How Vermont pays for disability services

Waiver inventory

Choices for Care (also under the 1115) is Vermont's long-term care program for older adults and adults with physical disabilities and is excluded here; it is not the state's DD vehicle.

State-only funded programs

Office of Public Guardian, DAIL/DDSD. Court-ordered public guardianship for adults with developmental disabilities and Vermonters age 60 and over. 861 people served unduplicated in SFY2025 (796 on guardian caseloads, 319 representative payee). Average caseload 25 per guardian. The SFY2025 annual report does not publish an appropriation amount. ddsd.vermont.gov

Beyond that, none identified. Checked: Flexible Family Funding, Family Managed Respite, the Bridge Program, and Peer Growth and Lifelong Learning are all described by DDSD as Global Commitment investments or other Medicaid funding, not state-only. The FY2024 legislative report states HCBS accounts for 97 percent of all DDSD appropriated funding and that the remaining 3 percent is "Other Medicaid Funding."

County / regional / local funding

None identified. Vermont has no county-level human services taxing authority for DD services. Services are delivered by ten private nonprofit Designated Agencies assigned to geographic regions along county lines plus five Specialized Service Agencies, all contracted directly by DDSD and funded by state and federal Medicaid dollars. No county levy, county board, or local mill levy stream appears in the DDSD annual report, the DD Act regulations, or the Administrative Rules on Agency Designation. ddsd.vermont.gov

Funding scale

• Total DD services: "more than 50% of $300+ million used to support individualized services for Vermonters with Developmental Disabilities engaged in Home-and-Community Based Services" (FY2024 legislative report). ddsd.vermont.gov
• HCBS is 97 percent of all DDSD appropriated funding (FY2024). ddsd.vermont.gov
• FMAP: 56.75 percent federal / 43.25 percent state general fund for FFY2024, as stated in the DDSD legislative report. KFF lists Vermont's FY2026 FMAP at 59.01 percent. kff.org
• Spending per participant: $66,545 average HCBS cost per person per year (FY2024); $223 average daily HCBS cost, against $281 per day for a Medicaid nursing facility. Inflation-adjusted FY2014 equivalent was $74,743, so real per-person cost has fallen. ddsd.vermont.gov
• New caseload funding FY2024: $22,226,021 allocated to 334 people; 57 percent to people new to services, 43 percent to existing recipients. ddsd.vermont.gov
• People served: 3,394 in HCBS (FY2024); 1,490 in 24-hour paid home supports; 539 in supervised or independent living.
• Waiting list: zero people waiting who met a State System of Care Plan funding priority in FY2024. 352 people were waiting who did not meet a funding priority, the largest categories being Service Coordination (208), Respite-Family (187), and Community Supports (109). Vermont's statute funds only the level of service identified by needs assessment for people meeting a priority, so there is no conventional waiver waitlist. ddsd.vermont.gov
• Medicaid waiver expenditures for people with I/DD per capita were $346 in Vermont versus a $143 national average (FY2020, RISP data cited in the FY2024 report).

Residential funding detail

Vermont funds five home support models, all under the 1115 Global Commitment. Number of people by setting as of June 30, 2024: Shared Living 1,317 in 1,171 homes; Supervised Living 274; Independent Living 265 (no paid home support); Staffed Living 95 in 72 homes; Group Living 78 in 20 homes; In-Home Family Supports 1,278 living with family. 96 percent of people in residential settings live in settings of one or two people, and the average is 1.15 people per home support setting against a national average of 2.3.

• Shared Living (host home / developmental home) is the dominant model, 75 percent of all people receiving home supports. Designated Agencies contract directly with home providers. The provider receives a monthly "difficulty of care" stipend for supervision, training, social support, transportation and community integration. That payment is exempt from federal and state income tax. Under the new model it is a monthly rate in four categories.
• Room and board is not Medicaid-funded. The home provider receives a separate monthly payment for the person's housing and food, paid from the person's SSI, other Social Security benefits, wages or other income. The Department for Children and Families pays room and board for children in custody who do not receive SSI. ddsd.vermont.gov
• Staffed Living is a home staffed full time serving one or two people, paid at a 15-minute unit under the new model (previously daily rates).
• Group Living is a licensed staffed home for three to six people, paid per diem with separate rate tiers for 3-4 bed and 5-6 bed homes.
• Supervised Living is hourly support in the person's own apartment, paid at a 15-minute unit.
• In-Home Family Supports is hourly support in the home of unpaid family caregivers.
• An ICF/DD serves a small number of people with intensive medical needs.

Payment structure changed on October 1, 2025. DDSD moved from agency-negotiated individualized budgets to Supports Intensity Scale-Adult (SIS-A) based budget ranges at six levels (1, 2, 3, 4, M for very high medical, B for very high behavioral) crossed with living arrangement, paid against a statewide fee schedule with encounter data reporting. Maximum annual individual budgets: Shared Living $112,146 to $283,179; Group Living 3-4 bed $209,556 to $361,528 and 5-6 bed $195,726 to $310,636; Staffed Living $471,088 to $483,108; living with unpaid support $56,940 to $165,920; living independently $59,660 to $106,208 with state review at levels 4, M and B. Communication Support and Planned Crisis Services are added above the budget range. Clinical assessment, therapies, behavior support, medication and medical support, unplanned crisis, home modifications and vehicle modifications are paid fee-for-service outside the range. ddsd.vermont.gov and ddsd.vermont.gov

Comparable service rates

Rate model wage base: direct support staff hourly wage $22.81 with a 34.2 percent benefit rate and a 1.35 productivity factor.

Official rate schedule links

• ddsd.vermont.gov
• ddsd.vermont.gov
• ddsd.vermont.gov
• ddsd.vermont.gov
• ddsd.vermont.gov
• ddsd.vermont.gov

Notable features and flags

• October 1, 2025: New DDS payment model went live. Statewide fee schedule replaces agency-specific rates, SIS-A drives six-level budget ranges by living arrangement, encounter data reporting with annual reconciliation, and an exceptions process with appeal rights. ddsd.vermont.gov
• August 18, 2025: Burns & Associates / HMA delivered final rate models converting Shared Living and Staffed Living from daily to monthly and 15-minute units and setting a $22.81 DSP wage assumption. ddsd.vermont.gov
• October 2025: Conflict-free case management began. CMS rejected Vermont's first remediation plan; the current plan was approved March 2023 with final implementation October 2025 and an evaluation window through May 2026. Case management moves from Designated Agencies and Specialized Service Agencies to separate Case Management Entities. ddsd.vermont.gov
• January 2, 2025: CMS approved an amendment to the Global Commitment to Health demonstration, which runs July 1, 2022 through December 31, 2027, adding vehicle modifications, home accessibility adaptations and personal emergency response systems to DD services. medicaid.gov
• Workforce: 48 percent of direct care workforce survey respondents in a late-2024 survey were 55 or older. 4,209 employees were paid through ARIS (the fiscal/employer agent) in FY2024.
• Housing: 27 Vermonters with I/DD receiving HCBS were unhoused as of June 30, 2024. Vermont reports it is ranked first nationally for the number of people with I/DD in supported employment; all sheltered workshops closed in 2002 and 1,154 people were supported to work in FY2024.

Confidence

Solid: the fee schedule (final rate models dated August 18, 2025), the individual budget ranges, the October 1, 2025 payment reform start, the residential model counts and definitions, room and board treatment, waiting list structure, per-person cost of $66,545, and the absence of county funding. All come from DDSD primary documents. Estimated or dated: total DD spending is stated only as "$300+ million" in the FY2024 legislative report rather than a precise appropriation, because the FY2024 annual report's Reference C funding appropriation table is a graphic that does not extract as text. The FY2026 FMAP of 59.01 percent is from KFF, not a Vermont document; the state's own figure of 56.75 percent is FFY2024. Could not find: an SFY2025 or SFY2026 DDSD annual or legislative report (the DDSD publications page lists FY24 as the most recent), a published service coordination or targeted case management rate, a Flexible Family Funding total appropriation (only the $1,000 per person annual maximum and 1,017 people served), an Office of Public Guardian appropriation, and a current State System of Care Plan document for FY2026 onward.

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