Group homes are grouped by how much supervision and hands-on help residents need, and the levels of group homes generally fall into four categories: low-support, moderate-support, high-support, and specialized. Labels vary from state to state, and some systems use three tiers instead of four, but the underlying logic is the same everywhere. The greater the resident’s functional needs, the higher the level of care the home provides. A clinical assessment matches a person to the tier that fits.
Low-Support Homes
Low-support homes serve people who handle most daily tasks on their own but do better in a structured setting with some oversight. You may see them called “semi-independent” or “Level 1.” Residents typically manage their own hygiene, meals, and schedules. Staff check in periodically rather than staying on-site around the clock, and the help tends to focus on transportation, budgeting, appointment scheduling, or navigating community resources.
This level fits someone transitioning out of a higher level of care, or stepping down from an institutional setting, who needs a safety net more than hands-on assistance.
Moderate-Support Homes
Moderate-support homes are for people who need consistent daily help but aren’t at risk of serious harm without constant supervision. Staff are on-site or nearby throughout the day and available overnight. Residents at this level often need help with medication management, meal preparation, personal hygiene, or structured therapeutic activities. The goal is building toward greater independence while making sure no one falls through the cracks on essential daily routines.
Most group homes for adults with intellectual or developmental disabilities fall somewhere in this range.
High-Support Homes
High-support homes provide intensive, around-the-clock care for individuals with significant cognitive, behavioral, or medical challenges. Staff-to-resident ratios are substantially higher. Residents may need physical assistance with nearly all daily activities, behavioral intervention plans, or ongoing medical monitoring. These homes sometimes resemble small assisted living or nursing facilities in their staffing and clinical resources, though they keep a residential feel by housing only a small number of residents.
Specialized Homes
Some group homes are organized around a specific population rather than a general tier of need. They may serve people with traumatic brain injuries, children with complex behavioral conditions, individuals in addiction recovery, or residents with medical needs requiring on-site nursing. What sets specialized homes apart from high-support homes is their focus: staff training, facility design, and programming are all tailored to one condition or population. A home for residents who use wheelchairs will have accessible layouts and may employ physical therapists; a home for people with severe mental illness will emphasize psychiatric services and crisis de-escalation.
Specialized placement isn’t necessarily “higher” than a general high-support home. It’s a different sort of match, built around who the resident is rather than how many hours of help they need.
Intermediate Care Facilities (ICF/IIDs)
One category of group home sits in its own federal classification. Intermediate Care Facilities for Individuals with Intellectual Disabilities, or ICF/IIDs, are Medicaid-certified residential programs whose primary purpose is providing health or rehabilitative services to people with intellectual disabilities or related conditions. To qualify, a facility must deliver what the law calls “active treatment”: ongoing, structured programming designed to help each resident gain or maintain functional skills.
ICF/IIDs are subject to federal conditions of participation that go beyond typical state licensing, including requirements that residents be free from unnecessary physical restraints or medication used for behavioral control, be allowed to manage their own finances to the extent they’re able, and be able to communicate freely and participate in community activities. If a resident’s clinical needs point toward “active treatment” rather than general residential support, an ICF/IID is a distinct option worth asking about by name.
What Services Each Level Provides
The menu of services scales with the level of care. At every tier, residents receive some combination of the following, with intensity increasing as you move up:
- Daily living assistance with bathing, dressing, grooming, and meals. In low-support homes this means reminders; in high-support homes it means hands-on physical help.
- Medication management, ranging from prompts to take prescribed medications on schedule up to full administration by trained staff.
- Therapeutic services, including individual or group counseling, behavioral therapy, and crisis intervention. Higher-level homes build these into daily programming.
- Life skills training in cooking, budgeting, household chores, and public transportation.
- Vocational and educational support, including job coaching, resume help, and supported employment coordination.
- Case management covering outside medical appointments, benefits applications, and community resources.
A resident in a low-support home might use only case management and occasional life skills coaching. A resident in a high-support home might receive every service on the list, every day.
How Your Level Is Determined
Placement into a specific level starts with a clinical assessment. A healthcare professional evaluates physical health, cognitive abilities, behavioral patterns, and capacity for self-care. The assessment typically looks at whether the person can manage daily activities independently, any nursing or therapy needs, current medications and whether the person can self-administer them, dietary requirements, and communicable disease screening.
For Medicaid-funded placements, the bar is higher. The individual must demonstrate a need for a level of care that would otherwise qualify them for institutional placement. That finding is what opens the door to Home and Community-Based Services waiver funding, which pays for group home care as an alternative to a nursing facility or other institution.
Assessments don’t happen only once. Reassessments occur periodically, and if a resident’s needs change significantly, the care team can recommend moving to a higher or lower level of support. A person recovering well from a brain injury might step down from a high-support home to a moderate-support one as they regain independence. The reverse happens too: a resident whose condition deteriorates may need to step up.
Each person receiving Medicaid-funded home and community-based services must have a written, person-centered service plan that documents their strengths, preferences, clinical needs, and goals, along with the services that will meet them. The individual, not the provider, drives the plan, and residents can request updates at any time. If a provider is steering the process rather than the resident, that’s a red flag worth raising with the state Medicaid agency or a disability rights organization.
What Each Level Costs and How It’s Paid For
Costs vary widely depending on the level of care, geographic location, and whether the home is publicly or privately funded. Assisted living and residential care facilities nationally run a median of roughly $6,200 per month, and group homes with higher staffing ratios or specialized medical services cost considerably more.
The most common public funding source is Medicaid, specifically Section 1915(c) Home and Community-Based Services waivers. These waivers let states pay for residential habilitation, personal care, case management, respite, and other services that keep people in community settings instead of institutions. To qualify, the individual must need a level of care that would meet the state’s threshold for institutional placement, and the state must show that providing waiver services costs no more than institutional care would.
States have significant flexibility in how they structure HCBS waivers. They can target services to specific populations, such as people with intellectual disabilities, traumatic brain injuries, or age-related conditions, and they can cap enrollment. Waitlists are common, sometimes stretching years in states with high demand.
Supplemental Security Income also plays a role. For 2026, the maximum federal SSI payment is $994 per month for an eligible individual. Many group home residents use SSI to cover room and board, since Medicaid waivers generally pay for services but not housing itself. Some states supplement the federal SSI amount for residents in licensed care facilities.
If you’re trying to match a person to a level, start with the assessment and the funding question together. The clinical finding tells you which tier fits; the waiver and SSI picture tells you which homes at that tier you can actually access, and how long the wait is likely to be.