Vermont Medicaid Section 1115 Demonstration Extended Until 2027

The Centers for Medicare and Medicaid Services (CMS) has approved an extension of Vermont’s Medicaid section 1115 demonstration, “Global Commitment to Health” through 2027. The extension will enable the state to continue to test, monitor, and evaluate a managed care-like delivery system, home and community-based services, and novel pilot programs, as well as pursue innovations to maintain high-quality services and programs that are cost-effective.

Overall, the demonstration extension will continue to promote health equity by expanding coverage and access to services.

Over the last 15 years, the Global Commitment to Health demonstration has been Vermont’s principal vehicle for major expansions of health coverage — building an extensive ecosystem for public health and health-related services, driving payer reform, and rebalancing long-term services and supports. As a result of these efforts, Vermont has nearly universal health coverage and one of the healthiest populations in the nation. Under the Global Commitment to Health demonstration, Vermont serves nearly 60 percent of enrollees eligible for nursing facility care in a home or community-based setting.

The extension approval allows Vermont to continue to fund a range of initiatives, from reducing the rate of uninsured and underinsured individuals to lowering healthcare costs, increasing access to quality health care, improving public health, investing in social determinants of health, and advancing home and community-based services and supports.

In this demonstration extension, Vermont is introducing new initiatives aimed at improving health coverage, access, and equity for people with Medicaid and other low-income individuals. Notable new initiatives include:

• The Supportive Housing Assistance Pilot, which will provide individuals with support services in order to secure and maintain housing for their needs.
• The Medicaid Data Aggregation and Access Program, a new incentive-based program to increase health information technology use and health information exchange connectivity by behavioral health and long-term services and supports providers.
• The Maternal Health and Treatment Services initiative, which will provide a whole-person and family-centered care model for treating pregnant women and mothers with substance use disorder (SUD) and/or a mental health condition at the Lund Home facility. The Lund Home provides mental health and SUD treatment to pregnant women, postpartum women, and mothers with children up to age five in a setting that allows the family to stay and be treated together.
• Establishing the SUD Community Intervention and Treatment eligibility group to increase access to SUD treatment services, such as counseling and residential treatment, for low- and moderate-income individuals with a SUD.

“I’m proud to approve this demonstration extension, which will expand access to behavioral health care, home and community-based services for seniors and people with disabilities, and whole-person care focused on treating substance use disorders and mental health needs during pregnancy,” said CMS Administrator Chiquita Brooks-LaSure, in a statement. “Vermont is also strengthening its data collection system, which will give us better information about the impact of the state’s demonstration and could inform future policymaking.”