RISP Data Bytes

Fewer People with IDD Live in ICF/IIDs, But Progress is Not Equal

RISP Data Bytes, June 2024


The use of Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) has been declining for 30 years. Medicaid ICF/IIDs are institutions in which between four and 500 people live and receive supports. In 1989, 147,000 people lived in ICF/IIDs, or 60 for every 100,000 people in the United States. By June 2019, only 67,200 people still lived in ICF/IIDs (21 for every 100,000 people).

Key Finding

This decline is not equal across states. Alaska, Michigan, Montana, and Oregon have closed all their ICF/IIDs. In the remaining 46 states, the number of people in ICF/IIDs per 100,000 of the population was 10 or fewer in 18 states, 11 to 30 in 18 states, 31 to 60 in seven states plus the District of Columbia, and 61 to 92 in three states.

ICF/IDD Recipients per 100k of Population

Map of the United States with states shaded according to how many ICF/IID recipients live there per 100,000 of the population. The states with zero people in ICF/IIDs are Alabama, Michigan, Montana, and Oregon. The states with 1 to 10 people per 100,000 living in ICF/IIDs are Alaska, Arizona, Colorado, Georgia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Missouri, Nevada, New Hampshire, Rhode Island, Utah, Vermont, Virginia, Washington, and Wisconsin. The states with 11 to 30 people per 100,000 living in ICF/IIDs are California, Connecticut, Delaware, Florida, Kansas, Maine, Minnesota, Nebraska, New Jersey, New Mexico, New York, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, West Virginia, and Wyoming. The states with 31 to 60 people per 100,000 living in ICF/IIDs are Arkansas, District of Columbia, Illinois, Indiana, Iowa, North Carolina, Ohio, and Oklahoma. The states with 61 to 92 people per 100,000 living in ICF/IID are Louisiana, Mississippi, and North Dakota.


Research shows that people living in smaller settings have better lives (Ticha, et al., 2013). States should close big institutions and help people move to small homes with roommates they choose. They should also help people who are waiting for a place to live. States should pay workers enough that they can afford to support people with intellectual disabilities. Advocates must teach lawmakers why they should support people to live in small homes with roommates they chose.

Data Sources

  • Ticha, R., Hewitt, A., Nord, D., & Larson, S. A. (2013). System and individual outcomes and their predictors in services and support for people with IDD. Intellectual and Developmental Disabilities, 51, 316–332.

This Data Byte is based on data from the Fiscal Year 2019 RISP report.


Sheryl A. Larson, Jon Neidorf, and Brian C. Begin. The authors acknowledge the contributions by Jerry Smith, Sarah Curtner and John Smith to this product.

The RISP project gets funds from the Administration on Community Living, U.S. Department of Health and Human Services, Cooperative Agreement #90DNPA0006 with supplemental funding from the National Institutes on Disability, Independent Living and Rehabilitation Research Grant #90RTCP0011.

Abbreviations used: IDD Intellectual or Developmental Disabilities; HCBS Home and Community Based Services