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ANCOR Urges All Members to Take the Following Action:

The Ask: Use our action tool to insist that your members of Congress fully fund the $400 billion investment in Medicaid Home and Community-Based Services (HCBS) in the budget reconciliation package.

The Details: Congress is currently negotiating its budget reconciliation bill, which could include an investment of billions of dollars in the HCBS program. The House version of the bill included $190 billion in the HCBS program, falling far short of the promise President Biden made in his American Jobs Plan to invest $400 billion in HCBS and failing to meet the funding level outlined in the Better Care Better Jobs Act.

While we celebrate this historic investment in the HCBS program, the level of financing is insufficient to sustain access and stabilize the direct care workforce. The dire conditions facing our nation’s direct care workforce demand a greater investment.

Why It Matters: A $400 billion investment in dedicated support for HCBS is essential for building a sustainable HCBS infrastructure that can begin addressing the magnitude of unmet need in our communities, and frankly, increased funding for HCBS can’t wait any longer. Not only does investing in this program enjoy wide bipartisan support—81% of voters want to see this funding in the reconciliation bill—but ANCOR’s recent research shows how badly community services need resources to stabilize a workforce in crisis.

Our new report, The State of America’s Direct Support Workforce Crisis 2021, reveals deep concerns from our providers, including:

  • 92% of providers report that the pandemic continues to inhibit their ability to recruit and retain workers; the majority of these respondents point to the fact that industries that previously paid comparable wages now pay employees more than they can afford to do.
  • 77% of providers have had to stop accepting new referrals due to high turnover or lack of staff.
  • 58% of providers have had to discontinue programs or services due to high turnover or lack of staff.
  • 84% of providers have had to delay the launch of new programs or the opening of new homes due to high turnover or lack of staff.
  • 81% of providers report difficulties achieving required quality standards due to high turnover or lack of staff.

The findings of this survey reveal the significant need for an immediate federal response. As the House and Senate continue to move this historic legislation and enter negotiations on the final package, it’s essential that every member of Congress hears from you now.

Message from ANCOR:

New research finds COVID-19 pandemic further decimating a direct care workforce in crisis.

Like you, we have long understood that the direct support workforce crisis our community has grappled with for years can be traced directly to long-standing underinvestment in community-based I/DD services. We have also long suspected—though couldn’t say for certain—that the onset of new pressures and hazards wrought by the pandemic has significantly exacerbated challenges related to recruitment and retention. 

Unfortunately, we now have stark evidence to confirm what we believed was true: the direct support workforce crisis has been made much, much worse by the COVID-19 pandemic.

This is a key takeaway from ANCOR’s newest research, which we published this morning.

The State of America’s Direct Support Workforce Crisis 2021 summarizes the findings of ANCOR’s survey of providers, which we fielded for a five-week period beginning in August 2021. The survey, which followed up on our 2020 research, garnered 449 responses and sought to understand the human and financial impact of the direct support workforce crisis. The survey measured the same dimensions we asked about in 2020, along with additional measures targeted specifically to the impact of COVID-19 on DSP hiring and retention.

Key findings from ANCOR’s 2021 State of America’s Direct Support Workforce Crisis survey include that:

  • 77% of providers are turning away new referrals, a 16.7% increase since the beginning of the pandemic.
  • 58% of providers are discontinuing programs and services, a 70.6% increase since the beginning of the pandemic.
  • 81% of providers are struggling to achieve quality standards, a 17.4% increase since the beginning of the pandemic.
  • Nearly 3 in 10 providers report spending at least $500,000 annually on costs associated with high turnover and vacancy rates.
  • 92% of providers report that the COVID-19 pandemic continues to complicate their ability to recruit and retain qualified direct support professionals.

To say the least, these results are troubling. But for those of us committed to moving beyond the direct care workforce crisis once and for all, it is imperative that we understand the true impacts of the crisis and the ways in which it is colliding with the COVID-19 pandemic. For these reasons, we invite you to download The State of America’s Direct Support Workforce Crisis 2021 and read lead author Lydia Dawson’s analysis today.

Download the State of America’s Direct Support Workforce 2021 issue brief today.

Capitol hill building in the morning with colorful cloud , Washington DC.

Message from ANCOR: 

Dear ANCOR Members,

The to-do list for Congress this week is quite massive and hugely significant. Speaker Pelosi’s list includes passing the bipartisan infrastructure package, the reconciliation, and a continuing resolution (CR) to fund the government. We wanted to give you a Monday overview of what we are following, planning and how you can help in the coming days!

First up, the Continuing Resolution or CR: If you’ll recall, the House did pass a CR, but it included provisions to raise the debt limit, disaster relief funding and Afghanistan refugee resettlement funding. The Senate is not going to pass the CR with all of that attached. There should be a party line vote today, primarily with Republicans refusing to raise the debt limit. (This is a drama that plays out in Congress all the time, no matter the party in power…haven’t we all seen this movie before?) Once that Senate vote fails today, both chambers will need to go back to the drawing board in order to pass a “clean” CR that can be signed by President Biden by midnight on September 30 to avoid a government shutdown.

Next up, the Bipartisan (hard) Infrastructure Package: Speaker Pelosi announced the House will vote on this package Thursday, September 30. Originally the date was set for a vote on both this package and the human infrastructure package TODAY in hopes of keeping both the progressive and moderate sides of her caucus satisfied, but things haven’t gone exactly to plan. The risk for Speaker Pelosi is that the progressive caucus has threatened to vote no on the bipartisan infrastructure package without significant progress toward the reconciliation package (where our HCBS funding lives). Speaker Pelosi has promised a “framework” for the reconciliation package in hopes that will be enough to bring the progressives on board to pass the bipartisan package first, but the vote is anything but certain.

Last but not least, the Human Infrastructure Package/Reconciliation: On Sunday, the House Budget Committee (after the markups) packaged the reconciliation bill and moved it to the House Rules Committee. As expected House and Senate Democrats are actively negotiating to develop an overarching framework and legislative text. Leadership is developing a reconciliation package for a potential vote on Thursday in hopes of moving the progressive Democrats to vote on the bipartisan package (see above).  Needless to say, this is a tall order to get this done by Thursday with so many disagreements among Democrats on what should and shouldn’t be included. One thing for sure, whatever happens this week with the reconciliation will not be the last step. There will still be plenty of time for change.


  • Recent polling shows over 80% of Americans support the HCBS provisions of the bill, even if they don’t agree with other parts of it.
  • Congress is hearing from a LOT of their constituents back home supporting HCBS. Keep it up! This is clearly not a partisan issue.
  • Tell your stories!
  • Take Action Alerts!

On Wednesday, ahead of the vote(s) in the House…we will be releasing a summary brief of our recent Workforce Impact Survey, along with a NEW Action Alert. Please be on the lookout for that, rally your groups and prepare for this important DAY OF ACTION. 

Thank you, everyone! Happy Monday!
Shannon McCracken
Vice President of Government Relations

ALEXANDRIA, VA. – Today, ANCOR CEO Barbara Merrill issued the following statement in response to the news that the House Energy & Commerce Committee’s budget proposal will include a $190 billion investment-less than half the amount proposed by President Biden and Senate Democrats-in Medicaid Home and Community Based Services (HCBS).

“Although decades of underinvestment in the Medicaid HCBS program make us grateful to see any allocation of resources to support community-based disability services and thankful for legislators who see these services as a priority, we were disheartened to learn that the House Energy & Commerce Committee is proposing to invest only $190 billion in HCBS in the Committee’s response to the Senate’s budget resolution.

“Indeed, $190 billion is not an insignificant amount of money, but it falls woefully short of the $400 billion proposed by President Biden in his Build Back Better agenda and approved by the Senate in the budget resolution it passed prior to the August recess.

“If our elected officials are to take seriously the need to overcome a decades-long direct care workforce crisis and support people with disabilities to bounce back from the perilous effects of the pandemic, it is absolutely essential that Congress approve the full $400 billion originally proposed for the Medicaid HCBS program. We know that legislators who care about their most vulnerable constituents will do the right thing and continue to push for the largest amount of funding possible to ensure that community-based services won’t continue to languish.”

Barbara Merrill
Chief Executive Officer
American Network of Community Options and Resources
Alexandria, VA
(703) 535-7850 (103)

The American Network of Community Options and Resources (ANCOR) provided feedback to the Occupational Safety and Health Administration’s (OSHA) emergency temporary standard (ETS). While ANCOR members understand and support OSHA’s intent to protect healthcare and healthcare support service workers from occupational exposure to COVID-19, there is a  concern that the rule remains unclear in its scope of implementation and may further exacerbate the current workforce crisis impacting services and supports for individuals with intellectual and developmental disabilities (I/DD).

A message from ANCOR:

Dear ANCOR member,

In early 2020, just before the pandemic began to wreak havoc on our lives, ANCOR fielded a survey of its members to discern the ways in which the direct support workforce crisis is impacting organizations like yours.

We understood innately that high turnover was leading to high vacancy rates, added onboarding costs and more. But we wanted to know: what is the human impact of these challenges on provider organizations and the people they support? Is the direct support workforce crisis impacting your ability to accept new referrals? Is it causing you to discontinue lines of service, or delay the launch of new programs? Is it complicating your efforts to achieve quality standards?

The response we received was overwhelming: more than 810 provider organizations responded, giving us a snapshot of just how deep the impacts of this crisis are and illustrating that you’re eager to share your concerns.

That’s why we come to you again with an important ask: we are now fielding a follow-up survey and hope you will take 10 minutes to respond to the questionnaire. Whether you responded to the initial survey or not, we need to hear from you.

Why go through this exercise again, especially so soon after we last solicited such similar data? Quite frankly, we know that although the snapshot we gleaned from the 2020 survey is helpful, it quickly became outdated thanks to the ways COVID-19 has exacerbated many of the challenges described in the survey. Just as our world has changed in the past 18 months, so too has the situation facing community providers. We created this new survey to capture the seismic shifts so we can better adapt to your needs and advocate on your behalf.

The survey can be completed by any organization that provides long-term services and supports to people with intellectual and developmental disabilities. We simply ask that, in order to avoid duplication, only one person per organization complete the survey.

Complete the 2021 direct support workforce crisis survey today.

With gratitude,

ANCOR staff submitted a written response to the Better Care Better Jobs Act to Leader Schumer, Chairman Casey, Chairman Wyden, Senators Duckworth, Hassan and Brown, and Representatives Dingell, Pallone, Schakowsky, and Matsui to express support for their efforts and the recognition of the fact that the direct care workforce has been decimated by the economic impact of the COVID-19 pandemic, leaving American families without critical support and people with disabilities at increased risk of hospitalization and institutionalization.