The Medicaid intermediate care facilities for the “mentally retarded” (ICF/MR) and Home and Community Based Services (HCBS) programs provide federal financial assistance to states to provide long-term supports for people with intellectual or developmental disabilities. The ICF/MR program, which began in 1971, promoted substantial change in institutional care of persons with disabilities, including population reductions in large facilities and the development of community group homes. The HCBS program, which began in 1981, supported continued reductions in institutional populations and fostered explosive growth in the number of people with disabilities receiving long-term supports in small community settings or in family homes. These changes have continued through the first decade of the 21st century despite the severe economic recession of 2007 through 2009.

One component of the American Recovery and Reinvestment Act of 2009 (ARRA), generally referred to as the “stimulus package,” was assistance...

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