[{"_1":2,"_87":-5,"_88":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},"mediaId",6364687,"mediaKeyId","2162305-715efc28423183fb8c2ac4178d44897b","parentId",2162305,"title","Providers urge H.13 to require annual Medicaid rate reviews for home and community‑based care, warn workforce at risk","audioSeconds",3427,"startMs",1816000,"endMs",5243000,"viewUrl","/Search/View?dp=1&key=2162305-715efc28423183fb8c2ac4178d44897b&start=1816&end=5243","thumbnailUrl","https://assets.pipeline.soar.com/2162305-715efc28423183fb8c2ac4178d44897b/thumbnail_1816000.jpg","articleUrl","/articles/6364687/Vermont/Providers-urge-H13-to-require-annual-Medicaid-rate-reviews-for-home-and-communitybased-care-warn-workforce-at-risk","mediaUrl","https://secure.pipeline.soar.com/6364687-f89b41b08fbb183800f07f7826e5c218/orig.mp4?Expires=1773770076&Signature=BnfwIXoBwQI5JLcK-A3K4xuy6VvSC39x8rbFlYblCRs2DFKfrMVKt7h8Bp5xdzN6YUSJEc~hORVxWonNoTzebMRErZnDA~DNbPjneSgjRM4pZraxIM-EKvS95a5PELCHqHq8dFc8A7aR1ePxVhAwhRCcOxcgQvbAc9tK2~71yxsq3CKdteyzukzX200a6Tmq7tEy029Y6y1YZeE8zPlSaiHYAfVpDc8bd1gnbKc7j-qjk967~gbFN7Y5x-MLKvRjp7o27KhgrCo1rg44-EL0UdhTaJyEGkhb8xEEtU1Jqhx~AHd8Yly8W21pRKna8g6zwRjLvlE502sw1R~PjDs1IA__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-01-29T18:02:11Z","article","Providers that deliver home and community‑based services told the House Human Services Committee they strongly support H.13, a bill that would require the secretary of human services to determine reasonable and adequate Medicaid payment rates for home and community‑based providers. Witnesses said annual rate studies and inflation adjustments are needed to address long‑running underfunding, staffing shortages and program closures.

Mary Hayden, executive director of the Vermont Association of Area Agencies on Aging, told lawmakers AAAs provide case management and other supports that let older Vermonters and people with disabilities remain at home. “The historical underfunding of this workforce and this worker shortage has brought us nearly to the brink of a crisis,” Hayden said, adding that annual, objective rate studies would help the state identify gaps and avoid downstream costs such as nursing‑home placements and hospital admissions.

Jill Olsen, executive director of the VNAs of Vermont, said home health agencies serve people who “by definition … need nursing‑home‑level clinical services and you are out of money” when they qualify for Choices for Care. Olsen told the committee that Vermont’s Medicaid reimbursement for skilled home health services is substantially below Medicare equivalents — she said agencies’ skilled rates are about 67% of Medicare — and that reductions and uncertainty in Medicare and Medicare Advantage reimbursements have eroded agencies’ ability to subsidize state programs.

Olsen also described operational pressures: one Vermont home health agency closed last year after a high share of Medicaid patients left the agency financially unsustainable; other agencies absorbed that service area. She and other witnesses said workforce shortages have increased reliance on expensive traveling staff.

Eric Fritz, executive director of Scotland House Adult Daycare and president of the Vermont Association of Adult Day Services, said adult day programs provide nursing, therapy, social work and meals and also relieve family caregivers. Fritz said there are now 11 adult day centers in Vermont (down from 14 pre‑pandemic) and that three closures affected larger population centers. He said the legislature’s Medicaid reimbursement increase to $25 an hour two years ago was critical to preventing still more closures: “If that had not happened, almost definitely more programs would have closed by now,” he told the committee. Fritz said centers together documented nearly $900,000 in lost revenue in the first six months of the fiscal year because Medicaid does not reimburse for participant absences.

Witnesses asked the committee to enact H.13 and to include inflationary adjustments in the FY26 budget. They also asked for clarity on which services are covered by rate reviews; the committee chair asked stakeholders to submit suggested clarifications and technical edits for the bill. Committee members questioned transition issues after changes to case management responsibilities, appropriate case manager caseloads (witnesses said a target of about 30 cases is a reference point but that more complex cases require lower caseloads) and whether existing regulations — for example, the 60‑day supervisory visit in Choices for Care — should be reviewed.

Lawmakers said they will hold additional hearings, solicit more written testimony and consider technical amendments during markup; the committee asked providers and people with lived experience to present further evidence to help quantify the fiscal and access impacts.","mediaType","Video","parentTitle","House Human Services - 2025-01-29 1:00 PM","oneSentenceSummary","Representatives of area agencies on aging, home‑health and adult‑day programs told the House Human Services Committee they back H.13, arguing that annual Medicaid rate reviews and inflation adjustments are needed to shore up home and community‑based care and stabilize a shrinking workforce.","taxTitle","Human Services, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",35147,"location","Vermont","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6364692,"Vermont State University: scholarships, VSAC loan program doubled counseling enrollment; asks legislature to continue funding",1560,232000,1792000,"/Search/View?dp=1&key=2162305-715efc28423183fb8c2ac4178d44897b&start=232&end=1792","https://assets.pipeline.soar.com/2162305-715efc28423183fb8c2ac4178d44897b/thumbnail_232000.jpg","/articles/6364692/Vermont/Vermont-State-University-scholarships-VSAC-loan-program-doubled-counseling-enrollment-asks-legislature-to-continue-funding","https://secure.pipeline.soar.com/6364692-3de1d4ec9f8d872ff3cf5b67edd3393e/orig.mp4?Expires=1773770076&Signature=VHypMi88FWc98mWeJ~6e50yO0aDSLyPcHKt~472VMoYky2o3tI3g6JcMm3r4CP~w1k2SsbEZjZmnoxhCdfQR0S58KZU6Kcweo4-GbpBfstlOpJ85V7czIWhfNWXxo-6kNfBEn6kP2rTjDhrKAfr7kQeDaVDbicMDoVpycbclbou34W7mCATuB7xHs-lkkobo0A6m1v4PRCSrpiJCLtlAj3Lp0ElXY1KxPzeIE5cwz-xeXdFdYZ7DXDRzQt8x1NinOBAKk9LbaslDUMAAZpj1CKen6kTPWCcYk-gi5nLNOLg~CrezoAkzWOHSM5zd3Lzg0WdHe7G29~UNrmJXsbK78Q__&Key-Pair-Id=KUT5TJCACFTXG","Vermont State University officials told the House Human Services Committee that state-funded critical‑occupation scholarships and the VSAC Mental Health Forgivable Loan Program helped double enrollment in the university’s clinical mental health counseling programs and urged the legislature to continue funding the forgivable loan program before it lapses.

Anna Marie Ciafari, director of the master of science in clinical mental health counseling at Vermont State University, said the combination of the critical‑occupation scholarships and the VSAC forgivable loan program “have helped double enrollment in our programs over the last 3 years.” She described the programs as the principal reason enrollment at the university’s two counseling program formats grew from roughly 80–85 students in fall 2018 to about 243 Vermonters several years later, and estimated the system now serves roughly 300 Vermont students across both delivery formats.

The increase matters to lawmakers and providers because many graduates enter the state’s public mental health system, designated agencies and school‑based clinical roles. Ciafari told the committee the forgivable loan program covers students across mental‑health disciplines and links tuition forgiveness to service: it requires “one year of work post‑licensure for every year of tuition [forgiveness] received,” a structure the university called a strong design for retaining providers in Vermont.

Ciafari and Michelle Rausch, assistant director and student advisor for the program, described who the scholarships and loan forgiveness reached: working adults, career changers and people already employed in community‑based behavioral health who could not otherwise afford graduate tuition. The witnesses said the aid expanded access for students in Bennington, Brattleboro, the Northeast Kingdom, Chittenden County and Burlington/Winooski and cited student testimonials.

Student testimony included Ezra Demers, a current student completing an internship with a family‑based supports program, who said, “I received a critical occupations grant for my first two years of the mental health counselor program. The grant allowed me to pursue my degree. I don't believe I would have been able to start graduate school without the grant. It has made an enormous difference for me.” Other alumni and students described career changes from banking and other fields into clinical mental health and said the financial support was decisive.

Ciafari also summarized VSAC award numbers presented to the committee: she said the VSAC forgivable loan program funded “about 111 people” in its first year and “53” in the most recent year, leaving a backlog of applicants that could not be awarded. She told lawmakers about roughly 150 applicants who were not awarded because funds were exhausted, and she warned the program is currently funded for one year only.

Committee members and witnesses discussed next steps. Representative Teresa Wood directed witnesses to share outcome and enrollment data with the Department of Economic Development (referred to in testimony as Commerce and Economic Development) because that agency makes workforce and scholarship recommendations to the Appropriations Committee. The witnesses said they would file written testimony and student stories for the committee record.

The university asked the legislature to consider renewing or restoring funding for the forgivable loan program to avoid a likely drop in new applicants and to sustain education pathways that lead to long‑term clinical careers in Vermont.","Vermont State University officials told the House Human Services Committee that state-funded critical‑occupation scholarships and the VSAC Mental Health Forgivable Loan Program helped double enrollment in the university’s clinical mental health counseling programs and urged the legislature to continue funding the forgivable loan program.","actionData","errors"]

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Providers urge H.13 to require annual Medicaid rate reviews for home and community‑based care, warn workforce at risk

Vermont State University: scholarships, VSAC loan program doubled counseling enrollment; asks legislature to continue funding