The future funding of Vermont's Medicaid program will be one of the biggest issues facing lawmakers during the upcoming Legislative session. On Monday, the House Appropriations Committee started its review of this ever-expanding program.
Decisions that lawmakers make this winter about the Medicaid budget could have a direct impact on how more than 200,000 Vermonters get their health care.
A recent decision to expand Medicaid eligibility will be under review and some legislators also want to look at the full scope of the Medicaid benefit package.
These questions are being raised because the state faces a roughly $30 million shortfall in the Medicaid program in the current fiscal year and a projected $60 million shortfall in next year's budget.
House Appropriations Committee chairwoman Mitzi Johnson thinks it's good news that so many Vermonters have signed up for Medicaid.
"As more and more people got health insurance, more of them qualified for Medicaid than for private insurance than we anticipated,” Johnson says. “So now we have to figure out to how to pay for that."
Lawrence Miller, the governor's chief of health care reform, says the bottom line is that thousands of previously uninsured Vermonters now have coverage through Medicaid.
"The fact that we've had an adjustment in that population on a one-time basis means we need to make some decisions about what the funding level is going to be, and how that relates to other things we fund in this state,” Miller says. “But it's really critical that we got a lot of people who weren't previously covered covered.”
House Minority leader Don Turner has a different point of view. He says the Medicaid program has grown beyond the capacity of Vermonters to pay for it. He thinks the program needs to be scaled back.
"We have to come to the Statehouse to make a decision. The Legislature policymakers have to come to some kind of consensus of what's more important,” Turner says. “More people covered, so we have the lowest number of uninsured in the country? Or do we want to have the most lucrative benefit package?"
Efforts to reduce the benefit package or the eligibility requirements will face the strong opposition of Gov. Peter Shumlin.
"I think it's both disingenuous and short sighted and fiscally irresponsible and downright cruel to say to Vermonters, 'Hey we're signing you up for health care, [but] we refuse to have the courage to pay for it, and therefore we're going to start taking away your health care from you,’” Shumlin says.
The Shumlin administration has proposed dealing with the Medicaid shortfall in the current fiscal year primarily by using one-time money that's available from several different state sources.
The governor will outline his long-term Medicaid fix in his budget address next month.