I/DD Waivers in Maine

All states: Medicaid disability services map

Maine I/DD services at a glance

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

Who runs I/DD services in Maine?

The Maine Department of Health and Human Services (DHHS) runs I/DD services through two offices. The Office of Aging and Disability Services (OADS) runs the I/DD waivers, handles intake and eligibility, and approves waiver providers. The Office of MaineCare Services (OMS) runs MaineCare, Maine's Medicaid program, and pays providers.

• Office of Aging and Disability Services (OADS): runs the two waivers for adults with intellectual disability or autism, Section 21 and Section 29. The section numbers refer to chapters of the MaineCare Benefits Manual, the state's Medicaid rule book.
• Office of MaineCare Services (OMS): enrolls providers in MaineCare, publishes the fee schedule and pays claims.
• Front door: adults apply to OADS Developmental Services intake by email (DSIntake.OADS@maine.gov) or through a regional office.
• Case management: community case management agencies approved by OADS provide targeted case management under MaineCare Section 13, a state plan service. Eligible adults get a list of these agencies with their eligibility letter. OADS itself provides case management to eligible adults who are not on MaineCare. The OADS waiver page says waiver services do not require case management.

What Medicaid waivers and programs serve people with I/DD in Maine?

Maine has two 1915(c) waivers for adults with intellectual disability or autism: Section 21, the Comprehensive Waiver, and Section 29, the Support Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. Both serve adults 18 and older, and a person can be enrolled in only one waiver at a time.

• Section 21, Home and Community Benefits for Members with Intellectual Disabilities or Autism Spectrum Disorder (control number ME.0159): serves adults with an intellectual disability, autism spectrum disorder or Rett syndrome who meet the medical eligibility for an intermediate care facility (ICF/IID) and whose yearly waiver cost is no more than 200% of the statewide average ICF/IID cost. Services include Home Support (24-hour group homes, quarter hour and remote support), Shared Living, Community Support, Work Support, Career Planning, Employment Specialist Services, crisis services, therapies and consultation, assistive technology, home adaptations and non-medical transportation. Self-direction is not offered. See the Section 21 rule.
• Section 29, Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder (control number ME.0467): serves adults with an intellectual disability or autism who are on MaineCare and meet Section 29 medical eligibility. Services include quarter hour and remote Home Support, Community Support, Work Support, Career Planning, Employment Specialist Services, respite, Shared Living, assistive technology, home adaptations and transportation. It also offers self-direction with Supports Brokerage and Financial Management Services, and Individual Goods and Services up to $10,000 a year. Agency group home (per diem) Home Support is not a Section 29 service. See the Section 29 rule. On June 30, 2026, Section 29 had 3,219 participants and Section 21 had 3,032.

OADS also runs Section 20 (control number ME.0995), a 1915(c) waiver for adults with cerebral palsy, seizure disorder and other related conditions rather than intellectual disability, and Section 18, a brain injury waiver. Neither is counted here as an I/DD waiver. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), under MaineCare Section 50, remain the institutional option, and people found eligible for Section 21 are told in writing that they can choose ICF/IID or waiver services.

Does Maine pay for I/DD services through managed care?

No. MaineCare pays for I/DD waiver services fee-for-service, which means providers bill MaineCare directly for each service at published rates. There are no health plans in between. A bill to move MaineCare to managed care, LD 1878, was voted Ought Not to Pass on May 27, 2025.

• Who pays claims: the Office of MaineCare Services.
• Who approves providers: OADS approves waiver providers, and providers then enroll with MaineCare.
• Who coordinates services: community case management agencies under Section 13, or OADS for adults who are not on MaineCare.

Is there a waiting list for I/DD services in Maine?

Yes. On June 30, 2026, 2,571 people were on the Section 21 waiting list, according to OADS participation and waitlist data. The Section 29 list was much shorter, with 9 people waiting. Section 21 openings are offered by priority, and Section 29 openings in date order.

• Section 21 priority order: openings are assigned by Priority 1, 2 and 3 criteria based on risk of abuse, neglect or exploitation. People who meet Priority 1 (for example, a need for adult protective services or an aging caregiver with serious risk) get an immediate offer. People on the list must confirm each year that they want to stay on it.
• Section 21 detail: of the 2,571 waiting, 2,005 had other coverage and 566 did not.
• Section 29: funded openings go in date order. A person who gets an offer must respond within 60 days and start services within six months.
• Across waivers: people can be on more than one list. The unduplicated total waiting across Sections 18, 20, 21 and 29 was 2,878 on June 30, 2026.
• Starting services: of 598 people authorized for waiver services under Sections 18, 20, 21 and 29 from July 1, 2024 to June 30, 2025, 47% had started services by June 30, 2025.

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

Adults first apply for MaineCare if they do not have it, then send an application packet to OADS Developmental Services intake. An OADS intake coordinator calls within 10 days of a complete packet. Once a person is found eligible, their case manager applies for Section 21 or 29, or people without a case manager email HCBS.Waiver@maine.gov.

• Application packet: an application form, a comprehensive evaluation by a licensed physician, clinical psychologist or psychological examiner, an adaptive behavior scale no more than two years old, and an intelligence test. Send it to DSIntake.OADS@maine.gov or the regional office.
• Eligibility: adults 18 or older. For intellectual disability, an IQ more than two standard deviations below the mean and adaptive behavior at least two standard deviations below age peers, both appearing before age 22. For autism, an autism diagnosis plus the same adaptive behavior deficit, appearing before age 22. Denials can be appealed within 60 days.
• Waiver medical eligibility: set with the BMS 99 assessment form (or another current Department-approved assessment) and reviewed by a Qualified Intellectual Disabilities Professional (QIDP) designated by DHHS.
• Support levels: OADS chose the Supports Intensity Scale-Adult, 2nd Edition (SIS-A) as its needs assessment, and Maximus has given it as a conflict-free assessor since spring 2023. In February 2026 DHHS said everyone in Section 21, Section 29 or Lifespan must complete a SIS-A because new rates will be tiered by SIS-A support level. OADS says the SIS-A does not reduce services for people staying in Sections 21 and 29.
• Limits: Section 21 quarter hour Home Support is capped at 336 quarter hours (84 hours) a week, and Section 29 Individual Goods and Services at $10,000 a year. We did not find a published individual budget amount for either waiver.

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

Providers in Sections 21 and 29 can offer Community Support (day services), Work Support and employment services, Home Support and Shared Living. Since December 3, 2025, agencies providing DHHS-funded services to adults with I/DD or autism must hold a license under 10-144 CMR Ch. 108, the Home and Community Support Service Agencies Licensing Rule, in addition to OADS waiver provider approval and MaineCare enrollment.

Day and employment services (Sections 21 and 29)

• Community Support: day support in the community or in an agency setting that meets the federal HCBS settings rule, including career exploration and supported retirement for people 55 and older. It comes in three tiers: Community Only-Individual (1:1), Community Only-Group (1:2) and Center-Based (no fewer than 1 staff for every 3 people). Billed in 15-minute units (T2021), with transportation built into the rate. It is not available while a person is in high school or at their workplace.
• Work Support (individual and group): supported employment at the person's job. Group Work Support covers 2 to 6 people in community business settings such as work crews, and must promote working alongside people without disabilities. Billed in 15-minute units (H2023), with group rates per person by group size. Employment support requires a Ch. 108 license.
• Career Planning and Employment Specialist Services: help to explore, plan for, find and keep competitive integrated work. The research did not find a published ratio or billing unit for these services.

Residential services

• Home Support, Agency Per Diem (Section 21): 24-hour support in an agency owned or controlled home. Since December 24, 2012, new placements are approved only in provider controlled homes with at least two people. Paid daily based on authorized weekly hours across the home, with a medical add-on for some people. Requires a Ch. 108 license.
• Home Support, Quarter Hour and Remote Support (Sections 21 and 29): support in a person's own owned or leased home for people who need less than 24-hour staff. Remote support (monitor only or interactive) is also covered. Requires a Ch. 108 license and is subject to EVV.
• Shared Living (adult foster care, Sections 21 and 29): a home provider lives with the person, in the person's home or the provider's, and gives direct support, personal care and medication oversight. Paid daily, with a higher rate for more support. Home providers work under an oversight agency, and OADS generally supports only one person per home unless they are family or have a long-standing relationship. We did not find whether the home provider needs its own license.
• Family-Centered Support (Section 21): a per diem model in licensed homes that is being phased out. No new licenses or license transfers are approved.

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

MaineCare publishes fee schedule rates set through the state's rate system reform process, with yearly cost of living adjustments between rate studies. The latest confirmed change is a 1.0% cost of living increase for Sections 20, 21 and 29 effective January 1, 2026. New agencies apply to OADS, but OADS has paused new waiver provider applications since April 13, 2026.

• How rates are paid: most waiver services pay per quarter hour. Agency Home Support pays a daily rate based on authorized weekly hours, and Shared Living pays a daily rate by number of people and level of support.
• Latest rate change: a 1.0% cost of living adjustment effective January 1, 2026, under P.L. 2025, ch. 388, Part GGG, per an OMS bulletin. We did not find a July 1, 2026 adjustment for Sections 21 and 29.
• Enrollment path: new waiver providers apply through the OADS HCBS Application and Compliance Portal, then get any required license, enroll with the Office of MaineCare Services and complete OADS onboarding. Details are on the OADS provider application and onboarding page. Provider questions go to WaiverProvider.OADS@maine.gov.
• Case management agencies: Section 13 case management for adults with developmental disabilities needs OADS program approval, and since 2026 its rate sits on the MaineCare fee schedule (15-minute units).
• EVV: in-home quarter hour Home Support (T2017) under Sections 21 and 29 and respite (S5150) under Section 29 must use electronic visit verification (EVV). Agencies can use the free state Sandata system or a Sandata-certified alternate system, per the state's EVV service code list. Claims without a verified visit pend and then deny. Per diem residential, Shared Living, Community Support and work services are not on the EVV code list, and live-in caregivers bill place of service 40, which is outside EVV.

What is changing next for I/DD services in Maine?

OADS plans to launch a new 1915(c) waiver called Lifespan, starting support at age 14, in May 2027. That date depends on approval from the federal Centers for Medicare and Medicaid Services (CMS) and is not final. New waiver provider applications have also been paused since April 2026, and OADS has not said when it will resume.

• Lifespan waiver (planned): DHHS says enrollment would begin in spring 2027, pending CMS approval, after it revises the draft following public comment and submits the application. Early enrollment would focus on youth 14 to 17, people with urgent needs and adults not already in Sections 21 or 29. Current Section 21 and 29 participants can stay in those waivers and will not be offered Lifespan during the first phase, according to the DHHS Lifespan update and an October 2026 provider bulletin.
• New tiered rates (pending): a rate study for Sections 18, 20, 21, 29 and Lifespan began in September 2023, and final recommended rate models were posted February 4, 2026. Rates are to be tiered by SIS-A support level. The effective date is listed as pending rulemaking.
• Section 21 amendment (proposed): an amendment posted February 27, 2026 would update Direct Care Worker training requirements, combined service caps and grievance procedures. Comments closed March 29, 2026. We did not find a CMS approval.
• Waiver renewals (proposed): DHHS posted five-year renewals of Section 21 (February 2025) and Section 29 (July 2025). The Section 21 renewal proposed limiting paid family members to Shared Living and Non-Medical Transportation. We did not find approval or effective dates.

For the status of Lifespan or the renewals, ask OADS or the Office of MaineCare Services.

Maine I/DD sources

• Maine DHHS OADS: Waiver Services (Sections 21 and 29)
• Maine DHHS OADS: Participation and waitlist data
• Maine DHHS OADS: Intake and eligibility (adults with intellectual disability and autism)
• MaineCare Benefits Manual, Chapter II, Section 21
• MaineCare Benefits Manual, Chapter II, Section 29
• Maine DHHS OADS: Provider application and onboarding resources
• Maine DHHS Division of Licensing and Certification: Home and community services (10-144 CMR Ch. 108)
• Maine DHHS OMS: MaineCare rate system reform
• Maine DHHS: Building a better path, moving Lifespan forward (July 17, 2026)
• Maine DHHS: EVV service codes (October 2023)

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)
• Maine 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.