The Center for Medicare and Medicaid Services (CMS) is a federal government agency that helps to pay for home and community-based services and oversee how states across the country implement Medicaid programs for these services . On May 3, 2023, CMS published a proposal for rules that are aimed at increasing the wages of direct care workers, which is necessary to ensure access to quality home and community based services. The general public has only 60 days to provide comments on these proposals and to help influence CMS’s final decision.
The proposal promises that (1) 80 percent of monies paid for home and community based services should go directly to the wages of direct care workers, (2) that each state should publish the rates for services and wages of workers in an easy to access place, (3) that workers voices should be consulted when considering how much Medicaid pays for service and how much direct care workers should earn. The National Domestic Workers Alliance is reaching out to direct care workers across the country to help advocate for the best set of rules to help this workforce to have better job quality and need your comments by June 23, 2023 so we can organize and share them with CMS.
Who are Direct Care workers?
Direct care workers, known also as personal care aides and home health aides, assist more than 8.6 million older adults and people with disabilities with daily tasks such as eating, dressing, and bathing in their homes or community settings.
What are long–term services and supports (LTSS)?
Care for older adults and people with disabilities who need support because of age; physical, cognitive, developmental, or chronic health conditions; or other functional limitations that restrict their abilities to care for themselves. Care may be provided in the home or in community-based settings (HCBS), or in facilities, such as nursing homes or intermediate care facilities (ICFs). LTSS includes a wide range of services to help people live more independently by assisting with personal and healthcare needs and activities of daily living (ADL).
What are home and community based services (HCBS)?
HCBS primarily includes help with activities of daily living to allow people to stay safe at home. It is often used by older adults with chronic illness, those with disabilities and people recovering from surgery. Home care is also sometimes called personal care, companion care, custodial care or homemaker services.
Who pays for LTSS/HCBS?
Medicaid continues to be the primary payer for long-term services and supports (LTSS), with these services typically unavailable or unaffordable through Medicare or private insurance.
How do Medicaid funds pay for HCBS?
Currently, the Medicaid dollars authorized by the government to pay for the critical services of direct care workers to the aging and persons with disabilities in their homes largely go to agencies to pay workers for the hours that they provide critical services. The agencies who receive Medicaid funding, are also not required to give workers a fair share of the money, even though direct care workers are the ones providing the hands-on assistance. For example, while the average rate agencies receive from Medicaid to pay for home and community based services in 2020 was $23.09/hour, the median hourly wage for these direct care workers was only $14.09.
What are the current wages for direct care workers?
The median hourly wage for direct care workers is $14.09 but as low as $10 in some states. Because many workers are only part-time, the median annual income for a direct care worker is only $19,100. One in six home care workers lives in a household below the federal poverty line. It is unacceptable that the essential workers taking care of the needs of some of the most vulnerable populations in this country, earn poverty-level wages.
What is the impact of earning such low wages?
Low wages lead to high turnover and the number of jobs in the sector is only increasing, in fact direct care is one of the largest and fastest growing occupations in the U.S. because of the rapidly growing population of older adults and preferences to receive care at home. From 2020 to 2030, the direct care workforce will have 4.7 million total job openings. But, while other industries are paying between $15-20/hr, there are places in the U.S. that still pay direct care workers less than $10/hr.