Agency of Human Services recommends staying unified, proposes targeted changes including mental-health/substance-use integration

At a joint hearing of the House Health Care and Human Services committees, Agency of Human Services leaders presented findings from the Act 119 (2024) review and recommended the agency remain a single, unified executive branch entity while pursuing targeted reforms.

The agency framed its recommendation around risk, cost and client continuity. "So what our recommendation is is that we strengthen, keep AHS together and strengthen as a unified agency," Ted Fisher, principal assistant and communications director for AHS, said while reviewing Tier 1 findings. The report team said splitting the agency would impose high financial and service-disruption costs and would not necessarily solve coordination problems.

Why it matters: AHS is Vermont’s largest executive agency, serving hundreds of thousands of residents and accounting for a substantial portion of the state budget and workforce. The review was charged with producing options, cost–benefit analysis, and an implementation plan; a final report of recommendations is due by 2025-11-01, the presenters said.

Key Tier 1 recommendations

- Keep the Agency of Human Services unified. The review found widespread agreement that strengthening internal coordination and leadership is preferable to a disruptive structural split, given the agency’s cross-cutting health and human services mission.

- Strengthen the Department for Children and Families (DCF). The team reported that divisions inside DCF (for example, economic services and family services) operate with siloed cultures that impede coordination; the recommendation calls for investments in leadership, operational capacity and cross-division coordination rather than immediate reorganization.

- Integrate substance-use clinical and billing functions into the Department of Mental Health (DMH). The presenters said having separate provider and billing systems for mental health and substance-use services creates friction for people with co-occurring conditions. "As many as 80% of the individuals in both these systems have co-occurring" needs, the secretary’s team said, supporting the case for integration while noting there was not unanimity on the precise approach.

- Retain DOC within AHS and pursue operational remedies. The report team visited correctional facilities and probation/parole units and concluded many frontline staff and partners see operational benefits from remaining within AHS; the team recommended strengthening coordination and operational capacity rather than removing DOC from the agency.

Method and caveats: The report team described a multi-phase process of broad public comment, focused interviews, thematic analysis and prioritization. Presenters emphasized that while some Tier 1 items could require legislation, many recommended changes could be advanced administratively. They also cautioned that the "how" of any structural or program change matters as much as the decision to pursue it.

Next steps: The agency told the committees it will refine implementation plans and return with additional details, and that the final recommendations will include organizational charts and cost estimates. Presenters said they will continue stakeholder engagement and share progress updates with the committees.

The committee did not take formal votes on these recommendations at the hearing; staff and legislators asked for copies of instruments used in the outreach and for additional detail on timelines and metrics for Tier 2/Tier 3 actions.