House Health Care chair tells Appropriations committee ACO bridge funding is top FY26 priority to avert primary-care losses

Representative Alyssa Black, chair of the House Committee on Health Care, told the House Appropriations Committee on March 11 that her committee’s top FY26 budget priorities are aimed at stabilizing primary care and the most fragile parts of the state’s mental‑health and home‑health systems.

“We took testimony on every single one of them,” Black said. “These are not just requests that were mailed to us or emailed to us. We took testimony on every single one of them.” She added, “Our system of healthcare, our system of mental healthcare is in a crisis.”

Nut graf: The Health Care Committee’s package focuses first on one‑time bridge funding to cover the wind‑down of the current ACO (OneCare/Blueprint payments) through the transition to the proposed AHEAD model, plus targeted base increases to federally qualified health centers (FQHCs), home‑health providers and designated mental‑health agencies. Committee members signaled the gap between the ACO ending in 2025 and AHEAD’s planned start in 2027 could leave primary‑care providers, especially independent practices, without critical per‑member payments.

Black said the governor’s recommendation includes an ACO transition payment described in the committee materials as $10,800,000 gross, with roughly $4.48 million in general‑fund support; the committee added further one‑time bridge funding requests aimed at replacing payments that primary‑care providers currently receive through OneCare/Blueprint. “If this funding is not provided … it would decimate primary care and particularly independent primary care,” Black said.

AHEAD staffing and contingency: The committee described a separate but related consequential ask: the Green Mountain Care Board needs additional positions to administer AHEAD if the state proceeds. The governor recommended funding three positions (included in a request the chair described as $750,000 gross with about $300,000 general fund), and the Care Board told the committee it would require five positions to remain a signatory and commit to AHEAD. Committee members said the additional two positions are contingent hires if AHEAD proceeds; if the positions are not funded and the Care Board withdraws, the committee said the AHEAD model would not move forward as planned. Black noted AHEAD is scheduled to begin in January 2027 and that preparatory work would begin earlier, creating an implementation timeline that requires staffing in advance.

Rates and base funding priorities: The committee’s top base priorities included raising FQHC Medicaid rates toward a higher share of Medicare payment and increasing home‑health rates, which Black said are “the cheapest, most efficient care” that prevent longer, costlier inpatient stays. The committee also prioritized designated agencies and special service agencies (DAs/SSAs) that provide community mental‑health services and have been repeatedly level‑funded, contributing to staffing shortages.

Behavioral‑health outreach and Howard Center: The committee flagged two governor‑recommended cuts — to first‑call/embedded clinicians in pediatric offices and to the Howard Center’s community‑outreach program in Chittenden County — and recommended retaining the community‑outreach funding in base for one additional year while DMH and providers clarify integration plans. Black and committee members emphasized that community outreach differs from mobile crisis response and that outreach teams build relationships with people who are not in an acute crisis.

Other one‑time and targeted requests: The Health Care Committee’s one‑time priorities include maintaining a SASH (Support and Services at Home) pilot in Brattleboro, moving Bridges to Health (a program serving agricultural workers and others through UVM Extension) from one‑time to base funding, continuing pilots such as Dulce (an embedded family support model in pediatric practices), and smaller items including training for forensic nurses, a modest family‑planning rate increase for Planned Parenthood of Northern New England, funding to develop a family‑medicine residency at Gifford (Maple Mountain Consortium), and one‑time support for an emergency‑service providers wellness commission that focuses on responder mental health.

Medicare‑savings alignment: The committee discussed aligning state Medicare‑savings programs so federal lists (LIS) and state QMB/QI eligibility match more closely. Black said aligning QMB up to 150% of federal poverty level could simplify enrollment and expand access to federal programs that pay Medicare cost sharing and prescription subsidies, and might yield administrative savings.

Process notes and follow‑up: Committee members asked staff and agency representatives detailed implementation questions — for example whether the three positions in the governor’s recommend count toward the five the Care Board requested — and Black said the committee will ask the Care Board and finance staff for clarification. The Health Care Committee’s priorities were presented as recommendations to Appropriations; the transcript records discussion and committee recommendations but no formal Appropriations vote on the Health Care packet during the session.

Ending: Members signaled a high level of concern about the 2025–2027 transition window and about preserving independent primary care and community outreach services. Appropriations staff and the Health Care Committee agreed to return with clarified budget language and staffing details for the Green Mountain Care Board and other contingency items before final budget actions.