The large, often miserable, state-run institutions that used to house people with intellectual or developmental disabilities (IDD) are closing as people with IDD increasingly live in community. Most states are actively working to close the remaining large state-run and non-state IDD institutions. If current trends continue, the remaining state-run institutions may be closed by 2025. However, workforce shortages made more severe by the COVID-19 pandemic threaten access to home and community-based supports for people with IDD. Medicaid resources and technical assistance are available to states to address the workforce shortages and to help states to continue to move toward providing individualized support for people with IDD.