Waiver Description
Vermont designed Choices for Care (CFC), the state’s Medicaid long-term care program, to help older state residents who require moderate to high levels of care assistance. The program helps them remain living at home or in their communities, such as assisted living residences or adult family care homes. However, via CFC, one can also choose to reside in a nursing home facility.
Choices for Care offers a consumer-directed option called Flexible Choices for participants who reside in a home-based setting. This option provides cash to the elderly in place of care services, which they then use to pay for their own care services. Family members, with the exception of legal guardians and spouses, can be hired as care providers.
Under Choices for Care, services are not limited to strictly personal care. Rather, a wide variety of services are possible, encompassing any assistance that helps persons maintain their independence or helps caregivers provide assistance. For example, home modifications, like wheelchair ramps and walk in-tubs, can be covered. CFC also includes an Enhanced Residential Care (ERC) option. ERC provides services in assisted living residences and certain residential care facilities and pays for fall monitoring and emergency response services.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
Eligibility Guidelines
There are several areas of eligibility for the Choices for Care Waiver for Vermont residents.
General Requirements
- Age: Applicants must be at least 18 years of age. Individuals 65 and older are subject to less rigid functional criteria.
- Level of Need: Persons 18-64 must be physically disabled. Those 65 and older must require a nursing home level of care, but a disability is not required.
Financial Requirements
Income Limits
An applicant’s income must be less than 300% of the Federal Benefit Rate (FBR). In 2024, this equals $2,829 a month. For couples when only one spouse is applying, the non-applicant’s income is not considered.
Further, the applicant spouse may be able to transfer part of his or her income to the non-applicant spouse as a spousal allowance to ensure the non-applicant spouse has sufficient income to support oneself, while also effectively lowering the applicant spouse’s income. Currently the maximum spousal allowance in 2024 is $3,853.50 a month. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.
When both spouses in a couple are applying for the waiver, each spouse is permitted up to $2,829 a month in income.
Asset Limits
Single applicants are permitted up to $2,000 in countable assets in 2024. The asset limit is increased to $5,000 if an applicant lives in his or her own home. When both spouses of a couple are applying, the asset limit is $4,000. When only one spouse is receiving Medicaid, the non-applicant spouse can have up to $154,140 in assets.
Please note: The last five years of asset transfers will be scrutinized to make sure no under market value transfers were made in an attempt to lower one’s assets to the Medicaid eligible level. Should such transfers exist, the applicant may still be accepted, but might be required to pay the value of transfer towards their care costs. Or the applicant will be penalized with a period of Medicaid ineligibility. More information about Medicaid’s Look-Back Period can be found here.
Over the Financial Limits?
Persons over these income and / or asset limit(s), or those with some uncertainty regarding their asset transfer history, should consult with a Medicaid planner in advance of application. These financial and legal experts can help them qualify for Medicaid in Vermont. Read more.
Benefits and Services
While CFC does allow a program participant to choose to live in a nursing home facility, one of Choices for Care’s goals is to prevent nursing home placement. Therefore, the services provided under this program are selected to increase the beneficiary’s ability to function independent of that environment. Each individual is approved for a specific suite of care and support services. These can include the following list:
- Adult Day Care
- Assisted Living / Enhanced Residential Care Services (room and board are not covered)
- Assistive Technology and Devices
- Case Management
- Companion Services
- Home Modifications
- Personal Care (assistance with Activities of Daily Living and Instrumental Activities of Daily Living)
- Personal Emergency Response Systems
- Respite Care
How to Apply / Learn More
The Choices for Care program operates within the Vermont Global Commitment to Health Waiver. One can find limited additional information about CFC on Vermont’s Department of Disabilities, Aging and Independent Living (DAIL) website, and a brochure about the program can be downloaded here.
For additional information or to apply for CFC, contact the Department of Children and Family Services’ benefit hotline at 800-479-6151. One can also contact their local Area Agency on Aging (AAA) office for assistance.
