[{"_1":2,"_86":-5,"_87":-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",[32,74],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":44,"_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":55,"_73":55},"mediaId",6308611,"mediaKeyId","2419433-38d9ff1e0bf296e392fe657e5b86e5bc","parentId",2419433,"title","Committee prioritizes implementing 2023 rate study and boosts for community-based services","audioSeconds",0,"startMs",1412000,"endMs","viewUrl","/Search/View?dp=1&key=2419433-38d9ff1e0bf296e392fe657e5b86e5bc&start=1412&end=1412","thumbnailUrl","https://assets.pipeline.soar.com/2419433-38d9ff1e0bf296e392fe657e5b86e5bc/thumbnail_1412000.jpg","articleUrl","/articles/6308611/Vermont/Committee-prioritizes-implementing-2023-rate-study-and-boosts-for-community-based-services","mediaUrl","https://secure.pipeline.soar.com/6308611-c4c860a90b22830d2ba587cd0bc084f7/orig.mp4?Expires=1770437856&Signature=XFzDIxca-T6UW61gY67LYPrrDXXJQLIy4791vHd-4CGem0Q5yn8itGISP~vUKu3xfn-AXR3~JjRV7X8ksxphxoS8yxBHtdn72c-m5Ja5Sy8p~4aVXOWINnk~HjvLWFTG-CKOPeph9h61zvpUBqzrsFXhGnQQuAKdl8gamhIwaj0~eY8g9npgh9u66u-Kelh9hskxq3gUWEhSTtL3v4guj0tTixI6OmfcuWQusUgxW7E2bAoWHu2nWFFfE9tJ~GgvFtORdCbTaJdtnxbHFBLrGWWJKGqhMvfif6nMMDh36NrCSPEtFOCztuKOYO0PUeS8I3JvwInmO5yaZNwJHVp4Cw__&Key-Pair-Id=KUT5TJCACFTXG","author","","date","2025-02-27T03:15:35Z","article","House Human Services reviewed proposed budget changes for home- and community-based services, recommending implementation of the remaining FY2023 rate-study increases and a mix of ongoing and one-time investments to shore up providers.

The discussion focused on completing funding tied to a 2023 rate study, raising reimbursement levels for services such as enhanced residential care (ERC) and personal-care/homemaker/respite services, expanding a HomeShare program into the Northeast Kingdom, increasing Meals on Wheels funding, and considering targeted one-time support for adult-day centers facing revenue loss from participant absences.

Why it matters: committee members and presenters said community-based providers face cost pressures from inflation, workforce and administrative fee increases that are built into state employee budgets but have not historically flowed to private or nonprofit providers. Members framed implementation of the 2023 rate study as a priority to reduce systemic inequities and stabilize services that support older Vermonters and people with disabilities.

What was proposed

- Implement FY2023 rate-study recommendations: Presenters recommended finishing the multi-year implementation that updates provider rates to the cost levels identified in the 2023 rate study. They proposed a $3.8 million general-fund increase to bring enhanced residential care (ERC) up to the 2023 rate levels and an additional $2.2 million for personal-care, homemaker and respite/companionship services; together these were presented as the top priorities to complete the 2023 rate-study adjustments.

- HomeShare expansion: Presenters proposed funding to expand HomeShare into the Northeast Kingdom to increase housing matches that help older Vermonters and people with disabilities remain housed. Presenters cited current statewide matches (about 274 unduplicated matches historically) and said uptake in a new region would depend on local start-up capacity; the number of expected matches in year one was not specified in the presentation and presenters said first-year uptake may be lower as programs ramp up.

- Meals on Wheels: The presenters proposed adding $2,000,000 general fund (about $4.85 million gross when accounting for Medicaid/global-commitment investment) to support meal providers. A presenter said the average cost per meal from a recent rate study is $13.43 and that augmenting state support would allow providers to invest in medically tailored meals and higher-quality food.

- 4% across-the-board increase for home- and community-based providers: Presenters recommended a 4% rate increase for many community-based provider categories (designated agencies, specialized service agencies, adult family care and ACCS) to prevent further erosion of reimbursements. Committee staff said the 4% figure was calculated on current reimbursement bases and may need adjustment once the 2023 rate-study increases are fully reflected.

- Conflict-free case management and DS case-management ramp: The governor’s budget proposes roughly $8.6 million to implement conflict-free case management required by federal rules. Committee staff noted the Developmental Services (DS) case-management piece involves creating a new contracting entity and may take several months to ramp up; staff estimated potential one-time savings (about $1.9 million gross) if ramp-up delays reduce near-term spending.

- Adult day centers and absentee-related revenue loss: Presenters reported that many adult-day providers face revenue loss when participants miss scheduled days (for transportation issues, medical appointments or weather). They estimated about $800,000 for six months of losses (roughly $2,000,000 annualized) and proposed a one-time general-fund payment to help stabilize providers while longer-term fixes are addressed in H.13 implementation work.

Committee direction and next steps

- Staff were asked to provide gross and general-fund amounts when possible, to reconcile whether the proposed 4% COLA should be calculated on current reimbursement rates or on rates after the 2023 rate-study increases, and to specify expected HomeShare start-up matches and Meals on Wheels targets for coverage estimates.

- Members agreed not to take an immediate vote. Presenters were told the department and staff will fold these priorities into the committee’s larger set of highest-priority asks for roll-up and will provide updated spreadsheets and language for committee review.

Quotes

\"These all go back to the '23 rate study, which we started funding last year and the year before, but this would finish it up,\" a presenter said, describing the rationale for completing the rate-study implementation.

\"It is grossly unequal,\" a committee member said of the disparity between state-employee budget treatments and community-based provider funding when discussing fee increases and administrative costs that affect private providers.

Clarifying details and unknowns

- Enhanced residential care (ERC) implementation: $3,800,000 general fund to bring ERC to FY2023 rate levels (presenters asked staff to add gross figures).
- Personal-care/homemaker/respite services: $2,200,000 general fund proposed to align those services with FY2023 rates.
- Meals on Wheels: $2,000,000 general fund (approximately $4.85M gross) to address average meal cost of $13.43; the split among federal Older Americans Act funding, Medicaid investments and local fundraising will vary by provider.
- 4% COLA: Presenters listed $11,100,000 general fund (about $26.2M gross with Medicaid match) but staff cautioned the number should be recalculated if the 4% is applied after the 2023 rate-study increases rather than before.
- Conflict-free case management: governor’s proposal ~ $8.6M; DS case-management implementation may take up to four months and could yield one-time savings of roughly $1.9M gross if pacing delays occur.
- Adult-day absenteeism: estimated $800,000 for six months (about $2,000,000 annualized) in lost revenue; presenters described the request as one-time general-fund stabilization money because missed attendance cannot be retrospectively billed to Medicaid.

Who spoke (as identified in the transcript)

- Dan — presenter for Aging/home-and-community-based services priorities (staff/agency presenter, government)
- Todd — presenter/staff member working on language and spreadsheets (staff, government)
- Nolan — committee staff member assisting with budget numbers (staff, government)
- Connor — executive director, HomeShare (nonprofit, referenced as potential implementation partner)
- Anne — committee member who questioned rate and utilization assumptions (committee member)

Authorities referenced

- FY2023 rate study (DALE/department rate study) — referenced_by:[\"home-and-community-based-services-priorities\"]
- H.13 (statutory/implementation reference previously passed) — referenced_by:[\"home-and-community-based-services-priorities\"]
- Older Americans Act (federal funding source for Meals on Wheels) — referenced_by:[\"home-and-community-based-services-priorities\"]

Discussion vs. decision

- Discussion: whether to complete 2023 rate-study implementation now, how to calculate COLA relative to rate-study increases, HomeShare expansion details and performance metrics, and how to structure one-time versus ongoing investments.
- Directions: staff to provide gross/GF splits, to recalculate COLA figures if applied after rate-study adjustments, and to draft specific HomeShare and Meals-on-Wheels implementation language including coordinated-entry referral options.
- Decisions: none final; presenters’ recommendations to prioritize rate-study completion and to consider limited one-time stabilization payments were recorded for roll-up.

Proper names

[{\"name\":\"HomeShare\",\"type\":\"organization\"},{\"name\":\"Meals on Wheels\",\"type\":\"program\"},{\"name\":\"Older Americans Act\",\"type\":\"other\"},{\"name\":\"H.13\",\"type\":\"other\"},{\"name\":\"FY2023 rate study\",\"type\":\"other\"}]

Searchable_tags:[\"home and community-based services\",\"rate study\",\"ERC\",\"HomeShare\",\"Meals on Wheels\",\"conflict-free case management\",\"adult day centers\"]

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","mediaType","Video","parentTitle","House Human Services 2025-02-26 9:00 AM","oneSentenceSummary","Presenters proposed implementing remaining pieces of the 2023 rate study for home- and community-based services, requested targeted increases for enhanced residential care and personal-care services, proposed a Meals on Wheels funding increase and suggested one-time support to offset adult-day center revenue losses.","taxTitle","Human Services, HOUSE OF REPRESENTATIVES, Committees, Legislative , Vermont","taxId",35147,"location","Vermont","headline","shortSummary",{"_33":75,"_35":36,"_37":38,"_39":76,"_41":77,"_43":78,"_45":79,"_46":80,"_48":81,"_50":82,"_52":83,"_54":55,"_56":57,"_58":84,"_60":61,"_62":63,"_64":85,"_66":67,"_68":69,"_70":71,"_72":55,"_73":55},6308616,"House Human Services flags questions on recovery funding, moves $40,000 bereavement request up",1139,26000,1165000,"/Search/View?dp=1&key=2419433-38d9ff1e0bf296e392fe657e5b86e5bc&start=26&end=1165","https://assets.pipeline.soar.com/2419433-38d9ff1e0bf296e392fe657e5b86e5bc/thumbnail_26000.jpg","/articles/6308616/Vermont/House-Human-Services-flags-questions-on-recovery-funding-moves-40000-bereavement-request-up","https://secure.pipeline.soar.com/6308616-4cc6ec1d3845f50e07b19684722facc8/orig.mp4?Expires=1770437856&Signature=gntMQHa8Psva9gcH46bF8EF5UwyTUmWIDUzN-PcCWSqpPCTwTvHWdAdtsW4Zv7prJESHLPDoXUiw~D6h6-AvMokWdAM0L45G48UvxLmLZIrPiW2SOnhrxO~jBO6uYK-Y1fcH-hPMHaeLnpVigb0k11LaPrsCsOilJeYjnZO1ZzEexV4m83V7jp0rs-tRgmqDf6K3i9wyNgL2CKbEE3ubkpgJv-FNS3muHvf4c4vzKYlhuHfs7X3YHo-1p2S6B3WHsnPb4ytjaWU~aX8Uo9YifjUalUYSkLj9-GEEky5eW7YGcgtd2Ne5xIoaO9rZujdbRjKumqRq947rlxFQYH~crQ__&Key-Pair-Id=KUT5TJCACFTXG","House Human Services reviewed Health Department budget proposals on substance-use prevention and recovery and recommended further review of several items in a separate bill, H.218, while forwarding a $40,000 general-fund request for a bereavement peer-support group as the department team’s highest-priority general-fund ask.

The committee’s health-department presenters told members that, because draft appropriation language is still preliminary, “we are not putting the language on our committee webpage at this point in time because all of it is in very draft form.” The presenters asked the panel to defer fuller action on several line items until the committee meets later to take up H.218, a companion bill that will carry opioid-abatement spending decisions.

Why it matters: several of the Health Department’s line items relate to opioid-abatement settlement money, Medicaid matching rules and the use of new special funds (including the cannabis excise tax). Committee members said moving the items into H.218 will allow the panel to review how special funds and budget constructs interact with Medicaid match and global-commitment options.

What the committee discussed

- Opioid-abatement spending and H.218: Health department staff and committee members agreed to move some appropriations discussion into H.218. As one presenter put it, H.218 will contain “money that is being appropriated from the opioid abatement special fund in a separate bill.” Committee members said H.218 will allow review of how previously appropriated opioid-settlement dollars and new requests interact.

- Cannabis excise-tax funds and prevention: The presenters said the governor’s recommended budget includes $3,000,000 in general fund plus an additional $6,750,000 from special funds tied to the cannabis excise tax for prevention activities. Committee staff said they do not recommend adjustments at this time but plan to ask Dr. Levine for clarification about how the cannabis-related dollars would be used and how outcomes would be measured.

- Aftercare navigators: The budget includes $320,000 (three positions) for aftercare navigators tied to correctional facilities to help people leaving incarceration connect to housing and supports. Staff said the program is intended to be non-duplicative of other efforts but noted possible overlaps with other recovery initiatives that will be discussed in H.218.

- Pilot Recovery Campus: The presenters described a proposed pilot 15-bed recovery housing site. They said $500,000 in the governor’s budget is intended for securing a site (not yet fully explained) and an additional $1,000,000 is for services. Committee staff reported they have not been able to get a clear accounting of a remaining $500,000 referenced in the budget documents and recommended moving discussion of this pilot to H.218 for fuller review.

- Recovery residences and recovery centers: Committee materials show a previously appropriated $1,200,000 for recovery residences and $1,060,000 for recovery centers that staff indicated had not yet been spent; members asked for clarification before deciding whether and how to reallocate or reauthorize those amounts.

- Empty Arms bereavement peer support: Committee staff recommended adding $40,000 in general-fund support for Empty Arms, a nonprofit that provides peer support to families who have experienced miscarriage, stillbirth, early infant loss or pregnancy termination for medical reasons. Presenters said the organization reaches several hundred people annually and that no comparable statewide service exists; the department team recommended the $40,000 request as its highest-priority new general-fund ask for the Health Department.

Committee direction and next steps

- The committee did not take a formal vote on the Health Department package at this meeting. Members directed staff to: (1) ask Dr. Levine to clarify intended uses and outcome measures for cannabis-excise and opioid-abatement spending, (2) clarify the purpose and accounting for the Pilot Recovery Campus budget lines, and (3) confirm the status of previously appropriated recovery-residence and recovery-center funds.

- The department team moved the $40,000 Empty Arms request to its highest-priority list; members emphasized that this recommendation is not a final funding commitment and that the request will be considered alongside other departments’ high-priority items at a later roll-up.

Quotes

“We are not putting the language on our committee webpage at this point in time because all of it is in very draft form,” a committee presenter said, explaining why additional detail is not yet public.

“We were requested to do that and appropriations said, okay, so that's what we're doing,” a presenter said of moving opioid-abatement appropriations into H.218.

Clarifying details and unknowns

- Cannabis funding: $3,000,000 general fund plus $6,750,000 from special funds (cannabis excise tax) — how exactly those funds will be allocated and measured was described as “not specified” pending discussion with Dr. Levine.
- Aftercare navigators: $320,000 for three positions attached to corrections facilities; described as non-duplicative but potentially connectable to other efforts — funding source noted as general fund in the governor’s budget.
- Pilot Recovery Campus: presenters said $500,000 appears intended for securing a site, $1,000,000 for services, and another $500,000 is listed in budget materials but its purpose was “not specified.”
- Empty Arms: $40,000 general-fund request; presenters said the group serves several hundred people annually.

Who spoke (as identified in the transcript)

- Committee chair (identified as the meeting’s chair) — committee official leading the session (government)
- “Doctor Levine” — referenced Health Department official; presenters said they would ask Dr. Levine for clarification (government)
- Nolan — staff member who addressed budget details and spreadsheets (government)
- Eason — staff member referenced on prevention high-school funding (government)
- Brenda — committee member who raised recovery-residence/center funding and priorities (committee member)
- Eric — staff member mentioned in discussion of opioid-related line items (government)

Authorities referenced

- H.218 (bill) — referenced_by: [\"health-department-budget-and-substance-use-funding\"]
- Opioid Abatement Special Fund — referenced_by: [\"health-department-budget-and-substance-use-funding\"]
- Governor’s FY26 budget (unnamed formal citation) — referenced_by: [\"health-department-budget-and-substance-use-funding\"]
- Medicaid Global Commitment (programmatic construct) — referenced_by: [\"health-department-budget-and-substance-use-funding\"]

Discussion vs. decision

- Discussion points: scope and intent of cannabis-excise spending; whether aftercare navigators duplicate other services; unclear accounting for portions of the Pilot Recovery Campus request; status of previously appropriated recovery residence/recovery center funds.
- Directions: staff to follow up with Dr. Levine on details, move substantive opioid-abatement-related items to H.218 for further review, and to confirm status of the $1,200,000 and $1,060,000 previously appropriated.
- Decisions: the department team recommended the $40,000 Empty Arms grant as a highest-priority new general-fund ask; no final funding decisions made at this meeting.

Proper names

[{\"name\":\"Empty Arms\",\"type\":\"organization\"},{\"name\":\"H.218\",\"type\":\"other\"},{\"name\":\"Opioid Abatement Special Fund\",\"type\":\"other\"},{\"name\":\"House Human Services\",\"type\":\"other\"}]

Searchable_tags:[\"opioid\",\"H218\",\"cannabis excise tax\",\"aftercare navigators\",\"Empty Arms\",\"recovery housing\",\"Medicaid\",\"Health Department\"]

Provenance:{\"transcript_segments\":[{\"block_id\":\"s_26.025\",\"local_start\":0,\"local_end\":48,\"evidence_excerpt\":\"let's have health department go first. I thought so. Yeah.\",\"reason_code\":\"topicintro\"},{\"block_id\":\"s_1085.62\",\"local_start\":0,\"local_end\":112,\"evidence_excerpt\":\"as a result, the $40,000 in general fund moved to the, highest priority as as your team's recommendation for MP arms.\",\"reason_code\":\"topicfinish\"}]}
","Committee members reviewed the Health Department budget lines tied to opioid, cannabis and recovery services, agreed to move discussion of several items into H.218, and recommended a $40,000 general-fund grant for Empty Arms as the department team's highest-priority ask for new general fund.","actionData","errors"]

Article not found

Committee prioritizes implementing 2023 rate study and boosts for community-based services

House Human Services flags questions on recovery funding, moves $40,000 bereavement request up