VCDR's 2009 Legislative Wrap-Up

Late at night on May 8, Vermont's legislators finished their work for 2009, the first year of the biennium. They adjourned knowing that they might be called back into session should the governor veto the 2010 budget. The governor did just that and legislators returned in early June to debate the issue and vote on whether to sustain the budget as passed by the Legislature or to continue to negotiate a new budget with the governor and his administration. In the end, the Legislature had the votes to override the governor's veto. The budget that was passed reflected over two years of revenue reductions and program cuts, despite sustained effort and some success in protecting services that Vermonters depend on.

Recent Budget Changes Reflect Economic Downturn

Since January of 2008 Vermont has experienced a $338 million revenue reduction. In addition to the revenue downgrades, General Fund spending needed to increase by $141 million to keep up with the increasing demand on state services in fiscal years 2009 and 2010.

The FY 2010 deficit totaled $281.5 million. The Legislature used federal stimulus funds to preserve the critical services and help keep Vermonters working. About $250 million of federal stimulus dollars are being used to fill the FY09 and FY10 gap. This federal relief is temporary and holes in the budget still needed to be closed. The Legislature also used a combination of cutting programs and services, finding efficiencies, increasing taxes or fees, collecting unpaid taxes, adjusting transfers between funds and using the state's reserve funds. The state had already cut more than $100 million in its spending before the 2010 budget was even proposed.

Many health and disability services have already reduced staffing and services in programs such as local mental health and developmental services, respite programs, attendant care rates, home health services and payments to a broad range of health care providers.

For FY 2010, which began July 1, the governor had proposed 4 percent across-the-board cuts in most all provider rates, and 4 percent across-the-board cuts in most Human Service Grants and contracts in addition to line item budget cuts and /or elimination of programs.

The fiscal year 2010 budget passed by the Legislature includes an additional $59.3 million in cuts to state programs and services. Legislative action and federal stimulus funds made it possible to protect and even enhance a few programs. The Legislature was successful in preserving, maintaining or enhancing important programs like VPharm, Reach Up, dental benefits, Children with Special Health Needs, June grads, Legal Aid funding and other program services for people with disabilities. The Home Access program was funded at the $1 million level, almost doubling its usual appropriation to try to take care of the backlog of needed projects. Provider rate funding was cut by 2 percent instead of 4 percent, and the Human Services grants and contracts were not cut in the budget but subject to the Secretary of Human Services finding General Fund Savings of $740,000 to be presented in a plan at the July Joint Fiscal meeting.

Cuts were still made in a number of Human Services areas including Medicaid, Department of Children and Families, the Department of Disabilities, Aging and Independent Living, most notably a reduction in Flexible Family Funding, and other areas of state government. Probably one of the ongoing impacts in the state budget cuts and rescissions will be noticed in the reductions in the state workforce, through elimination of employees, vacancies not being filled and retirement incentives.

Additional Budget Reductions Likely

The session may be over but continued threats to programs are very real. The big news out of the Joint Fiscal meeting on July 17 was the expected $28 million deficit for the FY 2010 budget year. Vermonters face another round of possible funding reductions from the FY 2010 budget that just went into effect on July 1. The administration will present a plan to the Joint Fiscal Committee and they have a certain amount of time to approve the plan and hold public hearings. (The process is in state law and has been adjusted in H.75 passed by the Legislature and signed into law by the governor on June 1.) The 28 million represents 2.5 percent of the general fund budget (over the 1 percent which requires Joint Fiscal approval). So this is the "never ending" budget that just keeps going. The Joint Fiscal Committee is scheduled to meet again on Aug. 5. We will wait to see what plan is presented and most likely have to defend our programs once again.

Budget Woes Overshadow Policy Work

Public policy took a back seat to budgetary and economic concerns. Early in the session we noticed that very few bills were moving out of committees. Many of the public policy committees, like House Human Services and House Health Care, spent much of the early part of the year examining the effects of the governor's proposed budget cuts on public policy. They looked at the proposed cuts on VPharm, regulation changes in Reach Up, cuts in dental coverage, premium increase, and what 4 percent cuts to providers and grants would do to the delivery of services. VCDR was asked to weigh in on several of the issues and worked to keep VPharm intact and to keep premiums from increasing. We also spoke constantly and to everyone about the negative effect the proposed 4 percent cuts would have on all programs and in particular, direct care services.

Bills that Passed

Disability History Week: H.R.17 and S.R.12 proclaim the third week of October of 2009 as Disability History Week, a time to recognize and celebrate Vermont work on disability rights, Deaf culture and related social change.

Palliative Care: VCDR took a leadership role in the development of this legislation, H.435. The purpose of this act to improve the quality of palliative care and pain management available to all Vermonters, to ensure that Vermonters are aware of their rights and of the care options available to them, and to expand access to palliative care services for children and adults in this state. This legislation is an offshoot of the study committee which met last summer and fall and focused on improving palliative and end-of-life care and pain management in Vermont.

The legislation adds the word "pain" in the statutes describing the responsibilities of doctors and nurses; a patient bill of rights for palliative care and pain management; adds a definition of COLST (clinician's orders for treatment) to the Advance Directive Statutes; and includes palliative care in the Blueprint for Health. It also asks AHS to ask for a report on the costs and effect of a waiver to allow Vermont to provide its Medicaid-eligible children who have serious medical conditions with concurrent palliative and concurrent curative care services. DAIL is asked to investigate the feasibility of allowing Vermonters to receive services under the state's Choices for Care program while also receiving hospice benefits under Medicaid or Medicare. Finally the legislation calls for a creation of a task force on palliative care and pain management managed by Vermont Ethics Network, and a board of medical practice report on improving the knowledge and practice of health care professionals in Vermont with respect to palliative care and pain management. This last piece was in lieu of requiring continuing medical education for doctors in palliative care and pain management. VCDR and other organizations advocated for that option.

Corrections: S.2, a bill relating to prisoners with disabilities, passed the House and Senate and has been sent to the governor for signature. This bill makes important changes in identifying people in corrections who may have developmental disabilities and/or mental illness and mandates the Department of Corrections to devise and institute rules about how inmates with functional impairments will be identified, treated and segregated. The bill also requires the department to make sure trauma-related issues are considered when evaluating and treating inmates. This bill is an improvement to identifying and treating people with mental illness/functional impairments and also improves the planning process for when the inmate is about to be released from prison so that treatment services can continue in the community.

S.125 passed both the House and Senate. The bill is mostly about the sex-offender registry but it also contains a section that could have negative effects for inmates with disabilities. Nutraloaf is a food product that doesn't taste very good and is used by prisons to "punish" inmates who have behaved badly. S.125 allows prisons in VT to serve Nutraloaf to an inmate who "misuses bodily waste or fluids, food, or eating utensils." The Nutraloaf may be served to that inmate for a maximum of seven consecutive days. There is an appeal process in the law that allows the inmate to appeal the decision to prison management. Ironically, the following section of the bill states that the serving of Nutraloaf (or "special management meals" as they are called in the bill) should in no way be construed as a punishment.

Prescription Drugs: S.48, an act relating to the marketing of prescription drugs, also passed the House and Senate. The bill contains a section creating a therapeutic equivalent drug work group. Advocates successfully fought off an attempt to mandate therapeutic equivalent drug substitution laws (except for a section of the budget bill, which mandates therapeutic equivalent drug substitution for cholesterol drugs and gastric acid drugs as part of a pilot program studying the budget effects of therapeutic equivalent programs) and the workgroup was created as a compromise. This issue will need to be monitored carefully next year. Allowing pharmacies to substitute therapeutic equivalents for a patient's prescribed medications could have severe consequences for some individuals.

Budget Authority: H.75 limits the ability of the Joint Fiscal Committee and the governor to decide on how to make large (think tens of millions of dollars) rescission cuts when the Legislature is not in session and in many cases require a public hearing before program cuts are made.

Other Policy Bills Taken Up by Committees

Graduation: H.66 is legislation that includes secondary students with disabilities in senior year activities and ceremonies. In April the committee took testimony from parents, advocates, students, legal aid, and staff from the Department of Education. The committee seemed stunned and upset that students are often not allowed to participate in these important ceremonies in Vermont. They asked very supportive and thoughtful questions. Barb Prine from Legal Aid gave the committee information on the language in the Individuals with Disabilities Education Act (IDEA) where school districts should take steps to ensure that children with disabilities have an equal opportunity for participation in these events. Witnesses from DOE testified against H.66, calling it a mandate. House Ed eventually put it aside and moved forward on other legislation. VCDR representatives spoke to the chairman of Senate Education Committee, Bobby Starr, who expressed interest in the legislation. VCDR will work with him and with the chairman of House Education, Joey Donovan, over the summer to generate more support for passage.

Vulnerable Person: In April, House Government Operations took up H.304, which proposes to establish the missing vulnerable persons alert program that will aid in the recovery of missing persons believed to be suffering from dementia or other cognitive impairment. Nicole LeBlanc, of Green Mountain Self-Advocates, testified on the bill. The committee also heard from public safety, a mother of a child with autism, VCDR and the manager of a nursing home in Burlington.