PCCM in Vermont

Vermont enacted comprehensive health care reform in 2006, known as Catamount Health.  One component of the reform is an expansion of Medicaid and SCHIP to children with family income below 300% FPL ($51,510 for a family of three in 2007), parents with family income below 185% FPL of poverty ($31,765 for a family of three), and non-disabled, childless adults with income below 150% FPL ($15,315 for an individual).  

Vermont provides coverage to Medicaid and SCHIP enrollees directly through the Office of Vermont Health Access (OVHA), which is licensed as the programs’ managed care organization.  Enrollees are required to choose a primary care provider (PCP), and OVHA reimburses that provider and other providers referred by the PCP for services.  This is simpler than contracting with a private insurer and paying the carrier a monthly capitation fee for enrollees, and appropriate because Vermont has a small provider community and fewer insurers in the market than other states.