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.
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 the Health Care Advocate HelpLine at 1-800-917-7787.