Vermont health advocates outline help for consumers and outreach plan as Medicare Savings Program expands

Mike Fisher, chief of the Office of the Health Care Advocate, and Emma Chavez, a health policy analyst with the same office, briefed a legislative committee on Jan. 16 on the office’s constituent services and outreach plans as eligibility for the state’s Medicare Savings Program widens.

Fisher said the office is available to any Vermonter who needs help with access to care, billing disputes, enrollment in public programs or other insurance problems: “When somebody is just pulling their hair out and they cannot solve this problem on their own, we are the people who hopefully can cut through the red tape and get a resolution that works for folks.”

The presentation laid out why the work matters and how advocates handle cases. The HCA said its staff of about 15 has assisted more than 70,000 Vermonters since the office was created by the legislature in 1998, and that the team combines a frontline advocacy unit with a policy team that participates in state regulatory proceedings before the Green Mountain Care Board, the Department of Vermont Health Access and the Department of Financial Regulation.

Case examples given to illustrate typical work included: a 24‑year‑old recently out of college with a new employer offer; a household that faces a large increase in employer family premiums but whose children may qualify for Dr. Dynasaur; a pregnant, undocumented Vermonter who may qualify for the Immigrant Health Insurance Plan and emergency Medicaid for labor and delivery; and a single retiree struggling to pay Medicare Part B and prescription costs who may qualify for the Medicare Savings Program and federal low‑income subsidy.

Chavez explained how recent federal and state rule changes affect families and individuals. On the longstanding “family glitch,” she said the Biden administration’s 2023 federal rule change allows family members to seek financial help through Vermont Health Connect even when one spouse has an affordable single coverage offer through an employer. She summarized the practical guidance advocates give in those situations and said the office helps people navigate multiple programs simultaneously.

Fisher and Chavez described language‑access and referral practices the office uses. The HCA provides written materials in multiple languages, uses telephone translator lines for live help, translates key applications such as the Immigrant Health Insurance Plan into Spanish, and partners with community organizations and clinics to reach immigrant and farmworker populations.

On outreach tied to the Medicare Savings Program expansion enacted by the Legislature last year, HCA staff said they are tracking clients who will become newly eligible on Jan. 1, 2026, and plan targeted enrollment help. Fisher said the agency has discussed necessary state plan amendments with state agencies and expects federal approval and implementation to begin Jan. 1, 2026. He said advocates keep a running list of clients who are currently not eligible but will be once the expansion takes effect so they can do outreach promptly.

Fisher highlighted programmatic and budget details the office shared: the HCA reported saving Vermonters an estimated $3.6 million in the prior year and said its state appropriation was about $1.8 million the prior year and the current appropriation is just over $2.0 million. Staff emphasized that some large program benefits are federally funded, including the Low‑Income Subsidy for prescription drugs and several levels of the Medicare Savings Program.

The presentation concluded with practical referral instructions for legislators: advocates said they need constituent permission to share case details, asked that referrals include a brief description of the issue and contact information, and offered an online intake form, helpline and direct email to the advocate team. Fisher provided business cards and said the office will coordinate with area agencies on aging and SHIP counselors for the upcoming MSP outreach.

The briefing included repeated requests from legislators for county‑level or district‑level counts of affected people; HCA staff said their case data are useful as a directional indicator but likely undercount the universe of Vermonters with problems and recommended county‑level estimates rather than district‑level counts.

Looking ahead, the HCA said it will continue to press for improvements to dental coverage for adults, private‑equity regulation in healthcare, and further work on the Medicare Savings Program and VPharm pharmacy assistance options.