[{"_1":2,"_123":-5,"_124":-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",[32,75,87,99,111],{"_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",6337496,"mediaKeyId","2272899-c10668dd9578c764ee5d76f5050c5e58","parentId",2272899,"title","DVHA funds eight positions for justice reentry Medicaid case management starting Jan. 2026","audioSeconds",332,"startMs",1690000,"endMs",2022000,"viewUrl","/Search/View?dp=1&key=2272899-c10668dd9578c764ee5d76f5050c5e58&start=1690&end=2022","thumbnailUrl","https://assets.pipeline.soar.com/2272899-c10668dd9578c764ee5d76f5050c5e58/thumbnail_1690000.jpg","articleUrl","/articles/6337496/Vermont/DVHA-funds-eight-positions-for-justice-reentry-Medicaid-case-management-starting-Jan-2026","mediaUrl","https://secure.pipeline.soar.com/6337496-ae9bb8a34b25deeeb8aa1748001fcd62/orig.mp4?Expires=1776055966&Signature=kgyThH3RxXHihCQCO44-FBIWkx6Intwk92s-JbpjozkUJaowxvtSIUZKUI-oVRyuXtt20PI1luVm7pVAR1r4enDgOna7tdGcvcU8etq3FvP9LIYzHg-eGoFAnVV37HNKO0nfjXjlENsBnoGwDqYIGF6Vj9IXEVVv9a~sEEs1nbCCH38-L1W0MmyUD6gZu~Q6e0NdN0xjeAPBHrRv6glbowEUsU5RpeEZUNZ4vSPGtt4GPxswbr8-CgjGxriS8PQ121YsmylgANEH9wcLc5cSvtr8UGW1PwtNzp408saQ7H6lc6seZOSnGBiLgt5GztVHzMgynrLdbmIMvGewMzXqlQ__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-02-12T14:02:30Z","article","Department of Vermont Health Access officials told the House Appropriations Committee they will add eight positions to the Vermont Chronic Care Initiative for a justice reentry case‑management program that begins service to incarcerated individuals prior to release.

Stephanie Barrett and other agency staff described the staffing request as the case‑management component of a waiver-approved initiative providing Medicaid services to people incarcerated shortly before release. The agency said services will begin approximately nine days before an individual’s release date; the program start is expected in January 2026.

Supporting details from testimony:
- New positions: eight staff positions budgeted for FY26 to support the Vermont Chronic Care Initiative (BCCI) Justice Reentry Initiative; agency materials treated BCCI as part of DVHA’s budget.
- Start date: DVHA told the committee the program start is expected in January 2026 and that meaningful performance metrics would likely be available about a year after operations begin.
- One-time equipment: DVHA included modest one-time equipment costs (laptops, work tools) in the FY26 operating budget to outfit the new staff.

Committee follow-up: lawmakers asked about metrics and timing; agency staff said they would expect to report meaningful performance metrics roughly one year after program start and would coordinate with the Department of Corrections and central office operations.

Ending: DVHA emphasized the positions are intended to support continuity of care as people transition from incarceration back into community Medicaid services; the agency said it would report implementation metrics after the program begins operations.

","mediaType","Video","parentTitle","House Appropriations - 2025-02-12 - 9:00AM","oneSentenceSummary","DVHA said it is adding eight positions to the Vermont Chronic Care Initiative to provide case management for people who will receive Medicaid services while incarcerated, with services beginning about nine days before release and the program expected to start Jan. 2026.","taxTitle","Appropriations, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",30573,"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},6337501,"DVHA pursues MMIS replacement and integrated eligibility procurement; call center vendor retained at higher cost",1437,197000,1634000,"/Search/View?dp=1&key=2272899-c10668dd9578c764ee5d76f5050c5e58&start=197&end=1634","https://assets.pipeline.soar.com/2272899-c10668dd9578c764ee5d76f5050c5e58/thumbnail_197000.jpg","/articles/6337501/Vermont/DVHA-pursues-MMIS-replacement-and-integrated-eligibility-procurement-call-center-vendor-retained-at-higher-cost","https://secure.pipeline.soar.com/6337501-85098c6cd240373bceec9efe7ce46210/orig.mp4?Expires=1776055966&Signature=Md~Mgm2Wm3qQPbVRJAf8~vcJG8jEbUgu15fB0HByWRyi-v4wIdqA1AxAX4C9vhdOGSdA8a0WpCdEd4CG4V4Krdu78tjBQnF4FKzV9QJluS4UiInXTGoVh7xRKp7CmbT341ZLdU0GI~EgbCPwbw3svI0BuPylEpXzcN0-8Hx90YxLjIx0cUWh2gm~ks3lIsrx05Q3o5ynVDLKhOLjJdaNdaHm-w214J3KTiBtbIFHTlD4JXqbD1~4TAtV9eOc0w2WUp2ZJyldFI70KP5~NY2sYrhtSfun9ypHiBMVTXxu4OkgW2Cytj6~-AWD-drtD2V17Klv4eyOWfjgD03O6CErbA__&Key-Pair-Id=KUT5TJCACFTXG","Department of Vermont Health Access officials told the House Appropriations Committee on Feb. 12 that the agency is moving forward on modernization of Medicaid information systems and integrated eligibility tools and that these changes included a contract amendment and funding switches to maximize federal match.

Deshaun Burrows described several elements of the agency’s IT work: a Medicaid data warehouse and analytical solution already implemented, a Medicaid Management Information System (MMIS) amendment with a FY26 cost beginning in July (agency materials listed an MMIS amendment at $816,000 gross with $129,000 general fund), and a forthcoming integrated eligibility and enrollment procurement intended to modernize eligibility/ enrollment across agencies. “The goal there is to modernize and integrate and leveraging a configurable interoperable system that can be compliant with CMS,” Burrows said.

Stephanie Barrett told lawmakers the agency is using Advanced Planning Documents (APDs) where appropriate to obtain higher federal-match rates (e.g., 90/10 for implementation projects) and to avoid blended match for activities that are purely Medicaid. She said the agency and the state’s Agency of Digital Services coordinate to place the Medicaid-only pieces in the appropriate APDs.

DVHA also confirmed the call-center procurement for eligibility and enrollment preserved the incumbent vendor, Maximus, but at an increased cost that will take effect July 2025. “We ended up choosing the same vendor that we have had for years and years…It just costs more,” Barrett said.

Supporting details:
- MMIS contract amendment: FY26 cost beginning in July estimated in agency materials at $816,000 gross, $129,000 general fund (presentation figure provided by DVHA).
- Integrated eligibility procurement: agency said procurement is underway and bids are being received; no final completion date was given in testimony.
- Call center vendor: Maximus retained with a new agreement that increases cost starting in July 2025.
- Funding approach: DVHA described use of Implementation APDs to obtain higher federal match rates where development/implementation are purely Medicaid functions.

Ending: DVHA said modernization work aims to improve data sharing and operational efficiency with other Vermont agencies and providers. The agency did not provide a final timeline for integrated eligibility completion and said federal matching rules govern how projects are budgeted and placed in APDs.

","DVHA told the House Appropriations Committee it is modernizing Medicaid systems with an MMIS amendment and a planned integrated eligibility and enrollment procurement, and that the state retained its call-center vendor Maximus under a more costly contract beginning July 2025.",{"_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},6337505,"DVHA reports $287 million drug spend, sets aside $4.5 million for new high-cost therapies",1804,884000,2688000,"/Search/View?dp=1&key=2272899-c10668dd9578c764ee5d76f5050c5e58&start=884&end=2688","https://assets.pipeline.soar.com/2272899-c10668dd9578c764ee5d76f5050c5e58/thumbnail_884000.jpg","/articles/6337505/Vermont/DVHA-reports-287-million-drug-spend-sets-aside-45-million-for-new-high-cost-therapies","https://secure.pipeline.soar.com/6337505-980bca81df7b344657a999bb5c742f59/orig.mp4?Expires=1776055966&Signature=HcwdXKXwX~jAET64lAJWd-OPQt9cQBGeC5Syon8IS3Je2cMfLFvZrq3XhKMwpAaxC6eISDKNwR1ZWGum3MMKMmR4rk~sueM8wMM7CF4xe~MQLcIa4sIpnYyfBKCXAN1xI6UwTtNMeS0TOdJKZtI6HJd99hRm2Lj0K1gdeCTUd8zV74ASCbkBO7iUO1XH9NERrbsdDy3fTfyp1pOsfRkYtWcCqOPM4f-KDykWM7UBy9YMAfgpCAHzh-mEZmcRcib88KCR2ks9FkyPjJqKcevMfEeo5CNilgplzMnb4hJGQGIO0uTpFLql25SJ1Wy24szboDqZu~8O~4jqLOnbKvU7Ug__&Key-Pair-Id=KUT5TJCACFTXG","Department of Vermont Health Access officials told the House Appropriations Committee that the agency manages about $287 million in gross drug spending across publicly funded programs and reported a roughly 4% decrease in gross spend in the most recent fiscal year.

Stephanie Barrett, DVHA chief financial officer, told the committee the total managed drug spend covers Medicaid and other public programs and that physician‑administered drugs sometimes fall outside the Medicaid system’s reporting. Barrett said DVHA recorded a decrease of about 4% in gross drug spend over the last fiscal year.

DVHA also asked for a $4.5 million adjustment to capture forecasted pressure from new high-cost pharmaceuticals that were not in the agency’s FY25 baseline. The agency said these include gene therapies and other single-case or small-population treatments with multi-hundred-thousand to multi-million-dollar price tags. Barrett and other witnesses cited examples such as emerging gene therapies and high-cost specialty drugs; the agency’s estimate is intended as a budget contingency for drugs that may be newly prescribed to Medicaid members.

On GLP-1 medications (commonly used for diabetes and, off-label, for weight loss), agency witnesses explained the coverage rule: DVHA covers GLP-1s when prescribed for covered diagnoses such as diabetes and certain cardiac conditions, but it does not cover them solely for weight-loss indications. “If they had a diabetes diagnosis…we do cover that. That’s a covered service for the GLP-ones,” a DVHA official said during questioning.

Supporting details:
- DVHA-reported drug spend managed: approximately $287,000,000 across public programs.
- Gross drug spend change: ~4% decrease from the prior fiscal year, according to agency testimony.
- Contingency request for new high-cost therapies: $4,500,000 built into FY26 request; agency noted that individual cases can cost millions.

Ending: Committee members asked how the agency identifies new drugs and how clinical eligibility will be determined. DVHA said the pharmacy unit produces reports and that the agency will return with more detailed analysis as new therapies emerge and coverage decisions are made.

","DVHA told lawmakers it manages roughly $287 million in drug spending across state programs, reported a 4% decline in gross drug spend last year and included a $4.5 million FY26 request to cover new, very high-cost therapies not in the current baseline.",{"_33":100,"_35":36,"_37":38,"_39":101,"_41":102,"_43":103,"_45":104,"_47":105,"_49":106,"_51":107,"_53":108,"_55":56,"_57":58,"_59":109,"_61":62,"_63":64,"_65":110,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6337511,"DVHA says prior-authorization requirements cut after review; pharmacy PAs dropped 43% from prior year",305,360000,665000,"/Search/View?dp=1&key=2272899-c10668dd9578c764ee5d76f5050c5e58&start=360&end=665","https://assets.pipeline.soar.com/2272899-c10668dd9578c764ee5d76f5050c5e58/thumbnail_360000.jpg","/articles/6337511/Vermont/DVHA-says-prior-authorization-requirements-cut-after-review-pharmacy-PAs-dropped-43-from-prior-year","https://secure.pipeline.soar.com/6337511-b3a64ad716c9dbd99d20c95a2af4b8e4/orig.mp4?Expires=1776055966&Signature=UZAyZQg1NK5aX3GCysXQJ1aiYta4jWshif1lQoStSbeA~PM4wkIOE52iC3e2Gh4cgDgP-b3~qoz0HRPAofte2f6DZWgBZHpCaSrASV9luS-4EHKprWKUxBsElIe4dToj5pJKGY1EY44SAkbGqbRFkBqDEhiZeuztATs-VSypA1gyBd2MzlXWnWgcm1zuvXm9Gc~2B9BUs0IbsrsE5DxeqEcrhGKRBGOJ4IkrGrv9RxUXLKtVERJ54mGvlLQOEljmlu11lr97WsIt4mv17llSxqeRIf9V16qWi8UXJLFNrFfAjm57CSehc~6OEk-JTKadTeQxswh3KrVEYIAWK~6qxw__&Key-Pair-Id=KUT5TJCACFTXG","Department of Vermont Health Access officials told the House Appropriations Committee on Feb. 12 that the agency removed a number of prior authorization (PA) requirements after a multi-year review and a pandemic-era suspension showed no systemic misuse.

Sandy Hoffman, deputy commissioner of the Department of Vermont Health Access, said the agency reviewed four years of data and concluded many prior authorizations could be eliminated while retaining medical-necessity documentation requirements. “We removed the requirements for prior authorization before getting the service,” Hoffman said. The agency now relies on providers to document medical necessity and says it will audit or review cases if utilization anomalies appear.

Alicia Cooper, director of managed care operations, explained value-based payment models were part of the context for the shift, noting that some authorizations remain in place for medications that are not on the preferred drug list or that pose imminent harm to members. “Anything that’s not on the preferred drug list requires prior authorization. Anything that could be considered harmful to a member requires authorization,” Cooper said.

Supporting details presented to the committee:
- Total prior authorizations in FY24: roughly 17,000, described by DVHA as about a 43% decrease from the prior year.
- The agency said it suspended many PA requirements during the COVID-19 emergency and used the suspension period to analyze whether suspending PAs led to overuse or inappropriate care. Officials reported they found no evidence of widespread misuse during that period.
- DVHA retains a limited “imminent harm” list and continues to require PA for non-preferred drugs and procedures that present safety risks.
- The agency said it will monitor claims and clinical documentation and reintroduce review if utilization trends indicate anomalies.

Committee reaction and follow-up: lawmakers asked whether fewer PAs meant members were not receiving care; committee members and staff sought clarity on whether removing PAs affected access or outcomes. DVHA said it will continue data monitoring and perform targeted reviews if utilization spikes occur.

Ending: DVHA emphasized the change is intended to reduce administrative burden and speed access to care while maintaining safeguards for safety-sensitive drugs and treatments.

","DVHA staff told the House Appropriations Committee that a four‑year review prompted removal of many prior authorization requirements for Medicaid services; total prior authorizations fell to about 17,000 in FY24, a roughly 43% decline from the prior year, agency witnesses said.",{"_33":112,"_35":36,"_37":38,"_39":113,"_41":114,"_43":115,"_45":116,"_47":117,"_49":118,"_51":119,"_53":120,"_55":56,"_57":58,"_59":121,"_61":62,"_63":64,"_65":122,"_67":68,"_69":70,"_71":72,"_73":56,"_74":56},6337517,"DVHA requests $1.26 billion for FY26 as caseload, Medicare-savings changes raise costs",4850,1000,4851000,"/Search/View?dp=1&key=2272899-c10668dd9578c764ee5d76f5050c5e58&start=1&end=4851","https://assets.pipeline.soar.com/2272899-c10668dd9578c764ee5d76f5050c5e58/thumbnail_1000.jpg","/articles/6337517/Vermont/DVHA-requests-126-billion-for-FY26-as-caseload-Medicare-savings-changes-raise-costs","https://secure.pipeline.soar.com/6337517-56f19fa16669c3cf16d7a7c23826466e/orig.mp4?Expires=1776055966&Signature=Uf-ajl1-cAMkfwk2dksh3nphCgLUGvw1UU9iKAo5pTmEC3qLrjfczhXVq0jTR6l8SuuS7g6mXqoaC1L9d0KeCZJgqqiVqSqviBe807GnwFW6G33Vgu~dZPr5Set7~W3xgkyN6hLpOfLFnFH-3g4Juo30W8SlMUVNkY2TC0gtRtzP1rWC0clXvJeX4CB6-aPjUztXiG6CXHI-nZKtY4nm~Dbqrk0Kf-dyP4VhpCy7tNK9BMt52okd5kckIFbeWbF6CJeX1vpwb292tWhJmVMzrB3aMkX-eQ4DuGyvfyRqhShvN7fJI7LiekbGlk9SxleYv8hnyWo5cxNINw5FPCdtJA__&Key-Pair-Id=KUT5TJCACFTXG","The Department of Vermont Health Access asked the House Appropriations Committee on Feb. 12 for a FY26 appropriation of about $1.2597 billion, citing an estimated $46.1 million increase for caseload and utilization across Medicaid programs and the partial-year cost of a congressionally enacted Medicaid policy change set to take effect in January 2026.

The budget presentation, delivered by Deshaun Burrows, commissioner of the Department of Vermont Health Access, and Stephanie Barrett, the agency’s chief financial officer, said the $46.1 million caseload and utilization increase reflects consensus estimates developed with the Agency of Human Services central office, the Joint Fiscal Office and the Department of Financial Management. “That caseload and utilization is the result of the consensus process,” Burrows said during testimony.

Why it matters: the global-commitment Medicaid line is the largest part of the DVHA budget. Small percentage shifts in utilization or cost per case translate into large dollars at the state level. Committee members pressed DVHA on how federal policy uncertainty could affect the projection.

Key details and supporting items presented to the committee:
- Total DVHA FY26 request: roughly $1,259,700,000 gross (administration and programmatic lines combined). The administration portion was discussed at about $182 million in the presentation.
- Caseload and utilization increase: $46,100,000 gross across global commitment, state-only and non-waiver lines; DVHA staff described this as the baseline change required to maintain current services and pricing.
- Medicare Savings Program (MSP) expansion: the agency is implementing a change that raises eligibility thresholds (qualified individuals to 195% of the federal poverty level) and will begin in January 2026. DVHA estimated a net state-general-fund impact in the budget materials (partial-year cost reflected in FY26). DVHA staff said outreach and take-up assumptions informed the fiscal estimate.
- One-time bridge funding: DVHA included a $10,800,000 global-commitment one-time appropriation for calendar year 2026 to replace certain payments that previously flowed from a Medicare ACO to programs such as SASH and Blueprint until the AHEAD cohort 2 decision in 2027.
- Graduate medical education: DVHA requested additional spending authority of $7,250,000 tied to federal formulas; DVHA said the state match for that item is provided by the University of Vermont, not the general fund.
- Administrative and contractual changes: DVHA moved an existing Vermont Legal Aid contract into its administrative base (no net programmatic change) and noted higher costs on several IT and vendor contracts.

Context and process notes: DVHA officials said the caseload and utilization figure was set through the consensus process used each fall with central office and fiscal staff and does not assume programmatic rate changes. Stephanie Barrett described how some appropriations are annualized from midyear policy changes, for example hospice and FQHC indexing previously enacted in 2025.

Committee members asked DVHA about contingency planning for potential federal policy changes that could affect Medicaid financing. “We are thinking about it,” Burrows said, noting the agency is monitoring congressional proposals and working with associations and academics on modeling. Staff cautioned that many proposals remain hypothetical and that precise modeling requires clearer federal proposals.

Ending: The committee did not take a vote on DVHA’s request at the Feb. 12 hearing; members said they would continue review and follow up with agency staff and the committee liaison. DVHA said it would return metrics on specific new initiatives, such as the justice reentry case-management program, as those programs begin operations.

","Department of Vermont Health Access told the House Appropriations Committee on Feb. 12 that its FY26 request totals roughly $1.26 billion, driven by a $46.1 million caseload and utilization increase and program changes including an expansion to Medicare Savings Programs that takes effect Jan. 2026.","actionData","errors"]

Article not found

DVHA funds eight positions for justice reentry Medicaid case management starting Jan. 2026

DVHA pursues MMIS replacement and integrated eligibility procurement; call center vendor retained at higher cost

DVHA reports $287 million drug spend, sets aside $4.5 million for new high-cost therapies

DVHA says prior-authorization requirements cut after review; pharmacy PAs dropped 43% from prior year

DVHA requests $1.26 billion for FY26 as caseload, Medicare-savings changes raise costs