Instructions for Sending Information For MABD

Have you already completed the booklet “Supplemental Information for Medicaid for the Aged, Blind and Disabled (205SUPP)” that we mailed to you?  
  • If yes, go to Step 2.  
  • If no, go to Step 1.  
Step 1. To get a copy of the booklet, click on the link 205SUPP. Then:  
  • Fill out the booklet on your computer.  
  • Save it to your computer. 
  • Print it. 
  • IMPORTANT: Sign it and put the date you sign it. 
Step 2. There are 2 ways to send us the booklet.  
  • Mail it to: 
Green Mountain Care 
Application and Document Processing Center 
280 State Drive 
Waterbury, VT 05671-1500 
  • OR send it to us using your computer or phone: 
  1. Scan pages 1-4 of your signed booklet on a copy machine to your computer as a PDF or take pictures of pages 1-4 of the booklet using your phone. Do not scan or take pictures of the first 2 pages of the booklet (i and ii)- we don’t need them; they are for you to keep. 
  2. Once you have the PDF file or all pictures ready to send to us, go to http://ahsuploader.vermont.gov/ on the internet. 
  3. Follow the steps in the Uploader instructions to send documents securely.
 

Contact Information

Green Mountain Care
Health Access Member Services
Department of Vermont Health Access
280 State Dr.
Waterbury, VT 05671-1010
Phone: 1-800-250-8427
Relay services for the Deaf and hard of hearing: 711