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A Guide to DC’s HCBS Waiver System

December 19, 2025|Mercyland Healthcare Inc.|3 min read|Updated September 24, 2026

Washington, DC HCBS Community Waiver Journey, in four steps: application submission through the DC Access System (application form, proof of residency, an IDD diagnosis, active Medicaid); eligibility determination (age, disability, financial need, functional need); needs assessment (in-home visit, financial coordination plan, provider choice); and receiving HCBS services (personal care, health care, support coordination, respite).

A correction to step 1 of the graphic above: you do not apply through the DC Access System. To apply for DDS services, call DDS at 202-730-1700 or walk in to 250 E Street SW to schedule an intake appointment. See DDS: How to apply.

Creating independence, inclusion, and meaningful support for every family.

Supporting a loved one with an intellectual or developmental disability (IDD) is a journey filled with care, commitment, and deep love. In Washington, D.C., families do not have to walk this path alone. The Home and Community-Based Services (HCBS) Waiver system exists so that people with IDD can thrive, not in institutions, but right at home and in the communities they love.

The system is run by the Department on Disability Services (DDS). It is the foundation of disability support in D.C., and providers like Mercyland Healthcare work within it to deliver the daily services, guidance, and person-centered care that help people build connected, empowered lives.

Why the waiver matters

Not long ago, people with IDD were often placed in large institutions, far from their families, friends, and everyday life. We now understand how harmful and isolating that was.

In 1999, a landmark Supreme Court decision, Olmstead v. L.C., confirmed that keeping someone in an institution unnecessarily is a form of discrimination. That ruling opened the door to a new vision of disability support, one rooted in rights, choice, and belonging in the community.

The HCBS Waiver program brings that vision to life. It uses Medicaid funding to deliver support where people belong: in their homes, their neighborhoods, and their communities. The result is greater independence, dignity, opportunity, and joy.

Understanding Washington, DC’s Waiver System. Waivers exist for people with intellectual and developmental disabilities, for community support, and for support to live independently. They use Medicaid funding to deliver support where people belong: in their homes, neighborhoods, and communities. Beside the text, Mercyland staff work with the people they support.

What makes D.C.’s HCBS Waiver so powerful for families

A support plan built around the person

Every person is unique, and their services should be too. Through Person-Centered Planning, families work with a team to create an Individual Support Plan (ISP) shaped around their loved one’s goals, abilities, challenges, and dreams. It is not about fitting a person into a program. It is about shaping the program around the person.

A wide range of services to meet real needs

The waiver covers the resources that help people live safely, happily, and independently in their community. These may include:

In-home personal care, such as bathing, dressing, meals, and laundry
Skill building and daily living training
Supported employment and job coaching
Behavioral support
Therapies such as speech, occupational, or physical therapy
Community integration activities
Home modifications such as ramps or safety adaptations
Respite care, so family caregivers can rest and recharge

Together, these services create stability, growth, and a higher quality of life.

Two waivers: IDD and IFS

DC has two HCBS waivers for people with intellectual and developmental disabilities. Which one fits depends on how much support a person needs and where they live.

The IDD Waiver is for people who need higher levels of support, including residential services or 24-hour care. Since January 1, 2026 it has a waitlist, ordered by Level of Need rather than by how long someone has waited.
The Individual and Family Support (IFS) Waiver is for people living with family or friends. It offers community and employment supports, does not cover housing, and usually has an annual spending cap. It continues without a waitlist when spots are available.

Being on the IDD Waiver waitlist does not affect eligibility for other DDS services. What the waitlist means for your family explains the priority groups and what you can do while you wait.

Who can apply

A person may qualify if they:

Have an intellectual or developmental disability
Need a level of support similar to what an institution would provide
Meet the standard Medicaid financial eligibility rules

If these apply, they may be eligible for services that help them live fully and safely in the community. You can start an application on the DDS How to Apply page.