Vermont Medicaid for Seniors & Long-Term Care

Seniors and people with disabilities who need Medicaid outside of a long-term care setting apply through the MABD pathway, which is separate from the standard MAGI Medicaid process. Vermont also administers Medicare Savings Programs that help low-income Medicare beneficiaries with Part B premiums and cost-sharing — these are applied for separately through DVHA.

Long-term care Medicaid has an asset test unlike standard MAGI-based Medicaid. The countable asset limit for a single Choices for Care applicant is $2,000. Exempt assets include the primary home while the applicant lives there or intends to return, or while a spouse, minor child, or disabled adult child lives there (up to a home equity limit of $752,000 in 2026), as well as one vehicle, personal belongings, and a prepaid funeral arrangement.

The income limit for nursing facility or HCBS-level Choices for Care coverage is approximately $2,982/month in 2026 — 300% of the SSI Federal Benefit Rate. Choices for Care allows a recipient to keep a portion of their own income before the rest goes toward the cost of care: $79.93/month for personal needs while living in a nursing facility, or $1,483/month for maintenance needs while living at home or in an apartment. A recipient who can return home within 6 months may also keep an additional $787.26/month toward the upkeep of their home.

Medicaid enforces a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. If income exceeds the institutional Medicaid limit, Vermont may use a Miller Trust (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Consult Vermont Medicaid or a Medicaid planning attorney before transferring assets.

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income. Vermont sets its CSRA at the federal maximum, allowing the community spouse to retain up to $162,660 of the couple's countable assets in 2026.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA), which in Vermont ranges from $2,707/month (the standard floor, unique among states in that it rises every January rather than every July) up to $4,066.50/month for a spouse with high shelter costs.

Vermont operates an estate recovery program for Medicaid members who received long-term care services at age 55 or older. DVHA may seek reimbursement from the member's estate after death. The home is exempt while a surviving spouse, minor child, or disabled child resides there. Consult a Vermont elder law attorney before transferring assets if a family member may need Medicaid LTC in the future.

Once approved for nursing facility or HCBS-level Medicaid, Vermont covers the following services for eligible seniors and adults with disabilities.