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.
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. However, Choices for Care remains active under the Global Commitment to Health Waiver and is still frequently referred to as Choices for Care. Please refer to this page to learn more about the Global Commitment to Health Waiver.
Vermont designed Choices for Care (CFC), the state's Medicaid long-term care program, to help older state residents that require moderate to high levels of care assistance. It helps them to remain living at home or in their communities, such as assisted living residences or adult family care homes. However, via CFC, one can also choose to reside in a nursing home facility. The Choices for Care waiver operates within Vermont’s Global Commitment to Health Waiver (GC). This waiver is a Section 1115 Medicaid Demonstration Waiver and is the authority that runs Vermont's Medicaid program. VT Medicaid is also called Green Mountain Care.
Choices for Care offers a consumer directed option called Flexible Choices for participants who reside in a home based setting. This option provides cash to the elderly in place of care services, which they then use to pay for 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 an option often preferred by both participants and state administrators. It allows program participants or one’s loved ones the option to age in a 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. CFC also includes an Enhanced Residential Care (ERC) option. ERC provides services in assisted living residences and certain residential care facilities 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.
There are 5 areas of eligibility consideration for the Choices For Care Waiver for Vermont residents.
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 must have income less than 300% of the Federal Benefit Rate (FBR). In 2019, this equals $2,313 / month. Income can be allocated from an applicant spouse to a non-applicant spouse, up to $3,160.50 / month. This is referred to as a spousal allowance and ensures a non-applicant spouse has sufficient income to support oneself while also effectively lowering the applicant spouse’s income. However, if one is still above the income limit or is unmarried, 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 in 2019. The asset limit is increased to $5,000 if an applicant lives in his/her own home. 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 $126,420 in non-exempt assets if they are not also receiving Medicaid assistance. This is called a community spouse resource allowance.
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. More information about Medicaid’s Look-Back Period can be found here.
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.
There is another program option within CFC called the Moderate Needs Group (MNG) Services Program. As the name suggests, it is for those who have a minimal need for assistance to remain living in their home. Via this program, case management, adult day care, homemaker services, and flexible funding is available. A nursing home level of care is not a requirement to be eligible for the Choices for Care Moderate Needs Services Program. In addition, one does not have to be eligible for Medicaid.
Benefits and Services
While CFC does allow a program participant to choose to live in a nursing home facility, one of Choices For Care's goals is to prevent nursing home placement. 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.
How to Apply / Learn More
The Choices for Care program operates within the Vermont Global Commitment to Health Waiver. One can find limited additional information about CFC, on Vermont’s Department of Disabilities, Aging and Independent Living (DAIL) website.
For additional information or to apply for CFC, contact the Department of Children and Family Services’ benefit hotline at 800-479-6151. One can also contact their local Area Agency on Aging (AAA) office for assistance. A program application can be downloaded here.