FOR IMMEDIATE RELEASE
July 23, 2025
Contact: [email protected]

AUSTIN, TX – In case you missed it, last week, advocates, providers, and community leaders who are invested in supporting Texans with intellectual and developmental disabilities (IDD) sounded alarms to the Texas Health and Human Services Commission (HHSC) during a public hearing on reimbursement rates for community-based IDD services in Texas.

The speakers expressed broad disappointment in the modest wage adjustments for direct support professionals (DSPs), who continue to be reimbursed at hourly wages less than those at most fast food restaurants, despite taking on a range of complex responsibilities to serve Texas’ most vulnerable residents.

During the hearing, Texans who serve people with IDD made clear to HHSC that the ongoing financial challenges facing Home and Community-based Services (HCS) group homes and Intermediate Care Facilities (ICFs) are unsustainable, and that decisions made by the Commission in implementing the legislatively appropriated funds for IDD services will prolong and exacerbate the DSP workforce crisis that threatens access to critical care for Texans with IDD and their families.

“As someone who has seen this community over the past 10 years that I’ve worked with this company, it just keeps seeming to inch along and not really get to a place where we’re actually providing what we need to keep this community sustainable. And the fact that there are so many HCS providers that are closing is evidence of this lack.”

– Carol Rabalais, Mary Lee Foundation, Austin, TX

“We know the decisions are about modeling and math, but for providers, they translate into real world trade-offs. When one piece of the puzzle is pulled off – whether it’s wages, benefits or supervision – our providers are left deciding what to cut, and in this space, it means levels of supervision, fewer benefits and running thin just to fill shifts. Unlike other Medicaid services, group home providers can’t offset shortfalls with private pay, and they can’t say ‘no’ when someone needs services, but staffing is short.”

– Sandy Batton, Providers Alliance for Community Services of Texas

“The system remains in crisis and unstable. The current financial model simply is unsustainable. Many providers are struggling to keep their doors open with a significant number of HCS homes and ICF facilities already closing. This trend will only accelerate if immediate and substantial action is not taken. When community-based providers are forced to close, individuals with IDD are left without vital services, placing immense strain on family and, ultimately, on state resources through more restrictive and costly placements. We urge HHSC to work with providers and legislators to look at the true cost of delivering these services.”

– Larry Hill, Hill Resources, Abilene, TX

“Community Healthcore is witnessing firsthand unraveling of the system we spent decades building…Today, local IDD authorities are terminating provider contracts at an alarming rate because the financial losses driven by a growing workforce crisis are simply unsustainable. Community Healthcore is one of those authorities who made the painful decision of terminating our ICF contract. That was not an easy decision to make.

We had one of our individuals who had been with us for over 20 years. Her dad had passed years earlier. Before passing, he looked at myself and the ICF manager and stated that he knew that his daughter was in good hands. It was extremely painful to say goodbye to her as she went to another provider who I hope had the capacity to make room for her. We continue out here in the field – as the authority – to see providers who are constantly struggling because of lack of staffing. We’ve seen a significant increase in the number of potential health threats.”

– Sandra Taylor, Community Healthcore, Longview, TX

“This is horrifying. It is absolutely horrifying…We’re putting people on the street. We have another provider who got a call and was able to accept 50 of those clients, but there are over 100 who are looking for a place to go. They’re looking for a group home, they’re looking for a provider who will provide transportation to and from their jobs, they’re looking for a provider who can do what the other provider did, but is now closing…

…For now, it’s going to be $13 [an hour] to change adult diapers and to feed them and care for them and position them. That’s why we can’t find people to work, good people to work with our adult children and our children in our homes who need attendant care.”

– Laura LaVigne, Arc of Fort Bend County, Sugarland, TX

“Along with many people on this call and in person today, we participated in public hearings with our state legislators. I personally believe it was worthwhile, and I think they’re patting themselves on the back for giving us $13 an hour over $10.60, but I really believe that they missed the boat on what type of individual has to serve this higher need population…I don’t believe they understand the actual needs, the job duties of an attendant in an HCS home.”

– Leslie Russell, Parent of a daughter with IDD, Flower Mound, TX

“I think we’re going to find ourselves two years down the road, with the next legislative session, in the same position that we’re finding ourselves now. More group homes are going to close, and I think the crisis is going to grow. So, I think it was a poor use of our funds to make a blanket $13 an hour wage increase…

…We have to have an enhanced staffing rate capability for those individuals who are more impacted and are not being identified in these low ends.”

– Dr. Debra Caudy, 29 Acres, Cross Roads, TX

“Worrying about how to keep these programs going keeps me up every night. We’ve been operating HCS services at a loss since before my time as CEO, which is about six years, losing hundreds of thousands of dollars each year based on the proposed rates…

…Nearly half of that loss comes from the three group homes we operate. To keep them running, we’ve had to pull in staff from other areas, mental health staff, team leaders, just to cover shifts. The new rates won’t change that reality…

…The Texas Conservative Coalition Research Institute put out a white paper in August of 2024 that warned of the consequences that the state didn’t act to substantially raise IDD direct support professional based wages. They predicted exactly what we’re seeing now: staffing shortages leading to group home closures, worse outcomes for people with IDD and higher reliance on more expensive settings like nursing homes, hospitals, or state supported living centers.”

– Chris Barnhill, PermiaCare, Midland, TX

“The ripple effects of this instability extend well beyond providers themselves. Our police departments, sheriffs and county judges are seeing more individuals with IDD in crisis, eloping from group home, cycling through jails, stuck in settings that are not appropriate or cost effective. Reports of abuse, neglect and exploitation made to DFPS are rising while investigations are delayed for months. When families and providers have nowhere else to turn, they go to the local hospital emergency room. A central Texas safety net hospital reports a 140% increase in patients with IDD presenting in the emergency departments since 2018…

…If we continue down this path, more providers will close, more families will be left without options, and more individuals with IDD will land in crisis. The proposed rates may slow the unraveling, but they will not stop it.”

– Erin Lawler, Texas Council of Community Centers

“In the past several years, our losses were so substantial that we closed our first intermediate care facility in 2021. Some may view it as voluntarily closing, but I assure you, had there been any way to recruit and retain staff, we would still be operating that home today. Had funding been at least at a rate where providers could offer employees a living wage, that home would still be in existence.

Although we are a business, when we close what some see as a facility is actually home to six people. Another of our homes was relocated with a populous community in hopes that staff recruiting efforts would be more successful – it was not. Any employer not paying a living wage will continue to struggle. We had hoped that the survival of our programs would be sealed with the outcome of this last legislative session, but those hopes were not realized. We began preparations to close another program, and to be clear: closing that program is removing the security of home for people with intellectual disabilities.”

– Linda Bailey, Evergreen Life Services, Texarkana, TX

“Our direct support professionals who provide these services are critical, ensuring the high quality of life and good health for those who serve. My primary objective is keeping individuals with complex care needs healthier, in their communities, and out of costlier, less integrated care settings such as hospitals and nursing homes. These community-based settings present significant cost savings for Texas. We are disappointed in the way in which HHSC is proposing to apply the legislative funding to residential services including CFC, HCS and ICF IDD programs…Residential IDD services are also being treated differently than attendant care, an application of the administration portion of the proposed rate.”

– Jodie Braden, EduCare Community Living, San Angelo, TX

“Once again, the Legislature and HHSC rate analysis has failed the IDD community, and the private providers have supplied much needed services…We can’t give a raise on this. Can’t be done. I don’t know what you guys were thinking, whatever increase we’re going to get – which is not much – is going to be used to cover the health insurance and liability insurance rate increase, which was received in June…So our DSPs aren’t getting a raise. Does everybody understand that?”

– Richard Thorne, Advo Companies, Amarillo, TX

“It’s a travesty. We cannot offer wages that are competitive in today’s labor market. People in fast food chains, big box stores offer higher pay with a lot less responsibilities, and we’re left scrambling to meet the basic needs of our folks. We are routinely forced to use overtime, limit admissions, and reduce services because we cannot find or keep qualified staff, and in some cases, providers have had to close their homes, as you’ve heard, or withdraw from providing services altogether. Again, a travesty…

…These are the most vulnerable Texans that there are. They need care. And the care that we, the great State of Texas, is giving them $13 an hour care – again, a travesty…

…We’ve got to do better. This is Texas. These are our most vulnerable individuals. Let’s work hard to make a huge difference – if we can’t do it now, then the next legislative session. But hear this: if we can’t do something soon, a lot of the people on this call may not be here next legislative session. And the State of Texas is going to be forced with putting these individuals in state supported living facilities, which we all know costs a whole lot more than our facilities.”

– Robert Marshall, Disability Resources, Abilene, TX

“I’m still in shock of where we’re at, but the reality is that now we are going to have to figure out which homes get to stay in place, and which programs are going to be shut down…

…It’s sad that we’re in a situation where we have to beg people to do the right thing…Look at what we’re at, where we’re at – the programs are closing down, and there have been so many hundreds of programs have closed down…

…Let’s try to sustain where we’re at and hope that next legislative session, we will have brand new people in place that will listen to where we’re at and what we do, and decide: what are we going to do with these folks? If everybody closes down, where do these people go? Do you build another state school for billions of dollars? Wouldn’t it just be better just to give the money to the ICF and HCS providers and let us do what we do, because most of us do it very, very well, and we do it so much cheaper than the state schools.”

– Karen Towery, Evergreen Life Services, Dallas, TX

On Thursday, July 24^th, HHSC will hold a public meeting of the IDD System Redesign Advisory Committee, which is set to discuss IDD group home closures, among other topics. For more information on how to attend and participate in the public meeting, click here.

For more information, please visit www.timetocaretx.org.