Access Plan Begins July 1, 2023
Access Plan is an optional Medicaid health insurance program for Vermonters who need family planning services.
You can check with your Family Planning Services Provider to see if they can conduct a presumptive eligibility screening. A presumptive eligibility screening allows you to be determined eligible by a provider and receive same day services.
You may be eligible for Access Plan if:
- You are a Vermont resident;
- You are a U. S. citizen*, national**, Native American, or qualified non-citizen***;
- You meet certain income requirements; and
- You do not have other insurance (including Medicaid, Medicare, or other insurance that covers family planning/family planning related services); and
- You are not pregnant.
*United States Citizen: For the purposes of qualifying as a United States citizen, the United States includes the 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands and the Northern Mariana Islands. Nationals from American Samoa or Swain´s Island are also regarded as United States citizens for the purpose of Medicaid eligibility.
**National: A "national" is a person who is not a U.S. citizen, but who owes permanent allegiance to the United States and may enter and work in the U.S. without restriction.
*** Qualified Non-citizen: A person who is "lawfully present" including lawful, permanent residents of the United States, refugees, and asylees. For additional information please see the Medicaid section at https://www.healthcare.gov/immigrants/lawfully-present-immigrants/.
Access Plan is a Medicaid program that ONLY covers family planning and family planning related services. Examples include:
- General reproductive services
- Birth control counseling and management
- Contraceptive services
- Routine primary preventive services, such as pap tests
Family Planning related:
- Treatment of medical conditions routinely diagnosed during a family planning visit, such as treatment of urinary tract infections or sexually transmitted infections
- Preventive services, such as the HPV vaccine
- Treatment of a major medical complication resulting from a family planning visit
For a list of covered procedure codes, see Access Plan Covered Codes.
Any Medicaid enrolled provider that delivers Family Planning services can bill under Access Plan.
Providers wishing to do presumptive eligibility screenings should review the Access Plan Provider Manual to understand the requirements and walk through the Provider Screening Tool with applicants to determine presumptive eligibility:
For additional questions, please contact Gainwell Provider Services at 800-925-1706.