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This article examines issues potentially raised under the Americans with Disabilities Act (ADA) by states' decisions whether and how to include disabled Medicaid recipients in the massive shift towards Medicaid managed care. Part II briefly examines the special issues that disabled Medicaid recipients pose with respect to managed care enrollment. These include issues of cost, quality, access, and program design and implementation. Part III describes various approaches that state programs have taken or are proposing to take with respect to the enrollment of disabled Medicaid recipients in managed care. These approaches range from simply excluding the SSI population from managed care enrollment, to developing specialized managed care plans for Medicaid recipients with special needs, to enrolling disabled recipients in mainstream Medicaid managed care plans. Finally, Part IV discusses the ADA issues that each of these approaches may raise and explores how those issues might be resolved. Part V concludes with suggestions regarding how state Medicaid officials can avoid ADA liability in developing Medicaid managed care programs. Ultimately, because Medicaid is not a single federal program but rather a multiplicity of state programs (in which variations only increase as states modify their traditional fee-for-service Medicaid programs toward managed care), the ADA's implications for Medicaid managed care must be addressed on a state-by-state and fact-specific basis. Nonetheless, considering how the ADA's nondiscrimination mandate might be raised in the movement to Medicaid managed care will help state planners not only avoid potential liability for an ADA violation, but also think in broad terms about how to design and implement Medicaid managed care programs in a fashion responsive to the various needs of the diverse Medicaid population.