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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. As a result, individuals with disabilities are waiting longer, receiving lower quality services, and relying more on informal caregivers for the supports they need. The COVID-19 pandemic worsened the shortage and illuminated the existing issues with recruitment and retention of DCWs, including low wages and limited career development opportunities.

During the first annual MLTSS Leadership Summit in October 2022, the direct care workforce crisis was universally identified as the single most pressing issue that MLTSS plans, MLTSS Association Partnership Program providers, and state government leaders were facing. 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.

Read the report here.

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