Public expenditures in federal and federal-state programs for working-age people with disabilities totaled an estimated $276 billion in 2002. The federal share of these expenditures, $226 billion, was 11.3 percent of all federal outlays; states contributed an additional $50 billion . These expenditures accounted for about 2.7 percent of the nation’s gross domestic product (GDP) and are growing much faster than GDP and all federal outlays. Most expenditures were for income support and health care to people with disabilities who were not employed or who had very low earnings. The fact that the relative economic well-being of working-age people with disabilities is falling has prompted increased scrutiny of how money is spent and whether there are any significant policy reforms that should be pursued (Stapleton and Burkhauser, 2003). This scrutiny will become more intense if the federal deficit rises, as it is projected to do, and the prevalence of disability grows as the baby boom generation ages. These circumstances make it an opportune time to re-evaluate the structure of federal disability programs and whether they are properly aligned with the evolving disability paradigm—a paradigm that stresses helping people with disabilities help themselves to be full members of the economic and social lives of their communities, rather than objects of charity (Stapleton et. al, 2005).