Vermont Medicaid pays for in-home personal care and related services through 3 programs, including the Choices for Care - High/Highest Needs, Home-Based option and the Choices for Care - Flexible Choices (self-directed). Choices for Care operates within Vermont's Global Commitment to Health 1115 Waiver (HCAR 7.102) and is run by DAIL's Adult Services Division, with Area Agencies on Aging providing case management. Confirm state plan personal care and developmental services with DAIL.
Which Vermont waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Choices for Care - High/Highest Needs, Home-Based option
Population
Aging or physically disabled Vermont adults who meet nursing home level of care (High or Highest Needs Group) and are financially eligible for long-term care Medicaid.
Services covered
personal care
respite
companionship
adult day services
personal emergency response
assistive devices and home modification funds
case management
Billing format
DAIL issues a service authorization that guides delivery and Medicaid payment; care is provided by certified home health or home care agencies (non-medical home care agencies may enroll since 2024-10-25) or self-directed caregivers.
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
