Click here for the application to VHAP

Any Vermonter that wishes to ask specific questions about their eligibility should speak to a state certified enrollment specialist at Member Services at 1 (800) 250-8427.

Any Vermonter that experiences difficulty with VHAP-related issues should call the Vermont Health Care Ombudsman’s Office at 1 (800) 917-7787

I. Eligibility

To be eligible for VHAP you must 18 years old or older, a state resident, and a U.S. citizen or able to meet the citizenship requirements.

You can still apply for VHAP even if you are not a U.S. citizen. Click here for more information.

A. Uninsured

If you have insurance, you must be uninsured for 12 months before you can enroll in VHAP. This 12-month waiting period will NOT prevent you from enrolling, however, if you lost your health insurance for one of the following reasons:

1. retirement, getting fired, quitting your job or having your hours reduced
2. the death of a household’s principle insurance policy holder
3. divorce or dissolution of a civil union
4. no longer qualifying as a dependent under the insurance plan of a parent or relative
5. no longer qualifying for, or voluntarily choosing to end, COBRA coverage
6. college or university-sponsored health insurance is no longer available because of graduation, a leave of absence or the termination of studies.

Having Medicaid or VHAP in the past 12 months does not count against you when determining if you meet the 12 month uninsured requirement.  You can have had either or both Medicaid and VHAP in the past 12 months and still be eligible for VHAP.

In addition, individuals whose income is at or below 75% of the federal poverty level (FPL) do not have to meet the 12-month uninsured rule. For an individual, 75% FPL is $680 and for a household of 2 it is $915.

Students can be eligible for VHAP if they meet the tests set out in regulation, which are somewhat complicated. Students under age 23 who are in college are not eligible for VHAP if they didn’t elect the insurance the school offered as long as it covers both doctor and hospital care, or if their parents have the option of covering them under their insurance but didn’t elect to do so.

B. Income eligibility

VHAP has a financial eligibility test for income only. There is no resource test for VHAP eligibility.

Eligibility is determined by the household income. Uninsured adults without dependent children are eligible up to 150% FPL ($1,348 month for a single person and $1,815 for a household of 2) and up to 185% FPL for uninsured adults with dependent children ($1,669 month for a single person and $2,239 for a household of 2).

II. Enrollment

VHAP applications can be obtained from the Vermont Department for Children and Families at 1 (800) 287-0589 or from Member Services at 1 (800) 250-8427.

Generally, the state has 30 days to process an application. If the individual is applying because he or she is disabled, the state has longer to process the application.

Individuals who qualify for VHAP are required to “recertify” their eligibility every 6 months. In other words, you have to prove you still meet the category and financial tests. The state sends a notice to Medicaid beneficiaries when it is time to recertify. In addition, beneficiaries are required to report changes in their income and resources within 10 days during their eligibility period.

III. Benefits

Generally, for adults VHAP covers physical and mental health services, naturopathic care, doctor office visits, prescriptions, and periodic eye exams. Some important services that are not covered include: eyeglasses and dental care.

IV. Cost Sharing

VHAP has no copayments or coinsurance other than a $25 Emergency Room co-pay($60 if it is determined the visit was not medically necessary). The only cost sharing associated w/VHAP are the monthly premiums. VHAP beneficiaries must pay monthly premiums ranging from $7 per person per month to $49 per person per month. Beneficiaries whose income is below 50% FPL (e.g., $453 for a household of one and $610 for a household of two) do not have pay a premium. Premiums must be paid prospectively, meaning prior to the month of coverage.

Where Do I show proof of Citizenship and Identity?

At one of the Economic Services Division District Offices, listed below. Most common forms of C&I is a birth certificate and Driver's License or a Current or expired passport.