General Health Care Services

Why Is This Important?

Why Is This Important?

What We Do

Who We Serve

How We Impact

What We Do

The Vermont Blueprint for Health designs community-led strategies for improving health and well-being. The Blueprint’s design work responds to the emerging needs of Vermonters and the latest opportunities in health and human services reform by creating change in the delivery system. This work began with Patient-Centered Medical Homes, Community Health Teams, and Self-Management and Healthier Living Workshops. It subsequently expanded to include the Hub & Spoke system of opioid use disorder treatment, and the Women’s Health Initiative. In support of program implementation, full population data and analytics and learning collaboratives are available for policy makers, communities, and practices.

Who We Serve

Services supported by the Blueprint for Health Program are available to all Vermonters.

How We Impact

The activities of the Blueprint serve as the foundation for strengthening primary care and expanding the ACO programs. This initiative is especially focused on building the links between community and medical services, so that patients have better coordinated care across the spectrum of services.

Together the following performance measures focus on whether Vermonters are better off as a result of this program. They do so by looking at the quality and efficiency of these programs and services.

Action Plan

The top 3 priorities/initiatives for the Blueprint in SFY20 are:

• Strategic planning to align with All Payer Model Health Reform
• Full implementation of the Women’s Health Initiative
• Developing data/analytics services that include using and linking state data sets in service AHS and DVHA priorities

What We Do

The Health Access Eligibility and Enrollment Unit (HAEEU) consists of five teams that each fulfill a specific function in helping Vermonters down the path from learning about health programs to applying, enrolling, and understanding their rights and responsibilities.

Eligibility & Enrollment Team works directly with members and is responsible for managing documents sent in by applicants, determining eligibility, assisting in enrollment, providing customer support through the call center, and resolving escalated cases.

Maintenance & Operations Team ensures that the Unit’s systems are well maintained and tested. They monitor the integrity, accuracy, and timeliness of transactions and are accountable for the overall success and delivery of Open Enrollment. They document policies and procedures, streamline business processes, and provide member facing staff with the training and knowledge needed to be operationally ready. During Open Enrollment they manage outreach and education efforts, helping Vermonters understand health insurance terms, compare options, and get the most out of their health coverage by communicating with community partners, including hospitals, clinics, agricultural organizations, libraries, pharmacies, and other stakeholders.

Data Team reconciles file transactions between Vermont Health Connect’s case management system, billing system, health insurance issuers, and the State’s legacy ACCESS system. They maintain the Unit’s data and provide operational reports and dashboards.

Assistant Operations Team serves as the policy liaison for HAEEU. They provide guidance, direction, and interpretation of state health care eligibility and enrollment rules. They also direct the technical and operational implementation of those rules. Additionally, this team manages member notices, and application and form development.

Assister Team supports and manages the In Person Assister program which works to ensure that Vermonters have in person (or remote) assistance available to them to understand their benefits and responsibilities and help potential applicants understand health care programs and the application process. The program includes Assisters from 43 organizations throughout Vermont offering coverage of all 14 Vermont counties. Vermont In Person Assisters support thousands of households annually and each Assister organization has between 1 and 17 Assisters on staff. The Assister team also supports customers questions and concerns via the customer service email inbox and social media.

Who We Serve

HAEEU serves the more than 200,000 Vermonters who receive health benefits through Medicaid programs and/or the State's health insurance marketplace. Medicaid program members include those Vermonters who receive health coverage through Medicaid for Children and Adults (MCA), Dr. Dynasaur, Medicaid for the Aged, Blind and Disabled, VPharm, and the Medicare Savings Programs. The health insurance marketplace enrolls members in qualified health plans (QHP) and administers federal and state-based financial assistance, while also providing resources to Vermonters who buy unsubsidized health coverage on their own or through a small business.

How We Impact

Quality health coverage is a key ingredient of health and well-being. Vermont has one of the lowest uninsured rates in the nation and its health care system is consistently ranked one of the best, with one of the narrowest gaps in access between rich and poor residents. For many Vermonters, HAEEU is the doorway into this healthcare system.

Action Plan

SFY22 priorities are:

• PHE Unwind
• Premium Processing Implementation
• Staff Engagement (recruit and retain)

What We Do

The Vermont Chronic Care Initiative (VCCI) provides holistic, intensive, and short-term case management services to Vermont residents enrolled in Medicaid, including dually eligible members. VCCI works with members referred for complex case management by healthcare and human services providers, state colleagues and partners, as well as through our care management predictive modeling methodology. VCCI case managers and outreach coordinators are also welcoming members new to Medicaid (NTM), and screening members to identify and prioritize needs. Our screening tool asks members questions about access to care (including primary and dental) , the presence and status of health conditions, and inquiry about other needs that would assist them in maintaining +/or improving their health such as housing, food and safety. The VCCI team works to connect members with medical homes, community-based self-management programs, local care management teams and assist in navigating the system of health and health related care.

Who We Serve

VCCI serves Medicaid members except members:

• receiving CMS funded case management
• receiving services through Department of Aging & Independent Living (DAIL) or Department of Mental Health (DMH) 

How We Impact

The VCCI case managers are community based; and are stationed within the communities they live in. They work closely with their community health care and social service providers; collaboratively working with each other and the member on the member identified priorities. The case managers are closely linked with their AHS Field Directors – which has proven vital when working with members that may be involved with DCF, DOC, DMH, DAIL, and VDH. VCCI case managers meet with members in varied locations- homes, PCP offices, homeless camps, hospitals, shelters- successfully engaging members that have been historically hard to find and difficult to engage.

Action Plan

SFY21 priorities are:

• Provide complex case management to all Medicaid members regardless of designation to other programs/services. Case management services support initial stabilization focusing on gaps in care, including social determinants of health (sdoh)The VCCI will work to connect and transition members to appropriate long term service and care teams.
• Participate in the development of a referral process for members’ transitions to communities from the Department of Corrections.
• Outreach all member new to Medicaid to facilitate connections to primary and dental care and other services (behavioral health, 3squares, housing agencies).

What We Do

3SquaresVT is a federal USDA program (formerly food stamps) that provides money to purchase food. The benefits depend on household size, income, and expenses.  If a family is eligible and a school-age child, and the school participates in a federal meals program, the child also qualifies for free meals.

Who We Serve

Eligible for 3SquaresVT if:

• Your gross household income is equal to or less than 185% of the federal poverty level (FPL) — regardless of the resources you own.
• Your gross household income is over 185% of FPL but your household includes someone age 60+ or with a disability. We will consider the resources you own (e.g., bank accounts and vehicles) with some exceptions (e.g., your home and certain retirement accounts).
• You have children and get the Vermont Earned Income Tax Credit.

Budget information

What We Do

The Choices for Care Moderate Needs Program is an option for individuals who may not meet nursing home level of care but require some services to assist them to remain independent in their home, preventing a more intense level of service.  Services may include case management, homemaker, adult day, flexible funds.

Who We Serve

We serve Vermonters 18 years of age or older who meet both clinical and financial eligibility criteria and have a functional limitation resulting from a physical condition including stroke, dementia, TBI, and similar conditions or associated with aging.

How We Impact

The Choices for Care program provides a full array of long-term services and supports for older Vermonters and adults with physical disabilities. The Choices for Care program supports Vermonters to live in the setting of their choice, pursuing their individual goals and preferences within their chosen communities.

What We Do

The Choices for Care program provides long term services and supports to eligible Vermonters. These services provide support to allow Vermonters to choose where they want to receive their services, with ability to access services in the community or in a nursing facility.

Who We Serve

Choices for Care offers long term care services to eligible Vermonters who need nursing home level of care and who need Medicaid to pay for their care. 

How We Impact

The Choices for Care program provides a full array of long-term services and supports for older Vermonters and adults with physical disabilities. The Choices for Care program supports Vermonters to live in the setting of their choice, pursuing their individual goals and preferences within their chosen communities.

Budget information

What We Do

The Vermont Traumatic Brain Injury Program supports Vermonters with a moderate to severe traumatic brain injury, diverting or helping them return from hospitals and rehabilitation facilities to a community-based setting. This program is focused on rehabilitation and driven by participant choice, supporting individuals to achieve their optimum level of independence and to return to work.

Who We Serve

The Vermont Traumatic Brain Injury Program serves Medicaid eligible Vermonters with a moderate to severe traumatic brain injury.

How We Impact

The Vermont Traumatic Brain Injury Program helps Medicaid eligible Vermonters with moderate to severe traumatic brain injuries to achieve their optimum level of independence and to return to work.