States continue to be challenged with serving their citizens with I/DD. The most recent data—State Of The States In Intellectual And Developmental Disabilities—shows total public spending grew 7% from 2021 to 2023. Eighty-three percent of this spending comes from Medicaid and 87% of those beneficiaries live in community settings with six or fewer people.

To address the increasing demand for services and related costs, states are taking different policy directions. The California Department of Health Care Services is developing a state plan amendment to move its ICF housing settings from waiver coverage to a state plan benefit (see California To Move An ICF-DD Setting From Waiver To State Plan To Comply With Federal HCBS Settings Final Rule). Vermont is…