Throughout the United States, the availability of disability services varies significantly, leading to a drastic change in people’s quality of life when moving from one state to another. This reality is poignantly described by Manyvone Champavannarath. As a quadriplegic, living in Florida, she finds it challenging to survive on less than a thousand dollars each month while navigating stringent benefit regulations.
Her challenges are not unique. They highlight a national problem characterized by fragmented systems, antiquated regulations, and a considerable disconnect between policymakers and the people who depend on these services.
The United States Medicaid system is run by a combination of state-administered programs, with Medicaid serving as the primary source of long-term services for disabled people. Since each state establishes its own eligibility requirements, covered services, and funding priorities, two people with identical disabilities may have vastly different experiences solely based on their address. One state might offer robust coverage, whereas another could have lengthy waitlists that leave people without essential care.
This inconsistency is not just a state-to-state issue. Even within a single state, the differences can be astonishing. California, frequently regarded as a pioneer in disability rights, is a perfect example of this.
A 2022 report from a disability advocacy organization highlighted significant disparities in spending based on race, ethnicity, and location within the state’s regional center network. The Lanterman Regional Center, which serves areas such as central Los Angeles and Hollywood, had an $8,561 difference in average spending per individual among various racial and ethnic groups residing at home, with Latino clients receiving the least assistance.
In contrast, the Westside Regional Center allocated over $30,000 per adult client living at home, while the San Diego Regional Center spent less than $11,000. These discrepancies are alarming; they indicate entirely different levels of support, opportunities, and independence.
The disparities become even more evident when examining services that help people live independently. The Eastern Los Angeles Regional Center spent over $80,000 per client for independent living support, while the Inland Regional Center, which serves Riverside and San Bernardino counties, allocated approximately $14,000. Within the same state system, disabled adults were experiencing two different realities.
This problem is not limited to California. Minnesota serves as another clear illustration of how geographical location can influence the quality of disability services. Michaela Johnson, a child from Mora, MN, was born with several disabilities, including blindness and epilepsy.
When her anxious parents sought assistance from Medicaid for in-home nursing, officials in Pine County denied their requests twice. They were even advised to call 911 if their daughter experienced a seizure. This solution perfectly illustrates the lack of support that some counties are prepared to offer.
Because they were desperate, the Johnsons sold their home and relocated 40 miles west to Kanabec County. Within two months, Michaela was granted approval for in-home nursing care, medical equipment, and over $60,000 in funding for home health nurses every year. The only difference was their ZIP code.
Their experiences mirror those of countless families in Minnesota navigating the unpredictable Medicaid waiver system. These waivers allocate over $3 billion each year to individuals with severe disabilities. However, the county regulations are so inconsistent that some families find themselves moving frequently over long distances to access the care they are entitled to.
The differences are striking. In 2018, Dakota County allocated an average of $109,000 per family for the highest-level waiver, whereas Stearns County provided only $50,000. Scott County invested $105,000 per recipient for traumatic brain injury support, in contrast to Pope County’s $22,500. Although approximately 86,000 Minnesotans receive waivers, one in five resides in counties where high-need waivers are rarely approved.
These state-level discrepancies are part of a national crisis in home and community-based services. According to the Kaiser Family Foundation, more than 700,000 people are waiting for services provided by Medicaid waivers which are designed for disabled and elderly people, which enable them to help them live independently.
The need for services is staggering. Some people wait for several years for assistance, leaving families to take on caregiving roles with no help or very little help. Each state has handled the service differently, some adding funds to eliminate waiting lists, while others lack funds and employees.
These trends reveal a deeper reality: disability services in the U.S. are influenced more by geography, race, and administrative beliefs than by genuine need. Behind these policies are real people whose lives are limited by rules created without their input. Advocates often point out that not everyone has family support to fill in the gaps. When state systems fail, there is often nowhere else to turn.
A more just approach would require rethinking the basics. Benefits could reflect regional costs. Asset limits could be updated or removed to allow people to save for emergencies. Core Medicaid services could be standardized, ensuring that basic support doesn’t depend on geography. Caregivers could be paid better wages to attract and keep workers, reducing chronic staffing shortages that leave approved services unfilled. Most importantly, disabled individuals should be involved in creating the policies that impact their lives.
The disparities in disability services across the country, and even within states, aren’t just administrative quirks. They impact whether people can live independently, seek employment, or simply meet their basic needs. The stories of Manyvone Champavannarath and Michaela Johnson, along with the stark statistics from California, Minnesota, and national waiting lists, reveal the reality.
The current system doesn’t just vary. It fails many people it is supposed to support. A more consistent national approach could bring us closer to a place where having a disability does not result in living at the mercy of your ZIP code.
Sources:
Burns, Alice, et al. “A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2025.” KFF, KFF, 20 Nov. 2025, http://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2025/. Champavannarath, Manyvone. “People with Disabilities Struggle with Paltry Help: Commentary.” The Ledger, USA Today Co., 11 Jan. 2026, http://www.theledger.com/story/opinion/columns/2026/01/11/people-with-disabilities-struggle-with-paltry-help-commentary/88082673007/.
Reyes, Emily Alpert. “In California, Spending on Adults with Disabilities Differs by ‘Race and Place’.” Los Angeles Times, Los Angeles Times Communications LLC, 27 Oct. 2022, https://www.latimes.com/california/story/2022-10-27/california-race-and-place-spending-on-adults-with-disabilities?_amp=true.
Serres, Chris, and Glenn Howatt. “’Geography Is Destiny’ for Families Living with Disabilities in Minnesota.” Star Tribune, Star Tribune Media Company, LLC, 16 Sept. 2019, https://m.startribune.com/medicaid-waivers-minnesota-disability-county-policies-differ-for-medically-fragile-children/558453052/?clmob=y&c=n.