Vermont disabilities, aging agency briefs Appropriations on midyear budget pressures, nursing home relief requests

Commissioner Jill Bowen, commissioner of the Department of Disabilities, Aging, and Independent Living, told the Senate Appropriations Committee on Jan. 31 that the agency’s midyear budget adjustment request includes multiple items to address nursing home and long‑term services cost pressures and collective‑bargaining increases for direct support workers.

Bowen said the department’s priorities reflect Vermont’s aging demographics and its multisector 10‑year plan, Strong Vermont, and summarized divisions and services that serve older Vermonters and people with disabilities including Choices for Care, residential supports, case management, respite and rehabilitation services. “Our mission statement is to make Vermont the best state in the nation in which to grow old or live with a disability, with dignity, respect, and independence,” Bowen said.

Why it matters: committee members pressed the department on where midyear carryforward and reserve funds can be applied and how ongoing cost pressures for nursing homes are being handled. The department said a statutory 1% reserve is used to prevent implementation of a high‑needs wait list and that only funds above that reserve are available for reinvestment.

Key details presented

- Nursing home financial relief: The department estimated roughly $21 million in extraordinary financial relief (EFR) requests for the remainder of the fiscal year, reflecting both amounts already approved and anticipated future requests. Bowen said about $17 million has been executed in EFR orders to date, with an average EFR request of about $1.5 million, leaving room for roughly three to four additional requests under current estimates.

- Bed‑day pressure and usage: The agency tied nursing home Medicaid “bed‑day pressures” to both utilization and acuity changes; the presentation included an estimate of 77,755 bed days tied to $24.5 million in pressure.

- PDPM acuity methodology: Committee members asked about the nursing payment methodology shift to the Patient‑Driven Payment Model (PDPM). The department estimated the PDPM conversion accounts for about $1.3 million of increased cost because PDPM calculates slightly higher acuity for some residents.

- Collective bargaining and workforce supports: The midyear ask includes increases tied to a state collective‑bargaining agreement for independent direct support workers. The department described a $14.75 statutory minimum hourly rate and a year‑one retention and recruitment bonus in the two‑year agreement; Bowen said the first‑year retention bonus is reflected in this budget adjustment. The department also said it will launch a recruitment campaign highlighting direct‑care opportunities.

- Carryforward and reserve rules: Committee members asked about $729,986 in carryforward in Choices for Care and whether statute required reinvestment. Department staff cited an internal policy and statutory framework that permits up to a 1% reserve of the previous year’s expenses; amounts above that threshold can be reinvested, but the department said the most recent closeout did not exceed 1%.

- Veterans’ home and other items: Bowen noted a veterans’ home cost settlement in the midyear request in the low‑millions range and described a technical fund‑coding change ($1.0 million) related to grant administrative accounting.

What committee members asked and direction given

Committee members pressed for a breakdown of executed EFRs and what remains in the estimate; the department said it would provide a list showing the approximately $17 million already executed and the remaining estimate to reach $21 million. Members also asked about timing of the nursing rebasing scheduled to begin in fiscal 2026; staff said the rebasing is intended to better align rates with recent costs and that it should help stabilize but not eliminate EFR needs.

No formal votes were taken. The committee requested follow‑up materials including (1) a list of executed EFR orders and amounts, (2) details on the Choices for Care carryforward and statutory reserve calculation, and (3) a clearer accounting for internal service and service‑level agreement charges shown in the department’s exhibit.

Ending: The committee said it would hear additional budget items and the treasurer’s office in subsequent meetings and asked the department to supply the requested breakdowns before the next hearing.