Vermont Medicaid for seniors and long-term care
Last verified: June 2026
Long-term care Medicaid rules are complex
Vermont Choices for Care waiver is the primary long-term care Medicaid pathway — apply through DVHA
Choices for Care: Vermont's long-term care Medicaid waiver
Vermont's long-term care Medicaid operates primarily through the Choices for Care 1915(c) waiver. Unlike many states where HCBS waivers are a secondary pathway after nursing facility coverage, Vermont's program is explicitly structured around choice — eligible individuals decide between nursing facility care and home and community-based care with the same Medicaid funding.
MACPAC (Medicaid and CHIP Payment and Access Commission) has cited Vermont's Choices for Care program as an example of a nationally flexible HCBS approach that successfully redirects long-term care spending toward community-based settings. Vermont maintains a higher proportion of HCBS spending relative to institutional care than most states.
- Nursing facility (nursing home) coverage
- Enhanced residential care — support services in assisted living settings
- Home-based care — personal care, adult day services, home health
- Homemaker and chore services
- Respite care for family caregivers
- Adult day programs
- Case management and care coordination
- Home modifications and adaptive equipment
- Hospice care
Source: DVHA long-term care page (dvha.vermont.gov/members/long-term-care); MACPAC analysis of state HCBS program structures.
Medicaid for the Aged, Blind and Disabled (MABD)
Seniors and people with disabilities who need Medicaid outside of a long-term care setting apply through the MABD pathway. MABD is separate from the standard MAGI Medicaid process — apply directly through DVHA at dvha.vermont.gov/members/medicaid/medicaid-aged-blind-or-disabled-mabd.
Vermont also administers Medicare Savings Programs that help low-income Medicare beneficiaries with Part B premiums and cost-sharing. These are applied for separately through DVHA at dvha.vermont.gov/members/medicare-savings-program.
Vermont Medicaid estate recovery
Vermont operates an estate recovery program for Medicaid members who received long-term care services at age 55 or older. DVHA may seek reimbursement from the member's estate after death. The home is exempt while a surviving spouse, minor child, or disabled child resides there. Vermont enforces the federal 60-month asset lookback period. Consult a Vermont elder law attorney before transferring assets if a family member may need Medicaid LTC in the future.
Medicaid as the primary payer for long-term care
Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.
Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Vermont's share of that population is administered through Vermont Medicaid (Green Mountain Care). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.
Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.
Nursing facility coverage
Vermont Medicaid (Green Mountain Care) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.
Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.
If income exceeds the institutional Medicaid limit, Vermont may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Vermont uses this approach with Vermont Medicaid (Green Mountain Care).
Home and community-based services (HCBS)
HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Vermont Medicaid (Green Mountain Care) differs from what's available in neighboring states.
Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.
Contact Vermont Medicaid (Green Mountain Care) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.
Asset limits for long-term care Medicaid
Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.
Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.
Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Vermont Medicaid (Green Mountain Care) or a Medicaid planning attorney before transferring assets.
Spousal protections
When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.
The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Vermont's current CSRA is set by Vermont Medicaid (Green Mountain Care) and published on their website.
The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).
Estate recovery applies to long-term care recipients age 55 and older
What long-term care Medicaid typically covers
- Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
- Physical, occupational, and speech therapy provided in a nursing home
- Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
- Home health aide visits for those receiving care at home
- Adult day health care programs
- Respite care to give family caregivers temporary relief
- Durable medical equipment prescribed by a physician
- Transportation to and from medical appointments