Green Mountain Care Board asks for staff and funding as AHEAD payment model and OneCare exit reshape regulation

The Green Mountain Care Board told the Senate Appropriations Committee that its FY26 budget request includes new positions and contract funding tied to a potential federal payment‑reform effort known as the AHEAD model, while also seeking statutory changes to its billing formula after OneCare Vermont announced it will leave the market.

At a committee hearing, Owen Foster, chair of the Green Mountain Care Board, summarized the agency's regulatory remit: “We regulate hospital budgets. We regulate the qualified health plans that insurers offer on this market, and we regulate ACOs.” He and staff said changes in the provider landscape — in particular OneCare Vermont’s planned exit — require adjustments in the board’s funding and staffing model.

Jean Stuttering, the board’s administrative services director, told senators the agency “currently have[s] 33 positions” and noted the board met the governor’s recommended budget increase of 5 percent for FY26. She said the board requested five new positions to support work on the AHEAD model, and the governor’s recommendation included three positions plus funding for contracts; the board presented a gross increase of about $750,000 that combines a $300,000 general‑fund increment with bill‑back (special fund) revenue.

Why it matters: the board’s regulator-funded special fund (the Green Mountain Care Board bill‑back/special fund) historically covered roughly 60 percent of operating costs while general fund made up about 40 percent. With OneCare Vermont exiting, the board said it needs statutory flexibility to adjust who pays the bill back. The board’s draft statutory language and supporting bill (S.63) would change fee allocations and create a separate fee and review path for smaller, Medicare‑only ACOs.

Board officials also flagged major implementation uncertainties around the AHEAD model, a federal payment‑reform agreement signed under the prior administration. Foster said the state, the Agency of Human Services and the governor signed on with the federal government to begin AHEAD in 2027 but that the new federal administration’s stance is unclear and the model is voluntary — hospitals would have to opt in. He told the committee: “There are a lot of unknowns out there” and said the board has had limited contact during a federal “blackout” period.

The board said the AHEAD work will be resource‑intensive. Stuttering said the Green Mountain Care Board requested five positions for FY26 to begin the methodology and regulatory work and estimated the state would need many more positions over time if the model proceeds. Foster added that the board’s internal vote to support participation in AHEAD passed by the minimum three votes and that one of the conditions for board support was securing sufficient staff and contractor resources.

Officials described other budget items: the board’s prescription drug regulation work created after Act 134 is funded through the board’s special fund and accounts for a one‑time jump in their special‑fund share; the board also asked for limited‑service data positions to automate reporting from the state’s claims and discharge databases and reduce manual work.

Committee members pressed on outcomes and priorities. Senators asked for performance measures; Foster pointed to controlling hospital rate increases as a major success, saying the board had reduced hospital commercial rate increases to a level more consistent with medical inflation in recent years. Senators raised staffing pressures across care settings and asked whether additional funding would be used for permanent positions or contractor support; board staff said the FY26 ask included positions and contract authority tied to federal AHEAD grant funding (the board referenced planned federal contractor resources of roughly $12 million to support implementation work if the model proceeds).

On bill‑back and OneCare: the board explained the 2018 change that added OneCare Vermont to the bill‑back formula and said the exit of OneCare requires reweighting the share borne by hospitals and insurers. The board’s proposal would shift a larger share of costs to hospitals and reduce insurers’ share to roughly 5 percent, reflecting that hospitals previously paid OneCare dues that effectively covered part of the regulatory cost.

No formal legislative action was taken at the hearing. Board staff said they will post draft statutory language and referenced documents on the committee website for review. Foster and Stuttering described the next possible funding request timeline: the board asked for initial positions in FY26 and would return in subsequent budget cycles with requests for additional full‑time staff if the AHEAD model advances.

The committee hearing made clear that the Care Board’s budget request is tied to larger policy choices — whether AHEAD proceeds, how Medicare‑only ACOs are regulated, and how the loss of OneCare Vermont’s market role will be absorbed — and that those choices carry implementation risk and potential shifts in who ultimately pays for regulation.