Only One State Has No Waiting List for Disability Services. Here’s What It Costs.

I started this piece expecting to write a tidy comparison of five states that eliminated their disability waiting lists. Then I checked the states, and most of them had not.

This happens more than I would like in this work. A claim circulates in advocacy circles, gets repeated in a conference presentation, appears in a blog post citing the presentation, and eventually becomes something everybody knows. Then you go looking for the primary source and it is not there.

So here is what I actually found, and I think it is a more useful post than the one I meant to write.

The states that did not do it

Connecticut is the one I hear most often. Connecticut did not eliminate its waiting list. In 2013 the Department of Developmental Services had 961 people waiting while serving 7,892. In 2023 it had 928 people waiting while serving 7,853. Ten years, a net reduction of thirty three people.

The 2023 legislative session did real work. The General Assembly appropriated $30 million over two fiscal years for human services initiatives, allocated $16 million in state bonding for supportive housing through DDS, and required the commissioner to report annually on progress reducing the list. A separate and more urgent autism services list, with more than 2,000 people on it, got the majority of that $30 million with a mandate to remove at least 600 people over two years.

That is meaningful. It is not elimination, and the legislators involved did not claim it was. One of them described the bill as a work in progress for a bunch of years.

New Jersey is the other one people name. The New Jersey Division of Developmental Disabilities publishes a waiting list page for the Community Care Program, updated as recently as July 2026, which states that the division generally works through the list chronologically and that being added to the list is not a guarantee of eligibility or enrollment.

The one state that genuinely has no list

California, and the reason is structural rather than budgetary.

The Lanterman Developmental Disabilities Services Act, enacted in 1969, creates a statutory entitlement to services and supports for eligible individuals ages three and older. The California Department of Developmental Services describes the state as the only one in the country that provides an entitlement to services and supports for all residents, after other sources have been exhausted.

An entitlement cannot produce a waiting list, and this is worth understanding precisely. A waiting list exists because a program has a fixed number of slots and more eligible people than slots. Under an entitlement, eligibility itself creates the obligation. There is no cap for demand to exceed. The mechanism that generates lists simply is not present.

The mechanism nobody talks about, which is the one Michigan could actually use

Louisiana is the interesting case, because it did something a capped state can do.

In April 2019 the Louisiana Department of Health announced it had eliminated a 25 year old waiting list for people with developmental disabilities. It did not do this by making services an entitlement or by funding every person on the list. It changed how the list worked.

The state implemented a Tiered Waiver plan built on the Screening for Urgency of Need, a five tier assessment. Tier 4, emergent, means supports are needed within 90 days. Tier 3, urgent, within three to twelve months. Tier 2, critical, within one to two years. Tier 1, planning, within three to five years. Tier 0 means no current unmet need. More than 12,000 people received a SUN assessment.

What this replaced was chronological ordering, which is the quiet cruelty at the center of most waiting lists. First come, first served sounds fair. In practice it means a family in genuine crisis waits behind a family who registered early and is currently managing, and neither family can do anything about it. Urgency tiering says the person whose situation is about to collapse goes first.

I want to be honest about what this is and is not. Louisiana did not create capacity out of nothing. Some people who were on that list are now in Tier 0 or Tier 1, which means they are not waiting in the old sense but they are also not receiving services. Calling that elimination is a definitional choice you can argue with. But sorting by urgency instead of by registration date is a real improvement that does not require an entitlement, and that makes it the most transferable idea in this entire post.

Where Michigan actually stands

Michigan’s Habilitation Supports Waiver is capped at 7,481 slots allotted region by region across the PIHPs. Whether your county calls that a waiting list or not, it is a cap, and caps produce queues.

Michigan does have priority rules, which is a partial version of the Louisiana idea: adults 21 and older requiring private duty nursing, children transitioning off the Children’s Waiver, and individuals at high risk of institutional placement. Those priorities are real and families should invoke them. What Michigan does not have is a systematic urgency assessment applied to everyone waiting, which is the difference between three priority categories and a five tier sort.

And nationally the pressure is going the wrong way. KFF’s November 2025 survey found over 600,000 people on HCBS waiting or interest lists, up 14% from 2024, across 41 states. 74% of them have intellectual or developmental disabilities. Twelve states reported new waiting lists in 2025, five of them specifically for I/DD waivers. Autism-specific waivers average a 63 month wait, against 37 months for I/DD waivers and 32 months overall.

Autistic people wait longer than anyone else being tracked. Nearly twice the I/DD average.

What I would ask for, in order

First, urgency tiering. It costs comparatively little, it does not require an entitlement, Louisiana has already built and documented the model, and it puts families in crisis at the front of a line they are currently stuck in the middle of. This is the winnable ask.

Second, transparency. Michigan should publish, by PIHP region, how many people are waiting for HSW slots and how long they have waited. You cannot argue about a number that does not exist, and right now families are told to ask their CMHSP one at a time.

Third, the entitlement conversation, honestly. Ask your legislator whether any bill would make eligibility an entitlement rather than a capped slot. Expect the answer to be no. Ask anyway, because the question forces the distinction into the open, and because California proves it is a thing a state can decide to do.

I wanted to hand you five states and a menu. What I have instead is one entitlement, one clever sorting mechanism, and a lot of states that are described as having solved a problem they are still living inside. That is less satisfying. It is also the truth, and the truth is what survives contact with a legislative staffer.