Medicaid services are a lifeline for many people with developmental disabilities. But getting the government services can be an uphill battle and your odds of being successful often depend on what state you live in.

When United Cerebral Palsy (UCP) ranked the 50 states last month, Vermont came out on top for providing the highest quality Medicaid services to individuals with intellectual and developmental disabilities.

But behind that ranking are years of hard work, dedication and planning. So, what can you do to make sure that Vermont cedes its title to your state next year? Tarren Bragdon, an independent health and Medicaid policy researcher who crunched the numbers for UCP, tells you how.

Get out in the community

First and foremost, the single biggest predictor of the quality of Medicaid services a state provides to individuals with intellectual and developmental disabilities is how many individuals are living in community-based settings, Bragdon says.

In the UCP ranking, this alone accounted for half of each state’s score. So, most of the states at the top of the list boast limited institutionalization, if any at all.

In Vermont, for example, all Medicaid funding goes toward community-based housing and everyone lives in homes with fewer than seven people.

“That’s phenomenal. That really sets them apart,” Bragdon says.

Yet even in states where total deinstitutionalization isn’t a reality yet, there are major possibilities for success. Take supported employment, for example. It encourages meaningful activity for people with disabilities and it’s also an easy sell to politicians since it’s low-cost and has a clear monetary return. (Oklahoma and Washington take the cake in that arena.)

Another key indicator of a successful state is the number of families receiving support. (New Mexico and New Hampshire are tops here.)

How do you get there?

Help end institutionalization in your state by demystifying life in an institution for the people in charge, Bragdon says. Take your legislators to an institution to see what it’s really like and to ask questions. Then, ask if they would want their loved one living in an institutional setting.

Also, look at your state’s structure. Most successful states focus on individuals. Michigan (ranked #6), for example, has a very strong county system, Bragdon says. So instead of every resident looking to a state department for assistance, there is a locally based office to turn to with staff who are more likely to know you and your unique needs.

Persistence Pays Off

The top performing states in 2009 represented some of the biggest and smallest states. They were rich and poor states with varying tax structures. And, while some states spent a lot on each individual with a developmental disability, some did not.

What made the different, however, was persistence.

“For those states that were most successful they were never states that got one great policy change and then went home,” Bragdon says. “They were always pushing.”

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