What is the Federal PACE Program?
The Program of All-Inclusive Care for the Elderly (PACE) is a national Medicare and Medicaid initiative designed to help older adults with significant health needs continue to live in their community rather than enter a nursing home. The program is administered by local PACE organizations that provide a comprehensive, coordinated set of medical and social services. A dedicated interdisciplinary team of healthcare professionals manages and delivers all aspects of a participant's care, from primary medical services and prescriptions to home care and therapy. Most services are delivered at a PACE day health center, with transportation provided for participants.
Vermont's Long-Term Care Alternative: Choices for Care (CFC)
For Vermonters seeking comprehensive, community-based long-term care, the state’s primary resource is the Choices for Care (CFC) Medicaid program. This program was designed to provide long-term services and supports for eligible individuals aged 18 and older who require a nursing home level of care. It gives participants the flexibility to receive care in their own home, in an assisted living residence, or an adult family care home. While PACE is a federally defined model, Choices for Care is Vermont’s own state-run program tailored to the needs of its residents.
Choices for Care Eligibility Requirements
To be eligible for the Choices for Care program, an individual must meet several criteria:
- Residency: Must be a Vermont resident.
- Age/Disability: Must be at least 65 years old, or 18 years or older with a physical disability.
- Clinical Need: Must meet the state's clinical criteria for a nursing home level of care. This typically means needing extensive daily assistance with activities such as dressing, bathing, and eating.
- Financial Need: Applicants must meet the financial and non-financial eligibility criteria for Long-Term Care Medicaid.
Services Offered Through Choices for Care
The services covered by Choices for Care are determined by an individual's specific needs and may include:
- Personal Care Assistance: Help with daily activities like bathing, dressing, and mobility.
- Nursing Services: Skilled nursing care and medication management.
- Adult Day Care: Provides social activities, health services, and meals at a day health center.
- Case Management: A case manager helps coordinate services and navigate the care system.
- Home Modifications: Adaptations to the home to improve safety and accessibility.
- Homemaker Services: Assistance with meal preparation, housekeeping, and shopping.
- Flexible Choices Program: An option that allows eligible individuals to self-direct their care, including hiring their own caregivers.
- Respite Care: Services to provide temporary relief for family caregivers.
Choices for Care: High Needs vs. Moderate Needs
Vermont’s Choices for Care program has different service tiers to address varying levels of need.
- High Needs Group: This tier is for individuals who meet the full nursing home level of care criteria. It provides a comprehensive package of services, including adult day care, nursing, and personal care assistance.
- Moderate Needs Group: This group is for individuals who do not yet meet the nursing home level of care criteria but need some assistance to remain at home. Services are limited and may include homemaker or adult day services.
A Comparison of PACE and Vermont's Choices for Care
| Feature | Federal PACE Program | Vermont's Choices for Care (CFC) Program |
|---|---|---|
| Availability in VT | Not operational in Vermont as of 2025. | Available statewide for eligible Vermonters. |
| Program Model | Comprehensive, integrated care model managed by a single PACE organization. | State-run Medicaid program with options for self-directed or agency-provided care. |
| Services Covered | A wide range of medical and social services, including all Medicare/Medicaid benefits, determined by an interdisciplinary team. | Supports for home, assisted living, or facility care, covering personal care, nursing, and more based on need. |
| Primary Service Site | Majority of services delivered at a PACE day health center. | Care provided at home, in assisted living, or other authorized settings. |
| Eligibility | Age 55+, meet state's nursing home level of care, live in a PACE service area, and can live safely in the community. | Age 65+ (or 18+ with disability), VT resident, meet financial criteria, and meet clinical criteria. |
How to Apply for Vermont's Choices for Care
To begin the process of applying for Choices for Care in Vermont, follow these steps:
- Obtain an application: You can download the application from the Vermont Department of Health Access website, or request one by phone.
- Submit the application: Mail your completed application to the Green Mountain Care Application and Document Processing Center.
- Determine financial eligibility: The Department of Vermont Health Access will review your financial information to determine if you meet the requirements.
- Determine clinical eligibility: The Department of Disabilities, Aging and Independent Living (DAIL) will conduct an assessment to determine if you meet the clinical criteria for the program.
- Seek assistance: For help with the application process, contact the Vermont Senior Helpline at 1-800-642-5119 or your local Vermont Association of Area Agencies on Aging.
Conclusion
While the federal Program of All-Inclusive Care for the Elderly is not available in Vermont, the state's comprehensive Choices for Care Medicaid program offers a robust alternative. This program provides eligible seniors and individuals with disabilities the necessary support to remain in their homes and communities, fostering a better quality of life and greater independence. By understanding the distinct eligibility criteria and services of Choices for Care, Vermonters can effectively navigate their long-term care options and access the assistance they need. For more information on Vermont's long-term care programs and eligibility criteria, visit the official Department of Vermont Health Access website.
