Appeals – Vermont Health Connect
When you apply for a health care plan through Vermont Health Connect (VHC), you will get decisions that tell you if you:
- qualify for Medicaid
- can buy a VHC plan
- qualify for tax credits and a state subsidy to help pay your plan’s premiums
- qualify for financial help to help with your cost-sharing
- how much will you get, if you qualify for financial help
You can appeal any of the eligibility decisions made by Vermont Health Connect by asking for a fair hearing. Pay attention to the date on the decision. You have 90 days from that date to ask for a fair hearing.
Find out how to ask for a fair hearing on the Appeals – State/Medicaid Decisions page. In a fair hearing, the Human Services Board, which is not part of Vermont Health Connect, will decide if the original decision was correct.
It can take 75 days or more to have a fair hearing and get a final decision.
Has Vermont Health Connect decided that you are not eligible for Medicaid or do not qualify to buy a plan? Does that decision put your life, health or ability to function at risk because you have immediate, serious health care needs? If so, you may be able to get an “expedited appeal.” Expedited means faster.
Expedited appeals may also be used if you have Medicaid and are denied coverage of a medical procedure, service, or prescription that your provider says you need and, without it, your life, health or ability to function will be at risk. See our Appeals – State / Medicaid Decisions page for details.
You can ask for an expedited appeal by calling Vermont Health Connect at 1-855-899-9600. Vermont’s Agency of Human Services (AHS) will decide whether to grant your request for an expedited appeal and will decide whether or not the VHC decision was right.
- If AHS denies your request for an expedited appeal, they will give you a written decision. You will still be able to ask for a fair hearing.
- If your request for an expedited appeal is approved, AHS will usually make a decision about whether or not VHC made the right decision within three days.
- If you get an expedited appeal and AHS says Vermont Health Connect’s decision was right, you can still have a fair hearing to appeal the decision.
If you aren’t sure if an expedited appeal is right for your situation, contact the Office of the Health Care Advocate. Call us at 1-800-917-7787 or fill out our form to ask for help.