IDD Medicaid rates in Vermont are in the middle of a payment overhaul, and supported employment is the service where the state compares best. Vermont pays $17.42 per 15 minutes for supported employment on code T2019, or $69.68 an hour, effective October 1, 2025. That ranks 7th of 39 states and is 70.6% above the national median of $40.84 an hour.
What sets Vermont apart is how its Developmental Disabilities Services (DDS) are paid. Since October 2025, Vermont has finalized DDS payment reform, a value-based payment model and conflict-free case management, with a further rate increase proposed for July 2026.
T2019 Vermont Medicaid rate: supported employment
Vermont's $69.68 hourly supported employment rate sits behind New York ($141.64), Arkansas ($102.36), the District of Columbia ($97.08), Iowa ($79.82), Missouri ($77.80) and one other state in the top seven. The bottom three are Tennessee ($14.96), West Virginia ($12.80) and Wyoming ($12.36).
The economics are strong. Vermont's median direct support wage is $22.42 an hour, slightly above the national $22.08, and the loaded wage is 44.5% of the T2019 rate. That leaves $38.68 an hour for job development, employer outreach, travel and supervision.
T2019 carries 4 prior authorization rules in Vermont's coverage listing, so employment providers should expect authorization steps before services start.
Vermont Medicaid IDD reimbursement for other services
The national IDD comparison ranks Vermont on two services. Besides supported employment:
- Prevocational services (T2015): $18.38 an hour, effective October 1, 2025. Ranks 15th of 28, 1.6% below the national median of $18.67. Oregon ($74.31), Minnesota ($69.42) and Utah ($60.68) lead; California ($7.23), Indiana ($5.66) and the District of Columbia ($3.95) trail.
- In-home and community living supports (T2017): $6.60 as published, effective July 1, 2025.
Vermont's prevocational rate sits almost exactly on the national median, while its supported employment rate is well above it. That gap gives Vermont providers a financial reason to move people from prevocational programs into individual employment.
For services Vermont pays in other ways, the national medians are useful benchmarks: $34.92 an hour for community living supports, $23.14 for day habilitation, $280.27 a day for residential habilitation and $78.07 an hour for behavior support.
DDS payment reform and the value-based model
Vermont's recent changes are structural rather than simple rate updates. In the order they were filed:
- GCR 25-092 (final, October 24, 2025; effective October 1, 2025). DAIL conflict-free case management, Developmental Disabilities Services payment reform and support brokering.
- GCR 26-024 (proposed December 31, 2025; final April 24, 2026; effective January 1, 2026). An update to the Developmental Disabilities Services Program value-based payment model.
- GCR 26-059 (proposed April 20, 2026; effective June 1, 2026). An additional notice on the Developmental Disabilities Services payment methodology.
- GCR 26-086 (proposed June 30, 2026; effective July 1, 2026). Medicaid rate increases from the DAIL Developmental Disabilities Services Division.
- GCR 26-068 (proposed June 30, 2026; effective July 1, 2026). Medicaid reimbursement for self-directed personal care services and respite.
Vermont's DDS home and community-based services are organized around a per-member-per-month bundle, case management and related lines, alongside state plan DDS lines paid fee-for-service by DDSD. For providers, the shift to a value-based model means revenue depends on how the bundle is set and measured, not just on unit rates. The October 2025 effective date of the supported employment and prevocational rates lines up with the payment reform rule.
How Vermont compares with the highest- and lowest-paying states
On supported employment, Vermont is closer to the top of the national range than to the middle. Its $69.68 hourly rate is far above Wyoming's $12.36, and it trails New York's $141.64 by a wide margin. On prevocational services, Vermont sits in the middle of a range that runs from Oregon's $74.31 down to the District of Columbia's $3.95. For a Vermont employment provider, the practical comparison is with other high-rate states: the national IDD rates page shows where each one lands.
Direct support wages in Vermont
Federal occupational wage data for May 2025 places Vermont above the national median on every IDD role:
- Direct support professional: $22.42 an hour, versus $22.08 nationally (based on the closest comparable occupation)
- Residential advisor: $21.50, versus $20.31
- Home health and personal care aide: $20.00, versus $17.21
- Licensed practical nurse: $33.62, versus $30.96
The personal care aide wage stands out: at $20.00, it is far above the national median and close to the direct support wage. Vermont IDD agencies therefore compete with home care for the same workers on nearly equal pay terms. The proposed GCR 26-068 rule on self-directed personal care and respite reimbursement is relevant here, since it covers personal care work that draws on the same labor pool.
Managed care and Vermont DDS
Vermont's Choices for Care long-term services and supports run under Global Commitment, administered by DAIL. Vermont's plan landscape is small, with 3 plans and arrangements. Developmental disability services are paid through DAIL's Developmental Disabilities Services Division. The Vermont managed care page has the details.
The Vermont Medicaid rates hub covers the full DVHA fee schedule, and IDD Medicaid rates by state compares every IDD service. Rates are compiled from official state Medicaid publications with links to their source documents; see our methodology.
Updated 2026-10-05