Disability service providers across the nation are turning away new referrals and scaling back programs. And, with massive funding cuts on the horizon, they see no relief in sight.
A survey out this week of 524 intellectual and developmental disabilities service providers hailing from every state and Washington, D.C. paints a bleak picture.
Some 85% of providers report that they’ve experienced moderate or severe staffing shortages in the past year. As a result, 55% have declined new referrals and 29% cut back on programs and services for existing clients. More than half of providers indicated that they held off on rolling out new programs.
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With no sign of the staffing challenges easing, 48% of providers indicated that they are considering additional program cuts, according to findings from the annual survey conducted by the American Network of Community Options and Resources, or ANCOR, which represents disability service providers across the country.
“The reality is that if we cannot recruit and hire enough direct support professionals into this field, services for the disability community may appear to exist on paper, but will become impossible to access in practice,” said Tom Rice, director of policy and regulatory affairs at ANCOR.
The survey comes at a tenuous moment for service providers.
Last year, Congress approved nearly $1 trillion in cuts to Medicaid, the primary funder of home and community-based services for people with developmental disabilities. That has already prompted some states to consider slashing funds for such services. The survey found that the threat of these state-level changes is influencing decisions by providers, with 56% indicating that they opted not to expand services this year as a result.
“The most troubling finding in this year’s report is how little has changed,” said Barbara Merrill, CEO at ANCOR. “Year after year, providers are telling us that they cannot find enough workers, that they are turning people away, and that they are eliminating or delaying services because they do not have enough staff to deliver those services.”
Among providers who cut programs, residential habilitation, home-based services and day habilitation were the most frequently cited. Nearly 60% of providers say that they serve areas where few or no alternate options exist for people with disabilities. And, more than half of those offering case management said they struggle to connect people with services.
The staffing difficulties experienced by disability providers have been compounded by federal immigration enforcement efforts, ANCOR found, with estimates showing that immigrants account for about 30% of the direct care workforce.
Providers are also coping with payment delays due to a crackdown on Medicaid waste, fraud and abuse, a situation that could impact access to services, the findings show. Nearly half of providers said that they would have to end services within three months if faced with a pause or delay in Medicaid payments.
“We have reached a dangerous equilibrium where crisis conditions have simply become the norm,” Merrill said. “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. There is no cushion left. Providers are already stretched beyond capacity, workers are already burning out and people with disabilities are already struggling to find the support they need.”
