How to Pay for In-Home Care
How to Pay for Home Care in Vermont
Jump to a state to see its Medicaid programs, waivers, and other ways to help pay for in-home care.
Vermont families typically start by screening adults 65+ and adults 18+ with qualifying physical disabilities for Choices for Care High/Highest Needs, which meets nursing-home-level clinical criteria and Medicaid financial rules and can authorize home-based personal care, respite, companion care, adult day, assistive devices, home modifications, PERS, and case management as alternatives to facility care. Choices for Care participants can self-direct none, some, or all services, with Flexible Choices as the all-self-directed option (ARIS handles payroll for participant employees), letting personal care, respite, and companion services be purchased within an approved budget subject to worker and service rules. Adults who don't meet nursing-home-level criteria should look at Moderate Needs for limited homemaker, adult day, case management, and flexible funds, or the separate Attendant Services Program, which helps adults with permanent severe disabilities direct paid attendants under Medicaid and General Fund rules that differ, especially around spouse payment. Families should also screen Children's Personal Care Services (which now has a specific legally responsible individual payment pathway when recurring barriers prevent use of an outside attendant), pediatric/adult High Technology Home Care, the Brain Injury Program, and Developmental Disabilities Services, layering on Medicaid for Working People with Disabilities, Medicare Savings Programs, Extra Help, VPharm, Area Agency on Aging caregiver/respite programs, 3SquaresVT, Fuel Assistance, weatherization, property-tax relief, and Veteran benefits.
Updated August 2026
Reviewed by Valerie VanBooven, RN, BSN
Medicaid LTSS
Choices for Care (CFC) High / Highest Needs
YesHelps pay for: Long-term services and supports at home, in Adult Family Care, Enhanced Residential Care or a nursing facility.
Who qualifies: Generally age 65+ or age 18+ with a qualifying physical disability; must meet nursing-home-level clinical criteria and long-term-care Medicaid financial rules.
How to start: Contact DAIL Adult Services for intake/clinical screening and apply for long-term-care Medicaid.
Good to know: Family caregiver payment: Depends on service/worker rules
CFC Home-Based Service
Personal Care
YesHelps pay for: Hands-on and cueing assistance with ADLs/IADLs in the home when assessed and authorized.
Who qualifies: Must be enrolled in CFC High/Highest and have authorized need in the service plan.
How to start: Request personal-care assessment through CFC case manager/AAA.
Good to know: Family caregiver payment: Potentially under self-direction; verify relationship restrictions
Respite Care
YesHelps pay for: Temporary substitute care to relieve a primary unpaid caregiver.
Who qualifies: Authorized based on assessed need and service-plan limits.
How to start: Ask CFC case manager to assess respite need.
Good to know: Family caregiver payment: May hire qualifying workers under self-direction
Companion Care
Yes / supportiveHelps pay for: Supervision, social support and assistance that helps a person remain safely at home.
Who qualifies: Must be medically/clinically justified and authorized within CFC.
How to start: Discuss companion services with case manager.
Good to know: Family caregiver payment: May hire qualifying workers under self-direction
Adult Day Services
Indirect / partialHelps pay for: Structured daytime health, supervision and activities that can reduce home-care hours and caregiver burden.
Who qualifies: Must be assessed and authorized; provider availability varies by area.
How to start: Ask case manager about adult day options.
Good to know: Family caregiver payment: No regular family wage
Assistive Devices
IndirectHelps pay for: Equipment or devices needed to support independence and ADLs/IADLs.
Who qualifies: Must be authorized and related to assessed needs; funding rules and caps can apply.
How to start: Request through person-centered plan/case manager.
Good to know: Family caregiver payment: No
Home Modifications
IndirectHelps pay for: Accessibility adaptations that help a participant function safely at home.
Who qualifies: Must be approved as part of the CFC plan and meet program requirements.
How to start: Request home-modification assessment and prior approval.
Good to know: Family caregiver payment: No
Personal Emergency Response System (PERS)
IndirectHelps pay for: Emergency call/alert technology that can reduce risk of living alone.
Who qualifies: Available when assessed and approved under the service plan or self-directed budget.
How to start: Ask case manager or Flexible Choices advisor.
Good to know: Family caregiver payment: No
CFC Case Management
AAA Choices for Care Case Management
IndirectHelps pay for: Assessment, person-centered planning, referral/linking, monitoring and reassessment.
Who qualifies: By Jan. 1, 2026 all CFC HCBS participants, including Flexible Choices and Adult Family Care, were to have case management through a Vermont Area Agency on Aging.
How to start: Call statewide Senior Helpline to reach the appropriate AAA.
Good to know: Family caregiver payment: No
CFC Residential Alternative
Adult Family Care (AFC)
Yes - residential supportHelps pay for: 24-hour home-based support in an approved caregiver household for one or two adults, as an alternative to facility care.
Who qualifies: Must meet CFC eligibility and choose an approved AFC setting; case management is through an AAA.
How to start: Ask CFC intake/case manager about AFC.
Good to know: Family caregiver payment: Provider is paid under AFC model; relationship rules apply
Enhanced Residential Care (ERC)
Yes - residentialHelps pay for: Personal care, nursing oversight, medication help, meals, supervision and other supports in an approved residential setting.
Who qualifies: CFC eligibility plus approved ERC placement/service authorization.
How to start: Request choice counseling through DAIL/AAA.
Good to know: Family caregiver payment: No regular family wage
Self-Direction
Flexible Choices (CFC)
YesHelps pay for: All-self-directed CFC option using an individualized budget; participant manages workers and approved goods/services.
Who qualifies: Available to eligible CFC participants who choose to manage all HCBS; case management is outside the self-direction budget.
How to start: Ask CFC case manager about Flexible Choices and ARIS enrollment.
Good to know: Family caregiver payment: Potentially, subject to worker/relationship rules
Flexible Choices Service
Self-Directed Personal Care
YesHelps pay for: Participant hires/manages employees to deliver authorized personal care within the approved budget.
Who qualifies: Employee enrollment, background checks, payroll and budget rules apply.
How to start: Work with Flexible Choices advisor and ARIS.
Good to know: Family caregiver payment: Potentially; verify specific family-worker restrictions
Self-Directed Respite / Companion
YesHelps pay for: Participant-directed respite and companion services paid from the approved budget.
Who qualifies: Must fit the approved service plan and worker qualifications.
How to start: Budget with advisor and enroll worker through fiscal/payroll process.
Good to know: Family caregiver payment: Potentially; qualifying relatives may be possible depending on role
Approved Goods, Appliances, PERS & Home Modifications
IndirectHelps pay for: Budget may cover approved goods/appliances supporting ADLs/IADLs, PERS, assistive devices and home modifications.
Who qualifies: Purchase must be allowable, necessary and within the approved budget.
How to start: Discuss proposed purchase with advisor/case manager before committing funds.
Good to know: Family caregiver payment: No
Moderate Needs
Choices for Care Moderate Needs Group
Yes / limitedHelps pay for: Limited HCBS for adults with functional needs who do not meet nursing-home-level criteria.
Who qualifies: Age 18+ with qualifying functional limitation/physical condition; income guidelines and available program funding apply.
How to start: Apply through a participating case management agency/AAA.
Good to know: Family caregiver payment: Usually not a direct family wage
Moderate Needs Service
Homemaker Services
Yes / supportiveHelps pay for: Help with shopping, cleaning, laundry and other IADLs to help a person remain independent.
Who qualifies: Authorized after Moderate Needs assessment; program limits and funding availability apply.
How to start: Ask Moderate Needs case manager for homemaker authorization.
Good to know: Family caregiver payment: No regular family wage
Adult Day Services
Indirect / partialHelps pay for: Daytime supervision, health and social supports.
Who qualifies: Must be authorized under Moderate Needs and available locally.
How to start: Request adult-day screening through case manager.
Good to know: Family caregiver payment: No
Flexible Funds
Indirect / partialHelps pay for: Limited flexible funding for goods or services needed to support community living.
Who qualifies: Must be enrolled in Moderate Needs and use funds for approved needs consistent with program rules.
How to start: Develop flexible-funds budget with case manager.
Good to know: Family caregiver payment: Not an hourly caregiver wage
Physical Disability / State & Medicaid
Attendant Services Program (ASP)
YesHelps pay for: Funding for participant-directed attendants who help with bathing, dressing, eating and other ADLs.
Who qualifies: Adult 18+ with permanent severe disability, needs attendant help with at least two ADLs, and can direct care; other-program eligibility rules apply.
How to start: Contact DAIL Adult Services/Attendant Services.
Good to know: Family caregiver payment: Can include chosen attendants; spouse rules differ by funding source
ASP Service
Participant-Directed Attendant Services
YesHelps pay for: Participant hires, trains, schedules and supervises attendants.
Who qualifies: Must meet ASP eligibility and program agreement requirements; General Fund vs Medicaid rules matter.
How to start: Complete ASP assessment and employer/payroll steps.
Good to know: Family caregiver payment: Yes, for qualifying attendants
Personal Services
YesHelps pay for: Attendant care for eligible elders/adults with disabilities in the home when needed to avoid institutionalization.
Who qualifies: Medicaid/state-funding coordination applies; participants generally must use available Medicaid options first.
How to start: Ask ASP staff which funding category applies.
Good to know: Family caregiver payment: Program-specific
Paid Spouse Exception
ASP Spouse Payment Rule
Yes, in limited casesHelps pay for: A narrow pathway can preserve spouse payment in specific ASP circumstances.
Who qualifies: ASP rule says a spouse cannot be reimbursed through Medicaid attendant care, but a participant already paying a live-in spouse for IADL services may be able to remain in ASP if moving to CFC would end that payment. Verify current application of the rule.
How to start: Ask DAIL Attendant Services to review spouse relationship and funding source before changing programs.
Good to know: Family caregiver payment: Yes - limited exception
Brain Injury Medicaid
Brain Injury Program (BIP)
YesHelps pay for: Community-based rehabilitation and supports for people with moderate to severe traumatic brain injury.
Who qualifies: Program targets people with qualifying brain injury and Medicaid eligibility/clinical need; services are individualized.
How to start: Contact DAIL Adult Services for BIP intake.
Good to know: Family caregiver payment: Potentially under self-direction; verify worker rules
Brain Injury Service
BIP Home / Community Rehabilitation Supports
YesHelps pay for: Rehabilitation, supervision, crisis support, counseling, medication instruction and individualized supports in community settings.
Who qualifies: Must be authorized in the BIP plan based on rehabilitation goals and assessed need.
How to start: Develop plan with BIP case manager and provider team.
Good to know: Family caregiver payment: Program-specific
Brain Injury Self-Direction
BIP Self-Directed Services
YesHelps pay for: BIP participants can choose to manage some or all of their HCBS.
Who qualifies: Budget, payroll, support-broker and service-plan requirements apply.
How to start: Ask new BIP case manager about self-direction and support brokering.
Good to know: Family caregiver payment: Potentially, subject to worker rules
Complex Medical Care
Adult High Technology Home Care
Yes - skilledHelps pay for: Intensive in-home nursing/technology-dependent care for qualifying adults with complex medical needs.
Who qualifies: Requires medical necessity and program-specific clinical/Medicaid eligibility.
How to start: Ask DAIL Adult Services about Adult High Technology screening.
Good to know: Family caregiver payment: Usually no direct family wage; verify current rules
Children / Complex Medical Care
Pediatric High-Tech Nursing
Yes - skilledHelps pay for: In-home skilled nursing for Medicaid-enrolled children with complex technology-dependent medical needs.
Who qualifies: Clinical and Medicaid eligibility plus physician/provider documentation and authorization apply.
How to start: Contact Children with Special Health Needs / pediatric high-tech program.
Good to know: Family caregiver payment: Program-specific; verify
Children / Medicaid
Children’s Personal Care Services (CPCS)
YesHelps pay for: One-on-one help with age-appropriate ADLs such as dressing, bathing, grooming, toileting, eating and mobility.
Who qualifies: Child must be under 21, have Vermont Medicaid, documented condition/disability and medically necessary ADL assistance.
How to start: Work with trained assessor at regional designated agency to submit CPCS application.
Good to know: Family caregiver payment: Yes in qualifying circumstances
Paid Family Caregiver
CPCS Legally Responsible Individual (LRI) Payment
YesHelps pay for: Allows a legally responsible individual to be compensated for authorized children’s personal care when outside attendants are repeatedly unavailable.
Who qualifies: LRI must attest to significant recurring barriers to outside PCA availability, ability to provide medically necessary care, and use the state-sanctioned fiscal employer agent; LRI is paid the current Medicaid rate.
How to start: Ask CPCS about LRI attestation and enrollment with fiscal agent.
Good to know: Family caregiver payment: Yes - parent/stepparent/adoptive parent/legal guardian/spouse/civil union partner may qualify
CPCS Self-Direction
Family-Directed CPCS / Flexible PCA Wage
YesHelps pay for: Families direct who, how and when care is provided and use ARIS for payroll; non-LRI PCAs may be paid within the allowed wage range.
Who qualifies: Background checks, EVV, fiscal-agent and authorized-budget rules apply; LRI compensation follows separate fixed-rate rules.
How to start: Enroll approved PCA through ARIS after CPCS authorization.
Good to know: Family caregiver payment: Yes for qualifying non-LRI relatives; LRI has separate rule
I/DD Medicaid
Developmental Disabilities Services (DDS)
YesHelps pay for: HCBS and supports for Vermonters with qualifying developmental disabilities, individualized under the statewide system of care.
Who qualifies: Must meet Vermont developmental-disability eligibility and applicable Medicaid/funding priority requirements.
How to start: Contact a designated agency for intake and DAIL DDSD for system questions.
Good to know: Family caregiver payment: Depends on service and payment policy
DDS Self-Direction
DDS Self / Family Management
YesHelps pay for: Individual or family manages eligible services, hires and oversees employees and acts as employer of record with fiscal/support infrastructure.
Who qualifies: Can self/family-manage eligible services; may manage up to 12 hours/day of In-Home Family Supports or Supervised Living; some residential models cannot be self-managed.
How to start: Discuss self/family management with DDS case manager and support broker/ISO.
Good to know: Family caregiver payment: Potentially; family manager is not automatically the paid worker
DDS Service
In-Home Family Supports
YesHelps pay for: Individualized support delivered in the family home to build/maintain daily living and community skills.
Who qualifies: Must be authorized in the DDS plan; self/family management may be available within limits.
How to start: Request through DDS person-centered planning.
Good to know: Family caregiver payment: Potentially under approved worker/payment policy
Supervised Living
YesHelps pay for: Residential/home supports that can be self/family-managed within program limits.
Who qualifies: DDS rules allow self/family management of up to 12 hours/day of Supervised Living; plan and budget limits apply.
How to start: Discuss model and staffing with DDS case manager.
Good to know: Family caregiver payment: Potentially subject to policy
Respite Supports
YesHelps pay for: Intermittent/time-limited alternate caregiving to give family or shared-living providers relief.
Who qualifies: Must be authorized in the DDS plan and follow worker/training rules.
How to start: Request respite during person-centered planning.
Good to know: Family caregiver payment: May use approved family-directed respite workers
DDS Residential
Shared Living Provider
Yes - residentialHelps pay for: Individualized home support for one or two people living in the provider’s home under contract with an authorized agency.
Who qualifies: Shared Living is an agency-contracted residential model and cannot be self/family-managed as a service.
How to start: Ask DDS case manager about shared-living suitability and providers.
Good to know: Family caregiver payment: Provider compensation; relationship/conflict rules apply
Children / DDS
Family Managed Respite (FMR)
YesHelps pay for: Respite funding for families caring for a child with a disability, planned or used in response to a crisis.
Who qualifies: Available to eligible children under 21 living with biological/adoptive family or legal guardian who are not receiving HCBS funding; Medicaid and program criteria apply.
How to start: Ask regional designated agency about FMR eligibility and allocation.
Good to know: Family caregiver payment: Family directs respite worker
Family Support / DDS
Flexible Family Funding (FFF)
Indirect / partialHelps pay for: Income-based flexible funds for families caring for a person with developmental disability at home.
Who qualifies: Sliding-scale, income-based funding through designated agencies; may purchase legal goods/activities such as respite, assistive tech, home modification or household needs.
How to start: Apply through local designated agency.
Good to know: Family caregiver payment: Can offset respite and household support costs; not necessarily wages
DDS Flexible Support
Assistive Technology / Home Modification / Individualized Goods
IndirectHelps pay for: Disability-related equipment, home modifications and other individualized supports authorized in DDS plans or family funding.
Who qualifies: Must be disability-related and authorized under the applicable funding stream.
How to start: Ask DDS case manager whether Medicaid HCBS, FFF or another fund is appropriate.
Good to know: Family caregiver payment: No
DDS Safety Support
Crisis Supports / Emergency Staffing
YesHelps pay for: Time-limited support intended to stabilize health/safety and prevent loss of community placement.
Who qualifies: Must be clinically justified and authorized through DDS crisis/service planning processes.
How to start: Contact DDS case manager/designated agency when risk escalates.
Good to know: Family caregiver payment: Program-specific
Facility Transition
Money Follows the Person / Community Transition Supports
Yes / transitionHelps pay for: Transition planning and supports for eligible institutional residents moving to community settings.
Who qualifies: Eligibility depends on institutional stay, Medicaid and current transition-program criteria; availability/rules can change.
How to start: Ask DAIL Choices for Care/MFP staff before discharge planning.
Good to know: Family caregiver payment: Not a regular family wage
Medicaid State Plan
Vermont Medicaid Home Health
Yes - skilledHelps pay for: Medically necessary intermittent skilled nursing, therapy and home-health services.
Who qualifies: Requires Medicaid coverage, medical necessity, orders/certification and qualified provider.
How to start: Ask treating clinician/home health agency to verify Medicaid authorization.
Good to know: Family caregiver payment: No regular family wage
Home Telemonitoring
Indirect / medicalHelps pay for: Remote monitoring by qualified providers for Medicaid beneficiaries with serious or chronic conditions that can lead to recurrent hospital/ER use.
Who qualifies: Must meet Vermont Medicaid coverage criteria and provider requirements.
How to start: Ask clinician/home health provider whether telemonitoring is covered for the condition.
Good to know: Family caregiver payment: No
Hospice
Vermont Medicaid / Medicare Hospice
Yes - hospiceHelps pay for: Hospice team services, symptom management, equipment/medications related to terminal illness and limited respite when eligibility is met.
Who qualifies: Requires hospice eligibility/election and certified provider; custodial home-care coverage remains limited.
How to start: Request hospice evaluation from clinician or certified hospice.
Good to know: Family caregiver payment: No regular family wage
Medicaid Eligibility
Medicaid for Working People with Disabilities (MWPD)
IndirectHelps pay for: Medicaid pathway that can preserve health coverage while a person with disability works, helping free household resources for care.
Who qualifies: Vermont statute provides eligibility for workers with disabilities under specified income/resource rules; rules changed effective July 1, 2025. Verify current calculations.
How to start: Apply through Vermont health-benefit eligibility system and identify MWPD.
Good to know: Family caregiver payment: No
Medicare Cost Offset
Medicare Savings Programs (QMB / SLMB / QI)
IndirectHelps pay for: Can pay Medicare premiums and, for QMB, certain Medicare cost sharing, freeing income for home-care expenses.
Who qualifies: Medicare entitlement plus income/resource rules; Vermont may use state-specific rules.
How to start: Apply through Vermont Medicaid/benefits system or with SHIP help.
Good to know: Family caregiver payment: No
Medicare
Medicare Home Health
Yes - limited/skilledHelps pay for: Part-time/intermittent skilled nursing, therapy and home health aide services when federal coverage criteria are met.
Who qualifies: Must be homebound under Medicare rules and need qualifying skilled care; does not cover 24/7 custodial care.
How to start: Ask physician/allowed practitioner for home-health certification and use Medicare-certified agency.
Good to know: Family caregiver payment: No
Medicare Advantage
Plan Supplemental In-Home / Support Benefits
Sometimes / limitedHelps pay for: Some Medicare Advantage plans may offer limited supplemental supports such as meals, transportation, personal-care-related benefits or home safety services.
Who qualifies: Benefits vary by plan, county, eligibility and year; not a substitute for Medicaid LTSS.
How to start: Review Evidence of Coverage or call plan; compare annually.
Good to know: Family caregiver payment: Usually no direct family wage
Prescription Cost Offset
Medicare Part D Extra Help
IndirectHelps pay for: Reduces Part D premiums, deductibles and copays, freeing household funds for care.
Who qualifies: Income/resource limits apply unless automatically eligible.
How to start: Apply through Social Security or get SHIP help.
Good to know: Family caregiver payment: No
VPharm
IndirectHelps pay for: Vermont State Pharmaceutical Assistance Program that supplements Medicare Part D for qualifying Vermonters.
Who qualifies: Medicare Part D participation and Vermont VPharm income/general eligibility rules apply; statute covers income up to 225% FPL subject to program rules.
How to start: Apply through Vermont health-benefit system; secure Extra Help if eligible.
Good to know: Family caregiver payment: No
Caregiver Support
Vermont Area Agencies on Aging / National Family Caregiver Support
Indirect / respiteHelps pay for: Information, counseling, training, respite navigation and supplemental support for family caregivers.
Who qualifies: Eligibility/service availability varies; targets older adults, caregivers and kinship caregivers under Older Americans Act/state programs.
How to start: Call statewide Senior Helpline for local AAA caregiver program.
Good to know: Family caregiver payment: Usually not wages
Dementia Caregiver Support
Dementia Respite Grants
Yes / partialHelps pay for: AAA-managed respite grants may pay for in-home care, respite, homemaker or adult day services for dementia caregivers.
Who qualifies: Grant availability and local criteria vary by Area Agency on Aging.
How to start: Ask local AAA whether a dementia respite grant is currently available.
Good to know: Family caregiver payment: Generally pays respite/service, not ongoing family wage
Nutrition Cost Offset
Meals on Wheels / Senior Nutrition
IndirectHelps pay for: Home-delivered meals can reduce food preparation burden and household food costs.
Who qualifies: Local AAA/nutrition program criteria and availability apply, often focused on older adults with need.
How to start: Call Senior Helpline for local meal program.
Good to know: Family caregiver payment: No
Transportation Cost Offset
Older Adults / Disability Transportation
IndirectHelps pay for: Regional transportation can reduce family driving/caregiver time for medical visits, adult day, meals and essential trips.
Who qualifies: Eligibility and trip purposes vary by regional provider and funding source.
How to start: Ask AAA or Vermont 211 for local older-adult/disability transportation.
Good to know: Family caregiver payment: No
Assistive Technology
Vermont Assistive Technology Program
IndirectHelps pay for: Device demonstration, loan/reuse and assistance identifying technology that may reduce hands-on care needs.
Who qualifies: Program/service criteria vary by device and funding source.
How to start: Contact Vermont Assistive Technology or ask DAIL/AAA for referral.
Good to know: Family caregiver payment: No
Food Cost Offset
3SquaresVT (SNAP)
IndirectHelps pay for: Monthly nutrition benefits reduce grocery costs, preserving income for care and utilities.
Who qualifies: Household income and SNAP rules apply; expedited benefits may be available.
How to start: Apply through myVermont/DCF Economic Services.
Good to know: Family caregiver payment: No
Utility Cost Offset
Vermont Fuel Assistance / LIHEAP
IndirectHelps pay for: Helps eligible households pay home heating costs.
Who qualifies: Household income and program rules apply; benefit level depends on household and fuel-cost factors.
How to start: Apply through myVermont/DCF Economic Services.
Good to know: Family caregiver payment: No
Home Cost Offset
Home Weatherization Assistance Program
IndirectHelps pay for: Energy-efficiency improvements can reduce heating/utility expenses and improve home safety/comfort.
Who qualifies: Low-income eligibility and program capacity/technical eligibility apply.
How to start: Contact local Community Action weatherization provider or Vermont 211.
Good to know: Family caregiver payment: No
Property Tax / Housing
Vermont Homestead Property Tax Credit / Municipal Property Tax Credit
IndirectHelps pay for: Income-based tax relief can reduce housing costs and preserve funds for care.
Who qualifies: Annual filing and household-income/homestead rules apply; amounts and structure can change.
How to start: File required Vermont homestead/property-tax credit forms or consult Tax Department.
Good to know: Family caregiver payment: No
Veteran Benefit
VA Homemaker / Home Health Aide
YesHelps pay for: VA-authorized homemaker/personal-care help delivered through community agencies.
Who qualifies: VA enrollment, clinical need, eligibility and local authorization apply.
How to start: Ask VA primary care/social work for H/HHA assessment.
Good to know: Family caregiver payment: No direct family wage
Veteran Self-Direction
Veteran-Directed Care (VDC)
YesHelps pay for: Participant-directed VA budget for personal care and supports where locally available.
Who qualifies: VA eligibility, clinical need and local VDC availability required.
How to start: Ask VA Geriatrics/Extended Care or social work if VDC is available locally.
Good to know: Family caregiver payment: Potentially, under VDC worker rules
Veteran Caregiver Support
VA PCAFC Caregiver Stipend
Direct caregiver supportHelps pay for: Monthly stipend and supports for an approved primary family caregiver when Veteran/caregiver meet PCAFC criteria.
Who qualifies: Not hourly home-care wages; current PCAFC eligibility rules apply.
How to start: Apply through VA Caregiver Support.
Good to know: Family caregiver payment: Yes - stipend
Veteran Pension
VA Aid & Attendance / Housebound
Cash offsetHelps pay for: Additional pension amount can help qualifying Veterans/survivors pay for assistance at home.
Who qualifies: Must first qualify for VA pension/survivors pension and meet A&A or Housebound criteria.
How to start: File with VA or an accredited VSO.
Good to know: Family caregiver payment: Can be used for care expenses; not VA hourly wage
Private Funding
Long-Term Care Insurance / Personal Savings / Private Home Care
YesHelps pay for: Private LTC insurance, savings, retirement income, reverse-mortgage proceeds or family resources may pay for care not covered publicly.
Who qualifies: Policy terms, taxes, labor law, Medicaid transfer rules and affordability matter.
How to start: Review insurance policy and create written care/payment agreement when paying relatives privately.
Good to know: Family caregiver payment: Yes, if privately arranged and lawful
VA Benefits
VA Homemaker / Home Health Aide (H/HHA)
Direct in-home helpHelps pay for: VA-authorized personal care and homemaker assistance through community agencies.
Who qualifies: VA enrollment, clinical need, eligibility and local authorization apply. Ask VA primary care/social work for H/HHA assessment.
How to start: Ask the VA social worker or care team about VA Homemaker / Home Health Aide (H/HHA).
Good to know: Family caregiver payment: No direct family wage
Veteran-Directed Care (VDC)
Direct/self-directed home careHelps pay for: Participant-directed budget for personal care/supports where locally available.
Who qualifies: VA eligibility, clinical need and local VDC availability required. Ask VA Geriatrics/Extended Care or social work whether VDC is locally available.
How to start: Ask the VA social worker or care team about Veteran-Directed Care (VDC).
Good to know: Family caregiver payment: Potentially, under VDC worker rules
VA Skilled Home Health
Direct skilled home careHelps pay for: Intermittent skilled nursing, therapy and related home health authorized by VA.
Who qualifies: Clinical need and VA authorization/provider participation apply. Ask VA clinician for skilled-home-health referral.
How to start: Ask the VA social worker or care team about VA Skilled Home Health.
Good to know: Family caregiver payment: No direct family wage
VA Respite Care
Temporary relief for caregiverHelps pay for: In-home, adult-day or facility respite depending on eligibility and local availability.
Who qualifies: VA-enrolled Veteran with clinical need; benefit limits and availability apply. Ask VA social work/caregiver support for respite assessment.
How to start: Ask the VA social worker or care team about VA Respite Care.
Good to know: Family caregiver payment: No regular caregiver wage
VA Adult Day Health Care
Can reduce paid home-care hoursHelps pay for: Daytime health, rehabilitation and social services that can reduce home-care burden.
Who qualifies: Clinical eligibility, local availability and VA authorization apply. Ask VA Geriatrics/social work for Adult Day Health referral.
How to start: Ask the VA social worker or care team about VA Adult Day Health Care.
Good to know: Family caregiver payment: No direct family wage
VA Home Based Primary Care (HBPC)
Reduces outside medical visitsHelps pay for: Interdisciplinary primary care at home for Veterans with complex chronic conditions who have difficulty traveling.
Who qualifies: VA-enrolled Veteran with qualifying clinical need and local program availability. Ask VA primary care or social work for HBPC screening.
How to start: Ask the VA social worker or care team about VA Home Based Primary Care (HBPC).
Good to know: Family caregiver payment: No direct family wage
Program of Comprehensive Assistance for Family Caregivers (PCAFC)
Direct caregiver supportHelps pay for: Education, support and, when eligibility criteria are met, a monthly stipend and other benefits for an approved primary family caregiver.
Who qualifies: Veteran and caregiver must meet current PCAFC requirements; stipend is not hourly home-care wages. Apply through VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of Comprehensive Assistance for Family Caregivers (PCAFC).
Good to know: Family caregiver payment: Yes - stipend for approved caregiver
Program of General Caregiver Support Services (PGCSS)
Indirect caregiver supportHelps pay for: Training, coaching, peer support, referrals and caregiver resources.
Who qualifies: Generally for caregivers of Veterans enrolled in VA health care; program-specific rules apply. Contact VA Caregiver Support.
How to start: Ask the VA social worker or care team about Program of General Caregiver Support Services (PGCSS).
Good to know: Family caregiver payment: No stipend under PGCSS
VA Pension Aid & Attendance / Housebound
Cash may offset private home careHelps pay for: Additional pension amount for qualifying Veterans/survivors who need ADL help, are housebound or meet specified criteria.
Who qualifies: Must qualify for VA pension/survivors pension and meet A&A or Housebound criteria. File with VA or an accredited representative.
How to start: Ask the VA social worker or care team about VA Pension Aid & Attendance / Housebound.
Good to know: Family caregiver payment: Can be used for care expenses; not an hourly VA wage
VA Community Care Network - Vermont Region 1
May include authorized home health/community servicesHelps pay for: VA-authorized community providers can deliver approved care when Community Care eligibility/referral applies.
Who qualifies: Vermont is in CCN Region 1, administered by Optum. Non-emergency community care generally requires VA referral/authorization. Work through VA care team/community care office before scheduling non-emergency care.
How to start: Ask the VA social worker or care team about VA Community Care Network - Vermont Region 1.
Good to know: Family caregiver payment: Depends on underlying benefit
VA Caregiver Support Program - Vermont
Direct navigationHelps pay for: Navigation to respite, caregiver programs, in-home services and community resources.
Who qualifies: Each VA benefit has its own eligibility; caregiver support staff can triage options. Call the national Caregiver Support Line and request local coordinator.
How to start: Ask the VA social worker or care team about VA Caregiver Support Program - Vermont.
Good to know: Family caregiver payment: Connects to PCAFC and other programs
Vermont Office of Veterans Affairs
Indirect / temporary financial reliefHelps pay for: State Veteran benefit navigation, claims assistance/referrals and the Veteran Assistance Fund for qualifying critical needs.
Who qualifies: Benefit-specific Veteran/dependent eligibility applies; state assistance fund has residency/need rules. Contact Vermont Office of Veterans Affairs or an accredited VSO.
How to start: Ask the VA social worker or care team about Vermont Office of Veterans Affairs.
Good to know: Family caregiver payment: No direct caregiver wage
Where Vermont Families Can Start
Not sure where to begin? Match your situation to a contact below.
Choices for Care, Moderate Needs, Brain Injury, Adult High Technology and general adult LTSS questions.
DAIL Adult Services Division
CFC intake/program questions and long-term-care navigation.
Choices for Care Services
CFC case management, aging services, caregiver support, respite, meals, SHIP and local referrals.
Vermont Area Agencies on Aging / Senior Helpline
Participant-directed attendant services for adults with permanent severe disabilities; spouse/funding-rule questions.
DAIL Attendant Services
CPCS applications, LRI caregiver-payment questions and pediatric personal-care rules.
Children’s Personal Care Services
Payroll/fiscal-employer services for Vermont self-directed HCBS workers, including CFC and CPCS.
ARIS Solutions
DDS eligibility/system questions, service policy and statewide developmental-disability supports.
DAIL Developmental Disabilities Services Division
Conflict-free case management for DDS and BIP; participants choose Benchmark Human Services or The Columbus Organization.
DDS / BIP Case Management Organizations
Apply/access Medicaid health coverage, 3SquaresVT, Fuel Assistance and other state benefits.
myVermont / Vermont Benefits
Statewide referrals for benefits, Community Action, weatherization, transportation, food and local services.
Vermont 2-1-1
VA caregiver programs, respite, PCAFC/PGCSS and home-care navigation.
VA Caregiver Support
State Veteran benefit navigation, claims/referral help and Veteran Assistance Fund.
Vermont Office of Veterans Affairs
Before You Rely on Any Payment Source
Planning Issue
What to Know / What to Do
Start with the right Vermont entry door
For an older adult or adult with physical disability who may need nursing-home-level care, start with DAIL Adult Services for Choices for Care clinical intake and the local Area Agency on Aging for case management. For I/DD, start with the designated agency/DDS pathway; for children, screen CPCS and pediatric High-Tech separately.
CFC High/Highest and Moderate Needs are different programs
High/Highest Needs requires long-term-care Medicaid and nursing-home-level clinical criteria. Moderate Needs is a lower-intensity, limited-funding program for adults with functional needs who do not meet that level. Do not assume eligibility for one means eligibility for the other.
Every CFC HCBS participant now has AAA case management
Vermont’s conflict-of-interest transition moved CFC HCBS case management to the five Area Agencies on Aging. By January 1, 2026, this included Flexible Choices and Adult Family Care participants; self-directed budgets remain separate from case-management allocations.
Flexible Choices means employer responsibilities
CFC participants who self-direct workers are responsible for hiring/supervision and timely payroll information; ARIS handles payroll/fiscal functions. Background checks, EVV where applicable, approved budgets and service-plan rules still apply.
Do not generalize family-caregiver rules across Vermont programs
Vermont uses different family-worker rules for CFC/Flexible Choices, Attendant Services, CPCS and DDS. A relative being payable in one program does not mean that relationship is payable in another. Verify the exact service, funding source and worker role.
CPCS has a specific legally responsible individual payment pathway
Current CPCS rule allows a biological/adoptive parent, stepparent, legal guardian, spouse or civil-union partner to be paid only when significant recurring barriers make an outside PCA unavailable, required attestations are made, and the fiscal-agent process is used. LRI payment is at the current Medicaid rate rather than a flexible wage.
ASP spouse payment is unusually nuanced
The Attendant Services rule prohibits spouse reimbursement through Medicaid attendant care, but contains a narrow continuation rule for an existing live-in spouse paid for IADL services when moving to Choices for Care would end that payment. Have DAIL review the case before changing programs.
DDS self/family management is not the same as paying the family manager
A family member may manage authorized DDS services and act as employer of record, but that does not automatically make the manager a paid direct-support worker. Separate service, employee, legally responsible-person and payment-policy rules apply.
DDS and BIP case management changed in October 2025
Benchmark Human Services and The Columbus Organization began conflict-free case management for DDS and BIP participants on October 1, 2025. Direct-service agencies continue providing services, but case management is now separated from direct HCBS provision.
Provider workforce shortages can affect access even after authorization
Vermont has documented shortages of personal-care attendants and changed home-health rules so agencies are not treated as out of compliance when they lack staff for non-medical CFC services. Build a backup plan and consider self-direction when appropriate.
Use MWPD and household offsets to protect the care budget
For a working person with disability, screen Medicaid for Working People with Disabilities. Also apply for Medicare Savings Programs, Extra Help/VPharm, 3SquaresVT, Fuel Assistance, weatherization and property-tax relief when eligible so more household income can remain available for care.
Veterans should screen VA benefits in parallel
For a Veteran, ask about Homemaker/Home Health Aide, Veteran-Directed Care, respite, PCAFC and pension Aid & Attendance while pursuing Vermont Medicaid/HCBS. Vermont is in VA CCN Region 1 (Optum), but community care still generally requires VA eligibility and authorization.
Program rules, income limits, and availability change over time and can vary by county. Confirm current details with the program directly, or ask a home care provider in Vermont to help you navigate the application process.
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