People with disabilities who depend on home-aid and community-based services funded by Medicaid have had difficulty getting the care they need during the pandemic. Initially, health protocols made in-person care unsafe and infeasible. Still, as COVID becomes a manageable facet of existence for most, its stagnant wages for home health aides prevent people with disabilities from getting the Medicaid-funded care they require.
In many areas, home health aide wages are below those of fast food and retail positions, a situation that leaves skilled healthcare workers underpaid, undervalued, and looking for jobs that pay more money to cover the gaps created by steadily rising inflation.
Hope on the horizon
Funding to appropriately compensate home healthcare workers was made available to state governments in the American Rescue Plan Act that President Biden signed in March of 2021. The plan is set to inject roughly $25 billion in federal funding into Medicaid, which states could use to bolster home and community-based services with higher wages for caregivers.
Additionally, the new funding could be used to train more homecare workers, provide disability services to those who have been on waiting lists, and cover more services that help keep the elderly and people with disabilities independent and out of institutionalized care.
So, the federal government came through and solved a huge problem many households are facing, right?
Not so fast…
Despite the American Rescue Plan Act being signed into law a year ago, much of the Medicaid funding has not yet been used. The Centers for Medicare & Medicaid Services (CMS) must approve the spending plans of each state individually for them to receive their portion of the funds. Though CMS reports that all states have been "approved" as of January 2022, those approvals are qualified as "conditional" or "partial."
States who have received conditional approval can begin accessing the federal funds and carrying out their spending plans. But as of early March, around 19 states, including Indiana, Massachusetts, New York, North Carolina, Ohio, and Washington, have not received the "conditional approval" status needed to access the money entirely.
For those states who have attained a "partial approval" status, they can access some federal funding, but many are hesitant to begin using the funds without full spending approval from CMS. There are also other bureaucratic barriers to accessing the funds within other states, leaving them waiting for internal red tape to be cleared.
CMS has indicated that they are anxious to distribute funding as quickly as possible, working alongside states to facilitate speedy approval processes. However, motivation, approval, and distribution seem to be moving at a glacial pace despite this.
The delays can be attributed to the back-and-forth nature that is characteristic of the federal-state Medicaid partnership, as well as the fact that some states have conservative legislators or governors who are stubborn and stingy when it comes to Medicaid spending plans. Others still may have been slowed by their legislative calendars, but many states also want to be deliberate with their goals and spend their funding judiciously.
While precision and accountability from states are admirable, the needs of those who rely on Medicaid for home care are urgent. Funding was needed yesterday.
Urgent needs
Research from 2021 by the American Network of Community Options and Resources, an advocacy group for providers supporting intellectual and developmental disabilities, confirmed that many home service providers were experiencing staffing shortages. As a result, over 75% of care providers found themselves turning away new patient requests − over half of care providers surveyed were forced to discontinue programs or services due to funding constraints.
After states receive funding
Colorado was the first state to gain full access to federal funding and promptly put resources toward raising the base wage for home care workers from $12.47 to $15. Democratic Colorado Governor Jared Polis wants to make the wage bump permanent. Still, Polis and other state leaders must be cautious with their spending decisions because, unfortunately, the federal funding related to the American Rescue Plan Act will end in 2024.
This is one of the reasons that states are being careful with allocating funds in their spending plans. The funding injection is a one-shot deal, and bumping up wages may not be something every state will be able to maintain when the federal coffers run dry. Yet inflation persists, and without continual competitive pay increases, care providers will find themselves forever facing staff shortages.
This highlights the need for ongoing federal investments into homecare and community services that people with disabilities rely on. Federal funding should always be available to provide robust support to home-based services, not just emergency funding in the wake of a global health and economic crisis that made worse what was already untenable.
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