How Virginia pays for disability services

Waiver inventory

Virginia has no 1915(k) Community First Choice and no 1915(i) DD state plan option. Institutional coverage for people with DD is through ICF/IID, including the one remaining state training center, Southeastern Virginia Training Center.

State-only funded programs

Individual and Family Support Program (IFSP) Funding Program, DBHDS. Provides limited direct financial assistance to people on the DD waiver waiting list and their families for eligible costs that support continued living in an independent setting. FY2025: 5,198 applications received, 3,807 awards granted, $2,499,959 total awarded. DBHDS also runs an IFSP Community Coordination Program. dbhds.virginia.gov and dbhds.virginia.gov

State Rental Assistance Program (SRAP), DBHDS. State-funded rental assistance for people with developmental disabilities in the former DOJ settlement agreement population who want to lease private market housing, with services funded separately. Annual appropriation not published on the DBHDS page. dbhds.virginia.gov

Flexible Funding, DBHDS. One-time assistance to overcome financial barriers to obtaining and maintaining independent housing, administered by six CSBs across the five DBHDS regions. Appropriation not published. dbhds.virginia.gov

County / regional / local funding

CSB local matching funds. Virginia's 40 CSBs and Behavioral Health Authorities are created by cities and counties and are the local delivery system for DD services, including support coordination and waiver slot management. Code of Virginia § 37.2-509 caps state allocations: "Allocations to any community services board for operating expenses, including salaries and other costs, or the construction of facilities shall not exceed 90 percent of the total amount of state and local matching funds provided for these expenses or such construction, unless a waiver is granted by the Department pursuant to policy adopted by the Board." The effective floor is a 10 percent local government match on state general fund performance contract dollars, waivable by DBHDS. law.lis.virginia.gov

Geography: every city and county in Virginia is served by a CSB or BHA; several CSBs are multi-jurisdiction. Directory: vacsb.org

Scale of local government contributions: not found. DBHDS does not publish aggregate CSB local revenue on the pages retrieved.

Funding scale

• Waiver slots assigned: 19,924 as of November 25, 2025 (CL 11,704, FIS 7,412, BI 268), excluding 251 FIS and 65 CL slots allocated for 7/1/25 and 10/1/25 that were assigned 1/15/26. Projected 21,479 at end of FY2026. dbhds.virginia.gov
• Slot growth: 1,720 new slots funded in FY2025 and 1,720 in FY2026.
• Waiting list: 14,258 people as of November 25, 2025, of whom 2,727 were Priority One. Average wait time not published in the source retrieved. dbhds.virginia.gov
• State vs federal share: "DMAS obtains approximately 50% of all DD waiver expenses from the federal government." The DD waiver rate study states Virginia's SFY2027 blended Medicaid FMAP is 50.1 percent federal, 49.9 percent state. KFF lists Virginia's FY2026 FMAP at 50.39 percent. kff.org
• Expenditures for the 11 services in the 2025 rate study scope: $401,304,083 in SFY2024. Largest lines: In-Home Support Services $166,902,689; Private Duty Nursing $85,565,850; Personal Assistance $55,803,784; Community Engagement $45,643,931; Therapeutic Consultation $25,385,902. dmas.virginia.gov
• Projected for those same 11 services: $657.5 million in SFY2026 rising to $839.9 million in SFY2027 if the benchmark rates were adopted, a 27.7 percent increase with a state share increase of $91.0 million. These 11 services exclude group home residential, sponsored residential, day support and supported employment, so they are not the DD waiver total.
• Total all-funds DD spending and spending per participant: not found. DMAS publishes waiver utilization and expenditures only through an interactive Power BI dashboard. dmas.virginia.gov
• HCBS settings rule: 4,283 settings serving children and adults; 100 percent of reviews complete, 99 percent compliant, under 1 percent in remediation, with full compliance required by 12/31/25.

Residential funding detail

Virginia funds five residential models, only one of which is 24-hour congregate.

• Group Home Residential (congregate residential support), CL waiver only. Per diem, billed against 344 billing days per year. Rates vary on three axes at once: acuity Tier 1 through 4 (from the Supports Intensity Scale-based level), home size 4 through 12 people (modifiers UA and U2 through U9, with the rate falling as home size rises), and geography (Northern Virginia versus Rest of State, a 16.8 percent differential per the rate study).
• Sponsored Residential, CL waiver. A host family or sponsor home model. Per diem across four tiers, 344 billing days.
• Supported Living Residential, FIS and CL waivers. Per diem across four tiers, 344 billing days.
• Shared Living, all three waivers. Monthly and partial-month, billed at individual consideration (IC) rather than a published rate; the amount covers a share of the housemate's housing costs.
• In-Home Support Services, FIS and CL waivers. Hourly, with rates falling by group size 1, 2, 3 (modifiers UA, U2, U3).
• Independent Living Supports, BI and FIS waivers. Monthly and partial-month rates by tier.

Room and board: Medicaid does not pay room and board in these settings. People pay from SSI, SSDI, wages and other income, supplemented for a subset by the state-funded State Rental Assistance Program and by HUD Housing Choice Voucher set-asides negotiated for the settlement agreement population. dbhds.virginia.gov

Rate structure link: dmas.virginia.gov

Comparable service rates

All rates effective 7/1/2026 from the SFY2027 DD waiver rate file. NOVA = Northern Virginia; ROS = Rest of State.

Other published rates in the same file: Community Guide NOVA $67.45 / ROS $58.45 per hour; Peer Mentoring NOVA $38.24 / ROS $35.00 per hour; Companion Care NOVA $23.81 / ROS $20.23 per hour; CD Service Facilitation initial comprehensive visit NOVA $360.54 / ROS $323.64.

Official rate schedule links

• SFY2027 DD waiver rates, effective 7/1/2026: dmas.virginia.gov
• SFY2026 DD waiver rates, effective 7/1/2025: dmas.virginia.gov
• SFY2025 DD waiver rates: dmas.virginia.gov
• 2025 DD Waiver Rate Study (Guidehouse, October 10, 2025): dmas.virginia.gov
• Rates and rate setting index: dmas.virginia.gov
• CCC Plus waiver rates SFY2027: dmas.virginia.gov
• Waiver rate update bulletin, July 1, 2025: vamedicaid.dmas.virginia.gov

Notable features and flags

• January 15, 2025: The 12-year US DOJ settlement agreement concluded with entry of a permanent injunction by the federal court. The agreement, entered in August 2012 after a CRIPA and ADA/Olmstead investigation beginning in 2008, drove Virginia's training center closures and waiver redesign. Compliance indicators had been finalized January 14, 2020. dbhds.virginia.gov
• July 1, 2026: Rates for community coaching (T2013), community engagement (T2021), independent living supports (T2032), in-home support services (H2014), therapeutic consultation (97139), workplace assistance (97530) and H2025 were reset using the 2025 DD Waiver Rate Study. Everything else on the waiver file (group day support, community guide, peer mentoring, supported living residential, group home, sponsored residential) received a flat 2 percent increase. Skilled and private duty nursing received 3.8 to 5 percent. Personal care codes (personal assistance, respite, companion) received no increase and remain at the 7/1/2025 level. dmas.virginia.gov
• October 10, 2025: The Guidehouse rate study recommended benchmark rates averaging a 20.7 percent increase across 11 services, ranging 0.5 to 63.8 percent, with the state share rising $91.0 million. Actual 7/1/2026 implementation was far narrower, so the study's benchmark levels were not fully funded. The study also flagged the CMS Access Rule 80/20 requirement and recommended building a provider cost reporting program. dmas.virginia.gov
• July 1, 2025: A 3 percent increase applied to most DD waiver services and 2 percent to personal care codes. vamedicaid.dmas.virginia.gov
• Provider capacity: DBHDS reports shortages "especially apparent across nursing, day, in-home, and personal care services," and 36 percent of people receiving support coordination have had their coordinator less than one year. DBHDS also states that because fewer people need 24/7 residential, "funding fewer CL slots and more of the less expensive FIS waiver slots in the future may be warranted." dbhds.virginia.gov
• HCBS settings rule: Validation of all 4,283 settings concluded 12/31/25 with 99 percent found compliant; noncompliant providers face removal as enrolled HCBS providers.

Confidence

Solid: waiver slot counts and waiting list as of November 25, 2025, the FY2025 and FY2026 slot additions, the IFSP FY2025 award total, the 10 percent CSB local match statute, the full 7/1/2026 fee schedule with its change log, the rate study's SFY2024 expenditure detail and fiscal projections, and the January 2025 settlement conclusion. Estimated: the state and federal split is given only as "approximately 50%" by DBHDS and 50.1 percent blended by the rate study; KFF's 50.39 percent FY2026 figure is the statutory FMAP, not the blended waiver rate. Could not find: total all-funds DD waiver expenditures or spending per participant, because DMAS publishes them only in an interactive dashboard that does not extract; average waiting list duration; aggregate CSB local government revenue; a published DD support coordination or targeted case management rate; and the SRAP and Flexible Funding appropriations.

---