I/DD Waivers in Rhode Island

All states: Medicaid disability services map

Rhode Island I/DD services at a glance

Last verified against state sources: 2026-10-28.

Who runs I/DD services in Rhode Island?

The Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) runs adult I/DD services through its Division of Developmental Disabilities (DDD). DDD decides eligibility, authorizes services and pays providers. Services are delivered by Developmental Disability Organizations (DDOs), which are agencies licensed by BHDDH.

• BHDDH Division of Developmental Disabilities: delivers home and community-based services to adults with I/DD under state law and the state's Section 1115 Medicaid demonstration, according to the BHDDH billing manual. It pays DDOs on a fee-for-service basis.
• Executive Office of Health and Human Services (EOHHS): certifies the conflict-free case management agencies and enforces electronic visit verification (EVV) on Medicaid fee-for-service personal care claims.
• Front door: the DDD Eligibility Office at 6 Harrington Rd, Cranston (401-462-3421, Spanish 401-462-3014). The Rhode Island Parent Information Network (RIPIN, 401-270-0101) helps families with applications, according to the DDD eligibility brochure.
• Case management: Rhode Island is moving adults to conflict-free case management (CFCM), where the case manager does not work for an agency that provides the person's services. As of April 2026, five EOHHS-certified agencies were taking I/DD referrals: Care Link, Child and Family, West Bay Community Action, East Bay Community Action and Bethel. BHDDH social caseworkers also act as state case managers, and trained support brokers help people who self-direct.
• Consent decree: a federal consent decree shapes the state's work on employment, case management and the workforce. A 2023 court-ordered addendum set targets for each fiscal year through June 2026. We did not find what happened to the decree after June 2026.

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

Rhode Island has no 1915(c) waivers for I/DD. Its whole Medicaid program, including adult I/DD home and community services, runs under the Section 1115 Rhode Island Comprehensive Demonstration, a broad federal approval that absorbed the state's earlier 1915(c) waivers. CMS lists the demonstration as approved on November 28, 2025 and running through December 31, 2030.

• Who it serves: adults with intellectual or developmental disabilities who are approved for Medicaid long-term services and supports. Services can start at age 18.
• Residential services: residential habilitation (group homes), shared living arrangements including Whole Life Shared Living, and supportive living.
• Day and employment services: community-based supports, center-based day supports, individual employment services (job exploration, discovery, job development, job coaching and retention, personal care in the workplace) and group supported employment.
• Other services: transportation, respite, professional services, assistive technology, home and vehicle modifications, remote supports, peer supports and family-to-family supports.
• Self-direction supports: financial management through a fiscal intermediary, supports brokerage and individual goods and services.

The demonstration's 2024 annual monitoring report confirms that the former 1915(c) waivers were folded into it. Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) are the institutional option, but we did not verify Rhode Island's ICF/IID capacity in this review.

Does Rhode Island pay for I/DD services through managed care?

No. Adult I/DD services are paid fee-for-service. BHDDH authorizes each person's services and pays licensed DDOs through the state Medicaid claims system, which Gainwell runs. We did not find a health plan that manages or pays for BHDDH developmental disability services.

• Who authorizes: DDD, based on the person's SIS-A tier and individual budget.
• Who pays: BHDDH, through the Medicaid claims system.
• Who coordinates: conflict-free case management agencies certified by EOHHS, BHDDH social caseworkers and support brokers.

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

We could not confirm. We did not find a state source that describes a waiting list for adult DD services, and none that says there is no list. BHDDH budgets these services as a caseload and reports that it decides eligibility within 30 days.

• Caseload: BHDDH's April 2026 caseload testimony put the adult DD caseload at about 4,309 people for June 2026 and projected net growth of about 6 people a month in state fiscal year 2027.
• Who to ask: families who want to know whether there is a wait for services should call the DDD Eligibility Office at 401-462-3421.

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

People apply to the BHDDH DDD Eligibility Office. Each adult who is found eligible is assessed with the Supports Intensity Scale for Adults (SIS-A), which places the person in a tier from A to E. The tier sets the person's individual budget and the rate paid to providers for several services.

• Eligibility: an intellectual or developmental disability (or another serious, lifelong disability) that starts before age 22 and limits major life activities, plus approval for Medicaid. Applications can be filed 2 months before the 17th birthday, and DDD reports decisions within 30 days, according to the DDD eligibility brochure.
• Assessment: the SIS-A 2nd Edition, used with the Additional Needs and Support Questionnaire (ANSQ). A three-step process (SIS-A, ANSQ and an individual follow-up), and an annual two-step process (ANSQ and follow-up), can add funding through supplemental authorizations known as L9.
• Budgets: the tier sets the individual budget. Employment services are funded through a separate employment add-on budget.
• New tier algorithm: BHDDH planned to roll out a new SIS-A 2nd Edition tier algorithm by late spring 2026, with cost effects in state fiscal years 2027 and 2028. We did not confirm that the rollout is complete.
• Self-direction: a person can choose to self-direct services. A fiscal intermediary handles payroll and financial management, and supports brokerage and individual goods and services are available.

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

Licensed DDOs can offer community-based supports, center-based day supports, individual and group employment services, group homes, shared living and supportive living. Most day services are billed in 15-minute units and residential services per day, with rates that vary by the person's SIS-A tier. The details below come from the BHDDH billing manual.

Day and employment services

• Community-Based Supports: support in or outside the person's home to build independence and community inclusion, one-to-one or shared. It replaced the former prevocational, community-based day and home-based day services. It cannot be delivered in a provider-owned residence or a licensed center. Delivered by DDOs or self-directed workers, billed in 15-minute units (up to 96 a day) at tiered rates. The research did not find a published ratio.
• Center-Based Day Supports: skill building and community preparation at a licensed nonresidential site run by a DDO. Not allowed in group homes, supportive living or shared living homes. Billed in 15-minute units (up to 32 a day) at tiered rates. The research did not find a published ratio.
• Individual employment services: job exploration, discovery, job development, job coaching and retention, and personal care in the workplace, all funded through the employment add-on budget. Discovery, job development and job coaching require certified staff. Most are billed in 15-minute units, and job retention is billed per month. The research did not find a published ratio.
• Group Supported Employment: work and training in business settings, such as enclaves and mobile crews, for groups of no more than eight, supervised by an employment specialist. Billed in 15-minute units (up to 32 a day) at ratios from 1:2 to 1:6.

Residential services

• Residential Habilitation (group home): individually tailored supports around the clock in a home subject to BHDDH licensure, run by a DDO. Paid per day by tier on a 344-day billing year. The rate does not include room and board.
• Shared Living Arrangement (SLA) and Whole Life SLA: the person lives with a contracted individual or family who is recruited, matched and monitored by a shared living DDO. Whole Life SLA adds supports in place of day services. Paid per day by tier, with 300 respite hours a year. Room and board is two-thirds of the standard Rhode Island SSI payment.
• Supportive Living: the person rents their own affordable unit and receives coordinated supports, with staff on site during awake hours. BHDDH said in April 2026 that this service is under review for implementation in state fiscal year 2027. We did not find who licenses it.

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

BHDDH pays tiered rates built in a rate study led by Burns and Associates (HMA). Rates vary by SIS-A tier and are published each year in the BHDDH rate table. CMS gave final approval of the new rate structure in March 2023. To provide services, an agency must be licensed by BHDDH as a DDO.

• Recent rate changes: rates were raised in state fiscal year 2023 to fund a direct support professional (DSP) starting wage of $18 an hour, and in fiscal year 2024 to fund a $20 starting wage, according to BHDDH's May 2025 caseload testimony.
• Licensing: a DDO is an organization licensed by BHDDH to serve adults with disabilities under the department's licensing rules (212 RICR chapter 10).
• Enrollment: we did not find a published step-by-step enrollment path for new DD providers, or how DDO licensure connects to Medicaid provider enrollment. Agencies should ask BHDDH DDD (BHDDH.AskDD@bhddh.ri.gov).
• EVV: the BHDDH billing manual requires EVV for self-directed community-based supports and some professional services delivered in the home when the worker does not live with the person. EVV data goes to the state's Sandata aggregator. Since July 7, 2026, EOHHS has denied Medicaid fee-for-service personal care claims that are missing required EVV data, according to the Rhode Island EVV provider guide. We did not confirm whether these denials apply to BHDDH DD services or which EVV system DD agencies must use. Ask BHDDH or EOHHS.

What is changing next for I/DD services in Rhode Island?

As of October 28, 2026, we did not find a confirmed change with a set date for Rhode Island's I/DD services. BHDDH has described a possible provider rate change and a new assessment tier algorithm, but neither was confirmed as final.

• Possible rate change: in its April 2026 caseload testimony, BHDDH projected a potential rate change, based on a recommended rate review by the Office of the Health Insurance Commissioner (OHIC), estimated at about $16.7 million in state fiscal year 2027. BHDDH described it as potential. We did not confirm that it was funded or that it has taken effect.
• SIS-A 2nd Edition tier algorithm: BHDDH planned the rollout for late spring 2026, with costs falling in fiscal years 2027 and 2028. People's tiers, and so their budgets and provider rates, could change as it takes effect.
• Supportive Living: under review for implementation in fiscal year 2027.
• Consent decree: the court-ordered targets ran through June 2026. We did not find whether the decree has ended, been extended or moved to monitoring.

One recent change is already in place: CMS has approved remote supports since March 21, 2024. For the latest on rates, ask BHDDH DDD.

Rhode Island I/DD sources

• BHDDH: Developmental Disabilities billing manual (October 2024)
• BHDDH: Caseload Estimating Conference overview (April 2026)
• BHDDH: Caseload Estimating Conference overview (May 2025)
• BHDDH: DDD eligibility brochure (2024)
• Medicaid.gov: Rhode Island Comprehensive Demonstration
• Medicaid.gov: Rhode Island Comprehensive Demonstration annual monitoring report, 2024
• Rhode Island EVV provider guide (June 2026)

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)
• Rhode Island EVV requirements

Page history

• October 28, 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.