Vermont Medicaid (Green Mountain Care) Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. In Vermont, Medicaid is also called Green Mountain Care. This article focuses on Vermont Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through the Choices for Care program or Medicaid for the Aged, Blind and Disabled (MABD). This is different from regular Medicaid, which is for financially limited people of all ages.

 

Vermont Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Vermont Medicaid, via its Choices for Care program, will cover the cost of long-term care in a nursing home for financially limited Vermont seniors who require a Nursing Facility Level of Care. Vermont Nursing Home Medicaid coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

  • Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
  • Skilled nursing care
  • Physician’s visits
  • Prescription medication
  • Medication management
  • Mental health counseling
  • Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Vermont Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $79.93/month (as of 2024), which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

Vermont Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

  A Nursing Home Alternative – Vermont Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through Vermont’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents.

 

Home and Community Based Services via Choices for Care

Vermont’s Choices for Care (CFC) program provides home and community based long-term care services and supports to Vermont seniors. The program is intended to help financially limited Vermont seniors who need, or are at risk of needing, a Nursing Facility Level of Care (NFLOC) remain living in the community instead of moving to a nursing home. CFC program participants can live in their own home, the home of a loved one, an adult family care home, an assisted living residence, a Level III Residential Care Home or a home for the terminally ill. While CFC will provide services and supports in those settings, it will not cover room and board expenses.

Vermont’s CFC program is divided into two groups: High Needs and Moderate Needs. CFC High Needs Group beneficiaries must require a Nursing Facility Level of Care, while CFC Moderate Needs Group beneficiaries need to show a medical need for the program’s services. Vermont’s Department of Disabilities, Aging and Independent Living (DAIL) will conduct a functional assessment of CFC applicants to determine what level of care they require. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), their need for regular skilled nursing (such as dialysis, tube feedings and wound care) and their cognitive state.

Unlike Nursing Home Medicaid, Vermont’s CFC program is not an entitlement. Remember, entitlement means guaranteed by law. So, even if an applicant is eligible for Vermont’s CFC program, they are not guaranteed by law to receive the benefits. Instead, there are a limited number of enrollment spots. Once those spots are full, additional eligible applicants will be placed on a waitlist. CFC applicants who are already covered by Vermont’s Medicaid for the Aged, Blind and Disabled will receive priority on the waitlist.

Choices for Care High Needs Group
CFC High Needs Group benefits include adult day care, nursing services, home modifications, housekeeping services (including meal prep) and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). Benefits will be made available depending on the needs and circumstances of each individual.

The Department of Vermont Health Access can assign a licensed caregiver to provide CFC High Needs Group benefits, but program participants also have the option to self-direct their care through the Flexible Choices program. This means they can hire caregivers of their choice (including friends, spouses and other family members), and they have greater flexibility in the type of medical equipment and supports they can purchase.

CFC provides services and supports to individuals who live in a Level III Residential Care Home or an assisted living residence through its Assistive Community Care Services program. And it will provide benefits to individuals who reside in a private home and require medical technology to live through the High Technology Home Care program.

Choices for Care Moderate Needs Group
Vermont’s Choices for Care (CFC) Moderate Needs Group program provides long-term care services and supports to Vermont Medicaid recipients who have a medical need, but do not require a Nursing Facility Level of Care. CFC Moderate Needs applicants must meet one of the following functional, or medical, criteria:

  • Their health will worsen if they do not receive benefits.
  • They have a health condition that requires monitoring at least once a month.
  • They need daily supervision due to impaired decision making.
  • They need help with at least one Activity of Daily Living (mobility, bathing, dressing, eating, toileting) or one Instrumental Activity of Daily Living (such as shopping, cooking, cleaning, medication management) at least three times in a seven-day period.

CFC Moderate Needs Group benefits include adult day care, home modifications, housekeeping services (including meal prep) and personal care assistance with the Activities of Daily Living. The state can assign a licensed caregiver to provide CFC Moderate Needs Group services, but program participants also have the option to self-direct their care through the Flexible Choices program. This means they can hire caregivers of their choice (including friends, spouses and other family members), and they have greater flexibility in the type of medical equipment and supports they can purchase.

 

Medicaid for the Aged, Blind, and Disabled

Vermont’s Medicaid for the Aged, Blind and Disabled (MABD) provides healthcare coverage and long-term care services and supports to Vermont residents with limited financial means who are aged (age 65+), blind or disabled. MABD can sometimes be called Regular Medicaid for seniors, but it should not be confused with the Regular Medicaid that is for financially limited people of all ages. Vermont’s MABD is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via MABD depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

The state will conduct an assessment of MABD beneficiaries to determine what type of long-term care benefits they need and the state will cover. They can receive these long-term care benefits through the Attendant Services Program or the Adult Day Services program.

Attendant Services Program
Vermont’s Attendant Services Program (ASP) covers long-term care services and supports for MABD beneficiaries who have a “permanent and severe disability” and require help with at least two Activities of Daily Living (mobility, bathing, dressing, eating, toileting). ASP participants must live in their own home or the home of a loved one.

The Attendant Services Program provides personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and medication management). This assistance will be provided depending on the needs and circumstances of each individual. The state can provide a licensed caregiver to deliver these services, or the program participant can self-direct their care by hiring caregivers of their choice, including friends and family members.

Like Vermont’s MABD coverage, the Attendant Services Program is an entitlement. This means that all eligible applicants are guaranteed to receive benefits.

Adult Day Services
Vermont’s Adult Day Services program provides adult day care, supervision and health services to Vermont adults with physical and/or cognitive impairments.

This program operates 14 day health centers across the state. These centers offer social interaction and activities, health and therapy services, as well as nutritional meals. The centers also provide support, education and respite care for the program participant’s family members and caregivers.

For Vermont residents enrolled in MABD, the Adult Day Services program is an entitlement, which means all eligible applicants are guaranteed to receive benefits.

Vermonters who qualify for the state’s Choices for Care Medicaid program (which has less restrictive financial requirements than MABD) can also enroll in the Adult Day Services program. However, Adult Day Services is not an entitlement for Choices for Care beneficiaries. There are a limited number of enrollment spots for them, and once those are full, additional eligible applicants will be placed on a waiting list. The same goes for Vermonters who do not qualify for Medicaid at all. They can pay to use to Adult Day Services centers, as long as there are available enrollment spots.

Program of All-Inclusive Care for the Elderly (PACE)
PACE covers medical, social service and long-term care needs with one comprehensive plan and delivery system for Aged, Blind and Disabled Medicaid recipients in other states, including Medicare benefits for those who are “dual eligible.” PACE also administers vision and dental care, and PACE day centers provide adult day care, meals, social activities and regular health checkups. PACE program participants are required to need a Nursing Facility Level of Care, but they must live in their home or somewhere else in the community. Although Vermont does not have a PACE program of its own as of Jan. 1, 2024, neighboring Massachusetts has eight PACE centers. While seniors can not use PACE programs (or receive any kind of Medicaid benefits) in other states, or transfer their Medicaid coverage from state to state, they can re-apply for Medicaid in a new state without any waiting period if they relocate. To learn more about PACE, click here.

 

Eligibility Criteria For Vermont Medicaid Long Term Care Programs

To be eligible for Vermont Medicaid, a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program and services they are applying for – Nursing Home Medicaid coverage through Choices for Care, Home and Community Based Services (HCBS) through Choices for Care, or Medicaid for the Aged, Blind, and Disabled (MABD).

 Just For You: The easiest way to find the most current Vermont Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

 

Vermont Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Vermont residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Vermont Medicaid’s Choices for Care. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Vermont Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Vermont Medicaid beneficiaries who reside in nursing homes must give most of their income to the state to help pay for the cost of care. They are only allowed to keep $79.93/month of their income as a “personal needs allowance,” and they are allowed to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Vermont Medicaid is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Vermont Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Vermont has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Vermont Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. Vermont’s Department of Disabilities, Aging and Independent Living will conduct a functional assessment of applicants to determine if they do require that level of care. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), their need for skilled nursing and their cognitive state.

 

Eligibility Criteria for Home and Community Based Services via Choices for Care

Financial Requirements
Vermont residents have to meet an asset limit and an income limit in order to be financially eligible for home and community based services through Vermont’s Choices for Care program. For a single applicant in 2024, the asset limit is $2,000, with two exceptions. Single applicants who own and live in their own home have a $5,000 asset limit. And the asset limit for the Choices for Care Moderate Needs Group is $10,000 for both single applicants and couples with either one or two spouses applying. The asset limit takes into account almost all countable assets, such as bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a single applicant for Choices for Care home and community based services is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying for Choices for Care Highest Needs Group, the 2024 asset limit is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying for Choices for Care Highest Needs Group, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

  Plan Ahead: There are alternative pathways to eligibility for Vermont Choices for Care applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Vermont has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Choices for Care (CFC) depends on the program. CFC High Needs Group applicants must require a Nursing Facility Level of Care. Vermont’s Department of Disabilities, Aging and Independent Living will conduct a functional assessment of applicants to determine if they do require that level of care. The assessment will take into consideration an applicant’s ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting), their need for regular skilled nursing (such as dialysis, tube feedings and wound care) and their cognitive state.

CFC Moderate Needs Group applicants must meet one of the following functional, or medical, criteria:

  • Their health will worsen if they do not receive benefits.
  • They have a health condition that requires monitoring at least once a month.
  • They need daily supervision due to impaired decision making.
  • They need help with at least one Activity of Daily Living (mobility, bathing, dressing, eating, toileting) or one Instrumental Activity of Daily Living (such as shopping, cooking, cleaning, medication management) at least three times in a seven-day period.

 

Vermont Medicaid for the Aged, Blind, and Disabled Eligibility Criteria

Financial Requirements
Vermont residents have to meet an asset limit and an income limit in order to be financially eligible for Medicaid for the Aged, Blind and Disabled (MABD). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. For married applicants, the asset limit is a combined $3,000 combined, which applies to couples with both spouses applying or with just one spouse applying. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for a MABD applicants is $1,300/month. This applies to single applicants and married applicants with both spouses or just one spouse applying. There is an exception – the 2024 income limit for Chittenden County residents, both single and married, is $1,408/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

  Plan Ahead: There are alternative pathways to eligibility for Vermont MABD applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Vermont has a Look-Back Period of five years for Nursing Home Medicaid and Choices for Care applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for MABD applicants. However, MABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid or Choices for Care benefits, and those programs will deny or penalize the applicant for giving away assets.

 

Functional Requirements
The only functional requirement to receive healthcare coverage via Medicaid for the Aged Blind and Disabled in Vermont is being age 65 or over, blind or disabled. For MABD applicants/recipients who need long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning and taking medications) to determine what kind of long-term care benefits the state will cover.

 

How Medicaid Treats the Home

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

  • If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
  • If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
  • If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – MABD applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Vermont Medicaid applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Vermont and how you can protect your home from it, click here.

 

Applying For Vermont Medicaid Long Term Care Programs

The first step in applying for Vermont Medicaid Long Term Care is deciding what type of coverage you’re applying for – Nursing Home Medicaid through Choices for Care, Home and Community Based Services through Choices for Care, or Medicaid for the Aged Blind and Disabled (MABD).

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Vermont Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Vermont Medicaid applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, Vermont residents can apply for nursing home coverage and home and community based services through Choices for Care using application 202LTC, which can be found halfway down this webpage. They can also get the application by calling 800-479-6151. Completed applications should be mailed to Green Mountain Care, Application and Document Processing Center, 280 State Drive, Waterbury, VT, 05671-1500.

To apply for Medicaid for the Aged Blind and Disabled (MABD), Vermont residents can download the 205ALLMED application from this webpage, or they can get one by calling 855-899-9600. Completed applications can be mailed to Green Mountain Care, Application and Document Processing Center, 280 State Drive, Waterbury, VT, 05671-1500.

For step-by-step guides to applying for each of the 3 types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) Medicaid for the Aged Blind and Disabled.

  Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney. 

 

Choosing a Vermont Medicaid Nursing Home

After being approved for nursing home coverage through Vermont Medicaid, seniors have to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available space. Finding the right residence can be a challenge, especially if you’re looking in a specific location.

Vermont has 35 nursing homes, and 34 of them accept Medicaid. There are seven facilities within 25 miles of Burlington, six in the Montpelier area and four around Rutland. There are 12 nursing homes within 25 miles of Brattleboro, but only three of them are in Vermont. Residents in some Vermont communities, like Brattleboro and Rutland, often cross the state line for personal and business reasons, including healthcare, but Medicaid coverage does not cross state lines. So, someone with Vermont Medicaid would not be covered for nursing homes in New Hampshire, Massachusetts or New York, even if facilities in those states are convenient or well-suited for the Vermont resident.

 TOOLS: Vermont residents can find and compare nursing homes using Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country. They can also use this list of nursing homes by county from the Vermont Adult Services Division to search for nursing homes in their area.

When you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. You can also contact your local Area Agency on Aging to find out more information about nursing homes in Vermont.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

Data collected by CMS reveals that nursing homes in Vermont fare well when it comes to health standards and fire safety. Vermont nursing homes averaged 17.5 health deficiencies per facility from 2019-2022, while the national average during that time period was 25.7. And Vermont nursing homes averaged just 6.6 fire safety deficiencies, while the national average was 13.5. On the down side, 15.2% of residents in Vermont nursing homes had depressive symptoms, but the national average was only 8.1%.