While I/DD and behavioral health providers have to deal with federal guidance and mandates, there is also complexity at the state level to manage. This is challenging, as each state is different, and most aren’t required to serve every person with I/DD or provide needed person-centered supports to this population.

Nonetheless, getting some state trends on your radar will help you anticipate and handle challenges and make changes to benefit individuals, families, and staff alike. Here are the top five to pay attention to.

More Support, More Flexibility

“At the state level, we continue to operate against the backdrop of the COVID-19 pandemic of the past two years. We’re trying to provide continuity of support and services, as well as ensure a stabilized and strong workforce. There has been an historic level of funding from the federal government and state budgets, with some states going above and beyond with emergency COVID enhancements,” said Kevin Lundy, Vice President of Government Relations at BrightSpring Health Services.

Elsewhere, Kelly Jepson, Director of Government Relations at BrightSpring, noted, “During the pandemic, states have been more open to enabling providers to do what they needed to do for infection control purposes. We saw states look to providers as experts in terms of making decisions to keep people safe.” She added, “States were less prescriptive, utilized provider service flexibilities afforded to them by the federal government, and partnered with providers more, and providers really stepped up to make sure what needed to be done was accomplished.”

Addressing Workplace Woes

A report from ANCOR last year showed that 77% of providers are turning away new referrals, 58% are discontinuing programs and services, and 84% are delaying the launch of new programs or services due to workforce shortages. There is a growing urgency among state legislators to address this issue and its impact on the sector’s ability to provide needed services to individuals with I/DD.

Jepson said, “These decision-makers witnessed what a critical part of the pandemic response our services were, and they have shown an interest in finding solutions to our workforce challenges.” Among them:

  •  Increasing wages. State legislators are leveraging all avenues to try and increase wages for direct support professionals (DSPs), said Jepson, including one-time grant programs aimed specifically at DSP recruitment and retention.
  • Introducing new models. Ryan Green, Director of Government Relations at BrightSpring, said, “It is encouraging to see states picking up on models proven to be successful in other states. For example, Minnesota is piloting a host-home model, where residents choose to live with an individual or family in a private home. Providers like us can play an important role in facilitating these models.” Green said, “Many other states have found this a proven effective and successful model that has resulted in positive stable outcomes for the individual needing services as well as helping to address workforce shortages.”
  • Reducing waitlists. Another way states are pro-viding individuals access to I/DD settings is by reducing or eliminating waitlists. “This is positive on the surface, and we will be watching how this plays out in the months to come since it also requires a stabilized and strong workforce to support these additional individuals,” said Lundy.
  • Leveraging technology. “Post-COVID, states increasingly are looking at making telehealth services permanent, as well as an expansion of remote supports” Green suggested. “While technology isn’t a substitute for human interaction, it can help perform some tasks, reduce the time involved in some activities, and free staff to provide more direct care where necessary.”

Opportunities for Education

With 82% of the state legislative seats across the country up for election/re-election in 2022, Green said, “This is a great opportunity to educate these individuals about our services.”

Lundy agreed, observing, “This is the largest state election cycle, with 36 governorships up for grabs as well as more than 6,000 state legislative seats. For our industry, this means an opportunity not only to educate elected officials but also oversight agency officials appointed by governors. They can set the direction of health delivery systems for the coming years.”

He added that another issue involves I/DD and behavioral health champions in government positions retiring or not being re-elected. “We have to be concerned about the loss of institutional knowledge,” Lundy said, but it also presents an opportunity to gain new champions and advocates and keep I/DD issues on the radar of legislators and other decision-makers.

One Size Does Not Fit All

“We are seeing some changes in how rigid services are. Traditionally, Medicaid has been very rigid, but I think we will see more leveling out as CMS (the Centers for Medicare and Medicaid Services) and the states start to work together more. States will continue efforts with CMS to enable people to get the person-centered services they need through funding, workforce efforts, and other initiatives,” said Jepson.

A silver lining of the pandemic was the speed and willingness for federal and state agencies to try new things. While change in Medicaid policy usually took a longer time, the pandemic has required more immediate flexibility, which has showcased what workforce and other investments, blanket waivers, and quick amendments to a service can do.

Desire for Home and Community-Based Services (HCBS)

Another trend, Lundy offered, is that “people want to reside as independently as possible in community-based settings and are more vocal about this desire, and this hopefully will lead to an expansion of services and a more seamless continuity of care.” CMS has noted that among their many benefits, HCBS services are generally cost-effective (less than half the cost of residential care), culturally responsive, and provide individuals with a sense of familiarity with their own home or a small community facility that can lead to positive outcomes.