House Appropriations Committee receives 'Medicaid 101' briefing on costs, federal match and waiver

MONTPELIER, Vt. — On Jan. 14, 2025, the Vermont House Appropriations Committee heard a “Medicaid 101” briefing from Nolan Langloan, principal fiscal analyst at the Joint Fiscal Office, who outlined Medicaid’s share of state spending, the federal matching formula known as FMAP, and Vermont’s Global Commitment Section 1115 waiver.

Langloan said Medicaid accounted for roughly $2.3 billion in gross spending in the most recent published figures and made up about 27% of the state’s total appropriations in fiscal 2024. “Medicaid is complicated,” Langloan said during the presentation, noting that 197,000 Vermonters receive Medicaid or CHIP and that about 151,000 people—roughly 23% of the state’s population—have Medicaid as their primary insurance.

The presentation positioned Medicaid as one of the state’s largest budget items after K–12 education and explained how federal matching affects state costs. Langloan described FMAP, the Federal Medical Assistance Percentage, as a three‑year rolling formula tied to per‑capita state personal income; he said Vermont’s regular FMAP was about 59.01%, meaning the state share is about 41.2%. Langloan summarized the fiscal leverage: “For every $1 we put in, we’re getting $2.43 in service,” an explanation of the combined federal‑state spending multiple tied to that match rate.

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