Written by a parent, not a doctor. Nothing here is medical advice.

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Vermont program

Medicaid decision deadlines for your child's care

Vermont Medicaid has deadlines for deciding requests for your child's care.

What it is

Vermont Medicaid has deadlines for deciding requests for your child's care.

A care request should not sit without a decision indefinitely. Vermont Medicaid has a standard review deadline and a faster route when waiting could seriously harm your child. The children's benefit also reaches beyond some adult coverage limits.

Eligibility rules
  • Your child needs Vermont Medicaid. The clinician explains why waiting for standard review would seriously jeopardize the child for an expedited request.
What you get
  • A written decision timeline and an urgent review route.
  • Review of medically necessary children's care under Medicaid's children's benefit.
What the help includes
  • EPSDT applies to Medicaid members under 21. It covers medically necessary care within federal Medicaid benefit categories, not every requested service.
If you decide to apply
  1. Ask the requesting clinician when the request went in and whether it meets the urgent-review test.
  2. Have the service requested, submission date and any refusal ready for the hospital team or Health Care Advocate.

The clinician who requested care. Free Health Care Advocate help: 1-800-917-7787.

After you ask
  • A standard review can be extended by up to 14 calendar days in allowed circumstances.
  • Medicaid must answer a care request within seven days, or within 72 hours when waiting could harm your child; a medicine request within 24 hours. If the deadline passes with no answer, that counts as a refusal you can appeal.
Good to know

These are Vermont Medicaid deadlines. A work plan has its own review rules.

Other details
  • The reason for a refusal matters: medical necessity, missing paperwork and a coverage limit raise different questions.
Official sources
Ask your social worker

“If a care request is delayed or refused, could you help us check the deadline and the children's coverage rule? When would an urgent review be appropriate?”

Why I’m asking: I want to understand the review options if waiting could interrupt our child's care.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Write down the date the request went in, and ask for the expedited route in writing.

Your social worker

The hospital team marks the request expedited and states the clinical urgency.

The care team

The clinician says in writing why the standard timeframe would seriously jeopardise the child.

Who decides
The Department of Vermont Health Access.
Ask the care team
“Can this authorisation go in as expedited, with a note on why waiting would harm my child? I understand expedited is decided in 72 hours.”

How to apply

First step: When a request goes in, write down the date and ask the clinician to mark it expedited if discharge or treatment is waiting.

  1. Ask the clinician to mark the request expedited and to say in writing why waiting would harm your child.
  2. Write the date the request went in and count the days.
  3. If a service is refused as not covered, ask for it under the children's medical necessity rule by name.

Where it starts: Ask the requesting clinician to mark the request expedited and say why. Free help: the Health Care Advocate on 1-800-917-7787.

What to gather

  • The date the request was submitted
  • The name of the service requested
  • Any written refusal

How long: 7 calendar days standard, up to 14 more if extended, 72 hours expedited.

What a yes looks like

A written authorisation with dates.

What a no looks like, and the next move

Ask whether the no was medical necessity or paperwork, name the children's rule, and call the Health Care Advocate free on 1-800-917-7787.

Watch out

  • Expedited has to be asked for. Nothing speeds up because a family is anxious.
  • These deadlines bind Medicaid, not a work plan.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

A decision in 7 calendar days, or 72 hours when expedited, and cover for what a child medically needs even where adults do not get it.

  • $7 — Standard prior-authorisation decision
  • $14 — Extension available in set circumstances
  • $72 — Expedited prior-authorisation decision

Legal protection: A written decision deadline on any Medicaid authorisation · An expedited route at 72 hours · Cover for a medically necessary children's service even where it is not covered for adults

What it costs the family: Free.

The eligibility facts, as published

Coverage
Vermont Medicaid

The trap: The expedited route has to be asked for. Nothing speeds up on its own because a family is anxious; say in writing why waiting would harm the child.

Where I read this

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