The State of America’s Direct Support Workforce Crisis 2022
Every year, ANCOR’s State Association Executives and Board of Representatives share the status of their individual states through our State Share Survey. Their contributions are critical in supporting ANCOR’s efforts to identity trends and issues impacting members across the country. This year’s survey results are no exception – with the following key trends noted in the areas of funding, legislation, and administrative activities.
Budgets, Funding, and Rates, Oh My!
In a continuing trend, a growing number of states reported rate increases with 28 states reporting an increase up to 5% and beyond. Congratulations to Kentucky and Connecticut for topping the charts with Kentucky seeing a 10% increase – the first in over 10 years – and Connecticut receiving an increase sufficient to support a minimum DSP starting wage of $14.75. Additionally, more states reported rates remaining even with 11 states reporting no change this year, as compared to 7 states in 2017 and 2016. In an equally positive trend, the number of states reporting decreases dropped from 12 states in 2017 to only 5 states in this year’s survey.
This balance of rate increases versus decreases versus no rate changes held true across Home and Community Based Services (HCBS) Waivers, Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICFs/IDD), Vocational Rehabilitation Services and Early Intervention – Part C services, as follows:
Reported rate increases are most commonly being applied to address DSP Workforce (18 states), Wait Lists (12 states), and to increase Minimum Wage (10 states). Reported rate decreases are most commonly impacting state administrative costs (6 states), family supports (3 states), and employment first initiatives (2 states). Both the application of increases and decreases is consistent with prior years – particularly, relative to increases addressing DSP workforce and decreases impacting state administrative costs.
Legislative Initiatives Under Consideration
Beyond budgets and funding, several states considered legislative initiatives impacting people with intellectual and developmental disabilities and the provider networks that support them. Managed Care and Rate Setting tied for the top spot across the states with 11 states reporting related legislative initiatives, respectively. Tied for second were legislative initiatives related to ABLE Act implementation and Employment First – with 8 states each. This trend is consistent with last year, though the number of states considering such initiatives has doubled in all four areas. Of particular note among these initiatives, New Hampshire passed legislation prohibiting individuals with I/DD from being included in Managed Long-Term Services and Supports.
State Administrative Initiatives in the Spotlight
Managed Long-Term Services and Supports led the pack with 13 states considering initiatives and an additional six states considering Integrated Care Organizations like Accountable Care Organizations. This is an increase over last year when only 5 states were considering MLTSS. However, it is decrease over the high of 18 states considering MLTSS in 2016.
On the HCBS Settings Rule front, twenty-five states reported strategies being implemented to advance the improving the nature and quality of a person’s HCBS experience – i.e. choices, rights, and opportunities for integration. Among those strategies,
- four states reported increased funding or rates to incentivize service options,
- seven states reported newly developed or revised training materials to include a focus on person-centered thinking, choices, rights, and opportunities for integration,
- eleven states reported new service options that allow for more choices, rights, and opportunities, and
- three state reported developing tools and resources for providers.
Providers and State Associations at the Forefront
New to this year’s State Share Survey, we asked for insight on the state provider network’s priorities and initiatives. Not surprising DSP Workforce and Advocacy for Increased Funding and/or Rates topped the priority list with forty-three states. Following behind in second place was Addressing HCBS Rate Methodology reported by 21 states and in third place was Addressing Issues Related to Billing and Reimbursement reported by twelve states. To advance these priorities, State Associations and providers are employing a wide variety of strategies including building coalitions to widen their advocacy footprint, partnering with families and self-advocates on grassroots campaigns, and investing in public awareness / educational campaigns.
When asked what new initiatives state association executives and providers were most excited about, their top picks included:
- Evolutions in Person-Centered Thinking and Planning (12 States)
- Telehealth Opportunities (9 states)
- Connecting Quality to Payment (8 states)
- Movement to Value-Based Payments (7 states)
- Connecting Workforce Best Practices to Funding or Payment (6 states)
Overall, this year’s State Share Survey reflected continued positive trends relative to rates and addressing DSP wage, though significant and on-going challenges remain. As reflected in their accomplishments and initiatives, ANCOR members continue to demonstrate their commitment to building robust and responsive networks of person-centered services and supports.
**Information and analysis was provided from member surveys and may not reflect everything occurring within a particular state.
Kim Opsahl is ANCOR’s Director of State Partnerships and Special Projects. She can be reached at [email protected].