Vermont Medicaid income limits don't slam the door on you for earning a few dollars too much: the state lets over-income applicants spend down the excess on care instead of being shut out. That single design choice separates Vermont from the income-cap states next door, and it changes how a family should approach long-term-care eligibility here.
This guide walks through the 2026 income and asset rules for Vermont Medicaid long-term care, run by the Department of Vermont Health Access (DVHA) through its Choices for Care program. It covers the $2,000 asset limit, how the medically-needy spend-down works (and why there's no Miller Trust), what a nursing-home resident keeps, what a spouse at home is protected from, and the look-back and estate-recovery rules that catch families off guard.
What Choices for Care actually is
Most Vermont long-term-care Medicaid runs through a single program: Choices for Care, part of Green Mountain Care and administered by DVHA. It funds nursing-facility care, enhanced residential care, and home- and community-based services for aged, blind, and disabled Vermonters who need a nursing-facility level of care.
The point worth holding onto is that Choices for Care covers care outside a nursing home, not just inside one. A Vermonter who qualifies financially and clinically can often receive Medicaid-funded help at home or in an enhanced residential care setting, not only in a facility. The financial rules below (the asset limit, the spend-down, the spousal protections) apply across those settings.
The $2,000 asset limit, and what doesn't count
For a single long-term-care applicant, Vermont limits countable assets to $2,000. When both spouses apply, the limit is $4,000, which is $2,000 per spouse.
"Countable" is the word doing the work. Vermont, like every state, exempts a long list of assets from the count: your home (subject to an equity cap, covered below), one vehicle, household goods and personal effects, and prepaid burial arrangements. So the $2,000 applies to things like bank accounts, a second vehicle, and investments, not the roof over your head or the car in the driveway.
That low resource limit is the part of Vermont's rules that catches families by surprise, because the income side is far more forgiving than they expect.
How Vermont Medicaid income limits work: spend-down, not a cap
Here is where Vermont parts ways with several other states. Vermont is a medically-needy state, which means it does not impose a hard income ceiling on long-term-care Medicaid. An applicant whose income runs above the state's protected income level isn't disqualified. Instead, they qualify by spending down the excess on incurred medical and care costs.
The mechanics differ a little by setting. For a nursing-facility resident, "spend-down" effectively happens through the cost of care itself: the resident contributes income above their allowances toward the monthly bill, and Medicaid covers the balance. For community applicants whose income exceeds the protected level, the excess becomes a spend-down amount that's met by incurring medical or care expenses.
This is why Vermont does not require a Qualified Income Trust, also called a Miller Trust. In strict income-cap states, an applicant even one dollar over the limit is shut out of long-term-care Medicaid unless they route the excess income through that special trust every month. Vermont has no such cliff. If your income is high, you spend it down toward care; you are never simply "too rich" for Choices for Care.
Long-term care: what a nursing-home resident keeps
When Vermont Medicaid pays for nursing-facility care, the resident contributes almost all of their monthly income toward the cost of that care. What they keep for themselves is the Personal Needs Allowance (PNA), money reserved for small personal expenses such as clothing, a haircut, or a phone. Vermont sets its PNA at $79.93/month, well above the federal floor of $30.
The same $2,000 asset limit applies to nursing-home applicants. And because Vermont uses spend-down rather than an income cap, even a resident with substantial monthly income can qualify; they simply contribute more of it toward care after the PNA and other recognized deductions come out. For the national picture on how the PNA is calculated and what it covers, see our explainer on the Medicaid personal needs allowance.
The five-year look-back
Vermont reviews asset transfers made in the 60 months before a long-term-care application. Giving away money or property for less than fair market value during that window (gifting a grandchild a down payment, signing a house over to a child for a dollar) can trigger a penalty period during which Medicaid won't pay for long-term-care services, even though you're otherwise eligible.
There are legitimate exceptions (transfers between spouses, transfers to a disabled child, certain caregiver-child home transfers) and legitimate planning approaches, but anything done inside the five-year window deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.
Protecting the spouse who stays home
When one spouse needs long-term care and the other remains in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. Vermont applies the federal framework for 2026:
| Protection | 2026 Amount | What it does |
|---|---|---|
| Community Spouse Resource Allowance (CSRA) | Half the couple's countable assets, up to $162,660; minimum $32,532 | The most in countable assets the at-home spouse may keep, on top of the applicant's own $2,000. |
| Monthly Maintenance Needs Allowance (MMNA) | $2,643.75/month (through 6/30/2026) up to $4,066.50/month (effective 1/1/2026) | The most monthly income the at-home spouse may keep; income can be shifted from the applicant to reach it. |
| Home-equity limit | $752,000 | Equity in the primary residence above this amount is countable for long-term-care eligibility. |
So a married couple is in a very different position from a single applicant. The community spouse can hold up to $162,660 in assets and keep a meaningful share of the couple's monthly income while the other spouse receives Choices for Care funding. The exact MMNA within the federal range depends on the spouse's own income and shelter costs.
After death: estate recovery
Like every state, Vermont runs a Medicaid estate-recovery program. After a recipient who was 55 or older and received long-term-care services dies, the state may seek repayment from the estate, unless the recipient is survived by a spouse or a minor, blind, or disabled child. Federal exceptions and an undue-hardship waiver apply. For how estate recovery works and where families have room to plan, see our Medicaid estate recovery explainer.
How to apply in Vermont
Vermont long-term-care Medicaid is run by the Department of Vermont Health Access, and applications go through Vermont Health Connect. You have a few ways to start:
- By application form. File the Application for Long-Term Care Medicaid (form 202LTC) with Vermont Health Connect.
- By phone. Call Vermont Health Connect at 1-833-840-0061, or the long-term-care customer service line at 1-802-476-0100.
Long-term-care applicants also go through a clinical screening to confirm they need a nursing-facility level of care, which is what Choices for Care is built around. Apply even if you think you're over the income limit. Because Vermont uses spend-down instead of an income cap, many people who assume they earn too much for Medicaid still qualify.
Frequently Asked Questions
Vermont has no hard income cap for long-term-care Medicaid. It's a medically-needy spend-down state, so an applicant whose income exceeds the protected income level qualifies by spending the excess down on incurred medical and care costs. A nursing-facility resident contributes income above their Personal Needs Allowance and other deductions toward the cost of care.
No. Because Vermont is a medically-needy spend-down state rather than an income-cap state, there's no income ceiling that would require routing excess income through a Qualified Income Trust. That's a key difference from income-cap states, where an over-income applicant must use such a trust to qualify at all.
$2,000 in countable assets for a single long-term-care applicant, or $4,000 for a couple when both spouses apply ($2,000 each). The home (within an equity cap), one vehicle, household goods, and prepaid burial arrangements are exempt from the count.
For 2026, the at-home (community) spouse can keep up to $162,660 in countable assets (the Community Spouse Resource Allowance, with a $32,532 minimum) and a monthly income allowance in the federal range, up to $4,066.50 (the Monthly Maintenance Needs Allowance). The home is also generally protected, with an equity limit of $752,000.
A Personal Needs Allowance of $79.93/month for personal expenses. The rest of the resident's monthly income goes toward the cost of care, after recognized deductions such as a community-spouse allowance and certain health-insurance premiums.
Choices for Care is Vermont's main long-term-care Medicaid program, administered by DVHA. It funds nursing-facility care, enhanced residential care, and home- and community-based services for people who meet both the financial rules and a nursing-facility level-of-care standard.
Learn More
- Medicaid Planning Strategies
- How Medicaid Estate Recovery Works
- The Medicaid Personal Needs Allowance, Explained
Find personalized help working through Vermont Medicaid eligibility and the Choices for Care spend-down for your family at brevy.com.
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.