The State of Iowa has over 125 community providers who serve and support 160,000 Iowans with disabilities. These services mean Iowans with disabilities can live, learn, and work in their community of choice. The opportunity to continue to live in the community of their choice is in serious jeopardy due to the staffing crisis facing community providers who are unable to recruit Direct Support Providers (DSPs). According to the Iowa Association of Community Providers, 94% of participating providers have vacancies.

Over that last two years, businesses had to adapt to the impact of the pandemic. Traditional businesses implemented alternatives such as reduced hours, closing one or two days per week, or increasing their prices when expenses increased, or employees became scarce. Community providers like Skyline Center don’t have those options. Many of the services provided are 24 hours a day/seven days a week/365 days a year. Reimbursement rates are set by Medicaid which is the only way our Home and Community Based Services (HCBS) are reimbursed. Private insurance does not cover services provided for intellectual or developmental disabilities.

Additionally, consider that while many healthcare providers receive 25-30% of their revenue from Medicaid, many community providers receive more than 90% of their revenue from Medicaid. This means a community provider’s financial success and the ability to reinvest in their workforce are tied to reimbursement rates from Medicaid.

Due to Iowa’s fixed Medicaid reimbursement rate, it is nearly impossible for community providers to recruit new candidates since providers struggle to financially compete with other jobs in the community. The only way to increase rates and give community providers a chance to offer a more competitive wage is through legislative appropriation.

The Iowa House of Representatives has already submitted their proposed budget which contains $17.7 million to increase wages for direct support professionals and another $7.4 million to reduce the waiting list for HCBS services. The senate budget has not been finalized.

I urge community members to support Skyline Center and other community providers by contacting state legislators and urging them to support a $22 million increase in the HHS budget to increase HCBS rates. Additional information including contact information for state legislators can be found at Thank you for your support.

Shane Buer, Executive Director Skyline Center, Inc., Clinton

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