This bill requires Vermont Medicaid to cover medically necessary play therapy services for eligible patients. It directly affects Vermont Medicaid recipients, particularly children and adolescents receiving mental health treatment. The law mandates coverage for play therapy provided by specific licensed professionals (such as psychiatrists, psychologists, and clinical social workers) and defines play therapy as using toys, games, and role-playing to address mental health challenges. The coverage becomes effective July 1, 2025.
This bill (H 55) requires all health insurance plans in Vermont - including Medicaid - to cover gender-affirming health care services that are medically necessary and clinically appropriate, such as facial procedures and hair removal, without extra cost-sharing. It also mandates coverage for fertility-related services, including diagnostic care, IVF procedures, fertility preservation (like egg freezing), and related medications, while prohibiting financial barriers or restrictions based on donor use. The bill prohibits insurers from denying coverage for these services based on factors like donor sperm or eggs, though it excludes experimental procedures and nonmedical costs (e.g., donor fees). Insurers must report compliance annually to state health committees, and the Agency of Human Services must seek federal approval for Medicaid coverage changes. The bill directly affects all Vermont health insurers, Medicaid, and individuals seeking these specific health services.
H 120 requires Vermont's Secretary of Administration to study and design a long-term care trust fund. The study must examine funding through income-based contributions (starting July 2026 for Vermont residents with taxable income over 150% of the federal poverty level), a two-year payment requirement for benefits, and how the fund would interact with Medicaid. The Secretary must submit a report by January 15, 2026, including proposed legislation to establish the fund. This bill would directly affect Vermont residents who pay into the program and future beneficiaries of long-term care services.
H 267 establishes the Vermont Hospital Security Plan, creating a state-administered program to provide hospital coverage for all Vermont residents regardless of insurance status or ability to pay. The plan requires hospitals to accept the state's negotiated annual payments (based on global budgets) for services provided to all patients, prevents balance billing for Vermont residents beyond set cost-sharing amounts, and includes out-of-state hospital coverage for Vermont residents. Key mechanisms include annual global hospital budgets limiting cost growth to the Consumer Price Index plus 3.5%, a dedicated trust fund financed by state transfers and federal Medicaid/Medicare funds, and appeal processes for denied claims. This directly affects Vermont residents seeking hospital care and Vermont hospitals receiving state payments.
Senate Bill S 154 requires health insurance plans and Vermont's Medicaid program to provide coverage for biomarker testing. This testing analyzes a patient's samples to identify biological characteristics relevant to a disease or condition. Coverage is mandated for the diagnosis, treatment, management, and ongoing monitoring of a patient's disease. Such coverage is required when the test is supported by medical and scientific evidence, including FDA approvals, Medicare/Medicaid determinations, or nationally recognized clinical practice guidelines. The bill also specifies that coverage should be provided in a way that minimizes disruptions to patient care.
H 271 would change how Vermont health insurance and Medicaid cover physical therapy. It prohibits insurers and Medicaid from requiring a doctor's note or care plan to access physical therapy, and stops insurers from charging higher out-of-pocket costs for physical therapy than for primary care visits for similar conditions. The bill also mandates a 10% increase in Medicaid reimbursement rates for physical therapy services over two years. This directly affects Vermont residents needing physical therapy, their insurance providers, and physical therapy clinics by reducing barriers to care and improving provider payments. The bill aims to make physical therapy more accessible and affordable under Vermont's health programs.
This bill expands eligibility for Vermont's Dr. Dynasaur program to cover pregnant individuals with incomes up to 312% of the federal poverty level (FPL), effective January 2026. It also requires the Agency of Human Services to study and report by January 2026 on the feasibility and costs of expanding Dr. Dynasaur to all Vermont residents under 26 with incomes at or below 312% FPL, and Medicaid to adults aged 26-64 with incomes at or below 312% FPL. The bill appropriates $600,000 for implementing the pregnant individual eligibility change, with $180,000 from the General Fund and $420,000 in federal funds. The report must address federal waiver needs, cost estimates, and implementation timelines for potential broader expansions. This is a policy change focused on expanding healthcare access for specific income groups, not a procedural measure.
This bill (S.53) expands Vermont Medicaid coverage to include community-based perinatal doula services. It requires the Department of Vermont Health Access to seek federal approval for this coverage by July 1, 2026, with coverage becoming effective on that date or after federal approval, whichever comes later (per 33 V.S.A. § 1901n). The law directly affects Vermont Medicaid recipients seeking perinatal doula care and the doulas providing these services. The policy change mandates Medicaid reimbursement for doula services following the state’s federal approval process.
H 302 requires Vermont health insurance plans and Medicaid to cover specific fertility-related services. It mandates coverage for fertility diagnostic care (all members), fertility treatment for those with infertility (including IVF procedures), and fertility preservation services (all members), while excluding experimental procedures and nonmedical donor/surrogacy costs. The law takes effect for health insurance plans on January 1, 2026, and Medicaid coverage depends on federal approval of a state plan amendment by September 1, 2025. This directly affects Vermont residents with health insurance or Medicaid seeking fertility care.
This bill would establish universal Medicaid-equivalent health coverage for all Vermont residents, phased by age group starting in 2029. It requires coverage for under-26s beginning in 2029, then progressively older age groups through 2033, regardless of income. The state must seek federal funding approval for this expansion but will cover all costs with state funds if federal approval is denied. The bill mandates detailed cost estimates, an implementation plan, and a report on payroll tax options to fund the program, with key deadlines for these actions by 2026-2027.
