This qualitative dissertation captured the experiences of six Pioneer Families who created inclusive, self-determined lives in the community for their sons and daughters with a significant intellectual disability. Through extensive interviews and email communications, families shared their perceptions of the outcomes resulting from participant-directing the Medicaid HCBS Waiver. Families described three levels of outcomes resulting from participant direction and their Waiver access: short-term, intermediate, and ultimate. The ultimate outcomes represented an inclusive, self-determined life in the community. In addition, families also illuminated the impact that their context had on the accomplishment of desired outcomes. Contexts included both system factors and family factors. Finally, families offered recommendations for other families seeking to achieve similar outcomes. The recommendations offered were applicable for both Waiver access and general use.