Self-Direction and FMS in Vermont

All states: self-direction map

Vermont self-direction at a glance

Last verified against state sources: 2026-10-13.

Which Medicaid programs in Vermont offer self-direction?

Vermont offers self-direction in several Medicaid programs: Choices for Care (including its Flexible Choices option), the Attendant Services Program, Developmental Disabilities Services, Family Managed Respite and Children's Personal Care Services. In each one the participant, a family member or a surrogate hires and manages the workers. Flexible Choices and Developmental Services also give the person or family a budget to manage. Vermont Medicaid is fee for service, so the rules do not vary by health plan.

• Choices for Care, consumer-directed and surrogate-directed option: serves Vermonters age 65 and older, or 18 and older with a physical disability, who meet nursing home level of care and long-term care Medicaid financial rules. It is run by the Department of Disabilities, Aging and Independent Living (DAIL), Adult Services Division. The participant (consumer-directed) or a surrogate (surrogate-directed) has employer authority. The service plan sets the hours of personal care, respite and companion services. We did not find a clear statement that participants in this option have budget authority.
• Choices for Care, Flexible Choices: serves Choices for Care participants approved for home-based services who meet the employer certification criteria. It is run by the DAIL Adult Services Division. The individual or an eligible surrogate has both employer authority and budget authority. The home-based service plan is converted into an allowance that the participant budgets across personal care, goods and other services.
• Attendant Services Program (ASP): serves adults with a severe and permanent disability who need physical help with daily activities and can direct their own attendant care. It is run by the DAIL Adult Services Division. The participant has employer authority. Budget authority is not confirmed. The state program page says General Fund spending for the program has been frozen since July 2014 until further notice, so only the Medicaid-funded part, which ARIS calls Participant Directed Attendant Care, takes new people.
• Developmental Disabilities Services, self-managed, family-managed and shared-managed: serves people with intellectual and developmental disabilities. It is run by DAIL's Developmental Disabilities Services Division (DDSD). The individual or a family member is the employer of record and has both employer authority and budget authority. In shared management an agency runs some services and the person or family hires some workers. Home supports that run 24 hours a day cannot be self-managed or family-managed.
• Family Managed Respite (FMR): serves children and young adults under 21 with a mental health condition or developmental disability, and their families. It is run by DDSD, and families apply through the local Designated Agency. Families are the employers. Budget authority is not confirmed.
• Children's Personal Care Services (CPCS): serves children and youth under 21 with Vermont Medicaid and a health condition or disability who need help with daily living activities. It is run by the Vermont Department of Health, Children with Special Health Needs. The parent or primary caregiver enrolls as the employer. Budget authority is not confirmed.

Employer authority means the participant or family recruits, hires, schedules and supervises the workers. Budget authority means they also manage a set amount of money for services. Two more services are paid through the same fiscal agent but are not participant direction in the usual sense. In Adult Family Care Respite (part of Choices for Care), the ARIS employer handbook says the Adult Family Care home provider is authorized a respite budget to manage. In the Brain Injury Program, only the respite service is paid through ARIS. We did not find a clear statement of who the legal employer is in either one. Ask the DAIL Adult Services Division at (802) 241-0294.

Who handles financial management services (FMS) in Vermont?

One organization handles financial management services for every self-directed Medicaid program in Vermont: ARIS Solutions. Vermont uses a fiscal/employer agent (F/EA) model, which means ARIS runs payroll, taxes and background checks while the participant, a family member or a surrogate stays the legal employer of the workers. Because there is one state-contracted F/EA, participants do not pick among FMS vendors.

A fiscal/employer agent is the organization that handles the paperwork side of being an employer. It enrolls the workers, processes their timesheets, pays them and files the employer taxes on the employer's behalf. ARIS describes itself as the State of Vermont's contracted fiscal agent. Older Choices for Care documents call this role the Intermediary Service Organization.

• Legal employer: the participant, family member or surrogate is the employer of record. Vermont law treats independent direct support providers in Choices for Care, the Attendant Services Program, Children's Personal Care and Developmental Disabilities Services as employed by the service recipient, a surrogate or a shared living provider, and says the State is not a joint employer.
• Vendor by program: ARIS is the F/EA for Choices for Care (consumer-directed, surrogate-directed and Flexible Choices), the Attendant Services Program, Developmental Disabilities Services, Family Managed Respite and Children's Personal Care Services. It also pays Adult Family Care Respite and Brain Injury Program respite. The ARIS program page lists each program with its state contact.
• Is ARIS required: in Developmental Services, DDSD's guide to self and family management says the State contracts with ARIS as the F/EA and the employer of record is required to work with it.
• Support roles beside ARIS: two organizations help participants but do not run payroll. Transition II is the Supportive Intermediary Service Organization for self-managed and family-managed developmental services. It helps with hiring, planning and the budget. For Flexible Choices, a case manager from an Area Agency on Aging helps the participant build the budget.

Pay is shaped by a union contract. Independent direct support providers are covered by a collective bargaining agreement between the State and AFSCME Council 93 Local 4802, which sets a minimum wage for workers in the ARIS-paid programs. Employers set the wage at or above that minimum, within program limits. ARIS posts the current rates in its employer memos for each program.

Who can be a paid caregiver under self-direction in Vermont?

Relatives can be hired in Vermont, but each program limits which ones. Across all ARIS-paid programs, workers must be at least 18 and pass background checks, and parents, stepparents and legal guardians cannot be paid to serve their own child. Spouses and partners are barred or restricted in some programs. A few narrow exceptions pay legally responsible individuals, which means parents of a minor, spouses and legal guardians.

• Choices for Care: a spouse or civil union partner may not be paid for help with instrumental activities of daily living (tasks such as housekeeping and meal preparation), respite or companion services. A court-appointed legal guardian may not be paid for personal care, respite or companion services. A surrogate employer may not be paid to serve the participant they act for. We did not find a statement that says outright whether a spouse can be paid for hands-on personal care. Ask the DAIL Adult Services Division at (802) 241-0294.
• Developmental Disabilities Services: the employer of record may not hire the legal guardian (or the guardian's spouse or partner), the individual's parent, stepparent or adoptive parent, a parent's domestic or civil union partner, or the individual's spouse or partner. Workers must be 18 with a high school diploma unless a variance is granted.
• Exception for Developmental Services and the Brain Injury Program: a state policy notice says that since March 29, 2024 Vermont Medicaid allows payment to legally responsible individuals in these two programs under Health Care Administrative Rule 7.200. It is meant for times when direct support workers are not available. We did not confirm the weekly hour limit, so check with DDSD at (802) 241-0304 before relying on it.
• Family Managed Respite: the Rule 7.200 exception does not apply here. Beyond the general ARIS rules above, we did not find the program's own list of who may be the respite worker. Ask the local Designated Agency or DDSD.
• Children's Personal Care Services: an employee may not be the child's biological or adoptive parent, guardian, shared living provider, foster parent or stepparent, the primary caregiver's domestic or civil union partner, or a relative serving as primary caregiver. As a temporary back-up until an attendant can be hired, the program pays Legally Responsible Adults who live with the child. They are not employees and no payroll tax is withheld. That authority has run since May 11, 2023.
• Attendant Services Program: we did not find a program document that lists who may be a paid attendant. The general ARIS rules apply. Ask the DAIL Adult Services Division.

On hours, the ARIS employer handbook says overtime is paid at time and a half for hours over 40 in a Sunday to Saturday workweek, unless the employer marks the worker exempt on each timesheet (for example companionship-only or live-in domestic service employees). The overtime cost comes out of the participant's budget, so employers need to plan schedules with that in mind.

Does EVV apply to self-directed workers in Vermont?

Partly. Electronic visit verification (EVV) applies to in-home personal care, respite and home supports delivered by self-directed workers. Live-in caregivers and services delivered entirely outside the home are exempt. Workers use the state's Sandata Mobile Connect app or the Vermont telephone line through ARIS, not a system of their own choosing, and ARIS cannot process a timesheet for an in-scope visit without matching EVV data.

• Choices for Care, Flexible Choices, Attendant Services, Children's Personal Care and Brain Injury respite: the Department of Vermont Health Access (DVHA) lists these as Phase I EVV programs on its EVV page. DVHA says ARIS will not process timesheets without matching EVV data from July 1, 2022. The state's Medicaid claims system denies ARIS-billed self-directed personal care claims without compliant EVV for dates of service on or after November 1, 2023.
• Developmental Disabilities Services: EVV applies only to in-home respite and home supports by workers who do not live in. Collection began June 15, 2024, and the claims system has denied in-scope claims without EVV since April 1, 2025.
• Family Managed Respite and Adult Family Care Respite: both were added to EVV on June 15, 2024, with claim denial from April 1, 2025. The live-in and community-only exemptions apply to Family Managed Respite.

Good EVV practice protects both the worker's paycheck and the employer. A visit that is checked in and out on time, and matches the timesheet, can be paid from program funds without delay. For questions about a specific visit or exemption, call ARIS customer service at (800) 798-1658.

What is changing next for self-direction in Vermont?

ARIS plans to move several self-directed programs to a new timekeeping platform. The planned July 2026 start was postponed, and no new date had been published as of October 13, 2026. Until ARIS announces one, employers and workers in those programs keep using the current tools.

ARIS has said that Children's Personal Care, Developmental Services and Family Managed Respite users will move from eTimesheets and Sandata to a platform called EVVie, which includes a portal, a mobile app and a phone line. The ARIS EVVie transition page and its delay announcement are the places to watch. We did not find a statement on whether Choices for Care, Attendant Services or Brain Injury users will move later. Call ARIS at (800) 798-1658 for the current plan.

Two other changes are already in effect:

• Case management for Flexible Choices: case management for Flexible Choices and Adult Family Care participants has been moving to Area Agencies on Aging under Vermont's conflict-free case management work. This replaces the Transition II consultant role that the 2020 Choices for Care manual still describes. DAIL posts case management transition resources.
• Worker pay: a new collective bargaining agreement between the State and AFSCME Council 93 Local 4802 raised the minimum wage for independent direct support providers in July 2026. ARIS sent a memo for each program with the new minimum, the employer tax rate and the budgeted rate. Check the ARIS memo for your program for the exact figures and effective date.

Vermont self-direction sources

• ARIS Solutions: Vermont Agency of Human Services Programs
• ARIS Solutions: Vermont AHS Employer Handbook
• Vermont DDSD: Self-Management
• Vermont DDSD: Guide to Self and Family Management (August 2023)
• Vermont DAIL: Choices for Care High and Highest Needs Manual
• Vermont Department of Health: Children's Personal Care Services Guidelines (November 2025)
• Vermont Agency of Human Services: GCR 24-018, payment to legally responsible individuals
• Department of Vermont Health Access: Who will use the EVV system
• ARIS Solutions: EVVie transition

Related reading

• Self-Directed Medicaid Home Care Services in 2026
• Understanding Self-Direction and FMS
• Self-Direction Fiscal Intermediary: A Guide for Participant-Directed Care
• 5 Big Challenges in Self-Directed Care And How FMS Providers Can Solve Them
• Self-direction in every state (map)
• Vermont EVV requirements

Other states with one statewide FMS vendor

Arkansas, Connecticut, District of Columbia, Indiana, Iowa, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Washington, West Virginia, Wyoming. See every state on the self-direction map.

Page history

• October 13, 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 FMS organizations and agencies that support self-direction. If you would like to talk through your program, contact Ankota or read more about Ankota's self-direction and FMS software.