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Advocates urge Vermont to invest in community supports, Medicaid billing and consistent assessments
Summary
Witnesses told the Judiciary Committee that community-based supports, Medicaid funding and standardized assessments such as CANS are essential to reduce recidivism, preserve youth in least-restrictive settings and draw down federal funding.
Lauren Higbee, deputy advocate with the Office of Child, Youth and Family Advocate, told the committee that community services reduce racial disproportionality and recidivism and can be supported by federal reimbursement. "Medicaid is, you know, barge, for example, is a Medicaid funded service," she said, referring to balance-and-restorative-justice style programming that can be eligible for Medicaid when appropriately structured.
Higbee and Bernstein urged the committee to strengthen the state’s capacity to design Medicaid-reimbursable services for juvenile justice and child welfare populations. "Vermont should invest in some real high quality, high level expertise in developing Medicaid programs," Bernstein said, adding that the regulatory work is complex — including federal waivers and interagency coordination — but that the potential federal match can make community services financially sustainable.
On assessments, advocates flagged the youth assessment and screening instrument (YASI) currently used in some juvenile contexts and recommended exploring the Child and Adolescent Needs and Strengths (CANS) tool for broader, cross-system assessment. "The CANS is a nationally recognized evidence based assessment... other departments in Vermont use it," Bernstein said, arguing that shared assessment tools allow reassessment over time and better continuity of care as youths move between child-welfare and juvenile-justice services.
Lawmakers asked for examples of states that had successfully drawn Medicaid funding into juvenile services. Presenters named New Hampshire as a nearby example and said national technical expertise (including work cited in the Act 201 implementation plan) is available; they offered to provide follow-up specifics. Higbee emphasized the constitutional and statutory requirement that children be placed in the least restrictive setting consistent with their needs, and recommended prioritizing supports at the "shallow end" — community-based services — before expanding locked facilities.
Presenters noted the administrative and legal work required to translate programs into Medicaid-reimbursable services, including potential implications for privacy, eligibility and licensing. They asked the committee to fund expertise to develop programs and to consider phased IT and program development rather than large, single procurements.
