Request for State Participation: 2021 Direct Service Workforce Learning Collaborative


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The Centers for Medicare & Medicaid Services (CMS) invites states to participate in a learning collaborative that will facilitate the development, implementation, and expansion of innovative strategies for strengthening the direct service workforce (DSW) and addressing specific challenges related to the DSW.

CMS has long supported initiatives to expand access to home and community-based services (HCBS) for older adults and people with disabilities.  The HCBS DSW plays an integral role in efforts to rebalance long-term services and supports systems from institutional to community-based services that offer older adults and individuals with disabilities choice, control, and access to services that help them achieve independence, optimal health, and quality of life.

The learning collaborative will consist of eight virtual peer-to-peer learning sessions between May and December 2021.  The duration of each event is not expected to exceed 90 minutes.  Participants will actively engage and share among their peers, identify best practices, and support the implementation of promising practices in their state.  Each event will have a pre-identified topic with accompanying resources for states to reference at a later time, including a summary of each event.

Potential topics of focus for initial learning events and resources may include:

  • Understanding how people want to receive services
  • Addressing direct service workers’ cultural and linguistic competency
  • Support for people self-directing services
  • Matching individuals to direct service workers
  • The role of managed care plans in the DSW
  • Medicaid’s role in reducing turnover and building capacity
  • Understanding capacity and demand within the system
  • The intersection of improving quality and reducing cost, including the cost of DSW turnover
  • Challenges and rewards of becoming a Medicaid provider or participating in a Medicaid managed care network
  • Relationship of supervision to retention of direct service workers
  • Supporting direct service workers’ professional development
  • Appreciation and recognition of the direct service worker’s role


With the support of subject matter experts, the learning collaborative will provide interactive peer-to-peer learning opportunities, which will help state Medicaid agencies address key DSW challenges related to capacity and demand, recruitment, retention, training, coordination with other agencies, workforce safety, and other emerging topics.  The learning collaborative is an opportunity for states to develop new solutions and identify existing practices that can work across states.

State Participation

All interested states are welcome to participate in the learning collaborative by designating up to three people on the registration form.  In particular, CMS encourages participation by states that:

  • Have a commitment to strengthening the DSW under the Medicaid program
  • Have an interest in sharing experiences and learning from other states engaged in similar efforts
  • Have initiatives focused on strengthening the HCBS DSW already underway or in the planning stages
  • Have the support of the State Medicaid Director with specific staff designated for participation

Next Steps

The DSW Learning Collaborative activities are sponsored by CMS and coordinated by The Lewin Group .  If you have questions or are interested in participating in the learning collaborative please email  We would appreciate all those interested to respond by May 21, 2021.  Additional information can be found by visiting: