Another important initiative that2624 we have underway is the implementation of an electronic medical record. We have contracted with an EMR vendor and we'll be moving forward with implementation soon.
Our team is very excited to start in the near few As highlighted earlier, we will soon be moving into the CLC state of the art facility that will support vision of tomorrow's care today. In addition to the domiciliary side of campus we are embarking on with DECAMM and their part partner Penrose on the domiciliary campus redevelopment project. which will lease approximately 8.7 acres of the campus to create independent Veterans preference housing and supportive services. The phased redevelopment project will update the campus through a combination of rehabilitation and new construction to better meet2675 the needs of veterans and their family. It will provide updated affordable affordably priced housing options for veterans and their families.
The new development will include 220 plus units2688 of mixed income affordable housing with supportive services with 100% veterans preference. And so2696 support for the continuance of unique mission of providing housing and services for our veterans2702 and common wealth. The Veterans Home in Chelsea is looking forward to our future. The anticipated opening of the community living center, expanding our workforce and our veteran resident population, our community outreach and being part of the new executive office of Veterans Services, all of which will allow us to continue our mission, a mission we are honored to live every single day. Thank you for the opportunity to testify. I am happy to answer any questions you may have about the home and the FY 24, the gross budget SHOW NON-ESSENTIAL DIALOGUE
Thank
you, Mr. Engel. Representative?
REP SMOLA - Thank you very much to the panel for your testimony and Mr. Secretary, congratulations to you. We were sorry to lose you in the legislature, but we're happy to see you on the other side. We know you have a greater appreciation. I think for how that budget process works, and so we're excited to be working with you. In terms of our two homes, can you walk us through the process when somebody submits an app location or available bed space. How long does that process take on average? And so how long does it take from suit to not get somebody who submits post the review process and then gets an available space in in one of the facilities.
ENGELL - I I guess I could speak for us.2775 We are on a first come first serve basis. Our family will2780 submit either electronically or physically appropriate documents, which will support their application. And we will work we then work forward with and into display a veterinary team reviewing those applications and ensuring that the individual meets all eligibility criteria, both clinically and by being a veteran, etcetera. And we work through that process to offer beds as they become available.
BIELE - You what the average wait time is for for Chelsea?
ENGELL - I'm sorry that I don't, sir.
LAZO - For Holyoke, I would estimate six months.
SMOLA - Six 6 months.
LAZO - Yeah.
SMOLA - Sure. So, you know, 144, I think,2823 is great improvement, especially the way that the the process works. I think it's going to serve veterans much better as time goes on. In terms of our bed capacity, so how many available beds do you have the mission always, obviously, once those spaces become available to fill2839 them. But I I2840 guess, from this committee's perspective, we always have an eye, not just how here now, but what happens down the road? So in terms of projections for veterans that are cycling into the age bracket and then the need available bets, where do you see our bed capacity going in the next few years? I mean, our when's our worry point, I guess, for available bed space for veterans?
ENGELL - I guess I could speak. There were studies done within this decade that talked about the demand for services, demand for long term care of our population, and there's also studies that are done talking about long term care. And the need for long term care and the numbers sort of go in2881 different directions. I think that our two homes are flagship institution will always be fully subscribed. I think that they will continue to provide the best fare possible for our veteran population with an understanding.
And appreciation of needs of our veteran and we will also be embarking as part of the work of the council going forward as I commented earlier on understanding the needs of our different population across the commonwealth and the needs for addressing equitable access to high quality care and services. We're not sure exactly what that means, sir, but we do know that we will be exploring that and as part of the portfolio issue concerns that we look at as part2926 of our comp reward.
SMOLA - Very well. I appreciate those comments. I think 1 of the challenges, 1 of the worries that we have as legislators is we see what's happening in the healthcare industry, particularly in our nursing population. And it's no different in the veteran population I imagine as well as that make sure that not only that we can maintain, but we can make sure that we2944 have the availability as those is haven't flow over time. So I appreciate that the the state's gonna keep an eye on that, and and thank you for that. Mr. Secretary.
I know you've only been there a very short period2955 of time, but I know you have2956 your finger on the pulse of a lot of issues relative to veterans. One thing that's popped2960 up in our territory in in Central and Western Massachusetts has to do with VSOs and in some cases, the lack thereof coming into municipalities being able to kind of pick up the responsibility of what it'll look for municipality needs in the VSO to recruit and then retain. Have you seen that in any other parts of the Commonwealth relative to openings in availability for VSOs and various municipalities across the state?
SANTIAGO - Well, thank you for the question, representative. To your first question, let me just also add context as well out. The veteran community in Massachusetts is also decreasing. Right? And so as as Mr. Engell said, well, the concerns for long term care are increasing. Community action is decreasing. With respect VSOs, you're absolutely right. There's a concern with respect to equity engagement across of Commonwealth, particularly the more rural parts of the Commonwealth. There is a desire in the executive office to be fed up.
We have direct operations kind of overseas programming, primarily chapter 115 some annuities. But we've we've also decided to be fed up as well. We just hired actually a deputy director operation to assist with that effort. And we'll be working closely with the VSOs in fact. We do it once a week. I plan myself attending those videos as well to engage them. We also have a training with them once a year. But without question. You're absolutely right. The mission of the VSO, the mission of executive officer driven services. It's critical that we our communication that we're working closely with for another, and that our goals and our objectives are aligned.
SMOLA - Great. Thank you very much. Appreciate it.
REP LIPPER-GARABEDIAN- Thank you, panel. It's really to hear from you today. I wanted to talk a little bit just about the applications for old DPH licensure that's thing that I hadn't heard about, and it's really interesting to me. I'm Vice Chair of the Joint Committee on Elder Affairs. And we're looking really closely at state oversight of licensed nursing facilities and long term care. And so I'd certainly like to reach out to you after this. To get your impressions of this process and also ensure that the bills that we're gonna be considering in our committee, you know, are mindful of any nuances that you all are engaged in in the process of speech. And I guess that would be 1 of my questions is in the licensure process, are there particular and so your vision for nursing facilities that differ from others in in the state.
ENGELL - Yeah. I don't thank you very much for the for the question. We've really enjoyed very close partnership with the Department of Public Health with the Division of Licensure and Certification. We've had ongoing series of meetings with them and they've been incredibly supportive3121 as we've gone through this and3123 navigated through this process, both for DPH license and for CMS certification. So, truly, it has been a level of partnership and support that we've appreciated. And to the second part of your question, I don't know that we necessarily have thought through that question.
We know that services mindful of of trauma3146 informed care, PTSD, the unique needs of our vector population are things that we are certainly most3153 very mindful of and the sort and pure delivery that we provide. And that would be something that we'd be looking at also at the council level as we try to look at accessibility to access to these services across the commonwealth, both traditional long term care facilities and nontraditional ways through the full continuum of care services that are available for our veterans.
LIPPER-GARABEDIAN- And from your testimony and also the materials that the administration3178 provide in3179 advance, is it right that these are private, which are they private rooms or how many residents would be in a nursing facility room?
ENGELL - In Chelsea, they're all hundred rooms, and I believe the same is true in?
3196 LAZO3196 -3196 In3196 our3196 and our new building will3197 have 234 single rooms. We will3199 have 11 rooms that can be doubles if the and so chooses to have a room.
LIPPER-GARABEDIAN- Thank you, guys.
SANTIAGO - As you can imagine, from an infection control perspective, this makes things significantly easier to control the spread of things that can transmit. But, you know, we're excited about it and wrap it all up with the other information with respect to licensure. It's something that we've been talking about last couple of days. It's it's quite a bureaucratic process. I'm support. I mean, we're really focused on how we standardize these homes.
And as you may have heard, there are some differences between how both homes are kind of managed and and and and the strangle's role as the executive director comes in housing provides not necessarily oversight with respect the two superintendents, but a level of3244 of collaboration really focused on how we standardize processes, how we make things much more efficient for the veteran makes it so they can experience the process as streamlined as3255 well.
LIPPER-GARABEDIAN- Thank you all very much. SHOW NON-ESSENTIAL DIALOGUE
Yes, sir.
REP XIARHOS - Thank you, Chair. I think this is fantastic. All of us here are we shade out veterans. Many of us come from military families, secretary. I mean, what a background you have, a doctor, army major, peace core, legislator. It's fantastic. That you should be at cabinet level. I'm very proud of that. And what you're doing is life changing. And just have a couple of comments and then a question. Massachusetts should lead the country. This is where freedom began, we should do everything that we can for our veterans and their families. They shouldn't be living in broken down buildings. It should be in the best that we can offer. I've been to Chelsea.
The new building is incredible even just to look at. But 1 thing I saw there was the love and the passion given to the veterans by your people. The employees, they loved veterans. And I and I noticed that. That was very special to me. The 115 Chapter. Chapter 115 safety net, very important. Even on Cape Cod, it's used often. The VSOs talk about it all the time. The annuity programs for disabled vets, and even for, you know, gold stuff, analysts like mine. We appreciate that. Female veterans. The VSO situation where we want our veterans to able to go to one person and have that person navigate the entire state system and the federal system I've seen at work.
It's fantastic. The question I have is the save program and the mission to stop veteran suicide. Right? My son was killed in Afghanistan Combat. 7000,3382 I think, in America's longest war. More than that have taken their own lives when they come3390 home. And and that's horrible. So we have an 11% increase, thanks to the governor in the proposed budget. That's fantastic. What can we do more to help our veterans that made it home, to overcome PTS and anything else that is troubling them that would lead them to take their lives.
SANTIAGO - Thank you for the question, representative. Thank you for your sacrifice. And there are few people in this room that respect and honor the veteran and the military community wanted me to I appreciate your leadership on those efforts. With respect to save in a whole host of programs that work with PTSD, mental issues. I I concur with you. We can do more. We should do more. We will do more. What I've learned in my three weeks here is that although you're doing some work, we can do it more efficiently, but we can do it in partnership and collaboration. My first visit as secretary was with home based. Program based set up Charleston, really focuses on this that has invested in this.
And has created a number of innovative programs. And as a physician who oftentimes takes care of suffering in the tri effect of mental health subsidies and homelessness, which are incredibly challenging individually nevertheless, if if better in the certain certainly dealing with three of them. It's important that we support and engage these partners. And in this budget, there is an earmark going to them3486 $2 million. It's been there for a couple years, and we're looking to beat that up. But it was important to me with Home base since I don't have my first Wednesday office. They listen, we're gonna work with you close in collaboration. They played a tremendous role in supporting veterans, providing services.
And whether it's them or whether it's another nonprofit across the Commonwealth. The Cape, I was just in the Cape last week, there's an Cape and Islands, Veterans Outreach Center. And effectively, we've doubled their resources over the past year. We given an additional $0.5 million. And with that, they were able to significantly expand their food program. They're investing in better now thing. We plan to do the same. I I was telling them3529 and I'll tell you not to3530 reach another one of you. If there's a dollar bill out there in DC, we plan to go get it. We're hiring grant riders. So we're aggressively going to be getting as many resources as we possibly can provide the services that you so eloquently described.
XIARHOS - Thank you, sir. Thank you.
CRONIN - Mr. Secretary, I just want to thank you, Lynn, and the rest of the panel for your testimony today. We're we're at about an hour. But it we we're all really grateful for the work that you take on. And it it's incredibly impactful and the state really needs your leadership. So we wish you good luck and much success in your role. SHOW NON-ESSENTIAL DIALOGUE
And
Go on mute. For
the folks who will remote be able to ask questions. What's up?
Thank
you. We're going to move right along to the Department of Transitional Assistance with acting commissioner Mary Ian.
Alright. Welcome.
MARY SHEEHAN - DEPARTMENT OF TRANSITIONAL ASSISTANCE - Good afternoon. Chair Cronin, Chair LaNatra and, and distinguished members of the committee on ways and means. My name is Mary Sheehan. I'm the acting commissioner of Department of Transitional Assistance. I appreciate the opportunity to join you to discuss the work of our agency and how the Governor's fiscal year 24 budget a proposal supports our efforts to serve our most vulnerable residents. Over the upcoming months, we are preparing for the end of the federal administrative flexibilities related to the public health emergency and3648 supporting our client through termination of the extra federal food benefits that they have come to rely on.
The Haley Driscoll Administration Fiscal Year 24 budget proposal will enable the department to advance the agency's priorities and build on recent success This past year, the Supplemental Nutrition Assistance Program, SNAP, the Transitional Aid to Families with Dependent Children (TAFDC), The Emergency Aid to the Elderly, Disabled and Children (EAEDC) all have continued in seeing continued increases in the number of households served. And we expect to see continued high diesel levels as the administration continues work on the integrated eligibility and enrollment project. About 640, 000Massachusetts households receive food assistance SNAP.
That's 43% higher than pre pandemic levels. And DTA's economic assistance or cash caseloads continue to be impacted by state level legislative changes that expanded eligibility, including a 10 % increase to the income thresholds this year on top of previous year's increases as well as the elimination of the asset limits for these programs TAFDC and EAEDC caseloads are up 30 and 47% above pre pandemic levels actively. To date, DTA has managed the growth in caseloads with the operational flexibilities that federal waivers and the public health emergency have provided as well as through over time funded through ARPA. The department is preparing for the end of these flexibilities by increasing staff hiring.
To help manage the high higher workloads and separate from the House one budget proposal a fiscal year 23 supplemental bill has been filed by the Healey Driscoll Administration to better support3778 a DTA staffing needs and reduce the need3781 for over time long term. DTA respectfully requests full and expeditious passage of3787 this bill. DTA strives to maintain a high level of customer service even while facing these increased caseloads. While DTA offices are open across the state to provide in person services, the majority of our clients choose to do business with us through our enhanced online and telephonic platforms, including DTA Connect, our mobile app and online portal.
This is particularly important for the over 300,000 clients with disabilities and 236,000 seniors for whom travel to our offices may be difficult. DTA Connect is now available in Haitian Creole in3830 addition to English, Spanish, Vietnamese,3832 Portuguese, and simplified Chinese. DTA also recently added new features and security improvements to the mobile app. All reception areas now have pictorial communication boards to support clients who are deaf, hard of hearing, nonverbal, or have limited English for global proficiency. And we recently procured a new interpreter services vendor through which the agency has expanded its video remote interpreter access to all of our offices.
So overall, more than 300,000 clients with disabilities benefit from our inclusion of universal design principles in local offices, promoting an accessible and equitable client experience. The administration is committed to promoting food security in the Commonwealth3882 and strength thinning its local food systems and economy. The 2023 Consolidated Appropriations Act created a permanent summer EBT program that allows for $40 in food benefits per month for eligible children. The fiscal year 24 House one budget deposit includes $500,000 to support the necessary systems changes to implement this new programming time for the summer of 2024. Half of that cost will be reimbursed by the federal government.
I especially want to thank the legislature for supporting the $130 million request for the administrators administration's fiscal year 23 supplemental budget that creates an off ramp from the extra step emergency allotments benefit that federal government provided in response to the pandemic. That significantly increased each household's monthly snap benefits. This extra federal food support ended effective February of 2023. Another important part of DTA's work is its support of our clients' economic mobility. Through DTA's pathways to work program, department is engaging with families to connect them with employment, education and training that lead to meaningful tailored opportunities and high demand careers.
Overall, the administration fiscal year 24 budget proposal includes more than $29 million to support this work. This includes an3978 investment of $3.25 million up $1.5 million from fiscal year 23, the Massachusetts Office for Refugees and Immigrants (ORI) to enable them to serve the info of immigrants to the commonwealth through their employment support services program. Funding at both DTA and the Massachusetts Rehabilitation Commission (MRC), also supports expansion of our ongoing partnership, empowering to employ, to engage DTA clients with abilities in vocational rehabilitation and job placement services at MRC. I want to thank Commissioner Wolf and her team at seen for their partnership.
Finally, and unfortunately, we have seen a substantial increase in criminal actors US systematically targeting low income4029 households and stealing their benefits or using stolen identity for nation to initiate fraudulent benefit applications. While DTA has implemented multiple strategies to protect clients and their benefits, we need resources in order to successfully slow down or stop these steps. The administration's budget proposal includes $310,000 to purchase new functionality from the state's EBT vendor to allow clients to remotely lock or unlock their EBT cards in the vendors mobile application, we urge you to support the funding request for this initiative.
I I also want to thank the legislature for supporting the $2 million request in the administration's fiscal year 23 supplemental that supports clients who had their benefits stolen between April first and September4083 thirtieth of4084 2022. This funding will support a significant number of clients who are not covered under the 2023 congressional consolidated appropriations act or we reimbursement. Thank you all for your continued partnership in serving the Commonwealth's more vulnerable residents. I look forward to working with you as we navigate the end of the pandemic flexibilities as extra food benefits while continuing efforts to protect our clients from scams. I'm happy to take any questions you may have. SHOW NON-ESSENTIAL DIALOGUE
And I failed to introduce some my CFO, extraordinary. Rachel Goldstein. Rachel. Sorry about that.
Thank you. Missioner. Any questions from a committee? Oh,
yeah. Please.
MIRANDA - It feels cool to I hope this is on. Thank you so much, commissioner and CFO. I actually have quite a bit of comments and questions that can prepare to Okay. Add the honor of serving the second supper with your neighborhoods of Hyde Park all the way to the South and so many of my constituents actually either receive SNAP benefits or TAFDC benefits. And so I'm gonna start. So nationally, TAFDC and Massachusetts, TAFDC and Massachusetts choose to experience the drastic decline, in some cases, to reach the families who may need it the most. Access to transitional aid has been increasingly difficult.
Particularly for some of the families in deep need in our communities. We know at the federal level, policymakers have not increased and a block grant since its inception. And as a result, our aid limit is kind of low. The maximum benefit for a family of 3 with no income currently is $783 a month, and the federal government defines deep poverty as making less than a $1036 a month or a family of three. Is there a desire from the department to lift these come thresholds and asset limits higher than what they are and increase the grants. I know that you mentioned has been a 10% increase in income and in elimination of asset limits, which is incredibly important.
That's my first question to desire. The second is, House One proposed EAEDC line item. Sorry for the acronym. I'm trying to make and shorter does not include language requiring advanced notice to the legislature before the administration cuts benefits or makes changes in flexibility? So I just have a second question. Do you plan to provide notice or increase that capacity before you make cuts to program And then the last question in this part of the question and comments. As of March second, we know that the extra COVID refunds have ended. This means that over 640,000 households in Massachusetts are stripped of the benefits.
Never seen an extra federal snap payment. And we jumped in there in the supplemental budget to support 40%t of that, which was at a minimum of $95 per month for households. Are there any plans to ensure funding is giving to those families4285 who come to rely on these benefits? I know you're getting an off ramp. But $95 isn't a lot of money, but people really, really need it. And so we've come in and kind of saved the day a little bit with the4297 40% after that runs out, families are still gonna be hungry. And so we're just trying to figure out how do we actually build security needs.
SHEEHAN - Alright. Thank you so much for that. That's that's fine. And my short term member issues. I had to write down the questions. But yeah. Natio1nally, TANF caseloads are up, but in message, I mean, I are down. So but in Massachusetts, they're actually up. And that is due to the increase in the benefit thresholds because when the benefit thresholds increase, it actually increases the eligibility thresholds as well and the asset limit elimination really you know, brought on more cases in both TAFDC and EAEDC And your question in4349 that regard was, you know, regarding the the governor's budget and increasing benefits further.
Right now, our focus is on on transitioning folks through our employment services, our pathways to work program, trying to get them to a place where they have some economic mobility. And the governor's budget does include two initiatives. One investment is to help us streamline the process to issue a $300 infant support payment for any eligible child or a family with a newborn for the cost of cribs and supplies for a newborn. So so that is in the governor's budget as well as stipends for participation by clients in our advisory boards to get the client voice at the table. We feel like that will help us in terms of policies and procedures to understand from their perspective what they're experiencing and how we might be able to help.
As far as the notice before any program change, is, I mean, generally speaking, if if we were to be looking at a deficiency in our any of our case accounts. We we we would prefer to work with the administration to to see if there's an appetite and available for supplemental funding before we would make any changes to to eligibility or benefit levels, and that's generally and our our approach. We would work with EOHHS and and the administration. And then if we were to, you know, absolutely need to to make any changes, we would work with you all as well. As far as the emergency allotments, though, we've done a lot of work on this in terms of outreach.
Making sure that everybody is aware that these extra benefits that have been issued for three years now that have really helped. I think, not just the families, but quite frankly, the Massachusetts economy. These are federal benefits that helped that brought everybody's payment level up to maximum for their household size. And with those being a federal benefit, and and the4514 kind of surprise early ending of those that4518 came through the economic Bill, I can't remember. The Consolidated Appropriations Act, that that federal bill. That kind of took us by surprise that it was an early ending. So that is where the administration, you know, stepped in and filed the funding in.
Thank you so much for supporting that. That allowed some of the ramp down off of that benefit. We, you know, we don't control what the federal government does. We we did work with them in in trying to get their attention on this. Because it really is a a4558 significant issue for a lot of our families. Well, for all of our families, but a lot of of4564 families in Massachusetts. So what we have been messaging is really important. Certain of our seniors, for instance, can increase their base benefit by providing us with information about their medical costs or other deductions that can help to increase the benefit level that they receive on a monthly basis. After this the three months 40% benefit. So that will be critical.
We've been kind of marketing that, all every chance that we can, talking to our clients, talking to our sister agencies to make sure that folks contact us, give us that information. We've made it very easy easy for them to do that. They just have to fill out a form that says that they're what their medical expenses are, and that also includes, you know, over the counter things. So there isn't a real hardship for them to do that. And will help a lot. Yeah. And and the other thing we're doing is is providing them with information on where the food banks other resources might be they need housing assistance or or any other type4643 of support. We're providing them with nation so that they can try to find the help that they need.
MIRANDA - Thank you. And I have two more questions, but you don't have to to them today because I know my colleagues need to get to this. I had a real story about SNAP that in my district where a family at King Single Mother lost $2000 over a weekend just by going to a local store. She didn't drive So she didn't go to a Stop and Shop or Shop. She just went into a small boutique. And over the weekend, last there are not only social security benefits, but lots her SANP benefits because of fishing with the machines that she utilized. And I'm really happy that you have the $2 million in each one around replacing stolen benefits.
but I'm concerned there isn't really wraparound language to make sure that people are fully reimbursed. And so I'd love to see some language change to make sure she called my office almost desperate in tears around that. She couldn't live another day. Would of these benefits. And so it's incredibly important that they get reimbursed in a timely manner with its no fault of their own. And the last question of come is about the effect. I think most of my colleagues have heard from your constituents since you haven't. As soon as they get a job, and even if it $20 more a week. Sometimes they're very scared that determines that they should be getting less benefits.
When really in reality they they need a sustained benefit level even though they've gotten a new job. Many of them are working jobs. They still don't pay them enough in Boston, the median income in my district is $17,000 to $33,000 that people are making a year, and it takes over $52,0000 a year just to survive. And I'd like to say4754 it's probably close to $100,000 in4756 the city of Boston. And so I'd love to know about if you guys have gotten data, around how many folks that actually impacted each year with DTA, with cliff effects that actually increased money and getting a pathway to employment actually decreases their funds and how that is impacting them. Thank you for SHOW NON-ESSENTIAL DIALOGUE
both chairs.
watching. Okay? And you're you're
good with holding on those? Yes, sir. I
got a hard call. It's hard to hear today. Thank you, Senator. Thank you, Senator. Representative.
Make
SMOLA - Commissioner thank you very much a testimony here today, and we appreciate all that you and your team do, you know, how important and and valuable transitional assistance is to people all across the common off of Massachusetts. I'm I'm gonna expand a little bit actually on what senator Miranda was just talking about relative4801 to fraudulent claims because I I think we've all seen in our offices similar cases where you have constituents that communicate with us that say, I've got a situation here where I was supposed to have particular amount of resources here and now they're gone.4817
And I think I'm the victim of some sort of fraud. Can you define for us a little bit4821 how those fraudulent claims are process. What how did the rises of fraudulent claims? Somebody whose identity was stolen, someone whose benefits were stolen, somebody that submits a request for transitional assistance but gets denied. How do you classify that? And also, how do you quantify it in terms of the impact that it has. So financially, what kind of number are we talking about for fraudulent claims financing?
SHEEHAN - Yeah. So what's happening is is that our clients are using their EBT cards in, you know, their local neighborhood shop chopping. And fraudsters are putting a device right on the POS or the ATM machines and capturing their card number and their PIN. And then what they're doing is cloning the card and using it to transact the benefits4871 so they're stealing in, you know, these benefits from the client account. It's4876 coming at a very difficult time when you know, sending the message, the emergency allotments are ending. Try to stretch those SNAP dollars, you know, hang on to them and then they go to the store and they're wiped out. So this is a real national challenge.
It's not limited to mass instituted. In fact, we're seeing a lot of the transactions where the benefits are actually being stolen or out of state and not even in Massachusetts. And so for us, what we are doing is we're tracking that. We have to contact the client and verify if we, you know, if that they're we we have to do a little bit of investigation. But if that way to make sure that this is an authentically, you know, stolen benefit. If it's a cash assistance benefit, then we are re reimbursing if it's a SNAP benefit, those are federal, and we're not we have no authority to to reissue those benefits. Yet.The consolidated I can never remember the name of that bill. Consolidated Appropriations Act, the federal bill actually authorizes a basement.
But it limits it to any benefit stolen after October first. And we had almost $2 million stolen no. Actually, in and $1.5 million stolen prior to that that we know of. And it also limits the amount that the reimbursement can be. To up to two months of their benefits. So if they were saving their benefits as of the emergency allotment's ending, they will be limited in in what gets reimbursed. The bill that I believe is gonna be going to conference. I don't think it's in conference yet, has two different versions of that. The the house has you guys have it aligns with the governor's proposal, which aligns with the federal reimbursement and the senate version.
How has more of that what senator Miranda was talking about where it in it tries to get5015 to the full own benefit amount. So we'll we'll implement whichever bill comes out or whenever ever compromise happens through that conference committee, and we'll try to get those benefits out as soon as possible. We we are already, you know, working on5034 the requirements of5035 the systems changes to be able to do that.5037 It will take a little bit because of the uncertainty on the bill as to what programming we need to do. But once I mean, rest to share. This is a a big this in the emergency allotments are are high priorities for the department, and we will do everything we can get those benefits out as soon as possible.
SMOLA - Thank you for that. That 310,000 that you had referred to before relative to the mobile app where somebody can lock or unlock lock. Is is that supposed to be a super effective tool to try and reduce this fraud or somebody stealing identity? Can you tell us just quickly how that works?
SHEEHAN - Yeah. It should do that. Definitely, more effectively. So replacing the changing your pin is which is what we've been messaging our clients. It works right away. However, if the that client goes to another location or the same location and the information is stolen again, they're gonna have benefits still again. So what the locking and unlocking will allow them to do is only unlock their now, at the point that they wanna transact the benefit and use and use them. So they'll be able to access the benefit and then immediately lock it Could it, you know, could something slip through in that short time window potentially? So I I can't guarantee it a 100%, but it will definitely be hugely effective for our clients.
SMOLA - And last question on this. It wouldn't so so somebody goes they they go the POS identity gets stolen when they do the POS or an ATM. How do you know that it's fraudulent? Is it because the individual reports it? Or is it because it's something else in your system that you pick it up? So I'll I'll take, you know, as an individual, I I walk in and I go and I buy groceries, but I'm not necessarily paying close mention5145 always on what I spend on the5147 bottom line. My wife's a lot better at it than I am.
So when she goes through the bills, she she may see and bring this back. But I5153 don't know if I've, you know, spent a hundred bucks or 50 bucks or 70 bucks. And I imagine that some individuals they utilize the electronic benefit system may not even be aware the fact that they've been hacked or their their identity has been stolen or they have resources taken out unless they're keeping really solid track back of every single one of those transactions. So how do you know that fraud is is taking place when somebody may not be on top of it as an individual collection?
SHEEHAN - Right. Yeah. No. That's a good question. And we have worked you know, we we just prepared a an in analytics tool that takes a look at where there might be, you know, rapid transactions happening out of state, which is a clear indication that you know, somebody has cloned a a whole bunch of cards. And so so we are in we're in complementing that so that we'll be able to locate any clusters like that. And as far5211 as the clients are concerned. I think, you know, the thinking is that for for most of our clients, because they're so reliant on this benefit.
They are very aware5225 of their balances and they are5227 tracking it and you know, we have clients come into our offices all the time upset about this issue and and rightly so. And what our staff will do is is actually take a look at the transactions, print it out for them, have them, you know,5244 take a look and and and you can see it on the transaction that, you know, they've been in Massachusetts shopping on same day that something is transacted in Texas. So we're able to verify that way that this is5261 fragileant. And we'll like I5264 said, if if it's cash, we'll reimburse it. But5268 if it's snap where we will be. We will be. It's hopefully soon.
SMOLA - Thank you very much. SHOW NON-ESSENTIAL DIALOGUE
Thank you, representative. Before we get to RepPEase. I just want to address my colleagues on team. If you have a question, could you please text either myself or senator Roman, and we move recognize you with the question. Thank you, representative.
PEASE - Thank you, and appreciate it commissioner. So yesterday, I was having a conversation with our agent person. And she was talking about the food from the western mass food bank and that they did not receive any protein at all with a lady's shipment to provide food, and she also mentioned that homelessness and and mental health issues for the years error. I'm an increase quite a bit over the last few years. But have you seen that the things like she said, we couldn't even get any peanut butter. It's always a nice, you know, staple to have on hand. And5324 and I'm not sure if you're seeing that across a state or if that's a western, Massachusetts issue right now. But the food banks, so they have issues.
SHEEHAN - Well, we we don't administer anything with the food banks, but we do you know, relationship with them. I'm I'm sorry. I can't really speak to.
PEASE - I just figured if you maybe heard something from them to really short.
SHEEHAN - Yeah. No. But we we can definitely reach that.
PEASE - Thank you.
Thanks. Thank you. Rafael, and then we'll get to Rafael.
REP BIELE - Good afternoon, commissioner. Thank you for your testimony and also for everything you and the department to to help most vulnerable in our community. Just wanted to put something on your radar to start a a conversation beyond you on today's hearing. I've recently heard from providers in my district who had issues accessing5372 and navigating DTAs funeral and burial assistant program, which helps families make final arrangements for their ones with dignity and respect. So I know it's not specifically, you know, something that we expected to talk about today, but just wanna let you that there are issues out there and hope to work with your team to resolve those so that people can make arrangements for their loved ones during, especially difficult times.
SHEEHAN - Sure. And I can have staff reach out if that appropriate. I mean, we we wanna make sure that we're helping the funeral homes. You know, it we we if there's a specific issue, we just need to figure out what's going on and and resolve it. So I'm happy to work on that with you.
BIELE - Appreciate that. Thank you. Okay. SHOW NON-ESSENTIAL DIALOGUE
Thank you, Rafael, repaggerty.
REP HAGGERTY - Thank you. Now, I'm sure. Commissioner, what type of steps are we taking to claw back some of this money that's been fraudulently utilized. And and what steps are we taking to go after some of these bad factors. If in fact, this is something that's going on at a higher rate than certainly pre pandemic. And I again, maybe that's a question more for law enforcement, but I'm wondering whether or not you're teeing up a law enforcement and what that looks like so that we're we're tackling it.
SHEEHAN - Right. No. We I would love to prosecute these folks believe me, and there's nothing more maddening to me than somebody stealing benefits from the people that need it the most. We are working with the local law enforcement, state and federal authorities. We are, you know, like, I've said, we we have our focus primarily, we're we're not a law enforcement agency, so our focus has been on protecting the client. But these are large scale schemes. These are not, you know, by the onesies. We're we're seeing it come in big waves, you know, and5493 and go away.
So we will just continue to do that. We are hoping that there'll be some traction on some of the some of these cases that we'll be able to prosecute in California, they have prosecuted some, and that I think will really help to be serviced a deterrent. I mean, we we don't even know if if some of this organized scheme could be orchestrated rated within the country, some of them produce outside of the country. So this is a, like I said, a nationwide issue and the USDA is looking at it closely and investigating, and we'll provide any information. You have any contacts in any areas of law enforcement, we'd be happy to work with you as well.
HAGGERTY - Thank you. SHOW NON-ESSENTIAL DIALOGUE
Yes. And we're gonna finish up with Senator Cronin.
CRONIN - Commissioner, thank you for your testimony here today. In the department's 2022 annual report on the standard budgets of assistance for TAFDC, the department acknowledged that grants of lost value will the last 30 years, for example, the federal property line in 1989. We've gone up 129%.5571 Well, cash assistance has gone up 32% I'm just wondering if you believe that the grand amounts provided by the department are at like what to meet the purposes of the TAFDC5586 goal?
SHEEHAN - That's a great question. And for those of you, familiar with the report. It also explains about the the full package of benefits that clients receive. So you know, we there's no expectation that a client would be able to meet all of their needs with $700 as you voted. So it's really for us a matter of trying to get the5614 clients engaged in the employment training and the up up skilling so that they can, you know, get a career ladder that pays a good wage and is not, you know, leaving them stuck in that cycle where the cliff effect comes into play. So yeah.
CRONIN - That’s I have data on hand for how many people work. You, you know, you qualify success moving to that program.
SHEEHAN - Moving through our pathways5645 to I5647 don't have data here. I can try to get that for you,5650 but what what I do5651 know is that we've have seen an increase since we redesigned the program in the number of clients that are getting getting jobs, leaving for earnings and a decrease in the length of stay for clients by seven months. So they they've been able to, you know, move off of assistance. But if as far as, you know, data on how many outcomes I I'd have to get back to you on that.
CRONIN - Okay. Thank you. SHOW NON-ESSENTIAL DIALOGUE
questions.
Great. Thank you, commissioner Sheehan. We really appreciate you being here today and providing your testimony.
Thank you. Thanks a
lot.
Like to invite acting commissioner Wearden from Department services.
CECELY REARDON - MASSACHUSETTS DEPARTMENT OF YOUTH SERVICES - Good afternoon. Chair Cronin, Cahir LaNatra, and distinguished members of the Joint Committee on Ways means. My name is Cecely Reardon and I am the acting commissioner for5726 the Department of Youth Services with me here today is our Deputy Commissioner for Administration and Finance,5731 Matt Cole. And also in the audience, we have a Chief Our Chief of Staff, Nokuthula Sibanda and our Bud to Director, Christel LantinI am honored to appear before you today to speak about the department's mission, priorities, and the fiscal year 2024 house One budget. This is both an exciting and a challenging time for the department.
We are, as you know, the Commonwealth Juvenile Justice agency. When I last appeared before the joint committee, DYS when was in the beginning stages of launching a new strategic plan with a new mission and a new vision and a set of core values that we hope to embed in every aspect of our work. Since that time, we have enlisted staff across all roles. We've enlisted our young people, and we've enlisted parents to help us work with our executive team to identify a series of strategic goals that embody our values and that we believe provided framework to help us fulfill our mission and our vision. The strategic planning process identified tremendous opportunities.
For DYS impact the lives and futures of the young people in our care and custody, as well as new ideas about how to best partner around preventing system involvement in the first place. It also highlighted the challenges we face as our workforce and our young people recover from the COVID-19 pandemic. Like other use serving agencies, we have needed to develop new strategies for recruiting and retaining qualified staff. We have also needed to respond to the pandemic’s compounding impacts on a population of young people who already face significant obstacles. And Governor Healey’s proposed fiscal year 2024 House One budget of $182.6 million provides impact actual support for our strategic plan investments.
And consistent with our mission, it allows us to improve and expand preventative and rehabilitative services for our young people, as well as promote family engagement and community supports and ensure a fair and equitable juvenile the system for all. As you all know, DYS has seen a significant decline in its traditional census over the last 10 years. Much of this is attributable to our significant investments in preventative work with other child serving agencies such as DCF, DMH, as well as DPH. And our juvenile court partners as well, including our latest partnership with the Office of the Child Advocate, where we have partnered to create new diverse in learning labs, five of which in counties across the state. This decline in census has really necessarily required DYS to write size its continuum.
And invest in the services and the supports that this distilled population of young people We now serve a population of young people who are on average older. On our detained census, young people to be at least 16. And on our committed census, we are seeing young people on average at age 17.8, so very close to 18 team. Our young people have significant trauma histories and trauma reactive behaviors, and that requires significant staff responses. We also have young people who disproportionately hail from impoverished communities plagued by systemic racism. Our young people have diagnosed learning differences that are often years behind in school when they come to us.
And especially now, our young people come to us with significant unmet behavioral health and substance use needs. Governor Healey's budget allows us to meet our young people where they are right now and provide the individualized treatment and supports that they need to not just return safely to our communities, but to thrive. Let me give you some highlights. So the governor's budget allows for us to make some quality of life investments in our residential programming that reflect youth voice youth voices I prefer to say because it's not just one young person's voice that that fits into this equation. And also translate, we believe, into safety in our programs and positive community connections.
For example, the budget allows us to pride our young people with culturally responsive hygiene products, sourced through local small businesses, creating potential employment pathways. The budget also supports our expansion of Wi Fi capabilities in our facilities, which we've used to enhance family engagement opportunities, support virtual court hearings, and create other types of opportunities for virtual programming. The Governor's budget also allows us to increase our investments in educational and career readiness supports like early college, our partnerships with local community colleges, and trade certificate programs.
Our research has shown us actually partnership with Boston University and can't claim all all responsibility for that. But what our research has shown us is that DYS related educational and career readiness supports for committed young people as well as for our youth engaged and volunteer services post discharge are key factors in preventing and protecting6041 against recidivism. We've also learned that while we want every young person to see themselves as college material, that that's not every young person's chosen path, nor should it be. And so what we've we've done and we're very excited about and we're very excited about the support that the proposed budget will provide for this as we really try to increase our vocational investments.
We have a skill up initiative that we a procurement actually that we made last year, and the governor's budget will support that and allow us to expand it. And things that we're doing through that procurement are things like repurposing spaces in our existing sites to support additional vocational opportunities like we converted and underutilized space in our metro region into a fully functional barbershop. And the budget also allows us to invest in an all news, grow continuum. I think many of you have seen recent media coverage about how hard the pandemic has hit young women, and we are very well aware of that. And so we are using these opportunities to create an entire new girls continuum that provides community based gender responsive services and each of our five regions.
The budget also includes outside language, and that outside language enhances the preventative power of our voluntary services since our youth engaged and services initiative by allowing young people to request or resume voluntary services at any time post discharge until they turn 22. Now, these critical investments for young people supported by our6129 governor's budget necessarily also require us to make investments in our work force. We cannot provide young people the programming they require without first ensuring that we have a workforce that is stable, feel supported, valued, and safe. To that end, the budget allows us to invest in updated and expanded training that addresses the complex needs of the young people we have today.
Including gender responsive modalities, how to best support the unique needs of LGBTQ Youth, as well as traffic Youth The budget also allows us to invest in recruitment and retention strategies to ensure that we are hiring, developing, and promoting a workforce who reflect our young people and the communities we serve. We are6173 engaging with existing staff to utilize their personal networks through the convalescent referral bonuses. We're supporting new staff by expanding our pilot staff mentor program for all of our regions. We're also improving staff safety through a pilot of personal safety alarms to ensure we know immediately when a staff member needs assistance.
The budget also importantly supports our internal work on race equity and inclusion designed to engage our staff in exposing and eradicating implicit biases and educate them about the impacts6204 of racial trauma on our young people, their families, their communities, and our workforce. Hours. These are just some highlights of the critical work that Governor Healey's proposed budget supports. Critical work that we believe will alter the entry of young people before they enter DYS, as well as support their state and successful returns to their home communities. I look forward to working this committee and the entire legislature to fulfill our core goals and our objectives. And I thank you for this opportunity and for your time. I'm happy to answer any question you may have. SHOW NON-ESSENTIAL DIALOGUE
Sorry. I feel like I'm a broke record here. Today, but thank you.
MIRANDA - For most people that know my story, the men in my family were all either incarcerated at some point in time or I lost a young brother in 2017 that really catalyzed me to run for office. And so this is the issue I care a lot about in terms of juvenile justice. And I just wanna share some facts with you about our system of juvenile justice, and then I have a question about data collection. Massachusetts is one of the worst rates of racial disparity for youth incarceration in the country, despite more than a decade of reforms to reduce the pretrial to attention of young people.
While youth of color and all encompassing of color make only 365 of the youth population in Massachusetts. They represent close to 70% of those in custodial arrest and 75% who are detained or committed to the Department of DYS Black youth in Massachusetts are 8.8 times to 10.1 times, as likely as white youth to be detained and committed to DYS. Respectively LatinX seven times to 8.9 times more likely than what you to be detained and committed to DYS. For youth incarceration and national comparisons, but found that Massachusetts has the ninth worse black, white disparity.
And the first, whenever one, in worst Latino white disparity in the nation, and that's by the census project. A couple years ago, when I was a representative. We had cases of6357 four young people6358 coming out of DYS facilities who a dead within two months in Boston's neighborhoods. And, you know, I boggled my mind on how we're supposed to rehab young people and keep them safe and ensure that they're not going to the adult car cell system, but it seems like there's a direct population, a direct court relation between young people and DYS facilities that are either returning back to the DYS facilities.
If they're under the age of 18 going into the adult 15 prisons that we have in the Commonwealth or sadly some of them not6396 even making out within 90 days of the DYS system. And because I represent a community that's largely of color, this is something that has been on6407 my heart and mind as we begin to fix the system. This is consistently the legislature, advocates and family partners have worked to6416 success, demographical information without success. You talked about this strategic plan, so I really would love to get your sense of what has the system done differently to collect the data?
We often can't change or improve things we don't measure. And it's incredibly important as you're you know, as we give more money to systems that we actually want to see these disparities actually reduce and then be eliminated and that we're making strides to improve the system. To hear that black youth are eight to 10 times more likely or that the word the worst in the nation among around Latino white. Does severities in the DYS system is disheartening. And I want to make sure that we're improving the system before we're adding more funds to a system that may be Okay.
REARDON - Thank you, senator Miranda. I I share your concerns very deeply prior to coming to DYS, I spent 17 years as a public defender representing young people6475 in Roxbury, Dorchester, and all of the communities in Boston. Part of the reason I at DYS is that DYS was the only agency really working to try to reform the system. At that time, DYS had brought actually, it's now 15 years on that the Department of New Services brought in any EKC foundation juvenile detention alternative initiative. That is a national a national initiative that's in most states that is specifically designed to reduce the use of detention.
And the hope in the KC Foundation model is that by reducing the use of detention for young people who don't need to be in detention, that you will thereby reduce disparities. Like every other state in the nation however, Massachusetts has seen that while we have had a I think since 2015, we've had a 47% decline in our that we have not seen a decrease in disparities. We track these numbers daily, and we provide these numbers in our annual we provide these6531 numbers. We're actually working with the Executive Office of Public Safety and Public Safety and Security.
I'm sorry. The Executive Office of Technology, EOTSS, to pilot a a new JDAI dashboard so that we'll have data even more readily accessible. We park with the Office of the Child Advocate on they are using Juvenile Justice Policy and Data Board and the report that they publish every year. And so we actually and we respond to hundreds of public record requests every year. We we are actually most entities in Massachusetts when they are using juvenile justice data, they're getting it from us. So that6564 is something we actually take some pride in, is that we do elect a significant amount of data.
Because what we realized a short not probably not soon enough, is that for many years, the mantra was we don't control our front door. And so we thought, okay, well,6579 we're just we just accept the young people who come to us. And if there's racial expertise upstream, we'll do our best not to, you know, not to exacerbate them. We'll try to mitigate them. We'll try to make a difference. But what we came to realize is that that is not enough and that there is preventative language and our statutory mandate that requires us to step up. And that's what we started with JDAI, and now with our partnership with the Office child advocate around pre trial diversion,.
We're really hoping that that can also make a huge difference in that pipeline, because we feel those disparity is very, very hard. It just it it it we we just take it to heart very strongly. And it's something that is also part of our no racial and racial and race equity work. What we've tried to do over the last six to seven years is educate all of our managers at educate all of our decision makers about the impacts of systemic racism, about racial trauma, about implicit biases, and how all of that impact makes the decisions that we make as an agency, whether6641 it be about where a young person is placed, how long a young person spends in treatment?
When to return them from the community? And to really make sure that we are looking at each decision point through a race equity lens. We're also trying to do that with our staff in terms of the hiring decisions we make, the firing decisions we make, decisions about discipline, all of that. We have made a huge commitment a huge investment. Actually, that's one of the additional things that this budget allows us to do is to continue our relationship with some of our contracted providers who are providing us the technical assistance for those trainings. We have our own in house race equity training that every single employee attends.
That we had actually our entire workforce attend, and now it's part of our basic so every new employee also extends it.6685 We've used that to also create spaces for our staff to have difficult conversations patients so that they're prepared to have the difficult conversations necessary with young people about current events. So we we take every incident that happens in our communities to our young people extremely seriously. We do investigations into what has happened if a young person does not successfully return to the community. And we've also retooled how we look at when we bring a young person in from the community.
Because we know that there's only so much we can do in residential treatment for a young person. We have to give them the tools so that when6724 they come back to their communities, they can apply what we've helped them learn to their own situation. We can't just simply put them in sort of hermetically sealed space and hope that if we toss them back into everything else that was going on for them, that they'll somehow swing We just can't do that. So one of the things that we really are focused on is when our young people are in the community is building a very solid team around them. We have a caseworker that starts from the moment of commitment.
With that young person, we have family engagement specialists, we have job support, special we have deep development specialists, all who form a team around a young person in the community. And the goal really is for our young people to be in the community where we can then work with them them to fine tune a plan that ensures their best success, where we can actually pull them back in if we need to because things have not gone quite right in a safe and productive way so that when they finally come to a point where they're6779 ready and for discharge that they6781 are the best equipped they possibly can
We also, in 2014, or maybe in 2012, we stopped we took a very hard look at our voluntary services opportunity. That's been on the book since 1973, but it wasn't until 2012 2013 that we started offering it to every single young person with an aggressive sort of full court press to make sure every young person knew that was available. And what we see now is that 68.9% of young people leaving our custody request and accept voluntary services. And the average length of stay involved voluntary services has ticked up to about 16 months. And we're finding that participation in voluntary services has had a significant protective impact on recidivism.
We find that it can be as much as a, you know, 8% decrease in recidivism6831 if a young person6833 participates in6834 our youth engaged in services. It's really an initiative because we talk about programs as sites. But so it's an initiative. And those services range from educational support and and support, housing support, clinical support, and they all include case everyone has a case manager as well. The outside language just so it's clear. That allows young people. When we first expanded it in 2016, I believe, to include 20 year olds up to the age of 22, previously it ended at 21. So our youthful offenders would leave our custody.
And not have any opportunity for voluntary services. So we expanded the legislation to go to age 22 consistent with other agencies so that our useful expenditures would also have that opportunity. When we did that, we initially included a 90-day sort of period of time where someone who rejected services could come come back. And we thought that that would allow us to sort of monitor how many young people were coming back, what we could really afford to do. And what we found was that that was really contrary to positive development. Our young people need to be able to change their minds as adolescents and older even6898 older adolescents do.
And so now we've removed that 90 day cap.So that young people can come back anytime until the age of 22. And those are some of the things that we're trying to address the really critical issues that you raise, you know. And it's it's something we're investing in looking at national best models. Every everything we possibly can to try to make it most likely that a young person will be successful. We don't always win. And and those situations break our heart. Actually, we've now brought on a series of trauma6932 responsive specialists to work with our staff and also our young6937 people to influence how we care for our young people. Deal with just those situations.
MIRANDA - Thank you so much. In the last two questions, I'll leave for another day I can email you. And maybe we can go visit the Harvard street location. Absolutely in my district. I'm really excited about going to see there. This is for the A&F sorry. I forgot your name. Matthew Cole. Hi, Matthew. I saw in the budget that you requested or there's a line item around the Second Change Act, and it was for $25,000, and that just felt really low. For me, I don't know how many young people have in their statewide DYS system, and so I'd love to hear more about that maybe another time. And then you you spoke a lot about women and girls, and that is something we have seen in alarming rise also in Boston.
A sad statistic is out of the 50 to 70 homicides we've had in Boston over the last few years. Almost like 10 to 20% have been girls or trans young people. And that began to, like, really spike up my interest on, like, what is happening to our girls? Are they in facilities? Are they being over criminalized? Is there something happening in our, you know, gain culture in the city or just even street culture that is impacting girls differently? And but I didn't see a specific line item or request on how you're serving girls. And so I didn't know whether you're gonna come to us and say, hey, we see this alarming trend and we want to increase that budget line item to be able to better serve girls.
REARDON - So actually, the budget itself includes what we've factored in to be about $1.9 million that's going to specifically support the restructuring of our girls continuum. And what we found is that while young women comprise approximately 15% of our entire census and LGBTQ+ youth about 6% Those populations absolutely require specialized attention. And we actually we we've spent now the better part of a year and a half with our internal and external experts building out a model for a new girls continuum. We hope to issue you a request for responses within the next 2 months to really try to launch something in the fall.
And what we're actually doing. So we currently have about a 54% utilization rate in our current growth programs. But they are they skew towards hardware secure locations. So what we're trying to do is completely revamp that. And so we're seeing a net decrease7091 in 18 beds and the majority of those are in hardware secure settings. And so what we're envisioning is five staff secure locations in communities around the state so that we have one in each of our regions so that young women can be closer to home, closer to their communities, that they can have enhanced family engagement opportunities.
Because what we've seen previously is, you know, we we come up with great ideas for a program in the middle of a different part7117 of the state and say from where a young woman from my neighborhood in Boston is from. And so that young woman would say, oh, this is a great program, but I don't want to be in this community. Okay. Don't you have something in my community? And we found that it just makes such a difference if we can allow young people to maintain as many community connections as possible, especially for our girls because of their relational needs and how that factors into the treatment.
They need. So what that $1.9 milliono does is it allows that new system of localized support. It also allows us to enhance our gender responsive training. And it also allows for a host of new positions to search of aid that will not sort of7158 I'm sorry. That will aid7159 transition for young women who are detained back to their communities because we don't7164 the majority of young people who are detained in our pro rooms are never committed to our custody. They spend some amount of time and detention, but then some other plan is worked out or their matter their cases dismiss.
Or, you know, many other things happen. But what this really, this allows us to do is to have a much more warm hand off, I guess, would be the way to look at it for young women who are returning back to the community. We're also hoping to pilot that in some of our voice locations, but we're gonna see how it goes with the girls first. But that's some of what that $.9 million will do. And we you know, so we're looking at that ARPA now, and we are hopeful that that that an amount of money that we've allocated will allow us to make that significant7208 investment successfully.
MIRANDA - Thank you. Alright. SHOW NON-ESSENTIAL DIALOGUE
That's my question.
Thank
you, senator. We're gonna try to attempt to go to Zoom. I'd like to recognize representative Dougherty for question.
REP DOHERTY - Oh, thank thank you very much to the chairs. I appreciate that. And the presentation and the caring that's obvious in the presentation about our youth who are incarcerated for or in transition for 1 reason or another is really important. And I hope that that caring goes down, trickles down to the staff so that they are expressing the same thing to our youth. I visited the DYS facility here in Taunton. And I was impressed by7260 the young people who were there. We had an opportunity to interact with the young people who were there. They were7267 particularly proud of their success in the early college high7272 school program. It was very interesting to me.
What they wanted to do very much when I stepped into their academic classes was to show me where they were their studies with early college, high school, and how much they had accomplished in that regard. I think that that program is so important, so I'm hoping that7291 that continues I had a concern at the time and I would ask the question about the weight that young people have for court hearings it was a young man who was there for many years and had not had his court hearing scheduled at all so I would ask that question. I ask the same question about our adult population as well.
How long do people wait to have their court hearings. And lastly, there is decidedly, and you mentioned it earlier, an uptick in the number of youth who are having behavioral and emotional issues in our high schools. And so I, the question is about what the interface is between the Department of Youth Services and our high school in order to kind of mitigate the numbers of young people who are going into the DYS services or at least provide them the the kind of service that they need as young people who are having some great great difficulties in this social environment. Thank you very much for your hard work. I appreciate it.
REARDON - Thank you very much for your questions. I'll answer them the best I can. I can tell you that we are very invested in early college, and we see it as a real opportunity for our young people. So that absolutely is going to continue. And actually, the investment will help us with some of our facilities to increase the number of remote classes that we're able to bring to the table directly from universities. We've had these express significant interest in partnering with us around that, including Brandeis University. So that's something that we are absolutely committed to continuing.
In terms terms of what we see around the behavioral issues, behavioral health issues that you're speaking7404 about in high7405 school settings. We do a lot of7408 work with our young people. Education is a huge7410 priority for us. And but young people who come to DYS remain attached to their home high schools. They never we do not operate a school per se. We operate classroom7419 So, young people, we provide general education to every young person in our programs. The Department of Elementary and Secondary Education is responsible for special education. In our programs, but we remain we try to maintain connections with the youth homeschool.
So within the first week, we are checking at least 2 times to see what a young person's educational needs are and collaborating with their school to get information about what classes they were taking what their individualized education plan was, and so that we can make sure that we're implementing that as soon as possible. And we also work with families and young people to make sure that we have a transcript that they can take with them back to their homeschool, so that's their best equipped to get credit for the educational work they do in our programs. And also some of our collaborative work, our collaborative work, especially with the Mass Municipal Police Training Committee.
We've we've talked with them about their work around school resource officers and the training and parameters that setting in place. So we're part of those committees and at those tables and lending our expertise to those conversations as well as, I think, our diversion work is probably a critical piece of that with the Office of the Child Advocate. So right now, what we're sponsoring is the opportunity for judicial diversion. It also includes judicial diversion, diversion by police officers, diversion at the district attorney level, essentially any of the entities that are allowed by statute to divert. We are serving them with our diversion for a pilot learning labs. And so we're also connecting in those contexts with school police officers to see if that's an appropriate referral. I hope that answers your question?
DOHERTY - Yes, thank you very much. I appreciate that.
REARDON - You're welcome. SHOW NON-ESSENTIAL DIALOGUE
Any
other questions from the
committee?
Question.
Thank you very much for your test morning today. We appreciate it. Very welcome.
Thank you. I'd like to invite Commissioner Tony Wolf from the Massachusetts Rehabilitation Commission.
Like to introduce Movil Squas, who's our CFO and7556 incredible strategic partner. Snags me almost every day. Mhmm.
TONI WOLF - MASSACHUSETTS REHABILITATION COMMISSION - So thank you. It's really an honor to be in front of you all today. As indicated, I'm Toni Wolf. I'm the commissioner of the Massachusetts uses rehabilitation commission, and I'm7570 here to really speak to the issues of our mission. Our priorities in Governor Healey’s House One fiscal year 24 budget. For many decades, people with disabilities have challenged mainstream culture to recognize that disability has an important aspect of their lives not the whole of their lives. This movement has inspired the Massachusetts Rehabilitation Commission since its inception in 1956.
It has shaped our values and our perspectives, and we have strived to break down societal barriers and expand what's possible for people with disabilities across the commonwealth. Today, MRC continues to push boundaries. Going beyond service delivery, to create innovative partnerships, to meet the evolving needs, interests, and aspirations of individuals with disabilities and their families. Governor Healey's proposed budget of $88.9 million will allow MRC to continue to recruit, retain and train our dedicated workforce. Fund effective services and make strategic investments in service model. And expand what's possible in the lives of individuals and disabilities.
7657 We7657 are in the business if you haven't noticed a possibility. Our services focus on training and employment, community7664 living, and disability determination for federal benefit programs. The budget will increase funding for the supports that address the needs of individual with disabilities including additions to independent living assistance, individuals with dramatic brain injuries, and assisting individuals with physical disabilities transitioning out of high school with your supported living needs through our turning 2022 program.
In addition, the increased budget of $3.9 million in our vocational rehabilitation services, training and employment services will enable us to enhance service delivery by ensuring our workforce have the time and resources7714 needed to focus on supporting job seekers with disabilities. Leading to increased work placements. MRC has served 19,000 plus job seekers. Through a vocational rehabilitation division, assisted 15000 individuals through our community services division, and through our disability termination services as deemed eligible 64,000 people. These individuals who were placed have earned salaries that collectively total $75.7 million in their first year of employment.
The estimated public benefits savings from these individuals in the workforce in Massachusetts has resulted in $22.7 million So I guess I'm suggesting it's worth the investment. I now just want to take a few moments to highlight the initiatives this particular year that we've accomplished. These days, we are all spending on time as I'm looking at our remote, our colleagues online. We want to make it as easy as possible for people to learn about what we are about and access our services from home. We now have something called MRC Connect, which is our virtual gateway, our front door. It is allowed an individual to access all our services months for eligibility across the commonwealth.
It has allowed people to call and actually talk to a human being to get assistance and understand the services that MRC provides. And if necessary, assist them in applying for the online application. We know this has sped up access to services. Increased retention of their interest within the agency, and I believe provided a7831 superior customer service. Putting the customer at the center. Last year, also, we're really excited about launching another innovative program called next gen careers. And in an initiative to help young adults ages 18 to 30 explore the world of work. As we call next geners enrolled in this7855 program. Are paired with a team of mentors, counselors, benefit advisors.
And employment specialists to help them navigate their career path. This has been accomplished through a grant that we have received from the federal administration. We have services administration of $17.4 million What we're excited about for next gen was that it was co developed and designed with young adults. This program design is intentionally grounded and the belief that smaller caseload size is necessary. To really7894 enhance job placement, and it is particularly focusing on individuals from underserved communities, and we're very proud of7902 that. We know collaborators. We have partnered with our sister agencies, job seekers, defined solutions that have real impact for people's lives.
Our goal is to strengthen our relationships. And as commissioner DTA mentioned, we have this program together called powering to employ, an initiative that we're really proud of together with the Department of Transitional Assistance, and we also have a partnership with the Department of Mental Health, with a employment partnership that focuses on individuals living within the adult community clinical services arm. Empowering to employ maximizes opportunities, as said, for individuals receiving transitional aid to families with dependent children. It is a joint funded model of engagement and co case management between DTA and MRC.
And it has really allowed sustainable, important employment for individuals and their families. We MRC is interested in expanding our empowered to employ program to cover all our MRC DTA colocation sites. Currently, we have five MRC DTA sites together, and we would like to expand this now have the remaining eight MRC DTA sites and being able to expand their staffing services. Through our ACC partnership with the Department of Mental Health, we are very7995 excited that this has been a very successful program and is now part of our base services within Mass Rehab.
Our community program has also played an intricate role in providing supports for individuals pathways becoming self sufficient. We have provided services through our waiver programs services like transitional housing, search searches, transitional assistance, which is funding support necessary for furniture acquisition, getting people comfortable in their homes, right, in any other household necessities. We are also really excited through the waiver program that we've been able to support 888 individuals from the nursing homes into their communities.
More than 488 individuals have received home modifications, allowing them to transition successfully in their homes and 11 individuals have served, have been able to receive vehicle modifications. And these vehicle modifications are incredibly important to individuals who now want to be independent in the community and actually find employment. We also have to say that we are fortunate to have received American Rescue Plan Act of dollars, and we have a total number of $19 million that we're expected to be actually expended by March 2025. And there's an array of services that we're8087 providing under this program.
Let me just say I think what's really critical is to make sure that the people we serve are at the table. That people we serve are part of our decision making process. If we wanna build new services, we need to make sure they're there. They'll inform us what's really important to them. So we're really excited that this year as one of our initiatives. We have contracted with 10 disability inclusion leaders and 10 family partners. Those are individuals with families, either moms or dads or grandparents. Really have that perspective and wanna be sure that we hear what their perspective is in8128 caregiving roles. And in August, we had our first, finally, in person conference.Where we pulled together 300 individuals and just like today, it's nice to see everyone's face.
We were so excited to have 300 people come together and really feel the energy and really learn from each other. To be able to speed professional networking, to do8150 deaf networking services, to have a live experience panel to really talk about the services and how they could recruit others to understand the services MRC provides and really have what I told innovative conversations. So as you are hearing, MRC is changing. And not that our vision necessarily or core is changing, but the way we talk about ourselves changing. And with that, we also want to be able to, at this point in time, change the name of our organization. And we have been very excited to be able to talk to our disability communities to really vet some ideas and have done.
Conducted a number of research activities to really be able to look at how can we transform the name of the agency to be current for today. Be8199 able to be current to the next individual that wants to walk in our door. So I'm not yet ready to be able to share that name but I will really be eager to have work with each one of you to help us with that. So let me just state that our House One budget of $88.9 million submitted by the Governor Healey supports continued progress for MRC. And allows the agency to strategically utilize funds to better meet the needs of individuals with disabilities. We are grateful to Governor Healey, Secretary Walsh, and all of you, and the members of the legislation. You have been incredibly supportive to MRC incredibly supportive to the people with disabilities. And today, I just really want to thank you all and grateful to any questions you may have. SHOW NON-ESSENTIAL DIALOGUE
Thank you, commissioner.
8251 Well,8251 any questions from the committee? Yes.
Representative. Thank you.
KERANS - Thank you, commissioner. Amazing work going on. I'm kind of sorry that I have to bring this up, but we all learn by sharing information. So I had one constituent. It ultimately wound up okay, living independently, couldn't get job help. What is the delta between what you're able to provide and your resources?8288
WOLF - It's a great question, which is why we're really excited about the 3.8 increase in our services, particularly with employment and training. Our8296 caseloads are too high. And so we don't have8299 the availability to really spend the time to truly engage people. That's part of the work that has to act is engaged with individuals. This will be the first time that we have passed at MRC for state dollars to really look at his both sides.
And so I really am eager to support have8318 you support the governor's budget. I also wanna say that in order for us to really engage, we also have to go where people are.. And that's equally important. So it has to have councilors have to have the time to go where consumers are rather than always thinking that someone's coming to a press. So it's really shifting the paradigm, shifting the model, alright, which is why these dollars or vocational rehabilitation are so essential.
KERANS - Thank you. I appreciate the candor. I'll probably be following up. SHOW NON-ESSENTIAL DIALOGUE
Thank
you.
Any other questions?
Not seeing any text. I wanna thank you so much for joining us today and for your testimony.
Thank you8360 very
much.
Oh, geez. 1 second. I'm sorry. Believe Carol Daugherty has a question. He does. I'm sorry. Representative
Daugherty. Thank you, madam. I'm sure that you must have heard me say, oh, to the screen.
DOHERTY - Thank you very much. Yes, I do have a question. Some weeks ago, there was a lengthy at a editorial in the Boston Globe written to editorial is actually written by parents who are parents of adult children with disabilities. And they raised the question about the legislation that was adopted in 2014 called real lives. With a grave concern about the fact that that real lives legislation had not been implemented at all since that time. Just prior to that, as I understand it, and8415 I wasn't here in 2014, but there was a hearing. Our regulations finally were promulgated.
There was a hearing, and I was told that there were about 200 people who attended the hearing and some 50 or 60 people attended the hearing and no one of them felt that the regulations were compatible with the intent of the real lives8437 legislation. I don't know if this is in your bailiwick or if you are familiar with it or even if it's on your desktop. But I think that I would like to have an update. If you have 1, at some point in time, if not now, about the status of those regulations and the full implementation of that legislation.
WOLF - I'd be happy to get back with you. I actually do not know that much about what happened in 214, but eager to kind of learn from with you and really share. You know, we have been looking at our regulations across MRC to really make sure that services are accessible as much as possible. Not be delighted to talk to you. SHOW NON-ESSENTIAL DIALOGUE
Howard Bauchner:
DOHERTY - Just a footnote on that, the legislation has to do with self determination of these adults as they move through their lives. And I recently was invited to a birthday party of a young man who turned 30, who was not expected to turn more than 5 years old. And he is a young man that has managed with a lot of help from his family and with the state and federal resources that have become available in programs to have a self determined life. And I think that we need to take a look at why the regulations that have been promulgated don't seem to be compatible with the intent of the legislation. So I would really enjoy talking with you further if you are the person to discuss this with about what that future looks like. So thank you so much. I appreciate it
WOLF - Thank you very much. SHOW NON-ESSENTIAL DIALOGUE
Okay. Last chance being no other questions. Thank you so much again. You very
much.
Thank you.
And just a note for all members of the committee, we're gonna power through our testimony. So please feel free to get up and there's some some white finger food and sandwiches outside, and we'd invite all guests to work and testifying to help yourself this to our refreshments as well.
At
this point, we'd like to call commissioner Opi Suthama from the Massachusetts mission for the Deaf and Hard-of-Hearing. It's just fine. Thank you commissioner for being with us
today.
OPEOLUWA SOTONWA - MASSACHUSETTS COMMISSION FOR THE DEAF AND HARD-OF-HEARING - Good afternoon, Chair Cronin Chair LaNatra and members of the joint committee on ways and means. My name is Dr. Opeoluwa Sotonwa and I am a commissioner of the Massachusetts Commission for the Deaf and Heard-of-hearing MCDHH. I appreciate the opportunity to join you today to discuss the important work of our agency and how Governor Haley's fiscal year 24 investments will support our continued efforts to serve the approximately 1,400,000 individuals who are8635 deaf or heard-of-hearing in the Commonwealth of Massachusetts.
Most significantly, MCDHH is responsible for ensuring that deaf and hard appearing individuals in the commonwealth can access quality and timely communication. MCDH provides American sign language or ASL, English, interpretation, and Communication Access Real Time Transcription or CART referral services, including 24/7 Stand by referral or press conferences, referral for court and legal proceedings, and referral for emergencies, as well as ASL English interpreter training, mentorship, and quality assurance. Communication access training and technical assistance.
Additionally, MCDHH provides critical case management and independent living services for Deaf and Hard-of-Hearing adults and children in the community. As leading experts in accessibility and service for the Deaf and Hard-of-Hearing. MCDHH partners with sister agencies and community entities, to increase accessibility and improve the quality of services existing and new throughout the Commonwealth. This includes working directly with agencies such as DCF and DMH, to ensure accessibility is integrated into their service models, and to support Deaf and Hard-of-Hearing employees working for the commonwealth in these critical tasks.
Our dedicated and passionate staff provide the commonwealth with the resources it needs to serve deaf heard-of-hearing , and late deafened individuals in an extensive range of human service, healthcare, safety, legal, education, and economic settings. With the support of the Haley Driscoll Administration, MCDHH will continue to ensure that Deaf and Hard-of-Hearing individuals, living and working in the commonwealth, enjoy access and opportunity to all of the public services, opportunities, and benefits that Massachusetts has to offer. The proposed operating budget for MCDHH for FY 24 is $9.9 million. In line item 4125-0100. The budget recommendation is8831 $1.4 million or 16% above MCDHH's FY 23 General Appropriations Act.
The FY 24 budget includes critical funding increases over FY 23 that will support MCDHH to expand and improve the work we do for our constituents. In regards to increased support for our communication access services division. Increased funding for legal ASL interpretation and training will allow MCDHH to add critical capacity. To fill requests or communication access in courtrooms and other legal settings. Legal events that were postponed during the pandemic have now been returned to the docket. And8898 deaf individuals will be returning to jury service. These increased communication access needs have stressed and already fledgling workforce.
Because of the limited pool of quality, qualified legal interpreters, Court events must be rescheduled or scheduled around interpreter availability which slows down the resolution of cases. MCDHH has identified a subset of interpreters who will receive additional legal training and courtroom experience necessary to become fully qualified. With these focused trainings and retention efforts, MCDHH hopes to double the number of qualified legal interpreters within the commonwealth. The increase in annualized funds will not only address the workforce prices currently experienced by MCDHH but it will also address the critical needs of the trial courts, the jury commission, and the Department of Children and Families.
Court proceedings that8986 were postponed during the pandemic have now been returned to the docket. Deaf individuals will be returning to jury service and the numbers of families involved with ECM remain at a critical high while the workforce has decreased. MCDHH focus on recruitment. Training and retention will add qualified legal ASL interpreters and deaf interpreters from surrounding states to our referral list to address the significant workforce issue. MCDHH plans to increase our staff capacity by at least two FTEs as well as recruiting, training, qualifying, and retaining. At least 15 or more local freelance interpreters who are willing to work regularly on-site in court and legal settings.
With annualized funding, MCDHHH is developing specialized trainings for interpreters to increase and diversify the pool of qualified providers who are able to provide communication access across a variety of unique settings, including medical, behavioral health, Subsequent use disorder recovery, and in particular interactions between the Department of Children and families, deaf caregivers, and other community based legal settings. Through offering these targeted trainings, MCDHHH will enhance our capacity to provide linguistically and culturally competent services. And diversify our pool of communication access providers9115 in the settings with the goal of doubling the current pools of interpreters.
You meet the critical communication excess needs of the Deaf and Hard-of-Hearing people we serve. Annualized funding for the after-hours emergency communication program enables deaf and hard appearing individuals to access interpretation outside of our regular hours. Since expanding our services to include after-hours emergency services in FY 23, we have seen a 52% increase in the number of emergency requests. From April 2022, the first month that the pilot was implemented. Through February of 2023. The number of emergency requests went from four per month to over 30 per month. And these numbers are continuing to increase. This funding will support an after-hours emergency coordinator.
And add incentives for after-hours communication access providers who are willing to accept emergency on call shifts. Through this expansion of the program, MCDHH will be able to provide emergency referral services sufficient to meet the rapid growth in demand. Evident in the 52% increase in requests since this pilot began. Over9224 one million individuals in the commonwealth rely on assisted technology such as hearing aids. Yet many adults from economically disadvantaged communities cannot obtain and utilize these assistive technology devices. MCDHH will use available funding to assess issues impacting access to affordable hearing aids.
And develop a program model to increase access for9261 under resourced individuals. Through our strong partnerships with agencies9270 within EOHHS, MCDHH is engaged in ongoing efforts to increase the number of human service employees who are fluent in ASL and culturally competent to provide direct services to Deaf and Hard-of-Hearing individuals. In our cross agency work, MCDHH seeks to increase awareness of the diverse needs of our constituents, including the hiring of deaf and AS self-fluent service providers and interpreters who reflect the diversity within the Deaf and Hard-of-Hearing community. MCDHH seeks to model these principles within our own agency.
And to provide education and resources to agencies and departments seeking to grow their own workforces. Expansion of case management and social services, increased funding in the FY 24 budget9345 allows MCDHH to hire an additional children's specialist to serve our Deaf and Hard-of-Hearing children from birth to age 22 and their families in a better way. Children's specialists work with children, families, and schools to help make informed decisions and provide tools to advocate for the needs of Deaf and Hard-of-Hearing children, especially around issues of early language access. And that's early access to language either signed or spoken.
Studies have shown that language deprivation has a severe and lifelong lasting negative impact on Deaf and Hard-of-Hearing children. Through increasing our number of children's specialists MCDHH will be better able to structure our program to meet shifting geographical needs and balanced caseloads to ensure families and children receive high quality responsive supports. The children's specialists provide a lot of technical support around individual education programs, and9425 504 plans related to the Americans with Disability Act. Both with the parents to understand what it means and also with schools to help them understand the unique needs of Deaf and Hard-of-Hearing children.
MCDHH has noticed an increase in referrals from all over the common law. Many issues are related to the pandemic. Inability to access the curriculum while remote learning was occurring. Missed school therapies and other services late diagnosis due to not being able to get tested, little or no intervention services, etcetera. The Boston area has historically been underserved because of language and immigration concerns. Parents are afraid to ask for help. We need a dedicated children's specialist in this area to do more outreach to families. To ensure that Deaf and Hard-of-Hearing children are not missing vital services and that they have access to language from a very early.
Communication access training and technology services. MCDHH continues to build capacity to provide technical9525 assistance and communication access support to EOHSS agencies. Creating Vlogs. Vlogs are recorded visual content that is made available online. They are essential in ensuring that the Deaf and Hard-of-Hearing community has full access to commonwealth trainings announcements, and other critical information. With the increased funding, MCDHH will hire additional staff to support the communication access training and technology services department in providing new services. MCDHH will upgrade our website to blog hosting capability. This will bring us in line with what we have9580 long envisioned to be culturally and linguistically accessible website content
And provide a model for other public sector and private agencies to increase accessibility. In collaboration with various law enforcement entities in the Commonwealth, MCDHH is creating increased training opportunities for law enforcement on skillfully navigating with Deaf and Hard-of-Hearing individuals, how to maintain safety, reduce negative interactions, and increase the accessibility of emergency services. Deaf and Hard-of-Hearing independent living services or DHILS FY 24 budget proposed for DHILS is $2.7 millin which is an increase of 8.4% over the FY 23 budget per chapter 257 rate review. This funding supports the essential work of the DHILS 's centers.
Where Deaf and Hard-of-Hearing individuals receive assistance with advocacy, communication access, health reservation, life skills, personal safety, and economic well-being. Through the eight DHILS programs statewide, individuals can access one on one support peer mentoring, and assistance in the community as well as attending various community based education events outreach activities, and social events. Recently community members are accessing new9702 programs that include free ASL9704 classes. And are receiving additional support around housing, advocacy, immigration, and benefit planning in response to changes impacted by the end of the federal public health emergency.
EHS communication access funding, centralized billing. Included in this budget is a chargeback 4125-0124. Ceilings set at $6 million per fiscal year. This is decentralized contracted ASL and cart interpretation services billing at HHS agencies to facilitate on time payments for interpreters and expanding services since we have piloted this model in FY 23 we've been able to improve timely payment for communication access providers, making such providers much more available to take assignments at EHS agencies upon request. In9781 closing, we have adapted our service delivery model and we will continue to offer communication access solutions across various platforms, according to the needs of our workforce and constituents.
Being cognizant that we encompass a diverse and highly individual constituency. We are mindful that online access is a privilege and that many community members do not have reliable internet access. Nor laptops or smartphones nor do Deaf and Hard-of-Hearing and late deaf individuals currently have access to the same quantity and quality of education materials online as exists or hearing persons. As a result, MCDHH is emphasizing not only accessibility, but usability to an increasingly communicatively diverse audience. Across software and hardware platforms. From traditional hearing aids, to lower cost personal sound amplification products, as well as advocating for environmental notification products to help people stay safe in their homes and communities.
We have responded to an increased demand for American sign language interpreting and human powered captioning or CART services. By establishing effective remote protocols and guidance and advocating for increased access to platforms9894 that did9895 not initially consider the needs of9897 our constituency. In doing so, we have ensured that we are all well on the way to meeting the increased demand utilizing state of the art technology and continually evolving guidance. The FY 24 House One budget will support our efforts to consistently and proactively provide these vitally important services. And to strengthen our community partnerships.
We continue to make Massachusetts synonymous with leadership in the areas of communication access, integration of accessible technology. Training are diverse communities so that they can compete on equal footing. And above all, a commitment to recognizing that each of us has a part that we can play in the foundations of an equitable society. I would like to thank Governor Healey and Lieutenant Governor Driscoll as well as secretary Walsh for their incredible support of the Massachusetts Commission for the Deaf and Hard-of-Hearing. I asked that you support the governor's proposed budget will allow us to continue to address the societal barriers, Deaf and Hard-of-Hearing individuals face every day. Thank you, and I am happy to take any questions you may have.
CRONIN - Commissioner, thank you so much for your your leadership and your testimony here today. I wanna talk a little bit both the after-hours emergency services program that you mentioned in your testimony. There's a new proposal on H one for approximately $350,000. Could you describe a little bit about the vision for that program? Where will interpreters be located10020 will they be available to deploy across state or centered in Boston? And what is the hope for or expected response time for an interpreter to an emergency.
SOTONWA - Thank you for your question. When I became commissioner two years ago, one important area that I first noticed of need was that our referral team closed and our staff interpreters were not available to be deployed such that they individuals could not access certain service that they were having an emergency and they had to go to the if they were stopped by the police, they could not access services. So we have reinvented our after-hours emergency program such that we have interpreters on standby. We have a coordinator who works with our team.
Individuals who are willing to be on the emergency list are on call and they are paid a small stipend for being on standby for emergencies. If an emergency does occur, they are deployed. And we have interpreters in areas across the Commonwealth who are on this list. And we have10106 had situations where there have been crises in the state of Massachusetts, and there were not interpreters available. And we see crises happening nationally at this time, not just here in the commonwealth. And, you know, having lived through a pandemic and seen so many shifts in the10127 needs of the community and technology.
We have a lot of interpreters who are preferring to work from home remotely now so it's harder for us to cover all of these emergency situations. So we are planning to address these issues by increasing our pipeline through our workforce development program. Most recently, we had a group of subject matter expert consultants who came to work with us and consult with us and how we could develop a 10 year action plan. And these subject matter experts are members of historically marginalized communities that we wanted to make sure we were including members of various communities of color in this process as we redesign the services.
And also ensuring that our interpreter workforce reflects that community. And in Governor Healey's plan, with Mass Reconnect. It's a program where if a person is over the age of 25 years of age, they can go to college free of charge. And we at the Commission for the Deaf and Hard-of-Hearing strongly believe that this will increase people's motivation to consider interpreting as a potential profession and they can get training as an interpreter at a community college. So this could be10216 life changing for them and for our community. We're very excited about that. SHOW NON-ESSENTIAL DIALOGUE
Thank you. Any other questions from the community?
SEN GOBI - Thank you. I just had a question when you were speaking question, when you mentioned about the dedicated specialist, And I believe you mentioned to have 1 dedicated specialist. And I'm just wondering, is that included in the funding and from what you said that special a list would do. It sounded like we could use a lot more than 1. So I didn't know if you would expound on that a bit. Thank you.
SOTONWA - Absolutely. Thank you for asking. The after-hours emergency program is currently in a pilot phase. We have hired contractor to assist with the management and operation of this program. And in FY 24 budget, we have we are hoping make that position permanent, the specialized coordinator.
GOBI - Okay, just to follow-up if you don't mind, Mr.10279 Chairman, So the funding is included in the FY 24 or it is not for that one position.
10288 SOTONWA10288 -10288 It10288 is included.
GOBI - Thank you. SHOW NON-ESSENTIAL DIALOGUE
Any other questions from the committee?
Alright. Seeing hearing on. Thank you so much commissioner for being with us today in your10301 test morning.
Thank you.
Thank you. At this time, I'd like to invite deputy commissioner John Olivera from the Massachusetts Commission for the10320 Blind.
Thank you, deputy commissioner. Welcome.
JOHN OLIVEIRA - MASSACHUSETTS COMMISSION FOR THE BLIND - Good afternoon. Chair, Cronin, Chair, LaNatra and distinguish members of the joint committee on ways and means. I'm John Olivera, Deputy Commissioner of the Massachusetts Commission for the Blind. Thank you for the opportunity to provide testimony Governor Healey’s fiscal year 224 House One Budget. The governor's budget represents the important and highly specialized programs and services provided by our team at MCB. MCB serves approximately more than 30,000 individuals in Massachusetts who are legally blind or deaf blind.
Our mission is to provide our consumers with access to employment opportunities and social and rehabilitation services with a goal to increase their independent living and10398 self-determination. Governor Healey’s FY 24 House One for MCB is funded at $27.1 million. Which is $2 million or 7% decrease from the FY 23 GAA. MCB is pleased to report that all chapter 257 rate services are fully funded the deaf blind extended supports program or as you know it, the turning 22 program is our largest appropriation has received a small increase of $15,000, which we expect that projected chargeback costs will consume this increase. The administration and program operations appropriation 4110-001 has received a increase of10460 $210,000.
Which is expected to be used to offset the increases in rent in our Boston and Springfield office. The$2 million decrease in the governor's FY 24 H1 budget is largely attributed to removal of earmarked. The community services line item 4110-1000 contained $1 million mark. While the Massachusetts Audio and Information Network line item 4110-1010 contained $1.1 million line item. I appreciate the opportunity to speak in favor of the programs and services that each of these appropriations provide to our consumers. MCB has principal programs in that support our mission. The social rehabilitation services that we provide for both the support and independent living of consumers in a community setting.
Vocational rehabilitation, product services we provide, prepare and support consumers while they are attempting to engage in competitive, integrated employment or supported employment. 22 appropriation provides residential care, case management, and specialized services for our deaf blind consumers. In the written testimony that10569 we submitted, MCB submitted a chart, provided you10573 with some representation of the occurrence of vision loss by by county and by cause of vision loss. These data stem from a project funded by federal realignment dollars. That explored the delta between legal blindness, which is 20 over 200, approximately 10% vision and vision impairment.
Age related vision impairment exceeds any other ideology in every county in Massachusetts. Most irreversible low vision conditions, in the state and across the country are caused by age related by diseases. That chart contains lots of other information and may wanna review it and gain some additional knowledge about the different conditions that lead to legal blindness. So some of the areas that MCB will continue to continue to attempt to make progress in 2024. First,10646 we are continuing to try10648 to serve new and existing consumers. Currently, more than 30000 individuals are registered with MCB. The agency hosts two events to educate eye care providers annually.We attempt to teach them10667 about the services that MCB offers10669 and also make10671 them aware of MGL-C6, section 136.
Which requires them to register someone who has been declared legally blind. In their opinion or in their their work at at when they see the patients. We also will attempt to improve labor participation amongst work engage, wind, with nearly 2 thirds of working age individuals with disabilities, not in the labor force. Our community faces some some longstanding challenges. MCB is currently planning our 2023 internship program This program has been operating for 21 years. Consumers who go through this program develop some valuable information to put on their resume, gain some valuable experience meeting individuals and establishing a network to use later on in life as as they move towards employment. And they also get a a taste of different sort of industries that we place them in, in the State of Massachusetts.
We have reviewed the individuals who have gone through our internship program and have found that about 80% of them are individuals who achieve employment and move on and using that great experience that they picked up as interns in MCB's program. Last year, MCB placed 63 consumers in various internships throughout the Commonwealth. MCB hosts a reverse job fair that brings 30 employers in Massachusetts together with job ready consumers that are eagerly ready to to work and are ready to start an interview. And in some cases, consumers have obtained jobs right from those interviews. So10800 that's been a great program for us over the past several years. We'll continue to move forward with that as as we move on. Also, another area that we hope to improve is the independence and self-determination of for seniors.
Approximately 500 seniors attend different support groups. We currently have 53 and the goal is to expand that number during this10829 coming year so that more consumers can take benefit of attending these groups. It is found that individuals who attend these groups learn from other individuals attending groups and also gain valuable support from each other as they are experienced the same vision loss situation later in their life. Another area we we hope to engineer work on is we seek the opportunity to revive the MCB's public use law. Relative to small businesses and opportunities of vocational rehabilitation consumers. MCB would provide people who are blind or visually impaired with employment opportunities in a variety of areas, including web and document accessibility.
We also are utilizing the results from our AT survey conducted last summer to help align some of the service needs that our consumers have. And that's proven to be very helpful in fine tuning some of the needs that our consumers have. So in conclusion, MCB will continue providing important social residential and vocational programs while seeking opportunities for continued innovation. The proposed funding in the FY 2024 House One budget will allow10931 MCB to continue important initiatives while sustaining our three core programs for the community we serve. On behalf of Governor Healey, lieutenant governor, Driscoll and Secretary Walsh, thank you for the opportunity to testify today and welcome any questions that you may have.
LANATRA - Great. Thank you so much, deputy commissioner. Down on the sell show where I was at in Mount Viewmont, we have the talking information center?
OLIVEIRA - Yes.
LANATRA - Do you know if they are specifically named in the budget?
OLIVEIRA - So that's the the $1.1 million10976 that we talked about that I mentioned. Talking information is part of that network. So that was a near mark that was removed last year. And they are looking forward to having fun day again for this year, what I can tell.
LANATRA - Well, that's wonderful news. SHOW NON-ESSENTIAL DIALOGUE
Do we have any questions from the committee? Senator Goldberg? Yeah.
GOBI - Thank you. Thank you, deputy commissioner. I appreciate it. And I appreciate the comments that you made relative to seniors, and I'm going to be a bit Periocular right now, I have a organization that works out of Gardner called the Polus Center that I'm sure that you're familiar with that has been working with your organization for several years. But I know that they have some concern relative. And and it may be what you mentioned about some of the earmarks that are not there right now. But specifically, I'm looking at the community services program and that social rehab,
And specifically for those shut in seniors. My understanding that in the Gardner area, which would encompass where we're sitting right now as well, that there are about 600 homes on a waitiness seniors that want to be have services that the Polus Center is able to provide, helping them doing some adaptive technology teaching them how to use things on a a cell phone or on their iPad and and so forth. So I didn't know if you could speak to that and what may be in the future of far groups like the Polus Center trying to provide services specifically for those shutters dealers?
OLIVEIRA - So the mark I mentioned that in the 4110-1000 account. Polus Centerdid get some of the funding from that EMR for last year. And they did serve some consumers. Obviously, the funding is probably run out. But we are still11094 trying to serve consumers with with some of our staff. We are still trying to serve consumers. It it is a large number of seniors to serve. And so the the earmarked did take some of that11107 pressure off some of our staff. But as we we move forward, we'll continue to serve as many folks as we can with the resources that we have at this time.
GOBI - And just as a follow-up, So I know that there'll be many of us trying to advocate for some of that funding. Would you and I don't know. Do that 600 number for a waitlist just for this area. Does that surprise you?
OLIVEIRA - That 600 numbers is probably, I I haven't reviewed those figures lately. But at 600, it's probably individuals that are, in fact, are legally blind. They live in the area. And so we we haven't surveyed those 600, so we don't know if they all are waiting. But, you know, anyone who's who's legally blind could certainly use training, some orientation when it comes to using assistive technology to get a an iPhone, be it a some some special video magnifier, any of the devices that might help them. But So I'm not aware that 600 are on a waiting list. We we don't have a waiting list that MCB consumers come in we serve them, and we provide some of the services that we can. There's a limit on much our rehabilitation teachers can do.
As far as time goes, some of the other folks need more training than others. And that may require more time. But again, the number may be correct that that they're roughly probably around that number of people registered in in the state, but they're in this area, but there is not a waiting list as far as I know and and from our directors that there's no waiting list. There are people that are waiting to see folks. I I think it takes about three weeks at this point11225 to see 3 to 4 weeks to see a rehabilitation teacher after they've had a case manager managing the case at the agency. So but if any of those individuals would like to receive services, they could certainly call our our office, and we'll see what we can do for them. And provide what we can, what we're able to do.
GOBI - Thank you. I appreciate that.
OLIVEIRA - Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank you.
Any other question? You don't have any
yep. And
I think we're all set, deputy commissioner. Thank you so much for being here
today.
Now
I want to invite executive director, David Seltz, the Massachusetts Health Policy Commission to testify. Thanks for your patience. Appreciate
that.
I
have a presentation.
Oh.
Thank
you for your patience.
Let's give the second. Stack with your brain. It's your brain. Okay.
Thanks, Anthony. I really appreciate
it.
Well, good afternoon. Good afternoon. Good afternoon.
DAVID SELTZ - MASSACHUSETTS HEALTH POLICY COMMISSION - Thank you, Chair, Cronin, and thank you to the esteemed members of the Senate. Thank you, Chair LaNatra. Through you to the members of the House of Representatives, it is just such an honor to be able to testify before the Sistine Committee today I first wanna just say thank you to this committee for organizing this great event today and through you to your staff. I11345 know I've just been so instrumental in making this such a seamless day. I thank you to our board officers and to the members of Fitchburg for hosting this and this really really beautiful hearing room hearing room today.
I started my career in state government nearly 20 years ago at analysts for the ways and means committee. And so I I feel like I know firsthand how important this job is, how important your role is, developing the annual budget. It is a statement of values and priorities about where we dedicate our resources as a commonwealth. And I'm just honored to be able to11381 present on behalf of the Health Policy Commission. My name is David Seltz. I'm the Executive Director at HPC. I did prepare a presentation for you today, which I will walk through, and I know we're running late into the day, and I really appreciate your thoughts from this throughout this day.
And I one more thank you, just to the other commissioners and directors who testified before me who do just incredible work on that to come off and just really just sitting here listening to this incredible work has just been a a pleasure today. What I'd like to briefly do is just provide a little bit of background about the health policy commission, how the state agency came to11421 be established 10 years ago, share some of the work that we've been doing recently, and then finally close with our budget request for the fiscal 24 budget. Massachusetts is rightfully proud of being a national leader when it comes to expanding access to high quality11441 healthcare.
This commitment was most, I think, well known and demonstrated by the passage of what we call chapter 58 of the Acts of 2006. This was11453 landmark held perform11454 law spearheaded by the legislature, and the governor at that time to make as its goal that every Massachusetts resident should have access to health insurance and access the high quality care. This was a huge leap forward for one state to take this massive challenge on the challenge of the uninsured. This state in Massachusetts. Not only came together as a community and as stakeholders across the healthcare continuum to pass that law, but then to make that law a success. Massachusetts to this day still has the lowest rate of uninsured of any state in the country.11496
And of course, that law went on to become the model for the Affordable Care Act that was passed in 2010, a law that has expanded access to health insurance for tens of millions of Americans. But this promise of access to affordable health insurance and affordable care is pivoted on one word there, affordable. And Massachusetts, we have an incredible healthcare system that envy of many other states and across the world. It is also a very expensive healthcare system. And as policy makers a decade ago, we're seeing that the rising cost health care was having difficult impacts on both state government in terms of how we balance our budget. With high and rising healthcare costs that were growing at your double digit rates that meant for policymakers such as yourselves.
You would have to reduce funding in other areas of government. It's reduced funding in local aid and education and transportation. In order to be able to continue that promise of expansive healthcare. This same story about crowding out when healthcare costs grow rapidly is not just limited to government, it's limited to businesses and employers and especially small businesses in that Massachusetts, who were seeing that, you know, whatever revenue growth they were experiencing as companies they would be receiving at the same time a bid from their broker saying it's gonna be a 10%, 12%, 14% increase on your premiums for your employees. And then as an employer, that then results in some difficult choices.
Do I continue to provide the same level of of coverage do I actually pass more of my costs in terms of the premium onto my employees in the form of higher deductibles, co-pays? Do I buy down on my insurance? Do I not be able to provide wage growth to my employees because I want to balance health insurance? And then finally, of course, this crowding out effect place for families and individuals and residents of the Commonwealth who were seen and have seen whatever increases that they may experience in terms of their wage growth be subsumed by, at the same time, even more rapidly, increases in their health care costs. This first slide that I'm showing here on Slide three, demonstrates this with some data.
And here, we're just showing since the year 2000 to 2019 the growth in what employees11651 have paid in terms of their premium contributions, a 243% increase, the cost of a total family premium, almost a 200% increase what employers have contributed to healthcare, 180% increase. And at the same time, other markers of economic growth such as wage growth, more inflation, far, far below those trends. This is the crowding out effect. The policymakers wrestled with in 2012 and at that time passed another landmark piece of legislation to try and bend the health care cost curve. So this law was it's called the act improving the quality of healthcare, reducing costs through increased transparency, efficiency and innovation.
It is was a significant piece of legislation that I remember was finally passed on the last day of session on July 30 first of 2012. And as part of this this really comprehensive piece of legislation, it had kind of central to its goal, this idea of a setting a sustainable growth target that we do believe that health care and what we spend on the investment in healthcare should grow as to other parts of our economy, but should it grow so11724 much faster that we're forced to make those difficult trade offs? And so this idea of sustainable growth, still growth, but just had a more moderated and affordable level, is embodied in a goal that we call the healthcare cost growth benchmark. Which I'll speak a little bit about.
But is basically our target for annual growth in healthcare spending in the Commonwealth. As part of the same legislation in setting this goal, it also established a brand new state agency and the health policy commission. The Health Policy Commission or HPC is an independent state agency that was tasked to monitor and to measure the state performance against the healthcare cost of a11763 benchmark. And to work with other state agencies, as well as private all11768 private parts of our healthcare system and community, to work together to identify opportunities, to create efficiencies, to be able to meet that target that we had collectively set. There is another state agency, the Center for Health and Health Information Analysis or CHIA.
Which was an existing agency11785 but got a new name and a little bit of a new mission. But the health policy commission was truly a new agency, and I was the first executive director of that agency 10 years ago. Importantly, the vision of this legislation is not cutting costs at the expense of everything that matters in healthcare. The vision is 1 of better health and better care at a lower cost that we can achieve these goals together. And so we could find ways to cut costs in our healthcare system. And that could have very detrimental effects to access and to11822 the care people need. How do we balance these things together and the identity? Another important part of our vision that we have expanded on in recent years is the integration of Health Equity into this work.
We are very cognizant of fact of the interrelationship between healthcare access health care outcomes,11846 healthcare affordability, and health equity. We see that there are drivers of inequities and disparities of healthcare that stem from a lack of being able to access clearly needed. And so while our core mission has and will always be around advancing affordability, we think that advancing health equity is absolutely integral to that mission that they11868 are one of them the same.11869 And so we11870 wanted to change our mission statement to reflect that some of the words in orange here are changes we made to make that clear11877 that this goal is one for an equitable healthcare11880 system and then the benefits would apply for all residents across the Commonwealth.
Just briefly about our structure because I think we're a pretty unique state agency, certainly different than many of the agencies you've heard from today. We are an independent state agency. So I report to a Board of Directors. This Board of Directors is appointed by the Governor, the Attorney General, and the State Auditor. And you can see on this slide that each of those constitutional officers has a set of appointments to the board and in law, there are actually certain categories that each board member must have in terms of their expertise and experience. So we have someone with an expertise and behavioral health care. Someone who with expertise in healthcare consumer advocacy, a primary care physician, etcetera.
would also note that the Secretary of Health and Human Services and Secretary of Administration and Finance also sit on the board and act as important liaison for our collaborative work with the executive branch. I report to that that full board. And importantly,11946 as this board does represent important areas of expertise across our healthcare community. We recognize the need to to bring others into this conversation as well. And so you can see that line to the to the right of my little face11961 that is the HPC's advisory council. This is a 35 member advisor council that I meet with quarterly to discuss the work of the agency and our vision And this Advisor Council includes representatives from across the care continuum and beyond.
Including representatives from pharma and biotech, disability advocates, advocates in home care and senior care as the list kinda goes on and on, but we felt it was really important to bring all of these different perspectives into the work of this agency. Just a minute on the healthcare cost growth benchmark. As I said, it is a goal It is something12007 a measurable goal. It is not a12010 cap. We, as a commonwealth, have exceeded12013 the healthcare cost growth benchmark12015 in the past. But it provides a way of annually kind of looking at the data and understanding where are our healthcare trends going are there opportunities? And I think to me with the benchmark, it's not about whether we hit it or we don't hit it.
What's more important is to understand why or why not, and to go deeper into the data, and that really provides that platform. It is not a cap on individual providers what they can charge or what they get paid. It is not a cap on individual health plans and12049 what they can charge, it is really kind of an all in goal and target. Really, the there is one accountability mechanism for the healthcare cost growth benchmark as currently written law, which is that the health policy commission can review individual healthcare providers and health plans and their spending. And if we find that they have excessive spending that exceeds the benchmark12075 and for whom, you know, a performance improvement is warranted.
We can require that provider12081 help plan to file with the HPC and to implement what's called a performance improvement plan. We would only and have only required a performance improvement plan after a very thorough, multifactorial review of that provider to really understand what is driving their health care costs. And and to make sure that we understand before requiring a performance improvement plan. Are there things that are truly outside of that providers control that are raising spending. And that would mitigate, of course, our concern. And so there it is not a bright line test it really just provides a platform or conversations and discussions and potential accountability through the performance improvement plan process.
I'll speak a little bit about that in a minute. Since the passage of this law 10 years ago, many other states have worked to Massachusetts to see if this is a model that could be replicated in their own market. This idea of setting a measurable goal that everyone can work towards together. And I'm pleased to report that as of today, there are now eight states that have implemented called different things in different states. But this idea of a collective goal and all in goal of looking at healthcare spending to be able to promote policy development that advances cost containment. Many of these other states I should mention have directly copied our statute and the bill that was passed here 10 years ago. And in many cases, that have gone beyond it.
Adding additional oversight and accountability. Today, in United States, one in five Americans live in a state with such a target. So how do we do our work at the HPC? How, as an independent agency, are we working to try to bend that cost curve and to work with the healthcare community to meet those targets. Well, as I said, we can't tap. We don't tap prices. We don't regulate prices. So many of our powers and authorities are really around collaborative action. The first area that we work on is research and reporting. We've built an incredible data analytics team of health policy commission to be able to dive really deep into the data, use truly novel data sets and methodologies to understand the drivers of health care spending. We are a12230 partner.
We actually have invested more than $100 million into community hospitals and other community health organizations over the last 10 years, working with them, investing in them12241 to implement and evaluate innovative new ways of delivering care that achieve those goals. We're a convener. We know that there we live in a rich community of healthcare experts. How can we bring others to the table to discuss these issues and challenges and to find solutions And then finally, we act as a watch shop. And here, we act on behalf of the residents that and employers that struggle every day with the cost of healthcare and we'll identify activities or activities that certain healthcare systems or health plans are pursuing that are counter to our goals, and we will identify that. Publicly.
So with each of these four levers, I I just wanna give you just a really brief sense of of kind of going one level deeper a high level flyover of some of these functions. So first, let's start with some research and reporting and talk a little bit about what we have learned about healthcare spending over the last 10 years and really some of the more recent trends where we've had extreme disruptions with the pandemic. So here on slide 11, this is every dot here represents a year where we have the data for healthcare spending growth. And the dotted line and then kind of the solid red line indicates where we had set that target or goal. So you can see over the eight years that we have actually, nine years that we have sorry. Excuse me.
That there have been years where we have them below, and there have been years where we have been above. I would note the extreme disruptions that you can see at the end of this chart due to the pandemic. And so the circle blue showing a negative 2.3% growth in healthcare spending from 2019 to 2020. This is really a reflection of the reduction in in use of services as the pandemic necessitated the shutdown of certain in person services. And some of those services have still not yet even returned to pre-pandemic levels. And then you can see the other not filled in circle there, which is the 9% growth, which represents the next year where we went from kind of the nadir of the pandemic to the second year of the pandemic.
Where a lot of care did return to the healthcare system in person so you see a big increase. Notably, and I think most importantly though, you see a big swing both ways there, but if you average those two years out actually get 3.2% annual growth. And over the course of this entire time span, average annual growth has been 3.52% below our initial target of 3.6%t When we compare ourselves to on that same metrics, the country, Here, I am showing annual healthcare spending growth12420 in the United States and in Massachusetts. United States is in blue. Massachusetts is12426 in orange. And you can see throughout12428 the 2000, that Massachusetts often and sometimes far exceeded12432 the growth rate of the United States
But really throughout the 2010 during the time period through which this law has been effect, you can see that the orange line has been below the blue line in just about every year, including in the in the two extreme kind of pandemic years. This indicates to us that this effort has had at least some moderate healthcare spending growth. Although, I will acknowledge you have a lot more work to do. When we look at the just the last two years, it's always good to kind of dive any numbers and try to understand. Okay. Well, where where are those areas where we've seen some expands and expenses. And so this is averaging kind of from 2019 all the way through 2021. So kind of averaging out those swings.And notably, there was 1 category of service that grew in both years.
Many categories of services you might imagine. Had a negative year in 2020 and then a big rebounding year in 20 21. one of the notable categories that did not experience a decrease in either year was pharmacy spending. So our pharmacy spending increased an average of 7.7% a year during years. There are other areas where we have seen increased spending growth in the hospital outpatient, which is kind of common minor surgeries, tests and labs. That was increasing at, what, 5.4% a year. And and other categories of service here. But I I wanted to share this just to reflect that you wanna go beneath the numbers to understand not all things are growing or increasing and spend at the same rates and where you might identify those opportunities.
To moderate spending, you want to tackle where the spending growth has been the highest. We have made some recommendations about further accountability and oversight of the pharmaceutical sector as necessary to continue this work. Unfortunately, despite some of the, I think, notable and good progress that we have made in terms of moderator and our spending growth, I do want to reflect that the cost of healthcare is still very high in Massachusetts. Here, I am just comparing the average cost of a compact car shown in blue since the year 2000 to the average cost of a family premium in Massachusetts. And the average cost of a family premium has now seed at $ 20,000 a year, seed at the cost of that compact car.
I think in our most recent data, which I don't have them on this graph, it actually is supposed $25,000 a year for a family premium in Massachusetts. So that's buying a car, well, maybe now even kind of a luxury car every year at year after year.12601 And these impacts on affordability trickle down to our residents in important ways. So here on this graph, I wanted to show this is the average out of pocket spending or 30 day supply of prescription drugs or several common chronic diseases. And just showing from year 2017 to 2021 not that long ago. We can see that there have been in out of pocket increases of 60 65, 70% for what average Massachusetts resident is paying out of pocket. Or prescription drugs for the upfront disease.
What this leads to, and these affordability challenges at why this effort is so important is because it leads to deterioration of access to care. In 2001, 46 Massachusetts admit said that they did not get the care that they needed because of the cost of care. They for for gone care. They are skipping dental care. They are not going to their doctors. They12670 are cutting pills in12671 half, skipping prescriptions or12673 sharing prescriptions with other family members 46% of Massachusetts adults in a very high income state reporting that they can't get the care that they need to cost. And three and four Massachusetts residents worried about being able to afford healthcare in the future. And why it's always important to go even deeper into this data when we go deeper?
We see that there important disparities and12697 that there are certain populations that are even more disproportionately impacted by these affordability challenges. And so when we look at the survey results for black and Hispanic residents in Massachusetts,12709 we can see that those numbers increased to 75% and 68% reporting having affordability burden in the past 12 months. Moving on to our role as a watchdog. So here, we have a number of tools to try to understand the changing health fair market and12734 to steer accountability so that we12737 are increasing our affordability. Ono of the most. I'll mention four things under this the first that we do is that we do monitor and evaluate changes in our healthcare market. And by that, I mean kind of the business of how care.
Which providers are owned by whom? Which hospitals are part of what systems? We know from the academic literature that that actually has a huge impact on healthcare spending and costs, kind of the structure of our healthcare market and how consolidated or concentrated it may be. So when providers in particular are proposing12777 acquisitions of of new facilities or new joint ventures, they must file notice with how policy commission that notices. Public and transparent, and we can conduct an extensive review in certain circumstances to try to understand and to make public what we think the potential impacts of these market transactions may be on cost quality access and equity. We have conducted a number of these reviews over the past 10 years.
The most recent of the extensive reviews we did was a few years ago now, the merger of Beth has real and Laky Health System are number two and number three biggest healthcare systems. We did issue a report raising concerns about the impacts of that merger. And importantly, as in12828 part based on our12829 report, the attorney general and the Department of Public Health, only let that12833 merger go forward with a set of very specific conditions or12837 approval that included conditions on price growth, conditions on investment in community health, other areas that we had identified. I mentioned earlier that we have the ability and authority to require a performance improvement plan if we identify a provider health plan that is contributing to a recessive healthcare spending.
We have done this once in the 10 years. We do conduct an annual very extensive confidential review. And last year, last January, we did require that National Brigham file and implement12873 a performance improvement plan based on our review of their spending12877 trends over many years. They did that. And after months of constructive dialogue with them, that Health Policy Commission Board, did unanimously approve a plan last October that will save close to $200 million over the entire 18 months. Of the implementation time period. The numbers here are are sometimes annual. We will are in the process of of constructively collaborating with MGB to evaluate their performance on this plan to ensure that they implement it. But this is an important part of our accountability mechanisms.
The third I I'd like to mention briefly is that we do have a role with in a partnership with MassHealth when it comes to their review for their review of drug pricing and their ability to negotiate12925 supplemental rebates for the Medicaid program. This was again authorized by important legislation by the legislature a few years ago that authorized MassHealth to be able to negotiate directly with a manufacturer on rebates. If those negotiations fail, Nasal can refer a drug to the health policy commission, and we would conduct our own independent review of the drugs pricing as it relates to its value. That part of this process has not yet occurred. So it has stayed at the stage of Mass Health being able to negotiate these agreements. And I don't have their specific numbers.
But the last time I heard, those agreements had generated over $100 million, if not more, in savings to the Mass Health program. So we are proud to be a partner with them on this program even if it hasn't gone quite to the stage of referring a drug to us for review. And then finally, kind of a little bit of a a left turn here we operate within the HPC, what's called the Office of Patient Protection. And here we interface directly with the public. This is this is an office within our office that helps consumers navigate extremely complicated health insurance system and we provide counseling and support to residents. We also administer a program where if a resident with a certain health insurance, is denied a service and the health insurance company says, we don't believe that that's medically necessary.
We're not going to cover that. Consumers have13017 the right to appeal both13019 at the with the health insurance company. And if that fails, they can appeal with us. And we would conduct an external review with some of our contracted agencies. And we can oversee the health insurance company's decision and ensure that the residents have access and coverage. For the care that they need. And I will tell you of13038 of the number of waivers or or, I I mean, of appeals that we receive about half our overturned in benefit of the consumer. So I wanted to pause here just to mention all of you and your constituent offices. If you don't know about the Office of Patient Protection and you get a constituent calls concerned about a denial of medical services or medical coverage.
We have a hotline. We have people reach out to me. Reach out to our office. We wanna be a resource to you and your constituents. Third, as I mentioned, we are a partner. So here, we have been making grants into provider organizations over the years to really test innovative ways of delivering care. This slide, I skipped ahead to 25, but just shows the arc of some of the grant programs over the years. We have three that are currently operating on the13094 right hand side of the slide. And these three, I think, are are important13097 to mention because the legislature had a role in in each of these. The legislature actually directed us to develop a program of health, which we call MassUp, which is really about addressing the up stream determinants of health.
We know that what drives good health is not always access to the healthcare system, It is about the environments and communities in which you live in reside. And so we have 4 programs right now that are working to improve food security and economic stability for residents in 4 different communities. And then the last one I'll just mention quickly is our herbicide program, birth equity and support through the inclusion of dual expertise. This program was c funded by you, the legislature, in a $500,000 earmarked a number of years ago. Thank you. We have taken that $500,000 and created an incredible program that is connecting black birthing people to dual services. And dual services have an incredible an emerging evidence base of really being able to reduce unnecessary complications to improve the patient experience during childbirth to decrease costs.
And where we know that back13177 birthing people are often faced with of course, disproportionately higher rates of complications during childbirth. And during this episode of care, we really want to invest in support services that are erected that dual services that both reflect the patients that they are serving and to be able to support the expansion of this. I would note that dual services, I do believe MassHealth is going to be covering dual services in the in the future. With this grant13207 money, we were able to get two organizations really up and going and get their programs up and running. So we are working with this one13214 with the 500,000, we're working with Bay State Health and Boston Medical Center., so both tens of the Commonwealth.
And just to reflect something really quickly, the Bay State Health program, they reached out to us about a few weeks ago and said that they had already kind of checked out how many patients that they could put into the program given the money that we had awarded them. And13237 so that they were going to have to start denying patients that were interested in participating in the program. Because of the lack of additional award funding. Our team sat down. We looked at our budget. We found $50,000 of unallocated funding and we moved it into that base state award so that they could continue enrolling patients into this important program. And then finally, the last strategy here is as a convener. And as I mentioned before, really, how do we bring people together to talk about the biggest challenges facing our healthcare system?
And I want to highlight an event that we're going to be holding next week. Downtown Boston at Suffolk Law University focused on the extreme challenges facing our healthcare workflows right now. The pandemic expose and exacerbated many tensions within our healthcare workforce from direct care workers to workers in our nursing homes to skilled nursing facilities to nurses and and physicians, workers within our hospitals. This has had an incredible disruptive effect and has resulted in higher costs across a number of different settings of care and has ultimately impacted patient care, where we see that more and more residents are being stuck in emergency departments.
Especially residents presenting with mental health conditions or are stuck in hospitals awaiting discharge to a step down facility or to a nursing home or to home due to the lack of support in some of these areas. This is a big challenge, and it's one that I think is absolutely connected to our efforts around access and quality13331 and affordability. And so we wanted to pull an event to bring together important13336 stakeholders to discuss these challenges and identify solutions moving forward. As part of that event, we'll also be releasing a report that you, the legislature, asked us to do on examining the healthcare workforce and the impact of the COVID-19. So skipping ahead, a few minutes on what's next for us, this this beer We have a pretty ambitious agenda in terms of of the different priorities that we're putting forward.
In addition to all of the things that we're required to do is in our statute and mission, we're really trying to lean in this year a couple of of really big activities. one is continuing to bolster and to evolve our cost containment approach. We have 10 years of experience. We have identified opportunities for improving and advancing the way we think about moderating that cost curve. As I mentioned, healthcare workforce is incredibly important advancing HealthEquity, his part and parcel of every single one13397 of these other things, and13398 also important enough to mention on its own. As I mentioned, we see that there is opportunities to enhance the transparency and accountability of the pharmaceutical industry. And by that, I don't mean just pharmaceutical manufacturers. I've new pharmacy benefit managers, wholesalers. There's an entire continuum of that sector that was left out.
I would say of the initial version of this law where so much of the accountability and transparency was focused on healthcare providers. And health plans, the main members of the pharmaceutical industry are not subject to some of the same accountability measures. We believe that this is a shared responsibility effort and that everyone should be underneath the tent working together. We're using unnecessary administrative complexity there's so much administrative burden that we put on our healthcare providers as we can reduce some of that at a time of stress. Let's pursue13452 that. And then, again, skipping ahead to our budget request for fiscal year 24.So importantly, and again differently than many other state agencies, we are an assessed account. So what that means is that the number that is approved in the state budget by you for our annual appropriation.
We then go and we assess both health insurance companies and acute care hospitals for the total amount of that appropriation. So it's a 50-50 split amboyance surgery centers pay a very small amount there as well. Sorry. And that money is then deposited into the general fund such that the appropriation and the state is basically held on us. And so this has been an assessment that has been here for many years was modeled after the Center for Health Information Analysis. The other state agency that has had an assessment for even longer. And so our request for this year is shown on this side, if you get the last quote, $11.4 million. This represents, I think, a very modest 2.9%t increase from the available funding in the current year. And as I mentioned, will not impact the general funds or defer resources from other priorities.
This is a maintenance budget. This is a conservative budget. I am mindful of the fact that this budget is assessed to hospitals and health insurance plans. And I think It's always been a priority of mine to keep our commission as efficient as possible. There are a lot of unknowns in healthcare. And so this is this is the best figure that we have at the moment. And I would note that there are a number of considerations and bills out there that would expand our healthcare reform authority. Those are not included here. So if there were additional responsibilities you would welcome them. But may return to ensure that we have the resources to be able to do those to the level and of quality that we've established. I think reflective here on this near final slide is just our staffing levels. We are lean mean commission.
We have not really grown our footprint in terms of staff over the13596 last five years. I think the requested amount will will help us get maybe two to three more people, really. But we we have been pretty efficient at at kind of this level for a long time and we'll continue to work hard to maintain that. With that, I would say this is I've been an honor and13616 a privilege and just13617 always a fun opportunity to be able to present before you. I believe that the work of the commission is absolutely necessary to continue our journey of health care reform and we look forward to working with you and to be in a resource for the next 10 years. And that is my picture, but is not my contact information. But my contact information is davidseltz@mass,com, and you can reach out to me anytime as well. With that, I will conclude my presentation. Thank you for the indulgence. SHOW NON-ESSENTIAL DIALOGUE
Thank you so much, Peter. Roughly.
REP KILCOYNE - Hi, Doctor Seltz good to see you as always. I just wanted to comment and just thank you for the work that you and the commission does. My district includes Clinton Hospital, which is part of the UMass Health Alliance System that also includes campuses and Leominster. My colleague of Rebekah sitting next to me as well as Marlboro. As I'm sure you're aware, that system primarily does serve many patients who are public payer or uninsured. And just wanted to thank you for the work that you guys do around accountability and ensuring that when we talk about healthcare costs and especially ways in which we can save costs that we're not doing so that causes the disservice to those patients over13697 the years, Clinton Hospital in particular, saw a lot of cuts in services
And, you13702 know, they're in a pretty good place now. But I think we all know that, well, that may be good for the bottom line, reducing services in areas, especially in areas like this where we have, you know, rural areas surrounding highly densely populated ones, and we don't have a transit system solutions to that of Boston. We don't have any Ts. We have limited RTAs and service communities. So having the ability to go five minutes down the road to get the care you need is so essential and critical. And as we see growth of other hospitals system that we need to know ways in which they're going to impact our local community hospitals as well. So not really a question, but just wanted to highlight that and just thank you for the work that you do that helps us serve our communities as well.
SELTZ - Thank you. And I will take the opportunity to just reflect. I think I am concerned about some of the trends with our community hospitals. You know, our our first grant program that we ran was a community hospital focused grant program. And we just saw this tremendous opportunity within the community hospital of the Commonwealth that provide generally13773 really great value, really good quality. They serve a higher proportion of public payer patients as you mentioned. And yet, are often due to13784 some of the broader market dynamics, the ones that receive the least amount in commercial revenue and in payments. And when we look across, you know, these years, there is a concerning trend of closure of services in rural communities.
And for providers that have higher public payer payer mix We're losing13804 maternity services in in a lot13806 of parts of the Commonwealth. We're losing pediatric inpatient services and a lot of parts of the Commonwealth. Those are also being consolidated. So you know, I this is an area of interest of mine and and we'd love to to follow-up to to, you know, really see if there is a way as a commonwealth,13823 we can be a little bit more proactive in thinking about where do13828 we need healthcare services. And rather than being reactive to then having to face difficult closure situations or entities you know, just, you know, rightly making business decisions to close services. Could we13841 have gotten ahead of that somehow? And so just an area interest. Yeah.
KILCOYNE - No. And I thank you so much for those comments. I think, you know, I speak for myself obviously, but I know many of my colleagues in the area of them all worked hard to make sure that we're maintaining that care and protecting our community hospitals because they do serve such an important role and looking forward to working with you and partnering in the future to continue that work. So13864 thank you so much. SHOW NON-ESSENTIAL DIALOGUE
Representative.
MURATORE - Thank you so much. Good seeing you again. Thank you so much for all you do and your staff. Last week's hearing that we had the buying committee of HPC and Health Care Finance. I think it was sent to Friedman that brought it up with regard to this is all great information. But the general public that looks at this and says, you know, my my plan goes up, you know, 10:11, 12% every year. What is it that you think that we can we can do collectively as a as a body? Or or your group can actually do to maybe look at that and help figure that part out and see what we can do to kind of control that future. That can happen overnight to understand that.
SELTZ - Yeah. It's a really important point. Thank you, represent, for bringing in a backup again. And I'll say a little bit of what I said at that hearing. How do people feel health care costs? They feel it in their premiums, copays, their deductibles, what they pay at the counter. Right? That is how we feel health care costs. And some of the graphs and charts I show you where we're looking at total healthcare expenditures across the state and showing moderation. And that's really important, but it's not the same thing as kind of like how people feel healthcare costs. And so I think that there is an opportunity to expand and evolve our measurement approach here to incorporate more measures that are really around kind of like can people afford to care?
13958 Like,13958 how much of their income is going towards health care? I don't know13961 what that right metric is, but just as we've made, you know, the benchmark, an important metric that track year over year. Maybe we need an affordability benchmark. And and that way that we can keep and hold ourselves accountable as well. To that. Other states are doing this. California that recently passed a law that did set up a healthcare cost growth benchmark very similar to our model basically has like a secondary benchmark too that's around kind of affordability metrics. And I think that is something that we can really learn from. Rhode Island goes even a step further. They have within their division of insurance standards for approval of health insurance plans that that are based on can people actually afford these plans?
There are ways within our regulatory structure and within the structure of the HPC or I think we can more firmly embed affordability as the ultimate goal that we're trying to achieve. And you know, we'll move forward on this. I think it's the right thing to do and we'll start to model that out and come up with ideas to bring to you. We won't, you know, I think the weight of law and legislation would be real helpful. We'll move forward on it. And I and I as I mentioned, I I do think that there are other important metrics that we could think of as well to track performance and track improvement. What if we had a HealthEquity Benchmark? I don't know exactly what that would be.
But if we're trying to reduce and eliminate disparities in health and health outcomes, maybe we should set some pretty aggressive ambitious goals and track our performance and see how we're doing. I think that we should be tracking how much money we're putting into primary care and behavioral14057 health care. I think we14058 should be investing more in primary care and behavioral health are. So I do think that there are absolutely ways to go beyond the current structure to pick up14068 all of these other important pieces of help spending and healthcare values. And I think we can learn some other states, but I also think we could be leaders on some of these as well.
MURATORE - Great. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Dr. Miranda.
MIRANDA - Thank you so much for your presentation. White Type A, I was like this fabulous. I love paper. But something really important that you noted, and I wanna talk about maternal health, and a bunch of other questions, but I'm just gonna focus on this. As a member of the house, although I'm not a mom, I'm a black woman. And I heard a presentation for the march of times in my first week on the job that said that the 10 were ZIP codes to give birth in Massachusetts. Six of them were in the city of Boston. And we're predominantly black and brown communities. And I walked out of that meeting just with this extreme fear of, like, I don't wanna die even in a state that has the best healthcare.
We're dying two to three times the rate of white blood level. And our babies are being born preterm or passing away six to eight times out of white women. And so I was happy to work with then he's still the chair, Michlewitz around the $500,000. To the health policy. So I'm happy to see government spending actually working. And even though it's been 4 years, it's good14147 to see that that $500,000 initial investment along with passing the maternal and equities commission that we filed the report last year that basically chronicled what Massachusetts was actually facing has been leading to better outcomes. The bad news is that Massachusetts is the most expensive state to give birth in. The New14171 York Times just released the report that regardless of ZIP code, race, education, and economic status, black wealthy women
Still had poorer outcomes than poor white women. We've seen closures of birth centers, and maternity wards across the state, most berthing people live in a maternity desert, even in the14194 state that we have sought the best healthcare. And that's leading to even poor outcomes, which we haven't improved the morbidity and mortality rates of black and brown women. And so my question is kind of technical on this. You know, you talked a lot about HealthEquity and all four of the benchmarks. And for tracking them. But so often, we can't improve outcomes because we're not even at the table discussing this. When we did the maternal and equities commission, which was 95% people of color, some practitioners.
Some folks with lived experience, either14228 they had lost a partner during the postpartum stage or were taking care of children, berthing people who had passed away. And so14238 I had a question about14239 your advisory board and your board. Are there practitioners of color that are on those boards really driving the conversation. And if there isn't, are you willing as the executive director to really think about increasing the capacity of people of color to be able to sort of determine and fix? And the second question is around its maternity desert situation. We now have one birth center in the Commonwealth of Massachusetts and it's in Northampton. I'm happy to say that they might be the neighborhood work center. They might be opening up in the city of Boston in next year.
God willing, which will address that. But we have no birth center east of Northampton, which is pretty much the western part of the state. And Brockton Hospital, I don't represent Brockton but it is a gateway city just like Pittsburgh with a huge population of people of color and just said that they're at disaster mode. So they're not even able to serve birthing people. In a state, it feels like we're in a crisis mode even four years after giving $500,000 four year I mean, two years after doing a maternal and equities commission. What are we to do? Because I don't wanna see more women die. I don't wanna see a children die. Particularly in a state that has arguably the best public health infrastructure in the whole state. So I know that was loaded, but it's something I'm really passionate about.
SELTZ - Thank you. Thank you for your passion and for your leadership on this, and thank you for your advocacy to help us be able to put this this grant opportunity in place. You know, I'll take through a couple of things. I think, first, you asked about our the makeup of the adviser also in accordance of incorporating14346 voices into the design and implementation and evaluation of our work. That is reflective of of the communities we're trying to serve. I'm the advisory council. I’m Proud that we have made very significant progress in diversifying that advisory council. That is something where I have the ability to14368 make those appointments.
And we have, I think, in this last year, brought in a number of if we have a there was a nurse, which I had her first name. Oh, we have made strides to really expand on diversify. Advisor council to bring those voices to the table as we implement those programs. For the14389 HPC board itself, I do not have that control, those are appointments made up by the governor, the auditor, and the attorney general. And I know that there are an interest in continuing to diversify that that board at which we welcome as appointments cycle over. And I think the stats just to reiterate, stats that you laid out are pretty unconscionable for a state like Massachusetts.
A state a very high income state a state that prides itself on public health in our healthcare system. We, you know, we have done some research in work. We had identified that First Centers provided really high value opportunities, really high quality opportunity for alternative delivery of care. We, you know, after the the the closure in in Boston, we went and talked to the health plans and tried to I don't understand, like, how are they reimbursing for these services? Because the, you know, the burst centers were kind of saying, like, we can't make this sustainable. They've got a business model here. And talking to the health plans, it's okay.
But if we funnel more of these women into the hospitals that three, four for five times the cost. Why wouldn't you support these alternative settings of care where they have a track record of high quality? I don't know that we had a lot of you know, kind of good information coming back to us about that. But I do think that if we're going to and I do believe be expanding alternative settings of care like birth centers, we need to really think about what how we're paying for it, what the business model is to make sure that, again, we're not just, you know, putting more and more money into the most expensive settings of care. Let's find those opportunities. In terms of your your broad question of, like, what do we do?
How do we solve this? I do not have the answer for you. You know, you said earlier that we'll never gonna improve on things that we don't measure and track and understand We do actually have a lot of outcomes data on this, and it's pretty, pretty devastating. And so I agree with you, this is a crisis. And I I wish I had the the right perfect answer for you. I don't I would absolutely take another $500,000 earmark if you need to advocate for that. I'm not going to promise that this is going to solve this. This is, you know, these are some of these are our issues in systemic racism, candidly, in our healthcare system. And yet that we can't just accept that. And
MIRANDA - Thank you. I'll schedule some time to talk about that14557 and then send the recommendations14558 to the HE or the auditor or the governor around the board makeup but we can't keep throwing around the word health equity when there's a huge population of birthing people that are not getting equitable services in a common weapon. So That's where I'm trying to raise the issue for my colleagues because it's an incredibly important thing.
And I just wanna leave it one more fact. During COVID-19 42% A Massachusetts resident chose an alternative place to give birth because of fear. Hospitals were not safe. So they had birth in their homes or they tried to find birth centers and these the one or two centers that were left, that release now closed. We're really overwhelmed. And it is unconscionable for us as a state that has this many resources to not be providing the quality of care that we So thank you for your presentation.
SELTZ - Can I just add one final note on that? With the the side program, the graph program that we're running, We really as part of the evaluation of that program to try to understand, you know, that was the successful where we able to achieve positive outcomes. We very purposefully put it as part of our valuation. Actually talking to the patients and asking them about their experiences with dual services and their experience through the program.
And I will share this kind of, you know, kind of shocking realization when we talk to a contractor who is, you know, kind of advising us on the evaluation is well, that's not typical. We don't actually typically ask the people who receive services. What they thought of that. That's not really part of our our grant evaluation process. And I I found that to be pretty disappointing, and that's I think something that we have to do. So thank you.
REP MCKENNA - Thank you, Director. I certainly appreciate your presentation and the work that you do was hoping that you might expand a little bit on specifically the drug pricing review process. And specifically in that where14675 the intersection of a drug's price comes with its value. And for context, of course, when we hear situations like the insulin price spike where it's a relatively common drug that has an inexplicable large increase that's problematic. But for further context, I come from a family with extensive history with hemophilia, a rare bleeding disorder and my two-year old nephews on HEMLIBRA drug that took decades to develop and cost somewhere in the range of $3-4000 a dose.
But it allows him to live a normal life. And in Massachusetts, we have the world's leading life sciences and biomanufacturing, putting hundreds of millions of dollars into research for rare disease treatments and therapies. Where oftentimes14725 there's maybe a couple hundred14727 patients in the entire state or across the country to benefit from hundreds of millions of dollars of investment. So where is the intersection? And how do we balance ensuring that research continues, that lifesaving therapies are available. Obviously, there there's an economic boost to that that's incredibly challenging. So just wondering if you had any, you know, background on that.
SELTZ - Yeah. Absolutely. I think you've very articulately describe the challenge you're of wanting to maintain and support and expand our innovation and bio and medical technology. This is a centerpiece of our economy, but even more than that, it creates life changing life changing changes in life and care. As a side note, you know, This is why I think it's always important to dive beneath the data and understand what what's going on. In one of those years where we went through the benchmark, whereas a state,14791 we had healthcare spending that was above the benchmark.
It was because of the introduction of a new therapy and that therapy was a cure, a cure for Hepatitis C. And it was introduced at the market at a at a high price, but it was a cure that in indisputable. Resulted in a quality of life improvements, extended life for so many individuals. And so, you know, when I look at that year and I say, oh, you're above benchmark. I'm like, well, you know, maybe that was a good thing. Right? So I think that context is important to all of these things. And I think the balance is the word that I would probably stress. As we14836 have thought about, we have not yet had to do 1 of those reviews.
And, you know, even if we were to do one, the end of the process is really a report to the public. It doesn't really go beyond, you know, batter or setting pricing or setting caps on pricing. But I do think that there is nonetheless value in trying to bring science and data information to bear to say, let's look at the clinical evidence about the improvements that these drugs or therapies can have. Let's think about the cost of care and whether as a society we can continue before those and how do we balance those things? I don't think there's one answer because it will really depend on kind of the clinical profiles, the populations, the impact, it will it’s this is complicated stuff.
Can be wrong. But nonetheless, you know, there are unfortunately other circumstances where the pricing that is14896 being set you know, maybe this is a manufacturer that didn't do all that research and development, just bought a patent from another company, and then immediately increase the price to bear on the market. So for every really, I think, positive example that we should be upholding and supporting, there are unfortunately examples of of, you know, increasing pricing14918 or setting launch prices at higher rates than either residents or we can that we should examine and that we should bring some data to try and understand. So for me, it comes back with transparency. And balance. Thank you. SHOW NON-ESSENTIAL DIALOGUE
Thank
you. We're gonna try to go back to Zoom and recognize representative authority.
DOHERTY - Thank you. Thank you very much once again, nearing the end of a long day. Thank you, sir, for This presentation, I have learned such a great deal in the past hour or so that you have presented that you're worth your weight and gold just in that respect.14958 So thank you very much. I I thought about not having to add my voice to the chorus of voices who are concerned about community hospitals, but I thought why not? Because the community hospital and my Rick, the third Bristol District. Morton Hospital in the city of Taunton has been the mainstay of health care for most of the time that I have lived here in the community. We have been subsumed by a forecasted organization that has really suck the wind out of every single doorway that covers medical care across the community.
So pointed out, first, it was pediatrics. There are no pediatricians in this region. The nearest pediatrician lives in Eastern. And that it was maternity and all of the services and supports that go along with maternity care, maternal supports also well-being and health and well-being for women generally in the community. We have to go elsewhere out of the community. And then the Norwood Hospital closed its NorCap unit, moved here to Taunton and it is, for those who may not know, a unit in the hospital, 32 beds that takes care of opioid addicted persons. And they discovered recently that it wasn't15042 meeting the profit for profit standard that they had put forward, and so they have closed that unit. It's moving somewhere else in their catchment area here in Region five. So there are 32 beds that were renovated in the high hospital at ruinous expense.
I'm sure, that will partially become surgical beds. And I don't know what what will happen to that. And then all of this is exacerbated as I think perhaps it was senator Miranda who pointed out the fire in the Brockton Hospital has shifted that sand underneath us. So we rallied, we demonstrated we wrote letters over the years had legislation filed to prevent this from happening. And of course, it has happened because15090 there are only certain restrictions that can be placed15093 on for profits that come into the commonwealth. And so my, I15097 guess, my question15098 is, what is your strategy, if you can, to continue to advocate for the restoration of community hospitals where that's appropriate. And is there anything that can be done to slow down these for profit organizations that are subsuming our community services?
SELTZ - Thank you for that question, and thank you for your advocacy over the years for 1 hospital. A great community hospital. To repeat it something I think I said earlier, I I do think we need step back and take a a bigger picture of our health care market and really try to15135 understand where do we need services and who is providing those services and make a plan. Like, you know, there was this thing in chapter 224 about health planning. And really just15149 trying to understand where where do we maybe have too many services? Where do we not have enough?
I can tell you my concern is that if we leave this to the healthcare market to figure out, we will increasingly lose capacity in community hospitals and rural centers. Capacity will continually be consolidated into bigger systems into downtown urban centers and at a much higher cost. I think that there is a role for government with these stakeholders. Bring people together on the table. We need to have a plan and then be proactive about implementing that plan. So we're not, again, only reacting when we get the notice, it's like, well, we're going to have to close that unit. Once a hospital says files a notice that says, I'm gonna have to close this.
And then it's so hard to unring that bell. You know, what if there was an opportunity to work with that provider before that point? To have triage or prices or something where we can be more thoughtful before we lose the capacity altogether. So I do think we need to be more thoughtful about this plan and not just kind of letting the market itself figure this out. And then I to your second point, I do think that we need to evolve how we our strategies about the entrance of private equity into our healthcare system. And I'm not just you know, I'm not referring to Stuart necessarily here, but there are other for profit private equity firms that are have been increasingly purchasing physicians and practices.
Purchasing nursing homes. And I, you know, I think these raise important questions that should be we should be tracking very closely to understand, are their interests actually aligned with providing great quality care access or their interest really around a distressed asset that they would then flip for a short term profit. And again, even, you know, this isn't necessarily a private equity, but we see the Amazon entering this market as well. So I think important for us to be you15269 know, to be evolving with a rapidly evolving healthcare market and examining all of these different dynamics and I hope that we can stay at the forefront of that, but thank you representative.
DOHERTY - Thank you. And that's a message of hope as my ears are receiving it. So Thank you. SHOW NON-ESSENTIAL DIALOGUE
Any
other questions for me
today?
I'm
seeing non director. Thank you so much for your
support. And again, consider me a resource. Thank you.
Thank you. I'd like to invite Executive Director, Mary Phong. The office of refugees and immigrants, and thank you for your patience.
Thank you so much for your patience. I cannot be as articulate as David, but I have 2 long pages of script to go through. So please be patient with me as well. Thank you.
MARY TRUONG - OFFICE FOR REFUGEES AND IMMIGRANTS - So good afternoon, Chair LaNatra, chair Cronin and and members of the joint committee in ways and means. My name is15329 Mary Truong once again. I’m the executive director for the Office for Refugees15334 and. Immigrants or ORI. I would15335 like to be guided by extending the heartfelt thank you to each and everyone at the chairs and the members for keeping me this honor to speak before you. And to answer any question you may have regarding to ORI's fiscal 24 budget. I also like to express my gratitude to Governor Healey, Lieutenant governor, Driscoll, and for their proposal of $2, 036, 902 in state funding to invest in brand new administrative line item. Which includes increased program capacity and oversight.
And continued support for our studentship for the Do American program, which is CNAP, which will provide services to more than a thousand 700 refugees and immigrants. This appropriation will also support our Financial Literacy for Newcomers, which is FLN program to provide much needed potential training to 300 newcomers. So with your help, we can continue to make an impact on people's lives. I would like to highlight some of the important work that ORI has taken on in the last few years, utilizing15413 additional state funding appropriated viewed a supplemental budget underscoring our deed for this essential administrative expansion.
So first is after years of low number of refugee arrivals due to the federal policies, Massachusetts received a certain influx of Afghan human terror employees. Massachusetts received this AHP who arrived in Massachusetts as a part of the Operational Allied welcome. And were assigned to the states, six through seven agencies. In addition to implementing multiple newly federally funded programs for the AHP's or I15462 established the Afghan emergency assistant program known as AEAP to distribute $1215473 million in state funds allocated to the Massachusetts strategy we suddenly in the chapter 102 of the Act of 2021 titled Act. Relative to COVID-19 recover release.
So under the AEAP, the resettlement agency have provided approximately 1800 AHP's with direct financial and immigration assistance. So and receive the infrastructure support necessary to hire bilingual and by cultural staff and provide services So during the same period, a patient immigrant fleeing the economic and political crisis in hating while arriving in Massachusetts in significant and rising numbers. The legislator provided an additional $8 million for the recently arrived patient immigrants, also included in Chapter 102 of the act of 2021. ORI established the Patient Refugee Assistance Program, the HRAB, to distribute the $8 million designated funds to the15544 Immigrant Family Services Institute, known as IFSI consistent with the statue.
So under the age rep,15551 IFSI provided approximately 1600 eligible recently arrived patient immigrant with direct financial assistance an immigration assistant and receive funds for IFSI’s administration the program. So in July 2022, ORI initiated a third major state audit program. Referred to as the Mass Resettlement Support Program, MRSP, to distribute $10 million in funds designated in the fiscal year 2022 supplemental budget for the Massachusetts refugee settlement agencies to provide support or immigrant and refugees,15595 including refugees, I'm sorry, including15599 recently arriving Ukrainian humanitarian priorities.
So similar in structure to AEAP and HRAP and MRSP, is projected to provide direct assistance and immigration services to approximately 2000 eligible immigrant and refugees. So finally, ORI has created two new state funded programs to help address the search in the grand arriving in Massachusetts and animatic needs of shelter and assistance in coordination with Department of Housing and Community Development, DHCD, ORI established the Housing Stabilization Program, the HSP. The HSP was funded by the housing preservation and stabilization fund administered by DHCD.This is through the Mas General C-121 (B) Section 16.
So through HSP ORI provided emergency housing system, through community providers to meet the need housing needs of immigrant family, eligible for the DHCD's emergency assistant program. Additionally, targeting this population. ORI has issue a request for responses to provide case management at limited. Legal assistance15686 to immigrants in and or qualifying for emergency assistance. So governor's fiscal 24 budget supports a $1 million expansion for ORI to establish a new administrative line item to continue the work listed above and expand programmatic capacity.
The $1 million will fund at least six new all time employees to formalize they funded administrative capacity to address the changing needs of immigrant across the Commonwealth. So these essential positions will allow ORI to be more proactive when thinking of how to address the needs of immigrant and refugees across the Commonwealth. So in closing, I15735 would like to say that it has been an honor to work on behalf of the state to integrate newcomers into the company well. So thank you for the opportunity to present our fifth fiscal year 24 budget request. And I'm happy to answer any question. SHOW NON-ESSENTIAL DIALOGUE
Great. Thank you so much. Does anyone have any questions15755 on the committee? Yes.
MIRANDA - Thank you so much one of the questions I have, you spoke about IFC, which is in my district, And I was really proud to work with the Asian American caucus and my colleague, Ssenator Collins and representative Brandy Fluker Oakley once we saw the budget that had $15 million for Afghan refugees and did not include Haitian migrants, we decided to write a letter and the legislature supported us and we were able to get that million $8 million. I have the third largest Asian American community and haitian community in the whole country, only a third to Miami, Florida and New York City. Communities like Matapan and Hyde Park, Randolph Brockton and Everett make up led to top 5. I didn't see anywhere in your budget.
I saw $13.5 million strap Danny, refugees, 4.25, for Ukrainian refugees. What I'm wondering is where's the Asian migrant situation? That $8 million went by really fast, particularly at the cost of living, and the support service is needed for those migrants that are still arriving every day. Some of them are biring in Boston, but some of them are arriving in bus stations, across the state? Is that hidden somewhere in your request? Or is that not just directly stipulated? Because I do believe we're missing the mark if we're not directly sort of creating the line item to continue to do the work. Folks, once they get their resources Those resources are gone in a month, two months, three months, and they might need to come back for other services or for the newly arriving. Migrants, we might need to reissue more resources to organizations like us.
TRUONG - Thank you for asking that important question because it's always about money in order to increase in our capacity in general. We need to have funding to support more work and more support for that that that's so needed for these recent new customers. So at the federal level, we addressed that question to our federal office for refugee resettlement in particular to help support the Asian. And as you know, the Asian refugee immigrant they15901 have been supported as or eligible refugees. So they have been receiving cash the system that is it used to be for eight months. It has changed from the last 2 years to up to a year. So they get that cash assistant and they get all of the15921 support for case management, housing search helping their children and rolling in school.
They all our eligible population include the Cubanation. But in in our current world, we have been welcoming more Asians to our state than in the Cuban. But these tho population have been OR eligible since going back for over 20, 30 years. Before I have been in this role. So they will continue to receive the support. That is on the federal side. So the only concern that I have about, particularly the Asian refugees are that the I think the issue has been not receiving the employment authorization document in time. So that's something where the United States in shipping and immigration services have been working on to address that slowness.
In processing. They're eager to work. And meanwhile, they they could not because of that situation. Been while they've been involved in a large number from our service providers for employment preparation, learning English as much as they could. I'm talking about in particular the Jewish vocational services that they've been enrolling many of the Asian newcomers to to help with preparing for them when they're ready to work. Meanwhile, they learn English. And from the state side, we continue to receive many calls from many people, from all over the world, not just the Asian in particular, or the Ukrainian. And so they're looking for sponsors. And the good news is that there are so many private community sponsors
There's a program called community circle. They have been helping working alongside with the reseller agency to help refugee and and and immigrant individual and family to address any concern that they have. Giving them information and our office as well connecting them to services in general so that we want to be sure that we that we help address anyone and not letting them feel that they are isolated or they're not being hurt. So it's wonderful to see through your support that IFSY received $8 million They're very much appreciative of that. We work with Dr. Gabor. As you know, we where we're working now on another state EMR. And so, yes, Dr. Gabor is someone that we work closely with in addressing the age for the patient. Immigrant and refugees in general. So did I answer your questions?
MIRANDA - Yes. Thank you.
TRUONG - Thank you so much for that important question. SHOW NON-ESSENTIAL DIALOGUE
Thank you, representative.
PEASE - Thank you, madam Chair. Yes. I have a question about, like, the community notification because I think we've had some refugees that were brought in like Ukrainian16127 refugees, but they were kind of sponsored16129 by some churches we have in our city and community. But I don't think especially like the school or the city is getting notified that we're getting this influx of people who don't have very, you know, if at all, English skills that are gonna be incorporated in put into the school system.
So, obviously, there's gonna be more services. So I'm just wondering how that notification security data. And if if that's gonna be too long, then I don't mind you following up with me in another time, but I just wanna make sure that that's that's kind of a really kinda tightened up between either transition assistance or reaching out to the education department or just the community at large?
TRUONG - Yes. Thank you for that. A important question as well, Rep Pease So on every 3 months, on a quarterly basis, we have the quarterly consultation with all of the local stakeholders, and we conduct this through four different regions from Eastern Methuen Central Methuen, Western Mass. And so we have this conversation to address the need and how we can resolve together issues of concern from how many refugee would be arriving in our local town and how have they been able to serve.
So among all of the diverse local stakeholders, we address those issues. Because the participant have always been very diverse from different services from law enforcement16222 area to school to healthcare. Basically,16226 we have this conversation quarterly. So I would love to give you a schedule of this conversation if you would like we can send you so that you can send someone to come and address issues of your concern because this is where we have this kind of conversation. How are we able collectively to help? Address the16248 needs of these newcomers..
PEASE - Yeah I appreciate if you could follow-up and send me some information on it. Because, again,16256 the integration piece is the the key. We just can't have them coming in and then, you know, they're just getting left there. I mean, I got a call from a constituent the other day. With some folks who came in in the fall, and they were having a little tough time about getting some maybe some fuel assistance to help them get through the winter. And things so that I'm gonna, you know, reach out and see what's going on there with their community services. But, anyway, thank you.
TRUONG - Thank you. SHOW NON-ESSENTIAL DIALOGUE
Any other question?
Again, thank you so much for your patience. You. Thank you for being here today. Tag. Mhmm.
Sure. Yeah. Absolutely.
I and to conclude, I I wanted to thank our very gracious So City of Fitchburg, mayor Dina Tally, my colleagues in the Senate for joining today's Senate, who's Goldby Miranda, Senator Cumberford online, hearing the testimony from the secretary's commissioner's directors is truly indispensable to this committee's work put together a budget that meets the needs of our state and reflects our value. So we're grateful beyond measure for all the testimony that was provided today. And beyond that all the work you do throughout the year and every day to serve our state. And I will just conclude by thanking my staff who is the best team of Massachusetts politics for making this a seamless hearing on the road today. So thank you to team Chroma.
Thank you. And I'd like to reach out to all my house colleagues, and thank you for your important work that you do. And again, our staff as well. And your staff. Thank you. Thank
you.
Motion to adjourn.
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