In order to apply for coverage for members under the age of 21, a Medicaid-registered provider would need to apply for prior authorization. Prior authorisation forms are available here: dvha.vermont.gov/forproviders/clinical-prior-authorization-forms. The “Request for Exclusion” form for adults aged 21 and over is used. Call Member Service at 1-800-250-8427 with questions. For more information about EPSDT services, see section 5.2.1 of the Vermont Medicaid General Billing and Forms Manual here. . . .