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Administration warns Section 1115 waiver investments are vulnerable in renewal; administration outlines defense strategy
Summary
State Medicaid officials told the committee that Vermont's Section 1115 (Global Commitment) waiver provides federal funding and flexibility but that many waiver investments are at risk in the 2027 renewal; officials said they are prioritizing preservation and building evaluation evidence.
Agency officials briefed the committee on the state's Section 1115 Global Commitment waiver, explaining that the waiver provides federal financial participation and regulatory flexibility that permits the state to fund services and investments otherwise outside the Medicaid state plan.
Ashley Berliner, director of Medicaid policy for the Agency of Human Services, told members that the waiver is legally required to be budget neutral and that investments authorized under the waiver are under close federal scrutiny. "Investments are at the top of the list of vulnerabilities," Berliner said, explaining that some waiver investments lack clear outcome measures and are therefore more likely to be cut or restructured in renewal negotiations with CMS.
Officials said the waiver expires in 2027 and that the administration has begun a renewal process. They described a strategy of "defending" the highest-performing investments by converting them from loosely defined "investments" into explicit waiver authority when possible and by commissioning independent evaluations to produce stronger evidence.
Nolan (first name only in testimony) and other staff described contracts to assess investments: the University of Chicago will provide quantitative and qualitative evaluations of roughly 40 investments, and a UMass contract (with UVM subcontracting) will analyze the Medicaid program as a whole. Officials said evaluation results will be shared with the committee on a rolling cadence ahead of the renewal application.
Committee members pressed officials on what could be added to the waiver, how budget-neutrality caps work, and the risk that the administration's FY27 budget choices reflect negotiating priorities for the renewal rather than permanent program eliminations. Administration staff acknowledged the risk and said they are prioritizing items they think can be preserved through negotiation with CMS.
Officials did not present formal rule changes; they asked for legislative authority to begin negotiations on the renewal and said they would return with evaluation results and recommended preservation strategies before formal CMS negotiations.
