How to Apply for Choices for Care in Vermont Without a Geriatric Care Manager

You don't need a geriatric care manager to apply for Choices for Care. The application process is straightforward if you know the sequence: confirm clinical and financial eligibility, gather documentation, contact your regional Area Agency on Aging to schedule the ILA assessment, and submit the Medicaid application through the Department of Vermont Health Access. Thousands of Vermont families complete this process every year without professional help.

What makes it feel overwhelming isn't the complexity of any single step — it's that the information is scattered across a dozen state websites, and no one hands you a checklist. This guide walks through the entire process in order.

Step 1: Determine Clinical Eligibility Before You Apply

Choices for Care has two gates: clinical need and financial eligibility. The clinical gate comes first because it determines which tier your parent qualifies for — and the tiers have different implications for waitlists and services.

Highest Needs — your parent requires nursing facility level of care and meets the clinical criteria for immediate placement. This is an entitlement in Vermont: if your parent qualifies clinically and financially, services cannot be capped or waitlisted.

High Needs — your parent requires nursing facility level of care but at a level below Highest Needs. This is not an entitlement. When state funding runs out, applicants go on a waitlist.

Moderate Needs Group (MNG) — your parent needs some assistance but doesn't meet nursing facility level of care. Different financial rules apply (the adjusted-income formula), and this group has its own waitlist.

The clinical determination happens through the ILA (Independent Living Assessment), conducted by a nurse assessor who visits your parent's home. You request this assessment through your regional Area Agency on Aging — you don't schedule it directly with the state. The assessor evaluates:

• Activities of Daily Living (ADLs): bathing, dressing, toileting, transferring, eating
• Instrumental Activities of Daily Living (IADLs): medication management, meal preparation, housekeeping, transportation
• Cognitive function and behavioral needs
• Fall history and safety risks
• Current informal support (family caregiving hours)

What you can do to prepare: Before the assessment, document your parent's daily routine for a typical week — when they need help, with what specific tasks, and how often. The assessor's visit is a snapshot; if your parent has good days and bad days, the documentation ensures the bad days are represented. The ADL documentation worksheet in the Aging in Place in Vermont guide provides the exact categories the ILA assessor uses.

Step 2: Run the Financial Eligibility Math

Don't wait for the clinical assessment to start the financial calculation — run the numbers now so you know where you stand.

For High/Highest Needs (2026 thresholds)

• Monthly income limit: $2,982 (300% of the SSI Federal Benefit Rate)
• Countable asset limit: $2,000 for an individual
• Homeowner HCBS limit: Single homeowners who choose home and community-based services may have a $10,000 countable asset limit; the primary home itself is exempt under the applicable rules
• Exempt assets: Primary home (while occupied or with intent to return), one vehicle, personal effects, burial funds up to $10,000, term life insurance

For Moderate Needs Group

The MNG uses a different formula — the adjusted-income calculation:

1. Take countable assets above $10,000
2. Divide by 12 to get a monthly asset-income figure
3. Add that to actual monthly income
4. Deduct recurring medical expenses
5. Compare the result to the MNG income standard

This calculation is where most families get stuck. It's not intuitive, and the state's own materials don't walk through it step by step. The guide includes a worksheet that takes you through each line.

The Medically Needy Spend-Down

Vermont has no rigid income cap for long-term care Medicaid — if your parent's income exceeds the limit, they can qualify through the Medically Needy pathway by spending down excess income on medical expenses each month. Vermont doesn't require a Miller Trust (unlike many states). The Protected Income Level is $1,375 per month outside Chittenden County and $1,483 inside Chittenden County. Any income above this level gets spent down through documented medical expenses.

Step 3: Gather Documentation Before Contacting the AAA

Having these documents ready before your first call saves weeks of back-and-forth:

• Income verification: Social Security benefit letter (SSA-1099), pension statements, any other income documentation
• Asset documentation: Bank statements (last 3 months), investment account statements, life insurance policies with cash value, property deeds
• Medical records: Primary care physician's most recent notes, hospital discharge summaries (if recent), medication list, specialist reports relevant to care needs
• Insurance information: Medicare card, any supplemental insurance, long-term care insurance policy (if applicable)
• Legal documents: Power of attorney (if established), advance directive, any existing trust documents
• Housing information: Property tax bill, mortgage statement, homeowner's insurance declaration page

Step 4: Contact Your Regional AAA

Vermont has five Area Agencies on Aging, each covering specific counties:

• Age Well — Addison, Chittenden, Franklin, Grand Isle counties
• Central Vermont Council on Aging (CVCOA) — Lamoille, Orange, Washington counties
• Northeast Kingdom Council on Aging (NEKCOA) — Caledonia, Essex, Orleans counties
• Senior Solutions — Windham, Windsor counties
• Southwestern Vermont Council on Aging (SVTCOA) — Bennington, Rutland counties

Call the AAA for your parent's county and tell them you want to apply for Choices for Care. They will:

1. Conduct an initial phone screening
2. Schedule the ILA clinical assessment
3. Help you understand which application forms you need
4. Connect you with a case manager after eligibility is determined

You can also call the Senior HelpLine at 1-800-642-5119 if you're not sure which AAA serves your parent's area.

Step 5: Complete the Medicaid Application

The financial application goes through DVHA (Department of Vermont Health Access). Submit Form 202LTC:

• By mail to the Green Mountain Care Application and Document Processing Center in Waterbury
• By fax
• In person at a regional DVHA field office

The application asks for the financial information you gathered in Step 3. Common reasons applications get delayed:

• Missing bank statements (they need 3 months, not just the most recent)
• Failing to report all income sources (including small pensions or annuities)
• Not providing documentation of the home's value for the homeowner limit
• Missing signatures on authorization forms

A complete, well-documented application typically processes in 30-45 days. An incomplete one can take 90 days or more as DVHA requests additional documentation in rounds.

Step 6: Choose Your Service Setting

Once approved, your parent chooses among several settings — this is the "choice" in Choices for Care:

• Traditional Home-Based services — agency-provided aides visit on a schedule
• Flexible Choices (consumer-directed) — your parent hires their own caregiver through ARIS Solutions as fiscal agent, with more control over who provides care and when
• Adult Family Care — care in an unlicensed shared-living home
• Enhanced Residential Care — assisted living facilities that accept CFC

For families doing this without a care manager, Flexible Choices is often the most practical option because it gives you direct control over hiring and scheduling rather than depending on an agency's availability — which matters in Vermont's tight direct care workforce.

Who This Is For

• Families applying for Choices for Care for the first time who want to handle the process themselves
• Adult children who are organized and willing to work through a multi-step application process
• Anyone who wants to understand the system before deciding whether to hire professional help
• Families whose parent likely qualifies on straightforward financial criteria (clear income/asset situation)

Who This Is NOT For

• Families facing a Medicaid application denial who need to file an administrative appeal — consider an elder law attorney
• Situations involving complex asset transfers, trusts, or look-back period concerns — legal advice is warranted
• Parents who need immediate placement and can't wait for the standard application timeline

The Honest Tradeoff

Doing this yourself takes time. Plan for 15-20 hours total across the full process — gathering documents, filling out applications, preparing for the clinical assessment, making follow-up calls. A geriatric care manager ($150-$250/hour) would handle much of this coordination, but the total cost typically runs $1,500 to $3,000 for the application process alone.

The Aging in Place in Vermont: Home Care, Waivers & Support Guide compresses the self-guided path by giving you the exact sequence, thresholds, worksheets, and form references in one document — so your 15-20 hours are spent executing, not researching.

Frequently Asked Questions

How long does the Choices for Care application process take?

From first contact with the AAA to a coverage decision, timing varies with assessment scheduling and application completeness. DVHA's financial determination has a 45-day regulatory deadline after a complete application is received; incomplete applications can stretch this to 90+ days.

What happens if my parent is put on a waitlist?

High Needs and Moderate Needs Group services are not entitlements — they're subject to available funding. If your parent is waitlisted, the AAA can help connect you with interim resources: Moderate Needs Group services (if your parent qualifies for the lower tier while waiting for High Needs), community programs like Meals on Wheels and E&D transportation, and respite grants for family caregivers. Highest Needs is an entitlement and cannot be waitlisted.

Can I apply for Choices for Care while my parent is in the hospital?

Yes, and this is actually one of the most common application scenarios. Hospital discharge planners can help initiate the process and coordinate with the regional clinical team. Starting the application during a hospitalization can help organize the medical documentation needed for the assessment.

Do I need power of attorney to apply on my parent's behalf?

If your parent is competent and can sign the application themselves, you don't need power of attorney — you can help them fill out the paperwork and they sign it. If your parent lacks capacity to understand and sign the application, you'll need either a durable power of attorney (the financial type) or court-appointed guardianship. Vermont's durable power of attorney is established under Chapter 127 of Title 14.

What if my parent's income is slightly above the limit?

Vermont's Medically Needy spend-down pathway means there is effectively no hard income ceiling for long-term care Medicaid. If your parent's income exceeds the standard, they spend down the excess on documented medical expenses each month. No Miller Trust required — Vermont is one of the easier states for this pathway.

See more Vermont guides →