The market for intellectual and developmental disability (IDD) and autism services businesses has never been more active. In 2025 and 2026, private equity — attracted by Medicaid-funded revenues, demographic demand, and extreme fragmentation — made IDD one of the most transacted sub-sectors in all of healthcare.
If you own an agency providing residential support, day programs, supported living, community-based services, or behavioral support for individuals with IDD or autism, there is a large and motivated buyer universe for your business right now.
This guide covers what IDD agencies are worth in 2026, who the buyers are, and how to navigate a sale that captures real premium value.
Before discussing valuation, it’s worth understanding why buyers are so active in IDD. The investment thesis is strong:
Medicaid waiver funding. IDD services are primarily funded through Home and Community-Based Services (HCBS) Medicaid waivers — the fastest-growing component of Medicaid spending. Federal policy under both HCBS Final Rule and the ADA integration mandate has consistently pushed states toward expanding community-based IDD services.
Mission-driven, low churn. Individuals with IDD have lifelong service needs. Once an agency establishes a relationship with a participant and their family, retention is extremely high. This creates the kind of predictable, recurring revenue that PE investors value above almost anything else.
Extreme fragmentation. The IDD industry is dominated by small nonprofits and family-owned operators. Less than 10% of IDD services are provided by companies with more than 500 employees. This fragmentation creates significant consolidation opportunity.
Critical shortage of providers. In virtually every state, IDD waitlists exceed available provider capacity. Being a licensed, established provider creates meaningful entry barriers for new competitors.
IDD valuations are EBITDA multiple-based, like most healthcare M&A. The relevant multiples in 2026:
| Agency Type and Scale | Typical EBITDA Multiple |
|---|---|
| Small residential operator (<$500K EBITDA) | 3.5 – 5.5× |
| Mid-size community services operator ($500K – $2M EBITDA) | 5.0 – 7.0× |
| ABA/behavioral therapy provider ($1M+ EBITDA) | 6.0 – 9.0× |
| Large IDD platform ($2M+ EBITDA, multiple services) | 7.0 – 10×+ |
Note: ABA therapy providers focused on autism may qualify for higher multiples, particularly when school-district contracting or commercial insurance revenues add payer diversification.
The wide ranges reflect variability in key drivers discussed below.
Not all IDD services are equal from a valuation perspective:
Residential (group homes, host homes, supported living): Highest-value, most recurring. Once a participant is placed in residential supports, the relationship is typically years long. Buyers pay premium multiples for residential programs.
Day habilitation/adult day programs: Strong recurring revenue, community-based, lower capital intensity. Good multiples, but investors care about facility lease terms and whether participants have alternatives.
Employment supports (supported employment, job coaching): Solid but more variable — employment placements can be discontinued. Good add-on within a platform but less valued as a standalone.
ABA therapy: High demand, but reimbursement environment is evolving. Commercial insurance payers increasingly dominating over Medicaid-only. Buyers value ABA with payer diversification (Medicaid + commercial) over Medicaid-only ABA.
Crisis/behavioral support: Specialized skill set, high need, meaningful Medicaid rates in many states. Attractive niche, especially for platforms building comprehensive service arrays.
Medicaid waiver rates vary enormously by state — sometimes by a factor of 2–3×. High-rate states (Colorado, Massachusetts, Connecticut, Washington) support higher EBITDA margins and therefore higher enterprise values than lower-rate states (many Southern states, Mississippi, Alabama).
Buyers actively track state policies, pending rate increases, and HCBS expansion plans. Being in a state with a favorable rate environment is itself a valuation multiplier.
Direct Support Professionals (DSPs) are the business. An IDD agency with a stable, well-trained DSP workforce is categorically different from one with chronic turnover. Buyers look at:
IDD providers are among the most heavily regulated in healthcare. State developmental disability agencies conduct licensing inspections, plan reviews, and incident investigations. Buyers will thoroughly review your licensing history.
Critical flags that reduce value or disqualify transactions:
A clean regulatory record, by contrast, is a material positive. Buyers pay for compliance certainty when acquiring IDD businesses.
IDD group home programs often involve residential properties — owned or leased. Buyers care about:
The buyer landscape includes:
Large national IDD platforms — companies like Sevita (formerly ResCare), Pathways, Redwood Family Care Network, and others that operate in multiple states and are actively building scale. These buyers pay competitive multiples but expect you to join their operating infrastructure.
PE-backed regional platforms — sponsor-backed companies that may operate in 3–10 states and are actively acquiring to expand geographic footprint. These buyers often offer better price, more operational autonomy, and rollover equity.
State-level consolidators — operators that dominate one or two states and are building density within their geography before considering geographic expansion.
Nonprofit acquirers — in IDD specifically, nonprofit buyers are an active part of the market. They typically pay lower multiples than PE-backed buyers, but they may offer better cultural fit for mission-driven sellers.
In a competitive process, having PE-backed platform buyers competing against strategic operators typically produces the highest multiples.
Many IDD owner-operators started as nonprofits or converted at some point. If you are a nonprofit considering strategic options, the sale analysis is different:
Nonprofit IDD owners should involve specialized healthcare transactional counsel early in the process.
The quality of your preparation directly determines the price you receive. Prioritize:
12+ months before sale:
6 months before sale:
At launch:
The IDD market is active enough that knowing your range before speaking to any buyer is not optional — it’s essential. Buyers who approach you directly have already priced in the absence of competition.
Hendon Partners provides confidential preliminary valuations for IDD and IDD-adjacent agencies at no cost. We combine publicly available benchmark data with our own closed-transaction experience to give you a realistic picture of what your business would achieve in a competitive process.
Request your IDD valuation — confidentially and at no cost →
Hendon Partners covers all sub-sectors of home-based and community-based care including IDD, autism services, home health, hospice, and private duty.
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