Overview
If you’ve ever searched "how to start an IDD agency" or "how to open a group home for individuals with disabilities," you’re not alone. More people are looking to launch service organizations that support individuals with intellectual and developmental disabilities (IDD), and for good reason. The need is growing, and agencies that are well-prepared can make a lasting impact.
This blog outlines the core steps to starting an IDD agency, including legal requirements, Medicaid enrollment, staffing, and setting up systems for documentation and billing. Whether you're starting with one program or planning to expand, this guide will help you get started the right way.
Define your services
Start by getting clear on the type of IDD services your agency will provide. Common options include:
Residential services (like group homes or supported living)
Day programs or community integration services
In-home supports or personal care
Behavioral or mental health support
Employment or vocational services
Different services may require different licenses, staffing credentials, or waiver participation. Knowing your focus early helps guide every other step.
Apply for licensure
Every state has its own process for licensing IDD providers. This may involve working with your state’s Department of Health, Department of Human Services, or Developmental Disabilities division. Be prepared to submit information about your business structure, ownership, service model, the population you plan to serve, staff qualifications, and staff-to-individual ratios. Depending on your service type, you may also need to complete facility inspections and meet safety requirements.
In addition to these steps, most states require background checks, policy and procedure reviews, and in some cases, a readiness assessment to ensure your agency is fully prepared to begin services.
Medicaid and waiver programs
Once your license is approved, you’ll need to enroll as a Medicaid provider. This allows your agency to be reimbursed for services under Medicaid waiver programs, which are the primary funding source for most IDD services.
The Medicaid enrollment process usually includes:
Registering for an NPI (National Provider Identifier)
Submitting to the state’s Medicaid Management Information System (MMIS)
Completing training or orientation sessions
Signing a provider agreement
It’s important to identify which waivers your services fall under, as each one may have its own billing codes and requirements.
Hire the right team
In the beginning, you may be managing everything yourself, rom documentation and scheduling to billing and compliance. As your agency grows, you can begin building a team to take on those roles.
Start with DSPs who are compassionate, dependable, and aligned with your mission. Most roles will require CPR and first aid certification, background checks, and any state-specific training. As you scale, consider who will handle clinical supervision, shift coordination, administrative work, and compliance reviews.
Even if your team is small at first, a clear training process and a focus on person-centered care will set the foundation for long-term success.
Set up systems
A strong foundation means more than having the right people—it also means having the right systems. From day one, you’ll need a reliable way to document services, bill Medicaid accurately, track staff hours, manage authorizations, and stay audit-ready.
Look for IDD software that can handle daily shift notes, real-time documentation, ISP goal tracking, Medicaid billing, and electronic visit verification (EVV). If you provide residential services, features like staff scheduling and eMAR will also be essential. Your system should also support incident reporting and provide the kind of audit trails needed for compliance reviews.
Starting with the right tools early on will help you avoid billing mistakes, reduce administrative burden, and free up more time to focus on quality care.
Build partnerships and connect
Running an agency is not just about service delivery, it is also about staying connected to the broader IDD community. Building relationships with state provider associations, attending webinars, and connecting with case managers, support coordinators, and advocacy groups can open doors to growth and collaboration.
These partnerships help you stay informed about regulatory changes, access potential referrals or contracts, and learn directly from other agency leaders. They also give you a stronger voice when advocating for funding and policy improvements that affect your services.
No one builds a strong IDD agency alone. Being part of the network strengthens both your operations and your long-term impact.
Getting started with Giv
Starting an agency is complex. Your software shouldn't be. Giv is built specifically for IDD providers, combining documentation, billing, scheduling, eMAR, EVV, and more into one intuitive platform.
New agencies use Giv to document services in real time, reduce billing errors, and stay aligned with waiver requirements and audit expectations. Our tools are customizable, easy to learn, and designed to grow with you, so you can focus on care, instead of the paperwork. To learn more about Giv, check out our product page here.
We also created a free course for new founders and agency leaders covering licensing, Medicaid enrollment, staffing, and getting started the right way. Explore it here: How to Start and Grow Your IDD Agency.
