DOMA, a provider of intellectual and developmental disabilities (IDD) services, closed June with a deal announcement. The Minneapolis, Minnesota-based company reported that it has acquired Payee Support Services (PSS), an Ohio-based company delivering individualized services for people with IDDs.
The deal strengthens DOMA’s presence in the Midwest and marks its entry into the state of Ohio. Agenda Health, an Austin, Texas-based M&A advisory firm specializing in healthcare, acted as the exclusive sell-side advisor in the transaction.
DOMA provides IDD services with a focus on individualized, community-based care. The company provides an array of community living options, which are Medicaid-waivered services for individuals 18 and older, offering around-the-clock care customized to each person’s needs.
The IDD sector supports individuals with intellectual and developmental disabilities through tailored care, including housing, case management and community integration. Growing demand, driven by aging populations and policy shifts toward community-based models, is fueling M&A activity in this specialized healthcare field.
We spoke with Blake Elliott, Owner and President of DOMA, and Stephen Sargent, Senior Director at Agenda Health, to explore what drove this deal and its place in the IDD market.
“PSS stood out as an acquisition target due to several compelling factors,” said Elliott. “First and foremost, the organization is exceptionally well-run, with a strong, experienced leadership team that has demonstrated a clear commitment to quality service delivery and operational excellence.”
According to Elliott, the deal aligned well with DOMA’s strategic objective to expand its footprint in the Midwest, an area DOMA views as having both need and opportunity for innovation in the IDD space. Additionally, DOMA was drawn in by PSS’ highly customized approach to housing and service solutions. PSS’ focus on meeting individuals where they are, and tailoring care to each person’s needs, resonated strongly with DOMA’s core values.
Agenda Health played a pivotal role in connecting the two organizations.
“PSS was referred to us by one of the existing buyers we work with on a regular basis,” said Sargent, whose team helped facilitate the deal. “They knew Natalie personally and knew that we help oversee and advise on IDD transactions, so they made the connection for us.”
Agenda Health’s expertise in navigating regulatory complexities ensured a focused transaction process. Its close coordination with both parties facilitated a deal aligned with DOMA’s strategic goals.
“The biggest challenge was helping the buyer to establish Medicaid approval within the state of Ohio,” said Sargent. “Because that takes time, both sides were patient to continue moving forward with appropriate steps until this was finalized.”
DOMA’s entry into Ohio is particularly timely, given the state’s evolving IDD landscape. Ohio has been expanding access to community-based services through its Medicaid waiver programs, such as the Individual Options and Level One waivers, which support more than 40,000 individuals with developmental disabilities. Recent state initiatives, including increased funding for provider rates in the 2025 budget, aim to address workforce shortages and enhance service delivery. By acquiring PSS, DOMA gains a platform to tap into this growing market, leveraging Ohio’s policy support and PSS’s established relationships with local case managers and families to drive expansion.
Elliott emphasized that DOMA will maintain PSS’s strong care model while integrating shared resources to enhance operations. He highlighted anticipated synergies in back-office administration, technology and staff development, aiming to drive organic growth in Ohio by leveraging PSS’s reputation and ensuring staff remain supported.
This transaction gives DOMA a foothold in a new market at a time when workforce stability is a top concern across the IDD sector.
“Staffing remains the most significant challenge facing IDD providers nationwide,” Elliott said. “The workforce shortage has affected service consistency and organizational sustainability across the sector. PSS has successfully built a strong and loyal team of both leaders and direct support professionals, which gives DOMA a solid foundation in a new market. This acquisition allows us to learn from and build upon that strength while exploring new ways to attract, retain, and support talent.”
In response to these challenges, DOMA’s focus moving forward will be on reinforcing the strengths of PSS’s existing workforce.
“We are investing in workforce development and culture to ensure that our team members continue to feel valued and equipped to provide exceptional care,” Elliott said.
For other providers looking to grow through acquisition, Elliott underscored the importance of alignment beyond financials.
“Successful growth through acquisition hinges on the strength and alignment of leadership—both at the acquiring organization and within the target company,” he said. “Organizations should also prioritize cultural due diligence just as highly as financial or operational due diligence. Shared mission, values and a person-centered approach are essential. Finally, be patient and intentional—building trust, retaining staff and maintaining quality should always take precedence over rapid scaling.”
Sargent echoed those insights, pointing to the critical role that shared values, and a focused buyer pool played in this deal. Agenda’s established relationships and market insight enabled a targeted process that quickly surfaced a strong fit.
“The most effective strategy is for us to have ongoing, specific relationships with buyers in which we know their exact search metrics,” Sargent said. “Knowing that DOMA was focused on expanding their IDD coverage into Ohio based on previous profile calls we’d done with them, it was very natural to connect them to Payee Support.”
As more IDD providers weigh their options in today’s shifting regulatory and funding environment, transactions like this one reflect both opportunity and urgency in the space.
M&A activity in the Behavioral Health Care (BHC) and IDD markets has accelerated notably in 2025. During the first six months of the year, 57 BHC deals were announced, including seven specifically in the IDD specialty. This marks a significant increase compared to 35 BHC deals with only one IDD transaction in the same period of 2024, and 41 BHC deals with five IDD deals announced during the first half of 2023. The growing distribution of IDD transactions highlights heightened buyer interest in this specialized sector as providers like DOMA are capitalizing on opportunities to scale and enhance community-based care.
“The IDD market continues to be in a great place, and there are some wonderful IDD buying groups that offer a high level of care and passion for the IDD space,” said Sargent. “The constant threats of Medicaid reform and uncertainty of the future rates and protocols are constantly serving as a motivator for IDD buyers to consider going to market sooner than later.”
The IDD market continues to draw interest from strategic buyers as states push for more community-based care and providers seek scale to navigate regulatory and workforce pressures. With ongoing Medicaid uncertainty and rising demand for individualized services, deal activity is expected to remain strong as organizations look for partners that can offer both stability and mission alignment. We will be closely tracking these developments and evolving trends on the LevinPro HC platform.