Advocates tell Human Services panel H113 needed to set Medicaid payment rates so people can stay at home

Advocates from Vermont Legal Aid told the Human Services Committee that H113, a bill to establish a framework for setting Medicaid payment rates for home- and community-based services, is needed to keep Vermonters who are eligible for such services living safely in their homes.

Kylie Kiper, State Long Term Care Ombudsman at Vermont Legal Aid, said, “I am here in strong support of H113.” She told the committee her office regularly hears from Vermonters who cannot access the services they need to remain at home and said some people end up in long-term care facilities — sometimes out of state — because services are not available or staffed. “We hear from Vermonters every day who are unable to access the services they need to stay in their homes,” Kiper said.

Susan Garcia, staff attorney in Vermont Legal Aid’s Disability Law Project, also testified in support of H113. Garcia said the bill would “create a framework and a process, to determine what are the appropriate and adequate payment amounts for these services,” allowing the Legislature to make informed appropriation decisions. Garcia requested one specific drafting change: the bill’s written definition of “home and community-based services” explicitly mentions Choices for Care and the brain injury waiver but does not name services for people with developmental disabilities. She asked that the definition be revised to expressly include the developmental disabilities program.

Both witnesses gave examples the offices have seen. Kiper described a caregiver running out of eligible leave while trying to care for a partner with a progressive neurodegenerative disease; the family could not locate adequate in‑home services or a nearby long‑term care bed and was advised by a nurse to leave the person in an emergency room. Kiper said the closest available long‑term care bed the family found was “six hours away.” She also described a young man with traumatic brain injury who wanted to return to Burlington but could not secure enough community services and remained in a long‑term care facility, and a multilingual woman who, after a bad fall and hospitalization, lost her apartment and is now in a nursing home despite wanting to return to her residence.

Garcia explained that, as lawyers, Vermont Legal Aid often handles formal appeals when services are denied, but she is seeing a category of cases where eligibility and service plans are clear yet the services are not delivered because providers cannot fill staff positions. “When people don't get the staff support they need to live at home and to get out into the community, they end up being isolated and they suffer,” Garcia said, describing family caregivers who cut work or stop working because budgeted respite and in‑home supports are not available.

Committee members asked for data on how many Vermonters are placed out of state or remain hospitalized for lack of long‑term care placements. A member identified as Dr. Erdogan asked whether the witnesses had specific data on the scope of out‑of‑state placements. Kiper and Garcia said they could not provide representative statewide numbers from their intake; those examples were drawn from client contacts and casework and therefore anecdotal rather than a complete data set. Garcia also described a pilot Brain Injury and Developmental Disabilities Advocacy Project that conducts ombudsman‑style monitoring in a limited number of counties and directs people to VT Law Help for program information.

No formal vote on H113 was taken during the session. Committee members acknowledged the testimony and moved on to committee business, including time for members to work on budgets later in the day.

The committee did not adopt any committee amendments during this hearing; witnesses requested a drafting change to the bill’s definition of covered programs so that the developmental disabilities program is explicitly named alongside Choices for Care and the brain injury waiver.

The committee will consider the bill and any drafting changes in future committee work and appropriation deliberations.