House Healthcare reviews DMH budget lines: CCBHC funding, community outreach and copay proposals
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Summary
Committee members reviewed multiple DMH and AHS budget requests including CCBHC initiative funding, provider stabilization grants, a proposal to raise Medicaid drug copays, and a contested proposal to cut community outreach in favor of mobile crisis responses. Members pressed DMH for detail on case rates, shifting costs to designated agencies, and program transitions.
The House Healthcare committee spent significant time Feb. 17 reviewing DMH and AHS budget line items that would reallocate services, adjust reimbursements and change how some programs are delivered.
Committee staff summarized the spreadsheet of governor‑recommended items and non‑governor requests and explained the process the committee will use to rank priorities. Among the DMH items members discussed were a $2,000,000 one‑time provider stabilization request, a CCBHC initiative estimated in testimony at roughly $5,000,000 for five additional CCBHCs (DMH later referenced $5,400,000 as an initiative estimate), and a set of population‑specific services DMH proposed rolling into standard CCBHC or outpatient billing.
Several members warned that rolling population‑specific services into CCBHC billing or traditional outpatient bundles could effectively shift costs onto designated agencies without increasing their case‑rate targets. As one member summarized, agencies that are already at their case‑rate caps may not be paid for additional clients; committee member Amy Johnson, identifying herself as Vermont Care Partners, explained the mechanism: "there's an adult mental health bundle and a children's mental health bundle, and for every agency, there's a target. You hit your target, you pull down the funding, and those budgets are capped." The committee asked DMH whether it has a plan to avoid leaving agencies uncompensated; DMH acknowledged that some implementation questions remain and that agencies could absorb additional clients under current billing structures but that details vary by population.
Members also debated a DMH proposal to discontinue community outreach (a roaming, low‑barrier service in Chittenden County and other localities) and instead rely more heavily on 988 and mobile crisis teams. Supporters of community outreach described rapid, non‑emergency responses—library or business check‑ins and brief contacts—that can stabilize situations before they escalate. Opponents said needs exist statewide and expressed concern about equitable service distribution; DMH and staff discussed possible transition options, including phased funding or dual‑funding during a transition period.
Other items under review included a proposed cancelation of a Medicare assistance contract (Vermont Legal Aid) cited by staff; a request for 12 new positions in the eligibility/redetermination unit tied to HR 1 workload increases (budgeted for nine months in year one); and a small dental incentive pool the department proposed discontinuing amid rate changes. The committee also discussed a proposal to increase Medicaid drug copays from the current $1/$3 to $4/$8; testimony said copays have not been raised in a long time, but members noted possible access consequences and implementation questions tied to HR 1 requirements.
Several committee members requested more evidence before final recommendations, including utilization data for the emergency‑department per diem (DIVA said utilization declined) and follow‑up on whether family‑planning coding changes can be implemented. The committee took a short break and scheduled follow up for remaining non‑governor recommended items.
What happens next: Staff will collect additional utilization data, request clarifying language on family‑planning coding, and seek more detailed cost breakdowns and transition plans from DMH before the committee finalizes priorities to forward to appropriations.