House committee pitches new child care plan and lawmakers eye more funding for EMS
Vermont lawmakers are hoping to close out the 2023 legislative session by May 12, and that leaves them only a few weeks to find consensus on dozens of bills with significant implications for Vermonters.
On this week’s edition of the Capitol Recap, Vermont Public’s Mary Williams Engisch spoke with reporter Peter Hirschfeld to learn more about some of the proposals that lawmakers are wrestling with right now. Their conversation below has been edited and condensed for clarity.
Mary Williams Engisch: Pete, we’ve talked a lot about child care throughout this session. But we saw some major movement on that issue this week. The House has decided to make some pretty significant changes to the child care bill that the Senate approved last month. What do we need to know?
Peter Hirschfeld: The House Committee on Human Services has made a number of changes to the Senate bill. But the most significant one relates to how Vermont is going to handle child care and early education for 4-year-olds.
About a decade ago, Vermont passed a law that created a universal pre-kindergarten program, which was supposed to guarantee a placement in public schools for every 4-year-old in the state.
But Waterbury Rep. Theresa Wood said Vermont has not delivered on that promise. There are school districts with robust full-day pre-K programs, five days a week. Wood said there are other regions in the state where parents have virtually no access to pre-K.
What the House wants to do is institute a new requirement, starting in 2026, that would require school districts to provide full-time pre-K for all 4-year-olds in their district. Wood said this addresses access to child care for parents, and also ensures geographic equity across town and county lines.
“When we’re talking about public education that should be available to all individuals who are eligible for it, we have to assure that that exists in our system," Wood said.
The bill would also substantially increase child care subsidies for parents making up to 550% of the federal poverty level, which is about $170,000 a year for a family of four.
The legislation comes with a significant price tag, though. According to some new fiscal estimates, year one of the proposal would cost an additional $145 million. By year six of the plan, the state would be looking at about a quarter billion dollars a year in new spending to pay for all this.
The Senate wants to use a payroll tax to finance the new spending. It looks like House lawmakers are leaning toward an increase in corporate and personal income taxes. So this is going to be a complicated negotiation between the House and Senate as we head into the last few weeks of the session.
Lawmakers are also looking to increase funding to local emergency medical service agencies. Where does that legislation stand, and why has it become such a priority this year?
EMS and ambulance agencies in Vermont have been sounding the alarm for years now about funding shortages. And a report that came out earlier this year suggests that the state is now on the verge of a breaking point, and that we could see the collapse of local medical transport services if lawmakers don’t do something now.
This issue has really grabbed lawmakers’ attention this year. Here’s how Lamoille County Sen. Rich Westman put it:
“I think right now if we don’t increase the Medicaid rate you’re going to see EMSs across the state close," Westman said, "so I think there’s no disagreement that we need to do that.”
The Medicaid rate is important to EMS agencies because Medicaid reimbursements are a significant source of revenue for them. A bill that’s sitting in the Senate right now would increase Medicaid reimbursement rates by close to 50%, which would bring an additional $3.1 million to ambulance and EMS services next year. The bill also includes $1 million to train and recruit new emergency medical technicians, because there is a severe workforce shortage right now.
On-the-ground EMS providers say this legislation is welcome and needed. But they say it won’t be nearly enough to ensure longer-term solvency for medical transport and EMS services. And lawmakers will be commissioning a study to assess the situation during the off-session, and come back next year with recommendations for a permanent fix.
And finally, lawmakers are talking about creating a new facility for individuals who are accused of violent crimes, but aren’t competent to stand trial. What would this facility look like, and why are some advocates so concerned?
Many folks might have heard about a few high-profile violent crimes in recent years that were allegedly committed by people who were found mentally unfit to stand trial. Those cases have spotlighted the lack of appropriate placements for those individuals. And lawmakers in both the House and Senate have coalesced around a bill that would take nine beds at the state-run psychiatric hospital in Berlin and convert them into what’s known as a forensic facility.
Now, folks have probably also heard about the shortage of inpatient beds for people in mental health crisis. And advocates, including Jack McCullough with Vermont Legal Aid, have raised some serious questions about what it means to take nine beds offline at the only-state run psychiatric hospital, when you already have people waiting in emergency rooms for days and even weeks in some cases for an inpatient mental health bed to open up.
“For the last several years we’ve heard the Department of Mental Health and the hospitals clamoring for the creation of more hospital beds," McCullough said. "This proposal takes nine hospital beds offline, and I really don’t get that.”
There are also concerns, Mary, about patients’ due process rights, and how the state is going to determine who belongs in this forensic facility, and whether that’s the most appropriate and least restrictive environment for them to be in.
It’s a complicated policy question with some complex legal and ethical dynamics. And lawmakers in both the House and Senate are going to be grappling with some difficult policy questions as they figure out how to resolve this issue over the next few weeks.
Have questions, comments or tips? Send us a message or get in touch with reporter Peter Hirschfeld: