Vermont Medicaid HCBS waivers pay for long-term care at home instead of in a nursing home, and the state delivers them through one main program: Choices for Care.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 These home and community-based services (HCBS) are part of Medicaid, the joint federal and state health program, and they are meant for Vermonters who need a nursing-home level of care but would rather receive that care where they live.
In This Guide
- What Vermont Medicaid HCBS waivers are (and why Vermont uses a 1115 demonstration)
- Inside Choices for Care, Vermont's HCBS program
- Who qualifies for Vermont Medicaid HCBS waivers
- What Choices for Care covers
- How enrollment and eligibility determination work
- How to apply for Choices for Care
What Vermont Medicaid HCBS Waivers Are (and Why Vermont Uses a 1115 Demonstration)
Home and community-based services are the part of Medicaid that pays for long-term care outside an institution, in your own home or another community setting rather than a nursing facility. Most states build these services on a federal authority called the 1915(c) HCBS waiver, which lets a state "waive" certain Medicaid rules so it can fund community care for people who would otherwise need institutional placement.
Vermont takes a different route, and this is the detail that trips up families comparing states. Rather than run a standalone 1915(c) waiver for older and disabled adults, Vermont delivers Choices for Care under its Global Commitment to Health Section 1115 demonstration, a broad federal agreement that was first approved effective October 1, 2005 and is currently extended through December 31, 2027.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 For a reader, the practical effect is the same: Medicaid pays for long-term care in the community. The label is what differs, so if a national article tells you to look for Vermont's "1915(c) aged and disabled waiver," you won't find one under that name.
Inside Choices for Care, Vermont's HCBS Program
Choices for Care is Vermont's long-term-care program for adults who need a nursing-home level of care, and its defining feature is choice of setting. Once you qualify, you decide where to receive services: in your own 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. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 The point of the program is to let someone who would otherwise be headed for a nursing home stay in the community when that is what they prefer and it can be done safely.
Choices for Care is one of four programs under Vermont's Long-Term Care Medicaid umbrella. The other three serve different populations, so it helps to know which one fits before you apply. The four programs are:
- Choices for Care, the aged and disabled program covered in this guide.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- Developmental Disabilities Home and Community Based Services.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- The Brain Injury Program.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- Intensive Home and Community Based Treatment.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
If you are arranging care for an older parent or a disabled adult who needs help with daily personal care, Choices for Care is almost always the right door.
Who Qualifies for Vermont Medicaid HCBS Waivers
Choices for Care uses two separate tests, and you have to clear both. One is about your care needs, the other is about your finances.
The clinical test: nursing-home level of care
You must need a nursing-home level of care, which in practice means you typically require extensive or total assistance on a daily basis with personal care.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 DAIL determines this clinical eligibility for Choices for Care, and questions about it go to the DAIL Long-Term Care Clinical Coordinator for your area of the state.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
The financial test
You must also meet the financial criteria for long-term-care Medicaid in Vermont, which the Department of Vermont Health Access (DVHA), the state's Medicaid agency, determines.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 Vermont applies specific income and asset limits to long-term-care Medicaid, and those limits, not the Choices for Care program rules, are what the financial test turns on. For the current Vermont figures, see our companion guides to Vermont Medicaid long-term care and Vermont Medicaid eligibility and income limits.
The threshold requirements
On top of those two tests, you must be a Vermont resident and be at least 65 years old, at least 18 years old with a physical disability, or eligible for Medicaid under Vermont's Medicaid for Children and Adults rules.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
What Choices for Care Covers
Choices for Care pays for a package of long-term services and supports, the everyday help that lets someone with heavy personal-care needs live in the community.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 The specific services are built around your assessed needs, and where they are delivered depends on the setting you pick. Choices for Care will help pay for long-term care in any of these settings:
- Your own home, or the home of a family member.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- An Adult Family Care home.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- Enhanced Residential Care, an approved residential care home or assisted-living setting.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
- An approved nursing facility.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
The takeaway here is that Choices for Care is not only a home-care program. It is a single benefit that follows you across settings, so a person can start with services at home and, if needs change, move to Enhanced Residential Care or a nursing facility while staying in the same program.
How Enrollment and Eligibility Determination Work
Enrolling in Choices for Care means two Vermont agencies review your case, each handling the test it owns. DVHA determines your financial eligibility, and DAIL determines your clinical eligibility for the nursing-home level of care.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 The DAIL Long-Term Care Clinical Coordinator for your area of the state is who to ask about that clinical determination and the services available.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Because two separate determinations have to line up, it is worth starting both the financial application and the clinical assessment early rather than waiting for one to finish before beginning the other. Enrollment specifics and current timelines can change, so confirm where your case stands directly with DVHA and DAIL as you go.
How to Apply for Choices for Care
Applying for Choices for Care runs through the long-term-care Medicaid application, and the whole process is anchored to one form. Federal Medicaid rules require the state Medicaid agency to accept applications through multiple channels: online, by telephone, by mail, in person, and through other commonly available electronic means.U.S. Government Publishing Office. (n.d.). 42 CFR 435.907 — Application (eCFR, current). ecfr.gov. Retrieved Jul 13, 2026, from https://www.ecfr.gov/current/title-42/section-435.907 Vermont's long-term-care route is built around one paper form, so the steps below follow that path.
Get the 202LTC application
The application you need is the 202LTC Application for Long-Term Care Medicaid. You can print it from DVHA or request one by calling the Long-Term Care Customer Support Unit at 1-802-476-0100, toll-free 1-833-840-0061.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Complete and mail it
Send the finished application to the Green Mountain Care Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-1500.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Complete the clinical assessment
DAIL confirms the nursing-home level of care; the DAIL Long-Term Care Clinical Coordinator for your area of the state is who to ask about the assessment and the services available.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Get help if you need it
Vermonters who need help applying for Choices for Care can call the Vermont Senior Helpline at 1-800-642-5119, or contact their local Area Agency on Aging or their local home health agency.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Federal Medicaid rules also cap how long the state can take to decide. Under those rules, a Medicaid eligibility determination may not exceed 45 days for most applicants, or 90 days for applicants applying on the basis of disability, measured from the date of application.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912 That is a ceiling on the agency, not a promise of how fast your particular case will move, but it gives you a benchmark for when to follow up. The limits are not absolute: the same rules let the state exceed them in unusual circumstances, such as a delay caused by the applicant or an examining physician, or an administrative emergency beyond the agency's control. Once the federal community-engagement requirement is live, the rules add one more: the agency may exceed the standard while an applicant who was sent a notice of noncompliance is inside the 30-calendar-day window to respond.U.S. Government Publishing Office. (2026). 42 CFR 435.912(c)(3) — Timely determination of eligibility (eCFR current text, as revised eff. July 31, 2026). ecfr.gov. Retrieved Aug 7, 2026, from https://www.ecfr.gov/current/title-42/section-435.912
Frequently Asked Questions
Does Vermont have a 1915(c) HCBS waiver for seniors?
Not for Choices for Care. Vermont delivers Choices for Care under its Global Commitment to Health Section 1115 demonstration rather than a standalone 1915(c) waiver, so looking for a Vermont "aged and disabled waiver" under that name will not lead you to the program you want. Like other federal demonstration authority, the 1115 runs for a set term: Vermont's took effect October 1, 2005 and is currently approved through December 31, 2027.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 If you are comparing Vermont with a state that lists a 1915(c) waiver, the difference is mostly one of labeling; what Medicaid pays for in the community looks much the same.
Can Choices for Care pay for care in an assisted-living setting?
Yes. Choices for Care can pay for long-term care in Enhanced Residential Care, which is an approved residential care home or assisted-living setting, as well as in your own home, a family member's home, an Adult Family Care home, or a nursing facility.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 You choose the setting once you qualify.
What does it mean to need a "nursing-home level of care"?
It is a clinical standard, not a matter of where you currently live. In Vermont it means you typically require extensive or total assistance on a daily basis with personal care.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 DAIL makes this determination based on a clinical assessment of your needs, so the decision rests on documented daily-care needs rather than a diagnosis alone.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Aug 2, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
How much of my income can I keep once Medicaid is paying for my care?
It depends on where you receive care, and the two situations are governed by different rules. If you are in a nursing facility, federal Medicaid rules set a personal needs allowance (PNA), a small monthly amount an institutionalized person keeps for personal expenses rather than paying toward care; that federal floor is at least $30 a month for an aged, blind, or disabled individual, and at least $60 a month for an institutionalized couple if both spouses are aged, blind, or disabled.U.S. Government Publishing Office. (n.d.). 42 U.S.C. 1396a(q)(2) — Minimum monthly personal needs allowance deduction (govinfo.gov USCODE). govinfo.gov. Retrieved Aug 7, 2026, from https://www.govinfo.gov/link/uscode/42/1396a The federal amounts are a floor, not a ceiling, and a state may set a higher figure.U.S. Government Publishing Office. (n.d.). 42 U.S.C. 1396a(q)(2) — Minimum monthly personal needs allowance deduction (govinfo.gov USCODE). govinfo.gov. Retrieved Aug 7, 2026, from https://www.govinfo.gov/link/uscode/42/1396a
If instead you receive Choices for Care at home or in another community setting, that institutional floor is not the number that applies to you, so do not plan around $30 a month. Ask DVHA what you would keep in your setting, and see our guide to the Vermont Medicaid personal needs allowance and our Vermont Medicaid long-term care guide for the current Vermont figures.
Learn More
Find personalized help applying for Choices for Care 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.