Vermont Medicaid Appeals & Fair Hearings: Deadlines + Benefits

If your Vermont Medicaid was denied, cut, or terminated, you have the right to appeal and request a fair hearing, and you can often keep your benefits while the appeal is decided.1,2 Vermont runs this in two steps: you first ask the Department of Vermont Health Access (DVHA) to review its own decision, and only after that internal appeal can you request a fair hearing before the state's independent Human Services Board.2

In This Guide

• What you can appeal in Vermont Medicaid
• What are the deadlines to appeal Vermont Medicaid?
• How do I keep my benefits during a Vermont Medicaid appeal?
• How the internal appeal to DVHA works
• How to request a fair hearing in Vermont
• Frequently Asked Questions

What you can appeal in Vermont Medicaid

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency. Section 1902(a)(3) of the Social Security Act (42 USC 1396a(a)(3)) requires Vermont's Medicaid plan to grant a hearing to anyone whose claim for medical assistance is denied or is not acted on with reasonable promptness, and the implementing regulation at 42 CFR 431.220 extends that right to anyone who believes the agency acted erroneously or made an adverse determination.1

In Vermont, that right reaches any coverage, eligibility, or service decision by DVHA.2 In practice, you can appeal:

• An application denial (income, assets, household, or documentation)
• A termination or reduction of your eligibility or coverage
• A cut to the hours or amount of a service you already receive
• A prior authorization denial or a level-of-care determination
• A renewal or recertification denial

Whichever of these you are fighting, if the decision came from DVHA the same two-step path applies.2

What are the deadlines to appeal Vermont Medicaid?

Vermont sets two deadlines on a Medicaid appeal, and they are not the same number: 60 calendar days for the internal appeal to DVHA, and 120 days for the fair hearing request that follows it.2

You must ask DVHA to review its decision within 60 calendar days of that decision.2 Federal law caps a Medicaid fair hearing request at a reasonable time not to exceed 90 days from the date the notice of action is mailed, so Vermont's 60-day internal appeal sits comfortably inside that federal ceiling.3 Read the deadline off your own notice, and do not assume you have the full 90 days.

If the internal appeal does not resolve things in your favor, you have 120 days from the date of the appeal decision letter to request a fair hearing before the Human Services Board.2

One more deadline protects renewals specifically. If your coverage ended only because you did not return a renewal form on time, you do not always have to appeal or reapply: under 42 CFR 435.916, if you submit the renewal form within 90 days after the termination date, the agency must reconsider your eligibility without a new application. That duty covers eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Vermont may offer the same window but is not required to, so ask DVHA.4

How do I keep my benefits during a Vermont Medicaid appeal?

Continuation of benefits is not automatic in Vermont. If the decision you are appealing reduces or ends benefits or services you are currently getting and you want them to continue while the appeal is pending, you must request that continuation at the time you file the appeal or fair hearing request, not later.2

The federal rule behind this sets the timing. Under 42 CFR 431.230(a), if the agency sent the required advance notice and you request the hearing before the date of action stated on that notice, the agency may not terminate or reduce your services until a decision is rendered after the hearing, unless the only issue is one of federal or state law or policy.5 The trigger is the date of action on your notice, not a flat count of days after you received it, so file before that date if you want your coverage to hold.

If that date has already passed, one narrow path is still open. A separate federal provision, 42 CFR 431.231, lets the agency reinstate services when the hearing is requested no more than 10 days after the date of action.5 Reinstatement there is something the agency may do, not something it must do, so ask for it in writing when you file rather than assuming it.

How the internal appeal to DVHA works

The internal appeal is the required first step. You ask DVHA to review its own decision, and you must complete that review before the Human Services Board will take a fair hearing request.2 You have 60 calendar days from the date of the decision to file it, and you request it from DVHA, the department that issued the decision you are challenging.2

If waiting for a standard review could put you at risk, you can ask DVHA for an emergency expedited appeal, which is available when the normal timeframe could risk your life or health.2

You do not have to handle the appeal alone. A family member, friend, or another person such as a provider may help you request the internal appeal or the fair hearing, and may act as your representative through the process once you tell the State you want that person to act on your behalf.2

How to request a fair hearing in Vermont

A fair hearing is a legal process where the Human Services Board, a seven-member citizen panel created under 3 V.S.A. Section 3090, hears your case and decides whether DVHA made the right call.2 It is separate from DVHA, which is why it can review the agency's decision independently. You have 120 days from the date of the appeal decision letter to file the fair hearing request.2

You have three ways to file:

• By mail or email. Complete the Human Services Board fair hearing request form and send it to the Human Services Board, 6 Baldwin Street, Suite 305, Montpelier, VT 05633-4302, or email contact.hsb@vermont.gov.2
• By phone. Call the Vermont Health Connect and Green Mountain Care Customer Support Center at 1-800-250-8427 (TDD/TTY 1-888-834-7898) to file an appeal, a fair hearing request, or a grievance.2
• Online. An online fair hearing request form is also available on the Human Services Board website.2

Learn More

Find personalized help navigating a Vermont Medicaid appeal at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.