IDD waiver Medicaid reimbursement rates by state set the wages of the direct support workforce more directly than rates in almost any other field. The national median for in-home and community living supports, the core hourly IDD service, is $34.92 an hour across 40 states. South Carolina pays $85.96 an hour on code T2017; Louisiana pays $12.40.
Intellectual and developmental disabilities services run mostly through home and community-based waivers, with rates set service by service. We track 125,672 current IDD rates across 50 states, compiled from official state Medicaid publications and linked to their source documents. This page covers the eight services that make up most IDD provider revenue.
| Service | Unit | States | National median |
|---|---|---|---|
| In-home and community living supports | hour | 40 | $34.92 |
| Supported employment (job coaching) | hour | 47 | $40.84 |
| Behavior support services | hour | 29 | $78.07 |
| Day habilitation / day program | hour | 41 | $23.14 |
| Residential habilitation / group home | day | 44 | $280.27 |
| ICF/IID stay | day | 25 | $464.88 |
Two hourly services complete the picture: community integration at $26.70 across 26 states and prevocational services at $18.67 across 35 states.
IDD rates are harder to compare than most because each state designs its own waiver services. Three features shape every rate.
Service definitions
A service called "community living supports" in one state may include transportation, overnight support or nursing oversight that another state pays separately. The code helps, but the service definition decides what the rate is meant to cover.
Units and ratios
Hourly services are usually billed in 15-minute units, and many states set different rates for one-to-one and group support. Day programs are often priced per person at a group ratio, which is why their hourly figures look low.
Support levels
Many states vary rates by the person's assessed support level, so the same service can carry several rates. Before relying on any single figure, check which support level it applies to.
In-home and community living supports are the hourly backbone of most IDD waivers. South Carolina leads at $85.96 on code T2017, followed by South Dakota ($69.28), Massachusetts ($68.04), Alaska ($61.84) and Maryland ($61.32 on its state code W2142).
The bottom three are Idaho ($15.44 on H2016), West Virginia ($13.52) and Louisiana ($12.40), the latter two on S5125. Rates at that level sit below the median direct support wage, a point covered below.
Community living supports are the best measure for sorting states, because they are the most common hourly IDD service.
Top quartile
South Carolina, South Dakota, Massachusetts, Alaska and Maryland lead, with Delaware and Colorado close behind. Providers in these states can pay direct support professionals well above the median wage, fund training and supervision, and compete for staff in tight labor markets.
Middle half
Most states cluster near the $34.92 median, which New Mexico pays exactly. Florida, Indiana, Oregon, New Jersey and Kentucky sit nearby. Here the rate covers a median wage with a modest margin, and turnover costs often decide whether a program breaks even.
Bottom quartile
The lowest tier includes Nebraska, Arizona and Texas and ends with Idaho, West Virginia and Louisiana. At these rates, one-on-one hourly support pays less than the median direct support wage, so providers lean on group delivery, part-time staff or family caregivers paid through self-direction.
- South. The widest split. South Carolina leads community living supports, and Maryland and Delaware are top-tier, while Louisiana, Texas and West Virginia sit at the bottom across several services.
- Midwest. Minnesota leads day habilitation and residential habilitation, and South Dakota and Iowa pay well for hourly supports. Indiana is the most uneven state in the country across services.
- Northeast. Massachusetts is top-tier for community living supports, and New York leads supported employment. Connecticut and Rhode Island are high on day habilitation.
- West. Alaska and Colorado pay well for community living supports, and Oregon leads prevocational services. Idaho and Arizona sit in the bottom tier for hourly supports.
The regional picture matters less than in other fields because IDD rates are so service-specific. A provider weighing a new state should compare its own service mix line by line.
Day services are compared here per hour; states that publish a daily or partial-hour unit are converted so they line up.
- Day habilitation (T2021). National median $23.14 an hour across 41 states. Minnesota pays $100.00, Connecticut $57.28 and Rhode Island $52.12. Texas ($10.98), Louisiana ($9.92) and Indiana ($6.54 on T2020) are lowest.
- Community integration and community access. National median $26.70 an hour. Virginia pays $140.64 on T2021 and Indiana $104.56, then Maryland ($68.44) and the District of Columbia ($51.64). Louisiana ($16.00) and Georgia ($14.60) are lowest.
- Prevocational services. National median $18.67, the lowest of any IDD hourly service. Oregon leads at $74.31 on its state code OR541, followed by Minnesota ($69.42 on T2015). California ($7.23), Indiana ($5.66) and the District of Columbia ($3.95) are lowest.
Indiana shows how much services can diverge in one state: it is second-highest for community integration at $104.56 and lowest for day habilitation at $6.54.
Supported employment has the broadest coverage of any IDD service, with 47 states publishing a rate. The national median is $40.84 an hour. New York pays $141.64, Arkansas $102.36 on H2023 and the District of Columbia $97.08. Tennessee ($14.96), West Virginia ($12.80) and Wyoming ($12.36) are lowest. Job coaching often tapers as a worker gains independence, so a provider's revenue per client tends to fall over time even when the hourly rate is strong.
Behavior support services carry the highest hourly median in IDD at $78.07. Maryland pays $173.04, New Hampshire $167.32 and Kentucky $160.96, while New Jersey ($33.20), Tennessee ($27.00) and Idaho ($24.64) are lowest.
Residential services are paid per day and account for the largest share of revenue for providers that run group homes.
Residential habilitation (T2016). National median $280.27 a day across 44 states. Minnesota pays $999.00, then the District of Columbia ($567.62) and New York ($564.22). Iowa ($140.81), Illinois ($108.00) and Oklahoma ($88.66) are lowest. A daily rate must cover round-the-clock staffing, so the number of residents sharing staff in a home largely determines whether it covers cost.
ICF/IID. The facility-based alternative has a national median of $464.88 a day across 25 states. The District of Columbia pays $1,021.84, Maine $995.49 and South Dakota $926.97. Louisiana ($232.14), Wisconsin ($201.04) and Oklahoma ($174.35) are lowest.
IDD rates form a clear ladder by intensity. Prevocational ($18.67) and day habilitation ($23.14) pay the least per hour, community living supports ($34.92) and supported employment ($40.84) sit in the middle, and behavior support ($78.07), which typically requires a clinician, pays the most. On the daily side, ICF/IID at $464.88 pays well above community residential habilitation at $280.27.
Louisiana is the most consistent low-rate state: it is in the bottom three for community living supports, community integration, day habilitation and ICF/IID. The District of Columbia and Minnesota are the most consistent high-rate states, each appearing in the top five on several services.
Federal occupational wage data for May 2025 gives these national median hourly wages:
- Direct support professional: $22.08 (based on the closest comparable occupation, since there is no dedicated federal category)
- Residential advisor: $20.31
- Home health / personal care aide: $17.21
- Licensed practical nurse: $30.96
Against the $22.08 direct support wage, the community living supports median of $34.92 leaves room for payroll taxes, training, supervision and transportation, but not much. Day habilitation at $23.14 an hour barely exceeds the median wage, so day programs depend on staffing ratios, with one staff member supporting several people at once, to cover their costs. Prevocational services at $18.67 sit below the median wage outright.
Many of the lowest hourly rates on this page, from $3.95 up to $15.44, pay less than a direct support professional's median wage for an hour of one-on-one support. In those states, the rate itself becomes the limit on how much one-on-one support a provider can staff.
IDD waiver services are often paid fee-for-service, but some states deliver them through managed long-term services and supports plans. Where they do, the provider contracts with the plan, and the plan's rate and authorization process determine real revenue.
Key questions are whether plans must pay at least the state waiver rate, how they authorize hours and support levels, and whether residential and day services are included. Each state's managed-care rules set out how plans are allowed to pay.
- Cost each service at its ratio. Compare the rate with your wage cost per staffed hour at the ratio the service allows.
- Match the support level. Confirm which support level or tier applies to each person, since the same service can carry several rates.
- Model residential homes by occupancy. A daily rate per resident must cover the whole home's staffing; one vacancy can change the economics.
- Benchmark advocacy. When rates are reviewed, the national medians and peer-state figures are the clearest evidence of where a state stands.
All 125,672 IDD rates, with units, support levels and source documents, are available through our pricing plans.
Every rate on this page is compiled from official state Medicaid publications, including IDD waiver rate schedules and ICF/IID rate notices, and each figure links to the source document it came from. Hourly services are converted from their published unit to an hourly basis, daily services are compared per day, and rates published on state-specific codes are labeled with the code the state uses. Wage comparisons use national occupational wage data for May 2025. Our methodology explains how daily and unit rates are converted.