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Report on Strengthening the Direct Care Workforce

Despite increased demand for long-term services and supports (LTSS), a shortage of direct care workers (DCWs) remains a significant challenge for individuals with LTSS needs, states, MCOs, providers, and workers themselves. In January 2023, the MLTSS Association launched a Direct Care Workforce (DCW) Workgroup with member health plans charged with offering a unique managed care organization (MCO) lens on opportunities to address the DCW shortage, including how MCOs can be effective partners in designing and implementing solutions. Through this workgroup’s effort, and critical engagement with the MLTSS Association Partnership Program, this report was developed, which captures emerging promising practices for MLTSS MCOs and providers to optimize the DCW. The report also offers policy solutions for states and the federal government to facilitate and scale these practices more broadly.



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