HCBS Staffing Shortages Lead to Severe Cuts to Programs, Services, New Report Finds

McKnight’s Home Care / By Adam Healy
 
With the vast majority of home- and community-based services providers suffering from a lack of direct support workers, patients in need of home care have fewer programming options. 
 
Among 581 HCBS providers across 45 states, as many as 95% have experienced moderate to severe staffing shortages throughout 2022 and 2023, according to the American Network of Community Options and Resources’ (ANCOR) most recent State of America’s Direct Support Workforce Crisis survey. And as a result, 77% have had to turn away patients due to a lack of available workforce, and more than half said they have had to discontinue programs because of their staffing situations.
 
As part of the fallout from the shortage, connecting patients with care has become harder. About 75% of case management providers have experienced challenges connecting patients with services, since many are understaffed and unable to accept new patients. And though many states have laws barring providers from turning away new referrals, wait lists can make it just as difficult to access care.
 
“Even if someone is cleared from their state’s waiting list and approved to seek services, they are likely to continue facing barriers because of a lack of available providers,” the researchers wrote.
 
Lack of staff also makes it more challenging to meet quality standards. More than 70% of survey respondents said this was the case, and the HCBS Settings Rule implemented by the Centers for Medicare & Medicaid Services has made compliance even trickier, according to the report.
 
The biggest problem, according to ANCOR, is the lack of sufficient funding for HCBS programs. Many funding flexibilities put in place during the COVID-19 public health emergency have reached their expiration date.
 
“The roots of our ongoing direct support workforce crisis trace back to one source: underinvestment in Medicaid,” They noted. “Insufficient reimbursement rates in the Medicaid program have long hindered the ability of providers to compete for labor against other hourly wage industries.”
 
Last month, the Biden administration celebrated the American Rescue Plan Act’s investment of $37 billion in states’ HCBS programs.