Vermont

Choices for Care

Choices for Care is a long-term services and supports program that was launched in 2005 with the goal of providing home and community-based services and institutional services on an equal basis. Originally operated under its own 1115 Waiver, Choices for Care was integrated into Vermont's managed care 1115 Waiver, which is known as Global Commitment to Health, in 2015. The program provides services to adults with physical disabilities and seniors needing LTSS. Enrollment is mandatory.

Vermont's model for managed care is unique. Rather than contracting with commercial or non-profit managed care organizations, the Vermont Medicaid agency runs its managed care programs through a separate state agency, the Department of Vermont Health Access, which serves in the role of a managed care entity. Thus, there is no contract with an outside entity; instead, the language typically found in managed care contracts is embedded in state regulations. Although Choices for Care was originally a fee-for-service program, with the integration into the Global Commitment Waiver, Vermont has promised CMS to "ensure a managed LTSS plan for a comprehensive care model is developed that promotes the integration of home and community based services, institutional, acute, primary and behavioral health care."