Appropriations committee receives plan for Medicaid rate studies covering home‑and‑community‑based services

The House Appropriations Committee on Feb. 13 considered H.13, a bill directing the Secretary of Human Services to determine payment rates and a methodology for Medicaid‑funded home‑and‑community‑based services (HCBS) and for designated and specialized service agencies. Committee members were told the bill requires rate studies and reporting but does not itself appropriate new funds.

Dan Noyes, a member of the Human Services Committee who presented the Human Services strike‑all recommendation, said the bill establishes a definition of “home and community based services” under Title 33 that encompasses long‑term supports for older adults and adults with disabilities provided outside nursing homes, including enhanced residential services, home health and hospice, adult day rehabilitation and assistive community care services. The language also brings designated and specialized service agencies under the Title 33 rate‑setting framework.

“[The bill] directs the Secretary of Human Services to determine payment rates for the providers of home and community based services that are reasonable and adequate to achieve the required outcomes for the populations they serve,” Noyes said during the presentation.

Key elements: the bill directs the Secretary to establish a methodology that (1) requires a schedule of rate studies at least once every five years for each service type; (2) provides a predictable timeline for redetermination of base rates; (3) includes a process for annual inflationary adjustments to the extent permitted by federal rules; (4) accounts for provider financial impacts from client absences; and (5) must use Vermont labor market rates and Vermont operational costs. The bill also directs the agency to establish a process by which a provider at imminent risk of closure may request extraordinary financial relief; the statutory process would not itself appropriate funds.

On timing and fiscal effect, committee members were told that the bill requires the Agency of Human Services (AHS) to produce an implementation report by Jan. 15, 2026, describing methodology and a proposed schedule for Medicaid rate studies and that the bill “takes effect on passage.” A fiscal analyst told the committee there is no fiscal note attached because H.13 requires studies and methodologies rather than an immediate increase in reimbursement rates. He added that the extraordinary‑relief process could generate future appropriation requests depending on how the agency designs relief, but the bill does not obligate AHS to pay grants or awards.

Committee members pressed for clarity on what counts as a specialized service agency (SSA). The committee was given the Department of Disabilities, Aging and Independent Living’s definition: an SSA is an organization contracted by the state to provide developmental‑disability services in the community; the transcript includes SSA names used by the department, including Champlain Community Services, Families First, Green Mountain Support Services, Lincoln Street Incorporated and Specialized Community Care.

Action taken: Appropriations voted to accept the Human Services committee recommendation (strike‑all) on H.13 and advance the bill for further consideration. The Human Services committee vote to report the bill was recorded in committee as 11 in favor.

Why it matters: supporters said the bill will give appropriators and policymakers clearer, consistent data about the adequacy of current Medicaid reimbursement rates and a predictable schedule for studies so funding requests can be evaluated against an articulated methodology. Opponents or members skeptical of immediate costs noted that the statute directs studies and methodology but does not itself appropriate funds to pay higher rates.

Next steps: the committee advanced H.13 for further legislative consideration; AHS is expected to return with the implementation report and rate‑study schedule as required by the bill text.

Speakers quoted in this article are drawn from committee proceedings and include only those listed in the meeting record: Dan Noyes (Human Services Committee member); Jen Harvey (Office of Legislative Council); and a fiscal analyst identified in the meeting record as Fiscal Analyst, Joint Fiscal Office (name not specified in the transcript).