Residential Intellectual and Developmental Disability Facilities (NAICS 62321)

A Histometrics industry-level primer for public- and private-market investors

This level equals its one child. NAICS (North American Industry Classification System) code 62321 is a five-digit industry that contains a single six-digit national industry, 623210 — Residential Intellectual and Developmental Disability Facilities. Because there is exactly one child, this level is effectively identical to it: same scope, same firms, same statistics. This page gives the rollup figures and the essentials; for full detail — the investable universe, economics, demand drivers, regulation, and risks — see the 623210 primer.

1. Overview

This industry houses and supports adults and children with intellectual and developmental disabilities (IDD) — conditions such as autism, Down syndrome, and cerebral palsy — in staffed residential settings rather than in a family home. The dominant format is the small community group home (often 1–6 residents) with round-the-clock direct-support staff; a shrinking minority live in larger, more medical Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID).[9]

Why it matters to investors: this is a large, non-cyclical, government-funded human-services sector with structurally rising demand and a chronic supply shortage. Almost all revenue comes from Medicaid — the joint federal-state health program for low-income and disabled Americans — which makes cash flows stable and recession-resistant but caps pricing and ties fortunes to state budgets.[8] Ownership is overwhelmingly private (private-equity-backed national operators, large regional nonprofits, and thousands of small owner-run homes), so the public-market menu is thin and, after a 2026 divestiture, thinner still. All of this is developed in the child primer.

2. What's inside — and why this level equals its one child

The five-digit industry 62321 rolls up a single national industry:

When a NAICS industry has just one national industry beneath it, the two are definitionally the same economic activity; the extra digit adds no further breakout. So everything true of 623210 is true of 62321. The classification is narrow: it captures only the residential-facility slice of a much larger IDD-services economy and excludes non-residential day, vocational, and in-home supports (NAICS 624120), residential mental-health and substance-abuse care (623220), and skilled-nursing and elder-care settings (623110, 623311/623312).[9] The 623210 primer covers the group-home vs. ICF/IID split, the adjacent-code boundaries, and the nonprofit / for-profit / government ownership mix.

3. Size (this level's rollup figures)

The federal statistics ingested for NAICS 62321 are the ground truth below. They match 623210 exactly, as expected for a single-child level.

The Herfindahl-Hirschman Index (HHI, a standard market-concentration measure) is suppressed in the source data, so we do not report it.[2] Note the vintage mismatch: receipts and concentration are 2022 (Economic Census), while payroll and employment are 2023 (County Business Patterns), so the two blocks are not perfectly comparable.

Undercount caveat (matters here). The $37.8 billion receipts figure materially understates total public spending on residential IDD supports. County Business Patterns (CBP) and the Economic Census cover employer businesses (including nonprofits) but generally exclude government-operated establishments, so state-run developmental centers and county group homes are largely absent.[5] Tiny family-care, adult-foster, and host-home arrangements with no paid employees also fall outside employer statistics. And most IDD services are non-residential and sit in other NAICS codes. For scale, Medicaid provides long-term services to roughly 729,000 people with IDD, at about $50,000 a year for a single working-age adult — implying total public IDD long-term-care spending well into the tens of billions, far above this one residential line item.[8] Treat these figures as an employer-business baseline, not a complete measure of care activity.

4. Investable universe (where value concentrates)

Because the level equals its one child, the investable map is identical to 623210's. In brief: there is no clean U.S.-listed pure-play residential IDD operator today. BrightSpring Health Services (Nasdaq: BTSG) sold its ResCare Community Living division — the pure IDD residential business — to Sevita for $835 million in March 2026, removing the last large near-pure-play from the public markets.[11][12] Remaining listed exposure is indirect: adjacent personal-care operator Addus HomeCare (Nasdaq: ADUS), and the Medicaid managed-care payers Centene (NYSE: CNC), Molina (NYSE: MOH), and Elevance (NYSE: ELV).[19][16][17][18]

The real ownership is private and concentrated among a handful of national platforms atop a long tail of small operators — Sevita (owned by Centerbridge Partners and The Vistria Group; the largest national provider), Dungarvin, and private-equity-backed RHA Health Services, alongside large regional nonprofits (Bancroft, Benchmark Human Services, Mosaic, and local chapters of The Arc and Easterseals).[5][6][18] See the 623210 primer for the full company and owner tables.

5. How the money works

Owners earn a Medicaid rate — a Home- and Community-Based Services (HCBS) waiver residential rate or an ICF/IID per-diem — for each authorized resident, so revenue = funded slots × occupancy × reimbursement rate. Fixed rent and minimum staffing make occupancy (census) the single most important operating lever, as in a hotel or nursing home.[2] Labor is the business: hourly Direct Support Professionals (DSPs) drive roughly 70%+ of revenue, illustrated by the industry's $21.8 billion payroll against $37.8 billion of receipts.[1][2] The core tension is the rate-to-wage gap — states set reimbursement, but operators must pay a competitive wage in a tight labor market — which keeps margins thin (low-to-mid single digits) and makes consolidation and real-estate ownership the main routes to for-profit returns. Full mechanics and metrics are in the child primer.

6. Demand drivers

Demand is structurally rising and largely disconnected from the economic cycle: more than 710,000 people sit on Medicaid HCBS waiting/interest lists (about 73% with IDD, average wait ~50 months); nearly one million U.S. households include an adult with IDD supported by an aging caregiver whose adult child will eventually "age into" the system; and autism and other diagnoses, longer lifespans, and higher acuity keep expanding the eligible population.[3][8] The binding constraint is not demand but funding and workforce — how many waiver slots states pay for and how many DSPs operators can hire. See the 623210 primer.

7. Regulation

Government rules effectively create this market. The Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies fund and govern nearly the whole sector — setting rates, licensing facilities, and running the Section 1915(c) HCBS waivers.[14] The Olmstead v. L.C. (1999) Supreme Court decision and the CMS HCBS Settings Rule (compliance deadline March 2023) drive the shift from institutions to community homes, while ICF/IID conditions of participation, the 2024 Medicaid Access Final Rule, and state licensing/incident-reporting add ongoing compliance burden.[14][15] Antitrust enforcement has arrived: in January 2026 the Federal Trade Commission (FTC) required Sevita to divest 128 ICFs before allowing the ResCare acquisition.[11] Detail in the child primer.

8. Consolidation

A fragmented cottage industry consolidating from the top: 7,336 firms, with the four largest holding only 13.1% of revenue and even the top 50 under 30%.[2] A private-equity-led roll-up has run for a decade — acquiring sub-scale homes and centralizing billing, compliance, and HR overhead — but reimbursement is a hard price ceiling and operators compete for the same scarce workers, so scale helps only so far. The 2026 Sevita–ResCare deal, cleared only with FTC-mandated divestitures, signals the end of the unscrutinized roll-up era.[11][12]

9. Risks

The risks are those of 623210: reimbursement / Medicaid-budget risk (the dominant one, given near-total single-payer dependence); a chronic DSP workforce shortage (turnover near 40%, median wage ~$14.50/hour, with most providers turning away referrals for lack of staff); quality, safety, and reputational/legal exposure serving a vulnerable population; leverage at private-equity operators; and an antitrust ceiling on the growth playbook.[5][11][16] Federal employer statistics also understate government, nonprofit, and very-small-provider activity — a caution when sizing the market from these figures. Full treatment in the child primer.

10. How to invest & outlook

No pure-play listed vehicle exists after 2026; public routes are indirect (diversified HCBS/pharmacy names such as BrightSpring, adjacent personal care via Addus, or payer-side exposure via Centene, Molina, Elevance).[11][19][16][17][18] The genuine exposure is private — operating platforms and regional providers, group-home real estate, private-credit lending, and staffing/technology vendors — underwritten state-by-state on licenses, waiver authorizations, staffing coverage, and rate adequacy.[5][18] The long-run demand case is about as durable as any in health care, but this is a government-rate-taking, labor-constrained, thin-margin business; the swing factors to watch are federal Medicaid policy, DSP wages and labor supply, and antitrust-shaped consolidation. The ground-truth data contain no national industry growth forecast, so none is supplied. For the complete analysis, read the 623210 primer.

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Sources

Drawn from the child primer (623210); numbering preserved for cross-reference.

1. U.S. Census Bureau. County Business Patterns, NAICS 623210, 2023. (Establishments 35,559; employees 545,820; annual payroll $21.76 billion; Q1 payroll $5.27 billion.) https://www.census.gov/programs-surveys/cbp.html
2. U.S. Census Bureau. 2022 Economic Census — Concentration by Largest Firms, NAICS 623210, 2022. (Firms 7,336; receipts $37.8 billion; CR4 13.1%, CR8 16.4%, CR20 21.9%, CR50 29.2%; HHI suppressed.) https://www.census.gov/programs-surveys/economic-census.html
3. KFF. A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2024, 2024. https://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2024/
4. Stateline / The American Prospect / S&P Global (via PESP). Private equity in disability services; Sevita ownership, revenue, and leverage, 2025. https://stateline.org/2025/05/16/private-equity-snaps-up-disability-services-challenging-state-regulators/
5. Dungarvin. Company overview / About Us, 2026. https://www.dungarvin.com/about-us/
6. KFF. 5 Key Facts About Medicaid Coverage for People With Intellectual and Developmental Disabilities (IDD), 2024. https://www.kff.org/medicaid/5-key-facts-about-medicaid-coverage-for-people-with-intellectual-and-developmental-disabilities-idd/
7. U.S. Census Bureau. 2022 NAICS Definitions — 623210 and adjacent codes (623220, 623110, 623311/623312, 623990, 624120), 2022. https://www.census.gov/naics/?input=623210&year=2022&details=623210
8. U.S. Federal Trade Commission. FTC Takes Action to Prevent Anticompetitive Healthcare Services Merger (Sevita / ResCare), January 2026. https://www.ftc.gov/news-events/news/press-releases/2026/01/ftc-takes-action-prevent-anticompetitive-healthcare-services-merger
9. Home Health Care News / BrightSpring. BrightSpring Finalizes $835M Community Living Divestiture to Sevita, March 2026. https://homehealthcarenews.com/2026/03/brightspring-finalizes-835m-community-living-divestiture-to-sevita/
10. Centers for Medicare & Medicaid Services (CMS). HCBS Authorities (Section 1915(c)); Institutional Long-Term Care / ICF-IID; Olmstead v. L.C. (1999), 2024. https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities
11. KFF. How Are States Implementing New Requirements for Medicaid HCBS? (HCBS Settings Rule, effective March 2023), 2024. https://www.kff.org/medicaid/how-are-states-implementing-new-requirements-for-medicaid-home-and-community-based-services/
12. ANCOR. The State of America's Direct Support Workforce Crisis (2024–2025). (Turnover near 40%; median DSP wage ~$14.50/hour; 77% of providers turned away referrals.) https://www.ancor.org/resources/the-state-of-americas-direct-support-workforce-crisis-2025/
13. Blue Wolf Capital Partners. Blue Wolf Capital Acquires RHA Health Services, 2019. https://www.bluewolfcapital.com/wp-content/uploads/2019/08/08.05.19.RHA-Press-Release.pdf
14. Centers for Medicare & Medicaid Services. Ensuring Access to Medicaid Services / HCBS Provisions (2024 Access Final Rule), 2024. https://www.medicaid.gov/medicaid/access-care/home-and-community-based-services-provisions
15. Electronic Code of Federal Regulations. 42 CFR Part 483, Subpart I — Conditions of Participation for ICF/IID, current. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-G/part-483/subpart-I
16. Centene Corporation. 2025 Form 10-K, 2026. https://www.sec.gov/Archives/edgar/data/1071739/000107173926000049/cnc-20251231.htm
17. Molina Healthcare. 2025 Form 10-K, 2026. https://www.sec.gov/Archives/edgar/data/1179929/000117992926000005/moh-20251231.htm
18. Elevance Health. 2025 Form 10-K, 2026. https://www.sec.gov/Archives/edgar/data/1156039/000115603926000013/elv-20251231.htm
19. Addus HomeCare Corporation. 2025 Form 10-K, 2026. https://www.sec.gov/Archives/edgar/data/1468328/000143774926005352/adus20251231_10k.htm