House committee agrees to placeholder reporting language for H.32 while awaiting Medicaid 1115 waiver data

Madam Chair convened the House Corrections and Institutions committee on April 25 and opened discussion on H.32, a bill that would require reporting on whether individuals leaving custody continue medication for opioid use disorder (MOUD) after reentry.

The committee focused on whether existing data systems can measure MOUD continuity and what the first useful report should look like. Members repeatedly urged the Department of Vermont Health Access (DVHA) and the Department of Corrections (DOC) to identify what claims- and enrollment-based measures are feasible once the federal Section 1115 Medicaid demonstration waiver (the "1115 waiver") allows Medicaid enrollment before release.

Why it matters: Committee members said measuring continuation of MOUD after release is central to judging program success, to show whether investments in in-jail MOUD and community supports translate into sustained treatment, fewer overdoses and lower recidivism. At the same time, agency witnesses and staff warned the committee that the current data environment makes precise tracking difficult until the 1115 waiver starts to allow earlier Medicaid enrollment and clearer cross-system linkage.

The chair summarized the committee's near-term path: ask legislative counsel to draft broad placeholder statutory language for H.32, send a committee letter putting DVHA and DOC on notice to identify available metrics and to begin collecting data when the 1115 waiver permits, and pursue research support from University of Vermont's Justice Research Initiative and national repositories for model measures.

Committee discussion and agency input Katie McQuinn, legislative counsel, told the committee that agencies have already been talking and that the draft reporting language on page 12 of draft 3.1 had not been changed. Members and staff emphasized that the 1115 waiver will change what DVHA can track: "Beginning in January of '26, incarcerated individuals will be able to enroll in Vermont Medicaid 90 days prior to release," McQuinn said, and that change should make claims-based tracking substantially easier.

Isaac (DOC staff) described the operational effects: once a person is enrolled through the waiver, "we'll all be within the same system" and it will be easier to match corrections identifiers to Medicaid claims. He and others cautioned the committee, however, that DVHA had testified the current system presents administrative and technical burdens and that DVHA likely could not produce the requested crosswalk without the waiver.

Tony Follin, Department of Health Division of Substance Use, addressed available claims-based measures and cited how existing Medicaid prescription claims inform staffing and service allocation: "[They] track Medicaid prescriptions, and that's how they actually allocate the, the resources of staffing, both the nurse embedded staff into programs as well as the clinic counselor staffing." He and other staff said DVHA currently runs quarterly reports showing aggregate prescription counts by health service region, but those reports do not cross-reference corrections status until enrollment and identifiers are available through the 1115 waiver.

Committee members pushed on what would count as success. Representative Mary (committee member) framed success in human terms: "I'm just tired of these loose ends not connecting, and then we're making it even worse." Some members proposed specific measurable proxies (for discussion), including: prescriptions refilled at pharmacies after release, short-term readmission rates (for example 30-day readmissions analogous to hospital metrics), recidivism, overdose and death, and employment or tax-filing as indirect markers of stability.

Research and timing Members asked UVM's Justice Research Initiative and other academic partners to help identify validated metrics and suggested the National Conference of State Legislatures (NCSL) as a source of state-by-state comparisons. Abby Crocker and other UVM researchers were specifically named as possible partners who have already conducted manual chart-review work in Vermont that produced prior estimates (the committee heard past manual review showed about 70% of released people filled a MOUD prescription during a prior study period).

Because the committee anticipated that H.32 would not take effect this year and that the 1115 waiver most likely would not be operational until January, members agreed the first statutorily mandated report should be timed to give agencies a full year of claims data after the waiver is in effect. The committee discussed setting a first-report date of January 2027 so agencies could deliver a report based on a complete 12-month window of post-waiver data.

Committee directions and next steps The committee directed legislative counsel and staff to prepare placeholder statutory language for H.32 that (a) flags the committee's intent to track MOUD prescription refills and similar claims-based measures, and (b) sets a reporting timeline tied to the 1115 waiver rollout. The committee also agreed to send a formal letter asking DVHA and DOC to (1) describe what data they could feasibly collect when the waiver begins, (2) propose measurable metrics of success, and (3) indicate any technical barriers and staffing needs to produce the report.

Members volunteered follow-up work: outreach to the University of Vermont Justice Research Initiative (Abby Crocker), a staff member offered to do NCSL/state-comparison research, and legislative staff offered to draft placeholder language and the committee letter. No formal vote on H.32 was taken; members discussed and agreed on these procedural next steps.

Ending The committee left the statutory language broad and task-focused rather than prescriptive, to avoid locking agencies into measures that cannot be collected before the 1115 waiver takes effect. Members said they plan to revisit the specific report language and metrics in January after agencies respond and after the waiver begins to permit clearer claims-based linkage.