Letter to the Editor: Increases for Health Care Workers Do Not Go Far Enough

Jan. 19, 2017

To the Patch Editor:

This afternoon, the Rhode Island House of Representatives will formally introduce Governor Gina Raimondo’s State Fiscal Year 2018 (SFY18) budget proposal as a bill for the General Assembly’s consideration. Within this bill will be a proposed $2.5 million allocation for a seven-percent (7%) base rate increase for Medicaid-contracted home care providers and gives Health and Human Services Secretary Elizabeth Roberts unprecedented unilateral authority over its implementation.

While home care providers are appreciative that Governor Raimondo is proposing a small base rate increase, it does not go far enough as to revert the access to home care crisis”, said Nicholas Oliver, Executive Director of the Rhode Island Partnership for Home Care.

Under current reimbursement rates to home care providers, Massachusetts reimburses its home care providers at a 28.42% higher rate than Rhode Island. Connecticut’s rate is 29.69% higher than Rhode Island. During the Governor’s ‘State of the State Address’, she stated that “It will make us more competitive with Massachusetts and help us make sure we have the highest quality people taking care of our Rhode Island families.”

“Even if Governor Raimondo’s budget proposal passes, Rhode Island’s rates would still be at a significant competitive disadvantage to neighboring Massachusetts and Connecticut where reimbursement would still be over twenty-percent higher than Rhode Island”, said Oliver. “This does not correct the barriers to accessing healthcare services in lower-cost settings on taxpayer dollars, like home care, where home care providers will still be competing with nursing homes and hospitals, home care providers in Connecticut and Massachusetts, and even local retail and fast food companies, all of whom can pay higher wages and offer benefits that Rhode Island’s home care providers cannot offer under current and proposed reimbursement rates”.

The access to home care crisis continues to loom over the state’s Medicaid program. Beyond the implementation failure of the Unified Health Infrastructure Project (UHIP, alias “RI Bridges”) where providers have experienced significant delays in reimbursement or have seen months without payment, Medicaid beneficiaries have also struggled with not receiving any or enough care to keep them safely at home.

As of January 18, 2017, Neighborhood Health Plan of Rhode Island, the state’s Medicaid managed care organization, is reporting 100 cases that require 1,416.25 hours of authorized care that is currently unfilled. The Division of Elderly Affairs approximates that another 120 cases are currently unfilled, but intends to have concrete publicly reported data on or after February 1, 2017. The Department of Human Services and the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals have yet to publicly report their unfilled cases data.

“The unfilled cases data does not include under-fulfilled cases where additional homebound patients are receiving some level of care, but the provider is unable to fulfill all authorized hours as a result of inability to hire and retain quality staff to fill these cases under current reimbursement. Remember, each case is a resident of our state that is homebound requiring consistent healthcare services in order to avoid hospitalization and nursing home placement.”, said Oliver. “Small rate increases that only target one segment of a home care provider’s workforce does not encourage nurse assistants to consider working in or stay working in home care, nor does it support home care providers that are trying to hire and retain other healthcare workers, such as nurses and physical and occupational therapists, in which there has not been a rate increase for those services since state fiscal year 2002. That’s 16 years without a raise for nurses and therapists. This also does not include other costs to deliver home care, such as medical equipment and supplies, mandated insurance coverage, and taxes, including payroll taxes paid back to the state for any rate increase provided”.

SFY18 Budget Language and Data:

As the state’s Medicaid program seeks to assist more beneficiaries requiring long-term services and supports in home and community-based settings, the demand for home care workers has increased, and wages for these workers has not kept pace with neighboring states, leading to high turnover and vacancy rates in the state’s home care industry, the EOHHS shall institute a one-time increase in the base-payment rates for home-care service providers to promote increased access to and an adequate supply of highly trained home health care professionals, in amount to be determined by the appropriations process, for the purpose of raising wages for personal care attendants and home health aides to be implemented by such providers: (i) by October 1, 2017, and (ii) in a manner that meets specifications related to implementation and reporting approved by the secretary.

• 7% increase in SFY18 base rates over SFY17 after SFY17 base rate increase is implemented
• $2.5 million state allocation increase in SFY18 over SFY17 (there will be an additional $2.5 million federal match) = $5 million total

• $10.50 = average starting home care nurse assistant hourly wage pre-SFY17 wage-pass through
• $10.95 = projected average starting home care nurse assistant hourly wage upon implementation of the SFY17 wage-pass through
• $11.39 = projected average starting home care nurse assistant hourly wage upon implementation of the SFY18 base rate increase

Rhode Island

• $17.68 = base rate pre-SFY17
• $19.00 = base rate upon SFY17 base rate adjustment (7.5% increase)
• $20.33 = SFY18 proposed base rate adjustment (proposed 7.0% increase)

Massachusetts

• $24.40 = current base rate
• 38.01% higher than RI pre-SFY17
• 28.42% higher than RI upon SFY17 base rate adjustment (not enacted yet)
• 20.02% higher than RI if SFY18 proposed base rate adjustment is enacted

Connecticut

• $24.64 = current base rate
• 39.37% higher than RI pre-SFY17
• 29.69% higher than RI upon SFY17 base rate adjustment (not enacted yet)
• 21.21% higher than RI if SFY18 proposed base rate adjustment is enacted