Vermont HCBS Waiver Services for Developmental Disabilities: What's Covered

When a young adult with a developmental disability is approved for funded services in Vermont, those services are delivered through the state's Home and Community-Based Services (HCBS) waiver. Vermont runs its developmental services under the Global Commitment to Health Section 1115 Demonstration Waiver — a broad Medicaid waiver that gives the state flexibility in how it structures and delivers community-based supports. But what does that actually look like for a family whose young adult just got funded?

How the Waiver Works in Practice

The HCBS waiver is the alternative to institutional care. Instead of placing someone in a nursing facility or institutional setting, the waiver funds an array of community-based services that allow the person to live in their home, a shared living arrangement, or another integrated setting.

Vermont's developmental services HCBS structure separates three functions that used to be combined under local Designated Agencies:

1. Eligibility determination — handled by Public Consulting Group (PCG) through centralized intake
2. Case management — provided by an independent Care Management Organization (CMO)—Benchmark Human Services or The Columbus Organization
3. Direct service delivery — carried out by local Designated Agencies or independent providers

The CMO conducts a standardized needs assessment (typically the Supports Intensity Scale, SIS-A), develops the Individualized Service Plan (ISP), and manages the authorized budget. Direct service providers then deliver the supports specified in the plan.

Service Categories Available Under the Waiver

Shared Living — Vermont's most common residential service model, where a trained provider shares their home with the individual. The provider receives compensation and is responsible for daily support, meals, community access, and implementation of ISP goals. Shared living is essentially adult foster care, and it accounts for roughly 39% of HCBS recipients in the state.

Community Supports — Structured daytime services that focus on community integration, social skills development, volunteer opportunities, and recreational activities. These can be provided in group settings or one-on-one, depending on the ISP.

Supported Employment — Job coaching, workplace accommodation assistance, and customized employment development. Vermont's emphasis on competitive integrated employment means these services prioritize real jobs in community settings, not segregated workshop environments.

Respite Care — Temporary relief for family caregivers. Respite can be provided in the family home or in an approved respite setting, and is authorized for a set number of hours per month based on caregiver need and the ISP.

Clinical Services — Behavioral support consultation, crisis intervention, counseling, and therapeutic services related to the person's developmental disability when authorized. Ask the CMO how these supports interact with standard Medicaid services and the ISP.

Home Supports — Assistance with daily living tasks in the person's own home or apartment, including personal care, meal preparation, medication management, and household tasks.

Self-Directed Services — Vermont allows individuals (or their authorized representatives) to manage their own service budget. Under self-direction, the person hires, trains, and supervises their own staff and decides how to allocate their authorized funding within ISP parameters. This model provides maximum flexibility but requires organizational capacity to manage employment taxes, scheduling, and backup coverage.

The Budget Allocation

Each person's HCBS budget is individualized based on the SIS-A assessment and the ISP developed by the CMO. Vermont does not use a one-size-fits-all funding formula. A person needing 24-hour staffed residential support — which can cost over $140,000 annually — receives a different budget than someone needing 10 hours per week of community supports.

The budget covers the service categories listed above, and the CMO monitors spending to ensure services stay within the authorized amount. If needs change, the ISP (and potentially the budget) can be adjusted through a plan amendment process with the CMO.

What the Waiver Does Not Cover

The HCBS waiver is not a substitute for Green Mountain Care Medicaid. Ask DVHA or Green Mountain Care about medical, prescription, dental, and hospital coverage, and ask the CMO which disability-specific supports the developmental-services budget can fund.

Do not assume the developmental-services budget pays all room-and-board costs. Ask how SSI, personal income, and the authorized service budget are allocated in the specific living arrangement.

The Provider Shortage Reality

Vermont has a well-documented shortage of direct care workers and shared living providers. The state relies heavily on shared living (39% of HCBS recipients) and family homes (38%), and both models are under strain. Recruiting and retaining providers is difficult, and direct-care staffing constraints can delay service implementation.

For families transitioning a young adult into waiver services, this means that even after funding is authorized, finding an actual provider to deliver services can take additional time. The ISP may specify shared living, but if no shared living provider is available in the person's preferred geographic area, the CMO and family need to explore alternatives — home supports, self-directed services, or waiting for a provider match.

The Vermont SSI at 18 & Adult Disability Benefits Guide covers the full landscape of waiver services alongside the financial planning components, so families can understand both what services are available and how they interact with SSI, Medicaid, and the ABLE account framework.

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