Committee prioritizes implementing 2023 rate study and boosts for community-based services

House Human Services reviewed proposed budget changes for home- and community-based services, recommending implementation of the remaining FY2023 rate-study increases and a mix of ongoing and one-time investments to shore up providers.

The discussion focused on completing funding tied to a 2023 rate study, raising reimbursement levels for services such as enhanced residential care (ERC) and personal-care/homemaker/respite services, expanding a HomeShare program into the Northeast Kingdom, increasing Meals on Wheels funding, and considering targeted one-time support for adult-day centers facing revenue loss from participant absences.

Why it matters: committee members and presenters said community-based providers face cost pressures from inflation, workforce and administrative fee increases that are built into state employee budgets but have not historically flowed to private or nonprofit providers. Members framed implementation of the 2023 rate study as a priority to reduce systemic inequities and stabilize services that support older Vermonters and people with disabilities.

What was proposed

- Implement FY2023 rate-study recommendations: Presenters recommended finishing the multi-year implementation that updates provider rates to the cost levels identified in the 2023 rate study. They proposed a $3.8 million general-fund increase to bring enhanced residential care (ERC) up to the 2023 rate levels and an additional $2.2 million for personal-care, homemaker and respite/companionship services; together these were presented as the top priorities to complete the 2023 rate-study adjustments.

- HomeShare expansion: Presenters proposed funding to expand HomeShare into the Northeast Kingdom to increase housing matches that help older Vermonters and people with disabilities remain housed. Presenters cited current statewide matches (about 274 unduplicated matches historically) and said uptake in a new region would depend on local start-up capacity; the number of expected matches in year one was not specified in the presentation and presenters said first-year uptake may be lower as programs ramp up.

- Meals on Wheels: The presenters proposed adding $2,000,000 general fund (about $4.85 million gross when accounting for Medicaid/global-commitment investment) to support meal providers. A presenter said the average cost per meal from a recent rate study is $13.43 and that augmenting state support would allow providers to invest in medically tailored meals and higher-quality food.

- 4% across-the-board increase for home- and community-based providers: Presenters recommended a 4% rate increase for many community-based provider categories (designated agencies, specialized service agencies, adult family care and ACCS) to prevent further erosion of reimbursements. Committee staff said the 4% figure was calculated on current reimbursement bases and may need adjustment once the 2023 rate-study increases are fully reflected.

- Conflict-free case management and DS case-management ramp: The governor’s budget proposes roughly $8.6 million to implement conflict-free case management required by federal rules. Committee staff noted the Developmental Services (DS) case-management piece involves creating a new contracting entity and may take several months to ramp up; staff estimated potential one-time savings (about $1.9 million gross) if ramp-up delays reduce near-term spending.

- Adult day centers and absentee-related revenue loss: Presenters reported that many adult-day providers face revenue loss when participants miss scheduled days (for transportation issues, medical appointments or weather). They estimated about $800,000 for six months of losses (roughly $2,000,000 annualized) and proposed a one-time general-fund payment to help stabilize providers while longer-term fixes are addressed in H.13 implementation work.

Committee direction and next steps

- Staff were asked to provide gross and general-fund amounts when possible, to reconcile whether the proposed 4% COLA should be calculated on current reimbursement rates or on rates after the 2023 rate-study increases, and to specify expected HomeShare start-up matches and Meals on Wheels targets for coverage estimates.

- Members agreed not to take an immediate vote. Presenters were told the department and staff will fold these priorities into the committee’s larger set of highest-priority asks for roll-up and will provide updated spreadsheets and language for committee review.

Quotes

"These all go back to the '23 rate study, which we started funding last year and the year before, but this would finish it up," a presenter said, describing the rationale for completing the rate-study implementation.

"It is grossly unequal," a committee member said of the disparity between state-employee budget treatments and community-based provider funding when discussing fee increases and administrative costs that affect private providers.

Clarifying details and unknowns

- Enhanced residential care (ERC) implementation: $3,800,000 general fund to bring ERC to FY2023 rate levels (presenters asked staff to add gross figures). - Personal-care/homemaker/respite services: $2,200,000 general fund proposed to align those services with FY2023 rates. - Meals on Wheels: $2,000,000 general fund (approximately $4.85M gross) to address average meal cost of $13.43; the split among federal Older Americans Act funding, Medicaid investments and local fundraising will vary by provider. - 4% COLA: Presenters listed $11,100,000 general fund (about $26.2M gross with Medicaid match) but staff cautioned the number should be recalculated if the 4% is applied after the 2023 rate-study increases rather than before. - Conflict-free case management: governor’s proposal ~ $8.6M; DS case-management implementation may take up to four months and could yield one-time savings of roughly $1.9M gross if pacing delays occur. - Adult-day absenteeism: estimated $800,000 for six months (about $2,000,000 annualized) in lost revenue; presenters described the request as one-time general-fund stabilization money because missed attendance cannot be retrospectively billed to Medicaid.

Who spoke (as identified in the transcript)

- Dan — presenter for Aging/home-and-community-based services priorities (staff/agency presenter, government) - Todd — presenter/staff member working on language and spreadsheets (staff, government) - Nolan — committee staff member assisting with budget numbers (staff, government) - Connor — executive director, HomeShare (nonprofit, referenced as potential implementation partner) - Anne — committee member who questioned rate and utilization assumptions (committee member)

Authorities referenced

- FY2023 rate study (DALE/department rate study) — referenced_by:["home-and-community-based-services-priorities"] - H.13 (statutory/implementation reference previously passed) — referenced_by:["home-and-community-based-services-priorities"] - Older Americans Act (federal funding source for Meals on Wheels) — referenced_by:["home-and-community-based-services-priorities"]

Discussion vs. decision

- Discussion: whether to complete 2023 rate-study implementation now, how to calculate COLA relative to rate-study increases, HomeShare expansion details and performance metrics, and how to structure one-time versus ongoing investments. - Directions: staff to provide gross/GF splits, to recalculate COLA figures if applied after rate-study adjustments, and to draft specific HomeShare and Meals-on-Wheels implementation language including coordinated-entry referral options. - Decisions: none final; presenters’ recommendations to prioritize rate-study completion and to consider limited one-time stabilization payments were recorded for roll-up.

Proper names

[{"name":"HomeShare","type":"organization"},{"name":"Meals on Wheels","type":"program"},{"name":"Older Americans Act","type":"other"},{"name":"H.13","type":"other"},{"name":"FY2023 rate study","type":"other"}]

Searchable_tags:["home and community-based services","rate study","ERC","HomeShare","Meals on Wheels","conflict-free case management","adult day centers"]

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