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.
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.
|2021 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||$2,382 / month*||$2,000||Nursing Home||$4,764 / month*||$3,000||Nursing Home||$2,382 / month for applicant*||$2,000 for applicant & $130,380 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,382 / month||$2,000||Nursing Home||$4,764 / month||$3,000||Nursing Home||$2,382 / month for applicant||$2,000 for applicant & $130,380 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled (outside Chittenden County)||$1,100 / month||$2,000||None||$1,100 / month||$3,000||None||$1,100 / month||$3,000||None|
|Regular Medicaid / Aged Blind and Disabled (in Chittenden County)||$1,191 / month||$2,000||None||$1,191 / month||$3,000||None||$1,191 / month||$3,000||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. An exception exists for Covid-19 stimulus checks, as Medicaid does not count them as income, and therefore, they do not impact Medicaid eligibility.
When only one spouse of a married couple is applying for institutional Medicaid or home and community based services via a waiver, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. That said, income is calculated differently for married couples with one spouse applying for Medicaid for the Aged Blind or Disabled. In this case, the income of both the applicant spouse and the non-applicant spouse is used to determine eligibility. (Click here to learn more about Medicaid and income).
There is a Minimum Monthly Maintenance Needs Allowance (MMMNA), for non-applicant spouses of nursing home Medicaid applicants or HCBS Medicaid waiver applicants. This is the minimum amount of monthly income to which the non-applicant spouse is entitled. Effective 1/1/21, this figure is $2,178 / month. There is also a maximum monthly maintenance needs allowance, which a non-applicant spouse may be entitled to if his / her shelter and utility costs are high. Also effective 1/1/21, this figure is $3,259.50 / month. This spousal impoverishment 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. This spousal income allowance does not apply to non-applicant spouses of regular Medicaid applicants.
*Although the income limit for nursing home Medicaid is $2,382 / month (in 2021), a program participant cannot retain income up to this level. Instead, all of one’s income, with the exception of a personal needs allowance of $72.66 / month, and if applicable, a monthly maintenance needs allowance for a non-applicant spouse, must go towards the cost of nursing home care.
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 lives in the home, or has “intent” to live there, and his /her home equity interest is under $603,000 (in 2021). (Equity interest is the amount of the home’s value owned by the applicant). When a non-applicant spouse lives in the home, it is exempt regardless of the applicant spouse’s circumstances.
In 2021, for married couples with one spouse applying for institutional Medicaid or a Medicaid waiver, the community spouse (the non-applicant spouse) can retain up to a maximum of $130,380 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is called the Community Spouse Resource Allowance (CSRA). To be clear, this spousal resource allowance does not apply to married couples with one spouse applying for regular Medicaid.
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 2021, 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 60 months that immediately precedes 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 violates the look-back period, a penalty 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, 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 reduce one’s extra income in order to qualify for Medicaid.
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 reducing excess countable assets. However, one can “spend down” assets by spending excess assets on non-countable ones, such as home modifications to allow aging in place (i.e., 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, as well as to protect their home from Medicaid’s estate recovery program. 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 (CFC) – this waiver 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 Choices for Care Moderate Needs Group also receives benefits such as adult day care and financial assistance for home modifications to increase one’s ability to function independently.
Global Commitment (GC) 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 Program (ASP) – this is a Medicaid entitlement program that provides for a personal care attendant to help participants manage their activities of daily living. Select relatives are able to be hired to provide care.
Adult Day Care – an entitlement program that helps with daytime supervision, meals, medication management, and transportation to / from the day care center. This program 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 (ACCS) – 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.
How to Apply for Vermont Medicaid
In order to apply for Medicaid for the Aged, Blind or Disabled (MABD), Vermont residents can call 855-899-9600 to request a paper application (205ALLMED) be mailed to their home or they can print the application from this webpage (the application is midway down the page). Completed applications can be mailed to Green Mountain Care, Application and Document Processing Center, 208 State Drive, Waterbury, VT, 05671-1500.
Please note that the application process is different for Choices for Care. To apply for this long-term care program, one needs to complete application 202LTC, which can be found on this webpage, halfway down the page. Alternatively, seniors can call 800-479-6151 to request the application be mailed to their home. The completed application can be mailed to the same address mentioned above for MABD. Persons might find their local Area Agency on Aging office helpful with the application process. Applicants can also call Green Mountain Care at 800-250-8427.
Prior to submitting an application for Medicaid benefits in Vermont, senior applicants should be positive that they meet all eligibility requirements (as discussed above) for the program in which they are applying. Being over the income and / or asset limit(s), or being uncertain if eligibility criteria are met, can result in a denial of benefits. Persons in these situations should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. For additional information about applying for long-term care Medicaid, click here.