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[Rep. Jane Garibay (House Chair, Aging Committee)]: Welcome to the agent committee public hearing, 02/24/2026. Welcome, everyone, and thank you for coming. We're gonna get right into it. Our first speaker is Chantelle Vars from DSS, our deputy commissioner.

[Chantel Vars (Deputy Commissioner, DSS)]: Good morning. Good morning, chairs, Hakadell and Garibay, ranking members and distinguished members of the agent committee. My name is Chantel Vars. I'm the deputy commissioner for the department of social services. Commissioner Barton Reeves regrets that she was unavailable today, and I am pleased to offer remarks on her behalf. We've also submitted written testimony on several of the bills on today's agenda, and I am here today to speak specifically in strong support of senate bill two eighty eight. This bill provides vital support and care for our most vulnerable residents. It protects access to nursing home services in communities where residents lives live and ensures DSS has the necessary tools to audit nursing homes to protect Medicaid dollars and safeguard Medicaid funding for use to support nursing home resident care. We want to make a few clarification on this proposal, specifically to sections one and two. DSS does not wish to undo years of rightsizing and rebalancing of nursing home supports. Rather, this bill allows limited exception to the current moratorium on adding new nursing home beds in the state in very specific circumstances. With regards to section three, DSS is simply seeking timely responses to requests for data to better align with current federal requirements. We do not anticipate any additional burden on nursing homes. And lastly, in regards to section four of this bill, specifically to union employees, we'll cap the reimbursement rate of pay for Medicaid reimbursement for union employees who are related to own to owners. That concludes my verbal testimony. I am joined by my colleague, Nicole Godburn, and we will answer any of your questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Are there any questions? Senator?

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you for your testimony, and for this bill. And I just wanna say a special thanks to Nicole. She has been absolutely amazing, in helping us and making sure, that everything has been done right. So just a huge thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Is there anyone else? Is there anyone online? Yep. Rep Hughes.

[Rep. Anne Hughes]: Thank you, madam chair, and, thank you to everyone, for your, DSS. I would would like to ask if you could talk a little bit more about where we are with the rebalancing and why you think the exception is a good, is a good, you know, why in limited exceptions, it's a good idea. I agree with you. I just want, to explain what rebalancing is a little bit for our members.

[Nicole Godburn (DSS Fiscal Manager, Reimbursement & Certificate of Need)]: Great. Thank you, Representative. Again, my name is Nicole Godwin. I'm the fiscal manager of reimbursement and certificate of need with DSS. For years, the state has had in place rightsizing and rebalancing efforts. Those efforts are to ensure that we have a nice balance of available beds for nursing homes, for residents who need the assistance and support in nursing homes. We like to keep folks within their communities. So current statute defines that as a 15 mile radius. So we want to make sure that we have access for residents within a 15 mile radius so they can stay in their communities, receive services in nursing homes within the communities that they live in. Right size and rebalancing efforts were put in place years ago because we had too many beds. There was, quite, too many vacancies. And what that does for the Medicaid spend is it throws it into a little bit of imbalance. So we put in place those right sizing efforts to make sure the ship is right sized, essentially. After the public health emergency after COVID, we saw a record number of nursing homes be sold. Beds were decertified, taken offline. So what we saw is in particular geographic areas of the state, especially in the rural areas of our state, available space in nursing homes is becoming very tight. It's becoming very constrained. We still have available space, but knowing that Connecticut is an aging population and knowing that we like to keep folks within their communities, we want to make sure that we're being proactive and not undo years of right sizing, but just have tools and levers available to us that should we have an area of the state where space is becoming a concern, we will have an opportunity to expand capacity so people can stay within their communities. And again, we're really kind of looking at the rural areas of the state, Northwest Corner where I live, and then the other end of the state on the Northeast Side too. So those are kind of the areas that we're getting a little concerned about.

[Rep. Anne Hughes]: Thank you. Thank you. And through you, madam chair, do you think SB two eighty eight adequately addresses that shortage in this, in this language?

[Nicole Godburn (DSS Fiscal Manager, Reimbursement & Certificate of Need)]: Yes. We think it does. We But we recognize though that hindsight is always twenty twenty. So if this bill should pass, we're going to closely monitor it and watch it and work closely with the chairs and with the industry and with everyone who has an interest in this area to make sure that if this bill should pass, that it's doing the things that we hope it can do. If we find it's not and we need to make adjustments, we of course will come back to the legislature and make revisions if we have to. But we think that the way that it is written today, that it will have the, will

[Rep. Mitch Bolinsky (Ranking Member)]: give us the ability of what we're trying to accomplish. But if not, we're going to closely, closely monitor this. And if we need to make adjustments, we will.

[Rep. Anne Hughes]: Thank you so much. This is super reassuring. Thank you, madam chairs.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Repolinski.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you, madam chair. And I just I just wanted to, give a head nod to, the DSS commissioner, of the deputy commissioner and especially to Nicole. For those of us that are watching remote, which is gonna be far more than the folks that were able to make it in today, so you understand the process. This bill is one that, you know, had a couple of little red flags in it, but we kept them little and, we've initiated a working group And the working group, is something that doesn't appear necessarily on, CTN, although I believe we do have a a recording of our last working group on CTN. But, in that working group, we had participants from, the stakeholders. We had participants from, you know, from owners, from, industry lobbyists that are concerned about the the health and well-being, not just of our patients, but the financial well-being and the sustainability of our nursing home, facilities around the state. So, we had a really robust meeting, with an awful lot of issues that came up just the other day. And I wanna say that in the end, we all sort of agreed that we were all looking for the same basic thing And the flexibility that you that that, Nicole tried to describe, was very understated. We have we have partners in DSS and partners in the industry that are that are working together side by side to make this work. And, and for me, you know, in this building, that's a really remarkable thing. And, I'm very grateful. So thank you. Sure.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Any further questions? Seeing none, thank you very much. Next is Kathleen Holt Holt, state office of the health care advocate.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Thank you. Good morning. Can you hear me?

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yes. We can.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Great. Senator Hockadell, Representative Garibay, Senator Wong, Representative Balinski, and members of the aging committee. For the record, I am Kathy Holt, health care advocate for the state of Connecticut. For purposes of public information, the Office of the Healthcare Advocate is an independent state agency with a consumer focused mission. We move to assure that consumers have access to medically necessary healthcare, educate consumers about their rights and responsibilities under their health plans, assist consumers in resolving disputes with their health insurance carriers, inform legislators and regulators regarding problems that consumers face accessing care, and propose solutions to those problems. I appreciate the opportunity to comment in support of House Bill 5,302, an act concerning asset limits for Husky C beneficiaries. OHA is supportive of this bill and of other initiatives to raise or remove asset limits that impact eligibility for certain public benefits, especially health benefits for the aging and disabled. However, the increase proposed by this bill is too modest, and the Office of the Healthcare Advocate urges the Committee to consider raising the asset limit even further or eliminating it altogether. Asset limits create unnecessary barriers for individuals who may rely on their savings or other resources in order to meet their living expenses, particularly during periods of high inflation or unusual circumstances. The inevitability that higher cost events and emergencies will occur and financially burdened beneficiaries beyond the unfortunately low asset limit creates additional health harming physical and mental health stress on Husky C beneficiaries. Such limits also unfairly discriminate against the aging and disabled relative to beneficiaries of other Medicaid programs like Husky A, B, and D, which have no asset test to determine eligibility. This unequal treatment deprives potential Husky C beneficiaries of the ability to accumulate savings or other resources that can enable them to withstand periods of financial hardship. Instead, program participants are put in the position of having to spend down assets that they may have spent years saving just to maintain a very modest standard of living. We should be encouraging individuals to engage in good saving habits rather than disincentivize them via asset tests in order to help them adapt to unanticipated financial challenges that may arise. Further, the administration of asset tests can be costly so as to defeat their goal to keep Medicaid financially sustainable and to better manage program costs. In the spirit of reducing Medicaid program costs rather than a modest increase in Husky C assets, OHA encourages the state to study savings that would be achieved by more Husky C beneficiaries enrolling in the public traditional Medicare program. The Office of the Healthcare Advocate sees the cost shifting from private Medicare Advantage plans to Medicaid in our cases, particularly those who are enticed into the dual special needs private Medicare Advantage plans and on to Medicaid as the payer of last resort. Without this significant cost shifting from Medicare to Medicaid, more legitimate coverage would be made by Medicare and save Medicaid money. We know that twenty percent of hospital discharges are from Husky C beneficiaries, and testimony from last year indicated that at least some hospitals are paid 8% more by traditional Medicare. There is much to learn from examining all of the total options with everything on the table. Thank you very much for your consideration of this testimony and on this very important topic. I'm happy to take any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Are there any questions? Repolinski.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you for your testimony. And also thank you for using the word modest as opposed to other other adjectives to describe a program that we are actually purposely being conservative with because we're afraid of creating too big of a fiscal note and getting booted out the out the door because of it. But I'm fascinated by how incredibly well you explained the concept of keeping the expense within Medicare versus allowing it to go to Medicaid. Can you just elaborate a little bit about what that means? Is it a shifting of expenses from state to federal or is it, or is it, does it actually represent something that is an overall savings to the entire picture?

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Yeah, that's a great question. Thank you for asking it. There, what we know about traditional Medicare is that the doctors get to decide whether or not something is medically necessary for an individual. And the hospitals, it's very much driven by the needs of the individuals. So, there's more robust coverage being allowed under traditional Medicare. Under the private Medicare Advantage plans, that that there's a there's a very large, marketing opportunity there to, to bring people who are on Medicaid into these private Medicare Advantage plans. First of all, that's, that's, there's a very high, compensation level that's given to brokers to bring people into these dual special needs plans. And oftentimes, what we see at the Office of the Healthcare Advocate is the coverage is very skimpy. For instance, if you if you're in a nursing home, traditional Medicare any nursing home, operator will tell you that traditional Medicare will cover typically about twenty days. Depending on the situation, it can cover up to a hundred days, but typically, twenty days. Whereas a, someone who goes into a nursing home for rehabilitation after surgery, for instance, and they're in a Medicare Advantage plan, one of the private plans, the, amount of time that's allowed is typically five days. So that's just one example, but we see denials that happen quite frequently and aggressively with these private Medicare Advantage plans. And what happens when the when the Medicare Advantage plans don't pay is that then Medicaid is the payer of last resort, ends up kind of holding the bag for all of these costs that are denied by the private Medicare Advantage plans.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you very much. What an incredible concept. So trying to frame my next question. You know, why don't you come back to me if anybody else has any questions, madam chair? I'm I'm formulating.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. Thank you. Rephuse?

[Rep. Anne Hughes]: Thank you, madam chair. To follow-up on this really important line of questioning, which we're also dealing a lot with in the, Medicare and Medicaid oversight council, Does your office have the capacity, the office of health care advocate, to cut through that robust marketing of these private Medicare Advantage Plans? We're really, really concerned that seniors and those, you know, who are this is being targeted to don't understand, the risks and what they're losing, etcetera.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Yes. Thank you. To answer your question directly, we don't have the resources to do that. We see the problem. There are currently in the state of Connecticut over 200,000 people who are dually eligible for Medicare and Medicaid. If they were counseled properly, they would there would be more of an understanding. For instance, oftentimes Medicaid, duly eligible individuals don't understand that they can get dental coverage somewhere else. So, they are drawn into Medicare Advantage plans because, traditional Medicare doesn't cover dental. Doesn't mean they can't get it, that that dually eligible individuals can't get it from somewhere else.

[Matthew Barrett (President & CEO, CT Association of Health Care Facilities)]: Right.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: But there are also, you know, small token, gift cards that are given by the the Medicare Advantage programs. And the value of those compared to the value of, the the the hospital stays that are cut short or the other coverage that is not provided under the private plans, is very difficult to to, kind of get a handle on. Yeah. Exactly. But but it's a it's a, it's I don't wanna say it's low hanging fruit in terms of the amount of money that could be saved in Medicaid if people were in the proper Medicare plan. Not everyone should be healthy people. Maybe their the Medicare Advantage plans might work for them. But for people who are, it that, you know, it's just statistically people who are dually eligible have some of the highest, health care costs that are, out there. And most of the people who are sick are much better off. They have much better coverage in traditional Medicare.

[Rep. Anne Hughes]: So you said 200,000 people in the state of Connecticut are dually eligible. Do you have any sense of how many of those who have been, you know, had, these Medicare Advantage Plans, like, come back to you, try to change middle of the, eligibility cycle and go back to traditional Medicare? Like, how many of those come through your office, you know, with the denials and whatnot that you're like, you know, neutrally trying to, you know, get people navigated to a a plan that's a better fit for them, traditional Medicare.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: So we see a lot more of that happening for people who are not dually eligible because they have to pay for it out of their pocket. And Got it. The costs are so staggering for people who, who have to cover those out of pocket expenses. Whereas people who are dually eligible do have Medicaid as that backup. And and that's why those costs get shifted into Medicaid. And there isn't anyone really who is looking at should those costs have been paid by Medicare. So we do some of that for people, but the the incentive, frankly, for people who are dually eligible to make sure that Medicare should pay is not, is not high.

[Rep. Anne Hughes]: It's not there. Finally, if we, if we, increased or, or eliminated the Husky c asset limit, would we see more robust, you know I I just think that that asset limit is a leftover, you know, poor, poorly conceived policy from another era. And it it is really not working for our members that are eligible now. So I'm just wondering if you could talk just a a minute more about that from your office's perspective.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Sure. Well, you know, when you look at you take all of the programs together, all of the different Huskies. You take the Medicare savings program, which doesn't have an asset test. You put all of them on the table, and essentially, you have a Husky c recipients who are, in in essentially discriminated against in a way that, that the other populations aren't. So it's it's hard to know. Again, it would be interesting to put it all out on the table and see what the costs are to administer the asset test because somebody's gotta figure all that out.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: Right.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: From DSS's standpoint. That's right. But from from the standpoint of, the the, the people that we see, the distinctions between, for instance, people who don't have an asset limit on the Medicare savings program, but they are able to get all of their Medicare costs covered, and their out of pocket costs plus their Medicare costs, there's there's a big difference. And and that's that's very helpful to those people who are able to take advantage of it, but it it's very discouraging to, to people in the Husky Sea program.

[Rep. Anne Hughes]: Yeah. I I my my sense from speaking to many, many folks in the Husky Sea program is that, you know, it it comes from an era where we never expected people with disabilities to actually work and earn a living. And, that's why I say it's outdated because that is not, you know, self determination. Of course, people with disabilities can work, you know, and and be contributing members and they shouldn't have this on undue burden to have to prove over and over, that they are essentially abjectly poor to be eligible. So thank you. Thank you for expanding on that a little bit and, helping us navigate the these systems and see see what we could do to make it more fair. Thank you.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: So if I'm understanding correctly, what you're saying is not only is it the right thing to do, but that if we can find a way to educate the public, in the end, they could make a better choice and it would save us tons of money.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Exactly. I mean, since we good summary. Yes. I believe so. I believe so. I think that there's there's a lot more that can be done about Medicare. And and because the state doesn't necessarily have jurisdiction over Medicare, it's been a program that hasn't as it's connected in with Medicaid, hasn't been given as much attention as it needs.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Right. Because we have heard all of us have heard from many constituents about this issue, especially in the time on, what was it, December 31 when the insurance company and there was all that, and people were switching over. Agents were out for Medicare Advantage really pushing that, and they were leaving their regular insurance because they were afraid they were gonna be left without. And it was a huge issue. So thank you. Repolinski.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you, madam chair. Wow. What what an incredible revelation. Can I may I may I ask, how do we how do we efficiently and effectively close the gap and guide dual eligible individuals to be able to leverage Medicare, which is their better choice in coverage rather than just making an immediate leap into Medicaid? Because I think I mean, I I think the fear of of having just a flat out in insurance company declining benefit reimbursement is enough of a hammer laying over somebody's head where they are so happy to find a source of payment regardless of whether it's insufficient payment or whether it's coming from the wrong pot. They don't really care. They're just trying very hard to not get stuck with the bill. Now and and so that I I I have a sort of a purpose to the question because, you know, we've we've invested modest modestly to use a word from earlier, modest in in investments that we have made in our area agencies on aging, through service navigators. And what we're trying to do with that investment, which is under invested by the way, is is to is to basically have, the information get out, and spread not just from the area agencies, but, through them into our senior center so that everybody has an opportunity to hear what we're talking about and let them know that there's another way, and that other way might be better. How do we how how do we how do we get that message there? Because I this is really an opportunity.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: It it is an opportunity. And the area agencies on aging choices, the choices program, the state health insurance program, The those folks understand this. They they but they're so limited in personnel, in volunteers, in the ability to really get the get the word out and and to make it, more kind of, a a a regular thing, if you will, where, every year people get to choose during open enrollment how they're going to move forward with their with their plans. And and to your point about making sure that insurance companies don't just come kind of come in after people. They they there's extra money that's provided to the to the to the brokers and the agents and the producers to do risk assessments on individuals. And if someone is very sick, that risk assessment will will kind of shunt them off to another program. So it it's not that they're just out for certain certain people who are, able to just garner them money. They are also doing an assessment to determine whether or not they can with the additional money that they get from Medicare for serving dually eligible individuals that they that that will be money well spent for them. So they're very sophisticated. And and part of this is we can we have we have the tools. We understand what the process is. We just have to figure out how to, to replicate that in a way that serves, the the individuals that, would be better served if they had the right direction.

[Rep. Mitch Bolinsky (Ranking Member)]: So in in a perfect world, how do you think we would best handle it? Through, you know, through what function, and does that function already exist? Or does it, is it something that we need to discover, how to how to tackle?

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Well, I think we have the tools. I think we know what, what, how to guide people into the right program. We have developed those, programs. And so it's a matter of now being able to, to figure out how to implement them on a on a wide scale basis so that people who are dually eligible end up with the right program for them, in terms of, the the health care needs that they have.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you. I I could continue your questioning for about twenty five more minutes, but I'm not gonna do that out of consideration for everybody. Love to talk to you offline about this.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Thank you.

[Rep. Mitch Bolinsky (Ranking Member)]: You know, I, you know, in my family, we, my wife and I managed the affairs of three parents for over ten years, and, and we were faced with these exact same decisions and felt relatively trapped and powerless. You know, some some better information would would have been really great to have. So we we need to come back to this. Thank you very, very much for opening our eyes.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Well, I appreciate it. And I also wanna say thank you to the state of Connecticut because we have the best Medicare program in the country. We have the best ability to move between private Medicare and Medicare Advantage. I'm sorry. Private private Medicare and public Medicare. Most other states, once you make a choice to be in private Medicare, you cannot go back. In Connecticut, you can. And that's what makes this our ability, this function that we have given is such a gift. So it's it's important that we be able to to take advantage of that ability to move back and forth to the right plan for the right person.

[Rep. Mitch Bolinsky (Ranking Member)]: I'm finished. Thank you. Thank you, Madam Chair. Thank you, Madam Advocate. Very, very good testimony. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Rep Pizzuto?

[Rep. Bill Pizzuto]: Thank you, madam chair. Kathleen, thank you so much for your testimony. Just an opinion. What would an ombudsman say in the Medicaid environment to ensure the transition of people going from Medicare to Medicaid? Wouldn't it be an advantage to Medicaid to say, hey, you can still stay in Medicare? In other words, get some funding somehow from the feds and Medicare enough to pay for an ombudsman who can look at these thousands of transition that occur every day. I'm just trying to get your opinion on that.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Well, they're they're you know, I mean, this is this is the issue that we have people who are going from Medicaid to, to being duly eligible, on on a on a regular basis. So so helping people understand the transition and also knowing that you could be on Medicare. You could have Medicare for forty years, you know, you turn 65, even more if you're disabled. But let's say you, you, you turn 65 and you could live to 105. So the choices that you make along that continuum may change from year to year, but there are still choices to be made and there are important distinctions where, people are making the the unfortunate choices. So it's it's important to be able to, help people through through their continuum of of every year of their life. And so, I think, an ombudsman position, you know, there's many of us that kind of act in that role. We have, as I mentioned, the Choices program. Those folks are incredibly fantastic in terms of what what they do. They they're just they're they're too small for the task at hand.

[Rep. Bill Pizzuto]: I I appreciate that. I just I just think there's enough funding to you can't the seniors I talked to, and I'm a senior, obviously, can't just give them a website and say, go look at this. You know? They need someone that can help hold their hand, and I always appreciate that when I get a person rather than a link to a website. But I appreciate what you're saying as my ranking member, Balinski, had said. And obviously, we're all on the same page here for you raising the level of awareness that we should watch that dual eligibility before they just kick people from Medicare to Medicaid. Thank you.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Right. Right. And I should also mention the municipal agents that I testified before this committee last week. Municipal agents are such a gift to every town and most of them have the ability to be able to sit down. And again, it's probably one person in every town who has this ability to help people determine the best health care that they should have.

[Rep. Bill Pizzuto]: Well said. Thank you.

[Andre Brel (President, Juniper Home Care)]: Yeah.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Senator Wong.

[Sen. Tony Hwang (Ranking Member)]: Thank you, madam chair. Thank you very much for your work. I I think you'll hear it's it's a complete agreement with some of the challenges that that confront our seniors and and the services that are made available in the transition between Medicaid and Medicare. I think one of the hardest things is Connecticut has one of the the the lowest threshold guidelines for Medicaid requirement. And I think what we're talking about here is the national impact, but also the the the the structural impact that challenges it. But but I think one of the things that that I wanted to ask of you is one of the challenges for this committee is we're on agreement that things need to be done. But but what about the fiscal note that would encompass the change in this legislation? Can you anticipate the threshold increases in what you suggest, but also how we can navigate the the the fiscal note that'll come through? We can be unanimous in putting this out, but can you articulate the the the value added in in this policy in this bill, to a fiscal note and appropriations?

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Yes. Thank you. And I think that's why when I was preparing my testimony, I was thinking about the trade offs that we have, and that could be, anything from moving the, you know, the the cost of this. And and frankly, I don't I don't know the exact impact of either, raising the limit more or eliminating the asset test, for Husky c. I just know in terms of its relationship to the other programs, what the distinction is. So that's why I was thinking, you know, if what we're what we're trying to do is kind of make a more equal distribution for for everyone who is has access to these programs. And one way to cover the cost of that is to make sure that people are in the appropriate programs that they should be in, the in the appropriate Medicare that they should have. And and that would make a big difference. And and, you know, again, this isn't the fiscal note, but it it goes to, the idea that if hospitals are getting paid as much as 8% more from traditional Medicare than they are from the Medicare Advantage plans, that there's also another way to look at where some funding comes from, obviously, for the hospitals. But in terms of just making a way forward to pay for these programs. I know that doesn't address your question specifically, but, but the concept of trying to get the true numbers behind all of these moving parts is, is something that, would contribute to to making that fiscal note, a better option.

[Sen. Tony Hwang (Ranking Member)]: The the the cost of health care in itself has continued to increase. And and and I think in our senior care and particularly with the population senior population in Connecticut, I I think it's a a huge, huge hurdle to to address the fiscal note. And and and that's a challenge we have in this committee. I think we're relatively unanimous in in the philosophy and the approach, as you can see from our interactions with you. But but nonetheless, I think we need to look at a pathway in regards to see how we can add value added. And and I think having data of of, of these kind of initiatives are critical as we move forward and helping this committee advocate for the policies that we have cognizance over. So I look forward to getting more of that input from you as we move forward. And I do fully support this idea of raising the thresholds and and you bring up a novel idea of eliminating the asset test. So that I I'd be curious to see how that evolves. So thank you very much. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Thank you very much for coming today. I think with so many of the things that we look at, that when there's a cost savings, we have to balance the cost savings against what it's going to cost. It's not just an expenditure. There could be very well, and that's something that I and my colleagues look forward to looking more closely at. Thank you, Kathleen.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next, we have senator Gordon.

[Sen. Jeff Gordon]: Hello. Good morning.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Good morning.

[Sen. Jeff Gordon]: Co chairs Hokkadau and Garibay, ranking members Wong and Balinski, and members of the aging committee, thank you for the opportunity for me to provide testimony on SB two eighty five, an act providing a family caregiver, tax credit. I'm a strong supporter of it. I've, been working on it last year, and I'm pleased to see the committee's taking it up again. And I congratulate and commend the committee for doing it. This is clearly an issue that we know many of our constituents face when they have to care for family members, most of whom are elders such as parents. I did provide written testimony on this, so it should be in the system, I hope. I'm proud to be part of an effort this year to see what we can do with regards to providing a family caregiver tax credit. More and more families are serving as caregivers. I see it as a doctor and patients I care for. I myself am providing more care to my mother who's 87 and wants to be as independent as possible. And myself and my family are stepping in more and more as caregivers. And I see it with regards to a lot of my constituents as you all do. And when one is providing care to family members, especially elder family members who may have a number of medical conditions themselves to be attending to, it does require time, it does require resources, and we know it does require money. And given a lot of affordabilities that hardworking people and families face here in Connecticut, this is an additional burden on them that they otherwise are not, in a sense, getting reimbursed. I do know that, and as we all know, that it's just not elder family members whose families are taking care of. There are also non dependent adult children who may require caregiving, and many families are doing that. And that also is a growing aspect of this type of burden on families, especially financially. One of the things is is that this tax credit can actually be a win win. It can help families continue to to provide care to family members, which is very much needed, but also less savings. And I say that because traditionally, what would happen, especially for elder family members, they would just default end up, for example, in a long term care facility or a nursing home. That's not good necessarily for people across the board to physically do well or even or from a quality of life point of view. We certainly know, and there's no lack of medical data to support this, that if people can be at home where they really wanna be and cared for by family, then they actually do well. And it's less expense to have to be in a nursing facility. Those facilities are there for people who truly do need it, but the vast majority of people do not. And anything we can do to support families being caregivers and keep people, especially elder family members, at home for as long as possible is overall a good thing to do. Then I think it's a good return on investment for the state to provide a family a family caregiver, tax credit. So, again, I appreciate very much the, aging committee bringing this up. Once again, for consideration, thank you. I strongly support this effort, and I look forward to continuing to work with you all on the aging committee and our fellow legislators to see if this year we can enact it and try to be of help to the families that are serving as caregivers for their own family members. Thank you. And, again, I appreciate the opportunity to testify today before the committee.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, senator. Senator Hakadol.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: I just wanna say thank you, to senator Gordon. He has been reaching out since early, fall talking about this, and it is something that's really important, to us. So I just wanted to say thank you.

[Sen. Jeff Gordon]: Thank you very much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Are there any questions? Senator Wong.

[Sen. Tony Hwang (Ranking Member)]: Thank you, madam chair. Good morning, Senator Gordon. Thank you for your advocacy on this bill. I I I think you your shared experience in in caring for your parents is important in this aspect. You talk about eligible family members. Are you looking at immediate spousal care hold caregivers as well as extending beyond? What are the definition of eligible family members?

[Sen. Jeff Gordon]: Thank you, senator Long, and I appreciate your work on the aging committee. So thank you for that. To me, to eligible can be a bit broad. Usually, it's primary family members such as children who who are taking care of elder parents, for example, or parents taking care of a non dependent adult child and helping to provide care. That tends to be most of what we see, but there are actually other extended family members that may have to step in. It may be siblings. It may be a brother or a sister providing care to one of their own siblings who might be elder and in need of that type of caregiving. So I for me, I wasn't thinking of just trying to make it a narrow eligibility. I think we should recognize there are various people in a family who could be providing care, but again, it traditionally has just been children for for elder parents. But I think we should recognize some of the realities out there of what families are doing and give them opportunities to continue to provide that care. Because otherwise, if it becomes too financially burdensome for them, they can't provide that care, especially if they're working themselves. And then the state ends up stepping in, especially for elder people and has to pay for nursing home care, which can be very, very expensive, especially when it's not needed.

[Sen. Tony Hwang (Ranking Member)]: Thank you very much for that answer. And and I'm gonna just kinda flip it upside down on this. One of the things that, as a long time member of the aging committee, the past chairman, may rest in peace, representative Sarah educated me in regards to, family caregivers have kind of flipped upside down. In in this application of this bill, we're looking at caring for our senior population. But one of the recent, phenomenons is many of our seniors are now caring for their grandchildren. And one of the considerations is to be able to consider tax credits as it relates to that issue. Would you see this bill in this language be applicable to extending for those seniors that now are our caregivers and if not guardians of their grandchildren and their eligibility for tax credits in that through you, madam chair?

[Sen. Jeff Gordon]: I don't have a problem per se with it. The one caveat I have is if it if they're if grandparents are caring for grandchildren, if they're declaring them as actual dependents, how that might potentially be any legal issue if one were to try to offer them a family caregiver tax credit. So I think we do need to, be careful, about that. I don't know the legalities of that, but if they are providing care and it's they're not a dependent of them that they claim on income tax forms, then it is care for families. And you are right, Senator, for pointing this out. We do see a lot of that for various reasons, and we do wanna be supportive, especially when grandparents have to step in and be of help when needed for the care of, grandchildren. So I think those are things we can certainly discuss with regards to how one might, craft a tax credit, taking into account dependent child versus non dependent child.

[Sen. Tony Hwang (Ranking Member)]: I appreciate your thoughts on this and thank you for the indulgence, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Repuse.

[Rep. Anne Hughes]: Thank you, madam chair. Forgive me, senator, if you included this in your written testimony. Are others what other states, if any, are doing this? Do you know?

[Sen. Jeff Gordon]: I don't know all the states that are doing it. My understanding is Massachusetts does, New Jersey does. I don't have a full list of what other states do it. I can certainly look into that and and get that information to the committee if you would like, but I know that other there are other states that have. And I have looked at New Jersey for a number of different tax credits that they have to help families, for example, and this was one of them. But I can get that information to you if you would or to the committee, and I'm happy to do that.

[Rep. Anne Hughes]: Thank you. And my understanding is that this tax credit is is modest, to use Repolinski's term, you know, as a as a acknowledgment of, really the tremendous unpaid burden that families are doing to care for, you know, to to be primary caregivers of loved ones. Is that your assessment?

[Sen. Jeff Gordon]: It is. I recognize that one won't be able to cover all of the cost, and that's just realistic. I the states I looked at, especially New Jersey, didn't try to. Right. Yes. It is modest. Do I think it is a step in the right direction and can be helpful to families? Yes. I do. Would I like to see more? Sure. But we also face reality of of what we can achieve. I think if we can at least get something enacted, that's a huge start, and kudos to the state of Connecticut for doing that. Then one can always look what do we do in future years, cost of inflation, things like that. I think this is a reasonable step forward, but we all acknowledge it is modest. But, again, it can be helpful to a lot of families out there, so it's better than zero.

[Rep. Anne Hughes]: Yeah. Thank you. And and I just wanted to, flag another possibility of putting this sort sort of marker down in acknowledging the, family caregivers is that I I remember, probably about eight years ago, senator Murphy talking about putting in a a social security credit for caregivers who were out of the workforce because they're paying, I, I, because they are providing such intensive care at home to a loved one, a senior family member, and therefore they're not earning, social security credits. So something like this on a statewide program would start to correct that acknowledgement that they should be earning, social security credits as well. In, in my mind, I'm thinking that that that would be a really helpful because, these family caregivers are also going to need care at some point and they will not have the appropriate social security, working credits to, retire on. So thank

[Sen. Jeff Gordon]: you. Well, thank you. And that's an important point because we understand one of the burdens for caregivers is if they're working, they may have to work less, overwork less hours if they're paid by hour to be able to care for family members. That is certainly a financial hit in the short term, but you're right, in the long term, when they age and are needing care, hopefully their children will become caregivers to them, that becomes an issue. And so I I it's well said, representative. We do also have to think of the long term and not just the short term, and these are all very interesting discussions. I can tell you my experience over many years as a doctor, I have seen people who have cared for their elder parents, and when they aged, then they come in with their children as their caregivers. So it happens a lot more than we think, and these are things that we should look at in the long term. Yes.

[Rep. Anne Hughes]: Thank you. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Senator Hockadell has some good information on this. Senator.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. I did want to mention that the language that we are developing came from Oklahoma and Nebraska. And a shout out to Natalie at, AARP who brought that to us. And what we're trying to do is take the best of both worlds. And as she said, senator Gordon, how do you eat an elephant one bite at a time? And this is just one bite that we hope, in the years to come will expand. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Rep. Balinski.

[Rep. Mitch Bolinsky (Ranking Member)]: What a terrific conversation. Thank you so much. You know, when you contemplate modern society without getting too philosophical, you know, in the generation before us and much more even in the generation before it, elder care was handled in a multi generational home. Right? Those are very rare. They don't really exist outside of the, particularly, you know, maybe a multi generational farm family in the state of Connecticut anymore. So, but the incidence of of, caregivers, caring for a loved one is one that happens every day. Some people, such as my wife and I, we had the luxury of having enough flexibility at work to be able to team up and tackle the beast are, you know, together. But we can't forget the constituents that I have that started me on a road toward spousal compensation three or four years ago who have given up their careers to take care of a non Social Security spouse who had a disabling medical event. So, this is one of the ways to manage care, you know, the most affordable way without having to commit somebody to the most expensive and least personal method of care, which is in a nursing home. So, the results, the outcomes are always better at home. And, this is this is a really terrific conversation. Thank you for, you know, carrying it forward, everybody. And, Rip Hughes, thank you for, bringing us references from elsewhere. And, senator Hockadell, surfing in Nebraska is great. So thank you very much already.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Moving on, Mike representative Mike D'Amico.

[Rep. Mike Demicco]: Thank you, madam chair. Good morning to the distinguished chairs and ranking members and members of the aging committee. My name is Mike D'Amico. I'm the state representative from the 21st District in Farmington. I wanna thank you for the opportunity to testify this morning, and thank you especially for raising item number 12 on your, agenda today. House bill fifty three zero four, an act concerning long term care insurance premium rates. I am in support of house bill five three zero four provisionally, because it'll bring a small measure of relief to a significant number of long term care insurance policyholders in Connecticut, and it will do that in two ways. It will allow, them to, take an income tax deduction for the premiums that they've paid on these long term care insurance policies, and it will require the Connecticut insurance department to hold a public hearing at any time our our rate increase request exceeds, 10%. But I I say I'm provisionally in support because I believe that this bill could be much stronger, could be much better, could be much more effective for the people, who are who are affected by this, situation. I don't think that this bill goes far enough. This morning, after me, you will hear from, several of my constituents and and and others, from the state of Connecticut, residents of the state of Connecticut, about the excessive premium rate increases that are imposed on them year after year, by the companies who sold them these long term care insurance policies with seemingly no end in sight to these, excessive increases. So I would respectfully request that the aging committee amend this bill, house bill fifty three zero four, in one of two ways. The first way that you could amend it would be to adopt the recommendations given by the advocates to the members of this committee, and those recommendations are included in the testimony from mister Schwartzer, David Schwartzer, who is scheduled to testify later today. And those recommendations would include, that no long term care policy shall be approved for a premium increase once the new premium would be equal to 300 percent above the initial premium charged when the policy was issued. And the second recommendation is that any insurance company that files a rate, rate file files for a rate increase, for premiums for a long term care policy shall be required to demonstrate that they sold enough long term care insurance policies to produce sufficient premiums to substantially cover the anticipated losses. And the third recommendation that they make, is that any insurance company that files, a rate filing for an increase in premium rates for a long term care policy shall disclose all reinsurance agreements that is that are associated, and then that are subject to the rate increase in addition to disclosing all reinsurance recoveries that have been received by the company. So, those are the recommendations that that mister Schwarzer has in his testimony, and and and, I I I would I would urge you to take a a serious look at them. Now the second way that you could amend this bill, in my view, is to create a task force, composed of representatives from all of the, stakeholder parties, including policyholders, long term care insurance companies, the Connecticut Insurance Department, nationally recognized experts in the field, and so forth to examine all the aspects of this crisis and to require this task force to report back with recommendations to this committee in a timely fashion. And, finally, I would urge the committee to please take advantage of the opportunity to ask questions of the people who are gonna testify later today, several of whom have studied this issue literally for years. I would ask you to please use your significant authority to restore a sense of fairness and balance to this situation, and I thank you for your time.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, representative. Are there any questions? Rep Polinski and then Rep Nolan.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you, madam chair. Representative D'Amico, thank you so much. You are, you are a friend to all constituents and this issue is one that, the advocates have struggled with for, for many, many years. And and let me just cut to the chase and say, when when you take out a policy in good faith for long term care, and you find yourself with a sixfold increase in your premiums and you have to make choices between keeping a roof over your head, eating, and paying for your premium, or losing an investment of hundreds of thousands of dollars in some cases, We, we have a really serious problem and it's one that the legislature hasn't done a particularly robust job at addressing because it it involves some really, really tough decisions. And in the concepting of this bill, my my initial intent was to was to provide some guardrails for these policyholders to be able to maintain their coverage and know that they're gonna be cared for, in the if, you know, in in the unfortunate, possibility that they're going to wind up in long term care because they don't have a living caregiver to care for them anymore. Imagine the feeling of having to make a choice of food or your policy. Alright? This is a really serious, serious issue. And and in this building, it's one that we have not traditionally wanted to speak about. So, it typically goes, you know, through the, the insurance committee. And then from somewhere. And none of us can quite actually get a reason for it. And we hope to it during this. Process for some reason, a word comes down from some place in, you know, in in this, in this government that, something like a cap or or or another theoretical way to solve the problem is a nonstarter. And the only reasoning given typically is just because. Well, just because is no longer good enough because you're gonna you are gonna hear from folks today that are making long term life decisions that are being forced upon them to make to either give up their their their their coverage or or, make sacrifices as far as not being able to maintain their home or their their food. And, it's just a serious. This is really, really serious stuff, and it deserves a good conversation. And where I hope this goes is not this bill, because this bill was not actually what I intended when it was introduced. This bill needs to turn into this task force that representative D'Amico has just talked about, because without every single party at the table to talk about just exactly what it all is and, and come to some collective understanding, that we're all in this together, then we're just gonna keep kicking the Dan kicking the can down the hill. And in conversations with constituents of mine, one of whom lost her husband last year, The the fear of having to walk away from an investment like this is a hell of a risk and a big stress maker. So, please, everybody, listen to this one and contribute a solution instead of a out of the pocket no. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Rep Noland.

[Rep. Anthony Nolan]: How are you doing, everyone? Thank you, madam chair. And I just wanna tell our our you know, commend Mike, representative D'Amico. You were spot on. That's what we're hearing from our constituents. And it's time for us to show the authority we do have on this committee. Make sure that the changes that we have the ability to make for our seniors. Representative Baliski, I agree with you also on the importance of of us trying to make sure that we are the voice for people in our community. I hope to see the amendments in regards to things that representative D'Amico talked about because I would be ready to second it and ready to vote in favor of it strongly. And I hope that, we use the authority that we have on this committee to make those changes to make it better for our seniors. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Well, I think I can speak for this entire committee. We have met with this group of advocates. We spent a few hours. But even before that, I have a person from my district, who has talked to me extensively how this, has affected her life and her long term care insurance after paying into it for many, many years and now getting to the point where she may not be able to afford it. So we all understand it's a serious problem. We also understand that a bill starts as one thing, and it's developed over the time till it comes out. So we appreciate everyone's comments and coming forward and sharing their ideas. Thank you. We're gonna go

[Peter Ozwecki (Grandparent caregiver)]: a little bit

[Rep. Mike Demicco]: Thank you, madam chair. Appreciate it.

[Rep. Jane Garibay (House Chair, Aging Committee)]: K. And we've been in communication, Mike. So but we're gonna move two people up that were misplaced in the lineup. The next is, Mairead Painter.

[Mairead Painter (State Long-Term Care Ombudsman)]: Good morning, Senator Hackadel, Rep. Garibay, and distinguished members of our aging committee. It's nice to see you all this morning. I've presented written comments, and I'm going to testify verbally on a few of the bills here today. First bill is SB two eighty five, an act providing a family caregiver tax credit. We've heard a lot about this this morning and I really wanna recognize that family caregivers are the backbone of Connecticut's long term care system. Every day, family members provide essential hands on assistance to individuals they care about and the individuals that need care in our communities. Informal caregiving saves billions of dollars in taxpayer dollars a year. That contribution represents one of the largest cost offsets within our long term care system, yet caregiving comes at a significant personal cost to the individuals doing it. Frequently they incur out of pocket expenses, many reduce their working hours, they give up advancement in their career, or leave the workforce altogether. Over time, this can lead to financial instability and affect not only the caregiver but the broader system. When caregivers become financially strained, we see the consequences of delayed discharges from hospitals or nursing homes, unsafe transitions, or burnout, which potentially results in permanent placement in a long term care setting. For these reasons, I respectfully request that we support SB two eight oh, sorry, two eighty five. The next bill is SB two eighty eight, recommendations regarding nursing home bed moratorium, sorry, and the resident data for nursing home reimbursement caps related to party, related party employees. So this proposal really modernizes Connecticut's nursing home bed moratorium framework while reinforcing accountability and quality. Considering nursing home quality when we're looking at who is going to be able to open a new home or expand the home that they have, I think is essential. We wanna ensure that we have quality providers who are growing and expanding in our state. We wanna make sure that individuals have the ability to choose a home or a long term care setting in the community where they're from, and we've seen through Right Size rebalancing some changes throughout our state in access. Some areas of our state still have plenty of access, where there's other areas where there's some gaps, we wanna ensure that people really get to live in the communities where they wanna live and the settings that they meet that need, so looking at the small home, looking at new opportunities, I think is really important. Demonstrating bed need and high sustained occupancy rates goes hand in hand with that quality. I truly support clarifying the related party compensation standards to remote transparency and fiscal responsibility, so I really appreciate you putting that in there. That's something we've been really focused on over the past few years. And taken together these provisions adequately put together quality, accountability, and responsible stewardship while maintaining access where people really wanna receive it. The next bill is SB two eighty nine, an act concerning funding the quality metrics program for nursing homes. I greatly support this bill. I do have one recommendation. I think it's an important step in aligning Medicaid reimbursement with measurable outcomes, trying to enhance payments to the national enhance payments to national quality measures using consumer satisfaction. I think that's a really important component. I know that a lot is related to survey and their outcomes related to the five star rating through CMS. However, we really wanna look at the surveys that are being done by residents and family members in these homes because I think that's an extremely important component. Also, the integration of the PDPM data to the case mix calculations improves accuracy and reimbursement, and the Medicaid utilization pool recognizes the financial pressures that facilities face serving high populations of residents that may be on Medicaid. One of the recommendations that I would have is that when those quality surveys are done, we do have facilities that consistently come in at fair or low quality, and I really believe that those nursing homes should have to be, required to bring in a state approved quality improvement specialist in order to ensure that if we are spending taxpayer dollars for individuals to live in these settings, that they are at least good quality from their perspective of residents and family members. Sit there. House bill 5,299, an act allowing trained assisted living aids to administer medication in those settings. We support this bill, we think that having the ability to have individuals have the choice to do that, the one thing I would say is we wanna ensure that there's resident choice, that individuals living there can opt to have this be an option for them so that they can receive their medication maybe more timely in a way that's more to meet their individualized needs but that they should be able to choose whether or not to allow the nurse to provide that training and to receive the medication from that person. But if it gets some better access and access timely to their medication, we would support that. House Bill 5,300, an act concerning cost of living adjustment to the long term care facility residents personal needs allowance. This is huge for my office, this is the one area we hear most from residents that the $75 a month just doesn't go far enough for them to meet their personal needs. We're talking about clothing and shoes, these are things that without them and without them fitting properly, you risk falls and injuries, we're talking about the dignity of getting a haircut, some residents have said they had to give up their haircut or go to every other month because they can't afford it. Our residents have said that this is a cola, this is one can of coke out of a soda machine a a year that they're looking to have the increase go up. So I'd really hope that we can tie this annual cola or the cola to their social security increases. The next bill is five three zero one and acts excluding spousal income from certain rent fee and cost sharing calculations related to the home and community based services. So for this bill, what I really wanna focus on is the rent, so we have individuals who leave nursing homes and they transition to the greater community or they're in the greater community and they're receiving rental support, and where a spouse's income is counted into that, but the spouse is providing more than 25% of the care, it can be challenging at times for them to be able to, continue to do that. They may have to go back to work and then we're paying a caregiver to come in so that they have the money to pay for the rent and to pay for the other household things. So we're really looking for them to be excluded from the calculation of their rent, and household support so that they're able to be there for that individual and to provide them with the care from a loved one where we see really good outcomes and to maintain that person in the greater community. The next bill is house bill 5,303, an act allowing dental hygienists to provide dental hygiene services in private residence. Again, we believe that if an individual wants to choose this and they have a relationship with their dental hygienist who's able to do this, this is an area we find access is tight across the board. We hear this from a lot of the individuals that we serve, and so if this can allow them to have access, we think that it would really help them as we see health complications directly related to oral health in older adults that sometimes, would have been preventable, but otherwise have a negative impact to them because they're not able to have those needs met, or there might be transportation issues or, just physical ability to get in and out of, a setting. The last bill is an act concerning adult day transportation. Adult day centers are the cornerstone of Connecticut's long term care system for many individuals living in the greater community. They participate in continued community access and opportunity and programming that brings them quality and dignity, socialization and reduces loneliness. Transportation is often the determining factor on whether these services can be accessed at all. We know in certain areas of the state this is more challenging than others. When it's unavailable or financial instability impacts that, it really causes caregiver burnout because they don't have the opportunity to have someone go and be social in another setting and risks hospitalization or institutional placements because the person doesn't have the ability to connect and receive the services, in the greater community that they would otherwise be able to and be included in. For that reason, we ask for the support of this bill as well. That's my testimony for today. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. Any questions? Yes. You're amazing. Oh, thank you. It was very complete and captured, our intentions anyways. Great. So seeing none, thank you.

[Rep. Anne Hughes]: I have a question.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Rep Hughes.

[Rep. Anne Hughes]: Sorry. Thank you so much, Maureen. Can you talk just a clarifying thing. This spousal income we're trying to disallow from rental assistance eligibility and that state rental assistance. Correct?

[Mairead Painter (State Long-Term Care Ombudsman)]: Yes. Through the wrap. The rental assistance.

[Rep. Anne Hughes]: Wrap. Yep. Perfect. And the the adult day transportation, are are we talking about increasing that as part of the eligibility? Or what tell me specifically what you'd like to see, expanded for that.

[Mairead Painter (State Long-Term Care Ombudsman)]: I'm just reviewing this. We would like to see that the cost associated with the transportation keeps up with the need, right? So that if gas has gone up

[Rep. Anne Hughes]: Right.

[Mairead Painter (State Long-Term Care Ombudsman)]: Different things that impact the transportation providers, so that sort of like the cost of living for residents that we need to make sure that inflation meets the needs so that we don't lose transportation providers and access for people in the greater community.

[Rep. Anne Hughes]: Right. And so our daily rate, for instance, including that in the daily rate index to inflation, but also figuring out how to cover that cost from the state. Is that correct? Is that what I'm understanding?

[Mairead Painter (State Long-Term Care Ombudsman)]: Correct.

[Rep. Anne Hughes]: Yep. Okay. Got it. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: I'm sorry. I didn't hear that. Thank you, rep Hughes. Thank you, Marie, for your time today.

[Mairead Painter (State Long-Term Care Ombudsman)]: Thank you very much.

[Jan Kritzman]: Yep.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next is Michael Werner.

[Michael Werner (Lead Aging Policy Analyst, CWCSEO)]: Good morning, senator Hockadel, representative Garibay, senator Huang, representative Balinski, senator Miller, rep Fortier, and the other distinguished members of the aging committee. My name is Michael Werner. I'm the lead aging policy analyst for the Commission on Women, Children, Seniors, Equity, and Opportunity. And I'm here to take to testify in support of House Bill fifty three zero one and fifty three zero three. And we also submitted, written testimony as well. As we know, Connecticut's older adult population is booming, and we applaud the committee for raising these bills that represent truly innovative new approaches to address the growing needs for the years to come. While it's sometimes easy to overlook the damage of the pandemic, these bills both work to address important areas surrounding workforce shortages and accessibility, laying fertile groundwork to ensure Connecticut has a posture of resilience and serving the needs for our state's most vulnerable. House Bill fifty three zero one enact excluding spousal income from certain rent fee and cost sharing calculations related to home and community based services helps to recognize the highly valuable but unpaid labor of spousal caregiving by acknowledging a person who provides more than 25% of daily extraordinary care for their spouse. This is beyond the normal duties between husband and wife, and it is in support of the activities of daily living. By disregarding the spousal income, the household becomes more sustainable and allows for the recipient to age well in place in the community. While Connecticut has not yet passed legislation to compensate spouses for their extraordinary caregiving despite it being federally permissible, this proposal creates a compelling new opportunity to honor our commitment to support freedom of choice when it comes to aging in place in the community. And we also applaud the aging committee for raising house bill fifty three zero three, an act allowing dental hygienists to provide dental hygiene services in private residences, which is an innovative bill to uplift the importance of oral health for older adults in IDD populations, as well as to ensure greater accessibility for dental hygiene services among our vulnerable populations. This bill is elegantly written and simply adds a private residence to the places where a public health registered dental hygienist can practice in the community. We know that 62 of our 65 and over populations has four or more chronic conditions. Oftentimes, the medications prescribed for these conditions can exacerbate dry mouth and tooth decay, which can worsen overall health. This bill does not change the scope of practice for dental hygienists and maintains all of their duties, which includes providing education on disease prevention and home hygiene, performing cleanings, conducting caries risk assessments to identify potential cavities, and coordinating referrals to local dental offices for necessary treatment. Imagine how this simple change will serve anybody at home who is unable and can't access traditional dental appointments, including medically frail, hesitant, homebound, new moms, seniors, and more among others. Anybody who has teeth will be well served. This is an this also innovatively lays the groundwork for future complimentary use if Connecticut approves telemedicine for dental coverage. Thank you for your strong leadership and the opportunity to testify today.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, mister Werner. We do all hope that we keep our teeth for many, many years. Are there any questions? Repolinski?

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you, Michael, for your advocacy for oral health. It's, it is important, and it's something that can't be neglected. When we go to a home setting, are there any considerations about perhaps finding an unsanitary condition there? And then what would what would the hygienist hygienist role be if if that were the case and they didn't feel like it was necessarily safe to to to administer that care?

[Michael Werner (Lead Aging Policy Analyst, CWCSEO)]: Thank you so much for that question. So, registered first of all, registered dental hygienists are well trained in infection control, and there are existing models that utilize portable dental units. So we're not talking about something that's never been done before, and this is becoming more prevalent in the private sector. There's, some examples of, companies called Enable Dental and Jet Dental who model this behavior in the private sector. You know, we're we're moving in the direction of innovation as governor Lamont wants Connecticut to be a hub for innovation, and this opportunity allows us to further improve our infrastructure by allowing public health registered dental hygienist to access our most vulnerable population in their homes.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you, Michael. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Are there any further questions? Thank you so much.

[Michael Werner (Lead Aging Policy Analyst, CWCSEO)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: K. We're gonna go back up, and now we're gonna I'm gonna remind the public that you will have three minutes to share your ideas and concerns. There is a timer. It will go off, and then we'll ask you to wrap up within a few seconds after that. Next is Peter Ozwecki. Is Peter online? Oh, he's here.

[Peter Ozwecki (Grandparent caregiver)]: Good morning. Good morning, committee. I'm here in response to the raised bill number two eighty six, which is the act concerning grandparents raising grandchildren, the financial assistance. As we look back in history with this information, the Office of Legislative Research back in '98 talked about subsidies for guardianship. However, most grandparents who are raising grandchildren cannot receive those benefits because we have an income. I am a retired. I'm a retired police officer. We make too much money. However, we have been tasked with raising our well, in my case, my great grandson, which is, as everybody knows nowadays, raising a child to make them involved in sports, extracurricular activities, to raise them as a good citizen, it costs quite a bit of money. Nothing is free anymore. All these things cost money. In 2012, the Office of Legislative Research also talked about subsidy for guardianship, which most grandparents cannot receive. Because we are retired, we make some money. So what happens with grandparents or great grandparents? We have to return back to work at our age to be able to afford these children. Now I come to you not only saying we need some guidance and some help in this area, but but we also I come up here with a solution. We had to go through the process of the court system to get permanent guardianship, which means he's with us for the rest of our life. Okay? We had to go through that process. We had to be investigated by DCF, a thorough investigation in DCF. Can somebody please explain the difference between a foster family and a grandparent raising grandchildren if we vet all those criteria? I don't think anybody really can. It's the same thing. We for we're related somehow, shape, or form to that child. No matter how that child came into your life, it is something that you you step up and you do. Any grandparent, great grandparent would do the exact same thing. We've had ours like, we call him my son. We've had him for ten years because he's 10 years old. Not only that, but we also care for my mother who lives with us, like, which was another bill about a tax credit. We are caregivers for not only one, but two people. I am basically the stuffing in the middle of the Oreo. And we do it. We hold our head up high, and we're not ashamed that we're doing what we're doing.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Excuse me, sir. That's the three minutes. Do you wrap up your commentary?

[Peter Ozwecki (Grandparent caregiver)]: Yes, ma'am.

[Jan Kritzman]: Thank you.

[Peter Ozwecki (Grandparent caregiver)]: So I would encourage this committee to please move this forward. And if I could ever do anything, whether it be a task force, whether it be whatever, I'd be more than happy to. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Well, we really appreciate your coming and sharing that voice here with us today. My husband and I are guardians of my 46 year old niece with downs who lives with us. So we get kind of the gist of, you do things out of love, etcetera, but it is different than just retiring. Right? So I think we all understand that. It's just finding the way. Are there any questions from my colleagues? Rep Olinsky and then Rep Fortier.

[Rep. Mitch Bolinsky (Ranking Member)]: Peter, thank thank you so much for the years of service as a law enforcement officer and also for the sacrifices you make for your family, both and, yes, you are. You are you are part of the sandwich generation. I look around this room and I would venture to say that at least 25, maybe 30% of us in here are sandwich people. And we hear you. So, thank you so much. We we gotta get to work on the policy.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Rip Portier?

[Rep. Mary Fortier]: Yes. Thank you so much for your testimony. Again, I'm reiterating what my colleagues have said. We really do hear you. My husband and I took custody of three of our nieces, the cousins of our own children, and I think we, as a state, need to have policies that encourage that. We don't have enough foster parents as it is, and I think when a family member is willing to take someone into their home, they need to be recognized for that work and for the fact that it is a financial burden for any family that chooses to do it, and yet it's probably a good choice if a family member takes children so that they are connected to those family connections. So, again, thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: And I think in the end, again, it's always weighing what does something cost, etcetera. But when you talk about if a grandparent doesn't take that child, they could end up in foster care. You know, many different situations where they don't receive, the same as being in with your family. So bringing your voice is just really important, and keep that up, and we appreciate you're coming to testify today. Senator Wong.

[Sen. Tony Hwang (Ranking Member)]: Thank you. I was waiting. Thank you, madam chair. I I mentioned earlier when we talked about caregivers and the tax credit. One of the thoughts is in relation to the language of this bill, it's related to payments. But let me pivot and and share get your input on how would a tax credit look to you to be able to offset the financial burden for you being on a fixed income and the unanticipated burden of cost. Would a tax credit work equally as well or effective in alleviating the cost burden that you're addressing? Because what you shared earlier is the qualifications and the thresholds are are are rigorous and and you may not qualify. But for you and many of our senior caregivers that are maybe on fixed income, adding on to this, your tax burden is one of the biggest issues that impact your ability to be able to provide. So what are what are your thoughts in regards to that tax credit? Because we we are concerned about we wanna all agree on doing the right thing, but it's always a fiscal note on how we can do it and balance it. So how does a tax credit look to you to be able to offset the burden for many of our, senior caregivers?

[Peter Ozwecki (Grandparent caregiver)]: I think that part of it would be how much, and maybe there's a modified way where you can have both. You can actually have some finances and the tax credit, so it's gotta be a balance between the two somehow. And, ultimately, is what what it really boils down to is the financial cost.

[Sen. Tony Hwang (Ranking Member)]: Well, I appreciate that. It's a continued work in progress, but let me close by saying as as I've learned, your care of your family is unconditional love. You do it, but now with the cost of affordability, which is gonna be a a a a constant moniker in in this legislative session is the affordability of being able to provide and do the things you do. As I've spoken to many of our seniors who's now become second phase parents and guardians is this is certainly never anything you've anticipated. This is not what they write up when you expect to have a grandchild. But, nevertheless, you've stepped up because of circumstances beyond the control that you're providing unconditional love, and and it's becoming financially untenable. And this is why we're considering this process. But, we we've gotta look at alternative solutions to be able to ensure that your your grandchildren and extended families do not go into the foster care system outside of the love that you can provide to them. So thank you very much for leading, and thank you for your service in law enforcement. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Rep Bolinski?

[Rep. Mitch Bolinsky (Ranking Member)]: I have to I have to take a moment and note that this conversation is very, very similar to the one we had with our health care advocate earlier. So, you put a child into the DCF system and you roll them around through there with foster care for all those years, all the associated costs versus something that would be significantly less costly, which is something to help you make ends meet. So, is there a cost here? Or is there a potential savings? And that is a question that I think answers itself. Thank you, sir.

[Rep. Jane Garibay (House Chair, Aging Committee)]: And as everyone was speaking, I was just thinking of all the costs to bring up a child from school clothes every year if you're lucky enough that they last a whole year in the same size, right, or they're wearing two size bigger as mine did at times, you know, the food and just basic care, etcetera. So we hear you, and thank you for coming.

[Peter Ozwecki (Grandparent caregiver)]: Appreciate everybody very much. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next up is Magmarole.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: Thank you. Good morning, senator Hakadol, representative Garabay, senator Wong, representative Balinski, and distinguished members of the aging committee. My name is Meg Morelli, and I am the president of LeadingAge Connecticut and Rhode Island, a membership association representing not for profit provider organizations serving older adults across the continuum. Thank you for the opportunity to testify today. We've submitted several pages of testimony, and so I will provide very high level comments, but happy to discuss any of the bills. First, I wanna begin by thanking the committee for raising house bill fifty two ninety nine, an act allowing trained assisted living aids to administer medication to assisted living residents. Expanding our current med tech program to the assisted living sector would be a great benefit and opportunity for the aging services sector, both for those they serve and for those who work within it. We thank you for considering it. This year, we're asking you to consider this expansion to just the assisted living setting, opening up the opportunity to train and certify assisted living aids who are already required to be CNAs or certified health home health aids, train them to administer certain medications to residents in the setting. We propose that this would occur through the delegation of authority from a licensed registered nurse and that the statute be permissive and not mandatory. We have additional comments and information in our testimony. But to summarize, we respectfully request that the committee approve this opportunity to allow for certified med techs to work in the assisted living setting. Regarding SB two eighty eight, an act concerning certain DSS recommendations, on sections one and two, we support the objective of the proposed changes to our nursing home moratorium statute. Connecticut has had a moratorium in place on the building or expansion of new nursing homes with a few exceptions since 1991, and we'd be happy to discuss the moratorium in fur further if you request. But we do have some suggested changes to the language in these sections that is included in our testimony. Section three is where they, request significant changes to the minimum data set or MDS audits. The MDS is the standardized assessment that every nursing home in the country must complete for each resident. It's a comprehensive clinical profile, and it's used for three key purposes, care planning, quality monitoring, and Medicare and Medicaid payments. That is why DSS now audits the MDS. In section three of the bill, DSS is proposing revisions to treat MDS audits differently from other types of audits conducted by them on nursing homes and specifically limiting the opportunity to provide documentation to the auditors. We respectfully ask that you reject these requested changes. We think they're very problematic. Senate Bill 8,289, an act concerning the funding of quality metrics for nursing homes. This is much more than just the quality metrics piece, which we, of course, support. This is, this bill establishes a funding mechanism. I mean, all the elements of the governor's midterm budget adjustments related to the nursing home, funding mechanisms, including a three year phase in of a rate system adjustment. We've submitted comments on each component in the proposal contained in the bill. There's a lot to say about this proposal, and we know that this committee does not usually deal with the nursing home rate system changes. So please feel free to reach out to us if you have any questions or concerns regarding the testimony. I do wanna highlight briefly at the heart of the proposal is a three year phase in of the transition to a new acuity assessment framework, along with the recalculation of the base rates. This three year transition period will include phase stop gain and stop loss protections. And while we support this approach, in in theory and in policy, we have yet to see the details of the in or the impact of these recalculations. We are concerned that the current guardrails proposed for the transition include a stop loss of $15.75 in the first year, $22 in the second year, and unlimited in the third year. This indicates to us I

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: just wanted to let you know that three minutes have

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Oh, okay.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: I'm sorry. I did not hear the bell.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Thank you.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: This indicates that there will be nursing homes and maybe many that will be losing significant funding. So we respectfully reserve our right to comment on the details of the proposal once the details are released. Thank you for the opportunity to testify. Again, we've submitted a lot of testimony. Be happy to take any questions or to speak individually to committee members if you have questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you so much. You said a lot in a little time. That was great, Meg. Any questions?

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: A lot of bills out there today.

[Rep. Jane Garibay (House Chair, Aging Committee)]: I know. I know. Is there anyone online? I'm sorry. That's okay. Repuse. Repuse?

[Rep. Anne Hughes]: Thank you. Thank you, madam chair. Thank you, Meg. Can you say a little bit more about the phase in and those those figures that you represented? Is that per day for the for the acuity based payment? It's

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: the it's the per diem rates. So when they rebase the per diem rates and they apply a different acuity, system to them, they take the cost report and they put all of the costs in. They can recalculate rate according to the statute, which we've always supported as regular re rebasing of the rates. Right. They're gonna phase in the changes, the recalculation over three years, and it's a per diem rate. So it's per day. There will be some nursing homes in the first year that will actually have a rate drop of $15.95. And that's that's a big drop. Yeah. We don't know what it why it is. We know that DSS is open to negotiating with individual nursing homes if there's issues. One concern we have, we raised it in the testimony, is there are certain nursing homes that are not staffing units because they can't find the staffing. I mean, they're not admitting people to units because they don't have the staffing. They get hit in the rate system as it's structured because they don't, they're they're calculated according to a certain, licensed bed capacity. But if they're not filling the beds and receiving income on that licensed bed capacity, it hurts them.

[Rep. Anne Hughes]: Is there is there a amended language that could hold those harmless? I think what the concern is is that if we go to acuity base, then there'll be the selective, you know, process of admission that is taking the higher rate needs or, you know, like, we wanna make sure that we are being fair and also supporting a diversity of needs, I suppose, is

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: the way that we

[Barbara Monk (AARP Volunteer, Family Caregiver)]: did it.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: We are currently in an acuity based system. For three years, we've based in our acuity based system. Right. It was based on the RUGS, which was a different federal assessment. Okay. We have to move to the PDPM because the Medicare and the federal government is moving to PDPM. So it's a different type of assessment. It really looks at more of the holistic caring of the resident rather than the minutes of therapy that you're providing to to the resident.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Exactly.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: So that's you know, it's it's a positive move. I mean, we're not opposed to this move, and we're not opposed to the rebasing, but we just we were signaling that the the way it's being phased in, they're trying to do sort of a the stop loss is a way to do a hold harmless. It's like easing you in if you're losing a lot of money on your per diem rate, but it's a big I mean, it just signals to us that there's something out there that's causing a lot of nursing homes to be recalculated to a much lower rate. So we don't know what that is.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: I see.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: And so we just we just wanna sort of put the committee on notice that we wanna take a look at these details when they come in and may have a discussion once we see the details.

[Rep. Anne Hughes]: And do we have a timing on that?

[Rep. Mitch Bolinsky (Ranking Member)]: I

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: believe, next month, there was a there's a plan for DSS to roll that out to the to the stakeholders and to the sector, so it shouldn't it should be, fairly soon.

[Rep. Anne Hughes]: Okay. We'll look for that in Maybach as well. Thank you. Okay. Thank you. Madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Any further comments? Thank you so much for coming today and testifying.

[Meg Morelli (President, LeadingAge Connecticut & Rhode Island)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next is Kathleen Garrity online.

[Kathleen Garrity (Executive Director, CT State Dental Association)]: Thank you. To the chairs, vice chairs, ranking members, and all esteemed members of the agent committee, good morning. My name is Kathleen Garrity, and I am the executive director of the Connecticut State Dental Association representing licensed dentists and the patients we serve across our state. Thank you for the opportunity to supplement our written testimony regarding HB 5,303. The CSDA respectfully opposes this legislation as drafted and requests that the proposal be submitted for a formal scope of practice review through the Department of Public Health before any statutory changes are made. HB 5,303 represents a significant shift in how oral health care could be delivered in Connecticut. It would authorize dental assist, dental hygienists to provide care in private residences, a setting that is not currently included in Connecticut's enumerated practice locations. That expansion warrants careful, structured evaluation. As written, the bill would allow a hygienist to provide services in virtually any private home setting, whether their own, a patient's, or a third party's, which raises important questions about supervision, regulatory oversight, infection control standards, emergency protocols, and the safety of both patients and providers. These considerations are addressed in traditional practice settings and in the specific public health sites already defined in statute. But private residences present, sorry, my screen glitched, a different regulatory environment. We also note that the legislation appears to mirror models in other states that have created additional licensure categories, such as a registered dental hygienist and alternative practice. For example, states like Maine have adopted alternative practice pathways in response to significant rural workforce shortages. The ratio of dentists to population in Maine is 55 dentists to every 100,000 patients, below the nation's national average. Those models were developed with specific licensure requirements, additional training, and defined regulatory, structures. Connecticut's workforce profile is different. In Connecticut, we are well above the rate that ratio, having nearly 70 dentists per 100,000 residents. And with one of the youngest dentist populations in the country, our ratio is likely to remain. However, an ideal ratio of dentist to hygienists is one to two and a half hygienists. In Connecticut, we have a very low ratio of one dentist for every 1.1 hygienists. In addition, an estimated 40% of hygienists currently work part time or are in temporary arrangements, which already places strains on existing practices. This expansion of location effort will increase the strain system and could negatively impact all patient populations. Dentists and hygienists work collaboratively every day. Dentists cannot effectively treat patients without hygienists providing preventative care. Expanding practice settings without first examining workforce capacities, economic feasibility, reimbursement structures, equipment costs, and liability considerations raise significant policy questions. There are also safety concerns. Providing care in private homes introduces risks to both patients and providers. As the legislature has recognized in recent years when addressing protections for for visiting nurses and home based providers, home settings can present safety challenges. Expansion into private residences should include appropriate safeguards and protections for providers and patients. This is not a statement against improving access. We share the goal of serving homebound seniors and medically vulnerable patients. However, changing of this magnitude, particularly those involving new practice environments, should proceed through Connecticut's established scope of practice review process. That pathway ensures patient patient safety, regulatory clarity, and thoughtful system design. For these reasons, we respectfully ask that this bill be referred for a formal scope of review, practice moving forward. And I thank you for your time and your continued commitment to improving our oral health for our residents, and I'm happy to answer any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Are there any questions? So I actually have a few. Just in my mind, I cannot grasp the idea of someone who is in home care going without basic dental care because the cost of transportation, of not feeling well enough to go out of the house, etcetera. So some of your comments like, well, we don't know what it's like in the home. Well, have you been in some of our other facilities where the elderly are aging? Do you go in and inspect every nursing home? Do you go in and inspect the schools, etcetera? And again, this is in my mind and I'm listening, but I'm talking about a basic cleaning where they bring a portable, unit to be able to form this care where these elderly people are going without dental care, which we know your dental care affects your heart. It affects your whole system. So help me understand those challenges.

[Kathleen Garrity (Executive Director, CT State Dental Association)]: I appreciate that. I mean, we have I haven't obviously visited all those facilities you've listed, but we have done samplings of them. We work with our hygienist and our dentist to go into the public facilities, as enumerated by the statute, including school systems, assisted living, etcetera. We have a team of dentists and hygienists who do that routinely and they do it under existing protocols that have been well established. It's not always ideal, but we do the best we can given that situation. This shift from a public environment to a private environment is the most concerning with this statute as it's currently being drafted simply for the fact that there's a lot of pieces here we need to take under consideration. When you're and I agree with you, oral health is essential. We preach that all the time. We want all of our populations to have adequate health care. However, I think that this particular piece as drafted, has not gone through the proper protocols to look at all the things we've listed in our testimony. For instance, you know, I was talking to a dentist recently who does a lot of homebound care, and she was talking about a patient that she was working with that had Parkinson's, And it's normal to have, you know, seizures that happen of your muscles. His jaw locked up while she was working on him, and she was alone with him except for the wife that was somewhere in the residence. She was able to communicate to the wife to come and assist her, to get a device out of her bag that helped her to pry open the jaw appropriately so there was no damage to the patient. But in those types of situations, it takes a lot for us to prepare for somebody to go into the home. It's not just a matter of doing a toothbrush prophy. It's a matter of absolutely giving them the best possible care. So I'm not saying we shouldn't have these measures in place. What I'm saying is that by going through a scope of practice review as we do whenever we change scope for any health care provider, would be the appropriate way for us to vet this with all the stakeholders.

[Rep. Jane Garibay (House Chair, Aging Committee)]: I guess I would just look, for parity. If we're going to say that about a home, I would want every nursing home inspected for cleanliness. Every venue where we now go out to, the only place we're not allowed to do is home care. And so I do know of people, and I have been in nursing homes, I've been in home care, and we want our elderly to be able to choose where they age. And when they choose to age at home, they should not have to give up their dental care because they can't afford the $75 each way or whatever that transportation is, etcetera. So I have some concerns, and we'll review your testimony. Thank you.

[Kathleen Garrity (Executive Director, CT State Dental Association)]: I appreciate your comments, and I we all agree with you that the transportation piece as well as reimbursement piece is a key part of this, but it's not the only part. And so I'm hoping that if we do a scope review, we can address all of those topics with all the stakeholders and come up with a plan that makes sense and is safe for everyone.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. Thank you for your testimony.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Okay.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next is Marie Allen.

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: Good morning, esteemed members of the aging committee. Thank you for the opportunity to testify on behalf of Aging CT, Connecticut's five area agencies on aging. Aging CT is in support of raise bill number two eighty five, an act providing a family caregiver tax credit. Connecticut families are indeed the backbone of the long term care system in our state. Every day, thousands of unpaid family caregivers provide essential support that allows older adults to remain safely in their home, helping them to preserve independence and dignity. This bill represents a thoughtful and urgently needed investment in those caregivers. Family caregivers often incur significant out of pocket expenses as they support their loved ones. For caregivers with modest incomes, precisely the population targeted in this bill, those costs can be overwhelming. The nonrefundable tax credit of up to $2,000 provides meaningful relief. Regarding raised bill number two eighty seven, while we appreciate the intent of senate bill of SB two eighty seven, we respectfully request expansion of the language to include personal care attendants. Right now, the language is specific to home health aids in Connecticut's Medicaid waivers, the Connecticut home care programs, the typical staff to provide intensive care, especially for intermittent hands on needs, times when the individual needs to be touched by staff, we use personal care attendants. So by eliminating them from this legislation, it would allow them to continue to provide that care without the required protective, gear. Equally important though is the Medicaid reimbursement providers across the state continue to face rising costs associated with delivering that care. So if the protective equipment becomes another unfunded mandate, I'm always thoughtful about the number of providers, high quality providers leaving the Medicaid space, creating this two tiered system where if you have money, you can get quality care. But if you are low income and on the Medicaid program, you do not get the same quality of care. And finally, in support of bill number five three zero two, Husky c plays an essential role in ensuring that low income older adults, people with disabilities are able to access long term services. For years, Connecticut's asset limits of 1,600 for an individual and 2,400 a couple have remained among the lowest in the country and have not kept pace with economic realities. The bill responsibly increases those limits to 5,000 for an individual, 7,500 for a married couple. These revised limits better reflect the cost of living and allow individuals to maintain minimal financial cushion for emergencies. Without these changes, too many older adults are forced to complete into complete financial destitution to qualify for basic health coverage. Although aging CT has long advocated for an increase in Medicaid asset maximum to at least 10,000 individual, 15,000 couple, we do appreciate the reporting requirement and ask for a required reevaluation of the asset maximum as part of that 06/01/2027 report. This way, we're comparing the number of Husky individuals for the last two fiscal years, and we're seeing what is that woodworking effect that people are concerned about. I do believe that increasing the Husky seed limit with is both compassionate, practical, and financially sound policy. It brings Connecticut closer in line to other states, strengthens financial stability for older adults by managing a $1,600 asset. They are one

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Excuse me. With all due respect, that is the end of the three minutes. If you could wrap up your commentary.

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: Yes. Thank you very much for the opportunity to, present the legislation. Our written testimony has been submitted.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Are there any questions? Repuse.

[Rep. Anne Hughes]: Thank you, madam chair, and thank you, Marie. Good to see you as always. How many people do you think the asset c limit raising would would help. Do you have those numbers?

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: We do not know. There is we have looked long and hard to identify how many people have over that 1,600 and where they stop.

[Yiwei Bin (Graduate Student, Yale School of Public Health)]: Well, we

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: know from the Connecticut home care program, there's also a state funded limit, which limits individuals to, a a total asset of $449,000 approximately $49,000 a year. It is not a large number. It's about 20 of the overall Connecticut home care population.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: That's what I thought.

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: Our thinking to raise to 5,000 representative use would not be a large number, and 10,000 would be certainly more reasonable when you think about the fact that when an older adult goes into the hospital, they're not spending their money. So when they come out, if they're in a hospital and then go into a skilled nursing home for rehab, when they come out, all of their income, their Social Security income has been deposited into their checking account. They very quickly are over that $1,600, maximum and are at risk of losing their coverage. So it's this awful game because the Medicaid asset limit is so low. It was developed in 1974. Clearly, the cost of living is very different today in 2026. Mhmm. And back in 1974, most individuals were going into nursing homes with Medicaid. The idea of community based care was not really a reality in Connecticut or anywhere in 1974. So $1,600 made sense because you were living in a nursing facility with all of your emergent expenses cared for.

[Rep. Anne Hughes]: Yeah. Thank you for really level setting where this policy came from and that we are desperately trying to just update and modernize it to, like you said, to the actual the actual barriers of coming out of the hospital and having that asset limit and re eligibility and losing care. It's just it's it's a nightmare. And we this this committee, I really believe this is the year we're gonna get this over the finish line. But, we we get hit by a office of fiscal analysis large fiscal note, which I don't think is realistic at all at all. And that's why I asked you about the number that you think we're that we're actually going to help and that it will actually keep people in their homes longer and out of long term care, which is way more expensive for us. And, yeah, just trying to level set the the the population that we're talking about here. Thank you.

[Jan Kritzman]: Certainly.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, Marie. Being, you know, advocates for our seniors, the five agencies, I know how much my colleagues and I refer people to you and to you and your colleagues, and you always take care of them. So thank you.

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: Our pleasure. Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Next is Harold Kritzman. I'm sorry. I have to I went out of order. Can you wait one second, Harold? Yeah. Next. I'm sorry. It's Amelia Smith and Betty Merifino. Thank you. Welcome.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Press the button.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Are you both testifying now?

[Betty Marafino (President, CT Alliance for Retired Americans)]: Yes. We're we're

[Rep. Jane Garibay (House Chair, Aging Committee)]: So you can put that time together just so madam clerk.

[Betty Marafino (President, CT Alliance for Retired Americans)]: Yes. We will.

[Rep. Jane Garibay (House Chair, Aging Committee)]: It's two people.

[Betty Marafino (President, CT Alliance for Retired Americans)]: Okay. Senator Hakadol, representative Garibay, and members of the aging committee, thank you for hearing us today. I'm Betty Marafino, president of the Connecticut Alliance for Retired Americans, and I submitted my testimony. But we're here in in support of HR five three zero four, the long term care insurance premium rates. This is a national issue for the Alliance for Retired Americans, and it is a top priority for the Connecticut Alliance. We have been collecting excuse me. We have been collecting long term care insurance stories for years, and I'm going to turn it over to a board member, Amelia Smith.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Hello, Senator Hackendale and representative Jang ARB and the esteemed members of the aid committee, my name is Amelia Smith, and I am a resident of Windsor. And I'm on the executive board of the Connecticut Alliance for Retired Americans, and I am testifying in support of h B fifty three zero four. I purchased long term care insurance in 1994 through the travelers, and the monthly payment was $85.50. In 2005, the policy was sold to MetLife, and the monthly premium went up to a $111. In 2017, the policy was sold again, this time to US Bright House Financial. The monthly premium then went up to $500. In 2026, I am now paying $838.46 as a monthly premium. This amount is unmanageable for me. I bought this policy to protect myself in my later years, and now I cannot afford it. It. I used to travel to California to visit my son, family, and friends, but I can no longer do this anymore. Fortunately, I'm lucky enough that they come to visit me. My utility bills, like anyone's else, are going up very high. And believe me, I get cold in the winter. It is also essential that I keep a car going because I live alone. I drive myself to every appointment that I go to. Otherwise, I would not even have the amount to pay for the drive for someone to drive me there. And I'm very involved in my church. As a reverend, I now only I now only cannot wait a minute. I now can only pay my tithes to the church, and I can no longer give to other events to further help outreach of the church. Please support this bill to help seniors like me. Thank you so much for your time. And believe me, there's everything going sky high and nothing coming along to change this bill. That's a lot of money for a person like me and so many other seniors.

[Betty Marafino (President, CT Alliance for Retired Americans)]: And and Amelia I'm sorry.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: And I wanna thank you for your time and your support, and I know that I have somebody in my corner that's on the panel already.

[Betty Marafino (President, CT Alliance for Retired Americans)]: And Amelia is just one of the many stories that that we have been collected. So five three zero four is a step a baby step in the right direction, and we certainly will support everything that, representative D'Amico said and would welcome an opportunity if we could even serve on the task force that he has mentioned. So thank you very much for your time.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you. Amelia, how has this affected you? Are you at the point I know you had mentioned to me that you may have to drop the insurance because you can't afford $800 a month.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Yes. I was at had actually planned to drop the insurance, but my portfolio manager asked me to just hold on if possible for just a little longer because there is a plan where I'm paying this amount, but it goes by the amount as to whether you get five years, two years, and one year. Well, as to the amount that they will pay, where you're daily, staying there. But as it dropped the Lord, it dropped the Lord, your years are, bless the Lord of benefit. And by the time it dropped to that purpose, there's no sense in even having it.

[Rep. Jane Garibay (House Chair, Aging Committee)]: I know this is just offhand, but can you share some of the things that you've had to go without? Because now you have this $800 a month.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Well, like everyone else, as you know, I was sick a short while ago, and it comes to the fact that there are certain things now that I have to eat or that becomes a problem because we cannot I cannot afford to go out and buy this food that I used to buy, which isn't very healthy for me now. And so with changing those physical problems, the other things that I need, personal as well as food and the constant visiting of doctors. So every time I go to a doctor, I have a copay to pay. So and if the medicines come along, I have a copay to pay. And now the pharmacies have changed. I'm gonna be specific. Now with Aetna and Twine with CVS, CVS comes up with a brand, put it on the shelf. And so now the brand that you were taking, which is the brand you should be taking, they will drop that amount and say, now you can purchase it off the shelf. Well, that mean you have to pay the whole price for the shelf. And let me tell you, I have found that some of the things the CES are putting out, I'm sorry, but it's higher than some of the other places. But because you that's where your pharmacy are, that's where your nurses in your pharmacies send your prescriptions to. And I just had a battle. I put in for a medication. I don't mind sending injections in my knee, and then I put it in in the October. But because of big confusion between CVS and a CVS pharmacy and a CVS specialty, it took me from October to January to get that medicine. January 20 January 22 to get that medicine in, and they started injecting it the March. And all this time, there I wasn't paying very little that can could be done. So that damaged me to events, you know, quite a bit. So it's things like this that we had to go through. So now I'm gonna try to buy whatever I can and whatever I was told that could possibly help. Some did, some didn't. So there's medicine sitting in my closet that I didn't even need.

[Rep. Jane Garibay (House Chair, Aging Committee)]: So in the end, what you've been paying into this for almost twenty five years?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Since 1994?

[Rep. Jane Garibay (House Chair, Aging Committee)]: More than more than that. Almost thirty years. Right? For thirty years. Yeah. Yep. Thirty years. You've been paying into it faithfully, and I know you. So you were faithful with all your payments. But now because they've outpriced everything, you could lose the insurance that you've paid hundreds of thousands of dollars into to be a responsible person for your health care as you aged. Is that correct?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: That's correct.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. Thank you. Rip Olinsky.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you so much for being here, and I apologize. I might have missed part of your testimony because I had stepped out for a moment. But when you opened the policy back in 1994, what was your monthly premium?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: $85.50. That was your first payment.

[Rep. Mitch Bolinsky (Ranking Member)]: Let's let's let's try to be more precise. That's $85.46, you said?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: $85.50.

[Rep. Mitch Bolinsky (Ranking Member)]: 50¢. Thank you. Alright. That's that's amazing. I wish I had records like that at home.

[Natalie Shurtleff (Associate State Director, Advocacy & Engagement, AARP CT)]: She was a state employee.

[Rep. Mitch Bolinsky (Ranking Member)]: And you were a state employee on top of everything. Thank you very much. So let me ask you, when you when you took out the policy, were you were you told that the price of this policy was going to escalate it of a rate that far exceeds inflation?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: No. I was not told that. They said they did say that the policy would go up a bit probably each year if you expect it to maintain the five meters. You know. Otherwise, if you stop it, it could go down to two. If you decide not to stop if you stop it again, it could go down to the one year. And that's meaning the years that you would receive it, also the amount that you would receive on a daily basis.

[Rep. Mitch Bolinsky (Ranking Member)]: K. So so do you feel in any way like you were sort of baited and switched a little bit?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Yes. I do. But I didn't do this alone. I had a portfolio manager with me that got this policy, and we've talked to them about this. But the thing is I was never told that it would be sold. And I think it had not been sold. It would not have been this much. But I would never I was never told that they could sell it. But then when they sent sent you the papers, they simply said, this is what we're doing, and you can continue with them. You you know, you continue with them at what the policy first came out for, and that's about it. You had no choice to say anything other than drop it if you wanted to.

[Rep. Mitch Bolinsky (Ranking Member)]: Thank you so much. You know, I don't think any of us think about this, but insurance policies, particularly high ticket ones with, with a great amount of investment are typically, they will not typically, but they're commonly sold, just like our mortgages on our homes. They get sold and sometimes they get sold to people that. Give us no choice, but to accept a new rate there as well. It's, it's sort of an interesting. Conundrum, but it's, you know, it's really something that is a consumer protection matter of the highest degree, I believe. Nobody can see this coming, Yet, you're on the hook. Please, please help.

[Betty Marafino (President, CT Alliance for Retired Americans)]: To add to that. This is not an isolated case. We have been collecting many, many stories from people, many of whom have had to drop it. And a couple of years ago, I was at a forum in Newington that senator Chris Murphy called, and it was on the cost of long term care insurance. And one after another resident came and said how they had it for years and had to drop it because they as they said, now we're older, we have more health problems, and we had to drop it because we couldn't afford it. So

[Rep. Mitch Bolinsky (Ranking Member)]: And and you don't get an opportunity to keep the equity that you've built in that policy because especially if the especially if your policy has been brokered out and sold, the equity stays with the original insurer, which puts you completely at the mercy of a buyer. That's that is I can't understand for the life of me why consumer protection doesn't think that this is something that's just absolutely heinous. We, we are very interested in fixing this problem. And we're disappointed that that no other committee has stepped up. And accept or and failed to accept the excuse that. It's not gonna fly. Because, I mean, those are words that happen in this building a lot. I'm not sure who's the one that pulls the trigger and says what flies and what doesn't fly. But I guess we can we probably all could deduce that. That's not important. The important part is to actually do what's right. And to allow you to have the protections that you've been paying for, Adam, for thirty two years. At a cost that you can afford that has some relation to its at the very, very most, its cost of living adjustment you know, increases, but but but to open up an envelope and see your rate double, which you have seen on an occasion or two, there's There's no words to describe it except that it's just heinous. So thank you for your testimony. We're not through with this with this issue, and we are very, very motivated to work on this. And I also don't believe it involves a fiscal note to the State of Connecticut. I believe that this can be settled amongst parties with a reasonable compromise that looks out for your ability to not have to worry about this. Thank thank you so much for being here. Thank you, madam chair. Yes. I'm sorry.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: My only thing is that really bothered me. What if you die? I mean, you you say I passed away. Where does the money go?

[Rep. Mitch Bolinsky (Ranking Member)]: In the case of our usual insurance policy, it would go to your heirs.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: I under yeah. That's what I'm getting at. Yes. So why is it that they raising these things to this degree when they know if you pass away in between the car accident? Where does the money go?

[Rep. Mitch Bolinsky (Ranking Member)]: Into somebody's pocket, ma'am. So your your your point is is not wasted on us. We completely and totally understand, and we're willing to swim upstream for you. Thank you. Yes, ma'am.

[Betty Marafino (President, CT Alliance for Retired Americans)]: Point the Connecticut Alliance for retired Americans is very willing and eager to work with anyone who wants to, you know, further this investigation.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Right. One more question you have, rep Fortier?

[Rep. Mary Fortier]: Thank you. And thank you, Amelia, for being here and explaining so well how this has affected you. My question is actually for Betty, and I'm gonna ask you, Betty, to turn your microphone on because when you've spoken in the last few minutes, it's hard to hear. But my question is simply this, and you may not know it, but do you know how many folks in Connecticut have long term care policies? And perhaps your, you know, national organization knows that, if you could get that information for

[Betty Marafino (President, CT Alliance for Retired Americans)]: to I don't have that, but I do know that at least 20,000 state employees retired state employees.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Your your mic went off.

[Betty Marafino (President, CT Alliance for Retired Americans)]: Yeah. Okay. Did you I don't know if you heard me.

[Rep. Mary Fortier]: Yes. 20,000 retired state employees.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yes. Yeah.

[Rep. Mary Fortier]: That's a significant number. Right. Again, do you know if your national organization could get us the numbers in general?

[Betty Marafino (President, CT Alliance for Retired Americans)]: Here it is right now.

[Kathleen (Kathy) Holt (State Healthcare Advocate, OHA)]: It's 100

[Betty Marafino (President, CT Alliance for Retired Americans)]: 15373. Thank you.

[Rep. Mary Fortier]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Would you repeat that?

[Betty Marafino (President, CT Alliance for Retired Americans)]: Would you repeat that? 115,373.

[Rep. Mitch Bolinsky (Ranking Member)]: So so so the so the state employees, that portion of that is only 15% of the problem? Wow.

[Rep. Mary Fortier]: Thanks. Thanks for that. I think we do need to get this in context, and it's it's a large number. So thank you, and thank you for your advocacy.

[Andre Brel (President, Juniper Home Care)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you both. Okay. We have two people coming up together. Right. Harold and Jan Critzman are gonna come up together to testify and double their time. Are you gonna start with your video?

[Harold Kritzman]: Well, first of all, good day to the members of the committee on aging. My name is Harold Kritzman. I live in Newington. I'm 80 years old. You're gonna see a video from the NBC. Oh, sorry. Yes. Okay.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: That's fine.

[Harold Kritzman]: Okay. Good day, members of the committee on aging. My name is Harold Kritzman. I live in Newington. I am 80 years old. You're gonna see a video from the NBC nightly news segment that was entitled The Cost of Denial and features David Schwozner, of whom you will hear shortly. So would you please, for my time, play the video?

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Peter, can we post it in the chat? Could we post it in the chat online so folks that are online can look at it at their

[Rep. Mike Demicco]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. Thank you, and welcome.

[Jan Kritzman]: Good day, members of the committee on aging. My name is Jan Kritzman. I live in Newington. My husband here and I bought long term care insurance in 2004 for a combined annual premium cost of $2,000 I just got our bill for 2026, dollars 7,000 combined. That's after I pared down our benefits considerably. It's a 350% increase. You know, my late father gave me some invaluable advice. He said that whenever I'm faced with a serious dilemma, I should never act out right away, but rather to sleep on it. And here's what happened when I first saw last Friday night House Bill five three zero four. Initially, I felt hopeless, frustrated, and ignored. And then came the second thoughts the next morning. I believe that with a little stroking, buffing, and polishing, this bill could help the 100 plus thousand long term care policyholders in Connecticut to maybe, just maybe, afford to keep their policies. A policyholder with a long term care protection will save the state millions of dollars in Medicaid costs, probably offsetting any loss of revenue from the tax deduction mentioned in this bill. And we all know that Medicaid in our state is in deep financial peril. I mean, who wouldn't like a tax deduction? And who wouldn't like to attend a public hearing when the premium rate increases are demanded annually by the long term care insurance companies? I, for one, would love to go toe to toe with their greedy representatives. You go toe to toe with me, I'll tell them they're gonna lose. Sidebar, my esteemed colleague, David Schwartzer of Newington, whom you'll hear from today with his forty years of experience in the insurance industry, will explain four additional proposals which this committee has already seen but has not yet acted upon. But I'm hoping that if you amend or expand h b five three zero four to include his proposals, we may have something powerful and meaningful here. The bottom line is this. I don't want the state of Connecticut to endure any revenue loss that can't be made up another way like saving Medicaid. Let the long term care insurance company share in any expense. After all, they're the culprits who miscalculated the future. Did all the long term care companies twenty five, thirty years ago, forty years ago, underestimate the future due to ignorance or with malicious intent or both bait and switch. They didn't expect us to live so long. Well excuse me I didn't mean to live so long. Quoting the prophet Isaiah here I am all seventy eight years of me and then they claimed to have been oblivious to the historical nature of inflation. Regardless, did all of them make the same misjudgments? Food for thought. Also, I keep abreast of customer reviews for Transamerica Life. That's what we have. One platform averages 1.3 stars from 134 reviews. Another platform, one hundred and seventeen one star reviews out of 132 reviews. All the complaints were virtually identical. They drag out payments forever for legitimate claims or they don't pay at all. What have I been paying for? Evidently we've been screwed, glued and tattooed by the Dewey, Cheatham and Howe long term care insurance companies. Let me entertain any questions.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Excuse me. Just wanted to let you know that the the time has allotted. I'm done. If you could wrap up your time.

[Mairead Painter (State Long-Term Care Ombudsman)]: Thank you. I heard the bell a couple times.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Okay. Just making sure.

[Jan Kritzman]: I'm Any questions?

[Rep. Jane Garibay (House Chair, Aging Committee)]: First of all, thank you, for being here and for bringing attention to this as we've met. But you do know that a bill starts one way, and it can be changed. Hopefully, we will still

[Jan Kritzman]: the next morning. I remember that. Amendments.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Right. And so, there's we will still be in conversations as we will with, Betty and, their group, etcetera, on this. Is there anyone that has a concrete question, rep Balinski?

[Rep. Mitch Bolinsky (Ranking Member)]: You're you're Jan, I just I my only question is, can you actually tell us how you really feel? There's there's there's nothing to say other than what rep Garibay just said. Bills change. Bills develop. Sometimes we fall on our face with them. Sometimes they get punted from one committee to another and just sort of fade into the into the beautiful wallpaper behind me.

[Jan Kritzman]: You know,

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: tell me if we pass.

[Rep. Mitch Bolinsky (Ranking Member)]: We we we, we are intent on holding this thing and having those conversations. We can't promise you the time, but, but it will we we promise you that the due diligence is happening. It will happen.

[Jan Kritzman]: Can I tell just a very brief little incidence?

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Please.

[Jan Kritzman]: When I'm I'm a little bit extroverted, I think you probably figured that out. And, when I go shopping like at, Costco or Sam's club or Marshall's or something where there's long lines in the checkout line and you start chatting with the person in front of you and the chatting with the person behind you. And, you know, I say to like the lady behind me who looks like she's the senior citizen and I say to her, excuse me, I have to ask you a question. I mean, you're going to think I'm crazy. Most people do, but do you have long term care insurance? And they look at me. This is like nine times out of 10 in the checkout lines. No. Well, what are you gonna do if, God forbid, you should need long term care? I don't know. I, I guess I'll go on Medicaid. Then last week I'm at the doctor's office and I'm talking with a gentleman who was just about my age and I said to him, hi, let's change the subject for a minute. Do you have long term care insurance? And he said, no. I couldn't afford it and my mother couldn't either and she was in a nursing home for eight years and Medicaid took the house and everything she had. Okay. That's a good answer. My best answer. Don't get mad at me. I'm gonna tell him. I'm talking to a story. I'm talking to a gentleman in the checkout line at Sam's Club. And I said to him, do you have long term care insurance insurance? And he said, no, I don't. I have a gun. That's not funny. We're looking at you and we're hoping and we're praying that you can do something with HB five three zero four, amending it. You're gonna hear from David Schwartzer with his four proposals. I think you might already have seen them. And I I I I have a lot of hope and faith in you guys.

[Rep. Jane Garibay (House Chair, Aging Committee)]: We have the same hope and faith in the advocates to come forth, and that's why today's hearing is important and to hear your voice because you are really the catalyst about what happens. We're just the tool. So thank you very much for your testimony today. And I think I'm gonna bring up David now instead of waiting because it's the same theme. So I ask everyone to be patient.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Thank you. Distinguished members of the agent committee

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Can

[Rep. Jane Garibay (House Chair, Aging Committee)]: the others turn their mics off, please? Thank you.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: My name is David Schwartzer from Newington, Connecticut, and I come before you today in opposition of bill h b fifty three zero four. I appreciate that this committee has chosen to take up this important issue, but h b fifty three zero four offers the same suggestions that have failed over and over again. Surely, this committee knows that in 2025 alone, there were five bills introduced that suggested a tax deduction or credit for long term care insurance premiums paid as suggested in h b fifty three zero four. In fact, one of those bills was introduced by a member of this committee, senator Tony Wong. Surely, the senator knows that the Office of Fiscal Analysis evaluated that such a bill would cost the state as much as $67,000,000 per year in lost income tax revenue, and the Office of Policy and Management indicated that a bill with tax implications was a nonstarter. Not surprisingly, all five of those bills failed. The suggestion of public hearings for long term care insurance rate increases, also a part of HB fifty three zero four, has been introduced numerous times over the years, including twice in 2025. Again, one of those bills was introduced by senator Wong. Those bills, as in prior years, failed due in part from objection by the Connecticut Insurance Department who argued that they do not have the resources to hold all of those meetings. On 01/05/2026, my colleagues and I met with cochair Garibay and ranking member Balinski to discuss the ongoing long term care insurance premium crisis. At that meeting, we presented our twenty twenty six legislation proposals. Our four proposals were developed after years of research and failed prior attempts for legislation. Our current proposals eliminated the pitfalls that have caused previous legislative attempts to fail while remaining fair to the state of commit Connecticut by saving billions of dollars in future Medicaid liabilities. They're fair to the Connecticut insurance department, to the long term care industry, and brought long awaited substantive relief to policyholders. We came away from that meeting with an understanding or at least our hope that this committee would create a meaningful bill that embodied the intent, if not the actual language, of our proposals. HB fifty three zero four fails to do that. Connecticut's 100,000 long term care insurance policyholders are tired of seeing bills introduced year after year that repeat the same suggestions that have failed time and time again. I am asking this committee to do what is right for the citizens of Connecticut, rewrite h b fifty three zero four using our proposals to bring real solutions to this crisis. Thank you for your time, and I would be happy to answer any questions you may have.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Brett Balinski.

[Rep. Mitch Bolinsky (Ranking Member)]: Mister Schwarzer, thank you for being here. And your words matter a lot. And when you met with us, we understood. And we, we also were surprised to find, that you spent forty years in insurance. So, you have a little bit of insight that, that probably nobody on the aging committee does have. As as as as we've discussed, the most important thing in the world to me and to my co chairs and the members of this committee who all feel this with you is that we do address this. And unfortunately, the reason fifty three zero four looks the way it looks is because when we concept the bill, it initially goes to an office called the legislative commissioner's office and they interpret it. Sometimes their interpretation is what what was done on it last year. So that's why it looks a lot like last year's bills. In this committee, We take a lot of pride in being collaborative and inviting all stakeholders to the table. We know that no at no time in the past have all the stakeholders been brought to the table because there was an acceptance of anchor to fly or whatever. It's it's incumbent on us to get this in front of the right people and have everybody in the same room to talk about both the impact and possible solutions. The one that you propose is actually the cleanest, simplest one, saves the state a ton of money in Medicaid. And, truthfully, the solution, as I said before, is is almost certainly a sharing of the burden. The fiscal impact should not fall upon the state of Connecticut solely. So, I think we need to take the fiscal note off the table for the time being and try to figure out what the heck it is that we need to do to fix this. And in the process, be fair and equitable to everybody that's involved, even those that have imposed these one-sided and quite unreasonable increases upon you. Aside from that, that's that's that's my hope and my plan at this point. And I can't speak for anybody else, but I actually, I believe I can probably speak for the this wonderful lady to my left, my co chair. We took the time to meet with you. We appreciate your patience in allowing us to go through the bureaucracy of a building that sometimes is difficult to understand. Thank you.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Thank you. I think one of the things, listening to Amelia's story that, you know, her premium went from $85 a month to $800 a month. And I think one of the things that frustrates policyholders, and I think this was a question that was asked of her, I think I can speak for probably most of the 100,000 people that are suffering from this, that when we bought our policies, the state of Connecticut mandated that we answer a question which said, have you considered whether you would be able to afford your premium if it went up by 20%? That was not a promise. That was not a guarantee, but we were given an expectation and the many people that I have spoken to all say, I was prepared for something more than 20% even if they were wrong and it went to 40% or 50%. I had figured that I'd be able to afford it. Okay. But when you talk to people, in my case, it's 300%. I believe Jan's is close to 400%. The the question that I get asked time and time again is what happened to the 20%? And and I know you don't have an answer for it. I don't have an answer for it. I I actually watch that video where our former commissioner said to the question of who pays for this, he said, unfortunately, it's the policyholder and the industry. And the frustration that people have today is that neither the legislature, and and I make that collectively, and the Connecticut insurance department, who certainly has a lot of control in this situation has done nothing to make the industry pay for their mistakes.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Alright. I have one hot question. So can you tell me there's the middleman, the insurance agent. Are they at all responsible for selling an insurance? Did any could at any point over these thirty years Just trying to follow the line, or is it only between the consumer and the top company?

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: When these policies were sold in their heyday, which is probably from 2000 to about 2010, the industry was very interested in getting these policies sold and collecting premium. They paid, my understanding is, massive commissions to agents and brokers to sell these policies. I truly believe that the agents of brokers didn't really understand what the industry was planning to do. You know, the industry will say, we didn't understand the marketplace. We expected people to they expected 20% of their policyholders to turn in their policies every year and have said that by the time people were old enough to file a claim, they expected 80% of the people to not have policies anymore. They say that they didn't make the investment and interest income that they anticipated, and they say that they didn't anticipate people living as long as they did and filing as many claims as they would. Those are the industry's concerns. That's what the industry said are the mistakes that they made. The industry wants this to be a claim issue, and it's not a claim issue. It's a premium issue. I bought my policy in 2004. I was told at the time that Genworth Financial was selling that policy since 2002. What they didn't tell me is that they intended to close their policy that policy in 2005, which means for the past twenty years, while they've lost some of the policyholders, they've gained no new ones. And if you think about the fact that for my policy, I believe they sold around 5,000 policies, it is virtually, actuarially impossible to expect those 5,000 people in Connecticut to pay enough premium based on what was originally charged to cover the anticipated liabilities of the future. My premium is now up 365, almost 400%. Genworth Financial has filed for a 58 and a half percent increase, and if that's granted, my premium will be about $9,000 a year. My wife has the identical policy, and that will be her premium also. But Genworth has made it known. They've put it in writing that whether they get that 58% increase or not, they are going to file more rate increases until the entire rate increase is over 600% of the premium that I was charged initially. Now I've been told by people who disagree with my argument that these policy these insurers close these policies early because they understood what was going to happen, and they wanted to correct that issue by keeping making new policies that would be open longer. And it is true that in in later years, they did keep policies open for seven or eight, perhaps ten years. And you would think that they had learned their lesson until you look at a policy that was sold in 2012 here in Connecticut by Prudential Insurance Company who sold the policy for a total of four months to 25 policyholders, and then they closed the policy to new business. Today, there are 16 policyholders left in that policy group, and Prudential Assurance is begging for rate increase after rate increase after rate increase because they say there's not enough premium to cover future liabilities. 25 policyholders after four months will never generate the premium necessary to cover the future liabilities. So when these carriers say we made early mistakes and we wanna correct them, ask them to have Prudential Insurance explain and ask the insurance department to explain how they could approve a policy to be sold to 25 people over a four month period and then close the policy.

[Rep. Jane Garibay (House Chair, Aging Committee)]: So at what point did we, they, which may be different, realize this was happening? Ten years ago, fifteen years? Do you have an estimate of when did we realize this was a real problem? If you have an idea. It's not just the year. It's not this last year.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Clear around 2016 that this was a problem. Many of the policyholders who bought their policies during the heyday, which was probably 1995 to about 2010, had not seen any increases on their policies. My particular policy, which I bought in 2004, didn't get its first rate increase, which was 40% until 2014. Now I will add that Thomas McInerney, who is now was and at that time became the CEO of Genworth Financial, put in his 2014 annual statement that it was his mission of Genworth Financial to separate and isolate the long term care business into separate companies and isolate them and their potential losses from the parent corporation.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: This is

[Betty Marafino (President, CT Alliance for Retired Americans)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: We have a representative with a question, so I'm gonna interrupt you a little bit. Rep. Ace.

[Rep. Jay Case]: Thank you, madam chair. I appreciate the time, and I do remember Jan and the team at the table and come in testifying in human services. I think it was late in the evening last year or the year before, if I correct. And I think where it fell down and my question is this is is private insurance. Correct? It's nothing through the state. Am I correct in saying that?

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: There are individual policies and there are group policies. I know that the state of Connecticut has offered in the past to its employees long term care insurance policies. Those policies have not had the same impact of rate increases as individual policies, have had, but there are both individual and group policies.

[Rep. Jay Case]: Correct. And the cognizance of this committee is state policies. And what we found in human services, the private policies have to go to the insurance committee because they have cognizance of private insurers and how they're regulated, and I think that's the issue. We need to find out the regulations on what the premiums are allowed to increase. I get it. We need to find a solution. This has been in human services for quite a few years, and now it's over to aging. But the proper committee and I I hope there's a bill over there. If there's not, shame on us, but we insurance committee has to oversee what private insurers and agents they regulate. I know we we've sparked this issue as a long drawn out night that we had, Jan, when you were there, and there has to be a solution. And I think we have cognizance over state insurance, but not private insurers in this committee. But we've raised in the topic. We have a lot of people that are impacted with this. I hope we can get a resolution because it's sad, and and it's it's regulatory. Am I correct in saying that, guys? It's regulatory.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: To to answer your question, the insurance committee has introduced bill proposed bill two twelve. It was introduced by senator Anwar, and this is what it says. It says the general statute be amended to establish a tax credit, here we go again, equal to any increase in premium costs that exceed 2% of premiums paid annually to purchase an individual or group long term care insurance policy during a taxable year and allow long term care policyholders to carry such credit over to future taxable years.

[Rep. Jay Case]: Thank you. And I I thank you I thank you for your persistence in bringing it forward because it's something that we have to get, but we have to get the insurance committee and the commissioner's office involved because that's where the regulatory parts to where we can work on why the premiums are where they are and why they were allowed to increase to the way they were. And that we gotta get to the bottom line and get to the right person to get that to happen. I hope we get something on the floor this year. I know human services, we never had a chance to get it to the floor because it was referred, I believe, to the insurance committee, but we we gotta make a an impact and and get it to where it needs to go. But I thank you for your time. Thank you, madam chair.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, rep Case. Yes. Regular protocol is that an insurance bill or a general law, wherever it is, if it starts here, it will be referred to the committee of cognizance.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: If I could just respond to his question about why is the insure why are these increases allowed by the insurance department? Mhmm. If you look at the information submitted by these insurance carriers when they are requesting a rate increase, and I I will clarify that I am not an actuary. So there is a science behind this that clearly I am not qualified to speak on. But I can speak on it from a common sense perspective. And what these insurers present to the insurance department is information that shows a declining income of premium in future years, which makes sense because people are dropping their policies, people are passing away without needing a claim, or people go on claim in which at which point they stop paying premiums. And what they can what they show on the other side of the ledger are these massive liabilities that they have. Millions and millions of dollars a year in projected claims, which is interesting because statistically, and this has been shown in several other exhibits by different organizations, the average claim lasts about three years and costs about a $150,000. So to anticipate that these claims are going to last ten, eleven years as has been suggested by members of the legislature is just bad science. But what they also do is they project these diminishing premiums and massively increasing claim amounts to years going out to 2064. And if these policies were purchased in the early 2000s when the average age of a policyholder purchasing this policy is 55 years old, then they're projecting a massive amount of claims to be filed by people that are 100 years old. And, statistically, that's just not going to happen. But the insurance department looks at this data and says, well, they're losing money every day. We have to give them these rate increases because, look, they they made honest mistakes, and they need money because if we don't give it, they're gonna leave the state. They're gonna go insolvent, and no one's gonna be able to get paid. And, statistically, none of those things are true because

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: okay.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Rep Fortier?

[Rep. Mary Fortier]: Thank you. Just a quick question, because I know you've done so much research on this topic. Do you know if any other states have attempted to regulate this in the ways that you suggested in your written testimony?

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: So, several years ago, there was a proposal introduced. It has now been adopted by about 42 states that put some regulations in place. It is certainly not the perfect answer, and it it doesn't stop these rate increases, but it tries to temper them. Recently, the state of New York implemented new regulations, which actually does put a cap on rate increases in the sense of as people age, the percentage of rate increases are capped at certain levels. And then when they reach, I think it's actually the age of 65, they are not charged any additional rate increases. So, you know, this is a great question because I have heard many times from legislators, in this building that, you know, we're looking at what other states are doing. The insurance department has said we're looking at other states to see how they are handling this. And I would just point out to this committee and as you probably know, the Connecticut partnership program, which is now in about 43 states, was invented here in Connecticut. There's a reason that Hartford, Connecticut was the insurance capital of the world, and it's because we didn't wait to see what other states are going to do. We innovated, we researched, and we created an industry that the other states copied. There's no need for us to wait and see what other states are going to do. It's not gonna create confusion like other legislators have said to me. We have been a leader in the insurance industry. We are a leader in the insurance industry, and there's no reason that we can't be the leader in solving the long term care insurance premium crisis.

[Rep. Mary Fortier]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: We wanna thank you all from coming forward this morning, and we look forward to working with you moving forward. Thank you.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Up next is Chrissy Centini. I'm lying.

[Chrissy Scatini (President, CT Association of Adult Day Services)]: Hi. Good afternoon. Thank you

[Betty Marafino (President, CT Alliance for Retired Americans)]: so

[Chrissy Scatini (President, CT Association of Adult Day Services)]: much, representative Garibay, Senator Hockadell, and distinguished members of the aging committee. In kind of a turn of subject, I'm here today in support of House Bill five three zero five, an act concerning adult day center transportation. My name is Chrissy Scatini. I'm the president of the Connecticut Association of Adult Day Services, and I'm here today in support and urging your support for this bill five three zero five. First, I'd just like to thank this committee for the ongoing support of adult day services in Connecticut over the past several years. We've been so grateful for the work on this created awareness of our programs, the funding we received, and the overall value and recognition for the work our providers across the state are offering. So we truly thank you for that. As you know adult day centers are a vital part of home and community based services. Many provider types are working to keep seniors aging in place and able to live at home and I've testified to this before but just to say again today adult day centers are the community part of home and community based services. We offer a full day of supervised safe care, nursing service, medication management, activities, meals, and caregiver support along with many services that you I'm sure you're aware of. But it wouldn't be possible without our component of transportation. Our adult day programs are required to provide or arrange for seniors to be picked up and dropped off each day from their homes. These clients can't drive many of them can't even walk, but our program see to it that they safely leave the house come out into the community and get returned back home to their families each day and that's no small feat centers either pay contracted transportation companies or have vans to maintain include some passenger vans handicap wheelchair vans and also employees specially licensed drivers. Adult day center drivers are trained not only in navigating the roads, but but in providing care for the clients as they take them in and out of the house and back and forth to the program. Many of these folks would otherwise be confined to their homes. And as wonderful it is to be living at home and in the community, It is most beneficial for these citizens to be out actually in the community feeling part of the community and participating in the routine of daily life that's getting up and out of the house each day and being cared for safely. Although it's a crucial component of our service, the cost of transportation, however, is becoming unbearable. Transportation is included within our established rate, which is a maximum of a $102.91 per day and the expensive transport can take up to 30% of that funding per person per day. The cost of vans maintenance gas manpower has gone up exponentially. And while we appreciate the funding that we have and what we've received it just isn't enough for centers to meet the needs of our client in the vast geography of the state of Connecticut. Adult day centers bring clients back and forth to the program and some also offer transport to outings, events, and doctor's appointments at no extra charge. In fact, the Yes.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Wrap up your commentary. We're at the end of the three minutes.

[Chrissy Scatini (President, CT Association of Adult Day Services)]: Sure. Sorry. A full day in an adult day center can cost less than what's even billed for one medical transport to an appointment back and forth. So and that can even be a barrier for seniors to ask to access. Sorry. And the cost of our vans wheelchair accessible vans has nearly doubled in the last six years. And all of this affecting adult day services. And we are offering costs at a fraction of the cost of care as the cost of care at a fraction of the cost of similar services which is half the rate of in home service and a quarter of the cost of long term care placement. So our association is happy to provide relevant data to further discuss and answer any questions that you might have. But as we care for this vulnerable populations, we can only do so with the continued support of the state. So we kindly ask for your support of House Bill five three zero five that would help support adult day centers providing transportation and investing in the community part of home and community based services. Thank you so much for for hearing me today. Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much, Chrissy, for your advocacy and for, speaking out today. Are there any questions? I don't see any, so thank you. Have a great day.

[Chrissy Scatini (President, CT Association of Adult Day Services)]: You too. Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Next, we have Emily Kelly also online.

[Emily Kelly, RN (Director of Resident Health Services, Essex Meadows)]: Hello. Senator Hockadell, representative Garibay, senator Wong, representative Balinski, and distinguished members of the aging committee. My name is Emily Kelly. I'm a registered nurse and the director of resident health services at Essex Meadows, a life care retirement community and a member of LeadingAge Connecticut in Rhode Island. I'm pleased to submit my testimony in favor of house bill five two nine nine, an act that is allowing trained assisted living aids to administer medication to assisted living residents. I appreciate the opportunity to speak with you today regarding house bill five two nine nine, an important step toward addressing the evolving needs within our assisted living communities. As someone deeply entrenched in the field of health care services, specifically within assisted living and memory care units, I have witnessed firsthand the pressing need for enhanced framework that empowers assisted living aids. The proposed bill would allow these special trained professionals to administer medications. It represents pragmatic, forward thinking and improving care. Implementing a career ladder advancement program for assisted living aids would not only elevate their skills and responsibilities, but foster career growth. It is important to emphasize that this initiative is designed to support, not supplement the crucial role of the registered and licensed nurses. Allowing for special trained assisted living aids to administer certain medications, for example, eye drops, patches, topical creams, addresses both practical and economic issues. It alleviates the unnecessary cost burden imposed on residents who are incapable of self administering medications while ensuring that professional nursing staff are used where their skills are most needed. Enabling assisted living aids to take on these responsibilities contributes to higher satisfaction by providing new challenges and opportunities for professional development. It addresses it addresses the workforce shortage by making a nursing aide role more attractive and rewarding, ultimately contributing to better quality and safety outcomes for residents. The growing aging population highlights the need for this change. Ensuring well trained assisted living aids can safely assist stable residents within a nonacute setting not only benefits the resident, but it also supports the broader health goals public health goals. The provision for this certification to remain permissible respects the autonomy of assisted living service agencies while offering flexibility, a flexible solution tailored to diverse operational needs. In many states, this adaptation is already working. I personally feel that house bill five two nine nine is an essential move toward modernizing our health care systems, enhancing the efficacy of medication management, and aligning our workforce capabilities with the realities of the demographic change. Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. Perfect timing. Just as the bell.

[Lee (AARP Connecticut volunteer)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: I don't see any questions, so thank you for your advocacy and for testifying. Have a great day.

[Mairead Painter (State Long-Term Care Ombudsman)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Next, we have Barbara Munk. Munk. Okay. Thank you. And after that will be Natalie Shurtleff. Barbara, if you could just press the there you go. The button. Okay.

[Barbara Monk (AARP Volunteer, Family Caregiver)]: Good afternoon, senator Hockadell, representative Garrowby, senator Wang, representative Volinsky, and members of the agent committee. I'm grateful to be here to express my support for senate bill two eighty five, an act providing a family caregiver tax credit. My name is Barbara Monk. I'm an AARP volunteer, and I have been a caregiver, and I expect I will need a caregiver as I age. As late first lady Rosalynn Carter said, most of us are, have been, or will be a family caregiver or will ourselves need the help of a loved one to live independently. Family caregivers are the backbone of Connecticut's long term care system. They're the first line of assistance for most people, helping to make it possible for older adults and people with disabilities to remain at home and live with dignity and independence. My late mother had heart disease for fifteen years and was diagnosed with dementia months before she died in 2005. For over a decade, I set up pills, doctor's appointments, dealt with her frequent hospitalizations, and coordinated her discharge care, all the while taking care of my own family and working full time. I loved my mother, but it was a physical relief when she died since I was balancing work, family, and her every day. Relief was short lived. Less than ten months later, my husband was diagnosed with non Hodgkin's lymphoma. The cycle of blood tests, scans, chemo treatments became almost routine and was repeated four years later as non Hodgkin's lymphoma recurred. And this time, a stem cell transplant and radiation were added to double chemo. Three and a half years later during a routine scan, pancreatic cancer was found. And despite chemo, radiation, and surgery, he died fourteen months after being diagnosed. As a mother, daughter, wife, and sister, I relied on others to help with caregiving. My daughter had three surgeries before age six. Friends, neighbor, and, of course, family were all part of our unpaid care system. It was modeled by my divorced parents when they cared for my traumatic brain injured sister for decades in each of their homes with the help of services during the day when they worked. It's what families do. Their expenses including ramps, grab bars, and tons of host repairs as walkers and then wheelchairs bumped into every possible surface in their houses. There were also miles and miles of driving to a variety of medical appointments. They spent their retirement income to care for their daughter. I later supported my sister's care after my father's passing when she needed to move to a TBI group home.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Your your three minutes have allotted. Thank you for your testimony. Would you please summarize for the committee?

[Barbara Monk (AARP Volunteer, Family Caregiver)]: As an AARP volunteer who presents you in their caregiving journey in the community, I hear of all their personal stories and financial challenges. We try to tell them to take care of themselves, but they are often the last people who get a break. We need to help all those caregivers who truly are the backbone backbone of our health care system. Therefore, I support senate bill two eighty five enact providing a family caregiver back to credit.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Barbara, thank you so much for your heartfelt testimony. It's it's very sad, and I'm sorry for your losses. I don't see any questions. So thank you. Have a great day. Natalie followed by Andy Baron, I think, is gonna supposed to be online.

[Natalie Shurtleff (Associate State Director, Advocacy & Engagement, AARP CT)]: Good afternoon. I'm Natalie Shurtleff. I'm an associate state director of advocacy and engagement with AARP Connecticut, and I'm joined here by

[Andre Brel (President, Juniper Home Care)]: James.

[Natalie Shurtleff (Associate State Director, Advocacy & Engagement, AARP CT)]: James Shurtleff, my miniature advocate with me today. So I'm here to speak in support of senate bill two eight five, an act providing a family caregiver tax credit. We submitted testimony on this bill and several of the other bills on the agenda today. And you're also gonna be hearing from several of our a a AARP volunteers with sharing their own personal caregiving experience. You just heard from Barbara, and there's a few more that will be testifying later today. But I really just wanted to take a few moments to thank the committee for introducing this legislation and for bringing up this very important issue. We know that in Connecticut, we have 773,000 unpaid family caregivers that are providing an invaluable level of support to their loved ones. And they do it out of love, but it can be incredibly challenging work, physically exhausting, mentally exhausting, and financially challenging as well, purchasing, medications, home modifications, assistive technology, transportation, all of these things add up and create a real financial burden to people as they try to support their loved ones and keep them at home. So we thank the committee for raising this legislation to provide some modest financial relief to these family caregivers, and we believe that it will truly help people keep their loved ones at home, which we know is where people want to be. And in doing that, it keeps people out of taxpayer funded nursing homes. So at the end of the day, you know, this legislation is a step towards actually saving money by keeping people at home and not having to pay for expensive nursing home level of care. So I really thank you for for raising this bill and, you know, hope that we can follow along in the other states that have done this, Nebraska, Oklahoma. We know that there's a lot of support for this across the country and hope that Connecticut can be the next one to do this.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much, Natalie. I missed your guest's name.

[Natalie Shurtleff (Associate State Director, Advocacy & Engagement, AARP CT)]: Yes. This is James Shirtliff.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: James. Is this your son?

[Kathleen Garrity (Executive Director, CT State Dental Association)]: Yes.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: James, can I ask you a question?

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yeah. Are you are you proud of your mom? I'm just gonna tell you, you should be. She's a hero. And she's actually one of the creators of this bill, so we're so happy that you could both be here. Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: I don't see any questions.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Have a great day.

[Natalie Shurtleff (Associate State Director, Advocacy & Engagement, AARP CT)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: This bump from there. I don't see Andy Baron. I he was there, but now he is not. So I think I saw Lee. Yes. Lee is online. Go ahead, Lee. Lee, you're muted. If you could unmute, please.

[Lee (AARP Connecticut volunteer)]: There we go. I'm sorry. I was I'm the the third, obviously, of AARP. I spoke with you last year on the same bill or a different version. This is a senate bill,

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: that part of it,

[Lee (AARP Connecticut volunteer)]: two eighty five, as a caregiver. And this time, I'm gonna speak to you as a Eucharistic minister who's providing those services to an individual in her home who has developed Lewy body dementia. And that's the same sort of dementia that my thought my my husband had when I was providing care to him. And what I've seen in the three years that I've been visiting her is how she has or, really, how her son, whom she now lives with because of her decreasing ability to be independent in her home, How he has adjusted to this situation and the steady progression of her disease, which straps her, strips her of her fine motor and gross motor skills. So that makes her unsteady and unsafe in her home. And in this three year period, he's added the cameras, the different types of walkers, anything you can imagine that would make his mom more safe and secure in her home. And, as I was listening to other people testify, I know some issues came up about, who's qualified to give care. Actually, this individual would be. He's a blood family member. I do not know this individual's income, but in our bill, the caregiver can have an individual adjusted gross income of $50,000 or less. So that would speed that he would if his I don't know his criteria. If he met, that's where he'd be. My client or my the woman she's not my client. I visit her as a congregational member. But, you know, someone in her health care profession, namely a a doctor, a PA, or an APRN, would say that she has these deficit deficits, and she qualifies as an eligible family member. And then if her son qualifies under the income level, he's an eligible family caregiver. So there's your fiscal note. And, you know, you're just hearing stories repeatedly about how we we as caregivers will go to any lengths to keep our individuals, our the people we love, safe and secure in their home, and you don't think about the money until after the fact. And so I think anything that we could offer and, what's I'm looking at the legislation here. We're looking at offering $2,000 as a tax credit is from the legislation that I'm reading. So let me stop there and offer myself up for any questions. And I did wanna offer my thanks to all the members of the committee and anyone who's permitted submitted testimony.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you, Lee. I, just lost my godfather and the only uncle to Louis Vatti in November, so thank you for your testimony. I don't see any questions, so have a great day.

[Jan Kritzman]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Next is Ken Kollemeier. He is online as well.

[Rep. Bill Pizzuto]: Is

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: he? Yes.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Ken, if you can hear us?

[Ken Kollmeier (Aging advocate, Farmington)]: Just so I can hear you. Now can you hear me?

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Yes. I can.

[Ken Kollmeier (Aging advocate, Farmington)]: Okay. I I was on mute. Sorry about that. So dear senator Hakadol and representative Fortier, my name is Ken Kollmeier, an aging Farmington resident, and I respectfully do not support proposal h b five three zero four as written. So how can we resolve the long term care insurance crisis? For four years, I and colleagues, Jan Critzman and David Schwartzer, who you heard from, have invested hundreds of hours of precious time. Becoming educated about long term care insurance, networking with policyholders, attorneys, insurance brokers, local politicians, legislators, and state officials and employees, and following the facts. Locating peers who are negatively impacted. Wow. Our stories are more alike than different. We all seem to be inappropriately ashamed for being duped. Offering constructive ideas to responsible leaders possessing power and passion for positive change, we dialogued with the aging committee when the insurance and real estate committee showed zero interest. Our advocacy group kept its promises and conducted its business with integrity, professionalism, and total transparency, building credibility. Our advocacy group proactively constructed a fair and meaningful four part budget neutral built proposal that stops grossly unfair practices caused by insurer errors, poor regulatory oversight, and the 1989 loss ratio law CGS 38 a five zero one, which legalized the transfer of insurer cost overruns and premium shortfalls to policyholders. Ostensibly, policyholders are bailing out insurers. Crisis ownership rightfully belongs to insurers and their parent companies. Our proposal was shared and discussed with aging committee members but remains unused. Why? What did we do wrong? Nothing. But Connecticut system for unspoken reason is rigged leaving 100,000 mostly senior policy holders at risk. Evidently, there seems to be minimal authentic interest for senior vulnerability. Perhaps we don't check enough boxes to warrant action. Agent committee membership, please tell us why. Medicaid roles will soon overtax Connecticut resources. Ladies and gents, my confidence in the committee's recent bill proposal, HB five three zero four, is lacking. It seemingly repeats last year's ineffective offering which failed. Why is it better today? I respectfully ask you to redraft it using our four part bill proposal because it will protect us. If you choose not to, please be transparent and tell us why you can't or won't do something to protect us. An old proverb, if even one person like Amelia is treated unfairly and injustice has occurred that requires correction, most of you affirm that the system is unfair, you must have courage and act now. And as per representative Belinsky acknowledged, stopping a fair bill proposal just because, as we all know, is not acceptable. Thank you. Questions, please.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much, Ken, for your testimony. I don't see any questions, so thank you for your advocacy, and have a great day.

[Ken Kollmeier (Aging advocate, Farmington)]: Thank you. You as well.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Sandra Ferreira Molina, if you can hear me, you need to click yes to accepting to be allowed into the web. She did? Great. Hi, Sandra. Go ahead. The floor is yours.

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: Good afternoon, distinguished members of the Asian Committee. My name is Sandra Ferreira Molina, and I'm the policy and advocacy director for the Connecticut Oral Health Initiative, where our mission is to strengthen and safeguard access to quality, affordable oral health services for all Connecticut residents. I am here today to speak in strong support of house bill five three zero three. We are in a rare moment of consensus. Both supporters and those who oppose this bill agree that Connecticut faces an urgent crisis for homebound seniors and medically fragile residents. We all agree that as our population ages, this access gap will only widen. Where we differ is on the solution. I would like to clarify the distinction between scope and setting. Partners have suggested that this proposal constitutes a change in the scope of practice requiring years of formal study. I must respectfully disagree. A scope of practice change occurs when a professional is asked to perform a new procedure. This bill does not change what a hygienist does. It simply changes where they do it. It is important to note that the Connecticut Department of Social Services stands in support of this legislation. As DSS has confirmed, this bill simply adds private residences as another authorized setting under the public health registered dental hygienist framework. These professionals already practice and bill Medicaid for preventative services in schools, nursing homes, and behavioral health centers. Operationally, the only change for DSS would be adding a new place of service code to the policy. Connecticut law already authorizes experienced dental hygienists to provide these exact preventative services without a dentist on sites, in nursing homes, group homes, and schools. If it is safe for hygienists to clean the teeth of a medically fragile senior in a nursing home, it is equally safe to do so in the same senior's living room. A patient's front door should not be a legal stop sign that determines whether they receive care or suffer in isolation. Regarding the argument that this is an economic issue rather than a statutory one, we agree that Medicaid reimbursement rates must be addressed. However, we cannot use low rates as a reason to maintain a legal barrier that prevents willing providers from reaching the homebound. For a senior living with dementia who cannot be transported to an office, the economic visibility of a dentist travel is irrelevant if no dentist is currently coming. By removing this barrier, we allow licensed professionals to create viable pathway for care that simply does not exist. Further, we must address the concern of diagnostic oversight. Right now, the population we are discussing has gone years without seeing a dental professional. They are currently receiving zero diagnostic oversight. This bill does not separate hygiene from dentistry. It creates a bridge back to the network. A hygienist in the home acts as as a sentinel, identifying infection and oral cancers that would otherwise go unnoticed until they become 30,000 emergency room visits. HB five three zero three specifically mandates that these hygienists coordinate referrals to dentists for any needs outside their scope. Right now, ninety one percent of the homebound individuals receive home based medical care, but nearly fifty percent receive zero dental care.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: This bill me

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: that you've come to the end of your three minutes.

[Emily Kelly, RN (Director of Resident Health Services, Essex Meadows)]: If you Of course.

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: Is wrap

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: up your testimony. Thank you for testifying.

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: Thank you. HB five three zero three does not ask for a new government program or for extra money. It simply asks us to remove an arbitrary barrier. I urge you to support five three zero three. Let's ensure that aging in place in Connecticut does not mean suffering in place. Thank you for your time.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you, Sandra. And you have a question from refuse?

[Rep. Anne Hughes]: Thank you so much, madam chair, and thank you, Sandra. As a former group home manager, I'm just thinking through how this would so support our DDS population in group homes, settings, or even even seniors in home congregate, like, you know, clustered together. And I'm just wondering if you have thought through the implementation of that. How would you if you were supporting oral hygiene for more than one patient at a time in that setting, maybe it's a it's a couple, like both of the elder folks that have transportation and mobility issues. How would that work if you could see, you know, multiple patients in that home?

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: I would love to answer that question. I think that, I would definitely defer to the dental hygienist to really, talk through that out that process of how they would provide care to multiple patients within any given home visit. But I think it's a great question, and I think it's one that we we should definitely have. And I can certainly get a response from a dental hygienist for you.

[Rep. Anne Hughes]: That would be great. Just because, again, we struggle to keep our, you know, group home residents current with their oral hygiene is very, very difficult. And, I'm just thinking this could sort of revolutionize keeping current with their, oral health needs. Just throw

[Marie Allen (Executive Director, AgingCT – CT’s Area Agencies on Aging)]: it in.

[Rep. Anne Hughes]: Thank you.

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: Agree, and I appreciate the question, and I will get an answer.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. Go ahead. Rep Garibay has question.

[Rep. Jane Garibay (House Chair, Aging Committee)]: So I just wanna, get clarification. So the it is a dental hygienist, the same dental hygienist that sees me when I go into the dentist office, the same qualifications, working underneath a dentist. And not only will they already be able to go to schools and different things, but they'll be able to go into the home. Is that correct? Correct. Same dental hygienist, the same qualifications under the same guidelines, the same education, etcetera. Correct. Okay.

[Jan Kritzman]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yeah. I guess I'm left I'm left speechless. So

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: I see no further questions. So thank you for your testimony, and have a great day.

[Sandra Ferreira Molina (Policy & Advocacy Director, CT Oral Health Initiative)]: Thank you all.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Is Robin Anderson no. No. Not Robin. Okay. Next, we have Clayton Mansfield online.

[Clayton Mansfield (AARP Advocate)]: Good afternoon, distinguished members of the aging committee. My name is Clayton Mansfield. I'm an advocate for the for AARP, Connecticut, and I thank you for the opportunity to testify in support of senate bill two eighty five to create a fit family caregiver tax credit. My mother after my father passed away, my mother was living alone and largely independently in our family home, until one night when she had a devastating fall down the stairs from the 2nd Floor down to the 1st Floor of our home, and she wasn't found until for a couple hours, at least, till my sister came home from work. And so, I mean, thankfully, she recovered from her injuries. But my sisters and I sat down and said, we need a caregiving plan. So we spent tens of thousands of dollars to create a living space for my mother on the 1st Floor and invested in a ramp, grab bars, and other a new furnace and other improvements for her safety and comfort. And we share the burden. Willingly, we take it on to be unpaid family caregivers and be with her attending to her to her needs. But, unfortunately, because we have work and other commitments, we can't be there twenty four seven. So we have to employ paid caregivers to fill in the gaps. And we spent over $75,000 paying for caregivers when we were unable to do so ourselves, and that puts a serious has put a serious strain on our finances. So so I urge the committee to give you know, it was was said earlier by Natalie and other members of AARP. Those people in Connecticut like myself were unpaid caregivers and are struggling with the cost of caregiving to provide a tax credit to help help us cope with that burden and enable us to keep our mother, at home, where she belongs. So, I thank you for the opportunity to express my comments and support this bill, and I'd be happy to answer any questions.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much, Clayton. I don't see any questions, so thank you for your testimony. Have a great

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: day.

[Clayton Mansfield (AARP Advocate)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Next, we have Christy Gavam.

[Christy Koval (State Government Relations Director, Alzheimer’s Association CT)]: Good afternoon, senator Hockadell, representative Garebe, representative Balinski. My name is Christy Koval. I am the state government relations director for the Alzheimer's Association Connecticut chapter, and it is my pleasure today to talk a little bit about our support for Senate Bill two eighty five, which is an act providing a family tax giver tax caregiver tax credit. As we know, Alzheimer's disease is on the rise. Age is the biggest risk factor for developing Alzheimer's disease. Right now, we know there's about eighty thousand Connecticut residents who are living with Alzheimer's or another dementia with about one hundred and thirty thousand caregivers. That's here in Connecticut. And we know that for our dementia caregivers, fifty seven percent are reporting that they have to go in late, leave early, or take time off to fulfill their caregiving duties. And one in five have to reduce their hours of work. And so we know that on average, people who live with this disease, it's four to eight years, but it can be upwards of twenty years. And in that time, families will do anything. You know, they will bring in supports in the home on average. Dementia caregivers provide about thirty hours a week of of care, but then it's the other services that they need, transportation, adult day services, home care, those types of things. And so we know the financial burden is can be tremendous. And so we really want to emphasize that, this bill can provide some relief, to the dementia caregivers, particularly since there is such a high percentage of folks and families who are caring for those, with, Alzheimer's disease or other dementia in the home. So, I am happy to answer any questions. And it's also just worth noting that the Alzheimer's Association does support a national bill, in this regard as well. It's called the Credit for Caring Act, and AARP is one of our sponsors. So, we're happy to support this bill today, and I'm happy to take questions.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much for all you do.

[Rep. Mitch Bolinsky (Ranking Member)]: Are there any questions?

[Betty Marafino (President, CT Alliance for Retired Americans)]: Ditto.

[Rep. Mitch Bolinsky (Ranking Member)]: Yeah. Thank you for everything that you do. Yeah.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. Thank you. Have a great day. Is Matthew Barrett online? There he is.

[Matthew Barrett (President & CEO, CT Association of Health Care Facilities)]: Hi. Good afternoon, senator Harkendell, representative Garo Bey, and members of the agent committee. My name is Matthew Barrett. I'm president and CEO of the Connecticut Association of Health Care Facilities, and I'm, grateful for the opportunity to testify on, two bills on this afternoon's or today's, public hearing agenda. I've submitted written testimony on both bills. And then with your permission, I'll move forward summarizing, beginning with Senate Bill two eighty eight, an act concerning the Department of Social Services recommendations regarding exceptions to the nursing home bed moratorium, nursing home resident data, and nursing home reimbursement rate caps for related party employees. Section one and two of the bill express or provide for a limited opening of the nursing home bed moratorium, which we support. And our written testimony recommends a number of additional policy ideas that we think are consistent with the commissioner's ideas in the bill and leave those in our written testimony for your consideration. Section three, we're opposed to imposing controversial extrapolation methodologies on nursing homes, and we think it will be unfair and inequitable to do this at a time when even the current acuity based payment system is only in its fourth year. And in just four months, 07/01/2026, we're moving forward with a major overhaul of it in the implementation of a PDPM revision to the system. And so for those reasons, we don't recommend an extrapolation, methodology be methodology be imposed at, at this time. Finally, on the bill section four, we continue to be concerned that the provisions undermine how the Medicaid rates must reflect the results of a collective bargaining agreement. And I wanna say that I do appreciate that, this morning, deputy commissioner DSS's deputy commissioner clarified the agency's intention to honor the results of a collective bargaining agreement, and they were only looking to disallow the costs of salaries when they are in excess of what the collective bargaining agreement provides for. And we would support that as a concept, but we think the bill, as drafted doesn't align with that ex expressed intent. And so we ask you to review, the language specifically, in that regard. I try to, or I often, recommend substitute language, but that law has been on the books for some twenty something years, and I didn't wanna tinker around with it too much. But I'm happy to help, you know, going forward if, if you'd like my further input on that. Next, Senate Bill two eighty nine, an act concerning funding of the quality metrics program for nursing homes. This legislation implements a range of policies related to the 07/01/2026 rates for nursing homes as proposed in governor Lamont's state fiscal year '27 midterm budget adjustment now before the Appropriations Committee. And again, we've submitted very, extensive written testimony on this comprehensive bill. But I did want to, note right away that the budget adjustment, indicated by the governor in his announcement on February 4, said there was going to be an inflationary factor built into the rates. But Senate Bill two eighty eight doesn't have language to implement that, so my testimony includes an inflationary adjustment provision that we would offer as a recommended substitute on the bill. And I also wanted to take the opportunity to warn the committee that the budget proposal also in Senate Bill, two eighty eight indicate, the potential for enormous reductions in the rates to some nursing homes. Much more information is needed to evaluate this issue, and DSS has committed to providing rate models and calculations to the nursing homes, and I think also to the legislature, but it appears that the proposed reduction could mean an over 5% rate cut to some nursing homes. That would amount to almost a $500,000 reduction in rent Medicaid funds. And so we think significant changes.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Sarah, you've you've come to the end of the three minute allotment. If you could wrap up your commentary.

[Matthew Barrett (President & CEO, CT Association of Health Care Facilities)]: Yes. Thank you so much. And so we think significant changes are needed to to senate bill two eighty eight. And thank you so much for the opportunity to testify, and I'm happy to answer any questions you might have.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. I don't see any questions, so thank you for your testimony.

[Andre Brel (President, Juniper Home Care)]: Have a

[Rep. Jane Garibay (House Chair, Aging Committee)]: great day.

[David Schwartzer (Newington; Long-Term Care Insurance Advocate)]: Alright. Thank you very much.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Is Andre Breaux?

[Andre Brel (President, Juniper Home Care)]: Yep. Yes. I'm here. Good afternoon. Good afternoon, senator and Jen Hocobel, representative Jen Garibay, and distinguished members of the agent committee. My name is Andre Brell. I'm president of Juniper Home Care. We serve connected goods agent populations through homemaker and companion services, personal care assistance, adult family living, skilled nursing, assisted living, meals on wheels, and four adult day centers in Hampton, Hartford, New Britain, and West Hartford. I'm here today in also represent Connecticut Association of Adult Day Services, and I'm in the strong support of raised house bill number fifty three zero five. Transportation is not an optional service for adult day centers. It's a foundation that makes everything else possible. Most of the individuals we serve cannot drive. Some rely on wheelchairs and require specially equipped vans and train drivers who know how to safely and medically, assist medically fragile adults. Transportation costs have been risen dramatically. Fuel, insurance, maintenance, vehicle replacement, and wages have all increased. Wheelchair accessible vans are significantly more expensive than they were just a few years ago. Yet transportation is built into the kept daily reimbursement rate that has not kept pace. In some cases, up to 20% of our transportation cost daily cost goes toward transportation. At at at at 20% of our daily rate goes toward transportation. I want to share one comparison that highlights the imbalance. If Juniper clients who use a wheelchair needs transportation to see a doctor on a day when they do not attend my center, the state may pay close to 200 for a single round trip ride, which is this amount is roughly double of what we receive for the whole day at the Dao Day Center. And this adult and this day includes round trip wheelchair accessible transportation. It includes two meals, nursing oversight, medication management, personal care, therapeutic and recreation programming, social engagement, and caregiver's respite not even mention the dignity and joy of spending time with their friends and friends and neighbors. And from the fiscal standpoint, adult day services are the most cost effective investment in the in our long term care system. From a human standpoint, they prevent isolation, delay institutionalization, and support families who are trying to keep their loved ones at home. The 10% increase proposed in the bill fifty three zero five along with annual cost of living adjustments is a responsible step towards stabilizing transportation funding and preventing access I'm sorry. Preserving access to community based care. The deal is not about expanding car services. It's just about sustaining them. On behalf of Juniper, Home Care and family, we care about on behalf of Connecticut Association of Adult Day Services that include 28 members. This we are respectfully urge you to support bill fifty three zero five. Thank you for your time, and I'll I'll be happy to answer your questions.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you so much for your testimony. You have a question from rep Garabay.

[Andre Brel (President, Juniper Home Care)]: Thank you.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Good to

[Rep. Jane Garibay (House Chair, Aging Committee)]: see you, Andre.

[Andre Brel (President, Juniper Home Care)]: Nice to see you. Nice to see you.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: You to me.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Yeah. Can you tell us how much do you receive for someone attending the adult day center?

[Andre Brel (President, Juniper Home Care)]: This yes. Thank you for your question, Jane. And you I have to I have to admit you are an expert at adult day. I think you asked me this question, but you know the answer. You just want everybody

[Rep. Jane Garibay (House Chair, Aging Committee)]: I don't know the answer, Andre.

[Andre Brel (President, Juniper Home Care)]: You you're an expert. You know a lot, but I appreciate this. The answer is about $102, and thanks to you and your colleague and the whole legislature and department of social services, we just got a increase on January 1 of 4.9%. And it it's become it means our daily rate now for medical model adult day center is $100 a $102 with change.

[Rep. Jane Garibay (House Chair, Aging Committee)]: So you get a $102, give or take a little bit. What services are provided at an adult day center?

[Andre Brel (President, Juniper Home Care)]: Well, it's a it's it's a better service. If you you if you're ready to listen, I can give you let's start from this transportation. That's why we are here, and that's why I support this bill. The transportation is included in services. Nurse supervising with medication management and any other personal care is included. Two meals are included. Recreation services are included. Respect for their family members who are can go to work or can do go to school while their parents or grandparents at at the day center is included. The socialization, the recreation, the dignity of the being with friends and enjoys their life. This is all included in adult day adult day service during the day. All those services.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Okay. And I had another question. Just give me a second. So all this is included in that $9,100,102

[Andre Brel (President, Juniper Home Care)]: $102. Yes.

[Rep. Jane Garibay (House Chair, Aging Committee)]: A $102. Yes. All this is included. Don't you also have a nurse on staff at each adult day center?

[Andre Brel (President, Juniper Home Care)]: Absolutely. NURS NURSING is for for medical model adult day services, NURSING can stop is mandatory. And NURS usually is not just supervised services. They also provide medications as doctor doctor prescribed medications. But they also monitor our our our they monitor our clients. And this is where is the prevention and where is the day daily observation plays dramatic role. Because how many times are nurses because they are trained, they know how to distinguish any kind of changes in our in our clients' behavior. They can prevent many dramatic illnesses. They can they can send, insist a doctor to see a client or change medications or assign any other services. Nusink supervision is extremely valuable and necessary. And if you compare in my early testimony, I compare, round trip transportation, wheelchair transportation. It costs it costs a lot of money. Just one nurse visit, unmitigated rate is over a $100. Just when the nurse visits someone at home, the state of Connecticut pays over a $100 for just one visit for renewals. But renewals is on staff full day at adult day, and rate is still around $100 for for everything we also provide. I think I think adult day is extremely, extremely cost effective services. I'm happy I'm happy you, as a as a chair of of aging committee realize this, and and I know your colleagues. I know mister Balinski. He's he's

[Matthew Barrett (President & CEO, CT Association of Health Care Facilities)]: very,

[Andre Brel (President, Juniper Home Care)]: very big supporter of us. But but this transportation the transportation costs so much. It's it's we we just crying for help because it's literally becoming unsustainable for us to keep transportation included in the case. That's why this 10% and cost adjustment will go big, big, way to help us at, at, adult day services, providers.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Right. So this meets one of our goals, which is to allow people to choose how they age, where they age, etcetera. So this allows a person to stay at home, especially with family. But, again, we all have to work nowadays both, you know, moms, dads, kids are work. Everybody's working, so allows them to stay home. And if it's a $100 a day and I'm rounding it off, that goes to $500 a week, which is $6,000 a month, which is $70,000 a year. And I'm just trying to make the point. Personally, I think this is quite the bargain for a very safe place safe and happy place for people to age that choose to do so. Am I correct with those figures approximately?

[Andre Brel (President, Juniper Home Care)]: Yes. Your math is fantastic. It's absolutely it's it's maybe overall, maybe 70,000, 60,000 sounds like a lot of money, which is extremely a lot of money. But everything is comparison. We just we just months ago, we received we received rates average rates in Connecticut home care services, which include homemaker companion and nursing services. And it includes also nursing home being rate. And you you know how much is for it is now average nursing home rate on private. It's close to $700 a day. When I saw these numbers, I was even I am I am all my years, twenty over now it's I would say over twenty years in this business. I I when I saw these numbers for the nursing home private rate daily, I was surprised. But but it is what it is. And when you look at the $100 a day for a doll day, which is include many companies of other services, very inclusive, it becoming really, really bargain. And we need to keep it. We need to, preserve it, and we need to, like I said, not even increase, but at least to sustain this industry.

[Amelia Smith (CT Alliance for Retired Americans Board Member)]: Thank you.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Perfect. Any questions? Thank you. Any other questions? Seeing none, thank you so much for your testimony. Have a great day.

[Andre Brel (President, Juniper Home Care)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. Next, we have Kim Sander. Hi, Kim.

[Kimberly Sandor, MSN, RN (Executive Director, CT Nurses’ Association)]: Hi, everybody. Good afternoon, Senator Aucadell, Representative Garibay, Senator Huang, Representative Balinski, and all the distinguished members of the aging committee. Thank you for the opportunity today to speak in support of Senate Bill two eighty seven, an act requiring home health aid agencies providing certain PPE to home health aids and an opposition to five two nine nine, an act allowing trained assisted living aids to administer medication to assisted living residents. The testimony our testimony from the connect nurses hasn't been uploaded yet, so I just want it in case you were looking for it. It's not there, but it will be incoming. So hi, everybody. My name is Kimberly Sandor. I'm a nurse, and I'm the executive director of the Connecticut Nurses Association representing nurses across all specialty areas and practice settings. Senate Bill two eighty seven, an act requiring home health agencies to provide PPE to home health aids. Quite honestly, I was a little surprised it wasn't a thing already. Since the 1980s, standard precautions have been out there to protect not only the caregivers, but also the patients when it comes to blood and body fluids. Our testimony will include stuff from the CDC about, you know, each patient interaction is to look at their potential exposure. But just the very nature of home health aide and patient care assistance, doing bathing and toileting and feeding puts them right in that space. So we wholeheartedly support that. And don't think any of us would be asked to, you know, bring a desk or a computer or, you know, chairs to work. We wouldn't expect them to bring their own supplies either. Our opposition 25,299, which is an act allowing trained assisted living aids to administer medication to the assisted living residents. It's a little complicated. We deeply value the care provided in assisted living and the care that our older adults could need and what we can do to support them to be as independent as possible. We highly value the healthcare team that works together to provide this care. But, you know, it's our understanding when we've talked to nurses that work in the assisted living facility is that there's already ways that they support and do medication

[Rep. Jane Garibay (House Chair, Aging Committee)]: administration where the nurse is not involved

[Kimberly Sandor, MSN, RN (Executive Director, CT Nurses’ Association)]: in every administration of medication. Some medications that the patients aren't able to give themselves. Oftentimes, when a patient isn't able to do things themselves, those patients have private care providers that are caring for them. I know that you have received multiple pieces of testimony from some of our educators who can really go into what goes into medication administration and why nursing takes it so seriously. But I just wanna bring up the piece about delegation. You know, everyone throws it out there. Well, you can just delegate it. Well, delegation is actually a very legal thing. It's not just, oh, you know, like delegating your chores or delegating something at at at work. It is there's five rights to delegation, and they are the right task, the right circumstance, the right person, the right direction, and the right supervision. And that means that not everything can be delegated. Not everything all the time can be delegated and that the nurse must evaluate the person's skills and abilities to do it as well as the patient's appropriateness to receive the medication from somebody else. So that really needs to be thought about. There needs to be policies, training, pieces in place for that. We also understand that many as needed medications, there's already a plan in place that allows for swift administration of those medications. I also just wanna highlight just what our previous fellow said about a nurse's presence. When a nurse goes into a room and may may be doing a quote unquote task that seems to be just administering medication, But during that interaction, they're assessing somebody's color, the color of lips, their ability to hold a conversation, their respiratory rate, their ability to hold you know, use their breath during that time. How is there a mental alertness? Has there been a change since the last time? And the interaction, it's important, right, because they need their medications, but there's so many other things happening in that point. And I would hate it to be just distilled to that. You're you

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: have allotted your three minutes. If you could please wrap

[Kimberly Sandor, MSN, RN (Executive Director, CT Nurses’ Association)]: up just a moment. Thank you. Thank you. And I'm also just like to say, you know, I'm happy to meet more. I know that, this came up last year. We unfortunately, the timing of this was really hard for our, our assisted living folks with the storm coming and then yesterday, and everything's been a little hectic over there in that world that we, you know, weren't able to dive in and include everybody that wanted to submit testimony or provide information. But, you know, it's it's all the pieces around it too that make so much, so much of a difference. So we're happy to continue talking and working on it so we can get to a place of support.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thanks, Kim. You have a question from Rep Fortier. Sure. Hi.

[Rep. Mary Fortier]: Hi. Thank you, Kim. And I do appreciate your concerns. I did wanna ask. We had had a similar bill for nursing homes

[Jan Kritzman]: Mhmm.

[Rep. Mary Fortier]: In the past, and I, quite frankly, cannot remember whether that passed or not. I guess what I'm asking is if that passed and we are doing this kind of limited medication under the supervision of a nurse by a CNA, how is it working in nursing homes?

[Kimberly Sandor, MSN, RN (Executive Director, CT Nurses’ Association)]: So I I don't believe it did pass. I think Okay. Senator Hockadell could confirm that. And we know that there are medication administration by unlicensed assisted personnel in different state agencies. It does it does happen out there. But there are many pieces of protection and layers that go into that. You know, again, you know, Xanax and Zantac can sound very much the same, but they're completely different. One's for heartburn, one's for anxiety, right? A generic name and a brand name Lipitor and atorvastatin, very, very different. And you would hate for someone to get that medication twice because it wasn't noticed. So the policies and procedures and the way medication is dispensed, the way it's put out there, you know, how is it going to happen is is is just as important as being able being able to do it. And so there's it's so much more than just handing the pill, I guess, is what I'm saying. And this doesn't really the proposed bill doesn't really have any of that other stuff built into it.

[Barbara Monk (AARP Volunteer, Family Caregiver)]: Okay. Thank you. Sure.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you. I don't see any other questions. Thank you for your testimony, Kim. Have a great day.

[Kimberly Sandor, MSN, RN (Executive Director, CT Nurses’ Association)]: Seeing everyone.

[Rep. Mitch Bolinsky (Ranking Member)]: You too.

[Jan Kritzman]: Bye bye. Bye bye.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: And our last speaker. I I hope I'm pronouncing this right. Yi Wei Bin?

[Yiwei Bin (Graduate Student, Yale School of Public Health)]: Yeah. Hi. So good afternoon, Senator Hockdale, representative Gary Bey, senator Huang, representative Bolesky, and all the distinguished members of the agent committee. Thank you for the opportunity to speak today. So my name is Yvei Bin. I currently live in New Haven. I'm a graduate student in health policy at the Yale School of Public Health. Through my graduate research, I have examined service gaps in community based long term care and found that transportation consistently emerged as one of the most significant structural barriers that affecting the enrollment rates and service continuity, particularly for all the adults who no longer drive and for those living in rural areas with limited transit options. Thus, I'm here today in support of House Bill five three zero five, an act concerning auto day care transportation. This bill will increase auto day reimbursement rate by 10%, specifically to address the transportation cost and will establish annual cost of living adjustments moving forward. In short, it wants to help stabilize a system that is already on the stream because connected cars of the other population now represent nearly one fifth of the state's residents and that share continues to grow. At the same time, other day service capacity in the connected car is already well below the national average. In other words, demand is increasing while the supply is already constrained. And currently, the rising cost plays providers under significant physical pressure. Transportation now accounts for nearly one third of the per day reimbursement rate. Providers must observe rising causes for accessible vehicles, gas, and workforce with a fixed restructure. Although a 98.6% rate increase was implemented in 2024, the inflation and transportation expense have outpaced the adjustment. If rates continue to lag behind operational cost, providers may reduce routes, limit enrollments, or face closure. Because transportation is often the primary access point for participants, this reduction directly shrink service availability. In a state with already limited capacity, further contraction will undermine agent in place effort and shift cost more expensive institutional care. For this reason, I respectfully encourage the committee to support House Bill 5,305 to protect, provide stability, and sustain community based long term care. So thank you for your time and consideration, and thank you again for the opportunity to testify for this bill.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Thank you for your excellent testimony. I don't see any questions. So again, thank you, and have a great day.

[Yiwei Bin (Graduate Student, Yale School of Public Health)]: Thank you.

[Sen. Jan Hochadel (Senate Chair, Aging Committee)]: Is there anyone else who has testimony? Seeing none, we are adjourned. Thank you so much.

[Rep. Jane Garibay (House Chair, Aging Committee)]: Thank you, everyone.