I/DD Waivers in District of Columbia

All states: Medicaid disability services map

District of Columbia I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in the District of Columbia?

The Department on Disability Services (DDS) runs I/DD services through its Developmental Disabilities Administration (DDA). DDA operates both of the District's I/DD waivers day to day. The Department of Health Care Finance (DHCF), the District's Medicaid agency, keeps oversight, handles the waivers' finances and pays provider claims.

• DDS and DDA: DDA decides eligibility, assigns a service coordinator, writes the plan with the person and sends service authorizations to DHCF. DDS also certifies waiver providers. Waiver details and documents are on the DDS Medicaid waiver information page.
• DHCF: the Medicaid agency. It gives prior authorization based on DDA's authorizations, pays claims and publishes the rates on the DC Medicaid fee schedule.
• Front door: the DDA Intake and Eligibility Determination Unit at DDS, 250 E Street SW. People can walk in, call (202) 730-1700 to schedule, or email dds-dda.intake@dc.gov.
• Case management: DDA service coordinators are District staff in the Service Planning and Coordination Division. They complete the level of care review, write the Individual Support Plan (ISP), authorize services and monitor them. Service coordination is not a service that private agencies bill.

DDA served 2,611 people and received 186 applications for services in fiscal year 2025, according to the DDS Performance Accountability Report.

What Medicaid waivers serve people with I/DD in the District of Columbia?

The District has two 1915(c) waivers for people with intellectual and developmental disabilities, both for adults 18 and over. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. The IDD Waiver covers the full range of services, including residential. The Individual and Family Support (IFS) Waiver is for people who live in their own home or with family and do not need residential services.

• IDD Waiver (1915(c), control number DC.0307): the Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities. Its current five-year period began October 1, 2022, and its latest amendment took effect August 1, 2026. It serves District residents 18 and over who receive DDA services, qualify for Medicaid with income up to 300% of Supplemental Security Income (SSI) and meet the level of care for an intermediate care facility. It allows up to 2,023 people in waiver year 5 and reserves slots each year for 10 youth leaving the care of the Child and Family Services Agency (CFSA) and 3 people moving out of intermediate care facilities. Services include Residential Habilitation, Supported Living, Host Home, In-Home Supports, Day Habilitation, Individualized Day Supports, Employment Readiness, Supported Employment, Companion, Respite, Personal Care, Skilled Nursing, behavioral supports and therapies, assistive technology and Dental.
• Individual and Family Support (IFS) Waiver (1915(c), control number DC.1766): renewed effective October 1, 2025, with a technical amendment effective September 1, 2026. It serves District residents 18 and over with intellectual or developmental disabilities who live in their own home or with family or friends. Spending is capped at $75,000 per person per plan year. Slots run from 132 in year 1 to 252 in year 5. Services include In-Home Supports, Companion, Individualized Day Supports, Day Habilitation, Employment Readiness, Supported Employment, Education Supports, Respite, Personal Care, Skilled Nursing, Individual Directed Goods and Services, behavioral supports, therapies and assistive technology. It has no residential services.

The District also has Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) as the institutional option that both waivers are an alternative to. We did not find other District Medicaid programs serving people with I/DD outside these two waivers.

Does the District of Columbia pay for I/DD services through managed care?

No. I/DD waiver services in the District are paid fee-for-service. Private agencies enrolled as DC Medicaid providers deliver the services, DDA authorizes them, and DHCF pays the claims. No health plan sits between the provider and the Medicaid agency for waiver services.

• Who authorizes: the DDA service coordinator, who sends authorizations to DHCF for prior authorization.
• Who pays: DHCF, through the DC Medicaid system, at rates on the DHCF fee schedule.
• Who coordinates: DDA service coordinators, who are District staff, not agency employees or health plan staff.

Is there a waiting list for I/DD services in the District of Columbia?

Yes. The District limits waiver slots and does not publish a count of people waiting. The IDD Waiver amendment approved effective August 1, 2026 lists activating a waiting list for IDD Waiver services as one of its purposes. People on the list are prioritized by emergency, urgent or non-urgent need.

• Why it started: in its responses to public comments on the amendment, DDS said the waiting list was planned for January 1, 2026 because of fiscal year 2026 budget reductions. People who need IDD Waiver services and are not yet enrolled would be placed on it, and DDS said the list would be reduced as resources allow.
• Before 2026: DDS Transmittal 22-14 put a revised waiting list policy in place on October 20, 2022, and said that at that time there was no waiting list for either the IDD or IFS Waiver.
• IFS Waiver cap: if a person's needs go over the $75,000 IFS cap and no other option is available, the person keeps a place on the DDS waiting list.
• Reserved slots: the IDD Waiver holds 10 slots a year for youth leaving CFSA care and 3 a year for people leaving intermediate care facilities.

How do people apply for I/DD services in the District, and how are budgets set?

People apply through the DDA Intake and Eligibility Determination Unit. Intake staff complete a person-centered Front Door questionnaire, and an Intake and Eligibility Coordinator guides the application. After a person is found eligible, a DDA service coordinator uses the DC Level of Need (LON) tool to confirm level of care and set support levels.

• DDA eligibility: District residency and an intellectual or developmental disability that began before age 22. The Developmental Disability Eligibility Reform Amendment Act of 2022 added people with developmental disabilities, not only intellectual disability, if they have substantial limits in 3 or more major life areas.
• Waiver eligibility: Medicaid eligibility with income up to 300% of SSI, and the level of care for an intermediate care facility (ICF/IID).
• Assessment: the DC Level of Need (LON) Assessment and Risk Screening Tool, completed by the DDA service coordinator. LON scores set the acuity tier for Residential Habilitation, Host Home and Supported Living daily rates and decide who can use Small Group Day Habilitation.
• Budgets: services are set in the Individual Support Plan and authorized by DDA. The IFS Waiver caps spending at $75,000 per person per plan year. We did not find a dollar cap for the IDD Waiver.
• Self-direction: the IFS Waiver offers My Life, My Way, where the person hires and directs their own workers with help from a support broker and a vendor fiscal/employer agent. The 2026 IFS Waiver text lists Individual Directed Goods and Services, In-Home Supports, Companion and Individualized Day Supports as self-directable. We did not find self-direction confirmed in the IDD Waiver.

What day and residential services can I/DD providers offer in the District?

Both waivers cover Day Habilitation, Individualized Day Supports, Employment Readiness and Supported Employment, all billed in 15-minute units. Residential services (Residential Habilitation, Supported Living and Host Home) are in the IDD Waiver only. The District is moving away from large settings: no new facility-based day settings except small group, and no new referrals to group homes of 4 or more.

Day and employment services

• Day Habilitation: skill building and community inclusion in groups, with community activities in groups of no more than 4. Providers are certified by DDS through the Provider Certification Review and hold a DC Medicaid provider agreement. Ratio 1:1 or 1:4. Billed in 15-minute units (for example $7.46 for code T2021 U4 as of July 1, 2026), with meals billed daily. Up to 4 hours a day may be delivered remotely. No new facility-based settings are authorized, and large settings with a daily census of 50 or more take no new participants.
• Small Group Day Habilitation: no more than 15 people, not in the same building as a large program, for people with a LON score of 6 or more or complex behavior needs. Ratio 1:3.
• Individualized Day Supports: one-on-one community habilitation for people who choose not to attend a larger group program, including community activities, employment exploration and supported retirement. Billed in 15-minute units. The research did not find a published ratio or a separate certification.
• Employment Readiness (prevocational): time-limited learning and work experiences, including volunteer work, that build skills for paid community jobs. DDS Provider Certification Review. Ratio 1:1 or 1:4. Billed in 15-minute units ($6.44 for code T2015 U4 HI as of July 1, 2026). Facility-based settings may not grow, and new providers may not use them.
• Supported Employment (individual and small group): job development, training and supports for work in community jobs. Billed in 15-minute units. The research did not find a published ratio.

Residential services (IDD Waiver)

• Residential Habilitation (group homes): 24-hour supported group living, with nursing, transportation and supervision included in a daily rate tiered by support level (Basic, Moderate, Enhanced, Intensive, or with a 24-hour licensed practical nurse). Homes need a group home license under 22 DCMR Chapter 35 (District of Columbia Municipal Regulations) plus DDS Provider Certification Review, and providers may hold a Human Care Agreement with DDS. Homes of 5 or 6 people are being reduced over time, homes of 4 or more take no new referrals, and new homes over 4 people need DDA Deputy Director approval.
• Supported Living: supports in homes of 1 to 3 people, owned or leased by the agency or the person, paid daily or periodically in 15-minute units. A staffing-only form serves people in their own family home who need more than In-Home Supports. Requires DDS Provider Certification Review and a DC Medicaid agreement; a Human Care Agreement may be required. New supported living homes need DDA Deputy Director approval.
• Host Home: up to 24-hour support in a private home where the main caregiver lives, for people with few natural supports. No more than 3 unrelated people in the home, with a daily rate tiered by LON acuity. The research did not find a separate license for host homes.

How are I/DD provider rates set and how do agencies enroll in the District?

DDS develops waiver rates with DHCF oversight, and DHCF publishes them on the DC Medicaid fee schedule. Every provider gets the same rate for a service. Direct support wages in the rates are tied to the DC Living Wage. Agencies enroll by sending DDS a letter of intent, applying to DDA and passing the DDS Provider Certification Review.

• Rate method: Residential Habilitation and Supported Living daily rates are tiered by support level and built from ICF/IID cost factors. Hourly services are built from the DC Living Wage, a productivity factor, 20.75% fringe benefits, program support and 13% administration. Most rates are raised in line with the DC Living Wage.
• Latest change: DHCF Transmittal 26-21 (July 30, 2026) added rates for new IDD Waiver services effective August 1, 2026. It sets the direct support professional (DSP) wage at 117.6% of the $17.95 District living wage in effect July 1, 2025, with the DSP wage capped at $21.11.
• Sample rates as of July 1, 2026: Residential Habilitation in a 4-person home pays $389.26 to $752.69 a day by support level, In-Home Supports pays $8.97 per 15 minutes and Day Habilitation pays $7.46 per 15 minutes, per DHCF's 2026 payment rate transparency publication.
• Rate study: DDS posted a 2024 IDD Waiver rate study with a final recommendations report and proposed rates on December 18, 2024. We did not confirm which of the proposed rates were adopted.
• Enrollment: new IDD and IFS waiver agencies email DDS a letter of intent, then submit the DDA Medicaid Waiver Provider Application with their policies and licenses, and must meet the DDS Provider Certification Review policy (29 DCMR Chapter 19). Details are on the DDS waiver provider application page. Residential Habilitation also needs a District group home license.
• EVV: IDD Waiver In-Home Supports, Supported Living Periodic, Personal Care and in-home Respite visits must be recorded in electronic visit verification (EVV), either in the District's Sandata system or in an approved alternate EVV system that sends data to the Sandata Aggregator, according to the Sandata alternate EVV addendum. DHCF Transmittal 21-45, sent to home health agencies and IDD Waiver providers, denies personal care claims without a matching EVV visit for dates of service on or after December 1, 2021. Daily residential and day services are not visit-based and are not on the EVV list. We did not confirm whether agency-delivered IFS Waiver services require EVV; ask DHCF or DDS.

What is changing next for I/DD services in the District of Columbia?

DDS has posted a further IDD Waiver amendment, tentatively effective January 1, 2027. Its changes have not been released. The DDS page says a summary of changes, any rate changes and public forum details will be posted later, so the date and content may still change.

Several changes took effect in 2026:

• IDD Waiver amendment, August 1, 2026: approved by the Centers for Medicare and Medicaid Services (CMS) on July 10, 2026. It activated the IDD Waiver waiting list, added Health Assessment and Coordination by telehealth and a District option to provide waiver services in acute care hospitals, allowed Companion services at a 1:2 ratio, expanded Assistive Technology assessment, set Day Habilitation ratios at 1:1 or 1:4 (1:3 for small group), defined staffing-only Supported Living for people in their own home, and added a DSP living wage adjustment to rates.
• IFS Waiver technical amendment, September 1, 2026: corrected the slot counts to 132 in year 1 rising to 252 in year 5.

For news on future amendments or renewals, check the DDS Medicaid waiver information page or ask DDS.

District of Columbia I/DD sources

• DDS: Approved IDD Waiver amendment effective August 1, 2026 (DC.0307)
• DDS: Approved IFS Waiver renewal technical amendment 2026 (DC.1766)
• DDS: Medicaid waiver information
• DDS: How to apply for services
• DDS: HCBS waiver provider application process
• DHCF: Transmittal 26-21, new IDD Waiver service rates
• DHCF: 2026 payment rate transparency publication (home health and IDD)
• DHCF: Transmittal 21-45, electronic visit verification
• DDS: Transmittal 22-14, waiting list policy
• DDS: HCBS IDD Waiver 2027 amendment

Related reading

• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• What is Active Support in Disability Services?
• I/DD services in every state (map)
• District of Columbia EVV requirements

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.