Get access

The Transformation of Public Sector Intellectual/Developmental Disabilities Programming


  • Robert Agranoff is professor emeritus in the School of Public and Environmental Affairs, Indiana University Bloomington, and professor in the Government and Public Administration Program at the Instituto Universitario Ortega y Gasset, Madrid. His latest book is Collaborating to Manage: A Primer for the Public Sector (Georgetown University Press, 2012). He is currently working on a book on the historical development of intergovernmental management in the United States. E-mail:


Programming for persons with intellectual and developmental disabilities has shifted from state institutional care to community-based services, facilitated by federal government support as well as services delivered by nongovernmental organizations (NGOs). For persons with mental retardation, epilepsy, cerebral palsy, and autism, these programs not only have moved into the health care orbit but also are in search of more holistic ways to maintain persons with their families and in communities. Three major forces have led to this shift: federal financing, particularly under Medicaid; integration of services around clients; and externalized service delivery by NGOs. These are increasingly connected forces, facilitated particularly by the Medicaid Home and Community-Based Services Waiver. They have transformed state-operated systems. Increasingly, states are working with NGO case management and service delivery providers to organize and integrate services to face this continuing challenge.