For most of my 45 years in the intellectual and developmental disabilities (IDD) field, I never had to ask a basic question before opening a new program: Will there be money for this? For decades, the answer was always yes. Medicaid served as the infrastructure beneath our entire system of support. Providers planned expansions, opened new residential options, built day and vocational programs, and hired staff with the confidence that reimbursement would naturally follow.
That world is changing. And providers who do not prepare for this shift will find themselves unsteady at a moment when individuals with IDD need stability more than ever.
Why the Medicaid Foundation Is Shifting
Today’s financial landscape is shaped by forces far beyond the control of any individual provider. A national debt now exceeding $38 trillion and annual interest payments above $1 trillion are already limiting discretionary federal spending. KFF data shows that Medicaid remains the primary source of comprehensive health and long-term care coverage for roughly one in three people with disabilities. That includes 2.3 million children, 8.8 million working-age adults, and 4.4 million adults age 65 and older. For years, this level of coverage has been supported by a 90% federal match that was never intended to be permanent. Several states have passed trigger laws stating they will withdraw from Medicaid expansion the moment that match returns to the roughly 50% it was since inception and for decades.
This is not a political problem. It is a math problem. And math has a way of catching up to those dependent on perpetual growth.
Meanwhile, executives leading an IDD organization are confronting rising expenses in nearly every category: wages, major medical coverage, utilities, real estate, food, transportation — the list goes on. Annual cost-of-living adjustments, where they exist at all, rarely cover these increases.
If Medicaid alone is expected to carry the full weight of IDD organizational sustainability, the ground will continue to erode beneath us.
What I Learned at Chimes About Alternative Revenue
I spent years as CEO of Chimes International, one of the largest and most diverse organizations serving individuals with IDD and behavioral health needs in the Mid-Atlantic region. Chimes supports thousands of people annually across residential, vocational, educational, day, and employment programs.
During my tenure, I saw firsthand how fragile Medicaid-reliant operations can become. I also saw, just as clearly, how powerful the right alternative revenue streams can be in offsetting that fragility.
The strongest example was the federal AbilityOne Program. When I joined Chimes, the organization had long participated in AbilityOne but had not secured a new contract in nearly a decade. Once revitalized, the program’s impact was extraordinary. In the fiscal year ending June 2021, the organization generated more than $15 million in unrestricted surplus. This wasn’t theoretical revenue; it directly stabilized programs where Medicaid reimbursement lagged behind actual costs. Many in this field know exactly what those shortfalls look like: a day program costing $125 a day to run but reimbursed at $100, or residential rates that grow more slowly than the cost of major medical benefits, staffing, and housing.
AbilityOne remains one of the most powerful funding opportunities available to nonprofits employing individuals with significant disabilities. And because the federal government has already committed to expanding the size of the program substantially, providers willing to build the necessary infrastructure will find more doors opening, not fewer.
Looking Outside Traditional Boundaries
Alternative revenue is not just about federal contracting. Education services represent a massive, often overlooked arena. The United States spends nearly $1 trillion annually on K–12 and billions more on public post-secondary education. Many school districts struggle to serve students with autism, behavioral challenges, or complex learning needs, especially those returning from out-of-state placements. IDD organizations already hold the expertise these districts need: applied behavior analysis (ABA), speech and occupational therapy, behavioral consultation, home instruction, even school-based health services. These relationships can bring in meaningful revenue while keeping students closer to home and families better supported.
The Federal Supply Schedule (FSS), also called the Multiple Award Schedule, is another space where opportunity is plentiful. When Chimes became the first nonprofit agency accepted onto the FSS, thousands of federal solicitations suddenly became accessible. A single contract related to COVID-era laundry needs generated $600,000 in surplus during the first year alone. For organizations with operational discipline and strong compliance capacity, this pathway can be transformative.
Even mission-oriented social enterprises can play a role. A venture like Popcorn for the People demonstrates how a small team can build a business that provides dignified employment, public visibility, and stable revenue for adults with autism. Not every organization will launch a consumer brand, but every organization should be willing to think beyond traditional lanes.
Technology as the Backbone of Revenue Diversification
There is one truth that cuts across every alternative funding strategy: None of them work without airtight documentation. Whether an organization is billing commercial insurance for ABA services, completing performance reporting for AbilityOne, meeting the documentation standards for school-based related services, or managing compliance requirements for federal contracts, data integrity is not optional. It is now the cost of admission.
Throughout my career, I have watched the consequences when record keeping falls short. Insurers and state agencies now use sampling and extrapolation methodologies that can turn a handful of documentation errors into large repayment demands. Providers cannot afford those hits. Technology is the only realistic and practical safeguard.
Modern electronic records platforms, including those with support for new mobile tools for direct support professionals, fundamentally change what is possible. They reduce the burden on frontline staff, enforce required fields and signatures, ensure every service unit is captured, enable audit readiness, and create the data sets needed to demonstrate outcomes. In many cases, the question is not whether a provider can pursue new revenue streams. It is whether their documentation systems are strong enough to qualify for them at all.
For organizations exploring diversification, technology is no longer a luxury or an accessory. It is the foundation upon which every viable service line rests.
Mission at the Center
It is easy to speak about revenue in abstract terms, but none of this work is abstract. Every financial decision an IDD provider makes lands directly on the lives of people and families who rely on us. If a mother lies awake at night worrying about where her adult son with autism will live when she is gone, our commitment to new revenue streams must ultimately be about ensuring she does not face that fear alone.
Diversification is not about chasing dollars. It is about maintaining the continuity of care in a world where traditional funding is not guaranteed — and increasingly unlikely — to keep pace with real costs. It is about building organizational resilience so that services do not erode when policy winds shift. And it is about honoring the promise we make to every individual we serve: that their well-being will not be collateral damage in a changing financial landscape.
The field is entering a period that will require courage and adaptation. Providers who pursue new funding avenues with discipline, invest in strong technology, and refuse to lose sight of the people at the heart of this work will not only survive what is coming. They will build the next generation of support for individuals with IDD.
Terence Blackwell Jr.
Terence Blackwell Jr., an intellectual and developmental disabilities (IDD) expert and senior advisor for Core Solutions.
