Addressing the DSP Workforce Crisis

Direct support professionals (DSPs) provide mental health and disability supports and services. They provide support that help Iowans live, learn and work in their communities, not institutions. Some of the supports include cooking, cleaning, budgeting, shopping, banking, job development and coaching, transportation and community activities. 

Our 2022 Legislative Session Policy Priority is to "CLOSE THE GAP". Click here to view our Workforce Crisis one-pager.


-  Unable to accept referrals due to a lack of staff capacity leading to costly alternative placements.
-  Negative consequences to people being served by a workforce shortage:
    -  Diminished quality of service 
    -  Reduced progress to individual goals 
    -  Exposure to possible harm 
    -  Decreased access to individualized community services


Raising Wages is the First Step in Addressing the DSP Workforce Crisis 

Positive results of raising DSP wages 
-  Studies have found employee morale and work ethic improve when employees believe they are paid a fair wage. Higher wages result in better physical and mental health and reduced “decision fatigue,” leading to higher productivity. 
-  Higher wages lead to lower employee turnover. 

Raising wages results in: 
-  Reduced turnover and recruiting costs 
-  Reduced training costs related to turnover 
-  Reduced absenteeism 
-  Increased effective and consistent support 

Which Medicaid programs would be impacted? 
-  Habilitation 
-  Home and Community-Based Services/Intellectual Disabilities (HCBS/ID) 
-  Home and Community-Based Services/Brain Injury (HCBS/BI) 
-  Intermediate Care Facility/Intellectual Disabilities (ICF/ID) 

How do we ensure the funding goes to DSPs? 
IACP has been advocating for a 10% rate increase for HCBS services with a 75% pass-through for wages going to DSPs directly supporting individuals receiving these services. 25% would be at employer discretion to cover FICA, benefits, administrative and overhead costs. In 2021, there was a 3.55% rate increase for HCBS (effective July 1, 2021). Unfortunately, our need was 10% and the cost of living went up 6% in the last 12 months. We need funding to close the wage gap in order to attract and maintain quality DSPs. Without such funding, important services will be cut, and community providers will continue to consolidate or close. The fate of vulnerable Iowans is literally hanging in the balance.

Why separate Iowa’s community-based service providers from other health care providers? 
-  Nearly all of the services provided are funded through Medicaid 
-  Very little third party and private payment 
-  Lifelong Supports and Services 
-  Many services are provided 24 hours a day, 7 days a week, 365 days a year