State Medicaid Website: Vermont

Vermont Developmental Disabilities Council Website

Vermont Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 21,500 people with disabilities who are covered by Medicaid in Vermont. Vermont spent $16,453 for each Medicaid recipient with a disability in 2007.

14% of all people covered by Medicaid in Vermont have a disability, which is almost the same as the national percentage of Medicaid recipients with a disability (15%).

Vermont spends 42% of all the money it spends on Medicaid on services for people with disabilities, which is the same as the national percentage of Medicaid spending on these services.

Choices for Care:

This is a home and community-based services waiver designed to provide people the care they need outside of institutions. This waiver applies to people with disabilities who need high levels of services, and it uses person-centered planning and options counseling to develop a service plan.

Ages: 18 and older for people with a disability, 65 and older for people with or without a disability

Levels of Care: The plan has two options, for people who need nursing levels of care and intermediate levels of care

Options for Self-Direction: This waiver uses person-centered planning to work with the person with the disability to make a care plan.

For Nursing Levels of Care:

• Health: medication help
• Home: Personal care, meal services, homemaker services, independence support

For Intermediate Level of Care:

• Community: adult day services
• Home: homemaker services
• Social Services: limited case management

Other services available include:

• Community: adult day care, assistive devices
• Health: personal emergency response systems
• Home: personal care, respite, companion services, home modifications
• Social Services: case management

Vermont Global Commitment to Health:

This program provides access to basic services for adults and children with disabilities, including those who are also eligible for Medicare. However, people who are already covered under other waivers (including HCBS), CHIP, or those who reside in nursing or intermediate care facilities are not eligible.

• Community: transportation
• Health: chiropractic, dental, disease management, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, hospice, immunization, hospital services, mental health and substance abuse treatment, laboratory, occupational therapy, pharmacy, physical therapy, physician, podiatry, skilled nursing facilities, speech therapy, vision, x-ray
• Home: personal care
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Ages: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to an approved PACE center to be eligible.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs
• Home: home care home and environmental modifications
• Social Services: social services