2026 Workforce Crisis Survey: By the Numbers

This month, ANCOR released its seventh annual State of America’s Direct Support Workforce Crisis report documenting staffing shortages, service impacts, and policy pressures in the direct support professional (DSP) workforce serving people with intellectual and developmental disabilities (I/DD). Based on responses from 524 disability service providers across all 50 states and the District of Columbia, the workforce challenges ANCOR has tracked for years persist.  

Among the key findings from the 2026 report: 

• 85 percent of respondents reported moderate or severe staffing challenges in the past year; 

• 55 percent of respondents reported turning away new referrals due to inadequate staffing; 

• 29 percent of respondents indicated they were discontinuing programs and services because of staffing challenges; 

• 57 percent of respondents reported an intent to delay the launch of new programs due to staffing challenges; 

• 48 percent of respondents indicated that they were considering further cuts to programs if recruitment and retention challenges failed to subside; and  

• 59 percent of respondents delivered services in areas where few or no other options exist, a three percent increase since 2025. As a result, among respondents providing case management services, 56 percent indicated that they were struggling to connect people with available services. 

Alarmingly, these findings capture the state of the system before states have fully confronted the consequences of massive cuts to federal Medicaid funding passed last year. Medicaid is the primary funder of community-based disability services, and inadequate reimbursement rates have long limited providers’ ability to offer wages and benefits that compete with other hourly wage industries. New federal restrictions on Medicaid funding are now putting additional pressure on state budgets. Home- and community-based services are particularly vulnerable to further cuts because, unlike many other Medicaid benefits, they are not federally mandated. 

According to Barbara Merrill, chief executive officer for ANCOR, “Now we are asking this already-fragile system to absorb another shock. States are only beginning to grapple with how federal Medicaid cuts will affect their budgets and the services they can sustain.” 

The uncertainty of what existing and potential funding cuts will bring is already shaping providers’ operational decisions. In fact, 56 percent of respondents said the threat of state-initiated reimbursement reductions or service cuts in response to last year’s budget reconciliation law (H.R. 1) impacted their decisions not to expand services this year. 

In response to the 2026 survey results, ANCOR calls on policymakers to strengthen the direct support workforce by increasing federal support for Medicaid home- and community-based services, ensuring state reimbursement rates adequately cover the cost of delivering services and paying competitive DSP wages, establishing a standard occupational classification for DSPs, carefully assessing the workforce impact of immigration policies, and ensuring that implementation of federal Medicaid changes and program integrity initiatives do not further restrict access to community-based disability services. 

To learn more about this year’s findings, download the full report .

Tom Rice is the Director of Policy & Regulatory Affairs at ANCOR.