Supporting People as the Age

Direct Support Workforce Update communicates relevant research, policy, and practice updates to direct support professionals (DSPs) who support people with intellectual and developmental disabilities (IDD). If you have a question or topic you’d like us to address in Direct Support Workforce Update, please email frontline-dsp@umn.edu

What do we know about how federal funding cuts to Medicaid may affect services to people with IDD?

• Reduced Access to Services: Many people with IDD depend on Medicaid-funded Home and Community-Based Services (HCBS) to live independently. Funding cuts often lead to waiting lists, reduced service hours, or loss of eligibility. Self-advocate Sam Mattle emphasizes how access to direct support through Medicaid-funded home and community-based services supports his independence and keeps him from living in a nursing home.
• Reduced Workforce Funding: States typically respond to funding reductions by lowering provider reimbursement rates. This directly affects direct support professionals (DSPs) — leading to lower wages, higher turnover, and staff shortages.
• Institutional Risk: With community supports weakened, individuals may face increased risk of institutionalization or hospitalization, reversing decades of progress toward inclusion.
• Family Strain: Families often must fill the gap when services disappear, resulting in burnout, lost income, and emotional stress.
• Economic and Social Consequences: Medicaid-funded IDD services contribute to local economies and community inclusion. Cuts can harm both the workforce and the broader system that sustains community-based living for people with disabilities.
• Speak up to your elected officials. Your opinion matters. When many people speak up together, we have a louder voice and more power. Find your elected officials’ U.S. House and Senate contact information here . Tell them how important your job is to the people you support and to you. All you need to do is talk about what you do daily as a DSP or FLS to support people.

What can you tell me about the revisions to the National Alliance for Direct Support Professionals Code of Ethics?

• The NADSP Code of Ethics (COE) is intended to guide day-to-day ethical decision-making needed from direct support professionals. Frontline Initiative devoted an issue to the current NADSP Code of Ethics in 2023.
• Why revisions? The NADSP Code of Ethics was first developed and validated through a rigorous process in 1999-2000. There were slight revisions made and adopted in 2016. A lot has happened in the last 25 years to advance the role of direct support professionals as professionals. The Code of Ethics needs to address contemporary experiences.
• How is the COE being revised? This year, staff from the ICI and the NADSP have been working to update the COE. First, subject matter experts who focus on workforce development in community support to persons with disabilities and the elderly reviewed and provided recommendations for needed changes to the current COE. These changes were incorporated. Then, DSPs and FLSs from across the United States participated in focus groups to discuss their professional practice, ethical issues they face, and to identify any gaps or issues in the revised COE. Their feedback was then incorporated into the revision. Then, validation workshops for DSPs and FLSs were conducted at the 2025 NADSP Conference to test whether the COE was useful in problem-solving ethical dilemmas. DSPs and FLSs also edited the revised version of the COE. That feedback will be integrated and then reviewed by the same subject matter experts to finalize the revised version of the COE. The revised COE will be available in 2026.

Are there any updates on establishing a Standard Occupational Classification for direct support professionals?

• What is a Standard Occupational Classification (SOC)? The U.S. Bureau of Labor Statistics collects employment statistics using SOCs for many different workforces nationwide. In the past, DSPs have been counted with caregiving positions, like home health aides and personal care assistants. Today, DSPs also support people in actively living their lives, building relationships, and working in their communities. DSPs have different skills that distinguish their work. DSPs need a different SOC to help decision-makers better understand the workforce, support its growth, and build appropriate compensation systems.
• The NADSP has prioritized advocacy to support federal legislation. It would require the U.S. Department of Labor’s Office of Management and Budget to have a separate category within the Standard Occupational Classification system for direct support professionals. There are several updates to note:
• The "Recognizing the Role of Direct Support Professionals Act " (S. 1332) was unanimously passed by the Senate with support from Republicans and Democrats. Unfortunately, its companion Bill (H.R. 2941) was sent back to committee for changes. It was not passed by the House. It has not been reintroduced by this Congress.
• Last summer, the Office of Management and Budget opened public comments for new occupational classifications. We estimate that more than 10,000 direct support professionals submitted comments. The title "Direct Support Professional" received a lot of advocacy and attention. Several papers and recommendations were given to government officials by advocacy groups. Here is a link to one .
• The Bureau of Labor Statistics is now studying potential new occupational categories. That occurs every 8-10 years. We hope that all the information provided and our advocacy efforts will result in “direct support professional” becoming an official job title and classification.

Learn more about what’s happening at the Institute on Community Integration (ICI), University of Minnesota, sign up for FYI.

Learn more about what’s happening at the National Alliance for Direct Support Professionals (NADSP)

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