How to start an assisted living facility in Vermont
Vermont requires a Assisted living residence license, or residential care home license at Level III or Level IV from Vermont Department of Disabilities, Aging and Independent Living (DAIL), Division of Licensing and Protection to operate an assisted living facility.
- License required
- YesAssisted living residence license, or residential care home license at Level III or Level IV
- Application fee
- —
- Processing time
- —
- Companion care
- $12.98per 15 min · $51.92/hr
- Organizations in the state
- 34NPPES, Sep 13, 2026
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Vermont assisted living facility license
Vermont requires a Assisted living residence license, or residential care home license at Level III or Level IV from Vermont Department of Disabilities, Aging and Independent Living (DAIL), Division of Licensing and Protection to operate an assisted living facility.
- License required
- Yes
- License
- Assisted living residence license, or residential care home license at Level III or Level IV
- Issuing agency
- Vermont Department of Disabilities, Aging and Independent Living (DAIL), Division of Licensing and Protection
- Medicaid waiver coverage
- HHS's 2015 compendium reported that Vermont pays for services in both settings through the Assistive Community Care Services state plan benefit and the Choices for Care 1115 program.
- Regulation
- 33 V.S.A. ch. 71; Residential Care Home and Assisted Living Residence Licensing Regulations (adopted, effective April 1, 2025)
Steps to get licensed in Vermont
In order, as the licensing agency describes the process.
- Complete DLP's online new facility licensure packet for residential care homes and assisted living residences
- Renew with the facility re-licensure form, reporting units/beds, special care units and changes
Enrolling as a Vermont Medicaid provider
- Program
- Vermont Medicaid / Green Mountain Care (Department of Vermont Health Access, DVHA)
- Enrollment portal
- Provider Management Module (PMM)
- Fiscal agent
- Gainwell Technologies (enrollment department and revalidation notices)
- Application fee
- Under 42 CFR 455.460, institutional and certain other providers pay the application fee on initial enrollment, new practice locations and revalidation. Proof of payment goes to DVHA with the application. The fee is waived if already paid to Medicare, another state's Medicaid program or another Vermont state agency. CMS decides hardship waivers, and DVHA passes on the result. Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts.
- Fingerprinting
- High-risk providers get a fingerprint-based criminal background check. DVHA follows the CMS risk categories, under which newly enrolling DMEPOS suppliers and newly enrolling home health agencies are high risk. DVHA may raise a provider's risk level at any time, for example after a payment suspension, exclusion or Medicare revocation.
- Site visit
- Moderate-risk providers get on-site visits, for example ambulance suppliers, community mental health centers, CORFs, hospices, independent clinical labs, IDTFs and physical therapists. High-risk providers get them too.
- Revalidation
- Providers get system notices 90 and 45 days before their contract end date, and screening is repeated at revalidation. Missing the deadline ends enrollment, and coming back requires a new application. Under its 2026 strategy, Vermont is revalidating high-risk providers off-cycle starting July 1, 2026 and selected moderate-risk providers starting January 1, 2027 (about 300 providers); Gainwell contacts those affected. Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years.
Does Vermont require a certificate of need?
- CON program
- Yes
- Program
- Certificate of Need
- Services covered
- construction, purchase, renovation or capital expenditure by a health care facility above $10,000,000
- changes in licensed bed counts (addition, conversion or relocation)
- offering any home health service
- transfer of more than 50% ownership of a health care facility other than a hospital or nursing home
- single diagnostic or therapeutic equipment items above $5,000,000
- new services or technology with annual operating expense above $3,000,000
- conceptual development phase CON for projects above $50,000,000
Vermont wage floor
- State minimum wage
- $14.42 an hour
- Effective
- 2026-01-01
- Scheduled increases
- Adjusted each January 1 by CPI; the 2027 rate was not found in the sources reviewed.
- HCBS 80/20 rule
- Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.
Vermont market size
Counts from federal public files: NPPES (active organization NPIs), CMS Care Compare and CMS Medicaid enrollment.
- Assisted living facilities — active organization NPIs (NPPES)
- 34 (as of Sep 13, 2026)
- Total Medicaid and CHIP enrollment (latest reported month)
- 145,492 (as of Jun 1, 2026)
What Vermont Medicaid pays
Home care & personal care: published Vermont fee-for-service rates, each linked to its source.
| Service | Code | Vermont rate | Per hour | Rank |
|---|---|---|---|---|
| Companion careAide or attendant | S5135 | $12.98per 15 min | $51.92 | 1 of 20 |
| Respite care (hourly)Agency provider | S5150 | $6.68per 15 min | $26.72 | 17 of 38 |
| Respite care (daily)Agency provider | S5151 | $427.70per day | — | 9 of 34 |
| Adult day servicesClinical nurse specialist | T2021 | $6.44per 15 min. | — | — |
| Financial management services (self-direction)Self-directed worker | 097 | $89.00per month | — | 12 of 14 |
Vermont HCBS waivers
Medicaid home and community-based services programs that may pay for this service.
- Vermont Global Commitment to Health (1115)
Frequently asked questions
Do you need a license to start an assisted living facility in Vermont?
Vermont requires a Assisted living residence license, or residential care home license at Level III or Level IV from Vermont Department of Disabilities, Aging and Independent Living (DAIL), Division of Licensing and Protection to operate an assisted living facility.
Does Vermont require a certificate of need for an assisted living facility?
Vermont has a certificate of need program covering: construction, purchase, renovation or capital expenditure by a health care facility above $10,000,000, changes in licensed bed counts (addition, conversion or relocation), offering any home health service, transfer of more than 50% ownership of a health care facility other than a hospital or nursing home, single diagnostic or therapeutic equipment items above $5,000,000, new services or technology with annual operating expense above $3,000,000, conceptual development phase CON for projects above $50,000,000. Check whether your service is on that list.
How do you become a Medicaid provider in Vermont?
Enroll through Provider Management Module (PMM) (https://vermont.hppcloud.com/Home/Index/), run by Gainwell Technologies (enrollment department and revalidation notices).
What does Vermont Medicaid pay a assisted living facility?
Vermont Medicaid pays $12.98 per 15 min for companion care, effective Jul 1, 2026, ranking 1 of 20 states.