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Agency outlines Medicaid waiver investments and optional benefits at Appropriations hearing
Summary
State Medicaid officials detailed a range of optional programs, waiver‑funded investments and modest pilot benefits — including permanent supportive housing, new substance‑use wraparound services, pharmacy assistance and community mental health programs — and described how those items rely on Section 1115 waiver authority and state/federal match.
State Medicaid officials used an April 9 briefing to the House Appropriations Committee to catalog programs that are authorized through Vermont’s Section 1115 Global Commitment waiver and to list optional benefits and targeted pilot programs that could be threatened if federal funding or waiver authority changed.
Monica Ogilby, state Medicaid director, and Ashley Berliner, director of Medicaid policy, reviewed a portfolio of programs funded or enabled by the waiver and by other state decisions and gave program sizes and budgetary snapshots where available.
Why it matters: Vermont uses 1115 waiver investments and several optional benefits to support services that sit outside traditional Medicaid entitlements. Those investments — the officials said — total roughly $120,000,000 a year and include programs intended to keep people out of higher‑cost settings or to provide targeted supports for narrow populations.
Officials described several specific programs and the numbers they presented to the committee:
• Permanent supportive housing: Launched in January 2025, intended for a narrow clinical population exiting homelessness and designed to provide tenancy supports. The pilot was described as starting small (officials said the initial target was roughly 50 individuals) and is implemented with community housing partners.
• SUD‑CIT (Substance Use Disorder Community Intervention and Treatment): A benefit authorized in the waiver but not yet launched; officials budgeted the program to cover roughly 11,000 people and estimated about $9,000,000 in gross Medicaid costs for implementation.
• CRT (Community Rehabilitative Treatment): A mental health wraparound program for people above Medicaid income limits with severe mental illness; officials said about 1,300 people participate and the program costs roughly $117,000,000 gross.
• Epharm (pharmacy assistance for older Vermonters): Covers about 9,200 people, with roughly $10.5 million in gross spending, officials said.
• Qualified health plan premium assistance (Vermont Health Connect): Officials said the state provides premium assistance for people up to 300% of the federal poverty level, spending about $5.6 million to help roughly 15,000 people.
• Medicare Savings Program expansion: Enacted last year but not fully implemented, officials estimated roughly $11,000,000 gross for the planned expansion; details on eligible counts were not available at the briefing.
• Vermont cost‑sharing reduction: An optional program that officials said costs about $1.6 million and covers roughly 4,200 people.
• Moderate needs (Choices for Care) and immigrant health insurance programs: Officials listed the moderate‑needs component at about $1.5 million serving roughly 2,100 people; immigrant health coverage was discussed as a narrowly targeted program for children and pregnant women who lack lawful residency and otherwise meet income limits.
Officials said some waiver items — like planned authority to pay for up to six months of rent and medical respite — are approved but not yet implemented (the waiver was amended in January 2025 and implementation for those benefits cannot begin until January 2026) and that the state had not budgeted a state match for those services yet.
Ogilby summarized the state’s policy levers should federal funding fall short: “There are 4 of them by our count,” she said: backfill with state dollars, reduce provider rates, reduce eligibility, or reduce services. Committee members pushed for more granular cost breakdowns by mandatory versus optional services and for counts of affected people; officials said they would provide more detailed spreadsheets after the hearing.
Officials repeatedly cautioned that many budget numbers were estimates or pre‑implementation figures: the SUD‑CIT benefit and the health‑related social‑needs rent and respite authorities have not launched and the agency said it would return with refined modeling as program details crystallize.
Ending: The briefing set priorities for follow‑up: the agency will provide more detailed cost and enrollment figures, and the committee signaled it would use the information to consider state budget options to protect programs should federal participation shrink.
