While we’re into a new year, one thing that hasn’t changed is the biggest issue keeping I/DD providers up at night: the workforce crisis. With moderate to severe staffing shortages across the board, the impact is having significant effects on providers and those they serve, including:

• Turning away new referrals, further reducing access to care
• Difficulties adhering to established quality standards
• Trouble connecting people with services due to a lack of providers (among those offering case management


And the impacts are likely to worsen in 2024, with ANCOR’s “State of America’s Direct Support Workforce Crisis 2023” report noting that 60% of respondents are worried for the future, indicating they are likely to pursue additional discontinuations of programs and services unless high staff turnover abates. What can be done to address the crisis? Lydia Dawson, Senior Director of Government Affairs at ANCOR, shares some meaningful steps that could make a difference:

1. Investing in Community-Based Services: As more providers realize they don’t have enough staff to continue to offer services and programs, and risk closing, a growing number of policymakers are responding. For example, the HCBS Relief Act (S. 3118/ H.R. 6296), proposed last year, would provide dedicated Medicaid funds to states temporarily to, among other things, recruit and retain HCBS direct care workers.

2. Pushing for Adequate Reimbursement: “While payment rates for services funded through Medicaid should cover the entire cost of delivering a service, that’s often not the case,” explains Dawson. And though the private market was able to offer accommodations like hazard pay during the pandemic, Medicaid reimbursement rates weren’t adjusted the same way. Now, providers are having to do more with less and further increases in the cost of delivering services without a corresponding rise in reimbursement threaten access to community-based services.

3. Designating DSPs as an Officially Recognized Profession: Pending the Bureau of Labor Statistics’ decision on creating a new SOC in 2028, legislation has been proposed that would create a Standard Occupational Classification (SOC) for DSPs. “A distinct code would result in much-needed salary and occupational data to inform rate-setting,” says Dawson. Without a classification that accurately reflects the DSP profession, policymakers cannot make informed decisions to assist with recruiting, retaining, and adequately paying DSPs.

4. Developing the Workforce: Developing staff by expanding training of DSPs can help providers create and sustain a viable workforce. Several states offer incentive payments for additional credentialing and training as well as job retention – and other states take various other approaches to enhance the DSP workforce. Providers can also take steps by providing mentorship programs, resources for challenges staff may face at work, and having structured promotion paths. Legislation like the Support our Direct Care Workforce and Family Caregivers Act (S.1298) and
the Direct CARE Opportunity Act (H.R. 4720) would establish a career pipeline for DSPs and authorize federal grant programs to support the training, recruitment, retention and advancement of the direct support workforce.

5. Termination of COVID-19 Relief Funding: For a one-year period, states received a 10 percent increase in the percentage of Medicaid spending paid for by the federal government (FMAP) for their home and community-based services through the American Rescue Plan Act. $24.6B was spent on direct care worker recruitment and retention
activities in all 51 states and D.C. But the deadline to spend the funding is only available through March 31, 2025, creating a new fiscal cliff for providers reliant on these funds to stabilize the workforce.

The key to many of these steps is increased visibility into the staffing issue and the need for funding. One of the best ways providers can get involved is to share with policymakers all they are doing to support people with I/DD, including fostering community inclusion, autonomy, and self-determination. For easy ways to get involved, visit the ANCOR Amplifier at amplifier.ancor.org.

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