Findings are presented from a site visit to a Raleigh, North Carolina, program that provides in-home support to children and adults with severe disabilities and their families. The program, the Wake County Community Alternatives Program for Persons with Mental Retardation/Developmental Disabilities, is administered by the North Carolina Department of Human Resources under a Title XIX (Medicaid) waiver. The program's three components include a client screening procedure, a plan of care, and a set of locally developed community-based services. Positive program practices include responsive case management; family involvement; building supports around the individual's specific needs; individualized programming in the home; contracting with individual "providers"; attention to issues of cultural and racial diversity; and emphasis on positive relationships among case managers, caregivers, and the people they support. Program limitations are also noted. (JDD)