Working to Reduce Substance Abuse and Treat Substance Use Disorder
The State has comprehensive approach to addressing substance abuse, including a focus on the opioid epidemic, led largely through the Department of Health. This includes significant, ongoing investments in programs to support prevention, education, harm reduction, treatment, recovery and numerous related wrap-around services to help reduce the number of Vermonters struggling with addiction, help those with substance use disorder, and support a holistic system of care to address these complex issues. In addition to this statewide, ongoing work, the Governor has taken additional specific steps in the areas of Prevention, Treatment, Recovery and Enforcement.
- Governor Scott proposed, fought for, and secured the largest increase in prevention funding in state history in the FY23 budget. This includes $4 million to local and regional substance misuse prevention coalitions.
- Supported the creation of a Chief Prevention Officer, who as a member of the Governor’s senior staff making this a core policy area in the Governor’s office.
- Championed efforts to ensure revenue from the retail cannabis market went to education and prevention initiatives, including vetoing a bill to ensure the final passed-law included this requirement.
- Treatment and Recovery
- Increased funding - In 2022 (FY23), the Governor proposed, fought for, and secured significant new investments in treatment and recovery services, including:
- $2 million for substance use disorder treatment and recovery beds
- $1.2 million in rate increase for providers to support treatment and recovery
- $1.54 million for recovery centers, employment services and regional recovery partners, like Jenna’s House
- Expanding Access to Treatment – The Scott Administration has continued to build of the success of Vermont’s Hub and Spoke model of treatment, including:
- Worked with partners and providers to expedite opening of the St Albans Hub (including opening of a temporary hub at Northwest Medical Center). These efforts supported the hard work of providers and treatment professionals across the state, helping bring the Chittenden County treatment wait list to zero, which created the capacity statewide to get people into treatment quickly.
- Secured an amendment to Vermont’s Global Commitment to Health 1115 Demonstration waiver, allowing Medicaid to pay for inpatient residential treatment for addiction.
- Expanded Medication Assisted Treatment to a 120-day continuation at all Department of Corrections sites.
- Signed a legislative initiative to decriminalize buprenorphine and study the effectiveness of this measure to help people seek treatment and stay in recovery.
- Expanding Substance Use Disorder treatment workforce – To help address the shortage of the substance use disorder treatment professionals, the Governor:
- Coordinated a statewide substance use disorder workforce summit in April 2017, hosting more than 150 health, education and policy stakeholders to collaborate on solutions to substance abuse disorders, with a focus on increasing professionals in the treatment and recovery fields.
- After working with the Secretary of State's Office of Professional Regulation (OPR), providers and industry stakeholders, reformed administrative rules governing licensed treatment professionals. These reforms increased the efficiency of the licensing process, allowing for expansion of this sector of the workforce.
- Creating more opportunities for those in recovery – Implemented a new initiative that has Vermont Department of Labor employment counselors making regular visits to all of Vermont’s recovery centers, providing services and guidance to help those in recovery find and keep jobs.
- In response to crime in Vermont, in August 2022, Governor Scott issued a 10-point public safety plan, which include a focus on ensuring capacity within law enforcement and the court system to address drug trafficking and violent crime.
- The Vermont Drug Task Force, in partnership with federal and local law enforcement, has continually pursued significant drug trafficking investigations involving illegal opioids and other narcotics. These investigations target those responsible for distributing narcotics, including heroin in Vermont, and facilitating the distribution of illegal drugs by out-of-state suppliers.
Working to Strengthen our Mental Health System
- Implementing Mobile Response Services – Proposed, passed and implemented a mobile response pilot program in Rutland (FY22), which will be expanded with additional funding in FY23. This initiative takes services directly to children and families experiencing a mental health crisis, in real time, providing critical care to families in need and reducing pressure on emergency rooms.
- Suicide Prevention – Governor Scott proposed and secured a nearly $2 million increase for the state’s Zero Suicide initiative and the eldercare outreach program (FY23).
- Expanding capacity – While much more needs to be done to build capacity and workforce to support mental health needs in Vermont, the Administration has worked with the Legislature in some key areas:
- Secured funding for a permanent therapeutic community residence to replace the temporary facility in Middlesex, which will also expand capacity.
- Proposed and secured investments in our mental health system and worked with the Legislature to develop a plan to increase bed capacity at one of our designated hospitals, the Brattleboro Retreat.
- The $5.5 million in funding will increase our state’s capacity of level-1 beds by creating an additional 12 beds at the Retreat. The FY20 budget provides $1.5 million more to fund additional beds.
- By increasing out statewide capacity, we are making investments that will help us be more flexible in where patients are located, support those needing care, and reduce emergency department use.
- Helping kids in crisis
- Implementing a value-based incentive for screening children and adolescents – Beginning on January 1, 2023, all Vermont Designated Agencies will be able to earn a value-based incentive payment for providing screenings to children and adolescents (aged 12 and up) for depression and substance use. Screenings will improve our ability to engage in early intervention activities with youths experiencing mental health and substance use challenges.
- Implemented a Child Psychiatry Access Program, offering a consultation line for pediatricians statewide to help them access immediate psychiatric consultation to better care for child, youth and family mental health concerns during office visits. This program is providing training on mental health topics for PCPs and community providers, and trauma-responsive care trainings for emergency departments statewide to better support children, youth and adults waiting in EDs with mental health concerns.
- Secured federal resources and ongoing programming to strengthen prevention and intervention services related to youth suicide.
Health Care Reform to Improve Patient Outcomes & Control Costs
- Payment and Delivery System Reform - To make health insurance more affordable, we must address the underlying cost of health care. The Scott Administration is working to move away from the traditional fee-for-service payment system to a system that pays providers a set amount with a goal of healthier patients and better outcomes. By paying a set amount, the state hopes to encourage proactive (preventative) care instead of paying every time a service is delivered no matter the outcome. This proactive payment model incentivizes coordination across providers to focus on improving health and wellbeing. For the approach to work, we have to change enough payments from fee-for-service to proactive payments (meaning Medicaid, Medicare, and commercial insurance). This has been a goal of the All-Payer Model.
- Currently, this approach has prioritized paying differently for health care through our Medicaid program and the Administration is actively building on this success by expanding Medicaid’s model and promoting it as a template for other payers.
- The Administration is working toward simplifying administration of this payment through more consistent health care service payment, and consider delivery and quality metrics across payer types to help to slow the growth of health care costs.
- The benefit of this consistency is clear in the Blueprint for Health program for high performing primary care practices focusing on the integration of primary care, mental health, substance use disorder and other services that impact health related social needs.
- Growing the Health Care Workforce - The health care labor shortage is a primary factor in recent health care cost increases because staff vacancies must be covered by expensive contract workers and overtime pay rates. The Administration is working closely with the health care system to implement the Health Care Workforce Development Strategic Plan.
- In the short-term, a premium-pay grant program is helping health care organizations offer retention payments to their employees who worked during the COVID-19 pandemic, and scholarships and loan repayment opportunities will be increased and expanded to more health care professionals.
- New grant programs will provide additional financial incentives for nurses who help train other nurses in rural hospitals and will provide immediate funding to increase the number of nurse educators.
- Grant funds are also available to support a health care employer apprenticeship and pipeline program.
Addressing Climate Change for Healthy, Resilient Communities
With federal pandemic recovery funds, Governor Scott proposed and worked with the Legislature to pass historic investments – over $200 million – for initiatives to reduce our greenhouse gas emissions and improve communities’ residency to a changing climate. These investments will help drive progress toward Vermont’s carbon emissions goals, while supporting the health, economic security and affordability for Vermonters. These investments include:
- Home Weatherization Assistance Program - This program is weatherizing multi-and single-family households with the greatest needs, including affordable housing buildings and emergency housing shelters.
- Home efficiency upgrades - The state is also investing in home rehabilitation initiatives that improve energy efficiency and reduce costs for the homeowners. This includes upgrading home electrical systems and installing energy-saving technologies for heating and cooling.
- Flood Resilient Communities Fund - The state is supporting communities with the greatest need by helping households and property become more resilient to flooding. Six communities – Brandon, Cabot, Johnson, Rockingham, Starksboro and Washington – have already benefited from this program.
- Load control and management – To further work toward our climate change mitigation goals, the state is investing to help communities and municipalities capture and share benefits of load control and management, as well as to install back-up electricity storage. This includes helping municipalities convert to more efficient renewable or electric systems through assessments, technical assistance, and grants.
- Supporting transition to electric vehicles – The most recent Transportation Bill (FY23) invests $36.25 million to continue implementing programs that reduce carbon emissions from the transportation sector by investing million across multiple EV-related efforts, including:
- $6.25 million for electric vehicle (EV) fast charging on the highway network.
- $10 million for EV charging for multi-family dwellings, workplaces and community attractions.
- $14 million for a new EV incentive program and programmatic support from Drive Electric VT.
- $3 million for the Mileage Smart Incentive program for used EVs and Highly Efficient Vehicles (HEVs).
- $3 million for Replace Your Ride Incentive program for efficient transportation.
- An updated goal of installing EV fast charging infrastructure within one mile of each interstate exit and every 25 miles along state highways.
- Prior to this year, the Scott Administration has continuously invested in electric vehicle charging infrastructure and incentives to help more Vermonters afford electric vehicle purchases.
- Vermont is widely credited as having among the best pandemic responses in the country. Governor Scott and his cross-agency COVID-19 leadership team led a response that earned: