Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 170 - DEPARTMENT FOR CHILDREN AND FAMILIES (DCF) › Chapter 570 - HEALTHY VERMONTERS (5700) › Section 13 170 570 - HEALTHY VERMONTERS (5700)

Current through June, 2024
Section 5700 Healthy Vermonters
The legislature authorized the creation of the Healthy
				  Vermonters program with the passage of Act 127 (2002). This program provides a
				  pharmacy discount to eligible Vermonters, helping beneficiaries purchase
				  prescription medicines necessary to maintain their health and prevent
				  unnecessary health problems. The rules that follow describe this pharmacy
				  program.
Section 5701
				Beneficiary Fraud
A person who knowingly gives false or misleading information
				  or holds back needed information in order to obtain Healthy Vermonters benefits
				  may be prosecuted for fraud under Vermont law or federal law or both. If
				  convicted, the individual may be fined or imprisoned or both.
When the ESD learns that fraud may have been committed, it
				  will investigate the case with respect for confidentiality and the legal rights
				  of the beneficiary. If appropriate, the case will be referred to the State's
				  Attorney or Attorney General for a decision on whether or not to
				  prosecute.
Section 5710
				Eligibility
(05/01/2010, 10-02)
Individuals are eligible for Healthy Vermonters if they have
				  household income no greater than 350 percent of the federal poverty level
				  (FPL), as calculated under the rules for the VHAP program.
Individuals are also eligible for Healthy Vermonters if they
				  have household income no greater than 400 percent of the FPL, as calculated
				  under the rules for the VHAP program (5300), and meet the categorical
				  eligibility requirements.
The following table presents the eligibility
				  requirements.
Eligibility Requirements for Healthy Vermonters
Income Maximum
Categorical Eligibility Requirement
350 Percent of the FPL
None
400 percent of the FPL
Age 65 or older
Or disabled
Or disabled and eligible for social security
							 disability benefits
Individuals remain eligible as long as they meet all program
				  requirements.
Section 5711
				Insurance Coverage
Individuals must be without adequate coverage for
				  prescription drugs to be eligible. Individuals are considered without adequate
				  coverage if they have no insurance policy or program benefit that includes any
				  prescription drug coverage; however, beneficiaries on Part D in an MA-PD or PDP
				  plan will be considered uninsured as to excluded Part D drug classes, except to
				  the extent that such drugs are covered by the MA-PD or PDP plans. They are also
				  considered without adequate coverage if no prescription drugs are covered under
				  their policy because they have reached the annual maximum coverage
				  limit.
The department considers individuals covered by VHAP-Pharmacy
				  insured because that program has prescription drug coverage and no annual
				  maximum. Beneficiaries who are eligible for Part D must be enrolled in a Part D
				  prescription drug plan or a Medicare Advantage-Prescription Drug benefit plan
				  to be eligible for Healthy Vermonters. The department considers individuals
				  covered by VScript, including VScript expanded, to be uninsured for drugs that
				  are excluded from VScript coverage (3202) and for drug classes that are
				  excluded under Part D coverage (3403.4) for Medicare beneficiaries, and
				  automatically extends coverage for these drugs under the Healthy Vermonters
				  program.
Section 5712
				Citizenship and Identity
The rules for citizen ship and identity are in section M170.
Section 5813 Residence
An individual must be a state resident to be eligible.
				  Individuals are considered state residents if they are living in Vermont at the
				  time of submitting the application for the Healthy Vermonters Program:
a. with intent to remain permanently or for
				an indefinite period of time or
b.
				while incapable of stating intent.
Temporary absences from Vermont for any of the following
				  purposes do not interrupt or end Vermont residence: visiting, obtaining
				  necessary medical care, or obtaining education or training under a program of
				  vocational rehabilitation or higher education.
An individual must remain in contact with the department by
				  providing an up-to-date address.