Senate committee reviews S.36 and Vermont’s residential substance‑use treatment system

Senate Health & Welfare Committee members heard detailed testimony on S.36 and the state’s residential substance‑use treatment system on Feb. 19, with public health officials, treatment providers and family advocates offering competing views on length of stay, Medicaid payment rules and gaps in aftercare.

Kelly Daugherty, deputy commissioner at the Vermont Department of Health’s Division of Substance Use Programs, told the committee that residential treatment in Vermont is delivered across a small number of Medicaid‑covered programs and that clinical assessment — not a fixed number of days — should determine length of stay. “Length of stay is based off of evaluation from a healthcare provider,” Daugherty said, adding that “it is not at all clinical best practice to define a predetermined need for a particular length of stay.”

The department and clinical witnesses framed the issue as a systems problem: Daugherty and Tony Folland, clinical services manager for the Division of Substance Use, described a continuum that includes hospital care, medically managed residential services (high intensity), clinically managed low‑intensity residential services, intensive outpatient and recovery housing. Folland emphasized relapse as common in a chronic condition and said residential care’s goal is stabilization before step‑down and long‑term engagement.

Why it matters: Witnesses agreed that gaps at transitions — especially the period immediately after discharge from residential care — are where people are most likely to relapse or re‑enter high‑cost services such as emergency care or the justice system. Several testifiers urged that payment and placement rules be adjusted so residential providers can offer longer, coordinated episodes of care for people with complex, co‑occurring needs.

Key testimony and perspectives - Department of Health: Daugherty said Vermont does not classify facilities as “short‑term” or “long‑term” and that Medicaid does not dictate a fixed length of stay. She explained limits imposed by the federal “IMD exclusion” and Vermont’s Section 1115 Medicaid waiver: because some residential facilities are considered IMDs (more…