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Bill H.13 orders Medicaid rate study for home and community-based providers
Summary
The Health & Welfare committee reviewed H.13, which directs the Agency of Human Services to determine reasonable and adequate Medicaid payment rates for home and community-based service providers, require an annual report to the legislature and create a process for extraordinary financial relief for providers at imminent risk of closure.
BURLINGTON, Vt. — On March 28 the Senate Health & Welfare committee heard testimony on H.13, a bill from the House that directs the Agency of Human Services (AHS) to determine reasonable and adequate Medicaid payment rates for home and community-based service providers and to report those rates to the legislature annually, beginning with an implementation update on Jan. 15, 2026.
Rep. Dan Noyes, sponsor of H.13, told the committee that the bill “is a rate study that asked the Secretary of Human Service to determine reasonable and adequate rates for home and community based provider designated agencies, specialized service agencies.” He and other witnesses said the study aims to capture the full cost of delivering services to older Vermonters and people with disabilities so the Legislature can make informed funding decisions.
Supporters said the work is urgent because of long-running underfunding. Representative Noyes and other speakers cited a prior 2023 study showing some home and community-based services were underfunded and noted a net loss of 321 residential care beds since 2020, with three facilities closed and five opened in that period. Committee discussion also cited recent budget adjustments that included $24,000,000 for increased skilled nursing utilization and $21,000,000 for emergency financial relief.
Under H.13, the bill would add a definition of “home and community-based services” to the rate-setting chapter in Title 33 and direct the secretary to set a methodology for determining payment rates that is responsive to factors such as state and federal mandates, inflation, labor-market pressures and geographic cost differences. The bill requires AHS to: (1) study rates and rate methodologies for each service type at least once every five years; (2) provide for predictable timelines and an annual inflation adjustment to the extent federal rules allow; (3) consider attendance-based reimbursement issues such as adult day programs; and (4) create a process by which a provider at imminent risk of closure may seek extraordinary financial relief.
Jen Harvey of the Office of Legislative Counsel described how the bill integrates the designated and specialized service agencies (DAs and SSAs) into the same rate-setting framework and stressed that the statute would require AHS to calculate and report rates but would not automatically appropriate funds. “This requires AHS to determine what the rate should be. It does not require them to actually implement and increase the rates, right,” Harvey said.
Helen Lavin of the Vermont Health Care Association spoke in support, saying the association found the bill “great and important and very timely” and expressed surprise that a regularized rate-study process was not already in place. Other stakeholders in the room signaled support and said they intended to testify; members of a broader long-term care coalition were also reported to be following the bill.
What H.13 would change: it creates statutory authority for AHS to set methodologies and timetables for rate studies that apply to a broader set of Medicaid-funded community services than are currently captured under the Choices for Care program and the existing nursing-home rate-setting framework. The bill would also require AHS to report redetermined rates and the amounts necessary to fund them annually as part of the agency’s budget presentations to the Legislature; the Legislature retains authority over appropriation decisions.
Next steps and context: committee members and staff indicated they expect AHS to deliver an update on implementation by Jan. 15, 2026, and to include proposed schedules for rate studies and the methodology. The bill was passed by the House and was before the Senate committee for review; Representative Noyes said the House Human Services committee vote was reported as “11,” but the transcript does not specify vote details. Public testimony was expected to follow the committee briefing.
Votes at a glance: H.13 — House passage reported; committee vote in House Human Services reported as “11” (details not specified).
