Medicaid Global Commitment

Contain Health Care Cost

In 2005 Vermont entered into a five-year comprehensive 1115 Federal Medicaid Demonstration Waiver named Global Commitment to Health (GC).

This waiver is designed to:

• Provide the state with financial and programmatic flexibility to help Vermont maintain its broad public health care coverage and provide more effective services;
• Continue to lead the nation in exploring new ways to reduce the number of uninsured citizens; and
• Foster innovation in health care by focusing on health care outcomes.

The waiver program consolidates funding for all of the state's Medicaid programs, except for the new Choices for Care (long-term care) waiver and several small programs (SCHIP and DSH payments for hospitals). It also converts the Office of Vermont Health Access (OVHA), the state’s Medicaid organization, to a public Managed Care Organization (MCO).

Under this new waiver, the MCO can invest in health services that typically would not be covered in our Medicaid program, and Vermont’s Medicaid program has programmatic flexibility to implement creative programs and reimbursement mechanisms to help curb our health care costs. The State has requested an amendment from CMS to include Catamount Health and the Employer-Sponsored Insurance (ESI) premium assistance programs under the financial umbrella of this waiver. In 2007, CMS approved this request; with the exception that federal match for premium assistance was approved only for people with household incomes at or below 200% FPL. The state has kept open the request for this approval, with the expectation that impending changes at the federal level may result in a positive decision.