Title 33: Human Services
Chapter 19: MEDICAL ASSISTANCE
Sub-Chapter 03: Vermont Health Access Plan
33 V.S.A. § 1973. Vermont Health Access Plan
[Section 1973 effective until January 1, 2014; see also section 1973 repeal note set out below.]§ 1973. Vermont Health Access Plan
(a) The Agency of Human Services or its designee shall establish the Vermont Health Access Plan (VHAP) pursuant to a waiver of federal Medicaid law. The Plan shall remain in effect as long as a federal Section 1115 demonstration waiver is granted or renewed.
(b) The purpose of the Vermont Health Access Plan is to provide health care coverage for uninsured or underinsured low income Vermonters. The Agency of Human Services or its designee shall establish rules regarding eligibility and administration of the Plan.
(c) An individual who has been enrolled in an approved employer-sponsored insurance plan with premium assistance under section 1974 of this title shall not be subject to a 12-month waiting period before becoming eligible for the Vermont Health Access Plan as provided for in subdivision 1974(d)(1).
(d) An individual who has been enrolled in Catamount Health, with or without premium assistance, shall not be subject to a 12-month waiting period before becoming eligible for the Vermont Health Access Plan.
(e) An individual who is or becomes eligible for Medicare shall not be eligible for the Vermont Health Access Plan.
(f) As used in this section, "uninsured" means:
(1) An individual with household income, after allowable deductions, at or below 75 percent of the federal poverty guideline for households of the same size.
(2) An individual who had no private insurance or employer-sponsored coverage that includes both hospital and physician services within 12 months prior to the month of application.
(3) An individual who lost private insurance or employer-sponsored coverage during the prior 12 months for any of the following reasons:
(A) The individual's coverage ended because of:
(i) loss of employment, including a reduction in hours that results in ineligibility for employer-sponsored coverage, unless the employer has terminated its employees or reduced their coverage for the primary purpose of discontinuing employer-sponsored coverage and establishing their eligibility for Catamount Health;
(ii) death of the principal insurance policyholder;
(iii) divorce or dissolution of a civil union;
(iv) no longer receiving coverage as a dependent under the plan of a parent or caretaker relative; or
(v) no longer receiving COBRA, VIPER, or other State continuation coverage.
(B) College- or university-sponsored health insurance became unavailable to the individual because the individual graduated, took a leave of absence, decreased enrollment below a threshold set for continued coverage, or otherwise terminated studies.
(C)(i) The individual lost health insurance as a result of domestic violence. The individual shall provide the Agency of Human Services with satisfactory documentation of the domestic violence. The documentation may include a sworn statement from the individual attesting to the abuse, law enforcement or court records, or other documentation from an attorney or legal advisor, member of the clergy, or health care provider, as defined in 18 V.S.A. § 9402. Information relating to the domestic violence, including the individual's statement and corroborating evidence, provided to the Agency shall not be disclosed by the Agency unless the individual has signed a consent to disclose form. In the event the Agency is legally required to release this information without consent of the individual, the agency shall notify the individual at the time the notice or request for release of information is received by the Agency and prior to releasing the requested information.
(ii) Subdivision (i) of this subdivision (C) shall take effect upon issuance by the Centers for Medicare and Medicaid Services of approval of an amendment to the waiver set forth in subsection (a) of this section allowing for a domestic violence exception to the VHAP waiting period.
(4) Notwithstanding any other provision of law, when an individual is enrolled in Catamount Health solely under the high deductible standard outlined in 8 V.S.A. § 4080f(a)(9), the individual shall not be eligible for the Vermont Health Access Plan for the 12-month period following the date of enrollment in Catamount Health. (Added 2003, No. 122 (Adj. Sess.), § 133, eff. June 10, 2004; amended 2005, No. 174 (Adj. Sess.), § 99; 2007, No. 70, § 9; 2007, No. 174 (Adj. Sess.), § 23; 2007, No. 203 (Adj. Sess.), § 8, eff. June 10, 2008; 2009, No. 61, § 25; 2009, No. 1 (Sp. Sess.), § E.307.2.)
[Section 1973 repealed effective January 1, 2014; see also section 1973 effective until January 1, 2014 set out above.]§ 1973. Repealed. 2011, No. 171 (Adj. Sess.), § 41(h), effective January 1, 2014.