Session #1: Federal Action to Address the Direct Care Workforce Crisis

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About the Direct Care Workforce Crisis

Low wages, lack of benefits, limited opportunities for career growth, and other factors have resulted in a long-standing shortage of critical professionals who provide care. That shortage has become a dire crisis; today more than three-quarters of service providers declining new participants and more than half cutting services. As a result, people who need assistance often have no option except to move to a nursing home or other institution; people who want to leave these facilities cannot; and the health and safety of those who live in the community are put at risk.

We must build the nation’s capacity to support community living by expanding and strengthening the direct care workforce.

Building Capacity to Support Community Living

Created by the Administration for Community Living, the Direct Care Workforce Strategies Center will provide technical assistance to states and service providers while facilitating collaboration with stakeholders to improve the recruitment, retention, training, and professional development of members of the direct care workforce.

The Strategies Center:

· Provides tools and training to assist state systems and service providers and support the development and coordination of policies and programs that contribute to a stable, robust direct care workforce.

· Facilitates peer-to-peer sharing of lessons learned and promising systems-change practices through learning collaboratives between state systems, including Medicaid, aging, disability, and workforce agencies; service providers; and disability, aging, and labor stakeholders.

· Maintains a clearinghouse of resources and promising practices for delivering person-centered support and services for people living in the community.

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Ramsey Alwin

President & CEO

National Council on Aging

As President and CEO of the National Council on Aging, Ramsey Alwin is leading a nationwide movement to ensure equitable aging for every American. 

Building on NCOA’s 70 years of service and advocacy for older adults, Alwin is renewing the organization’s commitment to improving the lives of millions, especially those who are struggling. She is sparking critical conversations about the resources every American deserves to age well—and what needs to change to ensure all have access.

A seasoned thought leader and policy advocate, Alwin has changed the way people think about older adult poverty and economic security. She designed a new measure of economic security for older adults that better accounts for out-of-pocket health costs and worked to introduce the Measuring American Poverty Act in Congress to redefine the federal poverty measure for the older population. Thanks to Alwin’s efforts, the U.S. Census Bureau formally implemented the Supplemental Poverty Measure nationwide, virtually doubling the elder poverty count and better demonstrating true needs among this population. 

Prior to leading NCOA, Alwin directed financial resilience global thought leadership at AARP and served as Director of National Economic Security Programs at Wider Opportunities for Women. Currently, she serves on the Executive Committee of the UN NGO Committee on Aging, the America250 Health and Wellness Advisory Council, and the National Academy of Social Insurance Finance Committee.

Alison Barkoff

Performing the duties of the ACL Administrator and Assistant Secretary for Aging

U.S. Administration for Community Living

Alison Barkoff was sworn in as Principal Deputy Administrator on January 20, 2021 and is currently performing the duties of the ACL Administrator and the Assistant Secretary for Aging.  She provides executive leadership and coordination for ACL programs nationwide and advises the HHS Secretary on issues affecting people with disabilities and older adults.

A sibling of an adult brother with developmental disabilities and a civil rights attorney, Alison is a lifelong advocate for community living – both professionally and personally – and has been at the forefront of national efforts to expand the home and community-based services (HCBS) that make community living possible.

As part of countless coalitions of people with disabilities, older adults, and advocates, she has fought to uphold the rights of people with disabilities and older adults and advance policies to ensure their access to health care, housing, employment, education, and all other facets of community life. She has testified before Congress and the US Commission on Civil Rights on disability rights and community living.

She has served in a variety of leadership roles with disability rights organizations, including leading advocacy efforts at the Center for Public Representation and the Bazelon Center for Mental Health Law.

She also is a veteran of the federal government. As Special Counsel for Olmstead Enforcement in the Civil Rights Division of the Department of Justice, she led efforts to enforce the rights of people with disabilities to live, work and fully participate in their communities. She also led interagency initiatives with the Centers for Medicare & Medicaid Services on Medicaid HCBS and with the Department of Labor on direct care workforce issues.

Alison has brought that same focus on collaboration and coordination to her current role. Under her leadership, ACL is working with partners across HHS and the federal government on initiatives and interagency approaches to issues that affect people with disabilities and older adults, such as expanding access to HCBS and affordable, accessible housing; strengthening the direct care workforce; increasing competitive, integrated employment for people with disabilities; and advancing equity, to name just a few. 

Melissa Harris

Deputy Director

Centers for Medicare & Medicaid Services

Melissa Harris has been with the Centers for Medicare & Medicaid Services (CMS) since the summer of 1995, and is currently a Deputy Director for the Medicaid Benefits and Health Programs Group (MBHPG).  Prior to this role, Melissa was a Senior Policy Advisor in MBHPG, developing and implementing a myriad of policies advancing home and community-based services as an alternative to institutional placement. Before joining the Office of the Group Director, Melissa was the Director of the Division of Benefits and Coverage (DBC) from 2012 to 2015, in which she was responsible for overseeing implementation of most Medicaid benefits, including benefits provided to individuals in the Medicaid expansion population, and the establishment of national benefit policy.

Caroline Ryan

Deputy Director

Center for Innovation and Partnership, ACL

Caroline Ryan is the Deputy Director of the Center for Innovation and Partnership at the Administration for Community Living.  At ACL, Caroline leads a cross-agency team working to strengthen the recruitment, training, and retention of the direct care workforce.  Prior to this role, Caroline managed ACL partnerships with VA and CMS on innovative projects, including a collaboration with the VA on a consumer-directed home care program for Veterans of all ages at risk for nursing home admission.  She also analyzed policy trends and advanced innovative program strategies related to alternative payment models, social determinants of health, self-directed care, and care transitions.  Prior to joining HHS in 2010, Caroline served as a program manager at Aging Care Connections, where she implemented and evaluated a community-based care transition model at a local hospital and skilled nursing facilities.  Caroline received her undergraduate degree from Washington University in St. Louis and her master’s degree and certificate in health administration and policy from The University of Chicago.

Jessica Schubel

Special Assistant to the President for Health Care

White House Domestic Policy Council

Before joining the Domestic Policy Council as the Special Assistant to the President for Health Care, Jessica worked at the Center on Budget and Policy Priorities (CBPP) where she examined issues related to Medicaid and other coverage issues. Prior to her role at CBPP, Jessica served in various capacities at the Center for Medicaid and CHIP Services at CMS during the Obama Administration, working on Medicaid, CHIP, and the Basic Health Program and was an integral member of the Center’s senior leadership team. Before joining CMS, Jessica worked at the District of Columbia’s Medicaid agency, helping to oversee the city’s school-based health services program, Medicaid waivers as well as implementation of health reform and the American Recovery and Reinvestment Act. Born and raised in western New York, Jessica graduated from Syracuse University and the George Washington University.

Tisamarie Sherry

Deputy Assistant Secretary

Office of the Assistant Secretary for Planning and Evaluation

Tisamarie Sherry, M.D., Ph.D. was appointed the Deputy Assistant Secretary for Planning and Evaluation on May 10, 2021. Her experience includes working as a policy researcher at the RAND Corporation, and as a primary care physician. Dr. Sherry is a health economist and general internist whose research investigates health care delivery, financing, and policy strategies to improve the health and economic status of adults with chronic medical conditions – in particular, mental illness, substance use disorders and disabilities. Her research has been published in leading medical, health services research and health economics journals, shared with policymakers and practitioners, and covered in national media outlets. Dr. Sherry has previously worked in the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, has served as a fellow with the Centers for Disease Control and Prevention’s Global AIDS Program, and has served on the National Academies of Sciences, Engineering and Medicine’s Committee on Identifying Disabling Medical Conditions Likely to Improve with Treatment. She received her A.B. in molecular biology and public policy from Princeton University, her M.D. and Ph.D. in health policy (concentrating in economics) from Harvard University and completed residency training in internal medicine at Brigham and Women's Hospital. 

Meg Sullivan

Counselor to Secretary Becerra

Health & Human Services

Dr. Meg Sullivan is a Board-certified Pediatrician with extensive experience in public health, health equity, reproductive health, global health, infectious disease prevention and control, and emergency response. Dr Sullivan currently serves as a Counselor to the Secretary of the U.S. Department of Health and Human Services (HHS). Prior to this role, she most recently served as the Chief Medical Officer for the Administration for Strategic Preparedness and Response (ASPR), the agency within HHS that lead’s the nation’s medical and public health preparedness, response, and recovery efforts for disasters and public health emergencies.

Prior to joining ASPR, she served as the Medical Director at the Mecklenburg County Health Department where she provided medical leadership for all health department programs as well as the COVID-19 response. Previously, Dr. Sullivan has worked at the New York City Department of Health and Mental Hygiene, a Federally Qualified Health Center in Washington, DC, and as the Medical Director of an organization in Quetzaltenango, Guatemala.

Dr. Sullivan completed medical school at the University of California, San Diego and her residency at New York Presbyterian/Columbia University Medical Center. She received a Master of Public Health (MPH) degree from Johns Hopkins Bloomberg School of Public Health.

Daniel Tsai

Deputy Administrator and Director

CMS & CHIP Services Leadership

Daniel Tsai is the Deputy Administrator and Director of the Center for Medicaid and CHIP Services (CMCS). Daniel comes from the Commonwealth of Massachusetts where he served as the Assistant Secretary for MassHealth and Medicaid Director. His tenure has focused on building a robust and sustainable Medicaid program that ensures equitable coverage and reshapes how health care is delivered for two million individuals and families in the state. 


Daniel has helped lead Massachusetts Medicaid through its most significant restructuring since the 1990s through its landmark 2016 Medicaid 1115 waiver. Under these reforms, MassHealth implemented one of the most at-scale shifts to value-based care in the nation. Through the waiver, MassHealth also launched a unique program committing significant investments for nutritional and housing supports to address the social determinants of health for high cost, at-risk individuals. In addition, during his tenure, the agency has made critical investments in strengthening community health centers, behavioral health, and home and community-based services. 


Having worked closely with organizations across almost every aspect of health care, including a diverse range of Medicaid programs and provider organizations, Daniel brings extensive experience across Medicaid, Medicare, and working with stakeholders to design and implement innovative models for health care coverage, delivery and payment. 


Daniel earned a Bachelor of Arts in Applied Mathematics and Economics from Harvard University, summa cum laude. 

Kimberly Vitelli


Workforce Investment in Employment & Training Administration

Kim Vitelli is the Administrator of the DOL Employment and Training Administration’s Office of Workforce Investment, where she oversees formula and competitive grant programs that help people find employment and advance in careers. Her office is responsible for over $4.9 billion annually in grants that implement the Workforce Innovation and Opportunity Act and multiple competitive programs such as YouthBuild, the Reentry Employment Opportunities program, Strengthening Community Colleges grants, and the Indian and Native American Program.

Prior to joining the Senior Executive Service, she held roles in ETA’s policy office and budget office, and management roles overseeing Recovery Act implementation, online career tools, and WIOA implementation. Kim started her career as an Economist at the Bureau of Labor Statistics and an IT Systems Administrator at the British Embassy in South Korea before joining ETA as a Presidential Management Fellow. She has a B.A. in Economics and International Studies and a Master’s in Public Policy. She lives in Maryland with her husband and two sons, and cheers for the Washington Spirit and D.C. United soccer clubs.

Taryn Williams

Assistant Secretary

Office of Disability Employment Policy

Taryn Mackenzie Williams is the Assistant Secretary of Labor for Disability Employment Policy. In this position, she advises the Secretary of Labor on how the Department’s policies and programs impact the employment of people with disabilities and leads the Office of Disability Employment Policy (ODEP), which works with employers and all levels of government to promote evidence-based policy that improves employment opportunities and outcomes for people with disabilities. 


Previously, Williams was the managing director for the Poverty to Prosperity Program at American Progress, which works on progressive policies focused on a broad range of anti-poverty strategies. Before joining American Progress, she worked at ODEP on a variety of issues related to education, workforce policy, Social Security, Medicaid and civil rights. In her role as director of youth policy, Williams led agency efforts to coordinate education and employment policy in support of improved labor force outcomes for disabled youth. From 2014 through 2016, Williams served as ODEP’s chief of staff. She also undertook detail assignments as associate director for public engagement and liaison to the disability community at the White House from 2014 through 2015 and as a policy adviser on the U.S. Senate Committee on Health, Education, Labor, and Pensions from 2012 through 2013. 


Prior to joining the federal government, Williams worked as the research coordinator for leadership programs at the Institute for Educational Leadership and as the director of programs at the National Association of Urban Debate Leagues headquartered in Chicago. She holds a bachelor’s degree in public policy from Brown University and a master’s degree in education with a concentration in administration, planning, and social policy from Harvard University. She resides in Washington, DC. 


Federal Cross-Collaboration to Address the Direct Care Workforce Crisis
03/07/2024 at 10:30 AM (EST)  |  60 minutes
03/07/2024 at 10:30 AM (EST)  |  60 minutes Join the Direct Care Workforce Strategies Center Webinar Series Kick Off and hear from key leaders on how your state can benefit from various technical assistance opportunities.
Federal Cross-Collaboration to Address the Direct Care Workforce Crisis
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Session #1: Federal Action to Address the Direct Care Workforce Crisis
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