Vermont Medicaid - Green Mountain Care:

Vermont Health Access Program (VHAP) - The Vermont Health Access Plan is health insurance for uninsured adults who are not eligible for Medicaid. VHAP is a program for uninsured adults who do not have access to an approved employer sponsored insurance plan.  VHAP is available to Vermont residents with income up to 185% of the federal poverty level.  VHAP benefits include hospital, physician, and mental health coverage.  VHAP will also cover an eye exam, but not glasses.  There is NO dental coverage. 

Catamount Health Premium Assistance Program (CHAP) Catamount Health Insurance is an individual health insurance product created for uninsured Vermonters who do not have access to employer (group) insurance and do not qualify for other state subsidized health programs such as the Vermont Health Access Program (VHAP) or Dr. Dynasaur.  Private health insurance companies sell Catamount Health Insurance products. Catamount Health Insurance is what is known as a “Preferred Provider Organization (PPO)” product.  It provides a comprehensive benefits package that covers primary care, chronic care, and acute care and hospital services. Prescription drugs are also covered.  The CHAP program helps people pay for a Catamount Health Policy. CHAP is available to Vermont residents with incomes at or below 300 percent of the federal poverty level who are uninsured and who are not eligible for any other state health insurance program.

Catamount Health (CH) Catamount Health Insurance is an individual health insurance product created for uninsured Vermonters who do not have access to employer (group) insurance and do not qualify for other state subsidized health programs such as the Vermont Health Access Program (VHAP) or Dr. Dynasaur.  Private health insurance companies sell Catamount Health Insurance products. Catamount Health Insurance is what is known as a “Preferred Provider Organization (PPO)” product.  It provides a comprehensive benefits package that covers primary care, chronic care, and acute care and hospital services. Prescription drugs are also covered.

For information about Employer Sponsored Insurance Assistance programs please contact our hotline at 1-866-482-4723

VHAP and Pharmacy Programs -

VHAP Pharmacy is pharmacy and eyeglass coverage for aged or disabled individuals who are not eligible for Medicaid or VHAP who do not have pharmacy insurance.

VScript and VScript Expanded is pharmacy coverage for maintenance drugs for aged or disabled individuals who are not eligible for Medicaid, VHAP, or VHAP Pharmacy who do not have pharmacy coverage. 

Questions call 802-879-5900

Home Visiting - Vermont Medicaid funds all the home care services as Medicare including hospice. The rules for Vermont Medicaid home care are the same as the Medicare rules except that there is no homebound requirement.

Dr. Dynasaur - Dr. Dynasaur offers health care insurance for children under 18 and for pregnant women. The income guidelines are designed to cover as many families as possible. You may qualify even if you have other health insurance. Benefits for children include the cost of doctor visits, prescriptions, dental care, hospital care, occupational therapy, physical and speech therapy, vision care, immunizations, mental health care, and more. Benefits for pregnant women include cost of doctor visits, hospital care, lab work, tests, prescriptions including prenatal vitamins, and more.

Questions call 800-250-8427

Healthy Babies, Kids and Families - Healthy Babies Kids & Families is a benefit of Medicaid and Dr. Dynasaur health insurance programs. Nurses and family support workers provide education and help to connect parents with high quality health care and support services in the community.

Family, Infant & Toddler Program - The Family, Infant & Toddler Program provides early intervention services to children aged birth to three who have developmental delays or who have conditions that may lead to developmental delays. Services include specialty clinics, care coordination services, family supports and limited financial assistance for authorized medical services.

Questions call 800-660-4427

Attendant Services Program - Consumer-Directed Personal Assistance
The Attendant Services Program (ASP) supports independent living for adult Vermonters with disabilities who need physical assistance with daily activities.

·        What activities are covered? Attendants may only be paid to provide physical assistance with approved needs:

·        Activities of Daily Living (ADLS) Include dressing, bathing, grooming, toileting, transferring, mobility, range lf motion exercises, positioning and eating.

·        lnstrumental Activities of Daily Living Include meal preparation, medication management, care of adaptive & health equipment, management of finances  and mail, shopping, and cleaning.

Who Is Eligible?

To be eligible an individual must

• be a Vermont resident,
• be at least 18 years old, and
• meet all of the eligibility criteria for one of these programs:

1. General Fund Personal Services

·        have a disability;

·        need physical assistance with at least one activity of daily living or meal preparation; and

·        have Medicaid.

2. General Fund PDAC - Participant Directed Attendant Care

·        have a permanent & severe disability;

·        need physical assistance with at least two activities of dial living; and

·        be able to direct own personal care services.

3. Medicaid PDAC - Participant Directed Attendant Care

·        have a permanent & severe disability;

·        need physical assistance with at least two activities of daily living;

·        be able to direct own personal care services;

·        be willing to hire an attendant other than a spouse or civil union partner; and

·        have Medicaid.

How Does the Program Work?

1.      After an application is received program staff contact the applicant to screen for eligibility. Note: Applicants who are not eligible for Medicaid PDAC will be placed on a chronological waiting list until program funds are available.

2.      A program assessor completes an in-depth assessment of the applicant's needs in his or her home.

3.      An Eligibility Committee (consisting of program participants) reviews the assessment and authorizes a specific number of hours of service per day. Note: The Attendant Services Program may not cover all needs and activities.

4.      The participant signs an annual agreement and enrolls one or more attendants. The participant must comply with State and Federal employment laws.

5.      The participant and the attendant complete, sign and submit biweekly time reports to the designated payroll agent.

6.      Payments are processed and checks are mailed to the attendant on an established payroll schedule.

7.      Participant needs are reviewed at least annually.

Where to Apply

Attendant Services Program
Department of Disabilities, Aging and Independent Living
Vermont Agency of Human Services
103 South Main Street
Waterbury, VT 05671-1601

Voice:  (802) 241-2431
TTY:  (802) 241-3557

Traumatic Brain Injury Program - The Traumatic Brain Injury Program helps people 16 years of age or older who are receiving traditional Medicaid and have recent moderate to severe brain injury requiring one-on-one instruction focusing on independent living with a goal of returning to vocational activities. Call (802) 241-2186

High Tech Home Care Services
(Katie Beckett & Disabled Children’s Home Care - High Tech Program for Children)

Definition – The High Technology Home Care Program is an intensive home care program administered by the Department of Disability, Aging & Independent Living.  The program coordinates medical supplies, and sophisticated medical equipment, and provides skilled nursing care for technology-dependent beneficiaries.  The goal is to support the transition from hospital or other institutional care to the home or to prevent institutional placement.

Who is eligible for this program?

• A child with a disability
• The child must be under 19
• The child must need a level of care given in hospitals, nursing homes or in-patient care facilities. (For example and child with an IV or G-tube.)
• Candidates for care are beneficiaries whose care can be safely managed in a home setting with support from the health care community and a motivated family

 Covered Services: When prior authorized, the program covers: 

• Supportive nursing services (RN, LPN as appropriate)
• High-Tech aide services

 Guidelines 

• Medicaid eligible (Please note, the parent’s income and resources are not counted, only the child’s income and resources are counted toward eligibility.)
• The beneficiary requires one high tech modality (i.e. respiratory equipment, dialysis, enteral parental feeding)

• A physician must document medical necessity

 Program Limitations 

• The following services are not reimbursable under this program:
  1. Additional nursing services requested as a result of illness or absence of caregivers.
  2. Services requested to accommodate caregiver employment.
  3. Services than can be safely and effectively provided by the caregiver(s).
  4. Nursing care covering 24-hours per day.
      
• The maximum coverage of nursing care services that may be scheduled   is:

1.      First day – up to 22 hours

2.   Day 2 to first post-discharge conference – up to 20 hours

3.      Beyond the first conference – hours approved by DDAIL Nursing Consultant.

• The following evidence of caregiver training must be documented in the beneficiary’s care records:
  1. Successful operation of medical equipment
  2. Ability to provide therapies and medical procedures
  3. Family has capacity to provide of care “24 hour rooming in period”
  4. Completion of CPR training
  5. Safety of home environment such as electrical supply

How to Apply 

• Call the Health Access Member Services at 1-800-250-8427 and ask for the application for the Katie Beckett Program.

Choices for Care 

The Choices for Care program provides nursing-home level care in the home, in an enhanced residential care setting and in a nursing home.

 Services Provided 

• Case management
• Personal Care
• Respite or Companion Care
• Adult Day Services
• Personal Emergency Response Systems
• Assistive Devices/Home Modification.

 (24-hour care is not currently availability in the home-base option.)

 To be eligible an individual must: 

1. Be a Vermont resident, and
2. Be 18 years of age or older, and
3. Have a functional limitation resulting from a physical condition (including stroke, dementia, traumatic brain injury, and similar conditions) or associated with aging, and
4. Meet the clinical criteria for the program (nursing home level of care), and
5. Meet all financial and non-financial criteria for VT Long-Term Care Medicaid, and
6. Choose one of three settings in which to receive approved long-term care services:
   1. Home-Based Setting
   2. Enhanced Residential Care Setting
   3. Nursing Facility Setting

 Individuals NOT eligible are those who: 

1. Who do not meet all of the above criteria, or
2. Who have a need for services that can be adequately met with existing Medicare, Medicaid, VHAP, VA or private insurance covered services. (e.g. Home Health Agency services, Day Health & Rehab, CRT, TBI waiver, DD waiver, ASP, etc.)

More information – Call the Department of Disabilities, Aging and Independent Living at 802-241-2400