The best states for living with a disability

More than a quarter of people in the United States — 61 million Americans — live with disabilities, according to the Centers for Disease Control and Prevention (CDC), and 40% of people age 65 and older are living with a disability.

Even though such a large portion of the population lives with disabilities, life with a disability still poses unique legal, financial, and societal challenges. For example, there are legal protections for people with disabilities — like the Americans with Disabilities Act (ADA), which makes it illegal to discriminate against individuals with a disability — but it can be difficult to hold governments accountable when they fail to follow ADA requirements. 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 the U.S. certainly plays a part, but it’s exacerbated by low incomes: People with disabilities earn $11,992 less per year than the average worker. The poverty rate for people with disabilities is also very high at almost 20%.

To get a better sense of which states may be more livable for people with disabilities, we analyzed state data across three dozen metrics. This is our second annual look at the best states for people with disabilities, and this year’s study considers new data taking into account each state’s response to the ongoing COVID-19 pandemic, which has disproportionately affected people living with a disability.

This year, the top half of the rankings largely comprises states in the Northeast, Midwest, and Pacific Northwest. Many Southern states, and specifically Southeastern states, finished lower in our rankings. Alabama, Florida, Georgia, Mississippi, North Carolina, and South Carolina all rank in the bottom 15. Our rankings don't follow strict North-South or East-West trends, though. California ranked in the bottom 10, but neighboring Nevada ranked in the top 15.

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 — primarily from government sources — we ranked all 50 states and Washington, D.C., across 36 factors. While life with a disability isn’t the same for any two individuals, comparing data across these factors allows someone to make a more informed decision about how well their individual needs will be met in each state.

The factors we considered are broadly grouped into four categories:

• Economic conditions: Factors such as median incomes, unemployment rates, and access to certain free career services

• Affordability: Factors such as the cost of housing, the general cost of living, and the livable wage in a state

• Livability: How easy it is for residents to get around and how much of a community may exist in the state

• Health care: Factors such as the cost of and ease of access to health care plus the prevalence of certain programs, like Medicaid, for people with disabilities

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.

The map above shows how each state scores in the four categories of data that we considered. You can change the category you’re looking at by clicking on a different tab, and you can hover over a given state to see it’s ranking in that category plus some notable statistics for the state. For example, hovering over North Dakota while you’re in the Economic data tab will show you that the state ranked first in that category and that the median earnings in North Dakota are $26,596 for residents with disabilities. You can also filter out states that performed better or worse by clicking on the bar beneath the map.

How to use these rankings

In addition to a state’s overall ranking, looking at the data within each category allows you to focus on the factors that matter more to you personally. To explain how you can use this index, it’s useful to look at an example. Let’s consider California.

California ranks 43rd on our index, which means it has a low overall score but not necessarily that it scored poorly in every category. California scored seventh-highest in the livability category because many of its cities are walkable with above-average public transportation, much of which is ADA-accessible. Average commute times are longer than in other states, but someone who drives may not be as worried about commute time if they rely on Medicare and want to make sure they’re in a state with many Medicare providers, which California has.

In the economic category, even though the Golden State scored in the bottom half overall, it has the 12th-highest annual earnings ($27,279) for residents with disabilities. The state’s average benefit amount for the SSI, SSDI, and OASDI programs all rank in the top 10. On the other hand, California has some of the country’s highest housing costs in addition to high unemployment and low labor force participation for residents with disabilities.

So California may not be the best choice for the average person, but it does well in certain areas and could be suitable for people 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.

The top 3 states for living with a disability

No. 1: Pennsylvania

Coming in at number one (after finishing number two in our previous study), Pennsylvania ranks as our most livable state for a person living with a disability. Pennsylvania has the ninth-most-used public transit and the third-best transit score, 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 has the eighth-lowest minimum livable wage at $13.39 per hour. That’s the wage a single adult would need in order to comfortably meet the cost of living in Pennsylvania.

Most residents with disabilities are also insured, with 96.6% having health insurance. That’s the 15th-highest rate in our study. The percent of people with disabilities who said they couldn’t always afford health care was ninth-lowest, with about 80% saying they could always afford care.

No. 2: Vermont

Vermont is our second-best state for living with a disability, up from number three last year. Vermont ranks in the top 17 for three out of the four categories we considered: health care, livability, and economic conditions. It ranked especially well (second overall) in our health care category. Almost 98% of people with a disability in Vermont have health insurance. And even though median annual earnings are relatively low for residents with disabilities, at $20,942, and the annual cost for disability-related care is 12th highest, at $20,096, the Green Mountain State had the second-lowest percentage of people with a disability who said they couldn’t always afford health care (about 18%).

No. 3: North Dakota

North Dakota is our first Midwestern state in the top 10 this year (after ranking fourth in our previous study), and it does particularly well in the economic and affordability metrics. Of residents with disabilities, North Dakota has the highest rate participating in the labor force (58%) and the lowest unemployment rate at 6%. At the same time, North Dakota has the highest concentration of Ticket to Work offices, which provide free career services to people receiving Social Security disability benefits.

The median earnings of $26,596 are ninth-highest and the poverty rate for those with a disability is 17th-lowest at 18%. Living in the Peace Garden State is also affordable. The median monthly housing cost of $836 is 10th-lowest, and the minimum hourly wage needed to live comfortably is second-lowest at $13.08. Annualized, that wage comes very close to the median annual earnings for residents with a disability.

How COVID-19 affects people with disabilities

Our study looks at how well states treat residents living with a disability under normal circumstances. But people living with a disability are also disproportionately at risk from COVID-19. Studies have shown that people with disabilities, especially women of color who are below the poverty line and living with a disability, have a significantly higher risk of getting COVID-19 and suffering more serious complications from it than others in their community.

People with disabilities also aren’t getting vaccinated as quickly as the general population. According to a CDC and Census Bureau survey conducted in the top 15 metropolitan statistical areas between June and August of 2021, 79.1% of eligible people with disabilities have received at least one dose of the COVID-19 vaccine, compared to 83.7% of the general population who are eligible.

About our data

Policygenius created this ranking of the best and worst states for living with a disability by considering 36 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.

Economics

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 and is for 2019.

• Labor force participation rate for people with a disability: Data comes from the U.S. Census Bureau and is for 2019.

• Unemployment rate for people who have a disability and are in the labor force: Data comes from the U.S. Census Bureau and is for 2019.

• Poverty rate for people with a disability: Data comes from the U.S. Census Bureau and is for 2019.

• 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 and is for 2020.

• 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 and is for 2020.

Affordability

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 is in 2020 dollars and 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 and is for 2019.

• 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. Data is for 2019.

• Percent of residents with a disability in public housing: Data comes from the Department of Housing and Urban Development and is for 2020.

• 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 and is for 2019.

• Average SNAP benefit per person: Data comes from the USDA and is for 2020.

Livability

Our livability score considered seven metrics:

• Walk Score: This factor measures the walkability of cities within a state. Data is for 2021 and 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 is for 2021 and 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 (APTA) and is for 2019.

• Percent of population using public transportation: This is the percent of a state’s population that uses public transportation to get to work. Data is for 2019 and comes from the U.S. Census Bureau.

• Average commute time to work: Data comes from the U.S. Census Bureau and is for 2019.

• 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 and is for 2019.

• Percent of state residents that have a disability: Data comes from the U.S. Census Bureau and is for 2019.

Health care

Our health care category has 17 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 and is accurate as of May 2021.

• Percent of residents with a disability that have health insurance: Data comes from the U.S. Census Bureau and is for 2019.

• Average cost of disability-related health care: This is the average disability-associated health care expenditures per person with a disability. Data is from the Centers for Disease Control and Prevention and is in 2017 dollars.

• Percent of people with a disability who can’t afford all care: This is the prevalence of people who have a disability and said they could not see a doctor at some point in the past 12 months due to cost. Data is for 2019 except for New Jersey, which uses 2018 data since 2019 data isn’t available.

• Medicaid expansion: This yes or no factor shows whether or not a state has elected to expand Medicaid coverage under the Affordable Care Act (ACA). Data comes from the Centers for Medicare & Medicaid Services and is current as of 2021.

• Medicaid full-benefit enrollees: This shows the full-benefit Medicaid enrollees in a state as a percentage of the total population within the state that lives with a disability and is below the poverty line. Data on the number of Medicaid enrollees comes from the Centers for Medicare & Medicaid Services and is for 2018, while poverty data comes from the U.S. Census Bureau and is for 2019.

• 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 and is for 2019.

• 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 and is for 2019.

• Average Medicare bill per person: Data comes from the U.S. Centers for Medicare & Medicaid Services and is for 2019.

• 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 and is for 2019.

• Population receiving SSDI benefits: Of the people who are living with a disability, this shows the percentage who receive SSDI benefits. Data comes from the Social Security Administration and is for 2019.

• Average SSDI benefit: Data comes from the Social Security Administration and is for 2019.

• Average SSI benefit: Data comes from the Social Security Administration and is for 2019

• COVID-19 cases per 100,000 residents, all time: This is the number of all-time COVID-19 cases that a state has reported, per 100,000 residents in the state. Data comes from the Centers for Disease Control and Prevention and is current as of Aug. 22, 2021.

• COVID-19 deaths per 100,000 residents, all time: This is the number of all-time COVID-19 deaths that a state has reported, per 100,000 residents in the state. Data comes from the Centers for Disease Control and Prevention and is current as of Aug. 22, 2021.

• Current COVID-19 case rate: The number of cases in a state, reported as the seven-day rate of cases per 100,000 residents. Data comes from the Centers for Disease Control and Prevention and is current as of Aug. 22, 2021.

• COVID-19 vaccination rate: This is the percentage of state residents who are fully vaccinated against COVID-19, regardless of which brand of vaccine was received. Data comes from the Centers for Disease Control and Prevention and is current as of Aug. 22, 2021.