During the past 30 years, significant changes have occurred in how healthcare providers serve the developmentally disabled population. Non-state agencies are more involved in care provision, replacing the state-run institutional model that prevailed for many decades. Increases in the quality and effectiveness of health care for the developmentally disabled has accompanied this shift in provision of care. As a result, a population with chronically low life expectancies is now producing its first comprehensive population of elderly persons. They present unique challenges to health-care providers, as they couple the needs of the elderly with the specialized care required by the developmentally disabled. Care providers are faced with daunting challenges, especially in today’s fiscal environment, as they strive to meet the needs of this emerging population.