• The Earn, Keep, Save MORE website, hosted by PHI, provides information on which states offer EITC and other credits, and Michigan-specific information.
• The It All Adds Up Toolkit provides Iowa-specific information and is housed on the Iowa CareGivers Association site.

Long-term care employers are encouraged to use the sites to download materials — paycheck stuffers, fact sheets, and posters — to help their employees make this a rewarding tax season.

– by Deane Beebe

The report, Self-Determination and the MI Choice Medicaid Waiver Program (pdf), is based on a survey of 624 direct-care workers in the MI Choice Program. It offers recommendations and strategies to strengthen the SD program for workers and participants.

“The survey findings should stoke what should be a growing discussion of the intersection of the paid direct-care workforce and family caregivers,” said PHI Director of Midwest Policy Hollis Turnham.

“Self-direction models across the country rely on family caregivers as well as friends and neighbors to become paid direct-care workers,” Turnham said. “As self-direction grows as a delivery option, we need to acknowledge and learn more about that intersection of individual roles and public funding — both about the challenges and the opportunities.”

The survey of workers in the SD program was designed to:

• Collect baseline demographic information;
• Understand the workers’ motivations, job satisfaction, and training needs; and
• Identify strategies to strengthen and support recruitment and retention.

The report compares the findings from three types of SD workers — family, friends, and strangers — and explains that while they are “indistinguishable” in many aspects, “there are some remarkable differences among the groups.” For example, more friends and neighbors were found to be working with an individual with a disability rather than elders.

The Findings

The survey findings are summarized as follows:

Satisfaction: While SD workers are, overall, satisfied with their jobs and find the work rewarding, they indicated low satisfaction with their wages and the number of hours they work. SD workers earn wages that are among the lowest of all direct-care workers in the state, and have higher rates of uninsurance.

The SD workers — especially the SD workers who are family and friends — reported that they provided services for which they were not paid, which is an indication that the SD model is built on the informal unpaid support that these caregivers provide.

Relationships between Workers and Participants: Common assumptions about family members and friends working in the SD MI Choice Option are not reflected in the findings. In fact:

• A significant number of paid family members do want training. Almost half of the workers expressed an interest in training in specific clinical topics and communications skills.
• A majority of the family members (57 percent) do not live with the participant they support.

Recruiting and Retaining SD Workers: The MI Choice program — like every long-term care services and supports program — is challenged to find and retain qualified, competent workers. Only half of the workers indicated they intend to continue working for the participants for whom they currently provide support, which points to a “potentially high level” of turnover among these workers.

Recommendations

Based on the findings, PHI has made the following recommendations for the MI Choice program:

• Develop mechanisms to ensure that workers have the opportunity to receive training on topics that are relevant and of interest to them.
• Provide training opportunities and resources for participants to be effective employers in the MI Choice SD Option.
• Offer more and continuing work to current workers to build and sustain a workforce willing to serve SD participants.
• Explore opportunities to maximize outreach and enrollment in Medicaid and subsidized health plans under the Affordable Care Act (ACA) to secure health care for uninsured and underinsured workers.
• Identify mechanisms and opportunities for SD workers to recognize and address workload imbalances and concerns.

The project was made possible through a technical assistance award from the National Direct Service Workforce Resource Center to the Michigan Department of Community Health and, with additional funding from the Centers for Medicare and Medicaid Services State Profile Tool Grant to the Michigan Office on Services to the Aging.

– by Deane Beebe

SB 693 will create Michigan’s Exchange, the MiHealth Marketplace.  Although there are some concerning things in the version that was passed, we are very pleased that consumers will have be in the majority on the Marketplace Board.  It now moves on to the full Senate for a vote.

The ACA requires states to create an Exchange, the a new marketplace where individuals and small businesses will be able to find out information about health insurance plans and access tax credit subsidies to reduce the cost of health insurance.  Health insurance plans on the Exchange will have to meet specific quality and cost requirements and won’t be able to use health status to determine premims. This video explains what is in the ACA and what exactly an Exchange does.

By passing legislation to create the Exchange,  Michigan will be to apply for federal grants to pay for the development of the Exchange.  If the state does not create its own Exchange, it will have to participate in the federal Exchange.

PHI provided testimony (pdf) in the House and the Senate in support of Michigan creating our own Exchange and letting legislators know how the MiHealth Marketplace will help many direct-care workers and long-term care employers across the state.   We have also been very active with the Michigan Consumers for Healthcare in talking with legislators urging their support for moving forward with implementation.  Last month, PHI-Michigan participated in a press conference with MCH to outline our priorities in what a Michigan Exchange should look like, including the following:

• Consumer representation on the Exchange Board and not allowing the insurance industry to have a voting seat on the Board.
• Move beyond the “Orbitz for Healthcare” model by providing other ways for workers to get information about their health care options, including allowing community organizations to act as Navigators.
• Seamless enrollment in Medicaid to allow workers to move between Medicaid and private insurance to do so without gaps in coverage.

Even with the victory in the Committee, we still have long road ahead to creating a Michigan Exchange.  Many  legislators are opposed to the Exchange or even implementing the ACA  in Michigan.  It is important for them to hear from you about how the it will help make quality health coverage more accessible and affordable.  If you would like to get involved or contact your legislature, please contact Tameshia Bridges at tbridges@phintional.org.

PHI Michigan Senior Workforce Advocate Tameshia Bridges (at podium) with fellow MCH members

The Michigan Consumers for Healthcare (MCH) coalition held a press conference on October 11 to announce its support for a Senate bill to establish a state health insurance exchange and to offer recommendations on how to improve the legislation.

Under the Affordable Care Act (ACA), every state is required to create a health insurance exchange by 2014; the federal government is responsible for creating an exchange for states that do not comply with the law.

The MCH coalition, of which PHI Michigan is a member, is urging that the bill (SB 693) be modified to ensure that the proposed exchange’s governing board has a “dominant pro-consumer presence and culture,” and that there is “streamlined access to healthcare coverage for the state’s poor and underinsured.”

MCH is calling for the legislation’s proposed “opt-in” provision for Medicaid, MIChild, and other state-supported programs to be replaced with a “presumptive eligibility clause.”

“As the consumer voice for affordable, accessible, quality healthcare in our state, Michigan Consumers for Healthcare wants to see the proposed MIHealth Marketplace expand access, increase competition, reduce premium costs, be customer-service oriented and work for small businesses and individuals alike,” said MCH Director Don Hazaert.

Seamless Interaction with Medicaid Important to Direct-Care Workforce

Speaking at the press conference, PHI Michigan Senior Workforce Advocate Tameshia Bridges, a MCH board member, reported that 32 percent of Michigan’s 156,000 direct-care workers are uninsured (pdf). Direct-care workers in Michigan are three times more likely than the state’s general population to lack insurance.

“Seamless interaction between Medicaid and the proposed MIHealth Marketplace is important for the direct-care workforce,” Bridges said.

“Due to the low-wage and largely part-time work status of these workers, it is likely they will churn between Medicaid and private coverage, or that their families will get coverage from both sources,” she added.

Must Be a Reliable and Trusted Resource

The coalition also recommends that the bill’s language state that community organizations can serve as “navigators” for the exchange, and that specialized training be mandated for anyone serving as a navigator.

“Having credible and reliable people to explain health care options to both workers and employers has been shown to play an important role in boosting enrollment in other states with health care expansion programs,” Bridges said.

“The MIHealth marketplace must be seen as an accessible and trusted resource that direct-care workers can turn to for the health coverage options available to them, as well as for information that will help them determine the plan that best meets their needs.”

– by Deane Beebe

A recent Op-Ed by Charles Blow in The New York Times describes blue-collar and low-wage workers in simple yet powerful words. Direct-care workers are counted among those that he describes as, “They are honest people who do honest work — crack-the-bones work; lift-it, chop-it, empty-it, glide-it-in-smooth work; feel-the-flames-up-close work; crawl-down-in-there work — things that no one wants to do but that someone must.”

He rightly points to what many of who care about this workforce know – that though they are invisible to many policymakers, they are part of backbone of this country.

PHI’s Michigan’s Direct-Care Workforce: A Smart Target for Creating Better Opportunities and Better Jobs sheds light on the direct-care workforce as a critical part of Michigan’s economy. It also shows areas where both the Michigan Department of Community Health and Michigan Economic Development Corporation can make investments that will the improve quality of jobs and long-term supports services and the ability of employers to attract and retain qualified, trained staff.

Suggested investments include:

• Develop a system to regularly assess the volume, stability, and compensation of Michigan’s direct-care workforce.
• Update the state’s training program for certified nursing assistants (CNA) beyond the federal minimum of 75 hours.
• Include incentives that support employers’ ability to provide training and develop sector-specific strategies to enhance this workforce.

Michigan’s Building Training…Building Quality (BTBQ) project will build and operate a sustainable “gold standard” training program and provide education to over 1,500 new and working PCAs.

PHCAST Award

The training project is made possible by a three-year, $2.03 million Personal and Home Care Aide State Training Program (PHCAST) demonstration grant awarded to OSA on September 29 by the U.S. Department of Health and Human Services (HHS) through Affordable Care Act funds.

Michigan is one of six states to receive PHCAST funding.

“Currently, there are no mandatory training requirements in Michigan for PCAs,” says OSA Deputy Director Peggy Brey. “This grant provides the opportunity to develop curricula and mobilize the aging and disability networks to increase and improve the skills of the long-term care workforce.”

Project Goals

The BTBQ project’s goals are to:

• Create a core curriculum that is based on competencies needed by newly hired PCAs to serve MI Choice clients.
• Build the state’s capacity to deliver adult learner-centered training for the entire PCA workforce, starting with 400 PCAs serving MI Choice clients during the grant period.
• Train PCA peer mentors to support the PCAs in the first six months of employment.
• Offer additional in-service training to PCAs on dementia, home management skills, and prevention of adult abuse and neglect.

The project will be evaluated by Michigan State’s Clare Luz, Ph.D., a gerontologist with clinical experience, who has worked closely with OSA to evaluate previous statewide training programs related to long-term care.

Rapid and Large Growth of Home Health Jobs

“This project also speaks to the huge number of home health aide jobs that the state projects will be created in Michigan in the coming years,” says PHI Midwest Policy Director Hollis Turnham. “Caregiving jobs in long-term care are growing at rates faster and larger than almost all other employment sectors in the state.”

More information on PCAs and the projected growth of Michigan’s direct-care workforce is available at PHI State Facts: Michigan’s Direct-Care Workforce (pdf).

– by Deane Beebe

Many direct-care workers may qualify for the earned income tax credit (EITC), a refundable tax credit designed for low- and moderate-income working individuals and families. The maximum 2009 EITC is $5,657, depending on family size and income. As many as 24 states have a state EITC that provides an additional credit on state taxes.

People who are eligible for the EITC can save even more money by avoiding paying commercial tax preparers. Instead, workers can have their taxes done for free at a volunteer income tax assistance (VITA) site. These sites are available in most communities across the country starting in mid to late January and are staffed by IRS trained and certified volunteers.

“When it comes to taxes, every dollar that someone does not spend on preparation fees is a dollar that can be put towards improving their future,” says Ross Yednock, director of the Asset Building Policy Project of the Community Economic Development Association of Michigan.

Another option is I-CAN! E-File, a free alternative to other on-line tax programs which is available to anyone, regardless of income. I-CAN! is easy to use, provides on-line support, and can help people become more comfortable with doing their own taxes — and taking charge of their finances.

Both VITA and I-CAN! are also an alternative to expensive “rapid refund” loans, getting people their refunds within 10 days at no cost.

“We want to increase the number of EITC-eligible filers who use free VITA tax sites or I-CAN, because too often they go to commercial tax preparers and pay as much as 30 percent of their EITC for a ‘rapid refund’ loan,” says Peter Ruark of the Michigan Statewide EITC Coalition and the Michigan League for Human Services.

As tempting as a “rapid refund” may be, they come at a cost. In addition to the fee that commercial providers charge to process “rapid refunds” the loans can come with interest rates as high as 200 percent.

PHI is helping to get the word out about EITC, VITA, and I-CAN! E-File through the Earn, Keep, Save MORE campaign. The Michigan campaign provides employers with information and tools to share with their staff and can answer workers’ questions about these services and programs. To find VITA sites in other states, contact the local United Way, or visit the IRS or State Treasury Department websites.

PHI has released a fact sheet on Michigan’s direct-care workforce (pdf). The eight-page document reveals that while demand for workers is at a historic high and growing, the labor pool is shrinking and poor job quality is adding to the difficulty of attracting and keeping new workers.

These factors, warns the fact sheet, are leading to a potential workforce crisis for the long-term care industry and the families who rely on long-term care services and supports.

Some key facts from the report:

• Roughly a quarter of the state‘s direct-care workers do not have any health insurance.
• A third of Michigan’s direct-care workers live in households that rely on some kind of public benefits, such as Medicaid or food stamps.
• In 2007, the average Michigan direct-care worker received an annual income of $16,446.

“The problem for Michigan,” says PHI Midwest Director Hollis Turnham,
“is that the low wages earned by most direct-care workers put these jobs at income levels that do not support a family.

“Greater investment in direct-care jobs would make them more attractive to workers from shrinking industries like manufacturing, helping to keep Michigan residents employed here — rather than moving out of state.”

The document concludes with five policy recommendations for improving Michigan’s direct-care jobs including increasing wages, improving training, and improving access to health benefits.