State Plan under Title XIX of the Social Security Act - Medical Assistance Program
Vermont posts its plan on this webpage for informational purposes only; it is not legally binding and does not contain any pending State Plan Amendment (SPA) information. Draft versions of State Plan Amendments are available on the Global Commitment Register when they are posted for public notice.
**Please note that Section 2 - Coverage and Eligibility does not reflect Vermont's current State Plan. This section, and corresponding sections of the State Plan that address eligibility for Medicaid, have approved SPAs that are not yet posted on this webpage.**
COMPILED STATE PLAN DOCUMENT
Full-Text Version (last updated 10/29/2024)
TABLE OF CONTENTS
- State Plan Submittal Statement (page 1)
- SECTION 1 - SINGLE STATE AGENCY ORGANIZATION (pages 9a-9b)
- SECTION 2 - COVERAGE AND ELIGIBILITY (pages 10 - 18)
- SECTION 3 - SERVICES: GENERAL PROVISIONS (pages 19 - 31g)
- SECTION 4 - GENERAL PROGRAM ADMINISTRATION (pages 32 - 79dd)
- SECTION 5 - PERSONNEL ADMINISTRATION (pages 80 - 82)
- SECTION 6 - FINANCIAL ADMINISTRATION (pages 83 - 85)
- SECTION 7 - GENERAL PROVISIONS (pages 86 - 89)
LIST OF ATTACHMENTS
1.1-A Attorney General's Certification
1.2-A Organization and Function of State Agency
2.1-A Definition of an HMO that is not Federally Qualified
2.2-A Groups Covered and Agencies Responsible for Eligibility Determinations
Supplement 1 - Reasonable Classifications of Individuals under the Age of 21, 20, 19 and 18
Supplement 3 - Method of Determining Cost Effectiveness of Caring for Certain Disabled Children at Home
Supplement 4 - Presumptive Eligibility by Hospitals
2.6-A Eligibility Conditions and Requirements
Supplement 1 - Income Eligibility Levels
Supplement 2 - Resource Levels
Supplement 3 - Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered under Medicaid
Supplement 4 - Methods for Treatment of Income that differ from those of the SSI Program
Supplement 5 - More Restrictive Methods of Treating Resources than those of the SSI Program - Section 1902(f) States Only
Supplement 5a - Methods for Treatment of Resources for Individuals with Incomes related to Federal Poverty Levels
Supplement 6 - Standards for Optional State Supplementary Payments
Supplement 7 - Income Levels for 1902(f) States - Categorically Needy Who Are Covered Under Requirements More Restrictive than SSI
Supplement 8 - Resource Standards for 1902(f) States - Categorically Needy
Supplement 8a - More Liberal Methods of Treating Income Under Section 1902(r)(2) of the Act
Supplement 8b - More Liberal Methods of Treating Resources Under Section 1902(r)(2) of the Act
Supplement 9a - Transfer of Resources
Supplement 9b - Transfer of Resources
Supplement 10 - Consideration of Medicaid Qualifying Trusts - Undue Hardship
Supplement 11 - Cost-Effectiveness Methodologies for COBRA Continuation Beneficiaries
Supplement 12 - Eligibility Under Section 1931 of the Act
Supplement 13 - Treatment of Income and Resources for Institutionalized Spouses
Supplement 14 - Income and Resource Requirements for Tuberculosis Infected Individuals
Supplement 16 - Asset Verification System
Supplement 17 - Disqualification for Long-Term Care Assistance for Individuals with Substantial Home Equity
Supplement 18 - Methodology for Identification of Applicable FMAP Rates
3.1-A Amount, Duration, and Scope of Medical and Remedial Care and Services Provided to the Categorically Needy
Supplement 1 - Case Management Services
Supplement 2 - Medication-Assisted Treatment (MAT)
3.1-B Amount, Duration, and Scope of Services Provided Medically Needy Groups
Supplement 1 - Medication-Assisted Treatment (MAT)
3.1-C Standards and Methods of Assuring High-Quality Care
3.1-D Methods of Providing Transportation
3.1-E Standards for the Coverage of Organ and Tissue Transplant Services
3.1-H VT Health Homes for Medication-Assisted Therapy for Opioid Addiction
3.1-L Alternative Benefit Plan
3.2-A Coordination of Title XIX with Part B of Title XVIII
4.11-A Standards for Institutions
4.14-B Utilization Control - Intermediate Care Facilities Services
4.16-A Cooperative Arrangements with State Health and State Vocational Rehabilitation Agencies with Title V Grantees
4.17-A Liens and Adjustments or Recovery
4.18-A Charges Imposed on Categorically Needy (REPEALED - See Template G1-G3)
4.18-B Medically Needy - Premium
4.18-C Charges Imposed on Medically Needy and other Optional Groups (REPEALED - See Template G1-G3)
4.18-D Premiums Imposed on Low Income Pregnant Women and Infants
4.18-E Premiums Imposed on Qualified Disabled and Working Individuals
4.19-A Methods and Standards for Establishing Payment Rates - Inpatient Hospital Care
4.19-B Methods and Standards for Establishing Payment Rates - Other Types of Care
Supplement 1 - Methods and Standards for Establishing Payment Rates - Other Types of Care
4.19-C Other Methods and Standards for Establishing Payment Rates - Other Types of Care
4.19-D Methods, Standards, and Principles for Establishing Medicaid Payment Rates for Long-Term Care Facilities
Addendum A - Methods, Standards and Principles for Establishing Medicaid Payment Rates for Long-Term Care Facilities
Addendum B - Regulation Governing the Operation of Intermediate Care Facilities for the Mentally Retarded
4.19-E Timely-Claims Payment - Definition of Claim
4.22-A Requirements for Third-Party Liability - Identifying Liable Resources
Supplement 1 - Intergovernmental Correspondence Regarding Data Sharing
Supplement 2 - State Laws Requiring Third Parties to Provide Coverage, Eligibility and Claims Data
4.22-B Requirements for Third-Party Liability - Payment of Claims
4.22-C State Method on Cost-Effectiveness of Employer-Based Group Health Plans
4.32-A Income and Eligibility Verification System Procedures: Requests to Other State Agencies
4.33-A Method for Issuance of Medicaid Eligibility Cards to Homeless Individuals
4.34-A Requirements for Advance Directives Under State Plans for Medical Assistance
4.35-A Enforcement of Compliance for Nursing Facilities - Determining Deficiencies
4.35-B Enforcement of Compliance for Nursing Facilities - Termination of Provider Agreement
4.35-C Enforcement of Compliance for Nursing Facilities - Temporary Management
4.35-D Enforcement of Compliance for Nursing Facilities - Denial of Payment for New Admissions
4.35-E Enforcement of Compliance for Nursing Facilities - Civil Money Penalty
4.35-F Enforcement of Compliance for Nursing Facilities - State Monitoring
4.35-G Enforcement of Compliance for Nursing Facilities - Transfer of Residents
4.35-H Enforcement of Compliance for Nursing Facilities - Additional Remedies
4.38 Disclosure of Additional Registry Information
4.38-A Collection of Additional Registry Information
4.39 Definition of Specialized Services
4.39-A Categorical Determinations
4.40-A Survey and Certification Education Program
4.40-B Process for the Investigation of Allegations of Resident Neglect and Abuse and Misappropriation of Resident Property
4.40-C Procedures for Scheduling and Conduct of Standard Surveys
4.40-D Programs to Measure and Reduce Inconsistency
4.40-E Process for Investigations of Complaints and Monitoring
4.42-A Compliance Oversight of the False Claims Act
5.1-A Citations of State Laws, Rules, and Policy Statements Providing Assurance of Conformity to Federal Merit System Standards
7.2-A Methods of Administration - Civil Rights
7.7-A Vaccine and Vaccine Administration at section 1905(a)(4)(E) of the Social Security Act
7.7-B COVID-19 Testing at section 1905(a)(4)(F) of the Social Security Act
7.7-C COVID-19 Treatment at section 1905(a)(4)(F) of the Social Security Act
G1-G3 Medicaid Premiums and Cost Sharing - Template G1-G3
MCHIP State Plan (revised July 1, 2020)