New Hampshire ranks #2 overall in the nation in how well its state Medicaid program serves Americans with intellectual and developmental disabilities, according to the 2013 Case for Inclusion. This report, produced annually by United Cerebral Palsy (UCP), ranks all 50 states and the District of Columbia on outcomes for Americans with intellectual and developmental disabilities (ID/DD). Arizona came in at the top of the list, with Vermont at #4, Connecticut at #8, and Massachusetts at #10. New Hampshire’s high ranking can be linked to the fact that we have no state institution, and a well formed, family-supported community based service system. Highlights and a link to the report are at the end of this article.

How are rankings determined? This study measures outcomes by assessing how well each state does in five categories:

  • Promoting independence (community living)

  • Promoting productivity (employment)

  • Keeping families together

  • Reaching those in need (Wait List)

  • Tracking community involvement and safety

Here is how things play out on a national basis:

Ranking: All states still have room for improvement, but some states have consistently remained at the bottom since 2007, including Arkansas (#50), Illinois (#48), Mississippi (#51) and Texas (#49).

Community Based Services: 38 states now meet the 80/80 Community standard, which means that at least 80% of all individuals with ID/DD are served in the community, and 80% of all resources spent on those with ID/DD are for community support, nearly triple the 2007 number.

Institutions: As of 2011, 13 states have no state institutions to seclude those with ID/DD. Another 10 states have only one institution each. Since 1960, 209 of 354 state institutions have been closed, leaving just 149 remaining. The Laconia State School in NH was closed in 1991.

Family Support Services: Only 15 states support a large share of families through family support. This is important, because those 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.

Employment: Just 10 states have at least 33% of individuals with ID/DD working in competitive employment, a standard which recognizes and supports work as key to a meaningful life. This measure has plummeted in recent years. In 2007, 17 states were meeting this standard. This year NH weighs in at 45%.

Waiting Lists: More than a quarter of a million people are on a waiting list for Home and Community Based Services (HCBS). Since the 2007 ranking, the size of the waiting list nationally has almost doubled from 138,000 to 268,000. However, 20 states report no waiting list or a relatively small waiting list. NH is in this category.

What does all this mean? Even though we’re doing well here in New Hampshire, we not satisfied.

We’re not satisfied because we have a Wait List. It’s too high, even though on a national basis our numbers are considered relatively small. Employment remains a challenging issue to us. There are many people who want to work, but who aren’t. We are considered stellar on the inclusion front, but the reality is that many people we support don’t have friends, are lonely, want to fall in love, don’t feel connected.

The task of helping people have real lives has been so daunting for the last generation that, even with the progress that has been made, we’re nowhere near where we need to be. Much remains to be done.

Full details on this report are available on-line at

Highlights of the 2013 Case for Inclusion Report:

  • The number of states serving 80% of individuals with ID/IDD in the community, and dedicating 80% of spending to the community, (the 80/80 Community standard) has nearly tripled, from 14 to 38, since 2007 when these outcomes started being measured. NH has been in the top 10 on this particular front since 2007.

  • The number of states with at least one third of individuals with ID/IDD employed has dropped from 17 in 2007 to 10 in 2012. The employment rate in NH, as measured by this report, is reported at 45%. (The Bureau of Developmental Services shows the current NH rate at 37%.)

  • More than 265,000 Americans are on the wait list for services, double the number from 2007. NH’s numbers, which we think are too high, are considered in the relatively small range.

  • New Hampshire’s overall ranking has continued to improve over the years. We are making progress, as evidenced in our jump from #11 in 2007 to #2 today.