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1115 Waiver Documents

The Global Commitment to Health is a Demonstration Waiver authorized pursuant to Section 1115(a) by the Centers for Medicare and Medicaid Services (CMS), within the Department of Health and Human Services (HHS).

Current CMS Approved Global Commitment to Health Section 1115 Waiver (3/7/2023)

Vermont Global Commitment to Health Section 1115 Demonstration Amendment State Public Comment

The Agency of Human Services (AHS) is hosting a 30-day public comment period for the amendment to the Global Commitment demonstration from Wednesday, March 20, 2024, to Friday, April 19, 2024. Through this amendment, Vermont intends to expand access to care for Vermonters with mental health conditions and substance use disorders (SUD), provide housing and other supports to promote whole-person health, and advance payment and delivery system reforms by instituting Medicaid hospital global payment. The following materials have been shared for public comment:

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    The initial Global Commitment to Health (GC) and Choices for Care (CFC) demonstrations were approved in September 2005, effective October 1, 2005. The GC demonstration was extended for three years, effective January 1, 2011, and again for three years effective October 2, 2013. The CFC demonstration was extended for 5 years effective October 1, 2010. The following amendments have been made to the GC demonstration:

    • 2007: A component of the Catamount Health program was added, enabling the state to provide a premium subsidy to Vermonters who had been without health insurance coverage for a year or more, have income at or below 200 percent of the federal poverty level (FPL), and who do not have access to cost effective employer-sponsored insurance, as determined by the State.
    • 2009: The state extended Catamount Health coverage to Vermonters at or below 300 percent of the FPL.
    • 2011: Inclusion of a palliative care program for children who are at or below 300 percent of the FPL and have been diagnosed with life limiting illnesses that would preclude them from reaching adulthood. This program allows children to receive curative and palliative care services such as expressive therapy, care coordination, family training and respite for caregivers.
    • 2012: CMS provided authority for the State to eliminate the $75 inpatient admission copay and to implement nominal co-payments for the Vermont Health Access Plan (VHAP) as articulated in the Medicaid State Plan.
    • 2013: CMS approved the extension of the GC demonstration which included sun-setting the authorities for most of the 1115 Expansion Populations because they would be eligible for Marketplace coverage beginning January 1, 2014. The renewal also added the New Adult Group to the demonstration effective January 1, 2014. Finally, the renewal also included premium subsidies for individuals enrolled in a qualified health plan whose income is at or below 300 percent of the FPL.
    • 2015: As of January 30, 2015, the GC demonstration was amended to include authority for the former Choices for Care demonstration. In addition, the State received section 1115 authority to provide full Medicaid State Plan benefits to pregnant women who are determined presumptively eligible.
    • 2017: Global Commitment demonstration is extended from January 1, 2017 through December 31, 2021.
    • 2018: Global Commitment demonstration is amended effective July 1, 2018 through December 31, 2021 to authorize Vermont to receive federal financial participation for the continuum of services to treat addictions to opioids and other substances, including services provided to Medicaid enrollees with a substance use disorder who are short-term residents in residential and inpatient treatment facilities that meet the definition of an Institution for Mental Diseases (IMD).
    • 2019: As of December 5, 2019, the Global Commitment to Health demonstration was amended to include authority for Vermont to receive federal Medicaid funding on payments to IMDs for individuals ages 22 to 64 receiving mental health (SMI/SED) treatment for short term acute care stays that are no more than 60 days and when the statewide average length of stay meets the expectation of 30 days or less.

    Waiver Documents by Year:

    2024 Waiver Documents

    Global Commitment to Health Section 1115 waiver amendment request

    Waiver Documents by Year