Vermont Health Access Plan, Department of Aging & Disabilities, Department of Corrections, and Department of Developmental & Mental Health Services (Waterbury, VT and Williston, VT)

Since 1994, the Pacific Health Policy Group (PHPG) has provided ongoing assistance to Vermont in the design and implementation of a series of health reform initiatives. The largest of these, the "Vermont Health Access Plan" (VHAP), is a Section 1115(a) Waiver program under which the state is enrolling AFDC and ABD Medicaid recipients into managed care, while also expanding coverage to uninsured children and working poor, and providing pharmacy benefits to Medicare beneficiaries.

Despite unique challenges, including an immature managed care market and limited access to health care providers in many rural areas, the VHAP program has been successfully implemented. The state contracts with health plans to enroll and serve traditional and expansion eligibles, while directly administering the pharmacy program for Medicare beneficiaries.

PHPG has also assisted the state in several innovative programs, including development and implementation of a Demonstration Waiver initiative to extend targeted coverage to "at-risk" seniors, amending the VHAP waiver to include Community Rehabilitation and Treatment (CRT) services for the seriously mentally ill and children with severe emotional disturbance. PHPG also assisted the state in the development and approval of its CHIP program, and in restructuring of the state's special education reimbursement system

Specific activities and tasks have included:

• Overall project design

• Development of a Section 1115(a) Demonstration Waiver

• Design of computerized model for producing annual cost and utilization data books to be used in ratesetting activities

• Selection of an independent enrollment broker responsible for outreach, education, and enrollment activities

• Management of a health plan procurement process, including development of an RFP

• Development of Title XXI CHIP application

• Analysis of special education utilization and cost data and development of revised reimbursement mechanism