New Medicaid rules require that states separate the agency delivering community-based supports from the process of evaluating need and planning for services. About 80% of states already provide independent case management that does not operate out of the same agency as an individual’s support providers. Vermont’s developmental services system, however, was designed to provide the full continuum of services through its regional agencies.
The new rule also applies to case management services in Vermont’s Choices for Care Program and the Traumatic Brain Injury Program.
An exception to the new rule can be granted, but the federal Medicaid authority has been reluctant to waive the requirement even in frontier states like Alaska. There are ten (10) independent designated agencies, five (5) specialized services agencies, and about 3,000 Vermonters who will be affected by the system overhaul. Vermont is one of the last states to develop a plan for implementing this federal requirement.
"It's as much about giving choice to people receiving services as it is eliminating potential for conflict, including unconscience bias."
- Kirsten Murphy, Executive Director of the Vermont Developmental Disabilities Council
Restructuring case management is just one of the critical changes taking place within the Department. The State is also adopting a new assessment tool and revising how it pays the agencies that deliver services. There are several stakeholder groups involved in ongoing discussions about payment reform.