I/DD Waivers in Massachusetts

All states: Medicaid disability services map

Massachusetts I/DD services at a glance

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

Who runs I/DD services in Massachusetts?

The Department of Developmental Services (DDS) runs I/DD services in Massachusetts. DDS is part of the Executive Office of Health and Human Services (EOHHS), and MassHealth is the state's Medicaid agency. DDS decides who is eligible, plans services through its area offices and contracts with provider agencies, while MassHealth handles Medicaid financial eligibility and limits how many people each waiver can enroll.

• Department of Developmental Services (DDS): administers the three adult intellectual disability waivers and, through its Autism Division, the Children's Autism Spectrum Disorder Waiver. DDS also licenses I/DD providers and funds vendor-operated and state-operated residential, day and work programs from its own budget lines. Its adult waiver page is the main state page for families.
• MassHealth: the Medicaid agency. It decides Medicaid financial eligibility for waiver applicants, caps waiver enrollment under 130 CMR 519.007, and runs Day Habilitation as a separate MassHealth service.
• EOHHS: sets provider rates by regulation for DDS services and MassHealth day habilitation.
• Front door: a DDS application, filed at any DDS office or downloaded from the DDS website.
• Case management: DDS service coordinators, who work out of DDS area offices, bring together each person's Individual Support Plan (ISP) team, arrange assessments, watch how the plan is carried out and review it every six months.

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

Massachusetts has four 1915(c) waivers for people with I/DD, all run by DDS and all requiring an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) level of care. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. Three serve adults 22 and older with an intellectual disability, and one serves young children with autism. MassHealth also covers Day Habilitation for people with I/DD outside the waivers.

• Adult Supports Waiver (control number 0828.R03.00): for adults who need at least one waiver service but not 24-hour support. Services include individualized home supports, individualized day supports, individual and group supported employment, respite, adult companion, behavioral supports, family training, peer support, remote supports, assistive technology, home and vehicle modifications, individual goods and services, stabilization and transportation. It does not include residential habilitation.
• Community Living Waiver (control number 0826.R03.00): for adults who need a service available only in this waiver, delivered at home or in the community. It covers the Adult Supports services plus live-in caregiver support, and also excludes residential habilitation.
• Intensive Supports Waiver (control number 0827.R03.00): for adults who need support 24 hours a day, 7 days a week, in a 24-hour supervised residence or the family home. It is the only DDS adult waiver with residential habilitation, and it also covers shared living placement services, 24-hour self-directed home sharing support, live-in caregiver support, day and employment supports, transitional assistance and the Community Living services.
• Children's Autism Spectrum Disorder Waiver (control number 40207.R04.00): run by the DDS Autism Division for children under age 9 with a confirmed autism diagnosis who can be served safely at home. Parents' assets are not counted. Services include expanded habilitation and education, community integration, respite, homemaker, behavioral supports, family training, assistive technology, home and vehicle modifications, individual goods and services and home-delivered meals. The FY2027 state budget sets aside at least $5,500,000 for these services.

Adult waiver applicants must also qualify for MassHealth, with income up to 300 percent of the federal benefit rate and assets of $2,000 or less, according to 130 CMR 519.007. MassHealth Day Habilitation is a separate MassHealth service for members with an intellectual or developmental disability, including members who live in nursing facilities. DDS also runs state-operated ICF/IID facilities, the institutional option the waivers are an alternative to. DDS helps operate two other waivers, for people with acquired brain injury (ABI) and for people leaving nursing facilities through Money Follows the Person (MFP), but those serve other groups and are not counted here.

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

No managed care arrangement was found for DDS waiver services. DDS contracts with provider agencies and pays them directly from its budget, and DDS service coordinators, not health plans, plan and monitor each person's services. This is a fee-for-service model.

• DDS funding: the FY2027 state budget (Chapter 137 of the Acts of 2026) funds DDS directly for vendor-operated residential services ($2,067,601,853), state-operated residential services ($372,359,320) and community-based day and work programs with transportation ($313,470,092).
• Day Habilitation: paid by MassHealth under its own provider rules. We did not check whether MassHealth health plans pay day habilitation for their own members, so providers should ask MassHealth.

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

We did not find a published DDS waiting list or a count of people waiting. MassHealth limits how many people each DDS adult waiver can enroll, and DDS gives adult supports by priority of need, subject to available resources. Whether DDS keeps a formal waiting or planning list could not be confirmed.

• Priority order: under 115 CMR 6.07, first priority goes to supports needed to protect a person's health or safety, and second priority to supports needed to meet the person's assessed needs.
• Enrollment caps: each DDS adult waiver has a MassHealth enrollment limit under 130 CMR 519.007. We did not find the current number of slots.
• Young adults turning 22: the FY2027 budget includes $110,347,273 for DDS clients who turn 22 during fiscal years 2026 and 2027, the age when adult DDS services begin.

For a person's status, families should ask their DDS area office or service coordinator.

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

Anyone can apply by filing a DDS application form at any DDS office or from the DDS website. A DDS regional eligibility team decides eligibility, and the local area office then works with the person on a support plan. Massachusetts does not publish a standard assessment tool for setting DDS adult service levels or budgets.

• Adult eligibility: adults 22 and older who live in Massachusetts and have an intellectual disability (an IQ of about 70 or below with significant limits in daily living skills, starting before age 18), according to DDS rules in 115 CMR 6.04 and 115 CMR 2.01. Adults with autism, Prader-Willi syndrome or Smith-Magenis syndrome can qualify for community developmental disability supports.
• Waiver eligibility: waiver enrollment also requires ICF/IID level of care and MassHealth financial eligibility, which MassHealth decides.
• Support planning: the DDS service coordinator convenes the ISP team, arranges the assessments the plan needs and reviews the plan every six months.
• Assessment tool: DDS rules on ISP assessments (115 CMR 6.22) name no standard tool, and we did not find how DDS sets individual budgets. Ask DDS. MassHealth Day Habilitation is different: a MassHealth Leveling Tool sets each person's payment level.

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

Providers can offer community-based day supports, supported employment, residential supports, shared living and individualized home supports, all of which need a DDS license under 115 CMR 8.01. MassHealth Day Habilitation is a separate center-based service that needs a MassHealth provider contract and national accreditation instead. A full DDS license runs two years.

Day and employment services

• Community-based day supports (CBDS): group and individual day services that help adults take part in community activities and build communication, self-care and relationship skills. Licensed and certified by DDS as day supports. Billed in 15-minute units at levels A, B, C, D, I and W. The research did not find a published staff ratio.
• Supported employment: individual, ongoing individual and group supported employment, with high-intensity group and enhanced staffing options and travel to individual job sites. Licensed and certified by DDS as employment supports. Billed in 15-minute units. The rate schedule has enhanced 1:1 and 1:3 group rates, but we did not find a general staff ratio.
• Day Habilitation (MassHealth): a center-based program that follows a day habilitation service plan with measurable goals, combining activities with nursing and therapies. Providers must contract with MassHealth, hold CARF or Council on Quality and Leadership accreditation, operate five business days a week for six hours a day, and coordinate with DDS for DDS clients, under 130 CMR 419.404. Paid per diem, half day or quarter day at four levels. We did not find a published staff ratio.

Residential services

• 24-hour residential supports (group homes): vendor-operated and state-operated community residences, funded through the Intensive Supports Waiver's residential habilitation. Licensed and certified by DDS as residential supports. Paid per diem by service model (basic, intermediate, medical or specialized behavioral), home size (1, 2 to 3, or 4 or more people) and direct care staffing, with hourly add-ons for nursing, clinical and remote supports.
• Shared living: an adult lives with a paid caregiver, under Intensive Supports Waiver placement services. The agency is licensed and certified by DDS for placement services and is paid a daily operational rate by tier (A, B or C) plus a caregiver stipend up to a maximum for each tier.
• Individualized home supports: regular supports of less than 23 hours a day that teach skills such as money management, health, shopping, community safety and social skills, to help people stay out of institutions. Licensed and certified by DDS. Available in all three adult waivers.
• ICF/IID: DDS operates facilities for people with intellectual disabilities. The FY2027 budget directs DDS to move residents to community residential services when that is clinically suitable and costs no more.

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

EOHHS sets DDS provider rates by regulation under Chapter 257 of the Acts of 2008, the state law on human service rates. The FY2027 budget reserves $175,000,000 for Chapter 257 rate increases and requires providers to spend at least 75 percent of that money on pay for direct care, frontline and clinical staff. New agencies start by requesting a DDS licensure application.

• Rate regulations: 101 CMR 411.00 (shared living and placement), 415.00 (community-based day supports), 419.00 (supported employment), 420.00 (adult long-term residential) and 348.00 (day habilitation).
• Example rates: community-based day supports were $5.28 (level D) to $15.02 (level A) per 15 minutes in 101 CMR 415.03 as amended September 1, 2023. Day habilitation was $125.91 (level 1) to $414.09 (level 4) per day in 101 CMR 348.03 as amended August 2, 2024. Residential rates are in 101 CMR 420.03.

• DDS licensing: a new provider must request a DDS licensure application before starting services. DDS does an initial health, safety and human rights review within 60 days, then a full survey within six months after that, under 115 CMR 8.02. Residential, individualized home, employment, day, site-based respite and placement services all need a license, and all but site-based respite also need certification.
• Day Habilitation: providers contract with MassHealth and need CARF or Council on Quality and Leadership accreditation.
• EVV: we did not find a state source that places DDS waiver services in the Massachusetts electronic visit verification (EVV) program. The state's EVV service list names services in the ABI and MFP waivers, such as personal care, home health aide and nursing, but not the DDS waivers. Ask DDS or MassHealth whether any DDS service needs EVV.

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

As of October 23, 2026, we did not find a confirmed upcoming change with a set date for DDS waiver services. The FY2027 budget does fund new rate increases and asks DDS for two reports due by March 2, 2027.

• Chapter 257 rate increases: the FY2027 budget reserves $175,000,000 for rate increases during the fiscal year, with at least 75 percent going to staff pay. We did not confirm which DDS rates change or when.
• Shared living report: DDS must report on how shared living is used by March 2, 2027.
• Olmstead report: DDS must report by March 2, 2027 on its progress in moving people from ICF/IID facilities to community settings, in line with the Olmstead decision on community living.
• EVV for ABI and MFP waivers: MassHealth has announced EVV claim edits for some home care services in the ABI and MFP waivers, which DDS helps run. The start date has moved more than once and was not final at our last check. These edits are not tied to the DDS I/DD waivers.

Massachusetts I/DD sources

• CMS: Massachusetts waiver list and fact sheet
• Massachusetts DDS: HCBS waivers for adults with intellectual disabilities
• Massachusetts Legislature: FY2027 final budget (Chapter 137 of the Acts of 2026)
• 130 CMR 519.007 (MassHealth home and community-based waivers)
• 115 CMR 6.07 (DDS priority for supports)
• 115 CMR 8.01 (DDS provider licensure and certification)
• 115 CMR 8.02 (DDS licensure application)
• 130 CMR 419.404 (MassHealth day habilitation provider requirements)
• 101 CMR 415.03 (community-based day supports rates)
• 101 CMR 420.03 (adult long-term residential rates)

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
• Outcome Measures in Disability Services: Measuring what matters
• I/DD services in every state (map)
• Massachusetts 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.