[{"_1":2,"_99":-5,"_100":-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",[32,75,87],{"_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",6359537,"mediaKeyId","2177036-4413194c025c35f5152f91f221d9d2fb","parentId",2177036,"title","Vermont disabilities, aging agency briefs Appropriations on midyear budget pressures, nursing home relief requests","audioSeconds",1666,"startMs",25900,"endMs",1692350,"viewUrl","/Search/View?dp=1&key=2177036-4413194c025c35f5152f91f221d9d2fb&start=25&end=1692","thumbnailUrl","https://assets.pipeline.soar.com/2177036-4413194c025c35f5152f91f221d9d2fb/thumbnail_25900.jpg","articleUrl","/articles/6359537/Vermont/Vermont-disabilities-aging-agency-briefs-Appropriations-on-midyear-budget-pressures-nursing-home-relief-requests","mediaUrl","https://secure.pipeline.soar.com/6359537-a7cd5f3d67c8c1e919c24d6b73f1ef13/orig.mp4?Expires=1776692442&Signature=oSz~gpgnxbRgRT28f-oRTTGjetYuOBd1UiLfaHl2hwOAnOjXpf5wX5ltoDYTS4OybwXvIxItnasuaP52~w3D~SSugxqgewqxAiBnQw82S98F-ZJaGdjTAfmEcZZrW7aAghpNeI8R7DYaQR7ONuTuuvSau46ipu6tQXWOxHGr0g9kN7zN5pVUv7b9U3~qSCksPpM1BWIdBg3jfhy6CzMXeBMWbvbvdC3GnqGWWUVmmni1pyAhBJkvmFHM9-RE3OydQZEq88QhqNJYAaXEe8LEJIFWmXwJ95uKdXpI1hDaWEvscIVBAVZA2puksfs6Afw87RgEGvTxU08UPMprT2h3Ug__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-01-31T18:38:15Z","article","Commissioner Jill Bowen, commissioner of the Department of Disabilities, Aging, and Independent Living, told the Senate Appropriations Committee on Jan. 31 that the agency’s midyear budget adjustment request includes multiple items to address nursing home and long‑term services cost pressures and collective‑bargaining increases for direct support workers.

Bowen said the department’s priorities reflect Vermont’s aging demographics and its multisector 10‑year plan, Strong Vermont, and summarized divisions and services that serve older Vermonters and people with disabilities including Choices for Care, residential supports, case management, respite and rehabilitation services. “Our mission statement is to make Vermont the best state in the nation in which to grow old or live with a disability, with dignity, respect, and independence,” Bowen said.

Why it matters: committee members pressed the department on where midyear carryforward and reserve funds can be applied and how ongoing cost pressures for nursing homes are being handled. The department said a statutory 1% reserve is used to prevent implementation of a high‑needs wait list and that only funds above that reserve are available for reinvestment.

Key details presented

- Nursing home financial relief: The department estimated roughly $21 million in extraordinary financial relief (EFR) requests for the remainder of the fiscal year, reflecting both amounts already approved and anticipated future requests. Bowen said about $17 million has been executed in EFR orders to date, with an average EFR request of about $1.5 million, leaving room for roughly three to four additional requests under current estimates.

- Bed‑day pressure and usage: The agency tied nursing home Medicaid “bed‑day pressures” to both utilization and acuity changes; the presentation included an estimate of 77,755 bed days tied to $24.5 million in pressure.

- PDPM acuity methodology: Committee members asked about the nursing payment methodology shift to the Patient‑Driven Payment Model (PDPM). The department estimated the PDPM conversion accounts for about $1.3 million of increased cost because PDPM calculates slightly higher acuity for some residents.

- Collective bargaining and workforce supports: The midyear ask includes increases tied to a state collective‑bargaining agreement for independent direct support workers. The department described a $14.75 statutory minimum hourly rate and a year‑one retention and recruitment bonus in the two‑year agreement; Bowen said the first‑year retention bonus is reflected in this budget adjustment. The department also said it will launch a recruitment campaign highlighting direct‑care opportunities.

- Carryforward and reserve rules: Committee members asked about $729,986 in carryforward in Choices for Care and whether statute required reinvestment. Department staff cited an internal policy and statutory framework that permits up to a 1% reserve of the previous year’s expenses; amounts above that threshold can be reinvested, but the department said the most recent closeout did not exceed 1%.

- Veterans’ home and other items: Bowen noted a veterans’ home cost settlement in the midyear request in the low‑millions range and described a technical fund‑coding change ($1.0 million) related to grant administrative accounting.

What committee members asked and direction given

Committee members pressed for a breakdown of executed EFRs and what remains in the estimate; the department said it would provide a list showing the approximately $17 million already executed and the remaining estimate to reach $21 million. Members also asked about timing of the nursing rebasing scheduled to begin in fiscal 2026; staff said the rebasing is intended to better align rates with recent costs and that it should help stabilize but not eliminate EFR needs.

No formal votes were taken. The committee requested follow‑up materials including (1) a list of executed EFR orders and amounts, (2) details on the Choices for Care carryforward and statutory reserve calculation, and (3) a clearer accounting for internal service and service‑level agreement charges shown in the department’s exhibit.

Ending: The committee said it would hear additional budget items and the treasurer’s office in subsequent meetings and asked the department to supply the requested breakdowns before the next hearing.","mediaType","Video","parentTitle","Senate Appropriations – 2025-01-31 – 1:00PM","oneSentenceSummary","Commissioner Jill Bowen, commissioner of the Department of Disabilities, Aging, and Independent Living, told the Senate Appropriations Committee on Jan. 31 that the agency’s midyear budget adjustment request includes multiple items to address nursing home and long‑term services cost pressures and collective‑bargaining increases for direct support workers.","taxTitle","Appropriations, SENATE, Committees, Legislative , Vermont","taxId",36948,"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},6359528,"Appropriations questions deficit capitalization for state medical insurance fund amid bond paydown debate",62,2775670,2837980,"/Search/View?dp=1&key=2177036-4413194c025c35f5152f91f221d9d2fb&start=2775&end=2837","https://assets.pipeline.soar.com/2177036-4413194c025c35f5152f91f221d9d2fb/thumbnail_2775670.jpg","/articles/6359528/Vermont/Appropriations-questions-deficit-capitalization-for-state-medical-insurance-fund-amid-bond-paydown-debate","https://secure.pipeline.soar.com/6359528-754e7cc11a635421cd59d374076fdfb9/orig.mp4?Expires=1776692442&Signature=C6mX7BkZnORsauabXO8atLMlsfRGdOq71iuaGYvDfzaZUXkYHTBnkbeY0OxUJgtgUFW-Zrg2GPHypBgjHc4QSGF-blxRxLrGQqXNMRlJfZFC45rK1tGBXf20eEkF0NB~SfGNXAveG2KTMeTIAE4wj8QeIxouIE36BO~hP46FBYoBNZ7oOqfs7PcygMuFuDCLPO22tipnKr3pu~pTH1Wyaazrrlhblu9YJ50OPogvf4vc4XgdOXm6svGSl0-bcQLU7zcmGIZsVzXhPfyLeaH8XriBb8hxl7JN43G~OnS7gJnCRXMAijwfIX7B9nqNxB9G8RY-uczwYDMbnTQrUSFenQ__&Key-Pair-Id=KUT5TJCACFTXG","Members of the Senate Appropriations Committee raised questions on Jan. 31 about a proposed general‑fund transfer to cover a deficit in the state’s self‑insured medical insurance fund and whether those dollars could be redirected to other priorities, such as FQHC support.

Committee members said the administration proposes a deficit capitalization to cover increased expenditures in the medical insurance fund, in part from pharmacy costs. Staff and members discussed whether the capitalization is a multiyear amortization or a one‑time catch‑up, and whether reducing the transfer by some amount could free up funds for other needs. One member framed the trade‑off as choosing between additional support for health centers and addressing the insurance fund shortfall.

Related budget conversation: Treasury and bonds

Separately, committee members discussed state bond redemptions and a prior administration proposal to use surplus cash to pay off bonds. Members relayed that the treasurer’s office has questioned the value of redeeming certain bonds when the state’s current investment returns exceed borrowing rates and when paying down bonds would reduce available cash for other uses. The treasurer’s office was scheduled to appear but a staff member was reported sick; the committee planned to schedule the treasurer to explain options and timing.

Why it matters: Funding decisions for the medical insurance fund and bond‑redemption choices affect the state’s fiscal position and its ability to respond to provider distress or other urgent needs. Committee members requested charts and multi‑year analyses from agency staff and the treasurer to understand long‑term impacts of different capitalization or redemption choices.

Next steps: The committee requested that the treasurer’s office appear at a subsequent hearing to explain bond strategy and that the department provide a chart showing the medical insurance fund’s historical balances, recent pharmacy‑cost drivers and the proposed amortization schedule.","Committee members asked whether general‑fund transfers to cover a deficit in the state’s self‑insured medical insurance fund make sense while other priorities, including support for health centers, are under consideration; the treasurer’s office was not present and the committee scheduled follow‑up.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6359532,"Appropriations weighs expanding contingency fund for substance‑use facilities and FQHCs from $4M to $10M",74,2338520,2413030,"/Search/View?dp=1&key=2177036-4413194c025c35f5152f91f221d9d2fb&start=2338&end=2413","https://assets.pipeline.soar.com/2177036-4413194c025c35f5152f91f221d9d2fb/thumbnail_2338520.jpg","/articles/6359532/Vermont/Appropriations-weighs-expanding-contingency-fund-for-substanceuse-facilities-and-FQHCs-from-4M-to-10M","https://secure.pipeline.soar.com/6359532-fed8eaa166e293bfecc1a7df9d4c841b/orig.mp4?Expires=1776692442&Signature=LvlLRBYH9dAQsl-0T7B0Pz5Oo8THvl9H1fkEi0v~opQexCMDEenj89B4ntEz8ajvnsQY~zGrJB0jkRJ0xF~jfVslH1KssIUCvSYDL0I1JUoDg4OrWy~DheAvrq-TmVtGjwRwC~j9vOlO85ia5pu5H4M5fI4vLNJRho7bZz1u~JRKeaIcc12-~D9ElT22mxD3o1II3TIbfp1Tyyw3TKBmFYzM6MSl6oGJV4NORGGy~yPsTqPDlzQMUi8eAtvF4CrJ2hkkffWYtar9dZgQoVTyr0dW01zTxjC5UfMsk4TKC9xj6BnvnA7vVz5O-zS-TureZn0-jiFXZD9mJxb2hBBumA__&Key-Pair-Id=KUT5TJCACFTXG","Committee members discussed increasing a contingency fund for substance‑use residential providers and possibly expanding eligibility to federally qualified health centers (FQHCs) during the Jan. 31 Appropriations hearing.

The administration had proposed a $4 million line to support substance‑use residential facilities; committee materials and staff said the administration is seeking $10 million in the budget adjustment. Members said they had heard from FQHC representatives who warned that a widely distributed $10 million could be insufficient if spread across many centers.

Why it matters: FQHCs provide primary care, dental and behavioral health services in underserved areas and receive an enhanced Medicaid payment (staff noted a 125% Medicaid maximum rate for the federal designation). Several committee members said roughly a third of FQHCs in the state are experiencing financial stress and that support targeted at the most at‑risk sites could be more effective than a broad distribution.

Details from the hearing

- Requested change: The administration asked the committee to increase the request from $4 million to $10 million and to add language expanding eligibility to include FQHCs and other critical providers.

- Committee concerns: Members questioned whether the larger pot would be spread too thinly, and asked for clearer statutory language to define eligibility, distribution criteria and reporting requirements.

- Department direction: Staff suggested the department of health and the agency that oversees behavioral health would be best placed to explain allocation priorities; the committee asked staff to schedule a more detailed departmental presentation and to consult with the administration about specific language.

No formal action was taken. Committee members said they expected the administration to provide draft language clarifying which providers qualify and the conditions under which contingency funds would be released, and they requested testimony from the Department of Health and the administration’s designee on the topic in a subsequent session.","Committee members considered administration requests to increase a contingency fund for substance‑use residential facilities and expand eligibility to federally qualified health centers; members and staff said some FQHCs are in financial distress and urged clearer language on how funds would be allocated.","actionData","errors"]

Article not found

Vermont disabilities, aging agency briefs Appropriations on midyear budget pressures, nursing home relief requests

Appropriations questions deficit capitalization for state medical insurance fund amid bond paydown debate

Appropriations weighs expanding contingency fund for substance‑use facilities and FQHCs from $4M to $10M