MONTPELIER, Vt.--This month marks the first anniversary of Vermont's "Choices for Care" program, established under the first Medicaid waiver that lets residents choose whether they want to receive long-term care in their homes or in an institution.

Before the waiver was enacted by Gov. Jim Douglas, nursing home care was the only option available to the state's elderly Medicaid recipients.

"Our push for this waiver was driven by the belief that more people will choose to have their needs met in their own homes and communities rather than in institutions," Douglas said. "This is an option that is desired by Vermonters and saves the state money because community services cost less than institutional services."

The program was highlighted in a front-page story in the Oct. 23 Wall Street Journal. Under the program, Vermont residents can earn about $10 an hour to care for an elderly relative. The relatives typically receive about 25 to 30 hours of care per week.

A 2002 Vermont study showed that nursing home care costs the state $122 per day per resident, while home care costs $80 per day.

Describing the waiver as a way to contain growth of long-term Medicaid services, Patrick Flood, commissioner of the Vermont Department of Disabilities, Aging, and Independent Living, called the program "a forward-looking strategy to plan for the future growth in the aging population as a result of the baby boomers."

Flood told the Journal: "We are never going to build another nursing home. It is an outdated model."

In July, CMS said it would give states $1.75 billion over five years to allow elderly and disabled Medicaid recipients to live in the community rather than in institutions (see HomeCare Monday, July 31).