Key takeaway
Vermont is unusually flexible about paying family caregivers, especially through Choices for Care, the Attendant Services Program, and Adult Family Care, which can sometimes pay spouses.
- Choices for Care: Vermont's primary Medicaid long-term services program for adults at nursing-home level of care.
- Attendant Services Program (ASP): Lets people with physical disabilities hire and direct their own attendants, including family.
- Adult Family Care: Pays a caregiver — sometimes including a spouse — to host a qualifying adult in their home.
- Veterans: Aid & Attendance and Veteran Directed Care can fund in-home care; VDC can pay spouses.
Overview
Vermont's Department of Disabilities, Aging and Independent Living (DAIL) administers most long-term services and supports for older adults and people with disabilities. Choices for Care is the main Medicaid long-term services program, and it combines several flexible pathways for paying family caregivers, including self-directed services through the Attendant Services Program.
Compared with most states, Vermont has notably broad rules for who can be paid. Adult children, grandchildren, friends, and many other relatives can serve as paid attendants. Spouses face limits under most Medicaid options but may be paid through Adult Family Care or Veteran Directed Care. Vermont also funds limited state programs that help older adults who do not yet qualify for Medicaid.
Programs that pay family caregivers in Vermont
| Program (Type) | Care recipient eligibility | Paid family caregiver provisions |
|---|---|---|
| Choices for Care (Medicaid 1115 Waiver) | Age 65+ or adults with physical disabilities who need nursing-home level of care; income up to ~300% of SSI; assets generally ≤ $2,000 for an individual. | Funds in-home personal care, homemaker services, respite, and adult day. Family members other than spouses may be paid; some flexibility exists under specific care models. |
| Attendant Services Program (ASP) (Medicaid self-direction) | Adults with physical disabilities who can direct their own care; financial criteria depend on the funding stream (Medicaid or state-funded ASP). | Participant becomes the employer of record, sets schedules, and hires attendants. Adult children, siblings, friends, and most relatives may be hired. |
| Adult Family Care (Medicaid) | Adults who need a high level of care but want to live with a caregiver in a family setting; nursing-home level of care. | Pays the host caregiver to provide 24-hour care in the caregiver's home. In Vermont, spouses may sometimes be paid under specific eligibility rules. |
| Developmental Disabilities Services (Medicaid HCBS) | Individuals with developmental disabilities meeting institutional level of care. | Funds residential and personal supports through designated agencies. Family members (other than spouses or parents of minor children) may serve as paid staff. |
| Aid & Attendance Pension (VA benefit) | Wartime veteran or surviving spouse who needs help with activities of daily living and meets VA pension income/asset rules. | Increases pension to help pay for in-home care; can pay adult children and relatives. Spouses not paid directly. |
| Veteran Directed Care (VDC) (VA program) | Veterans in VA health care who need nursing-home level of care and live near a participating VAMC (White River Junction). | Provides a flexible monthly budget to hire caregivers, including spouses. |
Vermont Medicaid programs
Vermont Medicaid funds long-term services through Choices for Care and related options. Together they form one of the more flexible HCBS frameworks in New England.
Choices for Care
Choices for Care is Vermont's primary Medicaid long-term services program for older adults and people with physical disabilities. It funds personal care, homemaker services, respite, adult day, and home modifications.
- Three eligibility groups: highest needs, high needs, and moderate needs.
- Highest- and high-needs participants must meet a nursing-home level of care.
- Financial limits: income up to ~300% of SSI; assets generally ≤ $2,000.
- Family members other than spouses may serve as paid attendants.
Attendant Services Program (ASP)
ASP is Vermont's self-directed services option for adults with significant physical disabilities. The participant becomes the legal employer and hires their own attendants.
- Participant must be able to direct their own services or have a representative.
- A fiscal intermediary handles payroll, taxes, and worker's compensation.
- Most family members may be hired; spouse and certain parent rules may apply.
Adult Family Care
Adult Family Care places an adult in a host caregiver's home, where the caregiver provides 24-hour personal care. In Vermont, this can include certain spousal relationships, depending on case specifics.
- Caregiver receives a monthly payment for room, board, and personal care.
- Care recipient must meet nursing-home level of care.
- Spouses may sometimes serve as the host caregiver under defined rules.
State-funded supports through DAIL
Vermont also funds limited services through the Department of Disabilities, Aging and Independent Living and local Area Agencies on Aging. These programs serve residents who are not yet Medicaid-eligible.
A non-Medicaid version of the Attendant Services Program for adults with disabilities whose income is above Medicaid limits.
Federally funded under the Older Americans Act, offering respite, training, and limited stipends to family caregivers of older adults.
Who qualifies
- Vermont residents 60 or older or adults with disabilities who need help with daily activities.
- Adults above Medicaid income limits but unable to afford full private care.
- Family caregivers who need respite or supportive services.
Veterans' programs
Veterans in Vermont and their surviving spouses can use VA benefits to fund in-home care and pay family caregivers. The main paths are Aid & Attendance and Veteran Directed Care.
Aid & Attendance Pension
A&A increases the VA pension for qualifying veterans (or surviving spouses). The veteran can use the additional funds to pay a family caregiver.
- Wartime service, financial limits, and documented care needs required.
- Adult children and other relatives can be paid.
- A spouse cannot be paid directly because household income is combined.
Veteran Directed Care (VDC)
VDC provides a VA-funded monthly budget that the veteran controls. The White River Junction VA Medical Center may participate, though availability depends on capacity.
- Requires nursing-home level of care and VA health care enrollment.
- Self-directed model with a financial management services provider.
- Spouses may be paid caregivers under VDC.
Long-term care insurance
A qualifying long-term care insurance policy may pay benefits that the policyholder can use to compensate a family caregiver. Coverage and payment rules vary widely.
What to check in the policy
- Confirm coverage includes in-home personal care, not only facility care.
- Determine whether benefits are paid to the policyholder (cash/indemnity) or only to licensed agencies.
If the policy only reimburses licensed providers, some families form a small licensed home care agency under Vermont licensing rules so benefits can flow to the family caregiver.
How to apply in Vermont (step-by-step)
- Choose the likely path: Choices for Care, Attendant Services Program, Adult Family Care, state-funded supports, VA benefits, or LTC insurance.
- Collect documents: ID, Social Security number, proof of income and assets, medical records, medication list, and military service records if applicable.
- Contact the right agency:
- Choices for Care / ASP / Adult Family Care: contact DAIL or your local Area Agency on Aging for intake.
- State-funded supports: ask your Area Agency on Aging about state-funded ASP or Caregiver Support.
- VA paths: contact the White River Junction VA Medical Center or a Vermont Veteran Service Officer.
- LTC insurance: call the insurer to confirm caregiver-payment rules.
- Complete a clinical assessment to determine level of care and a financial review.
- Select your caregiver, complete training and background checks, and enroll with the fiscal intermediary or provider.
- Begin services. Submit time sheets, keep care logs, and prepare for annual reassessment.
Vermont paid caregiver FAQs
What is the Attendant Services Program and can a family member be paid through it?
ASP is Vermont's self-directed services option for adults with physical disabilities. The participant becomes the employer of record and hires their own attendants, who can include most family members.
Can a spouse be paid as a caregiver in Vermont?
In some cases yes. Adult Family Care can pay a spouse under specific eligibility rules, and Veteran Directed Care can pay spouses for eligible veterans. Standard Choices for Care personal care does not allow spouses to be paid.
What is Adult Family Care in Vermont?
Adult Family Care is a Medicaid program that pays a host caregiver to provide 24-hour personal care in their own home for a qualifying adult. In Vermont, the host can sometimes be a spouse depending on the situation.
How long does Choices for Care approval take?
Typical timelines run 60 to 120 days from application to start of services, depending on the assessment schedule and any documentation needs.
Do I need a license or certification to be a paid family caregiver in Vermont?
Formal licensure is not usually required, but background checks, basic training, and enrollment with the fiscal intermediary or provider agency are mandatory.
