Committee presses for bridge funding, AHEAD positions as primary care gaps loom

A state legislative health policy committee on Wednesday discussed a suite of health‑care budget requests aimed at shoring up primary care and behavioral‑health integration, and agreed to press the Legislature to fund two limited‑service positions that the Green Mountain Care Board says are needed to move forward with the AHEAD (all‑payer) model.

Committee members and provider representatives prioritized short‑term “bridge” funding for primary‑care payment reforms and said the positions tied to the AHEAD implementation are a must‑fund item to avoid losing federal model funds and to prevent program collapse.

The discussion centered on several interlocking requests submitted by the Vermont Medical Society and other provider groups: a bridge package to backfill population‑health per‑member‑per‑month (PMPM) payments and capitated payments (CPR) tied to OneCare; base funding and a possible expansion for the Blueprint for Health pilot that integrates mental‑health and substance‑use services (including a DULCE component for new families); workforce supports such as a proposed family‑medicine residency; and targeted pilot dollars for programs such as SASH for All.

Representatives of the Vermont Medical Society told the committee there is $10.8 million in the governor’s recommended budget for Blueprint, CHT patient‑centered medical homes and SASH, and identified two bridge asks they said were their highest priorities: a OneCare population‑health PMPM backfill and a CPR bridge for 19 independent primary‑care practices. The society’s materials and oral remarks indicated the OneCare/CPR requests total roughly $5.5 million for January–June of fiscal 2026 (a half‑year figure), and that these figures do not include funds drawn from the all‑payer model, hospital dues or Medicare dollars.

Committee members asked for clarifications on which payers the CPR payments cover; the Vermont Medical Society representative said she believed the CPR figure covered Medicare‑attributed patients but said she would confirm.

Cathedral Square, a nonprofit provider, told the committee its top priority is maintaining gap‑year funding in the governor’s budget to preserve the traditional SASH model and a related SASH for All pilot. Molly Dugan of Cathedral Square said the $400,000 one‑time SASH for All pilot serves nearly 300 adults and children in one locale and that losing that funding would eliminate services and jobs and hurt plans to scale the program statewide. Cathedral Square also listed priorities in descending order of importance: $75,000 for mental‑health clinicians in primary‑care settings, $40,000 for dental clinic expansion, $10,000 for in‑home Medicare wellness visits and a $2 million expansion fund for SASH beyond pilots.

Providers and committee members flagged uncertainty about several dollar amounts in the spreadsheet of requests. The transcript records varying figures for Blueprint expansion (references included both $3.1 million and $4.4 million) and a workforce residency ask listed at $4.6 million spread over four years. Participants repeatedly asked staff to confirm the correct line items and amounts; one staff speaker said the DIVA figure reported to the group was $4.431 million for the mental‑health integration and DULCE expansion.

A major portion of the meeting addressed staffing positions the Green Mountain Care Board says it needs to participate in AHEAD. Diane Lambert of the Green Mountain Care Board told the committee the board estimates it will need about 26 full‑time equivalents to operate the model long‑term and that five positions were the agreed‑upon minimum in the AHEAD agreement’s first year. Committee members noted the governor included three positions in the proposed budget; several legislators said the committee should ask the Legislature to add the two additional limited‑service positions so the board would reach the five‑position threshold and not withdraw from AHEAD. Committee members agreed they would “strongly support” funding the two additional positions and would include language tying those positions to implementation (money would revert if the AHEAD effort did not proceed), per staff counsel drafting.

Members also discussed a Vermont Care Partners request for a 6.2 percent rate increase for designated agencies and service providers; the committee considered aligning with Human Services Committee staff and proposed recommending a 4 percent increase as a consistent, cross‑committee ask.

Committee leaders said they will: (1) keep the governor’s recommended items on the spreadsheet and send all requests with a statement of support to Appropriations; (2) compile committee members’ ranked top five priorities using a points system; and (3) include explanatory language about why certain items are grouped together in the letter to Appropriations. Staff and several speakers emphasized a high implementation risk: many requests are contingent on federal AHEAD/all‑payer funding or on decisions by AHS and the Green Mountain Care Board.

The committee set a short break before members began ranking their top five priorities for the appropriation letter to the Appropriations Committee.

Ending: The committee did not take a formal recorded vote on any appropriation line during the session. Members left staff with instructions to confirm specific dollar figures on the spreadsheet, to draft language tying the two limited‑service positions to AHEAD implementation, and to present the compiled ranked priorities and clarifying figures at the next meeting.

Speakers referenced in this article appear verbatim in the meeting transcript and include provider representatives, Green Mountain Care Board staff, and multiple committee members.