Vermont's June Primary Care Law Asks Who Counts as a Primary Care Provider. The Answer Is Due January 15, 2027.

Vermont’s insurers and Medicaid have paid its medical home practices a monthly amount for patients attributed to them since 2010. That payment has almost nothing to do with the plan its candidates for governor are arguing about.

VTDigger reported on October 8 that universal primary care sits at the center of the November 3 race for governor. Democratic nominee Amanda Janoo proposes a “fair share tax” on the income of the wealthiest Vermonters to build a network of small-town primary care doctors and move toward what VTDigger calls “eventual full universal healthcare.” Janoo estimates that more free access to primary care, mental health clinicians and local care coordinators would cut emergency visits and hospitalizations enough to save the state up to $300 million a year, a figure she calls rough. Molly Gray, the Democratic candidate for lieutenant governor, runs on the same free publicly funded primary care proposal.

Gov. Phil Scott “supports the concept of universal access to primary care,” his campaign representative Emma Shouldice told the paper, and pointed to a bill he signed in June commissioning an exploratory report on whether universal primary care is feasible.

That bill carries more than a report.

What the June law changes

S.197 was signed June 18, 2026 as “An act relating to reform for primary care,” sponsored by Sen. Virginia Lyons with seven co-sponsors. The enacted text states four purposes in Sec. 1(b): “obtain the information necessary to develop a framework for implementation of universal primary care,” “optimize the Blueprint for Health,” “determine whether the Blueprint is an appropriate mechanism through which to provide universal primary care,” and explore alternatives to the Blueprint. That fourth purpose keeps the delivery vehicle an open choice.

The monthly payment it touches is old. 18 V.S.A. § 706 already requires per-person per-month payments to medical home practices from each health insurer and from Medicaid, covering attributed patients plus a contribution toward the shared costs of community health teams. The statute ties their size to the practice’s NCQA medical home score to the extent practicable. The Blueprint’s own Act 51 report on medical home payments dates the arrangement to 2010, and it is blunt about the reach: commercial insurers contribute for roughly 110,000 of the more than 210,000 commercially insured Vermonters, and the Blueprint “lacks any leverage to enforce this contribution mandate for smaller insurers.” Insurer participation has likewise been a condition of doing business in Vermont, and stays one under the new act, with carriers owing the Agency of Human Services information at least quarterly.

The payment supports medical home status and arrives on top of billing, which is why Sec. 3(a) has to ask what it would take to make it “include payment for the routine primary care needs of attributed patients.” Sec. 3(a) implies the narrower point: today those payments do not include the routine primary care needs of attributed patients.

So Act 173 edits a 16-year-old payment rather than inventing one. The act rewords the payee language to “medical home participating practices,” which it says includes medical homes and primary care providers, and it lets the Blueprint director substitute a different quality standard for the NCQA score.

January 15, 2027

The Blueprint for Health director, consulting the Blueprint Executive Committee and the Vermont Steering Committee for Comprehensive Primary Health Care, reports to the House Committee on Health Care and the Senate Committee on Health and Welfare on or before January 15, 2027.

The subject is what changes to payment amounts or payment methodologies, or both, would be necessary to transition the Blueprint’s per-person per-month payments to primary care practices so they include payment for the routine primary care needs of attributed patients who are covered by participating health plans.

The report has assignments: define primary care services, define primary care provider, define which services count as routine, and address differences in methodology across practice types.

That date is crowded. Sections 3a, 4, 6, 7 and 8 all report on or before January 15, 2027: funding through the claims tax, baseline primary care spending, who should hold which regulatory role, moving care from hospitals into community settings, and the Treasurer’s regional work with other northeastern states. Section 5 runs later, to January 1, 2028, when the Agency of Human Services owes a primary care spending target and a transitional schedule that raises it over time.

One section shows how far a single definition travels: Section 4 tells the Agency to measure baseline primary care spending using the definition of primary care provider that Section 3(a) asks the Blueprint director to write.

The words a membership practice should read

The money in Vermont’s monthly Blueprint payment goes to medical home participating practices, and the definition of a primary care provider the state will measure against gets drafted in the next 96 days.

The definition arrives as a report to two committees, not as statute. Act 173 does not codify it, and the same section asks the director to describe any additional legislation needed. A recommendation is not a law.

The act leaves the obvious follow-up open. It does not define attribution, which it hands to the report’s recommendations, and it does not say whether a practice that bills no participating health plan could be one of the practices paid. The transition it contemplates is scoped to attributed patients covered by participating health plans, and the enacted text stops there.

Vermont is an awkward place to be reading that. DPC Frontier’s Vermont page says the state has no DPC laws at present and tells prospective practices to review the Vermont Insurance Code when planning one. So a practice there starts from the Insurance Code, as that page advises, rather than from a statute written for the model.

The model keeps growing anyway. Susan Ridzon, executive director of the statewide private practice association Health First, told VTDigger in September that practices and providers using membership models are about 7% of the organization’s members, and that the share has been growing. The state health department’s latest survey, reported in August, has Vermont still losing primary care physicians, though the rate of loss is slowing.

The Tension the Model Lives Inside

Vermont’s medical home practices have taken monthly payments for 16 years, and Act 173 is the state asking what it would take for that money to include routine care. A membership retainer is already payment for the care. Practices and providers using membership models are about 7% of one association’s members and climbing. That label is loose, and the same VTDigger piece describes concierge medicine as mixing a membership fee paid by patients with insurance billing. DPC Frontier lists no Vermont statute written for the direct primary care version of it.

January 15 is when the state writes down what it means by a primary care provider, and the answer could sit either way. Drawn around medical home participating practices, it keeps the two systems in separate rooms. Drawn more broadly, a Vermont DPC practice would face a question it has not had to answer: whether taking a plan-routed monthly payment for routine care is still the thing it left fee-for-service to do.

Nothing in Act 173 picks, and the election on November 3 does not pick either.