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Rule Details
Rule Number:
25P025
Title:
Health Benefits Eligibility and Enrollment Rule, General Provisions and Definition (Part 1).
Type:
Standard
Status:
Adopted
Agency:
Agency of Human Services
Legal Authority:
3 V.S.A. 801(b)(11); 33 V.S.A. 1901(a)(1) and 1810
Summary:
These proposed rules amend Parts 1-5 and 7 of the 8-part Health Benefits Eligibility and Enrollment (HBEE) rule. Parts 1, 4, and 5 were last amended effective January 1, 2024. Parts 2, 3, and 7 were last amended effective January 1, 2025. Substantive revisions include: adding coverage of pre-release services for up to 90 days before release for sentenced, incarcerated individuals enrolled in Medicaid; using the Low Income Subsidy
(LIS) family size definition for Medicare Savings Program (MSP) eligibility determinations; raising the income limit for Qualified Medicare Beneficiaries from 100 to 145 of the Federal Poverty Level (FPL) and Qualifying Individuals 135 to 195 FPL; changing the household composition for the Access Plan; modifying noticing requirements for eligibility verifications; providing earlier Qualified Health Plan (QHP) effective dates for special enrollment periods and voluntary terminations.
Persons Affected:
Applicants and enrollees of Medicaid and Qualified
Health Plans with financial assistae; Health law, policy, and related advocacy and community-based organizations and groups including the Office of the Health Care Advocate; Health care providers, including Planned Parenthood of Northern New England; Eligibility and enrollment assisters, including agents and brokers; and the Agency of Human Services including its departments.
Economic Impact:
AHS anticipates that some of the proposed changes to HBEE will have an economic impact on the State's budget, beginning SFY2026. The estimated gross annualized budget impact of implementing 90 days of pre-release services for Medicaid enrollees is $ 1 million. The cost associated with MSP income eligibility expansion is estimated at $4.5 million annually to the general fund. These changes, as well as changes to the MSP family size definition, Access Plan household composition, and QHP enrollment effective dates represent meaningful economic benefits to eligible Vermonters. Other changes in Parts 1-5 and 7 align HBEE with federal and state guidance and law, provide clarification, correct information, improve clarity, and make technical corrections.
Posting date:
Jul 02,2025
Hearing Information
Information for Hearing # 1
Hearing date:
Location:
Waterbury State Office Complex, Conference Room Cherry C24 Room A-202
Address:
280 State Drive
City:
Waterbury
State:
VT
Zip:
05671
Hearing Notes:
ID required for access to building.
Hearing also available virtually via MS Teams at https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting Meeting ID: 274 818 117 808 7 Passcode: Uy97mt9z Dial in by phone +1 802-828-7667,,879146430# United States, Montpelier Phone conference ID: 879 146 430#
Information for Hearing # 2
Hearing date:
Location:
Virtually via MS Teams
Address:
https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting Meeting ID: 274 818 117 808 7 Passcode: Uy97mt9z Dial in by phone +1 802-828-7667,,879146430# United States, Montpelier Phone conference ID: 879 146 430#
City:
n/a
State:
VT
Zip:
n/a
Hearing Notes:
Virtually via MS Teams at: https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting Meeting ID: 274 818 117 808 7 Passcode: Uy97mt9z Dial in by phone +1 802-828-7667,,879146430# United States, Montpelier
Phone conference ID: 879 146 430#
Information for Hearing # 3
Hearing date:
Location:
Virtually via MS Teams
Address:
https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting Meeting ID: 274 818 117 808 7 Passcode: Uy97mt9z Dial in by phone +1 802-828-7667,,879146430# United States, Montpelier Phone conference ID: 879 146 430#
City:
n/a
State:
VT
Zip:
n/a
Hearing Notes:
Virtually via MS Teams at: https://www.microsoft.com/en-us/microsoft-teams/join-a-meeting Meeting ID: 274 818 117 808 7 Passcode: Uy97mt9z Dial in by phone +1 802-828-7667,,879146430# United States, Montpelier Phone conference ID: 879 146 430#
