DAIL seeks $783.5 million for FY26; requests $8.6M for federally required conflict‑free case management and nursing‑home rate rebasing

Commissioner Jill Bowen of the Department of Disabilities, Aging, and Independent Living (DAIL) told the Vermont Senate Appropriations Committee on Feb. 27 that DAIL’s fiscal year 2026 budget request totals $783,521,821 and asks the Legislature to fund several items tied to federal mandates and service stabilization.

"Our mission is to make Vermont the best state in which to grow old or live with a disability with dignity, respect, and independence, and that guides the delivery of all of our services," Bowen said during the presentation. She said the request is driven largely by Medicaid‑funded Global Commitment spending and by implementation costs for a federally required change to case management in home‑and‑community‑based services.

Why it matters: The request contains a one‑time and ongoing funding mix that officials say is intended to stabilize nursing facilities, implement a federal conflict‑free case‑management mandate for Home and Community‑Based Services (HCBS), and invest in workforce and supported‑housing pilots that affect older Vermonters and Vermonters with disabilities.

Key numbers and timing

Bowen said the department’s total FY26 request is $783,521,821: 88.8% Global Commitment (Vermont Medicaid), 4.6% general funds, 6.2% federal funds and other, and under 1% special and interdepartmental funds. By division she listed the requested totals and shares: Developmental Disability Services (DDS) $353 million (45% of DAIL), Adult Services $379 million (48%), Vocational Rehabilitation/HireAbility $32 million, Blind and Visually Impaired about $6 million, Licensing and Protection about 1% of the department total, and the commissioner’s office allocated across general and federal funds.

The department is asking for $8.6 million in Global Commitment funds specifically to cover costs tied to implementing the federal conflict‑free case‑management requirement. Bowen said an RFP and procurement work are under way, contracts are in negotiation and she expects contracts to be finalized by April 1, with an implementation date of Oct. 1.

"Vermont is virtually the last state to implement the federal requirements," Bowen said, describing the multiyear project and public documentation posted on the department’s website.

Nursing facilities and Choices for Care

DAIL proposed a substantial increase in Choices for Care spending — the Medicaid program that covers nursing homes and many home‑and‑community‑based services — from $293.6 million in FY25 to a recommended $338.7 million in FY26. Bowen said that change reflects a statutory nursing‑home inflationary increase ($15,362,423), a nursing rebase tied to updated cost data (about $11.9 million of the rebase figure provided), and a nursing‑home bed‑day utilization and adjustment pressure estimated at $24.5 million. Bowen said the department projects a portion of one‑time emergency funding needs (EFRs) should decline but did not guarantee EFRs would disappear.

Committee members asked whether the rebase will alleviate staffing and capacity problems. A committee member asked, "Do we think this is going to alleviate some of the problems that we're having?" Bowen replied that the rebase should stabilize the sector because the new base year is closer to current costs but that individual facilities will vary and some will still struggle.

Workforce and other initiatives

Bowen reviewed a multi‑pronged approach to the direct‑care workforce: participation in a state care learning collaborative, an upcoming direct‑care worker registry, and a multimedia recruitment campaign. She also highlighted the opening of a complex care nursing home in Bennington and said that movement helped hospitals by allowing some patients to leave hospital beds sooner.

The department described several grant‑funded initiatives: Pathways to Partnerships (a U.S. Department of Education Rehabilitation Services Administration award) to strengthen transitional services for students with disabilities; Act 186 pilot grants that supported Riverflow Inc.’s supported‑housing pilot; an opioid employment pilot expanded with opioid settlement dollars in Burlington and Newport (and being expanded to Brattleboro); and an adult day start‑up grant for a combined multigenerational adult day and child care center in Central Vermont.

Service counts and other program details

Bowen provided service counts she said are reflected in the FY25 activity year: about 49,000 people received Older Americans Act‑backed services, roughly 9,000 received home‑delivered meals, about 7,000 received Choices for Care services across settings, 5,000 participated in SASH (Support and Services at Home), and about 400 in adult day programs. In developmental services, Bowen said more than 3,000 people received home‑and‑community‑based services and more than 1,000 used flexible family funding; HireAbility served nearly 7,000 individuals and provided pre‑employment transition services to about 1,600 high‑school students.

Policy and statutory references

Bowen identified the department’s statutory basis in DAIL’s presentation and listed several state and federal references, including 33 V.S.A. chapter 5 (Vermont’s human services statute), the Older Americans Act, Act 186 pilot grants (2022), and Act 248 (noted in the presentation in the context of public safety caseloads for DDS). She also cited collective bargaining costs (AFSCME) and opioid settlement funds used for program expansion.

What was not decided

The hearing was informational; no formal committee votes or budget decisions were taken during the presentation. Several committee members asked questions and Bowen indicated procurement and contract steps would continue over the spring.

Ending

Bowen said the department will provide detailed budget pages and a 30‑page appendix for members to review. She closed by asking committee members to follow data in the department’s public trackers, including a year‑one progress report for DAIL’s "Age Strong Vermont" plan and an online goal tracker for community services.