Vermont Medicaid Office

Vermont Medicaid office (DVHA)

Vermont splits Medicaid administration between two front doors. The Department of Vermont Health Access (DVHA) handles policy, provider relationships, and member services — it's the agency that runs Medicaid. Vermont Health Connect is the public-facing application portal that handles both Medicaid and the qualified-health-plan marketplace through one application. Each has a different phone number, and they handle different parts of a member's case.

Two customer service centers, two phone numbers

Vermont's seven Medicaid programs under one roof

DVHA organizes member coverage into seven programs that share an application pipeline but apply different rules:

• Medicaid for Children and Adults (MCA) — the main category for non-disability, under-65 enrollment.
• Dr. Dynasaur — Vermont's brand for children under 19 and pregnant people.
• Medicaid for the Aged, Blind and Disabled (MABD) — non-MAGI track for adults 65+ or with a disability.
• Long-Term Care — nursing-facility and HCBS coverage on top of MABD eligibility.
• Medicare Savings Program — QMB / SLMB / QI tiers.
• Prescription Assistance — VPharm and related drug-cost programs.
• Access Plan / Special Needs Access — limited-benefit plans for specific populations not covered by full Medicaid.

Renewals

DVHA sends renewal information by mail when it's time to renew, with the specific notice telling each household how to renew. Vermont's renewal restart followed the federal continuous-coverage unwind period; the Renewal Restart page tracks each household's status.

Who qualifies for Vermont Medicaid?

Vermont divides Medicaid eligibility into two tracks based on age and disability status. The MCA track (Medicaid for Children and Adults) covers under-65 enrollees who aren't blind or disabled, with eligibility based on household income size. The MABD track (Medicaid for the Aged, Blind and Disabled) covers everyone else and uses a non-MAGI budget with resource tests. Dr. Dynasaur — Vermont's brand for children and pregnant people coverage — sits inside the MCA track but has its own application pathway.

Which track applies to you

• Under 65 and not blind/disabled — MCA, income-based. This includes Dr. Dynasaur for children under 19 and pregnant people.
• Age 65 or older, blind, or disabled — MABD, both income and resource tests. Adults transitioning into Medicare typically move to MABD.

Two distinctive Vermont eligibility rules

• Former Foster Care Youth Medicaid — free Medicaid coverage for adults under age 26 who aged out of foster care in Vermont OR another state. There is no income test; the only rule is the foster-care history and age. Apply through Vermont Health Connect like any other Medicaid coverage.
• HIPP Program (Health Insurance Premium Payment) — DVHA pays the premiums for an eligible Medicaid member's employer-sponsored health insurance or COBRA when it's cost-effective to do so. This lets some members keep their employer plan while Vermont Medicaid acts as secondary coverage.

EPSDT for children and youth

Members under 21 receive Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits — the federal Medicaid mandate that lifts most adult service limits for kids. Service limitations and exclusions that apply to adults may not apply to members under 21; providers can submit prior authorization requests for additional coverage on the Clinical Prior Authorization Forms page.

Vermont Medicaid income standards

Vermont does not publish a single combined Medicaid income chart inline. DVHA maintains three separate authoritative dollar tables — one for MAGI Medicaid (children, adults under 65, pregnant people, Dr. Dynasaur), one for the MABD Protected Income Level, and one for VPharm — each updated on its own annual schedule. The percentage thresholds below are stable from year to year; the dollar amounts they translate into change each January when the federal poverty level updates.

Where to find the current dollar figures

The Vermont eligibility rule that overrides the percentages

Vermont's Health Benefits Eligibility and Enrollment Rules (HBEE) is the master rule document covering both Medicaid and qualified-health-plan eligibility. DVHA also publishes a Modified Adjusted Gross Income (MAGI) Income Methodology document that defines how income is counted, including the Income Deductions Guide. For MABD members, the Long-Term Care Monthly Spenddown Procedures document explains how to count down income against medical bills.

Confirming where you fall

Run the screening at portal.healthconnect.vermont.gov — one application screens against every Vermont Medicaid program plus marketplace subsidies. Call Vermont Health Connect at 1-855-899-9600 (weekdays 8 a.m.–4:30 p.m.) or DVHA Customer Support at 1-800-250-8427 to ask whether your household is over or under for a specific program.

How to apply for Vermont Medicaid or Dr. Dynasaur

Vermont uses one application for Medicaid, Dr. Dynasaur, and marketplace coverage with subsidies — submitted through Vermont Health Connect. The portal routes qualifying households to Medicaid automatically; people who don't qualify for Medicaid can compare and enroll in qualified health plans with Advance Premium Tax Credit (APTC) subsidies in the same flow. This combined intake is unusual among states and is the reason Vermont publishes only one application URL.

Two main application channels

• Online — apply at portal.healthconnect.vermont.gov. The portal walks you through Remote Identity Proofing, household income, and verification. Plan Comparison Tool and Eligibility Tables sit on the same site.
• By phone — call Vermont Health Connect at 1-855-899-9600, weekdays 8 a.m.–4:30 p.m. A representative can take the full application or help you fix a stuck online application.

Free in-person help

Vermont Health Connect's "Find an Assister" feature lists certified application counselors, navigators, and brokers across the state who help residents apply at no cost. Federally Qualified Health Centers and hospitals also have certified counselors on staff. The portal page links directly to local-help search.

What to have ready

• Social Security Numbers (or document numbers for legal immigrants) for everyone applying
• Employer and income information for everyone in the household
• Policy numbers for any current health insurance
• Information about any job-based coverage available to the household

Federal decision deadlines

Federal Medicaid rules give DVHA up to 45 days to decide a non-disability application and up to 90 days for applications based on disability. Coverage can be retroactive up to three months before the application month when the applicant had qualifying medical bills during that window. Report life changes (marriage, birth, address, income change) through the Report A Change page rather than starting a new application.

What Vermont Medicaid and Dr. Dynasaur cover

Vermont Medicaid covers the standard federal mandatory benefits plus a generous set of state options — dental, vision, and hearing for adults, plus chiropractic and naturopathic care. The two patterns that distinguish Vermont from most states are tight per-service limits paired with low dollar copays (a $3 copay model for most cost-shared services), and a recently expanded continuous-eligibility window for children and postpartum.

Core covered services (Vermont Medicaid and Dr. Dynasaur)

• Outpatient hospital care without admission
• Emergency services
• Hospitalization (surgery and overnight stays)
• Pregnancy, maternity, and newborn care (before and after birth)
• Mental health and substance use disorder services, including counseling and psychotherapy
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Dental, vision, and hearing services
• Pediatric services
• Non-emergency medical transportation — arranged through the Vermont Public Transportation Association at (833) 387-7200

Adult copays (members 21 and older)

Copays are never required for members in a long-term care facility, members under 21, pregnant members through the 12 months postpartum, members in the Breast and Cervical Cancer Treatment Program, preventive services, family planning services and supplies, emergency services, or sexual assault services.

Adult service limits that matter

• Dental cap — $1,500 per member per calendar year, plus 2 preventive visits per calendar year that do not count toward the cap. Cosmetic, orthodontic, and certain elective procedures (bonding, sealants, periodontal surgery) are not covered for adults.
• Chiropractic — 12 manipulations per calendar year before prior authorization; treatment is limited to manual manipulation of the spine.
• PT / OT / Speech therapy — 30 combined outpatient visits per calendar year before prior authorization. Therapy in hospitals, nursing homes, rehab centers, or via home health agencies does not count toward the 30 visits.
• Short-term SNF stays — no more than 30 days per episode and 60 days per calendar year.
• Eye exams — one comprehensive exam plus one intermediate within a 2-year period, or two intermediates within 2 years.
• Hearing aids — one hearing aid per ear every three years for specified degrees of hearing loss.
• High-tech imaging — CT, CTA, MRI, MRA, PET, and PET/CT outpatient imaging requires prior authorization.

Dr. Dynasaur's new continuous coverage

Two policy changes that took effect recently:

• 12 months of protected continuous enrollment for children — all children enrolled in Dr. Dynasaur now get 12 months where their coverage will not be terminated. Eligibility losses only count for a short list of reasons (turning 19, moving out of Vermont, requesting end, not responding to non-financial verification). Continuous coverage also extends to Disabled Children's Home Care (DCHC/Katie Beckett), SSI Medicaid, and foster children.
• 12 months of free postpartum coverage — Vermont now offers free Dr. Dynasaur coverage for 12 months after pregnancy ends, improving access to postpartum and continued care.

Other state Medicaid pages