Vermont Medicaid's Global Commitment to Health Waiver
Program Description
Vermont's Global Commitment to Health (GC) Waiver is a Medicaid (Green Mountain Care) program that provides a wide range of services to a diverse set of beneficiaries. Here the program is examined from the perspective of elderly Vermont residents who require ongoing care and assistance.
This Section 1115 Demonstration Waiver assists elderly individuals to maintain their independence and avoid nursing home placement by providing services to them in their home, the home of a relative, adult family care home (adult foster care), or an assisted living facility. Several types of assistance are available, but of course the availability of the services depends on the setting in which the senior resides. Most relevant is personal care to assist the elderly in performing their Activities of Daily Living (ADLs), which includes tasks such as mobility, bathing, and eating. Adult day care and respite care help families who are caring for their loved one in their homes by providing them a break from their caregiving duties. Emergency response services (also known as PERS or Medical Alert systems) help individuals who live alone, as does assistance for assistive technology (medical equipment), and home modifications which allow persons to age in place.
The GC Waiver's self-direct care option allows family members to be paid as caregivers. While it is common for most states to allow the adult children of aging parents to serve as paid caregivers, Vermont is one of only a few states that also permits spouses to be paid.
Eligibility Guidelines
The Global Commitment Waiver has eligibility criteria related to both the finances of the applicant and of their functional abilities. While eligibility is not as strict as in many state Medicaid waivers, it can be very confusing.
Clinical Eligibility
Individuals whose care requirements put them at risk of nursing home placement are clinically eligible for this waiver. However, persons with moderate needs can also receive limited care, including adult day services and homemaker support.
Income Limits
The limits on an applicant's income depend on several factors including their age, marital status, location within the state, and whether or not a spouse is also applying to receive Medicaid assistance. It is beyond the scope of this webpage to examine all the eligibility rules for all constituent groups. Instead we will focus on those rules relevant to seniors. Applicants are permitted to have up $1,041 / month in income. However, if they reside at home (or not in a nursing home) they are permitted to deduct their care expenses from that amount. For example, if an applicant has $2,000 / month in income, but recurring monthly medical expenses of $1,000, they would have only $1,000 month in countable income and therefore would be eligible. In Chittenden County, the income limit is higher at $1,125 / month instead of $1,041.
Asset Limits
The "countable assets" of seniors are, as a rule-of-thumb, limited to $2,000. However, this excludes the value of many personal items and one's home, valued at no more than $572,000, if the applicant or their spouse lives in it. Furthermore, if only one spouse in a married couple is applying, the non-applicant spouse can maintain up to approximately $123,600 in common assets in 2018. This is in addition to the $2,000 the applicant spouse is able to retain.
Assistance is available to help families understand and qualify for Medicaid. Read more.
Benefits and Services
Because there are many programs wrapped into the GC program, some levels of service are dictated by factors such as the severity of the individual's condition, the setting in which services are provided (i.e. assisted living vs. in-home), and the client’s own personal choices.
For example, under the Choices for Care Waiver, which has been absorbed by the GC Waiver, persons in assisted living can receive an intensive degree of support, such as 24/7 supervision and nursing, laundry services and housekeeping. Assistance provided in nursing homes can include the previous plus room and board, transportation, therapies and medication management and recreational activities. Those living at home can receive personal care, adult day care, respite, PERS (Medical Alert) and assistance for home modifications and medical equipment. Obviously some of these home-based services are not relevant to persons who live in residential care.
A complete list of benefits relevant to the elderly follow:
- Adult Day Care
- Adult Family Care (commonly thought of as adult foster care)
- Assisted Living / Enhanced Residential Care
- Assistive Technology and Devices
- Case Management
- Companion Services
- Home Modifications
- Personal Care (assistance with ADLs, plus medication management, non-medical transportation, and help with preparing meals, and doing laundry)
- Personal Emergency Response System
- Respite Care
How to Apply / Learn More
To apply for the Global Commitment to Health Waiver, contact Vermont Health Connect, either through their website or by phone at 855-899-9600. For additional information about this waiver, click here. To avoid confusion, the GC Waiver is often simply referred to as “Medicaid”.
Paper applications are available and Vermont has a network of "assisters", including certified counselors, who help people with enrollment. A map of local assisters is available here. Finally, one's local Area Agency on Aging is also always ready to help.
With the Global Commitment to Health Waiver, Vermont has eliminated Medicaid waiting lists.
For those curious whether the new Medicaid, Community First Choice Option (CFCO) is available in Vermont, know that the Global Commitment to Health Waiver in many ways goes beyond the benefits offered by CFCO. Most importantly, it shares the two most senior-friendly aspects, the choice of providers and the elimination of waiting lists. While VT participation in CFCO is unclear at present, residents can rest assured they are receiving benefits at least equal to those offered by the program in other states.