RISP Data Bytes

Plain Language Summary | Institutions are places where four or more people with disabilities live. The number of people who live in institutions is getting smaller. Some states have a small number of people in institutions. Other states have a lot. People who live in smaller homes usually have better lives.

Background

The use of Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) has been declining for 30 years. Medicaid ICFs/IID are institutions where many people live and receive supports together. In 1989, 147,000 people lived in ICFs/IID, or 60 for every 100,000 people in the United States. By 2021, only 63,085 people still lived in ICFs/IID (19.1 for every 100,000 people).

Key Finding

This decline is not equal across states. As of FY 2021 and continuing today, Michigan, Montana, Oregon, and Rhode Island do not have any people in ICFs/IID, and Alabama and Alaska have very few people in ICFs/IID. (Vermont closed its final ICF/IID later in the 2021 fiscal year.) In the remaining states, the number of people in ICFs/IID per 100,000 of the population was 1–10 in 18 states, 11–20 in 15 states, and 21–87 in 13 states and the District of Columbia.

This map of the United States shows the number of people per 100,000 who lived in ICFs/IID by state. In 2021, an average of 19.1 people per 100,000 of the population lived in an ICF/IID. Michigan, Montana, Oregon, and Rhode Island had 0 people in ICFs/IID. Alabama had almost no people in ICFs/IID. States with 1–10 people per 100,000 in ICFs/IID were Alaska, Arizona, Colorado, Georgia, Hawaii, Kentucky, Maryland, Massachusetts, Missouri, Nevada, New Hampshire, Utah, Vermont, Virginia, Washington, Wisconsin, and Wyoming. States with 11–20 people per 100,000 in ICFs/IID were California, Connecticut, Delaware, Florida, Idaho, Kansas, Maine, Minnesota, Nebraska, New Jersey, New Mexico, New York, Pennsylvania, South Dakota, and Tennessee. States with 21–87 people per 100,000 in ICFs/IID were Arkansas, Illinois, Indiana, Iowa, Louisiana, Mississippi, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, Texas, West Virginia, and the District of Columbia. — People in ICFs/IID per 100,000 of the Population by State, FY 2021

Recommendations

People who live in smaller settings typically have better lives. 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 choose.

Data Source

Larson, S. A., Neidorf, J., Pettingell, S., Nye-Lengerman, K., & Vegas, L. (2025). Long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2021. University of Minnesota, Institute on Community Integration, Research and Training Center on Community Living. https://doi.org/10.13140/RG.2.2.10719.11682

Authors

Sheryl A. Larson, Jon Neidorf, and Sarah A. Hall.

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

Updated 4/2/2026