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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

Texas state capitol building in Austin

After several months of debate, potentially devastating cuts to Texas’s Medicaid reimbursement rates have been deleted from the state budget proposal, which was approved by a House-Senate committee on May 17.

The cuts — which had been supported primarily by the Republican-dominated Texas House — would have slashed Medicaid reimbursement rates for nursing homes by up to 10 percent. With the loss of matching federal funds factored in, the overall cut would have been closer to 33 percent.

Health care advocates had argued that as many as 80 percent of Texas’s nursing homes would have been forced to shut down as a result of the proposed cuts.

In a statement, the Texas Health Care Association said that, by maintaining the current Medicaid reimbursement rate, the latest budget proposal “will bring the Texas nursing home profession back from the brink of disaster and avert significant nursing home closures and job losses” if it is signed into law.

Concerns Remain

Health care advocates say they still have concerns about the latest version of the budget proposal, however.

Although the current Medicaid reimbursement rates are maintained in the next budget, advocates say they are still not high enough to genuinely influence the quality of care in Texas.

“We should never let ourselves become convinced that current reimbursement rates to nursing homes or home care providers are truly adequate to cover costs or entice direct-care workers to seek employment within this sector,” said Jane Bavineau, the executive director of Care for Elders, a Houston-based organization that focuses on eldercare issues.

“It is difficult now, and it will surely become more difficult in the years ahead,” Bavineau continued.

Indeed, the decision to maintain the current reimbursement rate for nursing homes will create an instant shortfall of $4.8 billion, which lawmakers will have to reckon with in 2013, the next time Texas has to submit a budget.

Community-Based Care Targeted

Additionally, the House-Senate committee agreed to cut $15 million from Community Based Alternatives (CBA), Texas’s Medicaid waiver program.

CBA coordinates the delivery of home care to Medicaid-eligible older adults and people living with disabilities who would otherwise have to live in a nursing home.

The cut represents approximately half of CBA’s budget.

The proposed $15 million cut “will harm home care agencies, which by definition harms consumers and direct-care workers,” said Dennis Borel, executive director of the Coalition of Texans with Disabilities.

“The tighter the belt, the harder it is for us to provide the care needed,” said Renee Tillman, a direct-care worker in Texas and the founding president of the Texas Association of Nurse Assistants.

Borel also said that he suspects that some home health agencies — particularly those in Texas’s sparsely populated rural areas — would not survive such a severe reduction in funding.

Health care advocates — including the Coalition of Texans with Disabilities — successfully fended off an attempt by the legislature to also cut CBA home care workers’ wages to the federal minimum of $7.25 an hour, from approximately $8.

– by Matthew Ozga

Montana state capitol building

The Montana Senate passed a House budget bill (HB 2) on March 30, after adding over 160 amendments, including one that appropriates funding for a time-limited pay increase or lump sum bonus for direct-care workers employed by Medicaid-funded nursing homes and community-based services.

If the measure is signed into law, the two-year wage appropriation would become effective on July 1.

Medicaid-funded long-term care providers who want to receive higher reimbursement rates to enhance their direct-care employees’ wages would be required to apply, and include a distribution plan for the increased payments. Providers who receive the increased rate will also have to complete an end-of-the year report to demonstrate that the enhanced payment was distributed to their direct-care workers as intended by the legislature.

Legislators Recognize Importance of the Workforce

“Legislators in Montana hear the drum beat of an aging population and know that they need to invest in the direct-care workforce,” said Mike Hanshew, who is the director of policy for Consumer Direct Personal Care, a privately owned, for-profit home care company, and advocated for the amendment.

“The providers will be glad to have the rate increase. Most likely they will give their direct-care workers lump sum bonuses instead of a time-limited wage increase because a quarter more per hour is not much when you only work 20 to 30 hours a week,” Hanshew said.

The average hourly wage rate for direct-care workers in Montana is about $10 to $11, according to Rose Hughes, executive director of the Montana Health Care Association, a non-profit, long-term care facilities professional association, which has been a key proponent of the amendment.

Providers from 93 nursing homes and about 50 community-based agencies would be eligible to apply for the enhanced rate increase which could potentially affect 6,000 direct-care workers in the state.

“The wage increase is well-deserved; the direct-care workers appreciate it and need it,” Hanshew said. “For many workers, wages have been frozen for two years. The legislators recognize the deserving nature of this workforce and the need.”

“We are fortunate in Montana that our legislators recognize the importance of the workers who care for our elderly and disabled in nursing homes and community settings,” Hughes agreed.

Funding Critical for Providers and Workers

“This funding is critical to the ability of providers to recruit and retain staff and for our workers who need this money to make ends meet. We feel strongly that we must continue to value these dedicated workers who are so committed to providing excellent care to those who need their help, and this funding is part of doing that,” Hughes continued.

The amendment, introduced by State Senator Rowlie Hutton (R), added about $5 million in state special revenue and $10 million in federal funds to the budget.

The budget bill passed the Senate in a 34-16 vote and will be taken up next by the Conference Committee.

“The wage amendment will make a huge difference,” Hanshew said. “While everyone is hoping for better economic times in the future, they will be grateful for the payment increase despite the one-time nature of the funding.”

Legislative History of Addressing Direct-Care Workers’ Needs

Montana has a long legislative history of addressing the needs of the direct-care workforce, Hanshew explained. The state legislature voted to provide enhanced Medicaid reimbursement for health coverage to providers who deliver in-home personal assistance and private-duty nursing services to the elderly and people with disabilities beginning in 2009.

More information on this legislative initiative is available in the PHI Health Care for Health Care Workers Case Study: Health Care for Montanans Who Provide Healthcare (pdf).

– by Deane Beebe

Within hours of the U.S. House of Representatives passing legislation to extend the Federal Medical Assistance Percentages (FMAP) increase to states, President Obama signed the bill into law.

By extending FMAP through the end of 2011, the federal government will distribute an additional $16.1 billion in Medicaid funding to states.

House Votes Along Party Lines

The representatives voted 247 to 161 to approve the state-aid package (H.R. 1586) during a special emergency session held on August 10. Just two Republicans voted to provide relief to the cash-strapped states; only six Democrats voted against the bill.

House Speaker Nancy Pelosi (D-CA) called the representatives back to Washington, D.C., from summer recess to vote on the legislation, after the Senate unexpectedly passed it.

“We are pleased that Congress did the right thing and voted in favor of extending additional funding to states for their Medicaid programs, funds essential to preventing further erosion of coverage and services,” said PHI Government Relations Director Carol Regan.

“However, this was accomplished, in part, by rolling back a temporary increase in food stamps,” Regan added. “We will work with our allies in the Leadership Council of Aging Organizations to restore assistance to low-income families relying on this program.”

Offsetting the Cost

To offset the cost of the state-aid package, several provisions are in place, including accelerating the timetable to halt temporary increases in food assistance benefits.

The $26 billion bill has been called the Jobs Bill, because it also includes $10 billion for states to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

A chart (pdf) on how the funding will be allocated in each state is available from the Center on Budget and Policy Priorities.

– by Deane Beebe

The Federal Medical Assistance Percentage (FMAP) increase is expected to be extended, since the U.S. Senate has voted to pass it.

Without the FMAP extension, many states were planning to cut or even eliminate health care programs serving poor and elderly residents.

The Senate voted on August 5 to pass the federal state-aid package that includes $16.1 billion to extend the FMAP increase through 2011.

First the Senate had to surmount a Republican filibuster — an outcome that seemed unlikely by all accounts just one week ago. Once the Senate voted on August 4 to end the debate, the bill headed to the Senate floor where it passed, 61-39.

Calling Representatives Back for the House Vote

Members of the U.S. House of Representatives have already left for summer recess. However, in an uncommon move, House Speaker Nancy Pelosi (D-CA) called them back to Washington, D.C. to vote on the measure next week.

Once the measure is passed in the House, as expected, the bill will be sent to President Obama, who has been pushing for its passage.

Extension Will Prevent Layoffs and Service Cuts

The $16.1 billion FMAP increase is part of a larger, $26 billion state-aid package of which $10 million is targeted to prevent teacher and other public service worker layoffs due to shortfalls in state budgets.

The bill was tied up in the Senate until two Maine Republicans, Susan Collins and Olympia Snowe, joined with Democrats to end debate on the bill.

“At a time when our economy is still regaining its footing and state budgets are strapped, this FMAP extension is critical to maintaining services for elders and people with disabilities, as well as ensuring stability to the direct-care workforce that provides those services,” said Steve Edelstein, PHI’s national policy director.

“We applaud the Senate leadership and Senators Collins and Snowe for putting the needs of our most vulnerable citizens at the forefront and for refusing to let this vital legislation die.”

– by Deane Beebe

Congressional inaction may cost states up to $24 billion in additional Medicaid funding.

The future of the Federal Medical Assistance Percentages (FMAP) increase remains in doubt, despite pleas from governors, state legislators, AARP, and the 64-member Leadership Council of Aging Organizations, of which PHI is a member.

In June, the House dropped an FMAP increase extension from legislation that would prolong certain tax provisions and unemployment benefits.

Later that month, Senate Republicans defeated a severely scaled-down version of the FMAP extension that had been written into the Senate’s legislation extending jobless benefits.

Origins of the FMAP Extension

As part of the American Recovery and Reinvestment Act, Congress authorized a temporary increase in the rate at which the federal government matches state funding for various social programs, including Medicaid. This rate is known as FMAP.

The temporary FMAP increase was originally scheduled to last through the end of 2010. However, many governors have requested an extension in order to bring relief to their cash-strapped states.

In their FY2011 budgets, approximately 30 states have assumed that the enhanced FMAP rates will be extended through the entire fiscal year, which ends next June 30.

Inaction Would Harm States

If the FMAP increase is not extended through the end of the 2011 fiscal year, states will be forced to reconcile roughly $24 billion in missing Medicaid funding.

Analysis from the Center for Budget and Policy Priorities shows exactly how each state will be affected if Congress fails to extend the FMAP increase.

“Without continued federal support, long-term care services could be seriously jeopardized,” said Carol Regan, PHI government affairs director. “Elders and people with disabilities could go without services, workers could face reduced hours and income, and family members will be forced to make even greater sacrifices to care for their loved ones.”

Medicaid currently pays for half of all long-term care spending in the country, costing over $100 billion annually.

Organizations Speak Out

Numerous organizations have urged Congress to extend the enhanced FMAP rates through June 30, 2011.

On July 21, the Leadership Council of Aging Organizations sent a letter (pdf) to Senate Majority Leader Harry Reid (D-NV) asking the Senate to approve the FMAP extension “without delay.”

Additionally, the American Health Care Association and the National Center for Assisted Living have teamed up to launch “Driving for Quality Care,” an RV tour through 40 states intended to drum up support for FMAP extension.

– by Matthew Ozga