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Independent primary‑care leaders warn of 2026 funding gap as OneCare winds down, AHEAD delayed
Summary
Leaders from Primary Care Health Partners told the Senate Health & Welfare committee that the end of OneCare Vermont and a delayed CMS AHEAD start risk cuts to services and clinic closures in 2026 without state or other funding to replace ACO‑backed payments.
Leaders of an independent Vermont primary‑care group told the Senate Committee on Health & Welfare that the end of OneCare Vermont and a delayed federal AHEAD model create a looming funding gap in 2026 that could force offices to cut services or close.
Toby Sadkin, a family physician and chair of Primary Care Health Partners, said the group — “the largest physician owned independent primary care group in Vermont” — cares for “over 30,000 Vermonters” from 10 office sites with 23 physician partner owners and about 200 employees. He told the committee the practices were stabilized by OneCare’s comprehensive payment reform program and related population‑health investments and are at risk without replacement funding.
“This really is serious and imminent,” Sadkin said, summarizing the group’s concern about 2026 if OneCare’s programs end and the AHEAD model does not begin until 2027.
John Aislin, chief operating and financial officer for Primary Care Health Partners, described the comprehensive payment reform (CPR) program as a mixture of hospital and state investments that provided monthly capitation, population health payments and incentives for quality that, together with state Blueprint funding, materially improved independent practices’ finances. He told the committee that losing CPR and population‑health payments would create a large shortfall; for their group those two streams combined are about $3,000,000.
Sadkin and Aislin said the loss would not only end programs such as care coordination and expanded mental‑health access but could force clinics to reduce staff or close. Aislin said the total of programs that supported Primary Care Health Partners “fund nearly $5,000,000” across their offices and urged the legislature to identify mitigation for 2026.
Their written submission and testimony included specific funding requests they asked the legislature to consider for 2026: $5,500,000 to cover population and CPR funding gaps for Medicare patients, $10,800,000 to replace lost Medicare payments that supported Blueprint‑funded services, $3,100,000 to continue Blueprint mental‑health and substance‑use programs, and $635,000 to sustain DULCE programs. They also urged an inflationary 3.5% increase to the Medicaid professional fee schedule and asked Vermont Medicaid to continue directing investments to primary care should ACO‑based mechanisms lapse.
The committee acknowledged the testimony and said policy members will pass the information to the Appropriations Committee when it develops budget recommendations: “We will be looking at this in context of our recommendations to the Appropriations Committee,” a panel member said.
Ending note: Committee members said they hear the urgency and will review submitted funding requests as they finalize policy and budget recommendations for 2026.
