Healthcare (Medicaid)

This bill expands Vermont's Dr. Dynasaur program to cover pregnant individuals with incomes up to 312% of the federal poverty level (FPL), effective January 2026. It also directs the Agency of Human Services to study expanding Dr. Dynasaur eligibility to all Vermont residents under 26 with incomes ≤312% FPL and Medicaid eligibility to adults aged 26-64 with incomes ≤312% FPL. The agency must report on feasibility, costs, federal waiver needs, and implementation timelines by January 2026. The study includes analyzing programmatic costs, technological requirements, and potential federal approval processes for broader expansions.

H.13 establishes new requirements for how the Secretary of Human Services calculates Medicaid payment rates for home- and community-based service providers. The bill directs the Secretary to set "reasonable and adequate" rates for services provided to older adults, individuals with disabilities, and those with mental health or substance use disorders. The calculation methodology must consider factors such as governmental mandates, inflation, and labor market dynamics, and includes a schedule for studying rates at least every five years. It also creates a process for providers at imminent risk of closure to request stabilization and requires annual recalculation and reporting of these rates.

This bill expands Vermont's Dr. Dynasaur program to cover all young adults under age 26 who live in Vermont and have incomes at or below 312% of the federal poverty level. It directly affects Vermont residents aged 18-26 who currently might not qualify for the program due to age or income limits. The key change amends eligibility rules to remove previous restrictions, making coverage available to all qualifying young adults regardless of prior enrollment status. The program, administered under federal Medicaid/SCHIP rules, will take effect on July 1, 2025.

This bill requires most health insurance plans and Vermont Medicaid to cover biomarker testing when supported by specific evidence, such as FDA approvals, drug labels, or nationally recognized clinical guidelines. It directly affects patients needing these tests (e.g., for cancer diagnosis or treatment) and insurers/Medicaid, mandating coverage for tests analyzing genes, proteins, or other biological markers in blood or tissue. Key provisions include limiting disruptions in care (e.g., avoiding repeated biopsies) and defining biomarker testing broadly to include advanced genetic sequencing. The requirement takes effect January 1, 2026, for new plans, with Medicaid coverage pending CMS approval.