MONTPELIER — During the House Appropriations Committee’s Dec. 16 review of DALE’s BAA, members raised concerns about how a multi-part rate study was implemented and about missing inflationary increases for case managers under Choices for Care.

DALE explained that a market-rate study contained multiple components — including ACCS and a three-tier ERC (Enhanced Residential Care) structure — that were enacted in separate pieces by the legislature. Commissioner Stephanie Gilmore said when the ACCS portion was approved first it created a large increase that benefited the system overall; however, some providers that primarily serve ERC tier‑1 clients later felt disadvantaged when tier‑2 and tier‑3 increases were enacted, creating perceived inequities.

A committee member said some tier‑1 providers “had a harder time” absorbing the sequencing of increases; DALE noted corrective efforts, including allowing providers who meet higher-tier criteria to adjust and offering stabilization grants to affected providers.

Separately, committee members flagged that case managers were omitted from the inflationary increase granted to Choices for Care providers last session. DALE staff said they would provide exact figures but reported a working estimate: a 1% increase for case management would cost roughly $70,004.52 (gross). The department said it could provide more precise fiscal impacts if the committee directed inclusion.

A member also asked whether a cited $9,963,000 figure represented new spending or merely spending authority; DALE clarified that it was spending authority to allow the agency to draw down and expend additional federal funds that exceeded prior expectations.

Next steps: The committee’s policy subgroup will continue to examine ERC tier impacts, and DALE will supply a written cost estimate for including case managers in future inflationary adjustments.