by Michael Arevalo, Psy.D., PMP on August 19, 2025
Medicaid is the single largest payer of services for individuals with intellectual and developmental disabilities (IDD). With 35% of all people with disabilities relying on this coverage, according to KFF, IDD providers and their revenue cycle management (RCM) staff face immense pressure to ensure accurate billing within a highly complex system.
In fact, Medicaid is so complex that it requires providers of IDD services to stay constantly up to date on billing codes, compliance protocols, and documentation requirements — all within a shifting federal funding landscape. It’s a tall order for any organization trying to optimize its RCM.
But there’s good news: The right electronic health record (EHR) can absorb much of that complexity. By streamlining coding, documentation, compliance, and other related tasks, an effective EHR empowers IDD providers and RCM teams to focus more on care delivery and less on administrative hurdles, helping free up valuable staff hours while stabilizing cash flow.
The Realities of Managing Medicaid in IDD Care
KFF reports that Medicaid covers more than 2.3 million children, 8.8 million adults under 65, and 4.4 million adults over 65. A substantial portion of these enrollees — 60% — have two or more chronic conditions, while 16% live with four or more.
Additionally, 47% of Medicaid enrollees with IDD or other disabilities struggle with independent living, which means nearly half require personal service professionals or home health aides.
In a coordinated care environment, providers of IDD services must work in lockstep with these professionals to collect and submit accurate data for IDD Medicaid billing. Doing so manually increases the risk of documentation errors and, therefore, significant billing delays or even loss of revenue.
Recent federal legislation is complicating Medicaid coverage and billing procedures even further, making it more difficult for organizations providing IDD services to effectively manage their revenue. According to the U.S. Senate, the "One Big Beautiful Bill” will reduce Medicaid spending by $1 trillion, potentially causing an estimated 11.8 million people to lose their insurance coverage.
Common IDD Medicaid Billing Challenges — and How an EHR Can Help
With shifting policies and massive funding cuts, IDD Medicaid billing presents considerable hurdles for organizations, particularly because billing codes, reimbursement rates, and service eligibility vary from state to state. The American Council on Aging notes that income thresholds for eligibility can also vary widely, further complicating compliance.
While the federal Medicaid program includes some across-the-board coverage and billing requirements, individual states often layer on their own criteria. For example, according to the U.S. Department of Health and Human Services, only 33 states covered mobile crisis teams, 28 covered stabilization facilities, and 12 covered hotline services, which individuals with IDD often utilize.
This lack of consistency across states makes it especially difficult for IDD services providers to ensure clean, timely claims. An advanced EHR can help, easing multiple challenges such as:
Complying With Federal and State Documentation Requirements
To meet federal and state IDD Medicaid billing requirements, organizations need precise, real-time documentation that includes key details such as:
- Staff and client names
- Service type
- Start and end times for each delivered service
- Location of delivered service
But that’s just the starting point. Providers of IDD services must go beyond listing logistical details, offering thorough descriptions of the services rendered — including what was done, how, and why — how they align with care plans. The Centers for Medicare & Medicaid Services (CMS) notes that providers are legally required to maintain up-to-date records covering the extent of the services and support claims for billing. That includes details about individualized service plans for IDD clients that show how the delivered service supported the client’s goals.
EHRs with embedded documentation capabilities can streamline the documentation process, while helping minimize errors and ensuring the accuracy of submissions. Ambient documentation tools powered by artificial intelligence (AI) record provider notes and offer real-time summaries for quick access to relevant billing information. With an advanced EHR, providers and staff can reduce the time they spend on documentation and avoid claims delays and denials that impact their RCM.
Submitting the Right IDD Billing Codes
To receive accurate reimbursement through federal Medicaid systems, IDD services must correctly match each delivered service to the right billing code. This requires navigating multiple coding systems, including:
- ICD-10 medical codes
- Current Procedural Terminology (CPT) codes
- Healthcare Common Procedure Coding System (HCPCS) codes
Each state applies these codes differently, with its own Medicaid program determining which services are covered and how they must be reported. Such variability makes coding a frequent source of claim denials, payment delays, and unsatisfied clients, all of which can severely impact IDD services organizations, especially those with locations in multiple states.
Top EHRs, however, offer RCM solutions that include features like those that can verify billing codes against services delivered and align codes with each contract’s billing rules and requirements. Providers and staff can set custom checks or use pre-integrated checklists to assess codes before they’re submitted. The system helps reduce coding errors and enhance RCM success.
Accounting for IDD Service Complexity
Care coordination is essential in the IDD space, as IDD services providers often work collaboratively with primary care physicians, residential habilitation facilities, transportation services, community-based support systems, and day programs to support the intertwining physical, mental, and emotional needs of their clients.
When done well, this level of coordinated care benefits clients with IDD significantly, but it also adds complexity to IDD Medicaid billing procedures. Providers must generate clean claims for all services provided, which requires a level of collaboration and communication that advanced EHRs can help with.
The right EHRs enable teams to use evidence-based workflows and secure communication features to effectively coordinate care. With these tools, providers across specialty areas can ensure they document service details accurately and submit claims in a timely manner.
EVV and the Evolution of Medicaid Requirements
Electronic visit verification (EVV) reflects how Medicaid requirements for IDD services continue to evolve. Originally mandated under the 21st Century Cures Act, EVV was designed to reduce fraud, improve care oversight, and help ensure Medicaid recipients receive the services they’re billed for. It also supports the broader move toward value-based care by increasing transparency and accountability.
How? By electronically verifying key details of services rendered by personal care providers or home healthcare providers. Rollout for personal care services started in 2020, and home healthcare providers were added to that timeline in 2023.
To comply with Medicaid’s EVV requirements, service professionals must accurately log service details, including who delivered care, where and when it occurred, and what was provided. If they don’t, they risk financial penalties in the form of medical assistance reductions from the federal government.
An EHR can help ensure the accuracy of this information with integrated compliance checkers, custom workflows, and secure checklists. Those with electronic visit verification capabilities can also streamline data-sharing with state aggregators. AI-powered tools can check information against iterative rules, and service providers can log critical information (e.g., check-in and check-out times, service notes, location) directly through their EHR platform.
An All-in-One Solution for Medicaid Billing and RCM
Core Solutions’ Cx360 EHR platform helps IDD services providers optimize their RCM capabilities and effectively navigate the ever-evolving complexities of IDD Medicaid billing. Tailor-made for the IDD space, Cx360 offers powerful features including:
- Secure care coordination and communication functionality
- Compliance trackers
- AI-enabled tools for better service delivery
- Client engagement capabilities for every stage of the care journey
- Solutions for making better, more informed clinical decisions
Together, these features, together with other advanced RCM capabilities, make Cx360 a go-to solution for enhancing revenue cycles and delivering better-quality care to Medicaid recipients with IDD.
Read more about how the right technology solutions like Core’s Cx360 can help with IDD billing and payment challenges, then schedule a demo of Cx360 to get a firsthand look at the platform’s impressive capabilities.
