New York’s Budget Should Support Direct Care Workers

The COVID-19 pandemic has spotlighted the importance of New York’s direct care workers, who include nearly 530,000 personal care aides, home health aides, and nursing assistants across the state. During this crisis, these workers have put their own health and safety at risk to provide services to older adults and people with disabilities statewide. Despite their essential contribution to long-term care and to the broader economy—direct care is larger than any other single occupation in the state and will have the most projected job openings in the decade ahead—direct care workers continue to struggle for adequate recognition, compensation, and support.

As part of New York State’s annual budget-making process, PHI recently submitted testimony to the New York State legislature on the Executive Budget proposal—emphasizing, overall, the importance of ensuring that Medicaid funding levels are adequate to support quality direct care jobs. As well as responding directly to budget provisions that impact direct care workers and their services, PHI added the following recommendations for strengthening and stabilizing the direct care workforce in New York.  (Read the full PHI Health Budget Testimony.)

Encourage Innovation

PHI recommended in our testimony that the budget include the Home Care Jobs Innovation Fund (S4222), which would invest in innovative recruitment and retention projects across the state’s home care sector, where the direct care workforce shortage is most acute. The ultimate goal of these projects will be to identify strategies that can be most effectively scaled-up at the regional or state level.

Improve Compensation

The budget should include provisions to improve direct care workers’ compensation so that workers can afford to remain in their essential roles. Specifically, PHI recommended that the budget include the Fair Pay for Home Care bill that will increase home care worker wages in New York—which are less than $13.50 per hour, on average—to at least 150 percent of the state minimum wage.

Raise Industry Standards

More broadly, PHI recommended that the state engage in a transparent process to assess the costs of providing long-term services and supports—including providers themselves in the process to ensure accuracy—and set a minimum reimbursement rate that Medicaid-funded Managed Long Term Care Plans must pay providers. This “baseline rate” should adequately cover all labor-related costs, including wages and benefits as well as training and other expenses.

Cover COVID-19 Expenses

PHI also recommended that the New York State budget include a Medicaid funding pool to cover new COVID-related costs, many of which pertain directly to the direct care workforce—including the costs of procuring personal protective equipment (PPE), managing the vaccination process, covering paid sick leave and other labor expenses, addressing training and technology needs, managing increased administrative expenses, and more. This coverage could occur through the proposed Extraordinary COVID-19 Relief Fund or through a separate process.

Sustain Workforce Development

In our testimony, PHI also urged the legislature to extend the deadline for Workforce Investment Organizations to conclude their training, upskilling, and career advancement activities. This deadline extension will help bridge a potential gap in workforce development while the state determines the structure of its next Medicaid-specific workforce investment program.

Confront the Workforce Crisis

With workforce concerns more pressing than ever, PHI also recommended that the budget establish a Direct Care Workforce Taskforce—a diverse group of stakeholders tasked with proposing solutions to long-standing workforce challenges (including compensation, training, and career development, among others) and addressing new challenges that have arisen due to COVID-19. We suggest that the taskforce release a public report with recommendations within one year and follow-up reports every two years thereafter.

Measure and Track Progress

Finally, PHI recommended that the state develop a robust direct care workforce data system to accurately measure and track key workforce indicators, monitor the impact of policy changes, and plan for future needs and emergencies. In our testimony, we proposed that this year’s budget start by: (1) requiring the identification of data sources and gaps through an assessment of data collected by various state departments; and (2) funding a statewide survey of direct care workers.

Read the full PHI Health Budget Testimony.

Learn more about New York State’s direct care workforce here.