June 24, 2025

NEED TO KNOW

DVHA Outlines Loss of Insurance Coverage for Vermonters, Federal Dollars due to Federal Reconciliation Bill

Last week, the Department of Vermont Health Access outlined the Medicaid and Insurance Marketplace impacts that would result from the Reconciliation bill currently under consideration in the U.S. Senate. DVHA estimates that the bill could result in over 45,000 Vermonters losing insurance coverage and the loss of over $1.3 billion in federal funding to Vermont’s Medicaid program by 2034. See also coverage by Vermont Public here. The US Senate may act on the proposal before July 4^th.

This bill would affect Vermont’s Medicaid program, the insurance exchange marketplace, and the broader health care system in four primary ways:

1. Loss of Health Insurance Coverage

Estimated loss of half of the new adult expansion Medicaid population (30,000 individuals), at least initially based on historical 50% non-response rate for document requests.

Implements work requirements that would impose an administrative barrier to enrollment and renewal processes for many Vermonters, including those who work.
Cuts the duration of Medicaid eligibility for adults in half, from 12 to 6 months, increasing the chance individuals lose coverage for failing to provide paperwork.
Shortens Medicaid retroactive coverage from 3 months to 1 month, increasing uncompensated care.

Estimated loss of half of the health insurance exchange/Marketplace enrollment (15,000 individuals)

Subjects most of the marketplace population to new paperwork requirements as a prerequisite to enrollment and eliminates automatic re-enrollment.
Prohibits individuals who cannot meet Medicaid work requirements from receiving coverage on the exchange.
Limits open enrollment and special enrollment periods.
Eliminates marketplace eligibility for lawfully present immigrants.

Eliminates the Family Planning coverage option through Planned Parenthood for Vermonters who need reproductive health care but are not otherwise eligible for Medicaid.

2. Loss of Federal Investment in Vermont’s Health Care System

Loss of Medicaid coverage equates to a cut in federal financial support to Vermont’s health care system
Requires a phase down of provider taxes used to draw down federal funding for the Medicaid program
Reduces marketplace premium tax credits beginning in 2026.
Bars Medicaid reimbursement to Planned Parenthood.
Implements funding penalties if Vermont continues the Immigration Health Plan (IHIP)

3. Increases the Rates of “Churn” or coverage disruptions and coverage loss that occurs when switching between different health insurance plans or experiencing periods of being uninsured.

4. Substantial increase in administrative burden for members, state staff, and providers: Adult Medicaid members will have to provide paperwork to prove eligibility twice as often, while newly adhering to work requirements that will necessitate navigating additional paperwork.

The AMA sent a letter to Senate leadership last week highlighting cuts to Medicaid, changes in eligibility criteria, and the exclusion of the House-passed Medicare provisions as threats to patients’ access to care. VMS has also joined a state medical society coalition letter being sent to Senate leadership raising the alarm that the Senate proposal is even worse than the House and doubles the Medicaid provider tax cuts up to $400 billion, fails to address Medicare physician payment, and continues student loan cuts.

You can still take action by joining the Protect our Care Text Campaign to key Senate districts. Learn more here.

VMS Joins AMA Letter Urging Reinstatement of ACIP Members

Last week, the American Medical Association, joined by dozens of national and state medical societies, wrote Secretary Kennedy urging him to immediately reinstate the terminated members of the Advisory Committee on Immunization Practices (ACIP) and honor their commitments to serve through the end of their appointed terms. When the terms of current ACIP members come to an end, the organizations strongly urged Kennedy to follow the long-established public process for ACIP nominations and selection of members, ensuring that experience and subject-matter expertise are prioritized. See the full letter here. VMS’ statement released on June 10^th opposing the removal of the members of ACIP can be found here.

Changes to Covid-19 Vaccine Recommendations from the Vermont Department of Health Immunization Program

On May 27, 2025, the federal Department of Health and Human Services (HHS) announced that COVID-19 vaccines would no longer be routinely recommended for healthy children or healthy pregnant people. Typically, ACIP reviews vaccines and makes recommendations to the CDC about their use. Then, the CDC Director makes their official recommendation based on ACIP’s review. In this case, the announcement came directly from the HHS Secretary.

Then, on May 30, 2025, CDC issued further guidance keeping COVID-19 vaccines on the vaccination schedule for healthy children 6 months to 17 years old, but added a new condition that children and their caregivers will be able to get the vaccines “in consultation with a doctor or provider.” CDC also removed the routine recommendation for pregnant people, and currently does not offer any guidance for this population.

The Health Department’s Recommendation on COVID-19 Vaccines for Children

The Vermont Department of Health agrees with the position of the American Academy of Pediatrics (AAP) to maintain access to vaccination and advises providers to use shared clinical decision-making for children with no underlying risk factors.

The Health Department’s Recommendation on COVID-19 Vaccines for Pregnant Vermonters

The ACIP vaccination schedule now cites “No Guidance/Not Applicable” for COVID-19 vaccination during pregnancy. However, CDC still lists pregnancy as a risk factor for severe disease in COVID-19. Most recent data continues to show that COVID-19 infection during pregnancy increases the risk of severe COVID-19 and adverse pregnancy outcomes.

The Vermont Department of Health agrees with the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) recommendations that all pregnant people continue to receive COVID-19 vaccines.

The newly-appointed ACIP is scheduled to meet this Wednesday & Thursday, June 25-26 and the Department of Health will closely monitor any decisions made in that meeting, particularly those that may impact the existing vaccine schedule. The Department plans to issue a detailed guidance regarding vaccination recommendations after reviewing findings from the ACIP meeting and remains committed to evidence-based science and providing routine vaccines through Vermont’s Immunization Program.

Health Plans Pledge to Take Action to Simplify Prior Authorization

National health insurance plans announced Monday a series of voluntary commitments to streamline, simplify and reduce prior authorization. The commitments are being implemented across insurance markets, including for those with commercial coverage and Medicare Advantage, consistent with state and federal regulations, and will benefit 257 million Americans.

Participating health plans committed to:

Work toward implementing common, transparent submissions for electronic prior authorization, by January 1, 2027
Commit to specific reductions in medical prior authorizations by January 1, 2026
Beginning January 1, 2026, when a patient changes insurance companies during a course of treatment, the new plan will honor existing prior authorizations for benefit-equivalent in-network services as part of a 90-day transition period
In 2027, at least 80 percent of electronic prior authorization approvals will be answered in real-time

Read the full announcement here.

Update on J-1 Visa Processing for Physicians

Last week, the AMA sent the attached letter to Secretary of State Marco Rubio regarding J-1 appointments for foreign national physicians which were paused by the U.S. Department of State. Shortly after the AMA letter was submitted, the Department of State announced that interviews for visas will no longer be paused and that interview availability for physicians will be prioritized, due to the approaching July 1, 2025, residency start date. Intealth, parent organization of the Educational Commission for Foreign Medical Graduates (ECFMG), the universal sponsor for J-1 physicians, has worked aggressively over the past few weeks to provide an exception and prioritization for physicians throughout this interview pause that began in May of 2025. The AMA has been in constant contact with, and supported, ECFMG in this effort.

Call for VMS' Leadership Awards

Nominations are now open for VMS’ Leadership Awards! We are asking members to nominate Vermont leaders who have provided outstanding contributions to the medical profession, to health organizations and to the welfare of the public. Please nominate a Vermont leader here. Nominations are open through August 13, 2025.

Awards include:

Distinguished Service Award
Physician of the Year Award
Physician Award for Community Service
Citizen of the Year Award
Founders’ Award

The awards ceremony will be held on the evening of November 7th at the 212th VMS Annual and Collaborative Meeting. Stay up to date on event details here.

MISC.

Vermont Medicaid Telehealth Place of Service Update

As a reminder, Telehealth Services are reimbursed by Vermont Medicaid (DVHA) according to the fee schedule based on place of service. For dates of service on or after 1/1/25, see below for clarification on the use of place of service 02 and 10.

POS 02: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in a hospital or other facility when receiving services.
POS 10: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home, which is a location other than a hospital or other facility where the patient receives care. This includes work or other community locations.

As a reminder, providers are required to append the appropriate modifier indicating if services were delivered via audio only (93) or audio-video (95). For more information, including audio-only telehealth services covered by Medicaid, see https://dvha.vermont.gov/providers/telehealth.

Back for 2025, Quarterly Financial Webinars Hosted by Pinnacle Wealth (FKA Pastore Financial Group).

Pinnacle Wealth has been a supporter of VMS for decades. Our independent, fiduciary advisors will share insights to help you on your financial journey. Can’t make the webinar but have questions? Please email info@pinnaclevt.com for an individual meeting.

Early Career: Questioning your student loan strategy? Do you have the right amount of life and disability insurance? Are you maximizing opportunities to accumulate wealth and minimize taxes? Join us for an exclusive seminar for VMS members. We will discuss updates to SAVE and PSLF, important insurance concepts, and strategies to maximize accumulation during your early years as a physician.

Approaching Retirement: Are you confident in your retirement plan? Concerned about market volatility? Do you have a strategy to protect your investments while maximizing returns? Join us for an exclusive retirement planning seminar for VMS members. We will discuss key strategies to secure your financial future and enhance your investment growth in today’s unpredictable market.

Concierge Medical Practice for Sale – Stowe, Vermont

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For more details, please visit: davidbisbeemd.com or contact directly: dbisbee@docbisbee.com

One More Week To Apply - Physician Leadership Development Course Applications Due July 1^st!

The Vermont Medical Society is now partnering with the University of Vermont to offer a statewide physician leadership development course beginning in September 2025 and running until March 2026. The course is designed to empower physician leaders across Vermont with the skills, knowledge, practical experience, and networking opportunities needed to foster effective team success.

See the course information and FAQs here.

Applications are due by July 1, 2025!

Applicants submit a brief statement of interest in the course and a CV. Apply here. If there are more interested candidates than seats, VMS will select participants with the goal of wide representation from practice types, specialties and locations. (Please note, UVM Health Network physicians should apply separately - learn more here.)

Key dates: