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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 DAIL determines this clinical eligibility, and your local Designated Agency arranges the assessment that documents your needs.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 The Choices for Care and DVHA pages describe this requirement in general terms rather than publishing a single dollar cutoff on the program page, so for Vermont's current long-term-care income and asset limits, see our companion guide 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 Your local Designated Agency, a community organization that serves your area, arranges the necessary assessments that DAIL relies on.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Jul 17, 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 to let you apply through more than one channel, including by telephone and by mail, so you are not limited to a single method.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
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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Complete the clinical assessment
Your local Designated Agency arranges the assessment DAIL uses to confirm the nursing-home level of care.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
Get help if you need it
Older Vermonters who need help applying for Choices for Care can call the Vermont Senior Helpline at 1-800-642-5119.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Jul 17, 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 calendar days for most applicants, or 90 calendar days for applicants applying on the basis of disability, measured from the date of application.U.S. Government Publishing Office. (2024). 42 CFR 435.912 Timely determination and redetermination of eligibility (2024 ed.) — govinfo.gov. govinfo.gov. Retrieved Jun 25, 2026, from https://www.govinfo.gov/content/pkg/CFR-2024-title42-vol4/pdf/CFR-2024-title42-vol4-sec435-912.pdf That is the outer limit, not a promise of how fast your particular case will move, but it gives you a benchmark for when to follow up.
Frequently Asked Questions
Does Vermont have a 1915(c) HCBS waiver for seniors?
No. Vermont delivers Choices for Care under its Global Commitment to Health Section 1115 demonstration rather than a standalone 1915(c) waiver, so there is no separate aged-and-disabled waiver to search for. One practical difference of the 1115 route is that the demonstration runs for a fixed federal term and has to be renewed rather than continuing indefinitely: Vermont's current authority took effect in October 2005 and is approved through December 31, 2027.Centers for Medicare & Medicaid Services. (n.d.). Vermont Global Commitment to Health. medicaid.gov. Retrieved Jul 17, 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, that difference in labeling and renewal cycle is the main thing to understand.
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 Jul 17, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391 DAIL makes this determination based on an assessment arranged by your local Designated Agency, 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 Jul 17, 2026, from https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/83391
If I move into a residential setting, how much of my income can I keep?
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. The federal personal needs allowance floor is at least $30 a month for an aged, blind, or disabled individual.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 Jun 24, 2026, from https://www.govinfo.gov/link/uscode/42/1396a States can and often do set a higher amount, so for Vermont's specific figure and how the post-eligibility income rules work, see our guide to the Vermont Medicaid personal needs allowance.
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.