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Northeast Kingdom agencies tell House Healthcare investments reduced waits but warn of risks from HCBS eligibility changes
Summary
Representatives from Northeast Kingdom Human Services and partner groups described reduced wait lists, a new urgent-care "front porch" and plans for crisis stabilization beds, while warning that proposed Home and Community-Based Services eligibility changes and frequent reassessments could destabilize people who rely on ongoing supports.
Representatives of Northeast Kingdom Human Services and partner providers told the Vermont House Committee on Health Care on Feb. 20 that recent state investments have expanded local mental-health capacity, cut children's wait times and kept most people out of emergency departments — but they urged caution about upcoming Home and Community-Based Services eligibility changes.
Kelsey (representative of Northeast Kingdom Human Services) said the agency now has no adult-service wait list and that children’s wait times have fallen from about one year to roughly three months after stepped-up funding and workforce growth. “When you invest, it makes a difference,” Kelsey said, adding that designated agencies serve as “training grounds for therapists, for case managers” and that roughly 90% of funding goes to staff.
The committee heard several concrete markers of expansion. Kelsey said the region’s crisis “front porch” urgent-care program has diverted people from emergency departments most months, with October and November showing 2% and about 4.5% of visitors going to the ED. NKHS is renovating two-to-10-day crisis-stabilization beds scheduled to come online in the fall, which Kelsey said will increase local capacity.
Why it matters: committee members and providers framed these programs as both a public-health response and a cost-control measure. Kelsey noted that home- and community-based providers relieve pressure on hospitals, law enforcement and primary care by keeping people in their communities or providing step-down care after inpatient stays.
Providers described persistent access challenges. Kelsey said psychiatric specialty access, especially for children, remains constrained: referrals to Dartmouth or UVM can carry year-long waits, prompting NKHS to provide monthly psychiatric consultation to pediatricians and to hire a medical director, Pat Daley, to increase local capacity. Transportation and geography also shape access: the Northeast Kingdom covers about 2,000 square miles, and NKHS logged just under 2,000,000 miles of client transportation last year — a cost Kelsey estimated at about $1,200,000.
Committee questions focused on pending policy changes. Daisy (committee member) asked whether changes to CRT eligibility and a shift of some HCBS services onto a state plan could cause people to lose services. Kelsey said implementation and reassessment processes are the core concern: “I do worry that people could lose a higher level of care, which would, you know, have them become destabilized,” she said, noting the need for training and careful reassessment protocols ahead of a July 1 implementation date mentioned in the hearing.
Providers also discussed homelessness and housing instability as drivers of crisis-care use. Kelsey said shelters in St. Johnsbury are full, there is no shelter in Newport, and outreach and motel placement are being used to manage overflow. Amanda Cochran of Umbrella (the regional domestic-violence nonprofit) added that her programs manage motel pools and operate supervised visitation services, and that shelter capacity for people fleeing domestic violence is limited.
The testimony emphasized coordination among hospitals, community-based organizations and law enforcement. Kelsey highlighted partnerships with Northern Counties Healthcare, North Country Hospital and other regional hospitals, and said accountable-health-community planning and a NEK-wide community health needs assessment give providers a shared data source for planning.
The committee did not take any formal votes on these items. Providers asked lawmakers to sustain and consider expanding investments that support home- and community-based services and local crisis capacity while working with agencies to ensure reassessments and eligibility changes do not inadvertently remove needed supports.
For context, Kelsey said NKHS has been evolving alongside the statewide CCBHC (Certified Community Behavioral Health Clinic) rollout and that many of the region’s innovations have drawn interest from other states and regions. She asked for continued legislative support for workforce and program investments that keep care local and reduce higher-cost hospital use.
