General Health Care Services

The Agency of Human Services envisions a Vermont in which everyone of all ages benefits from positive phsyical and mental health and reliable, equitable access to health care services.  AHS delivers public health programming that supports all Vermonters and whole communities, and health care services to individuals and families to ensure good health outcomes and healthy living environments across the state.

 

Make sure to look at our Mental Health & Substance Use Scorecard to learn more about those specific programs and services.

Vision for Vermont
Children and Youth
Adults and Older Adults
Health-Adults
O
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
Why Is This Important?
I
2018
96%
100%
1
I
2018
73%
85%
1
Department of Vermont Health Access
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
What We Do
Who We Serve
How We Impact
PM
2017
68.1%
51.7%
1
PM
2017
50.9%
48.4%
1
PM
2017
55.1%
58.1%
1
PM
2017
50.8%
55.1%
1
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
What We Do

The Vermont Blueprint for Health is a state-led, nationally-recognized initiative that helps health care providers meet the medical and social needs of people in their communities. The Blueprint’s aim is constant: better care, better health, and better control of health care costs.

The Blueprint encourages initiatives to support and improve health care delivery. It promotes innovative initiatives aimed at improving health outcomes, increasing preventive health approaches, addressing quality of life concerns, and increasing access to quality care through patient-centered medical homes and community health teams.

Who We Serve

The Blueprint for Health serves 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
PM
SFY 2017
53.3%
64.1%
1
PM
SFY 2017
65.7%
73.0%
2
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
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.  

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, providing guidance, direction, and interpretation on federal regulations and state rules and how those policies are implemented technically and operationally.

Customer Experience Team works to ensure that current members understand their benefits and responsibilities and that potential applicants understand health care programs and the application process. They manage member notices, a contracted call center, and a network of nearly 300 In-person Assisters. They manage health insurance literacy efforts – helping Vermonters understand health insurance terms, compare options, and get the most out of their health coverage – and focus on groups of Vermonters likely to lack access to health insurance, including farmers, justice-involved individuals, new Vermont residents, and those in the 26-34 age group. They collaborate with community partners, including hospitals, clinics, agricultural organizations, libraries, pharmacies, and other stakeholders.

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
  • Operational performance improvement as an on-going effort to continually improve processes, products, and the services we provide with DVHA and DCF staff acting as one unit that strives towards operational excellence and sustainability and continues its focus on technical development work with different IT platforms, leveraging different vendors, creation and restructuring positions, and an aggressive approach to minimizing the financial footprint created by contractors and large staffing numbers in the current fiscal year.
  • Advance several Integrated Eligibility and Enrollment products, including an online application, a customer portal that will allow Vermonters to apply online for benefits electronically, and reconfiguring and developing our systems to return premium billing to the carriers.
PM
Jan 2020
53%
75%
1
PM
Jan 2020
95%
95%
1
PM
Jan 2020
2
15
1
PM
Jan 2020
100%
100%
28
PM
Jan 2020
4.8%
4.7%
1
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
What We Do

The Vermont Chronic Care Initiative (VCCI)

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 non- ACO members identified using claims-based methodology and members identified by health care providers and community partners in need of complex care management. VCCI case managers are also welcoming new members to Medicaid, by outreaching and asking questions about primary care provider, health conditions and other supports that would assist them in maintaining or improving their health as well as housing, food and safety. The VCCI team works to connect members with medical homes, community-based self- management programs, and local care management teams.

The VCCI utilizes common tools and processes adopted by the local community care teams as part of the complex care model to include eco mapping, identification of lead care coordinator, facilitating care teams, and shared care plan development.

Licensed case managers trained in the complex care model, deliver services in communities throughout the state.

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) 
  • who are attributed to the ACO
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’.

Action Plan

THE TOP PRIORITIES/INITIATIVES FOR the VCCI unit IN SFY20 ARE:

  • Align with health care reform efforts and formal adoption of complex care model and team-based care; utilization of common tools.
  • Facilitate connection to appropriate level of care within the ACO model either at primary care or with a care team.
  • New to Medicaid or those members with gaps in PCP care – outreach/screen – orient to system of care; provide brief intervention to facilitate PCP and dental access.  Connect to appropriate level of care.
  • High/Very High Risk – short term case management to connect to appropriate level of care. 
Department of Health
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
PM
HY1 2019
67%
75%
4
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
PM
2018
5.1%
5.0%
1
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
PM
2018
77%
100%
1
PM
2018
70%
100%
1
VDH
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
VDH
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
PM
HY2 2014
80
50
1
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
Department for Children and Families
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
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.
PM
2017
48.00
90.00
1
PM
2017
42,333
4
P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
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.

P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
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.

P
Time
Period
Current
Actual
Value
Current
Target
Value
Current
Trend
Budget information
FY20 PROGRAM BUDGET  
Primary Appropriation # 3460070000
FY 2020 Appropriation $$$ $6,005,225.00
Portion ($$$) of Appropriation Dedicated to Program $6,005,225.00
TOTAL PROGRAM BUDGET FY 2020 $6,005,225.00
   
   
FY18 PROGRAM ACTUALS  
FUND: GC (Code: 20405) $5,531,534.32
TOTAL ACTUAL FY18 $5,531,534.32
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.

Scorecard Result Program Indicator Performance Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy