The New Rules Shaping DSP Pay and Policy

For leaders in human services, there’s one reality everyone feels but few can easily fix: you can’t deliver great care without a stable workforce.

The struggle to hire and keep Direct Support Professionals (DSPs) has shaped nearly every conversation in the field for years — and while the headlines often focus on crisis, the truth is more complex. Across the country, DSP wages are rising, turnover is finally trending down, and there’s new momentum behind workforce reform.

But beneath that hopeful trendline, something bigger is unfolding.

The rules of the game are changing.

A New Era of Accountability and Opportunity

In the latest episode of The IDD Leader Podcast, NASDDDS’s Laura Vegas and HSRI’s Dorothy Hiersteiner unpack how the CMS “Access Rule” and the National Core Indicators (NCI) State of the Workforce Survey are reshaping the way states — and the providers they fund — think about wages, data, and accountability.

At the center of that shift is one key requirement:

States must demonstrate that 80% of certain waiver rates go directly to DSP wages.

That single line of policy is sparking an industry-wide conversation. How do you prove compliance? What counts toward that 80%? And how do providers balance that mandate with rising costs, supervision, and training investments?

As Vegas and Hiersteiner explain, the goal isn’t just transparency — it’s transformation. The hope is that states will use real data to understand where dollars go, how they affect workforce outcomes, and what supports actually make a difference in retention and satisfaction.

Data That Drives Change

For years, the National Core Indicators State of the Workforce Survey has quietly gathered vital information about DSP turnover, tenure, pay, and benefits across the country. That data is now front and center — shaping legislation, funding requests, and even rate-setting decisions.

“We get calls from federal lawmakers on the Hill,” Vegas shared, “wanting to see the State of the Workforce data as they’re working on bills or legislation. Lawmakers are making policy decisions based on what we’re collecting.”

That connection between data and decision-making is good news for providers. It means that the information agencies contribute — often painstakingly — isn’t disappearing into a spreadsheet. It’s being used to push for better wages, smarter funding models, and stronger recognition of the DSP role.

You can explore the most recent NCI State of the Workforce Survey results here.

What States Are Trying

Across the U.S., states are experimenting with new approaches that tie training, credentialing, and pay together. Some are building career ladders that give DSPs clearer advancement paths. Others are developing statewide training systems through community colleges or online platforms, so that credentials are portable across employers.

As Hiersteiner notes, these strategies not only help DSPs build careers—they also help providers reduce early turnover, which remains one of the most costly and disruptive challenges.

And for states, that kind of progress requires collaboration. Data helps agencies make their case for higher rates; providers help states understand what works in real settings.

It’s a two-way street — one that’s starting to move in the right direction.

Why It Matters

For leaders in human services, the takeaway is clear: policy isn’t something that happens “out there.” The data your agency contributes, the training investments you make, and the stories you share all shape the broader system you operate in.

The CMS “Access Rule” and NCI workforce data are creating a new era of accountability — but also a new opportunity. For the first time in years, the national conversation about wages, funding, and workforce stability is backed by credible, consistent data.

And that means your voice — and your data — matter more than ever.

Keep the Conversation Going

You can listen to the full episode of The IDD Leader Podcast here:
Episode 58 - The New Rules Shaping DSP Pay and Policy or find it on Spotify or Apple Podcasts.

Want weekly insights like this?

Get tips, encouragement, and practical advice from industry experts and human services leaders — straight to your inbox.
Sign up for the weekly IDD Leader newsletter (form at the bottom of the page).