Vermont home care Medicaid rates include the highest companion care rate in the country. Vermont Medicaid pays $12.98 per 15 minutes on S5135, or $51.92 an hour. That ranks 1st of 20 states with a comparable rate and is 100.0% above the national median of $25.96, double the typical state.
No other Vermont home care line stands out the same way. Daily respite pays well above the median, hourly respite sits close to it, and the monthly fee for self-direction administration is near the bottom. Vermont has no ranked hourly agency personal care rate, so companion care is the clearest benchmark for what the state pays for an aide's hour. Every figure below is compiled from official Vermont Medicaid publications and linked to its source document.
The current S5135 rate took effect on July 1, 2026, the start of state fiscal year 2027. Vermont's home care rates for older and physically disabled adults are published by DAIL ASD under Choices for Care, part of the Global Commitment long-term services and supports program. The state also lists the Vermont Attendant Services Program - Medicaid for self-directed attendant care and the Brain Injury Program.
The gap at the top of the companion ranking is wide. South Dakota is second at $43.24 and Montana third at $37.56, followed by Minnesota ($31.60) and the District of Columbia ($31.56). The bottom of the range is a different market: Nebraska pays $11.33, Iowa $8.48 and Arkansas $6.72.
For an agency, Vermont is a state where companion care can be run as a full service line rather than a low-paid add-on to personal care.
Vermont mixes national HCPCS codes with short state codes. Companion care, respite and attendant care use national codes such as S5135, S5150 and S5151. Self-direction and several Choices for Care services use three-digit state codes such as 095, 096 and 097.
The units differ by service:
- 15-minute units for companion care, hourly respite and adult day on T2021. The hourly figures here are four units.
- Day units for daily respite on S5151.
- Month units for financial management on 097.
For billing staff, the state codes are the part most likely to trip up an agency new to Vermont, because they appear on no other state's schedule and carry weekly caps rather than prior authorization.
Vermont pays respite both by the hour and by the day, and the two rates rank very differently.
| Service | Code | Vermont rate | Rank | vs national median |
|---|---|---|---|---|
| Companion care (hour) | S5135 | $51.92 | 1 of 20 | +100.0% |
| Respite (hour) | S5150 | $26.72 | 17 of 38 | +5.6% |
| Respite (day) | S5151 | $427.70 | 9 of 34 | +76.6% |
| Financial management (month) | 097 | $89.00 | 12 of 14 | -21.9% |
Hourly respite. S5150 pays $6.68 per 15 minutes, or $26.72 an hour, just above the $25.30 median. That rate has been in effect since July 8, 2018. The top hourly respite rates are Virginia ($74.04), New York ($59.32) and South Dakota ($43.24).
Daily respite. S5151 pays $427.70 a day, also in effect since July 8, 2018. Only eight states pay more, led by Minnesota ($938.09), Missouri ($623.73) and New York. For families who need overnight or full-day relief, Vermont's daily rate is the stronger benefit.
Adult day. Vermont pays adult day on T2021 at $6.44 per 15 minutes, effective July 1, 2024. Because most states pay adult day per day, Vermont's rate is not ranked against the $68.67 national daily median.
Vermont home health and personal care aides earned a median of $20.00 an hour in May 2025, above the US median of $17.21. Registered nurses had a median of $46.86, almost exactly the national $46.90.
The companion rate absorbs that higher wage easily. The aide wage takes 54.8% of the $51.92 rate, leaving a margin of $23.49 an hour after loaded wages.
Hourly respite tells the opposite story. The wage takes 106.4% of the $26.72 rate, which means each respite hour staffed by a median-wage aide runs at a loss of $1.71 after loaded wages. Because the hourly respite rate has been in place since 2018, agencies that offer hourly respite in Vermont depend on companion hours to carry it.
In most states, companion care is the cheapest service an agency sells, and agencies steer clients toward personal care codes where the rate is better. Vermont reverses that logic. Its companion rate is the highest in the country, and it pays an aide's hour at a level most states reserve for hands-on care.
That has three practical effects for a Vermont agency:
- Companion hours are a core line. Supervision, companionship and help with daily routines can be staffed and marketed as a primary service rather than an add-on.
- Workforce can be broader. Companion work generally requires less hands-on training than personal care, so an agency can draw on a wider pool of workers while still paying above the state's $20.00 median.
- Respite needs a second look. With hourly respite losing money at the median wage, the agency should check whether a family's need is better authorized as companion care or as daily respite, where the rates are stronger.
The authorization still has to match the person's actual needs. The point is that in Vermont the companion service is priced to be delivered well, not to be avoided.
Most Vermont home care codes in our coverage data carry no prior authorization rules: S5125, S5126, S5135 and S5150 all show zero. The state codes 095 and 096 carry weekly limits instead. Code 99199, which Vermont uses for a developmental disabilities HCBS bundle, carries 4 prior authorization rules.
For an agency, the practical work is tracking weekly units on the state codes rather than seeking prior approval for each companion or respite episode.
Home care in Vermont is funded through a handful of programs, each run by a different part of state government:
- Choices for Care, the Global Commitment long-term services and supports program run by DAIL ASD, which carries the companion and respite rates in this article.
- Vermont Attendant Services Program, in a Medicaid version and a state-funded General Fund version, for self-directed attendant care.
- Vermont Brain Injury Program, with rehabilitation, long-term and mental-health-funded tracks.
- Developmental Disabilities Services, paid partly through State Plan lines and partly through an HCBS bundle.
- Money Follows the Person transition grants.
An agency should tag each client to a program at intake. The program decides the code set, the limits and which rate edition applies, and Vermont's programs update on their own schedules.
Vermont's recent notices touch both rates and the self-directed side of home care:
- DAIL ASD Medicaid rates: SFY2027 edition dated July 17, 2026, effective July 1, 2026, with a listed change of 1.07%. This is the edition that carries the current companion rate.
- GCR 26-068 PROPOSED: Medicaid Reimbursement for Self-Directed Personal Care Services and Respite, published June 30, 2026, with a proposed effective date of July 1, 2026.
- GCR 26-077 FINAL: Medicaid Assistive Community Care Services Reimbursement, published August 28, 2026, effective July 1, 2026.
GCR 26-068 is the one to watch for self-directed workers and the agencies that support them, since it addresses personal care and respite reimbursement directly.
Vermont pays $89.00 a month for financial management services on its code 097, effective February 1, 2025. That ranks 12th of 14 states, 21.9% below the $113.98 median. California ($265.00) and New York ($260.24) pay the most; only Alabama ($80.00) and Wisconsin ($36.75) pay less than Vermont.
On the managed-care side, our summary for Vermont lists no plan payment rules for any service line. We have 3 plans on file for the state. The Vermont managed care page shows what is on file.
For home care, that means agencies bill Vermont Medicaid's fee-for-service schedule and its DAIL programs directly. There are no plan contracts to negotiate, and the published rate is the rate.
- South Dakota home care rates are second for companion care at $43.24.
- Montana home care rates are third at $37.56.
- Maine home care rates and New Hampshire home care rates are the closest New England comparisons.
The national home care overview compares every state.
Budgeting. Model companion hours, hourly respite, daily respite and self-direction separately. They range from the best margin in the country to a loss.
Wage planning. Vermont's aide wages are above the national median. The companion margin can absorb increases; hourly respite cannot.
Tracking limits. Build weekly caps on the state codes into scheduling software.
Watching changes. Follow GCR 26-068 and the DAIL ASD rate editions published each July.
Rates on this page are compiled from official Vermont Medicaid publications, including the DAIL ASD Medicaid rates and the Vermont Medicaid Fee Schedule, and each links to its source document. Vermont's full dataset holds all 34,243 current Vermont Medicaid rates, with history back to 1990; the Vermont Medicaid rates hub covers the full fee schedule. Our methodology explains how hourly conversions and ranks are calculated.