Vermont's Choices for Care pays a spouse only for personal care with Activities of Daily Living (ADLs), and pays a legal guardian only with an individual variance. Vermont's Department of Disabilities, Aging and Independent Living (DAIL) decides those variances case by case. In Vermont, DAIL's Choices for Care personal care limits name spouses, legal guardians and surrogate employers, and don't name an adult child as an allowed or barred family member; DAIL says Choices for Care participants may hire their own caregivers through the consumer or surrogate-directed option.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
Which Family Members Can Vermont Choices for Care Pay?
Choices for Care is the Medicaid long-term care program run by Vermont's Department of Disabilities, Aging and Independent Living (DAIL). Choices for Care serves Vermonters who need a nursing home level of care and are at least 65, at least 18 with a physical disability, or eligible under Vermont's Medicaid for Children and Adults rules. For any service other than nursing facility care, DAIL's Choices for Care manual requires a functional physical limitation from a physical condition (such as a stroke, dementia or a traumatic brain injury) or from aging, and a person whose need comes from a developmental disability, autism or mental illness isn't eligible. Each eligible person chooses where to get services: at home, in a family member's home, in an Adult Family Care home, in Enhanced Residential Care, or in a nursing facility.Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf
Who the program will pay depends on your relationship and on the route. DAIL's Choices for Care manual, its 2007 spousal-caregiver guidelines and a July 2023 memo set the rules:Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
| Your relationship | Self- or surrogate-directed personal care | Adult Family Care home provider |
|---|---|---|
| Spouse or civil union partner | ADL personal care only | No |
| Adult child | Not named; ask DAIL | Not on the barred list; must meet the home-provider rules |
| Parent, stepparent or domestic partner | Not named; ask DAIL | No |
| Legal guardian (probate court) | Only with an individual DAIL variance | No |
| Surrogate employer | No, not for the person they act for | Not on the barred list |
| Representative payee | Not named; ask DAIL | No |
"Not named" isn't a yes. DAIL's personal care limits restrict spouses, legal guardians and surrogate employers, and they don't name adult children either way.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf Get DAIL's answer in writing before you count on the income.
What a Spouse Can and Can't Be Paid For
Under Vermont Choices for Care, a spouse can be paid, but only for hands-on help with ADLs. DAIL's manual says a spouse or civil union partner "shall not be paid to provide assistance with Instrumental Activities of Daily Living (IADLs)," and bars spouses from paid respite care and companion care too. Choices for Care's ban on paying a spouse for IADLs also applies in its Flexible Choices option.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
During the pandemic, Vermont briefly paid spouses for more. DAIL's July 2023 memo says those added categories (companionship, respite, and IADLs such as housekeeping and shopping) ended after November 11, 2023, and that "Spouses continue to be paid to provide personal care for Activities of Daily Living (ADL)."Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf If someone told you a spouse can be paid for cleaning or errands, that information is out of date.
DAIL's Choices for Care Guidelines for Paying Spouses as Caregivers, effective May 1, 2007, add conditions for a Vermont spouse to be paid:
- A paid spouse must meet the same minimum requirements as every other Choices for Care personal care provider.
- A paid spouse can't also be the Choices for Care participant's surrogate employer or legal guardian.
- Under DAIL's Choices for Care spouse guidelines, a family member of a paid spouse can act as the participant's surrogate only if they don't live in the household.
- A plan for the paid spouse's relief must be in place; under DAIL's guidelines, adult day, respite or companion services can meet it.
- Under DAIL's guidelines, the decision to pay a spouse rests with the Choices for Care participant.Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf,Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
The relief plan exists so a paid spouse still gets breaks. For every route a spouse can use, see getting paid to care for a spouse in Vermont.
Can a Legal Guardian or Surrogate Be Paid?
Under Vermont Choices for Care, a legal guardian usually can't be paid. DAIL's manual says a legal guardian appointed by probate court "may not be paid to provide Personal Care Services," and bars guardians from paid respite, companion and Flexible Choices services too. During the pandemic DAIL granted a blanket variance that let participants hire workers such as legal guardians; its July 2023 memo ended that and returned to "the previous case-by-case individual variance process." So a guardian can be paid only if DAIL grants an individual variance.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf For how other states treat this, see whether a guardian can be paid to care for a parent.
DAIL's Choices for Care manual says a surrogate employer, a proxy who directs care on the participant's behalf, "shall not be paid to provide Personal Care Services to the participant for whom they are acting as a Surrogate."Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf,Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf
Every Choices for Care enrollee picks how services are delivered: self-direct, have a qualified designated representative direct them, or use traditional agency-based delivery.Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf
Adult Family Care: When a Relative Is the Home Provider
Adult Family Care is a 24-hour shared-living option inside Vermont's Choices for Care. DAIL's Choices for Care manual says an Adult Family Care home provider must:
- be 21 or older;
- own or rent the home where the care is provided;
- live there, under the same roof as the participant; and
- be in a home that contracts with an Authorized Agency.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
DAIL's Choices for Care manual also lists who can't be the paid Adult Family Care home provider: the participant's "parent, stepparent, adoptive parent, domestic partner, spouse, legal guardian, or representative payee." Adult children aren't on Vermont's Adult Family Care barred-provider list.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf That's a reading of the list, not a promise, and the home must still contract with an Authorized Agency.
A separate rule covers a live-in caregiver in an unrelated person's unlicensed home: that caregiver can't be paid through Choices for Care for 24-hour care and supervision, room and board, or home maintenance and repair.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
How Many Hours a Family Member Is Paid Under Vermont Choices for Care
You don't set the hours. DAIL's Choices for Care manual limits personal care to the maximum hours allocated on the DAIL-approved service plan, and limits IADLs (not counting meal preparation and medication management) to 4.5 hours a week.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf Under Choices for Care, a paid spouse can't bill IADL time at all.
That means the paid hours are the plan's hours, not the hours your family actually spends. If you're also covering nights, laundry and errands, any care beyond the plan's hours goes unpaid. Plan for that gap before the income becomes part of your household budget.
The roughly $20.00 an hour figure is the May 2025 U.S. Bureau of Labor Statistics median wage for home health and personal care aides in Vermont, not a Choices for Care rate.data.bls.gov. (2025). BLS OEWS Profiles, May 2025, 31-1120 Home Health and Personal Care Aides (national estimates). Retrieved Oct 14, 2026, from https://data.bls.gov/oesprofile/?year=2025&major_group=310000&occupation=311120&measure=01&areas=INDUSTRY,STATE,MSA We haven't found a published Choices for Care wage for family caregivers, so ask DAIL how a family caregiver's hourly pay is set before you enroll.
Does the Caregiver Reimbursement Protocol Affect Choices for Care?
No. Some pages you may find say spouse pay waits on Vermont's Caregiver Reimbursement Protocol. The Centers for Medicare & Medicaid Services (CMS) has approved Vermont's Caregiver Reimbursement Protocol and said it will become Attachment P to Vermont's Section 1115 demonstration, and the protocol covers payment to legally responsible individuals in two programs other than Choices for Care: Developmental Disability Services and the Brain Injury Program. Vermont's Caregiver Reimbursement Protocol isn't a pending condition on Choices for Care spouse pay.Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf,Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
Pages that quote an "allow a family member to be paid" check-box are out of date too. Vermont's family-member pay check-box sat in its COVID-19 Attachment K, which CMS extended only to March 29, 2024, so that authority has expired.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf The standing authority is narrower: Vermont's Section 1115 demonstration, approved through December 31, 2027, covers personal care by Choices for Care participants' spouses and legal guardians, within the DAIL limits described above.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
How to Start
Call for help applying
The Vermont Senior Helpline at 1-800-642-5119 helps with Choices for Care applications.dvha.vermont.gov. (n.d.). Vermont Department of Vermont Health Access — Long-Term Care (how to apply; 202LTC; LTC Customer Support Unit contacts; DVHA/DAIL/Designated Agency/DMH eligibility split; eligibility criteria; covered settings; annual review). Retrieved Jul 10, 2026, from https://dvha.vermont.gov/members/long-term-care
File form 202LTC
Print the Application for Long-Term Care Medicaid from the Department of Vermont Health Access (DVHA), or call 1-802-476-0100 (toll-free 1-833-840-0061) to have one mailed. DVHA decides financial eligibility and DAIL decides clinical eligibility.dvha.vermont.gov. (n.d.). Vermont Department of Vermont Health Access — Long-Term Care (how to apply; 202LTC; LTC Customer Support Unit contacts; DVHA/DAIL/Designated Agency/DMH eligibility split; eligibility criteria; covered settings; annual review). Retrieved Jul 10, 2026, from https://dvha.vermont.gov/members/long-term-care See how to apply for Vermont Medicaid.
Meet the clinical test
DAIL decides Choices for Care clinical eligibility within 30 days. Choices for Care's Highest Need group includes people who need extensive or total help with toilet use, eating, bed mobility or transfer plus at least limited help with another ADL; its High Need group includes people who need extensive-to-total daily help with bathing, dressing, eating, toilet use or walking.Centers for Medicare & Medicaid Services. (2025). CMS — Vermont Global Commitment to Health Section 1115 Demonstration, approval letter and Special Terms and Conditions (January 2, 2025; demonstration period through December 31, 2027), incl. Attachment C. medicaid.gov. Retrieved Oct 4, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf
Ask the family question directly
When the service plan is set, tell DAIL who you want as the paid caregiver. A spouse should have the relief plan ready; a guardian should ask about an individual variance; an adult child should ask DAIL to confirm in writing.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
For what the program covers in each setting, see Vermont Medicaid home and community care.
Frequently Asked Questions
Can I be paid to care for my mother through Choices for Care?
Possibly, by two routes. Vermont Choices for Care doesn't name adult children for self- or surrogate-directed personal care, so ask DAIL to confirm in writing; and adult children aren't on DAIL's list of relatives barred from being a paid Adult Family Care home provider, if your mother lives in a home you own or rent and you meet the home-provider rules.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
Who directs the care if my mother can't manage her own caregivers?
Under Vermont Choices for Care, a qualified designated representative can direct services on her behalf, or she can choose traditional agency-based delivery.Centers for Medicare & Medicaid Services. (2022). CMS approval of Vermont Global Commitment to Health Section 1115(a) demonstration amendment, with Special Terms and Conditions (approval period July 1, 2022 through December 31, 2027). medicaid.gov. Retrieved Aug 3, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-appvl-01022025.pdf Under DAIL's Choices for Care rules, a surrogate employer who directs her care can't also be paid to provide her personal care.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
Can a spouse be paid for respite so the family gets a break?
No. DAIL's Choices for Care manual bars a spouse or civil union partner from paid respite and companion care, and DAIL's 2007 spouse guidelines require a separate plan for the paid spouse's relief, which adult day, respite or companion services can meet.Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf
Is Choices for Care pay taxable?
IRS Notice 2014-7 covers payments under a section 1915(c) waiver for care in the caregiver's own home.Internal Revenue Service. (n.d.). Certain Medicaid waiver payments may be excludable from income. irs.gov. Retrieved Aug 1, 2026, from https://www.irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income Choices for Care runs under Vermont's Section 1115 demonstration instead,Centers for Medicare & Medicaid Services. (2024). CMS approval of Vermont's Caregiver Reimbursement Protocol (March 22, 2024), enclosing the Global Commitment to Health waiver/expenditure authorities, STCs and approved Attachment P - medicaid.gov. medicaid.gov. Retrieved Oct 14, 2026, from https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/vt-global-commitment-to-health-apprvl-03222024.pdf so ask a tax professional, and see whether Medicaid waiver payments are taxable.
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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.
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