Page Reviewed / Updated - Mar. 2019
Assistive Community Care Services (ACCS) program is an option for Vermont residents who are currently enrolled in the community Medicaid program and are residing in or are moving into Level III assisted living facilities and residential care homes. Functionally, these individuals cannot reside independently in their homes, but they do not have to require the level of care typically provided in nursing homes. That being said, their level of care need can be as great as that which is provided in a nursing home. By helping participants remain in assisted living, the state can avoid more expensive nursing home care. Through the ACCS program, eligible applicants are provided personal care service, routine nursing services, medication monitoring, and other benefits in Medicaid-approved residential care homes and assisted living homes.
The services available through the ACCS program can be accessed via Community Medicaid and is an entitlement if an individual is enrolled in Medicaid. (In Vermont, the Medicaid program is also referred to as Green Mountain Care). ACCS services are also available via Long Term Care Medicaid, such as Choices for Care (CFC), which as of January 31, 2015, operates under the Vermont Global Commitment to Health Waiver, a section 1115 demonstration waiver.
The ACCS program is administered by the Vermont Department of Disabilities, Aging and Independent Living.
To be eligible for the ACCS program, applicants must be Vermont residents who are 65 years of age or older, or at least 18 years old and disabled. They must require the services provided by this program and reside in a Level III assisted living facility or residential care home that is an approved Medicaid provider for this program.
There are also income and asset requirements, which are the same as for the Community Medicaid program. As of 2019, the allowable Protected Income Level (PIL) for a single individual living inside Chittenden County is $1,158 per month. For those living outside of Chittenden County the PIL is slightly lower at $1,066 per month. The asset limit, which refers to liquid assets, such as bank accounts, stocks, and bonds, is $2,000 for a single applicant.
The value of one’s home is not included in an applicant's countable assets, if the owner resides in the home. Since this program is for persons in assisted living, they cannot also reside in their home. Therefore, their home would be counted towards the asset limit. However, should the program participant have a spouse or a dependent who remains living in the home, the home would be exempt and not counted towards the asset limit should the value of the home’s equity not be greater than $585,000. Other exempt assets include personal effects, such as clothing and a wedding ring, and pre-paid funeral / burial plans.
For those who exceed the asset limit, giving away assets or selling them under fair market value is not a viable solution in order to reach Medicaid’s asset limit. Doing so may violate Medicaid’s Look-Back Period (a 5-year stretch of time) and may result in a period of Medicaid ineligibility. For those with greater assets than Medicaid allows, consulting a Medicaid Planning Professional is highly advised, as they can help reallocate assets in order to help one become eligible.
It’s important to note that those who have a monthly income in excess of the PIL, yet still cannot afford their full cost of care, may still be eligible for Medicaid and ACCS by utilizing what is called an income spend-down. Medical bills and other care expenses can go towards meeting the spend-down. For example, let’s take an individual who lives in Chittenden County, resides in an approved Medicaid provider home, and has a monthly income of $1,200. Since the PIL inside of Chittenden County is $1,158, the individual has a monthly income that is $42 in excess of the PIL. In this case, once the individual pays $42 / month towards medical costs and ACCS services, Medicaid will kick in the remainder.
The above information is current for 2019 as of February. A cost of living increase is expected in April or May of 2019, which may impact these numbers by 1%-2%.
It’s important to note that ACCS does not cover the cost of room and board. However, individuals are entitled to a monthly personal needs allowance, also referred to as a minimum personal spending amount, of $93. With ACCS, consumer direction of services is not available.
For additional information on the ACCS program, download the Vermont Department of Disabilities, Aging and Independent Living PDF.
Individuals not currently on Medicaid need to first apply for Medicaid. One’s local Area Agency on Aging office can one assist one in applying for Medicaid. Those not eligible for Medicaid should consider working with a Medicaid planner to gain eligibility.
Those persons already on Medicaid should contact their local Agency of Human Services office to apply for this program.