Vermont Medicaid Definition
Medicaid in Vermont is called Green Mountain Care, and Vermont’s long-term care program is referred to as Choices for Care. Medicaid is a wide-ranging, federal and state funded health care program for low-income individuals of any age. However, this page is focused on Medicaid eligibility, specifically for Vermont residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Vermont seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Vermont offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement (meeting the eligibility requirements ensures assistance will be provided) and is provided at home or adult day care. In Vermont, this program is abbreviated as MABD.
Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Vermont offers multiple pathways towards eligibility. The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Vermont Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Medicaid in Vermont. More.
|2019 Vermont Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,313 / month||$2,000||Nursing Home||$4,626 / month||$3,000||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Help w/ 2 Activities of Daily Living||$4,626 / month||$3,000||Help w/ 2 Activities of Daily Living||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help w/ 2 Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled (outside Chittenden County)||$1,066 / month||$2,000||None||$1,066 / month||$3,000||None||$1,066 / month||$2,000||None|
|Regular Medicaid / Aged Blind and Disabled (in Chittenden County)||$1,158 / month||$2,000||None||$1,158 / month||$3,000||None||$1,158 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. (Click here to learn more about Medicaid and income). There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 2018, this figure falls between $2,114 / month and $3,160.50 / month. (The first figure will increase in July 2019 and the second figure will increase in January 2020). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $585,000 (in 2019). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
Please note that there are two exceptions to the asset limits listed above in the eligibility chart. For a single applicant who is applying for Vermont’s long-term care program, Choices for Care, and owns and lives in his / her own home, the asset limit is higher. As of 2019, an individual in this situation can have up to $5,000 in assets. (If that same person is admitted to a nursing home or enhanced residential care facility, the asset limit is $2,000). The second exception is for persons applying for the Moderate Needs Group (MNG) within the Choices for Care program. The MNG program is for both Medicaid and non-Medicaid individuals and allows an applicant to retain up to $10,000 in assets.
One should be aware that Vermont has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue. More on the Look Back Rule.
Qualifying When Over the Limits
For Vermont residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In a nutshell, persons may still be eligible for Medicaid services even if they are over the income limit if they have high medical bills and meet all the other eligibility requirements. Often referred to as a Medicaid “Spend-Down” Program, the way this program works is one’s “excess income,” (one’s income over the Medicaid eligibility limit) is used to cover medical expenses. Examples of medical expenses include health insurance deductibles and premiums, past due medical bills, over-the-counter medications, and uncovered medical items. Once one has paid down his or her excess income to the Medicaid eligibility limit, Medicaid will kick in for the eligibility period. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.
Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications to allow one to age in place, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Vermont Medicaid Programs
Medicaid in Vermont (Green Mountain Care) pays for state residents to reside in a nursing home if they medically require that level of care and they qualify financially for the program. However, the state also has many different programs that help nursing home qualified individuals (and those with lesser care requirements) to live outside of nursing homes.
Choices for Care – this program helps nursing home qualified or disabled persons avoid nursing homes and live in assisted living communities, adult foster care homes or at home. A separate eligibility group called the Moderate Needs Group receives benefits such as adult day care and financial assistance for home modifications to increase one’s ability to function independently.
Global Commitment to Health Waiver – this is a Section 1115 Demonstration Waiver and is the authority that operates Vermont’s Medicaid program. The Choices for Care program, mentioned above, is administered under the Global Commitment to Health Waiver.
Attendant Services – this is a Medicaid entitlement program that provides for a personal care attendant to help participants manage their activities of daily living.
Adult Day Care – an entitlement program that helps with daytime supervision, meals, medication management and transportation. Adult day care enables working families to hold jobs while caring for a loved one at home.
High Technology Home Care – provides nursing home level care to technology-dependent persons in their homes.
Assistive Community Care Services – assisted living-like care program for persons who cannot function independently at home, but don’t require the level of care provided in a nursing home.