Adult Day Care Vermont

All states: adult day services map

Vermont adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Vermont?

Vermont does not license adult day centers. Instead, the Adult Services Division (ASD) of the Vermont Department of Disabilities, Aging and Independent Living (DAIL) certifies them under the Standards for Adult Day Services in Vermont (January 2017). There is no separate adult day health care license. Medicaid pays for adult day through two programs, Choices for Care and Day Health Rehabilitation Services, both delivered by the same certified centers.

Three layers can apply to a Vermont center, and each comes from a different source:

• Certification (DAIL Adult Services Division). ASD is responsible for certifying adult day centers, and the standard it posts on its Agency Certification Standards page is the January 2017 Standards for Adult Day Services. This is a state certification standard, not an administrative code chapter. ASD also provides quality assurance and improvement support to the centers it certifies.
• Medicaid (DAIL with the Agency of Human Services and the Department of Vermont Health Access). Choices for Care runs under Vermont's Global Commitment to Health 1115 demonstration and pays for adult day for people with high or highest needs living at home and for its Moderate Needs group. Day Health Rehabilitation Services (DHRS), also called Adult Day Health Services, is a Medicaid state plan service with its own eligibility and service rules, set out in the DHRS prior authorization instructions.
• Other funding. Older Americans Act caregiver respite, managed by ASD through the Area Agencies on Aging, can be used in adult day settings, and the U.S. Department of Veterans Affairs pays for adult day health care for some veterans.

Adult day care vs adult day health. All Vermont centers are certified under one standard. The difference shows up in Medicaid: DHRS is for people who need health-related services (see the Medicaid section below) and must be supervised by a registered nurse. The state's 2023 provider rate study says the same rate is paid for adult day and adult day rehabilitation.

Where the layers overlap, Medicaid DHRS adds participant-level service requirements, such as weekly health services and RN supervision, on top of certification. We could not compare the certification standard's own rules because its text was not readable.

Do you need a license to open an adult day center in Vermont?

No. Vermont has no adult day license. A center that wants to serve participants funded through DAIL programs, such as Choices for Care and Medicaid DHRS, must be certified by the DAIL Adult Services Division and then enroll as a Medicaid provider.

Who does not license adult day. DAIL's Division of Licensing and Protection licenses home health agencies, residential care homes, assisted living residences and nursing facilities, but adult day is not on its list. Certification by ASD is the only state entry requirement we found.

How to apply. ASD's Forms and Applications page lists provider enrollment and the DHRS prior authorization form for adult day, but we did not find a separate certification application posted. Contact ASD to start the certification process.

What we did not find. The certification steps, fees, whether each site needs its own certification, what happens when a center is sold, how often certification is renewed and how often centers are reviewed would all be in the 2017 standards, which we could not read. We also did not find a certificate of need requirement or a moratorium for adult day. Ask ASD about each of these before you sign a lease or agree to buy a center.

What are the staffing rules for adult day centers in Vermont?

We could not confirm Vermont's adult day staffing ratio. The certification standard that would set it could not be read, and we did not find the ratio in any other state source. The one staffing rule we confirmed is that Medicaid Day Health Rehabilitation Services must be provided under the supervision of a registered nurse.

• Certification (DAIL ASD): not confirmed. Ask ASD for the staffing section of the current standards.
• Medicaid (DHRS): no ratio specified in the DHRS instructions, but services must be under RN supervision.
• Other funding: we did not find staffing standards for adult day from any other funding source.

A rate assumption, not a rule. When the state set adult day rates in its 2023 rate study, it assumed on average one direct care staff person working with up to four clients at a time, plus an administrator and kitchen staff. That figure was used to price the service. It is not a staffing requirement.

What we did not find. We did not confirm a dementia ratio, minimum staff on site, who counts toward a ratio, director or aide qualifications, training hours, background check rules, or TB and vaccination rules for staff. Ask ASD for each of these.

What does an adult day center in Vermont have to provide?

ASD describes Vermont adult day centers as providing professional health, social and therapeutic services, a nutritious meal and social interaction in a safe, supportive setting. Centers that serve Medicaid DHRS participants must deliver the health services those participants qualify for. The certification standard's own list of required services, space and policies could not be read.

Services for DHRS participants. DHRS covers health assessment and monitoring, nursing, personal care, physical, occupational and speech therapy, social work and nutrition, all under RN supervision. A participant may receive up to 50 hours of DHRS a week.

Hours. We did not find a rule on minimum hours or days. The 2023 rate study reports that centers usually provide service up to nine hours a day on weekdays, not counting holidays, and its rate model includes the cost of food, recreation and a medication program.

What we did not find. We did not confirm rules on space per participant, capacity, restrooms, rest areas, meals, transportation, required written policies or emergency drills. These would be in the 2017 standards, so ask ASD what the current standards require.

What rules protect participants in Vermont adult day centers?

The participant rules we could confirm come from the Medicaid DHRS program. A DHRS participant needs a current Vermont Independent Living Assessment and a DHRS application, and the center keeps the completed prior authorization form in the participant's file. We did not confirm the certification standard's rules on enrollment, care plans, discharge or incident reporting.

Medicaid DHRS enrollment. Under the DHRS prior authorization instructions:

• The center completes or obtains a Vermont Independent Living Assessment (ILA), the state's standard needs assessment, and a DHRS application. An ILA more than one year old may not be used.
• A completed application that shows the participant meets the service test is treated as pre-authorized and is kept in the participant's file at the center, kept up to date.
• The center must check that the applicant is not eligible for or already using other public funding for the service.
• People living in a nursing home, receiving enhanced residential care, or living in Medicaid-funded residential care are not eligible for DHRS.

What we did not find. We did not find enrollment requirements outside Medicaid, required contents for an enrollment agreement, care plan timelines, discharge reasons or notice periods, attendance record rules, record retention periods or incident reporting rules. Families should ask a center for its written admission, discharge and fee policies, and operators should ask ASD what the standards require.

How does Medicaid pay for adult day in Vermont?

Vermont Medicaid pays for adult day through Choices for Care and through the state plan Day Health Rehabilitation Services program. Both are billed in 15-minute units under state billing codes rather than HCPCS codes. The most recent rate we could confirm from a readable state notice is $4.65 per 15 minutes ($18.60 an hour) from July 1, 2022, and rates have been raised since.

Choices for Care. DAIL's Adult Services Division runs Choices for Care under the Global Commitment to Health 1115 demonstration. The 2022 rate notice (GCR 22-065) lists these adult day codes:

• 078: Choices for Care home-based adult day (high and highest needs), $4.65 per 15 minutes as of July 1, 2022.
• 096: Choices for Care Moderate Needs adult day, $4.65 per 15 minutes as of July 1, 2022.
• 084: Choices for Care respite delivered by an adult day provider, $4.66 per 15 minutes as of July 1, 2022.

Day Health Rehabilitation Services. DHRS is a Medicaid state plan service paid under the Global Commitment rate authority (State Plan Attachment 4.19-B, page 5a) and listed in the 2022 notice as Adult Day Health Services under the DAIL budget, at $4.65 per 15 minutes as of July 1, 2022. To qualify, a participant must have a physical or cognitive impairment and need at least two of five service areas (personal care, nursing, special therapies, social work and nutrition counseling), receive both at least weekly, and receive at least one of them on each day attended. The limit is 50 hours a week.

Current rates. Vermont raised these rates again on July 1, 2023 (GCR 23-069), but we could not read the new amounts, and ASD's online rate page was not available when we checked. Treat the 2022 figures as history and ask ASD for its current Medicaid rate table.

Transportation. We did not confirm whether transportation is billed separately or included in the adult day rate.

Attendance documentation. The DHRS authorization records the planned days and hours of service each week. We did not find a rule that spells out the sign-in or attendance records needed to bill adult day, so ask ASD what documentation it expects to support claims.

What we did not find. We did not find a PACE program in Vermont, and we did not confirm whether the Developmental Disabilities Services or Traumatic Brain Injury programs pay for adult day.

Can a private-pay adult day center operate in Vermont without Medicaid?

Families can pay privately for adult day in Vermont, and ASD says certified centers offer private pay on a sliding fee scale. Certification is described as what lets a center serve participants in DAIL-funded programs. We did not find a state source that says plainly whether a center serving only private-pay participants must be certified, so ask ASD before you open one.

What we did not find. We did not find a state rule limiting what an uncertified program may offer, or consumer protections written specifically for private-pay participants.

Other funding.

• Older Americans Act. Vermont's Older Americans Act Policy and Operations Manual (February 2025) lists out-of-home day respite, which includes adult day care, as a caregiver support service. Your local Area Agency on Aging can tell you what is available in your region.
• Veterans. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical criteria, at VA medical centers, State Veterans Homes or community organizations, and a copay may apply. We did not find which Vermont centers hold VA contracts.

The market. The ASD Adult Day Services page says it certifies 11 adult day providers statewide, and the 2023 rate study also counted 11 centers. The Vermont Association of Adult Day Services has testified to the legislature on behalf of centers, but we did not find a website for it.

What is changing next for adult day in Vermont?

As of our last check on October 21, 2026, we did not find a confirmed upcoming change to Vermont's adult day certification standards or adult day Medicaid payment. Two items are worth watching.

• Medicaid rates. Vermont has raised adult day rates since 2022, but we could not confirm the current rate or the rate for the year that began July 1, 2026. Ask ASD for its current rate table.
• Act 14 of 2025. Act 14 of 2025 (H.13), on Medicaid payment rates for community-based service providers, was approved by the Governor on May 13, 2025. We did not confirm whether or how it affects adult day rates.

Vermont adult day sources

• DAIL Adult Services Division: Adult Day Services
• DAIL Adult Services Division: Agency Certification Standards
• Standards for Adult Day Services in Vermont, January 2017
• DAIL: Instructions for the Day Health Rehabilitation Services Prior Authorization Form
• Global Commitment Register 22-065: DAIL rate increase (2022)
• Global Commitment Register 23-069: DAIL Medicaid rate increases (2023)
• Specific Home and Community Based Service Provider Rate Study Report, February 2023
• Vermont Older Americans Act Policy and Operations Manual, February 2025
• Vermont Legislature: H.13 (Act 14 of 2025)
• U.S. Department of Veterans Affairs: Adult Day Health Care

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Simplifying Payments with Electronic Billing for Adult Day Care
• Effective Transportation Tracking for Elder Day Centers
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states with no state adult day license

Alabama, Alaska, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, New York, North Dakota, Ohio, Oregon, South Dakota, Washington, West Virginia, Wisconsin. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.