Vermont Choices for Care: High and Highest Needs: Vermont 2026 Guide
Choices for Care is Vermont’s Long-Term Care Medicaid program for older adults and adults with physical disabilities, run by the Department of Disabilities, Aging and Independent Living (DAIL) under the state’s Global Commitment to Health 1115 waiver. The Highest and High Needs groups cover people who need a nursing facility level of care and can be served at home, in an enhanced residential care setting or in a nursing facility.
Below we cover the 2026 eligibility rules for Choices for Care (High and Highest Needs), the services it can pay for, the steps to apply, how waiting lists work, and how the program sits alongside nursing home Medicaid in Vermont. For the full statewide rules on income, assets, spouses and the look-back, see our Vermont Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What Choices for Care (High and Highest Needs) is
Choices for Care combines nursing facility care and home and community-based services in one program. People in the Highest Needs group are entitled to services. People in the High Needs group are served when funds allow. Services at home can be agency-directed, consumer-directed or surrogate-directed, and Flexible Choices converts services into a budget that can pay family caregivers.
Waivers get their name from federal law: Vermont has permission to waive certain standard Medicaid rules so that money that would otherwise go only to nursing homes can pay for care at home and in community settings. Waivers are optional for states, so each sets its own services and, often, a limit on enrollment. That is the main difference from regular Medicaid benefits: meeting the rules does not by itself guarantee a slot.
Who qualifies in 2026
Vermont looks at both how much help a person needs and what they own and earn. In general, to qualify for Choices for Care (High and Highest Needs) an applicant must:
- be 18 or older with physical or aging-related limits;
- live in Vermont;
- meet the clinical rules for the Highest or High Needs group, assessed by a DAIL clinical coordinator; and
- meet Vermont’s long-term care Medicaid financial rules.
Income and assets. The financial side of Choices for Care (High and Highest Needs) follows Vermont’s long-term care Medicaid rules. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. Gifts made in the five years before applying can trigger a penalty that delays waiver services, just as it would delay nursing home coverage.
In 2026, Vermont’s income standard is $2,982 a month and the single-person asset limit is $2,000. People receiving care at home or in enhanced residential care pay a monthly share toward their care after keeping a personal maintenance allowance (DAIL lists $1,483 a month from January 1, 2026).
For reference, these are Vermont’s key 2026 long-term care Medicaid figures:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (institutional income standard) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $752,000 |
| Spouse at home: resource allowance (CSRA) | Up to $162,660 |
| Spouse at home: monthly income allowance | $2,707 (standard) / maximum $4,066.50 |
| Personal needs allowance (nursing home) | $79.93 a month |
| Look-back period | 60 months (5 years) |
Married applicants. When one spouse applies and the other stays at home, spousal impoverishment protections generally apply, so the spouse at home can keep a share of the couple’s assets and may receive part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.
Services Choices for Care (High and Highest Needs) can cover
Services are listed in a written plan of care, built from the assessment and the person’s goals. Not everyone gets every service. Depending on need, Choices for Care (High and Highest Needs) can include:
- case management
- personal care, agency or self-directed
- adult day services
- respite and companion services
- enhanced residential care in licensed residential care homes and assisted living
- assistive devices and home modifications
- personal emergency response
- Flexible Choices budgets
- nursing facility care
Limits to keep in mind. Choices for Care (High and Highest Needs) does not pay for rent, groceries or utilities; in residential settings, room and board is the resident’s responsibility. The plan of care often assumes some help from relatives where it is available. Medical care continues through Medicaid and Medicare in the usual way.
How to apply for Choices for Care (High and Highest Needs)
Here is how applying for Choices for Care (High and Highest Needs) usually works. Filing the Medicaid application and the waiver request together saves time.
- Complete Vermont’s long-term care Medicaid application (Form 202LTC) through the Department for Children and Families, Economic Services Division.
- Request a clinical assessment by a DAIL long-term care clinical coordinator, or through a home health agency or Area Agency on Aging.
- DAIL decides the need level and authorizes services.
- Choose a setting and providers, or a self-directed option.
- Services start, with periodic reassessments.
Practical tips. Keep copies of everything you send and note the name of each person you speak with. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Memory problems, falls and the need for supervision all count, even when the person can still do some tasks alone. If the answer is no, the written notice explains how to request a fair hearing and the deadline.
Waiting lists and timing
The Highest Needs group is an entitlement and does not have a waiting list. High Needs applicants may be placed on a waitlist if funds are not available.
Getting on a list early, before a crisis, is usually wise. In the meantime, families often combine state plan personal care, adult day, PACE in areas that have it, and Area Agency on Aging services. The waiver waiting lists page explains common rules.
How it relates to nursing home Medicaid
Choices for Care includes nursing facility care, so a person moves between home, residential care and a nursing facility within one program.
Choices for Care (High and Highest Needs) and nursing home Medicaid serve the same group of people; the difference is where care is given. Nursing home Medicaid is an entitlement for people who qualify, so it has no waiting list, while a waiver may. Switching settings is possible in both directions: from home to a nursing home if needs grow, and back home with help from Money Follows the Person.
Tips for families
Start early, because the money test, the assessment and any wait can all take time. Pull together five years of financial statements and keep a short care log ahead of the assessment. If income is above the limit, a Miller trust or a spend-down may apply, depending on the state. If money has been given to family in the past five years, get advice before applying. A reassessment can be requested whenever needs change.
Many families find it worthwhile to talk with a Certified Medicaid Planner before applying for Choices for Care (High and Highest Needs). A planner who knows Vermont’s rules can review income and assets, explain which program fits, map the timing against any waiting list, and help with the paperwork. Fees vary: roughly $500 to $6,000 for application help, $2,500 to $15,000 or more for full planning, and $150 to $600 an hour for advice.
Related pages
- Vermont Medicaid guide
- Vermont Choices for Care: Moderate Needs
- HCBS waivers explained
- Applying for a waiver
- Nursing home level of care
- Waiver waiting lists
- The five-year look-back
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.