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Speech language and hearing (SLH) services can improve people with intellectual and developmental disabilities’ (IDD) health, autonomy, and community participation. The aim of this study was to explore how SLH services are offered to people with IDD across the nation, particularly in fiscal year 2015 Medicaid Home and Community Based Services (HCBS) 1915(c) waivers (N = 111 waivers). Findings revealed, unlike Medicaid state plans, HCBS waivers were often utilized to offer SLH services in alternative settings, like participants’ homes, and provide long-term habilitative care rather than immediate acute care. Given increased risk for and under identification of communication and hearing disorders in people with IDD, adequate access to sufficient SLH services is essential to ensure the rights of people with IDD