Why a Fully Funded I/DD Service Can Still Go Undelivered: The Direct Support Workforce Gap
SUMMARY
Congress funds home and community-based services (HCBS), but those services only reach people if there is a direct support professional (DSP) available to deliver them. Right now, the federal government cannot accurately measure that workforce, because DSPs have no distinct occupational classification in federal labor data, which leaves offices making funding and oversight decisions about a workforce they cannot see.
The Administration for Community Living projects that more than 1.3 million new direct care workers will be needed by 2030. [1] Capacity is already constrained. In ANCOR's 2026 national provider survey, 55% of providers reported turning away new referrals because of inadequate staffing, 29% had discontinued programs or services, and 48% were weighing further cuts if recruitment and retention did not improve. [2] Public dollars are being authorized for services that providers are not equipped to deliver. If federal investment can be directed toward DSP compensation, training, retention, and workforce infrastructure, those dollars can more efficiently achieve the outcomes they were appropriated for.
IN THE COMMUNITY
One of our direct support professionals is a boxer. He runs the fitness program in our adult day program.
Two others are professional musicians and recording artists. They run our music therapy and theatre programs. Licensed cosmetologists on our staff work with individuals in our on-site beauty salon. Another DSP has a talent for nonprofit development and works alongside our advancement team building donor relationships that fund the very program she supports.
Instead of treating DSPs as interchangeable staff, the Roland Center creates roles where their expertise, whether in fitness, music, or development, can grow into a lasting career.
The Roland Center has served adults with intellectual and developmental disabilities (I/DD) in the San Gabriel Valley for more than six decades. We have held CARF International accreditation continuously since 1996, and currently hold three-year accreditation across six programs, including Community Integration accredited for both Older Adults/Dementia Care and Autism Spectrum Disorder-Adults. [11] Sustaining specialized accreditation in two distinct clinical populations is not possible with a workforce that turns over before it masters the work.
At current reimbursement-driven wage levels, the pay that funding allows is not enough to retain a stable, expertly trained workforce. To build a sustainable career model we have to integrate specialized training in syndrome-specific and complex care, genuine pathways into Lead DSP roles and beyond, program roles matched to the skills our staff already have, and active support for the small businesses and ventures many of them run outside these walls.
Our model is one strategy, carefully built after decades of disability education and care, and we can put a number on it. Across all service lines, 70.3% of our direct support professionals stayed with us through 2025 and 2026. We will state our method plainly, because it differs from the national one: our figure treats the two years as a single period and excludes separations for reasons outside the employee's control or ours. NCI's national turnover ratio for calendar 2024 was 37.1%, measured across a single year and counting every separation. [3] The two measures are not interchangeable, and we are not claiming a precise margin. But every I/DD provider in California operates under the same reimbursement constraints, and holding most of a workforce across two years is not what the national trend predicts.
Peer-reviewed analysis of national NCI survey data finds wages to be the strongest predictor of DSP retention, which is exactly why reimbursement rates matter. [10] Wages are not the only lever, though. A state-commissioned University of Minnesota evaluation of New York's DSP credentialing pilots found 92% of participating providers reported improved retention compared with non-participating providers. [9] Where wage increases are capped by reimbursement, training, advancement, and job design still move retention. That is testable, documentable, and replicable.
We cannot produce reliable evidence about our model alone. Validating a retention model across different provider types and regions, and building what works into federal workforce policy, requires resources and standing that are unavailable to a single non-profit. The work that could lead to a national solution for better care and efficiency would require federal partnership.
THE POLICY ISSUE
Direct support professionals do not have their own occupational classification in the federal Standard Occupational Classification (SOC) system, maintained by the Office of Management and Budget (OMB) and used by the Bureau of Labor Statistics (BLS) to produce federal employment and wage data.
Without a distinct SOC code, DSPs are absorbed into broader categories alongside workers doing substantially different jobs. The practical consequences:
- No reliable federal wage benchmark for the workforce on which Medicaid-funded community services depend
- No federal vacancy or shortage data specific to direct support, so shortage projections rest on voluntary state and provider surveys rather than federal statistics
- No clean basis for workforce development targeting because federal workforce programs generally organize around recognized occupations
The Recognizing the Role of Direct Support Professionals Act (H.R. 6137 / S. 3211) addresses this. Both were introduced on November 19, 2025, the House bill by Reps. Brian Fitzpatrick (PA-1) and Joe Morelle (NY-25), the Senate companion by Sens. Maggie Hassan (D-NH) and Susan Collins (R-ME). The bill requires OMB to consider establishing a separate SOC code for direct support professionals at the next revision of the system, and report to Congress with reason if OMB declines. [6][7][8]
The bill is a recognition and accountability measure, not a funding bill. It does not require OMB to create a separate DSP code or appropriate new funds. What it requires is a decision on the record: OMB must consider the classification and, if it declines, explain that decision to Congress. That is less than full visibility and more than the status quo offers, and it is the precondition for the evidence Congress, states, providers, and workforce planners need to design better solutions.
The two bills have moved at different speeds. The Senate Homeland Security and Governmental Affairs Committee ordered S. 3211 reported favorably with an amendment on August 6, 2026, and the bill was reported to the Senate on September 14, 2026 with ten bipartisan cosponsors. H.R. 6137 was referred to the House Committee on Education and Workforce on introduction. [7] Congress.gov carries the current status of both bills. [13]
WHY IT MATTERS LOCALLY
The DSP workforce gap is a measurable barrier between approved plans and the support someone receives. The data laid out below explains why public funding, eligibility, and authorization do not guarantee access on their own. A funding model that does not measure workforce stability cannot predict whether the services it pays for will actually be delivered.
National data from the most recent NCI-IDD State of the Workforce survey, covering calendar year 2024 and drawn from 3,936 provider agencies representing 344,179 DSPs across 26 states and DC: [3]
- Weighted mean turnover ratio of 37.1%, ranging from 16.7% to 53.7% across states
- 64% of DSPs who left had been with their agency less than one year
- Median hourly wage of $18.39, up from $17.20 in 2023
- Vacancy rates of 9.7% for full-time and 13.2% for part-time DSP positions
In California, the Department of Developmental Services projects serving roughly 525,000 individuals with developmental disabilities in 2026-27 under the Lanterman Act, an increase of about 35,000 over the prior year. [5] DDS administers its own DSP Workforce Survey and publishes results through a public dashboard. [4]
One caution worth stating plainly: participation in that survey is voluntary, the dashboard summarizes responses by category rather than by individual agency, and DDS itself notes the data may not be representative of the state's full DSP workforce or of any particular region. It is the best California-specific source available, and it is not a substitute for the federal statistics a SOC code would produce. That is the argument in miniature.
The operational effect is straightforward. When a provider cannot fill or hold a direct support position, an authorized service does not get delivered. The funding was appropriated. The eligibility was determined. The service plan was approved. The person still goes without.
WHAT CONGRESS CAN DO
1. Cosponsor H.R. 6137, or move S. 3211 to a floor vote. The classification requirement carries no appropriation, has bipartisan support in both chambers, and has already cleared Senate committee. It will not by itself put a single direct support professional in a job, and we are not claiming otherwise. It is the step that makes every funding decision after it an evidence-based one, which is why we put it first rather than last.
2. Request district-level workforce data directly. Published state dashboards report aggregates, not district or provider detail. State developmental disability agencies and, in California, the regional centers that vendor providers, collect the underlying data at a finer grain. An office can request a district picture rather than waiting for federal statistics to catch up.
3. Conduct oversight on the gap between authorized and delivered services. Ask CMS and state Medicaid agencies how many approved service hours went undelivered due to staffing, not funding. This distinction is rarely reported and frequently decisive.
4. Fund career infrastructure, and evaluate what works. Training, credentialing, and advancement pathways are typically treated as provider overhead rather than workforce policy. The evidence does not support that framing. When New York's Office for People With Developmental Disabilities had the University of Minnesota evaluate its DSP credentialing pilots, 92% of participating providers reported improved retention relative to non-participants. [9]
Providers vary widely in their ability to hold staff under identical reimbursement conditions, and that variation is undocumented federally. ACL's Direct Care Workforce Strategies Center already gives tailored technical assistance to selected states and maintains a research function. [12] An office could direct ACL, through report language or an oversight request, to use it to identify high-retention providers, evaluate which practices transfer, and publish the findings. The Roland Center is prepared to participate.
QUESTIONS STAFFERS CAN ASK
Of CMS or a state Medicaid agency:
- How many authorized HCBS service hours went undelivered in the last fiscal year due to direct support staffing shortages rather than funding or eligibility?
- Does the state track the gap between service plan authorization and actual service delivery? If not, what would be required to track it?
Of OMB or BLS:
- What is the current status of SOC revision review, and what evidence would be required to support a distinct direct support classification?
- Which existing SOC codes currently absorb direct support professionals, and what is known about the resulting measurement error?
Of a state developmental disability agency:
- What is the current DSP turnover ratio and vacancy rate in this congressional district, and how does it compare to the state average?
- What proportion of DSP separations occur within the first twelve months of employment?
Of providers in the district:
- What retention strategies have worked, independent of wage increases, and what would it take to scale them?
- How many individuals are currently waiting for an authorized service that cannot be staffed?
KEY TERMS
Direct Support Professional (DSP): Paid staff whose primary responsibility is direct support, skills development, guidance, or personal assistance to individuals with I/DD.
Standard Occupational Classification (SOC): The federal system, maintained by OMB, used to classify workers into occupational categories for federal statistical purposes, including BLS wage and employment data.
Turnover ratio: As used by NCI-IDD, a point-in-time indicator: DSPs who separated during the year divided by DSPs employed as of December 31 of that year.
Lanterman Act: California's statutory entitlement to services and supports for individuals with developmental disabilities, administered through the Department of Developmental Services and a network of regional centers.
HCBS: Home and Community Based Services. Medicaid-funded supports delivered in a person's own home and community rather than an institutional setting.
SOURCES
[1] Administration for Community Living, “Strengthening the Direct Care Workforce.” https://acl.gov/programs/direct-care-workforce
Accessed November 3, 2026.
[2] ANCOR, “The State of America's Direct Support Workforce Crisis 2026.” https://www.ancor.org/resources/the-state-of-americas-direct-support-workforce-crisis-2026/
Accessed November 3, 2026.
[3] National Core Indicators IDD, “State of the Workforce in 2024 Survey Report” (published December 2025). https://idd.nationalcoreindicators.org/wp-content/uploads/2025/12/2024-NCI-IDD-SoTW_Final-Tagged.pdf
Accessed November 3, 2026.
[4] California Department of Developmental Services, DSP Workforce Survey and interactive dashboard. https://www.dds.ca.gov/rc/vendor-provider/dsp-workforce-survey/
Accessed November 3, 2026.
[5] California Legislative Analyst's Office, “The 2026-27 Budget: Department of Developmental Services.” https://lao.ca.gov/Publications/Report/5157
Accessed November 3, 2026.
[6] U.S. Congress, House, H.R. 6137, Recognizing the Role of Direct Support Professionals Act, 119th Cong., introduced November 19, 2025. https://www.govinfo.gov/app/details/BILLS-119hr6137ih
Accessed November 3, 2026.
[7] U.S. Congress, Senate, S. 3211, Recognizing the Role of Direct Support Professionals Act, 119th Cong., reported in Senate September 14, 2026. https://www.govinfo.gov/app/details/BILLS-119s3211rs
Accessed November 3, 2026.
[8] Office of Rep. Brian Fitzpatrick, “Fitzpatrick, Morelle Introduce Bipartisan, Bicameral Legislation to Strengthen the Direct Support Professional Workforce” (November 2025). https://fitzpatrick.house.gov/2025/11/fitzpatrick-morelle-introduce-bipartisan-bicameral-legislation-to-strengthen-the-direct-support-professional-workforce
Accessed November 3, 2026.
[9] New York State Office for People With Developmental Disabilities, “Investments in Direct Support Workforce Increase Retention and Job Satisfaction According to University of Minnesota Report.” https://opwdd.ny.gov/news/investments-direct-support-workforce-increase-retention-and-job-satisfaction-according
Accessed November 3, 2026.
[10] Pettingell, Houseworth, Tichá, Kramme and Hewitt, “Incentives, Wages and Retention Among Direct Support Professionals: National Core Indicators Staff Stability Survey,” Intellectual and Developmental Disabilities, vol. 60, no. 2 (2022), pp. 113-127. https://pmc.ncbi.nlm.nih.gov/articles/PMC10288864/
Accessed November 3, 2026.
[11] CARF International, provider record for The Roland Center. https://carf.org/provider/the-roland-center-7132/
Accessed November 3, 2026.
[12] Administration for Community Living, Direct Care Workforce Strategies Center. https://acl.gov/dcwcenter
Accessed November 3, 2026.
[13] Congress.gov bill pages, current status: H.R. 6137 at https://www.congress.gov/bill/119th-congress/house-bill/6137 and S. 3211 at https://www.congress.gov/bill/119th-congress/senate-bill/3211.
The Roland Center provides day program, employment support, and specialized dementia care for adults with intellectual and developmental disabilities in the San Gabriel Valley, California. Residential services are administered by the San Gabriel Valley Training Center Residential Facility (SGVRF), a separate legal and financial entity that operates alongside The Roland Center. To connect with our Communications and Advancement team, contact atalia@sgvtc.org.