The authors discuss recent developments in services for people with intellectual disabilities (ID) in the Nordic countries. They note that all of the countries saw important reforms during the 1990s, regarding both deinstitutionalization and decentralization. However, they posit that the litmus test of the reforms is not what happens during reform years, but after the reform energy decreases and political attention fades. Thus, developments after 2000 are of particular interest. The comparative analysis is based on research reviews in the five Nordic countries. The analysis observed a trend toward larger group homes and congregations, inequality across municipalities, marketization, and new public management, but also an increasing emphasis on consumer rights and the use of the personal assistance scheme in services for people with ID. The authors conclude that diverging trends coexist, with improvements going together with significant setbacks. They explore the trends from a political science perspective and, in particular, note how they relate to recent shifts in public management and changing drivers of change.