Existing public policies often fail to acknowledge differences between older (ages sixty-five and older) and younger (younger than age sixty-five) people with disabilities residing in nursing homes. We compared long-stay (over sixty days) residents across age groups and then documented state-level variation in their age-adjusted prevalence in 2019 and trends in prevalence during the period 2013-19. Compared with older residents, younger residents tended to have different diagnoses and were more likely to reside in for-profit and lower-quality facilities, as well as to be non-White and male. Among younger people with disabilities, nursing home use varied widely across states, and trends in use were only weakly correlated with trends for older adults. Although rates of state-level nursing home placement among older adults generally declined, in many states they stagnated or grew among those younger than age sixty-five, with no convergence of trends in placement across states. Our findings suggest the value of approaching younger people with disabilities as a distinct population. We offer targeted policies to divert these people from nursing homes to home and community-based settings.