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Owen Foster, chair of the Green Mountain Care Board, in 2023. File photo by Glenn Russell\/VTDigger<\/p>\nOwen Foster, chair of the Green Mountain Care Board, in 2023. File photo by Glenn Russell\/VTDigger<\/p>\n
The wishlist for achieving a more stable health care system in Vermont is a long and lofty one: By 2031, the Agency of Human Services says it aims to strengthen the rural health care workforce in the state and increase access to timely care in those rural areas, all while increasing quality and reducing cost.\u00a0<\/p>\n
One big piece of achieving those goals rests in moving more of the health care Vermonters receive outside of hospitals, the agency argues in its latest vision<\/a> for hospital transformation, made public last week.<\/p>\n In a bid for a five-year federal rural health grant worth at least $500 million to the state, the agency proposes a sweeping range of expenditures, ranging from the broad \u2014\u00a0like allocations for incentivizing primary care providers to increase appointment access \u2014 to the specific \u2014 like funding more recovery housing for those with substance use disorders or investing in dialysis and ventilator units in nursing homes, rather than hospitals.\u00a0<\/p>\n READ MORE<\/p>\n \t\t\t\t\t\t\t\t \t\t\t\t\t\t\tby Olivia Gieger<\/a> What might become a reality depends in part on grant funding decisions the federal government is expected to make by the end of this year.<\/p>\n The national opportunity<\/a> became available in September after funding for the program was inserted into the federal budget reconciliation package to win the needed support of rural Senate Republicans concerned about the impacts of Medicaid spending cuts in that bill<\/a>.\u00a0<\/p>\n Since then, health care professionals across Vermont have closely watched how the state might use the grant, to solidify the otherwise eroding foundation of the health care system in the state.\u00a0<\/p>\n \u201cIt does give us a lifeline if we use it really well,\u201d Owen Foster, the chair of the Green Mountain Care Board, told VTDigger in October, before the state submitted an application.<\/p>\n Still, now that the agency\u2019s application is public, much remains up in the air about how much funding will come to the state and what exactly it will go toward when it does.<\/p>\n The new funding availability comes at a time when the majority of Vermont\u2019s hospitals face serious solvency risks<\/a> and Vermonters bear some of the highest health care costs in the country<\/a>. At the same time, the state\u2019s rural populations are overall less healthy<\/a> than the rest of the state, with higher rates of chronic disease, obesity, opiod-related death<\/a> and suicide<\/a>.<\/p>\n Many providers, patients, regulators and lawmakers in the state agree that the system is in dire need of a radical reboot. Some are still waiting for the details of that reboot to become more concrete.<\/p>\n \u201cThe proposal is more of a list of priorities than a detailed plan of what Vermont would do with federal funds if or when they arrive,\u201d Alex Garlick, a UVM political science professor who specializes in health care policy but who is not involved in the application process, told VTDigger.\u00a0<\/p>\n \u201cThe ideas for shoring up the delivery of rural health care are sound, but I\u2019d categorize them as incremental instead of transformational,\u201d he said.<\/p>\n \u2018A holistic view\u2019<\/p>\n Part of the plan\u2019s high-level scope is because of how the federal government plans to dole out the funding.<\/p>\n The Centers for Medicare and Medicaid Services said they will award $10 billion a year between 2026 and 2030. Each year, half of that will go equally to each approved state \u2014 suggesting<\/a> that each of the 50 eligible U.S. states are expected to get $100 million per year. The remaining $5 billion pot will go to states based on a more competitive grant evaluation criteria.\u00a0<\/p>\n Agency staff think it\u2019s likely that Vermont will receive only its share of the half promised to all states, said Jill Mazza Olson, AHS\u2019s director of Medicaid and health systems, who oversaw the application process. The federal agency has already posted its scoring metrics that the state can judge its eligibility against.<\/p>\n Nevertheless, the state proposed a budget for $200 million of spending each year in part to make a bid for the higher amount. But also the state agency can\u2019t be sure which of the proposed priorities the feds will accept as ways to spend the state\u2019s allocation, so Olson says the agency intentionally made the application flexible.<\/p>\n Olson said her agency tried to build upon programs for health system transformation that the state has already set in motion largely through a 2022 law, known as Act 167<\/a>, a bill focused on shoring up the state\u2019s hospitals.\u00a0<\/p>\n That was a practical necessity because the application needed to come together quickly: CMS released the applications in mid-September and gave states until Nov. 5 to submit them.\u00a0<\/p>\n \u201cIt\u2019s a really really short amount of time to develop a plan and get the kind of input that you want when you\u2019re doing something as complex as this,\u201d Olson said.<\/p>\n Still, while trying to move quickly by building off existing projects, Olson said that the agency also tried to broaden the scope beyond hospital-specific reform. Often receiving care in a hospital is more expensive<\/a> than getting the same treatment in an outpatient clinic or independent facility<\/a>.<\/p>\n \u201cIf we\u2019re going to have less care in hospitals, we\u2019re going to need more care somewhere else,\u201d Olson said. \u201cThere are other providers who we haven\u2019t really engaged with in the same way on transformation.\u201d\u00a0<\/p>\n Specifically, the application identifies investments in staff, technology and supplies for nursing homes, home health care, community mental health and substance use clinics, as well as through increased support and training for EMTs and paramedic emergency response teams.<\/p>\n Garlick, the UVM professor, specifically pointed to training programs for licensed nursing assistants and supporting primary care as good ideas for ways to strengthen the delivery of rural health care.\u00a0<\/p>\n \u201cThere are also outside-the-box considerations, including grants to increase the housing stock available to health care workers, which show the state is taking a holistic view of the problems related to health care finance,\u201d he said.<\/p>\n A far bigger federal challenge\u00a0\u00a0<\/p>\n Health care officials remain clear-eyed about the importance these funds can have in boosting a system in such dire straits.\u00a0<\/p>\n \u201cVermont\u2019s healthcare system, including all provider types, remains under significant financial strain,\u201d Foster, the care board chair, wrote in a Friday email to VTDigger. \u201cWe are seeing many service line closures and disruptions to patient care.\u00a0 Hospitals are expected to continue to experience great financial pressure at a time when Vermonters cannot afford to pay more for healthcare.\u201d\u00a0<\/p>\n Foster wrote that he was optimistic that Vermont\u2019s application for the program would garner support, adding that he was encouraged by its recognition of the importance of preventative care and community-based providers. \u201cVermont has committed to intentional and meaningful health system transformation, and these critical funds would bolster our ability to transition Vermont into a sustainable and modern health system,\u201d he said.<\/p>\n Still, strong headwinds remain against the rural health care system across the country as well as in Vermont.\u00a0<\/p>\n The changes to Medicaid enshrined in the big budget reconciliation President Donald Trump signed into law this July could result in a $137 billion loss to rural hospitals over 10 years<\/a>, an analysis by the health care news organization KFF found. Comparatively, this five-year $50 billion rural health transformation<\/a> grant, also included in that law, cannot balance the scale.<\/p>\n \u201cThe dollars that are available to us are really addressing a different set of concerns than the dollars that we\u2019re losing. This is an opportunity, and we want to use this opportunity, but from a policy perspective it doesn\u2019t make up for [other losses],\u201d Olson said.\u00a0<\/p>\n
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\n\t\t\t\t\t\tOctober 31, 2025, 5:26 pmNovember 3, 2025, 4:39 pm\t\t\t\t<\/p>\n