Overview
The Medicaid landscape is changing fast, and for IDD agencies, staying ahead is essential. Redetermination continues, waiver programs are being updated, and several states are testing performance-based models for long-term supports.
2026 may not bring a single sweeping reform, but the steady buildup of state-level changes could reshape how services are delivered, documented, and reimbursed. Now is the time for agencies to strengthen systems and stay alert to what’s coming.
Redetermination continues unfolding
While the public health emergency officially ended in 2023, its impact continues. Redetermination has caused millions of Medicaid recipients to lose coverage, and many IDD agencies are still seeing disruptions as families miss renewal deadlines or struggle with documentation.
In 2026, we will likely continue to see ripple effects, especially for individuals who cycle on and off coverage. Agencies need a plan to monitor eligibility, follow up with families, and reduce unreimbursed care tied to lapsed Medicaid enrollment.
Waivers are evolving
Across the country, states are revisiting how their HCBS waivers are structured. Some are consolidating waivers, introducing tiered rates, or requiring stronger documentation tied to outcomes.
Expect continued changes in waiver renewals and amendments throughout 2025 and into 2026. Agencies should monitor their state Medicaid websites for updates and ensure their services remain aligned with billing and authorization requirements.
Audit risk is rising
States are tightening oversight of Medicaid spending. From post-payment reviews to EVV enforcement and clinical record audits, the risk of penalties is higher, especially for agencies with inconsistent documentation.
In 2026, expect more states to expand audit triggers tied to billing errors, missed EVV logs, or incomplete shift documentation. Building defensible documentation habits now will protect your agency in the long run.
Value-based care is growing
More states are piloting value-based models in IDD and HCBS services. These programs tie reimbursement to outcomes such as reduced crisis events, progress on ISP goals, or successful community integration.
Even if your state has not rolled out a value-based model yet, it may be coming. Agencies that track outcomes, align services to goals, and document progress in real time will be better prepared when funding shifts.
Behavioral health is expanding
There is increasing overlap between behavioral health and IDD supports. Some states are launching integrated funding initiatives, while others are layering behavioral expectations into waiver services.
In 2026, agencies may see more opportunities and requirements for offering or coordinating behavioral health. This means stronger documentation, more staff training, and clear visibility across clinical and direct support teams.
What to do now
Agencies do not need to overhaul everything. But they do need to tighten internal systems. Focus on:
Making real-time documentation a habit
Tracking ISP alignment for all services
Monitoring Medicaid eligibility during redetermination
Reviewing billing workflows and export accuracy
Staying connected to state-level updates
Small improvements now can prevent major disruptions later.
How Giv supports readiness
Giv helps agencies prepare for what is ahead by simplifying documentation, billing, and compliance. Our platform makes it easy to capture shift data in real time, tie services to goals, and export clean, audit-ready records.
We also built Giv News to help providers track Medicaid updates, both national and state-specific, without getting overwhelmed. As 2026 approaches, Giv gives your agency the tools to stay informed, stay compliant, and stay focused on care.
