by Terence Blackwell Jr on January 13, 2026
For much of my professional life, growth in the intellectual and developmental disabilities (IDD) field followed a familiar pattern. When needs increased, providers expanded. When services evolved, reimbursement frameworks eventually caught up. The system was far from perfect, but it was predictable enough that IDD leaders could focus primarily on program quality and workforce development, trusting that funding mechanisms would adjust and keep pace over time.
Medicaid has been central to that predictability. It remains the backbone of services for people with IDD, and it will continue to be indispensable. What has changed is not Medicaid's importance, but its flexibility and the increasing uncertainty that surrounds it.
Today, IDD providers are operating in an environment where costs rise faster than rates, where adjustments lag real-world expenses, and where expansion through traditional funding alone is increasingly constrained. Even well-managed organizations are discovering that financial stability now requires more than incremental rate increases or occasional cost-of-living adjustments.
Over more than 45 years in this field, including my time as COO of Services for the UnderServed (S:US) and later as CEO of Chimes International, I watched organizations succeed or struggle based largely on whether they were willing to recognize that shift early — not by abandoning Medicaid or the mission it supports, but by acknowledging its limits and planning accordingly.
IDD Funding Strategies to Consider
The six revenue strategies that follow are not theoretical. I worked directly with each of them. None is easy, but all can generate meaningful, unrestricted revenue when executed with discipline. And every one of them depends on the same underlying truth: If you cannot document what you do, when you do it, and what impact it has, you cannot sustain growth.
I would add that many of these opportunities only become viable once an organization commits and begins moving forward. In my experience, progress itself creates access to partnerships, resources, and insights that simply do not appear at the planning stage. Waiting for perfect clarity before acting is often the surest way to remain stuck.
Applied Behavior Analysis
Applied behavior analysis (ABA) is one of the most mission-aligned revenue opportunities available to IDD providers today. Autism prevalence has increased dramatically, and ABA is now fully integrated into mainstream healthcare, with stable billing codes and mandated commercial insurance coverage in all 50 states for children ages 0–21. Demand continues to outpace supply.
That opportunity comes with responsibility. ABA is a clinical service that requires dedicated leadership, consistent supervision, and a deep commitment to quality. I learned early on that trying to add ABA by simply stretching existing leadership roles is a recipe for failure. Competency alone is not enough. Capacity matters.
From a financial standpoint, ABA can be sustainable because of how services are structured and reimbursed. But insurers expect precise documentation that demonstrates medical necessity, service delivery, and progress over time. Audits are common, and the use of sampling and extrapolation methodologies means even small documentation gaps can create significant repayment exposure. Strong electronic records are not optional here. They are essential.
I would add that this risk is no longer limited to Medicaid. Commercial insurers are now using the same sampling and extrapolation methodologies, meaning a small documentation failure can quickly become a significant financial exposure.
AbilityOne
Of all the alternative revenue streams I have worked with, AbilityOne stands apart. It is a federal employment program that sets aside contracts for nonprofit organizations employing individuals with significant disabilities. When properly executed, these contracts generate strong revenue while advancing competitive, integrated employment, which though not an evidence-based practice, is the current fad for employing individuals with disabilities.
At Chimes, revitalizing our AbilityOne portfolio resulted in more than $15 million in unrestricted surplus in a single fiscal year. That revenue directly stabilized programs where Medicaid reimbursement fell short of actual costs. Importantly, this is not a shrinking opportunity. The federal government already committed to significantly expanding the size of the AbilityOne program, and one of the challenges facing the commission today is a shortage of qualified nonprofit providers prepared to take on new contracts.
AbilityOne contracts are designed to include margin, but they are also compliance heavy. Providers must be able to document that individuals are legally disabled for the work, that staffing ratios meet program requirements, and that contract deliverables are met consistently. State and local set-aside programs operate in a similar way.
Without integrated systems that connect workforce data, service documentation, and contract reporting, organizations quickly find themselves overwhelmed. This is one of the clearest examples I know where technology is not an enhancement. It is essentially the cost of admission.
Education Services
Education represents one of the largest public funding streams in the country, yet it is often overlooked by IDD providers. School districts across the country are under pressure to serve students with autism, behavioral challenges, and complex learning needs, particularly those placed out of state.
IDD providers already possess much of the expertise districts need, including behavioral supports, related therapies, nursing services, and home instruction. In many cases, helping districts bring students back in state improves outcomes while restoring access to federal matching funds. Beyond funding considerations, school districts are also under increasing pressure to place students in the least restrictive environment possible, making in-state, community-based solutions more attractive from both a compliance and educational standpoint.
It is important to understand that education services are documentation intensive. Services must align with individualized education plans, approved minutes, and regulatory requirements that vary by state. Providers who lack systems capable of managing educational records alongside clinical and vocational documentation will struggle to scale. Those who invest in strong infrastructure are well positioned to become trusted, long-term partners to school systems.
Federal Supply Schedule
The Federal Supply Schedule opens the door to thousands of federal contracting opportunities, yet it remains unfamiliar to many nonprofit providers. Once an organization is approved, it gains access to solicitations across a wide range of services.
When Chimes became the first nonprofit accepted onto the schedule, it fundamentally expanded our reach. One COVID-era laundry contract alone generated $600,000 in unrestricted surplus in its first year alone.
The application process is complex, and compliance expectations are high. Pricing discipline, performance tracking, and audit readiness are non-negotiable. Organizations that succeed typically have strong back-end systems that allow them to manage subcontractors while maintaining visibility into service delivery and outcomes.
Veterans Affairs Contracts
The Department of Veterans Affairs continues to expand its use of community-based providers, particularly for housing, vocational, and outpatient support services. Programs such as HUD VASH — the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing — can be both highly lucrative and closely aligned with the mission of many IDD and behavioral health organizations.
These contracts require careful coordination across housing stability, employment supports, and clinical services. Reporting requirements are rigorous. Providers without reliable data capture and reporting infrastructure often find themselves buried in administrative work. Those with strong systems are better positioned to manage complexity and scale responsibly.
Proprietary Retail Models
Not all revenue diversification comes from government contracts. Social enterprises like Popcorn for the People demonstrate how mission-driven retail models can generate revenue while creating meaningful employment for adults with autism.
These ventures require a willingness to operate in competitive markets and to think differently about productivity, quality, and workforce participation. They also require tracking performance in ways that may be unfamiliar to traditional providers. The right IDD technology again plays a critical role in turning a good idea into a sustainable operation.
A Final Word on IDD Revenue Readiness and Responsibility
Not every revenue strategy is right for every IDD organization. The most common mistake I see is not choosing the wrong idea but underestimating what it takes to execute well. Diversification fails far more often because systems, staffing, and documentation are not ready than because the opportunity itself was flawed. Many non-profit organizations, if not most, forget they are a business, and the “tax exempt” component is only an attribute as to how the business reports its earnings and donations. Mission-first is critical, concurrently with remembering the agency is a business that must break even or better to continue to be of value to the community they serve.
Medicaid will remain central to our field. But we have seen that it cannot be the only pillar supporting organizational stability in an environment where costs continue to rise, flexibility continues to narrow, and uncertainty and unpredictability are the norm. Diversification, pursued thoughtfully and strategically, is not a departure from mission. Think of it more as a way of protecting mission.
And central to any diversification effort, as well as efforts to scale existing programs and operations, is technology. For IDD providers, it can no longer be treated as a side conversation. It is foundational to demonstrating value, managing risk, and pursuing new opportunities without overwhelming staff or increasing frontline documentation burden. Leaders who recognize that reality and act on it deliberately will be better positioned to sustain services and honor the commitments we have made to the people we serve.
