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.  

The increase in the number of applications in process was due to a number of factors including DVHA beginning the federally required “unwinding” from Medicaid continuous coverage in April 2023.  The “unwind” from continuous Medicaid eligibility has increased the volume of work in the LTC unit.  Applications also pend longer when applicants need additional time to submit verification documents.  Another reason applications remain in process longer is that the applicant may not have available placement in a long-term care setting or have a service plan in place.  During the public health emergency as well as during 2024, some Vermont Medicaid Providers have been reporting that they are experiencing staffing shortages which reduces the number of available beds for some providers.  Until placement is available, LTC Medicaid applications remain pending.

Last Updated: 05/20/2024

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

DVHA LTC recognizes that some applications remain pending longer because applicants need additional time to submit financial verification documents. DVHA LTC Management often hears from Medicaid providers about clients with a pending LTC Medicaid application. To help inform Vermont Medicaid providers on the best methods for assisting an applicant, DVHA LTC created an external facing internet page for providers: 
Long-Term Care Medicaid | Department of Vermont Health Access

DVHA LTC also began offering LTC Medicaid overview training to Vermont Medicaid Providers.  The training materials and training dates are available on the new Internet page.   Each of the trainings had approximately 80 participants and all training feedback has consistently been excellent.   

Finally, DVHA LTC produces a report for the DAIL LTC clinical coordinators to identify those LTC Medicaid applications which cannot be approved due to lack of available placement.  This issue is being addressed by leadership in many of the AHS Departments (including DVHA, DAIL and DMH).

Last updated 5/20/2024