The Adult Services Division is responsible for approving all new providers of the Choices for Care (home-based, Adult Family Care, Enhanced Residential Care) and Traumatic Brain Injury programs. This page provides an overview of the provider enrollment process by provider type and provider-specific fillable enrollment applications.
1. Before applying as a Choices for Care or Traumatic Brain Injury Provider read this: "Provider Enrollment Process Summary"
2. When you are ready to submit an application, click on the fillable application below, save a copy and fill in the form.
3. Follow all instructions for required attachments and send the form to the email on the application form. AHS.DAILASDProviderEnrollment@vermont.gov.
4. If approved by DAIL, the provider will then be instructed to submit a Medicaid Provider Enrollment application with the State's Medicaid Fiscal Agent.