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For Vermonters who are enrolled in Medicaid or Dr. Dynasaur to find out more about their health care coverage and find other important resources available to them.

Dr. Dynasaur

Dr. Dynasaur is low-cost or free health coverage for children and teenagers under age 19. Starting this year, all children enrolled in Dr. Dynasaur will now get 12 months of protected continuous enrollment, with a few exceptions. Their coverage will not be terminated before they have completed 12 months of continuous enrollment. Children will continue to be eligible to receive Dr. Dynasaur, even if there was a change making others in their household ineligible for Medicaid. Learn more about this new benefit.

  • Other Medicaid programs for children also benefitting from continuous coverage include Disabled Children's Home Care (DCHC/Katie Beckett), SSI Medicaid, and foster children.

Dr. Dynasaur is also free for pregnant people who meet the rules. Vermont now also offers free coverage for 12-month after the pregnancy ends. This improves access to health care services and continued care. Learn more about how to take care of yourself before, during, and after pregnancy:

During this 12-month period, coverage is only lost for a few reasons. For children, these include turning 19, moving out of Vermont, asking for coverage to end, and not responding to non-financial verification requests. For pregnant people, reasons include moving out of Vermont and not returning required proof of citizenship or immigration status.

To find out if you are eligible and apply for coverage, go to Vermont Health Connect.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT)

Covered Services

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.

Limitations

Chiropractic
  • 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 twelve (12) treatments per calendar year per beneficiary.
  • Treatments beyond twelve per year require prior authorization.
  • Treatments for children under 12 years of age require prior authorization.
Dental
  • 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.
Eye Exams
  • 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
Eyeglasses
  • 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
  • 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.
Naturopaths
  • 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. 
Nursing Facility
  • Short-term Skilled Nursing Facility (SNF) stay that is limited to not more than 30 days per episode and 60 days per calendar year.
Outpatient Hospital
  • Administratively necessary or court ordered tests are not covered, unless they are medically necessary.
Podiatry
  • 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
    • Stroke
    • Amputation
    • 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.