Committee reviews EFR report: 33 Medicaid nursing homes, heavy Medicaid dependence and recoupment explained

At a House Committee on Human Services briefing, Jamie Mooney, director of the Division of Rate Setting at the Department of Vermont Health Access, summarized a report prepared under budgeting language tied to section E306B on extraordinary financial relief (EFR) for nursing homes. Mooney told the committee the report lists 33 Medicaid-participating nursing homes and three that do not participate in Medicaid, and that ownership in the universe includes 23 for-profit facilities, six nonprofits, three hospital-related nonprofits and one state facility.

Mooney said payer-mix data in the report show 26 of the 33 facilities—about 79%—derive 60% or more of their revenue from Vermont Medicaid. "Medicare is the secondary payer," she said, and commercial insurance is typically negligible. She warned that facilities with very high Medicaid dependence have little revenue buffer if Medicaid rates do not cover costs.

The presentation included operational detail: short-term stays (under 90 days) typically average 27 to 56 days, most clustering around 35—5 days consistent with post-acute rehabilitation, while long-stay averages ranged roughly 167 to 329 days.

On EFRs, Mooney gave a multi-year accounting of requests and outcomes and provided an FY2023 award total: roughly $8.8 million awarded across nine awards covering eight facilities (timing caused some cross-year reporting). She said the EFR review functions like an audit: rate setting examines audited financial statements, balance sheets, accounts payable and receivable, staffing claims, rate decreases and other details to verify whether an "urgent cash need" exists before awarding relief. Mooney confirmed EFR funds are subject to recoupment and that recouped sums flow back into the state's Choices for Care account at annual closeout.

Lawmakers pressed for more transparency in the next update, asking the department to add a column showing amounts requested versus amounts actually awarded (committee members said a 2025 snapshot would be most useful). They also sought a flag in the update identifying which facilities had received EFR on one or more occasions so the committee could analyze correlations between relief and staffing patterns.

The committee also discussed consequences when facilities close: Mooney said the Green Mountain Nursing Home ultimately closed despite relief efforts and described the department's practice of attempting recoupment and, where necessary, pursuing receivership or other legal steps to protect quality of care.

The committee recessed after the briefing and asked staff to return updated 2025 data at the department's next appearance.