Dr. Dynasaur is low-cost or free health coverage for children, teenagers under age 19 and pregnant women.
To find out if you are eligible and apply for coverage, go to Vermont Health Connect.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a covered benefit for children and youth under age 21.
The following services are covered under Dr. Dynasaur. This is not a complete list of covered services. Certain services may have service limitations. Please call the Customer Support Center at 1-800-250-8427 if you have questions about your coverage.
- Outpatient hospital care you get without being admitted to a hospital
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including mental health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Dental, vision, and hearing services
- Pediatric services.
- Non-Emergency Medical Transportation.
- Chiropractic services are limited to treatment by means of manual manipulation of the spine for the correction of a misalignment of the spine.
- Coverage is limited to ten (10) treatments per calendar year per beneficiary.
- Treatments beyond ten per year require prior authorization.
- Treatments for children under 12 years of age require prior authorization.
- Prior authorization is required for most special dental procedures.
- Dental coverage under Dr. Dynasaur includes the dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.
- Services covered under Dr. Dynasaur are:
- Prevention, evaluation and diagnosis, including radiographs when indicated;
- Periodic prophylaxis, including topical fluoride applied in a dentist’s office;
- Periodontal therapy;
- Treatment of injuries;
- Treatment of disease of bone and soft tissue;
- Oral surgery for tooth removal and abscess drainage;
- Treatment of anomalies;
- Root canal therapy (endodontics);
- Restoration of decayed teeth;
- Orthodontics; and
- Replacement of missing teeth, including fixed and removable prosthetics (i.e. crowns, bridges, partial dentures and complete dentures).
Conditions of Coverage
- Coverage of periodic oral evaluation is limited to once every six months, except more frequent treatments can be authorized by the department's dental consultant.
- Prior authorization by the department's dental consultant is required for most special dental procedures.
- Non-surgical treatment of TMJ (jaw) disorders is limited to the fabrication of a TMJ splint.
- Provides either
- One comprehensive eye exam and one intermediate eye exam within a two year period,
- Two intermediate eye exams within a two year period
- For beneficiaries under the age of six (6):
- One pair of eyeglass frames per year
- One new lens per eye per year
- One fitting per year
- For beneficiaries age six (6) and older and under age 21:
- One pair of eyeglass frames per two years
- One new lens per eye per two years
- One fitting per two years
- Hearing aids are limited to one hearing aid per ear every three years for specified degrees of hearing loss.
Lab Tests and X-rays or Imaging
- The following outpatient high-tech imaging services require prior authorization:
- Computed tomography (CT) (previously referred to as CAT scan);
- Computed tomographic angiography (CTA);
- Magnetic resonance imaging (MRI);
- Magnetic resonance angiography (MRA);
- Positron emission tomography (PET); and
- Positron emission tomography-computed tomography (PET/CT).
- Laboratory services for urine drug testing is limited to eight (8) tests per calendar month.
- This limitation applies to tests provided by professionals, independent labs and hospital labs for outpatients. Exceptions to this limitation require prior authorization.
- Services are limited to those specified in protocols for licensure and reviewed and accepted by the State of Vermont, Director of the Office of Professional Regulation, and are services covered by Medicaid.
Non-Emergency Medical Transportation
- Non-emergency medical transportation is limited to rides to prior-scheduled Medicaid-billable appointments, including prescriptions.
- Transportation cannot be otherwise available to the member, including from other members of the Medicaid household.
- To set up rides with your area provider, contact the Vermont Public Transportation Association at (833)387-7200.
- Visit the Non-Emergency Medical Transportation webpage for more information.
- Short-term Skilled Nursing Facility (SNF) stay that is limited to not more than 30 days per episode and 60 days per calendar year.
- Administratively necessary or court ordered tests are not covered, unless they are medically necessary.
- Podiatrists’ services are limited to non-routine foot care.
Physical Therapy, Occupational Therapy and Speech or Language Therapy (Adult)
- Services are limited to thirty (30) therapy visits per calendar year, and include any combination of physical therapy, occupational therapy and speech/language therapy.
- Prior authorization beyond 30 therapy visits in a calendar year will only be granted to beneficiaries with the following diagnoses
- Spinal Cord Injury
- Traumatic Brain Injury
- Severe Burn
Physical Therapy, Occupational Therapy and Speech or Language Therapy (Children under 21)
- Eight (8) therapy visits from the start of care date per diagnosis or condition for each type (physical therapy, occupational therapy, and speech/language therapy) are covered based on a physician’s order.
- Provision of therapy services beyond the initial 8 visits is subject to prior authorization.