This study used qualitative multiple case study analysis to explore community inclusion implementation among developmental disability service providers in Massachusetts. The Americans with Disabilities Act of 1990 (and its affirmation of community inclusion in Olmstead vs. L.C., 1999) set the stage for rights-based understanding of community inclusion, in contrast to custodial care or basic-needs paradigms of years prior. More recently, the Centers for Medicare and Medicaid have committed to not only community-based services for those with disabilities (2014) but also to value-based contracting and payment measures that focus on outcomes tied to social determinants of health, including community inclusion. In Massachusetts in 2016, more than $300 million dollars were spent on day and employment services for 16,127 adults with disabilities, of which community inclusion was by far the most common (more than 98% of those receiving day services participated in community-based non-work supports). Massachusetts contracts primarily with nonprofit human service agencies to provide these services. These nonprofit service providers are uniquely situated at the nexus of regulatory, payment, and rights-based change. This study analyzed documents and conducted nine semi-structured interviews at nine case organizations in Massachusetts, with eighteen senior leaders interviewed who were primarily responsible for program design and evaluation. 39 documents on community type, financial size, and program evaluation were reviewed, from both internal (case organization created) and external (public agency) sources. Moore's Public Value Theory was applied as a theoretical framework, whereby the operational capacity of case organizations relies upon, and is heavily interrelated with, public policy authority and public value outcomes. Focus areas for the inquiry included case organization response to regulation, internal best practices, and outside factors affecting service delivery. Key takeaways from the study include an evident tension between regulatory specificity and operational flexibility; weak incentives for excellent community inclusion services, with correspondingly unclear rate-setting procedures; and an awareness that value-based contracting and alternative payment models have significant implications for how services are designed, delivered, and evaluated going forward. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]