Vermont Medicaid, SCHIP, & Federal Authority

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Section 1115 Waiver - In September of 2005, the Centers for Medicare and Medicaid Services (CMS) approved Vermont's new Section 1115 waiver program, the Global Commitment to Health. Vermont will manage its Medicaid program within a five-year, $4.7 billion budget. The state will be financially at risk to keep expenditures below this target.

Vermont has chosen to accept a capped federal contribution, with a 9 percent inflationary trend adjustment, in exchange for increased program flexibility, the authority to alter pieces of the benefit package, increased participant cost sharing, and flexibility to implement new cost-control strategies. To implement the demonstration, the Office of Vermont Health Access (OVHA) converted into a statewide public managed care organization and has the authority to use any additional funds to reduce the uninsured/underinsured rate; increase access to quality health care; support public health approaches to improve the health outcomes and the quality of life for Medicaid-eligible individuals in Vermont; and encourage the formation and maintenance of public-private partnerships in health care.

This waiver was amended in 2007 to include premium assistance for individuals without access to employer-sponsored insurance with incomes at or below 200 percent of the federal poverty level (FPL).2

Vermont Health Access Plan (VHAP) - In 1995, Vermont received Section 1115 authority to implement VHAP.  After various amendments, VHAP covered parents with incomes up to 185 percent of the FPL and childless adults up to 150 percent of the FPL. The VHAP population is now part of the “Global Commitment to Health” Section 1115 waiver approved in September 2005.

Dr. Dynasaur -  Vermont uses the Dr. Dynasaur brand to represent all Medicaid coverage programs for children up to age 18.  These include traditional Medicaid and coverage up to 225 percent of the FPL, which were included in the 1995 Section 1115 waiver that created VHAP. Starting in 1998, Vermont has used SCHIP funds to cover children with family incomes between 225 percent and 300 percent of the FPL, as part of the Dr. Dynasaur program.