New Report: Medicaid Investments in Recent Years Yielded Modest Improvements to Direct Support Workforce Crisis, But Access to Services Remains Key Challenge
ANCOR report sheds light on job turnover rate remaining above 40%, despite average hourly wages for direct support professionals exceeding $15/hour for the first time in 2022
People with intellectual and developmental disabilities spent an average of 50 months waiting to receive services in 2023, showing need for continued investment
Press Contact: Sean Luechtefeld, 571.207.9108
ALEXANDRIA, VA. — Today, ANCOR and United Cerebral Palsy (UCP), two of the leading national voices for providers of long-term support services for people with intellectual and developmental disabilities (IDD), released the inaugural Case for Inclusion Data Snapshot detailing the ongoing severity of the direct support workforce crisis and where disability service providers have been able to make gains in improving wages and reducing turnover. The lack of sufficient disability support staff nationwide remains the greatest barrier to people with IDD and their families accessing Medicaid-funded home- and community-based services (HCBS).
The Case for Inclusion Data Snapshot reveals that while community-based providers have been able to increase hourly wage averages for direct support professionals (DSPs) to an average of $15.79 in 2022 (compared to $14.41 the year prior), the national average turnover ratio remains high, indicating that this modest increase is not sufficient to attract and retain desperately needed workers to the field long-term. As disability service providers struggle to maintain programs and serve new referrals amid the workforce crisis, as of 2023, individuals with IDD spent 50 months on average—just over four years—languishing on state waiting lists to receive services.
The nominal improvement in turnover and vacancy rates within the direct support workforce was made possible in large part due $26.3 billion in spending on recruitment and retention initiatives from the American Rescue Plan Act (ARPA). In addition, every state used at least some of their ARPA funds for workforce initiatives, such as developing credentialing programs or piloting recruitment strategies, enabling service providers to in turn increase hourly wages for DSPs. However, starting wages for DSPs in states like Louisiana and Alabama remain below $11/hour.
Continued progress remains uncertain, as ARPA funding was only authorized over a limited time and the spending deadline for these funds is March 31, 2025. Meanwhile, insufficient Medicaid reimbursement rates continue to threaten the provision of adequate compensation. Without a mechanism to compel states to engage in regular reimbursement rate reviews and increases, providers will continue to struggle to offer wages competitive with employers in other hourly wage industries like fast-food restaurants or retail and convenience stores.
“Increased hourly wages and reduced turnover and vacancy rates highlight providers’ desire to offer proper compensation and actively engage in strategies to help recruit, hire and retain direct support professionals. With increased resources due to state and federal action, including emergency funding from the American Rescue Plan, it’s clear that providers are eager and willing to address the ongoing workforce crisis—they just need the support to do so,” said Barbara Merrill, ANCOR’s chief executive officer.
Armando Contreras, president & CEO for UCP, added: “Decades of underinvestment in the Medicaid program, in which reimbursement rates are set by states and financed with federal matching funds, have effectively rendered providers powerless to raise wages to a competitive level. Without meaningful action to support the direct care workforce, and the indispensable services direct support professionals provide, people with intellectual and developmental disabilities will continue to spend years waiting for services, delaying their fundamental right to live in their communities and in the most integrated settings possible.”
Key Findings from the inaugural Case for Inclusion Data Snapshot include:
- Average hourly wages for DSPs increased from $14.41 in 2021 to $15.79 in 2022
- The average turnover ratio was 40.9% in 2022, while average vacancy rates for DSPs were 15.3% and 17.9% for full- and part-time positions, respectively
- Despite improved turnover and vacancy rates, 60% of community-based providers indicated in 2023 that they were likely to pursue additional discontinuations of programs and services due to insufficient staffing
- Similar to 2022, nearly a half-million people in the U.S. were on their state’s waiting list for I/DD services in 2023, indicating states have made little progress in speeding up the process of connecting people with services
- On average, people with I/DD spent 50 months waiting to receive services in 2023
The inaugural Data Snapshot marks the start of a new series that is part of the broader Case for Inclusion family of data and advocacy resources. Case for Inclusion Data Snapshots are designed to provide targeted insights on the state of access to home- and community-based services based on the latest available data from a range of reputable sources.
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