The Case for Inclusion rankings were developed through a broad, data-driven effort. Demographic, cost, utilization, key data elements and outcomes statistics were assembled for all 50 states and the District of Columbia. Ninety-nine individual data elements from numerous governmental, nonprofit and advocacy organizations were reviewed. Dozens of Medicaid, disability and I/DD policy experts were consulted, as well as members of national advocacy and research organizations. They were asked to consider the attributes of top-performing Medicaid programs and offer opinions and recommendations on key data measures and outcomes.
To comprehensively determine the top-performing states, a weighted scoring methodology was developed. Thirty key outcome measures and data elements were selected and individually scored in five major categories on a total 100-point scale. If a person is living in the community, it is a key indicator of inclusion; therefor, the “Promoting Independence” category received half of all possible points.
The rankings were changed slightly for 2019. Five measures were dropped (to remove a focus on spending and large private institutions), one measure was added (participation in the National Core Indictors Staff Stability Survey), and 12 measures had updated scoring. The Case for Inclusion 2019 has 23 data elements and 100 total points. For a complete list of data measures, the points scored for each and the source from which each measure is drawn, consult pages 24-25 of the full Case for Inclusion 2019 report.
In general, the top-performing state for each measure was assigned the highest possible score in that category. The worst-performing state was assigned a zero score in that category. All other states were apportioned accordingly based on their outcome in comparison to the highest- and lowest-performing states for that measure.
Most data in the Case for Inclusion 2019 are from 2016, but all data is the most recently available from credible national sources. Much of the data are self-reported by the states. These state rankings are a snapshot in time, and policy changes or reforms enacted or beginning in 2016 or later would not have an impact on the rankings.
When reviewing an individual state’s ranking, it is important to consider action taken since 2015, if any, to accurately understand both where that state was and where it is presently. Also, it is important to note that not all individuals with disabilities were considered—only those with intellectual and developmental disabilities. This limited the scope of the effort, allowing focus on subsequent initiatives of meaningful, achievable improvement.
Advocates using the Case for Inclusion should be aware that just 40 points separate the highest- and lowest-ranked states, only eight points separate the #1 state from the #10 state, and only 14 points separate the #1 state from the #25 state. Therefore, minor changes in state policy or outcomes could significantly affect how a state ranks on future or past Case for Inclusion reports.