Vermont officials outline Medicaid’s $2.3 billion share of state budget and explain full 1115 “Global Commitment” waiver, including new housing authority not-y<

Vermont health officials told a legislative briefing that Medicaid accounted for roughly $2.3 billion of the state’s $8.7 billion appropriation in the most recent budget, equal to about 27% of the state appropriation, and described how the state’s 1115 “Global Commitment” waiver gives Vermont both federal funding and flexibility to pay for programs that would not otherwise qualify under the Social Security Act.

The Global Commitment waiver also recently granted the state authority to pay up to six months of rent or six months of medical respite for people experiencing homelessness, but officials said the authority is not yet implemented because it requires state funding and comes with CMS guardrails.

Why it matters: Medicaid’s size and the federal match rates behind it shape large swaths of Vermont spending. State officials told legislators that in addition to direct Medicaid spending, the waiver lets Vermont use federal matching dollars in ways other states generally cannot — including reinvestments and several targeted programs — and that changes to those waiver-authorized elements require federal approval.

Officials said about 197,000 Vermonters receive some form of Medicaid or Children’s Health Insurance Program (CHIP) assistance; roughly 150,000 use Medicaid as their primary coverage and another roughly 46,000 have a partial relationship with Medicaid (for example, receiving drug assistance while holding Medicare as primary). Total health spending for Vermonters across public and private payers was presented as roughly $8 billion (a cited 2020 number that…