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VT Global Commitment to Health

Published on
August 14, 2023
Last updated
February 29, 2024
Written by
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Katie Wilkinson
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The Global Commitment to Health Waiver is a Medicaid waiver program that provides health care services and compensation for caregivers to low-income residents in Vermont.
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Vermont is one of the states that has implemented a Medicaid waiver program called the Global Commitment to Health (GC). This program allows Vermont to receive federal funding for providing health care services to low-income residents, including some services not usually covered by Medicaid, such as developmental disabilities services, long-term care services, and substance use disorder treatment.

This article covers how the GC waiver works, who is eligible, what services are covered, and how family caregivers can get paid for caregiving under this program. We will also provide tips and resources for applying for the GC waiver and finding support as a family caregiver.

Overview of Global Commitment to Health Waiver

The Global Commitment to Health (GC) waiver is a Medicaid waiver program that allows Vermont to receive federal funding for providing health care services to low-income residents, including some services that are not usually covered by Medicaid, such as developmental disabilities services, long-term care services, and substance use disorder treatment.

The GC waiver covers nearly all of Vermont’s Medicaid population, which includes children, pregnant women, parents, caretakers, adults without dependent children, seniors, and people with disabilities. To be eligible for the GC waiver, care recipients must meet particular income and resource limits in addition to other criteria depending on their specific program.

The GC waiver has several goals and objectives, such as:

  • Improving access to quality health care for Vermonters
  • Promoting health equity and reducing health disparities
  • Enhancing care coordination and integration across the healthcare system
  • Supporting innovation and transformation in healthcare delivery and payment models
  • Strengthening population health and prevention efforts
  • Increasing transparency and accountability for healthcare outcomes and costs

The GC waiver also allows Vermont to fund investments for health-related services and programs, such as flexible family funding, emergency medical services, and public health programs, that Medicaid does not directly reimburse. These investments are intended to improve the health and well-being of Vermonters and reduce the need for more costly services in the future.

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Eligibility Requirements

To be eligible for the GC waiver, individuals must meet certain income and resource limits and other criteria depending on their specific program. The income and resource limits vary by program and household size and are updated annually.

The income and resource limits for the Global Commitment to Health Waiver in Vermont in 2023 are as follows:

  • The income limit for the Children’s Health Insurance Program (CHIP) is up to 312% of the Federal Poverty Level (FPL), and there is no resource limit.
  • For the Dr. Dynasaur program, which covers pregnant women and children under 19, the income limit is up to 317% of the FPL, and there is no resource limit.
  • For the Vermont Health Access Plan (VHAP), which covers adults without dependent children, the income limit is up to 138% of the FPL, and there is no resource limit.
  • For the Aged, Blind, and Disabled (ABD) Medicaid program, which covers seniors and people with disabilities, the income limit is up to 100% of the FPL, and the resource limit is $2,000 for an individual and $3,000 for a couple.
  • For the Choices for Care program, which provides long-term care services, the income limit is up to 300% of the Supplemental Security Income (SSI) Benefit Rate ($2,382 per month in 2021), and the resource limit is $10,000 for an individual and $20,000 for a couple1.

The income and resource limits vary by program and household size and are updated annually. The federal government also updates the FPL and SSI Benefit Rates annually.

In addition to the income and resource limits, individuals must meet other eligibility criteria for each program. For example, to qualify for CHIP, individuals must be under 19 years old and not eligible for Medicaid or have access to employer-sponsored insurance. To qualify for Choices for Care, individuals must be elderly or have a physical disability and need a nursing home level of care.

Comprehensive Services and Supports

The Global Commitment to Health waiver in Vermont provides comprehensive services and supports to enhance the well-being and quality of life for eligible individuals. These services cover a broad spectrum of needs, from medical assistance to community integration. Some of the key benefits and supports offered under this waiver include:

  • Personal Care Assistance: Assistance with daily activities such as bathing, dressing, and grooming.
  • Skilled Nursing Services: Medical care and monitoring provided by licensed nurses.
  • Behavioral Supports: Intervention and strategies to manage challenging behaviors.
  • Respite Care: Temporary relief for caregivers to prevent burnout.
  • Home Health Aide: Support with household tasks and personal care.
  • Community Integration Services: Activities and programs to foster participation in the community.
  • Assistive Technology: Devices and equipment to enhance independence.
  • Transportation Services: Help with traveling to medical appointments and community activities.
  • Adult Day Health Services: Structured daytime programs offering health and social activities.
  • Environmental Modifications: Adaptations to living spaces for accessibility.

These services empower individuals to live independently while receiving necessary care and support. The Global Commitment to Health waiver recognizes the importance of tailoring services to individual needs, promoting inclusion, and enabling a higher quality of life for waiver recipients in Vermont.

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Compensation for Caregivers

One of the benefits of the GC waiver is that it compensates unpaid family caregivers for providing care to their loved ones. Family caregivers are essential to the health care system, as they provide valuable support and assistance to people who need long-term care. However, family caregivers often face financial challenges and emotional stress due to caregiving responsibilities. By paying family caregivers, the GC waiver recognizes their contribution and helps them afford the costs of caring.

The GC waiver offers a self-directed option for some of the home and community-based services, such as personal care, homemaker, adult day, respite, and assisted living. Self-directed services allow individuals more choice and control over their services, such as hiring, training, and managing their workers, setting their schedules, and purchasing goods and services that meet their needs. This option is available for several programs under the GC waiver, such as the Choices for Care program, which provides home and community-based services to help people stay in their homes or communities instead of institutional settings.

Under the self-directed option, care recipients can hire family members as their paid caregivers if they are not legally responsible for the individual or living in the same household. Family caregivers can receive compensation for providing personal care services, homemaker, respite, and assisted living services to their loved ones. To be eligible for self-directed services and caregiver compensation, individuals must meet specific criteria, such as having a service plan, a budget, and a support broker. They must also follow the rules and regulations of the GC waiver and the self-directed option.

If you are interested in self-directed services and compensation for caregivers, you can contact your case manager or service coordinator to discuss your options and preferences.

A note from Givers

If you are a primary caregiver in Vermont, you may be eligible for compensation under the GC waiver. Please fill out this form, and we will get back to you soon.

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