Community integration / community access (IDD): Medicaid rates by state

This is a service-level benchmark rather than a single code: each state's headline rate for community integration / community access (IDD) is chosen to match the same service and the same provider level.

• Provider level. States are compared at the self-directed worker (hired by the person or family) level. Rates for other levels on file (any qualified provider, agency provider, independent (non-agency) provider and behavior technician) are kept separate, never mixed into this ranking.
• Unit. Of the 21 states, 18 publish their headline rate per 15 min and 3 per hour. The ranking converts every time-based rate to an hour of service, so states that bill by the 15 minutes and by the hour compare directly.
• Variants. 19 of the 21 states publish more than one rate for this service (by modifier, program, setting or provider type); the headline rate is the one that matches the comparison, and the workspace lists every variant.
• Depth. 2,747 rates for this service are on file across all states, versions and provider levels; this page shows one headline rate per state.

The highest-paying state, Virginia, pays $140.64 per hour; the lowest, Florida, pays $13.32 per hour, a 10.6x gap. 10 of the 21 states pay above the median of $27.00 per hour. Common reasons rates for IDD services services spread this way:

• Waiver rates are usually built from a rate model with assumptions about wages, benefits, training and productive time, and states rebuild those models on different schedules.
• Rates vary with staffing ratio, setting and the person's assessed level of support.
• Each waiver can carry its own fee schedule, so one state may publish several rates for the same service.

Billing notes

Modifiers often identify the staffing ratio or support tier, and each carries its own rate. Day services and supported employment are commonly billed in 15-minute units or per day; residential services per day or per month.