Legitalk:

[Senator Matt Lesser (Chair, Human Services Committee)]: Good morning, everyone. Happy, Saint Patrick's Day. I'd like to call to order, the March 17, hearing of the Human Services Committee. This might be a new Connecticut record for the most people signed up to testify on bills in the Human Services Committee. We've got over 280 people, and it's a lot to talk about looking at a whole bunch of different issues. I wanna just make some announcements. This is a hybrid meeting. The meeting will be streamed on YouTube and CTN and is being recorded. Please have your mic muted if you are not speaking. Please do not use the chat function on Zoom as this is a public meeting. Please raise your hand on Zoom by clicking reactions and then raise your hand to be recognized. And with that, we have safety announcements too. Is that we don't have safety announcements, but I think I can do it by memory. If in the event of a lockdown notice, please take cover. The back doors can be used in the event of an emergency. If directed to leave the building, please do so and do not return until you are directed to do so by a safety official. And with that, I'll turn it over to my colleagues for any announcements any announcements from Representative Goldprest.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Just very impressed that you memorized the emergency announcement. Looking forward to today. Thank you all for being here.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, madam chair. Our rankings, any, open comments? No. With that, we've got, a lot to get to today. And first up in our docket is our good friend, commissioner Andrea Barton Ruge for the Department of Social Services. Commissioner?

[Speaker 2]: Good morning. Good morning.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Good morning, Chairs Lesser and Gilchrist, ranking members Perillo and Case, and distinguished members of the Human Services Committee. I am Andrea Barton Reeves, Commissioner of the Department of Social Services, and I'm pleased to offer remarks today on several bills of today's agenda. You've probably have before you our extensive written testimony. I do not intend to go through all of it because it is quite extensive, but I was hoping I could just have one moment of your time before we begin to give our testimony some context, if that's alright with you. Okay? So at the heart at its heart, our department is that it is a dedicated workforce of seven of 1,770 people committed to improving the lives of residents across the state. While we administer billions of dollars in programs okay. It's on and I'm I'm not sure what else to do. Should I use a different microphone?

[Speaker 4]: Leaning into it. I just

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Should I use a different one? You put ton on both. We could try that. Yeah. Let's get that a try, see if that helps. Okay. Is that any better? Yes. Okay.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: We're gonna shut the doors because I think that's causing some Okay.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: That's fine. We'll wait. In a bigger room. Yeah.

[Senator Matt Lesser (Chair, Human Services Committee)]: Please please continue. And so, sorry about the disruption. Yeah.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Oh, no. It's fine. I think I underestimated the, noise from the hallway. So while we administer billions of dollars in programs and we serve over a million people, it's the knowledge, skill, and compassion of the staff that makes these services meaningful and accessible to the individuals who rely on them. Our workforce brings together professionals from a wide range of disciplines, social workers, eligibility staff, autism case managers, policy analysts, data and technology experts, program managers, healthcare professionals, financial specialists, communication specialists, and customer service professionals, all of whom play an essential role in our agency's mission. We operate in a complex and ever changing policy environment and our staff must balance regulatory requirements with compassion and practical problem solving. We have been in many instances ahead of the curve and proactive in ensuring our state can be informed as prepared as possible for the major changes, especially those coming from the federal government. We are at the stage of technical execution of major changes of HR1. We have generally excelled as technical execution and changes. We're one of the top performers nationally during the public health emergency unwinding with higher ex parte and overall renewal rates. We also moved faster than any other state to line up federal funding for HR1. We focused our work on our clients and we were the first state to be awarded federal funds $59,000,000 covering over 90% of our technology costs. And our application was so stellar that our federal partners have asked us to provide guidance to other states in preparing our applications. We are asking for support that we need to be successful. More meetings and reports and additional levels of review and approval can slow the sorely needed flexibility we need to be responsive. We are committed to continuing dialogue in the established spaces for engagement, including MIPOC and subcommittees and informal channels, which are demonstrated by the many members of the House and Senate with whom I've had the pleasure of communicating regularly on both sides. We welcome accountability, but we must also have the flexibility to be responsive and responsible in our stewardship of the Medicaid program. Thank you. I'll start my testimony with Senate Bill three, an act concerning health care affordability. Section four of this act establishes a Connecticut option within the Office of Policy Management for creating a new health coverage. And our agency is required to consult on the development of that option and implementation. We while we appreciate the intent and goals of this Connecticut option, our suggestion respectfully is that we have more time to research and study this opportunity before the implementation process can begin and recommends language included in the governor's bill, House Bill fifty-forty one, which ensures a thoughtful and deliberative approach to this process. Sections five and six require the Department to establish a basic health program and a basic health account. While these sections certainly have laudable aims to reduce the uninsured rate, the bill's timeframe and process are quite quick. So despite its name, the basic health care problem is actually quite complex, and it needs thorough analysis before we can begin this work. So we respectfully ask for more opportunity to explore that. It is certainly an option for states under the Affordable Care Act that is intended to provide coverage for individuals in Medicaid with up to with incomes up to 200% of the federal poverty level. Thorough analysis would be necessary to determine the anticipated policy and fiscal impacts upon establishing a basic health program for Connecticut. And these extensive operational requirements come at a very challenging time, which is why we're asking for more opportunity in order to be able to explore it. Section 10 of the bill establishes a hospital finance assistance program. While the department supports the goals of enabling more access to health care services, it is funded through the disproportionate share hospital payments under section 11, which I will speak to in just a bit, and therefore we have some concerns. Section 11 does have some additional operational requirements on the department and undefined costs that are not included in the particular bill. Again, the bill doesn't include any criteria or budget for these proposed payments. The essence of my testimony in this particular section is that the circumstances under which disproportionate share payments goes to hospitals are highly regulated by the federal government. So for in order for us as a state to be able to provide our own means in which we would do that, could lead us into a circumstance where there is a conflict between the state and the federal government as to the way in which dish payments are actually calculated and provided to hospitals. So what we were asking for is further conversation and dialogue because we do have concerns about this.

[Senator Matt Lesser (Chair, Human Services Committee)]: Commissioner Yes. I I I hate to interrupt you again. Nothing that you've done wrong, but I do wanna acknowledge, we have a banner crowd here today. And so our clerk, in response to the, crowding here has secured an overflow room for folks who are looking for a little more, space and a room to sit down. So if you are interested, Room 2 C around the corner is available as an overflow road. And we will also will be, I I believe we'll be live streaming it there. And if you're signed up to testify, you can certainly come over as we get closer to that. So room What's that? Yes. The other thing that might be helpful is I know we've got a lot of DSS staff, and maybe to help free up some space, if it's okay with them, we could invite them to come up and sit sit up here at the chairs up here as well, just to in the interest of crowd management. Like, Commissioner, you are a pro at rolling with the punches, so thank you thank you for your patience. Moving.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I was ready to Yeah.

[Representative Kurt Vail]: I was

[Senator Matt Lesser (Chair, Human Services Committee)]: like, get out of here. No. We got you're not we're not letting you walk easy. No.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I I would show up in the other room. I wouldn't just disappear. It would it would actually be okay. You'd be alright.

[Speaker 6]: So so

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: You just know that you have enough I'm so sorry.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yeah. So no. I was gonna say so so yes. Again, it's two c for the overflow room. If folks are looking for if there are not enough seats here, two c is, available for the folks here.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So I'll move on to, section 11 of senate bill three. The, the challenge that we have here is that it references appeal rights under Connecticut General statute 17 b 60, which are actual rights for individuals Okay. I'll stop again. Here we go.

[Senator Matt Lesser (Chair, Human Services Committee)]: Please continue. We're k.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: See what's going on. Are we good? We're okay? Alright. Great. The it's not necessarily the process that is designed for hospitals and as defined under section 11. Section 12 speaks to a safety net mitigation working group. We we would just like some clarification, perhaps an an opportunity to have some conversation about the proposed working group and its specific purpose and how we use it to coordinate and operationalize federal requirements while ensuring federal compliance. Thank you. Section 13 speaks to consultation with DOL, a direction to submit to the committees of cognizant's monthly reports related to the implementation of federal work and community engagement requirements and the specific contents of those. We, are already actually working quite closely with DOL in the work that we are doing as long as well as with other state agencies. We are we appreciate the need for the transparency. And what we're asking for is for the the the opportunities that we already have, which are Maypoc, subcommittees, and other places to present those that kind of information because we have a finite number of people who are actually working on HR one right now. So pulling away from them to present to to prepare the reports would be very, very challenging for us. But we understand the need to have information, and we're more than willing to participate in that. There are dozens of staff that work on, HR one every day, and the the deadlines are, unrelenting and they cannot move as far as the federal government is concerned. Section 14 stipulates that the OPM secretary in consultation with the department has to submit written notice to the committees of cognizance whenever there is a federal statute regulation rule or administrative guidance is enacted or adopted. We are particularly concerned about what we just think is really the impracticality of this because this happens every single day. There is something that comes from the federal government that either clarifies the work that we're doing, provides new guidance, provides new mandates. It is it is, all that we can do to be able to keep up with it daily. And I think, to provide, written notice of whenever federal statutes change would would not quite frankly be something that we would be able to to do. Section subsections a, b, and d stipulate that for the purposes of administering the public assistance programs, including Husky and SNAP, that we have a data sharing that is maintained by other state agencies. This one is actually similar to another section that also speaks to data sharing. And I would say that at this point, we actually have very robust memoranda of understanding between departments for data sharing. This is not one of the challenges that we are facing. While we appreciate the statute trying to address this issue, it's it's not one of the issues, that we're actually con contending with as it as it relates to the work that that we are doing. So I will move on to section 16, which is medical frailty. This section requires the department to establish a state definition of medical frailty for the purposes of exemptions from work and community engagement requirements. The challenge we have here are several. First, the statute, I would say the federal regulation that governs medical frailty is pretty rigid. And what we can do is work with that particular statute. Let me step back a bit. We've also been given a very clear, unequivocal directive from our federal partners that there is no other way to do it other than what's defined in the statute. So ours has to be a flexible way of taking the language that already exists for medical frailty and finding ways in which we can define that for as many people as possible so that they can fit into the categories that are federally permissible. If, again, as I mentioned in a previous, piece of my testimony, we have a conflict between our federal law and our state law, that is highly problematic for us because we would have to reconcile that. It might be irreconcilable and we would have to go with the federal definition of medical frailty. I will say, and I see that Deputy Commissioner Hadler is here to my left. We have been working on this constantly. We have been talking to other states. We have been working with the Yale Tobin Center, and we've been speaking with, all of the trade associations that manage this area of human services to find out what other states are doing in terms of managing the definition for medical frailty. So we are deeply engaged in this. We're happy to bring back what we're finding. But in terms of a statutory definition, there are some challenges to that. So but we thank you, for, the proposal. They make sure that I move on to section 17. Section 17 establishes a new process to require the department to submit any proposal for change to fee for service Medicaid to managed care payment model to the committees of cognizance. The first thing that I will note here is that Section 17 is in many ways duplicative because the current statute already provides for significant legislative oversight for major changes to the Medicaid program. As we know, Connecticut General Statute 17 B eight requires our department to submit any Medicaid waiver and any Medicaid state plan amendment that changes program requirements that would have required a waiver, but for the Affordable Care Act. So this Care Act. So this the oversight that this particular part of the, proposed legislation proposes to add actually already exists in statute. And so it largely duplicates the sections that already exist. And we have again, with any major change that may come to the program, we are obligated to come before the legislature to make that happen. Moving on to Senate Bill four seventy nine, an act concerning the oversight of federal fund applications. This bill actually requires the department to submit any application for rural health transformation, including grants to implement eligibility related systems modifications. We are thrilled that our state received $54,000,000 over the baseline amount of money that every state was guaranteed under the federal, under the federal program known as the rural health transformation grant. The challenge with this particular statute is that those deadlines are hard and fast and they move quite quickly. So as an example, the department submitted our application on November 4. The application itself was issued on September 15, and it had a November 5 due date. Not only was this time period compressed, but CMS And and And and, what is being proposed in this session would actually have a deleterious effect on our ability to be flexible as federal changes come about. CMS has approved all of the applications for every state and based on the grant sorry. Based on the structure of the grant and the federal statute, as well as the funding opportunity, it's a five year grant as we know, and they have informed us that the state let me read again. CMS has informed states through official communications that approved projects must be carried out within approved budget limits and the state cannot propose new or substantially modified approved projects unless CMS specifically seeks some adjustments. So it's very clear from CMS's direction, they are the ones that are in charge of how this process works. We're happy to bring more information as we're working on these, as you mentioned, through Maybach and and other for where we can speak very directly on what it is that we're doing. Senate bill four eighty, which is an act targeting fraud, waste, abuse, and corruption, actually directs us as an agency to issue chip cards as opposed to the cards that we have now. I will say that we share your concern and deep consternation around the amount of fraud that is happening not just in Connecticut, but around the country. It is it is disturbing. It is actually happening in a manner that has brought has brought the issue to the attention of the federal government and also, you know, to many states across the country. What we've done within the resources that we have available is issue a new security feature that allows members to lock their EBT cards in very much the same way you can lock your debit or credit cards. And we've had a number of people take that take up that issue. Members can also block any out of state transactions if they don't intend to leave the state and they they want safety. Our primary concern around, this particular issue is cost. Right now, our EBT cards cost about $2 per card to print and to ship. The the cost is to switch to a chip card would be an additional $3. So it would cost us about $5 per cards per card, which doesn't seem like a lot, but we have 204,000 households that have that now receives that benefits. So we anticipate that this will be a $3,000,000 cost for vendor costs in order to support chip cards and another million dollars to actually replace all the cards themselves, and that does not include the the the carrying costs year over year of administering the program. And it would take us, we believe, about a year, maybe perhaps a bit longer in order to have these systems changes fully implemented. So in the first year low, we're looking at about $4,000,000 in an annualized cost of about $621,000 Moving on to Senate Bill four eighty two and our concerning legislative oversight of Medicaid waivers. Again, we we reference the, Senate, the the sorry, the the yes, the the state bill that provides the human services and other committees of cognizance the ability to oversee and approve all waivers and changes to the Medicaid program. This would this particular section would lead to additional oversight. We support transparency and oversight, and we have done that. And I do know that the legislators, we're quite proud of this on both sides of the aisle, can reach out to us at any time with any questions that they might have. But we do believe that the process is being proposed in this statute would be administratively prohibitive. Given how quickly we need we often need to move. It would result in potential lengthy delays for the submission of spas, and it would require significant staff resources to implement. Again, 17 b eight requires us to submit all spas and waivers to the legislature. So there's already a significant amount of oversight. Moving on to senate bill four ninety eight, an act protecting paychecks for personal care attendants and expanding public access to state programs. This section requires, section one requires the DSS commissioner to compile and publicly post on its website and submit to the Human Services and Labor Committee quarterly reports beginning with quarter 06/30/2024, with the most recent completed financial audit statements of the fiscal intermediary. And that personal attendant timesheet reports, budget, customer service, call centers are all to be listed on the website. So I will say this, that we strongly agree that participants who are enrolled in the program that utilize the services of the fiscal intermediary, they rightly deserve and respect the entity to be accessible, responsive, accurate, and highly performing in all of those areas. And we do know that those expectations have not been met. We share those expectations of high performing standards, but the public quarterly reporting, provides some challenges to us in in that we want to continue to try to do what we can. Let me say it a different way. There are several concerns. I will just actually read from my from my testimony. One of them is the restriction on the department's ability to, amend the performance measures as they're needed. That's that's the first one. The second is a risk of the interpretation of the, the risk of the misinterpretation of the data, which would be we would be available to try to help with that interpretation. What we're also concerned about is we very much admit that our current fiscal intermediary has a significant number of challenges. We need to continue to work with them, however, because in the absence of a fiscal intermediary, we are not able to actually support our Community First Choice program because we need that we need to have a fiscal intermediary in order to in order to do that. What we would propose instead is that we continue to work with our partners, many of whom are here in the room, 1199, and we have been working very closely with them to try to resolve some of the issues that we've had with the fiscal intermediary. And we're continuing to be committed to working with them as we try to move to a new fiscal intermediary to address many of the concerns that they've raised and for us to make sure that they are not the ones that pay the price for what the fiscal intermediary has not done. Moving on to Senate Bill four ninety nine and act concerning Medicaid rate increases. The Department appreciates the intent of this bill and a significant interest and planned investment in the Medicaid program, our concern here is that we have, as a state, invested in two very substantial Medicaid rate studies. And the this bill and another that I will speak to are outside of the the recommendations that have been made for the rate study. And specifically, and I will point to, Nicole Godburn, has worked on a specific plan that allows us to review provider rates on a regular basis. And we and with those with those rate reviews, we can determine, you can as a legislature with the executive branch and obviously with our budget analyst sorry, our budget department, the office of policy management, which of the reviews we have resources for and how those changes in their rates can be made. We certainly understand that there are providers that have not had rate increases in some time. We do have rate increases that I think we've received resources for in this last session, and we have recommendations around those rate increases. But working outside of the Medicaid rate study, first of all, would, would cost about well, let me say it a different way. The rate study determined that in order for us to make all of the adjustments to all of our rates, that would require an an additional $300,000,000 and that is just that is the gross share. And we that funding is simply not contemplated in the agency's budget or in the governor's budget. More importantly, though, what we're really looking for is a is a joint commitment to have a rational regular review of rates, rather than us having to be here with with one another, speaking session after session about what we should do and what we shouldn't do. I so what I what we would like to recommend is that we come together, we look at the plan that Nicole and her team has put together. We try to to create a process that has actually been created in Maine. It works quite well, where there is a committee that actually does a review of the rates, and we do that with partners at the table. And And then we make a determination as to whether or not we have the resources to do that. It's that or some other kind of process that can be followed that holds each of us accountable for what it is that we're doing and has some transparency for providers, which I think are all of the things that we were looking for and all the things that were called in the rate study. So for this reason right now, we're not in support of these of this particular bill, but only for the reasons that I cited that they're outside of the rate study. House bill fifty five sixty two, an act concerning various revisions to human services statutes. This includes let me just go to the end here. We urge passage of this legislation. Yes. So that concludes my verbal testimony this morning. We were very cognizant of the fact that there were a number of bills in front of you. There are many more that I know that have been proposed. We I really wanna be respectful of everyone who's here. This is the public house, the people's house. They deserve to have an opportunity to sit here. I feel grateful that I have a chance to be first, and it's only because of the job that I sit in. I'm no more important than anyone else. So I want to say my piece, be on our way, and open up more dialogue as we move forward. So I thank you for your time.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, commissioner. You may you may have said your piece, but you're not on your way. You're I understand. We have we have some questions for you. And and and first of all, let me just say at the outset that the Department of Social Services is in the eye of the storm. You are dealing with innumerable crisis, one layered after the other. We are, you know, being targeted by HR one, the federal legislation passed last year, which has slashed funding for food assistance and for Medicaid and caused innumerable headaches for all of us. And I know that you are focused on that issue, but also all of these other issues that we're looking at all at the same time. And I don't know how you do it because it's a lot. But there's a lot we have to figure out. And so

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Senator, do you mind if I respond to your comment? Just

[Senator Matt Lesser (Chair, Human Services Committee)]: No. Go right ahead.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Okay. So first of all, thank you for acknowledging the enormous amount of work that that we do. We we really do appreciate that. We spent about fifteen seconds feeling sorry for ourselves on July 4, and then the rest of our time was immediately redirected to doing the work that we needed to do, which is why in my opening statement, which, you know, I don't usually make, I really felt that it was really important to highlight what it is that we're doing and that the flexibility that we need in order to move quickly and to be nimble and to be responsive can be hindered by some of the the proposed legislation here. We we are across the country really regarded for the quality of our Medicaid program. We have a lot of improvement. There's there's no question about it. But even very recently, the governor of Minnesota, who we know whose program is really under, it's under scrutiny right now, we'll put it that way, said that he looked at a number of states who do Medicaid administration exceptionally well, and he named Connecticut three times publicly as to the work that we do. So I I know that there's room for improvement. I appreciate that. But I also am asking for the for the continued flexibility for us to be able to do all the work that we do so that we can continue to hold the reputation that we do nationally, to bring in resources to the state, and for us to be able to be held accountable in a way that doesn't hold us back from the critical work we need to do for the million people that rely on us every day. So thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, thank you, commissioner. And as you're responding to these federal changes, there are also long standing issues that we've had in Connecticut. Things like underfunding chronic underfunding of Medicaid rates that haven't been adjusted since, in many cases, since the nineties, more often since 2007 and issues like, PCAs that, where we we have an issue that is is been we've had issues before, but those are those crises don't go away just because we're dealing with new, new federal pressures. And I know you know that. Mhmm. Just, I have a I have a bunch I'm trying to figure out how to handle this because I have a ton of questions, but I also know that we got a lot of members on this committee. What I might do is actually just hand it over to my colleagues first and then see if some of my questions get answered, and then I'll come and pepper you afterwards. Representative Douglas.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Great. Thank you so much. Thank you, commissioner, and thank you to the team. I echo the remarks about just gratitude for everything your agency is taking on. So diving in, starting with senate bill three, section 13 with regards to work and community engagement responsibilities. Mhmm. I hear you. And I think there has to be a balance because I also think some of the conversations we need to have might need to be more private than public. Mhmm. But I, at this point in time, don't feel like Mapoc has been the appropriate venue.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Okay.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Because what I'm hearing from community partners who have a lot of came from the advocacy world, you know, a lot of experience and also a lot of resources and tools at their disposal

[Representative Kurt Vail]: Right.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Is that they have recommendations that I think could be very helpful. And I would love to see us be able to get to a place where there is more conversation going on, to inform how we move forward. Okay.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I think we can do that. So we had a group of advocates actually reach out to us and send us a letter and ask for an opportunity to speak. And we we did have a meeting and I think many of our members here, some of our senior team were on that call and they shared a a lot of their feedback, much of which we have taken back and incorporated in sort of the direction that we're changing.

[Representative Susan Johnson]: I

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: so representative, perhaps what we need to do, and we've done this before, is really have more sort of informal open informational sessions. So what we used to do, right, when I first got here, and it's it's kind of a practice I borrowed from paid leave, is that I would just schedule open forums. You could just come. Right? I we'd hold them in the morning, in the afternoon, after work. You know, I'd even impose on staff sometimes to do them on the weekend. That was never popular, but, you know so sometimes I ended up doing them because, you know, I'm the one that asked for it. So that's how that goes. And we would do that. And so we would invite people to just come in to those fora and to and to share their ideas and to share where we are, to share where because there was a lot of anxiety during that time because we were trying to build a new program, and it was the middle of COVID. And I found that it really helped to bring the temperature down. We are more than happy to bring that back. Well, we've never had it, but to bring it back here Yeah. To bring it back into DSS, which I think would then provide some predictability as to the ways in which we share information. It would not necessarily, to your point, be in a mapoque setting, But we and we can set a regular cadence for that. And I think that would be really helpful, and it was extremely helpful in paid leave. I'm happy to do that again.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Okay. Fantastic. I think that would be helpful. And then that also speaks to, for me, section 16, the medical frailty. You know, I just think these are places where if we're having some conversation to your point, people are then gonna know what each other's working on. I think right now, there's just a lack of It's

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: a gap. To understand. Yeah. And the gap is gonna be because we are just moving at a pace that is it's really indescribable how fast we have to go. But we don't want that to be perceived as leaving people out of the process. So I clearly hear you, so I think there's a way for us to fix that, and we will.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Wonderful. Okay. Senate bill four eighty. This is the snap. I see in the testimony and appreciate what it would cost to update I think senate bill four eighty. Did I get the number wrong?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: No. That's right. Snap.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: No worries. I'm wondering how much do we lose annually from snap fraud?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Yeah. It it well exceeds this number. I can get you the exact number. It well exceeds this number. I I will say though that it's not as if we're sort of throwing our hands up and saying, you know what, we offer the lock. Good luck to you. That is not what we're doing. We are actually looking within other, federal vehicles that we have. There are other funding vehicles that we have to see where we can put some dollars together to at least begin to work on this process. We weren't surprised to see this, and it's a it's a source of frustration for us as well. One of the worst conversations you can have with someone is for them to call the office, like one of our benefit centers, and say, my card's not working. And for us, tell them that their benefits were misappropriated and there's nothing that we can do. That's those aren't conversations we wanna continue to have. So we will I don't know. I think, DC, Barz, maybe you wanted to speak a little bit to that, about what we're trying to do.

[Chantal (Deputy Commissioner, CT DSS)]: Good morning. So we know that this is a problem Can you

[Senator Matt Lesser (Chair, Human Services Committee)]: please introduce introduce yourself?

[Chantal (Deputy Commissioner, CT DSS)]: I apologize. I just figured everybody knows me. Chantal Vars, deputy commissioner DSS. And what I just wanted to say is that we do know that this is a national issue. We know that it's crime rings. During our investigations, we do find that it is, you know, groups of fraud that is happening. It's not just an individual. We'll have, you know, maybe a 100 people show up to one of our resource centers and says that their SNAP benefits have been stolen. And so we are working really, really hard. We've tried to collaborate, with some of our grocery, organizations and the like to try and combat some of that, snap fraud. So this is something that is on the department's to do list as a top priority. And we are looking to secure additional funding within federal funding that we could probably take a look at how we could go about paying for something like this. But it is on our radar. We are putting putting a lot of resources into trying to be more proactive when this kind of thing happens. But it is very challenging when it's, you know, we know that it's a crime ring that is actually performing some of this fraud.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Just as I think it would be helpful at some point if we could know what is that total amount. And then I wonder also, can we use bonding to do the underlying fixes to the cards? Or are you saying the federal funds could potentially help with those upgrades?

[Chantal (Deputy Commissioner, CT DSS)]: We're looking for more federal funding in terms of fraud, fraud, waste, and abuse prevention across all of our programs.

[Speaker 9]: Okay.

[Chantal (Deputy Commissioner, CT DSS)]: And so that's something that we're looking to try and gain federal funding for under this administration, and something like this would fall under one of those safeguards.

[Speaker 10]: Thank you.

[Peter Hadler (Deputy Commissioner, CT DSS)]: Okay. I I think DC Handler I'll just very quickly hi. Peter Haddock, deputy commissioner at DSS. I've got the number for you just to give you a sense of of the scale of it. During the period of time in which the federal government was replacing the benefits when that was authorized for a period of time, we replaced $6,000,000 worth of benefits over a little over two years between 2022 and 2024. Yeah.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Wow. Okay. Thank you. Okay. I'll keep going. Sorry, everybody. Senate bill four nine eight. This is the the CPAs, the the issues with our systems currently.

[Representative Kurt Vail]: Yeah.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Could you talk briefly? What would you propose going forward? So there have been conversations, obviously, about folks not being paid on time. The other issue of an individual the individual who receives the Medicaid knowing how many hours they have, the CPA doesn't know how many hours that individual has. What are you if you can share, what are things you're thinking that we could work with you on going forward to improve the system?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I think we can work on all on all of those things. I may ask Christine to step in as well. The the way in which the program is currently working doesn't work for us, and it doesn't work for the PCAs. So we just wanna be really clear about that. We are not defending the way that this process is going because I don't think that's the responsible thing to do. I think that our, our fiscal intermediary needs to and I'm sure this person will come at some point and testify, so I, you know, I hope they have an opportunity to respond. Needs to continue to work on the improvements that we are asking for and that all of us need in order for the program to work better. So more transparency around the number of hours that an individual has, I think, is one of the things that we want to do. The ways in which we do that, I think, is really what we're we're being challenged by technologically. So if we just sort of have a baseline of what we think would be an ideal program, it's making sure that, clients have a clear line and an easy line of sight to figure out how many hours they have, how how many they've used in a particular time period, whether it's a month, a day, a year, whatever that time period is, and how many they have remaining. Then there needs to be a clear line of sight so that there's collaboration and coordination with their PCA so that there's you know, we don't have this cross communication that's happening. And then there also needs to be a way for us to reconcile this, easily, and people need to get paid on time. Like, those those things just need to happen, period. End of story. Now the question is, how do we get there? Is it having a a a better process with our fiscal intermediary? I don't think there's any question about that. And I've been very open and honest with, our partners at, eleven ninety nine that some of the processes that we put in place as a department in order to better manage monthly budgets and and I think in an effort to help our clients manage their budgets fell disproportionately on the PCAs. And that is why when I learned that that's what was happening, we pulled it back, made some adjustments, and those changes remain in abeyance to this day until we can fix the things that we that I just talked about. So that's what I'm talking about. In terms of the specificity of how we get from one place to another, I have some ideas. My team has some ideas. Other states have other ideas. Some some states use multiple FIs as opposed to a single one so that there's not a single point of failure. So we're and and we also are receiving technical assistance from the federal government so that we can get ideas from other states as to what to do. So as I sit here today, I have a clear sense of the vision that we want, how we get there. We're still working through that. But in the meantime, we're trying to do we are all trying to do everything that we can to minimize the harm that our current system is creating. And we clearly recognize that, and I'm trying to work on it as hard as we can. Okay.

[Representative Robin Comey]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Alright. And my final, senate bill four nine nine and then whatever the house bill is on Medicaid rates. Yes. I need I'll start with a statement. So Okay. Our Medicaid rates are a two pronged issue. It's about people being able to access the health care they need.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Right.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: It's also a workforce issue because our low rates are making it so people can't hire folks. They're losing staff. Turnover is impacting the care people get, and folks are moving to other states to work. I will also make the statement that I am not putting this on you and the department. I'm actually going to call out the governor's office. Last year, we allocated funding in an amount that was nowhere near what we needed based on the two Medicaid rate studies. And then that money was actually siphoned off to go to FQHCs who are vitally important and I support, but that wasn't the original intent. So you can probably tell I am frustrated, as much as I also respect the lobbyists who work in this building, to meet with folks daily about different provider types who need Medicaid rate increases is not also what we all wanna be doing. We know that there's a problem, and we know they all need to be lifted up. So a big piece of this is just us needing to invest more money, which, again, I know is not at your department's you know, you can't make that decision necessarily. You can make recommendations. Correct. I would say when it comes to Maine, I'm excited to hear that being talked about because I respect and appreciate this the plan and the systems that are being put in place by the department on how to continuously update the rates, I do think we need that to be in a more public forum. Okay. Otherwise, we are going to keep seeing these bills introduced every single year.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Understood.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Because everybody needs their rates increased, and we need to keep beating that drum because some people in this building feel like we checked the box last year. We did not we did not at all. When people got a 7¢ raise, we didn't do our job. So I would love to continue the conversation. Okay. And I think if we can move in the direction of a main model where we are updating rates and putting the money in in four year or five year cycle, we'll be able to move this along. Alright. Thank you. Appreciate it. Thank you, mister chair.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yes. Thank you, representative Gilchrist, representative Case, and then, and then I will jump in after that. And then we'll go to.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you, mister chair. Appreciate it. And and a lot of comments. I just wanna make a comment and a few questions. So we talk a lot in this room about the PCAs. We talk a lot about the rates. Bunch of years ago, I think it was before you before the chairs are here, but we did the e b b, the electronic verification. How is that worked out? That was supposed to fix all problems.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Yeah. I don't think there's any form of technology that can fix all problems. You know, I think that's probably an unrealistic Christine, do we know how EVV is working? I'll turn it to Christine.

[Christine Weston (Director of Community Options, CT DSS)]: Hi. So, Christine Weston, director of community options at the Department of Social Services. So, I'm not gonna go into too much detail about EVV. We could provide you with our recent report outs, to CMS, the Centers for Medicare and Medicaid on that. But EVV, there's the concept of EVV, and then there's what it was really intended to do. So EVV is electronic visit verification where an individual is supposed to arrive at their location, clock in, verify with the individual or through whatever the the system of verification is, and then upon end of visit, clock out and leave. There's a geofences, there's locations, there's parameters. But in we in Connecticut, EVV is also can be manually entered into a system post visit and after the fact and still be in compliance with an electronic visit verification being logged. So there's the essence of logging a visit, and then there's the actual intent which was to reduce fraud, waste, and abuse and capture them in the moment of the visit, which we have two very different numbers on what that looks like. And and, our medical operations team at the Department of Social Services has been amazing in the EVV implementation, and we can get you those details from that department. But there's EVV and then there's actual

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: EVV.

[Representative Jay Case (Ranking Member, Human Services)]: Okay. Thank you. And, you know, that explains because that that's what was geared towards moving to the financial person so they would have the correct information on how they're paying out. And I agree with my chair. The bottom line is two rate studies are done. Millions of dollars to do the studies. Last year was $400,000,000 to put it out. We got $15,000,000 out of the budget. 8,900,000.0 that went to the FQHCs. The rest went to you for rates. 400,000,000 down to five. And I I I my chair is correct. It's not just paying the workers. It's a workforce issue because we have doctor's office, dentist's office, others that aren't getting rate increases. So we're seeing less and less of them because they're going elsewhere. It's something we have to stress to the executive branch. We have the studies. I hate to say it. We have the studies here for rate reimbursements. We have the studies for ECS for school. We have we know what needs to be put there. We're not putting the money where it needs to go. And you have the the the fraud. I think you have a team in your in VSS that does just fraud, not just for this. Yes. And the 6,000,000 for Snap is a big number. But what other fraud is out there? It's happening. It's happening in Connecticut. What we need to do is we need to get the monies with the why did we do the studies? Why did we do the studies? I'm looking forward to hearing from the finance financial person that's gonna come in front of us to talk about that because our calls that come in, blame it all on them because they're not getting paid. Then we call you. They're getting paid. I think it's a two pronged issue that we need to the bottom line, and and a good share said it, it's about paying the people who are doing the work. And if we need we need to step that up in the state of Connecticut. We talk about it every year. I mean, I've been here fourteen years. We've been talking about this. EVV was the first thing we talked about, and now we're we're still batting up and trying to figure out how to fix it. So I appreciate your advocacy. And, mister chair, it's all you.

[Senator Matt Lesser (Chair, Human Services Committee)]: It's not all. It's all of us. Thank you, Representative Case. Just so just going down a hopefully, a short list. One with respect, I I wanna, you know, sort of dig in on on s b three. And s b three is our attempt at addressing the loss of health care coverage that we're experiencing across the state. Two different, but related issues, the cuts to Medicaid, and the impact on hospitals, on patients, and also the expiration of the enhanced advanced premium tax credits. You know, the Trump administration let those lapse, and so people in the state are seeing a tripling of their, insurance coverage. And so the governor made an important first step by using, some money to sustain covered Connecticut and also, to, restore some of the tax credits for people who purchase private insurance for one year, but there right now is no plan that I'm aware of. There's nothing in the governor's budget to continue those tax credits beyond this year, and there are a lot of folks who didn't haven't seen anything yet. But with respect to the covered Connecticut population, to the to the other folks who have lost coverage thanks to HR one, I think the question is, what do we do? And I know that you're, you know, you're focused on the work requirements issues, and and that is is important. But there are just also lots of folks who are just losing coverage and for various provisions of the law. Cover Connecticut has been a godsend. It has kept a lot of folks from losing coverage who would otherwise have lost coverage, but it's up for renewal next year. It is. And we don't know yet whether the administration will allow us to do that or not. My concern and when I've had conversations with the governor of the month's administration, a lot of the answers I've gotten on enhanced tax credits, on other potential federal cuts are, well, we're asking them to not do those bad things. And we are hoping that they won't do those bad things. And so we're not going to go and do that worst case scenario planning because we don't think, at the end of the day, they're gonna do the bad thing that is gonna hurt people in Connecticut. Now I am very sympathetic to that. I I certainly hope that, the considered wisdom people the president's folks will give him the best advice and decide not to do the bad thing. But on the tax credits, he did the bad thing. Right? We lost the tax credits, and, unfortunately, my view is that the state didn't do enough planning ahead of time to prevent, you know we we're doing the work on the back end, but we didn't do the work on the front end to prevent gap of coverage. And, looking at the next big thing or a next big thing, which is Covered Connecticut, you know, if December 2027 we lose that program or there is some sort of action before then, I I appreciate your testimony as well. We can do a lot of planning between then and sort of look at a basic health plan. But why not do that work? Why not just say, yes. We're committing to do that work to make sure that there isn't a gap of coverage, especially, one, because cover the basic health plan will be essential if covered Connecticut goes away. But, also, even if connect covered Connecticut somehow does not go away, we could look to a basic health plan to cover populations that are not eligible for for Covered Connecticut. That there are folks for either because of income or because they are legal immigrants, but they are excluded from a Covered Connecticut that we may be able to cover with a basic health plan. Why not just start that process and say, yes, we're gonna need to do that planning. And and maybe the federal government will pull back and not do the bad thing, but at least we'll have those plans in place in case that that thing happens.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So thank you for your question. I and and perhaps our testimony wasn't clear. It says we we're in alignment that something needs to be done for all of the reasons that you that you articulated. It's the time frame in which we need to get it done. We don't think we're gonna be able to get a lot of this work done in the time frame that this statute particularly lays out for us, given the fact that we have very limited resources to to do the work. That that really is our primary concern at the moment is that we if we do this, we wanna do it well. And we wanna make sure that we have enough resources to do it. And and it does take a long time. We have had other states that have done this, not very many, but it takes a long time to get this done. So it may take, you know, well over the year that we have. And with the same people who are working on HR one, it's going to be very difficult for us to meet those deadlines. So philosophically, Senator, we are we are aligned. I don't think there's any question about that. We're just really concerned about how we are actually going to operationalize this.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yeah. I'm I'm sympathetic. I do I do believe that other states have done set up a basic health plan in as little as six months, and I I know that that requires that that's a lot of work. I'm not saying that that's easy.

[Representative Kurt Vail]: Mhmm.

[Senator Matt Lesser (Chair, Human Services Committee)]: But we have people who are losing their health insurance right now. We're gonna have people lose their health insurance this year. And if you are someone who loses your health insurance because you screw up some piece of paperwork and you're working, but you failed to meet, the work requirement standard that the feds have pushed down through simply an administrative screw up. You you don't dot your I or cross your t in exactly the way. Not only do you use your Huskie coverage, but you also lose access to ACA subsidies, and you could be in this, you know, caught between a rock and a hard place where you have no health insurance available to you. And those that's gonna happen this year. And so I appreciate that we need to do a lot of planning and whatnot. I'm not saying this is easy. I just I'm not sure if if we do take a couple years to look at it and study it. I don't know if we have that that time. And I think that I I see a basic health plan as being one of those ways where we catch folks who would otherwise go uncovered, and we say that they will have the health care that they need if this thing goes if this thing happens. So I I I'm not I'm sympathetic to the timing issue. I your staffing issue, we need to get you more staff. That is true. But I I'm also trying to figure out how can we how can we walk and chew gum at the same time and Right. And move deliberately to get these folks the coverage that they need.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So I I think, senator, would again, we we appreciate the concern. We we talk about this regularly. I'm looking at deputy commissioner Hadler and I because we do spend a lot of time really concerned about that group of people that you mentioned. Those that will fall off, because they haven't met the the community engagement requirements and because of the period of time that may elapse that they will end up with no coverage. So at this point, I think what maybe DC how they may can go back and take a closer look at a more specific timeline. Yeah.

[Peter Hadler (Deputy Commissioner, CT DSS)]: I will I will just note that I think it is a very complex process. I just don't I just wanna emphasize that this is not something that any state has entered lightly, and it is a pretty significant change. Right? There are major components like procuring a managed care organization, bring those into the fold, and and figuring out how to structure this. It may also eliminate cover candidate. We'll get to explore whether we're even allowed to have both of them at the same time. Examples of things like that and trying to figure out the actuarial analysis of whether this is a preferable type of program is something we we would have to look very closely at. And I'll just cautiously note that the population that's above the Medicaid income threshold and above 200% on its face should meet work requirements. Right? That is that is sort of a by by virtue of their their literal income, which we've been able to verify, they should be have have demonstrated that they've got sufficient income to meet those requirements. So I would be optimistic that the that that's not the group that's most at risk from some of the work requirements, elements. But I I I it doesn't mean we can't go back and look at this and give you, you know, some some time frame in which we can do some analysis. I think it's gonna require additional resources above and beyond what we have at the department right now.

[Senator Matt Lesser (Chair, Human Services Committee)]: And I'm the last person to say that we need to listen more to insurance companies, the general rule, but I also think we need to engage very carefully with the two insurance carriers that provide coverage on Covered Connecticut to work with them to see how this might work. And I suspect they might be also working around I don't I don't wanna talk about contracts or whatever, but they might they might be involved in the transition in a big respect. Just with respect to the SNAP error rate issue and also the the gift sorry. The the EBT card theft issue that that representative Gilchrist asked about. One question that I had was about the, federal funding that we've received, for the, work the the SNAP work requirement, upgrades. Is there a way as we're as we're making systems upgrades to reduce our SNAP error rate to also address the chip and PIN issue? Is that something that we could fold into that? Is there I know that there's a conversation about no one is opposed to fixing this issue, I I believe. But his question is, like, how do we how do we Yeah. Figure out a way how to pay for it?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So there they so I'm looking at my deputy commissioners. I'm sure they will answer, help me to answer this question. They're they are actually, two different bodies of work. Right? The reduction of the SAP error rate and actually fixing the the fraud issues with the SAP cards. With respect to the SAP area, I'm actually thinking I'm gonna ask one of our DCs, whichever one turns on their microphone first. Okay. That that wasn't the way to get them to speak.

[Peter Hadler (Deputy Commissioner, CT DSS)]: I'll start. But let me just start

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: to talk about this. Yeah.

[Peter Hadler (Deputy Commissioner, CT DSS)]: Yeah. Go ahead. Just very preliminarily. Right? It it's not directly connected to work requirements. So that's Right. That's a challenge that we would have to navigate. It would probably require an additional path of procurement, an additional request for better funding, and corresponding state funds to be able to do that. And then, of course, there's the annualized out year cost of maintaining and operating a more expensive card replacement process for people. So those costs would have to be accounted for, but I think we would have to request additional funding beyond what we've requested because it's not part of our current request and it's separate from fund from work requirements.

[Senator Matt Lesser (Chair, Human Services Committee)]: And so you wouldn't consider I and I we provide SNAP benefits to a resident of the state. They are entitled to those benefits. Those benefits then don't go to them. They'll go to somebody else who has stolen those those benefits.

[Speaker 15]: Mhmm.

[Senator Matt Lesser (Chair, Human Services Committee)]: That's not that's not considered to be an error?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: No. It's not. Yeah.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, it's a shame.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Error staff errors are measured in the eligibility process.

[Senator Matt Lesser (Chair, Human Services Committee)]: With respect to I I hear you with respect to creating a a firm process around the Medicaid, rate issue. When we started on this journey a few years ago, the last thing we wanted to do was to pick, winners and losers and say, hey. We're gonna give $9 to this particular medical procedure. I think we're all in agreement that we need a more robust process that works for the stakeholders. I think what we've heard though is just that, you know, at this moment, that process doesn't seem to exist in a way that gives us the distance to say to to say no to folks. And, you know, we're see we're seeing acute crises, you know, everywhere. People are providers are, you know, facing financial ruin. I mean, we're all sorts of areas where it causes real gaps of coverage and at a time when when we're receiving less federal funding overall. So I I wanna work with the department to come up with that robust process that that it sort of fulfills the promise of the rate study. I just will echo my, co chair's frustration that, years after doing these rate studies, we don't see the governor's budget doing the thing that the governor's own study said we need to be doing, which is to put money into the Medicaid program to sustain it going forward. And, you know, if that's what the study says, you did the study. It's a great study. We should actually put the dollars in to, accomplish what your own work says we need to do. And I know you you're not gonna go and criticize the governor's budget, but that is my frustration is I know it's representative Gilchrist.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Thank thank you, senator. I I from from our perspective, one of the most important things that the rate study did, in addition to identifying the gaps that need to be filled, is to recommend a regular review process. And the reason that Maine got to the place where it was is that it it was very much in the same place that we were, where there there wasn't a consistent approach to providing increases to rates. It wasn't reliable. It wasn't consistent. It was it was just troubling. And so they completely turned it around. And that and they did that by starting out with the REIT study and then following the recommendations of the study and creating a plan. I think if we can we can do that, then at least we can have a a road map to follow so that we don't find ourselves in the places where there's frustration around, you know, what direction are we going in and which rates have been reviewed when. Because I that's that's part of the process that can be eliminated. Part of the frustration of the process, It could be eliminated with with having a process in place.

[Senator Matt Lesser (Chair, Human Services Committee)]: So with respect to, our PCA bill, you know, I am just at a loss because I I the the the stories of human suffering that I've heard, you know, from folks who are there to provide care but are themselves homeless because they have lost pay that they're entitled to, that there have been one issue after another. I was on the phone trying to troubleshoot a constituent during Thanksgiving week, and her whole family was, lost their housing, were living in a car, had no food for days on end, through no fault of their own as far as I could tell. And I I know that you have worked to get to to to address this issue, but I also know that there are folks who still have not gotten paid or still have outstanding issues. And I you know, one of the things that I've heard from all directions, from DSS, from the third party intermediary, from the consumers, from the PCAs, is that there are problems that one, we need there's there could be value to bringing in agencies, to bringing in case management, that there are problems with the data reporting. So why not put some funding in to do something that I think DSS identified two years ago and upgrade the MMIS architecture and say that we will make sure that we can get, you know, accurate wage and hour data, and then we can also build that architecture on there. Is that something that if we were to identify funding for that DSS would agree as a priority in a way to help move that ball forward?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So MMIS is the system that we use for Medicaid billing. It's not the one that we use to, to pay for PCA. So that's why we have our third party administrator. And, Christine, I'm gonna need you to help me out here. So that that directing funding or additional resources in that direction wouldn't necessarily address this issue?

[Speaker 15]: Unless Yeah.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I'm wrong about that proposal.

[Christine Weston (Director of Community Options, CT DSS)]: Again, Christine Weston, director of community options at DSS. So there are small components with upgrading the MMIS that could support, just general, the Community First Choice program in general, the self directed PCAs. We are actually in an active build right now with the MMIS to support an authorization file that you may hear in testimony from our fiscal intermediary that has been causing some of the problems. We have some old antiquated systems that we are trying to upgrade to provide cleaner authorizations. So that is actually in flight right now. The I think senator Lester, what you're referencing is the inclusion of agency based into the MMIS, which is not gonna help the $11.99 PCA payment issue, but would help the CFC program as a whole. The MMIS is on the road map for opportunity under CT METS. So that will have to be kind of orchestrated along those other Medicaid infrastructure programs. But we are working towards cleaning up the authorization files, which has caused some of the concerns and some of the conflict in authorization and and being able to pay.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. That that's helpful. Mhmm. If we could get a if if we could get a specific proposal from the agency about how to put that together and and with respect to the agency, I I understand what you're talking about with the committee for choice, but my thought was that that a lot of the clients also need assistance in managing right? If they're doing self directed care that they need some assistance potentially, some of the clients need assistance in managing the hours. And so having that framework might be helpful for that. Is that not did I misunderstand that?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Yeah. Go ahead. Okay.

[Christine Weston (Director of Community Options, CT DSS)]: So yeah. So, yes, we agree that there has been some gaps in so the the individuals that employ the eleven ninety nine PCAs are considered self directed employers. Management, and we're building out contracts now to kinda support and lift up access to case management. We also have something called support and planning coaches that we are trying to roll out, which in other testimony we've shared has been difficult, but we are working to implement that. The the case management solution will help. We also had feedback around making the budgets and the portals for the Medicaid participants that are the employers more legible. That has rolled. We had had some

[Representative Kurt Vail]: delays in what that looked like and how they understood what

[Christine Weston (Director of Community Options, CT DSS)]: their authorized hours are. We've made all those like and how they understood what their authorized hours are. We've made all those recommended improvements. We took feedback from eleven ninety nine. We took feedback from the employers of record and our Medicaid participants, and we have updated the portal. So those are the incremental steps that we're making. We're cleaning up the authorization files. We've made the employer portal more accessible. I think the line that we can't cross, which I think the PCs in the room will wanna say and they wanna have access to, is that they want visibility into their employer's plan of care. And the department just simply can't offer that. The employers can offer that. The employers can share their portal with their PCAs if they choose to. They can work with the their trusted parties, their natural supports to help with that scheduling and that support. We just can't present that level of visibility to the PCAs that they're requesting. But those other mechanisms where it's easier for the employer to see it and translate that to the PCA and say, yes, I've used 80 of my hundred hours. We're gonna have to figure out what the next week looks like has been updated in the portal with g into the employer portal for GTI.

[Senator Matt Lesser (Chair, Human Services Committee)]: Great. I'm almost done. I promise. Couple things. One, the rural health transformation grant, congratulations on receiving that grant. Getting question about when, when those funds are going to start rolling out to the partners that you've identified. Yes. There's, you know, there's a lot of interest in that particularly, you know, with serving rural parts of the state.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Yeah. So there there is a plan, and doctor Dalal, doctor Mehul Dalal and Joel Norwood are the two two individuals and then we have a, you know, a whole host of people and our partners at OPM, they're putting a plan together. So we are waiting for our final approval of the projects from CMS, and we can't really move forward until that happens. And then those funds would then be released. There will be there will be, and I know representative Guilfoyle will be happy to hear this. We have planned information sessions that we're putting together now. Right? There will be a schedule because I I heard you very clearly, and even before I came today, it's like, we need to be more transparent and visible about what's happening with these dollars. So there will be information sessions. They will be online that people can come to, and you'll be able to see what we are doing, what specificity around the projects, where the dollars are going, and how that process is going to work. There are individual organizations that are looking for specific dollars. That that is not the way that this grant works. It's a it's it is a pass through in some instances, but there are administrative costs that are associated with that that have limitations that are very specific to this grant. But we know that there is a lot of excitement around this grant, so we have plans to to have more public forums so people can hear what we're doing. I will also share today that our leadership team for rural health transformation has been hired. It's four individuals. The person who will be leading the the team actually just worked for USAID and actually is coming to us. He was last in Albania. So he's coming to Connecticut. So he he will be he will be doing this. So we really have stellar talent that has agreed to come. Some are in the state already, couple are out of state that are all coming because they're excited about this process of working in the rural health transformation space. And they specifically said that because we are a small state, we are nimble, we're creative, we're innovative, they're really excited to be here.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, glad to know we stack up favorably with Old mania.

[Representative Kurt Vail]: We

[Senator Matt Lesser (Chair, Human Services Committee)]: But It's

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: a fine country, so I'm happy about that. I I

[Senator Matt Lesser (Chair, Human Services Committee)]: I hear great things. Can one last one last question, and I know it's it may be a sensitive question, but we do have a bill just asking for more reporting and more understanding of the role of community action agencies in our state. I know that there have been some disruptions or potential disruptions in coverage and just wanted to see what you can share because I know it's been an issue of interest to members of this committee is to figure out how we can make sure that everyone in the state gets the Fine. Support that they need.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So I will say that the the concern that we had about the bill is that it focused on a specific provider type, which is the community action agencies. And there was a single community action agency that actually had some some challenges. So it it's we didn't want our committee action agencies to feel as if we believed as a as a state writ large that we did not trust them because they they do extraordinary work. So we were hoping we could have a conversation about just overall and more visible accountability and ways in which we can maybe be more be more proactive around our just not for profit partners in general around their their general fiscal health. That was really the concern that that we had when we were discussing this bill as a department.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. And in terms of any specifics and sort of beyond the the bill, I mean, the the sort of the underlying reason for the bill is because of of well, one one specific Yes. Issue. But I I don't I am not gonna ask you to talk about the specifics of that. Okay. Others might. But Thank you. But but just in terms of the department's role, you know so community action agencies receive federal funding and a much more limited set of state funding, I think. But, generally, they're federal funded partners. And so I know that this the state has a a role in, you know, ensuring that they are they're doing their job and fulfilling their mission.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: That's

[Senator Matt Lesser (Chair, Human Services Committee)]: right. And when there's an issue with one of them that I I does the department has step up? Like, how do you make sure that that we don't have a gap of coverage in a a particular region? What's the And

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: and I'll also ask deputy commissioner Hadler to weigh in because it's his department that oversees the community action agencies day to day. But the community action agencies are required to, provide us regular reports when it comes to the programs that they're responsible for administering. And so also let me be very clear, it's not just DSS. Many of the CAAs have have contracts with other state agencies, mostly human services agencies. And they do an exceptional job in managing those programs and delivering the services. The ways in which we keep track is that we do have a regular audit schedule. We have a regular review. They the, they have reports that they have to send to us and they have to send us their financials. And when we see those financials and we have a concern, then we do reach out to that community action agency and ask exactly what's going on. Fortunately, the circum the the circumstances under which or the times in which we've had to directly intervene have been so few, and that really is a testament to the ways in which they run their organizations. And DC, Heather, if you wanted to say more.

[Peter Hadler (Deputy Commissioner, CT DSS)]: Yeah. Thank you, Krishna. I think you I think you said it very well. I just will emphasize that there are multiple funding streams for most of the community action agencies. I think they would be very well versed in being able to discuss that with you about, you know, how their structures look. We can provide our insight from what we see. We obviously fund them with federal funds and state funds depending on the the project initiatives. And and as the commission referenced, multiple other state agencies are often funders. Each community action agency is different. They also have private funding streams, and they access grants directly. So they're a a diverse group of organizations. And and, while they have, you know, a lot of commonalities, they are also distinct. So I think that, you know, as the commissioner referenced, as part of our routine work in overseeing, for example, the community services block grant, we have, you know, funding that goes to their administrative, purposes, and we have check ins about that. We help support and ensure that they're in compliance with, the requirements of federal law around their structures and composition, provide technical assistance. But they are but it's a it's a diverse group of people, and I think that that they they would certainly be able to help bring forward information about themselves as as much as we could.

[Senator Matt Lesser (Chair, Human Services Committee)]: I I said something that wasn't true. I said that was my last question, and I have actually one one thing I forgot to ask about that's kind of a big deal. The you know, on on Snap, I know that you're dealing with a lot right now, including trying to get your error rate down to avoid the, what, $140,000,000 federal penalty is just, you know, astounding, plus the largest unfunded mandate of administering the program, but $40,000,000 on top of that. It is a massive unfunded mandate on the Department of Social Services on the state of Connecticut that is unconscionable. But there are also a lot of people in the state who are losing their food benefits because they live in a town that has a high unemployment rate and they're just simply our jobs. That was an exemption that existed before. There are folks who are losing their benefits because they are veterans. They are serving they are transitioning back to civilian life. There was an exemption for veterans that was taken away. And so veterans are losing their food assistance, survivors of human trafficking and domestic violence, people aging out of foster care, a whole group of people are losing their food benefits. And so prior to 2017, the state had a state based food benefit that no longer exists. And one of our bills today contemplates creating a bridge program to ensure that we're doing something to cover folks. I know food is really expensive, but and I know that that funding is not in the governor's budget. So I don't wanna hear, hey, the governor's budget doesn't doesn't provide it. I I get that. We did create an emergency fund to address lot drops of federal funding. To me, that's why we created it, and I would make that case to the governor and to his finance folks who I think are listening, that that's why we created the fund. But on a practical basis, DSS would have to implement any such program. And I see deputy commissioner Hadler is sort of squirming here because because I know that there's some technical issues there, and I just wanted to see if you could sort of talk about the, you know, technical questions if the the state department decided to implement such a program. Are there ways to do that? Are there ways I know that, there's a terminal architecture, but then there's also, you know, there are other few other ways to get benefits onto cards. And so I was just curious in terms of if, you know, if we had a standard benefit, would that take there there's just different ways to address administrative complexity, and I didn't know if you or your team, commissioner, had thoughts about how we should think about

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: that. Oh.

[Senator Matt Lesser (Chair, Human Services Committee)]: The the sort of the

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Sure.

[Senator Matt Lesser (Chair, Human Services Committee)]: Aside aside from whether or not we will do it, like Yeah. What like, how that might work.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I don't have a lot of insight into what happened in in 2017. Well, I I can tell you we have a we have a a few concerns, which is running, parallel snap programs. Right? Because that that that in and of itself is extremely challenging. And we would want to make sure that we got it right. We and we also wouldn't want to inadvertently have an adverse impact on our federal SNAP program because we've diverted resources to our state SNAP program. So thank you for acknowledging that even at the outset, we this is not within the governor's budget. So that's actually implementing it is is not something that we can do from a fiscal standpoint. With respect to standing up an actual state SNAP program, all of the the challenges that you just identified would be true, which means we would need the terminals and cards and quality assurance and a fraud unit. And all the things that we have for our current SNAP program, we would need to have for this particular SNAP program. We'd also try to be managing two different criteria for SNAP because they they would not be the same criteria. We're we would actually look at people who are falling off of SNAP because of the changes to HR one, and those criteria would be different than the criteria for those that are currently on SNAP, right now. So the same SNAP has always had work requirements. So that's always been the case, but it's expanding the population of people that that it applies to. And if it's a bridge, so does the bridge look different than our regular SNAP program? Or does it look the same? And then how do

[Speaker 16]: you how do you get

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: it to look the same? And then the the I think a more sort of outline challenge that we have with the the concern that we've raised is, will our federal partners see it as just an extension of the SNAP program? And will it have an opportunity to actually add to their oversight and possibly our SNAP error rate? So these are all of the things that we're considering and and most concerned about when it comes to administering a state administered SNAP program on top of the cost itself. Is it how there's anything else you'd like to add?

[Peter Hadler (Deputy Commissioner, CT DSS)]: I think you pretty much covered it, commissioner. I think it it is is it's just a complex undertaking. Right? And so you start to think about some of the very nuanced things you very quickly. How do people renew? How do you balance out somebody who perhaps didn't complete a piece of paperwork on the federal side? Do they shift immediately into the state coverage? You know, just to to look back historically, one of the reasons why I think it was a little easier to construct a a program that was state funded in the past is because it was a very defined and limited group of people who are not eligible for federal benefits under any circumstances. And this is where non citizens who are legally present in The United States but hadn't been here for five years, which is was a requirement that was introduced in federal law in the mid nineties. And because that was a very specific carve out for people who that we could identify, and provide a set of benefits to, it was it was doable. It was not easy. It had costs, but it was more feasible than a the sort of many categories of people that we would try to support as, you know, due to the changes in federal law. So there's there's real complexity from an administrative perspective. I think we all have a lot of, you know, we're we're trying to figure out how best to support people who we know do need food support from these changes, you know, helping to facilitate them to get, you know, employment or volunteer opportunities to help comply where they can. But we recognize that that sometimes it is paperwork that is built into this bill, is built into the federal projections that some people struggle with with the process. So we're we're we're gonna work as hard as we can to help the people where we know the barriers are about access and try to to to identify other sources. For example, we have bolstered, a lot of funding for the statewide food pantries. Again, it's not ideal. It's not a one to one match. It's not perfect, but it is action that we can take that won't take us a year plus to implement with complexities that we may not be able to resolve.

[Senator Matt Lesser (Chair, Human Services Committee)]: We we heard this morning from the head of the Connecticut Veterans Legal Center that or who argued that I think there's 9,000 veterans in Connecticut who were covered under the the previous veterans exemption. And, right, a lot of those folks are disabled. They're disabled veterans. Now if you are I think maybe I I don't wanna get this wrong, but a 100% permanently and totally disabled, you do qualify for SNAP still. But if you are just a little bit disabled, let's say you're only 80% disabled veteran, then you would lose your SNAP benefits. You know? And, obviously, there are also folks who are coming back from a deployment. They may have a disability. They may have PTSD. They may be in the process of filling that out, but they haven't established their disability status yet because you're still going through VA paperwork. Why not just say to every veteran in the state, if you are meet the income threshold, you would qualify for a a a state benefit if you don't if you don't qualify for SNAP. Please don't please don't no. No. No. We don't we don't we I'm sorry. I appreciate the support, but we don't we don't we don't do either either if you agree with something somebody says or if you disagree, that's we'll say that in your testimony, but don't please don't do that. But thank you.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So, Senator, the I I appreciate what you've just expressed. And and obvious and I've, you know, many veterans in my family, so I I do appreciate this. It's not a matter of withholding a benefit from a veteran. I just wanna be really, very clear about that. All of the challenges that we identified apply to veterans that are returning and have served our country very bravely and honorably. And it and it also applies to everyone else as well who are going to lose their SNAP benefit. We are troubled by that and are really trying to find a way to strike a balance so that people don't have to make the kinds of decisions that you are making. Part of that also has been continuously lobbying our federal partners to say that these changes just don't make any sense and that, you know, are you really taking into consideration the the enormous impact that this has on people that why should you have to be 100% disabled in order to qualify for staff? You're no less hungry if you're 100% disabled than if you're 50% disabled. Right. That doesn't make any sense. So we're really trying to fight it on on several fronts. But as you mentioned in the beginning, in terms of the resources that we have available, those are limited right now. So we're not disagreeing with you, you know, philosophically or in terms of policy. What we're saying is that practically, can we work together to figure out what we what we can do? And if if this is not the solution, creating a state SNAP program, then let's try to work together to find something that would be. And that has just to bring the perspective of community action agencies, this is why part of the funding that we asked for out of the $500,000,000 fund was directed to a community action agencies to hire community health workers so that they can be a hand by hand support for people who are going to be losing their benefits under SNAP so that people aren't just left out into the wind to figure out what to do for themselves, including our veteran population.

[Senator Matt Lesser (Chair, Human Services Committee)]: Just in terms of the administrative complexity, I heard I I I Prisha, I don't remember if it was you or deputy Hadler said that one of the things that would have to happen is purchase new terminals and and whatnot. And and that, to me, seems like a lot. I I don't know whether it is or not, but it sounds like a lot, you know, in terms of if we were to create a state program, we would we might need new new terminals or some sort of other infrastructure. Would it be administratively simpler instead to, you know, sort of in lieu of providing a specific food benefit to provide a cash benefit equivalent to a food benefit as a and loaded that onto a card? Is that something that would just be an administratively easier thing to talk about?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: That is not something that we've actually actively explored, so I can that give you a cogent answer, but I'm happy to take that back.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. Thank you. Now, I'm done. Alright. Okay.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: I'm gonna take over as chair. Yes. Representative Hughes, go right away.

[Representative Anne Hughes]: Thank you, madam chair. Sorry for keeping you so long, commissioner, but you're you're you're really digging into some of the policy implementations of life or death issues. So so we as legislators, policymakers wanna partner with you in getting, you you know, getting these proposals right. Just to tag on to, senator Lessor's, when we preloaded when the federal government shut down or whatever and we preloaded for that weekend, did we take it back out? How did the state do that with our own funds?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So we ended up not spending our own funds. We had right. What we had to do is and this might be too in the weeds and, lots of us didn't sleep, I think, in trying to figure this out, but we made that work, is we had to, essentially offer a pledge to our vendor because there are only three vendors in the country that that actually administer SNAP programs in terms of putting benefits on cards. That if there was a if there was an adverse outcome at the in this in the courts as to to reinstate the full 100% benefit, then we would actually guarantee the 35% difference in the benefit. Because at the time, the feds were only covering 65%. So with that guarantee, we were able and with that pledge that came directly from the governor, I wanna be really clear about that. Right. That we were able to load those cars at 100% benefit. That's how we were able to do it. And then afterwards, it turns out that the that states were triumphant. Right? Those of us that actually took the chance to fill the cards at 100%. And and we were fully funded, so we never ended up having to spend state dollars to make up that difference.

[Representative Anne Hughes]: Okay. Well, I I just thought it was really interesting because we did pivot nimbly to try to meet the emergency right, and get people the money they needed on their Snap cards. And I'm just wondering if there is a way to do that in this proposed bridge Snap program. Absolutely. And and and part of I I hear you loud and clear. We don't wanna violate these ridiculous Byzantine federal parameters that are set up deliberately to create barriers to just, you know, people being fed. And it's it's it's unconscionable that we have to be working around those barriers by the federal by this administration. It's unconscionable. But they're especially with our veterans and our most vulnerable people, but here we are. Anyways, go ahead.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So so thank you. The the difference is that it was relatively speaking easier, and I use that term very advisedly, to load money onto an existing program with existing cards. Sure. Right? In Yeah. Right? In in collaboration with our federal partners to stand up something completely different. And we had to pledge those dollars, which you would have been able to spend. And that $35,000,000, I think we spent $80,000,000 a month on Snap.

[Representative Kurt Vail]: Mhmm. So

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: it's a pretty significant amount of money.

[Representative Kurt Vail]: Mhmm.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: That that one time load would not be sustainable over time. So this that was part of the challenge that we also have we're having here. But to stand it up as a state program, that would be a much, much heavier lift, substantially heavier, with also thinking about what sustainability looks like over time.

[Representative Anne Hughes]: Yeah. I understand. But I also this ties into, SB three, section 17 about having additional legislative approval because we do not trust this administration at all. So we feel like we need, when when when you say we may not need it because waivers have to already go through the committees of cognizance. We could go to a managed care contract without a waiver because other states have done it. So, again, we have a responsibility as legislators to create a heightened oversight about some of these changes because, you know, we would like to be clear in SB three that the entire legislature must approves any such move that is radically changing the way people are, you know, getting health care, especially if it was capitated care, especially if it was eliminating community first choice, that kind of thing for future people that need it. Because the existing statutory authority is for the governor to contract with MCOs, and, they could do that without a waiver. So we know that the waiver process exists. We'd we come in with our standing committees of cognizance and we approve changes to waivers. But what if something is happening outside the waiver?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Do you wanna speak to that?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I I will try to speak to that. I I'm as you're talking, I'm trying to contemplate a circumstance where we would make that substantial a change outside of the waiver. Because the way that our state plan amendment is written, every change practically needs a waiver, which is why we're always here. So you'll see us for the smaller ones. You'll see us for the for you'll see us come before you for the larger ones. And I think that the the statute and the way that our spa is drafted between those two things, I think there there's more than adequate protections that this department could not make a a substantial wholesale change to the way in which Medicaid works without coming before the legislature. It's designed. So even when we make small changes, you'll notice that a report will come to the legislature. So you'll see that. And so the and the large some of them are very routine. We we do many, many of them so that we can keep certain remain compliant with federal law. So I I I would guess I would say, representative Hughes, that having done this job for the last three and a half years, I guess I I feel like I don't share the same concern about that because I feel like we you do have a lot a lot of say as a legislature as to what we do and how we do it and bringing those waivers before you, on a pretty regular basis. And, you know, we do that. We welcome that input and feedback and the accountability. But what's being proposed in this legislation would make things considerably more difficult. And let me just say, from a practical standpoint, anyone who sits in this chair after me, I think that we make that kind of sustain or propose to make that kind of substantial change to the Medicaid program at their peril. It is just not a smart thing to do.

[Representative Kurt Vail]: Right.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: I would really I would really hope that the person who would be, nominated and eventually confirmed and appointed would be someone that would actually understand that and work collaboratively with the legislature as as we have and not try to do something like that.

[Representative Anne Hughes]: I completely trust you, commissioner. I completely trust my colleagues. I just don't trust this federal administration and changing the rules on the fly with which could which could impact how we are allowed. Can I say that? To to run our Medicaid program. I really think that our MAPOC committee is one of the best in the country in terms of oversight and really scrutiny. And to that end, my other question was about the, rate study. There were some populations that were left out of it. So, those populations who will hear testimony from today, especially around medically fragile home care providers for medically fragile children and nurses. And we're very concerned that they continue to be left behind. That's why some of the legislation proposed today does include them. And, again, I hear my colleague's concern about, you know, we don't wanna pit anybody against each other for getting these increases, but we also, let's be very clear, cannot leave these providers and their families that with the with the with the most medically fragile, excluded from desperately needed rate increases. Again, not just in a matter between life or death, but a matter between, multiple hospitalizations, which then costs the state a lot of money, but then really further diminishes these patients' health outcomes.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: So with I my so my response is brief, and that is that the the rate study, just by its nature, could not include

[Representative Kurt Vail]: Right.

[Representative Lucy Dathan]: Right? All of them. Understood.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: But this this is why, again, I will emphasize why it's so important to have a process for regular review. Because even if there are providers that weren't included in the study or ones that we think, you know, should have a higher or lower level of review, however we this plan full process, we can make those decisions. And and so that you can we can speak to providers who feel that they're being left out or don't have an opportunity to have a as as regular a review.

[Representative Kurt Vail]: Mhmm.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: But having that rate study lay the foundation for us for a process is really one of the most critical things that we can do.

[Representative Anne Hughes]: Thank you. Thank you for all your work. All all all you ladies and deputy handler. Top of the morning to you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you, representative. Representative Johnson.

[Representative Susan Johnson]: Thank you so much, madam chair. And thank you so much for your amazing work and the same to all the deputy commissioners as well. Really much appreciated. Just a quick question, regarding the fraud. I don't know if, we have looked at trying to work with other states, to see if there's a way that we can build a fund or create some type of a public insurance program to address that. Because it seems to me if we could do that with other states, maybe, the private insurance company would want to be involved. That's a joke. But anyway, so I just, I just can't, help but wonder if there isn't a way to, to work with other states on this. Because as we all know, the telecommunications act of 1996 has not been updated yet. I mean, we have had our banks hacked, our credit cards hacked on a regular basis yet. There's no action on this, but if we have, multiple states working on this, maybe that would be a notice to people in Congress to maybe try and update the telecommunication system so that people are not hacked in the banks. Now banks have insurance and, and the, the SNAP program does not. And so that is just a question. I don't know if it's been talked about. So.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: It has not, representative. So I think it's something that we can certainly take back. I am quite active in our and all of us are actually in our trade associations for human services. It's not an it's not an idea that's ever surfaced. What most states are doing is, what's been proposed in one of the pieces of legislation is that they're moving toward different technology to secure it. And again, as, deputy commissioner Barr has testified, we really are trying to find the resources to be able to do that over time. So it's not currently within the governor's budget, right, or or our our resources, but it's top of mind for us. But I I don't know of any state that's done that because as you heard earlier in the testimony, the numbers are staggering. They're in the millions of dollars.

[Representative Susan Johnson]: They are. And the and the and the horror that's bestowed upon the people who are hacked is really unfortunate and it then it trickles into the community. And as we all know, under Doge, we lost hundreds and thousands and millions of pounds of food a day, because they got rid of the, surplus agriculture. And that, and what happened to that? I mean, so, that's rhetorical, but anyway, I just, I just wanted to mention that as well because I think that's been part of the conversation when people say that they could go to the pantry. The pantry is, at least in my area, we are we're sending out about 10,000,000 meals a year. And, and and we also have three pantries. And then, I'm sorry, a million meals a year. But we have the have the, the pant three pantries. And they were getting their food from the surplus agriculture nationally, and that is gone. And so the other idea is to look at what we can do to enhance agriculture here and maybe work in that area as well, but that's also something I'd be glad to do offline. But thank you so much for your work, everyone.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you very much. Alright. Thank you all. Thank you for being here. And thank you for the work you do. We have gone past the first hour, which means we'll now go back and forth between the public and state agencies. And so first public is Suzanne Garafa. I don't know if Suzanne is with us yet. Okay. So, Suzanne, come on over when you can. How about Ruth Grobe? Okay. Is Tiffany McDonald as well? Just maybe the one or two because the issue will be the back and forth. Maybe David Morgana in the meantime. David, why don't you go right ahead, David Morgana? Also wanna let folks know who are online, you have to please accept the promotion. But alright, David. Go right ahead.

[Speaker 19]: Hello? Can you hear me?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. We can.

[Speaker 19]: Alright. One second. I'm sorry. Hello, members of the human services committee. My name is David Morgana. I had a car accident twenty nine years ago, which resulted in a spinal cord injury. In the last twenty nine years, I've used a power wheelchair, power assisted manual wheelchair, and currently a manual wheelchair. I'm a long time disability advocate. I've been involved with the wheelchair repair issue from the very beginning. I participated in the wheelchair work group which then transitioned to the wheelchair task force and currently serve on the wheelchair repair council. I use NuMotion for my wheelchair repair needs. There is also a second company currently known as National City Mobility. Ever since the private equity controlled company, new company, New Motion has come into existence, customer service has dropped off a cliff and has still not recovered. The discussions with the industry started over three years ago in the wheelchair work group. We told them then and we continue to tell them now they need to increase staffing levels. They simply don't have enough technicians out on the road doing in home repairs. The industry has repeatedly given excuses as it's hard to find qualified candidates to hire or pass background checks. I believe the starting hourly rate is being advertised between twenty and twenty five dollars an hour. In my opinion, the industry is not being realistic in what they're offering for compensation. The accuracy of the data being presented by the companies has been called into question. To be clear, I'm not making any accusations. However, from personal experience, the majority of my repairs since the current repair laws went to effect have been delayed beyond the ten day law. I have also filed complaints with OHA, but making these complaints only serve as a record. Currently, there are no penalties or enforcement mechanism in law. In my opinion, there probably needs to be. In my opinion, New Motion has been manipulating wheelchair users by offering and shop repairs in a much shorter time frame. New Motion has sent out email notices telling their customers it is quicker to come into the shop to get repairs done. New Motion has been using this tactic for a while now to get consumers to come into the shop to get repairs done because when we go into the shop, it saves them money. Also, when you call customer service line, the phone representative asks when can you come into the shop to get the repair done? They actively ask this first and do not mention home repairs in the beginning of the conversation. This, I believe, is a continuation of pressuring and manipulating customer to come into the shop for repairs. I had an incident once when a new motion representative told me that the company did not have the obligation to provide me with in home repair. This immediately became an argument because I happen to know my rights and pointed this out immediately. Eventually, this was resolved. I brought this concern directly to upper management in a wheelchair repair council meeting. Fault was admitted, and the incident was blamed on a lack of training. The industry has come out against the bills that have been introduced to the legislature. They claim legislation isn't necessary and say that things are improving. Give us more time or or we'll do better, we promise. I've heard the same thing said for a long time now. I just don't believe them. I don't believe they will improve or come into compliance without enhancements to the current law. We need to improve current law in several ways, including enforcement mechanisms, informing consumers of their rights, and holding the industry mechanisms, informing consumers of their rights, and holding the industry accountable. Time is our most precious commodity. None of us know how much of it we're gonna get. Every day that people's wheelchairs are broken and repairs delayed is another moment taken from us. We are not able to live our lives to the fullest because we are stuck in bed, can't go to work, can't go to school, or just spend time stressing out over when our wheelchairs are going to be fixed. These delays steal away our time and our peace. Please, I ask the government to act now. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Thank you very much for your testimony and for being with us today. I don't see any wait. Yep. Representative D'Amico. Go right ahead.

[Representative D’Amico]: Yeah. Just just a quick question. Thank you, David, for testifying. So I missed the beginning of your testimony, and I I assume you you submitted written testimony. Correct?

[Speaker 19]: I'm gonna be sending what I just wrote. I'll be sending that in along with some other documents and referencing Sheldon Tubman's testimony that he'll be getting in to the technicals of one of the proposed bills that are that are up this year.

[Representative D’Amico]: Okay. So so so, I I presume in your in your written testimony, you you you're going to describe what what you feel we should be doing with with Senate Bill five zero one to to to make it better. I I assume you don't think it's perfect?

[Speaker 19]: No. It's not it's not perfect. And and Sheldon actually has a pretty thorough, written testimony that I've looked at, and I'll defer to him and some other people that get into the specifics of that. But I wanted to take my three minutes to tell everyone that, you know, there's still a problem. And it's it's a failure, I would say, a failure of government at one point, and it's it's also the government, you know, not doing what's needed. And we have the the, you know, these private equity overlords controlling everything to you know, not putting the resources in where they need to go, and people are suffering. And, you know, and it's a real it's a real suffering. It takes away from our peace and our time.

[Representative D’Amico]: Thank you. I I appreciate that. Thank you for your indulgence, madam chair.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you, representative. Thank you, David. Have a great afternoon.

[Speaker 19]: Thank you for the time.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next, we will hear from Kathleen Holt of the state office of the Health Care Advocate. And then is Suzanne okay. Perfect. Thank you.

[Kathleen (Kathy) Holt (State Healthcare Advocate)]: Put everything on. Senator Lesser, Representative Gilchrist, Senator Perillo, Representative Case, and distinguished members of the Human Services Committee. I'm Kathy Holt, State of Connecticut Healthcare Advocate. I'm sensitive to the fact that there are two seventy nine people, waiting to speak to you. So, I will leave my detailed written testimony on the numerous bills, that we have addressed on health insurance to speak for themselves. I think it's more important to share with you today a related singular message we hear from dozens of consumers served by the office of the healthcare advocate every day. As we look for options to ensure 100 of state residents, all of us are suffocating under the cost of access to quality healthcare. We are sacrificing our quality of life for increasingly limited access to health care with insurmountable out of pocket costs like high deductibles. Every day consumers ask us when do we get to participate in the choices payers and providers are making that are diminishing our quality of life. Where is this going and how does it get better? Connecticut residents are frustrated with being spoken for. Insurers use us to say costs are too high. Providers use us to say payments are too low. Consumers say look at us, see us, hear us. We ask you, the committee and the legislature to bring payers and providers together with us in a spirit of true transparency to work with us to understand our priorities about how they spend our money on our health care. Health policy can only get better if payers, providers, employers, consumers, and all of us agree to work together to act unselfishly and transparently for the North Star goal that is consumer access to safe, quality, affordable healthcare. Patient safety, quality and affordable must be at the center of each of our decisions, and we must agree to leave no stone unturned to reverse this problem. We need this committee and our state leadership to hold us all accountable. There are too many self interests involved to solve to solve this health care crisis without your thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you very much. Thank you for all that you do and for looking out for individuals. We will take a look at your testimony as we work through this process, and we'd love to partner with your office. Thank you for being here today. Appreciate it. Next up is Suzanne Garafa.

[Representative Kurt Vail]: My

[Speaker 22]: name is so I

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: think that moves. Do you wanna pick that up, if you don't mind? There. Yeah. Perfect.

[Suzanne Graff]: Hi. My name is Suzanne Graff. I'm from West Hartford. You've seen me last week with TC equals a, the wheelchair coalition and ADAPT. I'm gonna have Ruth read my testimony for me. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Great. Thank you for being here.

[Ruth Grobe]: Honorable members of the human services committee. I am a vol oh, you just said that.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yeah. Why don't we get the chair back? Thank you.

[Rosanna (Rose) Ferrero (Universal Health Care Foundation of CT)]: Thank you.

[Ruth Grobe]: I wanna thank you very much for your help in addressing the delays in wheelchair repair that make it so hard for me to have less pain and more independence in my life. We have made progress, but there is still a way to go to get wheelchair repair companies to follow through on the law passed in 2024, public act twenty four fifty eight. That is why I am testifying today about SB five zero one, an act concerning the wheelchair repair advisory council. And here is my story. Six months ago, I reported problems to National Seating and Mobility because the foot rest on my wheelchair is cracked, making it hard to adjust. When I can't adjust the position of my legs and feet, it causes pain in my back. The wheelchair technician recommended a replacement foot rest, and I was under the impression that it would be done in house because this is how they used to do it. After a long wait when nothing happened, I called and was told that NSM was no longer doing it in house and that it would have to go out to another company. More time went by. And when I called again, I was told that NSM no longer did business with the company they had proposed to use and that they were looking to get a new foot rest from yet another company. None of this had been reported to me. In the meantime, I have become eligible for a new wheelchair, and I am due to be measured in May. If we cannot obtain the new foot rest before the new chair arrives, NSM will not put the new foot rest on my old chair, which I could use as a backup. In the meantime, my feet keep falling off the present foot rest, and unless I have someone to help me put them back, they hang out over it and cause a lot of strain on my back. Because my back is hurting a lot, my repair technician put in for new side pieces for the old foot rest because they might help to keep my feet in place. The side pieces have come in, but we are still waiting for the parts to install them. I am very much hoping that s b five zero one will be the last bill I have to testify about this issue, but it needs some significant changes. I support moving the Wheelchair Chair Repair Advisory Council to the office of the health care advocate, but I do not support adding another wheelchair repair company representative to the council at the expense of one of the consumer representatives. I support the new language requiring the companies to advise their clients of their consumer rights, but it needs to be more clear about how this applies to the right to in home repair. Finally, although we advocates have asked for this language, there is nothing in the bill about providing me as a consumer with a timeline of the repair process at the completion of the job. I thank you for the opportunity to testify and ask you to consider changes to the bill.

[Speaker 10]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you very much. Thank you for being here, and thank you for the recommendations. Any questions? Yep. I expect it, and I'm excited about it. Thank you. It's always nice seeing you. Alright. Next, we will go to Dan Beam from the long term care ombudsman program.

[Daniel Beam (Community Ombudsman Manager, CT LTCO Program)]: Hello. Good afternoon. Can you guys hear me and

[Senator Matt Lesser (Chair, Human Services Committee)]: see me okay? Just making sure.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Go ahead. Thank you.

[Daniel Beam (Community Ombudsman Manager, CT LTCO Program)]: Very good. Good afternoon, representative Gilchrist, Senator Lesser, representative Case, Senator Perillo, and, members of the Human Services Committee. My name is Daniel Beam, and I'm a community ombudsman manager with the office of the Long Term Care Ombudsman. Providing oral testimony today on behalf of Murray Painter, Connecticut State Long Term Care Ombudsman. Our office is established under the federal Older Americans Act to advocate, on behalf of the health, safety, welfare, and rights of individuals receiving long term services and supports in Connecticut and to identify patterns, elevate resident voice, and recommendations to improve policy and practice. We have submitted a more detailed written testimony, but today I wanted to provide our brief positions on several bills, five zero one, four seventy eight, four eighty one, four ninety five, but primarily focus on house bill five five six two and act on serving various revisions to the human service statutes. And in particular, wanted to focus on sections one and nine related to managed residential communities and the reinforcement of important protections related to antipsychotic medications and informed consents in nursing homes. First, the amendment, program supports the provisions requiring managed residential communities to post the resident bill of rights in a prominent place, including the contact information for the Department of Public or Department of Social Services for protective service reporting. This is an important resident rights measure. Residents are most meaningful when residents and their families know what those rights are and where to turn to when they have questions, concerns, or complaints. Clear and visible posting strengthens awareness, supports the ability to raise grievances, and reinforces access to outside agencies when concerns related to abuse, neglect, exploitation, or abandonment arise. We also support, the section nine. And Connecticut already has strong statutory protections including the right to be free from chemical restraints used for discipline or convenience and important limits on psychopharmacological use for discipline or convenience, otherwise. However,

[Speaker 19]: many of

[Daniel Beam (Community Ombudsman Manager, CT LTCO Program)]: the most detailed and operational safeguards that govern how antipsychotic medications are actually used in practice currently exist at the federal level rather than being clearly codified at the state level. These include requirements for document documented clinical indicators, the use of behavioral interventions, and the gradual dose reduction, monthly pharmacist review, and physician follow ups, strict limits on PRN antipsychotic orders, and meaningful informed consent. At the same time, the federal landscape is shifting. We've talked about several times, the repeals that the federal government is going through, including, the December repeal of the nursing home minimum staffing rule. And now as of March 6, the announcement of a federal review of antipsychotic medication policies in response to sustained industry pressure. This raises real concern. The existing safeguards may be weakened over time and we agree that section nine is a direct and thoughtful response to that moment. By incorporating, four eighty three, 40, forty five and four eighty three, 10 as they existed on January 1 in the Connecticut statute, this bill ensures that these are well established protections remain in place for Connecticut residents regardless of future federal changes. In practical terms, this means that even if the federal, rules are relaxed, Connecticut residents will continue to have those clear protections requiring clinical justification, ongoing review, limits on use, and full informed consent in language that they understand. From the unbuttoned position, this is more about, more than just a regulatory alignment. It's ensuring that individuals are not subject to powerful medications without clear need, appropriate oversight, and without their knowledge or understanding. And for these reasons, we feel this is a proactive step, and show a showcase of the way that things are working and, addressing them rather than waiting for things to become weakened over time. And then briefly to touch on Senate Bill five zero one, we support it because it strengthens accountability for wheelchair repairs that residents depend on for mobility, autonomy, and dignity. You've heard several testimonies already, and I'm certain we'll continue to hear more. These are practical, reasonable, and steps that align responsibility with the impact of individuals who cannot safely wait weeks or months for a repair. Four seventy eight. Support four seventy eight because we believe that it is a thoughtful consumer protection bill that improves transparency and safeguards, for policyholders in Connecticut Partnership for Long Term Care. For families making decisions during illness, it's understandable that options can, determine whether someone can remain at home or is pushed into a nursing facility simply because community supports become unaffordable. We also support Senate Bill four eighty one, resident centered transparency and accountability bill for nursing home residents, especially where private equity ownership is involved. It requires disclosure of beneficial ownership and key financial documents. Authorize authorizes penalties for noncompliance and creates a performance bond to protect residents from the risk of, rapid resale or nursing home real estate interests. It prohibits mandatory arbitration agreements as a condition of admission and continued care, and national research has shown that private equity acquired homes experience higher rates of ambulatory care, sensitive emergency visits, and hospitalizations. Forhibiting required arbitration agreements is crucial so that residents and families are not pressured to waive legal rights at one of the most vulnerable moments in their own lives. And finally, Senate Bill four ninety five. We appreciate the emphasis on long term care planning across home and community based services. However, we must oppose the provision that adds to long term care ombudsman as the formal member. Under the Older Americans Act and its regulations, the ombudsman must remain independent in order to identify harms, raise concerns about system failures, and advocate without hesitation planning decisions that negatively affect residents. We feel that this independence is better preserved through our ability to provide testimony, reporting, and consultations via forums such as the long term care advisory committee rather than through the body that guides the agency action itself. And so thank you so much for our opportunity to provide testimony today.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you so much for your testimony. We look to your office as playing a vital role in providing oversight over the long term care sector and providing safety for our patients. Sorry for sticking on a task force that you can't be on, but by federal law, we just wanted to hear your voice, but I I understand that was a mistake. So thanks for thanks for keeping us out of violating federal law. That was obviously not our intent. Are there questions or comments from members of the committee? Seeing none, thank you. Have a wonderful day. You as well. Next, we'll have Ruth Grobe.

[Ruth Grobe]: Think you've seen me before too. Senator Lessig, representative Gilchrist, senator Perillo, representative Kaes, and members of the Human Services Committee. Thank you for listening to my testimony regarding SB five zero one today, even though I do not use a wheelchair. As the secretary of the Citizens Coalition for Equal Access, I would like to convey the story of our co chair, Gary Gross, who is presently in a rehab facility and cannot be here to testify. Gary is blind and uses a wheelchair because of cerebral palsy, which also affects the sensitivity in his fingertips, making it almost impossible for him to read braille or use a computer. He has a manual wheelchair with an electric tilt installed in it so that he can push a lever a lever that makes the chair tilt backward. This is very important when he goes to the dentist because there is no lift or accessible exam chair, so he has to tilt back while sitting in his wheelchair in order to have procedures done. Almost a full year ago, Gary reported to New Motion that his tilt was no longer working. Since that time, at least three different technicians came to his apartment to try to fix the tilt. All of them have told Gary that they have never before seen an electric tilt on a manual wheelchair. New batteries and parts have been ordered and have taken many weeks to come in. A couple of times, the technician has managed to get the tilt to work, but in a few days, it goes out of commission again. Batteries are definitely part of the problem. And we advocates are concerned that the wheelchair companies are using cheaper batteries than in the past. The process I just described has been going on for almost a year now. And during that time, Gary has never been able to go to the dentist, even though before the tilt stopped working, he was scheduled to go every three months. The medical community has been stressing the importance of dental health to overall health. And I don't believe it is a coincidence that Gary's health has significantly deteriorated over the past year. Now he is in a nursing home for the foreseeable future. Gary's experience illustrates the need for an amendment to s b five zero one, a bill which I support in general, but which needs significant strengthening. His tilt is finally fixed, and it would be really helpful if new motion were required to provide him with a timeline of the repair process since the first time he reported the tilt problem. There have been long periods when it appears that a part was on order and hadn't come in, but it was all pretty ambiguous. And Gary was always the one who had to call and try to get an update as to where things stood with the repair. It is hard to believe every single ordered part took weeks to come in. And yet this seems to have been the case. There are other problems with SB five zero one as it is currently written, but I would refer you to my written testimony in order to save your time today. I very much appreciate your taking the time to hear about the people so badly affected by delays in wheelchair repair. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your testimony. Are there questions or comments from members of the committee? Representative Demetrile.

[Representative D’Amico]: Thank you, mister chair. Thank you, Ruth, as always, for coming in and keeping us informed. So I I want to take advantage of your your offer or Gary's offer, I guess. Could you just briefly outline the other portions of of or other suggestions on how to improve Senate Bill five zero one?

[Ruth Grobe]: Yes. Well, Suzanne mentioned a little bit the fact that the bill proposes to nominate another representative of the wheelchair repair companies to the advisory council, but it would replace one of the consumer in in place of one of the consumer advocate positions. And I don't think we should be reducing the number of consumer advocates on the the advisory council. And

[Representative Susan Johnson]: I'm trying to think what

[Ruth Grobe]: the other ones are. I'm sorry.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Oop.

[Speaker 27]: I've got it here somewhere. I'm sorry to take so long.

[Ruth Grobe]: I I do I I would refer you to Sheldon Taubman's testimony, which is coming later. But oh, yes. We would we would we would recommend a requirement that when the monthly reports are submitted to the council by the wheelchair repair companies that those reports be certified as accurate by the authorized dealers identified compliance officer. So that because there have been the the data has been a little questionable at times is my understanding.

[Representative D’Amico]: Thank you. I I know it was in writing, but sometimes it's better to just get it out so everyone can hear it. So thank you. Those are good suggestions, and I hope the committee will will, will will consider them. Thank you, mister chair.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, representative. Other comments or questions from members of the committee? If not, thank you for your testimony this afternoon. Good to see you after so many minutes apart. Next, we will hear from Access Health Connecticut. I believe we've got John Carbone on the line.

[John Carbone (Access Health CT)]: Yes, sir. Good afternoon, Chairs Lesser and Gil Crest, ranking members Perillo and Case, and distinguished members of the Human Services Committee. My name is John Carbone. I'm the director of small group, broker support and product development with Access Health. James Michell, CEO of Access Health is out of the state dealing with a family issue, is unable to join today. On behalf of Access Health, thank you for the opportunity to submit testimony and strong support of House Bill fifty forty one, an act expanding health care coverage. Particularly, section four, which creates a temporary Connecticut tax credit qualified for for qualified small businesses to offer an individual health reimbursement arrangement. An individual coverage, health reimbursement arrangement allows employers to offset, contributions that employers can use to buy health care coverage in the individual market. Instead of offering a single group plan, employers give a monthly contribution and the employees choose a plan that best fits their needs. This set this this setup offers an employer predictable costs and greater flexibility, including giving including the ability to customize contributions by employer class, while giving employees the freedom to select coverages that meets their needs, provider preferences, and also work with their current supporting broker. Connecticut small employers continue to face increasing premium cost administrative hurdles and limited flexibility in the small group mark market. Many small business want to provide health benefits to their employees, but find it difficult to do so, especially with modest margins, seasonal workforces, and limited human resources employees. Section four of this bill directly addresses these issues by helping employers take practical first steps towards offering coverages that is manageable and predictable. The governor's proposal is designed as a time limited on ramp to encourage adoption at at times. A time when a small small employer needs the additional support to begin offering this type of coverage. Section four of this bill established the tax credit for qualified small businesses with fewer than 50 employees capped at $5,000,000 annually statewide. This credit is tied actually to employer contribution up to a thousand dollars per covered employee and is available only for the first income year that ICRA is offered in the immediate success in year. Connecticut is well positioned in implementing this policy. Access Health has developed the first state based exchange for called Business Plus platform to support small employers, brokers, and the employees navigating coverage decisions and administrating, allowing them to take advantage of the ICRA options. Business Plus helps reduce complexity, provides a structure that will boost small business competitiveness in hiring and retention. For those reasons, Access Health respectfully, request that the committee support House Bill fifty forty one.

[Speaker 27]: Thank you

[John Carbone (Access Health CT)]: for your time, and we'll be more than happy to answer any questions.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your testimony, and I I personally think that it's very well taken. I know there have been a lot of different proposals in this building about ways to address the affordability of small group health care, and the governor's proposal to provide a tax credit for NICRA to me seems like the most straightforward simple way to address this issue while strengthening the market and ensuring that patients who need access to things like preexisting condition protections can get them. So I think that's very well taken, and I I personally am very sympathetic to that. Just a question. I don't I know we were hoping to see hear from director Michelle. I know he can't be with us today. I do have a question about some other provisions that pertain to access health, and I don't know if you can speak to them or not. But s p three contemplates extending the tax credits that the that the governor has already made available through the emergency funds for people who purchase private health insurance. Do you know if those tax credits have been made available yet? What is the status of that? Have people gotten compensated for their out of pocket costs? And are does Access Health website as of today show the correct price or does it still show the unsubsidized price?

[John Carbone (Access Health CT)]: Senator Les, I'll be more than happy to take that question back and give you something back in writing within the next couple of days. Unfortunately, I don't have all that information right at my fingertips. So I'd like to accurately make sure I get that information back to you.

[Senator Matt Lesser (Chair, Human Services Committee)]: I I had a hunch that wasn't your part of the book. Throwing that curve ball at you, but I would I would love to throw it at mister Michelle when he is available. And I understand he is

[John Carbone (Access Health CT)]: I'll make sure that it gets sent. And Susan.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank thank you so much. And are there other comments or questions from members of the committee? Seeing none, I really appreciate your testimony.

[John Carbone (Access Health CT)]: Thank you. Have a great day, everybody.

[Speaker 29]: You too.

[Senator Matt Lesser (Chair, Human Services Committee)]: Next, we have Tiffany McDonald followed by Melvette Hill.

[Tiffany McDonald]: Good afternoon, esteemed members. My name is of the Human Services Committee. My name is Tiffany McDonald from Farmington. And I first, I wanted to thank senator Lester and representative Gilchrist for your attention to the wheelchair repair problems in the past few years. The passage of public act 24 dash 58 was a great first step forward. But today, I need to tell you about my problems with wheelchair repair in the past year because more needs to be done. Approximately a year ago, my motorized wheelchair went dead and wouldn't work at all. A technician came out and tried to re and replaced some parts, but it still didn't work. As National City Mobility to take it to their facility and make sure that it was working before returning it. It took them three to four months to to pick up my chair. And when I requested a loaner chair, they said they had none. I had to use my my manual wheelchair the entire time, and it severely limited my life and made it very hard to carry out my commitments I had made. Then more recently, the casters of my motorized realtor started to make loud noises. And NSM took two months to install replacement casters. Despite the replacement casters, my realtor was still making noise. I happened to be visiting a friend when National Seating Mobility technician was working on her chair, and he asked him to, like, take a look at my newly replaced casters. He did say that they were in terrible condition and were probably used. So I had I made a second official appointment with National Seating Nobility technician, and it took another month to get new casters. Although I am very grateful for the passage of public act 24 dash 58, it has no enforcement provisions. The only way that we consumers have a voice is through the wheelchair repair advisory council fifth senate bill five zero one. Make steps in the right direction by placing the council under the supervision of the office of health care advocate, which has been very helpful to consumers in the past year. However, Senate Bill five zero one also needs amending in order to make sure that wheelchair users are adequately represented and that their voices are adequately heard. And I would direct you to the testimony of Sheldon Tubin of Disability Rights Connecticut. Thank you very much.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you. Thank you for your testimony. Are there comments or questions from members of the committee? Seeing none, thank you for being here this afternoon.

[Representative Kurt Vail]: Welcome.

[Senator Matt Lesser (Chair, Human Services Committee)]: Next, we have Nelvette Hill from CWCSEO. Followed by Marianne Langton, followed by Muna Abbas. Good afternoon.

[Melvette Hill (Executive Director, CWCSEO)]: Good afternoon. Good afternoon, Senator Lasser, Representative Gilchrist, Senator Perillo, Representative Case, Senator Maher, Representative Comey, not sure if people are on Zoom, and other distinguished members of the Human Services Committee. I am Melvette Hill. I am the executive director for the Commission on Women, Children, Seniors, Equity, and Opportunity. And we wish to support a number of bills today that is indicated in our written testimony, but I'll just be speaking to two, raise bills fifty five forty and four ninety seven. So the CWCSEO strongly supports HB fifty five forty and commends the committee on its ongoing commitment to center the voices and needs of families in Connecticut. Residents accessing benefits have shared with us the complexities of seeking and acquiring employment only to suddenly lose critical public benefits. The sudden elimination of public support programs when a resident earns even a dollar more than the eligibility limit is referred to as a benefits cliff. And the commission is part of the Connecticut, two gen initiative, which we've been doing in this state for about eleven years. We, in our role, support the the group, by collaborating with agencies, appointing parent members, and convening and staffing the advisory board. And since the inception, the voices of parents have been at the center of the work. They have been an integral part of, helping to helping us to understand what their needs are. And right from the beginning, they told us that benefits clips was a big issue for them. As we know, benefits clips disincentivizes people from seeking work or higher paying opportunities because there is more to lose than to gain in the short term. That is why a smooth and supported transition off of public benefits programs is necessary and likely to support the state's long term financial goals while also laying the groundwork for families to become financially stable and independent. This bill aims to address benefits cliffs, but it will be essential to analyze how to include and address programs beyond TFA. That is why benefits cliff pilot is necessary. The pilot referenced in section three will explore how the best the best practices and the best ways to eradicate benefits cliffs for all residents accessing public benefits, not just those, who are accessing TFA. The pilot is the next step in a multiyear process initiated by this legislature. The TouGen initiative completed a feasibility study for such a pilot and submitted a report on its findings to the legislature. This bill to us is affirmation of the legislature's ongoing commitment and a continuation of the work that we as partners across Connecticut have undertaken together. This pilot will generate valuable insights to inform future policy improvements that better serve both families and employers and address benefit cliff challenges. It also reflects evidence based national research advocating for policy reforms that smooth benefit transitions and ensure work enhancements truly benefit families financially. A recent Northwestern University researcher demonstrated that smoothing benefits cliffs creates broad economic gains, benefiting not only individual workers and families, but strengthening the entire economy. The research focused on the large portfolio of benefit programs in nine Southern US states. The author combined proprietary data with the American Community Survey to analyze how households respond to these benefits cliffs. Now this pilot approach positions Connecticut as a leader in addressing one of the most persistent challenges facing working families across the nation. And with this, we offer a few recommendations. For Section three b, we ask that you include implementation of the pilot along with design and evaluation. As it will take time to design and then implement, which will include selection and onboarding of 200 families. Second, we recommend extending the pilot duration to four years, Which will allow families to sufficiently be a part of the program and have the opportunity to complete necessary education and training programs. Ensuring they can successfully transition beyond the cliffs. And finally, we ask that you include parents, family members and other people with lived experience accessing public benefits in the pilot design, implementation and evaluation, which is consistent with the values of our two generational approach. We are grateful to the committee for its leadership on raising this important and timely issue, and we offer our strongest support for 5540. And finally, I would add, SB four ninety seven. We say this bill is a wonderful step in the step in the right direction in addressing food insecurity, here in Connecticut. And we would offer, that as we we think about opportunities to strengthen the foundation that we're building on, that there are still some unaddressed federal, cut issues. And so we respectfully, propose a number of recommendations in our, written testimony. I'll just offer it to you now for the sake of time. We would encourage the legislature to, convene a food data work group to measure food insecurity and related concepts at the state level, since the USDA is terminating its annual household food, security survey. And then we would also ask you to please create a food and nutrition special fund that can receive public and private funds to finance this work. And we we thank you for the opportunity to give testimony today. And if you have any questions, we'll be glad to answer.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, thank you so much, for your testimony and the fine work of the commission. Are there comments or questions from, representative Cohen?

[Representative Robin Comey]: Thank you, Melvette. 29 pages of testimony.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Awesome. Bills. They well, can you

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for not reading them.

[Representative Robin Comey]: No. I appreciate it and all the studies that are connected to it. And, thank you for your work and and leadership with with the food security and and all of the other items. So thank you for your team. I'm sure you didn't do this together.

[Melvette Hill (Executive Director, CWCSEO)]: Oh, yes. We have a great team and many Didn't

[Representative Robin Comey]: do this alone. I mean

[Melvette Hill (Executive Director, CWCSEO)]: Yeah. We did it together.

[Senator Matt Lesser (Chair, Human Services Committee)]: I yes. And I just echoing representative Comey. I just wanna thank you and for the specific suggestions, particularly on the food nutrition bill. We'll take a look very close look at those with that work.

[Representative Lucy Dathan]: Thank you very much.

[Senator Matt Lesser (Chair, Human Services Committee)]: Are there other comments from members of the committee? If not, thank you. Good to see you. Thank you. Next, we have, Mary Anne Langton followed by Munna Abbas. Mary Anne spends more time in the human services committee than the chairs do. So

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Oh, you just have to push the button.

[Representative Kurt Vail]: I have two

[Mary Anne Langton]: testimonies. We Alright. Hello, senator Lesser, representative Gilchrist, and distinguished community members. My name is Mary Anne Langton from West Hartford, and my personal assistant, Kayla Sage from Hartford will be reading this statement. This statement is from CT Adapt which fights for the civil liberties of people with disabilities. CT Adapt is in favor of HB five zero one. In our state, there are six thousand five hundred people with disabilities that rely on mobility devices such as wheelchairs and scooters. These devices are critical for assisting people in being productive and remaining independent with or in their lives. When wheelchairs and scooters work, life can go on whenever sorry. Life can go on. Sorry. I just lost my thing. Life can go on. However, the minute they break, people are stuck and vulnerable. Many people do not have backup wheelchairs to use as replacements, so they end up spending valuable time and days in bed. As a result, people can develop bed sores and other health issues due to being in bed too long. The wheelchair advisory council is very imperative with overseeing the work done by new motion and national seating and mobility. However, we would strongly suggest that the council member terms are for two years. We are afraid that a one year term will not give members enough time to acclimate to the council to make meaningful contributions. Also, we are concerned about the composition of the advisory board because there should be fifty one percent representation of people with disabilities. Members of Adapt strongly agree that the wheelchair dealer should notify the consumer of the rights to timely repairs. They must be able to communicate with the clients on repair and how long it will take. People with disabilities often think about their wheelchairs as their legs. So how would you like it if you took if you took your car to the dealer for for repairs and you have no idea whether it will be returned to you? This has happened many times to people with disabilities. Thank you, and let's strengthen this bill. And then the second testimony. Senator Lesser, representative Gilchrist, and distinguished committee members. My name is Mary Anne Langton from West Hartford. Thank you. Goodbye. Okay. This statement is from

[Representative Kurt Vail]: They they know. Okay.

[Mary Anne Langton]: You guys get who we are. This statement is from CT Adapt which fights for civil liberties of people with disabilities. CT adapt is in favor of HB number 5,557, an act concerning eligibility determinations by the Department of Developmental Services. Most Medicaid programs in The United States use the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders DSM-five as a standard reference for diagnosing mental health conditions and determining eligibility for treatment coverage. This bill would simply align the definition of intellectual disability in Connecticut general statutes with the meaning as provided in the DSM-five which now encourages a more comprehensive view of the individual. The DSM-five has abandoned IQ scores as an exclusive diagnostic criterion for the intellectual disability. The DSM-five now places more emphasis on adaptive functioning and the performance of life skills. However, our state has their own definition that is more restrictive. Why does the state of Connecticut have its own definition of intellectual disability? Why do we use a definition that is more restricted? In conclusion, we will urge that Connecticut look at the entire person with a disability and meet their support and services needs in both this important bill out of committee. Thank you.

[Representative Kurt Vail]: Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, Mary Anne. Other comments or questions from, yes, representative.

[Representative Robin Comey]: Thank you, Marianne. Do you agree with with the other folks who came up here regarding the moving the committee to the office of the health care care advocate and not removing a consumer? Yes. I do. Yeah.

[Mary Anne Langton]: Okay. I do very much. Very much.

[Representative Robin Comey]: Okay. Thank you. And do you know why we use the d s the more restrictive you you asked us, and I'm wondering if you know.

[Representative Kurt Vail]: No. I did get you to do a DIA guide to probably engage. Write.

[Representative Robin Comey]: Well, I'm intrigued now, so I'm gonna go dig deep.

[Representative Kurt Vail]: You're

[Mary Anne Langton]: Yeah. And wishing about your old her old chair.

[Representative Robin Comey]: Yeah. Thank you so much. Thanks for coming. See you soon.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, representative. Other comments, questions? Seeing none, thank you for being here this afternoon. Next, Munna Abbas, followed by Omoreen Emeril. And you're bringing out okay. Great. Yeah. We're coming up together. Terrific. And just identify yourselves. I I know you are, but just identify yourself for the record. Thank you.

[Mona (Muna) Abbas (Acting Director, Commission on Racial Equity in Public Health)]: Hello. Good afternoon. Chairs ranking and esteemed members of the Human Services Committee, my name is Mona Abbas. I'm the acting director of the Commission on Racial Equity in Public Health, and I'm here with my colleague, Gretchen Shugart, alongside me. We're a nonpartisan legislative office charged with making policy recommendations to the legislature to reduce racial inequities in public health. We appreciate the opportunity to testify today in support of SB three, an act concerning health care affordability. Health care affordability and accessibility is a priority of the commission. It has been since its inception, But we have been sounding the alarm over the last six months in particular that the state needs to make a plan to mitigate the harms that we are going to see when the federal changes take effect. So we were really pleased to see that SB three take steps towards making that plan a reality, and, hence, we are in full support of the bill. Due to time constraints, we're only gonna be focusing today on sections five to eight on establishing a basic health program in Connecticut and why that's a good step, but our written testimony elaborates in greater detail about our support for the other parts of the bill.

[Gretchen Shugart (Commission on Racial Equity in Public Health)]: Last fall, the commission convened the work group with the goal of developing practical and affordable health care options that could be modeled and considered in the upcoming session. Of the options discussed, the basic health program or BHP was the most attractive due to the relative ease with standing up the program and that's in comparison to, like, a thirteen thirty two or eleven fifteen waiver, and being able to leverage the federal funding associated with it. A BHP is an optional provision under the ACA and allows states to establish a health insurance program for low income residents who are 65 up to 200% FPL and ineligible for Medicaid. Instead of having individuals purchase subsidized plans through a state exchange, the federal government provides states with 95% of the federal, subsidy amount. In exchange, the states operate the program directly. BHPs currently operate in a few states and can be a promising option in reducing uninsurance rates while providing affordable high quality insurance. In addition, BHP can serve as an alternative option for covered Connecticut enrollees should the existing waiver not be renewed in 2027. For these reasons, the work group prioritized modeling this option, and our hope is that modeling will help the legislature better understand the implementation of a BHP in Connecticut and its cost in if any, to the state. The results are expected to be complete completed in mid to late April in time for members to have the information needed to better assess its impact on the state.

[Mona (Muna) Abbas (Acting Director, Commission on Racial Equity in Public Health)]: So in closing, the state is facing, a health care coverage crisis, and the commission is really pleased that through SB3 that this committee is thinking seriously about sustainable, equitable, and options that which will protect the residents in the state who we are really afraid are gonna slip through the cracks. So thank you again for the opportunity to testify, and we welcome any questions.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you to you both for your work and for the work of the Commission on Racial Equity in Public Health for its commitment to helping us respond to what is happening nationally. Just just with respect to there have been a lot of questions about s p three, and when I was listening carefully to the and and reading the department's testimony, one of the things that they did was they urged they urge us to move more slowly, and I understand that you're move urging us to move a little quicker just in responding in it. But I I think you're also acknowledging that there's quite a lot of work that has to happen around around modeling different elements of it. One of those elements is the proposal to enact a basic health plan. In in the department's testimony, I believe I heard a deputy commissioner say that to enact a basic health plan, we would have to enlist an MCO. That's not my understanding of the federal regs, and I was just wondering if you could help clarify what we would have to do or what who is eligible to operate a?

[Gretchen Shugart (Commission on Racial Equity in Public Health)]: That's correct. An MCO is one option. Just like our Medicaid program, we have the option to use, an MCO. Most states throughout the country use MCOs. Connecticut does not. Connecticut has no interest in that. And since it's not a requirement for BHP, we recommend that we move forward without using MCOs because Connecticut's experience with them hasn't been very good.

[Senator Matt Lesser (Chair, Human Services Committee)]: Indeed, you have I I wanted to just also just give you an opportunity. We I I think there's a lot of promises for a basic health plan. It gives us 95% of the federal tax credits for the entire population that could potentially be served, which in other states has allowed them to have enormous flexibility in meeting local needs and addressing changing environments. That's something that our sister state, New York, has found and it's been, I think, widely credited as a success there. But did you have any with looking at the department's testimony you're listening to before, did you wanna respond to anything else that they they said and sort of clear clear things up that you know, as we work towards this common goal?

[Mona (Muna) Abbas (Acting Director, Commission on Racial Equity in Public Health)]: Yeah. We totally hear and recognize some of the challenges that the DSS commissioner shared about their anxiety about the the fast timeline that BHP, it looks like in s p three right now as it's written. I think as you also mentioned, Santa Lasser, is that we want to be able to have things in place so that we don't risk any coverage gaps. Some populations, as you noted, have already lost their coverage and BHP can actually be an option to already put those populations into the BHP program. As you noted, this has already been up in place in several states, New York, Minnesota, Oregon, most recently, the District Of Columbia, who I believe managed to get their BHP set up within approximately six months. The data right now shows that it has been relatively successful. And in fact, states have had to not have had to put in little to to no money on top of that. Our the modeling that we are currently overseeing as a commission will share more information. And so I know the DSS commission also shared that they would like to do some studying. We would offer them to put questions towards our modelers too if they would like to be involved in that in in that modeling so that they can perhaps they've got questions that they want answered too.

[Senator Matt Lesser (Chair, Human Services Committee)]: So you secured funding to do an actual aerial analysis or modeling of a basic health plan that we might be able to implement on a much sooner return?

[Mona (Muna) Abbas (Acting Director, Commission on Racial Equity in Public Health)]: Yes. Right now, we are having modeling done by Urban Institute, a think tank doing economic analysis out of DC, and they are looking specifically at what the basic health program would look like in Connecticut and especially its cost, if any, to the state. And they're looking at various different options and and what it would look like in our state landscape.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, thank you for doing that. I think that's really important, and I know that we heard loud and clear from DSS that they are overtaxed, and they are trying to put out many buyers. And I'm hoping that that work that you're doing right now will be of useful to them and to our other state partners as we look to evaluate if this is an appropriate fit. It looks like it is. Now just in terms of, you know, how it would fit with Covered Connecticut Remind Fit, I know that that may be something you're modeling. You know, this is a program that's currently working. It has you know, there's no immediate threat, but there is a question about whether it will get renewed or or could be addressed. And so do you have thoughts about about that role and how we can work around that?

[Mona (Muna) Abbas (Acting Director, Commission on Racial Equity in Public Health)]: Yeah. So I think it would be wise as a I myself am a planner. So if I was thinking, let's say, I would plan as if it wasn't to be renewed. And if it wasn't to be renewed, then basic health program would capture all of those folks in in Covered Connecticut. I believe No.

[Gretchen Shugart (Commission on Racial Equity in Public Health)]: I also just wanted to jump in. It also expands coverage because Covered Connecticut is up to a 175% FPL, whereas the BHP would be up to 200%. So it would be able to cover a few more people.

[Speaker 35]: Yeah. Sorry. Just wanted to add that little detail.

[Senator Matt Lesser (Chair, Human Services Committee)]: Great. Alright. I may I I don't I've certainly more to talk about, but I know that there are a couple people behind you who are looking to testify. So in the interest of time, I just wanna thank you for your commission's work. Look forward to continue to work with the commission and would turn it over to any members of my committee if they have questions or comments. Seeing none, thank you for being here this afternoon. Thank

[Speaker 36]: you very much.

[Senator Matt Lesser (Chair, Human Services Committee)]: Next, we have Maureen Emeril followed by Melissa Combs.

[Maureen Emero (Co-Chair, Wheelchair Repair Advisory Council)]: Thank you, Senator Lesser, and representatives of the members of the committee. My name is Maureen Emero. I am a member of the Wheelchair Reform Coalition, and I'm serving as cochair of the Wheelchair Repair Advisory Council. I thank this committee for its work on Public Act twenty four fifty eight and SB five zero one. I am testifying in support of this bill. Please see my written testimony as I provided suggested language as agreed upon by the wheelchair advocates to strengthen this bill. The two greatest weaknesses I see of PA twenty four fifty eight are the lack of enforcement and the lack of notice. Neither of the two wheelchair providers, NewMotion or NSM will inform their customers about all of their rights under the law, namely the timeliness requirements of repairs, the complaint hotline established under OHA, or the right to an in home assessment or repair. As a customer of New Motion, I am usually not offered the option of an in home appointment. And when I request one, I'm met with resistance. I'm asked if I can find help to come into the office, help to transport my broken equipment over in a van and someone to assist me to navigate their inaccessible office. In one phone call, I may have to insist four or five times before they will agree to an in home appointment. I know about the law, so I know to push back. Other people don't know about the law, and they feel that they need to come into the, office even if it's not safe for them. I find this to be outrageous and a blatant disregard of the law. We're also oh, wait. Because we have no re because we have no enforcement, we are relying heavily on the council to monitor and respond to data. So with the council regard council related changes, we do have some suggestions. So I first of all, I thank the committee for housing us with housing us for this past year and a half. Thank you to the clerks. And I support, our move to OHA. I support adding a second member from the industry, but not in place of an existing advocate member. I ask you to change the requirement of one at one of the advocate positions from representing a private payers to representing Medicare because that's more closely aligned to the wheelchair population. I ask you to maintain a cochair structure with an advocate member and a member from DSS or ADS. A tri share situation is very could be very cumbersome and disruptive. If we are adding items, I mean, adding terms for the industry and advocates, I ask that they are two year terms or a one year term effective, the passage of the bill. And this would just ensure continuity, especially when we are transitioning over to to OHA. I support receiving monthly data and the ability to request and receive additional data as necessary. So please see my comments, in my written testimony, and thank you so much.

[Senator Matt Lesser (Chair, Human Services Committee)]: We do, and thank you very much for your testimony. Other comments or questions from members of the committee? Seeing none, thank you for being here this afternoon. Next, we have Melissa Combs. And are you going up with Rachel Simon? Okay.

[Rachel Simon (LGBTQ+ Justice & Opportunity Network)]: Good afternoon.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Good afternoon.

[Rachel Simon (LGBTQ+ Justice & Opportunity Network)]: Senator Lesser, Representative Gilchrist, and distinguished members of the Human Services Committee.

[Senator Matt Lesser (Chair, Human Services Committee)]: Is madam clerk, should are both are both microphones on or is that Oh. Yeah. This Great. Thank you very much. Great.

[Rachel Simon (LGBTQ+ Justice & Opportunity Network)]: My name is Rachel Simon. I use shethey pronouns. I serve as the co chair of the LGBTQ plus Justice and Opportunity Network and as executive director of Triangle Community Center in Fairfield County. I am here today with my co chair Melissa Combs, sheher pronouns, and we urge your support for HB 5,562, specifically Section four. In 2019, the Connecticut General Assembly made history by creating the LGBTQ plus Justice and Opportunity Network. Connecticut became the first state in the nation to establish a statewide LGBTQ plus network through legislative action, recognizing that protecting the health, dignity, and safety of LGBTQ plus people requires more than good intentions. It requires coordination, investment, and leadership. That vision has made a real difference. Through the network, Connecticut has supported community organizations, provided direct funding to critical programs, and has brought together advocates and policymakers to address the needs of LGBTQ plus residents across the state. As the network has grown, it has also become clear that its governance structure needs to evolve to keep pace with the work that it was created to do and meet this moment of unprecedented animus from the federal government. Right now, voting membership is largely determined by organizational affiliation rather than professional expertise or lived experience. Because of this limitation, the network currently has only 13 voting members even though the statute allows up for up to 20. That means fewer voices at the table and fewer opportunities to ensure the network reflects the full diversity of Connecticut's LGBTQ plus community. HB 5,562 fixes this. This bill allows the network to adopt its own bylaws and establish a more modern governance structure, one that includes clear accountability, defined roles, transparent decision making, and a voting body that better reflects the communities we serve. This is not a dramatic change. It is a practical update that will allow the network to operate more effectively as a state supported initiative. At a time when LGBTQ plus people, particularly transgender people and youth, are facing unprecedented attacks across the country, Connecticut's leadership matters. Strengthening the infrastructure that supports LGBTQ plus residents is part of how our state continues to lead. HB 5,562 ensures that the network can remain strong, accountable, and responsive to the communities it was created to serve. For those reasons, we respectfully urge the committee to support the bill. We have submitted written testimony which provides more detail. Thank you for your time and consideration, and we're happy to answer any questions.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for the your testimony and for the work of the organization, and appreciate working with us on the membership and the suggestion that you have. Are there questions or comments from members of the committee? Representative Cummings.

[Representative Robin Comey]: Thank you so much. So I see that that you folks are actually you're taking your own organization out of this bill. Correct? I mean, the I mean, you've you're in brackets. Right? The try you said you were with That's my day job.

[Rachel Simon (LGBTQ+ Justice & Opportunity Network)]: Okay. Yes. So Triangle Community Center is my day job. Right. And I and we serve as the co chairs

[Representative Robin Comey]: Of this. Of this. Okay. Great.

[Speaker 40]: Yeah. So we're moving away from organizational affiliations in the statute to professional expertise and lived experience.

[Representative Robin Comey]: Yeah. Yeah. I think I think that that's a a positive change certainly, especially with the changing, you know, organizations going from here to there and moving and trans transitioning in and out of the work they're doing. So thank you so much. Yes.

[Committee Member (Unidentified)]: Representative.

[Representative Lucy Dathan]: Thank you so much, and thank you for coming today and thank you for coming yesterday as well. It was great to see you guys. I hear so many wonderful things in my community about the work that you do and how important it is for so many young people, especially, these days. So I just wanted to say, appreciate you coming and and making sure that you're visible to all of us because we we do see you, and we hear you. So thank you so much. Thank you, mister chair.

[Speaker 29]: Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, representative. Other comments or questions from members of the committee? Seeing none, thank you for being here this afternoon. Next, we have Todd Johnston.

[Representative Kurt Vail]: Is Todd

[Senator Matt Lesser (Chair, Human Services Committee)]: with us? Not online. We No? He's not in person. Okay. Why don't we go to Constanza Segovia, and then we'll go back to we'll go to Walter Glom next. Alright. Well, we'll go to why don't we go to Walter Glom? Walter?

[Walter Glomb (Executive Director, CT Council on Developmental Disabilities)]: Thank you. Good afternoon. I'm Walter Glomb. I'm the Executive Director of the Connecticut Council on Developmental Disabilities. I'm also a dad of an adult son who received services from DDS, who by the way is here with me today. So it was Nick. Nick drew number 198 today, so you may be hearing from him much, much, much later, if at all. Anyway, I'm glad to be here. I'm here in support of House Bill Number 5,557, an act concerning the eligibility determination by the Department of Developmental Services. I want to start just by saying thank you to the committee for raising this bill. As you know, it's something we've been seeking for a number of years. DDS offers a marvelous array of services and supports people with developmental disabilities. They have day and employment programs. They have, residential supports. You can get those services through agencies. You can self direct. They offer, person centered case management, so all the individuals in the system have individualized plans. This menu reflects the fact that people have many different dimensions. And each individual has their own needs and comes to the department on their own trajectory for their own reasons. People can't be reduced to a single number like an IQ. K? It's it's not it's just not practical. Psychology and and social science has recognized this for decades. There's volumes of literature on this. I've written on it. You may have seen some of my my past testimony in writing on this. The DSM-five reflects this science. The DSM has moved away from the IQ measure or any single linear measure of an individual to a more multifaceted assessment of the reality of a person. Eligibility determinations must assess the whole person and that's what the DSM-five does now. Yet Connecticut still works with IQ. It's an archaic measure. As far as I know, there are only other two other states left in the country that still use it exclusively the way we do. And when I say exclusively, I mean as a hard limit to exclude people from services. Many states still consider it though most don't. Most states don't consider IQ at all in their eligibility determinations. And those that do, it's a factor among others. So the definition of ID in the DSM-five takes care of this issue and that's why we're recommending the change. I'm one of the people who's asked rhetorically why does Connecticut have a different definition? And I think someone here asked that question earlier. Why do they? And I as far as I know from my research, the current definition, the use of IQ in the statute, it was put there in 1981 around the time that, Mansfield Training School was being closed. The state was setting up the system we have today, of, community based services. And in 1981, one could argue based on the science that the IQ was at least a practical tool. Okay. It's certainly easy to implement. However, it's been forty five years and there's been a lot more research done. Other tools have been developed. There's no need for there's no no reason for us to continue using such an archaic tool. So I encourage you to make this change. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, Walter, and thanks for testifying in support of that provision. Just a question about how to make that transition. So, you know, because I think the the concerns that we've gotten are just about making sure that as we, you know, transition to another way of providing the assessment that we're not closing the door for folks who would have received services but for that change. And so I think that that's one of the questions that's sort of you know, I also I agree with you that it is an archaic tool that doesn't reflect the science today and our understanding today. But how do we do this in a way that that works? And I know you suggested a pilot program as a way in which we address that.

[Walter Glomb (Executive Director, CT Council on Developmental Disabilities)]: I've made a number of suggestions, you know, over time. In fairness to the people behind me in line, I'm not going to dwell on all that now. I'll simply say that the the tools are there. I mean, I mean, first of all, again, most other states, all but two are doing this. So the examples are there. OPM commissioned the report by Altarum a couple of years ago. Altarum pointed to some other things, some other suggestions. I've written on this. I've, you know, I can point you to states and other tools. The DSM-five, I mean, you know, the definition is there. The tools to do the assessment are there. Okay? And, you know, if if I make, Commissioner Reeves in her testimony to appropriations spoke to this a bit. This is in the context of where we're going with CFC. We need in any case, we need to develop better tools here to prioritize levels of need, which we generally don't do. Right? We use we we have these eligibility criteria, and then we have waiting lists and then we we don't do a very good job of sorting the list in terms of priorities. As the commissioner said, none of us like waiting lists and we wish we didn't have them. Let's find a way to eliminate them. But while we're here and we've got these lists, the fact is we're rationing care and there are tools available to help us do that better. And this points in that direction, ways of determining levels of need. And that, Senator, that was one of my suggestions is that we begin that process of performing that level of need assessment on a larger population. I think it might've been mentioned earlier today in a different context, but we have Connecticut. Connecticut doesn't do a very good job of, doing population surveys, on this. We tend to rely on federal data, the American, the Census, American Community Survey. We, we've got lots of data on the people we serve. We have lots of, of, of, of data on the, what we do. We don't do a very good job of measuring what we don't do. And

[Representative Kurt Vail]: one

[Walter Glomb (Executive Director, CT Council on Developmental Disabilities)]: of my suggestions is that we start a program to do more level of need or universal assessment on the general population so we have a better understanding of what's the distribution of needs are and we can do a better job of prioritizing because you're absolutely right. We make this change. We're gonna need a different process for deciding how waiver dollars are gonna be allocated. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank thank you, very much. Other comments, questions? Representative Dathan.

[Representative Lucy Dathan]: Thank you very much, mister chair, and thank you, Walter, for your testimony. You highlighted the Altamiram report that was issued, as part of our twenty twenty three five thousand one, bill. There are five recommendations there. Do you mind just doing a quick summary of each of the recommendations?

[Senator Matt Lesser (Chair, Human Services Committee)]: I don't have any.

[Representative Lucy Dathan]: You don't have any? Okay. I'm not gonna be sit wild.

[Representative Kurt Vail]: There is a there is a since I've seen the report. Yeah. There is a some really

[Representative Lucy Dathan]: good, kind of things that are there, and I think they do have a a variety of cost element to this. But as we've been talking about with CFC and any waiver program, it does create a waving a waiting list, and so then it prioritizes folks. So seeing that we have, you know, DDS waiting list and DSS waiting list for each of these programs, I know other states look at ways that they can make sure that services are offered to right folks. In particular, the Washington and Vermont also does a assessment system, And they have an assessment tool for each, neurodivergent population Mhmm. Or, the DDS population. And, you know, looking at trying to constantly improve their assessment tools. Also, Washington does look at best practices. Or Washington does have some really good practices there that have slowly rolled out looking at behavior indicators as part of the assessment. All of these, you know, are part of the assessments that are already being done either within the school system generally. And so, I think, you know, you you hit upon something we hear a lot about in, DDS, which is the level of need and really focusing on those folks. I appreciate your, advocacy. I do recommend that we continue to look at this study. It was a paid study and wanna make sure that we are able to serve as many people in our state as we need to. So thank you so much, and thank you, mister chair.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you. Thank you, representative. Other comments or questions from members of the committee? Seeing none, thank you for being here this afternoon. Next, we have, Constanza Segovia followed by Josh Wojcick and the office of policy management.

[Constanza Segovia (Health Justice Now / CT for All Coalition)]: Hello. We actually have a panel with Rose Ferrero also, and we understand we have three minutes total. That's three of us. And she's online.

[Senator Matt Lesser (Chair, Human Services Committee)]: I also apparently, I skipped someone. So we we're making too much progress. Keep going. We'll go back to them. But I just want I apparently, we're moving we're moving too fast. That was not a feedback I thought I would be receiving today. Alright. So go please go ahead with your with, with the panel if that works.

[Constanza Segovia (Health Justice Now / CT for All Coalition)]: Yeah. And I think Rose will start, and then we'll continue.

[Senator Matt Lesser (Chair, Human Services Committee)]: Alright. Three minutes total.

[Rosanna (Rose) Ferrero (Universal Health Care Foundation of CT)]: Good afternoon to the Human Services Committee. I am Rosanna Ferrero. I live in North Brantford. I'm the policy director at Universal Healthcare Foundation of Connecticut. Thank you for the opportunity to speak on Senate Bill three and act concerning health care affordability. Today, I'm here with the Health Justice Now campaign to fight for quality affordable health care for all Connecticut residents. This is something that Universal has been doing since we were founded in 2000

[Representative Kurt Vail]: and are happy to do again and again until everyone

[Rosanna (Rose) Ferrero (Universal Health Care Foundation of CT)]: has access to the care that again until everyone has access to the care they need, when they need it, at a price they can afford. Changes to federal policy, as you well know, are taking us backward, and we will see a rise in the uninsured rate if our policymakers don't act. The uninsured rate is not just a number. It's these are real people living without coverage, without access to care. And we need more than stopgap measures offered by the governor, more than solutions that are only looking at problems when they are emergencies. SB3 makes real investments in health care affordability. It is a way forward. Specifically, the Connecticut option is a way forward. We support other parts of the bill. I'll let my colleagues speak on that. But the Connecticut option buys us time in the short term and sets up real solutions in the long term. Yes, we have big decisions to make about what the long term program looks like, including how we're going to make sure we don't leave anyone behind. The Connecticut option could not only catch folks priced out of health care, but help so many actually have coverage they can afford and use. Thank you for your time. I'll pass it to Tanisha.

[Speaker 40]: Is it back on?

[Tanisha Signore (She Leads Justice)]: Hello, members of the Human Services Committee. My name is Tanisha Signore. I live in Middlefield, and I'm the policy director at She Leads Justice, formerly known as Quealth. We're part of the Health Justice Now campaign in fighting for equality, affordable health care for all Connecticut residents. And this testimony, though my written will be in in support of other bills, I'm testifying today in support of senate bill three. We work every day with women in our state who are struggling in many ways, but the issue of affordability is always at the top of the list. Families are struggling to make ends meet, and the reality is compounded by expensive health care costs and unrelieved medical debt. We need to stop medical debt before it even happens. The governor's efforts on this have made headlines, but it is not a long term solution. The proposed hospital financial assistance policies set standards for hospitals and offer support for help. They're already required to provide for their patients, but generally don't. Connecticut is behind the curve on holding hospitals accountable for ensuring everyone who is eligible can access assistance, and sections nine through 11 of this bill are a start to catching up to other states. The basic health plan will help folks just over husky income eligibility and up to 200% of the federal poverty level by offering quality health insurance they can afford. Establishing strong hospital financial assistance policies and the basic health program are two critical ways s b three addresses medical debt getting at the root of some of this problem. We need to make sure all of these policies apply to all Connecticut residents. We cannot leave anyone behind. Thank you.

[Constanza Segovia (Health Justice Now / CT for All Coalition)]: And I'm Constanze Segovia. We are all part of the Connecticut for all coalition and health justice now campaign. We represent hundreds of thousands of Connecticut residents in labor, community, and faith organizations. Affordability is not a buzzword for us. Making the critical interventions that are outlined in this bill should not require making cuts in any other areas and should not be funded with one time gimmicks. We need your support in adjusting the volatility cap this year to make sure that funding is available permanently for this important policies. And we must make our tax policies more balanced by increasing contributions made by the highest earners in our state. We know this that keep folks afloat. That keep folks, afloat. This should not be a pipe dream in this country and in this state. PCAs need dignity in their work and we all need, affordability and dignity in our lives. We are glad that this committee is taking these important steps. Thank you for your time.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for, your testimony and for your work and support of all these issues. I just will say that we are our cognizance on this committee is limited to, human services policy. So we we don't get involved in tax policy. Those are the finance folks down the hall, but we hear you. Other questions or comments, well, I appreciate all three organizations and the coalition for working with this committee on these important issues.

[Representative Anne Hughes]: Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Next, we're gonna go to OPM, and then we're gonna go back to William Olegos, who I inadvertently skipped. Apologies, William. And then and then after William, we'll go to Janice Beverell.

[OPM Representative (on behalf of the Governor/Secretary)]: Good afternoon, senator Lesser, ranking member case, distinguished members of the Human Services Committee. Thank you for having us today to speak in strong support of the governor's bill, HB 5,041. We're here in substitution for the secretary who was delayed and not able to join but sends his regards. And we're also here on behalf of the governor. So before we begin, I wanna acknowledge the shared success that we've had as an administration and with this committee's leadership in making significant progress over the past several years on health care access, coverage, quality, and affordability. We have established things like the covered Connecticut program, which has become a signature in Connecticut, covering almost a third of our exchange population with fully subsidized coverage. We've, curbed the use of unfair surprise hospital facility fees. And last year, we had a landmark generic RX bill. We see the governor's bill, h b fifty forty one, as being a continuation of that progress. In specific, we have, the bill proposes a number of short and long term strategies all aimed to bring down the cost of health care for people in Connecticut. In the immediate short term, you've heard about the ICRA tax credits for small businesses. This is an opportunity for small business owners to provide an efficient way to leverage the exchange, our health insurance exchange to offer their employees better healthcare insurance, more choices, and also remove some of the administrative and complex burdens on small employers of having to set up their own group plans. Additionally, in the short term, we've authorized the use of portable benefits accounts. This is a recognition that a growing percentage of our workforce chooses to work in gig jobs and in the gig economy, especially if they have family responsibilities or family caregiving responsibilities. In fact, about 6% of the state labor force currently derives most of its income through, the gig economy. And these portable benefits are designed to help address those workers and help them get health care contributions from companies that they do business with. It's gonna close a critical gap in our contracted workers and making sure they also have access to health care. It's based on a successful pilot in both Pennsylvania and Maryland. The third short term strategy is a policy that would facilitate access to lower cost generic drugs on healthcare plans. The the proposal simply requires net cheaper generic drugs to also be included on a health plan if a more expensive branding op brand name option is included. This gives the consumers more choice to be able to navigate and choose to the generic drugs, which may be more price conscious and still effective for them and helping to bring down costs. Again, empowering consumers to make sure they make they can make the best health care decisions for themselves and their families. In the immediate intermediate term rather, we've proposed language that allows Connecticut the flexibility to navigate and figure out the continuation of our covered Connecticut program. We're very grateful that the governor, with the support of the legislature, has fully backfilled our covered Connecticut program by drawing down on the Federal Reserve dollars and ensuring that we could pay for the enhanced subsidies and the additional costs of that program through the 2027, which is our authorization period under our 11/15 waiver. We also recognize that at the 2027, we will have to renegotiate this program with a very different administration than the Biden administration that first authorized it. And in recognition of that and to make sure that we could get the best deal for Connecticut families and preserve the highest quality health care and most robust coverage under covered Connecticut, we're seeking some flexibility. We're also seeking an alternative pathway so that if an eleven fifteen option is not available to us, there's some assurances that people will continue to have zero premium coverage through a basic health program, a thirteen thirty one option. Finally, in addressing more of the long term affordability challenges, the governor has put forward a publicly designed privately run Connecticut option. The whole goal here is to take a step by step approach, lean into some of the unique opportunities that Connecticut has in our healthcare insurance industry, our provider systems and networks, and try to design a more cost effective alternative that could be offered alongside existing programs on our access health exchange. I also want to acknowledge that we're very pleased to see Senate Bill three share some of the themes and priorities that we have put forward. Obviously, trying to design a Connecticut option program, also looking at pathways to continued coverage Connecticut through some Medicaid authority. And I look forward to a spirited conversation and discussion through the next several weeks to make sure we have a comprehensive bipartisan bicameral package. With that, I'll take any questions.

[Senator Matt Lesser (Chair, Human Services Committee)]: I have a lot of questions for you, but I don't think I have several weeks worth of questions. If that's what yours thank you. Thank you, mister Galtieri, for your for your testimony. I'm sorry we missed secretary Wojcik. Although, this hearing will be going on for a while. So if it's delayed, he may be able to make it after all. Just with respect to a few different things, you know, I know that one of the things we've talked about and s p three looks at is the issue of subsidies made available to people who purchase private insurance on Access Health Connecticut, which, you know, folks lost a lot of tax credits at the beginning of the year. This the governor has stepped up and provided $50,000,000. I asked a question earlier about the status of that of representative access health. I couldn't quite get an update. Can you give us from your vantage point, an update of where that where that lands today? Have those funds actually been expended? Has anybody got their their premiums reduced? And do the prices on the website reflect that support?

[OPM Representative (on behalf of the Governor/Secretary)]: Yes, Senator. Thank you for that question. So I'll I'll start by saying, we were thrown a very unique challenge from Washington, when these programs and these subsidies went away. And the two populations that we chose to cover in Connecticut are one, some of the most vulnerable that just missed the covered Connecticut. So up to 200% of FPL, that one seventy five to 200, and the above 400. And I think the theory of the case behind which groups we chose is above 400 lost all coverage. They were no longer eligible for the basic affordable care act subsidies. That was a huge cliff and spike in terms of their premium cost. And from the one seventy five to 200, this is the most price sensitive group, so we recognize that there needed to be a little bit of a backfill there. I say that because the above 400 group, once you are no longer able to be qualified for the ACA, it wasn't a matter of simply plussing up what was lost. It was now setting up a brand new system for eligibility determination, income verification, and a way to get those credits back onto the individual consumers' accounts. So that took a little bit of time. I am happy to say that we worked, in all deliberate speed with Access Health, DSS, the OPM team. And we were able to stand up a manual based system so that those data files have started to transfer. So access health has produced and the carriers have confirmed that they were able to upload who's eligible and for what amount of ACA state backfill they're eligible for. And that those are hitting bills depending on your billing cadence starting in late February. But now, I imagine most people will see it in March and by the end of this month. So all good progress has been made. To your second question, obviously, we still have a small delay in the operational IT upgrades at Access Health CT. That system build out will take a little longer. I'm expecting that by the March, the full access health website will be updated to reflect the net payment after the state premium subsidy is applied. But in the interim, we've really done a lot of work educating up the brokers so that people can talk to a broker and someone could counsel them so they're very assured about what the price will be after all of the discounts and all of the state subsidies.

[Senator Matt Lesser (Chair, Human Services Committee)]: I hear that, but I'm I'm discouraged by that. I know that there's been a lot of work that's gone into moving this funding out. The governor announced that we would be providing that support to the people of the state in December. And now, we're hearing that the website won't even show it until the March. And I know that's a lot of work, and I get it. And I I'm respectful of that. And there's not just OPM, it's also DSS and Access Health and working with carriers, and there's a lot of complexity to that. And I am very sensitive to it. But I can't help but look at it and say that, look, we have we have not we should have started the planning process earlier. And we were I'm not not saying at any point would have been easy, but other states have also not every state. A lot of states are doing nothing, and I I I think it's very serious that governor Lamont has been, generous and serious and come to the table and said we wanna do something. But because, we didn't have that planning process in place, we we have a lot of people who are losing coverage who they should not well, you know, who who should not be losing coverage because the state has said they should have could be coverage. We the governor has made a financial commitment, but the Access Health website still shows the wrong prices. And, you know, I'm hoping by the March, but that's a quarter a quarter of the year has already gone by, and people are still and I don't know how those folks are doing. They're paying twice as much as they should be paying for health insurance, and they'll get a refund, but it is it is a it's in a lot to ask the people to connect. And I'm not saying that this is any of this is your choice or OPM's choice or Governor Lamont's choice. This is a policy failure by the federal government, but we should have done the planning in advance to head this off so we would have been more able to to respond. And the re I don't mean to play Monday morning quarterback. The the the thing that I think is instructive is that we're seeing this again with respect to other federal changes that are coming down, where we're looking at parts of HR one. We're looking at the potential renew of Covered Connecticut. And this time, if not before, this time, I think we really need to start that planning process in advance so that we're not just saying, we hope the federal government doesn't stick it to the people of Connecticut because they have before and they will again until we until we start planning and sort of head that off. So that's that's my view. And just in terms of the the basic health plan actually, no. I will actually, going going back going back to the subsidies for a second. Right now, the governor has created a one year promise, but there's a cliff. So if we get those if we are able to get those subsidies fully up by the March, is there any plan at present of continuing them forward?

[OPM Representative (on behalf of the Governor/Secretary)]: Senator, I appreciate it. I wanna just take a moment first to go back to your other point, which is, yes, I will leave it to Access Health to talk about the timeline for operationalizing the website. But let's be absolutely clear for the people listening at home. Just because the website says that there's a higher sticker price does not mean people aren't feeling the benefits of those dollars and those subsidies going out now. People are paying the reduced price on the promises made and the funding that Connecticut has before to backfill those subsidies. So on the back end, they're actually seeing the relief currently. Thousands of individuals on the exchange are getting the benefits. So I wanna distinguish the actual impact of the benefit is happening now and is currently being felt by consumers. And, yes, there's some publicity and communication strategy that needs to be tightened up and accelerated on the access outside. To the second point about planning, the unique thing here, and I started out by saying we chose two very discrete subpopulations to help backfill. And I think part of that was a recognition that when we were talking about this in the summer, we had a sticker price of backfilling the ACA subsidies at north of $320,000,000 And no one knew how the actual subsidies would roll out because we had not approved rates at that time. So I understand, what you're saying. We should try to be as planful as possible. But sometimes, there are inflection points and critical details that develop much later in the cycle, like approval of the insurance department rates, which happened in early September often that made a radical difference. Because in the state of Connecticut, the way the Molina and Anthem prices were approved, we created a situation where the second lowest silver, which sets the premium subsidy for people on the exchange, was significantly increased. Meaning that for people between 204100% of FPL, they actually were net better in '26 than they were the year previously. So when we're trying to be thoughtful about designing a backfill, sometimes we need to be waiting for other factors and key data points to come into play. I also take your point about being planful of covered Connecticut. I think that's why both, senate bill three and the governor's proposal, intentionally starts this process early. We know that we're good until the '27, but we should start a two pronged process, one with a thirteen thirty one basic health program, one with the eleven fifteen to see what's our best deal, and let's start that process now and make sure we have the flexibility to do that. So I think we're aligned there and moving forward.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, I I hear you. But so going to the the question about the subsidies, subsidies are in effect for so, you know, in theory in effect from January for this year to January. I don't see anything on the governor's budget contemplating that they continue past January. So if folks just gonna lose coverage next January, what's the what's the is there a plan in place to extend them if Congress does not reop them?

[OPM Representative (on behalf of the Governor/Secretary)]: I think just like this year, we continue to contingency plan and scenario plan to make sure that whatever options we have available, we're gonna be presenting the governor with maximum flexibility and a number of options, and we'll take stock of the circumstances as it comes closer to the time. Part of it also matters on what we were able to accomplish this year. You know, are we able to do some really creative and innovative stuff this year that reduces the cost of health care? And then we, you know, take a look at different strategies. The basic health program may be the way to backfill the up to 200. So that's under consideration as we look to explore new continuation of the covered Connecticut program. So I think there are multitude of strategies. I don't think we're yet at this place where we're just beginning the plan year or first quarter of plan year '26 that we'd wanna lock into what exactly is gonna be the solution. I think the governor has always said where the federal government steps down, we're gonna look to make sure that the most vulnerable are protected and do what we can in a prudent and reasonable way to to help fill that gap. That doesn't mean we can do everything, but I think we're gonna be thoughtful and do where we can.

[Senator Matt Lesser (Chair, Human Services Committee)]: So senate bill three contemplates, and I and I appreciate your your willingness to work with us on senate bill three and the governor's priority bill, contemplates, you know, this issue and says, hey, we should start that planning process now by creating a health care affordability trust fund. We created a $500,000,000 federal response fund to address cuts in federal funding. We've seen cuts in federal funding. That problem has happened. So we could create a fund, put it off budget, have it in, you know, present in case Congress does not re up the funds, and then we've done the planning process so that we know that that that gap doesn't happen. If you're saying, hey, let's wait until December again next year or December this year, find out whether or not Congress acts before the end of the year, and then realize, oh my goodness, there's a spending cap. There's no funds to set this up. We haven't had conversations with the carriers. We haven't had conversations with Access Health. That's what I'm worried about that that we might run into, and that's why I'm suggesting that we just start that process earlier because we we know that this is gonna be an issue whether or not they get we don't, you know, I don't have a crystal ball. I don't know what Congress is gonna do at the latter part of this year. But but I we know this is gonna be a question, and people always are gonna wanna know whether they're gonna see a quadrupling of their premiums or whatever. And so that's something that we need to address. So I'm hoping we do that. Just with respect to you know, you you mentioned some other issues that are gonna happen in 2027. My understanding is that there's some populations that have lost health care this year. So for for example, the lawful permanent immigrant. These are lawful immigrants. It's in their name, permanent residents. A number of them have lost coverage about 5,000. Is there anything in the governor's proposal that addresses that population?

[OPM Representative (on behalf of the Governor/Secretary)]: Thank you, senator. So, we did draw down funding from the emergency response fund, in order to backfill and provide supplemental payments to our FQHCs. This is a access point where individuals can go for behavioral, dental, and primary care visits. They don't ask any questions. It's obviously paid for in a sliding fee scale. So even if you don't have insurance, you could avail yourself of that. And because these are legal residents, I mean, they are able to access services through the FQHCs, which are great partners in this work. I recognize that that's not a comprehensive health care plan, but it is something that we were able to quickly deploy. We're also able to leverage some federal match to double that investment in our FQHCs. And we're actively considering other strategies moving forward about building on the FQHC investment for more comprehensive coverage. I think it's in our shared interest to make sure that population where possible is getting screenings, prevention, primary care because in all likelihood, especially that subset that lost insurance this year is under a hundred percent of FPL. They may very well likely become on Medicaid within the next one to five years. So the healthier they come on to the Medicaid population, I think the better for us. So it's in our shared interest to identify those individuals, either connect them to work so that they're making more money than a 100% in getting premiums, subsidies, or finding some way for they can so they can access the basic primary care and prevention services they need to stay healthy.

[Senator Matt Lesser (Chair, Human Services Committee)]: So the in addition to the cuts to health care, there are also cuts to food assistance, and large numbers of people are going to be losing their food assistance this year, thanks to HR one. We were we've heard we've had some conversation about cuts to veterans, but also folks who live in, cities that have high unemployment rates, folks who are, aging out of foster care, all sorts of different populations that are being affected. Is there any openness for this for the governor to consider or the a a state food assistance program? And if not, what are the what are the other ways we can address this issue?

[OPM Representative (on behalf of the Governor/Secretary)]: So, again, you know, I think today, our intention coming here, and I don't wanna lose sight of the fact that the governor's health care bill and senate bill three are huge priorities. So I don't wanna lose sight of the fact that health care affordability is a top priority, and it's something that we have before us in our control here in the state of Connecticut, and we ought to get something done. Yes. There are a number of federal changes at the at the, in the congressional level that we're gonna have to contend with. And we are fortunate enough to have put aside some money and we have the flexibility to continue to deploy those resources strategic and thoughtfully. We have in the past anyed up money. So when the federal government was closed in a lot of states, they had SNAP benefits that were expired and no one could access SNAP and food assistance. We were able to provide, some backfill and some assurances for the people in Connecticut. We've also put significant resources into food share to try to fill the gap where we can. We've expanded on that more recently by making sure that local pantries could also take advantage of additional state supports and assistance. On top of that, we're looking at ways to connect people through two zero one, our community action agencies, and community health workers to connect to other local services and support. So I think there's always been a measured, targeted, and thoughtful approach to help the most vulnerable. We've continued to do that through the Lamont administration. We know there's more turbulence ahead, and we have the resources we believe to continue to help make sure that our most vulnerable are as best protected as can be.

[Senator Matt Lesser (Chair, Human Services Committee)]: The governor has undertaken, I think, two Medicaid rate studies over the last number of years that suggest that the Medicaid program is severely underfunded with respect to neighboring states or to Medicare. And that's creating access issues and recommends significant investments into the Medicaid program. The governor's budget does not, at the moment, did not add any additional funds to the Medicaid program. So I wondered if you have any additional beyond what we had already appropriated last year in terms of making up the rate deficiency. Is there a timeline that you anticipate for when we are gonna be able to meet the goals of the rate study?

[OPM Representative (on behalf of the Governor/Secretary)]: Thank you, Senator. One, I think that's a reminder of why it's so important that we continue down the path that Connecticut has set forth of growing and strengthening our exchange and our commercial market wherever possible. The more we rely on, Medicaid, the difficult more difficult it's gonna be because there's gonna be that water ballooning effect where it's even just putting more pressure on our commercial rates. Because if Medicaid can't keep up with commercial payments or with peer states, it's gonna mean that needed hospitals and health service systems have to go elsewhere. And that, unfortunately, becomes on the backs of people who are price sensitive and trying to afford commercial insurance. Secondly, to your point about, you know, what what else can be done, I I think that, you know, we'll have to just sort of continue to have conversations about it.

[OPM Staff (first name referenced as “Zanu”)]: Yeah. I also think to your question, I think we came here for the affordability bill, and I think that is an appropriate question for appropriations. And as we continue, we have looked at the rate study. We've appropriated money in the past to work through it, and it's an ongoing thing as we continue to work through it. So it's a discussion we have. We work with DSS. It's an appropriate question for DSS as well, but I appreciate the question.

[OPM Representative (on behalf of the Governor/Secretary)]: And just to add on, thank you, Zanu, for You

[Senator Matt Lesser (Chair, Human Services Committee)]: you don't care. You can't get away with that. You come here. We're gonna ask you whatever we want. So no. Go ahead. I'm sorry. Go ahead.

[OPM Representative (on behalf of the Governor/Secretary)]: I I do just wanna remind the committee that the enacted budget had a significant investment of over $40,000,000. So the current, we adopted two year budget. There's a $40,000,000 state share, 80 plus million once you leverage the federal funding on targeted rate increases. And I think that despite some of the consternation that when we had limited resources in FY '26, we did put a heavy amount of money into our FQHCs. I always believe we ought to achieve the tipping point, critical mass. If we just shred the peanut butter super thin and give everyone a small 1% increase, we haven't changed behavior or actually improved access. So I understand there's been some, second guessing of why do we put so much in the FQHCs. But to me, it was a three year commitment that solved the problem, that actually got the rate sufficiency up. In addition, we have made huge investments in nursing homes through the settlement agreements to make sure that workers are paid higher. And those are Medicaid costs in excess of a $100,000,000 over a three year package. DDS group work DDS group home workers are also part of our Medicaid system, and we've increased their rates significantly. So I think this budget does contemplate even you guys going into, you know, early in session, you did the eCert that added several million dollars to ICF workers. Those are Medicaid rates. So we have done where we can in terms of trying to address access issues. But, obviously, this has been an issue that's many years in the making, and we're not gonna make it up in in one budget cycle.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. So with respect to the governor's health care bill, there's a lot in there that I actually applaud and support and think are very thoughtful about access to prescription drugs, about if it's important conversations around around market reforms and what we can and can't do and how we sort of plan and engage stakeholders. And I think all of that is is very good. Just with respect to portability, there's an something called the ABC test about determining whether an employer is an employer or whether they are an independent contractor. And so I understand the the portability attempts to get health insurance benefits to people who have who are independent contractors. And, you know, there's a big issue of misclassification in the country. There are folks who should be employers employees but are not getting Medicare, Social Security, are not getting workers' compensation. And I was wondering what sort of due diligence you had done to sort of the governor's office had done to sort of think about how this intersects with the ABC test for determining whether or not someone is a a valid employee.

[OPM Representative (on behalf of the Governor/Secretary)]: Yeah. That's a good question, Senator. I think our intention here, and that's why we followed the measured example in Pennsylvania and in Maryland, is that this is agnostic on classification status. We're not looking to referee that. It simply removes a hesitation that certain employers have now for not wanting to back into a different type of relationship, nor that the employees may not wanna have that different type of relationship. So the ABC test, you're bringing me back to my law school days, so I'm a little rusty. But it's a it does it's a multifaceted test that looks at essentially the degree of control that the hiring entity has over the individual employees. And that includes terms of hours, type of training, when you have to work, what the modifications or job and employment environment is for that individual. Can health care be used in some cases? I think that's the chilling effect that we're trying to remove. So all we're trying to do here is remove a barrier for willing, hiring, contracting parties to provide health insurance benefits or seed money for portable benefit accounts without respect to the employer test. There's still plenty of other factors that will weigh into that agnostic of whether there's a portable benefit. Gentle suggestion would

[Senator Matt Lesser (Chair, Human Services Committee)]: be to look at possible having a mental multi employer ICRA to allow folks to purchase coverage on the exchange with support for multiple employers. I think that might address the issue in a way that wouldn't raise questions about misclassification. I'm happy to work with you on that and other issues. And then, I think, that does it for me for the moment. Questions from members of the committee? Folks don't want anything to do with the Office of Policy Management. Anything else? Okay. Is Josh back in state now? I don't know.

[OPM Representative (on behalf of the Governor/Secretary)]: I think you have a few more hours. Okay. Keep going till midnight. I'll make sure he comes down here for the next

[Senator Matt Lesser (Chair, Human Services Committee)]: hour. Sounds good.

[Representative Kurt Vail]: Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Representative Bill, Chris, you want anything? No. You're good. Alright. Thank Thank you. Very much. Appreciate it. Alright. So now we'll go back to William Olegos.

[William Elias]: Hello. Thank you very much. Apologies for the confusion. I'm just here to echo some of the great sentiment that my fabulous co chairs from the LGBTQ plus Justice Opportunity Network already shared. But again, I appreciate the opportunity. Good afternoon, Senator Lesser, Representative Gilchrist and honorable members of the Human Services Committee. My name is William Elias and I serve as the administrator of Connecticut's LGBTQ plus Justice and Opportunity Network. I'm speaking today in my personal capacity. I first joined the network as a volunteer in December 2022. I'm sorry. I first joined the network as a volunteer in December 2020. In 2022, I became the first paid administrator in the network's history and I remain the only staff person supporting its work. Over the past six years, I have had the privilege of watching the network grow from a relatively small coalition into a statewide body that brings together organizations, advocates and community leaders working to improve access and opportunity for LGBTQ plus residents across Connecticut. I want to speak specifically about section four of HB 5,562, which updates the statute governing the network. As you've already heard today, the network itself was established by the Connecticut General Assembly in 2019. Its purpose is to help protect the health, dignity, and safety of LGBTQ plus people in our state by bringing community expertise together to inform state policy and strengthen services. In my experience working with the network over several years, one of the biggest practical challenges in maintaining a strong statewide coalition is the reality that nonprofit organizations evolve. Leadership changes, organizations merge, and sometimes they close entirely. When a statute ties membership to specific organizations, it can unintentionally create barriers to keeping the network active, representative, and responsive to the community. The proposed change in this bill moves the statute toward category based representation such as health care providers, educators, youth serving organizations, and others who work with LGBTQ plus communities. This approach better reflects how the community and service landscape actually functions. It allows the network to include the expertise and lived experience needed at the table, even as the specific organizations doing that work may change over time. These updates will also help ensure the network can fully utilize the membership structure envisioned in statute and better reflects the diversity of Connecticut's LGBTQ plus community. This flexibility will help ensure that the network remains sustainable, representative, and able to continue advising state government effectively in the years ahead. This moment underscores why the network's mission remains so important. In recent years, we have seen a wave of national actions targeting LGBTQ plus people, particularly transgender youth and families, including efforts in multiple states to restrict gender affirming care, attempts to roll back nondiscrimination protections, and increasing political attacks on the rights and visibility of LGBTQ plus people. In that context, the work of the network becomes even more critical. It provides a structured way for community expertise and lived experience to inform state policy, way for community expertise and lived experience to inform state policy so that can so that Connecticut can con continue to build a safer, healthier, and more just environment for LGBTQ plus residents. Thank you for your time and for your consideration of this bill.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your testimony. I I think I recognize that building behind you. It may be part of my district.

[Committee Member (Unidentified)]: It is.

[Senator Matt Lesser (Chair, Human Services Committee)]: Been there once or twice. Any comments or questions from members of the committee? If not, thank you for your work and for your testimony today.

[William Elias]: Thank you very much.

[Senator Matt Lesser (Chair, Human Services Committee)]: Next, I don't actually, let's go to Janice Favreau.

[Walter Glomb (Executive Director, CT Council on Developmental Disabilities)]: Okay.

[Senator Matt Lesser (Chair, Human Services Committee)]: And then after Janice, I don't see senator Looney here, and I don't see commissioner Porter. But if either of them pop in, we'll go to them. If not, we have plenty of other people to go to. Oh, if not, we'll go to Todd Johnston.

[Janice Favreau]: Good afternoon, Representative Gilchrist, Senator Lesser, members of the committee. My name is Janice Favreau, and I am the chair of the DDS North Region Advisory Council. But I'm here speaking today on as a parent and legal representative for my son, Christopher Favreau, who is a current resident in a DDS public home. I speak in support of HB 5,558 and in particular to the amendment language on page one, lines nine through 11. Christopher has been in a group home system for thirty years. And prior to his current residency, he spent twenty seven of those years in a private non provider home private non profit provider home. During this time, Christopher has been subject to numerous abuse and neglect incidents, the majority of which were listed as unsubstantiated because the source of the neglect was not identified. Never in the 29 of his residency was I provided with a written copy of any of the investigations or the findings. I was in I was told I was not entitled to it. On 06/30/2024, during a visit to my home, I discovered a seven inch diagonal bruise up the small of Christopher's Christopher's back. I immediately called the group home to report it. Allegedly, they knew nothing about it. On 07/01/2024, I notified the group home supervisor and his DDS case manager by email of the injury, which included the photo of the injury. I received an acknowledgment from the case manager and that it would be reported to the abuse investigations division of DDS. During the next sixteen months, and despite repeated requests for status update on the case, I was told no information was available. I later learned that the investigation was completed by the January '25. But it was not until November 25 when a new DDS case manager was assigned to Chris, and I again asked for a status that I was finally informed the abuse and neglect charge was unsubstantiated. I requested a written

[Representative Kurt Vail]: copy of the report, and then for the first time in twenty

[Janice Favreau]: nine years, I forward my request in writing to Commissioner Jordan Shuff. Upon reading the report, which did not contain my original picture of the injury, I found the entire fact pattern to be incorrect, including the finding which cited the wrong body part. I asked for a meeting with Kendra Slally, DDS director of investigations. And after presenting the facts, she agreed to reopen the investigation in December '25, the result of which is still pending today. Had I not gotten the written copy of this unsubstantiated abuse and neglect report on my son, I would have not discovered that the entire fact pattern was, in fact, erroneous. Christopher bears the scars of several of these abuse incidents and I bear it every day on my heart as I worry about his safety and his care. In conclusion, the written report and the findings of both substantiated and unsubstantiated reports should be automatically provided to the parent legal representative to ensure the accuracy of the report along with improved oversight and transparency in the care of our children. Thank you. I'd like to also make one note that on page three of this raised bill in line 49 through 51 where it talks about reviewing the department's method for sharing information, it says regarding substantiated abuse and neglect complaints, if you want to modify that to include unsubstantiated, I would appreciate that. And I'd also just like to make one further comment that the recently released DDS abuse and neglect numbers of four thousand two hundred and forty six cases from 2024 alone are absolutely appalling and Christopher was one of those cases. But what is equally appalling is the lack of transparency and timely reporting on these abuse and neglect reports and the herculean effort that it takes for a parent representative to obtain a written copy of the investigative information on a reported injury to their child. So I, as a parent, ask that HB 5,558 be moved along to passage to ensure better oversight on the health and well-being of our children. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your, testimony, and I I I'm just so sorry that you're going through this, and you have to be an advocate for your son. I'm sorry.

[Janice Favreau]: By the way, this is also an substantiated abuse charge. This was when he was at an Oak Hill home. This is unsubstantiated. So we definitely need to provide more oversight on the unsubstantiated reports. Thank you so much.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, appreciate hold on. Hold on. You have to see if the people have questions and whatnot. We you may be off, but let me let's just see. So I I just wanna say that this committee has has been really focused on the issue of abuse and neglect in EDS facilities for a couple years now, and it's something that is of interest to many of us. And so appreciate your testimony and your suggestions for the legislation. Are there comments from members of the committee? Representative Dave.

[Representative Lucy Dathan]: Thank you so much, mister chair, and thank you for your testimony. This is something I take very seriously into heart. I did note in the 2024 release of the, DDS audit, one of the findings was control over abuse and neglect, investigations. And one of the, this was a a new finding by the auditors of public accounts. And, the department said, the recommendation was that they need to strengthen its returnal controls and monitoring efforts to ensure prompt completion and adequate documentation of abuse and neglect investigations. So, the agency has responded, and they have highlighted, where they are. And I know that this is gonna be this finding will be investigated, as part of the ongoing audit that is currently happening right now with DDS. We will be having an audit report for the latest cycle released probably a little bit later this year. But, I agree with you that we need to make sure that we are on top of this and that the investigations are being reviewed properly and communicated to the next of kin, on a adequate prompt basis. So appreciate you coming today. I know as a parent, it must be so difficult to to see this and, and having to come and relive it up here for us. But this is stories like this, you know, make sure that we we do take this seriously, like every other agency, and want to move forward with, some better oversight and better, control over this. So thank you so much. Thank you, mister chair.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, representative. I'll just also note that DDS did submit written testimony against the bill. I wish they had been here to have a conversation with us so we could ask questions about what you're talking about and what other folks are talking about as well. There's a a couple of bills that pertain to DDS, and it would be nice to have that conversation. Any other comments or questions, members of the committee? Yes. Representative Gilchrist.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Great. Thank you. And thank you for raising this issue and being here today. And I echo my deepest apologies for what has happened, but really appreciate you using that to try and help others. In the submitted testimony from DSS, they do speak to how in the scenario you're discussing with us when you requested the report that this would potentially be a violation of an individual's

[Janice Favreau]: right and that this information isn't always open to parents and legal representatives? If the parent is considered to be the perpetrator, I can understand why the report would not be released to them. But as the legal representative for my son, he to release the information to him, he does not have the capacity. That's why he has me as the legal guardian. So it would be there are very few residents that are in the group homes that are their own guardians. And so they do have legal representatives. Therefore, it's imperative that we, as the legal representative, receive these findings so that we can ensure that they have been accurately reported. This is the entire issue and I have no idea over the past twenty nine years. I still don't know what were the results of this. My son was brought to me this day to church to church. He was brought to church to us. And when I said, why does he have this black eye? I don't know. How did it happen? I don't know. Never got a finding. Never heard anything until I was told it was unsubstantiated. And unsubstantiated reports mean they cannot determine who created this or how it happened, so they just wash their hands. And what you'll hear other folks talk about probably later today is the fact that private agencies are allowed to investigate themselves, which generally means that you have an administrator person who is the person who's doing that investigation and why would they report against themselves? Why would they make a finding against themselves that could account for why so many of the years, the twenty seven years Chris was in a private non private nonprofit provider home, that we never got substantiated charges because they were allowed to investigate themselves, and that must stop. We need to have third party investigators Thank you. Someone who's trained for doing that. So I really we do appreciate and the council the parents on the council are appreciative of all of the efforts that you have made in, you know, last year on our behalf and for our children. And we hope that with continued modifications and amendments, we can make this a a better bill. So thank you very much. Thank you. Thank you, mister chair.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you, representative. Next, we have commissioner Amy Porter. After commissioner Porter, we're gonna go to Todd Johnston, and then we will go to, James Kritzman and David Schwartzer.

[Commissioner Amy Porter (Aging and Disability Services)]: Great. Good afternoon, senator Lesser, representative Gilchrist, senator Perillo, representative Case, and distinguished members of the Human Services Committee. My name is Amy Porter, and I'm commissioner of aging and disability services. I submitted written testimony. So in the interest of time, I'll just briefly touch on three of the bills being heard today. Section five zero one deals with wheelchair repair. As this committee knows well, the breakdown of a wheel chair is more than an inconvenience. It can negatively impact employment, education, physical health, mental well-being, and overall quality of life. We appreciate the committee convening the Complex Rehab Technology and Wheelchair and including our agency on it. The work of this council has resulted in significant service improvements. SB five zero one modifies council membership, requires wheelchair dealers to submit data monthly instead of annually, and requires them to notify consumers of their rights to timely repairs. ADS supports these changes, particularly as the data submission is consistent with current practice and requiring notifications to consumers about their rights is the next logical HB 5,556 looks at designing and implementing a system to close service gaps for young adults with intellectual disabilities who have co occurring behavioral health needs. And we just wanted to note that to the extent that this work includes employment services for this population, ADS would welcome inclusion in these planning activities. And finally, House Bill 5,562, which deals with various revisions to human services statutes, ADS support section one requiring managed residential communities to add contact information for DSS's protective services program to their posted notices of resident rights. Based on our agency's responsibilities under the long term care ombudsman program, we believe strongly that this information should be readily available at facilities, both to strengthen awareness and to strengthen our state's overall safety net. As you're considering these and other revisions to the human services statutes, we respectfully request inclusion of an ADS specific technical adjustment in the bill. This adjustment would eliminate reference to an outdated statutory caseload formula for our teachers who work with students who are blind. The new language would align with our current practice by requiring consideration of instruction levels established in the student's IEP or five zero four service plan. The student's geographical location, and other relevant caseload management factors that are outlined in our service delivery guidelines. This will help us determine the appropriate number of teachers needed to serve our school districts, allow us to effectively serve as many students as possible within our budgeted resources. On behalf of our dedicated team, we thank you for your ongoing support, and we'd welcome the opportunity to work with you on any of these critical concepts. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your testimony. We look forward to engaging with you and your team at ADS on your proposals, and we, appreciate your testimony. Other comments or questions from members of the committee? Seeing none, thank you for your patience with us today. Yes.

[Speaker 50]: Work with

[Senator Matt Lesser (Chair, Human Services Committee)]: the committee.

[Representative Kurt Vail]: Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. Great. Thank you very much. Next up, we have Todd Johnston followed by by Jan and David.

[Todd Johnston]: Good afternoon, everyone. My name is Todd Johnston and I'm a person with a disability who is employed and is on Medicaid through MedConnect. And I also use a power wheelchair. I am here today to speak on s p three and s p five zero one. First, s p three, I request that you read through the details of Sheldon Tobin's testimony of which I've taken a little excerpt. Section 17 b dash 28 b and section 17 b dash two sixty six, repealing these two sections should go a long way to protecting the 900,000 plus Connecticut individuals on Medicaid, including those with disabilities. In the event a governor should again seek to return us to the inefficient capitated managed care. Second, on SB five zero one, the Wheelchair Repair Act revisions, I speak as a member of the Wheelchair Reform Coalition. I greatly appreciate the leadership of the Human Services Committee, in particular, Senator Lesser and Representative Gilchrist in passing PA 24 dash 58, and now seeking to improve it on raising SB five zero one. There are nine points which the Wheelchair Reform Coalition would like to make sure you as a committee are aware of, of which I'll just comment on a few. This bill should help, but will need some revisions to be fully effective. We do fully support moving the administration of the council to the office of health care advocate. The structure of the council having two chairs has worked well, and Maureen Emerault has been a stellar co chair. We think it should stay with the common model of one state agency chair and one private stakeholder chair. Appointment of a second wheelchair dealer to the council is reasonable and consistent with the council's recommendations, but not a place of not in place of a consumer advocate on the council. The current appointees of private pay including I mean, individuals in 42 dash three three nine B four be changed to Medicare enrollees as Medicare enrollees because they are responsible for 20% of the cost of their devices paid for by Medicare. And lastly, providing written notification to the consumer with the timeline of the repair at the time of completion of the repair. It is a priority of the wheelchair counsel, especially if there is going to be going to continue to be no direct enforcement of the deadlines in the law, either by state agencies or through the creation of the private right of action. There is suggested new language required in the provision of this document, which is included in the proposed new subsection two f attached to the testimony of Maureen Eremalt. I'm sorry. Thank you for allowing me to testify.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you for your testimony and for your suggestions. We really appreciate them. Are there questions or comments? Members of the committee? Seeing none, thank you, for being here this afternoon. Next up, we have, Jan, Chrisman and David Schwartzer.

[Speaker 29]: Members of the committee, good afternoon. My name is David Schwartzer from Newington, Connecticut, and I'm here in support of SB four seventy eight. The purpose of this bill the I'm sorry. The proposals in this bill are long overdue and are an important step in bringing an end to the punitive rate increases imposed on the over 100,000 Connecticut long term care insurance policyholders, mostly seniors, who purchased their policies in good faith only to learn years later that the industry misrepresented at best and outright lied at worst about the future premiums that they may have to pay. Today, policyholders are paying premiums of 200, 300, 400% higher than they expected. The insurance companies continue to want us to believe that they are the victims in this crisis. They cry poverty and say they need these increases to survive. They fake concern for their policyholders by offering alternatives that benefit themselves much more than they do the policyholders. To add insult to injury, the Connecticut Insurance Department continue to accept their unproven excuses so that they can continue to line their pockets with these punitive rate increases. Both the industry and the Connecticut Insurance department would have you and I believe that this is a claim crisis. It is not. This is a premium crisis created by the long term care insurance companies when they violated the foundational principles of their own industry. This is not a crisis due to a lack of data when they first started selling these policies fifty years ago or a lack of interest in investment income or because people did not give up their policies as much as they expected or because people are living longer than expected or because health care costs have increased more than expected. And this certainly is not a crisis because just one or two companies made mistakes. This is a crisis because an entire industry created a product that was underpriced, undersold, and doomed to failure before the first policy was ever delivered. The purpose of s b four seventy eight is clear, to bring long awaited accountability for the actions of an industry that has put executive compensation over policyholder compassion, lame statistics over policyholder security, and corporate profits over policyholder protection. When we buy an insurance policy, all we get is a piece of paper and a promise. The long term care insurance industry has delivered the paper, but they are not delivering on their promises. SB four seventy eight can begin to fix, to fix that, and I urge each member of the committee to support this bill and move it to the house and senate for final passage. Thank you for your consideration, and I would be happy to answer any questions you may have.

[Senator Matt Lesser (Chair, Human Services Committee)]: I thank you for your testimony. Oh, your friend, representative Vale, has a question.

[Representative Kurt Vail]: I just thank you, mister chairman. Good afternoon. I agree with what you're saying. Again, I used to I still am a licensed insurance agent, so I'm familiar with, you know, underwriting and underwriting process. I've done long term care, not recently, but in the past. And, the cost of health care is irrelevant to the policy like that because it's a it's a bag of money. We've had this conversation in the past. It's a specific dollar amount. So the only thing that would cost risk and and is if more people are going in and using their policies than anticipated. So they did the math. They did it poorly because a policy like that, you buy at a certain age like you do life insurance. So when you buy a life insurance policy, there's a a chance you could pass away, knock on wood, in two weeks or but they're gonna bet that you pay your premiums long enough and enough people pay their premiums that it's based on your life expectancy at the time you purchase a life insurance policy. And and the premiums are they have the best mathematicians in the world as actuaries to figure out these statistics so they make a profit, and that's okay. Because we're gonna put into our monthly thing, you know, so we take care of our families when we're gone, however that works. And it's based on when you buy the policy. Well, the same holds true for a long term care policy. You know, if you have ailments, you you might get an increased premium. You might not get accepted at all. So first off, there's very stringent acceptance policy for long term care. As selling it, you know, I you do underwriting when your own underwriting. And if you see if you know there's things that are gonna disqualify someone, you're not gonna write the policy in the first place. But even then, it's very difficult to get in a long term care policy approved. So they have all these very strict things and it's based on a certain amount of money. It's so what it costs what health care costs is irrelevant because you bought $300 a day, you know, with with inflation, and they should figure out the math accordingly. So it is on them for not having done the math correctly in the first place. And, unfortunately, they don't wanna take a loss at all, so they're putting that back on all the policyholders. And so, hopefully, we can get this in do I think it I don't know. Do I think it was done on purpose? I don't know. But regardless, it it the math the math didn't work, and now the policyholders are paying the price. So it's already how many people think to buy long term care insurance? Right? They took on not a lot. You know? And so the the people did that so they could protect their assets and have good insurance to to to do all that. And then in the end, you know, it doesn't work out. It it's it's very frustrating for me having done it, and I appreciate your testimony. And I hear what you're saying, and I'll listen to more of it. But I'm probably gonna cosign this legislation as I sit here right now. So thank you. I don't know. I I thought I was gonna have a question, but I guess I just started ranting. So

[Speaker 29]: yeah. Well, if I could add to that, because the the industry for years has been saying that when they started selling long term care insurance, they had no data, and and they had no way of really understanding what was going on. And now they're saying because they had no data, they didn't get the interest income they expected. People are living longer than they expected. And the reality is it's not that they didn't have the data. It's that they didn't want to look back to figure it out. You know, we it you can't predict the future, but you can look at the past. And if you look at the past, what you find out is their argument about not getting the interest they expected. Well, in 1974, it was a good year. The average interest rate was 10 and a half percent. If they said, well, that's what we're gonna get in the future, they miscalculated. Because if they had looked back just ten years, they would have found out that the interest rate was only 3.5%. And if they said, well, we need twenty years to figure this out. Let's look back twenty years. They would have found out that in 1954, the interest rate was 1.01%. And if they decided they didn't wanna look back to better understand what the future might hold, All they had to do was look another couple of years because while it was 10.5% in 1974, it dropped to 5.82% just a year later, and then a year after that dropped again to five point o 5%. So their argument of we didn't get the interest we expected just doesn't make sense because the data was there if they had looked back to see the massive fluctuations in interest. They also talk about people living longer than had been expected. And the reality is, again, if they had looked back, they would have been in better shape than they are today because in 1954, the average life expectancy for a man was 66.7 and for a female was 72.7. In 1974, when they started selling long term care insurance, The life expectancy for a man was 68.3 and the life expectancy for a female was 76. So if they had just used that 1.6 and that three point three, they actually would have been ahead of the game. But if you look at 1974 to 2024, because that's the most recent data available, the life expectancy for men only went up three and a half years. The life expectancy for women went down four point four years. Mhmm. Sorry, women. And at age 65, men were living three point nine years longer, but women were living two point eight years less. The fact of the matter is if they had just used gone back twenty years and used the information that they could have looked at, this life expectancy issue doesn't exist. These are all things that they're making up to justify the fact that they closed these policies within a few years cutting off the influx of premium that they could have collected for ten, fifteen, twenty years from new policy purchasers to build the reserves necessary to pay the claims today. I don't necessarily disagree that the sub companies, the writing companies that the larger parents have created to hold these money losing policies have a financial issue. But that's a manufactured issue to give policyholders and regulators and legislators the false impression that this is a crisis that they're the victims of because they're not.

[Representative Kurt Vail]: But, also, you talked about they started selling policies in 1974. I don't think there's anyone here pushing for this that bought a policy in 1974. So I assume that most of these policies were having issue with was born in the late eighties, the nineties. And then so by that time, they should have had more data on top of what you're talking about being able to go back. And and so that excuse doesn't really play well with me either. The information's out there, and you gotta use that. And then, also, how many times have they increased? I could see if they there's a major miscalculation, and they made a onetime adjustment. But it's like it seems like it's perpetual. These policies were intended to be static, like or not go up. And it much like it's again, it's it's an indemnity policy. It's not the cost of the doctor. You have $300 per day of coverage, period, or 400 or 500 or a 5% cut. Whatever that number is, it's a bag of money. That's all you're entitled to, x per day and all that. So the cost of the care, you have to assume that the cost is gonna hit that threshold when you're doing your premiums. And then how many people would go in and so on and so forth. So the cost of medical it's not medical insurance. That's different. I cannot that you can make that argument that the cost of, taking care of your your medical bills goes up because the cost of health care is going up. That makes sense. But when you buy an indemnity plan, it's a set dollar amount. So that's irrelevant unless there's more people going into nursing homes. And, again, a lot of these policies people are in trouble with have a lifetime benefit or have, you know, a five year benefit a lot people bought. But, yeah, I definitely see the problem. And my problem is a constant the constant and I get out missus Kritzman's up there with you. So I know she has to introduce herself. But I'm just curious. You've had your policy like, when you purchased your policy and how many increases have you faced over the years? And yes. So

[Speaker 29]: and I think this is important again. Tom McInerney, the CEO of Genworth Financial had come to a informational session that was hosted by former commissioner maze and made the statement that they needed twenty years to figure this out. He said, we started selling it in 1974. We needed twenty years to really understand the market. I bought my policy in 2004, a full decade after his twenty year period. When I bought my policy, I paid $1,170 per year.

[Representative Kurt Vail]: How old were you? When I bought it? Yes. 50. So 50, it was $1,100 per year. Yep.

[Speaker 29]: And And I think I have had six rate increases. My premium this year was $4,600. I'm sorry, in 2025 was $4,600. This year, it will be $5,200. There is a current rate increase from Genworth before the Department of Insurance for another 58 and a half percent. If that is granted, my individual premium will be over $9,000 a year.

[Representative Susan Johnson]: Times two.

[Speaker 29]: My wife has an identical policy, and her premiums are the same. What what's your benefit? I have a three year policy. It started at $200 a day with about a $200,000 policy cap. Because it is a partnership policy, it has a 5% annual benefit increase. So what's that up to now? Today, it is roughly $647 a day.

[Representative Kurt Vail]: But for for my colleagues, that's figured into the original cost, the 5%. Like, it it doesn't that's not an annual increase. That was figured into the the premium at that time. It's not like, oh, every year it's gonna go up. But this is nothing like medical insurance at all. Just it's an indemnity plan, and that's supposed to be figured into that premium. And you should have somewhat of an expectation that maybe that never go up. They won't tell you that because that would be that that's they can't say that because there's no guarantees you could have cat even with life insurance, most life insurance don't go up. But if we had some catastrophic event and they had to pay off a bunch of life insurance, then it can go up. You know? But, they had the right metrics on this. But, yeah, this is this this problem, they just don't seem to have a fix for it. And I do think is this your understanding that is it only a few companies? This is an industry wide or is it an industry wide problem?

[Speaker 29]: So I I for the past four years since I started investigating this, I have looked at many of the rate increase requests that have been posted by the Department of Insurance. 100% of those rate increase requests have the same thing in common, and that is that the policies were closed to new business after a

[Representative Kurt Vail]: very short period of time. So those specific pools were closed, but they are continuing to sell the long term care insurance with new pools? No. No. Sorry. I'll ask the insurance industry when they come up

[Speaker 29]: with Yeah. The the poster child, the industry will say, and I've been I've been criticized by people in the industry saying, well, you had a relatively early policy. Yes. We closed your policy after four years because we had realized we were making mistakes in the pricing, and we wanted to fix that. So what they did is they closed my policy in 2005, a year after I bought it, which means for the past twenty years, they've not added a single policyholder to add new premium. They're basically asking me to self insure by raising my premium so much that I'm gonna be paying for my own care.

[Representative Kurt Vail]: But that's the opposite of how insurance is supposed to. That's right. You always have to have new premiums coming in to offset the Exactly. Payments you have going out. So So so

[Speaker 29]: once pushing your child against their argument that they learned their lesson is a policy that was issued in 2012 by Prudential Insurance Company. It was sold here in the state of Connecticut for four months to 25 policyholders, and then it was closed to new business. They continue Prudential continues to ask for rate increases because they say that the 16 remaining policyholders today cannot produce enough premium for the anticipated liabilities going forward. It's virtually impossible to ask 16 people to pay enough premium to pay benefits that are in the hundreds of thousands of dollars for these policies. And the fact that this happened in 2012 goes against the industry's argument that they learned their lesson early and were going to change their ways.

[Representative Kurt Vail]: Is are we is this a nationwide crisis? I would imagine it is. It is. Yeah. Alright. I could do this all day, but I'll stop. Thank you. I appreciate your testimony in those conditions. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: Alright. Thank you, representative Vale. I did enjoy the back and forth, and I I will look to see if your name is added as a as a sponsor of the of the bill. I will I will I will I'll be clicking refresh. No. I just want to thank you both. You've both been fabulous advocates on this issue over many years. I just regret that the state hasn't moved faster. You know, it's obviously, this is not a Connecticut created issue, but we haven't, fixed the issue either. And as the insurance capital of the world, would like to think that, we have a special responsibility. I know that, the NAIC and other national leaders look to Connecticut as a leader on insurance issues. And yet on this issue, we have been timid. And so, you know, the question people always ask is why is the Human Services Committee looking at a a long term care insurance? And the answer is very simple. It's because of the partnership plan, which is offered by, the state or endorsed by the state, which simply says that you if you purchase one of these state certified plans, and they often have the flag or the state seal on the plans, you can access the you can you can access your Medicaid benefits without without exhausting your assets. And it is a it is a state endorsed plan that Office of Policy and Management who were who were here earlier and our Department of Social Services have worked on because it looks to combine this insurance product with the state endorsement and access to state benefits. And so hearing the stories, I'm every time I hear one of these stories, I get even more and more infuriated at the situation, at the fact, as David mentioned, that companies are hiding behind these legal fictions where they wall off a tiny bank of business and then create a circumstance where there is no alternative but to let something, you know, a horrendous increase go through. And they've been designed to be unaffordable year after year after year where you see these, you know, catastrophic unsustainable increases, but people are locked in. So it it's really market failure, and it's market failure, and we haven't adequately policed the market to ensure that the the the companies are doing right by their policyholders. I'm I'm hopeful that this year, we'll be able to do something. I really do. We came close last year, and it'll be nice if we could get something done this year. I just wanna point out one change from prior version is that there is now a role in here for the attorney general to intervene. And that was something that the attorney general's office told us that they would not oppose, that they would seek to have expanded role for them in in looking at these companies. And that's something that, I think is helpful and interesting, and, I appreciate the attorney general's willingness, to get involved on behalf of policyholders. With that, I will take, questions. Yes. Representative Ford.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. And thank you again for being here. I've seen you in the aging committee and this committee over several years. And thank you to attorney Vail for helping clarify some of the issues surrounding this because not not everyone has these policies either. So it is sometimes difficult for the general public to understand what it is we're talking about. Something that you sort of said quickly in your testimony, and I just wanted to ask for maybe some examples. You said that sometimes the companies offer an alternative that benefits them and not you. Can you give us some examples of alternatives that may have been offered?

[Speaker 29]: Sure. And and this is something that's actually in 38 a five zero one that companies are required to give alternatives to help reduce the premiums. So what companies will say is if if you want to freeze your premium, it won't go up anymore, but we're going to add what's known as a coinsurance factor, which basically means for every dollar that they have to pay in a claim, you have to pay 10%. So they're lowering they're they're freezing your premium. They're sometimes reducing your benefits, sometimes not. But they're asking you to become a partner almost like a deductible on your policy in order to to get that benefit. Then there are other options that will say, you can reduce your premium if you reduce your benefit. One of our colleagues who has a a policy had to give up hundreds of thousands of dollars of potential benefits for a relatively minor reduction in his premium, but those premiums are not frozen. They are still subject to more rate increases. So you you kind of you buy your your piece for one year and then you're right back where you started from. The most offensive option that they give in my opinion and and Genworth has offered this to me, is consider your policy fully paid. You don't have to pay any more premiums, but your policy is only going to be equal to the premiums you have paid to date. So, for example, I have paid a little over $50,000 in premium. What they've said to me is, you don't have to pay any more, but your policy is only gonna be worth $50,000. In the meantime, even with their lower than anticipated interest and investment income, they've had these premium payments for twenty years that they have invested. And what they're basically saying is you no longer have insurance. We're just gonna take the money that you gave us that we invested, that we've made profits on. And if you need coverage, we'll give that back to you. So instead of three years of coverage, I would probably have about six weeks of coverage. But it's my own money. So those are the types of options that they offer, and they say they're doing policyholders a favor. But in reality, what's happening is for the minimal decrease in premium, they're reducing their exposure by hundreds of thousands of dollars for each policyholder.

[Representative Susan Johnson]: Right.

[Speaker 29]: I happen to see that one of the lobbyist organizations submitted written testimony about this bill and objected to the concept that insurance companies would be required to offer the return of premium as an option to policyholders. For every dollar that they would return, they would remove hundreds of thousands of dollars of liability off of their balance sheet. Now

[Janice Favreau]: And they still

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: made money on investing

[Speaker 29]: Well, sure.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: That money

[Speaker 29]: Sure. They they they made money on the investment. They've lowered their liability. In my opinion, what they're afraid of is they will no longer be able to give this false sense of insolvency Right. Because they've reduced all of this liability. Several years ago, for my policy, Genworth Financial changed their accounting method in Midland. Their premiums went down by $55,000,000. Of Of course, at the same time, their incurred claim amount also went down by a huge amount. I questioned this to the insurance department. They went back to Genworth. And after a bunch of long letter writing, what they basically said was, well, we decided to take the interest and investment income out of our premiums, and that caused us to reduce the the earned premium that we had. What they should have really said was, we realized that our claim liability went down. And if we had all of this premium, our loss ratio would go down, and it would be harder for us to get a rate increase. So in middle of everything, they just changed their accounting method, and the insurance department let them do it.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much for your advocacy on this.

[Speaker 29]: Thank you. I I'd also just like to quickly say that I wanna thank senator Lesser. I know you have been a very strong advocate of this issue for years, and I wanna thank the entire committee because this committee has put forth some of the strongest potential legislation that we have seen for this issue. And this bill, four seventy eight, is perhaps the strongest one that has been forth put forth from any committee in the past four years.

[Senator Matt Lesser (Chair, Human Services Committee)]: Well, thank you. Well, we're gonna keep trying. Thank you. Good to good to see you both. Any other comments or questions, members of the committee? Seeing none, thank you for being here this afternoon.

[Jan Kritzman]: Greetings, members of the human services. No. I no. We haven't done yet.

[Representative Kurt Vail]: We

[Senator Matt Lesser (Chair, Human Services Committee)]: we when we I'm I'm I'm sorry. So when we allow folks to come up together, they have to share the three minutes. And that is I I love you, Jan. You're a constituent. You're a dear friend, but I I can't waive the rules just because I like what you I you can't I I have, like, 200 people behind you, Claudia.

[Jan Kritzman]: I talk very fast.

[Senator Matt Lesser (Chair, Human Services Committee)]: Can you do thirty seconds, please? What? I got it. I got it. We gotta we have rules. We have rules.

[Jan Kritzman]: Okay. Bree's gonna ring the bell, and I'm just gonna keep talking. But

[Senator Matt Lesser (Chair, Human Services Committee)]: No. No. No. No. No. No.

[Jan Kritzman]: No. Okay. My name is Jan Kritzman, and I live in Newington. In Mai Mai, you all look familiar. I support s b four seventy eight, a bill which I

[Speaker 53]: believe takes a big bite out

[Jan Kritzman]: of the punishment approximately 100,000 Connecticut seniors, policyholders have endured from the vicious ever increasing premium rate increases in our long term care insurance policies by greedy, abusive industry higher ups. It is their actuarial miscalculations and short sightedness and perhaps collusion that have thrown us now into this painful premium crisis now decades later. My husband and I purchased long term care in 2004 at a cost of about $1,000 each from Monumental Life and some years later became Transamerica Life and it's now owned by Aegon, something out of a Dutch company. Companies change their names like you change your socks. Premiums remained pretty stable for about twelve to fifteen years and then all of a sudden they doubled and then they doubled again. We're now looking at more than more than 350% premium increase or $7,000 a year combined together. Now that's not the worst part. I got up my courage, and I checked out the policyholder reviews for Transamerica on the consumer affairs plan.

[Senator Matt Lesser (Chair, Human Services Committee)]: January. January. We got we gotta move on. I'm sorry. I love you. I love you. But we can't we got I I can't look at my colleagues today. They're making their constituents wait.

[Jan Kritzman]: Oh, no. No. Ask me one question because I have one answer.

[Senator Matt Lesser (Chair, Human Services Committee)]: Jan, we will I will be happy to ask you questions in the hallway, but not right here. We can't. We can't. We can't. I got too many other people's constituents here. We can't if I if I do that for my constituents, then everybody else will ask to do the same thing for theirs.

[Jan Kritzman]: The last paragraph, you're gonna love it. It's all about you. Please pass this bill out of committee. I predict that senator Lesser, that would be you, will make an impassioned plea in the senate chamber. It'll pass unanimously like it did last year or similar, then it'll go on to the house and it'll sail through and then the governor will be thrilled to sign it. I have faith. Good bill ought to pass.

[Senator Matt Lesser (Chair, Human Services Committee)]: From your lips to God's ear. Thank you for being here this afternoon. Appreciate your testimony. Good to see you both. Moving on. Alright. So next, we have Anthony Thomas followed by Brooke Foley. Is Anthony here?

[Jan Kritzman]: If nobody shows up, I can continue.

[Senator Matt Lesser (Chair, Human Services Committee)]: So Brooke Brooke Foley follow no. Brooke Foley? Is Brooke Foley here? Oh, you'll get there you are. My Brooke Foley followed by Ruchi Sheth.

[Brooke Foley (IAC/ACLI/AHIP)]: Good afternoon, Senator Lesser, Representative Gilchrist, vice chairs, ranking members, and distinguished members of the Human Services Committee. My name is Brooke Foley, and I'm here on behalf of the Insurance Association of Connecticut, the American Council of Life Insurers, and AHIP. Thank you for the opportunity to speak today. We appreciate the committee's continued focus on long term care and the challenges facing Connecticut residents. We did submit written testimony, so I'll just highlight a few key points. While we respect the intent behind Senate Bill four seventy eight, we do have serious concerns with the bill as drafted. First, the bill's limitations on premium adjustments for partnership policies raises significant concerns. Long term care insurance is priced based on assumptions that extend decades into the future. When those assumptions change whether due to increased longevity, low interest rates, or higher than expected claims, insurers must be able to adjust premiums to ensure policies remain viable over time. Restrictions in this area could create challenges for the market and may affect the continued availability of coverage in Connecticut. Second, it's important to consider the broader impact on Medicaid. Private long term care insurance helps individuals plan for future care needs and reduces reliance on the state's Medicare program. When private coverage becomes less accessible, more individuals ultimately return to Medicaid. Long term care costs in Connecticut are significant with nursing facilities care averaging roughly 148,000 per year. As demand increases, Medicaid already represents a substantial and growing portion of the state budget. Policies that unintentionally limit access to private coverage risk shifting additional costs to the state over time. We are also concerned with several of the bill's operational provisions, including duplicative reporting requirements and expanded disclosure obligations related to reinsurance, which are already subject to review by the insurance department. These provisions would add administrative burden without meaningfully improving consumer protections. Finally, I want to highlight the study language related to premium refunds which raises particularly serious concerns. Requiring insurance each year all premiums paid regardless of the coverage that has already been provided would represent a significant departure from how long term care insurance is designed and financed and raises significant concerns about insurance ability to maintain the financial stability necessary to meet their long term obligations. Changes of this nature would make it very difficult for insurers to continue to pay claims over time and may negatively impact long term care insurers market in Connecticut. If the private market is weakened, more individuals will ultimately rely on Medicaid increasing pressure on the state budget. We welcome the opportunity to work with the committee and the insurance department on approaches that strengthen consumer protections while preserving a stable private market for long term care coverage. Thank you for your time, and I'm happy to answer any questions.

[Senator Matt Lesser (Chair, Human Services Committee)]: Alright. Thank you for your testimony, representative Gilchristin.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you, mister chair. Thank you for being here. So why are the premiums going up so much each year?

[Brooke Foley (IAC/ACLI/AHIP)]: So when long term care policies were first became on the market, which was in the eighties, the alright. Late seventies and eighties, they were, priced based on assumptions based on life insurance policies. And at that time, there were a lot of the policies had a lifetime benefit. Now most of the policies have a shorter benefit time. So when they had a lifetime benefit and it was based on assumptions for life insurance, not long term care, the premiums were a lot lower. But what has happened in the forty years since those a lot of those policies were made is we have forty years of medical technology, and we also have had the creation of facilities like long term care facilities, assisted care facilities that didn't exist at that time, and those are extremely expensive facilities. And the other thing too is many of those people who are in those who have long term care insurance have memory care issues, and those are very expensive claims to pay. So if a person keeps the same defined benefit amount that they had when they originally had the policy, it wouldn't cover the claims. The cost of the claims right now is much higher for a variety of reasons. Not only were assumptions not accurate, the assumptions about lapse rate was also inaccurate. So, insurers had made assumptions that the people that wouldn't continue to pay for, long term care policies, that more people would lapse. So lapse is when you stop paying on an insurance policy and you basically lose the benefit. And so under the original long term care policies, they didn't see the lapse rate that they expected to see. So a lot more people were carrying those policies long term, which may need claims, the cost of claims remain very high.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Okay.

[Brooke Foley (IAC/ACLI/AHIP)]: So the labs projections were wrong. Low interest rates over time, interest rates have decreased over time. So the projections of what the interest rates were gonna be on the money for the premiums that was collected to pay claims. So with long term care, the the money for the premiums is paid earlier, but the claims are paid later. At least that's what's projected when you get a long term care policy. And so what they do, what insurance companies do is they invest that money. And if the projected money that's invested doesn't make the insurance the the expected interest rates, then that's also a factor in how much money they have to pay claims. And so, anyway, that's why it's required by statute, not only in Connecticut, but the NAIC and and the model act requires that insurance companies give written notice to long term care policyholders, not only when they very first buy the policy, but anytime there's a rate increase, they have to give them the option. Okay. If you wanna keep your policy premium, what it is right now, we have to offer you these other options. One of those options is they can take the same benefit that they currently have and, you know, keep the lower keep a lower amount of of benefit. And if they wanna continue the same benefit, then, they have to pay a little bit higher. And they these are required by statute to it's already in statute even though we've seen them in bills, several times, that policyholders are given these notices every time there's a rate increase. And rate increase requests are, they're submitted to the insurance department. The insurance department looks at them and considers them, and they make a determination whether or not they should be approved or not. And many times, they disapprove the rate increases for long term care. And you can go on the insurance department's website and you can see all of the requests, and you can see that many of them are either, outright rejected or if they're only partially accepted. So and some companies may offer a non non forfeiture, I think it's called, where they say, okay. Well, you can like he explained, that you can keep your the premiums that you put in, say you paid in $50,000, like he had said, and that's a non forfeiture benefit, which means you're not forfeiting that money that you already paid in. But you're not gonna get the benefit of the value of the policy if you were to just, you know, increase your premium. Because, like I said, for for memory care assisted living facilities, you could pay between the $10,000 a month or $15,000 a month. The the cost of care for these claims is outrageous and exorbitant. It's very, very expensive. And if a person had to pay out of pocket, it would be way more than the $50,000 that they would get. So when you pay for car insurance, you're paying for a limited amount of time. And if you stop, you don't get a refund. So during the time when you first get a policy and you're paying on a long term care policy, you're covered for the risk that whole time. And those monies that are getting, invested, those are paying claims. It's not like it's a savings account that only goes to the person that is, making the payments for those premiums. It's a it's a pool of money that goes to pay claims for everybody that it has those policies. And, yes, they the the long term care industry nationwide and and probably even worldwide, you know, this has been a problem because, like I said originally, they didn't have the accurate assumptions when they first doing started selling these policies, you know, fifty years ago. But, so so a lot of those original policies are a closed book of business. They're not continuing to sell lifetime benefit long term care policies anymore because it's just too expensive to pay the claims. So what they do do is they offer shorter policies with different assumptions, and the assumptions that are originally made at the outset are correct. They're based on different assumptions, not the ones that they originally made when they first started selling, but they're different assumptions based on what the cost of care is now and and not based on life insurance. So it's totally different now. And it's also not a life in lifetime benefit now. So there's a lot of different reasons why the cost of the claims is so expensive.

[Representative Kurt Vail]: K.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. I still find it a little odd that if it's been around for fifty years and folks started getting them twenty years in, thirty years in, I would assume people would have updated the calculation. But I'm gonna go to representative.

[Representative Kurt Vail]: Thank you, madam chair. And if you do check online, my name does come up on senate bill for 78 now. Good afternoon, Brooke.

[OPM Staff (first name referenced as “Zanu”)]: Representative Bail.

[Representative Kurt Vail]: I apologize ahead of time because you're gonna have to take the brunt for for the insurance industry, and I think it's terrible that they put you up here to have to do this. Assumptions. Who made the assumptions?

[Brooke Foley (IAC/ACLI/AHIP)]: So insurance companies have actuaries?

[Representative Kurt Vail]: Yes. And they made assumptions. None of the policyholders made assumptions.

[Brooke Foley (IAC/ACLI/AHIP)]: Oh, but that when you get a poll and I have a long term care policy myself, and I've had to go through this process myself. And when you buy a long term care policy, they tell you upfront that there is a possibility of rate increase. A possibility. Yes.

[Representative Kurt Vail]: And but not likely.

[Brooke Foley (IAC/ACLI/AHIP)]: Nobody told me it wasn't likely.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: That was just my own

[Representative Kurt Vail]: Well, it's based on again, you could compare these to any type of indemnity. It's an indemnity policy. It says fixed dollar amount per day. Okay? So it someone earlier is $200 a day. Now if they had a flat $200 a day policy and they still had that same policy, I'm thinking maybe their rates would have went up anyways. But let's say they didn't they only have $200 a day. The nursing home costs $600 a day. They get a $200 a day benefit, and the other $400 they have to pay out of their pocket. That's how that works. Or they might have it set up monthly, or the whole bag of money. If they can do it all, that bag of money, $200 a day for five years, whatever that money comes out to, they have that and then they go through it in two years instead of five years, whatever that is. A bag of money, it's a fixed benefit. And whether the rates go up or not is irrelevant because they have a 5% cost of living index that goes up whether it's five three whatever that number is, 5%. And the state signed off on all this stuff for that partnership plan that they told everybody, hey. We got this so we can all feel warm and snuggly about it. So the state's culpable for this shit too. And it really it it it really infuriates me. You know? If it's the insurance industry, it's the state, and we need to take responsibility for it. Not the people who took put their trust in the state, in insurance industries, in insurance agents to have the benefits they were supposed to have and to say that it's your assumptions that are wrong. And then on top of that so let's let's give you the benefit of the doubt. You screwed up the first twenty years. We're buying policies now in the two thousands, and we're still having the same power. What's the excuse now? After thirty years of screwing it up, now now we're in the 2 thousands, so we're still screwing it up, and people's assumptions are going up. So let me give you another benefit of the doubt. Say you made another mistake. Okay? How many mistakes can you make that people's premiums are still going up every time? Fix it once. Figure out what that is and move but then you shut down the plans. You have no insurance works when there's premiums coming in and new healthier people buying premiums. 50 year olds buying premiums, and they plan over time. But when you cut it off and that rates go up, what do you think is gonna happen? This is the whole purpose of insurance. You buy life insurance when you're 35, it's gonna cost less than when you buy it at 57, my age, and you're out of shape and you have high cholesterol, might be lucky to even get it. But if I bought it when I was 35 and I paid $20 a month based on me living to be 76, then that's how this stuff works. And it's the same with this. So that's what infuriates me. The insurance industry made the mistakes, and it could be a couple bad players. It could have been an honest mistake. Who knows? But they're not doing anything to really try to fix it. And guess what? Sometimes when you make a mistake, you have to brunt the the remedy. You're still trying to to squeeze every penny out of these people and it it it's just not the way it's supposed to work. When you make mistakes, you're supposed to brunt bear the brunt of those mistakes. Not people who put their trust in you and their agents and in the state of Connecticut.

[Brooke Foley (IAC/ACLI/AHIP)]: So if I may, this is a problem. It's a nationwide problem. It's been going on for a long time. The insurance department is well aware of this problem and a lot has been done to try to remedy these these issues. And I would, I would also note that there are many less insurance companies in this long term care business because they cannot afford to continue to stay in this business. And I would also note that there are a lot of insurance companies that have become insolvent because of the claims that they have had to pay because they don't have enough money coming in. Research the Penn Treaty insolvency in Pennsylvania. And if you look at the Penn Treaty insolvency and how much money they lost, Genworth has 11 times more policies than Penn Treaty did. So if Genworth goes insolvent, it's gonna be a lot of money, a lot more money. So this is a big problem, and it's not just the insurance company that's trying to fix it. The insurance departments are well aware of this problem, and n I NAIC is well aware of this problem. It's ongoing.

[Representative Kurt Vail]: Where do people from the insurance department come from?

[Representative Robin Comey]: Excuse me?

[Representative Kurt Vail]: Where do we usually hire people to run our insurance department in the state of Connecticut?

[Brooke Foley (IAC/ACLI/AHIP)]: The insurance commissioner is

[Representative Kurt Vail]: not usually come from the industry. You know? So, I mean, somebody's gotta be held accountable, and they shouldn't be the policyholders. Because you not you. And I I think you're for everyone, I think she's wonderful. I feel really bad about this. But it's there's so many things. I I literally could stay up here for hours, and I'm and I'm just not wrong.

[Speaker 55]: So I wanna

[Brooke Foley (IAC/ACLI/AHIP)]: also note that when a insurance company goes insolvent, there are agencies in each state that can pay up to a certain amount of claims. And for long term care for Connecticut, the I'm blanking on the name of the company, right, not the state agency. But they are they can only pay up to $300,000 of claims, and that's set in the statute. So if there is no, if a long term care company goes in solvent, then the policyholders are limited to that small amount of claim, potential claim. And after that, they don't get the benefit of their contract. So and insurance companies pay into that. The guaranteed fund is what it's called. So, yes, insurance and the policyholders do suffer if insurance companies go and solve it. And it's a key it's a it's a huge problem. Talk to the insurance, commissioner about it. Talk to anybody at the insurance department about it. It's a big problem. Come to the NAIC meeting in San Diego next week. It's a huge problem. So it's not it's not something you can easily solve by magically cutting certain policy requirements. It's it's not gonna solve the problem.

[Representative Kurt Vail]: Well, the only thing that it seems they wanna solve is to jack everybody's rates up and have the rate payer solve the problem. That that's where my issue is. They didn't make the mistake.

[Brooke Foley (IAC/ACLI/AHIP)]: I understand.

[Senator Matt Lesser (Chair, Human Services Committee)]: Not a

[Representative Kurt Vail]: lot of people. I'm telling you, it's hard to get long term care insurance.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: It is.

[Representative Kurt Vail]: It's very difficult. In Massachusetts, they have a thing called the Massachusetts lien law. And it's a very you get a very basic bottom line policy and it'll protect your assets up to a certain amount. But again, what bothers me even more is that the state signs off and puts their little, labor on it and says, hey, everybody. This is a great policy. You should do it. So I think we're we're culpable in this as well.

[Brooke Foley (IAC/ACLI/AHIP)]: The part

[Speaker 2]: of the

[Brooke Foley (IAC/ACLI/AHIP)]: plan benefits means that for, it gives asset protection for Medicaid. So for the companies that are part of the partnership plan, the part the policyholders that have a long term care policy in the partnership plan, for $300,000 of their assets, that's not considered when they later need to file for, Medicaid benefits.

[Representative Kurt Vail]: Yep.

[Brooke Foley (IAC/ACLI/AHIP)]: So that's the benefit for the pump

[Representative Kurt Vail]: What's the what's the period now? So if I sign my assets over and I don't have a long term care policy, I sign my assets over to my children and then

[Brooke Foley (IAC/ACLI/AHIP)]: I think

[OPM Staff (first name referenced as “Zanu”)]: it's a

[Representative Anne Hughes]: five year loan.

[Representative Kurt Vail]: Is it it's sixty months? So most people would probably buy a five year policy. And then if they got went in, they probably sign their assets over that. I think that's why five years is is

[Speaker 2]: but So the cost

[Brooke Foley (IAC/ACLI/AHIP)]: of this care is so expensive that the benefit that you get from a long term care policy is still has a lot of value.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Yeah. But it's not enough long term care.

[Representative Kurt Vail]: But it's not enough. I mean, 600, the gentleman earlier started with 200 and with his cost limits up to $6.47. But you do the math on that So so and it happens.

[Brooke Foley (IAC/ACLI/AHIP)]: $100 a day benefit, which is expensive.

[Representative Kurt Vail]: Well, I know. But it's irrelevant because they bought a policy that's gonna go up. That's the per diem rate they have. If they have less than 600

[Brooke Foley (IAC/ACLI/AHIP)]: policies work.

[Representative Kurt Vail]: I know. I I'm pretty sure I know how they work. Right? I was there at the original meeting in 1980 or 1992 when they in in in put this stuff in. I was doing this then, and I was new in in in learning all about it. And it was supposed to protect people. Well, it doesn't sound like it's protect how? By by by strangling their month, you know, these are people who are now retired, may took the initiative to make this investment that most people don't. Right? And don't take that initiative. It's hard to go tell somebody in their forties and fifties, never mind someone even younger than that, that, hey. You're probably gonna be in a nursing home today. Why don't you buy some insurance for that when you're 48 years old? Who so people who have, you know, the foresight to do that should be rewarded because now they're not gonna cost the state and have to go on title 19. They took that that so they that initiative so they wouldn't do that, and they could give assets to their children. And they're the ones being punished. It's outrageous. And then it it just the industry needs to do better, come up with a real solution that helps people instead of trying to still make a profit. Sometimes when you make bad decisions, you gotta take a hit. Okay? And listen. You guys got plenty of money, so you can figure it out. You know, it's and and, again, I'm not mad at you for it. Right? I'm mad at you for this. I'm not mad at you for making a profit. And I understand if you didn't, you wouldn't be in business, and we wouldn't have car insurance, we wouldn't have homeowners. I get all that. Okay? But you're wrong on this one, and you need to fix it. And if you're not gonna, then we're gonna. Now that's where we're at. I know you got a strong lobby here, so maybe that won't happen. But it it it's not gonna matter to me. So

[Brooke Foley (IAC/ACLI/AHIP)]: We encourage you to work with the insurance commissioner and talk to them and work

[Representative Kurt Vail]: I'd encourage him to work with me. Oh. Okay.

[Brooke Foley (IAC/ACLI/AHIP)]: That's great.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you, representative. Yes, representative D'Amico.

[Representative D’Amico]: Thank you, madam chair. I don't know that I could improve on the questioning of, my colleague across the way there, but I will I will, I will try. So, so, thank you for coming to testify today. I got here halfway through your testimony or maybe even further along than that, so if I miss something, I don't, I don't, I forgive me for making you repeat. You made reference to the fact that the Connecticut Insurance Department is well aware of this long term care insurance premium problem CHAIRMAN POWELL. For lack of a better word, to say the least. What efforts you said that you've made efforts or the excuse me, the Insurance department has made efforts. Would you be able to identify what efforts the insurance department has made to try to solve this problem?

[Brooke Foley (IAC/ACLI/AHIP)]: The insurance department reviews long term care rate rate increase request. Every rate increase request that any insurance company has has to go through the insurance department and they they didn't they turn a lot of them down.

[Representative D’Amico]: Well, and they also approve a lot of them.

[Senator Matt Lesser (Chair, Human Services Committee)]: They do.

[Representative D’Amico]: As as my constituents have have made clear to me and everyone else. Okay. Alright.

[Brooke Foley (IAC/ACLI/AHIP)]: The the industry as a whole, NAIC and

[Representative D’Amico]: Well, since you mentioned NAIC, I have to ask you. I I was reading some literature from the NAIC recently, and and and they they pointed out that that, and they specified two states, Texas and Minnesota specifically, have have come up with a way to do what my good colleague, alluded to a few minutes ago, that that Texas and Minnesota specifically, as I understand it, have, required the the insurance industry, the insurance companies themselves, to share in the pain rather than put all the burden on on the policyholders. Are you familiar with the Texas and Minnesota plans that that that shift some of a significant amount of of the burden for these mistakes onto onto the insurance companies?

[Brooke Foley (IAC/ACLI/AHIP)]: I am not sure if I'm I'm aware of that or not. I'm not

[Representative Kurt Vail]: Okay.

[Brooke Foley (IAC/ACLI/AHIP)]: Tell me more details.

[Representative D’Amico]: Well, I I I would I would encourage you and the insurance commissioner to take a look at that. You know, I just wanna ask another question about insolvency. Isn't it true that most, if not all, of these long term care insurance policy companies are part of a much larger corporation that can well absorb whatever financial hit they might take as a result of this spiraling crisis?

[Brooke Foley (IAC/ACLI/AHIP)]: I think some insurance companies are owned by bigger conglomerates, but I'm not, I wouldn't say that they could just easily absorb, the claims. There's a lot of insurance companies that have gone insolvent because they cannot pay the claims, and I would, like I said before, I would encourage you to research the Penn Treaty insolvency and the SHIP insolvency, and there is another insolvency that's been going on right now here in Connecticut. So, yeah, a lot of them cannot.

[Representative D’Amico]: Okay. Madam chair, can I ask one or two other questions specifically about the bill itself? So so so I'm looking at at lines ten ten through 21 of of raise bill four seventy eight that's in front of us today. Would you would you favor what's lines 10 through 21, which indicate that OPM needs to file a report with the legislative committees on the incurred loss and actual paid loss for each long term care policy?

[Brooke Foley (IAC/ACLI/AHIP)]: Like, I wrote in my in the written testimony that we submitted, the incurred loss and the actual loss like you've requested in this reporting, it doesn't give you an accurate amount. It doesn't give you an accurate determination of the cost of claims over time. Because in these in any one year, if you look at those stats for any one year, that's not gonna give you an accurate, measurement of what the claims are gonna be over time. Because usually, like I mentioned earlier, the premiums are collected at the beginning, and then it's a long time usually if and when a person has to file claim. And once they go on claim, they're not no longer paying premiums. So those those reporting requirements, for one thing, the insurance department already regulates insurance companies. So this is duplicative and unnecessary, and it's not even gonna give an accurate determination of, what you wanted to give.

[Representative D’Amico]: So I I I appreciate that. So so so speaking of duplicative and unnecessary, are lines 77 through 83, duplicative and unnecessary when they require insurance companies to provide details of any and all reinsurance contracts associated with the policy at issue? Is that duplicative and unnecessary?

[Brooke Foley (IAC/ACLI/AHIP)]: Yes. Because the insurance department already regulates reinsurance and a lot of that is proprietary information.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: So excuse me.

[Representative D’Amico]: Okay. I guess we'll agree to disagree. But I I don't wanna belabor this, madam chair. Thank thank you. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Thank you, representative. I would just remind folks

[Speaker 56]: in the

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: audience not to speak to the speakers. I wanna quickly build off what rep D'Amico said in terms of the long term insurance providers plans to address this. According to a Hartford current article from January 2025, Genworth, which is Genworth Financial, one of the companies that sells coverage through Connecticut state partnership plan, they're quoted as saying that their plan is to pursue significant premium rate increases and associated benefit reductions on an older generation block. So that's concerning that the plan is to do the very thing we're here trying to pass policy to prevent. And then, also, the CEO pays continue to skyrocket, including Thomas McErnie's, the company CEO of this same company, Genworth Financial. He gets more than $9,800,000 in 2023. So why wouldn't the company make a decision to maybe rein in that insanely high CEO pay to offset some of these costs?

[Brooke Foley (IAC/ACLI/AHIP)]: I can't comment on what the CEO pay is because I'm not familiar with that, you know, how that works. But I would say that if, in this bill, it does have a provision to, not ties, the executive pay to profit or however you worded it in there. But I don't know how you would implement that given the fact that these insurance companies operate in many different states, not just in Connecticut. And so their pay structure is handled, in various ways, and I don't know how you would just limit that for Connecticut when, you know, they they are operating many other different states as well. So I that's that's what I've, you know, what we put in the written testimony as well. I don't know how you would implement that provision. Okay.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. I don't see any other questions. Thank you for your testimony and your time. Thank you. Next up is oh, we're number 36. Number 36, Eric Valentin.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Hello, member members of the humans Human Services Service Society. I am testifying today in favor of s b five zero one because I believe that people with with disabilities should unite to support one another as we work to achieve equal testament access to service as a wheelchair repair. My friend Tiffany testified earlier about her problems with wheelchair

[Representative Kurt Vail]: repair.

[Jordan DeAngelo]: K.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Sorry. I'm done.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Well done. Thank you so much. Representative D'Amico.

[Representative D’Amico]: So so yeah. Thank you, madam chair. So so just one one quick question. Would you be able to tell us about a a a particular problem or problems that that you personally have had with wheelchair repairs?

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Okay. As far as as I I cannot explain to you what problem I had. I can tell you what she had was that she had an issue with repairing a chair and did not have a access to a a better chair that was able to replace that chair in the meantime. That would they were repaint repairing that chair.

[Representative D’Amico]: I I I see. So so so, hopefully, if if this bill goes forward, we will we will get to the bottom of that and and and and solve that particular problem and and others as well. Yes.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: That would be great.

[Representative D’Amico]: Thank you for coming to testify today. We really appreciate it.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Thank you for having me.

[Representative D’Amico]: Thank you for being so patient and and waiting for so long. Thank you. Thank you, madam chair.

[Representative Lucy Dathan]: Thank you. Thank you so much.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Have a great afternoon.

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: You too. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next, we will hear from Ruchi Sheth.

[Ruchi Sheth (CT Voices for Children)]: Good to see you again, Senator Lesser, Representative Gilchrist, ranking members, Senator Perillo, Representative Case, and distinguished members of the Human Services Committee. My name is Ruchi Sheth and I'm testifying on behalf of Connecticut Voices for Children, a research and advocacy organization working to ensure that one day Connecticut is a thriving and equitable state where all children reach their full potential. Connecticut Voices submits testimony in support of SB three, SB four nine six, SB four nine seven, SB four nine nine, HB five five five nine, and HB five five six one. Together, these bills take important steps to protect access to affordable health care and food security for Connecticut reason residents at a critical moment. Following last year's passage of congressional mega bill HR one, also known as the one big beautiful bill act, Connecticut faces a nearly $1,000,000,000 federal funding shortfall to food assistance and healthcare in fiscal year twenty seven with continuing losses expected in subsequent years. HR1 cuts to healthcare that total approximately $407,000,000 to Connecticut in FY '26 and $847,000,000 in FY '27. These cuts threaten to take health care from roughly 150,000 Connecticut residents, 130,000 via direct 130,000 via direct cuts, and 20,000 due to expiration of premium tax credit enhancement. Left unchecked, HR one would reverse much of the good progress Connecticut and this committee in particular has led on to make healthcare improves This bill also strengthens consumer protections and improves oversight of changes to federal eligibility requirements that could disrupt coverage for thousands of residents. But as we know, health care and food go hand in hand, which is why we support SB four ninety seven, which would help to address the growing risk of food insecurity in Connecticut. HR one includes cuts to SNAP that total approximately $74,000,000 to Connecticut in FY '26 and nearly $150,000,000 in FY '27. These cuts threaten to increase the cost of food for approximately 220,000 households, reduce the benefit for an additional 58,000 households, and eliminate food assistance entirely for tens and thousands of residents. This also means that this these benefit dollars are not circulating within our economy. The worry that food insecurity and poverty in Connecticut will worsen as a result of the new rigorous federal SNAP work requirements is not unfounded. According to DSS enrollment data, the state has witnessed a drop in SNAP in SNAP enrollment of 16,923 people since November 2025. As we approach and surpass the three month mark of the implementation of the work requirements, demand to other programs such as local food banks and pantries will increase. However, the potential prolonged use of food banks since people who don't meet the work requirements are time limited to three months and a thirty six month period is likely understandable. These bills represent or recognize the importance of a robust social safety net. When families lose access to basic supports, the consequences ripple outwards. For these reasons and more, Connecticut Voices for Children respectfully urges the committee's support of these bills. Thank you for this thank you for your time and consideration. I'm happy to take any questions.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. Senator Lesser.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yes. I actually don't have any questions. I mean, we got a lot of people testifying today. I just wanna thank, yeah, you and Voices for your work on these issues, and hopefully, we can move something forward. Thank you for

[Representative Robin Comey]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. Thank you so much. Thanks for being here. Next up is Erin McCleary.

[Dr. Erin McCleary (Optometrist)]: Hello. Good afternoon. Can you see and hear me?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes, we can go right ahead.

[Dr. Erin McCleary (Optometrist)]: Alright. Thank you for having me today. I would like to say first of all thank you, for Senator Lesser, Representative Bilcrest, and ranking members Senator Perillo, and, Representative, Case for allowing me to speak today and testify. I'm Doctor. Erin McCleary, a board certified advanced practice optometrist in Plainville, Connecticut and live in West Hartford. I'm a past president of the Connecticut Association of Optometrists and have been a Medicaid provider for nearly twenty years. I'm testifying in support of section seven of House Bill 5,561, an act concerning Medicaid rate increases for certain providers. I did provide our written testimony today, and rather than reading the entire thing in its entirety, I just will give you some of the highlights and a couple additional pieces of information that I gleaned even this, as late as this afternoon. So basically, as an optometrist in the state of Connecticut, we are actually reimbursed 10% less than all ophthalmologists for providing the exact same care, the same TPT codes, same diagnosis, the same medical care, and we have been reimbursed for 90¢ on every dollar that they make. In Connecticut optometry continues to be a primary care provider for all of our Medicaid patients and there is a large percentage of optometrists in the state of Connecticut who do accept Medicaid and we are approximately about 89%, so a large percentage of optometrists do take Medicaid, and unfortunately we are seeing more and more of our providers who are limited and are worried about continuing to take Medicaid because of some of the non parity in perceived decreased rates of reimbursement for these patients in their care. The piece of information I wanted to highlight actually is that I found out today that myeye doctor, which is a private equity group that has taken over a lot of private practices throughout the entire state of Connecticut, not to mention other regions in the Northeast, but they have recently decided to take Medicaid no longer. So that means there's a large percentage of providers that have just decided to quit taking Medicaid because they find it as a, non reimbursable and not equitable, way to provide care. In my practice, I have 30% of my patient base is a Medicaid population and of that, I have a very large pediatric population and that percentage is much much higher for pediatrics and, so these are obviously some concerns that we're having. According to the Department of Social Services, we are seeing approximately 120,000 non duplicated Medicaid patients as of the most recent year of data was 2024. So basically I just kind of plead to definitely pass this bill so that we can get some parity. If we're able to get parity on board with ophthalmology and optometry hopefully we'll be able to persuade more optometrists in the state to continue providing a lot of this medical care that we already provide for this much needed patient population and to create better access for those patients. In addition, I as well on behalf of the CAO also support senate bill four ninety nine and act concerning Medicaid rate increases and urge to approve that as well. That's pretty much a summary of my written testimony. I I really appreciate the time to be able to speak today and, I welcome any questions anyone may have for me.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. We really appreciate you being here and your testimony. Have a great afternoon.

[Speaker 36]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next up is Jeff Vander Klug.

[Dr. Jeffrey Vander Ploeg (CHDI)]: Good afternoon, everyone. Senators Lester, representative Gilchrist, senator Perillo, representative Case, members of the Human Services Committee. My name is doctor Jeffrey Vander Ploeg. I'm the president and CEO at the Child Health and Development Institute. CHDI is a nonprofit organization dedicated to advancing system practice and policy solutions that improve children's behavioral health systems and services. And I'm testifying today in support of both SB four ninety nine and HB 5,561 on Medicaid rate increases. However, I would strongly recommend to the committee that h b five five six one be amended to include behavioral health rates and particularly rates for children's behavioral services, which is what I wanna talk about today. Increasing Medicaid rates is perhaps the single most effective and important strategy for strengthening behavioral health workforce and increasing access to behavioral health care, which are two significant priorities that the legislature has for children's behavioral health. And clearly, when we strengthen behavioral health workforce and make those services more accessible, children and community and communities in Connecticut are stronger. In 2023, CHDI published a report titled Strengthening Connecticut's Behavioral Health Workforce for Children, Youth, and Families, a strategic plan for Connecticut. That report and strategic plan can be found on the chdi.org website with developing collaboration with families and providers and state agencies and behavioral health workforce experts from other states. It was commissioned by DCF through the legislatively created Children's Behavioral Health Plan Implementation Advisory Board, and the results have been presented to you and reviewed there as well as by the legislatively created Transforming Children's Behavioral Health Policy and Planning Committee. The report and plan found an escalating cycle of stagnant reimbursement rates resulting in low salaries, high burnout, and high vacancy rates, and in turn, long wait lists and delays in access to behavioral health care. For example, our report found that in Connecticut, behavioral health providers regularly experience vacancy rates of over 20% and annual turnover rates of nearly 40%. So to address the behavioral health shortages, the number one recommendation in this report was for Connecticut to increase Medicaid reimbursement rates. This was also the number one recommendation of the infrastructure work group of the transforming children's behavioral health policy and planning committee. And I would note at this point that CHDI is not the direct service provider, so we don't bill Medicaid for any revenue, But we do talk to providers and schools and families every single day, and, we've been working alongside the system and we hear something about the importance of Medicaid rates every day. In the workforce strategic plan, many other states that we spoke with were in the process of substantially raising their Medicaid rates. And as we know from DSS's own Medicaid rate study recently, behavioral health reimbursement rates had a notable $42,000,000 gap in comparison to the five states that were included in the study. So I'm very grateful to the legislature and to the governor and OPM for the last few years where some behavioral health Medicaid rates have been increased and that's been a very good start. However, it's really important to acknowledge that it won't be possible to meet the needs of children and families without continuing to raise rates. So let's complete the job now by raising Medicaid behavioral health rates to meet or exceed the five state average and then index future rate increases to match inflation and the actual cost of providing high quality care. Thank you for your time, and I'm happy to take any questions you have.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much, doctor. I don't see any hands. Thank you for being here, and thank you for your testimony.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next is Todd Van Clerck Van Kirk. My apologies.

[Todd Van Kirk (Aspire Living & Learning)]: Yep. Thank you, co chairs Gilchrist and Lester and distinguished members of the human services committee. Thanks for, allowing me to come speak to you today. I have offered a written testimony as well, so again, I won't read it. But my name is Todd Van Kirk. I'm a senior director of operations for Aspire Living and Learning here in the state of Connecticut. We're an IDD provider, intellectual disabilities, operating about 20 group homes serving at least over 200 people across the state. And I'm here to testify in support of the languages contained in house bill five five six one, particularly section 16, subsection d, which would assist the state in viewing multi department or multi agency providers like Aspire as one agency. And so by way of information, what that means is we currently operate a number of different programs for folks with intellectual disabilities, one of which is called the community living arrangement. That's CLA is the term. It's sort of a traditional group home, if you will. It's funded by DDS, Department of Developmental Services. At the same time, we operate intermediate care facilities called ICFs. Those are funded through Department of Social Services. And right now, each of those departments has their own cost reporting system where our financials are viewed as separate financials even though we are one agency providing services to people in the IDD world through a variety of different means. And so in supporting the language that's in this bill above subsection d, essentially will allow the state to look at Aspire's cost reports as one, which essentially would mean if and when there were a surplus in our cost reporting mechanism, we could use we could make the case to use any surplus funds where the greatest need is at whatever home and whatever program or whatever staffing situations we may have versus right now being sort of siloed to keeping those two pools separate even though they're both Medicaid funded services. So, just offering testimony to support that, and we appreciate all the work on a global sense that this committee has done and others in advancing, some of the crisis and funding in the IDD space in totality. Knowing it's not easy and there's lots of competing interests, I just thank you for that all again as well as, the language currently in this bill, section 16 subsection d, And I'll take any questions you may have. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Thank you so much for being here, for the work you do, and for your testimony. I don't see any questions.

[Representative Kurt Vail]: Have a

[Speaker 15]: great Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next up is Tiffany Williams. Is Tiffany with us? Alright. Then we're gonna go

[Representative Kurt Vail]: to Tom Cosker.

[Speaker 6]: Good afternoon. Tom Cosker, advocate with Disability Rights Connecticut. Good afternoon, members of the Human Services Committee, and thank you for having me here today. I'm here to talk about HB 5,558 on DDS abuse and neglect, bill. I've covered a couple comments. First is thank you for, having this bill in front of you, and and this is a follow-up on a bill last year on seventy one zero eight, and this is, you know, aiming to make some improvements on that bill. There's been a series of audits that you may or may not be familiar with from the auditors of public accounts, from OCA, from health and human services offered the inspector general, all of which point to concerns about the safety of individuals with intellectual and developmental disabilities in Connecticut and across the country. So I applaud this this committee for for taking that on in in some regard. Specifically, the pieces in HB five five eight, the investigation reports that are issued after at the end of an investigation by AID, the evaluation reports, it's critical that we provide those to parents, guardians, legal guardians. It has been a challenge to get those for parents. It's most parents that we talk to, again, as an advocate with dissimilar rights connected, we talk to families all the time. I talk to parents who aren't even aware they can get those. They can. They have to ask the commissioner. If you see the eight point font at the bottom of page four on this particular thing that you might get, it's not common. So making it a mandatory that the the the DDS provides those reports. I read that the DDS commissioner commissioners. I'm happy to talk about that later because I have some thoughts on that. But as a parent, I can imagine not having that. We've heard from from parents today as an advocate. It's appalling that parents don't and guardians don't have access to that information. It should be automatic. Regarding the annual reporting that's they just issued for the first time, which I applaud the idea of the annual report, and I think it's great. There were some startling numbers in there, over 4,000, you know, allegations of abuse, neglect, many of which were substantiated. There are some things I'd love to see added. You'll see in my written testimony about timeliness of the investigations, looking at not just the average length of stay, which I think is what's in this bill right now, but a little more detail on that because average can be very misleading. Average of five months might be there's a percentage of them that are taking over a year. So maybe bracketing that in terms of how many, what percentage are in issued within three to six months, six to nine months, nine plus, whatever, something like that. So it's just one thought. The other pieces I think that are important in the annual report are the implementation of any corrective actions and what the results of the implementation of corrective actions that DDS and that report, the investigation issues. Right? So oftentimes, there's corrective actions issued, recommendations, are they followed through with, what's the follow through on some of those, corrective actions. In addition, I would like to see some comments about or some pieces in the annual report about addressing some of the systemic issues that have been raised again and again in some of these audits that I mentioned earlier. Another thing, and I know I'm getting close to my three minutes, but in seventy one zero eight, there was a thing about a forum, and I can't remember exactly what it was called, like an annual forum in front of you all regarding the safety and around, you know, abuse and neglect. I would love to see that happen and and maybe become an annual hearing looking at the safety of the again, individuals with IDD in the system. I think an annual hearing looking at these different audits. I know government oversight now is is a new committee that might also partner with that. I hear the bell going. Thank you, Brianne. Quick comment on third party investigators. Well, I know I brought up earlier. I think that's a critical piece of this. You can see in the report that DDS did most of the investigations are done by provider, which I really just go, really? Like, really? That really is the way it is? It is. I I talk to these people all the time. That's the way it works. It's troubling. I'll stop there. I have other comments, but thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Great. Thank you. Yes. We are planning to have an informational hearing to give an opportunity to go over the report that came out because to your point, very startling. Things though that families knew for quite a while. I I would love to hear your thoughts on, in particular, the piece from the commissioner's testimony about not allowing parents or the guardian to get the report without the individual's permission, even though our language is specific that this would be make sure that the person seeking the information didn't, you know, do the abuse. Yeah. We'd just love to hear your thoughts on that.

[Speaker 6]: Yeah. No. And that's I think that's an of course. Right? If they're the perpetuator or the ones that alleged to do abuse and neglect, that's a different story. But assuming putting that aside, and that's in language in the bill now, I think, again, vast majority of these individuals that are being subjected to abuse and neglect have high support needs. Many of them have guardians. You know, many, if not most, have guardians. So the guardian is a legal guardian anyway. So I'm not sure what now if they don't have a guardian, clearly, you need I understand having permission and who that report gets released to by the individual who is their own guardian. That makes sense to me. I think that makes sense to us. But for the vast majority of them and and, again, we could ask for that information too in the report. How many of these individuals it's another piece of information you could ask for the report, who had allegations of abuse and neglect against them had guardians versus didn't? We can ask for that data. That that data is there. Again, not naming names, just percentage and numbers. But yeah. I mean and I understand. I mean, the the commissioner talks about the legal requirements of what can be released and not released and all that stuff. And and I get that. I mean, that that's okay. But the reports being produced, we've seen them. At Disability Rights Connecticut, we have the authority to get some of those if it's part of an investigation we're doing. So I've seen those report redacted. You know, they appropriately redacted as need be for names and stuff like that. But, no, I I don't see again, the fact that the numbers are high and that's a reason that we can't do it is really disturbing to me. I think to all of us that there's so many that we can't do it and that's the reason that we can't do it is just the wrong message entirely. Like, that's just really disturbing. But yeah. So I I think and I understand the need sort of, although I'm not an attorney. I don't play one on TV. I'm not an attorney. But, like, there's requirements that they need to be taken into consideration before they release those reports, I guess. I I don't know. I I read this report. But I I don't see that as being and even all that said, I mean, even that large paragraph, which was the bulk of his testimony, it's still the right of the individual and their guardians to have that information. It's sad. For years, some people wait. I talked about a client right now who's been waiting over a year for the report. And, again, thanks to them being super involved, they were able to ask for that. So go ahead.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Representative Dathan followed by Representative Hughes.

[Representative Lucy Dathan]: Thank you so much, representative and chair. Just wanted to find out, are you familiar under which, parts of HIPAA would not allow, a parent or legal representative or other sort of guardian to not receive, information?

[Speaker 6]: I am not. I am not an attorney. I'm not, you know Okay. Familiar with that.

[Speaker 62]: Kind of where where you

[Representative Lucy Dathan]: said you were an attorney. I

[Speaker 6]: thought Yeah. I I'm not I'm not familiar with it, though. I'm sure there are people both in the room or where I can get the answer for you. You can circle back on that, you know, outside of this. Yeah. I know HIPAA. We hide behind HIPAA a lot.

[Senator Matt Lesser (Chair, Human Services Committee)]: Like Yeah.

[Speaker 6]: Lots of people do, but, like, it's it's yeah. Once you're the guardian, I think that's that's also a very different thing. And they can sign off I mean, I sign off all the time for my wife to see my information on HIPAA form. I mean, I sign I wanna go to the doctor, so it doesn't seem like a a giant issue.

[Representative Lucy Dathan]: Because in my experience with, you know, my kids when they turned 18, they had to write basically my mom can see my medical files or can see the explanation of benefits or whatever it is. And there was an approval. And she said I'm still the sort of legal guardian. And I'm just wondering, under the same law, if there is such a thing. The other question I had to you in your experience, do you do parents when they get these referrals finally, it talks about here personal information redacted. Are there any have you seen in your experience any other aspects of the report or complaints or part of the investigation that would be redacted when the parents do ask for a copy of the report?

[Speaker 6]: Yeah. Thank you for the question. My my experience is that the redactions are generally like staff, roommate names. Right? So a lot of these happen in group homes, for example, or in day programs, and there's other individuals involved, and they might be interviewing those other individuals and some of that information's so it's a lot of that that personal, identifiable information, not about the person who the abuse or neglect is alleged to happen against, but the others that might be, again, in the same group home or something like that, you can't be telling that it's Tom Cosgrove is the roommate and that, you know, this that that that he answered this and said that. So because those reports have a lot of details, and and the commissioner aptly points out some of them are lengthy. Right? There's lots of aspects of these investigations that happen. But yeah. So it's that sort of stuff from my experience that's that's redacted. Staff names, you know.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Sorry?

[Speaker 6]: We wanna hear you.

[Representative Lucy Dathan]: I just said this words of wisdom that no one will ever hear, and I won't remember. One of the aspects that I also kind of thought about, the subsection c regarding the criminal history background checks. Just wanted to have in your experience helping these families, is this been an issue that you have come across within your

[Speaker 6]: work? I think, honestly, in in in my work, for both me, although I've come to learn it's not the case, but for parents, they assume that's the case. Right? They assume that background checks have been done, the appropriate background checking as a point of staff. So that's sort of the baseline that they just assume. I don't think that they I haven't seen from my experience where people like, oh my gosh. This person who, you know, ended up abusing my child come to find out had a criminal background and they it didn't get checked and stuff like that. So I have not experienced that. But the assumption by them is, like, that's kind of the base level. Right? Like, of course, that's happening, isn't it? So yeah. So I applaud anything in there that we can do to strengthen that and make sure it happens by staff and by providers.

[Representative Lucy Dathan]: Unfortunately, I didn't get a chance to talk to DDS about this bill, but one of the questions I did have is, you know, how automated their sort of process is. Are the reports sort of in an automated format that could be, actually easier for them to share with, family members or other legal, representatives because they they kind of talk about that this would be, administratively burdensome. Are you aware of anything?

[Speaker 6]: I am not aware I'm sorry. Yeah. I'm I'm not aware of any automation or anything. I know the issued. They happen. They even have to produce the reports now no matter who they give them to. So the report's there. The issue that he brings up, the commissioner, is the the the challenge of redacting them, going through them, making sure they're clean and ready to give to. Right? Because internally, they they don't have to redact at all. They're just the report. So, I mean, I I that part, I can't imagine could be automated at all, right, redacting something and such like that. So I'm not aware of it, and it doesn't seem like it be easily done.

[Representative Lucy Dathan]: Okay. But Thank you so much. Thank you, madam chair. Thank you. Representative Hughes?

[Representative Anne Hughes]: Thank you, madam chair. One of the the startling things, I think, is the high number of cases of alleged, and like you testified, many substantiated. So I think that is, dumbfound, you know, very startling, and we're looking at high systemic systems where abuse and neglect is allowed or normalized. And what we're talking about with the reports is after the fact, of course, and not prevention. So I want to hear a couple of different things. One is this third party investigating, how can that contribute to a culture of prevention rather than reaction?

[Speaker 6]: Good question. I think the idea of third party administrators, as I sort of said earlier, is one of those really. The providers are investigating themselves. It's bizarre, but you see the numbers in that report that they did. It's a high percentage of seventy five or something like that percent are investigated by the provider themselves. So I think just if it were and I know it's a it's a it's a resource thing as well. Right? Because it costs money to hire third party investigators. I acknowledge that and then how many are out there and what their availability is. But having someone I mean, this is having someone that you know is gonna be looking at these issues outside of your own organization, I think, would put you on higher alert possibly. Right? Now having said that, sometimes not the case. Right? So DDS does get involved in a certain number of them, and you see that in the report. Sometimes it's DDS and the provider. Sometimes it's DDS and a third party. I think they call it other in the report, actually.

[Senator Matt Lesser (Chair, Human Services Committee)]: Mhmm.

[Speaker 6]: Yeah. I don't know if that answers your question, but I I think it it it definitely no. There are also other and DDS could to talk in more detail about this. But there's other levels of because one of our issues too is this as a provider has repeated numbers of abuse and neglect

[Representative Kurt Vail]: Yeah.

[Speaker 6]: Or a staff member

[Representative Anne Hughes]: Or a staff member.

[Speaker 6]: Or on a particular individual with disabilities, right, and repeated in five and six and eight and nine in a year, and these are clients I talked to that have had nine issues No. Some substantiated, most substantiated, some not. Within a year, right, you're shaking your head. It's like, is there there's to me, there should be some other level of oversight, of monitoring, of investigation. They could be pulled together.

[Daniel Beam (Community Ombudsman Manager, CT LTCO Program)]: They they

[Alexander Cruz]: kind of they kind of They do first.

[Representative Kurt Vail]: Yeah.

[Speaker 6]: And they investigate them individually a lot of times, which I understand you have to do an individual. Like, when it's the fifth one in six months, I mean, there should be, like, 10 red flags going up on that.

[Alexander Cruz]: Right.

[Speaker 6]: So, yeah, so we have issues around that. And, again, some of that I highlight in my written testimony, which is a bit longer.

[Representative Anne Hughes]: Is there any we have a a companion supportive decision making bill also before the this session. And I just am trying to think through systemic issues and, educating, you know, high needs population how to be more, empowered and proactive about their needs and and safety and self determination. And interesting when you talk about guardians versus non guardians, how do you see that supportive decision making playing into changing, again, the culture where this is just happening way too much on our watch?

[Speaker 6]: Yeah. I mean, I think supported decision making I mean, you you heard my testimony on that, Bill. But the the supported decision making is really a tool and an option, right, a decision making option for individuals who may not need guardianship, right, to give them another option, an alternative outside of guardianship or conservatorship. For those individuals, and many of them are high supporting individual individuals who are getting abused and neglected are often those with guardians, to be fair. Right? So that's often the case. And they don't have necessarily the voice that they others might. So the guardians are speaking out on behalf. Someone is alleging that abuse or neglect is happening. Some mom, you saw the pictures, is seeing their son come home with a a black eye. They might not otherwise be saying that. I don't. However, if they have the ability to do that and communicate and advocate for themselves, then they may be able to. Now that's also very hard. Right? It doesn't have to be the individual, whether or not they have a guardian, saying I was abused or neglected. It could be any community member, to be fair. Right? It could be disability rights connect. It could be a parent. Sure. A non guardian parent. It could be anybody that that submits that. It could be DDS workers. It could be the provider. And oftentimes, it is all of the above. So I I mean, that support decision making is related to that in the sense that it just gives those who may not need guardianship another option to get support, and there's more supporters around that person available to kind of be looking out for that person. Right? Yeah. And Sort of answer your question.

[Representative Anne Hughes]: And and that does kinda contribute to how can we create a culture of safety, accountability, and we're all looking out for each other. And I think this comes back to one of our original things that we were looking at, which is Medicaid rates and providers and staffing levels where where people have enough support and resources to really keep a high especially high needs individuals safe. And and understaffing leads to a culture of at least neglect, if not, you know, high incidences of abuse. It could be from other, you know, other members, clients. It could be, you know, whoever. But, that is something that we really have to understand. We've allowed and normalized because we have failed to invest the resources as a state in keeping our communities safe.

[Speaker 6]: Yeah. Yeah. And again, yes. Yes and yes. There's lots of reasons that abuse neglect happened. Staffing is one of the many reasons. What this piece does is, again, pro reactively, right, trying to trying to get at that, like, what happened, corrective actions

[Representative Kurt Vail]: Right.

[Speaker 6]: Which is my point for I think that's an important piece of this is what are the corrective actions that are being issued on a investigation and systemically looking at, again, these audits that have happened. What are those things? And and the reports have happened. The audits have happened. They're there. They're you can get access to them. The what are we doing about those things? So that's why I'd like to see some of the reporting done by DDS on annual basis or whatever basis at this annual hearing that we have to say what is being done to fix some of these things that we have repeatedly in 2022, '23, '24, '25 said, and other different parties said the same thing, basically, over and over again. And now we have this annual report in front of you all with some information. It could be better and could be more. But what are we doing to be proactive to fix those things? And having said all of this, the DDS system and and and the commissioner and everyone behind them, they're appalled by these things as well. I mean, I I'm not suggesting in any way. I mean, they are working I know. Hard. As is DDS AID, we work with those people. They are working hard to do it. Staffing is always an issue even within DDS. And do they have enough people to do the investigations? No. Again, disturbing for a lot of reasons because there's 4,000 allegations every year. But, anyway, yeah, lots of reasons for that.

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

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Representative Case.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you. Thank you for coming forward. Yes. I think it's just something that you said that we need to be proactive. You know? Somebody who I don't talk about it often in this building, but lost a brother ten years ago, proven neglect from a 400 page report from DDS. He died. Supposed to have thirty minute checks, wasn't checked for five hours. How do we tell our parents that we feel confident? Whether it's staffing, whatever it is, we need to fix it. I lived it. I don't wanna be proactive. And right now, I'm reactive. But what are we doing? We need to learn from that thing those things. And if there's that many reports out there, they need to be released. People need to know. I didn't know right away. I thought he was in a great place till I found out everything. So we're hoping to get more information, get stuff out there. I'm free and ready to talk about everything that happened. It was ten years ago, but a 400 page report was being blocked. It's it's scary, and I was sitting in this building when it happened. So thank you for coming forward. Let's see what we can get out of our joint informational session. And, you know, we need to make sure the parents and the relatives feel comfortable where they leave their loved ones at the end of the day. Thank God the night before he died, he was with my mother. And then she brought him back to his group home, and he died hours later. So she had the last say. So I, you know, I take it to heart, but it's we gotta do something proactively. So thank you.

[Speaker 6]: Thank you, Rob Case. And and, you know, I it's often I get choked up at many of my testimonies because of the work I do. You you you got me there today. I wasn't there yet, but but thank you for that. But thank you for sharing. It's it's there's many others that that have been through what you're going through and going through. And you saw in the in that report, right, there's 15 deaths in this case. Now there are many deaths that happened of of individuals under DDS, you know, in the DDS system. And and let me just state the fifteenth death doesn't mean that they were the result of abuse neglect. Right? So all that was saying is that fifteen deaths had some abuse neglect allegation associated with it. Right? So I think there's more detail that can be provided in that piece too because that's a little bit misleading, to be fair. Like, I don't know the details of those fifteen deaths, but but we could ask that question or or some level of detail on those, like, how many of those deaths were the result of abuse and neglect, for example, not just associated? Because there might been, again, some neglect as part of it, but it didn't lead to the death. Right? As in the sad case of your brother. But so anyway, I think there's more information that we sent presented there. So thank you for your questions.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. And thank you, Representative Case.

[Speaker 6]: Oh, and I'm sorry. One last quick thing. I did there is some substitute language to that. It wasn't me, but someone else. I think Sarah Egan from CCA had put in her testimony. So just take a peek. There wasn't a ton of testimony on this bill, to be fair, I think, through only six or so. All those have some technical problems that Fran was helping me with getting it submitted. So but there was some substitute language suggested to clean up some of the stuff that we talked about I talked about. And she's, like, a 100 and something on the list, so she's expecting to be sleeping by the time

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you.

[Speaker 6]: She testifies.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: So Thank you so much.

[Speaker 19]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thanks for being here. Thanks. Next up is Catherine Stroud. Catherine, if you're on, just unmute, please.

[Suzanne Graff]: Can you hear me?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. We can. Go right ahead.

[Suzanne Graff]: Alright. Sorry about that. Alright. Good afternoon, esteemed members of the Human Services Committee. My name is Catherine Sprout, and I'm a member of the Connecticut Council on Developmental Disabilities, but I am also the mother of a 28 year old man with a developmental disability. I'm writing in support of Ray's House Bill five five five seven, an act concerning eligibility determinations by the Department of Developmental Services. I'm sure you know that a person can have an IQ of a 150, which is considered genius level, but not be able to tie their shoes, ride a bike, drive a car, use a knife properly, plan or prepare meals, take a shower without being told, and basically function the way you would expect an adult to function. I'm sure you know that many individuals with a developmental disability with an IQ over 69 or higher could benefit from job coaching hours to allow them time to reach their potential in employment. I'm also sure you know that having a higher IQ, sometimes extremely high, is very valuable. And because of it, it allows that individual to process at a much higher level and look at things in innovative, very creative ways, which enables them to be very valuable employees. Think engineers. There are thousands of individuals in Connecticut with developmental disabilities with an IQ over 69 that need a little help to become functioning adults. They currently receive no help or scaffolding from the Department of Developmental Services. It's called the Department of Developmental Services, but it only services individuals with intellectual disabilities. Why is that? If you aren't going to service people with all developmental disabilities, then change the name because it's misleading and it's just not true. Better yet, do what the name says and serve all people with developmental disabilities regardless of IQ. Many of these individuals are on Medicaid but wouldn't need to be with a little help or scaffolding to reach their potential. That would look like transportation, mentors, behavioral therapy, job coaching. Working adults benefit Connecticut. Working adults pay taxes. IQ as a determining factor for services in Connecticut is antiquated and inappropriate. Many other states don't use IQ for determining eligibility for services for people with disabilities. Determination of eligibility should be based on having a developmental disability and level of need and not IQ or diagnosis. It should be determined by a universal assessment tool for all people with developmental disabilities and not based on IQ. Maya Angelou said that when you know better, you should do better. We know better. We've been we've been telling you this for years. I know you know better. Now we need to do better. Open the door to services for people with all developmental disabilities on level of need and not IQ, and watch how this help in scaffolding saves money for Connecticut. Thank you very much for letting me testify.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much for being here today and for your testimony.

[Suzanne Graff]: You're welcome. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Questions. Have a great evening.

[Suzanne Graff]: Thank you. You too. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next is Doug Stranko. Nope. Mark Spellman.

[Dr. Mark Spellman (Psychologist)]: Good afternoon, Representative Gilchrist, Senator Lesser, and distinguished members of the Human Services Committee. I'm Mark Spellman. I'm a psychologist in private practice in New Fairfield, Connecticut. I'm testifying on behalf of the Connecticut Psychological Association to express our strong support for house bill fifty five sixty one, section eight, which calls for a raise in Medicaid reimbursement for psychologists. I've accepted Husky, Connecticut Medicaid for twelve years. Most of us who take Husky consider it part of our ethical responsibility and professional mission to provide services to those who need it the most. Our neighbors who have Husky for insurance. When psychologists submit an authorization for treatment for Husky, we have to rate our patients on literally 20 social and psychological dimensions. And for good reason. Folks on Husky come typically with pretty complex situations. Typically childhood trauma, neuropsychic issues like ADHD, dyslexia, learning disabilities, usually some pretty serious health conditions. It comes with the territory. I think psychologists are uniquely well qualified to help people with these kinds of complicated situations. It's slow work. But over the years, my patients typically get better, get back to work, or get better jobs, and sometimes obtain commercial health insurance. It's a long journey, but we usually get there. My point is we're a good investment. Increasing access to mental health care from psychologists ultimately reduces Medicaid health costs because people who get the mental health care they need, need less physical health care in the long run. It decreases criminal justice costs, increases income tax revenue by supporting patients return to work or getting better jobs. Think of us as a good investment. Now we're not really asking for a raise. What we're really asking for is a restoration. When I first started accepting Husky, we were reimbursed at the Medicare rate. Then in 2017 for the budget crisis, our reimbursement was dropped by over 25%. It's nine years later, we're still reimbursed at less than 75% of the Medicare rate. So please invest in us and it will really help me encouraging my colleagues to join the Husky panel if I could say, in addition to being easy to work with with Husky, which they are, we're reimbursed at the Medicare rate. Please support section eight of house bill fifty five sixty one. Thank you for the opportunity to submit my testimony. And happy Saint Patrick's Day.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Happy Saint Patrick's Day. Thank you so much for your testimony and for being here.

[Dr. Mark Spellman (Psychologist)]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next up is Theresa Coyle. No? Okay. Brian Lynch.

[Dr. Brian Lynch (Optometrist)]: Good afternoon. Senator Lesser, representative Gilchrist, members of the Human Services Committee, especially representative Robin Comey who represents my office's district. I'm Brian Lynch. I'm a practicing optometrist in Brantford, Connecticut. Currently, I serve as the legislative chairman for the Connecticut Association of Optometrists, and I've been a Medicaid provider for forty five years. I'm here to testify in support of section seven of House Bill 5,561, an act concerning Medicaid rate increases for certain providers. Currently, DSS regulations require optometrists to be reimbursed 10% less than ophthalmologists when providing the exact same service. No other insurer is allowed to do this by statute and Medicare recognizes the care delivered by both professions as identical. Currently, optometrists are Medicaid's primary eye care providers. We have been the backbone of the Medicaid eye care delivery system for years. When I first entered the profession, we were considered the vision care providers. Over the years, we've evolved into those doctors not only caring for vision care needs, but also meeting our patients' medical eye care needs. Education, technology, as well as scope expansion have enabled us to treat most of the medical eye diseases we encounter, co manage our diabetic patients with PCPs, and perform minor surgical procedures in our office, and co manages more complicated ones with ophthalmologists. Currently, approximately seventy percent of all of the eye care delivered to the Medicaid population is delivered by optometrists, both locally and nationally. In a 2024 study conducted by our association, we gathered the following statistics. Eighty nine percent of our members participate in Medicaid. The eleven percent who do not would be willing to do so if fees were adjusted, accordingly. One out of every five optometrists in the state state that a majority of their patients are Medicaid patients. Four percent of our of our state providers, mentioned that 75% of their daily caseload are Medicaid patients. According to the Department of Social Services, we saw 120,000 non duplicated, patients for the fiscal year of 2024. We were also reimbursed 13,500,000.0 for that care delivered. Our willingness as a profession to participate in Medicaid and care for our patients coupled with the declining number of ophthalmologists willing to participate, will only increase Medicaid population's dependency upon optometric care. Our Medicaid patients deserve comprehensive eye care, and we've always been there to provide it. In summary, please enact section seven of this bill that requires parity between optometry and ophthalmology for the same procedures and services. You have mandated fee parity in Medicaid for both podiatry and nursing midwives. We ask that you give us the same consideration. By establishing parity like all other payers, including Medicare, you will help to ensure access to comprehensive eye care to the Medicaid population. Thank you very much for giving me the opportunity to comment on this provision bay and and addressing the concerns of my association. And I too would like to wish you all a happy Saint Patrick's Day.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much, and love your lovely green. Thank you for your testimony. Oh, yes. Representative Comey.

[Representative Robin Comey]: Hello, doctor Lynch. Good to see you.

[Dr. Brian Lynch (Optometrist)]: Good to see you too, representative.

[Representative Robin Comey]: I can see you because I have glasses.

[Dr. Brian Lynch (Optometrist)]: Touche.

[Representative Robin Comey]: So I was wondering, this this provision in the bill, if you could, ask me how much this fee parity would would would cost the state.

[Dr. Brian Lynch (Optometrist)]: Sure. Since optometry and ophthalmology, we're being paid 10% less than ophthalmology. So if we look at the amount that was reimbursed in fiscal year twenty twenty four, that was $13.03 5. But with federal matching, that would be half that. So approximately 6.7 or $670,000 to establish that fee parity. Having shared that too, and I'm I'm glad you're here today, I wanna share with you in our community how difficult it is for me to find an ophthalmologist who will accept Medicaid. Pretty much every office in the Brantford and surrounding community have no longer accepted no longer accept Medicaid, and I'm left with really only one resource locally, and that is Yale. That being said, it creates a problem as far as my patients getting into New Haven. So, again, limiting access. But to the best of our knowledge and based upon the information that DSS has shared with us, our guesstimate is that it's about $675,000 in that ballpark.

[Representative Robin Comey]: Thank you so much. Yeah. And and I would just note that it's no easy feat to get an appointment at at your office as well. Yeah. It's be scheduled well ahead of time, and so there there must be a great demand for that.

[Dr. Brian Lynch (Optometrist)]: There really is because, quite frankly, I think we're about the only provider in our community. And and Brantford is is one of those communities you wouldn't expect to see a high Medicaid population in our offices, but we do because they are coming in from New Haven, and the surrounding communities because we are one of the few offices who do continue to accept.

[Representative Robin Comey]: Well, thank you for what you do, and it's good to see you again. Thank you, Matt.

[Speaker 15]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. And thank you very much. Have a great evening.

[Dr. Brian Lynch (Optometrist)]: You also.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Yep. Next up is Eric Reinemann. No. No Eric. Ayesha Clark.

[Ayesha Clark (Health Equity Solutions)]: Sorry. Thank you so much. Good afternoon. I'm senator Lesser, representative Gilchrist, and esteemed members of the human service committee. My name is Ayesha Clark, and I'm joined here by my my colleagues, Karen Siegel and Kallie Moquette. Thank you for accepting this testimony in support of SB three and SB four ninety six on behalf of HealthEquity Solutions, a non profit, non partisan advocacy organization where I serve as the executive director. We HES stands with Health Justice Now. Medical debt is catastrophic. Lack of health insurance and unaffordable coverage have real consequences. Families delay treatment, skip medications and sometimes even die. Even before federal changes, Connecticut families struggled to pay for care. Now that the state faces a full blown affordability crisis, this burden affects patients, providers and employers and the broader economy. And systemic inequities persist. Black and Hispanic families are far more likely to carry medical debt, trapping trapping them in stress, poor health, and long term financial hardships. Yet many millions in so called bad debt are from Connecticut patients who should have qualified for financial assistance while hospitals have reduced financial assistance spending. CHA claims that provisions shift responsibility for uncompensated care to hospitals. But in reality, hospitals have already are legally responsible. What this bill does is is standardize financial assistant practices and ensure hospitals meet the obligations tied to the public tax subsidies they receive while the state steps in to help them meet the obligations to address the growing crisis. SB three and SB four ninety six create state funding programs for uncompensated care while hospitals can access if they follow standardized financial assistance and billing practices used in other states. For example, SB four ninety six protects patients with household incomes below 200% FPL from medical billing, requires responsible payment plans for others, and standardizes income verification and billing practices. It also ensures that people receive the support they are entitled to in reduced confusion, errors, and inappropriate collections. At the same time, SB three moves to address the national health insurance dilemma. We did not create this situation. But we do have the resources and expertise to stop the bleeding. SB SB three proposes a thoughtful three part strategy to ensure every Connecticut resident can access an affordable health care plan. First, a temporary extension of state subsidies while longer plan solutions are developed. Second, the creation of basic health plan that can replace and expand Covered Connecticut. And finally, a study and implementation of additional options including a state run health plan to ensure that every Connecticut resident has access to affordable health coverage. HES supports these strong proposals other than other other similar bills be excuse me. HES supports these strong proposals over other similar bills because they maximize impact while minimizing state spending and potential federal scrutiny. HES made several technical recommendations to clarify the language of SB four ninety six and section 10 of s b three. I want to highlight two of these. We urge the legislature to ensure that the disproportionate share of hospital payment and uncompensated care funding reimburses hospitals for actual costs, not inflated charges, and to authorize the attorney general to enforce existing hospital financial assistance laws so hospitals meet their obligation to patients. Lives depend on this. Now more than ever before, and we want to ensure that create policies that address these. Thank you so much, and I welcome any, comments and or, questions.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. Senator Lesser.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yes. Thank you, Ayesha, for your, your for your testimony and for the work of your team there that you've been, huge, advocates for, these issues, and I'm just very grateful for, your thoughtful, advocacy and your expertise on, on so many of the issues before us. Just talk about with respect to, the medical debt portion. You know, a lot of folks are falling through the cracks. We're at risk of falling through the cracks because of HR one, and it's, you know, designed, I think, to, you know, bury people with paperwork and to and and tactical minutiae. You get something wrong, and all of a sudden, you don't get health insurance. And so as I understand it, this proposal says that the the the medical debt part of s p three says that we're not we're simply not going to have folks with, who are below 200% of poverty or if they're on, SNAP or WIC, if they're higher levels, sort of have presumptive eligibility. We're saying, please say that you won't get you won't get us a bill. And in exchange, the hospitals will get compensated for that. Is that is that right? And what am I what am I missing? And is this is and just maybe talk about why that's so important.

[Ayesha Clark (Health Equity Solutions)]: No. Correct. So you are right, senator Lesser. The reason why this is important is because many individuals who are receiving bills from medical debt would be presentably eligible for the financial assistance anyways. And so what we're looking to do is because we know that there's gonna be burdens when it comes to, work requirements and others for financial administrative burden, we believe that it's important for these individuals to be presumptively already eligible for the financial assistance instead of filling out additional paperwork when we know that they would already be eligible if they were to be presumptively eligible before that. I know I said that word plenty of times. But essentially, it just means that we know that these people would qualify for financial assistance. So rather than filling out additional paperwork, if they're already on SNAP and other benefits that would preclude them to be a part of the financial assistance, go ahead and ensure that they are a part of this so that they will not get continue more bills and things of that nature, which we know will cause more burdens.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. And these hospitals are all nonprofit hospitals. They all receive state funding. These are all they all required to have financial assistance policies and they all do have financial assistance policies currently. But your testimony suggests that it's often difficult for patients to navigate those policies and to get access to the care that they were supposed to be getting already.

[Ayesha Clark (Health Equity Solutions)]: That is correct. As many of you know from a federal standpoint, if you are a nonprofit hospital, the requirement is for you to provide financial assistance or community benefit. Many of the individuals will call it charity care. And so with that, we are just proposing things that are should be in place. Many hospitals at Shearson and the Lesseur do have a financial assistance. But what we are hearing from community members is that they it's difficult for them to figure it out, find it, and or there are different policies in place to collect that data. And so we are really just suggesting that there is an eligibility part specifically for those who want staff and other benefits to be presumptively eligible eligible for that.

[Senator Matt Lesser (Chair, Human Services Committee)]: And then just with respect to DISH payments, because we did receive some testimony from DSS with concerns about the policy. You mentioned that DISH payments are if it's federally mandated policy, their their hospitals are eligible for based on their actual incurred expenses. I I hope that's the language that's actually in the bill. And if it's not, that that we obviously, that's the intent is that that that that that those payments would be for those incurred expenses based on the federal formula, based on their actual incurred expenses.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Thank you.

[Ayesha Clark (Health Equity Solutions)]: Yeah. Thank you for that question. I'm gonna pull my colleague, Kelly Moquette, up.

[Speaker 67]: Is that okay?

[Senator Matt Lesser (Chair, Human Services Committee)]: Just identify yourself for the record, please.

[Callie Moquette (Health Equity Solutions)]: Callie Moquette, Health Equity Solutions. So additionally to your former question, for SNAP and WIC presumptive eligibility, we know this wouldn't cause an undue burden on hospitals because other states have already implemented it. Right? We know that with the new federal requirements, when you enroll in SNAP, when you enroll in WIC, you demonstrate your your income status to the state already. Right? So going through additional hoops and bounds is just an additional hoop, another administrative burden that we would put additional things on families who've demonstrated this. Right? So we know that these families are demonstrating this time and time again. They'll be doing this every six months. We know that there's exceptions. We know that when families are under 200% of the federal poverty level, that they should have no cost care. Right? When some of the testimony submitted by the Connecticut Hospital Association indicates that they're already doing this. However, standardizing this and giving them additional compensation is something that this bill offers. We also know that giving this bill these provisions will ensure that there's no bill being sent to these patients. That's the difference. The hospitals that have implemented the the hospital financial assistance provisions require patients to submit applications. That would presume they even know about these applications. Not receiving a bill and no bill for these applications is a huge component. And again, like you just mentioned, senator Lesser, no bill means no application. No application means no administrative burden. And we know that that is huge. Another portion of this bill, which also is implemented in other states. Again, I mentioned Illinois. I mentioned Maryland. We know that Colorado already does the no billing for under 200% FPL. So again, if other hospitals are doing this in other states, Connecticut can follow this lead and do this too.

[Senator Matt Lesser (Chair, Human Services Committee)]: Thank you.

[Representative Anne Hughes]: Thank you. Representative Hughes. Thank you, madam chair. So forgive me. I already thought that hospitals could only bill for the actual cost, not the inflated markup. So you're saying that's not true and and we are dealing with inflated medical debt?

[Callie Moquette (Health Equity Solutions)]: No. So there's a different so the the my comment was to the former question from senator Lesser.

[Representative Kurt Vail]: Yep.

[Callie Moquette (Health Equity Solutions)]: Then he asked a a latter question about the dish payments and what our recommendation was ensuring that if the dish payment portion of so that is section 11 of senate bill three

[Representative Kurt Vail]: Mhmm.

[Callie Moquette (Health Equity Solutions)]: And I believe it is section two of senate bill four ninety six. So to ensure that if this bill were passed and this provision is implemented, that it's tying it to actual cost for hospitals if they're going to be reimbursed for implementing these additional provisions so that it's not inflated. Right? So we know that sometimes if you look at the Office of Health Strategy community benefit reports, right, there there's questions around what how they're quantifying their bad debt. Right? Some of those patients that are are being written as bad debt would have qualified for hospital financial assistance or should have qualified for hospital financial assistance. So if you're writing that or quantifying that as bad debt, that's not an actual cost. Right? Like, you're getting paid twice for that. And then I can also turn to Karen Siegel, our deputy director,

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: if there's anything she'd like to add. Please.

[Speaker 36]: I think the short sorry. I think the short version is that hospital charges bear no relationship to

[Representative Lucy Dathan]: the actual cost of care.

[Speaker 36]: There's no correlation. There's been a number of national studies done on this. And so what we're saying is that that if the state is going to reimburse hospitals for something that is their obligation, which we support, I think this is a hard time for them, what the state reimburses for should be based on cost of care, not on charge

[Representative Anne Hughes]: gas. I completely agree. And through you, madam chair, you you mentioned several other states that have implemented it. Has it can you verify that they have not lost their hospitals as a result?

[Dr. Barbara Dune (Optometrist) / or Association Rep]: Yes.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Absolutely.

[Representative Anne Hughes]: Makes a difference. Okay. Thank you, madam chair.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Thank you so much

[Representative Anne Hughes]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: For everything you do. Have a great afternoon. You too. Next up is Jordan DeAngelo.

[Jordan DeAngelo]: Good evening, senator less senator Lesser, representative Gilchrist, and distinguished members of the human services committee. My name is Jordan DeAngelo, and I'm a personal care attendant. I've been my mother's caregiver since 2012 when she start started to struggle with fibromyalgia. It was natural that I stepped in to help her after I did the same thing for my grandmother for years before. Now I've seen a lot of things change in my 14 as a caregiver, and I know a lot needs to be fixed still. So I'm proud to support senate bill four ninety eight and act protecting paychecks for personal care attendants and expanding public access to state programs, and I ask you to do the same. So, unfortunately, my I'm I apologize. Unfortunately, my mother's health went downhill in 2016 when she suffered a traumatic brain injury. She was just 54 years old and went to respiratory failure before slipping into a coma for nine days. Since then, she has required around the clock care. She's needed to have she's needed help re to relearn everything, how to feed herself, how to walk, and how to communicate. I accepted and became a PCA to start. We now have two other PCAs on our care team who helped me. Life happens, though. They get sick or need a day off, so I'm always gonna be there for her. I've been doing this since I was about 18, and I'll be doing it for the rest of her life. But she's my mother, so I'd do anything for her. It's hard. It's mentally and physically exhausting some days. But despite all we do for her and all the care she needs, she briefly faced losing key hours of care when DSS decided to change their calculations from annual to monthly budgets. They miscalculated the hours she should have had, and it briefly left us wondering what to do if my mother would get would get the care that she needs. Other PCAs and myself went without her income, and one of them lost their home. And that's the worst feeling known that the person that I depend on to help take care of her wasn't even able to take care of themselves. We cannot have caregivers living like this in Connecticut, not knowing if or when the next paycheck will show up, not knowing if they can afford their rent, pay their bills, or worry about where they will have to sleep at night. Because if that's the Connecticut we live in, I'm here for our future. Please support and help pass SB four ninety eight for all the PCAs in our state and all those who depend on them. Thank you for your time, and I'm happy to have it answer any questions.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much for your testimony and for being here tonight. I don't see any questions. Have a good evening.

[Jordan DeAngelo]: You as well.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Next up is Benigno Colin Rivera. No? Oh, yes. Great. Thank you. Nope. It'll turn red. There you go. And, Benino, you just need to unmute.

[Speaker 55]: Hello?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. We can hear you.

[Speaker 55]: Okay. Hi. My name is Sammy from.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Wonderful.

[Speaker 55]: Okay.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Excuse me?

[Speaker 15]: Yeah.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. So

[Benigno Colón Rivera]: good afternoon, senator senator Lester, representative Gilchrist, and and members of the committee. My name is Benigno Colon Rivera. I live in I live in Waterbury, and I am testifying in favor of s p four nine seven and s p three. So I'm speaking in favor of because I live on Social Security. Snap, for me is a lifeline. It has the benefit of protecting folks like myself and making sure that I can be fed with respect and dignity. And currently, these federal cuts put thousands of residents in Connecticut in risk of going hungry, and this includes children, babies. Of course, our senior citizens are veterans and folks with disabilities as well. And thousands more run the risk of losing their their medical coverage through Husky. And this help is, you know, not there for folks that, need it currently.

[Daniel Beam (Community Ombudsman Manager, CT LTCO Program)]: And we need to do this

[Benigno Colón Rivera]: for folks that need it just like me, just like us.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. Thank you for your Next up is Natasha Kelly.

[Representative Kurt Vail]: No.

[Dr. Barbara Dune (Optometrist) / or Association Rep]: Natasha.

[Representative Kurt Vail]: Catherine Valada.

[Speaker 36]: Good afternoon. I think we have one of our panelists on Zoom, Amir, but I'll get us started. Dear senator

[Suzanne Graff]: I'm here.

[Speaker 36]: Vilcas. Hi, Amir. And esteemed members of the human services committee. My name is Catherine, and I'm the coalition director for Husky for Immigrants. We're a statewide coalition of over 40 organizations advocating for equitable access to health care for all residents regardless of their immigration status. We're guided by a fundamental belief that health care is a human right and we stand with health justice now. Thank you for the opportunity to testify this afternoon in strong support of SB3 alongside our partners at Connecticut Students for a Dream and the Connecticut Worker Center and Connecticut For All. SB three very accurately recognizes both the limitations of the emergency response fund put putting forth key policy proposals like the basic health plan, medical debt prevention, and the Connecticut option study. But it also recognizes its potential by leveraging it long term by establishing the the trust fund and growing that investment to continue to respond to federal cuts. SB three is a step in the right direction to respond to these cuts with real structural solutions that will protect Connecticut residents from medical debt and offer more pathways to coverage at a time when the federal administration works to take, coverage away. Our coalition members specifically have felt the ongoing attacks from the federal administration, both related to increased immigration enforcement activities, but also related to cuts to safety net programs. So with that in mind, I do implore the committee to ensure that the proposals that are being considered in s b three are implemented but are also in inclusive of all income eligible residents regardless of their immigration status. And with that, I will pass it over to Rosa.

[Speaker 67]: Good afternoon, members of the Human Service Committee. My name is Rosa Rodriguez. I am a mother I am a member of Conerico Worker Center and I am proud mother of four children. I stand with Health Justice Now. I state wide campaign fighting for the quality, affordable health care for everyone in Connecticut. In this very difficult and expensive times, families like mine are doing everything we can just to keep up. As a mother, my biggest responsibility is protect my children and make sure they are healthy. But the truth is right now I do not have health insurance and that is something that worries me every day. As a mother of four, I live with fear and getting sick because medical care is so expensive. I worry about what will happen to my children if I become ill and call no afford the care I need. No one should have to live with this fear of getting sick sick because they cannot afford or see a doctor. Health care should not be a luxury. It should be something every family can access when they need it. When health care is affordable, people are more likely to see help, get regular checkups, and treat illness early before they become more serious and more expensive. That's why I support SV3. Conerico families need real solutions to make health care more affordable, more accessible. Policies like basic health programs, a strong hospital financial assistance, and a state run health insurance option can help families like mine get the care we need without fear of medical death. For the those reasons, I respectful urge you to support SB3 so that all Kanerika residents, we can have access to quality and affordable health care. Thank you for your time and considerations.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Is Amir going?

[Speaker 36]: Yeah. Amir should be on Zoom.

[Amir Flores (Student, Southern CT State University)]: Yeah. Hi. Good evening. Good chairs, vice chairs, and ranking members of members of the union human services. I am Amir Flores, a student of Southern Connecticut State University in London. I'm with Connecticut Students for a Dream. I am submitting testimony in support of s b three. I stand with how I choose this now. I know someone very close to me whose immigration status is very complicated. And right now is what what is what makes is it difficult for them to receive their health care they need. They are afraid because they don't know which places are safe and not having health insurance makes it make it hard for them to even be treated be treated. Sorry. But even if they did have insurance, the limited coverage and a higher out of pocket cost, like co pays and medications will be will force them to delay seeking treatment in life with constant pain. No one should have the to choose between their health and what they can afford to pay. This isn't just just happening to people I know. It's something that happens every day in many parts of this country. Everyone deserve their right to health health insurance. Thank you for the time, members of the human services committee.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you very much. Thank you all so much for being here.

[Representative Lucy Dathan]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Have a great evening. Next up is Sarah Ganang. Alright. Noreen Simmons.

[Speaker 53]: Good afternoon. I am really honored to be here and I'm kind of struck by the enormity of your jobs. You have a lot of power and you have I'm I'm just really impressed right now by what I'm hearing. But I'm here piggybacking on Catherine Stroud's testimony, but my story hopefully will get you because it's my personal story for HB5557 and act concerning eligibility determination for DDS services. As you know, the current determinator determiner for DDS services is IQ under 70. My sons I have two sons on the autism spectrum level one and level two. They are young adults. They both still live at home with us. We live in West Hartford. I'm Jillian's constituent and I've been advocating for my oldest son is 24 for, you know, twenty four years basically for autism causes. My son's, I feel is serve as a clear example of how that IQ determiner is problematic and discriminatory. My 24 year old son, Weller, has a ASD and an IQ of 69. Therefore, he receives DDS services through the Central Connecticut Arc. They've provided exceptional vocational training, enabling him to become competitively employed part time, and he is thriving. He works at a a rest home. He washes dishes and delivers meals to the patients, and he has purpose in his life because of that. Only part time, but it's great. My second son. Sorry. This is doing something weird. My second son is 21 years old and struggling. He also has a ADS ADS, anxiety disorder and depressive disorder, but he has a higher IQ. He was unable to succeed taking a few college community college courses. Sadly, he's unemployed and he lives at home despite very high IQ. He does not qualify for DDS supports because of the higher IQ. Autism is a really complicated disorder. And many individuals with higher IQ still face many challenges, sensory challenges, executive functioning issues, social and communication challenges, anxiety, but mostly the social and communication challenges. They need supports to live too. Some think autism waivers are the answer, but they're not. The current wait list for the autism waiver is extremely long with individuals waiting years before gaining access to services. Those with with a d ASD cannot wait for years. By changing the IQ level as a major determiner of level of need for individuals with autism spectrum disorders, those like my younger son, I'll finish up, could become eligible for DDS services such as vocational training, resume writing, interviewing, job searching, job coaching. This could make a huge difference in hundreds of people's lives in Connecticut, Really life changing. It could help employers fill empty positions. People with autism show up for work every day. They love to go to work. And it would turn more folks into Connecticut into taxpayers. Well worth the funding. It's simply the right thing to do to change this determination. Please support this legislation and feel free to contact me with questions as needed. Any questions?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much and thank you for your continued advocacy.

[Speaker 53]: Thank you. Wait, Representative Hughes. Yeah.

[Representative Anne Hughes]: Hey, thank you so much for your personal testimony of the, you know, unfortunate situation of the haves and have nots.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Mhmm. You know,

[Representative Anne Hughes]: we do believe that everyone with the right supports and resources can be successful and, you know, live, self determined lives. And I think that, we have defaulted to a system that of that IQ cutoff because we otherwise would not have the resources, shall we say, to to, you know, so I think we're now trying to figure out how to bridge to include, you know, those folks that have been denied resources and services and how to have a budget that, that reflects that investment, like you said. Do you have, do you have any, testimony about counterparts in other states that are not using the IQ cutoff?

[Speaker 53]: I don't, but I can certainly get that to you because I volunteer for Autism Speaks, and I can absolutely get that through any of you. I'll just stop here but to your point I think I think this will be a short term investment for many of these people. I think they're just wallowing at home doing nothing and a little boost of short term funding, not long term for the rest of their lives could make a huge difference. So I

[Representative Anne Hughes]: So some case management support, some

[Speaker 53]: Vocational training.

[Representative Anne Hughes]: Vocational training support.

[Speaker 53]: Support getting a job and keeping it for maybe, you know, under a year, they're probably on their way to go.

[Representative Anne Hughes]: Okay. That's helpful. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. Thank you so much. Next up is, Burnett Lowry. Okay. How about Rachel Conley?

[Rachel Conley]: Hi. Can you all hear me?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. Go right ahead.

[Rachel Conley]: Sorry. I still don't have power, over in the Eastern Side Of Connecticut, so please bear with me. Good afternoon, chairs and members of the Human Services Committee. My name is Rachel Conley. I'm a Connecticut resident and a master of social work and master of public administration candidate at the University of Connecticut. Thank you for the opportunity to speak today. I'm here in strong support of SB four ninety seven. I wanna start with the context of what's happening right now. Recent federal changes to SNAP have expanded, and tightened work requirements, limiting many adults to just three months of benefits in a three year period unless they can document at least eighty hours of work per month or qualify for an exemption. At the same time, exemptions have been reduced, meaning more people are being pushed into these requirements, whether or not they are realistically able to meet them. The result is that thousands of Connecticut residents are at risk of losing access to food, not because they don't want to work, but because the system is no longer aligned with the realities of people's lives. And that raises a bigger question. What are we actually expecting from people? Food is a basic human need. I would argue it is a basic human right. We live in a country that already heavily subsidizes food production from dairy to produce because we recognize that food systems matter. But those systems only work if people can actually access the food. It is not reasonable or safe to expect someone to be consistently to expect consistent employment from people who are not consistently nourished. Hunger impacts cognitive functioning, physical well-being, and the ability to focus, plan, and perform at work. When we take food away first and then require work, we are setting up people to fail. We are setting a dangerous precedent for who is deserving of food. SB four ninety seven responds to this reality in a practical and necessary way. By creating a state fund by creating a state funded transitional benefit program, this bill ensures that people do not simply fall off a cliff when they lose federal SNAP benefits. In both social work and public policy, we talk about benefit cliffs as one of the most harmful features of assistance programs. When supports disappear abruptly, it creates instability, not self sufficiency. This bill instead provides a bridge, time limited assistance combined with job training and case management. That approach supports people in meeting requirements rather than punishing them when they cannot. I also want to highlight the importance of reducing barriers to access for people on probation or parole. Access to food is a basic need and restricting it does not improve public safety. In fact, stability, including food access is one of the strongest predictors of successful reentry. If we want safer communities, we need policies that support people in meeting their basic needs. More broadly, food insecurity has ripple effects across every system we rely on. It leads to worth worse health outcomes, increased health care costs, and greater reliance on emergency food networks. When people lose access to food, those costs don't just disappear. They shift elsewhere. And I do wanna acknowledge the great cost that this bill, SB four nine seven, will put on the state itself. But I do think that the state has a responsibility to the residents. And when the federal government fails, it's the state's opportunity to step in. Connecticut is more than capable of providing for everyone. And as one of the wealthiest states, I hope that we can be a leader here. SB four nine seven is an opportunity for Connecticut to step in and prevent harm. At a time when federal policy is creating new gaps, this bill ensures our state does not leave people behind. It reflects our commitment to dignity, stability, and the basic well-being of our communities. I urge you to support s b four nine seven, and I appreciate your time.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. It's always so nice to see a fellow MSW. Mhmm. And and good luck with the power. Thank you. Next up is Adrian Benjamin. And happy social worker appreciation month.

[Speaker 27]: I should know that by now. I'm sorry, but I have to talk about some really unhappy stuff. It's not my it's not what I wanna do, but it's what I must do. Much appreciation to you all. Representative Gilchrist, representative Senator Lesser, representative Comey, Hughes, representative Case, and representative Vail. It's been a busy day. I'm here to support house bill five five five eight regarding DDS and abuse and neglect. I'm especially concerned about the problem with background checks. I'm here both as the chair of the Connecticut Profound Autism Alliance and Zoe's mom. She's 29, but like a two year old developmentally nonverbal and lives in a group home. Unfortunately, Zoe was brutally brutalized on a midnight shift in 2024, October 2024. And I need to share the details of what happened as unpleasant as they are because it it does really reveal the kind of problem we have with people that get these jobs who should not get these jobs. Between three and 6AM, October 13, she woke up. She wakes up all the time. That's just part of her profound autism. Wants to walk around and have some Cheerios, but the staff member, no. Didn't wanna do that. So the staff member, again and again, repeatedly pushed and shoved her back onto the bed, with a lot of force. And at some point, she decided to just block it. You know, she just blocked her in the room and wouldn't let her open the door. That's against the rules. She also, took her into the bathroom for a while where she yanked her hair back, missed her neck, slapped her, hit her, actually punched her in the head. Zoe had a broken nose. Then instead of calling as she's bleeding, instead of calling 911, she cleans up the blood, changes her clothes, got rid of all the evidence so they can she can just tell the EMTs that Zoe fell, which is what she told the EMTs. And I apologize for showing you these pictures, but this is reality of what my girl went through. So she was brutalized. There's no other word for it. This lasted between three and 6AM. The EMTs were finally called, and I was also called, and I met the ambulance to drive go with her to the hospital. I couldn't believe her face. It was not from a fall. How do I know all the details? This the the story the the the videotape is there because I requested a videotape from a previous thing that happened. The video machine is in the top of the the camera. It's on the top of the ceiling, and it showed what happened minute by minute. And the police the Weathersfield police did a wonderful job of of explaining everything. And I'm sorry. I'm probably gonna blow the time limit. Without that camera, that woman would still be working there brutalizing other people. But this is not just about Zoe. The data that has come out from DDS in 2021 and 2022, there were about two thousand cases of abuse or neglect. 2020 three, three thousand five hundred. And now this year, it's actually twenty twenty four. Four thousand two hundred and forty six cases of alleged abuse and neglect. It's stunning. It's sickening. And, I know the commissioner said we do we do really good background checks. No. They don't. They don't do good background checks. Yes. There's a criminal background check. That's that's great. But there's something wrong with the hiring process. Could how how could the very reputable agency where Zoey is hire such a cruel, cruel person? Just because someone has no prior arrest doesn't mean they're decent, doesn't mean they're kind, doesn't mean they have compassion and patience. So our background checks are not adequate. I have brought up before in meetings, we need some kind of psych testing, not like a deeply you know, we don't need to know all of their little issues with their mother or whatever. I have a therapist. So we but we need to know that they're kind and they're patient and they have good values. So, I support this bill and, hopefully, there can be some real research done on what kind of testing what what should be added to our background checks so that these kind of things don't happen again. Because, obviously, maybe Zoe's an extreme case, maybe not. I'm just gonna say one more sentence. I talked to Tom at and he had he did tell me to tell you he misspoke. Because when you read the DDS report on the deaths, the fourteen deaths in 2019 that were confirmed are connect they are connected to abuse and neglect as are the fifteen that are connected this year. They're not random like, well, maybe they had abuse six years ago. They are connected to current to recent abuse and neglect. Thank you very much.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Wow. Thank you. And no parent would ever wanna have to experience that. So I appreciate you being here and the advocacy you do. Thank you. Yes. Senator Lesser.

[Senator Matt Lesser (Chair, Human Services Committee)]: No. I just wanna echo that. And, Adrian, I know you and I have talked about this before and I visited Zoe who's a constituent of mine in Wethersfield and after the event. But it's what a what a what a stunning failure on our part to not do our part to make sure that that she's safe. Do you you know, I I I don't you know, words fail me other than, you know, there are a whole bunch of it seem like there are a bunch of different issues, right, for paying bottom basement wages, and that also limits our ability to attract good people. And there are wonderful people who work in group homes, and I I'm not trying to insult any of them. But in terms of attracting good people into the profession, it's really hard to do that when the wages are competitive. But then also you mentioned also whatever else we could do around psychological screening or any other way to figure out is this something that's likely to ever recur when you know, I'm glad there was a camera there. But if the camera's not watching, how do we make sure that that we're we're doing that? So please accept, you know, my deep regrets and our regrets. And I know that we're gonna do everything we can to make sure that this doesn't happen to someone else.

[Speaker 27]: You I certainly do not blame any of you.

[Senator Matt Lesser (Chair, Human Services Committee)]: No. I didn't think you were blaming me.

[Alexander Cruz]: But, yes, I Or any of you. Yeah.

[Representative Anne Hughes]: Representative Hughes. Thank you, madam chair, and thank you, Adrian, for testifying again on behalf of all families. I wanna ask you, and I'm deeply sorry that this happened to you and to Zoe. I wanna ask you in terms of proactively, we talked about that a little bit earlier today. You're talking about a different type of screening. Is there anything else that you think is vastly missing in terms of our system to, screen appropriate matches with with this kind of work?

[Speaker 27]: Well, one thing that's missing is autism training, especially for people with profound autism. You know, DDS has a series of, you know, uploading training people and there's not there's not a course on profound autism, which is autism we know is the fastest rate rate of growth in in developmental disabilities, and twenty six percent of people with autism have this more severe form where people are gonna need one on one help for the rest of their lives. So autism training would be a would be good. And there you know, there's people that work with Zoe who are lovely people. They've never had a minute of autism training, but it's just they're patient. They're caring. They're kind. I don't think any training could have gotten this woman to be patient, caring, and kind. You cannot behave that way. She you know, her cruelty is deeply rooted. And I was at court today in New Britain superior court. She has not yet been it has not been adjudicated yet. She's charged with two felonies and we're still waiting. Postpone, postpone, postpone. That's a whole another challenge.

[Representative Anne Hughes]: And what just through you madam chair, one more question. You know, I've been a Group Home Manager and and the difficulty in in trying to staff overnights, trying to staff, you know, you know, that that double staffing, you know, standard that we should have. I'm just curious as to is there any other systemic thing that we could do that could help, you know, mitigate, like you said, some of it's recruiting. I kinda wonder was this person only working at nighttime in that She had been

[Speaker 27]: there She excuse me. She'd been there five months. She wasn't even in out of probation yet. Okay.

[Representative Anne Hughes]: Yeah. Well, as a as a former group home manager and and supported living manager, supervision is so important. And and it is interesting that you say you were the one who required the video in the ceiling. Absolutely. It wasn't standard at all for the group home.

[Speaker 27]: You have to fight for that. There's a committee called the Human Rights Committee. It's part of DDS.

[Speaker 22]: Mhmm.

[Speaker 27]: And I don't know any of the people there. So and they don't know me. They don't know Zoe. And when they they fight, they think she's on too much medication, sleep, and she still wakes up. She's on the maximum dose. And I feel like maybe you should have her over to spend the night, and then you can tell me that she's on too much medication. They make decisions for people they've never met, and it was a fight to get the camera because they're very concerned with privacy.

[Representative Kurt Vail]: Mhmm.

[Speaker 27]: I'm concerned with safety. Yep. And I'm not saying first. I'm not saying privacy isn't important for some people. Everybody's different. And I I do think we need to next year, I'm planning to come and talk about how important cameras are. But I can talk about it now.

[Representative Anne Hughes]: You heard it. Well, it's an ecosystem. Right? We're talking about, you know, investigations, which is, again, after the fact. Right. How are we preventing this from happening, harming our most vulnerable population, especially non verbal folks that, you know, are easy to exploit.

[Speaker 27]: You know, I I'm from New Orleans, and every year I throw a Mardi Gras party at the house. And when I threw one this year, like, three weeks ago, I realized not one staff member had been there the year before. No. So turnover is a big red flag. Manager. Not any of the staff had been there even for a year.

[Representative Anne Hughes]: That's a that's a big red flag. Huge

[Speaker 27]: red flag. Yeah.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Okay.

[Representative Anne Hughes]: Thank you, madam chair, and thank you for your testimony. Thank you so much.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Representative Vail.

[Representative Kurt Vail]: Thank you. How long ago did this happen?

[Speaker 27]: October 2020 10/13/2024.

[Representative Kurt Vail]: And it's been a year and a half and it hasn't been adjudicated in the courts yet?

[Speaker 27]: Correct.

[Representative Kurt Vail]: Is there a bond? The person's out on bond?

[Speaker 27]: She's out on bond. Yeah.

[Representative Kurt Vail]: Okay. And there are two felonies pending. Was the group home cooperative or not?

[Representative Anne Hughes]: Yes.

[Representative Kurt Vail]: They were. But but you had to pursue the camera?

[Speaker 27]: I pursued the camera three prior years ago because she had bilateral handprint bruises on her arm.

[Representative Kurt Vail]: You pursued getting the camera. Did did you did you have to was it a struggle to get the footage or no?

[Speaker 27]: The the footage about this brutality, no. There was not it took a while to get it. It's sort of an old fashioned system that needs to be updated. But the and that's the only camera in the whole house. So if something happened in the living room, we wouldn't know. But she'd had handprint bruises that were unsubstantiated because there was no camera. So that's when I said we have to have a camera. And it went through the Human Rights Committee. I mean, we did get it, but, you know, you have to sort of beg. And she's nonverbal, so there's other people who I know need cameras and don't have them.

[Representative Kurt Vail]: If you would, if I didn't really get to see the photos. I would like to see those. You can give them to me Okay. Later. I just had one last question. Do you serve hurricanes at your

[Speaker 29]: at your New Orleans party?

[Speaker 27]: I I serve red beans and rice Okay. And I serve, king cake.

[Andrew (Andy) Selinger]: Okay. Alright.

[Representative Kurt Vail]: Thank you.

[Speaker 27]: I wasn't that kind of New Orleans person.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Very important question. Thank you.

[Speaker 27]: I left I left when I was 18. So I visit, but yeah.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you for being here. Next up is Anna Vasquez. Go right ahead.

[Representative Anne Hughes]: Yes. Just a moment.

[Representative Kurt Vail]: Okay.

[Representative Robin Comey]: Okay. Thank you.

[Anna Vasquez]: Dear members of the human services committee, my name is Anna Vasquez, and I am a resident of East Hartford. I support Health Justice Now, a statewide campaign fighting for quality, affordable health care for all Connetic residents. I am submitting this testimony in support of s v three. In Connecticut, medical costs have skyrocketed A basic health program and a stronger hospital financial assistance programs are real solutions. I support these proposals because they offer direct relief from the medical debt that burden families like mine. This is my my story. For a long time, I have struggled to access treatment for my health condition. I have attended community health centers where doctor informed me that I have uterine fibroids and that they are the cause of my anemia. Many years passed during which I took medication to help my sin my symptoms, but the root of the problem was not being addressed. My situation worse until in two occasions, my hemoglobin levels dropped below 4.5. The doctors did not understand how I was still walking and performing my daily activities as I always felt extremely exhausted. To try to control the emorigen, I had to undergo a treatment with injections that were, by the way, very expensive. After six months of treatment, my doctor gave me a surgical option. I felt hopeful, but the cost was very high, and I needed the intervention urgently. The hospital helped me with some funds, but to cover the rest, I have to accept a monthly payment plan in addition to the anesthesia cost that I have to pay separately. This was very difficult experience for me by not having health insurance. I had to do everything possible to gather the money and pay. I do not wish this terrible experience in anyone else. I am certain that with access to health insurance, I could I could have received care sooner and avoid all the sex sequence complaint complications. This happened to me in 2021, and to this day, I'm still paying off my plan payment plan. I you I wish you support this bill to ensure that all Connecticut residents are protected from medical death and have access to affordable high quality health care. Thank you for your time and attention.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. And thank you for the translation, and thank you for your testimony.

[Representative Robin Comey]: Yeah.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Alright. Meian Liu.

[Meihan (Mei Han) Lu]: Hello. Can you hear me well?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Yes. Go right ahead.

[Meihan (Mei Han) Lu]: Alright. Good afternoon, senator Lasser, representative Gilchrist, and distinguished members of the Human Services Committee. My name is Mei Han Lu, and I am a grad student at Yale School of Public Health in New Haven. Thank you so much for the opportunity to testify today in support of s b three, an ad concerning health care affordability. Access to stable and affordable health care coverage is one of the most important foundations of population health. When individuals experiences gaps in insurance coverage, they're more likely to delay need care, rely on emergency departments, that's what I sometimes do, and experience worsening health care outcomes. SB three addresses a real affordability challenge facing many families in Connecticut. As federal health policies evolve, especially after the EHR one, states may need to play a larger role in ensuring residents not to lose access to affordable coverage. In particular, new federal Medicaid work requirements may increase the risk of coverage disruptions for many individuals even when they remain eligible for coverage. Research from the Kaiser Family Foundation shows that coverage disruptions can lead people to postpone or even forego needed care and could place millions of people at risk of losing interest nationwide. On the basic health program as described in s p three seems to be an effective solution to such concern. Other states in the Northeastern Region provides helpful examples. In Massachusetts, programs like Connector Care provide subsidized insurance plans with low premiums and minimal cost sharing, helping residents maintain continuous access to care. So overall, policies that strengthen coverage of affordability and stability ultimately support healthier communities and reduce long term health care system costs. For these reasons, I respectfully suggest the committee to support the s v three. That's my testimony for today, and thank you very much for your time and consideration.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much for your testimony and for being here. Next up is Douglas Kerr.

[Speaker 10]: Good afternoon, senator Lester and representative Gilchrist and distinguished members of the human service committee. My name is Douglas Kerr, and I am the payroll director for one of Connecticut's prominent human services organization. As the director, I am acutely aware of the challenges an individual can face when not paid on time or as expected. That is why I'm here today to strongly advocate for the passing of Senate Bill four ninety eight, an act protecting paychecks for personal care attendants and expanding public access to state programs because our PCAs are putting their trust in you to ensure they are paid every week. Unfortunately, they are not. Our PCAs, ours, yours and mine, have the crucial responsibility of going to the homes of their clients, which include those that are not family members and provide care that often are undervalued by those outside the caregiving community. But without this caregiving, these clients would struggle to thrive in their homes or worst case scenario, not thrive at all and be forced into another caregiving setting, potentially away from their loved ones and the comfort of their homes. As a result, if our PCAs are not being paid on time or are not being paid the amount expected, it sets them up for serious financial challenges. We should not jeopardize the living standards of our caregivers, causing them to seek other job opportunities with more reliable income because the services our caregivers provide are essential, making them essential to the state. Getting paid should never be an uncertainty. It should be the standard that the checks are received on time and are accurately paid because their bills are certain every month. It is disheartening to hear that our caregivers are not valued by you, our state, and neglected over and over again for months on end. The fact that we have hundreds of caregivers going unpaid, some for multiple months at a time, is just unacceptable. You, the state, our partners, is responsible for making sure these workers are paid and you have failed them. It is time to pass SB four ninety eight and prove to our PCAs and caregivers across Connecticut that they do matter to you. Nobody should go unpaid ever. Thank you.

[Representative Lucy Dathan]: Thank you,

[Speaker 10]: Estelle. Any questions you have?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you for being here. I don't see any questions. Thank you so much for your testimony. Next up is a panel, Xiomara de la Cruz. As a reminder, the panels are three minutes. So if you chose to be a panel, you're supposed to all fit it in within the three minutes. Thank you so much.

[Speaker 22]: Thank you. I will, summarize this, as quick as as possible. My name is Veronica, and I'm the health organizer at Metroboard Connecticut. And I'll, summarize this for Maria. I'm a mother and a wife, and also a leader member of Metroboard Connecticut. My, my family is, four of us, and we currently, only my husband works. I take care of the children and manage everything at home. We need quality affordable health care for everyone because like many working families, we live like paycheck. And every month, we try to cover basic things like family, food, and rent. We don't we're afraid to get sick because we know that we're going to get a high medical bill. That also we it's come with phone calls trying to charge us. So that's why I'm here today to support this law for the greater access to financial assistance at hospitals and health insurance for our low income families. Thank you for your support. Thank you, Garellis. I firmly believe that every person deserve access to quality affordable health insurance regardless of their income level, background, or immigration status. For many immigrant and low income families, access to health care is not merely right, but is urgent necessity. As a mother, I know the importance to be able to take a sick child to the doctor without having first to wonder whether I will be able to pay the bills. As an immigrant, I also understand the fear and uncertainty that many families experience when a lack of health coverage or when the fear of losing it. As a community health organizer, I I constantly hear stories from people seeking health insurance. They do not they don't know how to obtain health insurance or because they have lost it. Stories of families now burdened with massive medical debt simply for not having a for having a visit to the emergency room. And stories of others who do not seek medical care when they need it, for fear of, receiving a bill that they cannot possibly pay. Furthermore, the problem extends beyond insurance premiums. Many families also pay co pays, deductibles, and high cost of medication, factors that renders health care inaccessible even for those who have coverage. In Connecticut, medical costs have skyrocket, making an increasingly difficult for many families to maintain or obtain health insurance. As a community health worker, I see every day the impact that that the current system has in our communities. No one should have to go no one should have to choose between taking care of their health or risking their family financial stability. For this reason, I respectfully urge you to support this bill, SB three and SB four ninety six, to ensure that Connecticut residents are protected against unfair medical death and have access to truly affordable health care. Thank you very much for your time. And I just wanna add a little bit. I'm also a health organizer here in in Hartford, and I also hear a lot of stories from, you know, all constituents in Hartford that it's really hard for them to get access to health care. Right? It could be low income because they can prove their income and stuff like that. So it's constantly fear looking for financial assistance. So I urgently, you know, support this bill. This is very important for all constituents, all, Connecticut residents. We need to make sure that all Connecticut has access to a good health care. Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you so much. Now I'm gonna turn it over to representative oh, do you both have questions? Okay. Represent okay. Representative Hughes, wait. We have a question.

[Representative Anne Hughes]: You said you're a community health worker. And and we have another bill about I I think last year that we implemented community health workers to help create a more healthy community. Right? So has that changed since last year since we've implemented some more community health workers as part of Medicaid? You have not seen a big difference? Okay. Well, it's really important we keep you healthy so you can do your work. So I thank you for your testimony.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you very much. Turn it over to you. Thank you.

[Representative Lucy Dathan]: Thank you so much, madam chair. Next, we have Tamir Capehart.

[Tamia (Tamir) Capehart (PCA, SEIU 1199)]: Good afternoon, Senator Lesser, representative Gilchrist. I hope I did not mispronounce that. And distinguished members of Human Services Committee. My name is Tamia Kapor, and I am a member of SEIU eleven ninety nine. And I'm a personal care attendant. I am here today to offer my full support to senate bill four ninety eight and act the center's paycheck for personal care attendants and expanding public access to the state program. And you asked and asked, to do just the same. I asked you to do just the same. I stand before you standing outside DSS twice in the last four months, once to deliver a bucket filled with thousands of grievances, and a second time when the state office locked us out and refused to address our concerns. Both times, we were there because hundreds of our members have been dealing with ongoing issues with their paycheck. It is time for the state of Connecticut to find a means to address and correct this problem. You are looking at dozens of hardworking caregivers standing here today, caregivers who provide life sustaining care every single day. Many of them, like me, are parents with children who depend on them. I am a single mother of three boys who are my entire world. I go to work every day with one goal, to come home and provide the best life possible for my children. Yet, week after week, so many of these dedicated caregivers are left facing the hardship of missing pay or no paychecks at all. Since GTI, independent since GTI, I'm sorry, independent took over our payroll from Allied in April 2024, we have filed more than 3,000 grievances, with over one third of them filed since October 2025. Instead of improving over time, the situation has actually gotten worse. How is that acceptable? No working person should ever have to struggle without a paycheck. You put in the hours, you do the work, you should be paid. But GTI does not seem to care that bills go unpaid or that late fees pile up. And when paycheck don't arrive, instead, caregivers are forced to make impossible choices. Do we pay for heat, put food in refrigerator, or put gas in the car so we can get to the very job that isn't paying us while still holding on to hope that things will change? I can stand here and say that I was lucky until I wasn't lucky. I also got hit with a payment issue in November, and it took nearly a month to fix it. But as a union delegate, I have also spoken with many others who are not as fortunate. Two people I have worked with closely have gone through periods of not being paid for the hard work they do every day. This is not how caregivers in our state or anywhere should be treated. It feels like the recent changes to how approved hours were calculated were made in a sneaky way, very sneaky. We were notified. We weren't notified. Our union was not notified. Instead, the information was buried in a letter sent to consumers. A letter only provided in English, not highlighted, and not offering any explanation of why the change was made or how the calculation works.

[Speaker 77]: Miss Kaffart? Yes.

[Representative Lucy Dathan]: Summarize your testimony here. I I know a couple of the members probably have questions, but if you could just summarize, that'd be great. Thank you.

[Tamia (Tamir) Capehart (PCA, SEIU 1199)]: Thank you. We made in a it was made in a sneaky way. We weren't notified our union. A letter only provided in English, not highlighted, and offering no explanation as why the changes was made or how the count the hours are calculated. While we have been able to get the that change temporarily revised, many of our members still have not been made whole. So I ask you, how is this appropriate treatment for caregivers in our state? Why are they not receiving the pay they have rightfully earned when they expect it? Finally, our frustrations have started to be hurt. A settlement was recently reached, getting hundreds of caregivers their money they deserve for the hours they worked in October and November, but the damage is already done. It was too late when one person went unpaid. So today, you need to also decide that it is no longer acceptable for this to be the norm and to support s b four nine eight. Thank you.

[Representative Lucy Dathan]: Thank you so much, miss Capehart, for your testimony today. Do we have one of the members, representative Hughes, has a question.

[Representative Anne Hughes]: Thank you, ma'am madam chair, and thank you for your testimony. Did you see some of DSS's testimony earlier today about their attempts to fix that situation? And, you know, do you have any thoughts?

[Tamia (Tamir) Capehart (PCA, SEIU 1199)]: Yes, ma'am. I was actually present in the office. It's a step forward. Right? But until something is actually done, that is just conversation up in the air. We need things to be happen now. How about asking a family that went homeless or family that's been sleeping in their car due to no fault of their own? So, yes, I did hear it, and I only could wish in behalf of 15,000 of us home care workers can only wish something was done immediately is the best way I can answer you.

[Representative Anne Hughes]: Oh, I appreciate that. And thank you for watching all day. I you you know, this is a systemic issue that should be addressed absolutely now. I agree with you. Thank you.

[Representative Lucy Dathan]: Thank you so much. Seeing no other questions, I appreciate you sticking with us today. Have a good evening.

[Tamia (Tamir) Capehart (PCA, SEIU 1199)]: You as well. Thank you.

[Representative Lucy Dathan]: You. Next, we have Leslie Bennett.

[Speaker 55]: Good evening, senator Lesser and members of the committee. It's thank you for staying. I appreciate it. My name is Leslie Bennett. I am a Brantford resident and I am the cochair of the Connecticut Rare Disease Advisory Council. We were enacted to advise not just the governor's office and state agencies but also the CGA on matters that concern the rare disease population in the state, which is about three hundred thousand people. A large portion of them are children and there are, as I when I testified last year, I think I informed you that there are over two thousand rare genetic disorders that are the known cause of intellectual disability. I would like to remind the council that although we've changed the name to the Department of Developmental Services, It used to be the Department of Mental Retardation. My daughter, Kelly, born over thirty years ago, was when she first got services through DMR. It was the Department of Mental Retardation. And I think when we change the name to developmental services, it confuses people. Not all developmental disabilities are intellectual disability. Intellectual disability is one of many, so is autism. They are both neuro neurodevelopmental disorders, but they're very distinct. They can overlap, but they don't always. Only about one third of those, or a little more than a third of those with autism have an intellectual

[Representative Kurt Vail]: true intellectual disability. There are a lot of people with autism

[Speaker 55]: who are very high disability. There are a lot of people with autism who are very high functioning, they are normal or to very high IQs. But they do need services. We understand that. We commend the committee for trying to get them services. Our only problem is that we're afraid of what you're doing going through the Department of Developmental Services right now. Their waivers are for intellectual disability and we'd like to, at the moment, leave it that way. There's no funding in this bill to to make the change. There's no plan in place to make the change to what you're talking about. And last year when I testified in opposition to House Bill, what was I think it was seven one zero eight that would have changed the definition of intellectual disability, I pointed out that we needed to be included and I thought your committee would include us in that. We agree that there does need to see be some flexibility and we need to move away from a hard, IQ. It would also help our community as well. But we need to do that in a planned way to where we have finances and we also need to take into account what we're doing that that waiver is going to need to be changed. We can't change it by by July 1 as the bill is calling for. That's just not feasible. And before we even do that, we need to get an impact study from the Department of Developmental Services. What would happen with that change? We need to figure out. I'm old enough and I've been around enough that I can remember. And in the we've always accepted the fact that the definition of intellectual disability is two standards of deviation below the what we consider the average intelligence. And that's that is an IQ value of 70. It's always been below 70. There are states that accepted 70 or less and here in Connecticut we decided to go with 69. I know this is a long time ago and when they were changing the name to Department of Developmental Disabilities, that was one of the discussions. And we decided to keep it at 69 because there were too many people. There were thousands when we went to 70 and the state couldn't afford it. If we go now to the changes that you're asking, it's going to be even more than that. There's already a two to three year wait and that affects our community drastically. We have a lot of children born with rare disorders that are progressive, neurodegenerative and they go very quickly. Tay Sachs, infantile Tay Sachs, juvenile Tay Sachs. You've heard from the Negron family about their daughter Chloe. Those, when that diagnosis is made, they have a three year window. Now they may have an IQ on the day they get the diagnosis in in excess of 70, but within a week, it's below 60. And so, I mean, it goes that quickly. We need to get these families help. And if you're going to we can't, we have families that can't even apply for the DDS waiver because their child will die before they're eligible, before they get it. And we get that a lot. So these are things that we need to do. The only state in talking to rare disease advocates across the country, the only state that has fully adopted the DSM-five into their statute is Louisiana. That's what I've been told. Others use portions of it, but they haven't adopted the whole thing.

[Brooke Foley (IAC/ACLI/AHIP)]: If we're going to adopt it

[Representative Lucy Dathan]: If you could summarize, that would be great.

[Speaker 55]: Yeah. If we're going to adopt it, we need to clearly define what we mean by that. And right now, the DSM-five does not eliminate IQ. It shifts focus from using just that, you know, that one hard number. We would shift from using that. It uses three criteria: intellectual function, which is measured by IQ and that's an objective according to the geneticist. That's the objective value that they're using. It uses the daily life skills which is subjective and the fear that we have is most of these evaluators have no training in rare disease. So this is a huge issue for us. And then it changes the, age of onset from 18 to 22. Thank you. So, that's we need to do that. The other thing it does recognize, it recognizes global developmental delay, which for us is a huge problem. We have there's a gap right now for us from children that go through the birth to three program and then at age when they hit four, there's a gap from four to seven when they can get IQ testing. And the DSM-five recognizes global developmental delay and feels those children should have services.

[Speaker 10]: And we

[Speaker 55]: would ask that

[Representative Lucy Dathan]: that's included. Thank you. Hopefully, you've submitted written testimony as well. I have seen it on the system. That's why

[Speaker 55]: I'm asking. It deals with the other issues. I will submit it on this. This just came up yesterday and last night.

[Representative Lucy Dathan]: Okay. Great. I have indicated, You know, this is something that is near and dear to my heart.

[Speaker 55]: Oh, I know. Workplace. And you've you've done a tremendous amount. You've carried on Kathy Abercrombie who was I was very close to her tradition with the autism community. You've done a tremendous job and we appreciate that. But we just want to preserve this right now. Absolutely. The the behavioral veranda.

[Representative Lucy Dathan]: We did do some expansion of the Katie Beckett waiver. It's not enough. It's not enough. I hear you. And I think you highlighted it with the Tay Sachs. Tay Sachs is

[Speaker 55]: one, but there's a lot But

[Representative Lucy Dathan]: it's just one. I'm Yeah.

[Speaker 55]: There's a lot of these disorders that it's five years. Yeah. These children don't live much beyond their fifth or sixth birthday. We need to get them help as soon as we can.

[Representative Lucy Dathan]: I I hear you, and I'm really hoping that we can get some I know. Some progress for this. It's we need to help this whole community, not just one and and the other. And I think That's right. Representative Abercrombie was a a great teacher for me, and I enjoyed being her vice chair several years ago and learning a lot. And he was I wanted to make sure I carried on her her mission there because it is such an important one.

[Speaker 55]: You've done a you've done a tremendous job.

[Tiffany McDonald]: Thank you.

[Speaker 55]: We sincerely appreciate it. We're hoping that maybe we can hold a forum, as the commissioner had said, with DDS, DSS, and all the groups. And once again, I really must ask that you include the Connecticut Rare Disease Advisory Council. That's what we're here for. We've been excluded from the definition change and it is something that's really going to tremendously affect our community.

[Representative Lucy Dathan]: Thank you. I think we'll make note of that for next time if we can't get anything through on the JF bill this year.

[Speaker 27]: We will

[Representative Lucy Dathan]: do it. But thank you so much for your testimony. We do have one question, representative Comey.

[Speaker 55]: Oh. She's my representative.

[Representative Robin Comey]: Hey, Leslie. Thanks for coming. It's always a pleasure to see you, and I and you do such great advocacy.

[Speaker 55]: And your daughter your your story is I understand. It's tremendously moving. Appreciate it. Thank you.

[Representative Lucy Dathan]: Thank you, miss Bennett. Appreciate it. Next, we have Philippe Collin. Don't see him in the room. We can come back to him or her when sorry, Philippe. We can come back. Maria Kelly? She's not coming. Okay. Melissa Castas? Thank you.

[Melissa Costas]: Good afternoon, representatives and senators of the human services committee. My name is Melissa Costas. I am from Middletown, Connecticut, and I am here in support of senate bill four nine seven and bill three. I am current I am somebody who is actually currently on food stamps and health insurance and, again, a mother of three children who is also on Husky insurance. And, you know, my young life, I grew up in the DCF system. At 18 years old, I signed out so I know what it is like to go without food for days upon weeks upon months. And even with no food, not even having the financials to afford a doctor to check me out and make sure I'm okay already under the circumstances that are so terrible of my life with not even a roof over my head and at times I was sleeping in the snow. I am about to be 27 this year and thankfully I started from the bottom. Now I'm here and advocating for the voices that are voiceless and that are silenced or maybe can't get to these, legislative testimonies. And, unfortunately, I have also first handedly witnessed my own family members and in laws who need medications and who still have to pay co pays even being on Medicare or on SSI and SSDI. My own father passed away in 2023 because he, unfortunately, didn't take care of himself properly, but also he did not get the proper medical care he needed by doctors. My own mother had been in and out of the hospital for months, and now she is being forced in an inpatient about to go to a rehabilitation center because Middlesex Hospital overlooked giving her the proper treatment she needed. So I you know, this little bit of paperwork here and there that's missing, it means nothing compared to the lives were are being put at stake that depend on these food stamps and depend on how this health insurance, at that point, you're sending them to their death sentence. Because think about those with cancer and with diabetes, food stamps may be the only way they can even eat. And, you know, diabetic shock is a real thing. My father lived with diabetes. My mother-in-law lives with diabetes. And if her blood sugar goes under 50, we're calling an ambulance and having her admitted. It it's not just immoral, inhumane, and injust. It is criminal, and you are literally sending citizens to their deathbed at that point. So I wanna ask you, do you wanna be on the side of humanity and equality and where you as our government are supposed to be for the citizens, or do you wanna be on the side that is sending our very citizens to their deathbed? Thank you for your time and your consideration.

[Representative Lucy Dathan]: Thank you miss Casas. That was a very moving testimony. I really appreciate you having the courage to come up here and share your story and, you know, the difficulties that you faced in your life. I know we really do care and it is important that we do hear from you. And we are working towards getting avail availability to make help out for especially the cuts that we've seen within our federal government. So appreciate you testifying today. Seeing no other testimony, thank you for being patient with us.

[Representative Robin Comey]: Thank you all.

[Representative Lucy Dathan]: Have a good day. You as well. God bless. Thank you. Next, we have Sanne Shaw.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Oh, there she is.

[Sana (Sanae) Schon (CT Project Action Fund)]: Good evening, chairpersons Lesser and Gilchrist, ranking members, Case and Perillo, and distinguished members of the Human Services Committee. My name is Sana Schon. I'm the director of policy and advocacy at the, Connecticut Project Action Fund. Thank you for your for the opportunity to testify in support of House Bill five five four zero, which mitigates benefits cliffs and temporary family assistance, SB three, which will protect access to health coverage and public benefits in response to federal policy changes, and SB, four nine seven, which will create a SNAP transitional benefit program. No one should be punished for hard work. Our state safety net should encourage progress. But under the current structure of temporary family assistance, when families begin earning slightly more income, they can lose benefits very quickly even though their wages remain low. That sudden drop in support can prevent parents from accepting a raise, working more hours, or taking a job that offers a path to advancement. Research shows that roughly twenty to thirty percent of families receiving cash assistance reenter the program within two years often because the transition off benefits was too abrupt. House bill five five four zero helps correct this by aligning our safety network with upward mobility. First, the bill creates a twelve month transitional benefit period for families whose income exceeds the eligibility threshold. Families would receive six months of full benefits followed by six months of gradually reduced support. This Clyde path gives parents time to stabilize their finances while they remain in the workforce. Second, the bill removes the asset limit, allowing families to build savings rather than penalizing them for trying to create a financial cushion. Third, it creates a $5,000 workforce retention bonus for families who remain employed after leaving the program, rewarding people who stay in jobs and pay more and continue moving forward with their careers. Each year, an estimated, 1,500 to 3,000 Connecticut families exceed the TFA income limit and could benefit from a smoother transition to financial independence. At a relatively modest cost, we can better support parents who are doing exactly what we want them to do, work, earn more, and build a stable future for their children. Additionally, we support SB3, which strengthens Connecticut safety net by protecting access to health coverage and nutrition assistance in the face of potential federal policy changes. We also support senate bill four ninety seven, which establishes a critical SNAP transitional benefit fund to ensure Connecticut residents do not lose access to food assistance due to new federal work requirements. The bill provides a temporary state fund state funded benefits along with job training and case management to help residents maintain food security while they work to meet federal requirements or document exemption. The investments proposed in SB four ninety seven in SB three would help to protect working class people, including mothers, children, veterans, and people with disabilities from a crisis they did not create. This is a modest price for treating people with respect and dignity dignity and is ultimately money that goes back into our families and local economies. Thank you for your time and consideration.

[Representative Lucy Dathan]: Thank you so much, representative Hughes.

[Representative Anne Hughes]: Thank you so much for your testimony. I wanna hear a little bit more about the benefits cliff program and the TANF dollars. We've been wrestling with this for years and now it's super critical, with all the federal cuts. What is your organization looking at in terms of evidence based how this works?

[Sana (Sanae) Schon (CT Project Action Fund)]: Yeah. So, I'd be happy to send you our policy brief. We worked with a research firm in examining, some of the benefits with the steepest cliff. And we understand that, you know, particularly with TANF, we're going after a very small population.

[Representative Kurt Vail]: Mhmm.

[Sana (Sanae) Schon (CT Project Action Fund)]: But as you know, these, compound over you know, compound, and so we're also working on, care for kids. And I could talk to you a little bit about, that recommendation offline, which actually has the steep the steepest cliff. But we're we're smoking in a working in a small population, hopefully expanding that over time. But, you know, we we wanna incentivize families to work and

[Representative Kurt Vail]: Right.

[Sana (Sanae) Schon (CT Project Action Fund)]: Support in their careers. And we actually worked a bit with representative that helped us connect this also to workforce pathways that are available. And so not only are we helping families gradually transition off benefits, we're also connecting them with programs that are already available that they may not necessarily know about so that they can continue to grow in their careers. Yeah.

[Representative Anne Hughes]: Yeah. We've we've noticed some bipartisan support for for piloting that. Again, to to your point, to graduate and provide the scaffolds so people get, you know, can get off of TANF without or retain their essential health care but move up in their job and career and and income bracket. So many of these barriers are really about the health care. Like, people cannot afford to lose their health care as as high deductible plan or whatever it is, as high cost it is. It's it's it's, you know, like we keep hearing, it's it's a life saving, life or death. And it seems like we have failed to update some of these benefits, CLIFS, TANF rules that were, draconian years ago, and they, are so, not serving their purpose to provide temporary assistance. So, anything you can give to us, I'm sure my colleagues would be happy to, you know, get that detailed analysis to help support passing that. Thanks.

[Sana (Sanae) Schon (CT Project Action Fund)]: Absolutely. Sarah will follow-up with with resources.

[Representative Lucy Dathan]: Great.

[Sana (Sanae) Schon (CT Project Action Fund)]: Thank you.

[Representative Lucy Dathan]: Thank you so much, Michelle. Seeing no other questions, I appreciate your testimony. Next, we have James Reid.

[James Reid (Registered Nurse, dialysis)]: Good evening, Sting. Thank you for staying so late. Good evening, chairpersons, members of the Human Services Committee. My name is Jim Reid. I am here to discuss HB five five six one. I'm a registered nurse who's been working with chronic and end stage renal disease patients for thirty five years in Connecticut. For the last twenty six years, I've been working with the largest not for profit dialysis company in The US, Dialysis Clinics Incorporated. Dialysis provides life saving treatment for people who no longer have fully functioning kidneys. The issue at hand is that Medicaid reimbursement rate for the in center dialysis procedure has not increased since 2008. Medicaid pays a $139 for treatment while the cost of providing care is more than $310. For Dialysis Clix Incorporated alone, the deficit is more than $700,000 per year. And the larger providers, Fresenius and DaVita, the deficit and reimbursed is more than $10,000,000 per year. The margin is so slim in caring for dialysis patients that clinics are not making enough to cover the cost for all patients due to the financial deficits created in part by Medicaid's lower reimbursement. In some cases, this has led to clinic closures, ultimately limiting access to care. We are a not for profit company that started caring for patients in 1971 and have begun discussing the need to make choices that dialysis providers have not had to make since 1973. Before 1973, panels decided who get dialysis, essentially who would live and who would die. We have been discussing with our physicians whether it's appropriate to limit the number of Medicaid patients we can accept within our clinics. If dialysis facilities cannot accept patients, there will be a ripple across the health care system. Without life sustaining treatment three times a week, patients suffering with end stage renal disease face emergent care and hospital burn serums, likely inpatient hospitalizations or worse. A single missed dialysis treatment leads to an increased hospitalization risk of forty percent in the following thirty days compared to those who'd not missed their treatment. As an example, here's a real life scenario that outlines the impact this may have on our patients. We had a patient who was forced to receive dialysis in the hospital for twenty one months. During that time, the patient received 116 treatments. However, she should have received 273. To receive dialysis, she had to endure long hours in the ER, which caused her to come less frequently and be chronically underdialized. If she had been in an outpatient clinic, she would have been able to live a full life and receive quality dialysis. Instead, she met an untimely end and died at 23 years old. The cost to the system was approximately a $158,000 to care for in the hospital, where if she had been an outpatient clinic, it would have been $16,000. Dialysis facilities can no longer bear the financial strain of Medicaid underpayment. So in Medicaid dialysis, patients cannot be admitted to outpatient facilities. There will be a large increase in cost to the system as a whole and a decrease in patient's quality of life coupled with potential increase in mortality. I've been working with the, across the industry with other dialysis providers for the last two years in this issue. We agree that dialysis clinics are an active crisis and looking for funding to remain viable. Surrounding and comparable states have outpaced Connecticut's Medicaid rates, and, again, we have not had an increase since 2008. We respectfully request an increase in ESRD Medicaid, Medicaid dialysis patient rate by 10%. This will result in Connecticut Medicaid rate being 56% of the Medicare rate. We request to add the ESRD patient dialysis care rate increase to phase one. By 2028, we request increased in ESRD patient dialysis rates by 38% resulting in Connecticut Medicaid becoming 70% of Medicare rate. This increase will not make dialysis facilities whole. It will simply allow us to survive. I appreciate this opportunity to testify today about the impact, and if I'm happy to answer any questions if you have any.

[Representative Lucy Dathan]: Thank you very much, mister Reed, for sharing that today. Any questions? Oh, representative Hughes.

[Representative Anne Hughes]: Thank you, madam chair, and thank you for, staying. Did you submit that in writing? Did you submit okay. And did you say it's cost 16,000 as opposed to

[James Reid (Registered Nurse, dialysis)]: 100 and something.

[Representative Anne Hughes]: 100 and something. Can you give us and that

[James Reid (Registered Nurse, dialysis)]: and 15,000 versus 158.

[Representative Anne Hughes]: Okay. 16,000 versus That's just

[James Reid (Registered Nurse, dialysis)]: not including all her medical that occurred in the hospital. That's for dialysis services.

[Representative Anne Hughes]: Just for dialysis services. And of that 16,000 cost, what are you getting reimbursed?

[James Reid (Registered Nurse, dialysis)]: No. That would be what we would have been paying.

[Representative Anne Hughes]: Would have been what you would

[Senator Matt Lesser (Chair, Human Services Committee)]: That's what

[James Reid (Registered Nurse, dialysis)]: it would cost to care for her would be 16,000 versus the 158 it actually cost for her for the dialysis services. So what's gonna happen is if if we have this if we cannot accept these patients, like, I'm asking the doctor, which patient do you want to take? Do you wanna take the elderly patient Mhmm. Or do you wanna take the younger patient who has children?

[Representative Anne Hughes]: Mhmm.

[James Reid (Registered Nurse, dialysis)]: And we shouldn't be in a situation we have to make those decisions, but we're there. And if we don't get some kind of relief, it's gonna be something that is gonna really impact. More patients are gonna be not coming to dialysis. We're not gonna accept them.

[Representative Anne Hughes]: And forgive me because I am not sure if you were were part of the rate study or not. Is that, something that

[James Reid (Registered Nurse, dialysis)]: The rate study for the

[Representative Anne Hughes]: For Medicaid rates. Yeah.

[James Reid (Registered Nurse, dialysis)]: We've been talking with people about it. I've got different representatives to have a discussion, but we're not part of that.

[Representative Anne Hughes]: Okay. I know. Thank you. And we'll look forward to looking at your testimony online. Thank

[James Reid (Registered Nurse, dialysis)]: you. Time tonight.

[Representative Lucy Dathan]: Thank you, mister Reed. Have a good evening. Next online, I see Megan Phillips.

[Megan Phillips (Disability Rights CT)]: Senator Lesser, Representative Gilchrist, and distinguished members of the Human Services Committee. My name is Megan Phillips, and I am testifying on behalf of Disability Rights Connecticut in support of HB fifty five fifty seven. DRCT's executive director, Toby Parks Davies, submitted written testimony on this bill. I'm here to briefly express DRCT support for HB fifty five fifty seven as this is an important first step in expanding services for individuals with intellectual and developmental disabilities who have long term support needs that are not being met. Based on the current eligibility criteria, anyone with an IQ above 69 is ineligible for DDS services. And as a result, there are many individuals with long term support needs who are not receiving services solely because they do not meet this IQ cutoff. The IQ fails to capture essential adaptive behaviors like social, emotional, and practical life skills that affect the ability to gain employment, live independently, and participate in the community. The DSM five has abandoned IQ as an exclusive criterion for intellectual disability and encourages a more comprehensive view of the individual by placing emphasis on adaptive functioning. As a protection and advocacy system for the state of Connecticut, DRCT receives countless requests from concerned parents who are worried about how their children will succeed in adulthood when they will no longer be eligible for services. But an individual's IDD diagnosis does not disappear at the age of 22 or when they exit special education. Individuals with IDD still require support with transportation, career development, residential and independent living, and community participation. In the absence of long term supports, individuals with IDD and their families face a range of negative outcomes such as regression, un or underemployment, caregiver burnout, and unnecessary institutionalized care. For these reasons, DRCT supports using the definition of intellectual disability in the DSM five. This is an important step in ensuring more individuals can access the support they need to pursue meaningful employment, live independently, and participate fully in their communities. Thank you for your consideration.

[Representative Lucy Dathan]: Thank you thank you so much for your testimony, miss Phillips. I appreciate you coming out and speaking about, how we can support the IDD community and, your testimony is very meaningful to us. No questions from us. I hope you have a good evening and thank you for sticking with us this evening.

[Lina Esposito]: Thank you.

[Representative Lucy Dathan]: Great. Next we have Crystal Polonia. She looks like she should be remote, but I don't see her online. Have you seen her? Nope. Okay. Crystal, if you're there watching at home, please, log in. We'd love to hear from you. We'll next go to Joseph Young.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Oh, here he is.

[Representative Lucy Dathan]: Thank you, Joseph.

[Joseph Young]: Got my green for Saint Patrick's Day too. Good afternoon, Senator Lesser, Representative Gilchrist, and members of the Human Services Committee. My name is Joseph Young, and I live in Manchester. I I'm testifying in support of s p four ninety seven and s p three. SNAP is about keeping people fed with respect and dignity. Right now, federal cuts are putting thousands of Connecticut residents at risk of going hungry, including babies, children, seniors, veterans, and people with disabilities. And thousands more are at risk of losing their Husky health care coverage. Over the years, Husky and SNAP have helped me to keep going. I have struggled with paying my bills, but I wouldn't worry about having food in my table because of SNAP. I I was glad I had that help because everything nowadays is pricey including food. Husky has been very helpful as well. I think that everybody deserves the right to health care. I I actually think that health care, food, and housing are the only three fundamental rights that we should all be guaranteed. I don't ever wanna be in a position where I have to decide whether I should go to the doctor or pay my bills. And I think anyone want I I I don't think that anybody wants to be in that position. State funded SNAP transitional benefits give people a bridge of support so no one loses food while they're getting their SNAP eligibility approved. The the this is the state doing its job, protecting residents from having to choose between seeing a doctor or putting food on the table. I support these bills because Connecticut should put money behind protecting our access to food and health care so no one falls through the cracks. The the numbers tell the story. Right now, the state is is not sharing how many people lose Husky and Snap due to federal cuts. Our communities deserve to know how many of our people and families are are losing their food and health care and and this bill makes that information public. People who qualify for Husky and SNAP should not lose health care and food because of paperwork. The bill directs the state to automatically identify who qualifies for an exemption from work requirements and protect them. SNAP and Husky are are are about respecting our families and protecting our health. I'm asking this committee to pass SB four ninety seven and SB three. Nobody should have to choose between feeding their kids and keeping them healthy. Please keep us protected from federal cuts with state investments that bridge the gap. Thank you.

[Representative Lucy Dathan]: Thank you so much, mister Young. It's really great to hear from you, and hear how important SNAP has been to you and Husky. Seeing no questions, appreciate you sticking with us today. Hope you have a good rest of your evening.

[Joseph Young]: Thank you.

[Representative Lucy Dathan]: I'm gonna go back on to the off the agenda down to, Philippe Cohen? Oh, yes. Philippe Cohen, can you please, accept the invitation to become a panelist? We can't, give you an opportunity to testify, sir, if you don't, accept that. Oh, here you go. You can just unmute yourself when you're ready. Thank you so much.

[Speaker 15]: Oh, how are you doing, miss? Can you hear me?

[Representative Lucy Dathan]: We can hear you.

[Speaker 15]: Hey. Alright. Well, good afternoon, legislators and members of the human service committee. My name is Felipe Colon. I'm an individual who is suffering from food insecurity all because I was removed from receiving the help of Snap. I'm a part time employee who pays rent, light, phone, Internet, and now gas. Struggling to have enough to buy food to keep myself from starving in the roof over my head. I'm here to support bill three and four ninety seven. SNAP and Husky is helpful government that is elected to provide services for citizens of the constitution state, a constitution that protects every human being in this country from suffering from hunger and lack of medical coverage. The government is not listening to the voices and count that count and put them in and put them in office to make sure we have the system that works for the people of this beautiful state and served by them. So I ask that you not allow another hardworking citizen to go hungry or without medical coverage. I am a former prisoner and law abiding returning citizen that is maintaining this clean slate because I have the fortitude and strength of my ancestors running that runs in my veins, something that keeps me positive and civilized. But many of my returning brothers and sisters will not have that same resilience and will suffer a great injustice and injury if these bills are not put to work for the people that put you in chair. I'm a member of the black and brown community and mo that mostly suffer from these services not being available to them because them we them to this causes them to reenter a life of crime, and this becomes a greater issue in our community. Something that I continually see this house pushing to pushing on the television is a problem that needs to be addressed. Well, this is your opportunity to make a change, not because it is what you want, but what the people are grieving and requesting from our government. Thank you for your time. I appreciate you guys.

[Representative Kurt Vail]: Thank you,

[Representative Lucy Dathan]: mister Cavon. I appreciate your testimony today. There any questions from the committee? Seeing none. Appreciate you testifying and, hope you have a good evening.

[Speaker 15]: Yes, ma'am.

[Representative Lucy Dathan]: Next we have Alex Brown.

[Tiffany McDonald]: Good evening.

[Speaker 77]: There you go. Good evening, co chairs, ranking members, and members of the Human Services Committee. My name is Alex Brown. I'm an MSW student at UConn and someone with lived experience navigating the criminal legal system and community supervision. Thank you for the opportunity to testify today in support of SB four ninety seven, an act protecting food security for veterans and others mitigating federal cuts to nutritional assistance. Access to food is a basic human need, but for many people on probation or parole, the system creates barriers that make accessing any type of assistance much harder than it should be. One of the problems is on the SNAP application itself. When people are asked about probation violations and see harsh warnings about penalties for mistakes, it creates fear. Even if someone is eligible, they may decide not to apply because simple misunderstanding could create consequences for their supervision. This effectively keeps food away from the people who need it most. When you are working to successfully reenter and remain in your community, you are already balancing a long list of barriers and collateral consequences to having a criminal conviction. Housing, employment, and supervision requirements are just, some. Adding food insecurity to that list doesn't improve public safety. It just makes stability much harder to reach. Data backs this up. More than half the people on probation earn under $20,000 a year. And this is especially critical for justice impacted women, many of whom are mothers and primary caregiver caregivers navigating low wages and unstable housing. When we discourage them from accessing food, we aren't just hurting an individual. We are hurting an entire family. Food security strengthens our community. Research shows that SNAP access is is directly linked to improved neighborhood safety and reduced recidivism. When people have their basic necessities met, they are better able to stabilize their lives and maintain employment. This is about basic dignity and common sense. If we truly want people to succeed, we need policies that supports I'm sorry, that supports stability, not ones that quietly push people further into hardship. Removing the question on the snap application makes sense. Thank you for your time, and I respectfully urge the committee to support SB four ninety seven.

[Representative Lucy Dathan]: Thank you, miss Brown, for your testimony this evening. Any questions from oh, representative Hughes?

[Representative Anne Hughes]: Thank you, madam chair, and thank you, Alex, for naming the the the returning population, especially of women that this severely impacts, and there is, like, waiving support in the room that you can see. But I just want to hear that. Thanks.

[Speaker 16]: Thank you.

[Representative Lucy Dathan]: Thank you, representative. Thank you, Alex, for sticking with us. Next, we have Christina Emery. I don't see oh, here she is.

[Dr. Barbara Dune (Optometrist) / or Association Rep]: Good evening, co chairs Senator Lesser and Representative Gilchrist, ranking members, Senator Pirillo, Representative Case, and distinguished members of the committee. My name is Christina Emery, and I'm the executive director of Brooker Memorial in Torrington, a non profit that cares for children regardless of their ability to pay. Thank you for the opportunity to testify today on House Bill 5,561, for listening to our previous concerns and including provisions in this bill that directly support pediatric dental safety net clinics like us. Oral healthcare is essential as dental decay continues to be the most common chronic disease in children even though it's very preventable. When kids don't get treatment, it impacts everything. Pain, missed schools, speech problems and ultimately drives up costs across our healthcare system. Last year alone, Burger Memorial provided over 11,000 dental visits at our clinic in Torrington and 10 school based clinics throughout Litchfield County. We've worked hard to expand access by adding a bilingual pediatric dentist that specializes in dental related fear, growing our residency program in partnership with the Yukon School of Dental Medicine, and opening a new school based clinic at Head Start in Torrington. Despite these efforts, we're having trouble to keep up with the demand. We are the only pediatric dental provider in Litchfield County accepting Husky and we are constantly hearing from families trying to get their children care. Right now, new patient appointments for a cleaning and exam are booking more than four months out, and restorative appointments with the dentist are not available until May. For a child in pain, that kind of delay can turn a small issue into a much more serious problem. We want to expand our capacity, including the construction of new operatories and recruiting providers. But the current system makes that very difficult. Last year, our dental clinic operated at a $202,000 loss due to low Medicaid reimbursement rates. That's not sustainable and it directly limits our ability to expand and meet the need. Increased reimbursement rates, for safety net Medicaid providers along with reimbursement for uncompensated care are critical to ensuring that we meet the needs of our community and I am grateful for that provision in House Bill 5,561. I also want to note that as board member of COHAI, the Connecticut Oral Health Initiative, I support the adult dental provisions included in this bill. While we don't serve adults at Brooker, we do see every day how gaps in care affect families. Strengthening access will improve overall family health, reduce financial strain, and support better outcomes for children. I respectfully ask for your support of House Bill 5,561 as investing in Medicaid reimbursement rates and dental coverage is an investment in prevention, equity and long term health of our communities. Thank you for your support and your time tonight.

[Representative Lucy Dathan]: Thank you so much, miss Emery, and I appreciate you highlighting why it's so important. Any oh, representative Case.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you, madam. Christina, how many how many years have you been here asking?

[Dr. Barbara Dune (Optometrist) / or Association Rep]: It's been a few.

[Representative Jay Case (Ranking Member, Human Services)]: So I remember your predecessor was also here.

[Representative Kurt Vail]: Yep.

[Dr. Barbara Dune (Optometrist) / or Association Rep]: At least four years. Yes.

[Representative Jay Case (Ranking Member, Human Services)]: We have the study. It tells us what we need to do. We need to do it. There's how many facilities like you in the state of Connecticut that do adolescent dental?

[Dr. Barbara Dune (Optometrist) / or Association Rep]: We're a really unique situation in that we're a nonprofit provider that's not an FQHC or affiliated with a medical school. So it's really only Brooker and one other agency in Hartford. We're the only one that supports predominantly pediatric patients.

[Representative Jay Case (Ranking Member, Human Services)]: Well, thank you. And I I hope we can get something across the line. We know what we have to do. Here 400,000,000. I hear 300,000,000. We did 5,000,000 last year. It doesn't cut it. But I appreciate your advocacy and and, you know, you've been in the documents. The name has been in the documents. We just need to work to get this across the finish line. It's a unique situation that we have in the Northwest Corner. Thank you for what you do, and let's see what we got.

[Dr. Barbara Dune (Optometrist) / or Association Rep]: Thank you, representative Case, and thank you all for your time.

[Representative Lucy Dathan]: Thank you. Thank you, representative Case as well. Next, we have Barbara Dune. Looks like she's remote. I don't know if she's not on oh, here she is. Good evening, miss Dune. Please Good

[Tracy Wodatch (President/CEO, CT Association for Healthcare at Home)]: evening.

[Speaker 4]: Can I go ahead?

[Representative Lucy Dathan]: Yes. Please do. Thank you.

[Speaker 4]: Okay. Good evening, representatives and senators of the Human Services Committee. My name is Doctor. Barbara Doon. And I'm a practicing optometrist in Hartford. Currently, I am the president of the Connecticut Association of Optometrists. And I am testifying in support of Section seven of the House Bill 5,561, an act concerning Medicaid rate increases for certain providers. You have already heard from two of my esteemed colleagues, so I won't belabor the details that have already been presented. I've also submitted my written testimony. I work in Downtown Hartford and the North End Of Hartford. I serve a large population of Medicaid recipients. There is a great demand for our services as optometrists, as this is a population with great health challenges. We are the primary gatekeepers to eye care services. And many of these patients end up losing significant vision as they do not receive timely intervention, as they cannot get in to see us. As seen in the survey that we carried out, more optometrists would be willing to participate in Medicaid care if reimbursements improved. As a profession, we are ready and willing to increase our participation in looking after this population. But it is only fair we get comparable reimbursements as the ophthalmologist for the same procedures and services. I have been working with Medicaid patients for the last sixteen years. So in summary, we would please ask that you enact Section seven of this bill, which requires fee parity between optometry and ophthalmology for the same procedures and services. By establishing this parity, like all other pairs, including Medicaid Medicare, sorry, you'll be helping to secure continued access to comprehensive eye care for the Medicaid population. I and the CAO also support Senate Bill four ninety nine, an act concerning Medicaid rate increases, and urge you to approve it. Thank you for giving me this opportunity to comment on this provision on behalf of my colleagues in the Connecticut Association of Optometrists. And I'd be happy to take any questions.

[Representative Lucy Dathan]: Thank you so much. Appreciate that. Seeing no questions appreciate your testimony this evening miss Doon.

[Speaker 4]: Thank you.

[Representative Lucy Dathan]: Next we have Tracy and I

[Tracy Wodatch (President/CEO, CT Association for Healthcare at Home)]: Thank you. Representative Dathan can you hear me?

[Representative Lucy Dathan]: Can. Apologies. Thank you.

[Tracy Wodatch (President/CEO, CT Association for Healthcare at Home)]: Very good. Thank you. Good evening distinguished members of the Human Services Committee. My name is Tracy Wodach, president and CEO of the Connecticut Association for Health Care at Home. I'm an RN with more than forty years experience. Our association represents Connecticut's licensed home health and hospice agencies along with homemaker companion agencies. Together our members deliver the essential services that allow residents to receive safe high quality and cost effective care where they overwhelmingly want to be at home. Thank you for raising sections nine and ten of HB 5,561. I am here in strong support because Medicaid reimbursement for home and community based services is dangerously out of step with the real cost of care and it is undermining access across Connecticut. When adjusted for inflation Medicaid rates for many home care services are now 51% below the 2,007 levels. Outside of temporary ARPA funding and minimum wage adjustments our sector has seen just a 1% increase in these two decades. At the same time providers are facing escalating costs, higher wages, inflation, increased patient acuity and growing regulatory demands. Yet personal care assistants in the self directed program have received recent appropriate increases which we support and are now paid $23 per hour while homemaker companion agencies are locked into reimbursement rates that do not come close to covering the cost of recruiting, employing, and supervising staff. On top of that, agencies continue to absorb unfunded mandates like electronic visit verification, the state home care registry, and enhanced worker safety requirements. The result is exactly what you would expect. Agencies are cutting staff, turning away Medicaid referrals, and operating under unsustainable financial pressure. Access to care is shrinking in real time. HB five five six one is a critical step towards stabilizing the system. It provides meaningful rate increases and eliminates the home health subsequent visit rate penalty. They are long overdue corrections necessary to align rates with the actual cost of delivering safe, reliable care. This bill is also foundational to broader policy changes. The governor's proposal to eliminate community first choice state option and shift individuals into agency based care is premised on cost savings that simply do not exist. It relies on a chronically underfunded agency based system and assumes agency based providers can continue operating under the current level of reimbursement. At current Medicaid rates neither the workforce nor provider capacity is sustainable. Without action more individuals will be forced into institutional care at significantly higher cost and against their wishes. The choice before us is clear. Invest in home based care now or pay far more later financially and in human impact. On behalf of the Connecticut Association for Health Care at Home, I urge you to support HB5561 and invest in a system that allows people to receive care where they want to be at home. Thank you for your time.

[Representative Lucy Dathan]: Thank you so much, Representative Hughes.

[Representative Anne Hughes]: Thank you. Thank you, Tracy. And thank you, madam. Did you submit all that testimony online?

[Tracy Wodatch (President/CEO, CT Association for Healthcare at Home)]: Yes. I actually submitted a pretty extensive written testimony.

[Representative Anne Hughes]: That's what I thought. Covering some of those different, vulnerable categories that we had talked about in Maypach. Right?

[Monica Nugent (CT Community Nonprofit Alliance)]: Yes. Thank you.

[Representative Lucy Dathan]: Thank you so much, for your testimony. Seeing no other questions, we're going to go to Mary Viet Morales.

[Speaker 16]: Good evening senators and representatives and members of the human Service Committee. My name is Marivette Morales and I live in Meriden and I and I'm testifying in support of SB four ninety seven and SB three. I'm an outreach engagement specialist for the Open Door Department at the Woman and Family Center in Meriden and one of the, first point of contact in our department. I see everyone and I and all their struggles. My

[Speaker 67]: daughter,

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Take a deep breath.

[Speaker 16]: My my daughter did everything she had to do in order to get a job in an apartment. She did what she needed to do to support her family as a single mom. But then DSS dropped her food stamps to $120 for a three person household. Her rent is $1,500 and she gets paid biweekly. She received a raise of $2. They took her food stamps and her husky completely away. When she pays her rent at the beginning of the month, she's left with a $100. She can't buy food and can barely pay her bills and and has make and may has to make tough choices. I worry if she has enough food for the boys, my grandchildren. It breaks my heart worrying about them all the time. It's not fair that such a small raise can cause her to lose her husky and food stamps. No one can no one can make it in Connecticut at $23 an hour. You can't even go to the pantries anymore because the pantries have lost most of their fundings. At my job, many people go through our employment training programs but are still struggling to find employment. We can't survive here in Connecticut with the prices skyrocketing for food, gas, utility bills, daycare and more. We can't afford for fundings to be taken away. Make it make sense. We are the people of Connecticut. This puts the people in a predicament of trying to make decisions on how to pay rent, how to feed our families, and pay our prescriptions. Single moms are being asked to work and just paying for daycare is another burden. There are single moms that have more than one child comp that is completely disabled, so they cannot work. Let alone take the time away from their children to get the documentations they need to prove that they're unable to work. This is this is what the benefit letters from Social Security is for. The parents are these child's payee for a reason. They're you are sitting in these seats making these decisions that have the power to choose whether to pass a bill or not. But are you benefiting from good paying you are benefiting from good paying job with government benefits and have medical coverage and have the money to pay for medical coverage and and food. Some of us don't. We are not the ones making the decisions for the rest of us. Thank you for the opportunity for allowing me to testify. Please support SB497 and s B3.

[Representative Lucy Dathan]: Thank you very much, missus, Morales, for your testimony. I know it was heart wrenching to talk about some of these issues that you have, so appreciate your brave bravery

[Representative Anne Hughes]: here. Thank you.

[Representative Lucy Dathan]: No questions. Thank you so much. Next, we have Barbara Bellevue. Is Barbara okay. I will hold come back to Barbara. Next, we have Richard Rothstein. Hi, Richard.

[Committee Member (Unidentified)]: Hi, Representative Dayton. Good evening, distinguished members of the Human Services Committee. My name is Richard Rothstein. I'm a steering committee member of the Connecticut Profound Autism Alliance, an all volunteer organization of Guardian Advocates, which receives no governmental or provider funding. I'm here in to support legislation such as in House Bill 5,558 to improve the situation we are facing these days with abuse and neglect in our IDD and autism waiver systems. My 43 year old son, Spencer, has lived in Hart Group Homes for the last thirty five years, currently in West Hartford. Our family is extremely grateful and appreciate the funding of these supports, and we appreciate HARC as an outstanding agency. Last year, the committee took and the legislature took a major step in passing house bill seventy one zero eight. It was just a first step then, and it's still a first step now. Myself and two other guardians from our group testified of our family's personal experience with abuse and neglect. We're not I'm not going to go through my son's situation again. Abuse and neglect concerns weigh heavily on guardians and affect not just those with profound autism, but people of every level of need. We would like to work with the committee and DDS to improve the health and safety of all with DDS and autism that are funded by in IDD or autism adult programs. These aren't new issues. We did we're successful in obtaining a report with your help that showed there were four thousand two hundred and forty six reported allegations of abuse or neglect in 2024, including fifteen cases that resulted in death as a result of the abuse and or neglect. I was personally shocked by these numbers. Several of us had asked for this information before coming to the legislature. And to the best of our knowledge, this information has never been shared with the public or with this or public health committees. Of the number of allegations in 2024, forty three percent were substantiated. Something you should understand is unless the alleged distribution of neglect can be attributed to a particular person, place, and time, the allegation is considered by DDS to be unsubstantiated. You could still have bruises on your arms, but on your loved one's arms. You know someone had to do it, but you don't know who it is, so it's unsubstantiated even with pictures or video. The purpose of these investigations is to help protect the health and safety of those who receive these services. The investigations are the fact finders in a particular allegation. Determinations of the facts and whether abuse or neglect has happened is, something that should be done by, independent, investigators and not, the private providers who currently, serve that individual. They need to be completed independently and timely so recommendations can be implemented. DDS has to follow-up to ensure that the recommendations were implemented appropriately. DDS should also use these to watch for patterns that may indicate a system systemic issue, such as with particular types of individuals and particular agencies and so forth. DDS did not comply with the requirement of house bill 7,108 that confirms that follow-up occurred when recommendations were made in a substantiated or unsubstantiated case. They threw it back on the legislature and said, we don't understand it. We'll have to ask you for a legislative change. I'm assuming that no one called Chairman Lesser or Chairperson, Doug Krastor, any of you, to find out what it meant. They also were aware of the language at the time the bill was considered. Further, the rules for providers for operating DDS programs are in a provider handbook, which is posted on the DDS website. That's wonderful except access to this as well as communications to providers are only acceptable accessible to providers. Families are essentially quality control agents and we we don't know if the provider is complying with rules or not unless we know what the rules are. The report under boost and neglect required under the legislation is posted on the DDS website. We're grateful for that.

[Speaker 22]: Sorry. I didn't

[Committee Member (Unidentified)]: However, even for someone Thank you

[Representative Lucy Dathan]: so much. I'm sorry

[Senator Matt Lesser (Chair, Human Services Committee)]: to hear the bell.

[Committee Member (Unidentified)]: Even, for someone, who is adept in using the Internet cannot find it using your usual tools. These reports should be posted prominently on the website. So come

[Representative Jay Case (Ranking Member, Human Services)]: to see

[Representative Lucy Dathan]: this to Rostene.

[Ruchi Sheth (CT Voices for Children)]: Can you have a right

[Committee Member (Unidentified)]: brief testimony.

[Representative Lucy Dathan]: Great. That's fantastic. I know you're up here a lot. We appreciate you coming to I appreciate

[Committee Member (Unidentified)]: all you all of you folks doing in your various hats on different committees, and there's much to be done, and we're glad that you're on it. So thank you. Great.

[Representative Lucy Dathan]: Thank you. Next, we have John Carmichael. And I know we have a duo here. If you can please introduce yourself so that you're both on the record. I know Pearl Barnett. Is that right? Pearl Barnett. Okay. Great.

[Representative Kurt Vail]: Thank you.

[OPM Staff (first name referenced as “Zanu”)]: And my name is John Carmichael. Good after good evening, Madam Chair, members of the committee. Senator Lesser, thank you for, giving me this chance to testify. My name is John Carmichael. I am the CEO of GT Independence. Let me start by saying clearly, first of all, thank you for the opportunity to speak on bill senate bill four ninety eight. And I wanna say clearly that we support the goal of Senate Bill four ninety eight. Personal care attendants must be paid accurately and on time every time. Workers and the individuals they support depend on that stability. I've been listening to testimony all day. The PCA workers, the what they came and said in their testimony, I didn't find one thing to disagree with in that testimony. GT Independence, my company, is the fiscal intermediary for Connecticut's self directed programs. Our job is to make sure payroll, taxes, and compliance are handled correctly so people can live independently in their homes and in their communities. This responsibility is the core of everything we do. Again, we support the intent of this bill. However, we respectfully oppose it as written because it does not address the root causes of the challenges that we've seen. The issues Connecticut has experienced are not due to lack of fiscal intermediary capability. They're driven by infrastructure gaps, inconsistent authorization data, and evolving program policies across multiple state systems. Over the past two years, during a major program transition where we took over, we encountered significant data misalignment across systems. Despite that, our priority never changed, protect workers' paychecks. When conflicts arose, we we advanced payroll, escalated issues, and worked the Department of Social Services to prevent disruption because behind every time sheet is a worker and a family. Since then, we've partnered closely with the state to strengthen the system, improving eligibility verification, authorization tracking, and budget monitoring. Progress is being made. Many of the reporting and oversight measures proposed in this bill already exist today under current contracts. Rather than restructure the model, let's keep focusing on improving system infrastructure. It's also important to recognize that payroll reliability in these programs depends on multiple factors and not just fiscal intermediary. A penalty structure that ignores that shared responsibility actually could create unintended consequences. You might be incentivizing the fiscal intermediary to do things you don't want them to do. Also encourage caution when in considering a state run model. Other states have tried this and faced the same or greater challenges, often requiring significant investment to rebuild capabilities that already exist today. It is not the trend nationally. The trend is away from state run models. Lesson is simple. It's It's not who administers the program, but whether the program itself is strong. Let me close with this. We do not benefit when workers experience pay instability. Our success depends on their trust, our accuracy. We are committed to ensuring that PCAs are never put at financial risk. We want the same outcome and we look forward to continuing to work on that. Thank you.

[Representative Lucy Dathan]: Thank you, mister Carmichael, for your testimony. I know there's a a variety of, different bills in government oversight. We heard one recently as well. I did have some follow-up questions from your testimony. You highlight that, you serve multiple states, Connecticut, Delaware, Maine, New Hampshire, Maryland, District of Columbia, Ohio, Michigan, Florida, Ohio, almost a home just one and and other, 150 contracts as well with 60 Medicaid waivers. In terms of the number of transactions that you manage, I know you have shared with my committee some transaction data. Like, for example, in January 26, you said that you had 265,000 transactions here in Connecticut. In relation to some of the other states that you operate in, how big is Connecticut's contract compared to some of the other states I mentioned?

[OPM Staff (first name referenced as “Zanu”)]: Thank you for your question, Representative Dathan. Connecticut is not our largest contract. Connecticut is a large contract. It's a large program. I think we have over 13,000 people that we're serving. So that might put it in the certainly puts it in the top five in terms of states, but is not the largest.

[Representative Lucy Dathan]: Okay. And you did supply my committee some information on your payroll error rate in January, but I during the time that there was significant issues, we're talking sort of q four twenty twenty five. Can you tell the committee what sort of error rate you had on those transactions in each of the months?

[Pearl Barnett (GT Independence)]: If if I can add, so in the instances in q four, those were would not be considered errors because that that was at the direction of the Department of Social Services for us to change from operating on a annual, authorization basis to a monthly authorization basis. So the Department of Social Service made that, direction, provided that information to us, and we aligned our systems with that request. So we provided the information and provided payment at the direction of the department.

[Representative Lucy Dathan]: Okay. So does the do other states have similar reporting requirements to what Connecticut's DSS has asked you to do and how you do the reporting? And is that consistent with CMS direction? Or

[Pearl Barnett (GT Independence)]: Yes. So there are a number of ways that utilization, that's what we call it, utilization management happens in self direction. So either you do an annual authorization, which means that you can use the units or dollars within the full year period, and it provides the ultimate flexibility. Then there's the monthly utilization, which is what Department of Social Services sought to go to in October '5. That is utilized across the country as well. So, states use both models. And then there's even weekly models. So, some states and health plans also use a weekly authorization structure. The the situation here was that the the budgets were set at an annual basis, and then there was an attempt to change it to a monthly utilization with not a lot of, headway for people to prepare for that change. And so it created, quite a bit of disruption because people were not prepared for that change.

[Representative Lucy Dathan]: Okay. That that's helpful to understand. I think, you know, I'd like to try to understand, you know, where if these are solely to do with this change in reporting system is what you're saying, because I'm not sure that, I've heard quite the same thing and so I'm trying to get to the bottom of this to get myself, familiar. But in terms of on average, do you do an analysis by week in terms of error rate and other sort of issues that come up? And are other states experiencing the same level of errors that Connecticut faces on average?

[OPM Staff (first name referenced as “Zanu”)]: Thank you, representative. Yeah. I think I understand the the question. Just a a couple of comments I think to to get to, where you're going. The October, November, December error rates that we reported to, state of Connecticut are point zero four, point zero eight, and point zero two. In other words, 99.98% in December was how accurate we were issuing paychecks. Of course, that leaves out those paychecks that we were told not to pay because of overutilization. Different states across the country have slightly different ways to measure payroll accuracy, but it about amounts to the same thing. It's really, did you get that person paid on time? Did you pay them what they put on their time sheet? And that's what we're tracking here and in other states. This is a good rate. This is I think we've we've made extra effort given some of the challenges we've faced in Connecticut to make sure that we're doing our job properly. Now to to the question of that's not the only problem, I won't say that GT Independence has never made a mistake with a paycheck. I mean, we have made mistakes. In in fact, we're reporting that we've made some mistakes. But what we see in those mistakes is that they're isolated issues. They could be related to a training issue on our end. They could be related to a communication issue that happened. Of course, those things always happen. They've happened throughout the history of our company. The the perception that I'm hearing of widespread payroll in security or inaccuracy is driven almost entirely by policy and system infrastructure and not general inaccuracy of the fiscal intermediary.

[Representative Lucy Dathan]: Okay. Did you have a chance to leave read the commissioner's testimony? And can you respond to what your thoughts are based on her testimony today?

[OPM Staff (first name referenced as “Zanu”)]: Yes. So I did have a chance to read to read the commissioner's testimony. I might not characterize the situation exactly the way she the commissioner characterized it in her testimony. I think it's fair to say that in general, without assigning blame, there have been problems getting the program to a place where we would call it operating smoothly and efficiently. So I can agree with the commissioner in that sense. I would also say that we have worked very closely with DSS to continue to address where there might be deficits. And I feel like we've made progress. I feel like there's an increased capacity to receive eligibility data. I think there is a clearer understanding of where to go with policy. We're not there yet and there's some investment I think that has to be done in terms of infrastructure for DSS. Absolutely. I'll just add one more comment related to the commissioner's remarks. We have a broad base of states that we serve. We've been doing business for twenty two years. We do only fiscal intermediary services. This is our passion, and this is where we have a high degree of technical capacity. So I have a little trouble accepting the notion that it's a problem of GT independence not being able to scale. I think I would characterize that part of her testimony a little bit differently. But certainly recognize that there are infrastructure issues that we need to work together on.

[Representative Lucy Dathan]: When you, onboard a new contract like you did with Connecticut in '23, how long does it take to, fully be onboarded where you've kind of eliminated these sort of teething items that you're kind of referring to?

[OPM Staff (first name referenced as “Zanu”)]: I think there are multiple approaches to onboarding contracts. There are some cases where we, we do, you know, a pilot, the subgroup of of folks so that we can work things out. I think the key to onboarding contracts is ensuring that those data connections and those policies are in place. And I think we had a a situation when we onboarded Connecticut where where the system was in a little bit different condition than than what we thought we were gonna be entering into. So that extended probably the time for ironing out onboarding issues.

[Representative Lucy Dathan]: So when you onboard a new contract, do you highlight the sort of infrastructure needs of the new contract, and do you help the, I hate to say client, but the new state figure out those issues and how that they can rectify them? Is that part of your sort of onboarding process?

[OPM Staff (first name referenced as “Zanu”)]: Yeah. Representative, if I could defer to my colleague who is more directly involved in onboarding.

[Pearl Barnett (GT Independence)]: Yes. So absolutely. In early twenty twenty four, after we did a small pilot here in Connecticut, There was a, well documented report of that pilot and concerns with rolling out next steps in the self directed program here in Connecticut. We felt confident that we could continue processing payment, and we did as we supported the onboarding of of the 13,000 people who we serve here in Connecticut and all of their PCAs. But there was an extensive report provided to the Department of Social Services acknowledging the, concerns with the current system as well as, indicating, information related to policy decisions that needed to be made, to move forward, for the process to to be effective.

[Representative Lucy Dathan]: Okay. That that's helpful. Just to clarify, does do you all at JTI, do you do, like, some sort of call center so you can help rectify that? I think we talked about that in in my government, oversight committee. And, you know, there's, on average, it looks like there's, you know, fifteen, sixteen thousand calls per month that are made. I think the concerning thing for me is 13% of the calls that were made were abandoned. So people didn't get their answers and abandoned the call. And, you know, we're talking about people that, you know, may not have all the time in the world to to do this. How are we able to rectify that, and how is this call abandonment rate similar to what you experienced in other states?

[Pearl Barnett (GT Independence)]: So in Connecticut, we do have slightly higher call abandonment rate, but that's not always necessarily a bad thing. When you call our call center, you get a list of options that you can do to get the information that you may be wanting to get to a human to talk to. So we offer a web portal that provides access to pay stub information, that provides access to information related to, the services and support that someone might call to to get a understanding of. And so when you call, we point you into those resources where you can find information, and some people decide, oh, okay. I have the information that I need and decide to go and find that information in the places that are available to them. But I would also say that, we have increased our we are within our contractual requirements of answering the phone, but we're we're working to answer it much faster. So so from an organizational perspective, we we the the limit that the service level agreement, which is listed in the contract, is not our desired goal. We really want to do a much better job in getting those calls answered and making sure that they get complete resolution of any concern that they're calling for.

[Representative Lucy Dathan]: That was gonna be my next question. So thank you for fielding that. There's a lot of questions. Senator Lesser.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yeah. I saw one accounting that suggested that 5,000 paychecks were not delivered properly last year, maybe more. So last year, this year when the shift happened. And the I don't know about majority an awful lot of PCAs that you service are living paycheck to paycheck. And so when you don't get a paycheck, and you need that paycheck to not be homeless, to pay for food for your family, the consequences can be catastrophic. You've heard the testimony for hours from PCAs who've gone through hell and back. Is there anything you wanna tell them?

[OPM Staff (first name referenced as “Zanu”)]: Absolutely. And I appreciate you asking me the question and give me an opportunity to respond. First, I can tell you that it absolutely guts us to feel like we had a hand in creating financial insecurity for somebody who is a personal care attendant. I know how hard that work is. I know what it's like to care for a loved one who has an intellectual disability. I am a caregiver. I started this business because I was caring for my older brother, Ben, who has an intellectual disability. I know how special those people are. And so to think that GT Independence participated in somebody not receiving their paycheck, it it it guts us. It also guts the rest of the company, the hundreds of people who receive phone calls on a regular basis, who are trying to help these people work through their payroll issues, and all of the staff from me on down to the very front line. So make no mistake. We are absolutely overcome with disappointment when when we don't make it work properly. We try to apply program rules. We try to update data as quickly as possible. I've talked about infrastructure issues, but by no means are those infrastructure issues an excuse. We, despite those issues, have taken extraordinary steps to make sure that people can get paid because we know how important it is. We've issued payments on a on a say so without waiting for documentation to back up because we know how important it is to folks. So, senator, I I can just say that I appreciate the opportunity to address that question.

[Senator Matt Lesser (Chair, Human Services Committee)]: You know, I heard what you said. I listened to your testimony and your answers to representative Dayton earlier. I I didn't hear you say sorry. I didn't hear you say sorry to the people. Like, I had a constituent who was evicted, living in their car, was homeless entire Thanksgiving week. And I'm on the phone trying to get this family housing and food. They had no food for a week, for Thanksgiving week. This is a caregiver for a young man with a spinal cord injury, and five people and a dog are living in a car. And the answer that I got was, it's Thanksgiving week. We can't do anything. Everybody's out. And the best answer you can tell me is I I I didn't hear I I I don't wanna mischaracterize your words, but I did not hear a sorry. And there are a lot of people who suffered because of this. We hired you as a state. You are a state contractor. We hired you to perform a service, and that service wasn't performed. And so, you know, this legislation and other bills like it around the legislature are are in response to it. And I I'm still not hearing, like, a real answer. I'm not hearing the answer that the folks out there who are performing the service, who were relying on you, are expecting to hear.

[OPM Staff (first name referenced as “Zanu”)]: Thank you, senator. Let me reiterate that I am personally affected by what happens to these folks, and I am sorry when people don't receive their paychecks as they expected to do. I am sorry when the process that we've put together as a as a program fails these people. I do have to take issue with how you might characterize our efforts. I would say that we did exactly what our job was. We are required to apply program rules. We are required to apply utilization management policy. We the paychecks in question, the 5,000 paychecks that you mentioned, were not issued at the directive of the department because we they exceeded utilization rules. So Every and and I'm sorry. I'm gonna click every single one

[Senator Matt Lesser (Chair, Human Services Committee)]: of those was exceeded utilization rules?

[OPM Staff (first name referenced as “Zanu”)]: No. No. Not every single one, senator. I've I've said earlier in my testimony that from time to time, we make mistakes. And and when we make mistakes, we recognize them and we try to move heaven and earth to get those mistakes corrected. We have the ability to issue payments quickly. And when we identify mistakes, we correct them. My my my understanding and I'd love to be corrected is that there weren't like a handful of mistakes. There were hundreds of mistakes. People who should have been paid but weren't

[Senator Matt Lesser (Chair, Human Services Committee)]: paid and did not get could not get that resolved, not for days, but for weeks and months. And I'm not sure how people are supposed to live like that. And and there are still I think as of today, I I saw one recounting that there are a 150 folks who are still claiming that they are owed money and haven't been paid.

[OPM Staff (first name referenced as “Zanu”)]: Is that is that accurate or inaccurate? You tell me. I I can't speak, senator, to the accuracy of of that subset of payments. I would love to have the direct information that you're refer referring to and could get that answer back to you, whether that was an issue of policy or an issue where we truly made a mistake.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yeah. I k. I think that's all I have. Madam chair.

[Representative Lucy Dathan]: Thank you for highlighting that to the committee. Representative Case.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you, madam chair. So I'll say thank you for coming because you're not from Connecticut. You flew in here. I like to go on to finding facts and see what's happening. How many states again are you in?

[OPM Staff (first name referenced as “Zanu”)]: We serve 20 states in the District Of Columbia.

[Representative Jay Case (Ranking Member, Human Services)]: And I think I spoke to you earlier. It says some of the hardest calls I get is when people don't get paid. And we're trying to figure out what's happening. There's a lot of eyes opening to this issue. You are a contractor of the state of Connecticut. Correct?

[OPM Staff (first name referenced as “Zanu”)]: Correct.

[Representative Jay Case (Ranking Member, Human Services)]: When these issues happen and you have to follow so what I understand is constituent a gets a directive or a policy from DSS or DDS on how much they're able to receive. All you get in an office is how much that person is eligible for. Correct?

[OPM Staff (first name referenced as “Zanu”)]: That's correct. We call that an authorization representative case, but, yes, that's correct.

[Representative Jay Case (Ranking Member, Human Services)]: So an authorization is what allows you to pay that person whether there is an issue as far as what the the constituent or what the caregiver believes that their person they're giving the care to has four hours left. I'm just trying to bring it down to the average everyday person that they might think that they have thirty hours when they only have twenty hours, but they also might not know that, you know, they do have twenty hours, but they gave five hours for this care, ten hours for that. There's some complicated procedures. Is that correct? Not not for you because you know you pay the person twenty hours. But the person who's getting the care needs to know that they have to live through those twenty hours and their caregiver might not know that that's what they have.

[OPM Staff (first name referenced as “Zanu”)]: That is a correct statement, Representative Case. I would say that part of sub direction is in is empowering individual Medicaid beneficiaries to control that. And and to a certain extent, those beneficiaries need to be supported in doing

[Representative Jay Case (Ranking Member, Human Services)]: that. So when somebody new comes in and signs up for service and you're the pay the fiduciary payee for DDS and DSS, I think those are the two biggest contracts you have. What's the process? Is there a a manual or something that people go through in order to apply for service? Or is that through DDS and then they give you the information that this person gets x dollars per month?

[OPM Staff (first name referenced as “Zanu”)]: There is a process for people to obtain eligibility. There's a there's a process for determining level of care needs. There's a process for planning services. And all of those things happen before an authorization for services is issued. And so, yes, there is. There's the eligibility process that happens at the beginning, and then there's the planning process that's very important for determining services.

[Pearl Barnett (GT Independence)]: If I can add. So all of that happens before they come to us as a new referral. So DSS, or the DSS is done here in Hartford. The eligibility is done by DSS. The authorization is done by either the case management team or the access agency through DDS or DSS services. And then once that is determined, then then we would receive a referral for that new participant. They would come over to to GT. We would then set them up as an employer because ultimately in self direction, the participant becomes an employer. And then we would set their employees up to receive payment through us. And we would give the participant and the employer, all of the information they need to be able to access all of the systems and services and provide them with the information that we have of the program.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you. I I I guess, you know, in this committee in human services, we we look at it, and it is the hardest calls that we get when people aren't getting paid. And I don't care if it's a holiday. It's not a holiday, but you are under procedure and policy from our state agencies. And I'm not defending them. I'm not defending you. You know, it's a process that we have because we can't handle it in house, so we outsource it. You did have some hiccups in early fall last year or in 2024. With those issues that took place and you worked through them, do we still owe you money?

[Pearl Barnett (GT Independence)]: Yes. We are owed a significant amount of dollars from the

[Representative Jay Case (Ranking Member, Human Services)]: What is that money? What is

[Jordan DeAngelo]: that dollar?

[Pearl Barnett (GT Independence)]: The amount there's approximately 12,000,000 from a request to pay on the services from people who did not necessarily have the authorization hours, in their budgets that we pay.

[Representative Jay Case (Ranking Member, Human Services)]: Carrying that on your books now. And I'm not defending what we do. But if we need to take care of something and there were mess ups because maybe you overpaid because you covered some people's work that weren't supposed to be covered because the policy didn't have it, shouldn't we be paying you?

[Pearl Barnett (GT Independence)]: That's correct.

[Representative Jay Case (Ranking Member, Human Services)]: So you're carrying it on a on a ledger as a loss right now until we can come up and figure out how we get to the 12 to $15,000,000. I'm not saying that that's I don't know whose fault that is. I don't know where that is, but I will definitely put that question off to our contractual agency, DSS, to see where that money is. We're worried about paying people's paychecks, and you covered those paychecks for times when you went above and beyond what policy was. I get what everybody's trying to do here. We're trying to figure out what the process is. I didn't realize that we make the process. We make the procedures to how much you are allowed to pay. If you overpaid, I'm sorry. But we need that on record so that we can get you the monies back. You are a contractor of the state of Connecticut. If you don't fulfill your job, then we have a right to look at that contract and pull it back. But who are we gonna get to do this work? There's not a lot of agencies that do this. I take the pride in in listening to the contracts that we have and that we negotiate through DSS. And it's DDS also because that is where a lot of the PCAs, the caregivers of our beloved intellectual developmental autistic people that we take care of. There are so many complicated and I I was blown away. I didn't know that you didn't have the right to decide how the person gets paid. It's a policy of this building that goes to you on how much you're allowed to pay people, period. You don't make the policy. You can't say, missus Smith, oh, you worked an extra five hours. We're gonna give you that extra five hours money. You have to follow the policy of what the state's gonna reimburse you. Is that correct?

[OPM Staff (first name referenced as “Zanu”)]: That is correct.

[Representative Jay Case (Ranking Member, Human Services)]: I don't know where else we go with this. I mean, I know representative Dayton thought we talked about it in another committee also. But if we have a contract on this, and I don't I I can talk to her afterwards because we talk a lot about this stuff. But it's we have to follow procedure. We talk about this with MTM, our our nonemergency medical transportation, because they have policies they have to follow, and they have to follow federal guidelines. You can't just change an f endorsement license because you want more drivers. You have a policy because there's liability. You have a policy you have to follow. I'm concerned because some of the calls I'm getting is people are having problems with training, setting up new caregiver workers. Everybody's passing the buck and the blame is going everywhere. Your fiduciary issue is to pay the people what the state of Connecticut says they're eligible to be paid, bottom line. We need to work on that here, work on the procedures on our side, and we need to get you paid. Thank you.

[Representative Lucy Dathan]: Thank you very much, representative representative Bail. Oh, so sorry.

[Representative Anne Hughes]: Let representative Vail Thank

[Representative Lucy Dathan]: you, miss. First. Yeah. Representative Hughes.

[Representative Kurt Vail]: Appreciate your indulgence. Okay. This I wasn't gonna ask questions. I've been trying to follow along with this. So this one is in my wheelhouse. I think I finally understand what what's going so people who receive care are the employers. Correct. Correct. So, obviously so you facilitate on their behalf. You set them up with the PCAs that come in and take care of them.

[OPM Staff (first name referenced as “Zanu”)]: Correct. A a way to characterize that would be we act as their employer agent. We help them become the employer. We help them hire their employees.

[Representative Kurt Vail]: And that's a normal way of doing business in

[OPM Staff (first name referenced as “Zanu”)]: The United States? That is how ADP and Paychex do business, those large payroll companies.

[Representative Kurt Vail]: Is that a smart way to do business? Making making carrier receivers employers?

[OPM Staff (first name referenced as “Zanu”)]: I believe it is. It is part of an idea called self directed services that has taken takes place all over the country and is growing. And the idea is to put the control over that caregiver relationship squarely where it belongs, which is with the person receiving services. And what studies have found are that when people have control over who walks through their front door, they are happier, they have less incidence of negative health outcomes, they have less family caregiver stress and they generally get more out of their services.

[Representative Kurt Vail]: Okay. Bear with me for a few as I work my way through this to understand. So, are there a lot of family members who take care of their loved ones who may be a PCA and go through

[Dr. Jeffrey Vander Ploeg (CHDI)]: you? Yes.

[Representative Kurt Vail]: Is that a majority, fifty fifty, ballpark on that?

[OPM Staff (first name referenced as “Zanu”)]: I I think that the universe of caregivers who are working in self directed arrangements constitutes family members, close friends, and, yeah, a significant I don't know if it's a majority, but it's a significant amount of of those caregivers.

[Representative Kurt Vail]: So if it's a family member I I took care of my mom for a little while when she had some issues. And is it is there a special requirement needed if you're a family member to be a PCA?

[OPM Staff (first name referenced as “Zanu”)]: There are certain employee eligibility requirements for family members. For example, you can't be the legal guardian of the person receiving services. One way to think of it is you can't sign your own time sheet. But, you know, there are different rules about whether, for example, a spouse caregiver. And those rules were actually discussed a little bit during COVID where those rules were relaxed. But generally, it's not spouses. Generally, it's not guardians. But other family members are generally eligible to provide care. And perhaps Pearl can speak to the specifics of our program here in

[Pearl Barnett (GT Independence)]: Connecticut. John John is correct. For the eight programs here in Connecticut, there are different rules for DDS services, for DSS waiver services, and for the Community First Choices program as to who can provide care from a family perspective. But anybody who is able to provide care under a self directed arrangement would follow the same rule process for eligibility determination of the employee.

[Representative Kurt Vail]: Okay. I'm going further down this rabbit hole. So you're the intermediary between that because people obviously, people who are receiving care are gonna have the setup to have their own employees. So you manage all this for the whole state of Connecticut? You're the only contractor that does this for the state of Connecticut?

[Pearl Barnett (GT Independence)]: I believe there's For for DSS and DDS and ADS services. Yes.

[Kevin Alexander]: Okay. Thank you.

[Pearl Barnett (GT Independence)]: There are some smaller contractors that support veteran programs, in Connecticut, but those would be smaller programs.

[Representative Kurt Vail]: And I heard, someone earlier mentioned twenty out is that the maximum, twenty hours per week? And so and are there are benefits involved in this?

[Speaker 56]: So Or

[Representative Kurt Vail]: there are workers?

[Pearl Barnett (GT Independence)]: So the maximum hours for, a person services is determined by their, plan of care. So that is what the the DSS or DDS staff or the access agency determines based on the person's needs and goals to live safe in the home, in the community.

[Representative Kurt Vail]: So what if I was the the person receiving care and I was approved for forty hours? If some are are there gonna be multiple people that provide that? Or if if it's one person, wouldn't they be required to receive benefits? Or are they sub are they considered subcontractors? How does that work? And who pays them?

[Pearl Barnett (GT Independence)]: So the program would determine whether or not benefits were eligible or not eligible based on the, the participants are the employers. Right? So they would not have 50 plus employees that will require benefits. There are certain programs in America that do allow for some level of benefits, but that doesn't apply here in Connecticut.

[Representative Kurt Vail]: And so there could be multiple so you just facilitate the schedule? Who goes? I'm I'm just I'm trying to understand. So this this seems a little Appreciate the question. Convoluted to me.

[OPM Staff (first name referenced as “Zanu”)]: Maybe there's a maybe there's an easy way to sort of lay it out. The the individual Medicaid beneficiary is based on their level of need allocated some number of hours. They choose to participate in self direction, this community first choice program. That means they wanna hire their own worker and they wanna direct that worker, tell them when to come, tell them give them guidance on what to do. So a participant in that program goes about doing that by engaging with us. And we, collect some information about that person, some demographic information. We collect authorization information from DSS or DDS as the case may be about that person. And then we collect information about the person that they wanna hire, like a job application and a consent for criminal background check and maybe some documentation that they've had first aid, CPR training, these types of things. We register the individual, the person receiving services as an employer. We get them a tax ID number. And we execute employer employee agreements between the individual and that and that worker. And away they go, self directing. They know that they have this number of services, this amount of services. Twenty hours is a good example. It's it's a representative example. And they they begin using those services, directing that worker to provide services in that amount. And

[Representative Kurt Vail]: then then you so who pays them? You? The worker. So they they get approved for the pay. So this where does the money come from, and how does it get to the worker?

[OPM Staff (first name referenced as “Zanu”)]: So the worker gets access to an app, and this is where we call electronic visit verification. So we have an app that we've designed that meets the requirements for timekeeping. According to the twenty first Century Cures Act allows people to record their time. Captures where they are when they clock in and clock out. It's a fraud prevention technique. So they punch in and punch out. And they at the end of the pay period, say it's two weeks actually, it's one week in in Connecticut. Mhmm. They we get that data from the app, and we pay it as long as they didn't use more than their twenty hours a week.

[Pearl Barnett (GT Independence)]: After it's approved by the participant employer. So the the worker is gonna clock in, clock out. The participant employer approves that time, and we would then pay up to the authorized amount every week for the time worked.

[Representative Kurt Vail]: Okay. And I'm I'm getting close. So what's why aren't people getting paid? Where's the hiccup that I listened to the previous testimony? I'm finally starting to catch up with this story here. Where where what why aren't people getting paid? Where where's the hole in the hose or the the bubble? Where is that?

[OPM Staff (first name referenced as “Zanu”)]: The very simplest answer to that question is they're putting thirty hours a week in instead of twenty hours a week. The more complex answer to that question is we're the DSS is still working on what are the rules for measuring whether or not they overused. Do we measure that over an annual period? Do we measure that over a monthly period? What are the rules there? And there have been some there's been some development in those policies, and I think there's been some difficulty in terms of communicating

[Representative Kurt Vail]: that. So someone who is approved for twenty hours, the person might have worked thirty hours and that's where the that's where the problem is. So if they work twenty hours and it was approved for twenty, there's not an issue with getting paid there?

[Peter Hadler (Deputy Commissioner, CT DSS)]: Correct.

[Representative Kurt Vail]: Works approved for thirty, work thirty. Okay. One last thing. So if someone this is when someone chooses to, like, you have a company like I'll use Companion and Homemakers. Can someone choose to just go with them? Is that a is that do they have to go through, or is that a separate issue altogether? Like, if they get approved for this, can they just go to them?

[Pearl Barnett (GT Independence)]: So in Connecticut, for the DSS waivers and the DDS DDS waivers, they can choose agency support. Okay.

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: So most of the community

[Pearl Barnett (GT Independence)]: first choices for Community First choices, the the self direction option is the only option for Connecticut.

[Representative Kurt Vail]: So I can't choose to go to I can choose to go to companion homemakers businesses like that, or I have a choice between the two?

[OPM Staff (first name referenced as “Zanu”)]: A person in Connecticut who requires personal care services can get agency services through a waiver or self direct through Community First Choice. Alright.

[Representative Kurt Vail]: I'm getting there. I appreciate your patience and, your time. Thank you.

[Representative Lucy Dathan]: Thank you very much, representative representative Hughes.

[Representative Anne Hughes]: Okay. Thank you. Just real quick. Did you hear the testimony about the dashboarding and some way for the workers to understand where they're at and and some transparency on that. I wanna hear your thoughts about that. Is that an infrastructure thing that you're talking about? Is that a technical thing? And and is that something that DSS or DDS has to design or or approve or where are we at with that?

[Pearl Barnett (GT Independence)]: Yeah. So during the d d DSS testimony this morning, I I believe it was clear clearly stated that DSS is not comfortable sharing the authorization data with the employees Mhmm. The workers. That is not an infrastructure issue. It tends to be considered HIPAA information for the services that someone is receiving. And as you are being empowered to be an employer, you might decide you don't want that employee, e, that worker, to work the full twenty hours. You only want them to work five hours because you have another worker that you want to work the other five hours. Exactly. And so it's giving you the option and control to make decisions.

[Representative Anne Hughes]: So what are other states doing? How are they resolving that?

[OPM Staff (first name referenced as “Zanu”)]: That is a standard practice and a core tenant of self directed services. The work the individual controls the budget, not the worker.

[Representative Anne Hughes]: So did you hear the testimony about some way to for, you know, the worker to ask the self directed employer where we at with that? Like, we we we need to resolve the worker understanding the the limits so that they're not working hours that they won't get paid. So we need we need both both things to be resolved. So what's your suggestion?

[OPM Staff (first name referenced as “Zanu”)]: Right. So that's a it's a great question. And there is absolutely nothing wrong with an employer choosing to share with a worker how much how much service they have available. We just want it to be their choice.

[Representative Kurt Vail]: Mhmm.

[OPM Staff (first name referenced as “Zanu”)]: And if the employer is having trouble interpreting the information on the portal, they have other avenues, they can call us and get that information. One of the challenges that we've seen is that a lot of the you know, we wanna provide that data in real time. We want you to be able to go on to our portal and at any moment, that data is up to date and accurate. And I think that's one of the challenges that I've heard is people are not experiencing that. But but, of course, that goes back to an infrastructure problem. You you can't give me a piece of paper and expect me to update my portal instantly. But if you gave me a data feed, I could. And so, you know, so so that's one of the issues. But but but the other issue is generally, yes, it's the employer can absolutely share that information. So I think what we can do, we can work together to support employers to to know that, to know that there's help for them to control the the funds that they have control over and to and they they are able to share it with workers if possible if they want to.

[Representative Anne Hughes]: But you your your answer didn't didn't address how to you know? Again, there's a power imbalance. Even though they're the employer, like you say, they might be wanting to save fifteen of the hours for another favorite worker. How do we resolve that? There's gotta be other states that are doing this better.

[OPM Staff (first name referenced as “Zanu”)]: Representative Hughes, I wanna make sure that I understand your question thoroughly because I wanna give you the right answer. Your question is, how do we get the information into the hands of the worker?

[Representative Anne Hughes]: No. We need to also support workers with significant high needs to be keep them in good graces with their employees, but but also be transparent about where they are in the work week. Right? So there's gotta be I mean, we're supporting high needs individuals across other states too. Right. There's gotta be ways technically to solve this issue without saying, oh, well, employers can just tell them. True. But these are people that have difficulties on a number of of of things. And they rely, depend on these workers for their very, their very survival. So how can we help people understand where they're at in the work week, what, what their allotted time is to work, and and have a a a real, you know, a real, effective, like you said, real time stream of so we're we're not in this hitch situation. There's got to be a way out of it.

[OPM Staff (first name referenced as “Zanu”)]: Thank you for the question. And I'll let Pearl comment on this. But I want to say there are mechanisms for supporting employers to be successful at self directing. And lots of employers who have various levels of need and are are very successful at self directing. There's a service called support brokerage where an individual is assisting on a regular basis, making regular contact with an employer, helping them to understand where they're at with their budget, what's outstanding, you know, if if they're trying to get a new employee hired. Hey. Let's get that background check-in, that type of thing. That's a service called support brokerage. It's employed in many states. It's something that GT Independence employs in several states and others others, do that as well. You know, there's there are just case management services which are, to my understanding, not available at in CFC. And, you know, also, employers can designate representatives that can help them act in this employer role. That's a that's a possibility in any program. So so I think those are generally avenues that we use to to support employers to manage those those funds well. And I think with those things, you know, you you tend to see better communication about utilization and and better overall management of the workers.

[Representative Anne Hughes]: Okay. So we are looking for a solution that that workers, especially in other states that are self directed, are notified when a budget is changed or reduced or some other situation. So there's gotta be language out there. We've gotta find what it is, how to adopt that that allows, you know, those self directed individuals to communicate with their workers without violating HIPAA and without feeling compromised because they're trying to, you know, have the best service for themselves at the and get their needs met. Right? So any of that you could share with us would be great.

[Pearl Barnett (GT Independence)]: We are certain we're certainly open to working with the department, working with SEIU eleven ninety nine to determine what best fits for everyone involved to get the information to the people who most need it. And in this case, it's the participants and the workers, and we understand that.

[Representative Anne Hughes]: Alright. Thank you. Thank you, madam chair.

[Representative Lucy Dathan]: Thank you. I have one more question, but I'm gonna let a good ranking member, representative Case, go first.

[Representative Jay Case (Ranking Member, Human Services)]: Thank you, madam. So and I I think this is a conversation that we've had. A lot of this is supported decision making. Getting somebody the proper help to make the decision because it can get complicated if I'm gonna use the number again, twenty hours. If that purse that person who's getting the care wants five hours from Sally and wants ten hours from Ed, and then there's five hours left, but maybe they say, well, I need ten more hours of service. They can't make that decision if they're going to twenty five hours. That has to be a policy decision from here in Hartford. Correct?

[OPM Staff (first name referenced as “Zanu”)]: Correct. And that gets to different methods used to measure utilization, different time windows and so forth.

[Representative Jay Case (Ranking Member, Human Services)]: So I think I spoke to you earlier and what it comes down to, what we need to do here, it's an education. Not only an education for us, but a a campaign to let these people understand that we're all just people trying to get people paid. And there's policies to follow, there's rules to follow, and maybe some supportive decision making on the part of the person who's consuming the service because they're the employer. They make the decision on who's coming in to give them care. We gotta come up with a campaign because we we talk about we want people to get care at home. We want people there. We we thrive on that because it's the better place for people to be. As I think, representative Hughes just said, there's a hiccup. Something's going on that we're not educating whoever, but now we're getting educated because you're here. It really bothers me that and I'm gonna ask the question again. How long have we owed you the money?

[Pearl Barnett (GT Independence)]: So we've been owed money over a period between October 2024 through it was May 2025 is

[Melissa Combs (LGBTQ+ Justice & Opportunity Network)]: I wanna punch you here.

[Pearl Barnett (GT Independence)]: That information.

[Representative Jay Case (Ranking Member, Human Services)]: You've held that money on your balance. I I that boggles me that we can do that with a contract and and and how we get away with that. Because if you did that to any one of these people that we had to pay as employers, you'd be fired. I I don't get that. We have to figure this out. This is mind boggling, 12 to $15,000,000, but we're really hitting you hard because missus Smith isn't getting a paycheck. But she's getting it. It's just she might not be getting the hours that she wants. She's getting the hours that are under the policy of the agency that is providing that care, whether that's DSS or DDS. Isn't is those the two agencies that you particularly work with in Connecticut?

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Correct.

[Speaker 6]: Yes.

[Representative Jay Case (Ranking Member, Human Services)]: Because I hear a lot from my DDS constituents because of the care that they get, whether it's a home care, a group care, because all your PCAs get paid through. It it's a checks and balances instead of the Department of Social Services, Department of DDS sending out those check. We couldn't do it as a state. How many clients do you have

[Paul Kidwell (CT Hospital Association)]: in Connecticut? 13,000. 13,000 in Connecticut. We can't handle

[Representative Jay Case (Ranking Member, Human Services)]: that right now. I'm telling you. That's why we have agencies that do it. I mean, it's thank you. Thank you for coming. You it's an education that we had here. I don't know what we're gonna do with legislation that's here to try to fix things. I don't know where we're at with this. I think there's a lot of things going on that we as a committee need to understand also. Number one, educate the caregiver, educate the person who's getting the care, and pay our bills. Thank you for coming.

[Representative Lucy Dathan]: Thank you so much. I don't know your contract provisions. I don't know if there's a retention on paying bills if you haven't delivered. I'm not gonna talk about that as part of this committee. It's not my purview right here, and that's more of a DAS, DSS issue. I think what we're trying to get to the bottom of is figuring out, how we can get this right. We've heard from so many people today how much they count in their pay check. We've heard today from people who suffer from benefit cliff issues and how just that extra dollar means the world getting benefits or not. It's it's heart wrenching to hear those stories and, you know, I don't have to belabor that point. The last question I really had was to understand, because some I'm a CFO by trade and so I deal a lot with, like, the paychecks, the ADPs of this world. So I understand a lot about the reasons that you outsource this

[Representative Kurt Vail]: is to get things done accurately and right.

[Representative Lucy Dathan]: I never wanted to do payroll internally. Accurately and right. I never wanted to do payroll internally because it's it is a difficult task. But one of the things, you know, you mentioned in your testimony, you work with a variety of different states out there. And I know that some of the issues that we're facing are due and payments are dependent on state specific Medicaid requirements or sort of parameters that we might be having here in Connecticut that might be not standard to other states. Is there an issue with our sort of policy that we pay for, these programs that you are not facing in other states due to our state specific Medicaid, parameters.

[OPM Staff (first name referenced as “Zanu”)]: I think I'd defer to Pearl on that.

[Pearl Barnett (GT Independence)]: Yeah. I don't think there's any specific concerns as as it relates to, what services or goods that are paid for here in Connecticut different from other states. We work in 20 states plus D. C. And there are a variety of different types of programs and self direction. There are two main authorities that are given to the program. One is called employer authority that John talked about where you get to choose who provides your services and supports and, who supports you, coming into your home, hire, fire, make the decisions on when they work. The second one is called budget authority. So that's also present in Connecticut programs where you get to decide what services, what amount of the different services that you may need you can receive. That model is used all across the country. One of the major challenges here in Connecticut, and I think Senator Lesser spoke to this earlier, we don't receive all of that information through electronic data feeds. So we are receiving certain, particularly for the waivers, we're receiving the information. For CFC, we're receiving kind of a bundled and we've only been receiving this bundled information since October 2025. So if someone is receiving different services the way it's sent over to us, we kinda have to do a little bit of management to get to the actual authorization that is provided per service. I believe that the DSS is working on that in the MMIS upgrades to pull that information into the MMIS system so that that can be sent over through electronically in accordance to the contract.

[Representative Lucy Dathan]: Okay. That I mean, that's helpful to understand. I was trying to understand if maybe some of these issues were stemming out of complex policies of our state compared to other states, but it states, but it sounds like there's not too much of that and it's pretty standard that you deal with this in your state work.

[OPM Staff (first name referenced as “Zanu”)]: I think that's fair characterization. I think have a clear, consistent policy is good advice and automate the data exchange. I think if I were if you were to ask me the two things that would go farthest towards making sure that PCAs get paid on time and accurately, I'd say those two things.

[Representative Lucy Dathan]: Okay. And then just my very, very last question, I promise. Are there any sort of reports that are done, like, maybe by KKR that do the Kaiser Foundation that does, you know, analysis on third party contractors who manage payroll? Or is there any sort of studies that are done? Because I'm trying to understand if this is a problem with other providers, or is this a unique GTI problem, or what are we doing that we can prevent this from happening in the future?

[Pearl Barnett (GT Independence)]: So I don't have a specific Kaiser Family Foundation policy, but MACPAC just recently did a policy white paper related to self direction in, I believe it was June 2025. And that paper is very useful to look at to see what's being done across the nation as it relates to self direction. While Connecticut is not managed care, but the Managed Long Term Services and Support Association is working on a self directed group, and they will be releasing a, a paper soon related to some of the work that's being done across the nation in managed care programs. And then another point is applied self direction has several different papers that they release on a regular basis. The National Self Directed Self Direction Inventory is released through applied self direction. And then lastly, I might have said lastly already, but AARP does a LTSS scorecard, and self direction is included in the LTSS scorecard as well.

[Representative Lucy Dathan]: Okay. That's nighttime reading, it sounds like, for us. I think seeing no further questions, thank you so much for your testimony and appreciate you spending the extra time with us this evening. I did wanna announce that we are going to try to get through as it's past 08:00. We are going to get through the folks who are in person. So folks who are on the Zoom, if you can continue to hang tight, and we are going to just, get through. So if you know that someone else is around the building and would like to come testify, we'd love to hear from you. But we are gonna go start starting with number the next person is number 82, Kate Sweeney.

[Speaker 27]: Okay.

[Representative Lucy Dathan]: We'll hold on here for Kate. Next, we're gonna try Matt. Oh, sorry. I see. I thought it said I hear. Okay. Yep. Yep. Okay. Carmen Lanchey? Okay. Moving swiftly on. Sarah Parker McKernan. Okay. Moving swiftly on. Next in person, Alexander Cruz. Oh, you're

[Representative Kurt Vail]: up.

[Representative Lucy Dathan]: Thank you so much, Alexander. You've got three minutes.

[Alexander Cruz]: Can you hear me? Perfect. Good evening. I wanted to thank the committee members for taking all this time to hear all the testimonies. I know it means a lot, and I hope you're not going to bother late into the night. But I'm not here with a specific organization. I heard about SB3, s b four nine six, and HB5559. And just as a Connecticut citizen, as a school teacher, as a former recipient of Medicaid, I just wanted to give some personal anecdotes in my testimony. Don't wanna belabor the point. I'm sure you've heard many of these already. Between one hundred and thirty three percent and two hundred percent of the federal poverty line, I think is a place where many people are used to bouncing back and forth between. I certainly was. I qualified for at many points throughout my life, Medicaid And I remember seeing it seeing that little symbol of a husky on envelopes that we would get in the mail as kind of a symbol of hope. Leaving the house with the silver card and knowing that I had some sense of security that if something were to happen, I wouldn't have to jeopardize putting my family into insurmountable debt if an emergency were to happen and we were not covered. This this gap between that 133200%, I've I have I felt it as a child. I I, you know, understand it at a you know, on a deeper level now, why it happens, and that gap between qualifying for aid and making enough to be able to pay your private insurance payments, without it inhibiting your ability to, you know, have upward mobility. So wanted to talk as well. I'd be remiss if I didn't credit. Was gonna talk a little bit about my my mother and her struggle for upward mobility. I wanna, for the sake of time, briefly talk about my father just because I think he represents the immigrant population and people of color population who are disproportionately affected by the barriers, have a tougher time finding upward mobility and have a tougher time finding coverage. He certainly did find upward mobility. In his case, he went from being a line cook to a head chef, dishwasher to a line cook to a head chef and was able to afford Medicare for my siblings, but never himself. I don't believe he's ever had health care. He made sure that we were always covered whenever he had the means. As a teacher now, I see myself and a lot of my students having worked in in Glastonbury, East Hartford, New Britain, and now even Plainville. I see it every single day. I'm sure you've heard this echoed throughout this entire hearing, but students who the closest thing to a doctor that they will that they have seen up to this point is their school nurse, who are overloaded with with students as we know. I spend parent teacher conferences talking to parents about their students not being able to get their glasses prescription filled. We can work with them, move them closer to the board. I can increase the the the font on their text for their work. That's something that we can do. Students that are unable to get their inhalers replaced because the prescription, they don't have coverage. That's something that we can work with, you know. They're not going to have to do the mile run for that year. But when it comes to students who are unable to refill their medication or they are cutting pills in half or in quarters to have to ration their ADHD or the depression medication is not something that we can really fix.

[Representative Robin Comey]: Oh, sorry. Can you wrap up?

[Alexander Cruz]: Absolutely. In my in my role as a teacher, I've I've seen all too often that students and families are are left in this left in this purgatory zone between that 133200%. I think that the state of Connecticut has an incredible opportunity right now with SB three, SB four ninety six, and HP 55, 59 as a clear decisive path forward. I hope that we can find the funding. I hope that the organizations who spoke today, are are able to do the research that they say they're going to do, to find the find the funds for it, and find that this is a research backed, effective plan. I hope that we have the courage to be a leader in health care as we move forward in this country.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank Thank

[Representative Robin Comey]: you, Alexander. Thank you so much for coming out. You know, your experience, your personal experience is really meaningful for us to hear and you coming out and speaking on behalf of your students as well and and what you see in them, as a reflection sort of in the mirror of what you you experienced as yourself. So thanks for coming out, and we hope to do you right. Thank you so much. Take care. Okay. So we will go next in person is Susan Reynolds.

[Susan Reynolds]: Good evening, members, of the Human Services Committee. My name is Susan Reynolds and I'm the cofounder and community organizer for Seniors in Hartford Organizing for Power. I also work with Cultivating Justice on their free CT campaign. It is Cultivating Justice that initiated the language for s b four ninety seven regarding, people with probation or parole violations. These people should not be penal penalized. I am here today to ask you to support s b four ninety seven, an act concerning protecting food security for veterans. This bill would remove barriers to snap access for people currently disqualified for having probation or parole violations. This issue is important to me because it affects my immediate neighbors, my Frog Hollow neighborhood, Hartford in the state of Connecticut. Many of my neighbors have family members who have been disqualified from the SNAP program due to probation or parole violations. And these neighbors help their family members with food. If the neighbor is a senior on a fixed income, helping a relative puts that senior at risk. If they give them food from their kitchen, it depletes their immediate resources. If they give them money, it depletes their financial resources. When many individuals in a community use their income to help family and friends in need due to arcane laws, the entire community becomes unstable. Think about that. Connecticut continues to penalize individuals by withholding oh, crap. Oops. Withholding, safety net programs such as SNAP. Not only does this destabilize the individuals, denied thank you. Denied the most basic human need food, but it also destabilizes the entire community, our entire state. Everyone in our community deserves equal access to SNAP benefits, especially people working to successfully reenter and remain in our communities. Thank you for your time.

[Representative Robin Comey]: Thank you, Susan. Thanks for coming out and explaining, what's going on in your neighborhood and being an advocate for your neighbors. Anyone have any comments, questions? Thank you so much. Nice work. Okay. Next, I will go to Meryl Eaton. Yeah. We're going in person. Then we will go to the next in person is Alex Kajistura. Okay. We'll keep down the list here. Chris Pankratz. Calling for Chris. Carol Rios from the Connecticut Project Action Fund. Carol? Janelle Santos? Monica Nugent?

[Monica Nugent (CT Community Nonprofit Alliance)]: Good evening, members of the Human Services Committee. My name is Monica Nugent, and I'm the manager of public policy and advocacy at the Connecticut Community Nonprofit Alliance. The Alliance is the statewide association of community nonprofits. The Alliance has submitted a number of, testimony on a number of bills on your agenda today, including senate bill three and are concerning health care affordability. I am here to testify today in per in person for senate bill four ninety nine and house bill five five six one. Both senate bill four ninety nine and house bill five five six one would provide valuable and much needed rate increases to a variety of services under Medicaid. Behavioral health services are inherently included in senate bill four ninety nine, but missing as a specific provider type in house bill five five six one. We would encourage this committee to prioritize behavioral health rate increases in the final plan of senate bill four ninety nine and to include behavioral health services to be part of the list of certain providers in house bill five five six one. According to the state's rate study as reference in senate bill four ninety nine, behavioral health services have the highest rate of underfunding in the state. But in a plan released by DSS earlier this session, one of the lowest investments of the 45,000,000 allocated in the enacted fiscal year twenty seven budget. In that plan, DSS proposes to invest only 8,000,000 of that 45,000,000 for behavioral health services. With the study showing that rates for behavioral health services are 42,400,000.0 beneath the five state benchmark, a 117 below where they need to be, this proposal is simply not going to make the meaningful impact in the ability of nonprofit providers to sustain their services. Providers have been sounding the alarm about this underfunding for a decade. In 2015, the Alliance published a study showing that the annual loss in Connecticut for the top 10 behavioral health codes by volume was more than 27,000,000. Since then, rates have been stagnant and costs and demand for services have skyrocketed. Compounding the losses, nonprofit outpatient behavioral health providers are almost entirely reliant on Medicaid to fund their programs. They exist to serve people with low incomes and as a result, on average, approximately 70, but up to ninety percent of patients in those clinics receive their health care from Medicaid. We urge this committee to add more detail to Senate Bill four ninety nine as to which services get increases in the timing and prioritize behavioral health services. Further, to comment on house bill five five six one, we support sections nine and ten to increase the rates for home and community based services. We urge this committee to ensure that the vital codes for the acquired brain injury waiver are included in these increases as referenced in our written testimony. We support the increases in sections 15 and the study in section 17. We support a process designed to allow providers more flexibility related to the use of retained revenue in section 16, but we urge this committee to broaden the scope of the language to include all the state agencies that participate in the revenue retention program as established by public act 23 dash one eighty six. We do have concerns with lines five ninety and five ninety one that would require participating in state agencies to report every single revenue retention plan interaction they have with providers to OPM. Providers already manage contracts with OPM oversight and include that includes the process of revenue retention. Thank you.

[Representative Robin Comey]: Thank you, Monica. And thanks for your advocacy on behalf of your your team, your big team. Anyone have questions? No? Okay. And so just a reminder to folks that we are going through we're trying to get through the people in the room. So if you have gone home and you may be next on the list or are testifying by remote, we are gonna try to zip through some of the the folks here in the room before it gets too late. So to that end, we will go to Cameron English. Okay. Ernie Davis. Alec Lewis.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Sections Thank you. Section six, which would establish PLA codes or precision pricing within the biomarker testing program. This is important legislation enacted at Connecticut that is fairly new. It is now fully effective for both Medicaid and private commercial insurance as of January 1. It kicked in on the private commercial side. But I wanted to respond specifically to the commissioner's testimony. And while, I respect it, I wanted to respectfully work to refute some of the points that were made in the commissioner's response. It's their responses in on page 25 of and I wanna go through that very quickly, but relatively speaking line by line. So, respectfully, I would offer to the Connecticut Department of Social Services here that they are continuing to be an outlier in not adopting PLA code price for their Medicaid fee schedule. Most of the biomarker states have moved in this direction and Connecticut is now one of only a handful of states that has not adopted PLA codes for biomarker testing, on their Medicaid fee schedule. And this is a problem because coverage without codes is in reality coverage in name only. PLA codes are critical for modern biomarker tests and most states have recognized this. It ensures fair and consistent reimbursement. It enables the enforcement of the existing biomarker testing law in Connecticut. And, I think most importantly for real people here in this great state, it prevents delays in cancer care. And, of course, we know that for anyone suffering from cancer, time is essential. It keeps Medicaid aligned with innovation, nationally. And the sixty day timeline that's in the legislation comes directly from legislation that was just signed into law today in Mississippi, which is now part of their biomarker statute. So this is not new and this is a direction that most states again are moving in. The other I also wanted to kind of go through a couple other pieces that the commissioner mentioned. PLA codes, do not determine coverage. They enable accuracy. And these are not unvetted tests. PLA codes are issued by the American Medical Association which the commissioner's testimony does not mention. And I wanted to mention that for this committee. The PLA codes are in fact from the American Medical Association. And clinical value off ultimately is driven by guidelines, not billing codes. Clinical decisions are made by modern medicine. They're not made by what type of billing code a test has. And PLA codes are unique. They're precise. They're specific as opposed to catch all CPT codes or other types of miscellaneous codes. This is an opportunity for the Medicaid program to invest in real accountability. Finally, I would just recognize that PLA codes align Medicaid with modern medicine. There's no new cost mandates here. This is simply about helping Connecticut to properly implement its existing biomarker law. Thank you so much, and I welcome any questions you might have.

[Representative Robin Comey]: Thank you. Yeah. The the last sentence of the commissioner's testimony on the section says that it's not included in the governor's budget. And I'm just wondering, you know, in your view, how much would that, what is the cost associated with this?

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: I would respectfully disagree with that with the commissioner's assessment. The the cost should be fairly minimal. These PLA codes, I can't speak for every type of genetic testing company, but the PLA codes are tied to a specific test. So most Medicaid units already have these codes. They've priced them on their fee schedule. It would really be a one time essential essentially a data entry project to put the codes within the system. And then once they're initially in there, it would be periodically updating the Medicaid fee schedule for new PLA codes as a test went through the approval process and was vetted by the Medicaid program. So there's no significant fiscal cost. So I would respectfully disagree with the the assessment made in the commissioner's testimony.

[Representative Anne Hughes]: Thank you, madam chair. So, yeah, when you say, Connecticut is an outlier and other states have have done this, can you talk about that? Sure.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: So most biomarker states and and when I say that I mean states that have passed and enacted the biomarker testing coverage law. That's a national model legislation through NCOIL that's been broadly supported by the American Cancer Society. Connecticut is now only one of a handful of states, I believe one of four states that currently has not put PLA codes on its fee schedule in terms of pricing. Two of those four states are have either approved using PLA codes and are in the transition or are reviewing. So moat some other biomarker states just to help you get a national scope of this that have used PLA codes on their Medicaid fee schedule include Illinois, Pennsylvania, Florida, Minnesota, New Jersey, Georgia, Kentucky, Indiana, Maryland, Iowa, California, Arizona, Colorado, and New Mexico, and Oklahoma. It's most of those states. So, this is very important because we don't want Connecticut to fall behind with biomarker compliance and Connecticut really has an opportunity to get ahead of this and in front of this and make sure that the biomarker testing promise is made real for all residents of the state of Connecticut.

[Representative Anne Hughes]: And finally, what does PLA stand for?

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Stands for proprietary laboratory analysis codes. And there are particular type of billing code that have that are have been developed and approved by the American Medical Association.

[Representative Anne Hughes]: Okay. Thank you. Thank you.

[Representative Susan Johnson]: Go ahead. Thank you so much, madam chair. And thank you for your testimony. Just quickly, could we just take the codes from the other states? Or what about the Medicare program?

[Senator Matt Lesser (Chair, Human Services Committee)]: Yes. That Does

[Representative Susan Johnson]: the Medicare program actually have the are they utilizing these Yes. Codes? And how about the insurance industry? Just a little bit of a summary for each one of those.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Sure. Great question. So I can't speak again for every single genetic testing company. We have tests that have been approved, by Medicare Advantage and have what's the term the Medicare LCD coverage determination. It's one of several pieces of criteria within the biomarker law that is meant to trigger coverage under the biomarker law as is. So, yes, these billing codes do not need to be created out of the blue in Connecticut. They already exist. The majority of states already use them. Medicare Advantage uses them. We just need the Connecticut Department of Social Services to recognize them and accordingly update the fee schedule. And again, I'm just if you hear from any other genetic testing company, they will likely tell you the same thing. These codes are specific, they're proprietary and they offer immense opportunity for the state to really implement the biomarker law correctly and effectively. And every economic study that that we continue to look at shows that the biomarker testing law is such an enormous opportunity for both Medicaid and private insurance to save money. And to your question about the private insurance, I hope I'm answering that through this statement. Private insurance typically, again, does recognize PLA codes because it's really just a best billing practice and it helps providers ultimately bill whether it's private insurance or Medicaid properly.

[Representative Susan Johnson]: And just to follow-up quickly on the Medicare aspect, you said Advantage Plan, which is the privatized version of the Medicare program. But also, how about Medicare fee for service and the supplemental programs? Medicare in general. So That's federal and it's nationals.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: I wanna be just very careful and specific to what I how I respond to your question. So I cannot speak again for every type of genetic testing company. We have two specific tests, Signatera, which is our flagship cancer care test, and then, Prospera, which is our flagship organ health test, which has the Medicare local coverage determination status. So that's an existing process that goes through the clinical review and vetting. And the national model biomarker legislation recognizes that a test that has gone through that process and has that designation should be qualified for coverage under the biomarker law. FDA approvals and designations are another one. And that's another issue where I would sort of respectfully point holes at the commissioner's testimony. There's a very kind of not obsession, I would say, but just a very particular focus on the FDA piece. And the FDA approval or or being in that process is only one of several eligibility criteria that's in existing Connecticut law. And again, Connecticut's biomarker law is based on the national NCOIL model legislation that includes all those criteria which includes FDA approval or designation, CMS determinations, clinical evidence, or peer reviewed studies. It's really meant to give actually DSS broad ability to assess the clinical validity of tests as is. I think they have concerns on that. I would argue they already have that authority and the PLA codes aren't related to that at all. It's really a red herring and we're simply just trying to have precision pricing for precision medicine. And ultimately, for accountability, you have precision spending. You have real numbers that point to exactly how much money is being spent on what tests.

[Representative Susan Johnson]: Just one more quick question and that would be, did you have you followed up to see the analysis in states where they use the biomarker testing analysis versus the states that don't and the pricing?

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Yes. I mean, states have some have some ability to have I mean, look, in a perfect world, every state would price these these tests to a 100% of the Medicare rate. But reasonably, you know, states have the ability to price at what they see fit. Florida recently just, you know, I think of Florida as a good example. They priced, I wanna say, roughly 50% on their Medicaid fee schedule to what the Medicare advantage the Medicare rate is, excuse me. Ultimately, we know it's a long term process to implement this. The biomarker law is still fairly new, nay nationally. I think the earliest states that have done it only go back a few years ago. So, really, we just wanna make sure Connecticut has the opportunity to get it right and ultimately helps people from particularly with cancer, but when we think of cancer care, women's health and organ health and all the opportunities that exist with biomarker testing to just help ultimately improve real health care outcomes and and save lives and help families. We want Connecticut to be able to realize that.

[Representative Susan Johnson]: Great. Thank you so much, madam chair.

[Representative Robin Comey]: Very welcome. Rep. Vale?

[Representative Kurt Vail]: Thank you. Madam chair, make this sweet. So so you support section six?

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Yes. Absolutely.

[Representative Kurt Vail]: We do. Thank you. There's a lot yeah. And now I know what a BLA is too. So Great. Yeah.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Yeah. You probably know more about it than you ever wanted or

[Speaker 6]: needed to know. No.

[Representative Kurt Vail]: It's all good. I learned a lot today so far.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Any other questions?

[Representative Robin Comey]: No. That's it. Thank you. Sorry.

[Policy Witness (Biomarker PLA codes) – likely industry advocate]: Well, thank you all so much for your time and your attention and your questions.

[Representative Robin Comey]: Absolutely. Thanks for joining us today. Okay. Next, we have, Mark De Jong. Is he here? Okay. Next in person is Grace Brangwyn.

[Speaker 67]: Cheers.

[Representative Robin Comey]: Hi, Grace.

[Speaker 62]: Alright. Good evening to the chairs, ranking members, and members of the Human Services Committee. My name is Grace Brangman, and I am the policy director for health care, insurance, and housing at the Connecticut Business and Industry Association, more commonly known as CBIA. Thank you very much for the opportunity to provide remarks on a few bills on the agenda tonight. The first of which is House Bill five zero four one, an act expanding health care coverage. Section four of this bill establishes a tax credit for small businesses who offer ICRA's. We find that this is another option for small businesses who are unable to offer traditional group health plans. I do wanna flag for the committee, however, that with the establishment and tax credits for ICRA's, it really does shift the onus of finding health care onto the employee which may not always be the most intuitive and it also negates the employer's ability to look at and manage health care costs at the macro level. Section five of this bill also establishes what's called portable benefit accounts which really is geared towards those who have ten ninety nine tax status so those who work in the gig economy. I've never seen a proposal like this until this session and I'd be interested to learn more about it and to see other models of success in other states because that's really a market that we haven't really addressed, in this session so far. The next bill I wanna talk about and respectfully oppose is senate bill three, an act concerning health care affordability. My written testimony is online for the committee to view, but I do wanna hit upon a few main points here tonight. Our first major point of concern is regarding the Connecticut Affordable Healthcare Trust. I understand that the initial deposit for this account would be $200,000,000, but currently as written, the bill would also allow additional state funds to be used. And CBIA is concerned over violations of the physical guardrail, particularly in regards to the spending cap. The bill also, as written, includes subsidies for those enrolled in the Connecticut option. And I would like to respectfully remind the committee that whenever there is a subsidy, there is going to be a cost shift, particularly, in regards to, increased potential premiums on in the commercial space. CBA also respectfully voices concerns about the structure of the working group. This bill requires not only OPM to create and formulate a working group but also to implement the model that the working group recommends. This essentially bypasses the legislative process and we do feel that as structured, the current working group, really lacks representation from those in the commercial market and consumers, of healthcare as well. Finally, I'd like to note that, as we're in, there's only at least one public hearing, for this working group and we really do encourage, the committee to put forth this proposal through the entire legislative process in order to create a very fair and transparent conversation. And with that being said, I would just like to close by saying that I acknowledge, you know, the proponents of this bill and CBA may have to agree or disagree on this proposal specifically. I do wanna leave the door open for future communications and also, allowing the business community to have a seat at the table. With that, I'll end there and I'm happy to answer any questions.

[Representative Robin Comey]: Thank you very much. Senator Lesser online.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yes. Thank you, madam chair, and thank you for the testimony. First of all, I appreciate that, that offer to the extent that I'm, one of the proponents and happy to that always happy to talk to CBIA. Just a question about the first part. You know, you testified on the ICRA proposal. It wasn't clear to me if you are in support of it or opposed to what.

[Speaker 62]: Yeah. We definitely are in favor of options. You know, we really think that the best options for small businesses are to have more options. So, you know, we, support anything that would make it easier for small businesses to provide health care for their employees. You know, CBIA did put out, an article last week talking about this proposal and we do recognize that it has had bipartisan support from, you know, states who have implemented ICRA. So, you know, we do think that there is an opportunity for small businesses to provide health care to their employees, but we do also wanna be cautious and acknowledge that ICRA's, you know, they don't always address really kind of the the cost drivers of health care. So we, you know, we do support it, but we are wary that it's not, you know, the panacea or it's not the cure all.

[Senator Matt Lesser (Chair, Human Services Committee)]: I'm sorry. So the governor is proposing a thousand dollar tax credit to small businesses in the state per employee, and CBIA is not supporting it? I

[Speaker 62]: think we we support alleviate any the ability to alleviate any health care costs. The governor did say in an article in Politico that this has been implemented in in other states. And we do think that this is another option for small businesses. So I do wanna also know that the bill as written does have a cap on how much money can be put forth for these tax credits. And it also creates a time limit for them as well. What excuse me, as well. So with the ICRA tax credit, that would only be eligible for two years. So it's not you know, it's kind of a short term solution, but it would provide some immediate relief.

[Senator Matt Lesser (Chair, Human Services Committee)]: So if we were to lift those caps, is that I I guess I'm what I'm not sure about is I I must not understand your members the way you do, and I I I very easy to I'm very very freely admit that. But look, it's hard for me to understand why CBIA would not support a tax cut for small employers.

[Speaker 62]: Well, I think, you know, there are limitations on the tax credit. I think that's one of our major hesitations. Again, it's for businesses with fewer than 50 employees. And again, there's a limit on when these businesses would be eligible for the tax credit. So

[Representative Kurt Vail]: So if

[Senator Matt Lesser (Chair, Human Services Committee)]: we if we if we went up on the tax if we if we adjusted that to make it instead of for two years for three years or if we went from 50 to 75 of voice, is that is there a point or would I guess I guess I'm I just I'm not sure why you you wouldn't support it.

[Speaker 62]: Well, I think that we would be open to negotiations and to see if we can kind of, you know, kind of adjust those parameters or adjust the goal post in order to, allow more businesses to be eligible for that.

[Senator Matt Lesser (Chair, Human Services Committee)]: Is there a downside? Like, what what what how does that does any employer lose from getting their cap their their taxes cut?

[Speaker 62]: I wouldn't say that, but I also wanna note that especially with, this proposal specifically, these tax credits would go for or towards businesses who would, kinda push their employers towards the health exchange. You know, I really do think that the employer sponsored, health care model is probably the best. So we do wanna be very wary that this is kind of a a short term potentially Band Aid solution And we do obviously are very much in favor of employer sponsored health care.

[Paul Kidwell (CT Hospital Association)]: Why?

[Speaker 62]: Because employer sponsored health care is a way to provide stable, affordable benefits where businesses really get to know their employees and are able to advocate for them because they know their employees best.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. I I don't know. Maybe maybe you talk to some very different employers than I do, but the the businesses, the entrepreneurs in in my area, my neck of the woods, when they go into business, I've not heard a single person who says, you know what I wanna spend my time doing is negotiating health benefits and fighting insurance companies. I've never met an entrepreneur who says that that's that's the reason they opened their coffee shop or that's why they, you know, went to work at their family's manufacturing company or whatever. Like, that's I've never heard anybody say that, and it's it's not I mean, that's ringing true to me. I you know, I I I can only talk about the five towns that I represent, so it's possible that in other places, people that's why you open a coffee shop is to go fight insurance companies. But, right, when an employer has the opportunity to just hand a check to their employee and say, go buy insurance, and that's what a NICRA is. It's just say, here here's a voucher, and we're getting it we're giving you a tax credit to do that. To me, that seems like it's allows the employer to focus on their core competence, which is running their business. And if they don't wanna do it, they can still provide employer sponsored health care. This is just an option that an employer who doesn't wanna spend all day fighting their insurance company can do. No. The thing in the bill is I can read it is is is banning and supporting sponsored care. So so what am I what I'm sorry. What what am I missing here?

[Speaker 62]: Well, I think, you know, Senator, one thing that we can both agree on is that we want to be able to support our small businesses and provide those businesses different options to have health care, and ICRA's are one of those options. So I think we do have that in common. Like I said, I think we'd be interested in kind of changing those parameters and making it more accessible to different kinds of businesses.

[Senator Matt Lesser (Chair, Human Services Committee)]: So you don't wanna just limit it to small employers. You wanna make sure that that big businesses get a tax cut credit for an ICRA. Is that is that what you're saying?

[Speaker 62]: We wanna make sure that all businesses have different options, not just the ICRA, you know, not just, you know, different plans in the current in the market currently. We wanna make sure that they have the ability to choose what is best for the employees. And in certain cases, maybe an ICRA isn't the best thing for an employee, and that's okay. But that's what we really wanna ensure, and that's kind of what we're driving home in this conversation.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. And and then and just because I this is the governor's bill and I you know, I'm not an expert in the governor's bill. The bill doesn't require any employer to participate in the ICRA. Right? This is a this is all but the governor's proposal is purely voluntary. Right?

[Speaker 62]: Yeah. It is. And I think that, you know, businesses can choose and, you know, implement whatever models that they see fit for their employees. So I we do think that the fact that it it is voluntary is a good thing because now businesses have the flexibility to to really pick a plan that's that's the best for them.

[Senator Matt Lesser (Chair, Human Services Committee)]: But you're not supporting that?

[Speaker 62]: I mean, I I we would support any option that really would drive down the cost of health care. So, you know, again, I'm happy to article that provides commentary further. You know, it is an option. We did provide general comments on it, but we know we we kinda wanna be able to provide sustainable health care for a while. And again, you know, with the current language limiting this tax credit to only two years, we'd be interested in changing that.

[Senator Matt Lesser (Chair, Human Services Committee)]: Okay. I'm sorry. I've been going down this rabbit hole for a while. I I'm still not fully understanding, but I appreciate the back and forth. Thank you for testing

[Speaker 62]: this time. Thank you for your, input.

[Representative Robin Comey]: Thank you, senator. Representative Vail.

[Representative Kurt Vail]: Thank you, madam chair. Good evening. So how many businesses in Connecticut are do you represent?

[Speaker 62]: We represent thousands of businesses, 90% of which are small businesses with less than a 100 employees.

[Representative Kurt Vail]: Do you dictate to them what they want, or do you do you reach out do you do you constantly communicate with the businesses to see what they want? Or are you telling them what they want when you come up here?

[Speaker 62]: We ask for their feedback. So we solicit, you know, opinions or stories. My role here is really to be a storyteller for the business community.

[Representative Kurt Vail]: And so when you're giving your testimony on on this bill, it's something that you had discussed with all the businesses, both small and large. Obviously, I don't think when you have that many people, there's gonna be a consensus. But when you give these these opinions here on uncertain bills, you you advocating with their input. Is that correct?

[Speaker 62]: That's correct.

[Representative Kurt Vail]: Okay. Thank you.

[Representative Robin Comey]: Thank you, representative. I think we're all we're all set. Thanks for for hanging around with us.

[Speaker 62]: Thank you. Have a nice night.

[Representative Robin Comey]: Alright. Our next in person is number 133, Paula Musangiana. I don't see her here. Kevin Bunnell. No Kevin. Zipping through the in person as we continue forward, Terrence Brown. What about Elizabeth Bouch? Let's jump to Rosa Rodriguez. Next, I have Matt Barrett. Matthew.

[Matthew Barrett (CT Association of Health Care Facilities)]: Good evening, Representative Comey and Chairman Jill Treston, members of the Human Services Committee. On behalf of the Connecticut Association of Healthcare Facilities, a trade association of skilled nursing facilities and assisted living communities, my name is Matthew Barrett. I'm the President and CEO and I appreciate the opportunity to present testimony in opposition to Senate Bill four ninety five, an act concerning long term care. Subsection improperly adds persons and organizations who are external to the Executive Branch and Legislative Branch of Connecticut State Government as members of the Long Term Care Planning Committee, when it is more appropriate that their participation in developing Connecticut's Long Term Services and Supports Plan should remain as members of the Long Term Care Advisory Committee established under Section 17B-three 88 of the Connecticut General Statutes. Specifically, the bill would add members to the Planning Committee who are now members of the Statutory Advisory Committee, namely the Long Term Care Ombudsman, a representative of an employee organization of long term care workers, and a representative of an organization representing retirees appointed by the proposed legislative committee chairpersons. As background, the Long Term Care Planning Committee was a 1996 recommendation of the Legislative Program Review and Investigations Committee after a comprehensive study, which among other things found considerable Executive Branch fragmentation in the increasing import and expanding long term care planning, policy development, and implementation activities among various state agencies. It's noteworthy that the program review committee did not envision, legislative committee members initially as their recommendation to an established, a planning committee as it was PRI's vision that the new Committee was badly needed to better coordinate long term care fragmented planting in the Executive Branch. However, the Chairs and Ranking Members of the various Committees of Cognizance were included in the 1998 enabling legislation. Still, given a major underlying charge of the new Committee was and continues to be to plan and coordinate Executive Branch activities, it recently followed that a representative of OPM was initially elected Chair from among the various Committee members and today a representative from OPM continues to Chair the Committee. It would be a reversal of the original purpose of the Committee to statutorily establish the Chairs from the legislative committees of cognizance only, and we would recommend against that. Noting that a legislator could be elected as Chair under the enabling legislation, but it remains, in our view, more desirable that an executive branch member chair the committee insofar as considerable coordination among the various state agencies involved in long term care remains a major charge of the committee. I've submitted written testimony on this bill, written testimony on several other bills on the agenda, and I'd be happy to answer any, questions that you have. And I appreciate the opportunity to testify very much.

[Representative Robin Comey]: Thank you. Thank you for coming. So you would like so how would you if you don't like the way that it's it's being made up now, how would you like it to to change or stay the same?

[Matthew Barrett (CT Association of Health Care Facilities)]: Well, I would note that the the representatives outside of the executive branch and legislative branch named in the bill are already statutory members of the advisory committee. So I don't think anything needs to change in that regard. I recommend against the statute itself naming the chairs of two committees of cognizance as the chairpersons of a committee that was established initially to be an executive branch coordinating committee and has been a longstanding, chaired by, the Executive Branch and the entity of, the Office of Policy and Management. And I'd add that, you could hardly, speak against the great work they have done. We have really, completely rebalanced our long term care system since 1998 in favor of home and community based services. The lion's share of our spending, the lion's share of our recipients, Medicaid especially, are being served in home and community based environments. And that was a charge given to the planning committee with OPM as its head, and I think they've done an outstanding job. I can't think of a reason to change that organizational structure with this bill.

[Representative Robin Comey]: Okay. Thank you. Rep. Johnson?

[Representative Susan Johnson]: Thank you so much, madam chair. Just quickly, I you say you wouldn't like to see any changes based on the changes that were made for setting everything up for home based health care and and then he follows the person and all of that. I'm wondering though, we see, at this point in time, a need to address a hospital discharge planning to be able to make sure nursing facilities actually can accept people, and it seems as though bed availability is an issue. Is there anything, that you would have to comment regarding that?

[Matthew Barrett (CT Association of Health Care Facilities)]: Yeah. I think that should be a a consideration and an issue that is considered by both the advisory committee and the long term care planning committee. In fact, one of the, hallmark features of the, the planning committee over time was that they started to branch out and do focus group and regional meetings and try to get input across the state. And that would be, really a terrific issue for them to, consider in a real specific way. And the advisory committee could perform its role in in their advisory capacity to weigh in on on that issue as well. And I and I can and while I believe we we we have refocused and rebalanced the system, I say it's culturally part of the the Medicaid program now to consider everything from a home and community based services perspective. And as much as we understand, at least I hope we understand, we still need a vibrant group of institutional providers such as skilled nursing facilities. But money follows the person and all the rest of the home and community based issues, our work is not done. And these groups should continue to focus on those in those areas as well.

[Representative Susan Johnson]: And, one other quick question. With respect to one of the the issues that we're faced with in this day and age is the investment and maybe taking of, resources from nursing facilities when you have the private equity, groups offering support and investing. Have you got any concerns regarding private equity and their impact on the access for people in the availability of nursing home beds?

[Matthew Barrett (CT Association of Health Care Facilities)]: I do. I do. And I and I'd wanna begin by applauding the Human Services Committee for the work that they did on private equity issues last last session, especially Senator Lesser. We didn't get a compromise bill over the finish line, but we're in dialogue again this session with the potential that we might be able to reach an agreement. We favor and I think this has been a moving position of my association and the nursing home owners. We favor vibrant, transparent disclosure modeled after CMS disclosure requirements that were passed during the Biden administration but have been delayed in terms of implementation and actually are under the category of suspended, not as a final rule. It is the law, but apparently there's been a whole range of software and implementation issues that have suspended those disclosure requirements. My view is that elevates the importance of in Connecticut passing a disclosure bill, a vibrant one, that is included in Section one in Senate Bill four eighty one, which is before the committee today. And we would support that. We would not support any prohibitions or alienations against the transfer of property, which is also a provision on the bill. And we certainly don't support having nursing homes post a performance bond, which we would view as a state mandated performance bond that we think would actually, increase Medicaid costs in the program and, don't see its value in terms of offsetting those costs.

[Representative Susan Johnson]: One other just quick question. In terms of, a lot of the, stays now in nursing facilities are, more short term than they are long term in terms of, the what happens. I mean, of course, the original vision of the Medicare program was to go to the hospital, go to the nursing home, and then the home care. And now, there were changes in terms of the funding, back in the late nineties, for home care services, which capitated them. I I just wonder in terms of being able to make that discharge to from the nursing facility to the home, does that have an impact on whether or not you accept somebody, in terms of, the discharge planning from the hospital and then moving on to the nursing home and then knowing that maybe they're gonna not be able to get, home care services because they may have a chronic condition that the that the home care agency won't accept?

[Matthew Barrett (CT Association of Health Care Facilities)]: Representative Johnson, I think that is a very thoughtful and, and, really, a pointy question. And I will begin by answering by saying that the system is a continuum. And so we absolutely must have a vibrant home and community based services, a contingency of providers. And insofar as payment rates to home and community based services providers is an impediment to building that infrastructure. I think that's a major problem that we continue to need to work on. But I think you're specifically referring to housing instability and homelessness and how homelessness increases emergency room utilization and discharge after emergency room into either onto the streets in towns London or Willimantic or across Connecticut or into into skilled nursing facilities. And even even if there's Medicaid eligibility, I think there is increasingly a reluctance to take admission when you cannot really when a nursing facility can't ascertain or can't organize a pathway for a safe discharge into the community for a person with housing instability, which I think is another major problem in the system. And we need to keep working on that. I think it's a big issue. And I think one answer to that is developing an infrastructure of residential care homes around Connecticut, which is kind of a step down model for skilled nursing facilities. And there are several projects and one I'm particularly familiar with in New London, Connecticut that might actually these are settings that can deliver forty, fifty units of housing in a in a supportive environment, and that could go a long way to addressing many of the issues that I think you've expressed.

[Representative Susan Johnson]: I really appreciate that answer very much, and I would love to have you talk to us some more in Mapuc. And I appreciate all the work that you do and your communication with this committee and all the work you do, to make sure people get, nursing facility care. Thank you, madam. Thank you.

[Representative Robin Comey]: Thank you very much, representative. Anyone else with questions? Alright. Thank you for coming out, Matthew.

[Speaker 15]: Thank you.

[Representative Robin Comey]: Okay. I don't see Thomas here. Thomas Burr?

[Representative Anne Hughes]: Tamara

[Representative Robin Comey]: Selinger.

[Tamara Zelinger]: Tamara. Good evening. I'm Tamara Zelinger from West Hartford and I'm in support of House Bill five fifty five, an act concerning the Department of Developmental Services abuse and neglect investigation. I'd like to thank the members of Human Services Committee for bringing this topic to light. I'm the parent and guardian of two adults diagnosed with Fragile X Syndrome and who also are affected by profound autism. I'm the co leader of the National Fragile X Foundation Connecticut chapter and a member of the steering committee of the Connecticut Profound Autism Alliance. Currently, when there is a neglect or abuse situation and the situation is reported, parents and guardians are sometimes notified and sometimes not. Once the investigation is complete and a report is available with the results and the recommendations if it's substantiated, the parents and guardians need to request the report. They are not automatically provided to them. We are entrusted by the court with the responsibility of overseeing those who we are guardians of, are safe and are being treated appropriately? How can we do this as effectively as possible when we aren't automatically given the reports and at times don't even know that a situation has occurred? In addition, we as the parents and guardians should be a part of the investigation process. Situations occur where an investigation is completed and the facts are not represented correctly. For example, a case where a bruise is being investigated and an individual has many bruises on their arms. The parent or guardian can easily redirect the investigation to concentrate on the newly reported bruises versus the scars from the past. Parents and guardians should be part of the team that work with the investigators so that the most efficient and correct investigation is completed. Both of our children reside in group homes in West Hartford. Our son, while under the care of an agency previous to the agency that he is currently with, had many situations that mandated reporters that surrounded him should have reported. They did not, so I had to. Even then, we were not included in any discussion about the case and needed to request the finalized report. After reading it, we were not given the opportunity to correct some incorrect facts reported that certainly would have changed the outcome. And there are some pictures, but my husband is next and he has the pictures to show you. So thank you very much for your attention to this and for working to keep some of our most vulnerable Connecticut citizens safe.

[Representative Robin Comey]: Thank you very much. And it was interesting because, you know, I'm on the education committee as well, and we always wanna, you know, inform parents when their children are hurt the very same day. Right? Or within law is now twenty four hours, but we're moving it to the very same day. So, you know, it should be no different.

[Tamara Zelinger]: Twenty four hours beats not ever at all.

[Representative Robin Comey]: Yeah. That's true. Okay. Any other questions? Thank you so much for sticking around.

[Jordan DeAngelo]: Thank you.

[Representative Robin Comey]: I believe is there a Brigitte Prince? Okay. I'm sorry. I had you down as remote. My apologies. Go ahead. I missed you. Welcome.

[Speaker 2]: I believe it's on. Yes. Good evening, madam chairwoman and distinguished human services piano. Thank you for the opportunity to speak before you. It was definitely worth the wait to address this committee. Earlier this morning or maybe it was afternoon, I heard testimony about veterans losing some of their benefits. I am a veteran, disabled veteran, but I am also a caretaker for my 82 year old mother. I am here to talk about the unreasonable, which I really believe it is, unreasonable process that we go through to try to get her Medicaid, the actual Medicaid benefits that can help sustain her care. My mother was an educator who retired after several years of meritorial service, went into the Medicare system because she could not afford the COBRA payments, and then also received some type of Medicaid. Now I don't know exactly what this I don't know I don't know what the different Medicaid benefits that she you know, that they offer, but it's one that does not help her with the care that she needs. My mother right now was in Hartford Hospital, and it's actually been a blessing because we have not been able to medically transport my mother to her primary care doctor, to her cardiologist, to her, what else did she call she's audit she has hearing aids. So there she said vascular doctors because we can't afford to pay the American AMR ambulance service $700 to take her to her doctor appointment because, Medicare only provides transportation to the hospital. So her being in the hospital has actually allowed her to have the care that she cannot get because she can't be transported. So I'm here to ask that in this legislation proposed

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: that

[Speaker 2]: service can be offered or benefits can be offered to elderlies here in the state of Connecticut, at least from 75 and older, that they don't have to go through what my mother goes through and miss misses appointments that she critically needs. Like I said, right now, she is in Hartford Hospital in the kidney transplant unit, because she had a kidney transplant, about eleven years ago. So I left left there to come here, and my mother was like, tell them what you need to tell them. She said, and don't just talk for black people, talk for all people. So I'm here to talk for everybody. I'm here to talk for the elderly. And I really thank you for the time. Also want one more point. I know there was something I read in the language about nonprofit hospitals. We've been to Hartford Hospital several times this year. My mother has spent days in the hallways, in the emergency room. And part of that through our research, and I'm here with my colleague who's a civil rights attorney, Cynthia Jennings, we've been researching it. Part of that is based on overcrowding and boarding, and it is something that I learned that they do. They they observe you. They they have, two midnights, and after two midnights, you're there for three days. And I've heard had dozens of people tell me that they've been in emergency room for three days. So this is something that they do within the system to get paid. But I'm just hoping that my mother will be able to get the Medicaid benefits that she needs so we can get her to the appointments that she needs to go to. And I don't have to keep on bringing her to the emergency room just so she can see a doctor because the ambulance is the only way that we can transport her. She's had two broken kidneys I mean, excuse me, broken hips, and so now she's you know, she can't walk. Okay. So, we really need that service.

[Representative Robin Comey]: Okay. Thank you.

[Speaker 55]: Thank you very much.

[Representative Robin Comey]: Here and testifying.

[Speaker 2]: Thank you.

[Representative Anne Hughes]: Thank you, madam chair. Is your mom watching?

[Speaker 2]: My mom's probably watching Family Feud.

[Representative Anne Hughes]: Come on. We wanna say hi to mom. We wanna say you did a great job, daughter.

[Speaker 2]: Thank you so much.

[Representative Robin Comey]: Okay. Oh, Rep. Johnson? Yeah.

[Representative Susan Johnson]: Thank you so much. And thank you for being here. I'm sorry your mom isn't doing well, and she's had all those needs to go back and forth. And but she's never been admitted into the hospital. I understand from your testimony is here today.

[Speaker 2]: She is actually admitted now. She is admitted. She had to go through, Sunday. She had to go back to the hospital, with the UTI. And Mhmm. People don't even know how the UTI affects the elderly. So, she's there, but they have to they put, you know, the kidney transplant because they always always have to monitor her kidneys. So they always have to be mindful of how much medication they give her because it will affect her transplanted kidney. But she's she's admitted.

[Representative Kurt Vail]: Mhmm. Mhmm.

[Representative Susan Johnson]: So she's she's admitted now. How about in the past? Was she admitted in the past or was she Yes. Yes. She was admitted in the past. So she was not in observation status?

[Speaker 2]: She was. She was in observation status.

[Representative Susan Johnson]: Observation status means you're not admitted?

[Speaker 2]: She was there until she got admitted. So she's been in a

[Representative Kurt Vail]: Okay.

[Speaker 2]: Until we started making noise. You know, the time she went to the emergency room, it was always three days and we just started

[Senator Matt Lesser (Chair, Human Services Committee)]: Mhmm.

[Speaker 2]: Like like coming here, coming to places like here and making noise. Because in those three days, she now they're concerned about her heart because they can't regulate her blood pressure because she's now stressed out because you're in the hallway and you're, like, hearing what is wrong with everybody else. You're seeing what is wrong. There's a lot of stuff that goes on in those hallways. So that and then she developed delirium. They now they have to monitor her kidney. So so there was a there was a lot at through that observation period, but she finally got there. So now since we've been kinda making noise and talking to people at the hospital, when she goes to the emergency room the last two times she went, which was like in the within the past two weeks, they've kept her in the emergency room for a very short period of time. When she went Sunday, they put her in a private room in the emergency room. I don't even know they have private rooms

[Representative Kurt Vail]: Yeah.

[Speaker 2]: With screen TVs and everything, so she's there. And then before the next day, they put her in a room. So, you know, the fact that we're advocating for her is really making a difference.

[Representative Susan Johnson]: Absolutely. It does. And and thank you so much for being here and advocating for her and everybody else as well.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Thank you very much.

[Representative Susan Johnson]: Your testimony. Thank you very

[Representative Robin Comey]: much, sir. Thank you very much.

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: Have a great night. Okay.

[Representative Robin Comey]: I believe we are going to Andrew Selinger.

[Andrew (Andy) Selinger]: Thank you very much, human service committee, for hearing my testimony. Thank you for all you do. I am the parent and guardian of two children diagnosed with Fragile X Syndrome and affected by profound autism. I am the co leader of the National Fragile X Foundation Connecticut chapter since 1995, steering committee of the Connecticut Profound Autism Alliance, and twenty five year, board member of the Jewish Association for Community Living. So I have the earned the right to talk on this subject as Dale Carnegie would say. My two children receive services from DDS and reside in group homes. My daughter is the recent addition to that, and it's been one year, and I'm very appreciative to DDS services. I am in support of HB five five five eight, and this is the reason. Well, this is my son, Brian. This was probably one of the better days in my life when he graduated from New England Center for Children, and he was ready for the world. Then the only placement that was available and the only agency that, actually, agreed to serve Brian because of his, you know, extreme needs, and was there for three years. And this is what happened to Brian under the care of this agency. And there were a stack of incident reports that we had that through the three years of many, many, many instances like this, and these are all from restraint. So, the, my my son's doctor, when he was brought there three days after he was hurt, only after we reported the incident and then was taken to the, doctor's office. And the doctor said that the assessment was, multiple trauma, including soft tissue around the eyes, left ear, strongly suspicious of an assault. When the incident occurred, the agency typically investigates, themselves. Self investigation is not appropriate for many reasons. Information is manipulated. Brian's individual plan says that he exhibits self injurious abusive behavior, which is from skin picking. When the report was issued, it gave, it it it omitted the word skin picking, which gave the impression to the reviewer that read this report that this was normal for Brian to injure himself and hit himself. Although, it's very unlikely for somebody to give themselves two black eyes. And when we, you know, looked at all the accounts from the direct support staff of the incident, There were three people involved in the incident, and the reports, the the were all, like, all over the place. Like, they weren't even in the same room, same place when this happened. Very disturbing. So some of the reasons that I feel that, you know, the self investigation is extremely inappropriate is that, they're not trained investigators, and and it's done by the management. It takes away from their job functions, and it's hard to be objective when you're investigating your own people and people that you work with, and it it can be considered a conflict of interest. And, you know, in the case where judge, attorneys, the juries

[Representative Susan Johnson]: Please rule

[Andrew (Andy) Selinger]: up the band. Yes. I will. Thank you. Recruce themselves in in these types of situations. So I don't think it's any different that an agency should, be allowed to investigate themselves. This this, abuse and neglect issue is, you know, serious. And after reading an article about what happened in North Brantford, prompted, me and some other families to contact Jillian and revisit, the public act and strengthen the language in in that law.

[Representative Robin Comey]: Thanks for your advocacy on behalf of everyone. Right? Representative Hughes?

[Representative Anne Hughes]: Thank you, madam chair. Thank you. Thank you both last year, the year before, this year. I you know, listening to both of your testimony and and, previous testimony, I really think that we are uncovering like long term systemic normalization, the way that these responses instead investigation, instead of immediate calls to, for medical care, instead of immediate putting everybody on administrative leave until the investigate Like, it just seems like we have normalized the abuse once again of our, you know, folks with a different, fragile and and disability populations, which was the norm, of course, you know, in institutions and so forth and that's why we closed them. Right? So I would ask the same question. What do you think some of the magic wands besides strengthening the investigation, of course, third party and and the reporting and so forth, But prevention, what do you think the safeguards are prevention?

[Andrew (Andy) Selinger]: Well, our agents the agency that Brian is in now and my daughter, he has been there for nine years without one single restraint. He was receiving restraints on a regular basis and being injured in the process. So, what I can speak to is it's a culture for one. It's a culture because the go to of the agency that he was in was manhandling, abuse, lack of respect, so many other things that, were were problematic. Of course, we all know people aren't getting paid enough. I still believe that this should not be just anybody, any warm body that just gets trained on CPR and some basic training. This requires a skill to work with people. The things that they did at the New England Center for Children with my son, Brian, with skilled professionals was just amazing. He has extreme anxiety, and one individual decided she was gonna take him to King Richard's fair, which is a medieval fair up in the Boston area. So they she took him one time, and it was difficult, and and they didn't get too far. And and but then she took him again with her mother, and they spent a good amount of time, and and they were a miss he was afraid of animals. They were a miss of horses and jousting and and all kinds of stuff that typically, you know, wouldn't work for him. But with the proper supports, he can do it. That's the key. You need people that are comfortable and trained and paid a living wage.

[Representative Anne Hughes]: And finally, through you, madam chair, what's the turnover rate of your staff now in in your son's setting?

[Andrew (Andy) Selinger]: Term of the the the the A turnover. A turnover? Like We have thirty year employees, more than one. The the the staff at at JCL, in average, we have five, ten year employees. There's you know, in recent times, the turnover is a little bit more than it had been in years past. But we have retention because we respect our employees, and we treat them with, you know, the same respect and dignity that the people we serve. So that all equates to retention.

[Representative Anne Hughes]: Thank you. And thank you for that. I think that you highlighted a couple of things, but especially also very specific training. If people are not getting invested in the proper training on de escalation, on on, you know, like what was a previous testifier talked about certain techniques for different folks. Restraints should never be a go to ever.

[Andrew (Andy) Selinger]: Right. Last resort.

[Representative Anne Hughes]: Thank you. Yep.

[Speaker 29]: Thank you.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Representative Gilchrist. Just wanna thank you and Tamara for coming and bringing this information to me personally, but to the entire committee. Because of the reporting, it really sheds light on how these investigations are being done and not being done. And I too was shocked to see how many are done by the very own organization. And so just wanna say thank you for your continued advocacy.

[Speaker 29]: Thank you, Will. Thank you.

[Representative Robin Comey]: Thanks for spending the day with us.

[Francis (Fran) Truszewski]: My pleasure.

[Representative Robin Comey]: And night. Yes. Okay. We'll go next to Heather Gates. She's not here. Nancy Jones? D Pearl Barnett. Okay. The g t. Yep. Next, we have Fiona Crowley. Kevin Alexander. Thanks for coming back.

[Kevin Alexander]: Thank you for having me. Good evening, Senator Lesser, Representative Gilchrist, and distinguished members of our Health and Human Services Committee. My name is Kevin Alexander. I am from West Hartford, and I am a personal care attendant for a family friend who has autism. I stand here before you today to offer testimony in support of Senate Bill four ninety eight, an act protecting paychecks for personal care attendants and expanding public access to state programs, as well as SB3 to expand health care for working folks and protections. I was drawn to providing care after seeing how our society often fails people with disabilities, something that became painfully clear to me after the killing of Jordan Neely on a New York City subway. This was not the career I originally intend imagined for myself, but when my friend and my aunt asked if I could help care for my son help help care for her son, it felt like a meaningful way to give back to our community. The challenge is that it's only a part time job about twenty hours a week, but I make it work. I'll gladly work more hours, but if I did, I would lose access to my health insurance, coverage I depend on. I've been asked by my consumer's doctor if I would be interested in working with more consumers. And like the last gentleman said, it really is a skill that you need to work with adults that have these disabilities. I would be interested in working with more consumers. I would love to be able to improve more lives in our state. The only problem is I would no longer qualify for Husky, and we would not provide suitable we are not provided with suitable health care insurance options. Choosing between helping more people and losing my health insurance or helping only one while keeping my health insurance is not a choice I or any PCA should have to make. Being presented with this choice is a failure of our political system. SB three is a important step to eliminate this choice and support workers like me when it comes to affordable health care. I also wanna talk about GTI. I heard their testimony earlier. And one story I wanted to share with you is I work, like, twenty hours and my client gets, like, thirty two hours. So another lady works some days, and then I come in, fill it with her. Sometimes all three of us are cons my consumer, me and her, we all socialize for about ten minutes. She clocks out after she leaves. I clocked in when I got there ten minutes earlier. I am not paid for that full shift even though my consumer has the hours. GTI doesn't notify us by email, through the app, or anything. They just ignore it. Hopefully, we don't see it on our paycheck. I don't know. I'm not really sure. So we send them an email, wonder what's going on. We don't really receive an email for, I would say three to four weeks later saying, looks like your problem's already been solved. So because I've called in the meantime, been on hold, had many phone calls with them to just get those eight hours of work. So their staffing is not adequate in my opinion. They are a private company. Their goal is not their goal is to pay us, but their main purpose is profit. It is a private company for profit making money from our state and our workers. So I definitely support any protections we have with bill four ninety eight. I'd be happy to answer any questions you have. I also want to say that I worked in customer service for, like, five years, And I worked for eBay and StubHub in East Granby. And our goal was to get email responses because it is more cost effective. Like, I don't want to tell them how to run their company, but it'd be very convenient for us to be able to email them and get a response and not have to sit on hold for ten, fifteen, twenty minutes sometimes. And then, also when they said my paycheck, they I did fix the error. It was it was on it was our fault because we can't overlap. And our my consumer, his dad does the payroll for him. He didn't catch the ten minute overlap either. So it gets sent to them, but then doesn't get sent back or notified. No no one's notified. So it's a little bit of a failure over their payroll system in that aspect to not be paid for the full shift. And, yeah, I just wanna say

[Representative Robin Comey]: Thank you.

[Representative Kurt Vail]: There's time

[Representative Jay Case (Ranking Member, Human Services)]: for this

[Kevin Alexander]: yes. Yeah. I appreciate you all.

[Representative Robin Comey]: Thank you, Kevin.

[Kevin Alexander]: Yeah.

[Representative Robin Comey]: Thanks for for what you do as well.

[Tiffany McDonald]: Rep. Vale?

[Representative Kurt Vail]: Thank you, madam chair. So just when you say you know you paid for a hold shift, are you talking about the ten minutes overlap or some other signature?

[Kevin Alexander]: Exactly. So the ten minute overlap, and then I get eight hours well, it was like a six hour shift. So I my paycheck is six hours short. That whole shift is not paid. And they don't notify us either. So if I don't check my pay stub in, like, six hours, my paycheck hours vary every week, so I might not even notice it.

[Representative Kurt Vail]: So you're talking about ten minutes or six hours?

[Kevin Alexander]: That I don't get paid for six hours. Why don't you get paid for

[Representative Kurt Vail]: the six hours?

[Kevin Alexander]: That's a that's a great question.

[Representative Kurt Vail]: Because there's an overlap?

[Kevin Alexander]: Because there's an overlap. Yeah.

[Representative Kurt Vail]: So if you punched in ten minutes later, you would probably

[Kevin Alexander]: pay The person who punched in first still gets paid their full shift. Yeah. But the person that punched in on the overlap does not get paid any money on For

[Representative Kurt Vail]: that whole shift. Exactly. Alright. So then why not just punch in when the other person punches out?

[Kevin Alexander]: Well, I don't know when they punch out. I don't I don't have access to her information. I don't have access to

[Representative Kurt Vail]: Aren't you together at the time? We are. I You can't just say, hey. When you punch let me know when you punch out so I can punch in?

[Kevin Alexander]: If I knew I wasn't gonna get paid for that shift, I would definitely do that.

[Representative Kurt Vail]: Okay. Alright. Thank you.

[Representative Robin Comey]: That's Thank you. Any other questions? Senator

[Representative Lucy Dathan]: Lesser.

[Senator Matt Lesser (Chair, Human Services Committee)]: Yeah. It's this is just so ridiculous. It is against the law in Connecticut for someone to work and not get paid. And you know, I've been listening to this debate for hours and hours and hours, and I'm just mystified why the intermediary DSS can't figure out how to get you all paid. This is ridiculous. It is against the law. If you work, you need to be a paid end of snore.

[Kevin Alexander]: I agree. I appreciate that.

[Representative Robin Comey]: Thank you, senator.

[Representative Susan Johnson]: Thank you. I think we're

[Representative Robin Comey]: all set, Kevin. Thanks for highlighting your

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: issues.

[Representative Robin Comey]: Next, we have Lynn Afori. No, Lynn. Kevin Johnson? Paul Kidwell.

[Paul Kidwell (CT Hospital Association)]: Good evening, representative Comihan, members of the committee. It's good to be with you this evening. My name is Paul Kidwell. I'm here today representing the Connecticut Hospital Association. We've submitted testimony on 12 of the bills before the committee today. I'm happy to speak to any of those, but I'm gonna limit my testimony this evening to h b fifty forty one and s b three. Related to h b fifty forty one, we respectfully oppose the inclusion of a feasibility study of a public option program within the bill. Although framed as exploratory, such studies frequently serve as precursors to rate setting or reimbursement caps tied to Medicare or other benchmarks. Commercial payment help offset chronic Medicare and Medicaid underpayment and fund critical services, Imposing additional downward pressure on commercial reimbursement through a government run health insurance plan would further jeopardize access to care, making the problem worse without addressing the drivers of the cost shift Medicare and Medicaid underpayment. We do support the policies in the bill that assist small businesses in supporting their employees' healthcare, namely sections four and five of the bill. Related to SB three, we strongly support section 18 which would make several meaningful improvements to prior authorization and utilization review. These reforms respond directly to longstanding concerns CHA has raised with the inappropriate use of utilization management, particularly prior authorization to delay or restrict access to medically necessary care. We also support sections sixteen and seventeen. As HR one is implemented, we encourage the state to adopt an appropriately expansive definition for purposes of determining exemptions from Medicaid work and community engagement requirements. We also support the requirement in section 17 to require DSS to obtain approval from this committee and the Appropriations Committee before changing the Medicaid payment model from a fee for service model to managed care or seeking related federal approvals. We support sections 12 through 15, which would establish a formal process for the state to monitor, report on and disseminate information to beneficiaries regarding eligibility for an exemption from Medicaid community engagement and work requirements. We must respectfully oppose Sections four through eight. The bill indicates that the Connecticut option could structurally operate as a plan that looks like Medicaid or mirrors Medicaid. As I noted earlier, we are opposed to any plan design and implementation built on top of the current Medicaid program without addressing the significant deficiencies in it. Namely, Medicaid reimbursement rates do not come close to covering the cost of care. Connecticut hospitals are already operating under significant financial strain. The Office of Health Strategy recently issued a report showing statewide operating margins at 0.2%. Reimbursement from government payers remain well below the cost of care. Our hospitals incur nearly 3,000,000,000 in Medicare and Medicaid losses annually. We are also concerned with sections ten and eleven. We do appreciate the committee's continued focus on helping patients manage the cost of care, but have concerns with the financial assistance provisions in these two sections. Although we greatly appreciate the sentiment, we have concerns about conditioning DSH payments on adoption of financial assistance policies. Under federal Medicaid DSH rules, each hospital is subject to a specific DSH limit and the availability of DSH must be evaluated together with other Medicaid reimbursement including supplemental payments. As a result, DSH may not be available or available in the same amount for all hospitals that adopt these proposed financial assistance policies. We instead propose that the state consider establishing a dedicated and stable funding pool for a hospital and compensated care payments that is not contingent upon this voluntary financial assistance program. Again, I appreciate the time this evening and happy to answer any of your questions.

[Representative Robin Comey]: Thank you. And how many bills did you say that 12. 12.

[Representative Lucy Dathan]: 12. Okay.

[Representative Robin Comey]: We'll have to

[Andrea Barton Reeves (Commissioner, CT Department of Social Services)]: We submitted all the testimonies.

[Representative Robin Comey]: And you submitted All the tests. Separately.

[Paul Kidwell (CT Hospital Association)]: We all submitted them separately.

[Representative Robin Comey]: A little challenging to to go through all at once. So thank you. Any questions? No. Thank you.

[Senator Matt Lesser (Chair, Human Services Committee)]: So my hand is up. Sorry.

[Representative Robin Comey]: No. It's lost, sir.

[Speaker 50]: Yeah. Just just really quick.

[Senator Matt Lesser (Chair, Human Services Committee)]: I just wanna appreciate your testimony and look forward to continuing to work with CHA on these issues. Thank you.

[OPM Staff (first name referenced as “Zanu”)]: Thank you, senator.

[Representative Robin Comey]: Thank you, senator.

[Speaker 6]: Thank you.

[Representative Robin Comey]: Thank you. Okay. Next, we have Sandy Pope. Is she in the room? Yep. We're gonna go to Natalie shirt shirt left. Okay. Nicholas Glom. Oh, I remember Nicholas. He's not here. We will go now to Kasia Flynn, Nikki Schultz. Oh, Kasia.

[Speaker 67]: Sorry. Waiting on her.

[Speaker 35]: Good evening. Good evening, Senator Lesser, Representative Gilchrist, ranking members Case and Perullo, and distinguished members of the Human Services Committee. My name is Casey F. Flynn, and I live in East Hartford. I'm a graduate student at the Yale School of Public Health, where I study how gaps in our social safety net impact the health and stability of individuals and families. Thank you for the opportunity to testify in support of SB3, an act concerning health care affordability. This bill would establish a Connecticut affordable health care trust fund, expand affordable coverage options, and position the state to respond equitably to federal changes in social services. Health care affordability is a growing crisis. Nationally, forty four percent of adults report difficulty affording health care. In Connecticut, eighty percent of households earning under $50,000 and seventy six percent earning between $50,000 and $75,000 experienced at least one health care affordability burden in the past year. As costs and premiums continue to rise faster than incomes, individuals are at greater risk of losing health care coverage, disproportionately impacting low income households. SP3 presents a critical opportunity to address these challenges in three key ways. First, it improves access to care. Small increases in income can cause individuals to lose eligibility for affordable coverage, which disrupts care. By expanding options like the Connecticut option and basic health program, SB3 helps to fill these gaps. It also strengthens our hospital financial assistance programs, ensuring that uninsured individuals can still access care without facing SB3 helps to protect Connecticut residents from burdensome medical bills. SB3 helps to protect Connecticut residents from burdensome medical bills. Third, it advances population health. When health care is affordable, people are more likely to seek care early rather than delay it. This leads to better prevention, early diagnosis, and improved management of chronic conditions. Expanding access to care can reduce health disparities, improve outcomes, and alleviate the mental health strain associated with financial stress. I respectfully urge you to support SB3 so that all Connecticut residents, especially those most vulnerable, can access affordable care, achieve financial stability, and live healthier lives. Thank you for your time.

[Representative Robin Comey]: Thank you, Kaseya. Thanks for your work in this important area. Any questions for go ahead, Reb Johnson.

[Representative Susan Johnson]: Thank you so much. And thank you for your testimony and your work. You said that you, had been able to observe the impact of people not being able to access the basic needs and how it works with respect to their health and access to health care coverage. Just tell us a little bit about that.

[Speaker 35]: Yeah. So I think the social determinants of health play a really big factor in how people are able to access health care. And structural barriers like financial deprivation can pose a great risk for people who can't access health care financially. Even if there are health care centers near them, physically, they might not have the financial resources to access them. And I think SV3 provides an opportunity to kind of fill those gaps for people who are experiencing cuts due to the federal changes given HR one.

[Representative Susan Johnson]: Thank you so much. Thank you, madam chair.

[Representative Robin Comey]: Okay. Good question. Okay. Thank you so much. Thank you. Drive safe. Alright. Next, we have, Michelle. Nope. We are going to Nikki Schultz. New Nikki. Drew Michael, Drew Michael McQueeny? Nope. Meg Gorman. What about David Schwartzer?

[Senator Matt Lesser (Chair, Human Services Committee)]: He already went.

[Representative Robin Comey]: Okay. Thank you, Samuel. Harold Kritzman? Who's left this? John Kissell, definitely not here.

[Speaker 10]: Oh, we

[Representative Robin Comey]: Okay. Asking.

[Lina Esposito]: Yeah. What's the

[Representative Robin Comey]: Okay. So we're John Satterfield, you're next. Although, I have a Paul Boudreaux. He's not here. Okay. So, John, yes, you're next.

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: Distinguished members of the Human Services Committee, my name is John Satterfield. I'm the past president of Connecticut State Society of Anesthesiologists and I've been working as an anesthesiologist in Connecticut since 1991. I applaud your efforts to address Connecticut Medicaid rates as addressed in Senate Bill four ninety nine. Because Medicaid rates are often determined in association with Medicare rates, it's imperative to recognize a longstanding issue anesthesiologists face with Medicare payments. In the process of updating the Medicare payment methodology in 1992, a tragic calculation error was made in regards to our reimbursement. It is now well recognized that anesthesia services are woefully underpaid by Medicare. The federal government accounting office has confirmed the massive underpayment to anesthesiologist as shown here. Physicians specialties typically experience Medicare payment rates that are 80% of average commercial rates. The GAO found that Medicare payments to anesthesiologists were only 27% of average commercial rates. This huge underpayment by Medicare to anesthesiologists does not begin to cover the cost of providing care. In this diagram, please note the 50% increase in consumer price index over the last twenty years. In the same time span there has been a nominal Medicare increase for Connecticut anesthesiologists and absolutely no increase.

[Representative Robin Comey]: Would you move move it closer to you so we can get it on the camera? Because we have a lot of a lot of committee members that

[Speaker 36]: are online.

[OPM Staff (first name referenced as “Zanu”)]: That. Yeah.

[Representative Robin Comey]: That's good.

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: So let me just say again, there there's been a 50% increase in consumer price index. There's been a nominal increase in Medicare rates for anesthesiologists and no increase in Medicaid rates over the last twenty years for anesthesiologists. And finally, over the last ten years, most physician specialties have experienced a five to 6% increase in Medicare allowable charges While anesthesia providers have experienced an 8.5% decrease. The five state benchmark developed by DSS states that the Medicaid payment rate for Connecticut anesthesiologists is 86% of the national average. The reality is that our Medicaid payment is actually 70% of the national average. Please see my written testimony for further detail. In light of all of these facts, Medicaid reimbursement for Connecticut anesthesiologist must be based on a sound and thorough evaluation. It cannot be linked to a percentage of Medicare rates or a limited analysis of other states' Medicare payments. Every Medicaid patient that comes to a hospital in Connecticut and requires surgery, receives the care of an anesthesiologist, it's time to address the massive Medicaid underpayment Connecticut anesthesiologist experience. Thank you.

[Representative Robin Comey]: Thank you very much and thank you for bringing the the the boards there.

[Suzanne Graff]: Yeah. Visuals.

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: I'd also just like to say thank you to all of you for for being here tonight. And a word of appreciation, within minutes of here, there's 10 anesthesiologists who are going to work all night taking care of patients in surgery rooms, surgery operating rooms, and in labor and delivery. And it's our privilege to care for those patients. It's a great honor. And a majority of those patients or a large percentage of them are Medicaid patients. And so on behalf of the patients who we take care of, I appreciate how hard this decision is for you to allocate limited resources. And the Connecticut Society of Anesthesiologists is very grateful you took the time to hear our testimony. Thank you very much.

[Representative Robin Comey]: Thank you for your leadership. Rep Johnson has a quick question for you.

[Representative Susan Johnson]: Yep. Sure. So, when you get to the diagnostic related groupings, should there be some type of indexing based on that sort of work that you have to do because it is kind of really technical?

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: Our billing process is very specific to anesthesiologists. So, we do submit CPT codes, but they're very limited in scope. And so the the process for anesthesiologist to bill, is very, very difficult, very, very different than other medical specialties. Basically, we're paid about $60 an hour to work by, Medicaid. This how how it, how it actually works out for us.

[Representative Susan Johnson]: Yeah. I I was just curious in terms of the the amount of time that you spend in one one type of patient within a versus another and, you know It's

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: a good question. We we are paid based upon our time and a specific diagnosis code. Yeah.

[Representative Kurt Vail]: So

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: so and we do have modifiers, but but honestly, that's another issue for us. They're not allowing us to submit modifiers to identify patient complexity.

[Representative Susan Johnson]: I was just thinking that if we understood more in terms of the diversity there might be a way to have some type of a guide for the reimbursement.

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: I think that the better, the better way to do it is is to our billing is appropriate and adequate. I think what needs to happen is the rate needs to increase. We do identify complexity by our billing in a process called crosswalk that all insurers and Medicaid do recognize and understand our billing process. So, the response, the appropriate response as we have requested a is a rate increase because we are able to identify complexity both in terms of time and to a certain degree the codes we the codes we submit for specific procedures that we're taking care of when patients are having surgery.

[Representative Susan Johnson]: Thank you for the clarification. Thank you, madam

[Dr. John Satterfield (CT State Society of Anesthesiologists, Past President)]: chair. Thank you.

[Representative Robin Comey]: Thank you very much. Have a good night. Okay. Catherine Valada? Oh, what do we got? Number 27264. I have good memories. Okay. Willard Lewis.

[Speaker 50]: Good evening. So I'd like to first open up by thanking this committee, chair Gilchrist and Lesser, as well as the ranking members, Case and Representative Case and, of course, Perillo. I come here in support of HB 5,041, which is designed, as I understand it, to expand access to health care and seek innovation in particular. In fact, I like to associate myself with the remarks of senator Looney, who thought that it is time for innovation and it's time for a couple of new fresh ideas. However, I'd also like to associate myself with the remarks of Joshua Wojcik from the Office of Policy and Management who is rightly concerned, and I think everyone is really concerned with cost mitigation, cost structure, and policy that is fiscally responsible and sustainable for Connecticut taxpayers. Taken together, these these perspectives point toward an important opportunity for policy innovation. And Connecticut can pursue strategies that expand access while simultaneously addressing underlying drivers of long term health care costs. And therefore, I rise today not only to support this but also to introduce what I believe is a very innovative idea to do just that. We've heard a lot of testimony here about long term costs, long term care costs. And that is indeed one of the largest drivers of our budget, including especially obviously with Medicare. Sorry, Medicaid, excuse me. Housing and healthcare are inextricably linked. One of the largest determinants of whether or not somebody who is 55 or older on Medicaid is going to be in good shape long term is the condition of their housing. And therefore, I began to think about how we can address these concerns of how we can keep folks in their homes but very, very healthy. And I started to identify this program which we worked on, I believe, last year called PACE. It stands for the patient all inclusive yes. Yes, representative. Patient all inclusive care for the elderly. Thank you very much for holding that up. I believe we have a unique opportunity here to do two things. My my MBA from UConn and my now law degree from that I'm pursuing at Quinnipiac has taught me to kinda think and think about problems in this way. We have an abundance of Connecticut residents who will be aging into Medicaid eligibility. 55 and older aging into being able to be sent to a long term care facility on the public dime. But we also have a shortage of housing. And I believe we can begin to marry these two things for I believe we can begin to connect these two dots here. We need to simply rethink the way that we look at, mixed use facilities. Rather than put a relatively unstable, coffee shop or restaurant on the Bottom Floor of a mixed use property with rental units up above, why don't we replace that with a fifteen to twenty year long term medical grade lease? And on top of that, rather than have rental units, why don't we put them in condos? What we if we do that, what we wind up with is a situation where the mixed use facility, which is usually sort of a risky underwriting endeavor for a lot of lending institutions, It turns into an actual powerhouse. It turns into a very underwritable idea when you have a billion dollar corp company potentially on the bottom floor backing backing the lease. Banks love this. This is how we begin to shorten the gap when trying to build units. The biggest problem that we have, the biggest hurdle that we're facing here is it is very difficult to build of and finance affordable, I'm sorry, attainable units. It is also very difficult to to try and have people stay healthy in their in their in their homes. If we have a PACE provider on the Bottom Floor, we can do both. We can certainly incentivize the building of, really not really nice units. We can make it we can provide a new capital stack for the people out there who really do want to step in and do want to provide some housing liquidity for our for our communities. And we also can provide some solutions for people who want to make sure that their parents are staying healthy. I think it's a really, really good win. It's a really good I it's a really good way to reduce, as you'll see in my white paper, which I provided for you. It's a really good way to reduce hospitalizations. It's a really good way to begin to capture some of the cost avoided which other states have been experiencing, by doing something very similar to what I propose to do here. This innovation doesn't require any new subsidies. It doesn't require any new appropriations. What this requires is simply a shift in the way that we think about how we finance not only housing but health care. It addresses some of the things

[Representative Robin Comey]: Wrap it up, please. Yes, representative. Mind.

[Speaker 50]: Yes, representative.

[Speaker 27]: Thank you.

[Representative Robin Comey]: I'll get the evil eye over there.

[Representative Kurt Vail]: No. No. No problem.

[Speaker 50]: I appreciate the evil eye. I appreciate it. I respectfully request that we look at doing a pilot program under the under DSS. We have an existing structure that can do this under the PHAP, the Public Health Accountability Plan. And with an SPA, we can begin to find out what type of savings there actually are. And I believe the savings are immense. If you look in my proposal that I provided to the committee, Massachusetts, 12 approximately twenty minutes to our north, and and certainly mapping it, but twenty minutes to our north is experiencing a 12% year over year reduction in Medicaid, expenditures and a 24% reduction in hospitalizations. That's the main driver of the costs. That's where it's all coming from.

[Representative Robin Comey]: Okay. We're gonna look at your your proposal here for sure, your white paper, and we may have some questions here.

[Speaker 56]: So

[Speaker 50]: Yes. I I I'm open to questions. Yes.

[Representative Anne Hughes]: Just thank you, madam chair. Just a couple of points. We did include, the a possibility of a pilot program in 05/00/2001. What was that? Two years ago. We didn't really act on it, but but we are open to exploring. It some other and this bill is not really addressing that. So I will say that we'll we'll, we'll think about it. But, two, two things about the PACE program. It is an all inclusive, some may say it is a little bit in terms of Medicaid reimbursement, some may, may, criticize that it is a form of capitated care. But I I hear your nuance, like, if if all the things are sort of cited together, that that could resolve some of the housing things. That's why PACE programs are within a large population area so that it can really serve, you know, to scale more. The the thing I will say about when we come up with proposals that seniors don't come up with themselves, they don't tend to go there, like, you know, like until they have to, because we all imagine staying in the homes that we are living in or, you know, raise children in or whatever. So so designing a program that shifts that perception of aging in place, long term care. I mean, nobody thinks, well, I'm just gonna grow up, get on Medicaid, and or grow old, get on Medicaid, and go into long term care. No one thinks that. So so how do we kind of, you know, marry the innovation that you're speaking up, which is actually a way of developing with some private public support?

[Speaker 50]: Yeah. Thank very much. Thank you very much for your question, Rupuse. So the first part is sort of the the the criticism that you said that some people might level against PACE being a capitated vendor. I actually lean into that. I I lean I lean into that. I think that PACE, as if structured properly, re incentivizes health care facilities to move from a sick care, model to a wellness care model. I think incentivizing hospitals and medical facilities to pay more attention, to be more detailed, to actually try to keep people healthy, I think that's a really good thing. And from I'm I'm I'm unafraid to lean into it and say, I really like the that idea. It turns it into a wellness care. It incentivizes them. And, you know, the capitated care absolutely, would would do something like that. Although, Connecticut, as you mentioned, is still rolling out their system. And there's a lot of policies still still to be written, which is why I'm proposing the the the pilot. To the sec to the middle part of your to of your remarks, which I certainly appreciate and associate myself with, I'm very sensitive to the idea that I I want I do like a a free market sort of private and private public partnership. I like the idea that rather than doing subsidies and rather than doing appropriations, we're simply setting up a new modality which a developer might be able to take advantage of if they had a certain type of property. For example, large buildings. I'll give you the the, the atrium in Bloomfield, Connecticut, for example. Huge building, 682,000 square feet. Very hard to move in this day and age. A lot there's a lot of buildings like that in the state of Connecticut. This could be a way to solve a lot of different problems, including what do we do with these very large or very large buildings, which we're having trouble financing. If we if we make it a stronger underwriting proposal, then the price of money, the cost of money can get cheaper. And then the gap between equity and leveraged debt can get narrower. And maybe then we've got a better chance of getting some of that some of that private partnership to come in with us because we all want the same thing. We wanna keep people healthy and we wanna keep our keep our books healthy as well. This is which is why I associated myself with the governor's bill and and with the OPM and senator Looney. Finally, to answer the last part of your your your remarks, I am not yet in in in of age to be qualified for for Medicare Medicaid in this way. Excuse me. But what I do know is commercial real estate and housing. And what I do realize is that what the data is showing us here is that those folks who were who had three and four and five kids in the nineteen eighties and nineteen nineties, who bought a five a four bedroom, a five bedroom, or a three bedroom home, they've had a reluctance to to refinance out or or maybe even downsize now that they're perhaps at at some some folks would call empty nesters. They're having that reluctance for a number of different reasons, but this also could help us inject some liquidity into the market by offering a product, an opportunity to still own a home, to still to still own a home and own that and own that home at at or less than the cost of subsidized rent. One of the things I didn't mention, and I wanna make sure I got it in, one of the things I mentioned didn't I'm sorry. I didn't mention was that in this plan, part of that reinvestment structure under PHAP is gonna go toward making sure that the people who live above in the owner occupied owner occupied units, the medical anchor is actually going to pay be be be, paying toward the HOA, which means that this and the condo fees. So we're gonna have our seniors in medically high grade units getting equity for at or less than the price of subsidized rent. I can't possibly see how this would be not at least an option for somebody who may be looking to downsize. And maybe their pan maybe their kids are like, hey. Maybe I would like mom or dad to be living above their their, their doctor. Maybe I don't want them to have to take a taxi or drive themselves to the to the to the medical facility. These medical interventions lead to hundreds of millions, if not billions of dollars in costs avoided in places like Massachusetts, Pennsylvania, and Oakland, California. I've given those results in my, in my white paper. I think we can I think we can do that here in Connecticut? And I think this is a magnificent way to reimagine how we look at health care and housing.

[Benigno Colón Rivera]: I'm sorry. I said

[Senator Matt Lesser (Chair, Human Services Committee)]: it again. Sorry. I didn't mean to interrupt you.

[Representative Robin Comey]: Anything else? Oh. Thank you so much. And is the link do you have an electronic link in the to this in your testimony online?

[Speaker 50]: Yes. I supported my Okay. Supported my I'm sorry. I submitted my my testimony online.

[Representative Robin Comey]: Okay. Okay. And that includes the paper?

[Speaker 50]: Yes. That includes that's that that entire document.

[Representative Robin Comey]: Okay. Fantastic.

[Speaker 50]: Yes, ma'am. And sorry for the mama's military. I, I call everybody ma'am and sir.

[Alexander Cruz]: It's I can't really avoid all the time.

[Representative Robin Comey]: Well, thank you. Thanks for your thoughtful

[Speaker 50]: Thank you very much.

[Representative Robin Comey]: Testimony and work. Okay. We have one Cynthia, you are our

[Speaker 56]: Good evening. My name is Cynthia Jennings, and I had the pleasure of meeting our chairperson, earlier this afternoon. I did not know you were gonna chair this meeting. So I'm glad to be here and thank you all for coming and staying so late. My goodness. Okay. I'm I'm my name is Cynthia Jennings. I live in North Hartford and I, I'm a civil rights attorney and I'm also an environmental attorney. So I've had a lot of, concerns and a lot of, issues around what has happened to our community and to our environment. Excuse me while I put these glasses on. As I get older, I know I have to have them. Okay. So, one of the things I wanted to talk to you about was one of the best ways to eliminate long term health care is to avoid it. It's important to provide seniors with, with health care that they can have in their own homes, with proper health care, aids and people coming in that care about them. I don't think any of us would have, you know, would want the choice of, being able to or having to live into a long term care facility. And I think it's important that we take a look at that. We also have to work to reduce health disparities. I live in North Hartford and our health disparities have got to be double of any health disparities anywhere else in this in this state and probably in this country. There are so many ways that we can we can provide a reduction in health disparities. One of the things I think that is important is that, and I applaud our governor for this, and that is he's he's he without hesitation stepped in to provide access to food when people were going to be removed from SNAP by an administration that clearly doesn't understand poverty and really, you know, could care less about poverty. But I think it's important that we make sure that those food deserts that we talk about are real and that our people need to have food. They need to be trained to grow their own food. If they have any place, if they can be part of a community garden, they've got to be trained about nutrition so that they can look out for their own health. They don't have to wait until they're sick and go to a doctor. And I think it's important that we also think about when we spend money in this city and in this state that we provide access to urgent care centers. I think it was Hartford Hospital that have they celebrated their fiftieth urgent care center. But we don't have one urgent care center in North Hartford. So we have to think about where we are placing these urgent care centers. If you want to reduce the cost of health care, don't wait until people get so sick that they they are expensive to care for. Provide access to urgent care centers. I also believe that we have to provide programs that support public health and that have a public health basis. And by that, I mean, if you are in an emergency room and I went with Bridget to the emergency room to visit her mom and that emergency room had no room for people. They spent they slept in the halls. How how sanitary is that? It was like being a third world country. I mean, I've never seen this any time in my life. It's got to be there's got to be an answer to that. People do not deserve to set, you know, to sit up in emergency rooms and sit up in in in in hospital waiting rooms and be exposed to all kinds of disease. COVID should have taught us that. So that is another way that we can cut back on health care. I also feel that when we provide, when we provide home health care to seniors, it gives them options. I mean, I am 77 years old and I am not looking forward to moving into a long term care center under any circumstances. My brother is there. He can't walk. He can't lift his hands. And so it got very difficult. And it probably had to do with the profession he had and the trauma he was faced with every day. He was a police chief in Bloomfield. Oh, not police chief. Police, sergeant in Bloomfield. And, it was a very, very, stressful job for him. So we have to think about providing mental health care to everyone. At the time, no, no person that was in the police department would ever admit that they needed mental health care. But so, therefore, they didn't get the care. And a lot of times, that affects our physical health. Let me see what else I had here.

[Ruchi Sheth (CT Voices for Children)]: Okay. I was about Montgomery. Summarize, please, Cynthia. I'm sorry?

[Representative Robin Comey]: Can you summarize, please?

[Speaker 56]: Sure. Okay. Thank you. I will. Let me just look and see what I think is most important here. Alright. I will say that the father of medicine, Hippocrates, was the his statement was, let food be your medicine and let medicine be your food. And I think that we must support that as we move forward and take care of people, that we take care of their food and their basic needs first. And I also think that it's very important the next time there is an urgent care center cited anywhere in the in in the in the state of Connecticut, that there be consideration and a a a will to place some in the urban center so that people don't have to use the emergency room as their urgent care center. Thank you.

[Representative Robin Comey]: Thank you so much. Representative Gilchrist?

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Thank you. I know it's late, but I do just have a comment. Well, thank you for being here. That's very fascinating. We've we've had conversations in here about birthing centers and we have one birthing center in the state and the goal has been to get them into areas where there's a lack of labor and delivery. But I've actually never heard the conversation and appreciate the conversation about urgent cares and that is shocking coming from a community in West Hartford where it feels like we have three on every corner. So that's fascinating.

[Speaker 56]: We have three bars on every corner. So thank you so much. Did anyone else have any questions or comments?

[Representative Anne Hughes]: Mad madam chair, just thank you for bringing up the, Food is Medicine, which we have several initiatives around and also, to to get train us to grow our own food. I think that that is a really, you know, good point point to bring bring up as as we address manmade food scarcity. Thank you. Thank you.

[Representative Robin Comey]: Thank you for coming and spending some time with us today. Appreciate your testimony.

[Speaker 56]: Thank you. Thank you for allowing me to, testify today, and I wish all of you a lot of success in what you do. You it seems that we have a lot of people that do care about health care and health for for Connecticut residents, and I appreciate that. Thank you, representative Gilchrist. Okay.

[Representative Robin Comey]: Thank you. Thank you. Okay. So it looks like we have wrapped the people in the room. So we're going to go back and start taking through the remote folks. Okay. Right. Okay. So I will start with, what I don't see checked off here, which is Jessica Regierz. And I don't see her online. But I do see Jamie Polotsak. She has been with us online for a very long time. Go ahead, Jamie. You can turn on your mic and camera

[Representative Kurt Vail]: Yes.

[Speaker 9]: Hello. Thank you. Thank you so much. Yes. I've been on for about eleven hours. So good evening, senators, representatives, and members of the Human Services Committee. Thank you for the opportunity to testify in support of House Bill 5,557. My name is Jamie Polichak, and I'm the mother of my 25 year old daughter, Sophie, who was diagnosed with autism when she was just three and a half years old. At that time, although she qualified for some supports, the reality was that I spent years fighting for every service she needed in order to succeed. I advocated constantly throughout her elementary, middle, and high school years just to make sure she had the basic supports that would allow her to learn and grow alongside her peers. Like many parents of children with disabilities, I was always told that the goal was to help my daughter become as independent and successful as possible. But when Sophie turned 22 and aged out of the school system, that support system disappeared overnight. It truly felt like she fell off a cliff. My daughter didn't suddenly become less disabled the day she turned 22. The system simply stopped seeing her. Because Sophie's IQ is above 69, the state of Connecticut determined that she was not disabled enough to qualify for services through the Department of Developmental Services. At the same time, she is still on the autism waiver waiting list, almost ten years after applying. So today, my daughter receives no meaningful services from the state at all. What makes this so difficult is that my daughter's disability cannot be measured by an arbitrary IQ number. Sophie has significant developmental challenges that affect her adaptive functioning, her daily living skills, and her ability to live independently or maintain employment without support. She struggles every single day with things most young adults take for granted, things like organization, problem solving, navigating social situations, and managing basic daily responsibilities. After high school, Sophie attended a transition program that was supposed to prepare her for employment and adulthood. Unfortunately, it did not give her the skills she truly needed to succeed in the real world. And then came the next challenge, finding someone willing to hire her. It took us eighteen months after she aged out of the system to find an employer who would give her a chance. As a parent, it is heartbreaking to watch your child work so hard and still struggle simply because the system does not recognize the full picture of their disability. House Bill 5,557 recognizes something that families like mine have known for years, that disabilities are more complex than a single number on an IQ test. There are many individuals like Sophie who fall into this gap. Too high functioning to qualify for services, but still facing very real and significant barriers to independence. No parent should have to watch their child work this hard and still be told they are not disabled enough to deserve help. I respectfully urge you to support House Bill five five five seven so that young adults, like my daughter, are not

[Susan Reynolds]: left behind by a system that was meant to support them.

[Speaker 9]: Thank you for your time and consideration.

[Representative Robin Comey]: Thank you so much. It's been a very long and, you know, I think passionate day that we've heard from a lot of families that really love love their children and, want to see the best for them. And I can, see how much you are, fighting for her every day. So thank you for staying with us all of this time.

[Speaker 9]: Yes. Thank you. Thank you for staying as well. We really do appreciate it. And I, you know, I just want to say that, I think the state knows and has known for a long time that this criteria this eligibility criteria needs to change. It has to change. It it it really there needs to be services available to kids like my daughter because they are falling through the cracks.

[Speaker 55]: So

[Representative Robin Comey]: Alright. Thank you so much.

[Speaker 9]: Thank you.

[Representative Robin Comey]: Okay. Next, we have Sheldon Taubman.

[Sheldon Taubman (Disability Rights Connecticut)]: Good evening, representative Comey and senator Lester, represent Billcrest, other members of the committee. My name is Sheldon Taubman, litigation attorney with Disability Rights Connecticut. I have written testimony. I just highlight things and talk about something else not in there. Section 17 of SB three, which provides protections from going back to capitated managed care, which is very inefficient and harms access to care. The statute of the bill in section 17 is good start, but it'd be better if the whole legislature have to approve such a radical change and also to remove the existing right now as authority for the government to just go to capitated managed care, technically without even getting legislative approval of any kind. What's missing in s b three is not addressing the people who are gonna lose health insurance because of the bureaucratic parts related to HR one and the work requirements, but specifically the call center, the DSS call center you've all heard about. It hasn't been fixed. They've stopped reporting the data that they keep stop they keep ceasing to report data when it goes bad until they temporarily do hires. They can make it look good. You have to put an end to this, and that's why I'm urging you to add into s b three a duty to report how they're doing a minimum standard for for timely compliance with answering phone calls and call abandonment rates. But mostly, I wanna talk about s b five zero one, which is the wheelchair repair bill. This is a good step forward, but we need we suggesting revisions to it so we don't go backwards. First of all, we can't take consumer advocates off of it or we're gonna we'll have a majority. It's the only place where there's a voice for consumers here because there's no enforcement. There's no actual enforcement of the timelines. So if you're going to have this council, it's gotta be majority consumer advocates. Having another dealer on there is fine, but don't take one away. If there's gonna be terms as suggested, the suggestion is keep things so that nothing changes until August, like, have it be, you know, two years from from when they were appointed back in August '24, change the the private pay people to be Medicare people, the duty to inform consumers of the right to in home repair. This is a really important thing that's in your bill, but it needs to be strengthened. It's in my testimony how you can do that. But in addition, based on the testimony today, I think it has to also be said when a company is called to get a repair done, they have to be they have to tell people it's a choice right then and there, as well as on the website. They should be told because NewMotion won't tell them. And lastly, something not in the bill but really important is that there be a some kind of notice at the end when the when the wheelchair is delivered that gives a basic timeline of what happened. And the reason for that is this. There's a ten business day deadline, but the companies get a pass for any time waiting for prior auth or waiting for parts to come in. And those are days that are allowed and they should be. But the problem is the consumer has no idea. If if it took them ten days, if it took them fifteen, it took them twenty days, they can't tell if it was compliance in compliance with the statute unless there's a timeline given where they can check for those days out that don't count. So we're urging you to include that as well as a basic thing, a basic consumer mandate given the fact that there is no real enforcement, and we're going to have to rely upon self enforcement here. Thank you very much. Happy to answer any questions.

[Representative Robin Comey]: Thank you, Sheldon.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: So I have a

[Representative Robin Comey]: question as far as how you how would you how would you let them know? Are you talking about, like, the phone call or, you know, constant communications by email or some other some other

[Sheldon Taubman (Disability Rights Connecticut)]: Let them know their basic rights or or the the timeline for them particularly.

[Representative Robin Comey]: That you were specifically asking to add.

[Sheldon Taubman (Disability Rights Connecticut)]: Then what the language that that I've suggested provides is that it would be either the choice of in in writing, either by, you know, paper or by electronic at the at the election of the consumer. Just we're gonna give you the thing. How do you want it? We'll send it to you.

[Representative Robin Comey]: Okay. Thank you. Okay. Rep Johnson and then rep D'Amico.

[Representative Susan Johnson]: Thank you so much, Sheldon, for your testimony and being with us. I I just wonder about the the information, about the repair and what was repaired, because it probably will help if there's something else that goes wrong, just in a short time after the wheelchair is returned or even a little bit later or even longer. Could you go into a little bit more detail about the type of information that should be provided?

[Sheldon Taubman (Disability Rights Connecticut)]: Well, the suggestion of the advocates is pretty straightforward. It's just what was done, and when you requested it, how long it's been before it was delivered, which that part you can probably figure out your own. But also, how many days they were waiting for prior auth if they had to ask for it, and how long it took from the time they ordered the parts till the time the parts arrived. And and those those days would be subtracted from the total to see if it satisfies the ten business days. So not elaborate information. Pretty basic stuff.

[Representative Susan Johnson]: Okay. Thank you so much. Thank you, madam chair.

[Representative Robin Comey]: You're welcome, representative. Rep. D'Amico.

[Representative D’Amico]: Yeah. I just wanted to say thank you, Sheldon, for your good practical suggestions as always, and thanks for hanging in there all day and all night long. Really appreciate it.

[Representative Kurt Vail]: Thank you,

[Representative D’Amico]: madam chair.

[Sheldon Taubman (Disability Rights Connecticut)]: Thank you all for hanging in all night long. We really, really appreciate it tremendously. Thank you.

[Representative Robin Comey]: Just wanna remind people to please accept the the promotion if you are online because we have only basically committee members online. So please accept the promotion so we can call on you next and okay. So are we at 92 or is that the next one? Okay. Thank you, ma'am. Number 92, Mariel de Aquila.

[Mario De Aquila (Assisted Living Services, Inc.)]: Good evening, distinguished members of the human services committee. Thank you for the opportunity to speak tonight. My name is Mario De Aquila. I'm the chief operating officer and co owner of Assisted Living Services Inc, chairman of the DSS Medicaid Committee for HCAOA Connecticut, and a board member of the Association for Health Care at Home. Our company has provided nonmedical home care at Connecticut since 1996. Our mission began when my great grandfather was diagnosed with Alzheimer's and needed care at home. For nearly thirty years, we've helped seniors live safely and with dignity in their homes for as long as possible. Today, we serve hundreds of Connecticut seniors through Medicaid waiver programs, including the Connecticut Home Care Program for Elders. These services are a lifeline for seniors and one of the most cost effective forms for long term care. However, Medicaid reimbursement rates have not kept pace with rising costs or with other payer sources. Agency based Medicaid PCA reimbursement in Connecticut averages roughly $25 per hour. By comparison, private pay and long term care insurance cases often reimburse over $35 per hour, and VA cases can exceed hour. Those higher rates allow agencies to offer meaningfully higher wages for the same caregiving work. As a result, caregivers understandably choose higher paying assignments, often traveling to neighboring states where Medicaid rates are higher, making it increasingly difficult for Connecticut providers to recruit and retain staff for Medicaid cases. This is no longer just a provider issue. This is now an access issue. When Medicaid rates are 10 to $18 per hour lower than other payer sources, The workforce shifts away from Medicaid clients, and seniors who rely on Medicaid may wait longer for care or struggle to get services at home. At the same time, Connecticut's minimum wage has increased significantly in recent years, and providers have absorbed these costs without meaningful rate adjustments. We strongly support raise bill five five six one, which would increase the Medicaid fee schedule for homemaker companion services by 13% for the next two fiscal years, followed by 10% annual adjustments for three additional years to help keep pace with rising workforce costs. Without these adjustments, providers will be forced to limit or or stop accepting new Medicaid waiver clients. This is not a matter of willingness to serve. It's a matter of financial sustainability and workforce reality. Investing in home care preserves access, stabilizes the workforce, helps the state avoid far more costly institutional care. Thank you for your time and consideration.

[Representative Robin Comey]: Thank you for coming out. We couldn't agree more. Any questions from the committee? Any online? No. Thank you so much, Mario.

[Amir Flores (Student, Southern CT State University)]: Thank you.

[Representative Robin Comey]: Okay. So what we're gonna do is we're gonna go back to where we left off with number 78. I'm gonna call people's names out so that hopefully,

[Representative Susan Johnson]: we

[Representative Robin Comey]: maybe wake people up to join us. Okay. Chris Fox. We are going now to Victor Sanchez. So if these folks are online, please accept your promotion. Ruth Kenobi. Kate Sweeney, Matt Blinsterbus. We have Carmen Lanche at number 84. And then we have Sarah Parker McKernan, Rachel Cottle Latham. We have Kevin Borque. Okay. And next, we have Crystal Rivas. Not yet. Maria Lebron.

[Representative Kurt Vail]: Nope.

[Representative Robin Comey]: Number 93, Juana Lopez. Mercedes Damacy. Mercedes.

[Representative Anne Hughes]: Hello?

[Mercedes (Resident advocate)]: Hello. I'm here.

[Representative Jillian Gilchrest (Chair, Human Services Committee)]: Hi. Thank you.

[Mercedes (Resident advocate)]: Thank you so much for the time. I appreciate your time, and I wanna acknowledge the members of the committee, the chairs, the co chairs, and everyone. Thank you for allowing us to testify or give our testimony. I'm here today to give my testimony in support of s t three, regarding health care affordability in Connecticut. I just wanted to share a little bit about my personal story. I, I'm 40 years old. I was born in Connecticut. I have lived through my entire life with my family, and, I became disabled at the age of 15, due to Lyme disease. So I went from being a I I just wanna show some photos. I was a junior Olympian. These are photos of me from my fencing career. From the Junior Olympics. So I went from this and being the mouse king and the, Danbury Music Center Nutcracker to spending time just in bed and just being extremely ill. And you can see me here. I have a cuff around my arm for where I have a PIP line for IV antibiotics. My illness, put tremendous financial stress on my family and almost bankrupted my family. And just no one should ever be able to go through that. No one should be worried about paying for health care when trying to deal with just keeping their child alive, because I almost died multiple times. But thankfully, I I was able to access treatment, and, I was able to recover enough to be able to attend Western Connecticut State University, where I graduated summa cum laude I'm sorry, magna cum laude with honors. And I served as a student trustee for the Connecticut State University system, which I was very proud to do. But I wouldn't have been able to do that had I not had health care. And I'm very grateful that, my family was privileged enough to be able to support me through that. But I'm here to speak in support of this bill because just I have struggled financially my whole life due to my illness. And paying for my treatment, and my continued issues that I've had has been very expensive. So here's a binder that my mom made, to appeal to health insurance companies, when I had Lyme. And I just wanna show you a photo. Just to give some context. Here I am. I was the youngest state champion in women's foil, and without access to health care, I would have died. So I'm just here to speak in support of affordable health care for all in Connecticut because I think it's very important to be to continue to be a leader in governance and to support our citizens and to support people so that they have the opportunity to give back. And I work very part time now for the faculty union for Western Connecticut State University. And many of the professors are in need of healthcare as well. So I just think that this bill would be awesome for everyone in the state to be able to access health care so that we can contribute to society. Because health really isn't a choice and disability can come for anyone. And most of us are just one infection or accident away from living a very different life that we wouldn't think

[Speaker 40]: we would have

[Mercedes (Resident advocate)]: normally. So, I'm testifying from my bed, and, thank you for your time. I appreciate it.

[Representative Robin Comey]: Thank you. Thanks for being here.

[Mercedes (Resident advocate)]: Thank you.

[Representative Robin Comey]: Nope. Okay. Have a good night.

[Mercedes (Resident advocate)]: Thank you.

[Representative Robin Comey]: Okay. We have Meryl Eaton. Okay.

[Representative Lucy Dathan]: We

[Representative Robin Comey]: 88. Okay. Crystal Crystal Rivas. Go ahead.

[Suzanne Graff]: Hello.

[Speaker 40]: Okay. So my name is Crystal Rivas, and I live in Waterbury. I'm part of the women's wisdom circle with the, She Leads Justice. I go to New Life Church in Waterbury. I urge legislators to support s p three. This bill is necessary, to ensure that everyone has access to affordable care, especially the most vulnerable in our society, such as children's, moms, and immigrants. When I was younger, I used husky health. This medical insurance was very helpful helpful for me and my family. My father was deported when I was 11 years old, and that left my mom as the sole caretaker of me and my siblings. It was very difficult for her to take care of three children and make ends meet. And the Husky Health Insurance was a big help. It allowed us to get our yearly checkups, and we were covered if we had any big surgeries without adding more debt and stress to on my mom. Connecticut lawmakers, you need to take action because politicians in Washington DC are cutting Medicaid and putting cost increases on patients. This will affect families like mine. I have seen how medical debt has made life more difficult for my mother. She has never received any help from the government. I have seen my mother refuse to go to the hospital while in pain to avoid receiving a huge bill afterwards. If it was really bad, she went to the emergency room, but then she was in debt and it was hard to get it by. Health care should be a human right for everyone in Connecticut because no one deserves to be in pain or in or in big debt. We all deserve to be treated with decency and care. Everyone contributes to this society. So I urge legislators to stop any cuts to husky health to prevent any cost increases on families who use husky health and to ensure that everyone has access to affordable care, especially the most vulnerable in our society, children's moms and immigrants. Thank you.

[Representative Robin Comey]: Thank you very much, Crystal. Have a great night.

[Speaker 40]: You too.

[Representative Robin Comey]: Okay. Next, we have Francis Truszewski, number 98. Hi, Francis.

[Francis (Fran) Truszewski]: Good evening and thank you all for staying up late to hear my testimony. I'm Fran Truszewski. I live in Canton, Connecticut. I am the parent of an adult with a with a, developmental disability. I also serve as the chairperson for the Connecticut Council on Developmental Disabilities and is the, board treasurer for both the Arc Connecticut in favor of the Arc of the Farmington Valley. But I'm testifying this evening as a parent and a friend and a concerned citizen, not not for any of those organizations. I'm testifying in support of HB number five five five seven, an act concerning eligibility determinations by the Department of Developmental Services. This bill will move the state of Connecticut from a support system for the developmentally disabled based on a limited intellectual assessment criteria, I e less than 69, an IQ of less than 69 to a far more fair and more logical level of need type of criteria as is used in almost every other state. Our current IQ based system severely restricts eligibility for Medicaid home and community based services waivers in the Department of Developmental Services so as to exclude a large number of individuals who live with a real need for those services. My own daughter happens to meet the the current IQ criteria and is eligible for DDS services. That said, however, we both know personally a large number of individuals and families whose developmentally disabled child has an IQ of over 69 and yet has a significant need for ongoing support to function in daily life. These individuals who have profound support needs meet the criteria of having a significant developmental disability with a chronic need for home and community based services. Providing care for individuals who fall into this category of profound developmentally developmental disability with a with a high level of need that do not meet an IQ criteria for support is not only the fair thing to do, it's the right thing to do as a state. If this bill, if enacted, will at a minimum modernize the definition for who is eligible for services. The follow-up, of course, will need to be enactment of appropriate changes to actually provide the support for all of these individuals. I urge you to pass House Bill five five five seven and continue our progress toward a more appropriate model for supporting the developmentally disabled in the state of Connecticut. Thank you so much for hearing my testimony.

[Representative Robin Comey]: Thank you, Francis. And you're absolutely right. We need to associate the funding, not just the legislation. Appreciate you. Rep. Tamika?

[Representative D’Amico]: Yeah. I I just wanna say hello, Francis. Thank you for all of your hard work over the years and for your leadership on on, you know, those issues. And, and and you you your daughter does a great job. You do a great job, and we really appreciate the fact that you're such a great advocate. So thank you.

[Francis (Fran) Truszewski]: Thank you.

[Representative Robin Comey]: Thank you, representative. I think we're all set. Thank you so much, Francis. Have a great night.

[Francis (Fran) Truszewski]: Thank you. You too.

[Representative Robin Comey]: Okay. Lina Esposito, you're next.

[Lina Esposito]: Yes. Thank you. Good good evening, everyone. Thank you, the Human Service Committee, Senator Lazer, and the distinguished state representatives. My name is Lena Esposito. I live in New Haven and a parent, an advocate, and also a member of the Council for Developmental Disabilities. I want to give this support for the bill 5,557 and add concerning eligibility determinations by the Department of Developmental Services. As we know, developmental disabilities, there are long life condition that begins before age 22 and they affect physical learning and behavior functioning. These affect one of six children in US, Children and individuals with disabilities to have access to service regardless of the IQ score. The IQ score, it doesn't reflect the necessities of an individual. Many of these individuals with I with a high IQ score, they need different services including the social changes challenges, physical and coordination coordination issues, behavior, communication difficulties. But the most important and there are there are some, like, our intervention, specialized education, therapies, speech occupational therapy, physical therapy, health care, and monitoring, and ongoing medical and developmental support, family support, training for for family and resources for caregiver. They are essential. Long term support that many individuals need that with ongoing assistance with adult food life. Supporters may be include, supported living arrangements, job training, employment support, community inclusion, and social opportunities. Support works best when it's they are, of course, with their intervention, individualized, consistent, and focus on independence and inclusion. Helping people live meaningful and solidified lives is important for everyone. Then don't forget, you know, that this denied, you know, the children or adults or adolescents or adults for these services. They're still, you know, against, you know, the the idea.