Sell your I/DD services agency

What buyers look at in an I/DD agency

Most I/DD agencies are paid through Medicaid 1915(c) waivers or similar state programs: residential habilitation, supported living, host homes, in-home supports, day habilitation, respite, and community integration. A buyer is paying for the people you support today, the staff who support them, and the state contracts and licenses that let you keep doing it. Value is a multiple of adjusted EBITDA, and these are the things that move that multiple.

State and rate stability

Your rates are set by the state. Buyers look at recent rate studies, increases, and how dependent you are on one waiver or one state budget.

DSP workforce

Turnover, vacancies, overtime, and wage levels against your rates. Staffing is what limits growth in this segment.

Service mix

Residential services bring higher revenue per person and longer relationships; non-residential and in-home services need less capital. Buyers price the mix, not just the total.

Quality and compliance record

Incident reports, abuse and neglect investigations, survey findings, and corrective action plans are reviewed early and can stop a deal.

Owner dependence

If you hold the relationships with case managers, support coordinators, and the state office yourself, buyers will want a transition plan.

Selling a group home business

If you operate group homes, decide early what you are selling. Many owners hold the houses in a separate company and lease them to the agency. A buyer may want to buy the real estate, lease it from you, or have a third party buy it. Each choice changes the agency's EBITDA, because rent you charge yourself below market will be adjusted to market rent in the buyer's model.

Licenses are usually tied to each site, and residential settings paid by Medicaid must meet the federal HCBS settings rule (including a lease or similar agreement for each person, privacy, and access to the community). Expect buyers to inspect each home, read recent licensing surveys, and check how each site was assessed against the settings rule.

Who buys I/DD providers

Buyers range from national operators to regional, often private equity backed, platforms that add agencies state by state, and nonprofits that expand by acquisition. In March 2026 Sevita completed its $835 million purchase of BrightSpring's ResCare Community Living business, and the FTC required 128 intermediate care facilities in Indiana, Louisiana, and Texas to be sold to Dungarvin to resolve competition concerns. Smaller regional deals happen every year, and most do not disclose terms.

In many states a waiver provider agreement or residential license does not simply transfer with a sale. Depending on the state and the deal structure, the buyer may need to enroll as a new provider, obtain new site licenses, or file change of ownership notices. That timeline often decides whether a deal is an asset sale or a stock sale.

Demand, workforce, and rates: what buyers model

Demand for I/DD services is not the constraint. KFF counted more than 710,000 people on Medicaid home and community based services waiting or interest lists in 2024, and 73 percent of the waiver waiting list population were people with intellectual or developmental disabilities, who waited 50 months on average. What limits an agency is staff. The 2024 National Core Indicators State of the Workforce survey, covering 3,936 provider agencies, found a weighted average DSP turnover ratio of 37.1 percent, and 63.7 percent of DSPs who left had been with their agency for less than a year. More than a quarter of agencies (26.6 percent) turned away or stopped accepting new referrals because of staffing, down from 38.1 percent in 2023.

Buyers therefore look at your turnover, vacancies, and overtime next to your state's rates. The median DSP wage in the survey was $18.39 an hour in 2024. If your state has run a recent rate study and raised rates, say so and show how the increase flowed to wages. On the federal side, the 80 percent direct care compensation requirement in CMS's 2024 access rule applies to homemaker, home health aide, and personal care services, not habilitation, but states will report the share of habilitation payments that goes to direct care worker compensation, so expect buyers to ask for that figure.

Group homes, real estate, and licenses

In a group home business for sale, the houses and the licenses are separate questions from the services. Residential settings paid by Medicaid have had to meet the HCBS settings rule since the transition period ended on March 17, 2023, and provider owned or controlled homes carry extra requirements such as a lease or similar agreement, privacy, and freedom to choose visitors and schedules. Buyers will check each site.

Licensing is often site by site, and waiver provider agreements do not always follow the company. The table shows the usual questions; the answers depend on your state and on whether the deal is an asset or stock sale.

Preparing an I/DD agency for sale

Most of the work is making your data easy to verify and your quality record easy to read. Start with the items below.

How Lartico fits in

Lartico works on the buy side. You share your agency's details, we introduce you to approved acquirers looking for I/DD and waiver agencies in your states, and you choose which ones to speak with. There is no listing, no exclusivity, and no fee to you; the buyer pays our fee at closing.