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Committee told electronic system upgrades needed to implement Section 1115 reentry waiver; funding uncertain
Summary
The committee heard that a planned electronic upgrade to support the Section 1115 ("11-15") Medicaid waiver — intended to pause Medicaid termination prior to release — depends on funding that may be delayed or vetoed; staff said delays would push back implementation until funds are secured.
The Senate Institutions Committee discussed Thursday the state work needed to implement a Section 1115 Medicaid demonstration waiver intended to preserve Medicaid coverage for people prior to release from correctional custody.
The chair summarized the policy need in plain terms, saying there is currently "no pause button. I'll talk really clear, you know, simple. There's no pause button. It's a cancel button," meaning the state’s claims-processing system cannot temporarily suspend termination and must instead cancel coverage unless the system is updated.
A staff member from the Department of Vermont Health Access (DVHA) told the committee that if the funding included in the budget adjustment (BAA) or other sources is not secured, "it would delay the implementation" of the 11-15 waiver until the state can find funds. Committee members were told the upgrade requires changes to the Medicaid management information system (MMIS) and related electronic workflows.
Committee discussion noted there is money in DVHA’s budget and possible federal capacity funds for MMIS modernization, but the timing and availability are unclear. The staff summary said the waiver’s operational work is tied to both state budget actions and federal approvals. One committee member asked whether the federal agency oversight for waivers would be the Centers for Medicare & Medicaid Services; staff confirmed CMS/ HHS is the relevant federal entity.
No formal committee action was taken. Committee members asked staff to follow up with DVHA and the secretary’s office to identify contingency funding plans and report back on whether the MMIS work can proceed without the BAA appropriation.
