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The caseload for the Medicaid program providing health care services to persons with severe disabilities has been growing faster than the overall population in Washington State. This report examines factors that may contribute to caseload growth in this program and the characteristics of individuals who qualify for Medicaid on the basis of a severe disability. Some of the key findings are that the number of individuals qualifying for Supplemental Security Income (SSI) due to mental disorders is growing faster than the overall SSI caseload and that likely contributors to caseload growth include changes in the mix of occupations and industries in Washington, the rising value of Medicaid benefits, and the declining numbers of nursing home beds in the state.