The first question caregivers and families often ask is, "How do we qualify?" Vermont’s Medicaid programs for home care prioritize need, income, and personal resources. While it may seem like a complicated process, it's more manageable when broken down into steps.

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Clinical Eligibility:

To receive long-term home care through the Choices for Care program, applicants must be aged 65 or older — or be an adult with a physical disability aged 18 or older — and demonstrate a clinical need equivalent to that of someone in a nursing home. This includes:

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• Needing assistance with daily tasks like bathing, dressing, eating, or mobility
• Experiencing cognitive impairments such as dementia that impede safe, independent living
• Requiring skilled nursing or therapeutic services on a regular basis

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A state nurse or clinical assessor conducts an in-home evaluation and uses a standardized needs assessment to determine if the applicant meets the high or highest needs levels required for Choices for Care benefits.

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Financial Eligibility:

For 2024, the financial limits for Vermont’s Choices for Care Medicaid Waiver include:

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• An income limit of approximately $2,742/month for an individual
• An asset cap of around $2,000 in countable resources, although certain personal assets like a primary residence, car, and household belongings may be exempt

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Importantly, Vermont follows Medicaid rules that allow spousal impoverishment protections. This means that the healthy spouse, known as the "community spouse," can retain a portion of shared income and resources even if the other spouse qualifies for Medicaid.

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Those with slightly higher incomes might still qualify under a “Medicaid spend-down” approach or by establishing a Medicaid-compliant trust, especially with guidance from an elder law attorney.

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Application Process:

To apply, families should begin by contacting the local Area Agency on Aging or the Department of Disabilities, Aging and Independent Living (DAIL). The process typically involves:

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1. Completing a financial and clinical eligibility assessment
2. Submitting proof of income, assets, and medical need
3. Coordinating with a case manager to develop an individualized care plan
4. Choosing a Medicaid-approved home care provider

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Once enrolled, services can begin quickly — often within a few weeks, assuming all documentation is in order. Keep in mind that documentation must be thorough and up-to-date to avoid delays.

Once eligibility is confirmed, Vermont Medicaid can become the support system families rely on. The range of home services covered under the Choices for Care program and Medicaid Home Health Services is impressively comprehensive — tailored to meet both physical and emotional needs with dignity.

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Choices for Care (Long-Term Services):

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• Personal Care Attendants (PCAs): Assistance with daily living tasks such as bathing, grooming, toileting, and mobility.
• Homemaker Services: Light housekeeping, laundry, grocery shopping, and meal preparation.
• Respite Care: Temporary help for family caregivers who need time to rest, attend appointments, or travel.
• Adult Day Programs: Supervised daytime care offering medical monitoring, activities, and peer socialization.
• Case Management: Coordinates care and connects individuals to additional resources such as transportation or community programs.
• Companionship Services: Reduce isolation and support emotional well-being.
• Home Modifications and Adaptive Equipment: Installation of wheelchair ramps, grab bars, hospital beds, or stairlifts to improve home safety and independence.

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Medicaid Home Health Services (Short-Term):

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• Skilled Nursing: In-home checkups, medication administration, catheter changes, or disease monitoring.
• Rehabilitation Therapies: Physical, occupational, and speech therapy services to aid in recovery.
• Medical Social Services: Psycho-social evaluation and support for patients and families navigating new medical diagnoses.

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Additionally, individuals with intellectual and developmental disabilities may qualify for services under Vermont’s Developmental Disabilities Services Division (DDSD), which may include home-based supports tailored to their unique needs.

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Families have the freedom to choose from an approved list of home care agencies, or in some self-directed care models, they may even hire their own caregivers — including certain family members. This flexibility allows for better continuity, trust, and control over care delivery.

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It’s important to note that services are tailored through a care plan, developed collaboratively with a case manager. This means families aren’t left to assemble care on their own — guidance and customization are built in.