Vermont Medicaid Choices for Care Waiver: Benefits & Eligibility

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

As of January 30, 2015, Vermont's Choices for Care Medicaid Waiver was consolidated with the newer and more comprehensive Global Commitment to Health Waiver. Please refer to this page to learn more about the program.

This page is maintained for historical purposes. 

Vermont designed this Medicaid waiver to help older state residents that require moderate to high levels of assistance. It helps them to remain living at home or in their communities, such as assisted living residences. The Choices for Care waiver is also referred to as the 1115 Long-Term Care Medicaid Waiver. Vermont Medicaid is also called Green Mountain Care.

Choices for Care offers a consumer directed option called Flexible Choices. This option provides cash to the elderly in place of care services which they then use to hire their own care services. Family members can be hired as care providers. In some states this type of program is referred to as Cash and Counseling. Flexible Choices is preferred by both participants and state administrators. It allows them or their loved ones the option to age in an location in which they are familiar and comfortable. Also, the elderly living at home use family caregivers instead of nursing home personnel, which are less costly to the state.

Under Choices for Care, services are not limited to strictly personal care. Rather, a wide variety of services are possible, encompassing any assistance that helps persons maintain their independence or helps caregivers to provide assistance. For example, home modifications like wheelchair ramps and walk in-tubs replacements for showers can be covered. The waiver also includes an Enhanced Residential Care (ERC) option that provides services in assisted living residences and pays for fall monitoring and emergency response services.

 Vermont seniors are eligible for free quotes on home modifications to help aging in place such as walk-in tubs.   Get started here.

 

Eligibility Guidelines

There are 5 areas of eligibility consideration for the Choices For Care Waiver.

1) Age - applicants must be at least 18 years of age. Individuals 65 and older are subject to less rigid functional criteria.

2) Level of Need - persons 18-64 must be physically disabled. Those 65 and over must require nursing home level care but a disability is not required.

3) Income - applicants have less than the Protected Income Level (PIL) for Vermont Medicaid. In 2015, in most areas of the state this limit is $981 / month for a single person. However, VT also offers a Medically Needy program that allows persons over this limit with high recurring medical expenses to qualify and to pay a share of the costs.

4) Assets - single applicants are permitted up to $2,000 in countable assets. However, these do not include one's home and primary vehicle. The husband or wife of a married applicant is permitted to retain up to $119,220 if they are not also receiving Medicaid assistance.

5) Past Asset Transfers - VT Medicaid and Choices For Care reserve the right to review up to 5 years of an applicant's asset transfers to make sure no under market value transfers were made in an attempt to lower one's assets to the Medicaid eligible level. Should such transfers exist, the applicant may still be accepted but might be required to pay the value of transfer towards their care costs.

Persons over these limits or those with some uncertainty regarding their asset transfer history should consult with a Medicaid planner in advance of application. These financial and legal experts can help them to qualify for Medicaid in Vermont.  Read more.

 

Benefits and Services

One of Choices For Care's goals is to prevent nursing home placement and therefore, the services provided under this program are selected to increase the beneficiary's ability to function independent of that environment. Each individual is approved for a specific suite of care and support services. These can include the following list.

  • Adult Day Care
  • Assisted Living / Enhanced Residential Care
  • Assistive Technology and Devices
  • Case Management
  • Companion Services
  • Home Modifications
  • Personal Care
  • Personal Emergency Response System
  • Respite Care

 

How to Apply / Learn More

This waiver has been replaced by the Vermont Global Commitment to Health Waiver.

This waiver is available in all Vermont counties although it is possible that a waiting list for services may exist. Wait list prioritization is based on time of application and severity of need.   One can learn more on the following webpage. To apply, one can visit their local VT Area Agency on Aging or apply online.

 State residents suffering from dementia or Alzheimer's and their caregivers might also find assistance from the state's Dementia Respite Care Grants.