How we grade every state's HCBS system A–F. Our data sources, composite weighting, normalization approach, and honest limitations — published so you can verify our work.
Annual HCBS waiver program report filed by every state with CMS. Primary source for waiver slots, expenditures, and unduplicated participant counts.
Transformed Medicaid Statistical Information System. State-level enrollment, service utilization, and claims data.
Waitlist survey data, per-capita HCBS spending, institutional vs. community balance ratios.
Waiver applications, renewals, and amendments filed with CMS. Source for program-specific eligibility, caps, and target populations.
National Association of State Directors of DD Services. Self-determination program status, waitlist management approaches.
Each state receives a composite score from 0–100 based on six weighted factors. Factors are normalized using min-max scaling across all 50 states plus D.C., then weighted and summed.
| Factor | Weight | Description |
|---|---|---|
| HCBS Spending Per Capita | 25% | Total HCBS expenditure divided by state population with IDD. Higher per-capita spending = more available services. |
| Waitlist Length (Months) | 25% | Average months from application to enrollment across the state's waiver programs. Shorter = better. |
| Waiver Program Count & Breadth | 15% | Number of distinct waiver programs and the range of populations served (IDD, aging, TBI, physical disability). |
| Self-Determination Availability | 15% | Whether the state offers participant-directed budgeting (full SD, partial, or none). |
| Institutional vs. Community Balance | 10% | Ratio of community-based spending to institutional spending. Higher community balance = better. |
| Application Accessibility | 10% | Online application availability, language access, intake phone responsiveness, and geographic coverage. |
Full self-determination, short waitlists (<12 mo), high per-capita HCBS spending, broad waiver inventory
Partial SD or moderate waitlists (12-24 mo), above-average spending, multiple waiver options
Limited programs, waitlists 24-48 months, average spending, narrow waiver coverage
Long waitlists (48+ mo), below-average spending, few waiver options, no SD
No DD-specific waiver or extremely limited access, institutional bias in spending
Each factor is normalized using min-max scaling: score = (value - min) / (max - min) × 100. The min and max are drawn from the full set of 50 states plus D.C. for each factor independently.
For inverse factors (waitlist length), the score is flipped: shorter waitlists produce higher scores. The final composite score is the weighted sum of all normalized factor scores, capped at 0–100.
Full refresh: Annually in Q1, when new CMS Form 372 and KFF survey data become available. All 50 states re-scored.
Interim updates: Monthly spot checks for major policy changes (new waivers, waitlist freezes, legislative action). States with material changes are re-scored mid-cycle.
Current vintage:CMS FY 2023 + KFF 2024 + state filings through April 2026. The “Live · CMS data Apr '26” badge on the homepage reflects the most recent data incorporated.
Six-factor composite model. CMS FY 2023, KFF 2024, and state filings through April 2026.