Direct support professional (DSPs) are crucial to long-term services and supports (LTSS) in the United States for people with intellectual and developmental disabilities (IDD). This study examined how states utilize DSPs' personal care services in Medicaid Home and Community Based Services (HCBS) 1915(c) waivers across the nation. We found extreme variance across states and services; ensuring people with IDD receive quality services demands this lack of standardization is reduced. Not only did the reimbursement rates range widely, the majority of rates were very close to the federal minimum wage. In recognition of this important work, states need to reconsider the waiver reimbursement rates of services provided by DSPs.

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