You asked for information on Vermont's “Dr. Dynasaur” health care program, including the issuance of enrollment and identification cards.

SUMMARY

The Dr. Dynasaur program was created in 1989 as a state-funded program for pregnant women and children through age six who did not have health insurance or qualify for traditional Medicaid. At that time, the program covered children up to 225% of the Federal Poverty Level (FPL) and pregnant women up to 200% of FPL (see below for current eligibility levels). In 1992, Dr. Dynasaur coverage was integrated into the Medicaid program under section 1902(r)(2) of the federal Social Security Act and coverage was expanded to children through age 17. To conform to traditional Medicaid, coverage under other health insurance no longer precluded eligibility and co-payments were eliminated. In October 1998, coverage was further expanded to children in families with incomes up to 300% of FPL through § 1902(r)(2) and Vermont's § 1115(a) demonstration waiver, and the State Children's Health Insurance Program (SCHIP) authorized by federal law.

Vermont sends enrollment information to all school age children and their families through postcard distribution at the start of the school year. Dr. Dynasaur beneficiaries are issued identification cards in the same manner as traditional Medicaid beneficiaries.

DR. DYNASAUR

Program Goals

Dr. Dynasaur has two main goals. The primary goal is to assure access for pregnant women and children up to age 18 to a full range of health care services with a strong emphasis on prenatal and preventive care. The program is meant to provide a system of coverage in concert with private health insurance that ensures universal health insurance coverage for all Vermont children. A secondary goal is to help working families maintain self-sufficiency. This complements Vermont's welfare reform initiative by offering health coverage to low and moderate-income families who do not receive cash assistance.

Eligibility

The income guidelines for Dr. Dynasaur are up to 300% of FPL for children and up to 200% FPL for pregnant women. There is no asset limit for Dr. Dynasaur eligibility.

Services and Fees

Coverage under Dr. Dynasaur is as comprehensive as Medicaid. For children and teens up to age 18, the program helps cover the costs of doctor visits; prescriptions; dental and vision care; hospital care; occupational, physical, and speech therapy; immunizations; mental health care; and other medical services. Dr. Dynasaur coverage for pregnant women includes doctor visits, hospital care, lab work and tests, prescriptions, prenatal vitamins and other medical services. Most Dr. Dynasaur beneficiaries receive services through a managed care delivery system.

Currently, individuals requesting Dr. Dynasaur coverage with income above 185% of FPL (about $ 38,700 annual income for a family of four as of April 2005) but no more than 225% ($ 43,548) must pay a monthly premium of $ 30 per household. Those with income between 225% and 300% of FPL ($ 58,056 for a family of four) pay a $ 40 per month premium if the family has other insurance that includes hospital and physician coverage and $ 80 if it has no insurance besides Dr. Dynasaur.

Vermont's recently passed 2006 health care insurance legislation (H. 861; see OLR Report 2006-R-0358) reduces Dr. Dynasaur premiums paid by 50% beginning July 1, 2007. The new monthly premium rates are $ 15, $ 20, and $ 40 respectively.

Enrollment and Identification Cards

At the beginning of each school year, postcards are distributed to Vermont's school-aged children informing them and their families about health insurance coverage available through the Dr. Dynasaur program. Vermont's health department distributes these postage paid postcards to every school. The card briefly describes income eligibility and contact information. Parents and guardians are encouraged to mail back the cards if they are interested in getting more information about the program. This effort is supported in part by the Robert Wood Johnson Foundation's “Back to School Program” that promotes efforts to get children enrolled via community outreach and partnership.

Dr. Dynasaur benefits are identical to traditional Medicaid benefits and follow the same rules. Dr. Dynasaur beneficiaries are issued green VermontAIM identification cards (traditional Medicaid beneficiaries also receive these). This is a green plastic identification card that can be used with the Eligibility Verification System (EVS) to confirm the bearer's eligibility. The EVS is an automated system that informs enrolled providers about beneficiary's eligibility.

Vermont has established a primary care case management program developed as part of the state's § 1115 waiver known as “Primary Care Plus” (PCPlus). This program allows beneficiaries to chose a primary care provider who is responsible for providing primary care and coordinating specialty care. Some Dr. Dynasaur beneficiaries may be enrolled in PC Plus. A gold PC Plus identification card is issued to those enrolled in this program. Membership is mandatory for all Dr. Dynasaur beneficiaries who are not otherwise exempt from managed care enrollment under provisions of the § 1115 waiver.

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