Vermont’s Medicaid program is called Green Mountain Care — and Vermont is among the most health-insured states in the country, with one of the lowest uninsured rates in the United States even before the ACA.
That’s not an accident.
Vermont had already built near-universal coverage for low-income residents through earlier state programs like VHAP and Dr. Dynasaur — which is why ACA expansion in 2014 produced less dramatic enrollment growth here than in states with larger coverage gaps.
Two features make Vermont’s Medicaid distinctly different from most states in this series:
No Qualified Income Trust required. Vermont is a “spend-down” state — when a senior’s income exceeds the long-term care Medicaid limit, they use the Medically Needy pathway to deduct medical expenses rather than establishing a QIT. This is simpler and less legally complex than the QIT structure required in Texas, Pennsylvania, Tennessee, and most other states.
Dr. Dynasaur — one of the most recognizable Medicaid program names in the country. Children up to age 19 and pregnant women qualify for Green Mountain Care through Dr. Dynasaur, with income thresholds reaching 312% FPL for children. Dr. Dynasaur monthly premiums are currently suspended indefinitely, making coverage free for all enrolled children regardless of income.
This guide covers every Vermont Medicaid program, 2026 income limits, the Choices for Care HCBS waiver structure, the IHIP immigrant coverage pathway, Vermont’s prescription assistance programs, and how to apply through Vermont Health Connect. For a comparison to other states, see Medicaid income limits across all 50 states.
Vermont Medicaid Programs
Green Mountain Care (Medicaid for Children and Adults — MCA) is the base Medicaid program covering children, pregnant women, parents, and adults up to 138% FPL.
ACA expansion in Vermont has been in effect since 2014. Adults 19–64 earning up to 138% FPL qualify with no asset test and no dependent-children requirement.
Dr. Dynasaur provides free or low-cost health coverage for children under age 19 and pregnant women.
Vermont’s CHIP is delivered through Dr. Dynasaur — covering children up to 312% FPL with no asset test. Monthly premiums are suspended indefinitely, meaning Dr. Dynasaur is currently free regardless of where a family’s income falls within the 312% FPL threshold. Pregnant women qualify through Dr. Dynasaur up to 213% FPL, with 12 months of postpartum coverage.
IHIP (Immigrant Health Insurance Plan) covers immigrants who would otherwise qualify for Medicaid or Dr. Dynasaur except for their immigration status.
Vermont offers state-funded coverage for immigrants who meet income requirements but don’t meet federal immigration status requirements for standard Medicaid. This program covers children and pregnant women specifically. This pathway is unique to Vermont among states covered in this series.
MABD (Medicaid for the Aged, Blind, and Disabled) covers low-income elderly (65+), blind, or disabled Vermonters who do not need nursing home care.
Vermont’s MABD income limit has a unique county-specific variation: $1,375/month outside Chittenden County and $1,483/month inside Chittenden County (both for singles and married couples combined). This county-differentiated income limit is unlike any other state in this series. Asset limit: $2,000 (single), $3,000 (couple).
Nursing Home Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.
This is an entitlement. Income limit: $2,982/month (2026). Asset limit: $2,000 (single).
Choices for Care (CFC) is Vermont’s primary HCBS waiver program for seniors and adults with disabilities who need nursing home-level care but want to remain at home or in a community setting.
Choices for Care uses a structured needs-level tiering system: Highest Needs, High Needs, and Moderate Needs. Each tier determines the services available and the level of care coordination provided. Income limit: $2,982/month for the Highest Needs group. Slots are limited — waiting lists may apply.
VPharm — Vermont’s prescription assistance program for Vermonters enrolled in Medicare Part D.
VPharm helps Medicare-enrolled Vermonters manage prescription drug costs based on income, disability status, and age. It operates separately from standard Green Mountain Care coverage.
Healthy Vermonters — a prescription drug discount program for Vermonters who don’t qualify for full Medicaid.
There is no monthly premium for Healthy Vermonters. Eligibility is based on household income. This is a distinct pathway for Vermonters who need prescription help but don’t qualify for comprehensive Medicaid coverage.
Income Limits — 2026
All figures are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.
| Program | Single | Married (Both Applying) |
|---|---|---|
| Nursing Home / Choices for Care (Highest Needs) | $2,982/mo | $5,964/mo |
| MABD (outside Chittenden County) | $1,375/mo | $1,375/mo combined |
| MABD (inside Chittenden County) | $1,483/mo | $1,483/mo combined |
| ACA Expansion Adults (19–64) | $1,799/mo (138% FPL) | $2,432/mo |
| Children / Dr. Dynasaur | Up to ~$4,074/mo (312% FPL) | — |
| Pregnant Women / Dr. Dynasaur | Up to $2,787/mo (213% FPL) | — |
Note: The source document states 317% FPL for children and 256% FPL for pregnant women. Vermont Health Connect currently lists 312% FPL for children and 213% FPL for pregnant women. Verify current thresholds at vermonthealthconnect.gov.
Key Notes on Vermont’s Income Rules
No QIT required in Vermont. Vermont is a Medically Needy state — meaning excess income above the nursing home limit is handled through medical expense spend-down, not a Qualified Income Trust.
This is a significant planning difference. In Texas, Pennsylvania, Tennessee, and most other states, seniors with income above the LTC limit must establish an irrevocable QIT trust account and deposit excess income monthly. In Vermont, instead of a QIT, you deduct qualifying medical expenses from countable income to bring it below the threshold.
Personal Needs Allowance = $79.93/month. Vermont’s nursing home PNA is confirmed at $79.93/month for 2026 — the highest in this Medicaid article series (TX: $75, SC: $65, TN/RI: $50, PA/UT: $45, SD: $30). Vermont’s nursing home residents retain more discretionary income than in any other non-expansion state covered so far.
MABD county difference. The $108/month gap between Chittenden County (Burlington, Vermont’s most expensive area) and the rest of the state reflects Vermont’s cost-of-living adjustment for its most urban county. No other state in this series differentiates income limits by county for the ABD program.
Dr. Dynasaur premiums suspended. Vermont suspended Dr. Dynasaur monthly premiums indefinitely — meaning all enrolled children and pregnant women pay nothing for coverage, regardless of where their income falls within the 312% FPL threshold.
Postpartum coverage: 12 months after the end of pregnancy. Coverage can only be lost during this period by moving out of Vermont or failing to provide required citizenship/immigration documentation.
Federal Poverty Level Reference — 2026
| Household Size | 100% FPL | 138% FPL (Adults) | 213% FPL (Pregnant) | 312% FPL (Children) |
|---|---|---|---|---|
| 1 | $1,304/mo | $1,799/mo | $2,787/mo | ~$4,074/mo |
| 2 | $1,762/mo | $2,432/mo | $3,754/mo | ~$5,502/mo |
| 3 | $2,221/mo | $3,064/mo | $4,730/mo | ~$6,930/mo |
| 4 | $2,679/mo | $3,697/mo | $5,707/mo | ~$8,356/mo |
Use the federal poverty level calculator to find the exact threshold for your household size.
Asset Rules
No asset test applies to ACA expansion adults, children, or pregnant women. Asset limits apply to nursing home, Choices for Care, and MABD programs.
| Situation | Countable Asset Limit |
|---|---|
| Single applicant (LTC / Nursing Home / Choices for Care) | $2,000 |
| Married, both applying (LTC) | $4,000 |
| Married, one applying — applicant | $2,000 |
| Married, one applying — community spouse | Up to $162,660 (CSRA) |
| MABD Regular Medicaid (single) | $2,000 |
| MABD Regular Medicaid (couple) | $3,000 |
CSRA: The community spouse may keep up to 50% of the couple’s total countable assets, up to $162,660. If the non-applicant’s share falls below $32,532, they may keep up to 100% of assets up to that floor.
Home equity limit: $730,000. Primary home is exempt while the applicant or spouse resides there or intends to return.
Exempt (Non-Countable) Assets
- Primary home (within the $730,000 cap)
- One vehicle
- Household goods and personal effects
- Irrevocable Funeral Trusts (IFTs)
- Medicaid Compliant Annuities
- Life insurance with face value $1,500 or less
Vermont’s Medically Needy Pathway — No QIT Needed
Vermont is one of a minority of states that does not require a Qualified Income Trust for LTC applicants with income above the limit.
Instead, Vermont uses the Medically Needy spend-down pathway:
If your income exceeds $2,982/month (the nursing home limit), you deduct qualifying medical expenses from your countable income to bring it below the threshold. The amount you spend on medical bills in a given period “spends down” your countable income to the Medically Needy Income Level.
What qualifies as deductible expenses: Nursing home bills, medical premiums, prescription costs, medical equipment, home health care bills, and other unreimbursed medical expenses.
This is procedurally simpler than a QIT — there’s no separate trust account, no attorney required to draft trust documents, and no bank account to maintain. However, it does require careful tracking of medical expenses.
Consult a Vermont Certified Medicaid Planner or the Office of the Health Care Advocate (1-800-917-7787) for guidance on how the spend-down works for your specific situation.
The Choices for Care Waiver
Vermont’s Choices for Care HCBS program uses a structured tiering system to assign services based on level of need.
Highest Needs Group: For individuals who need the most intensive support — equivalent to nursing home level of care. Full HCBS services including personal care assistance, adult day, home modifications, meals, and emergency response systems. Income limit: $2,982/month. Asset limit: $2,000 (single).
High Needs Group: For individuals who need regular support but whose needs are somewhat less intensive than the Highest group.
Moderate Needs Group: For individuals who need supportive services but can be managed with a lower level of intervention.
The tiering system means that your specific service plan is calibrated to where you fall in the needs assessment — not a one-size-fits-all package. Vermont’s Choices for Care assessment is conducted by the Department of Disabilities, Aging and Independent Living (DAIL).
Choices for Care is not an entitlement — slots are limited and waiting lists may apply. Contact DAIL at 1-800-642-5119 to initiate the assessment process early.
Vermont’s 60-Month Look-Back Period
Vermont enforces a 60-month (5-year) look-back for Nursing Home Medicaid and Choices for Care.
When you apply, DVHA reviews all asset transfers from the 5 years before your application date. Transfers below fair market value trigger a penalty period of ineligibility.
Exempt transfers:
- Transfers to a spouse
- Transfers to a blind or disabled child
- Home transfer to a caregiver child who lived there at least 2 years before institutionalization and whose care delayed nursing home placement
- Transfer to a sibling with an equity interest who lived there at least 1 year before institutionalization
No look-back applies to MABD, ACA expansion adults, children, or pregnant women.
MABD applicants should note: although the look-back doesn’t apply to MABD itself, past transfers could create problems if you later need nursing home or Choices for Care eligibility.
Medical and Functional Requirements
To qualify for Nursing Home Medicaid or Choices for Care, applicants must demonstrate Nursing Facility Level of Care (NFLOC) through documented limitations in:
ADLs: Mobility, bathing, dressing, eating, and toileting.
IADLs: Cooking, shopping, managing finances, medication management.
Cognitive or behavioral issues: Alzheimer’s or dementia — diagnosis alone is not sufficient.
For MABD, proof of disability (65+ age, blindness, or SSA-defined disability) is required — NFLOC is not necessary.
Medicaid Estate Recovery
Vermont’s Medicaid Estate Recovery Program may seek reimbursement for long-term care costs after a beneficiary’s death.
Recovery most commonly targets the primary home when not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption.
Options If You Exceed the Limits
Medically Needy Spend-Down: Vermont’s primary pathway for excess income — deduct unreimbursed medical expenses to bring income below the Medically Needy threshold. No trust required.
Irrevocable Funeral Trusts (IFTs): Pre-paid funeral costs are exempt from asset limits.
Spend Down Assets: Convert countable assets into exempt ones — home improvements, vehicle purchase, paying off debt.
Medicaid Compliant Annuities: Convert excess assets into an income stream.
Federal Policy Changes Coming to Vermont
Work Requirements (January 2027): Will apply to ACA expansion adults who are not seniors, disabled, pregnant, or otherwise exempt.
Vermont’s political orientation makes it likely the state will seek exemptions or challenge implementation, but federal requirements will create eligibility pressure on expansion adults. See how SNAP work requirements function — the Medicaid version follows similar logic. Full policy context: how the One Big Beautiful Bill affects Medicaid and SNAP.
Reduced Retroactive Coverage (January 2027): Coverage will go back only 2 months from application date, down from 90 days.
Apply promptly if you believe you qualify.
More Frequent Renewals (December 2026): Renewals shift to every 6 months for most expansion enrollees.
Use Vermont Health Connect at vermonthealthconnect.gov to renew online.
New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free. Seniors, children, pregnant women, and nursing facility residents are exempt.
Vermont Medicaid and 3SquaresVT (SNAP)
Vermont’s SNAP program is called 3SquaresVT — one of the most distinctive SNAP brand names in the country, reflecting Vermont’s food culture.
3SquaresVT is administered by the Department for Children and Families (DCF) through the MyBenefits portal at mybenefits.vermont.gov — a separate system from Vermont Health Connect, which handles Medicaid.
Unlike Utah or South Dakota (where Medicaid and SNAP share the same agency and portal), Vermont uses two separate portals for these two programs.
Many Vermont families qualify for both simultaneously. Vermont 3SquaresVT uses 185% FPL BBCE, making it more accessible than the 130% federal floor.
Useful links for Vermont residents:
- Vermont 3SquaresVT SNAP benefits and eligibility
- How to apply for 3SquaresVT SNAP in Vermont
- Vermont WIC income guidelines
- Whether seniors on Social Security can also qualify for food stamps
How to Apply for Vermont Medicaid
Online (Recommended): Apply through Vermont Health Connect at vermonthealthconnect.gov.
Vermont Health Connect is both the state’s ACA marketplace and its Medicaid application portal. A single application determines eligibility for Medicaid, Dr. Dynasaur, and subsidized private insurance. All three are screened through the same Vermont Health Connect application.
By Phone: Call Vermont Health Connect at 1-855-899-9600 for assistance. For general Green Mountain Care questions: 1-800-250-8427.
By Mail: Complete the 205ALLMED application and mail to: Vermont Health Connect, Application and Document Processing Center, 280 State Drive, Waterbury, VT 05671-8100.
For current MABD recipients transitioning to Medicare at age 65, use the shorter 205SUPP application instead of the full ALLMED form.
In Person: Contact a Vermont Health Connect certified assister — trained navigators available statewide at no cost.
Long-Term Care / Choices for Care: Contact DAIL at 1-800-642-5119 to initiate the Choices for Care assessment before submitting your Medicaid application.
Office of the Health Care Advocate: If you receive a denial or coverage dispute, the Office of the Health Care Advocate (a free resource) at 1-800-917-7787 can assist with appeals.
For the complete step-by-step application guide: applying for Medicaid in Vermont.
Documents You’ll Need
- Vermont residency proof (utility bill, lease, or official mail)
- U.S. citizenship or qualifying immigration status documentation
- Income proof: pay stubs, SSA award letters, pension statements
- SSNs for all household members
- For LTC / MABD: bank statements, property records, 60 months of financial history
- For disability: SSA disability documentation or physician letter
Processing Times
- Standard applications: Up to 45 days
- Disability-based applications: Up to 90 days
- Pregnant women / urgent cases: Expedited processing available
Frequently Asked Questions
Why doesn’t Vermont need a QIT/Miller Trust for Medicaid?
Vermont uses the Medically Needy spend-down pathway instead of Qualified Income Trusts.
When a Vermont senior’s income exceeds the $2,982/month nursing home limit, they deduct qualifying medical expenses — nursing home bills, prescriptions, premiums — to bring countable income below the threshold. There’s no separate trust account to establish or maintain. This is simpler and less legally complex than the QIT structure required in Texas, Pennsylvania, Tennessee, and most other states.
What is Dr. Dynasaur and who qualifies?
Dr. Dynasaur is Vermont’s Medicaid program for children under age 19 and pregnant women — one of the most recognizable program names in any state’s Medicaid system.
Children qualify with household incomes up to approximately 312% FPL. Pregnant women qualify up to 213% FPL. Monthly premiums are suspended indefinitely, making Dr. Dynasaur free for all currently enrolled children regardless of family income. A child can qualify for Dr. Dynasaur even if the parents don’t qualify for adult Medicaid.
What is the IHIP and who is it for?
IHIP (Immigrant Health Insurance Plan) covers immigrants who meet Vermont’s income requirements for Medicaid or Dr. Dynasaur but don’t meet federal immigration status requirements for standard Medicaid.
Vermont funds IHIP with state dollars to extend coverage to children and pregnant women who would otherwise be excluded from Medicaid due to immigration status. This is a Vermont-specific program not available in most other states.
What makes Vermont’s MABD income limit unusual?
Vermont’s MABD income limit varies by county — $1,375/month outside Chittenden County and $1,483/month inside Chittenden County (Burlington and surrounding area).
This county-differentiated approach reflects Vermont’s higher cost of living in its most urban county. No other state in this Medicaid series differentiates ABD income limits by county. The $108/month difference matters for seniors in the Burlington area.
What is the Choices for Care tiering system?
Choices for Care uses three needs levels — Highest, High, and Moderate — to match HCBS services to the intensity of an individual’s care needs.
The Highest Needs group has the same income limit as nursing home Medicaid ($2,982/month) and provides the most comprehensive in-home services. The assessment is conducted by DAIL (Department of Disabilities, Aging and Independent Living). Apply early — slots are limited and waiting lists exist for some tiers. Call DAIL at 1-800-642-5119 to begin.
What is Vermont’s Personal Needs Allowance?
$79.93/month — the highest Personal Needs Allowance of any state covered in this series.
Vermont nursing home residents on Green Mountain Care retain $79.93/month for personal discretionary spending after their income goes toward care costs. For comparison: Texas protects $75, South Carolina $65, Tennessee and Rhode Island $50, Pennsylvania and Utah $45, South Dakota $30. Vermont’s $79.93 reflects the state’s broader commitment to maintaining beneficiary dignity.
Can I apply for Medicaid and SNAP (3SquaresVT) at the same time in Vermont?
Medicaid and SNAP are on separate portals and separate agencies in Vermont.
Apply for Medicaid through Vermont Health Connect at vermonthealthconnect.gov. Apply for 3SquaresVT (SNAP) through the MyBenefits portal at mybenefits.vermont.gov, administered by DCF at 1-800-479-6151. Many Vermont families qualify for both. See Vermont 3SquaresVT SNAP benefits and eligibility for income limits and details.
Last updated: 2026 | Sources: Vermont Health Connect, Department of Vermont Health Access (DVHA), medicaidlongtermcare.org, healthinsurance.org/medicaid/vermont, USDA FPL guidelines, CMS.gov. Verify current thresholds at vermonthealthconnect.gov or by calling Vermont Health Connect at 1-855-899-9600. This guide is for informational purposes only — eligibility is determined by DVHA.