IDD Medicaid Rates in the District of Columbia (2026)

IDD Medicaid rates in the District of Columbia sit at the top of the country for facility and residential care. DC Medicaid pays $1,021.84 for an ICF/IID stay, effective 2026-07-01. That ranks 1st of 12 states and is 119.8% above the national median of $464.88.

DC is also 2nd for residential habilitation, 3rd for supported employment and 4th for community integration. Yet it ranks last of 28 states for prevocational services, on a rate unchanged since 2011-09-01. Rates are compiled from official state Medicaid publications and link to their source documents.

Two further services are published in units that are not ranked: in-home support on code 99509 at $8.97, and behavior support on H0025 at $24.19, both effective 2026-01-01.

The table runs from the top of the national range to the very bottom. Four of the six ranked services are in the top five, one is close to the middle and one is last. For a DC provider the lesson is that service selection, not the overall level of rates, determines whether a program works financially.

DC's IDD services run through the Intellectual and Developmental Disabilities (IDD) waiver and the Individual and Family Support (IFS) waiver, both 1915(c) waivers operated by the Department on Disability Services (DDS). The IDD waiver covers the full range of residential, day and employment supports; the IFS waiver is designed for people who live with family or on their own and need a lighter package of support. ICF/IID stays are paid separately, fee-for-service, by the Department of Health Care Finance (DHCF).

Modifier-driven billing

DC identifies services by code plus a modifier string. Community integration and day habilitation both bill T2021, separated by U3 or U4 and an X1 modifier; residential habilitation bills T2016 with GT, UC and V2; supported employment bills H2023 with 22. Two services sharing one base code at very different rates makes the modifier the most important field on a DC claim.

Fee schedules in the DC Register

DC publishes its waiver fee schedules as notices in the DC Register. The 2026-07-01 schedules appeared as notices N145317 (IDD waiver) and N145318 (IFS waiver), and the 2026-01-01 schedules as N143483 and N143480. Billing staff can use the notice number to confirm which schedule a claim date falls under.

DC's ICF/IID rate of $1,021.84 leads Maine ($995.49), South Dakota ($926.97), Rhode Island ($734.52) and Iowa ($503.46). The lowest ICF/IID rates are in Louisiana ($232.14), Wisconsin ($201.04) and Oklahoma ($174.35).

Residential habilitation on T2016 pays $567.62 a day, effective 2026-07-01. Only Minnesota pays more, at $999.00, and DC is just ahead of New York at $564.22. For providers running group homes under the DC IDD waiver, the daily rate is double the national median.

A high daily rate does not remove the core risk of residential care: staffing is largely fixed while revenue depends on occupancy. In a high-cost labor market, a single vacant bed can erase much of a home's margin, so DC operators should model occupancy carefully even at this rate.

Supported employment on H2023 pays $24.27 per 15 minutes, or $97.08 an hour, effective 2025-01-01. Only New York ($141.64) and Arkansas ($102.36) pay more. Community integration on T2021 with the U3 modifier pays $12.91 per 15 minutes, or $51.64 an hour, 4th of 22 states.

Supported employment is the strongest hourly line on the DC schedule. It pays enough to fund the unbilled work job coaching requires: developing relationships with employers, learning job tasks and gradually fading support as the worker becomes independent.

Day habilitation, billed on T2021 with the U4 modifier, pays $7.46 per 15 minutes, or $29.84 an hour, effective 2026-07-01. That is 29.0% above the $23.14 median and 11th of 32 states.

Prevocational services are the exception. At $3.95 an hour on T2015, DC pays the lowest prevocational rate of any ranked state, below Indiana ($5.66) and California ($7.23). A program cannot staff prevocational services at that rate except as part of a larger day program, so providers have a strong reason to plan around day habilitation, community integration or supported employment.

The rate has carried a 2011-09-01 effective date for well over a decade. Whether intentional or not, a rate this far below every other DC service functions as a signal: the District's schedule steers people toward community-based day and employment services instead.

DC's direct support wage is well above the national median. May 2025 federal occupational data shows:

• Direct support professional: $28.59 vs $22.08 nationally (based on the closest comparable occupation)
• Residential advisor: $18.50 vs $20.31
• Home health / personal care aide: $20.53 vs $17.21
• Licensed practical nurse: $36.42 vs $30.96

The high wage is matched by high rates. On supported employment, the loaded direct support wage takes 40.7% of the $97.08 rate, leaving $57.55 an hour. On community integration, the loaded wage takes 76.5% of the $51.64 rate, leaving $12.11 an hour. Supported employment is the more profitable service by a wide margin.

Community integration's thinner margin is worth noting: at $28.59 an hour, DC's direct support wage is the highest of any jurisdiction in this comparison group, so a rate that looks generous nationally is only moderately comfortable locally.

DC attaches a large number of prior authorization rules to its IDD codes. Coverage records show 454 rules on T2016 residential habilitation, 272 on T2019, 80 on T2033, 57 on T2021, 45 on H0025 behavior support and 25 on H2023 supported employment. No unit limits are recorded.

For a provider, the high rates come with heavy authorization work. Billing staff should match each claim to the authorized service, modifier and units, and agencies should budget for administrative staff who manage authorizations as a core function rather than an afterthought.

DC's managed-care plans include AmeriHealth Caritas District of Columbia, MedStar Family Choice DC and Health Services for Children with Special Needs (HSCSN), and DC's IDD plan listings count 6 entries. IDD waiver services are paid through the DDS-operated waivers and ICF/IID stays through DHCF fee-for-service, so the published schedules on this page are the rates providers receive. See the DC managed care page.

DC changed IDD rates several times in 2026:

• July 1 fee schedules. DC Register Vol 73/22 notices N145317 and N145318, published 2026-05-29, set the Medicaid fee schedules for the IDD waiver and the Individual and Family Support waiver, effective 2026-07-01.
• New waiver services. A CMS-approved IDD waiver amendment, approved 7/10/2026, took effect 2026-08-01, alongside Transmittal 26-21, New IDD Waiver Service Rates and Updated Service, also effective 2026-08-01.
• IFS rulemaking. DC Register Vol 73/35 N146348, a Notice of Final Rulemaking amending 29 DCMR Ch. 90 for the Individual and Family Support waiver, was enacted 2026-08-28.
• Skilled nursing rates. Transmittal 26-25, Skilled Nursing Rate Changes, took effect 2026-10-01.

With two fee schedules a year plus mid-year amendments, DC providers should reconcile remittances against the schedule in force on each date of service.

Many DC providers also operate in the surrounding states, and the comparison is instructive. On community integration, DC's $51.64 an hour ranks behind Virginia at $140.64 and Maryland at $68.44, the first and third highest in the country. On behavior support, Maryland leads the nation at $173.04 an hour, while DC publishes its H0025 behavior support rate in a unit that is not ranked.

The pattern is that the region as a whole pays well for community-based IDD services, and DC stands out mainly on residential and facility care, where it leads or nearly leads the country. An agency running programs on both sides of the District line should expect different service definitions, codes and authorization rules in each jurisdiction, even for services that look the same to the people receiving them.

• Build around employment and residential lines. These carry the strongest rates and, for supported employment, the widest margin.
• Avoid standalone prevocational programs. At $3.95 an hour, prevocational work only fits within a broader day program.
• Staff authorization management. With hundreds of rules on key codes, authorization errors are the likeliest source of lost revenue.
• Track the DC Register. New schedules arrive in January and July; amendments can add services mid-year.

Rates on this page are compiled from official state Medicaid publications, including DC Register fee schedule notices and DHCF transmittals, and each rate links to its source document. Hourly figures are derived from published 15-minute units; residential and ICF/IID rates are shown per day. Wage figures are May 2025 federal occupational medians. All 87,654 current DC Medicaid rates are available with an account; see pricing, our methodology, the IDD rates by state hub and the DC Medicaid rates page.