How to start an IDD waiver provider in Washington

Washington requires a Certified Community Residential Services and Supports (CCRSS) certification - supported living, group home, group training home, community protection (group homes also need an adult family home or assisted living license) from Washington DSHS Aging and Long-Term Support Administration, Residential Care Services (certification); DSHS Developmental Disabilities Administration (DDA) (contract); Health Care Authority (billing enrollment) to operate an IDD waiver provider. Fee: An annual certification fee is required (WAC 388-101-3120); amount not stated in the rule text reviewed.

License required

Yes

License

Certified Community Residential Services and Supports (CCRSS) certification - supported living, group home, group training home, community protection (group homes also need an adult family home or assisted living license)

Issuing agency

Washington DSHS Aging and Long-Term Support Administration, Residential Care Services (certification); DSHS Developmental Disabilities Administration (DDA) (contract); Health Care Authority (billing enrollment)

Fee

An annual certification fee is required (WAC 388-101-3120); amount not stated in the rule text reviewed.

Survey and inspection

DSHS may conduct on-site certification evaluations at any time; RCW 71A.12.080 calls for evaluation of each provider at least every two years.

Regulation

WAC 388-101 (certification) and WAC 388-101D (requirements for residential services and supports); RCW 71A.12

1. Send DSHS a letter of intent with contact information, service area and service type (group home, supported living, community protection, group training home)
2. Submit the signed application with attachments: administrator resumes, statements of financial stability, professional references, relevant experience, nondiscrimination assurance, and a copy of the license for a group home
3. Submit background authorization forms for the applicant, associated persons and the administrator
4. Receive DSHS's written certification decision (only complete applications are processed)
5. After initial certification, request a DDA residential services contract

Program

Washington Apple Health (Medicaid), Washington State Health Care Authority (HCA)

Enrollment portal

ProviderOne

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. HCA's enrollment and revalidation pages do not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. HCA's enrollment and revalidation pages do not describe a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. HCA's enrollment and revalidation pages do not describe a separate state site visit process.

Revalidation

HCA revalidates providers every five years under 42 CFR 455 and mails one letter per group or facility to the ProviderOne mailing address. The provider has 30 days from the notice date. After that a deactivation notice is sent and the provider gets 90 more days before billing privileges are affected. Billing providers revalidate through ProviderOne's 'Manage Provider Information' Business Process Wizard. They update ownership, managing-employee and controlling-interest disclosures and submit the Core Provider Agreement, Debarment Statement, W-9 and type-specific documents. Nonbilling providers use the nonbilling forms and the HCA support portal or fax. HCA and DSHS are doing off-cycle revalidations of certain providers by June 5, 2028.

Full Washington Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Washington State Department of Health, Certificate of Need Program

Services covered

• new health care facilities: hospitals, behavioral health hospitals, nursing homes, hospices and hospice care centers, home health agencies, kidney disease treatment centers, ambulatory surgical facilities
• sale, purchase or lease of an existing hospital
• nursing home capital expenditures above the expenditure minimum or that substantially change services
• bed capacity increases and redistribution among acute, nursing home and assisted living care
• new tertiary health services
• added dialysis stations

Washington certificate of need details →

Model

open/provider choice

Services in scope

• personal care
• respite
• home health

Alternate EVV allowed

Yes

Program

https://www.dshs.wa.gov/altsa/stakeholders/electronic-visit-verification

Washington EVV requirements →

State minimum wage

$17.13 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.73 on 2027-01-01 (CPI-W indexing; no tip credit).

Rate pass-through

When individual-provider home care wages and benefits change under the collective bargaining agreement, DSHS adds the per-quarter-hour amount to the home care agency vendor rate, and agencies must use any increase only for direct-care workers' wages, benefits and related employer costs. From FY2028 a set share of the vendor rate is dedicated to compensation, with verification of agency spending from 2027-07-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Intellectual/developmental disability residential facilities — active organization NPIs (NPPES)

45 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,781,187 (as of Jun 1, 2026)

All Washington IDD / waiver Medicaid rates, ranked →

• WA Basic Plus Waiver (1915(c))
• WA Children's Intensive In-Home Behavioral Support Waiver (1915(c))
• WA Community Protection Waiver (1915(c))
• WA COPES Waiver (1915(c))
• WA Core Waiver (1915(c))
• WA Individual and Family Services Waiver (1915(c))
• WA New Freedom Waiver (1915(c))
• WA Residential Support Waiver (1915(c))
• Washington Medicaid Transformation Project 2.0 (1115)

Washington waivers and waiting lists →