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At the same time, the number of full time staff increased by 55% (69,494 to 107,737). The "maintenance expenditures" increased by over 100% ($353 million to $764 million).

In 1965, changes to the Social Security Act created Medicare and Medicaid and with it another major source of funding for services to people with developmental disabilities, particularly those with severe disabilities.

Again, the initial effect was to increase institutionalization of various forms and create obstacles to community living options for people with severe disabilities.

It was not until the 1980s that Medicaid became a major source of support for the kind of community living arrangements we would recognize today.

Initially, the Medicaid program provided federal matching funds ranging from 50% to 82%, including the admission of people into nursing homes.

Key developments in the Medicaid program and its role in
American's health care system:

President Lyndon Johnson
Photo courtesy of PCMR report, "MR-67"

Because people with developmental disabilities met the income guidelines to qualify for skilled nursing facilities, there was a rapid rise in the number of people admitted to them.

Intermediate Care Facilities (ICFs) were "intermediate" to hospitals and skilled nursing facilities.

In 1971, under P.L. 92-223, states were allowed to cover services in ICFs for elderly people and in ICFs/MR for people with developmental disabilities.  The ICFs/MR program was established through Medicaid.

It allowed states to receive federal matching funds for institutional services that had been funded by state or local government. To qualify for cost sharing, ICFs/MR had to comply with federal standards.

Today, those standards include eight areas: management, client protection, facility staffing, active treatment services, client behavior and facility practices, health care services, physical environment and dietetic services. Institutions were also called developmental centers.

Dining Room
Photo courtesy William Bronston, M.D.