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VT LEG #378801 v.1
S.1 1
Introduced by Senators Vyhovsky, Gulick, Watson and White 2
Referred to Committee on 3
Date: 4
Subject: Health; Medicaid; eligibility 5
Statement of purpose of bill as introduced: This bill proposes to provide 6
Medicaid-equivalent coverage to all Vermonters by age bands over time, 7
regardless of household income. It would direct the Agency of Human 8
Services to seek approval for federal financial participation in the expanded 9
coverage, with the State paying the full amount if the federal government does 10
not approve the request. The bill would direct the Agency of Human Services 11
and others to develop cost estimates for the Medicaid-equivalent coverage and 12
a detailed implementation plan. The bill would also require the Department of 13
Taxes to report on potential payroll tax design options to support the State’s 14
financial obligation in providing the Medicaid-equivalent coverage, both with 15
and without the federal funding. 16
An act relating to providing Medicaid-equivalent coverage to all 17
Vermonters 18 BILL AS INTRODUCED S.1
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VT LEG #378801 v.1
It is hereby enacted by the General Assembly of the State of Vermont: 1
Sec. 1. 33 V.S.A. chapter 18, subchapter 3 is added to read: 2
Subchapter 3. Medicaid-Equivalent Coverage 3
§ 1851. MEDICAID-EQUIVALENT COVERAGE FOR ALL VERMONT 4
RESIDENTS 5
The Agency of Human Services shall provide hospital, medical, dental, and 6
prescription drug coverage equivalent to coverage in the Vermont Medicaid 7
state plan to all Vermont residents, regardless of their household income, as 8
follows: 9
(1) to individuals up to 26 years of age, for coverage beginning in 2029; 10
(2) to individuals who are not less than 55 years of age and not more 11
than the age of eligibility for the federal Medicare program, for coverage 12
beginning in 2030; 13
(3) to individuals who are not less than 45 years of age and not more 14
than 54 years of age, for coverage beginning in 2031; 15
(4) to individuals who are not less than 35 years of age and not more 16
than 44 years of age, for coverage beginning in 2032; and 17
(5) to individuals who are not less than 26 years of age and not more 18
than 34 years of age, for coverage beginning in 2033, at which time all 19
Vermont residents shall be eligible for coverage. 20 BILL AS INTRODUCED S.1
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Sec. 2. GLOBAL COMMITMENT WAIVER AMENDMENT 1
(a) On or before September 1, 2025, the Secretary of Human Services shall 2
request approval from the Centers for Medicare and Medicaid Services to 3
amend Vermont’s Global Commitment to Health Section 1115 Demonstration 4
Waiver to make all Vermont residents eligible for hospital, medical, dental, 5
and prescription drug coverage equivalent to coverage in the Vermont 6
Medicaid state plan, regardless of income, as set forth in 33 V.S.A. § 1851. 7
(b) In the event that the Centers for Medicare and Medicaid Services does 8
not approve Vermont’s request for federal financial participation in providing 9
Medicaid-equivalent coverage to all Vermonters, regardless of income, the 10
coverage shall be funded with State-only dollars. 11
Sec. 3. AGENCY OF HUMAN SERVICES; COST ESTIMATES; 12
IMPLEMENTATION PLAN; REPORT 13
(a) The Agency of Human Services, in consultation with the Green 14
Mountain Care Board and the Department of Financial Regulation, shall: 15
(1) estimate the costs of providing hospital, medical, dental, and 16
prescription drug coverage equivalent to coverage in the Vermont Medicaid 17
state plan to all Vermont residents as set forth in 33 V.S.A. § 1851, including 18
the amount of State funds that would be required to support the program 19
through full implementation in 2033 both with and without federal Medicaid 20
dollars; 21 BILL AS INTRODUCED S.1
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(2) estimate the potential cost offsets in the health care system and 1
elsewhere in the economy as a result of all Vermont residents having access to 2
Medicaid-equivalent coverage; and 3
(3) develop and propose a detailed implementation plan for providing 4
Medicaid-equivalent coverage to all Vermont residents, beginning with 5
individuals up to 26 years of age in 2029 and continuing through full 6
implementation in 2033. 7
(b) On or before January 15, 2026, the Agency of Human Services shall 8
provide its cost and cost-offset estimates and implementation plan to the House 9
Committees on Health Care, on Appropriations, and on Ways and Means and 10
the Senate Committees on Health and Welfare, on Appropriations, and on 11
Finance. 12
Sec. 4. DEPARTMENT OF TAXES; PAYROLL TAX OPTIONS; REPORT 13
On or before January 15, 2027, the Department of Taxes, in consultation 14
with the Agency of Human Services, shall provide to the House Committees 15
on Health Care and on Ways and Means and the Senate Committees on Health 16
and Welfare and on Finance options for structuring a payroll tax to generate 17
the revenue necessary to support the State portion of the Medicaid and CHIP 18
expansion established in Sec. 1 of this act, both with and without federal 19
Medicaid dollars, based on the Agency’s cost estimates developed pursuant to 20
Sec. 3 of this act and any subsequent additional fiscal analysis. The 21 BILL AS INTRODUCED S.1
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Department’s report shall set forth at least three payroll tax options and shall 1
include the Department’s recommendation for which option is the most 2
administratively feasible for employers, employees, and the State. 3
Sec. 5. EFFECTIVE DATES 4
(a) Sec. 1 (33 V.S.A. § 1851; Medicaid-equivalent coverage for all 5
Vermont residents) shall take effect on January 1, 2029. 6
(b) The remainder of this act shall take effect on passage. 7