March 15, 2023

by: Emily Hastings

Case for Inclusion 2023 Report

A new report issued by the American Network of Community Options and Resources (ANCOR) Foundation and United Cerebral Palsy (UCP) finds that as the need for home- and community-based services (HCBS) funding grows more dire, provider organizations, including UCP affiliates, are struggling to maintain programs and services for people with intellectual and developmental disabilities (IDD) because of significant shortages of caregivers.

The report was released February 28. According to the report:

      • 481,601 people with IDD remained on state waiting lists for services as of the end of 2021. Now, with program closures and service reductions growing, there is no assurance that a service provider will be available when a person with IDD makes it off of a waiting list.
      • National median wage for direct care workers, who are 86% women and 61% people of color, is less than $14 per hour.
      • In the past year alone, 63% of community service providers have discontinued programs or services due to lack of staff. This represents a staggering 85% jump since the early days of the COVID-19 pandemic.
      • Among home care workers, which encompasses many types of jobs including DSPs, more than half receive some form of public assistance, with a median annual income of $19,100, and 43% live in a low-income household.
      • Immigrants make up 16% of the total U.S. labor force, but 31% of home care workers, and experts say that figure is likely and undercount, given that some percentage of those workers are undocumented.

“I have worked in disability services for over 20 years. The majority of the time, I’ve had to maintain a second job just to get by,” said Greta Robinson, Director of Community Living UCP South Carolina. “Meanwhile, most of our DSPs, who bend over backwards to provide care, are oftentimes work two or possibly more jobs. The system is broken.”

The Case for Inclusion 2023 comes at a critical time. The HCBS Settings Rule, established to ensure people receiving services do so within their communities when possible, instead of institutional settings, is slated to formally go into effect this March.

Among the report’s recommendations to address the workforce crisis:

      • Congress should enact legislation to significantly increase the federal share of Medicaid funding for home- and community-based services to stabilize the direct support workforce.
      • Congress should enact legislation that would fund federal grant programs to support the training, recruitment, retention and advancement of the direct support workforce.
      • The Biden administration should expedite visa programs that ensure opportunities for aspiring Americans interested in joining the direct support workforce.
      • States should establish systems that provide regular review of Medicaid reimbursement rates to ensure payments stay current with increasing costs of service delivery and safeguard access to quality home- and community-based services.
      • State and federal agencies should collect and publicly report on measures related to workforce volume, stability and compensation, as well as systemic barriers to equity and the delivery of culturally competent services within the direct support workforce.

To read the Case for Inclusion 2023 or download a copy of the report, go to

This article was obtained from UCP National.

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