DVHA and Vermont Medicaid made a number of changes during the pandemic to help Vermonters maintain health insurance and access health care. To view the previous changes, visit DVHA's COVID-19 webpage.
Some of these changes were tied to the federal declaration of a COVID-19 public health emergency. The federal government ended the COVID-19 public health emergency effective May 11, 2023.
This page contains information about what is changing in Vermont Medicaid. Some of these changes are because the COVID-19 emergency is ending.
Co-pays: Vermont Medicaid includes co-pays for hospital outpatient services and certain prescription drugs. This cost-sharing has been reinstated. For further details visit the Global Commitment Register Medicaid Copay Changes webpage.
Premiums: Vermont Medicaid includes monthly premiums that Vermonters pay for Dr. Dynasaur. Dr. Dynasaur premium billing will remain suspended until at least the spring of 2024.
Eligibility and Enrollment
Vermont Medicaid renewals were paused during the pandemic. Renewals have resumed as of April 2023. For further information visit DVHA's Medicaid Renewals Restart webpage.
Telehealth: Coverage of telehealth services, including audio-only or telephonic services, will remain in effect until July 1, 2023. Vermont Medicaid is reviewing the list of telephone-only services to identify those that will continue through December 31, 2024. Telephone-only services must be medically necessary and clinically appropriate for delivery through audio-only means. Public notice will be provided before changes are implemented. Check back for further updates.
COVID-19 vaccines, testing, and treatment: Medicaid members will not pay any copays for services, drugs, testing, and vaccines, related to the treatment and prevention of COVID-19 through September 30, 2024. Vermont Medicaid will maintain coverage of COVID-19 services as medically necessary following the end of this mandatory coverage period. For further details visit the Global Commitment Register COVID-19 Vaccines, Testing, and Treatment webpage.
During the public health emergency, DVHA implemented several changes to prior authorization requirements and processes.
As the public health emergency comes to an official close on May 11, 2023, please reference all prior authorization requirements on the DVHA fee schedule, including the new prior authorization requirements effective January 1, 2023 for the entire Medicaid population.
Please contact your Provider Representative if you have questions at 800-925-1706.
The national emergency declaration enabled CMS to grant state and territorial Medicaid agencies a wider range of flexibilities under Section 1135 waivers for Provider Enrollment. As of May 11, 2023, with the ending of the federal emergency, the following requirements will no longer be waived by the State of Vermont:
1. Temporarily waive provider enrollment requirements to ensure a sufficient number of providers are available to serve Medicaid enrollees. Such requirements include the payment of application fees, criminal background checks, or site visits.
2. Temporarily cease the revalidation of providers who are located in-state or otherwise directly impacted by a disaster.
3. Temporarily waive requirements that physicians and other health care professionals be licensed in the state or territory in which they are providing services, so long as they have equivalent licensing in another state. For further information please refer to the Office of Professional Regulation and the Vermont Medical Board websites.
Current COVID-19 testing access and guidance
For more information about COVID-19 in Vermont, visit the Vermont Department of Health’s COVID-19 website.
Stay Connected with Primary Care Provider (PCP) tips
The word “primary” means first. Your PCP is who you call first when you need medical care. Your PCP will provide most of your health care and work with you to schedule specialty care when you need it. If your PCP is new to you, ask your old PCP to send your medical records to your new PCP. Call your new PCP to say that the records are coming. It is important for your PCP to have your medical records. To locate a Vermont Medicaid participating PCP, please visit the Vermont Medicaid Provider Lookup.
Check the Vermont Department of Health website for general health tips
For more information and tools on how you can keep yourself healthy, visit the Vermont Department of Health's website.