Medicaid Long-Term Care Guide in Vermont
Long-term care eligibility, benefits, and how to apply through the Department of Vermont Health Access (DHVA).
What makes Vermont Medicaid different
Vermont Medicaid, called Green Mountain Care, operates under the Global Community to Health Waiver (1115(a) Medicaid Waiver). The state's long-term care program is called Choices for Care, which offers services in nursing homes, assisted living, adult foster care, and at home. Vermont has a two-tier waiver system (High/Highest Needs and Moderate Needs groups) with different eligibility criteria, and Regular Medicaid income limits vary by county (Chittenden vs. outside Chittenden). Vermont expanded Medicaid under the Affordable Care Act.
Administered by the Department of Vermont Health Access (DHVA).
Program Types
Institutional / Nursing Home Medicaid
An entitlement program providing care in Medicaid-certified nursing home facilities
Level of care: Nursing Home Level of Care (NHLOC)
Medicaid Waivers / HCBS (Choices for Care)
Home and Community Based Services with limited participant slots and potential waiting lists (includes High/Highest Needs and Moderate Needs groups)
Level of care: Nursing Home Level of Care (NHLOC) for High/Highest Needs; Help with ADLs for Moderate Needs
Regular Medicaid / Medicaid for the Aged, Blind and Disabled (MABD)
Medicaid for the Aged, Blind and Disabled with some long-term care benefits like personal care assistance
Level of care: Help with ADLs (not NHLOC)
2026 Vermont Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid
Medicaid Waivers / HCBS (Choices for Care)
Regular Medicaid / MABD (outside Chittenden County)¶
Regular Medicaid / MABD (in Chittenden County)¶
*All of a beneficiary's monthly income, with the exception of $79.93/month for a Personal Needs Allowance, Medicare premiums, and potentially a Needs Allowance for a non-applicant spouse, must go towards nursing home costs (Patient Liability).
†A beneficiary may not be able to keep monthly income up to this level; they may have to contribute to care costs.
‡Moderate Needs Group has 'adjusted income' limit. Adjusted income = (countable assets above $10,000 ÷ 12) + monthly income. Nursing Facility Level of Care not required for Moderate Needs.
§For a single applicant who owns and lives in their own home, the asset limit is $5,000.
¶SSI eligibility pathway: Persons eligible for SSI are automatically approved for Regular Medicaid, including long-term services if functional criteria are met.
Explore Vermont Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to Vermont.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — Vermont
How the main LTC programs available in Vermont compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $16–19/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in Vermont | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
Vermont Medicaid programs
Global Commitment Waiver
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in Vermont
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in VermontHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: AHS · dvha.vermont.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in Vermont
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in Vermont. The process typically takes 45–90 days from application to first paycheck.
Apply in Vermont: AHS · dvha.vermont.gov
Medicaid Eligibility Screener — Vermont
Answer 7 quick questions — we'll check the financial and care requirements for Vermont and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income counts: employment wages, alimony, pensions, Social Security (including SSDI), IRA withdrawals, and stock dividends
- Nationally, Holocaust restitution payments are NOT counted
- Vermont: VA Aid & Attendance and Housebound Pensions (above Basic VA Pension) do NOT count as income
- Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
- Married couples (Regular Medicaid): Both spouses' income is counted toward eligibility limit
- Geographic variation: Regular Medicaid income limits differ between Chittenden County ($1,483/mo) and outside Chittenden ($1,375/mo)
- Choices for Care has two tiers: High/Highest Needs ($2,982/mo) and Moderate Needs ($2,996.04/mo adjusted income)
- Countable assets: cash, stocks, bonds, cryptocurrency, investments, bank accounts, and non-residential real estate
- Exempt assets: primary home, personal belongings, household furnishings, one automobile
- Burial funds: Irrevocable burial trusts up to $10,000 are exempt
- IRAs/401Ks: Exempt if in 'payout status' (Required Minimum Distribution being withdrawn)
- Special waiver rule: Single applicants who own and live in their own home have $5,000 asset limit (instead of $2,000)
- Married couples: All assets considered jointly owned regardless of which spouse applies
- Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
- Home equity interest limit: $713,000 (2026)
- If above family members don't live in home, applicant must have 'Intent to Return'
- Regular Medicaid: No home equity interest limit applies
- Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
- Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program—state may seek reimbursement from deceased's estate
- Vermont has a 60-month (5-year) Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
- Medicaid reviews all asset transfers during the 60 months immediately before application date
- Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
- Transfers by non-applicant spouses are also reviewed and can trigger penalties
- U.S. Federal Gift Tax Rule (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
- Regular Medicaid: No Look-Back Period applies
- Keep documentation of all asset transfers and expenditures to prove compliance
- MMMNA: $2,707/mo · CSRA: $162,660 · CSRA Min: N/A
- Minimum Monthly Maintenance Needs Allowance (MMMNA): Non-applicant spouse can receive income from applicant spouse up to $2,707/month (eff. 1/1/26 – 12/31/26)
- If non-applicant's housing and utility costs exceed 'shelter standard' of $813/month, Spousal Income Allowance can be increased
- Maximum MMMNA: Spousal Income Allowance cannot push non-applicant's total income over $4,066.50/month
- Community Spouse Resource Allowance (CSRA): Non-applicant spouse can retain up to $162,660 of couple's assets (2026)
- Vermont does not specify a CSRA minimum—the standard is up to $162,660
- Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid
- Medically Needy Pathway / Spend-Down Program: For applicants over income limit with high medical expenses—MNIL is $1,375/mo (outside Chittenden County) or $1,483/mo (in Chittenden County) for individuals and couples (eff. 1/1/26–12/31/26)
- Spend-down amount (deductible) is the difference between monthly income and MNIL—can be met by paying health insurance deductibles/premiums, past due medical bills, over-the-counter medications, and uncovered medical items
- Once spend-down is met, one is income-eligible for the remainder of the month
- Medically needy asset limits: $2,000 for individuals, $3,000 for couples
- Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications for aging in place (wheelchair ramps, stair lifts)
- Additional spend-down options: Prepay funeral/burial expenses, pay off debts
- CRITICAL: Never gift assets or sell below fair market value within 60-month Look-Back Period—always keep receipts
- Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery
Vermont Medicaid Programs
Choices for Care (CFC)
Waiver program helping nursing home qualified seniors avoid nursing homes and live in assisted living, adult foster care, or at home. Includes High/Highest Needs Group (NHLOC required) and Moderate Needs Group (lesser care requirements, Medicaid eligibility not required). Benefits include adult day care, homemaker services, home modifications, personal care services, and companionship.
Attendant Services Program (ASP) / Medicaid Participant Directed Attendant Care (PDAC)
Medicaid entitlement program providing a 'personal assistant' to help with Activities of Daily Living (bathing, dressing, eating). Select relatives, including adult children, can be hired to provide care.
Adult Day Services Program / Adult Day Health Rehabilitation Services
Entitlement program providing daytime supervision, meals, medication management, and transportation to/from day care center. Enables working families to hold jobs while caring for loved ones at home.
Assistive Community Care Services (ACCS)
Assisted living-like care program for persons who cannot function independently at home but don't require nursing home level care. Benefits include health monitoring, routine nursing tasks, and personal care assistance.
Money Follows the Person
Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.
How to Apply
- Regular Medicaid (MABD): Apply online, call 855-899-9600 to request paper application (205ALLMED), or print Application for Health Coverage and Help Paying Costs
- Choices for Care: Complete Application for Long-Term Care Medicaid (Form 202LTC), or call 833-840-0061 or 802-476-0100 to request mailed application
- Mail completed applications to: Vermont Health Connect, Application and Document Processing Center, 280 State Drive, Waterbury, VT, 05671-8100
- Contact local Area Agency on Aging for assistance
- Vermont offers 'Assisters' available to answer questions and help apply for Green Mountain Care
Application process varies by program. Find an Assister for personalized help. Ensure all eligibility requirements are met before applying—consider Medicaid Planning if over income/asset limits or uncertain about eligibility.
More Vermont Long-Term Care Resources
Take the Next Step for Vermont Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- Department of Vermont Health Access (DHVA) — Vermont Medicaid — Official site