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Vermont DOC touts Section 1115 waiver and rising health needs among incarcerated population
Summary
Department leaders told the House Appropriations Committee that incarcerated Vermonters have high medical and behavioral‑health needs and that a Section 1115 Medicaid waiver, expected Jan. 2026, will allow Medicaid coverage 90 days before release for sentenced individuals.
Nick Dimelon, Commissioner of Corrections, told the House Appropriations Committee on Feb. 12 that the health needs of people in Vermont correctional facilities have increased and that the department is redesigning health services to respond.
Dimelon said many people entering the system arrive with multiple chronic conditions and substance‑use disorders and noted several data points: "something like 97 percent of our population are on prescription medication," with an average of "5 and a half" prescriptions per person; about 60% on psychotropic medications; and nearly 70% on medication‑assisted treatment for opioid use disorder.
Dimelon described a health‑system redesign and a change in contractors about 18 months prior that he said "has gone quite well." He highlighted an approved federal Section 1115 Medicaid waiver that will allow states to expand Medicaid services to people up to 90 days before release from incarceration. He said Vermont is among the first states accepted for the waiver and estimated the program will affect about 1,400 people in its first year. "The 1115 waiver will give us 90 days to connect folks with primary care providers, get them enrolled in Medicaid, help them with bridge prescriptions," Dimelon said.
Under current federal rules, Medicaid eligibility generally stops on incarceration and resumes upon release; the waiver changes reimbursement rules for pre‑release services for sentenced individuals. Dimelon said the waiver is a combined effort between the Department of Vermont Health Access and the Department of Corrections and estimated Vermont's waiver implementation for January 2026, citing time needed to build Medicaid billing systems.
Committee members asked for scope and cost estimates; the department said the estimate of about 1,400 people is included in the department's budget "ups and downs" and that savings must be reinvested in reentry services, including care management through the Vermont Chronic Care Initiative.
No formal committee action or vote was taken on the health items during the presentation. The department said it would refine cost and utilization projections as the waiver launch approaches.
