Medicaid Disability Services by State

Where are I/DD services changing next?

These are the changes states have announced or scheduled that affect I/DD services: new or replacement waivers, moves to managed care, rate changes, provider moratoriums, new assessment tools and waiting list changes. Dates come from the state. Where no date has been published, we say so.

With a date

• Michigan, November 1, 2026: New per diem community living supports and overnight health and safety codes start November 1, 2026. Direct support staff must finish settings and rights training by March 30, 2027.
• South Dakota, November 5, 2026: Revised DDD rules take effect November 5, 2026, covering critical incident reporting, cost report deadlines and insurance requirements. The Family Support 360 approval ends May 31, 2027.
• Arizona, December 1, 2026: Revised needs assessment and extraordinary care review rules take effect December 1, 2026 for members under 18, including DDD children.
• Arkansas, January 1, 2027: Updated payment rates for I/DD home and community services in the PASSE health plans take effect January 1, 2027.
• Colorado, January 1, 2027: From January 1, 2027, youth aging out of the children's waivers no longer move automatically onto the DD waiver unless they are in child welfare.
• Illinois, January 1, 2027: A proposed amendment would raise the direct support wage built into rates from $21.30 to $21.90 an hour and lift residential, day and employment rates on January 1, 2027 or on CMS approval.
• Iowa, January 1, 2027: Iowa Medicaid moves all waiver and habilitation services to a uniform fee schedule on January 1, 2027.
• Pennsylvania, January 1, 2027: ODP lists new fee schedule rates for select community-based services effective January 1, 2027, and is drafting amendments to the Chapter 6100 provider regulations.
• Virginia, January 1, 2027: The 2026 Appropriation Act raises personal care, respite and companion rates by 4 percent on January 1, 2027 and 3.9 percent on January 1, 2028. Whether this covers DD waiver codes is being confirmed.
• Wisconsin, January 1, 2027: DHS submitted the 2027 to 2031 CLTS waiver renewal to CMS and expects it to take effect January 1, 2027, pending approval. IRIS is also moving to a single fiscal employer agent.
• Wyoming, January 1, 2027: The minimum EVV compliance rate for providers rises from 75 percent to 85 percent by January 1, 2027.
• Kentucky, January 31, 2027: Under 2026 House Bill 2, people on the Michelle P. waiver waiting list must return a signed provider attestation with their primary diagnosis by January 31, 2027 to stay on the list.
• North Carolina, April 20, 2027: Innovations providers that have not chosen the new service options in NCTracks and reported national accreditation lose Innovations reimbursement eligibility on April 20, 2027.
• Texas, September 1, 2027: State law schedules TxHmL to begin moving into managed care on September 1, 2027, then CLASS in 2029 and HCS and DBMD in 2031, depending on a pilot and an evaluation.
• Vermont, December 31, 2027: The Global Commitment to Health 1115 agreement that authorizes Vermont's DD services runs through December 31, 2027. No renewal request has been posted yet.

Announced, no date yet

• Alabama: Alabama asked CMS in August 2026 to extend its Community Waiver Program demonstration through September 2031. Approval has not been published.
• California: DDS has proposed standardizing intake eligibility assessments and replacing the Client Development Evaluation Report (CDER) with a new strengths and needs evaluation. No date has been set.
• Connecticut: DDS plans further rate increases (3.3 percent general plus 3 percent residential) in July 2027 and January 2028. They are not yet in an enacted budget.
• Delaware: CMS approved three new Lifespan Waiver services in July 2026: Enhanced Behavioral Residential Services, Crisis Stabilization and Remote Supports. The state has not published a start date.
• District of Columbia: DDS has posted a further IDD Waiver amendment, tentatively effective January 1, 2027. Its changes have not been released.
• Florida: AHCA has amendments pending for the iBudget waiver (proposed for November 1, 2026) and the iBudget managed care option (proposed for December 1, 2026). CMS approval has not been confirmed.
• Georgia: DBHDD is developing a three-tier planning list, a new assessment tool and a new waiver. The NOW waiver's current approval ends in November 2027.
• Idaho: A court settlement requires a new way of setting adult budgets. Idaho is piloting the Level of Need assessment with about 800 adults from November 2026 to April 2027; no go-live date is set.
• Indiana: Indiana's Waiver Reset targets a new Youth Waiver for July 1, 2027 and new adult waivers in 2028. A moratorium on new waiver providers has been in effect since August 1, 2026.
• Kansas: KDADS plans to split Day Supports into new habilitation, community and employment services with a new rate model and a waiver amendment. No date has been published.
• Maine: OADS plans to launch the Lifespan waiver, starting support at age 14, in May 2027 pending CMS approval. New waiver provider applications have been paused since April 2026.
• Maryland: A waiver amendment with a 2 percent rate cut is under CMS review. Agency-run waiver rates stay at June 2026 levels until it is approved.
• Minnesota: State law calls for a two-waiver structure with individual budgets on January 1, 2027 or federal approval, but DHS says it cannot launch by then and has set no new date.
• Missouri: Wait lists for new enrollment in the Comprehensive, Community Support and Partnership for Hope waivers began October 15, 2026. Two waiver renewals are pending.
• Montana: Montana is piloting the SIS-A needs assessment with 500 members into early 2027, aiming for rates set by level of need around 2029.
• Nebraska: DHHS paused enrollment of new waiver agency providers on October 1, 2026 and plans an independent review of its interRAI-based budgets. The Family Support Waiver approval ends in February 2027.
• New Hampshire: New cost-based rates tied to SIS-A need levels were planned in phases through September 2027, subject to budget approval.
• New Jersey: DDD posted a refreshed version of its NJCAT assessment in September 2026 and expects it to go live in late 2027. The date is an estimate.
• New Mexico: HCA has proposed a Mi Via waiver amendment that adds Support Broker Services. No effective date has been published.
• North Dakota: North Dakota has planned a new children's cross-disability waiver and a new level of care. No draft or submission has been published.
• Ohio: DODD posted draft amendments to the IO and SELF waivers (adult day support settings rules, a $15,000 environmental adaptation cap, in-person assessments). CMS approval has not been confirmed.
• Oklahoma: Oklahoma's EVV system is moving from Fiserv AuthentiCare to Acumen DCI. DDS expected fall 2026; no go-live date has been published.
• South Carolina: SCDHHS has proposed renewing the ID/RD waiver from January 1, 2027, with mostly technical changes. CMS approval has not been published. The Community Supports waiver comes up for renewal July 1, 2027.
• Utah: A proposed amendment, open for comment until November 26, 2026, would let supported employment be self-administered and let State Developmental Center residents enter the Community Transitions Waiver.
• Washington: DDA plans to consolidate its five waivers into two under its Waiver Restructure Report. This needs legislative funding and has no effective date.

How do I/DD programs compare across states?

One row for each state and Washington DC. Filter the table to find the states that share a setup, and click a state for its programs, waiting list, day and residential services, rates and sources.

Swipe sideways to see every column.

How does Medicaid pay for I/DD services?

Most home and community-based services for people with intellectual and developmental disabilities are paid for by Medicaid, usually through 1915(c) waivers that a state's developmental disabilities agency runs under the state Medicaid agency. A state may have one waiver or several, often split by age or by how much support a person needs. Some states also use a 1915(i) state plan option, Community First Choice under 1915(k), or an 1115 demonstration in place of or alongside waivers.

What is the difference between fee-for-service and managed care for I/DD?

In most states the state, its DD agency or county boards acting for it authorize services and pay providers directly from a fee schedule. That is fee-for-service. In a smaller group of states, health plans or regional managed care entities receive a monthly payment per person and contract with and pay providers themselves. Case management by county boards or regional centers does not make a state managed care on its own.

Why do so many states have waiting lists?

A waiver has a cap on the number of people it can serve, set in the state's agreement with CMS and limited by what the legislature funds. When demand is higher than the funded slots, states keep a waiting, interest or planning list and offer openings by urgency of need, by application date, or both. A few states report no waiting list because services are an entitlement under state law or because recent funding cleared the list.

How are services and budgets set for each person?

Most states use a standardized assessment, such as the Supports Intensity Scale (SIS), the ICAP or an interRAI tool, to place each person in a support level. That level sets an individual budget or the rate tier a provider is paid for residential and day services. Several states are moving to new assessment tools, which can change budgets and rates for everyone in a program.

How current is this information?

Each state summary is checked against primary sources such as the state's developmental disabilities agency, its Medicaid agency, approved waiver documents on medicaid.gov, provider manuals and state budget documents. Each state page shows the date it was last verified. This page is a reference, not legal advice, so confirm details with your state before you act on them.

Frequently asked questions about Medicaid I/DD services by state

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Developmental Disabilities vs. Mental Health: Key Differences
• Disability Services DayHab Has a Dilemma: How to Solve It
• Outcome Measures in Disability Services: Measuring What Matters
• Self-Direction by State: FMS and participant direction map
• Medicaid Home Care by State: EVV requirements map

Ankota provides software for I/DD provider agencies, including electronic visit verification, day and residential service documentation, goal tracking and Medicaid billing. If you want to talk through how your state's programs apply to your agency, contact Ankota.