ANCOR in the News - 04.19.22

Federal Medicaid Director Daniel Tsai Addresses I/DD Providers Regarding Upcoming Implementation of HCBS Settings Rule

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Medicaid chief acknowledges need to maintain integrity of HCBS Settings Rule while attending to staffing crisis in direct support workforce


ALEXANDRIA, VA. —The American Network of Community Options and Resources (ANCOR) was honored that Daniel Tsai, director of the Center for Medicaid & CHIP Services at the Centers for Medicare & Medicaid Services, accepted the association’s invitation to speak at Elevate: The 2022 ANCOR Annual Conference last week. As the person chiefly responsible for overseeing the federal Medicaid program, Director Tsai addressed community-based providers of intellectual and developmental disability (I/DD) services about the intersection between the direct care workforce crisis and the forthcoming compliance deadline for the Home and Community Based Services (HCBS) Settings Rule.

ANCOR has long supported the HCBS Settings Rule, applauding how it insists on autonomy, self-determination and access to high-quality, long-term supports for people with I/DD. The rule, which is set to go into effect in March 2023, aims to reinforce the tenets of individualized supports and ensure availability of choice.

Achieving the outcomes promised by the HCBS Settings Rule will require an adequate direct support workforce. However, the COVID-19 pandemic has decimated this workforce in ways that have forced the conversation to pivot from one about high turnover and vacancy rates to one about permanent closures of I/DD programs. These closures, when realized, threaten access to quality services and heighten the risk of institutionalization and isolation.

During his address, Director Tsai acknowledged the myriad challenges facing I/DD service providers. As ANCOR’s own research has found in The State of America’s Direct Support Workforce Crisis 2021, 58 percent of providers are discontinuing programs and services due to insufficient staffing—a nearly 71 percent increase since the beginning of the of the pandemic. Survey results further indicate that 77 percent of providers are turning away new referrals and 84 percent are delaying the launch of new programs or services for lack of staffing.

“CMS’ priority is to ensure the HCBS Settings Rule is implemented in a way that is meaningful for individuals receiving services, affirming their dignity and human rights, while also reflective of realities states and providers face in addressing COVID-19,” said Daniel Tsai, director of the Center for Medicaid & CHIP Services at CMS. “We reiterate our commitment to the HCBS settings regulation, and we assure the stakeholder community that we have heard you. We understand the myriad of challenges the [public health emergency] brings to this table, including the ongoing workforce needs.”

Barbara Merrill, ANCOR’s chief executive officer, added: “To have such a strong partner at CMS as Director Tsai who understands the unpredictable ways in which the public health emergency has exacerbated the [direct support] workforce crisis has been invaluable. We were thrilled when [Tsai] accepted our invitation to address attendees at ANCOR’s 2022 Annual Conference, but we all breathed a collective sigh of relief when he reinforced something ANCOR has insisted upon all along: that we must simultaneously uphold the civil rights of people with disabilities while also shoring up the direct support workforce so that the dream of community inclusion can be a reality.”

ANCOR continues to welcome the opportunity to collaborate with CMS and all other stakeholders that are committed to addressing the direct workforce crisis and maintaining the integrity of the HCBS Settings Rule.



For more than 50 years, the American Network of Community Options and Resources ( has been a leading advocate for the critical role service providers play in enriching the lives of people with intellectual and developmental disabilities (I/DD). As a national nonprofit trade association, ANCOR represents nearly 2,000 organizations employing more than a half-million professionals who together serve more than a million individuals with I/DD. Our mission is to advance the ability of our members to support people with I/DD to fully participate in their communities.