Vermont School-Based Services Implementation Program to Expand Access to Care, Improve Administrative Efficiencies, and Maximize Allowable Federal Medicaid Reimbursement - Vermont’s Agency of Human Services (AHS) seeks a grant award in the “Implementation” category to redesign its School-Based Services (SBS) program reimbursement approach, inclusive of both medical and administrative services, to expand access to care and maximize available federal Medicaid reimbursement under the program to all Local Education Agencies (LEAs). Grant funds will be used to support the development of a comprehensive policy approach, methodology development, and payment rates aligned with a redesigned SBS program model to be inclusive of all Medicaid-covered services provided in the school setting. Vermont recognizes that schools are vital places to provide children with access to important health care services on-site, including preventive services, therapies, and chronic disease management. Providing these services on-site limits disruption to caregivers’ work schedules or concerns with transportation, increases overall access, and reduces the stigma of accessing certain services. Schools can also serve as a catalyst for children to access primary care, promoting health and educational equity in the school setting. These settings also include critical Medicaid administrative services that promote the availability, accessibility, coordination, and appropriate utilization of additional health services. AHS is embarking on a collaborative process to evaluate and redesign Vermont’s SBS program considering CMS’s recent guidance. Funds requested in this grant application would be used to evaluate the current SBS program and determine and prioritize program improvements to expand opportunities for reimbursement and address barriers to full program participation. The project will occur in stages, beginning with a full assessment of the current program that will inform the development of recommended changes best suited for Vermont. This initial phase focus on current program evaluation and redesign. Next, efforts will focus on planning for implementation of expected changes. The final stage will focus on implementation of a statewide modernized SBS program. Throughout the process, the goals of expanding access to care, improving administrative efficiencies, enabling full and equitable participation by all LEAs, and maximizing allowable federal Medicaid reimbursement under the program will be prioritized. Vermont aims to submit a SPA and any other required documents to CMS for review and approval within 12 months of project launch, but no later than June 1, 2026. The foundation of Vermont’s SBS redesign project will be the completion of a comprehensive needs assessment that builds upon existing reports to fill in any gaps that are most pertinent to SBS. These initial assessments identified several important themes on barriers to accessing health care services that exist in the state’s rural communities. Vermont plans to identify solutions to create a robust SBS program that helps to alleviate many pressing healthcare issues for Vermont’s children. This application requests funding to explore recommendations to support infrastructure needs, including the exploration of Electronic Health Records and data sharing solutions, as well funding for state Medicaid positions, and meaningful technical assistance and support for all LEAs. The grant will be a key source of funding for Vermont’s evaluation and redesign of its School-based Medicaid program, as well as to explore other opportunities to enhance program participation, expand covered services, and reduce burdens to LEAs. The sustainability of initiatives undertaken through redesign of Vermont’s SBS program will be funded by the anticipated increase in FFP derived from these efforts to expand covered services and ensure that all LEAs are able to fully participate in the expanded program.
