Significant Takeaways from the 2016 Rankings
- All states still have room for improvement, but some States have consistently remained at the bottom since 2007, including Arkansas (#49), Illinois (#47), Mississippi (#51) and Texas (#50) primarily due to the small portion of people and resources dedicated to those in small or home-like settings in these four states.
- 32 States, same as last year, meet the 80/80 Home and Community Standard, which means that at least 80 percent of all individuals with ID/DD are served in the community and 80 percent of all resources spent on those with ID/DD are for home (less than 7 residents per setting) and community support. Those that do not meet the 80/80 standard are: Arkansas, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Mississippi, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah and Virginia. Connecticut is very close (with 79% spent on HCBS).
- As of 2014, 15 States report having no state institutions to seclude those with ID/DD, including: Alabama, Alaska, Colorado, Hawaii, Indiana, Maine, Michigan, Minnesota, New Hampshire, New Mexico, Oregon, Rhode Island, Vermont, West Virginia and Washington, D.C. Another 9 States have only one institution each (Arizona, Delaware, Idaho, Montana, Nevada, North Dakota, South Dakota, Utah and Wyoming). Since 1960, 205 of 354 state institutions have been closed, according to the University of Minnesota’s Research and Training Center on Community Living.
- 27 States, up from 26, now report meeting the 80 percent Home-Like Setting standard, which means that at least 80 percent of all individuals with ID/DD are served in settings such as their own home, a family home, family foster care or small group settings like shared apartments with fewer than four residents. The U.S. average for this standard is 80 percent. Just eleven (up from 8) States meet a top-performing 90 percent Home-like Setting standard: Alaska, Arizona, California, Colorado, D.C., Michigan, Nevada, New Hampshire, Vermont, Washington, and Wisconsin.
- Fifteen States, up from ten last year, report at least 10 percent of individuals using self-directed services, according to the National Core Indicators survey in 36 States. Five states report at least 20 percent being self-directed. These states include: Florida, Illinois, New Hampshire, Utah and Vermont.
Tracking Health, Safety and Quality of Life
- 47 States, up from 42 last year, participate in the National Core Indicators (NCI) survey, a comprehensive quality-assurance program that includes standard measurements to assess outcomes of services. A total of 36 States, up from 29 last year, reported data outcomes in 2015.
Keeping Families Together
- Only 15 States, up from 14 last year, report that they are supporting a large share of families through family support (at least 200 families per 100,000 of population). These support services provide assistance to families that are caring for children with disabilities at home, which helps keep families together, and people with disabilities living in a community setting. These family-focused state programs were in: Arizona, California, Delaware, Louisiana, Minnesota, Montana, New Hampshire, New Mexico, New York, Pennsylvania, South Carolina, South Dakota, Vermont, Wisconsin, and Wyoming.
- 10 States, up from 8 last year, report having at least 33 percent of individuals with ID/DD working in competitive employment. These States include: Connecticut, Maryland, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, Vermont, Washington, and West Virginia.
- 15 States report successfully placing at least 60 percent of individuals in vocational rehabilitation in jobs, with nineteen States reporting the average number of hours worked for those individuals placed being at least 25 hours and four States reporting at least half of those served getting a job within one year. No states met the standard on all three success measures.
Serving Those in Need
- Waiting lists for residential and community services are high and show the unmet need. Almost 350,000 people, 28,000 more than last year, are on a waiting list for Home and Community-Based Services. This requires a daunting 46 percent increase in States’ HCBS programs. 18 States, an increase from 16 last year, report no waiting list or a small waiting list (requiring less than 10 percent program growth).
The Best and Worst Performing States and Facts About the Top 10
The Best Performing States
- New Hampshire
- District of Columbia
- South Dakota
The Worst Performing States
- North Dakota
Facts About the Best Performing States
- Top Performers are both big and small States in population – “big” population States include California (biggest) and Michigan (#9) as well as “small” population States such as South Dakota (#46), Vermont (#50) and the District of Columbia (#49).
- Top Performers are both rich and poor States in terms of median family income – “rich” States include Maryland (richest), New Hampshire (2nd richest), Hawaii (3rd richest), and D.C. (5th richest) and less affluent States such as Arizona (#38), South Dakota (#31) and Michigan (#32).
- Top Performers are high tax and low tax burden States – “high tax burden” States include California (#6, tied), D.C. (#10) and Maryland (#6, tied) and “low tax burden” States include Arizona (#37), New Hampshire (#45), and South Dakota (#49).
- Top Performers are big and low spenders per person served through Home and Community-Based Services – “big spender” States are Vermont (#16) and D.C. (#2) and “low spender” States include Arizona (#49), California (#48), Michigan (#42), and South Dakota (#45).
- While Top Performers tended to trend more politically Democratic, with seven of the top ten being Blue States (according to their 2012 Presidential Election results), three Red States were in the top ten showing some political diversity.
Population and Median Family Income data is from the Kaiser Family Foundation using U.S. Census Bureau data. Tax burden data is from the Tax Foundation. And spending data is from Research and Training Center’s RISP 2016 Report.
- New Hampshire
- District of Columbia
- South Dakota
- New York
- South Carolina
- West Virginia
- New Jersey
- Rhode Island
- North Carolina
- New Mexico
- North Dakota
|Dist. of Columbia||7|
Most Improved and Biggest Drops Since 2007
District of Columbia–up 42 places: Reports a significant increase in the share of individuals (from 44 percent to 82 percent) and resources (from 10 percent to 64 percent) dedicated to those receiving home and community-based services. Now reports 93% of those served are in home-like settings.
Indiana–up 17 places: Reports an increase in the share of individuals (from 70 percent to 89 percent) and resources (from 54 percent to 67 percent) dedicated to the community and also closed 5 state institutions. In addition, Indiana receives high marks on the National Core Indicators quality outcomes, which were added to the ranking beginning in 2014.
Kentucky–up 21 places: Reports an increase in the share of individuals (from 79 percent to 97 percent) and resources (from 63 percent to 79 percent) dedicated to the community, and reduced the population at state institutions by 39 percent. In 2008, Kentucky also added a Medicaid Buy In program to support coverage when individuals work and increase their income.
Maryland–up 23 places: Substantially increased the portion of resources dedicated to people in the community (from 86 percent to 99 percent), dramatically increased the portion of people served in home-like settings (from 74 percent to 82 percent), closed the last two state institutions, started participating and reporting outcomes for the NCI.
Missouri–up 33 places: Dramatically increased the portion of resources dedicated to people in the community (from 59 percent to 88 percent), closed six state institutions (reducing by 60 percent the number of individuals isolated in large state institutions), and started participating in and reporting outcomes for the NCI.
Ohio–up 32 places: Dramatically increased the portion of resources dedicated to people in the community (from 50 percent to 65 percent) as well as the share of individuals served in the community (from 63 percent to 84 percent), closed a state institution (reducing by more than half the portion of individuals served in large institutions from 18 percent to 6 percent), started participating in and reporting outcomes for the NCI.
South Dakota–up 17 places: Primarily improved its ranking as a direct result of its high marks on the National Core Indicators quality outcomes, which were added to the ranking beginning in 2014.
Alaska–down 28 places: Fell dramatically because the number of people being served in a family home was previously estimated (by the state) at 3,700 for the 2007 ranking. Beginning with the 2010 ranking, it was reported accurately and is now at around 332 people served in a family home. Alaska now participates in NCI, but outcomes will not be available until next year.
Connecticut–down 21 places: Primarily dropped in the rankings due to a decline in the portion served in home-like settings (from 71 percent to 58 percent) and a drop of 65 percent in number of families served by Family Support. While CT remained flat in competitive employment at about 50 percent, the top scoring state (now Washington State) dramatically improved to 86 percent, meaning Connecticut lost ground (and points) to the top performers.
Idaho–down 17 places: Increased the share of individuals (from 75 percent to 93 percent) but only slightly increased the share of resources (from 51 percent to 68 percent) dedicated to community based services. Significantly reduced the portion of individuals served in home-like settings (from 92 percent to 81 percent), and now participates in the NCI but data on outcomes will not be reported until the 2017 ranking.
Massachusetts–down 22 places: Primarily dropped in the rankings as direct result in the drop in the portion of people served in home-like settings (from 76 percent to 65 percent) and a drop in competitive employment (from 43 percent to 29 percent).
Montana–down 29 places: Reported a significant (38 percentage point) reduction in the portion of individuals served in home-like settings (from 80 percent to 42 percent) and does not participate in the NCI.
New Mexico–down 27 places: Primarily dropped due to not reporting on all outcomes measures on the NCI.
West Virginia–down 17 places: Primarily dropped in the rankings due to the fact that it does not participate in NCI.
Wyoming–down 26 places: Primarily dropped in the ranking because the state just started participating in the NCI, but data will only become available for scoring in next year’s ranking. Also, the state had a drop in competitive employment (from 25 percent to 18 percent) and remained stagnant while most other states improved overall causing the state to fall in comparison to others.
Census – U.S. Census Bureau’s Annual Community Survey 2014.
Coleman – The Coleman Institute for Cognitive Disabilities, University of Colorado – The State of the States in Developmental Disabilities’ state profiles (through fiscal year 2013).
ICI – University of Massachusetts’ Institute for Community Inclusion – StateData: The National Report on Employment Services and Outcomes 2015.
Kaiser – Kaiser Family Foundation’s State Indicators – Waiting Lists for HCBS Waivers 2014.
Mathematica – Mathematica’s Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2011
NASDDDS – National Association of State Directors of Developmental Disabilities Services and Rutgers Center for State Health Policy – State Strategies for Determining Eligibility and Level of Care for ICF/MR and Waiver Program Participants 2008.
RTC – University of Minnesota’s Research and Training Center’s – In-Home and Residential Long-Term Supports and Services for Persons with Intellectual or Developmental Disabilities: Status and Trends Through 2012 – Residential Information Systems Project (RISP) – advance copies of the 2016 report provided to UCP. The 2015 report is available online.