Medicaid agency: DVHA
Vermont Medicaid is administered by the Department of Vermont Health Access (DVHA), within the Agency of Human Services (AHS). Rather than contracting with commercial managed care organizations, Vermont runs a public managed care model: DVHA itself serves as the state's sole managed-care-like entity under the Global Commitment to Health Section 1115 demonstration, running through December 31, 2027. Long-term care and behavioral health are carved out administratively to two other AHS departments rather than to DVHA or a private vendor: the Department of Disabilities, Aging and Independent Living (DAIL) runs Choices for Care, Vermont's LTSS program, and the Department of Mental Health (DMH) runs Medicaid behavioral health through a statewide network of Designated Agencies and Specialized Service Agencies. OneCare Vermont, the state's Medicaid accountable care organization, wound down at the end of 2025, and Vermont withdrew from the federal AHEAD model in July 2026 after renegotiated funding terms sharply cut the state's anticipated allocation, redirecting that effort toward the Rural Health Transformation Program instead. Federal work requirements and more frequent eligibility reviews take effect January 1, 2027, described in DVHA's own communications only as "federally required changes"; Vermont is one of the plaintiff states in the multistate litigation challenging CMS's work-requirements rule, which remains in effect while the case continues.
Vermont runs a public managed care model rather than contracting with commercial health plans: the Agency of Human Services (AHS), the state Medicaid agency, oversees the Department of Vermont Health Access (DVHA), which serves as Vermont's own sole managed-care-like entity under the Global Commitment to Health Section 1115 demonstration. AHS pays DVHA a capitated per-member-per-month rate, though CMS's own program materials also describe the underlying payment to Vermont providers as fee-for-service with value-based methodologies layered on top; both characterizations appear side by side in CMS's description of the arrangement. No commercial managed care organizations operate in Vermont Medicaid, consistent with CMS's national managed care enrollment dataset showing zero real plans for the state.
Long-term services and supports are delivered through Choices for Care, administered not by DVHA but by a separate AHS department, the Department of Disabilities, Aging and Independent Living (DAIL), on a fee-for-service basis with no managed care plan or private vendor involved. Choices for Care held its own separate Section 1115 waiver until that authority expired January 30, 2015; it has operated under the Global Commitment to Health demonstration since.
Not integrated into managed care
Medicaid behavioral health is administered separately from DVHA's general medical benefits: the Department of Mental Health (DMH), a distinct AHS department, administers Medicaid behavioral health and substance use benefits through a statewide network of Designated Agencies and Specialized Service Agencies rather than through DVHA directly or a contracted managed care vendor.
Carved out
Dental is a direct fee-for-service Medicaid benefit administered by DVHA through the general provider network, with no separate dental benefit manager. Northeast Delta Dental, the one dental vendor under contract with the state, administers dental coverage only for Vermont Health Connect's commercial marketplace plans, a separate program from Medicaid.
Change Healthcare Pharmacy Solutions, since acquired by Optum, administers Vermont Medicaid's pharmacy benefit under contract with DVHA. A separate Optum Rx contract manages supplemental drug rebates outside the primary PBM relationship.
The Vermont Public Transportation Association brokers non-emergency medical transportation for Vermont Medicaid statewide under contract with DVHA.
Gainwell Technologies is Vermont Medicaid's fiscal agent and MMIS vendor, operating the vtmedicaid.com provider portal. eviCore Healthcare holds a separate contract for radiology benefit management, reviewing prior authorization for advanced imaging services.
218 agency updates tracked for Vermont. Available with Pro.
See them with ProIncumbent Lt. Gov. John Rodgers and Democratic challenger Molly Gray debated Tuesday in a Vermont Public-hosted forum, trading personal attacks over past experience more than policy. The two largely agreed on the need to lower the cost of living, support rural Vermonters, and address education spending, healthcare, land-use policy and property taxes, but clashed over Gray's education and prior departure from the lieutenant governor's office and Rodgers' record on constituent work. Gray proposed universal primary care funded partly by recouping federal tax cuts and taxing luxury second homes, while Rodgers criticized her for not detailing funding sources. The debate occurred ahead of Vermont's lieutenant governor election.
Vermont officials and advocates are addressing voting accessibility gaps ahead of the November election, including for nursing home residents, people with disabilities, and other underserved groups. The Vermont Health Care Association issued guidance in September clarifying residents' voting rights and the assistance process, following a July CMS memo reminding nursing facilities to avoid coercing or influencing residents while preserving their right to vote. The CMS memo followed election fraud allegations in Texas and Wisconsin involving residents with diminished cognitive capacity. Advocates, including the state long-term care ombudsman, worry the memo could create a "chilling effect" where facilities wrongly withhold voting assistance from residents with cognitive impairment, even though Vermont law only bars voting for those judged incompetent by a court.
Brattleboro Memorial Hospital's board named David Sanville, a healthcare finance consultant and former Mt. Ascutney Hospital CFO, as interim CEO effective at the start of fiscal year 2027. He replaces co-CEOs Tony Blofson and Elizabeth McLarney, who led the hospital for a year following the unexplained departures of the prior president and CFO in late 2025. The hospital faces a forecast $7.1 million deficit for fiscal 2027, following an estimated $9.5 million shortfall in fiscal 2026, and Vermont's Green Mountain Care Board recently level-funded the facility's budget pending clarification of inconsistencies in its proposal. The hospital does not expect to break even until fiscal 2028 at the earliest.
Vermont's Department of Vermont Health Access starts implementing federal Medicaid changes on Oct. 1, with a second phase beginning January 2027, stemming from the federal budget bill passed in July 2025. The first phase restricts eligibility for certain immigrants, cutting off most adult refugees and asylum seekers (an estimated 235 people), while exempting lawful permanent residents, pregnant people, and those under 21. The January phase will require roughly 49,000 Vermonters ages 19-64 to prove monthly earnings of at least $580 or document 80 hours per month of work, education, or community service, and will shorten eligibility renewal from annual to every six months, with broad exemptions for pregnant people, Indigenous people, medically frail individuals, disabled veterans, caregivers, and others. State officials say the goal is to maximize coverage retention amid heavy new paperwork burdens, and the state has added 12 staff and is pulling existing wage and benefits data to reduce self-reporting needs.
In a VTDigger commentary, Matt Swenson, founder of Omnidex Solutions, argues that Vermont's healthcare debate focuses too narrowly on prices while ignoring a worsening access crisis. He cites recent layoffs at the University of Vermont Health network (199 positions affected) and Dartmouth Health (124 cuts plus eliminated vacant positions), alongside state data showing primary care physicians fell from 634 in 2004 to 529 in 2024. Swenson argues the Green Mountain Care Board's price regulation and movement toward reference-based pricing, while worthwhile, must be paired with an access-to-care dashboard tracking wait times, ER boarding, and practices' new-patient capacity. He also criticizes Gov. Phil Scott's conciliatory approach and argues single-payer financing reforms alone won't solve a shrinking physician pipeline.
2 active waivers tracked for Vermont. Available with Pro.
See them with Pro5 active solicitations tracked for Vermont. Available with Pro.
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