House Health Care reviews $10.8 million proposal to bridge Medicare payments for Blueprint programs

House Health Care members on Feb. 25 heard from Blueprint and Agency of Human Services officials about a governor’s budget proposal that would provide $10.8 million in interim funding to replace Medicare payments to three programs tied to the Blueprint for Health model while Vermont transitions between all‑payer arrangements.

Blueprint health services researcher Abby Armstrong told the committee that Medicare currently makes per‑member‑per‑month payments to patient‑centered medical homes (PCMHs), core community health teams (CHTs) and to Support and Services at Home (SASH). Armstrong said the federal agreement that allows Medicare to make those non‑standard payments “is coming to an end this year,” meaning the Medicare payments will stop unless a new agreement begins.

The administration’s $10.8 million proposal covers three Medicare contributions: about $2.6 million for the PCMH monthly payments; roughly $3.1 million for the core CHTs; and approximately $5.1 million that Medicare currently pays to SASH, which Armstrong noted is administered by Cathedral Square. Armstrong told the committee the $10.8 million is split roughly between state general fund dollars — about $4.45 million — and federal matching funds of about $5.55 million.

Why it matters: committee members pressed officials to clarify what services and staff these dollars support. Armstrong said the Medicare PCMH payments represent roughly 25% of total PCMH funding and currently cover roughly 77,000 Medicare beneficiaries attributed to Blueprint practices statewide. She said Medicare’s share of CHT funding is about 30%, supporting roughly the equivalent of 30 full‑time positions statewide and paying for an estimated 7.1 million patient encounters annually when aggregated across reported encounter frequencies.

Agency of Human Services Medicaid policy director Monica Ogilby said AHS is supporting the interim funding plan to avoid a gap in essential services during the transition to a planned new all‑payer model in 2027. “The last thing we wanted to do was lose some of those essential services that had created traction and momentum,” Ogilby said, adding that the proposal aims to cover the Medicare contribution for a single calendar year while planning continues.

Committee members also sought detail about other payments and gaps that will result from the planned closure of OneCare Vermont, the state’s largest accountable care organization, on Dec. 31, 2025. Officials said some OneCare functions and payments are separate from the Blueprint‑administered items the $10.8 million covers. AHS and Blueprint staff told the committee they have not finalized which state entity would assume certain operational roles that OneCare currently performs, including analytics, quality‑improvement supports and distribution of several payment streams.

Officials provided additional figures for those separate gaps. Committee staff reported a total anticipated gap of $14.6 million for OneCare population health management payments; $4.8 million of that amount currently appears in the agency’s base budget, leaving a net remaining gap of about $9.36 million tied to the loss of the distribution mechanism. Separately, the committee discussed a $3.78 million total GAAP amount for comprehensive payment reform bridge funds, with portions already accounted for in existing budgets; officials said they would circulate a written memo with precise accounting.

Committee members repeatedly asked for written documentation. Sarah Rosenblum, deputy director of health care reform at AHS, said she would defer detailed operational descriptions of OneCare programs to OneCare Vermont but agreed to a follow‑up memo on finances. Ogilby also committed to providing the requested dollar amounts and further detail on which payments remain in base budgets and which will require new distribution mechanisms.

The discussion clarified scope limits for the governor’s $10.8 million line: Armstrong said it does not include other Blueprint programs such as spoke expansions, pregnancy intention initiatives, comprehensive payment reform payments, or ACO population health management payments. Officials repeatedly emphasized the distinction between Medicare payments the governor’s proposal seeks to replace for one year and other funding streams that will require separate decisions.

The committee asked staff to provide a written memo as soon as possible; members noted the committee’s budget work was scheduled to conclude later in the week. AHS staff said they would follow up with the requested financial detail and operational options for distributing funds previously handled by OneCare.