This guide discusses participant-driven managed support in which people with disabilities and their families steer their own futures by having more control over the money used to provide long-term supports. After an introductory chapter, chapter 2, "What Is Managed Care," describes managed care, traditional managed care players, and the 10 tools of managed care (eligible population, capitation, risk, care criteria, the flow of money, network management, utilization reviews, care coordination/gatekeeping, service substitution, and quality assurance). Chapter 3, "What Do We Want," discusses the deinstitutionalization of people with disabilities and the move by current services and programs to embrace participant-driven approaches. Chapter 4, "The Way To Go--Participant Driven," highlights participant-driven supports such as: (1) a valid cost containment strategy; (2) allowing consumers to make choices; and (3) giving individuals with developmental disabilities the opportunity to increase control over their lives. The ways in which participant-driven managed supports work at the system level and at the individual level are described. Concerns relating to participant-driven programs are also addressed. The final chapter lists the essential elements of future support systems, including vision, self-determination, flexible services, personal advocates/brokers and business agents, partnerships, unified funding, outcome focus, and cost containment. A glossary of relevant terms is attached. (CR)