Department of Vermont Health Access requests midyear budget increase, $10M provider stabilization and pharmacy procurement after redetermination shortfalls

The Department of Vermont Health Access (DVHA) told the House Appropriations committee on Jan. 23 that it is asking for a midyear adjustment to its FY25 budget to cover higher-than-expected Medicaid costs per enrollee, a one-time $10 million provider stabilization fund, and initial funding to begin procurement of a new pharmacy benefit management system.

Daisy, Department staff, the agency’s presenter, said the agency’s administration line now projects $179,000,000 in spending authority after adjustments and that the administration request includes a $331,000 gross item to hire temporary staff “to help us clear the backlog of our agent blinded disabled population in the redetermination. We have a backlog within the vicinity of 1,500 still.”

The midyear program adjustment seeks approximately $83,500,000 in all funds across DVHA’s program lines, the presenter said, driven primarily by a higher cost per case than the agency projected after the federal unwinding and subsequent redeterminations. “The caseload projection stayed consistent with our expectations. It's the cost per case for the folks that are in our caseload that we got wrong last year,” Daisy said.

Why it matters: The requested increases reallocate both state general fund and federal Global Commitment funds and affect provider payments and planned procurements. Committee members pressed DVHA for detail about pharmacy impacts, provider relief criteria and the scope of the budget ask.

Pharmacy benefi…