Until 1990, case management in Indiana was provided only by governments agencies. In that year, Indiana privatized case management within its Medicaid Home and Community-Based Services (HCBS) waiver program for individuals with developmental disabilities. The motivation for privatization was two-fold. First, downsizing the bureaucracy became popular across the country at that time, beginning at the federal level and moving down to local government. Federal, state, and local government began using more and more private contractors in all areas, from pouring concrete to writing sophisticated computer software. A second more specific motivation for privatizing case management was to reduce the caseloads of state case managers, and support a focus on quality rather than quantity in their work.