Vermont Medicaid (Green Mountain Care) Choices for Care (CFC) Program: Moderate Needs Group

Last updated: March 08, 2024

 

Overview of Vermont Choices for Care: Moderate Needs Group

Vermont’s Choices for Care Program, or CFC Program, provides Medicaid-funded long-term care for seniors and adults with physical disabilities. The CFC Program is broken into two groups based on care needs: the Moderate Needs Group and the High / Highest Needs Group. This Choices for Care page is focused on the Moderate Needs Group.

The Moderate Needs Group is unique in that while it is a Medicaid program, applicants do not have to be eligible for Medicaid. Via this group, limited home and community based services (HCBS) are available for aged and disabled persons who are at risk of institutionalization (nursing home admission), but do not require the level of care that is provided in a nursing home facility. Benefits may include adult day care, homemaker services, and flexible funding to purchase needed goods and services, to promote independent living in one’s home or the home of a loved one while also preventing and delaying the need for more extensive care.

Flexible funding, also called flexible funds, is a consumer-directed option for program participants. The program participant or a “surrogate”, such as a friend or relative, becomes the “employer”. With the assistance of a case manager, a care plan and budget is created, and services and supports are purchased by the participant. Examples include home modifications, personal emergency response services, and assistive devices. Participants can also hire, train, supervise, and even fire, the “attendant” (caregiver) of their choosing to provide personal care assistance and homemaker services. While friends and relatives, such as one’s adult child can be hired to provide care, spouses are prohibited from this role. A Fiscal Intermediary Service Organization handles the financial aspects of employment responsibilities such as background checks, tax withholding, and caregiver payments.

Medicaid in Vermont is called Green Mountain Care. Vermont’s entire Medicaid program operates under an 1115(a) Demonstration Waiver called Global Commitment to Health. The Choices for Care Moderate Needs Group is a subgroup of the Choices for Care Program and is authorized under this Demonstration Waiver. Home and Community Based Services (HCBS) offered under the Moderate Needs Program are not an entitlement; meeting the eligibility criteria does not mean one will immediately receive program benefits. Instead, the number of participant slots may be limited, and when these slots are full, a waiting list forms.

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 To be eligible for the CFC Moderate Needs Group, one does not have to be eligible for Vermont Medicaid. Furthermore, persons who are enrolled in the Moderate Needs Group are not automatically eligible for Medicaid. Instead, applications for Medicaid must be submitted separately.

 

Benefits of Choices for Care: Moderate Needs Group

The following benefits are available via the Moderate Needs Group. The exact benefits a program participant receives is based on an individualized service plan.

– Adult Day Care – daytime care and supervision in an adult day center
– Case Management
– Flexible Funds – self-directed budget with which participants can purchase needed goods / services (i.e., personal care assistance, respite care, companionship, home modifications, personal emergency response systems, assistive devices)
– Homemaker Services – housecleaning, laundry, cooking, essential shopping

 

Eligibility Requirements for Vermont Medicaid’s Choices for Care Program

The Moderate Needs Group is for seniors (65+ years of age) and adults with physical disabilities (18+ years old) who are Vermont residents. Additional eligibility criteria follows and is relevant for 2024.

Financial Criteria: Income, Assets & Home Ownership

Income
The individual income limit is an “adjusted” limit of $2,898.12 / month. For a couple, the “adjusted” income limit is $4,409.64 / month, regardless of if one or both spouses are applicants. To calculate “adjusted” income, an individual or couple’s non-exempt assets (countable) above $10,000 are taken into account. Examples include cash, checking, savings, money market, and stocks. The total amount of “excess” assets is divided by 12 and then that figure is added to an individual or couple’s monthly income.

 Many home and community based services (HCBS) Medicaid programs allow a non-applicant spouse to retain a larger portion of a couple’s income and assets. Vermont’s Choices for Care Moderate Needs Group does not. However, the Choices for Care High / Highest Needs Group, which offers a wider selection of HCBS, allows a non-applicant spouse a Monthly Maintenance Needs Allowance from their applicant spouse and a Community Spouse Resource Allowance.

Assets
The asset limit is $10,000. This figure is the same for an individual and a couple with one or both spouses as applicants. Assets above $10,000 are used to calculate “adjusted” monthly income, as discussed above.

Some assets are not counted towards the asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While VT long-term care Medicaid has a 60-month Look-Back Rule in which assets should not be given away or sold under fair market value, an applicant for the Moderate Needs Group does not have to be eligible for Medicaid to be eligible for the Moderate Needs Groups.

Home Ownership
The home is often the highest valued asset a Moderate Needs Group applicant owns, and many persons worry that they will not be able to keep it. The home, however, is exempt from the Moderate Needs Group asset limit. This means it is not counted. Remember, persons do not have to be eligible for VT Medicaid to be eligible for the Moderate Needs Group. For persons who require the of care provided in a nursing home and require services and support via Choices for Care High / Highest Needs Group Program, the home exemption rules are different. Learn more here.

 

Medical Criteria: Functional Need

Unlike many long-term care Medicaid programs that require an applicant to have a Nursing Facility Level of Care (NFLOC) need, the Choices for Care Moderate Needs Group does not require this level of care. Instead, one of the following criteria must be met:

1) In 7 days, the applicant requires supervision or physical assistance at least 3 times with an Activity of Daily Living (ADL), an Instrumental Activity of Daily Living (IADL), or a combination of ADLs and IADLs. These activities include bathing, dressing, toileting, eating, preparing meals, housework, and shopping.
2) The applicant requires daily general supervision due to impaired decision making skills or judgement.
3) The applicant requires monitoring of a chronic health condition on a monthly basis (at a minimum).
4) The applicant’s health condition will get worse if they do not receive program services.

While persons with Alzheimer’s disease or a related dementia can meet the functional criteria, a diagnosis, in and of itself, does not mean one will automatically qualify.

 Seniors with greater care needs should consider the Choices for Care High / Highest Needs Group. It is for seniors and adults with disabilities who require a Nursing Facility Level of Care. The High / Highest Needs Group offers a wider selection of home and community based services than does the Choices for Care Moderate Needs Group. Available benefits include adult family care services, assisted living services, personal care assistance, home modifications, respite care, and personal emergency response systems.

Learn more about long-term care Medicaid in Vermont.

 

Qualifying When Over the Limits

Having income and / or assets over the Moderate Needs Group limit(s) does not mean an applicant cannot still qualify for benefits.

Persons who have income over the adjusted income limit, but have regular monthly medical bills, can become income-eligible by deducting these expenses from their income. This includes prescription medications, doctor bills, Medicare and other health insurance premiums, and medical supplies.

When persons have assets over the limits, they can “spend down” their excess assets on ones that are not countable. Examples include paying off debt, making home modifications, updating household appliances and furnishings, and even taking a vacation.

While persons do not have to be eligible for VT Medicaid to be eligible for the Moderate Needs Group, persons may require a greater level of care in the future via the Choices for Care High / Highest Needs Group. For this group, Medicaid’s 60-month Look-Back Rule, is applicable. Therefore, one should be careful not to give away assets or sell them for less than fair market value in the event that a greater level of care is required.

 

How to Apply for Vermont Choices for Care: Moderate Needs Group

Before You Apply

Prior to applying for CFC Moderate Needs Group, 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.

Medicaid long-term care programs generally require applicants to gather a variety of documentation, such as proof of income and assets, for submission. For the Moderate Needs Group, financial eligibility is based on self-reported income and assets.

Since benefits provided via the Moderate Needs Group are not an entitlement, there may be a waiting list to receive assistance. In the case of a waiting list, applicants who are enrolled in VT’s Regular Medicaid program, called Community Medicaid, are given priority and then services are awarded by application date.

 

Application Process

Persons can begin the application process for the Choices for Care Moderate Needs Group by completing a Moderate Needs Group Application (CFC 900). It can be found here under the “Moderate Needs Program Forms”. The completed application should be submitted to a Case Management Agency listed on the application. After receipt of the application, a case manager will complete a functional and financial eligibility screening and then submit the entire application packet to VT’s Department of Disabilities, Aging & Independent Living for authorization of services.

Persons who are eligible for the Moderate Needs Group are not automatically eligible for VT’s Community Medicaid program. For seniors, this program is called Medicaid for the Aged, Blind and Disabled (MABD). Persons must apply separately for MABD, and can do so online, or by calling Customer Services at 855-899-9600, or by submitting a paper application.

More information about the Choices for Care Moderate Needs Group can be found here. Persons can also call the Area Agency on Aging (AAA) Helpline at 800-642-5119 to be connected to their local agency, or click here, for links to the 5 local agencies.

The Department of Disabilities, Aging & Independent Living (DAIL) within the Vermont Agency of Human Services (AHS) administers the Choices for Care Moderate Needs Group.

 

Approval Process & Timing

While persons do not have to be eligible for VT Medicaid, the Choices for Care Moderate Needs Group is still a Medicaid program. The 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. If the application is not properly completed, or required documentation is missing, the application process can 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. Furthermore, as a waiting list for home and community based services may exist, approved applicants may spend many months waiting to receive benefits.

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