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AHS outlines S.36 plan to merge stabilization beds, expand residential care and add correctional residential treatment
Summary
The Agency of Human Services told the Senate Health & Welfare Committee Feb. 27 that S.36 would rebuild crisis stabilization by merging public inebriate and mental‑health stabilization beds, expand residential treatment and recovery housing, add correctional residential treatment capacity, and use Medicaid tools such as a 1115 waiver for permanent supportive housing.
The Agency of Human Services (AHS) presented a multi‑part strategy to the Senate Health & Welfare Committee on Feb. 27 to expand Vermont’s continuum of care for people with substance use disorder, with specific budget and program proposals the agency said it would include in this year’s budget and related bills.
For the record, Jenny Samuelson, AHS secretary, led the presentation and said the agency’s proposals reflect a year of cross‑agency work and discussions with people with lived experience, providers, law enforcement and the judiciary. “With the emergence of stimulants and particularly with polypharmacy, we are beginning to see many, many more individuals and many more communities impacted,” Samuelson said, describing changes in the substance supply that affect treatment needs.
Key elements of the AHS package presented to the committee include:
- Crisis stabilization: Rebuild and merge existing public inebriate beds with mental‑health stabilization beds to improve staffing efficiency and provide co‑occurring care. AHS said the merged model would help address staffing shortages that have forced some communities to close inebriate programs.
- Sunset repeal for use of correctional placement in limited safety cases: The agency asked the committee to repeal a sunset provision that currently allows (in limited circumstances) transport to corrections when an individual cannot be safely housed elsewhere; AHS said the authority has been used as a safety backstop when no other clinically appropriate safe option exists.
- Residential continuum and payment model review: Require residential treatment providers to offer a full continuum of care (medical withdrawal through lower‑acuity supports) to reduce multiple transitions between levels of care. AHS said it will review payment methodologies to ensure incentives align with providing care for as long as patients clinically need it rather than imposing arbitrary time limits.
- Correctional residential treatment: Convert one correctional facility (the presentation referenced St. Johnsbury as the likely site for conversion) to provide residential‑level treatment for incarcerated people who would benefit from that level of care; AHS said the program would not expand incarceration but would extend residential services to people already in custody.
- Recovery housing and stable housing supports: AHS proposed expanding higher‑intensity recovery housing by 15 beds this year and emphasized a long‑term need for more units — the agency estimated a statewide demand of roughly 200–250 recovery housing units. Medicaid‑funded permanent supportive housing, enabled by a recently approved 1115 waiver authority, would pair housing with intensive supports for people with complex health and social needs.
- Reentry and navigation services: Using new CMS authority, AHS described a reentry services program that can provide intensive care coordination beginning up to 90 days before release from incarceration to ensure connections to treatment, identification and housing supports.
- Evidence‑based treatment innovations: The agency plans to expand contingency management and other evidence‑based interventions where appropriate and to pilot aligned crisis stabilization sites with a small number of designated provider organizations before scaling up.
Monica Ogilby, Vermont Medicaid director, described Medicaid initiatives that would backstop the continuum, including the permanent supportive housing option in the 1115 waiver and reentry services. Ogilby said the permanent supportive housing authority took effect Jan. 1 and that the agency would pair that with limited rental assistance for a narrowly defined population to help people transition to stable housing.
AHS said the proposal is intentionally multiyear for components such as recovery housing and transitional housing for people leaving corrections, because the state lacks the physical units to scale immediately. Committee members raised staffing and quality concerns for stabilization beds and asked for clarity on how length‑of‑stay decisions would be made; AHS said it will work with providers to design a payment model and decision processes that align clinical need with placement and length of stay.
The agency requested input on language to place in S.36 and said more detailed budget documents and draft contract language would be shared with the committee and stakeholders. No committee votes on S.36 were recorded during the session.
