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Lawmakers and DDAIL Officials Debate Whether to Separate Choices for Care Budget Lines
Summary
Lawmakers questioned whether Vermont should split Choices for Care funding for nursing homes and home‑and‑community services after testimony showing nearly 7,000 recipients and shifting utilization; the department urged caution and highlighted service trends and reinvestment rules.
During testimony on the Department of Disabilities, Aging, and Independent Living’s FY27 budget, committee members and department officials debated whether Choices for Care should remain a single budget line or be split into separate funding lines for nursing facilities and home‑and‑community‑based services.
“Nearly 7,000 people received Choices for Care services,” Commissioner Jill Bowen told the committee, saying 973 were in moderate‑needs groups and over 6,000 in highest‑needs groups. Bowen added that nearly 4,600 recipients receive services in home‑based settings, nearly 800 are in residential care or assisted living, and nearly 3,000 are in nursing facilities.
Representative Doug Bishop and other members raised the prospect of separating nursing‑facility funding from home‑and‑community‑based services (HCBS) to ensure neither side is inadvertently subsidized by the other. “I think we have reached a critical point where we actually shouldn't be reducing the number of nursing home beds,” one committee member said, arguing the state still needs existing capacity.
Bill Kelly, the department’s finance director, urged caution. Kelly told committee members that historically nursing‑home Medicaid bed days have fallen sharply and that about two‑thirds of the Choice for Care budget remains tied to nursing homes. He said the statute’s savings‑and‑reinvestment language contemplates returning savings to HCBS in later years and warned that “if we were to split, it would be shortsighted.”
Department officials said the FY27 presentation was intended to highlight where services are being delivered and to inform further discussion rather than to announce an immediate structural change. Bowen said overall the state still serves more people in home‑and‑community settings than in nursing homes and asked members to weigh both utilization trends and statutory reinvestment requirements before acting.
The committee did not vote on any budget structure changes during the hearing. Members asked staff to provide additional data on per‑bed costs, utilization trends and any statutory constraints that would affect a split, and to return with more detailed analysis in later meetings.
