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Many states are looking to their Medicaid programs to help balance their budgets. This is having a significant impact on workers and beneficiaries of these programs. Below are updates on three states that are currently in the news.

California Adult Day Health Programs to Remain Open

A legal settlement recently reached between Disabilities Rights California and California state officials will halt the 275 adult day health programs in the state from shutting down on December 1.

Eliminating the adult day health programs was planned as a Medi-Cal cost-saving measure to help fill the state budget gap.

Instead, the adult day health programs will remain open until February 29.

After that date about half of the 35,000 program participants – low income elders and adults living with disabilities who are risk for nursing home placement – will be eligible for Community-Based Adult Services, a similar program that will be offered through managed health care plans.

The remaining program participants will be “eligible for intensive case management services to help them remain in their homes,” explains a Los Angeles Times article.

“This settlement makes it clear that the services provided by center‐based adult day health programs are irreplaceable in preventing or reducing use of higher‐cost institutional services,” California Association for Adult Day Services Executive Director Lydia Missaelides said in a press statement (PDF).

Oregon Governor Proposes Cutting Home Care Workers’ Health Benefits

Faced with a $107 million shortfall in the current two-year budget, Oregon Governor John Kitzhaber (D) is considering eliminating health care coverage for home care workers who provide Medicaid-covered services to low-income elders and people with disabilities, according to SEIU Local 503 whose members rallied against the proposal on November 21.

“The state is proposing to cut the number of home care workers who get employer-provided health insurance by increasing the number of hours they must work to qualify from 80 hours a month to 130,”a union spokesperson told nwLaborPress. “That would save the state an estimated $9.6 million a year.”

State-funded home care services hours are already slated to be cut by 5 percent beginning Jan. 1.

Home care workers in Oregon are reported to make $10.20 an hour and have not had a raise since 2007.

Visit the PHI State Data Center for more information on wages and benefits of direct-care workers in Oregon.

Kansas Governor Proposes Medicaid Reforms to Cut Costs

Kansas Governor Sam Brownback (R) unveiled a proposal on November 6 to reform the state’s Medicaid program to cut spending in the next budget year while improving care outcomes.

“KanCare” will be “a comprehensive, integrated, person-centered care coordination program,” that includes home and community-based services (HCBS) and long-term care, asserts Brownback’s executive summary.

The program “includes long-range changes to the delivery system by aiding the transition away from institutional care and toward services that can be provided in individuals’ homes and communities,” the summary states. “The reforms also include helping nursing facilities build alternative HCBS capacity.”

“Some Democrats expressed skepticism Brownback will significantly reduce spending on Medicaid without jeopardizing the well-being of Kansans,” according to an article in the Topeka Capital-Journal.

The Governor expects to save $853 million over five years, according to Long-Term Living.

Deane Beebe

The failure of the Super Committee to reach agreement on a proposal for deficit reduction means that drastic cuts to federal Medicaid funding have been averted for the time being.

While that reprieve comes as a relief to advocates for long-term services and supports, the Super Committee’s failure also triggers what is called “sequestration.”

Sequestration, required by the Budget Control Act, means $1.2 trillion in cuts to defense and non-defense discretionary spending starting in 2013. Dozens of programs that provide supports and services to frail elders, people with living with disabilities, and low-income Americans will be subject to the mandated cuts.

Social Security, Medicare, Medicaid, CHIP, SNAP (formerly known as the Food Stamp Program), child nutrition, Supplemental Security Income (SSI), refundable tax credits such as the Earned Income Tax Credit, veterans’ benefits, federal retirement and certain other programs are exempt from sequestration.

However, not all health care and related domestic programs are protected. Of particular concern are cuts to housing, transportation, and Older Americans Act services, such as, Meals on Wheels and home and community-based services, upon which individuals who need long-term services and supports rely to continue to live independently.

Also subject to the cuts would be some discretionary programs created by the Affordable Care Act, such as the Public Health and Prevention Fund.

Because sequestration requires drastic cuts in both defense and non-defense programs which are important to Republicans and Democrats alike, Congress has already begun to discuss formulating legislation which would eliminate the sequester before it takes effect in 2013.

“Although the Super Committee has closed its doors, advocates must keep up their work,” said PHI Government Affairs Director Carol Regan. “Congress is already considering the next budget. The fight over spending levels versus additional revenues will continue.”

For additional information on sequestration and the 2013 budget cuts see this report from the Center for Budget and Policy Priorities.

Gail MacInnes, PHI National Policy Analyst

For Immediate Release
November 10, 2011

Contact:
Deane Beebe, PHI Media Relations Director
646-285-1039
DBeebe@phinational.org
Amy Robins, PHI Massachusetts Policy Director
857-939-9875
ARobins@phinational.org

Joint Committee Hearing to be Held on Bill to Establish a Task Force to Assess State’s Long-Term Care Preparedness

Boston, MA — Massachusetts lawmakers will conduct a hearing on a bill to establish a task force to ensure that there is an adequate direct-care workforce – nursing aides, home care aides, and personal care attendants – and infrastructure to meet the rising demand for long-term services and supports in the Commonwealth.

The hearing on Senate bill (S45), “An Act to Establish a Task Force Relative to the Commonwealth’s Direct-Care Workforce,” introduced by Senator Pat Jehlen, co-chair of the Joint Committee on Elder Affairs, will be held by the Joint Committee on Children, Families, and Persons with Disabilities at the Massachusetts State House on November 15 at 10:30 AM in room B2.

Massachusetts’ nearly 104,000 direct-care workers comprise the largest occupational group in the state – even larger than retail salespersons and all teachers from pre-school through grade 12.

With nearly one in five Massachusetts residents projected to be age 65+ by 2020, and another million more residents anticipated to be living with disabilities, the demand for this workforce is expected to grow by at least 21 percent by 2018. Other job sectors in the state are expected to grow by only 3 percent.

Yet the number of women age 25-54, those who typically care for elders and people with disabilities, is projected to decline by 85,000 by 2030. This leaves Massachusetts with not only a shrinking labor pool for high-demand caregiving jobs, but with fewer women available to care for aging family members.

“Families depend on these workers to care for their loved ones – often so that they can work themselves,” said Senator Jehlen. “If Massachusetts is going to meet the rapidly-growing demand for this workforce, we need to ensure that these jobs are good jobs with decent wages, health coverage, better training, and opportunities for career advancement.”

The direct-care task force – comprised of representatives from state agencies that employ or contract for direct-care services – would focus on gathering accurate data on the current workforce, such as the number of workers, turnover and vacancy rates, and wages and benefits, and also assess the current training and credentialing infrastructure. It would develop workforce policies that ensure an adequate supply of frontline caregivers, especially in home and community-based settings.

Recently, an AARP survey ranked Massachusetts 40th among the states and District of Columbia in providing home and community-based options to its low-income residents.

“If direct-care jobs continue to be so poorly compensated—and to lack training and advancement opportunities—few workers will want to take these positions and employers will continue to pay the costly price of a revolving door,” said PHI Massachusetts Policy Director Amy Robins. “To improve the quality of care for Massachusetts elders and people with disabilities we need to improve the quality of jobs for direct-care workers. This bill is a significant step forward.”

In Massachusetts in 2010, the median hourly wages for home care aides and personal care attendants was $12.23 and $12.48, respectively, and $13.53 for nursing aides. The median hourly wage for all occupations in the state was $20.13.

From 2007-2009, as many as 40 percent of direct-care workers in the Commonwealth relied on means-tested public assistance.

The direct-care workforce task force would be charged with reporting their findings to the governor and legislature by December 31, 2012.

For more information on the direct-care workforce in Massachusetts, including downloadable charts and graphs, and the “Act to Establish a Task Force Relative to the Commonwealth’s Direct-Care Workforce,” visit PHI Massachusetts on the PHI PolicyWorks website.

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PHI (www.PHInational.org) is a national organization that works to improve the lives of people who need home or residential care — and of the direct-care workers who provide that care. PHI’s work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers.

For Immediate Release
June 16, 2011

Contacts:
Carol Regan, PHI Government Affairs Director
202-223-8355
cregan@phinational.org

Home Care Workers Deserve Minimum Wage and Overtime Protections
Direct Care Job Quality Improvement Act Calls for Fair Treatment of Vital Workforce

Washington, D.C. — With the fourth anniversary of the Supreme Court decision in Long Island Care at Home v. Coke earlier this week, PHI reiterates its support for revision of the Fair Labor Standards Act (FLSA) “companionship exemption“ and commends the introduction of the Direct Care Job Quality Improvement Act. The exemption currently excludes nearly two million home care workers from basic federal minimum wage and overtime protections.

“Home and personal care workers are vital to aging, disability, and health care services,” says PHI National Policy Director, Steven Edelstein, “We appreciate the commitment of Representative Sanchez, Senator Casey and the U.S. Department of Labor to ensuring they receive fair and equal treatment under our nation’s labor laws.”

Home Care is a Large and Essential Occupation
Currently, the U.S. employs 1.7 million workers in home care jobs. That number is expected to increase by nearly 50 percent over the next decade – growing faster than almost any other occupation in the U.S.

Home Care Work is Skilled Work
Most home care workers assist elders and people with disabilities with personal care needs like dressing, bathing, eating, mobility—services which are far more crucial and require more skill than providing simple companionship.

People Want to Receive Long-Term Services and Supports at Home
The exemption of home care workers from minimum wage and overtime protections undermines federal policies aimed at expansion of home- and community-based services by keeping wages extremely low for home care workers and thereby discouraging workers from seeking employment in those jobs. Most individuals who need long-term services and supports (LTSS) prefer to receive services at home rather than in an institution.

“Expansion of federal wage and hour protection to home care workers is the right thing to do,” says Carol Regan, PHI Director of Government Affairs. “These workers provide essential services to millions of individuals and families and they deserve to be treated fairly. We applaud Representative Sanchez’s leadership on fixing this outdated policy by introducing of the Direct Care Job Quality Improvement Act. We also look forward to the release of revised FLSA regulations by the Department of Labor in the fall.”

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PHI (www.PHInational.org) is a national organization that works to improve the lives of people who need home or residential care – and of the direct-care workers who provide that care. PHIs work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers.

For more information about PHI’s campaign to change the companionship exemption, visit www.PHInational.org/fairpay.

PHI President Steven Dawson speaks about direct-care workers at a Brookings Institution event called “Health Care Reform and Older Americans: Achieving Better Chronic Care at Lower Costs” on January 28, 2010.

Hilda Solis

A July 9 New York Times editorial calls for home care aides to receive minimum wage and overtime protections under the Fair Labor Standards Act. As the Times notes, in 2007, the Supreme Court upheld a 1975 labor regulation that defined home care aides as “companions,” but that regulation can be reversed anytime by Secretary of Labor Hilda Solis. This is the second editorial the Times has published on the issue; the first appeared in January 2009. Continue Reading