How District of Columbia pays for disability services

Waiver inventory

The District has no 1915(k)/CFC and no 1115 authority for the IDD population. IDD waiver services are fee-for-service through DHCF, not carved into managed care.

State-only funded programs

The District is a city-state, so "local funds" is the equivalent of state-only money. DDS local funds total $162,478,928 approved for FY 2026, up 14.0 percent from $142,523,234 in FY 2025.

• Residential support (room and board) for people in IDD waiver residential settings. Funded inside the FY 2026 local funds increase of $9,063,950 in nonpersonnel services, which the budget describes as covering "residential support, such as rent, food, clothing, and household items, for individuals receiving residential services through the IDD waiver," alongside IDD and IFS waiver growth, mortality investigation and quality assurance contracts. DDS Developmental Disabilities Administration. cfo.dc.gov
• Direct Support Professional wage supplement under the DSP Wage Act of 2023. One-time local funds increase of $11,526,290 in the Operations Services division for FY 2026, paying annual supplemental payments to qualifying providers of direct services to people with intellectual and developmental disabilities. Same source.
• DDA residential services administration fee restoration, $1,000,000 one-time local funds added by the Council in the approved FY 2026 budget. Same source.
• DDA service coordination. Service coordinators are DDS employees rather than a billable waiver service; funded from local funds inside the Service Planning and Coordination Operations activity. Same source.
• Locally funded services for people with IDD who are not Medicaid-eligible. The FY 2025 DDS performance accountability report describes DDA Consumer Resources as "the array of home and community-based services offered under the DDA HCBS waiver or local funds." oca.dc.gov
• Cost of Care recoveries, Special Purpose Revenue of $13,945,000 approved for FY 2026 (up $3,563,433 from FY 2025), from Supplemental Security Income, Social Security Disability Insurance and pension payments of non-Medicaid clients receiving Cost of Care support. This is an offset, not an appropriation.

Offsetting reduction: the approved FY 2026 budget cut $1,681,161 in local funds from Operations Services to realize savings in HCBS/IDD Waiver costs.

County / regional / local funding

Not applicable. The District has no counties, no sub-District taxing authorities for human services, and no regional centers. All non-federal funding is District local funds appropriated to DDS and to the Department of Health Care Finance. Checked: the FY 2026 DDS approved budget chapter, DDS publications index, and the IDD waiver application.

Funding scale

• DDS gross operating budget: $184,586,057 FY 2023 actual; $198,957,361 FY 2024 actual; $206,692,375 FY 2025 approved; $229,398,222 FY 2026 approved, an 11.0 percent increase. FTEs 435.5. cfo.dc.gov
• FY 2026 DDS revenue mix: local funds $162,479,000; Special Purpose Revenue $13,945,000; federal grant funds $36,379,000; federal Medicaid payments $16,595,000. Note that DDS's own budget covers agency operations and locally funded services; the bulk of IDD waiver claims are paid through the Department of Health Care Finance, not through DDS. Same source.
• IDD waiver services projected in the cost-neutrality demonstration: $257,885,176 in waiver year 1 for 1,943 participants, a Factor D of $132,725.26 per participant. dds.dc.gov
• IFS waiver: $75,000 per person aggregate annual spending cap; the original application projected $2,150,624 total with a Factor D of $71,687.47. dds.dc.gov
• People served: Developmental Disabilities Administration clients served, 2,611 in FY 2025; DDA applications for services received, 186; DDA prior authorizations processed, 9,141. oca.dc.gov
• FMAP: 70.00 percent for FY 2026, the District's statutory rate. kff.org
• State versus federal share: at 70 percent FMAP the District pays 30 cents on the dollar for waiver services, the most favorable match of any jurisdiction in this set. Applied to the $257.9 million waiver year 1 estimate, the local share is roughly $77 million. This is a derived figure.
• Waiting list: the District had never operated one. The 2022 renewal states plainly that "the District has never had a Waiting List and, with the newly approved slots amendment, do not project that one will occur." That changed. The October 15, 2025 public notice states: "DDS will activate the waitlist on January 1, 2026." Applicants are assessed with the DDA Level of Need Assessment and Screening Tool and ranked priority, emergency, urgent, or non-urgent under the DDS Waiting List for HCBS Waivers Procedure. No count of people on the activated list was found. dds.dc.gov

Residential funding detail

The District funds three residential models plus one-to-one intensive support, all as fixed daily rates. Residential Habilitation and daily Supported Living rates are built on the ICF methodology, which is stated at the top of the published rate workbook.

Residential Habilitation. Group settings sized for four people or for five to six people, each priced across four acuity levels plus a skilled nursing tier. Four-person homes, effective July 1, 2026: Basic Support Level 1 $389.26 per day; Moderate Support Level 2 $546.69; Enhanced Support Level 3 $615.89; Intensive Support $752.69; with 24-hour skilled nursing (LPN) $820.15. Five- or six-person homes: Basic $416.11; Moderate $496.07; Enhanced Moderate $544.57; Intensive $705.39; with 24-hour LPN $694.61.

Supported Living. The most granular tier structure in this set. Rates vary by household size (SL(3) for three people, SL(2) for two, SL(1) for one-to-one), by support level (Basic, Moderate, Intensive, each with Level 1 and Level 2), by whether transportation is included (W/TRANS), and by remote overnight configuration (R-ON, R-ON+1, R-ON+2, where remote overnight monitoring replaces or supplements on-site staff). Examples effective July 1, 2026: SL(3) Basic Support Level 1 $349.24 per day, or $438.36 with transportation, or $308.68 with remote overnight; SL(2) Basic Support Level 1 $479.86; SL(2) Intensive Support Level 1 $758.34, or $875.02 with transportation; SL(1) One to One Awake Overnight $929.73, or $1,129.09 with transportation. A Specialized Rate is available up to $2,500.00 per day. Supported Living with 24-hour skilled nursing (LPN) for three people is $677.98, or $767.11 with transportation. Supported Living Periodic is billed at $9.52 per 15 minutes.

Host Home. Four acuity bands, unchanged between the January and July 2026 rate updates: Basic Acuity $234.11 per day; Medium Acuity $261.83; Intense Acuity $340.37; High Acuity $770.09. Host home rates are quoted without transportation.

In-home and family settings. In-Home Supports $8.97 per 15 minutes ($35.88 per hour); High Intensity In-Home Supports $9.80 per 15 minutes ($39.19 per hour); a remote variant is priced at essentially parity. In-Home Supports cannot be combined with Host Home, Residential Habilitation or Supported Living.

Room and board. Under District law, everyone receiving residential services and supports must contribute to the cost of those services and to rent, food, clothing, medical expenses, furniture, utilities and other personal items and equipment. This applies to host homes, residential habilitation and supported living. Most people contribute from SSI or SSDI; people who work and still receive benefits contribute based on combined income. The District then backfills the remainder with local funds, which is why the FY 2026 local funds increase explicitly names rent, food, clothing and household items. Recovered benefit income is booked as the $13,945,000 Special Purpose Revenue Cost of Care line.

ICF/IID. DDA's Health and Wellness Unit provides health care oversight in both ICFs/IID and HCBS waiver settings, so ICFs/IID remain part of the District's residential continuum. ICF/IID per diem rates are set by DHCF and were not located in the DDS rate publication.

Rate structure link: dds.dc.gov

Comparable service rates

All rates below are the July 1, 2026 column of the published IDD and IFS waiver rate workbook. IFS rates are identical to IDD rates for every service except Education Supports and the participant-directed set.

Rate-setting mechanics visible in the workbook: rates are driven off a Direct Support Professional wage of $21.11 and a Living Wage of $18.40 as of July 1, 2026 (up from $17.95 on January 1, 2026), with a forecast of $18.40 on January 1, 2027 and $18.90 on July 1, 2027. The July 1, 2026 inflationary factor applied was 2.5070 percent.

Official rate schedule links

• 2026 IDD and IFS Waiver Rates Effective July 1, 2026, updated August 10, 2026 (workbook contains the rate table, the rate methodology, and the per-model cost builds for 4-bed, 6-bed, supported living and one-to-one): dds.dc.gov
• DDS IDD waiver rates publication page: dds.dc.gov
• DBH public notice of the Medicaid fee schedule for the IDD HCBS waiver: dbh.dc.gov
• Approved IDD Waiver Renewal 2022 (includes Appendix J cost build and Appendix I payment methodology): dds.dc.gov
• Appendix J, IDD Waiver Draft DC.002.05.00, effective October 1, 2022: dds.dc.gov
• 2026 IDD Waiver Amendment public notice, October 15, 2025: dds.dc.gov
• FY 2026 DDS approved budget chapter: cfo.dc.gov
• FY 2026 DDS budget tables: cfo.dc.gov

Notable features and flags

• January 1, 2026: DDS activated a waiting list for the IDD waiver for the first time in the program's history. Enrollment is now gated on both waiver openings and local fund availability, with applicants ranked priority, emergency, urgent or non-urgent using the DDA Level of Need Assessment and Screening Tool. This reverses the District's 2022 statement that it had never had and did not project a waiting list.
• July 10, 2026: CMS approved the current IDD waiver amendment (DC.0307.R05.00). It clarifies nine existing services, adds telehealth as a modality to eight services, and adds two new services: Health Assessment and Coordination (24/7 urgent care telehealth by a licensed physician, $30 per assessment per month, effective August 1, 2026 in the IDD waiver) and a state option to provide HCBS in acute care hospital settings for people receiving residential habilitation, supported living or in-home supports ($7.70 per 15 minutes).
• July 1, 2026 rate increase: a Direct Support Professional enhancement plus a 2.5070 percent living wage inflator raised residential habilitation and daily supported living rates roughly 2 to 3 percent over the January 1, 2026 rates. Fifteen-minute services split: employment, therapies, day habilitation and professional supports rose, while in-home supports, personal care, companion, respite, host home and paraprofessional employment rates were held flat.
• FY 2026 budget: an $11,526,290 one-time local funds enhancement for Direct Support Professional wages under the DSP Wage Act of 2023, and a $1,000,000 Council-added one-time restoration of the DDA residential services administration fee, offset by a $1,681,161 reduction to realize HCBS/IDD waiver savings. The DSP payment being one-time rather than recurring is a live risk for FY 2027.
• The IFS waiver's $75,000 per person annual aggregate cap is the District's main lever for serving people who live with family without opening a residential slot. It is the only DC waiver service package with Education Supports (four classes at $1,250 each, lifetime tuition maximum $35,000) and participant-directed services.
• Supported living had 74 published vacancies at the time of the 2022 renewal comment response, and DDS states there is no cap on supported living residences but refers people to existing vacancies before approving new ones. Combined with a newly activated waiting list, this is the clearest capacity-management signal in the District's documents.

Confidence

Solid: every rate in the comparable services table and the residential detail, taken cell by cell from the District's own published July 1, 2026 rate workbook, including procedure codes and the underlying wage assumptions; the DDS FY 2023 through FY 2026 operating budget by fund; the IDD waiver identifier, term, participant projections and Factor D; the waiting list activation date and the amendment contents; the 70 percent FMAP; and the 2,611 DDA clients served in FY 2025. Estimated: the roughly $77 million local share of waiver services, which I derived from Factor D times participants times the local match rather than reading a published total; and total IDD spending across DDS and DHCF combined, which no single retrieved document reports. Could not find: current IFS waiver enrollment (the medicaid.gov record for DC.1766.R01.00 was not retrievable and the only application located is the November 2020 draft with its 30/60/90 phase-in); the number of people now on the activated waiting list; District ICF/IID per diem rates, which sit with DHCF rather than DDS; and the University of Kansas State of the States District of Columbia profile.

I have gathered the primary source material. Here are the three profiles.

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