VT rejects troubling federal AHEAD changes, CT still considering it
Vermont, one of the first two states scheduled to implement the federal AHEAD model has withdrawn from the program. State officials stated, “Vermont originally pursued the model when it was launched in 2023 as an opportunity to strengthen our health care systems. However, new policy and operational guidance to bring Vermont in alignment with other AHEAD states substantially reduced anticipated funding to reinvest in some providers like primary care practices.”
Along with five other states, including Vermont, Connecticut signed up for the troubling AHEAD option in 2024. Very few people in Connecticut are aware of AHEAD or how it could severely damage healthcare in our state. It is scheduled to begin in January 2028.
Originally AHEAD included dangerous hospital global budgets and support for primary care. However, the deal changed when the Trump administration took over the program.
Hospitals are a major driver of rising healthcare costs in Connecticut and across the US. AHEAD is intended to lower healthcare spending by setting total hospital budgets, regardless of how many people need care or how much care they need. If budgets are set too low, hospitals would have to cut back on care. However, if they don’t spend all the money, they get to keep it. AHEAD’s global budgets are voluntary for hospitals, which allows systems to send patients to different hospitals, in or outside of the cap, to maximize their profits.
In good news, AHEAD also includes some resources for Medicare members’ primary care coordination. However, there is a catch. Maryland’s AHEAD agreement with Medicare includes over a dozen exemptions and qualifications to receive the funds. If patients’ total costs of care, not just for primary care, exceed federal expectations, practices would have to return up to 10% of the payments. This uncertainty does not encourage investing in care management.
Geo-AHEAD, the new, third part of AHEAD, added by the Trump administration would default hundreds of thousands of Connecticut Medicare beneficiaries who chose not to enroll in one of the troubled Medicare Advantage plans into those plans or something like them. Default assignment would be based on where they live. Under this new Geo-AHEAD provision, the federal government will choose the entities that will control Medicare members’ care, based on how much they can save Medicare. Entities can include Medicare Advantage plans, large health systems, technology companies, or other entities that choose to apply. Just as for primary care, if patients’ total health costs are more than expected, the entities will have to absorb the loss. But if they can lower costs, including denying needed care, they will keep the profit.
While Vermont decided to leave AHEAD because the deal no longer works for their residents, Connecticut is still considering staying in the program. State officials report that they expect to receive federal AHEAD plans for our state soon and begin discussions. CT officials are scheduled to sign the AHEAD agreement by November 1st, but the deadline may be extended due to delays.
There are better, safer ways to achieve the state’s goals – healthcare savings and preserve critical providers. Let’s work together to get this right, rather than letting a federal agency take control.