VT Medicaid Forms
Medicaid SGD Evaluation Form
by Department of Vermont Health Access
Required evaluation form for requesting Speech Generating Device to be funded by Vermont Medicaid.
VT Medicaid Medical Necessity Form
by Department of Vermont Health Access
When requesting a speech device from VT Medicaid, the applicant’s Primary Care Physician must complete this form of medical necessity.
Application Process Resources
The materials below have been created by the Vermont I-Team’s AAC Consultants to help us guide teams through communication device trials. They specifically reflect Vermont Medicaid’s device funding requirements. Also, because we pair them with AAC Consultation services there may be individualized needs or steps that are not fully captured in the documentation alone.
SGD Trial Introduction
App and Device Features to Consider
Trial Roles and Responsibilities
SGD Implemenation Plan
SGD Trial Data Chart
SGD Trial Steps
SGD Baseline / Endline Document
VT Medicaid Required Documents Chart