Vermont Medicaid Eligibility and Enrollment
- Vermont Medicaid has several plans to ensure older adults and people with disabilities have access to medical care. Keep reading to learn more about these plans.
What Is Vermont Medicaid?
Like other states, Vermont has a Medicaid program to ensure low-income residents have access to health care. The state's Department of Vermont Health Access and the Centers for Medicare & Medicaid Services, a federal agency, both provide funding for the medical and behavioral health services covered by Vermont Medicaid.
What Is Medicaid Called in Vermont?
In Vermont, Medicaid is known as Green Mountain Care.
What Services Are Covered?
Under federal guidelines, each state's Medicaid program must cover a variety of services necessary for preventing, diagnosing and treating acute and chronic medical conditions. This includes the following mandatory benefits:
- Hospital care
- Lab tests
- X-rays
- Doctor visits
- Home health services
In addition to the mandatory benefits required by the Centers for Medicare & Medicaid Services, states are allowed to offer as many optional services as they would like. Green Mountain Care covers several of these optional services, including prescriptions, occupational therapy, physical therapy, speech/language therapy and hospice care.
Limitations and Exclusions
Although Green Mountain Care is a comprehensive program, it doesn't cover eyeglasses, dentures or orthodontics. Enrollees also need to be aware of limitations on certain services. These limitations are as follows:
- Chiropractic care: Maximum of 10 treatments per beneficiary, per year without prior authorization
- Eye exams: Limit of one comprehensive eye exam and one intermediate eye exam OR two intermediate eye exams within a two-year period
- Dental care: Limit of $1,000 per beneficiary, per year; no coverage for cosmetic dental services, including bridges, sealants, bonding and periodontal surgery
- Hearing aids: Limit of one hearing aid per ear within a three-year period
- Skilled nursing care: Maximum of 30 days per episode and 60 days per calendar year
- Podiatric services: No coverage for routine foot care
- PT, OT and speech/language therapy: Max of 30 visits per year for all three services combined; more than 30 visits may be approved for beneficiaries with stroke, severe burns, traumatic brain injury, spinal cord injury and amputations
- Urine drug testing: Maximum of eight tests per calendar month
Beneficiaries must also obtain prior authorization before having the following tests:
- Magnetic resonance angiography (MRA)
- Magnetic resonance imaging (MRI)
- Computed tomographic angiography (CTA)
- Computed tomography (CT)
- Positron emission tomography-computed tomography (PET/CT)
- Positron emission tomography (PET)
Medicaid Costs
People enrolled in Green Mountain Care don't pay a monthly premium for their health coverage; however, some enrollees are required to pay small co-payments for prescriptions, dental care and outpatient hospital care.
Prescription co-payments depend on the cost of each prescription. If a drug costs less than $30, the co-payment is $1. The co-payment increases to $2 per prescription for drugs costing between $30.01 and $49.99. There is a $3 co-payment for drugs costing $50 or more. Dental care has a co-payment of $3 per visit, but the co-pay is waived for preventive services. The co-payment for outpatient hospital services is $3 per day.
Co-payments are waived for adults living in long-term care facilities, beneficiaries under the age of 21 and women who are pregnant or who have given birth within the last 60 days.
Who Is Eligible for Medicaid in Vermont?
Vermont has two Medicaid plans that are of interest to older adults. The first plan, Medicaid for Children and Adults (MCA), is for adults up to 64 years old who aren't eligible for Medicare. Medicaid for the Aged, Blind and Disabled (MABD) is for adults who are at least 65 years old, blind or disabled.
Medicaid for Children and Adults
To qualify for MCA, an adult must meet the following requirements:
- Vermont resident
- S. citizen or lawfully present immigrant
- Between the ages of 19 and 64
Income limits are based on household size, as displayed in the following table:
|
Household Size |
Maximum Income Level |
| 1 | $19,392 |
| 2 | $26,228 |
| 3 | $33,064 |
| 4 | $39,900 |
| 5 | $46,737 |
| 6 | $53,573 |
| 7 | $60,409 |
| 8 | $67,245 |
Medicaid for the Aged, Blind and Disabled
To qualify for MABD, an individual must meet the following requirements:
- Vermont resident
- S. citizen or lawfully present immigrant
- At least 65 years old, blind or disabled
- Household income of no more than $1,100 per month outside Chittenden County and no more than $1,191 per month inside Chittenden County
How Do I Enroll in Medicaid in Vermont?
Medicaid for Children and Adults
- To apply online, visit the Vermont Health Connect website and click Get Started (under "New Customers"). When the next page loads, click Apply Now, which is at the bottom of the menu on the left side of the page.
- Apply via telephone at (855) 899-9600.
- Make an appointment with a local assister. Vermont Health Connect maintains a list of trained assisters on its website.
Medicaid for the Aged, Blind and Disabled
- To apply for health coverage and help paying medical expenses, visit the Green Mountain Care website to download the 205ALLMED form, "Application for Health Coverage and Help Paying Costs."
- To apply for Medicaid without help paying for medical costs, visit the Green Mountain Care website to download the 205INFA form, "Application for Health Coverage."
- Mail either completed form to Vermont Health Connect, 280 State Drive, Waterbury, VT 05671-8100.
- Call (855) 899-9600 for assistance.
Contact Information for Vermont Medicaid
Customer Service Center: (855) 899-9600
Member Services: (800) 250-8427
Mailing Address: 280 State Drive, Waterbury, VT 05671-1010
