People often ask us who can help them open an ICF/DD-H home. The honest first answer is the regional center, then DDS, then CDPH. A consultant helps you move through them in the right order with a complete package. This guide shows that order, so you can see the whole path before you commit to a property.
01 · What it is An ICF/DD-H home serves people who need training and support, not continuous nursing.
ICF/DD-H means intermediate care facility for the developmentally disabled, habilitative. It is a licensed health facility with four to fifteen beds. It gives 24-hour personal care, habilitation, developmental and supportive health services. The residents have intermittent, recurring needs for nursing services, but a physician certifies that they do not need continuous skilled nursing care.1
That makes it different from two neighbors. An ICF/DD-N home serves people who are medically fragile and need skilled nursing care on a recurring basis. An adult residential facility is a community care facility, licensed by a different department, with no nursing requirement. If your residents need daily skilled nursing, read our guide to the ICF/DD-N path instead.
02 · The seven steps The state sets the order, and two steps must come before you buy anything.
- Ask the regional center resource developer if the beds are needed. DDS tells new applicants to start here.2 A regional center that does not need your beds will not refer residents to them.
- Complete the sixteen hour new provider orientation. The applicant or a designee must attend a program that DDS approved, before the first license.3 Do it early, because the certificate goes inside the program plan package. Our guide to the sixteen hour orientation explains the content.
- Choose the house with the license in mind. CDPH asks for building clearance or a certificate of occupancy, and a fire safety inspection request.4 State law treats a home of six or fewer residents as a residential use for zoning.5 A city or county can still ask CDPH to deny a new license when too many of these homes are close together.4
- Build the program plan package and send it to DDS. You send it by email to DDS Health Facilities. DDS assigns an analyst only when every document is present.6
- Apply to CDPH for the license. The CDPH Centralized Applications Branch takes the HS 200 application, a copy of the DDS-approved program plan, a criminal record clearance for the administrator and the supporting documents.4
- Pass the surveys. A license lets you open. Medi-Cal certification is a separate review against federal standards, and only certification lets you bill.2
- Get vendored by the regional center. Vendorization gives you a vendor number. The regional center cannot refer anyone to you until it approves you. You can apply with proof that your license application is in progress.7
Buying or leasing the house first. The regional center decides need, DDS decides the program, and CDPH decides the building. A house with no assessed need behind it is only a house.
03 · The DDS package The program plan is the document your home will run on, so DDS reads all of it.
DDS publishes an instructions and checklist document for the ICF/DD-H program plan. The current version is dated September 2025.6 The package has four parts: the DS 1852 application, the program plan, nine attachments, and the checklist signed by the licensee. The program plan itself has eight sections.
| Section | What DDS looks for |
|---|---|
| I. Introduction | Philosophy, mission, and a statement that you will keep current state and federal rules in your policies. |
| II. Individual placement process | Who you will serve, entrance and exit criteria, the preadmission assessment, placement and the discharge plan. |
| III. Assessment and interdisciplinary team | Team members, the difference between an ISP and an IPP, how the QIDP directs the plan, and the review schedule. |
| IV. Program elements | Registered nurse duties, active treatment, documentation, and programs from daily living skills to nutrition. |
| V. Behavior management | Functional assessment, positive behavior supports, psychoactive medication rules, and your position on restraint. |
| VI. Human rights | A human rights committee, its members, and how residents learn and use their rights. |
| VII. Orientation and in-service training | Eight hours of orientation in the first 40 hours of work, and three hours of training each month. |
| VIII. Abuse prevention and reporting | Your system to prevent, report and investigate abuse, and your written abuse policy. |
Some lines in the checklist set numbers that shape your daily schedule. Put them in your plan as written:
- Each resident gets an active treatment program seven days a week, with no less than 56 hours a week.
- No more than two hours in a row pass without active treatment, unless the individual service plan says otherwise.
- The individual service plan is complete within 30 days of admission and is reviewed every six months.
- The human rights committee meets at least every quarter, and it includes the administrator, the QIDP, a registered nurse and a regional center representative.
| Attachment | Format |
|---|---|
| 1. Consultant and professional staff list | DDS template |
| 2. Staff schedule | DDS template |
| 3. Floor plan with the area of each bedroom and the sprinkler locations | |
| 4. Contracts and professional credentials | |
| 5. Proof of the sixteen hour new provider orientation | |
| 6. Emergency preparedness plan | |
| 7. Facility operations: weekly schedule, weekend program, organization chart, community resources | Word |
| 8. Quality assurance plan with a tool or checklist | Word |
| 9. Medication administration training plan, with its own checklist | Word |
A DDS nurse consultant reviews the medication administration training plan. Send it as a separate document.6
04 · Why packages come back Most delays come from missing paper, not from a weak program.
The DDS checklist names the problems that stop a review. Check for each one before you send:
- A document is missing. DDS does not accept the package until it is complete.
- A professional license has expired. DDS does not accept expired licenses.
- A consultant contract has no date, or only one party signed it.
- A file is in the wrong format. Attachments 1 and 2 use the DDS templates, 3 to 6 are PDF, and 7 to 9 are Word.
- The revised plan comes back late. You must return DDS revision requests within two weeks.
- The DDS comments were deleted. Keep them in the revised file, because DDS checks each one.
Every item on that list is in your control. A complete first submission is the fastest path through DDS.6
05 · Staffing and money The staffing floor is fixed, so model the home at five residents, not six.
At four to six residents, an ICF/DD-H home needs 252 direct care hours a week, which is 36 hours a day. A registered nurse must visit no less than one hour a week for each resident, and the QIDP must give 1.75 hours a week for each resident.8 Those hours do not go down when a bed is empty.
Medi-Cal pays the home through a daily rate for each occupied bed. For a 4 to 6 bed ICF/DD-H home, the 2026 rate is $424.66 a day. It was $363.12 in 2024, an increase of 16.9 percent.9
| Occupied beds | Revenue per day | Required hours per day | Revenue per required hour |
|---|---|---|---|
| Six | $2,547.96 | 36 | $70.78 |
| Five | $2,123.30 | 36 | $58.98 |
| Four | $1,698.64 | 36 | $47.18 |
One empty bed for a full year removes about $155,000 of revenue and almost no cost. Wages, payroll taxes, the nurse, the QIDP, food, rent and insurance all come out of the figure in the last column. Our article on the cost of running a small home works through those costs.
06 · Questions What applicants ask before they start.
Who can help me open an ICF/DD-H home in California?
Three public offices decide the steps: the regional center resource developer, DDS Health Facilities and the CDPH Centralized Applications Branch. A consultant such as DirectCare helps you prepare the program plan package and the license application, and get ready for the surveys.
Do I need the sixteen hour orientation before I apply?
Yes. The applicant or a designee must complete a DDS-approved sixteen hour orientation before the first license, and the program plan package must include proof of attendance.
Do I need zoning approval for a six-bed ICF/DD-H home?
State law treats a home of six or fewer residents as a residential use for zoning. CDPH still asks for building clearance or a certificate of occupancy and a fire safety inspection request, and a city or county can ask CDPH to deny a license where there are too many of these homes close together.
Should I open an ICF/DD-H or an ICF/DD-N home?
Decide from the needs of the people you will serve. ICF/DD-H residents need training and support but not continuous skilled nursing. ICF/DD-N residents are medically fragile and need skilled nursing on a recurring basis, which adds licensed nursing hours every day.
Who pays an ICF/DD-H home?
Medi-Cal pays a daily rate for each occupied bed. For a 4 to 6 bed ICF/DD-H home the 2026 rate is $424.66. The regional center refers residents and pays for day programs and transportation that it buys for them.
How long does it take to open an ICF/DD-H home?
No agency publishes a timeline. The time depends on the regional center, the DDS review, the CDPH application and the surveys. Budget for a range of months, not a fixed date, and send a complete package the first time.
Planning an ICF/DD-H home?
DirectCare helps California applicants through the regional center conversation, the DDS program plan package, the CDPH application and the first survey. The first conversation is free and honest.
Notes and sources
- Definition of an ICF/DD-H facility in Health and Safety Code section 1250(e), including the four to fifteen bed capacity and the physician certification. public.law ↩
- DDS Intermediate Care Facilities page: contact the regional center resource developer to learn if a facility is needed, program plan approval before licensure, and the difference between licensure and Medi-Cal certification. dds.ca.gov ↩
- Health and Safety Code section 1268.6 and the DDS New Provider Training page, which lists the approved orientation agencies and requires the certificate in the program packet. dds.ca.gov ↩
- CDPH provider checklist for ICF/DD and ICF/DD-H initial and change of ownership applications: HS 200, a copy of the DDS-approved program plan, building clearance or certificate of occupancy, the STD 850 fire safety inspection request, administrator criminal record clearance, and the overconcentration note under Health and Safety Code section 1267.9. cdph.ca.gov ↩
- Health and Safety Code section 1267.8, on facilities that serve six or fewer persons and zoning. public.law ↩
- DDS ICF/DD-H Program Plan Instructions and Checklist, dated September 9, 2025: submission by email to [email protected], package contents, the eight sections, attachments 1 to 9 and their formats, the nurse consultant review of the medication administration training plan, and the two week resubmission rule. PDF ↩
- Vendorization: the vendor number, proof of a pending license application, and the bar on referrals before approval. California Code of Regulations, Title 17, sections 54302 and 54310. Cornell LII ↩
- ICF/DD-H direct care hours and registered nurse visits under California Code of Regulations, Title 22, sections 76800 to 76962, and the qualified professional requirement of 1.75 hours per client per week. PDF ↩
- Medi-Cal per diem rates for ICF/DD facilities by peer group, calendar years 2024 to 2026. dhcs.ca.gov ↩
Figures and rules were current on the date of publication. Forms and rates change. Confirm each requirement with your regional center, DDS and CDPH before you commit money to a project. This article is not legal advice.