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Vermont Medicaid's Global Commitment to Health Waiver

Page Reviewed / Updated - May 04, 2020

Program Description

Vermont's Global Commitment to Health (GC) Waiver is the authority that operates VT’s Medicaid (Green Mountain Care) program. Via this authority, a wide range of services is provided to a diverse set of beneficiaries. Here the GC Waiver 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 homes, the homes of a relative, adult family care homes (adult foster care), or assisted living facilities. 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 ones 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, assistance for assistive technology (medical equipment), and home modifications, which allow persons to age in place.

Under the GC Waiver, family members, such as adult children, can be paid caregivers for their loved ones.

The GC Waiver's self-direct care option allows family members to be paid as caregivers.  While the adult children of aging parents can serve as paid caregivers, Vermont does not permit spouses to be paid. 

Vermont's encompassing Global Commitment Waiver has absorbed the former Choices For Care Waiver and the state's PACE Program.  Constituents continue to receive the same services under the new program.  

Eligibility Guidelines

The Global Commitment Waiver has eligibility criteria related to both the finances of applicants and 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 in some cases, 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.

Categorically needy applicants, also referred to as Medicaid for the Aged, Blind, Disabled (MABD), are permitted to have up $1,091 / 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. (This is referred to as Medically Needy). In Chittenden County, the income limit is higher at $1,175 / month instead of $1,091. 

Please note: The income limits for institutional Medicaid and Choices for Care is higher. As of 2020, the income limit is $2,349 / month. Furthermore, in 2020, an applicant spouse may be able to transfer as much as $3,216 / month to the non-applicant spouse to prevent spousal impoverishment. This is called a monthly maintenance needs allowance.

Asset Limits
The "countable assets" of seniors are, as a rule-of-thumb, limited to $2,000. Married couples, with one or both spouses applying for Medicaid for the Aged, Blind, or Disabled, are allowed up to $3,000 in assets. However, this excludes the value of many personal items and one's home, given the Medicaid applicant’s equity interest in it is no more than $595,000. The applicant or their spouse must also live in the home unless the applicant expresses an intent to return to it. 

If only one spouse in a married couple is applying for institutional Medicaid or Choices for Care, the non-applicant spouse can maintain up to approximately $128,640 in common assets in 2020. 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.

An option for seniors who are not Medicaid eligible is the Home Sharing Program, which provides a way for homeowners to receive assisted living level care while remaining at home. Another option to help aging in place is the Home Access Program.  

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, 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 follows:

  • 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, 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 Vermont's  Medicaid program under the authority of the Global Commitment to Health Waiver, Vermont has eliminated Medicaid waiting lists.

Community First Choice in Vermont? The Community First Choice Option (CFCO) is currently unavailable in Vermont. However, 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.  Residents can be rest assured they are receiving benefits at least equal to those offered by CFCO in other states.