Missouri’s Partnership for Hope (PfH) is a home and community-based services (HCBS) Medicaid waiver that targets services to the needs of individuals with intellectual and developmental disabilities (IDD). PfH is predicated on a unique federal–state–county partnership, where counties may vote to participate in PfH by leveraging funds for services. The aim of this study was to explore the economic impact of PfH. The economic contribution and impact of PfH (October 2010–September 2013) were explored using IMPLAN software and data. Results indicate that a county and state investment of US$3.5 million each leveraged US$11.7 million in federal funds, contributed almost US$22.2 million to Missouri’s gross state product (GSP), and was responsible for more than 435 jobs for Missourians. An estimated 13.8 million of those dollars were "new" to the state’s economy. Economic impact analyses showed that PfH spending facilitated economic growth. The unique structure of PfH grants counties greater administrative authority and allows the state and counties to split the state Medicaid match dollar amount. Furthermore, results indicate that encouraging participants to self-direct services, and providing support for them to do so, is beneficial to a state’s economy, particularly job creation.