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Deinstitutionalization Toolkit

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NCD’s Deinstitutionalization Toolkit is designed to provide all those interested in institutional closures and expanded community living opportunities for people with intellectual disabilities and developmental disabilities (ID/DD) with information, strategies, state data, and case studies that can facilitate closure and build community capacity to serve more people with ID/DD in the community.


How To Use This Toolkit

Companion Paper


This section covers topics such as building a broad-based coalition, becoming Medicaid experts, understanding and working within the political environment, and creating a community system of care.


This section reviews relevant laws, policies, and court decisions; and the roles key organizations and agencies play.


This section reviews trends, populations, costs, and other statistics for large, state institutions.


This section defines community based settings, contrasts community and institutional settings, and presents common myths and realities regarding settings.


This section describes the role of the Social Security Administration and Medicaid in funding the deinstitutionalization process and providing related services and supports.


This section compares the costs of institutions versus community-based settings; reviews cost variations across states; and examines transition costs.


This section offers detailed information on and comparisons of state closure plans.

Case Studies

This section provides the methodology, key questions, and evaluation of two states' experiences at different stages during the process of deinstitutionalization and building community support systems.