Rehabilitation Reform

Ohio scores 61/100 (Tier 2, Progressing) in the 2026 SCII: a county board of developmental disabilities system that is unique in the nation, paired with a managed care transition that has disrupted HCBS access, a persistent ICF/IID census among the ten highest nationally, and no subminimum wage phase-out legislation.

North Dakota scores 56/100 (Tier 3, Lagging) in the 2026 SCII: a small-population state where geographic isolation compounds provider shortages, and where the Life Skills and Transition Center continues to house individuals who could live in community settings with adequate supports.

North Carolina scores 58/100 (Tier 3, Lagging) in the 2026 SCII: a managed care behavioral health system in transformation, a Medicaid expansion that reached 600,000 enrollees, and an Olmstead enforcement landscape shaped by active DOJ monitoring of the state’s psychiatric hospital census.

New Mexico scores 56/100 (Tier 3, Lagging) in the 2026 SCII: a Mi Via self-direction waiver that is among the most flexible in the country, undermined by geographic provider shortages, a DD waiver waitlist stretching to thousands, and mental health infrastructure that ranks among the lowest per capita nationally.

New Jersey scores 71/100 (Tier 2, Progressing) in the 2026 SCII: a robust Division of Developmental Disabilities with one of the most comprehensive HCBS waiver systems in the Northeast, subminimum wage on a legislative phase-out path, and a Third Circuit that has consistently supported integration mandate enforcement.

New Hampshire scores 67/100 (Tier 2, Progressing) in the 2026 SCII: the only state to have closed all state psychiatric hospitals and converted to a fully community-based mental health model, now grappling with what happens when community capacity doesn’t match the ambition of deinstitutionalization.

Nevada scores 52/100 (Tier 3, Lagging) in the 2026 SCII: rapid population growth that has outpaced community mental health infrastructure, a state psychiatric hospital operating at crisis census, and one of the lowest Medicaid LTSS HCBS spending ratios in the West.

Nebraska scores 57/100 (Tier 3, Lagging) in the 2026 SCII: a 2019 DOJ settlement on developmental disability services that closed the Beatrice State Developmental Center, paired with persistent waitlists for the waiver slots those transitions were supposed to fill.

Montana scores 55/100 (Tier 3, Lagging) in the 2026 SCII: a high HCBS-to-institutional spending ratio driven by geographic necessity rather than policy intent, offset by frontier-scale provider shortages and a mental health system that relies on out-of-state placements for the most complex needs.

Missouri scores 48/100 (Tier 3, Lagging) in the 2026 SCII: a landmark 2016 DOJ consent decree on mental health services that the state has struggled to implement, compounded by the nation’s highest per-capita nursing home bed rate and persistent sheltered workshop employment.