Long-Term Care Costs in Vermont

Vermont's long-term care costs are among the highest in the nation — nursing home care averages $14,113 per month, approximately 47% above the national average, while assisted living averages $8,597 per month, roughly 39% above the national average of $6,200. Home care averages $8,580 per month, about 29% above the national rate. Vermont Medicaid is called Green Mountain Care, administered by the Department of Vermont Health Access (DVHA). The state's long-term care program is Choices for Care, which uniquely includes both a High/Highest Needs Group and a Moderate Needs Group — the latter does not require Medicaid financial eligibility. The income limit for Nursing Home Medicaid and HCBS is $2,982 per month. Vermont uses a Medically Needy/Spenddown pathway rather than Miller Trusts for applicants over the income limit. Vermont expanded Medicaid under the ACA. This guide covers what care costs in Vermont, how to qualify for Green Mountain Care, and what options exist for veterans and family caregivers in Burlington, Montpelier, Rutland, and across the Green Mountain State.

Vermont's Aging Population: The Numbers Behind the Need

Vermont has approximately 140,000 residents aged 65 or older — roughly 21% of the state's total population, making it one of the oldest states in the nation by median age. The senior population is concentrated in Chittenden County (Burlington, South Burlington, Essex, Williston), Rutland County, Washington County (Montpelier, Barre), and Windham County (Brattleboro). Smaller senior communities exist in Bennington, St. Albans, St. Johnsbury, Newport, and Springfield.

Vermont's rural character — with a total population under 650,000 spread across the Green Mountains — creates distinct challenges for long-term care delivery. Many communities in the Northeast Kingdom, southern Vermont, and central mountain towns have limited facility options, making home and community-based services essential for keeping seniors near their families and support networks.

Unpaid Caregivers in Vermont: Scale and Impact

An estimated 80,000 unpaid family caregivers in Vermont provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving. Vermont's rural setting and aging population mean that family caregivers often take on longer and more intensive caregiving roles.

Vermont's Attendant Services Program (ASP) — also called Participant Directed Attendant Care — allows participants to hire a "personal assistant" to help manage Activities of Daily Living, and select relatives including adult children can be hired to provide care. The Choices for Care program also provides respite care, adult day services, and homemaker services to support family caregivers.

What Long-Term Care Costs in Vermont

Vermont's care costs are among the highest in the country:

• Assisted Living: $8,597 per month — approximately 39% above the national average of $6,200
• Nursing Home (semi-private room): $14,113 per month — approximately 47% above the national average of $9,581
• Home Care (home health aide): $8,580 per month — approximately 29% above the national average of $6,673

At these rates, a three-year nursing home stay in Vermont costs approximately $508,000 — nearly 50% more than the national average. Home care totals roughly $309,000 over the same period. Assisted living, at $8,597/month, represents approximately $310,000 over three years. Vermont's extremely high costs make early financial planning and Medicaid qualification strategies particularly critical. For a detailed breakdown of care costs by type and how Vermont compares to other states, visit our Vermont Care Costs page.

How to Qualify for Green Mountain Care in Vermont: Eligibility Rules for 2026

Vermont Medicaid is called Green Mountain Care, administered by the Department of Vermont Health Access (DVHA). Vermont's entire Medicaid program operates under a Global Community to Health Waiver (1115(a) Medicaid Waiver). The state's long-term care program is Choices for Care. Vermont expanded Medicaid under the Affordable Care Act. Consulting with a Vermont elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month. All of a beneficiary's monthly income, with the exception of a $79.93/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must go toward nursing home costs (Patient Liability). Asset limit of $2,000 (single) or $4,000 (married couple, both applying). When only one spouse applies, the non-applicant spouse may retain up to $162,660 in assets. This is an entitlement.
• Medicaid Waivers / HCBS (Choices for Care — High/Highest Needs): Income limit of $2,982/month. Asset limit of $2,000 (single). For a single applicant who owns and lives in their home, the asset limit is $5,000 — a unique Vermont provision. This is not an entitlement — slots are limited and waiting lists may exist.
• Choices for Care — Moderate Needs Group: Uses an "adjusted" individual income limit of $2,996.04/month (adjusted income = countable assets above $10,000 ÷ 12 + monthly income). Nursing home level of care is NOT required. One does not have to be financially eligible for Medicaid to receive Moderate Needs services.
• Regular Medicaid / Aged, Blind and Disabled (MABD): Income limit of $1,375/month (outside Chittenden County) or $1,483/month (in Chittenden County) (eff. 1/1/26 – 12/31/26); asset limit of $2,000 (single) or $3,000 (couple). SSI recipients are automatically approved for Medicaid in Vermont. This is an entitlement.

Vermont applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members and transfers by one's spouse — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax exclusion (2026) does NOT apply to Medicaid's look-back rules. There is no look-back period for Regular Medicaid. For the full Vermont Medicaid eligibility breakdown, see our Vermont Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or Choices for Care in Vermont, only the applicant spouse's income is counted. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $162,660 in countable assets.

The Minimum Monthly Maintenance Needs Allowance (MMMNA) in Vermont is $2,707 per month (eff. 1/1/26 – 12/31/26). If the non-applicant spouse's income falls below this amount, income can be transferred from the applicant spouse. A non-applicant spouse can increase their allowance if housing/utility costs exceed the shelter standard of $813/month. The Maximum MMMNA is $4,066.50. For Regular Medicaid, both spouses' income is counted and there is no MMMNA or CSRA.

Vermont Medicaid Programs: Choices for Care and Community Services

Vermont offers several Medicaid-funded long-term care programs:

• Choices for Care (CFC) — High/Highest Needs Group: Vermont's primary HCBS waiver program helping nursing home-qualified seniors avoid institutional placement. Benefits are provided in assisted living communities, adult foster care homes, or at home. Services include personal care, homemaker services, adult day care, respite care, home modifications, and medical equipment.
• Choices for Care — Moderate Needs Group: A unique program for individuals not yet at nursing home level of care. Benefits include adult day care, homemaker services, home modifications, personal care services, and companionship. One does not have to be financially eligible for Medicaid to receive these services — a significant advantage for early intervention.
• Attendant Services Program (ASP): Also called Participant Directed Attendant Care (PDAC). An entitlement program providing a "personal assistant" to help with ADLs. Select relatives, including adult children, can be hired to provide care.
• Adult Day Services Program: An entitlement program providing daytime supervision, meals, medication management, and transportation to/from adult day care centers.
• Assistive Community Care Services (ACCS): Assisted living-like care for persons who cannot function independently at home but don't require nursing home level of care. Benefits include health monitoring, routine nursing tasks, and personal care assistance.
• Money Follows the Person (MFP): Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.

Qualifying When Over the Limits: Spenddown and Asset Strategies

Vermont offers several pathways for applicants who exceed the income or asset limits. Vermont does not use Miller Trusts (Qualified Income Trusts) — instead, the state uses a Medically Needy/Spenddown pathway:

• Medically Needy Pathway (Spenddown): For applicants over the income limit. The Medically Needy Income Limit (MNIL) is $1,375/month (outside Chittenden County) or $1,483/month (in Chittenden County) (eff. 1/1/26 – 12/31/26). The "spenddown" amount is the difference between monthly income and the MNIL. Applicants can meet their spenddown by paying health insurance premiums, past-due medical bills, over-the-counter medications, and uncovered medical items. Once met, the applicant is income-eligible for the remainder of the month.
• Asset Spend-Down: Reduce countable assets by spending on exempt items — home modifications (wheelchair ramps, stair lifts, walk-in showers), prepaying funeral and burial expenses (irrevocable burial trusts up to $10,000 are exempt in Vermont — one of the highest exemptions in the nation), and paying off debt. Assets cannot be gifted or sold under fair market value within the 5-year Look-Back Period — keep documentation.
• Medicaid Planning: Work with a Certified Medicaid Planner or Vermont elder law attorney to employ legal strategies for eligibility and protect your home from Estate Recovery.

Asset Rules: What Counts and What Doesn't

Countable assets in Vermont include cash, stocks, bonds, cryptocurrency, investments, bank accounts (money market, savings, checking), and real estate in which one does not reside. Non-countable (exempt) assets include personal belongings, household furnishings, one automobile, irrevocable burial trusts up to $10,000, life insurance with a combined face value up to $1,500, and generally one's primary home (subject to the home equity limit). IRAs and 401(k)s are exempt if in "payout status" — meaning Required Minimum Distributions are being withdrawn.

All assets of a married couple are considered jointly owned. The CSRA allows the non-applicant spouse to retain up to $162,660 of the couple's assets. There is no CSRA for Regular Medicaid. Nationally, Holocaust restitution payments are not counted as income. In Vermont, VA Aid & Attendance and Housebound Pensions (above Basic VA Pension) do NOT count as income for Medicaid eligibility purposes.

Veterans and Long-Term Care in Vermont

Vermont has approximately 38,000 veterans. The White River Junction VA Medical Center serves as the primary VA healthcare facility for the state, with community-based outpatient clinics in Burlington, Rutland, Bennington, and Brattleboro. Vermont also operates the Vermont Veterans' Home in Bennington, which provides skilled nursing care to eligible veterans and their spouses.

The VA Aid & Attendance benefit provides additional monthly income to veterans and surviving spouses who require assistance with activities of daily living. In Vermont, VA Aid & Attendance and Housebound Pensions do NOT count as income for Medicaid eligibility purposes, allowing veterans to potentially qualify for both benefits simultaneously. Given Vermont's extremely high care costs, combining VA benefits with Medicaid can be a critical planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in Vermont

Understanding how to pay for nursing home care in Vermont — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $14,113/month (47% above the national average), a 60-month look-back period, and a $2,982/month income limit, advance planning is essential. Vermont long-term care insurance policies, personal savings, veterans benefits, and Green Mountain Care each play a role. Key steps include:

• Understanding your current financial position relative to Vermont Medicaid eligibility thresholds
• Knowing that Vermont's nursing home costs ($14,113/month) are among the highest in the nation — a three-year stay costs approximately $508,000
• Exploring the Choices for Care Moderate Needs Group, which does not require Medicaid financial eligibility — an early intervention pathway unique to Vermont
• Taking advantage of the Attendant Services Program to hire family members, including adult children, as paid caregivers
• Noting Vermont's $10,000 irrevocable burial trust exemption — one of the highest in the nation
• Understanding that IRAs/401(k)s are exempt when in payout status — unlike states that count retirement accounts as assets
• Recognizing that Vermont has different Regular Medicaid income limits for Chittenden County ($1,483/month) vs. the rest of the state ($1,375/month)
• Researching Vermont long-term care insurance options while still healthy enough to qualify
• Exploring veterans benefits if the care recipient or spouse served during wartime
• Consulting with a Vermont elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in Vermont

Vermont operates a Medicaid Estate Recovery Program (MERP), which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Green Mountain Care. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $752,000 (in 2026). Home equity is the value of the home after subtracting outstanding debt. If neither the applicant nor qualifying family live in the home, the applicant must demonstrate Intent to Return. There is no home equity limit for Regular Medicaid. The home is NOT exempt from estate recovery — families should consult a Vermont elder law attorney to explore legal protections including irrevocable trusts, the caretaker child exemption, and the sibling equity interest exemption.

Regional Cost Variations Across Vermont

Long-term care costs in Vermont vary by region, though the overall market is expensive statewide. Chittenden County (Burlington, South Burlington, Essex, Williston) has the highest costs in the state — driven by being the only metropolitan area and having the highest cost of living. Vermont's Medicaid program recognizes this by providing a higher Regular Medicaid income limit ($1,483/month) for Chittenden County residents. Rutland and Windham County (Brattleboro) represent mid-range pricing. The Northeast Kingdom (Caledonia, Essex, and Orleans Counties — including St. Johnsbury and Newport) generally has lower costs but the fewest available facilities and providers in the state. Central Vermont (Washington County — Montpelier, Barre) and southern Vermont (Bennington, Springfield) offer moderate costs with limited provider options.

Application Timeline and Process

Vermont Medicaid applications can be submitted through several channels depending on the program:

• Regular Medicaid (MABD): Apply online at my.vermont.gov, call 855-899-9600 to request a paper application, or print the application from the Vermont Health Connect website
• Choices for Care: Complete the Application for Long-Term Care Medicaid (Form 202LTC), available on the DVHA website. Call 833-840-0061 or 802-476-0100 for assistance
• Mail completed applications to: Vermont Health Connect, Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-8100
• Contact your local Area Agency on Aging or find a Vermont Health Connect "Assister" for help with the application process

It is vital that applicants are confident they meet all eligibility criteria before submitting a Medicaid application. For seniors who don't meet the requirements, Medicaid Planning is recommended. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including Vermont's Choices for Care program — are likely targets for cuts. Vermont expanded Medicaid under the ACA, and the initial cuts on January 1, 2026, eliminated a 2-year temporary financial incentive for expansion states. This law is still facing legal challenges. Families relying on or planning to use Choices for Care should monitor developments and consider applying early.

Last updated: September 2026. Data sources: Department of Vermont Health Access (DVHA), CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.