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.
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.
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.
This bill requires Vermont Medicaid to cover medically necessary play therapy services for eligible patients. It directly affects Vermont Medicaid recipients, particularly children and adolescents receiving mental health treatment. The law mandates coverage for play therapy provided by specific licensed professionals (such as psychiatrists, psychologists, and clinical social workers) and defines play therapy as using toys, games, and role-playing to address mental health challenges. The coverage becomes effective July 1, 2025.
This bill (H 55) requires all health insurance plans in Vermont - including Medicaid - to cover gender-affirming health care services that are medically necessary and clinically appropriate, such as facial procedures and hair removal, without extra cost-sharing. It also mandates coverage for fertility-related services, including diagnostic care, IVF procedures, fertility preservation (like egg freezing), and related medications, while prohibiting financial barriers or restrictions based on donor use. The bill prohibits insurers from denying coverage for these services based on factors like donor sperm or eggs, though it excludes experimental procedures and nonmedical costs (e.g., donor fees). Insurers must report compliance annually to state health committees, and the Agency of Human Services must seek federal approval for Medicaid coverage changes. The bill directly affects all Vermont health insurers, Medicaid, and individuals seeking these specific health services.
