Vermont Medicaid Rules

Unlike Medicare, which is federally administered and intended for senior citizens older than 65, Medicaid is a health insurance benefit that is state-controlled and "needs-based." You qualify for it based on lack of income or resources, rather than advanced age. The Vermont Department of Prevention, Assistance, Transition and Health Access (PATH) establishes rules for eligibility and enrollment in the state's Medicaid programs, as well as the benefits.

Programs

• The Vermont PATH Department administers four main Medicaid programs. The "Dr. Dynasaur" program provides health insurance to uninsured pregnant women. The Vermont Health Access plan, or VHAP, extends benefits to other uninsured residents, regardless of pregnancy. The state also has launched a Dr. Dynasaur program for children younger than 18; in some cases, adults who provide care for these children can receive Medicaid benefits as well.

Eligibility and Enrollment

• Medicaid eligibility requirements in Vermont vary, depending on the program to which you apply. For example, pregnant women who want to qualify for Dr. Dynasaur must earn less than twice the federal poverty level, although there is no limit on these women's other resources. As of August 2010, the state limits parents and caretakers of Medicare-eligible children who also want to receive Medicare to resources of $2,000 per person (or $3,000 per couple). Total household income must be 185 percent or less of the federal poverty level. That increases to 300 percent if only children are to be considered for benefits. Any uninsured Vermont resident who seeks benefits under VHAP must have been without health insurance for at least a year. Regardless of which program best fits your needs, you must apply through the Vermont Department for Children and Families, after which you may wait as long as 30 calendar days for a decision. If you need Medicaid benefits long term, you will need to provide updated proof of your eligibility each year.

Benefits and Premiums

• According to the Vermont Health Care Security for Education Fund, all of the state's Medicaid programs offer both physical and mental health care, including visits to the doctor's office, hospital stays and prescription drug benefits. The Fund website notes that while adults receiving Medicaid are not eligible for vision coverage, for example, children are. On the whole, it characterizes children's Medicaid services as more comprehensive than those extended to adults. In some cases, beneficiaries must pay part of their benefits--this is known as a "co-pay." Pregnant women who receive Dr. Dynasaur benefits and earn between 185 percent and 200 percent of the federal poverty level, for example, must pay $25 each month toward their care, as of August 2010. Families of children who receive benefits must also pay toward their children's benefits--for example, $25 per month if their income range is between 185 percent and 225 percent of the federal poverty level, or $35 for all remaining incomes up to 300 percent.