Initial Medicaid Implementation: Vermont passed the implementation of Medicaid in July 1966 and implemented their Medicaid program in January of 1967. The state participated in the Kerr Mills program that proceeded the Medicaid program. Approximately 63 people participated in the program accounting for less than 0.1 percent of all Kerr-Mills beneficiaries but 0.14 percent of the aged on the program’s rolls. Their program included a family responsibility provision which required other members of the family to be interviewed and for a social worker to determine whether the applicant’s family could contribute to their medical expenses. Since the program requirements were already low, families were expected to contribute heavily in addition to the individual in order for the state to provide financial assistance for medical services.
Key Medicaid Political Issues: Vermont has a largely rural and older population and the state has been affected by the opioid epidemic in recent years. The state’s response to the problem has been a focus of how other states could emulate their model. The plan includes a hub and spoke model of care delivery. In 1995 the state implemented the Vermont Health Access Plan and Dr. Dynasaur which covered children and pregnant women. This program provided coverage to children up to 300 percent of poverty, pregnant women up to 200 percent of poverty, parents up to 185 percent of poverty and other adults up to 150 percent of poverty. The state also created a program called Catamount Health which allowed people to purchase subsidized coverage if their incomes were below 300 percent of poverty. The programs were terminated at the end of 2013 as the Affordable Care Act’s coverage expansions began.
Medicaid Expansion Implementation: Vermont expanded Medicaid on January 1, 2014 with enrollment beginning on October 1, 2013. The state did not have a seamless rollout of their exchange website which meant that beneficiaries that had coverage through VHAP would not be able to smoothly transition to the health insurance marketplace. The state has taken several efforts to go beyond the coverage expansions of the Affordable Care Act, first undertaking the planning to institute a single payer program, then requesting a waiver for all payer rate setting. This means that the same rate is set for all Medicaid, Medicare and privately insured patients within a hospital. The state put forward the goal of capping costs for health care in the state at 3.5 percent. In total 9 of the state’s 14 hospitals are participating although some of the hospitals are only participating with Medicaid patients.
General facts about Vermont Medicaid:
Medicaid program name: Medicaid
CHIP Program name: Dr. Dynosaur
Separate or combined CHIP: Medicaid Expansion
Medicaid Enrollment:159,000 (2018 estimate)
Total Medicaid Spending: $1.6 billion (FY 2017 estimate)
Share of total population covered by Medicaid: 25% estimate
Share of Children covered by Medicaid: 55% estimate
Share of Medicaid that is Children and Adults: 75%
Share of Spending on Elderly and people with disabilities: 71%
Share of Nursing Facility Residents covered by Medicaid: 64%
Expansion state: Yes
Number of people in expansion: 60,600 (2017 estimate)
Work Requirement: No