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Health Care Advocate warns against Medicaid copay hike, flags family-planning coding loss and highlights MSP expansion
Summary
The Health Care Advocate told the committee that raising Medicaid pharmacy copays would shift costs to low-income Vermonters and forego federal match; the HCA also highlighted a coding problem that prevents drawing a 90/10 family-planning match and described the newly expanded Medicare Savings Program that will make roughly 14,000 people newly eligible.
Mike Fisher and other Health Care Advocate (HCA) staff briefed the committee on several areas of concern in the administration's budget recommendations, including DIVA staffing needs, a proposed increase in Medicaid prescription copays, a family-planning coding problem that prevents a 90/10 federal match, and the rollout of the expanded Medicare Savings Program (MSP).
The HCA supported DIVA's request for 12 additional positions to handle administrative changes and redeterminations and warned that under-staffing could cause eligibility errors and coverage gaps. The HCA opposed a proposed increase in pharmacy copays for Medicaid enrollees, saying the state would forfeit federal matching dollars and shift costs onto low-income people. "To save the state $461,000 the state is giving up ... $639,000 of federal money and transferring that entire $1,100,000 load onto low income Vermonters," an HCA presenter said.
HCA staff also said a coding-change issue prevents the state from drawing down the 90/10 federal match for family-planning services, costing providers an estimated $765,000 in foregone federal funds. The HCA asked the committee to direct DIVA to explain why the match is not implementable and what resources are needed to fix the problem.
On a positive note, HCA described the MSP expansion that took effect Jan. 1 and will make an estimated 14,000 Vermonters newly eligible for benefits, including Part B premium assistance and the Low-Income Subsidy for prescription drugs. HCA presenters said the state's annualized general-fund investment (about $5.7 million) is expected to draw down an estimated $67.8 million in combined savings and benefits for enrollees.
HCA staff requested an additional $450,000 in base funding to sustain the agency's advocacy work, arguing the helpline and outreach generate outsized returns through federal drawdown and individual savings.
