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A brief roundup of recent direct-care worker state news:

Court Rules That Missouri Home Care Workers Can Unionize

A state appeals court ruled May 1 that Missouri home care workers can unionize, ending their three-year battle to gain legal recognition as a union in the eyes of the state.

In 2009 and 2010, Missouri’s 13,000 home-care workers voted — by overwhelming margins — in favor of unionization. Both times, however, the votes were thrown out in court after anti-union activists challenged the results, alleging procedural flaws in the voting process.

Last week, however, a Missouri appeals court ruled that the state had to validate the 2010 election, thus clearing a path to the creation of a union for home-care workers.

The newly formed union, Missouri Home Care Union, is a partnership between SEIU and AFSCME.

Minnesota PCAs Temporarily Spared Wage Cuts

Proposed wage cuts to thousands of personal care aides (PCAs) in Minnesota were left out of the state’s latest Health and Human Services (HHS) budget, which Governor Mark Dayton (D) signed into law April 30.

The original HHS budget bill would have reduced state spending on PCAs by nearly $6 million. The cuts would have affected as many as 7,000 family caregivers who serve as PCAs to low-income relatives and receive payment through Medicaid.

The controversial cuts were deemed legal by a district judge in March after being challenged in court by eight Minnesota home care agencies. Despite the judge’s ruling, however, the legislature removed the cuts from the final budget sent to the governor.

Additionally, the budget bill postpones a $20.6 million rate cut to long-term care facilities. The postponement could give Minnesota enough time to negotiate a deal with the federal government, rendering the cut unnecessary.

Alabama Gov. Pushes for More Medicaid Funding

Alabama Governor Robert Bentley (R) vowed on May 2 that he would veto any General Fund budget bill that allots less than $602 million for Medicaid.

The governor’s announcement was a response to an early FY 13 budget proposal from state lawmakers that would have set aside just $400 million in Medicaid spending, 30 percent less than the FY 12 Medicaid allotment.

On May 8, a State Senate committee approved a budget bill that would devote $418 million of the General Fund to Medicaid, with the remaining $184 million to come from a line of credit from a state trust fund.

The credit line can only be created through a constitutional amendment, however. The state legislature is currently considering the amendment; if it passes, it will have to be approved by Alabama voters.

– by Matthew Ozga

The Centers for Medicare & Medicaid Services (CMS) released final regulations (pdf) for the Community First Choice (CFC) Option after incorporating input from stakeholders, including PHI (pdf).

The CFC Option is a new state plan option in the Medicaid program created by the Affordable Care Act.

States that participate in the CFC Option will receive a six percentage point increase in federal Medicaid matching funds (FMAP) to provide home and community-based services (HCBS) to beneficiaries who would otherwise receive services in an institution.

As noted in a recent Kaiser Family Foundation report, many states continue to face high demand for Medicaid services while state resources are limited.

Some states have implemented — or are considering — a wide range of Medicaid cost-containment measures, including significant cuts in eligibility and benefits for some groups.

Opportunity to Improve Direct-Care Jobs

Not only does the CFC Option offer states additional funding for expanding Medicaid HCBS, it is also an opportunity to improve direct-care jobs, explains a PHI health reform fact sheet (pdf).

“This is an important opportunity for states to achieve their rebalancing goals and invest in a strong personal care attendant (PCA) workforce,” said Carol Regan, PHI government affairs director.

“We urge advocates to promote participation in the CFC Option in their states and to encourage state policymakers to use of some of the new federal funds to improve compensation for PCAs, while expanding services,” Regan said.

Although the CFC Option regulations are final, CMS is seeking additional public comments on how “home and community-based settings” should be defined. That definition will apply to the CFC Option as well as to other Medicaid programs that deliver HCBS.

On an April 27 call with stakeholders, CMS representatives encouraged interested states to proceed with the CFC Option implementation while the definition of “home and community-based settings” is being finalized.

For states deciding to begin implementing the CFC Option, CMS will provide “at least one year” of transition time to allow them to adjust once the final rule defining HCBS settings is published.

– by Gail MacInnes, PHI National Policy Analyst

Consumers, workers, and other stakeholders in the Illinois nursing home industry are voicing their opposition to a proposed 18 percent cut to the state Medicaid program.

Details of the potentially devastating round of cuts began to emerge on April 19. According to published reports, Governor Pat Quinn (D) wants to slash Medicaid rolls by 215,000 while lowering Medicaid reimbursement rates for doctors, hospitals, and nursing homes.

Quinn’s plan would save the state $2.7 billion.

A Quick Response

Nursing home stakeholders responded immediately to the threat. The Health Care Council of Illinois (HCCI), an organization representing nursing homes, scheduled a 17-stop protest tour to speak out against the cuts. HCCI held rallies in Rockford and Chicago during the weekend of April 21-22.

If enacted, the drastic Medicaid cuts would cause thousands of elders to be kicked out of their nursing homes, according to HCCI Executive Director Pat Comstock.

“What will happen to some of these residents is that they may not be able to stay here. They may lose their home,” Comstock told WBBM, a Chicago-area television network.

Report Shows Folly of Cuts

On April 25, the Campaign for Better Care and Families USA released a joint report (pdf) documenting the economic toll Quinn’s cuts would take on Illinois.

The report finds that the proposed $2.7 billion worth of cuts to Medicaid would put more than 25,000 jobs at risk and cost the state $3.3 billion in economic activity.

Many of those imperiled jobs would be in the nursing home industry, the report says.

“Cuts could mean jobs lost for [nursing] facilities’ employees, such as aides, nurses, pharmacists, and facility maintenance and management staff,” the report states. “Inadequate staffing lessens the quality of care that facilities are able to provide.”

– by Matthew Ozga

The Alabama House of Representatives passed a Fiscal Year 2013 Budget on April 10 that slashes the Medicaid program by 30 percent — $175 million — which would result in a Medicaid budget of $400 million if the proposal is signed into law.

More than 900,000 Alabamians depend on Medicaid for their health care coverage, including many direct-care workers.

Don Williamson, M.D., who heads up the Alabama Department of Public Health and has been charged with overseeing a Medicaid Task Force, said that “the agency may be forced to reduce payments to doctors, hospitals, and other health providers that serve Medicaid patients.”

Williamson is seeking ways to cut Medicaid programs while at the same time complying with federal Medicaid requirements. However, he has been reported to say that the “proposed budget would not only lead to cuts to optional services, but cuts to programs mandated by the federal government.”

For every $1 that Alabama spends on Medicaid, the federal government matches it with $2, compounding the state’s Medicaid budget loss.

“I don’t think there’s any way in the world any human being can make this budget work at $400 million without serious cuts to someone,” Williamson said.

Will Mean Job Losses

“If nursing homes and other medical-related facilities are forced to make cuts, that will mean job losses,” SalLee Sasser-Williams, an Alabama nursing home owner, told the Andalusia Star-News.

In the meantime, the Star-News reports that Williams is “looking for small cuts that don’t affect patient care” and depending on volunteers to take on tasks such as resident activities, which “frees our activities director to do other things.”

The Alabama Nursing Home Association issued a statement saying that, “We agree with Dr. Williamson that current budget figures for the next fiscal year will make it virtually impossible to avoid serious cuts in the access to care and the quality of care delivered. As Dr. Williamson observed, some of the cuts we may face could mean life or death for many.”

Alabama Governor Robert Bentley (R), a physician, is opposed to raising taxes or other revenue, including increasing the cigarette tax, a measure supported by the House Democrats.

The proposed cuts come on top of a recent 10.6 percent across-the-board budget cut to the state’s General Fund this fiscal year.

“Medicaid cuts this severe will hurt families, health care workers, and many direct-care employers at a time when families are already hurting economically,” said Carol Regan, PHI director of government affairs. “Advocates at the state and national level must continue to protect American families and fight for a strong safety net.”

– by Deane Beebe

In a March 28 blog post, eldercare author Howard Gleckman explains what would happen to health care for elders if the Supreme Court finds the Affordable Care Act (ACA) unconstitutional.

For example, Gleckman notes that the ACA incentivizes states to expand Medicaid long-term care services for people receiving care in their home. By striking down the ACA, the Supreme Court would take away those incentives.

Gleckman also explains how a repeal of the law would impact Medicare, integrated care, and the CLASS Act.

The Supreme Court heard oral arguments this week in a case that will decide the fate of the ACA. At issue is the law’s requirement that individuals purchase health insurance or pay a penalty.

In his post, Gleckman notes that most of the ACA’s effects on eldercare “have nothing at all to do with the controversial insurance reforms in the ACA. But if the Court strikes down the entire law, all of these provisions would die.”

– by Matthew Ozga

March 23 marks the two-year anniversary of the passage of the Affordable Care Act (ACA). While some Americans remain confused about what exactly this law really means for them and their families, and others disregard it as just another big political fight, the impact on many direct-care workers has been and will continue to be positive.

Because of the ACA, direct-care workers can no longer have their pre-existing conditions held against them by a health insurance company. They can keep their adult children covered under their employer-provided plan up to the age of 26. And those who get their insurance coverage from Medicare no longer have to pay out of pocket for preventive services.

The ACA has meant better health, better care, and in some cases, a few more dollars in the pockets of direct-care workers. For them, the ACA is not confusing or political — it’s real, and it’s about health and security.

More Health Benefits to Come

Millions of low-income women, including direct-care workers, will continue to benefit as ACA provisions are implemented between now and January 2014. These include:

• The expansion of community health centers that serve low-income communities.
• Expanded Medicaid coverage that will make health care affordable for hundreds of thousands of direct-care workers.
• Public subsidies that will help make health insurance premiums less expensive for those who don’t qualify for Medicaid.
• Free coverage for women’s preventive health care, including birth control.
• An end to discriminatory practices that make insurance premiums at least a third more expensive for women than for men.

Improving Direct-Care Jobs and Care

In addition to greatly expanding access to affordable coverage for direct-care workers, the ACA is improving the quality of direct-care jobs and care for elders and people with disabilities. For example:

• Six states have received three-year grants to develop core competencies, pilot training curricula, and test the viability of certification programs for personal and home care aides.
• More than 30 states developed comprehensive health care workforce development strategies using ACA grants.
• New transparency rules are making information about direct-care worker wages and benefits, staffing levels, and turnover in nursing homes available to the public.
• Training for certified nurse assistants includes new requirements for learning about dementia and abuse prevention.
• States have received additional funding to transition individuals out of nursing homes into their homes or in the community.
• Demonstration programs testing new models of care coordination — including new roles for direct-care workers — are being funded by an innovation center at the U.S. Department of Health and Human Services.

Expanded coverage, new training opportunities for direct care workers, and investments that build an aging and disability services infrastructure to better serve consumers — these are all positive outcomes of the ACA.

But there’s more work to do. Some in Congress have been chipping away at the law, and further budget cuts could undermine implementation, particularly the expansion of the Medicaid program. And the Supreme Court will hear challenges to the individual mandate and the Medicaid provisions in the ACA starting March 26, with a decision expected this summer.

Over the next 18 months, it will be important to remain vigilant, and to remind friends, family, and colleagues that the Affordable Care Act is already providing better care, at lower costs, to millions of Americans.

– by Carol Regan, PHI Government Affairs Director