Medicaid 101: JFO and AHS brief legislators on who is covered, financing and data gaps

Noel Manuel of the Joint Fiscal Office introduced a Medicaid overview on Jan. 16 and said the session would cover basic definitions, Medicaid finance and the state’s Global Commitment waiver.

Ashley Berliner, director of Medicaid policy at the Agency of Human Services, told the committee that Medicaid is a state–federal program that provides coverage primarily for low-income children and adults, and for older adults and people with disabilities. “Medicaid is a state federal program, primarily for low income children and adults,” Berliner said, adding that the program is financed through a partnership of state and federal dollars and that each state’s Medicaid program looks different because of that state–federal discretion: “If you’ve seen one Medicaid program, you’ve seen one Medicaid program.”

Why it matters: Medicaid is a major component of state health spending and covers a large share of the population in Vermont. Berliner said about 24% of Vermonters were covered by Medicaid in 2021; she noted the figure is from 2021 and that the number is unlikely to have changed dramatically but could be updated once surveys and analyses are complete.

Coverage and program distinctions - Medicare v. Medicaid: Berliner reminded the committee that Medicare is a federal program (primarily for people 65 and older and certain disabled individuals) and the state has no jurisdiction over Medicare funding; Medicaid is a state–federal partnership and the state makes policy choices within federal rules. - Population served: The JFO presentation cited a 2021 estimate that about 24% of Vermont residents had Medicaid coverage. Presenters noted a broader trend of increasing shares of government coverage (Medicaid and Medicare combined) in recent years.

Financing and data issues - Berliner described Medicaid financing as a joint state–federal responsibility and said the state operates Medicaid under a federal framework and waiver (the Global Commitment waiver was referenced as the state’s organizing agreement for many Medicaid-funded services). - The presenters said some source data the committee expects—such as the Vermont Household Health Insurance Survey and the Green Mountain Care Board’s expenditure analysis—are temporarily delayed or lagged; the budget included funding for a new household insurance survey to fill gaps.

Operational notes and limitations - Berliner warned that some numbers in the presentation were outdated because source reports have not been updated yet, and she identified the household insurance survey and an expenditure-analysis report as near-term fixes being funded or pursued. - Committee members asked clarifying questions about Medicare v. Medicaid and about specific data sources; presenters agreed to provide follow-up material where available.

Ending The Medicaid overview was presented as a high-level situational briefing; staff told the committee that updated surveys and expenditure analyses are expected to provide fresher data during the budget cycle and that AHS would be available for deeper technical follow-ups.