Intermediate Care Facilities for Individuals with Intellectual Disability (ICF/IID)

Eligibility for ICF/IID Benefit?
ICF/IID is available only for individuals in need of and receiving, active treatment services. Active treatment refers to aggressive, consistent implementation of a program of specialized and generic training, treatment and health services. Active treatment does not include services to maintain generally independent clients who are able to function with little supervision and who do not require a continuous program of habilitation services. States may not limit access to ICF/IID service, or make it subject to waiting lists, as they may for HCBS. Therefore in some cases, ICF/IID services may be more immediately available than other long-term care options. Many individuals who require this level of service have already established disability status and Medicaid eligibility.

Services Included in the ICF/IID Benefit:
An ICF/IID provides active treatment, a continuous, aggressive, and consistent implementation of a program of specialized and generic training, treatment, and health or related services, directed toward helping the enrollee function with as much self-determination and independence as possible. ICF/IID is the most comprehensive benefit in Medicaid.

Day Programs?
Individuals residing in ICF/IID work in the community, with supports, or participate in vocational or other activities outside of the residence, and engage in community interests of their choice. These activities are collectively often referred to as day programs. The ICF/IID is responsible for all activities, including day programs, because the concept of active treatment is that all aspects of support and service to the individual are coordinated towards specific individualized goals in the Individual Habitation Plan.

Where are ICF/IID Services are Provided?
Medicaid coverage of ICF/IID services is available only in a residential facility licensed and certified by the state survey agency as an ICF/IID. Medicaid ICF/IID services are available only when other payment options are unavailable and the individual is eligible for Medicaid. There are few resources similar to an ICF/IID under any payment source.