A diverse group of states spanning the nation came out on top in an annual ranking of services for people with intellectual and developmental disabilities.

The analysis released Thursday by United Cerebral Palsy looks at Medicaid services offered across the 50 states and the District of Columbia.

For the fourth year in a row, Arizona took first place in the listing. Other states leading the pack include Maryland, Missouri, New York, Hawaii, Colorado, Minnesota, the District of Columbia, South Carolina and Ohio.

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The ranking is largely based on data from 2013 and assesses a number of factors including how easily services are accessed, what types of environments people with developmental disabilities live in and how much they participate in the community.

Nationally, the report found that 14 states had no institutions, but the number of states where at least 80 percent of people and dollars are allocated to community-based settings fell to 32.

At the same time, waiting lists for home and community-based services grew to 322,000 people.

Top states included those that are both big and small as well as those with high and low taxes. The level of per-person spending on home and community-based services also did not appear to affect a state’s odds of faring well in the ranking.

Mississippi came in dead last for the ninth year in a row. In addition, the report calls out Arkansas, Illinois and Texas for consistently falling at the bottom of the list since 2007.

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