Earlier this month, representatives from 12 of ANCOR’s state association members gathered in Baltimore for our annual winter retreat. During this year’s session, state associations discussed legislative and policy-related issues they expect to be grappling with in the year ahead.
Key topics included attainment of significant rate increases targeting the direct support workforce in most of the states. Association directors reported rate increases averaging 23%, most of which is being paid with funding from the American Rescue Plan Act (ARPA). While this is concerning to some due to the temporary nature of the funding, many states reported that their legislatures ensured that the state matched the federal funds and added these increases to the base funding for I/DD services. This is a big win for service providers in these states as it represents a more permanent increase for DSPs.
Another widespread initiative discussed was active rate studies, or rate reform, in multiple states. This is an important activity for providers as it is one of the key vehicles used to demonstrate whether or not current rates for services are aligned with actual expenses.
Once these studies are completed and recommendations are made, the studies help state administrations and legislatures determine what additional support should be added to state I/DD budgets. Over the years we have seen some states fail to review and update their rates for a decade or more. This results in significantly insufficient funding for services, and creates an enormous hurdle to overcome when advocating for current, sufficient funding.
Other initiatives we’re tracking include states shifting to self-directed services, host homes, and paid family caregivers to enhance individual and family autonomy (but also as a means for combatting the workforce crisis), and the move by some state legislatures to eliminate 14c certificates and promote competitive integrated employment.
Lastly, the state associations spoke at length about the need for “crisis services” for people with complex support needs. All are concerned about the increasing reliance on hospitals or other institutional settings as the only option for supporting someone in a behavioral or mental health crisis.
As workforce shortages continue and the need to fund agency infrastructure continues to be front of mind, providers are increasingly unable to support individuals with these complex needs despite a desire to do so. In the coming year, ANCOR will focus on resources to support state associations by promoting promising crisis support models and other alternative service models that may help to ensure all individuals wanting to live and receive services in the community are able to do so.
Donna Martin is Senior Director of State Partnerships & Innovation at ANCOR.
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