Medicaid for people who are 65 or older, blind or disabled. Click above for more information about the program and to apply.
For Children and Adults (MCA)
- Medicaid for children as well as adults under age 65 who are not blind or disabled.
- Eligibility is based on household income size (this includes Dr. Dynasaur which is specifically for children under age 19 and pregnant women).
- Visit Vermont Health Connect to get details about the program and to apply.
Medicaid for Former Foster Care Youth
You may be able to get Medicaid IF you:
- Are a young adult under age 26 AND
- Were in foster care in Vermont when you were 18 or older AND
- Had Dr. Dynasaur or other Medicaid when you aged out of foster care AND
- Not eligible for or enrolled in a required Medicaid coverage group.
Medicaid for Former Foster Care Youth is free. It does not matter how much income you have.
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 limitations on services and the list of services not covered for adults may not apply to children and youth under age 21.
- To request coverage for members under age 21, a Medicaid enrolled provider should submit a prior authorization request. Prior authorization forms can be found on the Clinical Prior Authorization Forms webpage.
The following services are covered under Vermont Medicaid. This is not a complete list of covered services. Certain services may require a copay or 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.
Some services may require you to pay a small fee. This is known as a copayment. Copayments are never required for the following:
- Individuals in a long-term care facility;
- Those under age 21;
- Those who are pregnant or in a 60-day postpartum period;
- Enrolled in Medicaid for former foster care youth.
- $1.00 for prescriptions costing less than $30.00;
- $2.00 for prescriptions costing $30.00 or more, but less than $50.00;
- $3.00 for prescriptions costing $50.00 or more.
- $3.00 per visit for dental services ;
- preventive dental services do not require a copay.
Outpatient Hospital Copay
- $3.00 per day per hospital for outpatient hospital services.
Limitations (Adults 21 and Older)
Some services may have limitations. Please call the Customer Support Center at 1-800-250-8427 if you have any questions about service limitations. Covered services that have limitations are:
- 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 Medicaid member.
- Treatments beyond ten per year require prior authorization.
- The adult dental benefit is limited to $1,000 per member per calendar year.
- Allowing up to 2 visits for preventive services per calendar year that do not count towards the $1,000 annual maximum dollar limit.
- Non-covered services include cosmetic procedures and certain elective procedures, including but not limited to: bonding, sealants, periodontal surgery, comprehensive periodontal care, orthodontic treatment, processed or cast crowns and bridges.
- Prior authorization is required for most special dental procedures.
- Provides either:
- One comprehensive eye exam and one intermediate eye exam within a 2-year period, or
- Two intermediate eye exams within a 2-year period.
- 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.
- Medicaid transportation rules and regulations may be found here.
- 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
- 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;
- Amputation; and
- Severe Burn.