What is a Grievance?

A grievance is a complaint about how you were treated by the Department of Vermont Health Access (DVHA). DVHA is the state agency that runs Green Mountain Care. Green Mountain Care includes Medicaid, VPharm and the Medicare Savings Programs. A grievance can also be a complaint about a company that provides services for Medicaid.

Here are examples of why you might file a grievance:

• Medicaid pays for your rides to doctor’s appointments and you are having a problem with the bus company or the driver.
• You are unhappy with how you’ve been treated by someone at the state and it involved your Medicaid, VPharm or Medicare Savings Program.

A Grievance is Not an Appeal

A grievance is not the same as an appeal. When Green Mountain Care denies you coverage, or reduces or changes your benefits, and you disagree, then you should ask for an appeal.

Here are examples of why you might file an appeal:

• Medicaid says it will not cover a drug or procedure you need.
• Medicaid says that it will not give you a ride to your medical appointment.
• Medicaid sends you a letter saying your benefits will end next month.

How to File a Grievance

There are two ways to file a grievance with Green Mountain Care. To file a grievance, you must call or send a letter to Green Mountain Care within 60 days of the issue that you are filing the complaint about.

By mail:

• Write a letter to Green Mountain Care. Include the date, your address, your birthdate and the ID number on your Green Mountain Care card.
• In the letter, write: What is the problem? Who is the problem with? What do you wish they did differently?
• Sign the letter and mail it to:

Department of Vermont Health Access
280 State Drive
Waterbury, Vermont 05671-1010

By phone:

• Call Green Mountain Care at 1-800-250-8427. Tell them that you want to file a grievance.
• Tell them why you are calling. What is the problem? Who is the problem with? What do you wish they did differently?
• Ask the Green Mountain Care representative to read back their notes about your problem. If you need to, suggest changes.
• Ask the Green Mountain Care representative for their first name. Write down their name, the date and time of your call. Keep this information for your records.

What Happens Next?

• Within five days, Green Mountain Care must send you a letter confirming they got your grievance.
• If you do not get this letter after two weeks, contact the Office of the Health Care Advocate for help. Fill out our form or call 1-800-917-7787.
• Within 90 days, Green Mountain Care must send you another letter with their answer.