Overview of Vermont Adult Day Health Rehabilitation Services Program
Vermont’s Adult Day Health Rehabilitation Services (DHRS) Program provides adult day services, or in other words, adult day care, for seniors and adults 18+ years old who are physically or cognitively impaired. Intended to prevent and delay the need for institutionalization (nursing home admission), program beneficiaries, including those with Alzheimer’s disease or a related dementia, receive daytime care and supervision in community-based adult day centers. Assistance may include personal care services, health assessments, health monitoring, nursing services, and meals. For family caregivers, adult day services can be extremely instrumental in providing respite care.
There are approximately 11 Medicaid-enrolled adult day centers throughout Vermont. While a program participant can generally select which center they would like to attend, a center may prioritize residents in their area.
Program participants can live in their own home, that of a loved one, or an adult family care home. They cannot live in an assisted living residence.
Adult Day Health Rehabilitation Services are an entitlement. The state does not put a cap on the number of program participants. However, if there is not an available spot at an adult day center, a waiting list forms.
Vermont’s entire Medicaid program operates under the authority of an 1115 Demonstration Waiver called Global Commitment to Health. The Adult DHRS Program operates under this waiver and is part of Vermont’s Regular State Medicaid Plan.
Benefits of the Adult Day Health Rehabilitation Services Program
While the following services and supports are available, the exact benefits one receives is based on their care plan.
– Education for Families / Caregivers
– Health Assessments / Monitoring
– Meals
– Medication Management
– Personal Care Services
– Professional Nursing Services
– Respite Care
– Therapies (physical, speech, occupational)
– Therapeutic Activities
– Transportation to / from the Adult Day Center
Eligibility Requirements for Adult Day Health Rehabilitation Services Program
DHRS is for Vermont residents 18 years of age and older. Additional eligibility criteria follows.
Financial Criteria: Income, Assets & Home Ownership
Income
In 2024, the income limit is $1,300 / month for persons who live outside of Chittenden County. For persons who live inside of Chittenden County, the income limit is $1,408 / month. For married applicants, the income limits remain the same, regardless of if one spouse or both spouses are applicants.
Assets
In 2024, the asset limit is $2,000 for a single applicant. For married couples, it is $3,000, regardless of whether one spouse or both are applicants.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or long-term home and community based services via the Choices for Care Program, it does not apply to Vermont’s Adult Day Health Rehabilitation Services Program.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Vermont Medicaid will take it. Applicants for the Adult Day Health Rehabilitation Services Program need not worry. As long as they live in their home, the home is exempt (non-countable). However, if they live in a relative’s home, they must have Intent to Return home in order for it to remain exempt. It is important to note that other VT Medicaid programs, such as the Choices for Care Program and Nursing Home Medicaid, have more rules surrounding home exemption. Learn more about when Medicaid can and cannot take the home.
Medical Criteria: Functional Need
While many long-term care Medicaid programs require an applicant need a Nursing Facility Level of Care (NFLOC), VT’s Adult Day Health Rehabilitation Services Program does not. Instead, an applicant must require assistance with at least two of the following five areas weekly (at a minimum) and will receive assistance with one of the areas on any given day at the Adult Day Center.
1) Personal Care – assistance with Activities of Daily Living (i.e., bathing, personal hygiene, dressing, toiletry, mobility, eating)
2) Nursing Services – a medical need that requires monitoring (at least monthly)
3) Special Therapies – i.e., occupational therapy, physical therapy, speech therapy
4) Social Work – i.e., depression, grief, isolation, anxiety
5) Nutrition Counseling / Services – being monitored by a registered dietician
The Vermont Independent Living Assessment (ILA) is used to help determine if one meets the criteria. While persons with Alzheimer’s Disease or a related dementia can qualify, a diagnosis in and of itself does not mean one will automatically qualify.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for VT Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Persons who have income over the limit, but have high medical bills, can become income-eligible via Vermont’s Spend-Down Program. This program permits applicants to spend their “excess” income on medical expenses in order to meet the medically needy income limit. The amount that must be paid each month can be thought of as a deductible. Once one’s “deductible” has been met for the month, the Adult Day Health Rehabilitation Services Program will pay for services and supports. More about the Medically Needy Pathway to eligibility.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons may also “spend down” countable assets on ones that are exempt (non-countable). Examples include making home reparations and modifications, purchasing home furnishings, and even taking a vacation. Persons might also purchase a Medicaid-Compliant Annuity, which converts a lump sum of cash into a monthly income stream. There are many other Medicaid planning strategies available when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Vermont to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, while Medicaid’s 60-month Look-Back Rule does not apply to the Vermont Adult Day Health Rehabilitation Services Program, it does apply to Nursing Home Medicaid and the Choices for Care Program. As more extensive Medicaid-funded care might be required in the future, it is vital that one not violate the Look-Back Rule. Medicaid planning strategies should ideally only be implemented with careful planning and well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s).
How to Apply for Vermont Adult Day Health Rehabilitation Services Program
Before You Apply
Prior to applying for Vermont Medicaid, and hence the Adult Day Health Rehabilitation Services Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Application Process
To apply for the Adult Day Health Rehabilitation Services Program, one should be enrolled in VT Medicaid. Persons can apply for Medicaid online, by calling the Department of Vermont Health Access (DHVA) at 855-899-9600, or by completing an Application for Health Coverage and Help Paying Costs.
Persons who are enrolled in VT Medicaid can contact an Adult Day Center to initiate enrolling in Adult Day Health Rehabilitation Services.
More on Adult Day Services. Persons can also contact the Department of Disabilities, Aging and Independent Living at 802-241-2401 for additional information.
The Adult Day Health Rehabilitation Services Program is administered by the Adult Services Division (ASD) within Vermont’s Department of Disabilities, Aging, and Independent Living (DAIL).
Approval Process & Timing
The Vermont Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.