In December 2021, then-Gov. Asa Hutchinson announced a promising initiative with a commitment of $37.6 million to eliminate the waiting list for Medicaid waiver services for individuals with intellectual and developmental disabilities in Arkansas. This move was celebrated as a significant step forward in addressing the urgent needs of thousands of individuals and families, many whom had been waiting for services for close to a decade.
However, the challenges facing these individuals and their caregivers extended far beyond the waiting list.
Disability advocates and providers immediately and consistently raised concerns about the ongoing workforce catastrophe that severely affects the quality and accessibility of essential support services in home and community-based settings. The concerns then were that without significant changes to the existing service system, individuals with disabilities would move from the state's long waiting list for services to a new waiting list at the provider level as providers struggle to recruit, train, and retain adequate support staff to provide services.
As predicted, those concerns have become reality.
Direct Support Professionals (DSPs) are the backbone of home and community-based services, offering support and assistance that enable individuals with disabilities to live with dignity and participate fully in their communities. Yet the compensation and resources allocated to these workers have not kept pace with the demands of their critical roles or the compensation offerings in competing industries. Advocates and providers have consistently called for increased reimbursement rates to provide living wages to DSPs, accompanied by investments in training and career development opportunities, and the integration of enabling technology supports to enhance access to quality supports and services.
Despite these calls to action, the only significant progressive development since the initial funding announcement has been the temporary introduction of bonus payments to DSPs funded through the American Rescue Plan Act (ARPA) beginning in 2022. The ARPA spending plan provided funds for a narrowly defined group of DSPs to receive recruitment and/or retention incentive payments as dictated by the plan specifications, often resulting in eligible DSPs receiving up to $1,000 recruitment incentive payments or between $300 and $600 monthly retention payments for existing workers.
The temporary relief provided by the ARPA payments has become essential in many DSPs' personal budgets and is often the difference between paying the rent or not. However, in accordance with the state ARPA plan and the federal guidelines for utilizing funds, Arkansas' ARPA bonuses end this month, and with the cessation of these incentive payments, DSPs are thrust back into a pre-pandemic compensation structure that fails to recognize the escalating cost of living and the increasingly complex duties and demands of their work.
The result is a direct support workforce that is depleted, overworked, and significantly under-resourced, facing conditions that no longer just border on unsustainable--they are unequivocally untenable. Without access to the supplemental funds that many relied on for basic necessities, the risk of exacerbating the already volatile workforce shortage looms large, threatening the integrity of support systems for individuals with intellectual and developmental disabilities in Arkansas.
The situation presents a critical juncture for state leaders, policymakers, and managed-care organizations. The temporary relief offered by ARPA bonuses highlights the profound impact that financial incentives can have on stabilizing the direct support workforce.
However, it also underscores the need for lasting solutions that address the root causes of the workforce calamity. This includes re-evaluating reimbursement rates to reflect the skilled and essential nature of DSP work, investing in workforce development to create clear career pathways and reduce turnover, and embracing innovative service delivery models that can enhance the quality of support services.
Arkansas has an opportunity to transform its approach to supporting individuals with intellectual and developmental disabilities by building a robust and sustainable system that values and adequately compensates the professionals at its heart. This requires a collaborative effort among policymakers, managed-care companies, providers, advocates, and the community to prioritize investments in the direct support workforce as a cornerstone of quality, accessible services.
As the state moves forward, the focus must shift from temporary fixes to comprehensive, long-term strategies that ensure individuals with disabilities can thrive in their communities. This means recognizing and addressing the workforce emergency not as an isolated issue but as a critical component of the broader challenge of providing equitable, person-centered support services.
Without such action, Arkansas risks not only the well-being of people with disabilities and the direct support professionals who support them, but also the integrity of its commitment to dignity, inclusion, and community for all.
Syard Evans, Ph.D., is CEO at Arkansas Support Network.