Overview of Vermont’s Attendant Services Program
Vermont’s Medicaid Attendant Services Program (ASP), also called Medicaid Participant Directed Attendant Care (PDAC), provides in-home personal care assistance for state residents who are elderly or disabled and have a “permanent and severe disability”. This is defined as a physical disability that is expected to be lifelong and limits one’s ability to independently complete their Activities of Daily Living (i.e., bathing, dressing, mobility) to the extent that hands on assistance with these activities is required. Seniors with functional limitations due to the natural process of aging could potentially qualify. To assist program participants in continuing to live in their homes, the Attendant Services Program provides them with assistance with bathing, dressing, toileting, mobility, meal preparation, eating, light housecleaning, and shopping for essentials.
ASP is a consumer-directed program, which means program participants self-direct their own attendant services. They recruit, hire, train, manage, and even fire, their own “personal assistant” (caregiver). Friends and relatives, such as one’s adult child, can be hired. While spouses, civil union partners, and legal guardians usually cannot be hired, this is temporarily being allowed due to the Covid-19 public health emergency. A Fiscal Employer Services Agency, ARIS Solution, handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
Program participants can live in their own home or that of a loved one. They cannot live in an assisted living residence or an adult foster care home.
Vermont’s entire Medicaid program operates under the authority of an 1115 Demonstration Waiver called Global Commitment to Health. The Attendant Services Program operates under this Waiver and is part of Vermont’s Regular State Medicaid Plan. Attendant Services are an entitlement. This means meeting the state’s Medicaid eligibility requirements guarantees one will receive assistance; there is never a waiting list for program participation.
There is also a non-Medicaid component to the Attendant Services Program called General Funds Attendant Services. Unfortunately, General Funds spending was frozen in July of 2014 and has yet to resume.
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 Vermont’s Attendant Services Program
Assistance may be provided with the following activities.
– Ambulation / Walking
– Bathing
– Bed Mobility
– Dressing / Undressing
– Eating
– Grooming / Shaving
– Laundry
– Light Housecleaning
– Household Maintenance
– Meal Preparation
– Medication Management
– Range of Motion Exercises
– Shopping for Essentials
– Toileting
– Transferring – i.e., from a bed to a wheelchair
– Transportation
Eligibility Requirements for Vermont’s Attendant Services Program
ASP is for Vermont residents 18 years of age and older who are able to self-direct their own care. 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 Attendant 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 Attendant 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. 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 here.
Medical Criteria: Functional Need
While many long-term care Medicaid programs require an applicant need a Nursing Facility Level of Care (NFLOC), the Attendant Services Program does not. Instead, an applicant must require physical assistance with at least 2 Activities of Daily Living (ADLs). These activities include bathing / showering, grooming (i.e., shaving, brushing teeth, combing hair), dressing / undressing, toileting, bed mobility, transferring (i.e., getting in / out of bed), moving around in one’s home, range of motion exercises (i.e., twisting from side to side, reaching above your head), eating, and positioning (i.e., getting into a sitting position). While persons with Alzheimer’s Disease or a related dementia can meet the functional need, 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 Attendant 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 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 Attendant 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). Find a Medicaid Planner.
How to Apply for Vermont’s Attendant Services Program
Before You Apply
Prior to applying for ASP, 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 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, 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 Attendant Services Program, one should be enrolled in VT Medicaid or recently been denied Medicaid coverage or Choices for Care (long-term care Medicaid) coverage. Persons who do not have Medicaid coverage or have not been denied, can request a Medicaid application by calling the Economic Services Division (ESD) Benefits Service Center at 800-479-6151. Persons can also apply online here.
Persons who are already enrolled in VT Medicaid or recently been denied Medicaid coverage or Choices for Care coverage can complete and submit an Attendant Services Program Application.
More information about ASP can be found here. Persons can also contact the Adult Services Division at 802-241-0294. The Attendant Services Program is administered by the Adult Services Division (ASD) within the 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. 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.