According to the Centers for Disease Control and Prevention (CDC), 61 million Americans live with a disability. That’s over a quarter of the U.S. population. And of people age 65 or older, 40% have a disability.
The Americans with Disabilities Act (ADA) is one form of legal protection for people living with disabilities. The legislation makes it illegal to discriminate against individuals with disabilities in any area of public life, including work, business, school, transportation, and all other places open to the general public. The law doesn’t require a community to provide public transportation, but if the community does then it must be ADA-compliant.
Even with ADA requirements, living with a disability presents many challenges. For example, areas where public transportation is not fully ADA-compliant can make it difficult to work or simply get around.
Data from the CDC also shows that one in three Americans with a disability has health care needs they haven’t addressed because of high costs. The high cost of health care in general plays a part in this, but so does the fact that people with disabilities typically earn lower wages than the average person. Census Bureau data shows that the median annual earnings for people with disabilities is $10,650 less than for people not living with a disability.
For the most up-to-date data, read our best states for living with a disability in 2021, which includes 12 additional data factors and a look how COVID-19 has affected people living with disability.
What makes a state better or worse for residents with disabilities?
Policygenius created this index to paint a clearer picture of which states are more livable for Americans with disabilities. Using the most recent data available, including the latest government-reported data, we compared all 50 states and Washington, D.C., across more than two dozen factors. The factors are grouped into four categories:
economic data, including income and the unemployment rate for residents with a disability
affordability, including housing costs as a percent of income
livability, how easy it is for residents to get around
the state of health care and insurance
Comparing data across these four areas allows someone to make a more informed decision about how well their individual needs will be met in each state. For example, someone who drives may not be as worried about moving to a state with good public transportation. But they may want to reconsider if they rely on Medicare and are moving to a place without many Medicare providers.
A higher ranking indicates a higher average score across the four categories, and therefore a better place to live if you have a disability. We’ve included more detailed information on where we got our data and how we created the index at the end of this article.
Exploring the index
The top half of the index is largely states in the Northeast, Midwest, and Pacific Northwest. Southeastern states found themselves toward the end of the list, with Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina all ranking in the bottom 10.
States at the bottom of the ranking struggled particularly in the economic category. Across the bottom 10, unemployment for residents with disabilities in the workforce averaged more than 15% and the average poverty rate was more than 21%.
The California example
To explain how our data came together, and how this index can help you make a personal decision on where to live, it’s useful to look at an example. Let’s consider California.
Overall, the index rankings give the average person an understanding of how suitable each state is for people with disabilities to live in. But looking at the data within each category allows you to focus on the aspects of the index that matter more to you personally.
For example, the Golden State ranks 45th on our index, which means it has a low overall score, but not necessarily that it scored poorly in every category. In fact, California scored seventh-highest in the livability category because it’s a generally walkable state with good public transportation and almost all of the public transit stations are ADA accessible.
For the economic category — although California scored 10th worst — it has the 16th-highest annual earnings ($23,773) for residents with disabilities. Unfortunately, other economic factors, like the high unemployment and low labor force participation, overshadow the high income to bring down the overall economic score.
So because California ranks 45th overall, it may not be the best choice for the average person. But because it still does well in certain areas, it could be a suitable home for people who value the ease of getting around and who can afford the high cost of living. The maps above detail how states score in each category to help you compare according to the factors that matter most to you.
Massachusetts tops our index thanks in large part to the fact that it has the second-best livability score and the fourth-best health care score. On the livability side, the Bay State ranks in the top 10 for its walkability and for its public transit.
As for health care, 98.3% of residents with disabilities have health insurance. That’s the highest rate in the country. The number of Medicare providers per capita is also fourth-highest in the country.
The unemployment rate for residents who have a disability and are in the labor force is high — at 15% it’s 15th-highest — but the median annual earnings of $23,984 is also 15th-highest in the country.
Coming in at number two, Pennsylvania is a very livable state. In fact, it earned the top livability score out of all the states. Pennsylvania has the ninth-most-used public transit and the third best transit score, which is a metric that looks at the accessibility of public transportation in the state’s biggest cities. If you’re looking to get some fresh air, the Keystone State is also the fourth-most-walkable in the country.
In terms of affordability, Pennsylvania ranks in the top half for its minimum livable wage of $11.45 per hour. That’s the wage a single adult would need in order to comfortably meet the cost of living in Pennsylvania. Annualized, that wage comes very close to the median annual earnings for residents with a disability ($21,696).
Most residents with disabilities are also insured, with 95.6% having health insurance. That’s the 13th-highest rate in our study. Medicare recipients have the seventh-lowest average Medicare bill at just $32.
Vermont, our third-best state for living with a disability, ranks in the top 16 for three out of the four scores we used: health care, livability, and economic data.
Residents with disabilities in Vermont have the second-highest rate of health insurance coverage at 97.7%. Only Massachusetts has a higher coverage rate. And while the median annual earnings are relatively low at $20,427, unemployment is 12th-lowest at 11%.
When it comes to getting around, Vermont is in the top five for its public transit accessibility and it has a top-10 score for its level of walkability.
North Dakota is our only Midwestern state in the top 10, and it does particularly well in the economic and affordability metrics. Residents with a disability who are in the labor force have the lowest unemployment rate in our study at just 6%. Only two other states even have a rate below 10% (Nebraska and South Dakota at 9%).
The median earnings of $24,809 are 10th-highest and the poverty rate for those with a disability is 15th-lowest at 19%. Living in the Peace Garden State is also affordable. The median monthly housing cost of $782 is ninth-lowest, and the minimum hourly wage needed to live comfortably is 15th-lowest at $11.12.
The health care in Maryland plays a big part in the state’s top-five ranking. About 96% of residents with disabilities have health insurance and the density of Medicare providers is among the 10 highest in the country. The state also ranks in the top five for its average Old Age, Survivors, and Disability Insurance (OASDI) benefit of $1,118 and its Social Security Disability Insurance (SSDI) benefit of $1,242. These are both slightly above the average U.S. benefits, which are about $1,060 for OASDI and $1,197 for SSDI benefits.
The OASDI program awards benefits to partially replace income that is lost because of old age, the death of a spouse, or a disability. The Social Security Administration awards SSDI benefits to people who can't work because of a medical condition that's expected to last at least one year or result in the person’s death.
On the economic side, Marylanders with disabilities have median annual earnings of $30,031. Only one state (Alaska) earns more. Livability is also high with Maryland ranking 16th in that category.
The median annual earnings and the unemployment rate of West Virginians with disabilities rank in the middle of the pack, but West Virginia is also one of the most affordable states in the nation. The hourly wage a worker would need to live comfortably is $10.84, sixth-lowest.
Median monthly housing costs are also just $591. No other state has monthly housing costs of less than $600 and only two have costs of less than $700. Those housing costs work out to 34% of the median earnings for West Virginians with disabilities. That’s also the nation’s lowest rate. In almost all states (47, including Washington, D.C.) median housing costs are more than 40% of the median annual earnings for residents with disabilities.
Delaware has our second-highest health care score. That’s thanks largely to it also having the second-highest OASDI and SSDI benefit awards, at $1,148 and $1,278, respectively. Livability in the First State is also high. Overall, Delaware has the 12th-best livability score. It has a top-10 score for both its public transit and its walkability.
When looking at the state’s economic score, Delaware has the fourth-lowest poverty rate among residents with disabilities at 16%.
The data also shows that the Ticket to Work Program, which provides free employment support services to Social Security disability beneficiaries, is widely used. The density of Ticket to Work offices is 10th-highest and the number of tickets per capita is also high.
People age 18 through 64 who receive SSDI or Supplemental Security Income (SSI) benefits can get a ticket through the program, which means they qualify to receive career assistance. A ticket allows them to apply for help with a service provider (office) of their choice.
While the Evergreen State has one of the highest costs of living in the country — the average resident needs to earn more than $13 per hour to live comfortably — the median annual earnings for residents with disabilities are also high. The median earnings of $25,504 is seventh-highest. The labor force participation, unemployment, and poverty rates also rank in the top half of all states.
And though Washington’s public transit received our 18th-highest score, one area dragging the state down is its low walkability outside of Seattle.
Helping New York state land in our top 10 is its top-five score for livability. Public transportation plays a big part in that score, with the public transit system received the seventh-highest score. It’s also a popular mode of transportation with almost 30% of workers using public transit to get to work. Interestingly, New York also has the longest average commute time at 33 minutes.
Like other states in the Northeast, New York has a high cost of living (third-highest). The annual earnings for people with disabilities are also high, though, ranking in the top 15.
Notably, many New Yorkers with disabilities also receive benefits from the Supplemental Nutrition Assistance Program (SNAP), commonly called food stamps. Of the households in which at least one member has a disability, a full 30% receive SNAP benefits. That’s the third-highest rate in the country. The average SNAP benefit award is also fifth-highest, at about $135 per month.
Much like its neighbor to the north, Oregon ranks high for livability. The state has the 12th-best walkability and public transit scores, and all 83 of the state’s public transit stations are ADA-accessible.
Accessibility may be especially important because Oregon has one of the highest percentages of residents with disabilities — 15% of the state population. Nearly 30% of those residents are also in public housing. That’s the fifth-highest rate in the U.S.
Some potential areas of improvement for the Beaver State are its employment rates and median annual earnings. Looking at just those in the labor force, more than 15% of workers with a disability are unemployed. That’s the 12th-highest rate we found. The median annual earnings of $20,343 for residents with disabilities are the 11th-lowest.
About the index
Policygenius created this ranking of the best and worst states for living with a disability by considering 26 factors. The factors were spread across four general categories: economics, affordability, livability, and health care. To determine our final rankings, we scored each individual factor and then averaged those scores to create category scores. The final index is the average of the four category scores.
Within our economic score we looked at six metrics related to the financial situation of residents with disabilities:
Median earnings for people with a disability: Data comes from the U.S. Census Bureau.
Labor force participation rate for people with a disability: Data comes from the U.S. Census Bureau.
Unemployment rate for people who have a disability and are in the labor force: Data comes from the U.S. Census Bureau.
Poverty rate for people with a disability: Data comes from the U.S. Census Bureau.
Ticket to Work offices: This is the total number of Ticket to Work offices in a state. An office is a location where ticket recipients can receive free career services. Data comes from the Social Security Administration.
Ticket to Work tickets: This is the number of tickets available through the Ticket to Work program as a percent of the number of eligible beneficiaries. Data comes from the Social Security Administration.
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There were six factors in our affordability score:
Livable wage: This is the wage that allows residents to meet minimum standards of living within a state. Data comes from MIT’s Living Wage Calculator.
Monthly housing costs: This is the median housing cost in a state. Data comes from the U.S. Census Bureau.
Housing costs as a percent of income: This is the median housing cost in a state as a percent of the median earnings for residents with disabilities.
Percent of residents with a disability in public housing: Data comes from the Department of Housing and Urban Development.
Percent of households receiving SNAP benefits: Of the households having at least one member with a disability, this is the percent that received SNAP benefits (food stamps). Data comes from the U.S. Census Bureau.
Average SNAP benefit per person: Data comes from the USDA.
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Our livability score considered seven metrics:
Walk Score: This factor measures the walkability of cities within a state. Data comes from Walkscore.com.
Transit Score: This measures how useful public transit is by considering factors like the type of transit available, typical distance to the nearest transit route, and the frequency of the route. Data comes from Walkscore.com.
ADA-accessible transit stations: This is the number of ADA-accessible public transit stations per resident with a disability. Data comes from the American Public Transportation Association.
Percent of population using public transportation: This is the percent of a state’s population that uses public transportation to get to work. Data comes from the U.S. Census Bureau.
Average commute time to work: Data comes from the U.S. Census Bureau.
Population of residents with a disability: This is the total number of residents in a state who have a disability. Data comes from the U.S. Census Bureau.
Percent of state residents that have a disability: Data comes from the U.S. Census Bureau.
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Our health care category has seven metrics related to health care and different types of disability insurance:
Accredited health departments per capita: This is the number of state, tribal, and other local public health departments that have achieved five-year accreditation through the Public Health Accreditation Board divided by state population. Data comes from the Centers for Disease Control and Prevention.
Percent of residents with a disability that have health insurance: Data comes from the U.S. Census Bureau.
Medicare enrollees: This is the number of residents enrolled in Medicare parts A and B as a percentage of the total number of state residents who both have a disability and are at least 65 years old. Data on Medicare enrollment comes from the U.S. Centers for Medicare & Medicaid Services.
Medicare providers per capita: This is the number of Medicare providers in the state per resident who both has a disability and is age 65 or older. Data on Medicare providers comes from the U.S. Centers for Medicare & Medicaid Services.
Average Medicare bill per person: Data comes from the U.S. Centers for Medicare & Medicaid Services.
Average OASDI benefit: This is the average benefit for people who receive OASDI benefits for reasons related to a disability. Data comes from the Social Security Administration.
Average SSDI benefit: Data comes from the Social Security Administration.
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