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The Best States for People with Disabilities

Expert occupational therapist Megan Elizabeth Driscoll and our research team spent 60 hours ranking every state to find the best places in the U.S. to live with a disability. The top three states for 2016 were Colorado, Minnesota, and Pennsylvania.

 

Overview of Research

Under the supervision of occupational therapist, Megan Elizabeth Driscoll (MOT, OTR/L), our team spent over 60 hours researching disabilities data and statistics for this 2016 ranking.

Megan_driscoll
Megan Driscoll

MOT, OTR/L

Megan is an occupational therapist specializing in both orthopedic and neurological rehabilitation. She is currently a facility director for one of the largest rehab service providers in the state of Pennsylvania, overseeing all occupational and physical therapy, as well as vocational rehabilitation services.

We collected data across 37 types of state statistics and then categorized them into five core metrics to use when ranking each state, weighing them equally in our methodology: community accessibility, employment and economic independence, access to specialized healthcare, independent home living, and availability of disability benefits. These metrics were selected based on the most common concerns and desires of those with disabilities looking for inclusion and independent living within their communities.

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The Best States for People with Disabilities

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Percent of Medicaid and State-Funded LTSS Spending Going to HCBS (rank)
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Methodology

Our expert

Our research was guided by Megan Elizabeth Driscoll, MOT, OTR/L. A graduate of the University of Pittsburgh, Megan is an occupational therapist specializing in both orthopedic and neurological rehabilitation. She is currently a facility director for one of the largest rehab service providers in the state of Pennsylvania, overseeing all occupational and physical therapy, as well as vocational rehabilitation services. Megan and her colleagues work daily with people with disabilities, helping their quest to achieve physical independence through a combination of both treatment and education.

Megan is an active member of the American Occupational Therapy Association, the American Society of Hand Therapists, and the Pennsylvania Occupational Therapy Association. As a frequent guest lecturer at her alma mater, she also applies her insight and experience to teaching the next generation of therapists on new approaches to treating chronic pain disorders, an area that her facility is at the forefront of, and a subject on which she has seen recent industry journal publication.

How we selected which data to use in our methodology

Our expert chose a number of key data points to grade each state against; these choices were based on her assessment of the major public sources currently releasing state-level data on people with disabilities.

With our data selected, Megan identified five core metrics and assigned every data point to one of the aforementioned core metrics. In this way, the data points became sub-metrics to our core metrics. Here is how the metrics and sub-metrics break down:

Metric 1: Community Accessibility (20% of final score)

Metric 2: Employment and Economic Independence (20% of final score)

Metric 3: Access to Specialized Healthcare (20% of final score)

Metric 4: Independent Home Living (20% of final score)

Metric 5: Availability of Disability Benefits (20% of final score)

How we scored our methodology

After defining each core metric by a number of sub-metrics, we then ranked every state across all sub-metrics. The final score for each of our five core metrics was based on how each state performed in its various sub-metrics within each core metric.

For example, our #1 overall state, Colorado, ranked 4th in Employment and Economic Independence with a score of 9.4. The economic core metric is made up of nine sub-metrics. Here’s how Colorado ranked for each:

  1. Average Annual Earnings of Workers with Disabilities: 11th
  2. Employment Discrimination Charges Filed Under the ADA: 33rd
  3. Medicaid Buy-in Enrollment: 1st
  4. Percent with Annual Income Less than $15,000: 5th
  5. Percent of Workers with Disabilities with BA Degree or Higher: 1st
  6. Percent of Workers with Disabilities in Competitive Employment: 8th
  7. Percent Employed: 11th
  8. Percent Unemployed: 19th
  9. Percent Who Could Not Visit Doctor in Past 12 Months Due to Cost: 23rd

To determine Colorado’s score for the economic core metric, we converted the sub-metric rankings into scores out of 10, weighted them equally, and then averaged them. In the end, Colorado finished 4th for the economic core metric with a score of 9.4.

We then calculated Colorado’s scores for the remaining core metrics in the same manner and averaged them out (we chose to weigh them equally) to calculate its overall score.

Our expert chose equal weights across all our sub-metrics and core metrics to avoid favoring certain needs over others. Because every disability is different, each person living with one has unique needs and priorities. Applying a heavier weight to any one metric involves a high level of assumption about the overall needs of every individual using the rankings and could potentially isolate a portion of those with disabilities at the outset.

However, because it is generally accepted that the issues addressed by our five core metrics are of importance to everyone who has a disabilitiy, equal weights allow the overall rankings to apply to the widest range of disabilities. Our interactive directory and comparison tools for each core metric then allow those with weighted priorities to focus on the areas most important to them.

Drawbacks of our methodology

Ranking the best places to live for anyone, especially someone with the special needs associated with a physical or cognitive disability, is an inherently subjective endeavor. That’s why we tried to be as objective as possible, employing a purely data-driven approach. However, even with all of the statistical information at our disposal, there was still a certain level of subjectivity in choosing which metrics to focus on. Every person is unique, as is every disability. There was no way to be entirely objective and address the specific needs of every disability in every situation. With the guidance of our expert, we tried to focus only on the core metrics that addressed the basic, most common needs associated with disabilities.

But ultimately, the person living with a disability knows their needs better than anyone else. Our hope is that our interactive directory, with its personalized ranking feature, will help to compensate for any perceived drawbacks in our methodology.

Also, we understand that a majority of state data comes from its larger cities. It is important to bear in mind that there may be some instances in our rankings where those living in rural areas of a state may not see the same benefits as those living in its urban centers or larger suburbs.

Understanding Our Data

Learn about our core metrics

1. Community Accessibility back to metric

Important

20.00% of our methodology score

Central to the independent living movement is the ability for those with disabilities to physically participate in all aspects of community life. In order to be truly independent, they need to be able to freely access the same buildings, parks, and services as those without disabilities. This often includes special physical accommodations within those places. However, that access needs to extend beyond just the destinations within the community to also include the actual means of getting to them from the home. Therefore, our accessibility metric not only focuses on the physical accommodations of a state’s buildings, landmarks, and services but also on transportation and geography.

The Americans with Disabilities Act mandates that all public buildings and gathering places be accessible to those with physical disabilities. However, older buildings are often harder to make accessible, if they can be converted at all, and some newer buildings only meet the minimum requirements.

We gave high marks to states with favorable accessibility ratings from several disability advocacy groups, rankings which go beyond the physical accommodations (such as wheelchair ramps and elevators) to include services such as braille documents, ASL interpreting services, and available adaptive equipment in libraries, schools, hospitals, and all state and federal government buildings.

The one key metric missing from other rankings is the availability of public transportation. Many people with disabilities rely exclusively on transit systems for their independence. Therefore, we ranked each area based on the availability and quality of their public transit. However, even though the ADA mandates the accessibility of all public transportation, the nature of some disabilities make typical transit impractical, if not impossible. Therefore, we also gave special consideration to states with active, quality demand response paratransit services. It’s worth noting that several states with little to no general public transportation had a large number of public paratransit options, many of which are highlighted below.

We also felt it was important to analyze the cumulative “walkability” score of each state’s cities. If the geography of a community allows it to be accessed on foot, it negates much of the need for special transportation. We also gave high marks to states that received high community satisfaction responses in surveys of those with disabilities.

Important caveats and notes: Some transit data and walkability scores only reflect larger cities and suburbs, not a state’s rural communities. However, we feel we’ve gathered more than enough statewide data to make a fair overall ranking.

Highest Scoring States in Community Accessibility
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2. Employment and Economic Independence back to metric

Important

20.00% of our methodology score

One of the key components of independent living for any individual is a steady income. For those with disabilities, that income takes on even greater importance as it is often used to pay for required health care, special living accommodations, transportation, or any other unique financial concerns that exist in addition to the basic necessities of everyday living. Our economic metric focuses on the job market in each state for people with disabilities who are willing and able to work.

Within this metric we analyzed job statistics for workers with disabilities such as employment and unemployment percentages, average income, and minimum earnings. We also gave special consideration to the percentage of those workers with disabilities who are in competitive employment, which is defined as work performed in an integrated setting at a rate comparable to workers without disabilities performing the same tasks.

Unfortunately, one problem that still plagues the communities with disabilities is discrimination by employers who are unable or simply unwilling to provide the reasonable accommodations necessary for a worker with disabilities to perform their duties. Therefore, we also made sure to research the number of discrimination charges filed under the ADA in every state for the previous year.

Important caveats and notes: Our economic metric does not necessarily reflect the needs of those individuals whose disability prevents them from working. Those concerns are addressed in our disability benefits metric. However, this metric does take into consideration those who receive disability benefits but still wish to work through a close analysis of each state’s participation in the Medicaid Buy-in program. The program workers with disabilities to receive income from employment without disqualifying them from disability benefits.

Highest Scoring States in Employment and Economic Independence
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3. Access to Specialized Healthcare back to metric

Important

20.00% of our methodology score

Those living with disabilities often have special healthcare needs beyond those of people living without. These needs often require specialists in addition to the general physicians and hospitals readily-available in many areas. Existing rankings focus solely on their own hospital system ratings and the number of family physicians in an area. But statistically, patients with disabilities visit general physicians at the same frequency as those without disabilities. Instead, our ranking focuses on the more important issue of access to healthcare specialists in fields relevant to those with disabilities, access that can vary greatly from state to state.

We first researched and ranked the specialist-to-patient ratio for a number of relevant healthcare occupations in each state, including surgeons, occupational and physical therapists, speech language pathologists, and rehabilitation counselors.

And because of the monetary limitations of many patients with disabilities, we also analyzed healthcare costs and financial statistics specifically associated with disabilities in each state.

Important caveats and notes: Every disability, as with every person, has its own unique healthcare needs. Your desired specialty service may not be included in these rankings. However, under the advice of our expert, we surveyed a wide sampling of healthcare specialties that address the needs of the most common disabilities and had readily available data.

Highest Scoring States in Access To Specialized Healthcare
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4. Independent Home Living back to metric

Important

20.00% of our methodology score

One of the main causes of the original disability rights movement was the de-institutionalization of people with disabilities. The modern extension of that is the independent living movement, which continues to advocate accessibility and the choice of at-home living for those with disabilities, as opposed to nursing and long-term care facilities. Choice is one of the most important aspects of inclusion. Those living with disabilities want to dictate their own lives, not have society do it for them. But too often, that choice is taken away and many people with disabilities are forced into assisted living facilities because of a lack of accommodations that would allow them to live independently in their own homes. This metric looks at the independent living potential of each state.

Unfortunately, because of the fixed income of many people living with a disability, independent living can be cost prohibitive. In some cases, the costs of necessary in-home care also add to that burden. Therefore, in addition to homeownership and living statistics, we also examined the relative costs of at-home living in each state.

Important caveats and notes: Illinois and Iowa did not release statistics relating to the percentage of their population with disabilities living independently in their own home, which did negatively affect their ranking. However, there was available data for all of the remaining sub-metrics, which allowed us to make a fair assessment.

Highest Scoring States in Independent Home Living
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5. Availability of Disability Benefits back to metric

Important

20.00% of our methodology score

A growing percentage of the population has a disability so severe that it either prevents them from working or greatly limits their earnings. In those cases, they often rely on Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) payments. Because disability determinations are most often made through state agencies, benefits vary by state. This metric focuses on those variations.

Specifically, we examined enrollment statistics, approval percentages, wait times, and average monthly payments for all types of people with disabilities. We also gave special consideration to states with unmatched funds available for additional Medicaid funding.

Important caveats and notes: The Medicaid Buy-in and Ticket to Work programs allow those with disabilities to work while still receiving benefits. Though they are disability benefit programs, we chose to apply those statistics to our employment core metric instead. Also, several states did not release their benefit statistics, which did negatively affect their rankings. However, we feel that there was enough total information across all of the sub-metrics to conduct a fair review.

Highest Scoring States in Availability of Disability Benefits
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Editor's Awards

Colorado

Colorado leads the way in disability inclusion for 2016 with strong signs of financial independence and high marks in accessibility and healthcare.

While the definition of livability is multi-faceted, each aspect influences the other in some way. Of all the states, Colorado ranked among the highest in both economic independence and disability benefits. The influence of that financial security is clear in the state’s top-tier ratings for independent living.

With an above average benefit approval of 39%, Colorado ranks 13th in the nation. And with an equally strong ranking for processing time, benefits are in the hands of those who need them quicker than in most other states. The amount of those benefit payments are statistically higher too. Colorado has top five and six rankings for each disbursement category, with workers receiving an average of $1280, widows $745, and adult children $577 monthly. For those with disabilities who are willing and able to work, Colorado ranked first in Medicaid Buy-in and Ticket-to-Work participation, which allows workers to receive income from employment without disqualifying them from benefits.

And those who are working with disabilities in the state rank among the highest in competitive employment rates, average annual salaries, and education level. They also have one of the lowest percentages of workers with disabilities living below the poverty line. The positive economic environment of the state, coupled with a low average annual cost for in-home care, also contributes to one of the higher percentages of individuals with disabilities living in their own home.

While there is still room for improvement in specialized healthcare and some aspects of community accessibility, Colorado is currently the most inclusive state in the country and doesn’t look to drop out of the top five states anytime soon.

Drawbacks:

  • Colorado has some of the lowest per capita disability-related health care expenditure rates in the country, as well as a low percentage of healthcare expenditures associated with a disability.
  • Colorado did have solid public transportation and paratransit scores, but some rural areas of the state are underserved.

Ranking Results:

  • Community Accessibility – 7.6/10
  • Employment and Economic Independence – 9.4/10
  • Access to Specialized Healthcare – 7/10
  • Independent Living – 7.8/10
  • Availability of Disability Benefits – 9.6/10



Illinois’ public and paratransit systems, along with high satisfaction and walkability scores, make it this year's most accessible state.

One of the key provisions of the ADA is accessibility to public buildings and meeting places. Yet, despite the federal mandate, some states are still lacking in their accommodations, which is why accessibility remains one of the main campaign topics of the independent living and inclusion movements. While every state has room for improvement, some are considerably more advanced, with Illinois being the current leader.

As previously discussed, one of the main problems affecting community accessibility is transportation for those with disabilities. Illinois has one of the top public transit systems in the country, currently ranking third for annual ridership and sixth overall for public transportation funding. Of course, this speaks, at least in part, to the state’s considerable infrastructure and population. It’s arguable more important to see how the state fared in terms of paratransit services. Currently, the state averages over 2.5 million annual paratransit trips, the fourth highest total in the country. When combined with their ADA accessible public transit services, passengers with disabilities have more transportation options in Illinois than virtually anywhere else in the country. Add to that high walkability, building accessibility, and community satisfaction scores, and it becomes clear the destinations people with disabilities in Illinois are being transported to are as accommodating as the transit services themselves.

Though it did suffer from lower economic and healthcare scores, solid marks in benefits and independent living combine with its exceptional accessibility ranking make Illinois a solid state to live a disability, finishing 7th in our overall rankings.

Drawbacks:

  • The state had low scores in specialized healthcare and employment.
  • Illinois did not release data for some our independent living sub-metrics.

Ranking Results:

  • Community Accessibility – 10/10
  • Employment and Economic Independence – 5.6/10
  • Access to Specialized Healthcare – 6/10
  • Independent Living – 6.6/10
  • Availability of Disability Benefits – 7.2/10



With the highest competitive employment rates and the lowest unemployment rates in the country, North Dakota has the highest potential for economic independence.

Though it does rank in the lower half of other key metrics, North Dakota provides the most opportunity for those individuals with disabilities who are willing and able to work. While it does only rank in the mid-range for annual salary, top marks in both employment rates and competitive employment percentages, coupled with the lowest unemployment rate for those with disabilities, it is the state with the best chance for financial success

Drawbacks:

  • North Dakota had low scores in accessibility and independent living.
  • The state ranks in the mid-range for average annual salary.

Ranking Results:

  • Community Accessibility – 2.6/10
  • Employment and Economic Independence – 10/10
  • Access to Specialized Healthcare – 7/10
  • Independent Living – 3.6/10
  • Availability of Disability Benefits – 6.2/10



Connecticut has one of the highest concentrations of healthcare specialists and some of the lowest disability-related care costs in the nation.

Connecticut ranks in the top ten in seven out of ten sub-metrics in our healthcare category. Most of those top scores are in the area of healthcare specialists, giving the state one of the highest concentrations of specialized medical personnel in the country. It also ranked very high in both the percentage of expenditures and annual expenses associated with disabilities. So not only are there more healthcare options to choose from, but they also tend to cost less than in other states.

Drawbacks:

  • The state has a high percentage of adults with a disability living at or below 250% of the poverty level.
  • Connecticut has one of the highest cost of living indexes.

Ranking Results:

  • Community Accessibility – 6.4/10
  • Employment and Economic Independence – 6.2/10
  • Access to Specialized Healthcare – 10/10
  • Independent Living – 3.8/10
  • Availability of Disability Benefits – 8.2/10



With one of the lowest cost of living indexes in the country, high home ownership rates, and a large percentage of people with disabilities living independently, Idaho currently provides the most home choices.

A top three cost of living index rating and below average annual in-home care costs combine to contribute to Idaho’s home ownership rate and independent living percentage among its residents with disabilities. It also ranks in the top tier of state funding for home and community based services, making it a very attractive option for those whose main concern is living independently in their own home.

Drawbacks:

  • Though it has a high percentage of accessible homes, Idaho has a low overall community accessibility ranking.
  • The state has a high per capita for disability-related health care expenditures.

Ranking Results:

  • Community Accessibility – 2/10
  • Employment and Economic Independence – 6.8/10
  • Access to Specialized Healthcare – 3/10
  • Independent Living – 10/10
  • Availability of Disability Benefits – 3.6/10



Hawaii has the highest approval percentage and one of the fastest processing times for disability benefit claims.

At 63%, Hawaii has the highest disability claim approval rates in the country. It also ranks in the top five for processing time and among the highest for annual average payments. For those people living with disabilities who either can’t work or need supplemental benefits in addition to their income, Hawaii is the best choice for receiving them.

Drawbacks:

  • Hawaii ranked among the bottom ten for healthcare accessibility.
  • The state also received low scores in home living independence.

Ranking Results:

  • Community Accessibility – 6.6/10
  • Employment and Economic Independence – 9/10
  • Access to Specialized Healthcare – 2/10
  • Independent Living – 3/10
  • Availability of Disability Benefits – 10/10

Last Updated on April 4, 2016

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