Key Takeaways:
- A small number of states have eliminated their developmental disability (DD) waiver waitlists – some holding that status for over two decades – though the specifics vary by waiver type and program structure.
- The single biggest factor separating the best states from the rest is whether HCBS access functions as an entitlement (qualify and receive services) or a limited-slot program (qualify, then wait).
- The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, cuts roughly $900 billion to $1 trillion from Medicaid over the next decade – putting even the best-performing states under significant pressure.
- Diamonds of Disability provides a full 10-state breakdown.
- No single state is the right fit for every disabled adult – housing costs, provider availability, and climate all shape which state actually works for a specific person’s needs.
Choosing the right state can be one of the most consequential decisions a disabled adult or their family makes. The gap between a state with a 10-year HCBS waitlist and one with no waitlist at all is not a minor administrative difference – it determines whether someone gets to live in their community or waits years without proper support.
Several States Have Moved Toward Eliminating DD Waitlists
Most people do not realize how few states have actually closed the gap. Across the country, over 600,000 people are on HCBS waiver waitlists at any given time, according to KFF data. But a handful of states – Minnesota, Oregon, and Wisconsin – have built systems where eligibility plays a central role in determining access – reducing or eliminating waiting lists for key programs.
What separates these states is not just funding levels. The mechanism behind service access matters. Entitlement-based programs and legal settlements create enforcement pressure that budget-dependent waiver programs simply do not have.
How These States Were Ranked
Eight Categories, Real-World Outcomes
The rankings are built on eight categories that directly affect daily life for disabled adults: Medicaid waiver access, in-home caregiver support, housing affordability, transportation, vocational rehabilitation, overall affordability, state tax treatment, and disability services infrastructure. Waitlist status is weighted heavily – because a waiver program with a 7-year wait is not meaningfully accessible to someone who needs help today.
The Top 10 States for Disabled Adults
Minnesota: Reduced DD Waitlist Pressure Through County-Based Reform
Minnesota ranks first. The AARP LTSS Scorecard placed Minnesota at the top in its most recent 2023 report cycle, and the state’s disability infrastructure has remained consistently strong. Minnesota eliminated the CADI waiver waitlist and implemented urgency-based access reforms for the DD waiver, significantly reducing wait times through a county-based coordination model. When someone meets eligibility criteria in Minnesota, they are connected to services through a structured priority system rather than an open-ended queue.
Minnesota’s Consumer Directed Community Supports (CDCS) program lets disabled individuals hire and direct their own caregivers, including family members. Vocational rehabilitation outcomes are consistently among the nation’s best.
The honest tradeoff: Minnesota is not cheap. The Twin Cities is one of the pricier Midwest metros, and direct support professional shortages in rural areas are a persistent real-world problem.
Washington: Strong HCBS Infrastructure, No State Income Tax on Wages
Washington ranked second in the 2023 AARP LTSS Scorecard, just behind Minnesota. Its personal care and attendant services are available without an enrollment cap through its state plan structure. Washington’s Consumer Directed Employer (CDE) model gives disabled adults significant control over who provides their care, including the ability to hire individual providers – sometimes family members. The no-state-income-tax advantage is real money for anyone on a fixed income: SSDI, SSI, and pension income face zero state income taxation.
The honest tradeoff: The federal SSI maximum stretches much further in Spokane than in Seattle – city selection inside Washington matters enormously.
Massachusetts: Strong HCBS Programs and Near-Universal Disability Coverage
Massachusetts ranks at the top of WorldPopulationReview’s 27-factor disability index and third here, because the weighting prioritizes waitlist access and housing affordability – two categories where Massachusetts has real challenges for lower-income disabled adults. What pushes it to the top tier: a very high rate of disabled residents with health insurance. The MassHealth PCA Program uses full consumer direction, and the state has one of the highest concentrations of Medicare providers per capita nationally. For complex medical needs, Massachusetts is genuinely exceptional.
The honest tradeoff: Boston’s housing market is among the most expensive in the country.
Oregon Through Colorado: Ranks 4-10
Oregon: Only state to eliminate DD waiver waitlist through legal action — and maintain it for 25+ years. Strong CFC participation. No sales tax.
Vermont: 98% health insurance coverage rate. Lowest healthcare costs in region. Strong state supplemental payments. Highly regarded holistic care model.
New York: robust state supplemental SSI payments. Extensive urban accessibility infrastructure and nonprofit disability services ecosystem.
Maryland: on track for 50% DD waitlist reduction by 2028.
New Jersey: strong median wages for disabled workers.
Colorado: heavy investment in HCBS programs and accessible urban areas.
Honorable Mentions Worth Knowing
Five states that nearly made the top 10 deserve attention depending on individual circumstances: Connecticut (strong healthcare access, CFC participant, expensive housing); Hawaii (strong disability rights protections, state SSI supplements, year-round accessibility – offset by extremely high living costs); Rhode Island (strong services in a small, navigable state, more affordable than neighboring Massachusetts); North Dakota (Policygenius ranks it first nationally for living with a disability, with strong employment outcomes and exceptional affordability – but a smaller overall service ecosystem); and Maine (strong HCBS waiver programs with active waitlist reduction goals, low healthcare costs – challenged by severe rural transportation gaps).
What Makes Waitlist Elimination Stick?
Legal Settlements vs. Legislative Mandates
Oregon’s no-waitlist status survived 25 years because it came from a legal settlement – courts can enforce compliance in ways that budget cycles cannot easily undo. Minnesota’s reforms came through sustained legislative and county-level commitment. Maryland’s End the Wait Act represents a third path: a mandated trajectory with a specific deadline, creating accountability even where full elimination has not yet been achieved. The common thread in all three is enforceability – someone is legally on the hook if the commitment slips.
Entitlement Structure: The Access Difference
Some states have converted personal care and attendant services from waiver-based programs – limited slots, possible waitlists – into state plan entitlements or enrollment-cap-free programs. Anyone who qualifies receives services. That structure is what makes a no-waitlist commitment durable rather than temporary. Washington and Massachusetts are confirmed participants in the Community First Choice (CFC) state plan option; other top-ranked states achieve similar access through alternative program structures.
Federal Pressure Threatening Every Top State
Medicaid Cuts and the OBBBA’s Long-Term Risk
The One Big Beautiful Bill Act, signed July 4, 2025, cuts approximately $900 billion to $1 trillion from Medicaid over the next decade. Harvard Medical School’s Lisa Iezzoni, speaking to Newsweek about the impact of these cuts, warned that even generous states might reduce services like personal care assistants – the very services that allow people with disabilities to live independently in their own homes. States with entitlement-based programs and legal mandates are the most resistant to these cuts – but none are immune.
The DOJ’s Olmstead Reversal Adds New Risk
In June 2026, the Department of Justice issued a legal opinion stating that federal disability rights laws do not require states to provide services that allow disabled people to remain in their homes rather than institutions. This directly contradicts the 1999 Olmstead v. L.C. Supreme Court ruling, which had anchored community integration policy for a generation. Some states facing ongoing disability rights lawsuits have already cited the memo in court filings. The ACLU’s Disability Rights Program director Zoe Brennan-Krohn called it “very troubling and very dangerous” – a warning that enforcement of integration mandates may weaken even where the underlying law has not changed.
No State Fits Every Disabled Adult
The state that ranks first for someone with a developmental disability may be the wrong choice for someone whose primary need is affordable housing near specialized medical providers. Climate, housing costs, provider availability, family proximity, and the specific type of disability services needed all shape which state actually works for a given person. These rankings reflect how states perform across eight categories on average – they are a framework, not a final answer.
Use this list to narrow the field, then investigate the specific situation before making any major decisions. For a deeper look at disability resources, state-by-state comparisons, and practical guidance for disabled adults and their families, visit Diamonds of Disability – a resource built to help disabled adults navigate their options with clear, honest information.
Diamonds of Disability
260 South 1200 West
Orem
Utah
84058
United States
