Agency of Human Services officials told the House Appropriations Committee on Jan. 14 that HR 1 will change who qualifies for Medicaid, increase the frequency of eligibility renewals for expansion enrollees and add a new work/community‑engagement test that will require significant administrative work.

"A lot of the provisions that Ashley has described, hit on the Medicaid program either financially or in our capacity," said Addie Stromilo, deputy commissioner of the Department of Vermont Health Access (DVHA). Stromilo said the agency is focusing on three major eligibility provisions with near‑term implementation timelines.

First, Stromilo said HR 1 will block eligibility for certain categories of noncitizens — including some asylees and refugees — effective Oct. 1, 2026. "It's a little bit hard to predict the number of impacted members because ... we don't collect this level of detail on people's immigration status," she said, but added AHS's "best guess" is that the number affected in Vermont is in the hundreds.

Second, Stromilo said the bill shortens renewal (redetermination) frequency for the Medicaid expansion (the "new adults") from every 12 months to every 6 months. She said the expansion population is about 55,000 people and estimated that the change would mean roughly a 30% increase in eligibility workload in fiscal year 2027; AHS said it has staffing projections to support that work and will include those needs in budget materials.

Third, Stromilo described the statutory "community engagement" requirement, which she equated to a work requirement for the expansion population. "This requires members to demonstrate 80 hours per month of work, community service, or education as a condition of Medicaid eligibility," she said, and noted statutory exceptions for pregnant individuals, those who are medically frail and certain caregivers. AHS estimated the additional verification burden would affect about 30,000 members who will face new paperwork and documentation demands.

Committee members pressed AHS on the fairness and practicality of the changes. Representative Tom Stevens said the policy framing risks creating an inaccurate impression that people on Medicaid do not work. Stromilo acknowledged that DVHA does not systematically track employment status and that income is used as a proxy in many cases, making verification more complex.

Members also asked about IT capacity and whether federal match supports implementation. Stromilo said DVHA will modify its eligibility vendor contract, that there is an enhanced 90/10 federal match for certain IT work, and that administrative operations will shift toward the state with costs reflected in budget requests.

Stromilo warned of a particular transition risk for people who lose Medicaid for noncompliance with the work requirement: under HR 1 the same exclusions can carry into the marketplace, meaning those individuals may be unable to receive premium assistance for qualified health plans and could be left without a straightforward pathway to subsidized coverage. She described the issue as a potential "stuck" population that will require regulatory guidance and mitigation.

What happens next: AHS said it will inventory affected populations, present staffing and IT cost estimates, consult with attorneys about statutory language and return to the committee with detailed fiscal and operational plans. The committee did not take formal action at the hearing.