Individuals with intellectual and developmental disabilities (IDD) face significantly poorer health outcomes and experience greater health disparities compared with people without IDD, in part because of health system failures. This article summarizes health system assessments completed in the United States at the national level and in 3 states (Pennsylvania, Washington, and Wisconsin) to identify existing barriers and gaps. To reflect the US health architecture, there is also a discussion of particularly relevant national or federal policy features that influence health equity for people with IDD. Despite existing federal legislation, there are significant opportunities for improvement across all components of the health system, at both federal and state levels. One of the areas of most significant state-level innovation has to do with supported decision-making and alternatives to guardianship, demonstrating that there is precedent for state leadership. States should continue to treat federal legislation as the floor of protection, rather than the ceiling, and pursue further reforms that promote health equity for people with IDD. (Am J Public Health. 2026; 116(S2):S103-S111. https://doi.org/10.2105/AJPH.2026.308452).
Anjela Jenkins (Fri,) studied this question.