Witnesses tell House Human Services Committee H.13 needed to address Medicaid shortfalls, workforce and wait lists

At a House Human Services Committee hearing on H.13, witnesses including providers, advocates and family members told lawmakers that current Medicaid payments for assisted living and residential care fall short of providers’ costs and contribute to closures, staffing shortages and long wait lists.

Helen Laban, executive director of the Vermont Health Care Association, told the committee that assisted living, residential care and nursing facilities in Vermont provide about "6,000 beds statewide in this category." She summarized findings from a 2023 rate study, saying the analysis showed "an eye‑popping 79% there for ACCS and then up to 60% more needed for ERC," referring to assisted community care services (ACCS) and enhanced residential care (ERC). Laban said the ACCS rate was increased by the full 79% in state fiscal year 2024 but ERC was not, and she said getting ERC rates to cover cost remains "one of our goals."

Molly Dugan, director of policy and strategic initiatives at Cathedral Square, described how those gaps play out on the ground at two licensed assisted‑living communities her organization operates. Cathedral Square’s downtown Burlington assisted living has 30 apartments (it had 38 until the facility took eight units offline in 2021 because of workforce shortages), and its Williston memory‑care site has 14 apartments. Dugan said Cathedral Square had "302 people on our wait list for our downtown property" and "118 people on that wait list" for the memory‑care site. She said one facility’s 2024 budgeted agency (traveler) staffing cost was $200,000 but the organization actually paid about $788,000.

Kirsten Murphy, executive director of the Vermont Developmental Disabilities Council, framed the issue for Medicaid‑funded developmental‑disability services and urged more regular reviews and transparency. Murphy said the system has moved toward cost‑based rates and that payment reform should improve participants’ ability to see how their individual budgets are used and to get the hours they were assessed to need. "We need to have regular rate reviews so we keep up with inflation. It's that simple," she told the committee, and she said the state plans to publish cleaner utilization data using 2024 data at the end of February.

Parents and family members described daily impacts when budgeted supports are not delivered. Laurie Mumley, a parent and member of the Developmental Disabilities Housing Initiative, cited an informal DDHI survey in which she said "18% of the families are receiving 0, 0 of the hours that their family member had been determined." Mumley said families are often paying private caregivers well above state rates to obtain support and that 26% of responding families reported leaving jobs or reducing hours because of caregiving needs. Donna Roberts, another parent, recounted that her son, approved for 12 hours per week, currently receives "just 4 hours of support per week." Both parents explicitly said they support H.13 and urged lawmakers to ensure rate increases reach direct support workers.

Witnesses identified several recurring themes: geographic variation in available beds and services (witnesses noted openings concentrated in Chittenden and Washington counties), uncertainty about how many licensed facilities actually accept or utilize Medicaid (licensing data and utilization data are kept by different state units), and the cost pressure created by reliance on agency/traveler staff when hiring and retention fail. Multiple witnesses called for a predictable, periodic rate review process (one estimate offered during testimony suggested a more intensive "true‑up" study about every five years, with more frequent adjustments for inflation), and for any rate increases to be tied to wages for direct support professionals.

Committee chair Representative Teresa Wood closed the hearing by saying the committee expects to continue work on H.13: "I'm hoping to wrap up testimony on H.13 next week and, actually start some markup on 13," she said, and staff noted the committee also plans additional budget hearings in coming days.

The committee did not take a formal vote on H.13 during the hearing; witnesses provided testimony and several said they "support H13."