The number of people with intellectual and developmental disabilities across the country who are on waiting lists to receive Medicaid-funded home- and community-based services is on the rise.

There were 473,000 people on waiting lists in 2017, some 49,000 more than the year before, according to an analysis released Thursday by the ANCOR Foundation and United Cerebral Palsy.

Known as the “Case for Inclusion,” the annual report examines 58 measures to assess how well states are serving people with intellectual and developmental disabilities.

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Nationally, waiting list enrollment jumped nearly 12 percent, the report found. In looking at states individually, though, the picture varied. Nine states and Washington, D.C. had no wait at all while another 10 saw their lists shrink between 2016 and 2017. In 23 states, the waiting list grew, with the most extreme example in Texas where nearly 218,000 people were seeking services.

One issue that may help explain the lack of community-based offerings for people with disabilities is the shortage of direct support workers to assist them, the report notes. Across the country, the analysis found that the turnover rate for these workers is 43.8 percent, leaving 8.1 percent of full-time and 17.3 percent of part-time positions vacant.

States are also struggling to help people with intellectual and developmental disabilities find jobs. Since the last Case for Inclusion report a year ago, the analysis found that just 3,000 more individuals attained integrated employment, an increase of 1 percentage point, bringing the total number of people in this population who are working to 127,000 nationwide.

Those behind the report said the findings highlight the significant needs that people with disabilities have.

“Especially as we head into 2020 and one of the most pivotal election years our nation has seen, it is absolutely critical that lawmakers at all levels of government understand how decades of underinvestment in long-term supports and services for people with I/DD has been one of our generation’s most significant public policy failures,” said Barbara Merrill, chief executive officer for the ANCOR Foundation.

Previous incarnations of the Case for Inclusion have ranked states on their disability services. That overall comparison was left out of the current report due to methodology that was “becoming needlessly complex,” the authors said.