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HOW TO FILL OUT AND SEND US YOUR SUPPLEMENTAL INFORMATION FORM FOR MABD (205SUPP)

If you received a letter telling you to apply for Medicaid for the Aged, Blind and Disabled (MABD), there will be a form included, “Supplemental Information for Medicaid for the Aged, Blind and Disabled (205SUPP)”.

If you did not receive a letter and have not applied for Medicaid through Vermont Health Connect, you must do that first. Visit the Vermont Health Connect website for ways to apply.

  1. How to apply:
  • Use our online application.
  • Call us at 1-855-899-9600 Monday-Friday 8AM-4:30PM.
  • Contact an in-person assister for help with the application.
  • Fill out a paper form (205SUPP) and send it to us.
  • Fill out on your computer via a fillable PDF.
    Note: If you choose this option you will have to print and sign the form.

  2. Submit the 205SUPP form online or mail it to us.

  1. Online using the Uploader:
    • Scan pages 1-4 of your signed form on a copy machine to your computer as a PDF or take pictures of the form using your phone.
    • Read the Uploader Instructions.
    • Submit the form on the website my.vermont.gov.
    • Select “healthcare” as the program you are submitting the form for and then upload it. 
  2. Mail:

Green Mountain Care
Application and Document Processing Center
280 State Drive
Waterbury, VT 05671-1500