Page Reviewed / Updated - Feb. 2019
The Attendant Services Program (ASP) is designed for disabled, Vermont residents that require assistance to manage their activities of daily living. Policymakers designed it to help persons remain living in their homes and avoid institutional (nursing home) placement. The participant is responsible for hiring, training, and managing their own care providers and receives financial assistance in order to pay for that care. This type of program is also referred to as consumer-direction or Cash and Counseling
As mentioned previously, this program is intended to help participants avoid nursing home placement. However, this does not mean the participants must be living at home. The program’s regulations allow for participants to reside in certain group living environments, such as adult foster care homes and certain licensed assisted living residences.
Friends, neighbors, and family members can be hired to provide attendant care services. This means the adult children of aging parents that require assistance can be paid to be caregivers. However, spouses, civil union partners, and legal guardians are excluded from being paid in this program. Caregivers are paid a Medicaid-approved hourly rate which is estimated at somewhere between $14.75 and $18.75.
To help avoid confusion, it is worth noting that there are three possible funding sources for the Attendant Services Program and the name of the program changes slightly depending on the source. One might find the program referred to as General Fund Participant Directed Attendant Care (PDAC), Medicaid PDAC, or General Fund Personal Services.
The eligibility requirements for the Attendant Services Program vary slightly depending on which source of funding is used. Regardless of funding source, program participants must be at least 18 years of age and must meet functional and financial requirements. Functionally, persons must have a disability and require assistance managing at least two of their activities of daily living.
Financially, persons must be eligible for Vermont Medicaid (Green Mountain Care) or nearly eligible. Both income and assets are considered. As of early 2019, single applicants must have less than the allowed Protected Income Level (PIL) of $1,066 per month (or $1,158 in Chittenden county). They are permitted up to $2,000 in countable resources. Worth noting is that one's home, given the applicant or their spouse lives in the home and the equity value is under $585,000, household furnishings, and a vehicle can be excluded from the countable resource calculation.
Persons over the income limit need not be discouraged as Vermont has a medically needy pathway to eligibility. This is often referred to as a Spend Down Program or Cost of Share program. In an overly simplified explanation, persons who have high medical bills in relation to their income are able to deduct their medical expenses, including Medicare premiums, from their monthly income. Once one has spent their income down to the medically needy income limit, he/she will be eligible for Medicaid for the remainder of the “spend down” period.
There are many exceptions to the income and asset limits. Working with a professional Medicaid Planner can help individuals structure their income and assets using trusts to ensure their eligibility for the Attendant Services Program. More information.
The Attendant Services Program provides self-directed, personal assistance with the activities and instrumental activities of daily living. All of the following activities are possible, though not everyone will be approved to receive assistance with each of them.
One can learn more about the program from the Vermont Department of Disabilities, Aging & Independent Living webpage. Alternatively, one can call the Adult Services Division at 802-241-0294 for more information. The program's regulations are available here, but be forewarned, these are not written for a consumer audience. One can also download an application.