How Idaho pays for disability services

Waiver inventory

Excluded: ID Aged and Disabled Waiver (1076.R07), which serves people 65+ and adults 18 to 64 with physical disabilities and is not Idaho's primary DD vehicle.

State-only funded programs

• Extended Employment Services (EES), Idaho Code Title 56 Chapter 17. Pays for remunerative work and long-term employment support for adults with developmental disabilities or mental illness who cannot obtain competitive employment. FY2025 appropriation $3,526,100; FY2026 Governor's recommendation $3,531,000. Administered by the Department of Health and Welfare, Division of Services for the Developmentally Disabled (moved from Vocational Rehabilitation in FY2023). legislature.idaho.gov
• Southwest Idaho Treatment Center (SWITC), Nampa. State-operated specialized residential and crisis facility for people with developmental disabilities who have no other placement option. FY2025 appropriation $15,171,800 (mixed funds; the FY2025 budget included $1,297,700 specifically for SWITC crisis patient treatment not covered by Medicaid). Same source.
• Community Developmental Disability Services, the seven regional adult and children's DD programs performing identification, screening, eligibility determination, and quality assurance. FY2025 appropriation $26,994,300. Same source.
• Crisis Prevention Court Services, $400,000 one-time General Fund in FY2025 for housing, food, treatment, and other supports to keep people with developmental disabilities in community settings. Same source.
• Idaho Council on Developmental Disabilities, funded within Independent Councils (12.00 FTP; the division's General Fund line was $564,700 in FY2025, shared with the Domestic Violence Council). Same source.

Division total for Services for the Developmentally Disabled: FY2025 appropriation $45,692,200 all funds, of which $24,021,200 General Fund.

County / regional / local funding

None identified. Checked: the Idaho Legislative Budget Book FY2026 (Department of Health and Welfare, Services for the Developmentally Disabled and Division of Medicaid sections), the Idaho Medicaid Provider Handbook for HCBS and LTSS, and the Adult DD waiver application. Idaho delivers DD services through seven state regional offices rather than county boards, and no county levy, county board, or regional center allocation for DD appears in any of these documents. Idaho has no equivalent of a county mill levy for developmental disabilities.

Funding scale

• Medicaid developmental disability services expenditures: $577,000,000 in FY2024 actual, projected $640,000,000 in FY2025, an increase driven by average weekly users rising from 7,148 to 7,638 and average weekly expenses from $11.1M to $12.3M. legislature.idaho.gov
• Adult DD waiver services alone (Appendix J, waiver year 1 of the R07 cycle): $503,459,540.37 across 7,458 participants. medicaid.gov
• Per participant: Factor D $67,505.97 (waiver services only) in WY1, rising to $87,653.20 in WY3 and $99,642.18 in WY5. Waiver plus other Medicaid (D + D') is $94,445.06 in WY1. The ICF/IID comparison (G + G') is $121,577.10. Same source.
• General Fund exposure: the Legislature found the state pays more than $176.5 million from the General Fund through Medicaid for residential habilitation and other HCBS. legislature.idaho.gov
• State versus federal share: Idaho's FMAP fell from 67.59% in the first quarter of FY2026 to 66.91% for the remainder of FY2026, so the state share is roughly 33.1%. legislature.idaho.gov and kff.org
• Non-Medicaid DD division: FY2025 $45,692,200 all funds, FY2026 Governor's recommendation $122,925,800 (the large jump reflects moving federal child care and other lines into the division, not DD service growth). Same budget book.
• People served: 7,458 approved waiver slots; 8,322 total state IDD agency caseload in FY2023 per RISP. publications.ici.umn.edu
• Waiting list: Idaho does not operate a standing DD waiver waiting list. The waiver states "the state does not limit the number of participants that it serves at any point in time." The provider handbook adds that if the CMS-approved maximum is reached, later applicants "are placed on a waiting list to have their applications processed after March 31st for the new DD Waiver year." idmedicaid.com

Residential funding detail

Idaho funds residential support through a single waiver service, Residential Habilitation, delivered in two settings:

1. Supported Living, provided in the participant's own home or apartment. Billed hourly and per diem under codes H2015, H2015-HQ, H2016, and H2022. Two intensified daily tiers exist: Intense Supported Living and High Supported Living, both paid as a daily rate. People authorized for either tier may not also receive Developmental Therapy, Adult Day Health, or Non-Medical Transportation, because those are bundled into the daily rate.
2. Certified Family Home (CFH), Idaho's host home / shared living model, licensed under IDAPA 16.03.19 and billed under code S5140. Rates vary by level of CFH service.

Idaho does not operate community ICF/IID group homes as its main model. The state-operated ICF/IID is SWITC in Nampa for people with the most complex behavioral or medical needs (22 people in large state facilities in FY2023 per RISP).

Payment structure: rates do not vary by provider type for Residential Habilitation, only by level of Supported Living or CFH service. Rates are built from provider-specific cost surveys plus Bureau of Labor Statistics and IRS data, with statutorily required annual cost surveys and 15% audit sampling for residential habilitation, DDA services, community-supported employment, personal care, and targeted service coordination. Rates were last reviewed in SFY2023 and last rebased in SFY2019. Rate changes require legislative approval.

Room and board: not state-funded and not in the Medicaid rate. The waiver states that "the room and board allowance in a residential setting is the responsibility of the participant (and/or family or legal representative as appropriate) and is paid to the provider directly on a monthly basis." Residential settings must furnish room, utilities, and three daily meals, with the charge fixed in a written admission agreement under IDAPA 16.03.19. The room and board allowance is not used to determine Medicaid eligibility or client participation. In practice this falls to SSI and other participant income.

Rate structure source: Adult Developmental Disabilities Waiver Services Fee Schedule, published in the Idaho Medicaid Fee Schedules library at publicdocuments.dhw.idaho.gov

Comparable service rates

Idaho's published fee schedules sit behind a Laserfiche portal that refuses automated retrieval. The figures below are the CMS-approved average cost per unit from Appendix J-2-d of the Adult DD waiver application (amendment R07.02, effective July 1, 2025, approved December 9, 2025). They are actuarially blended averages, not line-item fee schedule entries.

Also from Appendix J: Financial Management Services $107.22 per member per month; Behavior Consultation / Crisis Management $12.90 per 15 minutes; Chore Services $500.00 per chore; Environmental Accessibility Adaptations $3,362.12 per job.

Official rate schedule links

• Idaho Medicaid Fee Schedules library (contains the Adult DD Waiver Services Fee Schedule, Children's DD & CHIS DDA Fee Schedule, Children's DD & CHIS Independent Provider Fee Schedule, Personal Assistance Agency Fee Schedule, and the Service Coordination Fee Schedule): publicdocuments.dhw.idaho.gov
• DD provider reimbursement rates document library: publicdocuments.dhw.idaho.gov
• Idaho Medicaid Provider Handbook, HCBS and LTSS, revised August 17, 2026 (rate methodology, service definitions, billing): idmedicaid.com
• Adult DD waiver application with Appendix I rate methodology and Appendix J rate tables: medicaid.gov
• IDAPA 16.03.26, Medicaid Plan Benefits (Sections 571, 574, 590, 610 govern DD coverage and provider reimbursement): adminrules.idaho.gov

Notable features and flags

• March 26, 2026: House Bill 863 signed into law (Session Law Chapter 161), cutting Medicaid residential habilitation rates. Fiscal note: the Medicaid budget reduces by $21.8 million General Fund in FY2027, reversing rate increases the Legislature appropriated in 2022 (Chapter 252, Laws of 2022, a $70,393,100 line item). The bill also nullifies certain IDAPA 16.03.26 rules effective 7/1/2026 and funds $1.7 million ($850,000 GF / $850,000 FF) for an independent auditor. Passed House 60-8-2 on 3/12/26 and Senate 19-15-1 on 3/23/26. legislature.idaho.gov
• KW v. Armstrong litigation remains unresolved. A 2016 federal court order found Idaho's adult DD budget tool violated due process. A 2017 settlement required a new resource allocation model; the court set a June 2022 deadline, then ruled that the assessment tool was insufficiently transparent, causing the vendor to decline contract renewal and leaving the new model non-operational. Idaho requested $200,000 ongoing in FY2026 to contract with HSRI and pay plaintiffs' attorney fees. The stalled service enhancements are the stated justification for the 2026 rate rollback. legislature.idaho.gov
• Statewide Medicaid managed care is coming but has been delayed to January 1, 2030 under House Bill 345 (enacted March 2025). LTSS and DD services and waivers are within scope; school-based Medicaid and Katie Beckett are carved out. Three MCO contracts are planned, RFP posting anticipated in 2027, with an RFP blackout period beginning December 1, 2026. healthandwelfare.idaho.gov
• Waiver amendment R07.02 effective July 1, 2025, approved November 4 / December 9, 2025. The waiver runs 4/1/2023 to 3/3/2028. medicaid.gov
• ARPA section 9817 reinvestment funds (7/1/2022 to 1/30/2024) paid for five targeted rate increases: DDA rates (Adult Day Health plus three 1915(i) services), residential habilitation agency rates (H2015, H2015-HQ, H2016, H2022), Certified Family Home rates (S5140), supported employment (H2023), and home delivered meals (S5170). Those enhancements have expired. medicaid.gov
• Statutory cost-survey and audit regime. Idaho Code 56-265, as amended in 2026, requires annual cost surveys with 15% or more of responses audited for residential habilitation, personal care, DDA services, community-supported employment, and targeted service coordination, and requires providers to spend at least the appropriated allocation on direct care worker wages and employee-related expenses. legislature.idaho.gov

Confidence

Solid: waiver structure, authorities, CMS-approved participant limits, cost-neutrality figures, rate methodology, room and board policy, FMAP, HB 863 and its fiscal note, the KW litigation history, and the managed care timeline. All come from the CMS-approved waiver application, the state provider handbook, the Idaho Legislative Budget Book, and the enrolled bill.

Estimated: the per-service dollar figures in the comparable rates table. These are Appendix J average cost per unit values, which approximate but do not equal published fee schedule line items, particularly for Residential Habilitation, where the single blended 15-minute figure masks distinct Supported Living tiers, Intense and High Supported Living daily rates, and Certified Family Home rates.

Could not find: the actual published Adult DD Waiver Services Fee Schedule tables, the Children's DD fee schedules, and the 1915(i) developmental therapy and targeted service coordination rates. Idaho publishes these only through a Laserfiche WebLink portal that requires cookies and rejected roughly a dozen automated retrieval attempts across several endpoints; the files open normally in a browser. Also not found: children's 1915(i) enrollment counts, Idaho's private ICF/IID census, and any post-HB 863 revised rate schedule.