The Caregiver Cliff: What Hampton Roads Families Need to Know About Virginia’s HCBS Workforce in Late 2026
Think about the person who walks into your home every week to help your loved one.
The one who knows that Tuesday mornings are rough.
The one who knows the exact tone of voice that gets your son to put on his shoes without a meltdown.
The one who’s been there long enough that your daughter calls them by name and lights up when they come through the door.
That person is not a given.
That person is the result of a workforce that has been quietly, expensively held together for the last four years by federal funding most families never knew existed.
That funding is running out.
This isn’t a panic post. It’s a “let’s get ahead of it” post – written in the same month the Americans with Disabilities Act turns 36, because the ADA’s promise of community living was never just a legal one.
It depends, every single day, on whether there are enough trained, fairly-paid people willing to show up at your door.
Why the Last Four Years Felt a Little More Stable
In March 2021, in the middle of the pandemic, Congress quietly passed something called Section 9817 of the American Rescue Plan Act.
It gave states a temporary 10 percentage-point boost to the federal Medicaid match, but only for home- and community-based services, and only for one year.
States got the money. Then states got a deadline to spend it well — first March 2024, then extended to March 2025, then extended again for many states into 2026.
Nationally, the planned spending added up to roughly $37 billion in state and federal funds reinvested in HCBS.
And almost every state’s plan – including Virginia’s – put workforce at the top of the priority list.
Sign-on bonuses. Retention bonuses. Wage bumps. Training programs. Recruitment campaigns.
Stabilization grants to keep small providers from closing their doors.
If your caregiver situation has felt a little more stable since 2022 – a few more people in the rotation, less turnover, maybe an actual raise for the DSP who comes to your home – there’s a reason.
It wasn’t an accident. It was a one-time wave of federal money that bought the system time.
And now the wave is breaking.
The National Association of Counties has put it plainly: once ARPA funding expires at the end of 2026, the home care workforce will take an added hit.
What Happens When Federal Money Walks Out the Door
To understand why this matters in your home specifically, it helps to look at what direct support professionals are actually being asked to do, and what they’re being paid to do it.
A DSP at a Hampton Roads agency might be helping someone manage a behavioral crisis, transferring them safely to a wheelchair, administering medications on a strict schedule, and de-escalating a panic episode – all in the same shift.
It’s skilled, emotionally demanding work.
And the reimbursement rates that pay for it haven’t kept pace with what fast-food restaurants, warehouses, and retail jobs in Hampton Roads are now paying.
Before the pandemic, DSP turnover rates in the disability field already hovered around 40% nationally, with vacancy rates between 12 and 15 percent.
ARPA didn’t solve that. It softened it.
It gave providers like ours the ability to compete on wages for a stretch, fund training that made DSPs more skilled, and put real money toward keeping people in the field instead of watching them leave for jobs with less weight on their shoulders.
That money is in its final stretch. And it’s landing alongside another pressure – the federal Medicaid cuts under the One Big Beautiful Bill Act (the statutory short title of H.R.1, the federal spending law signed in July 2025), which begin rolling out in late 2026 and phase down the provider taxes states use to fund their share of Medicaid.
Two squeezes landing in the same window.
For your family, in real terms, that pressure can show up as a longer wait when a DSP quits and needs to be replaced. More turnover in your home or at your loved one’s day program.
Tighter scheduling for respite and companion care. Difficulty finding consumer-directed attendants willing to work at Medicaid reimbursement rates.
It doesn’t mean any of this will hit your specific family. Virginia has been one of the stronger states for disability services.
The Commonwealth added 3,440 new DD Waiver slots and a 3% rate increase for care providers by mid-2026, and the permanent SSDI eligibility protection that passed this spring shows the state is still moving in the right direction.
But the pressure is real. And families who get ahead of it will have a smoother ride than families who get caught off guard.
What Families Can Actually Do Right Now
What does “getting ahead of it” actually look like for a Hampton Roads family right now?
It starts with knowing exactly what’s on your loved one’s plan. Pull out your most recent Individual Support Plan.
Sit down with your support coordinator.
Confirm how many hours of each service are authorized, what’s actually being used, and what’s authorized but not yet activated.
Every year we see families who’ve quietly left hours on the table – services they were entitled to but never started, sometimes because no one explained the option clearly.
Workforce pressure makes those unused hours harder to claim later. Better to know now than to discover it during a staffing crunch.
It also means writing things down.
If you’ve found a DSP who really knows your loved one, capture what that person does and how they do it.
The schedule. The cues. The early warning signs. The phrases that work and the ones that don’t.
Your DSP is not going to be in your loved one’s life forever – that’s just the truth of the field, and when they leave, your knowledge becomes the only continuity.
The transition for the next caregiver is dramatically easier when they’re handed a real document instead of starting from scratch.
If you’re on consumer-directed services – where your family hires and supervises your own attendants – start identifying backup people now, while there’s still time.
Family members other than spouses or parents of minors can often be paid as attendants.
Adult siblings, aunts and uncles, cousins, even close family friends might be options worth exploring. The flexibility is one of the best features of consumer-directed care; the recruiting burden is the trade-off, and the trade-off gets harder when the labor market gets tighter.
And ask your provider about redundancy.
Most families lean on one or two key DSPs.
When those people quit, get sick, or have a life event of their own, the whole system bends.
It’s worth asking whether there’s any way to build in a backup DSP – even occasionally – so your loved one already knows them before the day you need them.
Finally, none of this is just a private family problem.
It’s a system problem with a political solution, and Virginia has a DD Waiver waitlist of 14,258 people that won’t get shorter without sustained advocacy.
State funding decisions in the 2027 General Assembly session will determine how much of the ARPA workforce momentum gets preserved when the federal piece goes away.
Your CSB hears from families. Your delegate and state senator listen to constituents.
The wins like HB 37 this spring didn’t happen because the right people happened to be in office.
They happened because families showed up, again and again, until lawmakers understood what was at stake.
Why We’re Telling You This
We’re a Hampton Roads agency. We’ve been doing this work for almost twenty years – across Virginia Beach, Norfolk, Chesapeake, Newport News, Suffolk, and Portsmouth – and we know what’s coming because we live inside it.
We hire DSPs. We compete with the warehouse jobs and the retail jobs and the fast-food jobs that pay more for less emotional weight.
We’ve watched beloved caregivers leave for jobs that paid $3 more an hour, and we’ve watched families navigate the heartbreak when it happens.
So we’re not writing this from the outside.
We’re writing it because the next six to twelve months are going to require everyone in this ecosystem – providers, families, advocates, legislators – to actually pay attention.
We’re paying attention. We’ll keep writing about it.
And we’ll keep doing the part that’s ours to do: showing up, taking care of your loved one with skill and dignity, and being honest with you when something on the horizon matters.
If you want to think through how to build more resilience into your loved one’s care plan – whether you’re already a CDS family or just trying to understand your options, we’re here.
Community Direct Services, Inc. 📞 (757) 965-4899 📧 info@cdsva.com 🌐 communitydirectservices.com 📍 5705 Thurston Ave., Virginia Beach, VA 23455
The ADA turned 36 this month.
The promise of community living it made is only as strong as the workforce that delivers on it.
Let’s protect that promise together.
Sources & Resources
- CMS — ARPA Section 9817 Strengthening and Investing in HCBS: https://www.medicaid.gov/medicaid/home-community-based-services/guidance-additional-resources/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817/index.html
- CMS — HHS Extends ARP HCBS Spending Deadline: https://www.cms.gov/newsroom/press-releases/hhs-extends-american-rescue-plan-spending-deadline-states-expand-and-enhance-home-and-community
- Virginia DMAS — ARP HCBS Section 9817 Spending Plan: https://www.dmas.virginia.gov/media/3554/arp-hcbs-sec-9817-spending-plan-and-narrative-virginia.pdf
- NACo — Medicaid Cuts Threaten Home and Community-Based Care: https://www.naco.org/news/medicaid-cuts-threaten-home-and-community-based-care
- VPM — Federal Cuts Could Inhibit Progress on Developmental Disability Care: https://www.vpm.org/news/2025-03-31/developmental-disability-waiver-virginia-federal-cuts
- Virginia DBHDS — Developmental Disability Waivers 2026 Report: https://dbhds.virginia.gov/wp-content/uploads/2026/01/Developmental-Disability-Waivers-2026.pdf
- ECNV — 2026 Virginia Legislative Update: https://www.ecnv.org/news/2026-virginia-legislative-update-on-disability-related-bills
- ADA National Network — 36th Anniversary: https://adata.org/ada-anniversary
