How to start a home care agency in Vermont and reach your first client faster
Vermont has no state license for nonmedical home care, and since October 2024 nonmedical agencies can serve Medicaid clients through Choices for Care. That opening comes with its own gate: a DAIL certification packet with ten written policies, a case for unmet need in each county, two letters of support, Vermont Medicaid enrollment, DAIL background checks and electronic visit verification. Home health and hospice are closed to new agencies by a Certificate of Need moratorium. We put all of it in the right order for you.
- Guides reviewed by Christine Ochimas, RN, LMFT, MBA
- One fixed price, agreed in writing
- You own 100%. No franchise fees or royalties
Get your free Vermont launch plan
A 30 minute call. No obligation.
- Christine OchimasRN, LMFT, MBA
- All three care typesNonmedical, home health, hospice
- Written to Vermont rulesthe DAIL Home Care Provider Standards and Certification Requirements (October 2024)
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Updated November 2026 · Reviewed by Christine Ochimas, RN, LMFT, MBA
Answer two questions. See exactly what Vermont requires.
Nonmedical home care for Choices for Care participants
- State license
- None for nonmedical care; DAIL Choices for Care Home Care Provider certification instead
- Who you deal with
- DAIL Adult Services Division and Vermont Medicaid (DVHA and its fiscal agent, Gainwell Technologies)
- Must haves
- Home Care Provider application with ten policies, unmet need and staffing plan for each county, two letters of support, Vermont Medicaid provider number, DAIL background checks, caregiver training, EVV
- Realistic time to first client
- Several months
Orientation for Vermont only. We confirm your exact path on the free call.
Three places new Vermont agencies lose months
Each one keeps you paying rent, insurance and payroll while no clients arrive.
Looking for a license instead of a certification
Owners call the state looking for a home care license and learn there is none for private pay nonmedical care. What they actually need for Medicaid is Choices for Care Home Care Provider certification from DAIL's Adult Services Division, plus a Vermont Medicaid provider number. Until someone explains that, the real packet has not started.
What it costs: Weeks of lost time before the Medicaid clock even starts.
The unmet need and support letter test
The DAIL application asks you to name your counties, describe the unmet need in each one, show your staffing or recruitment plan and attach two letters of support from participants or Vermont stakeholders, such as the local Area Agency on Aging, a hospital or a home health agency. It also needs ten written policies, each labeled with its standard number. A thin packet does not get accepted for review.
What it costs: Months of payroll, rent and insurance carried by your reserve while the packet goes back and forth.
Planning a home health agency the law does not allow
Vermont treats home health as a regional franchise. A new agency needs a Green Mountain Care Board Certificate of Need before it can apply for DAIL designation, and state law bars new Certificates of Need for home health services, including hospice, and for new home health agencies through January 1, 2030. Owners who budget for skilled care first lose a year to a door that is closed.
What it costs: A business plan, lease and clinical hires built around revenue you cannot earn.
What does a delay cost your agency?
Enter your own numbers. Nothing is stored or sent.
Home care vs home health vs hospice in Vermont
The three sound alike and are regulated differently. The one you choose decides your regulator, staffing, startup capital and timeline.
| Topic | Nonmedical home care | Home health (skilled) | Hospice |
|---|---|---|---|
| What your staff do | Personal care, respite and companionship; homemaker tasks for private pay clients | Part time or intermittent skilled nursing plus at least one other therapeutic service, such as therapy or home health aide services | Hospice services of the type covered by Medicare or Medicaid |
| State license | None. DAIL Choices for Care Home Care Provider certification to bill Medicaid | DAIL home health agency designation (33 V.S.A. 6304) | Provided under DAIL home health agency designation |
| Certificate of Need | No | Yes, Green Mountain Care Board; new ones barred through January 1, 2030 | Yes; the same moratorium covers hospice |
| Main payers | Private pay, Choices for Care (Vermont Medicaid) | Medicare, Vermont Medicaid, commercial insurance | Medicare hospice benefit, Vermont Medicaid |
| Medicare | Not covered | Medicare certification required before DAIL designation | Medicare certification required before DAIL designation |
| Key staff | Supervisor who checks competency and visits in person at least every 90 days; trained direct care workers | Administrator, director of nursing or equivalent, clinical staff, a board or advisory board with patients and family members | Physician, RN, social worker and counselor on the interdisciplinary group |
| Startup capital | Lowest | High, and no new Certificate of Need while the moratorium lasts | Highest, with the same Certificate of Need barrier |
| Time to first client | Weeks (private pay) to months (Choices for Care) | Not open to new agencies until the moratorium ends | Not open to new agencies until the moratorium ends |
Vermont law gives each designated home health agency a franchise for its geographic service area, so skilled home health and hospice are not open to new entrants while the Certificate of Need moratorium runs through January 1, 2030. For almost every new owner, the realistic route is nonmedical care for private pay families plus Choices for Care certification. Rules that took effect July 1, 2026 removed Choices for Care personal care, respite, companion and homemaker services from what designated home health agencies must provide, which leaves room for certified nonmedical agencies.
Vermont requirements at a glance
| Nonmedical home care license | None for private pay care. Choices for Care Home Care Provider certification from the DAIL Adult Services Division is required to bill Vermont Medicaid. |
|---|---|
| Home health and hospice | DAIL designation under 33 V.S.A. Chapter 63 and the Rules for the Designation and Operation of Home Health Agencies (effective July 1, 2026); the Division of Licensing and Protection is the state survey agency |
| Certificate of Need | Green Mountain Care Board, 18 V.S.A. 9434. New Certificates of Need for home health services, including hospice, and for new home health agencies are barred through January 1, 2030 (2024 Acts and Resolves No. 87, Sec. 93). |
| Medicaid program | Choices for Care, within Vermont's Global Commitment to Health Section 1115 waiver; home care providers serve the High and Highest needs groups |
| Medicaid enrollment | Department of Vermont Health Access (DVHA) through its fiscal agent, Gainwell Technologies, on the Vermont Medicaid Portal |
| Caregiver training | No state hour count. Choices for Care agencies need orientation, eight training topics before services, task training for each participant and a signed supervisor competency check. |
| Background checks | DAIL Background Check Policy: child and adult abuse registries, VCIC criminal check including the sex offender registry, federal exclusion lists, and a driving record for anyone who transports clients |
| Electronic visit verification | Required for Medicaid personal care since January 1, 2021 and home health since January 1, 2023; the state system is run by Sandata |
| Medicare (home health, hospice) | CMS paused new Medicare enrollment of home health agencies and hospices nationwide from May 13, 2026 for six months |
| Entity filing | Vermont Secretary of State, Business Services Division |
Summary of Vermont requirements as of November 2026. Rules change; confirm with each agency before filing.
Step by step: launching a home care agency in Vermont
The order matters. Start caregiver screening and your ten policies while the business paperwork is in progress, because the DAIL packet cannot be accepted without the policies, and no caregiver may work a Medicaid visit before background checks clear.
Form the business with the Vermont Secretary of State
File your LLC or corporation online, get an EIN, open a business tax account with the Department of Taxes for withholding, register with the Department of Labor for unemployment insurance, and check your town's rules.
You do this; we give you the checklistDecide your payer mix and counties
Private pay, Choices for Care or both. The DAIL application asks which of Vermont's counties you will serve and what unmet need you will meet in each, so choose your area with that in mind. Use the path finder above.
Decided on your free consultationSet up insurance and employment basics
Arrange workers' compensation, general and professional liability, and auto coverage for caregivers who drive. Build Vermont earned sick time into payroll from the first hire: at least one hour for every 52 hours worked.
You do this; we specify what is requiredWrite policies to the Home Care Provider Standards
The application must include ten policies, each named with its standard number: admission, transitions and discharge (1.3), complaints and grievances (1.4), conflict of interest (1.5), confidentiality (1.6), abuse, neglect and exploitation (1.8), emergency management (1.9), health and safety (1.10), communication (1.11), critical incident reporting (1.12) and quality management (1.14).
We write this for youBuild the caregiver pipeline
Run DAIL background checks before anyone starts, deliver orientation and the eight required training topics, train each worker on the tasks in each participant's plan, record a signed supervisor competency check, and schedule in person monitoring visits at least every 90 days.
We set up the system and trackerApply for Choices for Care certification
Send the Home Care Provider Application to the DAIL Adult Services Division with your counties, unmet need and staffing plan, EVV readiness, the ten policies and two letters of support. DAIL reviews an accepted application within 10 business days and, if approved, grants conditional approval.
We prepare the applicationEnroll in Vermont Medicaid
Certification requires an active Vermont Medicaid provider number. Enrollment goes through DVHA's fiscal agent, Gainwell Technologies, with a signed General Provider Agreement. DVHA screens each applicant by risk level and may make a site visit.
We prepare and manage itSet up electronic visit verification
Every Choices for Care visit must be verified with an EVV system that works with the state's EVV and claims systems. Vermont's state system is run by Sandata. Set it up before your first visit, because Medicaid does not pay for personal care recorded without EVV.
We walk you through setupStart services and pass the initial review
Bill only for services on or after your conditional approval date. Email DAIL your first service date within 10 working days of starting. DAIL then holds an initial certification review 30 to 90 days after you begin, with document review and staff and participant interviews.
We get you ready for the survey
Caregiver training and background checks
Vermont sets no state training hour count for private pay nonmedical caregivers. For Choices for Care, the DAIL Home Care Provider Standards (October 2024) set what every direct care worker must complete before serving a participant, and the DAIL Background Check Policy applies to every worker paid with funds DAIL administers.
- Orientation: Covers all job related policies, including federal confidentiality rules and documentation procedures, signed and dated by the worker and kept in the personnel file.
- Training before services: Cultural sensitivity, participant rights, mandatory reporting, person centered thinking, crisis management, emergency preparedness, incident reporting, and universal precautions and infection control.
- Task training and competency: Each worker is trained in the skills each participant's plan calls for, and a supervisor completes a signed, dated competency assessment after training and before the first visit.
- Monitoring visits: The agency makes in person monitoring visits at least once every 90 days to confirm services match the participant's plan.
- Background checks: Child abuse registry (DCF), adult abuse registry (DAIL), VCIC criminal check including the sex offender registry, federal exclusion lists such as the OIG LEIE, and a driving record for anyone who transports participants. The agency pays; workers may not be charged.
- No start before clearance: No one may begin work until the checks are complete and satisfactory, and Medicaid does not pay for services delivered before then. Variances for starting early are not considered.
- Convictions and variances: Substantiated abuse, neglect or exploitation and federal exclusion bar employment. Listed convictions also bar it unless the agency grants a documented variance, decided within 15 business days of the request.
- Home health aides: Medicare certified home health agencies follow 42 CFR 484.80: at least 75 hours of training with 16 hours of supervised practical training, an RN competency evaluation and 12 hours of in service training a year.
Six mistakes that slow Vermont agencies down
We look for every one of these in the first week of an engagement.
Waiting for a license application that does not exist
- What it costs
- Weeks lost while policies, caregiver screening and the DAIL packet sit untouched.
- How we prevent it
- Your first call ends with your exact Vermont path and the order to do it in.
Sending a thin DAIL application
- What it costs
- A packet without a clear unmet need case for each county, a staffing plan and two support letters is not accepted for review.
- How we prevent it
- We build the county by county need and staffing narrative and help you line up support letters early.
Letting a caregiver start before checks clear
- What it costs
- Medicaid will not pay for any service delivered before the background checks are complete and satisfactory.
- How we prevent it
- A tracker that blocks scheduling until every check, training topic and competency sign off is on file.
Billing before conditional approval
- What it costs
- Only services on or after the conditional approval date can be billed to Medicaid.
- How we prevent it
- We set your start date from the approval letter and schedule the first service notice to DAIL within 10 working days.
Calling the business home health or drifting into skilled care
- What it costs
- A business that meets the home health agency definition without designation gets a notice of violation, and knowing violations can bring criminal penalties under 33 V.S.A. 7116.
- How we prevent it
- Clear service definitions, a careful business name and website copy, and policies that keep caregivers out of skilled nursing.
Forgetting the renewal date
- What it costs
- A late renewal application can lead to suspension or revocation of certification, which stops Medicaid billing.
- How we prevent it
- We track your certification end date and send the renewal at least 60 days before it expires.
In a free 30 minute call we confirm your Vermont path, flag the mistakes that apply to your plan, and give you a fixed price to handle the rest.
Vermont launch packages
Three fixed price packages, matched to the path you choose. Your exact price is quoted in writing after your free call, before any work starts.
Private pay launch
For nonmedical agencies serving families who pay privately.
- Vermont path and a dated launch plan
- Policy and procedure manual written to the DAIL Home Care Provider Standards and Certification Requirements (October 2024)
- Service agreement, client rights and care plan forms
- Caregiver hiring and screening workflow
- Google Business Profile setup
Choices for Care ready agency
Everything in Private pay launch, plus the Medicaid route.
- Policies aligned to Choices for Care requirements
- Caregiver training and background check tracker
- Medicaid provider enrollment
- Credentialing packets for the DAIL Adult Services Division and Vermont Medicaid
- Survey and audit readiness
- Vermont city pages for local search
Home health and Medicare
For skilled home health. Hospice is scoped separately.
- Staffing and capital timeline
- Policies written to DAIL rules and the Medicare Conditions of Participation
- License application and inspection readiness
- Accreditation survey preparation
- Medicare and Medicaid enrollment support
Every package: one fixed price agreed in writing · you own 100% of your agency · no franchise fees or royalties.
On your own vs a franchise vs Lunaria
| Topic | On your own | Home care franchise | With Lunaria |
|---|---|---|---|
| Who owns the business | You | You, under the franchisor's brand and rules | You, 100% |
| Ongoing fees | None | Royalties and brand fees, usually a share of revenue | None. One fixed project fee |
| Knowing what Vermont requires | Pieced together from manuals and forums | A national playbook, adapted | Confirmed on your first call, then in writing |
| Policy manual | A template, often from another state | The franchisor's standard manual | Written to the DAIL Home Care Provider Standards and Certification Requirements (October 2024) |
| Medicaid credentialing | One application at a time | Varies by franchisor | Packets for the DAIL Adult Services Division and Vermont Medicaid prepared together |
| Your brand and marketing | Up to you | The franchisor's brand, with territory limits | Your brand, plus local search set up for you |
The Vermont home care startup checklist
Every Vermont step in order: business setup, your payer path, policies, caregiver screening and training, Medicaid enrollment and getting found. The items to start first are starred.
- Choose your care type, payer mix and the counties you will serve
- Form your LLC or corporation with the Vermont Secretary of State
- Get an EIN, open a Department of Taxes withholding account and register with the Department of Labor for unemployment insurance
- Buy workers' compensation, general and professional liability, and auto coverage
- Set up payroll with Vermont earned sick time (one hour per 52 hours worked)
- and 15 more steps
Christine Ochimas, RN, LMFT, MBA
Christine founded Lunaria Care Consulting to give nurses and caregivers a direct route from "I want my own agency" to a compliant business with clients. She reads state requirements the way a reviewer does and writes policies the way a nurse would actually use them.
- We serve owners in all 50 states and DC, with a plan written for Vermont
- We help through enrollment and survey readiness, not just the application
- We tell you what we cannot promise: no one can guarantee a state or health plan decision
Have these ready for your consultation
- The care you want to provide and the clients you want to serve
- The Vermont cities or counties you plan to cover
- Where you are now: idea, business formed or already operating
- Who you expect to pay: families, Choices for Care, Medicare
- Your target opening month and rough budget
No client or patient records. We never need them for a first call.
What it costs to start a home care agency in Vermont
| Item | Notes |
|---|---|
| State license | None for nonmedical care. The DAIL Home Care Provider Certification Requirements list no application fee. |
| Entity formation | Vermont Secretary of State filing fee and annual report fee. Check the current fee schedule. |
| Background checks | Paid by the agency for every worker and volunteer; workers may not be charged |
| Owner fingerprints | Only if DVHA screens your Medicaid enrollment as high risk; the provider pays |
| Caregiver training | Staff time and materials for orientation, the eight required topics and task training |
| Insurance | Workers' compensation, liability and auto coverage |
| EVV and scheduling software | Needed for every Choices for Care visit; an alternate EVV system adds vendor interface costs |
| Operating reserve | Covers payroll, rent and insurance while DAIL certification and Medicaid enrollment are pending |
Fees change. Confirm current amounts with each agency before budgeting.
How long it takes in Vermont
Weeks, once the business, insurance and hiring process are in place.
Several months: policies and support letters, DAIL application review, Vermont Medicaid enrollment, then the initial certification review 30 to 90 days after services begin.
Not open to new agencies while the Certificate of Need moratorium lasts, currently through January 1, 2030.
Vermont is a state of small towns and long rural drives, and the DAIL application asks you to make the case for unmet need county by county, from Chittenden to Essex. DAIL opened Choices for Care to nonmedical agencies in October 2024 because workforce shortages left the state needing more providers, and DAIL has said most designated home health agencies were operating under a variance from serving every Choices for Care referral. Reliable staffing in your chosen counties is your strongest selling point. Families often search by town, so a complete Google Business Profile and pages for Burlington, Rutland, Montpelier, Brattleboro, St. Johnsbury and your other towns matter.
Frequently asked questions
Do you need a license to start a nonmedical home care agency in Vermont?
No. Vermont does not license private pay nonmedical home care, and the home health designation rules leave private duty services outside designation. To bill Vermont Medicaid, you need Choices for Care Home Care Provider certification from the DAIL Adult Services Division and an active Vermont Medicaid provider number.
How does a Vermont home care agency get Choices for Care clients?
Apply to the DAIL Adult Services Division with the Home Care Provider Application, ten policies, a county by county unmet need and staffing plan and two letters of support, and enroll in Vermont Medicaid. After conditional approval you can bill for personal care, respite and companion services authorized for participants in the High and Highest needs groups.
How long does Choices for Care certification take?
DAIL reviews an accepted application within 10 business days. After conditional approval and your first services, the initial certification review happens 30 to 90 days after you start, takes up to 15 working days, and DAIL issues a report within 20 working days. Full certification lasts up to three years.
Can I open a new home health agency in Vermont?
Not right now. A new agency needs a Green Mountain Care Board Certificate of Need, Medicare certification and DAIL designation, and state law bars new Certificates of Need for home health services and new home health agencies through January 1, 2030, unless the legislature lifts it sooner.
Can I open a hospice in Vermont?
Not as a new agency at present. Hospice is a designated service under Vermont's home health agency rules, and the Certificate of Need moratorium expressly includes hospice. The law exempts a continuing care retirement community with a certificate of authority and a licensed home for persons who are terminally ill.
What training do Vermont caregivers need?
There is no state hour count for private pay nonmedical care. For Choices for Care, every worker needs orientation, training in eight topics such as participant rights, mandatory reporting and infection control, task training for each participant, and a supervisor's signed competency check before the first visit.
What background checks are required in Vermont?
Under the DAIL Background Check Policy: the child abuse registry, the adult abuse registry, a Vermont Crime Information Center criminal check including the sex offender registry, federal exclusion lists, and a driving record for anyone who transports clients. No one may start until all checks clear, and the agency pays for them.
Can I enroll a new home health agency or hospice in Medicare right now?
CMS put a nationwide six month moratorium on new Medicare enrollment of home health agencies and hospices starting May 13, 2026. It can be extended in six month steps, so it may have ended or been extended by the time you read this. In Vermont, the state Certificate of Need moratorium is the bigger barrier.
How much does Vermont home care consulting cost?
Lunaria charges one fixed price per engagement, based on your path: private pay or Choices for Care. You receive the price in writing after a free 30 minute consultation. There are no hourly charges, and you own 100% of your agency.
Do you only work in Vermont?
No. Lunaria works with owners in all 50 states and DC, so you can expand into a second state with the same team.
Sources checked for this guide (36)
- DAIL ASD: Home Care Providers Now Eligible to Enroll as Choices for Care Providers (October 25, 2024)
- DAIL ASD Home Care Provider Certification Requirements, Choices for Care (October 2024)
- DAIL ASD Home Care Provider Standards, Choices for Care (October 2024)
- DAIL ASD Home Care Provider Application (April 2025, posted July 29, 2025)
- DAIL ASD Provider Enrollment page
- DAIL ASD Choices for Care and TBI Provider Enrollment Process (July 2018)
- DAIL ASD Home Care Provider List (updated June 30, 2026)
- DAIL ASD Choices for Care Program
- AHS Health Care Administrative Rule 7.102, Choices for Care
- DAIL Background Check Policy (updated February 10, 2024)
- DAIL Rules for the Designation and Operation of Home Health Agencies (adopted, effective July 1, 2026)
- DAIL Division of Licensing and Protection facility regulations page
- Vermont Secretary of State rule 25P021 (designation rule amendment summary)
- Code Vt. R. 13-110-010, Designation and Operation of Home Health Agencies, 2019 version (Cornell LII)
- 2024 Acts and Resolves No. 87 (H.839), Sec. 93, home health CON moratorium through 2030 (Internet Archive copy of legislature.vermont.gov)
- 2019 Acts and Resolves No. 5 (S.14), earlier moratorium extension (Internet Archive copy)
- 18 V.S.A. 9434, Certificate of need general rules (Internet Archive copy, October 2026)
- 33 V.S.A. Chapter 63, Home Care Programs (Internet Archive copy, May 2026)
- 33 V.S.A. 6911, adult abuse registry and employer access (Internet Archive copy)
- 21 V.S.A. 482, earned sick time accrual (Internet Archive copy)
- DVHA: What is Vermont doing to implement an EVV system
- DVHA Third Party / Alternate EVV (AltEVV)
- DVHA Electronic Visit Verification
- AHS Global Commitment Register GCR 24-053, EVV for DAIL home based services (final)
- DVHA Provider Screening and Enrollment SOP (issued July 7, 2025)
- Vermont Secretary of State, Limited Liability Company formation
- Vermont Department of Taxes, withholding
- Vermont Department of Labor, register for UI quarterly tax reporting
- CMS Provider Enrollment Moratoria (last modified 08/27/2026)
- Federal Register 2026-09717, nationwide moratorium on Medicare enrollment of HHAs (effective May 13, 2026)
- Federal Register 2026-09718, nationwide moratorium on Medicare enrollment of hospices (effective May 13, 2026)
- 42 CFR 484.80, home health aide services (Cornell LII)
- 42 CFR Part 484, home health Conditions of Participation (Cornell LII)
- 42 CFR Part 418, hospice care (Cornell LII)
- CMS accreditation and approved accrediting organizations
- CMS-855A Medicare enrollment application, institutional providers
This guide is general information and reflects Vermont requirements as we understood them in November 2026. Requirements change. Confirm current rules, fees and procedures with the Vermont Department of Disabilities, Aging and Independent Living, the Department of Vermont Health Access, the Green Mountain Care Board and CMS before filing. Lunaria Care Consulting provides professional consulting services and does not provide legal advice.
Other states: see all state guides. What we do: licensing, compliance, Medicaid enrollment and local search marketing.