A direct support professional, often shortened to DSP, helps a person with an intellectual or developmental disability with daily living, personal care, medication reminders, transportation, and community activities. Because the role involves one on one time in a person’s home or a residential setting, every state that funds this work through its developmental disabilities agency or Medicaid waiver program requires some form of background screening before a DSP can be hired, and ongoing checks after that. The specific rule, the list of disqualifying offenses, and how often a recheck happens are set by each state, not by a single federal standard, so an employer or agency has to look at its own state developmental disabilities agency to get the requirements right.
Why DSP screening is treated differently than most jobs
People who receive services through an intellectual and developmental disability, or IDD, waiver are often unable to supervise their own care or report mistreatment. Federal Medicaid rules for home and community based services, known as HCBS waivers, require states to build in safeguards for participant health and welfare as a condition of federal funding, which is why states attach criminal history and registry checks to any staff member with direct access to a waiver participant. The federal regulation governing these waivers, 42 CFR Part 441, Subpart G, sets out the waiver assurances a state must meet, including participant safeguards, and leaves the specific screening mechanics such as fingerprinting and disqualifying offense lists to each state’s own Medicaid and developmental disabilities agencies.
What a state developmental disabilities agency typically requires
Most states route DSP background checks through the same agency that administers IDD waiver services, and most require fingerprint based criminal history checks rather than a name only search, plus a check against the state’s own abuse or neglect registry. Two examples show how specific a state rule can get.
Ohio’s developmental disabilities rule, Ohio Administrative Code 5123-2-02, requires a criminal records check through the state’s Bureau of Criminal Identification and Investigation before hire, a check of the federal health care exclusions list, Ohio’s abuser registry, and the sex offender registry, and enrollment of direct support staff in a retained applicant fingerprint database so that any new arrest triggers an automatic alert to the employer rather than waiting for the next scheduled recheck. The rule also sets tiers of disqualifying offenses, ranging from permanent exclusion for offenses such as certain sexual or violent crimes down to shorter exclusion periods for lower level theft or drug offenses, with a conditional hire allowed for a limited period while results are pending.
California handles the same goal differently. Under the state’s Department of Developmental Services background check program, anyone providing direct personal care to a participant in the state’s Self Determination Program, including a family member who is paid to provide that care, must be fingerprinted through Live Scan and cleared by the state Department of Justice and the FBI before starting work. Clearance can take time to process, and California allows applicants with certain older or less serious convictions to request an exemption, though the state’s own guidance is clear that some offenses, including rape, murder, robbery, and willful harm to a child or elder, are never exemptible. Both DOJ and the FBI continue to report new arrests of already cleared workers back to the state, which is how the ongoing monitoring piece works in California.
Because the agency, the specific registries checked, and the list of disqualifying offenses differ by state, an employer should not assume that a rule written for one state applies anywhere else. Where a state has not published a specific DSP screening rule, it is more accurate to say the requirement is unclear or still relies on general Medicaid provider enrollment screening than to guess at a fingerprinting requirement that does not exist.
Comparing two state approaches to disqualifying offenses
| Element | Ohio (OAC 5123-2-02) | California (DDS Self Determination Program) |
|---|---|---|
| Fingerprint method | State Bureau of Criminal Identification and Investigation | Live Scan through DOJ and FBI |
| Registries checked | Federal health care exclusions list, state abuser registry, sex offender registry | DOJ criminal history, FBI criminal history, DMV record |
| Most serious offenses | Permanent exclusion tier (murder, sexual offenses, trafficking) | Non exemptible offenses (rape, murder, robbery, harm to a child or elder) |
| Lower level offenses | Time limited exclusion tiers, five to ten years depending on offense | Case by case exemption request process |
| Conditional work pending results | Allowed for a limited period if other checks clear | Not described as a standard option in program guidance |
| Ongoing monitoring | Retained fingerprint enrollment with recheck at least every five years | DOJ and FBI report new arrests of cleared workers |
The OIG exclusion list and Medicaid funded DSP positions
Because DSP services are usually billed to a state’s Medicaid waiver, providers also have to check the federal exclusion list maintained by the Department of Health and Human Services. The OIG List of Excluded Individuals and Entities names people and entities barred from participating in any federally funded health care program. A provider agency that bills Medicaid for a DSP’s time while that DSP appears on the exclusion list risks civil monetary penalties and can jeopardize its own provider enrollment, so most state DD agency rules require checking the list before hire and on a recurring basis afterward, in addition to the state specific criminal history and registry checks described above. This exclusion screening duty exists alongside, not instead of, the state’s own background check requirement.
Medicaid waiver provider duties beyond the hiring check
A provider agency enrolled to deliver IDD waiver services generally has to document that each direct support employee has a current, clean background check on file, keep that documentation available for state audit, report certain incidents involving a participant to the state, and remove or reassign a staff member whose status changes, such as a new arrest or a registry match discovered during a recheck. These duties sit on top of general Medicaid provider enrollment requirements and vary by state waiver, so a provider operating in more than one state has to track each state’s documentation and reporting rules separately rather than assuming one state’s paperwork satisfies another’s.
Rechecks: a background check is not a one time event
Because a DSP’s eligibility can change after hire, most state rules require a recheck on a set schedule rather than relying only on the original pre employment result. Ohio’s rule, for example, pairs a retained fingerprint enrollment with a recheck no less than once every five years, on top of continuous arrest notification through the state’s fingerprint database. Other states set their own recheck intervals or rely on continuous registry monitoring instead of a fixed schedule. An employer should confirm the recheck cadence with its own state developmental disabilities agency rather than assuming a schedule used in another state.
FCRA rules when a third party runs the check
When a provider agency uses a consumer reporting agency rather than running fingerprint checks itself, the hiring process is also governed by the Fair Credit Reporting Act. Under 15 U.S.C. 1681b, an employer generally needs a standalone written disclosure and the applicant’s written authorization before ordering a consumer report for employment purposes, and if the employer intends to take an adverse action based on what the report shows, it has to send a pre adverse action notice with a copy of the report and a summary of rights, give the applicant a reasonable chance to respond, and only then send a final adverse action notice if it proceeds. A background check does not show the same information in every state, and what counts as reportable can depend on state law as well as the seven year reporting guidance that applies to many kinds of records, so a provider should not assume a report will surface every past offense or that any record is permanently hidden from a future check. For a closer look at how exclusion list checks specifically fit into a healthcare hiring process, see this overview of OIG and SAM exclusion screening, and for how a related in home caregiver role is typically screened, see this guide to home health and caregiver background checks.
What this means for hiring and compliance
A provider agency hiring direct support professionals generally needs to confirm its own state developmental disabilities agency’s fingerprint and registry rule, check the OIG exclusion list before hire and on a recurring basis, document both results, follow its state’s recheck schedule, and layer FCRA disclosure and adverse action steps on top of all of that if it uses an outside consumer reporting agency for any part of the process. Because disqualifying offense lists and exemption processes vary so much by state, an agency operating waiver services in more than one state should treat each state’s rule as a separate compliance obligation. Reveal Background works with employers who need to run consistent, documented background checks as part of that process; you can see how an employment screening order works at revealbackground.com.
Frequently asked questions
Does every state require fingerprint based background checks for direct support professionals?
Most states that fund IDD waiver services through their developmental disabilities agency require a fingerprint based criminal history check rather than a name only search, but the exact rule, the agency that runs it, and the registries checked are set state by state. Where a state has not published a specific DSP fingerprint rule, it is more accurate to say the requirement is unclear than to assume one exists.
What offenses generally disqualify someone from working as a DSP?
States generally set tiers of disqualifying offenses, with permanent or long term exclusion for serious violent or sexual offenses and shorter exclusion periods for lower level offenses such as some theft or drug charges. The specific tiers, time periods, and any exemption process are set by each state’s own rule, so the same prior conviction can be disqualifying in one state and exemptible in another.
Why does the OIG exclusion list matter for a Medicaid funded DSP role?
Because DSP time is usually billed to a state Medicaid waiver, a provider that employs or bills for someone on the federal exclusion list risks civil monetary penalties and can jeopardize its own Medicaid enrollment. Checking the list before hire and on a recurring basis is generally required in addition to, not instead of, a state’s criminal history and registry checks.
How often does a DSP background check need to be redone?
This depends on the state. Some states pair an initial fingerprint check with enrollment in a retained fingerprint database that flags new arrests automatically and still require a full recheck on a set schedule, such as at least once every five years; other states use a different interval or a continuous registry monitoring approach. An employer should confirm the current schedule with its own state developmental disabilities agency.
Do FCRA rules apply if a state agency runs the fingerprint check instead of a private background check company?
The FCRA generally applies when an employer orders a consumer report from a consumer reporting agency for employment purposes, which includes standalone disclosure, written authorization, and pre adverse and adverse action notice duties. A state run fingerprint and registry check conducted directly by a government agency is a separate process from a consumer report, though many provider agencies use both as part of a complete DSP hiring file.
Can a DSP be hired while a background check is still pending?
Some states allow a limited conditional hire while fingerprint results are pending, provided other checks such as the registry and exclusion list searches have already cleared, while other states do not describe this as a standard option. This is set by each state’s own rule, so an employer should confirm whether conditional hiring is permitted before relying on it.
This article is general information for employers and provider agencies, not legal advice. State developmental disabilities agency rules, disqualifying offense lists, and Medicaid waiver provider requirements change and vary by state, so confirm current requirements with your own state agency or counsel before making a hiring decision.
