Vermont medical groups urge lawmakers to restore primary-care funding and workforce supports
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Summary
Representatives of the Vermont Medical Society and AHEC asked the Health Care Committee to reverse proposed cuts to primary-care base payments and workforce programs, arguing rural recruitment, loan-repayment and scholarship funds cannot be replaced by federal RHT dollars.
Jessa Barnard, executive director of the Vermont Medical Society, told the committee on Feb. 11 that cuts in the governor's recommended budget threaten core primary-care payments and workforce programs and cannot simply be replaced with Rural Health Transformation (RHT) funds.
"RHT funding, as I'm sure you have heard many times over, can't go to base rates, can't ... go to provider base payments and also can't supplant budget items," Barnard said. She asked lawmakers to restore workforce line items (loan repayment, early pipeline programming and physician placement services) and to direct payments that formerly flowed through the ACO to continue reaching primary-care practices.
Barnard described the end of the statewide ACO, OneCare Vermont, and said the ACO's closure accounted for roughly $4.75 per attributed patient per month that had supported primary-care programs. She urged the committee to keep those dollars in a primary-care fee schedule even if they no longer flow through the ACO.
On the Medicaid professional fee schedule, Barnard asked the committee to adopt an inflationary index tied to Medicare's published economic index (2.67% for calendar-year 2026) rather than accept the state's budget-neutral conversion-factor update. She cited a gross cost of about $3,310,000 for an inflationary adjustment and said $788,000 of that would reach primary care under available breakdowns.
Dr. Anne Morris, associate dean for primary care and AHEC at the Larner College of Medicine, emphasized workforce development and the effect of scholarships and loan-repayment programs on rural recruitment. Morris said the AHEC and related scholarship programs are already legally limited by a sunset and by funding availability: the medical student incentive scholarship created by statute is scheduled to end on 06/30/2027, she said, and the Educational Loan Repayment program has distributed about $29.5 million through 3,364 awards over 28 years.
Morris asked lawmakers to: remove the scholarship's statutory sunset and restore three specific line items removed from the governor's FY27 proposal—$500,000 for the AHEC support grant, $667,000 for the Educational Loan Repayment program, and $50,000 for a physician-placement grant.
Committee members pressed witnesses on details including how DIVA previously flowed certain per-member-per-month payments and whether RHT funds could be repurposed; Barnard and Morris reiterated that, per CMS rules and the state's understanding, RHT cannot be used to supplant base payments or to fund loan repayment.
The committee did not take a vote during the session. Witnesses submitted analysis and handouts for members' review and asked the committee to consider budget language that would preserve the scholarship and the workforce line items moving forward.
