In July 2024, the secretary of Vermont’s Agency of Human Services announced that the state had been selected for a new federal health care reform model.
The All-Payer Health Equity Approaches and Development Model, or AHEAD Model, would draw down more Medicare dollars, direct federal funding to primary care practices and change how medical care is paid for, with the goal of lowering costs and improving residents’ overall health.
But as the newly installed administration of President Donald Trump embarks on a wide-ranging effort to cut the size of the federal government — starting with the elimination of diversity, equity and inclusion programs — the future of AHEAD is now in question.
Late last month, federal officials working with Vermont on the AHEAD Model halted communications and canceled meetings with state officials related to the model, according to emails obtained by VTDigger.
“(The Center for Medicare and Medicaid Innovation) has been issued a communications hold associated with the leadership transition in the new administration which extends to all state partners,” a federal staffer wrote to state Agency of Human Services officials on January 27. “To comply, we will be holding all emails, scheduled reports, and pulling down any planned meetings between now and February 7. This is a tentative date and may lift sooner/later. We’ll let you know more when we do.”
State officials said they have not received any more information since the communications hold was implemented.
Several federal health care reform staffers that worked with Vermont on preparing for the AHEAD Model have also been let go amid a wide-ranging downsizing of the federal government, according to state officials.
So what will become of AHEAD?
“We don’t know,” Brendan Krause, Vermont’s director of health care reform at the Agency of Human Services, said in an interview. “That’s not very satisfying, but that’s pretty much the answer you’re probably getting from everyone when it comes to federal programs. Our job is to continue working as if it is moving forward.”
Krause said that such communications holds are not uncommon amid shifts in presidential administrations. He said he could not say whether wide-ranging federal job losses are standard.
Sarah Rosenblum, the deputy director of health care reform, said that Vermont officials had been told that the communications hold would last until Mehmet Oz, the physician and TV host tapped by Trump to lead the Centers for Medicaid and Medicare Services, had been sworn in.
In an emailed statement, a spokesperson for the Centers for Medicare and Medicaid Services said that the Center for Medicare and Medicaid Innovation is reviewing all of its health care reform models to make sure they improve population health and use taxpayer dollars effectively.
Amid the uncertainty, Vermont officials, lawmakers and advocates are facing the possibility that AHEAD will not happen at all — and considering how to adapt.
“It’s hard for me to fathom a world in which a payment reform plan that has the word ‘equity’ in its title is going to live going forward,” Mike Fisher, Vermont’s chief health care advocate, told lawmakers on the Senate health and welfare committee last week.
Sen. Ginny Lyons, D-Chittenden Southeast, the chair of that committee, said in an interview that she was “very concerned” about the prospect that AHEAD would no longer take place.
But lawmakers plan to keep working to improve the state’s health care system with or without the program, Lyons said.
She pointed to a newly released bill in her committee that, in its current form, would make significant changes to how and how much Vermonters pay for health care — including the implementation of reference-based pricing, a program that limits how much health care providers can charge for services by pegging their prices to Medicare rates.
“We’re watching anxiously, but, you know, we have to maintain the course,” she said. “We can’t just stop dead in our tracks.”
Read the story on VTDigger here: Vermont was selected for a new federal health care reform program. Under Trump, will it happen at all?.