Skilled nursing Medicaid rates in Vermont are among the highest in the country. Vermont Medicaid's published daily rate for a nursing home stay is $409.20, effective October 1, 2026, compared with a national median of $282.59 among states with a comparable figure. Vermont is not part of the 21-state ranking, but its per diem is higher than every ranked state except New Mexico and Colorado.
Vermont's nursing facility payment rests on a rate setting rule rewritten in 2024, a fee-for-service program with no managed care plans setting rates, and a labor market where aides and licensed practical nurses earn above the national median. Every rate here is compiled from official state Medicaid publications and linked to its source document.
Vermont Medicaid nursing home rate per day: $409.20
The $409.20 per diem is Vermont Medicaid's payment for one nursing home resident day. It covers nursing at three licensure levels, room and board, dietary, housekeeping, activities, administration and the building.
The figure took effect on October 1, 2026, so it reflects Vermont's latest rate period. Vermont sets rates facility by facility under its long-term care rate rule, so the statewide figure is a reference point and each facility should confirm its own rate. The Vermont state page lists the published rates and links each to its source document.
The 2024 rate setting rule
Vermont's nursing home rates are governed by its Health Care Administrative Rules (HCAR). In 2024 the state adopted a set of changes that define the current system:
- HCAR adopted rule, Methods, Standards, and Principles for Establishing Medicaid Payment Rates for Long-Term Care Facilities: effective July 1, 2024. This is the core rule for nursing facility rate setting.
- GCR 24-046 FINAL, Nursing Home Rate Setting Methodology Update: finalized June 27, 2024, effective July 1, 2024.
- GCR 24-003 FINAL, Health Care Administrative Rules Update, Private Nonmedical Institutions and Long-Term Care Rules: finalized June 14, 2024, effective July 1, 2024.
Together, these mean the October 2026 rate is calculated under a methodology that is barely two years old. For operators, the rule text is the place to understand how a facility's reported costs and other inputs translate into its per diem, and any facility that has not reviewed its cost reporting since the 2024 update should do so.
A separate change, GCR 24-013, addressed a physician visit limit, finalized March 18, 2025 and effective February 15, 2025. It affects physician services for residents rather than the facility per diem itself.
The 2026 budget adjustment
Vermont's FY2026 budget adjustment act, Act 74 of 2026 (H.790), was enacted March 5, 2026. Its Section 87 adds Section E.334.1 to Act 27, with an effective date of April 1, 2026. Budget adjustment acts revise appropriations partway through the fiscal year, and this provision appears among the changes affecting Vermont's nursing facility sector. Facilities should review the section's text on the state page to see how it applies to their payments from April 1, 2026.
Wages: above the median where it matters most
Vermont's May 2025 wage data:
| Role | Vermont | US median |
|---|---|---|
| Registered nurse | $46.86 | $46.90 |
| Licensed practical nurse | $33.62 | $30.96 |
| Nursing assistant (CNA) | $22.66 | $20.32 |
Registered nurses earn essentially the national median, but licensed practical nurses and nursing assistants earn more. Those two roles deliver most of the hands-on care in a nursing home, so Vermont's labor costs run above the national norm where staffing hours are concentrated. The high per diem is paying for that. A rate well above the median does not leave an equally large margin, because the aide and LPN hours it buys cost more than in most states.
Fee-for-service, no plan negotiation
Vermont Medicaid pays providers on a fee-for-service basis through the Department of Vermont Health Access (DVHA). Long-term services and supports run through Vermont Choices for Care under the Global Commitment framework. Our data does not classify any Vermont service line under managed care rules, so the published per diem is the payment for a Medicaid resident day. We record 3 plans and related arrangements in Vermont, including the Vermont Public Transit Association for transportation. The Vermont managed care page summarizes them.
For an operator, the absence of plan contracting means rate changes come only through rule changes and budget acts, which makes the HCAR rule and the legislature's budget adjustments the two things to watch.
Vermont against the national range
Of the 44 states with a published nursing home rate, 21 are ranked on a single daily figure. New Mexico leads at $826.00, followed by Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78). At the low end are Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00).
At $409.20, Vermont would sit just behind Colorado and ahead of Rhode Island. Within New England, Vermont's figure sits above Rhode Island's ranked rate and far above Connecticut's.
For a Vermont operator, that high position is best read alongside the state's labor costs and its fee-for-service structure. The per diem is set by rule, not negotiated, so the gap between Vermont and other states changes only when Vermont revises its rule or budget, or when other states move their own rates.
See the skilled nursing industry hub for every state and the methodology page for how rates are compared.
Updated 2026-10-05