Home & Community-Based Medicaid Waiver

What Is It? The Home and Community-Based Medicaid Waiver program provides services at home and in the community to individual's who would otherwise need nursing home care. The Medicaid Waiver program does not, however, provide 24-hour care and supervision.

Who Is Eligible?

1) Vermont residents age 65 or older, or those age 18 and older who have a physical disability, and
2) Need the level of care given in a nursing home, and
3) Meet the income and resource criteria for Vermont Long Term Care Medicaid, and
4) Meet one of the Medicaid Waiver priority criteria.

Because enrollment is limited to a specified number of "slots" state wide, applications are prioritized and you may be placed on a waiting list.

What Does It Cost?
Vermont Long Term Care Medicaid pays the cost of waiver services. You may be required to pay a portion of the cost called a "Patient Share," depending on your income and resources.

Under certain circumstances, the cost of services may be recovered from your estate by the Department of Prevention, Assistance, Transition and Health Access (PATH). Ask your Case Manager or call your area PATH Office for more information. (Springfield area PATH office: 802-886-3551 or 800-589-5775; Brattleboro area PATH office: 802-257-2820, or 800-775-0515).

What Services are Available?

1) Personal Care Services: Personal Care Services provide help with activities like eating, walking, toileting, bathing. Cooking, cleaning, and shopping assistance is also available. Services are provided by your local Home Health Agency or by consumer or surrogate-directed employees. The amount of Personal Care Services you receive is based on your daily needs as identified through a detailed assessment.

2) Respite Care Services: Respite Care Services relieves family members or other unpaid caregivers for up to 720 hours a calendar year (combined with Companion Services). Respite Care Services can be provided at your home, in an approved facility or at a local Adult Day program.

3) Companion Services: Companion Services provide non-medical care, supervision and socialization up to 720 hours a year (combined with Respite Care Services). Companion Services may be provided through the local Home Health Agency, consumer or surrogate directed employees, or the VT Senior Companion Program.

If you are willing to direct your own care, you may be eligible for consumer-directed or surrogate-directed services. You become the employer and recruit, train, and supervise your own attendants. In this case, payroll services are provided. Ask your Case Manager for more details.

4) Adult Day Services: Adult Day Services provide personal care, meals, activities and respite in the community. Approved Adult Day Programs provide this service where it is available.

5) Assistive Devices & Home Modifications: Up to $750 a calendar year is available to purchase approved assistive devices or home modifications to increase your independence.

6) Personal Emergency Response System (PERS): PERS is an electronic device which enables individuals to secure help in an emergency. PERS is limited to those individuals who live alone, or who are alone for significant parts of the day, and have no regular caregiver for extended periods of time.

7) Case Management: Case Managers assist you in planning, coordinating, and monitoring your services. You may choose to receive case management services from either your local Area Agency on Aging or Home Health Agency. Case Management Services are provided to all Home-Based Medicaid Waiver participants.

How Do I Apply?
Contact your local Area Agency on Aging or Home Health Agency for an application and assistance in completing it, visit our contact page to find your local Area Agency on Aging office. You may also download the form from the Vermont Department of Disabilities web site: Click here to download the Home and Community Based Medicaid Waiver Services Application as a PDF, which can be printed and filled out.

Completed applications are then sent to the Designated Administrative Agency (DAA) in your area. Once your application is received by the DAA, a Case Manager will contact you to initiate the assessment process.

The amount of your "Patient Share" expense, if any, will be included on your Medicaid eligibility notice from PATH.

Appeals: Waiver applicants may appeal any decision made in regards to their waiver eligibility or Long Term Care Medicaid eligibility. Contact your Case Manager, the Department of Aging and Disabilities or the VT Health Care Ombudsman (1-800-917-7787) for more information on appeals.