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Wages & Reimbursement Rates

Low Medicaid reimbursement rates suppress wages for direct support professionals, leading to high turnover and vacancy rates. Our DSPs deserve better.

About This Priority

The workforce of direct support professionals (DSPs) has been haunted for decades by low wages. For years, DSP wages have stagnated between $12-13 per hour at the median. Thought of in terms of real dollar values, this means wages have actually decreased for these essential workers, despite a steadily increasing cost of living in just about every ZIP code in this country. As such, it’s often impossible for community providers to recruit and retain a large enough pool of qualified DSPs.

People often ask a reasonable question: if providers are struggling to recruit and retain workers, why don’t they pay DSPs more? While that simple solution works in most industries, providers don’t actually set the prices of the services they deliver in our industry. Rather, in most cases, they are reimbursed by their state Medicaid programs for the amount of time spent delivering services.

In other words, providers don’t set the rates they can pay their employees—those rates are determined by how much Medicaid is willing to pay in the form of reimbursement rates. But those rates have failed to keep pace with inflation thanks to decades of underinvestment in Medicaid. In turn, the amount of funding available to providers has stayed the same while the cost of operating has soared.

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