Services Covered by Medicaid

Medicaid pays for medically necessary physical and mental health services provided by hospitals, physicians and other providers; rural health clinics; and Federally Qualified Health Centers. Services include:

doctor’s office visits
prescriptions
ambulance services
home health
lab work
long-term care
medical supplies and equipment
physical and other therapies
x-rays

Medicaid also pays some dental, chiropractic and transportation costs. Medicaid does not cover dentures or eyeglasses for adults.

Starting January 1, 2020, the Medicaid dental benefit cap for adults increases to $1,000 per year and also includes two preventive care visits. There is no cap on dental benefits for kids or pregnant people on Dr. Dynausaur.

For dual-eligible adults who are eligible for both Medicare and Medicaid, Medicaid covers classes of drugs not covered by Medicare Part D.

Services covered by Dr. Dynasaur

For children and youth under age 19 who qualify, Dr. Dynasaur covers all of the services listed above plus eyeglasses and complete dental coverage.

For pregnant people who qualify, Dr. Dynasaur covers all of the services listed above plus complete dental coverage.

There is no cap on dental benefits for kids or pregnant people on Dr. Dynausaur.

EPSDT for under age 21

Young adults under the age of 21 who are enrolled in Medicaid also qualify for extra benefits under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. EPSDT services include dental, mental health, development and specialty services.

Pre-approval (prior authorization)

For some services or procedures, you need to get prior authorization (approval before a service is provided) or Medicaid won’t pay.

Your provider must submit a written request for prior approval. It needs to show you meet the Medicaid coverage criteria. It needs to show that the service is an accepted practice.

Exception request

If Vermont Medicaid tells you that it does not cover a service you need, you can ask Medicaid to make an exception and cover the service. To do this, you fill out the Patient Request for Medicaid Coverage Exception form. Your health care provider will have to fill out the Provider Request for Coverage Medical Need form. The two forms are found in this one document.

Ask your provider to write a detailed letter that explains why the service is medically necessary for you. The letter needs to show specifically how the service meets all 10 of the “medically necessary” standards. You can download and print our flyer about the 10 standards.

Follow this link to a web page with the text of the 10 standards flyer.
Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, use the link above.
Download a PDF of the 10 standards flyer.

Make a copy of the forms and the letter from your health care provider. Send the original letter and forms to the address on the bottom of the form. Keep a copy of the letter and forms for your records. You may need them later.

Getting an exemption can be hard. If you need help, call us at the Office of the Health Care Advocate at 1-800-917-7787 or fill out our form to ask for help.