The historically underfunded system of services for individuals with intellectual and developmental disabilities, and the direct support workforce that is the backbone of home and community services are rarely mentioned in current policy debates in Washington, D.C.  But recent changes in federal and state government policies to expand health insurance coverage and address income inequality are increasingly resulting in a Hobson's Choice between quality services for the people with disabilities or doing right by our workforce.  This can be and should be addressed by the president and Congress.

Direct support workers are the cornerstone of our nation’s long-term care system, and the quality and stability of this workforce is of fundamental importance to the well-being of the millions with disabilities that rely on them for essential care, services and support. Unfortunately, insufficient Medicaid funding to providers across the country result in employee turnover rates currently ranging from 30 percent to 80 percent.  Furthermore, with demand for quality services only accelerating with an aging baby boomer population, meeting this need will be extremely difficult to achieve without a committed, stable and well-compensated direct support workforce—and elected officials who recognize this need. 

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For nearly 15 years, the American Network of Community Options and Resources (ANCOR) under its National Advocacy Campaign has pushed to enhance the lives of people with intellectual and developmental disabilities by fighting to expand access to the resources needed to recruit, train and retain a highly qualified and sustainable workforce. We will not have a complete solution until Congress and the president acts. 

Medicaid is essentially the sole source of funding for services for people with intellectual disabilities and the workforce that enables people to live and work in their communities. Commercial insurance is virtually unavailable and private payment is rare. Therefore Mr. President, Congress, we urge you to work with us to find solutions, and to take immediate action to revise federal Medicaid rules to ensure that payments to providers are sufficient to absorb the additional employer costs associated with the ACA, minimum wage increases, and other actions that increase compensation, benefits and training requirements for direct support workers.

By working together, your actions can lift up thousands of direct support workers across the country without diminishing or compromising essential community services for people with disabilities.

Merrill is vice president for Policy, and CEO-elect, of the American Network of Community Options and Resources, based in Alexandria, Virginia.