Medical Billing Company in Vermont | Built for a Single Public Payer Model

Vermont's Medicaid program does not use commercial managed care organizations the way most states do. Since 2005, the entire program has operated under a federal Section 1115 demonstration waiver called the Global Commitment to Health, branded to residents as Green Mountain Care. Under this structure, the Department of Vermont Health Access acts as the state's sole managed care entity, a public, non-risk-bearing prepaid inpatient health plan rather than a network of competing private insurers. This means Vermont billing teams deal with one payer administering nearly all Medicaid services statewide, not a patchwork of MCO-specific fee schedules and prior authorization rules like states such as Texas or Tennessee. Long-term services and supports fall outside this main structure and run through a separate program called Choices for Care, billed on a fee-for-service basis rather than through DVHA's managed arrangement. Green Mountain Care covers more than 200,000 enrollees, nearly 30 percent of Vermont's population, and includes named sub-programs such as Dr. Dynasaur for children and pregnant women and MABD for aged, blind, and disabled residents. CMS most recently extended the Global Commitment waiver through December 31, 2027. Mediknocx's billing team tracks which sub-program and service category a claim falls under, since Choices for Care claims follow different rules than the rest of Green Mountain Care even though both sit under the same overall waiver.