[A]t first glance, home visits from nurses don’t have much in common with addiction treatment in prisons.
But both are part of a wide-ranging plan to spend as much as $9.6 million to boost Vermont’s substance use disorder initiatives over the next few years.
Human Services Secretary Al Gobeille presented the plan to the Legislature’s Joint Fiscal Committee on Friday. It is still preliminary and hasn’t yet received legislative approval, but Gobeille is enthusiastic about the availability of more funding for a variety of addiction-related programs.
“It’s building out the care continuum for substance use disorder,” he said.
Vermont already invests more than $100 million on treatment and medication for substance abuse, and the state’s hub and spoke system of medication-assisted treatment for opioid addiction is heavily used.
But the state’s fiscal 2019 budget bill also contains two new sources of potential funding.
There’s $7.1 million from the state’s general fund that the Agency of Human Services could use — in whole or in part — “to support substance use disorder activities including needle exchange programs, active case management of opioid-addicted persons and the distribution of naloxone.”
There’s also $2.5 million allocated to the agency from the state’s Tobacco Litigation Settlement Fund. That money is spread over three fiscal years and is supposed to finance “time-limited or self-sustaining substance use disorder initiatives including initiatives relating to prevention, intervention, harm reduction, treatment and recovery.”
For both funding sources, the legislation requires Gobeille to present a spending plan to the Joint Fiscal Committee. Members of that committee on Friday decided to delay their vote on the matter until September, but the meeting provided a glimpse into the state’s plans.
Gobeille started his presentation with the state’s efforts to expand medication-assisted addiction treatment in prisons. That’s a legislative mandate, but Gobeille said the fiscal 2019 budget appropriates only $400,000 – about half the money needed for the initiative.
Additional funding had been proposed as part of an unsuccessful effort to tax manufacturers of prescription opioids. “When that (bill) died, that revenue died,” Gobeille told lawmakers. “So we’d like you to consider funding (medication-assisted treatment) in corrections.”
Gobeille detailed six other potential uses for the funding, though not all had price tags attached at this point.
For example, Gobeille said the state needs money for two full-time positions supporting the governor’s [Opioid Coordination Council]. He said those are existing positions for which the fiscal 2019 budget allocates no funding.
The additional substance-use funding in this year’s budget also could support the state’s transition to a new nurse home-visiting program called Maternal and Early Childhood Sustained Home Visiting. The program targets families who need additional support and is designed to keep nurses involved from pregnancy until a child is about 2 years old.
Gobeille said his agency needs about $200,000 to expand that nursing program into every county.
In a similar vein, officials want more money to expand a pilot program for mental health and substance abuse screening. That’s been working well in emergency rooms and doctors’ offices in parts of the state, Gobeille said.
“We’re trying to work on an agreement with the federal government where we would be able to create a new model for this and actually expand it statewide,” Gobeille said. “We think this is very important.”
Gobeille also is looking to set aside an undetermined amount of money for “federal contingency funding” – in other words, funding to support state programs in preparation for federal budget cuts or policy changes.
“It should not come as a shock to anyone that the federal government is slightly unpredictable at the moment,” he said. “And we would like to have some money set aside for what we will just call really bad things that might happen.”
The Department of Corrections also needs cash to pay for inmates’ hepatitis C treatment, Gobeille said. The department has had difficulty coming up with a plan due to complicated, lengthy treatment schedules for the disease, which is sometimes linked to intravenous drug use.
Gobeille said it would cost somewhere between $1.9 million and $2.7 million to provide treatment for about 70 inmates who are expected to remain in custody long enough to complete the regimen.
“I would think it would be a great opportunity with this money to actually take this step,” he said. “I actually would call this one-time money, because you’re hopefully not going to need to treat them again.”
Lastly, the agency wants funding to expand “Syringe Services Programs.” Such programs go beyond needle exchange and include other services such as counseling.
While the Chittenden County area is well-served in this regard, that’s not the case elsewhere in Vermont. “We have a long way to go to improve this, and we think money should be put into that,” Gobeille said.
In addition to identifying his priorities for new addiction funding, Gobeille offered several other human services-related updates in his report to the committee, including:
• Officials continue to work on a plan to import prescription drugs from Canada. Though the state Legislature approved that initiative this year, it will require the federal government’s OK as well. Though some have been skeptical that federal officials will endorse drug importation, Gobeille noted that U.S. Health and Human Services Secretary Alex Azar recently ordered the Food and Drug Administration to establish a working group examining the concept.
“We believe it’s because of Utah and the state of Vermont asking, how do we do this?” Gobeille said. “We see it as a positive step. I would hope it’s not a negative one.”
• The agency has begun regulating nursing home sales as part of a legislative change made this year. As of July 1, Human Services took over that function from the Green Mountain Care Board. “We now have three nursing homes that have applied to us to transfer ownership,” Gobeille said. “I think that’s going well.”
• Gobeille also said he’s optimistic about the state’s proposed partnership with the Brattleboro Retreat to add at least a dozen new inpatient mental health beds. The state has allocated $5.5 million for developing those beds, but that money can’t be spent until there’s a formal agreement between the state and the Retreat. “I’ve had several meetings with the Brattleboro Retreat, including a site visit,” Gobeille said. “I feel confident we’ll be able to have an agreement by October at this point.”
Gobeille presented documents showing that his agency spent $2.47 billion in fiscal 2018. That’s slightly less than had been budgeted and less than the agency spent in fiscal years 2016 and 2017.
Gobeille said that’s in part due to a stronger economy, which puts less pressure on agency programs. But he also credited his staff.
“For every department to have come in to the good — meaning to have spent less than what was estimated in our budget — takes an incredible amount of work by a whole host of people, because there’s so many moving pieces at (the agency),” Gobeille said.
Legislators singled out the Corrections Department for its adherence to the budget. Sen. Jane Kitchel, D-Caledonia and Senate Appropriations chair, said the department’s performance is “not only financial. It really is reflective of a whole systems change.”