Medicaid has long served as a cornerstone of support for individuals with disabilities, evolving over six decades to meet the complex and diverse needs of this population. From its roots in the Social Security Act to the creation of Supplemental Security Income (SSI) and the expansion of Home and Community-Based Services (HCBS) waivers, Medicaid has grown to provide critical long-term services and supports (LTSS) that are often unavailable through other insurance programs. Today, over 15 million Americans live with a disability, and Medicaid covers 35% of them—offering not only medical care but also essential services that promote independence, dignity, and community integration.

This issue brief explores the historical milestones, policy innovations, and legal decisions that have shaped Medicaid’s role in disability care—from the Americans with Disabilities Act and the Olmstead decision to the rise of managed care and self-direction. It also highlights current challenges, including workforce shortages and growing demand for services, especially as the population ages. As Medicaid continues to adapt, this brief provides a comprehensive look at how the program remains vital to ensuring high-quality, person-centered care for individuals with disabilities across the country.