House Appropriations hears DALE budget as nursing homes cite $14.5M emergency relief need

MONTPELIER — The House Appropriations Committee on Dec. 16 heard a budget adjustment presentation from the Department of Disabilities, Aging, and Independent Living (DALE) that laid out a $30,313,848 net increase across funds and multiple strains on the state’s long-term care system, including a $14,500,000 Emergency Financial Relief (EFR) request for nursing-home pressures.

Stephanie Gilmore, who identified herself as commissioner for DALE, opened the department’s briefing by reading its mission “to make Vermont the best state in the nation in which to grow old or live with a disability with dignity, respect, and independence.” She said the BAA request includes an Internal Service Fund increase for ADS of $312,878 and a collective-bargaining bonus for direct care workers totaling $2,396,001 spread across several programs.

Why it matters: DALE told the committee the EFR is not a general budget line but a targeted, emergency response intended to stave off facility failures. “It’s a forensic audit,” Gilmore said of the EFR review process, adding that requests are subject to deep review — one had been approved, one denied, and several were pending. Committee members were told the EFR is intended to prevent closures and preserve bed capacity in a system the department described as operating at roughly 88% occupancy and serving an older, increasingly complex population.

DALE staff described dynamics that have driven demand and costs: rebasing of nursing-home rates reduced the projected EFR need from roughly $21 million last year to $14.5 million this year; however, inflationary pressures, difficulty hiring licensed nursing assistants and rising complexity of resident care continue to strain operators. The department also noted a nursing-home Medicaid bed-day pressure of $9,642,202 and an estimated FY24 cost settlement for the Vermont Veterans Home of $963,267.

Committee members pressed DALE on accounting for internal service fund charges from ADS. A member asked whether the ADS increases represented undercharging in past years or new money; DALE answered that many ADS charges were initially held in central office pending allocation and that the agency had been about 18 months behind in billing, so much of the adjustment is an internal reallocation rather than new net spending.

Members also discussed the broader strategy for long-term care. Gilmore said DALE is planning five to ten years ahead on workforce, financial stability, quality and complex-care capacity and pointed to Mission Care as an example of targeted capacity-building. She highlighted the Age Strong Vermont 10-year plan, noting the department is in year two and will publish a year‑2 report outlining progress and cross‑sector partnerships.

On payer mix, the committee heard that nursing homes rely heavily on Medicaid funding; a member estimated Medicaid covers about 80% of nursing-home operations. DALE said it is pursuing opportunities to serve higher-acuity residents and to secure federal funding where available.

Next steps: DALE will provide additional detail on ADS charges and pending EFR requests when the department returns for a fuller review. The committee adjourned the DALE portion of the session and proceeded to a break before hearing the next departments.

(Reporting based on the House Appropriations Committee hearing Dec. 16; all direct quotes attributed to speakers appearing in the committee record.)