Services Covered by Medicaid

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.

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.

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.

Learn more and share Medicaid’s webpage with your doctor: Clinical Forms and Prior Authorization Forms.  

If Vermont Medicaid tells you that it does not cover a service you need:  

• If you are age 0 – 20: Your doctor can ask Medicaid to cover a service by filling out a “Prior Authorization” form. Medicaid will use the EPSDT standard to decide if they will cover it. Services must be medically necessary. Learn more on Medicaid’s EPSDT webpage.
• If you are 21 years or older: You and your doctor can fill out the forms for an “Exception Request.”  Click on the “Exception request” section below to learn more.

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. 

If you are age 0 – 20: Your doctor can ask Medicaid to cover a service by filling out a “Prior Authorization” form. Click on the “Pre-approval (prior authorization)” section above to learn more.  

If you are 21 years or older: You and your doctor will need to fill out some forms and submit a letter. Follow these steps:  

• Download and print the exception request packet.  
  • Go to Vermont Medicaid’s “Coverage Exceptions” webpage.  
  • Click on “Member Request for Coverage Form.”
  • Print the forms. Or, if you do not have a printer, call Green Mountain Care (Medicaid): 1-855-554-4488. Ask them to mail you the “Medicaid exception request form, DVHA 211-RCMN.”
• Fill out the forms in the packet.  
  • You should fill out the “Beneficiary Request for Medicaid Coverage Exception” form.  
  • Your health care provider should fill out the “Request for Medicaid Coverage Exception - Medical Need form.”  The two forms are found in this one document. 
• Ask your health care provider to write a letter. Their letter should be detailed and say why the service is medically necessary for you. It should specifically say how the service meets all 10 of the “medically necessary” standards.
• Learn about the 10 medically necessary standards on our website or download our PDF.
  • Our PDF file does not fully comply with all applicable guidelines for accessible digital documents. For the most accessible experience, visit this web page.
  • Download the PDF of the 10 standards flyer.
• Make a copy or take a photo of the forms and the letter from your health care provider. Keep these for your records. You may need them later.
• Send the original letter and forms to the address listed at the bottom of the form.

Getting a coverage exception is 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.