D.VA tells Senate Health & Welfare HR1 will drive $1.3M admin cost; committee hears proposed Medicaid copay and ABA coding changes

Joint Fiscal Office analysts told Senate Health & Welfare on April 3 that federal changes under HR1 will require the Department for Vermont Health Access (D.VA) to perform Medicaid eligibility redeterminations every six months instead of annually. The administration's implementation estimate includes 12 new positions (about $1 million gross) and roughly $300,000 in additional operating expenses, a total near $1.3 million to process more frequent reviews.

Analysts also identified several administratively driven or policy-driven changes in the governor's budget: a proposed increase in Medicaid prescription co-pays (raising preferred/non-preferred drug co-pays from $1/$3 to $5/$11) estimated to reduce costs by about $1.1 million gross; a contentious Applied Behavior Analysis (ABA) coding adjustment the administration says removes duplicative codes (the House did not change that proposal); and House language (section E307.8) that asks D.VA to maximize family-planning billing codes while not restoring a previously proposed $85,000 match.

Committee members asked staff to clarify implementation feasibility and the potential service impacts, especially around ABA services for people on the autism spectrum and family-planning billing practices. Joint Fiscal Office staff recommended follow-up conversations with D.VA to resolve implementation confusion and assess risks of shifting costs or losing federal match.

The committee will schedule department-level hearings for D.VA and other AHS components to test assumptions and get more precise cost and operational detail before making final recommendations.