Committee notes $45M in skilled nursing pressures, urges longer term rate and workforce review

Committee staff briefed members on Budget Adjustment Act requests tied to long‑term care and residential facilities, including an increase to Choices for Care Medicaid bed‑day projections and an emergency financial relief pool for skilled nursing facilities.

Staff reported an increase in projected bed‑day utilization that translates to an estimated $24.4 million in additional Medicaid day‑of‑care pressures (Choices for Care) and a separate $21 million request in emergency financial relief for nursing facilities, for a combined roughly $45.4 million in pressures. Staff said the day‑of‑care calculation reflected 77,755 additional days and that the cost per day used in the presentation was about $315.

Members noted the underlying causes include staffing shortages, inflation and the fact that some rate methodologies are based on cost data from earlier years (2021 figures cited) that do not reflect current operating costs. Staff described an existing emergency financial relief process that requires facilities to spend down and demonstrate need before receiving relief.

Committee members recommended the committee pursue a broader FY26 discussion with the Department of Vermont Health Access and the rate‑setting division about whether and how rates might be re‑based or updated more responsively to avoid recurring emergency relief requests. Staff also noted that Vermont has lost many residential care beds since 2020 and that preserving and sustaining residential capacity is a cross‑cutting priority.

The committee agreed to include these topics in FY26 oversight and to recommend the requested BAA adjustments in the near term while pursuing structural solutions for rate‑setting and workforce pressures.