Vermont Medicaid / Green Mountain Care Assistive Community Care Services (ACCS)

Last updated: March 08, 2024


Overview of VT’s Assistive Community Care Services

Vermont’s Assistive Community Care Services, or ACCS, is a bundle of Medicaid-funded services for seniors and adults with disabilities who live in in Licensed Level III Residential Care Homes and Assisted Living Residences. Intended to prevent and delay nursing home admissions, Assistive Community Care Services help program participants who are at risk of nursing home admission to live independently. This includes providing assistance with Activities of Daily Living (i.e., dressing / undressing, bathing, grooming, eating, toileting, transferring) medication administration, and routine nursing tasks.

 Vermont Medicaid’s Attendant Services Program (ASP) also provides in-home personal care assistance, but outside of Residential Care Homes and Assisted Living Residences. Homemaker services, such as light housecleaning, laundry, shopping for essentials, and meal preparation, may also be provided via ASP.

While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver, this is not an option via ACCS. Program participants can, however, choose which Residential Care Home or Assisted Living Residence to reside in from a list of participating homes.

Vermont’s Assistive Community Care Services are available through VT’s Regular State Plan Medicaid. ACCS are an entitlement; meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance. In other words, there is never a waiting list. However, if there are no available beds available within a Licensed Level III Residential Care Home or Assisted Living Residence, one will have to wait until one becomes available.

 Medicaid Waivers vs. State Plan Medicaid
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid Plan, HCBS through Medicaid State Plans are an entitlement. This means meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they are filled, a waitlist for benefits forms. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.


Benefits of the Elderly and Disabled Waiver

In addition to case management, ACCS may include the following.

– Assistive Therapy (24/7 on-site) – to assist in improving cognitive skills or modifying behavior
– Health Monitoring
– Medication Assistance / Monitoring / Administration
– Nursing Assessment – i.e., evaluation and monitoring of one’s health conditions
– Personal Care Assistance – i.e., assistance with bathing, dressing, grooming, mobility, and eating
– Restorative Nursing – to sustain and maintain functioning
– Routine Nursing Tasks

Program participants may also receive assistance with housekeeping, laundry, and meal preparation. While Medicaid will cover the cost of Assistive Community Care Services, Medicaid will not pay the cost of room and board.


Eligibility Requirements for VT’s Assistive Community Care Services

ACCS are intended for VT residents who are aged (65+ years old), or 18+ years old and disabled, who live in an approved residence (Licensed Level III Residential Care Home or an Assisted Living Residence). Program participants must also be eligible for Vermont’s Community Medicaid program. Relevant eligibility criteria follows.

 The American Council on Aging now offers a quick and easy Medicaid Eligibility Test for VT seniors


Financial Criteria: Income, Assets & Home Ownership

In 2024, the income limit (also called a Protected Income Level) 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.

 Many home and community based services Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets. VT’s Assistive Community Care Services does not. However, the state’s Choices for Care Program, which offers a variety of long-term services and supports, allows a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse, as well as a Community Spouse Resource Allowance.

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 home and community based services via a Medicaid Waiver, it does not apply to Assistive Community Care Services.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Medicaid Spend Down Calculator.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that VT Medicaid will take it. While many long-term care Medicaid programs have a home equity interest limit for home exemption, this does not apply to applicants of Assistive Community Care Services. However, if an applicant does not live in their home nor has a spouse, minor child, or permanently disabled or blind child (of any age) living in their home, the applicant must have Intent to Return home in order for it to remain exempt from Medicaid’s asset limit. For ACCS this is especially relevant if a beneficiary is unmarried and lives in residential care. More on when Medicaid can and cannot take the home.


Medical Criteria: Functional Need

While many Medicaid long-term care programs require an applicant to have a Nursing Facility Level of Care (NFLOC) need, this is not required for Assistive Community Care Services. The applicant, however, must require assistance with their Activities of Daily Living (ADL). ADLs include bathing, dressing, eating, transferring, mobility, and toileting. While persons with Alzheimer’s disease or a related dementia might meet the functional need for care, a diagnosis of dementia in and of itself does not mean one will do so.

 Learn more about long-term care Medicaid in Vermont.


Qualifying When Over the Limits

Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid in Vermont. 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, may still become income-eligible via VT’s “Spenddown” Program. Also called a Medically Needy Pathway to eligibility, persons are able to spend their “excess” income on medical expenses in order to meet the Medically Needy Income Limit, which is the same as the Protected Income Level above. ACCS program participants can also pay privately for ACCS services in order to meet their “spenddown”, which is similar to a deductible, and is calculated for a 6-month period. Once one’s “deductible” has been met for the period, Vermont Medicaid will pay for Assistive Community Care Services for the remainder of that period.

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 (not counted) from Medicaid’s asset limit. The includes making home reparations and modifications, purchasing home furnishings, and even taking a vacation. 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 for Assistive Community Care Services, it does apply to Nursing Home Medicaid and the Choices for Care long-term 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). Find a Medicaid Planner.


How to Apply for VT’s Assistive Community Care Services

Before You Apply

Prior to submitting an application for Assistive Community Care Services, applicants need to ensure they meet VT Medicaid 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 free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid Eligibility Test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, prior 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 Vermont Assistive Community Care Services, one should find a Licensed Level III Residential Care Home or Assisted Living Residence that has an available bed, can provide the assistance that is required, and accepts Medicaid’s ACCS payments.

Persons who are not already enrolled in Medicaid, must apply. This can be done by calling DHVA (Department of Vermont Health Access) at 855-899-9600, filling out and submitting a paper application (Form 205ALLMED), or applying online.

Once enrolled in Medicaid, one should fill out a Verification of Eligibility for ACCS form with the selected Licensed Level III Residential Care Home or Assisted Living Residence.

Persons who are not on SSI should apply for SSI in a Level III Residential Care Home / Assisted Living Residence. The Social Security Administration, through which persons apply for SSI, can be reached at 800-772-1213. One can also find their local office here. Receiving SSI can help to pay for room and board.

Learn more about Assistive Community Care Services here. Persons can also call the Senior HelpLine at 800-642-1119 for more information or for application assistance.

Assistive Community Care Services are administered by the Department of Disabilities, Aging and Independent Living, Adult Services Division. Financial eligibility is determined by the Department of Children and Families, Economic Services Division. Both of these departments are within the State of Vermont Agency of Human Services. Assistive Community Care Facilities must be licensed by the Department of Aging and Disabilities, Division of Licensing and Protection as a Level III Residential Care Home and enrolled as a Medicaid provider.


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. 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 longer. Furthermore, if there are no available beds in a participating Residential Care Home or Assisted Living Residence, one will have to wait until a bed becomes available.

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