Starting a care business in Vermont

Child care thresholds count families, not children. Caring for the children of up to two other families needs no approval under 33 V.S.A. § 3502. Add a third family and a home program needs a registered family child care home registration, which allows 10 children year-round or 12 under the summer-vacation option. Any program outside your own home, paid or free, needs a center-based child care and preschool program license, applied for in three phases through CDD's BFIS portal. No registration or center license fee appears in the statute, the rules or CDD's guides.

Center rules dated April 17, 2022 are still the formal text, but CDD has changed them by memo and variance. Under Act 76 of 2023, a director must be on site 40% of the time children are present instead of the 60% the rule states. Draft replacement rules were posted in November 2025, and as of October 12, 2026 CDD listed no final proposed rule.

Residential adult care starts at three unrelated residents. Room, board and personal care for three or more people who are not your relatives requires a residential care home license from DAIL's Division of Licensing and Protection, at Level IV or at Level III, which adds nursing overview. A three-bed home and a large building follow the same April 1, 2025 rules. An assisted living residence license sits on top of the Level III rules and requires every unit to be a private apartment; new units need 225 square feet excluding bath and closets. Only Level III homes and assisted living residences can serve residents through Medicaid's ACCS and Enhanced Residential Care. For both licenses, plans go to the Division of Fire Safety before construction, and the license must be renewed every year. Running either kind unlicensed is a crime.

Skilled home health is effectively closed to newcomers. Vermont designates home health agencies rather than licensing them, and the order is fixed: a certificate of need from the Green Mountain Care Board, then Medicare certification, then DAIL designation under rules that took effect July 1, 2026. A session-law moratorium bars new home health and hospice certificates of need through January 1, 2030, apart from narrow exceptions. Since May 13, 2026, a federal freeze has also stopped new Medicare enrollment of home health agencies nationwide.

Two types have no state license at all. Adult day centers are certified by DAIL's Adult Services Division under the Vermont Standards for Adult Day Services. Certification is required to serve participants through DAIL, a new center must show unmet need, and the first certification lasts no more than one year. Non-medical personal care, homemaker and companion agencies need DAIL certification only if they bill Medicaid through Choices for Care. The home health rules expressly exclude these unskilled services from designation.