Services for adults with intellectual and developmental disabilities (IDD) include group homes, day programs, in-home support and respite. Medicaid pays for many of them, mainly through state home and community-based services waivers and intermediate care facilities. Medicare does not pay for long-term support with daily life.
This page describes the services and the money. It is not clinical advice and Carevo does not assess disability, eligibility or support needs. Your state's disability agency and the person's own team do that. For therapy for autistic children and adults, read ABA therapy.
What intellectual and developmental disability services are
"IDD services" is a grouping, not one service. Under Medicaid, the main types are:
- Residential support. A home where staff support a few people in daily life. Names vary: group home, supported living, residential habilitation, community residence.
- Day programs. Daytime activities, skills training and community participation.
- In-home support. Personal care, homemaker help, home health aide help and case management.
- Respite. A break for family caregivers.
- Intermediate care facilities. A residential facility with a program of active treatment, under a separate Medicaid benefit.
Medicaid.gov lists examples of what a home and community-based services waiver can cover: case management, homemaker, home health aide, personal care, adult day health, habilitation and respite care. States can propose others that help people move from institutions to home or community settings.
Who disability services are for
The ICF/ID page on Medicaid.gov explains who the facility benefit is for: a person in need of, and receiving, active treatment because of intellectual disability or a related condition. The underlying cause must have been manifested before age 22 and be likely to continue indefinitely. The page says definitions of related conditions are primarily functional, not diagnostic, and that each state sets its own level-of-care criteria.
Waivers target specific groups, and states can narrow eligibility by age or diagnosis. So there is no one national rule on who qualifies. Your state decides.
What residential support includes and leaves out
What a provider delivers depends on the person's plan and the program paying. For residential support, ask the provider to list:
- How many hours of staff support the person gets, and when
- Help with personal care, medicines and appointments
- Skills training and community outings
- Transportation
- Behavior support, if the plan includes it, and who writes it
- Meals and housekeeping
- What the person pays for rent, food and extras
Services outside the plan are usually extra or not available. Nursing and therapy may be provided by the home, billed separately, or arranged with outside providers, so ask.
Planning for the application process
Getting services usually starts with an application to the state, not to a provider, and waiting lists are possible. These steps help whichever program applies:
- Ask the state Medicaid agency and the state disability agency which waivers or programs exist for the person's age and situation, and how the level-of-care assessment works.
- Ask how long people wait, and whether anything is available in the meantime.
- Ask who writes the person-centered service plan, who is invited to the planning meeting and how often it is reviewed. Federal rules for Medicaid settings refer to a person-centered plan when a restriction on rights is proposed, so the plan is a real document with legal weight.
- Keep copies of diagnoses, assessments and any school or provider records the agency asks for.
- Ask whether the person can choose among providers, and how to change provider later. Federal rules say the setting should facilitate individual choice regarding services and supports, and who provides them.
Families sometimes need to plan ahead for the day a parent can no longer provide care. Ask the state agency how emergency placements work, and whether a place on a waiting list can be held.
Disability services vs nearby care options
- Board and care homes. Residential care mainly for older adults. ASPE says its board and care study left out homes licensed only for special populations, such as people with developmental disabilities. For a group home for people with IDD, ask which state agency licenses it.
- Assisted living and nursing homes. These serve people who need personal or nursing care, mostly older adults. Some younger adults with disabilities live there too, but they are not built around IDD supports.
- Adult day care. A daytime program. IDD day programs may be funded and run through the disability system instead.
- Home care and respite care. In-home support and breaks for caregivers. Waivers can cover these.
- ABA therapy. A therapy, not a living arrangement.
Who pays for IDD services
Medicaid HCBS waivers. A 1915(c) waiver lets a state offer home and community-based services as an alternative to institutional care. Medicaid.gov says eligible people must show a need for a level of care that meets state institutional eligibility requirements. States must show waiver services cost no more than institutional care, and states choose the maximum number of people served. Medicaid.gov's ICF/ID page notes that HCBS waivers can have waiting lists. Check your state's disability agency on the programs page and read Medicaid.
Room and board. Federal rules at 42 CFR 441.310 generally bar federal matching funds for room and board in waiver settings. The exceptions are respite in a state-approved facility that is not a private residence, and a portion of rent and food that can be reasonably attributed to an unrelated live-in personal caregiver, but not if the person lives in the caregiver's home. Practically, rent and food are often paid from the person's own income.
ICF/ID. Medicaid.gov says the ICF/ID benefit is optional but every state provides it, at least as an alternative to waivers. It is available only in a residential facility that the state licenses and certifies, and it requires active treatment, defined as aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. States may not limit access to ICF/ID or make it subject to waiting lists, which means it can be available sooner than other long-term care options. The page says it is the most comprehensive Medicaid benefit and is available only when other payment options are unavailable.
Medicare. Medicare.gov says Medicare does not pay for long-term care, which is mostly help with basic personal tasks of everyday life. You pay all costs for non-covered services. See what Medicare pays for.
Private pay. Families sometimes pay for supports the program does not cover, or while waiting for a waiver. See private pay.
What drives the cost of IDD services
We do not quote prices. Costs to the family depend on the state and the program paying. Things that change what the person or family pays:
- Which program pays: a waiver, an ICF/ID, or private funds
- The number of support hours the plan authorizes
- Whether overnight awake staff are required
- Rent and food, which waivers do not generally pay
- Waiting lists, which can mean paying privately or going without for a period
- Add-ons such as transport, therapy or day programs not in the plan
What rules apply to Medicaid-funded settings
CMS does not publish star ratings for IDD providers, and our listings carry none. The Medicaid HCBS settings rule is the federal baseline for Medicaid-funded home and community-based settings. At 42 CFR 441.301 it requires, among other things, that a setting is integrated in and supports access to the greater community, is selected by the person from among options including non-disability specific settings, protects privacy, dignity and respect, and facilitates choice of services and who provides them.
For provider-owned or controlled residential settings it adds: a specific physical place with tenant-level protections, a lockable entrance door with keys limited to appropriate staff, a choice of roommates, freedom to furnish and decorate, control over schedules and activities, access to food at any time and visitors of the person's choosing at any time. Any modification must be supported by a specific assessed need and recorded in the person-centered service plan. The rule also requires documentation of less intrusive methods tried and the person's informed consent.
ICF/ID facilities are certified under separate Medicaid rules. For how we use federal data, see our care ratings by state and methodology.
How to choose a disability services provider
- Contact your state's disability agency and your state Medicaid agency to ask how to apply and what the waiting list looks like.
- Make a short list of providers licensed in your state. Ask each one which agency licenses it.
- Visit more than once, and talk to residents and staff if you can.
- Ask to see a copy of the residency agreement, house rules and a sample support plan.
- Involve the person who will receive the support in every step. Federal rules treat the setting as the person's choice.
Questions to ask each provider
- Who licenses you, and when were you last inspected?
- How does the person choose roommates, furnishings and daily schedule?
- Can the person lock their bedroom door and have visitors when they want?
- How many staff are on at night and on weekends, and how long have they worked here?
- What does the person pay for rent, food and other items?
- How do you plan and review support, and who is involved?
- What happens if the person's needs change or a placement does not work out?
- Who do we contact with a complaint, and how are complaints handled?
Red flags when you visit a provider
- Rules that restrict visitors, food, schedules or door locks without a written, assessed reason in the person's plan
- No clear answer on who licenses the home
- The person was not part of choosing the setting
- A provider that will not show you the residency agreement
- Few staff, high turnover or poor answers on night cover
- Pressure to accept a bed without a plan for what happens next
About the providers listed below
Carevo is a directory and connection platform. It does not assess disability or eligibility, place people in homes or vouch for any provider. The lists below come from public data and provider records. Check each provider yourself, and use get matched if you want help finding options near you.