Vermont lawmakers approve health care rules

07/10/2014 6:03 AM

07/10/2014 6:44 PM

A Vermont legislative committee on Thursday approved a lengthy set of provisions governing health care, despite an earlier objection from legal advocates. But work will continue to examine possible scenarios that might play out for Vermonters from the rules.

The provisions on health benefits eligibility and enrollment are part of wider efforts for health care reform in the state, a major goal for Gov. Peter Shumlin and legislators.

"This is implementing key requirements of the Affordable Care Act," said Department of Vermont Health Access policy director Selina Hickman. "It also represents an effort to consolidate and streamline Medicaid and Vermont Health Connect eligibility processes as we move towards Green Mountain Care under Act 48."

Vermont Legal Aid believed one section as written might exclude certain populations from long-term care benefits in a Medicaid-funded program called Choices for Care. It offers benefits for long-term care and is designed to assist people who require intensive assistance.

The profile of the person whom they believed might be affected is very specific: Under age 65, non-disabled, above the poverty income threshold, without dependent minors, not pregnant and not blind.

There were concerns about if and how expenses — from traumatic injuries from a car crash that required extensive care for less than a year, for example — might factor into eligibility for Choices for Care for that population.

However, Vermont Legal Aid told the Legislative Committee on Administrative Rules that it is no longer objecting, provided that the state continues to work with them on program implementation.

"When we saw how the state was describing Choices for Care eligibility it didn't jive with our experience and it wasn't consistent with what we understood from previous state officials," Vermont Legal Aid's Chief Health Care Advocate Trinka Kerr said. "We were concerned about what it meant for a very small group of pretty vulnerable people."

State officials say they received assurances from the Centers for Medicare and Medicaid Services that the rule is consistent with federal law.

But this resolution won't end the conversation about Vermont Legal Aid's concerns.

"We're not simply saying, 'No, we're right and you're wrong.' We really want to make sure that anything that created the misunderstanding is improved, clarified and resolved," Hickman said.

Vermont Legal Aid welcomes the commitment from the state to continue working on the issue. "In this kind of process, we come up with a better set of rules and a program that works better," Kerr said.

State officials plan to file the set of provisions by next week so they can go into effect before emergency health care rules expire on July 29. The provisions don't require approval by the full legislature.

But there's still work to be done to unpack how the consolidating eligibility requirements might affect Vermonters.

"I'm still worried about that little group," Kerr said. "We have to figure out what the state can do for them, if anything."

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