More health care coverage options will be available to many Vermonters starting this month.
That's because of a new agreement with the federal government that gives the state a waiver to provide services Medicaid typically doesn’t pay for. The flexibility comes with the understanding that the state won’t spend more money than it would have otherwise.
The deal extends for just over five years, and includes housing support, expanded access to mental health and addiction treatment, and more affordable prescription medications for older Vermonters, among a range of other services.
“There will be particularly vulnerable sets of Vermonters who will get some real relief,” said Mike Fisher, a health care advocate with Vermont Legal Aid.
“If you have a serious mental illness and need mental health treatment, if your insurance isn’t paying for it, if you have a gap — we will pay for it.”Ashley Berliner, Vermont Agency of Human Services
One goal is to provide better access to mental health treatment, especially for people over a certain income threshold who wouldn’t typically qualify for Medicaid, and others whose commercial plan doesn’t cover treatment.
“Effective July 1st, we are eliminating the income cap,” explained Ashley Berliner, who leads Medicaid policy development at the Vermont Agency of Human Services.
“So regardless of your income in the state of Vermont, if you have a serious mental illness and need mental health treatment, if your insurance isn’t paying for it, if you have a gap, — we will pay for it,” she said.
The state can also use federal funds to treat substance use disorders for more people above the federal poverty level, though an income cap still applies. In this case, it’s just over $30,000 for a single-person household.
And a pilot program helps secure and maintain housing for people with developmental disabilities, brain injuries and chronic mental illness who already qualify for Medicaid.
"Things like first and last months’ rent, helping with moving costs, security deposits,” Berliner said.
There’s a lot of other exemptions packed into the deal: flexibility to adjust provider rates, support for Burlington’s Lund Home and funding for things like workforce recruitment and I.T. infrastructure.
And while this type of deal isn’t new — Vermont has been allowed some discretion in how it spends federal Medicaid dollars since 2005 — renegotiating the waiver with expanded flexibility was not guaranteed.
“It is a relief that we made an agreement,” Fisher said.
Lexi Krupp is a corps member for Report for America, a nonprofit national service program that places journalists in local newsrooms to report on under-covered issues and regions.
