4.2.5Segment

Intellectual & Developmental Disabilities (IDD)

Residential group homes, day programs, supported employment services, and home-based care for individuals with intellectual and developmental disabilities.

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Verticals

Overview

Intellectual & Developmental Disabilities (IDD) services covers residential group homes, day programs, supported employment, and home-based care for individuals with intellectual and developmental disabilities. It is a large, predominantly Medicaid-funded segment delivering long-term support services.

Consolidation has been active (Sevita, BrightSpring and others) as scaled operators build multi-state platforms, while the model depends heavily on Medicaid reimbursement rates and faces persistent direct-care workforce shortages. Demand is steady and growing with the shift to community-based care.

Market snapshot

Market size
~$38B
Growth
~6.2%CAGR (2017–22, nominal)
Companies
~7,304 firms
Firms by employee count

55.9% of firms have fewer than 20 employees: 4,083 micro-businesses, below most mandates.

The investable universe3,221 firms with 20+ employees
20–99
1,64951%
100–499
1,20137%
500+
37112%

Residential group homes, day programs, supported employment, and home-based care for people with intellectual and developmental disabilities — a large, predominantly Medicaid-funded long-term-support segment. Revenue tracks state Medicaid rates and waiver programs, and consolidation is active as multi-state providers scale a highly fragmented base of nonprofit and for-profit operators.

NAICS 623210. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Business model & economics

Revenue model

Medicaid per-diem and waiver-based reimbursement

Key economics

Revenue per firm
$5,175,267
Revenue per employee
$70,587
Employees per firm
72.6
Recurring revenue
High

long-term support services

EBITDA margin
10–18%

rate- and labor-constrained

Capex intensity
Moderate

Characteristics

  • Balanced cost base — payroll is 51% of revenue, leaving room to scale margin without cutting staff
  • Deep strategic-buyer pool — 371 firms exceed 500 employees, so a scaled asset has trade buyers
  • Predominantly Medicaid-funded long-term support.
  • Direct-care workforce shortages are a key constraint.
  • Shift to community-based care supports demand.

NAICS 623210. U.S. Census Bureau — 2022 Statistics of U.S. Businesses; U.S. Census Bureau — 2022 Economic Census.

Geographic concentration

AlabamaArizonaColoradoFloridaGeorgiaIndianaKansasMaineMassachusettsNew JerseyNorth CarolinaNorth DakotaOklahomaPennsylvaniaSouth DakotaTexasWyomingConnecticutMissouriWest VirginiaIllinoisNew MexicoArkansasCaliforniaDelawareDistrict of ColumbiaHawaiiIowaKentuckyMarylandMichiganMississippiMontanaNew HampshireNew YorkOhioTennesseeUtahVirginiaWashingtonNebraskaSouth CarolinaIdahoNevadaVermontLouisianaRhode IslandAlaskaMinnesotaOregonWisconsin

IDD providers are densest where Medicaid waiver programs run deepest — Oregon, Alaska, Minnesota, and Wisconsin — states that built out community-based intellectual-and-developmental-disability care per resident well beyond the national rate.

OregonAlaskaMinnesotaWisconsin

U.S. Census Bureau — 2022 Statistics of U.S. Businesses (firms by state), NAICS 623210. Concentration shown by location quotient.

M&A deal context

Deal activityModerate

Who’s acquiring

  • Multi-state IDD platforms
  • PE-backed services consolidators
  • Home- and community-based operators

What’s driving deals

  • Consolidation into multi-state platforms.
  • Medicaid-rate and workforce dynamics.
  • Shift toward community-based care.

Verticals in this segment

Find Intellectual & Developmental Disabilities (IDD) acquisition targets

Search Acquisera’s index for companies classified under Intellectual & Developmental Disabilities (IDD) (4.2.5) and build a targeted deal pipeline.

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