Choices for Care: Vermont's Medicaid Waiver Program
Choices for Care is Vermont's flagship program for seniors who need help staying at home. It is a Medicaid waiver program that provides home and community-based services as an alternative to nursing home placement — and Vermont's version is one of the most flexible in New England.
What Choices for Care covers: Personal care assistance (bathing, dressing, toileting, transferring), homemaker services (cooking, cleaning, laundry, errands), adult day services, respite care, companion services, assistive technology, home modifications, and care management.
Who qualifies: Vermont residents who meet Medicaid financial eligibility and have a clinical need for nursing facility-level care. Vermont expanded Medicaid more broadly than most states, so the income threshold is higher than you might expect. A single person can qualify with income up to approximately $2,829/month (2024 figures — check current limits).
The three tiers:
The Highest Need tier serves people who meet nursing facility clinical criteria. This provides the most comprehensive package of services.
The High Need tier serves people with significant but not nursing-facility-level needs. Services are still substantial but may have some limitations.
The Moderate Needs tier is the broadest — it serves people who need some help to remain independent but do not meet the clinical threshold for the higher tiers. This tier covers case management, adult day, and limited personal care.
How to apply: Contact your local Area Agency on Aging or the Department of Disabilities, Aging, and Independent Living (DAIL) at 802-241-2401. A clinical assessment determines your tier.
Key advantage: Vermont's self-directed option allows you to hire and manage your own caregivers, including family members. You receive a budget and decide how to spend it on the services you need most.
Support and Services at Home (SASH)
SASH is a Vermont innovation that coordinates health and support services for seniors living in affordable housing communities and surrounding neighborhoods. It is one of the most creative aging-in-place programs in the country.
How SASH works: A SASH coordinator and a wellness nurse are embedded in participating housing communities. They conduct health assessments, connect residents with services, coordinate care between providers, and run wellness programs — all on-site where people live.
What SASH provides: Health screenings and chronic disease management, medication management support, connections to home care and community services, exercise and wellness programs, social activities to reduce isolation, and help navigating benefits like Medicare and Medicaid.
Who can participate: SASH is available to residents of participating affordable housing properties and to community members in surrounding areas. You do not need to live in the housing community to access some SASH services.
Cost: SASH services are free to participants. The program is funded through Medicare, Medicaid, and grants.
Where SASH operates: Over 140 housing communities across Vermont participate. Contact Cathedral Square (the program administrator) at 802-863-6323 or your local Area Agency on Aging to find a SASH site near you.
Private-Pay Home Care Agencies
If you do not qualify for Medicaid or need services beyond what public programs cover, private home care agencies are the next option.
What private agencies provide: Companion care (conversation, meal prep, light housekeeping, errands), personal care (bathing, dressing, grooming, toileting), medication reminders, transportation to appointments, overnight and live-in care, and specialized dementia care.
Cost in Vermont: $25–$35 per hour for non-medical home care. Live-in care runs $250–$350 per day. The statewide average is approximately $30/hour, which is slightly below the national average but varies by region — rates near Burlington tend to be higher.
How to choose an agency: Verify the agency is licensed by the Vermont Department of Disabilities, Aging, and Independent Living. Ask about caregiver screening (background checks, references), training requirements, and supervision practices. Request references from current clients. Understand the cancellation and minimum-hours policies.
Key agencies in Vermont: Several agencies serve the entire state, while others focus on specific regions. Your Area Agency on Aging maintains a current list of licensed agencies in your area.
Home Health Agencies (Medical Home Care)
Home health care is different from home care. Home health provides skilled medical services — nursing, physical therapy, occupational therapy, speech therapy — in your home, typically after a hospitalization or for ongoing medical conditions.
Medicare coverage: Medicare covers home health services if you are homebound and need skilled care ordered by a physician. There is no copay for Medicare-covered home health. This is one of the most underutilized Medicare benefits.
What home health covers: Skilled nursing (wound care, injections, IV therapy, medication management), physical therapy, occupational therapy, speech therapy, and medical social work.
Vermont's home health agencies: Vermont has a network of home health agencies that cover the entire state. The Visiting Nurse Associations (VNAs) are the largest providers. Your doctor or hospital discharge planner can make a referral.
Vermont's Area Agencies on Aging
Vermont's five Area Agencies on Aging (AAAs) are the front door to nearly every aging service in the state. They provide information, assessment, care planning, and direct services.
Central Vermont Council on Aging serves Washington, Lamoille, and Orange counties. Based in Barre. 802-479-0531.
Council on Aging for Southeastern Vermont serves Windham and Windsor counties. Based in Springfield. 802-885-2669.
Northeastern Vermont Area Agency on Aging serves Caledonia, Essex, and Orleans counties. Based in St. Johnsbury. 802-748-5182.
Senior Solutions serves Bennington and Rutland counties. Based in Rutland. 802-786-5990.
Age Well serves Addison, Chittenden, Franklin, and Grand Isle counties. Based in Burlington. 802-865-0360.
What AAAs provide: Information and referral for all aging services, options counseling to help you understand your choices, Medicare and Medicaid benefits counseling (SHIP program), meals (congregate and home-delivered), transportation assistance, family caregiver support, case management for complex situations, and legal assistance referrals.
Veteran-Specific Home Care in Vermont
Vermont veterans have access to additional home care programs through the VA:
VA Home Based Primary Care: A VA physician-led team provides comprehensive care in the veteran's home. Available to veterans enrolled in VA healthcare who have complex chronic conditions.
VA Homemaker/Home Health Aide Program: Provides personal care and homemaker services to veterans who need help with daily activities.
Veteran Directed Care: Similar to Choices for Care's self-directed option — the veteran receives a budget and hires their own caregivers.
Aid and Attendance Pension: A VA pension benefit that provides additional monthly income ($1,000–$2,700+) for veterans or surviving spouses who need regular help with daily activities. This money can be used to pay for home care.
Contact the White River Junction VA Medical Center at 802-295-9363 or your local veterans service officer.
How to Get Started
The most efficient path through Vermont's home care system:
First, call your Area Agency on Aging. Describe your situation. They will assess your needs, screen for program eligibility, and help you understand your options. This call is free and saves hours of research.
Second, if you may qualify for Medicaid, pursue Choices for Care. It provides the most comprehensive coverage at the lowest cost. The application process takes time, so start early.
Third, look into SASH if you live in or near an affordable housing community. The wellness coordination and social connection SASH provides complement other home care services.
Fourth, if you need services immediately or do not qualify for public programs, contact licensed private home care agencies for rates and availability. Your AAA can provide a list.
Fifth, if you are a veteran, contact the VA. Veterans benefits can be combined with state programs to cover more of your care needs.
Frequently Asked Questions
Private-pay home care in Vermont costs $25–$35 per hour, with a statewide average around $30/hour. Live-in care costs $250–$350 per day. If you qualify for Choices for Care (Medicaid waiver), services may be covered at no cost. Contact your Area Agency on Aging for help finding the most affordable option.
Choices for Care is Vermont's Medicaid waiver program providing home and community-based services as an alternative to nursing home care. It covers personal care, homemaker services, adult day, respite care, and more. It has three tiers based on need level, and includes a self-directed option where you can hire your own caregivers.
Support and Services at Home (SASH) is a free Vermont program that embeds health coordinators and wellness nurses in affordable housing communities. They provide health screenings, chronic disease management, service coordination, and wellness programs. Over 140 communities participate statewide.
Yes, through Choices for Care's self-directed option. If your loved one qualifies for the program, they receive a budget and can hire caregivers of their choice, including family members. The VA's Veteran Directed Care program offers a similar option for eligible veterans.
Call your local Area Agency on Aging. Vermont has five AAAs covering the entire state. They assess your needs, screen for program eligibility, and connect you with appropriate services — all for free. This single call is the most efficient starting point.
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