I/DD Waivers in Virginia

All states: Medicaid disability services map

Virginia I/DD services at a glance

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

Who runs I/DD services in Virginia?

Two state agencies share the work. The Department of Behavioral Health and Developmental Services (DBHDS) runs Virginia's three developmental disability (DD) waivers day to day. The Department of Medical Assistance Services (DMAS), the state Medicaid agency, supervises the waivers, sets policy and pays claims. Local Community Services Boards are the front door and provide case management, which Virginia calls support coordination.

• Department of Medical Assistance Services (DMAS): the Medicaid agency. It holds the federal waivers, publishes the DD waiver program pages and the fee schedule, enrolls providers and pays DD waiver claims.
• Department of Behavioral Health and Developmental Services (DBHDS): operates the waivers, keeps the statewide waiting list, licenses most day and residential providers and oversees the Supports Intensity Scale assessments that set support levels.
• Front door: the local Community Services Board (CSB) or Behavioral Health Authority, a public agency that serves a city or county area. Virginia has 40 CSBs. The CSB screens people for eligibility and places eligible applicants on the waiting list.
• Case management: support coordinators employed by a CSB, or private support coordinators under contract with a CSB, plan and coordinate each person's services. Support coordination is paid fee-for-service and is not part of managed care.

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

Virginia has three 1915(c) waivers for people with developmental disabilities, including intellectual disability. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. All three require that the person meets the level of care for an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), and all three are run by DBHDS under DMAS.

• Community Living (CL) Waiver (1915(c), control number VA.0372): for children and adults who usually need support in their homes at all times, including people who live in staffed homes because of complex medical or behavioral needs. Services include Group Home Residential, Sponsored Residential, Supported Living, In-Home Support Services, Shared Living, day and employment services, personal assistance, respite and companion, nursing, therapeutic consultation, crisis supports, assistive technology, environmental modifications and electronic home-based supports. The 2026 Appropriation Act authorizes 12,520 CL slots as of July 1, 2026. Average cost per participant in fiscal year 2026 was $143,388, according to DBHDS's 2026 DD waiver services report.
• Family and Individual Support (FIS) Waiver (1915(c), control number VA.0358): for children and adults who live with family or friends or in their own homes, including some with medical or behavioral needs. Services include In-Home Support Services, Supported Living, Shared Living, day and employment services, personal assistance, respite and companion, nursing, therapeutic consultation, individual and family/caregiver training, crisis supports, assistive technology and environmental modifications. The Appropriation Act authorizes 8,559 FIS slots as of July 1, 2026. Under the January 1, 2025 FIS amendment, a person offered a slot can delay enrollment for up to one year. Average cost per participant in fiscal year 2026 was $64,178.
• Building Independence (BI) Waiver (1915(c), control number VA.0430): for adults 18 and older who can live mostly on their own, usually in housing they own, lease or control, and do not need support all the time. Services include Independent Living Supports, Shared Living, day and employment services, community guide, peer mentoring, benefits planning, electronic home-based supports and employment and community transportation. It is the smallest DD waiver (about 261 people received a service in fiscal year 2026, at an average cost of $26,824).

At the end of fiscal year 2026, 21,479 slots were funded across the three waivers. Virginia also has ICF/IID facilities as the institutional option that the DD waivers are designed to replace. Related programs not counted here are the brain injury services and the Commonwealth Coordinated Care Plus (CCC Plus) waiver, which DMAS runs for older adults and people with physical disabilities, and the state-funded Individual and Family Support Program, which helps people who are on the waiting list.

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

No. DD waiver services in Virginia are paid fee-for-service, directly by DMAS. People on the CL, FIS and BI waivers are enrolled in a Cardinal Care health plan (Virginia's Medicaid managed care program), but only for their non-waiver services such as doctor visits, hospital care, pharmacy and behavioral health.

• DD waiver services: billed to and paid by DMAS. The 2026 Appropriation Act (Item 291) keeps developmental disability waiver services fee-for-service and excluded from managed care contracts.
• Support coordination: also fee-for-service, provided by CSB or contracted private support coordinators, not by the health plan.
• Non-waiver care: handled by the person's Cardinal Care health plan, as described in DMAS's DD waivers and Cardinal Care guide. This page does not list the current plans; DMAS can provide them.

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

Yes. DBHDS keeps one statewide DD waiver waiting list ranked by urgency. As of September 21, 2026, 2,632 people were in Priority One, the most urgent group, according to DBHDS. The full list held 14,226 people in May 2026, a figure reported by the Virginia Board for People with Disabilities citing DMAS.

• Priority levels: under the state rule (12VAC30-122-90), Priority One is for people who need a waiver service within one year, Priority Two within one to five years, and Priority Three in five years or more. DBHDS updates the list at least once a year.
• Who gets a slot: local Waiver Slot Assignment Committees recommend who receives each open slot.
• New slots: 3,440 new slots were funded over fiscal years 2025 and 2026, including 1,720 in fiscal year 2026 (1,548 FIS and 172 CL). We did not find confirmed new slot funding for fiscal years 2027 and 2028.
• While waiting: the state-funded Individual and Family Support Program offers help to people on the waiting list.

For a person's place on the list, families can ask their CSB support coordinator or DBHDS.

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

A person applies by contacting their local Community Services Board or Behavioral Health Authority for a screening. If they have a documented developmental disability, meet the functional criteria and meet ICF/IID level of care, they are placed on the statewide waiting list with a priority level. Support levels and many rates are then set using the Supports Intensity Scale.

• Eligibility: a developmental disability diagnosis with documentation, functional limitations measured by the CSB, and ICF/IID level of care.
• Functional eligibility tool: the Virginia Individual Developmental Disabilities Eligibility Survey (VIDES).
• Support levels: the Supports Intensity Scale (SIS-A 2nd Edition) is required for nearly all DD waiver recipients. Its results set the person's support level and the reimbursement tier for certain services.
• Limits: Group Day Support, Community Engagement, Community Coaching, Workplace Assistance and supported employment together are capped at 66 hours a week. Individual Supported Employment is capped at 40 hours a week.

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

Virginia's DD waivers cover six day and employment services and six residential options. Most need a DBHDS license for the matching service, while supported employment needs a vendor agreement with the Department for Aging and Rehabilitative Services (DARS). Many services are paid at four SIS-based tiers, with separate rates for Northern Virginia and the rest of the state.

Day and employment services

• Group Day Support (CL, FIS, BI): skill-building in groups on a regular schedule. Needs a DBHDS center-based or non-center-based day support license and a DMAS participation agreement. No more than 7 people per staff person. Billed by the hour at four tiers.
• Community Engagement (CL, FIS, BI): support to take part in ordinary community activities such as education, volunteering and leisure, alongside people without disabilities. Needs a DBHDS non-center-based day support license. No more than 3 people per staff person. Billed by the hour at four tiers.
• Community Coaching (CL, FIS, BI): one-on-one help building the skills to take part in community activities. Needs a DBHDS non-center-based day support license. Billed by the hour. The research did not find a published ratio.
• Individual Supported Employment (CL, FIS, BI): one-to-one job development, training and retention in competitive community jobs. Needs a DARS vendor agreement. Billed by the hour, up to 40 hours a week. Not covered by the waiver when DARS or special education can pay for it.
• Group Supported Employment (CL, FIS, BI): continuous staff support for groups of 2 to 8 people working in the community, such as work crews or enclaves. Needs a DARS vendor agreement. Billed by the hour, with rates for 2 or fewer, more than 2 up to 4, and more than 4 people per staff.
• Workplace Assistance (CL, FIS): support at the job site beyond supported employment so a person can keep a job. Needs a DARS vendor agreement or a DBHDS non-center-based day support license. The research did not find a published ratio or billing unit.

Residential services

• Group Home Residential (CL): supports across 24 hours in a licensed home. Needs a DBHDS Group Home Residential license. Paid per day (344 billing days a year) at rates that vary by home size (4 or fewer up to 12 people) and SIS tier.
• Sponsored Residential (CL): a host home model in a sponsor's home serving no more than two people, managed by a licensed agency. Needs a DBHDS Sponsored Residential Home Services license. Paid per day by tier.
• Supported Living (CL, FIS): supports in an apartment or house run by a licensed provider, with staff available around the clock. Needs a DBHDS Supervised Living Residential or Supportive In-Home Residential license. Paid per day by tier.
• In-Home Support Services (CL, FIS): supports in the person's own or family home that add to unpaid care. Needs a DBHDS Supportive In-Home Residential Services license. Billed hourly, with rates for 1, 2 or 3 people supported.
• Independent Living Supports (BI): skill-building and support for adults living mostly on their own. Needs a DBHDS Supportive In-Home Residential Services license. Paid as a monthly (or partial month) rate by tier.
• Shared Living (CL, FIS, BI): pays the share of rent, food and utilities for an unrelated roommate who lives with the person and gives some support (parents and spouses are excluded). Run by a provider with a DBHDS license for DD services. Rates are set for each person.

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

DMAS sets a statewide fee schedule with two regions (Northern Virginia and the rest of the state) and SIS-based tiers for many services. The rates come from rate models built in periodic DD waiver rate studies, and the General Assembly funds changes through the Appropriation Act. Customized rates are available for people with intensive needs.

• Latest rate change: on July 1, 2026, DMAS rebased Community Coaching, Community Engagement, Independent Living Supports, In-Home Support, Therapeutic Consultation and Workplace Assistance using the 2025 DD Waiver Rate Study. Group Day, Group Home, Sponsored Residential, Supported Living, supported employment and several other services got a 2 percent increase, under Item 291.JJJJJ of the 2026 Appropriation Act. See the state fiscal year 2027 DD waiver rate file and the DMAS provider notice.
• Licensing: most day and residential services need a DBHDS license for the matching service, and supported employment needs a DARS vendor agreement. DBHDS's Prospective Provider Toolkit lists which license each service needs.
• Enrollment: after licensing, providers enroll with DMAS through the Virginia Medicaid provider portal and sign a participation agreement.
• EVV: electronic visit verification (EVV) has been required since September 1, 2020 for agency-directed and consumer-directed personal assistance, respite and companion services, according to DMAS's Medicaid Waivers 101 training. Agencies use their own EVV system, and consumer-directed attendants use the fiscal/employer agent's app. Live-in caregivers are exempt for now. We did not find a state source saying whether In-Home Support Services need EVV; ask DMAS.
• Self-direction: in the CL and FIS waivers, personal assistance, respite and companion can be consumer-directed, with a services facilitator and a fiscal/employer agent that handles payroll. The BI waiver does not offer participant direction.

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

The 2026 Appropriation Act raises agency and consumer-directed personal care, respite and companion rates in Virginia's home and community waivers by 4 percent on January 1, 2027 and by 3.9 percent on January 1, 2028. The Act also tells DMAS to seek federal approval for two other changes, which have no dates yet.

• Rate increases: 4 percent on January 1, 2027 and 3.9 percent on January 1, 2028 for personal care, respite and companion, per Item 291 of the 2026 Appropriation Act.
• Ending the EVV live-in caregiver exemption (proposed): DMAS is directed to seek federal approval. It would take effect only once approved, and no date has been set.
• 56-hour weekly limit on personal assistance (proposed): DMAS is directed to seek federal approval for a 56-hour weekly limit on personal care and assistance in the CL and FIS waivers. It would take effect only once approved, and no date has been set.

For waiver amendments or renewals, check DMAS's DD waiver pages or ask DMAS at the DD waiver mailbox.

Virginia I/DD sources

• DMAS: Developmental Disability (DD) Waivers
• DBHDS: Waiver information for individuals and families
• DBHDS: Item 295-K DD Waiver Services Report (2026)
• 12VAC30-122-90 (DD waiver waiting list and priority levels)
• DMAS: FIS waiver amendment effective January 1, 2025
• DMAS: BI waiver amendment effective January 1, 2025
• DMAS: Developmental Disabilities Waivers and Cardinal Care
• 2026 Appropriation Act, Item 291 (DMAS)
• DMAS: SFY 2027 DD waiver rate file (updated June 26, 2026)
• DBHDS: Prospective Provider Toolkit

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)
• Virginia 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.