Disability services staffing squeezed as Medicaid cuts loom
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Nearly 90% of the organizations providing Medicaid-funded community services for people with intellectual or developmental disabilities had staffing shortages this year, according to a trade group for the providers.
Why it matters: Staffing already is a long-standing problem for disability services providers and is expected to get worse as the effects of the budget reconciliation law and its nearly $1 trillion in Medicaid cuts are felt.
- State Medicaid programs aren't required to cover home- and community-based services and have cut funding in the past to respond to budget constraints.
State of play: More than 60% of 469 providers surveyed by the trade group ANCOR in August and September said they've had to turn away referrals of new program participants due to lack of staff.
- "Long-term underinvestment in Medicaid has hamstrung community providers' ability to offer wages that are competitive with employers in hourly wage industries, such as retail and fast food," ANCOR wrote in a report on its survey provided first to Axios.
- "Now, we see clearly the profound impact of these dynamics on the ability of community providers to deliver essential programs and support people with disabilities in their homes and communities."
Friction point: People with intellectual and developmental disabilities spent an average of 50 months on waitlists for Medicaid home- and community-based care services last year, per KFF.
- If providers don't have enough staff, people have to forgo services or stay in hospitals or institutional settings for longer, ANCOR said.
- Some states require people to access services within a certain time after coming off the waitlist. If no provider is available, they could end up back on the waitlist, according to the report.
Zoom in: Some 29% of providers report discontinuing services this year — lower than last year's 39%.
- But 52% reported considering additional cuts to programs, compared with 34% in 2024.
- Providers this year were most likely to report cutting back on residential services including around-the-clock at-home support and hourly skill-building and socialization support.
ANCOR's report asks policymakers to increase federal Medicaid matching funds to states for home- and community-based services and to create systems to monitor payment adequacy for direct support professionals, among other changes to support the workforce.
