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Local providers warn of staffing losses, pay disparity after case management transition
Summary
Designated agencies and local providers told the committee that staff recruitment and retention are already straining service delivery after two national case management organizations began hiring; officials and providers debated pay, caseload size and service continuity.
Leaders of Vermont’s designated and specialized service agencies told a legislative human services committee the state’s move to conflict‑free case management is already prompting staff departures and creating operational strain at local provider agencies.
Kelsey Savesup, who identified herself as an executive director and co‑president of Vermont Care Partners, told the committee that the state’s implementation is “supportive” in principle but warned that strategic planning must be paired with realistic implementation resources. “If you over‑index on planning administration and under‑resource implementation and direct services, you get unrealistic expectations that lead to frustration,” she said.
Rachel Lee, executive director of the Counseling Service of Addison County (CSAC), said her agency had lost multiple leaders and service coordinators in the recent weeks as the new case management organizations recruited staff. Lee said CSAC had already lost four service coordinators and had three people in active interviews; those departures translated into clients losing their longtime coordinators. “This is stressful. We're losing really talented people,” Lee told the committee.
Local providers described pay disparities between the incoming case management organizations and existing designated agencies. Lee provided salary comparisons she had collected: she said some CMO positions were advertised at roughly $62,000 for case managers and as high as about $116,000 for certain director roles, compared with CSAC case manager pay in the mid‑$40,000 range and program director ranges in the mid‑$70,000s. Providers said those differentials are causing staff to accept higher‑paid roles with the CMOs, sometimes within days of an offer.
Providers raised specific operational concerns:
- Caseload sizes and service frequency: State guidance referenced caseload averages around 30–35 for certain levels of acuity and national averages near 90–100, which local providers called too high for individualized support. State staff acknowledged the national average but said the state had set lower expectations.
- Division of duties: Under the new model, designated agencies will continue to provide service coordination and direct services while the contracted case management organizations will handle enrollment, choice counseling and certain case management duties; providers warned the split could create an extra communication layer that delays action if not well coordinated.
- Administrative burden and compliance costs: Providers said new documentation, encounter data and administrative requirements tied to compliance and payment reforms require more data staff, technology and training, which can reduce funds available for direct services.
- Transportation and 24/7 coverage: Rural providers emphasized cost and workforce strain tied to transporting clients across large areas and maintaining residential services and on‑call coverage.
Several providers urged state and legislative leaders to prioritize funding that supports frontline wages, arguing better pay and benefits are the clearest way to retain staff. “There are structural issues that are going to impact the ability to provide good services,” Kelsey Savesup said. “The number one thing every single year is pay.”
The incoming case management organizations told the committee they intend to work collaboratively with local agencies. Carlos Hernandez, senior vice president of care coordination at Columbus, said his organization intends to “defer to those relationships that have been occurring” and to act as a partner rather than a replacement. Rick Adams of Benchmark Human Services said Benchmark and Columbus have offered to help ease staffing gaps where possible, including short‑term arrangements to support local agencies through transitions.
What was not decided: The committee did not adopt new statutory authority or change reimbursement rules at the hearing; providers asked the committee and state staff for more data on caseload distributions, site‑by‑site staffing impacts and the final contract terms for the new case management organizations.
The committee said it will revisit implementation impacts and staffing data in January, after several months of the new model being operational.
