Around the world, the issue of disability inclusion is gaining increasing prominence. To promote disability-inclusion in programmes, a growing number of countries are considering the creation of a disability identification card. However, the administration of a disability ID card in low and middle-income countries differs from those in high-income countries. The purpose of this article is to discuss some of the challenges involved in creating a disability ID and how to address these challenges in the context of low and middle-income countries, suggesting that countries considering instituting disability ID cards must move with caution. ID card programmes can only advance disability policy and the wellbeing of persons with disabilities if undertaken in a well-designed manner in line with a country’s administrative capacity.