Direct support workers caring for people with disabilities gather at the Ohio Statehouse in 2018 to raise awareness of their industry’s employee shortage and low wages. (Jonathan Quilter/The Columbus Dispatch/TNS)
LILBURN, Ga. — Matthew Southern, 35, who has intellectual and developmental disabilities, is able to stay out of an institution because caregivers paid through a Medicaid program are helping him and his roommate, in the ordinary tasks.
But amid a worker shortage made worse by the pandemic, Southern’s father Dan had to step in to fill the gaps in his son’s care by volunteering at their home 45 minutes from his northwest suburb of ‘Atlanta. He blames low wages in the industry.
“Nobody wants to work for $12 an hour,” Dan Southern said. “People can work at Burger King and make more money.”
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Last year brought an injection of hope: The federal government, through the American Rescue Plan Act that President Joe Biden signed into law in March 2021, increased funding with a match of 10 percentage points that could account for some $25 billion in federal Medicaid funds for home and community services, which have long faced staffing shortages. This massive injection of cash could be used by states to bolster wages, remove people from waiting lists for disability services, train more workers, or expand covered services for seniors and people with disabilities, helping them to stay out of nursing homes.
But nearly a year later, Indiana, Massachusetts, New York, North Carolina, Ohio and Washington were among 19 states as of Feb. 17 that had yet to receive ‘conditional approval’. needed from the Centers for Medicare & Medicaid Services to fully access the money. .
More than half of states – 28 of them – received such approval in 2022, according to CMS. That’s more than nine months after the relief program was enacted. California, for example, received its conditional approval on January 4. Other states are awaiting legislative or other approvals, KHN found when surveying all state Medicaid offices.
“We all wish we’d seen the money flow sooner,” said Damon Terzaghi, senior director of ADvancing States, a national membership association for state agencies for aging and people with disabilities. “Bureaucracy is what it is.”
Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services, said this injection of federal aid was a “life-changing amount of funding” and that CMS staff members were doing all they could alongside. States to “move as quickly as possible”. possible.”
Tsai also pointed out that the states’ partial approval, which they have all received, allows them to access some of the money. But some states — like Kansas and Wyoming — have been reluctant to do so without full approval. Others lamented the slowness of the federal process.
The Medicaid disbursement process stands in stark contrast to the distribution of relief funds through Medicare channels to hospitals, said Connie Garner, national public policy adviser for Easterseals, a disability health care provider. Garner said the typical back and forth in the federal-state Medicaid partnership is partly to blame for the delay, along with states’ desire to spend the huge amount of money wisely. But the funding is needed now, she said.
“Necessary care cannot wait,” she says.
A 2021 survey by the American Network of Community Options and Resources, an advocacy group for providers who support people with intellectual and developmental disabilities, found that due to staffing shortages, more than three-quarters of providers of services were refusing new referrals, more than half were terminating programs and services, and the vast majority were having difficulty recruiting and retaining staff.
Seema Verma, administrator of CMS in the Trump administration, said such funding was crucial given staffing shortages, but state Medicaid programs have likely been challenged to effectively move this huge amount of money. .
“The reality is that different states may have different procurement processes that can take a long time,” she said.
Colorado was the first state to have full access to the money — nearly $530 million — in September, according to Bonnie Silva, director of the Office of Community Life in the Department of Health Care Policy and Funding. Colorado Health.
The money has already been used to raise the base pay of direct social workers from $12.47 to $15 an hour – which Democratic Gov. Jared Polis proposed in his budget to make permanent, as federal funds s stop in 2024. The state is also hiring dozens of term employees.
All of this was possible, Silva said, because his team leveraged relationships with their governor and lawmakers, and also met federal deadlines quickly. As for states that still haven’t received funds, “I don’t know what they’re doing,” she said. “It’s a lot of gymnastics, but they should be moving.”
In fairness, she said, some states may not have legislators or governors as willing to be as flexible with Medicaid, while others may have been slowed down by their legislative timelines.
CMS’s Tsai said agency staff have processed more than twice as many proposals and amendments for home and community services in the past year, in addition to processing those funding approvals. “We do our best to be able to sort and prioritize,” he said.
Careful planning and coordination from all sides is required, said Matt Salo, executive director of the National Association of Medicaid Administrators, because the silver slice is a one-time infusion. This makes some states hesitant to raise wages for homeworkers they may not be able to sustain.
Spending until 2024 in government time is like a “nanosecond,” Silva said. She hopes more money will come from Biden’s Build Back Better plan, though the fate of that legislation remains uncertain at best.
“If we are serious about transforming the way care is delivered, we must — not should, could — have continued federal investments to support that change,” Silva said.
Meanwhile, the Citizens with Disabilities Consortium, which represents several national disability groups, called on the federal government to consider extending the spending deadline beyond 2024, citing the compressed timeline CMS and states are facing. confronted.
New Mexico has not yet received the full green light from CMS, said its Medicaid director, Nicole Comeaux. Nothing is straightforward about this process, she said, as it may require waivers, public comment or legislative approvals. His agency also lost staff.
“We have the same people doing this work on top of their normal work, so that also made it slower than we would have liked,” Comeaux added.
Maine Department of Health and Human Services spokeswoman Jackie Farwell said her agency needed to make “significant changes” to its claims and accounting systems to meet federal requirements.
Others were more blunt about the federal heists: “The delay was because federal approval times were taking longer than expected,” said Sarah Berg, spokeswoman for the Department of Social Services. Minnesota.
Dan Berland, director of federal policy for the National Association of State Directors of Developmental Disabilities Services, pointed out that the money will get there because unclaimed federal money in last year’s game can be withdrawn retroactively.
For those facing labor shortages, however, the delay has real consequences. In Georgia, which got its full deal the week of Feb. 14, it’s unclear how quickly the money will flow to many provider organizations.
Bob Rice’s daughter-in-law, Jennifer, a 50-year-old nonverbal woman with cerebral palsy who uses a wheelchair, lived in a group home in Athens, Georgia, run by Hope Haven of northeast Georgia for several years.
But amid staff shortages during the pandemic, Hope Haven closed the facility.
Since then, Jennifer has cycled to her third group home, one hour from Rice’s house. And Rice fears the staffing issue will disrupt their lives again.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.