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Vermont home care payment guide
Last updated: 13 September 2026
Paying for help at home in Vermont often takes more than one source. Medicare may cover short-term skilled home health care. Choices for Care can cover long-term personal care for eligible Vermonters. Aging services, caregiver programs, veterans benefits, insurance, and private pay can fill gaps.
Bottom Line
If you need ongoing help with bathing, dressing, toileting, eating, or moving safely, ask about Vermont’s Choices for Care program. It is the state’s main Medicaid long-term-care route for people who need a nursing-home level of care. For age 60+, call the Senior HelpLine at 1-800-642-5119. For short-term skilled nursing or therapy after illness or hospitalization, ask about Medicare home health.
Need Help Right Now?
Call 911 for immediate danger or a medical emergency. For suspected abuse, neglect, or exploitation, Adult Protective Services takes reports at 1-800-564-1612. If someone cannot safely stay home without help, call 1-800-642-5119 or dial 2-1-1 while arranging longer-term care.
Start Here
- Define the need. Skilled nursing and therapy are different from ongoing personal care, supervision, meals, and housekeeping. See GFS home care basics if needed.
- For age 60+, call 1-800-642-5119. The Senior HelpLine connects you with the correct Area Agency on Aging and can screen for care and caregiver supports. See the GFS Vermont AAA guide.
- If nursing-home-level care may be needed, start the long-term-care application. Vermont uses the 202LTC application. Green Mountain Care can mail it by calling 1-802-476-0100 or 1-833-840-0061. The state explains the process on its long-term care page.
Quick Reference: Which Route Fits?
| Need | First route | What to know |
|---|---|---|
| Short-term nurse or therapy visits | Medicare home health | Requires skilled need and homebound status; it is not general round-the-clock custodial care. |
| Ongoing hands-on personal care | Choices for Care | Requires nursing-home-level clinical need plus long-term-care Medicaid financial eligibility. |
| Some help, but not nursing-home level | Moderate Needs / AAA | Can include homemaker, adult day, case management, or flexible funds; funding is limited. |
| Severe permanent physical disability | Attendant Services Program | For adults who meet disability rules and can direct their attendant care; as checked 13 September 2026, non-Medicaid funding has a waitlist. |
| Veteran needs daily-living help | VA home/community care | VA homemaker/home health aide and Veteran-Directed Care may help when clinical and local availability rules are met. |
| Program hours do not cover everything | Insurance / private pay | Use paid hours for the hardest tasks and combine them with adult day, respite, family help, or other supports when safe. |
First, Know Which Kind of Home Care You Need
The payer depends on the work. Skilled home health includes nursing or therapy for a medical need. Personal care means help with bathing, dressing, toileting, eating, transfers, or walking. Homemaker help may include meals, cleaning, and shopping.
A person may need both. Medicare might cover skilled visits while long-term personal care needs another payer. If home is unsafe even with added help, compare home care versus assisted living before buying around-the-clock care.
What Medicare May Pay for at Home
Original Medicare can cover home health when an allowed practitioner certifies that you need part-time or intermittent skilled services and you meet Medicare’s homebound rules. Covered care can include nursing, therapy, medical social services, and some aide care while you are also receiving qualifying skilled care. See Medicare’s home health coverage page.
Medicare lists a $0 cost for covered home health services themselves. Durable medical equipment can have separate Part B cost-sharing, and the home health agency generally must be Medicare-certified.
Reality check: Medicare is not long-term custodial coverage
Medicare generally does not pay for 24-hour home care, meal delivery, unrelated homemaker work, or personal care when that is the only need. For long-term bathing, dressing, supervision, or meal help, check Vermont long-term-care programs.
If Medicare premiums and cost sharing are also straining the budget, the GFS Medicare Savings guide explains Vermont help with Medicare costs.
Choices for Care Is Vermont’s Main Long-Term Home-Care Route
Choices for Care (CFC) High/Highest is Vermont’s main Medicaid long-term services and supports program for adults 18+ who need a nursing-home level of care. Eligible people may receive services at home, in a family home, Adult Family Care, Enhanced Residential Care, or a nursing facility. See the state’s Choices for Care page.
Who may qualify
You must meet both a clinical test and long-term-care Medicaid financial rules. DAIL decides clinical eligibility based on daily-living, health, and safety needs. DVHA decides financial eligibility.
Do not screen yourself out using one income number. CFC can use a patient-share calculation, and resource rules change with living arrangement and marriage. Vermont Legal Aid explains the 2026 income rules and 2026 resource rules. Its current guide lists a $2,000 countable-resource limit for one person in a long-term-care facility and $5,000 when an applicant owns and continues living in a home; married applicants can have added spousal protections.
Do not give away money or property just to qualify
CFC asks about finances and transfers during the prior five years. Giving away money or property can affect long-term-care coverage. Get Medicaid-law advice before transferring assets. Vermont Legal Aid’s CFC requirements guide explains the review.
How to apply
- Complete the 202LTC application. Vermont keeps the current form on its CFC forms page.
- If you need a paper copy, call 1-802-476-0100 or toll-free 1-833-840-0061.
- Mail the completed application to Green Mountain Care, Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-1500.
- Respond to both financial and clinical requests; both reviews must be complete.
Home-based and self-directed choices
CFC can authorize home-based personal care and related supports. Vermont also maintains Flexible Choices and self-/surrogate-directed options, giving some participants more control over an approved care budget. That does not mean every relative can be paid or that families set their own rates.
Vermont posts a current home-care provider list. Staffing varies by region, so approval does not guarantee an aide is immediately available.
If the person is already in a nursing facility and wants to return home, ask the CFC team about Money Follows the Person. Vermont continues to post 2026 program materials for this transition route, which is designed to help people overcome barriers to moving back to a community setting.
Can Choices for Care have a waitlist?
Yes. Vermont’s current HCAR rules say Highest Needs is not subject to a waitlist. New High Needs applicants may be waitlisted when funds are unavailable. Current forms still include High Needs scoring and follow-up. Report worsening needs because reassessment may change the clinical decision.
Medicaid rule change on 1 October 2026
Vermont says federal changes will restrict Medicaid eligibility for some immigrants on 1 October 2026. If you received a state notice, follow it promptly and confirm how it affects long-term-care Medicaid. See the state’s Medicaid changes page. This guide has an early review date because of that change.
If You Do Not Meet Nursing-Home Level of Care
If you do not meet CFC nursing-home-level criteria, ask about Moderate Needs. It can provide limited homemaker, adult day, case management, and flexible-fund help. Medicaid eligibility is not required, but funding is limited. See Vermont’s Moderate Needs page.
Vermont’s five Area Agencies on Aging can screen people age 60+ for services and caregiver help. Find the service regions in the state’s AAA directory or call 1-800-642-5119.
Caregiver respite and adult day can stretch a budget
Vermont’s AAAs manage the Dementia Respite Grant and National Family Caregiver Support Program. Support may help with in-home care, respite, homemaker services, or adult day, depending on eligibility and funds. See the state’s caregiver support page.
Adult day can reduce private-care hours while providing supervision, health and social services, meals, and respite. Funding may come through CFC or another Medicaid route; private-pay fees may use a sliding scale. See the state’s adult day page.
Attendant Services Program
Vermont’s Attendant Services Program may fit an adult with a severe and permanent disability who needs physical help and can direct attendant care. The current state page says Medicaid eligibility is required for its Medicaid route and, as checked 13 September 2026, non-Medicaid funding has a waitlist. Check the program application page. GFS also has Vermont disability help.
Can a Family Member Be Paid?
Sometimes, but not automatically. CFC includes self- and surrogate-directed options. Who can be hired depends on the option, relationship, approved care plan, and program rules. Being a spouse, adult child, or other relative does not guarantee payment.
If paying a relative matters, ask at the first assessment: “Can this CFC option hire this family caregiver, and what employer, payroll, background-check, and timesheet rules apply?” See the GFS paid caregiver guide.
Helpful tip
Caregiver support and caregiver pay are different. Respite may pay for substitute care, while a self-directed Medicaid or VA option may hire an approved worker. Ask which kind is being offered.
Veterans: Check VA Home-Care Help Early
Eligible enrolled veterans may have routes separate from Vermont Medicaid. VA Homemaker/Home Health Aide can help with daily activities when clinical, community-care, and local availability rules are met. A copay may apply.
Veteran-Directed Care gives eligible veterans a budget and control over hiring workers; VA says a worker may include a family member or neighbor, subject to rules and availability.
For a veteran or survivor who qualifies for VA pension, Aid and Attendance can add to the pension when extra care rules are met. It is not a stand-alone home-care benefit for everyone.
Ask a VA social worker to screen all three routes. The VA Caregiver Support Line is 1-855-260-3274. See the GFS Vermont veteran benefits guide.
Long-Term Care Insurance and Private Pay
If a long-term care insurance policy exists, call before paying large bills. Ask what home care is covered, whether there is an elimination period, the daily or monthly maximum, and provider requirements. See the GFS long-term care insurance guide.
For private pay, prioritize hours that require hands-on help or supervision. Meal programs, adult day, transportation, home changes, and family scheduling can sometimes reduce paid hours safely.
If a bathroom, doorway, or other barrier drives care needs, home changes may reduce paid hours. See GFS home repair help.
How to Start Without Wasting Time
- List the care tasks. Write what the person cannot do safely, how often help is needed, and what happens without it.
- Document function. Ask the doctor to describe bathing, dressing, eating, toileting, transfers, walking, cognition, and safety—not only diagnoses.
- Call the Senior HelpLine. For age 60+, call 1-800-642-5119 for CFC and local supports. The GFS Vermont senior benefits guide can identify other costs to reduce.
- Check major payers first. Before heavy private spending, screen for CFC, VA, Medicare home health, and insurance.
- Keep every notice. Save applications, confirmations, assessment dates, contact names, and decisions.
Document Checklist
- Photo ID and Vermont residency information.
- Medicare, Medicaid, VA, and other insurance cards.
- Medication list and names of treating doctors.
- Recent hospital, rehabilitation, therapy, or home-health records.
- A written list of daily tasks the person cannot do safely alone.
- Income records such as Social Security, pension, wages, or VA benefits.
- Bank, investment, property, and other resource information when applying for long-term-care Medicaid.
- Records of major gifts, transfers, or property changes during the prior five years if CFC is being considered.
- Long-term care insurance policy and claim instructions, if any.
- Power of attorney or authorized-representative papers, when someone else is helping with the case.
Who Decides What?
| Question | Main decision-maker | What helps |
|---|---|---|
| Does Medicare home health fit? | Treating practitioner and Medicare-certified agency | Medical order, homebound facts, skilled nursing or therapy need |
| Is CFC financially eligible? | DVHA long-term-care Medicaid | Complete income, resource, spouse, property, and transfer records |
| Is CFC clinically eligible? | DAIL | Clear evidence of daily-living, health, cognition, and safety needs |
| Is local respite or aging help available? | Local Area Agency on Aging | Caregiver situation, age, functional needs, current local funding |
| Does VA home care fit? | VA care team / social worker | VA enrollment, clinical assessment, daily-living needs, local availability |
Phone Scripts You Can Use
Senior HelpLine — 1-800-642-5119
“I am helping a Vermont resident age [age] who needs help with [bathing/dressing/meals/supervision]. We want to keep the person at home if it is safe. Can you screen us for Choices for Care, Moderate Needs, respite, adult day, and any local caregiver support? What should we apply for first?”
Long-term-care Medicaid — 1-833-840-0061
“I need the current 202LTC application for Choices for Care. Please tell me what financial documents are required, where to send them, and how I can confirm that the financial part of the application is complete.”
Doctor or discharge planner
“Can you tell me whether this person meets Medicare home-health rules for skilled nursing or therapy? If yes, please make the home-health referral. We also need a separate plan for the nonmedical personal care Medicare will not cover.”
VA social worker
“This veteran needs help with daily activities at home. Please screen for Homemaker/Home Health Aide, Veteran-Directed Care, respite, and any pension-related Aid and Attendance option that may apply. Which services are available in this area?”
Reality Checks for Vermont Families
- Approval and staffing are different. A program may authorize care while a local agency still has trouble filling all requested hours.
- CFC is not a simple age benefit. Turning 65 does not create automatic eligibility. Clinical and financial rules still apply.
- High Needs can be waitlisted. Vermont rules allow a waitlist when funding is unavailable. Highest Needs is treated differently under the rule.
- Moderate Needs is limited. It is useful for people below nursing-home level, but the state expressly says funding is limited.
- Medicare and Medicaid solve different problems. Medicare home health is mainly skilled medical care. CFC is the stronger route for long-term personal care.
- Private pay adds up quickly. Screen for benefits, insurance, adult day, respite, and home modifications first.
Common Mistakes to Avoid
- Calling all home care “Medicare-covered.” Ask whether the service is skilled home health or long-term custodial/personal care.
- Waiting until discharge day. Start CFC, VA, and AAA calls during hospital or rehabilitation care when possible.
- Giving away assets too soon. CFC reviews five years of transfers; get advice first.
- Assuming relatives can be paid. Payment depends on the program, relationship, care plan, and employer rules.
- Ignoring a denial notice. Deadlines may run from the notice date, so ask for help quickly.
- Hiring without written terms. Put tasks, schedule, rate, minimum shift, cancellation, backup staffing, and supervision in writing.
Denied, Delayed, or Overwhelmed?
Ask for the decision in writing and follow its challenge instructions. For Choices for Care or other long-term-care problems, the Vermont Long-Term Care Ombudsman can help. Call 1-800-889-2047, ext. 3.
Do not assume every appeal has the same deadline. Act quickly if services are reduced or stopped, and ask the Senior HelpLine about temporary supports while the case is reviewed.
Vermont and Official Resources
- Senior HelpLine: 1-800-642-5119 for people age 60+ and their families.
- Green Mountain Care LTC: 1-802-476-0100 or 1-833-840-0061 for the 202LTC application and long-term-care Medicaid questions.
- Long-Term Care Ombudsman: 1-800-889-2047, ext. 3, for CFC and other long-term-care rights or service problems.
- Adult Protective Services: 1-800-564-1612 when abuse, neglect, or exploitation is suspected.
- VA Caregiver Support Line: 1-855-260-3274 for veteran caregiver support and service navigation.
- Vermont 2-1-1: dial 2-1-1 for local community resources and urgent non-emergency referrals.
Resumen en Español
En Vermont, Medicare puede pagar atención médica en el hogar por tiempo limitado cuando la persona necesita servicios especializados y cumple las reglas de Medicare. Para ayuda personal de largo plazo, como bañarse, vestirse, comer o moverse, el programa principal de Medicaid es Choices for Care. La persona debe cumplir requisitos médicos y financieros.
Si la persona tiene 60 años o más, llame a la Senior HelpLine al 1-800-642-5119. Pida información sobre Choices for Care, Moderate Needs, cuidado de relevo, centros de día y apoyo para cuidadores. Para una solicitud 202LTC, llame al 1-833-840-0061. Si recibe una denegación o tiene un problema con servicios de cuidado a largo plazo, llame al Ombudsman de Vermont al 1-800-889-2047, opción 3.
Importante: algunas reglas de Medicaid para ciertos inmigrantes cambian el 1 de octubre de 2026. Si recibió una carta del estado, confirme su cobertura antes de depender de Medicaid para pagar cuidado en el hogar.
Frequently Asked Questions
Does Medicare pay for home care in Vermont?
Medicare can pay for qualifying home health care when you need part-time or intermittent skilled services and meet its homebound rules. It can include some aide care when you are also receiving qualifying skilled care. Medicare generally does not pay for 24-hour custodial care, meals, unrelated homemaker work, or personal care when that is the only service needed.
Does Vermont Medicaid pay for nonmedical home care?
Yes, Choices for Care can pay for long-term home- and community-based services, including personal care, for eligible people who meet nursing-home-level clinical criteria and long-term-care Medicaid financial rules. The approved services and hours depend on the person’s assessment and care plan.
Can a family member be paid to provide care?
Sometimes. Choices for Care has self- and surrogate-directed options, and Veteran-Directed Care can also allow an eligible veteran to hire workers who may include family members. The exact relationship, employer, payroll, care-plan, and service rules must be checked before assuming a relative can be paid.
What if I do not meet nursing-home level of care?
Ask about Vermont’s Moderate Needs program and local Area Agency on Aging services. Moderate Needs can provide limited homemaker, adult day, case management, and flexible-fund help for people below nursing-home level, but state funding is limited. Caregiver respite and adult day may also reduce the amount of private home care needed.
Is there a Choices for Care waitlist?
Vermont’s rules say the Highest Needs group is not subject to a waitlist. New applicants who meet High Needs criteria may be placed on a waitlist when funding is unavailable. If your health or daily-living needs worsen while waiting, report the change so the program can review whether reassessment is needed.
About This Guide
This guide uses official federal, state, local, and other high-trust nonprofit and community sources mentioned in the article.
Editorial note
This guide is produced based on our Editorial Standards using official and other high-trust sources, regularly updated and monitored, but not affiliated with any government agency and not a substitute for official agency guidance. Individual eligibility outcomes cannot be guaranteed.
Verification
Last verified 13 September 2026, next review 2 October 2026.
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Please note that despite our careful verification process, errors may still occur. Email info@grantsforseniors.org with corrections and we will respond within 72 hours.
Disclaimer
This article is for informational purposes only and is not legal, financial, medical, tax, disability-rights, immigration, or government-agency advice. Program rules, policies, and availability can change. Readers should confirm current details directly with the official program before acting.
Last updated: 13 September 2026 · Next review: 2 October 2026
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