H.580 would create a unified public employees' health plan covering current and retired State, school, municipal, and university workers in Vermont. It establishes an independent commission to design the plan and set cost-sharing between employers and employees, while removing health care from collective bargaining. The bill requires all public employee health insurance costs to be tracked in a single budget line item, mandating annual transparency reports on total costs, cost per covered person, and year-over-year trends. It also directs the Governor’s budget to present public employee health benefits and Medicaid costs together, along with detailed breakdowns of expenditures for other state health programs.
S 200 transfers sole authority for Vermont's Medicaid school-based services program from the current shared arrangement to the Agency of Human Services (AHS), requiring AHS to ensure all federal Medicaid compliance. It establishes a School-Based Medicaid Reimbursement Fund managed by AHS, directing 55% of federal reimbursement funds to supervisory unions (groups managing multiple schools) based on submitted cost reports, and up to 25% to cover administrative costs for both the Agencies of Education and Human Services. The bill also mandates AHS to adopt rules for service eligibility, documentation, and provider requirements to meet federal standards. This directly affects supervisory unions receiving funds, the Agencies of Education and Human Services in their administrative roles, and students eligible for Medicaid-covered school health services.
H.815 limits health insurers and Vermont Medicaid from reducing reimbursement rates for mental health, substance use disorder, or developmental disability services below the previous year’s rate. It requires insurers to provide 90 days’ public notice, host stakeholder meetings, and publish impact analyses before changing billing, coding, or service authorization policies affecting these areas. Insurers must also monitor access metrics like provider availability and wait times for 12 months after policy changes and take corrective action if access declines. This directly affects insurers, Medicaid, and mental health providers by standardizing payment stability and increasing transparency in coverage decisions.
This bill eliminates a requirement for Vermont's Department of Vermont Health Access to annually compile and share lists of prescription drugs with significant price increases (50%+ over five years or 15%+ in a year). The Department would no longer need to create these lists, which previously included details on cost increases, drug types (generic/brand), and spending data for the Office of the Attorney General and Green Mountain Care Board. The change directly affects the Department's administrative duties under existing prescription drug cost transparency rules. Other provisions in the bill adjust committee memberships, update health insurance market language, and modify Medicaid eligibility and doula service coverage timelines, but the core policy change is removing the annual drug price reporting requirement.
H 558 transfers sole authority for Vermont's Medicaid school-based services program from current oversight to the Agency of Human Services (AHS), while clarifying the Agency of Education's (AOE) role in coordinating with school districts. The bill establishes a School-Based Medicaid Reimbursement Fund managed by AHS, directing 55% of federal reimbursement funds to supervisory unions (which manage multiple school districts), 25% for AHS and AOE administrative costs, and any remaining balance to the Education Fund. It requires supervisory unions to submit Medicaid claims for eligible students and creates an incentive fund for unions with high participation rates (over 80%). This directly affects supervisory unions, AHS, AOE, and school districts by changing how Medicaid reimbursement funds are distributed and administered.
S.162 eliminates the Department of Vermont Health Access' (DVHA) annual requirement to create and publish lists of prescription drugs with significant price increases (over 50% in 5 years or 15% in a year). This directly affects DVHA, removing its duty to share these lists with the Green Mountain Care Board and Attorney General's office. The bill also modifies Medicaid Advisory Committee membership rules (barring reappointments), updates health insurance market language, adjusts Clinical Utilization Review Board composition, and increases burial funds exclusion for Medicaid eligibility. Other minor changes include extending the timeline for Medicaid doula service coverage approval.
This bill requires Vermont Medicaid to cover vitamin D deficiency testing for its beneficiaries. It directly affects Vermont residents enrolled in Medicaid who need testing for vitamin D deficiency. The key provision mandates that Medicaid must pay for this specific diagnostic test, removing a potential financial barrier to screening. The bill does not change broader Medicaid coverage rules but adds this testing as a required benefit.
H.664 would standardize income eligibility rules for two Vermont Medicaid programs. It requires the same income limits for both the Medicaid for Children and Adults program and the Medicaid for the Aged, Blind, and Disabled program. This change directly affects Vermont residents currently enrolled in either program, ensuring they face identical income thresholds for eligibility. The bill eliminates current differences in income requirements between these two Medicaid categories.
S.194 establishes a new monthly prospective payment system for Vermont's designated and specialized service agencies that provide community-based human services. It requires the Human Services Secretary to calculate payments based on per-member per-month amounts derived from approved agency budgets, updated annually with inflation adjustments and geographic cost factors. The bill mandates monthly payments on the first day of each month, annual rate recalculations, and an annual reconciliation process to align funding with actual service delivery. This directly affects community-based service providers receiving Medicaid funding, changing how they are reimbursed for services to individuals with approved care plans.
This bill increases transparency around prescription drug costs in Vermont. It prohibits pharmacy benefit managers from requiring patients to pay more than the drug's average cost plus a standard dispensing fee (based on Vermont Medicaid rates). Pharmacies must post notices informing patients about available price options, including cash prices. Hospitals must report annual details about their participation in the federal 340B drug discount program to the Green Mountain Care Board, and health insurers must send patients annual reports showing actual drug spending on their behalf. These requirements directly affect patients, pharmacies, insurers, and healthcare providers.
