The 2002 Supplemental Operating Budget directed JLARC to conduct a performance audit of the Division of Development Disabilities (DDD) within the Department of Social and Health Services (DSHS. This report reviews information used to make comparisons between case management levels in Washington and other states, provides additional information on the public benefits used by DD clients, and takes an in-depth look at the use of Federal Medicaid funds. The report also evaluates those state-to-state comparisons on case management levels used by DDD to compare itself unfavorably to other states and concludes that such comparisons are invalid. The package of public benefits is further analyzed which further illustrates that DDD services account for only two-thirds of the public resources utilized by DDD clients. Finally, the report documents the dramatic increase in Federal Medicaid funding and the recent highly critical analysis of the use of those funds completed by the Federal government. The report proposes three recommendations to improve the overall management of this program area. DSHS concurs with Recommendations 1 and 2, and partially concurs with Recommendation 3. The preliminary report was presented at JLARCs May 2003 meeting.