Vermont Medicaid Long Term Care Eligibility
Vermont Long Term Care
1. Residency and Citizenship – the applicant must be a resident of Vermont and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested.
3. Income Limitations – If single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be less than the nursing home level of care’s cost.
- If the applicant lives at home, he/she can keep $1,058.00/month for maintenance needs.
- If the recipient lives in a nursing home, they can keep $47.66/month as a personal needs allowance.
- The recipient can keep an additional $571.53/month for upkeep of a home if they reside in a nursing facility, but plan to return within six months and no one else living in the home receives the institutionalized person’s income.
- Up to $646.33/month may be kept for dependents beyond a spouse.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Vermont include:
i. $2,000 or less in cash/non-exempt assets if single.
ii. One home is exempt (equity limit $560,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Burial plans, not exceeding $10,000 in value. The $10,000 maximum amount includes the value of all items designated for burial such as pre-paid burial contracts, the cash value of all life insurance policies, bank accounts, CDs, burial plots, head stones, etc. Interest earned after you have designated an account for burial is excluded. Funds may be added to the account(s) as long as the total burial funds do not exceed the allowed maximum of $10,000.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220. If the community spouse’s assets do not equal $119,220, the community spouse is able to retain assets from the institutionalized spouse until the amount is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $1,992. The maximum amount of income that can be retained is $2,980.50 varying by case, depending on unique living expenses. Shelter costs that exceed $159/month will increase the standard community spouse’s income allowance. Shelter costs include rent or mortgage, maintenance fees, taxes and insurance. Vermont is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
See this sheet for how an applicant will be reviewed regarding their medical eligibility: http://www.ddas.vermont.gov/ddas-forms/forms-cfc/forms-cfc-highest-needs-documents/clinical-assessment
Vermont Programs and Waivers, policies and guidelines: http://www.ddas.vermont.gov/ddas-programs/programs-cfc/programs-cfc-default-page#legislation