How the system works
Ten plain-language briefs on how services for people with intellectual and developmental disabilities work: the history and law behind community living, how services are funded and rationed, and the rules that shape daily support.
6 of 10 published
Part 1 ·
Institutions to community: Willowbrook, Pennhurst, SouthburyIn 1967, 194,650 people with I/DD lived in large state institutions. Most of those places have closed, but Connecticut's Southbury still houses 84 people. How three institutions shaped today's community services and DSP jobs, as of September 2026.
Part 2 ·
Olmstead v. L.C.: what it requires, how it's enforcedThe 1999 Olmstead ruling says needless institutional isolation is disability discrimination. As of September 2026 it still stands, but federal enforcement has shifted. What it requires, how Georgia and Virginia settlements put it to work, and what changed in 2026.
Part 3 ·
Medical vs. social model of disability, explainedThe medical model locates disability in the person; the social model locates it in barriers around them. WHO's ICF blends the two, and U.S. rules mix both as of September 2026. What each model means for eligibility, support plans and a DSP's daily work.
Part 5 ·
HCBS waiting lists: why people with I/DD waitAbout 607,000 people were on Medicaid home care waiting lists in 41 states in 2025, most with I/DD. Why the lists exist, how states decide who comes off them, how long people wait and what the numbers miss, as of September 2026.
Part 7 ·
Self-direction and FMS in Medicaid, explainedMore than 1.5 million people self-directed their home care in 2023, mostly through Medicaid, with FMS handling payroll. How employer and budget authority work, who the legal employer is, and when family can be paid, as of September 2026.
Part 8 ·
Aging out of IDEA: what ends at 21 or 22Federal special education rights can last until about age 22, but adult disability services carry no such guarantee. What IDEA requires before school ends, how states differ and what adult systems come next, as of September 2026.