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Vermont's Global Commitment to Health 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 Waiver assists elderly individuals to maintain their independence and avoid nursing home placement by providing services to them in their homes. Several types of assistance is available. Most relevantly personal care to help the elderly with their activities of daily living. Adult day care and respite care, help families who are caring for their loved one in their homes. 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.
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.
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.
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 $1,008 / 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 $1,083 / month instead of $1,008. Note these numbers change annually are expected to rise by several dollars per month later in 2017.
The "countable assets" of seniors are, as a rule-of-thumb, limited to $5,000 for persons who reside in their homes. However, this excludes the value of many personal items and one's home. Furthermore, if only one spouse in a married couple is applying, the non-applicant spouse can maintain up to approximately $120,900 in common assets in 2017.
Assistance is available to help families understand and qualify for Medicaid. Read more.
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:
To apply, contact Vermont Health Connect, either through their website or by phone at 866-482-4723. 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.