Senate Health & Welfare receives primer on Vermont health care system, Medicaid and workforce pressures

Nolan Langwell of the Joint Fiscal Office told the Senate Health & Welfare committee that his “health care systems 101” briefing is “meant to lay out the landscape and also help level set” as lawmakers prepare for policy work this session.

The presentation walked committee members through Vermont’s providers, payers and regulators, with repeated cautions about outdated public data and several policy points the committee may revisit during Medicaid and budget deliberations.

Langwell said the state’s population increased from about 623,000 in 2019 to about 647,000 in 2023, and that an aging population is driving higher per‑person health costs. He described Vermont’s hospital system, federally qualified health centers, mental‑health providers and long‑term‑care capacity, then turned to payers and public programs.

Hospitals and providers

Langwell told the committee Vermont has 14 hospitals, including the University of Vermont Medical Center (UVMMC), the state’s only level‑1 trauma center. He said UVMMC accounted for the largest share of hospital patient revenue and for a notable share of emergency visits and inpatient days. Langwell said hospitals’ combined operating expenses reported in the most recent publicly available dataset were about $3.5 billion and cited roughly 238,919 emergency department visits in the referenced year.

Langwell said federally qualified health centers (FQHCs) play a major role in primary care: there are 11 FQHC organizations operating about 92 sites statewide and serving roughly 198,000 Vermonters, according to the materials he used.

On behavioral health, Langwell noted designated agencies and specialized service agencies (DAs and SSAs) administer community mental‑health services…