The sales thesis, short
Every I/DD hire is a compliance event. Providers operate under state Medicaid contracts that tie reimbursement to documented screening — criminal, MVR, drug, OIG/SAM exclusion, and state abuse/neglect registries. At 44% DSP turnover on 750K heads, the industry runs ~330K new-hire background checks a year, plus continuous monitoring on the remainder.
No vertical-only winner exists. Healthcare-leaning generalists (PreCheck/Cisive, IntelliCorp, First Advantage) have presence but not fit. SMB tools (Checkr, GoodHire) are too generic for Medicaid audit requirements. The opening is a vertical product that bundles screening + OIG/SAM + state registries + EVV-adjacent integrations with the I/DD EHRs (Therap, iCareManager, Kibu, SETWorks).
Go-to-market priorities
Spend trajectory
Total I/DD services spending, FY 2019 – FY 2023 ($B)
Where HCBS dollars go
FY 2021 breakdown of $43.2B in Medicaid HCBS spending for people with I/DD
Provider base
Population & access
How providers get paid
Medicaid dominates. Private pay and commercial insurance are rounding errors at the industry level — meaningful only as a supplemental market for waitlisted families.
Medicaid mechanisms
Big state models
Why this matters for screening
Medicaid reimbursement is conditional on compliance. Provider-enrollment audits verify that every DSP cleared criminal + OIG/SAM + state abuse registry checks at hire, and in many states monthly thereafter. A missed exclusion = clawbacks + civil monetary penalties (e.g., the $6.5M TN settlement).
Providers by state
Tap a state to see the largest I/DD providers.
Or use the quick list below.
National / multi-state providers
National associations
These are the megaphones. Sponsorships and vendor lists here hit the broadest share of the buyer universe.
State provider associations
Top 20 I/DD states. Most run annual conferences 200–1,000 attendees.
Where to spend channel budget first
Software systems serving I/DD
Consolidating market. PE-backed rollups (CaseWorthy, Netsmart/Apax) on one end; mobile-first challengers (Giv, Kibu) on the other. Therap remains the broad incumbent.
Tier 1 — broad EHR / case management
Tier 2 — specialized & niche
Tier 3 — EVV & compliance rails
Integration targets
Therap and Kibu publish APIs. An embedded "run screening" action inside the provider's EHR is the highest-leverage product bet — it removes the reason any agency shops the screen as a line item.
Background screening — competitive picture
A $14.7B US screening market growing ~12% annually. Two things shape the I/DD opportunity: (1) no competitor treats I/DD as a named vertical, and (2) healthcare-leaning players are the closest fit but still not purpose-built.