This performance measure was chosen by DVHA because it is a primary indicator of the number of Vermonters seeking access to Long Term Care (LTC) supports and services as well as an indicator of the current workload for the LTC Unit.  

Vermont LTC Medicaid applications are processed simultaneously by DVHA’s financial eligibility specialists and DAIL’s clinical coordinators.  DAIL communicates to DVHA when they complete the clinical eligibility determination and after they find placement with a provider.  DVHA is responsible for determining financial eligibility and issuing the Notice of Decision which advises the applicant of approval or denial of the application.  Applications remain pending until the applicant is approved for financial eligibility (DVHA), clinical eligibility (DAIL), and are placed in a LTC setting or have a service plan in place.  In the above table, DVHA tracks pending applications according to the status of the application.  

The number of pending new LTC Medicaid applications during any given month will include those received during that current month as well as those still pending from previous months.   Most applications will be pending for more than one month.  In 2022, the number of pending applications held steady around 600 which is the expected workload for LTC Medicaid under normal circumstances.  The number of pending applications is influenced internally by resource constraints. For example, DVHA began the federally required “unwinding” from Medicaid continuous coverage in April 2023.   LTC has initiated renewals of active LTC Medicaid cases which will increase the volume of work in the LTC unit.  The number of pending applications is influenced externally by the total number of applications submitted and the length of time it takes for applicants to submit required documentation.  (Note that DVHA LTC allows clients extensions of time to gather and provide verification documents to the LTC Specialist.  In some circumstances, clients may receive approval for three or four extensions of time.)  Another reason applications remain pending is that the applicant may not have available placement in a long-term care setting or have a service plan in place.   

Last Updated: 04/19/23

• Applicants, family members and assisters
• DAIL Clinical Coordinators and Nurse Managers
• Vermont Legal Aid
• Private Attorneys
• Area Agencies on Aging