52% of Providers Are Considering More Cuts: Inside the Provider Collapse
ANCOR surveyed 469 provider organizations across 48 states in 2025. More than half are considering further program cuts, up from about a third a year earlier. That is the largest single-year jump the survey has recorded.
Providers are not hiding this from you out of malice. They are trying to avoid alarming families about a decision that has not been made, and by the time it has been made you have thirty days. Ask the question directly and ask for an honest answer. If the answer is yes, or maybe, you have months instead of weeks to find an alternative, document the risk in your plan of service, and tell your CMHSP in writing that a service loss is coming.
88%
Staffing shortages
Of provider organizations reported moderate or severe staffing challenges in the 2025 survey. This is not a hiring problem anymore. It is a business model problem.
62% turned away referrals
Nearly two thirds declined new admissions because they could not staff them. Every one of those declines is a family somewhere being told to keep waiting.
59% delaying growth
Providers intend to delay launching new programs. Capacity that never gets built does not show up in any waiting list statistic, which is why the crisis looks smaller than it is.
44%
Residential cut first
Residential habilitation was the most commonly discontinued service. Home-based and day habilitation followed at 28%. Those are the services adults with high support needs depend on most.
36% see more incidents
More than a third report more frequent reportable incidents because of staffing shortages. Thin staffing is not just less service. It is less safe service.
62% missing quality marks
Providers report struggling to achieve quality standards. The standards did not change. The staffing did.
The 2025 survey, in numbers
We lost 50% of staff for one of our services there within a six-week period.
When your provider is the one in trouble
Move in this order
- 1Ask your provider directly whether the program your family member uses is under review for reduction or closure. Ask for the answer by email.
- 2Notify your supports coordinator in writing that a service interruption is possible, and ask that it be noted in the record.
- 3Ask your CMHSP for the current list of providers authorized to deliver that service in your region. Call more than one.
- 4If a provider gives notice, ask your CMHSP in writing what the continuity plan is and by what date it will be in place.
- 5If no comparable service is offered, request that the denial or the gap be issued as a written adverse action notice.
- 6File for a Medicaid fair hearing. A service that exists in the plan but cannot be delivered is still a service you are not receiving.
Document these now, before you need them
- The exact services and hours currently authorized in the plan of service
- The provider’s name, contract status, and your caseworker there
- Every staffing gap you have experienced, with dates and hours missed
- Any written notice of reduction, closure, or schedule change
- The names of other providers you contacted and what each one said
- What you paid out of pocket or lost in wages covering the gap
- Any incident, injury, or ER visit connected to a missed shift
- The date you first told your CMHSP a problem was coming
A provider closing is not a private business decision when the service is one the state authorized and the person is entitled to receive.
The call comes on a Thursday afternoon and the person on the other end sounds genuinely sorry, because she is. She has known your family for six years. She is telling you the program ends in thirty days.
I have taken that call. Most families reading this have taken that call or are going to. What I did not understand the first time was that the person telling me was not making a choice so much as reporting a result. The arithmetic had run out somewhere upstream of her, months earlier, and the thirty day notice was just the moment it became visible to me.
ANCOR, the national association representing community providers of disability services, surveys its field every year. The 2025 survey ran in August and September and collected responses from 469 provider organizations across 48 states and the District of Columbia. If you want to know what is happening to your services before it happens, this is the document to read.
The number that should end the debate
52% of provider organizations are considering further program cuts. In 2024 that figure was 34%.
An eighteen point jump in a single year, in a survey that has been asking the same question for a long time, is not noise. It is not providers being dramatic to make a budget case. Providers have every incentive to project stability, because families flee instability and staff flee instability faster. When more than half of them tell a national survey they are weighing further reductions, the honest reading is that the reductions are already decided in most of those organizations and the survey caught them before the announcements.
Layer the rest on top. 88% report moderate or severe staffing challenges. 62% turned away new referrals they could not staff. 29% have already discontinued programs and services. 59% are delaying launching new programs.
Which services die first, and why it is the worst possible ones
Residential habilitation was the most commonly discontinued service, cut by 44% of respondents. Home-based and day habilitation followed at 28%.
That ordering is not random and it is not sentimental. Residential and day habilitation are the most staff-intensive services in the array. A residential program requires bodies present, awake, and trained, around the clock, at a ratio the state specifies. When you cannot fill shifts, that is the first program you physically cannot run. It has nothing to do with which service matters most and everything to do with which service breaks first under a staffing constraint.
The cruelty is that those are exactly the services adults with the highest support needs cannot substitute their way out of. A person who can use a part-time community program has options when a program closes. A person who needs residential habilitation has, in most Michigan counties, a very short list of alternatives and usually a waiting list attached to each one.
Where safety enters the picture
36% of providers report more frequent reportable incidents as a result of staffing shortages. 62% report struggling to achieve quality standards.
I want to be careful with this, because it can read as an attack on direct support professionals and it is the opposite. The people doing this work are, in my experience, extraordinary. They are also being asked to cover a second person’s shift after their own, to supervise more people than the plan contemplates, and to do it at a wage that a warehouse three miles away beats without asking for a background check.
Thin staffing produces incidents the same way thin staffing produces incidents in any setting. Not because anyone stopped caring but because attention is finite and there are not enough people to divide it among. When 36% of providers say they are seeing more reportable incidents, that is the crisis stopping being an inconvenience and starting to be a safety problem.
The math providers are actually running
Here is the loop, as plainly as I can put it. Medicaid rates set the ceiling on what a provider can pay. Providers cannot raise the rate. They cannot charge families the difference. They cannot decline to meet the staffing ratios the state requires. So the only variable they control is how many programs they run.
When the rate does not cover the wage the labor market demands, the provider runs fewer programs. That is not a failure of management. It is the only available move. And the reason 52% are considering further cuts is that the gap between rate and wage has not closed, and the temporary funds that papered over it are gone.
A provider told ANCOR they lost 50% of staff for one service within a six week period. Sit with that. Half the workforce for a program, in six weeks. There is no management technique that absorbs that. There is no efficiency to find. You close the program.
What families should do with this
Ask the question early. At your next meeting, ask your provider whether the program is on any list of possible reductions. Providers will usually tell you the truth if you ask directly, and the difference between finding out in September and finding out in December is the difference between a search and a scramble.
Tell your CMHSP in writing before the closure, not after. A written record that you flagged a foreseeable service interruption changes what the agency owes you when it happens. It converts a surprise into a documented failure to plan.
Treat an undeliverable service as a denied service. This is the part families miss. If your plan of service authorizes twenty hours a week and the provider can only staff eight, you are not receiving the service the state authorized. Ask for that in writing as an adverse action, and take it to a fair hearing. Fair hearings create records, and records are the only thing that makes an invisible shortage countable.
Say it publicly. Rate adequacy arguments in Lansing are won with provider data and lost without family testimony. The 52% is the evidence. Your Thursday afternoon phone call is the story. Legislators need both, and only one of them can come from you.