Four organizations dedicated to serving people with developmental disabilities are joining the call to raise Medicaid rates to support a $20-an-hour wage
Asked Monday whether anything else could be done to support a dwindling workforce of Direct Service Providers, the Ohio Provider Resource Association, Ohio Association of County Boards, Ohio Health Care Association and the Arc of Ohio answered with a resounding "No."
"We've been trying for decades," said Gary Tonks, president and CEO of Arc.
Debbie Jenkins, OHCA policy director, said providers have consolidated the services they provide, which means they can only support a limited number of individuals. Some organizations have used one-time funding to increase wages, and others have had to close their doors.
The state's $1 million ad campaign last summer to recruit DSPs also had little impact.
"We've tried different things. The only way to respond" is to increase the wages, she said.
Mr. Tonks and Ms. Jenkins, along with Pete Moore, president and CEO of OPRA, and Adam Herman, CEO of OACB, are planning to bring their requests to the House Finance Subcommittee on Health & Human Services on Tuesday.
Their panel will follow a budget (HB 33 ) review of the Department of Developmental Disabilities' budget (Redbook) and a panel discussion with the Ohio Developmental Disabilities Council . (See Gongwer Ohio Report, March 10, 2023)
Their request goes beyond the current budget proposal that supports a $16 hourly wage.
"The key is getting our rates to a level where our providers can pay a competitive wage with other industries," Mr. Moore said. "You'll also hear in our testimony that the state developmental centers have a starting wage of over $20 for doing similar work, but our average is $13.76. We're asking to close that gap.
According to Mr. Moore, the DSP workforce has been declining for years, but was accelerated by the pandemic.
"People are leaving our field, and no one is coming to apply for jobs," he said.
Mr. Herman added that they have tried working with around five high school and college job training programs to establish a pipeline of workers, but that the programs would not take up the profession because wages were so low.
"They only want to train their students for a sustainable job," he said.
In addition, he said, OhioMeansJobs locally would not post DSP job placements because they did not pay enough.
"And the state of Ohio is exclusively in control of the wage component of reimbursement," he said. "This problem will only keep growing."
Mr. Tonks said their organizations serve around 100,000 people, representing 1.5% of the population. Meanwhile, the CDC says that over 17% of people between the ages of 3 and 17 meet the classification of developmental disabilities.
Further, DODD has projected a 24% increase in the demand for DSPs by the year 2028, and Mr. Moore speculated that there was a 25% decline in the number of DSPs over the last few years.
Mr. Tonks also said that while there are more people who have been approved for Medicaid waivers, and they are serving less people than they did three or four years ago.
"We got people on these waivers, and now they can't find the staff," he said.
The four organizations agreed that the proposed $16 is not enough to move the needle, particularly given that the wage does not include health care and that many DSPs are on government benefits themselves.
"We don't want anything taken away, but we need enough to get past the benefit cliff where they're going to be making more money but then they're ineligible for benefits so it's a net decline to their income," Ms. Jenkins said. "$20 gets them to a point of being self-sufficient and able to support themselves without those public assistance benefits."
The groups are not asking for any other policy changes in the budget, she added.
"We're trying to be singularly focused," she said. "We know it'll be a historic investment if it occurs."
"We know the No. 1 thing that keeps people from coming into our field or that makes them leave is their compensation," she said. "We've got to address the compensation before we can even start to address any other issues that the system might have."
HHS Chair Says Medicaid Rates Should Increase
After several weeks of health care providers requesting reimbursement rate increase, a finance subcommittee on Thursday had a chance to question the agency that sets them.
And while the chair of the committee said she believes the rates will increase through the budget process, she is not yet sure what number is feasible.
The House Finance Subcommittee on Health & Human Services has heard at nearly every meeting that the Medicaid reimbursement rates proposed in the Fiscal Year 2024-2025 spending plan (HB 33 ) are historically large, yet nowhere near sufficient.
Various direct care workers have asked for reimbursement rates that would support a $20 an hour wage, $4 more than what has been proposed by Gov. Mike DeWine. (Redbook)
Meanwhile, dentists have asked that Medicaid reimburse to be closer to private dental insurance rate. The current proposal allows for a 15% hike.
Department of Medicaid Director Maureen Corcoran told the committee that the requests beyond the as-introduced budget come as no surprise. (Video)
"There isn't any question that the need being articulated across the board is certainly much greater than $16," she said. "I'm not going to pretend that $16 is adequate or adequate across the board. But it represents historic increases in the rates."
"It's something the governor felt very strongly about, but he was also clear that it was subject to further discussion with the General Assembly," she said. "We know as you hear from stakeholders, you are also making judgements in the same way that need to all be brough together."
In her meetings with many of the 170,000 providers across the state, she said it was not uncommon to hear requests for 50% increases, a detail she also shared with the full Finance Committee in in February. (See Gongwer Ohio Report, February 8, 2023)
She also reiterated that the administration's goal was to have increased alignment across the seven Medicaid waivers while working toward a $16 average salary for the direct care workforce.
"We saw very clearly during the pandemic that if one waiver system increases rates by a dollar, then we have a number of workers leaving one waiver to go to the other," she said. "We think it's important that we do something to expand the workforce more generally and not end up in a situation where we're stealing from one waiver to staff another."
Director Corcoran also confirmed to Rep. Beth Liston (D-Dublin) that the actual rates are not set in the budget. Rather, the budget sets an allocation for Medicaid that would support a particular rate increase that then informs wages. Specific rates and individual billing codes are established with stakeholder input after the budget has been finalized, she said.
Responding to a prior request from the Finance Committee, Rep. Corcoran also included in her testimony a "calculator" to show how much it would cost the state to increase average wages for particular services for $17, $18, $19 or $20. (Testimony, Page 29)
For example, a $17 average wage level for personal care/aides would cost $189.8 million. At $20, the cost increases to $799 million.
Rep. Jean Schmidt (R-Loveland) asked several questions regarding specific line items to see where the department could "pinch pennies" and shift spending to support higher wages.
She said in an interview that she did not believe it was fair that state-run facilities have a starting wage of $20, which also comes with state benefits, and yet people who do similar work for an agency are being paid $12 an hour without benefits.
"I can't justify that in my head," she said. "I'm trying to find ways to answer this really dire need."
Chair Rep. Sara Carruthers (R-Hamilton) agreed.
"What we're hearing is just jarring," she said of the countless testimonies they have heard from people with developmental disabilities who have gone without services and from direct service providers who are forced to use public benefits because of low wages.
"To know that some of these people have to wait days to get care is very upsetting to me and I know it is to (Rep. Liston) too," she said.
"I think, no doubt, the rate will probably increase, I just don't know how much we can conceivably make it," she said.
Rep. Carruthers said she is planning to sit down with Finance Chair Rep. Jay Edwards (R-Nelsonville) and the House's budget director on the final day to submit amendments.
"We definitely know we have a problem and we've got to do something about it, but I don't think $16 is going to cut it," she said. "I think the governor's leaving it to us."
Rep. Carruthers said she did not believe the committee would find the needed funds in the Medicaid budget however, saying Director Corcoran already "squeezes every nickel she can."
She also does not believe an increase in funding should be at the expense of a proposed $1 billion transfer to the Health and Human Services Reserve Fund.
Rep. Carruthers said that reserve is needed in case the state is off in its projections on how the Medicaid rolls will decrease through the redetermination process.
Rep. Liston told Director Corcoran that committee members have expressed interest in ensuring that any budget increase to support higher wages actually results in workers receiving more money.
Director Corcoran responded that there is nothing in the system that would incentivize an agency to pay a worker less than the service rate.
"They can't take that money as profit and there's extensive cost reporting," she said. "If the don't spend the money the way it's designed, we take it back…There isn't a clear profit motive to not pay the rates that have been created."