Elder Care Index

What Medicaid Actually Covers for Senior Care

Navigating senior care can feel overwhelming, but Vermont's Medicaid program, known as Green Mountain Care, offers crucial support. The core long-term care program is called Choices for Care (CFC), designed to help older Vermonters and individuals with disabilities live in the setting that best suits their needs, whether that's at home, in an assisted living community, an adult foster care home, or a nursing facility.

If your parent needs nursing home care, Vermont Medicaid covers the full cost, including room and board, skilled nursing, personal care, doctor visits, and prescriptions in Medicaid-certified facilities. However, it's good to know that private rooms or non-medically necessary comfort items are not typically covered.

For those preferring to stay in their own home or a community setting, the Choices for Care Home and Community-Based Services (HCBS) Waiver provides a range of support. This includes personal care assistance (like help with bathing or dressing), adult day care, respite for caregivers, companion services, personal emergency response systems, assistive technology, and even home modifications such as wheelchair ramps. A key gap to remember is that while CFC covers services in assisted living and adult foster care, it generally does not pay for room and board in these settings. Vermont also offers a "Flexible Choices" option under CFC, which provides cash directly to eligible individuals to purchase their own care services, even allowing them to hire family members, excluding spouses or legal guardians.

Do You Qualify?

Understanding the financial picture for 2026 is critical. For a single applicant seeking Nursing Home Medicaid or the Choices for Care waiver, the income limit is $2,982 per month. For a married couple where both apply, the combined income limit for Nursing Home Medicaid is $5,964 per month. The asset limit for a single applicant is $2,000. For married couples, if only one spouse is applying, the applicant spouse can have $2,000 in assets, while the non-applicant spouse (known as the community spouse) can keep up to $162,660 as a Community Spouse Resource Allowance.

Many families wonder about their parent's home. In Vermont, a primary residence is generally exempt from asset limits, provided the applicant intends to return home or a spouse or dependent lives there, and the home equity does not exceed $752,000. If the home equity is higher, it may be counted as an asset. For parents with pensions or retirement accounts like IRAs and 401(k)s, these are typically exempt as assets if they are in "payout status," meaning regular withdrawals are being taken based on life expectancy. If income is above the limit, Vermont has a "medically needy" spend-down process where the difference between your income and a state-set limit acts like a deductible; once this is met through medical expenses, you become eligible for the rest of the month. Vermont also has a 60-month (5-year) "look-back" period for any asset transfers, which is important to consider for planning.

Waitlists & How to Apply

When it comes to waitlists, there's a key distinction: Nursing Home Medicaid and Medicaid for the Aged, Blind, and Disabled (MABD) are considered entitlements, meaning eligible individuals are guaranteed benefits, though not necessarily a specific facility. However, the Home and Community-Based Services (HCBS) Waivers under Choices for Care are not an entitlement, and enrollment slots are limited, meaning waitlists can exist. These waitlists can sometimes last for months or even years.

To apply for Choices for Care (LTC Medicaid), you'll need to complete the Application for Long-Term Care Medicaid (Form 202LTC). For MABD, you'll use the 205ALLMED application. You can request these forms by calling 833-840-0061 or 802-476-0100 for Choices for Care, or 855-899-9600 for MABD. Completed applications can be mailed to Vermont Health Connect, Application and Document Processing Center, 280 State Drive, Waterbury, VT, 05671-8100 (for MABD) or 05671-1500 (for LTC). It's advised to apply as soon as possible, even if you don't have all the paperwork, as they will give you more time to provide missing documents. The Department of Vermont Health Access (DVHA) handles financial eligibility, while the Department of Disabilities, Aging and Independent Living (DAIL) determines clinical eligibility. For assistance with the application process, your local Area Agency on Aging is a great resource; you can reach the Vermont Senior Helpline at 1-800-642-5119. Processing times average around 79 days for Nursing Home Medicaid and 89 days for HCBS Waivers.

Last updated: March 2026. Sources: CMS, state Medicaid agency, Genworth 2024.