WAIVER GRADES
Every US state and the District of Columbia, graded A–F on the Medicaid waiver system a family actually has to use. Six factors, normalized across all 51 jurisdictions and combined into a single 0–100 composite — so a grade tells you how your state compares to the rest of the country on the same measures.
Methodology v1.0, last updated May 2026. Built from CMS Form 372, T-MSIS / MACPro, Kaiser Family Foundation, State Agency Filings, NASDDDS / State DD Agency Reports. Data vintage: CMS FY 2023 · T-MSIS CY 2023 Q4 · KFF 2024 survey · state filings checked monthly. Read the full methodology, including each source’s refresh cycle and the limitations we know about.
The full ranking
Ranked by composite grade, then alphabetically within a grade. Waitlist status is reproduced as the state publishes it; “Not published” means the state does not disclose one, which is itself a finding.
| Rank | State | Grade | Waivers | Published waitlist status | Verified |
|---|---|---|---|---|---|
| 1 | California | A+ Grade A+ — strong: full self-direction, short waits | 2 | Lanterman Act entitlement via Regional Center eligibility — no traditional waitlist when eligible. | 2026-06-26 |
| 2 | Arizona | A Grade A — strong: full self-direction, short waits | 3 | NO waitlist — ALTCS is an entitlement for those meeting medical/functional criteria. | 2026-07-03 |
| 3 | Oregon | A Grade A — strong: full self-direction, short waits | 3 | NO waitlist — K Plan is a state plan entitlement. | 2026-07-03 |
| 4 | Connecticut | A- Grade A- — strong: full self-direction, short waits | 3 | DDS manages access by priority; verify with your DDS case manager. | 2026-07-03 |
| 5 | District of Columbia | A- Grade A- — strong: full self-direction, short waits | 3 | Eligibility through DDA intake; DC historically enrolls without long waitlists. | 2026-07-03 |
| 6 | Massachusetts | A- Grade A- — strong: full self-direction, short waits | 3 | DDS prioritization applies; verify with your area office. | 2026-07-03 |
| 7 | New Jersey | A- Grade A- — strong: full self-direction, short waits | 3 | Enrollment after DDD eligibility + Medicaid; no traditional waitlist. | 2026-07-03 |
| 8 | New York | A- Grade A- — strong: full self-direction, short waits | 1 | Access starts through the OPWDD Front Door intake and eligibility process. | 2026-06-26 |
| 9 | Colorado | B+ Grade B+ — good: partial self-direction, moderate waits | 5 | Long waitlist by order-of-selection date — enroll through your Case Management Agency early. | 2026-07-03 |
| 10 | Maryland | B+ Grade B+ — good: partial self-direction, moderate waits | 5 | DDA waiting list by priority category; transitioning youth get priority at 21. | 2026-07-03 |
| 11 | Minnesota | B+ Grade B+ — good: partial self-direction, moderate waits | 4 | County-administered; MnCHOICES assessment sets budget. | 2026-07-03 |
| 12 | Ohio | B+ Grade B+ — good: partial self-direction, moderate waits | 5 | Managed by County Boards of DD; waitlist varies by county. | 2026-07-03 |
| 13 | Rhode Island | B+ Grade B+ — good: partial self-direction, moderate waits | 2 | Eligibility through BHDDH DD Division; consent-decree reforms expanded community services. | 2026-07-03 |
| 14 | Vermont | B+ Grade B+ — good: partial self-direction, moderate waits | 2 | Funding priorities set annually in the System of Care Plan. | 2026-07-03 |
| 15 | Washington | B+ Grade B+ — good: partial self-direction, moderate waits | 4 | DDA enrolls by service need; request the No-Paid Services caseload if waiting. | 2026-07-03 |
| 16 | Delaware | B Grade B — good: partial self-direction, moderate waits | 2 | Delaware combined its DD waivers into Lifespan; verify enrollment timing with DDDS. | 2026-07-03 |
| 17 | Hawaii | B Grade B — good: partial self-direction, moderate waits | 2 | Hawaii generally enrolls eligible applicants; DDD case managers control service levels. | 2026-07-03 |
| 18 | Illinois | B Grade B — good: partial self-direction, moderate waits | 5 | PUNS database selection — enroll in PUNS and update yearly; selections are need+date based. | 2026-07-03 |
| 19 | Maine | B Grade B — good: partial self-direction, moderate waits | 3 | Priority-based waitlist; ask OADS for your priority level in writing. | 2026-07-03 |
| 20 | Michigan | B Grade B — good: partial self-direction, moderate waits | 4 | Slots held by CMHSPs; ask your CMH for HSW screening — many eligible people are never told about it. | 2026-07-03 |
| 21 | New Hampshire | B Grade B — good: partial self-direction, moderate waits | 3 | Funded through the state 'wait list' budget line; ask your Area Agency about funding year timing. | 2026-07-03 |
| 22 | Pennsylvania | B Grade B — good: partial self-direction, moderate waits | 4 | PUNS-based emergency/urgent prioritization; document crisis factors. | 2026-07-03 |
| 23 | Virginia | B Grade B — good: partial self-direction, moderate waits | 4 | Priority 1-3 waitlist ~13,000 statewide; slot assignment via regional committees. | 2026-07-03 |
| 24 | Wisconsin | B Grade B — good: partial self-direction, moderate waits | 4 | Wisconsin eliminated the CLTS waitlist statewide — every eligible child must be served. | 2026-07-03 |
| 25 | Florida | C+ Grade C+ — mixed: limited programs or long waits | 1 | Long Prioritization List except crisis cases; document urgent risks and category changes quickly. | 2026-06-26 |
| 26 | Indiana | C+ Grade C+ — mixed: limited programs or long waits | 4 | Multi-year waitlist by application date — apply the day of diagnosis. | 2026-07-03 |
| 27 | Iowa | C+ Grade C+ — mixed: limited programs or long waits | 4 | Managed through MCOs with state waitlist; verify timing with Iowa Medicaid. | 2026-07-03 |
| 28 | Nebraska | C+ Grade C+ — mixed: limited programs or long waits | 3 | Registry by application date — register at diagnosis, even for young children. | 2026-07-03 |
| 29 | Nevada | C+ Grade C+ — mixed: limited programs or long waits | 3 | Served through regional centers (Desert, Sierra, Rural); verify slot timing. | 2026-07-03 |
| 30 | North Carolina | C+ Grade C+ — mixed: limited programs or long waits | 4 | Registry of Unmet Needs exceeds 16,000 — register the day you have a diagnosis. | 2026-07-03 |
| 31 | Utah | C+ Grade C+ — mixed: limited programs or long waits | 2 | Capped funds can move faster than full waiver services; stay active with DSPD and update needs. | 2026-06-26 |
| 32 | Alaska | C Grade C — mixed: limited programs or long waits | 4 | Registry-based selection with annual draws; keep your registry review current. | 2026-07-03 |
| 33 | Idaho | C Grade C — mixed: limited programs or long waits | 3 | Idaho enrolls eligible adults; budget set by assessment. | 2026-07-03 |
| 34 | Kansas | C Grade C — mixed: limited programs or long waits | 4 | ~10-year waitlist historically — sign up through your CDDO immediately. | 2026-07-03 |
| 35 | Kentucky | C Grade C — mixed: limited programs or long waits | 3 | Very long waitlist — apply immediately and keep contact info current. | 2026-07-03 |
| 36 | Missouri | C Grade C — mixed: limited programs or long waits | 5 | Regional office intake; crisis prioritization. | 2026-07-03 |
| 37 | Montana | C Grade C — mixed: limited programs or long waits | 2 | Waitlist with crisis-first selection; document caregiver strain in writing. | 2026-07-03 |
| 38 | New Mexico | C Grade C — mixed: limited programs or long waits | 4 | New Mexico cleared its decades-long waitlist in 2022-2023 — allocations now come much faster. | 2026-07-03 |
| 39 | North Dakota | C Grade C — mixed: limited programs or long waits | 3 | North Dakota historically enrolls without long waitlists — apply through regional Human Service Centers. | 2026-07-03 |
| 40 | South Carolina | C Grade C — mixed: limited programs or long waits | 5 | Waitlist managed by DDSN; keep annual contact updates. | 2026-07-03 |
| 41 | South Dakota | C Grade C — mixed: limited programs or long waits | 3 | Served through Community Support Providers; verify capacity. | 2026-07-03 |
| 42 | Wyoming | C Grade C — mixed: limited programs or long waits | 3 | Individual budget model; verify timing with the Behavioral Health Division. | 2026-07-03 |
| 43 | Arkansas | D+ Grade D+ — weak: long waits and low spending per capita | 3 | Multi-year waitlist; recent funding rounds have pulled thousands off — keep contact info current. | 2026-07-03 |
| 44 | Georgia | D+ Grade D+ — weak: long waits and low spending per capita | 5 | Long planning list; short-term entry often starts with crisis documentation. | 2026-07-03 |
| 45 | Louisiana | D+ Grade D+ — weak: long waits and low spending per capita | 5 | Louisiana replaced first-come lists with urgency-of-need screening (SUN) — request a screening update after any change. | 2026-07-03 |
| 46 | Oklahoma | D+ Grade D+ — weak: long waits and low spending per capita | 4 | Oklahoma cleared its 13-year waitlist in 2022-2023 — new applications process much faster now. | 2026-07-03 |
| 47 | Tennessee | D+ Grade D+ — weak: long waits and low spending per capita | 3 | Enrollment targets by group; apply through TennCare health plans. | 2026-07-03 |
| 48 | Texas | D+ Grade D+ — weak: long waits and low spending per capita | 2 | Severe interest lists, often 10-15+ years; register on the Interest List early through your LIDDA. | 2026-06-26 |
| 49 | West Virginia | D+ Grade D+ — weak: long waits and low spending per capita | 4 | Managed enrollment list moves slowly; annual anchor date matters — apply early. | 2026-07-03 |
| 50 | Alabama | D Grade D — weak: long waits and low spending per capita | 4 | Waitlist managed through regional 310 boards; document urgent needs. | 2026-07-03 |
| 51 | Mississippi | D Grade D — weak: long waits and low spending per capita | 4 | Long waitlist; 1915(i) Community Support Program can start sooner. | 2026-07-03 |
What goes into a grade
The composite is fully disclosed. These weights are imported from the same module /methodology renders, so the two pages cannot state different numbers.
Each factor is normalized with min-max scaling across all 50 states plus DC — score = (value − min) / (max − min) × 100 — then combined as a weighted sum capped at 0–100. Inverse factors such as waitlist length are flipped so shorter is better. A grade therefore reflects how a state compares to the rest of the country on the same measures.
| Factor | Weight | What it measures |
|---|---|---|
| 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. |
Disclosure
SpectrumPathways' founders also lead Horizons of Hope Foundation, a California 501(c)(3) that works on California's Self-Determination Program. California receives the highest grade in this index. Grades are set from the published sources and weights above; we disclose the affiliation so you can weigh it yourself.
Journalists, researchers and advocacy organizations: take this.
The grade letters and the ranked table on this page — our own editorial output, not the surrounding text and not the underlying source data, which remains subject to its publishers’ terms — are offered under a Creative Commons Attribution 4.0 licence. Republish the table, chart it, quote a single state’s grade — no permission needed. We ask for a credit, a link, and the version string, so a reader can check the methodology for themselves.
Grades are an editorial composite intended for orientation and comparison. They are not a determination of eligibility, entitlement, or service availability in any state, and no warranty is given as to fitness for any particular purpose.
The PDF is the print-and-hand-out version: all 51 jurisdictions ranked, what each factor measures, and what a family should do next. Case managers, school teams and clinics are welcome to distribute it, logo alongside the attribution.
SpectrumPathways.ai. “Waiver Grades: All 50 States + DC Ranked A–F,” v1.0, published 2026-08-24 (data: CMS FY 2023 · T-MSIS CY 2023 Q4 · KFF 2024 survey · state filings checked monthly). https://www.spectrumpathways.ai/waiver-grades
Working on a story about your state’s waitlist? Email hello@spectrumpathways.ai and we will send the underlying figures and the source links for that state.
Looking up your own state?
Every state page breaks the grade down into the waivers you can actually apply for, who runs intake, and what the appeal deadline is.
