Vermont Medicaid Waivers & Home and Community Based Programs Overview

Vermont, known as The Green Mountain State, has a well-developed Medicaid Waiver and Home and Community-Based Services (HCBS) system designed to provide long-term care alternatives for seniors, individuals with disabilities, and those with chronic health conditions.

Administered by the Vermont Department of Disabilities, Aging, and Independent Living (DAIL) and the Department of Vermont Health Access (DVHA), the state’s Medicaid waiver programs allow eligible individuals to receive services in their homes or community settings rather than institutional care. Unlike most states, Vermont operates under a Global Commitment to Health 1115 Demonstration Waiver, which consolidates multiple HCBS services into a flexible, streamlined system.

Key HCBS programs include the Choices for Care (CFC) Waiver, which provides personal care, adult day services, and home modifications for seniors and adults with physical disabilities, and the Developmental Disabilities (DD) Home and Community-Based Services Waiver, which offers residential, employment, and behavioral health support for individuals with intellectual and developmental disabilities (IDD). Other significant programs include the Traumatic Brain Injury (TBI) Program, the Flexible Choices Program, which allows participants to self-direct their care, and the Children’s Personal Care Services Program, which supports children with complex medical needs.

Regulatory oversight in Vermont is managed through DAIL, DVHA, and the Division of Licensing and Protection (DLP), ensuring quality standards, provider licensing, and compliance enforcement. The state operates under a Managed Care model, with HCBS services coordinated through OneCare Vermont, an Accountable Care Organization (ACO), which integrates long-term services with medical and behavioral healthcare for better service coordination and cost-effectiveness.

Vermont has also implemented Electronic Visit Verification (EVV) for personal care services, ensuring compliance and accountability in home-based care programs. Providers must navigate Medicaid enrollment, waiver-specific service authorizations, and rigorous quality assurance measures to participate successfully in the state’s HCBS system.

With a strong emphasis on self-direction, community-based care, and person-centered planning, Vermont’s Medicaid waiver system ensures that individuals receive high-quality, sustainable long-term care while maintaining independence, dignity, and full inclusion in their communities.

---

Explore Policy and Procedure manual for licensing and certification for your state Medicaid Waiver and HCBS programs here.

Browse Policy & Procedure Manual for This State's Programs and Services