Vermont

Vermont Medicaid and the new work rules

Medicaid for Children and Adults (MCA) covers non-disabled adults ages 19-64 up to 138% of the federal poverty level (133% FPL plus a 5-percentage-point income disregard). It is marketed to the public as part of Green Mountain Care, Vermont's umbrella name for state-run health coverage — if you're applying, you'll see 'Green Mountain Care' on your card, but the Medicaid category itself is MCA. is run by Department of Vermont Health Access (DVHA), within Vermont's Agency of Human Services (AHS). Vermont expanded Medicaid on 2014-01-01, which is why the new federal work requirement reaches this state — and why what you do before January 1, 2027 matters.

Work rules start January 1, 2027 Medicaid expanded 159,892 enrolled 49,000 in the expansion group

Start here

From January 1, 2027, most adults have to show 80 hours a month

The requirement applies to adults aged 19 to 64 covered through Medicaid expansion — around 49,000 people in Vermont. It is not only about paid work: study, job training, volunteering and a mix of them all count , and earning at least $580 a month satisfies it on its own.

Starting in 2027, DVHA plans to rely on self-attestation that will be subject to audit; starting in 2028, members may need to submit documentation (pay stubs, school records, proof of SNAP/TANF participation, program enrollment letters) rather than simply attest. CMS's June 2026 rule limits states to using claims/encounter data no older than 12 months to verify exemptions such as medical frailty.

If your hours swing from month to month, say so. The rule is written per month, which is the wrong shape for farm and fishing work, construction, tourism and seasonal retail — a good month and a dead month average out to a living, but the dead month is the one that fails. Federal law has a provision for exactly this: a seasonal worker can satisfy the requirement using their average monthly income over the previous six months instead of hours worked in the month being checked. It is at 42 CFR 435.552(a)(7), and the law defines who counts as seasonal by pointing at the tax code rather than listing jobs, so do not decide for yourself that it misses you. If your work is seasonal or your hours are irregular, tell the state that when you report, and ask for the six-month average to be used.

2026-06-01 · already happened

CMS's interim final rule implementing the federal work requirement takes effect, narrowing the statutory 'medically frail' exemption to require that a condition 'significantly impairs' the person's ability to meet the requirement.

2026-07-01 · already happened

DVHA publishes an online work-requirement screening tool; DVHA stresses it is informational only and not an eligibility determination.

2026-08-01 · already happened

DVHA begins sending outreach information to Medicaid members aged 19-64 who may be affected by the new rules.

2026-09-16 · already happened

DVHA tells the Joint Fiscal Committee about 49,000 Vermonters will be subject to the new work and renewal requirements; the agency says it has no estimate yet of how many will lose coverage.

2027-01-01

The 80-hour/month work requirement (or $580/month in qualifying earnings) applies to new applications in the expansion group; retroactive coverage shortens to one month for that group; six-month renewal cycles begin.

2028-01-01

Self-attestation gives way to documentation requirements (pay stubs, school enrollment records, proof of program participation) for verifying hours or an exemption.

You do not have to prove anything if any of these describe you

Exemptions are meant to be applied by the state automatically from records it already holds, but records are imperfect. If one of these fits you and you still get asked to report hours, say so and ask them to check — don't assume the notice is right.

Parents or caretakers of a child age 13 or under, or of a household member with a disability (DVHA's own materials describe this as caring for a dependent child or a person with a disability)

Pregnant and postpartum people

People who are medically frail or have serious or complex medical needs — narrowed by a June 2026 CMS rule to require showing the condition 'significantly impairs' the person's ability to comply, a stricter standard than the underlying statute

Veterans with a total disability rating

American Indians and Alaska Natives

People in a drug or alcohol treatment program

People already meeting SNAP (3SquaresVT) or TANF (Reach Up) work requirements

People recently released from incarceration

People in a federally declared disaster area or a county with high unemployment (situational exemptions DVHA's screening materials also reference)

Income limits

What you can earn and still qualify

Monthly income, before tax, for the whole household. These are the state's own published figures, which is what its caseworkers actually apply. If you are close to a line, apply anyway — some income does not count, and only the agency can run the calculation for your situation.

Adults 19 to 64138% of the poverty line

1 person: $1,835.50
2 people: $2,489.20
3 people: $3,141.85
4 people: $3,795.50
5 people: $4,449.20
6 people: $5,101.85
7 people: $5,755.50
8 people: $6,408.20

Parents and caretakers138% of the poverty line

1 person: $1,835.50
2 people: $2,489.20
3 people: $3,141.85
4 people: $3,795.50
5 people: $4,449.20
6 people: $5,101.85
7 people: $5,755.50
8 people: $6,408.20

Pregnant213% of the poverty line

1 person: $2,489.20
2 people: $3,841.20
3 people: $4,849.85
4 people: $5,857.50
5 people: $6,866.20
6 people: $7,874.85
7 people: $8,882.50
8 people: $9,891.20

Source: Department of Vermont Health Access, '2026 MCA FPL Chart — Eligibility for Benefits Determined in Relation to 2026 Federal Poverty Level' (dvha.vermont.gov and info.healthconnect.vermont.gov). A note on precision: DVHA publishes two similar 2026 charts that disagree by $0. We publish the state figure.

January 1, 2027

Two other changes land on the same day

Renewals get more frequent, and back-dated coverage gets shorter.

Renewals every six months Starting with each expansion-group member's first renewal in 2027, DVHA reviews Green Mountain Care/MCA eligibility every six months instead of once a year; the first such renewal looks back 12 months, and each one after that looks back 6 months.

Back-dated coverage is changing on January 1 Vermont enrollees in the expansion ('New Adult') group get one month of retroactive coverage; pregnant people and children under 19 keep two months — down from three months for everyone, per DVHA's published summary of the federal changes. If you have unpaid medical bills, applying sooner covers more of them.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

Do this now

Update your address and phone number first. Everything about the new rules arrives by mail, and a stale address is the most common reason people lose coverage they are still entitled to. Then check whether an exemption applies to you.

Apply, renew or update details Apply through Vermont Health Connect Vermont Health Connect — not healthcare.gov — is Vermont's own state-based marketplace. Talk to a person 1-855-899-9600 Green Mountain Care / Dr. Dynasaur Member Services Alternate toll-free number for the same Member Services unit 1-800-250-8427

About the phone numbers: Member Services is staffed Monday-Friday, 7:45am-4:30pm (closed state holidays); both toll-free numbers ring the same unit, so there's no need to call both.

Deaf, hard of hearing or speech-impaired: 711.

EnglishFrenchSpanishVietnameseNepaliGermanOromoArabicRussianPortugueseJapaneseChineseItalianSerbo-CroatianTagalogThai

If English isn't your first language, Vermont Health Access provides free interpreter and translation services in any language — just call Member Services at 1-855-899-9600 (TTY: 711) and ask. Many forms and notices are already available in French, Spanish, Vietnamese, Nepali, Arabic, Russian, Portuguese, Chinese, Japanese, Italian, German, Tagalog, Thai, Oromo, and Serbo-Croatian, and staff can arrange a phone or in-person interpreter, read documents to you over the phone, and help you apply or renew with language support at no cost. You can also ask Member Services to connect you with a local, in-person Assister who speaks your language.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

Nationally, most people who lose Medicaid lose it over paperwork rather than because they stopped qualifying. From January 1, 2027 that matters more, not less.

Department of Vermont Health Access (DVHA), within Vermont's Agency of Human Services (AHS) · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Our records do not show that you met the community engagement requirement for the reporting period.

2If you believe this is incorrect, or if an exemption applies to you, contact us on or before February 11, 2027.

3Coverage for other members of your household is not affected by this notice.

The clock starts on this date. Not the day it reached you. Assume you have less time than it feels like.

"Our records do not show" is not the same as "you did not".The state is matching against databases that are often out of date. If you worked those hours, or an exemption fits you, say so — call 1-855-899-9600.

Your children's coverage is separate. The work requirement does not apply to them. A notice about you does not end their coverage.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking can keep your coverage running while it's reviewed.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what those numbers mean if you are the person enrolled.

Primary care supply · America's Health Rankings

349 /100k

Provider supply here is around the national middle.

Book an appointment before you need one, not when you do.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

Where you live in this state changes what coverage is worth. Vermont is one of the most rural states in the country, and many towns are 30 to 60 minutes from the nearest hospital on winter roads. The Vermont Medical Society has projected a shortage of about 370 full-time-equivalent primary care providers by 2030 — already roughly 115 short, a 22% gap versus the national benchmark, as of 2022. The state cited this shortfall in its successful application for federal Rural Health Transformation Program funding, winning $195,053,740 in first-year (FFY2026) federal money that it is directing toward its Blueprint for Health primary-care system and rural capacity statewide. Vermont Medical Society primary care workforce data, cited in Vermont's CMS Rural Health Transformation Program application (Vermont Joint Fiscal Office/legislature.vermont.gov materials, 2025); CMS Rural Health Transformation Program first-year state award announcement, 2025.

Common questions

Questions people ask about this

Do the new Medicaid work rules apply to me in Vermont?

They apply to adults aged 19 to 64 who are covered through Medicaid expansion — about 49,000 people in Vermont. Children, people over 65, and most people covered on grounds of disability or pregnancy are not in that group. There is also a long list of exemptions.

How many hours a month do I have to work?

80 hours a month. Work is not the only way to meet it — study, job training, volunteering and a combination of these count too, and earning at least $580 a month also satisfies it.

Who is exempt from the work requirement in Vermont?

Exemptions include: Parents or caretakers of a child age 13 or under, or of a household member with a disability (DVHA's own materials describe this as caring for a dependent child or a person with a disability); Pregnant and postpartum people; People who are medically frail or have serious or complex medical needs — narrowed by a June 2026 CMS rule to require showing the condition 'significantly impairs' the person's ability to comply, a stricter standard than the underlying statute; Veterans with a total disability rating; American Indians and Alaska Natives; People in a drug or alcohol treatment program; People already meeting SNAP (3SquaresVT) or TANF (Reach Up) work requirements; People recently released from incarceration.

When do the Vermont work rules start?

January 1, 2027. Starting with each expansion-group member's first renewal in 2027, DVHA reviews Green Mountain Care/MCA eligibility every six months instead of once a year; the first such renewal looks back 12 months, and each one after that looks back 6 months. Keeping your address and phone number current with the state is the single most important thing to do before then, because everything arrives by mail.

What is the income limit for Vermont Medicaid?

For adults 19 to 64, about $1,835.50 a month for one person and $6,408.20 for a household of 8.

How do I apply for Medicaid for Children and Adults (MCA) covers non-disabled adults ages 19-64 up to 138% of the federal poverty level (133% FPL plus a 5-percentage-point income disregard). It is marketed to the public as part of Green Mountain Care, Vermont's umbrella name for state-run health coverage — if you're applying, you'll see 'Green Mountain Care' on your card, but the Medicaid category itself is MCA.?

Online at Apply through Vermont Health Connect, or by phone on 1-855-899-9600. It is free and there is no open-enrollment window — you can apply at any time of year.

How often do I have to renew Vermont Medicaid?

Adults covered through Medicaid expansion move from a yearly renewal to one every six months starting with renewals due on or after January 1, 2027. Children, people over 65 and most people covered on grounds of disability stay on yearly renewals. Keep your address and phone number current so the renewal notice reaches you, and answer it before the date on the letter — most people who lose coverage lose it over paperwork.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

MassachusettsThe new work rules New HampshireThe new work rules New YorkThe new work rules

See all 50 states and Washington, D.C. on the map →

If you're a Vermont Medicaid member age 19 to 64, watch your mail and your Vermont Health Connect account this fall: starting January 1, 2027, most adults in Green Mountain Care's expansion group will need to show 80 hours a month of work, school, or qualifying activity (or about $580 in monthly earnings) to stay covered, renewals move from once a year to every six months, and retroactive coverage for new applications drops to one month.

DVHA estimates about 49,000 Vermonters will be affected — if you're pregnant, caring for a young child or a family member with a disability, medically frail, a veteran with a total disability rating, or already meeting SNAP or TANF work rules, you're very likely exempt, but confirm it with Member Services now at 1-855-899-9600 rather than waiting for a renewal notice.

Updating your address takes two minutes and protects everything else. Do that first, then check the exemption list above.

Go to Apply through Vermont Health Connect →