Department of Mental Health expands alternatives to emergency departments; seeks sustainable funding as pilot grants expire

Department of Mental Health officials told the House Appropriations Committee on Feb. 5 that Vermont has a patchwork of "alternatives to emergency departments" (sometimes called mental health urgent cares) and that the state is working to expand and align those programs with 988 and enhanced mobile crisis services as current grant funding expires.

"Alternatives to emergency departments is a critical piece of what is needed in our community," Deputy Commissioner Samantha Swee said, emphasizing that these programs let people seek crisis screening and supports in a community setting rather than at a hospital emergency room.

Why it matters: Department witnesses told the committee these alternatives can shorten the time to connect people with a designated agency and provide more therapeutic spaces than emergency rooms. Funding that currently supports many programs flows from HCBS FMAP dollars; that grant funding ends in March 2026. The department said it is requesting roughly $800,000 for the last quarter of FY2026 to sustain and evaluate the programs and to develop a regional approach.

Scope and locations: Swee and other presenters listed several programs across the state: Interlude (Addison County; adults only), Front Porch (Northeast Kingdom; all ages), Access Hub (Washington County; adults only), Howard Center's Mental Health Urgent Care (Chittenden County; adults only), psychiatric urgent care for children (PUC) by United Counseling Services in Bennington (ages 3—218), EPIC in Lamoille County (youth), a youth stabilization program in Windham and Windsor counties provided by HCRS, and CARES in Burlington (ages 6 and up), a partnership modeled after CAHOOTS that pairs police with EMT or nurse responders.

Data on timing and capacity: Contrary to some expectations, department staff said most calls and crises occur during daytime and early evening hours rather than overnight. Swee said 988 call data show most calls come before 9 p.m., with a peak window around 7 p.m. to 10 p.m.; very few calls come in during overnight hours. The department also said staffing agencies to extend into evening and overnight remains challenging and that designated agencies continue to operate 24/7 hotlines for immediate response.

Funding and service shifts: Several committee members asked how the programs are funded and whether local outreach positions would be cut. The department said many alternatives-to-ED programs were funded with HCBS FMAP grant dollars that expire March 2026; the Howard Center and Northeast Kingdom models are exceptions already funded differently. Deputy Commissioner Swee explained the department anticipates a shift from small, town-based general-fund outreach positions to an enhanced mobile crisis model that is Medicaid-billable and can provide a two-person 24/7 response team (often including a peer) and statewide dispatch via 988. "What we see here is a natural shift in what used to be non-billable to what's billable, and the 24/7 support for communities," Swee said.

Planned reductions and reallocation: The department identified a proposed reduction to the Howard Center community outreach line (general fund) that officials described as a reallocation rather than an elimination: the outreach functions outside Burlington will be rolled into the enhanced mobile crisis capacity so the services are billable and available at greater scale. The committee was also told an embedded clinician position in some pediatric offices has been vacant for years and the department proposes reallocating those limited resources toward systemwide functions that ensure families are connected to insurance and community providers.

Ending: Department officials asked the committee to consider short-term funding to bridge the grant expiration and to let the state analyze what program models work regionally before committing to a permanent expansion. Committee members pressed for further data on capacity, hours of operation and costs as the Appropriations Committee considers base funding and whether to convert grant-supported pilots into recurring appropriations.