Rosemary Collaboratory: A Policy, Systems, and Environmental Approach to Understanding and Addressing Health Inequities for People With Intellectual and Developmental Disabilities, United States.

This article focuses on health system assessments in the United States at the federal and state levels (Pennsylvania, Washington, and Wisconsin) to identify barriers and gaps affecting people with intellectual and developmental disabilities (IDD). Despite existing federal laws such as the Americans with Disabilities Act (ADA) and the Developmental Disabilities Assistance and Bill of Rights Act (DD Act), people with IDD experience significantly poorer health outcomes and face unique challenges including stigma, inaccessible communication, and complex systems. The assessments highlight state-level innovations, particularly in supported decision-making as an alternative to guardianship, and reveal persistent gaps in governance, health financing, data collection, workforce training, and accessible health information. The findings suggest that states should build upon federal legislation to advance reforms promoting health equity for people with IDD.