05/06/2026 
New York I/DD agencies paid $1.6 billion in overtime in 2025. Vacancies are running at 17% statewide — roughly 20,000 unfilled direct support positions, still 42.5% above pre-pandemic levels. Federal Medicaid cuts of $911 billion over the next decade are already in law. The math has stopped working.
This is what the ground actually looks like in April 2026 — and what the agencies surviving it are doing differently.
OPWDD’s most recent workforce survey found 9,206 full-time and 5,122 part-time DSP vacancies among voluntary providers. New York Disability Advocates puts the full picture at 20,000 unfilled positions across the sector.
But a vacancy isn’t just a missing name on a roster. It is a shift somebody else is now working. That’s the part that gets miscounted in board meetings — and it’s exactly how overtime becomes the sector’s de facto staffing strategy.
ANCOR’s 2025 national report confirms the severity: 88% of providers reported moderate or severe staffing shortages, with 39% closing programs they couldn’t staff. New York is not an outlier. It’s one of the harder cases.
The New York State Comptroller’s April 2026 report puts the cost in plain terms: state agency overtime jumped 22.7% in a single year, with OPWDD absorbing a significant share. The voluntary sector — which delivers most of the care to most of the 130,000 New Yorkers with I/DD — was tracking $90 million in provider overtime as far back as 2018, and that number has been compounding ever since.
Overtime is the most expensive way to staff a shift. It’s also the fastest path to burning out the worker who took it — which directly creates the next vacancy. This is the loop New York is stuck in.
In a sector with this level of turnover, the recruiters doing the hiring churn with it — typically every 14 to 18 months. What leaves with them isn’t just a headcount. It’s the institutional memory of the hiring function: which sources work, which candidates were almost-hires, which coordinators want what.
A new recruiter starts cold. Time-to-fill resets. Pipelines regress. The candidates who were “save for September” never get called — because nobody remembers who they were. Only 3% of nonprofit HR leaders told Cherry Bekaert they felt “very prepared” for the disruption ahead. The other 97% are improvising.
Governor Hochul’s FY26 budget commits $10.1 billion to OPWDD, including $850 million in annualized funding for nonprofit provider wages. NYDA is pushing for a 7.8% rate increase and a human services wage commission. Bill S4907 / A226 would require OPWDD to activate an emergency staffing plan when vacancies fall below 90%.
The fact that this bill is necessary tells you where things are.
Meanwhile, voluntary-sector DSPs start barely above minimum wage — while state-operated Direct Support Assistants open at $52,225 and step to $56,413. Voluntary agencies are competing for the same labor pool as the state, and getting outbid by it. Add federal Medicaid headwinds from the One Big Beautiful Bill Act — $911 billion in cuts over a decade, with HCBS the first line states cut — and the margin gets even thinner.
“Innovation” in staffing has become a placeholder for buying more software. That’s not what’s working. The agencies absorbing the squeeze without losing programs are doing three things:
This is the thesis Soter has spent three years testing across 13 states and 3,500 placements — including with New York agencies. The results: 14-day average time-to-fill. 23% lower turnover than industry average. 75% of placed DSPs staying past one year.
Rates are compressed. Workers are harder to find and more expensive to keep. Federal posture is moving against HCBS. Recruiters are leaving before their pipelines mature. The New York agencies that get through the next 12 months are not the ones working harder at the old playbook. They are the ones replacing it.
📄 Read the full field report: [Full Report Link]
📅 Talk to Soter about your staffing picture: [Schedule a Consultation] — or reach out directly to eric@soter.ai.
